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Ojo A, Rizun N, Walsh GS, Przychodzen W, Mashinchi MI, Foley C, Rohde D. Building confidence and trust in Ireland's National Maternity Services Workforce -What matters most and how? Health Policy 2023; 138:104947. [PMID: 37992566 DOI: 10.1016/j.healthpol.2023.104947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 11/04/2023] [Accepted: 11/16/2023] [Indexed: 11/24/2023]
Abstract
National surveys on care experiences are increasingly adopted as regulatory mechanisms for improving care quality and increasing public trust in healthcare services. Based on data collected as part of Ireland's 2020 National Maternity Experience Survey, this study investigates care-related factors that contribute most to confidence and trust in the professional workforce (or carers) within Irish maternity services. The survey covered the full spectrum of maternity care and received 3,206 responses which were analysed using structural equation modelling. Results show that trust in carers may be enhanced through greater attention to the quality of interpersonal aspects of maternity care in a few core areas. We found that factors related to dignity and respect (β=0.270), involvement in decision-making (β=0.186), pain management (β=0.172), and communication (β=0.151) are core determinants of confidence and trust in the professional workforce of maternity services. Perceived quality of care in these four aspects increased on average, with the women's age. Women under 29 rated their experiences in these areas as significantly lower than the average. Women with a disability also rated their experiences significantly lower than average in three core areas. Our results suggest that trustworthy, equitable, and high-quality maternity care requires ongoing development of interpersonal skills within the maternity services professional workforce particularly in caring for younger women (under 29 years) and those with a disability.
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Affiliation(s)
- Adegboyega Ojo
- School of Public Policy and Administration, Carleton University, Ottawa, ON, Canada.
| | - Nina Rizun
- Gdansk University of Technology, Gdansk, Poland
| | - Grace S Walsh
- CONNECT, the Science Foundation Ireland Research Centre for Future Networks and Communications, Maynooth; School of Business, Maynooth University, Kildare, Ireland
| | | | | | - Conor Foley
- National Care Experience Programme, Health Information and Quality Authority, Cork, Ireland
| | - Daniela Rohde
- National Care Experience Programme, Health Information and Quality Authority, Cork, Ireland
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Stein DF, Foley C, Byott M, Nastouli E, Ambler G, Arulkumaran N. Biological sex is associated with heterogeneous responses to IL-6 receptor inhibitor treatment in COVID-19-A retrospective cohort study. Sci Rep 2023; 13:13504. [PMID: 37598275 PMCID: PMC10439929 DOI: 10.1038/s41598-023-40744-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 08/16/2023] [Indexed: 08/21/2023] Open
Abstract
COVID-19 is associated with higher inflammatory markers, illness severity and mortality in males compared to females. Differences in immune responses to COVID-19 may underpin sex- specific outcome differences. We hypothesised that anti-IL-6 receptor monoclonal antibodies are associated with heterogenous treatment effects between male and female patients. We conducted a retrospective cohort study assessing the interaction between biological sex and anti-IL-6 receptor antibody treatment with respect to hospital mortality or progression of respiratory failure. We used a Cox proportional hazards regression model to adjust for age, ethnicity, steroid use, baseline C-reactive protein, and COVID-19 variant. We included 1274 patients, of which 58% were male and 15% received anti-IL-6 receptor antibodies. There was a significant interaction between sex and anti-IL-6 receptor antibody use on progression to respiratory failure or death (p = 0.05). For patients who did not receive anti-IL-6 receptor antibodies, the risk of death was slightly higher in males (HR = 1.13 (0.72-1.79)), whereas in patients who did receive anti-IL-6 receptor antibodies, the risk was lower in males (HR = 0.65 (0.32-1.33)). There was a heterogenous treatment effect with anti-IL-6 receptor antibodies between males and females; with anti-IL-6 receptor antibody use having a greater benefit in preventing progression to respiratory failure or death in males (p = 0.05).
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Affiliation(s)
- Dan F Stein
- Institute of Health Informatics, University College London, London, UK
| | - Conor Foley
- Institute of Health Informatics, University College London, London, UK
| | - Matt Byott
- Advanced Pathogen Diagnostics Unit, Department of Clinical Virology, UCL Hospitals NHS Trust, London, W1T 4EU, UK
| | - Eleni Nastouli
- Advanced Pathogen Diagnostics Unit, Department of Clinical Virology, UCL Hospitals NHS Trust, London, W1T 4EU, UK
- Department of Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Gareth Ambler
- Department of Statistical Science, University College London, London, UK
| | - Nishkantha Arulkumaran
- Bloomsbury Institute of Intensive Care Medicine, University College London, Gower St, London, WC1E 6BT, UK.
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Drummond L, Guiney S, Connolly D, Foley C, O'Connor L, O'Carroll T, Flynn R, Rohde D. Experiences of shared decision making in acute hospitals: A mixed methods secondary analysis of the Irish National Inpatient Experience Survey. Patient Educ Couns 2023; 113:107755. [PMID: 37099839 DOI: 10.1016/j.pec.2023.107755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 03/04/2023] [Accepted: 04/12/2023] [Indexed: 06/05/2023]
Abstract
INTRODUCTION This study explored patient experiences of shared decision making (SDM) in public acute hospitals in Ireland. METHODS Quantitative and qualitative data from three years of the Irish National Inpatient Experience Survey were analysed. Survey questions were mapped to definitions of SDM and subjected to principal components analysis. Three SDM subscales (care on the ward; treatments; discharge) and one overall SDM scale were created. Differences in experiences of SDM by aspects of care and patient group were assessed. Thematic analysis of qualitative responses was undertaken. RESULTS 39,453 patients participated in the survey. The mean SDM experience score was 7.60 ± 2.43. Experience scores were highest on the treatments sub-scale, and lowest during discharge. Patients who had a non-emergency admission, those aged 51-80 years and men had more positive experiences than other groups. Patient comments highlighted that opportunities to clarify information and facilitation of families/caregivers in SDM were found to be lacking. CONCLUSION There were differences in experiences of SDM by aspects of care and patient group. PRACTICE IMPLICATIONS Efforts to improve SDM in acute hospitals are required, particularly at the time of discharge. SDM may be improved by facilitation of more time for discussion between clinicians and patients and/or their families/caregivers.
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Affiliation(s)
- Linda Drummond
- Health Information and Quality Authority, Dublin, Ireland.
| | | | | | - Conor Foley
- Health Information and Quality Authority, Dublin, Ireland
| | - Laura O'Connor
- Health Information and Quality Authority, Dublin, Ireland
| | | | - Rachel Flynn
- Health Information and Quality Authority, Dublin, Ireland
| | - Daniela Rohde
- Health Information and Quality Authority, Dublin, Ireland
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Ó Coimín D, Rohde D, Foley C, O’Carroll T, Murphy R. Dying, death and bereavement: developing a national survey of bereaved relatives. BMC Palliat Care 2023; 22:14. [PMID: 36823584 PMCID: PMC9947439 DOI: 10.1186/s12904-023-01135-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 02/08/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Assessing and measuring the experience and quality of care provided is central to the improvement of care delivery of all healthcare systems. This paper reports on the development of a survey instrument to capture the experiences of care at end of life from the perspective of bereaved relatives in the Republic of Ireland. METHODS A multi-method, multi-stakeholder, sequential approach was adopted for this study. Items for inclusion in the survey instrument bank were identified through (1) a feasibility study and scoping literature review, (2) expert panel programme board review, (3) focus groups and (4) gap analysis. The following steps were undertaken to prioritise the items for inclusion in the final survey instrument: (1) a Delphi study (2) technical expert panel review (3) cognitive interviews with bereaved relatives and an (4) expert panel programme board review. RESULTS Following an iterative process with key stakeholders, a survey instrument was developed with sections focusing on the provision of care at home, in the last nursing home / residential care facility, hospice and hospital, as well as care experience in the last 2 days of life, the relative's experiences of care and support, the circumstances of care surrounding death and demographic information. In total, a bank of 123 questions were prioritised to be included in the National End of Life Survey instrument. CONCLUSION The survey will provide a standardised national approach to capturing the experience of care of those who have died, from the perspective of bereaved relatives in the Republic of Ireland. This will allow health service providers, policy makers and regulators to gather important insights into the experiences of care at end of life and will help fulfil the requirement of healthcare services to ensure they are providing high-quality care.
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Affiliation(s)
- Diarmuid Ó Coimín
- Hospice Friendly Hospitals Programme, Quality and Patient Safety Directorate, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland.
| | - Daniela Rohde
- National Care Experience Programme, Health Information and Quality Authority, George’s Court, George’s Lane, Smithfield, Dublin 7, D07 E98Y Ireland
| | - Conor Foley
- National Care Experience Programme, Health Information and Quality Authority, George’s Court, George’s Lane, Smithfield, Dublin 7, D07 E98Y Ireland
| | - Tracy O’Carroll
- National Care Experience Programme, Health Information and Quality Authority, George’s Court, George’s Lane, Smithfield, Dublin 7, D07 E98Y Ireland
| | - Róisín Murphy
- National Care Experience Programme, Health Information and Quality Authority, George’s Court, George’s Lane, Smithfield, Dublin 7, D07 E98Y Ireland
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Rohde D, Foley C, Murphy R, Kelly M, Drummond L. Patient experiences of hospital care during the COVID-19 pandemic in Ireland. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac131.282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
The COVID-19 pandemic has greatly impacted healthcare service delivery. This study explored patient experiences of hospital care during the COVID-19 pandemic in Ireland, using National Inpatient Experience Survey (NIES) 2021 data.
Methods
NIES is a repeat cross-sectional survey of inpatient experiences in all public acute hospitals in Ireland. Patients who spent 24+ hours in hospital and were discharged in September 2021 were eligible to participate. 7 questions addressed experiences specific to the pandemic. Comparisons between 2019 and 2021 were conducted using t-tests. Effect sizes (d) are reported. Qualitative data were thematically analysed.
Results
10,743 patients participated (42% response rate). While 68% did not feel at risk of catching COVID-19, 9% felt at risk. 35% reported that staff always helped them to keep in touch with family. There were small, statistically significant differences between 2019 and 2021 ratings, with questions on opportunity for family to talk to a doctor (d=-.328), provision of information to family (d=-.136), and being able to find staff to talk to about worries and fears (d=-.167) recording the biggest decreases. Scores for cleanliness of wards (d = 0.063) and bathrooms (d=.075), and privacy during examination or treatment in the ED (d = 0.085) improved significantly. Patients commented on their appreciation of staff, but missed having visitors, with restrictions posing challenges for those with sensory or physical impairments.
Conclusions
Given the unique challenges experienced by acute healthcare services during the COVID-19 pandemic, comparisons with pre-pandemic patient experiences should be interpreted with caution. Continuing to gather patient feedback during a pandemic presents a unique opportunity to understand the resilience of healthcare systems as they continue to operate under unprecedented pressure, with the potential to inform responses and delivery of care during future pandemics or other emergencies.
Key messages
• Visiting restrictions posed many challenges for patients and affected communication both between patients and their family members, as well as between healthcare staff and patients’ family.
• Gathering patient feedback during a pandemic presents a unique opportunity to inform responses and delivery of care during future pandemics or other emergencies.
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Affiliation(s)
- D Rohde
- National Care Experience Programme, Health Information and Quality Authority , Dublin, Ireland
| | - C Foley
- National Care Experience Programme, Health Information and Quality Authority , Dublin, Ireland
| | - R Murphy
- National Care Experience Programme, Health Information and Quality Authority , Dublin, Ireland
| | - M Kelly
- National Care Experience Programme, Health Information and Quality Authority , Dublin, Ireland
| | - L Drummond
- National Care Experience Programme, Health Information and Quality Authority , Dublin, Ireland
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Miles D, Paprcka S, Foley C, Qu S, Lamani M, Paladugu S, Huang H, Tibrewal N, Chen A, Kulusich J, Garrido-Shaqfeh S, Fabila P, Sridhar S, Liu S, Swinarski D, Zhao X, Fernandez-Salas E, Green D, Jin L, Leleti M. Discovery and characterization of potent and selective AXL receptor tyrosine kinase inhibitor AB801. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)01074-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Rohde D, Isazad Mashinchi M, Rizun N, Gruda D, Foley C, Flynn R, Ojo A. Generating actionable insights from free-text care experience survey data using qualitative and computational text analysis: A study protocol. HRB Open Res 2022; 5:60. [PMID: 37994330 PMCID: PMC10663659 DOI: 10.12688/hrbopenres.13606.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2022] [Indexed: 11/24/2023] Open
Abstract
Introduction:The National Care Experience Programme (NCEP) conducts national surveys that ask people about their experiences of care in order to improve the quality of health and social care services in Ireland. Each survey contains open-ended questions, which allow respondents to comment on their experiences. While these comments provide important and valuable information about what matters most to service users, there is to date no unified approach to the analysis and integration of this detailed feedback. The objectives of this study are to analyse qualitative responses to NCEP surveys to determine the key care activities, resources and contextual factors related to positive and negative experiences; to identify key areas for improvement, policy development, healthcare regulation and monitoring; and to provide a tool to access the results of qualitative analyses on an ongoing basis to provide actionable insights and drive targeted improvements. Methods:Computational text analytics methods will be used to analyse 93,135 comments received in response to the National Inpatient Experience Survey and National Maternity Experience Survey. A comprehensive analytical framework grounded in both service management literature and the NCEP data will be employed as a coding framework to underpin automated analyses of the data using text analytics and deep learning techniques. Scenario-based designs will be adopted to determine effective ways of presenting insights to knowledge users to address their key information and decision-making needs. Conclusion:This study aims to use the qualitative data collected as part of routine care experience surveys to their full potential, making this information easier to access and use by those involved in developing quality improvement initiatives. The study will include the development of a tool to facilitate more efficient and standardised analysis of care experience data on an ongoing basis, enhancing and accelerating the translation of patient experience data into quality improvement initiatives.
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Affiliation(s)
- Daniela Rohde
- National Care Experience Programme, Health Information and Quality Authority, Dublin, Ireland
| | - Mona Isazad Mashinchi
- Maynooth University School of Business, Maynooth University, Maynooth, Co Kildare, Ireland
| | - Nina Rizun
- Maynooth University School of Business, Maynooth University, Maynooth, Co Kildare, Ireland
- Department of Informatics in Management, Gdansk University of Technology, Gdansk, Poland
| | - Dritjon Gruda
- Maynooth University School of Business, Maynooth University, Maynooth, Co Kildare, Ireland
| | - Conor Foley
- National Care Experience Programme, Health Information and Quality Authority, Dublin, Ireland
| | - Rachel Flynn
- National Care Experience Programme, Health Information and Quality Authority, Dublin, Ireland
| | - Adegboyega Ojo
- Maynooth University School of Business, Maynooth University, Maynooth, Co Kildare, Ireland
- School of Public Policy and Administration (SPPA), Carleton University, Ottawa, K1S 5B6, Canada
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Foo S, Canavan M, Marzaioli V, Veale D, Wade S, Macdermott E, Deely D, Foley C, Killeen O, Fearon U. POS0495 CYTOKINE SYNERGY ENHANCES SYNOVIAL FIBROBLAST ACTIVATION IN CHILDREN WITH DOWN’S SYNDROME-ASSOCIATED ARTHRITIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundWe have previously shown that children with Down’s syndrome-associated arthritis (DA) display a more aggressive form of inflammatory arthritis compared to that of Juvenile Idiopathic Arthritis (Shih et al., 2019). DA is associated with an increase in polyfunctional T-cells coexpressing TNF-α DA is associated with an increase in polyfunctional T-cells coexpressing TNF-fibroblasts (FLS) (Foley et al., 2019).ObjectivesIn this study we examine the effect of cytokine synergy on primary DA FLS function.MethodsPrimary DA FLS were cultured and stimulated with TNF-α (0.1 and 1ng/ml), IL-17A (20 and 50ng/ml), IFN-ɣ (10 and 50ng/ml) and GM-CSF (20 and 100ng/ml) or a combination of these cytokines and the following functional experiments performed. Chemokine and adhesion molecule cell surface expression were quantified by flow cytometry, in addition to quantification of leukocyte-DA-FLS adhesion assays. Gene and protein expression of proinflammatory and metabolic mediators were quantified by ELISA and RT-PCR. Furthermore, real-time metabolic activity in response to cytokine stimulation was assessed by measuring the two major energy pathways: glycolysis (ECAR) and oxidative phosphorylation (OCR), by the Seahorse XFe96 Analyser.ResultsWe examined the effects of T cell derived cytokines, TNF-α, IL-17A, IFN-γ and GM-CSF, alone and in combination on DA FLS function. TNF-α, IL-17A and IFN-γ induced IL-6, RANTES and MCP-1 production, with no effect observed for GM-CSF. Furthermore, TNF-α, IFN-ɣ and IL-17A increased leukocyte adhesion to DA FLS. TNF-α and IFN-ɣ induced cell surface expression of CXCR3, CXCR4, ICAM-1 and VCAM-1 on DA FLS. Next, we investigated the potential synergistic relationship that these cytokines could have on proinflammatory mediators. IL-17A and IFN-ɣ potentiated the effects TNF-α on IL-6 and MCP-1 secretion compared to stimulation alone. Furthermore, cytokine synergy significantly induced IL-6, IL-8, RANTES and LDHA mRNA expression compared to basal. IL-17A and IFN-αL-17A and IFN- eeased ts TNF-α on IL-6 and MCP-1 secretion compared to stimulation alone. Additionally, IFN the ECAR:OCR ratio demonstrating a shift in the metabolic profile of DA FLS to glycolysis. Overall DA FLS are transformed from a quiescent metabolic state to an energetic phenotype.ConclusionTNF-αNF-lusion:OCR ratio demonstrating a shift in the metabolhe aggressive phenotype of DA FLS through increased cytokine, adhesion molecule and chemokine expression, which is pathways for the treatment of DA.References[1]Foley, C. et al. (2019) ‘Increased T cell plasticity with dysregulation of T follicular helper, T peripheral helper and T regulatory cell responses in children with JIA and Down syndrome-associated arthritis’, Arthritis & Rheumatology, pp. 0–1. doi: 10.1002/art.41150.[2]Shih, Y. J. et al. (2019) ‘Enthesitis-related arthritis is the most common category of juvenile idiopathic arthritis in Taiwan and presents persistent active disease’, Pediatric Rheumatology. Pediatric Rheumatology. doi: 10.1186/s12969-019-0363-0.Disclosure of InterestsNone declared.
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Mwakilasa MT, Foley C, O'Carroll T, Flynn R, Rohde D. Care Experiences of Older People in the Emergency Department: A Concurrent Mixed-Methods Study. J Patient Exp 2021; 8:23743735211065267. [PMID: 34917753 PMCID: PMC8669876 DOI: 10.1177/23743735211065267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The growing population of older people has increased demand to meet their complex healthcare needs, including in emergency departments (EDs). This study explored the experiences of people aged 65+ in Irish EDs, involving secondary analysis of quantitative and qualitative data from the 2019 National Inpatient Experience Survey (NIES). Experiences in the ED and overall hospital experiences were dichotomized as poor to fair or good to very good. Logistic regression was used to model quantitative data. Free text comments relating to EDs were thematically analyzed. Of 12,343 survey participants, 4,442 (39.9%) were aged 65+ years and used the ED. Longer waiting times, completion of the questionnaire by another person either with or on behalf of the patient, and having both a medical card and private health insurance were predictors of poor to fair ED experiences. Patients aged 85+ years were more likely to report good to very good ED experiences. Poor experiences in the ED were associated with poorer overall hospital experiences (odds ratio [OR]: 2.19, 95% confidence interval [CI]: 1.76 to 2.73, p < .001). Thematic analysis revealed that long waiting times and unpleasant waiting conditions, including lack of communication, privacy, and personal care were important challenges encountered in the ED, with some older patients noting their preference for separate ED services. There is a need to reduce waiting times and integrate user perspectives in the planning, organization, and delivery of ED care to improve experiences and quality of care for a growing older population.
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Affiliation(s)
- Magreth Thadei Mwakilasa
- School of Social Work and Social Policy, Trinity College Dublin, Dublin, Ireland
- Muhimbili University of Health and Allied Sciences, Ilala, Tanzania
| | - Conor Foley
- Health Information and Quality Authority, Dublin, Ireland
| | | | - Rachel Flynn
- Health Information and Quality Authority, Dublin, Ireland
| | - Daniela Rohde
- School of Social Work and Social Policy, Trinity College Dublin, Dublin, Ireland
- Health Information and Quality Authority, Dublin, Ireland
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10
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Abstract
Abstract
Background
While breastfeeding may be among the most effective ways to ensure child health and survival, breastfeeding rates in Ireland are consistently low. This study aimed to explore women's experiences of infant feeding in Ireland.
Methods
Thematic analysis of feeding-related free-text comments from the National Maternity Experience Survey 2020 was undertaken. The survey collected data on the experiences of women who were 16 years or older and gave birth in one of Ireland's 19 maternity hospitals or units or had a home birth.
Results
3,204 women participated in the survey (50% response rate). In the first few days after birth, 41.9% of women breastfed exclusively, 29.0% used formula and breast milk, and 29.1% bottle fed only. 824 comments related to feeding were received. A number of themes were identified, including support and encouragement from healthcare professionals, information and education regarding feeding, and pressure and respect for personal preferences. Women highlighted that while breastfeeding was encouraged in antenatal care, this was not always the case in the postnatal ward, where formula was readily available, with an apparent lack of resources for breastfeeding women. Some women described feeling pressured to use a feeding method that was not their first preference, with some feeling pushed to breastfeed when this may not have been their wish, while women who wished to breastfeed felt pressured to supplement with formula. Staffing shortages on postnatal wards, a lack of lactation consultants and contradictory advice from healthcare professionals exacerbated difficulties with both feeding methods.
Conclusions
Some women experience a lack of practical support with infant feeding, regardless of feeding method, and clear and concise information on feeding practices is needed. The addition of lactation consultants, home supports and further education and training could benefit mothers on their breastfeeding journey.
Key messages
Barriers to breastfeeding included a lack of support from healthcare professionals and conflicting information. It is important to support women regardless of their chosen feeding method.
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Affiliation(s)
- R Murphy
- National Care Experience Programme, Health Information and Quality Authority, Mahon Cork, Ireland
| | - D Rohde
- National Care Experience Programme, Health Information and Quality Authority, Mahon Cork, Ireland
| | - C Foley
- National Care Experience Programme, Health Information and Quality Authority, Mahon Cork, Ireland
| | - T O'Carroll
- National Care Experience Programme, Health Information and Quality Authority, Mahon Cork, Ireland
| | - R Flynn
- National Care Experience Programme, Health Information and Quality Authority, Mahon Cork, Ireland
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Panou E, Panagou E, Foley C, Kravvas G, Watchorn R, Alnajjar H, Muneer A, Bunker CB. Male genital lichen sclerosus associated with urological interventions and microincontinence: a case series of 21 patients. Clin Exp Dermatol 2021; 47:107-109. [PMID: 34499360 DOI: 10.1111/ced.14869] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 06/09/2021] [Accepted: 07/26/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND Male genital lichen sclerosus (MGLSc) is an acquired, chronic, inflammatory cutaneous disease associated with significant morbidity and squamous cell carcinoma of the penis. Consideration of all of the evidence suggests that chronic exposure of susceptible epithelium to urinary occlusion by the foreskin is the most likely pathomechanism. MGLSc never occurs in men who were circumcised at birth, and has been associated with trauma, instrumentation and anatomical abnormalities, e.g. frank hypospadia that results in microincontinence. AIM To describe 21 patients who developed MGLSc following urological diagnoses and procedures. METHODS We conducted a retrospective review of patients with a diagnosis of MGLSc whose symptoms related to urological procedures who attended or saw one of the authors (CBB) privately during the period June-October 2018. RESULTS In total, 21 patients (mean age 59 years) were identified. The referrals came from the local urology departments, primary care or extramural dermatology services. Most of the patients were uncircumcised men. All had developed symptoms and signs of MGLSc within 5 years following their urological procedure; on examination, 30% of the patients were found to have damp penile skin due to microincontinence. Of the 21 patients, 10 had undergone radical prostatectomy for prostate cancer, 4 had a diagnosis of Peyronie disease, 4 had undergone multiple cystoscopies and urethroscopies, 2 had undergone surgery on the bladder neck and 1 had undergone implantation of a penile prosthesis to treat erectile dysfunction. CONCLUSION This case series further strengthens the urinary occlusion hypothesis for the causation of MGLSc. It is important to recognize that urological interventions can create incompetence of the naviculomeatal valve post voiding. In uncircumcised men, this creates a risk factor for MGLSc that was not previously present. Occlusion, the phenomenon of koebnerization and currently unelucidated epithelial susceptibility factors lead to inflammation, sclerosis and cancer. Patients and urologists should be aware of these possibilities and preventative measures instituted, e.g. adaptive voiding habits and barrier protection.
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Affiliation(s)
- E Panou
- Departments of Dermatology, University College Hospital
| | - E Panagou
- Departments of Dermatology, University College Hospital
| | - C Foley
- Departments of Dermatology, University College Hospital
| | - G Kravvas
- Departments of Dermatology, University College Hospital
| | - R Watchorn
- Departments of Dermatology, University College Hospital
| | - H Alnajjar
- Urology, University College Hospital, University College London Hospitals NHS Foundation Trust, London, UK
| | - A Muneer
- Urology, University College Hospital, University College London Hospitals NHS Foundation Trust, London, UK
| | - C B Bunker
- Departments of Dermatology, University College Hospital
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12
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Foo S, Floudas A, Wade S, O’ Brien A, Ansboro S, Mullan R, Veale D, MacDermott E, Deely D, Foley C, Killeen O, Fearon U. POS0069 INCREASED T CELL RESPONSES, METABOLIC ACTIVITY AND FIBROBLAST INVASIVE CAPACITY IN CHILDREN WITH DOWN’S SYNDROME-ASSOCIATED ARTHRITIS COMPARED TO JUVENILE IDIOPATHIC ARTHRITIS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Juvenile idiopathic arthritis (JIA) was thought to be the most common inflammatory arthritis in children (Shih et al., 2019). However an aggressive, erosive arthritis of little-known immunologic mechanism occurs 20 times more frequently in children with Down’s syndrome (Foley et al., 2019).Objectives:This study was undertaken to characterize immune cell responses and synovial fibroblast invasiveness in children with Down’s syndrome-associated arthritis (DA).Methods:Multiparametric flow cytometric analysis was used to examine peripheral blood T cell, B cell and monocyte populations. In addition, T cell cytokine responses and their metabolic profile in children with DA, JIA, Down’s Syndrome (trisomy 21 [T21]), and in healthy controls were assessed. The function of DA primary synovial fibroblasts (FLS) was assessed in response to stimulation with pro-inflammatory mediators alone and in combination (TNF-α, IL-17a, IFN-γ, GM-CSF). The two major energy pathways glycolysis (ECAR) and oxidative phosphorylation (OCR) were quantified by the Seahorse XFe96 Analyser. Migration, adhesion, invasion and cytokine/chemokine secretion were quantified by wound repair scratch assays, Transwell collagen invasion chambers, adhesion binding assays, and ELISAs.Results:T cell frequencies were higher in DA compared to JIA and T21 in contrast to B cell frequencies which were decreased. T cell responses in DA were characterized by increased frequencies of CD4+ and CD8+ TNF- α, IFN- γ and GM-CSF producing T cells. The frequency of T peripheral helper (Tph) cells were elevated in children with DA compared to all other groups. In parallel, an increase in their metabolic profile evident by higher phosphorylation of mTOR pathway components AKT, mTOR and S6. Comparison of DA and JIA FLS demonstrated that DA FLS display a more invasive/migratory capacity and are more metabolically active. Based on the increased cytokine responses in DA T cells, we next examined the effect T cell derived cytokines TNF-α, IL-17A, IFN-γ and GM-CSF alone and in combination on DA FLS function. TNF-α, IL-17a and IFN-γ induced IL-6, RANTES and MCP-1 secretion, with no effect observed for GM-CSF. Furthermore, TNF-α and IL-17A induced DA FLS migration and PBMC adhesion to DA FLS. Finally IL17A and IFN-γ potentiated the effect of TNF-α on IL-6 and MCP-1 secretion compared to stimulations alone.Conclusion:DA is a more common and aggressive form of arthritis compared to JIA. It is characterized by increased T cell responses and a more invasive FLS phenotype compared to that of JIA, with T cell derived cytokine alone and in combination further inducing DA FLS pathogenic mechanisms. These effects mirror the increased erosive disease observed clinically.References:[1]Foley, C. et al. (2019) ‘Increased T cell plasticity with dysregulation of T follicular helper, T peripheral helper and T regulatory cell responses in children with JIA and Down syndrome-associated arthritis’, Arthritis & Rheumatology, pp. 0–1. doi: 10.1002/art.41150.[2]Shih, Y. J. et al. (2019) ‘Enthesitis-related arthritis is the most common category of juvenile idiopathic arthritis in Taiwan and presents persistent active disease’, Pediatric Rheumatology. Pediatric Rheumatology. doi: 10.1186/s12969-019-0363-0.Disclosure of Interests:None declared.
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Chao M, Jassal S, Baker C, Tacey M, Law M, Loh S, Cheng M, Yong C, Zantuck N, Bevington E, Hyett A, Guerrieri M, Cokelek M, Brown B, Chipman M, Chew G, Yeo B, Lippey J, Neoh D, Lamoury G, Spillane A, Foley C, Kechagioglou P, Rolfo M, Foroudi F. OC-0330: Neoadjuvant breast radiotherapy for one stage mastectomy and autologous breast reconstruction. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00354-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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14
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Foley C, Floudas A, Canavan M, Biniecka M, MacDermott EJ, Veale DJ, Mullan RH, Killeen OG, Fearon U. Increased T Cell Plasticity With Dysregulation of Follicular Helper T, Peripheral Helper T, and Treg Cell Responses in Children With Juvenile Idiopathic Arthritis and Down Syndrome–Associated Arthritis. Arthritis Rheumatol 2020; 72:677-686. [DOI: 10.1002/art.41150] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 10/24/2019] [Indexed: 01/25/2023]
Affiliation(s)
- C. Foley
- Our Lady’s Children’s HospitalCrumlin and Trinity College Dublin Dublin Ireland
| | | | | | - M. Biniecka
- Centre for Arthritis and Rheumatic DiseasesEULAR Centre of ExcellenceSt. Vincent’s University Hospital, and University College Dublin Dublin Ireland
| | | | - D. J. Veale
- Centre for Arthritis and Rheumatic DiseasesEULAR Centre of ExcellenceSt. Vincent’s University Hospital, and University College Dublin Dublin Ireland
| | - R. H. Mullan
- Tallaght University Hospital and Trinity College Dublin Dublin Ireland
| | - O. G. Killeen
- Our Lady’s Children’s Hospital Crumlin, Dublin Ireland
| | - U. Fearon
- Trinity College Dublin Dublin Ireland
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15
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Cormican S, Connaughton DM, Kennedy C, Murray S, Živná M, Kmoch S, Fennelly NK, O'Kelly P, Benson KA, Conlon ET, Cavalleri G, Foley C, Doyle B, Dorman A, Little MA, Lavin P, Kidd K, Bleyer AJ, Conlon PJ. Autosomal dominant tubulointerstitial kidney disease (ADTKD) in Ireland. Ren Fail 2020; 41:832-841. [PMID: 31509055 PMCID: PMC6746258 DOI: 10.1080/0886022x.2019.1655452] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Introduction: Autosomal dominant tubulointerstitial kidney disease (ADTKD) is a rare genetic cause of renal impairment resulting from mutations in the MUC1, UMOD, HNF1B, REN, and SEC61A1 genes. Neither the national or global prevalence of these diseases has been determined. We aimed to establish a database of patients with ADTKD in Ireland and report the clinical and genetic characteristics of these families. Methods: We identified patients via the Irish Kidney Gene Project and referral to the national renal genetics clinic in Beaumont Hospital who met the clinical criteria for ADTKD (chronic kidney disease, bland urinary sediment, and autosomal dominant inheritance). Eligible patients were then invited to undergo genetic testing by a variety of methods including panel-based testing, whole exome sequencing and, in five families who met the criteria for diagnosis of ADTKD but were negative for causal genetic mutations, we analyzed urinary cell smears for the presence of MUC1fs protein. Results: We studied 54 individuals from 16 families. We identified mutations in the MUC1 gene in three families, UMOD in five families, HNF1beta in two families, and the presence of abnormal MUC1 protein in urine smears in three families (one of which was previously known to carry the genetic mutation). We were unable to identify a mutation in 4 families (3 of whom also tested negative for urinary MUC1fs). Conclusions: There are 4443 people with ESRD in Ireland, 24 of whom are members of the cohort described herein. We observe that ADTKD represents at least 0.54% of Irish ESRD patients.
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Affiliation(s)
- S Cormican
- Nephrology Department, Beaumont Hospital , Dublin , Ireland
| | - D M Connaughton
- Nephrology Department, Beaumont Hospital , Dublin , Ireland.,Department of Medicine, Boston Children's Hospital, Harvard Medical School , Boston , MA , USA.,Trinity Health Kidney Centre, Trinity Translational Medicine Institute , Dublin , Ireland
| | - C Kennedy
- Nephrology Department, Beaumont Hospital , Dublin , Ireland.,Department of Medicine, Royal College of Surgeons , Dublin , Ireland
| | - S Murray
- Nephrology Department, Beaumont Hospital , Dublin , Ireland.,Department of Medicine, Royal College of Surgeons , Dublin , Ireland
| | - M Živná
- Department of Pediatrics and Adolescent Medicine, Research Unit for Rare Diseases, First Faculty of Medicine, Charles University , Prague , Czech Republic
| | - S Kmoch
- Department of Pediatrics and Adolescent Medicine, Research Unit for Rare Diseases, First Faculty of Medicine, Charles University , Prague , Czech Republic
| | - N K Fennelly
- Pathology Department, Beaumont Hospital , Dublin , Ireland
| | - P O'Kelly
- Nephrology Department, Beaumont Hospital , Dublin , Ireland
| | - K A Benson
- Nephrology Department, Beaumont Hospital , Dublin , Ireland.,Department of Medicine, Royal College of Surgeons , Dublin , Ireland
| | - E T Conlon
- Nephrology Department, Beaumont Hospital , Dublin , Ireland
| | - G Cavalleri
- Department of Medicine, Royal College of Surgeons , Dublin , Ireland
| | - C Foley
- Trinity Health Kidney Centre, Trinity Translational Medicine Institute , Dublin , Ireland.,Clinical Research Centre, Royal College of Surgeons , Dublin , Ireland
| | - B Doyle
- Pathology Department, Beaumont Hospital , Dublin , Ireland
| | - A Dorman
- Pathology Department, Beaumont Hospital , Dublin , Ireland
| | - M A Little
- Trinity Health Kidney Centre, Trinity Translational Medicine Institute , Dublin , Ireland.,Trinity Health Kidney Centre, Tallaght Hospital , Dublin , Ireland
| | - P Lavin
- Trinity Health Kidney Centre, Tallaght Hospital , Dublin , Ireland
| | - K Kidd
- Section on Nephrology, Wake Forest School of Medicine , Winston-Salem , NC , USA
| | - A J Bleyer
- Section on Nephrology, Wake Forest School of Medicine , Winston-Salem , NC , USA
| | - P J Conlon
- Nephrology Department, Beaumont Hospital , Dublin , Ireland.,Department of Medicine, Royal College of Surgeons , Dublin , Ireland
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16
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Velazquez R, Meechoovet B, Ow A, Foley C, Shaw A, Smith B, Oddo S, Hulme C, Dunckley T. Chronic Dyrk1 Inhibition Delays the Onset of AD-Like Pathology in 3xTg-AD Mice. Mol Neurobiol 2019; 56:8364-8375. [PMID: 31240602 DOI: 10.1007/s12035-019-01684-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 06/17/2019] [Indexed: 01/14/2023]
Abstract
There is a critical need for new treatment approaches that can slow or prevent the progression of Alzheimer's disease (AD). Targets that act simultaneously on multiple relevant pathways could have significant therapeutic potential. Dual-specificity tyrosine phosphorylation-regulated kinase 1A (Dyrk1a) phosphorylates both amyloid precursor protein (APP) and tau. Dyrk1a is upregulated in post-mortem brains of AD patients, and such elevated expression is associated with cognitive deficits. We previously demonstrated that small molecule inhibition of Dyrk1 is well-tolerated and reduces amyloid plaques and pathological forms of tau in 3xTg-AD mice if administered after formation of these pathologies. However, while insoluble forms of hyperphosphorylated tau were reduced by Dyrk1 inhibition, overt neurofibrillary tangle (NFT) pathology remained unchanged. Herein, we specifically test the hypothesis that inhibition of Dyrk1 prior to NFT formation will delay the onset of pathology. 3xTg-AD mice were treated chronically, beginning at 6 months of age, prior to NFT pathology. Mice were dosed daily for either 3 or 6 months and amyloid and tau pathology were assessed. We show that chronic Dyrk1 inhibition reduces insoluble forms of amyloid beta peptides (Aβ) and hyper-phosphorylated tau long-term and that these reductions are associated with dramatic delay in the onset of both amyloid plaques and NFTs. In addition, we show that DYR219, a potent and selective small molecule Dyrk1 inhibitor, induces degradation of Dyrk1a protein, likely contributing to the efficacy of this small molecule approach in vivo. Collectively, these results suggest that therapeutic strategies targeting tau phosphorylation will show the greatest effect if administered very early in the pathogenesis of AD.
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Affiliation(s)
- R Velazquez
- Neurodegenerative Disease Research Center, Biodesign Institute, Arizona State University, Tempe, AZ, 85281, USA
| | - B Meechoovet
- Neurogenomics Division, Translational Genomics Research Institute, Phoenix, AZ, 85004, USA
| | - A Ow
- Neurodegenerative Disease Research Center, Biodesign Institute, Arizona State University, Tempe, AZ, 85281, USA
| | - C Foley
- Division of Drug Discovery and Development, Department of Pharmacology and Toxicology, College of Pharmacy, The University of Arizona, Tucson, AZ, 85721, USA
| | - A Shaw
- Division of Drug Discovery and Development, Department of Pharmacology and Toxicology, College of Pharmacy, The University of Arizona, Tucson, AZ, 85721, USA
| | - B Smith
- Division of Drug Discovery and Development, Department of Pharmacology and Toxicology, College of Pharmacy, The University of Arizona, Tucson, AZ, 85721, USA
| | - S Oddo
- Neurodegenerative Disease Research Center, Biodesign Institute, Arizona State University, Tempe, AZ, 85281, USA
- School of Life Sciences, Arizona State University, Tempe, AZ, 85281, USA
| | - C Hulme
- Division of Drug Discovery and Development, Department of Pharmacology and Toxicology, College of Pharmacy, The University of Arizona, Tucson, AZ, 85721, USA
| | - Travis Dunckley
- Neurodegenerative Disease Research Center, Biodesign Institute, Arizona State University, Tempe, AZ, 85281, USA.
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Curry N, Foley C, Wong H, Mora A, Curnow E, Zarankaite A, Hodge R, Hopkins V, Deary A, Ray J, Moss P, Reed MJ, Kellett S, Davenport R, Stanworth S. The application of a haemorrhage assessment tool in evaluating control of bleeding in a pilot trauma haemorrhage trial. Transfus Med 2019; 29:454-459. [PMID: 31680331 DOI: 10.1111/tme.12644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 08/22/2019] [Accepted: 10/06/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To determine whether it was feasible to use a haemorrhage assessment tool (HAT) within a trauma trial and whether the data obtained could differentiate patients who had achieved haemostasis. BACKGROUND Major haemorrhage is one of the leading causes of death worldwide, affecting 40% of trauma patients. Clinical trials evaluating haemostatic interventions often use transfusion outcomes as a primary endpoint. Transfusion is highly dependent on local practice, limiting its reliability as a robust, transferable endpoint. METHODS A five-point HAT questionnaire was applied to participants enrolled into the EFIT-1 trial. This RCT evaluated the feasibility of administering a 6 g fibrinogen concentrate to patients with severe trauma haemorrhage. RESULTS Of participants, 98% completed a HAT; 75% participants had 'achieved haemostasis' at the time of tool completion, as determined by clinical acumen alone. HAT scores were able to differentiate which participants required transfusion after 3 h. Of participants, 56% were transfused red blood cells when they scored 0-2, compared to 17% with HAT scores between 3 and 5. CONCLUSION This study has confirmed the feasibility of using a HAT during the emergency care of patients suffering trauma haemorrhage, and future studies should be conducted to determine its value as an endpoint in haemostasis studies.
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Affiliation(s)
- N Curry
- Department of Haematology, Oxford University Hospitals NHS Trust, Oxford, UK.,NIHR BRC Blood Theme, Oxford University, Oxford, UK
| | - C Foley
- NHS Blood and Transplant Clinical Trials Unit, NHS Blood and Transplant, Cambridge and Bristol, UK
| | - H Wong
- Department of Haematology, Oxford University Hospitals NHS Trust, Oxford, UK.,NIHR BRC Blood Theme, Oxford University, Oxford, UK.,NHS Blood and Transplant, John Radcliffe Hospital, Oxford, UK
| | - A Mora
- NHS Blood and Transplant Clinical Trials Unit, NHS Blood and Transplant, Cambridge and Bristol, UK
| | - E Curnow
- NHS Blood and Transplant Clinical Trials Unit, NHS Blood and Transplant, Cambridge and Bristol, UK
| | - A Zarankaite
- NHS Blood and Transplant Clinical Trials Unit, NHS Blood and Transplant, Cambridge and Bristol, UK
| | - R Hodge
- NHS Blood and Transplant Clinical Trials Unit, NHS Blood and Transplant, Cambridge and Bristol, UK
| | - V Hopkins
- NHS Blood and Transplant Clinical Trials Unit, NHS Blood and Transplant, Cambridge and Bristol, UK
| | - A Deary
- NHS Blood and Transplant Clinical Trials Unit, NHS Blood and Transplant, Cambridge and Bristol, UK
| | - J Ray
- Department of Emergency Medicine, John Radcliffe Hospital, Oxford, UK
| | - P Moss
- Department of Emergency Medicine, St. George's Hospital, London, UK
| | - M J Reed
- Emergency Medicine Research Group Edinburgh (EMERGE), Royal Infirmary of Edinburgh, Edinburgh, UK
| | - S Kellett
- Department of Anaesthetics, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - R Davenport
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK
| | - S Stanworth
- Department of Haematology, Oxford University Hospitals NHS Trust, Oxford, UK.,NIHR BRC Blood Theme, Oxford University, Oxford, UK.,NHS Blood and Transplant, John Radcliffe Hospital, Oxford, UK
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18
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Thomas S, Foley C, Kane B, Johnston BM, Lynch B, Smith S, Healy O, Droog E, Browne J. Variation in resource allocation in urgent and emergency Care Systems in Ireland. BMC Health Serv Res 2019; 19:657. [PMID: 31511009 PMCID: PMC6737720 DOI: 10.1186/s12913-019-4504-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 08/30/2019] [Indexed: 11/10/2022] Open
Abstract
Background A key challenge for most systems is how to provide effective access to urgent and emergency care across rural and urban populations. Tensions about the placement and scope of hospital emergency services are longstanding in Irish political life and there has been recent reform to centralise hospital services in some regions. The focus of this paper is a system approach to examine the geographic variation in resourcing and utilisation of such care across GP practices, out-of-hours care, ambulance services, Emergency Departments and Local Injury Units in Ireland. Methods We used a cross-sectional study design to evaluate variation in resource allocation by aggregating geographic funding to various elements of the urgent and emergency care system and assessing patterns in hospital resource utilisation across the population. Expenditure, staffing, access and activity data were gathered from government sources, individual facilities and service providers, health professional bodies, private firms and central statistics. Data on costs and activity in 2014 are collated and presented at both county and regional levels. Analyses focus on resources spent on urgent and emergency care across geographic areas, the role of population concentration in allocation, the relationship between pre-hospital spending and in-hospital spending, and the utilisation of hospital-based emergency care resources by residents of each county. Results An array of funding mechanisms exists, resulting in a fragmented approach to the resourcing of urgent and emergency care. There are large differences in spending per capita at the county-level, ranging from between €50 and €200 per capita; however, these are less pronounced regionally. Distribution of hospital emergency care resources is highly skewed to the North East of the country, and away from the recently reconfigured South and Mid-West regions. Conclusions This analysis advances the traditional approach of evaluating individual services or hospital resourcing. There are notable differences in utilisation of hospital-based emergency care resources at the regional level, indicating that populations within those regions which have been reconfigured have lower utilisation of hospital resources. There is a clear case for more integration in decision-making around funding and consideration of key principles, such as equity, to guide that process. Electronic supplementary material The online version of this article (10.1186/s12913-019-4504-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Steve Thomas
- Centre for Health Policy and Management, Trinity College Dublin, 3-4 Foster Place, College Green, Dublin 2, Ireland.
| | - Conor Foley
- Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
| | - Bridget Kane
- Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
| | - Bridget M Johnston
- Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
| | - Brenda Lynch
- Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
| | - Susan Smith
- Department of General Practice, Royal College of Surgeons, Dublin, Ireland
| | - Orla Healy
- Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
| | - Elsa Droog
- Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
| | - John Browne
- Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
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19
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Morais M, Ma M, Foley C, Cusnir R, Lange J. Tetrakis(3,4-hydroxypyridinone) bifunctional chelators for zirconium-89 imaging of antibodies. Nucl Med Biol 2019. [DOI: 10.1016/s0969-8051(19)30283-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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20
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McHugh S, Droog E, Foley C, Boyce M, Healy O, Browne JP. Understanding the impetus for major systems change: A multiple case study of decisions and non-decisions to reconfigure emergency and urgent care services. Health Policy 2019; 123:728-736. [PMID: 31208824 DOI: 10.1016/j.healthpol.2019.05.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 05/22/2019] [Accepted: 05/28/2019] [Indexed: 01/26/2023]
Abstract
OBJECTIVE The optimal organisation of emergency and urgent care services (EUCS) is a perennial problem internationally. Similar to other countries, the Health Service Executive in Ireland pursued EUCS reconfiguration in response to quality and safety concerns, unsustainable costs and workforce issues. However, the implementation of reconfiguration has been inconsistent at a regional level. Our aim was to identify the factors that led to this inconsistency. METHODS Using a multiple case study design, six case study regions represented full, partial and little/no reconfiguration at emergency departments (EDs). Data from documents and key stakeholder interviews were analysed using a framework approach with cross-case analysis. RESULTS The impetus to reconfigure ED services was triggered by patient safety events, and to a lesser extent by having a region-specific plan and an obvious starting point for changes. However, the complexity of the next steps and political influence impeded reconfiguration in several regions. Implementation was more strategic in regions that reconfigured later, facilitated by clinical leadership and "lead-in time" to plan and sell changes. CONCLUSION While the global shift towards centralisation of EUCS is driven by universal challenges, decisions about when, where and how much to implement are influenced by local drivers including context, people and politics. This can contribute to a public perception of inequity and distrust in proposals for major systems change.
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Affiliation(s)
- Sheena McHugh
- School of Public Health, University College Cork, Western Rd, Cork, Ireland.
| | - E Droog
- South/South West Hospital Group, Erinville, Western Road, Cork, Ireland
| | - Conor Foley
- School of Public Health, University College Cork, Western Rd, Cork, Ireland
| | - M Boyce
- School of Public Health, University College Cork, Western Rd, Cork, Ireland
| | - O Healy
- South/South West Hospital Group, Erinville, Western Road, Cork, Ireland
| | - J P Browne
- School of Public Health, University College Cork, Western Rd, Cork, Ireland
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Marsden M, Benger J, Brohi K, Curry N, Foley C, Green L, Lucas J, Rossetto A, Stanworth S, Thomas H, Davenport R. Coagulopathy, cryoprecipitate and CRYOSTAT-2: realising the potential of a nationwide trauma system for a national clinical trial. Br J Anaesth 2018; 122:164-169. [PMID: 30686301 DOI: 10.1016/j.bja.2018.10.055] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 10/06/2018] [Accepted: 10/27/2018] [Indexed: 01/10/2023] Open
Affiliation(s)
- M Marsden
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK; Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK; Barts Health NHS Trust, London, UK.
| | - J Benger
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - K Brohi
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK; Barts Health NHS Trust, London, UK
| | - N Curry
- Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK; Radcliffe Department of Medicine, University of Oxford, UK
| | - C Foley
- NHS Blood and Transplant, Clinical Trials Unit, Cambridge, UK
| | - L Green
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary, University of London, London, UK; Barts Health NHS Trust, London, UK
| | - J Lucas
- NHS Blood and Transplant, Clinical Trials Unit, Cambridge, UK
| | - A Rossetto
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK; Barts Health NHS Trust, London, UK
| | - S Stanworth
- Oxford NIHR BRC Haematology Theme, Oxford Centre for Haematology, University of Oxford, UK; NHS Blood and Transplant, Transfusion Medicine, Oxford, UK; Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK; Radcliffe Department of Medicine, University of Oxford, UK
| | - H Thomas
- NHS Blood and Transplant, Clinical Trials Unit, Bristol, UK; NHS Blood and Transplant, Transfusion Medicine, Oxford, UK
| | - R Davenport
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK; Barts Health NHS Trust, London, UK
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Foley C, Huss T, O’Carroll T, Flynn R. ISQUA18-1307The Development, Implementation and Outcomes of a National Patient Experience Survey and Associated Quality Improvement Infrastructure: Lessons from Ireland. Int J Qual Health Care 2018. [DOI: 10.1093/intqhc/mzy167.55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- C Foley
- Health Information and Quality Authority, Cork, Ireland
| | - T Huss
- Health Information and Quality Authority, Cork, Ireland
| | - T O’Carroll
- Health Information and Quality Authority, Cork, Ireland
| | - R Flynn
- Health Information and Quality Authority, Cork, Ireland
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23
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Lynch B, Fitzgerald AP, Corcoran P, Healy O, Buckley C, Foley C, Browne J. Case fatality ratios for serious emergency conditions in the Republic of Ireland: a longitudinal investigation of trends over the period 2002-2014 using joinpoint analysis. BMC Health Serv Res 2018; 18:474. [PMID: 29921263 PMCID: PMC6006987 DOI: 10.1186/s12913-018-3260-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 05/30/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND In the past decade, the Republic of Ireland has undertaken significant reconfiguration programmes to improve emergency services. During this time the public healthcare system experienced a large real decrease in resources. This study assesses national and regional population outcomes over the period 2002-2014, and whether changes coincide with system reconfiguration and the financial restrictions imposed by the 2008 recession. METHODS Case fatality ratios (CFRs) were constructed for emergency conditions for 2002-2014. Total emergency conditions and individual condition trends were analysed nationally using joinpoint analysis. National results informed the investigation of trends at a regional and county level using an inverse standard error weighted generalised linear model with a log link to construct funnel plots. County-level CFRs were compared for the first and last 3 years of the period to further investigate the changes to county results over the 13 year period, specifically in comparison to the national-level CFR. RESULTS Nationally, there was an annual fall in CFRs (2.1%). The decline was faster from 2002 to 2007 (annual percentage change = - 3.4; 95% CI-4.4, - 2.4), compared to 2007-2014 (annual percentage change = - 1.2; 95% CI -1.9, - 0.5). The South-East had a lower rate of decrease and the West had a higher rate. Cross sectional analysis of two periods (2002-2004 and 2012-2014) showed high consistency in the counties performance relative to the national CFR in both periods. CONCLUSION Change in the national trend coincided with the onset of economic stress on the public health system. Attributing the decline in CFR improvement to economic factors is weakened by the uneven nature of the trend change. No distinct pattern of change was identified among regions which underwent substantial reconfiguration of emergency services.
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Affiliation(s)
- Brenda Lynch
- University College Cork, School of Public Health, 4th Floor, Western Gateway Building, Western Road, Cork City, Ireland.
| | - Anthony P Fitzgerald
- University College Cork, School of Public Health, 4th Floor, Western Gateway Building, Western Road, Cork City, Ireland
| | - Paul Corcoran
- University College Cork, School of Public Health, 4th Floor, Western Gateway Building, Western Road, Cork City, Ireland
| | - Orla Healy
- Health Service Executive, South/South West Hospital Group, Ernville, Western Road, Cork, Ireland
| | - Claire Buckley
- University College Cork, School of Public Health, 4th Floor, Western Gateway Building, Western Road, Cork City, Ireland.,Health Service Executive, South/South West Hospital Group, Ernville, Western Road, Cork, Ireland
| | - Conor Foley
- University College Cork, School of Public Health, 4th Floor, Western Gateway Building, Western Road, Cork City, Ireland
| | - John Browne
- University College Cork, School of Public Health, 4th Floor, Western Gateway Building, Western Road, Cork City, Ireland
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Chao M, Foroudi F, Jassal S, Hyett A, Neoh D, Bevington E, Loh S, Zantuck N, Stoney D, Guerrieri M, Foley C, Grinsell D, Law M, Cheng M, Yu V, Chew G, Taylor K, David C, Chipman M, Baker C. Tumor down staging in high risk or locally advanced breast cancer patients undergoing neoadjuvant radiotherapy prior to definitive surgery and autologous breast reconstruction. Eur J Cancer 2018. [DOI: 10.1016/s0959-8049(18)30397-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Chao M, Foroudi F, Jassal S, Hyett A, Neoh D, Bevington E, Stoney D, Zantuck N, Law M, Foley C, Guerrieri M, Grinsell D, Loh S, Chew G, Yu V, Cokelek M, Taylor K, Cheng M, Chipman M, Baker C. The use of neoadjuvant radiotherapy in high risk or locally advanced breast cancer patients prior to definitive surgery with mastectomy and autologous breast reconstruction does not impact on post operative surgical complications. Eur J Cancer 2018. [DOI: 10.1016/s0959-8049(18)30419-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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26
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Shortall J, Foley C, Sleator R, O’Brien B. The effect of dairy cow breed on milk production, cow traffic and milking characteristics in a pasture-based automatic milking system. Livest Sci 2018. [DOI: 10.1016/j.livsci.2018.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Baker C, Chao MW, Jassal S, Neoh D, Bevington E, Hyett A, Grinsell D, Loh SW, Zantuck N, Stoney D, Foley C, Law M, Chew G, Yu V, Cheng M, Guerrieri M, Taylor K, Chipman M, Cokelek M, Lim Joon D, Foroudi F. Abstract P2-11-16: The safety and pathological impact of neoadjuvant radiotherapy for local advanced breast cancer undergoing mastectomy and autologous reconstruction. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p2-11-16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction
Delayed breast reconstructions are preferred if post mastectomy radiotherapy is indicated due to lower complication rates compared to immediate permanent implant or autologous reconstructions (AR) but cosmetic outcomes are inferior. Radiotherapy has a deleterious effect on implants and autologous tissue and often an interim tissue expander is place which has inherent pain and complications.
However, neoadjuvant radiotherapy (NART) prior to surgery allows for definitive oncological surgery to be performed with an immediate AR in a single operation and the avoidance of a temporary expander. The aim of this study is to assess the safety and downstaging impact of NART.
Methods
This is a prospective review of patients who underwent NART at GenesisCare Victoria, the Austin and the Alfred hospital. 59 LABC patients (median age 49.2 years) were divided into two groups; clinically staged and pathologically staged for reporting. There were 15 pathologically staged patients (pStage 2A-3C) and 43 clinically staged patients (cStage 2A-3B). All patients initially underwent NACT, followed by NART (median dose 50.4Gy in 28 fractions) to the breast, supraclavicular fossa and level 3 axilla with or without coverage of their Level 1 and 2 axilla, and/or internal mammary nodes. Approximately 6 weeks after completing NART, patients underwent definitive surgery and AR.
Results
All patients completed their NART with minimal toxicity and no break in treatment. 55 patients had a skin-sparing mastectomy (SSM) and 3 patients had a modified radical mastectomy. All clinically staged patients underwent an AD. ARs with a DIEP flap were performed in the majority of patients (51). The average length of hospitalisation was 6.2 days.
The Miller Payne (MP) scoring index was used to record pathological responses in clinically staged patients. Overall 36 patients achieved significant downstaging of their disease, with MP scores of 5/5 for 20 and 4/5 for 16. Only 1 patient failed to achieve any downstaging with a MP score of 1/5. All 12 Her2 positive patients, 3/5 Triple negative patients and 5/26 Luminal A/B patients achieved a MP score of 5/5. All patients achieved R0 resection margins. This included 6 patients who had initial cT4 disease (cT4a X2, cT4b X1 and cT4d X3). 15 patients had initial cN2/3 disease and all successfully underwent their axillary dissections with R0 resections achieved. 10/15 had no involved axillary nodes with significant scarring seen in 6. 5/15 had residual involved nodes with significant scarring seen in 3 patients.
Post surgical toxicities were graded using Clavien-Dindo classification. 8 significant grade 3 toxicities were seen in 6 patients, with no grade 4 or 5 toxicities. No patients developed DVT or PE. No flap losses were seen.
Median follow up is 23 months. Cosmesis was rated as good to excellent in all cases. 1 patient developed simultaneous loco-regional and distant recurrence with another 3 patients developing distant metastases only.
Conclusion
This review demonstrated that NART is a safe technique, which has not lead to an increase in surgical complication rates or resulted in a detriment in cosmetic outcome. NART can achieve a shorter, simpler reconstructive journey for patients.
Citation Format: Baker C, Chao MW, Jassal S, Neoh D, Bevington E, Hyett A, Grinsell D, Loh SW, Zantuck N, Stoney D, Foley C, Law M, Chew G, Yu V, Cheng M, Guerrieri M, Taylor K, Chipman M, Cokelek M, Lim Joon D, Foroudi F. The safety and pathological impact of neoadjuvant radiotherapy for local advanced breast cancer undergoing mastectomy and autologous reconstruction [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P2-11-16.
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Affiliation(s)
- C Baker
- St Vincents Hospital, Melbourne, Victoria, Australia; Victorian Breast and Oncology Centre, Melbourne, Victoria, Australia; Genesis Care Cancer Centre, Melbourne, Victoria, Australia; Austin Hospital, Melbourne, Victoria, Australia; Maroondah Hospital, Melbourne, Victoria, Australia; Alfred Hospital, Melbourne, Victoria, Australia
| | - MW Chao
- St Vincents Hospital, Melbourne, Victoria, Australia; Victorian Breast and Oncology Centre, Melbourne, Victoria, Australia; Genesis Care Cancer Centre, Melbourne, Victoria, Australia; Austin Hospital, Melbourne, Victoria, Australia; Maroondah Hospital, Melbourne, Victoria, Australia; Alfred Hospital, Melbourne, Victoria, Australia
| | - S Jassal
- St Vincents Hospital, Melbourne, Victoria, Australia; Victorian Breast and Oncology Centre, Melbourne, Victoria, Australia; Genesis Care Cancer Centre, Melbourne, Victoria, Australia; Austin Hospital, Melbourne, Victoria, Australia; Maroondah Hospital, Melbourne, Victoria, Australia; Alfred Hospital, Melbourne, Victoria, Australia
| | - D Neoh
- St Vincents Hospital, Melbourne, Victoria, Australia; Victorian Breast and Oncology Centre, Melbourne, Victoria, Australia; Genesis Care Cancer Centre, Melbourne, Victoria, Australia; Austin Hospital, Melbourne, Victoria, Australia; Maroondah Hospital, Melbourne, Victoria, Australia; Alfred Hospital, Melbourne, Victoria, Australia
| | - E Bevington
- St Vincents Hospital, Melbourne, Victoria, Australia; Victorian Breast and Oncology Centre, Melbourne, Victoria, Australia; Genesis Care Cancer Centre, Melbourne, Victoria, Australia; Austin Hospital, Melbourne, Victoria, Australia; Maroondah Hospital, Melbourne, Victoria, Australia; Alfred Hospital, Melbourne, Victoria, Australia
| | - A Hyett
- St Vincents Hospital, Melbourne, Victoria, Australia; Victorian Breast and Oncology Centre, Melbourne, Victoria, Australia; Genesis Care Cancer Centre, Melbourne, Victoria, Australia; Austin Hospital, Melbourne, Victoria, Australia; Maroondah Hospital, Melbourne, Victoria, Australia; Alfred Hospital, Melbourne, Victoria, Australia
| | - D Grinsell
- St Vincents Hospital, Melbourne, Victoria, Australia; Victorian Breast and Oncology Centre, Melbourne, Victoria, Australia; Genesis Care Cancer Centre, Melbourne, Victoria, Australia; Austin Hospital, Melbourne, Victoria, Australia; Maroondah Hospital, Melbourne, Victoria, Australia; Alfred Hospital, Melbourne, Victoria, Australia
| | - SW Loh
- St Vincents Hospital, Melbourne, Victoria, Australia; Victorian Breast and Oncology Centre, Melbourne, Victoria, Australia; Genesis Care Cancer Centre, Melbourne, Victoria, Australia; Austin Hospital, Melbourne, Victoria, Australia; Maroondah Hospital, Melbourne, Victoria, Australia; Alfred Hospital, Melbourne, Victoria, Australia
| | - N Zantuck
- St Vincents Hospital, Melbourne, Victoria, Australia; Victorian Breast and Oncology Centre, Melbourne, Victoria, Australia; Genesis Care Cancer Centre, Melbourne, Victoria, Australia; Austin Hospital, Melbourne, Victoria, Australia; Maroondah Hospital, Melbourne, Victoria, Australia; Alfred Hospital, Melbourne, Victoria, Australia
| | - D Stoney
- St Vincents Hospital, Melbourne, Victoria, Australia; Victorian Breast and Oncology Centre, Melbourne, Victoria, Australia; Genesis Care Cancer Centre, Melbourne, Victoria, Australia; Austin Hospital, Melbourne, Victoria, Australia; Maroondah Hospital, Melbourne, Victoria, Australia; Alfred Hospital, Melbourne, Victoria, Australia
| | - C Foley
- St Vincents Hospital, Melbourne, Victoria, Australia; Victorian Breast and Oncology Centre, Melbourne, Victoria, Australia; Genesis Care Cancer Centre, Melbourne, Victoria, Australia; Austin Hospital, Melbourne, Victoria, Australia; Maroondah Hospital, Melbourne, Victoria, Australia; Alfred Hospital, Melbourne, Victoria, Australia
| | - M Law
- St Vincents Hospital, Melbourne, Victoria, Australia; Victorian Breast and Oncology Centre, Melbourne, Victoria, Australia; Genesis Care Cancer Centre, Melbourne, Victoria, Australia; Austin Hospital, Melbourne, Victoria, Australia; Maroondah Hospital, Melbourne, Victoria, Australia; Alfred Hospital, Melbourne, Victoria, Australia
| | - G Chew
- St Vincents Hospital, Melbourne, Victoria, Australia; Victorian Breast and Oncology Centre, Melbourne, Victoria, Australia; Genesis Care Cancer Centre, Melbourne, Victoria, Australia; Austin Hospital, Melbourne, Victoria, Australia; Maroondah Hospital, Melbourne, Victoria, Australia; Alfred Hospital, Melbourne, Victoria, Australia
| | - V Yu
- St Vincents Hospital, Melbourne, Victoria, Australia; Victorian Breast and Oncology Centre, Melbourne, Victoria, Australia; Genesis Care Cancer Centre, Melbourne, Victoria, Australia; Austin Hospital, Melbourne, Victoria, Australia; Maroondah Hospital, Melbourne, Victoria, Australia; Alfred Hospital, Melbourne, Victoria, Australia
| | - M Cheng
- St Vincents Hospital, Melbourne, Victoria, Australia; Victorian Breast and Oncology Centre, Melbourne, Victoria, Australia; Genesis Care Cancer Centre, Melbourne, Victoria, Australia; Austin Hospital, Melbourne, Victoria, Australia; Maroondah Hospital, Melbourne, Victoria, Australia; Alfred Hospital, Melbourne, Victoria, Australia
| | - M Guerrieri
- St Vincents Hospital, Melbourne, Victoria, Australia; Victorian Breast and Oncology Centre, Melbourne, Victoria, Australia; Genesis Care Cancer Centre, Melbourne, Victoria, Australia; Austin Hospital, Melbourne, Victoria, Australia; Maroondah Hospital, Melbourne, Victoria, Australia; Alfred Hospital, Melbourne, Victoria, Australia
| | - K Taylor
- St Vincents Hospital, Melbourne, Victoria, Australia; Victorian Breast and Oncology Centre, Melbourne, Victoria, Australia; Genesis Care Cancer Centre, Melbourne, Victoria, Australia; Austin Hospital, Melbourne, Victoria, Australia; Maroondah Hospital, Melbourne, Victoria, Australia; Alfred Hospital, Melbourne, Victoria, Australia
| | - M Chipman
- St Vincents Hospital, Melbourne, Victoria, Australia; Victorian Breast and Oncology Centre, Melbourne, Victoria, Australia; Genesis Care Cancer Centre, Melbourne, Victoria, Australia; Austin Hospital, Melbourne, Victoria, Australia; Maroondah Hospital, Melbourne, Victoria, Australia; Alfred Hospital, Melbourne, Victoria, Australia
| | - M Cokelek
- St Vincents Hospital, Melbourne, Victoria, Australia; Victorian Breast and Oncology Centre, Melbourne, Victoria, Australia; Genesis Care Cancer Centre, Melbourne, Victoria, Australia; Austin Hospital, Melbourne, Victoria, Australia; Maroondah Hospital, Melbourne, Victoria, Australia; Alfred Hospital, Melbourne, Victoria, Australia
| | - D Lim Joon
- St Vincents Hospital, Melbourne, Victoria, Australia; Victorian Breast and Oncology Centre, Melbourne, Victoria, Australia; Genesis Care Cancer Centre, Melbourne, Victoria, Australia; Austin Hospital, Melbourne, Victoria, Australia; Maroondah Hospital, Melbourne, Victoria, Australia; Alfred Hospital, Melbourne, Victoria, Australia
| | - F Foroudi
- St Vincents Hospital, Melbourne, Victoria, Australia; Victorian Breast and Oncology Centre, Melbourne, Victoria, Australia; Genesis Care Cancer Centre, Melbourne, Victoria, Australia; Austin Hospital, Melbourne, Victoria, Australia; Maroondah Hospital, Melbourne, Victoria, Australia; Alfred Hospital, Melbourne, Victoria, Australia
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Droog E, Foley C, Healy O, Buckley C, Boyce M, McHugh S, Browne J. Perspectives on the underlying drivers of urgent and emergency care reconfiguration in Ireland. Int J Health Plann Manage 2017; 33:364-379. [PMID: 29072341 PMCID: PMC6032929 DOI: 10.1002/hpm.2469] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 09/10/2017] [Accepted: 09/11/2017] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND There is an increasing tendency to reconfigure acute hospital care towards a more centralised and specialised model, particularly for complex care conditions. Although centralisation is presented as "evidence-based", the relevant studies are often challenged by groups which hold perspectives and values beyond those implicit in the literature. This study investigated stakeholder perspectives on the rationale for the reconfiguration of urgent and emergency care in Ireland. Specifically, it considered the hypothesis that individuals from different stakeholder groups would endorse different positions in relation to the motivation for, and goals of, reconfiguration. METHODS Documentary analysis of policy documents was used to identify official justifications for change. Semi-structured interviews with 175 purposively sampled stakeholders explored their perspectives on the rationale for reconfiguration. RESULTS While there was some within-group variation, internal and external stakeholders generally vocalised different lines of argument. Clinicians and management in the internal stakeholder group proposed arguments in favour of reconfiguration based on efficiency and safety claims. External stakeholders, including hospital campaigners and local political representatives expressed arguments that focused on access to care. A "voter" argument, focused on the role of local politicians in determining the outcome of reconfiguration planning, was mentioned by both internal and external stakeholders, often in a critical fashion. CONCLUSION Our study adds to an emerging literature on the interaction between a technocratic approach to health system planning advocated by clinicians and health service managers, and the experiential "non-expert" claims of the public and patients.
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Affiliation(s)
- E. Droog
- Department of Epidemiology and Public Health, Faculty of Medicine and HealthUniversity College CorkCorkIreland
| | - C. Foley
- Department of Epidemiology and Public Health, Faculty of Medicine and HealthUniversity College CorkCorkIreland
| | - O. Healy
- Department of Public Health, HSE South RegionSt. Finbarr's HospitalCorkIreland
| | - C. Buckley
- Department of Public Health, HSE South RegionSt. Finbarr's HospitalCorkIreland
| | - M. Boyce
- Department of Epidemiology and Public Health, Faculty of Medicine and HealthUniversity College CorkCorkIreland
| | - S. McHugh
- Department of Epidemiology and Public Health, Faculty of Medicine and HealthUniversity College CorkCorkIreland
| | - J.P. Browne
- Department of Epidemiology and Public Health, Faculty of Medicine and HealthUniversity College CorkCorkIreland
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29
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Cokelek M, Chao M, Foroudi F, Jassal S, Neoh D, Bevington E, Hyett A, Grinsell D, Loh S, Zantuck N, Stoney D, Foley C, Law M, Yu V, Chew G, Cheng M, Taylor K, Guerrieri M, Chipman M, Baker C. Sequence Reversal: Neoadjuvant Radiation Therapy for Locally Advanced Breast Cancer. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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30
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Kaye DL, Fornari V, Scharf M, Fremont W, Zuckerbrot R, Foley C, Hargrave T, Smith BA, Wallace J, Blakeslee G, Petras J, Sengupta S, Singarayer J, Cogswell A, Bhatia I, Jensen P. Description of a multi-university education and collaborative care child psychiatry access program: New York State's CAP PC. Gen Hosp Psychiatry 2017; 48:32-36. [PMID: 28917392 DOI: 10.1016/j.genhosppsych.2017.06.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 06/06/2017] [Accepted: 06/06/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Although, child mental health problems are widespread, few get adequate treatment, and there is a severe shortage of child psychiatrists. To address this public health need many states have adopted collaborative care programs to assist primary care to better assess and manage pediatric mental health concerns. This report adds to the small literature on collaborative care programs and describes one large program that covers most of New York state. PROGRAM DESCRIPTION CAP PC, a component program of New York State's Office of Mental Health (OMH) Project TEACH, has provided education and consultation support to primary care providers covering most of New York state since 2010. The program is uniquely a five medical school collaboration with hubs at each that share one toll free number and work together to provide education and consultation support services to PCPs. METHODS The program developed a clinical communications record to track information about all consultations which forms the basis of much of this report. 2-week surveys following consultations, annual surveys, and pre- and post-educational program evaluations have also been used to measure the success of the program. RESULTS CAP PC has grown over the 6years of the program and has provided 8013 phone consultations to over 1500 PCPs. The program synergistically provided 17,523 CME credits of educational programming to 1200 PCPs. PCP users of the program report very high levels of satisfaction and self reported growth in confidence. CONCLUSIONS CAP PC demonstrates that large-scale collaborative consultation models for primary care are feasible to implement, popular with PCPs, and can be sustained. The program supports increased access to child mental health services in primary care and provides child psychiatric expertise for patients who would otherwise have none.
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Affiliation(s)
- D L Kaye
- University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, United States.
| | - V Fornari
- Hofstra/Northwell Health School of Medicine, Glen Oaks, NY, United States
| | - M Scharf
- University of Rochester School of Medicine, Rochester, NY, United States
| | - W Fremont
- SUNY Upstate Medical University, Syracuse, NY, United States
| | - R Zuckerbrot
- Columbia University Medical Center/NY State Psychiatric Institute, New York, NY, United States
| | - C Foley
- Hofstra/Northwell Health School of Medicine, Glen Oaks, NY, United States
| | - T Hargrave
- SUNY Upstate Medical University, Syracuse, NY, United States
| | - B A Smith
- University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, United States
| | - J Wallace
- University of Rochester School of Medicine, Rochester, NY, United States
| | - G Blakeslee
- SUNY Upstate Medical University, Syracuse, NY, United States
| | - J Petras
- Columbia University Medical Center/NY State Psychiatric Institute, New York, NY, United States
| | - S Sengupta
- University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, United States
| | - J Singarayer
- SUNY Upstate Medical University, Syracuse, NY, United States
| | - A Cogswell
- University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, United States
| | - I Bhatia
- University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, United States
| | - P Jensen
- REACH Institute, University of Arkansas for Medical Sciences, Little Rock, AK, United States
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Foley C, Lee J, Timor Tritsch I, Blank S, Pothuri B, Curtin J, Boyd L. Reoperation and recurrence rates in women undergoing conservative surgery for low malignant potential tumors. Gynecol Oncol 2017. [DOI: 10.1016/j.ygyno.2017.03.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Foley C, Droog E, Healy O, McHugh S, Buckley C, Browne JP. Understanding perspectives on major system change: A comparative case study of public engagement and the implementation of urgent and emergency care system reconfiguration. Health Policy 2017; 121:800-808. [PMID: 28578830 DOI: 10.1016/j.healthpol.2017.05.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 05/21/2017] [Accepted: 05/22/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Major changes have been made to how emergency care services are configured in several regions in the Republic of Ireland. This study investigated the hypothesis that engagement activities undertaken prior to these changes influenced stakeholder perspectives on the proposed changes and impacted on the success of implementation. METHODS A comparative case-study approach was used to explore the changes in three regions. These regions were chosen for the case study as the nature of the proposals to reconfigure care provision were broadly similar but implementation outcomes varied considerably. Documentary analysis of reconfiguration planning reports was used to identify planned public engagement activities. Semi-structured interviews with 74 purposively-sampled stakeholders explored their perspectives on reconfiguration, engagement activities and public responses to reconfiguration. Framework analysis was used, integrating inductive and deductive approaches. RESULTS Approaches to public engagement and success of implementation differed considerably across the three cases. Regions that presented the public with the reconfiguration plan alone reported greater public opposition and difficulty in implementing changes. Engagement activities that included a range of stakeholders and continued throughout the reconfiguration process appeared to largely address public concerns, contributing to smoother implementation. CONCLUSIONS The presentation of reconfiguration reports alone is not enough to convince communities of the case for change. Genuine, ongoing and inclusive engagement offers the best opportunity to address community concerns about reconfiguration.
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Affiliation(s)
- Conor Foley
- Department of Epidemiology and Public Health, Western Road, University College Cork, Ireland.
| | - Elsa Droog
- Department of Epidemiology and Public Health, Western Road, University College Cork, Ireland
| | - Orla Healy
- South/South West Hospital Group, Ireland
| | - Sheena McHugh
- Department of Epidemiology and Public Health, Western Road, University College Cork, Ireland
| | - Claire Buckley
- Department of Epidemiology and Public Health, Western Road, University College Cork, Ireland
| | - John Patrick Browne
- Department of Epidemiology and Public Health, Western Road, University College Cork, Ireland
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Geng C, Kaochar S, Li M, Rajapakshe K, Fiskus W, Dong J, Foley C, Dong B, Zhang L, Kwon OJ, Shah SS, Bolaki M, Xin L, Ittmann M, O'Malley BW, Coarfa C, Mitsiades N. SPOP regulates prostate epithelial cell proliferation and promotes ubiquitination and turnover of c-MYC oncoprotein. Oncogene 2017; 36:4767-4777. [PMID: 28414305 PMCID: PMC5887163 DOI: 10.1038/onc.2017.80] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 01/16/2017] [Accepted: 02/26/2017] [Indexed: 12/13/2022]
Abstract
The E3 ubiquitin ligase adaptor speckle-type POZ protein (SPOP) is frequently dysregulated in prostate adenocarcinoma (PC), via either somatic mutations or mRNA downregulation, suggesting an important tumor suppressor function. To examine its physiologic role in the prostate epithelium in vivo, we generated mice with prostate-specific biallelic ablation of Spop. These mice exhibited increased prostate mass, prostate epithelial cell proliferation, and expression of c-MYC protein compared to littermate controls, and eventually developed prostatic intraepithelial neoplasia (PIN). We found that SPOPWT can physically interact with c-MYC protein and, upon exogenous expression in vitro, can promote c-MYC ubiquitination and degradation. This effect was attenuated in PC cells by introducing PC-associated SPOP mutants or upon knockdown of SPOP via short-hairpin-RNA, suggesting that SPOP inactivation directly increases c-MYC protein levels. Gene set enrichment analysis revealed enrichment of Myc-induced genes in transcriptomic signatures associated with SPOPMT. Likewise, we observed strong inverse correlation between c-MYC activity and SPOP mRNA levels in two independent PC patient cohorts. The core SPOPMT;MYCHigh transcriptomic response, defined by the overlap between the SPOPMT and c-MYC transcriptomic programs, was also associated with inferior clinical outcome in human PCs. Finally, the organoid-forming capacity of Spop-null murine prostate cells was more sensitive to c-MYC inhibition than that of Spop-WT cells, suggesting that c-MYC upregulation functionally contributes to the proliferative phenotype of Spop knock-out prostates. Taken together, our data highlight SPOP as an important regulator of luminal epithelial cell proliferation and c-MYC expression in prostate physiology, identify c-MYC as a novel bona fide SPOP substrate, and help explain the frequent inactivation of SPOP in human PC. We propose SPOPMT–induced stabilization of c-MYC protein as a novel mechanism that can increase total c-MYC levels in PC cells, in addition to amplification of c-MYC locus.
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Affiliation(s)
- C Geng
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA.,Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX, USA
| | - S Kaochar
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA.,Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX, USA
| | - M Li
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA.,Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX, USA
| | - K Rajapakshe
- Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX, USA
| | - W Fiskus
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA.,Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX, USA
| | - J Dong
- Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX, USA
| | - C Foley
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA.,Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX, USA
| | - B Dong
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA.,Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX, USA
| | - L Zhang
- Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX, USA
| | - O-J Kwon
- Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX, USA
| | - S S Shah
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA.,Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX, USA
| | - M Bolaki
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA.,Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX, USA
| | - L Xin
- Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX, USA.,Dan L Duncan Cancer Center, Houston, TX, USA
| | - M Ittmann
- Dan L Duncan Cancer Center, Houston, TX, USA.,Department of Pathology and Immunology and Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - B W O'Malley
- Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX, USA
| | - C Coarfa
- Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX, USA.,Dan L Duncan Cancer Center, Houston, TX, USA
| | - N Mitsiades
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA.,Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX, USA.,Dan L Duncan Cancer Center, Houston, TX, USA.,Center for Drug Discovery, Baylor College of Medicine, Houston, TX, USA
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Abstract
OBJECTIVES To compare user experiences of 8 regional urgent and emergency care systems in the Republic of Ireland, and explore potential avenues for improvement. DESIGN A cross-sectional survey. SETTING Several distinct models of urgent and emergency care operate in Ireland, as system reconfiguration has been implemented in some regions but not others. The Urgent Care System Questionnaire was used to explore service users' experiences with urgent and emergency care. Linear regression and logistic regression were used to detect regional variation in each of the 3 domains and overall ratings of care. PARTICIPANTS A nationally representative sample (N=8002) of the general population was contacted by telephone, yielding 1205 participants who self-identified as having used urgent and emergency care services in the previous 3 months. MAIN OUTCOME MEASURES Patient experience was assessed across 3 domains: entry into the system, progress through the system and patient convenience of the system. Participants were also asked to provide an overall rating of the care they received. RESULTS Service users in Dublin North East gave lower ratings on the entry into the system scale than those in Dublin South (adjusted mean difference=-0.18; 95% CI -0.35 to -0.10; p=0.038). For overall ratings of care, service users in the Mid-West were less likely than those in Dublin North East to give an excellent rating (adjusted OR 0.57; 95% CI 0.35 to 0.92; p=0.022). Survey items relating to communication, and consideration of patients' needs were comparatively poorly rated. The use of public emergency departments and out-of-hours general practice care was associated with poorer patient experiences. CONCLUSIONS No consistent relationship was found between the type of urgent and emergency care model in different regions and patient experience. Scale-level data may not offer a useful metric for exploring the impact of system-level service change.
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Affiliation(s)
- Conor Foley
- Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
| | - Elsa Droog
- Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
| | - Maria Boyce
- Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
| | - Orla Healy
- Department of Public Health, Health Service Executive, Ireland
| | - John Browne
- Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
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Byrne N, Foley C, Cotter M, O'Gorman S, Storan E, Marren P. Shiitake Flagellate Dermatitis: the First Case Reported in Ireland. Ir Med J 2017; 110:500. [PMID: 28657277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Shiitake (Lentinula edodes) is the second most commonly consumed mushroom worldwide. The first case of shiitake mushroom flagellate dermatitis was described in Japan in 1977 and it is now being reported in the western world. We describe the first reported case in Ireland.
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Affiliation(s)
- N Byrne
- Department of Dermatology, University Hospital Galway, Galway
| | - C Foley
- Department of Dermatology, University Hospital Galway, Galway
| | - M Cotter
- Department of Pathology, University Hospital Galway, Galway
| | - S O'Gorman
- Department of Dermatology, University Hospital Galway, Galway
| | - E Storan
- Department of Dermatology, University Hospital Galway, Galway
| | - P Marren
- Department of Dermatology, University Hospital Galway, Galway
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Shortall J, Shalloo L, Foley C, Sleator R, O’Brien B. Investment appraisal of automatic milking and conventional milking technologies in a pasture-based dairy system. J Dairy Sci 2016; 99:7700-7713. [DOI: 10.3168/jds.2016-11256] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 05/29/2016] [Indexed: 11/19/2022]
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Foley C, Droog E, Healy O, Buckley C, Boyce M, Browne JP. OP12 Understanding perspectives on major service changes: Exploring the development and communication of arguments for and against system reconfiguration. Br J Soc Med 2016. [DOI: 10.1136/jech-2016-208064.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Coarfa C, Fiskus W, Eedunuri VK, Rajapakshe K, Foley C, Chew SA, Shah SS, Geng C, Shou J, Mohamed JS, O'Malley BW, Mitsiades N. Comprehensive proteomic profiling identifies the androgen receptor axis and other signaling pathways as targets of microRNAs suppressed in metastatic prostate cancer. Oncogene 2015; 35:2345-56. [PMID: 26364608 DOI: 10.1038/onc.2015.295] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 06/08/2015] [Accepted: 07/05/2015] [Indexed: 12/19/2022]
Abstract
MicroRNAs are important epigenetic regulators of protein expression by triggering degradation of target mRNAs and/or inhibiting their translation. Dysregulation of microRNA expression has been reported in several cancers, including prostate cancer (PC). We comprehensively characterized the proteomic footprint of a panel of 12 microRNAs that are potently suppressed in metastatic PC (SiM-miRNAs: miR-1, miR-133a, miR-133b, miR-135a, miR-143-3p, miR-145-3p, miR-205, miR-221-3p, miR-221-5p, miR-222-3p, miR-24-1-5p, and miR-31) using reverse-phase proteomic arrays. Re-expression of these SiM-miRNAs in PC cells suppressed cell proliferation and targeted key oncogenic pathways, including cell cycle, apoptosis, Akt/mammalian target of rapamycin signaling, metastasis and the androgen receptor (AR) axis. However, only 12%, at most, of these observed protein expression changes could be explained by predicted direct binding of miRNAs to corresponding mRNAs, suggesting that the majority of these proteomic effects result indirectly. AR and its steroid receptor coactivators (SRCs; SRC-1, -2 and -3) were recurrently affected by these SiM-miRNAs. In agreement, we identified inverse correlations between expression of these SiM-miRNAs and early clinical recurrence, as well as with AR transcriptional activity in human PC tissues. We also identified robust induction of miR-135a by androgen and strong direct binding of AR to the miR-135a locus. As miR-135a potently suppresses AR expression, this results in a negative feedback loop that suppresses AR protein expression in an androgen-dependent manner, while de-repressing AR expression upon androgen deprivation. Our results demonstrate that epigenetic silencing of these SiM-miRNAs can result in increased AR axis activity and cell proliferation, thus contributing to disease progression. We further demonstrate that a negative feedback loop involving miR-135a can restore AR expression under androgen-deprivation conditions, thus contributing to the upregulation of AR protein expression in castration-resistant PC. Finally, our unbiased proteomic profiling demonstrates that the majority of actual protein expression changes induced by SiM-miRNAs cannot be explained based on predicted direct interactions.
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Affiliation(s)
- C Coarfa
- Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX, USA.,Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - W Fiskus
- Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX, USA.,Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - V K Eedunuri
- Adrienne Helis Malvin Medical Research Foundation, New Orleans, LA, USA
| | - K Rajapakshe
- Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX, USA
| | - C Foley
- Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX, USA.,Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - S A Chew
- Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX, USA.,Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - S S Shah
- Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX, USA.,Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - C Geng
- Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX, USA.,Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - J Shou
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - J S Mohamed
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - B W O'Malley
- Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX, USA
| | - N Mitsiades
- Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX, USA.,Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX, USA.,Department of Medicine, Baylor College of Medicine, Houston, TX, USA
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Droog E, Foley C, Healy O, Buckley C, Boyce M, McHugh S, Browne JP. PP12 Transparency in re-designing urgent and emergency care services: an examination of the consultation process, trade-offs and the role of evidence. Br J Soc Med 2015. [DOI: 10.1136/jech-2015-206256.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Healy O, Buckley CM, Droog E, Foley C, McHugh S, Browne J. PP11 Analysis of emergency and urgent care system policy in ireland, policy coherence and implementation. Br J Soc Med 2015. [DOI: 10.1136/jech-2015-206256.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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41
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Foley C, Droog E, Healy O, Buckley C, Boyce M, McHugh S, Browne JP. PP39 Experiments in system re-design: a typology of models for changing urgent and emergency care services in one country. Br J Soc Med 2015. [DOI: 10.1136/jech-2015-206256.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Foley C, Killeen O, MacDermott E, Veale D. AB0219 Down's Arthropathy (DA): Features of Inflammatory Arthritis in Children with Trisomy 21. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.5426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Foley C, Killeen O, MacDermott E, Veale D. AB0220 Myeloid-Related Proteins 8 and 14 (MRP 8/14) – Potential Biomarkers of Disease Activity of Arthritis in Children with Trisomy 21? Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.5469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Kothari PJ, De BP, He B, Foley C, Chen A, Chiuchiolo MJ, Sondhi D, Kaminsky S, Babich J, Vallabajosula S, Crystal RG, Ballon D. 501. Radioiodinated Adeno-Associated Virus: A Promising New Approach for Monitoring Gene Therapy. Mol Ther 2015. [DOI: 10.1016/s1525-0016(16)34110-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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46
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Affiliation(s)
- C Foley
- Department of Dermatology, St. James' Hospital, Dublin 8, Ireland.
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47
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Foley C, Killeen OG. PReS-FINAL-2260: Provisional findings of an on-going study of musculoskeletal anomalies in a national cohort of patients with trisomy 21. Pediatr Rheumatol Online J 2013. [PMCID: PMC4042386 DOI: 10.1186/1546-0096-11-s2-p250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Creel S, Becker MS, Durant SM, M'Soka J, Matandiko W, Dickman AJ, Christianson D, Dröge E, Mweetwa T, Pettorelli N, Rosenblatt E, Schuette P, Woodroffe R, Bashir S, Beudels-Jamar RC, Blake S, Borner M, Breitenmoser C, Broekhuis F, Cozzi G, Davenport TRB, Deutsch J, Dollar L, Dolrenry S, Douglas-Hamilton I, Fitzherbert E, Foley C, Hazzah L, Henschel P, Hilborn R, Hopcraft JGC, Ikanda D, Jacobson A, Joubert B, Joubert D, Kelly MS, Lichtenfeld L, Mace GM, Milanzi J, Mitchell N, Msuha M, Muir R, Nyahongo J, Pimm S, Purchase G, Schenck C, Sillero-Zubiri C, Sinclair ARE, Songorwa AN, Stanley-Price M, Tehou CA, Trout C, Wall J, Wittemyer G, Zimmermann A. Conserving large populations of lions - the argument for fences has holes. Ecol Lett 2013; 16:1413, e1-3. [DOI: 10.1111/ele.12145] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 06/03/2013] [Accepted: 06/04/2013] [Indexed: 11/27/2022]
Affiliation(s)
- S. Creel
- Department of Ecology; Conservation Biology and Ecology Program; Montana State University; 310 Lewis Hall Bozeman MT 59717 USA
| | - M. S. Becker
- Department of Ecology; Conservation Biology and Ecology Program; Montana State University; 310 Lewis Hall Bozeman MT 59717 USA
- Zambian Carnivore Programme; Box 80 Mfuwe Eastern Province Zambia
| | - S. M. Durant
- Institute of Zoology; Zoological Society of London; Regents Park London NW1 4RY UK
- Wildlife Conservation Society, Bronx Zoo; 2300 Southern Blvd. Bronx NY 10460 USA
| | - J. M'Soka
- Department of Ecology; Conservation Biology and Ecology Program; Montana State University; 310 Lewis Hall Bozeman MT 59717 USA
- Zambia Wildlife Authority; Private Bag 1 Chilanga Zambia
| | - W. Matandiko
- Department of Ecology; Conservation Biology and Ecology Program; Montana State University; 310 Lewis Hall Bozeman MT 59717 USA
- Zambian Carnivore Programme; Box 80 Mfuwe Eastern Province Zambia
| | - A. J. Dickman
- Wildlife Conservation Research Unit, Department of Zoology; The Recanati-Kaplan Centre; University of Oxford; Tubney House Tubney OX13 5QL UK
| | - D. Christianson
- School of Natural Resources and the Environment; University of Arizona; Tucson AZ 85721 USA
| | - E. Dröge
- Zambian Carnivore Programme; Box 80 Mfuwe Eastern Province Zambia
| | - T. Mweetwa
- Zambian Carnivore Programme; Box 80 Mfuwe Eastern Province Zambia
| | - N. Pettorelli
- Institute of Zoology; Zoological Society of London; Regents Park London NW1 4RY UK
| | - E. Rosenblatt
- Department of Ecology; Conservation Biology and Ecology Program; Montana State University; 310 Lewis Hall Bozeman MT 59717 USA
- Zambian Carnivore Programme; Box 80 Mfuwe Eastern Province Zambia
| | - P. Schuette
- Department of Ecology; Conservation Biology and Ecology Program; Montana State University; 310 Lewis Hall Bozeman MT 59717 USA
- Zambian Carnivore Programme; Box 80 Mfuwe Eastern Province Zambia
| | - R. Woodroffe
- Institute of Zoology; Zoological Society of London; Regents Park London NW1 4RY UK
| | - S. Bashir
- Institute of Zoology; Zoological Society of London; Regents Park London NW1 4RY UK
| | - R. C. Beudels-Jamar
- Royal Belgian Institute of Natural Sciences; 29 Vautier str. Bruxelles 1000 Belgium
- CMS Scientific Council, UNEP/CMS; Hermann-Ehlers-Str. 10 Bonn 53113 Germany
| | - S. Blake
- Max Planck Institute for Ornithology; Whitney R. Harris World Ecology Center; Washington University in St. Louis; St. Louis 63130 USA
| | - M. Borner
- Institute of Biodiversity, Animal Health and Comparative Medicine; University of Glasgow; University Avenue Glasgow G12 8QQ UK
| | - C. Breitenmoser
- IUCN/SSC Cat Specialist Group; c/o KORA, Thunstrasse 31 Muri 3074 Switzerland
| | - F. Broekhuis
- Wildlife Conservation Research Unit, Department of Zoology; The Recanati-Kaplan Centre; University of Oxford; Tubney House Tubney OX13 5QL UK
| | - G. Cozzi
- Institute of Evolutionary Biology and Environmental Studies; Zurich University; Winterthurerstrasse 190 Zürich CH 8057 Switzerland
| | - T. R. B. Davenport
- Wildlife Conservation Society, Tanzania Program; PO Box 922 Zanzibar Tanzania
| | - J. Deutsch
- Wildlife Conservation Society, Bronx Zoo; 2300 Southern Blvd. Bronx NY 10460 USA
| | - L. Dollar
- Big Cats Initiative, National Geographic Society; 1145 17th Street NW Washington DC 20036-4688 USA
- Nicholas School of the Environment; Duke University; Durham North Carolina USA
- Department of Biology; Pfeiffer University; Misenheimer North Carolina 28109 USA
| | - S. Dolrenry
- Lion Guardians; PO Box 15550 Langata 00509 Kenya
| | - I. Douglas-Hamilton
- Save the Elephants; PO Box 54667 Nairobi Kenya
- Department of Zoology; University of Oxford; Oxford OX1 3PS UK
| | - E. Fitzherbert
- Wildlife Conservation Research Unit, Department of Zoology; The Recanati-Kaplan Centre; University of Oxford; Tubney House Tubney OX13 5QL UK
- Chester Zoo; Chester CH2 1LH UK
| | - C. Foley
- Wildlife Conservation Society, Tanzania Program; PO Box 922 Zanzibar Tanzania
| | - L. Hazzah
- Lion Guardians; PO Box 15550 Langata 00509 Kenya
| | - P. Henschel
- Panthera; 8 West 40th Street, 18th Floor New York NY 10018 USA
| | - R. Hilborn
- School of Aquatic and Fishery Sciences; University of Washington; Seattle WA 98195 USA
| | - J. G. C. Hopcraft
- Institute of Biodiversity, Animal Health and Comparative Medicine; University of Glasgow; University Avenue Glasgow G12 8QQ UK
| | - D. Ikanda
- Tanzania Wildlife Research Institute; Box 661 Arusha Tanzania
| | - A. Jacobson
- Institute of Zoology; Zoological Society of London; Regents Park London NW1 4RY UK
| | - B. Joubert
- Big Cats Initiative, National Geographic Society; 1145 17th Street NW Washington DC 20036-4688 USA
| | - D. Joubert
- Big Cats Initiative, National Geographic Society; 1145 17th Street NW Washington DC 20036-4688 USA
| | - M. S. Kelly
- Department of Fish and Wildlife Conservation; Virginia Tech; 146 Cheatham Hall Blacksburg VA 24061-0321 USA
| | - L. Lichtenfeld
- African People & Wildlife Fund; PO Box 624 Bernardsville NJ 07924 USA
| | - G. M. Mace
- Department of Genetics, Evolution and Environment; Centre for Biodiversity and Environment Research; University College London; Gower Street London WC1E 6BT UK
| | - J. Milanzi
- Zambia Wildlife Authority; Private Bag 1 Chilanga Zambia
| | - N. Mitchell
- Wildlife Conservation Society, Bronx Zoo; 2300 Southern Blvd. Bronx NY 10460 USA
- Conservation Programmes, Zoological Society of London; Regents Park London NW1 4RY UK
| | - M. Msuha
- Tanzania Wildlife Research Institute; Box 661 Arusha Tanzania
| | - R. Muir
- Africa Programme, Frankfurt Zoological Society Africa Regional Office; Serengeti National Park; Serengeti Tanzania
| | | | - S. Pimm
- Nicholas School of the Environment; Duke University; Durham North Carolina USA
- Department of Biology; Pfeiffer University; Misenheimer North Carolina 28109 USA
| | - G. Purchase
- Wildlife Conservation Society, Bronx Zoo; 2300 Southern Blvd. Bronx NY 10460 USA
- Conservation Programmes, Zoological Society of London; Regents Park London NW1 4RY UK
| | - C. Schenck
- Frankfurt Zoological Society; Bernhard-Grzimek-Allee 1 Frankfurt 60316 Germany
| | - C. Sillero-Zubiri
- Department of Zoology; IUCN/SSC Canid Specialist Group Wildlife Conservation Research Unit; The Recanati-Kaplan Centre; University of Oxford; Tubney House Tubney OX13 5QL UK
| | - A. R. E. Sinclair
- Beaty Biodiversity Research Centre; University of British Columbia; 6270 University Boulevard Vancouver V6T 1Z4 Canada
| | | | - M. Stanley-Price
- Wildlife Conservation Research Unit, Department of Zoology; The Recanati-Kaplan Centre; University of Oxford; Tubney House Tubney OX13 5QL UK
- IUCN/SSC Species Conservation Planning Sub-committee; Rue Mauverney 28 1196 Gland Switzerland
| | - C. A. Tehou
- Coordonnateur WAP/UNOPS Bénin; B.P. 527 Cotonou, République Bénin
| | - C. Trout
- African People & Wildlife Fund; PO Box 624 Bernardsville NJ 07924 USA
| | - J. Wall
- Laboratory for Advanced Spatial Analysis; Department of Geography; University of British Columbia; 1984 West Mall Vancouver BC V6T 1Z2 Canada
| | - G. Wittemyer
- Fish, Wildlife and Conservation Biology; Colorado State University; Fort Collins Colorado 80523 USA
| | - A. Zimmermann
- Wildlife Conservation Research Unit, Department of Zoology; The Recanati-Kaplan Centre; University of Oxford; Tubney House Tubney OX13 5QL UK
- Chester Zoo; Chester CH2 1LH UK
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Gandhi G, Allahbadia G, Kagalwala S, Allahbadia A, Ramesh S, Patel K, Hinduja R, Chipkar V, Madne M, Ramani R, Joo JK, Jeung JE, Go KR, Lee KS, Goto H, Hashimoto S, Amo A, Yamochi T, Iwata H, Morimoto Y, Koifman M, Lahav-Baratz S, Blais E, Megnazi-Wiener Z, Ishai D, Auslender R, Dirnfeld M, Zaletova V, Zakharova E, Krivokharchenko I, Zaletov S, Zhu L, Li Y, Zhang H, Ai J, Jin L, Zhang X, Rajan N, Kovacs A, Foley C, Flanagan J, O'Callaghan J, Waterstone J, Dineen T, Dahdouh EM, St-Michel P, Granger L, Carranza-Mamane B, Faruqi F, Kattygnarath TV, Gomes FLAF, Christoforidis N, Ioakimidou C, Papas C, Moisidou M, Chatziparasidou A, Klaver M, Tilleman K, De Sutter P, Lammers J, Freour T, Splingart C, Barriere P, Ikeno T, Nakajyo Y, Sato Y, Hirata K, Kyoya T, Kyono K, Campos FB, Meseguer M, Nogales M, Martinez E, Ariza M, Agudo D, Rodrigo L, Garcia-Velasco JA, Lopes AS, Frederickx V, Vankerkhoven G, Serneels A, Roziers P, Puttermans P, Campo R, Gordts S, Fragouli E, Alfarawati S, Spath K, Wells D, Liss J, Lukaszuk K, Glowacka J, Bruszczynska A, Gallego SC, Lopez LO, Vila EO, Garcia MG, Canas CL, Segovia AG, Ponce AG, Calonge RN, Peregrin PC, Hashimoto S, Amo A, Ito K, Nakaoka Y, Morimoto Y, Alcoba DD, Valerio EG, Conzatti M, Tornquist J, Kussler AP, Pimentel AM, Corleta HE, Brum IS, Boyer P, Montjean D, Tourame P, Gervoise-Boyer M, Cohen J, Lefevre B, Radio CI, Wolf JP, Ziyyat A, De Croo I, Tolpe A, Degheselle S, Van de Velde A, Tilleman K, De Sutter P, Van den Abbeel E, Kagalwala S, Gandhi G, Allahbadia G, Kuwayama M, Allahbadia A, Chipkar V, Khatoon A, Ramani R, Madne M, Alsule S, Inaba M, Ohgaki A, Ohtani A, Matsumoto H, Mizuno S, Mori R, Fukuda A, Morimoto Y, Umekawa Y, Yoshida A, Tanigiwa S, Seida K, Suzuki H, Tanaka M, Vahabi Z, Yazdi PE, Dalman A, Ebrahimi B, Mostafaei F, Niknam MR, Watanabe S, Kamihata M, Tanaka T, Matsunaga R, Yamanaka N, Kani C, Ishikawa T, Wada T, Morita H, Miyamura H, Nishio E, Ito M, Kuwahata A, Ochi M, Horiuchi T, Dal Canto M, Guglielmo MC, Fadini R, Renzini MM, Albertini DF, Novara P, Lain M, Brambillasca F, Turchi D, Sottocornola M, Coticchio G, Kato M, Fukunaga N, Nagai R, Kitasaka H, Yoshimura T, Tamura F, Hasegawa N, Nakayama K, Takeuchi M, Ohno H, Aoyagi N, Kojima E, Itoi F, Hashiba Y, Asada Y, Kikuchi H, Iwasa Y, Kamono T, Suzuki A, Yamada K, Kanno H, Sasaki K, Murakawa H, Matsubara M, Yoshida H, Valdespin C, Elhelaly M, Chen P, Pangestu M, Catt S, Hojnik N, Kovacic B, Roglic P, Taborin M, Zafosnik M, Knez J, Vlaisavljevic V, Mori C, Yabuuchi A, Ezoe K, Takayama Y, Aono F, Kato K, Radwan P, Krasinski R, Chorobik K, Radwan M, Stoppa M, Maggiulli R, Capalbo A, Ievoli E, Dovere L, Scarica C, Albricci L, Romano S, Sanges F, Barnocchi N, Papini L, Vivarelli A, Ubaldi FM, Rienzi L, Rienzi L, Bono S, Capalbo A, Spizzichino L, Rubio C, Ubaldi FM, Fiorentino F, Ferris J, Favetta LA, MacLusky N, King WA, Madani T, Jahangiri N, Aflatoonian R, Cater E, Hulme D, Berrisford K, Jenner L, Campbell A, Fishel S, Zhang XY, Yilmaz 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Foley C, Mushi A, Dixit A. Tension pneumocephalus after facial surgery. Assoc Med J 2013. [DOI: 10.1136/bmj.f536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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