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Smyth S, McFarland J, McGuiness D, Summerville S, Bainbridge E, Hallahan B, Higgins A, Casey D, Murphy K, McDonald C. A mixed methods study examining perceptions by service-users of their involuntary admission in relation to levels of insight. Int J Soc Psychiatry 2022; 68:1764-1773. [PMID: 34937408 DOI: 10.1177/00207640211061983] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Poor insight is associated with negative attitudes to involuntary admission and care in qualitative studies. AIMS The current paper aims to examine and compare retrospective qualitative perceptions of service-users in relation to their involuntary admission with their levels of clinical insight, using a mixed methods approach. METHODS Forty two participants were assessed 3 months after the revocation of their involuntary admission. Each provided qualitative data relating to their perceptions of the coercive care process, which was analysed using content analysis, along with a quantitative measurement of insight, the Schedule for the Assessment of Insight-Expanded (SAI-E). Employing a mixed methods design and incorporating NVivo matrix coding queries, the datasets were merged to enable qualitative themes to be identified against the quantitative data. RESULTS Differences were observed between those with high and low insight in terms of their understanding of the need for treatment, their levels of arousal at the time of admission and how they perceived the compassion of health professionals. Certain negative perceptions of care appeared more universal and were common across those with high and low insight. CONCLUSION Some negative perceptions of coercive practices appear linked to inherent elements of psychotic illness such as unawareness of illness. Individuals with higher levels of insight tended to perceive their involuntary admission and receiving a diagnosis as beneficial. Negative views that persist amongst service users with high insight levels can highlight areas for successful service improvement, including increased emphasis on non-pharmacotherapy based supports during the coercive care process.
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Affiliation(s)
- Siobhan Smyth
- School of Nursing and Midwifery, National University of Ireland, Galway, Ireland
| | - John McFarland
- Faculty of Education and Health Sciences, University of Limerick, Ireland
| | - David McGuiness
- College of Medicine Nursing and Health Sciences, National University of Ireland, Galway, Ireland
| | - Sarah Summerville
- College of Medicine Nursing and Health Sciences, National University of Ireland, Galway, Ireland
| | - Emma Bainbridge
- School of Medicine, National University of Ireland, Galway, Ireland
| | - Brian Hallahan
- School of Medicine, National University of Ireland, Galway, Ireland
| | - Agnes Higgins
- Faculty of Health Sciences, Trinity College Dublin, Ireland
| | - Dympna Casey
- College of Medicine Nursing and Health Sciences, National University of Ireland, Galway, Ireland
| | - Kathy Murphy
- College of Medicine Nursing and Health Sciences, National University of Ireland, Galway, Ireland
| | - Colm McDonald
- School of Medicine, National University of Ireland, Galway, Ireland
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Finnegan M, McLoughlin J, Bainbridge E, McGuinness D, Hallahan B, McDonald C. Quality of life after involuntary psychiatric admission. Int J Law Psychiatry 2022; 83:101810. [PMID: 35696760 DOI: 10.1016/j.ijlp.2022.101810] [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] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 06/03/2022] [Accepted: 06/03/2022] [Indexed: 06/15/2023]
Abstract
Studies seeking predictors of outcomes after involuntary admission, including quality of life (QoL), are limited and results inconsistent. We aimed to describe QoL 3 months after involuntary psychiatric admission and to investigate associated factors. One hundred and fifty-three involuntarily admitted inpatients were assessed for a range of sociodemographic and clinical variables. Structured scales included the Brief Psychiatric Rating Scale (BPRS), the MacArthur Admission Experience Survey, the Heinrichs Quality of Life Scale and the World Health Organisation Quality of Life Brief Assessment (WHOQOL-BREF, n = 124). The mean total score on the Heinrichs QoL scale at 3 months was 69.3 (SD = 24.1). Predictors of higher 3 month QoL after involuntary admission in a multiple regression model (adjusted R2 = 0.37, F = 7.1 (14, 138), p ≤0.001) were less severe negative symptoms on the BPRS at baseline (B = -4.56, p < 0.001), improvement in negative symptom scores between baseline and follow up (B = 4.58, p < 0.001) and higher current social class (B = -14.31, p = 0.001). Events during involuntary admission, such as being subject to coercive experiences, were not significantly associated with QoL after admission. The results suggest that a core determinant of service users' QoL after involuntary admission is negative symptom severity and change over time.
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Affiliation(s)
- M Finnegan
- School of Medicine, College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - J McLoughlin
- School of Medicine, College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - E Bainbridge
- School of Medicine, College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - D McGuinness
- School of Medicine, College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - B Hallahan
- School of Medicine, College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - C McDonald
- School of Medicine, College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
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Troxel AB, Petkova E, Goldfeld K, Liu M, Tarpey T, Wu Y, Wu D, Agarwal A, Avendaño-Solá C, Bainbridge E, Bar KJ, Devos T, Duarte RF, Gharbharan A, Hsue PY, Kumar G, Luetkemeyer AF, Meyfroidt G, Nicola AM, Mukherjee A, Ortigoza MB, Pirofski LA, Rijnders BJA, Rokx C, Sancho-Lopez A, Shaw P, Tebas P, Yoon HA, Grudzen C, Hochman J, Antman EM. Association of Convalescent Plasma Treatment With Clinical Status in Patients Hospitalized With COVID-19: A Meta-analysis. JAMA Netw Open 2022; 5:e2147331. [PMID: 35076699 PMCID: PMC8790669 DOI: 10.1001/jamanetworkopen.2021.47331] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 12/15/2021] [Indexed: 12/15/2022] Open
Abstract
Importance COVID-19 convalescent plasma (CCP) is a potentially beneficial treatment for COVID-19 that requires rigorous testing. Objective To compile individual patient data from randomized clinical trials of CCP and to monitor the data until completion or until accumulated evidence enables reliable conclusions regarding the clinical outcomes associated with CCP. Data Sources From May to August 2020, a systematic search was performed for trials of CCP in the literature, clinical trial registry sites, and medRxiv. Domain experts at local, national, and international organizations were consulted regularly. Study Selection Eligible trials enrolled hospitalized patients with confirmed COVID-19, not receiving mechanical ventilation, and randomized them to CCP or control. The administered CCP was required to have measurable antibodies assessed locally. Data Extraction and Synthesis A minimal data set was submitted regularly via a secure portal, analyzed using a prespecified bayesian statistical plan, and reviewed frequently by a collective data and safety monitoring board. Main Outcomes and Measures Prespecified coprimary end points-the World Health Organization (WHO) 11-point ordinal scale analyzed using a proportional odds model and a binary indicator of WHO score of 7 or higher capturing the most severe outcomes including mechanical ventilation through death and analyzed using a logistic model-were assessed clinically at 14 days after randomization. Results Eight international trials collectively enrolled 2369 participants (1138 randomized to control and 1231 randomized to CCP). A total of 2341 participants (median [IQR] age, 60 [50-72] years; 845 women [35.7%]) had primary outcome data as of April 2021. The median (IQR) of the ordinal WHO scale was 3 (3-6); the cumulative OR was 0.94 (95% credible interval [CrI], 0.74-1.19; posterior probability of OR <1 of 71%). A total of 352 patients (15%) had WHO score greater than or equal to 7; the OR was 0.94 (95% CrI, 0.69-1.30; posterior probability of OR <1 of 65%). Adjusted for baseline covariates, the ORs for mortality were 0.88 at day 14 (95% CrI, 0.61-1.26; posterior probability of OR <1 of 77%) and 0.85 at day 28 (95% CrI, 0.62-1.18; posterior probability of OR <1 of 84%). Heterogeneity of treatment effect sizes was observed across an array of baseline characteristics. Conclusions and Relevance This meta-analysis found no association of CCP with better clinical outcomes for the typical patient. These findings suggest that real-time individual patient data pooling and meta-analysis during a pandemic are feasible, offering a model for future research and providing a rich data resource.
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Affiliation(s)
- Andrea B. Troxel
- Department of Population Health, NYU Grossman School of Medicine, New York, New York
| | - Eva Petkova
- Department of Population Health, NYU Grossman School of Medicine, New York, New York
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, New York
- The Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York
| | - Keith Goldfeld
- Department of Population Health, NYU Grossman School of Medicine, New York, New York
| | - Mengling Liu
- Department of Population Health, NYU Grossman School of Medicine, New York, New York
- Department of Environmental Health, NYU Grossman School of Medicine, New York, New York
| | - Thaddeus Tarpey
- Department of Population Health, NYU Grossman School of Medicine, New York, New York
| | - Yinxiang Wu
- Department of Biostatistics, University of Washington School of Public Health, Seattle
| | - Danni Wu
- Department of Population Health, NYU Grossman School of Medicine, New York, New York
| | - Anup Agarwal
- Indian Council of Medical Research, New Delhi, Delhi, India
| | | | - Emma Bainbridge
- Zuckerberg San Francisco General, University of California San Francisco, San Francisco
| | - Katherine J. Bar
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Timothy Devos
- Department of Hematology, University Hospitals Leuven and Department of Microbiology and Immunology, Laboratory of Molecular Immunology (Rega Institute), KU Leuven, Leuven, Belgium
| | - Rafael F. Duarte
- Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Arvind Gharbharan
- Section of Infectious Diseases, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Priscilla Y. Hsue
- Zuckerberg San Francisco General, University of California San Francisco, San Francisco
| | - Gunjan Kumar
- Indian Council of Medical Research, New Delhi, Delhi, India
| | - Annie F. Luetkemeyer
- Zuckerberg San Francisco General, University of California San Francisco, San Francisco
| | - Geert Meyfroidt
- Department of Intensive Care Medicine, University Hospitals Leuven, Leuven, Belgium
| | - André M. Nicola
- Hospital Universitário de Brasília, University of Brasília, Brasília, Brazil
| | | | - Mila B. Ortigoza
- Department of Medicine, NYU Grossman School of Medicine, New York, New York
- Department of Microbiology, NYU Grossman School of Medicine, New York, New York
| | - Liise-anne Pirofski
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York
- Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, New York
| | - Bart J. A. Rijnders
- Section of Infectious Diseases, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Casper Rokx
- Section of Infectious Diseases, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - Pamela Shaw
- Biostatistics Unit, Kaiser Permanente Washington Health Research Institute, Seattle
| | - Pablo Tebas
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Hyun-Ah Yoon
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York
- Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, New York
| | - Corita Grudzen
- Department of Population Health, NYU Grossman School of Medicine, New York, New York
- Department of Emergency Medicine, NYU Grossman School of Medicine, New York, New York
| | - Judith Hochman
- Department of Medicine, NYU Grossman School of Medicine, New York, New York
| | - Elliott M. Antman
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
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4
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Lane-Donovan C, Bainbridge E, Szumowski J, Kerkhoff AD, Peluso MJ. Mycobacterium Avium Complex Infection as a Rare Cause of Cerebral Mass Lesion and IRIS in a Patient with AIDS: Case Report and Review of the Literature. Open Forum Infect Dis 2021; 8:ofab450. [PMID: 35559128 PMCID: PMC9088507 DOI: 10.1093/ofid/ofab450] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 10/29/2021] [Indexed: 11/28/2022] Open
Abstract
A patient with advanced HIV/AIDS presented with a brain abscess. While brain biopsy culture and pathology were unrevealing, universal broad-range polymerase chain reaction (uPCR) demonstrated Mycobacterium avium complex (MAC). We review the clinicopathologic characteristics of MAC brain abscesses and highlight the effectiveness of uPCR as a diagnostic tool in partially treated infections.
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Affiliation(s)
- Courtney Lane-Donovan
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Emma Bainbridge
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California San Francisco, San Francisco, CA, USA
| | - John Szumowski
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California San Francisco, San Francisco, CA, USA
| | - Andrew D Kerkhoff
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California San Francisco, San Francisco, CA, USA
| | - Michael J Peluso
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California San Francisco, San Francisco, CA, USA
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5
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Bond AR, Bainbridge E, Doernberg SB, Babik JM, Miller S, Khanafshar E, Henry T, David A, Russell M, Brandman D, Sherman CB, Yao F, Fung M. Disseminated Legionella micdadei infection in a liver transplant patient presenting as pulmonary nodules and a laryngeal lesion. Transpl Infect Dis 2021; 23:e13563. [PMID: 33434394 DOI: 10.1111/tid.13563] [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: 08/07/2020] [Revised: 11/04/2020] [Accepted: 12/22/2020] [Indexed: 11/28/2022]
Abstract
We report a liver transplant patient with disseminated Legionella micdadei infection with pulmonary, laryngeal, and suspected muscle involvement. This organism, which stains weakly acid-fast, primarily affects immunocompromised patients. The diagnosis is difficult to make; in this case, the organism was identified via molecular diagnostics on laryngeal and pulmonary biopsy tissue.
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Affiliation(s)
- Allison R Bond
- Division of Infectious Disease, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Emma Bainbridge
- Division of Infectious Disease, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Sarah B Doernberg
- Division of Infectious Disease, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Jennifer M Babik
- Division of Infectious Disease, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Steve Miller
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Elham Khanafshar
- Department of Pathology, University of California San Francisco, San Francisco, CA, USA
| | - Travis Henry
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Abel David
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Matthew Russell
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Danielle Brandman
- Division of Gastroenterology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Courtney B Sherman
- Division of Gastroenterology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Francis Yao
- Division of Gastroenterology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Monica Fung
- Division of Infectious Disease, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
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6
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Fung M, Nambiar A, Pandey S, Aldrich JM, Teraoka J, Freise C, Roberts J, Chandran S, Hays SR, Bainbridge E, DeVoe C, Roque Gardner A, Yokoe D, Henrich TJ, Babik JM, Chin-Hong P. Treatment of immunocompromised COVID-19 patients with convalescent plasma. Transpl Infect Dis 2020; 23:e13477. [PMID: 32989856 PMCID: PMC7537112 DOI: 10.1111/tid.13477] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [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: 09/01/2020] [Accepted: 09/06/2020] [Indexed: 12/24/2022]
Abstract
Immunosuppressed patients such as solid organ transplant and hematologic malignancy patients appear to be at increased risk for morbidity and mortality due to coronavirus disease 2019 (COVID‐19) caused by SARS coronavirus 2 (SARS‐CoV‐2). Convalescent plasma, a method of passive immunization that has been applied to prior viral pandemics, holds promise as a potential treatment for COVID‐19. Immunocompromised patients may experience more benefit from convalescent plasma given underlying deficits in B and T cell immunity as well as contraindications to antiviral and immunomodulatory therapy. We describe our institutional experience with four immunosuppressed patients (two kidney transplant recipients, one lung transplant recipient, and one chronic myelogenous leukemia patient) treated with COVID‐19 convalescent plasma through the Expanded Access Program (NCT 04338360). All patients clinically improved after administration (two fully recovered and two discharged to skilled nursing facilities) and none experienced a transfusion reaction. We also report the characteristics of convalescent plasma product from a local blood center including positive SARS‐CoV‐2 IgG and negative SARS‐CoV‐2 PCR in all samples tested. This preliminary evidence suggest that convalescent plasma may be safe among immunosuppressed patients with COVID‐19 and emphasizes the need for further data on the efficacy of convalescent plasma as either primary or adjunctive therapy for COVID‐19.
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Affiliation(s)
- Monica Fung
- Division of Infectious Disease, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Ashok Nambiar
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Suchi Pandey
- Department of Pathology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - J Matthew Aldrich
- Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, C,, USA
| | - Justin Teraoka
- Division of Infectious Disease, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Christopher Freise
- Division of Transplant Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - John Roberts
- Division of Transplant Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Sindhu Chandran
- Division of Nephrology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Steven R Hays
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Emma Bainbridge
- Division of Infectious Disease, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Catherine DeVoe
- Division of Infectious Disease, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Annelys Roque Gardner
- Division of Infectious Disease, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Deborah Yokoe
- Division of Infectious Disease, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Timothy J Henrich
- Division of Infectious Disease, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Jennifer M Babik
- Division of Infectious Disease, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Peter Chin-Hong
- Division of Infectious Disease, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
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7
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Fung M, Chiu CY, DeVoe C, Doernberg SB, Schwartz BS, Langelier C, Henrich TJ, Yokoe D, Davis J, Hays SR, Chandran S, Kukreja J, Ng D, Prostko J, Taylor R, Reyes K, Bainbridge E, Bond A, Chin-Hong P, Babik JM. Clinical outcomes and serologic response in solid organ transplant recipients with COVID-19: A case series from the United States. Am J Transplant 2020; 20:3225-3233. [PMID: 32476258 PMCID: PMC7300859 DOI: 10.1111/ajt.16079] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [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: 04/13/2020] [Revised: 05/03/2020] [Accepted: 05/15/2020] [Indexed: 01/25/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic caused by SARS coronavirus 2 (SARS-CoV-2) has caused significant morbidity and mortality for patients and stressed healthcare systems worldwide. The clinical features, disease course, and serologic response of COVID-19 among immunosuppressed patients such as solid organ transplant (SOT) recipients, who are at presumed risk for more severe disease, are not well characterized. We describe our institutional experience with COVID-19 among 10 SOT patients, including the clinical presentation, treatment modalities, and outcomes of 7 renal transplant recipients, 1 liver transplant recipient, 1 heart transplant recipient, and 1 lung transplant recipient. In addition, we report the serologic response in SOT recipients, documenting a positive IgG response in all 7 hospitalized patients. We also review the existing literature on COVID-19 in SOT recipients to consolidate the current knowledge on COVID-19 in the SOT population for the transplant community.
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Affiliation(s)
- Monica Fung
- Division of Infectious Disease, Department of Medicine, University of California San Francisco, San Francisco, California, USA,Correspondence Monica Fung
| | - Charles Y. Chiu
- Division of Infectious Disease, Department of Medicine, University of California San Francisco, San Francisco, California, USA,Department of Laboratory Medicine, University of California, San Francisco, California, USA,UCSF-Abbott Viral Diagnostics and Discovery Center, San Francisco, California, USA
| | - Catherine DeVoe
- Division of Infectious Disease, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Sarah B. Doernberg
- Division of Infectious Disease, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Brian S. Schwartz
- Division of Infectious Disease, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Charles Langelier
- Division of Infectious Disease, Department of Medicine, University of California San Francisco, San Francisco, California, USA,Chan Zuckerberg Biohub, San Francisco, California, USA
| | - Timothy J. Henrich
- Division of Infectious Disease, Department of Medicine, University of California San Francisco, San Francisco, California, USA,Division of Experimental Medicine, University of California San Francisco, San Francisco, California, USA
| | - Deborah Yokoe
- Division of Infectious Disease, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - John Davis
- Division of Infectious Disease, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Steven R. Hays
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Sindhu Chandran
- Division of Nephrology, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Jasleen Kukreja
- Division of Adult Cardiothoracic Surgery, Department of Surgery, University of California San Francisco, San Francisco, California, USA
| | - Dianna Ng
- Department of Laboratory Medicine, University of California, San Francisco, California, USA
| | - John Prostko
- Abbott Laboratories, Inc., Abbott Park, Illinois, USA
| | | | - Kevin Reyes
- Department of Laboratory Medicine, University of California, San Francisco, California, USA
| | - Emma Bainbridge
- Division of Infectious Disease, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Allison Bond
- Division of Infectious Disease, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Peter Chin-Hong
- Division of Infectious Disease, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Jennifer M. Babik
- Division of Infectious Disease, Department of Medicine, University of California San Francisco, San Francisco, California, USA
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8
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Bainbridge E, Hallahan B, McGuinness D, Higgins A, Murphy K, Gunning P, Newell J, McDonald C. A Three-Month Follow-Up Study Evaluating Changes in Clinical Profile and Attitudes Towards Involuntary Admission. Eur Psychiatry 2020. [DOI: 10.1016/j.eurpsy.2016.01.1746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
IntroductionInvoluntary admission and treatment is often a traumatic experience for patients and there is a wide variation in attitudes towards care even when patients are recovered.Objectives/aimsThe purpose of this large prospective study was to identify clinical predictors of attitudes towards care during involuntary admission.MethodsThree hundred and ninety-one consecutively admitted involuntarily patients to three psychiatric inpatient units over a 30-month period were invited to participate in the study. Comprehensive assessments at admission and 3 months after discharge were attained including measures of symptoms, insight, functioning, attitudes towards involuntary admission and coercive experiences. Multiple linear regression modelling was used to determine the optimal explanatory variables for attitudes towards care.ResultsTwo hundred and sixty-three individuals participated at baseline and 156 (59%) successfully completed follow-up assessments. Individuals improved significantly over time clinically and in their attitudes towards their care. At baseline greater insight (P < 0.001) and less symptoms (P = 0.02) were associated with more positive attitudes towards care as was older age (P = 0.001). At follow-up, greater insight (P < 0.001), less symptoms (P = 0.02) and being older (P = 0.04) were associated with more positive attitudes towards care. More positive attitudes towards care at follow-up were associated with greater improvements in insight over time (P < 0.001) and having a diagnosis of an affective psychosis (P = 0.0009).ConclusionsThe best predictors of positive attitudes towards care during and after involuntary admission are illness related factors, such as levels of insight and improvement in insight, rather than service or legislation related factors, such as the use of coercive measures, seclusion and restraint.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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9
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McGuinness D, Murphy K, Bainbridge E, Brosnan L, Keys M, Felzmann H, Hallahan B, McDonald C, Higgins A. Individuals' experiences of involuntary admissions and preserving control: qualitative study. BJPsych Open 2018; 4:501-509. [PMID: 30564446 PMCID: PMC6293449 DOI: 10.1192/bjo.2018.59] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 08/25/2018] [Accepted: 09/19/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND A theoretical model of individuals' experiences before, during and after involuntary admission has not yet been established. AIMS To develop an understanding of individuals' experiences over the course of the involuntary admission process. METHOD Fifty individuals were recruited through purposive and theoretical sampling and interviewed 3 months after their involuntary admission. Analyses were conducted using a Straussian grounded theory approach. RESULTS The 'theory of preserving control' (ToPC) emerged from individuals' accounts of how they adapted to the experience of involuntary admission. The ToPC explains how individuals manage to reclaim control over their emotional, personal and social lives and consists of three categories: 'losing control', 'regaining control' and 'maintaining control', and a number of related subcategories. CONCLUSIONS Involuntary admission triggers a multifaceted process of control preservation. Clinicians need to develop therapeutic approaches that enable individuals to regain and maintain control over the course of their involuntary admission. DECLARATION OF INTEREST None.
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Affiliation(s)
- David McGuinness
- Research Nurse, School of Nursing and Midwifery, National University of Ireland, Ireland
| | - Kathy Murphy
- Professor of Nursing, School of Nursing and Midwifery, National University of Ireland, Ireland
| | - Emma Bainbridge
- Honorary Clinical Fellow, School of Medicine, National University of Ireland, Ireland
| | - Liz Brosnan
- Survivor Researcher and Consultant, Centre for Disability Law and Policy, National University of Ireland, Ireland
| | - Mary Keys
- Former Lecturer in Law, School of Law, National University of Ireland, Ireland
| | - Heike Felzmann
- Lecturer in Philosophy/Ethics, Centre of Bioethical Research and Analysis, National University of Ireland, Ireland
| | - Brian Hallahan
- Senior Lecturer in Psychiatry, School of Medicine, National University of Ireland, Ireland
| | - Colm McDonald
- Professor of Psychiatry, School of Medicine, National University of Ireland, Ireland
| | - Agnes Higgins
- Professor in Mental Health, School of Nursing and Midwifery, Trinity College, University of Dublin,Ireland
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Bainbridge E, Hallahan B, McGuinness D, Gunning P, Newell J, Higgins A, Murphy K, McDonald C. Predictors of involuntary patients' satisfaction with care: prospective study. BJPsych Open 2018; 4:492-500. [PMID: 30564445 PMCID: PMC6293452 DOI: 10.1192/bjo.2018.65] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 09/12/2018] [Accepted: 10/07/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Involuntary admission can be traumatic and is associated with negative attitudes that persist after the episode of illness has abated. AIMS We aimed to prospectively assess satisfaction with care at the points of involuntary admission and symptomatic recovery, and identify their sociodemographic, clinical and service experience predictors. METHOD Levels of satisfaction with care, and clinical and sociodemographic variables were obtained from a representative cohort of 263 patients at the point of involuntary admission and from 155 of these patients 3 months after termination of the involuntary admission. Data were analysed with multiple linear regression modelling. RESULTS Higher baseline awareness of illness (B = 0.19, P < 0.001) and older age (B = 0.05, P = 0.001) were associated with more satisfaction with care at baseline and follow-up. Transition to greater satisfaction with care was associated with improvements in awareness of illness (B = 0.13, P < 0.001) and in symptoms (B = 0.05, P = 0.02), as well as older age (B = 0.04, P = 0.01). Objective coercive experiences were not associated with variation in satisfaction with care. CONCLUSIONS There is wide variation in satisfaction with coercive care. Greater satisfaction with care is positively associated with clinical variables such as increased awareness of illness. DECLARATION OF INTEREST None.
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Affiliation(s)
- Emma Bainbridge
- Honorary Clinical Fellow, College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Ireland
| | - Brian Hallahan
- Senior Lecturer in Psychiatry, College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Ireland
| | - David McGuinness
- Research Nurse, College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Ireland
| | - Patricia Gunning
- Clinical Research Biostatistician, HRB Clinical Research Facility, National University of Ireland Galway, Ireland
| | - John Newell
- Professor of Biostatistics, HRB Clinical Research Facility, National University of Ireland Galway and School of Mathematics, Statistics and Applied Mathematics, National University of Ireland Galway, Ireland
| | - Agnes Higgins
- Professor in Mental Health, School of Nursing and Midwifery, Trinity College Dublin, Ireland
| | - Kathy Murphy
- Professor of Nursing, School of Nursing and Midwifery, National University of Ireland Galway, Ireland
| | - Colm McDonald
- Professor of Psychiatry, College of Medicine, Nursing and Health Sciences, National University of Ireland Galway and HRB Clinical Research Facility, National University of Ireland Galway, Ireland
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Abstract
Aims and methodTo examine the prevalence of head shop drug usage in individuals attending a range of adult mental health services. We examined the effect of head shop drug usage on the mental state of individuals with a range of mental health disorders. Clinical data were obtained from 608 consecutively reviewed individuals attending adult mental health services in relation to their use of head shop and psychoactive drugs and the putative effects of head shop drugs on their mental state.ResultsThe prevalence of head shop drug use was 13% (n= 78), with a higher prevalence of usage noted in individuals younger than 35 years of age (25%). A large proportion of individuals (n= 41, 54%) reported adverse effects of these agents on their mental state, with psychotic symptoms being the most prevalent.Clinical implicationsHead shop drug usage was associated with a reported deleterious effect on mental state, which was particularly evident for individuals with a history of psychosis.
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Bainbridge E, Gallagher A, McDonald G, McDonald C, Ahmed M. General practitioners' attitudes on who should manage metabolic dysregulations associated with antipsychotics. ACTA ACUST UNITED AC 2018. [DOI: 10.1192/pb.bp.110.031351] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aims and methodTo assess attitudes of general practitioners (GPs) on who should be responsible for managing metabolic dysregulations associated with the use of antipsychotics prescribed by psychiatrists. A total of 121 GPs in West Galway catchment area were surveyed using a simple questionnaire.ResultsA total of 104 GPs responded (86% response rate). The vast majority of responders (82%) believed that medical management should be provided within primary care. However, 46% indicated that initial screening and simple non-pharmacological management should be provided by mental health services.Clinical implicationsThe vast majority of GPs appear willing to take over the medical management of metabolic dysregulations emerging from antipsychotic prescribing in secondary care. Clearly defined roles for mental health services and primary care in the management of metabolic complications are of paramount importance, and individual mental health services should implement protocols for screening, non-pharmacological management and referral to primary care.
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Lally J, ó Conghaile A, Quigley S, Bainbridge E, McDonald C. Stigma of mental illness and help-seeking intention in university students. ACTA ACUST UNITED AC 2018. [DOI: 10.1192/pb.bp.112.041483] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aims and methodA cross-sectional study to ascertain levels of personal and perceived public mental illness stigma in a university student population and the association between the respective levels of stigma and help-seeking intention. An adaptation of the Discrimination-Devaluation scale was used.ResultsA total of 735 students participated in the study (response rate 77%). There were higher mean perceived public stigma levels than personal stigma levels. Perceived public stigma was not significantly associated with future non-help-seeking intention (odds ratio (OR) = 0.871, P = 0.428). Personal stigma was significantly associated with a decreased likelihood of future help-seeking intention (OR = 1.44, P = 0.043). Being younger than 25, having no history of or treatment for mental illness and having no personal contact with someone with a history of mental illness were all associated with higher personal stigma levels.Clinical implicationsThis study indicates that personal stigma as distinct from perceived public stigma is a significant barrier to mental health utilisation for a student population and future stigma reduction campaigns could strategically focus on this.
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Smyth S, Casey D, Cooney A, Higgins A, McGuinness D, Bainbridge E, Keys M, Georgieva I, Brosnan L, Beecher C, Hallahan B, McDonald C, Murphy K. Qualitative exploration of stakeholders' perspectives of involuntary admission under the Mental Health Act 2001 in Ireland. Int J Ment Health Nurs 2017; 26:554-569. [PMID: 27785894 DOI: 10.1111/inm.12270] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/16/2016] [Indexed: 12/15/2022]
Abstract
There is international interest in, and continued concern about, the potential long-term impact of involuntary admission to psychiatric institutions, and the effect this coercive action has on a person's well-being and human rights. Involuntary detention in hospital remains a controversial process that involves stakeholders with competing concerns and who often describe negative experiences of the process, which can have long-lasting effects on the therapeutic relationship with service users. The aim of the present study was to explore the perspectives of key stakeholders involved in the involuntary admission and detention of people under the Mental Health Act 2001 in Ireland. Focus groups were used to collect data. Stakeholders interviewed were service users, relatives, general practitioners, psychiatrists, mental health nurses, solicitors, tribunal members, and police. Data were analysed using a general inductive approach. Three key categories emerged: (i) getting help; (ii) detention under the Act; and (iii) experiences of the tribunal process. This research highlights gaps in information and uncertainty about the involuntary admission process for stakeholders, but particularly for service users who are most affected by inadequate processes and supports. Mental health law has traditionally focussed on narrower areas of detention and treatment, but human rights law requires a greater refocussing on supporting service users to ensure a truly voluntary approach to care. The recent human rights treaty, the UN Convention on the Rights of Persons with Disabilities, is to guarantee a broad range of fundamental rights, such as liberty and integrity, which can be affected by coercive processes of involuntary admission and treatment.
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Affiliation(s)
- Siobhán Smyth
- School of Nursing and Midwifery, National University of Ireland, Galway, Ireland
| | - Dympna Casey
- School of Nursing and Midwifery, National University of Ireland, Galway, Ireland
| | - Adeline Cooney
- School of Nursing and Midwifery, National University of Ireland, Galway, Ireland
| | - Agnes Higgins
- School of Nursing and Midwifery, Trinity College, Dublin, Ireland
| | - David McGuinness
- School of Nursing and Midwifery, National University of Ireland, Galway, Ireland
| | - Emma Bainbridge
- School of Medicine, National University of Ireland, Galway, Ireland
| | - Mary Keys
- School of Law, National University of Ireland, Galway, Ireland
| | - Irina Georgieva
- School of Medicine, National University of Ireland, Galway, Ireland
| | - Liz Brosnan
- Centre for Disability Law and Policy, National University of Ireland, Galway, Ireland
| | - Claire Beecher
- School of Nursing and Midwifery, National University of Ireland, Galway, Ireland
| | - Brian Hallahan
- School of Medicine, National University of Ireland, Galway, Ireland.,Health Research Board Clinical Research Facility Galway, National University of Ireland, Galway, Ireland
| | - Colm McDonald
- School of Medicine, National University of Ireland, Galway, Ireland.,Health Research Board Clinical Research Facility Galway, National University of Ireland, Galway, Ireland
| | - Kathy Murphy
- School of Nursing and Midwifery, National University of Ireland, Galway, Ireland
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Murphy R, McGuinness D, Bainbridge E, Brosnan L, Felzmann H, Keys M, Murphy K, Hallahan B, McDonald C, Higgins A. Service Users' Experiences of Involuntary Hospital Admission Under the Mental Health Act 2001 in the Republic of Ireland. Psychiatr Serv 2017; 68:1127-1135. [PMID: 28669292 DOI: 10.1176/appi.ps.201700008] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The objective of the study was to explore the experiences of individuals admitted to the hospital involuntarily under the Mental Health Act 2001 in the Republic of Ireland. METHODS In this qualitative descriptive study, 50 individuals who had been involuntarily admitted to a hospital underwent face-to-face semistructured interviews approximately three months after revocation of the involuntary admission order. Data were analyzed by using an inductive thematic process. RESULTS Participants reported mixed experiences over the course of the admission, with both positive and challenging aspects. Participants reported feeling coerced, disempowered, and unsupported at various stages of the admission and highlighted the long-term deleterious impact on their psychological well-being. However, participants also described encounters with individuals who endeavored to initiate a collaborative, informative, and compassionate approach. Four key themes emerged consistently across the trajectory of participants' involuntary admission experiences: feeling trapped and coerced, feeling disengaged and unsupported, admission-induced distress, and person-centered encounters. CONCLUSIONS This qualitative study of service users' views across the entire trajectory of their involuntary admission identified a number of factors that should be addressed to reduce the negative impact of involuntary admission. A multifaceted strategy could include ongoing education and training of all stakeholders in the principles and practices of person-centered care, repeated provision of accessible information and emotional support to service users during all stages of involuntary admission, and a shift in culture to one that minimizes the traumatic impact of forced detention on individuals' psychological well-being.
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Affiliation(s)
- Rebecca Murphy
- Dr. Rebecca Murphy and Dr. Higgins are with the School of Nursing and Midwifery, Trinity College, The University of Dublin, Dublin. The other authors are with the National University of Ireland, Galway. Dr. McGuinness and Dr. Kathy Murphy are with the School of Nursing and Midwifery; Dr. Bainbridge, Dr. Hallahan, and Dr. McDonald are with the Department of Psychiatry; Dr. Brosnan is with the Centre for Disability Law and Policy; Dr. Felzmann is with the Centre of Bioethics Research and Analysis, Department of Philosophy; and Dr. Keys is with the School of Law
| | - David McGuinness
- Dr. Rebecca Murphy and Dr. Higgins are with the School of Nursing and Midwifery, Trinity College, The University of Dublin, Dublin. The other authors are with the National University of Ireland, Galway. Dr. McGuinness and Dr. Kathy Murphy are with the School of Nursing and Midwifery; Dr. Bainbridge, Dr. Hallahan, and Dr. McDonald are with the Department of Psychiatry; Dr. Brosnan is with the Centre for Disability Law and Policy; Dr. Felzmann is with the Centre of Bioethics Research and Analysis, Department of Philosophy; and Dr. Keys is with the School of Law
| | - Emma Bainbridge
- Dr. Rebecca Murphy and Dr. Higgins are with the School of Nursing and Midwifery, Trinity College, The University of Dublin, Dublin. The other authors are with the National University of Ireland, Galway. Dr. McGuinness and Dr. Kathy Murphy are with the School of Nursing and Midwifery; Dr. Bainbridge, Dr. Hallahan, and Dr. McDonald are with the Department of Psychiatry; Dr. Brosnan is with the Centre for Disability Law and Policy; Dr. Felzmann is with the Centre of Bioethics Research and Analysis, Department of Philosophy; and Dr. Keys is with the School of Law
| | - Liz Brosnan
- Dr. Rebecca Murphy and Dr. Higgins are with the School of Nursing and Midwifery, Trinity College, The University of Dublin, Dublin. The other authors are with the National University of Ireland, Galway. Dr. McGuinness and Dr. Kathy Murphy are with the School of Nursing and Midwifery; Dr. Bainbridge, Dr. Hallahan, and Dr. McDonald are with the Department of Psychiatry; Dr. Brosnan is with the Centre for Disability Law and Policy; Dr. Felzmann is with the Centre of Bioethics Research and Analysis, Department of Philosophy; and Dr. Keys is with the School of Law
| | - Heike Felzmann
- Dr. Rebecca Murphy and Dr. Higgins are with the School of Nursing and Midwifery, Trinity College, The University of Dublin, Dublin. The other authors are with the National University of Ireland, Galway. Dr. McGuinness and Dr. Kathy Murphy are with the School of Nursing and Midwifery; Dr. Bainbridge, Dr. Hallahan, and Dr. McDonald are with the Department of Psychiatry; Dr. Brosnan is with the Centre for Disability Law and Policy; Dr. Felzmann is with the Centre of Bioethics Research and Analysis, Department of Philosophy; and Dr. Keys is with the School of Law
| | - Mary Keys
- Dr. Rebecca Murphy and Dr. Higgins are with the School of Nursing and Midwifery, Trinity College, The University of Dublin, Dublin. The other authors are with the National University of Ireland, Galway. Dr. McGuinness and Dr. Kathy Murphy are with the School of Nursing and Midwifery; Dr. Bainbridge, Dr. Hallahan, and Dr. McDonald are with the Department of Psychiatry; Dr. Brosnan is with the Centre for Disability Law and Policy; Dr. Felzmann is with the Centre of Bioethics Research and Analysis, Department of Philosophy; and Dr. Keys is with the School of Law
| | - Kathy Murphy
- Dr. Rebecca Murphy and Dr. Higgins are with the School of Nursing and Midwifery, Trinity College, The University of Dublin, Dublin. The other authors are with the National University of Ireland, Galway. Dr. McGuinness and Dr. Kathy Murphy are with the School of Nursing and Midwifery; Dr. Bainbridge, Dr. Hallahan, and Dr. McDonald are with the Department of Psychiatry; Dr. Brosnan is with the Centre for Disability Law and Policy; Dr. Felzmann is with the Centre of Bioethics Research and Analysis, Department of Philosophy; and Dr. Keys is with the School of Law
| | - Brian Hallahan
- Dr. Rebecca Murphy and Dr. Higgins are with the School of Nursing and Midwifery, Trinity College, The University of Dublin, Dublin. The other authors are with the National University of Ireland, Galway. Dr. McGuinness and Dr. Kathy Murphy are with the School of Nursing and Midwifery; Dr. Bainbridge, Dr. Hallahan, and Dr. McDonald are with the Department of Psychiatry; Dr. Brosnan is with the Centre for Disability Law and Policy; Dr. Felzmann is with the Centre of Bioethics Research and Analysis, Department of Philosophy; and Dr. Keys is with the School of Law
| | - Colm McDonald
- Dr. Rebecca Murphy and Dr. Higgins are with the School of Nursing and Midwifery, Trinity College, The University of Dublin, Dublin. The other authors are with the National University of Ireland, Galway. Dr. McGuinness and Dr. Kathy Murphy are with the School of Nursing and Midwifery; Dr. Bainbridge, Dr. Hallahan, and Dr. McDonald are with the Department of Psychiatry; Dr. Brosnan is with the Centre for Disability Law and Policy; Dr. Felzmann is with the Centre of Bioethics Research and Analysis, Department of Philosophy; and Dr. Keys is with the School of Law
| | - Agnes Higgins
- Dr. Rebecca Murphy and Dr. Higgins are with the School of Nursing and Midwifery, Trinity College, The University of Dublin, Dublin. The other authors are with the National University of Ireland, Galway. Dr. McGuinness and Dr. Kathy Murphy are with the School of Nursing and Midwifery; Dr. Bainbridge, Dr. Hallahan, and Dr. McDonald are with the Department of Psychiatry; Dr. Brosnan is with the Centre for Disability Law and Policy; Dr. Felzmann is with the Centre of Bioethics Research and Analysis, Department of Philosophy; and Dr. Keys is with the School of Law
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Ranieri V, Madigan K, Roche E, McGuinness D, Bainbridge E, Feeney L, Hallahan B, McDonald C, O'Donoghue B. Caregiver burden and distress following the patient's discharge from psychiatric hospital. BJPsych Bull 2017; 41:87-91. [PMID: 28400966 PMCID: PMC5376724 DOI: 10.1192/pb.bp.115.053074] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Aims and method Caring for someone with a mental illness is increasingly occurring within the community. As a result, family members who fulfil a caregiving role may experience substantial levels of burden and psychological distress. This study investigates the level of burden and psychological distress reported by caregivers after the patient's admission. Results This study found that the overall level of burden and psychological distress experienced by caregivers did not differ according to the patient's legal status. However, the caregivers of those who were voluntarily admitted supervised the person to a significantly greater extent than the caregivers of those who were involuntarily admitted. Approximately 15% of caregivers revealed high levels of psychological distress. Clinical implications This study may emphasise a need for mental health professionals to examine the circumstances of caregivers, particularly of those caring for patients who are voluntarily admitted, a year after the patient's admission.
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Affiliation(s)
| | - Kevin Madigan
- Cluain Mhuire Community Mental Health Service, Blackrock, Co Dublin, Ireland
| | - Eric Roche
- DETECT, Early Intervention for Psychosis Service, Blackrock, Co Dublin, Ireland
| | - David McGuinness
- Clinical Science Institute, National University of Ireland, Galway, Ireland
| | - Emma Bainbridge
- Clinical Science Institute, National University of Ireland, Galway, Ireland
| | - Larkin Feeney
- Cluain Mhuire Community Mental Health Service, Blackrock, Co Dublin, Ireland
| | - Brian Hallahan
- Clinical Science Institute, National University of Ireland, Galway, Ireland
| | - Colm McDonald
- Clinical Science Institute, National University of Ireland, Galway, Ireland
| | - Brian O'Donoghue
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia; Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia
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McGuinness D, Higgins A, Hallahan B, Bainbridge E, McDonald C, Murphy K. Preserving Control: Understanding People's Experiences Before, During and After Detention Under the Irish Mental Health Act 2001. Eur Psychiatry 2016. [DOI: 10.1016/j.eurpsy.2016.01.1769] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
IntroductionThe Mental Health Act 2001 provides a legal framework for the involuntary admission and treatment of individuals deemed to have a mental disorder to psychiatric units. The perspectives of people who have been detained are relatively poorly understood.ObjectiveTo develop a theoretical understanding of individual's experiences throughout the trajectory of their detention and to understand the psychological and social processes that individuals use to cope before, during and after detention.MethodsFifty individuals subject to detention across three psychiatric units consented to be interviewed three months after their detention. Using a semi-structured interview people recounted their experiences. Interviews were analysed using the principles underpinning Grounded Theory.ResultsThe theory ‘Preserving Control’ encapsulates individuals’ experiences and consists of three related themes: ‘Losing Control’, ‘Regaining Control’ and ‘Maintaining Control’. ‘Losing Control’ describes individuals’ experiences of losing their autonomy and liberty thought the process of detention and hospitalisation. ‘Regaining Control describes, the strategies individuals used in an attempted to restore their loss of autonomy and control. ‘Maintaining Control’ describes how individuals lived with the consequences of detention and contended with impact on discharge.ConclusionsWhilst a large variation existed in relation to the subjective experience of being detained, the characteristic process that individuals tend to experience related to identifiable phases of preserving control in the face of this loss of autonomy. Findings from this study highlight the importance of more sensitive interactions support and information during and after the detention process.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Ranieri V, Madigan K, Roche E, Bainbridge E, McGuinness D, Tierney K, Feeney L, Hallahan B, McDonald C, O'Donoghue B. Caregivers' perceptions of coercion in psychiatric hospital admission. Psychiatry Res 2015; 228:380-5. [PMID: 26163727 DOI: 10.1016/j.psychres.2015.05.079] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 04/28/2015] [Accepted: 05/25/2015] [Indexed: 11/20/2022]
Abstract
While knowledge on service users' perspective on their admissions to psychiatric wards has improved substantially in the last decade, there is a paucity of knowledge of the perspectives of caregivers. This study aimed to determine caregiver's perception of the levels of perceived coercion, perceived pressures and procedural justice experienced by service users during their admission to acute psychiatric in-patient units. The perspective of caregivers were then compared to the perspectives of their related service users, who had been admitted to five psychiatric units in Ireland. Caregivers were interviewed using an adapted version of the MacArthur admission experience interview. Sixty-six caregivers participated in this study and the majority were parents. Seventy one percent of service users were admitted involuntarily and nearly half had a diagnosis of schizophrenia or schizoaffective disorder. Caregivers of involuntarily admitted individuals perceived the service users' admission as less coercive than reported by the service users. Caregivers also perceived a higher level of procedural justice in comparison to the level reported by service users. Reducing the disparity of perceptions between caregivers and service users could result in caregivers having a greater understanding of the admission process and why some service users may be reluctant to be admitted.
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Affiliation(s)
- Veronica Ranieri
- Department of Psychology, Trinity College Dublin, Dublin, Ireland
| | - Kevin Madigan
- Cluain Mhuire Mental Health Service, Blackrock, Co Dublin, Ireland
| | - Eric Roche
- DETECT, Early Intervention for Psychosis Service, Blackrock, Co Dublin, Ireland
| | - Emma Bainbridge
- Clinical Science Institute, National University of Ireland, Galway, Ireland
| | - David McGuinness
- Clinical Science Institute, National University of Ireland, Galway, Ireland
| | - Kevin Tierney
- Department of Psychology, Trinity College Dublin, Dublin, Ireland
| | - Larkin Feeney
- Cluain Mhuire Mental Health Service, Blackrock, Co Dublin, Ireland
| | - Brian Hallahan
- Clinical Science Institute, National University of Ireland, Galway, Ireland
| | - Colm McDonald
- Clinical Science Institute, National University of Ireland, Galway, Ireland
| | - Brian O'Donoghue
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia.
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Bainbridge E. Magazine cover is a textbook case of anatomical error. Nurs Stand 2015; 29:35; discussion 35. [PMID: 25902248 DOI: 10.7748/ns.29.34.35.s47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Lally J, Gallagher A, Bainbridge E, Avalos G, Ahmed M, McDonald C. Increases in triglyceride levels are associated with clinical response to clozapine treatment. J Psychopharmacol 2013; 27:401-3. [PMID: 23325369 DOI: 10.1177/0269881112472568] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [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] [Indexed: 11/16/2022]
Abstract
Increases in serum triglyceride (TG) levels are associated with clinical response to clozapine treatment. Clozapine is the most efficacious therapy for treatment of refractory schizophrenia, although its use is well recognised to be associated with substantial metabolic dysfunction. Interestingly, there is some evidence that the therapeutic benefit of clozapine is associated with treatment-emergent weight gain and dyslipidaemia, specifically hypertriglyceridaemia. In this prospective observational study, we examine associations between therapeutic response to clozapine in 49 patients with treatment-resistant schizophrenia and lipid dysregulation. An increase in TG levels was strongly predictive of clinical improvement (B=9.33, t =3.56, df=4, p<0.001) and of improvement in positive PANSS scores (B=2.85, t=3.61, df=4, p=0.001) as well as negative PANSS scores (B=1.93, t=2.36, df=4, p=0.02), when controlling for potential confounds of weight gain, change in waist circumference, baseline antipsychotic polypharmacy and serum clozapine levels. This finding suggests that clozapine's therapeutic efficacy is linked to serum lipid changes. Hypertriglyceridaemia as a predictor of clinical response in patients treated with clozapine merits further investigation in order to better elucidate its effect on the pharmacological activity of clozapine.
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Affiliation(s)
- John Lally
- Department of Psychosis Studies, Institute of Psychiatry, Kings College London and National Psychosis Service, South London and Maudsley NHS Foundation Trust, London, UK.
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Grumbach K, Bainbridge E, Bodenheimer T. Facilitating improvement in primary care: the promise of practice coaching. Issue Brief (Commonw Fund) 2012; 15:1-14. [PMID: 22712103] [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: 06/01/2023]
Abstract
Practice coaching, also called practice facilitation, assists physician practices with the desire to improve in such areas as patient access, chronic and preventive care, electronic medical record use, patient-centeredness, cultural competence, and team-building. This issue brief clarifies the essential features of practice coaching and offers guidance for health system leaders, public and private insurers, and federal and state policymakers on how best to structure and design these programs in primary care settings. Good-quality evidence demonstrates that practice coaching is effective. The authors argue that primary care delivery in the United States would benefit from a more systematic approach to the training and deployment of primary care practice coaches.
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Affiliation(s)
- Kevin Grumbach
- Department of Family and Community Medicine, University of California, San Francisco School of Medicine, USA.
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Egeblad M, Ewald AJ, Askautrud HA, Truitt ML, Welm BE, Bainbridge E, Peeters G, Krummel MF, Werb Z. Visualizing stromal cell dynamics in different tumor microenvironments by spinning disk confocal microscopy. Dis Model Mech 2008; 1:155-67; discussion 165. [PMID: 19048079 DOI: 10.1242/dmm.000596] [Citation(s) in RCA: 158] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2008] [Accepted: 06/18/2008] [Indexed: 02/06/2023] Open
Abstract
The tumor microenvironment consists of stromal cells and extracellular factors that evolve in parallel with carcinoma cells. To gain insights into the activities of stromal cell populations, we developed and applied multicolor imaging techniques to analyze the behavior of these cells within different tumor microenvironments in the same live mouse. We found that regulatory T-lymphocytes (Tregs) migrated in proximity to blood vessels. Dendritic-like cells, myeloid cells and carcinoma-associated fibroblasts all exhibited higher motility in the microenvironment at the tumor periphery than within the tumor mass. Since oxygen levels differ between tumor microenvironments, we tested if acute hypoxia could account for the differences in cell migration. Direct visualization revealed that Tregs ceased migration under acute systemic hypoxia, whereas myeloid cells continued migrating. In the same mouse and microenvironment, we experimentally subdivided the myeloid cell population and revealed that uptake of fluorescent dextran defined a low-motility subpopulation expressing markers of tumor-promoting, alternatively activated macrophages. In contrast, fluorescent anti-Gr1 antibodies marked myeloid cells patrolling inside tumor vessels and in the stroma. Our techniques allow real-time combinatorial analysis of cell populations based on spatial location, gene expression, behavior and cell surface molecules within intact tumors. The techniques are not limited to investigations in cancer, but could give new insights into cell behavior more broadly in development and disease.
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Affiliation(s)
- Mikala Egeblad
- Department of Anatomy, University of California, San Francisco, 513 Parnassus Avenue, San Francisco, CA 94143, USA.
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