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Biasini B, Donati M, Rosi A, Giopp F, Colić Barić I, Bituh M, Brečić R, Brennan M, Ilić A, Quarrie S, Sayed M, Tregear A, Menozzi D, Scazzina F. Nutritional, environmental and economic implications of children plate waste at school: a comparison between two Italian case studies. Public Health Nutr 2024:1-31. [PMID: 38361449 DOI: 10.1017/s136898002400034x] [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] [Indexed: 02/17/2024]
Abstract
OBJECTIVE This study aims at comparing two Italian case studies in relation to school children's plate waste and its implications, in terms of nutritional loss, economic cost, and carbon footprint. DESIGN Plate waste was collected through an aggregate selective weighting method for 39 days. SETTING Children from the first to the fifth grade from four primary schools, two in each case study (Parma and Lucca), were involved. RESULTS With respect to the served food, in Parma the plate waste percentage was lower than in Lucca (p<0.001). Fruit and side-dishes were highly wasted, mostly in Lucca (>50%). The energy loss of the lunch meals accounted for 26% (Parma) and 36% (Lucca). Among nutrients, dietary fibre, folate and vitamin C, calcium and potassium were lost at most (26-45%). Overall, after adjusting for plate waste data, most of the lunch menus fell below the national recommendations for energy (50%, Parma; 79%, Lucca) and nutrients, particularly for fat (85%, Parma; 89%, Lucca). Plate waste was responsible for 19% (Parma) and 28% (Lucca) of the carbon footprint associated to the food supplied by the catering service, with starchy food being the most important contributor (52%, Parma; 47%, Lucca). Overall, the average cost of plate waste was 1.8 €/kg (Parma) and 2.7 €/kg (Lucca), accounting respectively for 4% and 10% of the meal full price. CONCLUSION A re-planning of the school meals service organisation and priorities is needed to decrease the inefficiency of the current system and reduce food waste and its negative consequences.
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Affiliation(s)
- Beatrice Biasini
- Department of Food and Drug, University of Parma, Parco Area delle Scienze, 27/A, 43124, Parma, Italy
| | - Michele Donati
- Department of Chemistry, Life Sciences and Environmental Sustainability, University of Parma, Parco Area delle Scienze, 33/a, 43124, Parma, Italy
| | - Alice Rosi
- Department of Food and Drug, University of Parma, Parco Area delle Scienze, 27/A, 43124, Parma, Italy
| | - Francesca Giopp
- Department of Food and Drug, University of Parma, Parco Area delle Scienze, 27/A, 43124, Parma, Italy
| | - Irena Colić Barić
- Department of Food Quality Control, Faculty of Food Technology and Biotechnology, University of Zagreb, Pierottijeva 6, 10000, Zagreb, Croatia
| | - Martina Bituh
- Department of Food Quality Control, Faculty of Food Technology and Biotechnology, University of Zagreb, Pierottijeva 6, 10000, Zagreb, Croatia
| | - Ružica Brečić
- Marketing Department, Faculty of Economics and Business, University of Zagreb, Trg J. F. Kennedy 6, 10000, Zagreb, Croatia
| | - Mary Brennan
- University of Edinburgh Business School, 29 Buccleuch Place, Edinburgh, EH8 9JS, UK
| | - Ana Ilić
- Department of Food Quality Control, Faculty of Food Technology and Biotechnology, University of Zagreb, Pierottijeva 6, 10000, Zagreb, Croatia
| | - Steve Quarrie
- European Training Academy, Kneza Milosa 47, Belgrade, Serbia
| | - Maysara Sayed
- University of Edinburgh Business School, 29 Buccleuch Place, Edinburgh, EH8 9JS, UK
| | - Angela Tregear
- University of Edinburgh Business School, 29 Buccleuch Place, Edinburgh, EH8 9JS, UK
| | - Davide Menozzi
- Department of Food and Drug, University of Parma, Parco Area delle Scienze, 27/A, 43124, Parma, Italy
| | - Francesca Scazzina
- Department of Food and Drug, University of Parma, Parco Area delle Scienze, 27/A, 43124, Parma, Italy
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Carrette L, Santos A, Brennan M, Othman D, Collazo A, George O. Antagonists of the stress and opioid systems restore the functional connectivity of the prefrontal cortex during alcohol withdrawal through divergent mechanisms. bioRxiv 2024:2023.09.30.560339. [PMID: 37873478 PMCID: PMC10592857 DOI: 10.1101/2023.09.30.560339] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Chronic alcohol consumption leads to dependence and withdrawal symptoms upon cessation, contributing to persistent use. However, the brain network mechanisms by which the brain orchestrates alcohol withdrawal and how these networks are affected by pharmacological treatments remain elusive. Recent work revealed that alcohol withdrawal produces a widespread increase in coordinated brain activity and a decrease in modularity of the whole-brain functional network using single-cell whole-brain imaging of immediate early genes. This decreased modularity and functional hyperconnectivity are hypothesized to be novel biomarkers of alcohol withdrawal in alcohol dependence, which could potentially be used to evaluate the efficacy of new medications for alcohol use disorder. However, there is no evidence that current FDA-approved medications or experimental treatments known to reduce alcohol drinking in animal models can normalize the changes in whole-brain functional connectivity. In this report, we tested the effect of R121919, a CRF1 antagonist, and naltrexone, an FDA-approved treatment for alcohol use disorder, on whole-brain functional connectivity using the cellular marker FOS combined with graph theory and advanced network analyses. Results show that both R121919 and naltrexone restored the functional connectivity of the prefrontal cortex during alcohol withdrawal, but through divergent mechanisms. Specifically, R121919 increased FOS activation in the prefrontal cortex, partially restored modularity, and normalized connectivity, particularly in CRF1-rich regions, including the prefrontal, pallidum, and extended amygdala circuits. On the other hand, naltrexone decreased FOS activation throughout the brain, decreased modularity, and increased connectivity overall except for the Mu opioid receptor-rich regions, including the thalamus. These results identify the brain networks underlying the pharmacological effects of R121919 and naltrexone and demonstrate that these drugs restored different aspects of functional connectivity of the prefrontal cortex, pallidum, amygdala, and thalamus during alcohol withdrawal. Notably, these effects were particularly prominent in CRF1- and Mu opioid receptors-rich regions highlighting the potential of whole-brain functional connectivity using FOS as a tool for identifying neuronal network mechanisms underlying the pharmacological effects of existing and new medications for alcohol use disorder.
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Affiliation(s)
- L.L.G. Carrette
- Department of Psychiatry, UC San Diego, La Jolla, CA, United States
| | - A. Santos
- Department of Psychiatry, UC San Diego, La Jolla, CA, United States
| | - M. Brennan
- Department of Psychiatry, UC San Diego, La Jolla, CA, United States
| | - D. Othman
- Department of Psychiatry, UC San Diego, La Jolla, CA, United States
| | - A. Collazo
- Beckman Institute, CalTech, Passadena, CA, United States
| | - O. George
- Department of Psychiatry, UC San Diego, La Jolla, CA, United States
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Nelson P, Kuriakose L, Brennan M, Alemar D, Villamayor JM, Sebastian B, Cortes O, Goode-Marshall B. Procedural Unit Nurses' Perception of Confidence in Performing Critical Care Skills During COVID-19 Crisis. J Nurses Prof Dev 2023; 39:272-277. [PMID: 37683205 DOI: 10.1097/nnd.0000000000000922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Nursing professional development practitioners at an academic medical center conducted a quality improvement project to address the educational needs of procedural unit nurses during the COVID-19 pandemic. Procedural nurses completed a 1-day critical care nursing skills education and pre- and postsurveys. Survey results indicated an improved nurses' skills confidence in caring for COVID-19 patients, which was statistically significant, t (34.9) = 4.8, p < .001.
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Pinhasov T, Isaacs S, Donis-Garcia M, Oropallo A, Brennan M, Rao A, Landis G, Agrell-Kann M, Li T. Reducing lower extremity hospital-acquired pressure injuries: a multidisciplinary clinical team approach. J Wound Care 2023; 32:S31-S36. [PMID: 37405962 DOI: 10.12968/jowc.2023.32.sup7.s31] [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] [Indexed: 07/07/2023]
Abstract
OBJECTIVE Optimal methods of reducing incidence of hospital-acquired pressure injuries (HAPIs) remain to be determined. We assessed changes in yearly incidence of lower extremity HAPIs before and after an intervention aimed at reducing these wounds. METHOD In 2012, we implemented a three-pronged intervention to reduce the incidence of HAPIs. The intervention included: a multidisciplinary surgical team; enhanced nursing education; and improved quality data reporting. Yearly incidence of lower extremity HAPIs was tracked. RESULTS Pre-intervention, incidence of HAPIs was 0.746%, 0.751% and 0.742% in 2009, 2010 and 2011, respectively. Post-intervention, incidence of HAPIs was 0.002%, 0.051%, 0.038%, 0.000% and 0.006% in 2013, 2014, 2015, 2016 and 2017, respectively. Mean incidence of HAPIs was reduced from 0.746% before the intervention to 0.022% after the intervention (p<0.001). CONCLUSION An intervention by a multidisciplinary surgical team enhanced nursing education, and improved quality data reporting reduced the incidence of lower extremity HAPIs.
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Affiliation(s)
- Tamir Pinhasov
- Department of Surgery, Comprehensive Wound Care Healing and Hyperbarics, Northwell Health, Lake Success, NY 11042, US
| | - Shelby Isaacs
- Department of Surgery, Comprehensive Wound Care Healing and Hyperbarics, Northwell Health, Lake Success, NY 11042, US
| | - Miriam Donis-Garcia
- Department of Surgery, Comprehensive Wound Care Healing and Hyperbarics, Northwell Health, Lake Success, NY 11042, US
| | - Alisha Oropallo
- Department of Surgery, Comprehensive Wound Care Healing and Hyperbarics, Northwell Health, Lake Success, NY 11042, US
- Department of Vascular Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11550, US
- Department of Vascular Surgery, North Shore University Hospital, Manhasset, NY 11030, US
| | - Mary Brennan
- Department of Nursing, North Shore University Hospital, Manhasset, NY 11030, US
| | - Amit Rao
- Department of Surgery, Comprehensive Wound Care Healing and Hyperbarics, Northwell Health, Lake Success, NY 11042, US
| | - Gregg Landis
- Department of Vascular Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11550, US
- Department of Vascular Surgery, North Shore University Hospital, Manhasset, NY 11030, US
| | - Marie Agrell-Kann
- Department of Nursing, North Shore University Hospital, Manhasset, NY 11030, US
| | - Timmy Li
- Department of Emergency Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11550, US
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Altman SD, Tilley CP, Feldman R, Brennan M, Wholihan D. Curricular Quality Improvement in Midwifery: Simulating Unexpected Perinatal Loss. J Midwifery Womens Health 2023; 68:523-530. [PMID: 37092842 DOI: 10.1111/jmwh.13498] [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: 09/23/2022] [Revised: 01/27/2023] [Accepted: 02/27/2023] [Indexed: 04/25/2023]
Abstract
INTRODUCTION Caring for families experiencing perinatal loss is a fundamental component of midwifery practice, but little attention is paid to perinatal palliative care in midwifery curricula. Lack of educational preparation and self-care resources negatively impacts midwifery students and health care teams caring for families experiencing stillbirth. PROCESS A private, urban university conducted a curricular quality improvement project to integrate perinatal palliative care into the midwifery curriculum using a high-fidelity, branching simulation pedagogy. Simulation objectives were developed from curricular gap analyses and the Core Competencies for Basic Midwifery Practice. Development of the Unexpected Perinatal Loss Simulation was guided by the International Nursing Association for Clinical Simulation and Learning Outcomes and Objectives and Design Standards. The Unexpected Perinatal Loss Simulation was revised based on qualitative data from student focus groups and expert content validation. OUTCOMES Qualitative data yielded 4 key domains: presimulation, simulation skills, prior experience/personal reflections, and recommendations. Simulation procedures and scenario content were revised, after which 8 expert clinicians in the fields of midwifery, palliative care, and psychiatry validated the scenario content using the Lynn method. Two items did not meet the content validity index (CVI) threshold of 0.78, necessitating review by stakeholders; however, the overall scenario CVI threshold was met (0.82). DISCUSSION Through this project, faculty integrated perinatal palliative care into the midwifery program using a novel approach of high-fidelity, branching simulation, structured debriefing, and an introductory self-care skills workshop. Potential clinical impact includes skillful perinatal palliative care with effective communication skills to mitigate how families experience and remember a traumatic loss and facilitate the grieving process. Students voiced insights into how they would process loss and seek support to mitigate their own grief as future midwives.
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Affiliation(s)
| | | | | | - Mary Brennan
- NYU Rory Meyers College of Nursing, New York, New York
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Hansen CJ, Bolton S, Sulaiman AH, Duling S, Bagenal F, Brennan M, Connerney J, Clark G, Lunine J, Levin S, Kurth W, Mura A, Paranicas C, Tosi F, Withers P. Juno's Close Encounter With Ganymede-An Overview. Geophys Res Lett 2022; 49:e2022GL099285. [PMID: 37034391 PMCID: PMC10078441 DOI: 10.1029/2022gl099285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 05/20/2022] [Accepted: 05/28/2022] [Indexed: 06/19/2023]
Abstract
The Juno spacecraft has been in orbit around Jupiter since 2016. Two flybys of Ganymede were executed in 2021, opportunities realized by evolution of Juno's polar orbit over the intervening 5 years. The geometry of the close flyby just prior to the 34th perijove pass by Jupiter brought the spacecraft inside Ganymede's unique magnetosphere. Juno's payload, designed to study Jupiter's magnetosphere, had ample dynamic range to study Ganymede's magnetosphere. The Juno radio system was used both for gravity measurements and for study of Ganymede's ionosphere. Remote sensing of Ganymede returned new results on geology, surface composition, and thermal properties of the surface and subsurface.
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Affiliation(s)
| | - S. Bolton
- Southwest Research InstituteSan AntonioTXUSA
| | - A. H. Sulaiman
- Department of Physics and AstronomyUniversity of IowaIowa CityIAUSA
| | | | - F. Bagenal
- Laboratory for Atmospheric and Space PhysicsUniversity of ColoradoBoulderCOUSA
| | | | | | - G. Clark
- Johns Hopkins Applied Physics LaboratoryLaurelMDUSA
| | | | - S. Levin
- Jet Propulsion LaboratoryPasadenaCAUSA
| | - W. Kurth
- Department of Physics and AstronomyUniversity of IowaIowa CityIAUSA
| | - A. Mura
- Istituto Nazionale di AstroFisica – Istituto di Astrofisica e Planetologia Spaziali (INAF‐IAPS)RomeItaly
| | - C. Paranicas
- Johns Hopkins Applied Physics LaboratoryLaurelMDUSA
| | - F. Tosi
- Istituto Nazionale di AstroFisica – Istituto di Astrofisica e Planetologia Spaziali (INAF‐IAPS)RomeItaly
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Brennan M, Phelan S, Breen D. 90 A RETROSPECTIVE COHORT STUDY COMPARING THE CLINICAL CHARACTERISTICS, TREATMENT AND OUTCOMES OF BIOPSY-CONFIRMED SARCOIDOSIS IN LATE-ONSET AND YOUNGER-ONSET PATIENTS. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.074] [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: 11/13/2022] Open
Abstract
Abstract
Background
Late-Onset Sarcoidosis (LOS) accounts for up to one-third of cases and is diagnostically challenging due to the difficulty in satisfactorily excluding malignancy and infection, often necessitating repeated investigations. Endobronchial Ultrasound (EBUS) is the gold standard for diagnosing pulmonary sarcoidosis. This study aims to compare the clinical presentation, treatment and outcomes in patients with biopsy confirmed sarcoidosis in older and younger patients
Methods
A retrospective cohort analysis was performed on all patients with EBUS-confirmed sarcoidosis at a tertiary referral centre between 2012 and 2019. Electronic healthcare records were reviewed to obtain information on clinical presentation, confirmatory investigations, treatment and outcomes. LOS was defined as patients aged >65 years
Results
In total, 247 patients were included, 68.8% were male. LOS accounted for 9.3% (n=23).Extra-pulmonary and systemic features were less common in LOS (26.1% vs 58%, p<0.002). There was no difference in systemic treatment between cohorts (84.6% vs 67.9%, p=0.21) and LOS patients experienced comparably high rates of satisfactory outcomes. At follow up, the majority of patients either improved or achieved clinical stability in both groups (92.3% vs 76.1%, p=0.18). Clinical and/or radiological progression occurred in 7% in both groups with no reported deaths. Confirmatory investigations were infrequent and EBUS was safe and well-tolerated in older patients.
Conclusion
LOS was lower than expected and extra-pulmonary involvement was uncommon suggesting a pre-selected population. Referral for EBUS should be considered as first line for older patients with unexplained thoracic adenopathy provided further diagnostic investigations are in line with their goals of care. Clinical outcomes were excellent with low rates of progression, extra-pulmonary organ involvement and systemic therapy initiation, differing from prior studies and may represent less severe disease at diagnosis, enhanced diagnostic certainty or referral bias.
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Affiliation(s)
- M Brennan
- Galway University Hospital , Galway, Ireland
| | - S Phelan
- Galway University Hospital , Galway, Ireland
| | - D Breen
- Galway University Hospital , Galway, Ireland
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8
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Brennan M, Walsh S, Rutherford R, Garvey J, O'Hanlon S, Gargoum F. 89 DIAGNOSIS AND TREATMENT OF SUSPECTED OBSTRUCTIVE SLEEP APNOEA (OSA) IN OLDER PEOPLE: A RETROSPECTIVE COMPARATIVE ANALYSIS. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.073] [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
Background
Obstructive Sleep Apnoea (OSA) is common yet often undiagnosed in older people as symptoms of fatigue and poor sleep are common and non-specific. OSA screening tools also lack validity in older patients. This study aims to review the clinical presentation, use of screening tools and treatment adherence in older people.
Methods
A retrospective cohort study of patients >65 years attending a tertiary sleep clinic who underwent polysomnography for suspected OSA was performed. Electronic patient records were reviewed to obtain information on clinical presentation, screening scores, polysomnography reports and treatment initiated. Correlation between variables was performed using Pearson’s correlation co-efficient and represented using R-score. To compare CPAP usage with younger people, a cohort of controls <65 years were matched in 2:1 ratio for OSA severity (mild, moderate or severe) at diagnosis. Comparison of adherence rates was performed using Mann-Whitney U-test and represented using Z-scores.
Results
A convenience sample of 100 consecutive older patients were included. Fatigue was present in 53% and witness reported snoring in 86% and apnoeas in 56%. Moderate or severe OSA was confirmed by polysomnography in 91% cases. BMI and the STOP-BANG questionnaire were positively correlated with OSA severity as measured by Apnoea Hypopnea Index, while ESS and Berlin Questionnaire were not. Positive pressure ventilation was initiated in 90% patients. CPAP was extremely effective with the median AHI falling to within normal range on follow up. CPAP usage was significantly higher in older patients compared with younger matched control (85% vs 66% p=013).
Conclusion
Older people with OSA present with classical symptoms. STOP -BANG questionnaire and BMI were positively correlated with AHI values while other screening tools lacked validity. Treatment with CPAP was highly efficacious in older people with high usage rates and should be considered as first-line treatment for moderate and severe OSA in older patients.
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Affiliation(s)
- M Brennan
- Galway University Hospital , Galway, Ireland
| | - S Walsh
- Galway University Hospital , Galway, Ireland
| | | | - J Garvey
- St. Vincent's University Hospital , Dublin, Ireland
| | - S O'Hanlon
- St. Vincent's University Hospital , Dublin, Ireland
| | - F Gargoum
- Galway University Hospital , Galway, Ireland
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Brennan M, Nash D, Rutherford R. 87 VERTEBRAL FRACTURES IN OLDER PATIENTS WITH COPD: AN UNDER-DIAGNOSED AND UNDER-TREATED ENTITY. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.071] [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: 11/14/2022] Open
Abstract
Abstract
Background
Patients with Chronic Obstructive Pulmonary Disease (COPD) are at increased risk of osteoporosis. Vertebral Fractures (VF) are the most common manifestation of osteoporosis. Only one fourth to one third of incident radiographically identified VF are clinically diagnosed. The aim of this study is to evaluate patients the prevalence of VF in a cohort of patients admitted with Acute Exacerbation of COPD (AECOPD).
Methods
A retrospective review of AECOPD admissions over a four-month period was performed. Information on baseline characteristics, prescribed medications and reports of radiological imaging were obtained from Electronic Healthcare Records, discharge summaries and clinic letters.
Results
In total 116 patients were included over the study period. In 24% (n=28), VF was present on imaging. In those with VF, females accounted for 64.3% (n=18). Median age was 80 (76-85) and median CFS was 6. In 12 cases a single VF was present, in 9 two VFs and in 7 patients 3+ VF were present. There was no documented diagnosis of osteoporosis in 67.8% (n=19). VF were initially detected on CT thorax imaging performed to assess for pulmonary pathology in 35.7% (n=10) cases. Vitamin D3 was prescribed in 60.7% (n=17), concurrently with calcium in 28.6% (n=8). Antiresorptive therapy was prescribed in 39.3% (n=11), oral bisphosphonates in 4 patients and denosumab in 7. Vitamin D (OH) level was measured in 78.6% (n= 22) patients and was insufficient (<50mmol) in 25% (n=7).
Conclusion
Almost one-quarter of patients who were admitted with an AECOPD had vertebral insufficiency fracture on imaging. Identification and treatment of VF was suboptimal. Most were not identified as having osteoporosis nor prescribed antiresorptive therapy. CT imaging should be routinely reviewed for the presence of insufficiency fractures as part of case finding initiatives. Bone health assessment should be routinely performed in patients with COPD, particularly those with frequent corticosteroid usage.
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Affiliation(s)
- M Brennan
- Galway University Hospital , Galway, Ireland
| | - D Nash
- Galway University Hospital , Galway, Ireland
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10
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Conroy N, Brennan M, Cianci F, Migone C, Beatty K, Hamilton D. The Importance of a Proactive, Interdisciplinary, Multi-Departmental Approach to Migrant Health. Ir Med J 2022; 115:666. [PMID: 36920309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
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Smith EMD, Egbivwie N, Jorgensen AL, Ciurtin C, Al-Abadi E, Armon K, Bailey K, Brennan M, Gardner-Medwin J, Haslam K, Hawley DP, Leahy A, Leone V, Malik G, McLaren Z, Pilkington C, Ramanan AV, Rangaraj S, Ratcliffe A, Riley P, Sen E, Sridhar A, Wilkinson N, Wood F, Beresford MW, Hedrich CM. Real world treatment of juvenile-onset systemic lupus erythematosus: Data from the UK JSLE cohort study. Clin Immunol 2022; 239:109028. [PMID: 35513304 DOI: 10.1016/j.clim.2022.109028] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 04/28/2022] [Accepted: 04/28/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND In the absence of clinical trials evidence, Juvenile-onset Systemic Lupus Erythematosus (JSLE) treatment plans vary. AIM To explore 'real world' treatment utilising longitudinal UK JSLE Cohort Study data. METHODS Data collected between 07/2009-05/2020 was used to explore the choice/sequence of immunomodulating drugs from diagnosis. Multivariate logistic regression determined how organ-domain involvement (pBILAG-2004) impacted treatment choice. RESULT 349 patients met inclusion criteria, median follow-up 4-years (IQR:2,6). Mycophenolate mofetil (MMF) was most commonly used for the majority of organ-domains, and significantly associated with renal involvement (OR:1.99, 95% CI:1.65-2.41, pc < 0.01). Analyses assessing the sequence of immunomodulators focused on 197/349 patients (meeting relevant inclusion/exclusion criteria). 10/197 (5%) solely recieved hydroxychloroquine/prednisolone, 62/197 (31%) received a single-immunomodulator, 69/197 (36%) received two, and 36/197 patients (28%) received ≥three immunomodulators. The most common first and second line immunomodulator was MMF. Rituximab was the most common third-line immunomodulator. CONCLUSIONS Most UK JSLE patients required ≥two immunomodulators, with MMF used most commonly.
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Affiliation(s)
- Eve M D Smith
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, UK; Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, UK.
| | - Naomi Egbivwie
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, UK; Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, UK; Liverpool University Hospitals NHS Foundation Trusts, Liverpool, UK
| | | | - Coziana Ciurtin
- Centre for Adolescent Rheumatology, University College London, London, UK
| | - Eslam Al-Abadi
- Department of Rheumatology, Birmingham Children's Hospital, Birmingham, UK
| | - Kate Armon
- Department of Paediatric Rheumatology, Cambridge University Hospitals, Cambridge, UK
| | - Kathryn Bailey
- Department of Paediatric Rheumatology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Mary Brennan
- Department of Paediatric Rheumatology, Royal Hospital for Sick Children, Edinburgh, UK
| | | | - Kirsty Haslam
- Department of Paediatrics, Bradford Royal Infirmary, Bradford, UK
| | - Daniel P Hawley
- Department of Paediatric Rheumatology, Sheffield Children's Hospital, Sheffield, UK
| | - Alice Leahy
- Department of Paediatric Rheumatology, Southampton General Hospital, Southampton, UK
| | - Valentina Leone
- Department of Paediatric Rheumatology, Leeds Children Hospital, Leeds, UK
| | - Gulshan Malik
- Paediatric Rheumatology, Royal Aberdeen Children's Hospital, Aberdeen, UK
| | - Zoe McLaren
- Liverpool University Hospitals NHS Foundation Trusts, Liverpool, UK
| | - Clarissa Pilkington
- Department of Paediatric Rheumatology, Great Ormond Street Hospital, London, UK
| | - Athimalaipet V Ramanan
- University Hospitals Bristol NHS Foundation Trust & Bristol Medical School, University of Bristol, Bristol, UK
| | - Satyapal Rangaraj
- Department of Paediatric Rheumatology, Nottingham University Hospitals, Nottingham, UK
| | - Annie Ratcliffe
- Department of Paediatrics, Taunton & Somerset NHS Foundation Trust - Musgrove Park Hospital, Taunton, UK
| | - Phil Riley
- Paediatric Rheumatology, Royal Manchester Children's Hospital, Manchester, UK
| | - Ethan Sen
- Paediatric Rheumatology, Great North Children's Hospital, Royal Victoria Infirmary, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Arani Sridhar
- Leicester Children's Hospital, University Hospitals of Leicester NHS trust, Leicester, UK
| | - Nick Wilkinson
- Guy's & St Thomas's NHS Foundation Trust, Evelina Children's Hospital, London, UK
| | - Fiona Wood
- Department of Paediatrics, University Hospitals of Morecambe Bay NHS Foundation Trust, Royal Lancaster Infirmary, Lancaster, UK
| | - Michael W Beresford
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, UK; Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, UK
| | - Christian M Hedrich
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, UK; Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, UK
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Friedman DANIEL, Rose DAVID, Calkins HUGH, Digiorgi PAUL, Ramlawi BASEL, Awasthi Y, Ferguson M, Pulugan Z, Tiegland C, Brennan M. Real world outcomes of minimally invasive epicardial surgical left atrial appendage exclusion in atrial fibrillation patients with high risk of stroke and bleeding. Europace 2022. [DOI: 10.1093/europace/euac053.296] [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: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): AtriCure, Inc
Introduction
The left atrial appendage (LAA) is the site of thrombus formation in patients with atrial fibrillation (AF) and first line therapy for reducing the risk of stroke is oral anticoagulation (OACs). A subset of patients with AF carry a very high risk of stroke and bleeding and are ineligible for OAC and percutaneous LAA occlusion; these patients may be suitable for minimally invasive thoracoscopic epicardial surgical LAA exclusion (LAAE) which can be used with a wide variety of LAA morphologies with a ~98% rate of complete exclusion. While use of LAAE is well studied as a concomitant procedure, there are relatively few data on its use as a stand-alone procedure.
Purpose
To compare real-world outcomes of LAAE versus no-LAAE in AF patients at high risk of stroke and bleeding who are not on OACs.
Methods
We performed an analysis of Medicare beneficiaries with AF who were not on OACs and received LAAE (ICD10-PCS code 02L74CK, Oct 2015 – Dec 31, 2017) in the absence of a concomitant surgical or catheter AF ablation procedure. Patients were propensity-matched (1:4) to otherwise similar patients who did not receive LAAE (control), using age, gender, race, region, AF type, CHA2DS2-VASc, HAS-BLED, and co-morbidities. The primary endpoint was hospital readmission for a thromboembolic event (ischemic stroke, systemic embolism, or transient ischemic attack). Kaplan Meier event rates were calculated and 95% CI were generated via bootstrapping.
Results
A total of 243 patients who underwent LAAE and 1.7M control patients met study criteria. In the matched cohort, the mean age was 75 years, 61% were men, 77% had non-paroxysmal AF, and the mean CHADS2-VASC and HAS-BLED scores were 5.5 and 4.2, respectively. The 1-year rate of thromboembolism in the LAAE and control arms were 7.3% (95% CI 4.3% -10.9%) and 13.6 (95% CI 11.0% -16.4%) (Figure), respectively, with an absolute and relative risk reduction of 6.2% (95% CI 2.0-10.3, p-value=0.001, NNT 17) and 0.54 (95% CI 0.29-0.68, p=0.001).
Conclusion
Among high-risk AF patients who were not on OAC, LAAE was associated with a clinically meaningful and significantly lower risk of TE. Additional studies are needed to confirm these finding.
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Affiliation(s)
- DANIEL Friedman
- Duke University, Electrophysiology, Durham, United States of America
| | - DAVID Rose
- University of South Florida, Neurology, Tampa, United States of America
| | - HUGH Calkins
- Johns Hopkins University, Electrophysiology, Baltimore, United States of America
| | - PAUL Digiorgi
- Lee Health, Cardiac Surgery, Fort Myers, United States of America
| | - BASEL Ramlawi
- Lankenau Institute for Medical Research, Cardiac Surgery, Philadelphia, United States of America
| | - Y Awasthi
- AtriCure, Minnetonka, United States of America
| | - M Ferguson
- AtriCure, Minnetonka, United States of America
| | - Z Pulugan
- Avalere, Washington, United States of America
| | - C Tiegland
- Avalere, Washington, United States of America
| | - M Brennan
- Duke University, Cardiology, Durham, United States of America
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Palacios J, Hazkour N, Rao A, Brennan M, Oropallo A. ORIGINAL RESEARCH Virtual Events in the Era of COVID-19: Perspectives From a Virtual Interdisciplinary Wound Care Symposium. Wound Manag Prev 2022. [DOI: 10.25270/wmp.2022.5.1424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND: The coronavirus disease-19 pandemic has created changes in the way medicine is practiced. The move to virtual conferencing to avoid mass gatherings is a significant change to how health care professionals meet, discuss current trends, and share research. METHODS: Data from exit polls conducted after annual wound care symposiums were reviewed. Physicians, nurses, podiatrists, and other health care professionals attended. Respondents were asked to comment and reflect on their experiences of attending a virtual conference. RESULTS: Over 60% of all (N = 283) respondents stated the virtual conference was better than or on par with a live event. Many respondents had attended this live event in person in previous years. Of all respondents, 83% stated that they planned to access conference materials for the 30 days they remained posted after the event. More than 50% of respondents stated they favored the ability to communicate effectively with colleagues via the instant messaging feature offered by the conference. Approximately 80% of respondents stated that they would like to attend this and other conferences virtually in the future. CONCLUSIONS: The shift from in-person to virtual conferences has the potential to remain a significant method of attending health care conferences. Conference organizers are encouraged to consider how they can implement virtual components, including postconference access to materials, to enhance the conference experience. Additional work needs to be done to understand the impact of the virtual format on knowledge retention.
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McLellan K, Reilly L, Pollock L, Swann O, Anderson C, Martin N, Brennan M, Hague R, Walsh J. OA43 Development of a national across specialty multi-disciplinary team for management of hyper-inflammatory conditions during the SARS-CoV-2 pandemic. Rheumatology (Oxford) 2022. [DOI: 10.1093/rheumatology/keac132.043] [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: 11/14/2022] Open
Abstract
Abstract
Background/Aims
Effective multi-specialty team working is extremely beneficial in management of children with hyper-inflammatory conditions. With the recognition of paediatric inflammatory multisystem syndrome (PIMS) it became apparent a standardised process for discussion of patients would be beneficial. This includes urgent discussion, with access to multiple specialties, and sharing knowledge and experience in a novel condition. Delivering equitable healthcare including access to expertise, specific treatments and research is challenging in Scotland due to its geography. This is facilitated by successful clinical networks (Scottish Paediatric & Adolescent Rheumatology Network [SPARN] and Scottish Paediatric& Adolescent Infection & Immunology National Managed Clinical Network [SPAIIN]) and a well-established paediatric transport service (ScotSTAR). Our aim was to develop a multi-specialty multi-disciplinary team (MDT) for management of patients with hyper-inflammatory conditions.
Methods
Narrative account of MDT and service development
Results
We identified a core group of individuals with an interest in inflammatory disorders from different centres and specialties across Scotland including Rheumatology, Infectious Diseases, Cardiology, Intensive Care, Academic Paediatrics, Pharmacists and Clinical Nurse Specialists. Three priorities emerged from initial planning stages: urgent discussions around patient management, peer-to-peer learning and information sharing, and effective prioritisation of research. We designed a written framework and referral pathway, including criteria for acute cardiology involvement, ScotSTAR transfer and intensive care. An electronic proforma was designed to guide MDT discussion, medico-legal documentation and audit purposes. Table 1 describes characteristics of the first nine patients discussed. A particular strength was in diagnostics and consideration of differentials; among patients referred we identified those with haematological malignancy, systemic lupus erythematosus and non-accidental injury. Regular peer-review sessions were held, for reflection on cases and their management in both secondary and tertiary care settings. Clinicians throughout Scotland were encouraged to join via SPARN and SPAIIN networks.
Conclusion
This multi-specialty MDT has been and continues to be beneficial for management of hyper-inflammatory patients. We will review the process but hope the MDT will prove to continue to be beneficial for future patients. The authors would like to acknowledge all members of the MDT.
Disclosure
K. McLellan: None. L. Reilly: None. L. Pollock: None. O. Swann: None. C. Anderson: None. N. Martin: None. M. Brennan: None. R. Hague: None. J. Walsh: None.
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Affiliation(s)
- Kirsty McLellan
- Royal Hospital for Children, Paediatric Rheumatology, Glasgow, UNITED KINGDOM
| | - Liam Reilly
- Royal Hospital for Children, Paediatric Infectious Disease, Glasgow, UNITED KINGDOM
| | - Louisa Pollock
- Royal Hospital for Children, Paediatric Infectious Disease, Glasgow, UNITED KINGDOM
| | - Olivia Swann
- Royal Hospital for Children, Paediatric Infectious Disease, Glasgow, UNITED KINGDOM
| | - Catriona Anderson
- Royal Hospital for Children, Paediatric Rheumatology, Glasgow, UNITED KINGDOM
| | - Neil Martin
- Royal Hospital for Children, Paediatric Rheumatology, Glasgow, UNITED KINGDOM
| | - Mary Brennan
- Royal Hospital for Sick Children, Paediatric Rheumatology, Edinburgh, UNITED KINGDOM
| | - Rosie Hague
- Royal Hospital for Children, Paediatric Infectious Disease, Glasgow, UNITED KINGDOM
| | - Jo Walsh
- Royal Hospital for Children, Paediatric Rheumatology, Glasgow, UNITED KINGDOM
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15
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Brennan M, McDonnell MJ, Walsh SM, Gargoum F, Rutherford R. Review of the prevalence, pathogenesis and management of OSA-COPD overlap. Sleep Breath 2022; 26:1551-1560. [PMID: 35034250 DOI: 10.1007/s11325-021-02540-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 08/12/2021] [Revised: 11/22/2021] [Accepted: 11/25/2021] [Indexed: 02/08/2023]
Abstract
PURPOSE OSA-COPD overlap is an important and prevalent condition yet remains under-recognised among the vast majority of respiratory health professionals. Patients with OSA-COPD overlap experience more severe respiratory symptoms and worse quality of life, and the relative risk of exacerbations, hospitalisations, and mortality is higher than in either disease state alone. METHODS Electronic databases PUBMED and Google Scholar were searched for studies and academic papers that discussed OSA-COPD overlap. Relevant papers that discussed prevalence, pathophysiology, microbiome studies, treatment regimens and outcomes were included in this paper. RESULTS High-risk patients with either COPD or OSA should be screened for overlap syndrome as part of routine clinical practice. Screening questionnaires can identify high-risk patients with COPD who may benefit from formal polysomnography. Patients with OSA who are aged over 40 with a significant smoking history or environmental exposures have an increased pre-test probability of obstructive airway disease. The potential roles of gastro-oesophageal reflux disease and lung-gut microbiome are evolving and merit further investigation. A tailored approach to reach a timely diagnosis and thus optimisation of both conditions are key to management. CPAP is the primary therapy for OSA; however, patients with more advanced COPD, with daytime hypercapnia or severe nocturnal desaturations, may benefit from bilevel positive airway pressure. CONCLUSION Increased awareness, access to timely investigations and initiation of therapy will improve overall outcomes in OSA-COPD overlap by reducing hospitalisations for exacerbations of COPD and improve mortality rates.
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Affiliation(s)
- M Brennan
- Department of Respiratory Medicine, Galway University Hospital, Saolta University Hospital Group, Newcastle Road, Galway, Ireland.
| | - M J McDonnell
- Department of Respiratory Medicine, Galway University Hospital, Saolta University Hospital Group, Newcastle Road, Galway, Ireland
| | - S M Walsh
- Department of Respiratory Medicine, Galway University Hospital, Saolta University Hospital Group, Newcastle Road, Galway, Ireland
| | - F Gargoum
- Department of Respiratory Medicine, Galway University Hospital, Saolta University Hospital Group, Newcastle Road, Galway, Ireland
| | - R Rutherford
- Department of Respiratory Medicine, Galway University Hospital, Saolta University Hospital Group, Newcastle Road, Galway, Ireland
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Brennan M, McDonnell M, Duignan N, Gargoum F, Rutherford R. The use of cough peak flow in the assessment of respiratory function in clinical practice- A narrative literature review. Respir Med 2022; 193:106740. [DOI: 10.1016/j.rmed.2022.106740] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 01/05/2022] [Accepted: 01/09/2022] [Indexed: 12/12/2022]
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17
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Smith EMD, Tharmaratnam K, Al-Abadi E, Armon K, Bailey K, Brennan M, Ciurtin C, Gardner-Medwin J, Haslam KE, Hawley D, Leahy A, Leone V, Malik G, McLaren Z, Pilkington C, Ramanan AV, Rangaraj S, Ratcliffe A, Riley P, Sen E, Sridhar A, Wilkinson N, Hedrich CM, Jorgensen A, Beresford MW. Attainment of Low Disease Activity and Remission Targets reduces the risk of severe flare and new damage in Childhood Lupus. Rheumatology (Oxford) 2021; 61:3378-3389. [PMID: 34894234 PMCID: PMC9348762 DOI: 10.1093/rheumatology/keab915] [Citation(s) in RCA: 12] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 12/03/2021] [Indexed: 11/14/2022] Open
Abstract
Objectives To assess the achievability and effect of attaining low disease activity (LDA) or remission in childhood-onset SLE (cSLE). Methods Attainment of three adult-SLE derived definitions of LDA (LLDAS, LA, Toronto-LDA), and four definitions of remission (clinical-SLEDAI-defined remission on/off treatment, pBILAG-defined remission on/off treatment) was assessed in UK JSLE Cohort Study patients longitudinally. Prentice–Williams–Petersen gap recurrent event models assessed the impact of LDA/remission attainment on severe flare/new damage. Results LLDAS, LA and Toronto-LDA targets were reached in 67%, 73% and 32% of patients, after a median of 18, 15 or 17 months, respectively. Cumulatively, LLDAS, LA and Toronto-LDA was attained for a median of 23%, 31% and 19% of total follow-up-time, respectively. Remission on-treatment was more common (61% cSLEDAI-defined, 42% pBILAG-defined) than remission off-treatment (31% cSLEDAI-defined, 21% pBILAG-defined). Attainment of all target states, and disease duration (>1 year), significantly reduced the hazard of severe flare (P < 0.001). As cumulative time in each target increased, hazard of severe flare progressively reduced. LLDAS attainment reduced the hazard of severe flare more than LA or Toronto-LDA (P < 0.001). Attainment of LLDAS and all remission definitions led to a statistically comparable reduction in the hazards of severe flare (P > 0.05). Attainment of all targets reduced the hazards of new damage (P < 0.05). Conclusions This is the first study demonstrating that adult-SLE-derived definitions of LDA/remission are achievable in cSLE, significantly reducing risk of severe flare/new damage. Of the LDA definitions, LLDAS performed best, leading to a statistically comparable reduction in the hazards of severe flare to attainment of clinical remission.
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Affiliation(s)
- Eve M D Smith
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK.,Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK
| | - Kukatharmini Tharmaratnam
- Department of Health Data Science, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Eslam Al-Abadi
- Department of Rheumatology, Birmingham Children's Hospital, Birmingham, UK
| | - Kate Armon
- Department of Paediatric Rheumatology, Cambridge University Hospitals, Cambridge, UK
| | - Kathryn Bailey
- Department of Paediatric Rheumatology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Mary Brennan
- Department of Paediatric Rheumatology, Royal Hospital for Sick Children, Edinburgh, UK
| | - Coziana Ciurtin
- Centre for Adolescent Rheumatology, University College London, London, UK
| | | | - Kirsty E Haslam
- Department of Paediatrics, Bradford Royal Infirmary, Bradford, UK
| | - Daniel Hawley
- Department of Paediatric Rheumatology, Sheffield Children's Hospital, Sheffield, UK
| | - Alice Leahy
- Department of Paediatric Rheumatology, Southampton General Hospital, Southampton, UK
| | - Valentina Leone
- Department of Paediatric Rheumatology, Leeds Children Hospital, Leeds, UK
| | - Gulshan Malik
- Paediatric Rheumatology, Royal Aberdeen Children's Hospital, Aberdeen, UK
| | - Zoe McLaren
- Rheumatology Department, Aintree University Hospital, Liverpool, UK
| | - Clarissa Pilkington
- Department of Paediatric Rheumatology, Great Ormond Street Hospital, London, UK
| | - Athimalaipet V Ramanan
- University Hospitals Bristol NHS Foundation Trust & Bristol Medical School, University of Bristol, Bristol, UK
| | - Satyapal Rangaraj
- Department of Paediatric Rheumatology, Nottingham University Hospitals, Nottingham, UK
| | - Annie Ratcliffe
- Department of Paediatrics, Musgrove Park Hospital, Taunton, UK
| | - Philip Riley
- Department of Paediatric Rheumatology, Royal Manchester Children's Hospital, Manchester, UK
| | - Ethan Sen
- Paediatric Rheumatology, Great North Children's Hospital & Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Arani Sridhar
- Leicester Children's Hospital, University Hospitals of Leicester NHS trust, Leicester, UK
| | - Nick Wilkinson
- Guy's & St Thomas's NHS Foundation Trust, Evelina Children's Hospital, London, UK
| | - Christian M Hedrich
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK.,Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK
| | - Andrea Jorgensen
- Department of Health Data Science, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Michael W Beresford
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK.,Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK
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Smith EMD, Rasul S, Ciurtin C, Al-Abadi E, Armon K, Bailey K, Brennan M, Gardner-Medwin J, Haslam K, Hawley D, Lane S, Leahy A, Leone V, Malik G, Mewar D, Moots R, Pilkington C, Ramanan AV, Rangaraj S, Ratcliffe A, Riley P, Sen E, Sridhar A, Wilkinson N, Beresford MW, McCann LJ, Hedrich CM. Limited sensitivity and specificity of the ACR/EULAR-2019 classification criteria for SLE in JSLE?-observations from the UK JSLE Cohort Study. Rheumatology (Oxford) 2021; 60:5271-5281. [PMID: 33690793 PMCID: PMC8566265 DOI: 10.1093/rheumatology/keab210] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 02/23/2021] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES This study aimed to test the performance of the new ACR and EULAR criteria, that include ANA positivity as entry criterion, in JSLE. METHODS Performance of the ACR/EULAR-2019 criteria were compared with Systemic Lupus International Collaborating Clinics (SLICC-2012), using data from children and young people (CYP) in the UK JSLE Cohort Study (n = 482), with the ACR-1997 criteria used as reference standard. An unselected cohort of CYP positive for ANA (n = 129) was used to calculate positive/negative predictive values of the criteria. RESULTS At both first and last visits, the number of patients fulfilling the different classification criteria varied significantly (P < 0.001). The sensitivity of the SLICC-2012 criteria was higher when compared with that of the ACR/EULAR-2019 criteria at first and last visits (98% vs 94% for first visit, and 98% vs 96% for last visit; P < 0.001), when all available CYP were considered. The ACR/EULAR-2019 criteria were more specific when compared with the SLICC-2012 criteria (77% vs 67% for first visit, and 81% vs 71% for last visit; P < 0.001). Significant differences between the classification criteria were mainly caused by the variation in ANA positivity across ages. In the unselected cohort of ANA-positive CYP, the ACR/EULAR-2019 criteria produced the highest false-positive classification (6/129, 5%). CONCLUSION In CYP, the ACR/EULAR-2019 criteria are not superior to those of the SLICC-2012 or ACR-1997 criteria. If classification criteria are designed to include CYP and adult populations, paediatric rheumatologists should be included in the consensus and evaluation process, as seemingly minor changes can significantly affect outcomes.
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Affiliation(s)
- Eve M D Smith
- Department of Women’s & Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool
| | - Sajida Rasul
- Department of Paediatric Rheumatology, Royal Manchester Children’s Hospital, Manchester
| | - Coziana Ciurtin
- Department of Rheumatology, Centre for Adolescent Rheumatology, University College London, London
| | - Eslam Al-Abadi
- Department of Rheumatology, Birmingham Children’s Hospital, Birmingham
| | - Kate Armon
- Department of Paediatric Rheumatology, Cambridge University Hospitals, Cambridge
| | - Kathryn Bailey
- Department of Paediatric Rheumatology, Oxford University Hospitals NHS Foundation Trust, Oxford
| | - Mary Brennan
- Department of Paediatric Rheumatology, Royal Hospital for Sick Children, Edinburgh
| | | | - Kirsty Haslam
- Department of Paediatrics, Bradford Royal Infirmary, Bradford
| | - Daniel P Hawley
- Department of Paediatric Rheumatology, Sheffield Children’s Hospital, Sheffield
| | - Steven Lane
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool
| | - Alice Leahy
- Department of Paediatric Rheumatology, Southampton General Hospital, Southampton
| | - Valentina Leone
- Department of Paediatric Rheumatology, Leeds Children Hospital, Leeds
| | - Gulshan Malik
- Paediatric Rheumatology, Royal Aberdeen Children’s Hospital, Aberdeen
| | - Devesh Mewar
- Department of Rheumatology, Liverpool University Hospitals NHS Foundation Trust, Liverpool
| | - Robert Moots
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk
| | | | - Athimalaipet V Ramanan
- University Hospitals Bristol NHS Foundation Trust & Bristol Medical School, University of Bristol, Bristol
| | - Satyapal Rangaraj
- Department of Paediatric Rheumatology, Nottingham University Hospitals, Nottingham
| | | | - Phil Riley
- Department of Paediatric Rheumatology, Royal Manchester Children’s Hospital, Manchester
| | - Ethan Sen
- Paediatric Rheumatology, Great North Children’s Hospital, Royal Victoria Infirmary, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne
| | - Arani Sridhar
- Leicester Children’s Hospital, University Hospitals of Leicester NHS trust, Leicester
| | - Nick Wilkinson
- Department of Paediatric Rheumatology, Guy’s & St Thomas’s NHS Foundation Trust, Evelina Children’s Hospital, London, UK
| | - Michael W Beresford
- Department of Women’s & Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool
| | - Liza J McCann
- Department of Women’s & Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool
| | - Christian M Hedrich
- Department of Women’s & Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool
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Abstract
The demands of modern farming can place substantial stress upon the farmer, adversely impacting their wellbeing. This study identifies both the prevalence of stress and assesses the demographic, farm, and social characteristics that impact the incidence of stress. We report the results of a survey of a nationally representative sample of farm enterprises in Ireland undertaken in association with the Teagasc National Farm Survey (NFS) in 2018, which saw 736 questionnaires completed by farm operators. Frequency analysis is used to report the primary sources and prevalence of stress. A probit model is developed identifying and quantifying the factors that impact the incidence of stress. There were 57% of farmers who reported experiencing stress resulting from their farm work. Key sources of stress included "poor weather", (47%), "workload" (32%) and "financial" concerns (28%). The results of the probit model establish that the effect of age on the incidence of stress is significant, positive, and non-linear, indicating as farmers get older they are more likely to experience stress but at a declining rate. Operating a sheep farm system, as opposed to any other type of farm system, reduces the probability of stress. Working off-farm also reduces the probability of stress by 0.097, other things being equal. The findings highlight variance in the levels of stress reported by farmers by age and farm system, and consequently, the need to develop targeted supports that take consideration of differences within the population of farmers and farm enterprises.
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Affiliation(s)
- Mary Brennan
- Teagasc Rural Economy and Development Programme, Athenry, Co. Galway, Ireland.,Cork University Business School, University College Cork, Cork, Ireland
| | - Thia Hennessy
- Cork University Business School, University College Cork, Cork, Ireland
| | - David Meredith
- Teagasc Rural Economy and Development Programme, Athenry, Co. Galway, Ireland
| | - Emma Dillon
- Teagasc Rural Economy and Development Programme, Athenry, Co. Galway, Ireland
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Brennan M, Mulkerrin L, Wall D, O' Shea PM, Mulkerrin EC. A Comparison of Community-Acquired and Hospital-Acquired Hypernatraemia in Patients who are Acutely Admitted to Hospital. Ir Med J 2021; 114:407. [PMID: 34520642] [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: 06/13/2023]
Abstract
Background Hypernatraemia is associated with a short-term mortality of 20-60%. Age-related physiological changes predispose patients to hypernatraemia. This study reviewed acutely admitted patients comparing those with community-acquired (CAH) and hospital-acquired hypernatraemia (HAH). Methods A retrospective study of 102 consecutive acute medical in-patients with serum [Na]>145 mmol/L was conducted. Baseline characteristics, clinical presentation, laboratory values, monitoring, management and outcomes were compared between CAH and HAH groups. Results Patients were exclusively older (>69 years). Forty patients (39.2%) had CAH and sixty-two (61.8%) had HAH. Those with CAH were more likely to be NH residents, have dementia and reduced mobility. Most HAH patients had mild hypernatraemia initially (75.8%, n=47), and higher rates of acute kidney injury (27% (n=11) vs 8% (n=3)/p=0.02) were observed. Monitoring was inadequate and no patient had a free water deficit documented. Medication review and intravenous fluid prescribing was similar between groups. The median length of stay of discharged HAH patients was longer (22.5 vs 8 days/p=0.005). Mortality rates were similar (47% (n=29) vs 37% (n=15)/p=0.416). Time from admission to death was higher in HAH patients (16 vs 8 days/p=0.008). Conclusions Both CAH and HAH present similarly, however, older patients with cognitive/physical impairments are at an increased risk. Early identification of high-risk patients and adherence to best practice guidelines is required.
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Affiliation(s)
- M Brennan
- Department of Geriatric Medicine, Saolta University Health Care Group (SUHCG), University Hospital Galway, Co. Galway
| | - L Mulkerrin
- Department of Geriatric Medicine, Saolta University Health Care Group (SUHCG), University Hospital Galway, Co. Galway
| | - D Wall
- School of Mathematics, Statistics and Applied Mathematics, National University of Ireland Galway
| | - P M O' Shea
- Department of Clinical Biochemistry, Saolta University Health Care Group (SUHCG), Galway University Hospitals, Galway, Ireland
- School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - E C Mulkerrin
- Department of Geriatric Medicine, Saolta University Health Care Group (SUHCG), University Hospital Galway, Co. Galway
- School of Medicine, National University of Ireland Galway, Galway, Ireland
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21
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Brennan M, Uveges MK. Ethical Issues in the Care of Emerging Adults in Pediatric Intensive Care Units. AACN Adv Crit Care 2021; 32:219-226. [PMID: 34161968 DOI: 10.4037/aacnacc2021949] [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: 11/01/2022]
Affiliation(s)
- Mary Brennan
- Mary Brennan is a Registered Nurse, Boston Children's Hospital, 300 Longwood Avenue Boston, MA 02115
| | - Melissa Kurtz Uveges
- Melissa Kurtz Uveges is Assistant Professor, Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts
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Isaacs S, Pinhasov T, Oropallo A, Brennan M, Rao A, Landis G, Agrell-Kann M, Li T. An Interdisciplinary Team Approach to Decrease Sacral Hospital-acquired Pressure Injuries: A Retrospective Cohort Study. Wound Manag Prev 2021. [DOI: 10.25270/wmp.2021.5.2632] [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: 11/05/2022]
Abstract
BACKGROUND: Hospital-acquired pressure injuries (HAPIs) of the sacrum are among the most common iatrogenic events in health care. Multi-intervention programs have been shown to decrease the prevalence of pressure injuries. PURPOSE: To assess changes in the yearly incidence of sacral HAPIs before and after implementation of a 3-pronged interdisciplinary intervention to reduce HAPI incidence. METHODS: A retrospective study of all patients admitted between 2010 and 2017 was conducted to evaluate the effect of a 2012 initiative on the incidence of sacral HAPIs. In 2012, an interdisciplinary team was created, and enhanced education programs for nursing staff and quality data reporting measures were implemented for all patients admitted to North Shore University Hospital, Manhasset, NY. Pre- and post-intervention patient variables and sacral HAPI outcomes were compared. RESULTS: Pre- intervention, the sacral HAPI incidence was 0.353% and 0.267% (mean 0.31%) in the years 2010 and 2011, respectively. Post-intervention the HAPI incidence was 0.033%, 0.043%, 0.008%, 0.007%, and 0.004% in the years 2013, 2014, 2015, 2016, and 2017, respectively (mean 0.019%) (2-sample unpaired t-statistic: 11.5937; P < .001). Significant variables and outcomes differences between pre-intervention (n = 245) and post-intervention (n = 49) patients with a sacral HAPI were seen for race (P < .0001), length of stay (P = .0096), and HAPI stage (P < .0001). CONCLUSION: A hospital-wide, multi-part, interdisciplinary intervention resulted in a significant and sustained reduction in the incidence of sacral HAPIs.
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Isaacs S, Pinhasov T, Oropallo A, Brennan M, Rao A, Landis G, Agrell-Kann M, Li T. An Interdisciplinary Team Approach to Decrease Sacral Hospital-acquired Pressure Injuries: A Retrospective Cohort Study. Wound Manag Prev 2021; 67:26-32. [PMID: 34283802] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Hospital-acquired pressure injuries (HAPIs) of the sacrum are among the most common iatrogenic events in health care. Multi-intervention programs have been shown to decrease the prevalence of pressure injuries. PURPOSE To assess changes in the yearly incidence of sacral HAPIs before and after implementation of a 3-pronged interdisciplinary intervention to reduce HAPI incidence. METHODS A retrospective study of all patients admitted between 2010 and 2017 was conducted to evaluate the effect of a 2012 initiative on the incidence of sacral HAPIs. In 2012, an interdisciplinary team was created, and enhanced education programs for nursing staff and quality data reporting measures were implemented for all patients admitted to North Shore University Hospital, Manhasset, NY. Pre- and post-intervention patient variables and sacral HAPI outcomes were compared. RESULTS Pre- intervention, the sacral HAPI incidence was 0.353% and 0.267% (mean 0.31%) in the years 2010 and 2011, respectively. Post-intervention the HAPI incidence was 0.033%, 0.043%, 0.008%, 0.007%, and 0.004% in the years 2013, 2014, 2015, 2016, and 2017, respectively (mean 0.019%) (2-sample unpaired t-statistic: 11.5937; P < .001). Significant variables and outcomes differences between pre-intervention (n = 245) and post-intervention (n = 49) patients with a sacral HAPI were seen for race (P < .0001), length of stay (P = .0096), and HAPI stage (P < .0001). CONCLUSION A hospital-wide, multi-part, interdisciplinary intervention resulted in a significant and sustained reduction in the incidence of sacral HAPIs.
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Affiliation(s)
- Shelby Isaacs
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Tamir Pinhasov
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Alisha Oropallo
- Department of Surgery, Comprehensive Wound Care Healing and Hyperbarics, Northwell Health, Lake Success, New York; Department of Vascular Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Mary Brennan
- Department of Nursing, North Shore University Hospital, Manhasset, New York
| | - Amit Rao
- Department of Surgery, Comprehensive Wound Care Healing and Hyperbarics, Northwell Health, Lake Success, New York
| | - Gregg Landis
- Department of Vascular Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Marie Agrell-Kann
- Department of Nursing, North Shore University Hospital, Manhasset, New York
| | - Timmy Li
- Department of Emergency Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
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Kapadia A, Brennan M, Poniatowski L, Perito P, Walsh T. 150 Evaluation and Treatment of Complications of Penuma Penile Implant. J Sex Med 2021. [DOI: 10.1016/j.jsxm.2021.01.169] [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: 11/24/2022]
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Brennan M, Brennan M, Naumovski J. Should We Calculate CrCl in Advance for All Our Patients in Our Nursing Homes to Prepare for Flu Season? J Am Med Dir Assoc 2021; 22:B16-B17. [PMID: 34287157 DOI: 10.1016/j.jamda.2021.01.038] [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: 11/26/2022]
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Jung C, Jung C, Jongyotha K, De I, Brennan M, Naumovski J. Using Virtual Pet to Replace Pet Therapy Visits in Our Nursing Facility During the COVID-19 Pandemic. J Am Med Dir Assoc 2021; 22:B18. [PMID: 34287164 PMCID: PMC7902228 DOI: 10.1016/j.jamda.2021.01.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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Tilley CP, Roitman J, Zafra KP, Brennan M. Real-time, simulation-enhanced interprofessional education in the care of older adults with multiple chronic comorbidities: a utilization-focused evaluation. Mhealth 2021; 7:3. [PMID: 33634186 PMCID: PMC7882276 DOI: 10.21037/mhealth-19-216] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 06/01/2020] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Interprofessional education (IPE) is a curricular requirement for all healthcare professional education standards. To foster learning about, from and with each other, consistent with the Interprofessional Education Consortium's Core Competencies, many graduate schools are integrating interprofessional (IP) simulation experiences throughout their educational curricula, providing multiple opportunities for health professional students to collaborate and practice together. High-fidelity, real-time simulations help students from diverse professional backgrounds to apply their classroom learning in realistic clinical situations, utilize mobile technology to access clinical decision support (CDS) software, and receive feedback in a safe setting, ensuring they are practice-ready upon graduation. METHODS New York University Rory Meyers College of Nursing (NYU) and Long Island University College of Pharmacy (LIU) partnered for two consecutive years to create, coordinate and implement two interprofessional educational simulations involving patients with chronic cardiovascular disease. A utilization-focused evaluation of high-fidelity, simulation-enhanced IPE (Sim-IPE) was implemented to assess students' IP competencies before and after their participation in the IPE-simulation and their overall satisfaction with the experience. The Interprofessional Collaborative Competency Attainment Survey (ICCAS), a reliable instrument, was administered to both doctor of pharmacy students and primary care advanced practice nursing students before and after each simulation experience. Additionally, student satisfaction surveys were administered following the IPE-simulation. RESULTS Aggregated means revealed statistically significant improvements in each of the six domains including communication, collaboration, roles and responsibilities, collaborative patient/family approach, conflict resolution and team functioning. Student ratings revealed positive experiences with the IPE-simulations. CONCLUSIONS High-fidelity, real-time IPE-simulation is a powerful pedagogy to help graduate students from different professional backgrounds practice applying IP competencies in simulated experiences. Quality improvement studies and research studies are needed to assess the impact of high-fidelity, real-time simulations throughout graduate curricula with different types of patients to improve coordinated, team approaches to treatment.
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Affiliation(s)
- Charles P. Tilley
- Department of Nursing, Calvary Hospital and Hospice, The Bronx, NY, USA
- New York University Rory Meyers College of Nursing, New York, NY, USA
| | - Janna Roitman
- Long Island University (LIU) Arnold & Marie Schwartz College of Pharmacy and Health Sciences, Brooklyn, NY, USA
| | | | - Mary Brennan
- New York University Rory Meyers College of Nursing, New York, NY, USA
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Brennan M, Mulkerrin L, O'Keeffe ST, O'Shea PM. Approach to the Management of Hypernatraemia in Older Hospitalised Patients. J Nutr Health Aging 2021; 25:1161-1166. [PMID: 34866143 DOI: 10.1007/s12603-021-1692-5] [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] [Indexed: 10/20/2022]
Abstract
Hypernatraemia is associated with high morbidity and mortality and is more common in patients of older age, nursing home residents and those with cognitive impairment and restricted mobility. The most common cause in hospital settings is water dehydration due to reduced intake although other causes should be identified. Once identified, prompt management is necessary to avoid delayed correction as prolonged hypernatremia is associated with increased hospital stay and mortality. Comprehensive history-taking and physical examination, basic investigations and medication review are essential to identify causative and remediable factors in those admitted with hypernatraemia. Accurate calculation of fluid deficit and ongoing losses is essential in order to ensure adequate fluid replacement, The administration of appropriate, usually hypotonic, fluids is also essential to the timely restoration of eunatraemia. Although evidence of definite harm resulting from rapid correction is lacking, a serum sodium reduction rate of <12 mmol/l day is advised with the caveat that close monitoring of electrolytes is required to ensure the desired correction rate is being achieved. Medical and nursing professionals should have access to a local hospital protocol to guide management of patients with hypernatraemia to improve patient outcomes and mitigate the risk of harm, particularly from under-recognition and slow correction.
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Affiliation(s)
- M Brennan
- Dr Michelle Brennan, Specialist Registrar in Geriatric and General Internal Medicine, Department of Geriatric Medicine, Saolta University Healthcare Group, University Hospital Galway, Newcastle Road, Galway H91 YR71, Ireland. Tel No: 00535 91 524222,
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Lepelley A, Martin-Niclós MJ, Le Bihan M, Marsh JA, Uggenti C, Rice GI, Bondet V, Duffy D, Hertzog J, Rehwinkel J, Amselem S, Boulisfane-El Khalifi S, Brennan M, Carter E, Chatenoud L, Chhun S, Coulomb l’Hermine A, Depp M, Legendre M, Mackenzie KJ, Marey J, McDougall C, McKenzie KJ, Molina TJ, Neven B, Seabra L, Thumerelle C, Wislez M, Nathan N, Manel N, Crow YJ, Frémond ML. Mutations in COPA lead to abnormal trafficking of STING to the Golgi and interferon signaling. J Exp Med 2020; 217:e20200600. [PMID: 32725128 PMCID: PMC7596811 DOI: 10.1084/jem.20200600] [Citation(s) in RCA: 117] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/04/2020] [Accepted: 07/06/2020] [Indexed: 01/01/2023] Open
Abstract
Heterozygous missense mutations in coatomer protein subunit α, COPA, cause a syndrome overlapping clinically with type I IFN-mediated disease due to gain-of-function in STING, a key adaptor of IFN signaling. Recently, increased levels of IFN-stimulated genes (ISGs) were described in COPA syndrome. However, the link between COPA mutations and IFN signaling is unknown. We observed elevated levels of ISGs and IFN-α in blood of symptomatic COPA patients. In vitro, both overexpression of mutant COPA and silencing of COPA induced STING-dependent IFN signaling. We detected an interaction between COPA and STING, and mutant COPA was associated with an accumulation of ER-resident STING at the Golgi. Given the known role of the coatomer protein complex I, we speculate that loss of COPA function leads to enhanced type I IFN signaling due to a failure of Golgi-to-ER STING retrieval. These data highlight the importance of the ER-Golgi axis in the control of autoinflammation and inform therapeutic strategies in COPA syndrome.
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Affiliation(s)
- Alice Lepelley
- Laboratory of Neurogenetics and Neuroinflammation, Imagine Institute, Paris, France
| | | | - Melvin Le Bihan
- Immunity and Cancer Department, Institut Curie, Paris-Sciences-et-Lettres Research University, Institut National de la Santé et de la Recherche Médicale U932, Paris, France
| | - Joseph A. Marsh
- Medical Research Council Human Genetics Unit, Medical Research Council Institute of Genetics and Molecular Medicine, The University of Edinburgh, Edinburgh, UK
| | - Carolina Uggenti
- Centre for Genomic and Experimental Medicine, Medical Research Council Institute of Genetics and Molecular Medicine, The University of Edinburgh, Edinburgh, UK
| | - Gillian I. Rice
- Division of Evolution and Genomic Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Vincent Bondet
- Immunobiology of Dendritic Cells, Institut Pasteur, Paris, France
- Institut National de la Santé et de la Recherche Médicale U1223, Paris, France
| | - Darragh Duffy
- Immunobiology of Dendritic Cells, Institut Pasteur, Paris, France
- Institut National de la Santé et de la Recherche Médicale U1223, Paris, France
| | - Jonny Hertzog
- Medical Research Council Human Immunology Unit, Medical Research Council Weatherall Institute of Molecular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Jan Rehwinkel
- Medical Research Council Human Immunology Unit, Medical Research Council Weatherall Institute of Molecular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Serge Amselem
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale/UMRS_933, Trousseau University Hospital, Paris, France
- Genetics Department, Trousseau University Hospital, Assistance Publique–Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Siham Boulisfane-El Khalifi
- Emergency, Infectious Disease and Pediatric Rheumatology Department, Centre Hospitalier Régional Universitaire Lille, University of Lille, Lille, France
| | - Mary Brennan
- Department of Paediatric Rheumatology, Royal Hospital for Sick Children, Edinburgh, UK
| | - Edwin Carter
- Centre for Genomic and Experimental Medicine, Medical Research Council Institute of Genetics and Molecular Medicine, The University of Edinburgh, Edinburgh, UK
| | - Lucienne Chatenoud
- Paris Descartes University, Université de Paris, Sorbonne-Paris-Cité, Paris, France
- Laboratory of Immunology, Hôpital Necker-Enfants Malades, Assistance Publique–Hôpitaux de Paris, Centre-Université de Paris, Paris, France
- Institut Necker-Enfants Malades, Centre National de la Recherche Scientifique UMR8253, Institut National de la Santé et de la Recherche Médicale UMR1151, Team Immunoregulation and Immunopathology, Paris, France
| | - Stéphanie Chhun
- Paris Descartes University, Université de Paris, Sorbonne-Paris-Cité, Paris, France
- Laboratory of Immunology, Hôpital Necker-Enfants Malades, Assistance Publique–Hôpitaux de Paris, Centre-Université de Paris, Paris, France
- Institut Necker-Enfants Malades, Centre National de la Recherche Scientifique UMR8253, Institut National de la Santé et de la Recherche Médicale UMR1151, Team Immunoregulation and Immunopathology, Paris, France
| | - Aurore Coulomb l’Hermine
- Pathology Department, Trousseau University Hospital, Assistance Publique–Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Marine Depp
- Centre for Genomic and Experimental Medicine, Medical Research Council Institute of Genetics and Molecular Medicine, The University of Edinburgh, Edinburgh, UK
| | - Marie Legendre
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale/UMRS_933, Trousseau University Hospital, Paris, France
- Genetics Department, Trousseau University Hospital, Assistance Publique–Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Karen J. Mackenzie
- Medical Research Council Human Genetics Unit, Medical Research Council Institute of Genetics and Molecular Medicine, The University of Edinburgh, Edinburgh, UK
| | - Jonathan Marey
- Pneumology Department, Cochin Hospital, Assistance Publique–Hôpitaux de Paris, Centre-Université de Paris, Paris, France
| | - Catherine McDougall
- Department of Paediatric Respiratory Medicine, Royal Hospital for Sick Children, Edinburgh, UK
| | - Kathryn J. McKenzie
- Paediatric Pathology Department, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Thierry Jo Molina
- Paris Descartes University, Université de Paris, Sorbonne-Paris-Cité, Paris, France
- Pathology Department, Hôpital Necker-Enfants Malades, Assistance Publique–Hôpitaux de Paris, Centre-Université de Paris, Paris, France
| | - Bénédicte Neven
- Paris Descartes University, Université de Paris, Sorbonne-Paris-Cité, Paris, France
- Pediatric Hematology-Immunology and Rheumatology Department, Hôpital Necker-Enfants Malades, Assistance Publique–Hôpitaux de Paris, Centre-Université de Paris, Paris, France
- Institut National de la Santé et de la Recherche Médicale UMR 1163, Laboratory of Immunogenetics of Paediatric Autoimmunity, Imagine Institute, Paris, France
| | - Luis Seabra
- Laboratory of Neurogenetics and Neuroinflammation, Imagine Institute, Paris, France
| | - Caroline Thumerelle
- Pediatric Pneumology Department, Hôpital Jeanne de Flandre, Centre Hospitalier Régional Universitaire Lille, Lille, France
| | - Marie Wislez
- Pneumology Department, Cochin Hospital, Assistance Publique–Hôpitaux de Paris, Centre-Université de Paris, Paris, France
- Cordeliers Research Center, Université Paris Descartes, Université de Paris, UMRS1138 Inflammation, Complement and Cancer Team, Paris, France
| | - Nadia Nathan
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale/UMRS_933, Trousseau University Hospital, Paris, France
- Pediatric Pulmonology Department and Reference Center for Rare Lung Disease RespiRare, Trousseau University Hospital, Assistance Publique–Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Nicolas Manel
- Immunity and Cancer Department, Institut Curie, Paris-Sciences-et-Lettres Research University, Institut National de la Santé et de la Recherche Médicale U932, Paris, France
| | - Yanick J. Crow
- Laboratory of Neurogenetics and Neuroinflammation, Imagine Institute, Paris, France
- Centre for Genomic and Experimental Medicine, Medical Research Council Institute of Genetics and Molecular Medicine, The University of Edinburgh, Edinburgh, UK
| | - Marie-Louise Frémond
- Laboratory of Neurogenetics and Neuroinflammation, Imagine Institute, Paris, France
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Lin A, Helgeson E, Treister N, Schmidt B, Patton L, Elting L, Lalla R, Brennan M, Sollecito T. The Impact Of Head And Neck Cancer Radiotherapy On Salivary Flow And Quality Of Life: Results Of The OraRad Study. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.276] [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: 10/23/2022]
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Bambra W, Daly JM, Kendall NR, Gardner DS, Brennan M, Kydd JH. Equine influenza vaccination as reported by horse owners and factors influencing their decision to vaccinate or not. Prev Vet Med 2020; 180:105011. [PMID: 32438206 DOI: 10.1016/j.prevetmed.2020.105011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/26/2019] [Revised: 03/27/2020] [Accepted: 04/22/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Equine influenza virus is a highly contagious respiratory pathogen that causes pyrexia, anorexia, lethargy and coughing in immunologically naïve horses. Vaccines against equine influenza are available and vaccination is mandatory for horses that participate in affiliated competitions, but this group forms a small proportion of the total horse population. The aims of this study were to: i) identify the equine influenza vaccination rate as reported in 2016 by horse owners in the United Kingdom (UK); ii) examine the demographics of owners and horses which were associated with significantly lower influenza vaccination rates and iii) explore factors that influence horse owners' decisions around influenza vaccine uptake. RESULTS Responses from 4837 UK horse owners who were responsible for 10,501 horses were analysed. An overall equine influenza vaccination rate of 80% (8385/10501) was reported. Several owner demographic characteristics were associated with significantly lower (p<0.05) reported equine influenza vaccination rates including: some geographical locations, increasing horse owner age, annual household income of less that £15,000 and owning more than one horse. Horse-related features which were associated with significantly lower reported equine influenza vaccination rates included age ranges of <4 years and > 20 years, use as a companion or breeding animal or leaving their home premises either never or at most once a year. The most common reasons cited for failing to vaccinate horses was no competition activity, lack of exposure to influenza and expense of vaccines. In contrast, the most common underlying reasons given by horse owners who vaccinated their horse were protection of the individual horse against disease, veterinary advice and to protect the national herd. Owners of vaccinated horses had less previous experience of an influenza outbreak or adverse reaction to vaccination compared with owners of unvaccinated horses. CONCLUSIONS This study documented a high rate of equine influenza vaccination as reported by owners in a substantial number of horses in the UK, but this does not reflect the level of protection. Sub-populations of horses which were less likely to be vaccinated and the factors that influence each owner's decision around vaccination of their horses against equine influenza were identified, but may alter following the 2019 European influenza outbreak. This information may nevertheless help veterinary surgeons identify "at-risk" patients and communicate more personalised advice to their horse-owning clients. It may also influence educational campaigns about equine influenza directed to horse owners, which aim to improve uptake of vaccination against this pathogen.
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Affiliation(s)
- W Bambra
- School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington, Loughborough, Leicestershire, LE12 5RD, United Kingdom.
| | - J M Daly
- School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington, Loughborough, Leicestershire, LE12 5RD, United Kingdom.
| | - N R Kendall
- School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington, Loughborough, Leicestershire, LE12 5RD, United Kingdom.
| | - D S Gardner
- School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington, Loughborough, Leicestershire, LE12 5RD, United Kingdom.
| | - M Brennan
- School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington, Loughborough, Leicestershire, LE12 5RD, United Kingdom.
| | - J H Kydd
- School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington, Loughborough, Leicestershire, LE12 5RD, United Kingdom.
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Brennan M, Murray O, O'Shea PM, Mulkerrin EC. Increased rates of hypernatraemia during modest heatwaves in temperate climates. QJM 2020; 113:266-270. [PMID: 31665466 DOI: 10.1093/qjmed/hcz280] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 09/25/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Hypernatraemia is associated with morbidity and mortality, particularly in the older person. Last summer, Ireland experienced prolonged periods of excessive heat. The Irish meteorological service defines a heatwave as temperatures exceeding 25°C for five consecutive days. AIM This study sought to compare the frequency of hypernatraemia (sodium (Na+) >145 mmol/l) observed during a modest heatwave with that during average ambient temperature in the temperate Irish climate. DESIGN Retrospective cross-sectional analysis with nested case-control study. METHODS The 10-day period from 24 June to 3 July in 2017 and 2018 were chosen as the control and heatwave periods, respectively. Patients aged >65 with at least one Na+ value recorded on the laboratory information system were included. Local meteorological data, age, gender and Na+ levels were evaluated. RESULTS Maximum air temperatures were significantly higher during the heatwave period (mean 27°C vs. 16.8°C, P < 0.0001). Hypernatraemia was present in 3.6% (66/1840) of samples collected during the heatwave compared to 1.4% (23/1593) in the control period. The mean age of affected patients was similar in both groups, 75 years ±7 (P = 1.000). Almost half of participants (49.5%) were male. The frequency of hypernatraemia observed was not influenced by gender, P = 0.33. The median sodium concentrations were similar in both groups, P = 1.00. CONCLUSION Hypernatraemia was 2.5 times more frequent in samples drawn during the heatwave compared to the control period. In this study, neither age nor gender impacted the profile of patients diagnosed with hypernatraemia. A modest rise in temperatures increases hypernatraemia rates in temperate climates.
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Affiliation(s)
- M Brennan
- Department of Geriatric Medicine, Saolta University Health Care Group (SUHCG), University Hospital Galway, Newcastle Road, Galway, Ireland
| | - O Murray
- Department of Pharmacology & Therapeutics, National University of Ireland, Newcastle Road, Galway, Ireland
| | - P M O'Shea
- Department of Clinical Biochemistry, Saolta University Health Care Group (SUHCG), University Hospital Galway, Newcastle Road, Galway, Ireland
| | - E C Mulkerrin
- Department of Geriatric Medicine, Saolta University Health Care Group (SUHCG), University Hospital Galway, Newcastle Road, Galway, Ireland
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Fedotov AV, Altinbas Z, Belomestnykh S, Ben-Zvi I, Blaskiewicz M, Brennan M, Bruno D, Brutus C, Costanzo M, Drees A, Fischer W, Fite J, Gaowei M, Gassner D, Gu X, Halinski J, Hamdi K, Hammons L, Harvey M, Hayes T, Hulsart R, Inacker P, Jamilkowski J, Jing Y, Kewisch J, Kankiya P, Kayran D, Lehn R, Liaw CJ, Litvinenko V, Liu C, Ma J, Mahler G, Mapes M, Marusic A, Mernick K, Mi C, Michnoff R, Miller T, Minty M, Narayan G, Nayak S, Nguyen L, Paniccia M, Pinayev I, Polizzo S, Ptitsyn V, Rao T, Robert-Demolaize G, Roser T, Sandberg J, Schoefer V, Schultheiss C, Seletskiy S, Severino F, Shrey T, Smart L, Smith K, Song H, Sukhanov A, Than R, Thieberger P, Trabocchi S, Tuozzolo J, Wanderer P, Wang E, Wang G, Weiss D, Xiao B, Xin T, Xu W, Zaltsman A, Zhao H, Zhao Z. Experimental Demonstration of Hadron Beam Cooling Using Radio-Frequency Accelerated Electron Bunches. Phys Rev Lett 2020; 124:084801. [PMID: 32167359 DOI: 10.1103/physrevlett.124.084801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 01/24/2020] [Accepted: 02/03/2020] [Indexed: 06/10/2023]
Abstract
Cooling of beams of gold ions using electron bunches accelerated with radio-frequency systems was recently experimentally demonstrated in the Relativistic Heavy Ion Collider at Brookhaven National Laboratory. Such an approach is new and opens the possibility of using this technique at higher energies than possible with electrostatic acceleration of electron beams. The challenges of this approach include generation of electron beams suitable for cooling, delivery of electron bunches of the required quality to the cooling sections without degradation of beam angular divergence and energy spread, achieving the required small angles between electron and ion trajectories in the cooling sections, precise velocity matching between the two beams, high-current operation of the electron accelerator, as well as several physics effects related to bunched-beam cooling. Here we report on the first demonstration of cooling hadron beams using this new approach.
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Affiliation(s)
- A V Fedotov
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - Z Altinbas
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - S Belomestnykh
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - I Ben-Zvi
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - M Blaskiewicz
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - M Brennan
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - D Bruno
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - C Brutus
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - M Costanzo
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - A Drees
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - W Fischer
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - J Fite
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - M Gaowei
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - D Gassner
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - X Gu
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - J Halinski
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - K Hamdi
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - L Hammons
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - M Harvey
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - T Hayes
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - R Hulsart
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - P Inacker
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - J Jamilkowski
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - Y Jing
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - J Kewisch
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - P Kankiya
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - D Kayran
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - R Lehn
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - C J Liaw
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - V Litvinenko
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - C Liu
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - J Ma
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - G Mahler
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - M Mapes
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - A Marusic
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - K Mernick
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - C Mi
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - R Michnoff
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - T Miller
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - M Minty
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - G Narayan
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - S Nayak
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - L Nguyen
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - M Paniccia
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - I Pinayev
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - S Polizzo
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - V Ptitsyn
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - T Rao
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | | | - T Roser
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - J Sandberg
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - V Schoefer
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - C Schultheiss
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - S Seletskiy
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - F Severino
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - T Shrey
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - L Smart
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - K Smith
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - H Song
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - A Sukhanov
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - R Than
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - P Thieberger
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - S Trabocchi
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - J Tuozzolo
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - P Wanderer
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - E Wang
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - G Wang
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - D Weiss
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - B Xiao
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - T Xin
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - W Xu
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - A Zaltsman
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - H Zhao
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - Z Zhao
- Brookhaven National Laboratory, Upton, New York 11973, USA
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O'Brien S, Garvey P, Baker K, Brennan M, Cormican M, Cuddihy J, De Lappe N, Ellard R, Fallon Ú, Irvine N, Murphy S, O'Brien D, O'Connor M, O'Hare C, O'Sullivan MB, Part AM, Rooney P, Ryan A, Waldron G, Ward M, McKeown PJ. Investigation of a foodborne outbreak of Shigella sonnei in Ireland and Northern Ireland, December 2016: the benefits of cross-border collaboration and commercial sales data. Public Health 2020; 182:19-25. [PMID: 32120067 DOI: 10.1016/j.puhe.2020.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 08/27/2019] [Revised: 12/11/2019] [Accepted: 01/09/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To describe a cross-border foodborne outbreak of Shigella sonnei that occurred in Ireland and Northern Ireland (NI) in December 2016 whilst also highlighting the valuable roles of sales data and international collaboration in the investigation and control of this outbreak. STUDY DESIGN A cross-border outbreak control team was established to investigate the outbreak. METHODS Epidemiological, microbiological, and environmental investigations were undertaken. Traditional analytical epidemiological studies were not feasible in this investigation. The restaurant chain provided sales data, which allowed assessment of a possible increased risk of illness associated with exposure to a particular type of heated food product (product A). RESULTS Confirmed cases demonstrated sole trimethoprim resistance: an atypical antibiogram for Shigella isolates in Ireland. Early communication and the sharing of information within the outbreak control team facilitated the early detection of the international dimension of this outbreak. A joint international alert using the European Centre for Disease Control's confidential Epidemic Intelligence Information System for Food- and Waterborne Diseases and Zoonoses (EPIS-FWD) did not reveal further cases outside of the island of Ireland. The outbreak investigation identified that nine of thirteen primary case individuals had consumed product A from one of multiple branches of a restaurant chain located throughout the island of Ireland. Product A was made specifically for this chain in a food production facility in NI. S. sonnei was not detected in food samples from the food production facility. Strong statistical associations were observed between visiting a branch of this restaurant chain between 5 and 9 December 2016 and eating product A and developing shigellosis. CONCLUSIONS This outbreak investigation highlights the importance of international collaboration in the efficient identification of cross-border foodborne outbreaks and the value of using sales data as the analytical component of such studies.
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Affiliation(s)
- S O'Brien
- HSE-Health Protection Surveillance Centre, Dublin, Ireland; Department of Public Health HSE-NW, Sligo, Ireland.
| | - P Garvey
- HSE-Health Protection Surveillance Centre, Dublin, Ireland
| | - K Baker
- Food Standards Agency Northern Ireland, Belfast, Northern Ireland, Ireland
| | - M Brennan
- Food Safety Authority of Ireland, Dublin, Ireland
| | - M Cormican
- National Salmonella, Shigella and Listeria Reference Laboratory, Galway, Ireland
| | - J Cuddihy
- Department of Public Health HSE-SE, Kilkenny, Ireland
| | - N De Lappe
- National Salmonella, Shigella and Listeria Reference Laboratory, Galway, Ireland
| | - R Ellard
- Food Safety Authority of Ireland, Dublin, Ireland
| | - Ú Fallon
- Department of Public Health HSE-Midlands, Co Offaly, Ireland
| | - N Irvine
- Public Health Agency Northern Ireland, Belfast, Northern Ireland, UK
| | - S Murphy
- Environmental Health Department, Newry, Mourne & Down District Council, Northern Ireland, UK
| | - D O'Brien
- HSE Environmental Health Service Dublin Specialist Section, Dublin, Ireland
| | - M O'Connor
- Department of Public Health HSE-E, Dublin, Ireland
| | - C O'Hare
- Department of Public Health HSE-SE, Kilkenny, Ireland
| | | | - A M Part
- HSE Environmental Health Service Dublin Mid Leinster, Dublin, Ireland
| | - P Rooney
- Belfast Health and Social Care Trust, Belfast, Northern Ireland, UK
| | - A Ryan
- Department of Public Health HSE-NW, Sligo, Ireland
| | - G Waldron
- Public Health Agency Northern Ireland, Belfast, Northern Ireland, UK
| | - M Ward
- Department of Public Health HSE-E, Dublin, Ireland
| | - P J McKeown
- HSE-Health Protection Surveillance Centre, Dublin, Ireland
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Brennan M, Scott S, Bergin P. Sudden unexpected death in epilepsy (SUDEP) in New Zealand; a retrospective review. N Z Med J 2020; 133:65-71. [PMID: 31945043] [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: 06/10/2023]
Abstract
AIM Sudden unexpected death in epilepsy (SUDEP) is well recognised and widely reported but remains poorly understood. SUDEP in young adults is 27 times more common than sudden death in control populations. The incidence of SUDEP in New Zealand is not known but up to 40 people with epilepsy may die from SUDEP every year. A review of coroner's reports of SUDEP was undertaken to learn more about SUDEP in New Zealand. METHOD Coroner's reports of all cases of possible SUDEP in New Zealand from 2007-2016 (n=190) were obtained and post-mortem and toxicology results were reviewed. Cases were categorised using published criteria. RESULTS We obtained reports of 190 cases from the coroner's office. Of these 190 cases, we determined that 123 were definite SUDEP, 40 were definite SUDEP plus, three were probable SUDEP, seven were possible SUDEP and 17 were probably not SUDEP. The number of cases per year varied from 11-26 (2013). Cases were aged 1.5-67 years, with 63% aged 15-45 (mean 37 years). Sixty-one percent were male. Eighty-seven percent of the deaths occurred at home, with 74% found dead in their bed or bedroom. The majority were not employed, with only 33% working or retired at the time of death; 15% were children or students. Information regarding work status was not available for 11%. Toxicology results were available for 155 cases; antiepileptic drug (AED) use was detected in 67% of these cases, with a single AED detected in 44%, two AEDs in 21%, and three AEDs in 3% of samples taken at autopsy. Approximately half who took an AED were taking either sodium valproate or carbamazepine. CONCLUSION This study suggests that people with epilepsy who die from SUDEP in New Zealand are young and are often compliant with their medication. We plan to establish a nationwide SUDEP registry using the EpiNet database to determine the incidence of SUDEP in New Zealand, and to track changes in SUDEP rates. We are also planning to take part in an international case-control study of SUDEP in the hope that we might learn more about risk factors that predispose people with epilepsy to SUDEP, and factors that might reduce the risk.
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Affiliation(s)
- Mary Brennan
- Epilepsy Fellow, Neurology Department, Auckland City Hospital, Auckland
| | - Shona Scott
- Epilepsy Fellow, Neurology Department, Auckland City Hospital, Auckland
| | - Peter Bergin
- Neurologist, Neurology Department, Auckland City Hospital, Auckland
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Suarez-Sarmiento A, Brennan M, Suarez-Sarmiento A, Perito P. 394 Out-patient Penile Prosthesis Surgery: an institutional Study. J Sex Med 2020. [DOI: 10.1016/j.jsxm.2019.11.238] [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: 10/25/2022]
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Suarez-Sarmiento A, Houlihan M, Brennan M, Perito P, Kohler T, Suarez-Sarmiento A, Alom M, Ziegelmann M, Trost L, Fakhoury M. 389 Penile Prosthesis Glans Hypermobility Scale (GHS): Incidence, Severity, and Predictors in a Multi-Institutional Series. J Sex Med 2020. [DOI: 10.1016/j.jsxm.2019.11.233] [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: 10/25/2022]
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Wen L, Suarez-Sarmiento A, Suarez-Sarmiento A, Brennan M, Dodge N, Houlihan M, Kohler T, Perito P. 392 Do We Really Need a Catheter Post IPP? Urinary Retention Prevalence and Considerations. J Sex Med 2020. [DOI: 10.1016/j.jsxm.2019.11.236] [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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Raimondo V, Schmoll C, Kelly I, Brennan M, Davidson J. P47 Successful treatment of two cases of refractory JIA uveitis with intravenous tocilizumab and subcutaneous methotrexate. Rheumatology (Oxford) 2019. [DOI: 10.1093/rheumatology/kez416.014] [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: 11/15/2022] Open
Abstract
Abstract
Background
There is a need for additional treatment options in refractory JIA uveitis which has responded inadequately to MTX and anti TNFα. There has been interest in the use of tocilizumab, the APTITUDE trial using SC tocilizumab in JIA uveitis and the STOP-Uveitis study comparing 2 dosing regimens of iv tocilizumab in adults. Anecdotal evidence reports JIA uveitis patients who were stable on IV tocilizumab flaring when switched to sc administration. We describe the successful use of IV tocilizumab and concurrent sc MTX in two cases.
Methods
Retrospective review of patient paper and electronic medical records.
Results
Case 1.: A five-year-old female presented with severe anterior uveitis in her right eye. She was diagnosed with idiopathic uveitis and treated with topical steroid, oral then SC MTX infliximab, mycophenolate and adalimumab, all with inadequate control of her uveitis. At the age of 12, on adalimumab, she developed arthritis and her diagnosis was changed to JIA uveitis.
7 years after initial diagnosis she was commenced on IV tocilizumab 8mgs/kg 4-weekly with improved control of her uveitis although initially still requiring some topical steroid. She required intra-articular steroids for active arthritis and agreed to restart SC MTX. On tocilizumab and MTX combined, her arthritis settled and her topical eye drops were weaned for the first time since diagnosis.
From age 5 until 14 she was continually on topical steroids, consequently developing raised intraocular pressure and a dense cataract. With improved disease control she had cataract surgery aged 14. She has maintained good disease control for the last five years on the combination of IV tocilizumab and SC MTX and has not required any further steroids.
Case 2: A 3 year old female with oligoarticular JIA had severe bilateral uveitis at presentation. Initial treatment was with oral prednisolone, topical steroid and SC MTX. 6 months after diagnosis her uveitis remained active and she was commenced on infliximab with additional IV methylprednisolone. Venous access was challenging, required a portacath to facilitate treatment.
By the age of 6 she had developed a cataract requiring surgery and still had incomplete control of her uveitis. Infliximab was increased to 10mgs/kg 4 weekly with little further benefit and at the age of 7 she was changed to adalimumab. On this she developed macular oedema requiring pulse IV methylprednisolone.
5 years after diagnosis she was commenced on IV tocilizimab initially 4 weekly, increasing after three months to 2 weekly. Her methylprednisolone was weaned and she has subsequently maintained good disease control on IV tocilizumab 10mgs/kg 2 weekly with SC methotrexate.
Conclusion
We describe two cases of refractory JIA and uveitis in whom IV tocilizumab with SC methotrexate has provided good disease control. Further studies are required to determine the optimal dosing regimen.
Conflicts of Interest
The authors declare no conflicts of interest.
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Affiliation(s)
- Vanessa Raimondo
- Paediatric Rheumatology, Royal Hospital for Sick Children, Edinburgh, United Kingdom
| | - Conrad Schmoll
- Paediatric Rheumatology, Royal Hospital for Sick Children, Edinburgh, United Kingdom
| | - Imogen Kelly
- Paediatric Rheumatology, Royal Hospital for Sick Children, Edinburgh, United Kingdom
| | - Mary Brennan
- Paediatric Rheumatology, Royal Hospital for Sick Children, Edinburgh, United Kingdom
| | - Joyce Davidson
- Paediatric Rheumatology, Royal Hospital for Sick Children, Edinburgh, United Kingdom
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Abstract
Abstract
Background
To highlight the importance of considering new onset uveitis in adolescent patients with longstanding juvenile idiopathic arthritis (JIA).
Methods
We performed a retrospective review of electronic medical records.
Results
A 16 year-old girl was diagnosed in 2004, aged 15 months with extended oligoarticular JIA (ANA positive, >1/640 homogeneous). Her initial treatment included intra-articular steroid injections and approximately eighteen months later methotrexate, which she remained on for four years. During this time she received occasional intra-articular steroid injections. Etanercept was added in 2009 due to persistent active disease and she continued on this treatment regime for the next five years. Methotrexate was discontinued in 2013 due to intolerance. Etanercept was discontinued in 2014 due to disease remission but was restarted after three months when her arthritis flared.
In 2018 biologic treatment was changed due to poor disease control. Etanercept was switched to adalimumab, initially alternate weeks but increasing to weekly together with multiple joint injections. Six months later, her disease control remained poor and drug levels and antibodies were measured. She had a strongly positive anti-drug antibody level>200 AU/ml and her adalimumab level was <0.4mgs/L (normal range 5-10).
At this time our patient now aged 16 presented with a four-week history of intermittent reduced vision in her right eye. Ophthalmology review found bilateral anterior uveitis. This patient had regular eye screening from her JIA diagnosis until her 11th birthday, showing no previous evidence of uveitis.
Following diagnosis of uveitis she was commenced on steroid eye drops and IV methylprednisolone to treat both her uveitis and arthritis. Infliximab, (6mg/kg) was commenced then increased (10mg/kg) for ongoing uveitis and methotrexate was restarted. Despite this treatment she has persistent low grade right uveitis. Her left eye has settled and she has no lens opacities or raised intraocular pressures. She continues with joint discomfort secondary to her hypermobility but her arthritis is currently quiescent.
Conclusion
Type of arthritis and age at onset historically dictated the risk of developing uveitis. However uveitis can present in any age group and in patients with any type of JIA. In our case uveitis developed for the first time almost 15years after diagnosis.
With disease modifying treatments now widely used early in the management of JIA, uveitis may be masked and therefore present late or atypically. It is rare for uveitis to present so long after diagnosis, however this case highlights that rheumatology teams should be aware that it can still develop. Therefore we should never say never!
Conflicts of Interest
The authors declare no conflicts of interest.
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Affiliation(s)
- Imogen Kelly
- Paediatric Rheumatology, Royal Hospital for Children and Young People, Edinburgh, United Kingdom
| | - Joyce Davidson
- Paediatric Rheumatology, Royal Hospital for Children and Young People, Edinburgh, United Kingdom
| | - Mary Brennan
- Paediatric Rheumatology, Royal Hospital for Children and Young People, Edinburgh, United Kingdom
| | - Mary MacRae
- Ophthalmology, St John’s Hospital, Livingston, United Kingdom
| | - Julie Duncan
- Ophthalmology, St John’s Hospital, Livingston, United Kingdom
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Brennan M, Crowe A, Tiernan C, Smith M, Cogan L, Purcell R, Griffin C, Crowe M. 183 Risk of Hypoglycaemia in Older Patients in Residential Care on Oral Hypoglycaemic Medication. Age Ageing 2019. [DOI: 10.1093/ageing/afz103.107] [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: 11/13/2022] Open
Abstract
Abstract
Background
Diabetes mellitus (DM) is common in older patients in residential care(RC) with prevalence ranging from 11-36%.Guidlines(1) on glucose targets to avoid the risk of hypoglycaemia or hyperglycaemia respectively in older people recommend avoiding a fasting glucose on treatment of 6mmol/L or a random glucose level higher than 11.0mmol/L. An HbA1c of 53to 59mmol/mol(7-7.5%) should be aimed for although this may need adjusting in RC and StoppFrail guidelines suggest a target of HbA1c of <8%(64mmol/mol). We assessed the prevalence, drug treatment and glycaemic control in 107 older patients in residential care at two sites in Dublin.
Methods
Patients with DM were identified from review of medical notes. Hypoglycaemic treatment whether oral hypoglycemic drugs(OHD) or insulin, capillary blood glucose measurements(CBGM) over the previous 28 day period, HbA1c values and weight change over the previous year respectively were tabulated from patient records.
Results
Sixteen patients (15%) aged 66-93 were documented with DM. Eight (50%) were on no hypoglycaemic treatment in whom OHD had been discontinued in 2 patients over the previous 6 months because of risk of hypoglycaemia.. Six patients (38%) were only on OHD, whilst 2 were on insulin. Of the 6 patients on OHD, CABGM were below 6mmol/L in 3 patients (50%) with no values above 11mmol/L. All 3 patients had lost weight ( 2.5-6.8Kg) over the previous year and HbA1c levels were below 53mmol/mol (7%) in all 3 patients.
Conclusion
Although our numbers are small, 50% of our patients in residential care on OHD are at risk of hypoglycemia possibly related to weight loss. Reducing or discontinuing their OHD may be appropriate.
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Affiliation(s)
- M Brennan
- The Royal Hospital Donnybrook, Dublin, Ireland
| | - A Crowe
- The Royal Hospital Donnybrook, Dublin, Ireland
| | - C Tiernan
- The Royal Hospital Donnybrook, Dublin, Ireland
| | - M Smith
- The Royal Hospital Donnybrook, Dublin, Ireland
| | - L Cogan
- The Royal Hospital Donnybrook, Dublin, Ireland
| | - R Purcell
- Our Lady's Hospice Harold's Cross, Dublin, Ireland
| | - C Griffin
- Our Lady's Hospice Harold's Cross, Dublin, Ireland
| | - M Crowe
- The Royal Hospital Donnybrook, Dublin, Ireland
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Affiliation(s)
- M Costello
- From the Department of Diabetes, Endocrinology and Metabolism University College Hospital Galway, Galway, Ireland
| | - M Brennan
- Department of Geriatric Medicine University College Hospital Galway, Galway, Ireland
| | - C Newman
- From the Department of Diabetes, Endocrinology and Metabolism University College Hospital Galway, Galway, Ireland
| | - P O'Shea
- Department of Clinical Biochemistry, University College Hospital Galway, Galway, Ireland
| | - M Bell
- From the Department of Diabetes, Endocrinology and Metabolism University College Hospital Galway, Galway, Ireland
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Clooney L, Ronayne A, Glennon K, Brennan M, Hickey N, Magee C, Cooley S, Eogan M, Drew RJ. Impact of Introduction of a Clinical Pathway for the Management of Pyelonephritis on Obstetric Patients: a Quality Improvement Project. Ir Med J 2019; 112:951. [PMID: 31538439] [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: 06/10/2023]
Abstract
Aim To determine whether the introduction of a clinical pathway for the treatment of pyelonephritis in obstetric patients would improve outcomes. Methods This was a retrospective study conducted in a maternity hospital using quantitative analysis methods. Patients who met laboratory and clinical criteria for pyelonephritis during data collection were included. Results The study included analysis of 23 patients pre-intervention and 19 post-intervention. Baseline and patient characteristics were similar for both groups. A statistically significant difference was seen in 3 of 7 outcome measures. Increased use of gentamicin (13% Vs 52% p=0.006), Increased number of renal ultrasounds (17% Vs 47%, p=0.04) and increased use of prophylaxis (21% Vs 68%, p=0.003). The proportion of patients receiving ≥ 10 days of IV antimicrobials decreased from 48% to 21% post-intervention (p=0.07). Discussion This study has shown that the introduction of a pathway for the treatment of pyelonephritis in pregnancy had a positive impact on several important clinical outcomes.
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Affiliation(s)
- L Clooney
- The Rotunda Hospital, Parnell Square, Dublin 1
| | - A Ronayne
- The Rotunda Hospital, Parnell Square, Dublin 1
| | - K Glennon
- The Rotunda Hospital, Parnell Square, Dublin 1
| | - M Brennan
- The Rotunda Hospital, Parnell Square, Dublin 1
| | - N Hickey
- The Rotunda Hospital, Parnell Square, Dublin 1
| | - C Magee
- The Rotunda Hospital, Parnell Square, Dublin 1
| | - S Cooley
- The Rotunda Hospital, Parnell Square, Dublin 1
| | - M Eogan
- The Rotunda Hospital, Parnell Square, Dublin 1
| | - R J Drew
- The Rotunda Hospital, Parnell Square, Dublin 1
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Brennan M, Suarez-Sarmiento A, Suarez-Sarmiento A, Gheiler E, Perito P. 283 Midline Reservoir Placement Via the Infrapubic Approach: An Excellent Option In Patients with Previous Bilateral Inguinal Surgery. J Sex Med 2019. [DOI: 10.1016/j.jsxm.2019.01.287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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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Brennan M, Suarez-Sarmiento A, Perito P, Gheiler E. 038 Analgesic Implant Soaks with Ropivacaine are as Effective as Perioperative Penile Blocks. J Sex Med 2019. [DOI: 10.1016/j.jsxm.2019.01.049] [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: 10/27/2022]
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Brennan M, Suarez-Sarmiento A, Suarez-Sarmiento A, Gheiler E, Perito P. 205 Replacement of Malleable and Two-Piece Implants with an Inflatable Penile Prosthesis is Associated with High Patient Satisfaction and Improved Quality of Life. J Sex Med 2019. [DOI: 10.1016/j.jsxm.2019.01.213] [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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Suarez-Sarmiento A, Perito P, Brennan M, Suarez-Sarmiento A, Gheiler E. 300 Pain Associated with Abdominal Wall Reservoir Placement during IPP Surgery. J Sex Med 2019. [DOI: 10.1016/j.jsxm.2019.01.302] [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: 11/25/2022]
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Brennan M, Suarez-Sarmiento A, Suarez-Sarmiento A, Gheiler E, Perito P. 304 Narrow Cylinders: Establishing a Guideline for Use. J Sex Med 2019. [DOI: 10.1016/j.jsxm.2019.01.306] [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: 10/27/2022]
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Brennan M, Suarez-Sarmiento A, Gheiler E. 039 In-Vivo Width Assessment of Penile Implants. J Sex Med 2019. [DOI: 10.1016/j.jsxm.2019.01.050] [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: 10/27/2022]
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Brennan M, Suarez-Sarmiento A, Perito P, Gheiler E. 284 Early Experience with Optimized Tubing Length Penoscrotal Implants. J Sex Med 2019. [DOI: 10.1016/j.jsxm.2019.01.288] [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: 10/27/2022]
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