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Donovan P, O'Connor P. The confidence and competence of primary school staff to administer an adrenaline auto-injector. Eur J Pediatr 2024:10.1007/s00431-024-05562-y. [PMID: 38609653 DOI: 10.1007/s00431-024-05562-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 04/04/2024] [Accepted: 04/07/2024] [Indexed: 04/14/2024]
Abstract
School teachers are often inadequately prepared to use an adrenaline auto-injector (AAI), resulting in potentially dangerous treatment delays. The purpose of this study was to assess the observed competence, and self-reported confidence, of primary school teachers in the Republic of Ireland (RoI) to use an AAI. An evaluation of whether there was a link between confidence and competence was also assessed. Teachers from four primary schools in the RoI completed a questionnaire to assess their prior level of experience, training, and confidence levels with AAI administration. The four steps in administrating trainer AAI to a mannequin simulator were then assessed. A total of 61 teachers participated (out of a population of 80). The mean self-reported confidence was 1.82 out of 5 (SD = 0.96). There was no significant difference in confidence between trained and untrained participants (U = 240.5, NS). Participants who had received AAI administration training performed significantly more of the steps correctly (mean = 3.85, SD = 0.95) as compared to those who had received no training (mean = 2.97, SD = 1.10; U = 180.5, p = 0.008). There was no correlation between confidence in administrating AAI and the percentage of steps in the procedure performed correctly (rho = -0.17, NS). Conclusion: Improvements in readiness to administer AAIs can be achieved through the application of more effective approaches to teaching clinical skills, changes to school policies and practices, and consideration of the design of AAIs in order to make their operation safer and simpler. It is important that teachers have the confidence and competence to safely administer an AAI. What is Known: • Poor ability in adrenaline auto-injector use seen across population groups-healthcare professionals, patients, carers, and school staff • Training in the use of adrenaline auto-injectors has positive impact on competency What is New: • Irish school teachers show poor levels of competency in adrenaline auto-injector use • No observed correlation between reported confidence and competency.
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Affiliation(s)
- P Donovan
- School of Medicine, University of Galway, Galway, Ireland
| | - P O'Connor
- School of Medicine, University of Galway, Galway, Ireland.
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O'Connor P, Donohue G, Morrissey J, Needham M, Hargadon L, O'Toole C. An exploration of patient experiences of transitioning to a remote day programme following inpatient treatment in an adult eating disorder service. J Psychiatr Ment Health Nurs 2023; 30:1192-1202. [PMID: 37392056 DOI: 10.1111/jpm.12949] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 01/30/2023] [Accepted: 06/13/2023] [Indexed: 07/02/2023]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Traditionally, treatment for eating disorders (EDs) has been provided on an inpatient or outpatient basis, but more recently other levels of treatment provision to include, day care (DC) and community outreach programmes, have been developed. There is limited research exploring the experience of patients who have transitioned from inpatient ED treatment to a remote DC treatment. This lack of knowledge can impact mental health nurses' understanding of what that experience is like for patients and hence may influence the efficacy of collaboration and inclusion between patients and nurses. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This research addresses this dearth of knowledge and adds to our understanding of patients' experiences of attending a remote DC programme following a period of inpatient treatment for an ED. This is an important study for nurses and other mental health professionals working with people in ED treatment, as it highlights the specific challenges and anxieties of transitioning from inpatient to a remote DC programme and the individualized supports advisable during this process. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: This research provides a basis on which nurses can understand and address the challenges experienced by patients after transitioning to a less intensive supportive ED programme. The understanding of these experiences will enhance the therapeutic alliance between the nurse and patient, which will in turn support the patient in increasing agency as they progress through their recovery. This research provides a foundation on which to develop specific supports that need to be in place to help patients manage the anxieties they experience as they transition to a less intense and remote treatment. Findings from these lived experiences can be used to support the development of similar DC programmes for EDs in other settings. ABSTRACT INTRODUCTION: Day care (DC) treatment for people with an eating disorder (ED) provides for an easier transition from hospital to home, along with a treatment milieu where patients can maintain occupational and social functioning and allow for the transfer of newly acquired skills to everyday life. AIM To explore patients' experiences of attending a remote day programme following intense inpatient treatment in an adult ED service. METHOD A qualitative descriptive methodology informed the study. In-depth semi-structured interviews were conducted with 10 consenting patients. A thematic analysis framework was used to guide the process of data analysis. RESULTS Three themes reflected participants' experiences: 'Moving On: Preparing for Change', 'Navigating a New Support System' and 'Increasing Agency'. DISCUSSION An underlying issue for participants was an ongoing but changing experience of anxiety. While anticipatory anxiety is evident in preparing for discharge, this is replaced with a real-time anxiety as they endeavour to negotiate an effective support network. IMPLICATIONS FOR PRACTICE The findings from this study provide a basis on which mental health nurses can develop timely and effective treatment and support systems with patients who are transitioning from a high support inpatient ED programme to a less intensive ED remote DC programme.
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Affiliation(s)
| | | | - Jean Morrissey
- Trinity Centre for Practice and Healthcare Innovation, School of Nursing and Midwifery, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Mary Needham
- St. Patricks Mental Health Services, Dublin, Ireland
| | - Leah Hargadon
- St. Patricks Mental Health Services, Dublin, Ireland
| | - Clare O'Toole
- St. Patricks Mental Health Services, Dublin, Ireland
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Vaotuua D, O'Connor P, Belford M, Lewis P, Hatton A, Holder C, McAuliffe M. The Effect of Surgeon Volume on Revision for Periprosthetic Joint Infection: An Analysis of 602,919 Primary Total Knee Arthroplasties. J Bone Joint Surg Am 2023; 105:1663-1675. [PMID: 37651552 DOI: 10.2106/jbjs.22.01351] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
BACKGROUND Periprosthetic joint infection (PJI) is a devastating complication of total knee arthroplasty (TKA). An association between low surgeon volume and higher rates of infection following primary TKA has been suggested. The purpose of the present study was to determine if there was a relationship between surgeon volume and the rate of revision for infection after primary TKA. METHODS We searched the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) to identify all primary TKA procedures that were performed for the treatment of osteoarthritis from September 1, 1999, to December 31, 2020, and were subsequently revised because of infection. Surgeon volume was defined as the annual volume of procedures performed by a surgeon during the same year in which the primary TKA (which was subsequently revised for infection) was performed. Surgeon volume was defined as <25, 25 to 49, 50 to 74, 75 to 99, or ≥100 primary TKA procedures/year. The cumulative percent revision (CPR) for infection was determined with use of Kaplan-Meier estimates. Cox proportional hazards methods were used to compare rates of revision for infection by surgeon volume, with subanalyses for patellar resurfacing and polyethylene use. Further analyses for patients <65 years of age and male patients were undertaken. RESULTS Overall, 602,919 primary TKA procedures were performed for the treatment of osteoarthritis, of which 5,295 were revised because of infection. High-volume surgeons (≥100 TKAs/year) had a significantly lower rate of revision for infection, with a CPR at 1 and 19 years of 0.4% (95% confidence interval [CI], 0.3 to 0.4) and 1.5% (95% CI, 1.2 to 2.0), respectively, compared with 0.6% (95% CI, 0.5 to 0.7) and 2.1% (95% CI, 1.8 to 2.3), respectively, for low-volume surgeons (<25 TKAs/year). Hazard ratios (HRs), adjusted for age and sex, comparing these 2 groups varied, depending on the time point, between 3.07 (95% CI, 2.02 to 4.68) and 1.44 (95% CI, 1.26 to 1.63) but remained significant (p < 0.001). When the analysis was adjusted for age, sex, American Society of Anesthesiologists (ASA) classification, and body mass index (BMI), there remained an increased risk of revision for PJI for all lower surgeon volume levels in comparison with the high- surgeon-volume group (≥100 TKAs/year). The results were similar when stratified by patellar resurfacing and cross-linked polyethylene (XLPE) and adjusted for age and sex. CONCLUSIONS High-volume surgeons had lower rates of revision for infection. A better understanding of how surgical volume contributes to decreasing this complication is important and requires in-depth study. LEVEL OF EVIDENCE Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- D Vaotuua
- Gold Coast University Hospital, Southport, Queensland, Australia
| | - P O'Connor
- Ipswich General Hospital, Ipswich, Queensland, Australia
| | - M Belford
- Ipswich General Hospital, Ipswich, Queensland, Australia
| | - P Lewis
- Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), Adelaide, South Australia, Australia
| | - A Hatton
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| | - C Holder
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| | - M McAuliffe
- Gold Coast University Hospital, Southport, Queensland, Australia
- Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), Adelaide, South Australia, Australia
- St. Andrew's Ipswich Private Hospital, Ipswich, Queensland, Australia
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Maher V, Gallagher J, Agar R, Griffin D, Colwell N, O'Connor P, McAdam B, Tomkin G, Owens D, Ryan M, Tormey W, Durkan M. Abbreviated lipid guidelines for clinical practice : Based on ESC lipid guidelines 2019 and ESC cardiovascular disease prevention in clinical practice guidelines 2021. Ir J Med Sci 2023; 192:2151-2157. [PMID: 36746882 PMCID: PMC10522729 DOI: 10.1007/s11845-023-03277-x] [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: 10/18/2022] [Accepted: 01/04/2023] [Indexed: 02/08/2023]
Abstract
BACKGROUND Lipid disorders are now considered causal for atherosclerotic cardiovascular disease (ASCVD) which remains one of the most important contributors to morbidity and mortality in the developed world. Identification and early treatment of lipid disarrays remains the cornerstone of good clinical practice to prevent, halt and even reverse ASCVD. Guidelines for lipid management are imperative to help promote good clinical practice. Given the detail involved in comprehensive guidelines and the multiple areas of knowledge required by clinical practitioners, abbreviated, easy to understand, practical versions of guidelines are required to ensure dissemination of the most important information. The recent ESC lipid guidelines 2019 and the ESC guidelines on CVD prevention in clinical practice 2021 (1,2), provide an excellent detailed summary of all the latest evidence supporting lipid interventions that reduce ASCVD. METHOD We therefore developed a single-page document with hyperlinks to help practitioners gain easy access to practical information on lipid management. It has been developed for future electronic use in clinical practice. CONCLUSION It is presented here in a tabular format together with printable versions of the associated hyperlinks that provide the additional information required in decision making. It is hoped to audit the impact of this approach to help guide future ways of disseminating the latest clinical guideline updates.
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Affiliation(s)
- Vincent Maher
- ALMAR Centre, Tallaght University Hospital, Dublin 24, Ireland.
- Department of Cardiology, Trinity College Dublin, Dublin, Ireland.
| | - Joe Gallagher
- Department of General Practice, University College Dublin, Dublin, Ireland
| | - Ruth Agar
- ALMAR Centre, Tallaght University Hospital, Dublin 24, Ireland
- Department of Cardiology, Trinity College Dublin, Dublin, Ireland
| | - Damian Griffin
- Department of Chemical Pathology, University Hospital Galway, Galway, Ireland
| | - Niall Colwell
- Tipperary University Hospital, South Tipperary General Hospital, Clonmel, Ireland
| | - Patricia O'Connor
- Department of Clinical Pharmacology, St James Hospital, Dublin, Ireland
| | - Brendan McAdam
- Beaumont Hospital Dublin, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Gerald Tomkin
- Department of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Daphne Owens
- Department of Biochemistry, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Mary Ryan
- Department of Endocrinology, Bon Secours Hospital, Limerick, Ireland
| | - William Tormey
- Department of Chemical Pathology, Beaumont Hospital, Dublin, Ireland
| | - Maeve Durkan
- Department of Endocrinology, Bon Secours Hospital, University College Cork, Cork, Ireland
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Jacob J, O'Connor P, Pass B. Muscle Injury Around the Shoulder. Semin Musculoskelet Radiol 2022; 26:535-545. [DOI: 10.1055/s-0042-1756687] [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: 12/24/2022]
Abstract
AbstractAcute shoulder tendon and intra-articular injuries are common and their imaging well described. However, a subset of patients present with more unusual acute shoulder muscle injury. Of these, pectoralis major muscle injuries are encountered the most often and are increasingly prevalent due to a focus on personal fitness, particularly bench-press exercises. Other muscle injuries around the shoulder are rare. This article reviews the anatomy, mechanism of injury, and the imaging findings in relation to injuries of these muscles around the shoulder. We focus on pectoralis major injury but also review proximal triceps, latissimus dorsi, teres major, and deltoid muscle injuries, providing imaging examples.
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Affiliation(s)
- J. Jacob
- Chapel Allerton Hospital, Leeds Teaching Hospitals Trust, Leeds, United Kingdom
| | - P. O'Connor
- Chapel Allerton Hospital, Leeds Teaching Hospitals Trust, Leeds, United Kingdom
- NIHR Leeds Biomedical Research Centre, Leeds, United Kingdom
| | - B. Pass
- Chapel Allerton Hospital, Leeds Teaching Hospitals Trust, Leeds, United Kingdom
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Kennedy C, Hall M, O'Connor P. The patient will see you now: Patient preferences for lipid clinic reviews in a COVID era. Atherosclerosis 2022. [PMCID: PMC9425748 DOI: 10.1016/j.atherosclerosis.2022.06.989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Offiah G, O'Connor C, Kennedy C, Gallagher J, O'Connor P, McAdam B, Ray KK, Schoonen M, Maher V. The DA VINCI study: is Ireland achieving ESC/EAS guideline-directed LDL-C goals? Ir J Med Sci 2022:10.1007/s11845-022-03050-6. [PMID: 35776266 DOI: 10.1007/s11845-022-03050-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 06/02/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND The EU-wide, cross-sectional observational study of lipid-lowering therapy (LLT) use in secondary and primary care (DA VINCI) assessed the proportion of patients achieving low-density lipoprotein cholesterol (LDL-C) goals recommended by the European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) guidelines and provided an insight into regional use of LLT in Europe, including Ireland. AIMS This analysis focuses on data from patients in Ireland who participated in the DA VINCI study. METHODS The DA VINCI study enrolled patients receiving LLT at primary and secondary care sites across 18 European countries between June 2017 and November 2018. The study assessed the achievement of risk-based 2016 and 2019 ESC/EAS LDL-C goals. This subgroup analysis aimed to evaluate LDL-C goal attainment in an Irish cohort of primary and secondary care patients. RESULTS In total, 198 patients from Ireland were enrolled from three primary care and three secondary care centres. Most patients were White and male, and were receiving moderate- or high-intensity statin therapy (most frequently atorvastatin or rosuvastatin). Few patients (< 10%) were receiving combination therapy of statin and ezetimibe. Approximately 60% of patients achieved their 2016 ESC/EAC LDL-C goals while less than half the patients achieved their 2019 ESC/EAS goals. Approximately half of secondary prevention patients achieved their 2016 ESC/EAS goals and only 20% of secondary prevention patients achieved their 2019 ESC/EAS goals. CONCLUSIONS These results highlight the disparity between dyslipidaemia management in clinical practice in Ireland and guideline recommendations. TRIAL REGISTRATION ENCePP; EU PAS 22,075; date registered 06 February 2018.
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Affiliation(s)
- Gregory Offiah
- Department of Cardiology, Tallaght University Hospital, Dublin, Ireland
| | - Cormac O'Connor
- Department of Cardiology, Tallaght University Hospital, Dublin, Ireland
| | | | - Joe Gallagher
- The Palms GP Surgery, The Avenue, Gorey, Co. Wexford, Ireland
| | | | - Brendan McAdam
- Department of Cardiology, Beaumont Hospital, Dublin, Ireland.,Royal College of Surgeons, Dublin, Ireland
| | - Kausik K Ray
- Imperial Centre for Cardiovascular Disease Prevention and Imperial Clinical Trials Unit, Imperial College London, London, UK
| | | | - Vincent Maher
- Department of Cardiology, Tallaght University Hospital, Dublin, Ireland. .,Advanced Lipid Management and Research ALMAR Centre, Tallaght University Hospital, Dublin, Ireland.
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O'Connor P, Moore M, Cronin J. PO-1551 Monte-Carlo modelling of Hp(10) in a superficial treatment room to inform radiation risk assessments. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03515-0] [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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Reilly A, Quinn C, Traynor M, Devanney S, O'Shea J, O'Connor P, Murphy C, Keogh R, O'Dwyer R, Bredin P, Hamilton S, Murphy A, Judge L, Naidoo J, Matassa C, Morris P, O'Doherty D, Breathnach O, Doyle T, Grogan L. 1728P Clinical practice audit on prescribing frequency of buccal midazolam in patients with high grade gliomas. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Bojko M, Smith A, O'Connor P, Sheean P, Gomez-Perez S. Examining Inflammation in Women with Metastatic Breast Cancer With and Without Sarcopenia. J Acad Nutr Diet 2021. [DOI: 10.1016/j.jand.2021.06.055] [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: 11/29/2022]
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Biglands JD, Grainger AJ, Robinson P, Tanner SF, Tan AL, Feiweier T, Evans R, Emery P, O'Connor P. MRI in acute muscle tears in athletes: can quantitative T2 and DTI predict return to play better than visual assessment? Eur Radiol 2020; 30:6603-6613. [PMID: 32666321 PMCID: PMC7599135 DOI: 10.1007/s00330-020-06999-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [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: 03/09/2020] [Revised: 04/14/2020] [Accepted: 06/03/2020] [Indexed: 11/05/2022]
Abstract
OBJECTIVES To assess the ability of quantitative T2, diffusion tensor imaging (DTI) and radiologist's scores to detect muscle changes following acute muscle tear in soccer and rugby players. To assess the ability of these parameters to predict return to play times. METHODS In this prospective, longitudinal study, 13 male athletes (age 19 to 34 years; mean 25 years) underwent MRI within 1 week of suffering acute muscle tear. Imaging included measurements of T2 and DTI parameters. Images were also assessed using modified Peetrons and British athletics muscle injury classification (BAMIC) scores. Participants returned for a second scan within 1 week of being determined fit to return to play. MRI measurements were compared between visits. Pearson's correlation between visit 1 measurements and return to play times was assessed. RESULTS There were significant differences between visits in BAMIC scores (Z = - 2.088; p = 0.037), modified Peetrons (Z = - 2.530; p = 0.011) and quantitative MRI measurements; T2, 13.12 ms (95% CI, 4.82 ms, 21.42 ms; p = 0.01); mean diffusivity (0.22 (0.04, 0.39); p = 0.02) and fractional anisotropy (0.07 (0.01, 0.14); p = 0.03). BAMIC scores showed a significant correlation with return to play time (Rs = 0.64; p = 0.02), but modified Peetrons scores and quantitative parameters did not. CONCLUSIONS T2 and DTI measurements in muscle can detect changes due to healing following muscle tear. Although BAMIC scores correlated well with return to play times, in this small study, quantitative MRI values did not, suggesting that T2 and DTI measurements are inferior predictors of return to play time compared with visual scoring. KEY POINTS • Muscle changes following acute muscle tear can be measured using T2 and diffusion measurements on MRI. • Measurements of T2 and diffusion using MRI are not as good as a radiologist's visual report at predicting return to play time after acute muscle tear.
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Affiliation(s)
- J D Biglands
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
- Medical Physics and Engineering, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
| | - A J Grainger
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, University of Leeds, Leeds, UK
| | - P Robinson
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, University of Leeds, Leeds, UK
| | - S F Tanner
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Medical Physics and Engineering, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - A L Tan
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, University of Leeds, Leeds, UK
| | - T Feiweier
- Siemens Healthcare GmbH, Erlangen, Germany
| | - R Evans
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - P Emery
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, University of Leeds, Leeds, UK
| | - P O'Connor
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, University of Leeds, Leeds, UK
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Walsh C, Lydon S, Hehir A, O'Connor P. Development and evaluation of a novel caregiver-report tool to assess barriers to physical healthcare for people on the autism spectrum. Res Autism Spectr Disord 2020; 79:101680. [PMID: 33072182 PMCID: PMC7554131 DOI: 10.1016/j.rasd.2020.101680] [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] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 09/15/2020] [Accepted: 10/04/2020] [Indexed: 05/25/2023]
Abstract
INTRODUCTION People on the autism spectrum often experience poorer health than the general population despite higher engagement with the health services. This suggests a disparity in the accessibility of appropriate healthcare for autistic individuals. To improve access, barriers the autism community experience in healthcare first need to be identified. This paper aimed to: 1) develop and evaluate a caregiver-report tool; 2) identify barriers to physical healthcare for autistic individuals; and 3) identify potential contributing factors. METHODS A previously established taxonomy of barriers to healthcare for autistic individuals informed the development of the tool; this was then distributed to caregivers of autistic adults and children. Exploratory factor analysis (EFA) assessed validity and reliability of the tool. Multiple Regressions were performed to identify predictors of barriers. RESULTS In total, caregivers of 194 autistic children or adults participated in the study. The EFA produced four factors: 1) patient-level barriers; 2) healthcare provider-level (HCP) barriers; 3) healthcare system-level barriers; and 4) barriers related to managing healthcare. The greatest barriers included difficulties with identifying/reporting symptoms (endorsed by 62.4% of participants); difficulties handling the waiting area (60.3% of participants); and a lack of HCP knowledge regarding autism (52.1% of participants). Autism severity, general adjustment problems, anxiety, age and having unmet needs predicted the frequency and/or severity of barriers. CONCLUSIONS A tool that allows assessment of patient-, HCP-, and system-level barriers to healthcare was developed and evaluated. Patient-level barriers appear to occur frequently and pose substantial challenges. This tool will help identify areas most in need of intervention and support intervention evaluation.
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Affiliation(s)
- C Walsh
- Department of General Practice, School of Medicine, National University of Ireland Galway, Ireland
| | - S Lydon
- School of Medicine, National University of Ireland Galway, Ireland
| | - A Hehir
- School of Medicine, National University of Ireland Galway, Ireland
| | - P O'Connor
- Department of General Practice, School of Medicine, National University of Ireland Galway, Ireland
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Farrow M, Biglands JD, Grainger AJ, O'Connor P, Hensor EMA, Ladas A, Tanner SF, Emery P, Tan AL. Quantitative MRI in myositis patients: comparison with healthy volunteers and radiological visual assessment. Clin Radiol 2020; 76:81.e1-81.e10. [PMID: 32958223 DOI: 10.1016/j.crad.2020.08.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 08/21/2020] [Indexed: 10/23/2022]
Abstract
AIM To assess whether magnetic resonance imaging (MRI)-based measurements of T2, fat fraction, diffusion tensor imaging, and muscle volume can detect differences between the muscles of myositis patients and healthy controls, and to identify how they compare with semi-quantitative MRI diagnosis. MATERIALS AND METHODS Sixteen myositis patients and 16 age- and gender-matched healthy controls underwent MRI of their thigh. Quantitative MRI measurements and radiologists' semi-quantitative scores were assessed. Strength was assessed using an isokinetic dynamometer. RESULTS Fat fraction and T2 values were higher in myositis patients whereas muscle volume was lower compared to healthy controls. There was no difference in diffusion. Muscle strength was lower in myositis patients compared to healthy controls. In a subgroup of eight patients, scored as unaffected by radiologists, T2 values were still significantly higher in myositis patients. CONCLUSIONS Quantitative MRI measurements can detect differences between myositis patients and healthy controls. Changes in the muscles of myositis patients, undetected by visual, semi-quantitative scoring, can be detected using quantitative T2 measurements. This suggests that MRI T2 values may be useful for the management of myositis patients.
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Affiliation(s)
- M Farrow
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, University of Leeds, UK; NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK; School of Pharmacy and Medical Sciences, University of Bradford, UK
| | - J D Biglands
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK; Medical Physics and Engineering, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - A J Grainger
- Deprtment of Radiology, Cambridge University Hospital, Cambridge, UK; Academic Department of Radiology, University of Cambridge, UK
| | - P O'Connor
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, University of Leeds, UK; NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - E M A Hensor
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, University of Leeds, UK; NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - A Ladas
- Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - S F Tanner
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK; Medical Physics and Engineering, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - P Emery
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, University of Leeds, UK; NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - A L Tan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, University of Leeds, UK; NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
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Gomez-Perez S, Barrett R, Bojko M, Buzzi G, Smith A, O'Connor P, Sclamberg J, Rao R, Cobleigh M, Joyce C, Lomasney L, Vasilopoulos V, Sheean P. Prevalence of Sarcopenia in Women with Metastatic Breast Cancer. J Acad Nutr Diet 2020. [DOI: 10.1016/j.jand.2020.06.241] [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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15
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Bojko M, Barrett R, Morales-Perez M, Buzzi G, Smith A, Klein E, Usha L, Swoboda A, O'Connor P, Joyce C, Lomasney L, Sheean P, Gomez-Perez S. Adherence to American Cancer Society (ACS) Guidelines in Women with Metastatic Breast Cancer. J Acad Nutr Diet 2020. [DOI: 10.1016/j.jand.2020.06.200] [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: 11/29/2022]
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16
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MANNON E, Wilson K, O'Connor P. SAT-328 DIETARY NA+ LOADING WITH NACL OR NAHCO3 PRODUCES SIMILAR CHANGES IN CIRCULATING TH17 AND REGULATORY T-CELLS. Kidney Int Rep 2019. [DOI: 10.1016/j.ekir.2019.05.373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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17
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POLICHNOWSKI A, Potter J, Miles C, Eagan D, Youngberg G, O'Connor P, Picken M, Williamson G. SAT-114 ABERRANT RENAL AND MESENTERIC HEMODYNAMIC RESPONSES TO A HIGH SALT DIET AND BLOOD PRESSURE SALT-SENSITIVITY ARE ABOLISHED IN CONSOMIC SS.BN1 vs. DAHL SS RATS. Kidney Int Rep 2019. [DOI: 10.1016/j.ekir.2019.05.142] [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: 11/29/2022] Open
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18
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RAY S, Patel B, O'Connor P. SUN-171 PRETREATMENT WITH LOW DOSE LIPOPOLYSACCHARIDE PREVENTS ISCHEMIA-REPERFUSION INDUCED RENAL VASCULAR CONGESTION IN WKY RATS. Kidney Int Rep 2019. [DOI: 10.1016/j.ekir.2019.05.573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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19
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O'Connor P, Daly L, Higgins A. Partners' experiences of living with a person with an eating disorder: A grounded theory study. J Adv Nurs 2019; 75:1741-1750. [PMID: 31012143 DOI: 10.1111/jan.14032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 02/05/2019] [Accepted: 03/05/2019] [Indexed: 12/01/2022]
Abstract
AIM To explore the experiences of intimate partners of people with an eating disorder. DESIGN Qualitative grounded theory study. METHODS In-depth interviews were conducted with 18 partners of people with an eating disorder from 2013-2016. Data were analysed using the principles of classic grounded theory including, concurrent data collection and analysis, theoretical sampling, constant comparative analysis and memo writing. RESULTS Partners encounter disruptions to their lives when their significant other experiences an eating disorder. As a result, partners engage in a four-stage cyclical process involving: encountering a disruption; becoming an informed self; countering the disruption and reclaimed livability. By engaging in this process partners learn to support their significant other, remain committed to the relationship and recover their own lives. The process is drawn together and defined as the theory of 'Reconstructing Livability'. CONCLUSION The theory of 'Reconstructing Livability' provides a unique conceptualization of the experiences of partners who are living with a person with an eating disorder. It highlights the challenges faced by partners when supporting the recovery of their significant other and the intimate relationship, while reclaiming their own lives. IMPACT This study addresses the dearth of knowledge and understanding of partners' experiences. Partners engage in a process to enable them support recovery of their significant other and their own lives, but this is hindered by the challenges and unmet needs they experience. The theory provides a basis on which nurses can provide effective and timely supports to partners.
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Affiliation(s)
- Patricia O'Connor
- Department of Nursing and Midwifery, St. Patricks University Hospital, Trinity College Dublin, Ireland
| | - Louise Daly
- Department of Nursing and Midwifery, Trinity College Dublin, Ireland
| | - Agnes Higgins
- Department of Nursing and Midwifery, Trinity College Dublin, Ireland
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20
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Abstract
Healthcare providers and managers typically design programs based on what they believe patients need and want. Yet patients have knowledge and insight into how the system can be changed to better meet their needs, improve outcomes and reduce costs. We describe challenges in creating a culture of patient partnerships and the leadership actions and organizational context required now and in the future to support engagement-capable environments at the organizational and policy levels in Canada. Case examples illustrate the need for leaders to set clear expectations, develop the infrastructure to support patient partnerships and provide education to staff, physicians and patient partners.
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Affiliation(s)
- Patricia O'Connor
- Former chief nursing officer of the McGill University Health Centre. Patricia is a healthcare consultant, CFHI improvement advisor and curriculum coordinator of CFHI's Executive Training (EXTRA) program and assistant professor, Ingram School of Nursing, McGill
| | - Mario Di Carlo
- Was struck by polio at the age of 1 year. Since youth, he has faced challenges that have shaped his approach to living with a permanent condition and guided his interactions with the healthcare system. Having held senior leadership positions in public and Crown corporations, he has used his lived and work experience to partner with organizations eager to improve healthcare
| | - Jean-Lucien Rouleau
- Cardiologist at the Montreal Heart Institute, former dean of the Faculty of Medicine of the Université de Montréal and scientific director at the Institute of Circulatory and Respiratory Health of the Canadian Institutes of Health Research
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21
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Lydon S, Greally C, Tujjar O, Reddy K, Lambe K, Madden C, Walsh C, Fox S, O'Connor P. Psychometric evaluation of a measure of factors influencing hand hygiene behaviour to inform intervention. J Hosp Infect 2019; 102:407-412. [PMID: 30769147 DOI: 10.1016/j.jhin.2019.02.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 02/06/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Although the hand hygiene (HH) procedure is simple, the related behaviour is complex and is not readily understood, explained or changed. There is a need for practical tools to provide data that can guide healthcare managers and practitioners not only on the 'what' (the standards that must be met), but also the 'how' (guidance on how to achieve the standards). AIM To develop a valid questionnaire to evaluate attitudes to the factors that influence engagement in HH behaviour that can be readily completed, administered and analysed by healthcare professionals to identify appropriate intervention strategies. Construct validity was assessed using confirmatory factor analysis, predictive validity was assessed through comparison with self-reported HH behaviour, and convergent validity was assessed through direct unit-level observation of HH behaviour. METHODS The Capability, Opportunity, Motivation-Behaviour (COM-B) model was used to design a 25-item questionnaire that was distributed to intensive care unit (ICU) personnel in Ireland. Direct observation of HH behaviour was carried out at two ICUs. FINDINGS In total, 292 responses to the survey (response rate 41.0%) were included in the analysis. Confirmatory factor analysis resulted in a 17-item questionnaire. Multiple regression revealed that a model including capability, opportunity and motivation was a significant predictor of self-reported behavioural intention [F(3,209)=22.58, P<0.001]. However, the opportunity factor was not found to make a significant contribution to the regression model. CONCLUSION The COM-B HH questionnaire is reliable and valid, and provides data to support the development and evaluation of HH interventions that meet the needs of specific healthcare units.
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Affiliation(s)
- S Lydon
- Irish Centre for Applied Patient Safety and Simulation, School of Medicine, National University of Ireland Galway, Ireland
| | - C Greally
- Galway University Hospital, Galway, Ireland
| | - O Tujjar
- Sligo University Hospital, Sligo, Ireland
| | - K Reddy
- Health Services Executive, Ireland
| | - K Lambe
- Irish Centre for Applied Patient Safety and Simulation, School of Medicine, National University of Ireland Galway, Ireland; Discipline of General Practice, School of Medicine, National University of Ireland Galway, Ireland
| | - C Madden
- Irish Centre for Applied Patient Safety and Simulation, School of Medicine, National University of Ireland Galway, Ireland; Discipline of General Practice, School of Medicine, National University of Ireland Galway, Ireland
| | - C Walsh
- Irish Centre for Applied Patient Safety and Simulation, School of Medicine, National University of Ireland Galway, Ireland; Discipline of General Practice, School of Medicine, National University of Ireland Galway, Ireland
| | - S Fox
- Irish Centre for Applied Patient Safety and Simulation, School of Medicine, National University of Ireland Galway, Ireland
| | - P O'Connor
- Irish Centre for Applied Patient Safety and Simulation, School of Medicine, National University of Ireland Galway, Ireland; Discipline of General Practice, School of Medicine, National University of Ireland Galway, Ireland.
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22
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Rafter N, Finn R, Burns K, Condell S, Conroy RM, Hickey A, O'Connor P, Vaughan D, Walsh G, Williams DJ. Identifying hospital-acquired infections using retrospective record review from the Irish National Adverse Events Study (INAES) and European point prevalence survey case definitions. J Hosp Infect 2018; 101:313-319. [PMID: 30590090 DOI: 10.1016/j.jhin.2018.12.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 12/19/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Point prevalence surveys (PPSs) collect data on hospital-acquired infections (HAIs) at one point in time but do not provide information on incidence over the entire admission or impact on patients or healthcare resources. Retrospective record review examines the entire admission to determine adverse event prevalence, incidence, preventability, physical impairment and additional length of stay. AIM To establish whether European HAI surveillance definitions can be applied to the Irish National Adverse Events Study (INAES) retrospective record review data to determine HAI burden. METHODS In the INAES, 1574 admissions were reviewed using a two-stage methodology and 247 adverse events were found. These were examined against European HAI case definitions to determine whether the event was an HAI. Results were compared with the 2011/12 European PPS data for Ireland. FINDINGS The prevalence of HAI adverse events in INAES was 4.4% (95% confidence interval (CI) 3.1-6.1%) with an incidence of 3.8 (95% CI 2.5-5.2) HAI adverse events per 100 admissions. The PPS HAI prevalence for Ireland was 5.2%. HAI types and micro-organisms were similar in INAES and the PPS. Approximately three-quarters of INAES HAI adverse events were preventable, 7% caused permanent impairment and 7% contributed to death. A mean of 10 additional bed days were attributed to HAI adverse events, equivalent to €9400 per event. CONCLUSION Retrospective record review is an accurate source of information on HAI incidence, preventability and impact that complements PPS prevalence rates. HAI adverse events result in higher costs to the healthcare system than other adverse events.
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Affiliation(s)
- N Rafter
- Department of Epidemiology & Public Health Medicine, Division of Population Health Sciences, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland.
| | - R Finn
- Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
| | - K Burns
- Department of Clinical Microbiology, RCSI and Beaumont Hospital, Health Protection Surveillance Centre, Dublin, Ireland
| | - S Condell
- Clinical Effectiveness Unit, National Patient Safety Office, Department of Health, Dublin, Ireland
| | - R M Conroy
- Division of Population Health Sciences, RCSI, Ireland
| | - A Hickey
- Department of Psychology, Division of Population Health Sciences, RCSI, Ireland
| | - P O'Connor
- Discipline of General Practice, National University of Ireland, Galway, Ireland
| | - D Vaughan
- Department of Quality and Safety, Children's Hospital Group, Dublin, Ireland
| | - G Walsh
- Royal College of Physicians of Ireland, Dublin, Ireland
| | - D J Williams
- Department of Geriatric & Stroke Medicine, RCSI and Beaumont Hospital, Dublin, Ireland
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Baker GR, Fancott C, Judd M, O'Connor P. Expanding patient engagement in quality improvement and health system redesign: Three Canadian case studies. Healthc Manage Forum 2018; 29:176-82. [PMID: 27576853 DOI: 10.1177/0840470416645601] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Healthcare organizations face growing pressures to increase patient-centred care and to involve patients more in organizational decisions. Yet many providers worry that such involvement requires additional time and resources and do not see patients as capable of contributing meaningfully to decisions. This article discusses three efforts in four organizations to engage patients in quality improvement efforts. McGill University Health Centre, Saskatoon Health Region, and Vancouver Coastal and Fraser Health Regions all engaged patients in quality improvement and system redesign initiatives that were successful in improving care processes, outcomes, and patient experience measures. Patient involvement in redesigning care may provide a way to demonstrate the value of patients' experiences and inputs into problem-solving, building support for their involvement in other areas. Further study of these cases and a broader survey of organizational experiences with patient involvement may help elucidate the factors that support greater patient engagement.
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Affiliation(s)
- G Ross Baker
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
| | | | - Maria Judd
- Canadian Foundation for Healthcare Improvement, Ottawa, Ontario, Canada
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24
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Verma J, O'Connor P, Hodge J, Abrams H, Bennett J, Sinha S. Healthcare for the Aging Citizen and the Aging Citizen for Healthcare: Involving Patient Advisors in Elder-Friendly Care Improvement. ACTA ACUST UNITED AC 2017; 20:14-17. [PMID: 28550693 DOI: 10.12927/hcq.2017.25142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
With an aging population and a healthcare system that is overly reliant on providing expensive and sometimes problematic hospital-based care for older Canadians, driving improvements that promote elder-friendly care has never been more critical. The Acute Care for Elders (ACE) Strategy at Toronto's Mount Sinai Hospital is the focus of a pan-Canadian collaborative delivered by the Canadian Foundation for Healthcare Improvement in partnership with the Canadian Frailty Network. The intent is to spread the ACE Strategy's elder-friendly models of care and practices to 18 participating healthcare delivery organizations. A key element of the ACE Collaborative is the inclusion of patient advisors as members of the 18 teams. This article considers the development of elder-friendly care models and practices, with lessons for patient advisors and organizations on the necessary skill-mix, as well as lessons for providers and managers on ways to more effectively engage patient advisors in health system improvement to better serve an aging population.
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Affiliation(s)
| | - Patricia O'Connor
- Clinical improvement advisor at CFHI and Assistant Professor, Ingram School of Nursing, McGill University in Montreal
| | - Jerold Hodge
- Patient advisor with the Sinai Health System Geriatrics Steering Committee in Toronto
| | - Howard Abrams
- Director of OpenLab at the University Health Network in Toronto
| | - Jocelyn Bennett
- Senior administrative consultant and a co-faculty lead for the CFHI-CFN ACE Collaborative in Toronto
| | - Samir Sinha
- Director of geriatrics at Sinai Health System and University Health Network and a co-faculty lead for the CFHI-CFN ACE Collaborative in Toronto
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25
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O'Connor P, Jankovic D, Muscat M, Ben-Mamou M, Reef S, Papania M, Singh S, Kaloumenos T, Butler R, Datta S. Measles and rubella elimination in the WHO Region for Europe: progress and challenges. Clin Microbiol Infect 2017; 23:504-510. [PMID: 28111293 PMCID: PMC6434680 DOI: 10.1016/j.cmi.2017.01.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [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: 11/21/2016] [Revised: 01/02/2017] [Accepted: 01/04/2017] [Indexed: 11/17/2022]
Abstract
Globally measles remains one of the leading causes of death among young children even though a safe and cost-effective vaccine is available. The World Health Organization (WHO) European Region has seen a decline in measles and rubella cases in recent years. The recent outbreaks have primarily affected adolescents and young adults with no vaccination or an incomplete vaccination history. Eliminating measles and rubella is one of the top immunization priorities of the European Region as outlined in the European Vaccine Action Plan 2015-2020. Following the 2010 decision by the Member States in the Region to initiate the process of verifying elimination, the European Regional Verification Commission for Measles and Rubella Elimination (RVC) was established in 2011. The RVC meets every year to evaluate the status of measles and rubella elimination in the Region based on documentation submitted by each country's National Verification Committees. The verification process was however modified in late 2014 to assess the elimination status at the individual country level instead of at regional level. The WHO European Region has made substantial progress towards measles and rubella elimination over the past 5 years. The RVC's conclusion in 2016 that 70% and 66% of the 53 Member States in the Region had interrupted the endemic transmission of measles and rubella, respectively, by 2015 is a testament to this progress. Nevertheless, where measles and rubella remain endemic, challenges in vaccination service delivery and disease surveillance will need to be addressed through focused technical assistance from WHO and development partners.
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Affiliation(s)
- P O'Connor
- World Health Organization Regional Office for Europe, Vaccine-preventable Diseases and Immunization, Denmark
| | - D Jankovic
- World Health Organization Regional Office for Europe, Vaccine-preventable Diseases and Immunization, Denmark
| | - M Muscat
- World Health Organization Regional Office for Europe, Vaccine-preventable Diseases and Immunization, Denmark
| | - M Ben-Mamou
- World Health Organization Regional Office for Europe, Vaccine-preventable Diseases and Immunization, Denmark
| | - S Reef
- Centres for Disease Control and Prevention, Global Immunization Division, USA
| | - M Papania
- Centres for Disease Control and Prevention, Global Immunization Division, USA
| | - S Singh
- World Health Organization Regional Office for Europe, Vaccine-preventable Diseases and Immunization, Denmark
| | - T Kaloumenos
- World Health Organization Regional Office for Europe, Vaccine-preventable Diseases and Immunization, Denmark
| | - R Butler
- World Health Organization Regional Office for Europe, Vaccine-preventable Diseases and Immunization, Denmark
| | - S Datta
- World Health Organization Regional Office for Europe, Vaccine-preventable Diseases and Immunization, Denmark
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26
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O'Connor P, Bisson J, Asplin P, Gahir D. Retrospective analysis of self-reporting pain scores and pain management during head and neck IMRT radiotherapy: A single institution experience. Radiography (Lond) 2017; 23:103-106. [PMID: 28390539 DOI: 10.1016/j.radi.2017.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 09/17/2016] [Revised: 11/12/2016] [Accepted: 02/05/2017] [Indexed: 11/19/2022]
Abstract
AIMS Head and neck carcinomas are relatively rare in the United Kingdom with an estimated 9000 cases diagnosed annually. However, pain associated with disease and treatment side effects such as oral mucositis present a major issue for therapy radiographers in providing effective care and maintaining radiotherapy treatment compliance, all factors that can compromise patient outcome if not managed appropriately. METHOD This retrospective analysis of self-reporting pain scores collected during a course of radiotherapy aims to assess the perceived pain intensity scores in 30 patients. Data was collected during radiographer review sessions held weekly to determine if any variables to perceived pain scores occurred during a course of radiotherapy. RESULTS As treatment progressed, the self-reporting pain scores within the cohort increased, in week one the total cohort pain score was 35, this increased to 114 in week 3 and in the final week had totalled 151. An escalation in pain was observed in week 3 of treatment possibly as a result of radiation induced inflammation alongside cytotoxic chemotherapy. CONCLUSIONS The findings of this study provide further evidence to an individualised approach to patient pain relief and providing regular on treatment reviews, thus maintaining patient comfort and ensuring continued treatment compliance.
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Affiliation(s)
- P O'Connor
- Radiotherapy Department, Cancer Centre, City General Hospital, Stoke on Trent, Staffordshire ST4 6QG, United Kingdom. Paul.O'
| | - J Bisson
- Radiotherapy Department, Cancer Centre, City General Hospital, Stoke on Trent, Staffordshire ST4 6QG, United Kingdom
| | - P Asplin
- Radiotherapy Department, Cancer Centre, City General Hospital, Stoke on Trent, Staffordshire ST4 6QG, United Kingdom
| | - D Gahir
- Radiotherapy Department, Cancer Centre, City General Hospital, Stoke on Trent, Staffordshire ST4 6QG, United Kingdom
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27
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O'Connor P, Rothenberg E, Kim E, Patel R, Tabori N, Nowakowski F, Lookstein R, Fischman A. Introduction of a simulator-based curriculum for the integrated interventional radiology residency. J Vasc Interv Radiol 2017. [DOI: 10.1016/j.jvir.2016.12.631] [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: 11/15/2022] Open
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28
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D'Ortenzio RM, Hojjat SP, Vitorino R, Cantrell CG, Lee L, Feinstein A, O'Connor P, Carroll TJ, Aviv RI. Comparison of Quantitative Cerebral Blood Flow Measurements Performed by Bookend Dynamic Susceptibility Contrast and Arterial Spin-Labeling MRI in Relapsing-Remitting Multiple Sclerosis. AJNR Am J Neuroradiol 2016; 37:2265-2272. [PMID: 27686489 DOI: 10.3174/ajnr.a4939] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Accepted: 06/23/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND AND PURPOSE Quantitative CBF usage as a biomarker for cognitive impairment and disease progression in MS is potentially a powerful tool for longitudinal patient monitoring. Dynamic susceptibility contrast perfusion with bookend T1-calibration (bookend technique) and pseudocontinuous arterial spin-labeling have recently been used for CBF quantification in relapsing-remitting MS. The noninvasive nature of pseudocontinuous arterial spin-labeling is advantageous over gadolinium-based techniques, but correlation between the techniques is not well-established in the context of MS. MATERIALS AND METHODS We compared pseudocontinuous arterial spin-labeling CBF with the bookend technique in a prospective cohort of 19 healthy controls, 19 subjects with relapsing-remitting MS without cognitive impairment, and 20 subjects with relapsing-remitting MS with cognitive impairment on a voxelwise and Brodmann region basis. The linear Pearson correlation, SNR, and coefficient of variation were quantified. RESULTS Voxelwise paired t tests revealed no significant CBF differences between techniques after normalization of global mean intensities. The highest Pearson correlations were observed in deep GM structures (average r = 0.71 for the basal ganglia and r = 0.65 for the thalamus) but remained robust for cortical GM, WM, and white matter lesions (average r = 0.51, 0.53, 0.54, respectively). Lower Pearson correlations were observed for cortical lesions (average r = 0.23). Brodmann region correlations were significant for all groups. All correlations were maintained in healthy controls and in patients with relapsing-remitting multiple sclerosis. The highest SNR was present in bookend perfusion, while the highest coefficient of variation was present in white matter lesions. CONCLUSIONS Agreement between pseudocontinuous arterial spin-labeling and bookend technique CBF measurements is demonstrated in healthy controls and patients with relapsing-remitting MS.
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Affiliation(s)
- R M D'Ortenzio
- University of Toronto (R.M.D., P.O.C., L.L., A.F., R.I.A.), Toronto, Ontario, Canada
| | - S P Hojjat
- Medical Imaging (S.P.H., R.V., R.I.A.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - R Vitorino
- Medical Imaging (S.P.H., R.V., R.I.A.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - C G Cantrell
- Departments of Biomedical Engineering (C.G.C., T.J.C.)
| | - L Lee
- Neurology (L.L.)
- University of Toronto (R.M.D., P.O.C., L.L., A.F., R.I.A.), Toronto, Ontario, Canada
| | - A Feinstein
- From the Departments of Psychiatry (A.F.)
- University of Toronto (R.M.D., P.O.C., L.L., A.F., R.I.A.), Toronto, Ontario, Canada
| | - P O'Connor
- University of Toronto (R.M.D., P.O.C., L.L., A.F., R.I.A.), Toronto, Ontario, Canada
| | - T J Carroll
- Departments of Biomedical Engineering (C.G.C., T.J.C.)
- Radiology (T.J.C.), Northwestern University, Chicago, Illinois
| | - R I Aviv
- Medical Imaging (S.P.H., R.V., R.I.A.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- University of Toronto (R.M.D., P.O.C., L.L., A.F., R.I.A.), Toronto, Ontario, Canada
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29
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Chen Y, Cui Y, O'Connor P, Seo Y, Camarda GS, Hossain A, Roy U, Yang G, James RB. Test of a 32-channel Prototype ASIC for Photon Counting Application. IEEE Nucl Sci Symp Conf Rec (1997) 2016. [PMID: 28626357 DOI: 10.1109/nssmic.2015.7582272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A new low-power application-specific integrated circuit (ASIC) for Cadmium Zinc Telluride (CZT) detectors for single-photon emission computed tomography (SPECT) application is being developed at BNL. As the first step, a 32-channel prototype ASIC was designed and tested recently. Each channel has a preamplifier followed by CR-RC3 shaping circuits and three independent energy bins with comparators and 16-bit counters. The ASIC was fabricated with TSMC 0.35-μm complementary metal-oxide-semiconductor (CMOS) process and tested in laboratories. The power consumption is around 1 mW/ch with a 2.5-V supply. With a gain of 400 mV/fC and the peaking time of 500 ns, the equivalent noise charge (ENC) of 360 e- has been measured in room temperature while the crosstalk rate is less than 0.3%. The 10-bit DACs for global thresholds have an integral nonlinearity (INL) less than 0.56% and differential nonlinearity (DNL) less than 0.33%. In the presentation, we will report the detailed test results with this ASIC.
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Affiliation(s)
- Y Chen
- Brookhaven National Laboratory, Upton, NY 11973, USA
| | - Y Cui
- Brookhaven National Laboratory, Upton, NY 11973, USA
| | - P O'Connor
- Brookhaven National Laboratory, Upton, NY 11973, USA
| | - Y Seo
- University of California, San Francisco, San Francisco, CA 94143
| | - G S Camarda
- Brookhaven National Laboratory, Upton, NY 11973, USA
| | - A Hossain
- Brookhaven National Laboratory, Upton, NY 11973, USA
| | - U Roy
- Brookhaven National Laboratory, Upton, NY 11973, USA
| | - G Yang
- Brookhaven National Laboratory, Upton, NY 11973, USA
| | - R B James
- Brookhaven National Laboratory, Upton, NY 11973, USA
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30
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Vitorino R, Hojjat SP, Cantrell CG, Feinstein A, Zhang L, Lee L, O'Connor P, Carroll TJ, Aviv RI. Regional Frontal Perfusion Deficits in Relapsing-Remitting Multiple Sclerosis with Cognitive Decline. AJNR Am J Neuroradiol 2016; 37:1800-1807. [PMID: 27197989 DOI: 10.3174/ajnr.a4824] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 03/17/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND PURPOSE Cortical dysfunction, quantifiable by cerebral perfusion techniques, is prevalent in patients with MS, contributing to cognitive impairment. We sought to localize perfusion distribution differences in patients with relapsing-remitting MS with and without cognitive impairment and healthy controls. MATERIALS AND METHODS Thirty-nine patients with relapsing-remitting MS (20 cognitively impaired, 19 nonimpaired) and 19 age- and sex-matched healthy controls underwent a neurocognitive battery and MR imaging. Voxel-based analysis compared regional deep and cortical GM perfusion and volume among the cohorts. RESULTS After we adjusted for localized volumetric differences in the right frontal, temporal, and occipital lobes, progressive CBF and CBV deficits were present in the left middle frontal cortex for all cohorts and in the left superior frontal gyrus for patients with cognitive impairment compared with patients without impairment and controls. Compared with healthy controls, reduced CBF was present in the limbic regions of patients with cognitive impairment, and reduced CBV was present in the right middle frontal gyrus in patients with cognitive impairment and in the temporal gyrus of relapsing-remitting MS patients without cognitive impairment. CONCLUSIONS Consistent regional frontal cortical perfusion deficits are present in patients with relapsing-remitting MS, with more widespread hypoperfusion in those with cognitive impairment, independent of structural differences, indicating that cortical perfusion may be a useful biomarker of cortical dysfunction and cognitive impairment in MS.
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Affiliation(s)
- R Vitorino
- Medical Imaging (R.V., S.-P.H., L.Z., R.I.A.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - S-P Hojjat
- Medical Imaging (R.V., S.-P.H., L.Z., R.I.A.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Medical Imaging (S.-P.H., R.I.A.), University of Toronto, Toronto, Ontario, Canada
| | - C G Cantrell
- Departments of Biomedical Engineering (C.G.C., T.J.C)
| | - A Feinstein
- From the Departments of Psychiatry (A.F.)
- Psychiatry (A.F.)
| | - L Zhang
- Medical Imaging (R.V., S.-P.H., L.Z., R.I.A.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - L Lee
- Neurology (L.L.)
- Departments of Medicine (L.L., P.O.)
| | | | - T J Carroll
- Departments of Biomedical Engineering (C.G.C., T.J.C)
- Radiology (T.J.C.), Northwestern University, Chicago, Illinois
| | - R I Aviv
- Medical Imaging (R.V., S.-P.H., L.Z., R.I.A.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Medical Imaging (S.-P.H., R.I.A.), University of Toronto, Toronto, Ontario, Canada
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Freedman MS, Francis GS, Sanders EACM, Rice GPA, O'Connor P, Comi G, Duquette P, Metz L, Murray TJ, Bouchard JP, Abramsky O, Pelletier J, O'Brien F. Randomized study of once-weekly interferon β-1a therapy in relapsing multiple sclerosis: three-year data from the OWIMS study. Mult Scler 2016; 11:41-5. [PMID: 15732265 DOI: 10.1191/1352458505ms1126oa] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Background: Once weekly interferon β-1a for multiple sclerosis (OWIMS) demonstrated modest, but significant, magnetic resonance imaging (MRI) benefit of once-weekly (qw) interferon (IFN) β-1a at 48 weeks, but no significant effect on relapses. Objective: An OWIMS extension permitted assessment of longer-term efficacy/safety of qw IFN β-1a in relapsing-remitting multiple sclerosis (RRMS). Methods: Placebo patients were rerandomized to IFN β-1a, 22 or 44 mcg qw, for two additional 48-week intervals. Primary outcome was MRI lesion activity. Relapse rate and other MRI measures were secondary outcomes. Results: After three years, median (mean) T2 lesion count/patient/scan was 1.3 (2.6) for 44 mcg, 1.7 (3.3) for 22 mcg, 1.7 (3.4) for placebo/22 mcg, 2.0 (3.6) for placebo/44 mcg (all differences not significant). Annualized relapse rates were lowest for 44 mcg (0.77) versus other groups (0.83-0.86, not significant). Persistent neutralizing antibodies did not affect relapse rates, but MRI active lesions were increased in antibody-positive patients receiving 44 mcg compared to antibody negative patients. Conclusions: In RRMS, once weekly IFN β-1a, particularly 44 mcg, can induce a significant MRI, but not relapse, effect, compared with placebo. No significant dose effect was seen. In contrast to the significant effect observed with three-times-weekly dosing of subcutaneous IFN β-1a compared with placebo, this study confirms the lack of meaningful clinical benefit with once-weekly dosing.
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Affiliation(s)
- M S Freedman
- Ottawa Hospital - General Campus, Ottawa, Ontario, Canada.
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Fazekas F, Sørensen PS, Filippi M, Ropele S, Lin X, Koelmel HW, Fernandez O, Pozzilli C, O'Connor P, Enriquez MM, Hommes OR. MRI results from the European Study on Intravenous Immunoglobulin in Secondary Progressive Multiple Sclerosis (ESIMS). Mult Scler 2016; 11:433-40. [PMID: 16042226 DOI: 10.1191/1352458505ms1196oa] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Background: Monthly application of high-dose intravenous immunoglobulin (IVIG) to patients with secondary progressive multiple sclerosis (MS) showed no clinical benefit in the European Study on Immunoglobulin in MS (ESIMS). Magnetic resonance imaging (MRI) results may provide insights into the morphologic consequences of such treatment. Methods: A total of 318 patients (mean age 44± 7 years) were enrolled in 31 European and Canadian centres and treated monthly with 1 g/kg body weight of IVIG or equivalent amounts of albumin 0.1% for 27 months. MRI was performed at baseline and after 12 and 24 months and comprised of conventional dual-echo T2-weighted and T1-weighted scans before and after application of 0.1 mmol/kg Gd-DTPA. Results: Similar to clinical variables, MRI measures at baseline were well comparable between treatment groups except for a somewhat lower mean number of contrast-enhancing lesions and number of active scans in IVIG-treated patients. Over the trial period there was almost no change of the T2-lesion load and the ‘black hole’ volume in both treatment groups and the cumulative number of contrast-enhancing lesions were similar. There was only a trend for fewer new or enlarged T2-lesions in IVIG patients, which disappeared after correction for the imbalance in the number of contrast-enhancing lesions at baseline. Brain volume in terms of a partial cerebral fraction decreased significantly less with IVIG than placebo treatment (final visit:-0.62± 0.88% versus-0.88± 0.91%; P= 0.009). This difference remained statistically significant with correction for active lesions at baseline (P= 0.02) and was seen primarily in male patients and those with an Expanded Disability Status Scale score ≥ 6 and no relapses in the two years before the study. Conclusion: The absence of significant differences in conventional MRI measures between both treatment groups parallels the negative clinical results of ESIMS. The causes for and possible long-term clinical effects of a lower rate of brain volume loss in IVIG patients should be explored further.
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Affiliation(s)
- F Fazekas
- Department of Neurology, Medical University of Graz, Graz, Austria.
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Siddle H, Mandl P, Aletaha D, Vliet Vlieland T, Backhaus M, Cornell P, D'Agostino M, Ellegaard K, Iagnocco A, Jakobson B, Jasinski T, Kildal N, Lehner M, Möller I, Supp G, O'Connor P, Redmond A, Naredo E, Wakefield R. SAT0643-HPR Points To Consider for Health Professionals Undertaking Musculoskeletal Ultrasound for Rheumatic and Musculoskeletal Diseases: Progress of A Eular Task Force. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.4411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Hojjat SP, Kincal M, Vitorino R, Cantrell CG, Feinstein A, Zhang L, Lee L, O'Connor P, Carroll TJ, Aviv RI. Cortical Perfusion Alteration in Normal-Appearing Gray Matter Is Most Sensitive to Disease Progression in Relapsing-Remitting Multiple Sclerosis. AJNR Am J Neuroradiol 2016; 37:1454-61. [PMID: 27012299 DOI: 10.3174/ajnr.a4737] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 01/12/2016] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND PURPOSE The role of gray matter in multiple sclerosis is increasingly evident; however, conventional images demonstrate limitations in cortical lesion identification. Perfusion imaging appears sensitive to changes in tissue type and disease severity in MS. We sought to use bookend perfusion to quantify parameters in healthy controls and normal-appearing and lesional tissue at different relapsing-remitting MS stages. MATERIALS AND METHODS Thirty-nine patients with relapsing-remitting MS and 19 age-matched healthy controls were prospectively recruited. The Minimal Assessment of Cognitive Function in MS battery was used to assess cognitive performance. Perfusion parameters, including cerebral blood flow and volume and mean transit time, were compared for healthy controls and normal-appearing and lesional tissue for all study groups. Dispersion of perfusion measures for white matter lesions and cortical lesions was assessed. RESULTS Twenty of the 39 patients with relapsing-remitting MS were cognitively impaired. Significant differences were displayed between all relapsing-remitting MS subgroups and healthy controls in all comparisons except for normal-appearing gray matter CBV between healthy controls and unimpaired patients with relapsing-remitting MS and for all normal-appearing white matter perfusion parameters between healthy controls and unimpaired patients with relapsing-remitting MS. White matter lesion but not cortical lesion perfusion was significantly reduced in cognitively impaired patients with relapsing-remitting MS versus unimpaired patients with relapsing-remitting MS. Perfusion reduction with disease progression was greater in normal-appearing gray matter and normal-appearing white matter compared with cortical lesions and white matter lesions. Smaller dispersion was observed for cortical lesions compared with white matter lesions for each perfusion parameter. CONCLUSIONS Quantitative GM and WM analysis demonstrated significant but disproportionate white matter lesion, cortical lesion, normal-appearing white matter, and normal-appearing gray matter changes present between healthy controls and patients with relapsing-remitting MS with and without cognitive impairment, necessitating absolute rather than relative lesion perfusion measurement.
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Affiliation(s)
- S-P Hojjat
- Medical Imaging (S.-P.H., M.K., R.V., R.I.A., L.Z.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada Medical Imaging (S.-P.H., R.I.A.), University of Toronto, Toronto, Ontario, Canada
| | - M Kincal
- Medical Imaging (S.-P.H., M.K., R.V., R.I.A., L.Z.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - R Vitorino
- Medical Imaging (S.-P.H., M.K., R.V., R.I.A., L.Z.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - C G Cantrell
- Departments of Biomedical Engineering (C.G.C., T.J.C.)
| | - A Feinstein
- From the Departments of Psychiatry (A.F.) Psychiatry (A.F.)
| | - L Zhang
- Medical Imaging (S.-P.H., M.K., R.V., R.I.A., L.Z.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - L Lee
- Neurology (L.L.) Departments of Medicine (P.O., L.L.)
| | | | - T J Carroll
- Departments of Biomedical Engineering (C.G.C., T.J.C.) Radiology (T.J.C.), Northwestern University, Chicago, Illinois
| | - R I Aviv
- Medical Imaging (S.-P.H., M.K., R.V., R.I.A., L.Z.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada Medical Imaging (S.-P.H., R.I.A.), University of Toronto, Toronto, Ontario, Canada
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O'Dea B, O'Connor P, Lydon S, Murphy AW. Prevalence of burnout among Irish general practitioners: a cross-sectional study. Ir J Med Sci 2016; 186:447-453. [PMID: 26803315 DOI: 10.1007/s11845-016-1407-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [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: 10/30/2015] [Accepted: 01/07/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Burnout constitutes a significant problem among physicians which impacts negatively upon both the doctor and their patients. Previous research has indicated that burnout is prevalent among primary care physicians in other European countries and North America. However, there is a paucity of research assessing burnout among Irish general practitioners and examining predictive factors. AIMS To report the findings of a survey of burnout among Irish general practitioners, and assess variables related to burnout in this population. METHODS An online, anonymous questionnaire was distributed to general practitioners working in the Republic of Ireland. RESULTS In total, 683 general practitioners (27.3 % of practising Irish general practitioners) completed the survey. Of these, 52.7 % reported high levels of emotional exhaustion, 31.6 % scored high on depersonalisation and 16.3 % presented with low levels of personal accomplishment. In total, 6.6 % presented with all three symptoms, fulfilling the criteria for burnout. Emotional exhaustion was higher among this sample than that reported in European and UK studies of burnout in general practitioners. Personal accomplishment was, however, higher in this sample than in other studies. Multiple regression analyses revealed that younger age, non-principal status role, and male gender were related to increased risk of burnout symptoms. CONCLUSIONS The symptoms of burnout appear prevalent among Irish general practitioners. This is likely to have a detrimental impact both upon the individual general practitioners and the patients that they serve. Research investigating the factors contributing to burnout in this population, and evaluating interventions to improve general practitioner well-being, is, therefore, essential.
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Affiliation(s)
- B O'Dea
- Kilmoganny Health Centre, Mill Street, Kilmoganny, Co. Kilkenny, Ireland.
- Department of General Practice, National University of Ireland, Galway, Ireland.
| | - P O'Connor
- Department of General Practice, National University of Ireland, Galway, Ireland
| | - S Lydon
- Department of General Practice, National University of Ireland, Galway, Ireland
| | - A W Murphy
- Department of General Practice, National University of Ireland, Galway, Ireland
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Drake TC, Hsu FC, Hire D, Chen SH, Cohen RM, McDuffie R, Nylen E, O'Connor P, Rehman S, Seaquist ER. Factors associated with failure to achieve a glycated haemoglobin target of <8.0% in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial. Diabetes Obes Metab 2016; 18:92-5. [PMID: 26435375 PMCID: PMC6241305 DOI: 10.1111/dom.12569] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Revised: 07/26/2015] [Accepted: 08/28/2015] [Indexed: 11/30/2022]
Abstract
The aim of this study was to identify the clinical features of participants in the standard therapy arm of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) glycaemia trial who failed to reach the glycated haemoglobin (HbA1c) target. We analysed 4685 participants in the standard therapy arm, comparing participants who reached the HbA1c target of <8.0% with those whose HbA1c level was ≥8.0% 12 months after randomization. Baseline and 12-month clinical characteristics were compared. At 12 months after randomization, 3194 participants had HbA1c <8.0% and 1491 had HbA1c ≥8.0%. Black race [odds ratio (OR) 0.74, 95% confidence interval (CI) 0.61-0.89; p = 0.002], severe hypoglycaemia (OR 0.57, CI 0.37-0.89; p = 0.014) and insulin use (OR 0.51, CI 0.40-0.65; p < 0.001) were associated with failure to reach HbA1c goal at 12 months in the adjusted model. Even with free medications, free visits with clinicians and aggressive titration of medications, >30% of participants in the standard arm of the ACCORD trial had an HbA1c ≥8.0% at 1 year. Participants who were black, had severe hypoglycaemia and were on insulin were more likely to have an above-target HbA1c concentration after 12 months on the standard protocol.
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Affiliation(s)
- T C Drake
- Division of Endocrinology and Diabetes, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - F-C Hsu
- Division of Public Health Sciences, Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - D Hire
- Division of Public Health Sciences, Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - S-H Chen
- Division of Public Health Sciences, Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - R M Cohen
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Cincinnati and Medical Service, Cincinnati VA Medical Center, Cincinnati, OH, USA
| | - R McDuffie
- Clinical Translational Unit, Department of Medicine, Tulane University, New Orleans, LA, USA
| | - E Nylen
- Division of Endocrinology, Department of Medicine, VAMC, Washington, DC, USA
| | - P O'Connor
- Center for Chronic Care Innovation, HealthPartners Institute for Education and Research, Minneapolis, MN, USA
| | - S Rehman
- Department of Medicine, Phoenix VA Healthcare Systems, University of Arizona College of Medicine, Phoenix, AZ, USA
| | - E R Seaquist
- Division of Endocrinology and Diabetes, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
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Lettieri G, Abignano G, Eng S, Britton J, Ridgway J, Evans R, Rathbone A, O'Connor P, Emery P, Buch M, Del Galdo F. FRI0466 Digital Artery Flow Index by Non-Contrast Magnetic Resonance Angiography of the Hand: A Quantitative Outcome Measure of Fibroproliferative Vasculopathy in Raynaud's Phenomenon of Scleroderma. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.6045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Lavoie-Tremblay M, O'Connor P, Lavigne GL, Briand A, Biron A, Baillargeon S, MacGibbon B, Ringer J, Cyr G. Effective Strategies to Spread Redesigning Care Processes Among Healthcare Teams. J Nurs Scholarsh 2015; 47:328-37. [DOI: 10.1111/jnu.12141] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Mélanie Lavoie-Tremblay
- Associate Professor, Ingram School of Nursing McGill University, Nurse Scientist; McGill University Health Centre (MUHC); Montreal Quebec Canada
| | - Patricia O'Connor
- Senior Advisor for Patient Engagement and the McGill Nursing Collaborative, McGill University Health Centre (MUHC), and Assistant Professor, School of Nursing; McGill University, Montreal General Hospital; Montreal Quebec Canada
| | - Geneviève L. Lavigne
- Post-Doctoral CIHR Fellow, Ingram School of Nursing; McGill University; Montreal Quebec Canada
| | - Anaïck Briand
- TCAB and CSI Project Manager; McGill University Health Centre; Montreal Quebec Canada
| | - Alain Biron
- Assistant to the Director, Quality, Patient Safety, and Performance; McGill University Health Centre; Montreal Quebec Canada
| | - Sophie Baillargeon
- Assistant to the Director of Nursing; McGill University Health Centre; Montreal Quebec Canada
| | - Brenda MacGibbon
- Adjunct Professor, Universite du Quebec a Montreal; Departement de mathematiques; Montreal Quebec Canada
| | - Justin Ringer
- Healthcare Consultant; Quebec First Nations; Montreal Quebec Canada
| | - Guylaine Cyr
- Research Coordinator, Ingram School of Nursing; McGill University; Montreal Quebec Canada
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Abstract
Large national reviews of patient charts estimate that approximately 10% of hospital admissions are associated with an adverse event (defined as an injury resulting in prolonged hospitalization, disability or death, caused by healthcare management). Apart from having a significant impact on patient morbidity and mortality, adverse events also result in increased healthcare costs due to longer hospital stays. Furthermore, a substantial proportion of adverse events are preventable. Through identifying the nature and rate of adverse events, initiatives to improve care can be developed. A variety of methods exist to gather adverse event data both retrospectively and prospectively but these do not necessarily capture the same events and there is variability in the definition of an adverse event. For example, hospital incident reporting collects only a very small fraction of the adverse events found in retrospective chart reviews. Until there are systematic methods to identify adverse events, progress in patient safety cannot be reliably measured. This review aims to discuss the need for a safety culture that can learn from adverse events, describe ways to measure adverse events, and comment on why current adverse event monitoring is unable to demonstrate trends in patient safety.
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Affiliation(s)
- N Rafter
- From the Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland, St Stephens Green, Dublin 2, Ireland, Division of Population Health Sciences, Royal College of Surgeons in Ireland, St Stephens Green, Dublin 2, Ireland, Health Services Executive, Dr Steeven's Hospital, Dublin 8, Ireland, Whitaker Institute, Department of General Practice, National University of Ireland, Galway, Ireland and Royal College of Physicians of Ireland, Frederick House, 19 South Frederick St, Dublin 2, Ireland
| | - A Hickey
- From the Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland, St Stephens Green, Dublin 2, Ireland, Division of Population Health Sciences, Royal College of Surgeons in Ireland, St Stephens Green, Dublin 2, Ireland, Health Services Executive, Dr Steeven's Hospital, Dublin 8, Ireland, Whitaker Institute, Department of General Practice, National University of Ireland, Galway, Ireland and Royal College of Physicians of Ireland, Frederick House, 19 South Frederick St, Dublin 2, Ireland
| | - S Condell
- From the Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland, St Stephens Green, Dublin 2, Ireland, Division of Population Health Sciences, Royal College of Surgeons in Ireland, St Stephens Green, Dublin 2, Ireland, Health Services Executive, Dr Steeven's Hospital, Dublin 8, Ireland, Whitaker Institute, Department of General Practice, National University of Ireland, Galway, Ireland and Royal College of Physicians of Ireland, Frederick House, 19 South Frederick St, Dublin 2, Ireland
| | - R Conroy
- From the Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland, St Stephens Green, Dublin 2, Ireland, Division of Population Health Sciences, Royal College of Surgeons in Ireland, St Stephens Green, Dublin 2, Ireland, Health Services Executive, Dr Steeven's Hospital, Dublin 8, Ireland, Whitaker Institute, Department of General Practice, National University of Ireland, Galway, Ireland and Royal College of Physicians of Ireland, Frederick House, 19 South Frederick St, Dublin 2, Ireland
| | - P O'Connor
- From the Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland, St Stephens Green, Dublin 2, Ireland, Division of Population Health Sciences, Royal College of Surgeons in Ireland, St Stephens Green, Dublin 2, Ireland, Health Services Executive, Dr Steeven's Hospital, Dublin 8, Ireland, Whitaker Institute, Department of General Practice, National University of Ireland, Galway, Ireland and Royal College of Physicians of Ireland, Frederick House, 19 South Frederick St, Dublin 2, Ireland
| | - D Vaughan
- From the Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland, St Stephens Green, Dublin 2, Ireland, Division of Population Health Sciences, Royal College of Surgeons in Ireland, St Stephens Green, Dublin 2, Ireland, Health Services Executive, Dr Steeven's Hospital, Dublin 8, Ireland, Whitaker Institute, Department of General Practice, National University of Ireland, Galway, Ireland and Royal College of Physicians of Ireland, Frederick House, 19 South Frederick St, Dublin 2, Ireland
| | - D Williams
- From the Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland, St Stephens Green, Dublin 2, Ireland, Division of Population Health Sciences, Royal College of Surgeons in Ireland, St Stephens Green, Dublin 2, Ireland, Health Services Executive, Dr Steeven's Hospital, Dublin 8, Ireland, Whitaker Institute, Department of General Practice, National University of Ireland, Galway, Ireland and Royal College of Physicians of Ireland, Frederick House, 19 South Frederick St, Dublin 2, Ireland
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Lydon S, O'Connor P, McVeigh T, Offiah C, Byrne D. Medical speciality choice: does personality matter? Ir Med J 2015; 108:75-78. [PMID: 25876298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
There has been increasing interest in the personalities of doctors. This study examined whether personality differed based upon gender, level of training or medical speciality among 200 physicians and 134 medical students. Post-internship doctors scored significantly higher on conscientiousness (p = .001) than those pursuing basic medical training. Among those pursuing basic medical training, females scored significantly higher than males on agreeableness (p < .001) and conscientiousness (p = .001). Among post-internship respondents, females scored significantly higher on agreeableness (p = .004). There were no personality differences between post-internship doctors working in different specialities. However, among those pursuing basic medical training, those interested in person-focused medical specialities scored significantly higher on extraversion (p < .001), conscientiousness (p = .001), and lower on neuroticism (p = .01) than those who had no strong preference. These results suggest that there is no unique personality profile associated with medical practice, or medical speciality. Instead, it appears that medical school may shape personality.
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Simon JH, Kinkel RP, Kollman C, O'Connor P, Fisher E, You X, Hyde R. Ten-year follow-up of the 'minimal MRI lesion' subgroup from the original CHAMPS Multiple Sclerosis Prevention Trial. Mult Scler 2014; 21:415-22. [PMID: 25344370 DOI: 10.1177/1352458514547407] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patients with clinically isolated syndrome (CIS) and characteristic magnetic resonance imaging (MRI) lesions are at high risk for multiple sclerosis (MS). However, patients with a minimal MRI lesion burden (a low T2-hyperintense [low T2] lesion count) may have borderline formal diagnostic criteria, presenting a clinical management challenge. OBJECTIVE Compare the 10-year disease progression of patients with low and higher T2 lesion counts treated over most intervals. METHODS CIS patients from the original CHAMPS MS trial were retrospectively assigned to low-T2 (first quartile; 2-8 lesions) or higher-T2 (second through fourth quartiles; ≥ 9 lesions) groups using baseline T2 lesion counts. The 5- and 10-year open-label extension of CHAMPS (CHAMPIONS) evaluated conversion to clinically definite MS (CDMS), MRI activity, relapses, and disability. RESULTS The vast majority of patients showed new disease activity by MRI and/or clinical criteria at 10 years (low-T2 86%; higher-T2 98%). Fewer low-T2 than higher-T2 patients developed CDMS (40% vs. 63%; p = 0.013); low-T2 patients also had fewer new brain lesions, less brain volume loss, and less disability progression. CONCLUSION CIS patients with low T2 lesion counts show continued disease activity. However, all assessments of disease progression over 10 years indicated a significantly less severe disease course for low-T2 patients.
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Affiliation(s)
- J H Simon
- Portland VA Medical Center, VA Medical Center and Oregon Health Science Center, USA
| | - R P Kinkel
- Department of Neurosciences, University of California San Diego, USA
| | - C Kollman
- Department of Biostatistics, Jaeb Center for Health Research, Tampa, FL, USA
| | - P O'Connor
- Multiple Sclerosis Clinic, St. Michael's Hospital, Toronto, ON, Canada
| | - E Fisher
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA
| | - X You
- Departments of Biostatistics, Biogen Idec Inc, Cambridge, MA, USA
| | - R Hyde
- Global Medical Affairs, Biogen Idec Inc, Cambridge, MA, USA
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Lavoie-Tremblay M, O'Connor P, Lavigne GL, Biron A, Ringer J, Baillargeon S, MacGibbon B, Cyr G, Briand A. Transforming Care at the Bedside: managers' and health care providers' perceptions of their change capacities. J Contin Educ Nurs 2014; 45:514-20. [PMID: 25347086 DOI: 10.3928/00220124-20141023-02] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 08/26/2014] [Indexed: 11/20/2022]
Abstract
BACKGROUND The Transforming Care at the Bedside (TCAB) project engages frontline health care providers as the leaders of change and improvement efforts in their work environment. This study explored how health care providers and managers from three TCAB units in a university-affiliated health care center perceived the development of their change capacities following their involvement in this program. METHOD This descriptive, qualitative study involved focus groups and individual interviews. RESULTS Participants learned to work as a team and to expand their outlook. They had access to processes and tools to learn new skills. New relationships also developed among the various players, and they shared new roles, which enabled them to translate the desired changes into action and make the results visible. CONCLUSION The study showed the TCAB program helps develop health care providers' and managers' change capacities.
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Kinkel RP, Simon JH, O'Connor P, Hyde R, Pace A. Early MRI activity predicts treatment nonresponse with intramuscular interferon beta-1a in clinically isolated syndrome. Mult Scler Relat Disord 2014; 3:712-9. [PMID: 25891550 DOI: 10.1016/j.msard.2014.08.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 07/31/2014] [Accepted: 08/18/2014] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Determine whether MRI activity 6 months after treatment initiation in the Controlled High-Risk Subjects Avonex® Multiple Sclerosis Prevention Study (CHAMPS) predicted progression to clinically definite multiple sclerosis (CDMS) over the subsequent 30 months in intramuscular interferon beta-1a (IM IFNβ-1a)-treated patients vs placebo-treated patients. METHODS CHAMPS patients were randomized to once-weekly IM IFNβ-1a 30 μg or placebo for up to 36 months. MRI was performed every 6 months until CDMS confirmation. Patient groups were defined based on new T2 and/or Gd+ lesions at 6 months. RESULTS Thirteen IM IFNβ-1a patients (6.7%) and 24 placebo patients (12.6%) developed CDMS prior to month 6 and did not undergo the 6-month MRI. At 6 months, 29.7% of IM IFNβ-1a-treated patients vs 40.9% of placebo-treated patients were defined as having high MRI activity levels (≥2 new T2 and/or ≥2 Gd+ lesions). In this subgroup, estimated cumulative probabilities of CDMS were similar between groups (HR=0.88 [0.44-1.77], p=0.7227). A significant treatment response was seen for patients with <2 new T2 and <2 Gd+ lesions at 6 months (HR=0.39 [0.19-0.82], p=0.0120). CONCLUSION MRI scans 6 months after IM IFNβ-1a initiation in CIS patients predict early treatment non-response. Standardized scanning and monitoring may facilitate early disease management.
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Affiliation(s)
- R P Kinkel
- Department of Neurosciences, University of California San Diego, 9500 Gilman Dr, MC 0662, La Jolla, CA 92093, USA.
| | - J H Simon
- Portland VA Medical Center, 3710 SW U.S. Veterans Hospital Road, Portland, OR 97239, USA.
| | - P O'Connor
- Multiple Sclerosis Clinic, St. Michael׳s Hospital, 30 Bond Street, Toronto, ON M5B 1W8, Canada.
| | - R Hyde
- Biogen Idec Inc., 14 Cambridge Center, Cambridge, MA 02142, USA.
| | - A Pace
- Biogen Idec Inc., 14 Cambridge Center, Cambridge, MA 02142, USA.
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Backhouse M, Hodgson R, Stone M, Redmond A, O'Connor P. AB0991 The Role of Metal Artefact Correction Techniques in Patients with Metallic Joint Prostheses. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.1494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Francis PL, Chia TL, Jakubovic R, O'Connor P, Lee L, Feinstein A, Aviv RI. Extensive white matter dysfunction in cognitively impaired patients with secondary-progressive multiple sclerosis. AJNR Am J Neuroradiol 2014; 35:1910-5. [PMID: 24831599 DOI: 10.3174/ajnr.a3974] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND PURPOSE Cognitive impairment is a common, disabling symptom of MS. We investigated the association between cognitive impairment and WM dysfunction in secondary-progressive multiple sclerosis using DTI. MATERIALS AND METHODS Cognitive performance was assessed with a standard neuropsychological battery, the Minimal Assessment of Cognitive Function in Multiple Sclerosis. Cognitive impairment was defined as scoring >1.5 standard deviations below healthy controls on ≥2 subtests. Fractional anisotropy maps were compared against cognitive status using tract-based spatial statistics with threshold-free cluster enhancement. RESULTS Forty-five patients with secondary-progressive multiple sclerosis (median age: 55 years, female/male: 27/18, median Expanded Disability Status Scale Score: 6.5) were prospectively recruited. Cognitively impaired patients (25/45) displayed significantly less normalized global GM and WM volumes (P = .001, P = .024), more normalized T2-weighted and T1-weighted WM lesion volumes (P = .002, P = .006), and lower WM skeleton fractional anisotropy (P < .001) than non-impaired patients. Impaired patients also had significantly lower fractional anisotropy (p(corr) < .05) in over 50% of voxels within every major WM tract. The most extensively impinged tracts were the left posterior thalamic radiation (100.0%), corpus callosum (97.8%), and right sagittal stratum (97.5%). No WM voxels had significantly higher fractional anisotropy in patients with cognitive impairment compared with their non-impaired counterparts (p(corr) > .05). After the inclusion of confounders in a multivariate logistic regression, only fractional anisotropy remained a significant predictor of cognitive status. CONCLUSIONS Cognitively impaired patients with secondary-progressive multiple sclerosis exhibited extensive WM dysfunction, though preferential involvement of WM tracts associated with cognition, such as the corpus callosum, was apparent. Multivariate analysis revealed that only WM skeleton fractional anisotropy was a significant predictor of cognitive status.
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Affiliation(s)
- P L Francis
- Medical Imaging (P.L.F., T.L.C., R.J., R.I.A.), Sunnybrook Health Sciences Centre
| | - T L Chia
- Medical Imaging (P.L.F., T.L.C., R.J., R.I.A.), Sunnybrook Health Sciences Centre
| | - R Jakubovic
- Medical Imaging (P.L.F., T.L.C., R.J., R.I.A.), Sunnybrook Health Sciences Centre
| | - P O'Connor
- Department of Neurology (P.O.C.), St. Michael's Hospital University of Toronto (P.O.C., L.L., A.F., R.I.A.), Toronto, Ontario, Canada
| | - L Lee
- Neurology (L.L.) University of Toronto (P.O.C., L.L., A.F., R.I.A.), Toronto, Ontario, Canada
| | - A Feinstein
- From the Departments of Psychiatry (A.F.) University of Toronto (P.O.C., L.L., A.F., R.I.A.), Toronto, Ontario, Canada
| | - R I Aviv
- Medical Imaging (P.L.F., T.L.C., R.J., R.I.A.), Sunnybrook Health Sciences Centre University of Toronto (P.O.C., L.L., A.F., R.I.A.), Toronto, Ontario, Canada
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Kooyman RM, Zanne AE, Gallagher RV, Cornwell W, Rossetto M, O'Connor P, Parkes EA, Catterall CF, Laffan SW, Lusk CH. Effects of growth form and functional traits on response of woody plants to clearing and fragmentation of subtropical rainforest. Conserv Biol 2013; 27:1468-1477. [PMID: 23869490 DOI: 10.1111/cobi.12088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Accepted: 02/03/2013] [Indexed: 06/02/2023]
Abstract
The conservation implications of large-scale rainforest clearing and fragmentation on the persistence of functional and taxonomic diversity remain poorly understood. If traits represent adaptive strategies of plant species to particular circumstances, the expectation is that the effect of forest clearing and fragmentation will be affected by species functional traits, particularly those related to dispersal. We used species occurrence data for woody plants in 46 rainforest patches across 75,000 ha largely cleared of forest by the early 1900s to determine the combined effects of area reduction, fragmentation, and patch size on the taxonomic structure and functional diversity of subtropical rainforest. We compiled species trait values for leaf area, seed dry mass, wood density, and maximum height and calculated species niche breadths. Taxonomic structure, trait values (means, ranges), and the functional diversity of assemblages of climbing and free-standing plants in remnant patches were quantified. Larger rainforest patches had higher species richness. Species in smaller patches were taxonomically less related than species in larger patches. Free-standing plants had a high percentage of frugivore dispersed seeds; climbers had a high proportion of small wind-dispersed seeds. Connections between the patchy spatial distribution of free-standing species, larger seed sizes, and dispersal syndrome were weak. Assemblages of free-standing plants in patches showed more taxonomic and spatial structuring than climbing plants. Smaller isolated patches retained relatively high functional diversity and similar taxonomic structure to larger tracts of forest despite lower species richness. The response of woody plants to clearing and fragmentation of subtropical rainforest differed between climbers and slow-growing mature-phase forest trees but not between climbers and pioneer trees. Quantifying taxonomic structure and functional diversity provides an improved basis for conservation planning and management by elucidating the effects of forest-area reduction and fragmentation. Efectos de la Forma de Crecimiento y Atributos Funcionales en la Respuesta de Plantas Leñosas al Desmonte y Fragmentación de Bosque Lluvioso Subtropical.
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Affiliation(s)
- R M Kooyman
- National Herbarium of NSW, Royal Botanic Gardens and Domain Trust, Mrs Macquaries Road, Sydney, 2000, Australia; Department of Biological Sciences, Macquarie University, North Ryde 2113, Sydney, Australia
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Abstract
PURPOSE OF THE STUDY Smartphone use among healthcare professionals has become widespread and will continue to grow in the coming years. STUDY DESIGN In October 2012, a survey was distributed to 230 interns at two of the national intern training networks in the Republic of Ireland, asking how they used smartphones to carry out their clinical work. RESULTS It was found that out of 108 interns (47.0% response rate, 108/230), 94.4% (102/108) owned a smartphone. Of those respondents who owned a smartphone, on at least a daily basis for the purposes of work, 83.3% (85/102) made or received phone calls, 87.2% (89/102) sent or received texts, and 41.2% (42/102) sent or received emails on their smartphone. A total of 52.9% (54/102) had used their smartphone to take a work related picture. The most commonly used app was the British National Formulary. It was used daily by 30.4% (31/102) of respondents with a smartphone. The most commonly used website was Wikipedia. It was accessed at least weekly by 38.2% (39/102) of respondents with a smartphone. CONCLUSIONS Smartphones are used by the majority of interns on a daily basis in order to perform their job. As such, there is a need for guidance on how patient information can be safely secured and transmitted using smartphones, their appropriate use, and any restrictions on the use of these devices in certain clinical settings. For interns in particular, advice is needed on the credibility of medical apps and websites.
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Affiliation(s)
- P O'Connor
- Department of General Practice, National University of Ireland, , Galway, Ireland
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Francis G, Kappos L, O'Connor P, Collins W, Tang D, Mercier F, Cohen JA. Temporal profile of lymphocyte counts and relationship with infections with fingolimod therapy. Mult Scler 2013; 20:471-80. [PMID: 23950550 DOI: 10.1177/1352458513500551] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.9] [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: 11/16/2022]
Abstract
BACKGROUND Reduction in peripheral blood lymphocytes is an expected pharmacodynamic outcome of fingolimod therapy. OBJECTIVE The objective of this article is to evaluate lymphocyte dynamics during and after fingolimod therapy and assess the relationship between lymphocyte counts and infections. METHODS Lymphocyte counts and their relationship with infections were evaluated in three multiple sclerosis (MS) populations: (Group A) FREEDOMS phase 3 core study group (n = 1272); (Group B) All Studies group (one phase 2 and two phase 3 studies, plus their extensions; n = 2315); and (Group C) Follow-up group (after fingolimod discontinuation; n = 538). RESULTS Administration of fingolimod 0.5 mg led to reductions in lymphocyte counts to a steady-state of 24%-30% of baseline values within two weeks, which remained stable while on therapy. Following fingolimod discontinuation, average counts exceeded the lower limit of normal range within six to eight weeks, and were 80% of baseline values by three months. In Group A, infection rates per patient-year were 1.4 with placebo and 1.0 in fingolimod-treated patients who had the lowest lymphocyte counts (< 0.2 × 10(9)/l). No evidence was seen for an increase in serious or opportunistic infections. CONCLUSIONS Fingolimod induces a rapid and reversible reduction in lymphocyte counts without an increase in infections relative to placebo. Because fingolimod reduces blood lymphocyte counts via redistribution in secondary lymphoid organs, peripheral blood lymphocyte counts cannot be utilized to evaluate the lymphocyte subset status of a patient.
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Affiliation(s)
- G Francis
- Novartis Pharmaceuticals Corporation-NJ, USA
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Millar J, Wilson R, O'Connor P, McLaughlin R. Impact of closing an emergency department on a neighbouring teaching hospital: the concentrate effect. Crit Care 2013. [PMCID: PMC3642603 DOI: 10.1186/cc12195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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