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Ali MM, Parveen S, Williams V, Dons R, Uwaifo GI. Cardiometabolic comorbidities and complications of obesity and chronic kidney disease (CKD). J Clin Transl Endocrinol 2024; 36:100341. [PMID: 38616864 PMCID: PMC11015524 DOI: 10.1016/j.jcte.2024.100341] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 03/28/2024] [Accepted: 03/29/2024] [Indexed: 04/16/2024] Open
Abstract
Obesity and chronic kidney disease are two ongoing progressive clinical pandemics of major public health and clinical care significance. Because of their growing prevalence, chronic indolent course and consequent complications both these conditions place significant burden on the health care delivery system especially in developed countries like the United States. Beyond the chance coexistence of both of these conditions in the same patient based on high prevalence it is now apparent that obesity is associated with and likely has a direct causal role in the onset, progression and severity of chronic kidney disease. The causes and underlying pathophysiology of this are myriad, complicated and multi-faceted. In this review, continuing the theme of this special edition of the journal on " The Cross roads between Endocrinology and Nephrology" we review the epidemiology of obesity related chronic kidney disease (ORCKD), and its various underlying causes and pathophysiology. In addition, we delve into the consequent comorbidities and complications associated with ORCKD with particular emphasis on the cardio metabolic consequences and then review the current body of evidence for available strategies for chronic kidney disease modulation in ORCKD as well as the potential unique role of weight reduction and management strategies in its improvement and risk reduction.
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Affiliation(s)
- Mariam M. Ali
- Southern Illinois School of Medicine, Department of Medicine, Section of Endocrinology, Diabetes and Metabolism, 751 North Rutledge Street, Moy Building, Suite 1700, Springfield, Il 62702, United States
| | - Sanober Parveen
- Southern Illinois School of Medicine, Department of Medicine, Section of Endocrinology, Diabetes and Metabolism, 751 North Rutledge Street, Moy Building, Suite 1700, Springfield, Il 62702, United States
| | - Vanessa Williams
- Southern Illinois School of Medicine, Department of Medicine, Section of Endocrinology, Diabetes and Metabolism, 751 North Rutledge Street, Moy Building, Suite 1700, Springfield, Il 62702, United States
| | - Robert Dons
- Southern Illinois School of Medicine, Department of Medicine, Section of Endocrinology, Diabetes and Metabolism, 751 North Rutledge Street, Moy Building, Suite 1700, Springfield, Il 62702, United States
| | - Gabriel I. Uwaifo
- Section of Endocrinology, Dept of Medicine, SIU School of Medicine, 751 N Rutledge St, Moy Building, Suite 1700, Room #1813, Springfield, Il 62702, United States
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Hamadani M, Coleman M, Boccia R, Duras J, Hutchings M, Zinzani PL, Cordoba R, Oreiro MB, Williams V, Liu H, Stouffs M, Langmuir P, Sancho JM. Safety and efficacy of parsaclisib in combination with obinutuzumab and bendamustine in patients with relapsed or refractory follicular lymphoma (CITADEL-102): A phase 1 study. Hematol Oncol 2023; 41:848-857. [PMID: 37496298 DOI: 10.1002/hon.3209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 06/28/2023] [Accepted: 06/29/2023] [Indexed: 07/28/2023]
Abstract
Parsaclisib is a potent and highly selective PI3Kδ inhibitor that has shown clinical benefit with monotherapy in a phase 2 study in relapsed or refractory (R/R) follicular lymphoma (FL). CITADEL-102 (NCT03039114), a phase 1, multicenter study, assessed the efficacy of parsaclisib in combination with obinutuzumab and bendamustine in patients with R/R FL. Patients were ≥18 years of age with histologically confirmed and documented CD20-positive FL, and R/R to previous rituximab-containing treatment regimens. Part one (safety run-in) determined the maximum tolerated dose of parsaclisib in combination with standard dosage regimens of obinutuzumab and bendamustine. Part two (dose expansion) was an open-label, single-group design evaluating safety, tolerability (primary endpoint), and efficacy (secondary endpoint) of parsaclisib combination therapy. Twenty-six patients were enrolled in CITADEL-102 and all patients received parsaclisib 20 mg once daily for 8 weeks, followed by 20 mg once weekly thereafter, in combination with obinutuzumab and bendamustine. One patient in safety run-in experienced a dose-limiting toxicity of grade 4 QT interval prolongation that was considered related to parsaclisib. Eight patients (30.8%) discontinued treatment due to treatment-emergent adverse events (TEAEs) of colitis (2 [7.7%]), alanine aminotransferase and aspartate aminotransferase increase (both in one patient [3.8%]), neutropenia, thrombocytopenia, QT prolongation, tonsil cancer, and maculopapular rash (each 1 [3.8%]). The most common reported TEAEs were pyrexia (53.8%), neutropenia (50.0%), and diarrhea (46.2%). Twenty-three patients (88.5%) experienced grade 3 or 4 TEAEs; the most common were neutropenia (34.6%), febrile neutropenia (23.1%), and thrombocytopenia (19.2%). Seventeen patients (65.4%) had a complete response and 3 patients (11.5%) had a partial response, for an objective response rate of 76.9%. Overall, results from CITADEL-102 suggest that the combination of parsaclisib with obinutuzumab and bendamustine did not result in unexpected safety events, with little evidence of synergistic toxicity, and demonstrated preliminary efficacy in patients with R/R FL who progressed following prior rituximab-containing regimens.
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Affiliation(s)
- Mehdi Hamadani
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Morton Coleman
- Clinical Research Alliance Inc., Westbury, New York, USA
| | - Ralph Boccia
- Center for Cancer and Blood Disorders, Bethesda, Maryland, USA
| | - Juraj Duras
- Department of Haematooncology, University Hospital Ostrava and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Martin Hutchings
- Department of Haematology and Phase 1 Unit, Rigshospitalet, Copenhagen, Denmark
| | - Pier Luigi Zinzani
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna, Bologna, Italy
| | - Raul Cordoba
- Lymphoma Unit, Department of Hematology, Fundación Jimenez Diaz University Hospital, Madrid, Spain
| | | | | | - Huiqing Liu
- Incyte Corporation, Wilmington, Delaware, USA
| | | | | | - Juan-Manuel Sancho
- Clinical Hematology Department, Institut Català d'Oncologia-Hospital Germans Trias i Pujol, IJC, Barcelona, Spain
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Snooks H, Watkins A, Lyons J, Akbari A, Bailey R, Bethell L, Carson-Stevens A, Dale J, Edwards A, Emery H, Evans BA, Jolles S, John A, Kingston M, Porter A, Sewell B, Williams V, Lyons RA. Corrigendum to "Did the UK's public health shielding policy protect the clinically extremely vulnerable during the COVID-19 pandemic in wales? Results of EVITE immunity, a linked data retrospective study" [Public Health 218 (2023) 12-20]. Public Health 2023; 222:229. [PMID: 37463828 PMCID: PMC11021201 DOI: 10.1016/j.puhe.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Affiliation(s)
- H Snooks
- Swansea University, Medical School, ILS 2, Singleton Park, SA2 8PP, Swansea, UK.
| | - A Watkins
- Swansea University, Medical School, ILS 2, Singleton Park, SA2 8PP, Swansea, UK
| | - J Lyons
- Population Data Science, Swansea University, Medical School, Data Science Building, Singleton Park, SA2 8PP, Swansea, UK
| | - A Akbari
- Population Data Science, Swansea University, Medical School, Data Science Building, Singleton Park, SA2 8PP, Swansea, UK
| | - R Bailey
- Population Data Science, Swansea University, Medical School, Data Science Building, Singleton Park, SA2 8PP, Swansea, UK
| | - L Bethell
- Swansea University, Medical School, ILS 2, Singleton Park, SA2 8PP, Swansea, UK
| | - A Carson-Stevens
- Cardiff University, Division of Population Medicine, University Hospital of Wales, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK
| | - J Dale
- The University of Warwick, Medical School, Coventry CV4 7AL, UK
| | - A Edwards
- Cardiff University, Division of Population Medicine, University Hospital of Wales, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK
| | - H Emery
- Swansea University, Medical School, ILS 2, Singleton Park, SA2 8PP, Swansea, UK
| | - B A Evans
- Swansea University, Medical School, ILS 2, Singleton Park, SA2 8PP, Swansea, UK
| | - S Jolles
- Immunodeficiency Centre for Wales, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK
| | - A John
- Population Data Science, Swansea University, Medical School, Data Science Building, Singleton Park, SA2 8PP, Swansea, UK
| | - M Kingston
- Swansea University, Medical School, ILS 2, Singleton Park, SA2 8PP, Swansea, UK
| | - A Porter
- Swansea University, Medical School, ILS 2, Singleton Park, SA2 8PP, Swansea, UK
| | - B Sewell
- Swansea University, School of Health and Social Care, Vivian Tower, Singleton Park, SA2 8PP, Swansea, UK
| | - V Williams
- Swansea University, Medical School, ILS 2, Singleton Park, SA2 8PP, Swansea, UK
| | - R A Lyons
- Population Data Science, Swansea University, Medical School, Data Science Building, Singleton Park, SA2 8PP, Swansea, UK
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Snooks H, Watkins A, Lyons J, Akbari A, Bailey R, Bethell L, Carson-Stevens A, Edwards A, Emery H, Evans BA, Jolles S, John A, Kingston M, Porter A, Sewell B, Williams V, Lyons RA. Did the UK's public health shielding policy protect the clinically extremely vulnerable during the COVID-19 pandemic in Wales? Results of EVITE Immunity, a linked data retrospective study. Public Health 2023; 218:12-20. [PMID: 36933354 PMCID: PMC9928733 DOI: 10.1016/j.puhe.2023.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 02/03/2023] [Accepted: 02/07/2023] [Indexed: 02/17/2023]
Abstract
INTRODUCTION The UK shielding policy intended to protect people at the highest risk of harm from COVID-19 infection. We aimed to describe intervention effects in Wales at 1 year. METHODS Retrospective comparison of linked demographic and clinical data for cohorts comprising people identified for shielding from 23 March to 21 May 2020; and the rest of the population. Health records were extracted with event dates between 23 March 2020 and 22 March 2021 for the comparator cohort and from the date of inclusion until 1 year later for the shielded cohort. RESULTS The shielded cohort included 117,415 people, with 3,086,385 in the comparator cohort. The largest clinical categories in the shielded cohort were severe respiratory condition (35.5%), immunosuppressive therapy (25.9%) and cancer (18.6%). People in the shielded cohort were more likely to be female, aged ≥50 years, living in relatively deprived areas, care home residents and frail. The proportion of people tested for COVID-19 was higher in the shielded cohort (odds ratio [OR] 1.616; 95% confidence interval [CI] 1.597-1.637), with lower positivity rate incident rate ratios 0.716 (95% CI 0.697-0.736). The known infection rate was higher in the shielded cohort (5.9% vs 5.7%). People in the shielded cohort were more likely to die (OR 3.683; 95% CI: 3.583-3.786), have a critical care admission (OR 3.339; 95% CI: 3.111-3.583), hospital emergency admission (OR 2.883; 95% CI: 2.837-2.930), emergency department attendance (OR 1.893; 95% CI: 1.867-1.919) and common mental disorder (OR 1.762; 95% CI: 1.735-1.789). CONCLUSION Deaths and healthcare utilisation were higher amongst shielded people than the general population, as would be expected in the sicker population. Differences in testing rates, deprivation and pre-existing health are potential confounders; however, lack of clear impact on infection rates raises questions about the success of shielding and indicates that further research is required to fully evaluate this national policy intervention.
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Affiliation(s)
- H Snooks
- Swansea University, Medical School, ILS 2, Singleton Park, Swansea, SA2 8PP, UK.
| | - A Watkins
- Swansea University, Medical School, ILS 2, Singleton Park, Swansea, SA2 8PP, UK.
| | - J Lyons
- Population Data Science, Swansea University, Medical School, Data Science Building, Singleton Park, Swansea, SA2 8PP, UK.
| | - A Akbari
- Population Data Science, Swansea University, Medical School, Data Science Building, Singleton Park, Swansea, SA2 8PP, UK.
| | - R Bailey
- Population Data Science, Swansea University, Medical School, Data Science Building, Singleton Park, Swansea, SA2 8PP, UK.
| | - L Bethell
- Swansea University, Medical School, ILS 2, Singleton Park, Swansea, SA2 8PP, UK.
| | - A Carson-Stevens
- Cardiff University, Division of Population Medicine, Neuadd Meirionnydd, University Hospital of Wales, Heath Park, Cardiff, CF14 4YS, UK.
| | - A Edwards
- Cardiff University, Division of Population Medicine, Neuadd Meirionnydd, University Hospital of Wales, Heath Park, Cardiff, CF14 4YS, UK.
| | - H Emery
- Swansea University, Medical School, ILS 2, Singleton Park, Swansea, SA2 8PP, UK.
| | - B A Evans
- Swansea University, Medical School, ILS 2, Singleton Park, Swansea, SA2 8PP, UK.
| | - S Jolles
- Immunodeficiency Centre for Wales, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK.
| | - A John
- Population Data Science, Swansea University, Medical School, Data Science Building, Singleton Park, Swansea, SA2 8PP, UK.
| | - M Kingston
- Swansea University, Medical School, ILS 2, Singleton Park, Swansea, SA2 8PP, UK.
| | - A Porter
- Swansea University, Medical School, ILS 2, Singleton Park, Swansea, SA2 8PP, UK.
| | - B Sewell
- Swansea University, School of Health and Social Care, Vivian Tower, Singleton Park, Swansea, SA2 8PP, UK.
| | - V Williams
- Swansea University, Medical School, ILS 2, Singleton Park, Swansea, SA2 8PP, UK.
| | - R A Lyons
- Population Data Science, Swansea University, Medical School, Data Science Building, Singleton Park, Swansea, SA2 8PP, UK.
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Williams V, Uddin Ansari MJ, Jaju A, Ward S, O’Keefe D, Abdelkarim J, Montes N, Tarabichi U, Botchway A, Jakoby MG. Impact of Perioperative Dexamethasone on Hospital Length of Stay and Glycemic Control in Patients With Type 2 Diabetes Undergoing Total Hip Arthroplasty. J Patient Cent Res Rev 2023; 10:4-12. [PMID: 36714000 PMCID: PMC9851389 DOI: 10.17294/2330-0698.1971] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Purpose This study aimed to evaluate effects of perioperative dexamethasone on hospital length of stay (LOS) and glycemic control for patients with type 2 diabetes mellitus undergoing total hip arthroplasty (THA). Methods We performed retrospective case review of THA performed in adults (≥18 years old) with type 2 diabetes at Springfield Memorial Hospital (Springfield, IL) immediately before (2013), during (2014), and after (2015) publication of consensus guidelines for use of perioperative dexamethasone. Hospital LOS was the primary endpoint. Capillary blood glucose by hospital day, proportion of patients treated with insulin, and median insulin dose by hospital day were secondary endpoints. Results A total of 209 patients were included: 109 not dosed with dexamethasone ("no dexamethasone"), and 100 treated with perioperative dexamethasone. The most common dose of dexamethasone was 4 mg (63% of patients). Mean (95% CI) reduction in adjusted hospital LOS for dexamethasone-treated patients, compared to controls, was -2.8 (-3.7 to -1.9) days for all patients, -1.6 (-2.7 to -0.5) days for those with arthritis as the indication for THA, and -4.0 (-5.9 to -2.1) days for those with fracture as indication for THA (P<0.001 for all). Glycemic control measured by median capillary blood glucose was no different or slightly better in the dexamethasone group than the no dexamethasone group, except for postoperative day 1 among patients treated with insulin prior to surgery. Conclusions Perioperative dexamethasone significantly reduces hospital LOS for patients with type 2 diabetes undergoing THA, with modest effects on hyperglycemia.
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Affiliation(s)
- Vanessa Williams
- Division of Endocrinology, Southern Illinois University School of Medicine, Springfield, IL
| | | | - Amruta Jaju
- Division of Endocrinology, Southern Illinois University School of Medicine, Springfield, IL
| | - Stacey Ward
- Division of Endocrinology, Southern Illinois University School of Medicine, Springfield, IL
| | - Daniel O’Keefe
- Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, IL
| | - Jumana Abdelkarim
- Division of Endocrinology, Southern Illinois University School of Medicine, Springfield, IL
| | - Nicole Montes
- Department of Medicine, Memorial Physician Services, Springfield, IL
| | - Ula Tarabichi
- Division of Endocrinology, Southern Illinois University School of Medicine, Springfield, IL
| | - Albert Botchway
- Center for Clinical Research, Southern Illinois University School of Medicine, Springfield, IL
| | - Michael G. Jakoby
- Division of Endocrinology, Southern Illinois University School of Medicine, Springfield, IL
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Wade T, Roberts N, Ban JW, Waweru-Siika W, Winston H, Williams V, Heneghan CJ, Onakpoya IJ. Utility of healthcare-worker-targeted antimicrobial stewardship interventions in hospitals of low- and lower-middle-income countries: a scoping review of systematic reviews. J Hosp Infect 2023; 131:43-53. [PMID: 36130626 DOI: 10.1016/j.jhin.2022.09.008] [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: 06/23/2022] [Revised: 08/31/2022] [Accepted: 09/08/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Antimicrobial stewardship (AMS) initiatives in hospitals often include the implementation of clustered intervention components to improve the surveillance and targeting of antibiotics. However, impacts of the individual components of AMS interventions are not well known, especially in low- and lower-middle-income countries (LLMICs). OBJECTIVE A scoping review was conducted to summarize evidence from systematic reviews (SRs) on the impact of common hospital-implemented healthcare-worker-targeted components of AMS interventions that may be appropriate for LLMICs. METHODS Major databases were searched systematically for SRs of AMS interventions that were evaluated in hospitals. For SRs to be eligible, they had to report on at least one intervention that could be categorized according to the Effective Practice and Organisation of Care taxonomy. Clinical and process outcomes were considered. Primary studies from LLMICs were consulted for additional information. RESULTS Eighteen SRs of the evaluation of intervention components met the inclusion criteria. The evidence shows that audit and feedback, and clinical practice guidelines improved several clinical and process outcomes in hospitals. An unintended consequence of interventions was an increase in the use of antibiotics. There was a cumulative total of 547 unique studies, but only 2% (N=12) were conducted in hospitals in LLMICs. Two studies in LLMICs reported that guidelines and educational meetings were effective in hospitals. CONCLUSION Evidence from high- and upper-middle-income countries suggests that audit and feedback, and clinical practice guidelines have the potential to improve various clinical and process outcomes in hospitals. The lack of evidence in LLMIC settings prevents firm conclusions from being drawn, and highlights the need for further research.
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Affiliation(s)
- T Wade
- Department for Continuing Education, University of Oxford, Oxford, UK.
| | - N Roberts
- Bodleian Health Care Libraries, University of Oxford, Oxford, UK
| | - J-W Ban
- Section of Evidence-Based Practice, Western Norway University of Applied Sciences, Bergen, Norway
| | - W Waweru-Siika
- Section of Evidence-Based Practice, Western Norway University of Applied Sciences, Bergen, Norway
| | - H Winston
- Department of Family Medicine, University of Pittsburgh Medical Center, McKeesport, PA, USA
| | - V Williams
- School of Nursing, Nipissing University, North Bay, Ontario, Canada
| | - C J Heneghan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - I J Onakpoya
- Department for Continuing Education, University of Oxford, Oxford, UK
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Peterman J, Bioteau J, Williams V. Addressing Implicit Bias in the Women’s Health Department. J Obstet Gynecol Neonatal Nurs 2022. [DOI: 10.1016/j.jogn.2022.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Hamadani M, Coleman M, Boccia R, Duras J, Hutchings M, Zinzani PL, Cordoba R, Oreiro MB, Williams V, Stouffs M, Langmuir P, Sancho JM. P1104: A PHASE 1 STUDY EVALUATING SAFETY AND EFFICACY OF PARSACLISIB IN COMBINATION WITH BENDAMUSTINE + OBINUTUZUMAB IN PATIENTS WITH RELAPSED OR REFRACTORY FOLLICULAR LYMPHOMA (CITADEL-102). Hemasphere 2022. [PMCID: PMC9431125 DOI: 10.1097/01.hs9.0000847284.03476.7b] [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: 11/25/2022] Open
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Harrington SG, Gee MS, Williams V, Best S, Kilcoyne A. Impact of COVID-19 on radiology trainee safety, education and wellness: challenges experienced and proposed solutions for the future. J Am Coll Radiol 2022; 19:446-449. [PMID: 35081396 PMCID: PMC8747968 DOI: 10.1016/j.jacr.2021.11.013] [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] [Received: 09/19/2021] [Revised: 11/24/2021] [Accepted: 11/26/2021] [Indexed: 11/22/2022]
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Miranda A, Shield PW, Williams V, Starkey D, Kelly MA. Training undergraduate students for rapid on-site evaluation of fine needle aspiration cytology samples using a simulation based education activity. Cytopathology 2021; 33:321-327. [PMID: 34932830 DOI: 10.1111/cyt.13092] [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: 09/29/2021] [Revised: 11/23/2021] [Accepted: 12/17/2021] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Demand for rapid onsite evaluation (ROSE) of fine needle aspiration (FNA) cytology is rising and the role is increasingly being performed by non-medical cytologists. Undergraduate training for cytologists has traditionally focused on laboratory-based procedural activities and their theoretical underpinning, with minimal attention given to communication and other skills required to operate in an interprofessional setting. We evaluated the effectiveness and student reaction to a simulation-based education (SBE) exercise in ROSE designed to fill this void. METHODS We designed and evaluated a SBE exercise based on FNA ROSE across two tertiary institutions with 79 students. The exercise accurately reproduced the demands on cytologists operating as part of a multi-disciplinary team in a time- pressured environment. FINDINGS Pre- and post-simulation questionnaires indicated an improvement in technical knowledge related to the procedure. Students' perception of their competence and confidence in their role also improved significantly post simulation. Students uniformly found the exercise engaging and a valuable addition to their curriculum. DISCUSSION The simulation successfully provided a pseudo-clinical environment that highlighted the realities of practising technical and diagnostic tasks under time- pressure and interacting with other health professionals to provide an optimal patient outcome. The exercise is useful supplement to on-the-job training for ROSE.
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Affiliation(s)
- A Miranda
- Curtin Medical School, Curtin University, Perth, Western Australia, Australia
| | - P W Shield
- School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Australia.,Sullivan Nicolaides Pathology, Brisbane, Australia
| | - V Williams
- Curtin Medical School, Curtin University, Perth, Western Australia, Australia
| | - D Starkey
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - M A Kelly
- Curtin School of Nursing, Curtin University, Perth, Western Australia, Australia
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Williams V, Jabri H, Jakoby MG. Carney Complex With Endocrine Involvement Isolated to the Thyroid Gland. J Endocr Soc 2021. [DOI: 10.1210/jendso/bvab048.2030] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
Introduction: Carney complex is a rare autosomal dominant disorder characterized by pigmented lesions of skin and mucosae, endocrine neoplasms or overactivity, and myxomas of the heart, skin, and other organs. Most patients have at least two affected endocrine organs at time of diagnosis. We present a case of Carney complex with endocrine involvement limited to the thyroid gland. Case: A 48-year-old female was referred for evaluation of thyroid nodules incidentally discovered on imaging for submandibular salivary gland swelling. Ultrasound evaluation of the thyroid revealed numerous, bilateral nodules that were mostly cystic or spongiform, though some had irregular borders and microcalcifications. A brother with Carney complex had been diagnosed with papillary carcinoma, and the patient decided to undergo thyroidectomy. Fortunately, no thyroid carcinoma was found on postsurgical histopathology. Initial biochemical evaluation showed no evidence of hypercortisolemia (8 AM cortisol 1.7 mcg/dL on 1 mg dexamethasone suppression test; 24-h urine cortisol 26.1 mcg [reference: 4-50]), growth hormone excess (IGF-1 190 ng/mL [reference: 52-328]), or hyperprolactinemia (prolactin 10 ng/mL [reference: 2.74-26.72]). Imaging showed no pituitary or adrenal masses. The patient underwent total hysterectomy with bilateral salpingo-oophorectomy for endometrial cancer prior to referral. She was diagnosed with Carney complex at age 19 years, and her manifestations included atrial and ventricular myxomas, intraductal adenoma of the breast, multiple skin lesions (lentigines, blue nevi, and cutaneous myxomas), and myxomas of the external auditory canals. She is in a Carney complex kindred that includes her mother, two brothers, and a niece. Discussion: Carney complex is usually caused by inactivating mutations or large deletions in the protein kinase A type I alpha regulatory subunit (PRKAR1A) gene located on chromosome 17q22-24. Most mutations are inherited in an autosomal dominant manner, though approximately 30% of cases are due to de novo mutations. In a review of 365 cases, the median age at diagnosis was 20 years. Growth hormone adenomas or somatomammotroph hyperplasia occurs in approximately 75% of patients, and most have at least one additional endocrine abnormality including multinodular goiter, primary pigmented nodular adrenocortical hyperplasia, and testicular or ovarian masses. There is an approximately 10% chance of developing well differentiated thyroid carcinoma. Treatment for Carney complex is individualized depending on the patient’s presentation and includes excision or surgical removal of myxomas, neoplasms, and skin lesions, as well as regular evaluation for cardiac myxomas and endocrine overactivity. This case of Carney complex is unusual because the only endocrinopathy is multinodular goiter.
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Affiliation(s)
| | - Hadoun Jabri
- Division of Endocrinology, SIU school of Medicine, metairie, LA, USA
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12
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Jaju A, Williams V, Ansari MJU, Ali MM, Jakoby MG. Diagnosis of Sertoli-Leydig Cell Tumor of the Ovary Complicated by the Pattern of Hyperandrogenemia and Results of Imaging. J Endocr Soc 2021. [PMCID: PMC8090065 DOI: 10.1210/jendso/bvab048.1586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Introduction: Virilization in a postmenopausal woman requires evaluation for an androgen-secreting tumor. The differential diagnosis includes adrenal carcinomas and adenomas and Sertoli-Leydig cell tumors, granulosa-theca cell tumors, and hilus-cell tumors of the ovaries. We present a case of virilization in a postmenopausal woman caused by a Sertoli-Leydig cell tumor (SLCT) in which evaluation was complicated by the pattern of androgen elevation, bilateral adrenal nodules, and absence of an adnexal mass. Case: A 64-year-old female was referred for evaluation of hyperandrogenism. Hirsutism, temporal hairline regression, and unusually deep voice were noted on examination. Two total testosterone levels obtained one month apart were 146 ng/dL (2-45), and measurements of dehydroepiandrosterone sulfate (DHEAS) and androstenedione were 299 mcg/dL (12-133) and 1.84 ng/mL (0.130-0.820), respectively. Abdominal CT revealed bilateral adrenal nodules - 2 cm and - 5 Hounsfield units (HU) on the left, and 1.5 cm and 5 HU on the right - but no ovarian masses. Transvaginal ultrasonography also failed to identify a discrete ovarian mass but showed endometrial hyperplasia. Virilization, magnitude of testosterone elevation, and results of imaging were felt to be most strongly indicative of ovarian hyperthecosis, and the patient underwent laparoscopic bilateral salpingo-oophorectomy and hysterectomy. The right ovary was 2.3 cm in largest diameter and approximately 90% replaced by an orange-red mass that showed Sertoli and Leydig cells on microscopy, immunohistochemical staining for the sex cord proteins inhibin and calretinin, and presence of the Leydig cell marker melan A. It was classified as well differentiated. Additional CT imaging and robotic assisted laparoscopy confirmed a stage IA tumor. One month after surgery, hyperandrogenemia had completely resolved (total testosterone < 10 ng/dL, androstenedione 0.379 ng/mL, and DHEAS 99 mcg/dL), and changes of virilization had mostly regressed at an eight months appointment. Discussion: SLCTs are a type of sex-cord stromal ovarian tumor. They constitute < 0.5% of ovarian tumors but account for approximately 75% of testosterone-secreting ovarian masses. This patient’s case was unusual for multiple reasons: 1. Age - most SLCTs are diagnosed in the second or third decade, 2. Imaging - CT and ultrasonography usually show a solid or solid and cystic adnexal mass, and co-existing adrenal nodules are rare, likely due to typical young age of presentation, and 3. Pattern of androgen elevation - DHEAS was more than two-fold elevated, and usually < 10% of DHEA and DHEAS are produced by the ovaries. However, DHEAS fell significantly after oophorectomy. SLCTs are a potential etiology of virilization in postmenopausal women even in the absence of a detectable adnexal mass and when biochemistries and imaging raise the possibility of an adrenal source of androgen.
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Affiliation(s)
- Amruta Jaju
- SIU School of Medicine, Springfield, IL, USA
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Jaju A, Williams V, Ali MM, Rehman A, Imtiaz S, Jakoby MG. Pheochromocytoma as the Etiology of Cushing Syndrome Through Paracrine ACTH Signaling. J Endocr Soc 2021. [DOI: 10.1210/jendso/bvab048.299] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
Introduction: Pheochromocytomas are rare catecholamine-secreting tumors of the adrenal medulla that may also secrete ACTH. There are approximately 100 cases of ACTH-producing pheochromocytomas reported in the peer reviewed literature, and they typically cause Cushing syndrome by significantly raising circulating ACTH levels. We report a pheochromocytoma causing apparent ACTH-independent Cushing syndrome by paracrine action of locally produced ACTH on ipsilateral adrenal cortex. Case: A 64-year-old female was referred for an incidentally discovered left adrenal mass. The mass was 4 cm and 37 Hounsfield units on non-contrast computed tomography, and the right adrenal gland was unremarkable. The patient’s history was notable for three years of resistant hypertension, and examination revealed stigmata of Cushing syndrome including moon facies, scattered bruises, and wide, pink striae. Three measurements of plasma metanephrines ranged from 3- to 4.5-fold elevated, and 24 h urine metanephrines were 5.2-fold elevated. Urine 24 h epinephrine was 2.7-fold elevated. Three 8 AM cortisol measurements on overnight dexamethasone suppression tests were 16.3–17.4 mcg/dL (< 1.8), and 8 AM dexamethasone on one test was 494 ng/dL (140–295). Two midnight salivary cortisol measurements were 0.348 and 0.416 mcg/dL (< 0.112), and 8 AM ACTH levels on two occasions were 6.8 and 7.9 pg/mL (7.2–63.3). After adrenergic blockade, the patient underwent left adrenalectomy. Her tumor stained for synaptophysin and chromogranin consistent with pheochromocytoma, and focal staining for ACTH was also observed. Hyperplasia of the adjacent adrenal cortex was present. Hypertension resolved after adrenalectomy, and the patient developed secondary adrenal insufficiency (8 AM cortisol and ACTH 1.0 mcg/dL [> 15] and 2.9 pg/mL, respectively). Discussion: There are five published reports of pheochromocytoma and subclinical hypercortisolemia due to paracrine ACTH or IL-6 activity on ipsilateral adrenal cortex, but this case is distinguished by the occurrence of overt Cushing syndrome. Our patient had ACTH < 10 pg/mL on two measurements, her pheochromocytoma showed focal staining for ACTH, and hyperplasia of adjacent adrenal cortex was observed. In contrast, median ACTH level was 5-6x above the upper limit of normal in a recent review of 95 cases of pheochromocytomas with Cushing syndrome due to ectopic ACTH secretion. If Cushing syndrome was due to bilateral adrenal hyperplasia independent of the patient’s pheochromocytoma, cortisol excess would not have resolved after unilateral adrenalectomy. Communication between cortical and medullary circulations through venous radicles provides a mechanism for ACTH produced by the patient’s pheochromocytoma to affect the function of adjacent cortex. This case demonstrates a novel mechanism by which ACTH from a pheochromocytoma can cause Cushing syndrome.
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Affiliation(s)
- Amruta Jaju
- SIU School of Medicine, Springfield, IL, USA
| | | | | | - Anis Rehman
- SIU School of Medicine, Springfield, IL, USA
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Williams V, Jabri H, Jakoby MG. Night Sweats as the Presenting Symptom of Primary Hyperparathyroidism. J Endocr Soc 2021. [PMCID: PMC8090362 DOI: 10.1210/jendso/bvab048.421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: Approximately 25–40% of patients report night sweats in the previous month during appointments with their primary care clinicians. The differential diagnosis for night sweats is broad, with hyperthyroidism, carcinoid syndrome, pheochromocytoma, medullary thyroid carcinoma, insulinoma, and acromegaly as established endocrine causes. We present a case of primary hyperparathyroidism (PHPT) in which the patient’s chief complaint was night sweats and resolution occurred after parathyroidectomy. Case. A 39-year-old female reported one-year of daily night sweats that required changes of clothes and bedding. She denied excessive daytime sweating, frequent palpitations, tremors, nightmares, rashes, fevers, chills, cough, headaches, dizziness, abdominal pain, diarrhea, disrupted menses, or unintentional weight loss. Vital signs and examination were unremarkable. Hypercalcemia (11.0 mg/dL, 8.6–10.3) was noted and confirmed by additional serum calcium measurements. Intact PTH ranged from 27–33 pg/mL (12–88), and 24 h urine calcium (258 mg) excluded familial hypocalciuric hypercalcemia (FHH). Parathyroid scintigraphy and neck ultrasound identified a left neck mass, and the patient underwent successful resection of a left inferior parathyroid adenoma. Hypercalcemia and night sweats initially resolved after surgery, but the patient returned six weeks later with recurrence of night sweats. Reevaluation was notable for serum calcium 10.4 mg/dL, phosphorus 2.4 mg/dL (2.5–5.0), and intact PTH 104 pg/mL. A right superior parathyroid adenoma was identified on repeat parathyroidectomy, and the patient experienced durable resolution of night sweats and hypercalcemia following her second parathyroid surgery. She was screened for multiple endocrine neoplasia type 1 (MEN1) due to multiple parathyroid tumors, though no known pathogenic menin gene variants were identified. Conclusions: A title/abstract search in PubMed linking “hyperparathyroidism” and “hypercalcemia” to “night sweats,” “sleep hyperhidrosis,” “sweating,” “hot flashes,” “hot flushes,” “diaphoresis” and “vasomotor symptoms” yielded only one relevant case of a postmenopausal woman with hot flushes unresponsive to hormone replacement that resolved after parathyroidectomy for PHPT. Hypercalcemia is known to affect central nervous system function. It is possible that in rare cases hypercalcemia alters function of the medial preoptic area, lowering the temperature threshold above which peripheral vasodilatation and perspiration occur to dissipate heat. The patient’s predisposition to only night sweats is unclear, though unlike the first patient reported with PHPT and sweating, our patient is premenopausal. This case indicates that vasomotor symptoms may occur with PHPT and resolve after successful parathyroid surgery.
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Affiliation(s)
| | - Hadoun Jabri
- Division of Endocrinology, SIU school of Medicine, metairie, LA, USA
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Powles T, Meeks JJ, Galsky MD, Van Der Heijden MS, Nishiyama H, Al-Ahmadie HA, Goluboff ET, Hois S, Donegan SE, Williams V, Xiao F, Catto JWF. A phase III, randomized, open-label, multicenter, global study of efficacy and safety of durvalumab in combination with gemcitabine plus cisplatin for neoadjuvant treatment followed by durvalumab alone for adjuvant treatment in muscle-invasive bladder cancer (NIAGARA). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.6_suppl.tps505] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS505 Background: Management of muscle-invasive bladder cancer (MIBC) includes both surgery and systemic therapy. Neoadjuvant cisplatin-based combination chemotherapy has demonstrated improved pathologic complete response (pCR), event-free survival (EFS), and overall survival (OS) compared with radical cystectomy alone. Yet at least half of patients will still experience recurrence and will progress to metastatic disease. Durvalumab (anti–PD-L1 antibody) combined with gemcitabine + cisplatin, administered as either neoadjuvant or adjuvant treatment, may increase the rate of pathologic response and prolong long-term survival. This approach will be evaluated in this study in patients with MIBC identified for curable intent, as reflected in the NCCN guidelines. Methods: NIAGARA (NCT03732677) is a phase III, randomized, open-label, multicenter, international trial that will enroll ~1050 patients with MIBC who, prior to radical cystectomy, will be randomized (1:1) to durvalumab and gemcitabine + cisplatin (Arm 1) or gemcitabine + cisplatin (Arm 2). Following radical cystectomy, patients in Arm 1 will receive durvalumab monotherapy for 8 cycles (8 months) while patients in Arm 2 will receive no adjuvant treatment. Eligible patients are aged ≥18 years with resectable MIBC (clinical stage T2-T4aN0/1M0) with urothelial histology eligible for a radical cystectomy. Patients with pure non-transitional cell variant histologies and any small cell histology are not eligible. A tumor tissue sample for biomarker analysis is mandatory as PD-L1 expression is a stratification factor. Primary endpoints are pCR and EFS in patients with adequate renal function. Secondary and exploratory endpoints include proportion of patients who achieve pathologic response < stage II (stages Ta, T1, and carcinoma in situ) at the time of cystectomy following neoadjuvant treatment, EFS at 24 months, metastasis-free survival, efficacy of Arm 1 vs Arm 2 at radical cystectomy and proportion of patients who undergo cystectomy, OS rate at 5 years, safety, patient-reported outcomes, and pharmacokinetics. Immunogenicity and biomarkers are exploratory endpoints. Enrollment opened in Dec 2018. Clinical trial information: NCT03732677.
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Affiliation(s)
- Thomas Powles
- Barts Cancer Centre, Queen Mary University of London, London, United Kingdom
| | - Joshua J Meeks
- Northwestern University, Department of Urology, Feinberg School of Medicine, Chicago, IL
| | | | | | | | | | | | | | | | | | | | - James WF Catto
- Department of Oncology & Metabolism, The Medical School, Sheffield, United Kingdom
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Wade T, Heneghan C, Roberts N, Curtis D, Williams V, Onakpoya I. Healthcare-associated infections and the prescribing of antibiotics in hospitalized patients of the Caribbean Community (CARICOM) states: a mixed-methods systematic review. J Hosp Infect 2021; 110:122-132. [PMID: 33524426 DOI: 10.1016/j.jhin.2021.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 01/15/2021] [Accepted: 01/16/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Healthcare-associated infections (HCAIs) and variation in antibiotic prescribing pose a significant public health challenge in hospitals of low-resource countries. AIM To critically appraise and synthesize the evidence on HCAI and the prescribing of antibiotics in Caribbean Community (CARICOM) states. METHODS All primary qualitative and quantitative studies that addressed HCAI, and the prescribing of antibiotics in hospitalized patients of CARICOM states were included. Ovid Medline, Embase, Global Health, and regional databases were searched. Risk of bias was assessed using the Mixed Methods Appraisal Tool. Findings were presented in narrative and table formats. FINDINGS Twenty-one studies met the inclusion criteria for this mixed-methods systematic review (MMSR). Studies were from four different CARICOM states: Trinidad and Tobago, Jamaica, Haiti, and Antigua and Barbuda. Intensive care units (ICUs) had the highest rate of infections (67% over four years). Surgical site infections were discussed by seven studies and ranged from 1.5% to 7.3%. For inpatients with contaminated or infected wounds, rates ranged from 29% to 83%. Empiric and prophylactic therapies were common and inappropriately prescribed. Resources and training for healthcare workers in infection control and antimicrobial stewardship were insufficient. Few qualitative studies existed, so it was not possible to integrate evidence from qualitative and quantitative paradigms. CONCLUSION Evidence from CARICOM states shows high rates of HCAI and inappropriately prescribed antibiotics, primarily in ICUs. Disease surveillance, infection control, and antimicrobial stewardship programmes require urgent evidence-based improvements.
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Affiliation(s)
- T Wade
- Department for Continuing Education, University of Oxford, Oxford, UK.
| | - C Heneghan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - N Roberts
- Bodleian Health Care Libraries, University of Oxford, Oxford, UK
| | - D Curtis
- Usha Kundu, MD College of Health, University of West Florida, Pensacola, FL, USA
| | - V Williams
- School of Nursing, Nipissing University, North Bay, ON, Canada
| | - I Onakpoya
- Department for Continuing Education, University of Oxford, Oxford, UK
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Williams V, McManus B, Brooks‐Russell A, Yost E, Olds D, Tung G. Associations between Cross‐Sector Collaboration and Family Outcomes in Evidence‐Based Nurse Home Visiting. Health Serv Res 2020; 55:31-31. [PMCID: PMC7440420 DOI: 10.1111/1475-6773.13367] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2024] Open
Abstract
Home‐visiting prevention programs must coordinate with other community providers to be most effective. However, the associations between collaboration and program outcomes are not well understood. This study aimed to examine the associations between cross‐sector collaboration in Nurse‐Family Partnership (NFP), a model home‐visiting program, and client‐level outcomes. We used 2018 survey data with NFP supervisors that assessed agency‐level collaboration, as measured by relational coordination and structural integration with nine community provider types (including obstetrics care, substance use treatment, and child welfare). We paired the collaboration survey data with NFP program implementation data from 2014 to 2019 (n = 36,901) to examine outcomes including client retention, client smoking cessation, and childhood injury. We used random‐intercept models with nurse‐level random effects, controlling for client‐level demographics and health, nurse‐level demographics, and agency‐level administrative and geographic factors. NFP is an evidence‐based prenatal and early infancy home‐visitation program delivered by nurses to low‐income, first‐time mothers. NFP is implemented by over 250 agencies across the United States by public health departments, nonprofit organizations, and health care systems. Sample NFP clients were on average 23 years old and predominately single. Of sample clients, 47.5% were white, 33% were African American, 11.5% reported another race, and 8% declined reporting; 31% of clients identified as Hispanic. Consistent with past research, we found unmarried women and those visited by nurses who ceased employment with NFP prior to the client’s child’s birth were more likely to drop out of the NFP program, while older women and high school graduates were more likely to remain in NFP. Greater relational coordination with substance use treatment providers (OR: 1.148, P < .001) and stronger structural integration with CPS (OR: 1.056, P < .001) were associated with improved client retention at birth, even after adjusting for multilevel factors. Structural integration with CPS remains significantly associated with client retention at 12‐months postpartum. Greater nurse coordination with the Special Supplemental Nutrition Program for Women, Infants, and Children—WIC (OR: 1.090, P < .05) as well as with substance use treatment providers (OR: 1.115, P < .05) was associated with increased prenatal smoking cessation. Stronger nurse coordination with WIC (OR: 0.875, P < .01) and greater integration with mental health providers (OR: 0.969, P < .01) were associated with decreased probability of self‐reported emergency department (ED) use for childhood injury, while greater structural integration with WIC (OR: 1.022, P < .05) was associated with increased probability of ED use. Improving health care through relationships with other care providers is necessary to enhance the experience and outcomes of patients, particularly among high‐need complex populations. This study provides early results suggesting cross‐sector collaboration in a home‐visiting setting that bridges health care and addresses social determinants of health has potential to improve the retention of clients. More research is needed to understand how collaboration may improve maternal‐reported behaviors like smoking cessation and ED use for childhood injury. Our findings inform efforts to increase efficient delivery of prevention programs like NFP through intentional collaboration with cross‐sectors, as well as for future agency development for NFP expansion, especially as the program moves toward integration with health care delivery systems. Blue Meridian Partners.
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Affiliation(s)
| | - B. McManus
- Colorado School of Public HealthAuroraCOUSA
| | | | - E. Yost
- Nurse‐Family PartnershipDenverCOUSA
| | - D. Olds
- University of ColoradoAuroraCOUSA
| | - G. Tung
- Colorado School of Public HealthAuroraCOUSA
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Hirst JA, Farmer AJ, Williams V. How point-of-care HbA 1c testing changes the behaviour of people with diabetes and clinicians - a qualitative study. Diabet Med 2020; 37:1008-1015. [PMID: 31876039 PMCID: PMC7318570 DOI: 10.1111/dme.14219] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/19/2019] [Indexed: 02/07/2023]
Abstract
AIM To explore adults with diabetes and clinician views of point-of-care HbA1c testing. METHODS Adults with diabetes and HbA1c ≥ 58 mmol/mol (7.5%) receiving HbA1c point-of-care testing in primary care were invited to individual interviews. Participants were interviewed twice, once prior to point-of-care testing and once after 6 months follow-up. Clinicians were interviewed once. A thematic framework based on an a priori framework was used to analyse the data. RESULTS Fifteen participants (eight women, age range 30-70 years, two Asians, 13 white Europeans) were interviewed. They liked point-of-care testing and found the single appointment more convenient than usual care. Receiving the test result at the appointment helped some people understand how some lifestyle behaviours affected their control of diabetes and motivated them to change behaviours. Receiving an immediate test result reduced the anxiety some people experience when waiting for a result. People thought there was little value in using point-of-care testing for their annual review. Clinicians liked the point-of-care testing but expressed concerns about costs. CONCLUSIONS This work suggests that several features of point-of-care testing may encourage behavioural change. It helped some people to link their HbA1c result to recent lifestyle behaviours, thereby motivating behavioural change and reinforcing healthy lifestyle choices.
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Affiliation(s)
- J. A. Hirst
- Nuffield Department of Primary Care Health ScienceUniversity of OxfordRadcliffe Observatory QuarterOxfordUK
- National Institute for Health Research (NIHR) Oxford Biomedical Research CentreOxfordUK
| | - A. J. Farmer
- Nuffield Department of Primary Care Health ScienceUniversity of OxfordRadcliffe Observatory QuarterOxfordUK
- National Institute for Health Research (NIHR) Oxford Biomedical Research CentreOxfordUK
| | - V. Williams
- School of NursingNipissing UniversityNorth BayONUSA
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Boughey P, Jones C, Williams V, Rowe L, Marchant A, Lacey E, Evans B, Morcam C, Webb N, Davies R, Smith E, Shankland H, Leopold N, Harris W, Hudson C, Edwards R. Integrated care of older people (iCOP): an service delivering comprehensive geriatric assessment on the acute assessment unit at Singleton Hospital. Physiotherapy 2020. [DOI: 10.1016/j.physio.2020.03.249] [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: 11/27/2022]
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20
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Hollingsworth WR, Williams V, Ayzner AL. Semiconducting Eggs and Ladders: Understanding Exciton Landscape Formation in Aqueous π-Conjugated Inter-Polyelectrolyte Complexes. Macromolecules 2020. [DOI: 10.1021/acs.macromol.0c00029] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- William R. Hollingsworth
- Department of Chemistry and Biochemistry, University of California Santa Cruz, Santa Cruz, California 95064, United States
| | - Vanessa Williams
- Department of Chemistry and Biochemistry, University of California Santa Cruz, Santa Cruz, California 95064, United States
| | - Alexander L. Ayzner
- Department of Chemistry and Biochemistry, University of California Santa Cruz, Santa Cruz, California 95064, United States
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Nunnery D, Bonavire K, Williams V, Sastre L. Infant Feeding Practices and Social Determinants of Health of Women in Rural Nicaragua. J Acad Nutr Diet 2019. [DOI: 10.1016/j.jand.2019.08.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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22
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Scaife J, Boughey P, Jones C, Williams V, Rowe L, Marchant A, Lacey E, Rees O, Morcam C, Webb N, Davies R, Smith E, Leopold N, Harris W, Hudson C, Edwards R. 20INTEGRATED CARE OF OLDER PEOPLE (ICOP): A NEW SERVICE DELIVERING COMPREHENSIVE GERIATRIC ASSESSMENT (CGA) ON THE ACUTE ASSESSMENT UNIT AT SINGLETON HOSPITAL: RESULTS OF 2 PDSA CYCLES. Age Ageing 2019. [DOI: 10.1093/ageing/afz055.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- J Scaife
- Department of Medicine for Older People, Singleton Hospital
| | - P Boughey
- Department of Medicine for Older People, Singleton Hospital
| | - C Jones
- Department of Medicine for Older People, Singleton Hospital
| | - V Williams
- Department of Medicine for Older People, Singleton Hospital
| | - L Rowe
- Department of Medicine for Older People, Singleton Hospital
| | - A Marchant
- Department of Medicine for Older People, Singleton Hospital
| | - E Lacey
- Department of Medicine for Older People, Singleton Hospital
| | - O Rees
- Department of Medicine for Older People, Singleton Hospital
| | - C Morcam
- Department of Medicine for Older People, Singleton Hospital
| | - N Webb
- Department of Medicine for Older People, Singleton Hospital
| | - R Davies
- Department of Medicine for Older People, Singleton Hospital
| | - E Smith
- Department of Medicine for Older People, Singleton Hospital
| | - N Leopold
- Department of Medicine for Older People, Singleton Hospital
| | - W Harris
- Department of Medicine for Older People, Singleton Hospital
| | - C Hudson
- Department of Medicine for Older People, Singleton Hospital
| | - R Edwards
- Department of Medicine for Older People, Singleton Hospital
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Edwards S, Trevitt R, Williams V. P095 Siblings and positive respiratory samples. J Cyst Fibros 2019. [DOI: 10.1016/s1569-1993(19)30389-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Petry N, Lupu R, Gohar A, Larson EA, Peterson C, Williams V, Zhao J, Wilke RA, Hines LJ. CYP2C19 genotype, physician prescribing pattern, and risk for long QT on serotonin selective reuptake inhibitors. Pharmacogenomics 2019; 20:343-351. [PMID: 30983508 DOI: 10.2217/pgs-2018-0156] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To examine the impact of CYP2C19 genotype on selective serotonin reuptake inhibitor (SSRI) prescribing patterns. Patients & methods: Observational cohort containing 507 unique individuals receiving an SSRI prescription with CYP2C19 genotype already in their electronic medical record. Genotype was distributed as follows: n = 360 (71%) had no loss of function alleles, 136 (26.8%) had one loss of function allele and 11 (2.2%) had two loss of function alleles. Results & conclusion: For poor metabolizers exposed to sertraline, citalopram or escitalopram, providers changed prescribing patterns in response to alerts in the electronic medical record by either changing the drug, changing the dose or monitoring serial EKGs longitudinally. For intermediate metabolizers exposed to sertraline, citalopram or escitalopram, no alert was needed (mean QTc = 440.338 ms [SD = 31.1273] for CYP2C19*1/*1, mean QTc = 440.371 ms [SD = 29.2706] for CYP2C19*1/*2; p = 0.995).
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Affiliation(s)
- Natasha Petry
- Department of Pharmacy Practice, North Dakota State University, Fargo, ND 58108, USA.,Department of Internal Medicine, Sanford Health Fargo, ND 58122, USA
| | - Roxana Lupu
- Department of Internal Medicine, Sanford Health Sioux Falls, SD 57117, USA.,Department of Internal Medicine, Sanford School of Medicine, University of South Dakota, Sioux Falls, SD 57105, USA
| | - Ahmed Gohar
- Department of Internal Medicine, Sanford School of Medicine, University of South Dakota, Sioux Falls, SD 57105, USA
| | - Eric A Larson
- Department of Internal Medicine, Sanford Health Sioux Falls, SD 57117, USA.,Department of Internal Medicine, Sanford School of Medicine, University of South Dakota, Sioux Falls, SD 57105, USA
| | - Carmen Peterson
- Department of Internal Medicine, Sanford Health Sioux Falls, SD 57117, USA
| | - Vanessa Williams
- Department of Internal Medicine, Sanford Health Sioux Falls, SD 57117, USA
| | - Jing Zhao
- Department of Internal Medicine, Sanford Health Sioux Falls, SD 57117, USA.,Department of Internal Medicine, Sanford School of Medicine, University of South Dakota, Sioux Falls, SD 57105, USA
| | - Russell A Wilke
- Department of Internal Medicine, Sanford Health Sioux Falls, SD 57117, USA.,Department of Internal Medicine, Sanford School of Medicine, University of South Dakota, Sioux Falls, SD 57105, USA
| | - Lindsay J Hines
- Department of Neuropsychology, Sanford Health, Fargo, ND 58122, USA.,Department of Psychology, University of North Dakota, Grand Forks, ND 58202, USA
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Rohr A, Werth K, Shen X, Collins Z, Fishback S, Jones J, Ash R, Williams V. MRI findings of absorbable hydrogel spacer for prostate cancer therapy: a pictorial review. Abdom Radiol (NY) 2019; 44:247-251. [PMID: 29967983 DOI: 10.1007/s00261-018-1685-y] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Prior studies have shown that dose-escalated radiation therapy for prostate cancer improves clinical outcomes. However, this is associated with increased rectal toxicity. Hydrogel spacer for prostate cancer therapy is an effective way of decreasing rectal toxicity in the late post-therapeutic stages. In some occasions, the gel spacer may not be placed symmetrically between the rectum and prostate. There are several forms of a malpositioned spacer, including lateral displacement, rectal wall infiltration, and prostate capsule infiltration. This manuscript is aimed at evaluating appropriately positioned and malpositioned gel spacers, primarily via magnetic resonance imaging. There are limited educational imaging guides that address what radiologists should evaluate on post-spacer placement imaging. This pictorial review will specifically evaluate post-injection pitfalls such as asymmetry, rectal wall infiltration, and subcapsular injection.
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Affiliation(s)
- Aaron Rohr
- Department of Interventional Radiology, University of Stanford, 300 Pasteur Drive, H3531, Stanford, CA, 94305, USA.
| | - Kyle Werth
- Department of Radiology, University of Kansas Health Systems, Kansas City, USA
| | - Xinglei Shen
- Department of Radiation Oncology, University of Kansas Health Systems, Kansas City, USA
| | - Zachary Collins
- Department of Radiology, University of Kansas Health Systems, Kansas City, USA
| | - Shelby Fishback
- Department of Radiology, University of Kansas Health Systems, Kansas City, USA
| | - Jill Jones
- Department of Radiology, University of Kansas Health Systems, Kansas City, USA
| | - Ryan Ash
- Department of Radiology, University of Kansas Health Systems, Kansas City, USA
| | - Vanessa Williams
- Department of Radiology, University of Kansas Health Systems, Kansas City, USA
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Victor C, Williams V, Kinnear D, Ryan S. AGEING WITH A LEARNING DISABILITY: A CRITICAL LITERATURE REVIEW. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.2985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- C Victor
- Brunel University London, Uxbridge, England, United Kingdom
| | | | | | - S Ryan
- University of Oxford, Oxford, UK
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Marshall CL, Williams V, Ellis C, Taylor RE, Bewley AP. Delusional infestation may be caused by recreational drug usage in some patients, but they may not disclose their habit. Clin Exp Dermatol 2016; 42:41-45. [DOI: 10.1111/ced.12999] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2016] [Indexed: 11/26/2022]
Affiliation(s)
| | - V. Williams
- Barts and the London School of Medicine and Dentistry; London UK
| | - C. Ellis
- Barts and the London School of Medicine and Dentistry; London UK
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Yang JY, Lambdon P, Williams V, Cronk QC. Plastid markers from whole plastome sequencing for gene-flow studies in the endangered endemic bellflowers of St Helena, Wahlenbergia angustifolia and Wahlenbergia linifolia (Campanulaceae). CONSERV GENET RESOUR 2016. [DOI: 10.1007/s12686-016-0612-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
We have developed proprietary technologies for executing continuous flow assays in biochips which mimic human capillaries. Such technologies are integral to the rapidly growing laboratory instrumentation sector for applications in drug discovery, biotechnology, medical diagnostics and environmental studies. A common link between all sectors is the movement toward miniaturization to increase throughput, accuracy and efficiency in the development of new drugs. The miniaturization process itself leads to a demand for new instruments and tools capable of handling microlitre quantities of biological fluids and reagents, thus, we present an instrument which is capable of doing so in the form of a microfluidic enabling platform.
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Affiliation(s)
- V. Williams
- Physics Department, Trinity College Dublin 2, Ireland
| | - D. Kashanin
- Physics Department, Trinity College Dublin 2, Ireland
| | - I. V. Shvets
- Physics Department, Trinity College Dublin 2, Ireland
| | - S. Mitchell
- Dublin Molecular Medicine Centre, Trinity College, Dublin, Ireland
| | - Y. Volkov
- Dublin Molecular Medicine Centre, Trinity College, Dublin, Ireland
| | - D. Kelleher
- Dublin Molecular Medicine Centre, Trinity College, Dublin, Ireland
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Affiliation(s)
- C.L. Marshall
- Dermatology; York Teaching Hospitals NHS Foundation Trust; York Hospital; York U.K
| | - C. Ellis
- Medical School; Barts and the London School of Medicine and Dentistry; London U.K
| | - V. Williams
- Medical School; Barts and the London School of Medicine and Dentistry; London U.K
| | - R.E. Taylor
- Department of Psychiatry; Royal London Hospital; London U.K
| | - A.P. Bewley
- Department of Dermatology; Royal London Hospital; London U.K
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Williams V, Rawat A, Gupta A, Singh S. AB0157 Fc Gamma Receptor Expression Profile in Pediatric-Onset Systemic Lupus Erythematosus: Table 1. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.3863] [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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Williams V, Coles T, DeMuro C, Lewis S, Williams N, Yarr S, Barghout V, Lowes L, Alfano L, Goldberg B, Gnanasakthy A, Capkun G, Tseng B. Psychometric evaluation of the sporadic inclusion body myositis (sIBM) physical functioning assessment (sIFA). Neuromuscul Disord 2015. [DOI: 10.1016/j.nmd.2015.06.198] [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: 11/28/2022]
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DeMuro C, Williams V, Goldberg R, Lowes L, Price M, Capkun G, Barghout V, Tseng B. Resource utilization in a US-based sample of patients with sporadic inclusion body myositis (sIBM). Neuromuscul Disord 2015. [DOI: 10.1016/j.nmd.2015.06.195] [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: 11/28/2022]
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van Oers MHJ, Kuliczkowski K, Smolej L, Petrini M, Offner F, Grosicki S, Levin MD, Gupta I, Phillips J, Williams V, Manson S, Lisby S, Geisler C. Ofatumumab maintenance versus observation in relapsed chronic lymphocytic leukaemia (PROLONG): an open-label, multicentre, randomised phase 3 study. Lancet Oncol 2015; 16:1370-9. [PMID: 26377300 DOI: 10.1016/s1470-2045(15)00143-6] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Revised: 07/06/2015] [Accepted: 07/07/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND Ofatumumab is a human anti-CD20 monoclonal antibody that has proven efficacy as monotherapy in refractory chronic lymphocytic leukaemia. We assessed the efficacy and safety of ofatumumab maintenance treatment versus observation for patients in remission after re-induction treatment for relapsed chronic lymphocytic leukaemia. METHODS This open-label, multicentre, randomised phase 3 study enrolled patients aged 18 years or older from 130 centres in 24 countries who had chronic lymphocytic leukaemia in complete or partial remission after second-line or third-line treatment. Eligible patients had a WHO performance status of 0-2, had a response assessment within the previous 3 months, did not have refractory disease, autoimmune haemolytic anaemia requiring treatment, chronic or active infection requiring treatment, and had not previously received maintenance treatment or autologous or allogeneic stem-cell transplant. Using a randomisation list generated by a central computerised system and an interactive voice recognition system, we randomly assigned (1:1) patients to receive ofatumumab (300 mg followed by 1000 mg 1 week later and every 8 weeks for up to 2 years) or undergo observation. Randomisation was stratified by number and type of previous treatment and remission status after induction treatment (block size of four). Treatment assignment was open label. The primary endpoint was investigator-assessed progression-free survival in the intention-to-treat population. We report the results of a prespecified interim analysis after two-thirds of the planned study events (disease progression or death) had happened. This trial is closed to accrual but follow-up is ongoing. This trial is registered with ClinicalTrials.gov, number NCT00802737. FINDINGS Between May 6, 2010, and June 19, 2014, we enrolled 474 patients: 238 patients were randomly assigned to receive ofatumumab maintenance treatment and 236 to undergo observation. One (<1%) patient in the ofatumumab group did not receive the allocated intervention (withdrawal of consent). The median follow-up was 19·1 months (IQR 10·3-28·8). Progression-free survival was improved in patients assigned to the ofatumumab group (29·4 months, 95% CI 26·2-34·2) compared with those assigned to observation (15·2 months, 11·8-18·8; hazard ratio 0·50, 95% CI 0·38-0·66; p<0·0001). The most common grade 3 or higher adverse events up to 60 days after last treatment were neutropenia (56 [24%] of 237 patients in the ofatumumab group vs 23 [10%] of 237 in the observation group) and infections (31 [13%] vs 20 [8%]). 20 (8%) of 237 patients in the ofatumumab group and three (1%) of 237 patients in the observation group had adverse events that led to permanent discontinuation of treatment. Up to 60 days after last treatment, two deaths related to adverse events occurred in the ofatumumab treatment group and five deaths related to adverse events occurred in the observation group; no deaths were attributed to the study drug. INTERPRETATION These data are important for the development of optimum maintenance strategies in patients with relapsed chronic lymphocytic leukaemia, notably in the present era of targeted drugs, many of which are to be used until progression.
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Affiliation(s)
- Marinus H J van Oers
- Department of Hematology, Academisch Medisch Centrum, Amsterdam, Netherlands; The Haemato Oncology Foundation for Adults in the Netherlands (HOVON), Amsterdam, Netherlands.
| | | | - Lukáš Smolej
- 4th Department of Internal Medicine-Hematology, Faculty of Medicine in Hradec Králové, University Hospital and Charles University, Prague, Czech Republic
| | - Mario Petrini
- Azienda Ospedaliera Universitaria Pisana, University of Pisa, Pisa, Italy
| | | | - Sebastian Grosicki
- Department of Cancer Prevention, Faculty of Public Health, Silesian Medical University, Katowice, Poland
| | - Mark-David Levin
- The Haemato Oncology Foundation for Adults in the Netherlands (HOVON), Amsterdam, Netherlands; Albert Schweitzer Ziekenhuis, Dordrecht, Netherlands
| | - Ira Gupta
- GlaxoSmithKline, Collegeville, PA, USA
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Puryear M, Camel S, Williams V, Stallings S. Preliminary Findings from the Rocha Project: Oral Health Quality of Life. J Acad Nutr Diet 2015. [DOI: 10.1016/j.jand.2015.06.299] [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: 12/01/2022]
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Fang F, Bae EH, Hu A, Liu GC, Zhou X, Williams V, Maksimowski N, Lu C, Konvalinka A, John R, Scholey JW. Deletion of the gene for adiponectin accelerates diabetic nephropathy in the Ins2 (+/C96Y) mouse. Diabetologia 2015; 58:1668-78. [PMID: 25957229 DOI: 10.1007/s00125-015-3605-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 04/10/2015] [Indexed: 12/15/2022]
Abstract
AIMS/HYPOTHESIS Diabetic nephropathy is one of the most common forms of chronic kidney disease. The role of adiponectin in the development of diabetic nephropathy has not been elucidated, and the aim of the present study was to investigate the hypothesis that deletion of the gene for adiponectin would accelerate diabetic nephropathy in the Akita mouse. METHODS We followed four groups of mice from 4 weeks to 16 weeks of age (n ≥ 10 in each group): wild-type (WT) (Ins2 (+/+) Adipoq(+/+)) mice; APN(-/-) (Ins2(+/+) Adipoq(-/-)) mice; Akita (Ins2(+/C96Y) Adipoq(+/+)) mice and Akita/APN(-/-) (Ins2(+/C96Y) Adipoq(-/-)) mice. The mice were then killed and diabetic kidney injury was assessed. In vitro experiments were performed in primary mesangial cells. RESULTS Mice from both diabetic groups exhibited increased glomerular adiponectin receptor 1 (adipoR1) expression, kidney hypertrophy, glomerular enlargement, increased albuminuria and tissue oxidative stress compared with the WT control. Deletion of the adiponectin gene had no effect on glycaemia. However, Akita/APN(-/-) mice exhibited a greater extent of renal hypertrophy. In vitro, adiponectin attenuated high-glucose-induced phosphorylation of mammalian target of rapamycin (mTOR) and ribosomal protein S6 kinase (S6K). A higher level of fibrosis was observed in the tubulointerstitial and glomerular compartments of the Akita/APN(-/-) mice and adiponectin was found to inhibit TGFβ-induced Smad2 and Smad3 phosphorylation in vitro. There was an exaggerated inflammatory response in the Akita/APN(-/-) mice. Adiponectin also inhibited high-glucose-induced activation of nuclear factor κB (NFκB) in mesangial cells. CONCLUSIONS/INTERPRETATION Our data suggest that adiponectin is an important determinant of the kidney response to high glucose in vivo and in vitro.
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Affiliation(s)
- Fei Fang
- Institute of Medical Science, Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada,
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Bae EH, Konvalinka A, Fang F, Zhou X, Williams V, Song X, Zhang SL, John R, Oudit GY, Pei Y, Scholey JW. SP024MURINE RECOMBINANT ACE2 ATTENUATES KIDNEY INJURY IN EXPERIMENTAL ALPORTS SYNDROME (AS). Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv187.24] [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: 11/13/2022] Open
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Munro A, Leung Y, Spilsbury K, Stewart C, Semmens J, Codde J, Williams V, O'Leary P, Steel N, Cohen P. Comparison of cold knife cone biopsy and loop electrosurgical excision procedure in the management of cervical adenocarcinoma in situ: What is the gold standard? Gynecol Oncol 2015; 137:258-63. [DOI: 10.1016/j.ygyno.2015.02.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 02/26/2015] [Indexed: 10/23/2022]
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Österborg A, Wierda WG, Mayer J, Hess G, Hillmen P, Schetelig J, Schuh A, Smolej L, Beck C, Dreyfus B, Hellman A, Kozlowski P, Pfreundschuh M, Rizzi R, Spacek M, Phillips JL, Gupta IV, Williams V, Jewell RC, Nebot N, Lisby S, Dyer MJS. Ofatumumab retreatment and maintenance in fludarabine-refractory chronic lymphocytic leukaemia patients. Br J Haematol 2015; 170:40-9. [DOI: 10.1111/bjh.13380] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 02/04/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Anders Österborg
- Department of Haematology; Karolinska University Hospital; Stockholm Sweden
| | - William G. Wierda
- The University of Texas; M.D. Anderson Cancer Center; Houston TX USA
- Cancer Therapy Research Center; San Antonio TX USA
| | - Jiří Mayer
- Department of Internal Medicine/Haemato-Oncology; Faculty Hospital Brno; Brno Czech Republic
| | - Georg Hess
- Johannes-Gutenberg-Universtitaer Mainz; Mainz Germany
| | | | | | | | - Lukáš Smolej
- Faculty of Medicine in Hradec Kralove; University Hospital and Charles University in Prague; Hradec Kralove Czech Republic
| | - Christian Beck
- Haematologisch-Onkologisches Institut; Moenchengladbach-Rheydt Germany
| | | | | | | | | | - Rita Rizzi
- Azienda Ospendaliero Universitaria Policlinico Consorziale; Bari Italy
| | | | | | | | | | | | | | | | - Martin J. S. Dyer
- Ernest and Helen Scott Haematological Research Institute; University of Leicester; Leicester UK
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Bae EH, Konvalinka A, Fang F, Zhou X, Williams V, Maksimowski N, Song X, Zhang SL, John R, Oudit GY, Pei Y, Scholey JW. Characterization of the intrarenal renin-angiotensin system in experimental alport syndrome. Am J Pathol 2015; 185:1423-35. [PMID: 25777062 DOI: 10.1016/j.ajpath.2015.01.021] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 12/29/2014] [Accepted: 01/22/2015] [Indexed: 01/03/2023]
Abstract
Blockade of the renin-angiotensin system attenuates the progression of experimental and clinical Alport syndrome (AS); however, the underlying mechanism(s) remains largely unknown. We evaluated the renin-angiotensin system in 4- and 7-week-old homozygous for collagen, type IV, α3 gene (Col4A3(-/-)) and wild-type mice, a model of AS characterized by proteinuria and progressive renal injury. Renal angiotensin (Ang) II levels increased, whereas renal Ang-(1-7) levels decreased in 7-week-old Col4a3(-/-) mice compared with age-matched controls; these changes were partially reversed by recombinant angiotensin-converting enzyme 2 (ACE2) treatment. The expression of both the angiotensinogen and renin protein increased in Col4a3(-/-) compared with wild-type mice. Consistent with the Ang-(1-7) levels, the expression and activity of kidney ACE2 decreased in 7-week-old Col4a3(-/-) mice. The urinary excretion rate of ACE2 paralleled the decline in tissue expression. Expression of an Ang II-induced gene, heme oxygenase-1, was up-regulated in the kidneys of 7-week-old Col4a3(-/-) mice compared with wild-type mice by microarray analysis. Heme oxygenase-1 (HO-1) protein expression was increased in kidneys of Col4a3(-/-) mice and normalized by treatment with ACE inhibitor. Urinary HO-1 excretion paralleled renal HO-1 expression. In conclusion, progressive kidney injury in AS is associated with changes in expression of intrarenal renin Ang system components and Ang peptides. HO-1 and ACE2 may represent novel markers of AS-associated kidney injury, whereas administration of recombinant ACE2 and/or Ang-(1-7) may represent novel therapeutic approaches in AS.
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Affiliation(s)
- Eun Hui Bae
- Department of Medicine, Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea.
| | - Ana Konvalinka
- Division of Nephrology, University Health Network, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Fei Fang
- Department of Medicine, Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Xiaohua Zhou
- Department of Medicine, Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Vanessa Williams
- Department of Medicine, Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Nicholas Maksimowski
- Department of Medicine, Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Xuewen Song
- Division of Nephrology, University Health Network, University of Toronto, Toronto, Ontario, Canada; Division of Genomic Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Shao-Ling Zhang
- Faculty of Medicine, Hộtel-DieuHộpital, University of Montreal, Montreal, Quebec, Canada
| | - Rohan John
- Department of Pathology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Gavin Y Oudit
- Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - York Pei
- Division of Nephrology, University Health Network, University of Toronto, Toronto, Ontario, Canada; Division of Genomic Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - James W Scholey
- Department of Medicine, Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Division of Nephrology, University Health Network, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
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Roberts SCM, Fuentes L, Kriz R, Williams V, Upadhyay UD. Implications for women of Louisiana's law requiring abortion providers to have hospital admitting privileges. Contraception 2015; 91:368-72. [PMID: 25744615 DOI: 10.1016/j.contraception.2015.02.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [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: 01/13/2015] [Revised: 02/02/2015] [Accepted: 02/03/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND In 2014, Louisiana passed a law requiring abortion providers to have hospital admitting privileges. This law is temporarily on hold while a court case challenging it continues. We aimed to describe the population who would be affected if the law goes into effect and how closures of between three and five Louisiana abortion facilities would affect the distance Louisiana women would need to travel for an abortion. STUDY DESIGN We abstracted patient data from three of the five Louisiana abortion care facilities in the year before the law was scheduled to take effect. We then estimated distance traveled and distances women would need to travel if clinics close. FINDINGS Half (53%) of women who had an abortion had no education beyond high school, most were black (62%) or white (30%), three fourths (73%) had a previous live birth, and most (89%) were having a first-trimester abortion. Seventy-nine percent resided in Louisiana and 15% in Texas. The parishes in which abortion patients resided had lower median income and higher percentage poverty than the Louisiana average. Abortion patients residing in Louisiana traveled a mean distance of 58 miles each way for an abortion. If all Louisiana facilities close, the mean distance women would need to travel would more than triple to 208 miles, and the proportion of Louisiana women of reproductive age who live more than 150 miles from an abortion facility would increase from 1% to 72%. CONCLUSION The admitting privileges law will likely significantly increase the distance Louisiana women need to travel for an abortion. This burden is likely to disproportionately affect Louisiana's more vulnerable residents. IMPLICATIONS If all Louisiana abortion facilities close due to Louisiana's hospital admitting privileges law, the mean distance women would need to travel for an abortion would more than triple from 58 to 208 miles. Louisiana's law would thus present a considerable burden on many Louisiana women, particularly those who are more vulnerable.
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Affiliation(s)
- S C M Roberts
- Advancing New Standards in Reproductive Health (ANSIRH), University of California, San Francisco, Oakland, CA.
| | - L Fuentes
- Ibis Reproductive Health, Oakland, CA
| | - R Kriz
- Advancing New Standards in Reproductive Health (ANSIRH), University of California, San Francisco, Oakland, CA
| | - V Williams
- Louisiana State University Health New Orleans, School of Medicine, New Orleans, LA
| | - U D Upadhyay
- Advancing New Standards in Reproductive Health (ANSIRH), University of California, San Francisco, Oakland, CA
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Williams V, Simor AE, Kiss A, McGeer A, Hirji Z, Larios OE, Moore C, Weiss K. Is the prevalence of antibiotic-resistant organisms changing in Canadian hospitals? Comparison of point-prevalence survey results in 2010 and 2012. Clin Microbiol Infect 2015; 21:553-9. [PMID: 25677630 DOI: 10.1016/j.cmi.2015.01.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 01/13/2015] [Accepted: 01/22/2015] [Indexed: 10/24/2022]
Abstract
A national point-prevalence survey for infection or colonization with methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE), and for Clostridium difficile infection (CDI) was done in Canadian hospitals in 2010. A follow-up survey was done in November 2012 to determine whether there were any changes in the prevalence of these organisms; we also determined the prevalence of extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae, and carbapenem-resistant Enterobacteriaceae (CREs). Associations between prevalence and infection prevention and control policies were evaluated in logistic regression models. A total of 143 (67% of eligible facilities) hospitals with 29 042 adult inpatients participated in the survey, with representation from all 10 provinces; 132 hospitals participated in 2010 and 2012. There were no significant changes in the median prevalence of MRSA in 2010 (4.3%) compared to 2012 (3.9%), or of CDI in 2010 (0.8%) compared to 2012 (0.9%). A higher median prevalence of VRE was identified in 2012 (1.3%) compared to 2010 (0.5%) (p 0.04), despite decreased VRE screening in 2012. The median prevalence of ESBLs was 0.7% and was 0 for CREs; CREs were reported from only 10 hospitals (7.0%). A policy of routinely caring for patients with MRSA or VRE in a private isolation room was associated with lower prevalence of these organisms. Targeted screening of high-risk patients at admission was associated with lower MRSA prevalence; better hand hygiene compliance was associated with lower VRE prevalence. These data provide national prevalence rates for antibiotic-resistant organisms among adults hospitalized in Canadian hospitals. Certain infection prevention and control policies were associated with prevalence.
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Affiliation(s)
- V Williams
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - A E Simor
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
| | - A Kiss
- Institute of Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - A McGeer
- Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Z Hirji
- The Scarborough Hospital, Toronto, Ontario, Canada
| | - O E Larios
- University of Calgary, Calgary, Alberta, Canada
| | - C Moore
- Mount Sinai Hospital, Toronto, Ontario, Canada
| | - K Weiss
- Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
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Coles TM, Chen WH, Nelson LM, Williams V, McLeod LD. Current Sample Size Practices in the Psychometric Evaluation of Patient-Reported Outcomes for Use in Clinical Trials. Value Health 2014; 17:A571. [PMID: 27201904 DOI: 10.1016/j.jval.2014.08.1909] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- T M Coles
- RTI Health Solutions, Research Triangle Park, NC, USA
| | - W H Chen
- RTI Health Solutions, Research Triangle Park, NC, USA
| | - L M Nelson
- RTI Health Solutions, Research Triangle Park, NC, USA
| | - V Williams
- RTI Health Solutions, Research Triangle Park, NC, USA
| | - L D McLeod
- RTI Health Solutions, Research Triangle Park, NC, USA
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Coles TM, Dwyer KA, Mordin M, Williams V, Clatworthy M, Yates P, Hamilton W. Psychometric Evaluation Of The Patient's Knee Implant Performance (PKIP) Questionnaire For The Assessment Of Primary Total Knee Arthroplasty. Value Health 2014; 17:A568. [PMID: 27201888 DOI: 10.1016/j.jval.2014.08.1895] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- T M Coles
- RTI Health Solutions, Research Triangle Park, NC, USA
| | - K A Dwyer
- DePuy Orthopaedics, Inc, Warsaw, IN, USA
| | - M Mordin
- RTI Health Solutions, Ann Arbor, MI, USA
| | - V Williams
- RTI Health Solutions, Research Triangle Park, NC, USA
| | | | - P Yates
- Murdoch Orthopaedic Clinic, Murdoch, New Zealand
| | - W Hamilton
- Anderson Orthopaedic Research Institute, Alexandria, VA, USA
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Rooney C, Geh C, Williams V, Cresswell C, Al-Kadhimi K, Dymond M, French T, Smith P, Barrett C, Harrington E, Kilgour E. 520 Validation of Nanostring for FGFR1 gene expression analysis in squamous non-small cell lung cancer (sqNSCLC) tissue. Eur J Cancer 2014. [DOI: 10.1016/s0959-8049(14)70646-x] [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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Williams V, Hardinge M, Ryan S, Farmer A. OP36 Patients’ experience of identifying and managing exacerbations in Chronic obstructive pulmonary disease – a qualitative study. Br J Soc Med 2014. [DOI: 10.1136/jech-2014-204726.39] [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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Affiliation(s)
- A Njoroge
- Eastern Deanery AIDS Relief Programme, Nairobi, Kenya
| | - S Cassidy
- Freelance journalist, Cape Town, South Africa
| | - V Williams
- International Council of Nurses, Geneva, Switzerland
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Pineda JA, Grichanik M, Williams V, Trieu M, Chang H, Keysers C. EEG sensorimotor correlates of translating sounds into actions. Front Neurosci 2013; 7:203. [PMID: 24376395 PMCID: PMC3858667 DOI: 10.3389/fnins.2013.00203] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 10/13/2013] [Indexed: 11/24/2022] Open
Abstract
Understanding the actions of others is a necessary foundational cornerstone for effective and affective social interactions. Such understanding may result from a mapping of observed actions as well as heard sounds onto one's own motor representations of those events. To examine the electrophysiological basis of action-related sounds, EEG data were collected in two studies from adults who were exposed to auditory events in one of three categories: action (either hand- or mouth-based sounds), non-action (environmental sounds), and control sounds (scrambled versions of action sounds). In both studies, triplets of sounds of the same category were typically presented, although occasionally, to ensure an attentive state, trials containing a sound from a different category were presented within the triplet and participants were asked to respond to this oddball event either covertly in one study or overtly in another. Additionally, participants in both studies were asked to mimic hand- and mouth-based motor actions associated with the sounds (motor task). Action sounds elicited larger EEG mu rhythm (8–13 Hz) suppression, relative to control sounds, primarily over left hemisphere, while non-action sounds showed larger mu suppression primarily over right hemisphere. Furthermore, hand-based sounds elicited greater mu suppression over the hand area in sensorimotor cortex compared to mouth-based sounds. These patterns of mu suppression across cortical regions to different categories of sounds and to effector-specific sounds suggest differential engagement of a mirroring system in the human brain when processing sounds.
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Affiliation(s)
- Jaime A Pineda
- Department of Cognitive Science, University of California San Diego, La Jolla, CA, USA ; Neurosciences Group, University of California San Diego, La Jolla, CA, USA
| | - Mark Grichanik
- Department of Cognitive Science, University of California San Diego, La Jolla, CA, USA
| | - Vanessa Williams
- Department of Cognitive Science, University of California San Diego, La Jolla, CA, USA
| | - Michelle Trieu
- Department of Cognitive Science, University of California San Diego, La Jolla, CA, USA
| | - Hailey Chang
- Department of Cognitive Science, University of California San Diego, La Jolla, CA, USA
| | - Christian Keysers
- Netherlands Institute for Neuroscience, KNAW Amsterdam, Netherlands ; Department of Neuroscience, University Medical Center Groningen, University of Groningen Netherlands
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Tadesse Y, Yesuf M, Williams V. Evaluating the output of transformational patient-centred nurse training in Ethiopia. Int J Tuberc Lung Dis 2013; 17:9-14. [DOI: 10.5588/ijtld.13.0386] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Y. Tadesse
- Ethiopian Nurses Association, Addis Ababa, Ethiopia
| | - M. Yesuf
- St Peter's Hospital, Addis Ababa, Ethiopia
| | - V. Williams
- International Council of Nurses, Geneva, Switzerland
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Fedotkina TY, Williams V. The contribution of nurses to a multi-disciplinary approach to patient care in Tomsk, Russia. Int J Tuberc Lung Dis 2013; 17:33-35. [PMID: 24020599 DOI: 10.5588/ijtld.13.0331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The Tomsk Oblast Tuberculosis (TB) services have accumulated unique experience in the area of TB detection, care and control through their collaboration with various international partners since 1994. Nurses account for about one half of all health care personnel in both in-patient and out-patient care sectors in Tomsk TB services, and they have been involved throughout in the planning and delivery of care. The authors believe that a holistic approach to service provision has led to positive results in TB programme outcomes, which are better than many in Russia, even with historically high rates of drug-resistant TB.
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Affiliation(s)
- T Y Fedotkina
- Tomsk TB Dispensary, Tomsk TB Control Programme, Tomsk, Russian Federation
| | - V Williams
- International Council of Nurses, Geneva, Switzerland
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