96 results on '"Alcorn K"'
Search Results
2. Angiogenesis Inhibitor TNP-470 During Bone Marrow Transplant and in Minimal Residual Disease
- Author
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Fang, J., Stern, J. W., Shusterman, S., Alcorn, K., Pierson, G., Barr, R., Pawel, B., Diller, L., Maris, J. M., Grupp, S. A., Berdel, W. E., editor, Büchner, Th., editor, Kienast, J., editor, Jürgens, H., editor, Ritter, J., editor, and Vormoor, J., editor
- Published
- 2003
- Full Text
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3. Repeat testing for SARS-CoV-2: persistence of viral RNA is common, and clearance is slower in older people
- Author
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Stehlik, P, Alcorn, K, Jones, A, Schlebusch, S, Wattiaux, A, Henry, DA, Stehlik, P, Alcorn, K, Jones, A, Schlebusch, S, Wattiaux, A, and Henry, DA
- Published
- 2021
4. The State of Hepatitis B and C in the Mediterranean and Balkan Countries: Report from a Summit Conference
- Author
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Hatzakis, A., Van Damme, P., Alcorn, K., Gore, C., Benazzouz, M., Berkane, S., Buti, M., Carballo, M., Martins, Cortes H., Deuffic-Burban, S., Dominguez, A., Donoghoe, M., Elzouki, A-N., Bouafif, Ben-Alaya N., Esmat, G., Esteban, R., Fabri, M., Fenton, K., Goldberg, D., Goulis, I., Hadjichristodoulou, T., Hatzigeorgiou, T., Hamouda, O., Hasurdjiev, S., Hughes, S., Kautz, A., Malik, M., Manolakopoulos, S., Matičič, M., Papatheodoridis, G., Peck, R., Peterle, A., Potamitis, G., Prati, D., Roudot-Thoraval, F., Reic, T., Sharara, A., Shennak, M., Shiha, G., Shouval, D., Sočan, M., Thomas, H., Thursz, M., Tosti, M., Trépo, C., Vince, A., Vounou, E., Wiessing, L., and Manns, M.
- Published
- 2013
- Full Text
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5. PTSD due to childbirth stands at between 3.1% (adjusted) and 5.8% (unadjusted)
- Author
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PATRICK, J. C., DEVILLY, G. J., OʼDONOVAN, A., ALCORN, K. L., and CREEDY, D.
- Published
- 2011
6. A prospective longitudinal study of the prevalence of post-traumatic stress disorder resulting from childbirth events
- Author
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Alcorn, K. L., OʼDonovan, A., Patrick, J. C., Creedy, D., and Devilly, G. J.
- Published
- 2010
7. First report of candidatus mycoplasma haemohominis infection in Australia causing persistent fever in an animal carer
- Author
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Alcorn, K., Gerrard, J., Cochrane, T., Graham, R., Jennison, A., Irwin, P.J., Barbosa, A.D., Alcorn, K., Gerrard, J., Cochrane, T., Graham, R., Jennison, A., Irwin, P.J., and Barbosa, A.D.
- Abstract
Background Hemotropic mycoplasmas (hemoplasmas) infect animals and humans and can lead to clinical syndromes mainly characterized by hemolytic anemia. A novel pathogen, Candidatus Mycoplasma haemohominis, was recently associated with a case of human hemoplasmosis in Europe. Here we report the first detection of this pathogen in an Australian patient exhibiting persistent fever, hemolytic anemia, and pancytopenia over a 10-month period. Methods After exhaustive negative testing for human infectious diseases, whole genome sequencing (WGS) was performed on the patient’s bone marrow aspirate, using an Illumina NextSeq500 platform. Conventional polymerase chain reaction (PCR), followed by Sanger sequencing, was then performed on blood samples using novel Mycoplasma-specific primers targeting the 16S ribosomal RNA gene. In addition, a Mycoplasma-specific fluorescence in situ hybridization (FISH) assay was developed to differentiate Mycoplasma cells from other erythrocyte inclusions (eg, Pappenheimer and Howell-Jolly bodies) which are morphologically similar to bacterial cocci by light microscopy. Results WGS analysis revealed that approximately 0.04% of the total number of unmapped reads to human genome corresponded to Mycoplasma species. A 1-kb Mycoplasma 16S fragment was successfully amplified by conventional PCR, and sequence analyses revealed 100% identity with Candidatus Mycoplasma haemohominis. FISH confirmed that several (approximately 2%) epierythrocytic inclusions initially observed by light microscopy corresponded to Mycoplasma cells. Conclusions This represents the second report of hemolytic anemia associated with hemoplasma infection in a human, and the first report of human hemoplasmosis in Australia. This study highlights the importance of new and emerging diagnostic approaches and need for further investigations on the epidemiology of Candidatus Mycoplasma haemohominis in Australia.
- Published
- 2020
8. Repeat testing for SARS-COV-2: Persistence of viral RNA is common, and clearance is slower in older age groups
- Author
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Stehlik, P, Alcorn, K, Jones, A, Schlebusch, S, Wattiaux, A, Henry, D, Stehlik, P, Alcorn, K, Jones, A, Schlebusch, S, Wattiaux, A, and Henry, D
- Abstract
ABSTRACT
OBJECTIVE
Queensland’s Novel Coronavirus (SARS-CoV-2) suppression program has been relatively successful. Initially, it involved extensive community testing and repeat sampling of positive individuals for release from isolation. This enabled study of several characteristics, including persistence of detectable virus and how apparent viral clearance rates varied by age and sex.DESIGN
We conducted an exploratory analysis of Queensland Pathology SARS-CoV-2 reverse transcriptase polymerase chain reaction (RT-PCR) test results. Kaplan Meier analyses were used to estimate median time to apparent viral clearance, and Cox regression to explore the effects of sex and age.SETTING AND PARTICIPANTS
Individuals tested for presence of SARS-CoV-2 in the upper respiratory tract between January 19 and June 4, 2020.OUTCOME MEASURES
Presence of viral RNA detected by RT-PCR.RESULTS
We analyzed 97,476 individuals. Median age was 41y (range <1-105y), and 57.2% (95% CI 57.2, 57.2) were female. In total, 958 (0.98%; 95% CI 0.92,1.05) tested positive for SARS-CoV-2. Positivity rates were lower in regional areas than cities, in females (OR 0.80, 95% CI 0.70, 0.91), and in those aged 16y and below (p<0.01, test for trend). Of the 958 positive individuals, 243 had two or more (max 17) additional tests, and 92% (95% CI 88.1, 95.2) remained positive after 10 days (max 76 days) after the initial result. Median time to apparent viral clearance was longer in those 65y and over compared to those under 65y (29 v 43 days, HR 1.85; 95% CI 1.17, 2.90), and was unaffected by sex (HR 0.93; 95% CI 0.66, 1.30).CONCLUSIONS
Females and those 16y and under were less likely to test positive for SARS-CoV-2. Detectable RNA may persist for long periods, negating the value of repeat testing for declaring individuals free of infection. Viral clearance rates appear lower in those over 65y of age compared with younger individuals. “The known”- Published
- 2020
9. The State of Hepatitis B and C in the Mediterranean and Balkan Countries: Report from a Summit Conference
- Author
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Hatzakis, A. Van Damme, P. Alcorn, K. Gore, C. and Benazzouz, M. Berkane, S. Buti, M. Carballo, M. Cortes Martins, H. Deuffic-Burban, S. Dominguez, A. Donoghoe, M. and Elzouki, A-N. Bouafif, N. Ben-Alaya Esmat, G. Esteban, R. Fabri, M. Fenton, K. Goldberg, D. Goulis, I. and Hadjichristodoulou, T. Hatzigeorgiou, T. Hamouda, O. and Hasurdjiev, S. Hughes, S. Kautz, A. Malik, M. and Manolakopoulos, S. Maticic, M. Papatheodoridis, G. Peck, R. and Peterle, A. Potamitis, G. Prati, D. Roudot-Thoraval, F. and Reic, T. Sharara, A. Shennak, M. Shiha, G. Shouval, D. Socan, M. Thomas, H. Thursz, M. Tosti, M. Trepo, C. Vince, A. Vounou, E. Wiessing, L. Manns, M.
- Abstract
The burden of disease due to chronic viral hepatitis constitutes a global threat. In many Balkan and Mediterranean countries, the disease burden due to viral hepatitis remains largely unrecognized, including in high-risk groups and migrants, because of a lack of reliable epidemiological data, suggesting the need for better and targeted surveillance for public health gains. In many countries, the burden of chronic liver disease due to hepatitis B and C is increasing due to ageing of unvaccinated populations and migration, and a probable increase in drug injecting. Targeted vaccination strategies for hepatitis B virus (HBV) among risk groups and harm reduction interventions at adequate scale and coverage for injecting drug users are needed. Transmission of HBV and hepatitis C virus (HCV) in healthcare settings and a higher prevalence of HBV and HCV among recipients of blood and blood products in the Balkan and North African countries highlight the need to implement and monitor universal precautions in these settings and use voluntary, nonremunerated, repeat donors. Progress in drug discovery has improved outcomes of treatment for both HBV and HCV, although access is limited by the high costs of these drugs and resources available for health care. Egypt, with the highest burden of hepatitis C in the world, provides treatment through its National Control Strategy. Addressing the burden of viral hepatitis in the Balkan and Mediterranean regions will require national commitments in the form of strategic plans, financial and human resources, normative guidance and technical support from regional agencies and research.
- Published
- 2013
10. The authors reply: PTSD due to childbirth stands at between 3.1% (adjusted) and 5.8% (unadjusted)
- Author
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PATRICK, J. C., primary, DEVILLY, G. J., additional, O'DONOVAN, A., additional, ALCORN, K. L., additional, and CREEDY, D., additional
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- 2011
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11. O421 When to start therapy? The patient's viewpoint
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Cairns, G, primary and Alcorn, K, additional
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- 2008
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12. Post-transfusion purpura in an African-American man due to human platelet antigen-5b alloantibody: a case report
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Lynce Filipa, Yin Fang, Alcorn Kirsten, and Malkovska Vera
- Subjects
Medicine - Abstract
Abstract Introduction Post-transfusion purpura is a rare immunohematological disorder characterized by severe thrombocytopenia following transfusion of blood components and induced by an alloantibody against a donor platelet antigen. It occurs primarily in women sensitized by pregnancy and is most commonly caused by anti-human platelet antigen-1a antibodies. Here, we describe what we believe to be the first documented case of an African-American man who developed post-transfusion purpura due to an anti-human platelet antigen-5b alloantibody after receiving multiple blood products. Case presentation A 68-year-old African-American man initially admitted with atrial flutter was started on anticoagulation treatment, which was complicated by severe hematemesis. On days 4 and 5 of hospitalization, he received six units of packed red blood cells, and on days 4, 13 and 14 he received plasma. His platelet count began to drop on day 25 and on day 32 reached a nadir of 7 × 109/L. His platelet count increased after receiving intravenous immune globulin. An antibody with reactivity to human platelet antigen-5b was detected by a solid-phase enzyme-linked immunoassay. Our patient was homozygous for human platelet antigen-5a. Conclusion This case emphasizes the importance of including post-transfusion purpura in the differential diagnosis for both men and women with acute onset of thrombocytopenia following transfusion of blood products. The prompt recognition of this entity is crucial for initiation of the appropriate management.
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- 2012
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13. Recombinant activated factor VII (rFVIIa) as salvage treatment for intractable hemorrhage
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Aggarwal Anita, Malkovska Vera, Catlett Joseph P, and Alcorn Kirsten
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Diseases of the blood and blood-forming organs ,RC633-647.5 - Abstract
Abstract Background Recently, there has been an increased use of recombinant activated factor VII (rFVIIa) to promote hemostasis in various hemorrhagic conditions. The objective of this study was to determine the outcome of patients treated with rFVIIa who had intractable bleeding associated with cardiac surgery (CSP) or as a result of other causes (OBP). Methods The medical records of 40 consecutive patients treated with rFVIIa were retrospectively reviewed for blood product use before and after treatment. In all patients, rFVIIa was given only after all other measures to stop bleeding had failed. The number of transfused units of red cells (R), platelets (P), fresh frozen plasma (F), and cryoprecipitate (C) were determined both before and after administration of rFVIIa, and the results compared. Mortality at 4 hours and 30 days was assessed. Patients dying within 4 hours of rFVIIa administration were not evaluable for response. Patient characteristics were also assessed as risk factors for mortality. Results Twelve of 24 CSP survived for more than 4 hours. These 12 patients required an average of 17 units (U) of R, 18 U of P, 18 U of F and 15 U of C pre-treatment compared to an average of 6 U, 10 U, 9 U and 4 U of R, P, F and C respectively, post-treatment. These differences were statistically significant. For the OBP, 11 of 16 survived more than four hours. These 11 patients required an average of 10 U of R, 11 U of P, 14 U of F and 10 U of C pretreatment compared to an average of 1 U, 2 U, 2 U and 0 U of R, P, F, and C respectively, post-treatment. With the exception of C, there was a statistically significant decrease in blood product use following treatment with rFVIIa. Of the survivors in each group, 6 of 12 CSP and 2 of 11 OBP died between 3 and 30 days post-treatment from causes other than bleeding. Mortality at 30 days for CSP and OBP survivors was 50% and 18% respectively, whereas overall 30 day mortality was 75% for CSP and 44% for OBP. Conclusions rFVIIa is effective in decreasing blood product use and promoting hemostasis in patients with intractable bleeding associated with cardiac surgery and a variety of other causes.
- Published
- 2004
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14. Fill in the blanks.
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Alcorn K
- Published
- 2009
15. The impact of COVID-19 on public and private emergency departments in Queensland, Australia.
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Sweeny AL, Hall E, Padowitz A, Walters B, Zhang P, Alcorn K, Keijzers G, Marshall AP, Ranse J, and Crilly J
- Abstract
ObjectiveCOVID-19 affected health care globally. The aim of this study was to investigate the impact of COVID-19 on both public and private emergency departments (EDs).MethodsThis was a retrospective cohort study of ED presentations made to three private and two public hospital EDs located in one region in Queensland. Presentation rates per 1000 population and incident rate ratios (IRR) for three time periods: T1: pre-pandemic (March-June 2018/2019), T2: initial restrictions (March-June 2020), and T3: restrictions easing (March-June 2021) were calculated. Linear trends were produced to describe pre- and post-pandemic changes. Additional outcomes reported for public EDs included ED length of stay (LoS) and cost.ResultsIn T2, both public and private ED presentation rates decreased by 12% (overall IRR 0.88; 95% confidence interval (CI): 0.87-0.89). Private EDs experienced a quicker and greater return of patient volumes in T3, exceeding T1 levels. The median ED length of stay decreased and then increased above pre-pandemic levels (T1: 159 min, T2: 151 min, T3: 201 min). Total costs were higher during T2 but then decreased during T3, below that of T1 (T1: A$652, T2: A$791, T3: A$566). Between February 2020 and June 2021, 269 people tested positive for SARS-CoV-2, 19 of whom (7.1%) interfaced with the ED.ConclusionsDuring initial COVID-19 restrictions, a shift towards fewer ED presentations was observed. Private ED presentations rebounded more quickly than public. Few COVID-19 patients interfaced with an ED. Systems and public-private agreements made during this time appeared to protect EDs and soften the impact of reduced volumes for the private sector.
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- 2025
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16. The Microbiology, Management and Outcomes of Native Joint Septic Arthritis of the Hand in Adults of Southeast Queensland.
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Forman L, Forman A, and Alcorn K
- Abstract
Background: Native joint septic arthritis (NJSA) of the hand is poorly studied. Management guidelines are extrapolated from large joint infections despite differences in epidemiology, anatomy and aetiology. Limited evidence suggests shorter courses of antibiotics can achieve outcomes comparable to longer courses. The aim of our study is to characterise the presentation, management and outcomes of NJSA of the hand in an adult cohort from Southeast Queensland (SEQ) and determine if the route or duration of antibiotics affected the outcome. Our cohort was compared to those in the literature to determine if already published data could be applicable to our population. Methods: A coding based retrospective cohort of adult patients between 2016 and 2022 were assessed. The cohort was divided into short/long course antibiotics and primarily intravenous/oral route for outcome comparison. Results: Seventy-four patients were included with a joint culture positive rate of 75%. The most common aetiology of infection was direct trauma and the most common pathogen was Staphylococcus aureus . Resolution was achieved in 86% of patients after 1-year follow-up, with a median antibiotic duration of 14 days, and 48% had non-infectious sequelae. Failure to achieve resolution was associated with females and taking immunosuppressants. No significant difference was detected when analysed for primary route or duration of antibiotics. Conclusions: There was no difference in the rate of resolution attributable to the route or duration of antibiotics. We demonstrated comparability between our cohorts' demographics, management and outcomes with those in the literature. Based on the findings in our study, noting the retrospective nature and small cohort, the authors conclude for uncomplicated NJSA of the hand, a total antibiotic duration of 14 days in addition to early surgical intervention is likely to be successful in most patients. Level of Evidence: Level III (Therapeutic).
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- 2025
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17. Respiratory pathogen trends in queensland, australia between 2018 and 2021: A statewide cohort study before and after the initial COVID-19 outbreak.
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Sweeny AL, Gerrard J, Alcorn K, Grant G, Huang YL, Gerhardy B, and Keijzers G
- Abstract
Background: The SARS-CoV-2 pandemic and accompanying public health measures disrupted the normal transmission of respiratory viral pathogens. Less is known about the effects on bacterial pathogens., Aims: To assess the impact of public health restrictions on common respiratory pathogens (influenza viruses, respiratory syncytial virus (RSV) and the following bacterial pathogens: Streptococcus pneumoniae (S. pneumoniae), Klebsiella pneumoniae (K. pneumoniae), Pseudomonas aeruginosa (P. aeruginosa) and Staphylococcus aureus (S. aureus)., Methods: This statewide cohort study used respiratory specimen result data from 237 health facilities in Queensland, Australia, collected between January 2018 and June 2021. Trends and weekly positive rates per 100 tests/cultures for weeks 11-27 (with 95% confidence intervals) were compared between pre-pandemic (2018/2019), early pandemic restrictions (2020), and easing of restrictions (2021) periods., Results: Over 260,000 viral PCRs and 180,000 cultures were analyzed. Decreases in influenza and RSV were observed in 2020 from 10.8 to 1.1 and 9.5 to 2.5 per 100 tests, respectively; S. pneumoniae decreased from 1.7 to 1.1 per 100 cultures. Influenza levels remained low until the end of the study period. There was no change in the detection of S. aureus or P. aeruginosa per 100 cultures, but cultures positive for K. pneumoniae increased from 1.2 in 2018/2019 to 1.8 in 2020 and 1.6 in 2021. After restrictions eased, RSV rates increased to levels higher than before the pandemic., Conclusions: Transmission of droplet-spread pathogens decreased after the introduction of public health restrictions due to the COVID-19 pandemic. The increase in K. pneumoniae, often associated with nosocomial infections, warrants further investigation., Competing Interests: Conflicts of Interest All authors declare no conflicts of interest in the preparation of this work., (Copyright © 2024. Published by Elsevier Inc.)
- Published
- 2024
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18. Central Skull Base Osteomyelitis in Queensland, Australia, 2010-2020.
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Eustace MB, Braddick M, Alcorn K, Choong K, Satyaputra F, Siebert D, Smith S, Sommerville R, and McCarthy K
- Abstract
Background: Central skull base osteomyelitis (CSBO) is an incompletely defined, life-threatening infection of the bones of the cranial vault. We describe the clinical features and outcomes of CSBO in Queensland, Australia, over an 11-year period., Methods: Medical record coding enquiries identified cases of CSBO across 6 tertiary hospitals in Queensland, Australia, from January 2010 to December 2020. Epidemiological, demographic, diagnostic, management, and outcome data were collected from each identified case., Results: Twenty-two cases of CSBO were identified within the study period; the median age was 73 years with a male predominance (73%). High rates of comorbid disease were detected, with a median Charlson Comorbidity Index score of 5. Diabetes mellitus was the most frequently observed condition. Six cases had bone sampling for microbiological diagnosis while the remainder had superficial sampling of contiguous structures. The most common pathogen isolated was Pseudomonas aeruginosa followed by Staphylococcus aureus , with only 1 case of fungal infection. This series demonstrated a mortality rate of 31.8%, with 45.5% of cases left with long-term sequelae including persistent pain and cranial nerve deficits., Conclusions: Four key observations emerged in this series: (1) advanced age and diabetes mellitus are common risk factors for CSBO, (2) limited surgical intervention occurred, (3) microbiological diagnoses relied primarily on superficial sampling, and (4) significant mortality and morbidity was observed. Prospective studies are needed to better understand the optimal approach to the diagnosis and management of CSBO and to improve clinical outcomes., (© The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)
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- 2024
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19. Plasma-reduction for Apheresis Granulocyte transfusions in pediatric patients.
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Jung Y, Mallhi KK, Alcorn K, and Saifee NH
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- Adult, Humans, Child, Neutrophils, Leukocyte Transfusion, Blood Donors, Granulocyte Colony-Stimulating Factor therapeutic use, Granulocytes, Blood Component Removal
- Abstract
Granulocyte transfusion (GT) may be used to treat and prevent infections in patients with severe neutropenia or nonfunctioning granulocytes. For pediatric patients, the volume of granulocyte unit transfused is a crucial consideration given smaller blood volume and increased risk of volume overload compared to adults. There is limited literature on the optimal dosing or the maximum amount of granulocytes that can be tolerated, especially in pediatric patients. Additionally, no consensus exists regarding granulocyte collection method, frequency, or timing of GT initiation. Previous studies have described splitting or limiting collection volume for GT in pediatric patients, but these methods yield lower absolute neutrophil count (ANC) increment. Our blood supplier provides high-volume (0.5-1 L/unit), high-dose apheresis-collected granulocytes from donors stimulated with both granulocyte colony-stimulating factor and steroids. Here, we report cases of two pediatric patients with active infection undergoing bone marrow transplant with dramatic ANC increments (median one-hour ANC increment 5524/µL, interquartile range (IQR) 4417-10087; median 24-hour ANC increment 3880/µL, IQR 2550-5263) after infusing 100 mL plasma-reduced, apheresis collected GT. Our cases indicate that pediatric patients can tolerate 4-6 × 10
9 /kg plasma-reduced GT and have detectable ANC with GT every 3 days., Competing Interests: Declaration of Competing Interest The authors have no conflict of interest., (Copyright © 2024 Elsevier Ltd. All rights reserved.)- Published
- 2024
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20. How Clinicians Decide? Exploring Complexity of Antibiotic Prescribing in Emergency Departments Using Video-Reflexive Ethnography.
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Obucina M, Hamill L, Huynh R, Alcorn K, Cross J, Sweeny A, and Keijzers G
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- Humans, Prospective Studies, Qualitative Research, Emergency Service, Hospital, Anti-Bacterial Agents therapeutic use, Anthropology, Cultural
- Abstract
Antibiotic overprescribing is a global issue that significantly contributes to increased antimicrobial resistance. Strengthening antimicrobial prescribing practices should be considered a priority. The emergency department (ED) represents a setting where antibiotics are frequently prescribed, but the determinants that influence prescribing choices are complex and multifaceted. We conducted an exploratory qualitative study to investigate the contextual factors that influence antibiotic prescribing choices among clinicians in the ED. The study employed video-reflexive ethnography (VRE) to capture prospective clinical decision-making in situated practice. Data collection involved fieldwork observations, video observations, and delivery of facilitated group reflexive sessions, where clinicians viewed a selection of recorded video snippets relating to antibiotic prescribing. Study was conducted across two EDs within the same health service in Australia. A total of 29 clinical conversations focusing on antibiotic prescribing were recorded. Additionally, 34 clinicians participated in group reflexive sessions. Thematic analysis from the transcribed data yielded four themes: 'importance of clinical judgment', 'usability of prescribing guidelines', 'managing patient expectations', and 'context-dependent disruptions'. Our findings provide insights into the challenges faced by clinicians in navigating complex ED environment, utilising electronic decision-support tools and engaging in discussions about patient treatments with senior clinicians. The findings also indicate that VRE is useful in visualising full complexity of the ED setting, and in initiating meaningful discussions among clinical teams. Integrating the use of VRE in everyday clinical settings can potentially facilitate the implementation of pragmatic solutions for delivering effective antibiotic stewardship practices., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
- Published
- 2023
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21. Effect of covid-19 vaccination on long covid: systematic review.
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Byambasuren O, Stehlik P, Clark J, Alcorn K, and Glasziou P
- Abstract
Objective: To determine the effect of covid-19 vaccination, given before and after acute infection with the SARS-CoV-2 virus, or after a diagnosis of long covid, on the rates and symptoms of long covid., Design: Systematic review., Data Sources: PubMed, Embase, and Cochrane covid-19 trials, and Europe PubMed Central (Europe PMC) for preprints, from 1 January 2020 to 3 August 2022., Eligibility Criteria for Selecting Studies: Trials, cohort studies, and case-control studies reporting on patients with long covid and symptoms of long covid, with vaccination before and after infection with the SARS-CoV-2 virus, or after a diagnosis of long covid. Risk of bias was assessed with the ROBINS-I tool., Results: 1645 articles were screened but no randomised controlled trials were found. 16 observational studies from five countries (USA, UK, France, Italy, and the Netherlands) were identified that reported on 614 392 patients. The most common symptoms of long covid that were studied were fatigue, cough, loss of sense of smell, shortness of breath, loss of taste, headache, muscle ache, difficulty sleeping, difficulty concentrating, worry or anxiety, and memory loss or confusion. 12 studies reported data on vaccination before infection with the SARS-CoV-2 virus, and 10 showed a significant reduction in the incidence of long covid: the odds ratio of developing long covid with one dose of vaccine ranged from 0.22 to 1.03; with two doses, odds ratios were 0.25-1; with three doses, 0.16; and with any dose, 0.48-1.01. Five studies reported on vaccination after infection, with odds ratios of 0.38-0.91. The high heterogeneity between studies precluded any meaningful meta-analysis. The studies failed to adjust for potential confounders, such as other protective behaviours and missing data, thus increasing the risk of bias and decreasing the certainty of evidence to low., Conclusions: Current studies suggest that covid-19 vaccines might have protective and therapeutic effects on long covid. More robust comparative observational studies and trials are needed, however, to clearly determine the effectiveness of vaccines in preventing and treating long covid., Protocol Registration: Open Science Framework https://osf.io/e8jdy., Competing Interests: Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/disclosure-of-interest/ and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
- Published
- 2023
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22. Critical conversations on patient blood management with clinical colleagues.
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Gammon RR, Alcorn K, Friedman M, Hogan S, Manwanga S, Marinaro L, Shariatmadar S, and Bocquet C
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- Humans, Communication, Hospitals, Blood Transfusion, Transfusion Medicine
- Abstract
Although a subspecialty-trained transfusion medicine (TM) physician brings value to the clinical bedside, hospital transfusion service oversight often falls under the responsibility of pathologists primarily focused on surgical pathology. Yet, pathologists who lack TM fellowship training may not be quite as confident in their role as the TM physician in-charge, especially when the need to communicate with another clinician arises. Given that blood is a resource subject to frequent shortages, there is a need for constant monitoring of blood utilization such that those responsible for transfusion service oversight need to handle challenging clinical interactions when transfusion guidelines are breeched. Generally, the average pathologist is more knowledgeable regarding blood component therapy than other clinician. Yet, disagreements concerning patient transfusion management can arise, in spite of established evidence-based hospital transfusion guidelines. Since authoritative fact stating is not likely to be effective in changing the entrenched practices, pathologists must engage in strategies that will develop meaningful working relationships with their clinical colleagues. Such strategies include being a visible part of direct patient care, such as attendance at patient rounds or provision of mini-consultations by phone regarding transfusion management. Inviting clinicians to attend the hospital transfusion committee meetings and scheduling educational grand rounds are also useful strategies. Clinicians may be more receptive to blood conservation during times of shortages if open communication is established, particularly if hospital leadership is involved in urgent crisis messaging to the clinicians and other hospital staff involved in patient care., (Copyright © 2022 Elsevier Ltd. All rights reserved.)
- Published
- 2022
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23. Confusion in a 22-year-old woman, and diagnostic uncertainty.
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Elliott B, Newey C, Alcorn K, and McCoy L
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- Adult, Diagnosis, Differential, Female, Humans, Uncertainty, Young Adult, Confusion etiology
- Published
- 2022
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24. Monkeypox and the safety of the blood supply.
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Greninger A, Alcorn K, Pagano MB, Hermelin D, and Katz L
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- Animals, Disease Models, Animal, Disease Outbreaks, Humans, Mpox, Monkeypox epidemiology
- Published
- 2022
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25. AACN Essentials: Librarians as partners in successful implementation.
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Sharifi C, Alcorn K, Downey K, Hinton EG, Sender J, and Ver Steeg J
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- Curriculum, Humans, Education, Nursing, Baccalaureate, Librarians
- Published
- 2022
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26. Linking Primary Care Patients to Mental Health Care via Behavioral Health Social Workers: A Stepped-Wedge Study.
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Pfoh ER, Hohman JA, Alcorn K, Vakharia N, and Rothberg MB
- Subjects
- Adult, Anxiety, Humans, Mental Health, Primary Health Care, Social Workers, Depression diagnosis, Depression epidemiology, Depression therapy, Psychiatry
- Abstract
Objective: Demand for systematic linkage of patients to behavioral health care has increased because of the widespread implementation of depression screening. This study assessed the impact of deploying behavioral health social workers (BHSWs) in primary care on behavioral health visits for depression or anxiety., Methods: This quasi-experimental, stepped-wedge study included adults with a primary care visit between 2016 and 2019 at Cleveland Clinic, a large integrated health system. BHSWs were deployed in 40 practices between 2017 and 2019. Patients were allocated to a control group (diagnosed before BHSW deployment) and an intervention group (diagnosed after deployment). Data were collected on behavioral health visits (i.e., to therapists and psychiatrists) within 30 days of the diagnosis. Multilevel logistic regression models identified associations between BHSW deployment period and behavioral health visit, adjusted for demographic variables and clustering within each group., Results: Of 68,659 persons with a diagnosis, 21% had a depression diagnosis, 49% an anxiety diagnosis, and 31% both diagnoses. In the period after BHSW deployment, the proportion of patients with depression who had a behavioral health visit increased by 10 percentage points, of patients with anxiety by 9 percentage points, and of patients with both disorders by 11 percentage points. The adjusted odds of having a behavioral health visit was higher in the postdeployment period for patients with depression (adjusted odds ratio [AOR]=4.35, 95% confidence interval [CI]=3.50-5.41), anxiety (AOR=4.27, 95% CI=3.57-5.11), and both (AOR= 3.26, 95% CI=2.77-3.84)., Conclusions: Integration of BHSWs in primary care was associated with increased behavioral health visits.
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- 2022
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27. Clinical prediction scores and the utility of time to blood culture positivity in stratifying the risk of infective endocarditis in Staphylococcus aureus bacteraemia.
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Simos PA, Holland DJ, Stewart A, Isler B, Hughes I, Price N, Henderson A, and Alcorn K
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- Adult, Blood Culture, Humans, Staphylococcus aureus, Bacteremia complications, Bacteremia diagnosis, Endocarditis complications, Endocarditis diagnosis, Endocarditis, Bacterial complications, Endocarditis, Bacterial diagnosis, Staphylococcal Infections complications, Staphylococcal Infections diagnosis
- Abstract
Background: Infective endocarditis (IE) complicates up to a quarter of Staphylococcus aureus bacteraemia (SAB) cases. Risk scores predict IE complicating SAB but have undergone limited external validation, especially in community-acquired infections and those who use IV drugs. Addition of the time to positive culture (TTP) may provide incremental risk prognostication., Objectives: To externally validate risk scores for predicting IE in SAB and assess the incremental value of TTP., Methods: The modified Duke score was calculated for adults hospitalized with SAB at a major tertiary institution. All patients underwent echocardiography. Sensitivity and specificity of the risk scores for predicting IE were calculated, and the incremental value of TTP was assessed., Results: One hundred and six cases were analysed and 18 (17%) met definite IE criteria. The optimal TTP to predict IE was 11.5 h (sensitivity 88.9%; specificity 71.6%). The sensitivity of VIRSTA and PREDICT (Predicting risk of endocarditis using a clinical tool) were similar (94.4% for both) and higher than POSITIVE (Prediction Of Staphylococcus aureus Infective endocarditis Time to positivity, IV drug use, Vascular phenomena, pre-Existing heart condition; 77.8%). The receiver-operator characteristic AUCs were VIRSTA 0.83, PREDICT 0.75, POSITIVE 0.89 and TTP 0.85. Adding TTP to VIRSTA (i.e. VIRSTA+) resulted in the highest AUC (0.90), sensitivity (100%) and negative predictive value (100%), albeit with a low specificity (33%)., Conclusions: The VIRSTA and POSITIVE scores were the strongest predictors for IE complicating SAB. The addition of TTP to VIRSTA (VIRSTA+) significantly improved discriminatory value and may be safely used to rationalize echocardiography strategies., (© The Author(s) 2022. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
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- 2022
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28. Neutralizing antibody responses against SARS-CoV-2 in vaccinated people with multiple sclerosis.
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Gyang TV, Evans JP, Miller JS, Alcorn K, Peng J, Bell EH, Zeng C, Gumina R, Liu SL, and Segal BM
- Abstract
Background: Patients with multiple sclerosis (pwMS) are often treated with disease modifying therapies (DMT) with immunomodulatory effects. This is of particular concern following the development of several vaccines to combat coronavirus disease 19 (COVD-19), a potentially fatal illness caused by SARS-CoV-2., Objectives: To determine the efficacy of SARS-CoV-2 vaccination in pwMS and the impact of disease modifying therapies (DMT) on vaccine response., Methods: This is a prospective longitudinal study in pwMS. Longitudinal serum samples were obtained prior to, and after SARS-CoV-2 mRNA vaccination. A novel neutralizing antibody (nAb) assay was used to determine nAbs titres against SARS-CoV-2 spike., Results: We observed that (1) pwMS on B-cell depleting therapies exhibited reduced response to vaccination compared to other pwMS, correlating with time from last anti-CD20 infusion, (2) prior COVID-19 illness, DMT category, and pyramidal function were significant predictors of vaccine responsiveness, and (3) circulating absolute lymphocyte count (ALC) and IgG levels correlated with nAb levels., Conclusions: We demonstrate that pwMS exhibit reduced nAb response to mRNA vaccination dependent on DMT status and identify predictive biomarkers for vaccine efficacy. We conclude that additional vaccination strategies may be necessary to achieve protective immunity in pwMS., Competing Interests: Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: T.V. Gyang has served as consultant for Genentech, Horizon Therapeutics, Greenwich Biosciences and EMD Serono. J.P Evans reports no disclosure relevant to the manuscript. J. Miller reports no disclosure relevant to the manuscript. K. Alcorn reports no disclosure relevant to the manuscript. J. Peng reports no disclosure relevant to the manuscript. E.H. Bell reports no disclosure relevant to the manuscript. C. Zeng reports no disclosure relevant to the manuscript. R. Gumina reports no disclosure relevant to the manuscript. S-L. Liu reports no disclosure relevant to the manuscript. B.M. Segal has served as a consultant for Neurodiem, Senda Biosciences, and Banner Life Sciences, as a speaker for PRIME, Inc. and as a moderator for Neurodiem. He has served on a data safety monitoring board for Eli Lily., (© The Author(s), 2022.)
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- 2022
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29. Repeat testing for SARS-CoV-2: persistence of viral RNA is common, and clearance is slower in older people.
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Stehlik P, Alcorn K, Jones A, Schlebusch S, Wattiaux A, and Henry DA
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- Adult, Age Factors, Aged, Aged, 80 and over, COVID-19 epidemiology, COVID-19 Nucleic Acid Testing, Female, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Queensland epidemiology, Risk Factors, Viral Load, COVID-19 virology, RNA, Viral analysis, SARS-CoV-2 isolation & purification
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- 2021
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30. Demographics, clinical characteristics and outcomes among 197 patients with COVID-19 in the Gold Coast area.
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Je D, O'Brolchain A, Ulett KB, Zainudheen A, Gerrard J, Alcorn K, and Memon S
- Subjects
- Female, Humans, Male, Middle Aged, Australia, Demography, Retrospective Studies, SARS-CoV-2, COVID-19
- Abstract
Background: Clinical characteristics and outcomes of coronavirus disease 2019 (COVID-19) patients have been varied internationally but have not been studied in an Australian cohort., Aim: To describe characteristics and outcomes of approximately the first 200 documented COVID-19 cases during the first outbreak in the Gold Coast., Methods: Retrospective observational cohort study of COVID-19 patients managed by Gold Coast Hospital and Health Service (GCHHS). Demographics, clinical characteristics and outcomes data were collected., Results: One hundred and ninety-seven patients were included (mean age 45 years); 52.3% were female and 9.1% were healthcare workers. Most were overseas travellers (53.8%), contacts of a local confirmed case (25.4%) or cruise ship passengers (17.3%). The commonest comorbidities were hypertension (14.2%) and asthma (11.2%). The commonest symptoms were cough (74.1%), fever (58.9%), sore throat (48.7%), headache (48.7%) and rhinorrhoea (46.2%). Sixty-three patients were hospitalised and the rest admitted to a 'virtual ward'. Of 63 hospitalised patients, 5 (7.9%) required intensive care unit (ICU) admission and 3 (4.8%) required intubation. No patients died. Due to low numbers of accurate exposure dates, the incubation period could not be reliably calculated for a significant proportion of the cohort. Average duration of symptoms was 14 days, time from first symptom to hospitalisation was 5.3 days and time from first symptom to ICU admission was 11.6 days. The majority (88%) experienced mild disease and achieved complete symptom resolution (97%). Nasopharyngeal swab polymerase chain reaction was the main diagnostic method (99%). Twenty-four patients received anti-viral pharmacotherapy, with 87.5% getting hydroxychloroquine., Conclusions: The present study provides characteristics and outcomes of the first 197 patients with COVID-19 in the Gold Coast., (© 2021 Royal Australasian College of Physicians.)
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- 2021
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31. First Report of Candidatus Mycoplasma haemohominis Infection in Australia Causing Persistent Fever in an Animal Carer.
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Alcorn K, Gerrard J, Cochrane T, Graham R, Jennison A, Irwin PJ, and Barbosa AD
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- Animals, Australia, Caregivers, DNA, Bacterial genetics, Europe, Humans, In Situ Hybridization, Fluorescence, Phylogeny, RNA, Ribosomal, 16S genetics, Mycoplasma genetics, Mycoplasma Infections diagnosis, Mycoplasma Infections veterinary
- Abstract
Background: Hemotropic mycoplasmas (hemoplasmas) infect animals and humans and can lead to clinical syndromes mainly characterized by hemolytic anemia. A novel pathogen, Candidatus Mycoplasma haemohominis, was recently associated with a case of human hemoplasmosis in Europe. Here we report the first detection of this pathogen in an Australian patient exhibiting persistent fever, hemolytic anemia, and pancytopenia over a 10-month period., Methods: After exhaustive negative testing for human infectious diseases, whole genome sequencing (WGS) was performed on the patient's bone marrow aspirate, using an Illumina NextSeq500 platform. Conventional polymerase chain reaction (PCR), followed by Sanger sequencing, was then performed on blood samples using novel Mycoplasma-specific primers targeting the 16S ribosomal RNA gene. In addition, a Mycoplasma-specific fluorescence in situ hybridization (FISH) assay was developed to differentiate Mycoplasma cells from other erythrocyte inclusions (eg, Pappenheimer and Howell-Jolly bodies) which are morphologically similar to bacterial cocci by light microscopy., Results: WGS analysis revealed that approximately 0.04% of the total number of unmapped reads to human genome corresponded to Mycoplasma species. A 1-kb Mycoplasma 16S fragment was successfully amplified by conventional PCR, and sequence analyses revealed 100% identity with Candidatus Mycoplasma haemohominis. FISH confirmed that several (approximately 2%) epierythrocytic inclusions initially observed by light microscopy corresponded to Mycoplasma cells., Conclusions: This represents the second report of hemolytic anemia associated with hemoplasma infection in a human, and the first report of human hemoplasmosis in Australia. This study highlights the importance of new and emerging diagnostic approaches and need for further investigations on the epidemiology of Candidatus Mycoplasma haemohominis in Australia., (© The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.)
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- 2021
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32. Use of convalescent plasma in hospitalized patients with COVID-19: case series.
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Hegerova L, Gooley TA, Sweerus KA, Maree C, Bailey N, Bailey M, Dunleavy V, Patel K, Alcorn K, Haley R, Johnsen JM, Konkle BA, Lahti AC, Alexander ML, Goldman JD, Lipke A, Lim SJ, Sullivan MD, Pauk JS, and Pagel JM
- Subjects
- Adult, Aged, Aged, 80 and over, Betacoronavirus isolation & purification, Blood Component Transfusion methods, COVID-19, Coronavirus Infections diagnosis, Female, Humans, Immunization, Passive methods, Male, Middle Aged, Pandemics, Pneumonia, Viral diagnosis, SARS-CoV-2, Treatment Outcome, COVID-19 Serotherapy, Coronavirus Infections therapy, Pneumonia, Viral therapy
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- 2020
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33. Prepare to adapt: blood supply and transfusion support during the first 2 weeks of the 2019 novel coronavirus (COVID-19) pandemic affecting Washington State.
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Pagano MB, Hess JR, Tsang HC, Staley E, Gernsheimer T, Sen N, Clark C, Nester T, Bailey C, and Alcorn K
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- Blood Donors, COVID-19, Hospital Planning, Humans, SARS-CoV-2, Washington epidemiology, Betacoronavirus, Blood Transfusion, Coronavirus Infections epidemiology, Coronavirus Infections physiopathology, Pandemics, Pneumonia, Viral epidemiology, Pneumonia, Viral physiopathology
- Abstract
Background: The first coronavirus (COVID-19) case was reported in United States in the state of Washington, approximately 3 months after the outbreak in Wuhan, China. Three weeks later, the US federal government declared the pandemic a national emergency. The number of confirmed COVID-19 positive cases increased rather rapidly and changed routine daily activities of the community., Study Design and Methods: This brief report describes the response from the hospital, the regional blood center, and the hospital-based transfusion services to the events that took place in the community during the initial phases of the pandemic., Results: In Washington State, the first week of March started with four confirmed cases and ended with 150; by the end of the second week of March there were more than 700 cases of confirmed COVID-19. During the first week, blood donations dropped significantly. Blood units provided from blood centers of nonaffected areas of the country helped keep inventory stable and allow for routine hospital operations. The hospital-based transfusion service began prospective triaging of blood orders to monitor and prioritize blood usage. In the second week, blood donations recovered, and the hospital postponed elective procedures to ensure staff and personal protective equipment were appropriate for the care of critical patients., Conclusion: As community activities are disrupted and hospital activities switch from routine operations to pandemic focused and urgent care oriented, the blood supply and usage requires a number of transformations., (© 2020 AABB.)
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- 2020
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34. A need for implementation science to optimise the use of evidence-based interventions in HIV care: A systematic literature review.
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Cox J, Gutner C, Kronfli N, Lawson A, Robbins M, Nientker L, Ostawal A, Barber T, Croce D, Hardy D, Jessen H, Katlama C, Mallolas J, Rizzardini G, Alcorn K, Wohlfeiler M, and Le Fevre E
- Subjects
- Continuity of Patient Care, Delivery of Health Care, HIV Infections diagnosis, HIV Infections virology, Humans, Outcome Assessment, Health Care, Sustained Virologic Response, United Nations, Evidence-Based Medicine methods, HIV Infections drug therapy
- Abstract
To improve health outcomes in people living with HIV, adoption of evidence-based interventions (EBIs) using effective and transferable implementation strategies to optimise the delivery of healthcare is needed. ViiV Healthcare's Positive Pathways initiative was established to support the UNAIDS 90-90-90 goals. A compendium of EBIs was developed to address gaps within the HIV care continuum, yet it was unknown whether efforts existed to adapt and implement these EBIs across diverse clinical contexts. Therefore, this review sought to report on the use of implementation science in adapting HIV continuum of care EBIs. A systematic literature review was undertaken to summarise the evaluation of implementation and effectiveness outcomes, and report on the use of implementation science in HIV care. Ten databases were reviewed to identify studies (time-period: 2013-2018; geographic scope: United States, United Kingdom, France, Germany, Italy, Spain, Canada, Australia and Europe; English only publications). Studies were included if they reported on people living with HIV or those at risk of acquiring HIV and used interventions consistent with the EBIs. A broad range of study designs and methods were searched, including hybrid designs. Overall, 118 publications covering 225 interventions consistent with the EBIs were identified. These interventions were evaluated on implementation (N = 183), effectiveness (N = 81), or both outcomes (N = 39). High variability in the methodological approaches was observed. Implementation outcomes were frequently evaluated but use of theoretical frameworks was limited (N = 13). Evaluations undertaken to assess effectiveness were inconsistent, resulting in a range of measures. This review revealed extensive reporting on implementation science as defined using evaluation outcomes. However, high variability was observed in how implementation outcomes and effectiveness were defined, quantified, and reported. A more specific and consistent approach to conducting and reporting on implementation science in HIV could facilitate achievement of UNAIDS 90-90-90 targets., Competing Interests: JC, NK, KA, TB, DC, DH, HJ, CK, GR and MW received honoraria for advisory boards from ViiV Healthcare. JM received honoraria for advisory boards, lectures or research grants from Gilead, ViiV Healthcare, Roche, Janssen and Merck. CG, AL and MR work full-time at ViiV Healthcare and EF works as a part-time service provider for ViiV Healthcare. LN and AO received consulting fees from ViiV Healthcare for the conduct of the review. This does not alter our adherence to PLOS ONE policies on sharing data and materials.
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- 2019
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35. HIV in 2019: it's all about dolutegravir.
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Alcorn K
- Abstract
Competing Interests: Competing interests: I have read and understood BMJ policy on declaration of interests and have the following relevant interests to declare: I reported on IAS 2019 for www.aidsmap.com as part of the official online coverage of the conference. My previous employer, NAM, received an honorarium for my attendance at an advisory board on HIV implementation science and improvement of patient engagement in care. No specific products were discussed as part of that work.
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- 2019
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36. Appropriateness of antibiotic prescribing in the Emergency Department.
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Denny KJ, Gartside JG, Alcorn K, Cross JW, Maloney S, and Keijzers G
- Subjects
- Adolescent, Adult, Aged, Drug Prescriptions statistics & numerical data, Female, Humans, Male, Middle Aged, Queensland, Retrospective Studies, Young Adult, Anti-Bacterial Agents administration & dosage, Drug Prescriptions standards, Emergency Service, Hospital statistics & numerical data, Inappropriate Prescribing
- Abstract
Background: Antibiotics are some of the most commonly prescribed drugs in the Emergency Department (ED) and yet data describing the overall appropriateness of antibiotic prescribing in the ED is scarce., Objectives: To describe the appropriateness of antibiotic prescribing in the ED., Methods: A retrospective, observational study of current practice. All patients who presented to the ED during the study period and were prescribed at least one antibiotic were included. Specialists from Infectious Disease, Microbiology and Emergency Medicine and a Senior Pharmacist assessed antibiotic appropriateness against evidence-based guidelines., Results: A total of 1019 (13.6%) of patient presentations involved the prescription of at least one antibiotic. Of these, 640 (62.8%) antibiotic prescriptions were assessed as appropriate, 333 (32.7%) were assessed as inappropriate and 46 (4.5%) were deemed to be not assessable. Adults were more likely to receive an inappropriate antibiotic prescription than children (36.9% versus 22.9%; difference 14.1%, 95% CI 7.2%-21.0%). Patients who met quick Sepsis-related Organ Failure Assessment (qSOFA) criteria were more likely to be prescribed inappropriate antibiotics (56.7% versus 36.1%; difference 20.5%, 95% CI, 2.4%-38.7%). There was no difference in the incidence of appropriate antibiotic prescribing based on patient gender, disposition (admitted/discharged), reason for antibiotic administration (treatment/prophylaxis) or time of shift (day/night)., Conclusions: Inappropriate administration of antibiotics can lead to unnecessary adverse events, treatment failure and antimicrobial resistance. With over one in three antibiotic prescriptions in the ED being assessed as inappropriate, there is a pressing need to develop initiatives to improve antibiotic prescribing to prevent antibiotic-associated patient and community harms.
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- 2019
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37. Controlled Infection Immunization Using Delayed Death Drug Treatment Elicits Protective Immune Responses to Blood-Stage Malaria Parasites.
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Low LM, Ssemaganda A, Liu XQ, Ho MF, Ozberk V, Fink J, Sundac L, Alcorn K, Morrison A, O'Callaghan K, Gerrard J, Stanisic DI, and Good MF
- Subjects
- Adaptive Immunity, Animals, Azithromycin administration & dosage, Cytokines metabolism, Disease Models, Animal, Doxycycline administration & dosage, Female, Humans, Malaria prevention & control, Malaria, Falciparum, Male, Mice, Inbred BALB C, Mice, Inbred C57BL, Plasmodium chabaudi growth & development, Plasmodium falciparum growth & development, Plasmodium yoelii growth & development, Th1 Cells immunology, Young Adult, Antimalarials administration & dosage, Malaria drug therapy, Malaria immunology, Plasmodium chabaudi immunology, Plasmodium falciparum immunology, Plasmodium yoelii immunology, Vaccination methods
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Naturally acquired immunity to malaria is robust and protective against all strains of the same species of Plasmodium This develops as a result of repeated natural infection, taking several years to develop. Evidence suggests that apoptosis of immune lymphocytes due to uncontrolled parasite growth contributes to the slow acquisition of immunity. To hasten and augment the development of natural immunity, we studied controlled infection immunization (CII) using low-dose exposure to different parasite species ( Plasmodium chabaudi , P. yoelii , or P. falciparum ) in two rodent systems (BALB/c and C57BL/6 mice) and in human volunteers, with drug therapy commencing at the time of initiation of infection. CIIs with infected erythrocytes and in conjunction with doxycycline or azithromycin, which are delayed death drugs targeting the parasite's apicoplast, allowed extended exposure to parasites at low levels. In turn, this induced strong protection against homologous challenge in all immunized mice. We show that P. chabaudi / P. yoelii infection initiated at the commencement of doxycycline therapy leads to cellular or antibody-mediated protective immune responses in mice, with a broad Th1 cytokine response providing the best correlate of protection against homologous and heterologous species of Plasmodium P. falciparum CII with doxycycline was additionally tested in a pilot clinical study ( n = 4) and was found to be well tolerated and immunogenic, with immunological studies primarily detecting increased cell-associated immune responses. Furthermore, we report that a single dose of the longer-acting drug, azithromycin, given to mice ( n = 5) as a single subcutaneous treatment at the initiation of infection controlled P. yoelii infection and protected all mice against subsequent challenge., (Copyright © 2018 Low et al.)
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- 2018
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38. Appropriateness of Plasma Transfusion: A College of American Pathologists Q-Probes Study of Guidelines, Waste, and Serious Adverse Events.
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Alcorn K, Ramsey G, Souers R, and Lehman CM
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- Humans, Practice Guidelines as Topic, Blood Component Transfusion standards, Plasma
- Abstract
Context: - Plasma transfusion guidelines support patient care and safety, management of product wastage, and compliance; yet, there is little information across multiple institutions about use of and adherence to plasma transfusion guidelines., Objective: - To survey multiple institutions regarding their plasma transfusion guidelines and compliance, plasma wastage rates, and incidence of transfusion reactions associated with plasma transfusion., Design: - The College of American Pathologists Q-Probes model was used to collect data from 89 participating institutions. Each site was asked to provide data relevant to its most recent 40 adult patient plasma transfusion episodes, and complete a questionnaire regarding plasma transfusion guidelines, utilization and wastage of plasma, and transfusion reactions related to plasma transfusion., Results: - The participating institutions reported a total of 3383 evaluable plasma transfusion episodes with transfusion of 9060 units of plasma. Compliance with institution-specific guidelines was seen in 3018 events (89%). Pretransfusion and posttransfusion coagulation testing was done in 3281 (97%) and 3043 (90%) of these episodes, respectively. Inappropriate criteria were noted for more than 100 transfusion episodes. Thirty-two plasma transfusion episodes (1%) were associated with a transfusion reaction. Serious and fatal reactions were reported. Median plasma wastage rate for the year preceding the study was 4.5%., Conclusions: - Most participating institutions are compliant with plasma transfusion guidelines based on published references, supported by appropriate testing. With transfusions for indications that lack evidence of efficacy and incidence of transfusion reactions, there is an ongoing role for transfusion service leaders to continue to update and monitor plasma transfusion practices.
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- 2017
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39. Perioperative Complications in Posterior Pharyngeal Flap Surgery: Review of the National Surgical Quality Improvement Program Pediatric (NSQIP-PEDS) Database.
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Swanson JW, Johnston JL, Mitchell BT, Alcorn K, and Taylor JA
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- Child, Female, Humans, Male, Perioperative Period, Reoperation, Respiration, Artificial, Retrospective Studies, Risk Factors, Cleft Lip surgery, Cleft Palate surgery, Databases, Factual, Postoperative Complications epidemiology, Quality Improvement, Surgical Flaps
- Abstract
Background: Posterior pharyngeal flap (PPF) surgery is effective for treating velopharyngeal insufficiency but has historically been associated with risk of airway compromise. This study aims to identify risk factors for complications from and readmission after PPF using a national database., Methods: Patients who underwent PPF surgery were selected from the 2012 American College of Surgeons National Surgical Quality Improvement Program Pediatric (NSQIP-PEDS) database. Patient characteristics, comorbidities, and complication/readmission data were analyzed., Results: Among 225 study patients, 12 (5.3%) suffered perioperative complications. The most common complications were pulmonary in nature (5 patients, 2.2%), including prolonged postoperative mechanical ventilation (3 patients, 1.3%). Underlying asthma (P = .024) or any cardiac risk factor (P = .047) conveyed significant complication risk. Further, severe cardiac risk factors were associated with postoperative bleeding (P = .024). Readmission (4 patients, 1.7%) and reoperation (3 patients, 1.3%) occurred at mean intervals of 9 and 10 days after the original procedure. Seventy-nine patients (35%) were discharged postoperatively on an outpatient basis, and this subgroup included only one patient (1.2%) with a complication (P = .038)., Conclusions: The overall perioperative complication rate for PPF surgery is low at 5.3%. Patients with underlying cardiac risk factors, severe American Society of Anesthesiologists Physical Status class, and asthma should prompt greater attention given their heightened risk profiles.
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- 2016
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40. Seasonal variation in health care-associated bloodstream infection: increase in the incidence of gram-negative bacteremia in nonhospitalized patients during summer.
- Author
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Alcorn K, Gerrard J, Macbeth D, and Steele M
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Female, Health Education, Humans, Incidence, Male, Middle Aged, Seasons, Young Adult, Bacteremia epidemiology, Cross Infection epidemiology, Gram-Negative Bacterial Infections epidemiology
- Abstract
Objective: Recent research has suggested that episodes of gram-negative (GN) bloodstream infection (BSI) are more common in the population during summer months. Our objective was to determine if the same phenomenon could be observed in patients with health care-associated (HCA) BSI, and if so, whether a summer peak was less apparent in patients accommodated in a climate-controlled hospital environment., Methods: Data from episodes of HCA BSI spanning an 11-year period were analyzed. To test for seasonal variation in HCA BSI among hospitalized and nonhospitalized patients, and between GN and gram-positive organisms, the χ(2) goodness-of-fit test was used., Results: There were 440 episodes of HCA GN BSI of which 259 (59%) occurred in inpatients and 181 (41%) occurred in noninpatients. A significant increase in the frequency of HCA GN BSI was observed in nonhospitalized patients during the summer months (P = .03) but not in climate-controlled hospitalized patients. The most common source of infection in these patents was an intravascular device (38%)., Conclusions: We found an increased incidence of GN HCA BSI during summer that was not apparent in our inpatient cohort. The cause is unknown. It might be prudent to advise patients at risk of BSI (eg, those receiving intravascular infusions) to minimize exposure to high environmental temperature and to educate on possible behavioral factors that may increase risk., (Crown Copyright © 2013. Published by Mosby, Inc. All rights reserved.)
- Published
- 2013
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41. Pilot evaluation of a substance abuse prevention group intervention for at-risk bariatric surgery candidates.
- Author
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Ashton K, Heinberg L, Merrell J, Lavery M, Windover A, and Alcorn K
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- Adaptation, Psychological, Alcohol Drinking prevention & control, Bariatric Surgery adverse effects, Female, Humans, Male, Middle Aged, Motivation, Obesity, Morbid surgery, Patient Education as Topic methods, Pilot Projects, Bariatric Surgery psychology, Obesity, Morbid psychology, Substance-Related Disorders prevention & control
- Abstract
Background: Concerns have been raised about an increased incidence of substance abuse after bariatric surgery. Alcohol use after surgery may be particularly problematic because of changes in pharmacokinetics leading to greater intoxication. The present study evaluated a substance abuse prevention group pilot intervention for at-risk bariatric surgery candidates., Methods: Patients with a history of substance abuse/dependence or at-risk substance use applying for weight loss surgery (WLS; N = 86) were referred to a single-session 90-minute intervention (67.4% female; 65.1% Caucasian; mean age 46.2 years; mean body mass index 48.77 kg/m(2)). The session included education about the health effects of alcohol/substances on WLS outcomes, developing alternative coping strategies, identifying warning signs of misuse, and providing treatment resources. Patients completed a preintervention and postintervention questionnaire measuring knowledge of substance use health effects, the Alcohol Use Disorders Identification Test-Consumption Items, and items on motivation for abstinence., Results: Patients reported a significant increase in knowledge regarding the negative effects of substance abuse after surgery (t = 42.34; P<.001). Patients also reported more healthy alternative coping strategies after the intervention (t = 18.96; P<.001). In addition, a significant number of patients reported a lower intention of consuming alcohol after surgery (χ(2) = 16.18; P<.001) and were more likely to report health reasons as motivation to abstain (χ(2) = 102.89; P< .001)., Conclusions: At-risk patients applying for weight loss surgery may benefit from a substance abuse prevention intervention. More research will be needed to see if such benefits can be sustained over time and if interventions affect postsurgical behaviors., (Copyright © 2013 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)
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- 2013
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42. Evolutionary analysis of the MIXTA gene family highlights potential targets for the study of cellular differentiation.
- Author
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Brockington SF, Alvarez-Fernandez R, Landis JB, Alcorn K, Walker RH, Thomas MM, Hileman LC, and Glover BJ
- Subjects
- Amino Acid Sequence, Bayes Theorem, Conserved Sequence, Flowers cytology, Gene Duplication, Genes, Plant, Likelihood Functions, Magnoliopsida cytology, Molecular Sequence Data, Phylogeny, Plant Epidermis cytology, Sequence Analysis, DNA, Sequence Homology, Nucleic Acid, Cell Differentiation, Evolution, Molecular, Flowers genetics, Magnoliopsida genetics
- Abstract
Differentiated epidermal cells such as trichomes and conical cells perform numerous essential functions in plant biology and are important for our understanding of developmental patterning and cell shape regulation. Many are also commercially significant, such as cotton fibers and trichomes that secrete pharmaceutically useful or herbivore-deterring compounds. Here, we focus on the phylogeny and evolution of the subgroup 9 R2R3 MYB gene transcription factors, which include the MIXTA gene, and that are important for the specification and regulation of plant cellular differentiation. We have sequenced 49 subgroup 9 R2R3 MYB genes from key experimental taxa and combined these sequences with those identified by an exhaustive bioinformatic search, to compile a data set of 223 subgroup 9 R2R3 MYB genes. Our phylogenetic analyses demonstrate, for the first time, the complex evolutionary history of the subgroup 9 R2R3 MYB genes. A duplication event is inferred before the origin of seed plants giving rise to two major gene lineages, here termed SBG9-A and SBG9-B. The evolutionary conservation of the SBG9-B gene lineage has not been previously recognized and its role in cellular differentiation is unknown, thus an entire clade of potential candidate genes for epidermal cell regulation remains to be explored. Using a heterologous transformation bioassay, we provide functional data that implicate members of the SBG9-B lineage in the specification of epidermal projections. Furthermore, we reveal numerous putative duplication events in both SBG9-A and SBG9-B lineages, resolving uncertainty about orthology and paralogy among the subgroup 9 R2R3 MYB genes. Finally, we provide a robust framework over which to interpret existing functional data and to direct ongoing comparative genetic research into the evolution of plant cellular diversity.
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- 2013
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43. Health related quality of life in adolescents with bladder exstrophy-epispadias as measured by the Child Health Questionnaire-Child Form 87.
- Author
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Schaeffer AJ, Yenokyan G, Alcorn K, Furth SL, Diener-West M, Wu AW, Gearhart JP, and Dodson JL
- Subjects
- Adolescent, Child, Female, Humans, Male, Bladder Exstrophy complications, Epispadias complications, Quality of Life, Surveys and Questionnaires
- Abstract
Purpose: We determined health related quality of life as reported by adolescents with bladder exstrophy or epispadias using a validated generic instrument., Materials and Methods: Adolescents age 11 to 18 years with bladder exstrophy or epispadias (57) completed a validated, generic, health related quality of life instrument, the CHQ-CF87 (Child Health Questionnaire-Child Form 87). Urinary incontinence, catheterization status, and medical and surgical history data were also obtained. Mean summary scores and 95% CIs for each subdomain of the CHQ-CF87 were calculated, and descriptively compared to 2 population based samples. In our sample health related quality of life outcomes by continence status were compared using univariate and multivariate analysis. However, this analysis was limited by a small sample size., Results: Mean age of the 49 patients with bladder exstrophy and the 8 with epispadias was 14.3 years, 67% were male and 81% were Caucasian. There were 31 participants who reported incontinence and the median number of lifetime surgeries was 9. The exstrophy population scored well in all subdomains of the instrument when descriptively compared to 2 large samples of adolescent populations. In our sample incontinent patients had lower scores by multivariate analysis in 7 of 10 domains and better scores in 3 of 10 domains, although these differences were not statistically significant., Conclusions: Adolescents with bladder exstrophy and epispadias reported relatively good scores on the CHQ-CF87 when descriptively compared to other reference populations. This finding suggests that these children adapt well to the challenges of their condition. Analysis of the association of incontinence with health related quality of life was limited by the small sample size., (Copyright © 2012 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.)
- Published
- 2012
- Full Text
- View/download PDF
44. Parent perspectives of health related quality of life for adolescents with bladder exstrophy-epispadias as measured by the child health questionnaire-parent form 50.
- Author
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Dodson JL, Furth SL, Yenokyan G, Alcorn K, Diener-West M, Wu AW, and Gearhart JP
- Subjects
- Adolescent, Child, Female, Humans, Male, Attitude, Bladder Exstrophy complications, Epispadias complications, Parents, Quality of Life, Surveys and Questionnaires
- Abstract
Purpose: Few groups have examined health related quality of life for adolescents with bladder exstrophy-epispadias. We studied parent reported health related quality of life for adolescents with bladder exstrophy-epispadias using the Child Health Questionnaire-Parent Form 50., Materials and Methods: We recruited 11 to 17-year-old participants with bladder exstrophy-epispadias and their parents. Parents served as proxy respondents for the adolescents by self-administering a validated generic health related quality of life instrument, the Child Health Questionnaire-Parent Form 50. We collected urinary incontinence, catheterization status, and medical and surgical history data. Mean questionnaire scores were compared to population based norms., Results: Median age of the 55 patients was 14 years, 69% were male and 84% were white. Diagnoses included bladder exstrophy in 48 cases and epispadias in 7. Of the participants 29 (53%) reported urinary incontinence. The median number of lifetime surgeries was 9. Although physical and psychosocial summary measure scores were comparable to norms, the mean general health perception score was significantly worse than that of a population based sample (65.8 points, 95% CI 61.4-70.2 vs 73, 95% CI 71.3-74.7, p = 0.004). Mean family activity and parent emotional impact scores were also significantly worse than in a population based sample (83.6 points, 95% CI 79.3-88.0 vs 89.7, 95% CI 87.9-91.5, p = 0.02 and 67.7, 95% CI 61.9-73.6 vs 80.3, 95% CI 78.4-82.2, p <0.0001, respectively). Comparison of incontinent to continent children revealed a lower mean score on the parent emotional impact scale (62.6 points, 95% CI 55.5-69.8 vs 73.4, 95% CI 63.9-82.9), which approached significance (p = 0.06)., Conclusions: Although overall adolescent quality of life was comparable to norms, parents reported significantly impaired adolescent general health and family activity as well as a negative parental emotional impact. Further research is needed to identify interventions that can decrease the adverse impact of bladder exstrophy-epispadias on family activity and parent emotional distress., (Copyright © 2010 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.)
- Published
- 2010
- Full Text
- View/download PDF
45. Autistic behavior in boys with fragile X syndrome: social approach and HPA-axis dysfunction.
- Author
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Roberts JE, Clarke MA, Alcorn K, Carter JC, Long AC, and Kaufmann WE
- Abstract
The primary goal of this study was to examine environmental and neuroendocrine factors that convey increased risk for elevated autistic behavior in boys with Fragile X syndrome (FXS). This study involves three related analyses: (1) examination of multiple dimensions of social approach behaviors and how they vary over time, (2) investigation of mean levels and modulation of salivary cortisol levels in response to social interaction, and (3) examination of the relationship of social approach and autistic behaviors to salivary cortisol. Poor social approach and elevated baseline and regulation cortisol are discernible traits that distinguish boys with FXS and ASD from boys with FXS only and from typically developing boys. In addition, blunted cortisol change is associated with increased severity of autistic behaviors only within the FXS and ASD group. Boys with FXS and ASD have distinct behavioral and neuroendocrine profiles that differentiate them from those with FXS alone and typically developing boys.
- Published
- 2009
- Full Text
- View/download PDF
46. Haploidentical in utero hematopoietic cell transplantation improves phenotype and can induce tolerance for postnatal same-donor transplants in the canine leukocyte adhesion deficiency model.
- Author
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Peranteau WH, Heaton TE, Gu YC, Volk SW, Bauer TR, Alcorn K, Tuschong LM, Johnson MP, Hickstein DD, and Flake AW
- Subjects
- Animals, Busulfan administration & dosage, Dipeptidyl-Peptidase IV Inhibitors, Disease Models, Animal, Dogs, Female, Graft vs Host Disease immunology, Haploidy, Immune Tolerance, Immunosuppressive Agents administration & dosage, Leukocyte-Adhesion Deficiency Syndrome immunology, Lymphocyte Culture Test, Mixed, Male, Mice, Pregnancy, Transplantation Chimera, Transplantation Conditioning methods, Fetal Therapies methods, Hematopoietic Stem Cell Transplantation methods, Leukocyte-Adhesion Deficiency Syndrome therapy
- Abstract
In the murine model, in utero hematopoietic cell transplantation (IUHCT) has been shown to achieve low levels of allogeneic chimerism and associated donor-specific tolerance permitting minimal conditioning postnatal hematopoietic stem cell transplantation (HSCT). In this pilot study, we investigated IUHCT in the canine leukocyte adhesion deficiency (CLAD) model. Haploidentical IUHCT resulted in stable low-level donor cell chimerism in all dogs that could be analyzed by sensitive detection methodology (4 of 10) through 18 months of follow-up. In the 2 CLAD recipients, low-level chimerism resulted in amelioration and complete reversal of the CLAD phenotype, respectively. Six recipients of IUHCT (5 carriers and 1 CLAD) subsequently received postnatal HSCT from the same haploidentical prenatal donor after minimal conditioning with busulfan 10 mg/kg. Chimerism in 2 of 5 CLAD carriers that underwent HSCT increased from < 1% pre-HSCT to sustained levels of 35% to 45%. Control animals undergoing postnatal haploidentical HSCT without IUHCT had no detectable donor chimerism. These results demonstrate that haploidentical IUHCT in the CLAD model can result in low-level donor chimerism that can prevent the lethal phenotype in CLAD dogs, and can result in donor-specific tolerance that can facilitate postnatal minimal conditioning HSCT.
- Published
- 2009
- Full Text
- View/download PDF
47. The effect of an ICU liaison nurse on patients and family's anxiety prior to transfer to the ward: an intervention study.
- Author
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Chaboyer W, Thalib L, Alcorn K, and Foster M
- Subjects
- Australia, Female, Humans, Male, Middle Aged, Professional-Family Relations, Family Nursing, Intensive Care Units, Patient Care Planning, Patient Transfer, Stress, Psychological prevention & control
- Abstract
While an admission to the Intensive Care Unit (ICU) is stressful, the impending transfer from ICU to the ward can also result in anxiety for patients and their families. The aim of this study was to identify the effect of an ICU liaison nurse on anxiety experienced by patients and their families just prior to transfer to the ward. This block intervention study used a repeated before and after design, with the first control and intervention periods of 4 months, a wash-out period of 1 month, and then a second control and intervention period of 4 months duration. That is, after 4 months of control and another 4 months of intervention, the liaison nurse services were withdrawn and no data collection occurred for a month (wash-out) then a second set of 4-month blocks of control and intervention were undertaken. A standard transfer protocol was followed during the control periods whereas during the intervention periods, the liaison nurse prepared patients and their families for transfer to the ward. The State Trait Anxiety Form Y (State) was used to measure anxiety just prior to physical relocation to the ward. A total of 115 patients (62 control, 53 intervention) and 100 families (52 control, 48 intervention) were enrolled in the study. There was no difference in anxiety scores between the control and intervention groups in either patients or family groups. This study did not demonstrate a statistically significant beneficial effect of the liaison nurse in terms of pre-transfer anxiety, however it highlights several methodological issues that must be considered for future research including sample size estimates, timing and measurement of transfer anxiety and finally the intervention itself.
- Published
- 2007
- Full Text
- View/download PDF
48. Mixed co-receptor use associated with lower CD4 count.
- Author
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Morris K and Alcorn K
- Subjects
- HIV Infections immunology, Humans, Receptors, CXCR5, CD4 Lymphocyte Count, HIV Infections physiopathology, Receptors, CCR5 physiology, Receptors, Chemokine physiology
- Published
- 2007
49. Delaying maternal NVP-based ART more effective.
- Author
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Alcorn K
- Subjects
- Female, HIV Infections transmission, Humans, Pregnancy, HIV Infections prevention & control, Infectious Disease Transmission, Vertical prevention & control, Nevirapine administration & dosage, Pregnancy Complications, Infectious prevention & control, Reverse Transcriptase Inhibitors administration & dosage
- Published
- 2007
50. TMC125 study highlights failing NNRTI regimen task.
- Author
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Alcorn K
- Subjects
- Clinical Trials, Phase II as Topic, Drug Resistance, Viral, HIV genetics, HIV isolation & purification, Humans, Mutation, Nitriles, Pyridazines administration & dosage, Pyrimidines, Randomized Controlled Trials as Topic, Reverse Transcriptase Inhibitors administration & dosage, Viral Load, Pyridazines therapeutic use, Reverse Transcriptase Inhibitors therapeutic use
- Published
- 2006
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