Publications by authors named "Deborah Wright"

26 Publications

  • Page 1 of 1

Barriers and solutions to trainee-led research collaboratives in New Zealand.

N Z Med J 2021 Sep 3;134(1541):119-122. Epub 2021 Sep 3.

Senior Lecturer, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand; Consultant Colorectal Surgeon, Department of General Surgery, Dunedin Hospital.

This article seeks to describe our experience enabling large-scale collaborative studies within trainee-led surgical research networks, to highlight systemic barriers to the use of this methodology and to propose solutions that will facilitate trainee-led collaborative research in New Zealand.
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September 2021

Late Outcomes of the RAPID-TnT Randomized Controlled Trial: 0/1-Hour High-Sensitivity Troponin T Protocol in Suspected ACS.

Circulation 2021 Jul 16;144(2):113-125. Epub 2021 May 16.

College of Medicine and Public Health, Flinders University of South Australia, Adelaide (K.L., A.B., A.S., A.C., E.K., E.M., J.K., D.P.C.).

Background: High-sensitivity troponin assays are increasingly being adopted to expedite evaluation of patients with suspected acute coronary syndromes. Few direct comparisons have examined whether the enhanced performance of these assays at low concentrations leads to changes in care that improves longer-term outcomes. This study evaluated late outcomes of participants managed under an unmasked 0/1-hour high-sensitivity cardiac troponin T (hs-cTnT) protocol compared with a 0/3-hour masked hs-cTnT protocol.

Methods: We conducted a multicenter prospective patient-level randomized comparison of care informed by unmasked 0/1-hour hs-cTnT protocol (reported to <5 ng/L) versus standard practice masked hs-cTnT testing (reported to ≤29 ng/L) assessed at 0/3 hours and followed participants for 12 months. Participants included were those presenting to metropolitan emergency departments with suspected acute coronary syndromes, without ECG evidence of coronary ischemia. The primary end point was time to all-cause death or myocardial infarction using Cox proportional hazards models adjusted for clustering within hospitals.

Results: Between August 2015 and April 2019, we randomized 3378 participants, of whom 108 withdrew, resulting in 12-month follow-up for 3270 participants (masked: 1632; unmasked: 1638). Among these, 2993 (91.5%) had an initial troponin concentration of ≤29 ng/L. Deployment of the 0/1-hour hs-cTnT protocol was associated with reductions in functional testing. Over 12-month follow-up, there was no difference in invasive coronary angiography (0/1-hour unmasked: 232/1638 [14.2%]; 0/3-hour masked: 202/1632 [12.4%]; =0.13), although an increase was seen among patients with hs-cTnT levels within the masked range (0/1-hour unmasked arm: 168/1507 [11.2%]; 0/3-hour masked arm: 124/1486 [8.3%]; =0.010). By 12 months, all-cause death and myocardial infarction did not differ between study arms overall (0/1-hour: 82/1638 [5.0%] versus 0/3-hour: 62/1632 [3.8%]; hazard ratio, 1.32 [95% CI, 0.95-1.83]; =0.10). Among participants with initial troponin T concentrations ≤29 ng/L, unmasked hs-cTnT reporting was associated with an increase in death or myocardial infarction (0/1-hour: 55/1507 [3.7%] versus 0/3-hour: 34/1486 [2.3%]; hazard ratio, 1.60 [95% CI, 1.05-2.46]; =0.030).

Conclusions: Unmasked hs-cTnT reporting deployed within a 0/1-hour protocol did not reduce ischemic events over 12-month follow-up. Changes in practice associated with the implementation of this protocol may be associated with an increase in death and myocardial infarction among those with newly identified troponin elevations. Registration: URL: https://www.anzctr.org.au; Unique identifier: ACTRN12615001379505.
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http://dx.doi.org/10.1161/CIRCULATIONAHA.121.055009DOI Listing
July 2021

Sex Inequity in Surgical Training.

JAMA Surg 2020 11;155(11):1026-1027

Department of Surgery, Faculty of Medical and Health Sciences, School of Medicine, The University of Auckland, Auckland, New Zealand.

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http://dx.doi.org/10.1001/jamasurg.2020.3022DOI Listing
November 2020

A Randomized Trial of a 1-Hour Troponin T Protocol in Suspected Acute Coronary Syndromes: The Rapid Assessment of Possible Acute Coronary Syndrome in the Emergency Department With High-Sensitivity Troponin T Study (RAPID-TnT).

Circulation 2019 11 3;140(19):1543-1556. Epub 2019 Sep 3.

South Australian Department of Health, Adelaide (D.P.C., K.L., A.B., A.S., M.J.R.E., A.C., D.W., M.H., C.P.).

Background: High-sensitivity troponin assays promise earlier discrimination of myocardial infarction. Yet, the benefits and harms of this improved discriminatory performance when incorporated within rapid testing protocols, with respect to subsequent testing and clinical events, has not been evaluated in an in-practice patient-level randomized study. This multicenter study evaluated the noninferiority of a 0/1-hour high-sensitivity cardiac troponin T (hs-cTnT) protocol in comparison with a 0/3-hour masked hs-cTnT protocol in patients with suspected acute coronary syndrome presenting to the emergency department (ED).

Methods: Patients were randomly assigned to either a 0/1-hour hs-cTnT protocol (reported to the limit of detection [<5 ng/L]) or masked hs-cTnT reported to ≤29 ng/L evaluated at 0/3-hours (standard arm). The 30-day primary end point was all-cause death and myocardial infarction. Noninferiority was defined as an absolute margin of 0.5% determined by Poisson regression.

Results: In total, 3378 participants with an emergency presentation were randomly assigned between August 2015 and April 2019. Ninety participants were deemed ineligible or withdrew consent. The remaining participants received care guided either by the 0/1-hour hs-cTnT protocol (n=1646) or the 0/3-hour standard masked hs-cTnT protocol (n=1642) and were followed for 30 days. Median age was 59 (49-70) years, and 47% were female. Participants in the 0/1-hour arm were more likely to be discharged from the ED (0/1-hour arm: 45.1% versus standard arm: 32.3%, <0.001) and median ED length of stay was shorter (0/1-hour arm: 4.6 [interquartile range, 3.4-6.4] hours versus standard arm: 5.6 (interquartile range, 4.0-7.1) hours, <0.001). Those randomly assigned to the 0/1-hour protocol were less likely to undergo functional cardiac testing (0/1-hour arm: 7.5% versus standard arm: 11.0%, <0.001). The 0/1-hour hs-cTnT protocol was not inferior to standard care (0/1-hour arm: 17/1646 [1.0%] versus 16/1642 [1.0%]; incidence rate ratio, 1.06 [ 0.53-2.11], noninferiority value=0.006, superiority value=0.867), although an increase in myocardial injury was observed. Among patients discharged from ED, the 0/1-hour protocol had a negative predictive value of 99.6% (95% CI, 99.0-99.9%) for 30-day death or myocardial infarction.

Conclusions: This in-practice evaluation of a 0/1-hour hs-cTnT protocol embedded in ED care enabled more rapid discharge of patients with suspected acute coronary syndrome. Improving short-term outcomes among patients with newly recognized troponin T elevation will require an evolution in management strategies for these patients.

Clinical Trial Registration: URL: https://www.anzctr.org.au. Unique identifier: ACTRN12615001379505.
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http://dx.doi.org/10.1161/CIRCULATIONAHA.119.042891DOI Listing
November 2019

Initiation of a formalized precision medicine program in gynecologic oncology.

Gynecol Oncol 2016 Apr;141(1):24-8

Stephenson Cancer Center, University of Oklahoma Health Sciences Center, 800 NE 10th Street, Oklahoma City, OK 73104, USA. Electronic address:

Objective: In an effort to better incorporate precision medicine into clinical practice, we initiated a pilot project to screen, discuss, and genetically characterize patients with metastatic or recurrent gynecologic malignancies for whom no curative standard of care exists.

Methods: In 7/2014, we initiated a multi-disciplinary Precision Medicine Board (PMB) whose purpose was to apply molecular profiling to select and prioritize early phase clinical trial enrollment for high-risk gynecologic malignancies. Additional objectives were to record outcomes and enable scientific discussions of mutations which may foster local translational research. FoundationOne was the preferred genomic platform; results were reviewed by a team comprised of disease site specialists, phase I trialists, and basic and translational scientists affiliated with the Gynecologic Cancer Program. A detailed database for each patient was created and is followed prospectively for treatment use and resultant outcomes.

Results: To date, we have presented 62 cases with interpretable FoundationOne testing on 60 tumor samples (31 ovarian, 18 uterine, 9 cervical, and 4 other female genital tract). Significant genomic alterations were commonly found in all tumor types (median: 3); TP53 (45%) and PIK3CA (27%) were the most frequently noted mutations; however, molecular profiling resulted in identification of few actionable mutations (6%). To date, we have matched 4 patients on therapies based on actionable mutations.

Conclusions: The predominant function of our PMB is establishment of a forum to enhance research while providing clinical care for refractory malignancies. We have matched patients with specific mutations to ongoing trials and are developing investigator-initiated studies based on trends within genomic profiling results. Longer-term follow up will be required to determine the success of this strategy.
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http://dx.doi.org/10.1016/j.ygyno.2016.02.024DOI Listing
April 2016

Alcohol and remembering a hypothetical sexual assault: Can people who were under the influence of alcohol during the event provide accurate testimony?

Memory 2016 09 17;24(8):1042-61. Epub 2015 Aug 17.

a School of Psychology , University of Leicester , Leicester , UK.

We examined the influence of alcohol on remembering an interactive hypothetical sexual assault scenario in the laboratory using a balanced placebo design. Female participants completed a memory test 24 hours and 4 months later. Participants reported less information (i.e., responded "don't know" more often to questions) if they were under the influence of alcohol during scenario encoding. The accuracy of the information intoxicated participants reported did not differ compared to sober participants, however, suggesting intoxicated participants were effectively monitoring the accuracy of their memory at test. Additionally, peripheral details were remembered less accurately than central details, regardless of the intoxication level; and memory accuracy for peripheral details decreased by a larger amount compared to central details across the retention interval. Finally, participants were more accurate if they were told they were drinking alcohol rather than a placebo. We discuss theoretical implications for alcohol myopia and memory regulation, together with applied implications for interviewing intoxicated witnesses.
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http://dx.doi.org/10.1080/09658211.2015.1064536DOI Listing
September 2016

Seroconversion for infectious pathogens among UK military personnel deployed to Afghanistan, 2008-2011.

Emerg Infect Dis 2014 Dec;20(12):2015-22

Military personnel are at high risk of contracting vector-borne and zoonotic infections, particularly during overseas deployments, when they may be exposed to endemic or emerging infections not prevalent in their native countries. We conducted seroprevalence testing of 467 UK military personnel deployed to Helmand Province, Afghanistan, during 2008-2011 and found that up to 3.1% showed seroconversion for infection with Rickettsia spp., Coxiella burnetii, sandfly fever virus, or hantavirus; none showed seroconversion for infection with Crimean-Congo hemorrhagic fever virus. Most seroconversions occurred in personnel who did not report illness, except for those with hantavirus (70% symptomatic). These results indicate that many exposures to infectious pathogens, and potentially infections resulting from those exposures, may go unreported. Our findings reinforce the need for continued surveillance of military personnel and for education of health care providers to help recognize and prevent illnesses and transmission of pathogens during and after overseas deployments.
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http://dx.doi.org/10.3201/eid2012.131830DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4257834PMC
December 2014

Predictors of posttraumatic stress in parents of children diagnosed with a disorder of sex development.

Arch Sex Behav 2014 Feb 2;43(2):369-75. Epub 2013 Oct 2.

Department of Paediatrics, Addenbrooke's Hospital, Box 116, Level 8, Hills Road, Cambridge, CB2 0QQ, UK,

The aims of the current study were twofold: (1) to assess the prevalence/severity of posttraumatic stress symptoms (PTSS) as well as cognitive and emotional responses in parents whose children were diagnosed with a disorder of sex development (DSD); and (2) to assess factors which contributed to PTSS. We hypothesized that parents would show elevated levels of PTSS and that negative cognitive and/or emotional responses would be predictive. Participants were parents of children diagnosed with a DSD. Thirty-six mothers and 11 fathers completed a measure of posttraumatic stress and reported difficulties in the domains of cognition (e.g., confusion) and emotion (e.g., grief). Using multiple regression, we determined factors contributing to parental PTSS. Reported PTSS was high: 31 % of mothers and 18 % of fathers met the threshold for caseness for Posttraumatic Stress Disorder. Regression included: child sex, parent sex, child age at diagnosis, years since diagnosis, genital ambiguity, father occupation, cognitive confusion, and emotional distress. Only cognitive confusion contributed significantly to variance in PTSS. Parents of children with DSD may experience the diagnosis as traumatic, evidenced by high rates of PTSS in the current report. Assessment of reactions to their children's diagnoses revealed that cognitive confusion, and not emotional distress, predicted PTSS. In this case, direct cognitive interventions may be applicable. Though psychological support is widely recommended, no detailed intervention has been offered. Our findings suggest that we may directly apply models successful in other areas of pediatrics, such as pediatric oncology. Future studies may assess the usefulness of such an intervention.
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http://dx.doi.org/10.1007/s10508-013-0196-8DOI Listing
February 2014

Supply and demand mismatch for flexible (part-time) surgical training in Australasia.

Med J Aust 2013 May;198(8):423-5

Sydney Medical School, University of Sydney, Sydney, NSW, Australia.

Objectives: To define current patterns of flexible (part-time) surgical training in Australasia, determine supply and demand for part-time positions, and identify work-related factors motivating interest in flexible training.

Design, Setting And Participants: All Royal Australasian College of Surgeons trainees (n = 1191) were surveyed in 2010. Questions assessed demographic characteristics and working patterns, interest in flexible training, work-related fatigue and work-life balance preferences.

Main Outcome Measures: Interest in part-time training, and work-related factors motivating this interest.

Results: Of the 1191 trainees, 659 responded (response rate, 55.3%). Respondents were representative of all trainees in terms of specialty and sex. The median age of respondents was 32 2013s, and 187 (28.4%) were female. Most of the 659 respondents (627, 95.1%) were in full-time clinical training; only two (0.3%) were in part-time clinical training, and 30 (4.6%) were not in active clinical training. An interest in part-time training was reported by 208 respondents (31.6%; 54.3% of women v 25.9% of men; P < 0.001). Trainees expressing an interest in part-time training were more likely to report that fatigue impaired their performance at work and limited their social or family life, and that they had insufficient time in life for things outside surgical training, including study or research (P < 0.05).

Conclusions: There is a striking mismatch between demand for flexible surgical training and the number of trainees currently in part-time training positions in Australia and New Zealand. Efforts are needed to facilitate part-time surgical training.
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http://dx.doi.org/10.5694/mja12.11685DOI Listing
May 2013

The zebrafish reference genome sequence and its relationship to the human genome.

Nature 2013 Apr 17;496(7446):498-503. Epub 2013 Apr 17.

Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge CB10 1SA, UK.

Zebrafish have become a popular organism for the study of vertebrate gene function. The virtually transparent embryos of this species, and the ability to accelerate genetic studies by gene knockdown or overexpression, have led to the widespread use of zebrafish in the detailed investigation of vertebrate gene function and increasingly, the study of human genetic disease. However, for effective modelling of human genetic disease it is important to understand the extent to which zebrafish genes and gene structures are related to orthologous human genes. To examine this, we generated a high-quality sequence assembly of the zebrafish genome, made up of an overlapping set of completely sequenced large-insert clones that were ordered and oriented using a high-resolution high-density meiotic map. Detailed automatic and manual annotation provides evidence of more than 26,000 protein-coding genes, the largest gene set of any vertebrate so far sequenced. Comparison to the human reference genome shows that approximately 70% of human genes have at least one obvious zebrafish orthologue. In addition, the high quality of this genome assembly provides a clearer understanding of key genomic features such as a unique repeat content, a scarcity of pseudogenes, an enrichment of zebrafish-specific genes on chromosome 4 and chromosomal regions that influence sex determination.
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http://dx.doi.org/10.1038/nature12111DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3703927PMC
April 2013

Delay and déjà vu: timing and repetition increase the power of false evidence.

Psychon Bull Rev 2013 Aug;20(4):812-8

Department of Psychology, University of Warwick, Coventry, CV4 7AL, UK.

False images and videos can induce people to believe in and remember events that never happened. Using a novel method, we examined whether the timing of false evidence would influence its effect (Experiment 1) and determined the relationship between timing and repetition (Experiment 2). Subjects completed a hazard perception driving test and were falsely accused of cheating. Some subjects were shown a fake video or photograph of the cheating either after a 9-min delay (Experiment 1) or more than once with or without a delay (Experiment 2). Subjects were more likely to falsely believe that they had cheated and to provide details about how the cheating happened when the false evidence was delayed or repeated-especially when repeated over time-relative to controls. The results show that even a strikingly short delay between an event and when false evidence is disclosed can distort people's beliefs and that repeating false evidence over a brief delay fosters false beliefs more so than without a delay. These findings have theoretical implications for metacognitive models of autobiographical memory and practical implications for police interrogations.
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http://dx.doi.org/10.3758/s13423-013-0398-zDOI Listing
August 2013

Great expectations: use of molecular tests and computerised prognostic tools in New Zealand cancer care.

N Z Med J 2012 Apr 20;125(1353):9-21. Epub 2012 Apr 20.

Department of Molecular Medicine and Pathology, University of Auckland, Auckland, New Zealand.

Background: Use of molecular tests and computerised prognostic tools designed to individualise cancer care appears to be rapidly increasing in New Zealand. These tests have important clinical and health economic implications, but their impact on cancer care has not been fully assessed.

Aim: To determine cancer clinicians' use of and expectations for molecular tests and computerised prognostic tools.

Method: Online survey of clinicians managing cancer in New Zealand.

Results: 137 clinicians participated, 31% used molecular tests and 57% used computerised prognostic tools. These technologies affected clinical decisions made by a quarter of participants. Over 85% of participants believed that the impact of molecular tests and computerised prognostic tools would increase over the next decade and that a stronger evidence base would support their use.

Conclusions: Molecular tests and computerised prognostic tools already influence treatment provided to many New Zealand cancer patients. Clinicians who participated in this survey overwhelmingly expect the use of these tests to increase, which has important clinical implications since there is little high quality prospective data assessing the ability of these tests to improve patient outcomes. Expanded use of these often-expensive tests also has economic implications. The role of these technologies needs to be considered in the context of a wide-ranging cancer control strategy.
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April 2012

Complications of Foley catheters--is infection the greatest risk?

J Urol 2012 May 15;187(5):1662-6. Epub 2012 Mar 15.

VA Medical Center, University of Minnesota, Minneapolis, Minnesota, USA.

Purpose: Foley catheters cause a variety of harms, including infection, pain and trauma. Although symptomatic urinary tract infection and asymptomatic bacteriuria are frequently discussed, genitourinary trauma receives comparatively little attention.

Materials And Methods: A dedicated Foley catheter nurse prospectively reviewed the medical records of inpatients with a Foley catheter at the Minneapolis Veterans Affairs Medical Center from August 21, 2008 to December 31, 2009. Daily surveillance included Foley catheter related bacteriuria and trauma. Data were analyzed as the number of event days per 100 Foley catheter days.

Results: During 6,513 surveyed Foley catheter days, urinalysis/urine culture was done on 407 (6.3%) days. This testing identified 116 possible urinary tract infection episodes (1.8% of Foley catheter days), of which only 21 (18%) involved clinical manifestations. However, the remaining 95 asymptomatic bacteriuria episodes accounted for 39 (70%) of 56 antimicrobial treated possible urinary tract infection episodes (for proportion of treated episodes with vs without symptomatic urinary tract infection manifestations, p = 0.005). Concurrently 100 instances of catheter associated genitourinary trauma (1.5% of Foley catheter days) were recorded, of which 32 (32%) led to interventions such as prolonged catheterization or cystoscopy. Trauma prompting an intervention accounted for as great a proportion of Foley catheter days (0.5%) as did symptomatic urinary tract infection (0.3%) (p = 0.17).

Conclusions: In this prospective surveillance project, intervention triggering Foley catheter related genitourinary trauma was as common as symptomatic urinary tract infection. Moreover, despite recent increased attention to the distinction between asymptomatic bacteriuria and symptomatic urinary tract infection in catheterized patients, asymptomatic bacteriuria accounted for significantly more antimicrobial treatment than did symptomatic urinary tract infection. Elimination of unnecessary Foley catheter use could prevent symptomatic urinary tract infection, unnecessary antimicrobial therapy for asymptomatic bacteriuria and Foley catheter related trauma.
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http://dx.doi.org/10.1016/j.juro.2011.12.113DOI Listing
May 2012

Reduction of inappropriate urinary catheter use at a Veterans Affairs hospital through a multifaceted quality improvement project.

Clin Infect Dis 2011 Jun;52(11):1283-90

VA Medical Center Minneapolis, MN 55417, USA.

Background: Foley catheter (FC) use is a modifiable risk factor for hospital-acquired urinary tract infection, the most common type of nosocomial infection. It is unknown whether sustained, hospital-wide reductions in FC use are achievable by combining interventions with demonstrated short-term effectiveness in selected units.

Methods: A multifaceted quality improvement project to decrease unnecessary FC use and increase order documentation was instituted throughout the Minneapolis Veterans Affairs Medical Center in March 2005, after a >2-year baseline period. Bundled interventions included multiple types of education, system redesign, rewards, and feedback (phases I and II), plus, in phase III, involvement of a dedicated FC nurse.

Results: The daily prevalence of FC use dropped steeply during intervention phase I (5.5 months), from a 15.2% baseline mean to a 9.3% nadir, but rebounded quickly during the subsequent hiatus phase (1.2 months). It dropped again (mean, 13.6%) during intervention phase II (27.3 months) and even further (mean, 12.0%) during intervention phase III (22.8 months) (P ≤ .001, phase II or III vs baseline). Compared with baseline, during phase III (with the dedicated FC nurse) the mean daily percentages of nonordered and nonindicated FCs dropped from 17% to 5.1% and from 15% to 1.2%, respectively. During phases II and III combined, an estimated total of 6691 FC days were avoided.

Conclusions: Significant hospital-wide reductions in total and inappropriate FC use and improved FC order documentation were achieved through a multicomponent campaign. The greatest and most sustained improvements accompanied the involvement of a dedicated FC nurse.
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http://dx.doi.org/10.1093/cid/cir188DOI Listing
June 2011

Clinical decision support systems: should we rely on unvalidated tools?

ANZ J Surg 2011 May;81(5):314-7

Department of Molecular Medicine and Pathology, University of Auckland, Auckland City Hospital, New Zealand.

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http://dx.doi.org/10.1111/j.1445-2197.2011.05703.xDOI Listing
May 2011

Immunohistochemistry to detect hereditary nonpolyposis colorectal cancer in young patients: the 7-year Auckland experience.

Dis Colon Rectum 2011 May;54(5):552-8

Department of Surgery, University of Auckland, Auckland, New Zealand.

Background: In accordance with the Bethesda Guidelines, Auckland's metropolitan hospitals routinely perform immunohistochemistry for mismatch repair proteins on the tumor specimens of all patients with colorectal cancer aged 50 years and younger. When loss of expression is evident, patients are offered genetic counseling and gene mutation analysis.

Objectives: This study aimed to determine the completeness of young patient capture over the first 7 years of routine testing, to find whether patients were referred for genetic testing, and to determine the proportion of patients found to have a mismatch repair gene mutation.

Design: This study retrospectively reviewed clinical, pathological, and genetic data.

Settings: The study was conducted at 3 public hospitals in Auckland, New Zealand.

Patients: All patients aged 50 years and younger treated for colorectal cancer at Auckland's metropolitan hospitals between January 2001 and December 2007 (n = 243) were included.

Main Outcome Measures: The loss of expression of mismatch repair proteins by immunohistochemistry, referral for genetic testing, and proportion with mismatch repair gene mutation were the main outcome measures.

Results: Two hundred fourteen (88%) eligible patients had immunohistochemical analysis of their tumor and 33 (14%) had loss of expression of one or more mismatch repair proteins. Twenty-six patients were referred for genetic counseling, of whom 22 underwent genetic testing. A mismatch repair gene mutation was identified in 10 patients.

Limitations: Seven patients with loss of expression of mismatch repair proteins by immunohistochemistry were not referred for genetic assessment.

Conclusions: We have identified a mismatch repair gene mutation diagnostic of hereditary nonpolyposis colorectal cancer in 5% of all patients with colorectal cancer who were aged 50 years and younger. Routine immunohistochemical prescreening has important clinical benefit for these patients and their relatives.
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http://dx.doi.org/10.1007/DCR.0b013e31820e3265DOI Listing
May 2011

Improving the long-term storage of a mammalian biosensor cell line via genetic engineering.

Biotechnol Bioeng 2010 Jun;106(3):474-81

MIT Lincoln Laboratory, Lexington, Massachusetts 02420, USA.

The unique properties of mammalian cells make them valuable for a variety of applications in medicine, industry, and diagnostics. However, the utility of such cells is restricted due to the difficulty in storing them non-frozen for an extended time and still maintaining their stability and responsiveness. In order to extend the active life span of a mammalian biosensor cell line at room and refrigerated temperatures, we have over expressed genes that are reported to provide protection from apoptosis, stress, or oxidation. We demonstrated that over expression of genes from the extremophile, Artemia franciscana, as well as GADD45beta, extends room-temperature storage of fully active cells 3.5-fold, while over production of several anti-apoptotic proteins extended 4 degrees C storage 2- to 3-fold. Methodologies like these that improve the stability of mammalian-cell-based technologies in the absence of freezers may enable widespread use of these tools in applications that have been considered impractical based solely on limited storage characteristics.
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http://dx.doi.org/10.1002/bit.22700DOI Listing
June 2010

Tourniquets revisited.

J Trauma 2009 Mar;66(3):672-5

Department of Surgery, University of Medicine and Dentistry of New Jersey/NJMS, Newark, NJ 07101, USA.

Background: Controversy swirls about optimal control of life-threatening hemorrhage from an injured extremity whether in combat in the Middle East or in trauma care at home. Left unanswered are four critical questions: (1) What is the simplest tourniquet available? (2) Can it be used below the elbow and the knee? (3) Is pain a factor? (4) What data support so called "Pressure Points?"

Methods: To address these questions, we measured the effects of three common tourniquets on arterial pulses (Doppler signals) at wrist and ankle of 10 healthy adult volunteers of either sex. We recorded ease of application (1-3, with 3 easiest) by the applicant and pain experienced by the subject (none, light, moderate, severe). Tourniquets were applied sequentially to arm, forearm, thigh, and leg. Tourniquet success was defined as sustained elimination of distal pulse. Pressure points were brachial artery in arm and cubital fossa, common femoral artery (groin), and popliteal artery (knee). The same criteria defined success. All numerical data were meaned and standard error (SE) computed. Significance of apparent differences was assessed with Student's t test for paired observations.

Results: Mean age was 36.5 +/- 6.0 years; blood pressure was 123 +/- 6/72 +/- 4 mm Hg. All three tourniquets (sphygmomanometer, 1/2 inch rubber tubing, cloth and windlass) were successful in all patients in all four locations with two exceptions. Thighs of two subjects were too large for the sphygmomanometer and one person experienced test terminating pain with the rubber tube on arm and thigh and with the cloth and windlass on the thigh. Manual (digital) occlusion of the brachial artery in the arm was possible in all but one subject; however, the Doppler signal at the wrist returned within 40.6 +/-6.5 seconds in all but one of the other nine subjects. Pressure point control of the common femoral artery resulted in identical findings except that the pulse returned within 20.6 +/- 4.7 seconds despite sustained pressure. Attempts at control of the brachial artery at the elbow and the popliteal artery at the knee were less successful.

Conclusions: Our data indicate that all tourniquets can be used successfully below the knee or elbow. The cloth and windlass is the easiest to apply. It is probably the most readily available or simplest to procure/improvise. Pain is irrelevant. "Pressure Point Control" of extremity arterial hemorrhage is a euphemistic misnomer.
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http://dx.doi.org/10.1097/TA.0b013e3181986959DOI Listing
March 2009

Campylobacter and acute appendicitis?

ANZ J Surg 2008 Dec;78(12):1142

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http://dx.doi.org/10.1111/j.1445-2197.2008.04779.xDOI Listing
December 2008

Conformists or dynamic professionals: what's the current image that students are identifying with as a result of English Allied Health Professional Higher Education programmes?

Authors:
Deborah Wright

J Allied Health 2008 ;37(4):e338-53

London South Bank University, Health and Social Care Faculty, London SE1 OAA.

How Allied Health Professional (AHP) students and educational providers within England are redefining professionalism is the focus of this small scale case study. A single case study design was used to explore how AHP students viewed how they had learnt to be professional. A literature review highlighted that professional socialisation and professional knowledge were both aspects of professionalism that individual health professionals adhere to, however how English based AHPs have benefited from becoming regulated by one professional body (Health Professions Council, HPC) is a fundamental question asked by the researcher, as there has been a drive both within the educational arena and health institutions for interprofessional and generic working. Seven students at one London University, where they experienced interprofessional education (IPE), were engaged in semi-structured interviews and the researcher used a phenomenological approach to interpret the data. The findings showed that all the students defined professionalism in terms of generic skills associated with patient/client-centred care. This mainly conformed to what they were being taught, though they did not feel that IPE enhanced their learning. The students felt it was important to have an up to date knowledge base, but thought that some of the theory taught was not relevant to their practice. The study concludes that there needs to be greater collaboration between higher educational establishments and clinical partners to ensure students are given a relevant and consistent view of professionalism, which enhances not only their collaborative practice but also their independent professional integrity.
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November 2009

UV irradiation and desiccation modulate the three-dimensional extracellular matrix of Nostoc commune (Cyanobacteria).

J Biol Chem 2005 Dec 27;280(48):40271-81. Epub 2005 Sep 27.

Virginia Tech Center for Genomics, Department of Biochemistry, Virginia Tech, Blacksburg, Virginia 24061, USA.

Cyanobacterium Nostoc commune can tolerate the simultaneous stresses of desiccation, UV irradiation, and oxidation. Acidic WspA, of approximately 33.6 kDa, is secreted to the three-dimensional extracellular matrix and accounts for greater than 70% of the total soluble protein. The wspA gene of N. commune strain DRH1 was cloned and found in a single genomic copy, in a monocistronic operon. Transcription of wspA and sodF (superoxide dismutase), and synthesis and secretion of WspA, were induced upon desiccation or UV-A/B irradiation of cells. Recombinant WspA binds the UV-A/B absorbing pigment scytonemin through non-covalent interactions. WspA peptide polymorphism, and heterogeneity of multiple wspA sequences within cells of a single colony, account for distinct WspA isoforms. WspA has no similarity to entries in the sequence databases and wspA, a possible xenolog, is restricted to a subset of strains in the "form species" N. commune characterized through group I intron phylogeny. We hypothesize that WspA plays a central role in the global stress response of N. commune through modulation of the structure and function of the three-dimensional extracellular matrix, particularly the transport, distribution, and/or macromolecular architecture of mycosporine and scytonemin UV-A/B absorbing pigment complexes.
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http://dx.doi.org/10.1074/jbc.M505961200DOI Listing
December 2005

Speculum 'self-insertion': a pilot study.

J Clin Nurs 2005 Oct;14(9):1098-111

Quarry Health Centre, Northbridge, WA, Australia.

Aim: This paper reports phase II of a pilot study that aimed to determine whether self-insertion of a speculum by women undergoing a pap smear would be more comfortable and lead to an improvement in satisfaction and a decrease in anxiety associated with this procedure.

Background: Research demonstrates that pelvic examinations are considered by most women to be unpleasant and are routinely associated with embarrassment, apprehension, fear and often some level of discomfort and/or pain.

Design: The study used quantitative and qualitative data collection techniques. Phase I (described elsewhere) tested the newly developed Speculum Self-Insertion Satisfaction Questionnaire for content validity, internal consistency and clarity. Phase II pilot study tested the technique of speculum self-insertion. Women's general level of anxiety was measured using the State Trait Anxiety Inventory, both before and after they performed the self-insertion procedure. Women's satisfaction and acceptance of the procedure was measured using the Speculum Self-Insertion Satisfaction Questionnaire and explored through the use of qualitative research techniques.

Participants: A total of 198 women attending family planning clinics in Perth, Western Australia, between September and December 2003 were invited to participate in the study. One hundred and thirty-three women agreed to self-insert their own speculum.

Results: The study demonstrated that speculum self-insertion was acceptable to most women, especially younger women. Nearly 91% of women either agreed or strongly agreed that they were satisfied with the experience of self-insertion and would choose to self-insert the speculum again. This included the women who had not previously had a speculum examination. The quality of specimen collected was not detrimentally affected by speculum self-insertion.

Conclusions: The results of this pilot research, while needing to be replicated in a larger study, demonstrate that offering women the opportunity to self-insert a speculum during a routine pelvic examination is an acceptable, innovative, simple and cost-neutral change in clinical practice that increases women's comfort and satisfaction and potentially makes sexual health screening less threatening to women of all ages.

Relevance To Clinical Practice: Speculum self-insertion may encourage women's attendance at clinics for regular screening. Early diagnosis and treatment will result in better health outcomes for women, families and the community at large.
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http://dx.doi.org/10.1111/j.1365-2702.2005.01205.xDOI Listing
October 2005

Developing a central sterile surgical instrument technician program.

AORN J 2004 Aug;80(2):235-8, 241

University of Alabama at Birmingham Hospital, USA.

Many hospitals report high vacancy rates in their central sterile processing departments related to the lack of a workforce that is knowledgeable about instrument processing and medical terminology. Creating an education course that focused on the knowledge and skills necessary for success in this vocation provided a solution to this problem for one facility. Outcomes included a dramatic decrease in the number of vacancies in the central sterile processing department and an increase in community awareness of employment options available in perioperative services.
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http://dx.doi.org/10.1016/s0001-2092(06)60561-9DOI Listing
August 2004

Genomic DNA of Nostoc commune (Cyanobacteria) becomes covalently modified during long-term (decades) desiccation but is protected from oxidative damage and degradation.

Nucleic Acids Res 2003 Jun;31(12):2995-3005

Virginia Tech Center for Genomics (VIGEN), Virginia Tech, Blacksburg, VA 24061, USA.

Genomic DNA of Nostoc commune (Cyanobacteria) became covalently modified during decades of desiccation. Amplification of gene loci from desiccated cells required pretreatment of DNA with N-phenacylthiazolium bromide, a reagent that cleaves DNA- and protein-linked advanced glycosylation end-products. DNA from 13 year desiccated cells did not show any higher levels of the commonly studied oxidatively modified DNA damage biomarkers 8-hydroxyguanine, 8-hydroxyadenine and 5-hydroxyuracil, compared to commercially available calf thymus DNA. Different patterns of amplification products were obtained with DNA from desiccated/rehydrating cells and a liquid culture derived from the dried material, using the same set of primers. In contrast, a reproducible fingerprint was obtained, irrespective of time of rehydration of the DNA, using a primer (5'-GWCWATCGCC-3') based upon a highly iterated palindromic repeat sequence present in the genome. In vitro, the desiccation of cccDNA led to loss of supercoiling, aggregation, loss of resolution during agarose gel electrophoresis and loss of transformation and transfection efficiency. These changes were minimized when DNA was desiccated and stored in the presence of trehalose, a non-reducing disaccharide present in Nostoc colonies. The response of the N.commune genome to desiccation is different from the response of the genomes of cyanobacteria and Deinococcus radiodurans to ionizing radiation.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC162238PMC
http://dx.doi.org/10.1093/nar/gkg404DOI Listing
June 2003
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