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Article ; Online: Obstetric anal sphincter injury (OASI) in the presence of an intact perineum.

Worrall, Amy P / O'Leary, Bobby D / Salameh, Fadi

BMJ case reports

2023 Volume 16, Issue 10

Abstract: Obstetric anal sphincter injury (OASI) in the absence of concurrent injury to the perineal skin is not a common diagnosis. A primiparous woman delivered a healthy male infant by spontaneous vertex delivery. At time of delivery, a compound presentation of ...

Abstract	Obstetric anal sphincter injury (OASI) in the absence of concurrent injury to the perineal skin is not a common diagnosis. A primiparous woman delivered a healthy male infant by spontaneous vertex delivery. At time of delivery, a compound presentation of the fetal hand with the head was noted. Initial examination revealed a presumed second-degree tear; however, a small laceration above the anal verge was noted, which on exploration revealed a perineal injury through the anal sphincter complex. In the operating theatre, the perineal skin was incised to reveal a 3c OASI, which was repaired appropriately. While atypical OASI has been reported previously, this specific injury has never been described in detail in the literature. Awareness of atypical perineal injuries is needed and while careful perineal examination is required in all cases, this is especially important where the perineal skin appears intact to ensure appropriate diagnosis of any concurrent OASI.
MeSH term(s)	Pregnancy ; Female ; Male ; Humans ; Anal Canal/diagnostic imaging ; Anal Canal/injuries ; Perineum/injuries ; Risk Factors ; Delivery, Obstetric/adverse effects ; Lacerations ; Fecal Incontinence ; Obstetric Labor Complications/diagnosis
Language	English
Publishing date	2023-10-17
Publishing country	England
Document type	Case Reports ; Journal Article
ISSN	1757-790X
ISSN (online)	1757-790X
DOI	10.1136/bcr-2022-253922
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Article ; Online: Large labial haematoma needing surgical intervention.

Worrall, Amy P / Gaughan, Eve / Geary, Michael Pp

BMJ case reports

2021 Volume 14, Issue 11

MeSH term(s)	Gynecology ; Hematoma/diagnostic imaging ; Hematoma/etiology ; Hematoma/surgery ; Humans ; Obstetrics
Language	English
Publishing date	2021-11-09
Publishing country	England
Document type	Case Reports ; Journal Article
ISSN	1757-790X
ISSN (online)	1757-790X
DOI	10.1136/bcr-2021-247066
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Article: SVS WIfI score as a predictor of amputation after onset of CLI: Validation in an Irish tertiary vascular unit.

Ahmed, Zeeshan / Raza, Muhammad Zeeshan / Worrall, Amy P / Kheirelseid, Elrasheid / Naughton, Peter / Moneley, Daragh / McHugh, Seamus

The surgeon : journal of the Royal Colleges of Surgeons of Edinburgh and Ireland

2022 Volume 21, Issue 1, Page(s) 48–53

Abstract: ... in minor amputations (p < 0.0001).: Conclusion: The composite WIFi score (a summation of the Wound ...

Abstract	Introduction: Critical limb ischemia (CLI) in diabetic patients is defined by non-healing foot ulcer or rest pain for more than 2 weeks with ankle pressure of less than 40 mmHg. The SVS WIfI classification system stratifies CLI on the basis of perfusion, extent of wound and superadded infection to provide a composite score which guides further management and predicts final prognosis OBJECTIVE: The aim of the study was to use the SVS WIfI scoring system to predict the need for early revascularization versus early amputation depending on the composite WIfI score at presentation. Methodology: This was a retrospective observational study. Data was collected on patients admitted with CLI, in the last 2 years, to calculate composite WIfI score. The WIfI categories according to risk of limb loss were identified with endpoint being major or minor amputation. Results: Among the 87 patients reviewed, 35 patients (40%) required major amputation, and 29 of those underwent vascular intervention (83%) as part of their care. Median age of the cohort was 72 and 71% were male patients. Comparative analysis between major amputations and minor amputation showed the median score on initial clinical presentation to be 7 in major amputation and 5 in minor amputations (p < 0.0001). Conclusion: The composite WIFi score (a summation of the Wound, Ischaemia, and Infection sub-scores) was a good predictor of need for an amputation WIfI scoring system is a useful tool and should be used early in the management of infected ischaemic limbs.
MeSH term(s)	Humans ; Male ; Female ; Chronic Limb-Threatening Ischemia ; Risk Factors ; Treatment Outcome ; Limb Salvage ; Amputation, Surgical ; Ischemia/diagnosis ; Ischemia/surgery ; Retrospective Studies ; Peripheral Arterial Disease/surgery
Language	English
Publishing date	2022-03-23
Publishing country	Scotland
Document type	Observational Study ; Journal Article
ZDB-ID	2102927-1
ISSN	1479-666X
ISSN	1479-666X
DOI	10.1016/j.surge.2022.02.005
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Article ; Online: Health-related quality of life and quality of care in pregnant and postnatal women during the coronavirus disease 2019 pandemic: A cohort study.

Alaya, Fátimah / Worrall, Amy P / O'Toole, Fiona / Doyle, Jillian / Duffy, Richard M / Geary, Michael P

International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics

2021 Volume 154, Issue 1, Page(s) 100–105

Abstract: Objective: Health-related quality of life (HRQoL) and the delivery of high-quality care are ongoing concerns when caring for pregnant women during the coronavirus disease 2019 (COVID-19) pandemic. We compared self-reported HRQoL and hospital quality of ... ...

Abstract	Objective: Health-related quality of life (HRQoL) and the delivery of high-quality care are ongoing concerns when caring for pregnant women during the coronavirus disease 2019 (COVID-19) pandemic. We compared self-reported HRQoL and hospital quality of care among perinatal women with and without COVID-19. Methods: This is a prospective cohort study of perinatal women attending a tertiary maternity unit during the pandemic. Eighteen women who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and 20 SARS-CoV-2-negative women were recruited. Participants completed the Short Form Health Survey (SF-12), Clinical Outcomes in Routine Evaluation-Outcome Measure, and Quality from the Patient's Perspective questionnaires. Mean scores were compared. Results: Of the Non-COVID-19 cohort, 95% (n = 19) were Caucasian, whereas 67% (n = 12) of the COVID-19 cohort were not Caucasian (χ Conclusion: There was a significantly greater burden on physical health among pregnant women with COVID-19. Mental health and psychological status were similar in both groups. High quality of care during a pandemic is possible to deliver in a maternity setting, irrespective of COVID-19 status.
MeSH term(s)	Adult ; COVID-19/epidemiology ; Cohort Studies ; Female ; Humans ; Perinatal Care ; Postpartum Period/psychology ; Pregnancy ; Pregnancy Complications, Infectious/epidemiology ; Pregnant Women/psychology ; Quality of Health Care ; Quality of Life ; SARS-CoV-2
Language	English
Publishing date	2021-05-06
Publishing country	United States
Document type	Journal Article
ZDB-ID	80149-5
ISSN	1879-3479 ; 0020-7292
ISSN (online)	1879-3479
ISSN	0020-7292
DOI	10.1002/ijgo.13711
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Article ; Online: Immune screening in children with Down Syndrome.

Huggard, Dean / Worrall, Amy P / Kirkham, Colin / McGrane, Fiona / Mandira, Rajan / Casey, Laura / Condon, Therese / George, Sara / Lagan, Niamh / Roche, Edna / Balfe, Joanne / Leahy, Timonthy Ronan / Molloy, Eleanor J

Acta paediatrica (Oslo, Norway : 1992)

2022 Volume 111, Issue 10, Page(s) 2025–2028

MeSH term(s)	Biomarkers ; Child ; Down Syndrome/diagnosis ; Female ; Humans ; Mass Screening ; Pregnancy ; Prenatal Diagnosis
Chemical Substances	Biomarkers
Language	English
Publishing date	2022-07-24
Publishing country	Norway
Document type	Letter
ZDB-ID	203487-6
ISSN	1651-2227 ; 0365-1436 ; 0803-5253
ISSN (online)	1651-2227
ISSN	0365-1436 ; 0803-5253
DOI	10.1111/apa.16489
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Article: MicroRNA Expression Profile in Acute Ischemic Stroke.

Mainali, Shraddha / Nepal, Gaurav / Webb, Amy / Fadda, Paolo / Mirebrahimi, Darya / Nana-Sinkam, Patrick / Worrall, Brad / Woo, Daniel / Johnson, Nicholas / Hamed, Mohammad

Research square

2024

Abstract: Introduction: Acute ischemic stroke with large vessel occlusion (LVO) continues to present a considerable challenge to global health, marked by substantial morbidity and mortality rates. Although definitive diagnostic markers exist in the form of ... ...

Abstract	Introduction: Acute ischemic stroke with large vessel occlusion (LVO) continues to present a considerable challenge to global health, marked by substantial morbidity and mortality rates. Although definitive diagnostic markers exist in the form of neuroimaging, their expense, limited availability, and potential for diagnostic delay can often result in missed opportunities for life-saving interventions. Despite several past attempts, research efforts to date have been fraught with challenges likely due to multiple factors such as inclusion of diverse stroke types, variable onset intervals, differing pathobiologies, and a range of infarct sizes, all contributing to inconsistent circulating biomarker levels. In this context, microRNAs (miRNAs) have emerged as a promising biomarker, demonstrating potential as biomarkers across various diseases, including cancer, cardiovascular conditions, and neurological disorders. These circulating miRNAs embody a wide spectrum of pathophysiological processes, encompassing cell death, inflammation, angiogenesis, neuroprotection, brain plasticity, and blood-brain barrier integrity. This pilot study explores the utility of circulating exosome-enriched extracellular vesicle (EV) miRNAs as potential biomarkers for anterior circulation LVO (acLVO) stroke. Methods: In our longitudinal prospective cohort study, we collected data from acute large vessel occlusion (acLVO) stroke patients at four critical time intervals post-symptom onset: 0-6 hours, 6-12 hours, 12-24 hours, and 5-7 days. For comparative analysis, healthy individuals were included as control subjects. In this study, extracellular vesicles (EVs) were isolated from the plasma of participants, and the miRNAs within these EVs were profiled utilizing the NanoString nCounter system. Complementing this, a scoping review was conducted to examine the roles of specific miRNAs such as miR-140-5p, miR-210-3p, and miR-7-5p in acute ischemic stroke (AIS). This review involved a targeted PubMed search to assess their influence on crucial pathophysiological pathways in AIS, and their potential applications in diagnosis, treatment, and prognosis. The review also included an assessment of additional miRNAs linked to stroke. Results: Within the first 6 hours of symptom onset, three specific miRNAs (miR-7-5p, miR-140-5p, and miR-210-3p) exhibited significant differential expression compared to other time points and healthy controls. These miRNAs have previously been associated with neuroprotection, cellular stress responses, and tissue damage, suggesting their potential as early markers of acute ischemic stroke. Conclusion: This study highlights the potential of circulating miRNAs as blood-based biomarkers for hyperacute acLVO ischemic stroke. However, further validation in a larger, risk-matched cohort is required. Additionally, investigations are needed to assess the prognostic relevance of these miRNAs by linking their expression profiles with radiological and functional outcomes.
Language	English
Publishing date	2024-01-03
Publishing country	United States
Document type	Preprint
DOI	10.21203/rs.3.rs-3754883/v1
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Article ; Online: Affective domain predictors of PharmD student pursuit of and successful matching for postgraduate pharmacy residency training.

Oswald, Madison / Maxwell, Whitney D / Fierke, Kerry K / Griffith, Nicole / Davis, Sarah Elizabeth / Catchings, Erin / Worrall, Cathy L / Grant, Amy D / Magagnoli, Joe / Bookstaver, P Brandon

American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists

2022 Volume 79, Issue 19, Page(s) 1674–1684

Abstract: Purpose: A study was conducted to identify significant associations between affective domain (AD) features identified using the Birkman Method assessment and students' likelihood to pursue and to successfully match for postgraduate residency training ( ... ...

Abstract	Purpose: A study was conducted to identify significant associations between affective domain (AD) features identified using the Birkman Method assessment and students' likelihood to pursue and to successfully match for postgraduate residency training (PGRT), while controlling for demographic and academic variables known to impact PGRT match rates. Methods: A retrospective analysis of 3 graduating classes of PharmD students from 2 colleges of pharmacy was performed. Data points such as PGRT match results, PGRT pursuit, student demographics, academic performance information, and AD data from the Birkman assessment were analyzed. Regression analysis was used to identify statistically significant associations between demographic, academic performance, and AD variables with both pursuit of PGRT and successful matching for PGRT. Results: Data from 503 students were evaluated, with 211 (42%) pursuing PGRT. A variety of AD variables were significantly associated with pursuing PGRT and matching for PGRT. Two groups of actionable variables emerged: (1) variables associated with a lesser likelihood of pursuing PGRT but a greater likelihood of successful matching, and (2) variables associated with a greater likelihood of pursuing PGRT and a lesser likelihood of successful matching. Conclusion: Early identification of students' AD features along with specific interventions to promote PGRT pursuit in those less likely to pursue but more likely to match, as well as interventions to promote successful matching in students most likely to pursue but less likely to match for PGRT, is a strategy for possibly optimizing PharmD student career path planning and PGRT match success that merits further evaluation.
MeSH term(s)	Education, Pharmacy ; Education, Pharmacy, Graduate ; Humans ; Pharmacy Residencies/methods ; Retrospective Studies ; Students, Pharmacy/psychology
Language	English
Publishing date	2022-06-30
Publishing country	England
Document type	Journal Article
ZDB-ID	1224627-x
ISSN	1535-2900 ; 1079-2082
ISSN (online)	1535-2900
ISSN	1079-2082
DOI	10.1093/ajhp/zxac178
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Article ; Online: The effectiveness of continuous respiratory rate monitoring in predicting hypoxic and pyrexic events: a retrospective cohort study.

McCartan, Thomas A / Worrall, Amy P / Conluain, Ruán Ó / Alaya, Fátimah / Mulvey, Christopher / MacHale, Elaine / Brennan, Vincent / Lombard, Lorna / Walsh, Joanne / Murray, Myles / Costello, Richard W / Greene, Garrett

Physiological measurement

2021 Volume 42, Issue 6

Abstract: Respiratory rate (RR) is routinely used to monitor patients with infectious, cardiac and respiratory diseases and is a component of early warning scores used to predict patient deterioration. However, it is often measured visually with considerable bias ... ...

Abstract	Respiratory rate (RR) is routinely used to monitor patients with infectious, cardiac and respiratory diseases and is a component of early warning scores used to predict patient deterioration. However, it is often measured visually with considerable bias and inaccuracy.
MeSH term(s)	COVID-19/diagnosis ; Fever/diagnosis ; Fever/virology ; Humans ; Hypoxia/diagnosis ; Hypoxia/virology ; Monitoring, Physiologic ; Respiratory Rate ; Retrospective Studies
Language	English
Publishing date	2021-06-29
Publishing country	England
Document type	Journal Article
ZDB-ID	1149545-5
ISSN	1361-6579 ; 0967-3334
ISSN (online)	1361-6579
ISSN	0967-3334
DOI	10.1088/1361-6579/ac05d5
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Article ; Online: Online Search Trends Influencing Anticoagulation in Patients With COVID-19: Observational Study.

Worrall, Amy P / Kelly, Claire / O'Neill, Aine / O'Doherty, Murray / Kelleher, Eoin / Cushen, Anne Marie / McNally, Cora / McConkey, Samuel / Glavey, Siobhan / Lavin, Michelle / de Barra, Eoghan

JMIR formative research

2021 Volume 5, Issue 8, Page(s) e21817

Abstract: ... correlated against one another using a Spearman correlation. A P value of <.05 was considered significant ... Spearman correlation (P<.001, r=0.71) was found between the two data sets, showing an increase in VTE ...

Abstract	Background: Early evidence of COVID-19-associated coagulopathy disseminated rapidly online during the first months of 2020, followed by clinical debate about how best to manage thrombotic risks in these patients. The rapid online spread of case reports was followed by online interim guidelines, discussions, and worldwide online searches for further information. The impact of global online search trends and online discussion on local approaches to coagulopathy in patients with COVID-19 has not been studied. Objective: The goal of this study was to investigate the relationship between online search trends using Google Trends and the rate of appropriate venous thromboembolism (VTE) prophylaxis and anticoagulation therapy in a cohort of patients with COVID-19 admitted to a tertiary hospital in Ireland. Methods: A retrospective audit of anticoagulation therapy and VTE prophylaxis among patients with COVID-19 who were admitted to a tertiary hospital was conducted between February 29 and May 31, 2020. Worldwide Google search trends of the term "COVID-19" and anticoagulation synonyms during this time period were determined and correlated against one another using a Spearman correlation. A P value of <.05 was considered significant, and analysis was completed using Prism, version 8 (GraphPad). Results: A statistically significant Spearman correlation (P<.001, r=0.71) was found between the two data sets, showing an increase in VTE prophylaxis in patients with COVID-19 with increasing online searches worldwide. This represents a proxy for online searches and discussion, dissemination of information, and Google search trends relating to COVID-19 and clotting risk, in particular, which correlated with an increasing trend of providing thromboprophylaxis and anticoagulation therapy to patients with COVID-19 in our tertiary center. Conclusions: We described a correlation of local change in clinical practice with worldwide online dialogue and digital search trends that influenced individual clinicians, prior to the publication of formal guidelines or a local quality-improvement intervention.
Language	English
Publishing date	2021-08-31
Publishing country	Canada
Document type	Journal Article
ISSN	2561-326X
ISSN (online)	2561-326X
DOI	10.2196/21817
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Article ; Online: Statins for neuroprotection in spontaneous intracerebral hemorrhage.

Chen, Ching-Jen / Ding, Dale / Ironside, Natasha / Buell, Thomas J / Elder, Lori J / Warren, Amy / Adams, Amy P / Ratcliffe, Sarah J / James, Robert F / Naval, Neeraj S / Worrall, Bradford B / Johnston, Karen C / Southerland, Andrew M

Neurology

2019 Volume 93, Issue 24, Page(s) 1056–1066

Abstract: Statins, a common drug class for treatment of dyslipidemia, may be neuroprotective for spontaneous intracerebral hemorrhage (ICH) by targeting secondary brain injury pathways in the surrounding brain parenchyma. Statin-mediated neuroprotection may stem ... ...

Abstract	Statins, a common drug class for treatment of dyslipidemia, may be neuroprotective for spontaneous intracerebral hemorrhage (ICH) by targeting secondary brain injury pathways in the surrounding brain parenchyma. Statin-mediated neuroprotection may stem from downregulation of mevalonate and its derivatives, targeting key cell signaling pathways that control proliferation, adhesion, migration, cytokine production, and reactive oxygen species generation. Preclinical studies have consistently demonstrated the neuroprotective and recovery enhancement effects of statins, including improved neurologic function, reduced cerebral edema, increased angiogenesis and neurogenesis, accelerated hematoma clearance, and decreased inflammatory cell infiltration. Retrospective clinical studies have reported reduced perihematomal edema, lower mortality rates, and improved functional outcomes in patients who were taking statins before ICH. Several clinical studies have also observed lower mortality rates and improved functional outcomes in patients who were continued or initiated on statins after ICH. Subgroup analysis of a previous randomized trial has raised concerns of a potentially elevated risk of recurrent ICH in patients with previous hemorrhagic stroke who are administered statins. However, most statin trials failed to show an association between statin use and increased hemorrhagic stroke risk. Variable statin dosing, statin use in the pre-ICH setting, and selection biases have limited rigorous investigation of the effects of statins on post-ICH outcomes. Future prospective trials are needed to investigate the association between statin use and outcomes in ICH.
MeSH term(s)	Animals ; Cerebral Hemorrhage/drug therapy ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors/pharmacology ; Neuroprotective Agents/pharmacology
Chemical Substances	Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Neuroprotective Agents
Language	English
Publishing date	2019-11-11
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	207147-2
ISSN	1526-632X ; 0028-3878
ISSN (online)	1526-632X
ISSN	0028-3878
DOI	10.1212/WNL.0000000000008627
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