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  1. Article ; Online: A cost-analysis of managing secondary and apparent treatment-resistant hypertension in a specialist multidisciplinary hypertension clinic.

    Rabbitt, Louise / Curneen, James / Hobbins, Anna / Browne, Darragh / Joyce, Mary / Lappin, David / McEvoy, John William / Gillespie, Paddy / Dennedy, Michael Conall

    Journal of hypertension

    2023  Volume 42, Issue 1, Page(s) 58–69

    Abstract: Objectives: A knowledge gap exists around the costs and budget impact of specialist hypertension clinics. This study reports on the cost of providing care in a multidisciplinary hypertension clinic staffed by nephrologist, endocrinologist and ... ...

    Abstract Objectives: A knowledge gap exists around the costs and budget impact of specialist hypertension clinics. This study reports on the cost of providing care in a multidisciplinary hypertension clinic staffed by nephrologist, endocrinologist and cardiologist, which manages patients with suspected secondary hypertension and/or apparent treatment-resistant hypertension. The aim of this study is to provide the evidence required to inform policy and planning care pathways for this patient group.
    Methods: A cost analysis from a healthcare provider perspective using micro-costing techniques was conducted to estimate the direct implementation costs of existing standard practice for the care pathway of patients attending the multidisciplinary hypertension clinic. Sixty-five patients originally recruited for a study of medication adherence in hypertension were included in the sample.
    Results: The total care-pathway cost per patient, taking into account clinic visits, clinical reviews, investigations and MDT discussion, was estimated to be €3277, on average. For the patient subgroups, the average cost was €5644 for patients diagnosed with primary aldosteronism and €1446 for patients diagnosed with essential hypertension.
    Conclusion: There is significant cost associated with providing specialized hypertension care for patients with apparent treatment-resistant hypertension. Given the high rates of nonadherence in this population, it is likely that some of this cost could be avoided with better detection and management of medication adherence in this challenging population. Future studies should consider the cost-effectiveness of this or similar models of care by exploring the benefit to patients and the wider healthcare context of providing care of this type.
    MeSH term(s) Humans ; Costs and Cost Analysis ; Hypertension/drug therapy ; Ambulatory Care ; Medication Adherence
    Language English
    Publishing date 2023-11-16
    Publishing country Netherlands
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 605532-1
    ISSN 1473-5598 ; 0263-6352 ; 0952-1178
    ISSN (online) 1473-5598
    ISSN 0263-6352 ; 0952-1178
    DOI 10.1097/HJH.0000000000003535
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Zs.A 1885: Show issues Location:
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  2. Article ; Online: Prospective randomised phase II trial evaluating adjuvant pelvic radiotherapy using either IMRT or 3-Dimensional planning for endometrial cancer.

    Nugent, Killian / Browne, Darragh / Dunne, Mary / O Sullivan, Lydia / Shannon, Aoife M / Sharma, Deepti / Bradshaw, Shirley / McArdle, Orla / Salib, Osama / Lavan, Naomi / Gillham, Charles

    Acta oncologica (Stockholm, Sweden)

    2023  Volume 62, Issue 8, Page(s) 907–914

    Abstract: Objective: To compare the incidence of grade ≥2 gastrointestinal (GI) or genitourinary (GU) toxicity for patients undergoing 3DRT versus IMRT in the postoperative setting for endometrial cancer.: Methods: Eligible patients were post-operatively ... ...

    Abstract Objective: To compare the incidence of grade ≥2 gastrointestinal (GI) or genitourinary (GU) toxicity for patients undergoing 3DRT versus IMRT in the postoperative setting for endometrial cancer.
    Methods: Eligible patients were post-operatively randomly assigned to one of two parallel groups in a 1:1 ratio, to have their RT delivered using either a 3DRT technique or using IMRT. The prescription dose was 45 Gy in 25 fractions over 5 weeks followed by vaginal vault brachytherapy. Toxicity was graded according to National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version (v) 3.0. Fisher's exact tests were used to test for associations between toxicity and arm. Differences in dosimetric parameters for patients with or without toxicity were tested using Mann-Whitney
    Results: 84 patients with a median age of 62 were evaluable for primary outcome. The median follow-up was 52 months. 14 (35%) participants from the 3DRT arm and 15 (34%) from the IMRT arm experienced acute grade ≥2 GI toxicity with older patients having a statistically higher risk of grade ≥2 acute GI toxicity. 20 (50%) participants from the 3DRT arm and 25 (57%) from the IMRT arm experienced acute grade ≥2 GI or GU toxicity (
    Conclusion: Although IMRT can reduce dose to normal tissue, in this study no benefit in acute GI or GU toxicity outcome was seen.
    MeSH term(s) Female ; Humans ; Radiotherapy, Intensity-Modulated/adverse effects ; Radiotherapy, Intensity-Modulated/methods ; Prospective Studies ; Pelvis ; Endometrial Neoplasms/radiotherapy ; Endometrial Neoplasms/surgery ; Gastrointestinal Tract ; Radiotherapy Dosage
    Language English
    Publishing date 2023-07-26
    Publishing country England
    Document type Randomized Controlled Trial ; Clinical Trial, Phase II ; Journal Article
    ZDB-ID 896449-x
    ISSN 1651-226X ; 0349-652X ; 0284-186X ; 1100-1704
    ISSN (online) 1651-226X
    ISSN 0349-652X ; 0284-186X ; 1100-1704
    DOI 10.1080/0284186X.2023.2238555
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  3. Article ; Online: Likelihood of Irish university students adhering to recommended preventive measures during travel.

    Flaherty, Gerard / Browne, Darragh / Cooke, Regina

    Travel medicine and infectious disease

    2015  Volume 13, Issue 6, Page(s) 501–502

    MeSH term(s) Attitude to Health ; Cross-Sectional Studies ; Female ; Humans ; Ireland ; Male ; Risk Factors ; Students/psychology ; Surveys and Questionnaires ; Travel ; Universities
    Language English
    Publishing date 2015-11
    Publishing country Netherlands
    Document type Letter
    ZDB-ID 2170891-5
    ISSN 1873-0442 ; 1477-8939
    ISSN (online) 1873-0442
    ISSN 1477-8939
    DOI 10.1016/j.tmaid.2015.08.005
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    Zs.A 6236: Show issues Location:
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  4. Article ; Online: Major disparities in patient-reported adherence compared to objective assessment of adherence using mass spectrometry: A prospective study in a tertiary-referral hypertension clinic.

    Curneen, James M G / Rabbitt, Louise / Browne, Darragh / O'Donoghue, Darragh F / Alansari, Yousef / Harhen, Brendan / Ní Ghríofa, Ailbhe / Ferguson, John / McEvoy, John William / Lappin, David / Finn, David P / O'Shea, Paula M / Dennedy, Michael Conall

    British journal of clinical pharmacology

    2022  Volume 89, Issue 7, Page(s) 1948–1955

    Abstract: Aim: Many challenges exist in determining true rates of adherence to antihypertensive medications among individuals in a clinic setting. For the first time, we aimed to compare patient-reported antihypertensive adherence with objective evidence using ... ...

    Abstract Aim: Many challenges exist in determining true rates of adherence to antihypertensive medications among individuals in a clinic setting. For the first time, we aimed to compare patient-reported antihypertensive adherence with objective evidence using mass spectrometry spot urinalysis in a tertiary referral clinic setting.
    Methods: A prospective observational single-centre cohort study was performed in a tertiary referral hypertension clinic, encompassing antihypertensive initiation and persistence. Patients were referred with apparent treatment-resistant hypertension or for suspected secondary causes. Participants completed a self-reported assessment of antihypertensive adherence and provided a spot urine sample. The presence of antihypertensive medications and/or their respective metabolites was evaluated using high-performance liquid chromatography tandem mass spectrometry. Patients were determined to be adherent if they demonstrated both self-reported adherence and objective mass spectrometry evidence.
    Results: Of all 105 eligible participants initially recruited, 73 (69.5%) met the eligibility criteria. Only 27.4% (95% confidence interval 0.2-0.4) of participants demonstrated true adherence to their self-reported antihypertensives, despite 75.3% (0.6-0.8) reporting adherence. Greatest medication adherence was achieved with angiotensin II receptor blockers (61%), with calcium-channel blockers and mineralocorticoid antagonists demonstrating least adherence (38%).
    Conclusion: In patients attending a tertiary hypertension clinic, the combined use of spot urine mass spectrometry and self-reporting identifies higher rates of nonadherence when compared to either modality alone. Both techniques should be combined for more accurate detection of medication adherence.
    MeSH term(s) Humans ; Antihypertensive Agents/therapeutic use ; Prospective Studies ; Cohort Studies ; Hypertension/diagnosis ; Hypertension/drug therapy ; Medication Adherence ; Mass Spectrometry ; Referral and Consultation ; Patient Reported Outcome Measures
    Chemical Substances Antihypertensive Agents
    Language English
    Publishing date 2022-03-25
    Publishing country England
    Document type Observational Study ; Journal Article
    ZDB-ID 188974-6
    ISSN 1365-2125 ; 0306-5251 ; 0264-3774
    ISSN (online) 1365-2125
    ISSN 0306-5251 ; 0264-3774
    DOI 10.1111/bcp.15292
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Zs.A 1118: Show issues Location:
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  5. Article ; Online: 11

    O'Shea, Paula M / O'Donoghue, Darragh / Bashari, Waiel / Senanayake, Russell / Joyce, Mary B / Powlson, Andrew S / Browne, Darragh / O'Sullivan, Gerard J / Cheow, Heok / Mendichovszky, Iosif / Quill, Denis / Lowery, Aoife / Lappin, David / Gurnell, Mark / Dennedy, Michael C

    Clinical endocrinology

    2019  Volume 90, Issue 5, Page(s) 670–679

    Abstract: Objective: To describe clinical practice experience of : Context: Accurate lateralization of APA in the setting of PA offers the potential for surgical cure and improved long-term cardiovascular outcomes. Challenges associated with AVS, the current ... ...

    Abstract Objective: To describe clinical practice experience of
    Context: Accurate lateralization of APA in the setting of PA offers the potential for surgical cure and improved long-term cardiovascular outcomes. Challenges associated with AVS, the current gold standard lateralization modality, mean that only a small proportion of potentially eligible patients currently make it through to surgery. This has prompted consideration of alternative strategies for lateralization, including the application of novel molecular PET tracers such as
    Design: Clinical Service Evaluation/Retrospective audit.
    Patients: Fifteen individuals with a confirmed diagnosis of PA, undergoing lateralization with
    Measurements: All patients underwent screening aldosterone renin ratio (ARR), followed by confirmatory testing with the seated saline infusion test, according to Endocrine Society Clinical Practice Guidelines. Adrenal glands were imaged using dedicated adrenal CT.
    Results: We describe the individual lateralization and clinical outcomes for 15 patients with PA.
    Conclusion: 11
    MeSH term(s) Adult ; Clinical Decision-Making ; Etomidate/analogs & derivatives ; Humans ; Hyperaldosteronism/diagnosis ; Hyperaldosteronism/drug therapy ; Hyperaldosteronism/surgery ; Hyperaldosteronism/therapy ; Positron Emission Tomography Computed Tomography ; Radiopharmaceuticals
    Chemical Substances Radiopharmaceuticals ; metomidate (Z18ZYL8Y51) ; Etomidate (Z22628B598)
    Language English
    Publishing date 2019-03-18
    Publishing country England
    Document type Journal Article
    ZDB-ID 121745-8
    ISSN 1365-2265 ; 0300-0664
    ISSN (online) 1365-2265
    ISSN 0300-0664
    DOI 10.1111/cen.13942
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