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Tony Fitzgerald

Publications and source records attributed to Tony Fitzgerald.

5 recordsLinked to original sources
PubMed2006

CD38 expression level and pattern of expression remains a reliable and robust marker of progressive disease in chronic lymphocytic leukemia.

Chronic lymphocytic leukemia (CLL) follows a variable clinical course which is difficult to predict at diagnosis. We assessed somatic mutation (SHM) status, CD38 and ZAP-70 expression in 87 patients (49 male, 38 female) with stage A CLL and known cytogenetic profile to compare their role in predicting disease progression, which was assessed by the treatment free interval (TFI) from diagnosis. Sixty (69%) patients were SHM+, 24 (28%) were CD38+ and ten (12%) were ZAP-70+. The median TFI for: (i) SHM + versus SHM- patients was 124 versus 26 months; hazard ratio (HR) = 3.6 [95% confidence interval (CI) = 1.8 - 7.3; P = 0.001]: (ii) CD38- versus CD38+ patients was 120 versus 34 months; HR = 2.4 (95% CI = 1.4 - 5.3; P = 0.02); and (iii) ZAP70- versus ZAP70+ was 120 versus 16 months; HR = 3.4 (95% CI = 1.4 - 8.7; P = 0.01). SHM status and CD38 retained prognostic significance on multivariate analysis whereas ZAP-70 did not. We conclude that ZAP-70 analysis does not provide additional prognostic information in this group of patients.

ADP-ribosyl Cyclase 1↗
PubMed2006

Prehospital care pathway delays: gender and myocardial infarction.

AIM: This paper reports the findings of a study that identified gender specific prehospital care pathway delays amongst Irish women and men with myocardial infarction. BACKGROUND: Women are more likely to experience a poorer prognosis than their male counterparts following hospitalization for myocardial infarction, yet research shows that women continue to experience prehospital care pathway delays. METHODS: A 1-year prospective census was carried in six major academic teaching hospitals in Dublin, Ireland in 2001-2002. A total of 277 (31%) female and 613 (69%) male patients with confirmed myocardial infarction were included in the study. RESULTS: Women were more likely to experience prolonged 'initial symptom-onset to A&E delays' (14 hours vs. 2.8 hours P < 0.0001), and 'intense symptom-onset to A&E delays' (3.1 hours vs. 1.8 hours , P < 0.0001), i.e. arrival at a hospital accident and emergency department. Advancing age was associated with greater prehospital delays (P < 0.0001), whilst patients with private health insurance had shorter delays than public patients (without private health insurance) or those with medical cards (entitling them to means-tested medical benefits) (P = 0.001). Patients who drove themselves by car to hospital had shorter median prehospital times than those arriving by any other admission mode (P < 0.0001), whilst those referred by their general practitioner had longer delays than those who were self-referred (5 hours vs. 1.7 hours, P < 0.0001). CONCLUSIONS: Female gender, advancing age, referral source, insurance status and mode of transport to hospital are independent factors contributing to prehospital patient delays. Nurses who care for patients with coronary artery disease have a unique opportunity to educate people about the most appropriate action to be taken in the event of experiencing symptoms.

Age Factors↗
PubMed2005

In-hospital care pathway delays: gender and myocardial infarction.

AIM: This paper reports the in-hospital findings of a study identifying gender specific care pathway delays or treatment opportunities amongst Irish women and men hospitalized with myocardial infarction. BACKGROUND: Reperfusion therapy is of optimum benefit when administered early, yet research shows that women continue to experience greater in-hospital delays to treatment than men. METHOD: A 1-year prospective census was carried out from December 2001 to November 2002 with 277 (31%) female and 613 (69%) male patients with myocardial infarction who were consecutively admitted to the six major teaching hospitals in Dublin, Ireland. RESULTS: Women experienced greater 'Triage to first medical assessment' delays than men (P=0.001), and waited a median of 30 minutes for their first medical contact, compared with 20 minutes for men (P<0.0001). The median 'door to needle' time for women was 70 minutes in comparison with 52 minutes for men (P=0.02). Women waited longer than men for aspirin (P=0.02), whilst men received a bed in the coronary care unit almost 1 hour sooner than women (P<0.0001). Despite these delays to treatment, women and men experienced similar rates of reperfusion treatment. CONCLUSIONS: In-hospital treatment delays experienced by women may limit their potential to achieve the maximum benefits from reperfusion therapies. Triage nursing provides the first entry point to hospital care for the majority of female patients with myocardial infarction, and therefore Accident and Emergency Department nurses are in an optimum position to influence positively the pathway of care for this group.

Angioplasty, Balloon, Coronary↗