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Mantelakis A, McKean AR, Biju NE, Shet AS, Geh JLC. Evolutions in the use of Integra® and MatriDerm® in excision and reconstruction of cutaneous malignancies. J Plast Reconstr Aesthet Surg 2024; 93:24-27. [PMID: 38608534 DOI: 10.1016/j.bjps.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 03/04/2024] [Accepted: 03/18/2024] [Indexed: 04/14/2024]
Affiliation(s)
- Angelos Mantelakis
- Department of Plastic Surgery, Guy's, King's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, United Kingdom
| | - Andrew R McKean
- Department of Plastic Surgery, Guy's, King's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, United Kingdom
| | - Noel E Biju
- Faculty of Life Sciences and Medicine, School of Medicine, King's College London, Guy's Campus, Great Maze Pond, London SE1 1UL, United Kingdom
| | - Aryan S Shet
- Faculty of Life Sciences and Medicine, School of Medicine, King's College London, Guy's Campus, Great Maze Pond, London SE1 1UL, United Kingdom.
| | - Jenny L C Geh
- Department of Plastic Surgery, Guy's, King's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, United Kingdom
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2
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McKean AR, Attygalle AD, El-Sharkawi D, O'Connell RL, Sharma B, Wotherspoon A, Tasoulis MK, Khan AA. Supra-regional referral centre model for management of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) in the UK. J Plast Reconstr Aesthet Surg 2024; 90:73-75. [PMID: 38364671 DOI: 10.1016/j.bjps.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 02/01/2024] [Indexed: 02/18/2024]
Affiliation(s)
- Andrew R McKean
- Plastic Surgery Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London SW3 6JJ, UK; The Institute of Cancer Research, Fulham Road, London SW3 6JB, UK.
| | - Ayoma D Attygalle
- Haemato-oncology Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London SW3 6JJ, UK; Histopathology Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London SW3 6JJ, UK
| | - Dima El-Sharkawi
- Haemato-oncology Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London SW3 6JJ, UK
| | - Rachel L O'Connell
- The Institute of Cancer Research, Fulham Road, London SW3 6JB, UK; Breast Surgery Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London SW3 6JJ, UK
| | - Bhupinder Sharma
- The Institute of Cancer Research, Fulham Road, London SW3 6JB, UK; Department of Radiology, The Royal Marsden NHS Foundation Trust, Fulham Road, London SW3 6JJ, UK
| | - Andrew Wotherspoon
- Haemato-oncology Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London SW3 6JJ, UK; Histopathology Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London SW3 6JJ, UK
| | - Marios-Konstantinos Tasoulis
- The Institute of Cancer Research, Fulham Road, London SW3 6JB, UK; Breast Surgery Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London SW3 6JJ, UK
| | - Aadil A Khan
- Plastic Surgery Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London SW3 6JJ, UK; The Institute of Cancer Research, Fulham Road, London SW3 6JB, UK
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3
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McKean AR, Williams GJ, Macneal P, Moore LS, Idowu A, Milroy C. Paediatric paronychia: A single centre retrospective, microbiological analysis and national survey. J Plast Reconstr Aesthet Surg 2022; 75:2387-2440. [PMID: 35589547 DOI: 10.1016/j.bjps.2022.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 01/27/2022] [Accepted: 04/12/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Andrew R McKean
- St George's University Hospitals NHS Foundation Trust, Blackshaw Road, London, SW17 0QT, UK.
| | - Georgina J Williams
- St George's University Hospitals NHS Foundation Trust, Blackshaw Road, London, SW17 0QT, UK
| | - Peter Macneal
- St George's University Hospitals NHS Foundation Trust, Blackshaw Road, London, SW17 0QT, UK
| | - Luke Sp Moore
- Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH, UK; North West London Pathology, Imperial College Healthcare NHS Trust, Fulham Palace Road, London, W6 8RF, UK; National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Hammersmith Campus, Du Cane Road, London, W12 0NN, UK
| | - Akinyemi Idowu
- St George's University Hospitals NHS Foundation Trust, Blackshaw Road, London, SW17 0QT, UK
| | - Catherine Milroy
- St George's University Hospitals NHS Foundation Trust, Blackshaw Road, London, SW17 0QT, UK
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Abstract
Increased numbers of adrenaline auto-injectors (AAIs) are in circulation in the UK. The rate of accidental auto-injection injuries has increased during this time. Various treatment strategies are described in the literature. We present the case of a 32-year-old, right-hand-dominant man who sustained an unintentional AAI injury to the volar aspect of his right thumb. On presentation to the emergency department, the thumb was ischaemic. There was no improvement with simple conservative measures (warm soaks). The patient was referred to our tertiary hand surgery service and a digital block using 2% lidocaine promoted reversal of ischaemia within 2 hours with no long-term sequelae. Phentolamine rescue, on standby, was not necessary in this case. In this case report, we highlight the therapeutic challenges associated with managing AAI injury and propose an evidence-based treatment algorithm to prevent risk of severe adverse outcomes such as digital necrosis.
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Affiliation(s)
| | | | - Charles Bain
- Plastic Surgery, Saint Thomas' Hospital, London, UK
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5
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McKean AR, Knox J, Nanidis T, Khan A, Harris P, Ramsey K, James S, Power KT. Reducing postoperative venous thromboembolism in DIEP free flap breast reconstruction: Extended pharmacological thromboprophylaxis within an enhanced recovery programme. J Plast Reconstr Aesthet Surg 2021; 74:2392-2442. [PMID: 33839054 DOI: 10.1016/j.bjps.2021.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 03/11/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Andrew R McKean
- The Royal Marsden NHS Foundation Trust, Fulham Road, London SW3 6JJ, UK
| | - Jon Knox
- The Royal Marsden NHS Foundation Trust, Fulham Road, London SW3 6JJ, UK
| | - Theodore Nanidis
- The Royal Marsden NHS Foundation Trust, Fulham Road, London SW3 6JJ, UK
| | - Aadil Khan
- The Royal Marsden NHS Foundation Trust, Fulham Road, London SW3 6JJ, UK
| | - Paul Harris
- The Royal Marsden NHS Foundation Trust, Fulham Road, London SW3 6JJ, UK
| | - Kelvin Ramsey
- The Royal Marsden NHS Foundation Trust, Fulham Road, London SW3 6JJ, UK
| | - Stuart James
- The Royal Marsden NHS Foundation Trust, Fulham Road, London SW3 6JJ, UK
| | - Kieran T Power
- The Royal Marsden NHS Foundation Trust, Fulham Road, London SW3 6JJ, UK.
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Gallagher M, McKean AR, Macneal P, Rahman S, Geh JLC. A national shortage and increasing demand: Dispersing evidence-based use of hyaluronidase in plastic surgery. J Plast Reconstr Aesthet Surg 2020; 74:1633-1701. [PMID: 33414094 DOI: 10.1016/j.bjps.2020.12.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 12/17/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Michael Gallagher
- Department of Plastic Surgery, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH UK.
| | - Andrew R McKean
- Department of Plastic Surgery, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH UK
| | - Peter Macneal
- Department of Plastic Surgery, St George's Hospital, Blackshaw Road, London, SW17 0QT UK
| | - Shakeel Rahman
- Department of Plastic Surgery, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH UK
| | - Jenny L C Geh
- Department of Plastic Surgery, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH UK
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7
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McKean AR, Assiotis A, Hassan S, Elvey M, Moore LSP, Eckersley R. Cutibacterium (Propionibacterium) acnes Infection of the Native Wrist Joint. J Hand Surg Am 2020; 45:557.e1-557.e5. [PMID: 31585744 DOI: 10.1016/j.jhsa.2019.07.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 03/24/2019] [Accepted: 07/24/2019] [Indexed: 02/02/2023]
Abstract
Cutibacterium (Propionibacterium) acnes (C. acnes, previously known as P. acnes) is an anaerobic organism that commonly colonizes the human skin. After Staphylococcus spp. and Streptococcus spp., it is a common organism associated with deep prosthetic shoulder joint infections. We describe the case of rapidly progressive arthropathy of the native wrist secondary to infection with C. acnes. Diagnosis was made on prolonged enrichment cultures. The patient went on to complete a long-term course of oral sulfamethoxazole-trimethoprim with clinical improvement. To the best of our knowledge, this is the first report in the literature that C. acnes has been the main causative organism implicated in infection of the native wrist joint. It is imperative to request and wait for results of prolonged enrichment cultures to aid microbiological diagnosis in such cases.
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Affiliation(s)
- Andrew R McKean
- Department of Hand Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom.
| | - Angelos Assiotis
- Department of Hand Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - Sami Hassan
- Department of Hand Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - Michael Elvey
- Department of Hand Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - Luke S P Moore
- Department of Microbiology, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom; North West London Pathology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Rupert Eckersley
- Department of Hand Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
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McKean AR, Batten G, Macneal P, Rahman SM, Moore LSP, Horwitz MD. Utilising multiplex PCR technology for rapid microbial diagnosis in hand and upper limb infections. J Plast Reconstr Aesthet Surg 2020; 74:223-243. [PMID: 32527667 PMCID: PMC7247460 DOI: 10.1016/j.bjps.2020.05.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 05/15/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Andrew R McKean
- Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH, UK.
| | - Gemma Batten
- Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - Peter Macneal
- Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH, UK
| | - Shakeel M Rahman
- Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH, UK
| | - Luke S P Moore
- Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH, UK; North West London Pathology, Imperial College Healthcare NHS Trust, Fulham Palace Road, London, W6 8RF, UK; National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Hammersmith Campus, Du Cane Road, London, W12 0NN, UK
| | - Maxim D Horwitz
- Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH, UK
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9
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Gallagher M, McKean AR, McArthur G. Tourniquet use in hand surgery - Is it time to re-inflate the evidence? J Plast Reconstr Aesthet Surg 2019; 73:608-620. [PMID: 31870719 DOI: 10.1016/j.bjps.2019.11.056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 11/22/2019] [Indexed: 11/17/2022]
Affiliation(s)
- Michael Gallagher
- Department of Plastic Surgery, St Thomas' Hospital, Westminster Bridge Road, London SE17EH, United Kingdom
| | - Andrew R McKean
- Department of Plastic Surgery, St Thomas' Hospital, Westminster Bridge Road, London SE17EH, United Kingdom.
| | - Gordon McArthur
- Department of Plastic Surgery, St Thomas' Hospital, Westminster Bridge Road, London SE17EH, United Kingdom
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10
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Thiruchandran G, McKean AR, Rudran B, Imam MA, Yeong K, Hassan A. Improving consent in patients undergoing surgery for fractured neck of femur. Br J Hosp Med (Lond) 2019; 79:284-287. [PMID: 29727232 DOI: 10.12968/hmed.2018.79.5.284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Neck of femur fractures and their subsequent operative fixation are associated with high rates of perioperative morbidity and mortality. Consenting in this setting is suboptimal with the Montgomery court ruling changing the perspective of consent. This quality improvement project assessed the adequacy of consenting against British Orthopaedic Association-endorsed guidance and implemented a series of changes to improve the documentation of risks associated with surgery for fractured neck of femur. Methods Seventy consecutive patients who underwent any operative fixation of a neck of femur fracture were included over a 6-month period at a single centre. Patients unable to consent or without electronic notes were excluded. Consent forms were analysed and the documented potential risks or complications associated with surgery were compared to British Orthopaedic Association-endorsed guidance. A series of changes (using the plan, do study, act (PDSA) approach) was implemented to improve the adequacy of consent. Results Documentation of four out of 12 potential risks or complications was recorded in <50% of cases for patients with intracapsular fractures (n=35), and documentation of seven out of 12 potential risks or complications was recorded in <50% of cases for patients with extracapsular fractures (n=35). Re-audit following raising awareness and attaching consent guidance showed 100% documentation of potential risks or complications in patients with intracapsular and extracapsular fractures (n=70). A neck of femur fracture-specific consent form has been implemented which will hopefully lead to sustained improvement. Conclusions Consenting patients with fractured neck of femur for surgery in the authors' unit was suboptimal when compared to British Orthopaedic Association-endorsed consent guidance. This project has shown that ensuring such guidance is readily available has improved the adequacy of consent. The authors hope that introduction of a neck of femur fracture-specific consent form within their unit will lead to sustained adequate documentation of risks associated with surgery.
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Affiliation(s)
| | - Andrew R McKean
- Core Surgical Trainee, Department of Trauma and Orthopaedics, Ashford and St Peter's Hospitals NHS Foundation Trust, Chertsey, Surrey
| | - Branavan Rudran
- Foundation Year 2 Doctor, Department of Trauma and Orthopaedics, Ashford and St Peter's Hospitals NHS Foundation Trust, Chertsey, Surrey
| | - Mohamed A Imam
- Senior Upper Limb Fellow, Department of Trauma and Orthopaedics, Ashford and St Peter's Hospitals NHS Foundation Trust, Chertsey, Surrey
| | - Keefai Yeong
- Consultant Orthogeriatrician and Quality Improvement Lead, Department of Trauma and Orthopaedics, Ashford and St Peter's Hospitals NHS Foundation Trust, Chertsey, Surrey
| | - Abdel Hassan
- Consultant Orthopaedic Surgeon, Department of Trauma and Orthopaedics, Ashford and St Peter's Hospitals NHS Foundation Trust, Chertsey, Surrey KT16 0QA
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11
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McKean AR, Gallagher M, Elworthy K, Macneal P, Rahman SM, Jones I. Excision and direct closure of burns - A proposed wound follow-up protocol. J Plast Reconstr Aesthet Surg 2019; 72:1418-1433. [PMID: 31029584 DOI: 10.1016/j.bjps.2019.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 04/06/2019] [Indexed: 11/24/2022]
Affiliation(s)
- Andrew R McKean
- Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH United Kingdom.
| | - Michael Gallagher
- Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH United Kingdom
| | - Katherine Elworthy
- Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH United Kingdom
| | - Peter Macneal
- Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH United Kingdom
| | - Shakeel M Rahman
- Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH United Kingdom
| | - Isabel Jones
- Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH United Kingdom
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12
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Welman T, McKean AR, Duggan E, Rahman SM, Moore LSP, Horwitz M. Tetanus 'Quick Stik' - is the NHS missing a trick? Injury 2018; 49:1240-1241. [PMID: 29685702 DOI: 10.1016/j.injury.2018.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 04/14/2018] [Indexed: 02/02/2023]
Affiliation(s)
- T Welman
- Chelsea and Westminster NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH, United Kingdom.
| | - A R McKean
- Chelsea and Westminster NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH, United Kingdom.
| | - E Duggan
- Chelsea and Westminster NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH, United Kingdom.
| | - S M Rahman
- Chelsea and Westminster NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH, United Kingdom.
| | - L S P Moore
- North West London Pathology, Imperial College Healthcare NHS Trust, Fulham Palace Road, London, W6 8RF, United Kingdom; Imperial College London, South Kensington, London, SW7 2AZ, United Kingdom.
| | - M Horwitz
- Chelsea and Westminster NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH, United Kingdom.
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13
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McKean AR, Aggarwal D, Torres-Grau J, Welman T, Moore LSP, Jones I. Is flucloxacillin monotherapy sufficient for the treatment of skin and soft tissue infections in plastic surgery? J Plast Reconstr Aesthet Surg 2018; 71:919-920. [PMID: 29477266 DOI: 10.1016/j.bjps.2018.01.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 01/31/2018] [Indexed: 10/18/2022]
Affiliation(s)
- Andrew R McKean
- Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH, United Kingdom.
| | - Dinesh Aggarwal
- Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH, United Kingdom; North West London Pathology, Imperial College Healthcare NHS Trust, Fulham Palace Road, London, W6 8RF, United Kingdom
| | - Jana Torres-Grau
- Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH, United Kingdom
| | - Ted Welman
- Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH, United Kingdom
| | - Luke S P Moore
- Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH, United Kingdom; North West London Pathology, Imperial College Healthcare NHS Trust, Fulham Palace Road, London, W6 8RF, United Kingdom; Imperial College London, South Kensington, London, SW7 2AZ, United Kingdom
| | - Isabel Jones
- Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH, United Kingdom
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14
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Kumar S, McKean AR, Ramwell A, Johnston C, Leaver S. Optimizing postoperative handover to the intensive care unit at a tertiary centre. Br J Hosp Med (Lond) 2017; 78:12-15. [DOI: 10.12968/hmed.2017.78.1.12] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Shankar Kumar
- Academic Foundation Year 1 Doctor, General Intensive Care Unit, St George's University Hospitals NHS Foundation Trust, London
| | - Andrew R McKean
- Foundation Year 1 Doctor, General Intensive Care Unit, St George's University Hospitals NHS Foundation Trust, London SW17 0QT
| | - Andrew Ramwell
- Consultant Colorectal Surgeon, Department of Colorectal Surgery, St George's University Hospitals NHS Foundation Trust, London
| | - Carolyn Johnston
- Consultant Anaesthetist and National Emergency Laparotomy Quality Improvement Lead, Department of Anaesthesia, St George's University Hospitals NHS Foundation Trust, London
| | - Susannah Leaver
- Consultant in Intensive Care, Respiratory and General Medicine, General Intensive Care Unit, St George's University Hospitals NHS Foundation Trust, London
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15
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Cannon JA, McKean AR, Jhund PS, McMurray JJV. What can we learn from RELAX-AHF compared to previous AHF trials and what does the future hold? Open Heart 2015; 2:e000283. [PMID: 26719808 PMCID: PMC4692046 DOI: 10.1136/openhrt-2015-000283] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 09/06/2015] [Accepted: 10/13/2015] [Indexed: 01/08/2023] Open
Abstract
Each year in the USA there are over 1 million hospital admissions directly related to heart failure (HF). With similar rates across Europe, this places a huge economic burden on healthcare systems globally. Hospitalisation for HF is associated with poor clinical outcomes with 25% of patients being readmitted with signs and symptoms of HF within 1 month of discharge and 10-20% dying in the 6 months after discharge. Although hospital admission could be a sign of disease progression, it is also possible that some of the treatments given acutely for example, inotropic therapy, may result in neurohormonal, haemodynamic and other effects accelerating end-organ damage and contributing to these poor outcomes after discharge. In contrast to the treatment of chronic heart failure (CHF), clinical trials conducted over the past decade in patients with acute HF (AHF) have failed to show significant reductions in morbidity or mortality despite some agents causing beneficial changes in symptoms. As such, the current treatment of patients hospitalised with HF is mainly based on consensus rather than clinical evidence and has changed little over time. We review RELAX-AHF in the context of the other key, large-scale AHF trials conducted over the past 15 years and compare and contrast study design and outcomes in an attempt to determine which factors might be associated with a successful trial in the future.
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Affiliation(s)
- Jane A Cannon
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow , Glasgow , UK
| | - Andrew R McKean
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow , Glasgow , UK
| | - Pardeep S Jhund
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow , Glasgow , UK
| | - John J V McMurray
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow , Glasgow , UK
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16
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Affiliation(s)
- Ross T Campbell
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
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