1
|
Girach Z, Sarian A, Maldonado-García C, Ravikumar N, Sergouniotis PI, Rothwell PM, Frangi AF, Julian TH. Retinal imaging for the assessment of stroke risk: a systematic review. J Neurol 2024; 271:2285-2297. [PMID: 38430271 PMCID: PMC11055692 DOI: 10.1007/s00415-023-12171-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 12/21/2023] [Accepted: 12/23/2023] [Indexed: 03/03/2024]
Abstract
BACKGROUND Stroke is a leading cause of morbidity and mortality. Retinal imaging allows non-invasive assessment of the microvasculature. Consequently, retinal imaging is a technology which is garnering increasing attention as a means of assessing cardiovascular health and stroke risk. METHODS A biomedical literature search was performed to identify prospective studies that assess the role of retinal imaging derived biomarkers as indicators of stroke risk. RESULTS Twenty-four studies were included in this systematic review. The available evidence suggests that wider retinal venules, lower fractal dimension, increased arteriolar tortuosity, presence of retinopathy, and presence of retinal emboli are associated with increased likelihood of stroke. There is weaker evidence to suggest that narrower arterioles and the presence of individual retinopathy traits such as microaneurysms and arteriovenous nicking indicate increased stroke risk. Our review identified three models utilizing artificial intelligence algorithms for the analysis of retinal images to predict stroke. Two of these focused on fundus photographs, whilst one also utilized optical coherence tomography (OCT) technology images. The constructed models performed similarly to conventional risk scores but did not significantly exceed their performance. Only two studies identified in this review used OCT imaging, despite the higher dimensionality of this data. CONCLUSION Whilst there is strong evidence that retinal imaging features can be used to indicate stroke risk, there is currently no predictive model which significantly outperforms conventional risk scores. To develop clinically useful tools, future research should focus on utilization of deep learning algorithms, validation in external cohorts, and analysis of OCT images.
Collapse
Affiliation(s)
- Zain Girach
- Sheffield Medical School, University of Sheffield, Beech Hill Rd, Broomhall, Sheffield, UK
| | - Arni Sarian
- Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Oxford Rd, Manchester, UK
| | - Cynthia Maldonado-García
- Centre for Computational Imaging and Simulation Technologies in Biomedicine, School of Computing, University of Leeds, Leeds, UK
| | - Nishant Ravikumar
- Centre for Computational Imaging and Simulation Technologies in Biomedicine, School of Computing, University of Leeds, Leeds, UK
| | - Panagiotis I Sergouniotis
- Division of Evolution, Infection and Genomics, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- European Molecular Biology Laboratory, European Bioinformatics Institute (EMBL-EBI), Wellcome Genome Campus, Hinxton, UK
- Manchester Centre for Genomic Medicine, Saint Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
- Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Oxford Rd, Manchester, UK
| | - Peter M Rothwell
- Wolfson Centre for the Prevention of Stroke and Dementia, University of Oxford, Oxford, UK
| | - Alejandro F Frangi
- Division of Informatics, Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- School of Computer Science, Faculty of Science and Engineering, University of Manchester, Kilburn Building, Manchester, UK
- Christabel Pankhurst Institute, The University of Manchester, Manchester, UK
| | - Thomas H Julian
- Division of Evolution, Infection and Genomics, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
- European Molecular Biology Laboratory, European Bioinformatics Institute (EMBL-EBI), Wellcome Genome Campus, Hinxton, UK.
- Manchester Centre for Genomic Medicine, Saint Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK.
- Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Oxford Rd, Manchester, UK.
| |
Collapse
|
2
|
Arestakesyan H, LeFevre N, Posnack N, Sarian A, Grigoryan V, Ayvazyan N, Voskanyan A, Sarvazyan N, Karabekian Z. Changes in attachment and metabolic activity of rat neonatal cardiomyocytes and nonmyocytes caused by Macrovipera lebetina obtusa venom. Toxicol In Vitro 2024; 95:105755. [PMID: 38061605 DOI: 10.1016/j.tiv.2023.105755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 11/03/2023] [Accepted: 11/30/2023] [Indexed: 12/17/2023]
Abstract
The Caucasian viper Macrovipera lebetina obtusa (MLO) is one of the most prevalent and venomous snakes in the Caucasus and the surrounding regions, yet the effects of MLO venom on cardiac function remain largely unknown. We examined the influence of MLO venom (crude and with inhibited metalloproteinases and phospholipase A2) on attachment and metabolic activity of rat neonatal cardiomyocytes (CM) and nonmyocytes (nCM), assessed at 1 and 24 h. After exposing both CM and nCM to varying concentrations of MLO venom, we observed immediate cytotoxic effects at a concentration of 100 μg/ml, causing detachment from the culture substrate. At lower MLO venom concentrations both cell types detached in a dose-dependent manner. Inhibition of MLO venom metalloproteinases significantly improved CM and nCM attachment after 1-hour exposure. At 24-hour exposure to metalloproteinases inhibited venom statistically significant enhancement was observed only in nCM attachment. However, metabolic activity of CM and nCM did not decrease upon exposure to the lower dose of the venom. Moreover, we demonstrated that metalloproteinases and phospholipases A2 are not the components of the MLO venom that change metabolic activity of both CM and nCM. These results provide a valuable platform to study the impact of MLO venom on prey cardiac function. They also call for further exploration of individual venom components for pharmaceutical purposes.
Collapse
Affiliation(s)
- Hovhannes Arestakesyan
- Orbeli Institute of Physiology, National Academy of Sciences, 22 Orbeli Bros. St., Yerevan 0028, Armenia; Department of Pharmacology and Physiology, School of Medicine and Health Sciences, The George Washington University, Washington, DC 20037, USA
| | - Narine LeFevre
- Department of Pharmacology and Physiology, School of Medicine and Health Sciences, The George Washington University, Washington, DC 20037, USA
| | - Nikki Posnack
- Department of Pharmacology and Physiology, School of Medicine and Health Sciences, The George Washington University, Washington, DC 20037, USA; Children's National Heart Institute, Sheikh Zayed Institute of Pediatric Surgical Innovation, Washington, DC 20010, USA
| | - Arni Sarian
- Orbeli Institute of Physiology, National Academy of Sciences, 22 Orbeli Bros. St., Yerevan 0028, Armenia
| | - Vahan Grigoryan
- Orbeli Institute of Physiology, National Academy of Sciences, 22 Orbeli Bros. St., Yerevan 0028, Armenia
| | - Naira Ayvazyan
- Orbeli Institute of Physiology, National Academy of Sciences, 22 Orbeli Bros. St., Yerevan 0028, Armenia
| | - Armen Voskanyan
- Orbeli Institute of Physiology, National Academy of Sciences, 22 Orbeli Bros. St., Yerevan 0028, Armenia
| | - Narine Sarvazyan
- Orbeli Institute of Physiology, National Academy of Sciences, 22 Orbeli Bros. St., Yerevan 0028, Armenia; Department of Pharmacology and Physiology, School of Medicine and Health Sciences, The George Washington University, Washington, DC 20037, USA
| | - Zaruhi Karabekian
- Orbeli Institute of Physiology, National Academy of Sciences, 22 Orbeli Bros. St., Yerevan 0028, Armenia; Department of Pharmacology and Physiology, School of Medicine and Health Sciences, The George Washington University, Washington, DC 20037, USA.
| |
Collapse
|
3
|
Gordon M, Sinopoulou V, Akobeng AK, Sarian A, Moran GW. Infliximab for maintenance of medically-induced remission in Crohn's disease. Cochrane Database Syst Rev 2024; 2:CD012609. [PMID: 38372447 PMCID: PMC10875719 DOI: 10.1002/14651858.cd012609.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
BACKGROUND Infliximab is a monoclonal antibody that binds and neutralises tumour necrosis factor-alpha (TNF-α) which is present in high levels in the blood serum, mucosa and stool of patients with Crohn's disease. OBJECTIVES To determine the efficacy and safety of infliximab for maintaining remission in patients with Crohn's disease. SEARCH METHODS On 31 August, 2021 and 23 June, 2023, we searched CENTRAL, Embase, MEDLINE, ClinicalTrials.gov, and WHO ICTRP. SELECTION CRITERIA Randomised controlled trials (RCTs) in which infliximab was compared to placebo or another active comparator for maintenance, remission, or response in patients with Crohn's disease. DATA COLLECTION AND ANALYSIS Pairs of review authors independently selected studies and conducted data extraction and risk of bias assessment. We expressed outcomes as risk ratios and mean differences with 95% confidence intervals. We assessed the certainty of the evidence using GRADE. Our primary outcome was clinical relapse. Secondary outcomes were loss of clinical response, endoscopic relapse, and withdrawal due to serious and adverse events. MAIN RESULTS Nine RCTs with 1257 participants were included. They were conducted between 1999 and 2022; seven RCTs included biologically-naive patients, and the remaining two included a mix of naive/not naive patients. Three studies included patients in clinical remission, five included patients with a mix of activity scores, and one study included biologic responders with active disease at baseline. All studies allowed some form of concomitant medication during their duration. One study exclusively included patients with fistulating disease. The age of the participants ranged from 18 to 69 years old. All but one single-centre RCT were multicentre RCTs. Four studies were funded by pharmaceutical companies, two had a mix of commercial and public funding, and two had public funding. Infliximab is probably superior to placebo in preventing clinical relapse in patients who have mixed levels of clinical disease activity at baseline, and are not naive to biologics (56% vs 75%, RR 0.73, 95% CI 0.63 to 0.84, NNTB = 5, moderate-certainty evidence). We cannot draw any conclusions on loss of clinical response (RR 0.59, 95% CI 0.37 to 0.96), withdrawals due to adverse events (RR 0.66, 95% CI 0.37 to 1.19), or serious adverse events (RR 0.60, 95% CI 0.36 to 1.00) because the evidence is very low certainty. Infliximab combined with purine analogues is probably superior to purine analogues for clinical relapse (12% vs 59%, RR 0.20, 95% CI 0.10 to 0.42, NNTB = 2, moderate-certainty evidence), for patients in remission, and who are not naive to biologics. We cannot draw any conclusions on withdrawals due to adverse events (RR 0.47, 95% CI 0.15 to 1.49), and serious adverse events (RR 1.19, 95% CI 0.54 to 2.64) because the evidence is very low certainty. We cannot draw any conclusions about the effects of infliximab on serious adverse events compared to purine analogues (RR 0.79, 95% CI 0.37 to 1.68) for a population in remission at baseline because the evidence is very low certainty. There was no evidence available for the outcomes of clinical relapse, loss of clinical response, and withdrawal due to adverse events. Infliximab may be equivalent to biosimilar for clinical relapse (47% vs 40% RR 1.18, 95% CI 0.82 to 1.69), and it may be slightly less effective in averting loss of clinical response (49% vs 32%, RR 1.50, 95% CI 1.01 to 2.23, low-certainty evidence), for a population with mixed/low disease activity at baseline. Infliximab may be less effective than biosimilar in averting withdrawals due to adverse events (27% vs 0%, RR 20.73, 95% CI 2.86 to 150.33, low-certainty evidence). Infliximab may be equivalent to biosimilar for serious adverse events (10% vs 10%, RR 0.99, 95% CI 0.39 to 2.50, low-certainty evidence). We cannot draw any conclusions on the effects of subcutaneous biosimilar compared with intravenous biosimilar on clinical relapse (RR 1.01, 95% CI 0.65 to 1.57), loss of clinical response (RR 0.94, 95% CI 0.70 to 1.25), and withdrawals due to adverse events (RR 0.77, 95% CI 0.30 to 1.97) for an active disease population with clinical response at baseline because the evidence is of very low certainty. We cannot draw any conclusions on the effects of infliximab compared to adalimumab on loss of clinical response (RR 0.68, 95% CI 0.29 to 1.59), withdrawals due to adverse events (RR 0.10, 95% CI 0.01 to 0.72), serious adverse events (RR 0.09, 95% CI 0.01 to 1.54) for an active disease population with clinical response at baseline because the evidence is of very low certainty. There was no evidence available for the outcome of clinical relapse. AUTHORS' CONCLUSIONS Infliximab is probably more effective in preventing clinical relapse than placebo (moderate-certainty evidence). Infliximab in combination with purine analogues is probably more effective in preventing clinical and endoscopic relapse than purine analogues alone (moderate-certainty evidence). No conclusions can be drawn regarding prevention of loss of clinical response, occurrence of withdrawals due to adverse events, or total adverse events due to very low-certainty evidence for both of these comparisons. There may be little or no difference in prevention of clinical relapse, withdrawal due to adverse events or total adverse events between infliximab and a biosimilar (low-certainty evidence). Infliximab may lead to more loss of clinical response than a biosimilar (low-certainty evidence). We were unable to draw meaningful conclusions about other comparisons and outcomes related to missing data or very low-certainty evidence due to serious concerns about imprecision and risk of bias. Further research should focus on comparisons with other active therapies for maintaining remission, as well as ensuring adequate power calculations and reporting of methods.
Collapse
Affiliation(s)
- Morris Gordon
- School of Medicine, University of Central Lancashire, Preston, UK
| | | | - Anthony K Akobeng
- Pediatric Gastroenterology, Sidra Medicine, Doha, Qatar
- Weill Cornell Medicine, Cornell University, Doha, Qatar
| | - Arni Sarian
- School of Medicine, University of Central Lancashire, Preston, UK
| | - Gordon William Moran
- National Institute of Health Research Nottingham Biomedical Research Centre, University of Nottingham and Nottingham University Hospitals, Nottingham, UK
| |
Collapse
|
4
|
Neal S, Stone L, Moncrieff G, Matthews Z, Kingdon C, Topalidou A, Balaam MC, Cordey S, Crossland N, Feeley C, Powney D, Sarian A, Fenton A, Heazell AEP, de Jonge A, Severns A, Thomson G, Downe S. Assessing safe and personalised maternity and neonatal care through a pandemic: a case study of outcomes and experiences in two trusts in England using the ASPIRE COVID-19 framework. BMC Health Serv Res 2023; 23:675. [PMID: 37349751 DOI: 10.1186/s12913-023-09669-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 06/07/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has resulted in profound and far-reaching impacts on maternal and newborn care and outcomes. As part of the ASPIRE COVID-19 project, we describe processes and outcome measures relating to safe and personalised maternity care in England which we map against a pre-developed ASPIRE framework to establish the potential impact of the COVID-19 pandemic for two UK trusts. METHODS We undertook a mixed-methods system-wide case study using quantitative routinely collected data and qualitative data from two Trusts and their service users from 2019 to 2021 (start and completion dates varied by available data). We mapped findings to our prior ASPIRE conceptual framework that explains pathways for the impact of COVID-19 on safe and personalised care. RESULTS The ASPIRE framework enabled us to develop a comprehensive, systems-level understanding of the impact of the pandemic on service delivery, user experience and staff wellbeing, and place it within the context of pre-existing challenges. Maternity services experienced some impacts on core service coverage, though not on Trust level clinical health outcomes (with the possible exception of readmissions in one Trust). Both users and staff found some pandemic-driven changes challenging such as remote or reduced antenatal and community postnatal contacts, and restrictions on companionship. Other key changes included an increased need for mental health support, changes in the availability and uptake of home birth services and changes in induction procedures. Many emergency adaptations persisted at the end of data collection. Differences between the trusts indicate complex change pathways. Staff reported some removal of bureaucracy, which allowed greater flexibility. During the first wave of COVID-19 staffing numbers increased, resolving some pre-pandemic shortages: however, by October 2021 they declined markedly. Trying to maintain the quality and availability of services had marked negative consequences for personnel. Timely routine clinical and staffing data were not always available and personalised care and user and staff experiences were poorly captured. CONCLUSIONS The COVID-19 crisis magnified pre-pandemic problems and in particular, poor staffing levels. Maintaining services took a significant toll on staff wellbeing. There is some evidence that these pressures are continuing. There was marked variation in Trust responses. Lack of accessible and timely data at Trust and national levels hampered rapid insights. The ASPIRE COVID-19 framework could be useful for modelling the impact of future crises on routine care.
Collapse
Affiliation(s)
- Sarah Neal
- Department of Social Statistics and Demography, University of Southampton, Southampton, UK.
| | - Lucy Stone
- Faculty of Medicine, Health & Life Sciences, Swansea University Medical School, Swansea University, Swansea, UK
| | - Gill Moncrieff
- ReaCH Group, School of Community Health and Midwifery, Faculty of Health and Care, University of Central Lancashire, Preston, UK
| | - Zoë Matthews
- Department of Social Statistics and Demography, University of Southampton, Southampton, UK
| | - Carol Kingdon
- ReaCH Group, School of Community Health and Midwifery, Faculty of Health and Care, University of Central Lancashire, Preston, UK
| | - Anastasia Topalidou
- ReaCH Group, School of Community Health and Midwifery, Faculty of Health and Care, University of Central Lancashire, Preston, UK
| | - Marie-Clare Balaam
- ReaCH Group, School of Community Health and Midwifery, Faculty of Health and Care, University of Central Lancashire, Preston, UK
| | - Sarah Cordey
- ReaCH Group, School of Community Health and Midwifery, Faculty of Health and Care, University of Central Lancashire, Preston, UK
| | - Nicola Crossland
- MAINN Group, School of Community Health and Midwifery, Faculty of Health and Care, University of Central Lancashire, Preston, UK
| | - Claire Feeley
- Nursing, Midwifery & Palliative Care, Methodologies Division, King's College London, London, UK
| | - Deborah Powney
- School of Justice, University of Central Lancashire, Preston, PR1, UK
| | - Arni Sarian
- School of Medicine, University of Central Lancashire, Preston, UK
| | - Alan Fenton
- Newcastle Neonatal Service, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Alexander E P Heazell
- Maternal and Fetal Health Research Centre, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Ank de Jonge
- Department of Midwifery Science, AVAG/Amsterdam Public Health, Amsterdam University Medical Centre, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | | | - Gill Thomson
- MAINN Group, School of Community Health and Midwifery, Faculty of Health and Care, University of Central Lancashire, Preston, UK
| | - Soo Downe
- ReaCH Group, School of Community Health and Midwifery, Faculty of Health and Care, University of Central Lancashire, Preston, UK
| |
Collapse
|
5
|
van den Berg LMM, Balaam MC, Nowland R, Moncrieff G, Topalidou A, Thompson S, Thomson G, de Jonge A, Downe S, Ellison G, Fenton A, Heazell A, de Jonge A, Kingdon C, Matthews Z, Severns A, Thomson G, Topalidou A, Wright A, Akooji N, Balaam MC, Cull J, van den Berg L, Crossland N, Feeley C, Franso B, Heys S, Moncrief G, Nowland R, Sarian A, Booker M, Sandall J, Thornton J, Lynskey-Wilkie T, Wilson V, Abe R, Awe T, Adeyinka T, Bender-Atik R, Brigante L, Brione R, Cadée F, Duff E, Draycott T, Fisher D, Francis A, Franx A, Erasmus M, Frith L, Griew L, Harmer C, Homer C, Knight M, Mansfield A, Marlow N, Mcaree T, Monteith D, Reed K, Richens Y, Rocca-Ihenacho L, Ross-Davie M, Talbot S, Taylor M, Treadwell M. The United Kingdom and the Netherlands maternity care responses to COVID-19: A comparative study. Women Birth 2023; 36:127-135. [PMID: 35422406 PMCID: PMC8979792 DOI: 10.1016/j.wombi.2022.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 02/17/2022] [Accepted: 03/31/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND The national health care response to coronavirus (COVID-19) has varied between countries. The United Kingdom (UK) and the Netherlands (NL) have comparable maternity and neonatal care systems, and experienced similar numbers of COVID-19 infections, but had different organisational responses to the pandemic. Understanding why and how similarities and differences occurred in these two contexts could inform optimal care in normal circumstances, and during future crises. AIM To compare the UK and Dutch COVID-19 maternity and neonatal care responses in three key domains: choice of birthplace, companionship, and families in vulnerable situations. METHOD A multi-method study, including documentary analysis of national organisation policy and guidance on COVID-19, and interviews with national and regional stakeholders. FINDINGS Both countries had an infection control focus, with less emphasis on the impact of restrictions, especially for families in vulnerable situations. Differences included care providers' fear of contracting COVID-19; the extent to which community- and personalised care was embedded in the care system before the pandemic; and how far multidisciplinary collaboration and service-user involvement were prioritised. CONCLUSION We recommend that countries should 1) make a systematic plan for crisis decision-making before a serious event occurs, and that this must include authentic service-user involvement, multidisciplinary collaboration, and protection of staff wellbeing 2) integrate women's and families' values into the maternity and neonatal care system, ensuring equitable inclusion of the most vulnerable and 3) strengthen community provision to ensure system wide resilience to future shocks from pandemics, or other unexpected large-scale events.
Collapse
Affiliation(s)
- Lauri M M van den Berg
- Amsterdam University Medical Centre, Vrije Universiteit Amsterdam, Department of Midwifery Science, AVAG/Amsterdam Public Health, The Netherlands.
| | - Marie-Clare Balaam
- School of Community Health and Midwifery, Faculty of Health and Care, University of Central Lancashire, UK
| | - Rebecca Nowland
- School of Community Health and Midwifery, Faculty of Health and Care, University of Central Lancashire, UK
| | - Gill Moncrieff
- School of Community Health and Midwifery, Faculty of Health and Care, University of Central Lancashire, UK
| | - Anastasia Topalidou
- School of Community Health and Midwifery, Faculty of Health and Care, University of Central Lancashire, UK
| | - Suzanne Thompson
- Amsterdam University Medical Centre, Vrije Universiteit Amsterdam, Department of Midwifery Science, AVAG/Amsterdam Public Health, The Netherlands; Research Centre of Midwifery Science Maastricht, Zuyd University, The Netherlands
| | - Gill Thomson
- School of Community Health and Midwifery, Faculty of Health and Care, University of Central Lancashire, UK
| | - Ank de Jonge
- Amsterdam University Medical Centre, Vrije Universiteit Amsterdam, Department of Midwifery Science, AVAG/Amsterdam Reproduction and Development, The Netherlands
| | - Soo Downe
- School of Community Health and Midwifery, Faculty of Health and Care, University of Central Lancashire, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Cordey S, Moncrieff G, Cull J, Sarian A. 'There's only so much you can be pushed': Magnification of the maternity staffing crisis by the 2020/21 COVID-19 pandemic. BJOG 2022; 129:1408-1409. [PMID: 35544311 PMCID: PMC9321880 DOI: 10.1111/1471-0528.17203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 04/25/2022] [Accepted: 04/26/2022] [Indexed: 11/27/2022]
Abstract
This article includes Author Insights, a video abstract available at: https://vimeo.com/bjogabstracts/authorinsights17203
Collapse
Affiliation(s)
- Sarah Cordey
- School of Community Health and Midwifery, THRIVE Centre, University of Central Lancashire, Preston, UK
| | - Gill Moncrieff
- Research in Childbirth and Health Group, THRIVE Centre, University of Central Lancashire, Preston, UK
| | - Joanne Cull
- School of Community Health and Midwifery, THRIVE Centre, University of Central Lancashire, Preston, UK
| | - Arni Sarian
- School of Medicine, University of Central Lancashire, Preston, UK
| | | |
Collapse
|
7
|
Thomson G, Balaam MC, Nowland Harris R, Crossland N, Moncrieff G, Heys S, Sarian A, Cull J, Topalidou A, Downe S. Companionship for women/birthing people using antenatal and intrapartum care in England during COVID-19: a mixed-methods analysis of national and organisational responses and perspectives. BMJ Open 2022; 12:e051965. [PMID: 35017241 PMCID: PMC8753093 DOI: 10.1136/bmjopen-2021-051965] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To explore stakeholders' and national organisational perspectives on companionship for women/birthing people using antenatal and intrapartum care in England during COVID-19, as part of the Achieving Safe and Personalised maternity care In Response to Epidemics (ASPIRE) COVID-19 UK study. SETTING Maternity care provision in England. PARTICIPANTS Interviews were held with 26 national governmental, professional and service-user organisation leads (July-December 2020). Other data included public-facing outputs logged from 25 maternity Trusts (September/October 2020) and data extracted from 78 documents from eight key governmental, professional and service-user organisations that informed national maternity care guidance and policy (February-December 2020). RESULTS Six themes emerged: 'Postcode lottery of care' highlights variations in companionship and visiting practices between trusts/locations, 'Confusion and stress around 'rules'' relates to a lack of and variable information concerning companionship/visiting, 'Unintended consequences' concerns the negative impacts of restricted companionship or visiting on women/birthing people and staff, 'Need for flexibility' highlights concerns about applying companionship and visiting policies irrespective of need, ''Acceptable' time for support' highlights variations in when and if companionship was 'allowed' antenatally and intrapartum and 'Loss of human rights for gain in infection control' emphasises how a predominant focus on infection control was at a cost to psychological safety and human rights. CONCLUSIONS Policies concerning companionship and visiting have been inconsistently applied within English maternity services during the COVID-19 pandemic. In some cases, policies were not justified by the level of risk, and were applied indiscriminately regardless of need. There is an urgent need to determine how to sensitively and flexibly balance risks and benefits and optimise outcomes during the current and future crisis situations.
Collapse
Affiliation(s)
- Gill Thomson
- Maternal and Infant Nutrition & Nurture group, School of Community Health and Midwifery, University of Central Lancashire, Preston, UK
| | - Marie-Claire Balaam
- Research in Childbirth and Health group, School of Community Health and Midwifery, University of Central Lancashire, Preston, UK
| | - Rebecca Nowland Harris
- Maternal and Infant Nutrition & Nurture group, School of Community Health and Midwifery, University of Central Lancashire, Preston, UK
| | - Nicola Crossland
- Maternal and Infant Nutrition & Nurture group, School of Community Health and Midwifery, University of Central Lancashire, Preston, UK
| | - Gill Moncrieff
- Research in Childbirth and Health group, School of Community Health and Midwifery, University of Central Lancashire, Preston, UK
| | | | - Arni Sarian
- School of Medicine, University of Central Lancashire, Preston, UK
| | - Joanne Cull
- Maternal and Infant Nutrition & Nurture group, School of Community Health and Midwifery, University of Central Lancashire, Preston, UK
| | - Anastasia Topalidou
- Research in Childbirth and Health group, School of Community Health and Midwifery, University of Central Lancashire, Preston, UK
| | - Soo Downe
- Research in Childbirth and Health group, School of Community Health and Midwifery, University of Central Lancashire, Preston, UK
| |
Collapse
|
8
|
Sherafat A, Ashraf MA, Ahmadian S, Sarian A, Ramezannezhad E, Foroutan HR, Hiradfar M. P117 Surgical management of Ureteropelvic Junction Obstruction (UPJO) in Neonates amid COVID-19 pandemic; Review of Literature and a Cohort Study in Iran. BJS Open 2021. [PMCID: PMC8030214 DOI: 10.1093/bjsopen/zrab032.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction The current study presents a systematic review of literature on surgical management of ureteropelvic junction obstruction (UPJO) alongside an ongoing cohort study of neonates presenting with high grades of hydronephrosis due to UPJO requiring urgent treatment in a developing country amid the COVID-19 pandemic. The aim of this study is to investigate the efficacy and cost effectiveness of laparoscopic-assisted pyeloplasty. Methods Patients’ demographics, clinical presentations and treatment outcomes are recorded. The cohort is classified into 3 groups based on type of surgical treatment offered including open, laparoscopic and laparoscopic-assisted pyeloplasty. All patients admitted with grade 3-4 hydronephrosis due to UPJO are included. Patients with UPJO as part of a complex multisystemic syndrome are excluded. Literature review was conducted from 2000/1/1 to 2020/1/1 to include all original research papers on surgical management of UPJO. The age group was limited to neonates (under 1 year-old). Results 32 articles were included in the review. 20 papers (62.5%) recommended open pyeloplasty, 10 papers (31.3%) recommended laparoscopic pyeloplasty and 2 papers (6.25%) recommended laparoscopic-assisted pyeloplasty. The cohort study is currently recruiting patients treated by the 3 surgical approaches. Conclusion The majority of studies are focusing on open pyeloplasty. However, as more surgeons are going through the learning curve of laparoscopic pyeloplasty, the trend is towards more laparoscopic management in the future. It is important to discover the advantages of laparoscopic-assisted approach as a new technique to improve the outcome and shorten the hospital stay amid the COVID-19 pandemic.
Collapse
Affiliation(s)
- Alireza Sherafat
- School of Medicine, University of Central Lancashire, Preston, England
| | | | - Sarina Ahmadian
- School of Medicine, University of Central Lancashire, Preston, England
| | - Arni Sarian
- School of Medicine, University of Central Lancashire, Preston, England
| | | | | | - Mehran Hiradfar
- School of Medicine, University of Central Lancashire, Preston, England
| |
Collapse
|
9
|
Lowe A, Sarian A, Russell K, Gibani M, Moore L, Mughal N, Donaldson H. To screen or not to screen? Access Microbiol 2020. [DOI: 10.1099/acmi.fis2019.po0017] [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] [Indexed: 11/18/2022] Open
Affiliation(s)
| | - Arni Sarian
- University of Central Lancashire, Preston, United Kingdom
- Chelsea and Westminster Hospital, London, United Kingdom
| | | | - Malick Gibani
- Chelsea and Westminster Hospital, London, United Kingdom
| | - Luke Moore
- Chelsea and Westminster Hospital, London, United Kingdom
| | - Nabeela Mughal
- Chelsea and Westminster Hospital, London, United Kingdom
| | | |
Collapse
|