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Vandenberk B, Lei LY, Ballantyne B, Vickers D, Liang Z, Sheldon RS, Chew DS, Aksu T, Raj SR, Morillo CA. Syncope recurrence and long-term heart rate variability after cardioneuroablation for vasovagal syncope: a systematic review and meta-analysis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.655] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Cardioneuroablation (CNA) has emerged as a promising therapy in patients with refractory vasovagal syncope (VVS). Well-designed randomized clinical trials (RCT) are lacking.
Purpose
To provide an estimate of the procedural success rate of CNA, including subgroup analysis by method and target of ablation, as well as serial measurements of autonomic tone after CNA with heart rate variability (HRV).
Methods
A systematic search of studies was performed in MEDLINE and EMBASE according to the PRISMA guidelines, from inception to 14 February 2022. Observational studies and clinical trials reporting success rates were included. Quality assessment was performed using the CONSORT and STROBE recommendations. The primary outcome was freedom from syncope after CNA. Meta-analysis was performed with a random-effects model. The secondary outcome was serial HRV analysis (heart rate, SDNN, rMSSD and LF/HF ratio) analysed with one-way ANOVA with Bonferroni's correction for multiple testing.
Results
A total of 465 patients were included across 14 studies (mean age 40±4 years; 54% females). All included studies were of intermediate quality (median 17, IQR 16–18). Procedural approach to CNA was variable: 50 patients (10.8%) by mapping of fractionated electrograms, 73 patients (15.7%) with the spectral method, 210 (45.2%) with high frequency stimulation, 73 (15.7%) with a purely anatomically guided method, and 59 patients (12.6%) with a combination. The target was bi-atrial in 168 patients (36.1%), left atrium only in 259 patients (55.7%), and right atrium only in 38 patients (8.2%).
The freedom from syncope was 91.9% (95% CI 88.1–94.6%; I2=6.9%, p=0.376; Figure 1). CNA limited to right atrial ablation was associated with a significantly lower success rate (p<0.0001; 81.5%, 95% CI 51.9–94.7%) versus left atrial ablation only (94.0%, 95% CI 88.6–96.9%) and bi-atrial ablation (92.7%, 95% CI 86.8–96.1%). Subgroup analysis according to the technique used to identify GPs did not show any significant difference in success rate (p=0.206).
Ten studies (n=317, 68.2%) reported at least one HRV parameter. Results are presented in Figure 2 with the mean and standard deviations. There were significant increases in heart rate, and significant decrease in SDNN, rMSSD and LF/HF ratios for each follow-up timepoint available (p<0.0001 for all analyses). Recovery of these parameters was observed in 2 studies, but these were not associated with an increased risk in syncope recurrence.
Conclusion
This meta-analysis suggests a high procedural success rate of CNA in VVS of 92%. CNA induces long-term changes in HRV, however some studies reported recovery of these parameters without an association with syncope recurrence. Therefore, HRV changes may not be an appropriate surrogate endpoint for clinical response. Well-designed double-blind, multi-center sham controlled RCTs are needed to provide evidence for future treatment guidelines.
Funding Acknowledgement
Type of funding sources: Foundation.
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Affiliation(s)
- B Vandenberk
- Libin Cardiovascular Institute of Alberta , Calgary , Canada
| | - L Y Lei
- Libin Cardiovascular Institute of Alberta , Calgary , Canada
| | - B Ballantyne
- Libin Cardiovascular Institute of Alberta , Calgary , Canada
| | - D Vickers
- Libin Cardiovascular Institute of Alberta , Calgary , Canada
| | - Z Liang
- Libin Cardiovascular Institute of Alberta , Calgary , Canada
| | - R S Sheldon
- Libin Cardiovascular Institute of Alberta , Calgary , Canada
| | - D S Chew
- Libin Cardiovascular Institute of Alberta , Calgary , Canada
| | - T Aksu
- Yeditepe University Hospital , Istanbul , Turkey
| | - S R Raj
- Libin Cardiovascular Institute of Alberta , Calgary , Canada
| | - C A Morillo
- Libin Cardiovascular Institute of Alberta , Calgary , Canada
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Saboori S, Jarvis M, Baker J, Seminara B, Vickers D, Pacicco T, Moshiree B. Hard to Swallow Results. Dysphagia 2021; 37:863-867. [PMID: 34297152 DOI: 10.1007/s00455-021-10344-x] [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: 09/17/2020] [Accepted: 07/13/2021] [Indexed: 10/20/2022]
Abstract
The American Neurogastroenterology and Motility Society (ANMS) proposed quality measures (QMs) for performance and interpretation of esophageal manometry (EM). We implemented a quality improvement (QI) study at a large community hospital to assess and improve procedural adherence and interpretation of EM studies based on the ANMS QMs using the Chicago Classification 3.0 (CC) Guidelines. For pre-intervention, three motility independent reviewers reinterpreted 60 EM studies conducted by community gastroenterologists without Tier II-III motility training from October to December 2018 for compliance with pre-procedural, procedural, and data interpretation ANMS QMs. In December 2018, we developed a pre-procedural form, educated nurses on EM procedural compliance, and provided preliminary pre-intervention results to gastroenterologists along with literature utilizing the CC 3.0 Guidelines. For post-intervention, we reinterpreted 54 EM studies from January to August 2019 and investigated whether they met QMs for data interpretation with respect to the CC Guidelines and resulted in appropriate treatment. We found a statistically significant improvement in procedural compliance among nursing staff for 30 s of swallows (76% post-intervention versus 12% pre-intervention, p < 0.001) and 7 evaluable swallows (94% post-intervention versus 53% pre-intervention, p < 0.001). However, quality metrics within data interpretation by physicians post-intervention showed mixed results. An incorrect diagnosis was made in 50% (n = 27)) of studies with 72% (n = 39) having at least one missing item based on the CC. The most missed diagnosis was fragmented peristalsis (30%, n = 29). Among the 39% (n = 21) of surgery referrals, 24% (n = 5) were incorrectly referred. Our study shows poor data interpretation by community gastroenterologists without formal motility training despite adequate performance by nursing staff. This further supports the need for a national ANMS certification process for formal HRM education.
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Affiliation(s)
- S Saboori
- Department of Internal Medicine at Atrium Health's Carolinas Medical Center, 5th Floor Medical Education Building, 1000 Blythe Blvd, Charlotte, NC, 28203, USA.
| | - M Jarvis
- Department of Internal Medicine at Atrium Health's Carolinas Medical Center, Atrium Health Gastroenterology and Hepatology, Charlotte, USA
| | - J Baker
- Department of Internal Medicine and Surgery at Atrium Health's Carolinas Medical Center, Charlotte, USA
| | - B Seminara
- Atrium Health Gastroenterology and Hepatology, Charlotte, USA
| | - D Vickers
- Atrium Health Gastroenterology and Hepatology, Charlotte, USA
| | - T Pacicco
- Atrium Health Gastroenterology and Hepatology, Charlotte, USA
| | - B Moshiree
- UNC School of Medicine-Charlotte Campus, Atrium Health Gastroenterology and Hepatology, Charlotte, USA
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Indraratna P, Biswas U, McVeigh J, Vickers D, Watkins E, Yu J, Schreier G, Jan S, Lovell N, Ooi S. The Cost-effectiveness of TeleClinical Care: A Telemonitoring and Educational Smartphone App-based Model of Care. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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4
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Indraratna P, Biswas U, McVeigh J, Ziegl A, Mamo A, Magdy J, Vickers D, Watkins E, Briggs N, Cholerton N, Li J, Holgate K, Gallagher R, Ferry C, Jan S, Schreier G, Redmond S, Loh E, Yu J, Lovell N, Ooi S. TeleClinical Care: A Randomised Control Trial of a Smartphone-Based Model of Care for Patients with Heart Failure or Acute Coronary Syndrome. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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5
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Gray R, Friedman D, Yu J, Vickers D, Moragues J, Mathur G. 215 Exercise Induced Ventricular Tachycardia in a Patient With Mitral Annular Disjunction. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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6
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Capps KL, McLaughlin EM, Murray AWA, Aldus CF, Wyatt GM, Peck MW, Van Amerongen A, Ariëns RMC, Wichers JH, Baylis CL, Wareing DRA, Bolton FJ, Aird H, Allen R, Anderson P, Boughtflower M, Chen Q, Davies A, Dennis J, Gibson SJ, Green RA, Hilton J, Jorgensen F, Leuschner R, Loder C, Mackey B, Meldrum R, Millar I, Reid T, Robinson AJ, Robinson; I, Smith H, Surman S, Vickers D, Wood M. Validation of Three Rapid Screening Methods for Detection of Verotoxin-Producing Escherichia coli in Foods: Interlaboratory Study. J AOAC Int 2019. [DOI: 10.1093/jaoac/87.1.68] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
An interlaboratory study was conducted for the validation of 3 methods for the detection of all verotoxin-producing Escherichia coli (VTEC) in foods. The methods were a multi-analyte 1-step lateral flow immunoassay (LFIA) for detection of E. coli O157 and verotoxin (VT); an enzyme-linked immunosorbent assay targeted against VT1, VT2, and VT2c (VT-ELISA); and a polymerase chain reaction (PCR) method for detection of VT genes (VT-PCR). Aliquots (25 g or 25 mL) of 4 food types (raw minced [ground] beef, unpasteurized milk, unpasteurized apple juice [cider], and salami) were individually inoculated with low numbers (<9 to 375 cells/25 g) of 6 test strains of E. coli (serogroups O26, O103, O111, O145, and O157) with differing VT-producing capabilities. Five replicates for each test strain and 5 uninoculated samples were prepared for each food type. Fourteen participating laboratories analyzed samples using the LFIA, 9 analyzed the samples by ELISA, and 9 by PCR. The LFIA for O157 and VT had a specificity (correct identification of negative samples) of 92 and 94%, respectively, and a sensitivity (correct identification of positive samples) of 94 and 55%, respectively. The VT-ELISA and VT-PCR
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Affiliation(s)
- Katherine L Capps
- Central Science Laboratory, Sand Hutton, York, North Yorkshire, YO41 1LZ, United Kingdom
| | - Emiline M McLaughlin
- Central Science Laboratory, Sand Hutton, York, North Yorkshire, YO41 1LZ, United Kingdom
| | - Alistair W A Murray
- Central Science Laboratory, Sand Hutton, York, North Yorkshire, YO41 1LZ, United Kingdom
| | - Clare F Aldus
- Institute of Food Research, Norwich Research Park, Colney, Norwich, NR4 7UA, United Kingdom
| | - Gary M Wyatt
- Institute of Food Research, Norwich Research Park, Colney, Norwich, NR4 7UA, United Kingdom
| | - Michael W Peck
- Institute of Food Research, Norwich Research Park, Colney, Norwich, NR4 7UA, United Kingdom
| | - Aart Van Amerongen
- Agrotechnology and Food Innovations A&F B.V., Bornsesteeg 59, 6708 PD Wageningen, The Netherlands
| | - Renata M C Ariëns
- Agrotechnology and Food Innovations A&F B.V., Bornsesteeg 59, 6708 PD Wageningen, The Netherlands
| | - Jan H Wichers
- Agrotechnology and Food Innovations A&F B.V., Bornsesteeg 59, 6708 PD Wageningen, The Netherlands
| | - Christopher L Baylis
- Campden & Chorleywood Food Research Association, Chipping Campden, Gloucestershire, GL55 6LD, United Kingdom
| | - David R A Wareing
- Preston Public Health Laboratory, Royal Preston Hospital, PO Box 202, Sharoe Green LN, Fulwood, Preston, Lancashire, PR2 9HG, United Kingdom
| | - Frederick J Bolton
- Preston Public Health Laboratory, Royal Preston Hospital, PO Box 202, Sharoe Green LN, Fulwood, Preston, Lancashire, PR2 9HG, United Kingdom
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McGrath J, Guiney L, Li J, Vickers D, Mikhail P, Yu J, Blake V, Robaei D, Back L, Ooi S, Pitney M, Jepson N. Long-Term Clinical Outcomes Following Implantation of Bioresorbable Vascular Scaffolds: Experience From Two Australian Centres. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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9
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Green MA, Jones K, Harris R, Manley D, Vickers D, Johnston R. OP13 Are cancer mortality patterns random? an ecological analysis of england and wales, 2006–2009. Br J Soc Med 2015. [DOI: 10.1136/jech-2015-206256.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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10
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Affiliation(s)
- R Manikandan
- Department of Urology, Stepping Hill Hospital, Stockport, Cheshire, UK
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11
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Vickers D, Shehab S, Jain N, Rao S, Jabbour A, Jansz P, Hayward C. Derivation of left atrial pressure from flow analysis in continuous-flow left ventricular assist devices. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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12
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Vickers D, Robaei D, Carlyle A, Lau A, Giles R, Ooi S, Pitney M, Jepson N. Routine debulking rotational atherectomy preparation before drug eluting balloons for the management of in-stent restenosis. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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Jain N, Vickers D, Granegger M, Schima H, Moscato F, Macdonald P, Jansz P, Hayward C. Circadian variation of haemodynamic parameters during continuous-flow ventricular assist device support. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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14
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Mahon M, Vickers D, McCarthy K, Barker R, Merritt R, Szagun G, Mann W, Rajput K. Cochlear-implanted children from homes where English is an additional language: findings from a recent audit in one London centre. Cochlear Implants Int 2013; 12:105-13. [DOI: 10.1179/146701010x486552] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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15
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Esbensen SK, Chelton DB, Vickers D, Sun J. An analysis of errors in special sensor microwave imager evaporation estimates over the global oceans. ACTA ACUST UNITED AC 2012. [DOI: 10.1029/93jc00011] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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16
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Stewart T, Vickers D, Vickers P, Vickers M. Christopher Francis Howar d Vickers. Assoc Med J 2012. [DOI: 10.1136/bmj.e3687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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17
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Abstract
This paper presents an operative technique of syndactyly release (syndactylysis) without skin grafting. A series of 31 cases, of simple, complex and complicated syndactylies are presented with a mean follow-up of 4.4 years. The results demonstrate that a good outcome can be reliably obtained by syndactylysis without the use of skin grafts.
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Affiliation(s)
- D. Vickers
- Royal Children’s Hospital, Brisbane, Australia
| | - W. Donnelly
- Royal Children’s Hospital, Brisbane, Australia
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19
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20
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Abstract
Abstract
Stable boundary layer height h is determined from eddy correlation measurements of the vertical profiles of the buoyancy flux and turbulence energy from a tower over grassland in autumn, a tower over rangeland with variable snow cover during winter, and aircraft data in the stable marine boundary layer generated by warm air advection over a cool ocean surface in summer. A well-defined h within the tower layer at the grass site (lowest 50 m) and the snow site (lowest 30 m) was definable only about 20% of the time. In the remaining stable periods, the buoyancy flux and turbulence energy either (a) remained constant with height, indicating a deep boundary layer, (b) increased with height, or (c) varied erratically with height. Approximately one-half of the tower profiles did not fit the traditional concepts of a boundary layer. The well-defined cases of h are compared with various formulations for the equilibrium depth of the stably stratified boundary layer based on the Richardson number or surface fluxes. The diagnostic models for h have limited success in explaining both the variance and mean magnitude of h at all three sites. The surface bulk Richardson number and gradient Richardson number approaches perform best for the combined data. For the surface bulk Richardson number method, the required critical value varies systematically between sites. The surface bulk Richardson number approach is modified to include a critical value that depends on the surface Rossby number, which incorporates the influence of surface roughness and wind speed on boundary layer depth.
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Affiliation(s)
- D. Vickers
- College of Oceanic and Atmospheric Sciences, Oregon State University, Corvallis, Oregon
| | - L. Mahrt
- College of Oceanic and Atmospheric Sciences, Oregon State University, Corvallis, Oregon
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21
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Munns CFJ, Glass IA, Flanagan S, Hayes M, Williams B, Berry M, Vickers D, O'Rourke P, Rao E, Rappold GA, Hyland VJ, Batch JA. Familial growth and skeletal features associated with SHOX haploinsufficiency. J Pediatr Endocrinol Metab 2003; 16:987-96. [PMID: 14513875 DOI: 10.1515/jpem.2003.16.7.987] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study was designed to determine the intrafamilial effect of SHOX haploinsufficiency on stature, by comparing the growth and phenotype of 26 SHOX haploinsufficient individuals with 45 relatives and population standards. It confirmed that SHOX haploinsufficiency leads to growth restriction from birth to final height. Compared to unaffected siblings, the SHOX haploinsufficient cohort was 2.14 SDS (3.8 cm) shorter at birth and 2.1 SDS shorter through childhood. At final height females were 2.4 SDS (14.4 cm) shorter and males 0.8 SDS (5.3 cm) shorter than normal siblings. The family height analysis suggests that the effect of SHOX haploinsufficiency on growth may have been previously underestimated at birth and overestimated in males at final height. SHOX haploinsufficiency leads to short arms in 92%, bilateral Madelung deformity in 73% and short stature in 54%. Females were more severely affected than males. We conclude that SHOX is a major growth gene and that mutations are associated with a broad range of phenotype.
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Affiliation(s)
- C F J Munns
- Endocrine and Diabetes Research Unit, Royal Children's Hospital Foundation Research Centre, Department of Paediatrics and Child Health, University of Queensland, Brisbane, Australia.
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Munns CFJ, Berry M, Vickers D, Rappold GA, Hyland VJ, Glass IA, Batch JA. Effect of 24 months of recombinant growth hormone on height and body proportions in SHOX haploinsufficiency. J Pediatr Endocrinol Metab 2003; 16:997-1004. [PMID: 14513876 DOI: 10.1515/jpem.2003.16.7.997] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Leri-Weill syndrome (LWS) is a skeletal dysplasia with mesomelic short stature, bilateral Madelung deformity (BMD) and SHOX (short stature homeobox-containing gene) haploinsufficiency. The effect of 24 months of recombinant human growth hormone (rhGH) therapy on the stature and BMD of two females with SHOX haploinsufficiency (demonstrated by fluorescence in situ hybridisation) and LWS was evaluated. Both patients demonstrated an increase in height standard deviation score (SDS) and height velocity SDS over the 24 months of therapy. Patient 1 demonstrated a relative increase in arm-span and upper segment measurements with rhGH while patient 2 demonstrated a relative increase in lower limb length. There was appropriate advancement of bone age, no adverse events and no significant deterioration in BMD. In this study, 24 months of rhGH was a safe and effective therapy for the disproportionate short stature of SHOX haploinsufficiency, with no clinical deterioration of BMD.
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Affiliation(s)
- C F J Munns
- Endocrine and Diabetes Research Unit, Royal Children's Hospital Foundation Research Centre, Brisbane, Australia.
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Flanagan SF, Munns CFJ, Hayes M, Williams B, Berry M, Vickers D, Rao E, Rappold GA, Batch JA, Hyland VJ, Glass IA. Prevalence of mutations in the short stature homeobox containing gene (SHOX) in Madelung deformity of childhood. J Med Genet 2002; 39:758-63. [PMID: 12362035 PMCID: PMC1734979 DOI: 10.1136/jmg.39.10.758] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
Little research has been carried out on human performance in optimization problems, such as the Traveling Salesman problem (TSP). Studies by Polivanova (1974, Voprosy Psikhologii, 4, 41-51) and by MacGregor and Ormerod (1996, Perception & Psychophysics, 58, 527-539) suggest that: (1) the complexity of solutions to visually presented TSPs depends on the number of points on the convex hull; and (2) the perception of optimal structure is an innate tendency of the visual system, not subject to individual differences. Results are reported from two experiments. In the first, measures of the total length and completion speed of pathways, and a measure of path uncertainty were compared with optimal solutions produced by an elastic net algorithm and by several heuristic methods. Performance was also compared under instructions to draw the shortest or the most attractive pathway. In the second, various measures of performance were compared with scores on Raven's advanced progressive matrices (APM). The number of points on the convex hull did not determine the relative optimality of solutions, although both this factor and the total number of points influenced solution speed and path uncertainty. Subjects' solutions showed appreciable individual differences, which had a strong correlation with APM scores. The relation between perceptual organization and the process of solving visually presented TSPs is briefly discussed, as is the potential of optimization for providing a conceptual framework for the study of intelligence.
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Affiliation(s)
- D Vickers
- Psychology Department, University of Adelaide, Adelaide 5005, South Australia
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Abstract
P. Juslin and H. Olsson's (1997) distinction between Thurstonian and Brunswikian uncertainty is examined and their sampling model of sensory discrimination analyzed as a representative of the class of memoryless decision processes. The separate characteristics and combined behavior of 4 main components of the model are explored: (a) the basic decision process, (b) the assumption of deadline responding, (c) the moving window model of memory, and (d) the hypothesized basis for confidence. It is argued that grafting a moving window memory onto a memoryless decision process has several undesirable consequences. Moreover, the suggested basis for confidence leads to predictions that are counterintuitive and unsupported by empirical evidence. It is concluded that the window-sampling model is a maladapted combination of inappropriate elements, which is implausible as a model of decision making, memory, or confidence, in sensory discrimination.
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Affiliation(s)
- D Vickers
- Department of Psychology, Adelaide University, Adelaide, South Australia 5005, Australia.
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26
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Munns CF, Glass IA, LaBrom R, Hayes M, Flanagan S, Berry M, Hyland VJ, Batch JA, Philips GE, Vickers D. Histopathological analysis of Leri-Weill dyschondrosteosis: disordered growth plate. Hand Surg 2001; 6:13-23. [PMID: 11677662 DOI: 10.1142/s0218810401000424] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2000] [Accepted: 02/12/2001] [Indexed: 11/18/2022]
Abstract
Leri-Weill syndrome (LWS) is a dominant (pseudoautosomal) skeletal dysplasia with mesomelic short stature and bilateral Madelung deformity, due to dyschondrosteosis of the distal radius. It results from the loss of one copy of the Short Stature Homeobox Gene (SHOX) from the tip of the short arm of the X or Y chromosome. SHOX molecular testing enabled us to evaluate the histopathology of the radial physis in LWS patients with a documented SHOX abnormality. A widespread disorganisation of physeal anatomy was revealed with disruption of the normal parallel columnar arrangement of chondrocytes. Tandem stacking of maturing chondrocytes within columns was replaced by a side-by-side arrangement. The presence of hypertrophic osteoid with micro-enchondromata in the radial metaphysis suggests abnormal endochondral ossification. The Vickers' ligament was confirmed to blend with the triangular fibrocartilage complex (TFCC). This histopathological study demonstrates that the zone of dyschondrosteosis in LWS is characterised by marked disruption of normal physeal chondrocyte processes and that a generalised physeal abnormality is present.
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Affiliation(s)
- C F Munns
- Endocrine Research Unit, Royal Children's Hospital Foundation Research Centre, Royal Children's Hospital, Brisbane, Queensland, Australia.
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Heymen S, Pikarsky AJ, Weiss EG, Vickers D, Nogueras JJ, Wexner SD. A prospective randomized trial comparing four biofeedback techniques for patients with faecal incontinence. Colorectal Dis 2000; 2:88-92. [PMID: 23577991 DOI: 10.1046/j.1463-1318.2000.0136a.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The aim of this study was to compare four methods of biofeedback therapy for patients with faecal incontinence (FI). PATIENTS AND METHODS All patients with FI who were ineligible for surgical management were prospectively randomized using a computer generated randomization method into one of four protocols: 1, out-patient intra-anal electromyographic biofeedback training (EMG); 2, EMG plus intrarectal balloon training (BT); 3, EMG plus a home trainer (HT); and 4, EMG, BT and HT. All patients received weekly, 1 h, out-patient biofeedback training. Success for patients with FI was measured by a reduction in incontinent episodes (days/week). In all instances, patients maintained a daily log in which documentation was recorded regarding each bowel evacuation. RESULTS Forty patients were randomized into one of the four groups. Six patients withdrew after one session and were not included in the analysis. Therefore, 34 patients (23 female and 11 male) with a mean incontinence score of 12 (range 7-14) were randomized to one of the four groups (n=8, 8, 8, and 10, respectively). There was a statistically significant reduction in incontinent episodes for all groups. However, there were no significant differences in treatment outcome found in comparisons among the four groups. CONCLUSION Biofeedback therapy significantly improves FI. Moreover, EMG training was as effective alone as was the addition of HT, BT or both for the treatment of FI.
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Affiliation(s)
- S Heymen
- Cleveland Clinic Florida, Fort Lauderdale, FL, USA
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Lee MD, Vickers D. The importance of the convex hull for human performance on the traveling salesman problem: a comment on MacGregor and Ormerod (1996). Percept Psychophys 2000; 62:226-8. [PMID: 10703269 DOI: 10.3758/bf03212074] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
MacGregor and Ormerod (1996) have presented results purporting to show that human performance on visually presented traveling salesman problems, as indexed by a measure of response uncertainty, is strongly determined by the number of points in the stimulus array falling inside the convex hull, as distinct from the total number of points. It is argued that this conclusion is artifactually determined by their constrained procedure for stimulus construction, and, even if true, would be limited to arrays with fewer than around 50 points.
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Affiliation(s)
- M D Lee
- Defence Science & Technology Organisation, Salisbury, Australia
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Heymen S, Wexner SD, Vickers D, Nogueras JJ, Weiss EG, Pikarsky AJ. Prospective, randomized trial comparing four biofeedback techniques for patients with constipation. Dis Colon Rectum 1999; 42:1388-93. [PMID: 10566525 DOI: 10.1007/bf02235034] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE The aim of this study was to compare four methods of biofeedback for patients with constipation. METHODS Thirty-six patients were prospectively, randomly assigned to one of four protocols: 1) outpatient intra-anal electromyographic biofeedback training; 2) electromyographic biofeedback training plus intrarectal balloon training; 3) electromyographic biofeedback training plus home training; or 4) electromyographic biofeedback training, balloon training, and home training. All 36 patients received weekly one-hour outpatient biofeedback training. Success was measured by increased unassisted bowel movements and reduction in cathartic use. In all instances patients maintained a daily log in which documentation was maintained regarding each bowel evacuation and the need for any cathartics. RESULTS; There was a statistically significant increase in unassisted bowel movements for Groups 1, 2, and 4 (P < 0.05) and a reduction in the use of cathartics in Groups 1, 2, and 3 (P < 0.05). CONCLUSION There was a significant improvement in outcome after all four treatment protocols for constipation; however, no significant difference was found among the treatments. Therefore, electromyographic biofeedback training alone is as effective as with the addition of balloon training, home training, or both.
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Affiliation(s)
- S Heymen
- Department of Colorectal Surgery, Cleveland Clinic Florida, Fort Lauderdale, USA
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30
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Abstract
BACKGROUND A study was undertaken to determine outcome and to identify predictors of success for biofeedback for constipation. METHODS Patients who had at least one biofeedback session were evaluated whether or not they completed a treatment course. Parameters assessed included use of cathartics, number of spontaneous bowel movements per week, presence of rectal pain, number of biofeedback sessions and results of anorectal physiology. RESULTS A total of 194 patients (59 male, 135 female) of median age 71 (range 11-96) years, including 30 with concomitant rectal pain, were treated. The median number of spontaneous bowel movements per week before treatment was 0. Some 35 per cent of patients had complete success (three or more spontaneous bowel movements per week with discontinuation of cathartics), 13 per cent had partial success (fewer than three spontaneous bowel movements per week with continued use of cathartics) and 51 per cent had no improvement. Neither patient age, sex nor duration of symptoms significantly affected outcome. Only 18 per cent of patients who had between two and four sessions had complete success, compared with 44 per cent of those who had five or more (P < 0.001). A total of 63 per cent of patients who completed the treatment protocol experienced complete success, compared with 25 per cent of those who self-discharged (P < 0.0001). CONCLUSIONS This large study indicates that the success rate of biofeedback for patients with constipation is less than previously reported. However, the success rate improves significantly after five or more sessions and is significantly related to the patient's willingness to complete treatment.
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Affiliation(s)
- R Gilliland
- Department of Colorectal Surgery, Cleveland Clinic Florida, Fort Lauderdale 33309-1743, USA
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32
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Pietsch A, Vickers D. Memory capacity and intelligence: novel techniques for evaluating rival models of a fundamental information-processing mechanism. J Gen Psychol 1997; 124:229-339. [PMID: 9438970 DOI: 10.1080/00221309709595520] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Data from a fundamental cognitive task in which participants discriminate the relative frequency of visual or auditory binary stimuli were examined. Accuracy on this task correlates well with psychometric intelligence. The experimental paradigm is highly tractable, lending itself to rigorous analyses of precisely defined simulation models. Numerous models are evaluated, using multiple comparisons between response patterns of individual (and pooled) participants and predictive measures based on simulations for each trial sequence. Implications for theoretical accounts of short-term memory, discrimination, and absolute judgement as well as the measurement of individual differences in cognitive ability, are discussed. The results suggest a reinterpretation of memory capacity and support a new kind of model (with a single estimable parameter) in which discrete, valued units of information are stochastically displaced by further input.
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Affiliation(s)
- A Pietsch
- Department of Psychology, University of Adelaide, Australia
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33
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Abstract
PURPOSE A number of modalities have been used for the treatment of intractable rectal pain, with varying degrees of success. Electromyography (EMG)-based biofeedback therapy has been used in the treatment of this condition during the past six years. MATERIALS AND METHODS Medical records of 86 patients who completed at least one session of biofeedback for rectal pain between February 1989 and August 1995 were retrospectively reviewed. All sessions were one-hour outpatient encounters with a trained biofeedback therapist. There were 31 male and 55 female patients with a median age of 68 (range, 12-96) years. Surgery (19.8 percent) or stress (15.1 percent) were frequently cited as precipitating factors for the development of rectal pain. Eleven patients completed only one session of biofeedback and were excluded from further analysis. Of the remaining patients, 28 complained of concomitant constipation. Assessment of the benefit of therapy was based on the patients' subjective reports of the level of symptoms, aided by a linear analog scale. RESULTS Twenty six patients (34.7 percent) reported an improvement in symptoms. Outcome was not influenced by patients' ages (P = 0.63), duration of symptoms (P = 1.0), or a prior history of surgery (P = 0.14). Alleviation of symptoms was not significantly related to the presence of paradoxical puborectalis contraction demonstrated on either EMG (P = 1) or defecography (P = 0.12). Importantly, outcome was significantly improved in patients who completed the treatment schedule compared with those who self-discharged (P < 0.001). CONCLUSIONS Although idiopathic rectal pain is difficult to treat, EMG-based biofeedback can produce alleviation of symptoms. However, success depends on patients' willingness to pursue a full course of therapy.
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Affiliation(s)
- R Gilliland
- Department of Colorectal Surgery, Cleveland Clinic Florida, Fort Lauderdale 33309, USA
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34
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Abstract
Diagnostic comparisons of performance on parts A and B of the Trail Making Test (TMT) assume that path structure in the two parts is equivalent but that task complexity is greater for B. The two parts are shown to differ with respect to length and angular variability. However, measures of fractal dimension show no difference in structural complexity between paths A and B. This analysis suggests a principled method for generating alternative pathways, varying in complexity, and opens the way for a systematic study of path-following. It also suggests that path-following may be interpretable within a general approach, in which perceptual, linguistic, reasoning and motor processes are seen as related through different groups of geometric transformations.
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Affiliation(s)
- D Vickers
- Psychology Department, University of Adelaide, South Australia.
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35
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Vickers D, McDowell A. Accuracy in the frequency accrual speed test (fast), inspection time and psychometric intelligence in a sample of primary school children. Personality and Individual Differences 1996. [DOI: 10.1016/0191-8869(95)00208-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Vickers D. Management of anaphylactic reactions to food. Arch Dis Child 1995; 73:184-5. [PMID: 7574878 PMCID: PMC1511180 DOI: 10.1136/adc.73.2.184-d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Vickers D, Nielsen G. Madelung deformity: surgical prophylaxis (physiolysis) during the late growth period by resection of the dyschondrosteosis lesion. J Hand Surg Br 1992; 17:401-7. [PMID: 1402266 DOI: 10.1016/s0266-7681(05)80262-1] [Citation(s) in RCA: 82] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The majority of cases of Madelung deformity are caused by hereditary dyschondrosteosis at the wrist. The principal lesion in the ulnar zone of the distal radial physis retards growth asymmetrically, especially in late childhood. Resection of this zone and its replacement with autologous fat (Langenskiöld procedure, or physiolysis) restores growth and minimizes deformity. The resection of an abnormal ligament tethering the lunate proximally may assist carpal advancement. A series of 17 patients (24 wrists) treated over a 12-year period is presented, with sufficient follow-up for evaluation of 11 patients (15 wrists). The results of this prophylactic procedure are encouraging, and, if it is performed early, the authors believe that Madelung deformity may be preventable, or at least controllable.
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Affiliation(s)
- D Vickers
- Royal Children's Hospital, Brisbane, Australia
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Rudkin GE, Osborne GA, Finn BP, Jarvis DA, Vickers D. Intra-operative patient-controlled sedation. Comparison of patient-controlled propofol with patient-controlled midazolam. Anaesthesia 1992; 47:376-81. [PMID: 1599059 DOI: 10.1111/j.1365-2044.1992.tb02216.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Propofol and midazolam were compared for intra-operative patient-controlled sedation in 40 ASA 1 day patients undergoing surgical extraction of third molar teeth under local anaesthesia. All patients initially received 0.7 micrograms.kg-1 fentanyl. Patients in the propofol group self-administered 20 mg (2 ml over 6 s) bolus doses of propofol; successful demands averaged 8.0 (SD 4.4) and unsuccessful demands (during the 1 min lockout period) 2.8 (SD 4.1). The midazolam group self-administered 0.5 mg (2 ml over 6 s) bolus doses and averaged 14.0 (SD 6.3) and 17.6 (SD 19.8) successful and unsuccessful demands respectively. Postoperative memory, measured with delayed free recall, and postoperative mental performance, measured with the frequency accrual speed test index, were both significantly less impaired in the propofol group. Although there was no significant difference in patient satisfaction, measured postoperatively, propofol was judged the more suitable agent for patient-controlled sedation, because of its more rapid response to fluctuating intra-operative requirements, superior recovery characteristics and beneficial effect on mood.
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Affiliation(s)
- G E Rudkin
- Department of Anaesthesia and Intensive Care, Royal Adelaide Hospital, North Terrace, South Australia
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40
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Chittleborough MC, Osborne GA, Rudkin GE, Vickers D, Leppard PI, Barlow J. Double-blind comparison of patient recovery after induction with propofol or thiopentone for day-case relaxant general anaesthesia. Anaesth Intensive Care 1992; 20:169-73. [PMID: 1595851 DOI: 10.1177/0310057x9202000209] [Citation(s) in RCA: 53] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Postoperative recovery after induction with either propofol or thiopentone has been compared in forty ASA I unpremedicated day surgery patients undergoing surgical extraction of third molar teeth under relaxant general anaesthesia. Mean recovery times in the propofol group, required for patients to sit out of bed (44.8 minutes; SD 18.6) and meet discharge criteria (113.1 minutes; SD 34.5) were significantly (P less than 0.05) shorter than those in the thiopentone group (59.7 minutes; SD 21.4 and 133.5 minutes; SD 34.5). Fewer patients in the propofol group were treated in the recovery room for nausea and vomiting and the incidence of mild nausea not requiring treatment was less in the propofol group, but these differences were not statistically significant. Postoperative mental performance, measured by the FAST index, a new test of mental speed, was reduced on average by 1.7% of preoperative levels, during the recovery period tested, with no significant difference between the groups.
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Affiliation(s)
- M C Chittleborough
- Department of Anaesthesia and Intensive Care, Royal Adelaide Hospital, South Australia
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41
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Abstract
Fresh unspun and unstained urine specimens from 342 children with previous urinary tract infection (UTI) or symptoms compatible with a UTI were examined by microscopy at a magnification of x 400 in a mirrored counting chamber by a clinician, and sent for culture in a microbiology laboratory; 200 samples were also plated onto dip-slides. When microscopy and culture results were discrepant, further urine samples were collected until a diagnosis of UTI (24) or sterile urine (318) could be confirmed. Initial microscopy correctly identified 23 of 24 UTIs and 286 of 318 sterile urines; 1 false-positive result was caused by vaginal contamination with lactobacilli. 32 specimens (9%) gave an equivocal result on microscopy; the 1 other true-positive result was identified correctly on microscopy of the next urine specimen obtained. Culture of the initial urines correctly identified all 24 UTIs, but only 82% of the negative samples. Of the samples from uninfected children, 35 (11%) showed a mixed growth which was sterile on repeat sampling, and 21 (6.6%) initially grew a false-positive pure growth of more than 10(5) colony-forming units/ml of one organism. True UTIs were associated with bacterial counts above 10(7)/ml. Microscopy by a clinician represents a cheaper, quicker, and more reliable screening test for UTI in children than does routine culture in a microbiology laboratory.
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Affiliation(s)
- D Vickers
- Department of Child Health, Royal Victoria Infirmary, Newcastle upon Tyne
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Abstract
Urine was collected for microscopy and culture by standard use of sterile adhesive bags and by extraction from wet disposable nappies from 45 patients aged 1 to 23 months. Urine can readily be obtained by compression of wet nappy fibres within a 20 ml syringe if highly absorbent brands that contain gel beads are avoided. Red and white cell numbers were reduced on light microscopy of specimens obtained from nappies, but bacterial counts were unchanged. On culture, 6 children were shown to have urinary tract infections by both methods; of the children who did not have a urine infection, the contamination rate was lower from nappy collections (10/39 vs 17/39 from urine bags). Biochemical analysis of urine collected from 11 older children showed very close correlation for sodium, potassium, urea, and creatinine concentrations and osmolality between freshly voided urine and samples obtained after they were soaked into disposable nappies for 3 h and reclaimed, although there was greater variation for measurements of calcium and phosphate. Extraction of urine from disposable nappies put on within 4 h and which are not soiled by faeces is an inexpensive, rapid, and simple method to collect urine from young children for culture, microscopy for bacteria, and biochemical analysis.
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Affiliation(s)
- T Ahmad
- Department of Child Health, Royal Victoria Infirmary, Newcastle upon Tyne, UK
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Osborne GA, Rudkin GE, Curtis NJ, Vickers D, Craker AJ. Intra-operative patient-controlled sedation. Comparison of patient-controlled propofol with anaesthetist-administered midazolam and fentanyl. Anaesthesia 1991; 46:553-6. [PMID: 1862894 DOI: 10.1111/j.1365-2044.1991.tb09654.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The quality of sedation and postoperative recovery have been assessed for intra-operative sedation provided by either patient-controlled sedation with propofol or a standard method using divided doses of midazolam and fentanyl, in 40 ASA 1 day surgery patients undergoing extraction of third molar teeth under local analgesia. Patient-controlled sedation with propofol produced sedation no deeper than full eyelid closure with prompt response to verbal command, but deeper levels were seen in three patients in the midazolam and fentanyl group. Patient satisfaction was higher in the patient-controlled sedation propofol group for both subjective intra-operative feelings (p less than 0.01) and willingness to have the procedure again in the same manner (p less than 0.05). Amnesia was more limited to intra-operative events (rather than extending into the postoperative period) in the patient-controlled sedation propofol group (p less than 0.05). Drug dose was correlated with duration of procedure and surgical difficulty in the patient-controlled sedation propofol group but not in the midazolam and fentanyl group. Postoperative testing included a new computerised test, the FAST index, which indicated a dose-dependent reduction in cognitive function in the midazolam and fentanyl group, which persisted until the time of discharge. Changes in cognitive function in the patient-controlled sedation propofol group in the same postoperative interval were significantly less and not related to propofol dose.
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Affiliation(s)
- G A Osborne
- Department of Anaesthesia and Intensive Care, University of Adelaide, Royal Adelaide Hospital, South Australia
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Vickers D. Diagnosis of urinary tract infections. Br J Gen Pract 1991; 41:129. [PMID: 2031762 PMCID: PMC1371634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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45
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Vickers D. Inner city tuberculosis and immunization policy. Arch Dis Child 1989; 64:424-5. [PMID: 2705807 PMCID: PMC1791925 DOI: 10.1136/adc.64.3.424-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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46
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Vickers D. Fatal pulmonary aspiration of oral activated charcoal. West J Med 1988. [DOI: 10.1136/bmj.297.6649.684-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
The traditional approach to clinodactyly has been either to accept the deformity or to perform an osteotomy. As an alternative to osteotomy, a resection of the mid-zone of the continuous epiphysis along with the underlying physis and its replacement by a fat graft (physiolysis) is simpler and allows further growth in the phalanx. Twelve of these operations have been reviewed with a maximum follow-up of six years. Excellent functional and cosmetic results have been obtained. The renewed growth is manifest not only by an increase in length, but also by a decrease in the angular deformity and improvement of the articular surfaces. Osteotomy at maturity has only been necessary in one patient.
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Affiliation(s)
- D Vickers
- Royal Childrens Hospital, Brisbane, Australia
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49
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Vickers D. Abdominal tuberculosis. J R Soc Med 1987; 80:466. [PMID: 3656325 PMCID: PMC1290923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
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50
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Vickers D. Endocarditis prophylaxis: Do parents remember advice? West J Med 1987. [DOI: 10.1136/bmj.294.6566.247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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