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Stokes A, Karadakhy O, Lui C, Argyriou A, Almansoor Z, Adegboye O, Biswas S, Raj Krishna G, Agrawal D, Shah A, Kirkwood G, Morris G. Long-term lead and mortality following pacemaker and defibrillator implantation in adult congenital heart disease. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.740] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Adult congenital heart disease (ACHD) survival has dramatically improved in recent decades. As such, clinicians now face the complex long-term interactions of congenital and chronic heart diseases. One area of continuing mortality in this group is arrhythmias, especially in those with cardiovascular implantable electronic devices (CIEDs). With these developments in survival, the long-term outcomes of the CIED systems and their effects on mortality are beginning to be elucidated.
Aims
This study aims to compare the effects of system location, surgical history, patient demographics and congenital disease complexity on lead survival, complication distributions and patient mortality in ACHD CIED patients.
Methods
A retrospective cohort of 250 ACHD CIED patients with follow up at a heart centre was collated from clinical correspondence letters and CEID records. Data was collected on demographics, mortality and lead survival and complications. Survival data was analysed with Kaplan-Meier (KM) curves and hazard ratio tests.
Results
Complex ADHD patient survival was less than the non-complex cohort (HR 0.38, 95% CI 0.22–0.67, p<0.01). Lead survival was longer in non-surgical patients (HR 1.42, 95% CI 1.13–1.78, p<0.01) and longer in female patients (HR 1.35, 95% CI 1.07–1.69, p<0.01) (Figure 1). No significant differences in mortality or lead survival were seen between epicardial and transvenous systems.
Conclusions
Complex ACHD is associated with worse patient mortality in CEID patients. Surgical history and male gender are associated with worsened lead survival.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Stokes
- Manchester Royal Infirmary , Manchester , United Kingdom
| | - O Karadakhy
- Manchester Royal Infirmary , Manchester , United Kingdom
| | - C Lui
- East Lancashire Hospitals NHS Trust , Blackburn , United Kingdom
| | - A Argyriou
- University of Manchester , Manchester , United Kingdom
| | - Z Almansoor
- University of Manchester , Manchester , United Kingdom
| | - O Adegboye
- University of Manchester , Manchester , United Kingdom
| | - S Biswas
- University of Manchester , Manchester , United Kingdom
| | - G Raj Krishna
- University of Manchester , Manchester , United Kingdom
| | - D Agrawal
- University of Manchester , Manchester , United Kingdom
| | - A Shah
- St. Boniface General Hospital, Department of Internal Medicine; Section of Cardiology , Winnipeg , Canada
| | - G Kirkwood
- Sheffield Teaching Hospitals NHS Trust , Sheffield , United Kingdom
| | - G Morris
- Manchester Royal Infirmary , Manchester , United Kingdom
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Bruce C, Rogers S, Saraf K, Kirkwood G, Kirkland N, Wright M, Jamil-Copley S, Abozguia K, Fox D, Mccollum C, Morris G. P1450Deep vein thrombosis after right sided catheter ablation; more common then previously thought? Europace 2020. [DOI: 10.1093/europace/euaa162.324] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Bristol-Myers Squibb
Background
Right sided cardiac catheter ablation has become an indispensable tool to treat supraventricular cardiac dysrhythmias, with ablation of certain arrhythmias having cure rates over 90%. Due to this the frequency of these procedures is increasing annually and it is imperative we understand the incidence of all complication. One lesser studied complication is that of deep vein thrombosis (DVT), for which catheter ablation demonstrates all elements of Virchow"s triad. As right sided ablations are carried out to treat troublesome palpitations, not to reduce mortality, it is important all risks are identified, especially those which are themselves potentially life threatening and can be modified.
Purpose
To determine the incidence of DVT after right sided cardiac catheter ablation.
Methods
We undertook a prospective multi-center study recruiting adult patients undergoing clinically indicated cardiac ablation for atrioventricular nodal re-entrant tachycardia and atrioventricular re-entrant tachycardia with right sided accessory pathway. Important exclusion criteria included patients on anticoagulation or antiplatelet therapy. Participants underwent bilateral compression venous duplex ultrasonography from the inferior vena cava to the popliteal vein to access for DVT at 24 hours and between 10 to 14 days post-procedure. The uncannulated contralateral leg acted as a control.
Result
At interim analysis 71 participants had completed the study with average age 47 year (+/- 14), procedure duration 67 minutes, and with a female predominance. Seven patients developed acute DVT in either the femoral or internal iliac vein in the access leg. No thrombus was seen in the control leg. This gives an incidence of 10% (95% CI 4-19%) with p value of 0.023 on Chi-square testing.
Conclusion
We found a statistically significant proportion of patients undergoing right sided cardiac catheter ablation developed acute proximal DVT on ultrasound. All patients were treated with 3 to 6 months of anticoagulation therapy in accordance with NICE guidelines. These results suggest that DVT may occur at a high frequency then previously thought in this cohort and supports the consideration of peri-procedural prophylactic anticoagulation.
Abstract Figure. Acute thrombus in the femoral vein
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Affiliation(s)
- C Bruce
- Manchester University NHS Foundation Trust, Manchester, United Kingdom of Great Britain & Northern Ireland
| | - S Rogers
- University of Manchester, Academic Surgery Unit, Manchester, United Kingdom of Great Britain & Northern Ireland
| | - K Saraf
- Manchester University NHS Foundation Trust, Manchester, United Kingdom of Great Britain & Northern Ireland
| | - G Kirkwood
- Sheffield Teaching Hospitals NHS Trust, Sheffield, United Kingdom of Great Britain & Northern Ireland
| | - N Kirkland
- Sheffield Teaching Hospitals NHS Trust, Sheffield, United Kingdom of Great Britain & Northern Ireland
| | - M Wright
- Guys and St Thomas Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - S Jamil-Copley
- Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom of Great Britain & Northern Ireland
| | - K Abozguia
- Blackpool Teaching Hospitals NHS Trust, Blackpool, United Kingdom of Great Britain & Northern Ireland
| | - D Fox
- Manchester University NHS Foundation Trust, Manchester, United Kingdom of Great Britain & Northern Ireland
| | - C Mccollum
- University of Manchester, Academic Surgery Unit, Manchester, United Kingdom of Great Britain & Northern Ireland
| | - G Morris
- Manchester University NHS Foundation Trust, Manchester, United Kingdom of Great Britain & Northern Ireland
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Kirkwood G, Snowdon R, Das M, Morgan M, Ronayne C, Shaw M, Maille B, Gupta A, Gupta D. P5766Low baseline impedance and impedance response predict late pulmonary vein reconnection after ablation index guided ablation in persistent AF. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5766] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- G Kirkwood
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - R Snowdon
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - M Das
- Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - M Morgan
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - C Ronayne
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - M Shaw
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - B Maille
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - A Gupta
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - D Gupta
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
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Burton RA, Chévez JER, Sauerbrey M, Guinovart C, Hartley A, Kirkwood G, Boslego M, Gavidia ME, Alemán Escobar JE, Turkel R, Steketee RW, Slutsker L, Schneider K, Campbell CCK. Factors Associated with the Rapid and Durable Decline in Malaria Incidence in El Salvador, 1980-2017. Am J Trop Med Hyg 2018; 99:33-42. [PMID: 29761766 PMCID: PMC6085812 DOI: 10.4269/ajtmh.17-0629] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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] [Indexed: 11/24/2022] Open
Abstract
A decade after the Global Malaria Eradication Program, El Salvador had the highest burden of malaria in Mesoamerica, with approximately 20% due to Plasmodium falciparum. A resurgence of malaria in the 1970s led El Salvador to alter its national malaria control strategy. By 1995, El Salvador recorded its last autochthonous P. falciparum case with fewer than 20 Plasmodium vivax cases annually since 2011. By contrast, its immediate neighbors continue to have the highest incidences of malaria in the region. We reviewed and evaluated the policies and interventions implemented by the Salvadoran National Malaria Program that likely contributed to this progress toward malaria elimination. Decentralization of the malaria program, early regional stratification by risk, and data-driven stratum-specific actions resulted in the timely and targeted allocation of resources for vector control, surveillance, case detection, and treatment. Weekly reporting by health workers and volunteer collaborators—distributed throughout the country by strata and informed via the national surveillance system—enabled local malaria teams to provide rapid, adaptive, and focalized program actions. Sustained investments in surveillance and response have led to a dramatic reduction in local transmission, with most current malaria cases in El Salvador due to importation from neighboring countries. Additional support for systematic elimination efforts in neighboring countries would benefit the region and may be needed for El Salvador to achieve and maintain malaria elimination. El Salvador’s experience provides a relevant case study that can guide the application of similar strategies in other countries committed to malaria elimination.
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Affiliation(s)
| | | | | | - Caterina Guinovart
- PATH Malaria Control and Elimination Partnership in Africa (MACEPA)/ISGlobal Collaboration, Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
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5
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Kirkwood G, Pollock AM. Patient choice and private provision decreased public provision and increased inequalities in Scotland: a case study of elective hip arthroplasty. J Public Health (Oxf) 2017; 39:593-600. [PMID: 27474759 DOI: 10.1093/pubmed/fdw060] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 06/02/2016] [Accepted: 05/23/2016] [Indexed: 11/14/2022] Open
Abstract
Background This is the first research to examine how the policy of patient choice and commercial contracting where NHS funds are given to private providers to tackle waiting times, impacted on direct NHS provision and treatment inequalities. Methods An ecological study of NHS funded elective primary hip arthroplasties in Scotland using routinely collected inpatient data 1 April 1993-31 March 2013. Results An increased use of private sector provision by NHS Boards was associated with a significant decrease in direct NHS provision in 2008/09 (P < 0.01) and with widening inequalities by age and socio-economic deprivation. National treatment rate fell from 143.8 (140.3, 147.3) per 100 000 in 2006/07 to 137.8 (134.4, 141.2) per 100 000 in 2007/08. By 2012/13, territorial NHS Boards had not recovered 2006/07 levels of provision; this was most marked for NHS Boards with the greatest use of private sector, namely Fife, Grampian and Lothian. Patients aged 85 years and over or living in the more deprived areas of Scotland appear to have been disadvantaged since the onset of patient choice in 2002. Conclusions NHS funding of private sector provision for elective hip arthroplasty was associated with a decrease in public provision and may have contributed to an increase in age and socio-economic inequalities in treatment rates.
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Affiliation(s)
- G Kirkwood
- Centre for Primary Care and Public Health, Blizard Institute, Queen Mary University of London, London E1 2AB, UK
| | - A M Pollock
- Centre for Primary Care and Public Health, Blizard Institute, Queen Mary University of London, London E1 2AB, UK
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Wong RKY, McEwan J, Finlayson D, Chung S, Wan L, Salbach NM, Kirkwood G, Meschino C, Wright FV. Reliability and validity of the acquired brain injury challenge assessment (ABI-CA) in children. Brain Inj 2014; 28:1734-43. [DOI: 10.3109/02699052.2014.947620] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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7
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Freitag A, Kirkwood G, Scharer S, Ofori-Asenso R, Pollock AM. PP75 Systematic review of rugby injuries in children and adolescents under 21 years. Br J Soc Med 2014. [DOI: 10.1136/jech-2014-204726.170] [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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Verne J, Brown P, Slater W, Towner E, Bellis MA, Anderson Z, Hughes K, Lyons RA, Turner S, Shepherd J, Barron S, Stone D, Fischbacher C, Lumsden E, Pollock A, Kirkwood G. Injury Prevention News (IPN): a free e-newsletter for the UK and Ireland. Inj Prev 2010. [DOI: 10.1136/ip.2010.029215.301] [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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Stone D, Lyons RA, Turner S, Quigg Z, Barron S, Bellis MA, Brown P, Fischbacher C, Hughes K, Kirkwood G, Lumsden E, Pollock A, Shepherd J, Slater W, Towner E, Verne J. Creation and early development of an injury observatory for Britain and Ireland (IOBI). Inj Prev 2010. [DOI: 10.1136/ip.2010.029215.372] [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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Pollock AM, Kirkwood G. Independent sector treatment centres: learning from a Scottish case study. Br J Soc Med 2009. [DOI: 10.1136/jech.2009.096727z] [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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12
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Howard L, Kirkwood G. Sudden infant death syndrome and psychiatric disorders. Eur Psychiatry 2007. [DOI: 10.1016/j.eurpsy.2007.01.1089] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Pilkington K, Kirkwood G, Rampes H, Fisher P, Richardson J. Homeopathy for anxiety and anxiety disorders: A systematic review of the research. HOMEOPATHY 2006; 95:151-62. [PMID: 16815519 DOI: 10.1016/j.homp.2006.05.005] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2005] [Revised: 01/30/2006] [Accepted: 05/08/2006] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To conduct a systematic review of the clinical research evidence on homeopathy in the treatment of anxiety and anxiety disorders. METHODS A comprehensive search of major biomedical databases: MEDLINE, EMBASE, ClNAHL, PsycINFO, Cochrane Library; and of specialist complementary and alternative medicine (CAM) databases: AMED, CISCOM and Hom-Inform was conducted. Efforts were made to identify unpublished and ongoing research using relevant sources and experts in the field. Relevant research was categorised by study type and appraised according to study design. Clinical commentaries were obtained for studies reporting clinical outcomes. RESULTS Eight randomised controlled studies were identified. The types of anxiety and anxiety disorders studied were test anxiety, generalised anxiety disorder and anxiety related to medical or physical conditions such as cancer or surgical procedures. Single case reports/studies were the most frequently encountered study type but other study types including uncontrolled trials/case series and surveys were also found. No relevant qualitative research was identified. CONCLUSIONS A comprehensive search demonstrates that the evidence on the benefit of homeopathy in anxiety and anxiety disorders is limited. A number of studies of homeopathy in such conditions were located but the randomised controlled trials report contradictory results, are underpowered or provide insufficient details of methodology. Several uncontrolled and observational studies reported positive results including high levels of patient satisfaction but because of the lack of a control group, it is difficult to assess the extent to which any response is due to homeopathy. Adverse effects reported appear limited to 'remedy reactions' and included temporary worsening of symptoms and reappearance of old symptoms. On the basis of this review it is not possible to draw firm conclusions on the efficacy or effectiveness of homeopathy for anxiety. However, surveys suggest that homeopathy is quite frequently used by people suffering from anxiety. If shown to be effective, it is possible that homeopathy may have benefits in terms of adverse effects and acceptability to patients. Consequently, further investigation is indicated. Future research should be of pragmatic design and include qualitative studies.
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Affiliation(s)
- K Pilkington
- School of Integrated Health, University of Westminster, London, UK.
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Abstract
Between March and June 2004, a systematic review was carried out of the research evidence on the effectiveness of yoga for the treatment of anxiety and anxiety disorders. Eight studies were reviewed. They reported positive results, although there were many methodological inadequacies. Owing to the diversity of conditions treated and poor quality of most of the studies, it is not possible to say that yoga is effective in treating anxiety or anxiety disorders in general. However, there are encouraging results, particularly with obsessive compulsive disorder. Further well conducted research is necessary which may be most productive if focused on specific anxiety disorders.
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Affiliation(s)
- G Kirkwood
- Research Council for Complementary Medicine, London, UK
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Abstract
OBJECTIVE To systematically review the research evidence on the effectiveness of homeopathy for the treatment of depression and depressive disorders. METHODS A comprehensive search of major biomedical databases including MEDLINE, EMBASE, CINAHL, PsycINFO and the Cochrane Library was conducted. Specialist complementary and alternative medicine (CAM) databases including AMED, CISCOM and Hom-Inform were also searched. Additionally, efforts were made to identify unpublished and ongoing research using relevant sources and experts in the field. Relevant research was categorised by study type and appraised according to study design. Clinical commentaries were obtained for studies reporting clinical outcomes. RESULTS Only two randomised controlled trials (RCTs) were identified. One of these, a feasibility study, demonstrated problems with recruitment of patients in primary care. Several uncontrolled and observational studies have reported positive results including high levels of patient satisfaction but because of the lack of a control group, it is difficult to assess the extent to which any response is due to specific effects of homeopathy. Single-case reports/studies were the most frequently encountered clinical study type. We also found surveys, but no relevant qualitative research studies were located.: Adverse effects reported appear limited to 'remedy reactions' ('aggravations') including temporary worsening of symptoms, symptom shifts and reappearance of old symptoms. These remedy reactions were generally transient but in one study, aggravation of symptoms caused withdrawal of the treatment in one patient. CONCLUSIONS A comprehensive search for published and unpublished studies has demonstrated that the evidence for the effectiveness of homeopathy in depression is limited due to lack of clinical trials of high quality. Further research is required, and should include well-designed controlled studies with sufficient numbers of participants. Qualitative studies aimed at overcoming recruitment and other problems should precede further RCTs. Methodological options include the incorporation of preference arms or uncontrolled observational studies. The highly individualised nature of much homeopathic treatment and the specificity of response may require innovative methods of analysis of individual treatment response.
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Affiliation(s)
- K Pilkington
- Research Council for Complementary Medicine, London, UK.
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Affiliation(s)
- J. Beddington
- Division of Biology, Faculty of Life Sciences, Imperial College LondonLondon SW7 1NAUK
| | - G. Kirkwood
- Division of Biology, Faculty of Life Sciences, Imperial College LondonLondon SW7 1NAUK
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