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Nolan J, Alagic F, Sokol-Randell D, Rotundo MP, Deasy C, Crowley J. A Video Analysis of Helmet Area Injuries and Helmet Type Worn in Hurling and Camogie Over 2 Seasons. Ir Med J 2024; 117:914. [PMID: 38446258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
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Effects of empagliflozin on progression of chronic kidney disease: a prespecified secondary analysis from the empa-kidney trial. Lancet Diabetes Endocrinol 2024; 12:39-50. [PMID: 38061371 PMCID: PMC7615591 DOI: 10.1016/s2213-8587(23)00321-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Sodium-glucose co-transporter-2 (SGLT2) inhibitors reduce progression of chronic kidney disease and the risk of cardiovascular morbidity and mortality in a wide range of patients. However, their effects on kidney disease progression in some patients with chronic kidney disease are unclear because few clinical kidney outcomes occurred among such patients in the completed trials. In particular, some guidelines stratify their level of recommendation about who should be treated with SGLT2 inhibitors based on diabetes status and albuminuria. We aimed to assess the effects of empagliflozin on progression of chronic kidney disease both overall and among specific types of participants in the EMPA-KIDNEY trial. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA), and included individuals aged 18 years or older with an estimated glomerular filtration rate (eGFR) of 20 to less than 45 mL/min per 1·73 m2, or with an eGFR of 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher. We explored the effects of 10 mg oral empagliflozin once daily versus placebo on the annualised rate of change in estimated glomerular filtration rate (eGFR slope), a tertiary outcome. We studied the acute slope (from randomisation to 2 months) and chronic slope (from 2 months onwards) separately, using shared parameter models to estimate the latter. Analyses were done in all randomly assigned participants by intention to treat. EMPA-KIDNEY is registered at ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and then followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroups of eGFR included 2282 (34·5%) participants with an eGFR of less than 30 mL/min per 1·73 m2, 2928 (44·3%) with an eGFR of 30 to less than 45 mL/min per 1·73 m2, and 1399 (21·2%) with an eGFR 45 mL/min per 1·73 m2 or higher. Prespecified subgroups of uACR included 1328 (20·1%) with a uACR of less than 30 mg/g, 1864 (28·2%) with a uACR of 30 to 300 mg/g, and 3417 (51·7%) with a uACR of more than 300 mg/g. Overall, allocation to empagliflozin caused an acute 2·12 mL/min per 1·73 m2 (95% CI 1·83-2·41) reduction in eGFR, equivalent to a 6% (5-6) dip in the first 2 months. After this, it halved the chronic slope from -2·75 to -1·37 mL/min per 1·73 m2 per year (relative difference 50%, 95% CI 42-58). The absolute and relative benefits of empagliflozin on the magnitude of the chronic slope varied significantly depending on diabetes status and baseline levels of eGFR and uACR. In particular, the absolute difference in chronic slopes was lower in patients with lower baseline uACR, but because this group progressed more slowly than those with higher uACR, this translated to a larger relative difference in chronic slopes in this group (86% [36-136] reduction in the chronic slope among those with baseline uACR <30 mg/g compared with a 29% [19-38] reduction for those with baseline uACR ≥2000 mg/g; ptrend<0·0001). INTERPRETATION Empagliflozin slowed the rate of progression of chronic kidney disease among all types of participant in the EMPA-KIDNEY trial, including those with little albuminuria. Albuminuria alone should not be used to determine whether to treat with an SGLT2 inhibitor. FUNDING Boehringer Ingelheim and Eli Lilly.
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T, Tamori Y, Tamura R, Tamura Y, Tan CHH, Tan EZZ, Tanabe A, Tanabe K, Tanaka A, Tanaka A, Tanaka N, Tang S, Tang Z, Tanigaki K, Tarlac M, Tatsuzawa A, Tay JF, Tay LL, Taylor J, Taylor K, Taylor K, Te A, Tenbusch L, Teng KS, Terakawa A, Terry J, Tham ZD, Tholl S, Thomas G, Thong KM, Tietjen D, Timadjer A, Tindall H, Tipper S, Tobin K, Toda N, Tokuyama A, Tolibas M, Tomita A, Tomita T, Tomlinson J, Tonks L, Topf J, Topping S, Torp A, Torres A, Totaro F, Toth P, Toyonaga Y, Tripodi F, Trivedi K, Tropman E, Tschope D, Tse J, Tsuji K, Tsunekawa S, Tsunoda R, Tucky B, Tufail S, Tuffaha A, Turan E, Turner H, Turner J, Turner M, Tuttle KR, Tye YL, Tyler A, Tyler J, Uchi H, Uchida H, Uchida T, Uchida T, Udagawa T, Ueda S, Ueda Y, Ueki K, Ugni S, Ugwu E, Umeno R, Unekawa C, Uozumi K, Urquia K, Valleteau A, Valletta C, van Erp R, Vanhoy C, Varad V, Varma R, Varughese A, Vasquez P, Vasseur A, Veelken R, Velagapudi C, Verdel K, Vettoretti S, Vezzoli G, Vielhauer V, Viera R, Vilar E, Villaruel S, Vinall L, Vinathan J, Visnjic M, Voigt E, von-Eynatten M, Vourvou M, Wada J, Wada J, Wada T, Wada Y, Wakayama K, Wakita Y, Wallendszus K, Walters T, Wan Mohamad WH, Wang L, Wang W, Wang X, Wang X, Wang Y, Wanner C, Wanninayake S, Watada H, Watanabe K, Watanabe K, Watanabe M, Waterfall H, Watkins D, Watson S, Weaving L, Weber B, Webley Y, Webster A, Webster M, Weetman M, Wei W, Weihprecht H, Weiland L, Weinmann-Menke J, Weinreich T, Wendt R, Weng Y, Whalen M, Whalley G, Wheatley R, Wheeler A, Wheeler J, Whelton P, White K, Whitmore B, Whittaker S, Wiebel J, Wiley J, Wilkinson L, Willett M, Williams A, Williams E, Williams K, Williams T, Wilson A, Wilson P, Wincott L, Wines E, Winkelmann B, Winkler M, Winter-Goodwin B, Witczak J, Wittes J, Wittmann M, Wolf G, Wolf L, Wolfling R, Wong C, Wong E, Wong HS, Wong LW, Wong YH, Wonnacott A, Wood A, Wood L, Woodhouse H, Wooding N, Woodman A, Wren K, Wu J, Wu P, Xia S, Xiao H, Xiao X, Xie Y, Xu C, Xu Y, Xue H, Yahaya H, Yalamanchili H, Yamada A, Yamada N, Yamagata K, Yamaguchi M, Yamaji Y, Yamamoto A, Yamamoto S, Yamamoto S, Yamamoto T, Yamanaka A, Yamano T, Yamanouchi Y, Yamasaki N, Yamasaki Y, Yamasaki Y, Yamashita C, Yamauchi T, Yan Q, Yanagisawa E, Yang F, Yang L, Yano S, Yao S, Yao Y, Yarlagadda S, Yasuda Y, Yiu V, Yokoyama T, Yoshida S, Yoshidome E, Yoshikawa H, Young A, Young T, Yousif V, Yu H, Yu Y, Yuasa K, Yusof N, Zalunardo N, Zander B, Zani R, Zappulo F, Zayed M, Zemann B, Zettergren P, Zhang H, Zhang L, Zhang L, Zhang N, Zhang X, Zhao J, Zhao L, Zhao S, Zhao Z, Zhong H, Zhou N, Zhou S, Zhu D, Zhu L, Zhu S, Zietz M, Zippo M, Zirino F, Zulkipli FH. Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial. Lancet Diabetes Endocrinol 2024; 12:51-60. [PMID: 38061372 DOI: 10.1016/s2213-8587(23)00322-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND The EMPA-KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62-0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16-1·59), representing a 50% (42-58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1). INTERPRETATION In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease. FUNDING Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council.
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Nolan J, McCarthy K, Farkas A, Avent ML. Feasibility of individualised patient modelling for continuous vancomycin infusions in outpatient antimicrobial therapy, a retrospective study. Int J Clin Pharm 2023; 45:1444-1451. [PMID: 37532840 DOI: 10.1007/s11096-023-01618-5] [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: 01/26/2023] [Accepted: 06/24/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND The area under the curve (AUC) to minimum inhibitory concentration (MIC) ratio is proposed as a therapeutic drug-monitoring parameter for dosing vancomycin continuous infusion in methicillin-resistant Staphylococcus aureus (MRSA) infection. Individualised pharmacokinetic-pharmacodynamic (PK/PD) calculation of AUC24 may better represent therapeutic dosing than current Therapeutic Drug Monitoring (TDM) practices, targeting a Steady State Concentration of 15-25 mg/L. AIM To compare real world TDM practice to theoretical, individualised, PK/PD target parameters utilising Bayesian predictions to steady state concentrations (Css) for outpatients on continuous vancomycin infusions. METHOD A retrospective single centre study was conducted at a tertiary hospital on adult patients, enrolled in an outpatient parenteral antimicrobial therapy (OPAT) program, receiving vancomycin infusions for MRSA infection. Retrospective Bayesian dosing was modelled to target PK/PD parameters and compared to real world data. RESULTS Fifteen patients were evaluated with 53% (8/15) achieved target CSS during hospitalisation, and 83% (13/15) as outpatient. Median Bayesian AUC/MIC was 613 mg.h/L with CSS 25 mg/L. Patients suffering an Acute Kidney Injury (33%) had higher AUC0-24/MIC values. Retrospective Bayesian modelling demonstrated on median 250 mg/24 h lower doses than that administered was required (R2 = 0.81) which achieved AUC24/MIC median 444.8 (range 405-460) mg.h/L and CSS 18.8 (range 16.8-20.4) mg/L. CONCLUSION Bayesian modelling could assist in obtaining more timely target parameters at lower doses for patients receiving continuous vancomycin infusion as part of an OPAT program, which may beget fewer adverse effects. Utilisation of personalised predictive modelling may optimise vancomycin prescribing, achieving earlier target concentrations as compared to empiric dosing regimens.
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Affiliation(s)
- J Nolan
- The Royal Brisbane and Women's Hospital, Herston, Australia.
- School of Medicine, University of Queensland, 4029, Herston, Australia.
| | - K McCarthy
- The Royal Brisbane and Women's Hospital, Herston, Australia
- School of Medicine, University of Queensland, 4029, Herston, Australia
| | - A Farkas
- Mount Sinai West Hospital, New York, USA
- Optimum Dosing Strategies, Bloomingdale, New York, USA
| | - M L Avent
- The Royal Brisbane and Women's Hospital, Herston, Australia
- Queensland Statewide Antimicrobial Stewardship Program, University of Queensland Centre for Clinical Research, Herston, Australia
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Winans T, Oaks Z, Choudhary G, Patel A, Huang N, Faludi T, Krakko D, Nolan J, Lewis J, Blair S, Lai Z, Landas SK, Middleton F, Asara JM, Chung SK, Wyman B, Azadi P, Banki K, Perl A. mTOR-dependent loss of PON1 secretion and antiphospholipid autoantibody production underlie autoimmunity-mediated cirrhosis in transaldolase deficiency. J Autoimmun 2023; 140:103112. [PMID: 37742509 PMCID: PMC10957505 DOI: 10.1016/j.jaut.2023.103112] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/31/2023] [Accepted: 09/05/2023] [Indexed: 09/26/2023]
Abstract
Transaldolase deficiency predisposes to chronic liver disease progressing from cirrhosis to hepatocellular carcinoma (HCC). Transition from cirrhosis to hepatocarcinogenesis depends on mitochondrial oxidative stress, as controlled by cytosolic aldose metabolism through the pentose phosphate pathway (PPP). Progression to HCC is critically dependent on NADPH depletion and polyol buildup by aldose reductase (AR), while this enzyme protects from carbon trapping in the PPP and growth restriction in TAL deficiency. Although AR inactivation blocked susceptibility to hepatocarcinogenesis, it enhanced growth restriction, carbon trapping in the non-oxidative branch of the PPP and failed to reverse the depletion of glucose 6-phosphate (G6P) and liver cirrhosis. Here, we show that inactivation of the TAL-AR axis results in metabolic stress characterized by reduced mitophagy, enhanced overall autophagy, activation of the mechanistic target of rapamycin (mTOR), diminished glycosylation and secretion of paraoxonase 1 (PON1), production of antiphospholipid autoantibodies (aPL), loss of CD161+ NK cells, and expansion of CD38+ Ito cells, which are responsive to treatment with rapamycin in vivo. The present study thus identifies glycosylation and secretion of PON1 and aPL production as mTOR-dependent regulatory checkpoints of autoimmunity underlying liver cirrhosis in TAL deficiency.
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Affiliation(s)
- T Winans
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA; Departments of Biochemistry and Molecular Biology, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA
| | - Z Oaks
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA; Departments of Biochemistry and Molecular Biology, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA
| | - G Choudhary
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA; Departments of Biochemistry and Molecular Biology, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA
| | - A Patel
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA; Departments of Biochemistry and Molecular Biology, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA
| | - N Huang
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA; Departments of Biochemistry and Molecular Biology, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA
| | - T Faludi
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA
| | - D Krakko
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA
| | - J Nolan
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA
| | - J Lewis
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA
| | - Sarah Blair
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA
| | - Z Lai
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA
| | - S K Landas
- Departments of Pathology, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA
| | - F Middleton
- Departments of Neuroscience, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA
| | - J M Asara
- Division of Signal Transduction, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - S K Chung
- Faculty of Medicine, Macau University of Science and Technology, Taipa, Macau
| | - B Wyman
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA; Departments of Biochemistry and Molecular Biology, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA
| | - P Azadi
- University of Georgia, Athens, GA 30602, USA
| | - K Banki
- Departments of Pathology, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA
| | - A Perl
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA; Departments of Microbiology and Immunology, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA; Departments of Biochemistry and Molecular Biology, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA.
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Nolan J, Mildred H, Broadbear JH, Knight T, Rao S. Are there underlying differences between sexually diverse and non-sexually diverse people diagnosed with Borderline Personality Disorder? Psychology & Sexuality 2022. [DOI: 10.1080/19419899.2022.2137057] [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: 10/24/2022]
Affiliation(s)
| | | | | | | | - S. Rao
- Spectrum, Eastern Health & Monash University
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Weight N, Moledina S, Zoccai GB, Zaman S, Smith T, Siller-Matula J, Dafaalla M, Rashid M, Nolan J, Mamas MA. Impact of pre-existing vascular disease on clinical outcomes in patients with non-ST-segment myocardial infarction: a nationwide cohort study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1158] [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: 11/12/2022] Open
Abstract
Abstract
Aims
Little is known about the outcomes and processes of care of patients with non ST-segment myocardial infarction (NSTEMI) who present with “polyvascular” disease.
Methods
We analysed 287,279 NSTEMI patients using the Myocardial Infarction National Audit Project (MINAP) registry. Clinical characteristics and outcomes were analysed according to history of affected vascular bed; coronary artery disease (CAD), cerebrovascular disease (CeVD) and peripheral vascular disease (PVD), with comparison to a historically disease-free control group; comprising 167,947 patients (59%). Further analyses compared cumulative number of affected beds with our control.
Results
After adjusting for demographics and management, vascular bed disease was associated with increased likelihood of MACE (CAD OR: 1.06, 95% CI: 1.01–1.12, P=0.02) (CeVD OR: 1.19, 95% CI: 1.12–1.27, P<0.001) (PVD OR: 1.22, 95% CI: 1.13–1.33, P<0.001) and in-hospital mortality (CeVD OR: 1.24, 95% CI: 1.16–1.32, P<0.001) (PVD OR: 1.33, 95% CI: 1.21–1.46, P<0.001). Patients with no vascular disease were less likely to be discharged on statins (PVD 88%, CeVD 86%, CAD 90% and control 78%), and those with moderate (EF 30–49%) or severe left ventricular systolic dysfunction (LVSD) (EF<30%) were less likely to be discharged on ACE inhibitors (CAD 82%, CeVD 77%, PVD 77%, control 74%). Patients with polyvascular disease were less likely to be discharged on DAPT (PVD 78%, CeVD 77%, CAD 80%, control 87%).
Conclusion
Polyvascular disease patients had a higher adjusted incidence of in-hospital mortality and MACE. Patients with no history of vascular disease were less likely to receive statins or ACE inhibitors/ARBs, but more likely to receive DAPT.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- N Weight
- Royal Stoke University Hospital, Cardiology , Stoke-on-Trent , United Kingdom
| | - S Moledina
- Royal Stoke University Hospital, Cardiology , Stoke-on-Trent , United Kingdom
| | - G B Zoccai
- Sapienza University of Rome, Department of Medical-Surgical Sciences and Biotechnologies , Rome , Italy
| | - S Zaman
- Westmead Hospital, Department of Cardiology , Sydney , Australia
| | - T Smith
- Trinity Health System, Cardiovascular Service Line , Ohio , United States of America
| | - J Siller-Matula
- Medical University of Vienna, Department of Internal Medicine II , Vienna , Austria
| | - M Dafaalla
- Royal Stoke University Hospital, Cardiology , Stoke-on-Trent , United Kingdom
| | - M Rashid
- Royal Stoke University Hospital, Cardiology , Stoke-on-Trent , United Kingdom
| | - J Nolan
- Royal Stoke University Hospital, Cardiology , Stoke-on-Trent , United Kingdom
| | - M A Mamas
- Royal Stoke University Hospital, Cardiology , Stoke-on-Trent , United Kingdom
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Upadhana PS, Jagannatha GNP, Dewi PISL, Nolan J, Pamungkas KMN, Wijaya AR, Wirawan H. OR17. Clinical characteristics and risk factors of reduced ejection fraction in coronary artery disease patients undergoing percutaneous coronary intervention at sanglah hospital denpasar, bali, indonesia in 2021: a cross-sectional hospital-based study. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartjsupp/suab122.016] [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: 11/13/2022]
Abstract
Abstract
Aims
This study was conducted to determine the clinical characteristics and risk factors of reduced ejection fraction (EF) in coronary artery disease (CAD) patients undergoing percutaneous coronary intervention (PCI).
Methods and Results
Analytical observational study with a cross-sectional study design was conducted. All patients diagnosed with CAD and had a history of PCI at Sanglah Hospital from December 2020 – June 2021 were enrolled. Univariate analysis was performed to demonstrate the baseline characteristics of the patients. Chi-Square analysis was performed to determine the association between variables. Kruskal-Wallis analysis was performed to determine the differences in clinical characteristics between groups of patients based on the EF. There were 196 patients included in this study. Most of the patients were male (n = 135, 68.9%), with median age of 59 (22-81). The median of the EF was 59.2% (22-81). The most common comorbid found in the patients was hypertension (n = 108, 55.1%). Chi-Square analysis showed a significant association between hyperuricemia (p = 0.019; PR = 1.815; 95%CI= 1.163-2.831), arrhythmias (p = 0.002; PR = 2.271; 95%CI=1.491-3.459), and cardiomegaly (p = 0.011; PR = 1.722; 95%CI=1.151-2.577) with the reduced EF. In logistic regression analysis, arrhythmia (p = 0.009; PR = 4.191; 95%CI=1.426-12.320) was significantly associated with reduced EF. Kruskal-Wallis analysis showed a significant difference in white blood cell (p = 0.021), neutrophil (p = 0.027), and serum glutamic pyruvic transaminase (p = 0.013) in patients based on the EF.
Conclusion
The comorbidity of CAD had a significant association with the reduced EF. Early intervention against this factor can improve the quality of management in the patient.
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Affiliation(s)
- P S Upadhana
- Bachelor of Medicine and Medical Profession Study, Faculty of Medicine, Udayana University , Denpasar, Bali, Indonesia
| | - G N P Jagannatha
- Bachelor of Medicine and Medical Profession Study, Faculty of Medicine, Udayana University , Denpasar, Bali, Indonesia
| | - P I S L Dewi
- Bachelor of Medicine and Medical Profession Study, Faculty of Medicine, Udayana University , Denpasar, Bali, Indonesia
| | - J Nolan
- Bachelor of Medicine and Medical Profession Study, Faculty of Medicine, Udayana University , Denpasar, Bali, Indonesia
| | - K M N Pamungkas
- Bachelor of Medicine and Medical Profession Study, Faculty of Medicine, Udayana University , Denpasar, Bali, Indonesia
| | - A R Wijaya
- Bachelor of Medicine and Medical Profession Study, Faculty of Medicine, Udayana University , Denpasar, Bali, Indonesia
| | - H Wirawan
- Division of Cardiology, Sanglah General Hospital Denpasar, Faculty of Medicine, Udayana University , Denpasar, Bali, Indonesia
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Taber C, Senbel S, Ezzeddine D, Nolan J, Ocel A, Artan NS, Kaya T. Sleep and Physical Performance: A Case Study of Collegiate Women's Division 1 Basketball Players. Annu Int Conf IEEE Eng Med Biol Soc 2021; 2021:6787-6790. [PMID: 34892666 DOI: 10.1109/embc46164.2021.9630820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
In this work, we present a case study to evaluate the connections between sleep, training load, and the perceptions of physical/emotional state of a collegiate, division 1 Women's basketball team. The study took place during the off- (3 weeks) and pre-season (6 weeks) while sleep was tracked using WHOOP wearable straps. Training load was recorded by the strength coach and athletes. Short Recovery and Short Stress (SRSS) questionnaire was used to evaluate the perceptions of athletes on their own emotional and physical states. Our results showed that heart rate measurements are associated with stress levels and recovery perception. We also discovered that the training load was not linked to the sleep variables without the considerations of athletic performance. However, training load may alter perceived stress and recovery which requires further exploration.
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Borovac J, Kwok C, Mohamed M, Fischman D, Savage M, Alraies C, Kalra A, Nolan J, Zaman A, Ahmed J, Bagur R, Mamas M. The predictive value of CHA2DS2-VASc score on adverse in-hospital outcomes among patients with the acute coronary syndrome and atrial fibrillation who undergo PCI. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1657] [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: 11/14/2022] Open
Abstract
Abstract
Background
Patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) and having concomitant atrial fibrillation (AF) have a greater risk of adverse short- and long-term outcomes and death compared with patients in the same setting but without AF. On the other hand, the predictive value of CHA2DS2-VASc score in terms of in-hospital mortality and periprocedural adverse events following PCI among patients with ACS and AF is unknown.
Purpose
We retrospectively analyzed data of patients with the main admission diagnosis of ACS that underwent PCI and had AF during the 2004–2014 period from the large nationwide US National Inpatient Sample (NIS) database.
Methods
A CHA2DS2-VASc score was calculated for each patient and incorporated into a multivariable-adjusted logistic regression to determine its independent impact on in-hospital outcomes consisting of death, acute kidney injury (AKI), bleeding, vascular injury, and stroke/transient ischemic attack (TIA).
Results
A total of 283,890 patients with AF who underwent PCI following ACS were included in the analysis. The average reported prevalence of the AF in the whole cohort was 10.0% with a significant trend (p<0.001) of increase during the observed 10-year period. The average age of the cohort was 72.1±11 years, 63.4% were male while the median CHA2DS2-VASc score was 3 (IQR 2–4). Crude rates of adverse in-hospital outcomes were significantly higher among patient groups with higher CHA2DS2-VASc score (Table 1). Following adjustment for baseline covariates, incremental increase in CHA2DS2-VASc score was independently associated with an increased odds of in-hospital death (OR 1.20, CI 95% 1.18–1.22), periprocedural vascular injury (OR 1.18, 95% CI 1.17–1.20), bleeding (OR 1.17, 95% CI 1.16–1.18), stroke/TIA (OR 1.17, 95% CI 1.15–1.19), and AKI (OR 1.05, 95% CI 1.04–1.06) (Figure 1).
Conclusions
The CHA2DS2-VASc score provides important prognostic information in ACS patients with AF undergoing PCI and is independently associated with in-hospital death and periprocedural adverse events. Therefore, CHA2DS2-VASc score could be used as a practical and inexpensive tool for risk stratification in this population.
Figure 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- J.A Borovac
- Keele University, Stoke-on-Trent, United Kingdom
| | - C.S Kwok
- Keele University, Stoke-on-Trent, United Kingdom
| | - M.O Mohamed
- Keele University, Stoke-on-Trent, United Kingdom
| | - D.L Fischman
- Thomas Jefferson University Hospital, Philadelphia, United States of America
| | - M Savage
- Thomas Jefferson University Hospital, Philadelphia, United States of America
| | - C Alraies
- Detroit Medical Center, Detroit, United States of America
| | - A Kalra
- Cleveland Clinic, Cleveland, United States of America
| | - J Nolan
- Keele University, Stoke-on-Trent, United Kingdom
| | - A Zaman
- Freeman Hospital, Newcastle-Upon-Tyne, United Kingdom
| | - J Ahmed
- Freeman Hospital, Newcastle-Upon-Tyne, United Kingdom
| | - R Bagur
- Keele University, Stoke-on-Trent, United Kingdom
| | - M.A Mamas
- Keele University, Stoke-on-Trent, United Kingdom
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Cook TM, Kelly F, Pearse R, Nolan J. Anaesthesia research capacity: time for a rethink in light of the COVID-19 pandemic. Anaesthesia 2020; 76:574-575. [PMID: 33090468 DOI: 10.1111/anae.15289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2020] [Indexed: 12/18/2022]
Affiliation(s)
- T M Cook
- Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - F Kelly
- Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - R Pearse
- Queen Mary University of London and Barts and The London School of Medicine and Dentistry, London, UK
| | - J Nolan
- Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
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Smith CA, Nolan J, Tritz DJ, Heavener TE, Pelton J, Cook K, Vassar M. Evaluation of reproducible and transparent research practices in pulmonology. Pulmonology 2020; 27:134-143. [PMID: 32739326 DOI: 10.1016/j.pulmoe.2020.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 01/10/2020] [Revised: 07/01/2020] [Accepted: 07/03/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Study reproducibility is valuable for validating or refuting results. Provision of reproducibility indicators, such as materials, protocols, and raw data in a study improve its potential for reproduction. Efforts to reproduce noteworthy studies in the biomedical sciences have resulted in an overwhelming majority of them being found to be unreplicable, causing concern for the integrity of research in other fields, including medical specialties. Here, we analyzed the reproducibility of studies in the field of pulmonology. METHODS 500 pulmonology articles were randomly selected from an initial PubMed search for data extraction. Two authors scoured these articles for reproducibility indicators including materials, protocols, raw data, analysis scripts, inclusion in systematic reviews, and citations by replication studies as well as other factors of research transparency including open accessibility, funding source and competing interest disclosures, and study preregistration. FINDINGS Few publications included statements regarding materials (10%), protocols (1%), data (15%), and analysis script (0%) availability. Less than 10% indicated preregistration. More than half of the publications analyzed failed to provide a funding statement. Conversely, 63% of the publications were open access and 73% included a conflict of interest statement. INTERPRETATION Overall, our study indicates pulmonology research is currently lacking in efforts to increase replicability. Future studies should focus on providing sufficient information regarding materials, protocols, raw data, and analysis scripts, among other indicators, for the sake of clinical decisions that depend on replicable or refutable results from the primary literature.
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Affiliation(s)
- C A Smith
- Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, 1111 W. 17th St., Tulsa, OK 74107 USA.
| | - J Nolan
- Kansas City University of Medicine and Biosciences, 2901 St Johns Blvd, Joplin, MO 64804, USA
| | - D J Tritz
- Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, 1111 W. 17th St., Tulsa, OK 74107 USA
| | - T E Heavener
- Department of Medicine, Citizens Memorial Hospital, 1500 N. Oakland Ave, Bolivar, MO 65613 USA
| | - J Pelton
- Department of Internal Medicine, Oklahoma State University Medical Center, 744 W. 9th St., Tulsa, OK 74127 USA
| | - K Cook
- Department of Internal Medicine, Oklahoma State University Medical Center, 744 W. 9th St., Tulsa, OK 74127 USA
| | - M Vassar
- Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, 1111 W. 17th St., Tulsa, OK 74107 USA
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Böttiger BW, Lockey A, Georgiou M, Greif R, Monsieurs KG, Mpotos N, Nikolaou N, Nolan J, Perkins G, Semeraro F, Wingen S. KIDS SAVE LIVES: ERC Position statement on schoolteachers' education and qualification in resuscitation. Resuscitation 2020; 151:87-90. [PMID: 32339597 PMCID: PMC7194866 DOI: 10.1016/j.resuscitation.2020.04.021] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 04/14/2020] [Accepted: 04/16/2020] [Indexed: 12/11/2022]
Affiliation(s)
- B W Böttiger
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany.
| | - A Lockey
- Emergency Department, Calderdale Royal Hospital, Halifax, United Kingdom
| | - M Georgiou
- American Medical Center, Nicosia, Cyprus
| | - R Greif
- Department of Anesthesiology and Pain Therapy, Bern University Hospital, University of Bern, Bern, Switzerland; School of Medicine, Sigmund Freud University Vienna, Vienna, Austria
| | - K G Monsieurs
- Emergency Department, Antwerp University Hospital, Edegem, Belgium
| | - N Mpotos
- Faculty of Medicine and Health Sciences, Ghent University and Department of Emergency Medicine, St. Lucas General Hospital, Ghent, Belgium
| | - N Nikolaou
- Department of Cardiology and Cardiac Intensive Care, Konstantopouleio General Hospital, Athens, Greece
| | - J Nolan
- Warwick Clinical Trials Unit, University of Warwick and Department of Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, United Kingdom
| | - G Perkins
- Warwick Clinical Trials Unit and University Hospitals Birmingham NHS Foundation Trust, University of Warwick, Coventry, United Kingdom
| | - F Semeraro
- Department of Anaesthesia, Intensive Care and EMS, Maggiore Hospital, Bologna, Italy
| | - S Wingen
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany
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14
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Villar L, Hegarty R, Van Tol M, Godwin I, Nolan J. Dietary nitrate metabolism and enteric methane mitigation in sheep consuming a protein-deficient diet. Anim Prod Sci 2020. [DOI: 10.1071/an18632] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
It was hypothesised that the inclusion of nitrate (NO3–) or cysteamine hydrochloride (CSH) in a protein deficient diet (4.8% crude protein; CP) would improve the productivity of sheep while reducing enteric methane (CH4) emissions. A complete randomised designed experiment was conducted with yearling Merino sheep (n = 24) consuming a protein-deficient wheaten chaff control diet (CON) alone or supplemented with 1.8% nitrate (NO3–; DM basis), 0.098% urea (Ur, DM basis) or 80 mg cysteamine hydrochloride/kg liveweight (CSH). Feed intake, CH4 emissions, volatile fatty acids (VFA), digesta kinetics and NO3–, nitrite (NO2–) and urea concentrations in plasma, saliva and urine samples were measured. There was no dietary effect on animal performance or digesta kinetics (P > 0.05), but adding NO3– to the CON diet reduced methane yield (MY) by 26% (P = 0.01). Nitrate supplementation increased blood MetHb, plasma NO3– and NO2– concentrations (P < 0.05), but there was no indication of NO2– toxicity. Overall, salivary NO3– concentration was greater than plasma NO3– (P < 0.05), indicating that NO3– was concentrated into saliva. Our results confirm the role of NO3– as an effective additive to reduce CH4 emissions, even in a highly protein-deficient diet and as a source of additional nitrogen (N) for microbial protein synthesis via N-recycling into saliva and the gut. The role of CSH as an additive in low quality diets for improving animal performance and reducing CH4 emissions is still unclear.
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Abstract
BACKGROUND Maintaining glycaemic control during exercise presents a significant challenge for people living with Type 1 diabetes. Significant glycaemic variability has been observed in athletes with Type 1 diabetes in competitive contexts. While very-low-carbohydrate ketogenic diets have been shown to minimize glycaemic excursions, no published data have examined if this translates to exercise. CASE REPORT We report the case of a 37-year-old man with Type 1 diabetes who successfully undertook a 4011 km cycle across Australia over 20 consecutive days whilst consuming a very-low-carbohydrate ketogenic diet. Continuous glucose monitoring data capture was 98.4% for the ride duration and showed remarkable glycaemic stability, with a standard deviation of 2.1 mmol/l (average interstitial glucose 6.1 mmol/l) and 80.4% of time spent within a range of 3.9-10 mmol/l. Interstitial glucose was <3 mmol/l for 2.1% of this time, with only a single episode of symptomatic hypoglycaemia prompting brief interruption of exercise for carbohydrate administration. CONCLUSION This case demonstrates the viability of a very-low-carbohydrate ketogenic diet in an individual with Type 1 diabetes undertaking exercise. While the effect of a very-low-carbohydrate ketogenic diet is yet to be examined more broadly in athletes with Type 1 diabetes, the glycaemic stability observed suggests that fat adaptation may attenuate glycaemic swings and reduce reliance on carbohydrate consumption during exercise for maintaining euglycaemia.
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Affiliation(s)
- J Nolan
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands
| | - A Rush
- Type 1 Diabetes Family Centre, Osborne Park, WA, Australia
| | - J Kaye
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands
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16
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Franzoni M, O'Connor DT, Marcar L, Power D, Moloney MA, Kavanagh EG, Leask RL, Nolan J, Kiely PA, Walsh MT. The Presence of a High Peak Feature Within Low-Average Shear Stimuli Induces Quiescence in Venous Endothelial Cells. Ann Biomed Eng 2019; 48:582-594. [PMID: 31555984 DOI: 10.1007/s10439-019-02371-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 09/18/2019] [Indexed: 11/24/2022]
Abstract
Wall shear stress (WSS) is an important stimulus in vascular remodelling and vascular lesion development. The current methods to assess and predict the risk associated with specific unsteady WSS consider the WSS mean values or the presence of reverse phases described by the oscillatory shear index. Recent evidence has shown that the accuracy of these methods is limited, especially with respect to the venous environment. Unsteady WSS are characterised by several features that may individually affect endothelial cells. Consequently, we assessed the effects of averaged WSS (TAWSS), temporal WSS gradient (TWSSG), maximum WSS (WSS peak) and reverse phase (OSI) by applying different WSS profiles to venous EC in-vitro, using a real-time controlled cone-and-plate cell-shearing device for 24 h. We found that TWSSG and WSS peak affect cell elongation and alignment respectively. We also found that the WSS waveforms with a peak of 1.5 Pa or higher significantly correlate with the induction of a protective phenotype. Cell phenotype induced by these high peak waveforms does not correlate to what is predicted by the hemodynamic indices currently used. The definition of reliable hemodynamic indices can be used to inform the computational models aimed at estimating the hemodynamic effects on vascular remodelling.
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Affiliation(s)
- M Franzoni
- School of Engineering, Bernal Institute, University of Limerick, Limerick, V94 T9PX, Ireland.,Health Research Institute, University of Limerick, Limerick, Ireland
| | - D T O'Connor
- School of Engineering, Bernal Institute, University of Limerick, Limerick, V94 T9PX, Ireland.,Health Research Institute, University of Limerick, Limerick, Ireland
| | - L Marcar
- School of Engineering, Bernal Institute, University of Limerick, Limerick, V94 T9PX, Ireland
| | - D Power
- Health Research Institute, University of Limerick, Limerick, Ireland.,Department of Vascular Surgery, University Hospital Limerick, Limerick, Ireland
| | - M A Moloney
- Health Research Institute, University of Limerick, Limerick, Ireland.,Department of Vascular Surgery, University Hospital Limerick, Limerick, Ireland
| | - E G Kavanagh
- Health Research Institute, University of Limerick, Limerick, Ireland.,Department of Vascular Surgery, University Hospital Limerick, Limerick, Ireland
| | - R L Leask
- Department of Chemical Engineering, McGill University, Montreal, Canada
| | - J Nolan
- Health Research Institute, University of Limerick, Limerick, Ireland.,Graduate Entry Medical School, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - P A Kiely
- Health Research Institute, University of Limerick, Limerick, Ireland.,Graduate Entry Medical School, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - M T Walsh
- School of Engineering, Bernal Institute, University of Limerick, Limerick, V94 T9PX, Ireland. .,Health Research Institute, University of Limerick, Limerick, Ireland.
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17
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Mc Namara S, Stokes S, Nolan J. The Emergence of New Psychoactive Substance (NPS) Benzodiazepines. A Survey of their Prevalence in Opioid Substitution Patients using LC-MS. Ir Med J 2019; 112:970. [PMID: 31642644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Benzodiazepines have a wide range of clinical uses being among the most commonly prescribed medicines globally. The EU Early Warning System on new psychoactive substances (NPS) has over recent years detected new illicit benzodiazepines in Europe’s drug market1. Additional reference standards were obtained and a multi-residue LCMS method was developed to test for 31 benzodiazepines or metabolites in urine including some new benzodiazepines which have been classified as New Psychoactive Substances (NPS) which comprise a range of substances, including synthetic cannabinoids, opioids, cathinones and benzodiazepines not covered by international drug controls. 200 urine samples from patients attending the HSE National Drug Treatment Centre (NDTC) who are monitored on a regular basis for drug and alcohol use and which tested positive for benzodiazepine class drugs by immunoassay screening were subjected to confirmatory analysis to determine what Benzodiazepine drugs were present and to see if etizolam or other new benzodiazepines are being used in the addiction population currently. Benzodiazepine prescription and use is common in the addiction population. Of significance we found evidence of consumption of an illicit new psychoactive benzodiazepine, Etizolam.
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Affiliation(s)
| | - S Stokes
- HSE National Drug Treatment Centre
| | - J Nolan
- HSE National Drug Treatment Centre
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18
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Shoaib A, Farag M, Nolan J, Rigby A, Patwala A, Rashid M, Kwok CS, Perveen R, Clark AL, Komajda M, Cleland JGF. Mode of presentation and mortality amongst patients hospitalized with heart failure? A report from the First Euro Heart Failure Survey. Clin Res Cardiol 2018; 108:510-519. [PMID: 30361818 PMCID: PMC6484773 DOI: 10.1007/s00392-018-1380-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 09/25/2018] [Indexed: 01/20/2023]
Abstract
BACKGROUND Heart failure is heterogeneous in aetiology, pathophysiology, and presentation. Despite this diversity, clinical trials of patients hospitalized for HF deal with this problem as a single entity, which may be one reason for repeated failures. METHODS The first EuroHeart Failure Survey screened consecutive deaths and discharges of patients with suspected heart failure during 2000-2001. Patients were sorted into seven mutually exclusive hierarchical presentations: (1) with cardiac arrest/ventricular arrhythmia; (2) with acute coronary syndrome; (3) with rapid atrial fibrillation; (4) with acute breathlessness; (5) with other symptoms/signs such as peripheral oedema; (6) with stable symptoms; and (7) others in whom the contribution of HF to admission was not clear. RESULTS The 10,701 patients enrolled were classified into the above seven presentations as follows: 260 (2%), 560 (5%), 799 (8%), 2479 (24%), 1040 (10%), 703 (7%), and 4691 (45%) for which index-admission mortality was 26%, 20%, 10%, 8%, 6%, 6%, and 4%, respectively. Compared to those in group 7, the hazard ratios for death during the index admission were 4.9 (p ≤ 0.001), 4.0 (p < 0.001), 2.2 (p < 0.001), 2.1 (p < 0.001), 1.4 (p < 0.04) and 1.4 (p = 0.04), respectively. These differences were no longer statistically significant by 12 weeks. CONCLUSION There is great diversity in the presentation of heart failure that is associated with very different short-term outcomes. Only a minority of hospitalizations associated with suspected heart failure are associated with acute breathlessness. This should be taken into account in the design of future clinical trials.
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Affiliation(s)
- Ahmad Shoaib
- Keele Cardiovascular Research Group, Institute of Applied Clinical Sciences and Centre for Prognosis Research, Keele University, Stoke on Trent, UK.
- Department of Academic Cardiology, University of Hull, Kingston upon Hull, UK.
| | - M Farag
- Postgraduate Medical School, University of Hertfordshire, Hertfordshire, UK
| | - J Nolan
- Keele Cardiovascular Research Group, Institute of Applied Clinical Sciences and Centre for Prognosis Research, Keele University, Stoke on Trent, UK
| | - A Rigby
- Department of Academic Cardiology, University of Hull, Kingston upon Hull, UK
| | - A Patwala
- Keele Cardiovascular Research Group, Institute of Applied Clinical Sciences and Centre for Prognosis Research, Keele University, Stoke on Trent, UK
| | - M Rashid
- Keele Cardiovascular Research Group, Institute of Applied Clinical Sciences and Centre for Prognosis Research, Keele University, Stoke on Trent, UK
| | - C S Kwok
- Keele Cardiovascular Research Group, Institute of Applied Clinical Sciences and Centre for Prognosis Research, Keele University, Stoke on Trent, UK
| | - R Perveen
- Department of Academic Cardiology, University of Hull, Kingston upon Hull, UK
| | - A L Clark
- Department of Academic Cardiology, University of Hull, Kingston upon Hull, UK
| | - M Komajda
- Department of Cardiology, University of Pierre and Marie Curie Paris VI, La Pitié-Salpêtrière Hospital, Paris, France
| | - J G F Cleland
- Robertson Centre for Biostatistics, University of Glasgow and National Heart and Lung Institute, Imperial College London, London, UK
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Nagaraja V, Generaeux P, Cohen M, Suh W, Alasnag M, Potts J, Gunning M, Nolan J, Bagur R, Mamas M. P6029Impact of elixhauser comorbidity score on the outcomes of transcatheter aortic valve replacement. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- V Nagaraja
- Prince of Wales Hospital, Cardiology, Sydney, Australia
| | - P Generaeux
- Morristown Medical Center, Cardiology, Morristown, United States of America
| | - M Cohen
- University of Miami Leonard M. Miller School of Medicine, Cardiology, Miami, United States of America
| | - W Suh
- University of California Los Angeles, Cardiology, Los Angeles, United States of America
| | - M Alasnag
- King Fahad Armed Forces Hospital, Cardiology, Jeddah, Saudi Arabia
| | - J Potts
- University Hospital of North Staffordshire, Cardiology, Stoke On Trent, United Kingdom
| | - M Gunning
- University Hospital of North Staffordshire, Cardiology, Stoke On Trent, United Kingdom
| | - J Nolan
- University Hospital of North Staffordshire, Cardiology, Stoke On Trent, United Kingdom
| | - R Bagur
- London Health Sciences Centre, Department of Medicine, and Epidemiology & Biostatistics, London, Canada
| | - M Mamas
- University Hospital of North Staffordshire, Cardiology, Stoke On Trent, United Kingdom
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20
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Shoaib A, Kinnaird T, Curzen N, Ludman P, Belder MD, Rashid M, Kwok CS, Nolan J, Zaman A, Mamas M. P3583Outcomes following percutaneous coronary intervention in Non-ST-segment elevation myocardial infarction patients with previous coronary artery bypass grafts surgery. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3583] [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: 11/13/2022] Open
Affiliation(s)
- A Shoaib
- Keele University, Keele Cardiovascular Research Group, Institute for Primary Care and Health Sciences, Keele, United Kingdom
| | - T Kinnaird
- University Hospital of Wales, Cardiff, United Kingdom
| | - N Curzen
- University of Southampton, Southampton, United Kingdom
| | - P Ludman
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - M D Belder
- James Cook University Hospital, Middlesborough, United Kingdom
| | - M Rashid
- Keele University, Keele Cardiovascular Research Group, Institute for Primary Care and Health Sciences, Keele, United Kingdom
| | - C S Kwok
- Keele University, Keele Cardiovascular Research Group, Institute for Primary Care and Health Sciences, Keele, United Kingdom
| | - J Nolan
- Keele University, Keele Cardiovascular Research Group, Institute for Primary Care and Health Sciences, Keele, United Kingdom
| | - A Zaman
- Newcastle University, Newcastle upon Tyne, United Kingdom
| | - M Mamas
- Keele University, Keele Cardiovascular Research Group, Institute for Primary Care and Health Sciences, Keele, United Kingdom
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21
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Rashid M, Potts J, Kwok C, Mohammed M, Shoaib A, Esnsor J, Ayyaz-Ul-Haq M, Nolan J, Mamas M. 5258Trends and outcomes of use of coronary angiography in management of non-ST-Elevation acute coronary syndromes (NSTEACS), a population based cohort study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.5258] [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: 11/14/2022] Open
Affiliation(s)
- M Rashid
- Keele University, 1. Keele Cardiovascular Research Group, Centre for Prognosis Research, Stoke On Trent, United Kingdom
| | - J Potts
- Keele University, 1. Keele Cardiovascular Research Group, Centre for Prognosis Research, Stoke On Trent, United Kingdom
| | - C Kwok
- Keele University, 1. Keele Cardiovascular Research Group, Centre for Prognosis Research, Stoke On Trent, United Kingdom
| | - M Mohammed
- Keele University, 1. Keele Cardiovascular Research Group, Centre for Prognosis Research, Stoke On Trent, United Kingdom
| | - A Shoaib
- Keele University, 1. Keele Cardiovascular Research Group, Centre for Prognosis Research, Stoke On Trent, United Kingdom
| | - J Esnsor
- Keele University, 1. Keele Cardiovascular Research Group, Centre for Prognosis Research, Stoke On Trent, United Kingdom
| | - M Ayyaz-Ul-Haq
- Keele University, 1. Keele Cardiovascular Research Group, Centre for Prognosis Research, Stoke On Trent, United Kingdom
| | - J Nolan
- Keele University, 1. Keele Cardiovascular Research Group, Centre for Prognosis Research, Stoke On Trent, United Kingdom
| | - M Mamas
- Keele University, 1. Keele Cardiovascular Research Group, Centre for Prognosis Research, Stoke On Trent, United Kingdom
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Nolan J, Edgar AD. An X-ray investigation of synthetic pyroxenes in the system acmite--diopside-water at 1000 kg/cm2 watervapour pressure. ACTA ACUST UNITED AC 2018. [DOI: 10.1180/minmag.1963.033.263.01] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
SummaryAn X-ray investigation has been made of synthetic pyroxenes in the system acmite-diopside, crystallized at 750° C and 1000 kg/cm2 water-vapour pressure. Lattice parameters of these pyroxenes have been determined by least squares analyses of powder diffraction patterns and show an approximately linear relationship with composition, plotted as weight per cent. A rapid X-ray method has also been devised for the determination of the compositions of pyroxenes of this series.
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23
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Pucar PA, Nolan J, Hissaria P. P92: IgG4 RELATED DISEASE: A SINGLE CENTRE EXPERIENCE FROM SOUTH AUSTRALIA. Intern Med J 2017. [DOI: 10.1111/imj.92_13578] [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: 11/30/2022]
Affiliation(s)
- PA Pucar
- SA Pathology Frome Road; Adelaide Australia
- Royal Adelaide Hospital; Adelaide Australia
| | - J Nolan
- SA Pathology Frome Road; Adelaide Australia
| | - P Hissaria
- SA Pathology Frome Road; Adelaide Australia
- Royal Adelaide Hospital; Adelaide Australia
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O’Halloran A, Laird E, Healy M, Moran R, Nolan J, Beatty S, Molloy A, Kenny R. CIRCULATING BIOMARKERS PREDICT INCIDENT FRAILTY: THE IRISH LONGITUDINAL STUDY ON AGEING (TILDA). Innov Aging 2017. [DOI: 10.1093/geroni/igx004.089] [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: 11/13/2022] Open
Affiliation(s)
| | - E.A. Laird
- Trinity College Dublin, Dublin, Ireland,
| | - M. Healy
- St. James’s Hospital, Dublin, Ireland,
| | - R. Moran
- Waterford Institute of Technology, Waterford, Ireland
| | - J. Nolan
- Waterford Institute of Technology, Waterford, Ireland
| | - S. Beatty
- Waterford Institute of Technology, Waterford, Ireland
| | - A. Molloy
- Trinity College Dublin, Dublin, Ireland,
| | - R. Kenny
- Trinity College Dublin, Dublin, Ireland,
- St. James’s Hospital, Dublin, Ireland,
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25
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Lockey DJ, Crewdson K, Davies G, Jenkins B, Klein J, Laird C, Mahoney PF, Nolan J, Pountney A, Shinde S, Tighe S, Russell MQ, Price J, Wright C. AAGBI: Safer pre-hospital anaesthesia 2017: Association of Anaesthetists of Great Britain and Ireland. Anaesthesia 2017; 72:379-390. [PMID: 28045209 PMCID: PMC5324693 DOI: 10.1111/anae.13779] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2016] [Indexed: 12/19/2022]
Abstract
Pre-hospital emergency anaesthesia with oral tracheal intubation is the technique of choice for trauma patients who cannot maintain their airway or achieve adequate ventilation. It should be carried out as soon as safely possible, and performed to the same standards as in-hospital emergency anaesthesia. It should only be conducted within organisations with comprehensive clinical governance arrangements. Techniques should be straightforward, reproducible, as simple as possible and supported by the use of checklists. Monitoring and equipment should meet in-hospital anaesthesia standards. Practitioners need to be competent in the provision of in-hospital emergency anaesthesia and have supervised pre-hospital experience before carrying out pre-hospital emergency anaesthesia. Training programmes allowing the safe delivery of pre-hospital emergency anaesthesia by non-physicians do not currently exist in the UK. Where pre-hospital emergency anaesthesia skills are not available, oxygenation and ventilation should be maintained with the use of second-generation supraglottic airways in patients without airway reflexes, or basic airway manoeuvres and basic airway adjuncts in patients with intact airway reflexes.
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Affiliation(s)
- D. J. Lockey
- North Bristol NHS TrustAAGBI Working PartyBristol UniversityBristolUK
| | - K. Crewdson
- Anaesthetics and Intensive Care MedicineSevern DeaneryUK
| | - G. Davies
- Royal London Hospital/Royal College of Emergency MedicineLondonUK
| | | | - J. Klein
- Derby Hospitals NHS Foundation TrustFaculty of Pre‐hospital CareRoyal College of Surgeons of EdinburghEdinburghUK
| | - C. Laird
- British Association for Immediate CareAuchterarderPerthshireUK
| | - P. F. Mahoney
- Royal Centre for Defence MedicineImperial CollegeLondonUK
| | - J. Nolan
- Royal United Hospital, BathAnaesthesia and Intensive Care Medicine/Resuscitation Medicine at Bristol UniversityRoyal College of AnaesthetistsBristolUK
| | - A. Pountney
- Mid‐Yorkshire NHS TrustBritish Association for Immediate CareIpswichSuffolkUK
| | - S. Shinde
- North Bristol NHS TrustAAGBI BoardBristolUK
| | - S. Tighe
- Countess of Chester HospitalAAGBI BoardChesterUK
| | - M. Q. Russell
- Kent, Surrey, Sussex Air Ambulance TrustRoyal College of General PractitionersTonbridgeUK
| | - J. Price
- Royal United Hospital BathGroup of Anaesthetists in TrainingAAGBIAvonUK
| | - C. Wright
- St Mary's Major Trauma CentreImperial CollegeMilitary Pre‐hospital Emergency MedicineLondonUK
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Brewster DH, Fischbacher CM, Nolan J, Nowell S, Redpath D, Nabi G. Risk of hospitalization and death following prostate biopsy in Scotland. Public Health 2017; 142:102-110. [PMID: 27810089 PMCID: PMC5226055 DOI: 10.1016/j.puhe.2016.10.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 05/16/2016] [Revised: 09/22/2016] [Accepted: 10/04/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To investigate the risk of hospitalization and death following prostate biopsy. STUDY DESIGN Retrospective cohort study. METHODS Our study population comprised 10,285 patients with a record of first ever prostate biopsy between 2009 and 2013 on computerized acute hospital discharge or outpatient records covering Scotland. Using the general population as a comparison group, expected numbers of admissions/deaths were derived by applying age-, sex-, deprivation category-, and calendar year-specific rates of hospital admissions/deaths to the study population. Indirectly standardized hospital admission ratios (SHRs) and mortality ratios (SMRs) were calculated by dividing the observed numbers of admissions/deaths by expected numbers. RESULTS Compared with background rates, patients were more likely to be admitted to hospital within 30 days (SHR 2.7; 95% confidence interval 2.4, 2.9) and 120 days (SHR 4.0; 3.8, 4.1) of biopsy. Patients with prior co-morbidity had higher SHRs. The risk of death within 30 days of biopsy was not increased significantly (SMR 1.6; 0.9, 2.7), but within 120 days, the risk of death was significantly higher than expected (SMR 1.9; 1.5, 2.4). The risk of death increased with age and tended to be higher among patients with prior co-morbidity. Overall risks of hospitalization and of death up to 120 days were increased both in men diagnosed and those not diagnosed with prostate cancer. CONCLUSIONS Higher rates of adverse events in older patients and patients with prior co-morbidity emphasizes the need for careful patient selection for prostate biopsy and justifies ongoing efforts to minimize the risk of complications.
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Affiliation(s)
- D H Brewster
- NHS National Services Scotland, Gyle Square, 1 South Gyle Crescent, Edinburgh, Scotland, UK; Centre for Population Health Sciences, University of Edinburgh, Edinburgh, Scotland, UK.
| | - C M Fischbacher
- NHS National Services Scotland, Gyle Square, 1 South Gyle Crescent, Edinburgh, Scotland, UK; Centre for Population Health Sciences, University of Edinburgh, Edinburgh, Scotland, UK
| | - J Nolan
- NHS National Services Scotland, Gyle Square, 1 South Gyle Crescent, Edinburgh, Scotland, UK
| | - S Nowell
- NHS National Services Scotland, Gyle Square, 1 South Gyle Crescent, Edinburgh, Scotland, UK
| | - D Redpath
- NHS National Services Scotland, Gyle Square, 1 South Gyle Crescent, Edinburgh, Scotland, UK
| | - G Nabi
- Section of Academic Urology, Cancer Research Division, School of Medicine, Ninewells Hospital, Dundee, Scotland, UK; Department of Surgical Urology, Ninewells Hospital, NHS Tayside, Dundee, Scotland, UK
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Nolan J, Mummery V, Moses R. The impact of a specialist COPD rapid access physiotherapy pathway within the acute medicine unit (AMU). Physiotherapy 2016. [DOI: 10.1016/j.physio.2016.10.262] [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: 10/20/2022]
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Dick WF, Baskett PJF, Grande C, Delooz H, Kloeck W, Lackner C, Lipp M, Mauritz W, Nerlich M, Nicholl J, Nolan J, Oakley P, Parr M, Seekamp A, Soreide E, Steen PA, van Camp L, Wolcke B, Yates D. Recommendations for uniform reporting of data following major trauma - the Utstein style. Trauma 2016. [DOI: 10.1177/146040860000200105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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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Benger J, Coates D, Davies S, Greenwood R, Nolan J, Rhys M, Thomas M, Voss S. Randomised comparison of the effectiveness of the laryngeal mask airway supreme, i-gel and current practice in the initial airway management of out of hospital cardiac arrest: a feasibility study. Br J Anaesth 2016; 116:262-8. [DOI: 10.1093/bja/aev477] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Nolan J. 2015 Resuscitation Guidelines. Notf Rett Med 2015. [DOI: 10.1007/s10049-015-0102-0] [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: 10/22/2022]
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Bryant M, Farrar R, Freeman R, Brummitt K, Nolan J, Neville A. Galvanically enhanced fretting-crevice corrosion of cemented femoral stems. J Mech Behav Biomed Mater 2014; 40:275-286. [DOI: 10.1016/j.jmbbm.2014.08.021] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 08/14/2014] [Accepted: 08/22/2014] [Indexed: 12/14/2022]
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Affiliation(s)
- M. Stroud
- University Hospital Southampton Southampton UK
| | - J. Nolan
- Royal United Hospital NHS Trust Bath UK
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Affiliation(s)
- M. A. Stroud
- University Hospitals Southampton; Southampton UK
| | - J. Nolan
- Royal United Hospital NHS Trust; Bath UK
| | - N. Soni
- Chelsea and Westminster Hospital; London UK
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Hurford D, Cook T, Nolan J, Mihai R. Control group bias: a potential cause of over-estimating the benefit of videolaryngoscopy on laryngeal view. Br J Anaesth 2013; 111:124-5. [DOI: 10.1093/bja/aet184] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Krishnamoorthy S, Rowley S, Barth L, Wade E, Nolan J, Gunning M. 147 THE INDICATIONS AND OUTCOMES OF BALLOON AORTIC VALVULOPLASTY: A SINGLE CENTRE EXPERIENCE. Heart 2013. [DOI: 10.1136/heartjnl-2013-304019.147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Lahjibi E, Heude B, Dekker JM, Højlund K, Laville M, Nolan J, Oppert JM, Balkau B. Impact of objectively measured sedentary behaviour on changes in insulin resistance and secretion over 3 years in the RISC study: interaction with weight gain. Diabetes Metab 2013; 39:217-25. [PMID: 23541222 DOI: 10.1016/j.diabet.2012.12.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Revised: 12/10/2012] [Accepted: 12/15/2012] [Indexed: 11/29/2022]
Abstract
AIMS The importance of reducing sedentary time is increasingly being recognized in the prevention of diabetes and cardiovascular disease. Despite this, the prospective association between sedentary time and physical activity with insulin sensitivity and cardiometabolic risk factors has been little studied. METHODS In an analysis of data from the European RISC study, sedentary time and time spent in activity of moderate or vigorous intensity were assessed by accelerometry at baseline in 313 men and 414 women, aged 30-60 years, with insulin sensitivity as measured by euglycaemic-hyperinsulinaemic clamp. Three years later, cardiometabolic risk factors (anthropometry, glucose, insulin, lipids) were available for 549 participants. RESULTS In cross-sectional analyses using baseline data, after adjusting for age, gender, recruitment centre and time spent in activity of moderate or vigorous intensity, significant unfavourable associations were observed between higher sedentary time with body weight, HDL cholesterol, triglycerides, clamp-measured insulin sensitivity and insulin secretion (all P(trend)<0.002). Sedentary time remained significantly associated with insulin secretion after adjusting for insulin sensitivity (P(trend)=0.02). In longitudinal analyses, higher baseline sedentary time was associated with 3-year increases in fasting glucose, fasting insulin and the HOMA insulin-resistance index score for the 50% of the study population who increased their BMI by at least 0.3 kg/m(2) (all P(trend)<0.01); these relationships remained significant after adjusting for time spent in activity of moderate or vigorous intensity. The 3-year increase in insulin secretion was lower in those spending more time doing activity of moderate or vigorous intensity (P(trend)=0.03). CONCLUSION These prospective data suggest that less sedentary behaviour may partly counteract some of the negative effects of increasing body weight on glucose-insulin homoeostasis.
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Affiliation(s)
- E Lahjibi
- INSERM CESP Centre for Research in Epidemiology and Population Health, U1018, Epidemiology of diabetes, obesity and chronic kidney disease over the life course, 16, avenue Paul-Vaillant-Couturier, 94807 Villejuif cedex, France
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Orellana-Boero P, Seradj A, Fondevila M, Nolan J, Balcells J. Modelling urinary purine derivatives excretion as a tool to estimate microbial rumen outflow in alpacas (Vicugna pacos). Small Rumin Res 2012. [DOI: 10.1016/j.smallrumres.2012.04.006] [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: 10/28/2022]
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McMillan ND, Reddin M, Neill MO, Jordan R, Phillips D, Goff D, Nolan J, Harnedy R, Mitchell W, Harkin J, Lawlor V, McMillan LRL. The Tensiograph - A Novel Instrument for the Fingerprinting and Analysis of Multiple Physical Attributes of Beer. Journal of the Institute of Brewing 2012. [DOI: 10.1002/j.2050-0416.2000.tb00051.x] [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] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Li L, Davis J, Nolan J, Hegarty R. An initial investigation on rumen fermentation pattern and methane emission of sheep offered diets containing urea or nitrate as the nitrogen source. Anim Prod Sci 2012. [DOI: 10.1071/an11254] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The effects of dietary nitrate and of urea on rumen fermentation pattern and enteric methane production were investigated using 4-month-old ewe lambs. Ten lambs were allocated into two groups (n = 5) and each group was offered one of two isonitrogenous and isoenergetic diets containing either 1.5% urea (T1) or 3% calcium nitrate (T2). Methane production was estimated using open-circuit respiration chambers after 6 weeks of feeding. No difference in nitrogen (N) balance, apparent digestibility of N or microbial N outflow existed between treatments (P > 0.05). Animals offered the T2 diet lost less energy through methane than did those fed the T1 diet (P < 0.05). Total volatile fatty acid concentration, molar proportion of propionate, and the molar ratio of acetate to propionate in rumen fluid were not affected by dietary N source. Compared with urea inclusion, nitrate inclusion caused a significantly higher acetate and lower butyrate percentage in rumen volatile fatty acid. Nitrate supplementation tended to lower methane production by ~7.7 L/day relative to urea supplementation (P = 0.06). Methane yield (L/kg DM intake) was reduced (P < 0.05) by 35.4% when 1.5% urea was replaced by 3% calcium nitrate in the diet. Emission intensity (L methane/kg liveweight gain) was ~17.3% lower in the nitrate-supplemented sheep when compared with urea-fed sheep; however, the reduction was not statistically significant (P > 0.05). This study confirms that the presence of nitrate in the diet inhibits enteric methane production. As no clinical symptoms of nitrite toxicity were observed and sheep receiving nitrate-supplemented diet had similar growth to those consuming urea-supplemented diet, it is concluded that 3% calcium nitrate can replace 1.5% urea as a means of meeting ruminal N requirements and of reducing enteric methane emissions from sheep, provided animals are acclimated to nitrate gradually.
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Beringer RM, Kelly F, Cook TM, Nolan J, Hardy R, Simpson T, White MC. A cohort evaluation of the paediatric i-gel™ airway during anaesthesia in 120 children*. Anaesthesia 2011; 66:1121-6. [DOI: 10.1111/j.1365-2044.2011.06884.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Charalampidou S, Nolan J, Loughman J, Stack J, Higgins G, Cassidy L, Beatty S. Psychophysical impact and optical and morphological characteristics of symptomatic non-advanced cataract. Eye (Lond) 2011; 25:1147-54. [PMID: 21660066 DOI: 10.1038/eye.2011.123] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To investigate whether psychophysical, morphological, and/or optical characteristics of symptomatic non-advanced cataract are complementary to, or more appropriate than, visual acuity (VA) for the purposes of recording visual data that reflect subjective visual difficulty in patients with cataract that exhibit relative sparing of high contrast acuity (0.4 logarithm of minimal angle of resolution (logMAR) scale or better). METHODS Eighty-two patients with symptomatic non-advanced cataract and no other ocular pathology were asked to complete a validated questionnaire, and to perform a series of visual function assessments including: corrected distance VA (CDVA); photopic and mesopic contrast sensitivity; photopic and mesopic glare disability (GD); reading acuity and reading speed; stereoacuity; and retinal sensitivity. Optical and morphological characteristics of the cataract were evaluated by lens optical density and by the Lens Opacities Classification System III, respectively. Correlations between questionnaire score and each of these measures were calculated. RESULTS Statistically significant negative correlations were observed between the Rasch-scaled questionnaire score and mesopic GD (at 3 and 6 cycles per degree (cpd); r=-0.396 (P<0.01) and -0.451 (P<0.05), respectively) and between the Rasch-scaled questionnaire score and photopic GD (at 3 and 6 cpd; r=-0.328 (P<0.01) and -0.440 (P<0.01), respectively). CONCLUSION Symptomatic non-advanced cataract, in the presence of good CDVA, is associated with measurable subjective visual difficulty, best reflected in a decrease in mesopic and photopic GD (at medium spatial frequencies). CDVA does not reflect the patient's visual dissatisfaction in such cases.
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Affiliation(s)
- S Charalampidou
- Institute of Eye Surgery, Whitfield Clinic, Waterford, Ireland.
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Low D, Clark N, Soar J, Padkin A, Stoneham A, Perkins GD, Nolan J. A randomised control trial to determine if use of the iResus© application on a smart phone improves the performance of an advanced life support provider in a simulated medical emergency. Anaesthesia 2011; 66:255-62. [PMID: 21401537 DOI: 10.1111/j.1365-2044.2011.06649.x] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This study sought to determine whether using the Resuscitation Council UK's iResus© application on a smart phone improves the performance of doctors trained in advanced life support in a simulated emergency. Thirty-one doctors (advanced life support-trained within the previous 48 months) were recruited. All received identical training using the smart phone and the iResus application. The participants were randomly assigned to a control group (no smart phone) and a test group (access to iResus on smart phone). Both groups were tested using a validated extended cardiac arrest simulation test (CASTest) scoring system. The primary outcome measure was the overall cardiac arrest simulation test score; these were significantly higher in the smart phone group (median (IQR [range]) 84.5 (75.5-92.5 [64-96])) compared with the control group (72 (62-87 [52-95]); p=0.02). Use of the iResus application significantly improves the performance of an advanced life support-certified doctor during a simulated medical emergency. Further studies are needed to determine if iResus can improve care in the clinical setting.
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Affiliation(s)
- D Low
- Department of Anaesthesia, Royal United Hospital, Bath, UK.
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Sandroni C, Nolan J. ERC 2010 guidelines for adult and pediatric resuscitation: summary of major changes. Minerva Anestesiol 2011; 77:220-226. [PMID: 21368728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The new European Resuscitation Council (ERC) guidelines for cardiopulmonary resuscitation (CPR) published on October 18th, 2010, replace those published in 2005 and are based on the latest International Consensus on CPR Science with Treatment Recommendations (CoSTR). For both adult and pediatric resuscitation, the most important general changes include: the introduction of chest compression-only CPR in primary cardiac arrest as an option for rescuers who are unable or unwilling to perform expired-air ventilation; increased emphasis on uninterrupted, good-quality CPR and minimisation of both pre- and post-shock pauses during defibrillation. For adult resuscitation, the recommended chest compression depth and rate are 5-6 cm and 100-120 compressions per minute, respectively. Both a specific period of CPR before defibrillation during out-of-hospital resuscitation and use of endotracheal route for drug delivery during advanced life support are no longer recommended. During postresuscitation care, inspired oxygen should be titrated to obtain an arterial oxygen saturation of 94-98%, to avoid possible damage from hyperoxemia. In pediatric resuscitation, the role of pulse palpation for the diagnosis of cardiac arrest has been de-emphasised. The compression-to-ventilation ratio depends on the number of rescuers available, and a 30:2 ratio is acceptable even for rescuers with a duty to respond if they are alone. Chest compression depth should be at least 1/3 of the anterior-posterior chest diameter. The use of automated external defibrillators for children under one year of age should be considered.
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Affiliation(s)
- C Sandroni
- Department of Anesthesiology and Intensive Care, Catholic University School of Medicine, Policlinico Universitario "Agostino Gemelli", Rome, Italy.
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Patil S, Bhayani S, Denton JM, Nolan J. Therapeutic hypothermia for out-of-hospital cardiac arrest: implementation in a district general hospital emergency department. Emerg Med J 2010; 28:970-3. [DOI: 10.1136/emj.2010.091439] [Citation(s) in RCA: 4] [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: 11/04/2022]
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Field R, Soar J, Nolan J, Perkins G. Content analysis of resuscitation in the lay-press. Resuscitation 2010. [DOI: 10.1016/j.resuscitation.2010.09.396] [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: 10/18/2022]
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Dodd JW, Hogg L, Nolan J, Jefford H, Lord VM, Garrod R, Polkey MI, Jones PW, D-C Man W, Hopkinson NS. S76 The COPD assessment test score (CAT): a multicentre, prospective study of response to pulmonary rehabilitation. Thorax 2010. [DOI: 10.1136/thx.2010.150938.27] [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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Abstract
Perspectives on nail gun safety were sought from residential contractors as part of an injury surveillance and prevention effort (2005-2008). Anonymous surveys inquired about tool use, training, injury risk, and awareness of the 2003 American National Standards Institute (ANSI) standard calling for shipment of pneumatic nail guns used in wood framing with sequential actuation. Despite some awareness of inexperience, lack of training, speed and tool design in injury causation, 55 percent consistently reported injuries resulted from worker carelessness. Contractors reported safety experiences of their employees were considerably better than those of other residential contractors. After five years, only 16 percent reported any awareness of the voluntary standard. These findings raise questions as to what gains can realistically be expected from passage of voluntary standards such as the one described here. Given that the epidemiology of acute injuries from pneumatic nail guns is now well-described, the safer sequential trigger should be required to protect workers.
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Affiliation(s)
- H J Lipscomb
- Duke University Medical Center, Durham, NC 27710, USA.
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