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Newton A, Julian H, Theodoraki M, Redfern J, Cheung G, Brown D. Modes of failure following locking plate fixation of the distal radius: a thematic analysis of 517 fractures. J Hand Surg Eur Vol 2024; 49:366-371. [PMID: 37310030 DOI: 10.1177/17531934231179382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Anterior locking plate fixation of the distal radius is a common procedure with reliable results. Failure of fixation is sometimes seen. The aim of the present study was to identify the reasons for failure. In total, 517 cases met the study inclusion criteria. Of them, 23 cases had failure of fixation (4.4%). Failure analysis generated qualitative data. Subsequent thematic analysis identified the primary mode of failure and contributing factors. Primary modes were identified as failure to support all key fracture fragments (n = 20), wrong choice of implant (n = 1), failure of union (n = 1) and poor bone quality (n = 1). Contributing factors were errors in plate positioning, fracture reduction, implant selection and screw configuration, as well as fracture pattern complexity and poor bone quality. Most failed fixations had a primary mode and two or three contributing factors. Overall anterior plating is reliable with a low rate of surgical failure. Knowledge of failure modes will aid operative planning and prevent failure.Level of evidence: V.
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Affiliation(s)
- Ashley Newton
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Harriet Julian
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Mona Theodoraki
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - James Redfern
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Graham Cheung
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Daniel Brown
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
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2
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Julian HS, Kandemir G, Redfern J, J Joyce T, Brown DJ. Impingement-related osteolysis in Motec total wrist arthroplasty: an explant analysis and review of the literature. J Hand Surg Eur Vol 2024; 49:34-39. [PMID: 37666215 DOI: 10.1177/17531934231194287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
Abstract
We present five cases of osteolysis in the Motec total wrist prosthesis, three around the radial implant, one around the metacarpal implant and one around both. Three of these were progressive and required revision, and biomechanical explant analyses of these revised prostheses were performed. Ex vivo testing of the contact points of the Motec implants was also performed at maximum extension. Here, impingement occurs between the metacarpal screw and the dorsal rim of the cup (non-articulating surfaces) with the short-necked prosthesis, leading to metacarpal screw damage, titanium debris formation and osteolysis. An analysis of three previously published cases suggests that this may have been the likely mode of failure in those cases. This complication is preventable by avoiding use of the short-neck prosthesis.Level of evidence: IV.
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Affiliation(s)
- Harriet S Julian
- Liverpool University Hospitals NHS Foundation Trust. Department of Orthopaedics, Broadgreen Hospital, Liverpool, UK
| | - Göksu Kandemir
- School of Engineering, Newcastle University, Newcastle upon Tyne, UK
| | - James Redfern
- Liverpool University Hospitals NHS Foundation Trust. Department of Orthopaedics, Broadgreen Hospital, Liverpool, UK
| | - Thomas J Joyce
- School of Engineering, Newcastle University, Newcastle upon Tyne, UK
| | - Daniel J Brown
- Liverpool University Hospitals NHS Foundation Trust. Department of Orthopaedics, Broadgreen Hospital, Liverpool, UK
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Verran J, Wood J, Redfern J, Moravej H, Radclyffe-Thomas N. Hands On Biofilm! A multidisciplinary public engagement event using kombucha tea pellicle as an accessible example of biofilm. Biofilm 2023; 6:100169. [PMID: 38161327 PMCID: PMC10755530 DOI: 10.1016/j.bioflm.2023.100169] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 12/01/2023] [Accepted: 12/03/2023] [Indexed: 01/03/2024] Open
Abstract
Public engagement with science has become increasingly important for the scientific community. There are many documented public engagement events that focus on aspects of microbiology, but relatively few utilise biofilms as a topic, despite their importance. Kombucha tea pellicles are easy to grow biofilms, facilitating their use within the public domain as examples of these complex communities. The aim of this work was to deliver a public engagement event that introduced visitors to general concepts about biofilm, and applications around sustainability, using kombucha. The event encouraged visitors to: build a biofilm using model clay; inoculate kombucha tea cultures using different incubation conditions, as part of a citizen science experiment to assess impact on pellicle biofilm yield; create garments and drapes on mini-mannequins using dried kombucha pellicle fabric, and demonstrate the range and importance of fermented foods (including kombucha tea), and 'good bacteria'. Quantitative and qualitative indicators of engagement were built into the activities. More than 1200 visitors, mainly in family groups, visited the event over a 4-h period. Knowledge of biofilms was low at the beginning of the event. Participation in all activities was high. Indicators of quantitative engagement were impressive, but it was difficult to obtain qualitative evidence other than observations from the delivery team (nineteen members) because of the intensity of the event and volume of visitors. The event was clearly successful in terms of fulfilment of aims, audience engagement and enthusiasm: the embedded evaluations helped to evidence the impact and reach of the event, enabling confidence in dissemination of good practice in the enhancement of public understanding of the importance of biofilm in general, and kombucha in particular.
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Affiliation(s)
- Joanna Verran
- Department of Life Science, Manchester Metropolitan University, Manchester, M1 5GD, UK
| | - Jane Wood
- Textile and Fashion Technology, University of Manchester, Manchester, UK
| | - James Redfern
- Department of Natural Sciences, Manchester Metropolitan University, Manchester, M1 5GD, UK
| | - Haleh Moravej
- Department of Health Professions, Manchester Metropolitan University, Manchester, UK
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4
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Ragupathy R, Jolley KA, Zamuner C, Jones JB, Redfern J, Behlau F, Ferreira H, Enright MC. Core-Genome Multilocus Sequence Typing for Epidemiological and Evolutionary Analyses of Phytopathogenic Xanthomonas citri. Appl Environ Microbiol 2023; 89:e0210122. [PMID: 37067413 DOI: 10.1128/aem.02101-22] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2023] Open
Abstract
Xanthomonas citri subsp. citri is the cause of bacterial citrus canker, responsible for major economic losses to the citrus industry. X. citri subspecies and pathovars are responsible for diseases in soybean, common bean, mango, pomegranate, and cashew. X. citri disease has been tracked using several typing methods, but recent studies using genomic sequencing have been key to understanding the evolutionary relationships within the species, including fundamental differences among X. citri subsp. citri pathotypes. Here, we describe a core-genome multilocus sequence typing (cgMLST) scheme for X. citri based on 250 genomes comprising multiple examples of X. citri subsp. citri pathotypes A, A*, and Aw; X. citri subsp. malvacearum; X. citri pv. aurantifolii, pv. fuscans, pv. glycines, pv. mangiferaeindicae, pv. viticola, and pv. vignicola; and single isolates of X. citri pv. dieffenbachiae and pv. punicae. This data set included genomic sequencing of 100 novel X. citri subsp. citri isolates. cgMLST, based on 1,618 core genes across 250 genomes, is implemented at PubMLST (https://pubmlst.org/organisms/xanthomonas-citri/). GrapeTree minimum-spanning tree and Interactive Tree of Life (iTOL) neighbor-joining phylogenies generated from the cgMLST data resolved almost identical groupings of isolates to a core-genome single nucleotide polymorphism (SNP)-based neighbor-joining phylogeny. These resolved identical groupings of X. citri subsp. citri pathotypes and X. citri subspecies and pathovars. X. citri cgMLST should prove to be an increasingly valuable resource for the study of this key species of plant-pathogenic bacteria. Users can submit genomic data and associated metadata for comparison with previously characterized isolates at PubMLST to allow the rapid characterization of the local, national, and global epidemiology of these pathogens and examine evolutionary relationships. IMPORTANCE Xanthomonas citri is a plant pathogen that causes major economic losses to the citrus industry and sweet orange production in particular. Several subspecies and pathogens are recognized, with host ranges including soybean, common bean, mango, pomegranate, and cashew, among others. Recent genomic studies have shown that host-adapted X. citri subspecies and pathovars and X. citri subsp. citri pathotypes form distinct clades. In this study, we describe a core-genome multilocus sequence typing (cgMLST) scheme for this species that can rapidly and robustly discriminate among these ecologically distinct, host-adapted clades. We have established this scheme and associated databases containing genomic sequences and metadata at PubMLST, which users can interrogate with their own genome sequences to determine X. citri subspecies, pathovars, and pathotypes. X. citri cgMLST should prove to be an invaluable tool for the study of the epidemiology and evolution of this major plant pathogen.
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Affiliation(s)
- R Ragupathy
- Department of Life Sciences, Manchester Metropolitan University, Manchester, United Kingdom
| | - K A Jolley
- Department of Biology, University of Oxford, Oxford, United Kingdom
| | - C Zamuner
- Departamento de Biologia Geral e Aplicada, Universidade Estadual Paulista, Rio Claro, São Paulo, Brazil
| | - J B Jones
- Department of Plant Pathology, University of Florida, Gainesville, Florida, USA
| | - J Redfern
- Department of Life Sciences, Manchester Metropolitan University, Manchester, United Kingdom
| | - F Behlau
- Fundecitrus, Araraquara, São Paulo, Brazil
| | - H Ferreira
- Departamento de Biologia Geral e Aplicada, Universidade Estadual Paulista, Rio Claro, São Paulo, Brazil
| | - M C Enright
- Department of Life Sciences, Manchester Metropolitan University, Manchester, United Kingdom
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Verran J, Redfern J, Cunliffe A, Romachney A, Wood J. Hands on Biofilm! Utilizing a public audience in a citizen science project to assess yield variability when culturing kombucha pellicle. FEMS Microbiol Lett 2023; 370:fnad073. [PMID: 37496193 DOI: 10.1093/femsle/fnad073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/16/2023] [Accepted: 07/18/2023] [Indexed: 07/28/2023] Open
Abstract
The pellicle biofilm generated during the Kombucha tea fermentation process has, when dried, textile-like properties that may have real-life applications. However, pellicle yield can vary depending on inoculation and incubation conditions, which affects research investigations on the properties of the pellicle. To generate data on variability to help define optimum pellicle growth conditions, as part of a public engagement event about biofilm, a citizen science activity was hosted whereby visitors to a science festival were invited to select incubation conditions and inoculate different media with liquid or solid (pellicle). More than 220 samples were inoculated (in excess of 1200 visitors, mainly in family groups). The most popular incubation conditions were coconut water or tea medium, 30°C/room temperature and liquid inoculum. The most productive/reproducible in terms of yield and variability were tea medium, 30°C, and liquid inoculum, which reflect some of the conditions most used in the domestic setting for kombucha culture. The event provided both useful research data and generated public interest in a research area of which many will have been unaware. Interest in the results of the activity, available several weeks after the activity, was sustained using email contact and FlickR for the dissemination of images and data.
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Affiliation(s)
- Joanna Verran
- Department of Life Science, Manchester Metropolitan University, Manchester M1 5GD, UK
| | - James Redfern
- Department of Natural Sciences, Manchester Metropolitan University, Manchester M1 5GD, UK
| | - Alex Cunliffe
- Department of Natural Sciences, Manchester Metropolitan University, Manchester M1 5GD, UK
| | - Anna Romachney
- Department of Natural Sciences, Manchester Metropolitan University, Manchester M1 5GD, UK
| | - Jane Wood
- Fashion Business Technology, The Department of Materials, The University of Manchester, Manchester M13 9PL, UK
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Wood J, Redfern J, Verran J. Developing textile sustainability education in the curriculum: pedagogical approaches to material innovation in fashion. Int J Fash Des Technol Educ 2022; 16:141-151. [PMID: 38098645 PMCID: PMC10721227 DOI: 10.1080/17543266.2022.2131913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/29/2022] [Indexed: 12/17/2023]
Abstract
The textile industry needs to adopt environmentally sustainable approaches to address ecologically damaging practices. Whilst driven by initiatives such as Textiles 2030, it is current students who will carry this agenda forward. This project investigated pedagogical approaches to develop sustainable textiles for the fashion design curriculum. Pilot studies, using bacterial cellulose (BC) as a material for millinery, revealed members of the public were prepared to experiment with this novel material, and BC was compatible with traditional hat-making techniques. A further study challenged secondary school students, based on an experiential learning model, to grow their own BC biofilm, exploring this as a sustainable apparel fabric. Initial attitudes of reluctance developed into acceptance once engaged in the practical activity. This study illustrates that with appropriate communication and education strategies, the principles of sustainability in fashion, and the acceptability of novel materials, can be engendered in different audiences.
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Affiliation(s)
- Jane Wood
- Department of Materials, School of Natural Science, The University of Manchester, Manchester, UK
| | - James Redfern
- Department of Life Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
| | - Joanna Verran
- Department of Natural Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
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7
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Cunliffe AJ, Wang R, Redfern J, Verran J, Ian Wilson D. Effect of environmental factors on the kinetics of evaporation of droplets containing bacteria or viruses on different surfaces. J FOOD ENG 2022. [DOI: 10.1016/j.jfoodeng.2022.111195] [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: 10/17/2022]
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8
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Redfern J, Tosheva L, Malic S, Butcher M, Ramage G, Verran J. The denture microbiome in health and disease: an exploration of a unique community. Lett Appl Microbiol 2022; 75:195-209. [PMID: 35634756 PMCID: PMC9546486 DOI: 10.1111/lam.13751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/21/2022] [Accepted: 05/25/2022] [Indexed: 11/26/2022]
Abstract
The United Nations suggests the global population of denture wearers (an artificial device that acts as a replacement for teeth) is likely to rise significantly by the year 2050. Dentures become colonized by microbial biofilms, the composition of which is influenced by complex factors such as patient’s age and health, and the nature of the denture material. Since colonization (and subsequent biofilm formation) by some micro‐organisms can significantly impact the health of the denture wearer, the study of denture microbiology has long been of interest to researchers. The specific local and systemic health risks of denture plaque are different from those of dental plaque, particularly with respect to the presence of the opportunist pathogen Candida albicans and various other nonoral opportunists. Here, we reflect on advancements in our understanding of the relationship between micro‐organisms, dentures, and the host, and highlight how our growing knowledge of the microbiome, biofilms, and novel antimicrobial technologies may better inform diagnosis, treatment, and prevention of denture‐associated infections, thereby enhancing the quality and longevity of denture wearers.
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Affiliation(s)
- J Redfern
- Department of Natural Sciences, Faculty of Science and Engineering Manchester Metropolitan University UK
| | - L Tosheva
- Department of Natural Sciences, Faculty of Science and Engineering Manchester Metropolitan University UK
| | - S Malic
- Department of Life Sciences, Faculty of Science and Engineering Manchester Metropolitan University UK
| | - M Butcher
- Department of Oral Sciences, Glasgow Dental School, School of Medicine, Dentistry and Nursing University of Glasgow UK
| | - G Ramage
- Department of Oral Sciences, Glasgow Dental School, School of Medicine, Dentistry and Nursing University of Glasgow UK
| | - J Verran
- Department of Life Sciences, Faculty of Science and Engineering Manchester Metropolitan University UK
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Wood J, van der Gast C, Rivett D, Verran J, Redfern J. Reproducibility of Bacterial Cellulose Nanofibers Over Sub-Cultured Generations for the Development of Novel Textiles. Front Bioeng Biotechnol 2022; 10:876822. [PMID: 35547175 PMCID: PMC9081875 DOI: 10.3389/fbioe.2022.876822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 03/23/2022] [Indexed: 11/26/2022] Open
Abstract
The textile industry is in crisis and under pressure to minimize the environmental impact on its practices. Bacterial cellulose (BC), a naturally occurring form of cellulose, displays properties superior to those of its cotton plant counterpart, such as enhanced purity, crystallinity, tensile strength, and water retention and is thus suitable for an array of textile applications. It is synthesized from a variety of microorganisms but is produced in most abundance by Komagataeibacter xylinus. K. xylinus is available as a type strain culture and exists in the microbial consortium commonly known as Kombucha. Whilst existing literature studies have described the effectiveness of both K. xylinus isolates and Kombucha in the production of BC, this study investigated the change in microbial communities across several generations of sub-culturing and the impact of these communities on BC yield. Using Kombucha and the single isolate strain K. xylinus as inocula in Hestrin and Schramm liquid growth media, BC pellicles were propagated. The resulting pellicles and residual liquid media were used to further inoculate fresh liquid media, and this process was repeated over three generations. For each generation, the thickness of the pellicles and their appearance under SEM were recorded. 16S rRNA sequencing was conducted on both pellicles and liquid media samples to assess changes in communities. The results indicated that the genus Komagataeibacter was the most abundant species in all samples. Cultures seeded with Kombucha yielded thicker cellulose pellicles than those seeded with K. xylinus, but all the pellicles had similar nanofibrillar structures, with a mix of liquid and pellicle inocula producing the best yield of BC after three generations of sub-culturing. Therefore, Kombucha starter cultures produce BC pellicles which are more reproducible across generations than those created from pure isolates of K. xylinus and could provide a reproducible sustainable model for generating textile materials.
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Affiliation(s)
- Jane Wood
- Manchester Fashion Institute, Faculty of Arts and Humanities, Manchester Metropolitan University, Manchester, United Kingdom
| | - Christopher van der Gast
- Department of Life Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, United Kingdom
| | - Damian Rivett
- Department of Natural Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, United Kingdom
| | - Joanna Verran
- Department of Life Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, United Kingdom
| | - James Redfern
- Department of Natural Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, United Kingdom
- *Correspondence: James Redfern,
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Redfern J, Hughes T, George H. 49 Accurate Hip Reduction and SPICA Application for DDH – the Case for Intraoperative CT. Br J Surg 2022. [DOI: 10.1093/bjs/znac039.025] [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]
Abstract
Abstract
Aim
Accurate reduction of the hip joint and SPICA application for treatment of developmental dysplasia of the hip (DDH) is crucial for long term success – for those undergoing surgical intervention, or closed reduction only. In Alder Hey Children’s Hospital we compared two methods of confirming reduction for patients undergoing SPICA application for DDH. Those receiving either post-operative departmental computed tomography (CT) or an intra-operative CT. Specific outcome assessed were, need for repeat CT and SPICA application, return to theatre (RTT), repeat general anaesthetic (GA) (with associated risks), as well as effect on overall length of stay (LOS).
Method
Patient lists were attained from the radiography department, information regarding RTT and LOS were derived from Meditech V6. CT scans were checked on PACS imaging system.
Results
Retrospective analysis of all SPICA application cases performed, included 102 patients from 2015–2018 undergoing a departmental CT, after GA. Of these, 6 patients required a second GA, 1 patient required 3 GA’s. Mean LOS was 6 days in those requiring repeat SPICA application.
Analysis of the second group of intra-operatively CT scanned patients, included 72 patients from 2018–2020. Of these, 0 patients required a repeat GA and RTT, despite 1 patient requiring change of SPICA. Mean LOS was 4 days for these patients.
Conclusions
Intra-operative CT is crucial for getting it right first time, reducing risks of GA and cost of theatre time. It reduced the LOS for those requiring SPICA change from 6 to 4 days and reduced mean LOS by 1 day overall.
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Affiliation(s)
- J. Redfern
- Alder Hey Children’s Hospital, Liverpool, United Kingdom
- Liverpool University Foundation Trust, Liverpool, United Kingdom
| | - T. Hughes
- Alder Hey Children’s Hospital, Liverpool, United Kingdom
| | - H. George
- Alder Hey Children’s Hospital, Liverpool, United Kingdom
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Tu Q, Hyun K, Lin S, Hafiz N, Redfern J. Effectiveness of Person-Centred Integrated Care on Cardiovascular Risk Factors for People With Diabetes in High-Income Countries: A Systematic Review and Meta-analysis. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.047] [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: 10/16/2022]
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12
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Hafiz N, Hyun K, Hespe C, Usherwood T, Redfern J. Scope of Quality Improvement-Practice Incentive Program (QI-PIP): How Primary Care Practices Can Utilise QI-PIPs by Participating in a Quality Improvement Program (QUEL Study) Focussed on Improving Cardiovascular Disease. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.512] [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: 11/30/2022]
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13
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Munot S, Rugel E, Bauman A, Chow C, Redfern J. FirstCPR Process Evaluation: Recruitment and Engagement in a Community-Based Intervention Aimed at Training and Willingness to Respond to Cardiac Arrest in the Community. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.499] [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: 10/16/2022]
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14
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Raeside R, Redfern J, Partridge S. Co-Designing the Health4Me Text Message Intervention to Support and Improve Adolescent’s Physical and Mental Health Outcomes: An Active Research Partnership With Adolescents. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.524] [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: 10/16/2022]
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15
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Manandi D, Hafiz N, Tu Q, Hyun K, Redfern J. The Development of Assessment Tools for the Plan-Do-Study-Act Cycle. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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16
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Gauci S, Cartledge S, Redfern J, Gallagher R, Huxley R, Man Ying Lee C, Vassallo A, O’Neil A. Gender and Sex in Cardiovascular Disease: Biology, Bias, or Both? Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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17
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Weigelt L, Redfern J, Heyes GJ, Butcher C, Molloy A, Mason L. Risk Factors for Nonunion After First Metatarsophalangeal Joint Arthrodesis With a Dorsal Locking Plate and Compression Screw Construct: Correction of Hallux Valgus Is Key. J Foot Ankle Surg 2021; 60:1179-1183. [PMID: 34112585 DOI: 10.1053/j.jfas.2020.12.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 12/27/2020] [Indexed: 02/03/2023]
Abstract
First metatarsophalangeal joint (MTPJ) arthrodesis is currently the gold standard technique for advanced hallux rigidus. This retrospective study aimed to identify the risk factors for nonunion after first MTPJ arthrodesis with a dorsal locking plate and compression screw construct. Between April 2014 and April 2019, 165 consecutive patients (28 men and 137 women; mean age, 60 (range, 28-84) years) who underwent 178 primary first MTPJ arthrodeses were retrospectively reviewed. All arthrodeses were performed using either a dorsal locking plate with an integrated compression screw (Anchorage CP plate, Stryker, n = 97) or a dorsal locking plate (Anchorage V2 plate, Stryker, n = 81) with a separate compression screw (4 mm cannulated ACE screw). Union was defined as bone bridging across the fusion site on at least 2 of the 3 standard foot radiographs (anteroposterior, lateral, oblique) and no MTPJ movement or pain during clinical examination. Potential risk factors for nonunion were analyzed with the use of univariate and multivariate analyses. The overall nonunion rate was 6.2% (11 of 178 cases). The risk factors identified in the univariate analysis included preoperative hallux valgus deformity, postoperative residual hallux valgus deformity, and diabetes (p < .05). Multivariate analysis confirmed that postoperative residual hallux valgus deformity (odds ratio 6.5; p= .015) and diabetes (odds ratio 7.4; p = .019) are independent risk factors for nonunion after first MTPJ arthrodesis. Diabetes is the most important independent risk factor for nonunion after first MTPJ arthrodesis with a dorsal locking plate and compression screw construct. A residual postoperative hallux valgus deformity is associated with a significantly increased risk for nonunion. It is therefore crucial to correct the hallux valgus deformity to a hallux valgus angle of less than 20°.
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Affiliation(s)
- Lizzy Weigelt
- Trauma and Orthopaedics Department, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom.
| | - James Redfern
- Trauma and Orthopaedics Department, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Gavin John Heyes
- Trauma and Orthopaedics Department, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Clifford Butcher
- Trauma and Orthopaedics Department, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Andrew Molloy
- Trauma and Orthopaedics Department, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom; University of Liverpool, Liverpool, United Kingdom
| | - Lyndon Mason
- Trauma and Orthopaedics Department, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom; University of Liverpool, Liverpool, United Kingdom
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Bradley P, Wilson J, Taylor R, Nixon J, Redfern J, Whittemore P, Gaddah M, Kavuri K, Haley A, Denny P, Withers C, Robey RC, Logue C, Dahanayake N, Min DSH, Coles J, Deshmukh MS, Ritchie S, Malik M, Abdelaal H, Sivabalah K, Hartshorne MD, Gopikrishna D, Ashish A, Nuttall E, Bentley A, Bongers T, Gatheral T, Felton TW, Chaudhuri N, Pearmain L. Conventional oxygen therapy versus CPAP as a ceiling of care in ward-based patients with COVID-19: a multi-centre cohort evaluation. EClinicalMedicine 2021; 40:101122. [PMID: 34514360 PMCID: PMC8424135 DOI: 10.1016/j.eclinm.2021.101122] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Continuous positive airway pressure (CPAP) therapy is commonly used for respiratory failure due to severe COVID-19 pneumonitis, including in patients deemed not likely to benefit from invasive mechanical ventilation (nIMV). Little evidence exists demonstrating superiority over conventional oxygen therapy, whilst ward-level delivery of CPAP presents practical challenges. We sought to compare clinical outcomes of oxygen therapy versus CPAP therapy in patients with COVID-19 who were nIMV. METHODS This retrospective multi-centre cohort evaluation included patients diagnosed with COVID-19 who were nIMV, had a treatment escalation plan of ward-level care and clinical frailty scale ≤ 6. Recruitment occurred during the first two waves of the UK COVID-19 pandemic in 2020; from 1st March to May 31st, and from 1st September to 31st December. Patients given CPAP were compared to patients receiving oxygen therapy that required FiO2 ≥0.4 for more than 12 hours at hospitals not providing ward-level CPAP. Logistic regression modelling was performed to compare 30-day mortality between treatment groups, accounting for important confounders and within-hospital clustering. FINDINGS Seven hospitals provided data for 479 patients during the UK COVID-19 pandemic in 2020. Overall 30-day mortality was 75.6% in the oxygen group (186/246 patients) and 77.7% in the CPAP group (181/233 patients). A lack of evidence for a treatment effect persisted in the adjusted model (adjusted odds ratio 0.84 95% CI 0.57-1.23, p=0.37). 49.8% of patients receiving CPAP-therapy (118/237) chose to discontinue it. INTERPRETATION No survival difference was found between using oxygen alone or CPAP to treat patients with severe COVID-19 who were nIMV. A high patient-initiated discontinuation rate for CPAP suggests a significant treatment burden. Further reflection is warranted on the current treatment guidance and widespread application of CPAP in this setting. FUNDING L Pearmain is supported by the MRC (MR/R00191X/1). TW Felton is supported by the NIHR Manchester Biomedical Research Centre.
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Affiliation(s)
- P Bradley
- North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
- Respiratory department, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
- NWCORR North West Collaborative Organisation for Respiratory Research
| | - J Wilson
- Respiratory department, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
- Department of infectious diseases and tropical medicine. North Manchester General Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - R Taylor
- Research and Development, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - J Nixon
- Respiratory department, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
- NWCORR North West Collaborative Organisation for Respiratory Research
| | - J Redfern
- Respiratory department, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - P Whittemore
- Department of infectious diseases and tropical medicine. North Manchester General Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - M Gaddah
- Respiratory department, University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, UK
| | - K Kavuri
- Respiratory department, Royal Albert Edward Infirmary, Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust, Wigan, UK
| | - A Haley
- Respiratory department, University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, UK
| | - P Denny
- Respiratory department, University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, UK
| | - C Withers
- North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - RC Robey
- North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - C Logue
- North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - N Dahanayake
- Department of infectious diseases and tropical medicine. North Manchester General Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - D Siaw Hui Min
- Department of infectious diseases and tropical medicine. North Manchester General Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - J Coles
- Department of infectious diseases and tropical medicine. North Manchester General Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - M S Deshmukh
- Department of infectious diseases and tropical medicine. North Manchester General Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - S Ritchie
- Department of infectious diseases and tropical medicine. North Manchester General Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - M Malik
- Respiratory department, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - H Abdelaal
- Respiratory department, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - K Sivabalah
- Respiratory department, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - MD Hartshorne
- Respiratory department, Royal Albert Edward Infirmary, Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust, Wigan, UK
| | - D Gopikrishna
- Respiratory department, Royal Albert Edward Infirmary, Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust, Wigan, UK
| | - A Ashish
- Respiratory department, Royal Albert Edward Infirmary, Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust, Wigan, UK
| | - E Nuttall
- Respiratory department, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - A Bentley
- North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester and Manchester University NHS Foundation Trust, Manchester, UK
| | - T Bongers
- Respiratory department, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - T Gatheral
- Respiratory department, University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, UK
| | - TW Felton
- North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester and Manchester University NHS Foundation Trust, Manchester, UK
| | - N Chaudhuri
- North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester and Manchester University NHS Foundation Trust, Manchester, UK
| | - L Pearmain
- North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
- NWCORR North West Collaborative Organisation for Respiratory Research
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Wellcome Centre for Cell-Matrix Research, Faculty of Biology, Medicine and Health and Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- Corresponding author. L Pearmain. Piper Hanley Laboratory, Floor 3 AV Hill Building, The University of Manchester, Manchester, UK, M13 9PT
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Cunliffe AJ, Askew PD, Stephan I, Iredale G, Cosemans P, Simmons LM, Verran J, Redfern J. How Do We Determine the Efficacy of an Antibacterial Surface? A Review of Standardised Antibacterial Material Testing Methods. Antibiotics (Basel) 2021; 10:1069. [PMID: 34572650 PMCID: PMC8472414 DOI: 10.3390/antibiotics10091069] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 08/31/2021] [Accepted: 09/01/2021] [Indexed: 11/16/2022] Open
Abstract
Materials that confer antimicrobial activity, be that by innate property, leaching of biocides or design features (e.g., non-adhesive materials) continue to gain popularity to combat the increasing and varied threats from microorganisms, e.g., replacing inert surfaces in hospitals with copper. To understand how efficacious these materials are at controlling microorganisms, data is usually collected via a standardised test method. However, standardised test methods vary, and often the characteristics and methodological choices can make it difficult to infer that any perceived antimicrobial activity demonstrated in the laboratory can be confidently assumed to an end-use setting. This review provides a critical analysis of standardised methodology used in academia and industry, and demonstrates how many key methodological choices (e.g., temperature, humidity/moisture, airflow, surface topography) may impact efficacy assessment, highlighting the need to carefully consider intended antimicrobial end-use of any product.
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Affiliation(s)
- Alexander J. Cunliffe
- Department of Natural Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Chester Street, Manchester M1 5GD, UK;
| | - Peter D. Askew
- (Industrial Microbiological Services Ltd.) IMSL, Pale Lane, Hartley Whitney, Hants RG27 8DH, UK; (P.D.A.); (G.I.)
| | - Ina Stephan
- (Bundesanstalt für Materialforschung und -prüfung) BAM, Unter den Eichen 87, 12205 Berlin, Germany;
| | - Gillian Iredale
- (Industrial Microbiological Services Ltd.) IMSL, Pale Lane, Hartley Whitney, Hants RG27 8DH, UK; (P.D.A.); (G.I.)
| | | | - Lisa M. Simmons
- Department of Engineering, Faculty of Science and Engineering, Manchester Metropolitan University, Chester Street, Manchester M1 5GD, UK;
| | - Joanna Verran
- Department of Life Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Chester Street, Manchester M1 5GD, UK;
| | - James Redfern
- Department of Natural Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Chester Street, Manchester M1 5GD, UK;
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20
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Çakar ZP, Redfern J, Verran J. Analysis of university student responses to the pandemic in a formal microbiology assessment. FEMS Microbiol Lett 2021; 368:6316777. [PMID: 34232297 PMCID: PMC8344604 DOI: 10.1093/femsle/fnab091] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 07/05/2021] [Indexed: 11/12/2022] Open
Abstract
During the coronavirus pandemic, second-year students on the B.Sc. molecular biology and genetics degree at Istanbul Technical University sat an open-ended online exam for a microbiology course in which one of the compulsory questions asked how the course had helped them during the first phase of the pandemic (April–July 2020). Fifty of 69 students gave consent for their (anonymous) responses to be analysed in order to discern any key ways in which their knowledge had been applied. The aim of the study was to investigate whether taking an advanced microbiology course increases understanding of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) pandemic and has a positive impact on student behaviours with respect to public health practices. Findings were divided into four major themes: course content (information), application of course content to behavioural change (practice), professionalism and their ‘audience’ whilst at home in lockdown (family and friends). Social distancing, wearing face masks, and hand and surface hygiene were described as important behaviours, with this practice informed by their basic microbiology knowledge. This paper describes a scenario where rote assessment can be used to assess wider scientific literacy with respect to application in society, providing students with an opportunity to incorporate and apply their learning into real-life situations, whilst tutors can assess constructivist learning, conceptual understanding and impact on student behaviour.
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Affiliation(s)
- Zeynep Petek Çakar
- Department of Molecular Biology and Genetics, Faculty of Science and Letters, Istanbul Technical University, Maslak, 34469 Istanbul, Turkey.,Dr. Orhan Öcalgiray Molecular Biology, Biotechnology and Genetics Research Center (ITU-MOBGAM), Istanbul Technical University, Maslak, 34469 Istanbul, Turkey
| | - James Redfern
- Department of Natural Sciences, Manchester Metropolitan University, Manchester, M1 5GD, UK
| | - Joanna Verran
- Department of Life Sciences, Manchester Metropolitan University, Manchester, M1 5GD, UK
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21
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Redfern J, Wallace J, van Belkum A, Jaillard M, Whittard E, Ragupathy R, Verran J, Kelly P, Enright MC. Biofilm associated genotypes of multiple antibiotic resistant Pseudomonas aeruginosa. BMC Genomics 2021; 22:572. [PMID: 34311706 PMCID: PMC8314537 DOI: 10.1186/s12864-021-07818-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 06/14/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Pseudomonas aeruginosa is a ubiquitous environmental microorganism and also a common cause of infection. Its ability to survive in many different environments and persistently colonize humans is linked to its presence in biofilms formed on indwelling device surfaces. Biofilm promotes adhesion to, and survival on surfaces, protects from desiccation and the actions of antibiotics and disinfectants. RESULTS We examined the genetic basis for biofilm production on polystyrene at room (22 °C) and body temperature (37 °C) within 280 P. aeruginosa. 193 isolates (69 %) produced more biofilm at 22 °C than at 37 °C. Using GWAS and pan-GWAS, we found a number of accessory genes significantly associated with greater biofilm production at 22 °C. Many of these are present on a 165 kb region containing genes for heavy metal resistance (arsenic, copper, mercury and cadmium), transcriptional regulators and methytransferases. We also discovered multiple core genome SNPs in the A-type flagellin gene and Type II secretion system gene xpsD. Analysis of biofilm production of isolates of the MDR ST111 and ST235 lineages on stainless-steel revealed several accessory genes associated with enhanced biofilm production. These include a putative translocase with homology to a Helicobacter pylori type IV secretion system protein, a TA system II toxin gene and the alginate biosynthesis gene algA, several transcriptional regulators and methytransferases as well as core SNPs in genes involved in quorum sensing and protein translocation. CONCLUSIONS Using genetic association approaches we discovered a number of accessory genes and core-genome SNPs that were associated with enhanced early biofilm formation at 22 °C compared to 37 °C. These included a 165 kb genomic island containing multiple heavy metal resistance genes, transcriptional regulators and methyltransferases. We hypothesize that this genomic island may be associated with overall genotypes that are environmentally adapted to survive at lower temperatures. Further work to examine their importance in, for example gene-knockout studies, are required to confirm their relevance. GWAS and pan-GWAS approaches have great potential as a first step in examining the genetic basis of novel bacterial phenotypes.
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Affiliation(s)
- James Redfern
- Faculty of Science and Engineering, Manchester Metropolitan University, Chester Street, Manchester, United Kingdom
| | - Janine Wallace
- Faculty of Science and Engineering, Manchester Metropolitan University, Chester Street, Manchester, United Kingdom
| | | | | | - Elliot Whittard
- Faculty of Science and Engineering, Manchester Metropolitan University, Chester Street, Manchester, United Kingdom
| | - Roobinidevi Ragupathy
- Faculty of Science and Engineering, Manchester Metropolitan University, Chester Street, Manchester, United Kingdom
| | - Joanna Verran
- Faculty of Science and Engineering, Manchester Metropolitan University, Chester Street, Manchester, United Kingdom
| | - Peter Kelly
- Faculty of Science and Engineering, Manchester Metropolitan University, Chester Street, Manchester, United Kingdom
| | - Mark Charles Enright
- Faculty of Science and Engineering, Manchester Metropolitan University, Chester Street, Manchester, United Kingdom.
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22
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Whittard E, Redfern J, Xia G, Millard A, Ragupathy R, Malic S, Enright MC. Phenotypic and Genotypic Characterization of Novel Polyvalent Bacteriophages With Potent In Vitro Activity Against an International Collection of Genetically Diverse Staphylococcus aureus. Front Cell Infect Microbiol 2021; 11:698909. [PMID: 34295840 PMCID: PMC8290860 DOI: 10.3389/fcimb.2021.698909] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 06/14/2021] [Indexed: 11/13/2022] Open
Abstract
Phage therapy recently passed a key milestone with success of the first regulated clinical trial using systemic administration. In this single-arm non-comparative safety study, phages were administered intravenously to patients with invasive Staphylococcus aureus infections with no adverse reactions reported. Here, we examined features of 78 lytic S. aureus phages, most of which were propagated using a S. carnosus host modified to be broadly susceptible to staphylococcal phage infection. Use of this host eliminates the threat of contamination with staphylococcal prophage - the main vector of S. aureus horizontal gene transfer. We determined the host range of these phages against an international collection of 185 S. aureus isolates with 56 different multilocus sequence types that included multiple representatives of all epidemic MRSA and MSSA clonal complexes. Forty of our 78 phages were able to infect > 90% of study isolates, 15 were able to infect > 95%, and two could infect all 184 clinical isolates, but not a phage-resistant mutant generated in a previous study. We selected the 10 phages with the widest host range for in vitro characterization by planktonic culture time-kill analysis against four isolates:- modified S. carnosus strain TM300H, methicillin-sensitive isolates D329 and 15981, and MRSA isolate 252. Six of these 10 phages were able to rapidly kill, reducing cell numbers of at least three isolates. The four best-performing phages, in this assay, were further shown to be highly effective in reducing 48 h biofilms on polystyrene formed by eight ST22 and eight ST36 MRSA isolates. Genomes of 22 of the widest host-range phages showed they belonged to the Twortvirinae subfamily of the order Caudovirales in three main groups corresponding to Silviavirus, and two distinct groups of Kayvirus. These genomes assembled as single-linear dsDNAs with an average length of 140 kb and a GC content of c. 30%. Phages that could infect > 96% of S. aureus isolates were found in all three groups, and these have great potential as therapeutic candidates if, in future studies, they can be formulated to maximize their efficacy and eliminate emergence of phage resistance by using appropriate combinations.
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Affiliation(s)
- Elliot Whittard
- Department of Life Sciences, Manchester Metropolitan University, Manchester, United Kingdom
| | - James Redfern
- Department of Life Sciences, Manchester Metropolitan University, Manchester, United Kingdom
| | - Guoqing Xia
- Lydia Becker Institute of Immunology and Inflammation, University of Manchester, Manchester, United Kingdom
| | - Andrew Millard
- Department of Genetics and Genome Biology, University of Leicester, Leicester, United Kingdom
| | - Roobinidevi Ragupathy
- Department of Life Sciences, Manchester Metropolitan University, Manchester, United Kingdom
| | - Sladjana Malic
- Department of Life Sciences, Manchester Metropolitan University, Manchester, United Kingdom
| | - Mark C. Enright
- Department of Life Sciences, Manchester Metropolitan University, Manchester, United Kingdom
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23
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Bradley P, Nixon J, Wilson J, Redfern J, Saba T, Nuttall E, Bongers T. Continuous positive airway pressure (CPAP) as a ceiling of care treatment for hypoxaemic respiratory failure due to COVID-19. Clin Med (Lond) 2021; 21:21-22. [PMID: 34078682 DOI: 10.7861/clinmed.21-2-s21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Patrick Bradley
- Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - Jennifer Nixon
- Lancashire Teaching Hospitals NHS Foundation Trust, Lancashire, UK
| | - James Wilson
- Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - James Redfern
- Lancashire Teaching Hospitals NHS Foundation Trust, Lancashire, UK
| | - Tarek Saba
- Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - Emily Nuttall
- Lancashire Teaching Hospitals NHS Foundation Trust, Lancashire, UK
| | - Thomas Bongers
- Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
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24
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Redfern J, Ratova M, Dean AP, Pritchett J, Grao M, Verran J, Kelly P. Visible light photocatalytic bismuth oxide coatings are effective at suppressing aquatic cyanobacteria and degrading free-floating genomic DNA. J Environ Sci (China) 2021; 104:128-136. [PMID: 33985716 DOI: 10.1016/j.jes.2020.11.024] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 11/03/2020] [Accepted: 11/03/2020] [Indexed: 06/12/2023]
Abstract
Access to safe drinking water free from microbial pollution is an issue of global concern. The use of photocatalytic thin films in water treatment has focused on titanium dioxide, which requires UV-activation, proving a potential barrier to upscaling and implementation in the real world. Visible-light-activated photocatalytic thin films, such as bismuth oxide, have recently been shown to have antimicrobial properties. However, more understanding of the photocatalytic effect on the microbial population in water is required. Glass beads coated with bismuth oxide were incubated with either Microcystis aeruginosa, Anabaena sp. or free-floating genomic DNA. The presence of bismuth oxide-coated glass beads was able to rapidly stop a population of cyanobacteria from increasing. The coated beads were also able to degrade genomic DNA. Leachate from the beads showed no increase in toxicity against human liver cells. This data demonstrates the efficacy of bismuth oxide-coated glass beads for controlling potentially dangerous cyanobacterial populations, whilst potentially reducing the amount of free-floating genomic DNA (an essential issue in the face of antimicrobial resistance) - all of which should be essential considerations in emerging water treatment technologies.
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Affiliation(s)
- James Redfern
- Department of Natural Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Chester Street, M1 5GD, UK.
| | - Marina Ratova
- Surface Engineering Group, Faculty of Science and Engineering, Manchester Metropolitan University, Chester Street, M1 5GD, UK
| | - Andrew P Dean
- Department of Natural Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Chester Street, M1 5GD, UK
| | - James Pritchett
- Department of Life Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Chester Street, M1 5GD, UK
| | - Matthieu Grao
- Department of Natural Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Chester Street, M1 5GD, UK
| | - Joanna Verran
- Department of Life Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Chester Street, M1 5GD, UK
| | - Peter Kelly
- Surface Engineering Group, Faculty of Science and Engineering, Manchester Metropolitan University, Chester Street, M1 5GD, UK
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Redfern J, Goode R, Leung WY, Quarterman C, Rao A. Giving intravenous iron to patients with symptomatic heart failure is safe and cost effective. Br J Hosp Med (Lond) 2021; 82:1-5. [PMID: 34076520 DOI: 10.12968/hmed.2021.0034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIMS/BACKGROUND Heart failure affects approximately 1 million people in the UK, adversely affecting quality of life, functional capacity and cognitive health. Iron deficiency complicates heart failure in approximately 50% of patients. Giving intravenous ferric carboxymaltose has been shown to improve quality of life in patients with heart failure (New York Heart Association class and Kansas City Cardiomyopathy Questionnaire). METHODS A quality improvement project was designed to assess the feasibility, safety and cost implications of establishing an intravenous iron service in the authors' centre. RESULTS Between July and December 2019 61 patients who were screened met the inclusion criteria and were administered intravenous ferric carboxymaltose. There were statistically significant improvements in ferritin levels (83.3 ug/litre to 433 ug/litre; P<0.0001), transferrin saturation (18% to 30% P<0.0001) and haemoglobin levels (126 g/litre to 135 g/litre; P<0.01). No demonstrable changes in New York Heart Association class or quality of life scores were noted. The overall financial impact for the trust was income generation of £14 665, a net income of £240 per patient. CONCLUSIONS Intravenous iron replacement with ferric carboxymaltose is safe and cost effective, and should be considered in eligible iron-deficient patients with symptomatic heart failure. Integration with another day case intravenous service represented the most logistically simple and economically viable method of service delivery.
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Affiliation(s)
- James Redfern
- Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Rachel Goode
- Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Wing Yin Leung
- Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Clare Quarterman
- Department of Anaesthetics, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Archana Rao
- Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, UK
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26
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Scimone A, Redfern J, Patiphatpanya P, Thongtem T, Ratova M, Kelly P, Verran J. Development of a rapid method for assessing the efficacy of antibacterial photocatalytic coatings. Talanta 2021; 225:122009. [PMID: 33592748 DOI: 10.1016/j.talanta.2020.122009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 12/08/2020] [Accepted: 12/12/2020] [Indexed: 11/28/2022]
Abstract
Visible-light activated photocatalytic coatings may represent an attractive antimicrobial solution in domains such as food, beverage, pharmaceutical, biomedical and wastewater remediation. However, testing methods to determine the antibacterial effects of photocatalytic coatings are limited and require specialist expertise. This paper describes the development of a method that enables rapid screening of coatings for photocatalytic-antibacterial activity. Relying on the ability of viable microorganisms to reduce the dye resazurin from a blue to a pink colour, the method relates the time taken to detect this colour change with number of viable microorganisms. The antibacterial activity of two photocatalytic materials (bismuth oxide and titanium dioxide) were screened against two pathogenic organisms (Escherichia coli and Klebsiella pneumoniae) that represent potential target microorganisms using traditional testing and enumeration techniques (BS ISO 27447:2009) and the novel rapid method. Bismuth oxide showed excellent antibacterial activity under ambient visible light against E. coli, but was less effective against K. pneumoniae. The rapid method showed excellent agreement with existing tests in terms of number of viable cells recovered. Due to advantages such as low cost, high throughput, and less reliance on microbiological expertise, this method is recommended for researchers seeking an inexpensive first-stage screen for putative photocatalytic-antibacterial coatings.
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Affiliation(s)
- Antony Scimone
- Department of Life Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK.
| | - James Redfern
- Department of Natural Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
| | - Panudda Patiphatpanya
- Department of Chemistry, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand
| | - Titipun Thongtem
- Department of Chemistry, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand; Materials Science Research Center, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand
| | - Marina Ratova
- Surface Engineering Group, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
| | - Peter Kelly
- Surface Engineering Group, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
| | - Joanna Verran
- Department of Life Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK.
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27
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Bradley P, Nixon J, Wilson J, Redfern J, Saba T, Nuttall E, Bongers T. Continuous positive airway pressure (CPAP) as a ceiling of care treatment for hypoxemic respiratory failure due to COVID-19. J Intensive Care Soc 2021; 23:366-368. [PMID: 36033250 PMCID: PMC9403526 DOI: 10.1177/1751143721996538] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Patrick Bradley
- Respiratory Department, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - Jennifer Nixon
- Respiratory Department, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - James Wilson
- Respiratory Department, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - James Redfern
- Respiratory Department, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Tarek Saba
- Respiratory Department, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - Emily Nuttall
- Respiratory Department, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Thomas Bongers
- Respiratory Department, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
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Hafiz N, Hyun K, Tu Q, Knight A, Hespe C, Dhillon M, Frick C, Usherwood T, Redfern J. Do Quality Improvement Workshops Improve Health Professionals’ Knowledge on Implementing Change for Patients With Coronary Heart Disease in Primary Care? Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.408] [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: 11/30/2022]
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Raeside R, Jia S, Redfern J, Gibson A, Partridge S. Home is Where the Heart (Risk) is: How has the COVID-19 Pandemic Influenced Social Media Promotion of Food and Beverages From Popular Online Food Delivery Platforms? Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.433] [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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30
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Redfern J, Hyun K, Brieger D, Chew D, French J, Astley C, Gallagher R, Ellis C, Carr B, Lefkovits J, Nallaiah K, Lintern K, Neubeck L, Briffa T. Impact of cardiac rehabilitation on 3 year outcomes amongst patients after acute coronary syndrome: (ACS) SNAPSHOT ACS follow-up study. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3108] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Cardiovascular disease is the leading cause of disease burden globally. With advancements in medical and surgical care more people are surviving initial acute coronary syndrome (ACS) and are in need of secondary prevention and cardiac rehabilitation (CR). Increasing availability of high quality individual-level data linkage provides robust estimates of outcomes long-term.
Purpose
To compare 3 year outcomes amongst ACS survivors who did and did not participate in Australian CR programs.
Methods
SNAPSHOT ACS follow-up study included 1806 patients admitted to 232 hospitals who were followed-up by data linkage (cross-jurisdictional morbidity, national death index, Pharmaceutical Benefit Schedule) at 6 and 36 months to compare those who did/not attend CR.
Results
In total, the cohort had a mean age of 65.8 (13.4) years, 60% were male, only 25% (461/1806) attended CR. During index admission, attendees were more likely to have had PCI (39% v 14%, p<0.001), CABG (11% v 2%, p<0.001) and a diagnosis of STEMI (21% v 5%, p<0.001) than those who did not attend. However, there was no significant difference between CR attendees/non-attendees for risk factors (LDL-cholesterol, smoking, obesity). Only 19% of eligible women attended CR compared to 30% of men (p<0.001). At 36 months, there were fewer deaths amongst CR attendees (19/461, 4.1%) than non-attendees (116/1345, 8.6%) (p=0.001). CR attendees were more likely to have repeat ACS, PCI, CABG at both 6 and 36 months (Table). At 36 months, CR attendees were more likely to have been prescribed antiplatelets (78% v 53%, p<0.001), statins (91% 73%, p<0.001), beta-blockers (11% v 13%, p=0.002) and ACEI/ARBs (72% v 61%, p<0.001) than non-attendees.
Conclusions
Amongst Australian ACS survivors, participation in CR was associated with less likelihood of death and increased prescription of pharmacotherapy. However, attendance at CR was associated with higher rates of repeat ACS and revascularisation.
Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): New South Wales Cardiovascular Research Network, National Heart Foundation
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Affiliation(s)
- J Redfern
- University of Sydney, Westmead Applied Research Centre, Faculty of Medicine and Health, Sydney, Australia
| | - K Hyun
- University of Sydney, Westmead Applied Research Centre, Faculty of Medicine and Health, Sydney, Australia
| | - D Brieger
- ANZAC Research Institute, Sydney, Australia
| | - D Chew
- Flinders University, Adelaide, Australia
| | - J French
- University of New South Wales, Sydney, Australia
| | - C Astley
- South Australian Health and Medical Research Institute, Adelaide, Australia
| | | | - C Ellis
- Auckland City Hospital, Auckland, New Zealand
| | - B Carr
- NSW Agency for Clinical Innovation, Sydney, Australia
| | | | - K Nallaiah
- The George Institute for Global Health, Sydney, Australia
| | - K Lintern
- South Western Sydney Local Health District, Sydney, Australia
| | - L Neubeck
- Napier University, Edinburgh, United Kingdom
| | - T Briffa
- University of Western Australia, Perth, Australia
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Hyun K, Brieger D, Briffa T, Chew D, Horsfall M, French J, Ellis C, Hammett C, Nallaiah K, Redfern J. The impact of socioeconomic status on secondary prevention of the acute coronary syndrome. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2970] [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
Although socioeconomic status (SES) has been reported to be associated with health inequities, there are limited studies exploring the association between SES and secondary prevention of acute coronary syndrome (ACS) in countries with universal health cover.
Purpose
The aim is to examine whether SES has an impact on the secondary prevention of ACS in Australia.
Methods
Australian SNAPSHOT ACS data (2012) and its 18-month follow-up data were linked to admissions data from 6 jurisdictions covering all states and territories, national death index and Medicare Pharmaceutical Benefits Scheme data covering up to 3 years post-discharge. The five SES groups (lowest in Group 1 and highest in Group 5) were derived from the Australian Bureau of Statistics Socio-Economic Indexes for Areas (SEIFA) using the residential postcode at baseline. Outcomes were cardiac rehabilitation (CR) participation and smoking rate at 18 months post discharge as well as the use of ≥3 of the 4 indicated medications, all-cause death and cardiovascular disease (CVD) rates by 36 months of discharge. Outcomes were compared between the groups using the multilevel logistic regression with covariates of SES (5 groups), sex, GRACE risk score (4 groups), ACS diagnosis (STEMI/NSTEMI/UA) and the jurisdictions where the admissions data were linked.
Results
Of 1655 patients with ACS (mean age 68±13.5 yrs, 65% were male), who were discharged from hospital alive and had linked data available, 353 (21%) were in SES Group 1 (lowest SES), 369 (22%) in Group 2, 382 (23%) in Group 3, 296 (18%) in Group 4 and 255 (15%) in Group 5 (highest SES). Baseline clinical characteristics were comparable across the five SES groups. At 18-month after discharge, 1014 (61%) patients were followed-up with comparable loss to follow-up in each group. After adjustment, fewer patients in the lower SES groups (Groups 1 and 2) had participated in CR than those in the highest SES group (Group 5) (OR (95% CI): 0.60 (0.36, 0.99) and 0.56 (0.35, 0.91), respectively). Moreover, the odds of smoking was greater in Group 3 than Group 5 (2.60 (1.15, 5.89)) but no trend was found across the groups. By 36 months of discharge after adjustment, there was no difference in the odds of using ≥3 out of 4 medications between the SES groups. Despite this, patients in Groups 1 and 2 were significantly more likely to die than those in the highest SES group (1.96 (1.19, 3.21) and 1.91 (1.19, 3.07), respectively). The odds of CVD readmission did not differ across SES groups.
Conclusion
This study suggests that patients with low SES were less likely to participate in CR programs and more likely to die than those with high SES. Smoking rates varied between patients with intermediate and high SES but no trend was found across the groups. Despite the universal health cover available, inequity between the SES groups still exist. Future research is needed to further explore strategies to help close the evidence-practice gaps.
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Australian National Heart Foundation Postdoctoral Fellowship
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Affiliation(s)
- K Hyun
- University of Sydney, Sydney Medical School, Westmead Applied Research Centre, Sydney, Australia
| | - D Brieger
- Concord General Repatriation Hospital, Department of Cardiology, Sydney, Australia
| | - T Briffa
- The University of Western Australia, School of Population Health, Perth, Australia
| | - D Chew
- Flinders Medical Centre and Flinders University, Department of Cardiovascular Medicine, Adelaide, Australia
| | | | - J French
- Liverpool Hospital, Department of Cardiology, Sydney, Australia
| | - C Ellis
- Auckland Heart Group, Auckland, New Zealand
| | - C Hammett
- Royal Brisbane and Women's Hospital, Department of Cardiology, Brisbane, Australia
| | - K Nallaiah
- The George Institute for Global Health, Sydney, Australia
| | - J Redfern
- University of Sydney, Sydney Medical School, Westmead Applied Research Centre, Sydney, Australia
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Pearman CM, Redfern J, Williams EA, Snowdon RL, Modi P, Hall MCS, Modi S, Waktare JEP, Mahida S, Todd DM, Mediratta N, Gupta D. Early experience of thoracoscopic vs. catheter ablation for atrial fibrillation. Europace 2020; 21:738-745. [PMID: 30753411 PMCID: PMC6479510 DOI: 10.1093/europace/euy303] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 01/23/2019] [Indexed: 11/30/2022] Open
Abstract
Aims Video-assisted thoracoscopic surgery (VATS) ablation has been advocated as a treatment option for non-paroxysmal atrial fibrillation (AF) in recent guidelines. Real-life data on its safety and efficacy during a centre’s early experience are sparse. Methods and results Thirty patients (28 persistent/longstanding persistent AF) underwent standalone VATS ablation for AF by an experienced thoracoscopic surgeon, with the first 20 cases proctored by external surgeons. Procedural and follow-up outcomes were collected prospectively, and compared with 90 propensity-matched patients undergoing contemporaneous catheter ablation (CA). Six (20.0%) patients undergoing VATS ablation experienced ≥1 major complication (death n = 1, stroke n = 2, conversion to sternotomy n = 3, and phrenic nerve injury n = 2). This was significantly higher than the 1.1% major complication rate (tamponade requiring drainage n = 1) seen with CA (P < 0.001). Twelve-month single procedure arrhythmia-free survival rates without antiarrhythmic drugs were 56% in the VATS and 57% in the CA cohorts (P = 0.22), and 78% and 80%, respectively given an additional CA and antiarrhythmic drugs (P = 0.32). Conclusion During a centre’s early experience, VATS ablation may have similar success rates to those from an established CA service, but carry a greater risk of major complications. Those embarking on a programme of VATS AF ablation should be aware that complication and success rates may differ from those reported by selected high-volume centres.
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Affiliation(s)
- Charles M Pearman
- Department of Cardiology, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, UK.,Unit of Cardiac Physiology, Division of Cardiovascular Sciences, Manchester Academic Health Science Centre, 3.14 Core Technology Facility, University of Manchester, Manchester, UK
| | - James Redfern
- Department of Cardiology, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, UK
| | - Emmanuel A Williams
- Department of Cardiology, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, UK
| | - Richard L Snowdon
- Department of Cardiology, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, UK
| | - Paul Modi
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, UK
| | - Mark C S Hall
- Department of Cardiology, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, UK
| | - Simon Modi
- Department of Cardiology, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, UK
| | - Johan E P Waktare
- Department of Cardiology, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, UK
| | - Saagar Mahida
- Department of Cardiology, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, UK
| | - Derick M Todd
- Department of Cardiology, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, UK
| | - Neeraj Mediratta
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, UK
| | - Dhiraj Gupta
- Department of Cardiology, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, UK
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Verran J, Jackson S, Scimone A, Kelly P, Redfern J. Biofilm Control Strategies: Engaging with the Public. Antibiotics (Basel) 2020; 9:E465. [PMID: 32751577 PMCID: PMC7460344 DOI: 10.3390/antibiotics9080465] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/27/2020] [Accepted: 07/29/2020] [Indexed: 11/16/2022] Open
Abstract
There are few peer-reviewed publications about public engagement with science that are written by microbiologists; those that exist tend to be a narrative of an event rather than a hypothesis-driven investigation. However, it is relatively easy for experienced scientists to use a scientific method in their approach to public engagement. This short communication describes three public engagement activities hosted by the authors, focused on biofilm control: hand hygiene, plaque control and an externally applied antimicrobial coating. In each case, audience engagement was assessed using quantitative and/or qualitative methods. A critical evaluation of the findings enabled the construction of a public engagement 'tick list' for future events that would enable a hypothesis-driven approach with more effective communication activities and more robust evaluation.
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Affiliation(s)
- Joanna Verran
- Department of Life Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester M1 5GD, UK; (S.J.); (A.S.)
| | - Sarah Jackson
- Department of Life Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester M1 5GD, UK; (S.J.); (A.S.)
| | - Antony Scimone
- Department of Life Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester M1 5GD, UK; (S.J.); (A.S.)
| | - Peter Kelly
- Surface Engineering Group, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester M1 5GD, UK;
| | - James Redfern
- Department of Natural Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester M1 5GD, UK;
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Liao YW, Redfern J, Somauroo JD, Cooper RM. Hypertrophic cardiomyopathy and exercise restrictions: time to let the shackles off? Br J Cardiol 2020; 27:11. [PMID: 35747091 PMCID: PMC8793933 DOI: 10.5837/bjc.2020.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The health benefits of physical activity are well documented. Patients with hypertrophic cardiomyopathy (HCM) are often discouraged from participating in physical activity due to a perceived increase in the risk of sudden cardiac death (SCD). As a result, only 45% of patients with HCM meet the minimum guidelines for physical activity, and many report an intentional reduction in exercise following diagnosis. Despite most SCD being unrelated to HCM, guidelines traditionally focused on the avoidance of potential risk through restriction of exercise, without clear recommendations on how to negate the negative health impact of inactivity. Retrospective reviews have demonstrated that the majority of cardiac arrests in patients with HCM occurred at rest or on mild exertion and that the overall incidence of HCM-related SCD is significantly lower than previously reported. We will discuss current international guidelines and recommendations and consider the outcomes of various studies that have investigated the effects of exercise of different intensities on patients with HCM. In light of the growing evidence suggesting that carefully guided exercise can be both beneficial and safe in patients with HCM, we ask whether it is time to let the shackles off exercise restriction in HCM.
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Affiliation(s)
- Yuen W Liao
- Foundation Year 2 Doctor Institute of Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, L14 3PE
| | - James Redfern
- Cardiology Specialty Registrar Institute of Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, L14 3PE
| | - John D Somauroo
- Consultant Cardiologist Institute of Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, L14 3PE
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Redfern J, Enright MC. Further understanding of Pseudomonas aeruginosa’s ability to horizontally acquire virulence: possible intervention strategies. Expert Rev Anti Infect Ther 2020; 18:539-549. [DOI: 10.1080/14787210.2020.1751610] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- James Redfern
- Department of Natural Sciences, Manchester Metropolitan University, Manchester, UK
| | - Mark C. Enright
- Department of Life Sciences, Manchester Metropolitan University, Manchester, UK
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Redfern J, Bowater L, Coulthwaite L, Verran J. Raising awareness of antimicrobial resistance among the general public in the UK: the role of public engagement activities. JAC Antimicrob Resist 2020; 2:dlaa012. [PMID: 34222970 PMCID: PMC8210175 DOI: 10.1093/jacamr/dlaa012] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
In response to the accepted risk of emerging antimicrobial resistance, many organizations and institutions have developed and delivered events and activities designed to raise awareness of the issue and to change the behaviour of the intended audience. However, few of these events for a general public audience are documented or able to be sourced by those who might wish to repeat, adapt or modify, particularly those events that are successful. 'Insider knowledge' appears to be the best search tool. Moreover, evaluation of the success or impact of the event is rarely published. It would be useful if there were a 'hub' where descriptions of such activities could be deposited, enabling the building of a significant resource with real academic value.
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Affiliation(s)
- James Redfern
- Department of Natural Sciences, Manchester Metropolitan University, Manchester, UK
| | - Laura Bowater
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Lisa Coulthwaite
- Department of Life Sciences, Manchester Metropolitan University, Manchester, UK
| | - Joanna Verran
- Department of Life Sciences, Manchester Metropolitan University, Manchester, UK
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Hafiz N, Hyun K, Chow C, Briffa T, Gallagher R, Reid C, Hare D, Zwar N, Woodward M, Jan S, Atkins E, Laba T, Halcomb E, Billot L, Usherwood T, Redfern J. 732 Gender Comparison in the use of General Practice Management Plans (GPMPs) for Patients With Cardiovascular Disease (CVD). Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.739] [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: 10/23/2022]
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38
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Raeside R, Halim N, Partridge S, Redfern J. 713 A Review of Mobile Apps for Prevention of Chronic Disease in Adolescents Across a Range of Behaviours. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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39
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Partridge S, Raeside R, Singleton A, Mandoh M, Todd A, Latham Z, Hyun K, Gibson A, Redfern J. 726 Discretionary Food on Demand: Is the Emerging Trend of Online Food Delivery Contributing to Overconsumption of Discretionary Foods? Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.733] [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: 10/23/2022]
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Todd A, Mandoh M, Redfern J, Partridge S. 736 Mapping Obesity Prevention and Management Approaches for Adolescents Within New South Wales. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Nedkoff L, Greenland M, Hyun K, Sanfilippo F, Briffa T, Redfern J, Peeters A, Chew D, Brieger D. 552 Sex Specific Risk Profiles and Outcomes in Adults <55 Years With Acute Coronary Syndromes. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.559] [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: 10/23/2022]
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Singleton A, Raeside R, Partridge S, Hyun K, Sherman K, Elder E, Redfern J. 715 Are Women Managing Cardiovascular Risk Factors 12-Months After Active Breast Cancer Treatment? Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.722] [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: 10/23/2022]
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Hyun K, Hafiz N, Hare D, Reid C, Laba T, Usherwood T, Briffa T, Chow C, Gallagher R, Woodward M, Zwar N, Jan S, Atkins E, Billot L, Brieger D, Redfern J. 007 Characteristics of People With Cardiovascular Disease who did not Receive Influenza Vaccination: A Sub-Analysis Within QUEL Study. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.014] [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: 10/23/2022]
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Munot S, Redfern J, Bray J, Marschner S, Von Huben A, Semsarian C, Jennings G, Bauman A, Angell B, Coggins A, Kumar S, Middleton P, Ferry C, Kovoor P, Lai K, Oppermann I, Vukasovic M, Nelson M, Denniss A, Ware S, Chow C. 046 Bystander Cardiopulmonary Resuscitation (CPR) and use of Automated External Defibrillator (AED) for Out-of-hospital Cardiac Arrest (OHCA): Urban Versus Regional NSW. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.053] [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: 10/23/2022]
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Davis A, Gallagher R, Parker H, Chow C, Neubeck L, Celermajer D, Redfern J, Tolfer G, Buckley T, Schumacher T, Ferry C, Figtree G. 764 Women Are More Likely Than Men to Engage With an Open-Access Gamified Mobile Application for Coronary Heart Disease Secondary Prevention (MyHeartMate). Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.771] [Citation(s) in RCA: 1] [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: 11/24/2022]
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46
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Ayad M, Gullick J, Redfern J, Ryan M, Hyun K, D'Souza M, Brieger D. 490 Factors Influencing Catheterisation Rates following Acute Coronary Syndromes in Australia. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Redfern J, Enright G, Hyun K, Raadsma S, Allman-Farinell M, Innes-Hughes C, Khanal S, Lukeis S, Rissel C, Chai HC, Gyani A. 4225Effectiveness of a behavioural incentive scheme linked to goal achievement in overweight children: a multicenter cluster randomized controlled trial. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0132] [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
Background
The prevalence of childhood overweight and obesity is becoming an increasing concern worldwide and management is vital for primary prevention of cardiovascular disease. Studies in adults have shown that provision of incentives may facilitate behaviour change but there are no similar studies targeting weight management in children.
Purpose
To determine effectiveness of a structured goal setting incentive scheme, delivered within a community program, on health outcomes (with a focus on cardiovascular risk factors) in overweight children at 6 and 18 months.
Methods
Single-blind, multicenter, cluster randomized controlled trial with 10 weeks, 6 and 18 month follow-up. Eligible sites had to be delivering the standard children's weight management program and enrol at least 10 children per term. Eligible children had to be 7–13 years and have a body mass index (BMI) >85th percentile. Recruited sites were randomized to (i) standard weight management program plus incentive scheme (intervention) or (ii) standard program alone (control). The intervention group participated in the standard program plus received milestone based incentives for achievement of goals. Incentives were practical, and healthy in nature such as fun vegetable slicers, sports store vouchers, sport equipment and family zoo passes. Primary outcome was mean BMIz score at 18 months. Secondary outcomes included anthropometric (body weight, waist circumference), behavioural (physical activity, nutrition) and self-esteem (Physical Activity Enjoyment Scale, Rosenberg Self Esteem Scale) measures.
Results
A total of 37 sites (33 urban and 4 regional) and 512 children were recruited. There were no significant differences between the control and intervention groups at any follow-up time-points. There were significantly more participants in the intervention than control group who completed 10 sessions of the weight management program (23% v 13%, p=0.015). Compared to baseline, at 18 month follow-up, the total cohort achieved significant reductions in the mean BMIz score (1.7 v 1.0, p<0.001), median screen time (16.5 v 15.8 hours/week p=0.0414), median number of fast food meals per week (1.0 v 0.7, p<0.001) and significant increases in physical activity (6.0 v 10.0 hours/week, p<0.001) and self-esteem score (20.7 v 22.0, p<0.002).
Conclusions
The incentive scheme, delivered in addition to a standard community weight management program, did not have a significant impact on health outcomes in overweight children. However, the intervention increased program attendance and overall cohort achieved sustained improvements in clinical and lifestyle outcomes. The results of this study suggest that extrinsic rewards may not provide added value to current community weight management programs however, participation in such programs is likely to support primary prevention of cardiovascular disease.
Acknowledgement/Funding
This work was supported by National Heart Foundation (Australia) pilot funding as part of JR's Future Leader Fellowship, in-kind contributions from th
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Affiliation(s)
- J Redfern
- University of Sydney, Sydney, Australia
| | - G Enright
- University of Sydney, Sydney, Australia
| | - K Hyun
- University of Sydney, Sydney, Australia
| | | | | | | | - S Khanal
- NSW Government, Sydney, Australia
| | - S Lukeis
- Better Health Company, Sydney, Australia
| | - C Rissel
- NSW Government, Sydney, Australia
| | - H C Chai
- NSW Government, Sydney, Australia
| | - A Gyani
- NSW Government, Sydney, Australia
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Lowres N, Duckworth A, Chow CK, Thiagalingam A, Redfern J. P571Accuracy of a machine learning program to correctly triage incoming SMS text replies from a successful cardiovascular SMS-based secondary prevention program. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0182] [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
Cardiovascular SMS text programs are effective alternate secondary prevention programs for cardiac risk factor reduction and can be delivered as one-way or two-way communication. However, people text back regularly, leading to staffing costs to monitor replies. If you could reduce the need for staff review by 60–70%, costs and scalability of text programs would substantially improve.
Purpose
To develop and assess accuracy of a machine-learning (ML) program to “triage” and identify texts requiring review/action.
Methods
We manually reviewed and classified all replies received from two “TEXT ME” cardiovascular secondary prevention programs. Simultaneously a ML model was developed to classify texts and determine those needing a reply (figure). Comparison of ML models included “Naïve Bayes”, “random forest decision trees”, and “gradient boosted trees”, along with comparison to “convolutional neural network” and “recurrent neural network” classification approaches. “Natural language programming” was evaluated however this presented challenges in relation to text content due to non-standard English grammar, frequent use of non-standard abbreviations, and spelling errors. The ML program was trained with 70% of the data-set and accuracy was tested with 30%.
Results
Manual review of 3118 text replies revealed that only one text was considered urgent, and only 21% required review/action: categorisation was not straight forward due to complexity of texts often containing more than one sentiment (table). The ML program was able to correctly classify 84% of texts into the designated 12 categories. The sensitivity for correctly identifing the need for health professional review was 94% (6.4% false negatives; 3.6% false positives); but with addition of “heuristics” (e.g. searching for specified keywords, question marks etc) sensitivity increased to 97% (2.9% false negatives; 7.3% false positives). Therefore, health professionals would only have to review 27% (true + false positives) of all text replies.
Table 1. SMS manual categorisation (n=3118) REVIEW REQUIRED Health Question/concern Admin request Request to STOP Ceased smoking SMS not delivered Urgent/ distress (13%) (4.5%) (3%) (0.8%) (0.4%) (0.03%) NO REVIEW REQUIRED General statement Statement of thanks Reporting good health Blank message Unrelated/ accidental Emoticon only (33%) (23%) (11%) (6%) (4%) (2.4%)
Figure 1. Development process
Conclusions
The ML program has high sensitivity identifying text replies requiring health professional input and a low false negative rate indicating few messages needing response would be missed. Thus, introduction of the program could significantly reduce the workload of health professionals, leading to substantial improvements in scalability and capacity of text-based programs. The future implications for this technology are vast, including utilisation in other interactive mHealth interfaces and cardiovascular health “apps”.
Acknowledgement/Funding
National Heart Foundation Vanguard Grant; National Health and Medical Research Council Project Grant
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Affiliation(s)
- N Lowres
- Heart Research Institute and University of Sydney, Camperdown, Australia
| | | | - C K Chow
- Westmead Applied Research Centre, University of Sydney, Sydney, Australia
| | | | - J Redfern
- Westmead Applied Research Centre, University of Sydney, Sydney, Australia
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Hyun K, Redfern J, Briffa T, Chew D, French J, Brieger D. P4343Reconciling acute coronary syndrome diagnoses between linked administrative data and hospital medical records in medical research. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0751] [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/Introduction
Administrative data incorporating the International Classification of Diseases 10th Revision (ICD-10) is commonly used in cardiac research. Using patient records, diagnoses are systematically coded by trained coders who have limited/no clinical experience. Therefore, it is important to understand how systematically coded cardiac diagnoses compare with clinically assessed diagnoses to better analyse and interpret studies that have used linked administrative data to adjudicate patient's diagnosis.
Purpose
To assess the agreement between the acute coronary syndrome (ACS) diagnoses according to linked data compared to those extracted from hospital medical records by clinicians participating in a national registry and determine the factors associated with diagnoses disagreement.
Methods
The rate of ST-elevation myocardial infarction (STEMI), non-STEMI (NSTEMI) and unstable angina (UA) obtained from the medical records, from admission to discharge, for the nationwide SNAPSHOT ACS audit in 2012 were compared to the corresponding ICD-10 Australian Modification (ICD-10-AM) codes using linked data from 6 jurisdictions covering all Australian states (6) and territories (2). The proportions of the overall agreement (OA), the positive agreement (PA) and the Cohen's weighted kappa and the 95% confidence interval (CI) were derived using both data sources for STEMI, NSTEMI and UA individually, where kappa≥0.8 confers strong agreement and 0.6≤kappa<0.8 moderate agreement. The factors associated with the diagnostic disagreement were explored using multilevel multivariable logistic regression model (backward selection method), accounting for the hospital clustering effect.
Results
Overall, 3130 patients had both medical records and linked data available for comparison. The degree of agreement was greatest for STEMI and lowest for UA (STEMI: OA=97%, PA=85%, kappa (95% CI)=0.84 (0.81, 0.87); NSTEMI: OA=91%, PA=81%, kappa (95% CI)=0.76 (0.73,0.79); UA: OA = 81%, PA=53%, kappa (95% CI)=0.41 (0.38, 0.45)). Further, the independent factors associated with the disagreement between the medical records and the linked data were the diagnosis of UA (UA vs. STEMI (odds ratio (95% CI)): 6.85 (4.12, 11.40)), not receiving revascularisation (2.27 (1.69, 3.03)), and the state where the ICD-10-AM was coded (p=0.007) (see Figure).
Figure 1
Conclusion
This study suggests that the agreement between the systematically coded diagnoses from linked administrative data and the diagnosis from the clinical assessment is greater in patients who received revascularisation and worse in those with UA. Also, the degree of agreement varies between states. As the linked data and the ICD codes are being used more often in research to support the evidence-based policies and practice, more attention is needed in testing and improving the accuracy of the ICD-10 codes as well as the ICD-11 codes that are soon to be introduced.
Acknowledgement/Funding
KH is funded by Heart Foundation Postdoctoral Fellowship. SNAPSHOT data linkage project was funded by the NSW Heart Foundation CVRN Project Grant
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Affiliation(s)
- K Hyun
- University of Sydney, Sydney Medical School, Westmead Applied Research Centre, Sydney, Australia
| | - J Redfern
- University of Sydney, Sydney Medical School, Westmead Applied Research Centre, Sydney, Australia
| | - T Briffa
- The University of Western Australia, School of Population Health, Perth, Australia
| | - D Chew
- Flinders Medical Centre and Flinders University, Department of Cardiovascular Medicine, Adelaide, Australia
| | - J French
- Liverpool Hospital, Department of Cardiology, Sydney, Australia
| | - D Brieger
- Concord Repatriation General Hospital, Department of Cardiology, Sydney, Australia
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Redfern J, Usherwood T, Coorey G, Mulley J, Scaria A, Neubeck L, Hafiz N, Chow C, Peiris D. P5307A consumer-direct digital health intervention for cardiovascular risk management in primary care: the Consumer Navigation of Electronic Cardiovascular Tools (CONNECT) randomised controlled trial. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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
Digital health interventions linked to electronic health records offer patients an innovative approach to support cardiovascular disease (CVD) risk management.
Purpose
Test the effectiveness of a consumer-directed digital health strategy on medication adherence and cardiovascular health outcomes in patients presenting to primary care who are at moderate to high risk of CVD.
Methods
Randomised controlled trial (RCT) with 12 month follow-up. Intervention group received an interactive digital health strategy for CVD management. The intervention was integrated with patient's electronic health record to enable automated population of risk factor and medication data (Figure). Control group received usual care. Primary outcome was the proportion of patients taking guideline-recommended BP and cholesterol-lowering medications on at least 80% of days (administrative data). Secondary outcomes included mean SBP, LDL-cholesterol, BMI and proportion meeting risk targets for physical activity, achieving smoking cessation, quality of life (EQ5D) and ehealth literacy (eHEALS).
Results
Intervention (n=486) and control (n=448) groups were well matched at baseline (Table). Mean age of participants was 67±8.1 years, 77% were male, 41% had existing CVD. At 12 months, there was no significant difference between the groups for medication days covered or mean cholesterol and BP (Table). However, there were significantly more patients in the intervention than control group who were physically active and had high ehealth literacy (Table).
Table 1. Primary and Secondary Outcomes Baseline 12 months Outcome Control (n=448) Intervention (n=486) Control (n=431) Intervention (n=460) p value* Taking BP and cholesterol medication on ≥80% of days, % 29.7 28.9 29.9 32.8 0.485 SBP (mmHg), mean±SD 139.0±16.6 137.3±15.9 136.3±16.1 136.4±17.6 0.921 LDL (mmol/L), mean±SD 2.6±1.0 2.6±1.0 2.5±0.9 2.4±1.0 0.240 BMI (kg/m2), mean±SD 29.7±5.1 29.9±5.7 29.4±5.0 29.7±5.7 0.508 Proportion achieving BP and LDL target, % 11.2 12.3 11.7 16.5 0.065 Physically active, % 84.0 85.4 79.7 87.0 0.016 Current smoker, % 12.9 13.0 12.0 8.1 0.087 eHEALS, mean±SD 27.0±6.4 27.0±6.4 26.4±7.5 28.3±6.3 0.002 *Comparing intervention and control at 12 month follow-up.
Conclusions
The integrated digital health strategy did not significantly impact on days of medication covered however, patients in the intervention had higher physical activity and ehealth literacy. The RCT highlights the importance of conducting robust research if we are to understand the potential value of digital health interventions.
Acknowledgement/Funding
This work was supported by a Project Grant from the National Health and Medical Research Council of Australia
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Affiliation(s)
- J Redfern
- University of Sydney, Westmead Applied Research Centre, Faculty of Medicine and Health, Sydney, Australia
| | - T Usherwood
- University of Sydney, Discipline of General Practice, Faculty of Medicine and Health, Sydney, Australia
| | - G Coorey
- The George Institute for Global Health, Sydney, Australia
| | - J Mulley
- The George Institute for Global Health, Sydney, Australia
| | - A Scaria
- The George Institute for Global Health, Sydney, Australia
| | - L Neubeck
- Edinburgh Napier University, School of Health and Social Care, Edinburgh, United Kingdom
| | - N Hafiz
- University of Sydney, Westmead Applied Research Centre, Faculty of Medicine and Health, Sydney, Australia
| | - C Chow
- University of Sydney, Westmead Applied Research Centre, Faculty of Medicine and Health, Sydney, Australia
| | - D Peiris
- The George Institute for Global Health, Sydney, Australia
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