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Miller C, Ettridge K, Pettigrew S, Wittert G, Coveney J, Wakefield M, Roder D, Durkin S, Martin J, Kay E, Dono J. Warning labels for sugar-sweetened beverages and fruit juice: evaluation of 27 different labels on health effects, sugar content, energy and exercise equivalency. Public Health 2024; 230:138-148. [PMID: 38547760 DOI: 10.1016/j.puhe.2024.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 12/19/2023] [Accepted: 01/26/2024] [Indexed: 04/16/2024]
Abstract
OBJECTIVES Front-of-pack warning labels may reduce consumption of sugar-sweetened beverages, potentially mitigating negative health outcomes. Comparisons between different warning label types to inform future research and policy directions are lacking. This study compared 27 warning labels across six message types for their potential to reduce sugar-sweetened beverage consumption. DESIGN AND METHODS A national sample of regular soda (n = 2578) and juice (n = 1048) consumers aged 14-60 years participated in an online survey. Participants evaluated randomly allocated labels; one from each of six warning label sets (health-graphic, sugar-pictogram, sugar-text, exercise equivalents, health-text, energy information) on four measures of perceived effectiveness (PE: overall effectiveness, discourage from drinking, emotional response, persuasive potential). Participants could also provide open comments. A general linear model compared differences in mean scores across label sets for each measure of PE. RESULTS PE ratings differed significantly between label sets. Labels clearly quantifying sugar content (sugar-teaspoons) received consistently high PE ratings, whereas 'high in sugar' labels did not. Health-graphic labels were rated highly across all PE measures except persuasive potential. Exercise labels only rated highly on persuasive potential. Health-text results were mixed, and energy labels were consistently low. CONCLUSIONS Simple, factual labels were easily interpreted and perceived as most effective. Labels quantifying sugar content were consistently high performers and should be advanced into policy to help decrease overconsumption of sugar-sweetened beverages.
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Affiliation(s)
- C Miller
- School of Public Health, The University of Adelaide, Adelaide, Australia; Health Policy Centre, South Australian Health and Medical Research Institute, Adelaide, Australia.
| | - K Ettridge
- Health Policy Centre, South Australian Health and Medical Research Institute, Adelaide, Australia; School of Psychology, The University of Adelaide, Adelaide, Australia
| | - S Pettigrew
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - G Wittert
- Freemasons Centre for Male Health and Wellbeing, South Australian Health and Medical Research Institute and Faculty of Health Sciences, University of Adelaide, Adelaide, Australia
| | - J Coveney
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - M Wakefield
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Australia; School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | - D Roder
- Cancer Epidemiology and Population Health, University of South Australia, Australia
| | - S Durkin
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Australia; School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | - J Martin
- Food for Health Alliance, Cancer Council Victoria, Melbourne, Australia
| | - E Kay
- Health Policy Centre, South Australian Health and Medical Research Institute, Adelaide, Australia; College of Education Psychology and Social Work, Flinders University, Adelaide, Australia
| | - J Dono
- Health Policy Centre, South Australian Health and Medical Research Institute, Adelaide, Australia; School of Psychology, The University of Adelaide, Adelaide, Australia
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Jenkins DR, Auckland C, Chadwick C, Dodgson AR, Enoch DA, Goldenberg SD, Hussain A, Martin J, Spooner E, Whalley T. A practical approach to screening for carbapenemase-producing Enterobacterales- views of a group of multidisciplinary experts from English hospitals. BMC Infect Dis 2024; 24:444. [PMID: 38671365 PMCID: PMC11046869 DOI: 10.1186/s12879-024-09307-y] [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: 02/02/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
INTRODUCTION Carbapenemase-producing Enterobacterales (CPE) are an important public health threat, with costly operational and economic consequences for NHS Integrated Care Systems and NHS Trusts. UK Health Security Agency guidelines recommend that Trusts use locally developed risk assessments to accurately identify high-risk individuals for screening, and implement the most appropriate method of testing, but this presents many challenges. METHODS A convenience sample of cross-specialty experts from across England met to discuss the barriers and practical solutions to implementing UK Health Security Agency framework into operational and clinical workflows. The group derived responses to six key questions that are frequently asked about screening for CPE. KEY FINDINGS Four patient groups were identified for CPE screening: high-risk unplanned admissions, high-risk elective admissions, patients in high-risk units, and known positive contacts. Rapid molecular testing is a preferred screening method for some of these settings, offering faster turnaround times and more accurate results than culture-based testing. It is important to stimulate action now, as several lessons can be learnt from screening during the COVID-19 pandemic, as well as from CPE outbreaks. CONCLUSION Further decisive and instructive information is needed to establish CPE screening protocols based on local epidemiology and risk factors. Local management should continually evaluate local epidemiology, analysing data and undertaking frequent prevalence studies to understand risks, and prepare resources- such as upscaled screening- to prevent increasing prevalence, clusters or outbreaks. Rapid molecular-based methods will be a crucial part of these considerations, as they can reduce unnecessary isolation and opportunity costs.
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Affiliation(s)
- D R Jenkins
- University Hospitals of Leicester NHS Trust, Leicester, UK.
| | - C Auckland
- Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
| | - C Chadwick
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - A R Dodgson
- Manchester University NHS FT, Manchester, UK
| | - D A Enoch
- Cambridge University NHS Foundation Trust, Cambridge, UK
| | - S D Goldenberg
- Centre for Clinical Infection and Diagnostics Research, Guy's and Saint Thomas' Hospitals NHS Trust, London, UK
| | - A Hussain
- University Hospitals Birmingham NHS Foundation Trust, West Midlands, UK
| | - J Martin
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - E Spooner
- Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - T Whalley
- Lancashire & South Cumbria ICB, Preston, UK
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Yahanda AT, Koueik J, Ackerman LL, Adelson PD, Albert GW, Aldana PR, Alden TD, Anderson RCE, Bauer DF, Bethel-Anderson T, Bierbrauer K, Brockmeyer DL, Chern JJ, Couture DE, Daniels DJ, Dlouhy BJ, Durham SR, Ellenbogen RG, Eskandari R, Fuchs HE, Grant GA, Graupman PC, Greene S, Greenfield JP, Gross NL, Guillaume DJ, Hankinson TC, Heuer GG, Iantosca M, Iskandar BJ, Jackson EM, Jallo GI, Johnston JM, Kaufman BA, Keating RF, Khan NR, Krieger MD, Leonard JR, Maher CO, Mangano FT, Martin J, McComb JG, McEvoy SD, Meehan T, Menezes AH, Muhlbauer MS, O'Neill BR, Olavarria G, Ragheb J, Selden NR, Shah MN, Shannon CN, Shimony JS, Smyth MD, Stone SSD, Strahle JM, Tamber MS, Torner JC, Tuite GF, Tyler-Kabara EC, Wait SD, Wellons JC, Whitehead WE, Park TS, Limbrick DD, Ahmed R. The role of occipital condyle and atlas anomalies on occipital cervical fusion outcomes in Chiari malformation type I with syringomyelia: a study from the Park-Reeves Syringomyelia Research Consortium. J Neurosurg Pediatr 2024:1-9. [PMID: 38579359 DOI: 10.3171/2024.1.peds23229] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 01/30/2024] [Indexed: 04/07/2024]
Abstract
OBJECTIVE Congenital anomalies of the atlanto-occipital articulation may be present in patients with Chiari malformation type I (CM-I). However, it is unclear how these anomalies affect the biomechanical stability of the craniovertebral junction (CVJ) and whether they are associated with an increased incidence of occipitocervical fusion (OCF) following posterior fossa decompression (PFD). The objective of this study was to determine the prevalence of condylar hypoplasia and atlas anomalies in children with CM-I and syringomyelia. The authors also investigated the predictive contribution of these anomalies to the occurrence of OCF following PFD (PFD+OCF). METHODS The authors analyzed the prevalence of condylar hypoplasia and atlas arch anomalies for patients in the Park-Reeves Syringomyelia Research Consortium database who underwent PFD+OCF. Condylar hypoplasia was defined by an atlanto-occipital joint axis angle (AOJAA) ≥ 130°. Atlas assimilation and arch anomalies were identified on presurgical radiographic imaging. This PFD+OCF cohort was compared with a control cohort of patients who underwent PFD alone. The control group was matched to the PFD+OCF cohort according to age, sex, and duration of symptoms at a 2:1 ratio. RESULTS Clinical features and radiographic atlanto-occipital joint parameters were compared between 19 patients in the PFD+OCF cohort and 38 patients in the PFD-only cohort. Demographic data were not significantly different between cohorts (p > 0.05). The mean AOJAA was significantly higher in the PFD+OCF group than in the PFD group (144° ± 12° vs 127° ± 6°, p < 0.0001). In the PFD+OCF group, atlas assimilation and atlas arch anomalies were identified in 10 (53%) and 5 (26%) patients, respectively. These anomalies were absent (n = 0) in the PFD group (p < 0.001). Multivariate regression analysis identified the following 3 CVJ radiographic variables that were predictive of OCF occurrence after PFD: AOJAA ≥ 130° (p = 0.01), clivoaxial angle < 125° (p = 0.02), and occipital condyle-C2 sagittal vertical alignment (C-C2SVA) ≥ 5 mm (p = 0.01). A predictive model based on these 3 factors accurately predicted OCF following PFD (C-statistic 0.95). CONCLUSIONS The authors' results indicate that the occipital condyle-atlas joint complex might affect the biomechanical integrity of the CVJ in children with CM-I and syringomyelia. They describe the role of the AOJAA metric as an independent predictive factor for occurrence of OCF following PFD. Preoperative identification of these skeletal abnormalities may be used to guide surgical planning and treatment of patients with complex CM-I and coexistent osseous pathology.
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Affiliation(s)
| | - Joyce Koueik
- 2Department of Neurological Surgery, University of Wisconsin at Madison, Wisconsin
| | - Laurie L Ackerman
- 3Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - P David Adelson
- 4Department of Neurosurgery, West Virginia University School, Morgantown, West Virginia
| | - Gregory W Albert
- 5Division of Neurosurgery, Arkansas Children's Hospital, Little Rock, Arkansas
| | - Philipp R Aldana
- 6Division of Pediatric Neurosurgery, University of Florida College of Medicine, Jacksonville, Florida
| | - Tord D Alden
- 7Division of Pediatric Neurosurgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Illinois
| | | | - David F Bauer
- 9Division of Pediatric Neurosurgery, Texas Children's Hospital, Houston, Texas
| | | | - Karin Bierbrauer
- 10Division of Pediatric Neurosurgery, Cincinnati Children's Medical Center, Cincinnati, Ohio
| | - Douglas L Brockmeyer
- 11Division of Pediatric Neurosurgery, Primary Children's Hospital, Salt Lake City, Utah
| | - Joshua J Chern
- 12Division of Pediatric Neurosurgery, Children's Healthcare of Atlanta University, Atlanta, Georgia
| | - Daniel E Couture
- 13Department of Neurological Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - David J Daniels
- 14Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota
| | - Brian J Dlouhy
- 15Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Susan R Durham
- 16Division of Pediatric Neurosurgery, Children's Hospital of Los Angeles, USC Keck School of Medicine, Los Angeles, California
| | - Richard G Ellenbogen
- 17Division of Pediatric Neurosurgery, Seattle Children's Hospital, Seattle, Washington
| | - Ramin Eskandari
- 18Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina
| | - Herbert E Fuchs
- 19Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina
| | - Gerald A Grant
- 19Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina
| | - Patrick C Graupman
- 20Division of Pediatric Neurosurgery, Gillette Children's Hospital, St. Paul, Minnesota
| | - Stephanie Greene
- 21Divsion of Pediatric Neurosurgery, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Jeffrey P Greenfield
- 22Department of Neurological Surgery, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
| | - Naina L Gross
- 23Warren Clinic Pediatric Neurosurgery, Saint Francis Health System, Tulsa, Oklahoma
| | - Daniel J Guillaume
- 24Department of Neurosurgery, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Todd C Hankinson
- 25Department of Neurosurgery, Penn State College of Medicine, Hershey, Pennsylvania
| | - Gregory G Heuer
- 26Division of Pediatric Neurosurgery, Children's Hospital of Philadelphia, Pennsylvania
| | - Mark Iantosca
- 27Division of Pediatric Neurosurgery, Penn State Health Children's Hospital, Hershey, Pennsylvania
| | - Bermans J Iskandar
- 2Department of Neurological Surgery, University of Wisconsin at Madison, Wisconsin
| | - Eric M Jackson
- 28Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - George I Jallo
- 29Division of Neurosurgery, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | - James M Johnston
- 30Department of Neurosurgery, University of Alabama at Birmingham, Alabama
| | - Bruce A Kaufman
- 31Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Robert F Keating
- 32Department of Neurosurgery, Children's National Medical Center, Washington, DC
| | - Nickalus R Khan
- 33Department of Neurosurgery, The University of Tennessee Health Science Center, Memphis, Tennessee
| | - Mark D Krieger
- 16Division of Pediatric Neurosurgery, Children's Hospital of Los Angeles, USC Keck School of Medicine, Los Angeles, California
| | - Jeffrey R Leonard
- 34Division of Pediatric Neurosurgery, Nationwide Children's Hospital, Columbus, Ohio
| | - Cormac O Maher
- 35Department of Neurosurgery, Stanford University, Palo Alto, California
| | - Francesco T Mangano
- 10Division of Pediatric Neurosurgery, Cincinnati Children's Medical Center, Cincinnati, Ohio
| | - Jonathan Martin
- 36Department of Neurosurgery, Connecticut Children's Hospital, Hartford, Connecticut
| | - J Gordon McComb
- 16Division of Pediatric Neurosurgery, Children's Hospital of Los Angeles, USC Keck School of Medicine, Los Angeles, California
| | | | | | - Arnold H Menezes
- 15Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Michael S Muhlbauer
- 33Department of Neurosurgery, The University of Tennessee Health Science Center, Memphis, Tennessee
| | - Brent R O'Neill
- 25Department of Neurosurgery, Penn State College of Medicine, Hershey, Pennsylvania
| | - Greg Olavarria
- 37Division of Pediatric Neurosurgery, Arnold Palmer Hospital for Children, Orlando, Florida
| | - John Ragheb
- 38Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida
| | - Nathan R Selden
- 39Department of Neurological Surgery and Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Oregon
| | - Manish N Shah
- 40Division of Pediatric Neurosurgery, McGovern Medical School, Houston, Texas
| | - Chevis N Shannon
- 41American Society for Reproductive Medicine, Birmingham, Alabama
| | - Joshua S Shimony
- 42Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Matthew D Smyth
- 29Division of Neurosurgery, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | - Scellig S D Stone
- 43Division of Pediatric Neurosurgery, Boston Children's Hospital, Boston, Massachusetts
| | | | - Mandeep S Tamber
- 44Division of Neurosurgery, The University of British Columbia, Vancouver, British Columbia, Canada
| | - James C Torner
- 15Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Gerald F Tuite
- 29Division of Neurosurgery, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | | | - Scott D Wait
- 46Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina
| | - John C Wellons
- 40Division of Pediatric Neurosurgery, McGovern Medical School, Houston, Texas
| | - William E Whitehead
- 9Division of Pediatric Neurosurgery, Texas Children's Hospital, Houston, Texas
| | | | | | - Raheel Ahmed
- 2Department of Neurological Surgery, University of Wisconsin at Madison, Wisconsin
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Rshaidat H, Whitehorn GL, Collins M, Mack SJ, Martin J, Grenda TR, Evans NR, Okusanya OT. Factors Associated With Margin Positivity After Lung Resection Surgery. Clin Lung Cancer 2024:S1525-7304(24)00043-3. [PMID: 38658271 DOI: 10.1016/j.cllc.2024.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 03/01/2024] [Accepted: 03/31/2024] [Indexed: 04/26/2024]
Abstract
INTRODUCTION The purpose of this study is to utilize a representative national sample to investigate the factors associated with margin positivity after attempted surgical resection. Given the changes in surgical approaches to lung cancer for the last 10 years, margin positivity and outcomes between robotic, video assisted thoracoscopic surgery (VATS) and open surgical resections may vary. METHODS This retrospective cohort study utilized the National Cancer Database. Patients with non-small-cell lung cancer, 18 or older and who had a surgical lung resection between 2010 and 2019 were included. Demographic data, along with patient-level clinical variables were extracted. Patient-level outcome variables including 30-day, 90-day mortality and readmission rates were analyzed. Univariable and multivariable logistic regression was utilized to assess factors associated with margin positivity. RESULTS A total of 226,884 patients were identified. Of the total cohort, 9229 had positive margins (4.2%). Patients with positive margins had statistically significant increased 30-day, 90-day mortality, as well as increased readmission rate. Older age, male sex, patients undergoing an open resection, patients who underwent a wedge resection, higher clinical stage, larger tumor size, squamous and adenosquamous histologies, and higher Charlson-Deyo Comorbidity Index were all associated with having a positive margin after resection. CONCLUSION In conclusion, there was no difference in margin positivity when comparing robotic and VATS resection, however, open resection had increased rates of margin positivity. Increasing tumor size, clinical stage, squamous and adenosquamous histologies, male sex, and patients undergoing a wedge resection were all associated with increased rates of margin positivity.
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Affiliation(s)
- Hamza Rshaidat
- Department of Surgery, Division of Esophageal and Thoracic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Gregory L Whitehorn
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Micaela Collins
- Department of Surgery, Division of Esophageal and Thoracic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Shale J Mack
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Jonathan Martin
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Tyler R Grenda
- Department of Surgery, Division of Esophageal and Thoracic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Nathaniel R Evans
- Department of Surgery, Division of Esophageal and Thoracic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Olugbenga T Okusanya
- Department of Surgery, Division of Esophageal and Thoracic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA.
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Baudouin R, Hans S, Lisan Q, Morin B, Adimi Y, Martin J, Lechien JR, Tartour E, Badoual C. Prognostic Significance of the Microenvironment in Human Papillomavirus Oropharyngeal Carcinoma: A Systematic Review. Laryngoscope 2024; 134:1507-1516. [PMID: 37642393 DOI: 10.1002/lary.31010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/01/2023] [Accepted: 08/15/2023] [Indexed: 08/31/2023]
Abstract
OBJECTIVE The immune microenvironment of HPV-associated (HPV+) oropharyngeal squamous cell carcinomas (OPSCCs) (HPV+OPSCCs) differs from that of HPV-independent oropharyngeal cancers (HPV-independent OPSCCs). The literature on the subject is very abundant, demanding an organized synthesis of this wealth of information to evaluate the hypothesis associating the favorable prognosis of HPV+OPSCC patients with a different immune microenvironment. A systematic review of the literature was conducted regarding the microenvironment of HPV+OPSCCs. DATA SOURCE MEDLINE/PubMed, Embase, and Cochrane Library databases. REVIEW METHODS A literature search was performed following PRISMA guidelines (Moher D. PLoS Med. 2009). The PEO (Population, Exposure, and Outcome) framework is detailed as follows: P: patients with oropharyngeal squamous cell carcinomas, E: human papillomavirus (HPV), and O: histological and immunological composition of the tumoral microenvironment (TME). No meta-analysis was performed. RESULTS From 1,202 studies that were screened, 58 studies were included (n = 6,474 patients; n = 3,581 (55%) HPV+OPSCCs and n = 2,861(45%) HPV-independent OPSCCs). The presence of tumor-infiltrating lymphocytes (TIL), CD3+ in 1,733 patients, CD4+ in 520 patients, and CD8+ (cytotoxic T lymphocytes (CTL)) in 3,104 patients, and high levels of PD-L1 expression in 1,222 patients is strongly correlated with an improved clinical outcome in HPV+OPSCCs. CONCLUSION This systematic review provides the most comprehensive information on the immune microenvironment of HPV+OPSCCs to date. Tumor-infiltrating lymphocytes and PD-L1 expression are associated with a favorable prognosis. B, CD8+ and resident memory cells densities are higher in HPV+OPSCCs. The importance of myeloid lineages is still a matter of debate and research. LEVEL OF EVIDENCE NA Laryngoscope, 134:1507-1516, 2024.
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Affiliation(s)
- R Baudouin
- Department of Otolaryngology-Head & Neck Surgery, Foch Hospital, Suresnes, France
- School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Montigny-le-Bretonneux, France
| | - S Hans
- Department of Otolaryngology-Head & Neck Surgery, Foch Hospital, Suresnes, France
- School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Montigny-le-Bretonneux, France
| | - Q Lisan
- Department of Otolaryngology-Head & Neck Surgery, Foch Hospital, Suresnes, France
- School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Montigny-le-Bretonneux, France
| | - B Morin
- Department of Pathology, Hôpital Européen Georges Pompidou, Université Paris Cité, INSERM, PARCC, Paris, France
- Department of Biological Immunology, Hôpital Européen Georges Pompidou, Université Paris Cité, INSERM, PARCC, Paris, France
| | - Y Adimi
- Department of Pathology, Hôpital Européen Georges Pompidou, Université Paris Cité, INSERM, PARCC, Paris, France
- Department of Biological Immunology, Hôpital Européen Georges Pompidou, Université Paris Cité, INSERM, PARCC, Paris, France
| | - J Martin
- Department of Pathology, Hôpital Européen Georges Pompidou, Université Paris Cité, INSERM, PARCC, Paris, France
- Department of Biological Immunology, Hôpital Européen Georges Pompidou, Université Paris Cité, INSERM, PARCC, Paris, France
| | - J R Lechien
- Department of Otolaryngology-Head & Neck Surgery, Foch Hospital, Suresnes, France
- School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Montigny-le-Bretonneux, France
| | - E Tartour
- Department of Biological Immunology, Hôpital Européen Georges Pompidou, Université Paris Cité, INSERM, PARCC, Paris, France
| | - C Badoual
- Department of Pathology, Hôpital Européen Georges Pompidou, Université Paris Cité, INSERM, PARCC, Paris, France
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Sardesai N, Russo P, Martin J, Sardesai A. Utilizing generative conversational artificial intelligence to create simulated patient encounters: a pilot study for anaesthesia training. Postgrad Med J 2024; 100:237-241. [PMID: 38240054 DOI: 10.1093/postmj/qgad137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 11/13/2023] [Accepted: 12/02/2023] [Indexed: 03/20/2024]
Abstract
PURPOSE OF THE STUDY Generative conversational artificial intelligence (AI) has huge potential to improve medical education. This pilot study evaluated the possibility of using a 'no-code' generative AI solution to create 2D and 3D virtual avatars, that trainee doctors can interact with to simulate patient encounters. METHODS The platform 'Convai' was used to create a virtual patient avatar, with a custom backstory, to test the feasibility of this technique. The virtual patient model was set up to allow trainee anaesthetists to practice answering questions that patients' may have about interscalene nerve blocks for open reduction and internal fixation surgery. This tool was provided to anaesthetists to receive their feedback and evaluate the feasibility of this approach. RESULTS Fifteen anaesthetists were surveyed after using the tool. The tool had a median score [interquartile range (IQR)] of 9 [7-10] in terms of how intuitive and user-friendly it was, and 8 [7-10] in terms of accuracy in simulating patient responses and behaviour. Eighty-seven percent of respondents felt comfortable using the model. CONCLUSIONS By providing trainees with realistic scenarios, this technology allows trainees to practice answering patient questions regardless of actor availability, and indeed from home. Furthermore, the use of a 'no-code' platform allows clinicians to create customized training tools tailored to their medical specialties. While overall successful, this pilot study highlighted some of the current drawbacks and limitations of generative conversational AI, including the risk of outputting false information. Additional research and fine-tuning are required before generative conversational AI tools can act as a substitute for actors and peers.
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Affiliation(s)
- Neil Sardesai
- Emmanuel College, University of Cambridge, St Andrews Street, Cambridge, CB2 3AP, United Kingdom
| | - Paolo Russo
- Simulation Centre, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Jonathan Martin
- Simulation Centre, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
- Department of Anaesthesia, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Anand Sardesai
- Department of Anaesthesia, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
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Ademuyiwa AO, Bhangu A, Chakrabortee S, Glasbey J, Kamarajah SK, Ledda V, Li E, Morton D, Nepogodiev D, Picciochi M, Simoes JFF, Lapitan MC, Cheetham M, Forkman E, El-Boghdadly E, Ghosh D, Harrison EM, Hutchinson P, Lawani I, Aguilera ML, Martin J, Meara JG, Ntirenganya F, Medina ARDL, Tabiri S. Strategies to strengthen elective surgery systems during the SARS-CoV-2 pandemic: systematic review and framework development. Br J Surg 2024; 111:znad405. [PMID: 38300731 PMCID: PMC10833142 DOI: 10.1093/bjs/znad405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 09/12/2023] [Accepted: 10/27/2023] [Indexed: 02/03/2024]
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Jao S, Wang Z, Mukhi A, Chaudhary N, Martin J, Yuan V, Laskowski R, Huang E, Vosswinkel J, Singer AJ, Jawa R. Radiographic cervical spine injury patterns in admitted blunt trauma patients with and without prehospital spinal motion restriction. Trauma Surg Acute Care Open 2023; 8:e001092. [PMID: 38020851 PMCID: PMC10668292 DOI: 10.1136/tsaco-2023-001092] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 10/03/2023] [Indexed: 12/01/2023] Open
Abstract
Objectives Selective prehospital cervical spine motion restriction (C-SMR) following blunt trauma has increasingly been used by emergency medical service (EMS) providers. We determined rates of prehospital C-SMR and concomitant radiographic injury patterns. Methods A retrospective trauma registry and chart review was conducted for all adult blunt trauma patients who were transported by EMS and hospitalized with radiographic cervical spine injuries from 2011 to 2019 at a level 1 trauma center. Results Of 658 admitted blunt trauma patients with confirmed cervical spine injury by imaging, 117 (17.8%) did not receive prehospital C-SMR. Patients without prehospital C-SMR were significantly older (76 vs 54 years), more often had low fall as mechanism of injury (59.8% vs 15.9%) and had lower Injury Severity Score (10 vs 17). Patients without C-SMR (Non-SMR) experienced the full array of cervical spine injury types and locations. While the non-SMR patients most often had dens fractures,C-SMR patients most often had C7 fractures; frequencies of fractures at the remaining vertebral levels were comparable. On MRI, cervical spinal cord (8.5% vs 19.6%) and ligamentous injuries (5.1% vs 12.6%) occurred less often in non-SMR patients. Approximately 8.5% of non-SMR patients and 20% of C-SMR patients required cervical spine surgery. Conclusion Patients without prehospital C-SMR demonstrate a broad array of cervical spine injuries. While the rates of certain cervical injuries are lower in prehospital non-SMR patients, they are not insignificant. Level of evidence Level III.
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Affiliation(s)
- Susan Jao
- Stony Brook University, Stony Brook, New York, USA
| | - Zhe Wang
- Stony Brook University, Stony Brook, New York, USA
| | - Ambika Mukhi
- Stony Brook University, Stony Brook, New York, USA
| | | | | | | | | | - Emily Huang
- Stony Brook University, Stony Brook, New York, USA
| | | | - Adam J Singer
- Emergency Medicine, Stony Brook University, Stony Brook, New York, USA
| | - Randeep Jawa
- Stony Brook University, Stony Brook, New York, USA
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9
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Buchholz J, Goins S, Martin J. Endovascular treatment of chronic mesenteric ischaemia secondary to a superior mesenteric artery pseudoaneurysm: a modified neurointerventional technique. BMJ Case Rep 2023; 16:e255168. [PMID: 37931964 PMCID: PMC10632814 DOI: 10.1136/bcr-2023-255168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023] Open
Abstract
A man in his late 60s presented with intermittent abdominal pain, nausea, vomiting and approximately 40 pounds of weight loss over the course of a year, most concerning for chronic mesenteric ischaemia. Given a prior negative workup, a CT angiogram was performed and revealed a wide neck mid-superior mesenteric artery pseudoaneurysm (PSA). As PSAs are susceptible to thrombus formation and distal emboli, this incidental finding was considered a possible explanation for his intermittent symptoms and thus required treatment. Anatomical constraints precluded traditional coiling or covered stent placement, so the interventional radiology team used a neurointerventional technique and performed a successful balloon-assisted coil embolisation of the PSA with subsequent resolution of the patient's symptoms. More than 3 years postprocedure, the patient remains asymptomatic with no complications.
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Affiliation(s)
- Joseph Buchholz
- Department of Radiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Stacy Goins
- Department of Radiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jonathan Martin
- Department of Radiology, Duke University School of Medicine, Durham, North Carolina, USA
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10
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Christensen PM, Martin J, Uppuluri A, Joyce LR, Wei Y, Guan Z, Morcos F, Palmer KL. Lipid discovery enabled by sequence statistics and machine learning. bioRxiv 2023:2023.10.12.562061. [PMID: 37873101 PMCID: PMC10592805 DOI: 10.1101/2023.10.12.562061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Bacterial membranes are complex and dynamic, arising from an array of evolutionary pressures. One enzyme that alters membrane compositions through covalent lipid modification is MprF. We recently identified that Streptococcus agalactiae MprF synthesizes lysyl-phosphatidylglycerol (Lys-PG) from anionic PG, and a novel cationic lipid, lysyl-glucosyl-diacylglycerol (Lys-Glc-DAG), from neutral glycolipid Glc-DAG. This unexpected result prompted us to investigate whether Lys-Glc-DAG occurs in other MprF-containing bacteria, and whether other novel MprF products exist. Here, we studied protein sequence features determining MprF substrate specificity. First, pairwise analyses identified several streptococcal MprFs synthesizing Lys-Glc-DAG. Second, a restricted Boltzmann machine-guided approach led us to discover an entirely new substrate for MprF in Enterococcus , diglucosyl-diacylglycerol (Glc2-DAG), and an expanded set of organisms that modify glycolipid substrates using MprF. Overall, we combined the wealth of available sequence data with machine learning to model evolutionary constraints on MprF sequences across the bacterial domain, thereby identifying a novel cationic lipid.
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11
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Harz D, Catalán Gamonal B, Matute García S, Jeremias F, Martin J, Fresno MC. Prevalence and severity of molar-incisor hypomineralization, is there an association with socioeconomic status? A cross-sectional study in Chilean schoolchildren. Eur Arch Paediatr Dent 2023; 24:577-584. [PMID: 37432610 DOI: 10.1007/s40368-023-00820-3] [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: 07/22/2022] [Accepted: 06/24/2023] [Indexed: 07/12/2023]
Abstract
PURPOSE Data about molar-incisor hypomineralization (MIH) prevalence and its severity remains limited for some Latin American countries. Furthermore, its association with socioeconomic status (SES) is still unclear. Thus, this study aims to determine the prevalence and severity of MIH in Santiago, Chile and explore its association with SES. METHODS A cross-sectional study with schoolchildren between 6 and 12 years was conducted. Children were evaluated using the European Academy of Paediatric Dentistry to diagnose MIH, and the Mathu-Muju and Wright criteria to determine its severity. RESULTS A total of 1,270 children were included. The MIH prevalence was 12.8% without association with gender (p = 0.609). Prevalence was higher among schoolchildren ages 8 and 9 (p = 0.002), and in lower SES (p = 0.007). MIH mild cases were the most prevalent (63%), and severity was not related to gender (p = 0.656), age (p = 0.060), or SES (p = 0.174). CONCLUSIONS The prevalence of MIH in the province of Santiago, Chile is 12.8% and was found to have a higher incidence in 8-9-year-old students and among those categorized by low SES. Furthermore, MIH prevalence was associated with low SES. IMPLICATIONS Public health policies to address MIH in Chile should start with schoolchildren aged 8 to 9, and with low SES.
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Affiliation(s)
- D Harz
- Dental School, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | | | - F Jeremias
- Graduate Program in Dental Science Araraquara School of Dentistry, UNESP Univ Estadual Paulista São Paulo, Araraquara, São Paulo, Brazil
| | - J Martin
- Department of Restorative Dentistry, Faculty of Dentistry, University of Chile, Olivos 943, Independencia, Santiago, Chile
| | - M C Fresno
- Faculty of Dentistry, University of Chile, Santiago, Chile.
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12
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Crabb S, Wickens R, Jane-Bibby S, Dunkley D, Lawrence M, Knight A, Jones R, Birtle A, Huddart R, Linch M, Martin J, Coleman A, Boukas K, Markham H, Griffiths G. Evaluating atezolizumab in patients with urinary tract squamous cell carcinoma (AURORA): study protocol for a single arm, open-label, multicentre, phase II clinical trial. BMC Cancer 2023; 23:885. [PMID: 37726695 PMCID: PMC10510135 DOI: 10.1186/s12885-023-11397-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 09/12/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Bladder and urinary tract cancers account for approximately 21,000 new diagnoses and 5,000 deaths annually in the UK. Approximately 90% are transitional cell carcinomas where advanced disease is treated with platinum based chemotherapy and PD-1/PD-L1 directed immunotherapy. Urinary tract squamous cell carcinoma (UTSCC) accounts for about 5% of urinary tract cancers overall making this a rare disease. We have yet to establish definitive systemic treatment options for advanced UTSCC. Preliminary translational data, from UTSCC patient tumour samples, indicate high PD-L1 expression and tumour infiltrating lymphocytes in a proportion of cases. Both of these features are associated with differential gene expression consistent with a tumour/immune microenvironment predicted to be susceptible to immune checkpoint directed immunotherapy which we will evaluate in the AURORA trial. METHODS AURORA is a single arm, open-label, multicentre,UK phase II clinical trial. 33 patients will be recruited from UK secondary care sites. Patients with UTSCC, suitable for treatment with palliative intent, will receive atezolizumab PD-L1 directed immunotherapy (IV infusion, 1680 mg, every 28 days) for one year if tolerated. Response assessment, by cross sectional imaging will occur every 12 weeks. AURORA uses a Simon's 2-stage optimal design with best overall objective response rate (ORR, by RECIST v1.1) at a minimum of 12 weeks from commencing treatment as the primary endpoint. Secondary endpoints will include overall survival, progression-free survival, duration of response, magnitude of response using waterfall plots of target lesion measurements, quality of life using the EORTC QLQ-C30 tool, safety and tolerability (CTCAE v5) and evaluation of potential biomarkers of treatment response including PD-L1 expression. Archival tumour samples and blood samples will be collected for translational analyses. DISCUSSION If this trial shows atezolizumab to be safe and effective it may lead to a future late phase randomised controlled trial in UTSCC. Ultimately, we hope to provide a new option for treatment for such patients. TRIAL REGISTRATIONS EudraCT Number: 2021-001995-32 (issued 8th September 2021); ISRCTN83474167 (registered 11 May 2022); NCT05038657 (issued 9th September 2021).
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Affiliation(s)
- Simon Crabb
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK.
- University Hospital Southampton NHS Foundation Trust, Southampton, UK.
| | - Robin Wickens
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Sarah Jane-Bibby
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Denise Dunkley
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Megan Lawrence
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Allen Knight
- Action Bladder Cancer UK (Registered Charity No: 1164374), Tetbury, UK
| | - Robert Jones
- School of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Alison Birtle
- Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | | | - Mark Linch
- University College London Hospital, London, UK
| | - Jonathan Martin
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Adam Coleman
- Experimental Cancer Medicine Centre (ECMC), University of Southampton, Southampton, UK
| | - Konstantinos Boukas
- Wessex Investigational Sciences Hub Laboratory (WISH Lab), University of Southampton, Southampton, UK
| | - Hannah Markham
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Gareth Griffiths
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
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13
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Sepman H, Malm L, Peets P, MacLeod M, Martin J, Breitholtz M, Kruve A. Bypassing the Identification: MS2Quant for Concentration Estimations of Chemicals Detected with Nontarget LC-HRMS from MS 2 Data. Anal Chem 2023; 95:12329-12338. [PMID: 37548594 PMCID: PMC10448440 DOI: 10.1021/acs.analchem.3c01744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 07/23/2023] [Indexed: 08/08/2023]
Abstract
Nontarget analysis by liquid chromatography-high-resolution mass spectrometry (LC-HRMS) is now widely used to detect pollutants in the environment. Shifting away from targeted methods has led to detection of previously unseen chemicals, and assessing the risk posed by these newly detected chemicals is an important challenge. Assessing exposure and toxicity of chemicals detected with nontarget HRMS is highly dependent on the knowledge of the structure of the chemical. However, the majority of features detected in nontarget screening remain unidentified and therefore the risk assessment with conventional tools is hampered. Here, we developed MS2Quant, a machine learning model that enables prediction of concentration from fragmentation (MS2) spectra of detected, but unidentified chemicals. MS2Quant is an xgbTree algorithm-based regression model developed using ionization efficiency data for 1191 unique chemicals that spans 8 orders of magnitude. The ionization efficiency values are predicted from structural fingerprints that can be computed from the SMILES notation of the identified chemicals or from MS2 spectra of unidentified chemicals using SIRIUS+CSI:FingerID software. The root mean square errors of the training and test sets were 0.55 (3.5×) and 0.80 (6.3×) log-units, respectively. In comparison, ionization efficiency prediction approaches that depend on assigning an unequivocal structure typically yield errors from 2× to 6×. The MS2Quant quantification model was validated on a set of 39 environmental pollutants and resulted in a mean prediction error of 7.4×, a geometric mean of 4.5×, and a median of 4.0×. For comparison, a model based on PaDEL descriptors that depends on unequivocal structural assignment was developed using the same dataset. The latter approach yielded a comparable mean prediction error of 9.5×, a geometric mean of 5.6×, and a median of 5.2× on the validation set chemicals when the top structural assignment was used as input. This confirms that MS2Quant enables to extract exposure information for unidentified chemicals which, although detected, have thus far been disregarded due to lack of accurate tools for quantification. The MS2Quant model is available as an R-package in GitHub for improving discovery and monitoring of potentially hazardous environmental pollutants with nontarget screening.
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Affiliation(s)
- Helen Sepman
- Department
of Materials and Environmental Chemistry, Stockholm University, Svante Arrhenius väg 16, 106
91 Stockholm, Sweden
- Department
of Environmental Science, Stockholm University, Svante Arrhenius väg 8, 106 91 Stockholm, Sweden
| | - Louise Malm
- Department
of Materials and Environmental Chemistry, Stockholm University, Svante Arrhenius väg 16, 106
91 Stockholm, Sweden
| | - Pilleriin Peets
- Department
of Materials and Environmental Chemistry, Stockholm University, Svante Arrhenius väg 16, 106
91 Stockholm, Sweden
| | - Matthew MacLeod
- Department
of Environmental Science, Stockholm University, Svante Arrhenius väg 8, 106 91 Stockholm, Sweden
| | - Jonathan Martin
- Science
for Life Laboratory, Department of Environmental Science, Stockholm University, Svante Arrhenius väg 8, 106 91 Stockholm, Sweden
| | - Magnus Breitholtz
- Department
of Environmental Science, Stockholm University, Svante Arrhenius väg 8, 106 91 Stockholm, Sweden
| | - Anneli Kruve
- Department
of Materials and Environmental Chemistry, Stockholm University, Svante Arrhenius väg 16, 106
91 Stockholm, Sweden
- Department
of Environmental Science, Stockholm University, Svante Arrhenius väg 8, 106 91 Stockholm, Sweden
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14
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Musick A, Malhotra D, French R, Carrico C, Martin J. Return to the Reading Room: Implementation of a Hybrid Radiology Clerkship Model after Emergent Conversion to Remote Learning in the COVID-19 Pandemic. Acad Radiol 2023; 30:1738-1745. [PMID: 36153251 PMCID: PMC9420696 DOI: 10.1016/j.acra.2022.08.027] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/22/2022] [Accepted: 08/22/2022] [Indexed: 11/24/2022]
Abstract
RATIONALE AND OBJECTIVES The COVID-19 pandemic prompted the virtualization of historically in-person radiology rotations for medical students. As students return to in-person clinical education, there is an opportunity to reevaluate teaching strategies and incorporate best practices from the pandemic. We describe our experience with the conversion of a four-week radiology clerkship from an in-person (IP) to remote learning (RL) to hybrid model (HM) and its impact on student performance and satisfaction. MATERIALS AND METHODS Stratified by curriculum (Group 1 IP, Group 2 RL, Group 3 HM), student standardized final examination scores, final grades, lecture evaluation scores, and satisfaction scores were compared. Additional analysis was performed for Group 3 clinical divisions in which IP or RL models predominated. RESULTS A significant decrease in mean final exam score was noted in Group 2 (p < 0.0001). Average lecture rating decreased in Group 3 compared to Group 1 (p < 0.001). Group 3 students reported improved faculty (Group 1: 59, Group 2: 61, Group 3: 82; p < 0.001) and resident (Group 1: 76.5, Group 2: 68, Group 3: 90; p < 0.001) teaching effectiveness. Student-reported quantity and quality of formative feedback were also highest for Group 3 (Quantity; Group 1: 60.6, Group 2: 74, Group 3: 93; p < 0.001) (Quality; Group 1: 59.1, Group 2: 77, Group 3: 97; p < 0.001). Group 3 subanalysis demonstrated increased student-perceived usefulness of activities within IP divisions (p < 0.01) and a decrease for RL divisions (p < 0.05). CONCLUSION A hybrid curriculum resulted in improved student satisfaction and preserved student performance after an emergent conversion to remote learning.
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Affiliation(s)
- Alexis Musick
- Duke University School of Medicine (A.M., D.M.), Durham, North Carolina
| | - Deeksha Malhotra
- Duke University School of Medicine (A.M., D.M.), Durham, North Carolina
| | - Robert French
- Department of Radiology (R.F., C.C., J.M.), Duke University Medical Center, DUMC BOX 3808, 2301 Erwin Rd, Duke North, Room 1502, Durham, NC 27710.
| | - Caroline Carrico
- Department of Radiology (R.F., C.C., J.M.), Duke University Medical Center, DUMC BOX 3808, 2301 Erwin Rd, Duke North, Room 1502, Durham, NC 27710
| | - Jonathan Martin
- Department of Radiology (R.F., C.C., J.M.), Duke University Medical Center, DUMC BOX 3808, 2301 Erwin Rd, Duke North, Room 1502, Durham, NC 27710
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15
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Crabb S, Morgan A, Hunter MS, Stefanopoulou E, Griffiths G, Richardson A, Fenlon D, Fleure L, Raftery J, Boxall C, Wilding S, Nuttall J, Eminton Z, Tilt E, O'Neill A, Bacon R, Martin J. A multicentre randomised controlled trial of a guided self-help cognitive behavioural therapy to MANage the impact of hot flushes and night sweats in patients with prostate CANcer undergoing androgen deprivation therapy (MANCAN2). Trials 2023; 24:450. [PMID: 37430353 PMCID: PMC10332063 DOI: 10.1186/s13063-023-07325-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 04/12/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Androgen deprivation therapy (ADT) is prescribed to almost half of all men diagnosed with prostate cancer. Although ADT is effective treatment, with virtually all men with advanced disease showing initial clinical response, it is associated with troublesome side effects including hot flushes and night sweats (HFNS). HFNS can be both frequent and severe and can have a significant impact on quality of life (QoL). They can occasionally be so debilitating that patients stop ADT altogether, despite the increased risk of disease relapse or death. Previous research has found that guided self-help cognitive behavioural therapy (CBT) can be effective in reducing HFNS due to ADT when delivered by a clinical psychologist. MANCAN2 aims test whether we can train the existing NHS Prostate Cancer Nurse Specialist (CNS) team to deliver guided self-help CBT and whether it is effective in reducing the impact of HFNS in men undergoing ADT. METHODS MANCAN2 is a phase III multicentre randomised controlled trial and process evaluation. Between 144 and 196 men with prostate cancer who are currently receiving ADT and are experiencing problematic HFNS will be individually randomised in a 1:1 ratio in groups of 6-8 participants to either treatment as usual (TAU) or participation in the guided self-help CBT intervention plus TAU. A process evaluation using the normalisation process theory (NPT) framework will be conducted, to understand the CNS team's experiences of delivering the intervention and to establish the key influencers to its implementation as a routine practice service. Fidelity of implementation of the intervention will be conducted by expert assessment. The cost-effectiveness of the intervention and participant adherence to the trial intervention will also be assessed. DISCUSSION MANCAN2 will advance the program of work already conducted in development of management strategies for HFNS. This research will determine whether the severity of ADT-induced HFNS in men with prostate cancer can be reduced by a guided self-help CBT intervention, delivered by the existing NHS prostate cancer CNS team, within a multicentre study. The emphasis on this existing team, if successful, should facilitate translation through to implementation in routine practice. TRIAL REGISTRATION ISRCTN reference 58720120 . Registered 13 December 2022.
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Affiliation(s)
- Simon Crabb
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Alannah Morgan
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK.
| | - Myra S Hunter
- Kings College London, Institute of Psychiatry, Psychology and Neuroscience, Kings College, London, UK
| | | | - Gareth Griffiths
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Alison Richardson
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
- University of Southampton, Southampton, UK
| | - Deborah Fenlon
- Swansea University, Faculty of Medicine, Health and Life Sciences, Swansea University, Swansea, Wales
| | - Louisa Fleure
- Guys and St Thomas NHS Foundation Trust, St Thomas Hospital Westminster Bridge Road, London, UK
| | | | - Cherish Boxall
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Sam Wilding
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Jacqueline Nuttall
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Zina Eminton
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Emma Tilt
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Alice O'Neill
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Roger Bacon
- Prostate Cancer Support Organisation (PCaSO), Emsworth, UK
| | - Jonathan Martin
- Research Department of Primary Care and Population Health, University College London, London, UK
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16
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Simhal RK, Shah YB, Wang KR, Martin J, Shah S, Wright A, D'Amico M, Leong JY, Lallas CD, Shenot PJ, Shah MS, Murphy AM. Gender Diversity in Urology Residency Program Leadership Is Associated With Gender Diversity in Residency Cohort. Urology 2023; 177:222-226. [PMID: 37059231 DOI: 10.1016/j.urology.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 03/30/2023] [Accepted: 04/04/2023] [Indexed: 04/16/2023]
Abstract
OBJECTIVE To evaluate the association of program director (PD) gender on the proportion of female residents in urology residency programs. METHODS Demographics for program faculty and current residents matched in the 2017-2022 cycles at United States' accredited urology residency programs were collected from institutional websites. Data verification was completed using the American Urological Association's (AUA) list of accredited programs and the programs' official social media channels. Proportion of female residents across cohorts was compared using two-tailed Student's t-tests. RESULTS One hundred forty-three accredited programs were studied, and 6 were excluded for lack of data. Thirty (22%) of the 137 programs studied have female PDs. Of 1799 residents, 571 (32%) are women. There has been an upward trend in the proportion of females matched from 26% in 2018 to 30% in 2019, 33% in 2020, 32% in 2021, to 38% in 2022. When compared to programs with male PDs, those with female PDs had a significantly higher proportion of female residents (36.2% vs 28.8%, p = .02). CONCLUSION Nearly one-quarter of urology residency PDs are female, and approximately one-third of current urology residents are women, a proportion that has been increasing. Programs with female PDs are more likely to match female residents, whether those programs with female leadership rank female applicants more favorably or female applicants rank those programs higher. Given the ongoing gender disparities in urology, these findings indicate notable benefit in supporting female urologists in academic leadership positions.
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Affiliation(s)
- Rishabh K Simhal
- Department of Urology, Thomas Jefferson University, Philadelphia, PA
| | - Yash B Shah
- Department of Urology, Thomas Jefferson University, Philadelphia, PA; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Kerith R Wang
- Department of Urology, Thomas Jefferson University, Philadelphia, PA; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Jonathan Martin
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Sohan Shah
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Adam Wright
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Maria D'Amico
- Department of Urology, Thomas Jefferson University, Philadelphia, PA
| | - Joon Yau Leong
- Department of Urology, Thomas Jefferson University, Philadelphia, PA
| | - Costas D Lallas
- Department of Urology, Thomas Jefferson University, Philadelphia, PA
| | - Patrick J Shenot
- Department of Urology, Thomas Jefferson University, Philadelphia, PA
| | - Mihir S Shah
- Department of Urology, Thomas Jefferson University, Philadelphia, PA
| | - Alana M Murphy
- Department of Urology, Thomas Jefferson University, Philadelphia, PA.
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17
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Cullington HE, Jiang D, Broomfield SJ, Chung M, Craddock LC, Driver S, Edwards D, Gallacher JM, Jones LL, Koleva T, Martin J, Meakin H, Nash R, Rocca C, Schramm DR, Willmott NS, Vanat ZH. Cochlear implant services for children, young people and adults. Quality standard. Cochlear Implants Int 2023:1-13. [PMID: 37114384 DOI: 10.1080/14670100.2023.2197344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Affiliation(s)
- H E Cullington
- University of Southampton Auditory Implant Service, SO17 1BJ, UK
| | - D Jiang
- Hearing Implant Centre, Guy's and St. Thomas NHS Foundation Trust, London, UK
- Centre for Craniofacial and Regenerative Biology, King's College London, London, UK
| | - S J Broomfield
- West of England Hearing Implant Programme, University Hospitals Bristol and Weston NHS Foundation Trust, UK
| | - M Chung
- Auditory Implant Department, Royal National ENT & Eastman Dental Hospitals, University College London Hospitals NHS Foundation Trust, UK
| | - L C Craddock
- Midlands Hearing Implant Programme (Adult service), University Hospitals Birmingham NHS Foundation Trust, UK
| | - S Driver
- Hearing Implant Centre, Guy's and St. Thomas NHS Foundation Trust, London, UK
| | - D Edwards
- Emmeline Centre for Hearing Implants, Cambridge University Hospitals NHS Trust, UK
| | - J M Gallacher
- Scottish Cochlear Implant Program, Crosshouse Hospital, Kilmarnock, UK
| | - L Ll Jones
- North Wales Auditory Implant Service, Betsi Cadwaladr University Health Board, Bodelwyddan, UK
| | - T Koleva
- Emmeline Centre for Hearing Implants, Cambridge University Hospitals NHS Trust, UK
| | - J Martin
- Cochlear Implant Programme, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
| | - H Meakin
- Emmeline Centre for Hearing Implants, Cambridge University Hospitals NHS Trust, UK
| | - R Nash
- Cochlear Implant Programme, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
| | - C Rocca
- Hearing Implant Centre, Guy's and St. Thomas NHS Foundation Trust, London, UK
| | - D R Schramm
- University of Ottawa Auditory Implant Centre, Ottawa, Canada
| | - N S Willmott
- Auditory Implant Centre, Belfast Health and Social Care Trust, UK
| | - Z H Vanat
- Emmeline Centre for Hearing Implants, Cambridge University Hospitals NHS Trust, UK
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Ziegler C, Martin J, Sinner C, Morcos F. Latent generative landscapes as maps of functional diversity in protein sequence space. Nat Commun 2023; 14:2222. [PMID: 37076519 PMCID: PMC10113739 DOI: 10.1038/s41467-023-37958-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 04/05/2023] [Indexed: 04/21/2023] Open
Abstract
Variational autoencoders are unsupervised learning models with generative capabilities, when applied to protein data, they classify sequences by phylogeny and generate de novo sequences which preserve statistical properties of protein composition. While previous studies focus on clustering and generative features, here, we evaluate the underlying latent manifold in which sequence information is embedded. To investigate properties of the latent manifold, we utilize direct coupling analysis and a Potts Hamiltonian model to construct a latent generative landscape. We showcase how this landscape captures phylogenetic groupings, functional and fitness properties of several systems including Globins, β-lactamases, ion channels, and transcription factors. We provide support on how the landscape helps us understand the effects of sequence variability observed in experimental data and provides insights on directed and natural protein evolution. We propose that combining generative properties and functional predictive power of variational autoencoders and coevolutionary analysis could be beneficial in applications for protein engineering and design.
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Affiliation(s)
- Cheyenne Ziegler
- Department of Biological Sciences, University of Texas at Dallas, Richardson, TX, 75080, USA
| | - Jonathan Martin
- Department of Biological Sciences, University of Texas at Dallas, Richardson, TX, 75080, USA
| | - Claude Sinner
- Department of Biological Sciences, University of Texas at Dallas, Richardson, TX, 75080, USA
| | - Faruck Morcos
- Department of Biological Sciences, University of Texas at Dallas, Richardson, TX, 75080, USA.
- Department of Bioengineering, University of Texas at Dallas, Richardson, TX, 75080, USA.
- Center for Systems Biology, University of Texas at Dallas, Richardson, TX, 75080, USA.
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Zarchy R, Patel J, Rashidi A, Burke W, Shi F, Martin J. Blastomyces Osteomyelitis of the Calcaneus With Disseminated Multiorgan Involvement. Foot Ankle Orthop 2023; 8:24730114231166668. [PMID: 37063242 PMCID: PMC10103246 DOI: 10.1177/24730114231166668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2023] Open
Affiliation(s)
- Rachel Zarchy
- Department of Podiatric Medicine & Surgery, Weiss Memorial Hospital, Chicago, IL, USA
- Department of Podiatric Medicine & Surgery, Cook County Health, Chicago, IL, USA
- Rachel Zarchy, DPM, Department of Podiatric Medicine & Surgery, Weiss Memorial Hospital, 4646 N Marine Dr, Chicago, IL 60640-1501, USA.
| | - Juhi Patel
- Department of Podiatric Medicine & Surgery, Weiss Memorial Hospital, Chicago, IL, USA
- Department of Podiatric Medicine & Surgery, Cook County Health, Chicago, IL, USA
| | - Ali Rashidi
- Department of Internal Medicine, Weiss Memorial Hospital, Chicago, IL, USA
| | - Winston Burke
- Department of Podiatric Medicine & Surgery, Cook County Health, Chicago, IL, USA
- Department of Podiatric Medicine & Surgery, St. Bernard Hospital, Chicago, IL, USA
| | - Feinan Shi
- Department of Pathology, Cook County Health, Chicago, IL, USA
| | - Jonathan Martin
- Department of Infectious Disease, Cook County Health, Chicago, IL, USA
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20
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Hulo S, Jacques J, Sihrener F, Wasielewski E, Jourdan L, Poslednik G, Poulet C, Turlotte A, Gey T, Douadi Y, Thiberville L, Dewolf M, Lecerf JM, Estevié I, Ricard V, Martin J, Romain AC, Locoge N, Matran R, Scherpereel A. 160P Non-invasive analysis of VOCs in exhaled air can distinguish healthy controls from lung cancer patients and may improve the effectiveness of lung cancer screening. J Thorac Oncol 2023. [DOI: 10.1016/s1556-0864(23)00414-8] [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: 04/03/2023]
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21
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Barral E, Martin J. Abstract No. 70 Safety and Clinical Outcomes of Aspiration Thrombectomy in Patients with Massive PE: A Single-Center Retrospective Review. J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.115] [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: 02/27/2023] Open
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22
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Ajrawat H, Buchholz J, Triana B, Pabon-Ramos W, Martin J, Kim C, Cline B, Ronald J. Abstract No. 583 Financial Analysis of Intravascular Ultrasound-Guided Transvenous Biopsy in an Outpatient Medicare Population. J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023] Open
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23
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Gallo C, Cline B, Befera N, Ronald J, Martin J, Sag A, Pabon-Ramos W, Suhocki P, Smith T, Kim C. Abstract No. 97 Safety and Patency of Dedicated Venous Stents for Treatment of Thoracic Central Vein Stenosis Compared with Non-Venous Stents. J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.145] [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: 02/27/2023] Open
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24
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Barral E, Martin J. Abstract No. 501 Safety and Clinical Outcomes of Aspiration Thrombectomy in Patients with Intermediate-High Risk PE: A Single-Center Retrospective Review. J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.359] [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: 02/27/2023] Open
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Buchholz J, Ajrawat H, Cline B, Martin J, Kim C, Ronald J. Abstract No. 223 Intravascular Ultrasound-Guided Transvenous Biopsy of Retroperitoneal Lymph Nodes: Efficacy and Safety Compared with Percutaneous CT-Guided Biopsy. J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.284] [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: 02/27/2023] Open
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Kasivisvanathan V, Murphy D, Link E, Lawrentschuk N, O’Brien J, Buteau J, Roberts M, Francis R, Tang C, Vela I, Thomas P, Rutherford N, Martin J, Frydenberg M, Shakher R, Wong LM, Taubman K, Lee S, Hsiao E, Nottage M, Kirkwood I, Iravani A, Williams S, Hofman M. Baseline PSMA PET-CT is prognostic for treatment failure in men with intermediate-to-high risk prostate cancer: 54 months follow-up of the proPSMA randomised trial. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01275-7] [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: 02/12/2023]
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27
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Rice W, Martin J, Hodgkin M, Carter J, Barrasa A, Sweeting K, Johnson R, Best E, Nahl J, Denton M, Hughes GJ. A protracted outbreak of difficult-to-treat resistant Pseudomonas aeruginosa in a haematology unit: a matched case-control study demonstrating increased risk with use of fluoroquinolone. J Hosp Infect 2023; 132:52-61. [PMID: 36563938 DOI: 10.1016/j.jhin.2022.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 11/11/2022] [Accepted: 11/20/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Between September 2016 and November 2020, 17 cases of difficult-to-treat resistant Pseudomonas aeruginosa (DTR-PA) were reported in haematology patients at a tertiary referral hospital in the North of England. AIM A retrospective case-control study was conducted to investigate the association between DTR-PA infection and clinical interventions, patient movement, antimicrobial use and comorbidities. METHODS Cases were patients colonized or infected with the outbreak strain of DTR-PA who had been admitted to hospital prior to their positive specimen. Exposures were extracted from medical records, and cases were compared with controls using conditional logistic regression. Environmental and microbiological investigations were also conducted. FINDINGS Seventeen cases and 51 controls were included. The final model included age [>65 years, adjusted OR (aOR) 6.85, P=0.232], sex (aOR 0.60, P=0.688), admission under the transplant team (aOR 14.27, P=0.43) and use of ciprofloxacin (aOR 102.13, P=0.030). Investigations did not indicate case-to-case transmission or a point source, although a common environmental source was highly likely. CONCLUSION This study found that the use of fluoroquinolones is an independent risk factor for DTR-PA in haematology patients. Antimicrobial stewardship and review of fluoroquinolone prophylaxis should be considered as part of PA outbreak investigations in addition to standard infection control interventions.
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Affiliation(s)
- W Rice
- Field Epidemiology Training Programme, United Kingdom Heath Security Agency, London, UK; Field Service, United Kingdom Health Security Agency, Leeds, UK
| | - J Martin
- Leeds Teaching Hospitals NHS Trust, Leeds, UK.
| | - M Hodgkin
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - J Carter
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - A Barrasa
- Field Epidemiology Training Programme, United Kingdom Heath Security Agency, London, UK
| | - K Sweeting
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - R Johnson
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - E Best
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - J Nahl
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - M Denton
- Field Service, United Kingdom Health Security Agency, Leeds, UK; Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - G J Hughes
- Field Service, United Kingdom Health Security Agency, Leeds, UK.
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Badoual C, Adimi Y, Martin J, Morin B, Baudouin R. Les cancers des voies aérodigestives supérieures induits par une infection par Papillomavirus humain : spécificités épidémiologiques, diagnostiques, pronostiques et thérapeutiques. Bulletin de l'Académie Nationale de Médecine 2023. [DOI: 10.1016/j.banm.2022.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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29
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Ward DD, Martin J, Gordon EH. Is There a Sex-Frailty Paradox in Dementia? J Nutr Health Aging 2023; 27:1281-1283. [PMID: 38151880 DOI: 10.1007/s12603-023-2040-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 11/11/2023] [Indexed: 12/29/2023]
Affiliation(s)
- D D Ward
- David D. Ward, Centre for Health Services Research, The University of Queensland, Level 2, Building 33, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, QLD 4121, Australia.
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Podtschaske AH, Martin J, Ulm B, Jungwirth B, Kagerbauer SM. Sex-specific issues of central and peripheral arginine-vasopressin concentrations in neurocritical care patients. BMC Neurosci 2022; 23:69. [PMID: 36434506 PMCID: PMC9700878 DOI: 10.1186/s12868-022-00757-1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 11/17/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Arginine-Vasopressin (AVP) is a nonapeptide that exerts multiple functions within the central nervous system and in the blood circulation that might contribute to outcome in critically ill patients. Sex differences have been found for mental and physical effects of AVP. For example, stress response and response due to hemorrhage differ between males and females, at least in animal studies. Data on humans -especially on AVP within the central nervous system (CNS)-are scarce, as cerebrospinal fluid (CSF) which is said to represent central AVP activity, has to be collected by means of invasive procedures. Here we present data on 30 neurocritical care patients where we simultaneously collected blood, CSF and saliva to analyze concentrations in the central and peripheral compartments. PATIENTS AND METHODS 30 neurocritical care patients were included (13 male, 13 postmenopausal female, 4 premenopausal female) with a median age of 60 years. CSF, plasma and saliva were obtained simultaneously once in each patient and analyzed for AVP concentrations. Correlations between the central compartment represented by CSF, and the peripheral compartment represented by plasma and saliva, were identified. Relations between AVP concentrations and serum sodium and hematocrit were also determined. RESULTS In the whole patient collective, only very weak to weak correlations could be detected between AVP plasma/CSF, plasma/saliva and CSF/saliva as well as between AVP concentrations in each of the compartments and serum sodium/hematocrit. Regarding the subgroup of postmenopausal females, a significant moderate correlation could be detected for AVP in plasma and CSF and AVP CSF and serum sodium. CONCLUSION Absolute concentrations of AVP in central and peripheral compartments did not show sex differences. However, correlations between AVP plasma and CSF and AVP CSF and serum sodium in postmenopausal females indicate differences in AVP secretion and AVP response to triggers that deserve further examination.
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Affiliation(s)
- A. H. Podtschaske
- grid.6936.a0000000123222966Department of Anaesthesiology and Intensive Care Medicine, School of Medicine, Technical University of Munich, Munich, Germany
| | - J. Martin
- grid.6936.a0000000123222966Department of Anaesthesiology and Intensive Care Medicine, School of Medicine, Technical University of Munich, Munich, Germany
| | - B. Ulm
- grid.6936.a0000000123222966Department of Anaesthesiology and Intensive Care Medicine, School of Medicine, Technical University of Munich, Munich, Germany ,grid.6582.90000 0004 1936 9748Department of Anaesthesiology and Intensive Care Medicine, School of Medicine, University of Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - B. Jungwirth
- grid.6582.90000 0004 1936 9748Department of Anaesthesiology and Intensive Care Medicine, School of Medicine, University of Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - S. M. Kagerbauer
- grid.6936.a0000000123222966Department of Anaesthesiology and Intensive Care Medicine, School of Medicine, Technical University of Munich, Munich, Germany ,grid.6582.90000 0004 1936 9748Department of Anaesthesiology and Intensive Care Medicine, School of Medicine, University of Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany
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31
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Martin J, Elster C. Aleatoric Uncertainty for Errors-in-Variables Models in Deep Regression. Neural Process Lett 2022. [DOI: 10.1007/s11063-022-11066-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractA Bayesian treatment of deep learning allows for the computation of uncertainties associated with the predictions of deep neural networks. We show how the concept of Errors-in-Variables can be used in Bayesian deep regression to also account for the uncertainty associated with the input of the employed neural network. The presented approach thereby exploits a relevant, but generally overlooked, source of uncertainty and yields a decomposition of the predictive uncertainty into an aleatoric and epistemic part that is more complete and, in many cases, more consistent from a statistical perspective. We discuss the approach along various simulated and real examples and observe that using an Errors-in-Variables model leads to an increase in the uncertainty while preserving the prediction performance of models without Errors-in-Variables. For examples with known regression function we observe that this ground truth is substantially better covered by the Errors-in-Variables model, indicating that the presented approach leads to a more reliable uncertainty estimation.
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Sandler H, Shore N, Dearnaley D, Freedland S, Smith M, Rosales R, Brookman-May S, Dicker A, McKenzie M, Bossi A, Widmark A, Wiegel T, Martin J, Miladinovic B, Lefresne F, Ciprotti M, McCarthy S, Mundle S, Tombal B, Feng F. Challenges and Solutions during the COVID Pandemic for Patient Retention and Physician Engagement in the Phase 3 ATLAS Study of Apalutamide Added to Androgen Deprivation Therapy (ADT) in High-Risk Localized or Locally Advanced Prostate Cancer (HRLPC). Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1217] [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: 10/31/2022]
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Hatheway Marshall E, Fimbres DP, Musick A, French R, Martin J, Sharma P. Paint Me a Picture: Adding Patient Imaging Experiences and Radiology to a Longitudinal Integrated Clerkship. Acad Med 2022; 97:S129. [PMID: 37838862 DOI: 10.1097/acm.0000000000004857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Affiliation(s)
- Emily Hatheway Marshall
- Author affiliations: E. Hatheway Marshall, D.P. Fimbres, A. Musick, Duke University School of Medicine; R. French, J. Martin, Duke University School of Medicine, Department of Radiology; P. Sharma, Duke University School of Medicine, Department of Medicine
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Zheng J, Reynolds JE, Long M, Ostertag C, Pollock T, Hamilton M, Dunn JF, Liu J, Martin J, Grohs M, Landman B, Huo Y, Dewey D, Kurrasch D, Lebel C. The effects of prenatal bisphenol A exposure on brain volume of children and young mice. Environ Res 2022; 214:114040. [PMID: 35952745 DOI: 10.1016/j.envres.2022.114040] [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] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 08/01/2022] [Accepted: 08/02/2022] [Indexed: 06/15/2023]
Abstract
Bisphenol A (BPA) is a synthetic chemical used for the manufacturing of plastics, epoxy resin, and many personal care products. This ubiquitous endocrine disruptor is detectable in the urine of over 80% of North Americans. Although adverse neurodevelopmental outcomes have been observed in children with high gestational exposure to BPA, the effects of prenatal BPA on brain structure remain unclear. Here, using magnetic resonance imaging (MRI), we studied the associations of maternal BPA exposure with children's brain structure, as well as the impact of comparable BPA levels in a mouse model. Our human data showed that most maternal BPA exposure effects on brain volumes were small, with the largest effects observed in the opercular region of the inferior frontal gyrus (ρ = -0.2754), superior occipital gyrus (ρ = -0.2556), and postcentral gyrus (ρ = 0.2384). In mice, gestational exposure to an equivalent level of BPA (2.25 μg BPA/kg bw/day) induced structural alterations in brain regions including the superior olivary complex (SOC) and bed nucleus of stria terminalis (BNST) with larger effect sizes (1.07≤ Cohens d ≤ 1.53). Human (n = 87) and rodent (n = 8 each group) sample sizes, while small, are considered adequate to perform the primary endpoint analysis. Combined, these human and mouse data suggest that gestational exposure to low levels of BPA may have some impacts on the developing brain at the resolution of MRI.
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Affiliation(s)
- Jing Zheng
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Medical Genetics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Jess E Reynolds
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada; Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Madison Long
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Curtis Ostertag
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Tyler Pollock
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Medical Genetics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Max Hamilton
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Jeff F Dunn
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Jiaying Liu
- Department of Laboratory Medicine and Pathology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Jonathan Martin
- Department of Laboratory Medicine and Pathology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada; Department of Environmental Science and Analytical Chemistry, Stockholm University, Stockholm, SE-106 91, Sweden
| | - Melody Grohs
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Bennett Landman
- Department of Electrical Engineering & Computer Science, Vanderbilt University, Nashville, TN, USA
| | - Yuankai Huo
- Department of Electrical Engineering & Computer Science, Vanderbilt University, Nashville, TN, USA
| | - Deborah Dewey
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada; Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Deborah Kurrasch
- Department of Medical Genetics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Catherine Lebel
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.
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Martin J, Perraton L, Gupta A, Garofolini A, Malliaras P. The use of physical function capacity measures in the management of lower limb tendinopathy: A scoping review of expert recommendations. J Sci Med Sport 2022. [DOI: 10.1016/j.jsams.2022.09.150] [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: 11/17/2022]
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Gonzalez A, Anchor T, Hevia A, Posadas A, Wade J, Ansag R, Benko K, Bottoni B, Kazakova V, Alvarez M, Wong J, Martin J, Knauf R, Jantke K, Wu A. The evolution of the fAIble system to automatically compose and narrate stories for children. J EXP THEOR ARTIF IN 2022. [DOI: 10.1080/0952813x.2022.2104382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Affiliation(s)
- A.J. Gonzalez
- Intelligent Systems Laboratory, Computer Science Department, University of Central Florida, Orlando, FL, USA
| | - T. Anchor
- Intelligent Systems Laboratory, Computer Science Department, University of Central Florida, Orlando, FL, USA
| | - A. Hevia
- Intelligent Systems Laboratory, Computer Science Department, University of Central Florida, Orlando, FL, USA
| | - A. Posadas
- Intelligent Systems Laboratory, Computer Science Department, University of Central Florida, Orlando, FL, USA
| | - J. Wade
- Intelligent Systems Laboratory, Computer Science Department, University of Central Florida, Orlando, FL, USA
| | - R.A. Ansag
- Intelligent Systems Laboratory, Computer Science Department, University of Central Florida, Orlando, FL, USA
| | - K. Benko
- Intelligent Systems Laboratory, Computer Science Department, University of Central Florida, Orlando, FL, USA
| | - B. Bottoni
- Intelligent Systems Laboratory, Computer Science Department, University of Central Florida, Orlando, FL, USA
| | - V. Kazakova
- Computer Science Dept, Knox College, Galesburg, IL, USA
| | - M.J. Alvarez
- Intelligent Systems Laboratory, Computer Science Department, University of Central Florida, Orlando, FL, USA
| | - J.M Wong
- Intelligent Systems Laboratory, Computer Science Department, University of Central Florida, Orlando, FL, USA
| | - J. Martin
- Intelligent Systems Laboratory, Computer Science Department, University of Central Florida, Orlando, FL, USA
| | - R. Knauf
- Computer Science Faculty, Technical University Ilmenau, Ilmenau, Germany
| | | | - A.S. Wu
- Intelligent Systems Laboratory, Computer Science Department, University of Central Florida, Orlando, FL, USA
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Otten LS, Heine RT, Chiong J, Martin J, van den Heuvel M, Piet B, Burger D. EP08.02-090 Sotorasib Drug-Drug Interactions: Essential Guidance Requested by Physicians Worldwide. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.773] [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: 10/14/2022]
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Giraud E, Chiong J, Martin J, Burger D, Erp N, Smolders E. 1595P QTc-prolonging drug-drug interactions related to CDK4/6 inhibitors. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1688] [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: 11/28/2022] Open
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Dumble K, Driessen A, Borgstrom E, Martin J, Yardley S, Cohn S. How much information is 'reasonable'? A qualitative interview study of the prescribing practices of palliative care professionals. Palliat Med 2022; 36:1242-1251. [PMID: 35689410 DOI: 10.1177/02692163221103471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Prescribing clinicians have to negotiate ambiguities around information provision and consent for medications on a daily basis, despite the availability of professional guidance. AIM This study aims to explore some of the many factors prescribing clinicians in the United Kingdom take into account when deciding what information to give to patients about medication choices, and when. DESIGN In depth face-to-face interviews, utilising both a hypothetical scenario and semi-structured prompts, were conducted in order to elicit extended reflections on how clinicians individually work through such dilemmas and make decisions. SETTING/PARTICIPANTS Ten prescribing clinicians (doctors and nurses) from a large combined team of National Health Service (NHS) secondary and community palliative care providers in England. RESULTS Palliative care staff regularly face choices about information provision in prescribing discussions, in particular when considering whether information might increase distress. Participants presented three overlapping framings that helped them assess the range of factors that could potentially be taken into account; (1) assessing the individual patient, (2) tailoring the provision of information and (3) jointly forming a plan. CONCLUSIONS Information provision about medication choices and effects is a demanding, ongoing process, requiring nuanced judgements that constitute an unacknowledged yet significant aspect of clinical workload. Although current medical guidelines allow clinical discretion about information provision, this can leave individual clinicians feeling vulnerable. Further evolution of guidelines needs to establish a more sophisticated way to acknowledge professional and legal requirements, whilst also promoting professional autonomy and judgement.
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Affiliation(s)
- Katie Dumble
- Central and North West London NHS Foundation Trust, London, UK
| | | | | | - Jonathan Martin
- Central and North West London NHS Foundation Trust, London, UK.,National Hospital for Neurology and Neurosurgery, London, UK
| | - Sarah Yardley
- Central and North West London NHS Foundation Trust, London, UK.,UCL Marie Curie Research Department, London, UK
| | - Simon Cohn
- London School of Hygiene and Tropical Medicine, London, UK
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Evans RA, Leavy OC, Richardson M, Elneima O, McAuley HJC, Shikotra A, Singapuri A, Sereno M, Saunders RM, Harris VC, Houchen-Wolloff L, Aul R, Beirne P, Bolton CE, Brown JS, Choudhury G, Diar-Bakerly N, Easom N, Echevarria C, Fuld J, Hart N, Hurst J, Jones MG, Parekh D, Pfeffer P, Rahman NM, Rowland-Jones SL, Shah AM, Wootton DG, Chalder T, Davies MJ, De Soyza A, Geddes JR, Greenhalf W, Greening NJ, Heaney LG, Heller S, Howard LS, Jacob J, Jenkins RG, Lord JM, Man WDC, McCann GP, Neubauer S, Openshaw PJM, Porter JC, Rowland MJ, Scott JT, Semple MG, Singh SJ, Thomas DC, Toshner M, Lewis KE, Thwaites RS, Briggs A, Docherty AB, Kerr S, Lone NI, Quint J, Sheikh A, Thorpe M, Zheng B, Chalmers JD, Ho LP, Horsley A, Marks M, Poinasamy K, Raman B, Harrison EM, Wain LV, Brightling CE, Abel K, Adamali H, Adeloye D, Adeyemi O, Adrego R, Aguilar Jimenez LA, Ahmad S, Ahmad Haider N, Ahmed R, Ahwireng N, Ainsworth M, Al-Sheklly B, Alamoudi A, Ali M, Aljaroof M, All AM, Allan L, Allen RJ, Allerton L, Allsop L, Almeida P, Altmann D, Alvarez Corral M, Amoils S, Anderson D, Antoniades C, Arbane G, Arias A, Armour C, Armstrong L, Armstrong N, Arnold D, Arnold H, Ashish A, Ashworth A, Ashworth M, Aslani S, Assefa-Kebede H, Atkin C, Atkin P, Aung H, Austin L, Avram C, Ayoub A, Babores M, Baggott R, Bagshaw J, Baguley D, Bailey L, Baillie JK, Bain S, Bakali M, Bakau M, Baldry E, Baldwin D, Ballard C, Banerjee A, Bang B, Barker RE, Barman L, Barratt S, Barrett F, Basire D, Basu N, Bates M, Bates A, Batterham R, Baxendale H, Bayes H, Beadsworth M, Beckett P, Beggs M, Begum M, Bell D, Bell R, Bennett K, Beranova E, Bermperi A, Berridge A, Berry C, Betts S, Bevan E, Bhui K, Bingham M, Birchall K, Bishop L, Bisnauthsing K, Blaikely J, Bloss A, Bolger A, Bonnington J, Botkai A, Bourne C, Bourne M, Bramham K, Brear L, Breen G, Breeze J, Bright E, Brill S, Brindle K, Broad L, Broadley A, Brookes C, Broome M, Brown A, Brown A, Brown J, Brown J, Brown M, Brown M, Brown V, Brugha T, Brunskill N, Buch M, Buckley P, Bularga A, Bullmore E, Burden L, Burdett T, Burn D, Burns G, Burns A, Busby J, Butcher R, Butt A, Byrne S, Cairns P, Calder PC, Calvelo E, Carborn H, Card B, Carr C, Carr L, Carson G, Carter P, Casey A, Cassar M, Cavanagh J, Chablani M, Chambers RC, Chan F, Channon KM, Chapman K, Charalambou A, Chaudhuri N, Checkley A, Chen J, Cheng Y, Chetham L, Childs C, Chilvers ER, Chinoy H, Chiribiri A, Chong-James K, Choudhury N, Chowienczyk P, Christie C, Chrystal M, Clark D, Clark C, Clarke J, Clohisey S, Coakley G, Coburn Z, Coetzee S, Cole J, Coleman C, Conneh F, Connell D, Connolly B, Connor L, Cook A, Cooper B, Cooper J, Cooper S, Copeland D, Cosier T, Coulding M, Coupland C, Cox E, Craig T, Crisp P, Cristiano D, Crooks MG, Cross A, Cruz I, Cullinan P, Cuthbertson D, Daines L, Dalton M, Daly P, Daniels A, Dark P, Dasgin J, David A, David C, Davies E, Davies F, Davies G, Davies GA, Davies K, Dawson J, Daynes E, Deakin B, Deans A, Deas C, Deery J, Defres S, Dell A, Dempsey K, Denneny E, Dennis J, Dewar A, Dharmagunawardena R, Dickens C, Dipper A, Diver S, Diwanji SN, Dixon M, Djukanovic R, Dobson H, Dobson SL, Donaldson A, Dong T, Dormand N, Dougherty A, Dowling R, Drain S, Draxlbauer K, Drury K, Dulawan P, Dunleavy A, Dunn S, Earley J, Edwards S, Edwardson C, El-Taweel H, Elliott A, Elliott K, Ellis Y, Elmer A, Evans D, Evans H, Evans J, Evans R, Evans RI, Evans T, Evenden C, Evison L, Fabbri L, Fairbairn S, Fairman A, Fallon K, Faluyi D, Favager C, Fayzan T, Featherstone J, Felton T, Finch J, Finney S, Finnigan J, Finnigan L, Fisher H, Fletcher S, Flockton R, Flynn M, Foot H, Foote D, Ford A, Forton D, Fraile E, Francis C, Francis R, Francis S, Frankel A, Fraser E, Free R, French N, Fu X, Furniss J, Garner L, Gautam N, George J, George P, Gibbons M, Gill M, Gilmour L, Gleeson F, Glossop J, Glover S, Goodman N, Goodwin C, Gooptu B, Gordon H, Gorsuch T, Greatorex M, Greenhaff PL, Greenhalgh A, Greenwood J, Gregory H, Gregory R, Grieve D, Griffin D, Griffiths L, Guerdette AM, Guillen Guio B, Gummadi M, Gupta A, Gurram S, Guthrie E, Guy Z, H Henson H, Hadley K, Haggar A, Hainey K, Hairsine B, Haldar P, Hall I, Hall L, Halling-Brown M, Hamil R, Hancock A, Hancock K, Hanley NA, Haq S, Hardwick HE, Hardy E, Hardy T, Hargadon B, Harrington K, Harris E, Harrison P, Harvey A, Harvey M, Harvie M, Haslam L, Havinden-Williams M, Hawkes J, Hawkings N, Haworth J, Hayday A, Haynes M, Hazeldine J, Hazelton T, Heeley C, Heeney JL, Heightman M, Henderson M, Hesselden L, Hewitt M, Highett V, Hillman T, Hiwot T, Hoare A, Hoare M, Hockridge J, Hogarth P, Holbourn A, Holden S, Holdsworth L, Holgate D, Holland M, Holloway L, Holmes K, Holmes M, Holroyd-Hind B, Holt L, Hormis A, Hosseini A, Hotopf M, Howard K, Howell A, Hufton E, Hughes AD, Hughes J, Hughes R, Humphries A, Huneke N, Hurditch E, Husain M, Hussell T, Hutchinson J, Ibrahim W, Ilyas F, Ingham J, Ingram L, Ionita D, Isaacs K, Ismail K, Jackson T, James WY, Jarman C, Jarrold I, Jarvis H, Jastrub R, Jayaraman B, Jezzard P, Jiwa K, Johnson C, Johnson S, Johnston D, Jolley CJ, Jones D, Jones G, Jones H, Jones H, Jones I, Jones L, Jones S, Jose S, Kabir T, Kaltsakas G, Kamwa V, Kanellakis N, Kaprowska S, Kausar Z, Keenan N, Kelly S, Kemp G, Kerslake H, Key AL, Khan F, Khunti K, Kilroy S, King B, King C, Kingham L, Kirk J, Kitterick P, Klenerman P, Knibbs L, Knight S, Knighton A, Kon O, Kon S, Kon SS, Koprowska S, Korszun A, Koychev I, Kurasz C, Kurupati P, Laing C, Lamlum H, Landers G, Langenberg C, Lasserson D, Lavelle-Langham L, Lawrie A, Lawson C, Lawson C, Layton A, Lea A, Lee D, Lee JH, Lee E, Leitch K, Lenagh R, Lewis D, Lewis J, Lewis V, Lewis-Burke N, Li X, Light T, Lightstone L, Lilaonitkul W, Lim L, Linford S, Lingford-Hughes A, Lipman M, Liyanage K, Lloyd A, Logan S, Lomas D, Loosley R, Lota H, Lovegrove W, Lucey A, Lukaschuk E, Lye A, Lynch C, MacDonald S, MacGowan G, Macharia I, Mackie J, Macliver L, Madathil S, Madzamba G, Magee N, Magtoto MM, Mairs N, Majeed N, Major E, Malein F, Malim M, Mallison G, Mandal S, Mangion K, Manisty C, Manley R, March K, Marciniak S, Marino P, Mariveles M, Marouzet E, Marsh S, Marshall B, Marshall M, Martin J, Martineau A, Martinez LM, Maskell N, Matila D, Matimba-Mupaya W, Matthews L, Mbuyisa A, McAdoo S, Weir McCall J, McAllister-Williams H, McArdle A, McArdle P, McAulay D, McCormick J, McCormick W, McCourt P, McGarvey L, McGee C, Mcgee K, McGinness J, McGlynn K, McGovern A, McGuinness H, McInnes IB, McIntosh J, McIvor E, McIvor K, McLeavey L, McMahon A, McMahon MJ, McMorrow L, Mcnally T, McNarry M, McNeill J, McQueen A, McShane H, Mears C, Megson C, Megson S, Mehta P, Meiring J, Melling L, Mencias M, Menzies D, Merida Morillas M, Michael A, Milligan L, Miller C, Mills C, Mills NL, Milner L, Misra S, Mitchell J, Mohamed A, Mohamed N, Mohammed S, Molyneaux PL, Monteiro W, Moriera S, Morley A, Morrison L, Morriss R, Morrow A, Moss AJ, Moss P, Motohashi K, Msimanga N, Mukaetova-Ladinska E, Munawar U, Murira J, Nanda U, Nassa H, Nasseri M, Neal A, Needham R, Neill P, Newell H, Newman T, Newton-Cox A, Nicholson T, Nicoll D, Nolan CM, Noonan MJ, Norman C, Novotny P, Nunag J, Nwafor L, Nwanguma U, Nyaboko J, O'Donnell K, O'Brien C, O'Brien L, O'Regan D, Odell N, Ogg G, Olaosebikan O, Oliver C, Omar Z, Orriss-Dib L, Osborne L, Osbourne R, Ostermann M, Overton C, Owen J, Oxton J, Pack J, Pacpaco E, Paddick S, Painter S, Pakzad A, Palmer S, Papineni P, Paques K, Paradowski K, Pareek M, Parfrey H, Pariante C, Parker S, Parkes M, Parmar J, Patale S, Patel B, Patel M, Patel S, Pattenadk D, Pavlides M, Payne S, Pearce L, Pearl JE, Peckham D, Pendlebury J, Peng Y, Pennington C, Peralta I, Perkins E, Peterkin Z, Peto T, Petousi N, Petrie J, Phipps J, Pimm J, Piper Hanley K, Pius R, Plant H, Plein S, Plekhanova T, Plowright M, Polgar O, Poll L, Porter J, Portukhay S, Powell N, Prabhu A, Pratt J, Price A, Price C, Price C, Price D, Price L, Price L, Prickett A, Propescu J, Pugmire S, Quaid S, Quigley J, Qureshi H, Qureshi IN, Radhakrishnan K, Ralser M, Ramos A, Ramos H, Rangeley J, Rangelov B, Ratcliffe L, Ravencroft P, Reddington A, Reddy R, Redfearn H, Redwood D, Reed A, Rees M, Rees T, Regan K, Reynolds W, Ribeiro C, Richards A, Richardson E, Rivera-Ortega P, Roberts K, Robertson E, Robinson E, Robinson L, Roche L, Roddis C, Rodger J, Ross A, Ross G, Rossdale J, Rostron A, Rowe A, Rowland A, Rowland J, Roy K, Roy M, Rudan I, Russell R, Russell E, Saalmink G, Sabit R, Sage EK, Samakomva T, Samani N, Sampson C, Samuel K, Samuel R, Sanderson A, Sapey E, Saralaya D, Sargant J, Sarginson C, Sass T, Sattar N, Saunders K, Saunders P, Saunders LC, Savill H, Saxon W, Sayer A, Schronce J, Schwaeble W, Scott K, Selby N, Sewell TA, Shah K, Shah P, Shankar-Hari M, Sharma M, Sharpe C, Sharpe M, Shashaa S, Shaw A, Shaw K, Shaw V, Shelton S, Shenton L, Shevket K, Short J, Siddique S, Siddiqui S, Sidebottom J, Sigfrid L, Simons G, Simpson J, Simpson N, Singh C, Singh S, Sissons D, Skeemer J, Slack K, Smith A, Smith D, Smith S, Smith J, Smith L, Soares M, Solano TS, Solly R, Solstice AR, Soulsby T, Southern D, Sowter D, Spears M, Spencer LG, Speranza F, Stadon L, Stanel S, Steele N, Steiner M, Stensel D, Stephens G, Stephenson L, Stern M, Stewart I, Stimpson R, Stockdale S, Stockley J, Stoker W, Stone R, Storrar W, Storrie A, Storton K, Stringer E, Strong-Sheldrake S, Stroud N, Subbe C, Sudlow CL, Suleiman Z, Summers C, Summersgill C, Sutherland D, Sykes DL, Sykes R, Talbot N, Tan AL, Tarusan L, Tavoukjian V, Taylor A, Taylor C, Taylor J, Te A, Tedd H, Tee CJ, Teixeira J, Tench H, Terry S, Thackray-Nocera S, Thaivalappil F, Thamu B, Thickett D, Thomas C, Thomas S, Thomas AK, Thomas-Woods T, Thompson T, Thompson AAR, Thornton T, Tilley J, Tinker N, Tiongson GF, Tobin M, Tomlinson J, Tong C, Touyz R, Tripp KA, Tunnicliffe E, Turnbull A, Turner E, Turner S, Turner V, Turner K, Turney S, Turtle L, Turton H, Ugoji J, Ugwuoke R, Upthegrove R, Valabhji J, Ventura M, Vere J, Vickers C, Vinson B, Wade E, Wade P, Wainwright T, Wajero LO, Walder S, Walker S, Walker S, Wall E, Wallis T, Walmsley S, Walsh JA, Walsh S, Warburton L, Ward TJC, Warwick K, Wassall H, Waterson S, Watson E, Watson L, Watson J, Welch C, Welch H, Welsh B, Wessely S, West S, Weston H, Wheeler H, White S, Whitehead V, Whitney J, Whittaker S, Whittam B, Whitworth V, Wight A, Wild J, Wilkins M, Wilkinson D, Williams N, Williams N, Williams J, Williams-Howard SA, Willicombe M, Willis G, Willoughby J, Wilson A, Wilson D, Wilson I, Window N, Witham M, Wolf-Roberts R, Wood C, Woodhead F, Woods J, Wormleighton J, Worsley J, Wraith D, Wrey Brown C, Wright C, Wright L, Wright S, Wyles J, Wynter I, Xu M, Yasmin N, Yasmin S, Yates T, Yip KP, Young B, Young S, Young A, Yousuf AJ, Zawia A, Zeidan L, Zhao B, Zongo O. Clinical characteristics with inflammation profiling of long COVID and association with 1-year recovery following hospitalisation in the UK: a prospective observational study. Lancet Respir Med 2022; 10:761-775. [PMID: 35472304 PMCID: PMC9034855 DOI: 10.1016/s2213-2600(22)00127-8] [Citation(s) in RCA: 144] [Impact Index Per Article: 72.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/23/2022] [Accepted: 03/31/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND No effective pharmacological or non-pharmacological interventions exist for patients with long COVID. We aimed to describe recovery 1 year after hospital discharge for COVID-19, identify factors associated with patient-perceived recovery, and identify potential therapeutic targets by describing the underlying inflammatory profiles of the previously described recovery clusters at 5 months after hospital discharge. METHODS The Post-hospitalisation COVID-19 study (PHOSP-COVID) is a prospective, longitudinal cohort study recruiting adults (aged ≥18 years) discharged from hospital with COVID-19 across the UK. Recovery was assessed using patient-reported outcome measures, physical performance, and organ function at 5 months and 1 year after hospital discharge, and stratified by both patient-perceived recovery and recovery cluster. Hierarchical logistic regression modelling was performed for patient-perceived recovery at 1 year. Cluster analysis was done using the clustering large applications k-medoids approach using clinical outcomes at 5 months. Inflammatory protein profiling was analysed from plasma at the 5-month visit. This study is registered on the ISRCTN Registry, ISRCTN10980107, and recruitment is ongoing. FINDINGS 2320 participants discharged from hospital between March 7, 2020, and April 18, 2021, were assessed at 5 months after discharge and 807 (32·7%) participants completed both the 5-month and 1-year visits. 279 (35·6%) of these 807 patients were women and 505 (64·4%) were men, with a mean age of 58·7 (SD 12·5) years, and 224 (27·8%) had received invasive mechanical ventilation (WHO class 7-9). The proportion of patients reporting full recovery was unchanged between 5 months (501 [25·5%] of 1965) and 1 year (232 [28·9%] of 804). Factors associated with being less likely to report full recovery at 1 year were female sex (odds ratio 0·68 [95% CI 0·46-0·99]), obesity (0·50 [0·34-0·74]) and invasive mechanical ventilation (0·42 [0·23-0·76]). Cluster analysis (n=1636) corroborated the previously reported four clusters: very severe, severe, moderate with cognitive impairment, and mild, relating to the severity of physical health, mental health, and cognitive impairment at 5 months. We found increased inflammatory mediators of tissue damage and repair in both the very severe and the moderate with cognitive impairment clusters compared with the mild cluster, including IL-6 concentration, which was increased in both comparisons (n=626 participants). We found a substantial deficit in median EQ-5D-5L utility index from before COVID-19 (retrospective assessment; 0·88 [IQR 0·74-1·00]), at 5 months (0·74 [0·64-0·88]) to 1 year (0·75 [0·62-0·88]), with minimal improvements across all outcome measures at 1 year after discharge in the whole cohort and within each of the four clusters. INTERPRETATION The sequelae of a hospital admission with COVID-19 were substantial 1 year after discharge across a range of health domains, with the minority in our cohort feeling fully recovered. Patient-perceived health-related quality of life was reduced at 1 year compared with before hospital admission. Systematic inflammation and obesity are potential treatable traits that warrant further investigation in clinical trials. FUNDING UK Research and Innovation and National Institute for Health Research.
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Masucci M, Li Kam Wa A, Shingleton E, Martin J, Mahir Z, Breen K. Point of care testing to monitor INR control in patients with antiphospholipid syndrome. eJHaem 2022; 3:899-902. [PMID: 36051047 PMCID: PMC9422004 DOI: 10.1002/jha2.522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/09/2022] [Accepted: 06/15/2022] [Indexed: 11/12/2022]
Abstract
Patients with antiphospholipid syndrome (APS) typically require lifelong warfarin anticoagulation following a thrombotic event due to a significant risk of recurrent thrombosis. Point of care testing (POCT) to monitor INR is discouraged in patients with APS as interactions between antiphospholipid antibodies and thromboplastin used for INR testing may influence results. Review of INR testing in 36 APS patients showed 87.2% of paired POCT and venous INRs (n = 94) having acceptable variation (≤0.5 difference), and high correlation (r = 0.9) excluding INRs ≥4.8. Six‐month TTR was comparable for APS patients using POCT (57.1% ± 24.8%) to those using venous INR monitoring (59.2% ± 23.2%) (p = 0.66). These results support POCT management of APS but requires further study.
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Affiliation(s)
- Michael Masucci
- GKT School of Medical Education King's College London London UK
| | | | | | - Jonathan Martin
- GKT School of Medical Education King's College London London UK
| | - Zahra Mahir
- Haemostasis and Thrombosis Department Guy's and St Thomas' NHS Foundation Trust London UK
| | - Karen Breen
- Haemostasis and Thrombosis Department Guy's and St Thomas' NHS Foundation Trust London UK
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Abrahamsson D, Siddharth A, Young TM, Sirota M, Park JS, Martin J, Woodruff T. In Silico Structure Predictions for Non-targeted Analysis: From Physicochemical Properties to Molecular Structures. J Am Soc Mass Spectrom 2022; 33:1134-1147. [PMID: 35649165 PMCID: PMC9365522 DOI: 10.1021/jasms.1c00386] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
While important advances have been made in high-resolution mass spectrometry (HRMS) and its applications in non-targeted analysis (NTA), the number of identified compounds in biological and environmental samples often does not exceed 5% of the detected chemical features. Our aim was to develop a computational pipeline that leverages data from HRMS but also incorporates physicochemical properties (equilibrium partition ratios between organic solvents and water; Ksolvent-water) and can propose molecular structures for detected chemical features. As these physicochemical properties are often sufficiently different across isomers, when put together, they can form a unique profile for each isomer, which we describe as the "physicochemical fingerprint". In our study, we used a comprehensive database of compounds that have been previously reported in human blood and collected their Ksolvent-water values for 129 partitioning systems. We used RDKit to calculate the number of RDKit fragments and the number of RDKit bits per molecule. We then developed and trained an artificial neural network, which used as an input the physicochemical fingerprint of a chemical feature and predicted the number and types of RDKit fragments and RDKit bits present in that structure. These were then used to search the database and propose chemical structures. The average success rate of predicting the right chemical structure ranged from 60 to 86% for the training set and from 48 to 81% for the testing set. These observations suggest that physicochemical fingerprints can assist in the identification of compounds with NTA and substantially improve the number of identified compounds.
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Affiliation(s)
- Dimitri Abrahamsson
- Department of Obstetrics, Gynecology and Reproductive Sciences, Program on Reproductive Health and the Environment, University of California San Francisco, San Francisco, 94143, California, United States
| | - Adi Siddharth
- Department of Obstetrics, Gynecology and Reproductive Sciences, Program on Reproductive Health and the Environment, University of California San Francisco, San Francisco, 94143, California, United States
| | - Thomas M. Young
- Department of Civil and Environmental Engineering, University of California, Davis, One Shields Avenue, Davis, 95616, California, United States
| | - Marina Sirota
- Bakar Computational Health Sciences Institute, University of California San Francisco, San Francisco, 94158, California, United States
- Department of Pediatrics, University of California San Francisco, San Francisco, 94158, California, United States
| | - June-Soo Park
- Department of Obstetrics, Gynecology and Reproductive Sciences, Program on Reproductive Health and the Environment, University of California San Francisco, San Francisco, 94143, California, United States
- California Environmental Protection Agency, Department of Toxic Substances Control, Environmental Chemistry Laboratory, Berkeley, 94710, California, United States
| | - Jonathan Martin
- Science for Life Laboratory, Department of Environmental Science, Stockholm University, Svante Arrhenius väg 8, Stockholm, 106 91 Stockholm, Sweden
| | - Tracey Woodruff
- Department of Obstetrics, Gynecology and Reproductive Sciences, Program on Reproductive Health and the Environment, University of California San Francisco, San Francisco, 94143, California, United States
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Amanova N, Martin J, Elster C. Explainability for deep learning in mammography image quality assessment. Mach Learn : Sci Technol 2022. [DOI: 10.1088/2632-2153/ac7a03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
The application of deep learning has recently been proposed for the assessment of image quality in mammography. It was demonstrated in a proof-of-principle study that the proposed approach can be more efficient than currently applied automated conventional methods. However, in contrast to conventional methods, the deep learning approach has a black-box nature and, before it can be recommended for the routine use, it must be understood more thoroughly. For this purpose, we propose and apply a new explainability method: the oriented, modified integrated gradients (OMIG) method. The design of this method is inspired by the integrated gradientsmethod but adapted considerably to the use case at hand. To further enhance this method, an upsampling technique is developed that produces high-resolution explainability maps for the downsampled data used by the deep learning approach. Comparison with established explainability methods demonstrates that the proposed approach yields substantially more expressive and informative results for our specific use case. Application of the proposed explainability approach generally confirms the validity of the considered deep learning-based mammography image quality assessment (IQA) method. Specifically, it is demonstrated that the predicted image quality is based on a meaningful mapping that makes successful use of certain geometric structures of the images. In addition, the novel explainability method helps us to identify the parts of the employed phantom that have the largest impact on the predicted image quality, and to shed some light on cases in which the trained neural networks fail to work as expected. While tailored to assess a specific approach from deep learning for mammography IQA, the proposed explainability method could also become relevant in other, similar deep learning applications based on high-dimensional images.
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Kouli O, Murray V, Bhatia S, Cambridge WA, Kawka M, Shafi S, Knight SR, Kamarajah SK, McLean KA, Glasbey JC, Khaw RA, Ahmed W, Akhbari M, Baker D, Borakati A, Mills E, Thavayogan R, Yasin I, Raubenheimer K, Ridley W, Sarrami M, Zhang G, Egoroff N, Pockney P, Richards T, Bhangu A, Creagh-Brown B, Edwards M, Harrison EM, Lee M, Nepogodiev D, Pinkney T, Pearse R, Smart N, Vohra R, Sohrabi C, Jamieson A, Nguyen M, Rahman A, English C, Tincknell L, Kakodkar P, Kwek I, Punjabi N, Burns J, Varghese S, Erotocritou M, McGuckin S, Vayalapra S, Dominguez E, Moneim J, Salehi M, Tan HL, Yoong A, Zhu L, Seale B, Nowinka Z, Patel N, Chrisp B, Harris J, Maleyko I, Muneeb F, Gough M, James CE, Skan O, Chowdhury A, Rebuffa N, Khan H, Down B, Fatimah Hussain Q, Adams M, Bailey A, Cullen G, Fu YXJ, McClement B, Taylor A, Aitken S, Bachelet B, Brousse de Gersigny J, Chang C, Khehra B, Lahoud N, Lee Solano M, Louca M, Rozenbroek P, Rozitis E, Agbinya N, Anderson E, Arwi G, Barry I, Batchelor C, Chong T, 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Wyn-Griffiths F, Brew A, Kaur G, Soni D, Tickle A, Akbar Z, Appleyard T, Figg K, Jayawardena P, Johnson A, Kamran Siddiqui Z, Lacy-Colson J, Oatham R, Rowlands B, Sludden E, Turnbull C, Allin D, Ansar Z, Azeez Z, Dale VH, Garg J, Horner A, Jones S, Knight S, McGregor C, McKenna J, McLelland T, Packham-Smith A, Rowsell K, Spector-Hill I, Adeniken E, Baker J, Bartlett M, Chikomba L, Connell B, Deekonda P, Dhar M, Elmansouri A, Gamage K, Goodhew R, Hanna P, Knight J, Luca A, Maasoumi N, Mahamoud F, Manji S, Marwaha PK, Mason F, Oluboyede A, Pigott L, Razaq AM, Richardson M, Saddaoui I, Wijeyendram P, Yau S, Atkins W, Liang K, Miles N, Praveen B, Ashai S, Braganza J, Common J, Cundy A, Davies R, Guthrie J, Handa I, Iqbal M, Ismail R, Jones C, Jones I, Lee KS, Levene A, Okocha M, Olivier J, Smith A, Subramaniam E, Tandle S, Wang A, Watson A, Wilson C, Chan XHF, Khoo E, Montgomery C, Norris M, Pugalenthi PP, Common T, Cook E, Mistry H, Shinmar HS, Agarwal G, Bandyopadhyay S, Brazier B, Carroll L, Goede A, Harbourne A, Lakhani A, Lami M, Larwood J, Martin J, Merchant J, Pattenden S, Pradhan A, Raafat N, Rothwell E, Shammoon Y, Sudarshan R, Vickers E, Wingfield L, Ashworth I, Azizi S, Bhate R, Chowdhury T, Christou A, Davies L, Dwaraknath M, Farah Y, Garner J, Gureviciute E, Hart E, Jain A, Javid S, Kankam HK, Kaur Toor P, Kaz R, Kermali M, Khan I, Mattson A, McManus A, Murphy M, Nair K, Ngemoh D, Norton E, Olabiran A, Parry L, Payne T, Pillai K, Price S, Punjabi K, Raghunathan A, Ramwell A, Raza M, Ritehnia J, Simpson G, Smith W, Sodeinde S, Studd L, Subramaniam M, Thomas J, Towey S, Tsang E, Tuteja D, Vasani J, Vio M, Badran A, Adams J, Anthony Wilkinson J, Asvandi S, Austin T, Bald A, Bix E, Carrick M, Chander B, Chowdhury S, Cooper Drake B, Crosbie S, D Portela S, Francis D, Gallagher C, Gillespie R, Gravett H, Gupta P, Ilyas C, James G, Johny J, Jones A, Kinder F, MacLeod C, Macrow C, Maqsood-Shah A, Mather J, McCann L, McMahon R, Mitham E, Mohamed M, Munton E, Nightingale K, O'Neill K, Onyemuchara I, Senior R, Shanahan A, Sherlock J, Spyridoulias A, Stavrou C, Stokes D, Tamang R, Taylor E, Trafford C, Uden C, Waddington C, Yassin D, Zaman M, Bangi S, Cheng T, Chew D, Hussain N, Imani-Masouleh S, Mahasivam G, McKnight G, Ng HL, Ota HC, Pasha T, Ravindran W, Shah K, Vishnu K S, Zaman S, Carr W, Cope S, Eagles EJ, Howarth-Maddison M, Li CY, Reed J, Ridge A, Stubbs T, Teasdaled D, Umar R, Worthington J, Dhebri A, Kalenderov R, Alattas A, Arain Z, Bhudia R, Chia D, Daniel S, Dar T, Garland H, Girish M, Hampson A, Kyriacou H, Lehovsky K, Mullins W, Omorphos N, Vasdev N, Venkatesh A, Waldock W, Bhandari A, Brown G, Choa G, Eichenauer CE, Ezennia K, Kidwai Z, Lloyd-Thomas A, Macaskill Stewart A, Massardi C, Sinclair E, Skajaa N, Smith M, Tan I, Afsheen N, Anuar A, Azam Z, Bhatia P, Davies-kelly N, Dickinson S, Elkawafi M, Ganapathy M, Gupta S, Khoury EG, Licudi D, Mehta V, Neequaye S, Nita G, Tay VL, Zhao S, Botsa E, Cuthbert H, Elliott J, Furlepa M, Lehmann J, Mangtani A, Narayan A, Nazarian S, Parmar C, Shah D, Shaw C, Zhao Z, Beck C, Caldwell S, Clements JM, French B, Kenny R, Kirk S, Lindsay J, McClung A, McLaughlin N, Watson S, Whiteside E, Alyacoubi S, Arumugam V, Beg R, Dawas K, Garg S, Lloyd ER, Mahfouz Y, Manobharath N, Moonesinghe R, Morka N, Patel K, Prashar J, Yip S, Adeeko ES, Ajekigbe F, Bhat A, Evans C, Farrugia A, Gurung C, Long T, Malik B, Manirajan S, Newport D, Rayer J, Ridha A, Ross E, Saran T, Sinker A, Waruingi D, Allen R, Al Sadek Y, Alves do Canto Brum H, Asharaf H, Ashman M, Balakumar V, Barrington J, Baskaran R, Berry A, Bhachoo H, Bilal A, Boaden L, Chia WL, Covell G, Crook D, Dadnam F, Davis L, De Berker H, Doyle C, Fox C, Gruffydd-Davies M, Hafouda Y, Hill A, Hubbard E, Hunter A, Inpadhas V, Jamshaid M, Jandu G, Jeyanthi M, Jones T, Kantor C, Kwak SY, Malik N, Matt R, McNulty P, Miles C, Mohomed A, Myat P, Niharika J, Nixon A, O'Reilly D, Parmar K, Pengelly S, Price L, Ramsden M, Turnor R, Wales E, Waring H, Wu M, Yang T, Ye TTS, Zander A, Zeicu C, Bellam S, Francombe J, Kawamoto N, Rahman MR, Sathyanarayana A, Tang HT, Cheung J, Hollingshead J, Page V, Sugarman J, Wong E, Chiong J, Fung E, Kan SY, Kiang J, Kok J, Krahelski O, Liew MY, Lyell B, Sharif Z, Speake D, Alim L, Amakye NY, Chandrasekaran J, Chandratreya N, Drake J, Owoso T, Thu YM, Abou El Ela Bourquin B, Alberts J, Chapman D, Rehnnuma N, Ainsworth K, Carpenter H, Emmanuel T, Fisher T, Gabrel M, Guan Z, Hollows S, Hotouras A, Ip Fung Chun N, Jaffer S, Kallikas G, Kennedy N, Lewinsohn B, Liu FY, Mohammed S, Rutherfurd A, Situ T, Stammer A, Taylor F, Thin N, Urgesi E, Zhang N, Ahmad MA, Bishop A, Bowes A, Dixit A, Glasson R, Hatta S, Hatt K, Larcombe S, Preece J, Riordan E, Fegredo D, Haq MZ, Li C, McCann G, Stewart D, Baraza W, Bhullar D, Burt G, Coyle J, Deans J, Devine A, Hird R, Ikotun O, Manchip G, Ross C, Storey L, Tan WWL, Tse C, Warner C, Whitehead M, Wu F, Court EL, Crisp E, Huttman M, Mayes F, Robertson H, Rosen H, Sandberg C, Smith H, Al Bakry M, Ashwell W, Bajaj S, Bandyopadhyay D, Browlee O, Burway S, Chand CP, Elsayeh K, Elsharkawi A, Evans E, Ferrin S, Fort-Schaale A, Iacob M, I K, Impelliziere Licastro G, Mankoo AS, Olaniyan T, Otun J, Pereira R, Reddy R, Saeed D, Simmonds O, Singhal G, Tron K, Wickstone C, Williams R, Bradshaw E, De Kock Jewell V, Houlden C, Knight C, Metezai H, Mirza-Davies A, Seymour Z, Spink D, Wischhusen S. Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study. Lancet Digit Health 2022; 4:e520-e531. [PMID: 35750401 DOI: 10.1016/s2589-7500(22)00069-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 01/07/2022] [Accepted: 04/06/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications. METHODS We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC). FINDINGS In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]). INTERPRETATION In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required. FUNDING British Journal of Surgery Society.
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Miller C, Wright K, Dono J, Pettigrew S, Wakefield M, Coveney J, Wittert G, Roder D, Durkin S, Martin J, Ettridge K. "You can't just eat 16 teaspoons of sugar so why would you drink 16 teaspoons' worth of sugar?": a qualitative study of young adults' reactions to sugary drink warning labels. BMC Public Health 2022; 22:1241. [PMID: 35733102 PMCID: PMC9219237 DOI: 10.1186/s12889-022-13648-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 06/06/2022] [Indexed: 11/10/2022] Open
Abstract
Background Several jurisdictions have introduced nutrient warning front of pack (FoP) labels in an effort to curb consumption of ultra-processed foods and beverages high in free sugars (sugars added to foods and beverages, and sugars naturally present in honey, syrups, fruit juices and fruit juice concentrates). This study aimed to explore consumer understanding and perceptions of FoP warning labels that convey different nutritional and health information messages regarding the consumption of sugary drinks. Methods Sixteen focus groups were held with 4–8 young adults per group (aged 18–24; n = 105 participants in total) stratified by education level, location (rural centres, large cities) and gender (males, females) to ensure diversity. Labels shown to participants during group discussions included text warning labels of health effects, exercise equivalents, calorie/kilojoule information and sugar content as a “high in” label and as teaspoons (text and pictograms). Thematic analysis was undertaken. Results Four themes were identified related to participants’ perceived effectiveness of labels: the extent to which labels were perceived to be useful, relevant and credible; the extent to which a label elicited shock or disgust (perceived aversiveness); the extent to which the label message was resistant to self-exemption; and participants’ perceived potential of the label to reduce purchasing and consumption behaviour. Across all four themes, labels communicating the number of teaspoons of sugar in a sugary drink (whether by text or pictogram) were perceived as the most impactful, resistant to self-exemption and to have the greatest potential to reduce consumption, with enhanced reactions to the pictogram label. Labels depicting health effects, exercise equivalents, calorie/kilojoule information or a general ‘high in sugar’ warning were perceived by consumers to be less effective in one or more themes. Conclusions Labels conveying the amount of sugar in a beverage in teaspoons were perceived as highly factual, relatable and interpretable, and as having the greatest potential to impact consumption attitudes and intentions. Further quantitative studies are required to compare the potential effectiveness of the teaspoons of sugar labels in reducing purchasing and consumption behaviour than other alternative warning labels, such as health effects or “high in” sugar labels. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13648-1.
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Affiliation(s)
- C Miller
- The University of Adelaide's School of Public Health, Adelaide, Australia. .,Health Policy Centre, South Australian Health and Medical Research Institute, North Terrace, Adelaide, South Australia, 5000, Australia.
| | - K Wright
- Health Policy Centre, South Australian Health and Medical Research Institute, North Terrace, Adelaide, South Australia, 5000, Australia.,The University of Adelaide's School of Psychology, Adelaide, Australia
| | - J Dono
- Health Policy Centre, South Australian Health and Medical Research Institute, North Terrace, Adelaide, South Australia, 5000, Australia.,The University of Adelaide's School of Psychology, Adelaide, Australia
| | - S Pettigrew
- Food Policy, The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - M Wakefield
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Australia.,School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | - J Coveney
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - G Wittert
- Freemasons Foundation Centre for Men's Health, Faculty of Health Sciences, University of Adelaide, Adelaide, Australia.,Centre for Nutrition and GI Diseases, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - D Roder
- Cancer Epidemiology and Population Health, University of South Australia, Adelaide, Australia
| | - S Durkin
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Australia.,School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | - J Martin
- Obesity Policy Coalition and Alcohol and Obesity Policy, Cancer Council Victoria, Melbourne, Australia
| | - K Ettridge
- Health Policy Centre, South Australian Health and Medical Research Institute, North Terrace, Adelaide, South Australia, 5000, Australia.,The University of Adelaide's School of Psychology, Adelaide, Australia
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Ramesh B, Isseks A, Martin J, Mansoori S, Browne A, Suminski R, Chai S. Vitamin C and Copper Intake Associated With Cognitive Function in Older Adults. Curr Dev Nutr 2022. [DOI: 10.1093/cdn/nzac051.080] [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: 11/12/2022] Open
Abstract
Abstract
Objectives
Oxidative stress has been linked to the development of depression and anxiety as well as cognitive decline in older adults. Vitamins and minerals that have antioxidant properties or serve as cofactors can improve the oxidant-antioxidant balance in the body and lead to a reduction in oxidative stress and inflammation. We aimed to study antioxidant and antioxidant cofactor intake from diet in the older population in relation to mental and cognitive health.
Methods
A cross-sectional study was conducted that included 181 men and women aged 60–80 years. Individuals diagnosed with dementia, Alzheimer's, or other neurological disorders were excluded. Dietary information was obtained using a 3-day diet record and food frequency questionnaire. Mental and cognitive health were assessed using Geriatric Depression Scale, Geriatric Anxiety Inventory, Montreal Cognitive Assessment (MoCA), and Digit Span test. Partial Pearson Correlation analyses were performed using SPSS software.
Results
Our findings indicate that vitamin B1 [r = .18, p < .05], vitamin C [r = .24, p < .001], vitamin D [r = .15, p < .05], and zinc [r = .15, p < .05] were positively correlated with Total Digit Span score, after controlling for antioxidant supplementation and other covariates such as age, education, economic status, etc. However, after further controlling for daily caloric intake, only vitamin C remained significantly associated with Total Digit Span score [r = .18, p < .05], and copper was inversely associated with MoCA scores [r = -.18, p < .05]. No other associations were found between the other variables.
Conclusions
Our findings suggest that higher vitamin C and lower copper intake from foods, are associated with cognitive performance among older adults. Further studies are needed to better understand the role of vitamin C and copper intake in cognitive function of older adults.
Funding Sources
None.
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Krooupa AM, Stone P, McKeever S, Seddon K, Davis S, Sampson EL, Tookman A, Martin J, Nambisan V, Vivat B. Do palliative care patients and relatives think it would be acceptable to use Bispectral index (BIS) technology to monitor palliative care patients' levels of consciousness? A qualitative exploration with interviews and focus groups for the I-CAN-CARE research programme. BMC Palliat Care 2022; 21:86. [PMID: 35610644 PMCID: PMC9131519 DOI: 10.1186/s12904-022-00949-w] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 04/14/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Bispectral index (BIS) monitoring uses electroencephalographic data as an indicator of patients' consciousness level. This technology might be a useful adjunct to clinical observation when titrating sedative medications for palliative care patients. However, the use of BIS in palliative care generally, and in the UK in particular, is under-researched. A key area is this technology's acceptability for palliative care service users. Ahead of trialling BIS in practice, and in order to ascertain whether such a trial would be reasonable, we conducted a study to explore UK palliative care patients' and relatives' perceptions of the technology, including whether they thought its use in palliative care practice would be acceptable. METHODS A qualitative exploration was undertaken. Participants were recruited through a UK hospice. Focus groups and semi-structured interviews were conducted with separate groups of palliative care patients, relatives of current patients, and bereaved relatives. We explored their views on acceptability of using BIS with palliative care patients, and analysed their responses following the five key stages of the Framework method. RESULTS We recruited 25 participants. There were ten current hospice patients in three focus groups, four relatives of current patients in one focus group and one individual interview, and eleven bereaved relatives in three focus groups and two individual interviews. Our study participants considered BIS acceptable for monitoring palliative care patients' consciousness levels, and that it might be of use in end-of-life care, provided that it was additional to (rather than a replacement of) usual care, and patients and/or family members were involved in decisions about its use. Participants also noted that BIS, while possibly obtrusive, is not invasive, with some seeing it as equivalent to wearable technological devices such as activity watches. CONCLUSIONS Participants considered BIS technology might be of benefit to palliative care as a non-intrusive means of assisting clinical assessment and decision-making at the end of life, and concluded that it would therefore be acceptable to trial the technology with patients.
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Affiliation(s)
- Anna-Maria Krooupa
- Division of Psychiatry, Marie Curie Palliative Care Research Department, University College London, London, UK.
| | - Patrick Stone
- grid.83440.3b0000000121901201Division of Psychiatry, Marie Curie Palliative Care Research Department, University College London, London, UK
| | - Stephen McKeever
- grid.83440.3b0000000121901201Division of Psychiatry, Marie Curie Palliative Care Research Department, University College London, London, UK ,grid.1008.90000 0001 2179 088XDepartment of Nursing, The University of Melbourne, Melbourne, Australia
| | - Kathy Seddon
- grid.419428.20000 0000 9768 8171Marie Curie Palliative Care Research Voices, London, UK
| | - Sarah Davis
- grid.83440.3b0000000121901201Division of Psychiatry, Marie Curie Palliative Care Research Department, University College London, London, UK
| | - Elizabeth L. Sampson
- grid.83440.3b0000000121901201Division of Psychiatry, University College London, London, UK
| | - Adrian Tookman
- grid.419428.20000 0000 9768 8171Marie Curie Hospice Hampstead, London, UK ,Field Editor Cochrane; Palliative and Supportive Care, Oxford, UK
| | - Jonathan Martin
- grid.450578.b0000 0001 1550 1922Central & North West London NHS Foundation Trust, London, UK ,grid.52996.310000 0000 8937 2257National Hospital for Neurology & Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Bella Vivat
- grid.83440.3b0000000121901201Division of Psychiatry, Marie Curie Palliative Care Research Department, University College London, London, UK
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Nijhawan A, Kam J, Martin J, Forrester L, Thenabadu S, Aziz S. Medical students in the pre-hospital environment - An untapped resource for undergraduate acute care and interprofessional education. Med Teach 2022; 44:372-379. [PMID: 34723749 DOI: 10.1080/0142159x.2021.1994536] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND The King's College London Pre-hospital Care Programme (KCL PCP) is a student-run programme that provides undergraduate medical students with the opportunity to attend observer shifts with the local ambulance service. This study evaluates the contribution of pre-hospital exposure to medical students' clinical and professional development. METHODS Students were asked to complete a Likert-scale based survey on self-reported exposure and confidence in various aspects of acute patient assessment, communication and interprofessional education, both before and after the programme; additional qualitative questions querying their experience were asked post-programme. Pre and post-programme Likert-scale responses were matched and statistically analysed, alongside a thematic analysis of qualitative responses. RESULTS Exposure to ambulance service clinicians, confidence assessing acutely unwell patients, and confidence making clinical handovers all increased with statistical significance. Key areas of learning identified from the thematic analysis include increased confidence communicating with patients and families, and an enriched understanding of the work done by pre-hospital clinicians. CONCLUSIONS Time spent in the pre-hospital environment shadowing ambulance service clinicians positively contributes to acute care knowledge, inter-personal skills and interprofessional understanding. Rotating medical students through the pre-hospital environment could bridge education gaps in these areas in a manner that complements traditional pre-clinical and clinical teaching.
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Affiliation(s)
- Aditi Nijhawan
- GKT School of Medical Education, King's College London, London, UK
- Whipps Cross University Hospital, Barts Health NHS Trust, London, UK
| | - Joyce Kam
- GKT School of Medical Education, King's College London, London, UK
| | - Jonathan Martin
- GKT School of Medical Education, King's College London, London, UK
| | - Lewis Forrester
- GKT School of Medical Education, King's College London, London, UK
| | - Sam Thenabadu
- GKT School of Medical Education, King's College London, London, UK
| | - Shadman Aziz
- GKT School of Medical Education, King's College London, London, UK
- Newham University Hospital, Barts Health NHS Trust, London, UK
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Duffy FJR, Papadopolou C, Barrie J, Hendry A, Andrew M, Martin J. 799 FRAILTY MATTERS PROJECT. Age Ageing 2022. [DOI: 10.1093/ageing/afac036.799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Preventing and managing frailty is a new area for many community practitioners yet frailty specific education remains limited. We aimed to understand and strengthen the capability of District Nurses (DNs) in leading personalised care for older people with frailty.
Methods
We conducted a participatory action research (PAR) study with DNs in one Scottish NHS Board area. Phase 1 involved three focus groups (n = 17); one one-to-one interviews; and collection of baseline team dynamics questionnaires (n = 10). Evidence from phase 1 informed co-design of an educational framework, delivered in Phase 2 as a combined coaching and educational programme through small group learning, web based coaching and bite sized online education. Interactive sessions were supported by a person-centred coach and 2 older citizen ‘co-coaches’ to bring the experience of people affected by frailty. In Phase 3 we analysed participant feedback and assessed transferability to other disciplines and to health and care settings across the UK.
Results
At baseline, DNs did not perceive frailty as a long term condition. They identified a need for help to understand the concept of frailty and to build skills and confidence in delivering community interventions. Participants embraced the coaching and educational intervention and valued the opportunity for dialogue with peers and citizen co-coaches about what really matters to patients, families and professionals. Our survey of other disciplines and teams highlighted this educational programme is both relevant and transferable.
Conclusion
Through co-design we developed a contextually sensitive programme that makes sense of frailty in the reality of both community professionals and people living with frailty. Combining technical knowledge and relational skills-building with peer support and coaching helps prepare DNs to lead interprofessional teams caring for people living with frailty. The educational framework and combined coaching and educational package are highly applicable to interdisciplinary teams in other community settings.
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Affiliation(s)
| | | | - J Barrie
- University of the West of Scotland
| | | | - M Andrew
- Health and Social Care Alliance Scotland
| | - J Martin
- Health and Social Care Alliance Scotland
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van de Kuit A, Krishnan RJ, Mallee WH, Goedhart LM, Lambert B, Doornberg JN, Vervest TMJS, Martin J. Surgical site infection after wound closure with staples versus sutures in elective knee and hip arthroplasty: a systematic review and meta-analysis. Arthroplasty 2022; 4:12. [PMID: 35241172 PMCID: PMC8896293 DOI: 10.1186/s42836-021-00110-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 12/23/2021] [Indexed: 11/10/2022] Open
Abstract
Purpose This systematic review and meta-analysis aimed to study surgical site infection of wound closure using staples versus sutures in elective knee and hip arthroplasties. Methods A systematic literature review was performed to search for randomized controlled trials that compared surgical site infection after wound closure using staples versus sutures in elective knee and hip arthroplasties. The primary outcome was surgical site infection. The risk of bias was assessed with the Cochrane risk of bias assessment tool. The relative risk and 95% confidence interval with a random-effects model were assessed. Results Eight studies were included in this study, including 2 studies with a low risk of bias, 4 studies having ‘some concerns’, and 2 studies with high risk of bias. Significant difference was not found in the risk of SSI for patients with staples (n = 557) versus sutures (n = 573) (RR: 1.70, 95% CI: 0.94–3.08, I2 = 16%). The results were similar after excluding the studies with a high risk of bias (RR: 1.67, 95% CI: 0.91–3.07, I2 = 32%). Analysis of studies with low risk of bias revealed a significantly higher risk of surgical site infection in patients with staples (n = 331) compared to sutures (n = 331) (RR: 2.56, 95% CI: 1.20–5.44, I2 = 0%). There was no difference between continuous and interrupted sutures (P > 0.05). In hip arthroplasty, stapling carried a significantly higher risk of surgical site infection than suturing (RR: 2.51, 95% CI: 1.15–5.50, I2 = 0%), but there was no significant difference in knee arthroplasty (RR: 0.87, 95% CI: 0.33–2.25, I2 = 22%; P > 0.05). Conclusions Stapling might carry a higher risk of surgical site infection than suturing in elective knee and hip arthroplasties, especially in hip arthroplasty. Supplementary Information The online version contains supplementary material available at 10.1186/s42836-021-00110-7.
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Affiliation(s)
- A van de Kuit
- University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - R J Krishnan
- Department of Anesthesia & Perioperative Medicine and Department of Epidemiology & Biostatistics, MEDICI Centre, University of Western Ontario, London, Canada
| | - W H Mallee
- Department of Orthopaedics, Joint Research, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
| | - L M Goedhart
- Department of Orthopaedics, University Medical Center Groningen, Postbus 30.001, 9700 RB, Groningen, The Netherlands
| | - B Lambert
- Department of Orthopaedics, University Medical Center Groningen, Postbus 30.001, 9700 RB, Groningen, The Netherlands
| | - J N Doornberg
- Department of Orthopaedics, University Medical Center Groningen, Postbus 30.001, 9700 RB, Groningen, The Netherlands.
| | - T M J S Vervest
- Department of Orthopaedics, Tergooi Hospital, Hilversum, The Netherlands
| | - J Martin
- Department of Anesthesia & Perioperative Medicine and Department of Epidemiology & Biostatistics, MEDICI Centre, University of Western Ontario, London, Canada
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