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D'Costa I, Hunt I, Russell L, Adams K. A racial bias test with tertiary cancer centre employees: why anti-racist measures are required for First Nations Australians cancer care equity. AUST HEALTH REV 2023; 47:5-12. [PMID: 35477644 DOI: 10.1071/ah21113] [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] [Received: 03/31/2021] [Accepted: 01/18/2022] [Indexed: 02/04/2023]
Abstract
Objective To examine implicit bias in employees at a cancer centre using an Australian race (Aboriginal-white) Implicit Association Test (IAT), in an attempt to understand a potential factor for inequitable outcomes of First Nations Australians cancer patients. Methods All employees at an Australian cancer centre were invited to take part in a web-based, cross-sectional study using an Australian race IAT. The results were analysed using Welch t-tests, linear regression and ANOVA. Results Overall, 538/2871 participants (19%) completed the IAT between January and June 2020. The mean IAT was 0.147 (s.d. 0.43, P < 0.001, 95% CI 0.11-0.18), and 60% had a preference for white over First Nations Australians. There was no significant mean difference in IAT scores between sub-groups of gender, age or clinical/non-clinical employees. 21% of employees (95% CI 17.65-24.53) had moderate to strong preference for white over First Nations Australians, compared to 7.1% with moderate to strong preference for First Nations over white Australians (95% CI 5.01-9.09). Conclusions Inequitable cancer survival for First Nations patients has been well established and cancer is now the leading cause of mortality. This paper documents the presence of racial bias in employees at one cancer centre. We argue that this cannot be understood outside the history of colonialism and its effects on First Nations Australians, healthcare workers and our society. Further research is required to evaluate measures of racism, its effect on health care, and how to eliminate it.
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Affiliation(s)
- I D'Costa
- School of Medicine, Nursing and Health Science, Monash University, Wellington Road, Clayton, Melbourne, Vic. 3800, Australia; and Peter MacCallum Cancer Centre, Melbourne, Vic. 3000, Australia
| | - I Hunt
- University of Tasmania, Launceston, Australia
| | - L Russell
- Monash Indigenous Studies Centre, School of Philosophical, Historical, and International Studies, and Australian Research Council Centre of Excellence in Australian Biodiversity and Heritage, Wellington Road, Clayton, Melbourne, Vic. 3800, Australia
| | - K Adams
- Gukwonderuk Indigenous Health Unit, The Faculty of Medicine, Nursing and Health Sciences School, Wellington Road, Clayton, Melbourne, Vic. 3800, Australia
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2
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Garg PM, Paschal JL, Ansari MAY, Ware J, Adams K, Taylor C, Reddy K, Rosenfeld CR, Mir IN. Correlation of placental pathology with the postoperative outcomes and white matter injury in preterm infants following necrotizing enterocolitis. J Neonatal Perinatal Med 2023; 16:93-103. [PMID: 36744350 DOI: 10.3233/npm-221105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND To determine the association of placental pathologic lesions with postoperative outcomes, survival, and white matter injury (WMI) in preterm infants with NEC. METHODS A retrospective chart review of 107 neonates with NEC (Bell stage > IIa) from Jan 2013- June 2020 was completed. Demographic, clinical, and outcome data were compared between infants with or without placental pathologic lesions. RESULTS In this cohort, 59/107 (55%) infants had medical NEC, and 48 (45%) had surgical NEC. The infants had a mean gestational age of 28.1±3.7 weeks and a birth weight of 1103±647 g. Maternal vascular malperfusion (82/107, 76.6%) and acute histological chorioamnionitis (42, 39.3%) were the most common pathological placental lesions. Acute histologic chorioamnionitis with fetal inflammatory response was more common in infants with surgical NEC vs. medical NEC (35.4% vs. 15.3%; p = 0.02). The NEC Infants with WMI on brain MRI scans had a significantly higher incidence of acute histological chorioamnionitis (52% vs. 27.8%; P = 0.04). No significant differences in mortality, length of stay and postoperative outcomes in neonates with and without acute histologic chorioamnionitis with fetal inflammatory response were noted. On unadjusted logistic regression, acute histologic chorioamnionitis without fetal inflammatory response was also associated with higher odds of WMI (OR 2.81; 95% CI 1.05-7.54; p = 0.039). CONCLUSION Acute histological chorioamnionitis without fetal inflammatory response was associated with higher odds of WMI in infants with NEC, with no significant impact on mortality and other postoperative outcomes.
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Affiliation(s)
- P M Garg
- Department of Pediatrics/Neonatology, Atrium Health Wake Forest Baptist, Wake Forest School of Medicine, Winston Salem, North Carolina, USA.,Department of Pediatrics/Neonatology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - J L Paschal
- Department of Pediatrics/Neonatology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - M A Y Ansari
- Department of Data Science, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - J Ware
- Department of Pediatrics/Neonatology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - K Adams
- Department of Pathology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - C Taylor
- Department of Radiology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - K Reddy
- Department of Radiology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - C R Rosenfeld
- Department of Pediatrics/Neonatology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - I N Mir
- Department of Pediatrics/Neonatology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Lamidi S, Coe PO, Bordeianou LG, Hart AL, Hind D, Lindsay JO, Lobo AJ, Myrelid P, Raine T, Sebastian S, Fearnhead NS, Lee MJ, Adams K, Almer S, Ananthakrishnan A, Bethune RM, Block M, Brown SR, Cirocco WC, Cooney R, Davies RJ, Atici SD, Dhar A, Din S, Drobne D, Espin‐Basany E, Evans JP, Fleshner PR, Folkesson J, Fraser A, Graf W, Hahnloser D, Hager J, Hancock L, Hanzel J, Hargest R, Hedin CRH, Hill J, Ihle C, Jongen J, Kader R, Karmiris K, Katsanos KH, Keller DS, Kopylov U, Koutrabakis IE, Lamb CA, Landerholm K, Lee GC, Litta F, Limdi JK, Lopes EW, Madoff RD, Martin ST, Martin‐Perez B, Michalopoulos G, Millan M, Münch A, Nakov R, Noor NM, Oresland T, Paquette IM, Pellino G, Perra T, Porcu A, Roslani AC, Samaan MA, Sebepos‐Rogers GM, Segal JP, de Silva SD, Söderholm AM, Spinelli A, Speight RA, Steinhagen RM, Stenström P, Tsimogiannis KE, Varma MG, Verma AM, Verstockt B, Warden C, Yassin NA, Zawadzki A, Carr P, Devlin B, Avery MSP, Gecse KB, Goren I, Hellström PM, Kotze PG, McWhirter D, Naik AS, Sammour T, Selinger CP, Stein SL, Torres J, Wexner SD, Younge LC. Development of a core descriptor set for Crohn's anal fistula. Colorectal Dis 2022; 25:695-706. [PMID: 36461766 DOI: 10.1111/codi.16440] [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: 07/01/2022] [Revised: 09/21/2022] [Accepted: 11/08/2022] [Indexed: 12/04/2022]
Abstract
AIM Crohn's anal fistula (CAF) is a complex condition, with no agreement on which patient characteristics should be routinely reported in studies. The aim of this study was to develop a core descriptor set of key patient characteristics for reporting in all CAF research. METHOD Candidate descriptors were generated from published literature and stakeholder suggestions. Colorectal surgeons, gastroenterologists and specialist nurses in inflammatory bowel disease took part in three rounds of an international modified Delphi process using nine-point Likert scales to rank the importance of descriptors. Feedback was provided between rounds to allow refinement of the next ratings. Patterns in descriptor voting were assessed using principal component analysis (PCA). Resulting PCA groups were used to organize items in rounds two and three. Consensus descriptors were submitted to a patient panel for feedback. Items meeting predetermined thresholds were included in the final set and ratified at the consensus meeting. RESULTS One hundred and thirty three respondents from 22 countries completed round one, of whom 67.0% completed round three. Ninety seven descriptors were rated across three rounds in 11 PCA-based groups. Forty descriptors were shortlisted. The consensus meeting ratified a core descriptor set of 37 descriptors within six domains: fistula anatomy, current disease activity and phenotype, risk factors, medical interventions for CAF, surgical interventions for CAF, and patient symptoms and impact on quality of life. CONCLUSION The core descriptor set proposed for all future CAF research reflects characteristics important to gastroenterologists and surgeons. This might aid transparent reporting in future studies.
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Affiliation(s)
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- Department of Oncology and Metabolism, The Medical School, University of Sheffield, Sheffield, UK
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Bossi G, Lopes R, Adams K, Gonzalez V, Wiseman K, Overton D, Carreira R, Curnock A, Mahon T, Weber P. 045 Melanocyte-targeted Bispecific PD-1 Agonists as Localized Immune Suppressants against Vitiligo. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.09.054] [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: 11/19/2022]
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Brown M, Saund J, Qureshi A, Plowright M, Drury K, Gahir J, Simpson T, Newman T, Adams K, Galloway J, Durairaj K, Elgizouli K, Rampling T, Cole J, Easom N, Goodman AL, Marks M. Demographics and Outcomes of Initial Phase of COVID-19 Medicines Delivery Units Across 4 UK Centers During Peak B1.1.529 Omicron Epidemic: A Service Evaluation. Open Forum Infect Dis 2022; 9:ofac527. [PMID: 36320201 PMCID: PMC9605703 DOI: 10.1093/ofid/ofac527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 10/04/2022] [Indexed: 12/04/2022] Open
Abstract
Background COVID-19 medicines delivery units (CMDU) were established in late December 2021 to deliver early antiviral therapy to patients classified as at risk with the aim of preventing hospitalization. Methods We performed a service evaluation at 4 CMDUs in England. We assessed demographics and triage outcomes of CMDU referral, uptake of antiviral therapy, and the rate of subsequent hospitalizations within 2 weeks of CMDU referral. Results Over a 3-week period, 4788 patients were referred and 3989 were ultimately assessed by a CMDU. Overall, 832 of the patients referred (17%) were judged eligible for treatment and 628 (13%) were ultimately prescribed an antiviral agent. The overall rate of admission within 14 days was 1%. Patients who were admitted were significantly older than those who did not require hospitalization. Of patients prescribed molnupiravir and sotrovimab, 1.8% and 3.2%, respectively, were admitted. Conclusions There was a high volume of referrals to CMDU service during the initial surge of the Omicron wave in the United Kingdom. A minority of patients were judged to be eligible for therapy. In a highly vaccinated population, the overall hospitalization rate was low.
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Affiliation(s)
- Michael Brown
- Division of Infection, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jasjot Saund
- Division of Infection, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Azka Qureshi
- Department of Infection, Guys and St Thomas’s NHS Foundation Trust, London, United Kingdom
- South East London Covid Prevention and Intervention Service, Guys and St Thomas’s NHS Foundation Trust, London, United Kingdom
| | - Megan Plowright
- Department of Infectious Diseases and Tropical Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Katie Drury
- Infection Research Group, Hull University Teaching Hospitals NHS Foundation Trust, Hull, United Kingdom
| | - Joshua Gahir
- Division of Infection, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Tom Simpson
- Department of Respiratory Medicine, Lewisham Hospital, London, United Kingdom
| | - Thomas Newman
- Department of Infectious Diseases and Tropical Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Kate Adams
- Infection Research Group, Hull University Teaching Hospitals NHS Foundation Trust, Hull, United Kingdom
| | - James Galloway
- Centre for Rheumatic Disease, Kings College London, London, United Kingdom
| | - Kezia Durairaj
- Department of Infection, Guys and St Thomas’s NHS Foundation Trust, London, United Kingdom
- South East London Covid Prevention and Intervention Service, Guys and St Thomas’s NHS Foundation Trust, London, United Kingdom
| | - Kamla Elgizouli
- Infection Research Group, Hull University Teaching Hospitals NHS Foundation Trust, Hull, United Kingdom
| | - Tommy Rampling
- Division of Infection, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Joby Cole
- Department of Infectious Diseases and Tropical Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Nicholas Easom
- Infection Research Group, Hull University Teaching Hospitals NHS Foundation Trust, Hull, United Kingdom
| | - Anna L Goodman
- Department of Infection, Guys and St Thomas’s NHS Foundation Trust, London, United Kingdom
- South East London Covid Prevention and Intervention Service, Guys and St Thomas’s NHS Foundation Trust, London, United Kingdom
- Medical Research Council Clinical Trials Unit, University College London, London, United Kingdom
| | - Michael Marks
- Division of Infection, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Division of Infection and Immunity, University College London, London, United Kingdom
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Garrido-Mesa J, Adams K, Galvez J, Garrido-Mesa N. Repurposing tetracyclines for acute respiratory distress syndrome (ARDS) and severe COVID-19: A critical discussion of recent publications. Expert Opin Investig Drugs 2022; 31:475-482. [PMID: 35294307 PMCID: PMC9115781 DOI: 10.1080/13543784.2022.2054325] [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] [Indexed: 11/04/2022]
Abstract
Introduction Drug repurposing can be a successful approach to deal with the scarcity of cost-effective therapies in situations such as the COVID-19 pandemic. Tetracyclines have previously shown efficacy in preclinical acute respiratory distress syndrome (ARDS) models and initial predictions and experimental reports suggest a direct antiviral activity against SARS-CoV2. Furthermore, a few clinical reports indicate their potential in COVID-19 patients. In addition to the scarcity and limitations of the scientific evidence, the effectiveness of tetracyclines in experimental ARDS has been proven extensively, counteracting the overt inflammatory reaction and fibrosis sequelae due to a synergic combination of pharmacological activities. Areas covered This paper discusses the scientific evidence behind the application of tetracyclines for ARDS/COVID-19. Expert Opinion The benefits of their multi-target pharmacology and their safety profile overcome the limitations, such as antibiotic activity and low commercial interest. Immunomodulatory tetracyclines and novel chemically modified non-antibiotic tetracyclines have therapeutic potential. Further drug repurposing studies in ARDS and severe COVID-19 are necessary.
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Affiliation(s)
- Jose Garrido-Mesa
- Department of Medical and Molecular Genetics, Faculty of Life Sciences and Medicine, Guy's & St Thomas' NHS Foundation Trust and King's College London NIHR Biomedical Research Centre, London, UK
| | - Kate Adams
- Department of Bioscience, School of Health, Sport and Bioscience, University of East London, London, UK
| | - Julio Galvez
- Department of Pharmacology, Center for Biomedical Research (CIBM), University of Granada, AND Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Granada, Spain
| | - Natividad Garrido-Mesa
- Department of Pharmacy, School of Life Sciences, Pharmacy and Chemistry. Kingston University, London, UK
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7
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Mouajou V, Adams K, DeLisle G, Quach C. HAND HYGIENE COMPLIANCE IN THE PREVENTION OF HOSPITAL ACQUIRED INFECTIONS: A SYSTEMATIC REVIEW. J Hosp Infect 2021; 119:33-48. [PMID: 34582962 DOI: 10.1016/j.jhin.2021.09.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 09/20/2021] [Accepted: 09/22/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Healthcare worker's (HCW) hands are known to be a primary source of transmission of hospital-acquired infections (HAIs). Thus, practicing hand hygiene (HH) and adhering to HH guidelines are both expected to decrease the risk of transmission but there is no consensus on the optimal hand hygiene compliance (HHC) rate that HCWs should aim for. AIM The objective of this study was to systematically review the published literature to determine an optimal threshold of HCW HHC rate associated with the lowest incidence rate of HAIs. METHODS This systematic review was performed according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. We searched online databases using a comprehensive search criterion for randomized controlled trials and non-randomized controlled studies, investigating the impact of HCW's HHC rate on HAI rates in patients of all ages, within healthcare facilities in high income countries. FINDINGS Of the 8,093 articles citations and abstracts screened, 35 articles were included in the review. Most studies reported overall HAIs per 1000 patient-days and device-associated HAIs per 1000 device-days. Most studies reported HHC rates between 60%-70%. Lower incidence HAI rates seemed to be achieved with HHC rates of approximately 60%. Studies included were not originally designed to assess the impact of HHC on HAI rates but risk of bias was assessed as per our predetermined exposure and outcome criterion. 11 (31%) of studies were deemed at low risk of bias. CONCLUSIONS Although HHC is part of HCW's code of conduct, very high HHC rates were difficult to reach. In observational studies, HHC and HAI followed a negative relationship up to about 60%. Due to flaws in study design, causality could not be inferred; only general trends could be discussed. Given the limitations, there is a need for high-quality evidence to support the implementation of specified targets of HHC rates.
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Affiliation(s)
- V Mouajou
- Department of Microbiology, Infectious Disease and Immunology, University of Montreal, Montreal, QC, Canada
| | - K Adams
- Department of Epidemiology and Biostatistics, McGill University, Montreal, QC, Canada; Research Centre, CHU Sainte-Justine, Montreal, QC, Canada
| | - G DeLisle
- Research Centre, CHU Sainte-Justine, Montreal, QC, Canada
| | - C Quach
- Department of Microbiology, Infectious Disease and Immunology, University of Montreal, Montreal, QC, Canada; Research Centre, CHU Sainte-Justine, Montreal, QC, Canada; Infection Prevention and Control, CHU Sainte-Justine, Montreal, QC, Canada.
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8
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Hooper DG, Roberts DN, Lorencatto DF, Pollard DA, Spivey DM, Storr DW, Webster DD, Eccles MA, Ramsay MG, Jansen DJ, Thomas DR, Bounds DH, Eddie DM, Knight DS, Pearson DR, Khun Ng DJC, Weldring MT, Courtiour MS, Smith ML, DeVeaux MN, Cherian DB, Flack T, Rogen S, Mekki N, Ward H, Edwards S, Booth N, Clarke H, Rowe S, Adams K, Gotts D. Why do clinicians treat, or not treat, a patient for sepsis? Using the theoretical domains framework to elicit barriers and enablers to performing the Sepsis Six in UK hospitals. J Infect 2021; 83:709-737. [PMID: 34454956 DOI: 10.1016/j.jinf.2021.08.036] [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] [Received: 08/11/2021] [Accepted: 08/23/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Dr Guy Hooper
- Departments of Intensive Care and Anaesthesia, Royal Cornwall Hospital, Cornwall, United Kingdom.
| | - Dr Neil Roberts
- Departments of Intensive Care and Anaesthesia, Royal Cornwall Hospital, Cornwall, United Kingdom.
| | | | - Dr Adam Pollard
- Organisational Development, Royal Cornwall Hospital, Truro, Cornwall, United Kingdom.
| | | | - Dr Wendell Storr
- Department of Anaesthesia, Royal Victoria Infirmary, Newcastle, United Kingdom.
| | | | - Mr Alan Eccles
- Department of Radiology, University Hospitals Plymouth, Plymouth, Devon, United Kingdom
| | | | - Dr Jan Jansen
- Division of Acute Care Surgery, University of Alabama at Birmingham, Birmingham, AL, United States.
| | - Dr Ruth Thomas
- Dorset County Hospital, Dorchester, Dorset, United Kingdom.
| | - Dr Helen Bounds
- Department of Intensive Care, Dorset County Hospital, Dorchester, Dorset, United Kingdom.
| | - Dr Michael Eddie
- Department of Intensive Care, Dorset County Hospital, Dorchester, Dorset, United Kingdom.
| | - Dr Stephen Knight
- Monklands District General Hospital, Airdrie, Lanarkshire, United Kingdom.
| | - Dr Robert Pearson
- Department of General Surgery, Monklands District General Hospital, Airdrie, Lanarkshire, United Kingdom
| | - Dr James Chean Khun Ng
- Department of General Surgery, Monklands District General Hospital, Airdrie, Lanarkshire, United Kingdom
| | - Ms Theresa Weldring
- Project Monitoring Group, Kingston Hospital NHS Foundation Trust, Kingston Upon Thames, Surrey, United Kingdom.
| | | | - Ms Laura Smith
- Poole Hospital NHS Foundation Trust, Poole, Dorset, United Kingdom.
| | - Ms Nicola DeVeaux
- Great Western Hospitals NHS Foundation Trust, Swindon, Wiltshire, United Kingdom.
| | | | - Toby Flack
- University of Plymouth Hospitals Trust, United Kingdom
| | - Stephen Rogen
- University of Plymouth Hospitals Trust, United Kingdom
| | - Nadia Mekki
- University of Plymouth Hospitals Trust, United Kingdom
| | - Hope Ward
- University of Plymouth Hospitals Trust, United Kingdom
| | - Sian Edwards
- University of Plymouth Hospitals Trust, United Kingdom
| | - Nigel Booth
- University of Plymouth Hospitals Trust, United Kingdom
| | | | - Samantha Rowe
- University of Plymouth Hospitals Trust, United Kingdom
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Almeida Prado PS, Adams K, Fernandes LC, Kranioti E. Frontal sinus as an identity and sex indicator. Morphologie 2021; 105:281-287. [PMID: 33468429 DOI: 10.1016/j.morpho.2020.12.005] [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: 10/08/2020] [Revised: 12/17/2020] [Accepted: 12/18/2020] [Indexed: 11/15/2022]
Abstract
The present study explores the variability of frontal sinuses volume in modern Greeks and their potential use in the forensic identification process. METHODS The sample consisted of 102 CT scan images from a modern Greek population. 50 (49%) were male and 52 (51%) were female. Ages ranged from 19 to 101 (mean age 70.6 for males and 69.6 for females). 3D models of the skull were constructed, and volume calculations of the frontal sinus were done with the software Amira 5.4. 10 CT scans were used to extract 2D frontal and lateral images that were used as proxies of antemortem X-rays which were matched to the CT scans using manual craniofacial superimposition. RESULTS The average of frontal sinus volume of male was 9,220 mm3 (±SD) and female was 5,880 mm3 (±SD). Mann-Witney test confirmed that mean values were significantly different (P<0.05) between them. Pearson's correlation coefficient showed no evident correlation between the volumes and ages of the skulls in both groups. Using the lateral and anterior oriented radiographs for matching the sinuses, the method produced 60% sensitivity / 99.32% specificity and 80% sensitivity / 99.97% specificity, respectively. CONCLUSIONS Even though there are statistically significant differences in the shape and volume between sexes, these are not sufficient to be used as an indicator of sex in worldwide populations. The results indicate that using the anterior view of the frontal sinuses is more consistent in human identification, and that the method proves to be reliable, as long as the sinus is adequately observed on the radiograph.
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Affiliation(s)
- P S Almeida Prado
- Laboratoire d'Automatique de Mécanique et d'Informatique industrielles et Humaines (LAMIH), UMR CNRS 8201, Université Polytechnique Hauts-de-France, Valenciennes, France; Department of Bio-morphology, Federal University of Bahia, Salvador, Brazil.
| | - K Adams
- Edinburgh Unit for Forensic Anthropology, School of History, Classics and Archaeology, University of Edinburgh, Edinburgh, UK.
| | | | - E Kranioti
- Forensic Medicine Unit, Department of Forensic Sciences, University of Crete, Crete, Greece.
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Hussain F, Laharwani H, Sonani H, Adams K. Primary Conjunctival Kaposi Sarcoma; A Rare And Unheard Entity. Am J Clin Pathol 2020. [DOI: 10.1093/ajcp/aqaa161.218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction/Objective
Kaposi’s sarcoma (KS) is the most common malignant vascular tumor in human immunodeficiency virus (HIV) patients caused by human herpesvirus 8. It can affect the vascular endothelium of any part of the body however ocular KS as an initial manifestation has been reported only in 3 cases so far. It affects the vascular endothelium of the lacrimal gland, eyelids, orbit, palpebral and bulbar conjunctiva. It presents as a violaceous fleshy nodular mass.
Methods
A 23-year-old male with a past medical history of HIV presented with bilateral eye erythema and significant upper and lower lid edema. The patient was initially admitted for facial swelling which led to a conjunctival biopsy and a diagnosis of KS was made and doxorubicin along with chemotherapy was started. Four months later after the initiation of chemotherapy, the patient experienced worsening of facial swelling, and an area on the left side of his face got very firm. His physical examination was positive for a fever, drooling, facial swelling with trouble swallowing, and change of voice along with shortness of breath.
Results
CT of the orbit revealed symmetric enhancement swelling of the preseptal periorbital soft tissues which was thought to be nonspecific and a differential diagnosis included lymphedema, acute sinusitis, and orbital cellulitis was considered. A chest x-ray revealed bilateral pleural effusions and CT head revealed diffuse scalp and facial cutaneous and subcutaneous edema. Lab findings were significant for a low CD4: CD8 ratio. Cytological examination of the pleural fluid revealed predominantly blood, reactive mesothelial cells, macrophages, neutrophils, and lymphocytes, and appropriately controlled immunostain was positive for ERG and HHV8 with a possibility that Kaposi’s sarcoma cannot be completely excluded. Unfortunately, the patient passed away during the same time of pleural fluid analysis.
Autopsy findings revealed multiple metastatic foci in the mediastinal soft tissue, within the right land left lung, scalp soft tissue, retroperitoneal soft tissue, and hilar lymph node which were positive for CD34, CD31, and HHV8 and consistent with metastatic KS.
Conclusion
Thus, it is important to keep in mind that isolated conjunctival KP with later on systemic metastasis is rare with conjunctiva being an unusual site for the initial presentation, and a possibility of primary conjunctival KS should be considered in HIV positive patients.
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Affiliation(s)
- F Hussain
- Pathology, University of Mississippi Medical Center, Jackson, Mississippi, UNITED STATES
| | - H Laharwani
- Pathology, University of Mississippi Medical Center, Jackson, Mississippi, UNITED STATES
| | - H Sonani
- Pathology, University of Mississippi Medical Center, Jackson, Mississippi, UNITED STATES
| | - K Adams
- Pathology, University of Mississippi Medical Center, Jackson, Mississippi, UNITED STATES
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Simpson AI, Vaghela KR, Brown H, Adams K, Sinisi M, Fox M, Quick T. Reducing the Risk and Impact of Brachial Plexus Injury Sustained From Prone Positioning-A Clinical Commentary. J Intensive Care Med 2020; 35:1576-1582. [PMID: 32959717 DOI: 10.1177/0885066620954787] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Prone positioning is deployed as a critical treatment for improving oxygenation in patients with Acute Respiratory Distress Syndrome. This regimen is currently highly prevalent in the COVID-19 pandemic. The pandemic has brought about increased concern about how best to safely avoid brachial plexus injuries when caring for unconscious proned patients. METHODS A review of the published literature on brachial plexus injuries secondary to proning ventilated patients was performed. This was combined with a review of available international critical care guidelines in order to produce a succinct set of guidelines to aid critical care departments in reducing brachial plexus injuries during these challenging times. DISCUSSION There is no one manner in which prone positioning an unconscious patient can be made universally safe. This paper provides 6 key steps to reducing the incidence of brachial plexus injuries while proning and suggests a safe and sensible management and referral pathway for the conscious patient in which a brachial plexus injury is identified. CONCLUSION There is in truth no completely safe position for every patient and certainly there will be anomalies in anatomy that will predispose certain individuals to nerve injury. Thus the injury rate cannot be reduced to zero but an understanding of the principles of protection will inform those undertaking positioning.
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Affiliation(s)
- Ashley I Simpson
- Peripheral Nerve Injuries Unit, 159096Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, United Kingdom
| | - Kalpesh R Vaghela
- Peripheral Nerve Injuries Unit, 159096Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, United Kingdom
| | - Hazel Brown
- Peripheral Nerve Injuries Unit, 159096Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, United Kingdom.,UCL Centre for Nerve Engineering, Gower Street, London, United Kingdom
| | - Kate Adams
- Peripheral Nerve Injuries Unit, 159096Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, United Kingdom
| | - Marco Sinisi
- Peripheral Nerve Injuries Unit, 159096Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, United Kingdom
| | - Michael Fox
- Peripheral Nerve Injuries Unit, 159096Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, United Kingdom
| | - Tom Quick
- Peripheral Nerve Injuries Unit, 159096Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, United Kingdom.,UCL Centre for Nerve Engineering, Gower Street, London, United Kingdom
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York JA, Adams K, Cullen L, Delahay J, Ivan M, Lillie PJ, MacLachlan L, Barlow G. Tedizolid: a service evaluation in a large UK teaching hospital. Eur J Clin Microbiol Infect Dis 2020; 40:397-405. [PMID: 32851509 DOI: 10.1007/s10096-020-04015-2] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 08/24/2020] [Indexed: 10/23/2022]
Abstract
Tedizolid is a new oxazolidinone antibiotic with little real-life data on use outside of skin and soft tissue infections. There is a paucity of safety evidence in courses greater than 6 days. Our centre uses tedizolid predominantly when linezolid-associated adverse events have occurred. This service evaluation describes our experience to date. We performed a retrospective service evaluation by reviewing case notes, prescription charts, and laboratory system results for each patient prescribed tedizolid at our hospital and recording patient demographics, clinical details, and outcomes. Sixty patients received tedizolid between May 2016 and November 2018. Most were treated for bone or joint infections and had stopped linezolid prior to tedizolid prescription. Mean length of tedizolid therapy was 27 days. Haematological adverse effects were infrequent. Most patients (72%) finished the course and their clinical condition improved during treatment (72%). Adverse events were common, but often not thought to be tedizolid related. Tedizolid appears to be safe in prolonged courses within this context. It may be suitable for longer-term antibiotic therapy within a complex oral and parenteral outpatient antibiotic therapy (COPAT) service. Patients who do not tolerate linezolid can be safely switched to tedizolid if appropriate.
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Affiliation(s)
- Joshua A York
- Department of Infection, Hull University Teaching Hospitals NHS Trust; Hull Royal Infirmary, Anlaby Road, Hull, HU3 2JZ, UK. .,Hull York Medical School, John Hughlings Jackson Building, University Of York, Alcuin Way, Heslington, York, YO10 5DD, UK.
| | - Kate Adams
- Department of Infection, Hull University Teaching Hospitals NHS Trust; Hull Royal Infirmary, Anlaby Road, Hull, HU3 2JZ, UK
| | - Lorraine Cullen
- Department of Infection, Hull University Teaching Hospitals NHS Trust; Hull Royal Infirmary, Anlaby Road, Hull, HU3 2JZ, UK
| | - Joanne Delahay
- Department of Infection, Hull University Teaching Hospitals NHS Trust; Hull Royal Infirmary, Anlaby Road, Hull, HU3 2JZ, UK
| | - Monica Ivan
- Department of Infection, Hull University Teaching Hospitals NHS Trust; Hull Royal Infirmary, Anlaby Road, Hull, HU3 2JZ, UK
| | - Patrick J Lillie
- Department of Infection, Hull University Teaching Hospitals NHS Trust; Hull Royal Infirmary, Anlaby Road, Hull, HU3 2JZ, UK
| | - Laura MacLachlan
- Department of Infection, Hull University Teaching Hospitals NHS Trust; Hull Royal Infirmary, Anlaby Road, Hull, HU3 2JZ, UK
| | - Gavin Barlow
- Department of Infection, Hull University Teaching Hospitals NHS Trust; Hull Royal Infirmary, Anlaby Road, Hull, HU3 2JZ, UK.,Hull York Medical School, John Hughlings Jackson Building, University Of York, Alcuin Way, Heslington, York, YO10 5DD, UK
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13
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Lillie PJ, Samson A, Li A, Adams K, Capstick R, Barlow GD, Easom N, Hamilton E, Moss PJ, Evans A, Ivan M, Phe Incident Team, Taha Y, Duncan CJA, Schmid ML, The Airborne Hcid Network. Novel coronavirus disease (Covid-19): The first two patients in the UK with person to person transmission. J Infect 2020; 80:578-606. [PMID: 32119884 PMCID: PMC7127394 DOI: 10.1016/j.jinf.2020.02.020] [Citation(s) in RCA: 114] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 02/23/2020] [Accepted: 02/25/2020] [Indexed: 01/03/2023]
Affiliation(s)
- Patrick J Lillie
- Department of Infection, Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
| | - Anda Samson
- Department of Infection, Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
| | - Ang Li
- Department of Infection and Tropical Medicine, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Kate Adams
- Department of Infection, Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
| | - Richard Capstick
- Department of Infection and Tropical Medicine, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Gavin D Barlow
- Department of Infection, Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom; Hull York Medical School, University of York, United Kingdom
| | - Nicholas Easom
- Department of Infection, Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
| | - Eve Hamilton
- Department of Infection and Tropical Medicine, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Peter J Moss
- Department of Infection, Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
| | - Adam Evans
- Department of Infection and Tropical Medicine, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Monica Ivan
- Department of Infection, Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
| | - Phe Incident Team
- PHE Incident Team, Public Health England, National Infection Service, London NW9 5EQ, United Kingdom
| | - Yusri Taha
- Department of Infection and Tropical Medicine, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Christopher J A Duncan
- Department of Infection and Tropical Medicine, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom; Translational and Clinical Research Institute, Immunity and Inflammation Theme, Newcastle University, United Kingdom.
| | - Matthias L Schmid
- Department of Infection and Tropical Medicine, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom.
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Easom N, Moss P, Barlow G, Samson A, Taynton T, Adams K, Ivan M, Burns P, Gajee K, Eastick K, Lillie PJ. Sixty-eight consecutive patients assessed for COVID-19 infection: Experience from a UK Regional infectious diseases Unit. Influenza Other Respir Viruses 2020; 14:374-379. [PMID: 32223012 PMCID: PMC7228236 DOI: 10.1111/irv.12739] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 03/13/2020] [Indexed: 01/05/2023] Open
Abstract
Background Assessment of possible infection with SARS‐CoV‐2, the novel coronavirus responsible for COVID‐19 illness, has been a major activity of infection services since the first reports of cases in December 2019. Objectives We report a series of 68 patients assessed at a Regional Infection Unit in the UK. Methods Between 29 January 2020 and 24 February 2020, demographic, clinical, epidemiological and laboratory data were collected. We compared clinical features between patients not requiring admission for clinical reasons or antimicrobials with those assessed as needing either admission or antimicrobial treatment. Results Patients assessed were aged from 0 to 76 years; 36/68 were female. Peaks of clinical assessments coincided with updates to the case definition for suspected COVID‐19. Microbiological diagnoses included SARS‐CoV‐2, mycoplasma pneumonia, influenza A, non‐SARS/MERS coronaviruses and rhinovirus/enterovirus. Nine of sixty‐eight received antimicrobials, 15/68 were admitted, 5 due to inability to self‐isolate. Patients requiring admission on clinical grounds or antimicrobials (14/68) were more likely to have fever or raised respiratory rate compared to those not requiring admission or antimicrobials. Conclusions The majority of patients had mild illness, which did not require clinical intervention. This finding supports a community testing approach, supported by clinicians able to review more unwell patients. Extensions of the epidemiological criteria for the case definition of suspected COVID‐19 lead to increased screening intensity; strategies must be in place to accommodate this in time for forthcoming changes as the epidemic develops.
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Affiliation(s)
- Nicholas Easom
- Department of Infection, Hull University Teaching Hospitals NHS Trust, Castle Hill Hospital, Hull, UK
| | - Peter Moss
- Department of Infection, Hull University Teaching Hospitals NHS Trust, Castle Hill Hospital, Hull, UK
| | - Gavin Barlow
- Department of Infection, Hull University Teaching Hospitals NHS Trust, Castle Hill Hospital, Hull, UK
| | - Anda Samson
- Department of Infection, Hull University Teaching Hospitals NHS Trust, Castle Hill Hospital, Hull, UK
| | - Thomas Taynton
- Department of Infection, Hull University Teaching Hospitals NHS Trust, Castle Hill Hospital, Hull, UK
| | - Kate Adams
- Department of Infection, Hull University Teaching Hospitals NHS Trust, Castle Hill Hospital, Hull, UK
| | - Monica Ivan
- Department of Infection, Hull University Teaching Hospitals NHS Trust, Castle Hill Hospital, Hull, UK
| | - Phillipa Burns
- Department of Infection, Hull University Teaching Hospitals NHS Trust, Castle Hill Hospital, Hull, UK
| | - Kavitha Gajee
- Department of Infection, Hull University Teaching Hospitals NHS Trust, Castle Hill Hospital, Hull, UK
| | - Kirstine Eastick
- Department of Infection, Hull University Teaching Hospitals NHS Trust, Castle Hill Hospital, Hull, UK
| | - Patrick J Lillie
- Department of Infection, Hull University Teaching Hospitals NHS Trust, Castle Hill Hospital, Hull, UK
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15
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Burns P, Adams K, Hajjawi M, Wearmouth D. Developing a quality assurance system for the use of stimulan beads in a diabetic foot clinic. Access Microbiol 2020. [DOI: 10.1099/acmi.fis2019.po0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Phillipa Burns
- Hull University Teaching Hospitals, Hull, United Kingdom
| | - Kate Adams
- Hull University Teaching Hospitals, Hull, United Kingdom
| | - Mark Hajjawi
- Hull University Teaching Hospitals, Hull, United Kingdom
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16
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Varadarajan M, Thaker H, Samson A, Adams K, Harrison S, Cullen L. Impact of Integrase Inhibitors on Weight. Access Microbiol 2020. [DOI: 10.1099/acmi.fis2019.po0069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
| | | | - Anda Samson
- Hull Teaching Hospitals, Hull, United Kingdom
| | - Kate Adams
- Hull Teaching Hospitals, Hull, United Kingdom
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17
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Neaves B, Adams K. A100 Clemens von Pirquet Award Recipient LONG-TERM ADHERENCE TO IMPORTED FIRE ANT SUBCUTANEOUS IMMUNOTHERAPY. Ann Allergy Asthma Immunol 2019. [DOI: 10.1016/j.anai.2019.08.041] [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]
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18
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McCann C, Adams K, Schizas A, George M, Barrett NA, Wyncoll DLA, Camporota L. Outcomes of emergency laparotomy in patients on extracorporeal membrane oxygenation for severe respiratory failure: A retrospective, observational cohort study. J Crit Care 2019; 53:253-257. [PMID: 31301640 DOI: 10.1016/j.jcrc.2019.06.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 04/21/2019] [Accepted: 06/20/2019] [Indexed: 11/17/2022]
Abstract
PURPOSE There is a paucity of literature to support undertaking emergency laparotomy when indicated in patients supported on ECMO. Our study aims to identify the prevalence, outcomes and complications of this high risk surgery at a large ECMO centre. MATERIALS AND METHODS A single centre, retrospective, observational cohort study of 355 patients admitted to a university teaching hospital Severe Respiratory Failure service between December 2011 and January 2017. RESULTS The prevalence of emergency laparotomy in patients on ECMO was 3.7%. These patients had significantly higher SOFA and APACHE II scores compared to similar patients not requiring laparotomy. There was no difference in the duration of ECMO or intensive care unit (ICU) stay post decannulation between the two groups. 31% of laparotomy patients survived to hospital discharge. Major haemorrhage was uncommon, however emergency change of ECMO oxygenator was commonly required. CONCLUSION Survival to hospital discharge is possible following emergency laparotomy on ECMO, however the mortality is higher than for those patients not requiring laparotomy, this likely reflects the severity of underlying organ failure rather than the surgery itself. Our service's collocation with a general surgical service has made this development in care possible. ECMO service planning should consider general surgical provision.
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Affiliation(s)
- C McCann
- Department of Critical Care, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
| | - K Adams
- Department of Colorectal Surgery, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
| | - A Schizas
- Department of Colorectal Surgery, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
| | - M George
- Department of Colorectal Surgery, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
| | - N A Barrett
- Department of Critical Care, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Centre for Human & Applied Physiological Sciences, King's College London, London, United Kingdom.
| | - D L A Wyncoll
- Department of Critical Care, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
| | - L Camporota
- Department of Critical Care, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Centre for Human & Applied Physiological Sciences, King's College London, London, United Kingdom.
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19
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Affiliation(s)
- Kate Adams
- Enhanced Recovery Nurse, Walsall Healthcare NHS Trust, UK
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20
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Affiliation(s)
- K Adams
- University of Connecticut, Farmington, CT
| | - R Fortinsky
- Center on Aging, University of Connecticut School of Medicine
| | - D Steffens
- Department of Psychiatry, University of Connecticut Health Center
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21
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Szari S, Adams K, Quinn J, Stokes S, Sacha J, White K. CHARACTERISTICS OF VENOM ALLERGY AT INITIAL EVALUATION. Ann Allergy Asthma Immunol 2018. [DOI: 10.1016/j.anai.2018.09.075] [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: 11/25/2022]
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22
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Neaves B, Adams K, Smith D. SPORADIC CASE OF SPLICE SITE BTK MUTATION WITH DELAYED ONSET OF X-LINKED AGAMMAGLOBULINEMIA (XLA). Ann Allergy Asthma Immunol 2018. [DOI: 10.1016/j.anai.2018.09.334] [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: 10/27/2022]
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Nath P, Schapira R, Edwards K, Adams K. IMPORTED FIRE ANT HYPERSENSITIVITY AND MASTOCYTOSIS: A CASE SERIES OF SUCCESSFUL IMMUNOTHERAPY. Ann Allergy Asthma Immunol 2018. [DOI: 10.1016/j.anai.2018.09.208] [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]
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24
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Barry L, Adams K. THE HEALTHCARE NEEDS OF OLDER WOMEN PRISONERS: A FOCUS GROUP STUDY. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- L Barry
- University of Connecticut Center on Aging
| | - K Adams
- UCONN Health, Department of Psychiatry
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Phelan M, Meldon S, Brenner R, Deadwiler M, Adams K, Simon J, Levinson M, Hustey F, Mace S. 120 Skilled Nursing Facility 3-Day Waiver Pilot: Direct Admission to Skilled Nursing Facilities From the Emergency Department Avoids Hospital Admissions and Decreases Costs. Ann Emerg Med 2018. [DOI: 10.1016/j.annemergmed.2018.08.125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Adams K, Schulz-Kornas E, Arzi B, Failing K, Vogelsberg J, Staszyk C. Functional anatomy of the equine temporomandibular joint: Histological characteristics of the articular surfaces and underlining tissues. Vet J 2018; 239:35-41. [PMID: 30197107 DOI: 10.1016/j.tvjl.2018.08.003] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 05/29/2018] [Accepted: 08/09/2018] [Indexed: 12/01/2022]
Abstract
It has been assumed that dental conditions cause disorders of the equine temporomandibular joint (TMJ), due to biomechanical overload or aberrant loading. However, the incidence of published TMJ disorders in horses is low and this leads to the question whether the equine TMJ is adapted well to its biomechanical requirements or is able to remodel its articular surfaces in response to modified loading conditions. The aim of this study was to determine the histological characteristics of healthy equine TMJs. The tissue components of the articular surfaces of 10 TMJs obtained from horses without any clinical history of dental or TMJ disorders were analysed. Apart from the mandibular fossa of the temporal bone, the osseous aspects of the TMJ exhibited a uniform zoning pattern. The articular surfaces were composed of three tissue layers: (1) a superficial cell-rich dense connective tissue layer; (2) a middle fibrocartilage layer; and (3) a deep hyaline-like cartilage layer. The articular disc was composed of an inner core of fibrocartilage and hyaline-like cartilage meshwork covered with both cell-rich dense connective tissue and fibrocartilage at its dorsal and ventral aspects. In contrast, the mandibular fossa was only covered by a dense connective tissue, frequently supplemented by a synovial membrane, suggesting low biomechanical stress. Glycosaminoglycans, which are indicative of compressive loads, were predominantly present within the rostral part of the articular tubercle and the retroarticular process, the dorsal part of articular disc and the entire mandibular head, but were absent within the mandibular fossa. The results of this study suggest the presence of different biomechanical demands in the dorsal and ventral compartment of the equine TMJ.
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Affiliation(s)
- K Adams
- Institute of Veterinary-Anatomy, -Histology and -Embryology, Faculty of Veterinary Medicine, Justus Liebig University Giessen, 35390 Giessen, Germany
| | - E Schulz-Kornas
- Max Planck Weizmann Centre for Integrative Archaeology and Anthropology, Max Planck Institute for Evolutionary Anthropology, 04103 Leipzig, Germany
| | - B Arzi
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis 95616, CA, USA
| | - K Failing
- Unit for Biomathematics and Data Processing, Faculty of Veterinary Medicine, Justus Liebig University Giessen, 35390 Giessen, Germany
| | - J Vogelsberg
- Institute of Veterinary-Anatomy, -Histology and -Embryology, Faculty of Veterinary Medicine, Justus Liebig University Giessen, 35390 Giessen, Germany
| | - C Staszyk
- Institute of Veterinary-Anatomy, -Histology and -Embryology, Faculty of Veterinary Medicine, Justus Liebig University Giessen, 35390 Giessen, Germany.
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Catchpole I, Brett S, Sheppard N, Pradas DC, Jing J, Steiner D, Figueroa D, Tsvetkov L, Katlinskaya Y, Kaczynski H, Abbott R, Silk J, Adams K, Gerry A, Quattrini A, Tavano B, Crossland K, Weiderman G, Cornforth T, Britten C. Engineering T-cells for adoptive cell therapy to overcome TGF-β-mediated immunosuppression in the tumour microenvironment. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx711.081] [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: 11/13/2022] Open
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Agostini P, Lugg S, Adams K, Smith T, Kalkat M, Rajesh P, Steyn R, Naidu B, Rushton A, Bishay E. MA 08.09 Postoperative Mobilization and Rehabilitation Requirements for Lung Cancer Patients Undergoing Minimally Invasive Surgery. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Parés D, Drami I, Adams K, Grossi U, Suliman I, Knowles CH. Use of the Harmonic scalpel for Delorme's procedure. Colorectal Dis 2017; 19:O232-O234. [PMID: 28418599 DOI: 10.1111/codi.13688] [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: 10/17/2016] [Accepted: 01/04/2017] [Indexed: 02/08/2023]
Abstract
AIM There are many surgical techniques that deal with external rectal prolapse but perineal procedures have the advantage of reduced invasiveness. Therefore, despite concerns regarding high recurrence rates, the technique is still used by many surgeons. METHOD This manuscript and video describe our early clinical experience using the Harmonic scalpel in 11 consecutive patients who underwent a Delorme's procedure for external rectal prolapse. RESULTS The median age of patients was 76 (range: 30-94) years. There were no intra-operative complications, and the median operative time was 78 min. Intra-operative blood loss was minimal (mean 45 ml; range 20-70 ml). Median length of stay was 2 (range: 0-8) days. Overall morbidity and recurrence were both 18%, with a median follow-up of 15 (range: 1-23) months. Nine patients were operated on by a senior trainee with consultant supervision. CONCLUSION The advantages of this device are mainly those of ease of mucosal dissection, minimal blood loss and shorter operative time in comparison with published series.
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Affiliation(s)
- D Parés
- National Bowel Research Centre, The Blizzard Institute, Barts & the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.,The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - I Drami
- The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - K Adams
- The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - U Grossi
- National Bowel Research Centre, The Blizzard Institute, Barts & the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.,The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - I Suliman
- The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - C H Knowles
- National Bowel Research Centre, The Blizzard Institute, Barts & the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.,The Royal London Hospital, Barts Health NHS Trust, London, UK
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Zettler JA, Adams K, Frederick B, Gutting A, Ingebretsen N, Ragsdale A, Schrey A. Genetic structure of Pseudococcus microcirculus (Hemiptera: Pseudococcidae) populations on epiphytic orchids in south Florida. J Genet 2017; 96:33-38. [PMID: 28360387 DOI: 10.1007/s12041-016-0736-9] [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: 12/01/2022]
Abstract
In 2012, the orchid mealy bug Pseudococcus microcirculus was first detected in situ in North America's more diverse orchid region, the Big Cypress Basin (Collier Co FL). A follow-up survey showed that the mealy bug is more widespread and found on epiphytic orchids in two locations, in both the Fakahatchee Strand State Preserve (sites B and F) and the Florida Panther National Wildlife Refuge (sites M and C). There, we collected mealy bugs (n = 54) from 35 orchid individuals and screened allelic variation at seven microsatellite loci. We estimated genetic diversity and differentiation among all sites and compared the variation among individuals collected on the same plant. Genetic differentiation between sites M and C (FST = 0.03, P < 0.01) and,Mand B (FST = 0.04, P < 0.01) was detected.We also detected significantly lower mean pairwise relatedness among individuals from site B compared to all the other locations, and this population had the lowest inbreeding coefficient. Genetic diversity and mean pairwise relatedness were highly variable among plants with multiple individuals; however, plants from sites F and M tend to have collections of individuals with higher mean pairwise relatedness compared to sites B and C. Our results indicate that there is genetic diversity and differentiation among mealy bugs in these locations, and that collections of individuals on the same plant are genetically diverse. As such, the mealy bugs throughout these areas are likely to be genetically diverse and exist in multiple distinct populations.
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Affiliation(s)
- J A Zettler
- Department of Biology, Armstrong State University, Savannah, GA 31419, USA.
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Heazlewood I, Walsh J, Climstein M, Adams K, Sevrene T, DeBeliso M. Injury location, type and incidence of male and female athletes competing at the world masters games. J Sci Med Sport 2017. [DOI: 10.1016/j.jsams.2017.01.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Agostini P, Lugg ST, Adams K, Vartsaba N, Kalkat M, Rajesh PB, Steyn RS, Naidu B, Rushton A, Bishay E. S63 Postoperative pulmonary complications and physiotherapy requirements after open thoracotomy versus vats lobectomy: a propensity score-matched analysis. Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.69] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Agostini P, Lugg ST, Adams K, Smith T, Kalkat M, Rajesh PB, Steyn RS, Naidu B, Rushton A, Bishay E. S61 Risk factors and short-term outcomes of developing postoperative pulmonary complications after vats lobectomy. Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.67] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Jakes A, Jani P, Menon M, Adams K, Edey M, Fleming S, Bhandari S. Renal Squamous Cell Carcinoma of a Native Kidney After Renal Transplant: A Case Report. Transplant Proc 2016; 48:259-61. [PMID: 26915879 DOI: 10.1016/j.transproceed.2015.12.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 11/15/2015] [Accepted: 12/07/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND Renal squamous cell carcinoma is a rare primary tumor of the kidney that rapidly invades local structures and has a poor prognosis. Presentation is usually nonspecific and is associated with renal stone disease and chronic infection. Immunosuppressed renal transplant recipients are more likely to develop a malignancy than the general population. Squamous cell carcinoma of the kidney in the context of a renal transplant and long-term immunosuppression has not previously been described in the literature. CASE REPORT A 46-year-old white man with previous renal stones and recurrent urinary infections underwent a right nephrectomy and subsequent renal transplantation owing to failure of the remaining kidney. Five years posttransplant, an abdominal ultrasound scan was performed owing to recurrent urinary infections and ongoing pyuria. This was reported as normal, but he later developed a discharging sinus in his left flank. A computed tomography (CT) scan revealed a tracking perinephric abscess with an associated cystic lesion of the left kidney. A left nephrectomy was performed and histologic examination suggested an invasive squamous cell carcinoma of the renal pelvis. The patient later required major surgery for chronic infection, and further imaging revealed metastatic disease, resulting in the decision to manage palliatively. CONCLUSION Given the nonspecific nature of the symptoms and the poor prognosis, health care professionals should have a lower threshold for diagnostic imaging in these patients. Abdominal ultrasonography was unhelpful and only a later CT scan revealed the underlying malignancy. This should be expedited if there is a persistent abnormality on urinalysis. Once diagnosed, a change in immunosuppressant regime to include sirolimus should be considered.
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Affiliation(s)
- A Jakes
- Renal Unit, Hammersmith Hospital, Imperial College NHS Trust, London, UK
| | - P Jani
- Hull-York Medical School, University of Hull, Hull, UK
| | - M Menon
- St. James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - K Adams
- Department of Infection & Tropical Medicine, Castle Hill Hospital, Hull and East Yorkshire Hospitals NHS Trust, Cottingham, East Yorkshire, UK
| | - M Edey
- Renal Unit, Hull Royal Infirmary, Hull and East Yorkshire Hospitals NHS Trust, Anlaby Road, Kingston upon Hull, UK
| | - S Fleming
- Cellular and Molecular Pathology, Ninewells Hospital, University of Dundee, Dundee, UK
| | - S Bhandari
- Renal Unit, Hull Royal Infirmary, Hull and East Yorkshire Hospitals NHS Trust, Anlaby Road, Kingston upon Hull, UK.
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Connolly A, Donnellan N, Lutz E, Buys E, Lane F, Gecsi K, Adams K, Kenton K, Amundsen C, Gregory T, Botros S, Blanchard A, Dunivan G, Gosman G. Real-Time Feedback – Trying Something New – What Works? What Gets in the Way? Program Directors’ Perspectives on the myTIPreport Rollout Experience. J Minim Invasive Gynecol 2016. [DOI: 10.1016/j.jmig.2016.08.572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Stevens B, Bell S, Adams K. Initial evaluation of inlet thermal desorption GC–MS analysis for organic gunshot residue collected from the hands of known shooters. Forensic Chem 2016. [DOI: 10.1016/j.forc.2016.10.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Adams K, Schulz-Kornas E, Arzi B, Failing K, Vogelsberg J, Staszyk C. Functional anatomy of the equine temporomandibular joint: Collagen fiber texture of the articular surfaces. Vet J 2016; 217:58-64. [PMID: 27810212 DOI: 10.1016/j.tvjl.2016.09.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 05/03/2016] [Revised: 09/09/2016] [Accepted: 09/23/2016] [Indexed: 11/29/2022]
Abstract
In the last decade, the equine masticatory apparatus has received much attention. Numerous studies have emphasized the importance of the temporomandibular joint (TMJ) in the functional process of mastication. However, ultrastructural and histological data providing a basis for biomechanical and histopathological considerations are not available. The aim of the present study was to analyze the architecture of the collagen fiber apparatus in the articular surfaces of the equine TMJ to reveal typical morphological features indicating biomechanical adaptions. Therefore, the collagen fiber alignment was visualized using the split-line technique in 16 adult warmblood horses without any history of TMJ disorders. Within the central two-thirds of the articular surfaces of the articular tubercle, the articular disc and the mandibular head, split-lines ran in a correspondent rostrocaudal direction. In the lateral and medial aspects of these articular surfaces, the split-line pattern varied, displaying curved arrangements in the articular disc and punctual split-lines in the bony components. Mediolateral orientated split-lines were found in the rostral and caudal border of the articular disc and in the mandibular fossa. The complex movements during the equine chewing cycle are likely assigned to different areas of the TMJ. The split-line pattern of the equine TMJ is indicative of a relative movement of the joint components in a preferential rostrocaudal direction which is consigned to the central aspects of the TMJ. The lateral and medial aspects of the articular surfaces provide split-line patterns that indicate movements particularly around a dorsoventral axis.
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Affiliation(s)
- K Adams
- Institute of Veterinary-Anatomy, -Histology and -Embryology, Faculty of Veterinary Medicine, Justus Liebig University Giessen, Frankfurter Str. 98, 35390 Giessen, Germany
| | - E Schulz-Kornas
- Max Planck Weizmann Center for Integrative Archaeology and Anthropology, Max Planck Institute for Evolutionary Anthropology, Deutscher Platz 6, 04103 Leipzig, Germany
| | - B Arzi
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, CA 95616, USA
| | - K Failing
- Unit for Biomathematics and Data Processing, Faculty of Veterinary Medicine, Justus Liebig University Giessen, Frankfurter Str. 95, 35390 Giessen, Germany
| | - J Vogelsberg
- Institute of Veterinary-Anatomy, -Histology and -Embryology, Faculty of Veterinary Medicine, Justus Liebig University Giessen, Frankfurter Str. 98, 35390 Giessen, Germany
| | - C Staszyk
- Institute of Veterinary-Anatomy, -Histology and -Embryology, Faculty of Veterinary Medicine, Justus Liebig University Giessen, Frankfurter Str. 98, 35390 Giessen, Germany.
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Batsis M, Dagalakis U, Stratakis CA, Prodanov T, Papadakis GZ, Adams K, Lodish M, Pacak K. Attention Deficit Hyperactivity Disorder in Pediatric Patients with Pheochromocytoma and Paraganglioma. Horm Metab Res 2016; 48:509-13. [PMID: 27171833 PMCID: PMC7441823 DOI: 10.1055/s-0042-106725] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The aim of the study is to evaluate if there is an association between attention deficit hyperactivity disorder (ADHD) and the diagnosis of pheochromocytoma/paraganglioma (PHEO/PGL) in pediatric patients. A case series study of 43 patients under the age of 18 with PHEO/PGL tumors who were evaluated at the National Institute of Health between January 2006 and May 2014 is reported. Prior diagnosis of ADHD and treatment course with stimulant medications was recorded. Patient symptoms, catecholamine and metanephrine levels, tumor characteristics, and genetic analyses for syndromes associated with PHEO/PGL were evaluated. A chi-squared test was used to assess the prevalence of ADHD in the PHEO/PGL patients compared to the general population. Nine out of 43 (21%) of patients diagnosed with PHEO/PGL had been diagnosed with ADHD prior to tumor identification. Four of the 9 patients had been treated with amphetamine, dextroamphetamine, and/or methylphenidate, potentially exacerbating an adrenergic crisis. In addition, 4 patients exhibited hypertension at the initial diagnosis of their PHEO/PGL. Three patients had resolution of their ADHD symptoms after successful surgical removal of PHEO/PGL. Our study found a prevalence of ADHD in 21% of our PHEO/PGL patients, significantly higher than 7.2% seen in the general pediatric population. Symptoms of anxiety and difficulty in concentration in these patients may have been related to their underlying PHEO/PGL and were not recognized as part of the constellation of symptoms in a child with PHEO/PGL. In pediatric patients with hypertension and ADHD symptomatology, an evaluation to rule out PHEO/PGL is warranted prior to treatment with stimulant medications.
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Affiliation(s)
- M. Batsis
- Section on Endocrinology and Genetics, Program on Developmental Endocrinology and Genetics & Pediatric Endocrinology Inter-Institute Training Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - U. Dagalakis
- Section on Endocrinology and Genetics, Program on Developmental Endocrinology and Genetics & Pediatric Endocrinology Inter-Institute Training Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
- Albany Medical College, Albany, NY, USA
| | - C. A. Stratakis
- Section on Endocrinology and Genetics, Program on Developmental Endocrinology and Genetics & Pediatric Endocrinology Inter-Institute Training Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - T. Prodanov
- Program on Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - G. Z. Papadakis
- Department of Radiology and Imaging Sciences, Clinical Center (CC), National Institutes of Health (NIH), Bethesda, MD, USA
| | - K. Adams
- Program on Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - M. Lodish
- Section on Endocrinology and Genetics, Program on Developmental Endocrinology and Genetics & Pediatric Endocrinology Inter-Institute Training Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - K. Pacak
- Program on Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
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Encarnação P, Leite T, Nunes C, Nunes da Ponte M, Adams K, Cook A, Caiado A, Pereira J, Piedade G, Ribeiro M. Using assistive robots to promote inclusive education. Disabil Rehabil Assist Technol 2016; 12:352-372. [PMID: 27115833 DOI: 10.3109/17483107.2016.1167970] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE This paper describes the development and test of physical and virtual integrated augmentative manipulation and communication assistive technologies (IAMCATs) that enable children with motor and speech impairments to manipulate educational items by controlling a robot with a gripper, while communicating through a speech generating device. METHOD Nine children with disabilities, nine regular and nine special education teachers participated in the study. Teachers adapted academic activities so they could also be performed by the children with disabilities using the IAMCAT. An inductive content analysis of the teachers' interviews before and after the intervention was performed. RESULTS Teachers considered the IAMCAT to be a useful resource that can be integrated into the regular class dynamics respecting their curricular planning. It had a positive impact on children with disabilities and on the educational community. However, teachers pointed out the difficulties in managing the class, even with another adult present, due to the extra time required by children with disabilities to complete the activities. CONCLUSIONS The developed assistive technologies enable children with disabilities to participate in academic activities but full inclusion would require another adult in class and strategies to deal with the additional time required by children to complete the activities. Implications for Rehabilitation Integrated augmentative manipulation and communication assistive technologies are useful resources to promote the participation of children with motor and speech impairments in classroom activities. Virtual tools, running on a computer screen, may be easier to use but further research is needed in order to evaluate its effectiveness when compared to physical tools. Full participation of children with motor and speech impairments in academic activities using these technologies requires another adult in class and adequate strategies to manage the extra time the child with disabilities may require to complete the activities.
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Affiliation(s)
- P Encarnação
- a UCP - Católica Lisbon School of Business & Economics , Lisbon , Portugal
| | - T Leite
- b School of Education , Lisbon Polytechnic Institute , Lisbon , Portugal
| | - C Nunes
- b School of Education , Lisbon Polytechnic Institute , Lisbon , Portugal
| | - M Nunes da Ponte
- c Calouste Gulbenkian Rehabilitation Center for Cerebral Palsy , Lisbon , Portugal
| | - K Adams
- d Faculty of Rehabilitation Medicine , University of Alberta , Edmonton , AB , Canada.,e Glenrose Rehabilitation Hospital , Edmonton , AB , Canada
| | - A Cook
- d Faculty of Rehabilitation Medicine , University of Alberta , Edmonton , AB , Canada
| | - A Caiado
- c Calouste Gulbenkian Rehabilitation Center for Cerebral Palsy , Lisbon , Portugal
| | - J Pereira
- c Calouste Gulbenkian Rehabilitation Center for Cerebral Palsy , Lisbon , Portugal
| | - G Piedade
- a UCP - Católica Lisbon School of Business & Economics , Lisbon , Portugal
| | - M Ribeiro
- a UCP - Católica Lisbon School of Business & Economics , Lisbon , Portugal
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Broom J, Broom A, Adams K, Plage S. What prevents the intravenous to oral antibiotic switch? A qualitative study of hospital doctors' accounts of what influences their clinical practice. J Antimicrob Chemother 2016; 71:2295-9. [PMID: 27121400 DOI: 10.1093/jac/dkw129] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 03/18/2016] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Escalating antimicrobial resistance worldwide necessitates urgent optimization of antimicrobial prescribing to preserve antibiotics for future generations. Early intravenous (iv) to oral switch campaigns are one strategy that hospital-based antimicrobial stewardship programmes can incorporate to minimize inappropriate antibiotic use. Yet, iv antibiotics continue to be offered for longer than is clinically indicated, increasing hospital length of stay, increasing costs and placing patients at risk (e.g. cannula-related infections). This study aims to identify why this inappropriate prescribing trend continues. METHODS Twenty doctors (9 females and 11 males) working at a teaching hospital in north-east England participated in semi-structured interviews about their experiences of antibiotic use. NVivo10 software was used to conduct a thematic content analysis of the full interview transcripts driven by the framework approach. Results are reported according to COREQ guidelines. RESULTS Decisions around the choice of iv over oral antibiotics were influenced by three key issues: (i) consumerism, i.e. participants were concerned about the risk of litigation or complaints if patient expectations were not met; (ii) hierarchy of the medical team structure limited opportunities for de-escalation of antibiotics; and (iii) iv antibiotics were perceived as more potent and having significant mythical qualities, which participants acknowledged were not necessarily evidence based. CONCLUSIONS The iv to oral switch interventions should tailor strategies to demystify iv versus oral antibiotic efficacy, engage consumers around the negative effects of iv antibiotic overuse and examine strategies to streamline team decision-making. Addressing these issues has the potential to reduce inappropriate antibiotic use and resistance.
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Affiliation(s)
- Jennifer Broom
- Department of Medicine, Sunshine Coast Hospital and Health Service, PO Box 547, Nambour, QLD 5470, Australia The University of Queensland, Brisbane, QLD 4072, Australia
| | - Alex Broom
- School of Social Sciences, The University of New South Wales, Sydney, NSW 2052, Australia
| | - Kate Adams
- Hull and East Yorkshire NHS Trust, Kingston upon Hull HU3 2JZ, UK
| | - Stefanie Plage
- School of Social Sciences, The University of New South Wales, Sydney, NSW 2052, Australia
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Osinga TE, Xekouki P, Nambuba J, Faucz FR, de la Luz Sierra M, Links TP, Kema IP, Adams K, Stratakis CA, van der Horst-Schrivers ANA, Pacak K. SDH Subunit Mutation Status in Saliva: Genetic Testing in Patients with Pheochromocytoma. Horm Metab Res 2016; 48:247-50. [PMID: 26916530 DOI: 10.1055/s-0035-1569265] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Germline mutations occur in up to 30-40% of pheochromocytoma/paraganglioma, with mutations in the succinate dehydrogenase (SDH) subunits B (SDHB) and D (SDHD) being the most common. Blood samples are favored for obtaining high quality DNA, however, leukocytes can also be obtained by collecting saliva. The aim of this study was to determine whether SDHB and SDHD gene mutations in patients with pheochromocytoma/paraganglioma could be determined using a salivary sample. Paired blood and salivary samples were collected from 30 patients: 9 SDHB mutation positive, 13 with a SDHD mutation, and 8 without any SDHx mutations. The Oragene DISCOVER kit was used to collect and extract DNA from saliva. Blood DNA was extracted from EDTA blood samples. The DNA purification and concentration were measured by spectrophotometry. The 8 exons of SDHB and the 4 exons of SDHD were amplified and sequenced by PCR-based bidirectional Sanger sequencing. Total DNA yields from blood DNA were similar to those obtained from saliva DNA [mean (±SD) saliva vs. blood DNA concentration 514.6 (±580.8) ng/µl vs. 360.9 (±262.7) ng/µl; p=0.2)]. The purity of the saliva DNA samples was lower than that of blood [mean OD260/OD280 ratio 1.78 (±0.13) vs. 1.87 (±0.04); p=0.001, respectively], indicating more protein contamination in the saliva-extracted DNA. This study shows that salivary DNA collected from patients with pheochromocytoma/paraganglioma is a good alternative for extraction of genomic DNA for its high DNA concentration and acceptable purity and can be used as an alternative to blood derived DNA in screening for SDHB and SDHD mutations.
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Affiliation(s)
- T E Osinga
- Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, USA
| | - P Xekouki
- Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, USA
| | - J Nambuba
- Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, USA
| | - F R Faucz
- Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, USA
| | - M de la Luz Sierra
- Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, USA
| | - T P Links
- University of Groningen, Department of Endocrinology and Metabolic Diseases, University Medical Center Groningen, Groningen, The Netherlands
| | - I P Kema
- Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - K Adams
- Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, USA
| | - C A Stratakis
- Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, USA
| | - A N A van der Horst-Schrivers
- University of Groningen, Department of Endocrinology and Metabolic Diseases, University Medical Center Groningen, Groningen, The Netherlands
| | - K Pacak
- Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, USA
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Broom J, Broom A, Plage S, Adams K, Post JJ. Barriers to uptake of antimicrobial advice in a UK hospital: a qualitative study. J Hosp Infect 2016; 93:418-22. [PMID: 27130526 DOI: 10.1016/j.jhin.2016.03.011] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [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: 10/26/2015] [Accepted: 03/03/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND The role of infectious diseases (ID) and clinical microbiology (CM) in hospital settings has expanded in response to increasing antimicrobial resistance, leading to widespread development of hospital antimicrobial stewardship (AMS) programmes, the majority of which include antibiotic approval systems. However, inappropriate antibiotic use in hospitals continues, suggesting potential disjunctions between technical advice and the logics of antibiotic use within hospitals. AIM To examine the experiences of doctors in a UK hospital with respect to AMS guidance of antibiotic prescribing, and experiences of a verbal postprescription antibiotic approval process. METHODS Twenty doctors in a teaching hospital in the UK participated in semi-structured interviews about their experiences of antibiotic use and governance. NVivo10 software was used to conduct a thematic content analysis systematically. FINDINGS This study identified three key themes regarding doctors' relationships with ID/CM clinicians that shaped their antibiotic practices: (1) competing hierarchical influences limiting active consultation with ID/CM; (2) non-ID/CM consultants' sense of ownership over clinical decision-making and concerns about challenges to clinical autonomy; and (3) tensions between evidence-based practice and experiential-style learning. CONCLUSIONS This study illustrates the importance of examining relations between ID/CM and non-ID/CM clinicians in the hospital context, indicating that AMS models that focus exclusively on delivering advice rather than managing interprofessional relationships may be limited in their capacity to optimize antibiotic use. AMS and, specifically, antibiotic approval systems would likely be more effective if they incorporated time and resources for fostering and maintaining professional relationships.
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Affiliation(s)
- J Broom
- Department of Medicine, Sunshine Coast Hospital and Health Service, Nambour, QLD, Australia; School of Medicine, The University of Queensland, QLD, Australia.
| | - A Broom
- School of Social Sciences, The University of New South Wales, Sydney, NSW, Australia
| | - S Plage
- School of Social Sciences, The University of New South Wales, Sydney, NSW, Australia
| | - K Adams
- Department of Infectious Diseases, Hull and East Yorkshire NHS Trust, Kingston upon Hull, UK
| | - J J Post
- Department of Infectious Diseases, Prince of Wales Hospital and Prince of Wales Clinical School, The University of New South Wales, Sydney, NSW, Australia
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Kvasnovsky CL, Adams K, Sideris M, Laycock J, Haji AK, Haq A, Nunoo-Mensah J, Papagrigoriadis S. Elderly patients have more infectious complications following laparoscopic colorectal cancer surgery. Colorectal Dis 2016; 18:94-100. [PMID: 26331365 DOI: 10.1111/codi.13109] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [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: 01/05/2015] [Accepted: 05/11/2015] [Indexed: 02/08/2023]
Abstract
AIM Elderly patients may be at higher risk of postoperative complications, particularly infective, than younger patients. METHOD We prospectively followed 163 consecutive patients undergoing elective laparoscopic resection for cancer. We compared patients < 65, 65-80 and > 80 years of age at the time of surgery. RESULTS Seventy (42.9%) patients had no complication; 93 (57.1%) had at least one complication following surgery and in 20 (12.3%) this was major. There was no difference in major complications between the groups (P = 0.47). Patients over 65 years of age were more likely to have a complication of any severity [< 65 years, 39.3%; 65-80 years, 69.3%; and > 80 years, 63.0% (P = 0.002)]. The frequency of gastrointestinal complications (30.1%) was similar in the groups (P = 0.29), as was wound infection (25.2%) (P = 0.65). There was an increase in the frequency of infectious complications, especially chest infection, with age, from 14.8% in patients < 65 years, to 22.7% in patients 65-80 years, to 44.4% in patients > 80 years (P = 0.01). Multivariate analysis showed no increase in overall complications in elderly patients, but Stage II or Stage III cancer (OR = 2.59, P = 0.04) and increasing body mass index (BMI) (OR = 1.07 for each unit increase in BMI, P = 0.04) were related to complications. Age remained the only predictor of an infective complication on multivariate analysis. Patients > 80 years of age had 4.21 times the OR of an infective complication (P = 0.03). CONCLUSION Older patients are more susceptible to infective complications postoperatively, particularly chest complications. Surgeons should alter their practice to reduce morbidity, such as adopting protocols requiring early physiotherapy.
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Affiliation(s)
- C L Kvasnovsky
- Department of Colorectal Surgery, King's College Hospital, London, UK
| | - K Adams
- Department of Colorectal Surgery, King's College Hospital, London, UK
| | - M Sideris
- Department of Colorectal Surgery, King's College Hospital, London, UK
| | - J Laycock
- Department of Colorectal Surgery, King's College Hospital, London, UK
| | - A K Haji
- Department of Colorectal Surgery, King's College Hospital, London, UK
| | - A Haq
- Department of Colorectal Surgery, King's College Hospital, London, UK
| | - J Nunoo-Mensah
- Department of Colorectal Surgery, King's College Hospital, London, UK
| | - S Papagrigoriadis
- Department of Colorectal Surgery, King's College Hospital, London, UK
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Chetaille AL, Albert A, Adams K, Fortin P, Michou L. Diagnostics of CAPS in Quebec thanks to teaching program. Pediatr Rheumatol Online J 2015. [PMCID: PMC4597001 DOI: 10.1186/1546-0096-13-s1-p35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Seymour N, Rao C, Chishi I, Oke T, Siddiqui M, Adams K. Improving waiting times for abscess surgery: Experience from a complete audit cycle. Int J Surg 2015. [DOI: 10.1016/j.ijsu.2015.07.157] [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]
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Baysari MT, Adams K, Lehnbom EC, Westbrook JI, Day RO. iPad use at the bedside: a tool for engaging patients in care processes during ward rounds? Intern Med J 2015; 44:986-90. [PMID: 24989476 DOI: 10.1111/imj.12518] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 06/24/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Previous work has examined the impact of technology on information sharing and communication between doctors and patients in general practice consultations, but very few studies have explored this in hospital settings. AIMS To assess if, and how, senior clinicians use an iPad to share information (e.g. patient test results) with patients during ward rounds and to explore patients' and doctors' experiences of information sharing events. METHODS Ten senior doctors were shadowed on ward rounds on general wards during interactions with 525 patients over 77.3 h, seven senior doctors were interviewed and 180 patients completed a short survey. RESULTS Doctors reported that information sharing with patients is critical to the delivery of high-quality healthcare, but were not seen to use the iPad to share information with patients on ward rounds. Patients did not think the iPad had impacted on their engagement with doctors on rounds. Ward rounds were observed to follow set routines and patient interactions were brief. CONCLUSIONS Although the iPad potentially creates new opportunities for information sharing and patient engagement, the ward round may not present the most appropriate context for this to be done.
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Affiliation(s)
- M T Baysari
- Centre for Health Systems and Safety Research, University of New South Wales, Sydney, New South Wales, Australia; Department of Clinical Pharmacology and Toxicology, St Vincent's Hospital, Sydney, New South Wales, Australia
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Adams K, Greenbaum DS, Shaikh R, van Erp AM, Russell AG. Particulate matter components, sources, and health: Systematic approaches to testing effects. J Air Waste Manag Assoc 2015; 65:544-58. [PMID: 25947313 DOI: 10.1080/10962247.2014.1001884] [Citation(s) in RCA: 127] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
UNLABELLED Exposure to particulate matter (PM) is associated with adverse health outcomes. There has long been a question as to whether some components of the PM mixture are of greater public health concern than others so that the sources that emit the more toxic components could be controlled. In this paper, we describe the National Particle Component Toxicity (NPACT) initiative, a comprehensive research program that combined epidemiologic and toxicologic approaches to evaluate this critical question, partly relying on information from a national network of air quality monitors that provided data on speciated PM2.5 (PM with an aerodynamic diameter<2.5 μm) starting in 2000. We also consider the results of the NPACT program in the context of selected research on PM components and health in order to assess the current state of the field. Overall, the ambitious NPACT research program found associations of secondary sulfate and, to a somewhat lesser extent, traffic sources with health effects. Although this and other research has linked a variety of health effects to multiple groups of PM components and sources of PM, the collective evidence has not yet isolated factors or sources that would be closely and unequivocally more strongly related to specific health outcomes. If greater success is to be achieved in isolating the effects of pollutants from mobile and other major sources, either as individual components or as a mixture, more advanced approaches and additional measurements will be needed so that exposure at the individual or population level can be assessed more accurately. Enhanced understanding of exposure and health effects is needed before it can be concluded that regulations targeting specific sources or components of PM2.5 will protect public health more effectively than continuing to follow the current practices of targeting PM2.5 mass as a whole. IMPLICATIONS This paper describes a comprehensive epidemiologic and toxicologic research program to evaluate whether some components and sources of PM may be more toxic than others. This question is important for regulatory agencies in setting air quality standards to protect people's health. The results show that PM from coal and oil combustion and from traffic sources was associated with adverse health outcomes, but other components and sources could not definitively be ruled out. Thus, given current knowledge, the current practice of setting air quality standards for PM mass as a whole likely remains an effective approach to protecting public health.
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Affiliation(s)
- Kate Adams
- a Health Effects Institute , Boston , MA , USA
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Abstract
We present a case of an undifferentiated febrile illness in a 59-year-old man from East Yorkshire. He was initially treated for leptospirosis due to the fact that he had farm exposure and the findings of acute kidney injury (AKI), thrombocytopenia and a raised alanine transferase (ALT) on his initial blood results. Serology tests later proved him to have had another rodent-borne illness: hantavirus. An investigation by Public Health England (formerly known as Health Protection Agency) (PHE) went on to prove the presence of the same serotype of hantavirus in rats caught on the patient's property. After an initial deterioration, the patient made a relatively uneventful recovery and all his blood tests returned to normal levels.
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Affiliation(s)
- Kate Adams
- Department of Infection, Castle Hill Hospital, Cottingham, East Yorkshire, UK
| | - Lisa Jameson
- Rare and Imported Pathogens Laboratory, Salisbury, Wiltshire, UK
| | - Rolf Meigh
- Department of Infection, Castle Hill Hospital, Cottingham, East Yorkshire, UK
| | - Tim Brooks
- Rare and Imported Pathogens Laboratory, Salisbury, Wiltshire, UK
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Goedecke JH, Chorell E, Livingstone DEW, Stimson RH, Hayes P, Adams K, Dave JA, Victor H, Levitt NS, Kahn SE, Seckl JR, Walker BR, Olsson T. Glucocorticoid receptor gene expression in adipose tissue and associated metabolic risk in black and white South African women. Int J Obes (Lond) 2014; 39:303-11. [PMID: 24854429 DOI: 10.1038/ijo.2014.94] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Revised: 05/07/2014] [Accepted: 05/18/2014] [Indexed: 12/30/2022]
Abstract
BACKGROUND Black women have lower visceral adipose tissue (VAT) but are less insulin sensitive than white women; the mechanisms responsible are unknown. OBJECTIVE The study aimed to test the hypothesis that variation in subcutaneous adipose tissue (SAT) sensitivity to glucocorticoids might underlie these differences. METHODS Body fatness (dual energy X-ray absorptiometry) and distribution (computerized tomography), insulin sensitivity (SI, intravenous and oral glucose tolerance tests), and expression of 11β-hydroxysteroid dehydrogenase-1 (11HSD1), hexose-6-phosphate dehydrogenase and glucocorticoid receptor-α (GRα), as well as genes involved in adipogenesis and inflammation were measured in abdominal deep SAT, superficial SAT and gluteal SAT (GLUT) depots of 56 normal-weight or obese black and white premenopausal South African (SA) women. We used a combination of univariate and multivariate statistics to evaluate ethnic-specific patterns in adipose gene expression and related body composition and insulin sensitivity measures. RESULTS Although 11HSD1 activity and mRNA did not differ by ethnicity, GRα mRNA levels were significantly lower in SAT of black compared with white women, particularly in the GLUT depot (0.52±0.21 vs 0.91±0.26 AU, respectively, P<0.01). In black women, lower SAT GRα mRNA levels were associated with increased inflammatory gene transcript levels and abdominal SAT area, and reduced adipogenic gene transcript levels, VAT/SAT ratio and SI. Abdominal SAT 11HSD1 activity associated with increased VAT area and decreased SI in white, but not in black women. CONCLUSIONS In black SA women, downregulation of GRα mRNA levels with obesity and reduced insulin sensitivity, possibly via increased SAT inflammation, is associated with reduced VAT accumulation.
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Affiliation(s)
- J H Goedecke
- 1] Non-Communicable Disease Research Unit, South African Medical Research Council, Cape Town, South Africa [2] UCT/MRC Research Unit for Exercise Science and Sports Medicine, Department of Human Biology, Cape Town, South Africa
| | - E Chorell
- Department of Public Health and Clinical Medicine, Umeå University, Umea, Sweden
| | - D E W Livingstone
- Endocrinology Unit, University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, Scotland, UK
| | - R H Stimson
- Endocrinology Unit, University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, Scotland, UK
| | - P Hayes
- Divison of Surgery, Department of Plastic Surgery, University of Cape Town, Cape Town, South Africa
| | - K Adams
- Divison of Surgery, Department of Plastic Surgery, University of Cape Town, Cape Town, South Africa
| | - J A Dave
- Division of Diabetes and Endocrinology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - H Victor
- UCT/MRC Research Unit for Exercise Science and Sports Medicine, Department of Human Biology, Cape Town, South Africa
| | - N S Levitt
- Division of Diabetes and Endocrinology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - S E Kahn
- Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, VA Puget Sound Health Care System and University of Washington, Seattle, WA, USA
| | - J R Seckl
- Endocrinology Unit, University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, Scotland, UK
| | - B R Walker
- Endocrinology Unit, University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, Scotland, UK
| | - T Olsson
- Department of Public Health and Clinical Medicine, Umeå University, Umea, Sweden
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