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Wright M, Willmore S, Verma S, Omasta-Martin A, Sahota H, Prentice W, Stockley AJ, Finlay F, Verne J, Hudson B. Developing a generic business case for an advanced chronic liver disease support service. Frontline Gastroenterol 2024; 15:104-109. [PMID: 38486664 PMCID: PMC10935515 DOI: 10.1136/flgastro-2023-102530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 10/03/2023] [Indexed: 03/17/2024] Open
Abstract
Introduction Liver disease deaths are rising, but specialist palliative care services for hepatology are limited. Expansion across the NHS is required. Methods We surveyed clinicians, patients and carers to design an 'ideal' service. Using standard NHS tariffs, we calculated the cost of this service. In hospitals where specialist palliative care was available for liver disease, patient-level costs and bed utilisation in last year of life (LYOL) were compared between those seen by specialist palliative care before death and those not. Results The 'ideal' service was described. Costs were calculated as whole time equivalent for a minimal service, which could be scaled up. From a hospital with an existing service, patients seen by specialist palliative care had associated costs of £14 728 in LYOL, compared with £18 558 for those dying without. Savings more than balanced the costs of introducing the service. Average bed days per patient in LYOL were reduced (19.4 vs 25.7) also intensive care unit bed days (1.1 vs 1.8). Despite this, time from first admission in LYOL to death was similar in both groups (6 months for the specialist palliative care group vs 5 for those not referred). Conclusions We have produced a template business case for an 'ideal' advanced liver disease support service, which self-funds and saves many bed days. The model can be easily adapted for local use in other trusts. We describe the methodology for calculating patient-level costs and the required service size. We present a financially compelling argument to expand a service to meet a growing need.
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Affiliation(s)
- Mark Wright
- Hepatology, University Hospital Southampton, Southampton, Hampshire, UK
| | - Sarah Willmore
- Hepatology, University Hospital Southampton, Southampton, Hampshire, UK
| | - Sumita Verma
- Clinical and Experimental Medicine, Brighton and Sussex Medical School, Brighton, East Sussex, UK
- Gastroenterology and Hepatology, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | | | - Humraj Sahota
- Hepatology, University Hospital Southampton, Southampton, Hampshire, UK
| | - Wendy Prentice
- Department of Palliative Care Medicine, King's College Hospital NHS Foundation Trust, London, London, UK
| | - Amelia Jane Stockley
- Supportive and Palliative Care, Royal Devon and Exeter NHS Foundation Trust, Exeter, Devon, UK
| | - Fiona Finlay
- Palliative Care, Queen Elizabeth University Hospital Campus, Glasgow, UK
| | - Julia Verne
- Public Health, United Kingdom Department of Health and Social Care, London, UK
| | - Ben Hudson
- Hepatology, Royal Devon and Exeter NHS Foundation Trust, Exeter, Devon, UK
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Garcia-Rudolph A, Wright M, Cisek K, Garcia L, Cusso H, Sauri J, Opisso E. Return to work within a year after first stroke: blue and white collar workers comparison, predictors and causal mediation assessed during inpatient rehabilitation. Top Stroke Rehabil 2024:1-11. [PMID: 38375551 DOI: 10.1080/10749357.2024.2312640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 01/27/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND Most research focuses around impairments in body function and structure, with relatively only a small number exploring their social impact. OBJECTIVES 1) compare characteristics for individuals who before stroke were blue collar vs. white collar workers 2) identify clinical, functional, and job-related factors associated with return to work within 1 year after discharge 3) identify specific ADL individual items (assessed at rehabilitation discharge) as return to work predictors and 4) identify return to work causal mediators. METHODS Retrospective observational cohort study, analyzing adult patients with stroke admitted to rehabilitation between 2007 and 2021, including baseline Barthel Index (BI) and return to work assessments between 2008 and 2022. Kaplan-Meier survival curves and Cox proportional hazards were applied. Causal mediation analyses using 1000-bootstrapped simulations were performed. RESULTS A total of 802 individuals were included (14.6% returned to work), 53.6% blue-collar and 46.4% white-collar. Blue-collar workers showed significantly higher proportion of ischemic stroke, diabetes, dyslipidemia, and hypertension.Individuals not returning to work presented a higher proportion of blue collar, dominant side affected, aphasia, lower BI scores, and larger length of stay (LOS). Multivariable Cox proportional hazards identified age at injury, aphasia, hypertension, and total discharge BI score (C-Index = 0.74). Univariable Cox models identified three independent BI items at all levels of independence: bathing (C-Index = 0.58), grooming (C-Index = 0.56) and feeding (C-Index = 0.59). BI efficiency (gain/LOS) was a causal mediator. CONCLUSION Blue collar workers showed higher proportion of risk factors and comorbidities. Novel factors, predictors, and a return to work mediator were identified.
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Affiliation(s)
- Alejandro Garcia-Rudolph
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Mark Wright
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Katryna Cisek
- Information, Communication and Entertainment Research Institute, Technological University Dublin, Dublin, Ireland
| | - Loreto Garcia
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Hector Cusso
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Joan Sauri
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Eloy Opisso
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
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Basaula D, Hay B, Wright M, Hall L, Easdon A, McWiggan P, Yeo A, Ungureanu E, Kron T. Additive manufacturing of patient specific bolus for radiotherapy: large scale production and quality assurance. Phys Eng Sci Med 2024:10.1007/s13246-024-01385-1. [PMID: 38285272 DOI: 10.1007/s13246-024-01385-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 01/07/2024] [Indexed: 01/30/2024]
Abstract
Bolus is commonly used to improve dose distributions in radiotherapy in particular if dose to skin must be optimised such as in breast or head and neck cancer. We are documenting four years of experience with 3D printed bolus at a large cancer centre. In addition to this we review the quality assurance (QA) program developed to support it. More than 2000 boluses were produced between Nov 2018 and Feb 2023 using fused deposition modelling (FDM) printing with polylactic acid (PLA) on up to five Raise 3D printers. Bolus is designed in the radiotherapy treatment planning system (Varian Eclipse), exported to an STL file followed by pre-processing. After checking each bolus with CT scanning initially we now produce standard quality control (QC) wedges every month and whenever a major change in printing processes occurs. A database records every bolus printed and manufacturing details. It takes about 3 days from designing the bolus in the planning system to delivering it to treatment. A 'premium' PLA material (Spidermaker) was found to be best in terms of homogeneity and CT number consistency (80 HU +/- 8HU). Most boluses were produced for photon beams (93.6%) with the rest used for electrons. We process about 120 kg of PLA per year with a typical bolus weighing less than 500 g and the majority of boluses 5 mm thick. Print times are proportional to bolus weight with about 24 h required for 500 g material deposited. 3D printing using FDM produces smooth and reproducible boluses. Quality control is essential but can be streamlined.
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Affiliation(s)
- Deepak Basaula
- Peter MacCallum Cancer Centre, Department of Physical Sciences, 305 Grattan Street, Melbourne, VIC, 3000, Australia
| | - Barry Hay
- Peter MacCallum Cancer Centre, Department of Radiation Engineering, Melbourne, Australia
| | - Mark Wright
- Peter MacCallum Cancer Centre, Department of Radiation Engineering, Melbourne, Australia
| | - Lisa Hall
- Peter MacCallum Cancer Centre, Department of Radiation Therapy, Melbourne, Australia
| | - Alan Easdon
- Peter MacCallum Cancer Centre, Department of Radiation Engineering, Melbourne, Australia
| | - Peter McWiggan
- Peter MacCallum Cancer Centre, Department of Radiation Engineering, Melbourne, Australia
| | - Adam Yeo
- Peter MacCallum Cancer Centre, Department of Physical Sciences, 305 Grattan Street, Melbourne, VIC, 3000, Australia
- School of Applied Sciences, RMIT University, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Elena Ungureanu
- Peter MacCallum Cancer Centre, Department of Physical Sciences, 305 Grattan Street, Melbourne, VIC, 3000, Australia
| | - Tomas Kron
- Peter MacCallum Cancer Centre, Department of Physical Sciences, 305 Grattan Street, Melbourne, VIC, 3000, Australia.
- School of Applied Sciences, RMIT University, Melbourne, Australia.
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, Australia.
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia.
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Tyson LD, Atkinson S, Hunter RW, Allison M, Austin A, Dear JW, Forrest E, Liu T, Lord E, Masson S, Nunes J, Richardson P, Ryder SD, Wright M, Thursz M, Vergis N. In severe alcohol-related hepatitis, acute kidney injury is prevalent, associated with mortality independent of liver disease severity, and can be predicted using IL-8 and micro-RNAs. Aliment Pharmacol Ther 2023; 58:1217-1229. [PMID: 37781965 PMCID: PMC10946848 DOI: 10.1111/apt.17733] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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] [Received: 08/14/2023] [Revised: 09/01/2023] [Accepted: 09/18/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND The prevalence, prediction and impact of acute kidney injury (AKI) in alcohol-related hepatitis (AH) is uncertain. AIMS We aimed to determine AKI incidence; association with mortality; evaluate serum biomarkers and the modifying effects of prednisolone and pentoxifylline in the largest AH cohort to date. METHODS Participants in the Steroids or Pentoxifylline for Alcoholic Hepatitis trial with day zero (D0) creatinine available were included. AKI was defined by modified International Club of Ascites criteria; incident AKI as day 7 (D7) AKI without D0-AKI. Survival was compared by Kaplan-Meier; mortality associations by Cox regression; associations with AKI by binary logistic regression; biomarkers by AUROC analyses. RESULTS D0-AKI was present in 198/1051 (19%) participants; incident AKI developed in a further 119/571 (21%) with available data. Participants with D0-AKI had higher 90-day mortality than those without (32% vs. 25%, p = 0.008), as did participants with incident AKI compared to those without D0-AKI or incident AKI (47% vs. 25%, p < 0.001). Incident AKI was associated with D90 mortality adjusted for age and discriminant function (AHR 2.15, 1.56-2.97, p < 0.001); D0-AKI was not. Prednisolone therapy reduced incident AKI (AOR 0.55, 0.36-0.85, p = 0.007) but not mortality. D0 bilirubin and IL-8 combined, miR-6826-5p, and miR-6811-3p predicted incident AKI (AUROCs 0.726, 0.821, 0.770, p < 0.01). CONCLUSIONS Incident AKI is associated with 90-day mortality independent of liver function. Prednisolone therapy was associated with reduced incident AKI. IL-8 and several miRNAs are potential biomarkers to predict AKI. Novel therapies to prevent incident AKI should be evaluated in AH to reduce mortality.
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Affiliation(s)
- Luke D. Tyson
- Department of Metabolism, Digestion and ReproductionImperial College LondonLondonUK
- The Liver UnitSt Mary's HospitalLondonUK
| | - Stephen Atkinson
- Department of Metabolism, Digestion and ReproductionImperial College LondonLondonUK
- The Liver UnitSt Mary's HospitalLondonUK
| | - Robert W. Hunter
- Centre for Cardiovascular ScienceUniversity of EdinburghEdinburghUK
| | - Michael Allison
- Cambridge NIHR Biomedical Research CentreAddenbrooke's HospitalCambridgeUK
| | | | - James W. Dear
- Centre for Cardiovascular ScienceUniversity of EdinburghEdinburghUK
| | - Ewan Forrest
- Department of HepatologyGlasgow Royal InfirmaryGlasgowUK
- University of GlasgowGlasgowUK
| | - Tong Liu
- Department of Metabolism, Digestion and ReproductionImperial College LondonLondonUK
| | - Emma Lord
- Department of Metabolism, Digestion and ReproductionImperial College LondonLondonUK
| | - Steven Masson
- Department of HepatologyNewcastle Freeman HospitalNewcastle upon TyneUK
| | | | - Paul Richardson
- Department of HepatologyThe Royal Liverpool University HospitalLiverpoolUK
| | - Stephen D. Ryder
- NIHR Nottingham Biomedical Research Centre at Nottingham University Hospitals NHS Trust and the University of NottinghamQueens Medical CentreNottinghamUK
| | - Mark Wright
- Department of HepatologyUniversity Hospital Southampton NHS Foundation TrustSouthamptonUK
| | - Mark Thursz
- Department of Metabolism, Digestion and ReproductionImperial College LondonLondonUK
- The Liver UnitSt Mary's HospitalLondonUK
| | - Nikhil Vergis
- Department of Metabolism, Digestion and ReproductionImperial College LondonLondonUK
- The Liver UnitSt Mary's HospitalLondonUK
- GSKBrentfordUK
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Nel D, McNamee L, Wright M, Alseidi AA, Cairncross L, Jonas E, Burch V. Competency Assessment of General Surgery Trainees: A Perspective From the Global South, in a CBME-Naive Context. J Surg Educ 2023; 80:1462-1471. [PMID: 37453897 DOI: 10.1016/j.jsurg.2023.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 05/30/2023] [Accepted: 06/18/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE Before proceeding with local implementation of competency-based medical education-related assessment practices designed and evaluated in the Global North, we sought to challenge the assumption that this would be perceived as both necessary and acceptable in our context where training and assessment is based on a traditional, knowledge-focused approach. The aim of this study was to determine the perspectives of general surgery trainees and consultants towards the assessment of competence, how this has been achieved previously, and how it should be performed in the future at the University of Cape Town (UCT), South Africa. DESIGN Semi-structured interviews were conducted with consultants and trainees. Interviews were transcribed and then analyzed using a Reflexive Thematic Analysis approach. SETTING AND PARTICIPANTS Ten consultants (5 senior and 5 junior) and 10 trainees (5 South African and 5 international) from the Division of General Surgery at UCT in August 2022. RESULTS Five unique themes were developed: (1) Assessment of competence is essential, (2) competence includes multiple domains of practice, (3) a surgeon must be able to operate, (4) previously used methods were inadequate to assess competence, and (5) frequent assessment with feedback is desired. The themes were considered in the context of Situated Learning Theory, particularly Communities of Practice and their role in the training for, and authentic assessment of, competence in general surgery trainees. CONCLUSIONS Participants described a need to develop and implement a new competency assessment program for general surgery training in this context, which is aligned with described competency-based medical education principles. Thoughtful integration of the formative and summative use of direct observation in the workplace, with a clear emphasis on procedural ability and the provision of high-quality feedback, may enhance the successful implementation of a strategy for competency-based assessment in general surgery training programs.
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Affiliation(s)
- D Nel
- Department of Surgery, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa.
| | - L McNamee
- Center for Higher Education Development, University of Cape Town, Cape Town, South Africa
| | - M Wright
- Department of Radiodiagnosis, Tygerberg Hospital, University of Stellenbosch, Cape Town, South Africa
| | - A A Alseidi
- Department of Surgery, University of California, San Francisco, California
| | - L Cairncross
- Department of Surgery, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - E Jonas
- Department of Surgery, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - V Burch
- Department of Medicine, Groote Schuur Hospital and University of Cape Town, and the Colleges of Medicine of South Africa, South Africa
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Rathee S, Steciw S, Warkentin B, Schultz B, Wright M, Oliver P. Comparison of a Pre-Trained AI Contouring Model to Unseen Institutional Data. Int J Radiat Oncol Biol Phys 2023; 117:e709-e710. [PMID: 37786076 DOI: 10.1016/j.ijrobp.2023.06.2206] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) To compare contours generated by a pre-trained, commercial AI model to those manually drawn in house. MATERIALS/METHODS Previously treated radiotherapy patients (N = 20 per site) for several sites (brain, head & neck, thorax, abdomen, pelvis) with approved structure sets were selected for this retrospective analysis. For the planning CT of each patient, a pre-trained AI model auto-contoured several OARS: bladder, brain, eyes, femurs, kidneys, lenses, mandible, and parotids, etc. A two-step rejection method filtered the results based on unmatched structure names (i.e., contours existing in only one of the two structure sets causing incorrect auto-matching of structure names by the comparison algorithm), and structures with different superior and/or inferior extents. From the remaining contours, DSC (Dice Similarity Coefficient) and HD95% (95th percentile of Hausdorff Distance) were calculated between auto and manually generated contours using vendor-supplied software; median values were then calculated. RESULTS The entire data set contained 592 structures at the on-set of analysis. After applying the rejection filters, the remaining data had 294 structures; a large portion of filtering was due to unmatched names. Out of these, OARs with contours from at least 10 patients (N>9) were further analyzed to include the 25th and 75th percentile for DSC and HD95%. Results from this analysis (structures with N>9) are presented in the table below, where results of left-right paired structures are combined into one row. The submandibular glands, larynx, and optical nerves (5 < N < 10) all had median DSC < 0.77 while lungs had median DSC > 0.98 (N = 6). Parotids and lenses had poor DSC and HD95% scores and may require significant contour editing to achieve agreement with our clinical conventions. This study highlights the difficulty with retrospective analysis of contours with an external trained model due to variations in the superior/inferior extent of tubular structures such as rectum, cord, esophagus, etc. CONCLUSION: Results are encouraging, given that the pre-trained commercial model has not seen our institutional data. The pre-trained AI contouring model matched very well to manual contours for large volume, higher contrast structures but did not match well for parotids and lenses. Variability in conventions regarding the superior/inferior extent of some structures hinders retrospective comparison with a pre-trained AI model.
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Affiliation(s)
- S Rathee
- University of Alberta, Edmonton, AB, Canada
| | - S Steciw
- University of Alberta, Edmonton, AB, Canada
| | | | - B Schultz
- University of Alberta, Edmonton, AB, Canada
| | - M Wright
- University of Alberta, Edmonton, AB, Canada
| | - P Oliver
- Nova Scotia Health, Halifax, NS, Canada
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Wright M, Body S, Lutman D. Management of diabetic ketoacidosis in children. BJA Educ 2023; 23:364-370. [PMID: 37600214 PMCID: PMC10433311 DOI: 10.1016/j.bjae.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 03/08/2023] [Indexed: 08/22/2023] Open
Affiliation(s)
| | - S. Body
- Barts Health NHS Trust, London, UK
| | - D. Lutman
- Great Ormond Street Hospital for Children NHS Trust, London, UK
- Royal London Hospital, London, UK
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Martinez Q, Okrouhlík J, Šumbera R, Wright M, Araújo R, Braude S, Hildebrandt TB, Holtze S, Ruf I, Fabre PH. Mammalian maxilloturbinal evolution does not reflect thermal biology. Nat Commun 2023; 14:4425. [PMID: 37479710 PMCID: PMC10361988 DOI: 10.1038/s41467-023-39994-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 07/07/2023] [Indexed: 07/23/2023] Open
Abstract
The evolution of endothermy in vertebrates is a major research topic in recent decades that has been tackled by a myriad of research disciplines including paleontology, anatomy, physiology, evolutionary and developmental biology. The ability of most mammals to maintain a relatively constant and high body temperature is considered a key adaptation, enabling them to successfully colonize new habitats and harsh environments. It has been proposed that in mammals the anterior nasal cavity, which houses the maxilloturbinal, plays a pivotal role in body temperature maintenance, via a bony system supporting an epithelium involved in heat and moisture conservation. The presence and the relative size of the maxilloturbinal has been proposed to reflect the endothermic conditions and basal metabolic rate in extinct vertebrates. We show that there is no evidence to relate the origin of endothermy and the development of some turbinal bones by using a comprehensive dataset of µCT-derived maxilloturbinals spanning most mammalian orders. Indeed, we demonstrate that neither corrected basal metabolic rate nor body temperature significantly correlate with the relative surface area of the maxilloturbinal. Instead, we identify important variations in the relative surface area, morpho-anatomy, and complexity of the maxilloturbinal across the mammalian phylogeny and species ecology.
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Affiliation(s)
- Quentin Martinez
- Institut des Sciences de l'Évolution (ISEM, UMR 5554 CNRS-IRD-UM), Université de Montpellier, Place E. Bataillon - CC 064 - 34095, Montpellier Cedex 5, Montpellier, France.
- Staatliches Museum für Naturkunde Stuttgart, DE-70191, Stuttgart, Germany.
| | - Jan Okrouhlík
- Department of Zoology, Faculty of Science, University of South Bohemia, 37005, České Budějovice, Czech Republic
| | - Radim Šumbera
- Department of Zoology, Faculty of Science, University of South Bohemia, 37005, České Budějovice, Czech Republic
| | - Mark Wright
- Institut des Sciences de l'Évolution (ISEM, UMR 5554 CNRS-IRD-UM), Université de Montpellier, Place E. Bataillon - CC 064 - 34095, Montpellier Cedex 5, Montpellier, France
- Department of Organismic and Evolutionary Biology & Museum of Comparative Zoology, Harvard University, Cambridge, MA, 02138, USA
| | - Ricardo Araújo
- Instituto de Plasmas e Fusão Nuclear, Instituto Superior Técnico, Universidade de Lisboa, Lisboa, Portugal
| | - Stan Braude
- Biology Department, Washington University, St. Louis, MO, 63130, USA
| | - Thomas B Hildebrandt
- Department of Reproduction Management, Leibniz-Instiute for Zoo and Wildlife Research, 10315, Berlin, Germany
- Faculty of Veterinary Medicine, Freie Universität, Berlin, Germany
| | - Susanne Holtze
- Department of Reproduction Management, Leibniz-Instiute for Zoo and Wildlife Research, 10315, Berlin, Germany
| | - Irina Ruf
- Abteilung Messelforschung und Mammalogie, Senckenberg Forschungsinstitut und Naturmuseum Frankfurt, 60325, Frankfurt am Main, Germany
| | - Pierre-Henri Fabre
- Institut des Sciences de l'Évolution (ISEM, UMR 5554 CNRS-IRD-UM), Université de Montpellier, Place E. Bataillon - CC 064 - 34095, Montpellier Cedex 5, Montpellier, France
- Mammal Section, Department of Life Sciences, The Natural History Museum, SW7 5DB, London, United Kingdom
- Institut Universitaire de France (IUF), Paris, France
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García-Rudolph A, Wright M, García L, Sauri J, Cegarra B, Tormos JM, Opisso E. Long-term prediction of functional independence using adjusted and unadjusted single items of the functional independence measure (FIM) at discharge from rehabilitation. J Spinal Cord Med 2023:1-12. [PMID: 36913541 DOI: 10.1080/10790268.2023.2183326] [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] [Indexed: 03/15/2023] Open
Abstract
CONTEXT Being able to survive in the long-term independently is of concern to patients with spinal cord injury (SCI), their relatives, and to those providing or planning health care, especially at rehabilitation discharge. Most previous studies have attempted to predict functional dependency in activities of daily living within one year after injury. OBJECTIVES (1) build 18 different predictive models, each model using one FIM (Functional Independence Measure) item, assessed at discharge, as independent predictor of total FIM score at chronic phase (3-6 years post-injury) (2) build three different predictive models, using in each model an item from a different FIM domain with the highest predictive power obtained in objective (1) to predict "good" functional independence at chronic phase and (3) adjust the 3 models from objective (2) with known confounding factors. METHODS This observational study included 461 patients admitted to rehabilitation between 2009 and 2019. We applied regression models to predict total FIM score and "good" functional independence (FIM motor score ≥ 65) reporting adjusted R2, odds ratios, ROC-AUC (95% CI) tested using 10-fold cross-validation. RESULTS The top three predictors, each from a different FIM domain, were Toilet (adjusted R2 = 0.53, Transfers domain), Toileting (adjusted R2 = 0.46, Self-care domain), and Bowel (adjusted R2 = 0.35, Sphincter control domain). These three items were also predictors of "good" functional independence (AUC: 0.84-0.87) and their predictive power increased (AUC: 0.88-0.93) when adjusted by age, paraplegia, time since injury, and length of stay. CONCLUSIONS Discharge FIM items accurately predict long-term functional independence.
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Affiliation(s)
- Alejandro García-Rudolph
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain.,Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Mark Wright
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain.,Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Loreto García
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain.,Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Joan Sauri
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain.,Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Blanca Cegarra
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain.,Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Josep Maria Tormos
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain.,Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Eloy Opisso
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain.,Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
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10
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Siegele-Brown C, Siegele-Brown M, Cook C, Khakoo SI, Parkes J, Wright M, Buchanan RM. Testing to sustain hepatitis C elimination targets in people who inject drugs: A network-based model. J Viral Hepat 2023; 30:242-249. [PMID: 36529668 DOI: 10.1111/jvh.13786] [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: 10/26/2022] [Accepted: 12/03/2022] [Indexed: 01/14/2023]
Abstract
Little is known about the level of testing required to sustain elimination of hepatitis C (HCV), once achieved. In this study, we model the testing coverage required to maintain HCV elimination in an injecting network of people who inject drugs (PWID). We test the hypothesis that network-based strategies are a superior approach to deliver testing. We created a dynamic injecting network structure connecting 689 PWID based on empirical data. The primary outcome was the testing coverage required per month to maintain prevalence at the elimination threshold over 5 years. We compared four testing strategies. Without any testing or treatment provision, the prevalence of HCV increased from the elimination threshold (11.68%) to a mean of 25.4% (SD 2.96%) over the 5-year period. To maintain elimination with random testing, on average, 4.96% (SD 0.83%) of the injecting network needs to be tested per month. However, with a 'bring your friends' strategy, this was reduced to 3.79% (SD 0.64%) of the network (p < .001). The addition of contact tracing improved the efficiency of both strategies. In conclusion, we report that network-based approaches to testing such as 'bring a friend' initiatives and contact tracing lower the level of testing coverage required to maintain elimination.
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Affiliation(s)
- Chloë Siegele-Brown
- Faculty of Medicine, University of Southampton, Southampton, UK.,University Hospital Southampton, Southampton, UK
| | | | - Charlotte Cook
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Salim I Khakoo
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Julie Parkes
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Mark Wright
- University Hospital Southampton, Southampton, UK
| | - Ryan M Buchanan
- Faculty of Medicine, University of Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, Southampton, UK
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11
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Cook C, Reid L, Smith S, Crockford D, El Sharkawy AM, McPherson S, Wright M, Radley A, Malik H, Keall S, Catt J, Shah S, Hampton H, Powell J, Morris D, Boothman H, Khakoo SI, Parkes J, Buchanan RM. I-COPTIC: Implementation of community pharmacy-based testing for hepatitis C: Delphi consensus protocol. Int J Pharm Pract 2022; 30:541-547. [PMID: 35997159 DOI: 10.1093/ijpp/riac064] [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: 11/30/2021] [Accepted: 07/22/2022] [Indexed: 01/26/2023]
Abstract
OBJECTIVE The World Health Organisation aims to eliminate Hepatitis C (HCV) by 2030. To achieve this, targeted testing needs to be widely available. Studies have demonstrated that community pharmacies can deliver effective targeted testing for HCV and the National Health Service in England has commissioned a national service. However, a recent survey of HCV operational delivery networks has shown limited uptake of this service. The objective of this protocol is to guide the formation of a consensus statement to facilitate the widespread implementation of community pharmacy-based targeted testing for HCV. METHOD We will use a modified Delphi method. A purposive selection of panel participants will be identified and recruited from a national survey and via chain-referral sampling. The main inclusion criteria for selection is direct involvement in the implementation of an HCV testing service in pharmacies. We aim for a heterogenous group, encompassing all aspects of the testing service. We will conduct a three round Delphi. The first round will consist of open questions which will be qualitatively analysed using thematic analysis with a framework method based on the WHO Health Systems Framework. This analysis will generate statements, that will be sent to the participants in the second round. A third round will be used where consensus is not reached. CONCLUSIONS The findings from this Delphi consensus study will facilitate the widespread implementation of targeted testing for HCV in community pharmacies.
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Affiliation(s)
| | | | | | | | - Deborah Crockford
- Hampshire & Isle of Wight LPC (operating as Community Pharmacy South Central) , Hampshire , UK
| | - Ahmed M El Sharkawy
- Liver Unit, Queen Elizabeth Hospital Birmingham , Birmingham , UK
- National Institute for Health Research, Birmingham Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust , Birmingham , UK
| | - Stuart McPherson
- Liver Unit, The Newcastle upon Tyne Hospitals NHS Foundation Trust , Newcastle upon Tyne , UK
- The Translational and Clinical Research Institute, Newcastle University , Newcastle upon Tyne , UK
| | - Mark Wright
- University Hospital Southampton NHS Foundation Trust , Southampton , UK
| | - Andrew Radley
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee , Dundee , UK
- Ninewells Hospital, NHS Tayside , Dundee , UK
| | | | | | - Janet Catt
- Kings College NHS Foundation Trust , London , UK
| | - Sital Shah
- Kings College NHS Foundation Trust , London , UK
| | | | - Julia Powell
- Community Pharmacy Surrey and Sussex , Surrey , UK
| | | | | | - Salim I Khakoo
- Faculty of Medicine, University of Southampton , Southampton , UK
| | - Julie Parkes
- Faculty of Medicine, University of Southampton , Southampton , UK
| | - Ryan M Buchanan
- Faculty of Medicine, University of Southampton , Southampton , UK
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12
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Chhabra P, On W, Paranandi B, Huggett MT, Robson N, Wright M, Maher B, Tehami N. Initial United Kingdom experience of endoscopic ultrasound-directed transgastric endoscopic retrograde cholangiopancreatography. Ann Hepatobiliary Pancreat Surg 2022; 26:318-324. [PMID: 36042580 PMCID: PMC9721259 DOI: 10.14701/ahbps.22-019] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 04/28/2022] [Accepted: 04/29/2022] [Indexed: 12/15/2022] Open
Abstract
Backgrounds/Aims Gallstone disease is a recognized complication of bariatric surgery. Subsequent management of choledocholithiasis may be challenging due to altered anatomy which may include Roux-en-Y gastric bypass (RYGB). We conducted a retrospective service evaluation study to assess the safety and efficacy of endoscopic ultrasound-directed transgastric endoscopic retrograde cholangiopancreatography (EDGE) in patients with RYGB anatomy. Methods All the patients who underwent EDGE for endoscopic retrograde cholangiopancreatography after RYGB at two tertiary care centers in the United Kingdom between January 2020 and October 2021 were included in the study. Clinical and demographic details were recorded for all patients. The primary outcome measures were technical and clinical success. Adverse events were recorded. Hot Axios lumen apposing metal stents measuring 20 mm in diameter and 10 mm in length were used in all the patients for creation of a gastro-gastric or gastro-jejunal fistula. Results A total of 14 patients underwent EDGE during the study period. The majority of the patients were female (85.7%) and the mean age of patients was 65.8 ± 9.8 years. Technical success was achieved in all but one patient at the first attempt (92.8%) and clinical success was achieved in 100% of the patients. Complications arose in 3 patients with 1 patient experiencing persistent fistula and weight gain. Conclusions In patients with RYGB anatomy, EDGE facilitated biliary access has a high rate of clinical success with an acceptable safety profile. Adverse events are uncommon and can be managed endoscopically.
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Affiliation(s)
- Puneet Chhabra
- Department of Gastroenterology, Calderdale and Huddersfield Foundation Trust, Huddersfield, United Kingdom
| | - Wei On
- Department of Gastroenterology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Bharat Paranandi
- Department of Gastroenterology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Matthew T. Huggett
- Department of Gastroenterology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Naomi Robson
- Biomedical Communications, University of Toronto, Toronto, Ontario, Canada
| | - Mark Wright
- Department of Interventional Endoscopy, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Ben Maher
- Department of Interventional Endoscopy, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Nadeem Tehami
- Department of Interventional Endoscopy, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom,Corresponding author: Nadeem Tehami, BSc, FRCP (London), FRCPS (Glasg), FEBGH, MRCP Gastroenterology Department of Interventional Endoscopy, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, United Kingdom Tel: +44-23-8077-7222, E-mail: ORCID: https://orcid.org/0000-0003-3042-6574
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13
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Aspinall RJ, Hudson M, Ryder SD, Richardson P, Farrington E, Wright M, Przemioslo RT, Perez F, Kent M, Henrar R, Hickey J, Shawcross DL. Real-world evidence of long-term survival and healthcare resource use in patients with hepatic encephalopathy receiving rifaximin-α treatment: a retrospective observational extension study with long-term follow-up (IMPRESS II). Frontline Gastroenterol 2022; 14:228-235. [PMID: 37056320 PMCID: PMC10086718 DOI: 10.1136/flgastro-2022-102221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 10/02/2022] [Indexed: 11/12/2022] Open
Abstract
ObjectiveTo describe survival of patients with hepatic encephalopathy (HE), up to 5 years after initiation of rifaximin-α (RFX) treatment.Design/MethodA retrospective, observational extension study within 9 National Health Service secondary/tertiary UK care centres. All patients had a clinical diagnosis of HE, were being treated with RFX and were included in the previous IMPRESS study which reported the 1-year experience. Demographics, clinical outcomes, selected cirrhosis-related complications, hospital admissions and attendances up to 5 years from RFX initiation were extracted from patient medical records and hospital electronic databases. The primary outcome measure was survival at 5 years post-initiation of RFX treatment.ResultsThe study included 138 patients. The survival rate at 5 years post-initiation of RFX was 35% (95% CI 28.2% to 44.4%) overall and 36% (95% CI 26.1% to 45.4%) for patients with alcohol-related liver disease. Median survival from RFX initiation was 2.8 years (95% CI 2.0 to 3.8; n=136). Among 48 patients alive at 5 years, 69% remained on RFX treatment at the end of the observation period, 74% reported no cirrhosis-related complications and 24% (9/37) had received a liver transplant. Between 1 and 5 years post-initiation, total numbers of liver-related emergency department visits, inpatient admissions, intensive care unit admissions and outpatient visits were 84, 194, 3 and 709, respectively; the liver-related 30-day readmission rate was 37%.ConclusionWithin UK clinical practice, RFX use in HE was associated with a 35% survival rate with high treatment adherence, 76% transplant-free survival rate, minimal healthcare resource and low rates of complications at 5 years post-initiation.
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Affiliation(s)
- Richard J Aspinall
- Department of Gastroenterology & Hepatology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Mark Hudson
- Formerly Liver Unit, Freeman Hospital, Newcastle upon Tyne, UK
| | - Stephen D Ryder
- NIHR Biomedical Research Unit in Gastrointestinal and Liver Diseases at Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
| | - Paul Richardson
- Department of Gastroenterology and Hepatology, Royal Liverpool & Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - Elizabeth Farrington
- Department of Gastroenterology & Hepatology, Royal Cornwall Hospital, Cornwall, UK
| | - Mark Wright
- Department of Hepatology, University Hospital Southampton, Southampton, UK
| | | | - Francisco Perez
- Department of Gastroenterology, University Hospital of North Durham, Durham, UK
| | - Melanie Kent
- Department of Gastroenterology, University Hospital of North Durham, Durham, UK
| | | | | | - Debbie L Shawcross
- Institute of Liver Studies, Inflammation Biology, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, UK
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14
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Bowman MJ, Bolam SM, Wright M. The effect of COVID-19 on orthopaedics in Aotearoa New Zealand-a survey of orthopaedic surgeons and training registrars. N Z Med J 2022; 135:50-58. [PMID: 36302242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
AIM This study aimed to assess the impact of COVID-19 on orthopaedic practice in New Zealand, with a focus on training and mental health. METHODS An online survey was sent to the 385 consultant orthopaedic surgeons and registrars in New Zealand registered with the New Zealand Orthopaedic Association (NZOA). The survey consisted of 27 questions relating to demographics, the effects of COVID-19 on orthopaedic departments, on training, on mental health and the utilisation of telehealth and online teaching. RESULTS In total, 189 of 385 NZOA members (49%) completed the survey. Of the 51 orthopaedic registrars surveyed, 55% felt that their training had been moderately affected, while 17% felt it had been significantly affected. Of those surveyed, 65% felt the pandemic had at least a mild effect on their mental health. Seven percent of registrars described a significant impact on their mental health compared to 2% of consultants (p=0.029). Overall, 46.5% felt they were more burnt out because of the pandemic, which was significantly higher in registrars compared to consultants (51% vs 44%, respectively; p=0.029). CONCLUSIONS Despite the comparatively low number of COVID-19 cases, hospitalisations and deaths, the effects for orthopaedic surgeons and training registrars have been significant.
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Affiliation(s)
- Matthew J Bowman
- Department of Orthopaedic Surgery, Hawkes Bay Fallen Soldiers Memorial Hospital, Camberley, Hastings, New Zealand
| | - Scott M Bolam
- Department of Orthopaedic Surgery, Auckland City Hospital, Grafton, Auckland; New Zealand; Faculty of Medical and Health Sciences, The University of Auckland, Grafton, Auckland, New Zealand
| | - Mark Wright
- Department of Orthopaedic Surgery, Auckland City Hospital, Grafton, Auckland, New Zealand
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15
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Reitegger F, Wright M, Gasteiger-Klicpera B. Digital health literacy and well-being of university students in Austria during the pandemic. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac129.710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Previous findings suggest that depressive and anxiety-related symptoms have doubled among students since the beginning of the pandemic. Digital health literacy can act as a protective resource to strengthen well-being.
Objectives
This paper analyzes the relationship between digital health literacy, socioeconomic status and well-being and future-anxiety among students in Austria.
Methods
480 students from Austrian higher education institutions were surveyed via online questionnaire during the second wave of the Corona pandemic. Sociodemographic data, students’ self-assessments of well-being, fears regarding future development and perspectives, and digital health literacy were collected. Variance and regression analyses were used for the evaluation.
Results
About 50% of the students reported low scores in well-being and distinct fears about the future. A higher socioeconomic status correlated with higher well-being as well as lower fears about the future.Regarding digital health literacy, the ability to assess the relevance of information showed the highest correlation with well-being.
Conclusions
Individual factors such as gender or the study-program are relevant for the interaction between well-being and digital health literacy. The assessment of the relevance of information and its connection with one's own life reality seems to be important factors in promoting well-being.
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Affiliation(s)
- F Reitegger
- Institute of Education Research &Teacher Education, University of Graz , Graz, Austria
| | - M Wright
- Research Center for Inclusive Education, University of Graz , Graz, Austria
| | - B Gasteiger-Klicpera
- Institute of Education Research &Teacher Education, University of Graz , Graz, Austria
- Research Center for Inclusive Education, University of Graz , Graz, Austria
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16
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Wren MWD, Petts D, Guthrie G, Clarke S, Nation BR, Peters L, Mortlock S, Sturdgess I, Wright M, Burt C. Pestilence, Plague and Pandemics: A Troubled History. Ulster Med J 2022; 91:143-151. [PMID: 36474849 PMCID: PMC9720592] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Humankind has lived with the danger of endemic, epidemic and pandemic disease for thousands of years. The effects of these outbreaks have often devastated human populations. Sixteen pandemic events causing an estimated 147 million deaths have occurred since the eighth century, The Black Death and the influenza pandemic of 1918-1920 probably having the greatest impact. Animal populations, both wild and domestic, have similarly suffered devastating outbreaks of disease which, on occasions, have translated into serious effects on human health. The deliberate or accidental introduction of animals into virgin areas has given rise to unforeseen disease events occasionally leading to extinction. Similarly, human intent or negligence and the vagaries of nature itself has resulted in ill health and loss of life. This paper describes the history of pandemics, epidemics and disasters, and the attempts to bring them under control.
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Affiliation(s)
| | | | | | | | - BR Nation
- Correspondence: Brian Nation CSci FIBMS,
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17
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Bateman J, Buckley A, Robertson S, Wright M, Smith R, Doak S, Clift M. P13-18 Exposure models of nitrogen dioxide and particulate matter to assess mechanistic toxicology within advanced alveolar models. Toxicol Lett 2022. [DOI: 10.1016/j.toxlet.2022.07.557] [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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Abbott R, Abe H, Acernese F, Ackley K, Adhikari N, Adhikari R, Adkins V, Adya V, Affeldt C, Agarwal D, Agathos M, Agatsuma K, Aggarwal N, Aguiar O, Aiello L, Ain A, Ajith P, Akutsu T, Albanesi S, Alfaidi R, Allocca A, Altin P, Amato A, Anand C, Anand S, Ananyeva A, Anderson S, Anderson W, Ando M, Andrade T, Andres N, Andrés-Carcasona M, Andrić T, Angelova S, Ansoldi S, Antelis J, Antier S, Apostolatos T, Appavuravther E, Appert S, Apple S, Arai K, Araya A, Araya M, Areeda J, Arène M, Aritomi N, Arnaud N, Arogeti M, Aronson S, Arun K, Asada H, Asali Y, Ashton G, Aso Y, Assiduo M, Melo SADS, Aston S, Astone P, Aubin F, AultONeal K, Austin C, Babak S, Badaracco F, Bader M, Badger C, Bae S, Bae Y, Baer A, Bagnasco S, Bai Y, Baird J, Bajpai R, Baka T, Ball M, Ballardin G, Ballmer S, Balsamo A, Baltus G, Banagiri S, Banerjee B, Bankar D, Barayoga J, Barbieri C, Barish B, Barker D, Barneo P, Barone F, Barr B, Barsotti L, Barsuglia M, Barta D, Bartlett J, Barton M, Bartos I, Basak S, Bassiri R, Basti A, Bawaj M, Bayley J, Mills J, Milotti E, Minenkov Y, Mio N, Mir L, Miravet-Tenés M, Mishkin A, Mishra C, Mishra T, Mistry T, Bazzan M, Mitra S, Mitrofanov V, Mitselmakher G, Mittleman R, Miyakawa O, Miyo K, Miyoki S, Mo G, Modafferi L, Moguel E, Becher B, Mogushi K, Mohapatra S, Mohite S, Molina I, Molina-Ruiz M, Mondin M, Montani M, Moore C, Moragues J, Moraru D, Bécsy B, Morawski F, More A, Moreno C, Moreno G, Mori Y, Morisaki S, Morisue N, Moriwaki Y, Mours B, Mow-Lowry C, Bedakihale V, Mozzon S, Muciaccia F, Mukherjee A, Mukherjee D, Mukherjee S, Mukherjee S, Mukherjee S, Mukund N, Mullavey A, Munch J, Beirnaert F, Muñiz E, Murray P, Musenich R, Muusse S, Nadji S, Nagano K, Nagar A, Nakamura K, Nakano H, Nakano M, Bejger M, Nakayama Y, Napolano V, Nardecchia I, Narikawa T, Narola H, Naticchioni L, Nayak B, Nayak R, Neil B, Neilson J, Belahcene I, Nelson A, Nelson T, Nery M, Neubauer P, Neunzert A, Ng K, Ng S, Nguyen C, Nguyen P, Nguyen T, Benedetto V, Quynh LN, Ni J, Ni WT, Nichols S, Nishimoto T, Nishizawa A, Nissanke S, Nitoglia E, Nocera F, Norman M, Beniwal D, North C, Nozaki S, Nurbek G, Nuttall L, Obayashi Y, Oberling J, O’Brien B, O’Dell J, Oelker E, Ogaki W, Benjamin M, Oganesyan G, Oh J, Oh K, Oh S, Ohashi M, Ohashi T, Ohkawa M, Ohme F, Ohta H, Okada M, Bennett T, Okutani Y, Olivetto C, Oohara K, Oram R, O’Reilly B, Ormiston R, Ormsby N, O’Shaughnessy R, O’Shea E, Oshino S, Bentley J, Ossokine S, Osthelder C, Otabe S, Ottaway D, Overmier H, Pace A, Pagano G, Pagano R, Page M, Pagliaroli G, BenYaala M, Pai A, Pai S, Pal S, Palamos J, Palashov O, Palomba C, Pan H, Pan KC, Panda P, Pang P, Bera S, Pankow C, Pannarale F, Pant B, Panther F, Paoletti F, Paoli A, Paolone A, Pappas G, Parisi A, Park H, Berbel M, Park J, Parker W, Pascucci D, Pasqualetti A, Passaquieti R, Passuello D, Patel M, Pathak M, Patricelli B, Patron A, Bergamin F, Paul S, Payne E, Pedraza M, Pedurand R, Pegoraro M, Pele A, Arellano FP, Penano S, Penn S, Perego A, Berger B, Pereira A, Pereira T, Perez C, Périgois C, Perkins C, Perreca A, Perriès S, Pesios D, Petermann J, Petterson D, Bernuzzi S, Pfeiffer H, Pham H, Pham K, Phukon K, Phurailatpam H, Piccinni O, Pichot M, Piendibene M, Piergiovanni F, Pierini L, Bersanetti D, Pierro V, Pillant G, Pillas M, Pilo F, Pinard L, Pineda-Bosque C, Pinto I, Pinto M, Piotrzkowski B, Piotrzkowski K, Bertolini A, Pirello M, Pitkin M, Placidi A, Placidi E, Planas M, Plastino W, Pluchar C, Poggiani R, Polini E, Pong D, Betzwieser J, Ponrathnam S, Porter E, Poulton R, Poverman A, Powell J, Pracchia M, Pradier T, Prajapati A, Prasai K, Prasanna R, Beveridge D, Pratten G, Principe M, Prodi G, Prokhorov L, Prosposito P, Prudenzi L, Puecher A, Punturo M, Puosi F, Puppo P, Bhandare R, Pürrer M, Qi H, Quartey N, Quetschke V, Quinonez P, Quitzow-James R, Raab F, Raaijmakers G, Radkins H, Radulesco N, Bhandari A, Raffai P, Rail S, Raja S, Rajan C, Ramirez K, Ramirez T, Ramos-Buades A, Rana J, Rapagnani P, Ray A, Bhardwaj U, Raymond V, Raza N, Razzano M, Read J, Rees L, Regimbau T, Rei L, Reid S, Reid S, Reitze D, Bhatt R, Relton P, Renzini A, Rettegno P, Revenu B, Reza A, Rezac M, Ricci F, Richards D, Richardson J, Richardson L, Bhattacharjee D, Riemenschneider G, Riles K, Rinaldi S, Rink K, Robertson N, Robie R, Robinet F, Rocchi A, Rodriguez S, Rolland L, Bhaumik S, Rollins J, Romanelli M, Romano R, Romel C, Romero A, Romero-Shaw I, Romie J, Ronchini S, Rosa L, Rose C, Bianchi A, Rosińska D, Ross M, Rowan S, Rowlinson S, Roy S, Roy S, Rozza D, Ruggi P, Ruiz-Rocha K, Ryan K, Bilenko I, Sachdev S, Sadecki T, Sadiq J, Saha S, Saito Y, Sakai K, Sakellariadou M, Sakon S, Salafia O, Salces-Carcoba F, Billingsley G, Salconi L, Saleem M, Salemi F, Samajdar A, Sanchez E, Sanchez J, Sanchez L, Sanchis-Gual N, Sanders J, Sanuy A, Bini S, Saravanan T, Sarin N, Sassolas B, Satari H, Sauter O, Savage R, Savant V, Sawada T, Sawant H, Sayah S, Birney R, Schaetzl D, Scheel M, Scheuer J, Schiworski M, Schmidt P, Schmidt 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Search for continuous gravitational wave emission from the Milky Way center in O3 LIGO-Virgo data. Int J Clin Exp Med 2022. [DOI: 10.1103/physrevd.106.042003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Gill CE, Mitchell PJ, Clark J, Cornish J, Fergusson P, Gilchrist N, Hayman L, Hornblow S, Kim D, Mackenzie D, Milsom S, von Tunzelmann A, Binns E, Fergusson K, Fleming S, Hurring S, Lilley R, Miller C, Navarre P, Pettett A, Sankaran S, Seow MY, Sincock J, Ward N, Wright M, Close JCT, Harris IA, Armstrong E, Hallen J, Hikaka J, Kerse N, Vujnovich A, Ganda K, Seibel MJ, Jackson T, Kennedy P, Malpas K, Dann L, Shuker C, Dunne C, Wood P, Magaziner J, Marsh D, Tabu I, Cooper C, Halbout P, Javaid MK, Åkesson K, Mlotek AS, Brûlé-Champagne E, Harris R. Experience of a systematic approach to care and prevention of fragility fractures in New Zealand. Arch Osteoporos 2022; 17:108. [PMID: 35917039 PMCID: PMC9344235 DOI: 10.1007/s11657-022-01138-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 07/05/2022] [Indexed: 02/03/2023]
Abstract
This narrative review describes efforts to improve the care and prevention of fragility fractures in New Zealand from 2012 to 2022. This includes development of clinical standards and registries to benchmark provision of care, and public awareness campaigns to promote a life-course approach to bone health. PURPOSE This review describes the development and implementation of a systematic approach to care and prevention for New Zealanders with fragility fractures, and those at high risk of first fracture. Progression of existing initiatives and introduction of new initiatives are proposed for the period 2022 to 2030. METHODS In 2012, Osteoporosis New Zealand developed and published a strategy with objectives relating to people who sustain hip and other fragility fractures, those at high risk of first fragility fracture or falls and all older people. The strategy also advocated formation of a national fragility fracture alliance to expedite change. RESULTS In 2017, a previously informal national alliance was formalised under the Live Stronger for Longer programme, which includes stakeholder organisations from relevant sectors, including government, healthcare professionals, charities and the health system. Outputs of this alliance include development of Australian and New Zealand clinical guidelines, clinical standards and quality indicators and a bi-national registry that underpins efforts to improve hip fracture care. All 22 hospitals in New Zealand that operate on hip fracture patients currently submit data to the registry. An analogous approach is ongoing to improve secondary fracture prevention for people who sustain fragility fractures at other sites through nationwide access to Fracture Liaison Services. CONCLUSION Widespread participation in national registries is enabling benchmarking against clinical standards as a means to improve the care of hip and other fragility fractures in New Zealand. An ongoing quality improvement programme is focused on eliminating unwarranted variation in delivery of secondary fracture prevention.
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Affiliation(s)
- Christine Ellen Gill
- Osteoporosis New Zealand, Wellington, New Zealand
- New Zealand Implementation and Management Committee, Australian and New Zealand Fragility Fracture Registry, Wellington, New Zealand
| | - Paul James Mitchell
- Osteoporosis New Zealand, Wellington, New Zealand.
- New Zealand Implementation and Management Committee, Australian and New Zealand Fragility Fracture Registry, Wellington, New Zealand.
- School of Medicine, University of Notre Dame Australia, Sydney Campus, 128-140 Broadway, Chippendale, Sydney, NSW, 2007, Australia.
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
- Fragility Fracture Network, c/o MCI Schweiz AG, Zürich, Switzerland.
| | - Jan Clark
- Osteoporosis New Zealand, Wellington, New Zealand
| | - Jillian Cornish
- Osteoporosis New Zealand, Wellington, New Zealand
- Bone and Joint Research Laboratory, Department of Medicine, University of Auckland, Auckland, New Zealand
- Australian and New Zealand Bone and Mineral Society, Sydney, Australia
| | | | - Nigel Gilchrist
- Osteoporosis New Zealand, Wellington, New Zealand
- CGM Research Trust, 40 Stewart Street, Christchurch, New Zealand
| | - Lynne Hayman
- Osteoporosis New Zealand, Wellington, New Zealand
| | - Sue Hornblow
- Osteoporosis New Zealand, Wellington, New Zealand
| | - David Kim
- Osteoporosis New Zealand, Wellington, New Zealand
- New Zealand Implementation and Management Committee, Australian and New Zealand Fragility Fracture Registry, Wellington, New Zealand
- Australian and New Zealand Bone and Mineral Society, Sydney, Australia
- Waitemata District Health Board, Auckland, New Zealand
| | - Denise Mackenzie
- Osteoporosis New Zealand, Wellington, New Zealand
- New Zealand Implementation and Management Committee, Australian and New Zealand Fragility Fracture Registry, Wellington, New Zealand
| | - Stella Milsom
- Osteoporosis New Zealand, Wellington, New Zealand
- Fertility Associates, Auckland, New Zealand
- Auckland District Health Board, Auckland, New Zealand
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | | | - Elizabeth Binns
- Faculty of Health and Environmental Sciences, AUT University, Auckland, New Zealand
- New Zealand Implementation and Management Committee, Australian and New Zealand Hip Fracture Registry, Wellington, New Zealand
- Physiotherapy New Zealand, Wellington, New Zealand
| | - Kim Fergusson
- New Zealand Implementation and Management Committee, Australian and New Zealand Fragility Fracture Registry, Wellington, New Zealand
- New Zealand Implementation and Management Committee, Australian and New Zealand Hip Fracture Registry, Wellington, New Zealand
- Fracture Liaison Network New Zealand, Wellington, New Zealand
- Fracture Liaison Service, Marlborough District Health Board, Nelson, Nelson, New Zealand
| | - Stewart Fleming
- New Zealand Implementation and Management Committee, Australian and New Zealand Fragility Fracture Registry, Wellington, New Zealand
- New Zealand Implementation and Management Committee, Australian and New Zealand Hip Fracture Registry, Wellington, New Zealand
- OperaIT Data Services, Logan, Queensland, Australia
| | - Sarah Hurring
- New Zealand Implementation and Management Committee, Australian and New Zealand Hip Fracture Registry, Wellington, New Zealand
- Older Persons' Health Specialist Service, Canterbury District Health Board, Christchurch, New Zealand
| | - Rebbecca Lilley
- New Zealand Implementation and Management Committee, Australian and New Zealand Hip Fracture Registry, Wellington, New Zealand
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Caroline Miller
- New Zealand Implementation and Management Committee, Australian and New Zealand Hip Fracture Registry, Wellington, New Zealand
| | - Pierre Navarre
- New Zealand Implementation and Management Committee, Australian and New Zealand Hip Fracture Registry, Wellington, New Zealand
- Southland Hospital, Invercargill, New Zealand
- University of Otago, Dunedin, New Zealand
- New Zealand Orthopaedic Association, Wellington, New Zealand
| | - Andrea Pettett
- New Zealand Implementation and Management Committee, Australian and New Zealand Hip Fracture Registry, Wellington, New Zealand
- New Zealand Orthopaedic Association, Wellington, New Zealand
| | - Shankar Sankaran
- Osteoporosis New Zealand, Wellington, New Zealand
- New Zealand Implementation and Management Committee, Australian and New Zealand Hip Fracture Registry, Wellington, New Zealand
| | - Min Yee Seow
- Waitemata District Health Board, Auckland, New Zealand
- New Zealand Implementation and Management Committee, Australian and New Zealand Hip Fracture Registry, Wellington, New Zealand
- Australian and New Zealand Society for Geriatric Medicine, Sydney, NSW, Australia
| | - Jenny Sincock
- New Zealand Implementation and Management Committee, Australian and New Zealand Hip Fracture Registry, Wellington, New Zealand
- Canterbury District Heath Board, Christchurch, New Zealand
| | - Nicola Ward
- New Zealand Implementation and Management Committee, Australian and New Zealand Fragility Fracture Registry, Wellington, New Zealand
- New Zealand Implementation and Management Committee, Australian and New Zealand Hip Fracture Registry, Wellington, New Zealand
- Bay of Plenty District Health Board, Tauranga, New Zealand
| | - Mark Wright
- New Zealand Implementation and Management Committee, Australian and New Zealand Hip Fracture Registry, Wellington, New Zealand
- New Zealand Orthopaedic Association, Wellington, New Zealand
- Department of Orthopaedic Surgery, Auckland City Hospital, Auckland, New Zealand
| | - Jacqueline Clare Therese Close
- Australian and New Zealand Hip Fracture Registry Steering Group, Sydney, Australia
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, NSW, Australia
- Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Ian Andrew Harris
- Australian and New Zealand Hip Fracture Registry Steering Group, Sydney, Australia
- Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, Faculty of Medicine, University of New South Wales, Liverpool, NSW, Australia
| | - Elizabeth Armstrong
- Australian Hip Fracture Registry, Neuroscience Research Australia, Sydney, NSW, Australia
- School of Population Health, University of New South Wales, Sydney, Australia
| | - Jamie Hallen
- Australian Hip Fracture Registry, Neuroscience Research Australia, Sydney, NSW, Australia
| | - Joanna Hikaka
- New Zealand Implementation and Management Committee, Australian and New Zealand Fragility Fracture Registry, Wellington, New Zealand
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Ngaire Kerse
- New Zealand Implementation and Management Committee, Australian and New Zealand Fragility Fracture Registry, Wellington, New Zealand
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Andrea Vujnovich
- New Zealand Implementation and Management Committee, Australian and New Zealand Fragility Fracture Registry, Wellington, New Zealand
- Auckland University of Technology, Auckland, New Zealand
| | - Kirtan Ganda
- Australian and New Zealand Fragility Fracture Registry Steering Group, Sydney, Australia
- Department of Endocrinology, Concord Hospital, Concord, NSW, Australia
- Concord Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Markus Joachim Seibel
- Australian and New Zealand Fragility Fracture Registry Steering Group, Sydney, Australia
- Bone Research Program, ANZAC Research Institute, Concord, NSW, Australia
- Faculty of Medicine and Health, Sydney Medical School at Concord Campus, The University of Sydney, Sydney, NSW, Australia
| | - Thomas Jackson
- New Zealand Implementation and Management Committee, Australian and New Zealand Hip Fracture Registry, Wellington, New Zealand
- Accident Compensation Corporation, Wellington, New Zealand
| | - Paul Kennedy
- Accident Compensation Corporation, Wellington, New Zealand
| | - Kirsten Malpas
- New Zealand Implementation and Management Committee, Australian and New Zealand Fragility Fracture Registry, Wellington, New Zealand
- Accident Compensation Corporation, Wellington, New Zealand
| | - Leona Dann
- New Zealand Implementation and Management Committee, Australian and New Zealand Fragility Fracture Registry, Wellington, New Zealand
- Health Quality & Safety Commission New Zealand, Wellington, New Zealand
| | - Carl Shuker
- Health Quality & Safety Commission New Zealand, Wellington, New Zealand
| | | | - Philip Wood
- Waitemata District Health Board, Auckland, New Zealand
- New Zealand Implementation and Management Committee, Australian and New Zealand Hip Fracture Registry, Wellington, New Zealand
- Ministry of Health, Wellington, New Zealand
| | - Jay Magaziner
- Fragility Fracture Network, c/o MCI Schweiz AG, Zürich, Switzerland
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - David Marsh
- Fragility Fracture Network, c/o MCI Schweiz AG, Zürich, Switzerland
| | - Irewin Tabu
- Fragility Fracture Network, c/o MCI Schweiz AG, Zürich, Switzerland
- Department of Orthopedics, University of the Philippines - Philippine General Hospital, Manila, Philippines
- Institute on Aging-National Institutes of Health, UP Manila, Manila, Philippines
| | - Cyrus Cooper
- International Osteoporosis Foundation, Nyons, Switzerland
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | | | - Muhammad Kassim Javaid
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- International Osteoporosis Foundation, Nyons, Switzerland
| | - Kristina Åkesson
- International Osteoporosis Foundation, Nyons, Switzerland
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Orthopaedics, Skåne University Hospital, Malmö, Sweden
| | | | | | - Roger Harris
- Osteoporosis New Zealand, Wellington, New Zealand
- New Zealand Implementation and Management Committee, Australian and New Zealand Fragility Fracture Registry, Wellington, New Zealand
- New Zealand Implementation and Management Committee, Australian and New Zealand Hip Fracture Registry, Wellington, New Zealand
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Fletcher C, Hefting N, Wright M, Bell J, Anzures-Cabrera J, Wright D, Lynggaard H, Schueler A. Marking 2-Years of New Thinking in Clinical Trials: The Estimand Journey. Ther Innov Regul Sci 2022; 56:637-650. [PMID: 35462609 PMCID: PMC9035309 DOI: 10.1007/s43441-022-00402-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 04/04/2022] [Indexed: 11/30/2022]
Abstract
The ICH E9(R1) addendum on Estimands and Sensitivity Analyses in Clinical Trials has introduced a new estimand framework for the design, conduct, analysis, and interpretation of clinical trials. We share Pharmaceutical Industry experiences of implementing the estimand framework in the first two years since the final guidance became available with key lessons learned and highlight what else needs to be done to continue the journey in embedding the estimand framework in clinical trials. Emerging best practices and points to consider on strategies for implementing a new estimand thinking process are provided. Whilst much of the focus of implementing ICH E9(R1) to date has been on defining estimands, we highlight some of the important aspects relating to the choice of statistical analysis methods and sensitivity analyses to ensure estimands can be estimated robustly with minimal bias. In particular, we discuss the implications if complete follow-up is not possible when the treatment policy strategy is being used to handle intercurrent events. ICH E9(R1) was introduced just before the start of the COVID-19 pandemic, but a positive outcome from the pandemic has been an acceleration in the adoption of the estimand framework, including differentiating intercurrent events related or not related to the pandemic. In summary, much has been learned on the estimand journey and continued sharing of case studies will help to further advance the understanding and increase awareness across all clinical researchers of the estimand framework.
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Affiliation(s)
- C Fletcher
- Biostatistics, GlaxoSmithKline Plc, Stevenage, United Kingdom.
| | - N Hefting
- Clinical Development, Psychiatry, H. Lundbeck A/S, Valby, Denmark
| | - M Wright
- Analytics, Novartis Pharma AG, Basel, Switzerland
| | - J Bell
- Clinical Operations, Elderbrook Solutions GmbH, High Wycombe, United Kingdom
| | - J Anzures-Cabrera
- Data Sciences, Roche Products Ltd, Welywn Garden City, United Kingdom
| | - D Wright
- Statistical Innovation, DS&AI, BioPharma R&D, AstraZeneca, Cambridge, United Kingdom
| | - H Lynggaard
- Biostatistics, Data Science, Novo Nordisk A/S, Bagsværd, Denmark
| | - A Schueler
- Biostatistics, Epidemiology & Medical Writing, Merck Healthcare KGaA, Darmstadt, Germany
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21
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Macken L, Corrigan M, Prentice W, Finlay F, McDonagh J, Rajoriya N, Salmon C, Donnelly M, Evans C, Ganai B, Bedlington J, Steer S, Wright M, Hudson B, Verma S. Palliative long-term abdominal drains for the management of refractory ascites due to cirrhosis: a consensus document. Frontline Gastroenterol 2022; 13:e116-e125. [PMID: 35812034 PMCID: PMC9234735 DOI: 10.1136/flgastro-2022-102128] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 05/15/2022] [Indexed: 02/06/2023] Open
Abstract
Palliative care remains suboptimal in advanced cirrhosis, in part relating to a lack of evidence-based interventions. Ascites remains the most common cirrhosis complication resulting in hospitalisation. Many patients with refractory ascites are not candidates for liver transplantation or transjugular intrahepatic portosystemic shunt, and therefore, require recurrent palliative large volume paracentesis in hospital. We review the available evidence on use of palliative long-term abdominal drains in cirrhosis. Pending results of a national trial (REDUCe 2) and consistent with recently published national and American guidance, long-term abdominal drains cannot be regarded as standard of care in advanced cirrhosis. They should instead be considered only on a case-by-case basis, pending definitive evidence. This manuscript provides consensus to help standardise use of long-term abdominal drains in cirrhosis including patient selection and community management. Our ultimate aim remains to improve palliative care for this under researched and vulnerable cohort.
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Affiliation(s)
- Lucia Macken
- Gastroenterology and Hepatology, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Margaret Corrigan
- Hepatology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Wendy Prentice
- Department of Palliative Care Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Fiona Finlay
- Palliative Medicine, Queen Elizabeth University Hospital Campus, Glasgow, UK
| | | | - Neil Rajoriya
- Liver Unit, Queen Elizabeth Hospital, Birmingham, UK
| | - Claire Salmon
- Hepatology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | | | - Bhaskar Ganai
- Gastroenterology and Hepatology, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | | | - Shani Steer
- Patient and Public involvement, Brighton, UK
| | - Mark Wright
- Hepatology, University Hospital Southampton, Southampton, UK
| | - Ben Hudson
- Hepatology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Sumita Verma
- Gastroenterology and Hepatology, University Hospitals Sussex NHS Foundation Trust, Brighton, UK,Clinical and Experimental Medicine, Brighton and Sussex Medical School, Brighton, UK
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22
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Wright M, Woodland H, Hudson B. Symptom control in advanced chronic liver disease: integrating anticipatory palliative and supportive care. Frontline Gastroenterol 2022; 13:e109-e115. [PMID: 35812032 PMCID: PMC9234743 DOI: 10.1136/flgastro-2022-102114] [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: 03/17/2022] [Accepted: 05/16/2022] [Indexed: 02/04/2023] Open
Abstract
The number of patients coming to hospital with liver disease is increasing. There was a worrying trend before the pandemic, and this has intensified. Despite improvements in the management of patients with advanced cirrhosis many patients will die within 6-12 months of first presentation, and, despite this, the field of palliative and supportive care in liver disease is still in its infancy. This is a narrative review. Evidence is often thin in this field. Where it exists it is cited, but much of the commentary here is based on the authors own experience and readers are free to consider it and debate it. Most patients who die of liver disease receive palliative care very late in their illness (if at all). There are many barriers to supportive and palliative care in liver disease which are discussed. Symptom control is often poor because of these barriers. Before symptomatic control can be established, patients in need of it must to be identified and conversations had about the severity of their situation and what their wishes would be. Interest in palliative and supportive care for patients liver disease is growing as is the number of hepatologists and palliative care clinicians within the UK with an interest. It is important that this enthusiasm and interest can be rolled out and scaled up across the UK so that all patients, wherever they are, can benefit. The aims of these articles are first to highlight and bring into focus the unmet need for palliative and supportive care in liver disease and second to provide suggestions for its integration into liver services. Ask yourself the question: where would I start in my hospital to help these patients?
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Affiliation(s)
- Mark Wright
- Hepatology, University Hospital Southampton, Southampton, UK
| | - Hazel Woodland
- Department of Gastroenterology, Salisbury District Hospital, Salisbury, UK
| | - Ben Hudson
- Hepatology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
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23
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Sim I, Razeghi O, Solis Lemus JA, Mukherjee R, O’hare D, O’neill L, Kotadia I, Roney CH, Wright M, Chiribiri A, Niederer S, O’neill M, Williams SE. Atrial tissue characterisation using electroanatomic voltage mapping and cardiac magnetic resonance imaging. Europace 2022. [DOI: 10.1093/europace/euac053.177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): British Heart Foundation
Background
Atrial voltage mapping and atrial cardiac magnetic resonance imaging are two contemporary methods for quantification of atrial fibrosis. However, the absence of a gold standard for measuring atrial fibrosis has precluded their direct comparison. Nevertheless, understanding the relative performance of voltage mapping and atrial late gadolinium enhancement for identification of atrial cardiomyopathy remains critical to correctly targeting clinical application of these techniques.
Purpose
To assess the relative performance of electroanatomic voltage mapping and atrial late gadolinium enhancement imaging using three surrogate markers chosen to distinguish pre-procedural utility (progression to recurrent atrial fibrillation following ablation) from potential utility for providing atrial fibrillation mechanistic insights (paroxysmal vs. persistent status of atrial fibrillation and relationship with co-morbidities associated with atrial fibrillation).
Methods
123 patients underwent atrial late gadolinium enhancement imaging and electroanatomic voltage mapping prior to atrial fibrillation ablation. Atrial late gadolinium enhancement imaging was assessed with CEMRG software and electroanatomic voltage mapping processed with OpenEP software using previously published thresholds. Low voltage tissue was defined at (1) <0.5mV, (2) <1.17mV, and (3) <1.3mV. Atrial fibrosis using late gadolinium enhancement was defined using four thresholds (1) signal intensity >3.3 standard deviations above the blood pool mean; (2) image intensity ratio (IIR) 1.2x blood pool mean; (3) IIR 1.32x blood pool mean; and (4) IIR 0.97x blood pool mean.
Results
Patients with persistent atrial fibrillation and those with CHA2DS2VaSc >2 had increased low voltage area for each of the thresholds tested, but there was no increase in atrial late gadolinium enhancement area at any of the imaging thresholds tested.
Increased atrial fibrosis using IIR>0.97 was independently associated with recurrence of atrial fibrillation (OR 1.05 (CI 1.01-1.09), p=0.009) in both univariate and multivariate analysis. Low voltage area <1.13mV and low voltage area <1.17mV were associated with increased risk of recurrence (OR 1.02 (CI 1.01-1.04), p=0.01, and OR 1.03 (CI 1.01-1.04), p=0.009) in univariate analysis but neither voltage threshold remained statistically significant in multivariate analysis controlling for clinical variables.
Conclusion
Increased fibrosis burden measured with atrial magnetic resonance imaging, but not with low voltage area, is independently associated with recurrence of atrial fibrillation following catheter ablation. However, increased low voltage area measured with electroanatomic mapping is associated with persistent atrial fibrillation status and CHADS2VaSc score. These findings support the use of magnetic resonance imaging for pre-procedure assessment and the use of electroanatomic mapping for intraprocedural mechanism-based assessment of atrial cardiomyopathy.
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Affiliation(s)
- I Sim
- Kings College London, Biomedical Engineering and Imaging Sciences, London, United Kingdom of Great Britain & Northern Ireland
| | - O Razeghi
- Kings College London, Biomedical Engineering and Imaging Sciences, London, United Kingdom of Great Britain & Northern Ireland
| | - JA Solis Lemus
- Kings College London, Biomedical Engineering and Imaging Sciences, London, United Kingdom of Great Britain & Northern Ireland
| | - R Mukherjee
- Kings College London, Biomedical Engineering and Imaging Sciences, London, United Kingdom of Great Britain & Northern Ireland
| | - D O’hare
- Kings College London, Biomedical Engineering and Imaging Sciences, London, United Kingdom of Great Britain & Northern Ireland
| | - L O’neill
- Kings College London, Biomedical Engineering and Imaging Sciences, London, United Kingdom of Great Britain & Northern Ireland
| | - I Kotadia
- Kings College London, Biomedical Engineering and Imaging Sciences, London, United Kingdom of Great Britain & Northern Ireland
| | - CH Roney
- Kings College London, Biomedical Engineering and Imaging Sciences, London, United Kingdom of Great Britain & Northern Ireland
| | - M Wright
- St Thomas’ Hospital, Cardiology, London, United Kingdom of Great Britain & Northern Ireland
| | - A Chiribiri
- Kings College London, Biomedical Engineering and Imaging Sciences, London, United Kingdom of Great Britain & Northern Ireland
| | - S Niederer
- Kings College London, Biomedical Engineering and Imaging Sciences, London, United Kingdom of Great Britain & Northern Ireland
| | - M O’neill
- Kings College London, Biomedical Engineering and Imaging Sciences, London, United Kingdom of Great Britain & Northern Ireland
| | - SE Williams
- University of Edinburgh, Edinburgh, United Kingdom of Great Britain & Northern Ireland
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Bolam SM, Munro L, Wright M. Poor compliance documenting informed consent in trauma patients with distal radius fractures compared to elective total knee arthroplasty. ANZ J Surg 2022; 92:1831-1838. [PMID: 35588267 PMCID: PMC9543849 DOI: 10.1111/ans.17781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 04/29/2022] [Accepted: 05/04/2022] [Indexed: 11/30/2022]
Abstract
Background The purpose of this study was (1) to evaluate the adequacy of informed consent documentation in the trauma setting for distal radius fracture surgery compared with the elective setting for total knee arthroplasty (TKA) at a large public hospital and (2) to explore the relevant guidelines in New Zealand relating to consent documentation. Methods Consecutive adult patients (≥16 years) undergoing operations for distal radius fractures and elective TKA over a 12‐month period in a single‐centre were retrospectively identified. All medical records were reviewed for the risks and complications recorded. The consent form was analysed using the Flesch Reading Ease Score (FRES) and the Simple Measure of Gobbledygook (SMOG) index readability scores. Results A total of 133 patients undergoing 134 operations for 135 distal radius fractures and 239 patients undergoing 247 TKA were included. Specific risks of surgery were recorded significantly less frequently for distal radius fractures than TKA (43.3% versus 78.5%, P < 0.001). Significantly fewer risks were recorded in the trauma setting compared to the elective (2.35 ± 2.98 versus 4.95 ± 3.33, P < 0.001). The readability of the consent form was 40.5 using the FRES and 10.9 using the SMOG index, indicating a university undergraduate level of reading. Conclusions This study has shown poor compliance in documenting risks of surgery during the informed consent process in an acute trauma setting compared to elective arthroplasty. Institutions must prioritize improving documentation of informed consent for orthopaedic trauma patients to ensure a patient‐centred approach to healthcare.
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Affiliation(s)
- Scott M Bolam
- Department of Orthopaedic Surgery, Auckland City Hospital, Auckland, New Zealand.,Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Leigh Munro
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Mark Wright
- Department of Orthopaedic Surgery, Auckland City Hospital, Auckland, New Zealand
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Vedantam S, Amin S, Maher B, Ahmad S, Kadir S, Niaz SK, Wright M, Tehami N. Increased ERCP volume improves cholangiogram interpretation: a new performance measure for ERCP training? Clin Endosc 2022; 55:426-433. [PMID: 35114744 PMCID: PMC9178142 DOI: 10.5946/ce.2021.239] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 10/26/2021] [Accepted: 11/08/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND/AIMS Cholangiogram interpretation is not used as a key performance indicator (KPI) of endoscopic retrograde cholangiopancreatography (ERCP) training, and national societies recommend different minimum numbers per annum to maintain competence. This study aimed to determine the relationship between correct ERCP cholangiogram interpretation and experience. METHODS One hundred fifty ERCPists were surveyed to appropriately interpret ERCP cholangiographic findings. There were three groups of 50 participants each: "Trainees," "Consultants group 1" (performed >75 ERCPs per year), and "Consultants group 2" (performed >100 ERCPs per year). RESULTS Trainees was inferior to Consultants groups 1 and 2 in identifying all findings except choledocholithiasis outside the intrahepatic duct on the initial or completion/occlusion cholangiogram. Consultants group 1 was inferior to Consultants group 2 in identifying Strasberg type A bile leaks (odds ratio [OR], 0.86; 95% confidence interval [CI], 0.77-0.96), Strasberg type B (OR, 0.84; 95% CI, 0.74-0.95), and Bismuth type 2 hilar strictures (OR, 0.81; 95% CI, 0.69-0.95). CONCLUSION This investigation supports the notion that cholangiogram interpretation improves with increased annual ERCP case volumes. Thus, a higher annual volume of procedures performed may improve the ability to correctly interpret particularly difficult findings. Cholangiogram interpretation, in addition to bile duct cannulation, could be considered as another KPI of ERCP training.
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Affiliation(s)
- Shyam Vedantam
- Department of Medicine, University of Miami, Miami, FL, USA
| | - Sunil Amin
- Division of Digestive Health and Liver Diseases, Department of Medicine, University of Miami, Miami, FL, USA
| | - Ben Maher
- Department of Interventional Radiology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Southampton Interventional Endoscopy Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Saqib Ahmad
- Department of Gastroenterology, Sherwood Forest Hospitals NHS Foundation Trust, Sutton in Ashfield, UK
| | - Shanil Kadir
- Department of Gastroenterology, Liaquat National Hospital and Medical College, Karachi, Pakistan
| | - Saad Khalid Niaz
- Interventional Endoscopy Unit, Surgical Unit 4, Dow University of Health Sciences, Karachi, Pakistan
| | - Mark Wright
- Southampton Interventional Endoscopy Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Nadeem Tehami
- Southampton Interventional Endoscopy Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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26
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Romano M, Alunni-Fabbroni M, Barbone G, Bartzsch S, Bouchet A, Bunk O, Dinkel J, Djonov V, Eckhardt A, Giannini C, Giese A, Hirner-Eppeneder H, Hlushchuk R, Jacques L, Laissue J, Miettinen A, Mittone A, Ricke J, Ruf V, Sancey L, Wright M, Bravin A, Coan P. Spacial Fractionation A MULTISCALE AND MULTI-TECHNIQUE APPROACH FOR THE CHARACTERIZATION OF THE EFFECTS OF SPATIALLY FRACTIONATED X-RAY FLASH IRRADIATION IN LUNGS AND BRAINS. Phys Med 2022. [DOI: 10.1016/s1120-1797(22)01549-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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27
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Chhabra P, Maher B, Trivedi D, Karavias D, Arshad A, Wright M, Tehami N. Management of infected post-pancreatic resection fluid collections under endoscopic ultrasound guidance using lumen apposing metal stent: A case series and review of the literature. Ann Hepatobiliary Pancreat Surg 2021; 25:500-508. [PMID: 34845122 PMCID: PMC8639308 DOI: 10.14701/ahbps.2021.25.4.500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 06/27/2021] [Accepted: 06/28/2021] [Indexed: 01/08/2023] Open
Abstract
Backgrounds/Aims Post-operative pancreatic fistulas (POPF) and fluid collections (POPFC) remain significant sources of morbidity and mortality after pancreatic resections. There remains a paucity of literature describing endoscopic ultrasound (EUS) guided drainage of POPFC using a Hot AXIOS™ lumen apposing metal stent (LAMS). Methods We conducted a retrospective study, encompassing all consecutive patients with POPFC managed using Hot AXIOS™ LAMS at our institution between January 2017 and December 2019. Primary outcome measures were technical and clinical success. Secondary outcome measures were adverse events and recurrence rates. Results Five patients underwent EUS guided drainage using Hot AXIOS™ LAMS during the study period. Mean age of patients was 67.8 ± 2.16 years. The majority (60.0%) of patients were males. Median duration of symptom onset after surgery was 9 days. All patients presented with abdominal pain. Median size of the collection measured on computed tomography was 91 mm. Median interval time between symptom onset and EUS drainage was 30 days. Two patients required percutaneous drainage prior to EUS guided drainage. Technical and clinical success were achieved for all patients. No adverse events were observed. Median duration of follow-up was 90 days. No recurrence of collection occurred during the follow-up period. Conclusions EUS guided drainage of POPFC using Hot AXIOS™ LAMS is a safe and effective treatment modality with technical and clinical success rates of 100% in our experience.
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Affiliation(s)
- Puneet Chhabra
- Department of Gastroenterology, Southampton General Hospital, Southampton, United Kingdom
| | - Ben Maher
- Department of Interventional Radiology, Southampton General Hospital, Southampton, United Kingdom
| | - Dharmadev Trivedi
- Department of Hepatobiliary and Pancreatic Surgery, Southampton General Hospital, Southampton, United Kingdom
| | - Dimitrios Karavias
- Department of Hepatobiliary and Pancreatic Surgery, Southampton General Hospital, Southampton, United Kingdom
| | - Ali Arshad
- Department of Hepatobiliary and Pancreatic Surgery, Southampton General Hospital, Southampton, United Kingdom
| | - Mark Wright
- Department of Gastroenterology, Southampton General Hospital, Southampton, United Kingdom
| | - Nadeem Tehami
- Department of Gastroenterology, Southampton General Hospital, Southampton, United Kingdom
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28
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Malaweera A, Jogi R, Wright M, O'Neill M, Williams S. A mixed-reality holographic viewing platform enabling interaction with 3D electroanatomical maps using the HoloLens. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Three dimensional (3D) electroanatomical maps (EAMs) created during electrophysiology procedures are traditionally displayed on 2D monitors connected to mapping systems. This has limitations, such as the lack of interaction with EAMs, the need for another user to control them, and the size of EAM displayed, which is limited by the resolution of these monitors. To overcome these, we created a novel technology to display EAMs on a mixed reality (MR) platform.
Methods
We used the Microsoft® HoloLens to create this MR platform. Studies from patients who had already undergone catheter ablation for atrial fibrillation, where EAMs of the left atria had been generated using different mapping systems (CARTO®, Rhythmia™ and EnSite Precision™) were utilised. These EAMs consisting of 3D coordinates and annotations (e.g. voltage & activation times) were exported from the mapping system. EAMs were then compiled and transferred to the HoloLens using custom-developed functions on Unity©, Microsoft® C# and VisualStudio. Subsequently, feedback was obtained from 3 independent electrophysiologists on this technology.
Results
We successfully exported the EAMs generated on CARTO®, Rhythmia™ and EnSite Precision™ mapping systems as holograms on to the HoloLens (Figure). Positive feedback included themes such as 1) the ability to use hand gestures and voice commands to interact with EAMs independent of another user unlike traditional cardiac mapping systems 2) offering an interactive 3D holographic experience whilst preserving the operators' physical interaction in the cardiac catheter lab 3) the capacity to better appreciate 3D geometry of EAMs in comparison to 2D monitors. The challenge of wearing a headset during long procedures was perceived as a disadvantage.
Conclusion
This technology, which can be used with any mapping system, is currently optimised for offline display. Our software will be made available as an opensource teaching and simulation tool. Users will be able to explore EAMs for research, planning complex cases and immersive learning. The future directions will include extending this toolkit for real-time cardiac mapping with catheter localisation, and could potentially be translated to other cardiac imaging modalities.
Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): Cardiovascular diseases charitable fund (CDCF) at Guy's and St Thomas' NHS Foundation Trust. Process of creating Holograms of EAMsVoltage map of left atrium as a Hologram
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Affiliation(s)
| | - R Jogi
- King's College London, London, United Kingdom
| | - M Wright
- St Thomas' Hospital, London, United Kingdom
| | - M O'Neill
- St Thomas' Hospital, London, United Kingdom
| | - S Williams
- St Thomas' Hospital, London, United Kingdom
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Wright M, Dietz B, Yip E, Yun J, Gabos Z, Fallone BG, Wachowicz K. Time domain principal component analysis for rapid, real-time 2D MRI reconstruction from undersampled data. Med Phys 2021; 48:6724-6739. [PMID: 34528275 DOI: 10.1002/mp.15238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 08/31/2021] [Accepted: 09/12/2021] [Indexed: 11/08/2022] Open
Abstract
PURPOSE A rapid real-time 2D accelerated method was developed for magnetic resonance imaging (MRI) using principal component analysis (PCA) in the temporal domain. This method employs a moving window of previous dynamic frames to reconstruct the current, real-time frame within this window. This technique could be particularly useful in real-time tracking applications such as in MR-guided radiotherapy, where low latency real-time reconstructions are essential. METHODS The method was tested retrospectively on 15 fully-sampled data sets of lung patient data acquired on a 3T Philips Achieva system. High frequency data are incoherently undersampled, while the central low-frequency data are always acquired to characterize the temporal fluctuations through PCA. The undersampling pattern is derived in such a way that all of k-space is acquired within a pre-determined number of frames. The missing data in the current frame are then filled in by fitting the temporal characterizations to the acquired undersampled data, using a pre-determined number of PCs. A subset of six patients was used to test the contour ability of the images. Various accelerations between 3x and 8x were tested along with the optimal number of PCs for fitting. A comparison was also performed with previous work from our group proposed by Dietz et al. as well as with a standard low resolution acquisition. In order to determine how the method would perform at lower signal to noise ratio (SNR), noise levels of 2×, 4×, and 6× were added to the 3T data. Metrics such as normalised mean square error and Dice coefficient were used to measure the reconstruction image quality and contour ability. RESULTS The proposed method demonstrated good temporal robustness as consistent metrics were detected for the duration of the imaging session. It was found that the optimal number of PCs for temporal fitting was dependent on the acceleration rate. For the data tested, five PCs were found to be optimal at the acceleration rates of 3× and 4×. This number decreases to three at accelerations of 5× and 6× and further decreases to two at an acceleration rate of 8×, likely due to greater instability with fewer acquired data points. The use of too many PCs for fitting increased the chances of noisy reconstruction which affected contourability. CONCLUSIONS The proposed 2D real-time MR acceleration method demonstrated greater robustness in the metrics over time when compared with previous real-time PCA methods using metrics such as normalised mean squared error, peak SNR and structural similarity up to an acceleration of 8x. Improved temporal robustness of image structure contourability and accurate definition was also demonstrated using several metrics including the Dice coefficient. Reconstruction of raw acquired data can be performed at approximately 50 ms per frame using an Intel core i5 CPU. The method has the advantage of being very flexible in terms of hardware requirements as it can operate successfully on a single coil channel and does not require specialized computing power to implement in real-time.
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Affiliation(s)
- Mark Wright
- Department of Oncology, University of Alberta, Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Bryson Dietz
- Department of Oncology, University of Alberta, Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Eugene Yip
- Department of Oncology, University of Alberta, Cross Cancer Institute, Edmonton, Alberta, Canada.,Department of Medical Physics, Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Jihyun Yun
- Department of Oncology, University of Alberta, Cross Cancer Institute, Edmonton, Alberta, Canada.,Department of Medical Physics, Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Zsolt Gabos
- Department of Oncology, University of Alberta, Cross Cancer Institute, Edmonton, Alberta, Canada
| | - B Gino Fallone
- Department of Oncology, University of Alberta, Cross Cancer Institute, Edmonton, Alberta, Canada.,Department of Medical Physics, Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Keith Wachowicz
- Department of Oncology, University of Alberta, Cross Cancer Institute, Edmonton, Alberta, Canada.,Department of Medical Physics, Cross Cancer Institute, Edmonton, Alberta, Canada
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Brown C, Siegele M, Wright M, Cook C, Parkes J, I Khakoo S, Sacks-Davis R, Buchanan RM. Injecting network structure determines the most efficient strategy to achieve Hepatitis C elimination in people who inject drugs. J Viral Hepat 2021; 28:1274-1283. [PMID: 34048117 DOI: 10.1111/jvh.13554] [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: 02/26/2021] [Revised: 04/05/2021] [Accepted: 05/16/2021] [Indexed: 12/09/2022]
Abstract
Transmission of Hepatitis C (HCV) continues via sharing of injection equipment between people who inject drugs (PWID). Network-based modelling studies have produced conflicting results about whether random treatment is preferable to targeting treatment at PWID with multiple partners. We hypothesise that differences in the modelled injecting network structure produce this heterogeneity. The study aimed to test how changing network structure affects HCV transmission and treatment effects. We created three dynamic injecting network structures connecting 689 PWID (UK-net, AUS-net and USA-net) based on published empirical data. We modelled HCV in the networks and at 5 years compared prevalence of HCV 1) with no treatment, 2) with randomly targeted treatment and 3) with treatment targeted at PWID with the most injecting partnerships (degree-based treatment). HCV prevalence at 5 years without treatment differed significantly between the three networks (UK-net (42.8%) vs. AUS-net (38.2%), p < 0.0001 and vs. USA-net (54.0%), p < 0.0001). In the treatment scenarios UK-net and AUS-net showed a benefit of degree-based treatment with a 5-year prevalence of 1.0% vs. 9.6% p < 0.0001 and 0.15% vs. 0.44%, p < 0.0001. USA-net showed no significant difference (29.3% vs. 29.2%, p = 0.0681). Degree-based treatment was optimised with low prevalence, moderate treatment coverage conditions whereas random treatment was optimised in low treatment coverage, high prevalence conditions. In conclusion, injecting network structure determines the transmission rate of HCV and the most efficient treatment strategy. In real-world injecting network structures, the benefit of targeting HCV treatment at individuals with multiple injecting partnerships may have been underestimated.
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Affiliation(s)
- Chloe Brown
- Faculty of Medicine, University of Southampton, Southampton, UK
| | | | - Mark Wright
- University Hospital Southampton, Southampton, UK
| | - Charlotte Cook
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Julie Parkes
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Salim I Khakoo
- Faculty of Medicine, University of Southampton, Southampton, UK
| | | | - Ryan M Buchanan
- Faculty of Medicine, University of Southampton, Southampton, UK
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Keane D, Glyde M, Dasgupta I, Gardiner C, Lindley E, Mitra S, Palmer N, Dye L, Wright M, Sutherland E. Patient perspectives of target weight management and ultrafiltration in haemodialysis: a multi-center survey. BMC Nephrol 2021; 22:188. [PMID: 34016069 PMCID: PMC8138996 DOI: 10.1186/s12882-021-02399-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 04/30/2021] [Indexed: 12/29/2022] Open
Abstract
Background Decisions around planned ultrafiltration volumes are the only part of the haemodialysis prescription decided upon at every session. Removing too much fluid or too little is associated with both acute symptoms and long-term outcomes. The degree to which patients engage with or influence decision-making is not clear. We explored patient perspectives of prescribing ultrafiltration volumes, their understanding of the process and engagement with it. Methods A questionnaire developed for this study was administered to 1077 patients across 10 UK Renal Units. Factor analysis reduced the dataset into factors representing common themes. Relationships between survey results and factors were investigated using regression models. ANCOVA was used to explore differences between Renal Units. Results Patients generally felt in control of their fluid management and that they were given the final say on planned ultrafiltration volumes. Around half of the respondents reported they take an active role in their treatment. However, respondents were largely unable to relate signs and symptoms to fluid management practice and a third said they would not report common signs and symptoms to clinicians. A fifth of patients reported not to know how ultrafiltration volumes were calculated. Patients responded positively to questions relating to healthcare staff, though with significant variation between units, highlighting differences in perception of care. Conclusions Despite a lack of formal acknowledgement in fluid management protocols, patients have significant involvement in decisions regarding fluid removal during dialysis. Furthermore, substantial gaps remain in patient knowledge and engagement. Formalizing the role of patients in these decisions, including patient education, may improve prescription and achievement of target weights. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-021-02399-7.
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Affiliation(s)
- David Keane
- Renal Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK. .,Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
| | - Megan Glyde
- School of Psychology, University of Leeds, Leeds, UK
| | - Indranil Dasgupta
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | | | - Sandip Mitra
- Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK.,Devices for Dignity, NIHR MedTech & In-vitro Diagnostics Co-operative, Sheffield, UK
| | | | - Louise Dye
- School of Psychology, University of Leeds, Leeds, UK
| | - Mark Wright
- Renal Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Ed Sutherland
- School of Psychology, University of Leeds, Leeds, UK
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Baffit M, Pang ES, Wright M, O’Keeffe M, Hertzog P. Interferon-Lambda: A Key Cytokine for Dendritic Cell Development? The Journal of Immunology 2021. [DOI: 10.4049/jimmunol.206.supp.111.26] [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] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Abstract
In light of the current pandemic, COVID-19, our understanding of how the immune system combats viral infection has become more important than ever. Interferons (IFNs) are an integral component of the immune system’s anti-viral response. While the functions of Type I Interferons have been extensively studied, the newest member of the Interferon family, Interferon-Lambda (IFN-λ), is yet to be fully investigated. Currently, it is believed that the canonical signalling pathway of the IFN-λ receptor (R, defined as IFN-λR1 and IL-10Rb) is shared with Type I IFN-αR signalling and leads to the transcription of Interferon Stimulated Genes (ISGs), key genes involved in antiviral immunity. However, there is a growing body of evidence that indicates that IFN-λR1 is involved in signalling pathways that differ to IFN-αR. Notably amongst this evidence is IFN-λR1’s restricted expression to epithelial and some haematopoietic cells as well as non-redundant roles being discovered at mucosal barriers. Building on novel preliminary data, this project seeks to differentiate IFN-λR1 signalling from this canonical pathway and determine whether other receptor chains are involved. Dendritic Cells (DCs), key mediators linking innate and adaptive immunity, are the focus of this project as they are major producers of IFN-λ and are also one of the few haematopoietic cells which express IFN-λR1. Using DCs, this project will investigate the signalling pathways regulated by IFN-λR1 and other potential pathways instigated by the interaction between IFN-λR1 and other receptors. Additionally, this work will focus on how IFN-λ signalling contributes to cellular function in the context of DC differentiation and development.
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Affiliation(s)
- Mariam Baffit
- 1Department of Biochemistry & Molecular Biology, Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
| | - Ee Shan Pang
- 1Department of Biochemistry & Molecular Biology, Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
| | - Mark Wright
- 2Department of Allergy, Immunology and Respiratory Medicine, The Alfred Hospital, Australia
| | - Meredith O’Keeffe
- 1Department of Biochemistry & Molecular Biology, Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
| | - Paul Hertzog
- 3Department of Molecular and Translational Science, Hudson Institute, Australia
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Pang ES, Daraj G, Macri C, Balka K, de Nardo D, Hochrein H, Masterman KA, Zhan Y, Kile B, Lawlor K, Radford K, Wright M, O’Keeffe M. Activation of stimulator of interferon genes in dendritic cells induces interferon-lambda and subset- and species-specific dendritic cell death. The Journal of Immunology 2021. [DOI: 10.4049/jimmunol.206.supp.111.28] [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] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Abstract
Stimulator of Interferon (IFN) Genes (STING), a cytosolic DNA sensor that recognises cyclic dinucleotides (CDNs), has been an adjuvant target in many cancer immunotherapies. Activation of STING results in the production of Type I IFN through the phosphorylation of TANK-binding kinase 1 (TBK1) and IFN regulatory factor 3 (IRF3) and it is thought this enhances cross-presentation of tumour antigens by dendritic cells (DCs). However, DCs interrogated in many of these studies use in vitro-generated DCs instead of putative ex vivo DCs, and the direct effects of STING activation on different DC subsets are not completely understood. Here, we report that mouse and humanised mouse splenic DC subsets as well as human blood DCs are activated by CDN stimulation and produce Type III IFN (IFN-lambda) but only type 2 conventional DCs (cDC2s) and plasmacytoid DCs (pDCs) produce Type I IFN in response to CDN stimulation. However, only mouse pDCs aberrantly express extremely high levels of CD86 and CD80 and are ablated rapidly after STING activation. Some DC death was also observed in mouse and human cDC2s, but not in human pDCs. This ablation is STING-dependent and occurs via a cell-intrinsic mechanism involving intrinsic apoptosis. These observations demonstrate the differential effects STING activation has on DC subsets as well as highlight a discordance amongst mouse and human DCs during activation, which serve as an important consideration in the translation of animal cancer models and the use of STING ligands as adjuvants in cancer immunotherapy.
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Affiliation(s)
- Ee Shan Pang
- 1Department of Biochemistry and Molecular Biology, Biomedicine Discovery Institute, Monash University, Australia
| | - Ghazal Daraj
- 2Mater Research Institute-The University of Queensland, Australia
| | - Christophe Macri
- 1Department of Biochemistry and Molecular Biology, Biomedicine Discovery Institute, Monash University, Australia
| | - Katherine Balka
- 3Department of Anatomy and Developmental Biology, Biomedicine Discovery Institute, Monash University, Australia
| | - Dominic de Nardo
- 3Department of Anatomy and Developmental Biology, Biomedicine Discovery Institute, Monash University, Australia
| | | | | | - Yifan Zhan
- 5The Walter and Eliza Hall Institute of Medical Research, Australia, Australia
- 6Department of Medical Biology, University of Melbourne, Australia
| | - Benjamin Kile
- 7Faculty of Health and Medical Sciences, The University of Adelaide, Australia
| | - Kate Lawlor
- 8Hudson Institute of Medical Research, Australia
| | - Kristen Radford
- 2Mater Research Institute-The University of Queensland, Australia
| | - Mark Wright
- 9Department of Allergy, Immunology and Respiratory Medicine, The Alfred Hospital, Australia
| | - Meredith O’Keeffe
- 1Department of Biochemistry and Molecular Biology, Biomedicine Discovery Institute, Monash University, Australia
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Matthews L, Irwin E, Ezuma P, Ibrahim I, Bates L, Thompson E, Wright M, Figueiredo R, Bury Y, Wilson C. O67: PERFUSATE GLUCOSE REFLECTS TISSUE GLYCOGENATION DURING LIVER PERFUSION. Br J Surg 2021. [DOI: 10.1093/bjs/znab117.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Introduction
Normothermic machine perfusion (NMP) is a method of organ preservation that aims to replicate the physiological environment, achieved by perfusing the livers with a blood-based perfusate at physiological inflow pressures and temperature. NMP also permits viability assessment through evaluation of the perfusate flow rates through the portal vein and hepatic artery. In addition to this, biochemical assessment and perfusate gas analysis can be performed to provide insights into the metabolic activity of the liver.
Method
Discarded human liver grafts (n=6), were perfused for 24 hours. Core biopsies and perfusate samples were taken from each liver at 5 distinct time intervals over 24 hours. Core biopsies were fixed and stained with periodic acid-Schiff and analysed with Leica software to provide a quantitative estimate of the hepatocellular glycogen content.
Result
Hepatic glycogen concentration rose during the first hour, followed by a steady decline thereafter until the end of perfusion. Contrary to our initial hypothesis that glucose concentration within the circuit would show an inverse relationship to glycogen stores in the liver cells, we found that glucose concentration closely followed the same trend.
Conclusion
Change in hepatocyte glycogen content provides an important insight into the synthetic function of a liver destined for transplant. Our research suggests that glucose concentration can be used as a surrogate marker for the synthetic function of a liver on NMP and provides valuable information on the glycogen-synthesising capability of the hepatocytes. In future, this could potentially aid the decision-making process with regards to liver graft transplant viability.
Take-home message
Perfusate glucose concentration could provide an insight into the viability of liver transplants
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Affiliation(s)
| | | | | | - I Ibrahim
- Newcastle University
- Freeman Hospital
| | | | | | | | | | - Y Bury
- Newcastle University
- Freeman Hospital
| | - C Wilson
- Newcastle University
- Freeman Hospital
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Yadollahi S, Buchannan R, Tehami N, Stacey B, Rahman I, Boger P, Wright M. Endoscopic management of intentional foreign body ingestion: experience from a UK centre. Frontline Gastroenterol 2021; 13:98-103. [PMID: 35300468 PMCID: PMC8862457 DOI: 10.1136/flgastro-2021-101776] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 03/24/2021] [Accepted: 03/26/2021] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE We report on the increasing incidence and outcomes from intentional foreign body ingestion (iFoBI) presenting to our hospital over a 5-year period. The aim was to assess the impact on services and to identify ways to safely mitigate against this clinical challenge. DESIGN/METHOD We performed a retrospective observational study of all patients presenting to a university hospital between January 2015 and April 2020 with iFoBI with a focus on objects swallowed, timing of endoscopy and clinical outcomes. RESULTS 239 episodes of iFoBI in 51 individuals were recorded with a significant increase in incidence throughout the study period (Welch (5, 17.3)=15.1, p<0.001), imposing a high burden on staff and resources. Items lodged in the oesophagus were more likely to lead to mucosal injury (p=0.009) compared with elsewhere. Ingested item type and timing of endoscopy were not related to complications (p=0.78) or length of stay (p=0.8). In 12% of cases, no objects were seen at endoscopy. CONCLUSION In all except those patients with oesophageal impaction of the object on radiograph, there is no need to perform endoscopic extraction out of hours. A subset of cases can avoid endoscopy with an X-ray immediately prior to the procedure as a significant proportion have passed already. We discuss more holistic approaches to deal with recurrent attendances.
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Affiliation(s)
- Sina Yadollahi
- Gastroenterology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Ryan Buchannan
- Gastroenterology, University Hospital Southampton NHS Foundation Trust, Southampton, UK,Faculty of Medicine, University of Southampton, Southampton, UK
| | - Nadeem Tehami
- Gastroenterology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Bernard Stacey
- Gastroenterology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Imbadhur Rahman
- Gastroenterology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Philip Boger
- Gastroenterology, Southampton General Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Mark Wright
- Hepatology, University Hospital Southampton, Southampton, Hampshire, UK
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Hughes L, Saxby E, Wright M. Tarsoconjunctival 'Hughes' flap for repair of globe perforation: A modified technique in the management of severe scleral necrosis. Eur J Ophthalmol 2021; 32:NP60-NP63. [PMID: 33765845 DOI: 10.1177/11206721211004401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We report an unusual case of scleral and lid necrosis from suspected self-harm and the management of the resultant scleral perforation with a tarsoconjunctival 'Hughes' flap. To our knowledge, no previous literature describes such a technique in the repair of toxic scleral melts. Our case describes an alternative use for a Hughes flap in providing tectonic support and helping to restore the integrity of the globe in a complex case where conventional methods of 'patching' had failed.
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Affiliation(s)
- Laura Hughes
- Ophthalmology Specialist Registrar, Princess Alexandra Eye Pavilion, Edinburgh, UK
| | - Ed Saxby
- Ophthalmology Specialist Registrar, Princess Alexandra Eye Pavilion, Edinburgh, UK
| | - Mark Wright
- Ophthalmology & Oculoplastic Consultant, Princess Alexandra Eye Pavilion, Edinburgh, UK
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Forrest E, Petts G, Austin A, Lloyd K, Wright M, Vergis N, Atkinson S, Masson S, Patch D, Quaglia A, Thursz M, Goldin R. The diagnostic and prognostic significance of liver histology in alcoholic hepatitis. Aliment Pharmacol Ther 2021; 53:426-431. [PMID: 33326633 DOI: 10.1111/apt.16157] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 07/31/2020] [Accepted: 10/23/2020] [Indexed: 12/09/2022]
Abstract
BACKGROUND Liver biopsy may be of diagnostic and prognostic value but its role in alcoholic hepatitis (AH) has been controversial. AIM To assess the utility of liver biopsy in the assessment of clinically severe AH METHODS: The histological features of alcoholic steatohepatitis (ASH) were recorded and scored in patients enrolled in the Steroids or Pentoxifylline for Alcoholic Hepatitis (STOPAH) trial who underwent liver biopsy. These features were then assessed relative to outcome and established clinical prognostic scores. RESULTS The STOPAH trial recruited 1068 patients; biopsies were obtained in 182 (17%). One hundred and sixty-one biopsies were adequate for histological assessment and 140 (87%) were diagnostic for ASH. Only three biopsies (2%) did not have histological features of alcohol-related liver injury. In biopsies performed prior to randomisation, ASH was identified in 92.5% of patients meeting clinical trial definitions of severe AH. In biopsies with ASH, taken before or within 48 hours of randomisation, survival differences between Alcoholic Hepatitis Histological Score (AHHS) groups were not significant: comparison of mild / moderate (91%: 21 of 23 patients) with severe (78%: 29 of 37 patients) groups: P = 0.18. The AHHS was not superior to clinical scores of prognosis: area under the curve for 28-day mortality was 0.728, compared with 0.799 for the Glasgow alcoholic hepatitis score and 0.728 for the MELD score. CONCLUSION Liver histology taken before treatment rarely changes the diagnosis in patients meeting strict criteria for a clinical diagnosis of AH. The AHHS is similar to clinical scores in determining prognosis. Clinical trial registration EudraCT reference number: 2009-013897-42. ISRCTN reference number: 88782125. MREC number: 09/MRE09/59. UKCRIN ID 9143.
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Affiliation(s)
- Ewan Forrest
- Glasgow Royal Infirmary and University of Glasgow, Glasgow, UK
| | | | | | | | - Mark Wright
- Southampton University NHS Trust, Southampton, UK
| | | | | | - Steven Masson
- Freeman Hospital Newcastle on Tyne, Newcastle upon Tyne, UK
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Siau K, Webster G, Wright M, Maher B, Stedman B, Johnson G, Ahmad S, Tehami N. Attitudes to radiation safety and cholangiogram interpretation in endoscopic retrograde cholangiopancreatography (ERCP): a UK survey. Frontline Gastroenterol 2020; 12:550-556. [PMID: 34917311 PMCID: PMC8640384 DOI: 10.1136/flgastro-2020-101521] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 10/01/2020] [Accepted: 11/18/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Fluoroscopy during endoscopic retrograde cholangiopancreatography (ERCP) exposes staff and patients to potentially harmful ionizing radiation. We performed a UK survey to explore trainee and trainer attitudes to radiation protection and cholangiogram interpretation in ERCP. METHODS An electronic 10-point survey was prospectively distributed to endoscopy unit leads, training programme directors between October and November 2019. Only UK-based ERCP trainees and trainers with hands-on procedural exposure were eligible for the survey. RESULTS The survey was completed by 107 respondents (58 trainees and 49 trainers), with an estimated overall response rate of 46%. Overall, 49% of respondents were up to date with their radiation protection course, 38% were aware of European Basic safety standards directive (BSSD), 38% wore radiation protection goggles, and 40% were aware of the average radiation screening dose per ERCP procedure. Compared with trainers, trainees were less likely to routinely wear thyroid protection shields (76% vs 92%; p=0.028), have awareness of the BSSD (20% vs 49%; p=0.037) or know their average procedural radiation dosages (21% vs 63%; p<0.001). With regard to cholangiogram interpretation, only 26% had received formal training, with 97% of trainees expressing a desire for further training. CONCLUSION This survey highlights a relative complacency in safety attitudes to radiation protection during ERCP. These data provide impetus to improve training and quality assurance in radiation protection, which should be regarded as a mandatory safety aspect prior to commencing hands-on ERCP training.
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Affiliation(s)
- Keith Siau
- Department of Gastroenterology, Dudley Group of Hospitals NHS Trust, Dudley, West Midlands, UK,Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - George Webster
- Department of Gastroenterology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Mark Wright
- Department of Hepatology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Ben Maher
- Department of Interventional Radiology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Brian Stedman
- Department of Interventional Radiology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Gavin Johnson
- Department of Gastroenterology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Saqib Ahmad
- Department of Gastroenterology, Sherwood Forest Hospitals NHS Foundation Trust, Sutton-In-Ashfield, Nottinghamshire, UK
| | - Nadeem Tehami
- Department of Gastroenterology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Abayomi JC, Charnley MS, Cassidy L, Mccann MT, Jones J, Wright M, Newson LM. A patient and public involvement investigation into healthy eating and weight management advice during pregnancy. Int J Qual Health Care 2020; 32:28-34. [PMID: 32022232 DOI: 10.1093/intqhc/mzz081] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 05/03/2019] [Accepted: 05/13/2019] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To conduct patient and public involvement (PPI) to gain insight into the experience of healthy eating and weight management advice during pregnancy. DESIGN PPI in the planning and development of health interventions, aiming to ensure patient-centred care. Optimum nutrition and weight management are vital for successful pregnancy outcomes, yet many services report poor attendance and engagement. SETTING Community venues in Liverpool and Ulster (UK). PARTICIPANTS Two PPI representatives were involved in all aspects of the study: design, interview questions, recruitment and collection/analysis of feedback. INTERVENTION Feedback was collected via note taking during group discussions, two in Liverpool (n = 10 & 5); two in Ulster (n = 7 & 9) and an interview (n = 1, in Ulster). MAIN OUTCOME MEASURES Transcript data were collated and thematic analysis was applied in analysis. RESULTS Thematic analysis identified three themes: (i) weight gain is inevitable in pregnancy; (ii) healthy eating advice is important but currently lacks consistency and depth and (iii) expectations regarding the type of knowledge/support. CONCLUSIONS PPI provides opportunity to enhance research design and offers valuable insight towards the needs of healthcare users. Pregnant women want positive health messages, with a focus on what they can/should do, rather than what they should not do. Midwives need to consider their communication with pregnant women, to ensure that their unique relationship is maintained, especially when the topics of diet and weight management are addressed. A well-designed digital intervention could improve access to pregnancy-specific nutrition information; empowering midwives to communicate patient-centred, healthy eating messages with confidence. This has the potential to change dietary and weight management behaviour in pregnant women.
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Affiliation(s)
- J C Abayomi
- Applied Health & Social Care, Faculty of Health, Social Care & Medicine, Edge Hill University, St Helen's Road, Ormskirk, Lancashire L39 4QP
| | - M S Charnley
- Applied Health & Social Care, Faculty of Health, Social Care & Medicine, Edge Hill University, St Helen's Road, Ormskirk, Lancashire L39 4QP
| | - L Cassidy
- Ulster University, Cromore Road, Coleraine BT52 1SA Northern Ireland, UK
| | - M T Mccann
- Ulster University, Cromore Road, Coleraine BT52 1SA Northern Ireland, UK
| | - J Jones
- Liverpool Women's Hospital, Crown Street, Liverpool L8 7SS, UK
| | - M Wright
- Liverpool Women's Hospital, Crown Street, Liverpool L8 7SS, UK
| | - L M Newson
- Faculty of Science, Byrom Street, Liverpool L3 3AF, UK
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Taylor Z, Chory K, Wright M, Amatya A, Gard C, Woods ME. Incidence and Survival for Common Cancers Are Lower in New Mexico and Along the US-Mexico Border Than Elsewhere in the United States. Cureus 2020; 12:e11234. [PMID: 33269162 PMCID: PMC7704167 DOI: 10.7759/cureus.11234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background Few in-depth reports on cancer epidemiology in New Mexico or the United States-Mexico border region exist. We aim to quantify cancer incidence and survival in New Mexico and the United States-Mexico border region in New Mexico. Methods Incidence and survival were obtained using SEER*Stat 8.3. The data were divided into either New Mexico, or SEER 18 (comprised of the 17 remaining regions) and then further divided by county in New Mexico and by time period. Incidence rates were age-standardized to the 2000 US census. Five-year survival was calculated for each cancer type. Kaplan-Meier survival plots were produced, and significance was determined using log-rank analysis. Results Analysis demonstrated that cancers in New Mexico are diagnosed at a lower rate with the exception of thyroid, liver, and ovarian. Survival is generally lower in New Mexico with 10 of the 14 cancers having worse survival in New Mexico. Only uterine cancer had improved survival in New Mexico (77.9% vs 74.9%, P < .001). Additionally, breast (82.2%), prostate (83.3%), lung and bronchus (13.7%), colorectal (53.7%), melanoma (80.1%), kidney and renal pelvis (61.2%), uterine (78.5%), and ovarian (41.6%) all had lower survival in the border counties. Conclusion Comparing New Mexico to the other regions in the SEER 18 database, both cancer incidence and survival are consistently lower; these findings could be explained by lower access to healthcare, which can result in underreporting and delays in diagnosis.
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Gulliford MC, Juszczyk D, Prevost AT, Soames J, McDermott L, Sultana K, Wright M, Fox R, Hay AD, Little P, Moore M, Yardley L, Ashworth M, Charlton J. Electronically delivered interventions to reduce antibiotic prescribing for respiratory infections in primary care: cluster RCT using electronic health records and cohort study. Health Technol Assess 2020; 23:1-70. [PMID: 30900550 DOI: 10.3310/hta23110] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 01/26/2023] Open
Abstract
BACKGROUND Unnecessary prescribing of antibiotics in primary care is contributing to the emergence of antimicrobial drug resistance. OBJECTIVES To develop and evaluate a multicomponent intervention for antimicrobial stewardship in primary care, and to evaluate the safety of reducing antibiotic prescribing for self-limiting respiratory infections (RTIs). INTERVENTIONS A multicomponent intervention, developed as part of this study, including a webinar, monthly reports of general practice-specific data for antibiotic prescribing and decision support tools to inform appropriate antibiotic prescribing. DESIGN A parallel-group, cluster randomised controlled trial. SETTING The trial was conducted in 79 general practices in the UK Clinical Practice Research Datalink (CPRD). PARTICIPANTS All registered patients were included. MAIN OUTCOME MEASURES The primary outcome was the rate of antibiotic prescriptions for self-limiting RTIs over the 12-month intervention period. COHORT STUDY A separate population-based cohort study was conducted in 610 CPRD general practices that were not exposed to the trial interventions. Data were analysed to evaluate safety outcomes for registered patients with 45.5 million person-years of follow-up from 2005 to 2014. RESULTS There were 41 intervention trial arm practices (323,155 patient-years) and 38 control trial arm practices (259,520 patient-years). There were 98.7 antibiotic prescriptions for RTIs per 1000 patient-years in the intervention trial arm (31,907 antibiotic prescriptions) and 107.6 per 1000 patient-years in the control arm (27,923 antibiotic prescriptions) [adjusted antibiotic-prescribing rate ratio (RR) 0.88, 95% confidence interval (CI) 0.78 to 0.99; p = 0.040]. There was no evidence of effect in children aged < 15 years (RR 0.96, 95% CI 0.82 to 1.12) or adults aged ≥ 85 years (RR 0.97, 95% CI 0.79 to 1.18). Antibiotic prescribing was reduced in adults aged between 15 and 84 years (RR 0.84, 95% CI 0.75 to 0.95), that is, one antibiotic prescription was avoided for every 62 patients (95% CI 40 to 200 patients) aged 15-84 years per year. Analysis of trial data for 12 safety outcomes, including pneumonia and peritonsillar abscess, showed no evidence that these outcomes might be increased as a result of the intervention. The analysis of data from non-trial practices showed that if a general practice with an average list size of 7000 patients reduces the proportion of RTI consultations with antibiotics prescribed by 10%, then 1.1 (95% CI 0.6 to 1.5) more cases of pneumonia per year and 0.9 (95% CI 0.5 to 1.3) more cases of peritonsillar abscesses per decade may be observed. There was no evidence that mastoiditis, empyema, meningitis, intracranial abscess or Lemierre syndrome were more frequent at low-prescribing practices. LIMITATIONS The research was based on electronic health records that may not always provide complete data. The number of practices included in the trial was smaller than initially intended. CONCLUSIONS This study found evidence that, overall, general practice antibiotic prescribing for RTIs was reduced by this electronically delivered intervention. Antibiotic prescribing rates were reduced for adults aged 15-84 years, but not for children or the senior elderly. FUTURE WORK Strategies for antimicrobial stewardship should employ stratified interventions that are tailored to specific age groups. Further research into the safety of reduced antibiotic prescribing is also needed. TRIAL REGISTRATION Current Controlled Trials ISRCTN95232781. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 11. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Martin C Gulliford
- School of Population Health and Environmental Sciences, King's College London, London, UK.,NIHR Biomedical Research Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Dorota Juszczyk
- School of Population Health and Environmental Sciences, King's College London, London, UK.,NIHR Biomedical Research Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - A Toby Prevost
- School of Population Health and Environmental Sciences, King's College London, London, UK.,NIHR Biomedical Research Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK.,School of Public Health, Imperial College London, London, UK
| | - Jamie Soames
- Clinical Practice Research Datalink, Medicines and Healthcare products Regulatory Agency, London, UK
| | - Lisa McDermott
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Kirin Sultana
- Clinical Practice Research Datalink, Medicines and Healthcare products Regulatory Agency, London, UK
| | - Mark Wright
- Clinical Practice Research Datalink, Medicines and Healthcare products Regulatory Agency, London, UK
| | | | - Alastair D Hay
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Paul Little
- Primary Care Research Group, University of Southampton, Southampton, UK
| | - Michael Moore
- Primary Care Research Group, University of Southampton, Southampton, UK
| | - Lucy Yardley
- Department of Psychology, University of Southampton, Southampton, UK.,School of Psychological Science, University of Bristol, Bristol, UK
| | - Mark Ashworth
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Judith Charlton
- School of Population Health and Environmental Sciences, King's College London, London, UK
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Macken L, Bremner S, Gage H, Touray M, Williams P, Crook D, Mason L, Lambert D, Evans CJ, Cooper M, Timeyin J, Steer S, Austin M, Parnell N, Thomson SJ, Sheridan D, Wright M, Isaacs P, Hashim A, Verma S. Randomised clinical trial: palliative long-term abdominal drains vs large-volume paracentesis in refractory ascites due to cirrhosis. Aliment Pharmacol Ther 2020; 52:107-122. [PMID: 32478917 DOI: 10.1111/apt.15802] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [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: 01/21/2020] [Revised: 02/12/2020] [Accepted: 04/28/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Palliative care remains suboptimal in end-stage liver disease. AIM To inform a definitive study, we assessed palliative long-term abdominal drains in end-stage liver disease to determine recruitment, attrition, safety/potential effectiveness, questionnaires/interview uptake/completion and make a preliminary cost comparison. METHODS A 12-week feasibility nonblinded randomised controlled trial comparing large-volume paracentesis vs long-term abdominal drains in refractory ascites due to end-stage liver disease with fortnightly home visits for clinical/questionnaire-based assessments. Study success criteria were attrition not >50%, <10% long-term abdominal drain removal due to complications, the long-term abdominal drain group to spend <50% ascites-related study time in hospital vs large-volume paracentesis group and 80% questionnaire/interview uptake/completion. RESULTS Of 59 eligible patients, 36 (61%) were randomised, 17 to long-term abdominal drain and 19 to large-volume paracentesis. Following randomisation, median number (IQR) of hospital ascitic drains (long-term abdominal drain group vs large-volume paracentesis group) were 0 (0-1) vs 4 (3-7); week 12 serum albumin (g/L) and serum creatinine (μmol/L) were 29 (26.5-32.5) vs 30 (25-35) and 104.5 (81-115.5) vs 127 (63-158) respectively. Total attrition was 42% (long-term abdominal drain group 47%, large-volume paracentesis group 37%). Median (IQR) fortnightly community/hospital/social care ascites-related costs and percentage study time in hospital were lower in the long-term abdominal drain group, £329 (253-580) vs £843 (603-1060) and 0% (0-0.74) vs 2.75% (2.35-3.84) respectively. Self-limiting cellulitis/leakage occurred in 41% (7/17) in the long-term abdominal drain group vs 11% (2/19) in the large-volume paracentesis group; peritonitis incidence was 6% (1/17) vs 11% (2/19) respectively. Questionnaires/interview uptake/completion were ≥80%; interviews indicated that long-term abdominal drains could transform the care pathway. CONCLUSIONS The REDUCe study demonstrates feasibility with preliminary evidence of long-term abdominal drain acceptability/effectiveness/safety and reduction in health resource utilisation. TRIAL REGISTRATION ISRCTN30697116, date assigned: 07/10/2015.
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O"neill L, Sim I, O"hare D, Whitaker J, Mukherjee R, Roney C, Razeghi O, Niederer S, Harith A, Rosenthal E, Jones M, Wright M, Frigiola A, O"neill M, Williams S. P920Understanding arrhythmia mechanisms in patients with atrial septal defects. Europace 2020. [DOI: 10.1093/europace/euaa162.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Atrial arrhythmias represent a major cause of morbidity and hospitalization in patients with atrial septal defects (ASD). Optimum treatment strategies are unknown since the mechanisms of arrhythmia are undefined in this cohort.
Purpose
We investigated whether percutaneous ASD closure reduces atrial arrhythmias and subsequently examined the electrical and structural changes underpinning arrhythmogenesis in ASD patients.
Methods
Meta-analysis was used to study the effect of closure on arrhythmias. Bi-atrial electrical dysfunction was assessed through invasive measurement of atrial voltage, refractory periods (ERP) over three drive trains (600, 450 and 300ms) and local conduction velocity (CV) with subsequent assessment of ERP and CV restitution. Structural remodelling was assessed through non-invasive quantification of fibrosis using cardiac MRI (CMR). Origin of ectopy was evaluated invasively using isoprenaline infusion and non-invasively using 24-hour Holter monitoring. Comparison was made to normal heart controls.
Results
Meta-analysis
Meta-analysis of 25 studies found that percutaneous closure was associated with a weak reduction in atrial arrhythmias only in patients >40 years old (OR 0.777, 95% CI 0.616-0.979, P = 0.032).
Electrical Remodelling
On invasive assessment (21 ASDs; 21 controls), proportion of right atrial low voltage (<0.5mV) and scar (<0.05mV) was greater in ASD vs control patients (P = 0.02 and P = 0.039). In ASD patients, these parameters were greater in the right atrium vs the left atrium (P = 0.002 and P = 0.01). Right atrial ERP restitution slopes were steeper in ASD vs control patients (P = 0.016). Maximum right atrial CV and CV restitution slopes were greater in ASD vs control patients (P= 0.005 and P < 0.001 respectively) and CV decrement occurred at longer coupling intervals in the right atrium in ASD patients (P = 0.015).
Structural Remodelling
On CMR assessment (36 ASDs; 36 controls), bi-atrial fibrosis was greater in ASD vs control patients (P < 0.001). In ASD patients right atrial fibrosis was burden greater in patients with vs without atrial arrhythmias (P = 0.034).
Arrhythmia Triggers
On 24-hour Holter monitoring and during invasive isoprenaline infusion right and left atrial ectopy was equally prevalent in ASD vs control patients.
Conclusion
This study highlights the importance of right atrial electrical dysfunction to the occurrence of arrhythmias in ASD patients with extensive right atrial remodelling (fibrosis, low voltage, steeper ERP and CV restitution) seen in ASD patients compared to normal heart controls.
From the results of the meta-analysis it appears that percutaneous closure alone is insufficient to treat arrhythmias in ASD patients. Given the predominance of right atrial remodelling, right-sided ablation as an adjunct to conventional left-sided ablation should be investigated as a strategy to treat atrial arrhythmias in these patients.
Abstract Figure.
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Affiliation(s)
- L O"neill
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
| | - I Sim
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
| | - D O"hare
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
| | - J Whitaker
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
| | - R Mukherjee
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
| | - C Roney
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
| | - O Razeghi
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
| | - S Niederer
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
| | - A Harith
- St Thomas" Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - E Rosenthal
- St Thomas" Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - M Jones
- St Thomas" Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - M Wright
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
| | - A Frigiola
- St Thomas" Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - M O"neill
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
| | - S Williams
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
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Bruce C, Rogers S, Saraf K, Kirkwood G, Kirkland N, Wright M, Jamil-Copley S, Abozguia K, Fox D, Mccollum C, Morris G. P1450Deep vein thrombosis after right sided catheter ablation; more common then previously thought? Europace 2020. [DOI: 10.1093/europace/euaa162.324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Bristol-Myers Squibb
Background
Right sided cardiac catheter ablation has become an indispensable tool to treat supraventricular cardiac dysrhythmias, with ablation of certain arrhythmias having cure rates over 90%. Due to this the frequency of these procedures is increasing annually and it is imperative we understand the incidence of all complication. One lesser studied complication is that of deep vein thrombosis (DVT), for which catheter ablation demonstrates all elements of Virchow"s triad. As right sided ablations are carried out to treat troublesome palpitations, not to reduce mortality, it is important all risks are identified, especially those which are themselves potentially life threatening and can be modified.
Purpose
To determine the incidence of DVT after right sided cardiac catheter ablation.
Methods
We undertook a prospective multi-center study recruiting adult patients undergoing clinically indicated cardiac ablation for atrioventricular nodal re-entrant tachycardia and atrioventricular re-entrant tachycardia with right sided accessory pathway. Important exclusion criteria included patients on anticoagulation or antiplatelet therapy. Participants underwent bilateral compression venous duplex ultrasonography from the inferior vena cava to the popliteal vein to access for DVT at 24 hours and between 10 to 14 days post-procedure. The uncannulated contralateral leg acted as a control.
Result
At interim analysis 71 participants had completed the study with average age 47 year (+/- 14), procedure duration 67 minutes, and with a female predominance. Seven patients developed acute DVT in either the femoral or internal iliac vein in the access leg. No thrombus was seen in the control leg. This gives an incidence of 10% (95% CI 4-19%) with p value of 0.023 on Chi-square testing.
Conclusion
We found a statistically significant proportion of patients undergoing right sided cardiac catheter ablation developed acute proximal DVT on ultrasound. All patients were treated with 3 to 6 months of anticoagulation therapy in accordance with NICE guidelines. These results suggest that DVT may occur at a high frequency then previously thought in this cohort and supports the consideration of peri-procedural prophylactic anticoagulation.
Abstract Figure. Acute thrombus in the femoral vein
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Affiliation(s)
- C Bruce
- Manchester University NHS Foundation Trust, Manchester, United Kingdom of Great Britain & Northern Ireland
| | - S Rogers
- University of Manchester, Academic Surgery Unit, Manchester, United Kingdom of Great Britain & Northern Ireland
| | - K Saraf
- Manchester University NHS Foundation Trust, Manchester, United Kingdom of Great Britain & Northern Ireland
| | - G Kirkwood
- Sheffield Teaching Hospitals NHS Trust, Sheffield, United Kingdom of Great Britain & Northern Ireland
| | - N Kirkland
- Sheffield Teaching Hospitals NHS Trust, Sheffield, United Kingdom of Great Britain & Northern Ireland
| | - M Wright
- Guys and St Thomas Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - S Jamil-Copley
- Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom of Great Britain & Northern Ireland
| | - K Abozguia
- Blackpool Teaching Hospitals NHS Trust, Blackpool, United Kingdom of Great Britain & Northern Ireland
| | - D Fox
- Manchester University NHS Foundation Trust, Manchester, United Kingdom of Great Britain & Northern Ireland
| | - C Mccollum
- University of Manchester, Academic Surgery Unit, Manchester, United Kingdom of Great Britain & Northern Ireland
| | - G Morris
- Manchester University NHS Foundation Trust, Manchester, United Kingdom of Great Britain & Northern Ireland
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Gupta D, Vijgen J, De Potter T, Scherr D, Van Herendael H, Knecht S, Kobza R, Berte B, Sandgaard N, Albenque J, Szeplaki G, Stevenhagen Y, Taghji P, Wright M, Duytschaever M. P956Improved quality of life and symptomatic atrial fibrillation reduction in patients treated with a standardized ablation index workflow. Europace 2020. [DOI: 10.1093/europace/euaa162.190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background/Introduction
The use of a standardized ‘CLOSE’ ablation workflow for pulmonary vein isolation (PVI), with defined inter-tag distance (ITD) with targeted ablation index (AI) values, has been shown in single centre reports to result in good outcomes. The effect of this approach on patients’ quality of life (QoL) has not been studied.
Purpose
To evaluate the effects of paroxysmal atrial fibrillation (PAF) ablation by the CLOSE workflow on QoL and symptomatic AF reduction in the multicenter VISTAX study.
Methods
329 patients with PAF (61.5% male, 61.3 ± 10.1 year) were treated at 17 European centres by point-by-point radiofrequency ablation using the CLOSE protocol to achieve PVI. An ITD ≤6mm and AI values of ≥400 on the posterior wall and ≥550 on the anterior wall were targeted. The AI value on the posterior wall was lowered as per investigator discretion in case of safety concerns. Patients were monitored for atrial arrhythmia recurrences via weekly and symptom-activated transtelephonic monitoring (TTM), for 12 months post procedure. Patients completed an Atrial Fibrillation Effect on Quality-of-life (AFEQT) questionnaire at their baseline and 12-month follow up visits.
Results
Majority (83.3% [274/329]) of patients experienced freedom from symptomatic atrial recurrence through 12 months. Of the 70 documented recurrences, 34 (49%) were documented by trans-telephonic monitoring only. All domains captured on the AFEQT questionnaire showed improvement with the overall score improving by 25.7, which exceeded the threshold of clinically meaningful improvement (±5) (Table). Patient reported most improvements in PAF control and symptoms relieved. The overall AFEQT score improvement was seen both in patients with or without documented atrial arrhythmia recurrence, with improvement by 21.5 and 26.8, respectively.
Conclusion
PAF ablation using a standardized CLOSE workflow resulted in consistent improvements in QoL. The improved QoL was observed regardless of atrial arrhythmia recurrence likely reflecting the low residual arrhythmia burden in patients with documented recurrence identified only on TTM.
AFEQT Scores Through 12 Months AFEQT Domain Baseline 12 Months Change from Baseline* Daily Activities 59.2 85.3 26.0 Treatment Concerns 62.2 88.1 26.0 Controlling PAF 50.2 87.8 37.5 Symptoms 63.7 89.0 25.1 Symptoms Relieved 52.0 88.4 36.3 Overall AFEQT Score 61.3 87.2 25.7 *only includes patients who completed both baseline and 12 month AFEQT questionnaire
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Affiliation(s)
- D Gupta
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - J Vijgen
- Virga Jesse Hospital, Hasselt, Belgium
| | | | - D Scherr
- Medical University of Graz, Graz, Austria
| | | | - S Knecht
- St-Jan Hospital, Brugge, Belgium
| | - R Kobza
- Luzerner Kantonsspital Herzzentrum, Luzern, Switzerland
| | - B Berte
- Luzerner Kantonsspital Herzzentrum, Luzern, Switzerland
| | | | | | | | - Y Stevenhagen
- Thorax Centre in Medisch Spectrum Twente (MST), Enschede, Netherlands (The)
| | - P Taghji
- CLAIRVAL PRIVATE HOSPITAL, Marseille, France
| | - M Wright
- St Thomas" Hospital, London, United Kingdom of Great Britain & Northern Ireland
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Gupta D, Vijgen J, De Potter T, Scherr D, Van Herendael H, Knecht S, Kobza R, Berte B, Sandgaard N, Albenque J, Szeplaki G, Stevenhagen Y, Taghji P, Wright M, Duytschaever M. 1242The flexibility, ease of using, and leaving curve of a standardized ablation index workflow for catheter ablation of paroxysmal atrial fibrillation. Europace 2020. [DOI: 10.1093/europace/euaa162.189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background/Introduction
The ‘CLOSE’ protocol, incorporating standardized ablation index (AI) targets in conjunction with defined inter-tag distance (ITD) has been shown to improve the acute and long-term success of pulmonary vein isolation (PVI) when treating paroxysmal atrial fibrillation (PAF). The reproducibility and learning curve for this protocol has not been studied.
Purpose
To assess the acute and long-term efficacy of CLOSE PVI across multiple operators (n = 37) in the 17-centre European study ‘VISTAX’.
Methods
329 patients with PAF (61.8% male, 61.3 ± 10.1 years) underwent PVI according to the CLOSE protocol, with target AI values for each lesion of ≥400 on the posterior wall and ≥550 on the anterior wall, and target ITD of ≤6mm. Each 3-dimensional electroanatomic map was evaluated at a core lab where adherence to each of these criteria was assessed. 281/329 patients (85.1%) fulfilled all standardized workflow requirements and were adjudicated as having their PVI per-protocol (PP). First pass PVI and acute effectiveness (adenosine-proof first pass PVI at 30-minute challenge) were recorded. Clinical effectiveness was assessed as freedom from atrial arrhythmia recurrence through 12 months recorded via transtelephonic monitoring (weekly and symptomatically), in addition to holter and electrocardiogram monitoring during 3,6,12 month follow up visits. Learning curve analysis was evaluated on all investigators.
Results
First pass PVI rates were similar in the overall (86%) and PP cohorts (85%), as was acute effectiveness (82% in both cohorts). Freedom from atrial arrhythmia at 12 months too was identical for both cohorts (79%). Total procedure time and total ablation time decreased by an average 8 minutes and 10 minutes respectively after the first procedure and then showed further steady decreases over the number of ablations performed by the investigator (Figure). The procedural efficiencies and clinical success were reproducible across different centers. No significant deviations were found from individual sites.
Conclusion
The standardized CLOSE workflow is reproducible across centres, and is ‘forgiving’ without impacting on high efficacy of almost 80%. The learning curve is short, suggesting that the excellent clinical results can be replicated widely and easily.
Abstract Figure. Learning Curves- Procedure & Ablation
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Affiliation(s)
- D Gupta
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - J Vijgen
- Virga Jessa Ziekenhuis, Hasselt, Belgium
| | - T De Potter
- Onze Lieve Vrouwziekenhuis Ziekenhuis Aalst-Asse-Ninove, Aalst, Belgium
| | - D Scherr
- Medical University of Graz, Graz, Austria
| | | | - S Knecht
- St-Jan Hospital, Brugge, Belgium
| | - R Kobza
- Luzerner Kantonsspital Herzzentrum, Luzern, Switzerland
| | - B Berte
- Luzerner Kantonsspital Herzzentrum, Luzern, Switzerland
| | | | | | | | - Y Stevenhagen
- Thorax Centre in Medisch Spectrum Twente (MST), Enschede, Netherlands (The)
| | - P Taghji
- CLAIRVAL PRIVATE HOSPITAL, Marseille, France
| | - M Wright
- St Thomas" Hospital, London, United Kingdom of Great Britain & Northern Ireland
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Scorletti E, Afolabi PR, Miles EA, Smith DE, Almehmadi A, Alshathry A, Childs CE, Fabbro SD, Beavis J, Moyses HE, Clough GF, Sethi JK, Patel J, Wright M, Breen DJ, Peebles C, Darekar A, Aspinall R, Fowell AJ, Dowman JK, Nobili V, Targher G, Delzenne NM, Bindels LB, Calder PC, Byrne CD. Synbiotics Alter Fecal Microbiomes, But Not Liver Fat or Fibrosis, in a Randomized Trial of Patients With Nonalcoholic Fatty Liver Disease. Gastroenterology 2020; 158:1597-1610.e7. [PMID: 31987796 PMCID: PMC7613160 DOI: 10.1053/j.gastro.2020.01.031] [Citation(s) in RCA: 116] [Impact Index Per Article: 29.0] [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: 04/01/2019] [Revised: 12/05/2019] [Accepted: 01/11/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Dysbiosis of the intestinal microbiota has been associated with nonalcoholic fatty liver disease (NAFLD). We investigated whether administration of a synbiotic combination of probiotic and prebiotic agents affected liver fat content, biomarkers of liver fibrosis, and the composition of the fecal microbiome in patients with NAFLD. METHODS We performed a double-blind phase 2 trial of 104 patients with NAFLD in the United Kingdom. Participants (mean age, 50.8 ± 12.6 years; 65% men; 37% with diabetes) were randomly assigned to groups given the synbiotic agents (fructo-oligosaccharides, 4 g twice per day, plus Bifidobacterium animalis subspecies lactis BB-12; n = 55) or placebo (n = 49) for 10-14 months. Liver fat content was measured at the start and end of the study by magnetic resonance spectroscopy, and liver fibrosis was determined from a validated biomarker scoring system and vibration-controlled transient elastography. Fecal samples were collected at the start and end of the study, the fecal microbiome were analyzed by 16S ribosomal DNA sequencing. RESULTS Mean baseline and end-of-study magnetic resonance spectroscopy liver fat percentage values were 32.3% ± 24.8% and 28.5% ± 20.1% in the synbiotic group and 31.3% ± 22% and 25.2% ± 17.2% in the placebo group. In the unadjusted intention-to-treat analysis, we found no significant difference in liver fat reduction between groups (β = 2.8; 95% confidence interval, -2.2 to 7.8; P = .30). In a fully adjusted regression model (adjusted for baseline measurement of the outcome plus age, sex, weight difference, and baseline weight), only weight loss was associated with a significant decrease in liver fat (β = 2; 95% confidence interval, 1.5-2.6; P = .03). Fecal samples from patients who received the synbiotic had higher proportions of Bifidobacterium and Faecalibacterium species, and reductions in Oscillibacter and Alistipes species, compared with baseline; these changes were not observed in the placebo group. Changes in the composition of fecal microbiota were not associated with liver fat or markers of fibrosis. CONCLUSIONS In a randomized trial of patients with NAFLD, 1 year of administration of a synbiotic combination (probiotic and prebiotic) altered the fecal microbiome but did not reduce liver fat content or markers of liver fibrosis. (ClinicalTrials.gov, Number: NCT01680640).
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Affiliation(s)
- Eleonora Scorletti
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, United Kingdom; National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton National Health Service Foundation Trust, Southampton, United Kingdom; Department of Gastroenterology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania.
| | - Paul R. Afolabi
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK,National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton National Health Service (NHS) Foundation Trust, Southampton, UK
| | - Elizabeth A. Miles
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Debbie E. Smith
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK,National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton National Health Service (NHS) Foundation Trust, Southampton, UK
| | - Amal Almehmadi
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Albandri Alshathry
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Caroline E. Childs
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Stefania Del Fabbro
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Josh Beavis
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Helen E. Moyses
- National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton National Health Service (NHS) Foundation Trust, Southampton, UK
| | - Geraldine F. Clough
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Jaswinder K. Sethi
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK,Institute for Life Sciences, University of Southampton, Southampton, UK
| | - Janisha Patel
- Hepatology, Department of Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Mark Wright
- Hepatology, Department of Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - David J. Breen
- Department of Radiology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Charles Peebles
- Department of Radiology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Angela Darekar
- Department of Medical Physics, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Richard Aspinall
- Department of Hepatology, Portsmouth Hospitals NHS Trust, Queen Alexandra Hospital, Portsmouth, UK
| | - Andrew J. Fowell
- Department of Hepatology, Portsmouth Hospitals NHS Trust, Queen Alexandra Hospital, Portsmouth, UK
| | - Joanna K. Dowman
- Department of Hepatology, Portsmouth Hospitals NHS Trust, Queen Alexandra Hospital, Portsmouth, UK
| | - Valerio Nobili
- Hepatology, Gastroenterology and Nutrition Unit, IRCCS "Bambino Gesù" Children's Hospital, Rome, Italy,Department of Pediatric, University "La Sapienza", Rome, Italy
| | - Giovanni Targher
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Nathalie M. Delzenne
- Metabolism and Nutrition Research Group, Louvain Drug Research Institute, Université Catholique de Louvain, Brussels, Belgium
| | - Laure B. Bindels
- Metabolism and Nutrition Research Group, Louvain Drug Research Institute, Université Catholique de Louvain, Brussels, Belgium
| | - Philip C. Calder
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK,National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton National Health Service (NHS) Foundation Trust, Southampton, UK,Institute for Life Sciences, University of Southampton, Southampton, UK
| | - Christopher D. Byrne
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK,National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton National Health Service (NHS) Foundation Trust, Southampton, UK
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Singla R, Wall D, Anderson S, Zia N, Korte J, Kravets L, McKiernan G, Butler J, Gammilonghi A, Arora J, Wright M, Solomon B, Hicks R, Cain T, Darcy P, Cullinane C, Neeson P, Ramanathan R, Shukla R, Bansal V, Harrison S. First in Human Study of In-vivo Imaging of Ex-Vivo Labelled CAR T Cells with Dual PET-MR. Cytotherapy 2020. [DOI: 10.1016/j.jcyt.2020.04.074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Plumb JO, Otto JM, Kumar SB, Wright M, Schmidt W, Grocott MP, Montgomery HE. Application of the optimized carbon monoxide rebreathing method for the measurement of total haemoglobin mass in chronic liver disease. Physiol Rep 2020; 8:e14402. [PMID: 32207243 PMCID: PMC7090373 DOI: 10.14814/phy2.14402] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 02/20/2020] [Accepted: 02/23/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Anemia is common in liver cirrhosis. This generally infers a fall in total hemoglobin mass (tHb-mass). However, hemoglobin concentration ([Hb]) may fall due to an expansion in plasma volume (PV). The "optimized carbon monoxide rebreathing method" (oCOR) measures tHb-mass directly and PV (indirectly using hematocrit). It relies upon carboxyhemoglobin (COHb) distribution throughout the entire circulation. In healthy subjects, such distribution is complete within 6-8 min. Given the altered circulatory dynamics in cirrhosis, we sought in this pilot study, to assess whether this was true in cirrhosis. The primary aim was to ascertain if the standard timings for the oCOR were applicable to patients with chronic liver disease and cirrhosis. The secondary aim was to explore the applicability of standard CO dosing methodologies to this patient population. METHODS Sixteen patients with chronic liver parenchymal disease were studied. However, tHb-mass was determined using the standard oCOR technique before elective paracentesis. Three subjects had an inadequate COHb% rise. In the remaining 13 (11 male), mean ± standard deviation (SD) age was 52 ± 13.8 years, body mass 79.1 ± 11.4 kg, height 175 ± 6.8 cm. To these, mean ± SD dose of carbon monoxide (CO) gas administered was 0.73 ± 0.13 ml/kg COHb values at baseline, 6 and 8 min (and "7-min value") were compared to those at 10, 12, 15 and 20 min after CO rebreathing. RESULTS The "7-min value" for median COHb% (IQR) of 6.30% (6.21%-7.47%) did not differ significantly from those at subsequent time points (8 min: 6.30% (6.21%-7.47%), 10 min: 6.33% (6.00%-7.50%), 12 min: 6.33% (5.90%-7.40%), 15 min: 6.37% (5.80%-7.33%), 20 min: 6.27% (5.70%-7.20%)). Mean difference in calculated tHb-mass between minute 7 and minute 20 was only 4.1 g, or 0.6%, p = .68. No subjects reported any adverse effects. CONCLUSIONS The oCOR method can be safely used to measure tHb-mass in patients with chronic liver disease and ascites, without adjustment of blood sample timings. Further work might refine and validate appropriate dosing regimens.
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Affiliation(s)
- James O.M. Plumb
- Respiratory and Critical Care Research AreaNIHR Biomedical Research CentreUniversity Hospital Southampton NHS Foundation Trust / University of SouthamptonSouthamptonUK
- Centre for Human Integrative PhysiologyFaculty of MedicineUniversity of SouthamptonSouthamptonUK
- Anaesthesia, Perioperative Medicine and Critical Care Research UnitUniversity Hospital Southampton NHSFTSouthamptonUK
- Shackleton Department of AnaesthesiaUniversity Hospital Southampton NHSFTSouthamptonUK
| | - James M. Otto
- Respiratory and Critical Care Research AreaNIHR Biomedical Research CentreUniversity Hospital Southampton NHS Foundation Trust / University of SouthamptonSouthamptonUK
- Centre for Human Integrative PhysiologyFaculty of MedicineUniversity of SouthamptonSouthamptonUK
- Anaesthesia, Perioperative Medicine and Critical Care Research UnitUniversity Hospital Southampton NHSFTSouthamptonUK
- Shackleton Department of AnaesthesiaUniversity Hospital Southampton NHSFTSouthamptonUK
- University of Southampton Medical SchoolSouthamptonUK
| | - Shriya B. Kumar
- Centre for Human Integrative PhysiologyFaculty of MedicineUniversity of SouthamptonSouthamptonUK
- University of Southampton Medical SchoolSouthamptonUK
| | - Mark Wright
- Department of HepatologyUniversity Hospital SouthamptonSouthamptonUK
| | - Walter Schmidt
- Department of Sports Medicine/Sports PhysiologyUniversity of BayreuthBayreuthGermany
| | - Michael P.W. Grocott
- Respiratory and Critical Care Research AreaNIHR Biomedical Research CentreUniversity Hospital Southampton NHS Foundation Trust / University of SouthamptonSouthamptonUK
- Centre for Human Integrative PhysiologyFaculty of MedicineUniversity of SouthamptonSouthamptonUK
- Anaesthesia, Perioperative Medicine and Critical Care Research UnitUniversity Hospital Southampton NHSFTSouthamptonUK
- Shackleton Department of AnaesthesiaUniversity Hospital Southampton NHSFTSouthamptonUK
- Department of AnesthesiologyDuke University School of MedicineDurhamNCUSA
| | - Hugh E. Montgomery
- Centre for Human Health and Performance/ Institute of Sport, Exercise and HealthUniversity College London, and NIHR University College London Hospitals Biomedical Research CentreLondonUK
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Wilcock A, Charlesworth S, Prentice W, Selby P, McKenna M, Cripps S, Considine A, Orr A, Wright M, Mihalyo M, Oxberry S. Author's Response. J Pain Symptom Manage 2020; 59:e8-e9. [PMID: 31863834 DOI: 10.1016/j.jpainsymman.2019.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 12/03/2019] [Indexed: 10/25/2022]
Affiliation(s)
| | | | | | - Paul Selby
- Cambridge University Hospital NHS Trust, Cambridge, United Kingdom
| | - Maria McKenna
- Freeman Hospital, Newcastle Upon Tyne, United Kingdom
| | - Sarah Cripps
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | | | - Alison Orr
- Kings College Hospital, London, United Kingdom
| | - Mark Wright
- University Hospitals, Southampton, Southampton, United Kingdom
| | - Mary Mihalyo
- Mylan School of Pharmacy, Duquesne University, Pittsburgh, Pennsylvania, USA
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