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Porter L, Sultan O, Mitchell BG, Jenney A, Kiernan M, Brewster DJ, Russo PL. How long do nosocomial pathogens persist on inanimate surfaces? A scoping review. J Hosp Infect 2024; 147:25-31. [PMID: 38447803 DOI: 10.1016/j.jhin.2024.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 01/18/2024] [Accepted: 01/31/2024] [Indexed: 03/08/2024]
Abstract
Healthcare hygiene plays a crucial role in the prevention of healthcare-associated infections. Patients admitted to a room where the previous occupant had a multi-drug-resistant bacterial infection are at an increased risk of colonization and infection with the same organism. A 2006 systematic review by Kramer et al. found that certain pathogens can survive for months on dry surfaces. The aim of this review is to update Kramer et al.'s previous review and provide contemporary data on the survival of pathogens relevant to the healthcare environment. We systematically searched Ovid MEDLINE, CINAHL and Scopus databases for studies that described the survival time of common nosocomial pathogens in the environment. Pathogens included in the review were bacterial, viral, and fungal. Studies were independently screened against predetermined inclusion/exclusion criteria by two researchers. Conflicts were resolved by one of two senior researchers. A spreadsheet was developed for the data extraction. The search identified 1736 studies. Following removal of duplicates and application of the search criteria, the synthesis of results from 62 included studies were included. 117 organisms were reported. The longest surviving organism reported was Klebsiella pneumoniae which was found to have persisted for 600 days. Common pathogens of concern to infection prevention and control, can survive or persist on inanimate surfaces for months. This data supports the need for a risk-based approach to cleaning and disinfection practices, accompanied by appropriate training, audit and feedback which are proven to be effective when adopted in a 'bundle' approach.
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Affiliation(s)
- L Porter
- Department of Nursing Research, Cabrini Health, Malvern, Australia; School of Medicine, Monash University, Clayton, Australia
| | - O Sultan
- Department of Nursing Research, Cabrini Health, Malvern, Australia; School of Medicine, Monash University, Clayton, Australia
| | - B G Mitchell
- School of Nursing, Avondale University, Wahroonga, Australia; School of Nursing and Midwifery, Monash University, Clayton, Australia; School of Nursing and Midwifery, University of Newcastle, Callaghan, Australia
| | - A Jenney
- Microbiology Unit, Alfred Health, Prahran, Australia
| | - M Kiernan
- Richard Wells Research Centre, University of West London, London, UK
| | - D J Brewster
- Central Clinical School, Monash University, Clayton, Australia; Intensive Care Unit, Cabrini Health, Malvern, Australia
| | - P L Russo
- Department of Nursing Research, Cabrini Health, Malvern, Australia; School of Medicine, Monash University, Clayton, Australia; School of Nursing, Avondale University, Wahroonga, Australia.
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2
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Grady KL, Kallen MA, Cella D, Allen LA, Lindenfeld J, McIlvennan CK, Beiser DG, Walsh MN, Denfeld QE, Lee CS, Ruo B, Murks C, Stehlik J, Kirklin JK, Teuteberg J, Adler E, Kiernan M, Rich J, Bedjeti K, Hahn EA. Efficient measurement of multiple ventricular assist device patient-reported outcomes: Creation of a 20-item profile from the MCS A-QOL study. J Heart Lung Transplant 2024:S1053-2498(24)01635-8. [PMID: 38692444 DOI: 10.1016/j.healun.2024.04.060] [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: 11/28/2023] [Revised: 04/15/2024] [Accepted: 04/23/2024] [Indexed: 05/03/2024] Open
Abstract
BACKGROUND Patient-reported outcome (PRO) measures of distinct concepts are often put together into patient profile assessments. When brief, profile assessments can decrease respondent burden and increase measure completion rates. In this report, we describe the creation of 5 self-reported 4-item short forms and the Mechanical Circulatory Support: Measures of Adjustment and Quality of Life (MCS A-QOL) 20-item profile to assess PROs specific to adjustment and health-related quality of life (HRQOL) among patients who undergo left ventricular assist device (LVAD) implantation. METHODS Using a cross-sectional sample of patients (n = 620) who underwent LVAD implantation at 12 U.S. sites or participated in the MyLVAD.com support group, we created 5 4-item short forms: Satisfaction with Treatment, ventricular assist device (VAD) Team Communication, Being Bothered by VAD Self-care and Limitations, Self-efficacy Regarding VAD self-care, and Stigma, which we combined into a 20-item profile. Analyses included intercorrelations among measures, Cronbach's alpha (i.e., internal consistency reliability)/score-level-specific reliability, and construct validity. RESULTS The 620 patients were mean age = 57 years, 78% male, 70% White, and 56% on destination therapy LVADs. Intercorrelations among the 5 4-item measures were low to moderate (≤0.50), indicating they are associated yet largely distinct, and correlations with calibrated measures and 6-item short forms were ≥0.76, indicating their ability to reflect full-item bank scores. Internal consistency reliability for the 5 4-item short forms ranged from acceptable (≥0.70) to good (≥0.80). Construct validity was demonstrated for these measures. CONCLUSIONS Our 5 4-item short forms are reliable and valid and may be used individually or together as a 20-item profile to assess adjustment and HRQOL in patients who undergo LVAD implantation.
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Affiliation(s)
- Kathleen L Grady
- Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
| | - Michael A Kallen
- Department of Medical Social Sciences, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - David Cella
- Department of Medical Social Sciences, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Larry A Allen
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - JoAnn Lindenfeld
- Department of Medicine, Vanderbilt University, Nashville, Tennessee
| | - Colleen K McIlvennan
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - David G Beiser
- Section of Emergency Medicine, University of Chicago, Chicago, Illinois
| | | | - Quin E Denfeld
- School of Nursing, Oregon Health & Science University, Portland, Oregon
| | | | - Bernice Ruo
- Department of Medicine, University of California-San Diego, La Jolla, California
| | - Catherine Murks
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Josef Stehlik
- Department of Medicine, University of Utah, Salt Lake City, Utah
| | | | | | - Eric Adler
- Department of Medicine, University of California-San Diego, La Jolla, California
| | - Michael Kiernan
- Department of Medicine, Tufts University, Boston, Massachusetts
| | - Jonathan Rich
- Department of Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Katy Bedjeti
- Department of Medical Social Sciences, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Elizabeth A Hahn
- Department of Medical Social Sciences, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
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3
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Watkin S, Cloutman-Green E, Kiernan M, Ciric L. Trends in viable microbial bioburden on surfaces within a paediatric bone marrow transplant unit. J Hosp Infect 2024; 148:167-177. [PMID: 38621514 DOI: 10.1016/j.jhin.2024.03.015] [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: 02/20/2024] [Revised: 03/21/2024] [Accepted: 03/23/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND Despite their role being historically overlooked, environmental surfaces have been shown to play a key role in the transmission of pathogens causative of healthcare-associated infection. To guide infection prevention and control (IPC) interventions and inform clinical risk assessments, more needs to be known about microbial surface bioburdens. AIM To identify the trends in culturable bacterial contamination across communal touch sites over time in a hospital setting. METHODS Swab samples were collected over nine weeks from 22 communal touch sites in a paediatric bone marrow transplant unit. Samples were cultured on Columbia blood agar and aerobic colony counts (ACC) per 100 cm2 were established for each site. Individual colony morphologies were grouped and identified by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry or 16s rDNA sequencing. FINDINGS Highest mean counts were observed for sites associated with ward management activity and computer devices (3.29 and 2.97 ACC/100 cm2 respectively). A nurses' station keyboard had high mean ACC/100 cm2 counts (10.67) and diversity, while laundry controls had high mean ACC/100 cm2 counts (4.70) and low diversity. Micrococcus luteus was identified in all sampling groups. Clinical staff usage sites were contaminated with similar proportions of skin and environmental flora (52.19-46.59% respectively), but sites associated with parental activities were predominantly contaminated by environmental microflora (86.53%). CONCLUSION The trends observed suggest patterns in microbial loading based on site activities, surface types and user groups. Improved understanding of environmental surface contamination could help support results interpretation and IPC interventions, improving patient safety.
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Affiliation(s)
- S Watkin
- Department of Civil, Environmental and Geomatic Engineering, University College London, London, UK.
| | - E Cloutman-Green
- Department of Civil, Environmental and Geomatic Engineering, University College London, London, UK; Microbiology, Virology and Infection Prevention and Control, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - M Kiernan
- Richard Wells Research Centre, University of West London, London, UK
| | - L Ciric
- Department of Civil, Environmental and Geomatic Engineering, University College London, London, UK
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4
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Grady KL, Kallen MA, Beiser DG, Lindenfeld J, Teuteberg J, Allen LA, McIlvennan CK, Rich J, Yancy C, Lee CS, Denfeld QE, Kiernan M, Walsh MN, Adler E, Ruo B, Stehlik J, Kirklin JK, Bedjeti K, Cella D, Hahn EA. Novel measures to assess ventricular assist device patient-reported outcomes: Findings from the MCS A-QOL study. J Heart Lung Transplant 2024; 43:36-50. [PMID: 37591454 PMCID: PMC10867283 DOI: 10.1016/j.healun.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 07/24/2023] [Accepted: 08/09/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND Generic and heart failure-specific measures do not capture unique aspects of living with a ventricular assist device (VAD). Using state-of-the-science psychometric measurement methods, we developed a measurement system to assess post-ventricular assist device adjustment and health-related quality of life (HRQOL). METHODS Patients were recruited from 10/26/16-2/29/20 from 12 U.S. VAD programs. We created a dataset of participants (n = 620) enrolled before left (L)VAD implantation, with data at 3- or 6- months post-implantation (group1 [n = 154]), and participants enrolled after LVAD implantation, with data at one timepoint (group 2 [n = 466]). We constructed 5 item banks: 3 modified from existing measures and 2 new measures. Analyses included item response theory (IRT) modeling, differential item functioning tests for systematic measurement bias, and indicators of reliability and validity. RESULTS Of 620 participants, 56% (n = 345) were implanted as destination therapy, 51% (n = 316) were <12 months post-implantation, mean age = 57.3 years, 78% (n = 485) male, 70% (n = 433) White, 58% (n = 353) married/partnered, and 58% (n = 357) with >high school education. We developed 5 new VAD item banks/measures: 6-item VAD Team Communication; 12-item Self-efficacy Regarding VAD Self-care; 11-item Being Bothered by VAD Self-care and Limitations; 7-item Satisfaction with Treatment; and 11-item Stigma. Cronbach's alpha reliability ranged from good (≥0.80) to excellent (≥0.90) for item banks/measures. All measures, except VAD Team Communication, demonstrated at least moderate correlations (≥0.30) with construct validity indicators. CONCLUSIONS These measures meet IRT modeling assumptions and requirements; scores demonstrate reliability and validity. Use of these measures may assist VAD clinicians to inform patients about VADs as a treatment option and guide post-VAD interventions.
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Affiliation(s)
- Kathleen L Grady
- Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
| | - Michael A Kallen
- Department of Medical Social Sciences, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - David G Beiser
- Section of Emergency Medicine, University of Chicago, Chicago, Illinois
| | - JoAnn Lindenfeld
- Department of Medicine, Vanderbilt University, Nashville, Tennessee
| | | | - Larry A Allen
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Colleen K McIlvennan
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Jonathan Rich
- Department of Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Clyde Yancy
- Department of Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | | | - Quin E Denfeld
- School of Nursing, Oregon Health and Science University, Portland, Oregon
| | - Michael Kiernan
- Department of Medicine, Tufts University, Boston, Massachusetts
| | | | - Eric Adler
- Department of Medicine, University of California-San Diego, La Jolla, California
| | - Bernice Ruo
- Department of Medicine, University of California-San Diego, La Jolla, California
| | - Josef Stehlik
- Department of Medicine, University of Utah, Salt Lake City, Utah
| | | | - Katy Bedjeti
- Department of Medical Social Sciences, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Dave Cella
- Department of Medical Social Sciences, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Elizabeth A Hahn
- Department of Medical Social Sciences, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
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5
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Mitchell BG, Russo PL, Kiernan M, Fasugba O. Not the entire picture: a pragmatic review on CAUTI. J Hosp Infect 2023; 139:253-254. [PMID: 37286108 DOI: 10.1016/j.jhin.2023.04.018] [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] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 04/20/2023] [Indexed: 06/09/2023]
Affiliation(s)
- B G Mitchell
- School of Nursing, Avondale University, New South Wales, Australia; Central Coast Local Health District, Gosford Hospital, Gosford, New South Wales, Australia; Nursing and Midwifery, Monash University, Victoria, Australia.
| | - P L Russo
- School of Nursing, Avondale University, New South Wales, Australia; Nursing and Midwifery, Monash University, Victoria, Australia; Cabrini Research, Cabrini Health, Victoria, Australia
| | - M Kiernan
- School of Nursing, Avondale University, New South Wales, Australia; Richard Wells Research Centre, University of West London, London, United Kingdom
| | - O Fasugba
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne and Australian Catholic University, Australia; School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, Australia
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Slaughter M, Ahmed M, Allen S, Answini G, Bartoli C, Dhingra R, Dowling R, Egnaczyk G, Griffith B, Gulati S, Hall S, Jeng E, Joseph S, Kiernan M, Lozonschi L, Mahr C, Meyer D, Ono M, Ravichandran A, Shafii A, Soleimani B, Toyoda Y, Yarboro L. Initial Safety Cohort Analysis: Prospective Multi-Center Randomized Study for Evaluating The EVAHEART®2 Left Ventricular Assist System (The COMPETENCE Trial). J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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7
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Grady K, Burns J, Teuteberg J, Allen L, Beiser D, Lindenfeld J, Yancy C, Cella D, Kirklin J, Denfeld Q, Ruo B, McIlvennan C, Walsh M, Adler E, Klein L, Murks C, Pham D, Rich J, Stehlik J, Kiernan M, Hahn E. New Ventricular Assist Device-Specific Self-Report Measures are Important for Understanding Health-Related Quality of Life: Findings from the MCS A-QOL Study. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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8
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Hattersley AM, Kiernan M, Goldberg D, Dierickx C, Sliney DH, Haedersdal M, Nash JF. Assessment of adverse events for a home-use intense pulsed light hair removal device using postmarketing surveillance. Lasers Surg Med 2023; 55:414-422. [PMID: 36883997 DOI: 10.1002/lsm.23650] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 02/18/2023] [Accepted: 02/23/2023] [Indexed: 03/09/2023]
Abstract
BACKGROUND AND OBJECTIVES Home-use intense pulsed light (IPL) hair removal devices are convenient for consumers. Consumer safety associated with home-use IPL devices, however, remains a subject of interest. In this descriptive analysis, we assessed the most commonly reported adverse events (AEs) for a home-use IPL device from postmarketing surveillance and qualitatively compared these with AEs from clinical studies and medical device reports of home-use IPL treatments. MATERIALS AND METHODS For this analysis of voluntary reports, we queried a distributor's postmarketing database for IPL devices for the period beginning January 1, 2016, to December 31, 2021. All sources of comments, for example, phone, e-mail, company-sponsored web sites, were included in the analysis. AE data were coded according to the Medical Dictionary for Regulatory Activities (MedDRA) terminology. Also, we conducted a PubMed search to identify AE profiles from existing literature on home-use IPL devices and we searched the Manufacturer and User Facility Device Experience (MAUDE) database for reports on home-use IPL devices. These results were qualitatively compared to the data in the postmarketing surveillance database. RESULTS A total of 1692 cases involving IPL were identified from voluntary reports of AEs between 2016 and 2021. The shipment-adjusted reporting rate for AE cases (number of AE cases/100,000 shipped IPL devices) was 67/100,000 during this 6-year period. The most commonly reported AEs were pain of skin 27.8% (470/1692), "thermal burn" 18.7% (316/1692), and erythema 16.0% (271/1692). Among the top 25 AEs reported, no unexpected health events were observed. The reported AEs were qualitatively similar to the pattern seen in clinical studies and the MAUDE database associated with such home-use IPL treatments. CONCLUSION This is the first such report documenting AEs for home-use IPL hair removal from a postmarketing surveillance program. These data are supportive of the safety of such home-use low-fluence IPL technology.
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Affiliation(s)
| | | | - David Goldberg
- Skin Laser & Surgery Specialists of NY and NJ, Hackensack, New Jersey, USA
| | | | - David H Sliney
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Merete Haedersdal
- Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark
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9
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Hernandez NS, Kanter M, Sharma V, Wang A, Kiernan M, Kryzanski D, Heller R, Nail T, Riesenburger RI, Kryzanski JT. Radiographic risk factors for intracranial hemorrhage in patients with left ventricular assist devices. J Stroke Cerebrovasc Dis 2022; 31:106869. [DOI: 10.1016/j.jstrokecerebrovasdis.2022.106869] [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] [Received: 07/31/2022] [Revised: 10/17/2022] [Accepted: 10/26/2022] [Indexed: 11/07/2022] Open
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10
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Yousefzai R, Abraham J, Kiernan M, Tedford R, Benzuly K, Karas R, Burkhoff D. TCT-340 Intermittent Occlusion of the Superior Vena Cava Improves Urine Sodium Excretion in Patients With Acutely Decompensated Heart Failure. J Am Coll Cardiol 2022. [DOI: 10.1016/j.jacc.2022.08.399] [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: 11/24/2022]
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11
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Kiernan M, Yousefzai R, Tedford R, Benzuly K, Abraham J, Karas R, Burkhoff D. TCT-341 Intermittent Occlusion of the Superior Vena Cava Reduces Estimated Stressed Blood Volume in Patients With Acutely Decompensated Heart Failure. J Am Coll Cardiol 2022. [DOI: 10.1016/j.jacc.2022.08.400] [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: 10/14/2022]
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12
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Grandin EW, Gulati G, Nunez JI, Kennedy K, Rame JE, Atluri P, Pagani FD, Kirklin JK, Kormos RL, Teuteberg J, Kiernan M. Outcomes With Phosphodiesterase-5 Inhibitor Use After Left Ventricular Assist Device: An STS-INTERMACS Analysis. Circ Heart Fail 2022; 15:e008613. [PMID: 35332780 PMCID: PMC9205418 DOI: 10.1161/circheartfailure.121.008613] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Elevated right ventricular afterload following continuous-flow left ventricular assist device (CF-LVAD) may contribute to late right heart failure (LRHF). PDE5i (phosphodiesterase-5 inhibitors) are used to treat pulmonary hypertension and right heart dysfunction after CF-LVAD, but their impact on outcomes is uncertain. METHODS We queried Interagency Registry for Mechanically Assisted Circulatory Support from 2012 to 2017 for adults receiving a primary CF-LVAD and surviving ≥30 days from index discharge. Patients receiving early PDE5i (ePDE5i) at 1 month were propensity-matched 1:1 with controls. The primary outcome was the cumulative incidence of LRHF, defined using prevailing Interagency Registry for Mechanically Assisted Circulatory Support criteria; secondary outcomes included all-cause mortality and major bleeding. RESULTS Among 9627 CF-LVAD recipients analyzed, 2463 (25.6%) received ePDE5i and 1600 were propensity-matched 1:1 with controls. Before implant, ePDE5i patients had more severe RV dysfunction (13.1% versus 9.6%) and higher pulmonary vascular resistance (2.8±2.7 versus 2.2±2.4 WU), both P<0.001, but clinical factors were well-balanced after propensity-matching. In the unmatched cohort, ePDE5i patients had a higher 3-year cumulative incidence of LRHF, mortality, and major bleeding, but these differences were attenuated in the propensity-matched cohort: LRHF 40.8% versus 35.7% (hazard ratio, 1.14 [95% CI, 0.99-1.32]; P=0.07); mortality 38.6% versus 35.8% (hazard ratio, 0.99 [95% CI, 0.86-1.15]; P=0.93); major bleeding 51.2% versus 46.0% (hazard ratio, 1.12 [95% CI, 0.99-1.27]; P=0.06). CONCLUSIONS Compared with propensity-matched controls, adult CF-LVAD patients receiving ePDE5i had similar rates of LRHF, mortality, and major bleeding. While intrinsic patient risk factors likely account for more adverse outcomes with ePDE5i in the unmatched cohort, there is no obvious benefit of ePDE5i in the LVAD population.
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Affiliation(s)
- E. Wilson Grandin
- Cardiovascular Institute, Beth Israel Deaconess Medical Center, Boston MA
- Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston MA
| | - Gaurav Gulati
- Cardiovascular Center, Tufts Medical Center, Boston MA
| | - Jose I Nunez
- Cardiovascular Institute, Beth Israel Deaconess Medical Center, Boston MA
| | - Kevin Kennedy
- Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston MA
| | - J Eduardo Rame
- Division of Cardiology, Jefferson Heart Institute, Philadelphia, PA
| | - Pavan Atluri
- Division of Cardiothoracic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Francis D Pagani
- Division of Cardiothoracic Surgery, University of Michigan School of Medicine, Ann Arbor, MI
| | - James K Kirklin
- Division of Cardiothoracic Surgery, University of Alabama Birmingham School of Medicine, Birmingham, AL
| | - Robert L Kormos
- Division of Cardiothoracic Surgery, University of Pittsburgh; Abbott Laboratories, Austin, TX
| | - Jeffrey Teuteberg
- Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA
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13
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Slaughter M, Meyer D, Ravichandran A, Ono M, Dowling R, Yarboro L, Ahmed M, Kiernan M, Mahr C, Shafii A, Dhingra R, Smith J. The COMPETENCE Trial: Prospective Multi-Center Randomized Study for Evaluating the EVAHEART®2 Left Ventricular Assist System. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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14
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Sugden N, Thomas M, Kiernan M, Wilesmith M. Validation of the Prospective Memory Concerns Questionnaire (PMCQ). Front Hum Neurosci 2021; 15:686850. [PMID: 34512292 PMCID: PMC8427764 DOI: 10.3389/fnhum.2021.686850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 06/30/2021] [Indexed: 11/16/2022] Open
Abstract
Prospective memory (PM), the ability to remember to complete intended tasks, is essential for successfully completing activities of daily living. PM impairments are common in people with neuropathology such as acquired brain injury and dementia. These PM impairments affect individuals’ capabilities in key aspects of daily living including their health, safety, and independence. The Prospective Memory Concerns Questionnaire (PMCQ) was designed as a self-report measure to understand individuals’ concerns about their memory. This questionnaire may help identify issues with PM which in turn may assist clinicians in the targeted implementation of memory compensation strategies. The PMCQ was developed using Rasch and classical test methodologies, with subscales measuring frequency of forgetting behaviors, memory concerns, and retrieval failures. The current study aimed to confirm the factor structure of the PMCQ for use in adults in the general population. The study also aimed to examine relationships between the PMCQ and naturalistic performance-based measures of PM to determine how the self-report PMCQ could be used in conjunction with performance-based measures. A community dwelling sample of 558 adults completed the PMCQ, an event-based naturalistic PM task, and time-based naturalistic PM task. Confirmatory factor analyses (CFAs) indicated that a higher order model with three subscales containing 35 items produced acceptable fit [RMSEA = 0.056 (90% CI 0.054, 0.060), SRMR = 0.062, CFI = 0.915, TLI = 0.909] The PMCQ demonstrated good internal consistency (total α = 0.95, subscales: α = 0.88–0.89). The Forgetting Behaviors subscale significantly correlated with performance on the event-based naturalistic PM task (r = −0.14, p < 0.01). The Memory Concerns and Retrieval Failures subscales did not correlate significantly with performance-based PM tasks. These findings suggest that the PMCQ may be best suited for assessing individuals’ concerns about their forgetting behaviors and identifying appropriate compensation strategies or support services. It is recommended that the PMCQ be used alongside performance-based PM tasks and other cognitive measures to comprehensively assess PM. It was concluded that the PMCQ is a suitable measure for use in adults in the general population. Further validation research of the PMCQ in general population and clinical samples will determine the measures’ sensitivity and specificity in identifying PM impairments.
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Affiliation(s)
- Nicole Sugden
- School of Psychology, Charles Sturt University, Bathurst, NSW, Australia
| | - Matt Thomas
- School of Psychology, Charles Sturt University, Bathurst, NSW, Australia.,Marathon Health, Bathurst, NSW, Australia.,Western New South Wales Local Health District, Bathurst, NSW, Australia
| | - Michael Kiernan
- School of Psychology, Charles Sturt University, Bathurst, NSW, Australia
| | - Michele Wilesmith
- School of Psychology, Charles Sturt University, Bathurst, NSW, Australia
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15
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Graves N, Mitchell BG, Otter JA, Kiernan M. The cost-effectiveness of temporary single-patient rooms to reduce risks of healthcare-associated infection. J Hosp Infect 2021; 116:21-28. [PMID: 34246721 DOI: 10.1016/j.jhin.2021.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/30/2021] [Accepted: 07/06/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND The use of single rooms for patient isolation often forms part of a wider bundle to prevent certain healthcare-associated infections (HAIs) in hospitals. Demand for single rooms often exceeds what is available and the use of temporary isolation rooms may help resolve this. Changes to infection prevention practice should be supported by evidence showing that cost-effectiveness is plausible and likely. AIM To perform a cost-effectiveness evaluation of adopting temporary single rooms into UK National Health Service (NHS) hospitals. METHODS The cost-effectiveness of a decision to adopt a temporary, single-patient, isolation room to the current infection prevention efforts of an NHS hospital was modelled. Primary outcomes are the expected change to total costs and life-years from an NHS perspective. FINDINGS The mean expected incremental cost per life-year gained (LYG) is £5,829. The probability that adoption is cost-effective against a £20,000 threshold per additional LYG is 93%, and for a £13,000 threshold the probability is 87%. The conclusions are robust to scenarios for key model parameters. If a temporary single-patient isolation room reduces risks of HAI by 16.5% then an adoption decision is more likely to be cost-effective than not. Our estimate of the effectiveness reflects guidelines and reasonable assumptions and the theoretical rationale is strong. CONCLUSION Despite uncertainties about the effectiveness of temporary isolation rooms for reducing risks of HAI, there is some evidence that an adoption decision is likely to be cost-effective for the NHS setting. Prospective studies will be useful to reduce this source of uncertainty.
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Affiliation(s)
- N Graves
- Health Services & Systems Research, Duke-NUS Medical School, Singapore.
| | - B G Mitchell
- School of Nursing and Midwifery, University of Newcastle, Ourimbah, NSW, Australia
| | - J A Otter
- National Institute for Healthcare Research Health Protection Research Unit (NIHR HPRU) in HCAI and AMR, Imperial College London & Public Health England, Hammersmith Hospital, London, UK
| | - M Kiernan
- Gama Healthcare Ltd, Hemel Hempstead, UK
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16
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Ortoleva J, Nordan T, Chen F, Vest A, Kiernan M, DeNofrio D, Couper G, Kawabori M. Effect of the New Donor Heart Allocation System on Waitlist Mortality among All Candidates Listed with Mechanical Circulatory Support. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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17
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Huang D, Lacombe P, Gulati G, Couper G, Masashi K, Upshaw J, Vest A, DeNofrio D, Kiernan M. Preoperative Diuretic Resistance and Risk of Right Heart Failure (RHF) Post-LVAD Implantation. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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18
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Rich J, Najjar S, Keebler M, Mahr C, Mokadam N, Feller E, Kiernan M. Impact of Gastrointestinal Bleeding Following LVAD Implant in a Destination Therapy Population. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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19
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Sugden N, Thomas M, Kiernan M. A scoping review of the utility of self-report and informant-report prospective memory measures. Neuropsychol Rehabil 2021; 32:1230-1260. [DOI: 10.1080/09602011.2021.1875851] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Nicole Sugden
- School of Psychology, Charles Sturt University, Bathurst, Australia
| | - Matt Thomas
- School of Psychology, Charles Sturt University, Bathurst, Australia
| | - Michael Kiernan
- School of Psychology, Charles Sturt University, Bathurst, Australia
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20
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Affiliation(s)
| | - Barbara Hill
- Learning and Teaching Services, Charles Sturt University
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21
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Gulati G, Ruthazer R, Kent D, Kiernan M. A Clinical Prediction Model for Normalization of Pulmonary Vascular Resistance After Left Ventricular Assist Device Implantation. J Card Fail 2020. [DOI: 10.1016/j.cardfail.2020.09.429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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22
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Grady KL, Wortman K, Cummings P, Buono S, Lindenfeld J, Teuteberg J, Rich J, Cella D, Yancy C, Pham D, McILvennan C, Allen LA, Kiernan M, Beiser D, Murks C, Lee C, Denfeld Q, Klein L, Eshelbrenner C, Long J, Walsh M, Stehlik J, Adler E, Ruo B, Kallen M, Hahn EA. Patient Satisfaction Remains High from 3 - 6 Months After Lvad Implant: Findings from Mcs A-qol. J Card Fail 2020. [DOI: 10.1016/j.cardfail.2020.09.377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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23
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Abstract
Objective: Following acquired brain injury (ABI), young people may experience increased anxiety as well as difficulties with their psychosocial functioning. This study examined trait mindfulness as a mediator of the relationship between anxiety and psychosocial domains of School and Leisure Activities (SLA), Interpersonal Relationships (IR) and Daily Living Skills (DLS).Method: Participants were adolescents with ABI (aged 12-19 years, N = 38). Standardised measures were used to assess anxiety, trait mindfulness, and psychosocial functioning.Results: Higher levels of anxiety were found to be associated with reduced IR (p < .05) and DLS (p < .05). Increased trait mindfulness was found to be associated with lowered anxiety (p < .01), as well as with better IR (p < .05) and DLS (p <.01). Mediation analyses found a significant indirect effect for the relationship between anxiety and DLS through trait mindfulness.Conclusion: Findings highlight the contribution of trait mindfulness as a mediator between anxiety and psychosocial functioning, such that increased mindfulness and lower levels of anxiety are related to better DLS.
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Affiliation(s)
- Cheryl Soo
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Australia
| | | | - Vicki Anderson
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Australia
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24
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Gulati G, Ruthazer R, Kent D, Kiernan M. Characteristics Associated with Improved Pulmonary Vascular Resistance Following LVAD Surgery. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.1053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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25
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Babroudi S, McCallum W, Giczewska A, Pinzon PQ, Konstam MA, Kiernan M. COPEPTIN LEVELS IN ACUTE HEART FAILURE ARE ASSOCIATED WITH A HIGHER RISK PHENOTYPE, BUT NOT DIURETIC RESPONSE. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31523-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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26
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Senser E, Nunez J, Kennedy K, Kiernan M, Sabe MA, Garan A, Grandin E. POST-IMPLANT BETA-BLOCKER USE IS ASSOCIATED WITH DECREASED RATES OF LATE RIGHT HEART FAILURE AFTER LEFT VENTRICULAR ASSIST DEVICE. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31615-6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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27
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Gulati G, Kiernan M, Sabe MA. Massive retroperitoneal hemorrhage after external shock wave lithotripsy in a patient with a left ventricular assist device. Urol Case Rep 2020; 28:101033. [PMID: 31641612 PMCID: PMC6796679 DOI: 10.1016/j.eucr.2019.101033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 10/01/2019] [Accepted: 10/03/2019] [Indexed: 11/28/2022] Open
Abstract
As left ventricular assist devices (LVADs) become more prevalent, it is increasingly likely that patients with LVADs will require non cardiac procedures. Peri-procedural anticoagulation management is challenging in these patients and requires balancing risks of bleeding and pump thrombosis. We present a case of a patient with a HeartWare LVAD who developed a massive retroperitoneal hemorrhage after external shock wave lithotripsy (ESWL) for an obstructing renal calculus and briefly review the literature regarding bleeding complications after ESWL as well as peri-procedural anticoagulation management of patients with LVADs.
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Affiliation(s)
- Gaurav Gulati
- Cardiovascular Center, Tufts Medical Center, Boston, MA, United States
- Corresponding author. Tufts Medical Center, South Building, 6th Floor, 800 Washington St., Boston, MA, 02111, United States.
| | - Michael Kiernan
- Cardiovascular Center, Tufts Medical Center, Boston, MA, United States
| | - Marwa A. Sabe
- Cardiovascular Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
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Cutler C, Kiernan M, Willis JR, Gallardo-Alfaro L, Casas-Agustench P, White D, Hickson M, Gabaldon T, Bescos R. Post-exercise hypotension and skeletal muscle oxygenation is regulated by nitrate-reducing activity of oral bacteria. Free Radic Biol Med 2019; 143:252-259. [PMID: 31369841 DOI: 10.1016/j.freeradbiomed.2019.07.035] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 07/04/2019] [Accepted: 07/28/2019] [Indexed: 12/11/2022]
Abstract
Post-exercise hypotension (PEH) is a common physiological phenomenon leading to lower blood pressure after acute exercise, but it is not fully understood how this intriguing response occurs. This study investigated whether the nitrate-reducing activity of oral bacteria is a key mechanism to trigger PEH. Following a randomized, double blind and crossover design, twenty-three healthy individuals (15 males/8 females) completed two treadmill trials at moderate intensity. After exercise, participants rinsed their mouth with antibacterial mouthwash to inhibit the activity of oral bacteria or a placebo mouthwash. Blood pressure was measured before, 1h and 2 h after exercise. The microvascular response to a reactive hyperaemia test, as well as blood and salivary samples were taken before and 2 h after exercise to analyse nitrate and nitrite concentrations and the oral microbiome. As expected, systolic blood pressure (SBP) was lower (1 h: -5.2 ± 1.0 mmHg; P < 0.001); 2 h: -3.8 ± 1.1 mmHg, P = 0.005) after exercise compared to baseline in the placebo condition. This was accompanied by an increase of circulatory nitrite 2 h after exercise (2h: 100 ± 13 nM) compared to baseline (59 ± 9 nM; P = 0.013). Additionally, an increase in the peak of the tissue oxygenation index (TOI) during the reactive hyperaemia response was observed after exercise (86.1 ± 0.6%) compared to baseline levels (84.8 ± 0.5%; P = 0.010) in the placebo condition. On the other hand, the SBP-lowering effect of exercise was attenuated by 61% at 1 h in the recovery period, and it was fully attenuated 2 h after exercise with antibacterial mouthwash. This was associated with a lack of changes in circulatory nitrite (P > 0.05), and impaired microvascular response (peak TOI baseline: 85.1 ± 3.1%; peak TOI post-exercise: 84.6 ± 3.2%; P > 0.05). Diversity of oral bacteria did not change after exercise in any treatment. These findings show that nitrite synthesis by oral commensal bacteria is a key mechanism to induce the vascular response to exercise over the first period of recovery thereby promoting lower blood pressure and greater muscle oxygenation.
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Affiliation(s)
- C Cutler
- Institute of Health & Community, University of Plymouth, Plymouth, UK
| | - M Kiernan
- Peninsula Medical School, University of Plymouth, Plymouth, UK
| | - J R Willis
- Centre for Genomic Regulation (CRG), The Barcelona Institute of Science & Technology, Barcelona, Spain
| | - L Gallardo-Alfaro
- Research Group on Community Nutrition and Oxidative Stress, University of Balearic Islands & CIBEROBN (CB12/03/30038), Palma de Mallorca, Spain
| | - P Casas-Agustench
- Institute of Health & Community, University of Plymouth, Plymouth, UK
| | - D White
- Institute of Health & Community, University of Plymouth, Plymouth, UK
| | - M Hickson
- Institute of Health & Community, University of Plymouth, Plymouth, UK
| | - T Gabaldon
- Centre for Genomic Regulation (CRG), The Barcelona Institute of Science & Technology, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; Institució Catalana de Recerca I Estudis Avançats (ICREA), Barcelona, Spain
| | - R Bescos
- Institute of Health & Community, University of Plymouth, Plymouth, UK.
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29
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Kiernan M. Distal motor neuropathies. J Neurol Sci 2019. [DOI: 10.1016/j.jns.2019.10.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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30
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Kiernan M. ALS Treatment strategies. J Neurol Sci 2019. [DOI: 10.1016/j.jns.2019.10.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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31
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Blanton R, Gulati G, Kiernan M. Response by Blanton et al to Letter Regarding Article, "Preimplant Phosphodiesterase-5 Inhibitor Use Is Associated With Higher Rates of Severe Early Right Heart Failure After LVAD Implantation: An INTERMACS Analysis". Circ Heart Fail 2019; 12:e006465. [PMID: 31514516 DOI: 10.1161/circheartfailure.119.006465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Robert Blanton
- Cardiovascular Center, Division of Cardiology, Tufts Medical Center, Boston, MA (R.B., G.G., M.K.).,Molecular Cardiology Research Institute, Tufts Medical Center, Boston, MA (R.B.)
| | - Gaurav Gulati
- Cardiovascular Center, Division of Cardiology, Tufts Medical Center, Boston, MA (R.B., G.G., M.K.)
| | - Michael Kiernan
- Cardiovascular Center, Division of Cardiology, Tufts Medical Center, Boston, MA (R.B., G.G., M.K.)
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32
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Grady KL, Jackson K, Wortman K, Buono S, Beiser D, Murks C, Lindenfeld J, Lee C, Denfeld Q, Rich JD, Cella D, Yancy C, Goetz P, Pham DT, Banerjee D, McIlvennan C, Allen L, Kiernan M, Klein L, Walsh MN, Ruo B, Kallen MA, Hahn EA. Social Health with a Left Ventricular Assist Device is Similar to the General Population, Regardless of Time Since Implant. J Card Fail 2019. [DOI: 10.1016/j.cardfail.2019.07.407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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33
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Gulati G, Grandin EW, Kennedy K, Cabezas F, DeNofrio DD, Kociol R, Rame JE, Pagani FD, Kirklin JK, Kormos RL, Teuteberg J, Kiernan M. Preimplant Phosphodiesterase-5 Inhibitor Use Is Associated With Higher Rates of Severe Early Right Heart Failure After Left Ventricular Assist Device Implantation. Circ Heart Fail 2019; 12:e005537. [PMID: 31181953 DOI: 10.1161/circheartfailure.118.005537] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [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: 12/21/2022]
Abstract
Background Early right heart failure (RHF) occurs commonly in left ventricular assist device (LVAD) recipients, and increased right ventricular (RV) afterload may contribute. Selective pulmonary vasodilators, like phosphodiesterase-5 inhibitors (PDE5i), are used off-label to reduce RV afterload before LVAD implantation, but the association between preoperative PDE5i use and early RHF after LVAD is unknown. Methods and Results We analyzed adult patients from the INTERMACS registry (Interagency Registry for Mechanically Assisted Circulatory Support) who received a continuous flow LVAD after 2012. Patients on PDE5i were propensity-matched 1:1 to controls. The primary outcome was the incidence of severe early RHF, defined as the composite of death from RHF within 30 days, need for RV assist device support within 30 days, or use of inotropes beyond 14 days. Of 11 544 continuous flow LVAD recipients, 1199 (10.4%) received preoperative PDE5i. Compared to controls, patients on PDE5i had higher pulmonary artery systolic pressure (53.4 mm Hg versus 49.5 mm Hg) and pulmonary vascular resistance (2.6 WU versus 2.3 WU; P<0.001 for both). Before propensity matching, the incidence of severe early RHF was higher among patients on PDE5i than in controls (29.4% versus 23.1%; unadjusted odds ratio (OR), 1.32; 95% CI, 1.17-1.50). This association persisted after propensity matching (PDE5i, 28.9% versus control 23.7%; OR, 1.31; 95% CI, 1.09-1.57), driven by a higher incidence of prolonged inotropic support. Similar results were observed across a wide range of subgroups stratified by markers of pulmonary vascular disease and RV dysfunction. Conclusions Patients treated with preoperative PDE5i had markers of increased RV afterload and HF severity compared to unmatched controls. Even after propensity matching, patients receiving preimplant PDE5i therapy had higher rates of post-LVAD RHF.
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Affiliation(s)
- Gaurav Gulati
- Cardiovascular Center, Tufts Medical Center, Boston, MA (G.G., D.D.D., M.K.)
| | - E Wilson Grandin
- Cardiovascular Institute (E.W.G., F.C.).,Smith Center for Outcomes Research in Cardiology (E.W.G., K.K.)
| | - Kevin Kennedy
- Smith Center for Outcomes Research in Cardiology (E.W.G., K.K.)
| | | | - David D DeNofrio
- Cardiovascular Center, Tufts Medical Center, Boston, MA (G.G., D.D.D., M.K.)
| | - Robb Kociol
- Division of Cardiology (R.K.), Beth Israel Deaconess Medical Center, Boston, MA
| | - J Eduardo Rame
- Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia (J.E.R.)
| | - Francis D Pagani
- Division of Cardiothoracic Surgery, University of Michigan School of Medicine, Ann Arbor (F.D.P.)
| | - James K Kirklin
- Division of Cardiothoracic Surgery, University of Alabama Birmingham School of Medicine (J.K.K.)
| | - Robert L Kormos
- Heart and Vascular Institute, University of Pittsburgh Medical Center, PA (R.L.K.)
| | - Jeffrey Teuteberg
- Cardiovascular Medicine, Stanford University Medical Center, CA (J.T.)
| | - Michael Kiernan
- Cardiovascular Center, Tufts Medical Center, Boston, MA (G.G., D.D.D., M.K.)
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Grandin E, Gulati G, Kennedy K, Cabezas F, Birati E, Rame J, Atluri P, Pagani F, Kirklin J, Naftel D, Kormos R, Teuteberg J, Kiernan M. Post-Implant Phosphodiesterase-5 Inhibitor Use is Associated with Increased Rates of Late Right Heart Failure after LVAD: An INTERMACS Analysis. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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35
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Shah P, Mahr C, Rogers J, Kiernan M, Boyce S, Mokadam N, Pagani F, Vassiliades T, Teuteberg J. Impact of Stroke Onset Severity on 2-Year Survival in Destination Therapy Patients Supported by Centrifugal Flow versus Axial Flow Ventricular Assist Devices. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Grady K, Jackson K, Wortman K, Buono S, Beiser D, Murks C, Lee C, Denfeld Q, Lindenfeld J, Rich J, Yancy C, Pham D, Cella D, Goetz P, Bannerjee D, Kiernan M, McIlvennan C, Allen L, Klein L, Walsh M, Ruo B, Kallen M, Hahn E. Self-Reported Physical Health with a Left Ventricular Assist Device: Findings from the Mechanical Circulatory Support Measures of Adjustment and Quality of Life (MCS A-QOL) Study. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.1117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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37
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Gulati G, Sutaria N, Vest A, DeNofrio D, Kawabori M, Couper G, Kiernan M. Impaired Spirometry, but Not DLCO, is Associated with Risk of Death or Right Heart Failure Following LVAD Implantation. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.1133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Ross KM, Leahey TM, Kiernan M. Validation of the Stanford Leisure-Time Activity Categorical Item (L-Cat) using armband activity monitor data. Obes Sci Pract 2018; 4:276-282. [PMID: 29951218 PMCID: PMC6009990 DOI: 10.1002/osp4.155] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 12/20/2017] [Accepted: 12/26/2017] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE Accurate assessment of physical activity (PA) in public health and healthcare settings remains a challenge given limitations of existing brief assessment tools. The Stanford Leisure-Time Activity Categorical Item (L-Cat), a single item with six categories, has previously demonstrated excellent reliability and adequate validity relative to pedometer steps. However, pedometers cannot assess key dimensions of PA intensity or duration. METHODS We evaluated the L-Cat's criterion validity and sensitivity to change relative to objectively measured Sensewear armband activity monitors among 76 adults with overweight/obesity (mean age 50.8 ± 11.9 years, BMI = 33.1 ± 3.4 kg m-2) at baseline and end of a 6-month behavioural weight management pilot trial. RESULTS At baseline, L-Cat category was associated with armband-measured daily steps (Spearman's ρ = 0.41, p < 0.001), total weekly minutes of moderate/vigorous-intensity PA (MVPA) (ρ = 0.40, p < 0.001) and weekly minutes of MVPA accumulated in bouts ≥10 min (ρ = 0.47, p < 0.0001). Participants increasing ≥1 L-Cat category from baseline to 6 months had greater increases in steps (1,110.1 ± 1,852.1 vs. -18.0 ± 2,005.6 steps/d, p = 0.032), total minutes of MVPA (145.7 ± 180.6 vs. -2.1 ± 215.8 min/week, p = 0.007) and greater weight losses (-7.4 ± 7.7% vs. -3.1 ± 4.8%, p = 0.013) than those who stayed the same/decreased L-Cat categories. CONCLUSION The L-Cat demonstrated adequate criterion validity and excellent sensitivity to change relative to objectively measured PA among behavioural weight management pilot trial participants. The L-Cat may be particularly useful for identifying individuals at lower activity levels and when using all six categories.
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Affiliation(s)
- K. M. Ross
- Department of Clinical & Health Psychology, College of Public Health and Health ProfessionsUniversity of FloridaGainesvilleFLUSA
- Weight Control & Diabetes Research CenterProvidenceRIUSA
- Alpert Medical School of Brown UniversityProvidenceRIUSA
- The Miriam HospitalProvidenceRIUSA
| | - T. M. Leahey
- Weight Control & Diabetes Research CenterProvidenceRIUSA
- Department of Allied Health SciencesUniversity of ConnecticutStorrsCTUSA
- Alpert Medical School of Brown UniversityProvidenceRIUSA
- The Miriam HospitalProvidenceRIUSA
| | - M. Kiernan
- Stanford Prevention Research CenterStanford University School of MedicineStanfordCAUSA
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Shah P, Ha R, Singh R, Cotts W, Adler E, Kiernan M, Brambatti M, Meehan K, Phillips S, Kidambi S, Macaluso GP, Banerjee D, Mooney D, Pham D, Pretorius VD. Multicenter experience with durable biventricular assist devices. J Heart Lung Transplant 2018; 37:1093-1101. [PMID: 30173824 DOI: 10.1016/j.healun.2018.05.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 04/10/2018] [Accepted: 05/15/2018] [Indexed: 10/16/2022] Open
Abstract
BACKGROUND Severe right ventricular failure necessitating a right ventricular assist device (RVAD) complicates 6% to 11% of left ventricular assist device (LVAD) implants. Patient outcomes for those receiving durable continuous-flow VADs in a biventricular configuration (i.e., BiVAD) have been reported in limited case series. METHODS Data from United States centers with ≥ 6 BiVAD implants were collected. Characteristics and outcomes of patients receiving contemporaneous (i.e., same surgery) vs staged implantation of the HVAD as a BiVAD were compared. RESULTS From 2011 to 2017, 46 patients received durable BiVADs and had the following characteristics: median age, 46 years (interquartile range [IQR], 19-67 years), non-ischemic cardiomyopathy (80%), bridge to transplant (83%), Interagency Registry for Mechanically Assisted Circulatory Support Profile 1 or 2 (92%), use of temporary circulatory support (37%), right atrial pressure 19 mm Hg (IQR, 14-23 mm Hg), and cardiac index of 1.6 liters/min/m2 (IQR, 1.2-2.1 liters/min/m2). Operative mortality was 33%. Equal numbers of patients received a right atrial or right ventricular implant. Contemporaneous BiVAD implantation occurred in 31 patients (67%), and compared with 15 patients (33%) with staged implants, these patients had a shorter intensive care unit length of stay of 12 days (IQR, 7-23 days) vs 42 days (IQR, 28-48 days, p = 0.035) and were more likely to be discharged from the hospital on BiVAD support (61% vs 27%, p = 0.04). RVAD thrombosis developed in 17 patients (37%). Patients with contemporaneous BiVAD implants had a 1-year survival of 74% compared with 40% in staged BiVAD patients (p = 0.11). CONCLUSIONS Patients receiving durable BiVADs represent a critically ill patient population with severe biventricular failure who have high operative mortality and RVAD thrombosis rates. The 1-year survival for patients receiving contemporaneous BiVADs in experienced centers mirrors other contemporary durable biventricular support strategies.
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Affiliation(s)
- Palak Shah
- Department of Heart Failure and Transplantation, Inova Heart and Vascular Institute, Falls Church, Virginia.
| | - Richard Ha
- Department of Cardiac Surgery, Stanford University, Palo Alto, California
| | - Ramesh Singh
- Department of Heart Failure and Transplantation, Inova Heart and Vascular Institute, Falls Church, Virginia
| | - William Cotts
- Department of Heart Failure and Transplantation, Advocate Christ Medical Center, Chicago, Illinois
| | - Eric Adler
- Department of Heart Failure and Transplantation, University of California San Diego, San Diego, California
| | - Michael Kiernan
- Department of Heart Failure and Transplantation, Tufts University, Boston, Massachusetts
| | - Michela Brambatti
- Department of Heart Failure and Transplantation, University of California San Diego, San Diego, California
| | - Karen Meehan
- Department of Heart Failure and Transplantation, Advocate Christ Medical Center, Chicago, Illinois
| | - Sheila Phillips
- Department of Heart Failure and Transplantation, Inova Heart and Vascular Institute, Falls Church, Virginia
| | - Sumanth Kidambi
- Department of Cardiac Surgery, Stanford University, Palo Alto, California
| | - Gregory P Macaluso
- Department of Heart Failure and Transplantation, Advocate Christ Medical Center, Chicago, Illinois
| | - Dipanjan Banerjee
- Department of Cardiac Surgery, Stanford University, Palo Alto, California
| | - Dierdre Mooney
- Department of Heart Failure and Transplantation, Tufts University, Boston, Massachusetts
| | - Duc Pham
- Department of Cardiac Surgery, Northwestern University, Chicago, Illinois
| | - Victor D Pretorius
- Department of Heart Failure and Transplantation, University of California San Diego, San Diego, California
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Rame J, Birati E, Teuteberg J, Grandin E, Atluri P, Kiernan M, Oliveira G, Myers S, Naftel D, Pagani F, Kormos R, Kirklin J. Outcomes in Late Right Heart Failure after LVAD:A Contemporary Analysis of the New Intermacs 4.0 Definition. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.198] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Teuteberg J, Studdard G, Pagani F, Kiernan M, Oliveria G, Rame E, Alturi P, Gaffey A, Grandin E, Kirklin J, Myers S, Collum C, Kormos R. The Ebb and Flow of Right Heart Failure in INTERMACS: Does Right Heart Failure Get Better or Worse Over Time? J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Bailey J, Davies C, McCrossin T, Kiernan M, Skinner R, Steinbeck K, Mendis K. Fit4YAMs: Structuring a Lifestyle Intervention for Rural Overweight and Obese Young Adult Males Using Participatory Design. J Adolesc Health 2018; 62:S65-S71. [PMID: 29455721 DOI: 10.1016/j.jadohealth.2017.06.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 05/15/2017] [Accepted: 06/21/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Young adult males (YAMs) are understudied with respect to lifestyle interventions to address overweight and obesity in this group. This study reports on the participatory design of the structure and delivery of the Fit4YAMs text message-based lifestyle intervention for 18- to 25-year-old rural YAMs in Australia. METHODS Two semi-structured focus group discussions were held with six overweight or obese YAMs. Sessions explored their preferences for the structure and delivery of a weight loss intervention. Focus groups were recorded, and the contents transcribed verbatim for thematic analysis. RESULTS The YAMs were unanimous in their preference for a highly personalized intervention program, complete with personalized goal setting, personalized motivation and engagement strategies, and personalized text message content. A text message frequency of three-four messages per week was deemed optimal for this group. Minimal direct contact by the intervention team was requested, but with clear guidelines and reminders of key contacts whom they could contact should they require help and guidance. The YAMs also agreed that a comprehensive goal setting session and personalization session prior to commencement of the intervention would be best. CONCLUSIONS To engage rural YAMs in lifestyle interventions, a high degree of personalization of the program appears important. Although initially more time and resource intensive than a less personalized approach, it is essential to identify strategies to prevent and reverse weight gain in this hard to engage group. Maximizing their engagement using a more personalized approach could be the key to promoting long-term health outcomes in this group.
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Affiliation(s)
- Jannine Bailey
- Bathurst Rural Clinical School, School of Medicine, Western Sydney University, Bathurst, New South Wales, Australia.
| | - Cristyn Davies
- Discipline of Child and Adolescent Health, University of Sydney, The Children's Hospital at Westmead, New South Wales, Westmead, Australia
| | - Timothy McCrossin
- Bathurst Rural Clinical School, School of Medicine, Western Sydney University, Bathurst, New South Wales, Australia
| | - Michael Kiernan
- School of Psychology, Charles Sturt University, Bathurst, New South Wales, Australia
| | - Rachel Skinner
- Discipline of Child and Adolescent Health, University of Sydney, The Children's Hospital at Westmead, New South Wales, Westmead, Australia
| | - Katharine Steinbeck
- Discipline of Child and Adolescent Health, University of Sydney, The Children's Hospital at Westmead, New South Wales, Westmead, Australia
| | - Kumara Mendis
- Bathurst Rural Clinical School, School of Medicine, Western Sydney University, Bathurst, New South Wales, Australia
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Rowin E, Maron BJ, Abt P, Kiernan M, Vest A, Costantino F, Maron M, DeNofrio D. THE IMPACT OF ADVANCED THERAPIES IN IMPROVING SURVIVAL TO HEART TRANSPLANT IN HYPERTROPHIC CARDIOMYOPATHY. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)31222-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Chong W, Dabney L, Kiernan M, Oliva M, Ascher-Walsh C. 22: Comparison of postoperative voiding dysfunction in two different voiding trials after tension-free vaginal tape with or without concomitant surgery. Am J Obstet Gynecol 2018. [DOI: 10.1016/j.ajog.2017.12.040] [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: 11/16/2022]
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45
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Garg N, Nguyen T, Mathey E, Park S, Yiannikas C, Vucic S, Spies J, Krishan A, Pollard J, Kiernan M. Autoantibody targets in chronic inflammatory demyelinating polyneuropathy. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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46
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Leaper D, Wilson P, Assadian O, Edmiston C, Kiernan M, Miller A, Bond-Smith G, Yap J. The role of antimicrobial sutures in preventing surgical site infection. Ann R Coll Surg Engl 2017; 99:439-443. [PMID: 28660816 DOI: 10.1308/rcsann.2017.0071] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Healthcare associated infections (HCAIs) are falling following widespread and enforced introduction of guidelines, particularly those that have addressed antibiotic resistant pathogens such as methicillin resistant Staphylococcus aureus or emergent pathogens such as Clostridium difficile, but no such decline has been seen in the incidence of surgical site infection (SSI), either in the UK, the EU or the US. SSI is one of the HCAIs, which are all avoidable complications of a surgical patient's pathway through both nosocomial and community care. METHODS This report is based on a meeting held at The Royal College of Surgeons of England on 21 July 2016. Using PubMed, members of the panel reviewed the current use of antiseptics and antimicrobial sutures in their specialties to prevent SSI. FINDINGS The group agreed that wider use of antiseptics in surgical practice may help in reducing reliance on antibiotics in infection prevention and control, especially in the perioperative period of open elective colorectal, hepatobiliary and cardiac operative procedures. The wider use of antiseptics includes preoperative showering, promotion of hand hygiene, (including the appropriate use of surgical gloves), preoperative skin preparation (including management of hair removal), antimicrobial sutures and the management of dehisced surgical wounds after infection. The meeting placed emphasis on the level I evidence that supports the use of antimicrobial sutures, particularly in surgical procedures after which the SSI rate is high (colorectal and hepatobiliary surgery) or when a SSI can be life threatening even when the rate of SSI is low (cardiac surgery).
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Affiliation(s)
- D Leaper
- University of Newcastle upon Tyne , UK
| | - P Wilson
- University College of London Hospitals NHS Foundation Trust , UK
| | | | | | | | - A Miller
- University Hospitals of Leicester NHS Trust , UK
| | | | - J Yap
- Barts Health NHS Trust , UK
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Abt P, Rowin EJ, Maron B, Kiernan M, Vest A, Constantino F, Maron M, DeNofrio D. Heart Transplantation for Hypertrophic Cardiomyopathy: The Tufts Experience. J Card Fail 2017. [DOI: 10.1016/j.cardfail.2017.07.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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48
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Esposito M, Kuchibhotla S, Catalina B, Ryan O, Pedicini R, Andrew M, Annamalai S, Mark G, Kiernan M, Pham D, Anderson M, Morris D, Batsides G, Danny R, Kapur N. Increased Right Ventricular Afterload Is Associated with Poor Survival Among Patients Receiving Biventricular Impella (BiPella) Support for Cardiogenic Shock. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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49
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Teuteberg J, Studdard G, Pagani F, Kiernan M, Oliveria G, Rame E, Alturi P, Gaffey A, Grandin E, Kirlin J, Myers S, Collum C, Kormos R. The Incidence of Early and Late Clinical Right Heart Failure and the Impact on Survival After Continuous Flow Mechanical Support: Insights from the New INTERMACS Definition of Right Heart Failure. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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50
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Konstam MA, Kiernan M, Chandler A, Dhingra R, Mody FV, Eisen H, Haught WH, Wagoner L, Gupta D, Patten R, Gordon P, Korr K, Fileccia R, Pressler SJ, Gregory D, Wedge P, Dowling D, Romeling M, Konstam JM, Massaro JM, Udelson JE. Short-Term Effects of Tolvaptan in Patients With Acute Heart Failure and Volume Overload. J Am Coll Cardiol 2017; 69:1409-1419. [DOI: 10.1016/j.jacc.2016.12.035] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 12/23/2016] [Accepted: 12/29/2016] [Indexed: 12/18/2022]
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