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Tipler AE, Moses EA, Greer R, Delisser P, McCracken BD, Moses PA. Urinary catheterisation of female dogs: a comparison between three techniques for catheter placement. Aust Vet J 2020; 98:364-370. [PMID: 32458428 DOI: 10.1111/avj.12961] [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: 01/02/2020] [Revised: 04/26/2020] [Accepted: 04/26/2020] [Indexed: 12/01/2022]
Abstract
The objective of this study was to describe a new technique for urinary catheterisation of female dogs using a novel catheterisation device (NCD) and to compare the time taken to place a catheter using this technique with traditional techniques. A secondary objective was to survey participants on which of the techniques they preferred. Female canine cadavers of varying sizes were utilised and veterinary students who had not previously placed a urinary catheter were enrolled. Each participant performed three catheterisation techniques, Visual with speculum (SPEC), Blind Palpation (BP) and catheterisation with NCD on three sizes of dog. Time required using each technique was compared using Kaplan-Meier plots and mixed models Cox Proportional Hazards regression. Median times to catheterisation were 300 s (IQR 261-417 s) with the SPEC method, 420 s (IQR 253-545 s) with the NCD method and 725 s (574-1032s) with the BP method. Both SPEC and NCD methods were significantly faster compared to the BP method, with Hazard Ratios of 3.66 (95% CI 1.94-6.91, P < 0.001) and 3.57 (95% CI 1.87-6.81, P < 0.001), respectively. Six of nine participants found the NCD the easiest technique, 5/9 of the participants found the palpation technique most difficult and 4/9 found the speculum technique most difficult. BP appears to be the technique of least preference and increased time requirement. The novel urinary catheterisation device may provide a simpler method of visualisation of the urethral papilla and may provide a more sterile way of placing the catheter, although further investigation is needed to confirm this.
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Affiliation(s)
- A E Tipler
- Surgical Resident at Veterinary Specialist Services, 24/34 Goggs Road, Jindalee, Queensland, 4074, Australia
| | - E A Moses
- PhD Candidate and Research Assistant, University of Queensland, St Lucia, 4067, Australia
| | - R Greer
- Epidemiologist at Torus Research, 1026 Beams Rd, Bridgeman Downs, Queensland, 4035, Australia
| | - P Delisser
- Specialist surgeon at Veterinary Specialist Services, 24/34 Goggs Road, Jindalee, Queensland, 4074, Australia
| | - B D McCracken
- Surgical Registrar at Western Australian Veterinary Emergency and Specialty, 1/640 Beeliar Drive, Success, Western Australia, 6164, Australia
| | - P A Moses
- Director at Veterinary Specialist Services, 24/34 Goggs Road, Jindalee, Queensland, 4074, Australia
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Elisofon SA, Magee JC, Ng VL, Horslen SP, Fioravanti V, Economides J, Erinjeri J, Anand R, Mazariegos GV, Martin A, Mannino D, Flynn L, Mohammad S, Alonso E, Superina R, Brandt K, Riordan M, Lokar J, Ito J, Elisofon S, Zapata L, Jain A, Foristal E, Gupta N, Whitlow C, Naik K, Espinosa H, Miethke A, Hawkins A, Hardy J, Engels E, Schreibeis A, Ovchinsky N, Kogan‐Liberman D, Cunningham R, Malik P, Sundaram S, Feldman A, Garcia B, Yanni G, Kohli R, Emamaullee J, Secules C, Magee J, Lopez J, Bilhartz J, Hollenbeck J, Shaw B, Bartow C, Forest S, Rand E, Byrne A, Linguiti I, Wann L, Seidman C, Mazariegos G, Soltys K, Squires J, Kepler A, Vitola B, Telega G, Lerret S, Desai D, Moghe J, Cutright L, Daniel J, Andrews W, Fioravanti V, Slowik V, Cisneros R, Faseler M, Hufferd M, Kelly B, Sudan D, Mavis A, Moats L, Swan‐Nesbit S, Yazigi N, Buranych A, Hobby A, Rao G, Maccaby B, Gopalareddy V, Boulware M, Ibrahim S, El Youssef M, Furuya K, Schatz A, Weckwerth J, Lovejoy C, Kasi N, Nadig S, Law M, Arnon R, Chu J, Bucuvalas J, Czurda M, Secheli B, Almy C, Haydel B, Lobritto S, Emand J, Biney‐Amissah E, Gamino D, Gomez A, Himes R, Seal J, Stewart S, Bergeron J, Truxillo A, Lebel S, Davidson H, Book L, Ramstack D, Riley A, Jennings C, Horslen S, Hsu E, Wallace K, Turmelle Y, Nadler M, Postma S, Miloh T, Economides J, Timmons K, Ng V, Subramonian A, Dharmaraj B, McDiarmid S, Feist S, Rhee S, Perito E, Gallagher L, Smith K, Ebel N, Zerofsky M, Nogueira J, Greer R, Gilmour S, Robert C, Cars C, Azzam R, Boone P, Garbarino N, Lalonde M, Kerkar N, Dokus K, Helbig K, Grizzanti M, Tomiyama K, Cocking J, Alexopoulos S, Bhave C, Schillo R, Bailey A, Dulek D, Ramsey L, Ekong U, Valentino P, Hettiarachchi D, Tomlin R. Society of pediatric liver transplantation: Current registry status 2011-2018. Pediatr Transplant 2020; 24:e13605. [PMID: 31680409 DOI: 10.1111/petr.13605] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [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: 05/31/2019] [Revised: 08/08/2019] [Accepted: 09/27/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND SPLIT was founded in 1995 in order to collect comprehensive prospective data on pediatric liver transplantation, including waiting list data, transplant, and early and late outcomes. Since 2011, data collection of the current registry has been refined to focus on prospective data and outcomes only after transplant to serve as a foundation for the future development of targeted clinical studies. OBJECTIVE To report the outcomes of the SPLIT registry from 2011 to 2018. METHODS This is a multicenter, cross-sectional analysis characterizing patients transplanted and enrolled in the SPLIT registry between 2011 and 2018. All patients, <18 years of age, received a first liver-only, a combined liver-kidney, or a combined liver-pancreas transplant during this study period. RESULTS A total of 1911 recipients from 39 participating centers in North America were registered. Indications included biliary atresia (38.5%), metabolic disease (19.1%), tumors (11.7%), and fulminant liver failure (11.5%). Greater than 50% of recipients were transplanted as either Status 1A/1B or with a MELD/PELD exception score. Incompatible transplants were performed in 4.1%. Kaplan-Meier estimates of 1-year patient and graft survival were 97.3% and 96.6%. First 30 days of surgical complications included reoperation (31.7%), hepatic artery thrombosis (6.3%), and portal vein thrombosis (3.2%). In the first 90 days, biliary tract complications were reported in 13.6%. Acute cellular rejection during first year was 34.7%. At 1 and 2 years of follow-up, 39.2% and 50.6% had normal liver tests on monotherapy (tacrolimus or sirolimus). Further surgical, survival, allograft function, and complications are detailed.
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Affiliation(s)
- Scott A Elisofon
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, Massachusetts
| | - John C Magee
- Division of Surgery, University of Michigan Transplant Center, Ann Arbor, Michigan
| | - Vicky L Ng
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Transplant and Regenerative Medicine Center, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Simon P Horslen
- Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington
| | - Vicki Fioravanti
- Section of Hepatology and Liver Transplantation, Children's Mercy Hospital, Kansas City, Missouri
| | | | | | | | - George V Mazariegos
- Division of Pediatric Transplant Surgery, Hillman Center for Pediatric Transplantation, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
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Greer R, Gutierrez H, Maricle D, Miller D. C-26A Comparative Evaluation in Executive Function Assessment: A Closer Look at the Monitoring Indices of the BRIEF and CEFI within a Mixed Clinical Population. Arch Clin Neuropsychol 2017. [DOI: 10.1093/arclin/acx076.193] [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: 11/13/2022] Open
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Sykes BW, Underwood C, Greer R, McGowan CM, Mills PC. The effects of dose and diet on the pharmacodynamics of omeprazole in the horse. Equine Vet J 2016; 49:525-531. [DOI: 10.1111/evj.12630] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 08/19/2016] [Indexed: 12/13/2022]
Affiliation(s)
- B. W. Sykes
- School of Veterinary Science; The University of Queensland; Gatton Australia
| | - C. Underwood
- School of Veterinary Science; The University of Queensland; Gatton Australia
| | - R. Greer
- School of Veterinary Science; The University of Queensland; Gatton Australia
| | - C. M. McGowan
- Institute of Ageing and Chronic Disease; University of Liverpool; Liverpool UK
| | - P. C. Mills
- School of Veterinary Science; The University of Queensland; Gatton Australia
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Greer R, Longoria J, Maricle D, Miller D. C-66Examining the Academic Impact of Pediatric Neurological Impairment: Are There Group Differences in Reading, Writing, and Math? Arch Clin Neuropsychol 2016. [DOI: 10.1093/arclin/acw043.215] [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: 11/14/2022] Open
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6
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Longoria J, Greer R, Maricle D, Miller D. B-66Examining the Cognitive Impact of Neurological Insult in Pediatric Populations: Are There Group Differences in Attention, Processing Speed, and Working Memory? Arch Clin Neuropsychol 2016. [DOI: 10.1093/arclin/acw043.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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7
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Greer R, Daniel M, Maricle D. B-85Examining the Influence of Neurocognitive Constructs on Mathematical Ability. Arch Clin Neuropsychol 2015. [DOI: 10.1093/arclin/acv047.180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Sykes BW, Underwood C, Greer R, McGowan CM, Mills PC. Pharmacokinetics and bioequivalence testing of five commercial formulations of omeprazole in the horse. J Vet Pharmacol Ther 2015; 39:78-83. [DOI: 10.1111/jvp.12240] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Accepted: 04/23/2015] [Indexed: 11/27/2022]
Affiliation(s)
- B. W. Sykes
- School of Veterinary Sciences; The University of Queensland; Gatton Qld Australia
| | - C. Underwood
- School of Veterinary Sciences; The University of Queensland; Gatton Qld Australia
| | - R. Greer
- School of Veterinary Sciences; The University of Queensland; Gatton Qld Australia
| | - C. M. McGowan
- Institute of Ageing and Chronic Disease; University of Liverpool; Liverpool UK
| | - P. C. Mills
- School of Veterinary Sciences; The University of Queensland; Gatton Qld Australia
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Debruyne P, Johnson P, Pottel L, Daniels S, Greer R, Hodgkinson E, Kelly S, Lycke M, Samol J, Simpson J, Kimber D, Loucaides E, Parmar M, Harvey S. The United Kingdom (Uk) National Cancer Research Network (Ncrn) Chemotherapy and Pharmacy Advisory Service (Cpas): Service Development and Quality Control Experience of Pharmacy Aspects in Clinical Research Protocols. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu353.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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10
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Wang CYT, Arden KE, Greer R, Sloots TP, Mackay IM. A novel duplex real-time PCR for HPIV-4 detects co-circulation of both viral subtypes among ill children during 2008. J Clin Virol 2012; 54:83-5. [PMID: 22361219 DOI: 10.1016/j.jcv.2012.01.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Accepted: 01/23/2012] [Indexed: 11/16/2022]
Abstract
The two subtypes of the human parainfluenzavirus type 4 (HPIV-4) are rarely sought in testing for acute respiratory illness (ARI) and this may be confounding our understanding of its role. This study presents a novel duplex real-time RT-PCR assay targeting the P gene that can detect and differentiate the two subtypes in a single reaction. Subtype-specific synthetic RNA positive controls were prepared and used to determine an analytical sensitivity of 10 copies per reaction with an 8log(10) dynamic range. The assays were validated using 1140 clinical specimens mostly nasopharyngeal aspirates collected from children during 2008. These included specimens previously determined to be positive for all commonly considered respiratory viruses. The novel assay did not cross-reaction with any other virus. Fourteen HPIV-4 positives, ten detected in the absence of any co-detections (four with rhinovirus), were identified in 2008 and their subtype confirmed by conventional RT-PCR and sequencing of P gene fragments. Most detections were in children two years of age or younger. Our assay proved suitably sensitive and specific for inclusion in future studies seeking to better understand the role HPIV-4 and other respiratory viruses in children with ARI.
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Affiliation(s)
- C Y T Wang
- Queensland paediatric infectious diseases Laboratory, Queensland Children's Medical Research Institute, Sir Albert Sakzewski Virus Research Centre, Children's Health Services District, University of Queensland, Australia
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Greer R, Rahman J, Parfitt V. An unusual cause of confusion and hyponatraemia in an elderly patient. Acute Med 2012; 11:151-153. [PMID: 22993745] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
A large proportion of patients presenting on the acute medical take are frail and elderly and a significant proportion of these will have symptoms such as confusion, reduced mobility and electrolyte disturbances. These symptoms are typically attributed either to the iatrogenic effects of prescribed medications, disturbances in fluid balance and possible infective causes. We describe the case of a gentleman who presented with delirium, reduced mobility and hyponatraemia who was subsequently found to have pituitary failure secondary to pituitary apoplexy.
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Affiliation(s)
- R Greer
- FrenchayHospital Frenchay, Bristol, UK.
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12
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Abstract
The Mooncup is a menstrual cup that is an alternative to conventional sanitary protection. We aimed to determine whether the Mooncup is tolerated by asking 53 healthy female volunteers to record the frequency of changing sanitary protection and leakage over three menstrual cycles with regular sanitary protection and three cycles with the Mooncup. We measured the frequency of leakage and changing the Mooncup along with acceptability of the Mooncup. A total of 126 baseline cycles and 71 cycles with the Mooncup were recorded. The Mooncup leaked 0.5 times less frequently and required to be changed 2.8 times less frequently, on average, during one menstrual period than regular sanitary protection. Of the participants, 55% will carry on using the Mooncup for sanitary protection. Thus, we have concluded that, the Mooncup is acceptable for most women but could not be used for the objective measurement of menstrual blood loss because of the leakage that did occur.
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Affiliation(s)
- K Stewart
- Department of Obstetrics and Gynaecology, Queens Medical Centre, Nottingham, UK.
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Affiliation(s)
- K Stewart
- Menstrual Disorder Clinic, Queens Medical Centre, Nottingham, UK
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Dineen S, Roland C, Greer R, Carbon J, Toombs J, Bardeesy N, Brekken R. 174. Inhibiting XIAP with SMAC Mimetic JP-1201 Increases Sensitivity to Gemcitabine and Improves Survival in Murine Models of Pancreatic Cancer. J Surg Res 2009. [DOI: 10.1016/j.jss.2008.11.211] [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: 10/21/2022]
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Bhatta K, Greer R. Awareness and monitoring of tracheal tube cuff pressure in a multidisciplinary intensive care unit. Anaesth Intensive Care 2007; 35:302-3. [PMID: 17447298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
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Abstract
We tested the hypothesis that the number of surviving lambs counted in mid-summer from a Dall’s sheep ( Ovis dalli Nelson, 1884) population on Sheep Mountain, Yukon, Canada, is correlated to the density of snowshoe hares ( Lepus americanus Erxleben, 1777) in the surrounding boreal forest. We examined correlations between the number of lambs and the number of snowshoe hares at different phases in the 10-year snowshoe hare cycle. There were significant cross-correlations between the ratio of lambs to nursery sheep and hare densities with 1- and 2-year time lags. Lamb numbers also showed clockwise rotation with respect to hare densities when points were joined chronologically. Simple population models suggest several relationships: when hare densities are high, lamb population growth rates are inversely related to hare densities; during the low phase of the hare population cycle, lamb population growth rates show density-independent fluctuations. In the absence of compelling evidence for direct interactions between Dall’s sheep and hares, we hypothesize that the inverse relationship between lamb population growth and hare density is mediated indirectly by shared predators.
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Affiliation(s)
- J.F. Wilmshurst
- Parks Canada, 145 McDermot Avenue, Winnipeg, MB R3B 0R1, Canada
- Kluane National Park and Reserve, P.O. Box 5495, Haines Junction, YT Y0B 1L0, Canada
| | - R. Greer
- Parks Canada, 145 McDermot Avenue, Winnipeg, MB R3B 0R1, Canada
- Kluane National Park and Reserve, P.O. Box 5495, Haines Junction, YT Y0B 1L0, Canada
| | - J.D. Henry
- Parks Canada, 145 McDermot Avenue, Winnipeg, MB R3B 0R1, Canada
- Kluane National Park and Reserve, P.O. Box 5495, Haines Junction, YT Y0B 1L0, Canada
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Abstract
RATIONALE, AIMS AND OBJECTIVES To review critical incident reporting in UK intensive care units (ICUs). METHODS We conducted a postal survey of clinical directors of UK ICUs to ask if critical incident reporting was used in their ICU. Using a structured questionnaire, we also asked for details of critical incident reporting systems and for changes introduced as a result of incident reporting. RESULTS AND CONCLUSIONS Eighty-six of a total of 256 questionnaires were returned. Sixty-one units had been using a critical incident reporting system for a median duration of 3 years (interquartile range 2-5 years). There were wide variations in the structures of reporting systems between units. A median of four (interquartile range 3-8) critical incidents were reported per unit per month. In 141 changes, the development of protocols and guidelines (18) and changes in drug prescription and checking (20) were most common. A more consistent approach to reporting could improve patient care and 65 responders felt that a national reporting system was potentially useful.
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Affiliation(s)
- A N Thomas
- Intensive Care Medicine, Intensive Care Unit, Hope Hospital, Salford, UK.
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18
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Russell WC, Greer R, Harper NJN. The effect of neuromuscular blockade on oxygen supply, consumption, and total chest compliance in patients with high oxygen requirements undergoing mechanical ventilation. Anaesth Intensive Care 2002; 30:192-7. [PMID: 12002927 DOI: 10.1177/0310057x0203000211] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We investigated the effects of neuromuscular blockade with atracurium on oxygen consumption, oxygen delivery and total chest compliance in 20 sedated intensive care patients who required mechanical ventilation with an inspired oxygen fraction of at least 0.6. The reverse Fick method was used to measure oxygen consumption. Total chest compliance was measured from the ventilator pneumotachograph and pressure transducer. Measurements were made before neuromuscular blockade, at a standard level of neuromuscular blockade, and after demonstrated recovery of neuromuscular function. There was no statistical difference in any of the parameters measured. However there were large changes in oxygen consumption (range -35% to +17%) and total chest compliance (range -19.7% to +9.7%) in individuals. We conclude that in the setting of critical oxygenation, neuromuscular blockade cannot be assumed to reduce oxygen requirements or improve total lung compliance. If, however, neuromuscular blockade is selected as an adjunct to therapy, we recommend that the indices of oxygenation are calculated.
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Affiliation(s)
- W C Russell
- Intensive Care Units, Leicester Royal Infirmary, UK
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Wadsworth R, Greer R, MacDonald JMS, Vohra A. The use of remifentanil during general anaesthesia for caesarean delivery in two patients with severe heart dysfunction. Int J Obstet Anesth 2002; 11:38-43. [PMID: 15321574 DOI: 10.1054/ijoa.2001.0910] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We describe the management of two patients with severe heart dysfunction requiring caesarean section because of incipient left ventricular failure. One patient had a bicuspid valve and developed symptoms of severe aortic incompetence during pregnancy. The second patient had known hypertrophic obstructive cardiomyopathy and developed chest pain and symptoms of left ventricular failure at 32 weeks' gestation. In both cases the worsening cardiac disease prompted the decision for operative delivery. We decided to employ general anaesthesia and achieved cardiovascular stability using remifentanil as an adjunct.
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Affiliation(s)
- R Wadsworth
- Saint Mary's Hospital for Women and Children, Whitworth Park, Manchester, UK.
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20
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Abstract
We investigated the effects of peripheral oedema on the supramaximal current required for neuromuscular monitoring of critically ill patients. We studied 32 sedated patients who had not needed a neuromuscular blocking drug. The presence of oedema over the volar aspect of both wrists was assessed by a blinded observer and graded (grade 0, no oedema; grade 1, mild oedema; grade 2, gross oedema). The supramaximal current was derived by applying an incrementally increasing current over the ulnar nerve and measuring the amplitude of the electromyographic (EMG) response of the first dorsal interosseous muscle. The supramaximal current was that current above which there was no significant increase in EMG amplitude. It was 40 mA in the absence of oedema. This current was significantly increased in the presence of grade 1 oedema (60 mA, Mann-Whitney test, P<0.01) and grade 2 oedema (82.5 mA, Mann-Whitney test, P<0.01). In the presence of oedema, the required supramaximal current decreased significantly after the application of pressure over the stimulating electrodes (Wilcoxon signed rank test, P<0.05). Supramaximal current in critically ill patients is increased in the presence of peripheral oedema. We recommend that nerve stimulators used for neuromuscular monitoring in the ICU are capable of delivering a stimulus current of at least 100 mA.
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Greer R, Severn A. Postherpetic neuralgia. Why burden the pain clinic? BMJ 2001; 322:861. [PMID: 11290645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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Kapoor V, Greer R, Bazo A, Barnes DG. Transurethral vaporisation of the prostate. Anaesthesia 2000; 55:1036. [PMID: 11012522 DOI: 10.1046/j.1365-2044.2000.01727-23.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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23
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Greer R, Benson J. An assessment of attitudes to pulmonary artery flotation catheters in the United Kingdom and Ireland. Br J Anaesth 2000. [DOI: 10.1093/bja/84.5.679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Triggs WJ, McCoy KJ, Greer R, Rossi F, Bowers D, Kortenkamp S, Nadeau SE, Heilman KM, Goodman WK. Effects of left frontal transcranial magnetic stimulation on depressed mood, cognition, and corticomotor threshold. Biol Psychiatry 1999; 45:1440-6. [PMID: 10356626 DOI: 10.1016/s0006-3223(99)00031-1] [Citation(s) in RCA: 121] [Impact Index Per Article: 4.8] [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] [Indexed: 11/30/2022]
Abstract
BACKGROUND The pathophysiology of depression may include synaptic hypoactivity of left prefrontal cortex. Several groups of investigators have described improved mood associated with rapid transcranial magnetic stimulation (rTMS) but have not looked for possible cognitive side effects associated with left prefrontal magnetic stimulation. METHODS We measured the effects of left prefrontal rTMS on mood, cognition, and motor evoked potential threshold in 10 patients with medication-resistant major depression. RESULTS In a 2-week open trial of left prefrontal rTMS off antidepressant medications, scores on the Hamilton Rating Scale for Depression and the Beck Depression Inventory decreased by 41% and 40%, respectively. After resuming pre-rTMS antidepressant medication, improvement in mood was still significant at 1 and 3 months later. rTMS had no adverse effects on neuropsychological performance. rTMS treatments were associated with significant decreases in motor evoked potential threshold in the 9 of 10 patients who remained off psychotropic medications during the 2-week treatment period. CONCLUSIONS These preliminary data suggest that left prefrontal rTMS is safe and improves mood in patients with medication-resistant major depression. Changes in motor evoked potential threshold suggest that prefrontal rTMS may alter brain activity at sites remote from the stimulation. Double-blind, sham-controlled studies are needed.
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Affiliation(s)
- W J Triggs
- Human Motor Physiology Laboratory, University of Florida Health Science Center, Gainesville 32610-0236, USA
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25
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Abstract
We have compared tactile assessment of the train-of-four (TOF) count and TOF ratio by nursing staff, with measurements made by a new acceleromyographic monitor, the TOF-Watch. We assessed neuromuscular block in 30 sedated intensive care patients receiving a continuous infusion of atracurium. Five nurses made a tactile assessment of neuromuscular block in each patient within a 5-min period. Each assessment was paired with a blinded TOF-Watch measurement. The nurses were accurate in assessing twitch count in 55% of measurements and they tended to overestimate the degree of block using tactile assessment of TOF ratio.
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Affiliation(s)
- R Greer
- Intensive Care Unit, Manchester Royal Infirmary
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26
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Thomson MA, Storey P, Greer R, Cleghorn GJ. Canine-human transmission of Gastrospirillum hominis. Lancet 1994; 344:1097-8. [PMID: 7934483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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27
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28
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Abstract
We report electron microscopic evidence of transmission from a pet dog to a 12-year-girl of Gastrospirillum hominis which caused gastric disease in both that was eradicable with treatment.
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Affiliation(s)
- M A Thomson
- Gastroenterology Unit, Royal Children's Hospital, Brisbane, Australia
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29
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Quirk P, Greer R, Shepherd R, Cleghorn G. Serum immunoglobulin G directed against porcine trypsin in the serum of cystic fibrosis children receiving porcine pancreatic enzyme supplements. J Paediatr Child Health 1993; 29:196-200. [PMID: 8518002 DOI: 10.1111/j.1440-1754.1993.tb00486.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [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] [Indexed: 01/31/2023]
Abstract
Cystic fibrosis (CF) patients require pancreatic enzyme replacement therapy to correct pancreatic insufficiency. These enzymes are derived from porcine pancreas and are known to be antigenic. To determine the possible clinical consequences, a specific ELISA was developed to detect IgG antibody directed against porcine trypsin (PTAb) in the sera of CF patients. The assay was used to evaluate the occurrence of PTAb in a cross sectional study of 103 CF patients in relation to the introduction of porcine enzyme therapy, clinical status and genotype. Antibodies against porcine trypsin were detected in the sera of 63% of patients unrelated to the age of commencement or the duration of enzyme therapy. No differences were observed in the clinical status of CF patients who had developed PTAb (n = 65) and those who had no detectable PTAb (n = 38) as determined from: the current prescribed dose of porcine pancreatic enzyme capsules; Z scores for height and weight; and respiratory function tests. It is suggested that the PTAb commonly found in the sera of CF patients are of doubtful clinical significance but the prospect of PTAb contributing to immune complex disease should be examined further.
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Affiliation(s)
- P Quirk
- Department of Child Health, University of Queensland, Royal Children's Hospital, Herston, Australia
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30
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Abstract
Early deficits in nutritional status that might require specific treatment and early response to nutritional therapy were studied longitudinally in 25 infants with cystic fibrosis (CF) diagnosed by neonatal screening, using anthropometric and research body composition methodology, and evaluation of pancreatic function. At the time of confirmed diagnosis (mean 5.4 weeks), body mass, length, total body fat (TBF), and total body potassium (TBK) were all significantly reduced. Following diagnosis and commencement of therapy there was a normalization of weight, length, and TBK by 6-12 months of age, indicating catch-up growth. But in some individuals the response was incomplete, and as a group, mean total body fat remained significantly lower than normal at 1 year of age. Seven of 25 (28%) were pancreatic sufficient at diagnosis, and all but one had evidence of declining pancreatic function requiring the institution of pancreatic enzyme therapy during the next 1-9 months. The median age of commencement of enzyme therapy was 10 weeks (range 5 weeks to 11 months). These longitudinal assessments emphasize the dynamic changes occurring in absorptive function, body composition, and nutritional status following neonatal diagnosis of cystic fibrosis and may reflect previously described abnormalities of energy metabolism in this age group. Abnormal body composition is evident in most CF infants following diagnosis by neonatal screening but pancreatic damage may still be evolving. We suggest that early active nutritional therapy and surveillance for changes in pancreatic function are warranted in CF infants diagnosed by neonatal screening.
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Affiliation(s)
- R Greer
- Department of Pediatric Gastroenterology and Nutrition, Royal Children's Hospital, Brisbane, Queensland, Australia
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31
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Abstract
Pancreatic exocrine dysfunction has been frequently recorded in protein-energy malnutrition in underdeveloped countries. In addition, the pancreas requires optimal nutrition for enzyme synthesis and potentially correctable pancreatic enzyme insufficiency may play a role in the continuation of protein-energy malnutrition. This problem has not been previously evaluated in Australian Aborigines. We have applied a screening test for pancreatic dysfunction (human immunoreactive trypsinogen [IRT] assay) to the study of 398 infants (6-36 months) admitted to the Alice Springs Hospital over a 20-month period. All infants were assessed by anthropometric measures and were assigned to three nutritional groups (normal, moderate or severely malnourished) and two growth groups (stunted or not stunted). Of the 198 infants who had at least a single serum cationic trypsinogen measurement taken, normal values for serum IRT (with confidence limits) were obtained from 57 children, who were normally nourished. IRT levels were significantly correlated with the degree of underweight but there was no correlation with the degree of stunting or age. Mean IRT levels for the moderate and severely underweight groups were significantly greater than the mean for the normal group (P less than 0.01). Seventeen children (8.6%) had trypsinogen levels in excess of the 95th percentile for the normally nourished group, reflecting acinar cell damage or ductal obstruction. We conclude that pancreatic dysfunction may be a common and important overlooked factor contributing to ongoing malnutrition and disease in malnourished Australian Aboriginal children.
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Affiliation(s)
- G J Cleghorn
- Children's Nutrition Research Centre, Department of Child Health, University of Queensland, Royal Children's Hospital, Brisbane
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32
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Thomas BJ, Shepherd RW, Holt TL, Shepherd K, Greer R, Cleghorn GJ. Body composition studies in cystic fibrosis and myelomeningocele. Basic Life Sci 1990; 55:23-9. [PMID: 2088272 DOI: 10.1007/978-1-4613-1473-8_3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- B J Thomas
- Department of Physics, Queensland University of Technology, Australia
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33
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Abstract
To further evaluate the nature of malnutrition, define at-risk groups, and confirm the efficacy of nutritional supplementation on body composition in cystic fibrosis (CF), we have conducted longitudinal and cross-sectional studies of total body potassium (TBK) in 161 unselected CF subjects aged 1 month to 17 years. TBK was determined by measurement of 40K in a whole body counter, reflecting body cell mass (BCM), the vital work-performing and growing cellular component of the body. Compared with normal TBK data for age and sex from pooled measurements of 1,629 healthy children aged 1 week to 17 years, CF infants (n = 12) diagnosed by newborn screening were depleted in TBK at diagnosis and showed catch-up with therapy by 1 year; CF children aged 2-17 years (n = 140) showed a tendency for inadequate accretion of TBK (and thus BCM) with increasing age, although the normal correlation between TBK and weight and height was maintained in the majority suggesting a pattern of nutritional stunting of growth; and malnourished CF children (n = 9) showed significant catch-up in TBK with long-term nutritional rehabilitation (85-98% of TBK predicted for weight and height). These studies suggest that potentially serious, but possibly correctable deficits, in the growth of the body cell mass as measured by TBK occur commonly in CF. These deficits may be established very early in life and if not corrected lead to progressive nutritional growth retardation with increasing age.
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Affiliation(s)
- R W Shepherd
- Department of Gastroenterology and Nutrition, Royal Children's Hospital, Brisbane, Queensland, Australia
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34
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Little HL, Sacks A, Vassiliadis A, Greer R. Current concepts of pathogenesis of diabetic retinopathy: a dysproteinemia. Trans Am Ophthalmol Soc 1977; 75:397-426. [PMID: 613527 PMCID: PMC1311558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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35
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Sane S, Yunis E, Greer R. Subperiosteal or cortical cyst and intramedullary neurofibromatosis--uncommon manifestations of neurofibromatosis. A case report. J Bone Joint Surg Am 1971; 53:1194-200. [PMID: 4999155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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36
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Weber J, Greer R, Voight B, White E, Roy R. Unusual strength properties of echinoderm calcite related to structure. J Ultrastruct Res 1969; 26:355-66. [PMID: 5776310 DOI: 10.1016/s0022-5320(69)90043-4] [Citation(s) in RCA: 77] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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