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Eckman MH, Wise R, Knochelmann C, Mardis R, Leonard AC, Wright S, Gummadi A, Dixon E, Becker RC, Schauer DP, Flaherty ML, Costea A, Kleindorfer D, Ireton R, Baker P, Harnett BM, Adejare A, Sucharew H, Arduser L, Kues J. Can a best practice advisory improve anticoagulation prescribing to reduce stroke risk in patients with atrial fibrillation? J Cardiol 2024; 83:285-290. [PMID: 37579873 DOI: 10.1016/j.jjcc.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/02/2023] [Accepted: 08/08/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) is the most common cardiac rhythm disorder and a risk factor for stroke. Randomized trials have demonstrated that anticoagulation can reduce strokes in AF patients. Yet, widespread underutilization of this therapy continues. To address this practice gap, we designed a study to implement and evaluate the effectiveness of a best practice advisory (BPA) for an Atrial Fibrillation Decision Support Tool (AFDST) embedded within our electronic health record. METHODS Our intervention is provider-facing, focused on decision support. Clinical setting is ambulatory patients being seen by primary care physicians. We prospectively enrolled 608 patients in our health system who are currently receiving less than optimal anticoagulation therapy as determined by the AFDST and randomized them to one of two arms - 1) usual care, in which the AFDST is available for use; or 2) addition of a BPA to the AFDST notifying clinicians that their patient stands to gain significant benefit from a change in current therapy. Primary outcome was effectiveness of the BPA measured by change to "appropriate thromboprophylaxis" based on the AFDST recommendation at 3 months post-enrollment. Secondary endpoints included Reach and Adoption from the RE-AIM (Reach, Effectiveness, Adoption, Implementation, & Maintenance) framework for implementation studies. RESULTS Among 562 patients with a minimum follow-up of 3 months, addition of a BPA to the AFDST resulted in significant improvement in anticoagulation therapy, 5 % (12/248) versus 11 % (33/314) p = 0.02, odds ratio 2.31 (95 % CI, 1.17-4.87). CONCLUSIONS A BPA added to an AF decision support tool improved anticoagulation therapy among AF patients in a primary care academic health system setting.
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Affiliation(s)
- Mark H Eckman
- Division of General Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Ruth Wise
- Division of General Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Carol Knochelmann
- Division of Cardiovascular Health and Disease, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Rachael Mardis
- Division of Cardiovascular Health and Disease, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Anthony C Leonard
- Department of Family and Community Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Sharon Wright
- Department of Pharmacy, University Hospital, Cincinnati, OH, USA
| | - Ashish Gummadi
- Division of General Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Estrelita Dixon
- Division of General Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Richard C Becker
- Division of Cardiovascular Health and Disease, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Daniel P Schauer
- Division of General Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Matthew L Flaherty
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | | | - Dawn Kleindorfer
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Rob Ireton
- Center for Health Informatics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Pete Baker
- Center for Health Informatics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Brett M Harnett
- Center for Health Informatics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | | | - Heidi Sucharew
- Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Lora Arduser
- Department of English, University of Cincinnati, Cincinnati, OH, USA
| | - John Kues
- Department of Family and Community Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Sallie A, Wise R. Outcomes of traumatic brain injury patients in an adult intensive care unit of a South African regional hospital, without on-site neurosurgical service: A retrospective quantitative study on the neurological improvement at discharge. South Afr J Crit Care 2023; 39:e1286. [PMID: 38357691 PMCID: PMC10866207 DOI: 10.7196/sajcc.2023.v39i3.1286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2023] [Indexed: 02/16/2024] Open
Abstract
Background Traumatic brain injury (TBI) is a major cause of mortality and disability. The South African (SA) province of Kwazulu-Natal faces challenges in providing appropriate care for TBI patients owing to limited resources and delayed access to healthcare services. We aimed to assess the outcomes of patients with TBI who were treated at a hospital without a neurosurgical unit (NSU). Objectives The primary objective was to compare the Glasgow Coma Scale (GCS) scores at admission and discharge from the intensive care unit (ICU) for patients with TBI receiving neuroprotection. Secondary objectives included analysing demographics and identifying predictive factors associated with GCS score improvement. Methods This retrospective study analysed data from the already established ICU Integrated Critical Care Electronic Database. Data on patient demographics, mechanisms of injury and GCS scores were collected and analysed. Results The analysis included 95 TBI patients, most of whom were young males. Interpersonal violence and transport-related trauma were the main causes of injury among patients. Approximately 63% of patients had a GCS score improvement >1 upon discharge from the ICU. Patients who received >12 hours of neuroprotection in the emergency department had significantly lower rates of improvement. Conclusion Sixty-three percent of TBI patients had improved GCS scores by >1 on discharge from the ICU, but outcomes varied. Delayed ICU admission from the emergency department of >12 hours might contribute to worse outcomes. Timely neuroprotection, improved access to neurosurgical care and better understanding of the factors affecting outcomes are needed. Contribution of the study This study explores the outcomes of patients with TBI admitted to a non-neurosurgical ICU. Factors contributing to a worse outcome are identified, highlighting the need for adequate numbers of ICU beds and prompt admission from the emergency department.
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Affiliation(s)
- A Sallie
- Discipline of Anaesthesiology, and Critical Care, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, South Africa
| | - R Wise
- Faculty Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Belgium
- Adult Intensive Care Unit, John Radcliffe Hospital, Oxford University Hospitals Trust, Oxford, United Kingdom
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Lyon PC, Murchison AG, Chen M, Wise R, Barge T, Nazir SA. A bump in the night: a 15-year retrospective analysis of urgent inpatient and emergency CT reporting out of hours in a tertiary referral centre. Clin Radiol 2022; 77:810-822. [PMID: 36064658 DOI: 10.1016/j.crad.2022.06.023] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 05/27/2022] [Accepted: 06/09/2022] [Indexed: 11/03/2022]
Abstract
AIM To assess the impact on specialty trainee (ST) experience of out-of-hours (OOH) working, focusing on what might be improved with both patient safety and staff wellbeing in mind. MATERIALS AND METHODS The number of acute computed tomography (CT) examinations reported OOH over the last 15 years (2007-2021) at Oxford University Hospitals NHS Foundation Trust was analysed. Qualitative data from the radiology STs participating in the acute OOH rotas were obtained using questionnaires during winter months in 2019 and 2021, before and after the introduction of an OOH CT outsourcing service in 2020. RESULTS Overnight acute CT has increased over 10-fold over the last decade to almost 50 CT examinations in 2021, and similar increases were observed during evening and weekend shifts. The option to outsource acute CT on an ad hoc basis was introduced in 2020 to manage the increase in demand. This resulted in a statistically significant improvement in the STs' level of reported satisfaction for OOH shifts (p<0.018), despite significantly increased perception of how busy the shifts were (p<0.035). CONCLUSION OOH acute CT reporting at Oxford NHS Foundation Trust has increased dramatically over the previous 15 years. Working patterns and resources have changed incrementally to absorb this increase in demand, most recently with the option for outsourcing at times of peak demand. The trend for increasing OOH CT demand has considerable implications for future resource planning.
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Affiliation(s)
- P C Lyon
- Department of Radiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
| | - A G Murchison
- Department of Radiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - M Chen
- Department of Radiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - R Wise
- Department of Radiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - T Barge
- Department of Radiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - S A Nazir
- Department of Radiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Eckman MH, Wise R, Leonard AC, Baker P, Ireton R, Harnett BM, Dixon E, Awosika B, Ezigbo C, Flaherty ML, Adejare A, Knochelmann C, Mardis R, Wright S, Gummadi A, Becker R, Schauer DP, Costea A, Kleindorfer D, Sucharew H, Costanzo A, Anderson L, Kues J. Racial and sex differences in optimizing anticoagulation therapy for patients with atrial fibrillation. Am Heart J Plus 2022; 18:100170. [PMID: 38559416 PMCID: PMC10978356 DOI: 10.1016/j.ahjo.2022.100170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/28/2022] [Accepted: 06/28/2022] [Indexed: 04/04/2024]
Abstract
Study objective Atrial fibrillation (AF) is the most common cardiac rhythm disorder, responsible for 15 % of strokes in the United States. Studies continue to document underuse of anticoagulation therapy in minority populations and women. Our objective was to compare the proportion of AF patients by race and sex who were receiving non-optimal anticoagulation as determined by an Atrial Fibrillation Decision Support Tool (AFDST). Design setting and participants Retrospective cohort study including 14,942 patients within University of Cincinnati Health Care system. Data were analyzed between November 18, 2020, and November 20, 2021. Main outcomes and measures Discordance between current therapy and that recommended by the AFDST. Results In our two-category analysis 6107 (41 %) received non-optimal anticoagulation therapy, defined as current treatment category ≠ AFDST-recommended treatment category. Non-optimal therapy was highest in Black (42 % [n = 712]) and women (42 % [n = 2668]) and lower in White (39 % [n = 4748]) and male (40 % [n = 3439]) patients. Compared with White patients, unadjusted and adjusted odds ratios of receiving non-optimal anticoagulant therapy for Black patients were 1.13; 95 % CI, 1.02-1.30, p = 0.02; and 1.17; 95%CI, 1.04-1.31, p = 0.01; respectively, and 1.10; 95 % CI 1.03-1.18, p = 0.005; and 1.36; 95 % CI, 1.25-1.47, p < 0.001; for females compared with males. Conclusions and relevance In patients with atrial fibrillation in the University of Cincinnati Health system, Black race and female sex were independently associated with an increased odds of receiving non-optimal anticoagulant therapy.
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Affiliation(s)
- Mark H. Eckman
- Division of General Internal Medicine, University of Cincinnati College of Medicine, United States of America
| | - Ruth Wise
- Division of General Internal Medicine, University of Cincinnati College of Medicine, United States of America
| | - Anthony C. Leonard
- Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, United States of America
| | - Pete Baker
- Center for Health Informatics, University of Cincinnati College of Medicine, United States of America
| | - Rob Ireton
- Center for Health Informatics, University of Cincinnati College of Medicine, United States of America
| | - Brett M. Harnett
- Center for Health Informatics, University of Cincinnati College of Medicine, United States of America
| | - Estrelita Dixon
- Division of General Internal Medicine, University of Cincinnati College of Medicine, United States of America
| | - Bi Awosika
- Division of General Internal Medicine, University of Cincinnati College of Medicine, United States of America
| | - Chika Ezigbo
- Division of General Internal Medicine, University of Cincinnati College of Medicine, United States of America
| | - Matthew L. Flaherty
- Department of Neurology, University of Cincinnati College of Medicine, United States of America
| | - Adeboye Adejare
- Department of Biomedical Informatics, University of Cincinnati College of Medicine, United States of America
| | - Carol Knochelmann
- Division of Cardiovascular Diseases, University of Cincinnati College of Medicine, United States of America
| | - Rachael Mardis
- Division of Cardiovascular Diseases, University of Cincinnati College of Medicine, United States of America
| | - Sharon Wright
- University of Cincinnati Health System, United States of America
| | - Ashish Gummadi
- Division of General Internal Medicine, University of Cincinnati College of Medicine, United States of America
| | - Richard Becker
- Division of Cardiovascular Diseases, University of Cincinnati College of Medicine, United States of America
| | - Daniel P. Schauer
- Division of General Internal Medicine, University of Cincinnati College of Medicine, United States of America
| | - Alexandru Costea
- Division of Cardiovascular Diseases, University of Cincinnati College of Medicine, United States of America
| | - Dawn Kleindorfer
- Department of Neurology, University of Michigan College of Medicine, United States of America
| | - Heidi Sucharew
- Cincinnati Children's Hospital Medical Center, United States of America
| | - Amy Costanzo
- University of Cincinnati College of Nursing, United States of America
| | | | - John Kues
- Department of Family and Community Medicine, University of Cincinnati College of Medicine, United States of America
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Eckman MH, Wise R, Knochelmann C, Mardis R, Wright S, Gummadi A, Dixon E, Becker R, Schauer DP, Flaherty ML, Costea A, Kleindorfer D, Ireton R, Baker P, Harnett BM, Adejare A, Leonard AC, Sucharew H, Costanzo A, Arduser L, Kues J. Electronic health record-embedded decision support to reduce stroke risk in patients with atrial fibrillation - Study protocol. Am Heart J 2022; 247:42-54. [PMID: 35081360 DOI: 10.1016/j.ahj.2022.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 01/19/2022] [Accepted: 01/20/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) is the most common significant cardiac rhythm disorder and is a powerful common risk factor for stroke. Randomized trials have demonstrated that anticoagulation can reduce the risk of stroke in patients with AF. Yet, there continues to be widespread underutilization of this therapy. To address this practice gap locally and improve efforts to reduce the risk of stroke for patients with AF in our health system, we have designed a study to implement and evaluate the effectiveness of an Atrial Fibrillation Decision Support Tool (AFDST) embedded within our electronic health record. METHODS Our intervention is provider-facing and focused on decision support. The clinical setting is ambulatory patients being seen by primary care physicians. Patients include those with both incident and prevalent AF. This randomized, prospective trial will enroll 800 patients in our University of Cincinnati Health System who are currently receiving less than optimal anticoagulation therapy as determined by the AFDST. Patients will be randomized to one of two arms - 1) usual care, in which the AFDST is available for use; 2) addition of a best practice advisory (BPA) to the AFDST notifying the clinician that their patient stands to gain a significant benefit from a change in their current thromboprophylactic therapy. RESULTS The primary outcome is effectiveness of the BPA measured by change to "appropriate thromboprophylaxis" based on the AFDST recommendation at 3 months post randomization. Secondary endpoints include Reach and Adoption, from the RE-AIM framework for implementation studies. Sample size is based upon an improvement from inappropriate to appropriate anticoagulation therapy estimated at 4% in the usual care arm and ≥10% in the experimental arm. CONCLUSION Our goal is to examine whether addition of a BPA to an AFDST focused on primary care physicians in an ambulatory care setting will improve "appropriate thromboprophylaxis" compared with usual care. Results will be examined at 3 months post randomization and at the end of the study to evaluate durability of changes. We expect to complete patient enrollment by the end of June 2022. TRIAL REGISTRATION Clinicaltrials.gov NCT04099485.
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Levitte S, Sellers Z, Fuchs Y, Wise R. 212: Impact of lumacaftor/ivacaftor and tezacaftor/ivacaftor on pediatric liver health. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01637-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Wise R, Bishop D, Gibbs M, Govender K, James MFM, Kabambi F, Louw V, Mdladla N, Moipalai L, Motchabi-Chakane P, Nolte D, Rodseth R, Schneider F, Turton E. South African Society of Anaesthesiologists Perioperative Patient Blood Management Guidelines 2020. South Afr J Anaesth Analg 2020. [DOI: 10.36303/sajaa.2020.26.6.s1] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Anaesthesiologists regularly request and administer blood components to their patients, a potentially life-saving intervention. All anaesthesiologists must be familiar with the indications and appropriate use of blood and blood components and their alternatives, but close liaison with haematologists and their local haematology blood sciences laboratory is encouraged. In the last decade, there have been considerable changes in approaches to optimal use of blood components, together with the use of alternative products, with a need to update previous guidelines and adapt them for anaesthesiologists working throughout the hospital system.
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Affiliation(s)
- R Wise
- University of KwaZulu-Natal
| | | | | | | | | | | | | | - N Mdladla
- Sefako Makgatho Health Sciences University
| | | | | | - D Nolte
- University of the Witwatersrand
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Chipps B, Murphy K, Wise R, McCann W, Beuther D, Reibman J, George M, Eudicone J, Gandhi H, Harding G, Ross M, Zeiger R. P223 EVALUATING PERFORMANCE OF THE ASTHMA IMPAIRMENT AND RISK QUESTIONNAIRE (AIRQ™) AT 3-MONTH INTERVALS. Ann Allergy Asthma Immunol 2020. [DOI: 10.1016/j.anai.2020.08.120] [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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Carpenter AM, Asghar AK, Mudali JN, Reade MC, Wise R. Opinions of doctors working in South African critical care units regarding unconsented testing and empirical treatment of HIV-positive patients in ICU. Southern African Journal of Anaesthesia and Analgesia 2020. [DOI: 10.36303/sajaa.2020.26.1.2291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- AM Carpenter
- University of KwaZulu-Natal
- University of Cape Town
- University of Queensland, Australia
| | - AK Asghar
- University of KwaZulu-Natal
- University of Cape Town
- University of Queensland, Australia
| | - JN Mudali
- University of KwaZulu-Natal
- University of Cape Town
- University of Queensland, Australia
| | - MC Reade
- University of KwaZulu-Natal
- University of Cape Town
- University of Queensland, Australia
| | - R Wise
- University of KwaZulu-Natal
- University of Cape Town
- University of Queensland, Australia
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Geldenhuys L, Wise R, Rodseth R. The impact of a bundled intrahospital transfer protocol on the safety of critically ill patients in a South African Metropolitan Hospital System. Southern African Journal of Anaesthesia and Analgesia 2020. [DOI: 10.36303/sajaa.2020.26.3.2343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- L Geldenhuys
- University of KwaZulu-Natal
- Oxford University Trust Hospitals, UK
- Drs Jones, Bhagwan and Partners
| | - R Wise
- University of KwaZulu-Natal
- Oxford University Trust Hospitals, UK
- Drs Jones, Bhagwan and Partners
| | - R Rodseth
- University of KwaZulu-Natal
- Oxford University Trust Hospitals, UK
- Drs Jones, Bhagwan and Partners
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Joynt GM, Gopalan PD, Argent A, Chetty S, Wise R, Lai VKW, Hodgson E, Lee A, Joubert I, Mokgokong S, Tshukutsoane S, Richards GA, Menezes C, Mathivha LR, Espen B, Levy B, Asante K, Paruk F. The Critical Care Society of Southern Africa Consensus Guideline on ICU Triage and Rationing (ConICTri). South Afr J Crit Care 2019; 35:10.7196/SAJCC.2019.v35i1b.380. [PMID: 37719328 PMCID: PMC10503493 DOI: 10.7196/sajcc.2019.v35i1b.380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2019] [Indexed: 11/08/2022] Open
Abstract
Background In South Africa (SA), administrators and intensive care practitioners are faced with the challenge of resource scarcity as well as an increasing demand for intensive care unit (ICU) services. ICU services are expensive, and practitioners in low- to middle-income countries experience the consequences of limited resources daily. Critically limited resources necessitate that rationing and triage (prioritisation) decisions are routinely necessary in SA, particularly in the publicly funded health sector. Purpose The purpose of this guideline is to utilise the relevant recommendations of the associated consensus meeting document and other internationally accepted principles to develop a guideline to inform frontline triage policy and ensure the best utilisation of adult intensive care in SA, while maintaining the fair distribution of available resources. Recommendations An overall conceptual framework for the triage process was developed. The components of the framework were developed on the basis that patients should be admitted preferentially when the likely incremental medical benefit derived from ICU admission justifies admission. An estimate of likely resource use should also form part of the triage decision, with those patients requiring relatively less resources to achieve substantial benefit receiving priority for admission. Thus, the triage system should maximise the benefits obtained from ICU resources available for the community. Where possible, practical examples of what the consensus group agreed would be considered appropriate practice under specified South African circumstances were provided, to assist clinicians with practical decision-making. It must be stressed that this guideline is not intended to be prescriptive for individual hospital or regional practice, and hospitals and regions are encouraged to develop specified local guidelines with locally relevant examples. The guideline should be reviewed and revised if appropriate within 5 years. Conclusion In recognition of the absolute need to limit patient access to ICU because of the lack of sufficient intensive care resources in public hospitals, this guideline has been developed to guide policy-making and assist frontline triage decision-making in SA. This document is not a complete plan for quality practice, but rather a template to support frontline clinicians, guide administrators and inform the public regarding appropriate triage decision-making.
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Affiliation(s)
- G M Joynt
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong
| | - P D Gopalan
- Department of Anaesthesiology and Critical Care, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - A Argent
- Department of Paediatrics and Child Health, University of Cape Town, South Africa
| | - S Chetty
- Department of Anaesthesiology and Critical Care, Stellenbosch University, Cape Town, South Africa
| | - R Wise
- Department of Anaesthesiology and Critical Care, School of Clinical Medicine, University of KwaZulu-Natal, Durban, and Edendale Hospital,
Pietermaritzburg, South Africa
| | - V K W Lai
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong
| | - E Hodgson
- Department of Anaesthesiology and Critical Care, School of Clinical Medicine, University of KwaZulu-Natal, Durban, and Inkosi Albert Luthuli
Central Hospital, Durban, South Africa
| | - A Lee
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong
| | - I Joubert
- Department of Anaesthesia and Peri-operative Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - S Mokgokong
- Department of Neurosurgery, University of Pretoria, South Africa
| | - S Tshukutsoane
- Chris Hani Baragwanath Academic Hospital, Soweto, Johannesburg, South Africa
| | - G A Richards
- Department of Critical Care, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - C Menezes
- Chris Hani Baragwanath Academic Hospital, Soweto, Johannesburg, South Africa
- Department of Critical Care, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - L R Mathivha
- Department of Critical Care, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - B Espen
- Centre for Health Professions Education, Stellenbosch University, Cape Town, South Africa
| | - B Levy
- Netcare Rosebank Hospital, Johannesburg, South Africa
| | - K Asante
- African Organization for Research and Training in Cancer, Cape Town, South Africa
| | - F Paruk
- Department of Critical Care, University of Pretoria, South Africa
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12
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Joynt GM, Gopalan PD, Argent A, Chetty S, Wise R, Lai VKW, Hodgson E, Lee A, Joubert I, Mokgokong S, Tshukutsoane S, Richards GA, Menezes C, Mathivha LR, Espen B, Levy B, Asante K, Paruk F. The Critical Care Society of Southern Africa Consensus Statement on ICU Triage and Rationing (ConICTri). South Afr J Crit Care 2019; 35:10.7196/SAJCC.2019.v35.i1b.383. [PMID: 37719327 PMCID: PMC10503494 DOI: 10.7196/sajcc.2019.v35.i1b.383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2019] [Indexed: 09/19/2023] Open
Abstract
Background In South Africa (SA), intensive care is faced with the challenge of resource scarcity as well as an increasing demand for intensive care unit (ICU) services. ICU services are expensive, and practitioners in low- to middle-income countries experience daily the consequences of limited resources. Critically limited resources necessitate that rationing and triage (prioritisation) decisions are frequently necessary in SA, particularly in the publicly funded health sector. Purpose The purpose of this consensus statement is to examine key questions that arise when considering the status of ICU resources in SA, and more specifically ICU admission, rationing and triage decisions. The accompanying guideline in this issue is intended to guide frontline triage policy and ensure the best utilisation of intensive care in SA, while maintaining a fair distribution of available resources. Fair and efficient triage is important to ensure the ongoing provision of high-quality care to adult patients referred for intensive care. Recommendations In response to 14 key questions developed using a modified Delphi technique, 29 recommendations were formulated and graded using an adapted GRADE score. The 14 key questions addressed the status of the provision of ICU services in SA, the degree of resource restriction, the efficiency of resource management, the need for triage, and how triage could be most justly implemented. Important recommendations included the need to formally recognise and accurately quantify the provision of ICU services in SA by national audit; actively seek additional resources from governmental bodies; consider methods to maximise the efficiency of ICU care; evaluate lower level of care alternatives; develop a triage guideline to assist policy-makers and frontline practitioners to implement triage decisions in an efficient and fair way; measure and audit the consequence of triage; and promote research to improve the accuracy and consistency of triage decisions. The consensus document and guideline should be reviewed and revised appropriately within 5 years. Conclusion In recognition of the absolute need to limit patient access to ICU because of the lack of sufficient intensive care resources in public hospitals, recommendations and a guideline have been developed to guide policy-making and assist frontline triage decision-making in SA. These documents are not a complete plan for quality practice but rather the beginning of a long-term initiative to engage clinicians, the public and administrators in appropriate triage decision-making, and promote systems that will ultimately maximise the efficient and fair use of available ICU resources.
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Affiliation(s)
- G M Joynt
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong
| | - P D Gopalan
- Department of Anaesthesiology and Critical Care, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - A Argent
- Department of Paediatrics and Child Health, University of Cape Town, South Africa
| | - S Chetty
- Department of Anaesthesiology and Critical Care, Stellenbosch University, Cape Town, South Africa
| | - R Wise
- Department of Anaesthesiology and Critical Care, School of Clinical Medicine, University of KwaZulu-Natal, Durban, and Edendale Hospital,
Pietermaritzburg, South Africa
| | - V K W Lai
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong
| | - E Hodgson
- Department of Anaesthesiology and Critical Care, School of Clinical Medicine, University of KwaZulu-Natal, Durban, and Inkosi Albert Luthuli
Central Hospital, Durban, South Africa
| | - A Lee
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong
| | - I Joubert
- Department of Anaesthesia and Peri-operative Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - S Mokgokong
- Department of Neurosurgery, University of Pretoria, South Africa
| | - S Tshukutsoane
- Chris Hani Baragwanath Academic Hospital, Soweto, Johannesburg, South Africa
| | - G A Richards
- Department of Critical Care, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - C Menezes
- Chris Hani Baragwanath Academic Hospital, Soweto, Johannesburg, South Africa
- Department of Critical Care, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - L R Mathivha
- Department of Critical Care, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - B Espen
- Centre for Health Professions Education, Stellenbosch University, Cape Town, South Africa
| | - B Levy
- Netcare Rosebank Hospital, Johannesburg, South Africa
| | - K Asante
- African Organization for Research and Training in Cancer, Cape Town, South Africa
| | - F Paruk
- Department of Critical Care, University of Pretoria, South Africa
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Thomson J, Hofmann A, Barrett CA, Beeton A, Bellairs GRM, Boretti L, Coetzee MJ, Farmer S, Gibbs MW, H Gombotz H, Hilton C, Kassianides C, Louw VJ, Lundgren C, Mahlangu JN, Noel CB, Rambiritch V, Schneider F, Verburgh E, Wessels PL, Wessels P, Wise R, Shander On Behalf Of The South African Patient Blood Management Group A. Patient blood management: A solution for South Africa. S Afr Med J 2019; 109:471-476. [PMID: 31266571 PMCID: PMC10414180 DOI: 10.7196/samj.2019.v109i7.13859] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Indexed: 11/08/2022] Open
Abstract
For more than 70 years the default therapy for anaemia and blood loss was mostly transfusion. Accumulating evidence demonstrates a significant dose-dependent relationship between transfusion and adverse outcomes. This and other transfusion-related challenges led the way to a new paradigm. Patient blood management (PBM) is the application of evidence-based practices to optimise patient outcomes by managing and preserving the patient's own blood. 'Real-world' studies have shown that PBM improves patient outcomes and saves money. The prevalence of anaemia in adult South Africans is 31% in females and 17% in males. Improving the management of anaemia will firstly improve public health, secondly relieve the pressure on the blood supply, and thirdly improve the productivity of the nation's workforce. While high-income countries are increasingly implementing PBM, many middle- and low-income countries are still trying to upscale their transfusion services. The implementation of PBM will improve South Africa's health status while saving costs.
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Affiliation(s)
- J Thomson
- South African National Blood Service, Johannesburg, South Africa.
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Timofte I, Vesselinov R, Terrin M, Wijesinha M, Kaczorowski D, Mandathil R, Wise R, Sternberg A, Griffith B, Iacono A. Single versus Double Lung Transplantation for Chronic Obstructive Lung Disease(COPD). J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.550] [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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Wise R, Bishop D, Rodseth R. Perioperative populations are not homogeneous. Br J Anaesth 2019; 117:402. [PMID: 27543542 DOI: 10.1093/bja/aew237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- R Wise
- Kwazulu Natal, South Africa
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Olgiati E, Violante I, Li L, Faraj A, Sinclair T, Crow J, Wise R, Malhotra P. Targeted brain stimulation to ameliorate vigilance in stroke: a combined tDCS-fMRI approach. Brain Stimul 2019. [DOI: 10.1016/j.brs.2018.12.899] [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: 11/16/2022] Open
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Bunnell B, Wise R, Bowles A. Adipose stromal vascular fraction and adipose stem cells markedly decrease inflammation and alter immune cell frequencies in a murine model of multiple sclerosis. Cytotherapy 2018. [DOI: 10.1016/j.jcyt.2018.02.076] [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: 11/27/2022]
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18
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Timofte I, Wijesinha M, Vesselinov R, Kim J, Kon Z, Reed R, Rajagopal K, Scharf S, Wise R, Sternberg A, Kaczorowski D, Griffith B, Terrin M, Iacono A. Lower Six Minute Walk distance or FEV1 Predict a Survival Benefit of Lung Transplantation compared to Medical Management for End Stage COPD. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.401] [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: 10/17/2022] Open
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Aboumatar H, Naqibuddin M, Chung S, Adebowale H, Bone L, Brown T, Cooper LA, Gurses AP, Knowlton A, Kurtz D, Piet L, Putcha N, Rand C, Roter D, Shattuck E, Sylvester C, Urteaga-Fuentes A, Wise R, Wolff JL, Yang T, Hibbard J, Howell E, Myers M, Shea K, Sullivan J, Syron L, Wang NY, Pronovost P. Better Respiratory Education and Treatment Help Empower (BREATHE) study: Methodology and baseline characteristics of a randomized controlled trial testing a transitional care program to improve patient-centered care delivery among chronic obstructive pulmonary disease patients. Contemp Clin Trials 2017; 62:159-167. [PMID: 28887069 DOI: 10.1016/j.cct.2017.08.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 08/23/2017] [Accepted: 08/25/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of hospitalizations. Interventional studies focusing on the hospital-to-home transition for COPD patients are few. In the BREATHE (Better Respiratory Education and Treatment Help Empower) study, we developed and tested a patient and family-centered transitional care program that helps prepare hospitalized COPD patients and their family caregivers to manage COPD at home. METHODS In the study's initial phase, we co-developed the BREATHE transitional care program with COPD patients, family-caregivers, and stakeholders. The program offers tailored services to address individual patients' needs and priorities at the hospital and for 3months post discharge. We tested the program in a single-blinded RCT with 240 COPD patients who were randomized to receive the program or 'usual care'. Program participants were offered the opportunity to invite a family caregiver, if available, to enroll with them into the study. The primary outcomes were the combined number of COPD-related hospitalizations and Emergency Department (ED) visits per participant at 6months post discharge, and the change in health-related quality of life over the 6months study period. Other measures include 'all cause' hospitalizations and ED visits; patient activation; self-efficacy; and, self-care behaviors. DISCUSSION Unlike 1month transitional care programs that focus on patients' post-acute care needs, the BREATHE program helps hospitalized COPD patients manage the post discharge period as well as prepare them for long term self-management of COPD. If proven effective, this program may offer a timely solution for hospitals in their attempts to reduce COPD rehospitalizations.
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Affiliation(s)
- H Aboumatar
- Armstrong Institute for Patient Safety and Quality, The Johns Hopkins School of Medicine, United States; Division of General Internal Medicine, Dept. of Medicine, Johns Hopkins University School of Medicine, United States; Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, United States; Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, United States.
| | - M Naqibuddin
- Armstrong Institute for Patient Safety and Quality, The Johns Hopkins School of Medicine, United States
| | - S Chung
- Armstrong Institute for Patient Safety and Quality, The Johns Hopkins School of Medicine, United States
| | - H Adebowale
- Johns Hopkins Bayview Medical Center, United States
| | - L Bone
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, United States; Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, United States
| | - T Brown
- Armstrong Institute for Patient Safety and Quality, The Johns Hopkins School of Medicine, United States
| | - L A Cooper
- Division of General Internal Medicine, Dept. of Medicine, Johns Hopkins University School of Medicine, United States; Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, United States; Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, United States
| | - A P Gurses
- Armstrong Institute for Patient Safety and Quality, The Johns Hopkins School of Medicine, United States; Anesthesiology and Critical Care, The Johns Hopkins School of Medicine, United States; Division of Health Sciences Informatics, The Johns Hopkins School of Medicine, United States; Malone Center for Engineering in Healthcare, Whiting School of Engineering, Johns Hopkins University, United States
| | - A Knowlton
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, United States
| | - D Kurtz
- Johns Hopkins Bayview Medical Center, United States
| | - L Piet
- Johns Hopkins Bayview Medical Center, United States
| | - N Putcha
- Pulmonary and Critical Care Medicine, The Johns Hopkins School of Medicine, United States
| | - C Rand
- Pulmonary and Critical Care Medicine, The Johns Hopkins School of Medicine, United States
| | - D Roter
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, United States; Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, United States
| | - E Shattuck
- Patient Advocate/Co-investigator, BREATHE Project, United States
| | - C Sylvester
- Johns Hopkins Bayview Medical Center, United States
| | - A Urteaga-Fuentes
- Armstrong Institute for Patient Safety and Quality, The Johns Hopkins School of Medicine, United States
| | - R Wise
- Pulmonary and Critical Care Medicine, The Johns Hopkins School of Medicine, United States
| | - J L Wolff
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, United States
| | - T Yang
- Armstrong Institute for Patient Safety and Quality, The Johns Hopkins School of Medicine, United States
| | - J Hibbard
- Health Policy Research Group, University of Oregon
| | - E Howell
- Armstrong Institute for Patient Safety and Quality, The Johns Hopkins School of Medicine, United States; Johns Hopkins Bayview Medical Center, United States
| | - M Myers
- Johns Hopkins Home Care Group, United States
| | - K Shea
- Johns Hopkins Bayview Medical Center, United States
| | | | - L Syron
- Johns Hopkins Home Care Group, United States
| | - Nae-Yuh Wang
- Division of General Internal Medicine, Dept. of Medicine, Johns Hopkins University School of Medicine, United States; Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, United States
| | - P Pronovost
- Armstrong Institute for Patient Safety and Quality, The Johns Hopkins School of Medicine, United States; Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, United States; Anesthesiology and Critical Care, The Johns Hopkins School of Medicine, United States
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Koczulla R, Calverley P, Anzueto A, Dahl R, Müller A, Fowler A, Metzdorf N, Wise R, Dusser D. T Safety And Performance In Respimat® (TIOSPIR™): Safety And Efficacy In Patients With T HH® Use At Baseline. Pneumologie 2016. [DOI: 10.1055/s-0036-1572049] [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: 10/22/2022]
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Correa-Martín L, Párraga E, Sánchez-Margallo FM, Latorre R, López-Albors O, Wise R, Malbrain MLNG, Castellanos G. Mechanical Intestinal Obstruction in a Porcine Model: Effects of Intra-Abdominal Hypertension. A Preliminary Study. PLoS One 2016; 11:e0148058. [PMID: 26849559 PMCID: PMC4744005 DOI: 10.1371/journal.pone.0148058] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 12/03/2015] [Indexed: 12/16/2022] Open
Abstract
Introduction Mechanical intestinal obstruction is a disorder associated with intra-abdominal hypertension and abdominal compartment syndrome. As the large intestine intraluminal and intra-abdominal pressures are increased, so the patient’s risk for intestinal ischaemia. Previous studies have focused on hypoperfusion and bacterial translocation without considering the concomitant effect of intra-abdominal hypertension. The objective of this study was to design and evaluate a mechanical intestinal obstruction model in pigs similar to the human pathophysiology. Materials and Methods Fifteen pigs were divided into three groups: a control group (n = 5) and two groups of 5 pigs with intra-abdominal hypertension induced by mechanical intestinal obstruction. The intra-abdominal pressures of 20 mmHg were maintained for 2 and 5 hours respectively. Hemodynamic, respiratory and gastric intramucosal pH values, as well as blood tests were recorded every 30 min. Results Significant differences between the control and mechanical intestinal obstruction groups were noted. The mean arterial pressure, cardiac index, dynamic pulmonary compliance and abdominal perfusion pressure decreased. The systemic vascular resistance index, central venous pressure, pulse pressure variation, airway resistance and lactate increased within 2 hours from starting intra-abdominal hypertension (p<0.05). In addition, we observed increased values for the peak and plateau airway pressures, and low values of gastric intramucosal pH in the mechanical intestinal obstruction groups that were significant after 3 hours. Conclusion The mechanical intestinal obstruction model appears to adequately simulate the pathophysiology of intestinal obstruction that occurs in humans. Monitoring abdominal perfusion pressure, dynamic pulmonary compliance, gastric intramucosal pH and lactate values may provide insight in predicting the effects on endorgan function in patients with mechanical intestinal obstruction.
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Affiliation(s)
- L. Correa-Martín
- Laparoscopy Department, Jesús Usón Minimally Invasive Surgery Centre (JUMISC), Cáceres, Spain
- * E-mail: ;
| | - E. Párraga
- Department of Anatomy and Comparative Pathology, Veterinary Faculty, University of Murcia, Murcia, Spain
| | - F. M. Sánchez-Margallo
- Laparoscopy Department, Jesús Usón Minimally Invasive Surgery Centre (JUMISC), Cáceres, Spain
| | - R. Latorre
- Department of Anatomy and Comparative Pathology, Veterinary Faculty, University of Murcia, Murcia, Spain
| | - O. López-Albors
- Department of Anatomy and Comparative Pathology, Veterinary Faculty, University of Murcia, Murcia, Spain
| | - R. Wise
- Critical Care Unit, Edendale Hospital, Pietermaritzburg, South Africa, and Department of Anaesthetics and Critical Care, Perioperative Research Group, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - M. L. N. G. Malbrain
- Medical and surgical ICU and high care Burn Unit, Ziekenhuis Netwerk Antwerpen, Antwerpen, Belgium
| | - G. Castellanos
- Department of General Surgery, Virgen de la Arrixaca General University Hospital, Murcia, Spain
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Hart E, Rodrigues J, Ratcliffe L, Burchell A, Manghat N, Wise R, Nightingale A, Paton J. Cerebrovascular Abnormalities Supporting the Selfish Brain Hypothesis of Human Hypertension. FASEB J 2015. [DOI: 10.1096/fasebj.29.1_supplement.646.6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- E Hart
- CardioNomics University of BristolUnited Kingdom
| | - J Rodrigues
- CardioNomics University of BristolUnited Kingdom
| | - L Ratcliffe
- CardioNomics University of BristolUnited Kingdom
| | - A Burchell
- CardioNomics University of BristolUnited Kingdom
| | - N Manghat
- CardioNomics University of BristolUnited Kingdom
| | - R Wise
- CUBRIC Cardiff UniversityUnited Kingdom
| | | | - J Paton
- CardioNomics University of BristolUnited Kingdom
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Geßner C, Calverley P, Dusser D, Wise R, Pledger G, Dahl R, Mueller A, Montero Caballero J, Anzueto A. Exacerbator subtypes in the TIOtropium Safety and Performance In Respimat (TIOSPIR™) trial. Pneumologie 2015. [DOI: 10.1055/s-0035-1544714] [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]
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Geßner C, Dahl R, Dusser D, Wise R, Pledger G, Anzueto A, Mueller A, Fowler A, Calverley P. Prognostic factors of mortality and cardiovascular outcomes in the Tiotropium Safety and Performance in Respimat (TIOSPIR) trial. Pneumologie 2015. [DOI: 10.1055/s-0035-1544715] [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]
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Calverley P, Anzueto A, Dahl R, Mueller A, Fowler A, Metzdorf N, Wise R, Dusser D. P262 Tiotropium Safety And Performance In Respimat(R) (tiospir ): Safety And Efficacy In Patients With Tiotropium Handihaler(R) Use At Baseline. Thorax 2014. [DOI: 10.1136/thoraxjnl-2014-206260.390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Wise R, Calverley P, Dahl R, Dusser D, Metzdorf N, Mueller A, Fowler A, Anzueto A. P261 Tiotropium Safety And Performance In Respimat(R) (tiospir ): Safety And Efficacy In Patients Naive To Treatment With Anticholinergics. Thorax 2014. [DOI: 10.1136/thoraxjnl-2014-206260.389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Schauer DP, Arterburn DE, Wise R, Boone W, Fischer D, Eckman MH. Predictors of bariatric surgery among an interested population. Surg Obes Relat Dis 2013; 10:547-52. [PMID: 24355320 DOI: 10.1016/j.soard.2013.09.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Revised: 08/15/2013] [Accepted: 09/12/2013] [Indexed: 01/14/2023]
Abstract
BACKGROUND Severely obese patients considering bariatric surgery face a difficult decision given the tradeoff between the benefits and risks of surgery. The objectives of this study was to study the forces driving this decision and improve our understanding of the decision-making process. METHODS A 64-item survey was developed to assess factors in the decision-making process for bariatric surgery. The survey included the decisional conflict scale, decision self-efficacy scale, EuroQol 5D, and the standard gamble. Patients were recruited from a regularly scheduled bariatric surgery interest group meeting associated with a large, university-based bariatric practice and administered a survey at the conclusion of the interest group. Logistic regression models were used to predict who pursued or still planned to pursue surgery at 12 months. RESULTS 200 patients were recruited over an 8-month period. Mean age was 45 years; mean BMI was 48 kg/m(2), and 77% were female. The 12-month follow-up rate was 95%. At 12 months, 33 patients (17.6%) had surgery and 30 (16.0%) still planned to have surgery. There was no association between age, gender, or obesity-associated conditions and surgery or plan to have surgery. Patients having surgery or still planning to have surgery had significantly worse scores for quality of life and better scores for decisional conflict (indicating readiness to make a decision). CONCLUSION The decision to have bariatric surgery is strongly associated with patients' perceptions of their current quality of life. In addition, lower decisional conflict and higher self-efficacy are predictive of surgery. Interestingly, factors that clinicians might consider important, such as gender, age, and the presence of obesity-associated co-morbidities did not influence patients' decisions.
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Affiliation(s)
- Daniel P Schauer
- Division of General Internal Medicine, University of Cincinnati Medical Center, Cincinnati, Ohio.
| | | | - Ruth Wise
- Division of General Internal Medicine, University of Cincinnati Medical Center, Cincinnati, Ohio
| | - William Boone
- Division of General Internal Medicine, University of Cincinnati Medical Center, Cincinnati, Ohio; Miami University, Oxford, Ohio
| | - David Fischer
- Division of General Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio
| | - Mark H Eckman
- Division of General Internal Medicine, University of Cincinnati Medical Center, Cincinnati, Ohio
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Wise R, Rodseth R, De Laet I, Luis L, Correa-Martin L, Garcia M, Castellanos G, Malbrain M. Varying models of intra-abdominal hypertension and their effect on renal function in a porcine model. Crit Care 2013. [PMCID: PMC3642917 DOI: 10.1186/cc12357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Démonet J, Wise R, Frackowiak R. Les fonctions linguistiques explorées en tomographie par émission de positons. Med Sci (Paris) 2013. [DOI: 10.4267/10608/3014] [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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Wise R, Rodseth RN. The opinion of patients at a local South Africa teaching hospital on physician-industry relations. Southern African Journal of Anaesthesia and Analgesia 2013. [DOI: 10.1080/22201173.2013.10872916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- R Wise
- University of KwaZulu-Natal
- Department of Anaesthesiology, Critical Care and Pain Management, Grey's Hospital
- Perioperative Research Group, Discipline of Anaesthesiology and Critical Care Nelson R Mandela School of Medicine, University of KwaZulu-Natal
| | - RN Rodseth
- University of KwaZulu-Natal
- Perioperative Research Group, Discipline of Anaesthesiology and Critical Care Nelson R Mandela School of Medicine, University of KwaZulu-Natal
- Population Health Research Institute, Hamilton, Canada
- Outcomes Research Consortium, Cleveland, Ohio, USA
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Gordon K, Wise R. An unusual case of ST elevation. Southern African Journal of Anaesthesia and Analgesia 2013. [DOI: 10.1080/22201173.2013.10872938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- K Gordon
- Department of Anaesthetics, Critical Care, and Pain Management, Grey's Hospital
| | - R Wise
- University of KwaZulu-Natal Department of Anaesthetics, Critical Care, and Pain Management, Grey's Hospital Perioperative Research Group, Department of Anaesthetics, Nelson R Mandela School of Medicine, University of KwaZulu-Natal
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Eckman MH, Wise R, Leonard AC, Dixon E, Burrows C, Khan F, Warm E. Impact of health literacy on outcomes and effectiveness of an educational intervention in patients with chronic diseases. Patient Educ Couns 2012; 87:143-151. [PMID: 21925823 DOI: 10.1016/j.pec.2011.07.020] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2010] [Revised: 07/15/2011] [Accepted: 07/21/2011] [Indexed: 05/27/2023]
Abstract
OBJECTIVE Study impact of health literacy on educational intervention for patients "Living with Coronary Artery Disease." METHODS 187 patients were randomized to: VHS/DVD plus printed booklet; or booklet alone prior to scheduled visit. Main outcome measures included CAD knowledge assessment, clinical outcomes (weigh and blood pressure) and health behaviors (diet, exercise, and smoking); while functional health literacy was assessed as a possible predictor variable. RESULTS Knowledge scores and health behaviors improved following both interventions. Those receiving the booklet and video also had a significant improvement in exercise, and weight loss. There was a trend (p=0.07) towards greater improvement in test scores among those receiving the booklet plus video. Patients with lower health literacy benefited as much as higher literacy patients. CONCLUSIONS Incorporation of an educational program into clinical visits for patients with chronic disease improved disease-specific knowledge and prompted patients to become activated and involved in their care, improving health behaviors and outcomes. Lower health literacy was not a barrier to this beneficial effect. PRACTICE IMPLICATIONS Patients with lower health literacy may also benefit from educational, shared decision-making interventions.
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Affiliation(s)
- Mark H Eckman
- Division of General Internal Medicine, University of Cincinnati, Cincinnati, OH 45267, USA.
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Brooks J, Jenkinson M, Beckmann C, Miller K, Wise R, Clare S, Schweinhardt P, Wilson G, Tracey I. 300 NON-INVASIVE FUNCTIONAL IMAGING OF THE HUMAN SPINAL CORD. Eur J Pain 2012. [DOI: 10.1016/s1090-3801(06)60303-0] [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: 10/23/2022]
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Ündar A, Palanzo D, Qiu F, Alkan-Bozkaya T, Akcevin A, Talor J, Baer L, Woitas K, Wise R, McCoach R, Guan Y, Haines N, Wang S, Clark JB, Myers JL. Benefits of pulsatile flow in pediatric cardiopulmonary bypass procedures: from conception to conduction. Perfusion 2011; 26 Suppl 1:35-9. [DOI: 10.1177/0267659111404468] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This review on the benefits of pulsatile flow includes not only experimental and clinical data, but also attempts to further illuminate the major factors as to why this debate has continued during the past 55 years. Every single component of the cardiopulmonary bypass (CPB) circuitry is equally important for generating adequate quality of pulsatility, not only the pump. Therefore, translational research is a necessity to select the best components for the circuit. Generation of pulsatile flow depends on an energy gradient; precise quantification in terms of hemodynamic energy levels is, therefore, a necessity, not an option. Comparisons between perfusion modes should be done after these basic steps have been taken. We have also included experimental and clinical data for direct comparisons between the perfusion modes. In addition, we included several suggestions for future clinical trials for other interested investigators.
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Affiliation(s)
| | | | - F Qiu
- Penn State Hershey Pediatric Cardiovascular Research Center, Departments of Pediatrics, Surgery, Bioengineering, Public Health Sciences, and Comparative Medicine, Penn State Hershey College of Medicine, Penn State Hershey Children’s Hospital, Hershey, Pennsylvania, USA
| | - T Alkan-Bozkaya
- Dept. of Cardiovascular Surgery, American Hospital, Istanbul, Turkey
| | - A Akcevin
- Dept. of Cardiovascular Surgery, American Hospital, Istanbul, Turkey
| | - J Talor
- Penn State Hershey Pediatric Cardiovascular Research Center, Departments of Pediatrics, Surgery, Bioengineering, Public Health Sciences, and Comparative Medicine, Penn State Hershey College of Medicine, Penn State Hershey Children’s Hospital, Hershey, Pennsylvania, USA
| | - L Baer
- Penn State Hershey Pediatric Cardiovascular Research Center, Departments of Pediatrics, Surgery, Bioengineering, Public Health Sciences, and Comparative Medicine, Penn State Hershey College of Medicine, Penn State Hershey Children’s Hospital, Hershey, Pennsylvania, USA
| | - K Woitas
- Penn State Hershey Pediatric Cardiovascular Research Center, Departments of Pediatrics, Surgery, Bioengineering, Public Health Sciences, and Comparative Medicine, Penn State Hershey College of Medicine, Penn State Hershey Children’s Hospital, Hershey, Pennsylvania, USA
| | - R Wise
- Penn State Hershey Pediatric Cardiovascular Research Center, Departments of Pediatrics, Surgery, Bioengineering, Public Health Sciences, and Comparative Medicine, Penn State Hershey College of Medicine, Penn State Hershey Children’s Hospital, Hershey, Pennsylvania, USA
| | - R McCoach
- Penn State Hershey Pediatric Cardiovascular Research Center, Departments of Pediatrics, Surgery, Bioengineering, Public Health Sciences, and Comparative Medicine, Penn State Hershey College of Medicine, Penn State Hershey Children’s Hospital, Hershey, Pennsylvania, USA
| | - Y Guan
- Dept. of Cardiopulmonary Bypass, The Fuwai Hospital, Beijing, China
| | - N Haines
- Penn State Hershey Pediatric Cardiovascular Research Center, Departments of Pediatrics, Surgery, Bioengineering, Public Health Sciences, and Comparative Medicine, Penn State Hershey College of Medicine, Penn State Hershey Children’s Hospital, Hershey, Pennsylvania, USA
| | - S Wang
- Dept. of Cardiopulmonary Bypass, The Fuwai Hospital, Beijing, China
| | - J B Clark
- Penn State Hershey Pediatric Cardiovascular Research Center, Departments of Pediatrics, Surgery, Bioengineering, Public Health Sciences, and Comparative Medicine, Penn State Hershey College of Medicine, Penn State Hershey Children’s Hospital, Hershey, Pennsylvania, USA
| | - J L Myers
- Penn State Hershey Pediatric Cardiovascular Research Center, Departments of Pediatrics, Surgery, Bioengineering, Public Health Sciences, and Comparative Medicine, Penn State Hershey College of Medicine, Penn State Hershey Children’s Hospital, Hershey, Pennsylvania, USA
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Wise R, Blaser M, Carrs O, Cassell G, Fishman N, Guidos R, Levy S, Powers J, Norrby R, Tillotson G, Davies R, Projan S, Dawson M, Monnet D, Keogh-Brown M, Hand K, Garner S, Findlay D, Morel C, Wise R, Bax R, Burke F, Chopra I, Czaplewski L, Finch R, Livermore D, Piddock LJV, White T. The urgent need for new antibacterial agents. J Antimicrob Chemother 2011; 66:1939-40. [DOI: 10.1093/jac/dkr261] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [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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Finch R, Blaser M, Carrs O, Cassell G, Fishman N, Guidos R, Levy S, Powers J, Norrby R, Tillotson G, Davies R, Projan S, Dawson M, Monnet D, Keogh-Brown M, Hand K, Garner S, Findlay D, Morel C, Wise R, Bax R, Burke F, Chopra I, Czaplewski L, Finch R, Livermore D, Piddock LJV, White T. Regulatory opportunities to encourage technology solutions to antibacterial drug resistance. J Antimicrob Chemother 2011; 66:1945-7. [DOI: 10.1093/jac/dkr259] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
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White AR, Blaser M, Carrs O, Cassell G, Fishman N, Guidos R, Levy S, Powers J, Norrby R, Tillotson G, Davies R, Projan S, Dawson M, Monnet D, Keogh-Brown M, Hand K, Garner S, Findlay D, Morel C, Wise R, Bax R, Burke F, Chopra I, Czaplewski L, Finch R, Livermore D, Piddock LJV, White T. Effective antibacterials: at what cost? The economics of antibacterial resistance and its control. J Antimicrob Chemother 2011; 66:1948-53. [DOI: 10.1093/jac/dkr260] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [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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Livermore DM, Blaser M, Carrs O, Cassell G, Fishman N, Guidos R, Levy S, Powers J, Norrby R, Tillotson G, Davies R, Projan S, Dawson M, Monnet D, Keogh-Brown M, Hand K, Garner S, Findlay D, Morel C, Wise R, Bax R, Burke F, Chopra I, Czaplewski L, Finch R, Livermore D, Piddock LJV, White T. Discovery research: the scientific challenge of finding new antibiotics. J Antimicrob Chemother 2011; 66:1941-4. [DOI: 10.1093/jac/dkr262] [Citation(s) in RCA: 194] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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40
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Le Maitre D, de Lange W, Richardson D, Wise R, van Wilgen B. The economic consequences of the environmental impacts of alien plant invasions in South Africa. Biol Invasions 2011. [DOI: 10.1201/b10938-22] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Liu S, Solomon P, Carpio R, Fowler B, Simmons D, Wang J, Wise R, Imper G, Riley N, Moslehi M, Ravindra N. Modeling, Simulation and Control of Single Wafer Process in Cluster Tool Base on Ft-Ir In-Line Sensor. ACTA ACUST UNITED AC 2011. [DOI: 10.1557/proc-389-269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
ABSTRACTThis paper outlines our current approach to utilize infrared reflectance spectroscopy for thin film measurement in the semiconductor industry. The multi-layer thickness and doping concentration of IC wafers can be determined by a single angle, unpolarized infrared reflectance measurement performed using Fourier transform infrared spectrometer. A computer algorithm, which matches theoretical to measured infrared reflectance spectra, was successfully employed to determine multiple thin film properties.
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Andrews JM, Wise R, Baldwin DR, Honeybourne D. Concentrations of ceftibuten in plasma and the respiratory tract following a single 400 mg oral dose. Int J Antimicrob Agents 2010; 5:141-4. [PMID: 18611662 DOI: 10.1016/0924-8579(94)00044-u] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/1994] [Revised: 09/16/1994] [Accepted: 09/29/1994] [Indexed: 11/29/2022]
Abstract
Concentrations of ceftibuten in bronchial mucosa, epithelial lining fluid (ELF) and alveolar macrophages were determined from samples taken from 15 subjects at bronchoscopy following a single 400 mg oral dose. Concentrations at all sites were determined using a microbiological assay method which was unaffected by the trans-isomer of ceftibuten. The time from dosage to bronchoscopy ranged from 1.4 to 20.3 h and the subjects were analysed in three groups according to time after dosing. Group A had a mean time since dosing of 1.9 h with mean serum, mucosal and ELF concentrations of 15.2 mg/l, 5.7 mg/kg and 1.6 mg/l. Group B had a mean time of 6.5 h after dosing with mean serum, mucosal and ELF concentration of 14.0 mg/l, 3.2 mg/kg and 1.6 mg/l. Group C had a mean time of 13.3 h with mean serum, mucosal and ELF levels of 4.1 mg/l, 1.8 mg/kg and 1.2 mg/l. Macrophage-related ceftibuten could only be detected in two subjects. These levels are related to the minimum inhibitory concentrations of ceftibuten against common respiratory pathogens with the exception of Strep. pneumoniae.
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Affiliation(s)
- J M Andrews
- Department of Medical Microbiology, Dudley Road Hospital, Birmingham, UK
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Nahman A, Wise R, De Lange W. Environmental and resource economics in South Africa: Status quo and lessons for developing countries. S AFR J SCI 2010. [DOI: 10.4102/sajs.v105i9/10.108] [Citation(s) in RCA: 3] [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: 11/01/2022] Open
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Wise R. Antimicrobial resistance: the microbe's struggle for survival. Equine Vet J 2010; 35:530-1. [PMID: 14515950 DOI: 10.2746/042516403775467144] [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: 11/19/2022]
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Han MK, Wise R, Mumford J, Sciurba F, Criner GJ, Curtis JL, Murray S, Sternberg A, Weinman G, Kazerooni E, Fishman AP, Make B, Hoffman EA, Mosenifar Z, Martinez FJ. Prevalence and clinical correlates of bronchoreversibility in severe emphysema. Eur Respir J 2009; 35:1048-56. [PMID: 19926748 DOI: 10.1183/09031936.00052509] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) exhibits airflow obstruction that is not fully reversible. The importance of bronchoreversibility remains controversial. We hypothesised that an emphysematous phenotype of COPD would be associated with decreased bronchoreversibility. 544 patients randomised to the medical arm of the National Emphysema Treatment Trial formed the study group. Participants underwent multiple measurements of bronchoreversibility on a mean of four sessions over 1.91 yrs. They were also characterised by measures of symptoms, quality of life and quantitative measures of emphysema by computed tomography. Mean baseline forced expiratory volume in 1 s (FEV(1)) in this patient population is 24% predicted. 22.2% of patients demonstrated bronchoreversibility on one or more occasions using American Thoracic Society/European Respiratory Society criteria. Few patients (0.37%) had bronchoreversibility on all completed tests. Patients who demonstrated bronchoreversibility were more likely to be male, and have better lung function and less emphysema. 64% of patients demonstrated large (> or =400 mL) changes in forced vital capacity (FVC). In a severe emphysema population, bronchoreversibility as defined by change in FEV(1) is infrequent, varies over time, and is more common in males and those with less severe emphysema. Improvements in FVC, however, were demonstrated in the majority of patients.
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Affiliation(s)
- M K Han
- Division of Pulmonary and Critical Care Medicine, University of Michigan Medical Center, Ann Arbor, MI 48109-0360, USA.
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Abstract
Behavioural tasks produce changes in regional cerebral blood flow (rCBF), the result of increased local neural activity. These changes can be measured with positron emission tomography (PET). Language activation studies by means of PET are being used to relate regional patterns of cerebral activation to information-processing models of speech and reading. Significant activation confined to both superior temporal gyri has been observed when normal subjects hear words played backwards, listen to non-words, and perform category judgements on pairs of heard real words. Prestriate cortex is activated by seeing strings of letter-like symbols, consonant strings, pronounceable non-words and real words, with additional activation in left medial prestriate cortex in response to the non-words and real words. Left posterior superior temporal gyrus (PSTG), left dorsolateral prefrontal cortex (DLPFC) and supplementary motor area (SMA) are engaged when subjects retrieve verbs from memory to match nouns. Finally, primary sensorimotor cortex is activated during articulation. There is particular interest at present in the precise roles of left PSTG and DLPFC in single-word comprehension and generation, and interpretation of the results depends critically on the design of the single-word tasks used for behavioural activation.
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Affiliation(s)
- R Wise
- MRC Cyclotron Unit, Hammersmith Hospital, London, UK
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Andrews J, Honeybourne D, Ashby J, Jevons G, Fraise A, Fry P, Warrington S, Hawser S, Wise R. Concentrations in plasma, epithelial lining fluid, alveolar macrophages and bronchial mucosa after a single intravenous dose of 1.6 mg/kg of iclaprim (AR-100) in healthy men. J Antimicrob Chemother 2007; 60:677-80. [PMID: 17623694 DOI: 10.1093/jac/dkm242] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [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: 11/14/2022] Open
Abstract
OBJECTIVES A validated microbiological assay was used to measure concentrations of iclaprim (AR-100) in plasma, bronchial mucosa (BM), alveolar macrophages (AM) and epithelial lining fluid (ELF) after a single 1.6 mg/kg intravenous 60 min iv infusion of iclaprim. METHODS Male volunteers were randomly allocated to three nominal sampling time intervals 1-2 h (Group A), 3-4 h (Group B) and 5.5-7.0 h (Group C) after the start of the drug infusion. RESULTS Mean iclaprim concentrations in plasma, BM, AM and ELF, respectively, were for Group A 0.59 mg/L (SD 0.18), 0.51 mg/kg (SD 0.17), 24.51 mg/L (SD 21.22) and 12.61 mg/L (SD 7.33); Group B 0.24 mg/L (SD 0.05), 0.35 mg/kg (SD 0.17), 7.16 mg/L (SD 1.91) and 6.38 mg/L (SD 5.17); and Group C 0.14 mg/L (SD 0.05), no detectable level in BM, 5.28 mg/L (SD 2.30) and 2.66 mg/L (SD 2.08). CONCLUSIONS Iclaprim concentrations in ELF and AM exceeded the MIC(90) for penicillin-susceptible Streptococcus pneumoniae (MIC90 0.06 mg/L), penicillin-intermediate S. pneumoniae (MIC90 2 mg/L), penicillin-resistant S. pneumoniae (MIC90 4 mg/L) for 7, 7 and 4 h, respectively, and Chlamydia pneumoniae (MIC90 0.5 mg/L) for 7 h. Mean iclaprim concentrations in ELF exceeded the MIC90 for Haemophilus influenzae (MIC90 4 mg/L) and Moraxella catarrhalis (MIC90 8 mg/L) for up to 4 and 2 h, respectively; in AM the MIC90 was exceeded for up to 7 h. Furthermore, the MIC90 for methicillin-resistant Staphylococcus aureus of 0.12 mg/L was exceeded at all sites for up to 7 h. These data suggest that iclaprim reaches lung concentrations that should be effective in the treatment of community-acquired pneumonia.
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Affiliation(s)
- J Andrews
- Department of Medical Microbiology, City Hospital NHS Trust, Birmingham, UK.
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Luo ZW, Potokina E, Druka A, Wise R, Waugh R, Kearsey MJ. SFP genotyping from affymetrix arrays is robust but largely detects cis-acting expression regulators. Genetics 2007; 176:789-800. [PMID: 17409081 PMCID: PMC1894608 DOI: 10.1534/genetics.106.067843] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [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: 11/18/2022] Open
Abstract
The recent development of Affymetrix chips designed from assembled EST sequences has spawned considerable interest in identifying single-feature polymorphisms (SFPs) from transcriptome data. SFPs are valuable genetic markers that potentially offer a physical link to the structural genes themselves. However, most current SFP prediction methodologies were developed for sequenced species although SFPs are particularly valuable for species with complex and unsequenced genomes. To establish the sensitivity and specificity of prediction, we explored four methods for identifying SFPs from experiments involving two tissues in two commercial barleys and their doubled-haploid progeny. The methods were compared in terms of numbers of SFPs predicted and their ability to identify known sequence polymorphisms in the features, to confirm existing SNP genotypes and to match existing maps and individual haplotypes. We identified >4000 separate SFPs that accurately predicted the SNP genotype of >98% of the doubled-haploid (DH) lines. They were highly enriched for features containing sequence polymorphisms but all methods uniformly identified a majority of SFPs ( approximately 64%) in features for which there was no sequence polymorphism while 5% mapped to different locations, indicating that "SFPs" mainly represent polymorphism in cis-acting regulators. All methods are efficient and robust at predicting markers for gene mapping.
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Affiliation(s)
- Z. W. Luo
- School of Biosciences, University of Birmingham, Birmingham B15 2TT, United Kingdom, Scottish Crop Research Institute, Invergowrie, Dundee DD2 5DA, Scotland, United Kingdom, Laboratory of Population and Quantitative Genetics, Department of Biostatistics, School of Life Sciences, Institute of Biomedical Sciences, Fudan University, Shanghai 200433, China and Corn Insects and Crop Genetics Research, USDA–ARS, Department of Plant Pathology and Center for Plant Responses to Environmental Stresses, Iowa State University, Ames, Iowa 50011-1020
| | - E. Potokina
- School of Biosciences, University of Birmingham, Birmingham B15 2TT, United Kingdom, Scottish Crop Research Institute, Invergowrie, Dundee DD2 5DA, Scotland, United Kingdom, Laboratory of Population and Quantitative Genetics, Department of Biostatistics, School of Life Sciences, Institute of Biomedical Sciences, Fudan University, Shanghai 200433, China and Corn Insects and Crop Genetics Research, USDA–ARS, Department of Plant Pathology and Center for Plant Responses to Environmental Stresses, Iowa State University, Ames, Iowa 50011-1020
| | - A. Druka
- School of Biosciences, University of Birmingham, Birmingham B15 2TT, United Kingdom, Scottish Crop Research Institute, Invergowrie, Dundee DD2 5DA, Scotland, United Kingdom, Laboratory of Population and Quantitative Genetics, Department of Biostatistics, School of Life Sciences, Institute of Biomedical Sciences, Fudan University, Shanghai 200433, China and Corn Insects and Crop Genetics Research, USDA–ARS, Department of Plant Pathology and Center for Plant Responses to Environmental Stresses, Iowa State University, Ames, Iowa 50011-1020
| | - R. Wise
- School of Biosciences, University of Birmingham, Birmingham B15 2TT, United Kingdom, Scottish Crop Research Institute, Invergowrie, Dundee DD2 5DA, Scotland, United Kingdom, Laboratory of Population and Quantitative Genetics, Department of Biostatistics, School of Life Sciences, Institute of Biomedical Sciences, Fudan University, Shanghai 200433, China and Corn Insects and Crop Genetics Research, USDA–ARS, Department of Plant Pathology and Center for Plant Responses to Environmental Stresses, Iowa State University, Ames, Iowa 50011-1020
| | - R. Waugh
- School of Biosciences, University of Birmingham, Birmingham B15 2TT, United Kingdom, Scottish Crop Research Institute, Invergowrie, Dundee DD2 5DA, Scotland, United Kingdom, Laboratory of Population and Quantitative Genetics, Department of Biostatistics, School of Life Sciences, Institute of Biomedical Sciences, Fudan University, Shanghai 200433, China and Corn Insects and Crop Genetics Research, USDA–ARS, Department of Plant Pathology and Center for Plant Responses to Environmental Stresses, Iowa State University, Ames, Iowa 50011-1020
| | - M. J. Kearsey
- School of Biosciences, University of Birmingham, Birmingham B15 2TT, United Kingdom, Scottish Crop Research Institute, Invergowrie, Dundee DD2 5DA, Scotland, United Kingdom, Laboratory of Population and Quantitative Genetics, Department of Biostatistics, School of Life Sciences, Institute of Biomedical Sciences, Fudan University, Shanghai 200433, China and Corn Insects and Crop Genetics Research, USDA–ARS, Department of Plant Pathology and Center for Plant Responses to Environmental Stresses, Iowa State University, Ames, Iowa 50011-1020
- Corresponding author: School of Biosciences, University of Birmingham, Birmingham B15 2TT, United Kingdom. E-mail:
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Abstract
Intravenous drug users (IVDUs) often present to the emergency services with the medical complications of drug use. We report a case in which an acutely ischaemic lower limb of one such patient was thought to be the cause of cardiac arrest occurring during treatment in the emergency department (ED). Amputation of the limb was performed with cardiopulmonary resuscitation (CPR) in progress, spontaneous cardiac output was restored, and the patient made an excellent neurological recovery despite a total arrest time of 85 minutes. Possible causes of cardiac arrest, in relation to the release of potassium and metabolic toxins are discussed, as well as the decision making processes of the involved clinicians and other possible management strategies.
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Affiliation(s)
- R Wise
- Emergency Department, United Bristol Healthcare Trust, Bristol, UK
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Thorp ML, Ditmer DG, Nash MK, Wise R, Jaderholm PL, Smith JD, Chan W. A study of the prevalence of significant increases in serum creatinine following angiotension-converting enzyme inhibitor administration. J Hum Hypertens 2005; 19:389-92. [PMID: 15703773 DOI: 10.1038/sj.jhh.1001832] [Citation(s) in RCA: 7] [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: 11/09/2022]
Abstract
Angiontension-converting enzyme inhibitors (ACEIs) are beneficial in the treatment of diabetic and nondiabetic kidney disease, coronary artery disease and congestive heart failure. One adverse effect of ACEIs use is a rise in serum creatinine and potential renal failure. This paper attempts to quantify this risk and assess the need for pre- and post-ACEI serum creatinine measurements. A computerized search of Kaiser Permanente Northwest's electronic medical record was conducted to find patients over the age of 40 years taking lisinopril between July 1, 2000 and June 30, 2002. Patient demographic information and presence in diabetes and coronary artery disease registries was collected. A subsequent search for pre- and postlisinopril serum creatinine levels within 6 months of initial lisinopril prescription was conducted. Patients with prelisinopril creatinine < or = 1.2 mg/dl and postlisinopril creatinine > 2.5 mg/dl underwent chart review to discern adverse events associated with the rise in serum creatinine. A total of 18,977 patients were prescribed lisinopril between July 1, 2000 and June 30, 2002. In all 13 166 patients had a pre- and postlisinopril creatinine checked. In all, 31 patients had a rise in creatinine from < or = 1.2 mg/dl to > 2.5 mg/dl (0.2%). Possible contributors to rise in creatinine included congestive heart failure, dehydration and infection. No patients developed end-stage renal disease, although three died. In conclusion, end-stage renal disease is an unlikely outcome among patients prescribed lisinopril and is most likely associated with other events.
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Affiliation(s)
- M L Thorp
- Department of Nephrology, Kaiser Permanente Northwest, Milwaukie, OR 97267, USA.
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