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Visser E, Heuthorst L, Pathmakanthan S, Bemelman WA, D'Haens GR, Handley K, Fakis A, Pinkney TD, Buskens CJ, Dijkgraaf MGW. Clinical statistical analysis plan for the ACCURE trial: the effect of appendectomy on the clinical course of ulcerative colitis, a randomised international multicentre trial. Trials 2024; 25:218. [PMID: 38532488 DOI: 10.1186/s13063-024-08037-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 03/04/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND The primary treatment of ulcerative colitis (UC) is medical therapy using a standard step-up approach. An appendectomy might modulate the clinical course of UC, decreasing the incidence of relapses and reducing need for medication. The objective of the ACCURE trial is to assess the efficacy of laparoscopic appendectomy in addition to standard medical treatment in maintaining remission in UC patients. This article presents the statistical analysis plan to evaluate the outcomes of the ACCURE trial. DESIGN AND METHODS The ACCURE trial was designed as a multicentre, randomised controlled trial. UC patients with a new diagnosis or a disease relapse within the past 12 months, treated with 5-ASA, corticosteroids, or immunomodulators until complete clinical and endoscopic remission (defined as total Mayo score < 3 with endoscopic subscore of 0 or 1), were counselled for inclusion. Also, patients previously treated with biologicals who had a washout period of at least 3 months were considered for inclusion. Patients were randomised (1:1) to laparoscopic appendectomy plus maintenance treatment or a control group (maintenance therapy only). The primary outcome is the 1-year UC relapse rate (defined as a total Mayo-score ≥ 5 with endoscopic subscore of 2 or 3, or clinically as an exacerbation of symptoms and rectal bleeding or FCP > 150 or intensified medical therapy other than 5-ASA therapy). Secondary outcomes include number of relapses per patient, time to first relapse, disease activity, number of colectomies, medication usage, and health-related quality of life. DISCUSSION The ACCURE trial will provide comprehensive evidence whether adding an appendectomy to maintenance treatment is superior to maintenance treatment only in maintaining remission in UC patients. TRIAL REGISTRATION Dutch Trial Register (NTR) NTR2883 . Registered May 3, 2011. ISRCTN, ISRCTN60945764 . Registered August 12, 2019.
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Affiliation(s)
- Eva Visser
- Department of Surgery, Amsterdam University Medical Centre, Amsterdam, The Netherlands.
| | - Lianne Heuthorst
- Department of Surgery, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Shri Pathmakanthan
- Department of Gastroenterology, Queen Elizabeth University Hospital Birmingham, Birmingham, UK
| | - Willem A Bemelman
- Department of Surgery, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Geert R D'Haens
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - Kelly Handley
- University of Birmingham Clinical Trials Unit, Birmingham, UK
| | - Apostolos Fakis
- Derby Clinical Trials Support Unit, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Thomas D Pinkney
- Academic Department of Surgery, University of Birmingham, Birmingham, UK
| | - Christianne J Buskens
- Department of Surgery, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Marcel G W Dijkgraaf
- Department of Epidemiology and Data Science, University Medical Centre, Amsterdam, the Netherlands
- Methodology, Amsterdam Public Health, Amsterdam, the Netherlands
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Morgan G, Melson E, Davitadze M, Ooi E, Zhou D, Hanania T, Chen W, Thomas L, Allison I, Ding M, Blaggan P, Ng CY, Evans N, Warmington E, Radcliffe E, Soran V, Nirmal R, Boelaert K, Cooney R, Reddy-Kolanu V, Karavitaki N, Pathmakanthan S, Arlt W, Kempegowda P. Utility of Simulation via Instant Messaging - Birmingham Advance (SIMBA) in medical education during COVID-19 pandemic. J R Coll Physicians Edinb 2021; 51:168-172. [PMID: 34131679 DOI: 10.4997/jrcpe.2021.218] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Simulation via Instant Messaging - Birmingham Advance (SIMBA) aimed to improve clinicians' confidence in managing various clinical scenarios during the COVID-19 pandemic. METHODS Five SIMBA sessions were conducted between May and August 2020. Each session included simulation of scenarios and interactive discussion. Participants' self-reported confidence, acceptance, and relevance of the simulated cases were measured. RESULTS Significant improvement was observed in participants' self-reported confidence (overall n = 204, p<0.001; adrenal n = 33, p<0.001; thyroid n = 37, p<0.001; pituitary n = 79, p<0.001; inflammatory bowel disease n = 17, p<0.001; acute medicine n = 38, p<0.001). Participants reported improvements in clinical competencies: patient care 52.0% (n = 106/204), professionalism 30.9% (n = 63/204), knowledge on patient management 84.8% (n = 173/204), systems-based practice 48.0% (n = 98/204), practice-based learning 69.6% (n = 142/204) and communication skills 25.5% (n = 52/204). CONCLUSION SIMBA is a novel pedagogical virtual simulation-based learning model that improves clinicians' confidence in managing conditions across various specialties.
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Affiliation(s)
- Georgia Morgan
- Princess of Wales Hospital, Cwm Taf Morgannwg University Health Board, Bridgend, UK
| | - Eka Melson
- Ninewells Hospital, NHS Tayside, Dundee, UK
| | - Meri Davitadze
- Georgian-American Family Medicine Clinic "Medical House", Tbilisi, Georgia
| | - Emma Ooi
- RCSI & UCD Malaysia Campus, Malaysia
| | - Dengyi Zhou
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Thia Hanania
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Wentin Chen
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Lucretia Thomas
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Isabel Allison
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Michael Ding
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Parisha Blaggan
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | | | - Nia Evans
- Royal Glamorgan Hospital, Cwm Taf Morgannwg University Health Board, Rhondda Cynon Taf, UK
| | - Emily Warmington
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Eloise Radcliffe
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Vina Soran
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Rachel Nirmal
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Kristien Boelaert
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Rachel Cooney
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Vinay Reddy-Kolanu
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Niki Karavitaki
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Shri Pathmakanthan
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Wiebke Arlt
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Punith Kempegowda
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK,
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Morgan G, Ooi E, Hanania T, Davitadze M, Zhou D, Blaggan P, Melson E, Arlt W, Boelaert K, Cooney R, Pathmakanthan S, Reddy-Kolanu V, Karavitaki N, Ng CY, Allison I, Chen W, Thomas L, Evans N, Kempegowda P. Simulation via instant messaging - Birmingham advance (SIMBA): an innovative simulation-based learning model that helped to keep medical education continue during the COVID-19 pandemic. Clin Med (Lond) 2021; 21:34-35. [PMID: 34078689 DOI: 10.7861/clinmed.21-2-s34] [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: 11/27/2022]
Affiliation(s)
| | - Emma Ooi
- RCSI & UCD Malaysia Campus, Malaysia
| | - Thia Hanania
- College of Medical and Dental Sciences, Birmingham, UK
| | - Meri Davitadze
- Georgia-American Family Medicine Clinic (Medical House), Tbilisi, Georgia
| | - Dengyi Zhou
- College of Medical and Dental Sciences, Birmingham, UK
| | | | - Eka Melson
- Institute of Metabolism and System Research, Birmingham, UK
| | - Wiebke Arlt
- Institute of Metabolism and System Research, Birmingham, UK
| | | | | | | | | | | | | | | | - Wentin Chen
- College of Medical and Dental Sciences, Birmingham, UK
| | | | - Nia Evans
- Royal Glamorgan Hospital, Rhondda Cynon Taf, UK
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Trivedi PJ, Kiesslich R, Hodson J, Bhala N, Boulton RA, Cooney R, Gui X, Iqbal T, Li KK, Mumtaz S, Pathmakanthan S, Quraishi MN, Sagar VM, Shah A, Sharma N, Siau K, Smith S, Ward S, Widlak MM, Bisschops R, Ghosh S, Iacucci M. The Paddington International Virtual Chromoendoscopy Score in ulcerative colitis exhibits very good inter-rater agreement after computerized module training: a multicenter study across academic and community practice (with video). Gastrointest Endosc 2018; 88:95-106.e2. [PMID: 29548940 DOI: 10.1016/j.gie.2018.02.044] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Accepted: 02/28/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Electronic virtual chromoendoscopy (EVC) can demonstrate ongoing disease activity in ulcerative colitis (UC), even when Mayo subscores suggest healing. However, applicability of EVC technology outside the expert setting has yet to be determined. METHODS Fifteen participants across 5 centers reviewed a computerized training module outlining high-definition and EVC (iScan) colonoscopy modes. Interobserver agreement was then tested (Mayo score, Ulcerative Colitis Endoscopic Index of Severity [UCEIS], and the Paddington International Virtual Chromoendoscopy Score [PICaSSO] for UC), using a colonoscopy video library (30 cases reviewed pretraining and 30 post-training). Knowledge sustainability was retested in a second round (42 cases; 9/15 participants), 6 months after training provision. RESULTS Pretraining intraclass correlation coefficients (ICC) were good for the Mayo endoscopic subscore (ICC, .775), UCEIS scoring erosions/ulcers (ICC, .770), and UCEIS overall (ICC, .786) and for mucosal (ICC, .754) and vascular components of PICaSSO (ICC, .622). For the vascular components of UCEIS, agreement was only moderate (ICC, .429) and did not enhance post-training (ICC, .417); conversely, use of PICaSSO improved post-training (mucosal ICC, .848; vascular, .746). Histologic correlation using the New York Mt. Sinai System was strong for both PICaSSO components (Spearman's ρ for mucosal: .925; vascular, .873; P < .001 for both). Moreover, accuracy in specifically discriminating quiescent from mild histologic strata was strongest for PICaSSO (area under the receiver operating characteristic curve [AUROC] for mucosal, .781; vascular, .715) compared with Mayo (AUROC, .708) and UCEIS (AUROC for UCEIS overall, .705; vascular, .562; bleeding, .645; erosions/ulcers, .696). Inter-rater reliability for PICaSSO was sustained by round 2 participants (round 1 and 2 ICC for mucosal, .873 and .869, respectively; vascular, .715 and .783, respectively), together with histologic correlation (ρ mucosal, .934; vascular, .938; P < .001 for both). CONCLUSIONS PICaSSO demonstrates good interobserver agreement across all levels of experience, providing excellent correlation with histology. Given the ability to discriminate subtle endoscopic features, PICaSSO may be applied to refine stratified treatment paradigms for UC patients.
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Affiliation(s)
- Palak J Trivedi
- National Institute of Health Research (NIHR) Birmingham, Biomedical Research Centre (BRC), University of Birmingham, Birmingham, United Kingdom; Liver Unit, University Hospitals Birmingham Queen Elizabeth, Birmingham, United Kingdom; Department of Gastroenterology, University Hospitals Birmingham Queen Elizabeth, Birmingham, United Kingdom; Institute of Translational Medicine, Institute of Immunology and Immunotherapy Birmingham, United kingdom
| | - Ralf Kiesslich
- Department of Medicine, Division of Gastroenterology, HSK Hospital, Wiesbaden, Germany
| | - James Hodson
- Institute of Translational Medicine, Institute of Immunology and Immunotherapy Birmingham, United kingdom
| | - Neeraj Bhala
- Department of Gastroenterology, University Hospitals Birmingham Queen Elizabeth, Birmingham, United Kingdom
| | - Ralph A Boulton
- Department of Gastroenterology, University Hospitals Birmingham Queen Elizabeth, Birmingham, United Kingdom
| | - Rachel Cooney
- Department of Gastroenterology, University Hospitals Birmingham Queen Elizabeth, Birmingham, United Kingdom
| | - Xianyong Gui
- Department of Pathology and Laboratory Medicine, University of Calgary and Calgary Laboratory Services, Calgary, Alberta, Canada
| | - Tariq Iqbal
- Department of Gastroenterology, University Hospitals Birmingham Queen Elizabeth, Birmingham, United Kingdom
| | - Ka-Kit Li
- Department of Gastroenterology and Hepatology, Leicester Royal Infirmary, Leicester, United Kingdom
| | - Saqib Mumtaz
- Department of Gastroenterology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, United Kingdom
| | - Shri Pathmakanthan
- Department of Gastroenterology, University Hospitals Birmingham Queen Elizabeth, Birmingham, United Kingdom
| | - Mohammed Nabil Quraishi
- Department of Gastroenterology, University Hospitals Birmingham Queen Elizabeth, Birmingham, United Kingdom
| | - Vandana M Sagar
- National Institute of Health Research (NIHR) Birmingham, Biomedical Research Centre (BRC), University of Birmingham, Birmingham, United Kingdom; Liver Unit, University Hospitals Birmingham Queen Elizabeth, Birmingham, United Kingdom
| | - Ashit Shah
- Department of Gastroenterology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, United Kingdom
| | - Naveen Sharma
- Department of Gastroenterology, University Hospitals Birmingham Heart of England Foundation Trust, Birmingham, United Kingdom
| | - Keith Siau
- Department of Gastroenterology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, United Kingdom
| | - Samuel Smith
- Department of Gastroenterology, University Hospitals Birmingham Queen Elizabeth, Birmingham, United Kingdom
| | - Stephen Ward
- Department of Colorectal Surgery, University Hospitals Coventry and Warwickshire, Coventry, United Kingdom
| | - Monika M Widlak
- Department of Gastroenterology, University Hospitals Coventry and Warwickshire, Coventry, United Kingdom; Warwick Medical School, University of Warwick, Warwick, United Kingdom
| | - Raf Bisschops
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Subrata Ghosh
- National Institute of Health Research (NIHR) Birmingham, Biomedical Research Centre (BRC), University of Birmingham, Birmingham, United Kingdom; Department of Gastroenterology, University Hospitals Birmingham Queen Elizabeth, Birmingham, United Kingdom; Institute of Translational Medicine, Institute of Immunology and Immunotherapy Birmingham, United kingdom; Division of Gastroenterology, University of Calgary, Calgary, Alberta, Canada
| | - Marietta Iacucci
- National Institute of Health Research (NIHR) Birmingham, Biomedical Research Centre (BRC), University of Birmingham, Birmingham, United Kingdom; Department of Gastroenterology, University Hospitals Birmingham Queen Elizabeth, Birmingham, United Kingdom; Institute of Translational Medicine, Institute of Immunology and Immunotherapy Birmingham, United kingdom; Division of Gastroenterology, University of Calgary, Calgary, Alberta, Canada
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Bhala N, Cooney R, Critchlow T, Ghosh S, Glynn P, Iacucci M, Iqbal T, Pathmakanthan S, Sharma N, Shivaji U. 4.10-P14A 10-year review of abdominal tuberculosis in a single multi-ethnic secondary care population in the UK. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky048.153] [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)
- N Bhala
- Department of Gastroenterology, Queen Elizabeth Hospital Birmingham, United Kingdom
- Institute of Translational Medicine, University of Birmingham, United Kingdom
| | - R Cooney
- Department of Gastroenterology, Queen Elizabeth Hospital Birmingham, United Kingdom
| | - T Critchlow
- Department of Gastroenterology, Queen Elizabeth Hospital Birmingham, United Kingdom
| | - S Ghosh
- Department of Gastroenterology, Queen Elizabeth Hospital Birmingham, United Kingdom
- Institute of Translational Medicine, University of Birmingham, United Kingdom
| | - P Glynn
- Respiratory Medicine, Queen Elizabeth Hospital Birmingham, United Kingdom
| | - M Iacucci
- Department of Gastroenterology, Queen Elizabeth Hospital Birmingham, United Kingdom
- Institute of Translational Medicine, University of Birmingham, United Kingdom
| | - T Iqbal
- Department of Gastroenterology, Queen Elizabeth Hospital Birmingham, United Kingdom
- Institute of Translational Medicine, University of Birmingham, United Kingdom
| | - S Pathmakanthan
- Department of Gastroenterology, Queen Elizabeth Hospital Birmingham, United Kingdom
| | - N Sharma
- Institute of Translational Medicine, University of Birmingham, United Kingdom
- Division of Gastroenterology, Heartlands Hospital, United Kingdom
| | - U Shivaji
- Department of Gastroenterology, Queen Elizabeth Hospital Birmingham, United Kingdom
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McMullan C, Pinkney TD, Jones LL, Magill L, Nepogodiev D, Pathmakanthan S, Cooney R, Mathers JM. Adapting to ulcerative colitis to try to live a 'normal' life: a qualitative study of patients' experiences in the Midlands region of England. BMJ Open 2017; 7:e017544. [PMID: 28827271 PMCID: PMC5724065 DOI: 10.1136/bmjopen-2017-017544] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To provide a framework that is able to categorise whether patients are able to adapt to and lead a 'normal' life with ulcerative colitis (UC) and to detail the factors that influence this. DESIGN Qualitative research study using in-depth semi-structured interviews. SETTING Four clinical sites in the West and East Midlands regions of England. PARTICIPANTS 28 adult patients diagnosed with UC for years between 1 and 22. RESULTS Medication was rarely sufficient for patients to adapt to UC and live as 'normal' a life as possible. Virtually all patients tested and adopted non-medical adaptation methods to improve physical and psychological well-being, to help them carry on working and to prevent embarrassment. In addition, some patients benefited from outside support providing them with practical, emotional and/or financial help. In conjunction with adaptation strategies and the time to adapt, this meant that some patients with severe clinical disease were able to maintain a sense of normality in life. Patients reported that clinicians were not always receptive to discussion of the broader context of life with UC. CONCLUSIONS Patients' experience of UC and their ability to adapt in order to maintain a sense of normality in life is a complex interplay of symptoms, adaptation strategies and outside support. Over time patients test out a variety of non-medical adaptation strategies. Awareness of this may help clinicians and researchers to understand patients' views on the role of medical and other therapies. Further research around the utility of this framework in clinical practice and research is now required. TRIAL REGISTRATION NUMBER ISRCTN56523019, results.
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Affiliation(s)
- Christel McMullan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Thomas D Pinkney
- Academic Department of Surgery, University of Birmingham, Birmingham, UK
| | - Laura L Jones
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Laura Magill
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Dmitri Nepogodiev
- Academic Department of Surgery, University of Birmingham, Birmingham, UK
| | - Shri Pathmakanthan
- Department of Gastroenterology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Rachel Cooney
- Department of Gastroenterology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Jonathan M Mathers
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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Nepogodiev D, Howard R, Pathmakanthan S, Iqbal T, Singh B, Oo Y, Mathers J, McMullan C, Sahamai S, Gath J, Magill L, Handley K, Deeks J, Bemelman W, Morton D, Pinkney T. The ACCURE-UK trial: The effect of appendectomy on the clinical course of ulcerative colitis – A feasibility study. Int J Surg 2016. [DOI: 10.1016/j.ijsu.2016.08.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Abstract
A 75-year-old woman presented with severe abdominal pain and diarrhoea. Symptoms started 10 years earlier but multiple investigations failed to offer a clear diagnosis. On recent admission, blood tests, endoscopies and CT scans indicated chronic colonic inflammation. Treatment strategies for bowel inflammation were unsuccessful and the patient was subsequently discussed at a multidisciplinary team meeting with surgeons for consideration of colectomy. A drug review highlighted that the patient was taking an antiangina drug, nicorandil, thought to cause bowel ulceration. This was discontinued, which dramatically improved symptoms and avoided surgery and the patient was discharged within days. Follow-up colonoscopy showed much improved colitis, and the diarrhoea had resolved. It is important that clinicians are aware of the link between pharmacotherapy, specifically nicorandil and gastrointestinal ulceration and inflammation causing severe diarrhoea. Drug cessation is the only necessary and immediately effective treatment. Awareness of this will become more clinically relevant as nicorandil use increases.
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Affiliation(s)
- Kiran Samra
- University Hospitals of North Midlands, Stoke-On-Trent, UK
| | | | - Shri Pathmakanthan
- Department of Gastroenterology, Queen Elizabeth Hospital, Birmingham, Birmingham, UK
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Pathmakanthan S. Mucosally associated bacterial flora of the human colon: quantitative and species specific differences between normal and inflamed colonic biopsies. Microbial Ecology in Health and Disease 2009. [DOI: 10.1080/089106099435754] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- Shri Pathmakanthan
- Department of Gastroenterology, University Hospital Queens Medical Centre, Nottingham NG7 2UH, UK
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Affiliation(s)
- J R Butterworth
- Gastrointestinal Unit, University Hospital of Birmingham NHS Trust, Queen Elizabeth Hospital, Birmingham B15, UK
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Abstract
BACKGROUND AND AIM The present study determined the pattern of cytokine secretion (interleukin [IL]-1beta, tumor necrosis factor [TNF]-alpha, interferon [IFN]-gamma and IL-10) and their cellular sources in mononuclear cells isolated from colonic mucosa from normal and ulcerative colitis (UC) in response to probiotic and pathogenic bacteria. METHODS Mononuclear cells were extracted from normal and active UC colonic mucosa and incubated with pure sonicates of probiotic, commensal, and pathogenic bacteria. Cytokine secretion was measured in culture supernatant and intracellular cytokine staining measured using fluorescent-activated cytometry. RESULTS In mononuclear cells isolated from normal mucosa, significant increases in mean IL-1beta were observed with enteropathogenic Escherichia coli (286.3 +/- 138.7 pg/mL P < 0.05) and E. coli (440.5 +/- 194.0 pg/mL P < 0.01) compared with unstimulated control cells (16.7 +/- 4.8 pg/mL). In contrast, mononuclear cells isolated from active UC mucosa produced significant increases in mean IL-1beta in response to stimulation with Salmonella dublin (230.5 +/- 38.8 pg/mL P < 0.05), enteropathogenic E. coli (231.7 +/- 45.3 pg/mL P < 0.05) and E. coli (465.4 +/- 60.2 pg/mL P < 0.001) compared with unstimulated control cells (60.7 +/- 17.1 pg/mL). Escherichia coli also produced significant mean increases of TNF-alpha and IFN-gamma compared with unstimulated control cells. No significant increases in IL-1beta, TNF-alpha or IFN-gamma were observed with Lactobacillus plantarum in cells derived from normal or inflamed mucosa. Strikingly, incubation of L. plantarum with mononuclear cells isolated from active UC mucosa resulted in significant increases of mean IL-10 (327 +/- 53.5 pg/mL, P < 0.05) compared with unstimulated control cells (29.7 +/- 13.2 pg/mL). Intracellular cytokine staining confirmed T-cell and macrophage IL-10 production after L. plantarum stimulation. CONCLUSIONS Lactobacillus plantarum demonstrates beneficial immunomodulatory activity by increasing IL-10 synthesis and secretion in macrophages and T-cells derived from the inflamed colon. This may provide a mechanism through which probiotic bacteria ameliorate inappropriate inflammation and induce tolerance.
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Affiliation(s)
- Shri Pathmakanthan
- Division of Gastroenterology, University Hospital, Queens Medical Centre, Nottingham, UK.
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Abstract
OBJECTIVES To assess the prevalence and potential benefits of attitudes towards nurse endoscopy in the United Kingdom (UK). DESIGN Postal questionnaire. SUBJECTS All hospitals in the UK with accident and emergency, general medical and general surgical services in October 2000. MAIN OUTCOME MEASURES Number of teaching or district general hospitals employing nurse endoscopists, range of diagnostic and therapeutic endoscopic skills and potential benefits to the endoscopy unit and patients. RESULTS Seventy-six hospitals employed 102 nurse endoscopists. Forty-four nurse endoscopists performed both oesophago-gastroduodenoscopy (OGD) and flexible sigmoidoscopy with solitary OGD and flexible sigmoidoscopy performed by 17 and 31, respectively. Three performed full colonoscopy while seven could perform all three procedures. Nurse endoscopists were found to provide good patient care in the majority of endoscopy units with no compromise in safety. Lead clinicians were keen to restrict nurse endoscopy to diagnostic OGD and flexible sigmoidoscopy only in the majority of units. CONCLUSIONS Nurse endoscopy is widely practised in the UK and is not limited to one procedure or solely for diagnostic purposes. Benefits include good patient acceptability, improved care and safety. Most clinicians predict an important but restricted role for nurse endoscopy in contributing to endoscopic services.
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MESH Headings
- Attitude to Health
- Certification/statistics & numerical data
- Clinical Competence/standards
- Endoscopy, Digestive System/adverse effects
- Endoscopy, Digestive System/nursing
- Endoscopy, Digestive System/statistics & numerical data
- Hospitals, District
- Hospitals, General
- Hospitals, Teaching
- Humans
- Job Description
- Nurse Clinicians/education
- Nurse Clinicians/organization & administration
- Nursing Evaluation Research
- Nursing Staff, Hospital/education
- Nursing Staff, Hospital/organization & administration
- Safety
- Specialties, Nursing/education
- Specialties, Nursing/organization & administration
- Surveys and Questionnaires
- United Kingdom
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Affiliation(s)
- S Pathmakanthan
- Department of Gastroenterology, Northern General Hospital, 29 Hunter House Road, Sheffield S11 8TU, UK.
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14
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Pathmakanthan S, Murray IA, Heeley R, Smith K, Donnelly MT. The nurse endoscopy scene. Clin Med (Lond) 2001; 1:84-5. [PMID: 11358089 PMCID: PMC4952051 DOI: 10.7861/clinmedicine.1-1-84a] [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: 11/27/2022]
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Affiliation(s)
- S Pathmakanthan
- Division of Gastroenterology, University Hospital, Queens Medical Centre, Nottingham NG7 2UH, UK.
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Pathmakanthan S, Meance S, Edwards CA. Probiotics: A Review of Human Studies to Date and Methodological Approaches. Microbial Ecology in Health & Disease 2000. [DOI: 10.3402/mehd.v12i2.8108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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17
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Pathmakanthan S, Thornley JP, Hawkey CJ. Mucosally associated bacterial flora of the human colon: quantitative and species specific differences between normal and inflamed colonic biopsies. Microbial Ecology in Health & Disease 1999. [DOI: 10.3402/mehd.v11i3.7901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Abstract
Recent advances in inflammatory bowel disease therapeutics have led to improved formulations of existing treatments and new indications for established drugs. Truly novel therapies based on recent understanding of pathogenesis are also being developed. These new treatments and their likely impact on the management of inflammatory bowel disease in the future are discussed.
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Affiliation(s)
- S Pathmakanthan
- Division of Gastroenterology, University Hospital, Queens Medical Centre, Nottingham
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Pathmakanthan S, O'Donovan DG, Sheehan KM, Murray FE. Prospective evaluation of the utilization of aspirin and non-steroidal anti-inflammatory drugs in acute medical admissions. Ir Med J 1998; 91:58-60. [PMID: 9617032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The aim of this study was to analyse the frequency of aspirin and NSAID usage in 400 unselected patients admitted to the general medical wards through the Accident and Emergency Department. One hundred and twenty patients (30%) reported using NSAIDs (n = 27) or aspirin (n = 99) prior to admission. The median age was 70.5 years (IQR 54-80). Most aspirin use was low dose for cardiovascular prophylaxis and headache. The reported indications for NSAID use were osteoarthritis (n = 12), rheumatoid arthritis (n = 9), gout (n = 3) and psoriatic arthritis (n = 2) and headache (n = 1). Only 23 (19%) patients were aware of the potential side effects of these agents. Co-prescribing with an H2 antagonist (n = 10), proton pump inhibitor (n = 11) or misoprostol (n = 5) was noted in 21.6%. Approximately one third of patients admitted to general medical wards in this study were receiving NSAIDs or Aspirin. The indications for prescribing were appropriate for aspirin. NSAID use was more symptom based and may have been better managed using an analgesic in some cases. Despite the high prevalence of upper gastrointestinal symptoms, co-prescribing of ulcer healing drugs was relatively uncommon.
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Abstract
We report a patient with clinical, biochemical and immunological indices suggestive of autoimmune hepatitis with marked transaminasaemia, raised immunoglobulins and positive anti-nuclear and anti-smooth muscle antibodies. A coagulation screen revealed a transient, markedly increased, activated, partial thromboplastin time and a normal prothrombin time, with elevated levels of anticardiolipin antibodies and the presence of lupus anticoagulant, indicating the presence of antiphospholipid antibodies. Subsequent histology confirmed moderate hepatitis with piecemeal necrosis and fibrosis. Appropriate autoimmune therapy was commenced. This presentation illustrates the rare association of anti-phospholipid antibodies with autoimmune chronic active hepatitis presenting with a temporarily abnormal coagulation screen.
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Affiliation(s)
- S Pathmakanthan
- Department of Hepatology, Beaumont Hospital, Dublin, Ireland
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Burke CM, Sreenan S, Pathmakanthan S, Patterson J, Schmekel B, Poulter LW. Relative effects of inhaled corticosteroids on immunopathology and physiology in asthma: a controlled study. Thorax 1996; 51:993-9. [PMID: 8977599 PMCID: PMC472647 DOI: 10.1136/thx.51.10.993] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.9] [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: 02/03/2023]
Abstract
BACKGROUND Although corticosteroids are recognised as the most efficacious treatment for bronchial asthma, their mode of action remains unclear. A placebo controlled trial was undertaken of the effect of inhaled corticosteroids on physiological and immmunopathological parameters in asthmatic patients in whom the correlations between these indices were tested after treatment. METHODS Sixteen patients (two women) with asthma entered a double blind, placebo controlled, parallel study during which they inhaled either budesonide 800 micrograms twice daily or matching placebo for six weeks. Spirometric parameters and bronchial reactivity to histamine and terbutaline were measured and endobronchial biopsy samples were taken before and after treatment. Patients recorded morning and evening flow rates during the treatment period. The biopsy samples were subjected to immunohistological analysis to determine the disposition of inflammatory cells within the bronchial wall. RESULTS Treatment with budesonide resulted in a significant improvement in the 25-75% forced expiratory flow (FEF25-75) from a mean of 133 l/min before treatment to 169 l/min after treatment, and in the morning peak expiratory flow rate (PEFR) from a mean of 384 l/min before treatment to 415 l/min after treatment. No changes were seen in the placebo group. Comparison between the changes in the immunopathological indices after six weeks of treatment with placebo or budesonide showed a significant reduction in the numbers of mast cells (0.5/unit area to 0.2/ unit area), activated eosinophils, and the expression of HLA-DR antigens (relative density -1.9 before to 1.02 after treatment) on inflammatory cells in response to treatment with budesonide. Although reductions in the numbers of other inflammatory cells within the bronchial wall were recorded using immunohistological analysis, these changes were not statistically significant. Significant correlations were found between changing immunological indices and lung physiology. CONCLUSIONS This controlled study shows that inhaled corticosteroids cause improvement in physiological and immunopathological parameters in patients with stable asthma that are not seen with placebo, and that cause and effect relationships may exist between these two measures of disease status.
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Affiliation(s)
- C M Burke
- Department of Respiratory Medicine, James Connolly Memorial Hospital, Blanchardstown, Dublin, Ireland
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Feeney T, O’Muire O, Gilmartin JJ, Manning P, Sinclair H, Clancy L, O’Connell F, Springall DR, Polak JM, Thomas VE, Fuller RW, Pride NB, Lyons RA, Leonard C, Faul J, Tormey VJ, Poulter LW, Burke CM, Pathmakanthan S, Barry MC, Wang JH, Kelly CJ, Burke PE, Sheehan SJ, Redmond HP, Bouchier-Hayes D, Abdih H, Watson RWG, Burke P, Egan JJ, Barber L, Lomax J, Fox A, Craske J, Yonan N, Rahman AN, Deiraniya AK, Carroll KB, Turner A, Woodcock AA, McNeill K, Bookless B, Gould K, Corris P, Higgenbottam T, Webb A, Woodcock A, McManus K, Miller D, Allen M, Ilstrup D, Deschamps C, Trastek V, Pairolero P, Cotter TP, Vaughan C, Kealy WP, Duggan PF, Curtain A, Bredin CP, Waite A, Maguire CP, Ryan J, O’Neill D, Coakley D, Walsh JB, Kilgallen I, O’Neill S, Ryan M, O’Connor CM, McDonnell T, Lowry RC, Buick JB, Magee TRA, O’Riordan D, Hayes J, O’Connor C, FitzGerald MX, Cosgrave C, Costello C, Deegan PC, McNicholas WT, Nugent AM, Lyons J, Gleadhill I, MacMahon J, Stevenson EC, Heaney LG, Shields MD, Cadden IS, Taylor R, Ennis M, Kharitonov SA, O’Connor J, Owens WA, O’Kane H, Cleland J, Gladstone DJ, Sarsam M, Graham ANJ, Anikin V, McGuigan JA, Curry RC, Varghese G, Keelan P, Rutherford R, O’Keeffe D, McCarthy P, Gilmartin JJ, Moore H, Balbernie E, Gilmartin JJ, Coakley R, Keane M, Costello R, Byrne P, McKeogh D, McLoughlin P, Finlay G, Concannon D, McKeown D, Kelly P, Tanner WA, Bouchier-Hayes DJ, Arumugasamy M, Yacoub K, O’Leary G, Stokes K, Geraghty J, Osborne H, O’Dwyer R, Gilliland R, Saleem SM, Aherne T, Power CK, Burke CH, Byrne A, Murphy JFA, Sharkey R, Mulloy E, Sharkey K, Long M, Birchall MA, Moorat A, Henderson J, Jacques L, Cahill P, Condron C, Royston D, Murphy J, Neill SO. Irish Thoracic Society. Ir J Med Sci 1995. [DOI: 10.1007/bf02973289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Carson KD, Grimes SB, McGinley JM, Thornton MT, Mulhall J, Bourke AM, McCrory C, Marsh B, Hone R, Phelan D, White M, Fabry J, Hughes D, Carson K, Donnelly M, Shanahan E, Fitzpatrick GJ, Bourke M, Warde D, Buggy D, Hughes N, Taylor A, Dowd N, Markham T, Blunnie W, Nicholson G, O’Leary E, Cunningham AJ, Dwyer R, McMechan S, Cullen C, Dempsey G, Wright G, MacKenzie G, Anderson J, Adgey J, Walsh M, O’Callaghan P, Graham I, O’Hare JA, Geoghegan M, Iman N, Shah P, Chander R, Lavin F, Daly K, Johnston PW, Imam Z, Adgey AAJ, Rusk RA, Richardson SG, Hale A, Kinsella BM, FitzGerald GA, King G, Crean P, Gearty G, Cawley T, Docherty JR, Geraghty J, Osborne H, Upton J, D’Arcy G, Stinson J, Cooke T, Colgan MP, Hall M, Tyrrell J, Gaffney K, Grouden M, Moore DJ, Shanik G, Feely J, Delanty N, Reilly M, Lawson JA, Fitzgerald DJ, Reilly MP, McAdam BF, Bergin C, Walshe MJ, Herity NA, Allen JD, Silke B, Singh HP, O’Neill S, Hargrove M, Coleman E, Shorten E, Aherne T, Kelly BE, Hill DH, McIlrath E, Morrow BC, Lavery GG, Blackwood B, Fee JPH, Kevin L, Doran M, Tansey D, Boylan I, McShane AJ, O’Reilly G, Tuohy B, Grainger P, Larkin T, Mahady J, Malone J, Condon C, Donoghue T, O’Leary J, Lyons JF, Tay YK, Tham SN, Khoo Tan HS, Gibson G, O’Grady A, Leader M, Walshe J, Carmody M, Donohoe J, Murphy GM, O’Connor W, Barnes L, Watson R, Darby C, O’Moore R, Mulcahy F, O’Toole E, O’Briain DS, Young MM, Buckley D, Healy E, Rogers S, Ni Scannlain N, McKenna MJ, McBrinn Y, Murray B, Freaney R, Barrett E, Razza Q, Abuaisha F, Powell D, Murray TM, Powell AM, O’Mongain E, O’Neill J, Kernan RP, O’Connor P, Clarke D, Fearon U, Cunningham SK, McKenna TJ, Hayes F, Heffernan A, Sheahan K, Harper R, Johnston GD, Atkinson AB, Sheridan B, Bell PM, Heaney AP, Loughrey G, McCance DR, Hadden DR, Kennedy AL, McNamara P, O’Shaughnessy C, Loughrey HC, Reid I, Teahan S, Caldwell M, Walsh TN, McSweeney J, Hennessy TP, Caldwell MTP, Byrne PJ, Hennessy TPJ, El-Magbri AA, Stevens FM, O’Sullivan R, McCarthy CF, Laundon J, Heneghan MA, Kearns M, Goulding J, Egan EL, McMahon BP, Hegarty F, Malone JF, Merriman R, MacMathuna P, Crowe J, Lennon J, White P, Clarke E, Prabhakar MC, Ryan E, Graham D, Yeoh PL, Kelly P, McKeogh D, O’Keane C, Kitching A, Mulligan E, Gorey TF, Mahmud N, O’Connell M, Goggins M, Keeling PWN, Weir DG, Kelleher D, McDonald GSA, Maguire D, O’Sullivan G, Harvey B, Cherukuri A, McGrath JP, Timon C, Lawlor P, O’Shea J, Buckley M, English L, Walsh T, O’Morain C, Lavelle SM, Kanagaratnam B, Harding B, Murphy B, Kavanagh J, Kerr D, Lavelle E, O’Gorman T, Liston S, Fitzpatrick C, Fitzpatrick P, Turner M, Murphy AW, Cafferty D, Dowling J, Bury G, Kaf Al-Ghazal S, Zimmermann E, O’Donoghue J, McCann J, Sheehan C, Boissel L, Lynch M, Cryan B, Fanning S, O’Meara D, Fennell J, Byrne PM, Lyons D, Mulcahy R, Pooransingh A, Walsh JB, Coakley D, O’Neill D, Ryall N, Connolly P, Namushi R, Lawler M, Locasciulli A, Bacigalupo A, Humphries P, McCann SR, Pamphilon D, Reidy M, Madden M, Finch T, Borton M, Barnes CA, Lawlor SE, Gardiner N, Egan LJ, Orren A, Doherty J, Curran C, O’Hanlon D, Kent P, Kerin M, Maher D, Given HF, Lynch S, McManus R, O’Farrelly C, Madrigal L, Feighery C, O’Donoghue D, Whelan CA, Rea IM, Stewart M, Campbell P, Alexander HD, Crockard AD, Morris TCM, Maguire H, Davidson F, Kaminski GZ, Butler K, Hillary IB, Parfrey NA, Crowley B, McCreary C, Keane C, O’Reilly M, Goh J, Kennedy M, Fitzgerald M, Scott T, Murphy S, Hildebrand J, Holliman R, Smith C, Kengasu K, Riain UN, Cormican M, Flynn J, Glennon M, Smith T, Whyte D, Keane CT, Barry T, Noone D, Maher M, Dawson M, Gilmartin JJ, Gannon F, Eljamel MS, Allcut D, Pidgeon CN, Phillips J, Rawluk D, Young S, Toland J, Deveney AM, Waddington JL, O’Brien DP, Hickey A, Maguire E, Phillips JP, Al-Ansari N, Cunney R, Smyth E, Sharif S, Eljamel M, Pidgeon C, Maguire EA, Burke ET, Staunton H, O’Riordan JI, Hutchinson M, Norton M, McGeeney B, O’Connor M, Redmond JMT, Feely S, Boyle G, McAuliffe F, Foley M, Kelehan P, Murphy J, Greene RA, Higgins J, Darling M, Byrne P, Kondaveeti U, Gordon AC, Hennelly B, Woods T, Harrison RF, Geary M, Sutherst JR, Turner MJ, DeLancey JOL, Donnelly VS, O’Connell PR, O’Herlihy C, Barry-Kinsella C, Sharma SC, Drury L, Lewis S, Stratton J, Ni Scanaill S, Stuart B, Hickey K, Coulter-Smith S, Moloney A, Robson MS, Murphy M, Keane D, Stronge J, Boylan P, Gonsalves R, Blankson S, McGuinness E, Sheppard B, Bonnar J, MacDonagh-White CM, Kelleher CC, Newell J, White O, Young Y, Hallahan C, Carroll K, Tipton K, McDermott EW, Reynolds JV, Nolan N, McCann A, Rafferty R, Sweeney P, Carney D, O’Higgins NJ, Duffy MJ, Grimes H, Gallagher S, O’Hanlon DM, Strattan J, Lenehan P, Robson M, Cusack YA, O’Riordain D, Mercer PM, Smyth PPA, Gallagher HJ, Moule B, Cooke TG, McArdle CS, Burke C, Vance A, Saidtéar C, Early A, Eustace P, Maguire L, Cullinane ABP, Prosser ES, Coca-Prados M, Harvey BJ, Saidléar C, Orwa S, Fitzsimons RB, Bradley O, Hogan M, Zimmerman L, Wang J, Kuliszewski M, Liu J, Post M, Premkumar, Conran MJ, Nolan G, Duff D, Oslizlok P, Denham B, O’Connell PA, Birthistle K, Hitchcock R, Carrington D, Calvert S, Holmes K, Smith DF, Hetherton AM, Mott MG, Oakhill A, Foreman N, Foot A, Dixon J, Walsh S, Mortimer G, O’Sullivan C, Kilgallen CM, Sweeney EC, Brayden DJ, Kelly JG, McCormack PME, Hayes C, Johnson Z, Dack P, Hosseini J, O’Connell T, Hemeryck L, Condren L, McCormack P, McAdam B, Lawson J, Keimowitz R, O’Leary A, Pilkington R, Adebayo GI, Gaffney P, McGettigan P, McManus J, O’Shea B, Wen Y, Killalea S, Golden J, Swanwick G, Clare AW, Mulvany F, Byrne M, O’Callaghan E, Byrne H, Cannon N, Kinsella T, Cassidy B, Shepard N, Horgan R, Larkin C, Cotter D, Coffey VP, Sham PC, Murray LH, Lane A, Kinsella A, Murphy P, Colgan K, Sloan D, Gilligan P, McEnri J, Ennis JT, Stack J, Corcoran E, Walsh D, Thornton L, Temperley I, Lawlor E, Tobin A, Hillary I, Nelson HG, Martin M, Ryan FM, Christie MA, Murray D, Keane E, Holmes E, Hollyer J, Strangeways J, Foster P, Stanwell-Smith R, Griffin E, Conlon T, Hayes E, Clarke T, Fogarty J, Moloney AC, Killeen P, Farrell S, Clancy L, Hynes M, Conlon C, Foley-Nolan C, Shelley E, Collins C, McNamara E, Hayes B, Creamer E, LaFoy M, Costigan P, Al fnAnsari N, Cunney RJ, Smyth EG, Johnson H, McQuoid G, Gilmer B, Browne G, Keogh JAB, Jefferson A, Smith M, Hennessy S, Burke CM, Sreenan S, Power CK, Pathmakanthan S, Poulter LW, Chan A, Sheehan M, Maguire M, O’Connor CM, FitzGerald MX, Southey A, Costello CM, McQuaid K, Urbach V, Thomas S, Horwitz ER, Mulherin D, FitzGerald O, Bresnihan B, Kirk G, Veale DJ, Belch JJF, Mofidi A, Mofidi R, Quigley C, McLaren M, Veale D, D’Arrigo C, Couto JC, Woof J, Greer M, Cree I, Belch J, Hone S, Fenton J, Hamilton S, McShane D. National Scientific Medical Meeting 1994 Abstracts. Ir J Med Sci 1994. [DOI: 10.1007/bf02943102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Chan KH, Singh HP, Aherne T, Carabine U, Gilliland H, Johnston JR, Lowry KG, McGuigan J, Cosgrove J, Veerasingham D, McCarthy J, Hurley J, Wood AE, Gilliland R, McGuigan JA, McManus KG, Wilkinson P, Johnston LC, MacMahon J, Wilson D, Austin C, Anikin V, McManus K, McGuigan J, McManus K, Anikin V, Gibbons JRP, McGuigan J, Sharkey R, Long M, Maree A, O’Neill S, Maguire CP, Hayes JP, Masterson J, Fitzgerald MX, Hayes M, Maguire CP, Hayes JP, Masterson J, Fitzgerald MX, Quigley C, Mofidi A, Mofidi R, Fitzgerald MX, O’Neill M, Watson JBG, O’Halloran ET, Shortt C, Taylor M, Holland C, O’Lorcain P, Taylor M, Holland C, O’Lorcain P, Pathmakanthan S, Sreenan S, Power CK, Poulter LW, Burke CM, Reilly D, Pathmakanthan S, Sreenan S, Doyle S, Burke CM, Sreenan S, Power C, Pathmakanthan S, Goggin A, Burke CM, Poulter LW, Sreenan S, Doyle S, Pathmakanthan S, Poulter LW, Burke CM, Sreenan S, Debenham P, Pathmakanthan S, Burke CM, Poulter LW, Southey A, O’Connor CM, Fitzgerald MX, Bourke WJ, McDonnell TJ, Buck JB, Magee TRA, Lowry RC, Graham ANJ, Owens WA, Kelly SB, McGuigan JA, Costelloe RW, Ryan J, Collins J, Guerin D, Rooney D, Long E, O’Donnell M, O’Neill S, Cotter TP, Bredin CP, Buick JB, Lowry RC, MacMahon JJ, Finlay G, Concannon D, McDonnell TJ, Reid PT, Alderdice J, Carson J, Sinnamon DG, Murphy S, Scott T, Keane CT, Walsh JB, Coakley D, McKeown D, Kelly P, Clancy L, Kiely JL, Cryan B, Bredin CP, Killeen P, Farrell S, Kelly P, Clancy L, Kiely JL, O’Riordan DM, Sheehan S, Curtain J, Hogan J, Bredin CP, Malone A, Ahmed S, Watson JBG, Murphy M, Fennell W, Ahmed S, Watson JBG, Aherne T, Keohane C, O’Neill M, Gleeson CM, McGuigan J, Ritchie AJ, Russell SEH, Molloy E, Keane M, Coakley R, Costello R, Condron C, Watson RGW, O’Neill S, Kelly C, Redmond H, Watson W, Burke P, Bouchier-Hayes D, Donnelly SC, Haslett C, Dransfield I, Robertson CE, Carter DC, Ross JA, Grant IS, Tedder TF, Doyle S, Sreenan S, Pathmakanthan S, Burke CM, Heaney LG, Cross LJM, Stanford CF, Ennis M, Sreenan S, Pathmakanthan S, Power C, Goggin A, Poulter LW, Burke CM, Murphy S, Scott T, Keane CT, Walsh JB, Coakley D, O’Riordan DM, Gergely L, Deng N, Rose RM, Hennessy T, Hickey L, Thornton L, Collum C, Durity M, Power J, Johnson H, Lee B, Doherty E, Kelly E, McDonnell T, McKeown D, Kelly P, Clancy L, Wilkinson P, Varghese G, Anikin V, Gibbons J, McManus K, McGuigan J, Reid PT, Gower NH, Rudd RM. Irish thoracic society. Ir J Med Sci 1994. [DOI: 10.1007/bf02967229] [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: 12/01/2022]
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Clarkson K, Power CK, O'Connell F, Pathmakanthan S, Burke CM. A comparative evaluation of propofol and midazolam as sedative agents in fiberoptic bronchoscopy. Chest 1993; 104:1029-31. [PMID: 8404160 DOI: 10.1378/chest.104.4.1029] [Citation(s) in RCA: 73] [Impact Index Per Article: 2.4] [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: 01/30/2023] Open
Abstract
Propofol, a new intravenous sedative agent, was investigated in 41 asthmatic patients undergoing day-case (outpatient) fiberoptic bronchoscopy. The study design was a randomized comparison between propofol and midazolam, which is a well-established intravenous sedative agent. The age, weight, and American Society of Anesthesiologists physical status and lung function of the two groups were not significantly different. Mean (SD) induction dose of propofol was 104.7 (30.1) mg with a maintenance dose of 121.9 (38.5) mg. Corresponding values of midazolam were 9.3 (3.1) mg and 3.7 (2.3) mg. The required level of sedation was achieved significantly faster with propofol, mean (SD) 125.4 (39.8) s, compared with midazolam, 179.4 (55.2) s (p < 0.001). Significantly faster recovery was noted with propofol compared with midazolam in terms of time to recall name and date of birth 2.3 (1.7) min vs 6.3 (8.6) min, (p < 0.045). Alertness scored with the digital symbol substitution test (DSST) returned to prebronchoscopy values in the propofol group at 30 min, DSST score = 35.9 (18.2) vs 13.4 (9.1), in the midazolam group (p < .0001) and was still significantly higher at 90 min-39.4 (17.9) and 23.1 (13.8) (p < 0.01). We conclude that propofol is a useful sedating agent in fiberoptic bronchoscopy with similar efficacy to midazolam but with a faster onset of action and a more rapid recovery. These represent significant advantages for day-case procedures.
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Affiliation(s)
- K Clarkson
- Department of Respiratory Medicine, James Connolly Memorial Hospital, Blanchardstown, Dublin, Ireland
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