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Scantlebury A, Sivey P, Anteneh Z, Ayres B, Bloor K, Castelli A, Castro-Avila AC, Davies F, Davies S, Glerum-Brooks K, Gutacker N, Lampard P, Rangan A, Saad A, Street A, Wen J, Adamson J. Mixed Methods EvAluation of the high-volume low-complexity Surgical hUb pRogrammE (MEASURE): a mixed methods study protocol. BMJ Open 2024; 14:e086338. [PMID: 38643003 PMCID: PMC11033628 DOI: 10.1136/bmjopen-2024-086338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 03/25/2024] [Indexed: 04/22/2024] Open
Abstract
INTRODUCTION The waiting list for elective surgery in England recently reached over 7.8 million people and waiting time targets have been missed since 2010. The high-volume low complexity (HVLC) surgical hubs programme aims to tackle the backlog of patients awaiting elective surgery treatment in England. This study will evaluate the impact of HVLC surgical hubs on productivity, patient care and the workforce. METHODS AND ANALYSIS This 4-year project consists of six interlinked work packages (WPs) and is informed by the Consolidated Framework for Implementation Research. WP1: Mapping current and future HVLC provision in England through document analysis, quantitative data sets (eg, Hospital Episodes Statistics) and interviews with national service leaders. WP2: Exploring the effects of HVLC hubs on key performance outcomes, primarily the volume of low-complexity patients treated, using quasi-experimental methods. WP3: Exploring the impact and implementation of HVLC hubs on patients, health professionals and the local NHS through approximately nine longitudinal, multimethod qualitative case studies. WP4: Assessing the productivity of HVLC surgical hubs using the Centre for Health Economics NHS productivity measure and Lord Carter's operational productivity measure. WP5: Conducting a mixed-methods appraisal will assess the influence of HVLC surgical hubs on the workforce using: qualitative data (WP3) and quantitative data (eg, National Health Service (NHS) England's workforce statistics and intelligence from WP2). WP6: Analysing the costs and consequences of HVLC surgical hubs will assess their achievements in relation to their resource use to establish value for money. A patient and public involvement group will contribute to the study design and materials. ETHICS AND DISSEMINATION The study has been approved by the East Midlands-Nottingham Research Ethics Committee 23/EM/0231. Participants will provide informed consent for qualitative study components. Dissemination plans include multiple academic and non-academic outputs (eg, Peer-reviewed journals, conferences, social media) and a continuous, feedback-loop of findings to key stakeholders (eg, NHS England) to influence policy development. TRIAL REGISTRATION Research registry: Researchregistry9364 (https://www.researchregistry.com/browse-the-registry%23home/registrationdetails/64cb6c795cbef8002a46f115/).
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Affiliation(s)
| | - Peter Sivey
- Centre for Health Economics, University of York, York, Yorkshire, UK
| | - Zecharias Anteneh
- Centre for Health Economics, University of York, York, Yorkshire, UK
| | - Ben Ayres
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - Karen Bloor
- Department of Health Sciences, University of York, York, Yorkshire, UK
| | - Adriana Castelli
- Centre for Health Economics, University of York, York, Yorkshire, UK
| | | | - Firoza Davies
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Simon Davies
- Centre for Health and Population Sciences, Hull York Medical School, Hull, UK
| | - Karen Glerum-Brooks
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Nils Gutacker
- Centre for Health Economics, University of York, York, Yorkshire, UK
| | - Pete Lampard
- Department of Health Sciences, University of York, York, Yorkshire, UK
| | - Amar Rangan
- Department of Health Sciences, University of York, York, Yorkshire, UK
- Trauma and Orthopaedics, James Cook University Hospital, Middlesbrough, UK
| | - Ahmed Saad
- Opthamology, James Cook University Hospital, Middlesbrough, UK
- Hull York Medical School, Hull, UK
| | | | - Jinglin Wen
- Centre for Health Economics, University of York, York, Yorkshire, UK
| | - Joy Adamson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
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Ruphrect-Smith H, Davies S, Jacob J, Edbrooke-Childs J. Ethnic differences in treatment outcome for children and young people accessing mental health support. Eur Child Adolesc Psychiatry 2024; 33:1121-1131. [PMID: 37245162 PMCID: PMC11032270 DOI: 10.1007/s00787-023-02233-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 09/08/2022] [Accepted: 05/16/2023] [Indexed: 05/29/2023]
Abstract
Children and Young People (CYP) from minoritized ethnic backgrounds experience structural inequalities in Children and Young People's Mental Health Settings (CYPMHS). This mixed methods study explores whether CYP's ethnicity is associated with their treatment outcomes (operationalised as 'measurable change') from CYPMHS. A multilevel multi-nominal regression analysis, controlling for age, gender, referral source, presenting difficulty, case closure reason, suggests that CYP from Asian backgrounds (OR = 0.82, CI [0.70, 0.96]) and Mixed-race (odds ratio (OR) = 0.80; 95% CI [0.69, 0.92]) are less likely to report measurable improvement in mental health difficulties compared to White British CYP. Three themes from a thematic analysis of semi-structured interviews with 15 CYP from minoritized ethnic backgrounds focused on views and experiences of ending mental health support are also presented. CYP view personalised support and the right therapist as conducive to good endings and valued a range of outcomes pertaining to empowerment. Experiences of stigma and inequalities may begin to explain the less positive outcomes experienced by Asian and Mixed-race CYP found in the regression analysis. The implications of these findings and future areas of research are suggested.
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Affiliation(s)
- H Ruphrect-Smith
- Clinical, Educational, and Health Psychology, University College London, London, UK
| | - S Davies
- Evidence Based Practice Unit, University College London and the Anna Freud Centre, Anna Freud, 4-8 Rodney Street, London, N1 9JH, UK
| | - J Jacob
- Clinical, Educational, and Health Psychology, University College London, London, UK
- Child Outcomes Research Consortium, Anna Freud, London, UK
| | - J Edbrooke-Childs
- Clinical, Educational, and Health Psychology, University College London, London, UK.
- Evidence Based Practice Unit, University College London and the Anna Freud Centre, Anna Freud, 4-8 Rodney Street, London, N1 9JH, UK.
- Child Outcomes Research Consortium, Anna Freud, London, UK.
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Haines ER, Gan H, Kupelian A, Roggenkamp B, Lux L, Kumar B, Davies S. The Development and Implementation of Adolescent and Young Adult Oncology Programs: Teen Cancer America's Strategy. J Adolesc Young Adult Oncol 2024; 13:347-351. [PMID: 37922448 DOI: 10.1089/jayao.2023.0110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2023] Open
Abstract
Reflecting a growing recognition that adolescents and young adults (AYAs) with cancer have unique needs that demand novel approaches to care delivery, AYA-specific cancer programs are emerging across the United States to better serve this population. However, the limited availability of health system funding to support such efforts, in combination with the dearth of guidance that exists to guide AYA program development and implementation, has hampered the effective development and implementation of AYA oncology programs. In this article, we describe Teen Cancer America's strategy for partnering with hospitals to address this gap and improve care and outcomes for AYAs with cancer.
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Affiliation(s)
- Emily R Haines
- Department of Implementation Science, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Hilary Gan
- Teen Cancer America, Los Angeles, California, USA
| | | | | | - Lauren Lux
- UNC Adolescent and Young Adult Cancer Program, Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA
| | - Bindu Kumar
- Teen Cancer America, Los Angeles, California, USA
| | - Simon Davies
- Teen Cancer America, Los Angeles, California, USA
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4
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Keeling C, Davies S, Goddard J, Ramaswamy V, Schwalbe EC, Bailey S, Hicks D, Clifford SC. The clinical significance of sub-total surgical resection in childhood medulloblastoma: a multi-cohort analysis of 1100 patients. EClinicalMedicine 2024; 69:102469. [PMID: 38374970 PMCID: PMC10875250 DOI: 10.1016/j.eclinm.2024.102469] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 01/18/2024] [Accepted: 01/19/2024] [Indexed: 02/21/2024] Open
Abstract
Background Medulloblastoma patients with a sub-total surgical resection (STR; >1.5 cm2 primary tumour residuum post-surgery) typically receive intensified treatment. However, the association of STR with poor outcomes has not been observed consistently, questioning the validity of STR as a high-risk disease feature. Methods We collected extent of resection (EOR) data from 1110 patients (from UK CCLG centres (n = 416, collected between September 1990 and July 2014) and published (n = 694) cohorts), the largest cohort of molecularly and clinically annotated tumours assembled to specifically assess the significance of EOR. We performed association and univariable/multivariable survival analyses, assessing overall survival (OS) cohort-wide and with reference to the four consensus medulloblastoma molecular groups and clinical features. Findings STR was reported in 20% (226/1110) of patients. Non-WNT (p = 0.047), children <5 years at diagnosis (p = 0.021) and metastatic patients (p < 0.0001) were significantly more likely to have a STR. In cohort-wide analysis, STR was associated with worse survival in univariable analysis (p < 0.0001). Examination of specific disease contexts showed that STR was prognostic in univariate analysis for patients receiving cranio-spinal irradiation (CSI) and chemotherapy (p = 0.016) and for patients with Group 3 tumours receiving CSI (p = 0.039). STR was not independently prognostic in multivariable analyses; outcomes for patients who have STR as their only risk-feature are as per standard-risk disease. Specifically, STR was not prognostic in non-metastatic patients that received upfront CSI. Interpretation In a cohort of 1100 molecularly characterised medulloblastoma patients, STR (n = 226) predicted significantly lower OS in univariable analysis, but was not an independent prognostic factor. Our data suggest that maximal safe resection can continue to be carried out for patients with medulloblastoma and suggest STR should not inform patient management when observed as a sole, isolated risk-feature. Funding Cancer Research UK, Newcastle Hospitals Charity, Children's Cancer North, British Division of the International Academy of Pathology.
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Affiliation(s)
- Claire Keeling
- Wolfson Childhood Cancer Research Centre, Newcastle University Centre for Cancer, Translational and Clinical Research Institute, Newcastle upon Tyne, United Kingdom
| | - Simon Davies
- Wolfson Childhood Cancer Research Centre, Newcastle University Centre for Cancer, Translational and Clinical Research Institute, Newcastle upon Tyne, United Kingdom
| | - Jack Goddard
- Wolfson Childhood Cancer Research Centre, Newcastle University Centre for Cancer, Translational and Clinical Research Institute, Newcastle upon Tyne, United Kingdom
| | - Vijay Ramaswamy
- Neuro-oncology Section, Division of Hematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Edward C. Schwalbe
- Wolfson Childhood Cancer Research Centre, Newcastle University Centre for Cancer, Translational and Clinical Research Institute, Newcastle upon Tyne, United Kingdom
- Department of Applied Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Simon Bailey
- Wolfson Childhood Cancer Research Centre, Newcastle University Centre for Cancer, Translational and Clinical Research Institute, Newcastle upon Tyne, United Kingdom
- Great North Children's Hospital, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Debbie Hicks
- Wolfson Childhood Cancer Research Centre, Newcastle University Centre for Cancer, Translational and Clinical Research Institute, Newcastle upon Tyne, United Kingdom
| | - Steven C. Clifford
- Wolfson Childhood Cancer Research Centre, Newcastle University Centre for Cancer, Translational and Clinical Research Institute, Newcastle upon Tyne, United Kingdom
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Luyckx VA, Alasfar S, Bajpai D, Atwater CE, Knight J, Talbot B, Davies S, Niang A. Providing environmentally sustainable nephrology care: focus in low- and middle-income countries. Kidney Int 2024; 105:259-268. [PMID: 38008159 DOI: 10.1016/j.kint.2023.09.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 09/14/2023] [Accepted: 09/25/2023] [Indexed: 11/28/2023]
Abstract
Health care on a global scale significantly contributes to carbon emissions, with high-income countries being the primary culprits. Within health care, dialysis plays a significant role as a major source of emissions. Low- and middle-income countries have a high burden of kidney disease and are facing an increasing demand for dialysis. This reality presents multiple opportunities to plan for environmentally sustainable and quality kidney care. By placing a stronger emphasis on primary and secondary prevention of kidney disease and its progression, within the framework of universal health coverage, as well as empowering patients to enhance self-care, we can significantly reduce the need for costly and environmentally detrimental kidney replacement therapy. Mandating the adoption of lean and innovative low-carbon dialysis practices while also promoting the growth of kidney transplantation would enable low- and middle-income countries to take the lead in implementing environmentally friendly nephrology practices and reducing costs, thus optimizing sustainability and the well-being of individuals living with kidney disease.
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Affiliation(s)
- V A Luyckx
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland; Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa.
| | - S Alasfar
- Department of Medicine, Mayo Clinic, Phoenix, Arizona, USA
| | - D Bajpai
- Department of Nephrology, Seth G.S.M.C. and K.E.M. Hospital, Mumbai, India
| | - C E Atwater
- Department of Dialysis Capacity and Technical Operations, Bridge of Life, founded by Davita Inc., Denver, Colorado, USA
| | - J Knight
- The George Institute for Global Health, Newtown, Australia; Faculty of Medicine & Health, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - B Talbot
- The George Institute for Global Health, Newtown, Australia; Faculty of Medicine & Health, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - S Davies
- School of Medicine, Keele University, Keele, Staffordshire, UK
| | - Abdou Niang
- Nephrology Department, Cheikh Anta Diop University & Dalal Jamm University Hospital, Dakar, Senegal
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Talbot B, Davies S, Burman J, Ritchie A, Snelling P, Lynch S, Park Y, Jones B, Garvey V, Jaure A, Jardine M, Perkovic V, Gallagher M, Brandwood A, Kaur N, Knight J. The Point-of-Care Peritoneal Dialysis System Early Evaluation Study (POC-PDEE): A pilot proof-of-principal study of the Ellen Medical Devices Point-of-Care affordable peritoneal dialysis system. Perit Dial Int 2024:8968608231209850. [PMID: 38179591 DOI: 10.1177/08968608231209850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024] Open
Abstract
The global unmet need for kidney replacement therapy means that millions of people die every year as they cannot afford treatment. Peritoneal dialysis (PD) offers comparable survival to haemodialysis and is often more affordable, but one barrier to increasing access is that conventional manufacturing and distribution of PD fluid is costly. Here we report the results from a pilot proof-of-principal study demonstrating for the first time that the Ellen Medical Devices Point-of-Care system can be used by patients to produce sterile PD fluid at the point-of-care. With further development, this low-cost system could offer a solution to the many millions of people around the world who currently cannot afford treatment for kidney failure.
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Affiliation(s)
- Benjamin Talbot
- Renal and Metabolic Division, The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Ellen Medical Devices, Sydney, Australia
- Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | - Simon Davies
- Renal Research Group, School of Medicine, Keele University, UK
- Renal Department, University Hospital of North Staffordshire NHS Trust, Stoke-on-Trent, UK
| | | | - Angus Ritchie
- Concord Repatriation General Hospital, Sydney, Australia
- Faculty of Medicine and Health, The University of Sydney, Australia
| | - Paul Snelling
- Renal Unit, Royal Prince Alfred Hospital, Sydney, Australia
| | | | - Youn Park
- Renal Unit, Royal Prince Alfred Hospital, Sydney, Australia
| | - Brian Jones
- Concord Repatriation General Hospital, Sydney, Australia
- Renal Unit, Royal Prince Alfred Hospital, Sydney, Australia
| | - Vincent Garvey
- Renal and Metabolic Division, The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Ellen Medical Devices, Sydney, Australia
| | - Allison Jaure
- Sydney School of Public Health, The University of Sydney, Australia
| | - Meg Jardine
- Renal and Metabolic Division, The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Concord Repatriation General Hospital, Sydney, Australia
- NHMRC Clinical Trials Centre, The University of Sydney, Australia
| | - Vlado Perkovic
- Renal and Metabolic Division, The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | - Martin Gallagher
- Renal and Metabolic Division, The George Institute for Global Health, University of New South Wales, Sydney, Australia
- South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
| | - Arthur Brandwood
- Ellen Medical Devices, Sydney, Australia
- School of Biomedical Engineering, University of Sydney, Australia
| | | | - John Knight
- Renal and Metabolic Division, The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Ellen Medical Devices, Sydney, Australia
- Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
- Faculty of Medicine and Health, The University of Sydney, Australia
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Shabanian J, Capaldi JM, Luna-Lupercio B, Finster LJ, Noskoff K, Gan H, Davies S, Whiteway SL, Shirazipour CH. Healthcare providers' promotion of physical activity among child and adolescent cancer survivors: strategies and challenges. J Cancer Surviv 2023; 17:1546-1560. [PMID: 35759086 PMCID: PMC9244136 DOI: 10.1007/s11764-022-01218-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 05/19/2022] [Indexed: 12/03/2022]
Abstract
PURPOSE This study aims to investigate how healthcare providers (HCPs) promote physical activity (PA) to child and adolescent cancer survivors. METHODS Semi-structured interviews were conducted with HCPs (n = 16; women n = 12; men n = 4) who provide care for cancer survivor youth (age 3 to 18). Participants represented 7 professions, including child life specialists, oncologists, nurse practitioners, physical therapists, and social workers. A reflexive thematic analysis was conducted to explore the techniques that HCPs use to promote PA for this patient population and ways PA promotion can improve. RESULTS HCPs use five strategies to promote PA to cancer survivor youth: (1) broadening the definition of PA, (2) tailoring PA recommendations, (3) including families, (4) connecting patients to programming, and (5) promoting patient motivation. CONCLUSIONS This research highlights techniques that HCPs use to promote PA to young cancer survivors and reveals the need for additional ways to support HCPs to improve PA promotion for child and adolescent cancer survivors. While HCPs emphasized the importance of PA for this patient population, they navigate barriers that limit the quality of PA discussions. IMPLICATIONS FOR CANCER SURVIVORS Further research should explore interventions to improve PA promotion and PA participation among child and adolescent cancer survivors. By understanding the perspectives of HCPs, patients, and their families, PA promotion strategies can be improved, and more programs that support both patients and practitioners may be developed.
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Affiliation(s)
- Julia Shabanian
- Cedars-Sinai Medical Center, Cancer Research Center for Health Equity, 700 N San Vicente Blvd, 5th Floor, West Hollywood, CA, 90069, USA
| | - Jessica M Capaldi
- Cedars-Sinai Medical Center, Cancer Research Center for Health Equity, 700 N San Vicente Blvd, 5th Floor, West Hollywood, CA, 90069, USA
| | - Bianca Luna-Lupercio
- Cedars-Sinai Medical Center, Cancer Research Center for Health Equity, 700 N San Vicente Blvd, 5th Floor, West Hollywood, CA, 90069, USA
| | - Laurel J Finster
- Cedars-Sinai Medical Center, Cancer Research Center for Health Equity, 700 N San Vicente Blvd, 5th Floor, West Hollywood, CA, 90069, USA
| | | | - Hilary Gan
- Teen Cancer America, Los Angeles, CA, USA
| | | | - Susan L Whiteway
- Walter Reed National Military Medical Center, Bethesda, MD, USA
- Uniformed Services University Health Sciences, Bethesda, MD, USA
| | - Celina H Shirazipour
- Cedars-Sinai Medical Center, Cancer Research Center for Health Equity, 700 N San Vicente Blvd, 5th Floor, West Hollywood, CA, 90069, USA.
- Department of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
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Fotheringham J, Solis-Trapala I, Briggs V, Lambie M, McCullough K, Dunn L, Rawdin A, Hill H, Wailloo A, Davies S, Wilkie M. Catheter Event Rates in Medical Compared to Surgical Peritoneal Dialysis Catheter Insertion. Kidney Int Rep 2023; 8:2635-2645. [PMID: 38106573 PMCID: PMC10719604 DOI: 10.1016/j.ekir.2023.09.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 09/01/2023] [Accepted: 09/11/2023] [Indexed: 12/19/2023] Open
Abstract
Introduction How patient, center, and insertion technique factors interact needs to be understood when designing peritoneal dialysis (PD) catheter insertion pathways. Methods We undertook a prospective cohort study in 44 UK centers enrolling participants planned for first catheter insertion. Sequences of regressions were used to describe the associations linking patient and dialysis unit-level characteristics with catheter insertion technique and their impact on the occurrence of catheter-related events in the first year (catheter-related infection, hospitalization, and removal). Factors associated with catheter events were incorporated into a multistate model comparing the rates of catheter events between medical and surgical insertion alongside treatment modality transitions and mortality. Results Of 784 first catheter insertions, 466 (59%) had a catheter event in the first year and 61.2% of transitions onto hemodialysis (HD) were immediately preceded by a catheter event. Catheter malfunction was less but infection was more common with surgical compared with medical insertions. Participants at centers with fewer late presenters and more new dialysis patients starting PD, had a lower probability of a catheter event. Adjusting for these factors, the hazard ratio for a catheter event following insertion (medical vs. surgical) was 0.70 (95% confidence interval [CI] 0.43 to 1.13), and once established on PD 0.77 (0.62 to 0.96). Conclusion Offering both medical and surgical techniques is associated with lower catheter event rates and keeps people on PD for longer.
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Affiliation(s)
- James Fotheringham
- Sheffield Kidney Institute, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Ivonne Solis-Trapala
- School of Medicine, Faculty of Medicine and Health Sciences, Keele University, Staffordshire, UK
| | - Victoria Briggs
- Sheffield Kidney Institute, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - Mark Lambie
- School of Medicine, Faculty of Medicine and Health Sciences, Keele University, Staffordshire, UK
| | - Keith McCullough
- Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA
| | - Louese Dunn
- Sheffield Kidney Institute, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - Andrew Rawdin
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Harry Hill
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Allan Wailloo
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Simon Davies
- School of Medicine, Faculty of Medicine and Health Sciences, Keele University, Staffordshire, UK
| | - Martin Wilkie
- Sheffield Kidney Institute, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
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Lambie M, Davies S. An update on absolute and relative indications for dialysis treatment modalities. Clin Kidney J 2023; 16:i39-i47. [PMID: 37711635 PMCID: PMC10497377 DOI: 10.1093/ckj/sfad062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Indexed: 09/16/2023] Open
Abstract
Background Choosing a dialysis modality is an important decision for people to make as their kidney failure progresses. In doing so, their options should be informed by any absolute or relative indications that may favour one modality over another. Methods In creating this update, we reviewed literature using a framework that considered first, high-level outcomes (survival and modality transition) from large registry data and cohort studies when considering optimal patient pathways; second, factors at a dialysis provider level that might affect relative indications; and third, specific patient-level factors. Both main types of dialysis modality, peritoneal (PD) and haemodialysis (HD), and their subtypes were considered. Results For most people starting dialysis, survival is independent of modality, including those with diabetes. Better survival is seen in those with less comorbidity starting with PD or home HD, reflecting continued improvements over recent decades that have been greater than improvements seen for centre HD. There are provider-level differences in the perceived relative indications for home dialysis that appear to reflect variability in experience, prejudice, enthusiasm, and support for patients and carers. Absolute contraindications are uncommon and, in most cases, where modality prejudice exists, e.g. obesity, Adult Polycystic Kidney Disease, and social factors, this is not supported by reported outcomes. Conclusion Absolute contraindications to a particular dialysis modality are rare. Relative indications for or against particular modalities should be considered but are rarely more important than patient preferences.
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Affiliation(s)
- Mark Lambie
- School of Medicine, Faculty of Medicine and Health Sciences, Keele University, UK
| | - Simon Davies
- School of Medicine, Faculty of Medicine and Health Sciences, Keele University, UK
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Morelle J, Lambie M, Öberg CM, Davies S. The Peritoneal Membrane and its Role in Peritoneal Dialysis. Clin J Am Soc Nephrol 2023; 19:01277230-990000000-00223. [PMID: 37616463 PMCID: PMC10861113 DOI: 10.2215/cjn.0000000000000282] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 03/08/2023] [Accepted: 08/03/2023] [Indexed: 08/26/2023]
Abstract
A healthy and functional peritoneal membrane is key to achieve sufficient ultrafiltration and to restore fluid balance, a major component of high-quality prescription in patients treated with peritoneal dialysis (PD). Variability in membrane function at the start of PD or changes over time on treatment influence dialysis prescription and outcomes, and dysfunction of the peritoneal membrane contributes to fluid overload and associated complications. In this review, we summarize the current knowledge about the structure, function and pathophysiology of the peritoneal membrane with a focus on clinical implications for patient-centered care. We also discuss the molecular and genetic mechanisms of solute and water transport across the peritoneal membrane, including the role of aquaporin water channels in crystalloid vs. colloid osmosis; why and how to assess membrane function using peritoneal equilibration tests; the etiologies of membrane dysfunction and their specific management; and the impact of genetic variation on membrane function and outcomes in patients treated with PD. This review also identifies the gaps in current knowledge and perspectives for future research to improve our understanding of the peritoneal membrane and, ultimately, to improve the care of patients treated with PD.
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Affiliation(s)
- Johann Morelle
- Division of Nephrology, Cliniques universitaires Saint-Luc, Brussels, Belgium
- UCLouvain School of Medicine, UCLouvain, Brussels, Belgium
| | - Mark Lambie
- Faculty of Medicine and Health Sciences, Keele University, Keele, United Kingdom
| | - Carl M. Öberg
- Division of Nephrology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Simon Davies
- Faculty of Medicine and Health Sciences, Keele University, Keele, United Kingdom
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Davies S, Raju D. Powerful disinfectant properties. Br Dent J 2023; 234:844. [PMID: 37349415 DOI: 10.1038/s41415-023-6035-y] [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] [Received: 04/19/2023] [Accepted: 04/27/2023] [Indexed: 06/24/2023]
Affiliation(s)
- S Davies
- Founder of CleanCert Hygiene, Tisbury, United Kingdom.
| | - D Raju
- Founder of Green Dentistry, Bognor Regis, United Kingdom.
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12
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Abramov D, Kobo O, Davies S, Mathew RO, Van Spall HGC, Mamas MA. Cardiovascular mortality trends in patients with chronic kidney disease compared to the general population. J Nephrol 2023:10.1007/s40620-023-01654-4. [PMID: 37256538 DOI: 10.1007/s40620-023-01654-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 04/17/2023] [Indexed: 06/01/2023]
Affiliation(s)
- Dmitry Abramov
- Division of Cardiology, Department of Medicine, Loma Linda University Health, Loma Linda, CA, US
| | - Ofer Kobo
- Department of Cardiology, Hillel Yaffe Medical Center, Hadera, Israel
| | - Simon Davies
- Department of Renal Medicine, School of Medicine, Keele University, David Weatherall Building, Keele, UK
| | - Roy O Mathew
- Department of Medicine, Loma Linda VA Health Care System, Loma Linda, CA, US
| | - Harriette G C Van Spall
- Department of Medicine, and Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Population Health Research Institute, Hamilton, ON, Canada
- Research Institute of St. Joseph's, Hamilton, ON, Canada
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Stoke-On-Trent, UK.
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13
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Kalogeras K, Jabbour RJ, Pracon R, Kabir T, Shannon J, Duncan A, Quarto C, Heng EL, Rahbi H, Oikonomou E, Katsianos E, Patel N, Chandra N, Vavuranakis MA, Cadiz S, Bougiakli M, Smith RD, Siasos G, Vavuranakis M, Davies S, Dalby M, Panoulas V. Midterm Outcomes in Patients With Aortic Stenosis Treated With Contemporary Balloon-Expandable and Self-Expanding Valves: Does Valve Size Have an Impact on Outcome? J Am Heart Assoc 2023:e028038. [PMID: 37232270 PMCID: PMC10382012 DOI: 10.1161/jaha.122.028038] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Background No data currently exist comparing the contemporary iterations of balloon-expandable (BE) Edwards SAPIEN 3/Ultra and the self-expanding (SE) Medtronic Evolut PRO/R34 valves. The aim of the study was the comparison of these transcatheter heart valves with emphasis on patients with small aortic annulus. Methods and Results In this retrospective registry, periprocedural outcomes and midterm all-cause mortality were analyzed. A total of 1673 patients (917 SE versus 756 BE) were followed up for a median of 15 months. A total of 194 patients died (11.6%) during follow-up. SE and BE groups showed similar survival at 1 (92.6% versus 90.6%) and 3 (80.3% versus 85.2%) years (Plog-rank=0.136). Compared with the BE group, patients treated with the SE device had lower peak (16.3±8 mm Hg SE versus 21.9±8 mm Hg BE) and mean (8.8±5 mm Hg SE versus 11.5±5 mm Hg BE) gradients at discharge. Conversely, the BE group demonstrated lower rates of at least moderate paravalvular regurgitation postoperatively (5.6% versus 0.7% for SE and BE valves, respectively; P<0.001). In patients treated with small transcatheter heart valves (≤26 mm for SE and ≤23 mm for BE; N=284 for SE and N=260 for BE), survival was higher among patients treated with SE valves at both 1 (96.7% SE versus 92.1% BE) and 3 (91.8% SE versus 82.2% BE) years (Plog-rank=0.042). In propensity-matched patients treated with small transcatheter heart valve, there remained a trend for higher survival among the SE group at both 1 (97% SE versus 92.3% BE) and 3 years (91.8% SE versus 78.7% BE), Plog-rank=0.096). Conclusions Real-world comparison of the latest-generation SE and BE devices demonstrated similar survival up to 3 years' follow-up. In patients with small transcatheter heart valves, there may be a trend for improved survival among those treated with SE valves.
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Affiliation(s)
- Konstantinos Kalogeras
- Department of Cardiology, Royal Brompton and Harefield Hospitals Guy's and St Thomas' National Health Service Foundation Trust London UK
- 3rd Department of Cardiology, Sotiria Hospital, Medical School National and Kapodistrian University of Athens Athens Greece
| | - Richard J Jabbour
- Department of Cardiology, Royal Brompton and Harefield Hospitals Guy's and St Thomas' National Health Service Foundation Trust London UK
- Cardiovascular Sciences, National Heart and Lung Institute Imperial College London London UK
| | - Radoslaw Pracon
- Department of Cardiology, Royal Brompton and Harefield Hospitals Guy's and St Thomas' National Health Service Foundation Trust London UK
| | - Tito Kabir
- Department of Cardiology, Royal Brompton and Harefield Hospitals Guy's and St Thomas' National Health Service Foundation Trust London UK
| | - Joanne Shannon
- Department of Cardiology, Royal Brompton and Harefield Hospitals Guy's and St Thomas' National Health Service Foundation Trust London UK
| | - Alison Duncan
- Department of Cardiology, Royal Brompton and Harefield Hospitals Guy's and St Thomas' National Health Service Foundation Trust London UK
| | - Cesare Quarto
- Department of Cardiology, Royal Brompton and Harefield Hospitals Guy's and St Thomas' National Health Service Foundation Trust London UK
| | - Ee-Ling Heng
- Department of Cardiology, Royal Brompton and Harefield Hospitals Guy's and St Thomas' National Health Service Foundation Trust London UK
| | - Hazim Rahbi
- Department of Cardiology, Royal Brompton and Harefield Hospitals Guy's and St Thomas' National Health Service Foundation Trust London UK
| | - Evangelos Oikonomou
- 3rd Department of Cardiology, Sotiria Hospital, Medical School National and Kapodistrian University of Athens Athens Greece
| | - Efstratios Katsianos
- 3rd Department of Cardiology, Sotiria Hospital, Medical School National and Kapodistrian University of Athens Athens Greece
| | - Niket Patel
- Department of Cardiology, Royal Brompton and Harefield Hospitals Guy's and St Thomas' National Health Service Foundation Trust London UK
| | - Navin Chandra
- Department of Cardiology, Royal Brompton and Harefield Hospitals Guy's and St Thomas' National Health Service Foundation Trust London UK
| | - Michael-Andrew Vavuranakis
- 3rd Department of Cardiology, Sotiria Hospital, Medical School National and Kapodistrian University of Athens Athens Greece
| | - Suzane Cadiz
- Department of Cardiology, Royal Brompton and Harefield Hospitals Guy's and St Thomas' National Health Service Foundation Trust London UK
| | - Maria Bougiakli
- Department of Cardiology, Royal Brompton and Harefield Hospitals Guy's and St Thomas' National Health Service Foundation Trust London UK
| | - Robert D Smith
- Department of Cardiology, Royal Brompton and Harefield Hospitals Guy's and St Thomas' National Health Service Foundation Trust London UK
| | - Gerasimos Siasos
- 3rd Department of Cardiology, Sotiria Hospital, Medical School National and Kapodistrian University of Athens Athens Greece
| | - Manolis Vavuranakis
- 3rd Department of Cardiology, Sotiria Hospital, Medical School National and Kapodistrian University of Athens Athens Greece
| | - Simon Davies
- Department of Cardiology, Royal Brompton and Harefield Hospitals Guy's and St Thomas' National Health Service Foundation Trust London UK
| | - Miles Dalby
- Department of Cardiology, Royal Brompton and Harefield Hospitals Guy's and St Thomas' National Health Service Foundation Trust London UK
| | - Vasileios Panoulas
- Department of Cardiology, Royal Brompton and Harefield Hospitals Guy's and St Thomas' National Health Service Foundation Trust London UK
- Cardiovascular Sciences, National Heart and Lung Institute Imperial College London London UK
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14
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Daunov K, Daunov M, Noskoff K, Gan H, Davies S, Farrell M, Hadley W, Baffa A, Giesel J, Egler R, Huang AY, Letterio JJ, Lee RT. Are NCI Cancer Centers Providing Adolescents and Young Adults With Cancer Focused Clinical Services? A National Survey. J Natl Compr Canc Netw 2023; 21:487-495.e15. [PMID: 37156484 DOI: 10.6004/jnccn.2023.7001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 01/04/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND This study sought to evaluate the current services and delivery models of adolescent and young adult oncology (AYAO)-specific programs at NCI-designated Cancer Centers (NCI-CCs). PATIENTS AND METHODS NCI, academic, and community cancer centers were electronically sent surveys from October to December 2020 and administered via REDCap. RESULTS Survey responses were received from 50 of 64 (78%) NCI-CCs, primarily completed by pediatric oncologists (53%), adult oncologists (11%), and social workers (11%). Half (51%) reported an existing AYAO program, with most (66%) started within the past 5 years. Although most programs combined medical and pediatric oncology (59%), 24% were embedded within pediatrics alone. Most programs saw patients aged 15 (55%) to 39 years (66%) mainly via outpatient clinic consultation (93%). Most centers reported access to a range of medical oncology and supportive services, but dedicated services specifically for adolescent and young adults (AYAs) were available at a much lower extent, such as social work (98% vs 58%) and psychology (95% vs 54%). Although fertility preservation was offered by all programs (100%), only two-thirds of NCI centers (64%) reported providing sexual health services to AYAs. Most NCI-CCs (98%) were affiliated with a research consortium, and a lesser extent (73%) reported collaboration between adult and pediatric researchers. Nearly two-thirds (60%) reported that AYA oncology care was important/very important to their respective institution and reported providing good/excellent care to AYAs with cancer (59%), but to a lesser extent reported good/excellent research (36%), sexual health (23%), and education of staff (21%). CONCLUSIONS Results of this first-ever national survey to assess AYAO programs showed that only half of NCI-CCs report having a dedicated AYAO program, and that areas of improvement include staff education, research, and sexual health services for patients.
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Affiliation(s)
- Katherine Daunov
- 1Case Western Reserve University, Cleveland, Ohio
- 2University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Michael Daunov
- 1Case Western Reserve University, Cleveland, Ohio
- 2University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Kara Noskoff
- 3Children's Hospital of Orange County, Orange, California
| | - Hilary Gan
- 4Teen Cancer America, Los Angeles, California
| | | | | | - Whitney Hadley
- 2University Hospitals Cleveland Medical Center, Cleveland, Ohio
- 5Angie Fowler AYA Cancer Institute, UH Rainbow Babies & Children's Hospital, Cleveland, Ohio
- 6Now with The Gathering Place, Beachwood and Westlake, Ohio
| | - Amelia Baffa
- 2University Hospitals Cleveland Medical Center, Cleveland, Ohio
- 5Angie Fowler AYA Cancer Institute, UH Rainbow Babies & Children's Hospital, Cleveland, Ohio
| | - Jennifer Giesel
- 1Case Western Reserve University, Cleveland, Ohio
- 2University Hospitals Cleveland Medical Center, Cleveland, Ohio
- 5Angie Fowler AYA Cancer Institute, UH Rainbow Babies & Children's Hospital, Cleveland, Ohio
- 7Now with LifeStance Health, Beachwood, Ohio
| | - Rachel Egler
- 1Case Western Reserve University, Cleveland, Ohio
- 2University Hospitals Cleveland Medical Center, Cleveland, Ohio
- 5Angie Fowler AYA Cancer Institute, UH Rainbow Babies & Children's Hospital, Cleveland, Ohio
| | - Alex Y Huang
- 1Case Western Reserve University, Cleveland, Ohio
- 2University Hospitals Cleveland Medical Center, Cleveland, Ohio
- 5Angie Fowler AYA Cancer Institute, UH Rainbow Babies & Children's Hospital, Cleveland, Ohio
| | - John J Letterio
- 1Case Western Reserve University, Cleveland, Ohio
- 2University Hospitals Cleveland Medical Center, Cleveland, Ohio
- 5Angie Fowler AYA Cancer Institute, UH Rainbow Babies & Children's Hospital, Cleveland, Ohio
| | - Richard T Lee
- 1Case Western Reserve University, Cleveland, Ohio
- 8City of Hope Cancer Center, Duarte, California
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15
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Yates DRA, Davies S, Kane AD. Death is not the worst that can happen: risk scoring and outcomes in emergency laparotomy. Anaesthesia 2023. [PMID: 37017990 DOI: 10.1111/anae.16018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2023] [Indexed: 04/06/2023]
Affiliation(s)
- D R A Yates
- Department of Anaesthesia and Intensive Care Medicine, York and Scarborough Teaching Hospitals NHS Foundation Trust, York, UK
- North Yorkshire Academic Alliance of Perioperative Medicine, York, UK
| | - S Davies
- Hull York Medical School, York, UK
- North Yorkshire Academic Alliance of Perioperative Medicine, York, UK
| | - A D Kane
- South Tees University Hospital NHS Foundation Trust, Middlesborough, UK
- North Yorkshire Academic Alliance of Perioperative Medicine, York, UK
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16
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Davies S, Jian Z, Hatib F, Gomes A, Mythen M. Indicators of haemodynamic instability and left ventricular function in a porcine model of esmolol induced negative inotropy. J Clin Monit Comput 2023; 37:651-659. [PMID: 36335548 PMCID: PMC10068660 DOI: 10.1007/s10877-022-00937-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 10/19/2022] [Indexed: 11/09/2022]
Abstract
To investigate if the Hypotension Prediction Index was an early indicator of haemodynamic instability in a negative inotropy porcine model, and to assess the correlation of commonly measured indicators of left ventricular systolic function. Eight anaesthetised pigs were volume resuscitated and then underwent an incremental infusion of esmolol hydrochloride (0-3000 mg/hr), following which it was then reduced in a stepwise manner. Full haemodynamic measurements were taken at each stage and measurements of left ventricular systolic function including left ventricular stroke work index, ejection fraction and peripheral dP/dT were obtained. At an infusion rate of 500 mg/hr of esmolol there were no significant changes in any measured variables. At 1000 mg/hr MAP was on average 11 mmHg lower (95% CI 1 to 11 mmHg, p = 0.027) with a mean of 78 mmHg, HPI increased by 33 units (95% CI 4 to 62, p = 0.026) with a mean value of 63. No other parameters showed significant change from baseline values. Subsequent increases in esmolol showed changes in all parameters except SVV, SVR and PA mean. Correlation between dP/dt and LVSWI was 0.85 (95% CI 0.77 to 0.90, p < 0.001), between LVEF and dP/dt 0.39 (95% CI 0.18 to 0.57, p < 0.001), and between LSWI and LVEF 0.41 (95% CI 0.20 to 0.59, p < 0.001). In this model haemodynamic instability induced by negative inotropy was detected by the HPI algorithm prior to any clinically significant change in commonly measured variables. In addition, the peripheral measure of left ventricular contractility dP/dt correlates well with more established measurements of LV systolic function.
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Affiliation(s)
- Simon Davies
- Department of Anaesthesia, Critical Care and Perioperative Medicine, York Teaching Hospitals NHS Foundation Trust, York, UK.
- Centre for Health and Population Science, Hull York Medical School, York, UK.
| | | | | | | | - Monty Mythen
- UCL/UCLH National Institute of Health Research Biomedical Research Centre, London, UK
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17
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Richards T, Miles LF, Clevenger B, Keegan A, Abeysiri S, Rao Baikady R, Besser MW, Browne JP, Klein AA, Macdougall IC, Murphy GJ, Anker SD, Dahly D, Besser M, Browne J, Clevenger B, Kegan A, Klein A, Miles L, MacDougall I, Baikady RR, Dahly D, Bradbury A, Richards T, Burley T, Van Loen S, Anker S, Klein A, MacDougall I, Murphy G, Besser M, Unsworth I, Clayton T, Collier T, Potter K, Abeysiri S, Evans R, Knight R, Swinson R, Van Dyck L, Keidan J, Williamson L, Crook A, Pepper J, Dobson J, Newsome S, Godec T, Dodd M, Richards T, Van Dyck L, Evans R, Abeysiri S, Clevenger B, Butcher A, Swinson R, Collier T, Potter K, Anker S, Kelly J, Morris S, Browne J, Keidan J, Grocott M, Chau M, Knight R, Collier T, Baikady RR, Black E, Lawrence H, Kouthra M, Horner K, Jhanji S, Todman E, Keon‐Cohen Z, Rooms M, Tomlinson J, Bailes I, Walker S, Pirie K, Gerstman M, Kasivisvanathan R, Uren S, Magee D, Eeles A, Anker R, McCanny J, O'Mahony M, Reynolds T, Batley S, Hegarty A, Trundle S, Mazzola F, Tatham K, Balint A, Morrison B, Evans M, Pang CL, Smith L, Wilson C, Sjorin V, Khatri P, Wilson M, Parkinson D, Crosbie J, Dawas K, Smyth D, Bercades G, Ryu J, Reyes A, Martir G, Gallego L, Macklin A, Rocha M, Tam DK, Brealey DD, Dhesi J, Morrison C, Hardwick J, Partridge J, Braude P, Rogerson A, Jahangir N, Thomson C, Biswell L, Cross J, Pritchard F, Mohammed A, Wallace D, Galat MG, Okello J, Symes R, Leon J, Gibbs C, Sanghera S, Dennis A, Kibutu F, Fofie J, Bird S, Alli A, Jackson Y, Albuheissi S, Brain C, Shiridzinomwa C, Ralph C, Wroath B, Hammonds F, Adams B, Faulds J, Staddon S, Hughes T, Saha S, Finney C, Harris C, Mellis C, Johnson L, Riozzi P, Yarnold A, Buchanan F, Hopkins P, Greig L, Noble H, Edwards M, Grocott M, Plumb J, Harvie D, Dushianthan A, Wakatsuki M, Leggett S, Salmon K, Bolger C, Burnish R, Otto J, Rayat G, Golder K, Bartlett P, Bali S, Seaward L, Wadams B, Tyrell B, Collins H, Tantony N, Geale R, Wilson A, Ball D, Lindsey I, Barker D, Thyseen M, Chiam P, Hannaway C, Colling K, Messer C, Verma N, Nasseri M, Poonawala G, Sellars A, Mainali P, Hammond T, Hughes A, O'Hara D, McNeela F, Shillito L, Kotze A, Moriarty C, Wilson J, Davies S, Yates D, Carter J, Redman J, Ma S, Howard K, Redfearn H, Wilcock D, Lowe J, Alexander T, Jose J, Hornzee G, Akbar F, Rey S, Patel A, Coulson S, Saini R, Santipillai J, McCretton T, McCanny J, Chima K, Collins K, Pathmanathan B, Chattersingh A, McLeavy L, Al‐Saadi Z, Patel M, Skampardoni S, Chinnadurai R, Thomas V, Keen A, Pagett K, Keatley C, Howard J, Greenhalgh M, Jenkins S, Gidda R, Watts A, Breaton C, Parker J, Mallett S, James S, Penny L, Chan K, Reeves T, Catterall M, Williams S, Birch J, Hammerton K, Williamson N, Thomas A, Evans M, Mercer L, Horsfield G, Hughes C, Cupitt J, Stoddard E, McNamara H, Birt C, Hardy A, Dennis R, Butcher D, O'Sullivan S, Pope A, Elhanash S, Preston S, Officer H, Stoker A, Moss S, Walker A, Gipson A, Melville J, Bradley‐Potts J, McCormac R, Benson V, Melia K, Fielding J, Guest W, Ford S, Murdoch H, Beames S, Townshend P, Collins K, Glass J, Cartwright B, Altemimi B, Berresford L, Jones C, Kelliher L, de Silva S, Blightman K, Pendry K, Pinto L, Allard S, Taylor L, Chishti A, Scott J, O'Hare D, Lewis M, Hussain Z, Hallett K, Dermody S, Corbett C, Morby L, Hough M, Williams S, Williams P, Horton S, Ashcroft P, Homer A, Lang A, Dawson H, Harrison E, Thompson J, Hariharan V, Goss V, Ravi R, Butt G, Vertue M, Acheson A, Ng O, Bush D, Dickson E, Ward A, Morris S, Taylor A, Casey R, Wilson L, Vimalachandran D, Faulkner M, Jeffrey H, Gabrielle C, Martin S, Bracewell A, Ritzema J, Sproates D, Alexander‐Sefre F, Kubitzek C, Humphreys S, Curtis J, Oats P, Swann S, Holden A, Adam C, Flintoff L, Paoloni C, Bobruk K. The association between iron deficiency and outcomes: a secondary analysis of the intravenous iron therapy to treat iron deficiency anaemia in patients undergoing major abdominal surgery (PREVENTT) trial. Anaesthesia 2023; 78:320-329. [PMID: 36477695 PMCID: PMC10107684 DOI: 10.1111/anae.15926] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2022] [Indexed: 12/13/2022]
Abstract
In the intravenous iron therapy to treat iron deficiency anaemia in patients undergoing major abdominal surgery (PREVENTT) trial, the use of intravenous iron did not reduce the need for blood transfusion or reduce patient complications or length of hospital stay. As part of the trial protocol, serum was collected at randomisation and on the day of surgery. These samples were analysed in a central laboratory for markers of iron deficiency. We performed a secondary analysis to explore the potential interactions between pre-operative markers of iron deficiency and intervention status on the trial outcome measures. Absolute iron deficiency was defined as ferritin <30 μg.l-1 ; functional iron deficiency as ferritin 30-100 μg.l-1 or transferrin saturation < 20%; and the remainder as non-iron deficient. Interactions were estimated using generalised linear models that included different subgroup indicators of baseline iron status. Co-primary endpoints were blood transfusion or death and number of blood transfusions, from randomisation to 30 days postoperatively. Secondary endpoints included peri-operative change in haemoglobin, postoperative complications and length of hospital stay. Most patients had iron deficiency (369/452 [82%]) at randomisation; one-third had absolute iron deficiency (144/452 [32%]) and half had functional iron deficiency (225/452 [50%]). The change in pre-operative haemoglobin with intravenous iron compared with placebo was greatest in patients with absolute iron deficiency, mean difference 8.9 g.l-1 , 95%CI 5.3-12.5; moderate in functional iron deficiency, mean difference 2.8 g.l-1 , 95%CI -0.1 to 5.7; and with little change seen in those patients who were non-iron deficient. Subgroup analyses did not suggest that intravenous iron compared with placebo reduced the likelihood of death or blood transfusion at 30 days differentially across subgroups according to baseline ferritin (p = 0.33 for interaction), transferrin saturation (p = 0.13) or in combination (p = 0.45), or for the number of blood transfusions (p = 0.06, 0.29, and 0.39, respectively). There was no beneficial effect of the use of intravenous iron compared with placebo, regardless of the metrics to diagnose iron deficiency, on postoperative complications or length of hospital stay.
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Affiliation(s)
- T Richards
- Division of Surgery, University of Western Australia, Perkins South Building, Fiona Stanley Hospital, Murdoch, Perth, WA, Australia.,Institute of Clinical Trials and Methodology and Division of Surgery, University College London, UK
| | - L F Miles
- Department of Critical Care, Melbourne Medical School, The University of Melbourne, VIC, Australia.,Department of Anaesthesia, Austin Health, Melbourne, VIC, Australia
| | - B Clevenger
- Department of Anaesthesia, Royal National Orthopaedic Hospital, Stanmore, UK
| | - A Keegan
- Department of Haematology, PathWest Laboratory Medicine, King Edward Memorial Hospital, Subiaco, WA, Australia
| | - S Abeysiri
- Division of Surgery, University of Western Australia, Perkins South Building, Fiona Stanley Hospital, Murdoch, Perth, WA, Australia
| | - R Rao Baikady
- Department of Anaesthesia, The Royal Marsden NHS Foundation Trust, London, UK
| | - M W Besser
- Department of Haematology, Addenbrooke's Hospital, Cambridge, UK
| | - J P Browne
- School of Public Health, University College Cork, Ireland
| | - A A Klein
- Department of Anaesthesia and Intensive Care, Royal Papworth Hospital, Cambridge, UK
| | - I C Macdougall
- Department of Renal Medicine, King's College Hospital, London, UK
| | - G J Murphy
- Department of Cardiovascular Sciences, University of Leicester, UK
| | - S D Anker
- Department of Cardiology, Berlin Institute of Health Centre for Regenerative Therapies; German Centre for Cardiovascular Research partner site Berlin; Charité Universitätsmedizin Berlin, Germany
| | - D Dahly
- School of Public Health, University College Cork, Ireland.,Health Research Board Clinical Research Facility, University College Cork, Ireland
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Batista AFR, Petty D, Fairhurst C, Davies S. Psoas muscle mass index as a predictor of long-term mortality and severity of complications after major intra-abdominal colorectal surgery – A retrospective analysis. J Clin Anesth 2023; 84:110995. [PMID: 36371943 DOI: 10.1016/j.jclinane.2022.110995] [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] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 10/09/2022] [Accepted: 10/31/2022] [Indexed: 11/12/2022]
Abstract
STUDY OBJECTIVE Determine if psoas muscle area measured in routine preoperative computed tomography scans (CT) can be used to identify patients at increased risk of adverse postoperative outcomes after major elective abdominal surgery. DESIGN Retrospective analysis of data from a single-centre cohort study conducted in York Hospital between the 1st August of 2015 and the 31st of august of 2020. SETTING Preoperative clinic. PATIENTS 639 patients who attended the preoperative assessment clinic prior to major elective colorectal surgery and had an abdominal CT scan done up to 120 days before surgery. INTERVENTIONS None. MEASUREMENTS Psoas muscle area at the L3 level was measured in preoperative CT scans and normalised to patient height (psoas muscle index). The lowest sex-stratified tertile of psoas muscle index (PMI) was classed as sarcopenic. The primary outcome was 2-year mortality. Secondary outcomes included postoperative complications assessed using Clavien-Dindo graded major and minor complications, comprehensive complication index (CCI), and length of stay. MAIN RESULTS Multivariable regression analysis showed that sarcopenia was associated with 2-year mortality (aOR 1.79, 95% CI 1.03-3.10; p = 0.037) and survival at 2-years was significantly reduced in sarcopenic patients (log-rank test, p = 0.012). Sarcopenia was the only statistically significant predictor of major complications in multivariable logistic regression analysis (aOR 1.69, 95% CI 1.04-2.74, p = 0.034) and associated with an estimated increase of 16.6% in the comprehensive complication index (CCI) score of patients that had complications in multivariable linear regression analysis. Sarcopenia was not associated with length of stay. CONCLUSIONS Sarcopenia defined by psoas muscle mass is an independent predictor of 2-year mortality, major complications and severity of complications after major colorectal surgery and may be used for preoperative risk assessment.
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Nguyen VQ, Turner N, Barling J, Axtell CM, Davies S. Reconciling general transformational leadership and safety-specific transformational leadership: A paradox perspective. J Safety Res 2023; 84:435-447. [PMID: 36868673 DOI: 10.1016/j.jsr.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 07/31/2022] [Accepted: 12/06/2022] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Research exploring the relationship between transformational leadership and safety has used transformational leadership in context-free (e.g., "general transformational leadership," or GTL) and context-specific forms (e.g., "safety-specific transformational leadership," or SSTL), assuming these constructs are theoretically and empirically equivalent. In this paper, a paradox theory is drawn on (Schad, Lewis, Raisch, & Smith, 2016; Smith & Lewis, 2011) to reconcile the relationship between these two forms of transformational leadership and safety. METHOD This is done by: (a) investigating whether GTL and SSTL are empirically distinguishable; (b) testing the relative importance of GTL and SSTL in explaining variance in context-free work outcomes (i.e., in-role performance, organizational citizenship behaviors) and context-specific (i.e., safety compliance, safety participation); and (c) examining the extent to which perceived safety concern in the work environment renders GTL and SSTL distinguishable. RESULTS Two studies (one cross-sectional, one short-term longitudinal) show that GTL and SSTL are psychometrically distinct albeit highly correlated. Furthermore, SSTL explained statistically more variance than GTL in both safety participation and organizational citizenship behaviors, whereas GTL explained more variance in in-role performance than did SSTL. However, GTL and SSTL were only distinguishable in low-concern contexts but not high-concern contexts. CONCLUSIONS AND PRACTICAL APPLICATIONS These findings challenge the "either-or" (vs "both-and") approach to considering safety and performance, cautioning researchers to consider nuanced differences in context-free and context-specific forms of leadership and to avoid further proliferation of often redundant context-specific operationalizations of leadership.
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Affiliation(s)
| | - Nick Turner
- Haskayne School of Business, University of Calgary, Canada
| | | | - Carolyn M Axtell
- Sheffield University Management School, University of Sheffield, United Kingdom
| | - Simon Davies
- Institute of Work Psychology, University of Sheffield, United Kingdom
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Kobo O, Abramov D, Davies S, Ahmed SB, Sun LY, Mieres JH, Parwani P, Siudak Z, Van Spall HG, Mamas MA. CKD-Associated Cardiovascular Mortality in the United States: Temporal Trends From 1999 to 2020. Kidney Med 2022; 5:100597. [PMID: 36814454 PMCID: PMC9939730 DOI: 10.1016/j.xkme.2022.100597] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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] [Indexed: 12/29/2022] Open
Abstract
Rationale & Objective Chronic kidney disease (CKD) is associated with an increased risk of cardiovascular (CV) mortality, but there are limited data on temporal trends disaggregated by sex, race, and urban/rural status in this population. Study Design Retrospective observational study. Setting & Participants The Centers for Disease Control and Prevention Wide-Ranging, Online Data for Epidemiologic Research database. Exposure & Predictors Patients with CKD and end-stage kidney disease (ESKD) stratified according to key demographic groups. Outcomes Etiologies of CKD- and ESKD-associated mortality between 1999 and 2000. Analytical Approach Presentation of age-adjusted mortality rates (per 100,000 people) characterized by CV categories, ethnicity, sex (male or female), age categories, state, and urban/rural status. Results Between 1999 and 2020, we identified 1,938,505 death certificates with CKD (and ESKD) as an associated cause of mortality. Of all CKD-associated mortality, the most common etiology was CV, with 31.2% of cases. Between 1999 and 2020, CKD-related age-adjusted mortality increased by 50.2%, which was attributed to an 86.6% increase in non-CV mortality but a 7.1% decrease in CV mortality. Black patients had a higher rate of CV mortality throughout the study period, although Black patients experienced a 38.6% reduction in mortality whereas White patients saw a 2.7% increase. Hispanic patients experienced a greater reduction in CV mortality over the study period (40% reduction) compared to non-Hispanic patients (3.6% reduction). CV mortality was higher in urban areas in 1999 but in rural areas in 2020. Limitations Reliance on accurate characterization of causes of mortality in a large dataset. Conclusions Among patients with CKD-related mortality in the United States between 1999 and 2020, there was an increase in all-cause mortality though a small decrease in CV-related mortality. Overall, temporal decreases in CV mortality were more prominent in Hispanic versus non-Hispanic patients and Black patients versus White patients.
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Affiliation(s)
- Ofer Kobo
- Department of Cardiology, Hillel Yaffe Medical Center, Hadera, Israel,Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent, United Kingdom
| | - Dmitry Abramov
- Division of Cardiology, Department of Medicine, Loma Linda University Health, Loma Linda, California
| | - Simon Davies
- Department of Renal Medicine, School of Medicine, Keele University, David Weatherall Building, Keele, United Kingdom
| | - Sofia B. Ahmed
- Department of Medicine, University of Calgary, Alberta, Canada,Libin Cardiovascular Institute of Alberta, Calgary, Canada,Alberta Kidney Disease Network, Calgary, Canada
| | - Louise Y. Sun
- Division of Cardiac Anesthesiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Jennifer H. Mieres
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, New York
| | - Purvi Parwani
- Division of Cardiology, Department of Medicine, Loma Linda University Health, Loma Linda, California
| | - Zbigniew Siudak
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland
| | - Harriette G.C. Van Spall
- Department of Medicine and Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada,Population Health Research Institute, Hamilton, Ontario, Canada,Research Institute of St. Joseph’s, Hamilton, Ontario, Canada
| | - Mamas A. Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent, United Kingdom,Address for Correspondence: Mamas A. Mamas, Professor of Cardiology, Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, UK.
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Jahnke V, Cotier S, Martin M, Davies S. SOC-I-03 Advanced qualitative and quantitative 3t3 neutral red uptake tests for more physiologically relevant in vitro phototoxicity assessment. Toxicol Lett 2022. [DOI: 10.1016/j.toxlet.2022.07.074] [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: 10/14/2022]
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22
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Lindley EJ, Keane DF, Belcher J, Fernandes Da Silva Jeffcoat N, Davies S. Monitoring residual kidney function in haemodialysis patients using timed urine collections: validation of the use of estimated blood results to calculate GFR. Physiol Meas 2022; 43. [PMID: 35830833 DOI: 10.1088/1361-6579/ac80e8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 07/13/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVE With growing recognition of the benefits of preserving residual kidney function (RKF) and use of incremental treatment regimes, the incentive to measure residual clearance in haemodialysis patients is increasing. Interdialytic urine collections used to monitor RKF in research studies are considered impractical in routine care, partly due to the requirement for blood samples before and after the collection. Plasma solute levels can be estimated if patients are in 'steady state', where urea and creatinine concentrations increase at a constant rate between dialysis sessions and are reduced by a constant ratio at each session. Validation of the steady state assumption would allow development of simplified protocols for urine collections in HD patients. APPROACH Equations were derived for estimating plasma urea and creatinine at the start or end of the interdialytic interval for patients in steady state. Data collected during the BISTRO study was used to assess the agreement between measured and estimated plasma levels and the effect of using estimated levels on the calculated glomerular filtration rate (GFR). MAIN RESULTS The mean difference between GFR calculated with estimated plasma levels for the HD session after the collection and a full set of measured levels was 2.0% (95% limits of agreement -10.7% to +14.7%, N = 316). Where plasma levels for the session before the collection were estimated, the mean difference was 1.2% (limits of agreement -10.3% to +7.9%, N = 275). SIGNIFICANCE Using estimated levels for one session led to a clinically significant difference in the calculated GFR for less than 3% of the collections studied. This indicates that the steady state assumption can be used to estimate solute levels when determining GFR from timed urine collections. A pragmatic approach to monitoring RKF in HD would be for patients to collect for approximately 24 hours before routine bloods are taken.
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Affiliation(s)
- Elizabeth J Lindley
- Medical Physics, St James' University Hospital, Bexley Wing, Level 1, Beckett Street, Leeds, LS9 7TF, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
| | - David Francis Keane
- Renal Medicine, Leeds Teaching Hospitals Trust, Beckett Street, Leeds, LS9 7TF, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
| | - John Belcher
- School of Medicine, Keele University, David Weatherall Building, Keele, Staffordshire, ST5 5BG, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
| | - Nancy Fernandes Da Silva Jeffcoat
- School of Medicine, Keele University, David Weatherall Building, Keele, Staffordshire, ST5 5BG, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
| | - Simon Davies
- School of Medicine, Keele University, David Weatherall Building, Keele, Staffordshire, ST5 5BG, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
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Keeling C, Davies S, Hicks D, Clifford S. MEDB-31. THE CLINICAL SIGNIFICANCE OF EXTENT OF RESECTION IN MEDULLOBLASTOMA. Neuro Oncol 2022. [PMCID: PMC9165137 DOI: 10.1093/neuonc/noac079.405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Medulloblastoma (MB) patients determined to have a sub-total resection (STR), defined by >1.5cm2 post-surgical tumour residuum, receive intensified treatment regimes, but recently the designation of STR as a high risk feature is being questioned. We aimed to assess the clinical correlates of extent of resection (EOR) and its impact on survival, with particular consideration of EOR in relation to the four MB consensus molecular subgroups (WNT, SHH, Group 3, Group 4). We collected data from 1113 patients (n=419, UK CCLG institutions; n=694, published data) representing the largest ever combined cohort constructed to assess the impact of EOR in medulloblastoma. We performed association analyses and univariate/multivariate survival analysis using Kaplan-Meier, log-rank and Cox proportional hazard modelling, analysing overall survival (OS) cohort-wide and with reference to molecular subgroups and clinical features. Association analysis of the combined cohort evidenced that infant patients were more likely to have STR (p=0.02). In this whole-cohort analysis, EOR was significantly associated with survival in univariate analysis (HR 1.64, 95% CI 1.30-2.07, p=<0.001) but not in multivariate analysis. STR was variably prognostic in sub-cohort analyses of specific demographics and molecular subgroup; worse outcomes were observed in patients <5 years in SHH (p=0.044) and Group 4 (p=0.044). This was true for WNT patients >5 years old at diagnosis (p=0.034) although numbers were small and require validation in even larger cohorts. In this cohort of >1100 MBs, STR was significantly associated with a lower OS in univariate analysis, but this was driven by specific disease contexts (SHH and Group 4 patients <5 years old). STR was not independently prognostic overall or in any setting. We recommended that surgeons should continue to pursue maximal safe resection for all MB patients but suggest that consideration of STR as a high-risk feature should be disease context specific.
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Affiliation(s)
- Claire Keeling
- Wolfson Childhood Cancer Research Centre, Newcastle University Centre for Cancer, Newcastle-upon-Tyne, Tyne and Wear, United Kingdom
| | - Simon Davies
- Wolfson Childhood Cancer Research Centre, Newcastle University Centre for Cancer, Newcastle-upon-Tyne, Tyne and Wear, United Kingdom
| | - Debbie Hicks
- Wolfson Childhood Cancer Research Centre, Newcastle University Centre for Cancer, Newcastle-upon-Tyne, Tyne and Wear, United Kingdom
| | - Steven Clifford
- Wolfson Childhood Cancer Research Centre, Newcastle University Centre for Cancer, Newcastle-upon-Tyne, Tyne and Wear, United Kingdom
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Day C, Battes K, Butler B, Davies S, Farina L, Frattolillo A, George R, Giegerich T, Hanke S, Härtl T, Igitkhanov Y, Jackson T, Jayasekera N, Kathage Y, Lang P, Lawless R, Luo X, Neugebauer C, Ploeckl B, Santucci A, Schwenzer J, Teichmann T, Tijssen T, Tosti S, Varoutis S, Cortes AV. The pre-concept design of the DEMO tritium, matter injection and vacuum systems. Fusion Engineering and Design 2022. [DOI: 10.1016/j.fusengdes.2022.113139] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Cheung CK, Miller KA, Davies S, Gilman M, Lewis MA, Lopes G, Betz G, Berthaud FM, Thomas BN, Lee H, Ross VA, Brandon RE, Katerere-Virima T, Helbling LE, Tucker-Seeley R. Vital best practices for antiracist patient engagement in AYA oncology research and advocacy: A Delphi study of BIPOC AYA experts. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.12136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
12136 Background: In the thick of the ongoing global crises of the COVID-19 pandemic, uprisings against anti-Black racism and police brutality, and anti-Asian racism and violence, Black, indigenous, and people of color (BIPOC) adolescent and young adult (AYA) cancer patients may be particularly vulnerable and exploited. Whilst embroiled in sociopolitical complexity, BIPOC AYAs are increasingly called upon to contribute as patient advocates in AYA oncology research and advocacy. Researchers, clinicians, and advocates in AYA oncology must dismantle long-standing racism and create meaningful structural change. The purpose of this study is to derive vital best practices for implementing antiracist patient engagement in AYA oncology research and advocacy that are co-developed by BIPOC AYA cancer patients and oncology professionals. Methods: We utilized a modified Delphi technique with a panel of BIPOC AYA cancer patients (n = 32) to build consensus opinions on professional recommendations from a prior study ( Cheung et al., 2021 ), and to generate antiracist best practices in patient engagement. The Delphi study was comprised of three consecutive and iterative survey rounds over the course of 8 months in 2021; participants were BIPOC AYAs diagnosed with cancer between ages 15-36 years. Results: Results detail best practices for the implementation of antiracist patient engagement across all research activities within the Patient-Centered Outcomes Research Institute’s (PCORI) Framework for Patient Engagement. For example, BIPOC AYAs agreed with oncology professionals’ high priority recommendation for including BIPOC AYAs at the highest levels of decision making in research topic selection. As such, a best practice is for researchers to ensure that such representatives not only hold BIPOC AYA identity, but also hold direct experience with the particular oncology diagnosis, issue, or other outcome of interest. Additionally, BIPOC AYAs concurred with oncology professionals’ high priority for “transparency, honesty, and trust” as a core principle for best practices in patient engagement. They further explained that trustworthy relationships are especially important when collaborating with teens and young adults, who are developmentally just coming into their own. When describing successful experiences of inclusion, participants ranked “build collaborative relationships with BIPOC AYA communities and listen to patients not usually heard” and “recruit a diverse range of BIPOC patients and let them give actual input into the study” as the highest priority best practices. Conclusions: Findings from this study are instructional for AYA oncology researchers, clinicians, and advocates to prevent harmful tokenism and implement genuine antiracist inclusion to advance health equity. Future research should investigate best practices within unique clinical settings.
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Affiliation(s)
| | | | | | - Megan Gilman
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Gilberto Lopes
- University of Miami Miller School of Medicine, Miami, FL
| | - Gail Betz
- University of Maryland, Baltimore, Baltimore, MD
| | | | - Bria N Thomas
- Geisinger Commonwealth School of Medicine, Scranton, PA
| | - Haelim Lee
- University of Maryland, Baltimore, Baltimore, MD
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Davies S, Zhao J, McCullough KP, Kim YL, Wang AYM, Badve SV, Mehrotra R, Kanjanabuch T, Kawanishi H, Robinson B, Pisoni R, Perl J. International Icodextrin Use and Association with Peritoneal Membrane Function, Fluid Removal, Patient and Technique Survival. Kidney360 2022; 3:872-882. [PMID: 36128496 PMCID: PMC9438413 DOI: 10.34067/kid.0006922021] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 02/22/2022] [Indexed: 04/25/2023]
Abstract
BACKGROUND Icodextrin has been shown in randomized controlled trials to benefit fluid management in peritoneal dialysis (PD). We describe international icodextrin prescription practices and their relationship to clinical outcomes. METHODS We analyzed data from the prospective, international PDOPPS, from Australia/New Zealand, Canada, Japan, the United Kingdom, and the United States. Membrane function and 24-hour ultrafiltration according to icodextrin and glucose prescription was determined at baseline. Using an instrumental variable approach, Cox regression, stratified by country, was used to determine any association of icodextrin use to death and permanent transfer to hemodialysis (HDT), adjusted for demographics, comorbidities, serum albumin, urine volume, transplant waitlist status, PD modality, center size, and study phase. RESULTS Icodextrin was prescribed in 1986 (35%) of 5617 patients, >43% of patients in all countries, except in the United States, where it was only used in 17% and associated with a far greater use of hypertonic glucose. Patients on icodextrin had more coronary artery disease and diabetes, longer dialysis vintage, lower residual kidney function, faster peritoneal solute transfer rates, and lower ultrafiltration capacity. Prescriptions with or without icodextrin achieved equivalent ultrafiltration (median 750 ml/d [interquartile range 300-1345 ml/d] versus 765 ml/d [251-1345 ml/d]). Icodextrin use was not associated with mortality (HR=1.03; 95% CI, 0.72 to 1.48) or HDT (HR 1.2; 95% CI, 0.92 to 1.57). CONCLUSIONS There are large national and center differences in icodextrin prescription, with the United States using significantly less. Icodextrin was associated with hypertonic glucose avoidance but equivalent ultrafiltration, which may affect any potential survival advantage or HDT.
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Affiliation(s)
- Simon Davies
- School of Medicine, Keele University, Keele, United Kingdom
| | - Junhui Zhao
- Arbor Research Collaborative for Health, Ann Arbor, Michigan
| | | | - Yong-Lim Kim
- School of Medicine, Kyungpook National University Hospital, Daegu, South Korea
| | | | - Sunil V Badve
- Renal and Metabolic Division, George Institute for Global Health, UNSW Medicine, Sydney, Australia
- Department of Renal Medicine, St. George Hospital, Sydney, Australia
| | - Rajnish Mehrotra
- University of Washington, Department of Medicine, Seattle, Washington
| | - Talerngsak Kanjanabuch
- Division of Nephrology, Department of Medicine and Center of Excellence in Kidney Metabolic Disorders and Dialysis Policy and Practice Program (DiP3), School of Global Health, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | - Bruce Robinson
- Arbor Research Collaborative for Health, Ann Arbor, Michigan
| | - Ronald Pisoni
- Arbor Research Collaborative for Health, Ann Arbor, Michigan
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O’Connell Francischetto E, Jones J, Davies S, Allen K, Combes G, Damery S. 682 IMPACT OF DISCHARGE INTERVENTIONS FOR OLDER PATIENTS LEAVING HOSPITAL: A SYSTEMATIC REVIEW OF REVIEWS. Age Ageing 2022. [DOI: 10.1093/ageing/afac036.682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
The UK has an aging population and there is an increasing need for additional care and support services for elderly patients discharged from hospital. Despite a large evidence base on different discharge services there is inconsistent findings on their effectiveness. This systematic review of reviews aimed to evaluate the impact of a variety of discharge interventions on older people leaving hospital.
Method
Ten databases were searched (including Medline and The Cochrane Library) using multiple key search terms related to ‘systematic reviews’, ‘older people’ and ‘discharge’. Only systematic reviews of interventions for people aged over 60 years that provided additional support or adapted their discharge processes were included. Outcomes of interest included mortality, readmissions, length of hospital stay, patient health status and costs. Abstract, title and full-text screening was conducted independently by two reviewers. Interventions were categorised by intervention type and a narrative synthesis was conducted on data extracted.
Results
Of the 8,748 title and abstracts reviewed, 859 full texts were assessed for eligibility, of these 91 were taken forward to quality assessment and 66 moderate or high-quality reviews were included in the final synthesis. Interventions were categorised into 10 types and had varying impact on outcomes. A statistically significant positive impact on the outcomes of interest was found for: Interventions providing ‘rehabilitation, therapy or care at home (or in the community) around the time of discharge’ reducing length of stay; ‘primary care interventions’, ‘Discharge planning/coordination or case management’ and ‘patient education’.
Conclusion
This systematic review of reviews shows that different types and configurations of discharge interventions can benefit older patients in multiple ways when compared to usual care and highlights which intervention types make no difference or have negative impacts. These findings will help to inform the development of new discharge interventions and the direction of future research.
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Affiliation(s)
- E O’Connell Francischetto
- Prevention, Wellbeing and Communities Hub, Gloucestershire County Council & Applied Research Collaborations (ARC) West Midlands, University of Birmingham; Applied Research Collaborations (ARC) West Midlands, University of Birmingham; Surrey and Sussex Healthcare NHS Trust; Health Services Management Centre, University of Birmingham; Applied Research Collaborations (ARC) West Midlands, University of Birmingham; Applied Research Collaborations (ARC) West Midlands, University of Birmingham
| | - J Jones
- Prevention, Wellbeing and Communities Hub, Gloucestershire County Council & Applied Research Collaborations (ARC) West Midlands, University of Birmingham; Applied Research Collaborations (ARC) West Midlands, University of Birmingham; Surrey and Sussex Healthcare NHS Trust; Health Services Management Centre, University of Birmingham; Applied Research Collaborations (ARC) West Midlands, University of Birmingham; Applied Research Collaborations (ARC) West Midlands, University of Birmingham
| | - S Davies
- Prevention, Wellbeing and Communities Hub, Gloucestershire County Council & Applied Research Collaborations (ARC) West Midlands, University of Birmingham; Applied Research Collaborations (ARC) West Midlands, University of Birmingham; Surrey and Sussex Healthcare NHS Trust; Health Services Management Centre, University of Birmingham; Applied Research Collaborations (ARC) West Midlands, University of Birmingham; Applied Research Collaborations (ARC) West Midlands, University of Birmingham
| | - K Allen
- Prevention, Wellbeing and Communities Hub, Gloucestershire County Council & Applied Research Collaborations (ARC) West Midlands, University of Birmingham; Applied Research Collaborations (ARC) West Midlands, University of Birmingham; Surrey and Sussex Healthcare NHS Trust; Health Services Management Centre, University of Birmingham; Applied Research Collaborations (ARC) West Midlands, University of Birmingham; Applied Research Collaborations (ARC) West Midlands, University of Birmingham
| | - G Combes
- Prevention, Wellbeing and Communities Hub, Gloucestershire County Council & Applied Research Collaborations (ARC) West Midlands, University of Birmingham; Applied Research Collaborations (ARC) West Midlands, University of Birmingham; Surrey and Sussex Healthcare NHS Trust; Health Services Management Centre, University of Birmingham; Applied Research Collaborations (ARC) West Midlands, University of Birmingham; Applied Research Collaborations (ARC) West Midlands, University of Birmingham
| | - S Damery
- Prevention, Wellbeing and Communities Hub, Gloucestershire County Council & Applied Research Collaborations (ARC) West Midlands, University of Birmingham; Applied Research Collaborations (ARC) West Midlands, University of Birmingham; Surrey and Sussex Healthcare NHS Trust; Health Services Management Centre, University of Birmingham; Applied Research Collaborations (ARC) West Midlands, University of Birmingham; Applied Research Collaborations (ARC) West Midlands, University of Birmingham
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Nadeau-Fredette AC, Sukul N, Lambie M, Perl J, Davies S, Johnson DW, Robinson B, Van Biesen W, Kramer A, Jager KJ, Saran R, Pisoni R, Chan CT. Mortality Trends after Transfer from Peritoneal Dialysis to Hemodialysis. Kidney Int Rep 2022; 7:1062-1073. [PMID: 35570995 PMCID: PMC9091783 DOI: 10.1016/j.ekir.2022.02.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 01/31/2022] [Accepted: 02/21/2022] [Indexed: 01/08/2023] Open
Abstract
Introduction Transition to hemodialysis (HD) is a common outcome in peritoneal dialysis (PD), but the associated mortality risk is poorly understood. This study sought to identify rates of and risk factors for mortality after transitioning from PD to HD. Methods Patients with incident PD (between 2000 and 2014) who transferred to HD for ≥1 day were identified, using data from Australia and New Zealand Dialysis and Transplantation registry (ANZDATA), Canadian Organ Replacement Register (CORR), Europe Renal Association (ERA) Registry, and the United States Renal Dialysis System (USRDS). Crude mortality rates were calculated for the first 180 days after transfer. Separate multivariable Cox models were built for early (<90 days), medium (90–180 days), and late (>180 days) periods after transfer. Results Overall, 6683, 5847, 21,574, and 80,459 patients were included from ANZDATA, CORR, ERA Registry, and USRDS, respectively. In all registries, crude mortality rate was highest during the first 30 days after a transfer to HD declining thereafter to nadir at 4 to 6 months. Crude mortality rates were lower for patients transferring in the most recent years (than earlier). Older age, PD initiation in earlier cohorts, and longer PD vintage were associated with increased risk of death, with the strongest associations during the first 90 days after transfer and attenuating thereafter. Mortality risk was lower for men than women <90 days after transfer, but higher after 180 days. Conclusion In this multinational study, mortality was highest in the first month after a transfer from PD to HD and risk factors varied by time period after transfer. This study highlights the vulnerability of patients at the time of modality transfer and the need to improve transitions.
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Davies S, Clarke E, Hardy E, Hepworth C. COVID-19, child inactivity and the introduction of an online exercise class. Physiotherapy 2022. [PMCID: PMC8848158 DOI: 10.1016/j.physio.2021.12.021] [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: 11/17/2022]
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Nadeem MK, Walsh JL, Davies S, Behar JM. Takotsubo syndrome and complete heart block, which came first? A case report. Eur Heart J Case Rep 2022; 6:ytab500. [PMID: 35174304 PMCID: PMC8846180 DOI: 10.1093/ehjcr/ytab500] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 06/29/2021] [Accepted: 12/02/2021] [Indexed: 04/28/2023]
Abstract
BACKGROUND In 2018, the European Society of Cardiology published two consensus documents on takotsubo syndrome (TTS), which include the current consensus on nomenclature, diagnosis, management, and complications. However, little is mentioned on the association with complete heart block (CHB), except that 'AV block [occurs in] 2.9% of cases'. Complete heart block is a recognized rare association of TTS, but causation is often unclear. Does CHB trigger TTS or vice-versa? Here, we present a case of TTS associated with CHB. CASE SUMMARY An 89-year-old woman presented with a transient loss of consciousness, acute chest pain, and dyspnoea. A few days prior to this her daughter died suddenly of a myocardial infarction. On presentation, troponin levels were elevated, the electrocardiogram showed CHB with a broad QRS and an echo showed apical akinesis and ballooning. Angiographic investigation excluded significant coronary artery disease. A dual-chamber pacemaker was implanted after a brief period of temporary pacing. Ventricular function normalized during follow-up and her underlying rhythm remained CHB. DISCUSSION Takotsubo syndrome may be triggered by both emotional and physical stressors. Complete heart block is recognized association, but causation is often unclear. In our case, a clear emotional trigger was identified suggesting the TTS may have precipitated CHB not vice versa.
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Affiliation(s)
- Mohammad Khurram Nadeem
- Department of Cardiology, Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
- Corresponding author. Tel: +44 07425309684,
| | - Jason Leo Walsh
- Department of Cardiology, Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Simon Davies
- Department of Cardiology, Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Jonathan M Behar
- Department of Cardiology, Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
- Department of Imaging Sciences and Biomedical Engineering, Kings College London, UK
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Yu Z, Wang Z, Wang Q, Zhang M, Jin H, Ding L, Yan H, Huang J, Jin Y, Davies S, Fang W, Ni Z. Understand the difference between clinical measured ultrafiltrationand real ultrafiltration in peritoneal dialysis. BMC Nephrol 2021; 22:382. [PMID: 34781890 PMCID: PMC8594243 DOI: 10.1186/s12882-021-02589-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 10/26/2021] [Indexed: 11/30/2022] Open
Abstract
Background It has been noticed for years that ultrafiltration (UF) is important for survival in peritoneal dialysis. On the other hand, precise and convenient UF measurement suitable for patient daily practice is not as straight forward as it is to measure UF in the lab. Both overfill and flush before fill used to be source of measurement error for clinical practice. However, controversy finding around UF in peritoneal dialysis still exists in some situation. The current study was to understand the difference between clinical measured UF and real UF. The effect of evaporation and specific gravity in clinical UF measurement were tested in the study. Methods Four different brands of dialysate were purchased from the market. The freshest dialysate available in the market were intentionally picked. The bags were all 2 L, 2.5% dextrose and traditional lactate buffered PD solution. They were stored in four different conditions with controlled temperature and humidity. The bags were weighted at baseline, 6 months and 12 months of storage. Specific gravity was measured in mixed 24 h drainage dialysate from 261 CAPD patients when they come for their routine solute clearance test. Results There was significant difference in dialysate bag weight at baseline between brands. The weight declined significantly after 12 month’s storage. The weight loss was greater in higher temperature and lower humidity. The dialysate in non-PVC package lose less weight than PVC package. The specific gravity of dialysate drainage was significantly higher than pure water and it was related to dialysate protein concentration. Conclusion Storage condition and duration, as well as the type of dialysate package have significant impact in dialysate bag weight before use. Evaporation is likely to be the reason behind. The fact that specific gravity of dialysate drainage is higher than 1 g/ml overestimates UF in manual exchanges, which contributes to systemic measurement error of ultrafiltration in CAPD. Trial registration ClinicalTrials.gov ID: NCT03864120 (March 8, 2019) (Understand the Difference Between Clinical Measured Ultrafiltration and Real Ultrafiltration). Supplementary Information The online version contains supplementary material available at 10.1186/s12882-021-02589-3.
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Affiliation(s)
- Zanzhe Yu
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Zhuqing Wang
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Qin Wang
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Minfang Zhang
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Haijiao Jin
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Li Ding
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Hao Yan
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Jiaying Huang
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Yan Jin
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Simon Davies
- Faculty of Medicine and Health Sciences, Keele University, Keele, UK
| | - Wei Fang
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Zhaohui Ni
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
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Morelle J, Marechal C, Yu Z, Debaix H, Corre T, Lambie M, Verduijn M, Dekker F, Bovy P, Evenepoel P, Bammens B, Selgas R, Bajo MA, Coester AM, Sow A, Hautem N, Struijk DG, Krediet RT, Balligand JL, Goffin E, Crott R, Ripoche P, Davies S, Devuyst O. AQP1 Promoter Variant, Water Transport, and Outcomes in Peritoneal Dialysis. N Engl J Med 2021; 385:1570-1580. [PMID: 34670044 DOI: 10.1056/nejmoa2034279] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Variability in ultrafiltration influences prescriptions and outcomes in patients with kidney failure who are treated with peritoneal dialysis. Variants in AQP1, the gene that encodes the archetypal water channel aquaporin-1, may contribute to that variability. METHODS We gathered clinical and genetic data from 1851 patients treated with peritoneal dialysis in seven cohorts to determine whether AQP1 variants were associated with peritoneal ultrafiltration and with a risk of the composite of death or technique failure (i.e., transfer to hemodialysis). We performed studies in cells, mouse models, and samples obtained from humans to characterize an AQP1 variant and investigate mitigation strategies. RESULTS The common AQP1 promoter variant rs2075574 was associated with peritoneal ultrafiltration. Carriers of the TT genotype at rs2075574 (10 to 16% of patients) had a lower mean (±SD) net ultrafiltration level than carriers of the CC genotype (35 to 47% of patients), both in the discovery phase (506±237 ml vs. 626±283 ml, P = 0.007) and in the validation phase (368±603 ml vs. 563±641 ml, P = 0.003). After a mean follow-up of 944 days, 139 of 898 patients (15%) had died and 280 (31%) had been transferred to hemodialysis. TT carriers had a higher risk of the composite of death or technique failure than CC carriers (adjusted hazard ratio, 1.70; 95% confidence interval [CI], 1.24 to 2.33; P = 0.001), as well as a higher risk of death from any cause (24% vs. 15%, P = 0.03). In mechanistic studies, the rs2075574 risk variant was associated with decreases in AQP1 promoter activity, aquaporin-1 expression, and glucose-driven osmotic water transport. The use of a colloid osmotic agent mitigated the effects of the risk variant. CONCLUSIONS A common variant in AQP1 was associated with decreased ultrafiltration and an increased risk of death or technique failure among patients treated with peritoneal dialysis. (Funded by the Swiss National Science Foundation and others.).
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Affiliation(s)
- Johann Morelle
- From the Division of Nephrology, Cliniques Universitaires Saint-Luc (J.M., E.G., O.D.), and Institut de Recherche Expérimentale et Clinique (J.M., C.M., H.D., A.S., N.H., J.-L.B., E.G., O.D.) and Institut de Recherche Santé et Société, Faculty of Public Health (R.C.), UCLouvain, Brussels, the Division of Nephrology, Clinique Saint-Joseph, Liege (P.B.), and the Department of Microbiology, Immunology, and Transplantation, Nephrology and Renal Transplantation Research Group, KU Leuven (P.E., B.B.), and the Department of Nephrology, Dialysis, and Renal Transplantation, University Hospitals Leuven (P.E., B.B.), Leuven - all in Belgium; the Department of Nephrology, Shanghai Jiao Tong University School of Medicine and Renji Hospital, Shanghai, China (Z.Y.); the Faculty of Medicine and Health Sciences, Keele University, Keele, United Kingdom (Z.Y., M.L., S.D.); the Institute of Physiology, University of Zurich, Zurich (H.D., O.D.), and the Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne (T.C.) - both in Switzerland; the Department of Clinical Epidemiology, Leiden University Medical Center, Leiden (M.V., F.D.), the Division of Nephrology, Department of Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (A.M.C., D.G.S., R.T.K.), and the Department of Surgery, University Medical Center Groningen, Groningen (A.M.C.) - all in the Netherlands; the Division of Nephrology, Hospital Universitario La Paz, and Instituto de Investigación Sanitaria La Paz, Red de Investigación Renal, Universidad Autonoma, Madrid (R.S., M.A.B.); and Institut National de la Transfusion Sanguine, Paris (P.R.)
| | - Céline Marechal
- From the Division of Nephrology, Cliniques Universitaires Saint-Luc (J.M., E.G., O.D.), and Institut de Recherche Expérimentale et Clinique (J.M., C.M., H.D., A.S., N.H., J.-L.B., E.G., O.D.) and Institut de Recherche Santé et Société, Faculty of Public Health (R.C.), UCLouvain, Brussels, the Division of Nephrology, Clinique Saint-Joseph, Liege (P.B.), and the Department of Microbiology, Immunology, and Transplantation, Nephrology and Renal Transplantation Research Group, KU Leuven (P.E., B.B.), and the Department of Nephrology, Dialysis, and Renal Transplantation, University Hospitals Leuven (P.E., B.B.), Leuven - all in Belgium; the Department of Nephrology, Shanghai Jiao Tong University School of Medicine and Renji Hospital, Shanghai, China (Z.Y.); the Faculty of Medicine and Health Sciences, Keele University, Keele, United Kingdom (Z.Y., M.L., S.D.); the Institute of Physiology, University of Zurich, Zurich (H.D., O.D.), and the Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne (T.C.) - both in Switzerland; the Department of Clinical Epidemiology, Leiden University Medical Center, Leiden (M.V., F.D.), the Division of Nephrology, Department of Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (A.M.C., D.G.S., R.T.K.), and the Department of Surgery, University Medical Center Groningen, Groningen (A.M.C.) - all in the Netherlands; the Division of Nephrology, Hospital Universitario La Paz, and Instituto de Investigación Sanitaria La Paz, Red de Investigación Renal, Universidad Autonoma, Madrid (R.S., M.A.B.); and Institut National de la Transfusion Sanguine, Paris (P.R.)
| | - Zanzhe Yu
- From the Division of Nephrology, Cliniques Universitaires Saint-Luc (J.M., E.G., O.D.), and Institut de Recherche Expérimentale et Clinique (J.M., C.M., H.D., A.S., N.H., J.-L.B., E.G., O.D.) and Institut de Recherche Santé et Société, Faculty of Public Health (R.C.), UCLouvain, Brussels, the Division of Nephrology, Clinique Saint-Joseph, Liege (P.B.), and the Department of Microbiology, Immunology, and Transplantation, Nephrology and Renal Transplantation Research Group, KU Leuven (P.E., B.B.), and the Department of Nephrology, Dialysis, and Renal Transplantation, University Hospitals Leuven (P.E., B.B.), Leuven - all in Belgium; the Department of Nephrology, Shanghai Jiao Tong University School of Medicine and Renji Hospital, Shanghai, China (Z.Y.); the Faculty of Medicine and Health Sciences, Keele University, Keele, United Kingdom (Z.Y., M.L., S.D.); the Institute of Physiology, University of Zurich, Zurich (H.D., O.D.), and the Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne (T.C.) - both in Switzerland; the Department of Clinical Epidemiology, Leiden University Medical Center, Leiden (M.V., F.D.), the Division of Nephrology, Department of Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (A.M.C., D.G.S., R.T.K.), and the Department of Surgery, University Medical Center Groningen, Groningen (A.M.C.) - all in the Netherlands; the Division of Nephrology, Hospital Universitario La Paz, and Instituto de Investigación Sanitaria La Paz, Red de Investigación Renal, Universidad Autonoma, Madrid (R.S., M.A.B.); and Institut National de la Transfusion Sanguine, Paris (P.R.)
| | - Huguette Debaix
- From the Division of Nephrology, Cliniques Universitaires Saint-Luc (J.M., E.G., O.D.), and Institut de Recherche Expérimentale et Clinique (J.M., C.M., H.D., A.S., N.H., J.-L.B., E.G., O.D.) and Institut de Recherche Santé et Société, Faculty of Public Health (R.C.), UCLouvain, Brussels, the Division of Nephrology, Clinique Saint-Joseph, Liege (P.B.), and the Department of Microbiology, Immunology, and Transplantation, Nephrology and Renal Transplantation Research Group, KU Leuven (P.E., B.B.), and the Department of Nephrology, Dialysis, and Renal Transplantation, University Hospitals Leuven (P.E., B.B.), Leuven - all in Belgium; the Department of Nephrology, Shanghai Jiao Tong University School of Medicine and Renji Hospital, Shanghai, China (Z.Y.); the Faculty of Medicine and Health Sciences, Keele University, Keele, United Kingdom (Z.Y., M.L., S.D.); the Institute of Physiology, University of Zurich, Zurich (H.D., O.D.), and the Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne (T.C.) - both in Switzerland; the Department of Clinical Epidemiology, Leiden University Medical Center, Leiden (M.V., F.D.), the Division of Nephrology, Department of Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (A.M.C., D.G.S., R.T.K.), and the Department of Surgery, University Medical Center Groningen, Groningen (A.M.C.) - all in the Netherlands; the Division of Nephrology, Hospital Universitario La Paz, and Instituto de Investigación Sanitaria La Paz, Red de Investigación Renal, Universidad Autonoma, Madrid (R.S., M.A.B.); and Institut National de la Transfusion Sanguine, Paris (P.R.)
| | - Tanguy Corre
- From the Division of Nephrology, Cliniques Universitaires Saint-Luc (J.M., E.G., O.D.), and Institut de Recherche Expérimentale et Clinique (J.M., C.M., H.D., A.S., N.H., J.-L.B., E.G., O.D.) and Institut de Recherche Santé et Société, Faculty of Public Health (R.C.), UCLouvain, Brussels, the Division of Nephrology, Clinique Saint-Joseph, Liege (P.B.), and the Department of Microbiology, Immunology, and Transplantation, Nephrology and Renal Transplantation Research Group, KU Leuven (P.E., B.B.), and the Department of Nephrology, Dialysis, and Renal Transplantation, University Hospitals Leuven (P.E., B.B.), Leuven - all in Belgium; the Department of Nephrology, Shanghai Jiao Tong University School of Medicine and Renji Hospital, Shanghai, China (Z.Y.); the Faculty of Medicine and Health Sciences, Keele University, Keele, United Kingdom (Z.Y., M.L., S.D.); the Institute of Physiology, University of Zurich, Zurich (H.D., O.D.), and the Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne (T.C.) - both in Switzerland; the Department of Clinical Epidemiology, Leiden University Medical Center, Leiden (M.V., F.D.), the Division of Nephrology, Department of Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (A.M.C., D.G.S., R.T.K.), and the Department of Surgery, University Medical Center Groningen, Groningen (A.M.C.) - all in the Netherlands; the Division of Nephrology, Hospital Universitario La Paz, and Instituto de Investigación Sanitaria La Paz, Red de Investigación Renal, Universidad Autonoma, Madrid (R.S., M.A.B.); and Institut National de la Transfusion Sanguine, Paris (P.R.)
| | - Mark Lambie
- From the Division of Nephrology, Cliniques Universitaires Saint-Luc (J.M., E.G., O.D.), and Institut de Recherche Expérimentale et Clinique (J.M., C.M., H.D., A.S., N.H., J.-L.B., E.G., O.D.) and Institut de Recherche Santé et Société, Faculty of Public Health (R.C.), UCLouvain, Brussels, the Division of Nephrology, Clinique Saint-Joseph, Liege (P.B.), and the Department of Microbiology, Immunology, and Transplantation, Nephrology and Renal Transplantation Research Group, KU Leuven (P.E., B.B.), and the Department of Nephrology, Dialysis, and Renal Transplantation, University Hospitals Leuven (P.E., B.B.), Leuven - all in Belgium; the Department of Nephrology, Shanghai Jiao Tong University School of Medicine and Renji Hospital, Shanghai, China (Z.Y.); the Faculty of Medicine and Health Sciences, Keele University, Keele, United Kingdom (Z.Y., M.L., S.D.); the Institute of Physiology, University of Zurich, Zurich (H.D., O.D.), and the Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne (T.C.) - both in Switzerland; the Department of Clinical Epidemiology, Leiden University Medical Center, Leiden (M.V., F.D.), the Division of Nephrology, Department of Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (A.M.C., D.G.S., R.T.K.), and the Department of Surgery, University Medical Center Groningen, Groningen (A.M.C.) - all in the Netherlands; the Division of Nephrology, Hospital Universitario La Paz, and Instituto de Investigación Sanitaria La Paz, Red de Investigación Renal, Universidad Autonoma, Madrid (R.S., M.A.B.); and Institut National de la Transfusion Sanguine, Paris (P.R.)
| | - Marion Verduijn
- From the Division of Nephrology, Cliniques Universitaires Saint-Luc (J.M., E.G., O.D.), and Institut de Recherche Expérimentale et Clinique (J.M., C.M., H.D., A.S., N.H., J.-L.B., E.G., O.D.) and Institut de Recherche Santé et Société, Faculty of Public Health (R.C.), UCLouvain, Brussels, the Division of Nephrology, Clinique Saint-Joseph, Liege (P.B.), and the Department of Microbiology, Immunology, and Transplantation, Nephrology and Renal Transplantation Research Group, KU Leuven (P.E., B.B.), and the Department of Nephrology, Dialysis, and Renal Transplantation, University Hospitals Leuven (P.E., B.B.), Leuven - all in Belgium; the Department of Nephrology, Shanghai Jiao Tong University School of Medicine and Renji Hospital, Shanghai, China (Z.Y.); the Faculty of Medicine and Health Sciences, Keele University, Keele, United Kingdom (Z.Y., M.L., S.D.); the Institute of Physiology, University of Zurich, Zurich (H.D., O.D.), and the Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne (T.C.) - both in Switzerland; the Department of Clinical Epidemiology, Leiden University Medical Center, Leiden (M.V., F.D.), the Division of Nephrology, Department of Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (A.M.C., D.G.S., R.T.K.), and the Department of Surgery, University Medical Center Groningen, Groningen (A.M.C.) - all in the Netherlands; the Division of Nephrology, Hospital Universitario La Paz, and Instituto de Investigación Sanitaria La Paz, Red de Investigación Renal, Universidad Autonoma, Madrid (R.S., M.A.B.); and Institut National de la Transfusion Sanguine, Paris (P.R.)
| | - Friedo Dekker
- From the Division of Nephrology, Cliniques Universitaires Saint-Luc (J.M., E.G., O.D.), and Institut de Recherche Expérimentale et Clinique (J.M., C.M., H.D., A.S., N.H., J.-L.B., E.G., O.D.) and Institut de Recherche Santé et Société, Faculty of Public Health (R.C.), UCLouvain, Brussels, the Division of Nephrology, Clinique Saint-Joseph, Liege (P.B.), and the Department of Microbiology, Immunology, and Transplantation, Nephrology and Renal Transplantation Research Group, KU Leuven (P.E., B.B.), and the Department of Nephrology, Dialysis, and Renal Transplantation, University Hospitals Leuven (P.E., B.B.), Leuven - all in Belgium; the Department of Nephrology, Shanghai Jiao Tong University School of Medicine and Renji Hospital, Shanghai, China (Z.Y.); the Faculty of Medicine and Health Sciences, Keele University, Keele, United Kingdom (Z.Y., M.L., S.D.); the Institute of Physiology, University of Zurich, Zurich (H.D., O.D.), and the Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne (T.C.) - both in Switzerland; the Department of Clinical Epidemiology, Leiden University Medical Center, Leiden (M.V., F.D.), the Division of Nephrology, Department of Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (A.M.C., D.G.S., R.T.K.), and the Department of Surgery, University Medical Center Groningen, Groningen (A.M.C.) - all in the Netherlands; the Division of Nephrology, Hospital Universitario La Paz, and Instituto de Investigación Sanitaria La Paz, Red de Investigación Renal, Universidad Autonoma, Madrid (R.S., M.A.B.); and Institut National de la Transfusion Sanguine, Paris (P.R.)
| | - Philippe Bovy
- From the Division of Nephrology, Cliniques Universitaires Saint-Luc (J.M., E.G., O.D.), and Institut de Recherche Expérimentale et Clinique (J.M., C.M., H.D., A.S., N.H., J.-L.B., E.G., O.D.) and Institut de Recherche Santé et Société, Faculty of Public Health (R.C.), UCLouvain, Brussels, the Division of Nephrology, Clinique Saint-Joseph, Liege (P.B.), and the Department of Microbiology, Immunology, and Transplantation, Nephrology and Renal Transplantation Research Group, KU Leuven (P.E., B.B.), and the Department of Nephrology, Dialysis, and Renal Transplantation, University Hospitals Leuven (P.E., B.B.), Leuven - all in Belgium; the Department of Nephrology, Shanghai Jiao Tong University School of Medicine and Renji Hospital, Shanghai, China (Z.Y.); the Faculty of Medicine and Health Sciences, Keele University, Keele, United Kingdom (Z.Y., M.L., S.D.); the Institute of Physiology, University of Zurich, Zurich (H.D., O.D.), and the Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne (T.C.) - both in Switzerland; the Department of Clinical Epidemiology, Leiden University Medical Center, Leiden (M.V., F.D.), the Division of Nephrology, Department of Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (A.M.C., D.G.S., R.T.K.), and the Department of Surgery, University Medical Center Groningen, Groningen (A.M.C.) - all in the Netherlands; the Division of Nephrology, Hospital Universitario La Paz, and Instituto de Investigación Sanitaria La Paz, Red de Investigación Renal, Universidad Autonoma, Madrid (R.S., M.A.B.); and Institut National de la Transfusion Sanguine, Paris (P.R.)
| | - Pieter Evenepoel
- From the Division of Nephrology, Cliniques Universitaires Saint-Luc (J.M., E.G., O.D.), and Institut de Recherche Expérimentale et Clinique (J.M., C.M., H.D., A.S., N.H., J.-L.B., E.G., O.D.) and Institut de Recherche Santé et Société, Faculty of Public Health (R.C.), UCLouvain, Brussels, the Division of Nephrology, Clinique Saint-Joseph, Liege (P.B.), and the Department of Microbiology, Immunology, and Transplantation, Nephrology and Renal Transplantation Research Group, KU Leuven (P.E., B.B.), and the Department of Nephrology, Dialysis, and Renal Transplantation, University Hospitals Leuven (P.E., B.B.), Leuven - all in Belgium; the Department of Nephrology, Shanghai Jiao Tong University School of Medicine and Renji Hospital, Shanghai, China (Z.Y.); the Faculty of Medicine and Health Sciences, Keele University, Keele, United Kingdom (Z.Y., M.L., S.D.); the Institute of Physiology, University of Zurich, Zurich (H.D., O.D.), and the Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne (T.C.) - both in Switzerland; the Department of Clinical Epidemiology, Leiden University Medical Center, Leiden (M.V., F.D.), the Division of Nephrology, Department of Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (A.M.C., D.G.S., R.T.K.), and the Department of Surgery, University Medical Center Groningen, Groningen (A.M.C.) - all in the Netherlands; the Division of Nephrology, Hospital Universitario La Paz, and Instituto de Investigación Sanitaria La Paz, Red de Investigación Renal, Universidad Autonoma, Madrid (R.S., M.A.B.); and Institut National de la Transfusion Sanguine, Paris (P.R.)
| | - Bert Bammens
- From the Division of Nephrology, Cliniques Universitaires Saint-Luc (J.M., E.G., O.D.), and Institut de Recherche Expérimentale et Clinique (J.M., C.M., H.D., A.S., N.H., J.-L.B., E.G., O.D.) and Institut de Recherche Santé et Société, Faculty of Public Health (R.C.), UCLouvain, Brussels, the Division of Nephrology, Clinique Saint-Joseph, Liege (P.B.), and the Department of Microbiology, Immunology, and Transplantation, Nephrology and Renal Transplantation Research Group, KU Leuven (P.E., B.B.), and the Department of Nephrology, Dialysis, and Renal Transplantation, University Hospitals Leuven (P.E., B.B.), Leuven - all in Belgium; the Department of Nephrology, Shanghai Jiao Tong University School of Medicine and Renji Hospital, Shanghai, China (Z.Y.); the Faculty of Medicine and Health Sciences, Keele University, Keele, United Kingdom (Z.Y., M.L., S.D.); the Institute of Physiology, University of Zurich, Zurich (H.D., O.D.), and the Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne (T.C.) - both in Switzerland; the Department of Clinical Epidemiology, Leiden University Medical Center, Leiden (M.V., F.D.), the Division of Nephrology, Department of Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (A.M.C., D.G.S., R.T.K.), and the Department of Surgery, University Medical Center Groningen, Groningen (A.M.C.) - all in the Netherlands; the Division of Nephrology, Hospital Universitario La Paz, and Instituto de Investigación Sanitaria La Paz, Red de Investigación Renal, Universidad Autonoma, Madrid (R.S., M.A.B.); and Institut National de la Transfusion Sanguine, Paris (P.R.)
| | - Rafael Selgas
- From the Division of Nephrology, Cliniques Universitaires Saint-Luc (J.M., E.G., O.D.), and Institut de Recherche Expérimentale et Clinique (J.M., C.M., H.D., A.S., N.H., J.-L.B., E.G., O.D.) and Institut de Recherche Santé et Société, Faculty of Public Health (R.C.), UCLouvain, Brussels, the Division of Nephrology, Clinique Saint-Joseph, Liege (P.B.), and the Department of Microbiology, Immunology, and Transplantation, Nephrology and Renal Transplantation Research Group, KU Leuven (P.E., B.B.), and the Department of Nephrology, Dialysis, and Renal Transplantation, University Hospitals Leuven (P.E., B.B.), Leuven - all in Belgium; the Department of Nephrology, Shanghai Jiao Tong University School of Medicine and Renji Hospital, Shanghai, China (Z.Y.); the Faculty of Medicine and Health Sciences, Keele University, Keele, United Kingdom (Z.Y., M.L., S.D.); the Institute of Physiology, University of Zurich, Zurich (H.D., O.D.), and the Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne (T.C.) - both in Switzerland; the Department of Clinical Epidemiology, Leiden University Medical Center, Leiden (M.V., F.D.), the Division of Nephrology, Department of Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (A.M.C., D.G.S., R.T.K.), and the Department of Surgery, University Medical Center Groningen, Groningen (A.M.C.) - all in the Netherlands; the Division of Nephrology, Hospital Universitario La Paz, and Instituto de Investigación Sanitaria La Paz, Red de Investigación Renal, Universidad Autonoma, Madrid (R.S., M.A.B.); and Institut National de la Transfusion Sanguine, Paris (P.R.)
| | - Maria A Bajo
- From the Division of Nephrology, Cliniques Universitaires Saint-Luc (J.M., E.G., O.D.), and Institut de Recherche Expérimentale et Clinique (J.M., C.M., H.D., A.S., N.H., J.-L.B., E.G., O.D.) and Institut de Recherche Santé et Société, Faculty of Public Health (R.C.), UCLouvain, Brussels, the Division of Nephrology, Clinique Saint-Joseph, Liege (P.B.), and the Department of Microbiology, Immunology, and Transplantation, Nephrology and Renal Transplantation Research Group, KU Leuven (P.E., B.B.), and the Department of Nephrology, Dialysis, and Renal Transplantation, University Hospitals Leuven (P.E., B.B.), Leuven - all in Belgium; the Department of Nephrology, Shanghai Jiao Tong University School of Medicine and Renji Hospital, Shanghai, China (Z.Y.); the Faculty of Medicine and Health Sciences, Keele University, Keele, United Kingdom (Z.Y., M.L., S.D.); the Institute of Physiology, University of Zurich, Zurich (H.D., O.D.), and the Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne (T.C.) - both in Switzerland; the Department of Clinical Epidemiology, Leiden University Medical Center, Leiden (M.V., F.D.), the Division of Nephrology, Department of Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (A.M.C., D.G.S., R.T.K.), and the Department of Surgery, University Medical Center Groningen, Groningen (A.M.C.) - all in the Netherlands; the Division of Nephrology, Hospital Universitario La Paz, and Instituto de Investigación Sanitaria La Paz, Red de Investigación Renal, Universidad Autonoma, Madrid (R.S., M.A.B.); and Institut National de la Transfusion Sanguine, Paris (P.R.)
| | - Annemieke M Coester
- From the Division of Nephrology, Cliniques Universitaires Saint-Luc (J.M., E.G., O.D.), and Institut de Recherche Expérimentale et Clinique (J.M., C.M., H.D., A.S., N.H., J.-L.B., E.G., O.D.) and Institut de Recherche Santé et Société, Faculty of Public Health (R.C.), UCLouvain, Brussels, the Division of Nephrology, Clinique Saint-Joseph, Liege (P.B.), and the Department of Microbiology, Immunology, and Transplantation, Nephrology and Renal Transplantation Research Group, KU Leuven (P.E., B.B.), and the Department of Nephrology, Dialysis, and Renal Transplantation, University Hospitals Leuven (P.E., B.B.), Leuven - all in Belgium; the Department of Nephrology, Shanghai Jiao Tong University School of Medicine and Renji Hospital, Shanghai, China (Z.Y.); the Faculty of Medicine and Health Sciences, Keele University, Keele, United Kingdom (Z.Y., M.L., S.D.); the Institute of Physiology, University of Zurich, Zurich (H.D., O.D.), and the Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne (T.C.) - both in Switzerland; the Department of Clinical Epidemiology, Leiden University Medical Center, Leiden (M.V., F.D.), the Division of Nephrology, Department of Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (A.M.C., D.G.S., R.T.K.), and the Department of Surgery, University Medical Center Groningen, Groningen (A.M.C.) - all in the Netherlands; the Division of Nephrology, Hospital Universitario La Paz, and Instituto de Investigación Sanitaria La Paz, Red de Investigación Renal, Universidad Autonoma, Madrid (R.S., M.A.B.); and Institut National de la Transfusion Sanguine, Paris (P.R.)
| | - Amadou Sow
- From the Division of Nephrology, Cliniques Universitaires Saint-Luc (J.M., E.G., O.D.), and Institut de Recherche Expérimentale et Clinique (J.M., C.M., H.D., A.S., N.H., J.-L.B., E.G., O.D.) and Institut de Recherche Santé et Société, Faculty of Public Health (R.C.), UCLouvain, Brussels, the Division of Nephrology, Clinique Saint-Joseph, Liege (P.B.), and the Department of Microbiology, Immunology, and Transplantation, Nephrology and Renal Transplantation Research Group, KU Leuven (P.E., B.B.), and the Department of Nephrology, Dialysis, and Renal Transplantation, University Hospitals Leuven (P.E., B.B.), Leuven - all in Belgium; the Department of Nephrology, Shanghai Jiao Tong University School of Medicine and Renji Hospital, Shanghai, China (Z.Y.); the Faculty of Medicine and Health Sciences, Keele University, Keele, United Kingdom (Z.Y., M.L., S.D.); the Institute of Physiology, University of Zurich, Zurich (H.D., O.D.), and the Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne (T.C.) - both in Switzerland; the Department of Clinical Epidemiology, Leiden University Medical Center, Leiden (M.V., F.D.), the Division of Nephrology, Department of Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (A.M.C., D.G.S., R.T.K.), and the Department of Surgery, University Medical Center Groningen, Groningen (A.M.C.) - all in the Netherlands; the Division of Nephrology, Hospital Universitario La Paz, and Instituto de Investigación Sanitaria La Paz, Red de Investigación Renal, Universidad Autonoma, Madrid (R.S., M.A.B.); and Institut National de la Transfusion Sanguine, Paris (P.R.)
| | - Nicolas Hautem
- From the Division of Nephrology, Cliniques Universitaires Saint-Luc (J.M., E.G., O.D.), and Institut de Recherche Expérimentale et Clinique (J.M., C.M., H.D., A.S., N.H., J.-L.B., E.G., O.D.) and Institut de Recherche Santé et Société, Faculty of Public Health (R.C.), UCLouvain, Brussels, the Division of Nephrology, Clinique Saint-Joseph, Liege (P.B.), and the Department of Microbiology, Immunology, and Transplantation, Nephrology and Renal Transplantation Research Group, KU Leuven (P.E., B.B.), and the Department of Nephrology, Dialysis, and Renal Transplantation, University Hospitals Leuven (P.E., B.B.), Leuven - all in Belgium; the Department of Nephrology, Shanghai Jiao Tong University School of Medicine and Renji Hospital, Shanghai, China (Z.Y.); the Faculty of Medicine and Health Sciences, Keele University, Keele, United Kingdom (Z.Y., M.L., S.D.); the Institute of Physiology, University of Zurich, Zurich (H.D., O.D.), and the Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne (T.C.) - both in Switzerland; the Department of Clinical Epidemiology, Leiden University Medical Center, Leiden (M.V., F.D.), the Division of Nephrology, Department of Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (A.M.C., D.G.S., R.T.K.), and the Department of Surgery, University Medical Center Groningen, Groningen (A.M.C.) - all in the Netherlands; the Division of Nephrology, Hospital Universitario La Paz, and Instituto de Investigación Sanitaria La Paz, Red de Investigación Renal, Universidad Autonoma, Madrid (R.S., M.A.B.); and Institut National de la Transfusion Sanguine, Paris (P.R.)
| | - Dirk G Struijk
- From the Division of Nephrology, Cliniques Universitaires Saint-Luc (J.M., E.G., O.D.), and Institut de Recherche Expérimentale et Clinique (J.M., C.M., H.D., A.S., N.H., J.-L.B., E.G., O.D.) and Institut de Recherche Santé et Société, Faculty of Public Health (R.C.), UCLouvain, Brussels, the Division of Nephrology, Clinique Saint-Joseph, Liege (P.B.), and the Department of Microbiology, Immunology, and Transplantation, Nephrology and Renal Transplantation Research Group, KU Leuven (P.E., B.B.), and the Department of Nephrology, Dialysis, and Renal Transplantation, University Hospitals Leuven (P.E., B.B.), Leuven - all in Belgium; the Department of Nephrology, Shanghai Jiao Tong University School of Medicine and Renji Hospital, Shanghai, China (Z.Y.); the Faculty of Medicine and Health Sciences, Keele University, Keele, United Kingdom (Z.Y., M.L., S.D.); the Institute of Physiology, University of Zurich, Zurich (H.D., O.D.), and the Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne (T.C.) - both in Switzerland; the Department of Clinical Epidemiology, Leiden University Medical Center, Leiden (M.V., F.D.), the Division of Nephrology, Department of Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (A.M.C., D.G.S., R.T.K.), and the Department of Surgery, University Medical Center Groningen, Groningen (A.M.C.) - all in the Netherlands; the Division of Nephrology, Hospital Universitario La Paz, and Instituto de Investigación Sanitaria La Paz, Red de Investigación Renal, Universidad Autonoma, Madrid (R.S., M.A.B.); and Institut National de la Transfusion Sanguine, Paris (P.R.)
| | - Raymond T Krediet
- From the Division of Nephrology, Cliniques Universitaires Saint-Luc (J.M., E.G., O.D.), and Institut de Recherche Expérimentale et Clinique (J.M., C.M., H.D., A.S., N.H., J.-L.B., E.G., O.D.) and Institut de Recherche Santé et Société, Faculty of Public Health (R.C.), UCLouvain, Brussels, the Division of Nephrology, Clinique Saint-Joseph, Liege (P.B.), and the Department of Microbiology, Immunology, and Transplantation, Nephrology and Renal Transplantation Research Group, KU Leuven (P.E., B.B.), and the Department of Nephrology, Dialysis, and Renal Transplantation, University Hospitals Leuven (P.E., B.B.), Leuven - all in Belgium; the Department of Nephrology, Shanghai Jiao Tong University School of Medicine and Renji Hospital, Shanghai, China (Z.Y.); the Faculty of Medicine and Health Sciences, Keele University, Keele, United Kingdom (Z.Y., M.L., S.D.); the Institute of Physiology, University of Zurich, Zurich (H.D., O.D.), and the Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne (T.C.) - both in Switzerland; the Department of Clinical Epidemiology, Leiden University Medical Center, Leiden (M.V., F.D.), the Division of Nephrology, Department of Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (A.M.C., D.G.S., R.T.K.), and the Department of Surgery, University Medical Center Groningen, Groningen (A.M.C.) - all in the Netherlands; the Division of Nephrology, Hospital Universitario La Paz, and Instituto de Investigación Sanitaria La Paz, Red de Investigación Renal, Universidad Autonoma, Madrid (R.S., M.A.B.); and Institut National de la Transfusion Sanguine, Paris (P.R.)
| | - Jean-Luc Balligand
- From the Division of Nephrology, Cliniques Universitaires Saint-Luc (J.M., E.G., O.D.), and Institut de Recherche Expérimentale et Clinique (J.M., C.M., H.D., A.S., N.H., J.-L.B., E.G., O.D.) and Institut de Recherche Santé et Société, Faculty of Public Health (R.C.), UCLouvain, Brussels, the Division of Nephrology, Clinique Saint-Joseph, Liege (P.B.), and the Department of Microbiology, Immunology, and Transplantation, Nephrology and Renal Transplantation Research Group, KU Leuven (P.E., B.B.), and the Department of Nephrology, Dialysis, and Renal Transplantation, University Hospitals Leuven (P.E., B.B.), Leuven - all in Belgium; the Department of Nephrology, Shanghai Jiao Tong University School of Medicine and Renji Hospital, Shanghai, China (Z.Y.); the Faculty of Medicine and Health Sciences, Keele University, Keele, United Kingdom (Z.Y., M.L., S.D.); the Institute of Physiology, University of Zurich, Zurich (H.D., O.D.), and the Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne (T.C.) - both in Switzerland; the Department of Clinical Epidemiology, Leiden University Medical Center, Leiden (M.V., F.D.), the Division of Nephrology, Department of Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (A.M.C., D.G.S., R.T.K.), and the Department of Surgery, University Medical Center Groningen, Groningen (A.M.C.) - all in the Netherlands; the Division of Nephrology, Hospital Universitario La Paz, and Instituto de Investigación Sanitaria La Paz, Red de Investigación Renal, Universidad Autonoma, Madrid (R.S., M.A.B.); and Institut National de la Transfusion Sanguine, Paris (P.R.)
| | - Eric Goffin
- From the Division of Nephrology, Cliniques Universitaires Saint-Luc (J.M., E.G., O.D.), and Institut de Recherche Expérimentale et Clinique (J.M., C.M., H.D., A.S., N.H., J.-L.B., E.G., O.D.) and Institut de Recherche Santé et Société, Faculty of Public Health (R.C.), UCLouvain, Brussels, the Division of Nephrology, Clinique Saint-Joseph, Liege (P.B.), and the Department of Microbiology, Immunology, and Transplantation, Nephrology and Renal Transplantation Research Group, KU Leuven (P.E., B.B.), and the Department of Nephrology, Dialysis, and Renal Transplantation, University Hospitals Leuven (P.E., B.B.), Leuven - all in Belgium; the Department of Nephrology, Shanghai Jiao Tong University School of Medicine and Renji Hospital, Shanghai, China (Z.Y.); the Faculty of Medicine and Health Sciences, Keele University, Keele, United Kingdom (Z.Y., M.L., S.D.); the Institute of Physiology, University of Zurich, Zurich (H.D., O.D.), and the Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne (T.C.) - both in Switzerland; the Department of Clinical Epidemiology, Leiden University Medical Center, Leiden (M.V., F.D.), the Division of Nephrology, Department of Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (A.M.C., D.G.S., R.T.K.), and the Department of Surgery, University Medical Center Groningen, Groningen (A.M.C.) - all in the Netherlands; the Division of Nephrology, Hospital Universitario La Paz, and Instituto de Investigación Sanitaria La Paz, Red de Investigación Renal, Universidad Autonoma, Madrid (R.S., M.A.B.); and Institut National de la Transfusion Sanguine, Paris (P.R.)
| | - Ralph Crott
- From the Division of Nephrology, Cliniques Universitaires Saint-Luc (J.M., E.G., O.D.), and Institut de Recherche Expérimentale et Clinique (J.M., C.M., H.D., A.S., N.H., J.-L.B., E.G., O.D.) and Institut de Recherche Santé et Société, Faculty of Public Health (R.C.), UCLouvain, Brussels, the Division of Nephrology, Clinique Saint-Joseph, Liege (P.B.), and the Department of Microbiology, Immunology, and Transplantation, Nephrology and Renal Transplantation Research Group, KU Leuven (P.E., B.B.), and the Department of Nephrology, Dialysis, and Renal Transplantation, University Hospitals Leuven (P.E., B.B.), Leuven - all in Belgium; the Department of Nephrology, Shanghai Jiao Tong University School of Medicine and Renji Hospital, Shanghai, China (Z.Y.); the Faculty of Medicine and Health Sciences, Keele University, Keele, United Kingdom (Z.Y., M.L., S.D.); the Institute of Physiology, University of Zurich, Zurich (H.D., O.D.), and the Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne (T.C.) - both in Switzerland; the Department of Clinical Epidemiology, Leiden University Medical Center, Leiden (M.V., F.D.), the Division of Nephrology, Department of Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (A.M.C., D.G.S., R.T.K.), and the Department of Surgery, University Medical Center Groningen, Groningen (A.M.C.) - all in the Netherlands; the Division of Nephrology, Hospital Universitario La Paz, and Instituto de Investigación Sanitaria La Paz, Red de Investigación Renal, Universidad Autonoma, Madrid (R.S., M.A.B.); and Institut National de la Transfusion Sanguine, Paris (P.R.)
| | - Pierre Ripoche
- From the Division of Nephrology, Cliniques Universitaires Saint-Luc (J.M., E.G., O.D.), and Institut de Recherche Expérimentale et Clinique (J.M., C.M., H.D., A.S., N.H., J.-L.B., E.G., O.D.) and Institut de Recherche Santé et Société, Faculty of Public Health (R.C.), UCLouvain, Brussels, the Division of Nephrology, Clinique Saint-Joseph, Liege (P.B.), and the Department of Microbiology, Immunology, and Transplantation, Nephrology and Renal Transplantation Research Group, KU Leuven (P.E., B.B.), and the Department of Nephrology, Dialysis, and Renal Transplantation, University Hospitals Leuven (P.E., B.B.), Leuven - all in Belgium; the Department of Nephrology, Shanghai Jiao Tong University School of Medicine and Renji Hospital, Shanghai, China (Z.Y.); the Faculty of Medicine and Health Sciences, Keele University, Keele, United Kingdom (Z.Y., M.L., S.D.); the Institute of Physiology, University of Zurich, Zurich (H.D., O.D.), and the Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne (T.C.) - both in Switzerland; the Department of Clinical Epidemiology, Leiden University Medical Center, Leiden (M.V., F.D.), the Division of Nephrology, Department of Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (A.M.C., D.G.S., R.T.K.), and the Department of Surgery, University Medical Center Groningen, Groningen (A.M.C.) - all in the Netherlands; the Division of Nephrology, Hospital Universitario La Paz, and Instituto de Investigación Sanitaria La Paz, Red de Investigación Renal, Universidad Autonoma, Madrid (R.S., M.A.B.); and Institut National de la Transfusion Sanguine, Paris (P.R.)
| | - Simon Davies
- From the Division of Nephrology, Cliniques Universitaires Saint-Luc (J.M., E.G., O.D.), and Institut de Recherche Expérimentale et Clinique (J.M., C.M., H.D., A.S., N.H., J.-L.B., E.G., O.D.) and Institut de Recherche Santé et Société, Faculty of Public Health (R.C.), UCLouvain, Brussels, the Division of Nephrology, Clinique Saint-Joseph, Liege (P.B.), and the Department of Microbiology, Immunology, and Transplantation, Nephrology and Renal Transplantation Research Group, KU Leuven (P.E., B.B.), and the Department of Nephrology, Dialysis, and Renal Transplantation, University Hospitals Leuven (P.E., B.B.), Leuven - all in Belgium; the Department of Nephrology, Shanghai Jiao Tong University School of Medicine and Renji Hospital, Shanghai, China (Z.Y.); the Faculty of Medicine and Health Sciences, Keele University, Keele, United Kingdom (Z.Y., M.L., S.D.); the Institute of Physiology, University of Zurich, Zurich (H.D., O.D.), and the Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne (T.C.) - both in Switzerland; the Department of Clinical Epidemiology, Leiden University Medical Center, Leiden (M.V., F.D.), the Division of Nephrology, Department of Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (A.M.C., D.G.S., R.T.K.), and the Department of Surgery, University Medical Center Groningen, Groningen (A.M.C.) - all in the Netherlands; the Division of Nephrology, Hospital Universitario La Paz, and Instituto de Investigación Sanitaria La Paz, Red de Investigación Renal, Universidad Autonoma, Madrid (R.S., M.A.B.); and Institut National de la Transfusion Sanguine, Paris (P.R.)
| | - Olivier Devuyst
- From the Division of Nephrology, Cliniques Universitaires Saint-Luc (J.M., E.G., O.D.), and Institut de Recherche Expérimentale et Clinique (J.M., C.M., H.D., A.S., N.H., J.-L.B., E.G., O.D.) and Institut de Recherche Santé et Société, Faculty of Public Health (R.C.), UCLouvain, Brussels, the Division of Nephrology, Clinique Saint-Joseph, Liege (P.B.), and the Department of Microbiology, Immunology, and Transplantation, Nephrology and Renal Transplantation Research Group, KU Leuven (P.E., B.B.), and the Department of Nephrology, Dialysis, and Renal Transplantation, University Hospitals Leuven (P.E., B.B.), Leuven - all in Belgium; the Department of Nephrology, Shanghai Jiao Tong University School of Medicine and Renji Hospital, Shanghai, China (Z.Y.); the Faculty of Medicine and Health Sciences, Keele University, Keele, United Kingdom (Z.Y., M.L., S.D.); the Institute of Physiology, University of Zurich, Zurich (H.D., O.D.), and the Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne (T.C.) - both in Switzerland; the Department of Clinical Epidemiology, Leiden University Medical Center, Leiden (M.V., F.D.), the Division of Nephrology, Department of Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (A.M.C., D.G.S., R.T.K.), and the Department of Surgery, University Medical Center Groningen, Groningen (A.M.C.) - all in the Netherlands; the Division of Nephrology, Hospital Universitario La Paz, and Instituto de Investigación Sanitaria La Paz, Red de Investigación Renal, Universidad Autonoma, Madrid (R.S., M.A.B.); and Institut National de la Transfusion Sanguine, Paris (P.R.)
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Kalogeras K, Zuhair M, Kabir T, Jabbour R, Dalby M, Ghada M, Shai S, Katsianos E, Iqbal M, Naganuma T, Davies S, Shannon J, Duncan A, Vavuranakis M, Panoulas V. Real-world comparison of the last generation balloon-expandable and self-expanding valves in patients undergoing TAVI. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background/Introduction
The balloon expandable (BE) Edwards Sapien-S3/Ultra, and the self-expanding (SE) Medtronic Evolut-Pro represent the main volume of transcatheter aortic valve implantation (TAVI) procedures conducted worldwide.
Purpose
The present study represents the largest real-world comparison of periprocedural and short-term outcome between the aforementioned last generation devices.
Methods
Consecutive patients who had undergone TAVI with either the BE (S3/Ultra) or SE (Evolut-Pro/R-34mm if 34mm valve was required) device, in five centers were retrospectively studied. Periprocedural and short-term outcomes were recorded and compared.
Results
In total, 1341 patients (58.5% male) were treated with contemporary BE and SE valves (574 and 767pts with BE and SE respectively) and followed up for a median of 18.7 (IQR 30) months. Baseline demographics were similar between the two groups apart from severe left ventricle (LV) systolic impairment and extensive aorta calcification, being more prevalent amongst BE and SE groups respectively. Patients treated with the Evolut-Pro/R34mm device had significantly lower peak (16±9mmHg for SE vs 23.9±6mmHg for the BE valves, p=0.001) and mean (8.6±6mmHg SE vs 11.2±5.2mmHg BE, p=0.001) gradients at discharge.
Conversely, the BE group demonstrated significantly lower rates of at least moderate residual aortic regurgitation (AR) post-operatively (0.7% vs 5.2% for BE and SE valves respectively, p<0.001). Interestingly, the rate of new permanent pacemaker (PPM) required after the implantation in initially pacemaker-free patients, was higher for the S3/Ultra cohort compared to the self-expanding valve group (14.4% vs 12.3% respectively, p=0.001). No statistical difference was recorded between valve groups regarding cerebrovascular events (3.4% vs. 2.7% for SE and BE respectively, p=0.466), major vascular complications (4.2% vs. 3.0% for SE and BE respectively, p=0.251) and death to hospital discharge (1.6% vs. 2.9% for SE and BE respectively, p=0.117).
One-year Kaplan-Meier estimated survival was similar between the two groups (88.7% for BE vs. 91.4% for SE valves, plog-rank=0.093). When adjusting for age, extensive calcification of the aorta and baseline LV function all caused mortality hazard ratios were similar between patients treated with BE vs SE valves (HR 1.39; 95% CI 0.97 to 1.98, p=0.07).
Conclusions
Real life comparison of the last generation balloon expandable and self-expanding devices demonstrates superiority of the former in terms of residual PVL, at the expense of higher transvalvular gradients and higher need of new PPM implantation. The latter however may represent differences in center practices with regards to thresholds for permanent pacing. Long-term follow-up and future larger trials are required to establish any potential long-term difference in clinical outcomes and prognosis.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- K Kalogeras
- Athens Chest Hospital Sotiria, 3rd Department of Cardiology, University of Athens, Athens, Greece
| | - M Zuhair
- Imperial College London, London, United Kingdom
| | - T Kabir
- Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - R Jabbour
- Imperial College London, London, United Kingdom
| | - M Dalby
- Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - M Ghada
- Imperial College London, London, United Kingdom
| | - S Shai
- Royal Brompton Hospital Imperial College London, London, United Kingdom
| | - E Katsianos
- Athens Chest Hospital Sotiria, 3rd Department of Cardiology, University of Athens, Athens, Greece
| | - M Iqbal
- Imperial College London, London, United Kingdom
| | | | - S Davies
- Imperial College London, London, United Kingdom
| | - J Shannon
- Royal Brompton Hospital Imperial College London, London, United Kingdom
| | - A Duncan
- Royal Brompton Hospital Imperial College London, London, United Kingdom
| | - M Vavuranakis
- Athens Chest Hospital Sotiria, 3rd Department of Cardiology, University of Athens, Athens, Greece
| | - V Panoulas
- Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
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Cheung CK, Tucker-Seeley R, Davies S, Gilman M, Miller KA, Lopes G, Betz GD, Katerere-Virima T, Helbling LE, Thomas BN, Lewis MA. A call to action: Antiracist patient engagement in adolescent and young adult oncology research and advocacy. Future Oncol 2021; 17:3743-3756. [PMID: 34263658 PMCID: PMC10918508 DOI: 10.2217/fon-2020-1213] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 12/01/2020] [Accepted: 06/25/2021] [Indexed: 12/13/2022] Open
Abstract
Amidst the concurrent global crises of coronavirus disease 2019 (COVID-19), uprisings against Anti-Black racism and police brutality, as well as anti-Asian racism and violence, the field of medicine found itself simultaneously called upon to respond as essential workers in the public health devastation of COVID-19, and as representatives of healthcare institutions wrought with the impacts of systemic racism. Clinicians, researchers, and advocates in adolescent and young adult (AYA) oncology, must come together in authentic activism to begin the work of creating structural change to advance antiracist approaches to patient engagement in AYA oncology research and advocacy. Critical review of existing practices is needed to ensure that ethical and effective research methods are employed when engaging with racial and ethnic minority AYA patients with cancer, who may be particularly vulnerable and exploited in the current context.
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Affiliation(s)
- Christabel K Cheung
- University of Maryland School of Social Work, 525 West Redwood St., Baltimore, MD 21201, USA
| | - Reginald Tucker-Seeley
- University of Southern California, Leonard Davis School of Gerontology, Los Angeles, CA 90089, USA
| | | | - Megan Gilman
- AYA Psychiatry, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Kimberly A Miller
- Department of Preventive Medicine, USC Center for Young Adult Cancer Survivorship Research, Keck School of Medicine of the University of Southern California, Los Angeles, CA 90033, USA
| | - Gilberto Lopes
- Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | - Gail D Betz
- University of Maryland Health Sciences and Human Services Library, Baltimore, MD 21201, USA
| | - Thuli Katerere-Virima
- University of Maryland Health Sciences and Human Services Library, Baltimore, MD 21201, USA
| | - Laura E Helbling
- University of Maryland Health Sciences and Human Services Library, Baltimore, MD 21201, USA
| | - Bria N Thomas
- Loyola University Maryland, Baltimore, MD 21210, USA
| | - Mark A Lewis
- Department of Gastrointestinal Oncology, Intermountain Healthcare, Murray, UT 84107, USA
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Davies S, Zhao J, McCullough KP, Kim YL, Pisoni R, Wang AYM, Mehrotra R, Kanjanabuch T, Kawanishi H, Robinson B, Perl J. MO680INTERNATIONAL COMPARISONS OF ICODEXTRIN PRESCRIPTION PRACTICE AND ITS ASSOCIATION WITH FLUID REMOVAL, BLOOD PRESSURE, PATIENT AND TECHNIQUE SURVIVAL*. Nephrol Dial Transplant 2021. [DOI: 10.1093/ndt/gfab101.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background and Aims
Icodextrin is designed to maintain ultrafiltration during the long dwell, especially when there is a risk of increased fluid reabsorption (fast peritoneal solute transfer rate, PSTR), without the need for excessive use of high glucose. Randomized trials have demonstrated these benefits but are insufficiently powered to investigate a clear impact on survival. We aimed to establish international prescription practices and their relationship to clinical outcomes.
Method
The Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS) is an international prospective cohort study in collaboration with the International Society for Peritoneal Dialysis. The current analysis was drawn from A/NZ, Canada, Japan, UK, and US in PDOPPS phases 1-2 (2014-2019). Patient demographics, comorbidities, lab measurements, clinic blood pressure, membrane function (both solute transport rate and ultrafiltration capacity), dialysis prescription details, urine and 24-hour ultrafiltration volumes were captured at study enrollment. Mortality and permanent transfer to HD (HDT) events were collected during study follow-up [median (IQR) = 1.1 yrs (0.6, 1.7)]. Linear and logistic models were used to analyze the association between icodextrin and blood pressure. Cox regression, stratified by country, was used to analyze the association of icodextrin with time from study enrollment to (a) death and (b) HDT, and adjusted for demographics, 13 comorbidities, transplant waitlisting, serum albumin, urine volume, facility size and % APD use, study phase, while accounting for facility clustering.
Results
Icodextrin was prescribed in 1,929 (35%) of 5,432 patients studied, but this proportion differed by country, being >44% in all except the US, where it was 17%, and by facility within countries. Patients on icodextrin were more likely to have coronary artery disease and diabetes, have lower residual 24-hour urine volume and function, use less high glucose, have faster PSTR and reduced ultrafiltration capacity, and have been on PD longer (PD vintage: median 1.19, IQR 0.50-2.76). Despite this, patients using icodextrin achieved equivalent ultrafiltration to those using glucose at every level of residual urine volume (see figure). The low use of icodextrin in the US was more than compensated for by much greater use of high glucose and overall higher ultrafiltration volumes at each level of urine volume. Icodextrin use was not associated with blood pressure (effects: 0.90 mmHg, 95% CI: -0.68, 2.47), mortality (Hazard ratio [HR] 1.01, 95% CI: 0.83, 1.23) and HDT (HR 1.05, 95% CI: 0.90, 1.23).
Conclusion
There are important national and facility differences in the prescription of icodextrin, with the US a clear outlier, with less icodextrin and more high glucose use, resulting in higher ultrafiltration volumes. These practices and the targeting of patients with less efficient membranes for fluid removal may mask any potential survival advantage associated with icodextrin.
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Affiliation(s)
- Simon Davies
- Keele University, Stoke-on-Trent, United Kingdom
| | - Junhui Zhao
- Arbor Research Collaborative for Health, Ann Arbor, MI, United States of America
| | - K P McCullough
- Arbor Research Collaborative for Health, Ann Arbor, MI, United States of America
| | - Yong-Lim Kim
- Kyungpook National University Hospital, School of Medicine, Daegu, Korea, Rep. of South
| | - Ronald Pisoni
- Arbor Research Collaborative for Health, Ann Arbor, MI, United States of America
| | | | - Rajnish Mehrotra
- University of Washington, Department of Medicine, Seattle, WA, United States of America
| | | | | | - Bruce Robinson
- Arbor Research Collaborative for Health, Ann Arbor, MI, United States of America
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Lambie M, Zhao J, McCullough KP, Davies S, Kawanishi H, Johnson DW, Sloand J, Sanabria M, Kanjanabuch T, Kim YL, Shen JI, Pisoni R, Robinson B, Perl J. MO681PERITONEAL DIALYSIS TIME ON THERAPY AND REGIONAL DIFFERENCES IN DEATH, TRANSFER TO HEMODIALYSIS AND KIDNEY TRANSPLANTATION: RESULTS FROM THE PDOPPS. Nephrol Dial Transplant 2021. [DOI: 10.1093/ndt/gfab101.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background and Aims
Comparing and interpreting regional differences in peritoneal dialysis (PD) time on therapy needs to consider differences in the rates of permanent transfer to hemodialysis (HDT), death or kidney transplantation. Here we describe these outcomes among countries in the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS), as well as reasons for PD discontinuation.
Method
PDOPPS is a prospective cohort study of randomly selected patients across national samples of PD facilities from Australia/New Zealand (A/NZ), Canada, Japan, Thailand, the UK, and the US. Fine and Gray models were used on a population of 7115 patients, of varying PD vintages at study entry [median (IQR) vintage = 0.82 yrs (0.21, 2.03)], to analyse the cumulative incidence from PD start of transplantation, HDT, or death (on PD or within 7 days of transfer to HD). This allows for the determination of the % of patients remaining on PD at each PD vintage referred to as Time on Therapy (ToT). Models were left truncated to account for PD vintage at time of study enrollment. HDT was defined as no return from HD therapy within 12 weeks of transferring to HD. Cox models were used to calculate hazard ratios (HR) for death accounting for facility clustering and adjusted for patient age, sex, US black race, heart disease, diabetes, psychiatric disorder, prior HD experience, urine volume, and transplant waitlist referral.
Results
Mean patient age ranged from 56 yrs in Thailand to 64 yrs in Japan (Figure). Overall, 1261 patients transferred to HD, 76 patients transferred to HD/PD hybrid therapy, 900 patients died and 506 were transplanted during follow-up. By 3 years, the % of patients remaining on PD ranged from 25% in UK, 34-40% in A/NZ, Canada and US, to 47% in Thailand, and 54% in Japan (Figure). The much lower % of patients on PD at 3 yrs in the UK vs Japan was largely due to the high % of patients transplanted in the UK vs Japan: % transplanted ranged from 2% in Japan and Thailand to 32% in the UK at 3 yrs. When defining a ‘poor outcome’ as either death or HDT: (1) the % of patients still on PD or having been transplanted were quite similar across all 6 countries, and (2) death was a much larger proportion of this ‘poor outcome’ in Thailand vs other countries.
Similar risks of HDT were seen across all countries except Thailand which displayed much lower risks of HDT. This finding changed little with covariate adjustment (not shown). Infection, reported as primary HDT cause, varied from 30% (Canada) to 66% (Thailand) of cases, and insufficient solute or water clearance as primary HDT cause ranged from 6% (Thailand) to 44% (Japan) of cases (not shown).
In Cox models, the adjusted HR of death, compared to the US, was higher in Thailand [1.55 (1.17-2.06)], lower in Canada [0.75 (0.61-0.92)], A/NZ [0.60 (0.47-0.78)], and Japan [0.36 (0.27-0.48)], and close to 1 in UK [0.98 (0.75-1.28)].
Conclusion
Time on PD therapy differed considerably across countries. This was mainly due to large country differences in proportion transplanted, so that transplantation has a greater impact on country variability in ToT than HDT and death. Risk of death varied greatly across countries, particularly when accounting for case-mix. With the exception of Thailand, differences between countries in risk of HDT were modest. Marked differences in recorded reasons for HDT merit additional study.
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Affiliation(s)
- Mark Lambie
- Royal Stoke University Hospital, Renal Unit, Stoke-on-Trent, United Kingdom
| | - Junhui Zhao
- Arbor Research Collaborative for Health, Ann Arbor, MI, United States of America
| | - K P McCullough
- Arbor Research Collaborative for Health, Ann Arbor, MI, United States of America
| | - Simon Davies
- Keele University, Stoke-on-Trent, United Kingdom
| | | | | | - James Sloand
- AstraZeneca Pharmaceuticals, Gaithersburg, MD, United States of America
| | | | | | - Yong-Lim Kim
- Kyungpook National University Hospital, School of Medicine, Daegu, Korea, Rep. of South
| | - Jenny I Shen
- University of California, Los Angeles, LaBiomed at Harbor, Torrance, CA, United States of America
| | - Ronald Pisoni
- Arbor Research Collaborative for Health, Ann Arbor, MI, United States of America
| | - Bruce Robinson
- Arbor Research Collaborative for Health, Ann Arbor, MI, United States of America
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Daunov K, Daunov M, Noskoff K, Gan H, Davies S, Larbi O, Farrell M, Hadley W, Baffa AR, Giesel J, Egler RA, Huang AYC, Letterio JJ, Lee RT. Are National Cancer Institute Cancer Centers (NCI-CC) providing adolescents and young adults (AYA) with cancer focused clinical services? A national survey. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.1534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
1534 Background: AYA patients with cancer have inferior outcomes compared to their pediatric and adult counterparts. The NCI recommends they be treated by AYA focused healthcare professionals within an AYA oncology program. This survey captures the current landscape of AYA oncology care in the United States. Methods: An online survey was sent to 272 cancer centers in September 2020, in coordination with Teen Cancer America and included all clinically designated NCI-CC. The survey asked about the presence of an AYA program, types of patients, dedicated resources, clinical space, type of providers, associated support services, educational efforts, importance of AYA oncology care, and how well these services are provided. Results: In total, we received 93 responses, a 34% response rate, including 50 NCI centers, a 72% response rate. Only half (49%) of NCI-CC reported having an AYA program, and 70% were started in the past 5 years. One-third (32%) of centers reported plans to start an AYA program. Most programs included patient ages from ≥15 (56%) to ≤39 (63%) with a variety of cancers – most commonly hematologic (49%) and sarcoma (49%) and least commonly lung (36%), breast (38%), and head and neck cancer (38%). AYA programs are generally embedded in both adult and pediatric oncology services (63%). On average, cancer centers reported seeing 25-50 new AYA patients/month and 100-200 follow-up visits/month. Few programs reported a dedicated inpatient space (4%) or outpatient space (9%). Most NCI-CC have supportive services available for all oncology patients, but fewer of these services were dedicated specifically to AYA patients: navigators (92% vs. 71%), social work (98% vs. 57%), psycho-oncology (96% vs. 54%), dietician (98% vs. 24%), physical therapy (98% vs. 18%), chaplaincy (98% vs. 18%), and child life (83% vs. 26%). Other services available to the AYA population included sexual health (62%), academic support (62%), and career resources (36%). A minority of centers (30%) provided AYA training to their staff. A majority of NCI-CC felt AYA programs were important-very important (60%). They reported providing good-excellent overall AYA care (59%), but this dropped to 22% for sexual health and education of staff, which was relatively consistent across centers (Table). Conclusions: This survey is the first ever national survey to assess AYA oncology programs. Despite greater emphasis on the AYA cancer population, only half of NCI-CC report having a dedicated program, and areas of improvement include education of staff and sexual health services for patients. Self-report of providing good to excellent AYA care in specific areas.[Table: see text]
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Affiliation(s)
| | - Michael Daunov
- UH Cleveland Medical Center, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, OH
| | | | | | | | | | | | | | | | - Jennifer Giesel
- UH Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, OH
| | | | | | - John J. Letterio
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, University Hospitals Rainbow Babies & Children's Hospital Center, The Angie Fowler Adolescent & Young Adult Cancer Institute, United States, Cleveland, OH
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Mcleod RJW, Wilks L, Davies S, Elhassan HA. 448 The Impact of Noise in the Operating Theatre: A Review of the Evidence. Br J Surg 2021. [DOI: 10.1093/bjs/znab134.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Background
Noise has been recognised to have a negative impact on performance and wellbeing in many settings. Average noise levels have been found to range between 51-79 dB in operating theatres. Despite this, there is little research investigating the effect of noise on surgical team functioning.
Method
A literature review to look at the impact of noise in the operating theatre was performed on MEDLINE which included the search terms ‘noise’ OR ‘distraction’ AND ‘technical skill’ OR ‘Surgical skill’ OR ‘Operating Room’. 10 of 307 articles identified were deemed relevant.
Results
8 of 10 studies found noise to be detrimental to communication and surgical performance, particularly regarding total errors and time to task completion. No studies found noise to be beneficial. Two studies found case irrelevant verbal communication to be a frequent form of noise pollution in operating theatres; this is both perceived by surgeons to be distracting and delays patient care. Noise was most harmful to trainees.
Conclusions
Noise and irrelevant verbal communications were both found to be harmful to surgical performance, surgeon experience and team functioning. The worsened effect on the trainee exposes an urgent need to address noise pollution in the training environment.
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Affiliation(s)
| | - L Wilks
- Morriston Hospital, Swansea, United Kingdom
| | - S Davies
- Morriston Hospital, Swansea, United Kingdom
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Mahon C, Davies A, Gambaro A, Musella F, Costa AL, Panoulas V, Nicol E, Duncan A, Davies S, Mirsadraee S. Association of individual aortic leaflet calcification on paravalvular regurgitation and conduction abnormalities with self-expanding trans-catheter aortic valve insertion. Quant Imaging Med Surg 2021; 11:1970-1982. [PMID: 33936979 DOI: 10.21037/qims-20-1122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Complication rates of paravalvular aortic regurgitation (PVR) and permanent pacemaker insertion remain high in patients undergoing trans-catheter aortic valve insertion for severe aortic stenosis. The spatial distribution of calcium between individual aortic valve leaflets, and its potential role in these complications is gaining interest. We aimed to assess the accuracy of individual aortic valve leaflet calcium quantification, and to determine its effect on the frequency of these complications. Methods This was a retrospective study of 251 patients who underwent trans-catheter aortic valve insertion using the Evolut RTM valve. The off-line Terarecon software platform was used for Agatston scoring the short axis views. Results There was a correlation between the sum of the individual leaflet and the total aortic valve calcium score. There was a univariate association between an increase [per 100 Agatston unit (AU)] in both right coronary leaflet (RCL) and left coronary leaflet (LCL) calcium with the risk of PVR. There was an association between an increase in LCL calcium score (per 100 AU) and need for post-implantation balloon aortic valvuloplasty (BAV). There was no association between individual leaflet calcification on the risk of permanent pacemaker insertion. Conclusions This study supports the idea that a quantifiable and reproducible method of individual valve leaflet calcification score may serve as an independent risk factor for paravalvular regurgitation, beyond visual assessment of asymmetry. However, the same may not be true of spatial calcium distribution and permanent pacemaker implantation (PPI).
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Affiliation(s)
- Ciara Mahon
- Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Allan Davies
- Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Alessia Gambaro
- Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | | | - Ana Luisa Costa
- Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | | | - Edward Nicol
- Royal Brompton and Harefield NHS Foundation Trust, London, UK.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Alison Duncan
- Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Simon Davies
- Royal Brompton and Harefield NHS Foundation Trust, London, UK
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Maishman T, Sheikh H, Boger P, Kelly J, Cozens K, Bateman A, Davies S, Fay M, Sharland D, Jackson A. A Phase II Study of Biodegradable Stents Plus Palliative Radiotherapy in Oesophageal Cancer. Clin Oncol (R Coll Radiol) 2021; 33:e225-e231. [PMID: 33402268 DOI: 10.1016/j.clon.2020.12.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 12/02/2020] [Accepted: 12/10/2020] [Indexed: 01/21/2023]
Abstract
AIMS Self-expanding metal stents provide rapid improvement of dysphagia in oesophageal cancer but are associated with complications. The aim of the present study was to test the effectiveness of an alternative treatment of combining biodegradable stents with radiotherapy. MATERIALS AND METHODS A Simon two-stage single-arm prospective phase II trial design was used to determine the efficacy of biodegradable stents plus radiotherapy in patients with dysphagia caused by oesophagus cancer who were unsuitable for radical treatment. Fourteen patients were recruited and data from 12 were included in the final analyses. RESULTS Five of 12 patients met the primary end point: one stent-related patient death; four further interventions for dysphagia within 16 weeks of stenting (41.7%, 95% confidence interval 15.2-72.3%). The median time to a 10-point deterioration of quality of life was 2.7 weeks. Nine patients died within 52 weeks of registration. The median time to death from any cause was 15.0 weeks (95% confidence interval 9.6-not reached). CONCLUSION The high re-intervention observed, which met the pre-defined early stopping criteria, meant that the suggested alternative treatment was not sufficiently effective to be considered for a larger scale trial design. Further work is needed to define the place of biodegradable stents in the management of malignant oesophageal strictures.
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Affiliation(s)
- T Maishman
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - H Sheikh
- The Christie NHS Foundation Trust, Manchester, UK
| | - P Boger
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - J Kelly
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - K Cozens
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - A Bateman
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - S Davies
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - M Fay
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - D Sharland
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - A Jackson
- University Hospital Southampton NHS Foundation Trust, Southampton, UK.
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Brann P, Culjak G, Kowalenko N, Dickson R, Coombs T, Sved Williams A, Hoehn E, Davies S, Hoyland M, Burgess P. The interrater reliability of a routine outcome measure for infants and pre-schoolers aged under 48 months: Health of the Nation Outcome Scales for Infants. BJPsych Open 2021; 7:e85. [PMID: 33883058 PMCID: PMC8086387 DOI: 10.1192/bjo.2021.39] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND A review of Australian mental health services identified a gap in routine outcome measures addressing social, emotional and behavioural domains for pre-schoolers and infants. The Child and Adolescent Mental Health Information Development Expert Advisory Panel Working Group developed the Health of the Nation Outcome Scales for Infants (HoNOSI), a clinician-reported routine outcome measure for use with those aged under 4 years. Prior psychometric testing showed that the HoNOSI was considered to show face validity, and that it met the standards for concurrent validity and internal consistency. AIMS We aimed to investigate the interrater reliability of the HoNOSI. METHOD Forty-five infant mental health clinicians completed HoNOSI ratings on a set of five case vignettes. RESULTS Quadratic weighted kappa interrater reliability estimates showed the HoNOSI to have Almost Perfect interrater reliability for the HoNOSI total score. Of the 15 scales, one had Moderate, seven had Substantial and seven had Almost Perfect interrater reliability. Ten of the fifteen scales and the total score exceeded the COnsensus-based Standards for the Selection of Health Measurement INstruments criteria for interrater reliability (κw ≥ 0.7). CONCLUSIONS There has been a clear need for a routine outcome measure for use with infants and pre-schoolers. This study provides evidence of interrater reliability. The current findings, combined with the face and concurrent validity studies, support further examination of HoNOSI in real-world settings.
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Affiliation(s)
- Peter Brann
- Eastern Health Child and Youth Mental Health Service, Australia; and Monash University, Australia
| | - Gordana Culjak
- Australian Mental Health Outcomes and Classification Network, Health Education and Training Institute, Australia; and Sydney Medical School, University of Sydney, Australia
| | - Nick Kowalenko
- Department of Psychological Medicine, Sydney Children's Hospital Randwick, Sydney Children's Hospital Network, Australia
| | - Rosemary Dickson
- Child and Adolescent Mental Health Information Development Expert Advisory Panel, Australian Mental Health Outcomes and Classification Network, Health Education and Training Institute, Australia
| | - Tim Coombs
- Australian Mental Health Outcomes and Classification Network, Australia; and Illawarra Institute for Mental Health, Australia
| | - Anne Sved Williams
- University of Adelaide, Australia; and Women's and Children's Health Network, Australia
| | - Elisabeth Hoehn
- Queensland Centre for Perinatal and Infant Mental Health, Child and Youth Mental Health Service, Children's Health Queensland Hospital and Health Service, Australia
| | - Simon Davies
- Child and Adolescent Mental Health Service, Western Australia Child and Adolescent Health Service, Australia
| | - Margaret Hoyland
- Child and Youth Mental Health Service, Children's Health Queensland Hospital and Health Service, Australia
| | - Philip Burgess
- Australian Mental Health Outcomes and Classification Network Analysis and Reporting, School of Public Health, Faculty of Medicine, The University of Queensland, Australia
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Hamed MO, Barlow AD, Dolezalova N, Khosla S, Sagar A, Gribble FM, Davies S, Murphy MP, Hosgood SA, Nicholson ML, Saeb-Parsy K. Ex vivo normothermic perfusion of isolated segmental porcine bowel: a novel functional model of the small intestine. BJS Open 2021; 5:6220254. [PMID: 33839750 PMCID: PMC8038264 DOI: 10.1093/bjsopen/zrab009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 01/26/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND There is an unmet need for suitable ex vivo large animal models in experimental gastroenterology and intestinal transplantation. This study details a reliable and effective technique for ex vivo normothermic perfusion (EVNP) of segmental porcine small intestine. METHODS Segments of small intestine, 1.5-3.0 m in length, were retrieved from terminally anaesthetized pigs. After a period of cold ischaemia, EVNP was performed for 2 h at 37°C with a mean pressure of 80 mmHg using oxygenated autologous blood diluted with Ringer's solution. The duration of EVNP was extended to 4 h for a second set of experiments in which two segments of proximal to mid-ileum (1.5-3.0 m) were retrieved from each animal and reperfused with whole blood (control) or leucocyte-depleted blood to examine the impact of leucocyte depletion on reperfusion injury. RESULTS After a mean cold ischaemia time of 5 h and 20 min, EVNP was performed in an initial group of four pigs. In the second set of experiments, five pigs were used in each group. In all experiments bowel segments were well perfused and exhibited peristalsis during EVNP. Venous glucose levels significantly increased following luminal glucose stimulation (mean(s.e.m.) basal level 1.8(0.6) mmol/l versus peak 15.5(5.8) mmol/l; P < 0.001) and glucagon-like peptide 1 (GLP-1) levels increased in all experiments, demonstrating intact absorptive and secretory intestinal functions. There were no significant differences between control and leucocyte-depleted animals regarding blood flow, venous glucose, GLP-1 levels or histopathology at the end of 4 h of EVNP. CONCLUSIONS This novel model is suitable for the investigation of gastrointestinal physiology, pathology and ischaemia reperfusion injury, along with evaluation of potential therapeutic interventions.
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Affiliation(s)
- M O Hamed
- Correspondence to: Department of Surgery, Addenbrookes Hospital, Hills Road, Cambridge, CB2 0QQ, UK (e-mail:)
| | - A D Barlow
- Department of Surgery, University of Cambridge, and NIHR Cambridge Biomedical Research Campus, Cambridge, UK
| | - N Dolezalova
- Department of Surgery, University of Cambridge, and NIHR Cambridge Biomedical Research Campus, Cambridge, UK
| | - S Khosla
- Wellcome Trust – MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - A Sagar
- Wellcome Trust – MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - F M Gribble
- Department of Histopathology, University of Cambridge, Cambridge, UK
| | - S Davies
- Department of Histopathology, University of Cambridge, Cambridge, UK
| | - M P Murphy
- MRC Mitochondrial Biology Unit, Cambridge, UK
| | - S A Hosgood
- Department of Surgery, University of Cambridge, and NIHR Cambridge Biomedical Research Campus, Cambridge, UK
| | - M L Nicholson
- Department of Surgery, University of Cambridge, and NIHR Cambridge Biomedical Research Campus, Cambridge, UK
| | - K Saeb-Parsy
- Department of Surgery, University of Cambridge, and NIHR Cambridge Biomedical Research Campus, Cambridge, UK
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Schneider J, Davies S, Howarth A, GARCIA SANCHEZ J, Rao N, Grandy S, Bhatt P, Parackal A, Wong D, Briggs A. POS-321 TRANSLATING THE FINDINGS OF THE ROXADUSTAT NDD GLOBAL PHASE 3 PROGRAM INTO COST OFFSETS FROM A CANADIAN HEALTHCARE PERSPECTIVE. Kidney Int Rep 2021. [DOI: 10.1016/j.ekir.2021.03.337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Flexman AM, Shillcutt SK, Davies S, Lorello GR. Current status and solutions for gender equity in anaesthesia research. Anaesthesia 2021; 76 Suppl 4:32-38. [PMID: 33682100 DOI: 10.1111/anae.15361] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2020] [Indexed: 11/24/2022]
Abstract
Despite increasing numbers of women entering anaesthesia, they remain persistently under-represented within academic anaesthesia and research. Gender discordance is seen across multiple aspects of research, including authorship, editorship, peer review, grant receipt, speaking and leading. Women are also under-represented at higher faculty ranks and in department chair positions. These inequities are further magnified for women with intersectional identities, such as those who identify as Black, indigenous and women of colour. Several barriers to participation in research have been identified to date, including a disproportionate amount of family responsibilities, a disproportionate burden of clinical service, gender bias, sexual harassment and the gender pay gap. Several strategies to improve gender equity have been proposed. Increasing access to formal mentorship of women in academic medicine is frequently cited and has been used by healthcare institutions and medical societies. Senior faculty and leaders must also be conscious of including women in sponsorship and networking opportunities. Institutions should provide support for parents of all genders, including supportive parental leave policies and flexible work models. Women should also be materially supported to attend formal educational conferences targeted for women, aimed at improving networking, peer support and professional development. Finally, leaders must display a clear intolerance for sexual harassment and discrimination to drive culture change. Peers and leaders alike, of all genders, can act as upstanders and speak up on behalf of targets of discrimination, both in the moment or after the fact. Gender inequities have persisted for far too long and can no longer be ignored. Diversifying the anaesthesia research community is essential to the future of the field.
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Affiliation(s)
- A M Flexman
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - S K Shillcutt
- Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - S Davies
- Trinity College, Cambridge University, Cambridge, UK
| | - G R Lorello
- Department of Anesthesiology and Pain Medicine, University Health Network and University of Toronto, Toronto, ON, Canada
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Morelle J, Stachowska-Pietka J, Öberg C, Gadola L, La Milia V, Yu Z, Lambie M, Mehrotra R, de Arteaga J, Davies S. ISPD recommendations for the evaluation of peritoneal membrane dysfunction in adults: Classification, measurement, interpretation and rationale for intervention. Perit Dial Int 2021; 41:352-372. [DOI: 10.1177/0896860820982218] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Lay summary Peritoneal dialysis (PD) uses the peritoneal membrane for dialysis. The peritoneal membrane is a thin layer of tissue that lines the abdomen. The lining is used as a filter to help remove extra fluid and poisonous waste from the blood. Everybody is unique. What is normal for one person’s membrane may be very different from another person’s. The kidney care team wants to provide each person with the best dialysis prescription for them and to do this they must evaluate the person’s peritoneal lining. Sometimes dialysis treatment itself can cause the membrane to change after some years. This means more assessments (evaluations) will be needed to determine whether the person’s peritoneal membrane has changed. Changes in the membrane may require changes to the dialysis prescription. This is needed to achieve the best dialysis outcomes. A key tool for these assessments is the peritoneal equilibration test (PET). It is a simple, standardized and reproducible tool. This tool is used to measure the peritoneal function soon after the start of dialysis. The goal is to understand how well the peritoneal membrane works at the start of dialysis. Later on in treatment, the PET helps to monitor changes in peritoneal function. If there are changes between assessments causing problems, the PET data may explain the cause of the dysfunction. This may be used to change the dialysis prescription to achieve the best outcomes. The most common problem with the peritoneal membrane occurs when fluid is not removed as well as it should be. This happens when toxins (poisons) in the blood cross the membrane more quickly than they should. This is referred to as a fast peritoneal solute transfer rate (PSTR). Since more efficient fluid removal is associated with better outcomes, developing a personal PD prescription based on the person’s PSTR is critically important. A less common problem happens when the membrane fails to work properly (also called membrane dysfunction) because the peritoneal membrane is less efficient, either at the start of treatment or developing after some years. If membrane dysfunction gets worse over time, then this is associated with progressive damage, scarring and thickening of the membrane. This problem can be identified through another change of the PET. It is called reduced ‘sodium dip’. Membrane dysfunction of this type is more difficult to treat and has many implications for the individual. If the damage is major, the person may need to stop PD. They would need to begin haemodialysis treatment (also spelled hemodialysis). This is a very important and emotional decision for individuals with kidney failure. Any decision that involves stopping PD therapy or transitioning to haemodialysis therapy should be made jointly between the clinical team, the person on dialysis and a caregiver, if requested. Although evidence is lacking about how often tests should be performed to determine peritoneal function, it seems reasonable to repeat them whenever there is difficulty in removing the amount of fluid necessary for maintaining the health and well-being of the individual. Whether routine evaluation of membrane function is associated with better outcomes has not been studied. Further research is needed to answer this important question as national policies in many parts of the world and the COVID-19 has placed a greater emphasis and new incentives encouraging the greater adoption of home dialysis therapies, especially PD. For Chinese and Spanish Translation of the Lay Summary, see Online Supplement Appendix 1. Key recommendations Guideline 1: A pathophysiological taxonomy: A pathophysiological classification of membrane dysfunction, which provides mechanistic links to functional characteristics, should be used when prescribing individualized dialysis or when planning modality transfer (e.g. to automated peritoneal dialysis (PD) or haemodialysis) in the context of shared and informed decision-making with the person on PD, taking individual circumstances and treatment goals into account. (practice point) Guideline 2a: Identification of fast peritoneal solute transfer rate (PSTR): It is recommended that the PSTR is determined from a 4-h peritoneal equilibration test (PET), using either 2.5%/2.27% or 4.25%/3.86% dextrose/glucose concentration and creatinine as the index solute. (practice point) This should be done early in the course dialysis treatment (between 6 weeks and 12 weeks) (GRADE 1A) and subsequently when clinically indicated. (practice point) Guideline 2b: Clinical implications and mitigation of fast solute transfer: A faster PSTR is associated with lower survival on PD. (GRADE 1A) This risk is in part due to the lower ultrafiltration (UF) and increased net fluid reabsorption that occurs when the PSTR is above the average value. The resulting lower net UF can be avoided by shortening glucose-based exchanges, using a polyglucose solution (icodextrin), and/or prescribing higher glucose concentrations. (GRADE 1A) Compared to glucose, use of icodextrin can translate into improved fluid status and fewer episodes of fluid overload. (GRADE 1A) Use of automated PD and icodextrin may mitigate the mortality risk associated with fast PSTR. (practice point) Guideline 3: Recognizing low UF capacity: This is easy to measure and a valuable screening test. Insufficient UF should be suspected when either (a) the net UF from a 4-h PET is <400 ml (3.86% glucose/4.25% dextrose) or <100 ml (2.27% glucose /2.5% dextrose), (GRADE 1B) and/or (b) the daily UF is insufficient to maintain adequate fluid status. (practice point) Besides membrane dysfunction, low UF capacity can also result from mechanical problems, leaks or increased fluid absorption across the peritoneal membrane not explained by fast PSTR. Guideline 4a: Diagnosing intrinsic membrane dysfunction (manifesting as low osmotic conductance to glucose) as a cause of UF insufficiency: When insufficient UF is suspected, the 4-h PET should be supplemented by measurement of the sodium dip at 1 h using a 3.86% glucose/4.25% dextrose exchange for diagnostic purposes. A sodium dip ≤5 mmol/L and/or a sodium sieving ratio ≤0.03 at 1 h indicates UF insufficiency. (GRADE 2B) Guideline 4b: Clinical implications of intrinsic membrane dysfunction (de novo or acquired): in the absence of residual kidney function, this is likely to necessitate the use of hypertonic glucose exchanges and possible transfer to haemodialysis. Acquired membrane injury, especially in the context of prolonged time on treatment, should prompt discussions about the risk of encapsulating peritoneal sclerosis. (practice point) Guideline 5: Additional membrane function tests: measures of peritoneal protein loss, intraperitoneal pressure and more complex tests that estimate osmotic conductance and ‘lymphatic’ reabsorption are not recommended for routine clinical practice but remain valuable research methods. (practice point) Guideline 6: Socioeconomic considerations: When resource constraints prevent the use of routine tests, consideration of membrane function should still be part of the clinical management and may be inferred from the daily UF in response to the prescription. (practice point)
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Affiliation(s)
- Johann Morelle
- Division of Nephrology, Cliniques universitaires Saint-Luc, and Institut de Recherche Expérimentale et Clinique, UCLouvain, Brussels, Belgium
| | - Joanna Stachowska-Pietka
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland
| | - Carl Öberg
- Division of Nephrology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Liliana Gadola
- Centro de Nefrología, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | | | - Zanzhe Yu
- Department of Nephrology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Mark Lambie
- Faculty of Medicine and Health Sciences, Keele University, Keele, UK
| | - Rajnish Mehrotra
- Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington DC, USA
| | - Javier de Arteaga
- Servicio de Nefrología, Hospital Privado Universitario de Córdoba, Universidad Católica de Córdoba, Córdoba, Argentina
| | - Simon Davies
- Faculty of Medicine and Health Sciences, Keele University, Keele, UK
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Vandenbriele C, Balthazar T, Wilson J, Adriaenssens T, Davies S, Droogne W, Dubois C, Caetano AF, Goetschalckx K, Jacobs S, Janssens S, Ledot S, Meyns B, Soliman-Aboumarie H, Verbrugghe P, Price S. Left Impella®-device as bridge from cardiogenic shock with acute, severe mitral regurgitation to MitraClip®-procedure: a new option for critically ill patients. Eur Heart J Acute Cardiovasc Care 2020; 10:415-421. [PMID: 33620436 DOI: 10.1093/ehjacc/zuaa031] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/30/2020] [Accepted: 11/04/2020] [Indexed: 12/27/2022]
Abstract
AIMS Patients presenting with cardiogenic shock (CS) related to acute, severe mitral regurgitation (MR) are often considered too ill for immediate surgical intervention. Therefore, other less invasive techniques for haemodynamic stabilization should be explored. The purpose of this exploratory study was to investigate the feasibility and outcomes in patients with CS due to severe MR by using a novel approach combining haemodynamic stabilization with left Impella-support plus MR-reduction using MitraClip®. METHODS AND RESULTS We analysed whether a combined left Impella®/MitraClip®-procedure in a rare population of CS-patients with acute MR requiring mechanical ventilation is a feasible strategy to recovery in patients who had been declined cardiac surgery. Six INTERMACS-1 CS-patients with acute MR were studied at two tertiary cardiac intensive care units. The mean EURO-II score was 39 ± 19% and age 66.8 ± 4.9 years. All patients had an initial pulmonary capillary wedge pressure >20 mmHg and pulmonary oedema necessitating invasive ventilation. Cardiac output was severely impaired (left ventricular outflow tract velocity time index 9.8 ± 1.8 cm), requiring mechanical circulatory support (MCS) (Impella®-CP; mean flow 2.9 ± 1.8 L per minute; mean support 9.7 ± 6.0 days). Despite MCS-guided unloading, weaning from ventilation failed due to persisting pulmonary oedema necessitating MR-reduction. In all cases, the severe MR was reduced to mild using percutaneous MitraClip®-procedure, followed by successful weaning from invasive ventilation. Survival to discharge was 86%, with all surviving and rare readmission for heart failure at 6 months. CONCLUSIONS A combined Impella®/MitraClip®-strategy appears a novel, feasible alternative for weaning CS-patients presenting with acute, severe MR. Upfront Impella®-stabilization facilitates safe bridging to Mitraclip®-procedure and the staged approach facilitates successful weaning from ventilatory support.
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Affiliation(s)
- Christophe Vandenbriele
- Department of Cardiovascular diseases, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium.,Department of Adult Intensive Care, Royal Brompton and Harefield NHS Foundation Trust, Sydney St, Chelsea, London SW3 6NP, UK
| | - Tim Balthazar
- Department of Cardiovascular diseases, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium
| | - James Wilson
- Department of Adult Intensive Care, Royal Brompton and Harefield NHS Foundation Trust, Sydney St, Chelsea, London SW3 6NP, UK
| | - Tom Adriaenssens
- Department of Cardiovascular diseases, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium
| | - Simon Davies
- Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Walter Droogne
- Department of Cardiovascular diseases, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium
| | - Christophe Dubois
- Department of Cardiovascular diseases, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium
| | - Ana Francisca Caetano
- Department of Adult Intensive Care, Royal Brompton and Harefield NHS Foundation Trust, Sydney St, Chelsea, London SW3 6NP, UK
| | - Kaatje Goetschalckx
- Department of Cardiovascular diseases, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium
| | - Steven Jacobs
- Department of Cardiac surgery, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium
| | - Stefan Janssens
- Department of Cardiovascular diseases, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium
| | - Stephane Ledot
- Department of Adult Intensive Care, Royal Brompton and Harefield NHS Foundation Trust, Sydney St, Chelsea, London SW3 6NP, UK
| | - Bart Meyns
- Department of Cardiac surgery, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium
| | - Hatem Soliman-Aboumarie
- Department of Adult Intensive Care, Royal Brompton and Harefield NHS Foundation Trust, Sydney St, Chelsea, London SW3 6NP, UK
| | - Peter Verbrugghe
- Department of Cardiac surgery, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium
| | - Susanna Price
- Department of Adult Intensive Care, Royal Brompton and Harefield NHS Foundation Trust, Sydney St, Chelsea, London SW3 6NP, UK.,Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, London, UK
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Mulder PA, van Balkom IDC, Landlust AM, Priolo M, Menke LA, Acero IH, Alkuraya FS, Arias P, Bernardini L, Bijlsma EK, Cole T, Coubes C, Dapia I, Davies S, Di Donato N, Elcioglu NH, Fahrner JA, Foster A, González NG, Huber I, Iascone M, Kaiser AS, Kamath A, Kooblall K, Lapunzina P, Liebelt J, Lynch SA, Maas SM, Mammì C, Mathijssen IB, McKee S, Mirzaa GM, Montgomery T, Neubauer D, Neumann TE, Pintomalli L, Pisanti MA, Plomp AS, Price S, Salter C, Santos-Simarro F, Sarda P, Schanze D, Segovia M, Shaw-Smith C, Smithson S, Suri M, Tatton-Brown K, Tenorio J, Thakker RV, Valdez RM, Van Haeringen A, Van Hagen JM, Zenker M, Zollino M, Dunn WW, Piening S, Hennekam RC. Development, behaviour and sensory processing in Marshall-Smith syndrome and Malan syndrome: phenotype comparison in two related syndromes. J Intellect Disabil Res 2020; 64:956-969. [PMID: 33034087 PMCID: PMC8957705 DOI: 10.1111/jir.12787] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 08/19/2020] [Accepted: 09/15/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Ultrarare Marshall-Smith and Malan syndromes, caused by changes of the gene nuclear factor I X (NFIX), are characterised by intellectual disability (ID) and behavioural problems, although questions remain. Here, development and behaviour are studied and compared in a cross-sectional study, and results are presented with genetic findings. METHODS Behavioural phenotypes are compared of eight individuals with Marshall-Smith syndrome (three male individuals) and seven with Malan syndrome (four male individuals). Long-term follow-up assessment of cognition and adaptive behaviour was possible in three individuals with Marshall-Smith syndrome. RESULTS Marshall-Smith syndrome individuals have more severe ID, less adaptive behaviour, more impaired speech and less reciprocal interaction compared with individuals with Malan syndrome. Sensory processing difficulties occur in both syndromes. Follow-up measurement of cognition and adaptive behaviour in Marshall-Smith syndrome shows different individual learning curves over time. CONCLUSIONS Results show significant between and within syndrome variability. Different NFIX variants underlie distinct clinical phenotypes leading to separate entities. Cognitive, adaptive and sensory impairments are common in both syndromes and increase the risk of challenging behaviour. This study highlights the value of considering behaviour within developmental and environmental context. To improve quality of life, adaptations to environment and treatment are suggested to create a better person-environment fit.
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Affiliation(s)
- P A Mulder
- Autism Team Northern-Netherlands, Jonx Department of (Youth) Mental Health and Autism, Lentis Psychiatric Institute, Groningen, Netherlands
| | - I D C van Balkom
- Autism Team Northern-Netherlands, Jonx Department of (Youth) Mental Health and Autism, Lentis Psychiatric Institute, Groningen, Netherlands
- Rob Giel Research Centre, Department of Psychiatry, University Medical Center Groningen, Groningen, Netherlands
| | - A M Landlust
- Autism Team Northern-Netherlands, Jonx Department of (Youth) Mental Health and Autism, Lentis Psychiatric Institute, Groningen, Netherlands
| | - M Priolo
- Unità Operativa di Genetica Medica, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - L A Menke
- Department of Paediatrics, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - I H Acero
- Genetics Unit, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - F S Alkuraya
- Saudi Human Genome Project, King Abdulaziz City for Science and Technology, and Department of Genetics, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - P Arias
- Institute of Medical and Molecular Genetics (INGEMM), Hospital Universitario La Paz, IdiPAZ, Universidad Autónoma de Madrid, and CIBERER, Centro de Investigación Biomédica en Red de Enfermedades Raras, ISCIII, Madrid, Spain
| | - L Bernardini
- Cytogenetics Unit, Casa Sollievo della Sofferenza Foundation, San Giovanni Rotondo, Italy
| | - E K Bijlsma
- Department of Clinical Genetics, Leiden University Medical Centre, Leiden, Netherlands
| | - T Cole
- Department of Clinical Genetics, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - C Coubes
- Département de Génétique Médicale, Hôpital Arnaud de Villeneuve, CHRU Montpellier, Montpellier, France
| | - I Dapia
- Institute of Medical and Molecular Genetics (INGEMM), Hospital Universitario La Paz, IdiPAZ, Universidad Autónoma de Madrid, and CIBERER, Centro de Investigación Biomédica en Red de Enfermedades Raras, ISCIII, Madrid, Spain
| | - S Davies
- Institute of Medical Genetics, University Hospital of Wales, Cardiff, UK
| | - N Di Donato
- Institute for Clinical Genetics, TU Dresden, Dresden, Germany
| | - N H Elcioglu
- Department of Pediatric Genetics, Marmara University Medical School, Istanbul and Eastern Mediterranean University, Mersin, Turkey
| | - J A Fahrner
- McKusick-Nathans Institute of Genetic Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - A Foster
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - N G González
- Unit Hospital Universitario Central de Asturias, Oviedo, Spain
| | - I Huber
- Sørland Hospital, Kristiansand, Norway
| | - M Iascone
- Medical Genetics Laboratory, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - A-S Kaiser
- Institute of Human Genetics, Heidelberg University, Heidelberg, Germany
| | - A Kamath
- Institute of Medical Genetics, University Hospital of Wales, Cardiff, UK
| | - K Kooblall
- Academic Endocrine Unit, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - P Lapunzina
- Institute of Medical and Molecular Genetics (INGEMM), Hospital Universitario La Paz, IdiPAZ, Universidad Autónoma de Madrid, and CIBERER, Centro de Investigación Biomédica en Red de Enfermedades Raras, ISCIII, Madrid, Spain
| | - J Liebelt
- South Australian Clinical Genetics Services, Women's and Children's Hospital, North Adelaide, Australia
| | - S A Lynch
- UCD Academic Centre on Rare Diseases, School of Medicine and Medical Sciences, University College Dublin, and Clinical Genetics, Temple Street Children's University Hospital, Dublin, Ireland
| | - S M Maas
- Department of Clinical Genetics, Academic Medical Center, Amsterdam, Netherlands
| | - C Mammì
- Unità Operativa di Genetica Medica, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - I B Mathijssen
- Department of Clinical Genetics, Academic Medical Center, Amsterdam, Netherlands
| | - S McKee
- Northern Ireland Regional Genetics Service, Belfast Health and Social Care Trust, Belfast, UK
| | - G M Mirzaa
- Center for Integrative Brain Research, Seattle Children's Research Institute, and Division of Genetic Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - T Montgomery
- Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | - D Neubauer
- Institute of Human Genetics, University Hospital Magdeburg, Magdeburg, Germany
| | - T E Neumann
- Mitteldeutscher Praxisverbund Humangenetik, Halle, Germany
| | - L Pintomalli
- Unità Operativa di Genetica Medica, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - M A Pisanti
- Medical Genetic and Laboratory Unit, "Antonio Cardarelli" Hospital, Naples, Italy
| | - A S Plomp
- Department of Clinical Genetics, Academic Medical Center, Amsterdam, Netherlands
| | - S Price
- Department of Clinical Genetics, Northampton General Hospital NHS Trust, Northampton, UK
| | - C Salter
- Wessex Clinical Genetics Service, Princess Ann Hospital, Southampton, UK
| | - F Santos-Simarro
- Institute of Medical and Molecular Genetics (INGEMM), Hospital Universitario La Paz, IdiPAZ, Universidad Autónoma de Madrid, and CIBERER, Centro de Investigación Biomédica en Red de Enfermedades Raras, ISCIII, Madrid, Spain
| | - P Sarda
- Département de Génétique Médicale, Hôpital Arnaud de Villeneuve, CHRU Montpellier, Montpellier, France
| | - D Schanze
- Institute of Human Genetics, University Hospital Magdeburg, Magdeburg, Germany
| | - M Segovia
- CENAGEM, Centro Nacional de Genética, Buenos Aires, Argentina
| | - C Shaw-Smith
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - S Smithson
- University Hospitals Bristol NHS Trust, Bristol, UK
| | - M Suri
- Nottingham Clinical Genetics Service, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - K Tatton-Brown
- Division of Genetics and Epidemiology, Institute of Cancer Research, London and South West Thames Regional Genetics Service, St. George's University Hospitals NHS Foundation Trust, London, UK
| | - J Tenorio
- Institute of Medical and Molecular Genetics (INGEMM), Hospital Universitario La Paz, IdiPAZ, Universidad Autónoma de Madrid, and CIBERER, Centro de Investigación Biomédica en Red de Enfermedades Raras, ISCIII, Madrid, Spain
| | - R V Thakker
- Academic Endocrine Unit, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - R M Valdez
- Genetics Unit, Hospital Militar Central "Cirujano Mayor Dr. Cosme Argerich", Buenos Aires, Argentina
| | - A Van Haeringen
- Department of Clinical Genetics, Leiden University Medical Centre, Leiden, Netherlands
| | - J M Van Hagen
- Department of Clinical Genetics, VU University Medical Centre, Amsterdam, Netherlands
| | - M Zenker
- Institute of Human Genetics, University Hospital Magdeburg, Magdeburg, Germany
| | - M Zollino
- Department of Laboratory Medicine, Institute of Medical Genetics, Catholic University, Rome, Italy
| | - W W Dunn
- Department of Occupational Therapy Education, School of Health Professions, University of Missouri, Columbia, MO, USA
| | - S Piening
- Autism Team Northern-Netherlands, Jonx Department of (Youth) Mental Health and Autism, Lentis Psychiatric Institute, Groningen, Netherlands
- Rob Giel Research Centre, Department of Psychiatry, University Medical Center Groningen, Groningen, Netherlands
| | - R C Hennekam
- Autism Team Northern-Netherlands, Jonx Department of (Youth) Mental Health and Autism, Lentis Psychiatric Institute, Groningen, Netherlands
- Department of Paediatrics, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
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Ijaz S, Blanca Bolea, Davies S, Savović J, Richards A, Sullivan S, Moran P. Antipsychotic Polypharmacy and Metabolic Syndrome in Schizophrenia: A Review of Systematic Reviews. Focus (Am Psychiatr Publ) 2020; 18:482-492. [PMID: 33343261 DOI: 10.1176/appi.focus.18307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
(Reprinted with permission from BMC Psychiatry (2018) 18:275).
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Vandenbriele C, Balthazar T, Wilson J, Ledot S, Smith R, Caetano A, Adriaenssens T, Goetschalckx K, Janssens S, Dubois C, Jacobs S, Meyns B, Davies S, Price S. Left heart Impella-device to bridge acute mitral regurgitation to MitraClip-procedure: a novel implementation of percutaneous mechanical circulatory support. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1849] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Acute mitral regurgitation (MR) is an emergency, often requiring urgent surgery. Severe acute MR presenting with hemodynamic collapse is usually caused by papillary muscle rupture or dysfunction after acute myocardial infarction (AMI) or chordal rupture, resulting in flail mitral leaflet(s). Preoperative stabilization is complex due to concomitant hemodynamic collapse and hypoxic respiratory failure. Finding the right balance between both preload and inotropic support is challenging. When patients are too sick for immediate surgical intervention, mechanical circulatory support can be considered because of its ability to both unload and reduce of cardiac work while increasing coronary perfusion and cardiac output. Nevertheless, even after initial stabilization, surgical risk remains high in critically ill acute severe MR patients and transcatheter treatments such as MitraClip are increasingly being explored.
Methods
Between August 2017 and September 2019, patients presenting with acute severe mitral regurgitation and considered too ill for immediate surgical intervention (EURO-II score >11.2% plus pulmonary oedema necessitating mechanical ventilation and/or hemodynamic instability), were selected for an Impella-assisted LV unloading technique as bridge to MitraClip-procedure. Five patients were selected for the combined left Impella/MitraClip-procedure in two tertiary cardiac ICUs.
Results
The mean age was 72 years. The cause of MR was ischemic in 20% and all patients presented in cardiogenic shock state, necessitating mechanical ventilation. The overall cardiac operative risk assessment (Euro-II) score predicted a 35% chance of in-hospital mortality. Cardiac output was severely impaired (mean LVOT VTI 8.2 cm). All patients were on inotropic support and supported by an Impella-CP pVAD (mean flow 2.5 Liter per minute; mean 6.3 days of support). In all cases, we managed to reduce the LVEDP below 15 mmHg using the combination of medical therapy (afterload reduction, inotropes), mechanical ventilation and pVAD-therapy. The MR was significantly reduced by a MitraClip-procedure in each Impella supported patient. The overall survival at discharge was 80%. One patient with late referral and multiple organ failure at presentation deceased due to refractory cardiogenic shock. Overall, severe MR was reduced to grade 1+ and all four patients survived 6 months after discharge with only one readmission for decompensated heart failure.
Conclusions
A combined strategy of Impella and MitraClip appears to be a novel, feasible alternative for patients presenting with acute, severe MR unable to proceed to a corrective surgical procedure at presentation due to severe left ventricular forward flow failure. In these cases, the early initiation of pVAD-support may reduce the risk of development of irreversible end- organ damage and dysfunction. Exploration in a larger, randomised population is warranted to investigate this strategy further.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- C Vandenbriele
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | - T Balthazar
- University Hospitals (UZ) Leuven, Leuven, Belgium
| | - J Wilson
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | - S Ledot
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | - R Smith
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | - A.F Caetano
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | | | | | - S Janssens
- University Hospitals (UZ) Leuven, Leuven, Belgium
| | - C Dubois
- University Hospitals (UZ) Leuven, Leuven, Belgium
| | - S Jacobs
- University Hospitals (UZ) Leuven, Leuven, Belgium
| | - B Meyns
- University Hospitals (UZ) Leuven, Leuven, Belgium
| | - S Davies
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | - S Price
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
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Duncan A, Davies A, Quarto C, Davies S. Long-term outcomes of valve-in-valve transcatheter aortic valve implantation for degenerate homograft aortic valve replacement. EUROINTERVENTION 2020; 16:e760-e762. [PMID: 32420882 DOI: 10.4244/eij-d-20-00450] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Alison Duncan
- Heart Division, The Royal Brompton Hospital, London, United Kingdom
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