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Kerr A, Keogh M, Slachetka M, Grealy M, Rowe P. An Intensive Exercise Program Using a Technology-Enriched Rehabilitation Gym for the Recovery of Function in People With Chronic Stroke: Usability Study. JMIR Rehabil Assist Technol 2023; 10:e46619. [PMID: 37477954 PMCID: PMC10403794 DOI: 10.2196/46619] [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: 02/18/2023] [Revised: 06/14/2023] [Accepted: 06/26/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Rehabilitation improves poststroke recovery with greater effect for many when applied intensively within enriched environments. The failure of health care providers to achieve minimum recommendations for rehabilitation motivated the development of a technology-enriched rehabilitation gym (TERG) that enables individuals under supervision to perform high-intensity self-managed exercises safely in an enriched environment. OBJECTIVE This study aimed to assess the feasibility of the TERG approach and gather preliminary evidence of its effect for future research. METHODS This feasibility study recruited people well enough to exercise but living with motor impairment following a stroke at least 12 months previously. Following assessment, an 8-week exercise program using a TERG (eg, virtual reality treadmills, power-assisted equipment, balance trainers, and upper limb training systems) was structured in partnership with participants. The feasibility was assessed through recruitment, retention, and adherence rates along with participant interviews. Effect sizes were calculated from the mean change in standard outcome measures. RESULTS In total, 70 individuals registered interest, the first 50 were invited for assessment, 39 attended, and 31 were eligible and consented. Following a pilot study (n=5), 26 individuals (mean age 60.4, SD 13.3 years; mean 39.0, SD 29.2 months post stroke; n=17 males; n=10 with aphasia) were recruited to a feasibility study, which 25 individuals completed. Participants attended an average of 18.7 (SD 6.2) sessions with an 82% attendance rate. Reasons for nonattendance related to personal life, illness, weather, care, and transport. In total, 19 adverse events were reported: muscle or joint pain, fatigue, dizziness, and viral illness, all resolved within a week. Participants found the TERG program to be a positive experience with the equipment highly usable albeit with some need for individual tailoring to accommodate body shape and impairment. The inclusion of performance feedback and gamification was well received. Mean improvements in outcome measures were recorded across all domains with low to medium effect sizes. CONCLUSIONS This study assessed the feasibility of a holistic technology-based solution to the gap between stroke rehabilitation recommendations and provision. The results clearly demonstrate a rehabilitation program delivered through a TERG is feasible in terms of recruitment, retention, adherence, and user acceptability and may lead to considerable improvement in function, even in a chronic stroke population. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-doi.org/10.3389/fresc.2021.820929.
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Affiliation(s)
- Andy Kerr
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, United Kingdom
| | - Maisie Keogh
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, United Kingdom
| | - Milena Slachetka
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, United Kingdom
| | - Madeleine Grealy
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, United Kingdom
| | - Philip Rowe
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, United Kingdom
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Weng J, Dabaja B, Das P, Gunn G, Chronowski G, Bloom E, Lee P, Koong A, Ning M, Semien K, Sanders C, Ritchey R, Nguyen K, Hoffman K, Robinson I, Kerr A, Brokaw J, Liao Z, Nguyen Q. Radiation Therapy Decision Making Process and Operations for COVID-19 Positive Patients. Int J Radiat Oncol Biol Phys 2022. [PMCID: PMC9595469 DOI: 10.1016/j.ijrobp.2022.07.1722] [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: 11/03/2022]
Abstract
Purpose/Objective(s) A challenging clinical dilemma during the COVID-19 pandemic is management of cancer patients who test positive for COVID. Given the need to balance the risk of disease progression with the risk of transmission to other patients and staff, radiation therapy for these patients requires careful consideration and modification of standard workflows. It is also critical to develop processes to mitigate radiation treatment interruption, which can affect patient outcomes. The objective of this study was to report the clinical operations and outcomes for COVID positive patients receiving radiation therapy during the pandemic at a tertiary cancer center including 2 network locations. Materials/Methods During March 2020 to March 2022, the Radiation Oncology COVID committee (RO COVID) developed an integrated process to triage patients, provide treatment recommendations, and implement infection control procedures to safely deliver radiation therapy to COVID positive patients. Policies were created for each center with multidisciplinary input from infectious disease, radiation oncology, radiation therapy, and nursing. All COVID positive patients were presented to the RO COVID group and evaluated for clinical urgency, benefit with radiation, and life expectancy. If deemed necessary, a limited planned break or hypofractionated regimen was recommended to minimize staff exposure. We conducted a retrospective review of COVID positive patients with different primary malignancies treated through the COVID positive pathway. Results A total of 68 COVID positive patients were treated with the COVID positive pathway (HN 15, Breast 9, CNS 8, GU 8, GYN, 7, Thoracic 6, GI 5, HEME 5, PED 3, SARC 2). The median age was 57.1 years (IQR 45.8-63.4) and 47% were female. There were 39 patients (57%) who were asymptomatic and were tested for routine pre-radiation screening or due to concerns of COVID exposure. Twenty-three (34%) patients were treated with palliative intent and 8 (12%) were treated for an emergent indication (i.e., spinal cord compression, bleeding). Thirteen (19%) patients were receiving radiation treatment, had a treatment break (7-21 days), and then resumed their radiation course. All treatments were successfully completed without known nosocomial spread of COVID to staff or other patients. Among this heterogenous group of patients, 58 (85%) were alive with a median follow up of 2 months (IQR 0.5-7.5). COVID infection may have contributed to 3 out of 10 deaths (4% of total cohort). The remaining deaths were due to progression of disease or other non-COVID causes. Conclusion In this study, COVID positive patients were safely treated with radiation therapy through a comprehensive decision making and clinical operations pathway taking into account evolving COVID guidelines for three different variant surges. Although limited in follow up, patient outcomes are promising with few COVID-related deaths and low overall mortality rates, even with hypofractionated regimens.
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Affiliation(s)
- J. Weng
- MD Anderson Cancer Center, Houston, TX,Corresponding author:
| | - B. Dabaja
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - P. Das
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - G.B. Gunn
- MD Anderson Cancer Center, Houston, TX
| | - G.M. Chronowski
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - P. Lee
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - A.C. Koong
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - M.S. Ning
- MD Anderson Cancer Center, Houston, TX
| | - K. Semien
- MD Anderson Cancer Center, Houston, TX
| | | | | | - K. Nguyen
- MD Anderson Cancer Center, Houston, TX
| | - K.E. Hoffman
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - I. Robinson
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - A. Kerr
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - J. Brokaw
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Z. Liao
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Q.N. Nguyen
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
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Kerr A, Grealy MA, Kuschmann A, Rutherford R, Rowe P. A Co-creation Centre for Accessible Rehabilitation Technology. Front Rehabilit Sci 2022; 2:820929. [PMID: 36188853 PMCID: PMC9397706 DOI: 10.3389/fresc.2021.820929] [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] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 12/13/2021] [Indexed: 12/02/2022]
Abstract
Background: The prevalence of disabling conditions is increasing globally. Rehabilitation improves function and quality of life across many conditions, particularly when applied intensively. The limited workforce, however, cannot deliver evidence-based intensive rehabilitation. By providing individuals with the tools for self- rehabilitation, technology helps bridge the gap between evidence and practise. Few people, however, can access rehabilitation technology. Barriers such as cost, training, education, portability and poor design stand in the way of equitable access. Our group of engineers and researchers have established a centre dedicated to developing accessible technology through close, frequent engagement with users and industry. Methods: The centre employs a co-creation model, coupling engineering and science with user experience and industrial partnerships to develop accessible technology and associated processes. Due to the complexity and size of the challenge the initial focus is stroke. Recruited through a medical charity, participants, with a wide range of disabilities, use prototype and commercial technology during an 8-week rehabilitation programme with supervision from health professionals. The centre includes de-weighting systems, neurostimulation, virtual reality, treadmills, bespoke rehab games, communication apps, powered exercise equipment and gamified resistance equipment. Standard outcome measures (International Classification of Functioning, Disability and Health) are recorded before, during, immediately after, and 3 months after the intervention and used in combination with an interview to design the initial rehabilitation programme, which is reviewed fortnightly. Qualitative methods (surveys and interviews) are used to capture personal experiences of the programme and individual technology and an advisory group of stroke survivors help interpret outcomes to feed into the technology design process. Ethical approval has been granted for a pilot cohort study with stroke survivors, which is currently underway (01/09/2021–31/12/2021) investigating acceptability and feasibility, due to report findings in 2022. Discussion: Through partnerships, research collaborations and a co-creation model a new centre dedicated to the development of accessible rehabilitation technology has been launched and currently undergoing acceptability and feasibility testing with stroke survivors. The centre, through its close engagement with users and industry, has the potential to transform the way rehabilitation technology is developed and help revolutionise the way rehabilitation is delivered.
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Affiliation(s)
- Andy Kerr
- Biomedical Engineering, University of Strathclyde, Glasgow, United Kingdom
- *Correspondence: Andy Kerr
| | - Madeleine Ann Grealy
- Psychological Sciences and Health, University of Strathclyde, Glasgow, United Kingdom
| | - Anja Kuschmann
- Psychological Sciences and Health, University of Strathclyde, Glasgow, United Kingdom
| | | | - Philip Rowe
- Biomedical Engineering, University of Strathclyde, Glasgow, United Kingdom
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Aldayil E, Kerr A. Plantarflexor muscle activity during a change in walking speed on a treadmill: Comparison between Parkinson's and unimpaired controls. Physiotherapy 2021. [DOI: 10.1016/j.physio.2021.10.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Mbizvo RM, Alfadhel M, Williams MJA, Coffey S, Kerr A, Webster M, Lee M. A contemporary presentation of the incidence and management of spontaneous coronary artery dissection (SCAD) in New Zealand: an ANZACS-QI study. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1306] [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: 11/13/2022] Open
Abstract
Abstract
Background/Purpose
Spontaneous coronary artery dissection (SCAD) is an underdiagnosed and poorly understood condition that frequently affects younger women without cardiovascular risk factors. In this project we aimed to describe the present landscape of SCAD in New Zealand (NZ).
Methods
All patients in NZ who were admitted to hospital with a diagnosis of Acute Coronary Syndrome (ACS) from July 2019 to December 2020 and underwent coronary angiography were identified from the All NZ Coronary Syndrome Quality Imporvment (ANZACS-QI) registry.
Results
Of 12,053 patients admitted to hospital with an ACS, 122 had SCAD (1.0%). 80% of those with SCAD were female, with mean age of 57 years, and fewer traditional cardiovascular risk factors. Non-ST elevation myocardial infarction was the most common presentation (82.0%), while 16.4% presented with ST elevation myocardial infarction. The majority of patients were managed conservatively (91.8%) while 8.2% underwent PCI. 56.6% of SCAD patients had normal LV function. Nearly 80% of patients were discharged on Acetylsalicylic acid (ASA) therapy, while 60.7% had a P2Y12 inhibitor. Beta blockers, Statins and ACEI/ARB were part of the management strategy in 62.5%, 59.8% and 42.6% of patients respectively while 47.5% had a combination of all 3. Amongst 122 patients, only 1 in-hospital death and 1 inpatient recurrent MI occurred, with 3 patients having bleeding of any kind.
Conclusion
In NZ, incidence of SCAD is approximately 1%. Most patients affected in NZ are female with fewer traditional cardiovascular risk factors. Management is predominantly conservative, and there is a low rate of early adverse outcomes.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- R M Mbizvo
- University of Otago, Cardiology Department, Dunedin Hospital, Dunedin, New Zealand
| | - M Alfadhel
- University of British Columbia, Vancouver General Hospital, Vancouver, Canada
| | - M J A Williams
- University of Otago, Cardiology Department, Dunedin Hospital, Dunedin, New Zealand
| | - S Coffey
- University of Otago, Cardiology Department, Dunedin Hospital, Dunedin, New Zealand
| | - A Kerr
- The University of Auckland, Cardiology Department, Middlemore Hospital, Auckland, New Zealand
| | - M Webster
- The University of Auckland, Cardiology Department, Auckland City Hospital, Auckland, New Zealand
| | - M Lee
- The University of Auckland, Cardiology Department, Middlemore Hospital, Auckland, New Zealand
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Chan D, Stewart R, Kerr A, Dicker B, Kyle C, Adamson P, Devlin G, Edmond J, El-Jack S, Elliott J, Fisher N, Flynn C, Lee M, Liao Y, Rhodes M, Scott T, Smith T, Stiles M, Swain A, Todd V, Webster M, Williams M, White H, Somaratne J. The Impact of a National COVID-19 Lockdown on Acute Coronary Syndrome Hospitalisations in New Zealand: an ANZACS-QI study. Heart Lung Circ 2021. [PMCID: PMC8203216 DOI: 10.1016/j.hlc.2021.05.013] [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: 11/27/2022]
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7
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Liao Y, Lee M, Poppe K, Kerr A, Stewart R. Prediction of Statin Non-Adherence After Hospitalisation for an Acute Coronary Syndrome. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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8
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Chan D, Poppe K, Lund M, Lee M, Choi Y, Kerr A, Doughty R. Validation of Heart Failure Discharge Coding Utilising the PEOPLE Study and ADHF Registry. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.05.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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9
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Earle N, Poppe K, Cameron V, Aish S, Choi Y, Wall C, Stewart R, Kerr A, Harrison W, Devlin G, Pera V, Troughton R, Porter G, Gladding P, Rolleston A, Richards M, Legget M, Doughty R. Outcomes Among Patients With First-Time Acute Coronary Syndromes in New Zealand: The Multi-Ethnic New Zealand Study of Acute Coronary Syndromes (MENZACS). Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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10
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Wei D, Kerr A, Lee M. Revascularisation and Outcomes After Acute Coronary Syndromes in Patients with Prior Coronary Artery Bypass Grafting. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.05.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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11
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Devlin L, Millar S, Morris S, Sadozye A, Harrand R, Graham K, Kerr A, Duncanson C, Duffton A. PO-1882: The risk of pelvic insufficiency fractures after radiotherapy using planned dose analysis. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01900-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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12
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Duane F, Kerr A, Aznar M, Wang Z, Taylor C. Exposure of the oesophagus in breast cancer radiotherapy: A systematic review of oesophageal doses published 2013–2018. Eur J Cancer 2020. [DOI: 10.1016/s0959-8049(20)30757-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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13
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Muniandy A, Kerr A. A036 Prescription and Early Dispensing of Statin Therapy Following Acute Coronary Syndrome in Non surgically Revascularised Patients- Nationwide Perspective. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.05.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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14
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Chan Wah Hak Y, Ratnayake B, Chan D, Wang T, Kasargod C, Cicovic S, Dimalapang E, Kerr A, Somaratne J. A022 In-hospital Outcomes Following Cardiac Catheterisation in New Zealand (NZ): An All NZ Acute Coronary Syndrome Quality Improvement (ANZACS-QI) Analysis. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.05.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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15
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Gabriel R, Weeks P, Kerr A, Looi JL. A062 A Web-based Registry / Clinical Reporting Tool for Cardiac Magnetic Resonance Imaging linked to ANZACS-QI: Development and Implementation. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.05.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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16
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Yao-Cheng Ho C, Lee M, Harrison W, Kerr A. A030 False-positive Diagnosis in Suspected Acute Coronary Syndrome - an ANZACS-QI Study. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.05.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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17
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Davis R, Chieng J, Lydon A, Weeks P, Sutton T, Kerr A, Voss J, Pasley T, Lund M, Gabriel R, Looi J. A060 Māori and Pacific Patients With Non-Ischaemic Cardiomyopathy, Undergoing Cardiac Magnetic Resonance Imaging Have Worse Clinical Outcomes than European Patients. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.05.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Cicovic S, Wang T, Kasargod C, Chan D, Somaratne J, Webster M, Devlin G, Kerr A. A025 Diagnostic Coronary Angiography and Percutaneous Coronary Intervention Practices in New Zealand: The All New Zealand Acute Coronary SyndromeQuality Improvement CathPCI registry 3-year study (ANZACS-QI 37). Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.05.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Doughty R, Poppe K, Rolleston A, Aish S, Choi C, Earle N, Kerr A, Devlin G, Nunn C, Troughton R, Porter G, Gladding P, Cameron V, Legget M. A028 The Multi-Ethnic New Zealand Study of Acute Coronary Syndromes (MENZACS): Baseline Characteristics of Patients With First-time ACS. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.05.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Wang TKM, Grey C, Jiang Y, Jackson R, Kerr A. P3621Epidemiology of acute coronary syndrome by subtype in New Zealand 2006–2016: an ANZACS-QI nationwide linkage study of hospitalisation, procedures and case fatality. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0479] [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: 11/13/2022] Open
Abstract
Abstract
Background
Acute coronary syndrome (ACS) is a common manifestation of cardiovascular disease. Inconsistent trends have been reported in the management and outcomes of the three main categories of ACS (ST-elevation myocardial infarction [STEMI], non ST-elevation myocardial infarction [NSTEMI] and unstable angina [UA]). The aims of this study were to evaluate recent trends in the incidence, invasive management and case fatality of these ACS subtypes in New Zealand.
Methods
All ACS hospitalisations between 2006–2016 were identified from routinely collected national data, and categorised into STEMI, NSTEMI, UA, and unspecified myocardial infarction (MI). For each ACS subtype, annual hospitalisation and coronary procedure rates, 28-day and 1-year fatality rates were calculated and trends tested using Poisson regression adjusted for age and sex.
Results
There were 188,264 ACS admissions, of which 16.0% were STEMI, 54.5% NSTEMI, 25.7% UA and 3.8% MI unspecified. During this period, the incidence of all ACS subtypes fell, STEMI by 3.4%/y, NSTEMI by 5.9%/year and UA by 8.5%/year. There was also a rise in the proportion of ACS patients receiving angiography and revascularisation. Rates of percutaneous coronary intervention rose for STEMI, NSTEMI and UA, but rates of coronary artery bypass grafting increased only for NSTEMI and UA. Case fatality at 28 days and 1 year was higher for STEMI than NSTEMI, and lowest for UA. Over the period there was a relative 1.6%/y decline in one-year case fatality for NSTEMI (p<0.001), but no significant change for STEMI and UA.
Conclusions
The observed declines in the incidence of all ACS subtypes is reassuring, as is the increase in the rate of revascularisation among these patients. The finding that case fatality declined in NSTEMI patients but not in STEMI and UA patients, despite an increase in invasive management in all groups, require further investigation.
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Affiliation(s)
- T K M Wang
- Middlemore Hospital, Auckland, New Zealand
| | - C Grey
- The University of Auckland, School of Population Health, Auckland, New Zealand
| | - Y Jiang
- The University of Auckland, National Institute of Health Innovation, Auckland, New Zealand
| | - R Jackson
- The University of Auckland, School of Population Health, Auckland, New Zealand
| | - A Kerr
- Middlemore Hospital, Auckland, New Zealand
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Wang TKM, Kueh A, Gabriel R, Sutton T, Lund M, Kerr A, Looi JL. P757Methamphetamine-associated cardiomyopathy: a case-controlled study of clinical characteristics, management and outcomes. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Methamphetamine-associated cardiomyopathy (MAC) is an increasingly diagnosed condition with poor prognosis, and there remains paucity of literature including how MAC differs from other cardiomyopathies. We compared the characteristics and outcomes MAC patients with non-ischaemic cardiomyopathy controls at our centre.
Methods
Clinical profile, management and outcomes were prospectively assessed in consecutive patients with MAC at our hospital from 2006–2018. They were compared with randomly chosen controls with non-ischaemic dilated cardiomyopathy of similar age-group (20–65 year).
Results
Both groups had 62 patients followed for 3.0±2.9 years. MAC patients were younger, with higher proportion of Maori ethnicity, unemployment and cardiogenic shock during index admission and lower proportion of Pacific ethnicity, cardiovascular risk factors and atrial fibrillation. MAC patients also had higher peak NT-proBNP, lower ejection fraction, and lower attendance rate to outpatient appointments. There was no index admission mortality in both groups. MAC had higher mortality and trend to higher heart failure re-admissions rates during follow-up (Figure 1). Amongst MAC patients, baseline left ventricular end diastolic diameter and failure of improvement in right ventricular systolic function by one category during follow-up were independent predictors of mortality, while failure of improvement of left ventricular ejection fraction by one category predicted heart failure readmission.
Figure 1
Conclusions
MAC patients were younger but sicker on presentation, with higher mortality and trend towards higher heart failure readmission rates during medium-term follow-up than controls. Adherence to therapy and attendance to appointments may improve cardiac systolic function over time to reduce adverse clinical endpoints.
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Affiliation(s)
- T K M Wang
- Middlemore Hospital, Auckland, New Zealand
| | - A Kueh
- Auckland City Hospital, Auckland, New Zealand
| | - R Gabriel
- Middlemore Hospital, Auckland, New Zealand
| | - T Sutton
- Middlemore Hospital, Auckland, New Zealand
| | - M Lund
- Middlemore Hospital, Auckland, New Zealand
| | - A Kerr
- Middlemore Hospital, Auckland, New Zealand
| | - J L Looi
- Middlemore Hospital, Auckland, New Zealand
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22
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Kerr A. IBS07.01 Enhanced Recovery for Thoracic Surgery. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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23
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Yan M, Kong W, Kerr A, Brundage M. The Radiation Dose Tolerance of the Brachial Plexus: A Systematic Review and Meta-Analysis. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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24
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Kerr A, Cummings J, Barber M, McKeown M, Rowe P, Mead G, Doucet A, Berlouis K, Grealy M. Community cycling exercise for stroke survivors is feasible and acceptable. Top Stroke Rehabil 2019; 26:485-490. [PMID: 31327311 DOI: 10.1080/10749357.2019.1642653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 10/26/2022]
Abstract
Background: Physical activity is recommended after stroke but levels for stroke survivors are typically low. The use of indoor recumbent cycling, delivered through local government leisure facilities, may increase access to exercise among stroke survivors. Objective: This study aimed to evaluate the acceptability and feasibility of an indoor cycling program delivered through existing local government services. Methods: Participants were recruited through stroke liaison nurses and public advertising. After a home visit to assess eligibility and conduct psychological and general health assessments, participants attended their local leisure center for an initial fitness test and short battery of physical tests. Then, an 8 week training program was designed with weekly goals. Following the program the assessments were retaken along with an evaluation questionnaire. In-depth, semi-structured, interviews were conducted with 15 participants and five fitness coaches. Results: One hundred fifteen individuals volunteered to participate during a 10-month recruitment period, 77 met the inclusion criteria and consented, 66/77 (86%) completed the program including all nine non-ambulatory participants. The program and procedures (recruitment and outcome measures) were feasible and acceptable to participants (81% reported following the program). Participants were generally very positive about the experience. Significant improvements in sit-to-stand capacity (Mpre = 25.2 s, Mpost = 19.0 s, p = .002), activities of daily living (NEADL, Mpre = 12.2, Mpost = 13.2, p = .002), psychosocial functioning (SAQOL, Mpre = 3.82, Mpost = 4.15, p = .001), energy (SAQOL, Mpre = 3.75, Mpost = 4.02, p = .018) and depression (GHQ, Mpre = .97, Mpost = .55, p = .009) were observed. Conclusion: A cycling-based exercise program delivered through local leisure center staff and facilities was shown to be feasible and acceptable for people living with stroke.
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Affiliation(s)
- Andy Kerr
- Department of Biomedical Engineering, University of Strathclyde , Glasgow , UK
| | - Joanne Cummings
- School of Psychological Sciences and Health, University of Strathclyde , Glasgow , UK
| | - Mark Barber
- Department of Medicine for the Elderly, NHS Lanarkshire , Airdrie , UK
| | - Marie McKeown
- South Lanarkshire Leisure and Culture , Hamilton , UK
| | - Phillip Rowe
- Department of Biomedical Engineering, University of Strathclyde , Glasgow , UK
| | - Gillian Mead
- Centre for Clinical Brain Sciences, University of Edinburgh , Edinburgh , UK
| | - Amy Doucet
- School of Psychological Sciences and Health, University of Strathclyde , Glasgow , UK
| | - Katherine Berlouis
- School of Psychological Sciences and Health, University of Strathclyde , Glasgow , UK
| | - Madeleine Grealy
- School of Psychological Sciences and Health, University of Strathclyde , Glasgow , UK
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Kerr A, Clark A, Pomeroy VM. Neuromechanical Differences Between Successful and Failed Sit-to-Stand Movements and Response to Rehabilitation Early After Stroke. Neurorehabil Neural Repair 2019; 33:395-403. [PMID: 31046620 DOI: 10.1177/1545968319846119] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 11/16/2022]
Abstract
BACKGROUND Recovery of the sit-to-stand (StS) movement early after stroke could be improved by targeting physical therapy at the underlying movement deficits in those people likely to respond. AIM To compare the movement characteristics of successful and failed StS movements in people early after stroke and identify which characteristics change in people recovering their ability to perform this movement independently following rehabilitation. METHODS Muscle activity and kinematic (including center of mass, CoM) data were recorded from 91 participants (mean 35 days after stroke) performing the StS movement before (baseline), immediately after (outcome), and 3 months after (follow-up) rehabilitation. Three subgroups (never-able [n = 19], always-able [n = 51], and able-after-baseline [n = 21]) were compared at baseline with the able-after-baseline subgroup compared before and after rehabilitation. RESULTS The subgroups differed at baseline for quadriceps onset time ( P = .009) and forward body position when quadriceps peaked ( P = .038). Following rehabilitation, the able-after-baseline subgroup increased their forward position ( P < .001), decreased the time difference between bilateral quadriceps peaks ( P < .001) and between quadriceps and hamstrings peaks on the nonhemiplegic side ( P = .007). An improved performance in the always-able subgroup was associated with a number of baseline factors, including forward positioning ( P = .002) and time difference between peak activity of bilateral quadriceps ( P = .001). CONCLUSIONS This neuromechanical study of StS before and after rehabilitation in a sample of people early after stroke identified the importance of temporal coupling between forward trunk movement and quadriceps and hamstrings' activity. These findings advance the science of stroke rehabilitation by providing evidence-based therapy targets to promote recovery of the StS movement.
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Affiliation(s)
- Andy Kerr
- 1 University of Strathclyde, Glasgow, UK
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King M, Kerr A, Dixon S, Taylor S, Smith A, Merriman C, Mitchell J, Hunter V. MA17.11 Multi-Centred, Prospective, Audit to Identify Readmission Causes and Complications Within 30 of Primary Lung Cancer Surgery. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.464] [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: 10/28/2022]
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Oswald N, Kerr A, Mehdi R, Turner A, Naidu B. P2.06-28 Assessment of Chest Wall Motion Using Structured Light Plethysmography (SLP) in Mesothelioma and Benign Pleural Disease. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.1283] [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: 10/28/2022]
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Ho SF, Thomson A, Kerr A. 52FEEDBACK INTEGRATED REHABILITATION FOR SIT-TO-STAND TRAINING (FIRST): A PILOT RANDOMISED CONTROLLED TRIAL. Age Ageing 2018. [DOI: 10.1093/ageing/afy127.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- S F Ho
- Biomedical Engineering, The University of Strathclyde, Glasgow, Scotland, U.K
| | - A Thomson
- Biomedical Engineering, The University of Strathclyde, Glasgow, Scotland, U.K
| | - A Kerr
- Biomedical Engineering, The University of Strathclyde, Glasgow, Scotland, U.K
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Patel A, Ludwinski F, Kapoor P, Kerr A, Cho J, Fisher C, Hope A, Livieratos L, Saha P, Lyons O, Smith A, Modarai B. CD16+ monocytes stimulate arteriogenesis to salvage the ischemic Limb—a bench to bedside study. Cytotherapy 2018. [DOI: 10.1016/j.jcyt.2018.02.334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Kerr A, Webb J, Kadiri S, Oswald N, Bancroft H, Taylor J, Bishay E, Steyn R, Kalkat M, Naidu B. A randomised controlled trial to investigate the feasibly of a nutritional intervention of carbohydrate and post-operative nutritional drinks after elective major lung surgery. Lung Cancer 2018. [DOI: 10.1016/s0169-5002(18)30204-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bancroft H, Langman G, Kerr A, Naidu B. Lessons learnt from the initiation of PEACE (Posthumous Evaluation of Advanced Cancer Environment) at a regional thoracic centre. Lung Cancer 2018. [DOI: 10.1016/s0169-5002(18)30217-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Kerr A, Oswald N, Webb J, Kadiri S, Bancroft H, Taylor J, Rajesh P, Steyn R, Kalkat M, Bishay E, Naidu B. P1.10-002 Outcome of Pilot RCT in Lung Cancer Surgery Patients Receiving Either Preop Carbohydrate & Postop Nutritional Drinks or Water. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Kerr A, Kadiri S, Taylor J, Naidu B. P3.10-005 National UK Thoracic Surgery PPI Group Identify Key Questions in Routine Clinical Care for Further Research. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.1725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Konda N, Kerr A, Webb J, Rajesh P, Steyn R, Kalkat M, Bishay E, Naidu B. P-150RISK FACTORS FOR QUALITY OF LIFE FOLLOWING LUNG RESECTION SURGERY. Interact Cardiovasc Thorac Surg 2017. [DOI: 10.1093/icvts/ivx280.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
Objectives The sit to stand (STS) movement is key to independence and commonly affected by stroke. Repetitive practice is likely to improve STS ability during rehabilitation, however current practice levels are unknown. The objective of this study was simply to count the number of STS movements performed during the rehabilitation period of stroke patients using a physical activity monitor (PAM) and test whether being observed altered outcome. Methods Participants were medically stable patients referred for rehabilitation following stroke. Participants were randomly allocated to either wear or not wear the PAM for 14 days. STS ability and general mobility were recorded before and after. Results Sixty-one patients was recruited; aged 68.4 ± 13.15 years, weight 77.12 ± 22.73 Kg, Height 1.67 ± 0.1 m, within 9 ± 9 days of their stroke and an NIHSS score of 6.4 ± 3.3. The monitored group (n = 38) performed 25.00 ± 17.24 daily STS movements. Those requiring assistance achieved 14.29 ± 16.10 per day while those independent in the movement achieved 34.10 ± 12.44. There was an overall improvement in mobility (p = 0.002) but not STS performance (p = 0.053) neither outcome was affected by group allocation (p = 0.158). Cognition and mobility at baseline explained around 50% of daily STS variability. Discussion Low levels of STS activity were recorded during the rehabilitation period of stroke patient. The mean daily STS activity was lower than reports for frail older people receiving rehabilitation, and substantially below levels recorded by community living older adults. STS repetitions may represent general physical activity and these low levels support previous reports of sedentary behavior during rehabilitation.
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Affiliation(s)
- Andy Kerr
- a Centre of Excellence in Rehabilitation Research, Biomedical Engineering , University of Strathclyde , Glasgow , UK
| | - Jesse Dawson
- b Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary & Life Sciences , University of Glasgow , Glasgow , UK.,c Queen Elizabeth University Hospital , Glasgow , UK
| | - Chris Robertson
- d Department of Mathematics and Statistics , University of Strathclyde , Glasgow , UK
| | - Philip Rowe
- a Centre of Excellence in Rehabilitation Research, Biomedical Engineering , University of Strathclyde , Glasgow , UK
| | - Terence J Quinn
- b Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary & Life Sciences , University of Glasgow , Glasgow , UK
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Kerr A, McVey JT, Wood AM, Van Haren F. Safety of nicotine replacement therapy in critically ill smokers: a retrospective cohort study. Anaesth Intensive Care 2017; 44:758-761. [PMID: 27832565 DOI: 10.1177/0310057x1604400621] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Nicotine replacement therapy (NRT) is a common first-line treatment to prevent nicotine withdrawal in smokers. However, available literature reports conflicting results regarding its efficacy and safety in critically ill patients. The objective of this study was to evaluate the relationship between NRT in smokers in the intensive care unit (ICU) and outcomes. This case-control study was conducted in a university-affiliated tertiary hospital ICU. Over a period of five years, 126 active smokers who received transdermal NRT were matched to 126 active smokers who did not receive NRT. The groups were case-matched for sex, age and Acute Physiology and Chronic Health Evaluation II (APACHE II) score. The primary outcome was administration of antipsychotic medication. Secondary outcomes included use of physical restraints, 30-day mortality, and ventilation requirements. Antipsychotic medication was prescribed in 43 (34.1%) patients who received NRT compared to 14 (11.1%) in controls (P <0.01). Physical restraints were used in 37 (29.4%) patients who received NRT, compared to 12 (9.5%) of controls (P <0.01). The 30-day mortality and number of patients intubated was not statistically different between groups. Average length of intubation time was greater in the NRT group (2.56 days; standard deviation 4.16) compared to the control group (1.44 days; standard deviation 2.68) (P=0.012). The use of NRT to prevent nicotine withdrawal in ICU patients is associated with increased use of antipsychotic medication and physical restraint, and with prolonged mechanical ventilation.
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Affiliation(s)
- A Kerr
- Junior Medical Officer, Intensive Care Unit, The Canberra Hospital, ACT
| | - J T McVey
- Junior Medical Officer, Intensive Care Unit, The Canberra Hospital, ACT
| | - A M Wood
- Junior Medical Officer, Intensive Care Unit, The Canberra Hospital, ACT
| | - Fmp Van Haren
- Intensive Care Physician, Intensive Care Unit, The Canberra Hospital, Associate Professor, Australian National University Medical School, Canberra, ACT
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Van Haren F, Kerr A. In reply. Anaesth Intensive Care 2017; 45:424-426. [PMID: 28486902] [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] [Indexed: 06/07/2023]
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Kadiri S, Robertson A, Kerr A, Bishay E, Kalkat M, Steyn R, Rajesh P, Naidu B. 106: Patient experiences and factors affecting adherence to pulmonary rehabilitation classes before and after lung surgery – the need for a tailored programme. Lung Cancer 2017. [DOI: 10.1016/s0169-5002(17)30156-3] [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: 10/20/2022]
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Kerr A, Oswald N, Kadiri S, Bancroft H, Webb J, Taylor J, Virgilio E, Bishay E, Kalkat M, Steyn R, Rajesh P, Naidu B. 107: Positive impact on patient's journey through involvement in thoracic surgery clinical trials. Lung Cancer 2017. [DOI: 10.1016/s0169-5002(17)30157-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kerr A, Oswald N, Kadiri S, Bancroft H, Virgilio E, Webb J, Bellamy M, Taylor J, Bishay E, Kalkat M, Steyn R, Rajesh P, Naidu B. S65 Developing a multi-disciplinary thoracic surgery research team improves the recruitment into and quality of clinical trials. Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.71] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Browning D, Warren O, Johnson N, Seymour M, Lawson M, Jones L, Kerr A, White R, Mills S. Telephone assessment clinic (TAC): A more efficient way of dealing with two week wait colorectal cancer referrals. Int J Surg 2016. [DOI: 10.1016/j.ijsu.2016.08.168] [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: 10/20/2022]
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Kerr A, Tam L, Cioroch M, Hale A, Douglas G, Channon K, Wade-Martins R. A novel combinatorial non-viral vector to treat familial hypercholesterolaemia (FH). Atherosclerosis 2016. [DOI: 10.1016/j.atherosclerosis.2016.07.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Kerr A, Clark A, Cooke EV, Rowe P, Pomeroy VM. Functional strength training and movement performance therapy produce analogous improvement in sit-to-stand early after stroke: early-phase randomised controlled trial. Physiotherapy 2016; 103:259-265. [PMID: 27107979 DOI: 10.1016/j.physio.2015.12.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [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: 06/17/2015] [Accepted: 12/17/2015] [Indexed: 01/15/2023]
Abstract
OBJECTIVES Restoring independence in the sit-to-stand (STS) task is an important objective for stroke rehabilitation. It is not known if a particular intervention, strength training or therapy focused on movement performance is more likely to improve STS recovery. This study aimed to compare STS outcomes from functional strength training, movement performance therapy and conventional therapy. DESIGN Randomised controlled trial. SETTING Acute stroke units. PARTICIPANTS Medically well patients (n=93) with recent (<42 days) stroke. The mean age of patients was 68.8 years, mean time post ictus was 33.5 days, 54 (58%) were male, 20 showed neglect (22%) and 37 (40%) had a left-sided brain lesion. INTERVENTIONS Six weeks of either conventional therapy, functional strength training or movement performance therapy. Subjects were allocated to groups on a random basis. MAIN OUTCOME MEASURES STS ability, timing, symmetry, co-ordination, smoothness and knee velocity were measured at baseline, outcome (after 6 weeks of intervention) and follow-up (3 months after outcome). RESULTS No significant differences were found between the groups. All three groups improved their STS ability, with 88% able to STS at follow-up compared with 56% at baseline. Few differences were noted in quality of movement, with only symmetry when rising showing significantly greater improvement in the movement performance therapy group; this benefit was not evident at follow-up. CONCLUSIONS Recovery of the STS movement is consistently good during stroke rehabilitation, irrespective of the type of therapy experienced. Changes in quality of movement did not differ according to group allocation, indicating that the type of therapy is less important. Clinical trial registration number NCT00322192.
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Affiliation(s)
- A Kerr
- Centre of Excellence in Rehabilitation Research, University of Strathclyde, Glasgow, UK.
| | - A Clark
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - E V Cooke
- Therapies Department, St. George's Healthcare NHS Trust, London, UK
| | - P Rowe
- Centre of Excellence in Rehabilitation Research, University of Strathclyde, Glasgow, UK
| | - V M Pomeroy
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
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Oswald N, Konda N, Kerr A, Naidu B, Thickett D, Webb J, Dancer R. 172 A national survey of thoracic surgery units: pre-operative smoking cessation practice shows need for better provision of service. Lung Cancer 2016. [DOI: 10.1016/s0169-5002(16)30189-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lugg ST, Tikka T, Agostini PJ, Kerr A, Webb J, Adamas K, Bishay E, Steyn RS, Kalkat MS, Rajesh PB, Thickett DR, Naidu B. P164 Smoking at the time of curative-intent lung cancer surgery increases perioperative complications: is there a role for electronic cigarettes? Thorax 2015. [DOI: 10.1136/thoraxjnl-2015-207770.301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Kerr A, Prescott R, Theologis T. Bad science and how to avoid it, a movement analysis perspective: Study design, statistics and publication ethics. Gait Posture 2015; 42:224-6. [PMID: 26423463 DOI: 10.1016/j.gaitpost.2015.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Kerr A, Arrowsmith M, Young S, Jaimes H. Evaluation of a skin barrier cream for managing IAD in elderly patients using high-frequency ultrasound. Br J Community Nurs 2015; 19:585-91. [PMID: 25475672 DOI: 10.12968/bjcn.2014.19.12.585] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 11/11/2022]
Abstract
Incontinence-associated dermatitis (IAD) is a defined pathological entity and presents a significant burden for patients and health-care systems. The main objective of this evaluation was to test the efficacy and safety of a skin barrier cream in the management of uncomplicated IAD in elderly patients. Ten incontinent patients with mobility problems that presented with signs of IAD were included in the evaluation. The evaluation took place during a 2-week period. The product's efficacy was objectively evaluated in each patient with high-frequency ultrasound scans taken from the irritated skin compared with an ultrasound scan taken from normal adjacent (control) skin. Data analysis showed a statistical significance in favour of the capacity of the product to help reduce inflammatory signs. Photographic follow-up allowed correlation of ultrasound findings and clinical signs. The product was effective in treating the skin irritation and preventing further skin breakdown. There were no adverse events during the evaluation.
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Affiliation(s)
- Andy Kerr
- Senior Clinical Specialist (National Lead for Compression), 3M Health Care and Honorary Tissue Viability Nurse, Eastbourne
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Jain M, Lee M, Devlin G, Kerr A. Predictors of in-hospital and post-discharge bleeding after an acute coronary syndrome. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.04.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Wang T, Sathananthan J, Hood C, Marshall M, Kerr A. Relationships between anticoagulation regimen, risk score and adverse outcomes in dialysis patients with atrial fibrillation. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Turaga M, Kerr A, Devlin G, Lee M, Grey C. Statin use after Acute Coronary Syndrome, from discharge to three years: the Middlemore and Waikato Hospital ANZACS-QI cohort. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.04.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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