1
|
Ayyaz FM, Joyner J, Cheetham M, Briggs T, Gray WK. Association of day-case rates with post COVID-19 recovery of elective laparoscopic cholecystectomy activity across England. Ann R Coll Surg Engl 2024. [PMID: 38563060 DOI: 10.1308/rcsann.2023.0111] [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: 04/04/2024] Open
Abstract
INTRODUCTION The aim of this study was to investigate the safety of day-case laparoscopic cholecystectomy, and the association between day-case rates and, post the COVID-19 pandemic, recovery of activity to prepandemic levels for integrated care boards (ICBs) in England. METHODS This was a retrospective observational study of the Hospital Episodes Statistics (HES) data set. Elective laparoscopic cholecystectomies for the period 1 January 2019 to 31 December 2022 were identified. Activity levels for 2022 were compared with those for the whole of 2019 (baseline). Day-case activity was identified where the length of stay recorded in the HES was zero days. RESULTS Data were available for 184,252 patients across the 42 ICBs in England, of which 120,408 (65.3%) were day-case procedures. By December 2022, activity levels for the whole of England had returned to 88.2% of prepandemic levels. The South West region stood out as having recovered activity levels to the greatest extent, with activity at 97.3% of prepandemic levels during 2022. The South West also had the highest postpandemic day-case rate at 74.9% of all patients seen as a day-case during 2022; this compares with an England average of 65.3%. At an ICB level, there was a significant correlation between day-case rates and postpandemic activity levels (r = 0.362, p = 0.019). There was no strong or consistent evidence that day-case surgery had poorer patient outcomes than inpatient surgery. CONCLUSIONS Recovery of elective laparoscopic cholecystectomy activity has been better in South West England than in other regions. Increasing day-case rates may be important if ICBs in other regions are to increase activity levels up to and beyond prepandemic levels.
Collapse
Affiliation(s)
- F M Ayyaz
- Getting It Right First Time Programme, NHS England and NHS Improvement, UK
- Manchester University NHS Foundation Trust, UK
| | - J Joyner
- Getting It Right First Time Programme, NHS England and NHS Improvement, UK
- Croydon Health Services NHS Trust, UK
| | - M Cheetham
- Getting It Right First Time Programme, NHS England and NHS Improvement, UK
- The Shrewsbury and Telford Hospital NHS Trust, UK
| | - Twr Briggs
- Getting It Right First Time Programme, NHS England and NHS Improvement, UK
- Royal National Orthopaedic Hospital NHS Trust, UK
| | - W K Gray
- Getting It Right First Time Programme, NHS England and NHS Improvement, UK
| |
Collapse
|
2
|
Joyner J, Ayyaz FM, Cheetham M, Briggs TWR, Gray WK. Factors associated with conversion from day-case to in-patient elective inguinal hernia repair surgery across England: an observational study using administrative data. Hernia 2024; 28:555-565. [PMID: 38347244 DOI: 10.1007/s10029-023-02949-y] [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: 10/20/2023] [Accepted: 12/16/2023] [Indexed: 04/06/2024]
Abstract
PURPOSE Elective primary inguinal hernia repair surgery is increasingly being conducted as a day-case procedure. However, some patients planned for day-case surgery have to stay in hospital for at least one night. The aim of this study was to identify the factors associated with conversion from day-case to in-patient management for elective inguinal hernia repair surgery. METHODS This was an exploratory retrospective analysis of observational data from the Hospital Episode Statistics dataset for England. All patients aged ≥ 17 years undergoing a first elective inguinal hernia repair between 1st April 2014 and 31st March 2022 that was planned as day-case surgery were identified. The exposure of interest was discharged on the day of admission (day-case) or requiring overnight stay. The primary outcome of interest was 30-day emergency readmission with an overnight stay. For reporting, providers were aggregated to an Integrated Care Board (ICB) level. RESULTS A total of 351,528 planned day-case elective primary inguinal hernia repairs were identified over the eight-year study period. Of these, 45,305 (12.9%) stayed in hospital for at least one night and were classed as day-case to in-patient stay conversions. Patients who converted to in-patient stay were older, had more comorbidities, and were more likely to have bilateral surgery and be operated on by a low-annual volume surgeon. Post-procedural complications were strongly associated with conversion. Across the 42 ICBs in England, model-adjusted conversion rates varied from 3.3% to 21.3%. CONCLUSIONS There was considerable variation in conversion to in-patient stay rates for inguinal hernia repair across ICBs in England. Our findings should help surgical teams to better identify patients suitable for day-case inguinal hernia repair and plan discharge services more effectively. This should help to reduce the variation in conversion rates.
Collapse
Affiliation(s)
- J Joyner
- Getting It Right First Time Programme, NHS England and NHS Improvement, London, UK.
- Department of General Surgery, Croydon Health Services NHS Trust, Croydon University Hospital, 530 London Road, Croydon, CR7 7YE, UK.
| | - F M Ayyaz
- Getting It Right First Time Programme, NHS England and NHS Improvement, London, UK
- Manchester University NHS Foundation Trust, Manchester, UK
| | - M Cheetham
- Getting It Right First Time Programme, NHS England and NHS Improvement, London, UK
- Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, UK
| | - T W R Briggs
- Getting It Right First Time Programme, NHS England and NHS Improvement, London, UK
- Royal National Orthopaedic Hospital, London, UK
| | - W K Gray
- Getting It Right First Time Programme, NHS England and NHS Improvement, London, UK
| |
Collapse
|
3
|
Ademuyiwa AO, Bhangu A, Chakrabortee S, Glasbey J, Kamarajah SK, Ledda V, Li E, Morton D, Nepogodiev D, Picciochi M, Simoes JFF, Lapitan MC, Cheetham M, Forkman E, El-Boghdadly E, Ghosh D, Harrison EM, Hutchinson P, Lawani I, Aguilera ML, Martin J, Meara JG, Ntirenganya F, Medina ARDL, Tabiri S. Strategies to strengthen elective surgery systems during the SARS-CoV-2 pandemic: systematic review and framework development. Br J Surg 2024; 111:znad405. [PMID: 38300731 PMCID: PMC10833142 DOI: 10.1093/bjs/znad405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 09/12/2023] [Accepted: 10/27/2023] [Indexed: 02/03/2024]
|
4
|
Joyner J, Ayyaz FM, Cheetham M, Briggs TWR, Gray WK. Day-case and in-patient elective inguinal hernia repair surgery across England: an observational study of variation and outcomes. Hernia 2023; 27:1439-1449. [PMID: 37851291 DOI: 10.1007/s10029-023-02893-x] [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: 06/06/2023] [Accepted: 09/13/2023] [Indexed: 10/19/2023]
Abstract
PURPOSE Elective primary inguinal hernia repair surgery is increasingly being conducted as a day-case procedure. However, in England there is evidence of wide variation in day-case rates across hospitals. Reducing the extent of this variation has the potential to support more efficient use of resources (e.g., clinician time, hospital beds) and help the recovery of elective surgical activity following the COVID-19 pandemic. The aims of this study were to explore the extent of variation in day-case rates across healthcare providers in England and to evaluate the safety of day-case elective primary inguinal hernia repair surgery. METHODS This was an exploratory, retrospective analysis of observational data from the Hospital Episode Statistics data set for England. All patients aged ≥ 17 years undergoing a first elective inguinal hernia repair between 1st April 2014 and 31st March 2022 were identified. The exposure of interest was day-case or in-patient stay, and the primary outcome of interest was 30-day emergency readmission with an overnight stay. For reporting, providers were aggregated to an Integrated Care Board (ICB) level. RESULTS A total of 413,059 elective primary inguinal hernia repairs were identified over the 8-year study period. Of these, 326,833 (79.1%) were day-case procedures. During the most recent financial year (2021-22), the highest day-case rate for an ICB was 93.8% and the lowest 66.1%. After adjusting for covariates, day-case surgery was associated with significantly lower rates of 30-day emergency readmission (odds ratio (OR) 0.61, 95% confidence interval (CI) 0.58-0.64, p < 0.001) and for the secondary outcomes 180-day mortality and haemorrhage, infection and pain at 30-day post-discharge. Rates of 30-day emergency readmission were significantly lower in ICBs with high rates of day-case surgery (OR 0.84, 95% CI 0.74-0.96, p < 0.001) than in ICBs with low rates of day-case surgery, although rates of post-procedural haemorrhage within 30 days of discharge were significantly higher in trusts with high day-case rates (OR 1.20, 95% CI 1.04-1.40, p = 0.015). CONCLUSIONS For the outcomes studied, we found no consistent evidence that day-case elective inguinal hernia repair was unsafe for selected patients. Currently, there is substantial variation between ICBs in terms of delivering day-case surgery. Reducing this variability may help address the current pressures on the NHS in elective surgery.
Collapse
Affiliation(s)
- J Joyner
- Getting It Right First Time Programme, NHS England, London, UK.
- Croydon Health Services NHS Trust, Croydon, UK.
- Department of General Surgery, Croydon University Hospital, Croydon Health Services NHS Trust, 530 London Road, Croydon, CR7 7YE, UK.
| | - F M Ayyaz
- Getting It Right First Time Programme, NHS England, London, UK
- Manchester University NHS Foundation Trust, Manchester, UK
| | - M Cheetham
- Getting It Right First Time Programme, NHS England, London, UK
- Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, UK
| | - T W R Briggs
- Getting It Right First Time Programme, NHS England, London, UK
- Royal National Orthopaedic Hospital, London, UK
| | - W K Gray
- Getting It Right First Time Programme, NHS England, London, UK
- Royal National Orthopaedic Hospital, London, UK
| |
Collapse
|
5
|
Lie M, Visram S, Cheetham M, Christie A, Hodgson P, Jasperse J, Logan M. Gateways not gatekeepers – reaching seldom-heard groups to gather public health community insights. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac130.030] [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: 11/15/2022] Open
Abstract
Abstract
Background
Each local authority in England must develop a Health and Wellbeing Strategy (HWS) in collaboration with NHS partners to plan and support delivery of local improvements in health and wellbeing. HWSs often draw on diverse sources but few are informed by consultative exercises involving citizens. South Tyneside Council in Northern England sought to ensure their new HWS was community-informed, specifically including seldom-heard groups and individuals. Specific objectives of this community insights research were to:
1.Target sampling and recruitment activities at typically marginalized, vulnerable or otherwise underrepresented groups
2.Explore the health and wellbeing-related views and priorities of these groups to address health inequalities
Methods
A mapping exercise was undertaken to identify organisations who might act as gatekeepers to accessing participants from underrepresented groups. Focus groups were held in settings-based venues where members would be comfortable and known to one another. Representatives of voluntary and community sector (VCS) organisations often helped to co-facilitate the discussions.
Results
119 participants took part in 16 group discussions. Three were held online, two were outdoors, while 11 involved community venues where the groups regularly met. We reached older and younger people, minority ethnic groups, and vulnerable men and women, including residents who had experienced homelessness, mental health issues, substance misuse, offending, domestic violence and learning disabilities. Participants were largely concerned with the wider determinants of health (such as poverty, employment, and leisure spaces), shifting the narrative away from individual lifestyle factors that tend to be the focus of much public health discourse.
Conclusions
Gatekeepers from the VCS were essentially gateways, enabling us to include underrepresented voices in local consultation processes and generate new insights to inform the South Tyneside HWS.
Key messages
Collapse
Affiliation(s)
- M Lie
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - S Visram
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - M Cheetham
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne, UK
| | - A Christie
- Public Health, South Tyneside Council, South Shields, UK
| | - P Hodgson
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne, UK
| | - J Jasperse
- Public Health, South Tyneside Council, South Shields, UK
| | - M Logan
- Public Health, South Tyneside Council, South Shields, UK
| |
Collapse
|
6
|
Cheetham M, Atkinson PJ, Gibson M, Katikireddi SV, Moffatt S, Morris S, Munford L, Shenton F, Wickham S, Craig P. Exploring the mental health effects of Universal Credit: a journey of co-production. Perspect Public Health 2022; 142:209-212. [PMID: 35833554 PMCID: PMC9284081 DOI: 10.1177/17579139221103178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- M Cheetham
- Research Fellow, National Institute for Health and Care Research (NIHR), Applied Research Collaboration North East and North Cumbria (NIHR200173), based at Department of Nursing, Midwifery and Health, Northumbria University, Coach Lane Campus East, Room H213, Newcastle-u-Tyne, NE7 7XA, UK
| | | | - M Gibson
- Investigator Scientist, MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - S V Katikireddi
- Professor of Public Health & Health Inequalities, MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - S Moffatt
- Professor of Social Gerontology, Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, UK
| | - S Morris
- Post Doctoral Research Associate, Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, UK
| | - L Munford
- Senior Lecturer in Health Economics, Division of Population Health, Health Services Research & Primary Care, School of Social Sciences, University of Manchester, Manchester, UK
| | - F Shenton
- Public Involvement and Community Engagement Manager, National Institute for Health and Care Research (NIHR), Applied Research Collaboration North East and North Cumbria (NIHR200173), based at CNTW NHS Foundation Trust, St Nicholas' Hospital, Newcastle Upon Tyne, NE3 3XT, UK
| | - S Wickham
- Wellcome Trust Research Fellow, Department of Public Health, Policy & Systems, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - P Craig
- Professor of Public Health Evaluation, Inequalities and Health, MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| |
Collapse
|
7
|
Siebenhüner K, Blaser J, Nowak A, Cheetham M, Mueller BU, Battegay E, Beeler PE. Comorbidities Associated with Worse Outcomes Among Inpatients Admitted for Acute Gastrointestinal Bleeding. Dig Dis Sci 2022; 67:3938-3947. [PMID: 34365536 PMCID: PMC8349143 DOI: 10.1007/s10620-021-07197-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 07/25/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Multimorbidity increases healthcare resource utilization. Little is known on specific comorbidity combinations. AIMS To identify comorbidities associated with increased resource utilization among inpatients admitted for gastrointestinal bleeding (GIB). METHODS This retrospective cross-sectional study, 1/2010-5/2018 at the University Hospital Zurich, Switzerland, analyzed electronic health records of patients with upper (UGIB) and lower (LGIB) GIB, focusing on length of stay (LOS) and 30-day readmissions for resource use and clinical outcomes, investigated by multivariable regression adjusted for antithrombotics. RESULTS Of 1101 patients, 791 had UGIB and 310 LGIB, most often melena and bleeding diverticula, respectively. In UGIB, thromboembolic events showed a trend toward 27% increased LOS (1.27; 95% confidence interval [CI] 1.00-1.61), antithrombotics independently associated with 46% increased LOS (1.46; 95% CI 1.32-1.62). Cancer (odds ratio [OR] 2.86; 95% CI 1.68-4.88) independently associated with 30-day readmissions, anemia showed a trend (OR 1.68; 95% CI 1.00-2.84). In LGIB, none of the investigated comorbidities associated with increased LOS, but antithrombotics independently associated with 25% increased LOS (1.25; 95% CI 1.07-1.46). Atrial fibrillation/flutter (OR 2.69; 95% CI 1.06-6.82) and cancer (OR 4.76; 95% CI 1.40-16.20) associated strongly with 30-day readmissions. CONCLUSIONS In both groups, cancer associated with 30-day readmissions, antithrombotics with increased LOS. Thromboembolic events and anemia showed clinically important trends in UGIB. Atrial fibrillation/flutter associated with 30-day readmissions in LGIB. Prospective studies are needed to investigate these complex multimorbid populations and establish appropriate guidelines.
Collapse
Affiliation(s)
- K. Siebenhüner
- Institute of Epidemiology, Biostatistics and Prevention, University of Zurich, Hirschengraben 84, 8001 Zurich, Switzerland ,Department of Internal Medicine, University Hospital of Zurich, Zurich, Switzerland ,Centre of Competence Multimorbidity, University of Zurich, Zurich, Switzerland ,Department of Internal Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - J. Blaser
- Directorate of Research and Education, University Hospital of Zurich, Zurich, Switzerland
| | - A. Nowak
- Department of Endocrinology and Clinical Nutrition, University Hospital Zurich and University of Zurich, Zurich, Switzerland ,Department of Internal Medicine, Psychiatry University Hospital Zurich, Zurich, Switzerland
| | - M. Cheetham
- Department of Internal Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - B. U. Mueller
- Department of Internal Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - E. Battegay
- Department of Internal Medicine, University Hospital of Zurich, Zurich, Switzerland ,Centre of Competence Multimorbidity, University of Zurich, Zurich, Switzerland ,Department of Internal Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - P. E. Beeler
- Institute of Epidemiology, Biostatistics and Prevention, University of Zurich, Hirschengraben 84, 8001 Zurich, Switzerland ,Department of Internal Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| |
Collapse
|
8
|
Marcar VL, Battegay E, Schmidt D, Cheetham M. Parallel processing in human visual cortex revealed through the influence of their neural responses on the visual evoked potential. Vision Res 2021; 193:107994. [PMID: 34979298 DOI: 10.1016/j.visres.2021.107994] [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] [Received: 07/11/2021] [Revised: 12/22/2021] [Accepted: 12/22/2021] [Indexed: 10/19/2022]
Abstract
The neural response in the human visual system is composed of magno-, parvo- and koniocellular input from the retina. Signal differences from functional imaging between health and individuals with a cognitive weakness are attributed to a dysfunction of a specific retinal input. Yet, anatomical interconnections within the human visual system obscure individual contribution to the neural response in V1. Deflections in the visual evoked potential (VEP) arise from an interaction between electric dipoles, their strength determined by the size of the neural population active during temporal - and spatial luminance contrast processing. To investigate interaction between these neural responses, we recorded the VEP over visual cortex of 14 healthy adults viewing four series of windmill patterns. Within a series, the relative area white in a pattern varied systematically. Between series, the number of sectors across which this area was distributed doubled. These patterns were viewed as pattern alternating and on-/off stimuli. P100/P1 amplitude increased linearly with the relative area white in the pattern, while N135/N1 and P240/P2 amplitude increased with the number of sectors of which the area white was distributed. The decreases P100 amplitude with increasing number of sectors is attributed to an interaction between electric dipoles located in granular and supragranular layers of V1. Differences between the VEP components obtained during a pattern reversing display and following pattern onset are accounted for by the transient and sustained nature of neural responses processing temporal - and spatial luminance contrast and ability of these responses to manifest in the VEP.
Collapse
Affiliation(s)
- V L Marcar
- University Hospital Zurich, Department of Internal Medicine, Rämistrasse 100, CH-8091 Zürich, Switzerland; University Hospital Zürich, Comprehensive Cancer Centre Zurich, PO Box, 157, Rämistrasse 100, CH-8091 Zürich, Switzerland; University Hospital Zürich, Biomedical Optical Research Laboratory (BORL), Department of Neonatology, Frauenklinikstrasse 10, CH-8006 Zürich, Switzerland.
| | - E Battegay
- University Hospital Zurich, Department of Internal Medicine, Rämistrasse 100, CH-8091 Zürich, Switzerland; University Research Priority Program "Dynamics of Healthy Aging", University of Zürich, Zürich, Switzerland; International Center for Multimorbidity and Complexity in Medicine (ICMC), University Zurich, University Hospital Basel (Department of Psychosomatic Medicine), Merian Iselin Klinik Basel, Switzerland
| | - D Schmidt
- University Hospital Zurich, Department of Internal Medicine, Rämistrasse 100, CH-8091 Zürich, Switzerland
| | - M Cheetham
- University Hospital Zurich, Department of Internal Medicine, Rämistrasse 100, CH-8091 Zürich, Switzerland
| |
Collapse
|
9
|
Ahn K, Khan N, Desai N, Abdu M, Hiddema L, Odogwu S, Cheetham M, Pande R. 822 Lessons Learnt During the COVID-19 Pandemic on Emergency Surgical Admissions in A District General Hospital. Br J Surg 2021. [PMCID: PMC8135730 DOI: 10.1093/bjs/znab134.090] [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]
Abstract
Introduction Coronavirus disease (COVID-19) is an acute severe respiratory distress syndrome which resulted in an unprecedented impact on NHS service provision. We aimed to assess the impact of COVID-19 on general surgical services in a district general hospital. Method Electronic health care record data was retrospectively collected from 6th of April to 6th of May for both 2019 and 2020. Results Despite fewer referrals and admissions in 2020 (133 vs 177 admissions in 2019), there were more failed discharges (29 vs 17 in 2019) and higher associated costs. Higher numbers of biliary related pathologies and pancreatitis (50 in 2020 vs 25 in 2019), and fewer complaints of non-specific abdominal pain (10 in 2020 vs 22 in 2019) were observed. The use of outpatient investigations decreased by approximately 40% in 2020; however, utilisation of inpatient investigations was comparable. Conclusions Better utilisation of outpatient investigations and virtual clinic services may surmount pressures from further peaks of COVID-19. The increase in biliary related cases and pancreatitis may be consequent upon lifestyle changes during lockdown. This merits further investigation and if appropriate, public health intervention. In the absence of an efficacious vaccine, further research would be essential to streamline general surgical services based on clinical risk stratification.
Collapse
Affiliation(s)
- K Ahn
- Walsall Healthcare NHS Trust, Walsall, United Kingdom
| | - N Khan
- Walsall Healthcare NHS Trust, Walsall, United Kingdom
| | - N Desai
- Walsall Healthcare NHS Trust, Walsall, United Kingdom
| | - M Abdu
- Walsall Healthcare NHS Trust, Walsall, United Kingdom
| | - L Hiddema
- Walsall Healthcare NHS Trust, Walsall, United Kingdom
| | - S Odogwu
- Walsall Healthcare NHS Trust, Walsall, United Kingdom
| | - M Cheetham
- Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, United Kingdom
| | - R Pande
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| |
Collapse
|
10
|
Beeler PE, Cheetham M, Held U, Battegay E. Depression is independently associated with increased length of stay and readmissions in multimorbid inpatients. Eur J Intern Med 2020; 73:59-66. [PMID: 31791574 DOI: 10.1016/j.ejim.2019.11.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 11/08/2019] [Accepted: 11/14/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Little is known about the impact of depression across a broad range of multimorbid patients hospitalized for reasons other than depression. The objective of the study was to investigate in a large sample of multimorbid inpatients whether ancillary depression is associated with increased length of stay (LOS) and readmissions, two important clinical outcomes with implications for healthcare utilization and costs. METHODS We retrospectively analyzed a cohort of 253,009 multimorbid inpatients aged ≥18 at an academic medical center, 8/2009-8/2017. PRIMARY OUTCOME LOS. SECONDARY OUTCOMES LOS related to different main diagnoses, readmissions within 1, 3, 6, 12, and 24-months after discharge. RESULTS Multivariable linear regression showed 24% longer LOS in patients with ancillary depression (1.24; 95% confidence interval [CI]: 1.22, 1.25). Females stayed 22% longer (1.22; 95% CI: 1.20, 1.25), males 24% (1.24; 95% CI: 1.22, 1.27). We identified 16 main diagnosis clusters in which ancillary depression was associated with significant LOS increases, with associations being strongest for "Failure and rejection of transplanted organs and tissues", "Other noninfective gastroenteritis and colitis", and "Other soft tissue disorders, not elsewhere classified". Multivariable logistic and Poisson regression showed independent associations of ancillary depression with increased readmission odds and frequencies at 1, 3, 6, 12, and 24 months. CONCLUSIONS Ancillary depression was independently associated with increased LOS and more readmissions across a broad range of multimorbid inpatients.
Collapse
Affiliation(s)
- P E Beeler
- Department of Internal Medicine, University Hospital Zurich & University of Zurich, Zurich, Switzerland; University Research Priority Program "Dynamics of Healthy Aging", University Zurich, Zurich, Switzerland; Center of Competence Multimorbidity, University of Zurich, Zurich, Switzerland.
| | - M Cheetham
- Department of Internal Medicine, University Hospital Zurich & University of Zurich, Zurich, Switzerland; University Research Priority Program "Dynamics of Healthy Aging", University Zurich, Zurich, Switzerland.
| | - U Held
- Department of Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland.
| | - E Battegay
- Department of Internal Medicine, University Hospital Zurich & University of Zurich, Zurich, Switzerland; University Research Priority Program "Dynamics of Healthy Aging", University Zurich, Zurich, Switzerland; Center of Competence Multimorbidity, University of Zurich, Zurich, Switzerland.
| |
Collapse
|
11
|
Normanno N, Fairley J, Cheetham M, Denis M, Dequeker E, Keppens C, Fenizia F, Patton S, Rouleau E, Schuuring E, Van Casteren K, Deans Z. Results of a global external quality assessment scheme for EGFR testing on liquid biopsy. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz257.008] [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: 11/12/2022] Open
|
12
|
Abstract
About 20-25% of all persons and about 90% of all patients who are acutely hospitalized in internal medicine departments have multiple acute or chronic diseases. They are multimorbid. The encounter with multimorbid patients has become the most common situation in the health care system. Theoretically, multimorbidity results in an innumerable potential disease constellations. In addition, the likelihood of interactions between diseases (disease-disease interactions, DDI) and the complexity increases overproportionately with each additional disease. However, multimorbidity often occurs in typical diadic, triadic, or higher characteristic combinations, in "disease clusters", e. g., vascular risk factors, heart and lung diseases, Frailty and dementia, psychiatric and somatic disorders. Such combinations lead to a worsening of the overall prognosis. In addition, DDIs are often difficult to treat or are life-threatening. Examples of DDIs include the following: anticoagulation and simultaneous severe bleeding, pain treatment and hypertension or renal insufficiency, depression and reduced medication adherence, chronic obstructive pulmonary disease and depression, Frailty and neurodepressant drugs and frequent falls, and combined psychiatric and somatic disorders. Such DDIs are common. Nevertheless, there are few studies and clinical guidelines that address these issues. The care of multimorbid patients is, therefore, heavily reliant upon guidelines developed mostly for single diseases. However, multimorbidity and serious DDIs are usually not addressed in these. Clinical guidelines can thus inadvertently jeopardize the safety of persons suffering from multiple diseases. In addition, stressful dilemmas arise for physicians encountering DDIs because of difficult treatment decisions.
Collapse
Affiliation(s)
- E Battegay
- Klinik und Poliklinik für Innere Medizin, UniversitätsSpital Zürich, Rämistr. 100, 8091, Zürich, Schweiz. .,Kompetenzzentrum Multimorbidität, Universität Zürich, Zürich, Schweiz. .,Forschungsschwerpunkt Dynamics of Healthy Aging, Universität Zürich, Zürich, Schweiz.
| | - M Cheetham
- Klinik und Poliklinik für Innere Medizin, UniversitätsSpital Zürich, Rämistr. 100, 8091, Zürich, Schweiz.,Kompetenzzentrum Multimorbidität, Universität Zürich, Zürich, Schweiz.,Forschungsschwerpunkt Dynamics of Healthy Aging, Universität Zürich, Zürich, Schweiz
| | - B M Holzer
- Klinik und Poliklinik für Innere Medizin, UniversitätsSpital Zürich, Rämistr. 100, 8091, Zürich, Schweiz.,Kompetenzzentrum Multimorbidität, Universität Zürich, Zürich, Schweiz.,Forschungsschwerpunkt Dynamics of Healthy Aging, Universität Zürich, Zürich, Schweiz
| | - A Nowak
- Klinik und Poliklinik für Innere Medizin, UniversitätsSpital Zürich, Rämistr. 100, 8091, Zürich, Schweiz
| | - D Schmidt
- Klinik und Poliklinik für Innere Medizin, UniversitätsSpital Zürich, Rämistr. 100, 8091, Zürich, Schweiz.,Kompetenzzentrum Multimorbidität, Universität Zürich, Zürich, Schweiz.,Forschungsschwerpunkt Dynamics of Healthy Aging, Universität Zürich, Zürich, Schweiz
| | - S Rampini
- Klinik und Poliklinik für Innere Medizin, UniversitätsSpital Zürich, Rämistr. 100, 8091, Zürich, Schweiz
| |
Collapse
|
13
|
Cheetham M, Van der Graaf P, Khazaeli B, Gibson E, Wiseman A, Rushmer R. "It was the whole picture" a mixed methods study of successful components in an integrated wellness service in North East England. BMC Health Serv Res 2018; 18:200. [PMID: 29566687 PMCID: PMC5863899 DOI: 10.1186/s12913-018-3007-z] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 03/14/2018] [Indexed: 11/11/2022] Open
Abstract
Background A growing number of Local Authorities (LAs) have introduced integrated wellness services as part of efforts to deliver cost effective, preventive services that address the social determinants of health. This study examined which elements of an integrated wellness service in the north east of England were effective in improving health and wellbeing (HWB). Methods The study used a mixed-methods approach. In-depth semi-structured interviews (IVs) were conducted with integrated wellness service users (n = 25) and focus groups (FGs) with group based service users (n = 14) and non-service users (n = 23) to gather the views of stakeholders. Findings are presented here alongside analysis of routine monitoring data. The different data were compared to examine what each data source revealed about the effectiveness of the service. Results Findings suggest that integrated wellness services work by addressing the social determinants of health and respond to multiple complex health and social concerns rather than single issues. The paper identifies examples of ‘active ingredients’ at the heart of the programme, such as sustained relationships, peer support and confidence building, as well as the activities through which changes take place, such as sports and leisure opportunities which in turn encourage social interaction. Wider wellbeing outcomes, including reduced social isolation and increased self-efficacy are also reported. Practical and motivational support helped build community capacity by encouraging community groups to access funding, helped navigate bureaucratic systems, and promoted understanding of marginalised communities. Fully integrated wellness services could support progression opportunities through volunteering and mentoring. Conclusions An integrated wellness service that offers a holistic approach was valued by service users and allowed them to address complex issues simultaneously. Few of the reported health gains were captured in routine data. Quantitative and qualitative data each offered a partial view of how effectively services were working.
Collapse
Affiliation(s)
- M Cheetham
- Health and Social Care Institute, Constantine Building, Teesside University, Middlesbrough, TS1 3BA, UK. .,Fuse (UKCRC Centre for Translational Research in Public Health), Newcastle University, Newcastle-upon-Tyne, NE2 4AX, UK.
| | - P Van der Graaf
- Health and Social Care Institute, Constantine Building, Teesside University, Middlesbrough, TS1 3BA, UK.,Fuse (UKCRC Centre for Translational Research in Public Health), Newcastle University, Newcastle-upon-Tyne, NE2 4AX, UK
| | - B Khazaeli
- Gateshead Council, Public Health Team, Gateshead, NE8 1NN, UK
| | - E Gibson
- Gateshead Council, Public Health Team, Gateshead, NE8 1NN, UK
| | - A Wiseman
- Gateshead Council, Public Health Team, Gateshead, NE8 1NN, UK
| | - R Rushmer
- Health and Social Care Institute, Constantine Building, Teesside University, Middlesbrough, TS1 3BA, UK.,Fuse (UKCRC Centre for Translational Research in Public Health), Newcastle University, Newcastle-upon-Tyne, NE2 4AX, UK
| |
Collapse
|
14
|
Cheetham M, Wiseman A, Khazaeli B, Gibson E, Gray P, Van der Graaf P, Rushmer R. Embedded research: a promising way to create evidence-informed impact in public health? J Public Health (Oxf) 2018. [DOI: 10.1093/pubmed/fdx125] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [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)
- M Cheetham
- Health and Social Care Institute, Teesside University, Middlesbrough TS1 3BA, UK
- Fuse (UKCRC Centre for Translational Research in Public Health), Newcastle University, Newcastle-upon-Tyne NE2 4AX, UK
| | - A Wiseman
- Gateshead Council, Public Health Team, Gateshead NE8 1NN, UK
| | - B Khazaeli
- Gateshead Council, Public Health Team, Gateshead NE8 1NN, UK
| | - E Gibson
- Gateshead Council, Public Health Team, Gateshead NE8 1NN, UK
| | - P Gray
- Gateshead Council, Public Health Team, Gateshead NE8 1NN, UK
| | - P Van der Graaf
- Health and Social Care Institute, Teesside University, Middlesbrough TS1 3BA, UK
- Fuse (UKCRC Centre for Translational Research in Public Health), Newcastle University, Newcastle-upon-Tyne NE2 4AX, UK
| | - R Rushmer
- Health and Social Care Institute, Teesside University, Middlesbrough TS1 3BA, UK
- Fuse (UKCRC Centre for Translational Research in Public Health), Newcastle University, Newcastle-upon-Tyne NE2 4AX, UK
| |
Collapse
|
15
|
Abstract
INTRODUCTION Anecdotally, surgeons claim splenic flexure mobilisation is more difficult in male patients. There have been no scientific studies to confirm or disprove this hypothesis. The implications in colorectal surgery could be profound. The aim of this study was to assess quantitatively whether there is an anatomical difference in the position of the splenic flexure between men and women using computed tomography (CT). METHODS Portal venous phase CT performed for preoperative assessment of colorectal malignancy was analysed using the hospital picture archiving and communication system. The splenic flexure was compared between men and women using two variables: anatomical height corresponding to the adjacent vertebral level (converted to ordinal values between 1 and 17) and distance from the midline. RESULTS In total, 100 CT images were analysed. Sex distribution was even. The mean ages of the male and female patients were 68.1 years and 66.7 years respectively (p=0.630). The mean vertebral level for men was 8.88, equating to the inferior half of the T11 vertebral body (range: 1-17 [superior half of T9 to inferior half of L2]), and 11.36 for women, equating to the inferior half of the T12 vertebral body (range: 4-16 [superior half of T10 to superior half of L2]). This difference was statistically significant (p=0.0001) and is equivalent to one whole vertebra. The mean distance from the midline was 160.8mm (range: 124-203mm) for men and 138.2mm (range: 107-185mm) for women (p<0.0001). CONCLUSIONS The splenic flexure is both higher and further from the midline in men than in women. This provides one theory as to why mobilising the splenic flexure may be more difficult in male patients.
Collapse
Affiliation(s)
| | - Caw Macano
- Heart of England NHS Foundation Trust , UK
| | - T Stone
- Shrewsbury and Telford Hospital NHS Trust , UK
| | - M Cheetham
- Shrewsbury and Telford Hospital NHS Trust , UK
| | - L Meecham
- Heart of England NHS Foundation Trust , UK
| |
Collapse
|
16
|
Cheetham M, Visram S, Rushmer R, Greig G, Gibson E, Khazaeli B, Wiseman A. 'It is not a quick fix' structural and contextual issues that affect implementation of integrated health and well-being services: a qualitative study from North East England. Public Health 2017; 152:99-107. [PMID: 28881219 DOI: 10.1016/j.puhe.2017.07.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Revised: 07/19/2017] [Accepted: 07/19/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The objective of this article is to examine the factors affecting the design, commissioning and delivery of integrated health and well-being services (IHWSs), which seek to address multiple health-related behaviours, improve well-being and tackle health inequalities using holistic approaches. STUDY DESIGN Qualitative studies embedded within iterative process evaluations. METHODS Semi-structured interviews conducted with 16 key informants as part of two separate evaluations of IHWSs in North East England, supplemented by informal observations of service delivery. Transcripts and fieldnotes were analysed thematically. RESULTS The study findings identify a challenging organisational context in which to implement innovative service redesign, as a result of budget cuts and changes in NHS and local authority capacity. Pressures to demonstrate outcomes affected the ability to negotiate the practicalities of joint working. Progress is at risk of being undermined by pressures to disinvest before the long-term benefits to population health and well-being are realised. The findings raise important questions about contract management and relationships between commissioners and providers involved in implementing these new ways of working. CONCLUSIONS These findings provide useful learning in terms of the delivery and commissioning of similar IHWSs, contributing to understanding of the benefits and challenges of this model of working.
Collapse
Affiliation(s)
- M Cheetham
- School of Health and Social Care, Teesside University, Middlesbrough, TS1 3BA, UK; Fuse (UKCRC Centre for Translational Research in Public Health), Newcastle University, Newcastle-upon-Tyne, NE2 4AX, UK.
| | - S Visram
- Fuse (UKCRC Centre for Translational Research in Public Health), Newcastle University, Newcastle-upon-Tyne, NE2 4AX, UK; School of Medicine, Pharmacy and Health, Durham University Queen's Campus, Stockton-on-Tees, TS17 6BH, UK.
| | - R Rushmer
- School of Health and Social Care, Teesside University, Middlesbrough, TS1 3BA, UK; Fuse (UKCRC Centre for Translational Research in Public Health), Newcastle University, Newcastle-upon-Tyne, NE2 4AX, UK.
| | - G Greig
- Durham County Council, County Hall, Durham, DH1 5UZ, UK.
| | - E Gibson
- Gateshead Council, Public Health Team, Civic Centre, Gateshead, NE8 1HH, UK.
| | - B Khazaeli
- Gateshead Council, Public Health Team, Civic Centre, Gateshead, NE8 1HH, UK.
| | - A Wiseman
- Gateshead Council, Public Health Team, Civic Centre, Gateshead, NE8 1HH, UK.
| |
Collapse
|
17
|
Abstract
INTRODUCTION Often, left-sided colorectal surgery requires splenic flexure mobilisation (SFM) to allow a tension-free anastomosis to be carried out. This step is difficult and not without risk. We investigated a system of anatomical siting of the splenic flexure using computed tomography (CT). METHODS The Shrewsbury Splenic Flexure Siting (SSFS) system involves siting of the splenic flexure using the vertebral level (VL) as a reference point. We asked three surgical registrars (SRs) to analyse 20 CT scans of patients undergoing colonic resection to ascertain the anatomical site of the splenic flexure using the SSFS system. The distance from the centre of the vertebral body to the lateral edge (CVBL) of the splenic flexure was measured, as was the distance from the centre of the vertebral body to the inner abdominal wall (CVBI) along the same line, on axial images. RESULTS VL assessment demonstrated substantial inter-observer agreement with a kappa (κ) value of 0.742 (95% confidence interval (CI), 0.463-0.890). CVBL and CVBI demonstrated very strong inter-observer agreement (CVBL: κ = 0.905 (95% CI, 0.785-0.961); CVBI: 0.951 (0.890-0.979) (p<0.001). Overall, there was strong correlation between assessments by all three SRs across the three variables measured. CONCLUSIONS The SSFS system is an accurate method to site the splenic flexure anatomically using CT. We can use the SSFS system to develop a validated scoring system to help colorectal surgeons assess the difficulty of SFM.
Collapse
Affiliation(s)
- L Meecham
- Shrewsbury and Telford NHS Trust , UK
| | - A Brookes
- Shrewsbury and Telford NHS Trust , UK
| | | | - T Stone
- Shrewsbury and Telford NHS Trust , UK
| | | |
Collapse
|
18
|
Visram S, Cheetham M, Riby D, Lake AA, Crossley SJ. A systematic review of the effects associated with children and young people's use of energy drinks. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv173.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
19
|
Visram S, Crossley SJ, Cheetham M, Lake AA, Riby D. A qualitative study to explore the use of energy drinks by children and young people in England. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv170.090] [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
|
20
|
Visram S, Crossley SJ, Cheetham M, Lake AA, Riby DM. PP62 Energy drinks: hype or hyper? a qualitative exploratory study involving children, parents and staff from schools in North East England. Br J Soc Med 2015. [DOI: 10.1136/jech-2015-206256.159] [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]
|
21
|
Visram S, Cheetham M, Riby DM, Lake AA, Crossley SJ. PP63 Consumption of commercial energy drinks by children and adolescents: a systematic review of consumer attitudes and associations with health, behavioural, educational and social outcomes. J Epidemiol Community Health 2015. [DOI: 10.1136/jech-2015-206256.160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
22
|
Watson A, Cheetham M. Randomized clinical trial comparing primary closure with the Limberg flap in the treatment of primary sacrococcygeal pilonidal disease (Br J Surg 2005; 92: 1081-1084). Br J Surg 2005; 92:1453. [PMID: 16237746 DOI: 10.1002/bjs.5219] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
23
|
Abstract
BACKGROUND Faecal incontinence is a common symptom which causes significant distress and reduction in quality of life. Available treatment options for faecal incontinence include conservative treatments (biofeedback, pelvic floor muscle training, dietary manipulation or drug therapy) or surgical treatments (e.g. sphincter repair, post anal repair, neosphincter). Drug treatment is often given either alone or in combination with other treatment modalities. OBJECTIVES To assess the effects of drug therapy for the treatment of faecal incontinence. In particular, to assess the effects of individual drugs relative to placebo or other drugs, and to compare drug therapy with other treatment modalities. SEARCH STRATEGY We searched the Cochrane Incontinence Group trials register (January 2003) and the reference lists of relevant articles. Date of the most recent search: January 2003. SELECTION CRITERIA All randomised or quasi-randomised controlled trials of the use of pharmacological agents for the treatment of faecal incontinence in adults. DATA COLLECTION AND ANALYSIS Working independently, reviewers selected studies from the literature, assessed the methodological quality of each trial, and extracted data. MAIN RESULTS Eleven trials were identified for inclusion in this review. Nine trials were of cross-over design. Seven trials included only people with faecal incontinence related to liquid stool (either chronic diarrhoea or following ileoanal pouch surgery). Three trials (total 58 participants) compared topical phenylephrine gel with placebo. Two trials (56 participants) compared loperamide with placebo. One trial (11 participants) compared loperamide oxide with placebo. One trial (15 participants) compared diphenoxylate plus atropine with placebo. One trial (17 participants) compared sodium valproate with placebo. One trial (30 participants) compared loperamide with codeine with diphenoxylate plus atropine. Two further trials (total 265 participants) assessed the use of lactulose in elderly people.No studies comparing drugs with other treatment modalities were identified. There was limited evidence that antidiarrhoeal drugs and drugs which enhance anal sphincter tone may reduce faecal incontinence in patients with liquid stools. However, the trials were small and of short duration. REVIEWER'S CONCLUSIONS The small number of trials identified for this review assessed several different drugs in a variety of patient populations. The focus of most of the included trials was on the treatment of diarrhoea, rather than faecal incontinence. There is little evidence to guide clinicians in the selection of drug therapies for faecal incontinence. Larger, well-designed controlled trials, which include clinically important outcome measures, are required.
Collapse
Affiliation(s)
- M Cheetham
- Department of General Surgery, Watford General Hospital, Vicarage Road, Watford, Hertfordshire, UK, WD18 0HB
| | | | | | | |
Collapse
|
24
|
Guzhova I, Kislyakova K, Moskaliova O, Fridlanskaya I, Tytell M, Cheetham M, Margulis B. In vitro studies show that Hsp70 can be released by glia and that exogenous Hsp70 can enhance neuronal stress tolerance. Brain Res 2001; 914:66-73. [PMID: 11578598 DOI: 10.1016/s0006-8993(01)02774-3] [Citation(s) in RCA: 263] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Glial cells release a variety of molecules that support neuronal function. Because heat shock proteins (Hsps) are important in the survival of neurons subjected to metabolic stress, the possibility that glia can release the inducible form of the 70 kDa Hsp (Hsp70) was examined. Additionally, the ability of neuronal cells to show increased stress tolerance by taking up a mixture of constitutive and inducible forms of Hsp70 (Hsc/Hsp70) added to the extracellular fluid was tested. Human T98G glioma cells and differentiated LA-N-5 neuroblastoma cells were used as model glia and neurons to investigate these points. Hsp70 was analyzed using affinity chromatography, Western blotting, and immunofluorescence microscopy. The glioma cells were shown to export Hsp70 into the culture medium whether under normal conditions or subjected to heat shock. The amount of glial Hsp70 released ranged from 5 to 15 pg per 10(6) cells per day, being greater following heat shock. Neuroblastoma cells took up biotinylated Hsc/Hsp70 within 1 h after it was added to the culture medium and it made them more resistant to heat shock (44 degrees C) and to staurosporine-induced apoptosis. This increased stress tolerance was especially important in neuroblastoma cells induced to differentiate with phorbol ester because those 'mature neurons' showed a 10-fold decline in endogenous Hsp70, which was accompanied by increased susceptibility to heat shock and staurosporine-induced apoptosis. These results suggest that extracellular Hsp70 may provide a means by which glia can affect neuronal function, perhaps enhancing neuronal stress tolerance.
Collapse
Affiliation(s)
- I Guzhova
- Laboratory of Cell Protection Mechanisms, Institute of Cytology Russian Academy of Science Tikhoretsky 4, 194064, St. Petersburg, Russia.
| | | | | | | | | | | | | |
Collapse
|
25
|
|
26
|
Cheetham M. Bereavement in children. J R Soc Med 1999; 92:437. [PMID: 10656018 PMCID: PMC1297334 DOI: 10.1177/014107689909200825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
27
|
Abstract
The discrimination of apoptotic and normal rat thymocytes by forward-angle light scatter in the UV depended on the angle over which the scattered light was collected. To achieve good separation, the light needed to be collected over a narrow angle. It was also observed that apoptotic thymocytes gave less forward light scatter than normal cells, whereas, under identical conditions, apoptotic cells from a murine cell line gave more light scatter than their normal counterparts. We suggest that the forward light scatter of apoptotic cells is affected by several factors, including changes in cell size and in the internal structure of the cell.
Collapse
Affiliation(s)
- M G Ormerod
- Smith-Kline Beecham, Great Burgh, Epsom, United Kingdom
| | | | | | | |
Collapse
|
28
|
Allsop P, Cheetham M, Brooks S, Hall GM, Williams C. Continuous intramuscular pH measurement during the recovery from brief, maximal exercise in man. Eur J Appl Physiol Occup Physiol 1990; 59:465-70. [PMID: 2303053 DOI: 10.1007/bf02388630] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Muscle pH and temperature were measured before, and continuously for 30 min after, a 30-s maximal sprint exercise in ten subjects. These measurements were made with a needle-tipped pH electrode and a thermocouple placed in vastus lateralis. Venous blood samples were collected for pH, lactate and catecholamine estimations and measurements were also made of the arterial blood pressure and heart rate. The muscle and venous pH decreased from 7.17 +/- 0.01 (mean +/- SEM) and 7.39 +/- 0.01 to 6.57 +/- 0.04 and 7.04 +/- 0.03, respectively, in response to the exercise. No significant recovery occurred in either pH measurement for 10 min, after which muscle pH increased to 7.03 +/- 0.03 and venous pH to 7.29 +/- 0.01 by 30 min. Muscle temperature increased by 2.1 degrees C with exercise and also failed to return to pre-exercise values by 30 min. Blood lactate concentration increased from 0.75 +/- 0.04 mmol l-1 before exercise to a peak value of 15.76 +/- 0.35 mmol l-1 5 min after completion of the exercise, and then declined slowly to 10.30 +/- 0.61 mmol l-1 by 30 min. Arterial blood pressure increased transiently with exercise but recovered rapidly, whereas the exercise-induced tachycardia was sustained throughout the recovery period. The recovery from the metabolic and cardiovascular responses to maximal sprint exercise in man is incomplete 30 min after cessation of the exercise.
Collapse
Affiliation(s)
- P Allsop
- Department of Anaesthetics, Royal Postgraduate Medical School, Hammersmith Hospital, London, England
| | | | | | | | | |
Collapse
|
29
|
Adinolfi M, Cheetham M, Lee T, Rodin A. Ontogeny of human complement receptors CR1 and CR3: expression of these molecules on monocytes and neutrophils from maternal, newborn and fetal samples. Eur J Immunol 1988; 18:565-9. [PMID: 2835247 DOI: 10.1002/eji.1830180412] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Higher levels of the expression of CR1 and CR3 molecules were detected on the surface of monocytes and neutrophils from maternal and newborn (cord) blood samples than in adult controls. Chemotactic factors such as formyl-methionyl-leucyl-phenylalanine or leukotriene B4 induced an increase of the expression of CR1 and CR3 which was more pronounced on cells from maternal and cord samples than from nonpregnant adult controls. CR1 and CR3 molecules were detected in monocytes and neutrophils from peripheral blood obtained from fetuses more than 14 weeks old and on subpopulations of cells in bone marrow, spleen and thymus.
Collapse
Affiliation(s)
- M Adinolfi
- Paediatric Research Unit, United Medical School, Guy's Hospital, London, GB
| | | | | | | |
Collapse
|
30
|
Abstract
To determine the effect of barbiturates on sleep two subjects, after a control period, received 200 mg. of sodium amylobarbitone for 26 nights. All night sleep records taken during this period showed that the barbiturate shortened the delay to sleep, increased the total sleep period, lengthened the delay to rapid eye movement (R.E.M.) sleep, and depressed R.E.M. sleep. After five nights R.E.M. sleep returned to baseline values -that is, showed tolerance. On stopping the drug withdrawal phenomena were seen, even to this small dose of the drug.In a second experiment a subject dependent on 600 mg. of Tuinal was found to have low normal R.E.M. sleep while on drugs. On withdrawal, delay to sleep increased and total sleep time fell. R.E.M. sleep was doubled and the delay to R.E.M. became abnormally short.These findings suggest that hypnotics allow sleep to be "borrowed," and that patients should be supported while they are being withdrawn.
Collapse
|