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Bowen AC, Smith B, Daveson K, Eldridge L, Hempenstall A, Mylne T, Szalkowski R, Van Rooijen K, Anderson L, Stephens M, Tong SYC, Yarwood T. Capacity building to address antimicrobial resistance in remote Australia: The inaugural HOT NORTH Antimicrobial Academy. Infect Dis Health 2024; 29:117-123. [PMID: 38555194 DOI: 10.1016/j.idh.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 03/05/2024] [Accepted: 03/07/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND Rates of antimicrobial resistance (AMR) for some pathogens in Australia are considerably higher in rural and remote compared to urban regions. The inaugural Hot North Antimicrobial Academy was a 9-month educational programme aimed to build workforce knowledge and capacity in antimicrobial use, audit, stewardship, surveillance and drug resistance in remote primary health care. METHODS The Academy was advertised to Aboriginal and Torres Strait Islander, regional and remote healthcare workers. Participants were Aboriginal health practitioners, nurses, pharmacists and doctors from Queensland, Northern Territory, South Australia and Western Australia working in remote primary health care with a focus on Indigenous health. Due to COVID-19 restrictions, the Academy ran virtually from February-November 2021 using Microsoft Teams. The Academy was evaluated using surveys and yarning circles to assess impact and knowledge gain. RESULTS Participants and faculty from across Australia attended 19 lectures and mentorship sessions. Eleven participants commenced and eight (73%) completed the Academy. The Academy raised participants awareness of AMR guidelines, governance and generating change; built confidence in advocacy; grew knowledge about drug resistant infections; and created a community of AMR champions in Indigenous health. CONCLUSION The evaluation confirmed the Academy met the needs of participants, provided opportunities to move stewardship from tertiary hospitals into Indigenous and remote clinics and developed skills in research, audit, stewardship and advocacy for all involved. All sessions were recorded for future use, with facilitation by the National Aboriginal Community Controlled Health Organisation (NACCHO) in future years.
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Hunter L, Panagiotopoulou O, Mulholland J, Bannerman K, Young D, Anderson L. Impact of maternal body mass index (BMI) and the challenges of fetal echocardiography. Public Health 2024; 233:22-24. [PMID: 38823280 DOI: 10.1016/j.puhe.2024.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 02/20/2024] [Accepted: 04/11/2024] [Indexed: 06/03/2024]
Abstract
OBJECTIVES Fetal echocardiography is the gold standard modality to detect suspected congenital heart disease (CHD). Accurate diagnosis and subsequent prognosis is even more challenging in the presence of a raised maternal body mass index (BMI). This retrospective study aimed to gain insight into the prevalence of obesity within the cohort of patients referred for fetal echocardiography. STUDY DESIGN/METHODS Retrospective analysis of all pregnant patients referred to the Scottish National Fetal Cardiology Service between 2015 and 2021 due to a suspected fetal cardiac abnormality and examining the associated trends in maternal BMI and the Scottish Index of Multiple Deprivation (SIMD). RESULTS BMI data were available for 962 (96.3%) of the 998 patients referred during the study period. Median BMI during the study period was 31. BMI range in the seven-year period was 16-63. There was no association between BMI group and year (P = 0.889). A median of 58% of patients referred were classified as overweight (BMI > 25 kg/m2), and only 37% were reported to have a BMI within normal limits. Referral BMI was relatively consistent in the seven years with no dramatic increase in the obese categories. Mean BMI in SIMD 5 (lowest level of deprivation), was significantly lower (P = 0.001), than in SIMD 1 (highest deprivation). CONCLUSIONS People of child bearing age should be aware the potential limitations that a raised BMI may have upon diagnostic/screening accuracy impacting subsequent ability to provide accurate fetal cardiac diagnoses and prognostic fetal cardiac imaging.
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Farrell R, Zaunders J, Poynten IM, Anderson L, Evans L. Concurrent nonavalent human papillomavirus (HPV) vaccination and immune stimulation with imiquimod to treat recalcitrant HPV-associated high grade vaginal intra-epithelial neoplasia. Gynecol Oncol Rep 2024; 52:101350. [PMID: 38445009 PMCID: PMC10912037 DOI: 10.1016/j.gore.2024.101350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 02/13/2024] [Accepted: 02/20/2024] [Indexed: 03/07/2024] Open
Abstract
This is the first report describing detailed T cell responses to viral-like proteins contained in an HPV specific vaccine given in combination with Imiquimod for treatment of persistent VAIN2/3. We postulate that stimulation of the innate immune system with Imiquimod and the specific CD4 and CD8T cell responses following HPV vaccination with Gardasil9@ combined to induce clinical remission in a woman with treatment-refractory disease.
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McCormick NE, Earle M, Kent A, Ha C, Hakes L, Anderson L, Stoddart AK, Langille MGI, Gagnon GA. Betaproteobacteria are a key component of surface water biofilters that maintain sustained manganese removal in response to fluctuations in influent water temperature. WATER RESEARCH 2023; 244:120515. [PMID: 37634461 DOI: 10.1016/j.watres.2023.120515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 08/09/2023] [Accepted: 08/20/2023] [Indexed: 08/29/2023]
Abstract
The health risks associated with manganese (Mn) in drinking water, and an improved understanding of Mn accumulation within, and subsequent release from, distribution systems, have increased the need for robust, sustainable treatment options to minimize Mn concentrations in finished water. Biofiltration is an established and effective method to remove Mn in groundwater however, Mn removal in surface water biofilters is an emerging treatment process that has not been extensively studied. Seasonal variations in water temperature can present an operational challenge for surface water biofilters which may see reduced Mn removal under colder conditions. This study examined the microbiomes of surface water biofilters at three utilities (ACWD WTP, WTP B, and WTP D) which all experienced similar seasonal fluctuations in influent water temperature. High Mn removal was observed at the ACWD WTP for much of the year, but Mn removal decreased with a concurrent decrease in the influent water temperature (58% ± 22%). In contrast, both WTP B and WTP D achieved year-round Mn removal (84% ± 5% and 93% ± 8% respectively). Marker gene (16S rRNA) sequencing analysis of the biofilter microbiomes identified a high abundance of Betaproteobacteria in WTP B and WTP D (37% ± 12% and 21% ± 3% respectively), but a low abundance of Betaproteobacteria in the ACWD WTP (2% ± 2%). The microbiomes of new bench-scale biofilters, in operation at the ACWD WTP, were also investigated. The abundance of Betaproteobacteria was significantly greater (p < 0.05) after the biofilters had acclimated than before acclimation, and differential abundance analysis identified 6 genera within the Betaproteobacteria class were enriched in the acclimated microbiome. Additionally, the acclimated biofilters were able to maintain high Mn removal performance (87% ± 10%) when the influent water temperature decreased to 10 °C or less. Further analysis of previously published studies found the abundance of Betaproteobacteria was also significantly greater (p < 0.001) in biofilters with sustained Mn removal than in biofilters which did not treat for Mn as a contaminant, despite differences in design scale, source water, and media type. Microbiome network analysis identified multiple co-occurrence relationships between Betaproteobacteria and Mn oxidizing bacteria in the WTP B and WTP D biofilters, suggesting indirect contributions by Betaproteobacteria to biological Mn oxidation. These co-occurrence relationships were not present in the full-scale ACWD WTP microbiome. Whether the role of Betaproteobacteria in biological Mn oxidation is direct, indirect, or a combination of both, they are consistently present at a high abundance in both groundwater and surface water biofilters with sustained Mn removal, and their absence may contribute to the seasonal fluctuations in Mn removal observed at the ACWD WTP. This new insight to Betaproteobacteria and their role in Mn biofiltration could contribute to water innovation and design that would improve the reliability of Mn removal.
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Patel P, Bulka B, Churchill L, Tajima M, Anderson L. Ice is Not 4c: Thermodynamic Characterization of Lungs and Hearts Preserved on Ice. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Heynemann S, Prosser N, Lee J, Mahar A, Anderson L, Kao S, Cooper WA. Squamous cell carcinoma differentiation at progression as a resistance mechanism in metastatic non-small cell lung carcinoma harbouring a targetable mutation. Pathology 2022; 54:935-938. [PMID: 35570027 DOI: 10.1016/j.pathol.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 01/31/2022] [Accepted: 02/07/2022] [Indexed: 01/24/2023]
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Evenson A, Stovern S, Zwack C, Brewer K, Windsperger A, Milstroh J, Meyer-Iverson D, Metelmann L, Anderson L, Johnson G, Rooney E. The Effects of Gluten and Inulin on Breath Hydrogen, GI Symptoms, Satiety and Sensory Aspects in Adults with and without IBS. J Acad Nutr Diet 2022. [DOI: 10.1016/j.jand.2022.06.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Aldana-Bitar J, Cho G, Anderson L, Manubolu V, Verghese D, Hussein L, Quesada C, Budoff M, Karlsberg R. 492 CAC Score Correlation Between Artificial Intelligence Augmented Cardiac CT And Expert Human Readers: Early Clinical Experience. J Cardiovasc Comput Tomogr 2022. [DOI: 10.1016/j.jcct.2022.06.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Jones B, Relph WL, Anderson L, Edwards P, Broomfield L. Nasogastric tube never events during the Covid-19 crisis in the UK; fewer than predicted. Clin Nutr ESPEN 2022. [PMCID: PMC8937553 DOI: 10.1016/j.clnesp.2022.02.109] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Feng C, Langbo W, Anderson L, Cao D, Bajic P, Amarasekera C, Levine L. Sub-Coronal Inflatable Penile Prosthesis Placement: Patient Satisfaction and Outcomes. J Sex Med 2022. [DOI: 10.1016/j.jsxm.2022.01.188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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PARMAR S, Murphy D, Warrens H, Samir R, Anderson L, Banerjee D. POS-268 THE IMPACT OF HEART FAILURE AND CHRONIC KIDNEY DISEASE STAGES ON MORTALITY IN PATIENTS WITH BOTH CONDITIONS: AN AUDIT OF A NOVEL JOINT CLINIC. Kidney Int Rep 2022. [DOI: 10.1016/j.ekir.2022.01.287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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van Wifferen F, de Jonge L, Worthington J, Greuter MJ, Lew JB, Nadeau C, van den Puttelaar R, Feletto E, Yong JH, Lansdorp-Vogelaar I, Canfell K, Coupé VM, Anderson L, Besó Delgado M, Binefa G, Cust A, Dekker E, Dell’Anna V, Essue B, Espinas J, Flander L, Garcia M, Hahn A, Idigoras I, Katanoda K, Laghi L, Lamrock F, McFerran E, Majek O, Molina-Barceló A, Ledger M, Musa O, Njor S, O’Connor K, Portillo I, Salas D, Senore C, Smith H, Symonds E, Tachecí I, Taksler G, Tolani M, Treby M, Zauber A, Zheng Y. Prioritisation of colonoscopy services in colorectal cancer screening programmes to minimise impact of COVID-19 pandemic on predicted cancer burden: A comparative modelling study. J Med Screen 2021; 29:72-83. [PMID: 35100894 PMCID: PMC9087314 DOI: 10.1177/09691413211056777] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Objectives Colorectal cancer (CRC) screening with a faecal immunochemical test (FIT) has
been disrupted in many countries during the COVID-19 pandemic. Performing
catch-up of missed screens while maintaining regular screening services
requires additional colonoscopy capacity that may not be available. This
study aimed to compare strategies that clear the screening backlog using
limited colonoscopy resources. Methods A range of strategies were simulated using four country-specific CRC
natural-history models: Adenoma and Serrated pathway to Colorectal CAncer
(ASCCA) and MIcrosimulation SCreening ANalysis for CRC (MISCAN-Colon) (both
in the Netherlands), Policy1-Bowel (Australia) and OncoSim (Canada).
Strategies assumed a 3-month screening disruption with varying recovery
period lengths (6, 12, and 24 months) and varying FIT thresholds for
diagnostic colonoscopy. Increasing the FIT threshold reduces the number of
referrals to diagnostic colonoscopy. Outcomes for each strategy were
colonoscopy demand and excess CRC-related deaths due to the disruption. Results Performing catch-up using the regular FIT threshold in 6, 12 and 24 months
could prevent most excess CRC-related deaths, but required 50%, 25% and
12.5% additional colonoscopy demand, respectively. Without exceeding usual
colonoscopy demand, up to 60% of excess CRC-related deaths can be prevented
by increasing the FIT threshold for 12 or 24 months. Large increases in FIT
threshold could lead to additional deaths rather than preventing them. Conclusions Clearing the screening backlog in 24 months could avert most excess
CRC-related deaths due to a 3-month disruption but would require a small
increase in colonoscopy demand. Increasing the FIT threshold slightly over
24 months could ease the pressure on colonoscopy resources.
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McCormick NE, Earle M, Ha C, Hakes L, Evans A, Anderson L, Stoddart AK, Langille MGI, Gagnon GA. Biological and physico-chemical mechanisms accelerating the acclimation of Mn-removing biofilters. WATER RESEARCH 2021; 207:117793. [PMID: 34715404 DOI: 10.1016/j.watres.2021.117793] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 10/17/2021] [Accepted: 10/18/2021] [Indexed: 06/13/2023]
Abstract
This study investigated treatment strategies which accelerated the acclimation of new Mn-removing biofilters to help utilities respond to changing Mn regulations, such as the recent introduction of a health-based maximum acceptable concentration and a reduction in the aesthetic objective for Mn in drinking water by Health Canada. Bench-scale filters of either GAC or anthracite media were fed with applied water containing Mn (17-61 μg/L) from a full-scale plant over 294 days. Treatment strategies included the addition of H2O2 (1 mg/L) and/or an increase in pH from 6.8 to 7.5 through the addition of NaOH. The potential physico-chemical and biological mechanisms responsible for accelerated biofilter acclimation under the various redox conditions were investigated through thermodynamic modelling, to predict homogeneous Mn oxide formation, and 16S rRNA gene amplicon sequencing, to characterize the microbial community within the filters. GAC filters treated with NaOH, and both H2O2 and NaOH, were the first to acclimate (< 20 μg/L Mn in filter effluent) after 59 and 63 days respectively, while the ambient GAC filter took almost 3 times as long to acclimate (168 days), and the anthracite filters which received the same chemically adjusted water took almost 4 times as long (226 and 251 days, respectively). The accelerated acclimation in the treated GAC filters was likely due to physico-chemical oxidation via three potential mechanisms: (1) homogeneous oxidation of dissolved Mn(II) to Mn(III)/Mn(IV) oxides and the subsequent removal of oxides from solution through adherence to the GAC surface, (2) adsorption of dissolved Mn(II) to GAC and subsequent homogeneous or biological oxidation, or (3) formation of colloidal Mn(III)/Mn(IV) oxides and subsequent adsorption of dissolved Mn(II) to the Mn colloids. In the untreated GAC filter and all anthracite filters, which did not benefit from improved redox conditions or an active surface, physico-chemical mechanisms alone were insufficient for consistent Mn removal to less than 20 μg/L. Acclimation in these filters was delayed until a microbiome enriched with bacteria capable of biological nitrification and Mn oxidation evolved within the filters. The acclimated microbiome was consistent between GAC and anthracite filters and was significantly different from the non-acclimated microbiome (p < 0.001) initially formed during the early operation of the filters. Interestingly, treatment with NaOH, and NaOH and H2O2, which accelerated physico-chemical oxidation in GAC filters, was observed to delay the development of biological oxidation in anthracite filters, and thus deferred acclimation. Although some filters took longer to acclimate than others, once acclimation was reached all filters had a similar microbiome and were able to consistently remove Mn to below 20 µg/L.
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Voskamp C, Anderson LA, Koevoet WJ, Barnhoorn S, Mastroberardino PG, van Osch GJ, Narcisi R. TWIST1 controls cellular senescence and energy metabolism in mesenchymal stem cells. Eur Cell Mater 2021; 42:401-414. [PMID: 34825700 DOI: 10.22203/ecm.v042a25] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Mesenchymal stem cells (MSCs) are promising cells for regenerative medicine therapies because they can differentiate towards multiple cell lineages. However, the occurrence of cellular senescence and the acquiring of the senescence-associated secretory phenotype (SASP) limit their clinical use. Since the transcription factor TWIST1 influences expansion of MSCs, its role in regulating cellular senescence was investigated. The present study demonstrated that silencing of TWIST1 in MSCs increased the occurrence of senescence, characterised by a SASP profile different from irradiation-induced senescent MSCs. Knowing that senescence alters cellular metabolism, cellular bioenergetics was monitored by using the Seahorse XF apparatus. Both TWIST1-silencing-induced and irradiation-induced senescent MSCs had a higher oxygen consumption rate compared to control MSCs, while TWIST1-silencing-induced senescent MSCs had a low extracellular acidification rate compared to irradiation-induced senescent MSCs. Overall, data indicated how TWIST1 regulation influenced senescence in MSCs and that TWIST1 silencing-induced senescence was characterised by a specific SASP profile and metabolic state.
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Boden I, Reeve J, Robertson IK, Browning L, Skinner EH, Anderson L, Hill C, Story D, Denehy L. Effects of preoperative physiotherapy on signs and symptoms of pulmonary collapse and infection after major abdominal surgery: secondary analysis of the LIPPSMAck-POP multicentre randomised controlled trial. Perioper Med (Lond) 2021; 10:36. [PMID: 34689825 PMCID: PMC8543902 DOI: 10.1186/s13741-021-00206-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 07/11/2021] [Indexed: 11/10/2022] Open
Abstract
Background Preoperative education and breathing exercise training by a physiotherapist minimises pulmonary complications after abdominal surgery. Effects on specific clinical outcomes such as antibiotic prescriptions, chest imaging, sputum cultures, oxygen requirements, and diagnostic coding are unknown. Methods This post hoc analysis of prospectively collected data within a double-blinded, multicentre, randomised controlled trial involving 432 participants having major abdominal surgery explored effects of preoperative education and breathing exercise training with a physiotherapist on postoperative antibiotic prescriptions, hypoxemia, sputum cultures, chest imaging, auscultation, leukocytosis, pyrexia, oxygen therapy, and diagnostic coding, compared to a control group who received a booklet alone. All participants received standardised postoperative early ambulation. Outcomes were assessed daily for 14 postoperative days. Analyses were intention-to-treat using adjusted generalised multivariate linear regression. Results Preoperative physiotherapy was associated with fewer antibiotic prescriptions specific for a respiratory infection (RR 0.52; 95% CI 0.31 to 0.85, p = 0.01), less purulent sputum on the third and fourth postoperative days (RR 0.50; 95% CI 0.34 to 0.73, p = 0.01), fewer positive sputum cultures from the third to fifth postoperative day (RR 0.17; 95% CI 0.04 to 0.77, p = 0.01), and less oxygen therapy requirements (RR 0.49; 95% CI 0.31 to 0.78, p = 0.002). Treatment effects were specific to respiratory clinical coding domains. Conclusions Preoperative physiotherapy prevents postoperative pulmonary complications and is associated with the minimisation of signs and symptoms of pulmonary collapse/consolidation and airway infection and specifically results in reduced oxygen therapy requirements and antibiotic prescriptions. Trial registration ANZCTR 12613000664741; 19/06/2013. Supplementary Information The online version contains supplementary material available at 10.1186/s13741-021-00206-3.
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McConville K, McShane C, Fallis R, McConville K, Anderson L. MYOTONIC DYSTROPHY. Neuromuscul Disord 2021. [DOI: 10.1016/j.nmd.2021.07.261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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RYAN D, Murphy D, Ben-David E, Mandarano L, Anderson L, Banerjee D. POS-290 MANAGEMENT OF HEART FAILURE IN PATIENTS WITH CHRONIC KIDNEY DISEASE: A RETROSPECTIVE ANALYSIS OF 1,861 ADMISSIONS TO ST GEORGE'S HOSPITAL, LONDON. Kidney Int Rep 2021. [DOI: 10.1016/j.ekir.2021.03.305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Chapman SJ, Blanco-Colino R, Pérez-Ajates S, Bautista OA, Hodson J, Blanco-Colino R, Chapman SJ, Glasbey JC, Pata F, Pellino G, Soares ASA, van Elst T, Van Straten S, Nepogodiev D, Hodson J, Borakati A, Bath MF, Yasin IH, Mclean K, Arthur T, Kovacevic M, Delibegovic S, Karamanliev M, Swamad M, Žebrák R, Paramasivam R, Martensen A, Larsen HM, Rãdeker L, Frey PE, Kechagias A, Venara A, Duchalais E, Ioannidis A, Pata F, Pellino G, Pasquali S, Simioni ASA, Farina V, Podda M, Lorenzon L, ItSURG, Schaeff V, Otto A, Jakubauskas M, van Elst TR, Chu M, Fagan PVB, Wells CI, João AA, Soares A, Juloski J, Blanco-Colino R, Pérez-Ajates S, Bautista OA, El Kasmi YEK, Espin-Basany E, Clerc D, Ciubotaru C, Popescu S, Yanishev A, Lee S, Ozkan BB, Sen AY, Aktas MK, Baki BE, Yüksek B, Glasbey JC, Kamarajah S, Mclean K, Borakati A, Yasin IH, Khaw RA, Mills E, Goodson R, Thakral N, Ablett AD, Adra M, Kwek I, Khan SM, Quinn P, Manley LR, Badran A, Ramjeeawon A, Campbell A, Tan HL, Rye DS, Rajaraman N, Norman JG, Vutipongsatorn K, Solomou G, Akhbari M, Ali A, Brandao BD, Stainer B, Thavayogan R, Jones D, Onafowokan OO, Gharooni A, Dabab N, Carlton-Carew S, Kungwengwe G, Gabriel M, Sewart E, Shortland TC, Lawday S, Pockney P, Dawson A, Stewart P, Ng B, Luong JK, Delibegovic S, Ivanov V, Borisova A, Neykov V, Žebrák MFR, Harbjerg JL, Brandsborg S, Mark-Christensen A, Unbehaun KP, Dalsgaard P, Lycke KD, Kechagias A, LeNaoures P, Duchalais E, Brigand C, Dumange E, Gout M, Moehwald C, Prem M, Alhalabi O, Sliwinski S, Krupp J, Gablenz E, Schmitzer L, Kopp A, Steinle J, Gsenger J, Pohl LJ, Riccardi M, Christodoulou IM, Konstantinidis M, Machairas N, Zoikas A, Balalis D, Manatakis DK, Aguilera ML, Simioni ASA, Marano L, Fleres F, Lovisetto F, Sasia D, Segalini E, Pata G, Lucchi A, Sagnotta A, Campagnaro T, Petrelli F, Gallo G, Papandrea M, Testa V, Sinibaldi G, Di Candido F, Colombo F, Perrone G, Aresu S, Biancafarina A, Canonico G, Pagnanelli M, Curletti G, Bini R, de Manzoni Garberini A, Impellizzeri H, Cillara N, Tutino R, Picciariello A, Coletta D, Savino G, Ferrara F, Tamini N, Talamo G, Parini D, Giamundo P, Pagano G, Ripetti V, Pesce A, Menduni N, Pellino G, Giudicissi R, Podda M, Goldin E, Rega D, Belli A, Andriola V, Gordini L, Pata F, Foppa C, Piccolo G, Birindelli A, Ferrari C, Ballarini Z, Tirelli F, Milone M, De Rosa M, Federico NSP, Molteni B, Tilocca PL, Sancini G, Piozzi GN, Lauretta A, Mulas S, Schaeff V, Otto A, Jakubauskas M, Simcikas D, Portelli L, van Wijnbergen JWM, Dinger TL, ten Doesschate SFH, van Dalen ASHM, van den Bos DD, Hansmann M, Feliz JM, Kuiper SZ, Abdulrahman Z, Pruijssers SR, Geneta VP, Chu M, Wilton S, Kandelaki H, Peng SL, Campbell S, Lim YK, Yassaie SS, Murray M, Fagan PVB, Haran C, Tan J, Castro J, Laranjeira A, Catarino S, Neves-Marques C, Correia JG, Vieira BN, Quintela AC, Serra ML, Maciel J, Cunha M, Aparício DJ, Neves J, Azevedo J, Romano M, Eiró F, Romano J, Monteiro C, Claro M, Almeida, Peyroteo M, Machado ND, Capote H, Ferreira M, Sousa X, Devesa H, Cavadas D, Guerreiro I, Costa M, Rosete M, Salman M, English C, Mohammed N, Popescu S, Yanishev A, Litvin A, Ćuk VV, Mészárosová K, Van Straten S, Jaich R, De Lima H, Brooks S, Marx M, Salvation MN, Cardo JG, Mora-Guzmán I, Muriel JS, de Andres Olabarria U, Muriel P, Viñas CJ, Alconchel F, Sinovas OE, El Kasmi YEK, Oro CF, Pérez-Ajates S, Otero ML, Jiménez SF, Bellmunt OC, Caballero JM, Rubio-Pérez I, Aguilar-Martínez MM, Segura-Sampedro JJ, Moreno CO, Parra DN, Diz AME, Martín-Balbuena R, Recuenco CB, Bolaños REL, Fernández P, Padillo AD, Forero-Torres A, Román IAS, Rosés HS, Campos PV, Moreira CCL, Peralta PU, Navidad MS, Ripollés-Melchor J, Garcea A, Facundo HG, Bautista OA, Pereira PT, Guarinos CVP, Clerc D, Blaser B, Piazza G, Gagliardi B, Serin H, Sen AY, Yurdaor SS, Aktas MK, Arslan E, Kopac O, Uyanik A, Ozmen BB, Tiftik E, Aksoy B, Yalcinkaya A, Bilicen G, Cinar EN, Uslu Ö, Kaya Y, Wong J, Farhan-Alanie MMH, Suresh G, Asif A, Finch BJ, Bhahirathan 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Brandsma AM, Davids J, Rottier SJ, de Roy van Zuidewijn D, Hawkins R, Ong HI, Li Y, Desmond B, Winstanley J, Martins M, Rosete M, Americano M, Santos M, Frade S, Senhorinho R, Peixoto R, João AA, Alves-Vale C, Lamas M, O'Connor DB, Hoo M, Gopaul A, Scanlon K, O'Dwyer N, Negoi I, Jovanović M, Panyko A, De Lima H, Van Vuuren S, Centeno A, Bernado IR, Señorans MPG, Amor LG, Ramírez AC, Abrisqueta J, Gomez ME, Arroyo A, Cerdán C, Romeu NG, Forero-Torres A, Enriquez-Navascues JM, Collado-Roura F, Curchod P, Gaspar S, Imadalou L, Mutlu D, Akyol C, Uygur FA, Eray IC, Biyiklioglu O, Çetin MF, Isik AE, Karip B, Dogan H, Sarıgül L, Tunc E, Aydin T, Bodur S, Karabulut K, Francis AA, Al-hadithi A, Lau ISF, Smith E, Mahapatra S, McAuliffe O, Francis AA, Imam L, Akram B, Hossaini S, Davies R, Ko M, Collins J, Pandya A, Reilly S, Archer J, Livie J, Chaudhry FA, Ntakomyti E, Diallo R, Bylinski T, Wright J, Lawday S, Masiha E, Tung J, Shirazi B, Neilson A, Epton S, Patel N, Trussell S, Couldrey A, Donnelly C, Eftychiou S. Safety of hospital discharge before return of bowel function after elective colorectal surgery. Br J Surg 2020; 107:552-559. [PMID: 31976560 DOI: 10.1002/bjs.11422] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 10/06/2019] [Accepted: 10/08/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Ileus is common after colorectal surgery and is associated with an increased risk of postoperative complications. Identifying features of normal bowel recovery and the appropriateness for hospital discharge is challenging. This study explored the safety of hospital discharge before the return of bowel function. METHODS A prospective, multicentre cohort study was undertaken across an international collaborative network. Adult patients undergoing elective colorectal resection between January and April 2018 were included. The main outcome of interest was readmission to hospital within 30 days of surgery. The impact of discharge timing according to the return of bowel function was explored using multivariable regression analysis. Other outcomes were postoperative complications within 30 days of surgery, measured using the Clavien-Dindo classification system. RESULTS A total of 3288 patients were included in the analysis, of whom 301 (9·2 per cent) were discharged before the return of bowel function. The median duration of hospital stay for patients discharged before and after return of bowel function was 5 (i.q.r. 4-7) and 7 (6-8) days respectively (P < 0·001). There were no significant differences in rates of readmission between these groups (6·6 versus 8·0 per cent; P = 0·499), and this remained the case after multivariable adjustment for baseline differences (odds ratio 0·90, 95 per cent c.i. 0·55 to 1·46; P = 0·659). Rates of postoperative complications were also similar in those discharged before versus after return of bowel function (minor: 34·7 versus 39·5 per cent; major 3·3 versus 3·4 per cent; P = 0·110). CONCLUSION Discharge before return of bowel function after elective colorectal surgery appears to be safe in appropriately selected patients.
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JG, Vutipongsatorn K, Solomou G, Akhbari M, Ali A, Murray V, Baker DM, Brandao BD, Stainer B, Thavayogan R, Jones D, Onafowokan OO, Gharooni A, Dabab N, Carlton-Carew S, Kungwengwe G, Gabriel M, Sewart E, Shortland TC, Lawday S, Pockney P, Dawson A, Arthur T, Brumfitt CD, Stewart P, Ng B, Luong JK, Delibegovic S, Ivanov V, Borisova A, Neykov V, Kunčarová K, Kološová B, Antonova T, Farkašová M, Žebrák R, Harbjerg JL, Brandsborg S, Brinck S, Kjaer MD, Mark-Christensen A, Unbehaun KP, Dalsgaard P, Lycke KD, Kechagias A, LeNaoures P, Duchalais E, Brigand C, Dumange E, Gout M, Moehwald C, Prem M, Alhalabi O, Sliwinski S, Krupp J, Gablenz E, Schmitzer L, Kopp A, Steinle J, Gsenger J, Pohl LJ, Riccardi M, Christodoulou IM, Konstantinidis M, Machairas N, Zoikas A, Balalis D, Manatakis DK, Aguilera ML, Sgrò A, Simioni A, Marano L, Fleres F, Lovisetto F, Sasia D, Segalini E, Pata G, Lucchi A, Sagnotta A, Campagnaro T, Petrelli F, Gallo G, Papandrea M, Testa V, Sinibaldi G, Di Candido F, Colombo F, Perrone G, Aresu S, Biancafarina A, Canonico G, Pagnanelli M, Curletti G, Bini R, Manzoni Garberini A, Impellizzeri H, Cillara N, Tutino R, Picciariello A, Coletta D, Savino G, Ferrara F, Tamini N, Talamo G, Parini D, Giamundo P, lo Conte A, Pagano G, Ripetti V, Pesce A, Menduni N, Pellino G, Giudicissi R, Podda M, Goldin E, Rega D, Belli A, Andriola V, Gordini L, Pata F, Foppa C, Piccolo G, Birindelli A, Ferrari C, Ballarini Z, Tirelli F, Milone M, De Rosa M, Pipitone Federico NS, Molteni B, Tilocca PL, Sancini G, Piozzi GN, Lauretta A, Poillucci G, Mulas S, Schaeff V, Otto A, Jakubauskas M, Simcikas D, Portelli L, Wijnbergen JWM, Dinger TL, Doesschate SFH, Dalen ASHM, Bos DD, Hansmann M, Medina Feliz J, Kuiper SZ, Abdulrahman Z, Pruijssers SR, Farik S, Elliott BM, Geneta VP, Chu M, Wilton S, Kandelaki H, Peng SL, Campbell S, Lim YK, Yassaie SS, Murray M, Fagan PVB, Haran C, Tan J, Castro J, Laranjeira A, Catarino S, Neves-Marques C, Correia JG, Vieira BN, Quintela AC, Serra ML, 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SR, Demirtas B, Cavus T, Yuksek A, Mazlum SS, Yelkenci C, Baran T, Satilmisoglu M, Sahin AZ, Kilinç A, Isik K, Yumurtaci Ö, Emin A, Girit Ç, Yildirak MK, Senyigit E, Güldag A, Söyleyici B, Aytin YE, Akay FE, Iskan NG, Mutlu B, Sunay AO, Ablett AD, Tie-Gill T, Ramsay G, De Paola L, McGuckin S, Alshakhs A, Ahmeidat A, Wong J, Goergen N, Ali Z, Mullarkey L, Bath MF, Walshe R, Lewis E, Berry B, Moneim J, Mookerjee S, Christy S, Ojofeitimi O, Carroll L, Hylands A, Delaugere LP, Reveendran D, Coulter C, Ralston C, Laverty L, Gallagher P, Ahmed A, Yeo YQ, Elliott D, Bennett J, Mcnamara M, Sivarajah S, Dunmore C, Aitken G, Nair M, Aly MH, Buari M, Farhan-Alanie MMH, Ahmed K, Sheikh Z, Monks M, Lehmann J, Rotimi O, Bell T, Limnatitou D, Gormley S, Taleongpong P, Patel V, Macgregor L, Amini S, Turner C, Dwyer-Hemmings L, Busuttil A, Powell J, Hensher C, Vivian F, Wcislo K, Millar Z, Hirosue S, Ogunmwonyi I, Nakakande D, Kwek I, Gaze H, Nirmalanantha A, Bin Amran AM, Foulkes A, Jones N, Pillai S, Khoury G, Powell T, Maleyko I, Sangheli A, Ransome M, Isse M, Aromolaran O, Bholah H, Anbarasan J, Rehman S, Hu E, Timms S, Reynolds W, Hotchkies A, Misra V, Suresh G, Murray V, Theocharidou L, Malik T, Janmohamed I, Carhart B, Khan A, Asif A, Hullait R, Quinn P, Rylance A, Butt S, Leathes J, Finch BJ, Philip Rajathasan T, Jeddy H, Kyaw HA, Wong N, Karelia S, Clements JM, Rainey M, Joshi N, Rahman A, Gallagher M, Rebuffa N, Abdelgalil R, Siaw Yen Lai R, Laurence N, Thomas S, Green C, Frostick R, Khera R, Povey M, Wong HL, McCusker C, Hlukha L, Pike G, Kamel F, Thakkar R, Donaldson C, Sequeira Campos M, Bhahirathan Y, Armitage MN, Hussain AS, Hardy B, Hassan Serry MY, Herron J, Bradbury M, Osunronbi T, Tam LYC, Khanan Kaabneh A, Lawther J, Fisher P, Tribedi T, Moosa A, Ramdin A, Goble M, Downs E, Wheldon L, Baggus E, Mandal A, Nayeem A, Ahmed S, Fradley W, Wilson C, Gallagher S, Criswell T, Ward J, Mukkavilli A, Stubbs B, Fordyce W, Suchdev N, Wei Lim S, Yi Tew Z, Sookramanien SR, Chan A, Bointas G, Paul M, Ward KL, Bagnall M, Pherwani SA, Wang K, Mitchell L, Heyworth J, Ayyar S, Obukofe R, Polson R, Mason D, Mackenzie E, Russell C, Doyle N, Habib Z, Zardab M, Sartaj F, Farooq H, Tabibi M, Drury DJ, James SJ, Barnett R, Teasdale AB, Richardson ETJ, Thomas DA, Ahmed S, Williams RL, Najabat-Lattif HF, Cahya E, Lou G, Coyle M, Homyer K, Zhu LY, Woods M, Chang J, O'Callaghan H, Suchett-Kaye I, Mihailidis TH, Alawattegama H, Seite E, Barrett A, Riordan E, Lam W, Dowdeswell M, Mulvenna C, Netke T, Awokoya O, Gurowich L, Dhera K, Hayat S, Williams L, Tincknell L, Spazzapan M, Teeling F, Sysum K, Latter J, Latter M, Khan S, Guruswamy M, Beedham W, Brazier E, Elghobashy M, Bajaj M, Mann H, Etel E, Woodmass M, Hayden H, Kisiel A, Ali Y, Husain S, Arnold A, Pedersen AC, Cunha P, Ahmed M, Al Zawawi S, Kudva V, Liu FY, Theodoropoulou K, Miscampbell M, Robinson AV, Johnston J, Dharni A, Lamb S, Westerman T, Evans E, Campbell L, Gillespie M, Cheong CM, Kulathevanayagam K, Varghese A, Ike SI, Chu TSM, Baljer B, Mogg JAW, Rai P, Claireaux HA, Williams M, Smillie R, Goetz J, Appleby E, Fadipe T, Vaughan-Burleigh S, Puri G, Hussain P, James P, Flather R, Cutler A, Pathak S, Sheldon J, Collicott T, al-Ausi M, Mondal A, Jovaisaite A, Shah SM, Khalid N, Gutmann D, Davison S, Alame YJ, Syed L, Owen WJ, Ahsan SD, Kalderon R, Anthony-Uzoeto U, Macleod Hall C, Zheng S, Wynter K, James C, Sapre D, Ghosh R, Baird J, Cockburn L, Blackwood O, Nadama HH, Simpson W, Jeong S, Bishop S, Bate R, Hobson C, Adam AH, Redclift C, Do J, Adeleye O, Poli F, Batterham A, Brown S, Parekh JN, Clay W, Pieri K, Jackson A, Brown S, Saxena A, Gurung B, Oyebola T, O'Brien F, Djeugam B, Gardezi S, Ul-Hasan S, Martin-Hernandez MP, Sisley M, Modi S, Antakia R, Elbayouk A, Soh YJ, Mather J, Yusuf Z, Al-Sarraf Z, Naja M, Rassool SB, Convill J, Nikookam Y, Warsame A, Tam JPH, Pace C, Kiandee M, Ridwan R, Carey C, Hirri F, McMillan MJA, Ling JJ, Powell-Chandler A, Pendelbury L, Kerimzade K, Tang A, Howard EO, Humayun S, Wadsworth OJ, Tan K, Abdelhameed F, Haglund C, Radnaeva I, Hu N, Rambhatla S, Waldron D, Madahar P, Malik S, Campbell A, Meney LC, Ibrahim I, Kang CK, Chiu JZJ, Livie V, Ibrahim B, Khalil M, Pooley G, Shishkin B, Gorgievska R, Docherty J, Southgate A, Coomes A, McGee F, Flanagan S, Thakrar C, Tan QJ, Anwar H, Clough R, Chrisp B, Cassels J, Cross GWV, Ragavoodoo A, Mercer L, Mercer C, Refalo A, Hadley R, McTighe A, Farrow F, Brodie A, Davis G, Shah DR, Bowers C, Patel S, Morice O, Burzic A, Cheung J, Shashidhara A, Theodoraki G, Birk J, Ong A, Ng MPE, Wong RTW, Maese S, Yeap B, Iqbal Z, Rojoa DM, Cabaleiro Barciela C, Hussain M, Ruddy CM, Lindwe S, Qamar Y, Chuita S, Melaugh T, Hall JD, Palmer C, Kouli O, Hassane ASI, Azhar AW, Tan TK, Perchard W, Scurr T, Davidson K, Campbell E, Kelk L, Ghosh A, Gibbins A, Mala D, Loizidou A, Hall O, Mecia L, Hew C, Varathan K, Tong L, Chandrasekar B, Giacci L, Buchanan E, O'Connell M, Kwak SY, Ong EH, Gardner S, Lim J, Maden C, Illahi M, Hale J, Xuan Tan Z, Edwards S, Stahl R, Stahl J, Hickman A, Collett D, Goolam-Mahomed Z, Allen B, Atiyah A, Ahmad H, Jones J, McGregor O, Ogundiya E, Gan FW, Boulbadaoui A, Kirnon-Jackman O, Lim QX, Peckham H, Yeoh T, Yong SQ, Chen JY, Siva S, Sam ZH, Gilani M, Goh YN, Muthukumar MG, Phillips S, Makin-Taylor R, Tjoakarfa J, Giri A, Suresan S, Thavayogan R, Hey CY, Thomas P, Johnson TA, Williams RI, Rashid A, Kushairi A, Rais A, James A, Bugelli M, Chechelnitskaya Y, Sandhu N, Toh C, Tandon R, Gray M, Kumar A, Ciurleo C, Nyamali I, Hiremath S, Sinha S, Chowdhary M, Bradley E, McTiernan M, Macdonald S, Sharkey S, McLaughlin N, Amey C, Kraria L, Skan O, Kind C, Findlay JM, Tupper P, Van Rhee C, Honeyman SI, Menon G, Ahmed M, Jegatheeswaran L, Griffiths N, Madhavan A, Warne M, Malcolm FL, Lessware T, Wilkerson HT, Chatterjee-Woolman S, Yoong A, Ahmed WUR, Longshaw A, Flannery O, Green R, Leaning M, Cragg J, Sharriff H, Doherty C, Ganesananthan S, Kwan KWL, Sanders-Crook L, Bhatia S, Eames S, Lewis F, Kirupananthan P, Boh ZY, Dass S, Soma A, Newton A, Hill M, Shafiq Y, Brkljac M, Boyce L, Jasionowska S, English WJ, Lam S, Chipeta C, Yilmaz D, Jain C, Garofalidou T, Novotny SA, Locke S, Bowman C, Begaj A, Murphy C, Radcliffe K, Chong JT, Poustie M, Jeffrey E, Chaudhury N, Rajendran K, Akbar Z, Walters B, Kulendrarajah B, Tran N, Shrestha S, Parmar S, Gallagher C, Hennessy L, Pentti E, Badhrinarayanan S, Fung A, Mansoor M, Kenny R, Kan P, Lee DE, Khosla S, Samake M, Shaban F, Aftab R, Gough M, Woodburn B, Vayalapra S, McMurrugh K, Wong C, Jimulia D, Deol S, Pike S, Embury-Young Y, Turner T, Patel M, Kilgallon E, Keating R, Walsh A, Khan H, Logue G, Orekoya M, Alasmar M, Charalambides M, Clavé Llavall A, Williamson E, Bharwada Y, Zearmal S, Evans H, Panikkar M, Cruz G, Caplan J, Ruparelia A, Tanvir T, Soare C, Pang YL, Trotter J, Zaidi A, Thakrar V, Pulickal P, Ahmed H, Parnell J, Khan H, Lennock S, Ford V, Pyc W, Brignall R, O'Neill D, Hanna R, Kane R, Nicola M, Rajput K, Xiao Y, Warner C, Michael S, Wright E, Juniper S, Thompson E, Hoskyns L, Kanitkar A, Ross C, Unsworth A, Rshaidat H, Demarre K, Chiang A, Bareh A, Dellen J, Faqihinejad C, Gadhvi A, Grant R, Lewsey J, Morris A, Martin H, McClarty C, Sanyal S, Alsaif A, Palkhi A, Bhopal S, Vishnu K S, Papanikolaou A, Mitra A, Nur A, Ali F, Burford C, Huq T, Sloper W, Irwin E, Matthews L, Ngu WS, Hosfield T, Muneeb F, Page O, Zeb E, Coey J, Al-Azzawi A, McIntosh J, Vucicevic A, Hughes M, Brooks L, Fanibi B, Dixon M, Njoku P, Morris D, Jobson J, Chowdhury H, Alawode DOT, Wynell-Mayow W, Udayachandran V, Alsoof D, Ekert J, Joseph N, Zulkefley N, Hunt G, Christodoulou T, Wright O, Soman S, Jamal M, Beqiri S, Borgas P, Christie S, Pereira F, Browne S, Yiu J, Dworkin A, Brayley J, Palmer A, Charalambos M, Jones CJ, Toner S, Cowden R, Lee L, Nicol P, Holman O, Imtiaz M, Albert V, Leung SP, Erotocritou M, Wong J, Stroud R, Mason D, Wilkin R, Thomson W, Mackee L, G N, Bei Y, Sait S, Mckenna Favier S, Ibrahim A, Kler A, Reynolds L, Mohamed SH, Majeed Y, Fakim B, Jones A, Kowal M, Liversedge G, Carrington Z, Windebank J, Izzarina A, Akbani U, Craven J, Aldarragi A, Harding S, Millward A, Shortland TC, Bedford M, Stroud R, Obukofe R, Mackenzie E, Gopalan V, Midgen A, Khadka P, Cheng O, Taneja S, Manobharath N, Kok JY, Lim DWE, Buick T, Boland M, Piya S, Devlin R, Fairfield CJ, George RJ, Rahi M, Zaman S, Hajiev S, Ross T, Owen M, Crisp E, Thompson C, Charalambous A, Hollywood JL, Saiyed A, Hammond RFL, Matthews J, Mendonca V, Spinty J, Khan K, Cheng J, Glynn N, Muhammad U, Khan M, Anderson L, Mccormack K, Mak J, Patrawala S, Milinkovic N, Schofield R, Chauhan M, Hartley L, Hind J, Ashworth I, Nelson L, Ratnasingham D, Akbari K, Whitehead T, Dimitriadis S, Marshall K, Flint EJ, Curran M, Horner C, Heybourne A, Morgan H, Wickstone C, Panagiotou D, O'Connell E, Dean K, Iqbal R, Walsh L, Yu N, Rana N, Massie E, Ng J, Jung M, Lee YD, Harris M, White S, Delibegovic S, Boev B, Tonchev P, Prochazka V, Örhalmi J, Riško J, Skalický A, Chrz K, Ravn S, Ojakäär A, Duchalais E, Dörr-Harim C, Herrle F, Koutserimpas C, Giraudo G, Armellini A, Ruzzenente A, Mazzeo C, De Padua C, Realis Luc A, Maroli A, Giani I, Cufari ME, Vitali M, Ceccarelli G, Gusai GP, Quattromani R, Virgilio E, Berti S, Mulas S, Di Mola FF, Papagni V, Tuminello F, Magnoli M, Vittori L, Longheu A, Loche GA, Braccio B, De Luca E, Resta G, Ancans G, Tamosiunas A, Petrulionis M, Andrejevic P, Stellingwerf ME, Abdulrahman N, Pas KGH, Thomas G, Brandsma AM, Davids J, Rottier SJ, Roy van Zuidewijn D, Hawkins R, Ong HI, Li Y, Desmond B, Winstanley J, Martins M, Rosete M, Americano M, Santos M, Frade S, Senhorinho R, Peixoto R, Alagoa João A, Alves-Vale C, Lamas M, O'Connor DB, Hoo M, Gopaul A, Scanlon K, O'Dwyer N, Negoi I, Jovanović M, Panyko A, De Lima H, Van Vuuren S, Curchod P, Gaspar S, Imadalou L, Mutlu D, Akyol C, Uygur FA, Eray IC, Biyiklioglu O, Çetin MF, Isik AE, Karip B, Dogan H, Sarıgül L, Tunc E, Aydin T, Bodur S, Karabulut K, Francis AA, Al-hadithi A, To N, Lau ISF, Smith E, Mahapatra S, McAuliffe O, Francis AA, Imam L, Akram B, Hossaini S, Davies R, Ko M, Collins J, Pandya A, Reilly S, Archer J, Auty C, Roche CD, Livie J, Chaudhry FA, Ntakomyti E, Diallo R, Bylinski T, Wright J, Lawday S, Masiha E, Tung J, Shirazi B, Neilson A, Epton S, Patel N, Trussell S, Couldrey A, Donnelly C, Eftychiou S. Safety and efficacy of non-steroidal anti-inflammatory drugs to reduce ileus after colorectal surgery. Br J Surg 2020; 107:e161-e169. [PMID: 31595986 DOI: 10.1002/bjs.11326] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 05/06/2019] [Accepted: 07/04/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Ileus is common after elective colorectal surgery, and is associated with increased adverse events and prolonged hospital stay. The aim was to assess the role of non-steroidal anti-inflammatory drugs (NSAIDs) for reducing ileus after surgery. METHODS A prospective multicentre cohort study was delivered by an international, student- and trainee-led collaborative group. Adult patients undergoing elective colorectal resection between January and April 2018 were included. The primary outcome was time to gastrointestinal recovery, measured using a composite measure of bowel function and tolerance to oral intake. The impact of NSAIDs was explored using Cox regression analyses, including the results of a centre-specific survey of compliance to enhanced recovery principles. Secondary safety outcomes included anastomotic leak rate and acute kidney injury. RESULTS A total of 4164 patients were included, with a median age of 68 (i.q.r. 57-75) years (54·9 per cent men). Some 1153 (27·7 per cent) received NSAIDs on postoperative days 1-3, of whom 1061 (92·0 per cent) received non-selective cyclo-oxygenase inhibitors. After adjustment for baseline differences, the mean time to gastrointestinal recovery did not differ significantly between patients who received NSAIDs and those who did not (4·6 versus 4·8 days; hazard ratio 1·04, 95 per cent c.i. 0·96 to 1·12; P = 0·360). There were no significant differences in anastomotic leak rate (5·4 versus 4·6 per cent; P = 0·349) or acute kidney injury (14·3 versus 13·8 per cent; P = 0·666) between the groups. Significantly fewer patients receiving NSAIDs required strong opioid analgesia (35·3 versus 56·7 per cent; P < 0·001). CONCLUSION NSAIDs did not reduce the time for gastrointestinal recovery after colorectal surgery, but they were safe and associated with reduced postoperative opioid requirement.
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Jones DJ, Baldwin C, Lal S, Stanmore E, Farrer K, Connolly E, Weekes CE, Anderson L, Murphy J, Gillespie L, Welsh N, Ogden M, McDevitt M, Day R, Lynne S, Paulden P, Gronlund T, Burden ST. Priority setting for adult malnutrition and nutritional screening in healthcare: a James Lind Alliance. J Hum Nutr Diet 2019; 33:274-283. [DOI: 10.1111/jhn.12722] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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McMahon WA, Aleo VA, Schultz AM, Horter BL, Lindberg KG, Allen M, Anderson L, Barnes R, Bellow S, Bokina C, Boulter T, Caulkins L, Ceizyk M, Chavey C, Eastep Y, Gohil V, Guha S, Hall G, Hopkins K, Horter B, Kaufer A, Kaur D, Kim S, Kupski B, Lee J, Lester; T, Musch S, Silbernagel K, Sorce L, Steiner G, Sumpter R, Sutton J, Veach J. 3M™ Petrifilm™ Staph Express Count Plate Method for the Enumeration of Staphylococcus aureus in Selected Types of Meat, Seafood, and Poultry: Collaborative Study. J AOAC Int 2019. [DOI: 10.1093/jaoac/86.5.947] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
The 3M™ Petrifilm™ Staph Express Count plate method was compared with AOAC Official Method 975.55 for the enumeration of Staphylococcus aureus in selected foods. Four foods—cooked, diced chicken; cured ham; smoked salmon; and pepperoni—were analyzed for S. aureus by 12 collaborating laboratories. For each food tested, the collaborators received 8 blind test samples consisting of a control sample, a low inoculation level, a medium inoculation level, and a medium inoculation level with background flora, each in duplicate. The mean log10 counts for the methods were comparable for all 4 foods. The repeatability and reproducibility variances of the 24 h Petrifilm Staph Express Count plate method were similar to those of the 72 h standard method.
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Alferness PL, Wiebe LA, Anderson L, Bennett O, Bosch M, Clark D, Claussen F, Colin T, Cook C, Davis H, Ely V, Graham D, Grazzini R, Hickes H, Holland P, Hom W, Ingram R, Ling Y, Markley B, Peoples G, Pitz G, Robert G, Robinson C, Sen L, Sensue A, South N, Steginsky C, Summer S, Trower T, Wieczorek P, Zheng S. Determination of Glyphosate and Aminomethylphosphonic Acid in Crops by Capillary Gas Chromatography with Mass-Selective Detection: Collaborative Study. J AOAC Int 2019. [DOI: 10.1093/jaoac/84.3.823] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
A collaborative study was conducted to validate a method for the determination of glyphosate and aminomethylphosphonic acid (AMPA) in crops. The analytes are extracted from crops with water, and the crude extracts are then subjected to a cation exchange cleanup. The analytes are derivatized by the direct addition of the aqueous extract into a mixture of heptafluorobutanol and trifluoroacetic anhydride. The derivatized analytes are quantitated by capillary gas chromatography with mass-selective detection (MSD). The collaborative study involved 13 laboratories located in 5 countries 12 laboratories returned valid data sets. The crops tested were field corn grain, soya forage, and walnut nutmeat at concentrations of 0.050, 0.40, and 2.0 mg/kg. The study used a split-level pair replication scheme with blindly coded laboratory samples. Twelve materials were analyzed, including 1 control and 3 split-level pairs for each matrix, 1 pair at each nominal concentration. For glyphosate, the mean recovery was 91%, the average intralaboratory variance, the repeatability relative standard deviation (RSDr), was 11%, and the interlaboratory variance, the reproducibility relative standard deviation (RSDR), was 16%. For AMPA, the mean recovery was 87%, the RSDr was 16%, and the RSDR was 25% at mg/kg levels.
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Keteepe-Arachi T, Malhotra A, Basu J, Parry-Williams G, Ensam B, Miles C, Dassanayake S, MacLachlan H, Ibrahim B, Papdakis M, Tome M, Khong T, Sharma S, Anderson L. P3839Hypertension or hypertrophic cardiomyopathy? Using cardiovascular magnetic resonance imaging to unmask the great imitator. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Structural cardiac adaptations due to hypertension (HTN) present a diagnostic challenge when differentiating from hypertrophic cardiomyopathy (HCM), using traditional imaging techniques such as echocardiography (echo). Cardiac magnetic resonance imaging (CMR) offers reproducible anatomical, functional quantification and myocardial tissue characterisation which discriminates between hypertension and HCM.
Purpose
To identify hypertensive individuals with undiagnosed HCM using CMR imaging.
Methods
100 consecutive hypertensive patients underwent CMR at a tertiary centre dedicated blood pressure clinic (55% male, mean age 51 years). In keeping with ESC guidelines, end diastolic wall thickness (EDWT) ≥15mm identified individuals within the “grey zone” between hypertension and with a potential HCM diagnosis. 19 individuals were referred on to the dedicated inherited cardiac conditions clinic for further evaluation. Four patients expressed a definitive LV phenotype and were diagnosed with HCM. CMR parameters were compared in three groups: Hypertensive (HTN), “grey zone” Hypertensive (GZH) and HCM.
Results
CMR demonstrated end diastolic wall thickness (EDWT) >11 mm in 50% of hypertensives. 73% of the referred patients were Afro-Caribbean (AC) and all 4 HCM patients were AC. All referrals demonstrated EDWTs ≥14mm, 9 (47%) demonstrated late gadolinium enhancement of which 3 (16%) had HCM. Three had asymmetrical septal hypertrophy – 2 were in the HCM cohort and one underwent endomyocardial biopsy confirming HTN. Left ventricular mass index (LVMI) was significantly higher in GZH compared to HTN (p<0.0001) and in HCM compared to HTN (p=0.0004). EDWT was significantly greater in GZH compared to HTN (p<0.0001) and in HCM compared to HTN (p=0.0002). There was no significant difference in these parameters between GZH and HCM.
Table 1. P-values for CMR data in hypertensive (HTN), gray zone hypertensive (GZH) and hypertrophic cardiomyopathy (HCM) cohorts CMR Parameter HCM vs. HTN GZH vs. HTN GZH vs. HCM EDVI NS p=0.025 NS EDWT p=0.0002 p<0.0001 NS LVMI p=0.0004 p<0.0001 NS
Conclusion
This study reports a 4% prevalence of HCM among hypertensive patients - 20 x greater than in the general population - which would be left undiagnosed using echo alone. Screening hypertensive individuals with CMR is not routine but we advocate its use in these individuals especially in Afro Caribbeans and in those in the “grey zone”, to identify undiagnosed HCM, which has significant implications for lifestyle modification and family screening.
Acknowledgement/Funding
Cardiac Risk in the Young
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Hennigan BW, Good R, Adamson C, Martin L, Anderson L, Campbell M, Oldroyd KG. P328Is there evidence of a rebound increase in platelet aggregation following withdrawal of Aspirin or Ticagrelor in patients who have previously undergone PCI and coronary stenting? Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
In patients treated with coronary stents previous studies have demonstrated an increased risk of acute coronary syndrome in after discontinuation of clopidogrel. In this study, we recruited patients already randomised in the GLOBAL LEADERS study allocated to discontinue aspirin treatment, while remaining on ticagrelor, 1 month after coronary stenting (Ticag MonoRx group) and a control group discontinuing ticagrelor at 6–12 months while remaining on aspirin (ASA MonoRx group). Both groups underwent platelet studies at day 0, prior to discontinuation of aspirin or ticagrelor and then on day 2, 7 and 14 day post cessation with multiple electrode aggregometry.
Purpose
This study was designed to look for evidence of a rebound increase in platelet aggregation in response to collagen after withdrawal of either aspirin or ticagrelor in patients who have been treated with both drugs after PCI with DES implantation. We needed a sample size of 26 patients in each group for 90% power to detect a mean change in platelet aggregation of 100 AU/min with an alpha of 0.05. The primary outcome measure was change in platelet aggregation in response to collagen between baseline and day 2, day 7 and day 14 following cessation of DAPT. A rebound effect was defined as a >10% increase in collagen induced platelet aggregation on either day 2 or day 7 compared to day 14 post discontinuation of either aspirin or ticagrelor.
Methods
Patients provided written informed consent and underwent MEA using arachidonic acid (AA), adenosine diphosphate (ADP), thrombin receptor activator peptide (TRAP) and collagen in prespecified concentrations timed at 30 mins post phlebotomy. Results were calculated from the area under the curve and expressed as as whole number aggregation units (AU). Inbuilt QC analysis was used to determine the need for repeat assays.
Results
Collagen induced platelet aggregation was similar in both groups at day 0 (37 AU vs 34 AU; p=0.687) and at day 2 (55 AU vs 40 AU; p=0.12). By day 7, patients on ticagrelor monotherapy had higher collagen induced platelet aggregation (78 AU vs 37 AU; p=0.0001) and this difference was maintained at 14 days (80 AU vs 43 AU; p=0.0001). In patients, assigned to ticagrelor monotherapy after 1 month of DAPT, AA induced platelet aggregation progressively increased from day 0 to day 14. In the patients discontinuing ticagrelor and continuing on aspirin monotherapy, ADP induced platelet aggregation increased from day 0 to day 14. Rebound was seen in 6/17 (35%) patients in the ticagrelor monotherapy group versus 8/17 (47%) patients in the aspirin monotherapy group (p=0.728) with a mean peak of 21 AU (SD 6) and 10 AU (SD 6) respectively above baseline readings, p=0.003. There was no difference in TRAP induced aggregation at any time point.
Figure 1
Conclusions
Ticagrelor monotherapy was associated with higher collagen induced platelet aggregation than aspirin monotherapy at both 7 and 14 days post cessation of DAPT.
Acknowledgement/Funding
British Heart Foundation Project Grant PG/14/97/31263, AstraZeneca UK Limited
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Tabernero J, Grothey A, Van Cutsem E, Yaeger R, Wasan H, Yoshino T, Desai J, Ciardiello F, Loupakis F, Hong YS, Steeghs N, Guren T, Arkenau HT, García-Alfonso P, Gollerkeri A, Pickard M, Maharry K, Christy-Bittel J, Anderson L, Kopetz S. Encorafenib plus cetuximab with or without binimetinib for BRAF V600E–mutant metastatic colorectal cancer: Expanded results from a randomized, 3-arm, phase III study vs the choice of either irinotecan or FOLFIRI plus cetuximab (BEACON CRC). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz394.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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