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Mitchell C, Korcarz CE, Zagzebski JA, Stein JH. Effects of ultrasound technology advances on measurement of carotid intima-media thickness: A review. Vasc Med 2020; 26:81-85. [PMID: 33203316 DOI: 10.1177/1358863x20969826] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In this review, we describe how technological advances in ultrasound imaging related to transducer construction and image processing fundamentally alter generation of ultrasound images to produce better quality images with higher resolution. However, carotid intima-media thickness (IMT) measurements made from images acquired on modern ultrasound systems are not comparable to historical population nomograms that were used to determine wall thickness thresholds that inform atherosclerotic cardiovascular disease risk. Because it is nearly impossible to replicate instrumentation settings that were used to create the reference carotid IMT nomograms and to place an individual's carotid IMT value in or above a clinically relevant percentile, carotid IMT measurements have a very limited role in clinical medicine, but remain a useful research tool when instrumentation, presets, image acquisition, and measurements can be standardized. In addition to new validation studies, it would be useful for the ultrasound imaging community to reach a consensus regarding technical aspects of ultrasound imaging acquisition, processing, and display for blood vessels so standard presets and imaging approaches could reliably yield the same measurements.
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Jacobs PJ, Oosthuizen MK, Mitchell C, Blount JD, Bennett NC. Heat and dehydration induced oxidative damage and antioxidant defenses following incubator heat stress and a simulated heat wave in wild caught four-striped field mice Rhabdomys dilectus. PLoS One 2020; 15:e0242279. [PMID: 33186409 PMCID: PMC7665817 DOI: 10.1371/journal.pone.0242279] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 10/29/2020] [Indexed: 01/22/2023] Open
Abstract
Heat waves are known for their disastrous mass die-off effects due to dehydration and cell damage, but little is known about the non-lethal consequences of surviving severe heat exposure. Severe heat exposure can cause oxidative stress which can have negative consequences on animal cognition, reproduction and life expectancy. We investigated the current oxidative stress experienced by a mesic mouse species, the four striped field mouse, Rhabdomys dilectus through a heat wave simulation with ad lib water and a more severe temperature exposure with minimal water. Wild four striped field mice were caught between 2017 and 2019. We predicted that wild four striped field mice in the heat wave simulation would show less susceptibility to oxidative stress as compared to a more severe heat stress which is likely to occur in the future. Oxidative stress was determined in the liver, kidney and brain using malondialdehyde (MDA) and protein carbonyl (PC) as markers for oxidative damage, and superoxide dismutase (SOD) and total antioxidant capacity (TAC) as markers of antioxidant defense. Incubator heat stress was brought about by increasing the body temperatures of animals to 39-40.8°C for 6 hours. A heat wave (one hot day, followed by a 3-day heatwave) was simulated by using temperature cycle that wild four striped field mice would experience in their local habitat (determined through weather station data using temperature and humidity), with maximal ambient temperature of 39°C. The liver and kidney demonstrated no changes in the simulated heat wave, but the liver had significantly higher SOD activity and the kidney had significantly higher lipid peroxidation in the incubator experiment. Dehydration significantly contributed to the increase of these markers, as is evident from the decrease in body mass after the experiment. The brain only showed significantly higher lipid peroxidation following the simulated heat wave with no significant changes following the incubator experiment. The significant increase in lipid peroxidation was not correlated to body mass after the experiment. The magnitude and duration of heat stress, in conjunction with dehydration, played a critical role in the oxidative stress experienced by each tissue, with the results demonstrating the importance of measuring multiple tissues to determine the physiological state of an animal. Current heat waves in this species have the potential of causing oxidative stress in the brain with future heat waves to possibly stress the kidney and liver depending on the hydration state of animals.
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McSweeney SM, Christou EAA, Dand N, Boalch A, Holmes S, Harries M, Palamaras I, Cunningham F, Parkins G, Kaur M, Farrant P, McDonagh A, Messenger A, Jones J, Jolliffe V, Ali I, Ardern-Jones M, Mitchell C, Burrows N, Atkar R, Banfield C, Alexandroff A, Champagne C, Cooper HL, Patel GK, Macbeth A, Page M, Bryden A, Mowbray M, Wahie S, Armstrong K, Cooke N, Goodfield M, Man I, de Berker D, Dunnil G, Takwale A, Rao A, Siah TW, Sinclair R, Wade MS, Bhargava K, Fenton DA, McGrath JA, Tziotzios C. Frontal fibrosing alopecia: a descriptive cross-sectional study of 711 cases in female patients from the UK. Br J Dermatol 2020; 183:1136-1138. [PMID: 32652611 DOI: 10.1111/bjd.19399] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Mulvagh SL, Mitchell C, Bagley J, Feinstein L, Burgess P, Lindner JR, Lyshchik A, Umland M, Kelly K, Gorman B. A Survey of CEUS Education in Sonographer Training Programs: The Well-Opacified and Delineated Road Less Travelled, and Ready to be Taken. J Am Soc Echocardiogr 2020; 33:A19-A21. [DOI: 10.1016/j.echo.2020.07.010] [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: 10/23/2022]
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Kirkpatrick JN, Mitchell C, Taub C, Kort S, Hung J, Swaminathan M. ASE Statement on Protection of Patients and Echocardiography Service Providers During the 2019 Novel Coronavirus Outbreak: Endorsed by the American College of Cardiology. J Am Coll Cardiol 2020; 75:3078-3084. [PMID: 32272153 PMCID: PMC7194625 DOI: 10.1016/j.jacc.2020.04.002] [Citation(s) in RCA: 158] [Impact Index Per Article: 39.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
•ASE guidance for patient and provider protection during echo exams in the COVID-19 pandemic. •Triaging approach for prioritizing echo exams during the COVID-19 pandemic. •Recommended imaging approach and appropriate PPE use during echo exams.
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Mitchell C, Collins K, Hua L, McClanahan C, Shea E, Umland M, Wasserman M. Specific Considerations for Sonographers When Performing Echocardiography during the 2019 Novel Coronavirus Outbreak: Supplement to the American Society of Echocardiography Statement. J Am Soc Echocardiogr 2020; 33:654-657. [PMID: 32503701 PMCID: PMC7151492 DOI: 10.1016/j.echo.2020.04.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 04/07/2020] [Indexed: 11/23/2022]
Abstract
Sonographers need to be familiar with and prepared to implement strategies for reducing the risk of exposure to and transmission of the COVID-19 virus. Strategies to employ can be grouped into three broad categories: (1) whom to scan, (2) where to scan, and (3) how to scan. Whom to scan addresses sonographer strategies for determining essential and emergent scan status. Where to scan addresses sonographer practice strategies for selecting equipment, use of rooms, portable examinations, and training personnel. How to scan addresses the topics of scanning techniques (tailored protocols, right-handed scanning, use of barrier devices) and equipment cleaning and disinfecting.
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Kirkpatrick JN, Mitchell C, Taub C, Kort S, Hung J, Swaminathan M. ASE Statement on Protection of Patients and Echocardiography Service Providers During the 2019 Novel Coronavirus Outbreak: Endorsed by the American College of Cardiology. J Am Soc Echocardiogr 2020; 33:648-653. [PMID: 32503700 PMCID: PMC7129086 DOI: 10.1016/j.echo.2020.04.001] [Citation(s) in RCA: 145] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 04/02/2020] [Accepted: 04/02/2020] [Indexed: 12/20/2022]
Abstract
•ASE guidance for patient and provider protection during echo exams in the COVID-19 pandemic. •Triaging approach for prioritizing echo exams during the COVID-19 pandemic. •Recommended imaging approach and appropriate PPE use during echo exams.
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Hung J, Abraham TP, Cohen MS, Main ML, Mitchell C, Rigolin VH, Swaminathan M. ASE Statement on the Reintroduction of Echocardiographic Services during the COVID-19 Pandemic. J Am Soc Echocardiogr 2020; 33:1034-1039. [PMID: 32762917 PMCID: PMC7237908 DOI: 10.1016/j.echo.2020.05.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 05/16/2020] [Indexed: 11/17/2022]
Abstract
Echocardiography services have been interrupted by the COVID pandemic. Services are being gradually reintroduced as healthcare facilities reopen. Operational, workflow and prioritization considerations are suggested.
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Mitchell C, Burke K, Halford N, Rothwell K, Darley S, Woodward-Nutt K, Bowen A, Patchwood E. Value and learning from carer involvement in a cluster randomised controlled trial and process evaluation - Organising Support for Carers of Stroke Survivors (OSCARSS). RESEARCH INVOLVEMENT AND ENGAGEMENT 2020; 6:21. [PMID: 32419954 PMCID: PMC7210672 DOI: 10.1186/s40900-020-00193-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 04/14/2020] [Indexed: 05/26/2023]
Abstract
BACKGROUND Patient, Carer and Public Involvement (PCPI) should be embedded in health care research. Delivering PCPI can be challenging, but even when PCPI is carried out it is rarely reported resulting in lost opportunities for learning. This paper aims to describe PCPI in the OSCARSS study, a pragmatic-cluster randomised controlled trial with an embedded economic and process evaluation. METHODS A carer research user group (RUG) co-developed OSCARSS to evaluate how to best deliver support to caregivers of stroke survivors. The PCPI activity involved regular meetings and preparatory work, from the initial conceptualisation of the study through to dissemination. Written reports, structured group discussions and individual interviews were carried out with the RUG and researchers to capture the added value and learning. This paper was co-authored by two of the RUG members with contributions from the wider RUG and researchers. RESULTS The core six members of the caregiver RUG attended the majority of the meetings alongside three researchers, one of whom was the co-chief investigator. PCPI was instrumental in changing many aspects of the research protocol, design and delivery and contributed to dissemination and sharing of good practice. There were challenges due to the emotional toll when PCPI members shared their stories and the extensive time commitment. Positive experiences of learning and fulfilment were reported by the individual researchers and PCPI members. Wider organisational administrative and financial support facilitated the PCPI. The researchers' existing positive regard for PCPI and the clear focus of the group were key to the successful co-design of this research. CONCLUSIONS The value and learning from the PCPI collaborative work with the researchers was of benefit to the study and the individuals involved. Specific PCPI influences were a challenge to pinpoint as successful co-design meant the researchers' and carers' contributions were intertwined and decision-making shared.
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Steele L, Mitchell C, Sharma S, Keohane SG. Primary scalp dermatofibrosarcoma protuberans with periosteal involvement. Clin Exp Dermatol 2020; 45:661-663. [PMID: 31960488 DOI: 10.1111/ced.14166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2019] [Indexed: 11/30/2022]
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McGrath M, Eramo M, Gurung R, Sriratana A, Feeney S, Gehrig S, Lynch G, Lazarou M, McLean C, Mitchell C. O.36Defective lysosome homeostasis during autophagy causes skeletal muscle disease. Neuromuscul Disord 2019. [DOI: 10.1016/j.nmd.2019.06.319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Mitchell C, Piper ME, Smith SS, Korcarz CE, Fiore MC, Baker TB, Stein JH. Changes in carotid artery structure with smoking cessation. Vasc Med 2019; 24:493-500. [PMID: 31422759 DOI: 10.1177/1358863x19867762] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Carotid artery grayscale ultrasound echogenicity and texture features predict cardiovascular disease events. We evaluated the longitudinal effects of smoking cessation on four grayscale ultrasound measures. This was a secondary analysis of data from 188 age, sex, and body mass index (BMI)-matched smokers (94 eventual abstainers [EA], 94 continued smokers [CS]) from a smoking cessation trial that had carotid ultrasound examinations at baseline and after 3 years. General linear models that included time, smoking group (EA or CS), and a time*smoking interaction term were used to examine the impact of smoking abstinence on carotid artery grayscale marker values at year 3. Participants were mean (SD) 50.3 (11.4) years old (57% female, 86% white). The baseline grayscale median value (GSM) was inversely correlated with age, BMI, insulin resistance, and smoking pack-years (r = -0.20 to -0.30, p < 0.007 for all). There was a significant time*smoking status interaction for predicting GSM at year 3: GSM decreased significantly in the EA group compared to the CS group (-3.63 [13.00] vs CS 0.39 [12.06] units; p = 0.029). BMI increased more in the EA than the CS group (2.42 [3.00] vs CS 0.35 [2.57] kg/m2; p < 0.001). After adjusting for changes in BMI, the time*smoking status interaction no longer was significant (p = 0.138). From baseline to year 3, contrast increased similarly in both groups. Entropy and angular second moment did not change significantly in either group. Changes in carotid ultrasound echogenicity and grayscale texture features during a smoking cessation attempt are modest and mostly related to weight gain. Clinicaltrials.gov Identifier: NCT01553084.
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Bond A, Teubner A, Taylor M, Willbraham L, Gillespie L, Farrer K, McMahon M, Leahy G, Abraham A, Soop M, Clamp AR, Hasan J, Mitchell C, Jayson GC, Lal S. A novel discharge pathway for patients with advanced cancer requiring home parenteral nutrition. J Hum Nutr Diet 2019; 32:492-500. [PMID: 31006921 DOI: 10.1111/jhn.12650] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND The use of home parenteral nutrition (HPN) for palliative indications is increasing internationally and is the leading indication in some countries. Discharge on HPN can be complex in metabolically unstable patients and requires intestinal failure expertise. METHODS Between 2012 and 2018, we performed a retrospective analysis aiming to assess the impact of a novel remote discharge pathway for palliative HPN patients. This was evaluated using a quality improvement approach. RESULTS One hundred and twenty-five patients with active malignancy [mean (range) age 58 (25-80) years] were referred to the intestinal failure unit (IFU) for remote discharge. Of 82 patients were discharged from the oncology Centre on HPN using the pathway. The remaining 43 patients either declined HPN or the Oncology team felt that the patient became too unwell for HPN or died prior to discharge. There was an increase in patients referred for remote discharge from 13 in 2012 to 43 in 2017. The mean number of days between receipt of referral by the IFU to discharge on HPN from the oncology centre reduced from 29.4 days to 10.1 days. Following remote discharge, the mean number of days on HPN was 215.9 days. Catheter-related blood stream infection rates in this cohort were very low at 0.169 per 1000 catheter days. CONCLUSIONS This is the first study to demonstrate the remote safe, effective and rapid discharge of patients requiring palliative HPN between two hospital sites. This allows patients with a short prognosis more time in their desired location.
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Sannibale F, Filippetto D, Qian H, Mitchell C, Zhou F, Vecchione T, Li RK, Gierman S, Schmerge J. High-brightness beam tests of the very high frequency gun at the Advanced Photo-injector EXperiment test facility at the Lawrence Berkeley National Laboratory. THE REVIEW OF SCIENTIFIC INSTRUMENTS 2019; 90:033304. [PMID: 30927765 DOI: 10.1063/1.5088521] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 02/24/2019] [Indexed: 06/09/2023]
Abstract
The very-high-frequency gun (VHF-Gun) is a new concept photo-injector developed and built at the Lawrence Berkeley National Laboratory (LBNL) for generating high-brightness electron beams capable of driving X-ray free electron lasers (FELs) at MHz-class repetition rates. The gun that purposely uses established and mature radiofrequency and mechanical technologies has demonstrated over the last many years the capability of reliably operating in continuous wave mode at the design accelerating fields and required vacuum and mechanical performance. The results of VHF-Gun technology demonstration were reported elsewhere [Sannibale et al., Phys. Rev. Spec. Top.-Accel. Beams 15, 103501 (2012)]; here in this paper, we provide and analyze examples of the experimental results of the first high-brightness beam tests performed at the Advanced Photo-injector EXperiment test facility at LBNL that demonstrated the gun capability of delivering the beam quality required for driving high repetition rate X-ray FELs.
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Mitchell C, Wilbrand SM, Cook TD, Meshram NH, Steffel CN, Nye R, Varghese T, Hermann BP, Dempsey RJ. Abstract WMP47: Traditional Doppler Measures Do Not predict Cognition in a Cohort With Advanced Atherosclerosis. Stroke 2019. [DOI: 10.1161/str.50.suppl_1.wmp47] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Traditional Doppler measures have been used to predict cognitive performance in patients with carotid atherosclerosis. Novel measures, such as carotid strain indices (CSI) have shown associations with cognitive performance. We hypothesized that lower mean middle cerebral artery (MCA) velocities, higher bulb-internal carotid artery (ICA) velocities, MCA pulsatility index (PI) and CSI would be associated with poorer cognitive performance in individuals with advanced atherosclerosis.
Methods:
Neurocognitive testing, carotid ultrasound, transcranial Doppler and CSI were performed on 40 subjects scheduled for carotid endarterectomy. Kendall tau correlations were used to examine relationships between cognitive tests and the maximum peak systolic velocity (PSV) (from bulb, proximal, mid or distal ICA), mean MCA velocity and PI (on surgical side) and CSI (maximum axial, lateral and shear strain indices used to characterize plaque deformations with arterial pulsation). Cognitive measures included age adjusted indices of verbal fluency, verbal and visual learning/memory, psychomotor speed, auditory attention/working memory, visuoconstruction, and mental flexibility.
Results:
Participants were median age 71.0 (IQR 9.75) years, 26 male (65%) and 14 female (35%). Median stenosis was 70.00 (IQR 10.00) percent. Traditional Doppler parameters, PSV, mean MCA velocity and MCA PI did not predict cognitive performance (p values all >0.05). Maximum strain values were significantly associated with cognitive performance (p<0.05).
Table
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Conclusions:
Traditional velocity measurements of maximum bulb-ICA PSV, mean MCA velocity and PI were not associated with cognitive performance in patients with advanced atherosclerotic disease, however maximum strain indices were associated with cognitive performance. Findings suggest that cognition may be associated with unstable plaque (plaques at greater risk for rupture) rather than blood flow.
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Bullock B, Donovan P, Mitchell C, Whitty JA, Coombes I. The impact of a pharmacist on post-take ward round prescribing and medication appropriateness. Int J Clin Pharm 2019; 41:65-73. [PMID: 30610543 PMCID: PMC6394496 DOI: 10.1007/s11096-018-0775-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 12/17/2018] [Indexed: 11/29/2022]
Abstract
Background Medication communication and prescribing on the post-take ward round following patient admission to hospital can be suboptimal leading to worse patient outcomes. Objective To evaluate the impact of clinical pharmacist participation on the post-take ward round on the appropriateness of medication prescribing, medication communication, and overall patient health care outcomes. Setting Tertiary referral teaching hospital, Brisbane, Australia. Method A pre-post intervention study was undertaken that compared the addition of a senior clinical pharmacist attending the post-take ward was compared to usual wardbase pharmacist service, with no pharmacist present of the post-take ward round. We assessed the proportion of patients with an improvement in medication appropriateness from admission to discharge, using the START/STOPP checklists. Medication communication was assessed by the mean number of brief and in-depth discussions, with health care outcomes measured by comparing length of stay and 28-day readmission rates. Main outcome measures: Medication appropriateness according to the START/STOPP list, number and type of discussions with team members and length of stay and readmission rate. Results Two hundred and sixty patients were recruited (130 pre- and 130-post-intervention), across 23 and 20 post-take ward rounds, respectively. Post-intervention, there was increase in the proportion of patients who had an improvement medication appropriateness (pre-intervention 25.4%, post-intervention 36.9%; p = 0.004), the number of in-depth discussions about patients’ medication (1.9 ± 1.7 per patient pre-intervention, 2.7 ± 1.7 per patient post-, p < 0.001), and the number relating to high-risk medications (0.71 ± 1.1 per patient pre-intervention, to 1.2 ± 1.2 per patient post-, p < 0.05). Length of stay and 28-day mortality were unchanged. Conclusion Clinical pharmacist participation on the post-take ward round leads to improved medication-related communication and improved medication appropriateness but did not significantly improve health care outcomes.
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Mitchell C. The Powerful Role of the Sonographer in Clinical Medicine and Research. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2018. [DOI: 10.1177/8756479318813103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Choksi N, Hayward M, Kwon D, Marrazzo J, Mitchell C. Genetic variation of lactobacilllus crispatus strains isolated from a woman during and after bacterial vaginosis. Am J Obstet Gynecol 2018. [DOI: 10.1016/j.ajog.2018.10.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Sudhof L, Bergerat-Thompson A, McIver L, Briggs D, Wilkinson J, Andrews E, Ananthakrishnan A, Huttenhower C, Xavier R, Mitchell C. The vaginal microbiota is altered in women with inflammatory bowel disease. Am J Obstet Gynecol 2018. [DOI: 10.1016/j.ajog.2018.10.057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Oshi DC, Ricketts-Roomes T, Oshi SN, Mitchell C, Agu CF, Belinfante A, Mitchell G, Whitehorne-Smith P, Harrison J, Atkinson U, Abel WD. Gender differences in the factors associated with early age of initiation of cannabis use in Jamaica. JOURNAL OF SUBSTANCE USE 2018. [DOI: 10.1080/14659891.2018.1531946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Edwards RM, Currigan DA, Bradbeer S, Mitchell C. Does A Catheter over Needle System Reduce Infusate Leak in Continuous Peripheral Nerve Blockade: A Randomised Controlled Trial. Anaesth Intensive Care 2018; 46:468-473. [DOI: 10.1177/0310057x1804600507] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Continuous peripheral nerve blockade is a common technique in the analgesic management for many procedures. Leakage of local anaesthetic from around the nerve catheter insertion site can increase the chance of catheter dislodgement, risks infective complications, and could divert anaesthetic away from the nerve causing the block to fail. We conducted a randomised controlled trial to assess whether the type of nerve catheter influenced local anaesthetic leak rate. One hundred and ten patients scheduled for elective unilateral total knee arthroplasty were randomised to receive a perineural catheter with either a catheter over needle (CON) system (Pajunk® E-Cath) (PAJUNK® GmbH, Medizintechnologie, Geisingen, Germany), or catheter through needle (CTN) system (Pajunk® SonoLong) (PAJUNK® GmbH, Medizintechnologie, Geisingen, Germany). There was no statistically significant difference in the rate of leaking catheters between groups (CON 1.8% versus CTN 3.7%; P=0.618), however, the overall leak rate was much lower than anticipated from pilot data. The CON system was on average faster to insert (CON 357 seconds versus CTN 482 seconds; P=0.004), but associated with poorer needle visibility under ultrasound (Likert scale 1–5, mean [SD], CON 3.31 [0.96] versus CTN 3.89 [0.84]; P=0.001). All seven instances of inadvertent catheter dislodgement occurred in the CTN group (P=0.006). There was no statistically significant difference between groups in the proportion of patients who had adequate analgesia on day one (CON 80% versus CTN 86.5%; P=0.294) and day two postoperatively (CON 85.5% versus CTN 91.8%; P=0.369). Our findings show the overall leak rate to be very low with both catheter systems; however, the CON system may have advantages in terms of speed of use and rate of inadvertent catheter dislodgement.
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Mitchell C, Park MM, Roberts B. Update on a New Document Addressing Industry Standards for the Prevention of Musculoskeletal Injuries Through the Performance of Diagnostic Medical Sonography. J Am Soc Echocardiogr 2018; 31:A23. [DOI: 10.1016/j.echo.2018.04.012] [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: 10/14/2022]
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Bombil I, Louw L, Mitchell C, Mahlobo F, Muganza RA, Madima NR. Sonar guided focused parathyroidectomy under cervical block. S AFR J SURG 2018; 56:30-33. [PMID: 30010261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Presentation of hyperparathyroidism varies and is highly non-specific. The automated calcium analyzer has made the diagnosis easy. Similarly, the advent of Sestamibi scan has paved the way to minimally invasive parathyroidectomy indicated for parathyroid adenoma. There is no uniformity in the extent of minimally invasive parathyroidectomy that is done through limited incision under radio or sonar guidance and endoscopically. In this study, we are presenting the focused parathyroidectomy performed under sonar guidance and superficial cervical block (SCB). The prerequisite is concordant preoperative Sestamibi and ultrasound imaging. METHOD A two-year review of parathyroidectomies performed between January 2013 and December 2014. OBJECTIVE To reflect on the result of sonar-guided focused parathyroidectomy under SCB. RESULTS There was good correlation between the pre-operative imaging, the intra-operative findings and the postoperative histology result of the 15 cases analysed. CONCLUSION The focused parathyroidectomy under SCB yielded a good result with concordant preoperative Sestamibi and ultrasound findings.
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Mitchell C, Korcarz CE, Gepner AD, Kaufman JD, Post WS, Tracy R, Gassett AJ, Ma N, McClelland RL, Stein JH. Abstract 470: Ultrasound Carotid Plaque Features, Cardiovascular Disease Risk Factors and Events: the Multi-Ethnic Study of Atherosclerosis. Arterioscler Thromb Vasc Biol 2018. [DOI: 10.1161/atvb.38.suppl_1.470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Grayscale ultrasound atherosclerotic plaque characteristics may predict cardiovascular disease (CVD) events, though they have not been investigated in a large primary prevention cohort. This study determined if CVD risk factors were associated with carotid plaque ultrasound characteristics and if these characteristics could predict future coronary heart disease (CHD) and stroke/transient ischemic attack (TIA) events in a multi-ethnic cohort free of known CVD at baseline.
Methods:
We measured carotid artery total plaque area (TPA) and grayscale carotid plaque features (grayscale median, black areas, and discrete white areas) at baseline in participants of the Multi-Ethnic Study of Atherosclerosis that had B-mode carotid ultrasound examinations. There were 2205 participants with images available for TPA analyses and 1703 with images available for grayscale analyses. Multivariable linear regression analysis was used to examine relationships between baseline ultrasound carotid plaque features and CVD risk factors. Cox proportional hazards models were used to assess their ability to predict incident CHD and stroke/TIA events over an average follow-up of 13.3 years. The predictive characteristics of TPA and carotid plaque features were compared to carotid plaque score and coronary artery calcification (CAC) score.
Results:
Participants were mean (standard deviation) 65.4 (9.6) years old, 49% male, 39% White, 28% Black, 22% Hispanic, and 11% Chinese. Mean TPA (27.7 [24.7] mm
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), but not grayscale plaque features, were associated with several CVD risk factors. In risk factor-adjusted models, TPA was the only plaque feature that predicted incident CHD events (HR 1.23; 95% CI 1.11-1.36; p<0.001) with C-statistics for CHD that were similar to carotid plaque score, but lower than CAC score. TPA did not independently predict stroke/TIA events. No gray scale plaque feature predicted future CHD or stroke/TIA events.
Conclusions:
In middle-aged individuals free of known CVD, carotid TPA was associated with CVD risk factors and predicted incident CHD events while grayscale plaque features did not. For CHD, predictive characteristics of TPA were similar to carotid plaque score but lower than CAC score.
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