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Gray OM, Abdeen H, McDonnell GV, Patterson CC, Graham CA, Hawkins SA. An investigation of susceptibility loci in benign, aggressive and primary progressive multiple sclerosis in Northern Irish population. Mult Scler 2009; 15:299-303. [PMID: 19244395 DOI: 10.1177/1352458508099611] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To investigate the possibility that susceptibility loci in multiple sclerosis (MS) have a role in determining the disease outcome in Northern Ireland population. BACKGROUND The Genetic Analysis of Multiple Sclerosis in Europeans (GAMES) initiative and follow-up refined analysis identified 15 candidate susceptibility loci within the Northern Irish population for MS. We aimed to investigate the 12 most significant markers for their role in disease outcome. METHODS Cases with probable or definite MS (Poser criteria) were classified as benign onset (Kurtzke Expanded Disability Status Scale [EDSS]<or=3.0 at 10 years), aggressive (Kurtzke EDSS>or=6.0 by 10 years), or primary progressive MS. All cases were Caucasian of Northern Irish origin. DNA was extracted from venous blood, microsatellite markers were amplified using polymerase chain reaction and typed using fluorescent fragment analysis. Allele frequencies were compared statistically using a chi-squared test with allowance for multiple comparisons (critical P<0.0042); significant markers were further analyzed by CLUMP (critical P<0.0014). RESULTS Two microsatellite markers were significant: D3S1278 (Chr 3q13, P<0.001) and tumor necrosis factor (TNF)-alpha (Chr 6p21, P<0.001). A further three markers were significant in our preliminary analysis suggesting a trend toward impact on disease outcome; D4S432 (Chr 4p16, P=0.001), D2S347 (Chr 2q14, P=0.003), and D19S903 (Chr 19p13, P=0.003). CONCLUSIONS This is the first study to suggest a role for TNF-alpha in the disease outcome in MS. Larger replication studies need to be performed to assess the role of markers D4S432, D2S347, and D19S903.
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Hung KKC, Cheung CSK, Rainer TH, Graham CA. EMS systems in China. Resuscitation 2009; 80:732-5. [PMID: 19443099 DOI: 10.1016/j.resuscitation.2009.04.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2009] [Accepted: 04/10/2009] [Indexed: 11/19/2022]
Abstract
The prehospital emergency service is the initial part of the Emergency Medical Service System (EMSS) in China, and is the de facto overall emergency medical service for China. As the EMSS in China continues to undergo rapid development, it faces the challenge of providing rapid response times with adequate coverage for this highly populated country. The recent Sichuan earthquake on 12 May 2008 tested the ability of the EMSS response. This article focuses on the prehospital emergency service of the EMSS and discusses the strengths and weaknesses of the current system.
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Cattermole GN, Graham CA, Rainer TH. Ethics and analgesia. Emerg Med J 2009; 26:389. [PMID: 19386890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Yeung JHH, Leung CSM, Poon WS, Cheung NK, Graham CA, Rainer TH. Bicycle related injuries presenting to a trauma centre in Hong Kong. Injury 2009; 40:555-9. [PMID: 19195650 DOI: 10.1016/j.injury.2008.08.015] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2008] [Accepted: 08/04/2008] [Indexed: 02/02/2023]
Abstract
BACKGROUND Bicycle riding is a popular leisure activity and an important means of transportation in Hong Kong. Young cyclists' riding behaviour causes injury patterns which may differ from older riders. The aim of this study is firstly to describe bicycle related injuries presenting to a regional trauma centre in Hong Kong, and secondly to compare patients aged > 15 years with those patients aged < or = 15 years. METHODS This retrospective observational study examined all bicycle related injury patients presenting to the ED of the Prince of Wales Hospital (PWH) in 2006. RESULTS Results showed that bicycle helmet use was low in Hong Kong suggesting that the wearing of helmets when cycling should be promoted. Bicycle related injuries were common in children but the injuries in adults were more serious. Head and limb injuries were common and limbs on the left side were 2.5 times more likely to be injured than those on the right. The older group were more likely to be involved in a motor vehicle collision and sustained more severe injuries than the younger group. They had more serious head and neck, face, thorax and abdominal injuries compared to the younger group. CONCLUSION Prevention strategies should include more widespread helmet use and increasing bicycle lane provision to enable traffic separation in Hong Kong. The three 'E' approaches (education, enforcement and environment) should be implemented to prevent bicycle injuries in Hong Kong.
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Richards CH, Graham CA, Munro PT. Bier'S Block for Emergency Department Management of Distal Radius Fractures. HONG KONG J EMERG ME 2009. [DOI: 10.1177/102490790901600104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Distal radius fractures commonly present to emergency departments (ED). Optimum treatment methods remain unclear and individual hospital practices differ. Objectives To ascertain the number and success rate of manipulation under intravenous regional anaesthesia (IVRA) of distal radius fractures, and to determine the re-manipulation rate. Methods Retrospective observational study of patients undergoing manipulation of distal radius fracture under IVRA in the ED from January 2003 to January 2004. The resuscitation room procedure log, hospital computer records, ED records and theatre records were examined for each patient. Results A total of 84 manipulations were performed. Complete information was available for 74 procedures (73 patients). Manipulation was successful in 73.5% with only 19 out of 73 patients requiring operation. All patients were manipulated under IVRA with middle grade or consultant supervision; and 52 (71.2%) patients were managed entirely as outpatients. Conclusion Our policy of manipulating displaced distal radius fractures under IVRA in the ED has a high success rate and allows the majority of patients to be managed as outpatients. This policy may lead to cost savings from a health service financing perspective.
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Epstein LB, Graham CA, Heit MH. Impact of sacral colpopexy on in vivo vaginal biomechanical properties. Am J Obstet Gynecol 2008; 199:664.e1-6. [PMID: 18986642 DOI: 10.1016/j.ajog.2008.07.056] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2008] [Revised: 05/19/2008] [Accepted: 07/28/2008] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to determine if sacral colpopexy has an impact on in vivo vaginal biomechanical properties. STUDY DESIGN Thirty-five participants who underwent sacral colpopexy were enrolled in this prospective clinical trial. In vivo vaginal biomechanical properties, including elasticity, viscoelasticity, and vaginal stiffness index, as well as symptom severity questionnaires (pelvic floor distress inventory-short form) and Pelvic Organ Prolapse Quantification (POP-Q) examination, were performed preoperatively and 6 weeks postoperatively. RESULTS Thirty-two participants completed the study. Six weeks after sacral colpopexy participants demonstrated a decrease in prolapse related symptoms (POPDI-6 score, 39.8 vs 9.0, P < .00001) and 97% demonstrated anatomical cure of their prolapse. At 6 weeks follow-up participants demonstrated an increase in elasticity (2.26 vs 3.43, P < .00001), viscoelasticity (1.55 vs 4.08, P < .000001), and vaginal stiffness index (108.65 vs 164.50, P < .01). CONCLUSION These findings suggest that sacral colpopexy increases in vivo vaginal biomechanical properties, as well as decreasing anatomical and symptom-related severity of pelvic organ prolapse.
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Wright WT, Heggarty SV, Young IS, Nicholls DP, Whittall R, Humphries SE, Graham CA. Multiplex MassARRAY spectrometry (iPLEX) produces a fast and economical test for 56 familial hypercholesterolaemia-causing mutations. Clin Genet 2008; 74:463-8. [DOI: 10.1111/j.1399-0004.2008.01071.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Nicholls DP, Cather M, Byrne C, Graham CA, Young IS. Diagnosis of heterozygous familial hypercholesterolaemia in children. Int J Clin Pract 2008; 62:990-4. [PMID: 18492057 DOI: 10.1111/j.1742-1241.2008.01793.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Most children with familial hypercholesterolaemia (FH) are diagnosed by raised blood cholesterol levels, but the test lacks sensitivity and specificity. As such children have evidence of vascular dysfunction at an early age, correct identification of affected individuals is important so that treatment can be started. AIM To determine levels of total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) in children with genetically proven FH and their unaffected siblings, in order to identify a diagnostic cut-off point if possible. DESIGN Retrospective case-note survey. METHODS We studied the notes of 115 children aged 3-16 years, 69 proven FH and 46 unaffected sibs, 65 boys and 50 girls, from 31 families and 21 different mutations. Data recorded were age, sex, TC, and (when available) LDL-C. RESULTS The lowest TC level in an affected individual was 4.7 mmol/l and the highest in normal individual was 6.05 mmol/l. This overlap range included 21 children (18% of the total). The corresponding figures for LDL-C were 3.0 and 3.7 mmol/l, which included eight children (8%). CONCLUSION TC is not an effective test for differentiating affected and unaffected children with FH. LDL-C is better, but genetic testing remains the method of choice, especially if treatment decisions are to be taken.
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Crosby R, Milhausen R, Sanders SA, Graham CA, Yarber WL. Two heads are better than one: the association between condom decision-making and condom use errors and problems. Sex Transm Infect 2008; 84:198-201. [DOI: 10.1136/sti.2007.027755] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Canter MP, Graham CA, Heit MH, Blackwell LS, Wilkey DW, Klein JB, Merchant ML. Proteomic techniques identify urine proteins that differentiate patients with interstitial cystitis from asymptomatic control subjects. Am J Obstet Gynecol 2008; 198:553.e1-6. [PMID: 18455532 DOI: 10.1016/j.ajog.2008.01.052] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2007] [Revised: 11/20/2007] [Accepted: 01/24/2008] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The purpose of this study was to identify differences in urine proteins between patients with interstitial cystitis (IC) and asymptomatic control (AC) subjects with the use of proteomic techniques. STUDY DESIGN Nine patients with IC and their age-, race-, and sex-matched AC subjects volunteered a urine specimen. Urine proteins were separated with the use of 2-dimensional polyacrylamide gels. Differing proteins underwent digestion and matrix-assisted laser desorption ionization-time of flight mass spectrometry. Computer-assisted data analysis was used to identify the corresponding protein. Differences in urine protein responses between patients with IC and AC subjects were evaluated by the Mann-Whitney U test to account for the nonnormal frequency distribution of the parameter estimate or chi-square when data were bimodal. RESULTS Four proteins differed significantly between patients with IC and AC subjects. The AC subjects had a greater concentration of a uromodulin (P = .019) and two kininogens (P = .023, .046). The patients with IC had a greater concentration of inter-alpha-trypsin inhibitor heavy chain H4 (P = .019). CONCLUSION These urine protein isoforms may be biomarkers for IC.
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Epstein LB, Graham CA, Heit MH. Correlation between vaginal stiffness index and pelvic floor disorder quality-of-life scales. Int Urogynecol J 2008; 19:1013-8. [DOI: 10.1007/s00192-007-0551-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2007] [Accepted: 12/17/2007] [Indexed: 10/22/2022]
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Epstein LB, Graham CA, Heit MH. Systemic and vaginal biomechanical properties of women with normal vaginal support and pelvic organ prolapse. Am J Obstet Gynecol 2007; 197:165.e1-6. [PMID: 17689636 DOI: 10.1016/j.ajog.2007.03.040] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2006] [Revised: 01/06/2007] [Accepted: 03/12/2007] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The objective of the study was to compare the biomechanical properties of vaginal and systemic skin in women with and without pelvic organ prolapse. STUDY DESIGN In this cross-sectional study, 25 women with pelvic organ prolapse and 23 age-matched women with normal pelvic support were recruited from an office setting. A Cutometer MPA 580 and DermaLab skin probe were used to measure systemic biomechanical parameters and a 1.5 mm offset DermaLab skin probe was used for vaginal biomechanical measurements. RESULTS There were no significant differences in the baseline demographic, obstetrical, or gynecologic information between the 2 groups. There were no significant differences in the systemic biomechanical parameters between the 2 groups. Women with pelvic organ prolapse had significantly more extensible vaginal skin than women with normal pelvic support (initial stiffness index 7.3 vs 10.9 kpa, final stiffness index 5.9 vs 10.7 kpa; all P values less than .01). Furthermore, vaginal extensibility was related to pelvic organ prolapse quantification stage in a linear fashion. CONCLUSION Our findings suggest that local, rather than systemic, alterations in biomechanical skin properties are associated with pelvic organ prolapse.
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Stevenson AGM, Graham CA, Hall R, Korsah P, McGuffie AC. Tracheal intubation in the emergency department: the Scottish district hospital perspective. Emerg Med J 2007; 24:394-7. [PMID: 17513533 PMCID: PMC2658270 DOI: 10.1136/emj.2006.041988] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Tracheal intubation is the accepted gold standard for emergency department (ED) airway management. It may be performed by both anaesthetists and emergency physicians (EPs), with or without drugs. OBJECTIVE To characterise intubation practice in a busy district general hospital ED in Scotland over 40 months between 2003 and 2006. SETTING Crosshouse Hospital, a 450-bed district general hospital serving a mixed urban and rural population; annual ED census 58,000 patients. METHODS Prospective observational study using data collection sheets prepared by the Scottish Trauma Audit Group. Proformas were completed at the time of intubation and checked by investigators. Rapid-sequence induction (RSI) was defined as the co-administration of an induction agent and suxamethonium. RESULTS 234 intubations over 40 months, with a mean of 6 per month. EPs attempted 108 intubations (46%). Six patients in cardiac arrest on arrival were intubated without drugs. 29 patients were intubated after a gas induction or non-RSI drug administration. RSI was performed on 199 patients. Patients with trauma constituted 75 (38%) of the RSI group. 29 RSIs (15%) were immediate (required on arrival at the ED) and 154 (77%) were urgent (required within 30 min of arrival at the ED). EPs attempted RSI in 88 (44%) patients and successfully intubated 85 (97%). Anaesthetists attempted RSI in 111 (56%) patients and successfully intubated 108 (97%). Anaesthetists had a higher proportion of good views at first laryngoscopy and there was a trend to a higher rate of successful intubation at the first attempt for anaesthetists. Complication rates were comparable for the two specialties. CONCLUSIONS Tracheal intubations using RSI in the ED are performed by EPs almost as often as by anaesthetists in this district hospital. Overall success and complication rates are comparable for the two specialties. Laryngoscopy training and the need to achieve intubation at the first (optimum) attempt needs to be emphasised in EP airway training.
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Kelly AM, Loy J, Tsang AYL, Graham CA. Estimating the rate of re-expansion of spontaneous pneumothorax by a formula derived from computed tomography volumetry studies. Emerg Med J 2007; 23:780-2. [PMID: 16988306 PMCID: PMC2579599 DOI: 10.1136/emj.2006.037143] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Available evidence suggesting that the rate of re-expansion of spontaneous pneumothorax is 1.25%/day is based on a small sample and mathematical modelling-based estimates. AIM To estimate the rate of re-expansion of spontaneous pneumothoraces by a formula derived from computed tomography volumetry studies. METHODS This retrospective study included adult patients with spontaneous pneumothorax, identified from patient management databases, who were treated conservatively. Medical records were reviewed to confirm that no intervention such as aspiration or catheter drainage had occurred. Radiographs were reviewed independently by two researchers and measured according to the method described by Collins et al. Their formula was used to estimate pneumothorax size on each date. The rate of re-expansion was defined as the change in size (%)/number of days between radiographs. Patients were excluded if they did not have at least two radiographs taken, at least 1 day apart. Data were analysed using cluster analysis by patient to minimise the effect of repeated measures from an individual patient. RESULTS 88 episodes were identified in 57 patients. 82% were men and the patients had a median age of 22 years. The average rate of re-expansion was 2.2%/day (95% confidence interval 1.4% to 3.0%), but varied between -7.5% and 13.4%/day. CONCLUSION Spontaneous pneumothoraces treated conservatively re-expand at an average rate of 2.2%/day.
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Wai AKC, Kwok WO, Chan MS, Graham CA, Rainer TH. Patients' perceptions of nasopharyngeal aspiration in the emergency department of a teaching hospital in Hong Kong. Emerg Med J 2007; 24:35-6. [PMID: 17183041 PMCID: PMC2658151 DOI: 10.1136/emj.2006.039701] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Nasopharyngeal aspiration (NPA) is the preferred method for collecting specimens for viral culture in patients with respiratory tract infection. As virus identification may influence admission and treatment decisions, it is important to perform NPA in the emergency department. The test may be uncomfortable and poorly tolerated. This prospective study investigated patients' perceptions of NPA. Patients in the emergency department with upper respiratory tract infection undergoing NPA between 9 March 2005 and 12 August 2005 were included. 86 patients (mean (SD) age 47 (23) years; 49 women) were recruited. 22 (26%) patients complained that NPA was very uncomfortable, 59 (69%) reported that it was mildly uncomfortable and 5 (6%) patients reported no discomfort. On a 10-point scale, the median discomfort score was 4. 29 (34%) patients stated that NPA was more uncomfortable than blood taking, 19 (22%) patients felt that both were similar and 38 (44%) patients felt that NPA was less uncomfortable (p value not significant). NPA performed in the emergency department is well tolerated and should be considered in emergency departments when results may influence patient management.
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Crosby RA, Yarber WL, Sanders SA, Graham CA, McBride K, Milhausen RR, Arno JN. Men with broken condoms: who and why? Sex Transm Infect 2007; 83:71-5. [PMID: 16870644 PMCID: PMC2598576 DOI: 10.1136/sti.2006.021154] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2006] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES To identify (1) the prevalence of condom breakage, and demographic and sexuality-related differences among young men who have sex with women reporting and not reporting this event; (2) condom-specific behaviours associated with breakage. METHODS Young men (n = 278) attending a clinic for treatment of sexually transmitted infections (STIs) responded to an anonymous questionnaire aided by a CD recording of the questions. The samples were screened to include only men who had used a condom during penile-vaginal sex at least three times in the past 3 months. Condom-specific behaviours (including breakage) were assessed using these last three acts of condom use as the recall period. Correlates achieving bivariate significance were subjected to multivariate analysis. RESULTS Nearly one third (31.3%) of the men reported recent breakage. The breakage rate was 15%. Three correlates significantly distinguished between men who did and did not report breakage. Men who had past STIs were more likely to report breakage (adjusted odds ratio (AOR) 2.08), as were men who also reported condom slippage (AOR 2.72). Less self-efficacy for correct condom use was also significantly associated with breakage (AOR 1.07). Further, three condom-specific behaviours were significantly associated with breakage: allowing condoms to contact sharp objects (AOR 2.6), experiencing problems with the "fit or feel" of condoms (AOR 2.3) and not squeezing air from the receptacle tip (AOR 2.0). CONCLUSIONS Breakage may be common and may occur in a larger context of difficulties with condoms. STI clinics could potentially benefit some men by providing instructions on the correct use of condoms.
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Murphy M, Culligan PJ, Arce CM, Graham CA, Blackwell L, Heit MH. Construct validity of the incontinence severity index. Neurourol Urodyn 2006; 25:418-23. [PMID: 16652379 DOI: 10.1002/nau.20246] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
AIMS To assess the construct validity of the incontinence severity index (ISI) by testing its correlation with two health-related quality of life measures, the short forms of the Urogenital Distress Inventory (UDI-6) and the Incontinence Impact Questionnaire (IIQ-7), in women with urodynamic stress incontinence. MATERIALS AND METHODS A cohort of 170 women with the urodynamic stress incontinence who underwent corrective surgery completed the ISI, IIQ-7, and the UDI-6 both pre- and post-treatment. We correlated the pre- and post-treatment responses between the ISI, the IIQ-7, the UDI-6 and their subscales. We also assessed the sensitivity of the ISI to change by correlating the percent change in score between the three instruments. The results were analyzed using a non-parametric test of correlation, the Spearman's rho. RESULTS The ISI scores were generally not well correlated with the pre-treatment IIQ-7 and UDI-6 scores (r < 0.40). The post-treatment scores and percent change from pre- to post-treatment of the ISI, however, were highly correlated with that of the IIQ-7 and UDI-6 (r's > 0.70, P < 0.001). The ISI was most highly correlated with the UDI-6 stress symptoms subscale and most poorly correlated with the UDI-6 obstructive/discomfort subscale. CONCLUSIONS This study provides valuable insight into the construct validity of the ISI. Evidence of its convergent validity is found in the high correlation with the stress symptoms subscales of the UDI-6, while the poorer correlation with the obstructive subscale provides evidence of its divergent validity. These data also suggest that the ISI is highly sensitive to change seen with treatment.
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Abdeen H, Heggarty S, Hawkins SA, Hutchinson M, McDonnell GV, Graham CA. Mapping candidate non-MHC susceptibility regions to multiple sclerosis. Genes Immun 2006; 7:494-502. [PMID: 16837933 DOI: 10.1038/sj.gene.6364320] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Understanding the genetic basis of multiple sclerosis (MS) remains a major challenge, despite decades of intensive research. In order to identify candidate non-MHC susceptibility regions to MS, the results of whole genome screens for linkage or association and follow-up studies in 18 different populations were superimposed together in a combined genomic map. Analysis of this map led to the prediction of at least 38 potential susceptibility regions, each showing linkage and/or association in several populations. Among these, 17 regions were the most reproducibly reported in these studies, thus representing top predicted candidates for MS. This non-formal approach to meta-analysis demonstrated the ability to verify results and retrieve lost information in an association study. Assessment of the map in a Northern Irish refined screen (n=415 cases, n=490 controls) revealed association in 15 regions (P<0.05), including 10 promising candidates on chromosomes 1p13, 2p13, 2q14, 3p23, 7q21, 13q14, 15q13, 17p13, 18q21 and 20p12 (P<0.0025). Seven of these regions were previously overlooked in the Northern Irish whole genome association study. Collating results from numerous studies, this draft map represents a tool that should facilitate the analysis of the genetic backgrounds of MS in many populations.
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Simpson J, Munro PT, Graham CA. Rapid sequence intubation in the emergency department: 5 year trends. Emerg Med J 2006; 23:54-6. [PMID: 16373805 PMCID: PMC2564130 DOI: 10.1136/emj.2004.019398] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIM Airway management is a core aspect of emergency medicine. The technique of rapid sequence intubation (RSI) creates continuing debate between anaesthetists and emergency physicians in the UK, although similar complication rates for emergency department (ED) RSI have been shown for both specialties. This study examined prospectively collected data on every ED RSI performed in a university hospital in Glasgow over 5 years. METHODS Data were prospectively recorded for every attempted RSI in the ED on a dedicated form (as used in previous studies) between January 1999 and December 2003. Immediate complications were specifically sought in the questionnaire, as was the immediate destination on leaving the ED. The chi2 test was used for categorical data. RESULTS On average, 51 ED RSI were performed annually (range 42-60). Emergency physician RSI for trauma increased from 32% (7/22) in 1999 to 75% (21/28) in 2003 (chi2 = 9.32, df = 1, p = 0.002) and for non-trauma from 62% (18/29) in 1999 to 79% (23/29) in 2003 (chi2 = 2.08, df = 1, p = 0.15). Complication rates for emergency physician RSI decreased from 43% (3/7) to 14% (3/21) for trauma (chi2 = 2.55, df = 1, p = 0.11) and from 28% (5/18) to 4% (1/23) for non-trauma (chi2 = 4.44, df = 1, p = 0.035). This compares with mean complication rates for anaesthetists for trauma of 17% and for non-trauma of 22%. Incidence of hypotension decreased in all groups; however, oxygen desaturation is now the most common complication. The rate of ED RSI prior to computed tomography (CT) scans increased in both the trauma (79% v 42%; chi2 = 7.42, df = 1, p = 0.0065) and non-trauma (48% v 17%; chi2 = 5.85, df = 1, p = 0.016) groups. CONCLUSION Emergency physician performed ED RSI is increasingly common but is not associated with overall higher numbers of RSIs being performed in the ED. Effective pre-oxygenation should be emphasised during training.
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Culligan PJ, Blackwell L, Goldsmith LJ, Graham CA, Rogers A, Heit MH. A Randomized Controlled Trial Comparing Fascia Lata and Synthetic Mesh for Sacral Colpopexy. Obstet Gynecol 2005; 106:29-37. [PMID: 15994614 DOI: 10.1097/01.aog.0000165824.62167.c1] [Citation(s) in RCA: 130] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To compare the objective anatomic outcomes after sacral colpopexy performed with cadaveric fascia lata and polypropylene mesh. METHODS Patients undergoing a sacral colpopexy were randomized to receive either fascia lata or polypropylene mesh in a double-blinded fashion. Data were collected at 6 weeks, 3 months, 6 months, and 1 year postoperatively. The main outcome measures were pelvic organ prolapse quantification (POP-Q) system stage and individual POP-Q points over time. Objective anatomic failure was defined as POP-Q stage 2 or more at any point during the follow-up period. Proportions of patients with objective anatomic failure at 1 year in each group were compared using the chi(2) test. Mean POP-Q points and stage at 1 year were compared by using the independent samples t test. RESULTS One hundred patients were randomized to receive either fascia (n = 46) or mesh (n = 54). Of the 89 patients returning for 1-year follow-up, 91% (41/45) of the mesh group and 68% (30/44) of the fascia group were classified as objectively cured (P = .007). We found significant differences between the mesh and fascia groups with respect to the 1-year postoperative comparisons of points Aa, C, and POP-Q stage. There were no differences between the 2 groups with respect to points TVL (total vaginal length), GH (genital hiatus), PB (perineal body), Ap or Bp (2 points along the posterior vaginal wall). CONCLUSIONS Polypropylene mesh was superior to fascia lata in terms of POP-Q points, POP-Q stage, and objective anatomic failure rates. LEVEL OF EVIDENCE I.
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Murphy M, Culligan PJ, Arce CM, Graham CA, Blackwell L, Heit MH. Is the cough-stress test necessary when placing the tension-free vaginal tape? Obstet Gynecol 2005; 105:319-24. [PMID: 15684159 DOI: 10.1097/01.aog.0000152305.37853.7e] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To estimate whether the mode of anesthesia (and the resultant ability or inability to perform the cough-stress test) used during the tension-free vaginal tape (TVT) procedure affects postoperative continence. METHODS A cohort of 170 women who underwent the TVT procedure without any other concomitant surgery completed the short form of the Urogenital Distress Inventory (UDI-6) to assess their continence status preoperatively and postoperatively. Chi-squared, t, and Mann-Whitney U tests were used to determine the association between these data and anesthesia type during univariate analysis. RESULTS Both anesthesia groups showed significant improvement from their preoperative UDI-6 scores to their postoperative scores. However, when comparing the change from pre- to postoperative UDI-Stress Symptoms subscale scores between the 2 groups, we found a significant difference. Mean improvement in the local group was 58.3 (+/- 33.8) compared with 41.7 (+/- 39.4) in the general group (P = .02). CONCLUSION Women who undergo TVT show significant improvements in incontinence severity regardless of anesthesia type. However, greater improvements in stress incontinence, as measured by the UDI-Stress Symptoms subscale, are seen when the TVT is placed while using the cough-stress test under local analgesia. LEVEL OF EVIDENCE II-2.
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Corfield AR, Graham CA, Adams JN, Booth I, McGuffie AC. Emergency department thrombolysis improves door to needle times. Emerg Med J 2005; 21:676-80. [PMID: 15496692 PMCID: PMC1726488 DOI: 10.1136/emj.2004.014449] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To identify the effect on door to needle (DTN) time of moving the site of thrombolysis delivery from the coronary care unit (CCU) to the emergency department (ED). To ascertain if moving the site of thrombolysis enables appropriate use of thrombolysis. DESIGN Prospective cohort study. SETTING CCU and ED of a 450 bed Scottish district general hospital without on-site primary angioplasty. PARTICIPANTS Primary site for thrombolysis of patients presenting to the hospital with ST elevation MI (STEMI) moved from CCU to ED on 1 April 2000. Study patients who had a confirmed STEMI and/or received thrombolytic therapy before this date were defined as the pre-change group; those who were diagnosed as STEMI and/or received thrombolytic therapy after this date were defined as the post-change group. STATISTICAL ANALYSIS Mann-Whitney test was used to compare medians and chi(2) test for categorical data. RESULTS 1349 patients were discharged from CCU with a diagnosis of STEMI or received thrombolysis in the ED or CCU between April 1998 and April 2002. There were 632 patients in the pre-change group and 654 patients in the post-change group. Sixty three patients were excluded. Median DTN time for the pre-change group (321 thrombolysed patients) was 64 minutes and median DTN time for the post-change group (324 thrombolysed patients) was 35 minutes, a median difference of 25 minutes (95% CI for difference 20 to 29 minutes, p<0.0001, Mann-Whitney U test). A total of 37 patients were thrombolysed but did not have a final diagnosis of STEMI. CONCLUSION A significant reduction in DTN times accompanied this change in practice in this hospital.
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Graham CA. Advanced airway management in the emergency department: what are the training and skills maintenance needs for UK emergency physicians? Emerg Med J 2005; 21:14-9. [PMID: 14734367 PMCID: PMC1756338 DOI: 10.1136/emj.2003.003368] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
This article reviews the evidence for the training of emergency physicians in advanced airway management.
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Caldow SJ, Parke TRJ, Graham CA, Munro PT. Aeromedical retrieval to a university hospital emergency department in Scotland. Emerg Med J 2005; 22:53-5. [PMID: 15611548 PMCID: PMC1726520 DOI: 10.1136/emj.2004.016618] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Rural and island areas of Scotland benefit from the availability of the Scottish Ambulance Service paramedic staffed helicopter for transfers and primary scene responses. There are a small number of patients who require advanced airway management, invasive procedures, or critical care interventions to stabilise them before transport to definitive care. At present these additional skills are provided on an ad hoc basis by senior medical staff drawn from intensive care and emergency medicine at the receiving hospitals. Given the potential difficulties of training paramedics to use these infrequently used skills it may be preferable to establish a formalised system to access suitably trained medical staff. This case series illustrates the clinical challenges and potential benefits of such a service and discusses the practicalities involved.
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