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Bain CR, Myles PS, Martin C, Wallace S, Shulman MA, Corcoran T, Bellomo R, Peyton P, Story DA, Leslie K, Forbes A. Postoperative systemic inflammation after major abdominal surgery: patient-centred outcomes. Anaesthesia 2023; 78:1365-1375. [PMID: 37531295 PMCID: PMC10952313 DOI: 10.1111/anae.16104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2023] [Indexed: 08/04/2023]
Abstract
Postoperative systemic inflammation is strongly associated with surgical outcomes, but its relationship with patient-centred outcomes is largely unknown. Detection of excessive inflammation and patient and surgical factors associated with adverse patient-centred outcomes should inform preventative treatment options to be evaluated in clinical trials and current clinical care. This retrospective cohort study analysed prospectively collected data from 3000 high-risk, elective, major abdominal surgery patients in the restrictive vs. liberal fluid therapy for major abdominal surgery (RELIEF) trial from 47 centres in seven countries from May 2013 to September 2016. The co-primary endpoints were persistent disability or death up to 90 days after surgery, and quality of recovery using a 15-item quality of recovery score at days 3 and 30. Secondary endpoints included: 90-day and 1-year all-cause mortality; septic complications; acute kidney injury; unplanned admission to intensive care/high dependency unit; and total intensive care unit and hospital stays. Patients were assigned into quartiles of maximum postoperative C-reactive protein concentration up to day 3, after multiple imputations of missing values. The lowest (reference) group, quartile 1, C-reactive protein ≤ 85 mg.l-1 , was compared with three inflammation groups: quartile 2 > 85 mg.l-1 to 140 mg.l-1 ; quartile 3 > 140 mg.l-1 to 200 mg.l-1 ; and quartile 4 > 200 mg.l-1 to 587 mg.l-1 . Greater postoperative systemic inflammation had a higher adjusted risk ratio (95%CI) of persistent disability or death up to 90 days after surgery, quartile 4 vs. quartile 1 being 1.76 (1.31-2.36), p < 0.001. Increased inflammation was associated with increasing decline in risk-adjusted estimated medians (95%CI) for quality of recovery, the quartile 4 to quartile 1 difference being -14.4 (-17.38 to -10.71), p < 0.001 on day 3, and -5.94 (-8.92 to -2.95), p < 0.001 on day 30. Marked postoperative systemic inflammation was associated with increased risk of complications, poor quality of recovery and persistent disability or death up to 90 days after surgery.
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Affiliation(s)
- C. R. Bain
- Department of Anaesthesiology and Peri‐operative MedicineAlfred Hospital and Monash UniversityMelbourneVICAustralia
| | - P. S. Myles
- Department of Anaesthesiology and Peri‐operative MedicineAlfred Hospital and Monash UniversityMelbourneVICAustralia
| | - C. Martin
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVICAustralia
| | - S. Wallace
- Department of Anaesthesiology and Peri‐operative MedicineAlfred Hospital and Monash UniversityMelbourneVICAustralia
| | - M. A. Shulman
- Department of Anaesthesiology and Peri‐operative MedicineAlfred Hospital and Monash UniversityMelbourneVICAustralia
| | - T. Corcoran
- Department of Anaesthesia and Pain MedicineRoyal Perth HospitalPerthWAAustralia
| | - R. Bellomo
- Department of Critical CareUniversity of MelbourneMelbourneVICAustralia
- Australian and New Zealand Intensive Care Research CentreMonash UniversityMelbourneVICAustralia
| | - P. Peyton
- Department of AnaesthesiaAustin HospitalHeidelbergVICAustralia
| | - D. A. Story
- Department of Critical CareUniversity of MelbourneMelbourneVICAustralia
| | - K. Leslie
- Department of Critical CareUniversity of MelbourneMelbourneVICAustralia
- Department of Anaesthesia and Pain ManagementRoyal Melbourne HospitalMelbourneVICAustralia
| | - A. Forbes
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVICAustralia
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Frei DR, Beasley R, Campbell D, Forbes A, Leslie K, Mackle D, Martin C, Merry A, Moore MR, Myles PS, Ruawai-Hamilton L, Short TG, Young PJ. A vanguard randomised feasibility trial comparing three regimens of peri-operative oxygen therapy on recovery after major surgery. Anaesthesia 2023; 78:1272-1284. [PMID: 37531294 DOI: 10.1111/anae.16103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2023] [Indexed: 08/04/2023]
Abstract
International recommendations encourage liberal administration of oxygen to patients having surgery under general anaesthesia, ostensibly to reduce surgical site infection. However, the optimal oxygen regimen to minimise postoperative complications and enhance recovery from surgery remains uncertain. The hospital operating theatre randomised oxygen (HOT-ROX) trial is a multicentre, patient- and assessor-blinded, parallel-group, randomised clinical trial designed to assess the effect of a restricted, standard care, or liberal peri-operative oxygen therapy regimen on days alive and at home after surgery in adults undergoing prolonged non-cardiac surgery under general anaesthesia. Here, we report the findings of the internal vanguard feasibility phase of the trial undertaken in four large metropolitan hospitals in Australia and New Zealand that included the first 210 patients of a planned overall 2640 trial sample, with eight pre-specified endpoints evaluating protocol implementation and safety. We screened a total of 956 participants between 1 September 2019 and 26 January 2021, with data from 210 participants included in the analysis. Median (IQR [range]) time-weighted average intra-operative Fi O2 was 0.30 (0.26-0.35 [0.20-0.59]) and 0.47 (0.44-0.51 [0.37-0.68]) for restricted and standard care, respectively (mean difference (95%CI) 0.17 (0.14-0.20), p < 0.001). Median time-weighted average intra-operative Fi O2 was 0.83 (0.80-0.85 [0.70-0.91]) for liberal oxygen therapy (mean difference (95%CI) compared with standard care 0.36 (0.33-0.39), p < 0.001). All feasibility endpoints were met. There were no significant patient adverse events. These data support the feasibility of proceeding with the HOT-ROX trial without major protocol modifications.
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Affiliation(s)
- D R Frei
- Department of Anaesthesia and Pain Management, Wellington Hospital, Wellington, New Zealand
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - R Beasley
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - D Campbell
- Department of Anaesthesiology, University of Auckland, Auckland, New Zealand
- Department of Anaesthesia and Peri-operative Medicine, Auckland City Hospital, Auckland, New Zealand
| | - A Forbes
- Biostatistics Unit, Division of Research Methodology, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - K Leslie
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, VIC, Australia
- Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia
| | - D Mackle
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - C Martin
- Biostatistics Unit, Division of Research Methodology, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - A Merry
- Department of Anaesthesiology, University of Auckland, Auckland, New Zealand
| | - M R Moore
- Department of Anaesthesiology, University of Auckland, Auckland, New Zealand
| | - P S Myles
- Department of Anaesthesiology and Peri-operative Medicine, Alfred Hospital, Melbourne, VIC, Australia
- Department of Anaesthesiology and Peri-operative Medicine, Central Clinical School, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - L Ruawai-Hamilton
- Department of Anaesthesia and Pain Management, Wellington Hospital, Wellington, New Zealand
| | - T G Short
- Department of Anaesthesia and Peri-operative Medicine, Auckland City Hospital, Auckland, New Zealand
- Department of Anaesthesiology, University of Auckland, Auckland, New Zealand
| | - P J Young
- Department of Anaesthesiology, University of Auckland, Auckland, New Zealand
- Department of Intensive Care, Wellington Regional Hospital, Wellington, New Zealand
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Ilves N, Muhhamedjanov K, Forbes A. Malnutrition Risk, Subjective Global Assessment And GLIM (Global Leaders Initiative On Malnutrition) Scoring In Nordic Hospital Patients. Clin Nutr ESPEN 2023. [DOI: 10.1016/j.clnesp.2022.09.221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2023]
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Ilves N, Muhhamedjanov K, Eerme M, Laatspera H, Merilo A, Fragkos K, Forbes A. Towards Automated Nutrition Screening. Clin Nutr ESPEN 2023. [DOI: 10.1016/j.clnesp.2022.09.220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
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Sinclair AJ, Bellary S, Dashora U, Abdelhafiz AH, Rowles S, Reedman L, Turner B, Green M, Forbes A, Middleton A. Enhancing diabetes care for the most vulnerable in the 21st century: Interim findings of the National Advisory Panel on Care Home Diabetes (NAPCHD). Diabet Med 2023:e15088. [PMID: 36929728 DOI: 10.1111/dme.15088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 03/08/2023] [Accepted: 03/11/2023] [Indexed: 03/18/2023]
Abstract
Older adults with diabetes may carry a substantial health burden in Western ageing societies, occupy more than one in four beds in care homes, and are a highly vulnerable group who often require complex nursing and medical care. The global pandemic (COVID-19) had its epicentre in care homes and revealed many shortfalls in diabetes care resulting in hospital admissions and considerable mortality and comorbid illness. The purpose of this work was to develop a national Strategic Document of Diabetes Care for Care Homes which would bring about worthwhile, sustainable and effective quality diabetes care improvements, and address the shortfalls in care provided. A large diverse and multidisciplinary group of stakeholders (NAPCHD) defined 11 areas of interest where recommendations were needed and using a subgroup allocation approach were set tasks to produce a set of primary recommendations. Each subgroup was given 5 starter questions to begin their work and a format to provide responses. During the initial phase, 16 key findings were identified. Overall, after a period of 18 months, 49 primary recommendations were made, and 7 major conclusions were drawn from these. A model of community and integrated diabetes care for care home residents with diabetes was proposed, and a series of 5 'quick-wins' were created to begin implementation of some of the recommendations that would not require significant funding. The work of the NAPCHD is ongoing but we hope that this current resource will help leaders to make these required changes happen.
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Affiliation(s)
- A J Sinclair
- Foundation for Diabetes Research in Older People and King's College, London, UK
| | - S Bellary
- University of Aston and University Hospitals Birmingham Foundation Trust, Birmingham, UK
| | - U Dashora
- East Sussex Healthcare NHS Trust and Joint British Diabetes Societies-IP Care JBDS-IP and Association of British Clinical Diabetologists (ABCD), Malmesbury, UK
| | - A H Abdelhafiz
- Rotherham NHS Foundation Trust and Older Peoples Diabetes Network (OPDN), Rotherham, UK
| | - S Rowles
- Pennine Acute Hospitals NHS Trust and ABCD, Manchester, UK
| | | | | | | | | | - A Middleton
- Person Living with Diabetes (PLWD) and Diabetes, UK Diabetes Research Steering Group, London, UK
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Lim Y, Cicuttini F, Wluka A, Jones G, Hill C, Forbes A, Tonkin A, Berezovskaya S, Tan L, Ding C, Wang Y. AB0978 Effect of atorvastatin on skeletal muscles of patients with knee osteoarthritis: post-hoc analysis of a randomised controlled trial. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundStatins are often discontinued due to muscle-related side effects. The effect of statin on skeletal muscles in populations with osteoarthritis is unknown.ObjectivesThis study aims to examine the effect of atorvastatin on skeletal muscle biochemistry, strength, size and symptoms in patients with symptomatic knee osteoarthritis.MethodsThis is a post-hoc analysis of a multicentre randomised, double-blind, placebo-controlled trial over 2 years in which participants with knee osteoarthritis who met the American College of Rheumatology clinical criteria received atorvastatin 40mg daily (n=151) or placebo (n=153). Outcomes included levels of creatinine kinase (CK), aspartate transaminases (AST) and alanine transaminases (ALT) at baseline, 4 weeks, 6, 12 and 24 months; muscle strength measured by dynamometry at baseline, 12 and 24 months; vastus medialis cross-sectional area (CSA) on magnetic resonance imaging at baseline and 24 months; and self-reported myalgia during the trial.Results304 participants [mean age 55.7 (SD 7.6) years, 55.6% female] were randomised. There were no significant differences in CK and AST levels between atorvastatin and placebo groups at 4 weeks (CK median 107 vs 110, p=0.76; AST 22 vs 21, p=0.14), 6 (CK 109 vs 101.5, p=0.37; AST 21 vs 20, p=0.45), 12 (CK 103 vs 103, p=0.93; AST 22 vs 21, p=0.99), and 24 (CK 103 vs 93.5, p=0.17; AST 22 vs 21, p=0.34) months. The atorvastatin group had higher ALT levels than the placebo group at 4 weeks [26 vs 21, p=0.0004] and 6 months [25 vs 22, p=0.007] but no between-group differences at 12 [24 vs 21, p=0.08] and 24 [24 vs 21, p=0.053] months. Muscle strength significantly increased in the atorvastatin group but not the placebo group over 24 months with no between-group differences [mean 8.5 (95% CI 2.6,14.4) vs 5.6 (-0.3,11.5), p=0.50]. Change in vastus medialis CSA over 24 months showed between-group differences favouring the atorvastatin group [+0.12 (-0.09,0.34) vs -0.24 (-0.48,0.01), p=0.03] but of uncertain clinical significance. There was a trend for more myalgia in the atorvastatin group over 2 years (8/151 vs 2/153, p=0.06), mostly occurring within 6 months (7/151 vs 1/153, p=0.04). Of the 10 participants with myalgia, there was no relationship between the incidence of myalgia and CK levels.ConclusionIn those with symptomatic knee osteoarthritis, despite a trend for more myalgia, there was no clear evidence of an adverse effect of atorvastatin on skeletal muscles, including those most relevant to knee joint health.Disclosure of InterestsYuan Lim: None declared, Flavia Cicuttini: None declared, Anita Wluka: None declared, Graeme Jones Speakers bureau: GJ received honoraria for talks from BMS, Roche, AbbVie, Amgen, Lilly, Novartis, and Janssen, Grant/research support from: GJ received grant for a clinical trial from Covance, Catherine Hill: None declared, Andrew Forbes: None declared, Andrew Tonkin Speakers bureau: AT received honoraria for lectures from Pfizer; honoraria for lectures and advisory board participation from Amgen, Consultant of: AT received honoraria for lectures and advisory board participation from Amgen, honoraria for data and safety monitoring board participation from Merck, and honoraria for data and safety monitoring board participation from Novartis, Sofia Berezovskaya: None declared, Lynn Tan: None declared, Changhai Ding: None declared, Yuanyuan Wang: None declared
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Wong S, Hirani S, Forbes A, Kumar N, Hariharan R, O'Driscoll J, Viswanathan A, Harvey G, Sekhar R, Jamous A. Effect of lactobacillus casei shirota in preventing antibiotic associated diarrhoea including clostridium difficile infection in patients with spinal cord injuries: a multicentre randomised, double-blinded, placebo-controlled trial. Clin Nutr ESPEN 2021. [DOI: 10.1016/j.clnesp.2021.09.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Kurukulaarachchi S, Caroli-Bosc P, Gillis V, Szczepanek K, Wanten G, Schneider S, Forbes A. Thrombotic and haemorrhagic complications of home parenteral nutrition. Clin Nutr ESPEN 2021. [DOI: 10.1016/j.clnesp.2021.09.402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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9
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Forbes A, Cantin V, Develle Y, Dubé Y, Bertrand-Grenier A, Ménard-Lebel C, Sobczak S. Musculoskeletal ultrasound for 3D bone modeling: A preliminary study applied to lumbar vertebra. J Back Musculoskelet Rehabil 2021; 34:937-950. [PMID: 34092595 DOI: 10.3233/bmr-200259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND There is no non-invasive in vivo method to assess intervertebral kinematics. Current kinematics models are based on in vitro bone reconstructions from computed tomography (CT)-scan imaging, fluoroscopy and MRIs, which are either expensive or deleterious for human tissues. Musculoskeletal ultrasound is an accessible, easy to use and cost-effective device that allows high-resolution, real-time imaging of bone structure. OBJECTIVE The aim of this preliminary study was to compare the concordance of 3D bone modeling of lumbar vertebrae between CT-scan and ultrasound imaging and to study the intra and inter-reliability of distances measured on 3D ultrasound bone models. METHODS CT-scan, ultrasound, and in situ data of five lumbar vertebrae from the same human specimen were used. All vertebrae were scanned by tomography and a new musculoskeletal ultrasound procedure. Then, 3D bone modeling was created from both CT-scan and ultrasound image data set. Distances between anatomical bones landmarks were measured on the 3D models and compared to in situ measurements.
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Affiliation(s)
- A Forbes
- Chaire de Recherche en Anatomie Fonctionnelle, Université du Québec à Trois-Rivières, Trois-Rivières (QC) Canada, G8Z 4M3, Canada.,Groupe de Recherche sur les Affections Neuromusculosquelettiques (GRAN), Université du Québec à Trois-Rivières, Trois-Rivières (QC) Canada, G8Z 4M3, Canada
| | - V Cantin
- Groupe de Recherche sur les Affections Neuromusculosquelettiques (GRAN), Université du Québec à Trois-Rivières, Trois-Rivières (QC) Canada, G8Z 4M3, Canada.,Département des Sciences de L'activité Physique, Université du Québec à Trois-Rivières, Trois-Rivières (QC) Canada, G8Z 4M3, Canada
| | - Y Develle
- Chaire de Recherche en Anatomie Fonctionnelle, Université du Québec à Trois-Rivières, Trois-Rivières (QC) Canada, G8Z 4M3, Canada
| | - Y Dubé
- Département de Génie Mécanique, Université du Québec à Trois-Rivières, Trois-Rivières (QC) Canada, G8Z 4M3, Canada
| | - A Bertrand-Grenier
- Département de Chimie, Biochimie et Physique, Université du Québec à Trois-Rivières, Trois-Rivières (QC) Canada, G8Z 4M3, Canada.,CIUSSS de la Mauricie-et-du-Centre-du-Québec, Centre Hospitalier Affilié Universitaire Régional, Trois-Rivières, QC G8Z 3R9, Canada
| | - C Ménard-Lebel
- Chaire de Recherche en Anatomie Fonctionnelle, Université du Québec à Trois-Rivières, Trois-Rivières (QC) Canada, G8Z 4M3, Canada.,Groupe de Recherche sur les Affections Neuromusculosquelettiques (GRAN), Université du Québec à Trois-Rivières, Trois-Rivières (QC) Canada, G8Z 4M3, Canada
| | - S Sobczak
- Chaire de Recherche en Anatomie Fonctionnelle, Université du Québec à Trois-Rivières, Trois-Rivières (QC) Canada, G8Z 4M3, Canada.,Département D'anatomie, Université du Québec à Trois-Rivières, Trois-Rivières (QC) Canada, G8Z 4M3, Canada.,Groupe de Recherche sur les Affections Neuromusculosquelettiques (GRAN), Université du Québec à Trois-Rivières, Trois-Rivières (QC) Canada, G8Z 4M3, Canada
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Quaglino P, Prince H, Cowan R, Vermeer M, Papadavid L, Bagot M, Servitjie O, Berti E, Guenova E, Stadler R, Querfeld C, Busschots A, Hodak E, Patsatsi A, Sanches J, Maule M, Yoo J, Kevin M, Fava P, Ribero S, Zocchi L, Rubatto M, Fierro M, Wehkamp U, Marshalko M, Mitteldorf C, Akilov O, Ortiz-Romero P, Estrach T, Vakeva L, Enz P, Wobser M, Bayne M, Jonak C, Rubeta M, Forbes A, Bates A, Battistella M, Amel-Kashipaz R, Vydianath B, Combalia A, Georgiou E, Hauben E, Hong E, Jost M, Knobler R, Amitay-Laish I, Miyashiro D, Cury-Martins J, Martinez X, Muniesa C, Prag-Naveh H, Nikolaou V, Quint K, Ram-Wolff C, Rieger K, Stranzenbach R, Szepesi Á, Alberti-Violetti S, Felicity E, Cerroni L, Kempf W, Whittaker S, Willemze R, Kim Y, Scarisbrick J. Treatment of early-stage mycosis fungoides: results from the PROspective Cutaneous Lymphoma International Prognostic Index (PROCLIPI) study. Br J Dermatol 2021; 184:722-730. [PMID: 32479678 PMCID: PMC7704558 DOI: 10.1111/bjd.19252] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The PROspective Cutaneous Lymphoma International Prognostic Index (PROCLIPI) study is a prospective analysis of an international database. Here we examine front-line treatments and quality of life (QoL) in patients with newly diagnosed mycosis fungoides (MF). OBJECTIVES To identify (i) differences in first-line approaches according to tumour-nodes-metastasis-blood (TNMB) staging; (ii) parameters related to a first-line systemic approach and (iii) response rates and QoL measures. METHODS In total, 395 newly diagnosed patients with early-stage MF (stage IA-IIA) were recruited from 41 centres in 17 countries between 1 January 2015 and 31 December 2018 following central clinicopathological review. RESULTS The most common first-line therapy was skin-directed therapy (SDT) (322 cases, 81·5%), while a smaller percentage (44 cases, 11·1%) received systemic therapy. Expectant observation was used in 7·3%. In univariate analysis, the use of systemic therapy was significantly associated with higher clinical stage (IA, 6%; IB, 14%; IIA, 20%; IA-IB vs. IIA, P < 0·001), presence of plaques (T1a/T2a, 5%; T1b/T2b, 17%; P < 0·001), higher modified Severity Weighted Assessment Tool (> 10, 15%; ≤ 10, 7%; P = 0·01) and folliculotropic MF (FMF) (24% vs. 12%, P = 0·001). Multivariate analysis demonstrated significant associations with the presence of plaques (T1b/T2b vs. T1a/T2a, odds ratio 3·07) and FMF (odds ratio 2·83). The overall response rate (ORR) to first-line SDT was 73%, while the ORR to first-line systemic treatments was lower (57%) (P = 0·027). Health-related QoL improved significantly both in patients with responsive disease and in those with stable disease. CONCLUSIONS Disease characteristics such as presence of plaques and FMF influence physician treatment choices, and SDT was superior to systemic therapy even in patients with such disease characteristics. Consequently, future treatment guidelines for early-stage MF need to address these issues.
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Affiliation(s)
- P. Quaglino
- Dermatologic Clinic, University of Turin Medical School, Torino, Italy
| | - H.M. Prince
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Australia
| | - R. Cowan
- Christie Hospital, Manchester UK
| | - M. Vermeer
- Leiden University Medical Centre, The Netherlands
| | | | - M. Bagot
- Hospital St Louis, Paris, France
| | - O. Servitjie
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | | | | | - R. Stadler
- University Medical Centre, Johannes Wesling, Minden, Germany
| | - C. Querfeld
- City of Hope National Medical Center and Beckman Research Institute, Duarte, California, US
| | | | - E. Hodak
- Rabin Medical Center, Tel Aviv University, Israel
| | - A. Patsatsi
- Aristotle University of Thessaloniki, in Papageorgiou General Hospital, Greece
| | - J. Sanches
- University of Sao Paulo Medical School, Brazil, South America
| | - M. Maule
- Cancer Epidemiology Unit, Department Medical Sciences, University of Turin, Italy
| | - J. Yoo
- University Hospitals Birmingham, UK
| | - M. Kevin
- University Hospitals Birmingham, UK
| | - P. Fava
- Dermatologic Clinic, University of Turin Medical School, Torino, Italy
| | - S. Ribero
- Dermatologic Clinic, University of Turin Medical School, Torino, Italy
| | - L. Zocchi
- Dermatologic Clinic, University of Turin Medical School, Torino, Italy
| | - M. Rubatto
- Dermatologic Clinic, University of Turin Medical School, Torino, Italy
| | - M.T. Fierro
- Dermatologic Clinic, University of Turin Medical School, Torino, Italy
| | - U. Wehkamp
- University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | | | - C. Mitteldorf
- HELIOS Klinikum Hildesheim GmbH, University Medical Center Göttingen, Germany
| | - O. Akilov
- University of Pittsburgh School of Medicine, Pennsylvania, USA
| | | | - T. Estrach
- Hospital Clinico, University of Barcelona, Spain
| | - L. Vakeva
- Helsinki University Central Hospital, Finland
| | - P.A. Enz
- Hospital Italiano De Buenos Aires, Argentina, South America
| | - M. Wobser
- University Hospital Wuerzburg, Germany
| | | | - C. Jonak
- Dept of Dermatology, Medical University of Vienna, Austria
| | - M. Rubeta
- Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford UK
| | | | - A. Bates
- University Hospital Southampton, Southampton, UK
| | | | | | | | - A. Combalia
- Hospital Clinico, University of Barcelona, Spain
| | - E. Georgiou
- Aristotle University of Thessaloniki, in Papageorgiou General Hospital, Greece
| | - E. Hauben
- Belgium University Hospitals Leuven, Leuven, Belgium
| | | | - M. Jost
- University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - R. Knobler
- Dept of Dermatology, Medical University of Vienna, Austria
| | | | - D. Miyashiro
- University of Sao Paulo Medical School, Brazil, South America
| | - J. Cury-Martins
- University of Sao Paulo Medical School, Brazil, South America
| | - X. Martinez
- City of Hope National Medical Center and Beckman Research Institute, Duarte, California, US
| | - C. Muniesa
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | | | | | - K. Quint
- Leiden University Medical Centre, The Netherlands
| | | | | | - R. Stranzenbach
- University Medical Centre, Johannes Wesling, Minden, Germany
| | - Á. Szepesi
- Semmelweis University, Budapest, Hungary
| | | | | | - L. Cerroni
- Department of Dermatology, Research Unit Dermatopathology, Medical University of Graz, Graz, Austria
| | - W. Kempf
- Kempf und Pfaltz, Histologische Diagnostik, Zurich, Switzerland
| | - S. Whittaker
- Kings College London, Guys and St Thomas NHS Foundation Trust, London
| | - R. Willemze
- Leiden University Medical Centre, The Netherlands
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Thompson JA, Hemming K, Forbes A, Fielding K, Hayes R. Comparison of small-sample standard-error corrections for generalised estimating equations in stepped wedge cluster randomised trials with a binary outcome: A simulation study. Stat Methods Med Res 2021; 30:425-439. [PMID: 32970526 PMCID: PMC8008420 DOI: 10.1177/0962280220958735] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Generalised estimating equations with the sandwich standard-error estimator provide a promising method of analysis for stepped wedge cluster randomised trials. However, they have inflated type-one error when used with a small number of clusters, which is common for stepped wedge cluster randomised trials. We present a large simulation study of binary outcomes comparing bias-corrected standard errors from Fay and Graubard; Mancl and DeRouen; Kauermann and Carroll; Morel, Bokossa, and Neerchal; and Mackinnon and White with an independent and exchangeable working correlation matrix. We constructed 95% confidence intervals using a t-distribution with degrees of freedom including clusters minus parameters (DFC-P), cluster periods minus parameters, and estimators from Fay and Graubard (DFFG), and Pan and Wall. Fay and Graubard and an approximation to Kauermann and Carroll (with simpler matrix inversion) were unbiased in a wide range of scenarios with an independent working correlation matrix and more than 12 clusters. They gave confidence intervals with close to 95% coverage with DFFG with 12 or more clusters, and DFC-P with 18 or more clusters. Both standard errors were conservative with fewer clusters. With an exchangeable working correlation matrix, approximated Kauermann and Carroll and Fay and Graubard had a small degree of under-coverage.
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Affiliation(s)
- JA Thompson
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - K Hemming
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - A Forbes
- Biostatistics Unit, Monash University, Melbourne, Australia
| | - K Fielding
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - R Hayes
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
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Forde R, Collin J, Brackenridge A, Chamley M, Hunt K, Forbes A. A qualitative study exploring the factors that influence the uptake of pre-pregnancy care among women with Type 2 diabetes. Diabet Med 2020; 37:1038-1048. [PMID: 31127872 DOI: 10.1111/dme.14040] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/23/2019] [Indexed: 01/19/2023]
Abstract
AIM To elicit the views and experiences of women with Type 2 diabetes and healthcare professionals relating to the pregnancy and pre-pregnancy care they have received or provided. METHODS A qualitative study using in-depth semi-structured interviews with women with Type 2 diabetes (n=30) and healthcare professionals (n=22) from primary and specialist care. Women were purposively sampled to include different experiences of pregnancy and pre-pregnancy care. Data were transcribed verbatim and analysed thematically using Framework Analysis. RESULTS The median age of the women was 37 years, and most were obese (median BMI 34.9 kg/m2 ), of black or Asian ethnicity (n=24, 80%) and from areas of high deprivation (n=21, 70%). Participating healthcare professionals were from primary (n=14), intermediate (n=4) and secondary (n=4) care. Seven themes expressing factors that mediate reproductive behaviour and care in women with Type 2 diabetes were identified at the patient, professional and system levels. Type 2 diabetes was generally perceived negatively by the women and the healthcare professionals. There was a lack of awareness about the pre-pregnancy care needs for this population, and communication between both groups was unhelpful in eliciting the reproductive intentions of these women. The themes also reveal a lack of systemic processes to incorporate pre-pregnancy care into the care of women with Type 2 diabetes, and consequently, health professionals in primary care have limited capacity to provide such support. CONCLUSION If the current high levels of unprepared pregnancies in women with Type 2 diabetes are to be reduced, the reproductive healthcare needs of this group need to be embedded into their mainstream diabetes management.
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Affiliation(s)
- R Forde
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College, London, UK
| | - J Collin
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College, London, UK
| | | | - M Chamley
- North Wood Group Practice, London, UK
| | - K Hunt
- King's College Hospital NHS Foundation Trust, London, UK
| | - A Forbes
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College, London, UK
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Amerikanou C, Papada E, Tanaini A, Jiménez-Hernandez N, D’auria G, Mitsou E, Smyrnioudis I, Kyriakou A, Forbes A, Francino M, Kaliora A. SUN-PO055: The Effect of Mastiha Supplement in Microbiota Composition in Patients with IBD; Preliminary Results. Clin Nutr 2019. [DOI: 10.1016/s0261-5614(19)32689-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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14
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Patel P, Fragkos K, Keane N, Mountford C, Wilkinson D, Johnson A, Naghibi M, Chan D, Roberts B, Neild P, Yalcin M, Allan P, Fitzpatrick M, Gomez M, Williams S, Kok K, Sharkey L, Swfit C, Forbes A, Mehta S, Rahman F, Di Caro S. MON-PO399: Nutritional Care Pathways of Patients with Malignant Bowel Obstruction: Preliminary Findings from 8 UK Centres. Clin Nutr 2019. [DOI: 10.1016/s0261-5614(19)32232-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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15
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Patel P, Fragkos K, Keane N, Mountford C, Wilkinson D, Johnson A, Naghibi M, Chan D, Roberts B, Neild P, Yalcin M, Allan P, Fitzpatrick M, Gomez M, Williams S, Kok K, Sharkey L, Swfit C, Forbes A, Mehta S, Rahman F, Di Caro S. MON-PO400: Parenteral Nutrition in Patients with Malignant Bowel Obstruction: Preliminary Findings from 8 UK Centres: Are all Patients Referred Appropriately? Clin Nutr 2019. [DOI: 10.1016/s0261-5614(19)32233-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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16
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Papada E, Amerikanou C, Forbes A, Kaliora A. SUN-PO057: Adherence to Mediterranean Diet in Crohn’s Disease. Clin Nutr 2019. [DOI: 10.1016/s0261-5614(19)32691-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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17
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Patel PS, Fragkos K, Keane N, Mountford C, Wilkinson D, Johnson A, Naghibi M, Chan D, Roberts B, Neild P, Metin Devrim Y, Allan P, Fitzpatrick M, Gomez M, Williams S, Kok K, Sharkey L, Swift C, Forbes A, Mehta S, Rahman F, Di Caro S. OWE-17 Nutritional care pathways of patients with malignant bowel obstruction: preliminary findings from 8 UK Centres. Nutrition 2019. [DOI: 10.1136/gutjnl-2019-bsgabstracts.328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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18
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Due-Christensen M, Willaing I, Ismail K, Forbes A. Learning about Type 1 diabetes and learning to live with it when diagnosed in adulthood: two distinct but inter-related psychological processes of adaptation A qualitative longitudinal study. Diabet Med 2019; 36:742-752. [PMID: 30329176 DOI: 10.1111/dme.13838] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/12/2018] [Indexed: 11/27/2022]
Abstract
AIM To explore the experiences of adults with newly diagnosed Type 1 diabetes in order to understand the adaptive processes that occur in the early phase of the condition. METHODS We conducted longitudinal semi-structured interviews with 30 adults newly diagnosed with Type 1 diabetes (age range 20-67 years; 16 men; median diabetes duration 23.5 months), recruited from hospitals in Denmark and the UK. The data were analysed using a narrative approach. RESULTS The narratives could be grouped into three thematic areas: the diagnosis; learning about diabetes; and learning to live with diabetes. Diabetes was characterized as a major disruptor to the established and future life plans of participants, causing significant emotional distress. The narratives showed how early experiences triggered the development of ongoing psychological problems (fear of complications or hypoglycaemia) and diabetes distress, and that navigating different social scenarios (relationships and employment) could be challenging, leading to suboptimal self-management behaviours. The narratives also showed that health professionals often did not attend effectively to participants' emotional needs after diagnosis, and that the language used frequently triggered negative feelings, such as fear or a sense of failure. CONCLUSIONS Many of the common psychosocial problems associated with Type 1 diabetes seem to gestate in the early phase of life with the condition. There appear to be opportunities to enhance the support provided in this phase to minimize these problems.
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Affiliation(s)
- M Due-Christensen
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
- Steno Diabetes Centre Copenhagen, Gentofte, Denmark
| | - I Willaing
- Steno Diabetes Centre Copenhagen, Gentofte, Denmark
| | - K Ismail
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience at King's College London, London, UK
| | - A Forbes
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
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19
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Abstract
In our ageing society diabetes imposes a significant burden in terms of the numbers of people with the condition, diabetes-related complications including disability, and health and social care expenditure. Older people with diabetes can represent some of the more complex and difficult challenges facing the clinician working in different settings, and the recognition that we have only a relatively small (but increasing) evidence base to guide us in diabetes management is a limitation of our current approaches. Nevertheless, in this review we attempt to explore what evidence there is to guide us in a comprehensive scheme of treatment for older adults, often in a high-risk clinical state, in terms of glucose lowering, blood pressure and lipid management, frailty care and lifestyle interventions. We strive towards individualized care and make a call for action for more high-quality research using different trial designs.
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Affiliation(s)
- A J Sinclair
- Foundation for Diabetes Research in Older People, Diabetes Frail Ltd, Droitwich, UK
| | | | | | - M Munshi
- Harvard Medical School and Joslin Clinic, Boston, MA, USA
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20
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Vijayakumar A, Rosales-Guzmán C, Rai MR, Rosen J, Minin OV, Minin IV, Forbes A. Generation of structured light by multilevel orbital angular momentum holograms. Opt Express 2019; 27:6459-6470. [PMID: 30876231 DOI: 10.1364/oe.27.006459] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 01/19/2019] [Indexed: 05/23/2023]
Abstract
Structured light has been created by a myriad of near-and far-field techniques and has found both classical and quantum applications. In the case of orbital angular momentum (OAM), continuous spiral phase patterns in dynamic or geometric phase are often employed with the phase patterns existing across the entire transverse plane. Here, we exploit the uncertain relationship between OAM and angle in order to create structured OAM fields by using multilevel OAM holograms. We show theoretically and experimentally that only a multilevel angular phase contour in the near-field is needed to create structured OAM light in the far-field, exploiting the reciprocal nature of angular momentum and angle. We use this approach to demonstrate exotic 3D structured light control to show the Poynting vector's evolution in such fields and to highlight the physics underlying this phenomenon.
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21
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Parsons J, Sparrow K, Ismail K, Hunt K, Rogers H, Forbes A. A qualitative study exploring women's health behaviours after a pregnancy with gestational diabetes to inform the development of a diabetes prevention strategy. Diabet Med 2019; 36:203-213. [PMID: 30098217 DOI: 10.1111/dme.13794] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/06/2018] [Indexed: 01/20/2023]
Abstract
AIM To inform targeted interventions for women with gestational diabetes mellitus (GDM) by exploring the factors that influence their health behaviours and their preferences for lifestyle support. METHODS Participants were women with previous GDM taken from a diverse inner-city UK population. Data collection involved focus groups (n = 35 women in six groups) and semi-structured interviews (n = 15 women). The transcribed data were analysed using framework analysis. RESULTS Eight themes relating to factors influencing health behaviour were identified: psychological legacy of pregnancy, relationships with healthcare professionals, physical impacts of pregnancy, social support and cultural norms, life-scheduling, understanding and risk perception, appetite regulation, and prioritization of the baby. The women's recommendations for intervention components included addressing the emotional stress of pregnancy; conveying personalized risk in a motivational way, adopting a family-centered approach, focusing on women's health rather than just the infant's, and developing flexible interventions. These recommendations were used to construct a model integrating the behaviour-regulating factors with a suggested framework for intervention. CONCLUSIONS This study identified some common drivers that may regulate the health behaviours of women following GDM, and recognized some ways to improve care to impact on this. Interventions for diabetes prevention in this population need to address factors at both the individual and systemic levels.
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Affiliation(s)
- J Parsons
- Adult Nursing, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - K Sparrow
- Department of Psychological Medicine, Institute of Psychiatry, King's College London, London, UK
| | - K Ismail
- Department of Psychological Medicine, Institute of Psychiatry, King's College London, London, UK
| | - K Hunt
- Diabetes Research Group, Diabetes & Nutritional Sciences Division, King's College London, London, UK
| | - H Rogers
- Diabetes Research Group, Diabetes & Nutritional Sciences Division, King's College London, London, UK
| | - A Forbes
- Adult Nursing, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
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22
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Myles PS, Smith JA, Kasza J, Silbert B, Jayarajah M, Painter T, Cooper DJ, Marasco S, McNeil J, Bussières JS, McGuinness S, Byrne K, Chan MT, Landoni G, Wallace S, Forbes A, Myles P, Smith J, Cooper DJ, Silbert B, McNeil J, Marasco S, Esmore D, Krum H, Tonkin A, Buxton B, Heritier S, Merry A, Liew D, McNeil J, Forbes A, Cooper D, Wallace S, Meehan A, Myles P, Wallace S, Galagher W, Farrington C, Ditoro A, Wutzlhofer L, Story D, Peyton P, Baulch S, Sidiropoulos S, Potgieter D, Baker R, Pesudovs B, O'Loughlin J Wells E, Coutts P, Bolsin S, Osborne C, Ives K, Smith J, Hulley A, Christie-Taylor G, Painter T, Lang S, Mackay H, Cokis C, March S, Bannon P, Wong C, Turner L, Scott D, Silbert B, Said S, Corcoran P, Painter T, de Prinse L, Bussières J, Gagné N, Lamy A, Semelhago L, Chan M, Underwood M, Choi G, Fung B, Landoni G, Lembo R, Monaco F, Simeone F, Marianello D, Alvaro G, De Vuono G, van Dijk D, Dieleman J, Numan S, McGuinness S, Parke R, Raudkivi P, Gilder E, Byrne K, Dunning J, Termaat J, Mans G, Jayarajah M, Alderton J, Waugh D, Platt M, Pai A, Sevillano A, Lal A, Sinclair C, Kunst G, Knighton A, Cubas G, Saravanan P, Millner R, Vasudevan V, Patteril M, Lopez E, Basu R, Lu J. Tranexamic acid in coronary artery surgery: One-year results of the Aspirin and Tranexamic Acid for Coronary Artery Surgery (ATACAS) trial. J Thorac Cardiovasc Surg 2019; 157:644-652.e9. [DOI: 10.1016/j.jtcvs.2018.09.113] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 09/13/2018] [Accepted: 09/27/2018] [Indexed: 11/30/2022]
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23
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Leslie K, Myles PS, Forbes A, Chan MTV, Short TG, Swallow SK. Recovery from Bispectral Index-guided Anaesthesia in a Large Randomized Controlled Trial of Patients at High Risk of Awareness. Anaesth Intensive Care 2019; 33:443-51. [PMID: 16119484 DOI: 10.1177/0310057x0503300404] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Electroencephalographic monitors of anaesthetic depth are reported to assist anaesthetists in reducing recovery times. We explored the effect of bispectral index (BIS) monitoring on recovery times in a double-blind, randomized controlled trial of 2,463 patients at high risk of awareness. Patients were randomized to BIS-guided anaesthesia or routine care. In the BIS group, anaesthesia was adjusted to maintain a BIS value of 40–60 from the commencement of laryngoscopy to the start of wound closure, and 55–70 during wound closure. In the routine care group, anaesthesia was adjusted according to traditional clinical signs. In multivariate models, BIS monitoring, female gender, lower American Society of Anesthesiologists’ physical status and shorter duration of anaesthesia predicted faster time to eye-opening after anaesthesia, and faster time to post-anaesthesia care unit discharge. BIS monitoring did not affect times to tracheal extubation among patients admitted to the intensive care unit. We conclude that BIS monitoring has statistically significant, but clinically modest, effects on recovery times in high risk surgical patients.
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Affiliation(s)
- K Leslie
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Parkville, Vic
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24
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Corcoran T, Kasza J, Short TG, O'Loughlin E, Chan MTV, Leslie K, Forbes A, Paech M, Myles P. Intraoperative dexamethasone does not increase the risk of postoperative wound infection: a propensity score-matched post hoc analysis of the ENIGMA-II trial (EnDEX). Br J Anaesth 2018; 118:190-199. [PMID: 28100522 DOI: 10.1093/bja/aew446] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2016] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND In a post hoc analysis of the ENIGMA-II trial, we sought to determine whether intraoperative dexamethasone was associated with adverse safety outcomes. METHODS Inverse probability weighting with estimated propensity scores was used to determine the association of dexamethasone administration with postoperative infection, quality of recovery, and adverse safety outcomes for 5499 of the 7112 non-cardiac surgery subjects enrolled in ENIGMA-II. RESULTS Dexamethasone was administered to 2178 (40%) of the 5499 subjects included in this analysis and was not associated with wound infection [189 (8.7%) vs 275 (8.3%); propensity score-adjusted relative risk (RR) 1.10; 95% confidence interval (CI) 0.89-1.34; P=0.38], severe postoperative nausea and vomiting on day 1 [242 (7.3%) vs 189 (8.7%); propensity score-adjusted RR 1.06; 95% CI 0.86-1.30; P=0.59], quality of recovery score [median 14, interquartile range (IQR) 12-15, vs median 14, IQR 12-16, P=0.10), length of stay in the postanaesthesia care unit [propensity score-adjusted median (IQR) 2.0 (1.3, 2.9) vs 1.9 (1.3, 3.1), P=0.60], or the primary outcome of the main trial. Dexamethasone administration was associated with a decrease in fever on days 1-3 [182 (8.4%) vs 488 (14.7%); RR 0.61; 95% CI 0.5-0.74; P<0.001] and shorter lengths of stay in hospital [propensity score-adjusted median (IQR) 5.0 (2.9, 8.2) vs 5.3 (3.1, 9.1), P<0.001]. Neither diabetes mellitus nor surgical wound contamination status altered these outcomes. CONCLUSION Dexamethasone administration to high-risk non-cardiac surgical patients did not increase the risk of postoperative wound infection or other adverse events up to day 30, and appears to be safe in patients either with or without diabetes mellitus. CLINICAL TRIAL REGISTRATION NCT00430989.
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Affiliation(s)
- T Corcoran
- Department of Anaesthesia and Pain Medicine, Royal Perth Hospital, Perth, Western Australia, Australia .,School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia.,Western Australia Health Department, Perth, Western Australia, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - J Kasza
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - T G Short
- Department of Anaesthesia, Auckland City Hospital, Park Road, Grafton, Auckland, New Zealand
| | - E O'Loughlin
- School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia.,Department of Anaesthesia and Pain Medicine, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - M T V Chan
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - K Leslie
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Anaesthesia, Perioperative and Pain Medicine Unit, and Department of Pharmacology and Therapeutics, University of Melbourne, Melbourne, Victoria, Australia
| | - A Forbes
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - M Paech
- Department of Anaesthesia and Pain Medicine, Royal Perth Hospital, Perth, Western Australia, Australia.,School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia
| | - P Myles
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Department of Anaesthesia and Perioperative Medicine, Alfred Hospital, Melbourne, Victoria, Australia
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Papada E, Amerikanou C, Torovic L, Kalogeropoulos N, Tzavara C, Forbes A, Kaliora A. On the identification of plasma free amino acid profile in patients with quiescent IBD. A placebo-controlled randomised clinical trial with mastiha supplement. Clin Nutr 2018. [DOI: 10.1016/j.clnu.2018.06.1164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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26
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Player EL, Morris P, Thomas T, Chan WY, Vyas R, Dutton J, Tang J, Alexandre L, Forbes A. Bioelectrical impedance analysis (BIA)-derived phase angle (PA) is a practical aid to nutritional assessment in hospital in-patients. Clin Nutr 2018; 38:1700-1706. [PMID: 30170780 DOI: 10.1016/j.clnu.2018.08.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 08/01/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND Nutritional status can be difficult to assess. Bioelectrical impedance analysis (BIA)-derived phase angle (PA), and the plasma markers citrulline and transthyretin (pre-albumin) have the potential to assist, but the protocol of fasting and resting for BIA renders the investigation impractical for routine use, especially so in populations at high risk of malnutrition. AIMS 1 To clarify whether starving and resting are necessary for reliable measurement of PA. 2 To identify whether PA, citrulline and transthyretin correlate with nutritional status. METHODS Eighty consenting adult in-patients were recruited. Nutritional status was determined by subjective global assessment (SGA) used as gold standard. The Malnutrition Universal Screening Tool (MUST) was used and anthropometric measurements were performed. Serum was analysed for citrulline and transthyretin. PA was measured using Bodystat 4000. The PA was considered to define malnutrition when lower than reference ranges for sex and age, and severe malnutrition if more than 2 integers below the lower limit. Anthropometric measurements were categorised according to WHO reference centiles. Ordinal logistic regression estimated the strength of association of PA, citrulline and transthyretin with SGA. PA values in the different metabolic states were compared using paired t tests. RESULTS All 80 subjects completed the BIA and the nutritional assessments in the 3 different states; 14 declined to provide blood samples for the biochemical assays. Malnutrition was identified in 32 cases, severe malnutrition in 14 cases, the remaining 34 cases were deemed not to be malnourished. PA was strongly inversely associated with SGA (Odds Ratio [OR] per unit increase = 0.21, CI 0.12-0.37, p < 0.001). PA was not influenced by exercise (p = 0.134) or food intake (p = 0.184). Transthyretin was inversely associated with malnourished/severely malnourished states (OR = 0.98, 95% CI 0.97-0.99, p = 0.001), but had poorer predictive values than PA. There was no significant association between citrulline concentration and SGA (OR = 1.01, 95% CI 0.99-1.04, p = 0.348). CONCLUSIONS The BIA-derived PA reliably identifies malnutrition. It is strongly associated with SGA but requires less skill and experience, and out-performs circulating transthyretin, rendering it a promising and less operator-dependent tool for assessing nutritional status in hospital patients. Our novel demonstration that fasting and bed-rest are unnecessary consolidates that position.
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Affiliation(s)
- E L Player
- Norwich Medical School, University of East Anglia, Norwich, NR4 7UQ, UK.
| | - P Morris
- Norwich Medical School, University of East Anglia, Norwich, NR4 7UQ, UK.
| | - T Thomas
- Norwich Medical School, University of East Anglia, Norwich, NR4 7UQ, UK.
| | - W Y Chan
- Norwich Medical School, University of East Anglia, Norwich, NR4 7UQ, UK.
| | - R Vyas
- Norwich Medical School, University of East Anglia, Norwich, NR4 7UQ, UK.
| | - J Dutton
- Norwich Medical School, University of East Anglia, Norwich, NR4 7UQ, UK.
| | - J Tang
- Norwich Medical School, University of East Anglia, Norwich, NR4 7UQ, UK.
| | - L Alexandre
- Norwich Medical School, University of East Anglia, Norwich, NR4 7UQ, UK.
| | - A Forbes
- Norwich Medical School, University of East Anglia, Norwich, NR4 7UQ, UK.
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Winkley K, Upsher R, Keij SM, Chamley M, Ismail K, Forbes A. Healthcare professionals' views of group structured education for people with newly diagnosed Type 2 diabetes. Diabet Med 2018; 35:911-919. [PMID: 29633382 DOI: 10.1111/dme.13637] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/29/2018] [Indexed: 11/28/2022]
Abstract
AIM To determine healthcare professionals' (HCP) views of group structured education for people with newly diagnosed Type 2 diabetes. METHODS This was a qualitative study using semi-structured interviews to ascertain primary care HCPs' views and experiences of education for people with newly diagnosed Type 2 diabetes. A thematic framework method was applied to analyse the data. Participants were HCPs (N = 22) from 15 general practices in three south London boroughs. RESULTS All but one HCP viewed diabetes education favourably and all identified that low attendance was a problem. Three key themes emerged from the qualitative data: (1) benefits of diabetes education, including the group mode of delivery, improved patient interactions, saving HCPs' time and improved patient outcomes; (2) factors limiting uptake of education, including patient-level problems such as access and the appropriateness of the programme for certain groups, and difficulties communicating the benefits to patients and integration of education management plans into ongoing diabetes care; and (3) suggestions for improvement, including strategies to improve attendance at education with more localized and targeted marketing and enhanced programme content including follow-up sessions and support for people with pre-existing psychological issues. CONCLUSIONS Most HCPs valued diabetes education and all highlighted the lack of provision for people with different levels of health literacy. Because there was wide variation in terms of the level of knowledge regarding the education on offer, future studies may want to focus on how to help HCPs encourage their patients to attend.
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Affiliation(s)
- K Winkley
- Diabetes Psychiatry & Psychology, Department of Psychological Medicine and Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - R Upsher
- Diabetes Psychiatry & Psychology, Department of Psychological Medicine and Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - S M Keij
- Diabetes Psychiatry & Psychology, Department of Psychological Medicine and Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - M Chamley
- Lambeth Clinical Commissioning Group Diabetes Intermediate Care Team, London, UK
| | - K Ismail
- Diabetes Psychiatry & Psychology, Department of Psychological Medicine and Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - A Forbes
- Florence Nightingale Faculty of Nursing & Midwifery, King's College London, London, UK
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Bouzid O, Haddadi S, Fromager M, Cagniot E, Ferria K, Forbes A, Ait-Ameur K. Focusing anomalies with binary diffractive optical elements. Appl Opt 2017; 56:9735-9741. [PMID: 29240119 DOI: 10.1364/ao.56.009735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 11/02/2017] [Indexed: 06/07/2023]
Abstract
Binary diffractive optics have been extensively studied to date as tools for arbitrary laser beam shaping and experimentally implemented with etched transparent optics and spatial light modulators. Here we demonstrate that a simple one-step binary optic is able to enhance the intensity of a focused beam, displaying some counterintuitive focusing anomalies. We explain these effects by considering the optical aberrations in binary diffractive optics and outline how this may be exploited for further improvements in refractive/diffractive combinations for super-resolution microscopy.
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Ajabnoor S, Williams M, Parris A, Shaikh I, Forbes A. Effect of enteral nutrition with a pre-defined fat composition on the pathogenesis of Crohn's disease. Clin Nutr ESPEN 2017. [DOI: 10.1016/j.clnesp.2017.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ajabnoor S, Forbes A. Effect of fat composition in enteral nutrition for Crohn's disease in adults: A systematic review. Clin Nutr ESPEN 2017. [DOI: 10.1016/j.clnesp.2017.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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31
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Thomas T, Player E, Chan W, Alexandre L, Forbes A. MON-P208: Bioelectrical Impedance Analysis Derived Phase Angle as a tool for Detecting Malnutrition in Hospital In-Patients. Clin Nutr 2017. [DOI: 10.1016/s0261-5614(17)30880-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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32
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Thomas T, Player E, Chan WY, Alexandre L, Forbes A. PTU-121 Bioelectrical impedance analysis derived phase angle as a tool for detecting malnutrition in hospital in-patients. Nutrition 2017. [DOI: 10.1136/gutjnl-2017-314472.216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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33
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Fragkos KC, Forbes A. PWE-101 Citrulline as a marker of intestinal function and absorption in clinical settings: a systematic review meta-analysis. Nutrition 2017. [DOI: 10.1136/gutjnl-2017-314472.347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Cummin T, Araf S, Du M, Barrans S, Bentley M, Clipson A, Wang M, Ahmed S, Rahim T, Shah C, Hamid D, Dhondt J, Maishman T, Vaughan-Spickers N, Pocock C, Forbes A, O'Callaghan A, Westhead D, Griffiths G, Fitzgibbon J, Tooze R, Care M, Burton C, Davies A, Johnson P. PROGNOSTIC SIGNIFICANCE AND CORRELATION TO GENE EXPRESSION PROFILE OF EZH2
MUTATIONS IN DIFFUSE LARGE B-CELL LYMPHOMA (DLBL) IN 2 LARGE PROSPECTIVE STUDIES. Hematol Oncol 2017. [DOI: 10.1002/hon.2438_13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- T.E. Cummin
- Cancer Sciences; University of Southampton; Southampton UK
| | - S. Araf
- Centre for Haemato-Oncology, Barts Cancer Institute; Queen Mary University of London; London UK
| | - M. Du
- Division of Molecular Histopathology Department of Pathology; University of Cambridge; Cambridge UK
| | - S. Barrans
- Haematological Malignancy Diagnostic Service, Haematological Malignancy Diagnostic Service; St. James's Institute of Oncology; Leeds UK
| | - M.A. Bentley
- School of Molecular and Cellular Biology; University of Leeds; Leeds UK
| | - A. Clipson
- Division of Molecular Histopathology Department of Pathology; University of Cambridge; Cambridge UK
| | - M. Wang
- Division of Molecular Histopathology Department of Pathology; University of Cambridge; Cambridge UK
| | - S. Ahmed
- Haematological Malignancy Diagnostic Service, Haematological Malignancy Diagnostic Service; St. James's Institute of Oncology; Leeds UK
| | - T. Rahim
- Centre for Haemato-Oncology, Barts Cancer Institute; Queen Mary University of London; London UK
| | - C. Shah
- Bioinformatics group,IMCB; University of Leeds; Leeds UK
| | - D. Hamid
- Southampton Clinical Trials Unit, Southampton Clinical Trials Unit; University of Southampton; Southampton UK
| | - J. Dhondt
- Southampton Clinical Trials Unit, Southampton Clinical Trials Unit; University of Southampton; Southampton UK
| | - T. Maishman
- Southampton Clinical Trials Unit, Southampton Clinical Trials Unit; University of Southampton; Southampton UK
| | - N. Vaughan-Spickers
- Southampton Clinical Trials Unit, Southampton Clinical Trials Unit; University of Southampton; Southampton UK
| | - C. Pocock
- Haematology Department; East Kent Hospitals University NHS Foundation Trust; Canterbury UK
| | - A. Forbes
- Haematology Department; Royal Cornwall Hospital; Truro UK
| | - A. O'Callaghan
- Haematology Department; Queen Alexandra Hospital, PO6 3LY; Portsmouth UK
| | - D. Westhead
- School of Molecular and Cellular Biology; University of Leeds; Leeds UK
| | - G.O. Griffiths
- Southampton Clinical Trials Unit, Southampton Clinical Trials Unit; University of Southampton; Southampton UK
| | - J. Fitzgibbon
- Centre for Haemato-Oncology, Barts Cancer Institute; Queen Mary University of London; London UK
| | - R.M. Tooze
- Faculty of Medicine and Health, Leeds Institute of Cancer & Pathology; University of Leeds; Leeds UK
| | - M.A. Care
- Faculty of Medicine and Health, Leeds Institute of Cancer & Pathology; University of Leeds; Leeds UK
| | - C.H. Burton
- Haematological Malignancy Diagnostic Service, Haematological Malignancy Diagnostic Service; St. James's Institute of Oncology; Leeds UK
| | - A.J. Davies
- Cancer Research UK Centre; University of Southampton; Southampton UK
| | - P.W. Johnson
- Cancer Research UK Centre; University of Southampton; Southampton UK
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35
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Gleeson M, Peckitt C, To Y, Edwards L, Chau I, Johnson P, Ardeshna K, Wotherspoon A, Attygalle A, Begum R, Chua S, Zerizer I, Hawkes E, Macheta M, Collins G, Radford J, Forbes A, Hart A, Montoto S, McKay P, Benstead K, Morley N, Kalakonda N, Hasan Y, Turner D, Cunningham D. CHOP VERSUS GEM-P IN THE FIRST-LINE TREATMENT OF T-CELL LYMPHOMA (PTCL): INITIAL RESULTS OF THE UK NRCI PHASE II RANDOMISED CHEMO-T TRIAL. Hematol Oncol 2017. [DOI: 10.1002/hon.2437_63] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- M. Gleeson
- GI and Lymphoma Unit; The Royal Marsden Hospital; Sutton UK
| | - C. Peckitt
- GI and Lymphoma Unit; The Royal Marsden Hospital; Sutton UK
| | - Y.M. To
- GI and Lymphoma Unit; The Royal Marsden Hospital; Sutton UK
| | - L. Edwards
- GI and Lymphoma Unit; The Royal Marsden Hospital; Sutton UK
| | - I. Chau
- GI and Lymphoma Unit; The Royal Marsden Hospital; Sutton UK
| | - P. Johnson
- Cancer Research UK Centre; University of Southampton; Southampton UK
| | - K.M. Ardeshna
- Department of Haematology; University College Hospital; London UK
| | - A. Wotherspoon
- Department of Histopathology; The Royal Marsden Hospital; London UK
| | - A. Attygalle
- Department of Histopathology; The Royal Marsden Hospital; London UK
| | - R. Begum
- GI and Lymphoma Unit; The Royal Marsden Hospital; Sutton UK
| | - S. Chua
- Department of Radiology; The Royal Marsden Hospital; Sutton UK
| | - I. Zerizer
- Department of Radiology; The Royal Marsden Hospital; Sutton UK
| | - E.A. Hawkes
- Department of Oncology Research; Eastern Health; Melbourne Australia
| | - M.P. Macheta
- Department of Haematology; Blackpool Victoria Hospital; Blackpool UK
| | - G.P. Collins
- Oxford Cancer and Haematology Centre; Churchill Hospital; Oxford UK
| | - J.A. Radford
- Manchester Academic Health Science Centre; University of Manchester and the Christie NHS Foundation Trust; Manchester UK
| | - A. Forbes
- Department of Haematology; Royal Cornwall Hospital; Truro UK
| | - A. Hart
- Department of Haematology; New Victoria Hospital; Glasgow UK
| | - S. Montoto
- Department of Haemato-oncology; St Bartholomew's Hospital; London UK
| | - P. McKay
- Department of Haematology; The Beatson West of Scotland Cancer Centre; Glasgow UK
| | - K. Benstead
- Department of Oncology; Gloucestershire Hospitals NHS Foundation Trust; Gloucester UK
| | - N. Morley
- Department of Haematology; Royal Hallamshire Hospital; Sheffield UK
| | - N. Kalakonda
- Department of Haematology; Royal Liverpool University Hospital; Liverpool UK
| | - Y. Hasan
- Department of Haematology; Sandwell and West Birmingham Hospitals NHS Trust; West Bromwich UK
| | - D. Turner
- Department of Haematology; Torbay Hospital; Torquay UK
| | - D. Cunningham
- GI and Lymphoma Unit; The Royal Marsden Hospital; Sutton UK
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Gleeson M, Peckitt C, Cunningham D, To Y, Edwards L, Chau I, Johnson P, Ardeshna K, Wotherspoon A, Attygalle A, Begum R, Zerizer I, Hawkes E, Macheta M, Collins G, Radford J, Forbes A, Hart A, Montoto S, McKay P, Benstead K, Morley N, Kalakonda N, Hasan Y, Turner D, Chua S. THE ROLE OF 18F FDG-PET/CT IN PERIPHERAL T-CELL LYMPHOMA (PTCL): INITIAL RESULTS OF THE UK NCRI MULTICENTRE PHASE II RANDOMISED CHEMO-T TRIAL PET/CT SUBSTUDY. Hematol Oncol 2017. [DOI: 10.1002/hon.2438_108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- M. Gleeson
- GI and Lymphoma Unit; The Royal Marsden Hospital; Sutton UK
| | - C. Peckitt
- GI and Lymphoma Unit; The Royal Marsden Hospital; Sutton UK
| | - D. Cunningham
- GI and Lymphoma Unit; The Royal Marsden Hospital; Sutton UK
| | - Y.M. To
- GI and Lymphoma Unit; The Royal Marsden Hospital; Sutton UK
| | - L. Edwards
- GI and Lymphoma Unit; The Royal Marsden Hospital; Sutton UK
| | - I. Chau
- GI and Lymphoma Unit; The Royal Marsden Hospital; Sutton UK
| | - P. Johnson
- Cancer Research UK Centre; University of Southampton; Southampton UK
| | - K.M. Ardeshna
- Department of Haematology; University College Hospital; London UK
| | - A. Wotherspoon
- Department of Histopathology; The Royal Marsden Hospital; London UK
| | - A. Attygalle
- Department of Histopathology; The Royal Marsden Hospital; London UK
| | - R. Begum
- GI and Lymphoma Unit; The Royal Marsden Hospital; Sutton UK
| | - I. Zerizer
- Department of Radiology; The Royal Marsden Hospital; Sutton UK
| | - E.A. Hawkes
- Department of Oncology; Eastern Health; Melbourne Australia
| | - M.P. Macheta
- Department of Haematology; Blackpool Teaching Hospitals; Blackpool UK
| | - G.P. Collins
- Oxford Cancer and Haematology Centre; Churchill Hospital; Oxford UK
| | - J.A. Radford
- Manchester Academic Health Science Centre; University of Manchester and the Christie NHS Foundation Trust; Manchester UK
| | - A. Forbes
- Department of Haematology; Royal Cornwall Hospital; Truro UK
| | - A. Hart
- Department of Haematology; New Victoria Hospital; Glasgow UK
| | - S. Montoto
- Department of Haemato-oncology; St Bartholomew's Hospital; London UK
| | - P. McKay
- Department of Haematology; Beatson West of Scotland Cancer Centre; Glasgow UK
| | - K. Benstead
- Department of Oncology, Gloucestershire Hospitals NHS Foundation Trust; Gloucester UK
| | - N. Morley
- Department of Haematology; Royal Hallamshire Hospital; Sheffield UK
| | - N. Kalakonda
- Department of Haematology; Royal Liverpool University Hospital; Liverpool UK
| | - Y. Hasan
- Department of Haematology, Sandwell and West Birmingham Hospitals NHS Trust; West Bromwich UK
| | - D. Turner
- Department of Haematology; Torbay Hospital; Torquay UK
| | - S. Chua
- Department of Radiology; The Royal Marsden Hospital; Sutton UK
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Forbes A, Murrells T, Sinclair AJ. Examining factors associated with excess mortality in older people (age ≥ 70 years) with diabetes - a 10-year cohort study of older people with and without diabetes. Diabet Med 2017; 34:387-395. [PMID: 27087619 DOI: 10.1111/dme.13132] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/11/2016] [Indexed: 12/28/2022]
Abstract
AIMS To compare all-cause mortality in older people with or without diabetes and consider the associated risk of comorbidity and polypharmacy. METHODS A 10-year cohort study using data from the Health Innovation Network database (2003-2013) comparing mortality in people aged ≥ 70 years with diabetes (DM cohort) (n = 35 717) and without diabetes (No DM cohort) (n = 307 918). RESULTS The mean age of the DM cohort was 78.1 ± 5.8 years vs. 79.0 ± 6.3 years in the No DM cohort. Mean diabetes duration was 8.2 ± 8.1 years, and 30% had diabetes for > 10 years. The DM cohort had a greater comorbidity load and people in this cohort were prescribed more therapies than the No DM cohort. The 5- and 10-year survival rates were lower in the DM cohort at 64% and 39%, respectively, compared with 72% and 50% in the No DM cohort. The excess mortality in the DM cohort was greatest in those aged < 75 years with longer duration diabetes, the relative hazard for mortality was higher in females. Although comorbidity and polypharmacy were associated with increased mortality risk in the DM cohort, this risk was lower compared with the No DM cohort. The hazard ratios (95% confidence interval) for comorbidities > 4 and medicines ≥ 7 were 1.29 (1.19 to 1.41) and 1.34 (1.25 to 1.43) in the DM cohort and 1.63 (1.57 to 1.70) and 1.48 (1.40 to 1.56) in the No DM cohort, respectively. CONCLUSIONS There is significant excess mortality in older people with diabetes, which is unexplained by comorbidity or polypharmacy. This excess is greatest in the younger old with longer disease duration, suggesting that it may be related to the effect of diabetes exposure.
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Affiliation(s)
- A Forbes
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London
| | - T Murrells
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London
| | - A J Sinclair
- Diabetes Frail and the University of Aston, Birmingham, UK
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Chan M, Peyton P, Myles P, Leslie K, Buckley N, Kasza J, Paech M, Beattie W, Sessler D, Forbes A, Wallace S, Chen Y, Tian Y, Wu W. Chronic postsurgical pain in the Evaluation of Nitrous Oxide in the Gas Mixture for Anaesthesia (ENIGMA)-II trial. Br J Anaesth 2016; 117:801-811. [DOI: 10.1093/bja/aew338] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2016] [Indexed: 12/18/2022] Open
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Soeters P, Bozzetti F, Cynober L, Forbes A, Shenkin A, Sobotka L. Defining malnutrition: A plea to rethink. Clin Nutr 2016; 36:896-901. [PMID: 27769782 DOI: 10.1016/j.clnu.2016.09.032] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 08/19/2016] [Accepted: 09/30/2016] [Indexed: 01/07/2023]
Abstract
In a recent consensus report in Clinical Nutrition the undernourished category of malnutrition was proposed to be defined and diagnosed on the basis of a low BMI or unintentional weight loss combined with low BMI or FFMI with certain cut off points. The definition was endorsed by ESPEN despite recent endorsement of a very different definition. The approach aims to assess whether nutritional intake is sufficient but is imprecise because a low BMI does not always indicate malnutrition and individuals with increasing BMI's may have decreasing FFM's. The pathophysiology of individuals, considered to be malnourished in rich countries and in areas with endemic malnutrition, results predominantly from deficient nutrition combined with infection/inflammation. Both elements jointly determine body composition and function and consequently outcome of disease, trauma or treatment. When following the consensus statement only an imprecise estimate is acquired of nutritional intake without knowing the impact of inflammation. Most importantly, functional abilities are not assessed. Consequently it will remain uncertain how well the individual can overcome stressful events, what the causes are of dysfunction, how to set priorities for treatment and how to predict the effect of nutritional support. We therefore advise to consider the pathophysiology of malnourished individuals leading to inclusion of the following elements in the definition of malnutrition: a disordered nutritional state resulting from a combination of inflammation and a negative nutrient balance, leading to changes in body composition, function and outcome. A precise diagnosis of malnutrition should be based on assessment of these elements.
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Affiliation(s)
- P Soeters
- Faculty of Medicine and Life Sciences, Maastricht University Medical Centre, Maastricht, The Netherlands.
| | - F Bozzetti
- Faculty of Medicine, University of Milan, 20100 Milan, Italy
| | - L Cynober
- Service de Biochimie, Hôpital Cochin, AP-HP, Hôpitaux Universitaires Paris Centre, Paris, France; Biological Nutrition Laboratory, EA 4466, Faculty of Pharmacy, Paris Descartes University, Paris, France
| | - A Forbes
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - A Shenkin
- Department of Clinical Chemistry, University of Liverpool, Liverpool, United Kingdom
| | - L Sobotka
- Third Department of Medicine, Medical Faculty Hospital Hradec Králové, Charles University, Prague, Czech Republic
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Rogulska J, Osowska S, Giebułtowicz J, Zawada K, Forbes A, Majewska K, Sobocki J, Wroczyński P. MON-P178: The Oxidative Stability Estimation of All-In-One Admixtures for Parenteral Nutrition with 3 Different Lipid Emulsions after 24. Clin Nutr 2016. [DOI: 10.1016/s0261-5614(16)30812-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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41
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Ajabnoor S, Forbes A. SUN-LB276: Effect of Fat Composition in Enteral Nutrition for Crohn'S Disease in Adults: A Systematic Review. Clin Nutr 2016. [DOI: 10.1016/s0261-5614(16)30632-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Rudzki S, Armstrong D, Jeppesen P, Forbes A, Lee HM. MON-P083: Post HOC Analysis of Polyps in 9 Short Bowel Syndrome Patients Treated with Teduglutide. Clin Nutr 2016. [DOI: 10.1016/s0261-5614(16)30717-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Holt RIG, Nicolucci A, Kovacs Burns K, Lucisano G, Skovlund SE, Forbes A, Kalra S, Menéndez Torre E, Munro N, Peyrot M. Correlates of psychological care strategies for people with diabetes in the second Diabetes Attitudes, Wishes and Needs (DAWN2(™) ) study. Diabet Med 2016; 33:1174-83. [PMID: 26939906 DOI: 10.1111/dme.13109] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 01/18/2016] [Accepted: 03/01/2016] [Indexed: 01/30/2023]
Abstract
AIMS To assess the ways in which healthcare professionals address psychological problems of adults with diabetes in the second Diabetes Attitudes, Wishes and Needs (DAWN2(™) ) study. METHODS Approximately 120 primary care physicians, 80 diabetes specialists and 80 nurses and dietitians providing diabetes care participated in each of 17 countries (N=4785). Multiple regression analyses were used to evaluate independent statistically significant associations of respondent attributes concerning psychological care strategies, including assessment of diabetes impact on the patient's life, assessment of depression, provision of psychological assessment and support, and coordination with mental health professionals. RESULTS Psychological care strategies were positively associated with each other but differed by healthcare practice site and discipline; nurses and dietitians were less likely to assess depression than other healthcare professionals, while primary care physicians were less likely to coordinate with mental health specialists or ask patients how diabetes affects their lives. Psychological care was positively associated with healthcare professionals' beliefs that patients need help dealing with emotional issues and that clinical success depends on doing so, and also with level of psychological care training, multidisciplinary team membership and availability of resources for psychological care. There were significant between-country variations in psychological care strategies, before and after adjustment for individual-level factors, and significant country-by-covariate interactions for almost all individual-level factors investigated. CONCLUSIONS Improvements in training and resources, recognition and assessment of psychological problems, and increased belief in the efficacy of psychological support may enhance healthcare professionals' efforts to address psychological problems in adults with diabetes.
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Affiliation(s)
- R I G Holt
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
| | - A Nicolucci
- Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | - K Kovacs Burns
- Edmonton Clinic Health Academy, University of Alberta, Edmonton, AB, Canada
| | - G Lucisano
- Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | | | - A Forbes
- Kings College London, London, UK
| | - S Kalra
- Bharti Hospital and BRIDE, Karnal, India
| | | | - N Munro
- University of Surrey, Guildford, UK
| | - M Peyrot
- Loyola University Maryland, Baltimore, MD, USA
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Bellet C, Green M, Vickers M, Forbes A, Berry E, Kaler J. Ostertagia spp ., rumen fluke and liver fluke single- and poly-infections in cattle: An abattoir study of prevalence and production impacts in England and Wales. Prev Vet Med 2016; 132:98-106. [DOI: 10.1016/j.prevetmed.2016.08.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 08/24/2016] [Accepted: 08/29/2016] [Indexed: 11/26/2022]
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45
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Rogulska J, Osowska S, Giebuttowicz J, Forbes A, Sobocki J, Wroczyński P. MON-P176: Estimation of the Oxidative Stability of All-In-One (AIO) Admixtures for Parenteral Nutrition with 3 Different Lipid Emulsions After Three Days of Storage in the Fridge. Clin Nutr 2016. [DOI: 10.1016/s0261-5614(16)30810-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Basudev N, Crosby-Nwaobi R, Thomas S, Chamley M, Murrells T, Forbes A. A prospective randomized controlled study of a virtual clinic integrating primary and specialist care for patients with Type 2 diabetes mellitus. Diabet Med 2016; 33:768-76. [PMID: 27194175 DOI: 10.1111/dme.12985] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/30/2015] [Indexed: 12/29/2022]
Abstract
AIMS To investigate the effectiveness of a diabetes virtual clinic to enhance diabetes in primary care by developing clinical management plans for patients with suboptimal metabolic control and/or case complexity. METHODS A prospective study with randomized allocation to virtual clinic or usual care. Patients with Type 2 diabetes (n = 208) were recruited from six general practices in South London. The primary outcome for the study was glycaemic control, secondary outcomes included: lipids, blood pressure, weight (kg and BMI) and renal function (eGFR). Data were collected from participants' records at baseline and 12 months. We also considered process measures including therapy optimization. RESULTS The 12-month data show equivalence between the virtual clinic and control groups for glycaemic control with both achieving clinically significant reductions in HbA1c of 8 mmol/mol (0.6 ± 1.7%) and 10 mmol/mol (0.8 ± 1.9%), respectively (P = 0.4). The virtual clinic group showed superiority over the intervention group for blood pressure control with a mean reduction in systolic blood pressure of 6 ± 16 mmHg compared with an increased of 2 ± 18 mmHg in the control group (P = 0.008). There were no significant differences between the groups in terms of cholesterol, weight and renal function. Process measures showed an increased level of therapy adjustment in the virtual clinic group. CONCLUSION The virtual clinic model explored in this study showed a clinically important improvement in glycaemic control. Although this improvement was not superior to that observed in the control participants, this might be attributable to the systemic impact of the virtual clinic on the practice as a whole.
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Affiliation(s)
- N Basudev
- Lambeth Diabetes Intermediate Care Team, King's College London, London, UK
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK
| | - R Crosby-Nwaobi
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK
| | - S Thomas
- St Thomas's Hospital, London, UK
| | - M Chamley
- Lambeth Diabetes Intermediate Care Team, King's College London, London, UK
| | - T Murrells
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK
| | - A Forbes
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK
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Wong S, Banda T, Green D, Forbes A. A re-audit to evaluate the use of nutrition screening tool in the National Spinal Injuries Centre (NSIC) at Stoke Mandeville Hospital. Clin Nutr ESPEN 2015; 10:e197-e198. [DOI: 10.1016/j.clnesp.2015.03.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Wong S, Van Middendorp J, Belci M, Forbes A. Knowledge, attitudes and practices of medical staff towards obesity management in patients with spinal cord injuries: A UK, Netherland, Belgium and the Republic of Ireland survey. Clin Nutr ESPEN 2015; 10:e207. [DOI: 10.1016/j.clnesp.2015.03.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Klek S, Chourdakis M, Bischoff S, Dubrov S, Forbes A, Galas A, Genton L, Gundogdu H, Irtun O, Jagmane I, Jirka A, Jakobson-Forbes T, Kennedy N, Klimasauskas A, Khoroshilov I, Leon-Sanz M, Muscaritoli M, Panisic-Sekeljic M, Poulia K, Schneider S, Siljamäki-Ojansuu U, Uyar M, Wanten G, Krznaric Z. SUN-PP013: Reimbursement Affects Prescription of Enteral and Parenteral Nutrition? Results from European Multicenter Survey. Clin Nutr 2015. [DOI: 10.1016/s0261-5614(15)30164-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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50
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Leslie K, McIlroy D, Kasza J, Forbes A, Kurz A, Khan J, Meyhoff CS, Allard R, Landoni G, Jara X, Lurati Buse G, Candiotti K, Lee HS, Gupta R, VanHelder T, Purayil W, De Hert S, Treschan T, Devereaux PJ. Neuraxial block and postoperative epidural analgesia: effects on outcomes in the POISE-2 trial†. Br J Anaesth 2015. [PMID: 26209855 DOI: 10.1093/bja/aev255] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND We assessed associations between intraoperative neuraxial block and postoperative epidural analgesia, and a composite primary outcome of death or non-fatal myocardial infarction, at 30 days post-randomization in POISE-2 Trial subjects. METHODS 10 010 high-risk noncardiac surgical patients were randomized aspirin or placebo and clonidine or placebo. Neuraxial block was defined as intraoperative spinal anaesthesia, or thoracic or lumbar epidural anaesthesia. Postoperative epidural analgesia was defined as postoperative epidural local anaesthetic and/or opioid administration. We used logistic regression with weighting using estimated propensity scores. RESULTS Neuraxial block was not associated with the primary outcome [7.5% vs 6.5%; odds ratio (OR), 0.89; 95% CI (confidence interval), 0.73-1.08; P=0.24], death (1.0% vs 1.4%; OR, 0.84; 95% CI, 0.53-1.35; P=0.48), myocardial infarction (6.9% vs 5.5%; OR, 0.91; 95% CI, 0.74-1.12; P=0.36) or stroke (0.3% vs 0.4%; OR, 1.05; 95% CI, 0.44-2.49; P=0.91). Neuraxial block was associated with less clinically important hypotension (39% vs 46%; OR, 0.90; 95% CI, 0.81-1.00; P=0.04). Postoperative epidural analgesia was not associated with the primary outcome (11.8% vs 6.2%; OR, 1.48; 95% CI, 0.89-2.48; P=0.13), death (1.3% vs 0.8%; OR, 0.84; 95% CI, 0.35-1.99; P=0.68], myocardial infarction (11.0% vs 5.7%; OR, 1.53; 95% CI, 0.90-2.61; P=0.11], stroke (0.4% vs 0.4%; OR, 0.65; 95% CI, 0.18-2.32; P=0.50] or clinically important hypotension (63% vs 36%; OR, 1.40; 95% CI, 0.95-2.09; P=0.09). CONCLUSIONS Neuraxial block and postoperative epidural analgesia were not associated with adverse cardiovascular outcomes among POISE-2 subjects.
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Affiliation(s)
- K Leslie
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, Australia Anaesthesia, Perioperative and Pain Medicine Unit Department of Pharmacology, University of Melbourne, Melbourne, Australia Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - D McIlroy
- Department of Anaesthesia and Perioperative Medicine, Alfred Hospital and Monash University, Melbourne, Australia
| | - J Kasza
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - A Forbes
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - A Kurz
- Department of Outcomes Research, Cleveland Clinic, Cleveland, USA
| | - J Khan
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Canada Departments of Clinical Epidemiology Biostatistics, McMaster University, Hamilton, Canada Department of Anesthesiology, University of Toronto, Toronto, Canada
| | - C S Meyhoff
- Department of Anaesthesiology, Herlev Hospital and University of Copenhagen, Herlev, Denmark
| | - R Allard
- Department of Anesthesiology and Perioperative Medicine, Kingston General Hospital and Queen's University, Kingston, Canada
| | - G Landoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute and Vita-Salute University, Milan, Italy
| | - X Jara
- Department of Anesthesiology, Clinica Santa Maria and Universidad de Los Andes, Santiago, Chile
| | - G Lurati Buse
- Department of Anaesthesiology, Juravinski Hospital, Hamilton, Canada
| | - K Candiotti
- Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami, Miami, USA
| | - H-S Lee
- Department of Anesthesiology, Sultanah Aminah Hospital, Johor Bahru, Malaysia
| | - R Gupta
- Department of Medicine, Fortis Escorts Hospital, Jaipur, India
| | - T VanHelder
- Department of Anesthesia, Hamilton General Hospital, Hamilton, Canada
| | - W Purayil
- Department of Anaesthesia, Westfort Hi-tech Hospital, Thrissur, India
| | - S De Hert
- Department of Anaesthesiology, Ghent University Hospital, Ghent, Belgium
| | - T Treschan
- Department of Anaesthesiology, Duesseldorf University Hospital, Duesseldorf, Germany
| | - P J Devereaux
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Canada Departments of Clinical Epidemiology Biostatistics, McMaster University, Hamilton, Canada Department of Medicine, McMaster University, Hamilton, Canada
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