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Kelsey E, Wynn J, Holmes A, McLeod K. Anatomical location and number of injection sites of intravesical OnabotulinumtoxinA for females with refractory idiopathic overactive bladder: A scoping review. Neurourol Urodyn 2024; 43:553-564. [PMID: 38225733 DOI: 10.1002/nau.25392] [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] [Received: 08/17/2023] [Revised: 11/06/2023] [Accepted: 01/03/2024] [Indexed: 01/17/2024]
Abstract
AIMS The negative impact on quality of life and the economic-related burden to the patient and the health care system associated with idiopathic overactive bladder (iOAB) is well-documented. Intradetrusor OnabotulinumtoxinA (BTN/A) injections are a well-used treatment modality for the management of overactive detrusor refractory to medical management, with well-documented efficacy and safety profiles. There is currently no best practice guideline for the administration of BTN/A for this procedure and historically the trigone of the bladder has been excluded from the injection paradigm given the risk of vesicoureteral reflux (VUR). METHODS A scoping review methodology was employed to assess available literature to evaluate current techniques used. There is emerging literature that the inclusion of the trigone may increase the efficacy of the procedure, while maintaining a similar adverse effect profile. Similar results could also be obtained by decreasing the number of injection sites. A scoping review was completed with systematic methodology using the Preferred Systematic Reviews and Meta Analyses extension for Scoping Review checklist. The search strategy looked to evaluate BTN/A and number of injection sites and the inclusion of the trigone in female patients with iOAB. Studies with male or neurogenic bladder only were excluded. Mixed studies were included. A specialist research librarian was engaged, with supervision from a functional urologist using a combination of MeSH and natural language terms. Two investigators independently reviewed the titles and abstracts. RESULTS Twelve articles were included and were published between 2005 and 2021. There was no evidence of VUR in any of the results. All but one study reported similar if not improved efficacy of trigone-inclusion. Lower number of injection sites had similar efficacy profiles to higher numbers of intradetrusor injections. CONCLUSIONS Further high-quality randomized control trials of trigone inclusion and reduction of injection sites are required. It is hoped that with further exploration of intraoperative methods for BTN/A injections, the development of universally accepted guidelines may optimize management and experiences for patients with iOAB.
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Affiliation(s)
- Ellen Kelsey
- Department of Urological Surgery, Barwon Health, University Hospital Geelong, Geelong, Victoria, Australia
| | - Jessica Wynn
- Department of Urological Surgery, Barwon Health, University Hospital Geelong, Geelong, Victoria, Australia
| | - Angela Holmes
- Department of Urological Surgery, Barwon Health, University Hospital Geelong, Geelong, Victoria, Australia
| | - Kathryn McLeod
- Department of Urological Surgery, Barwon Health, University Hospital Geelong, Geelong, Victoria, Australia
- Department of Surgery, Deakin University, Geelong, Victoria, Australia
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Christensen PR, Hamilton VE, Mehall GL, Anwar S, Bowles H, Chase S, Farkas Z, Fisher T, Holmes A, Kubik I, Lazbin I, O’Donnell W, Ortiz C, Pelham D, Rogers S, Shamordola K, Tourville T, Woodward R. The Lucy Thermal Emission Spectrometer (L'TES) Instrument. Space Sci Rev 2023; 220:1. [PMID: 38130909 PMCID: PMC10730683 DOI: 10.1007/s11214-023-01029-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 11/20/2023] [Indexed: 12/23/2023]
Abstract
The Lucy Thermal Emission Spectrometer (L'TES) will provide remote measurements of the thermophysical properties of the Trojan asteroids studied by the Lucy mission. L'TES is build-to-print hardware copy of the OTES instrument flown on OSIRIS-REx. It is a Fourier Transform spectrometer covering the spectral range 5.71-100 μm (1750-100 cm-1) with spectral sampling intervals of 8.64, 17.3, and 34.6 cm-1 and a 7.3-mrad field of view. The L'TES telescope is a 15.2-cm diameter Cassegrain telescope that feeds a flat-plate Michelson moving mirror mounted on a linear voice-coil motor assembly to a single uncooled deuterated l-alanine doped triglycine sulfate (DLATGS) pyroelectric detector. A significant firmware change from OTES is the ability to acquire interferograms of different length and spectral resolution with acquisition times of 0.5, 1, and 2 seconds. A single ∼0.851 μm laser diode is used in a metrology interferometer to provide precise moving mirror control and IR sampling at 772 Hz. The beamsplitter is a 38-mm diameter, 1-mm thick chemical vapor deposited diamond with an antireflection microstructure to minimize surface reflection. An internal calibration cone blackbody target, together with observations of space, provides radiometric calibration. The radiometric precision in a single spectrum is ≤2.2 × 10-8 W cm-2 sr-1 /cm-1 between 300 and 1350 cm-1. The absolute temperature error is <2 K for scene temperatures >75 K. The overall L'TES envelope size is 37.6 × 29.0 × 30.4 cm, and the mass is 6.47 kg. The power consumption is 12.6 W average. L'TES was developed by Arizona State University with AZ Space Technologies developing the electronics. L'TES was integrated, tested, and radiometrically calibrated on the Arizona State University campus in Tempe, AZ. Initial data from space have verified the instrument's radiometric and spatial performance.
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Affiliation(s)
- P. R. Christensen
- School of Earth and Space Exploration, Arizona State University, Tempe, AZ USA
| | | | - G. L. Mehall
- School of Earth and Space Exploration, Arizona State University, Tempe, AZ USA
| | - S. Anwar
- School of Earth and Space Exploration, Arizona State University, Tempe, AZ USA
| | - H. Bowles
- School of Earth and Space Exploration, Arizona State University, Tempe, AZ USA
| | - S. Chase
- School of Earth and Space Exploration, Arizona State University, Tempe, AZ USA
| | - Z. Farkas
- School of Earth and Space Exploration, Arizona State University, Tempe, AZ USA
| | - T. Fisher
- School of Earth and Space Exploration, Arizona State University, Tempe, AZ USA
| | - A. Holmes
- School of Earth and Space Exploration, Arizona State University, Tempe, AZ USA
| | - I. Kubik
- School of Earth and Space Exploration, Arizona State University, Tempe, AZ USA
| | - I. Lazbin
- AZ Space Technologies, Gilbert, AZ USA
| | - W. O’Donnell
- School of Earth and Space Exploration, Arizona State University, Tempe, AZ USA
| | - C. Ortiz
- School of Earth and Space Exploration, Arizona State University, Tempe, AZ USA
| | - D. Pelham
- School of Earth and Space Exploration, Arizona State University, Tempe, AZ USA
| | - S. Rogers
- School of Earth and Space Exploration, Arizona State University, Tempe, AZ USA
| | - K. Shamordola
- School of Earth and Space Exploration, Arizona State University, Tempe, AZ USA
| | - T. Tourville
- School of Earth and Space Exploration, Arizona State University, Tempe, AZ USA
| | - R. Woodward
- School of Earth and Space Exploration, Arizona State University, Tempe, AZ USA
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Mbamalu O, Bonaconsa C, Surendran S, Nampoothiri V, Pennel T, Boutall A, Papavarnavas N, Singh S, Holmes A, Charani E, Mendelson M. Missed opportunities for hand hygiene at the patient's bedside: a pilot descriptive study. J Hosp Infect 2023:S0195-6701(23)00384-5. [PMID: 38070710 DOI: 10.1016/j.jhin.2023.11.011] [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] [Received: 10/30/2023] [Revised: 11/10/2023] [Accepted: 11/15/2023] [Indexed: 01/03/2024]
Affiliation(s)
- O Mbamalu
- Division of Health Systems and Public Health, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - C Bonaconsa
- Division of Infectious Diseases & HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - S Surendran
- Health Systems and Equity, The George Institute for Global Health, New Delhi, India
| | - V Nampoothiri
- Department of Health Sciences Research, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - T Pennel
- Chris Barnard Division of Cardiothoracic Surgery, Groote Schuur Hospital, Cape Town, South Africa
| | - A Boutall
- Colorectal Unit, Groote Schuur Hospital, Cape Town, South Africa
| | - N Papavarnavas
- Division of Infectious Diseases & HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - S Singh
- Department of Infection Control and Epidemiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - A Holmes
- Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - E Charani
- Division of Infectious Diseases & HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa; Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - M Mendelson
- Division of Infectious Diseases & HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
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Kelsey E, Holmes A, Tissot S, Campbell P, McLeod K. Management of recurrent localised bladder amyloid, has methotrexate helped? Urol Case Rep 2023; 51:102577. [PMID: 37811541 PMCID: PMC10551828 DOI: 10.1016/j.eucr.2023.102577] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 09/26/2023] [Indexed: 10/10/2023] Open
Abstract
Background Amyloidosis of the bladder is a benign condition which can present with a multitude of symptoms including bladder mass, irritative voiding symptoms and haematuria. Case presentation We report on the investigation and management of a patient with recurrent localised amyloidosis of the bladder, which appears to have been managed fortuitously by concurrent methotrexate prescribed for another indication. Conclusion We provide further assessment and management with a focus on the possible benefit of methotrexate for management of localised bladder amyloidosis.
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Affiliation(s)
- E. Kelsey
- Department of Urology, University Hospital Geelong, Barwon Health, Australia
| | - A. Holmes
- Department of Urology, University Hospital Geelong, Barwon Health, Australia
| | - S. Tissot
- Department of Urology, University Hospital Geelong, Barwon Health, Australia
| | - P. Campbell
- Department of Haematology, University Hospital Geelong, Barwon Health, Australia
- Deakin University School of Medicine, Australia
| | - K. McLeod
- Department of Urology, University Hospital Geelong, Barwon Health, Australia
- Deakin University School of Medicine, Australia
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Panca M, Blackstone J, Stirrup O, Cutino-Moguel MT, Thomson E, Peters C, Snell LB, Nebbia G, Holmes A, Chawla A, Machin N, Taha Y, Mahungu T, Saluja T, de Silva TI, Saeed K, Pope C, Shin GY, Williams R, Darby A, Smith DL, Loose M, Robson SC, Laing K, Partridge DG, Price JR, Breuer J. Evaluating the cost implications of integrating SARS-CoV-2 genome sequencing for infection prevention and control investigation of nosocomial transmission within hospitals. J Hosp Infect 2023; 139:23-32. [PMID: 37308063 PMCID: PMC10257337 DOI: 10.1016/j.jhin.2023.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Received: 03/08/2023] [Revised: 05/30/2023] [Accepted: 06/01/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND The COG-UK hospital-onset COVID-19 infection (HOCI) trial evaluated the impact of SARS-CoV-2 whole-genome sequencing (WGS) on acute infection, prevention, and control (IPC) investigation of nosocomial transmission within hospitals. AIM To estimate the cost implications of using the information from the sequencing reporting tool (SRT), used to determine likelihood of nosocomial infection in IPC practice. METHODS A micro-costing approach for SARS-CoV-2 WGS was conducted. Data on IPC management resource use and costs were collected from interviews with IPC teams from 14 participating sites and used to assign cost estimates for IPC activities as collected in the trial. Activities included IPC-specific actions following a suspicion of healthcare-associated infection (HAI) or outbreak, as well as changes to practice following the return of data via SRT. FINDINGS The mean per-sample costs of SARS-CoV-2 sequencing were estimated at £77.10 for rapid and £66.94 for longer turnaround phases. Over the three-month interventional phases, the total management costs of IPC-defined HAIs and outbreak events across the sites were estimated at £225,070 and £416,447, respectively. The main cost drivers were bed-days lost due to ward closures because of outbreaks, followed by outbreak meetings and bed-days lost due to cohorting contacts. Actioning SRTs, the cost of HAIs increased by £5,178 due to unidentified cases and the cost of outbreaks decreased by £11,246 as SRTs excluded hospital outbreaks. CONCLUSION Although SARS-CoV-2 WGS adds to the total IPC management cost, additional information provided could balance out the additional cost, depending on identified design improvements and effective deployment.
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Affiliation(s)
- M Panca
- Comprehensive Clinical Trials Unit, Institute of Clinical Trials and Methodology, UCL, London, UK.
| | - J Blackstone
- Comprehensive Clinical Trials Unit, Institute of Clinical Trials and Methodology, UCL, London, UK
| | - O Stirrup
- Institute for Global Health, UCL, London, UK
| | | | - E Thomson
- MRC-University of Glasgow Centre for Virus Research, Glasgow, UK
| | - C Peters
- NHS Greater Glasgow and Clyde, Glasgow, UK
| | - L B Snell
- Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - G Nebbia
- Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - A Holmes
- Imperial College Healthcare NHS Trust, London, UK
| | - A Chawla
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - N Machin
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Y Taha
- Departments of Virology and Infectious Diseases, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - T Mahungu
- Royal Free NHS Foundation Trust, London, UK
| | - T Saluja
- Sandwell and West Birmingham NHS Trust, UK
| | - T I de Silva
- Department of Infection, Immunity and Cardiovascular Disease, Medical School, The University of Sheffield, Sheffield, UK
| | - K Saeed
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - C Pope
- St George's University Hospitals NHS Foundation Trust, London, UK; Institute for Infection and Immunity, St George's University of London, London, UK
| | - G Y Shin
- University College London Hospitals NHS Foundation Trust, London, UK
| | - R Williams
- Department of Genetics & Genomic Medicine, UCL Great Ormond Street Institute of Child Health, UCL, London, UK
| | - A Darby
- Centre for Genomic Research, University of Liverpool, Liverpool, UK
| | - D L Smith
- Department of Applied Sciences, Northumbria University, Newcastle, UK
| | - M Loose
- School of Life Sciences, University of Nottingham, Nottingham, UK
| | - S C Robson
- Centre for Enzyme Innovation & School of Pharmacy and Biomedical Science, University of Portsmouth, Portsmouth, UK
| | - K Laing
- Institute for Infection and Immunity, St George's University of London, London, UK
| | - D G Partridge
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - J R Price
- Imperial College Healthcare NHS Trust, London, UK
| | - J Breuer
- Department of Infection, Immunity and Inflammation, Great Ormond Street Institute of Child Health, UCL, London, UK
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Keshavarz P, Yazdanpanah F, Holmes A, Cen N, Baradaran M, Sung K, Lu D, Raman S. Abstract No. 249 Prediction of Recurrence Following HCC Resection Using Artificial Intelligence: A Systematic Review of 23,693 Patients. J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.312] [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: 02/26/2023] Open
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Holmes A, Tissot S, Mirmilstein G. Macrocystic ductal adenocarcinoma, a good outcome for a rare cancer in an elderly comorbid patient. Urol Case Rep 2023; 47:102348. [PMID: 36844152 PMCID: PMC9946843 DOI: 10.1016/j.eucr.2023.102348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 02/07/2023] [Indexed: 02/10/2023] Open
Abstract
Ductal adenocarcinoma is an aggressive prostate cancer often presenting late due to low serum PSA. A variant presentation of ductal adenocarcinoma occurs with formation of large cystic structures in the prostate, often associated with lower urinary tract symptoms. We present a case illustrating investigation and successful management of a macrocytic ductal carcinoma in a 90 year old patient.
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Holmes A, O'Kane D, Wombwell A, Grills R. Clinical Utility of a Single-Use Flexible Cystoscope Compared with a Standard Reusable Device: A Randomized Noninferiority Study. J Endourol 2023; 37:80-84. [PMID: 36128833 DOI: 10.1089/end.2022.0210] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Objective: A noninferiority assessment of single-use digital flexible cystoscopy (FC) compared with standard reusable FC for bladder cancer surveillance, and investigation of lower urinary tract symptoms. Patients and Methods: Patients requiring FC who met inclusion criteria were randomly assigned to have their procedure performed using a single-use cystoscope (Ambu® aScope™ 4 Cysto System) or a standard reusable cystoscope (Olympus CYF-VH flexible video cystoscope). Primary outcomes were noninferiority of the single-use cystoscope, in terms of effective procedure completion rate, image quality, light quality, and maneuverability. Secondary objectives compared safety, operative, and perioperative time. The noninferiority margin was set at -10%. Results: One hundred one patients completed the study (n = 50 trial, n = 51 control). All primary outcomes demonstrated noninferiority of the single-use cystoscope, compared with standard reusable FC. Effective completion rate, image quality, light quality, and maneuverability between single-use and reusable cystoscopes were 100% and 98% (confidence interval [CI]: -0.059 to 0.019); 96% and 100% (CI: -0.014 to 0.092); 98% and 100% (CI: -0.018 to 0.058); and 98% and 100% (CI: -0.018 to 0.058). There was no difference in operation time (p = 0.415) or total theater use time (p = 0.441) between groups. Adverse event rates were 4.08% and 4.16% in the trial group and control groups, respectively. Conclusion: The single-use Ambu flexible cystoscope is noninferior to standard FC in terms of procedure completion and light quality, image quality, and maneuverability. Single-use flexible cystoscopes are an effective and safe alternative to reusable flexible cystoscopes and may act as a suitable alternative or adjunct in the urologist's armamentarium.
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Affiliation(s)
- Angela Holmes
- Department of Urological Surgery, Barwon Health, University Hospital Geelong, Geelong, Australia
| | - Dermot O'Kane
- Department of Urological Surgery, Barwon Health, University Hospital Geelong, Geelong, Australia
| | - Amy Wombwell
- Department of Urological Surgery, Barwon Health, University Hospital Geelong, Geelong, Australia
| | - Richard Grills
- Department of Urological Surgery, Barwon Health, University Hospital Geelong, Geelong, Australia.,Department of Surgery, School of Medicine, Deakin University, Geelong, Australia
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Holmes A, Kelsey E, Wombwell A, Molesworth C, McLeod K. Are we underestimating urinary retention following intravesical onabotulinumtoxinA in women with overactive bladder and a history of prior pelvic surgery? Neurourol Urodyn 2023; 42:106-112. [PMID: 36183370 PMCID: PMC10092604 DOI: 10.1002/nau.25054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 08/25/2022] [Accepted: 08/31/2022] [Indexed: 01/03/2023]
Abstract
AIMS This study's purpose is to review the rates of urinary retention requiring intermittent catheterization (IC) post intravesical OnabotulinumtoxinA (BTN/A) injection for idiopathic overactive bladder from a single practicing specialist urological surgeon. METHODS We performed a retrospective review of a single Australian urologist to identify the rate of intermittent catheterization in our clinical setting. Logistic regression was used to assess associations between requirement of IC and risk factors for urinary retention. RESULTS Ninety-four patients were included after inclusion and exclusion criteria were applied and the average age was 69.7 years (SD 17.2) and all participants were female. Thirty-six percent (n = 34) of patients required IC. Of patients requiring IC, 32% had a prior urethral sling, 35% had prior vaginal prolapse surgery, and 29% had a preoperative urinary tract infection (UTI). There was strong evidence of univariate associations between IC and prior sling (odds ratio [OR]: 5.26, 95% confidence interval [CI]: 1.64-16.55, p = 0.005), preoperative UTI (OR: 4.25, 95% CI: 1.31-13.08, p = 0.016) and prior vaginal prolapse surgery (OR: 4.91, 95% CI: 1.64-14.72, p = 0.005). Evidence that prior sling patients were more likely to require IC remained strong in a multivariable model (OR: 7.35, 95% CI: 1.59-34.11, p = 0.011). CONCLUSION Prior urethral sling surgery, prior vaginal prolapse surgery, and positive preoperative UTI, despite treatment, were found to be associated with a higher rate of initiation of intermittent catheterization. The rate of IC initiation of 36% was higher than reported in prior clinical trials.
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Affiliation(s)
- Angela Holmes
- Department of Urological Surgery, Barwon Health, University Hospital Geelong, Geelong, Victoria, Australia
| | - Ellen Kelsey
- Department of Urological Surgery, Barwon Health, University Hospital Geelong, Geelong, Victoria, Australia
| | - Amy Wombwell
- Department of Urological Surgery, Barwon Health, University Hospital Geelong, Geelong, Victoria, Australia
| | | | - Kathryn McLeod
- Department of Urological Surgery, Barwon Health, University Hospital Geelong, Geelong, Victoria, Australia.,Department of Surgery, School of Medicine, Deakin University, Geelong, Victoria, Australia
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Conneely M, Holmes A, O'Connor M, Leahy A, Gabr A, Saleh A, Okpaje B, Corey G, Barry L, Griffin A, O'Shaughnessy Í, Ryan L, Synott A, McCarthy A, Carroll I, Leahy S, Trepél D, Ryan D, Robinson K, Galvin R. 265 A PHYSIOTHERAPY-LED TRANSITION TO HOME INTERVENTION FOR OLDER ADULTS FOLLOWING EMERGENCY DEPARTMENT DISCHARGE: A PILOT FEASIBILITY RANDOMISED-CONTROLLED TRIAL. Age Ageing 2022. [PMCID: PMC9620307 DOI: 10.1093/ageing/afac218.233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background Older adults frequently attend the Emergency Department (ED) and experience high rates of adverse outcomes following ED presentation including functional decline, ED re-presentation and unplanned hospital admission. The development of effective interventions to prevent such outcomes is a key priority for research and service provision. A presentation to an ED can be viewed as an opportunity to assess those at risk of adverse outcomes and initiate a care plan in those deemed as ‘high risk'. Our aim was to evaluate the feasibility of a physiotherapy led integrated care intervention for older adults discharged from the ED (ED-PLUS). Methods Older adults presenting to the ED with undifferentiated medical complaints and discharged within 72 hours were computer randomised in a ratio of 1:1:1 to deliver usual care, Comprehensive Geriatric Assessment (CGA) in the ED, or ED-PLUS (Trial registration: NCT04983602). ED-PLUS is an evidence-based and stakeholder-informed intervention to bridge the care transition between the ED and community by initiating a CGA in the ED and implementing a six-week, multi-component, self-management programme in the patient’s own home. Feasibility (recruitment and retention rates) and acceptability of the programme were assessed quantitatively and qualitatively. Functional decline was examined post-intervention using the Barthel Index. All outcomes were assessed by a research nurse blinded to group allocation. Results 29 participants were recruited, indicating 97% of our recruitment target. 90% of participants completed the ED-PLUS intervention. All participants expressed positive feedback about the intervention. The incidence of functional decline at 6 weeks was 10% in the ED-PLUS group versus 70-89% in the usual care and CGA-only groups. Conclusion High adherence and retention rates were observed among participants and preliminary findings indicate a lower incidence of functional decline in the ED-PLUS group. Recruitment challenges existed in the context of COVID-19. Data collection is ongoing for six-month outcomes.
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Affiliation(s)
- M Conneely
- University of Limerick School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, , Limerick, Ireland
| | - A Holmes
- University of Limerick School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, , Limerick, Ireland
| | - M O'Connor
- University Hospital Limerick Department of Ageing and Therapeutics, , Dooradoyle, Limerick, Ireland
| | - A Leahy
- University Hospital Limerick Department of Ageing and Therapeutics, , Dooradoyle, Limerick, Ireland
| | - A Gabr
- University Hospital Limerick Department of Ageing and Therapeutics, , Dooradoyle, Limerick, Ireland
| | - A Saleh
- University Hospital Limerick Department of Ageing and Therapeutics, , Dooradoyle, Limerick, Ireland
| | - B Okpaje
- University Hospital Limerick Department of Ageing and Therapeutics, , Dooradoyle, Limerick, Ireland
| | - G Corey
- University Hospital Limerick Department of Ageing and Therapeutics, , Dooradoyle, Limerick, Ireland
| | - L Barry
- University of Limerick School of Nursing and Midwifery, Faculty of Education and Health Sciences, , Limerick, Ireland
| | - A Griffin
- University of Limerick School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, , Limerick, Ireland
| | - Í O'Shaughnessy
- University of Limerick School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, , Limerick, Ireland
| | - L Ryan
- University Hospital Limerick Department of Ageing and Therapeutics, , Dooradoyle, Limerick, Ireland
| | - A Synott
- University Hospital Limerick Department of Ageing and Therapeutics, , Dooradoyle, Limerick, Ireland
| | - A McCarthy
- University Hospital Limerick Department of Ageing and Therapeutics, , Dooradoyle, Limerick, Ireland
| | - I Carroll
- University Hospital Limerick Department of Ageing and Therapeutics, , Dooradoyle, Limerick, Ireland
| | - S Leahy
- School of Science & Computing, Atlantic Technological University, ATU Galway City Department of Sport, Exercise & Nutrition, , Old Dublin Road, Galway, Ireland
| | - D Trepél
- Trinity College Dublin Trinity Institute of Neurosciences, School of Medicine, , Ireland
| | - D Ryan
- University Hospital Limerick Limerick EM Education Research Training, Emergency Department, , Dooradoyle, Limerick, Ireland
| | - K Robinson
- University of Limerick School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, , Limerick, Ireland
| | - R Galvin
- University of Limerick School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, , Limerick, Ireland
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Holmes A, Tissot S, Kearns P. Case report: Recurrent urethral polyps, an atypical presentation of ductal prostate adenocarcinoma. Urol Case Rep 2022; 43:102103. [PMID: 35540559 PMCID: PMC9079252 DOI: 10.1016/j.eucr.2022.102103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 04/19/2022] [Accepted: 04/28/2022] [Indexed: 12/01/2022] Open
Abstract
Prostate ductal adenocarcinoma is a rare subtype of prostate adenocarcinoma which can show aggressive features and have poor response to conventional treatment. Early diagnosis aids in shared patient decision making. We report an atypical presentation of this rare condition where a recurrent urethral polyp which showed pagetoid spread was diagnosed as ductal adenocarcinoma of the prostate, with emphasis on review of prior available histology. Consider ductal prostate carcinoma if observing pagetoid spread down urethra. Consider as differential diagnosis for recurrent prostatic urethral polyps. If recurrent presentations especially if presence of atypia review original histology.
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Affiliation(s)
- Angela Holmes
- Corresponding author. Department of Urological Surgery, Barwon Health, University Hospital Geelong, Bellerine Street, Geelong, Victoria, 3220, Australia.
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12
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Holmes A, Tissot S, O'Neill S, Kearns P. Intraoperative indocyanine green fluorescence navigation in a robot-assisted partial nephrectomy for a large renal cell carcinoma in a horseshoe kidney. BMJ Case Rep 2022; 15:15/6/e248323. [PMID: 35725279 PMCID: PMC9214297 DOI: 10.1136/bcr-2021-248323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A man in his 60s was referred to the urology department with an incidental finding of large 75 mm mass within a horseshoe kidney. CT imaging highlighted the well-known aberrant arterial anatomy seen in horseshoe kidney which often causes significant surgical challenges.After careful preoperative planning, the mass was resected successfully during a robot-assisted partial nephrectomy. Intraoperatively, indocyanine green fluorescence navigation helped to confirm arteries supplying area of resection were appropriately clamped, allowing for safe resection of the mass. Histology revealed a chromophobe renal cell carcinoma with clear margins. The patient was discharged on day 4 postoperatively and continues to be cancer free on routine surveillance imaging.
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Affiliation(s)
- Angela Holmes
- Urology, Barwon Health, Geelong, Victoria, Australia
| | - Sophie Tissot
- Urology, Barwon Health, Geelong, Victoria, Australia
| | - Sarah O'Neill
- Urology, Barwon Health, Geelong, Victoria, Australia
| | - Paul Kearns
- Urology, Barwon Health, Geelong, Victoria, Australia
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13
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Holmes A, Tissot S, Braslis K. Case report: Challenging adult case of erosive coronal sulcus hair thread tourniquet. Urol Case Rep 2022; 41:101983. [PMID: 34987976 PMCID: PMC8703056 DOI: 10.1016/j.eucr.2021.101983] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 12/09/2021] [Accepted: 12/12/2021] [Indexed: 11/20/2022] Open
Abstract
Hair thread tourniquet syndrome has been well described in the literature, with one of the rare presentations including resultant tourniquet of the penis. We describe an unusual case in an adult resulting in erosion of the urethra as well as the reconstructive and social challenges faced in an attempt to preserve the glans. SECTION HEADING Trauma and Reconstruction.
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Affiliation(s)
- Angela Holmes
- Department of Urological Surgery, Barwon Health, University Hospital Geelong, Geelong, Victoria, 3220, Australia
| | - Sophie Tissot
- Department of Urological Surgery, Barwon Health, University Hospital Geelong, Geelong, Victoria, 3220, Australia
| | - Karl Braslis
- Department of Urological Surgery, Barwon Health, University Hospital Geelong, Geelong, Victoria, 3220, Australia
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14
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Grills R, Holmes A, Tissot S, McLeod K. Optimizing surgical training in the time of COVID-19-Victorian regional teaching hospital experience. ANZ J Surg 2022; 92:336-340. [PMID: 35019199 DOI: 10.1111/ans.17472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 12/21/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Reductions in elective surgery due to the COVID-19 pandemic led to a paralleled reduction in patient based surgical training opportunities. METHODS To quantify the impact of COVID-19 on surgical training, we completed a retrospective audit of the Urology Department activity during Victorian pandemic waves in 2020 at our large regional teaching hospital. Corresponding weeks in the year prior were used as the control. Interviews with department members illustrated the adaptive approach to surgical training used at our institution. RESULTS A State of Disaster Surgical Triage Team was assembled and surgical operations were split between one public and two private hospitals. A pandemic triaging protocol was established and 335 Category-2 patients were re-triaged. The first wave saw a 13.8% reduction in clinic reviews, with the second wave having an overall increase of 8.8% with 56% being telehealth. The second wave saw an 11.0% reduction in overall operating, with reduced emergency operating in both the first and second wave of 17.4% and 45.5%, respectively. Reductions impacted surgical technical skill training, resulting in surgical education provided through technology platforms including webinars, podcasts and pre-recorded operative videos. The unique challenges trainees were faced with due to the pandemic encouraged development of non-technical RACS competencies. CONCLUSION The COVID-19 pandemic presented significant challenges for service delivery and training. Reduced direct patient contact and procedures, but opportunities to develop the non-technical skills required to respond to the pandemic. The use of variable educational opportunities and tools ensured our trainees continued to progress through their training.
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Affiliation(s)
- Richard Grills
- Department of Urological Surgery, Barwon Health, University Hospital Geelong, Geelong, Victoria, Australia.,Department of Surgery, Deakin University, Geelong, Victoria, Australia
| | - Angela Holmes
- Department of Urological Surgery, Barwon Health, University Hospital Geelong, Geelong, Victoria, Australia
| | - Sophie Tissot
- Department of Urological Surgery, Barwon Health, University Hospital Geelong, Geelong, Victoria, Australia
| | - Kathryn McLeod
- Department of Urological Surgery, Barwon Health, University Hospital Geelong, Geelong, Victoria, Australia.,Department of Surgery, Deakin University, Geelong, Victoria, Australia
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15
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Nelson J, Perkins S, Holmes A, Hirschl J, Chopra Z, Medlin R, Fung C, Korley F, Burke J. 296 A Bayesian Approach to Predicting Outcomes During the Initial COVID-19 Outbreak. Ann Emerg Med 2021. [PMCID: PMC8536276 DOI: 10.1016/j.annemergmed.2021.09.309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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16
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Montañes Sancho I, Adamantos S, Holmes A. Diagnostic utility of canine cerebrospinal fluid preserved by 10% buffered formalin. J Small Anim Pract 2021; 63:22-26. [PMID: 34431098 DOI: 10.1111/jsap.13419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 06/12/2021] [Accepted: 08/06/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To examine the diagnostic utility of canine cerebrospinal fluid samples collected into tubes containing ethylenediaminetetraacetic acid (EDTA) with and without the addition of 10% buffered formalin analysed within 6 to 20 hours. MATERIALS AND METHODS Inclusion criteria were dogs presenting to a referral hospital with neurological signs and having cerebrospinal fluid analysis performed. Samples were submitted to an external laboratory in tubes containing ethylenediaminetetraacetic acid as paired-samples; one with the addition of one drop of 10% buffered formalin and the other without formalin. Cytology report, total nucleated cell counts, and protein concentration were reviewed. Three different categories of cell preservation were defined: diagnostic, non-diagnostic and unclassified. Each sample was included in one of these categories depending on cytological features, and the diagnostic quality between samples was compared. Samples were further divided in two groups depending on protein concentration using 50 mg/dL as cut-off value and the diagnostic quality between samples was compared. RESULTS 254 samples from 127 dogs were included. 47% of samples without formalin were non-diagnostic, 46% diagnostic and 6% unclassified. In the formalin group, 2% samples were non-diagnostic, 92% diagnostic and 6% unclassified. Samples with formalin preservation were statistically more likely to be diagnostic than samples without formalin preservation. In both protein groups (≥50 and <50 mg/dL) formalin samples were statistically more likely to be diagnostic as well. CLINICAL SIGNIFICANCE The addition of one drop of 10% formalin is a simple, widely available method which can help to improve the accuracy of cytological assessment in canine cerebrospinal fluid by preserving cellular morphology when analysis is performed within 6 to 20 hours.
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Affiliation(s)
- I Montañes Sancho
- Internal Medicine Department, Paragon Veterinary Referrals, Wakefield, WF1 2DF, UK
| | - S Adamantos
- Internal Medicine Department, Paragon Veterinary Referrals, Wakefield, WF1 2DF, UK
| | - A Holmes
- Internal Medicine Department, Paragon Veterinary Referrals, Wakefield, WF1 2DF, UK
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17
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Bal E, Kumar R, Hadigol M, Holmes A, Basso K, Khiabanian H, Pasqualucci L, Dalla‐Favera R. PERVASIVE HYPERMUTATION OF SUPER‐ENHANCER REGIONS DYSREGULATES ONCOGENE EXPRESSION IN DIFFUSE LARGE B‐CELL LYMPHOMA. Hematol Oncol 2021. [DOI: 10.1002/hon.4_2879] [Citation(s) in RCA: 1] [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: 11/10/2022]
Affiliation(s)
- E Bal
- Columbia University Institute for Cancer Genetics the Department of Pathology and Cell Biology the Herbert Irving Comprehensive Cancer Center, New York New York SA
| | - R Kumar
- Columbia University Institute for Cancer Genetics the Department of Pathology and Cell Biology the Herbert Irving Comprehensive Cancer Center, New York New York SA
| | - M Hadigol
- Columbia University Institute for Cancer Genetics the Department of Pathology and Cell Biology the Herbert Irving Comprehensive Cancer Center, New York New York SA
- Rutgers University Center for Systems and Computational Biology Rutgers Cancer Institute New Brunswick New Jersey USA
| | - A Holmes
- Columbia University Institute for Cancer Genetics the Department of Pathology and Cell Biology the Herbert Irving Comprehensive Cancer Center, New York New York SA
| | - K Basso
- Columbia University Institute for Cancer Genetics the Department of Pathology and Cell Biology the Herbert Irving Comprehensive Cancer Center, New York New York SA
| | - H Khiabanian
- Rutgers University Center for Systems and Computational Biology Rutgers Cancer Institute New Brunswick New Jersey USA
| | - L Pasqualucci
- Columbia University Institute for Cancer Genetics the Department of Pathology and Cell Biology the Herbert Irving Comprehensive Cancer Center, New York New York SA
| | - R Dalla‐Favera
- Columbia University Institute for Cancer Genetics the Department of Pathology and Cell Biology the Herbert Irving Comprehensive Cancer Center, New York New York SA
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18
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O"reilly M, Sommerfeld L, O"shea C, Broadway-Stringer S, Kabir S, Andaleeb S, Malinova A, Reyat J, Fortmueller L, Pavlovic D, Skryabin BV, Holmes A, Kirchhof P, Fabritz L. The SCN5A point mutation M1875T, associated with familial atrial fibrillation, causes a gain-of-function effect of the cardiac Nav1.5 channel in atrial cardiomyocytes. Europace 2021. [DOI: 10.1093/europace/euab116.547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): British Heart Foundation Leducq Foundation
Background
The point mutation M1875T in the SCN5A gene, which encodes the pore-forming α-subunit of the cardiac voltage-gated Na+ channel Nav1.5, has been associated with familial atrial fibrillation (AF), but its effects on atrial cardiomyocyte electrophysiology is unclear.
Aim
To investigate the effect of the point mutation M1875T on atrial electrophysiological parameters.
Methods
In a novel heterozygous knock-in murine model (Scn5a-M1875T+/-), whole-cell patch clamp electrophysiology was used to investigate Na+ currents in left atrial (LA) cardiomyocytes isolated from hearts of young adult mice (10-16 weeks). LA microelectrode and optical mapping recordings were used to study action potential (AP) characteristics. Cardiac size and function were measured by transthoracic echocardiography. Atrial Scn5a gene and Nav1.5 protein expression were assessed by Rt-PCR and Western blot.
Results
The Na+ current was increased in cardiomyocytes isolated from Scn5a-M1875T+/- LA (wildtype (WT) -22.7 ± 0.9 pA/pF (N = 14, n = 115); Scn5a-M1875T+/- -28.3 ± 1.1 pA/pF (N = 15, n = 117)). Scn5a-M1875T+/- intact isolated superfused LA had an elevated AP amplitude (100 ms pacing cycle length (PCL): WT 86.4 ± 0.9 mV (N = 8, n = 24); Scn5a-M1875T+/- 91.2 ± 0.7 mV (N = 8, n = 25)) and a faster peak upstroke velocity (100 ms PCL: WT 127.98 ± 3.28 mV/ms; Scn5a-M1875T+/- 142.80 ± 3.98 mV/ms). AP duration (APD) was not different apart from a small APD shortening at slow rates. Echocardiography revealed no difference in size and function at the age of investigation. Atrial Scn5a gene and Nav1.5 protein expression were comparable. When challenged with flecainide (1 µM), Scn5a-M1875T+/- LA showed less conduction slowing than WT (100 ms PCL: WT -10.43 ± 1.27 cm/s (N = 12); Scn5a-M1875T+/- -6.10 ± 1.34 cm/s (N = 12)). 5 µM flecainide caused significant increase in WT refractoriness (7/12 atria lost 1:1 capture at PCL ≤ 120 ms) compared to Scn5a-M1875T+/- (1/12).
Conclusion(s): SCN5A point mutation M1875T increases the Na+ current in atrial cardiomyocytes and intact atria, leading to a faster AP upstroke and an attenuated response to flecainide. Abstract Figure 1: Current-Voltage relationship
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Affiliation(s)
- M O"reilly
- Institute of Cardiovascular Sciences, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - L Sommerfeld
- Institute of Cardiovascular Sciences, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - C O"shea
- Institute of Cardiovascular Sciences, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - S Broadway-Stringer
- Institute of Cardiovascular Sciences, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - S Kabir
- Institute of Cardiovascular Sciences, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - S Andaleeb
- Institute of Cardiovascular Sciences, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - A Malinova
- Institute of Cardiovascular Sciences, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - J Reyat
- Institute of Cardiovascular Sciences, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - L Fortmueller
- University hospital Münster, Institute of Human Genetics, Muenster, Germany
| | - D Pavlovic
- Institute of Cardiovascular Sciences, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - BV Skryabin
- University of Muenster, Medical Faculty, Muenster, Germany
| | - A Holmes
- University of Birmingham, Institute of Clinical Sciences, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - P Kirchhof
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - L Fabritz
- Institute of Cardiovascular Sciences, Birmingham, United Kingdom of Great Britain & Northern Ireland
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19
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Abstract
Abstract
Introduction/Objective
Cutaneous plasmacytosis (CP) is an uncommon condition typically affecting Asian males in the 3rd to 5th decades. It is thought to be a reactive process that classically presents with asymptomatic, red-brown, plaques and nodules on the face and neck. It has been associated with polyclonal hypergammaglobulinemia and systemic involvement. Histologically it is characterized by dense superficial and deep dermal infiltrates of mature plasma cells with polyclonal differentiation on in-situ hybridization (ISH). The differential diagnosis includes neoplastic plasma cell processes, characteristically with monoclonal plasma cell infiltrate, and mature B cell neoplasms with polyclonal plasma cell differentiation.
Methods
We report a case of a 69 year old Caucasian male who presented with asymptomatic, enlarging red-brown nodules on bilateral nasal ala. Histologic examination revealed dense, superficial plasma cell infiltrate, concerning for a plasma cell neoplasm. CD138 and Kappa/Lambda ISH demonstrated plasma cell polyclonality. Further workup ruled out infectious or systemic involvement and a plasma cell dyscrasia was ruled out by Hematology/Oncology.
Results
These findings supported the diagnosis of CP. Treatment with intralesional steroids showed initial improvement with regrowth of the nodules. To date, treatment with topical steroids and CO2 laser ablation are being considered.
Conclusion
CP is reported as type of pseudolymphoma, which is described as a reactive lymphoproliferation that histopathologically and/or clinically imitates cutaneous lymphoma. The pathogenesis is unknown, however, there are studies suggesting an association with increased interleukin-6, which is involved in the differentiation of B cells to mature plasma cells. The majority of patients with CP have a favorable prognosis. There has been variable success with both topical and intralesional treatment to include, cyclophosphamide, topical tacrolimus, prednisone, intralesional steroid therapy, topical psoralens combined with ultraviolet A exposure, and other chemotherapies. Familiarity with this rare entity is imperative to prevent misdiagnosis and overtreatment.
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Affiliation(s)
- C N Giraldo
- Pathology, Brooke Army Medical Center, San Antonio, Texas, UNITED STATES
| | - D Myers
- Pathology, Brooke Army Medical Center, San Antonio, Texas, UNITED STATES
| | - A Holmes
- Pathology, Brooke Army Medical Center, San Antonio, Texas, UNITED STATES
| | - J Dodd
- Dermatology, Brooke Army Medical Center, San Antonio, Texas, UNITED STATES
| | - W Wendi
- Dermatology, Brooke Army Medical Center, San Antonio, Texas, UNITED STATES
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20
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Sancho IM, Holmes A, Adamantos S. Imerslund-Grasbeck syndrome in a cross-breed dog. J Small Anim Pract 2020; 62:709-711. [PMID: 33022748 DOI: 10.1111/jsap.13239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 08/24/2020] [Accepted: 09/15/2020] [Indexed: 11/26/2022]
Abstract
Imerslund-Gräsbeck syndrome is an autosomal recessive disease reported only in certain pure-breed dogs. An 18-month-old, male neutered beagle cross-breed was presented for evaluation of severe lethargy, progressive weakness and anorexia. Main clinicopathological findings included low body condition score (2.5/9), severe muscle atrophy, several neurological abnormalities, mild normochromic, normocytic, non-regenerative anaemia, severe hypocobalaminemia and mild proteinuria. Extensive diagnostic tests ruled out most of differential diagnoses for the aforementioned clinicopathological abnormalities and genetic evaluation showed that the dog was heterozygous for two previously described mutations affecting the CUBN gene, the beagle and the border collie variants. The dog showed an excellent clinical response to oral cobalamin supplementation with no relapse after 4 months. In conclusion, this case creates awareness that Imerslund-Gräsbeck syndrome should be considered even in mixed-breed dogs with compatible clinical signs and that two different pathogenic CUBN mutations in compound heterozygosity can lead to a typical Imerslund-Gräsbeck syndrome phenotype.
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Affiliation(s)
- I M Sancho
- Paragon Veterinary Referrals, Paragon Business Village Paragon Way, Red Hall Cres, Wakefield, WF1 2DF, UK
| | - A Holmes
- Paragon Veterinary Referrals, Paragon Business Village Paragon Way, Red Hall Cres, Wakefield, WF1 2DF, UK
| | - S Adamantos
- Paragon Veterinary Referrals, Paragon Business Village Paragon Way, Red Hall Cres, Wakefield, WF1 2DF, UK
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21
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Feldman K, Butler M, Hay K, Holmes A, Krautscheid P, Nosal M, Scannell D, Sleeper H, Stoutenburg S, Jarris P. Sara Alert: An enduring national resource to support public health monitoring & disease containment. Eur J Public Health 2020. [PMCID: PMC7543464 DOI: 10.1093/eurpub/ckaa165.353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background Public health agencies had to respond swiftly to the novel coronavirus that emerged in 2019 (COVID-19) to try to contain the virus, which requires early identification of new cases. Monitoring exposed individuals is labor intensive and available tools are often limited. MITRE, a company that operates federally funded research and development centers for the U.S. government, rapidly developed a configurable monitoring tool that allows public health authorities to monitor potentially exposed individuals in their jurisdictions. Methods A team, including public health leaders, field epidemiologists, software engineers, and health communication specialists, was quickly assembled to design and develop an open source, disease-independent monitoring tool called Sara Alert. Outreach to key public health stakeholders, including partner organizations and local and state health departments, was conducted early for requirements gathering and to validate assumptions. Public health law experts were consulted regarding data privacy and security. Results By four weeks, a minimally viable monitoring tool was available for testing by public health partners. Exposed individuals can be enrolled and reminded daily to enter a temperature and any symptoms by web or mobile interface, SMS messaging or phone. Public health officials monitor and can quickly take action if symptoms consistent with COVID-19 are reported of if there is failure to report within a configurable time frame. Dashboards provide insight into aggregated data appropriate to level of view. Conclusions Sara Alert serves as a force multiplier that supports disease containment and allows resources to be directed where they are most needed. Successful development was possible because key stakeholders across public health practice were consulted early. Sara Alert is available, free, to state and local public health departments and serves as an enduring resource easily configured for the next public health emergency. Key messages Sara Alert serves as a force multiplier that supports disease containment and allows resources to be directed where they are most needed. Sara Alert serves as an enduring resource easily configured for the next public health emergency.
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Affiliation(s)
- K Feldman
- MITRE Corporation, Windsor Mill, USA
| | - M Butler
- MITRE Corporation, Windsor Mill, USA
| | - K Hay
- MITRE Corporation, Windsor Mill, USA
| | - A Holmes
- MITRE Corporation, Windsor Mill, USA
| | | | - M Nosal
- MITRE Corporation, Windsor Mill, USA
| | | | - H Sleeper
- MITRE Corporation, Windsor Mill, USA
| | | | - P Jarris
- MITRE Corporation, Windsor Mill, USA
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22
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Veepanattu P, Singh S, Mendelson M, Nampoothiri V, Edathadatil F, Surendran S, Bonaconsa C, Mbamalu O, Ahuja S, Birgand G, Tarrant C, Sevdalis N, Ahmad R, Castro-Sanchez E, Holmes A, Charani E. Building resilient and responsive research collaborations to tackle antimicrobial resistance-Lessons learnt from India, South Africa, and UK. Int J Infect Dis 2020; 100:278-282. [PMID: 32860949 PMCID: PMC7449941 DOI: 10.1016/j.ijid.2020.08.057] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 08/14/2020] [Accepted: 08/20/2020] [Indexed: 12/18/2022] Open
Abstract
Research, collaboration, and knowledge exchange are critical to global efforts to tackle antimicrobial resistance (AMR). Different healthcare economies are faced with different challenges in implementing effective strategies to address AMR. Building effective capacity for research to inform AMR-related strategies and policies is recognised as an important contributor to success. Interdisciplinary, intersector, as well as international collaborations are needed to span global to local efforts to tackle AMR. The development of reciprocal, long-term partnerships between collaborators in high-income and in low- and middle-income countries (LMICs) needs to be built on principles of capacity building. Using case studies spanning local and international research collaborations to codesign, implement, and evaluate strategies to tackle AMR, we have evaluated and build upon the ESSENCE criteria for capacity building in LMICs. The first case study describes the local codesign and implementation of antimicrobial stewardship (AMS) in the state of Kerala in India. The second case study describes an international research collaboration investigating AMR surgical patient pathways in India, the UK, and South Africa. We describe the steps undertaken to develop robust, agile, and flexible AMS research and implementation teams. Notably, investing in capacity building ensured that the programmes described in these case studies were sustained through the current severe acute respiratory syndrome coronavirus pandemic. Describing the strategies adopted by a local and an international collaboration to tackle AMR, we provide a model for capacity building in LMICs that can support sustainable and agile AMS programmes.
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Affiliation(s)
- P Veepanattu
- Department of Infection Control and Epidemiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham University, Kochi, Kerala, India
| | - S Singh
- Department of Infection Control and Epidemiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham University, Kochi, Kerala, India
| | - M Mendelson
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - V Nampoothiri
- Department of Infection Control and Epidemiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham University, Kochi, Kerala, India
| | - F Edathadatil
- Department of Infection Control and Epidemiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham University, Kochi, Kerala, India
| | - S Surendran
- Department of Infection Control and Epidemiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham University, Kochi, Kerala, India
| | - C Bonaconsa
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - O Mbamalu
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - S Ahuja
- Centre for Implementation Science, Health Service and Population Research Department, King's College London, UK
| | - G Birgand
- NIHR Health Protection Research Unit, Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, UK
| | - C Tarrant
- Department of Health Sciences, University of Leicester, George Davies Centre, University Road, Leicester, UK
| | - N Sevdalis
- Centre for Implementation Science, Health Service and Population Research Department, King's College London, UK
| | - R Ahmad
- NIHR Health Protection Research Unit, Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, UK; Division of Health Sciences, City University, London, UK
| | - E Castro-Sanchez
- NIHR Health Protection Research Unit, Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, UK; Division of Health Sciences, City University, London, UK
| | - A Holmes
- NIHR Health Protection Research Unit, Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, UK
| | - E Charani
- NIHR Health Protection Research Unit, Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, UK.
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Bretherton P, Eysenck M, Richards A, Holmes A. Target and distractor processing and the influence of load on the allocation of attention to task-irrelevant threat. Neuropsychologia 2020; 145:106491. [DOI: 10.1016/j.neuropsychologia.2017.09.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 08/15/2017] [Accepted: 09/08/2017] [Indexed: 11/29/2022]
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24
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Holmes A, Kelly BD, Perera M, Eapen RS, Bolton DM, Lawrentschuk N. A systematic scoping review of multidisciplinary cancer team and decision-making in the management of men with advanced prostate cancer. World J Urol 2020; 39:297-306. [PMID: 32500304 DOI: 10.1007/s00345-020-03265-1] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 05/16/2020] [Indexed: 02/07/2023] Open
Abstract
PURPOSE The early diagnosis of prostate cancer and subsequent access to the treatment options helps to achieve optimal cancer outcomes. As the treatment options for patients with advanced prostate cancer continues to evolve, patients need to access a multidisciplinary team (MDT) meeting to receive best-practice care. METHODS In this paper a MEDLINE review was performed to assess clinical decision making in the context of MDT discussions for patients with advanced prostate cancer. RESULTS From 441 returned articles and abstracts, 50 articles were assessed for eligibility and 16 articles included for analysis. Sixteen articles were identified, 9 of the 16 articles used quantitative methodology including three retrospective analysis of clinical registry data, patient medical records and/or MDT meeting notes and three cross-sectional surveys. Other study designs included one observation study and one study using a combination of qualitative and quantitative methodologies and one mini-review. There were also four editorials included in the review and two consensus statements. CONCLUSION This paper highlights the important role the inter-disciplinary MDT has on shared decision making for men with advanced prostate cancer. The application of MDT care is a rapidly growing trend in uro-oncology and an efficient MDT service requires further research to assess its efficiency so that it may expand through all aspect of uro-oncology.
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Affiliation(s)
- A Holmes
- Department of Surgery, Austin Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - B D Kelly
- Department of Surgery, Austin Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - M Perera
- Department of Surgery, Austin Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - R S Eapen
- Department of Surgery, Austin Hospital, University of Melbourne, Melbourne, VIC, Australia.,Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - D M Bolton
- Department of Surgery, Austin Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - N Lawrentschuk
- Department of Surgery, Austin Hospital, University of Melbourne, Melbourne, VIC, Australia. .,Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia. .,EJ Whitten Prostate Cancer Research Centre at Epworth Healthcare, Melbourne, Australia. .,Department of Urology, Royal Melbourne Hospital, Melbourne, Australia.
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Celentano V, Beable R, Ball C, Flashman KG, Reeve R, Holmes A, Fogg C, Harper M, Higginson A. The Portsmouth protocol for intra-operative ultrasound of the small bowel in Crohn's disease. Colorectal Dis 2020; 22:342-345. [PMID: 31652389 DOI: 10.1111/codi.14888] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 07/24/2019] [Accepted: 09/30/2019] [Indexed: 12/27/2022]
Abstract
AIM Bowel preservation is paramount in Crohn's disease surgery as affected patients are typically young adults at risk of having several abdominal surgical procedures during their lifetime. Intra-operative assessment of the extent and location of Crohn's disease is not standardized and is left to a mixture of the surgeon's experience, tactile feedback, macroscopic appearance and preoperative imaging. The aim of this study was to describe the technical steps of a standardized protocol for intra-operative ultrasound assessment of the small bowel in patients undergoing surgery for ileocolic Crohn's disease. METHOD After laparoscopic mobilization of the bowel, a periumbilical incision is performed for extracorporeal division of the mesentery and the resection and anastomosis. A gastrointestinal consultant radiologist, with expertise in Crohn's disease imaging and abdominal ultrasound, performs full intra-operative assessment of the small bowel by applying a sterile ultrasound probe directly to the bowel, prior to resection being performed by the surgeon. The bowel is assessed through the wound protector with a sterile technique and the length, location and number of segments is documented together with further quantitative assessment using the METRIC (MR enterography or ultrasound in Crohn's disease) scoring guide. RESULTS A step-by-step protocol for intra-operative ultrasound evaluation of the entire small bowel is described. CONCLUSIONS A standardized approach to intra-operative evaluation of the extent and location of Crohn's disease is desirable. Intra-operative ultrasound may provide added value for assessment of proximal and multifocal Crohn's disease.
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Affiliation(s)
- V Celentano
- Portsmouth Hospitals NHS Trust, Queen Alexandra Hospital, Portsmouth, UK.,University of Portsmouth, Portsmouth, UK
| | - R Beable
- Portsmouth Hospitals NHS Trust, Queen Alexandra Hospital, Portsmouth, UK
| | - C Ball
- Portsmouth Hospitals NHS Trust, Queen Alexandra Hospital, Portsmouth, UK
| | - K G Flashman
- Portsmouth Hospitals NHS Trust, Queen Alexandra Hospital, Portsmouth, UK
| | - R Reeve
- Portsmouth Hospitals NHS Trust, Queen Alexandra Hospital, Portsmouth, UK
| | - A Holmes
- Portsmouth Hospitals NHS Trust, Queen Alexandra Hospital, Portsmouth, UK
| | - C Fogg
- Portsmouth Hospitals NHS Trust, Queen Alexandra Hospital, Portsmouth, UK
| | - M Harper
- University of Portsmouth, Portsmouth, UK
| | - A Higginson
- Portsmouth Hospitals NHS Trust, Queen Alexandra Hospital, Portsmouth, UK
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Birgand G, Troughton R, Mariano V, Hettiaratchy S, Hopkins S, Otter JA, Holmes A. How do surgeons feel about the 'Getting it Right First Time' national audit? Results from a qualitative assessment. J Hosp Infect 2019; 104:328-331. [PMID: 31711792 DOI: 10.1016/j.jhin.2019.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 10/05/2019] [Accepted: 11/01/2019] [Indexed: 11/29/2022]
Abstract
The implementation of the national 'Getting It Right First Time' was assessed by interviewing six surgeons involved at various levels in surgical site infection (SSI) audit. The positive impacts were to create new professional collaboration, improve stakeholder engagement, and increase the profile of SSIs. One particular knowledge gap highlighted was that some participants had been unaware until that point of the criteria for diagnosing an SSI. The quality of data collected was felt to be poor due to methodological flaws. The audit was described as highly time-consuming and unsustainable if leaning on junior surgeons, without protected time and designated responsibility.
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Affiliation(s)
- G Birgand
- National Institute for Health Research, Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College London, Hammersmith Campus, London, UK.
| | - R Troughton
- National Institute for Health Research, Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College London, Hammersmith Campus, London, UK
| | - V Mariano
- National Institute for Health Research, Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College London, Hammersmith Campus, London, UK
| | - S Hettiaratchy
- Major Trauma Centre, St Mary's Hospital, Imperial College Healthcare NHS Trust, Praed Street, London, UK
| | - S Hopkins
- National Infection Service, Public Health England, London, UK
| | - J A Otter
- Infection Control, Imperial College Healthcare NHS Trust, London, UK
| | - A Holmes
- National Institute for Health Research, Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College London, Hammersmith Campus, London, UK
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Honeyford K, Cooke GS, Kinderlerer A, Williamson E, Gilchrist M, Holmes A, Glampson B, Mulla A, Costelloe C. Evaluating a digital sepsis alert in a multi-site hospital: a natural experiment. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz185.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
This study investigated the impact of a digital sepsis alert on patient outcomes in a busy London multi-site hospital. Sepsis is a serious illness and common cause of death, but rapid diagnosis and treatment improve patient outcomes. Digital health records allow algorithms to be embedded which ‘alert’ clinicians to patients who are at risk of developing sepsis. Despite the current promotion of ‘digital health’, evidence of the impact of algorithm driven alerts on patient outcomes is limited.
Methods
A retrospective natural experiment utilising the phased introduction of a digital sepsis alert into a large, multi-site hospital in England. Silent alerts (not visible to clinicians) acted as controls. Outcome measures were in-hospital all-cause mortality within 30 days of the alert, extended hospital stay (≥7 days) and timely antibiotics (≤60 minutes of the alert). Inversely weighted multivariable logistic regression was used to determine associations between alert and patient outcomes.
Results
In a sample of 21,183 inpatients, the mortality rate was 5.9%. The active, visible alert was associated with lower odds of death (Odds Ratio (OR):0.76; 95%CI:(0.70, 0.84)). In 9988 emergency department attendances ending in admission, 40.6% had an extended hospital stay and 41.5% received timely antibiotics. The active alert was associated with lower odds of extended hospital stay (OR:0.93; 95%CI:(0.88, 0.99)) and increased odds of receiving timely antibiotics (OR:1.71; 95%CI:(1.57, 1.87)).
Conclusions
This study demonstrates that a move to digital health, through an automated sepsis alert, embedded in digital health records, was associated with improved health outcomes. Further work is needed to identify the causal pathway, which is likely to include more rapid treatment with antibiotics, and possible unintended consequences. These findings support the ongoing roll out of digital alerting and provide a model for robustly evaluating their impact.
Key messages
The introduction of an automated sepsis alert associated with the use of improvement methodology was associated with improved process measures and patient outcomes. Introduction of digital health interventions can, and should, be robustly evaluated with appropriate statistical approaches.
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Affiliation(s)
- K Honeyford
- Global Digital Health Unit, Imperial College, London, UK
| | - G S Cooke
- Infectious Disease Section, Imperial College, London, UK
| | - A Kinderlerer
- St Mary’s Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - E Williamson
- Electronic Health Records Research, LSHTM, London, UK
| | - M Gilchrist
- St Mary’s Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - A Holmes
- HPRU-AMR, Imperial College, London, UK
| | - B Glampson
- St Mary’s Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - A Mulla
- St Mary’s Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - C Costelloe
- Global Digital Health Unit, Imperial College, London, UK
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Santos Cade J, Papaioannou I, Siddiqui Y, Holmes A, Loizidou M, Schatzlein A, Denton C, Abraham D, Ponticos M. P6011NKX2-5 contributes to EndoMT and endothelial dysfunction in pulmonary arterial hypertension. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The onset of inflammation, hypoxia or shear stress within blood vessels can result in endothelial-to-mesenchymal transition (EndoMT), a disease-associated process where endothelial cells (ECs) downregulate endothelial markers and acquire mesenchymal features. EndoMT is observed in patients with scleroderma-associated pulmonary hypertension (SSc-PAH), which have the highest mortality amongst all the scleroderma patient subgroups. The homeobox transcriptional factor NKX2-5 is fundamental for cardiovascular development. However, NKX2-5 expression has not been reported yet in ECs of adult pulmonary blood vessels.
Purpose
To investigate the role of NKX2-5 in the pulmonary endothelium of SSc-PAH.
Methods
Human pulmonary artery endothelial cells (HPAECs) were treated with a cocktail of TGF-β (5 ng/mL), TNF-α (5 ng/mL), and IL-1β (0.1 ng/mL) for 5 days. Immunofluorescence was used to detect NKX2-5 and other markers in ECs. Western blotting and qPCR evaluated, respectively, protein and gene expression. Lentiviral transduction forced NKX2-5 expression in the cells. Transendothelial electrical resistance (TEER) measurements evaluated endothelial barrier function. Pharmacological inhibition was performed to determine the pathways that lead to NKX2-5 activation. Casein kinase 2 (CK2)-inhibition (CX4945) of a chronic hypoxia mouse model of PAH was used to assess right ventricular systolic pressure (RVSP).
Results
Immunofluorescence showed a strong expression of NKX2-5 in the endothelium of SSc-PAH human lungs (p<0.0001). Western blot analysis demonstrated a 5.3-fold downregulation of CD31 (p<0.001), and an increased production of NKX2-5 (5.6-fold, p<0.0001) and of Procollagen I (12-fold, p=0.0009) after 5 days of cytokine stimulation on HPAECs. Relative mRNA expression has shown a 3-fold gene downregulation of CD31 (p=0.0002) and a reduction of VE-Cadherin (2.3-fold, p=0.0008) and of vWF (10.4-fold, p=0.003) in EndoMT, whereas gene expression of COL1α2 (8.5-fold, p<0.0001) and of NKX2-5 (1.5-fold, p=0.003) were upregulated. Immunofluorescence of cells has revealed a decreased VE-Cadherin expression concomitant with upregulation of NKX2-5 in EndoMT cells. Forced expression of NKX2-5 downregulated endothelial markers and endothelial barrier function was impaired whereas proliferation rate of cells was increased. Inhibition of PI3K, ERK5, ALK5 and CK2 reduced NKX2-5 protein expression within cells. CK2-inhibited mice under hypoxia conditions resembled the normoxia mice group by normalising RVSP.
Conclusion
HPAECs undergoing EndoMT express NKX2-5 in vitro and in vivo, via mediation of CK2, TGF-β, ERK5 and PI3K signalling. NKX2-5 downregulates key adherence junctional proteins, disrupting endothelial barrier function. This study highlights the involvement of NKX2-5 in EndoMT and in endothelial dysfunction, leading to vascular disease progression in SSc-PAH.
Acknowledgement/Funding
British Heart Foundation, Arthritis Research UK, Scleroderma Research UK and Royal Free Hospital Charity
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Affiliation(s)
- J Santos Cade
- University College London, Centre for Rheumatology and Connective Tissue Diseases, London, United Kingdom
| | - I Papaioannou
- University College London, Centre for Rheumatology and Connective Tissue Diseases, London, United Kingdom
| | - Y Siddiqui
- University College London, Centre for Rheumatology and Connective Tissue Diseases, London, United Kingdom
| | - A Holmes
- University College London, Centre for Rheumatology and Connective Tissue Diseases, London, United Kingdom
| | - M Loizidou
- University College London, Department of Surgical Biotechnology, London, United Kingdom
| | - A Schatzlein
- University College London, School of Pharmacy, London, United Kingdom
| | - C Denton
- University College London, Centre for Rheumatology and Connective Tissue Diseases, London, United Kingdom
| | - D Abraham
- University College London, Centre for Rheumatology and Connective Tissue Diseases, London, United Kingdom
| | - M Ponticos
- University College London, Centre for Rheumatology and Connective Tissue Diseases, London, United Kingdom
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Christopherson KM, Berlind CG, Ahern CA, Holmes A, Lindsay WD, Smith BD, Das P, Smith GL. Improving quality through A.I.: Applying machine learning to predict unplanned hospitalizations after radiation. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.27_suppl.271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
271 Background: Unplanned hospitalizations may diminish quality of care among cancer patients receiving radiotherapy (RT). In patients undergoing RT for gastrointestinal (GI) cancers, we hypothesized that a machine learning approach would enable prediction of unplanned hospitalizations within 30 days of RT. Methods: We analyzed 836 abdominal (gastric, pancreatic, biliary, hepatic) and 514 pelvic (rectal, anal) courses of RT for GI cancers treated at our institution (3/2016—1/2019). Over 700 clinical/treatment variables and unplanned hospitalizations during or within 30 days after RT were mined from institutional databases. Using machine learning, we developed random forest (RF), gradient boosted decision trees (XGB), and logistic models for unplanned hospitalizations. Models were trained on 670 abdominal and 423 pelvic cases. Five-fold cross-validation (CV) was used to select model type and hyperparameters, using area under the ROC curve (AUC) to measure performance. The best model was validated on the subsequent 166 abdominal and 91 pelvic cases. AUC>0.70 was deemed clinically valid. Results: Among 1,350 cases, incidence of 30-day unplanned hospitalization was 12.3% (13.3% abdominal cohort; 10.7% pelvic cohort). Model CV AUCs are shown in table. The best models were XGB and RF for the abdominal and pelvic cohorts, respectively. Their validation testing AUCs are shown in table. For all models tested, lab values (e.g. potassium, lipoproteins, hemoglobin) prior to RT were significant predictors of unplanned hospitalizations. In the abdominal cohort, pancreatic primary and total RT dose were important. For the pelvic cohort, body mass index was important. Median healthcare costs from RT start - 30 days post-RT were $69,108 in non-hospitalized patients and $119,844 in hospitalized patients. Conclusions: In GI cancer patients undergoing RT, a machine learning model identified patients at risk of 30-day unplanned hospitalization. Predictive analytics may be a key tool to help providers identify high-risk patients and optimize interventions, while improving quality and value of care. [Table: see text]
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Affiliation(s)
| | | | | | | | | | | | - Prajnan Das
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - Grace L. Smith
- University of Texas MD Anderson Cancer Center, Houston, TX
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Holmes A, Chansky P, Simpson C. 847 Teledermatology can optimize treatment of cutaneous disease in under-resourced clinics. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.03.923] [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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31
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Holmes A, Williams C, Wang S, Barg F, Takeshita J. 279 Content analysis of psoriasis and eczema direct to consumer advertisements. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.03.355] [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: 10/27/2022]
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32
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Aliru M, Bernard V, Ng SP, Moningi S, Lindsay D, Berlind C, Ahern C, Holmes A, Edwards T, Smith B, Taniguchi C, Koay E, Das P, Holliday E, Herman J. Data Analytics Platform for Outcome Comparison of Patients Treated for Primary Pancreatic Cancer Using SBRT vs Conventional RT. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/s0360-3016(19)30527-9] [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: 10/27/2022]
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Troughton R, Birgand G, Johnson A, Naylor N, Gharbi M, Aylin P, Hopkins S, Jaffer U, Holmes A. Mapping national surveillance of surgical site infections in England: needs and priorities. J Hosp Infect 2018; 100:378-385. [DOI: 10.1016/j.jhin.2018.06.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 06/06/2018] [Indexed: 10/14/2022]
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Kyratsis Y, Ahmad R, Iwami M, Castro Sanchez E, Atun R, Holmes A. A multi-level analysis of infection control in English hospitals: coerced safety culture change. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky212.529] [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: 11/14/2022] Open
Affiliation(s)
| | - R Ahmad
- Imperial College London, London, UK
| | - M Iwami
- Imperial College London, London, UK
| | | | - R Atun
- Harvard University, Boston, USA
| | - A Holmes
- Imperial College London, London, UK
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35
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Balinskaite V, Holmes A, Johnson A, Aylin P. ISQUA18-2508An Assessment of Unintended Consequences in England Following a National Antimicrobial Stewardship Programme: An Interrupted Time Series Analysis. Int J Qual Health Care 2018. [DOI: 10.1093/intqhc/mzy167.53] [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: 11/14/2022] Open
Affiliation(s)
| | | | - A Johnson
- Public Health England, London, United Kingdom
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36
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Holmes A. G2B reviews: Epigenetics, epitranscriptomics, microRNAs and more: Emerging approaches to the study of genes, brain and behavior. Genes Brain Behav 2018; 17:e12453. [PMID: 29596736 DOI: 10.1111/gbb.12453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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37
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Rosterman JL, Pallotto EK, Truog WE, Escobar H, Meinert KA, Holmes A, Dai H, Manimtim WM. The impact of neurally adjusted ventilatory assist mode on respiratory severity score and energy expenditure in infants: a randomized crossover trial. J Perinatol 2018; 38:59-63. [PMID: 29072677 DOI: 10.1038/jp.2017.154] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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] [Received: 03/01/2017] [Revised: 08/01/2017] [Accepted: 08/30/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Examine respiratory severity scores (RSS) (mean airway pressure × fraction of inspired oxygen) and resting energy expenditure (REE) on neurally adjusted ventilatory assist (NAVA) compared with synchronized intermittent mandatory ventilation with pressure controlled and supported breath (SIMV (PC)PS). STUDY DESIGN A randomized, crossover trial in a level IV neonatal intensive care unit. Twenty-four patients were ventilated with NAVA or SIMV (PC) PS for 12 h and then crossed over to the alternative mode for 12 h. The primary outcome (RSS) and additional secondary respiratory outcomes were analyzed. RESULTS RSS and measured REE were not different between modes. On NAVA, peak inspiratory pressures were lower (17.8 vs 19.9 cmH2O (P<0.05)) without higher oxygen requirements. Respiratory rates were higher on NAVA (52 vs 39 (P<0.05)), estimated work of breathing (WOB) (0.01 vs 0.04 J l-1 (P<0.05)) was improved. CONCLUSION NAVA mode can be safe without increase in RSS or REE. Although respiratory rates were higher, this was offset by lower peak inspiratory pressures and WOB during NAVA.
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Affiliation(s)
- J L Rosterman
- Children's Mercy-Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - E K Pallotto
- Children's Mercy-Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - W E Truog
- Children's Mercy-Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - H Escobar
- Children's Mercy-Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - K A Meinert
- Children's Mercy-Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - A Holmes
- Children's Mercy-Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - H Dai
- Children's Mercy-Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - W M Manimtim
- Children's Mercy-Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
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Ramos VFML, Srivanitchapoom P, Thirugnanasambandam N, Pandey S, Holmes A, Kukke SN, Paine R, Considine E, Dang N, Wu T, Hallett M. Failed Attempt With Paired Associative Stimulation to Separate Functional and Organic Dystonia. Mov Disord 2017; 33:495-497. [PMID: 29239013 DOI: 10.1002/mds.27245] [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] [Received: 08/04/2017] [Revised: 10/10/2017] [Accepted: 10/12/2017] [Indexed: 11/06/2022] Open
Affiliation(s)
| | - Prachaya Srivanitchapoom
- Human Motor Control, National Institutes of Health, Bethesda, Maryland, USA.,Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Sanjay Pandey
- Human Motor Control, National Institutes of Health, Bethesda, Maryland, USA.,Department of Neurology, GB Pant Postgraduate Institute of Medical Education and Research, New Delhi, India
| | - Angela Holmes
- Human Motor Control, National Institutes of Health, Bethesda, Maryland, USA
| | - Sahana N Kukke
- Human Motor Control, National Institutes of Health, Bethesda, Maryland, USA.,Department of Biomedical Engineering, The Catholic University of America, Washington, DC, USA
| | - Rainer Paine
- Human Motor Control, National Institutes of Health, Bethesda, Maryland, USA
| | - Elaine Considine
- Human Motor Control, National Institutes of Health, Bethesda, Maryland, USA
| | - Nguyet Dang
- Human Motor Control, National Institutes of Health, Bethesda, Maryland, USA
| | - Tianxia Wu
- Office of Biostatistics, Clinical Trials Unit, National Institutes of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | - Mark Hallett
- Human Motor Control, National Institutes of Health, Bethesda, Maryland, USA
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Naylor N, Zhu N, Hulscher M, Holmes A, Ahmad R, Robotham J. Is antimicrobial stewardship cost-effective? A narrative review of the evidence. Clin Microbiol Infect 2017. [DOI: 10.1016/j.cmi.2017.06.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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40
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Crispin P, Holmes A. Clinical and pathological feature of bone marrow granulomas: A modern Australian series. Int J Lab Hematol 2017; 40:123-127. [PMID: 28984037 DOI: 10.1111/ijlh.12751] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 05/27/2017] [Accepted: 09/01/2017] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Marrow granulomas have been commonly associated with mycobacterial infections, prompting extensive investigations in some cases where they are found, but in the setting of changing infectious epidemiology, there is a lack of recent data to guide the search for probable causes. METHODS A retrospective case series examining the clinical and pathological findings in all cases where marrow granulomas were reported over a 10-year period at The Canberra Hospital, Australia. RESULTS Of the 6062 marrow biopsies performed, 73 (1.2%) from 66 individuals had confirmed granulomas. Some patients had multiple potential causes found. B-cell non-Hodgkin Lymphoma, sarcoidosis and autoimmune disease were the most frequently observed causes. Infections were less common in this cohort than in the previous series, with no tuberculosis seen. The presence of granulomas in the marrow did not signify the presence of active malignancy in the marrow. There were no associations with any specific morphological characteristics of the granulomas and the presumed causes. CONCLUSION Marrow granulomas are seen in a variety conditions. Neither their presence nor their morphological features are a guide to further investigations, which should be determined by the clinical presentation as appropriate.
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Affiliation(s)
- P Crispin
- Haematology Department, Canberra Hospital, Garran, ACT, Australia.,Haematology Department, ACT Pathology, Garran, ACT, Australia.,Australian National University Medical School, Acton, ACT, Australia
| | - A Holmes
- Haematology Department, ACT Pathology, Garran, ACT, Australia
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Pulcini C, Morel CM, Tacconelli E, Beovic B, de With K, Goossens H, Harbarth S, Holmes A, Howard P, Morris AM, Nathwani D, Sharland M, Schouten J, Thursky K, Laxminarayan R, Mendelson M. Human resources estimates and funding for antibiotic stewardship teams are urgently needed. Clin Microbiol Infect 2017; 23:785-787. [PMID: 28778544 DOI: 10.1016/j.cmi.2017.07.013] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 07/11/2017] [Accepted: 07/12/2017] [Indexed: 11/26/2022]
Affiliation(s)
- C Pulcini
- Lorraine University, EA 4360 APEMAC, Nancy, France; Nancy University Hospital, Infectious Diseases Department, Nancy, France; ESCMID Study Group for Antimicrobial stewardshiP (ESGAP).
| | - C M Morel
- University of Geneva Medical School, Geneva, Switzerland; London School of Economics, London, United Kingdom
| | - E Tacconelli
- Infectious Diseases, Internal Medicine 1, DZIF Centre, Tübingen University, Germany; European Committee on Infection Control (EUCIC)
| | - B Beovic
- ESCMID Study Group for Antimicrobial stewardshiP (ESGAP); University Medical Centre Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Slovenia
| | - K de With
- University Hospital Carl Gustav Carus at the TU Dresden, Division of Infectious Diseases, Dresden, Germany
| | - H Goossens
- Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - S Harbarth
- Infection Control Program and Division of Infectious Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - A Holmes
- Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK
| | - P Howard
- ESCMID Study Group for Antimicrobial stewardshiP (ESGAP); Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - A M Morris
- Division of Infectious Diseases, Department of Medicine, Sinai Health System, University Health Network, University of Toronto, Toronto, Canada
| | - D Nathwani
- Ninewells Hospital and Medical School, Dundee, UK; British Society for Antimicrobial Chemotherapy (BSAC), Birmingham, UK
| | - M Sharland
- Paediatric Infectious Diseases Research Group, St George's, University of London, London, UK
| | - J Schouten
- ESCMID Study Group for Antimicrobial stewardshiP (ESGAP); IQ Healthcare, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - K Thursky
- National Centre for Antimicrobial Stewardship, Royal Melbourne Hospital at the Peter Doherty Institute, Melbourne, Australia
| | - R Laxminarayan
- Centre for Disease Dynamics, Economics & Policy, New Delhi, India
| | - M Mendelson
- Division of Infectious Diseases & HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
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Charani E, Ahmad R, Tarrant C, Birgand G, Leather A, Mendelson M, Moonesinghe SR, Sevdalis N, Singh S, Holmes A. Opportunities for system level improvement in antibiotic use across the surgical pathway. Int J Infect Dis 2017; 60:29-34. [PMID: 28483725 DOI: 10.1016/j.ijid.2017.04.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 04/19/2017] [Accepted: 04/25/2017] [Indexed: 12/16/2022] Open
Abstract
Optimizing antibiotic prescribing across the surgical pathway (before, during, and after surgery) is a key aspect of tackling important drivers of antimicrobial resistance and simultaneously decreasing the burden of infection at the global level. In the UK alone, 10 million patients undergo surgery every year, which is equivalent to 60% of the annual hospital admissions having a surgical intervention. The overwhelming majority of surgical procedures require effectively limited delivery of antibiotic prophylaxis to prevent infections. Evidence from around the world indicates that antibiotics for surgical prophylaxis are administered ineffectively, or are extended for an inappropriate duration of time postoperatively. Ineffective antibiotic prophylaxis can contribute to the development of surgical site infections (SSIs), which represent a significant global burden of disease. The World Health Organization estimates SSI rates of up to 50% in postoperative surgical patients (depending on the type of surgery), with a particular problem in low- and middle-income countries, where SSIs are the most frequently reported healthcare-associated infections. Across European hospitals, SSIs alone comprise 19.6% of all healthcare-acquired infections. Much of the scientific research in infection management in surgery is related to infection prevention and control in the operating room, surgical prophylaxis, and the management of SSIs, with many studies focusing on infection within the 30-day postoperative period. However it is important to note that SSIs represent only one of the many types of infection that can occur postoperatively. This article provides an overview of the surgical pathway and considers infection management and antibiotic prescribing at each step of the pathway. The aim was to identify the implications for research and opportunities for system improvement.
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Affiliation(s)
- E Charani
- NIHR Health Protection Research Unit in Antimicrobial Resistance and Healthcare Associated Infection, Imperial College London, Department of Medicine, London, UK.
| | - R Ahmad
- NIHR Health Protection Research Unit in Antimicrobial Resistance and Healthcare Associated Infection, Imperial College London, Department of Medicine, London, UK
| | - C Tarrant
- Department of Health Sciences, University of Leicester, Centre for Medicine, Leicester, UK
| | - G Birgand
- NIHR Health Protection Research Unit in Antimicrobial Resistance and Healthcare Associated Infection, Imperial College London, Department of Medicine, London, UK
| | - A Leather
- King's Centre for Global Health & Health Partnerships, Division of Health & Social Care Research, Faculty of Life Sciences & Medicine, King's College London, UK
| | - M Mendelson
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, University of Cape Town, Groote Schuur Hospital Observatory, Cape Town, South Africa
| | - S R Moonesinghe
- Centre for Anaesthesia Critical Care and Pain Medicine, University College London Hospitals, London, UK()
| | - N Sevdalis
- Centre for Implementation Science, Institute of Psychiatry, King's College London, Denmark Hill, UK
| | - S Singh
- School of Medicine, Amrita University, Tamilnadu, Kochi, India
| | - A Holmes
- NIHR Health Protection Research Unit in Antimicrobial Resistance and Healthcare Associated Infection, Imperial College London, Department of Medicine, London, UK
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Martino J, Holmes A, Wise S, Xie H, Wise J. The role of centrosomes in chemical carcinogenesis: Hexavalent chromium induces aberrant centriole and centrosome separation and centrosome amplification. Toxicol Lett 2016. [DOI: 10.1016/j.toxlet.2016.07.655] [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: 10/20/2022]
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Dirkx E, Perea Gil I, Li MC, Gupta SK, Nguyen THM, Syeda F, Dirkx E, Raso A, Braga L, Zentilin L, Zacchigna S, Giacca M, De Windt LJ, Prat-Vidal C, Galvez-Monton C, Roura S, Llucia-Valldeperas A, Soler-Botija C, Diaz-Guemes I, Crisostomo V, Sanchez-Margallo FM, Bayes-Genis A, Cimino J, De Santis MC, Pianca N, Sciarretta S, Sandri M, Zaglia T, Mongillo M, Hirsch E, Ghigo A, Bauters C, De Groote P, Foinquinos A, Boon R, De Windt LJ, Batkai S, Pinet F, Thum T, Choquet C, Kober F, Bernard M, Kelly RG, Miquerol L, Lalevee N, Holmes A, Yu T, Tull S, Kuhlmann S, Pavlovic D, Betney D, Riley G, Kucera JP, Jousset F, De Groot J, Rohr S, Brown N, Fabritz L, Kirchhof P. Young Investigator Award Session - Heart40Targeting the miRNA-106b-25 cluster as a potential regenerative therapeutic approach for myocardial injury41An allogeneic bioengineered myocardial graft limits infarct size and improves cardiac function: pre-clinical study in the porcine myocardial infarction model42Phosphoinositide 3-kinase gamma inhibition protects against anthracycline-induced cardiomyopathy by boosting cardiac autophagy43Functional screening of microRNAs identifies miR-22 as a regulator of cardiac autophagy and aging44Functional defects and molecular mechanisms of left ventricular non-compaction in nkx2.5 mutant mice45PITX2 modulates atrial membrane potential, potentiating the antiarrhythmic effects of sodium channel blockers. Cardiovasc Res 2016. [DOI: 10.1093/cvr/cvw139] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Di Nardo A, Holmes A, Muto Y, Huang E, Preston N, Winkelman W, Gallo R. 281 Doxycycline modified release (MR) capsules improve rosacea clinical outcomes by modifying antimicrobial peptide metabolism: Results of a multicenter, randomized, double blind, placebo controlled study of 170 adults with papulopustular rosacea. J Invest Dermatol 2016. [DOI: 10.1016/j.jid.2016.02.311] [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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Izquierdo A, Brigman JL, Radke AK, Rudebeck PH, Holmes A. The neural basis of reversal learning: An updated perspective. Neuroscience 2016; 345:12-26. [PMID: 26979052 DOI: 10.1016/j.neuroscience.2016.03.021] [Citation(s) in RCA: 316] [Impact Index Per Article: 39.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 02/24/2016] [Accepted: 03/07/2016] [Indexed: 01/21/2023]
Abstract
Reversal learning paradigms are among the most widely used tests of cognitive flexibility and have been used as assays, across species, for altered cognitive processes in a host of neuropsychiatric conditions. Based on recent studies in humans, non-human primates, and rodents, the notion that reversal learning tasks primarily measure response inhibition, has been revised. In this review, we describe how cognitive flexibility is measured by reversal learning and discuss new definitions of the construct validity of the task that are serving as a heuristic to guide future research in this field. We also provide an update on the available evidence implicating certain cortical and subcortical brain regions in the mediation of reversal learning, and an overview of the principal neurotransmitter systems involved.
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Affiliation(s)
- A Izquierdo
- Department of Psychology, The Brain Research Institute, University of California, Los Angeles, Los Angeles, CA, USA.
| | - J L Brigman
- Department of Neurosciences, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - A K Radke
- Laboratory of Behavioral and Genomic Neuroscience, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - P H Rudebeck
- Department of Neuroscience and Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10014, USA
| | - A Holmes
- Laboratory of Behavioral and Genomic Neuroscience, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA
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Hartley ND, Gunduz-Cinar O, Halladay L, Bukalo O, Holmes A, Patel S. 2-arachidonoylglycerol signaling impairs short-term fear extinction. Transl Psychiatry 2016; 6:e749. [PMID: 26926885 PMCID: PMC4872450 DOI: 10.1038/tp.2016.26] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 12/11/2015] [Accepted: 01/11/2016] [Indexed: 12/17/2022] Open
Abstract
Impairments in fear extinction are thought to be central to the psychopathology of posttraumatic stress disorder, and endocannabinoid (eCB) signaling has been strongly implicated in extinction learning. Here we utilized the monoacylglycerol lipase inhibitor JZL184 to selectively augment brain 2-AG levels combined with an auditory cue fear-conditioning paradigm to test the hypothesis that 2-AG-mediated eCB signaling modulates short-term fear extinction learning in mice. We show that systemic JZL184 impairs short-term extinction learning in a CB1 receptor-dependent manner without affecting non-specific freezing behavior or the acquisition of conditioned fear. This effect was also observed in over-conditioned mice environmentally manipulated to re-acquire fear extinction. Cumulatively, the effects of JZL184 appear to be partly due to augmentation of 2-AG signaling in the basolateral nucleus of the amygdala (BLA), as direct microinfusion of JZL184 into the BLA produced similar results. Moreover, we elucidate a short ~3-day temporal window during which 2-AG augmentation impairs extinction behavior, suggesting a preferential role for 2-AG-mediated eCB signaling in the modulation of short-term behavioral sequelae to acute traumatic stress exposure.
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Affiliation(s)
- N D Hartley
- Department of Psychiatry, Vanderbilt University School of Medicine, Nashville, TN, USA
- Vanderbilt Brain Institute, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - O Gunduz-Cinar
- Laboratory of Behavioral and Genomic Neuroscience, National Institute on Alcoholism and Alcohol Abuse, National Institutes of Health, Bethesda, MD, USA
| | - L Halladay
- Laboratory of Behavioral and Genomic Neuroscience, National Institute on Alcoholism and Alcohol Abuse, National Institutes of Health, Bethesda, MD, USA
| | - O Bukalo
- Laboratory of Behavioral and Genomic Neuroscience, National Institute on Alcoholism and Alcohol Abuse, National Institutes of Health, Bethesda, MD, USA
| | - A Holmes
- Laboratory of Behavioral and Genomic Neuroscience, National Institute on Alcoholism and Alcohol Abuse, National Institutes of Health, Bethesda, MD, USA
| | - S Patel
- Department of Psychiatry, Vanderbilt University School of Medicine, Nashville, TN, USA
- Vanderbilt Brain Institute, Vanderbilt University School of Medicine, Nashville, TN, USA
- Department of Molecular Physiology and Biophysics, Vanderbilt University School of Medicine, Nashville, TN, USA
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Ahmad R, Iwami M, Castro-Sánchez E, Husson F, Taiyari K, Zingg W, Holmes A. Defining the user role in infection control. J Hosp Infect 2015; 92:321-7. [PMID: 26616416 DOI: 10.1016/j.jhin.2015.09.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [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: 05/07/2015] [Accepted: 09/28/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND Health policy initiatives continue to recognize the valuable role of patients and the public in improving safety, advocating the availability of information as well as involvement at the point of care. In infection control, there is a limited understanding of how users interpret the plethora of publicly available information about hospital performance, and little evidence to support strategies that include reminding healthcare staff to adhere to hand hygiene practices. AIM To understand how users define their own role in patient safety, specifically in infection control. METHODS Through group interviews, self-completed questionnaires and scenario evaluation, user views of 41 participants (15 carers and 26 patients with recent experience of inpatient hospital care in London, UK) were collected and analysed. In addition, the project's patient representative performed direct observation of the research event to offer inter-rater reliability of the qualitative analysis. FINDINGS Users considered evidence of systemic safety-related failings when presented with hospital choices, and did not discount hospitals with high ('red' flagged) rates of meticillin-resistant Staphylococcus aureus. Further, users considered staff satisfaction within the workplace over and above user satisfaction. Those most dissatisfied with the care they received were unlikely to ask staff, 'Have you washed your hands?' CONCLUSION This in-depth qualitative analysis of views from a relatively informed user sample shows 'what matters', and provides new avenues for improvement initiatives. It is encouraging that users appear to take a holistic view of indicators. There is a need for strategies to improve dimensions of staff satisfaction, along with understanding the implications of patient satisfaction.
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Affiliation(s)
- R Ahmad
- NIHR Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College London, London, UK.
| | - M Iwami
- NIHR Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College London, London, UK
| | - E Castro-Sánchez
- NIHR Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College London, London, UK
| | - F Husson
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - K Taiyari
- Department of Statistical Science, University College London, London, UK
| | - W Zingg
- NIHR Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College London, London, UK; Hôpitaux Universitaires de Genève, Service de Prévention et Contrôle de l'Infection, Geneva, Switzerland
| | - A Holmes
- NIHR Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College London, London, UK
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Holmes A, Rahemtulla R. DEVELOPMENT AND PEDIATRIC: LEARNING DISABILITYB-39Measuring the Academic Achievement Gap between Americans and Canadians Using the Wechsler Individual Achievement Test-Third Edition. Arch Clin Neuropsychol 2015. [DOI: 10.1093/arclin/acv047.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Janssen AB, Tunster SJ, Savory N, Holmes A, Beasley J, Parveen SAR, Penketh RJA, John RM. Placental expression of imprinted genes varies with sampling site and mode of delivery. Placenta 2015; 36:790-5. [PMID: 26162698 PMCID: PMC4535278 DOI: 10.1016/j.placenta.2015.06.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Revised: 06/25/2015] [Accepted: 06/26/2015] [Indexed: 12/23/2022]
Abstract
UNLABELLED Imprinted genes, which are monoallelically expressed by virtue of an epigenetic process initiated in the germline, are known to play key roles in regulating fetal growth and placental development. Numerous studies are investigating the expression of these imprinted genes in the human placenta in relation to common complications of pregnancy such as fetal growth restriction and preeclampsia. This study aimed to determine whether placental sampling protocols or other factors such as fetal sex, gestational age and mode of delivery may influence the expression of imprinted genes predicted to regulate placental signalling. METHODS Term placentas were collected from Caucasian women delivering at University Hospital of Wales or Royal Gwent Hospital within two hours of delivery. Expression of the imprinted genes PHLDA2, CDKN1C, PEG3 and PEG10 was assayed by quantitative real time PCR. Intraplacental gene expression was analysed (N = 5). Placental gene expression was compared between male (N = 11) and female (N = 11) infants, early term (N = 8) and late term (N = 10) deliveries and between labouring (N = 13) and non-labouring (N = 21) participants. RESULTS The paternally expressed imprinted genes PEG3 and PEG10 were resilient to differences in sampling site, fetal sex, term gestational age and mode of delivery. The maternally expressed imprinted gene CDKN1C was elevated over 2-fold (p < 0.001) in placenta from labouring deliveries compared with elective caesarean sections. In addition, the maternally expressed imprinted gene PHLDA2 was elevated by 1.8 fold (p = 0.01) in samples taken at the distal edge of the placenta compared to the cord insertion site. CONCLUSION These findings support the reinterpretation of existing data sets on these genes in relation to complications of pregnancy and further reinforce the importance of optimising and unifying placental collection protocols for future studies.
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Affiliation(s)
- A B Janssen
- Cardiff School of Biosciences, Cardiff University, Cardiff, Wales, CF10 3AX, UK
| | - S J Tunster
- Cardiff School of Biosciences, Cardiff University, Cardiff, Wales, CF10 3AX, UK
| | - N Savory
- Department of Obstetrics and Gynaecology, University Hospital Wales, Cardiff, Wales CF144XW, UK
| | - A Holmes
- Department of Obstetrics and Gynaecology, University Hospital Wales, Cardiff, Wales CF144XW, UK
| | - J Beasley
- Department of Obstetrics and Gynaecology, Royal Gwent Hospital, Newport, Wales NP202UB, UK
| | - S A R Parveen
- Department of Obstetrics and Gynaecology, Royal Gwent Hospital, Newport, Wales NP202UB, UK
| | - R J A Penketh
- Department of Obstetrics and Gynaecology, University Hospital Wales, Cardiff, Wales CF144XW, UK
| | - R M John
- Cardiff School of Biosciences, Cardiff University, Cardiff, Wales, CF10 3AX, UK.
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