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Wilson E, Palmer J, Armstrong A, Messer B, Presswood E, Faull C. End of life decision making when home mechanical ventilation is used to sustain breathing in Motor Neurone Disease: patient and family perspectives. BMC Palliat Care 2024; 23:115. [PMID: 38698397 PMCID: PMC11064348 DOI: 10.1186/s12904-024-01443-1] [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: 02/06/2024] [Accepted: 04/24/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND Motor Neurone Disease (MND) leads to muscle weakening, affecting movement, speech, and breathing. Home mechanical ventilation, particularly non-invasive ventilation (NIV), is used to alleviate symptoms and support breathing in people living with MND. While home mechanical ventilation can alleviate symptoms and improve survival, it does not slow the progression of MND. This study addresses gaps in understanding end-of-life decision-making in those dependent on home mechanical ventilation, considering the perspectives of patients, family members, and bereaved families. METHODS A UK-wide qualitative study using flexible interviews to explore the experiences of people living with MND (n = 16), their family members (n = 10), and bereaved family members (n = 36) about the use of home mechanical ventilation at the end of life. RESULTS Some participants expressed a reluctance to discuss end-of-life decisions, often framed as a desire to "live for the day" due to the considerable uncertainty faced by those with MND. Participants who avoided end-of-life discussions often engaged in 'selective decision-making' related to personal planning, involving practical and emotional preparations. Many faced challenges in hypothesising about future decisions given the unpredictability of the disease, opting to make 'timely decisions' as and when needed. For those who became dependent on ventilation and did not want to discuss end of life, decisions were often 'defaulted' to others, especially once capacity was lost. 'Proactive decisions', including advance care planning and withdrawal of treatment, were found to empower some patients, providing a sense of control over the timing of their death. A significant proportion lacked a clear understanding of the dying process and available options. CONCLUSIONS The study highlights the complexity and evolution of decision-making, often influenced by the dynamic and uncertain nature of MND. The study emphasises the need for a nuanced understanding of decision-making in the context of MND.
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Affiliation(s)
- Eleanor Wilson
- School of Health Sciences, University of Nottingham, Nottingham, UK.
| | - Jonathan Palmer
- University Hospitals, University Hospitals NHS Trust Plymouth, Plymouth, UK
| | - Alison Armstrong
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Ben Messer
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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Childs AM, Turner C, Astin R, Bianchi S, Bourke J, Cunningham V, Edel L, Edwards C, Farrant P, Heraghty J, James M, Massey C, Messer B, Michel Sodhi J, Murphy PB, Schiava M, Thomas A, Trucco F, Guglieri M. Development of respiratory care guidelines for Duchenne muscular dystrophy in the UK: key recommendations for clinical practice. Thorax 2024; 79:476-485. [PMID: 38123347 DOI: 10.1136/thorax-2023-220811] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 10/17/2023] [Indexed: 12/23/2023]
Abstract
Significant inconsistencies in respiratory care provision for Duchenne muscular dystrophy (DMD) are reported across different specialist neuromuscular centres in the UK. The absence of robust clinical evidence and expert consensus is a barrier to the implementation of care recommendations in public healthcare systems as is the need to increase awareness of key aspects of care for those living with DMD. Here, we provide evidenced-based and/or consensus-based best practice for the respiratory care of children and adults living with DMD in the UK, both as part of routine care and in an emergency. METHODOLOGY Initiated by an expert working group of UK-based respiratory physicians (including British Thoracic Society (BTS) representatives), neuromuscular clinicians, physiotherapist and patient representatives, draft guidelines were created based on published evidence, current practice and expert opinion. After wider consultation with UK respiratory teams and neuromuscular services, consensus was achieved on these best practice recommendations for respiratory care in DMD. RESULT The resulting recommendations are presented in the form of a flow chart for assessment and monitoring, with additional guidance and a separate chart setting out key considerations for emergency management. The recommendations have been endorsed by the BTS. CONCLUSIONS These guidelines provide practical, reasoned recommendations for all those managing day-to-day and acute respiratory care in children and adults with DMD. The hope is that this will support patients and healthcare professionals in accessing high standards of care across the UK.
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Affiliation(s)
- Anne-Marie Childs
- Department of Paediatric Neurosciences, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Catherine Turner
- John Walton Muscular Dystrophy Research Centre, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, UK
| | - Ronan Astin
- Division of Medical Specialties, University College London Hospitals NHS Foundation Trust, London, UK
| | - Stephen Bianchi
- Academic Department of Respiratory Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - John Bourke
- John Walton Muscular Dystrophy Research Centre, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, UK
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | - Lisa Edel
- Respiratory Neuromuscular Physiotherapy, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Christopher Edwards
- Leeds Centre for Children's Respiratory Medicine, Leeds Children's Hospital, Leeds General Infirmary, Leeds, UK
| | | | - Jane Heraghty
- Department of Paediatrics, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Meredith James
- John Walton Muscular Dystrophy Research Centre, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, UK
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Charlotte Massey
- Queen Square Centre for Neuromuscular Diseases, University College London NHS Foundation Trust, London, UK
- Institute for Translational Neuroscience, University of Sheffield, Sheffield, UK
| | - Ben Messer
- North East Assisted Ventilation Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Jassi Michel Sodhi
- John Walton Muscular Dystrophy Research Centre, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, UK
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Patrick Brian Murphy
- Lane Fox Respiratory Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Centre for Human and Applied Physiological Sciences, King's College London, London, UK
| | - Marianela Schiava
- John Walton Muscular Dystrophy Research Centre, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, UK
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Ajit Thomas
- Department of Respiratory Medicine, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Federica Trucco
- Dubowitz Neuromuscular Centre, University College London, London, UK
- Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK
| | - Michela Guglieri
- John Walton Muscular Dystrophy Research Centre, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, UK
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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3
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Rose L, Messer B. Prolonged Mechanical Ventilation, Weaning, and the Role of Tracheostomy. Crit Care Clin 2024; 40:409-427. [PMID: 38432703 DOI: 10.1016/j.ccc.2024.01.008] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
Depending on the definitional criteria used, approximately 5% to 10% of critical adults will require prolonged mechanical ventilation with longer-term outcomes that are worse than those ventilated for a shorter duration. Outcomes are affected by patient characteristics before critical illness and its severity but also by organizational characteristics and care models. Definitive trials of interventions to inform care activities, such as ventilator weaning, upper airway management, rehabilitation, and nutrition specific to the prolonged mechanical ventilation patient population, are lacking. A structured and individualized approach developed by the multiprofessional team in discussion with the patient and their family is warranted.
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Affiliation(s)
- Louise Rose
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, 57 Waterloo Road, London SE1 8WA, UK; Department of Critical Care and Lane Fox Unit, Guy's & St Thomas' NHS Foundation Trust, King's College London, 57 Waterloo Road, London SE1 8WA, UK.
| | - Ben Messer
- Royal Victoria Infirmary, Newcastle-Upon-Tyne NHS Hospitals NHS Foundation Trust, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, UK
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Alnajada A, Blackwood B, Messer B, Pavlov I, Shyamsundar M. International Survey of High-Flow Nasal Therapy Use for Respiratory Failure in Adult Patients. J Clin Med 2023; 12:3911. [PMID: 37373606 DOI: 10.3390/jcm12123911] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/04/2023] [Accepted: 06/05/2023] [Indexed: 06/29/2023] Open
Abstract
(1) Background: High-flow nasal therapy (HFNT) has shown several benefits in addressing respiratory failure. However, the quality of evidence and the guidance for safe practice are lacking. This survey aimed to understand HFNT practice and the needs of the clinical community to support safe practice. (2) Method: A survey questionnaire was developed and distributed to relevant healthcare professionals through national networks in the UK, USA and Canada; responses were collected between October 2020 and April 2021. (3) Results: In the UK and Canada, HFNT was used in 95% of hospitals, with the highest use being in the emergency department. HNFT was widely used outside of a critical care setting. HFNT was mostly used to treat acute type 1 respiratory failure (98%), followed by acute type 2 respiratory failure and chronic respiratory failure. Guideline development was felt to be important (96%) and urgent (81%). Auditing of practice was lacking in 71% of hospitals. In the USA, HFNT was broadly similar to UK and Canadian practice. (4) Conclusions: The survey results reveal several key points: (a) HFNT is used in clinical conditions with limited evidence; (b) there is a lack of auditing; (c) it is used in wards that may not have the appropriate skill mix; and (d) there is a lack of guidance for HFNT use.
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Affiliation(s)
- Asem Alnajada
- Wellcome Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast BT7 1NN, UK
- Prince Sultan bin Abdulaziz College for Emergency Medical Services, King Saud University, Riyadh 11362, Saudi Arabia
| | - Bronagh Blackwood
- Wellcome Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast BT7 1NN, UK
| | - Ben Messer
- The North East Assisted Ventilation Service, Royal Victoria Infirmary, Newcastle NE14LP, UK
| | - Ivan Pavlov
- Department of Emergency Medicine, Hôpital de Verdun, Montréal, QC H4G 2A3, Canada
| | - Murali Shyamsundar
- Wellcome Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast BT7 1NN, UK
- Regional Intensive Care, Royal Victoria Hospital, Belfast BT12 6BA, UK
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5
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Sobala R, Carlin H, Fretwell T, Shakir S, Cattermole K, Royston A, McCallion P, Davison J, Lumb J, Tedd H, Messer B, De Soyza A. An observational study of Pseudomonas aeruginosa in adult long-term ventilation. ERJ Open Res 2022; 8:00687-2021. [PMID: 35449759 PMCID: PMC9016266 DOI: 10.1183/23120541.00687-2021] [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: 12/06/2021] [Accepted: 02/22/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Pseudomonas aeruginosa increases morbidity and mortality in respiratory disease. To date the long-term ventilation population does not have clear guidelines regarding its management. Method We undertook a retrospective observational study in a regional long-term ventilation population (837 patients). We defined the primary outcome as P. aeruginosa isolation. In addition positive cultures for copathogens (Serratia, Proteus species, Stenotrophomonas, Burkholderia cepacia complex and nontuberculous mycobacteria) were recorded. Logistic regression and odds ratios were calculated. Results 17.6% of the cohort isolated P. aeruginosa, and this pathogen was cultured more frequently in patients with a tracheostomy (logistic regression coefficient 2.90, p≤0.0001) and cystic fibrosis/bronchiectasis (logistic regression coefficient 2.48, p≤0.0001). 6.3% of patients were ventilated via tracheostomy. In the P. aeruginosa positive cohort 46.9% of patients were treated with a long-term macrolide, 36.7% received a nebulised antibiotic and 21.1% received both. Tracheostomised P. aeruginosa positive patients received a nebulised antibiotic more frequently (OR 2.63, 95% CI 1.23–5.64, p=0.013). Copathogens were isolated in 33.3% of the P. aeruginosa cohort. In this cohort patients with a tracheostomy grew a copathogen more frequently than those without (OR 2.75, 95% CI 1.28–5.90). Conclusions P. aeruginosa isolation is common within the adult long-term ventilation population and is significantly associated with tracheostomy, cystic fibrosis and bronchiectasis. Further research and international guidelines are needed to establish the prognostic impact of P. aeruginosa and to guide on antimicrobial management. The increased risk of P. aeruginosa should be considered when contemplating long-term ventilation via tracheostomy. Pseudomonas aeruginosa isolation is common (17%) in long-term ventilated adults and significantly associated with tracheostomy, cystic fibrosis and bronchiectasis. Tracheostomy patients with P. aeruginosa isolates culture copathogens more frequently.https://bit.ly/3vvxBbB
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Affiliation(s)
- Ruth Sobala
- North East Assisted Ventilation Service, Newcastle Upon Tyne Hospitals Trust, Newcastle, UK
| | - Hannah Carlin
- North East Assisted Ventilation Service, Newcastle Upon Tyne Hospitals Trust, Newcastle, UK
| | - Thomas Fretwell
- North East Assisted Ventilation Service, Newcastle Upon Tyne Hospitals Trust, Newcastle, UK
| | - Sufyan Shakir
- North East Assisted Ventilation Service, Newcastle Upon Tyne Hospitals Trust, Newcastle, UK
| | - Katie Cattermole
- North East Assisted Ventilation Service, Newcastle Upon Tyne Hospitals Trust, Newcastle, UK
| | - Amy Royston
- North East Assisted Ventilation Service, Newcastle Upon Tyne Hospitals Trust, Newcastle, UK
| | | | | | | | - Hilary Tedd
- North East Assisted Ventilation Service, Newcastle Upon Tyne Hospitals Trust, Newcastle, UK
| | - Ben Messer
- North East Assisted Ventilation Service, Newcastle Upon Tyne Hospitals Trust, Newcastle, UK.,These authors contributed equally
| | - Anthony De Soyza
- North East Assisted Ventilation Service, Newcastle Upon Tyne Hospitals Trust, Newcastle, UK.,Freeman Hospital, Newcastle, UK.,Population Health Science Institutes, Newcastle University, Newcastle, UK.,These authors contributed equally
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Harbottle J, Carlin H, Payne-Doris T, Tedd HMI, de Soyza A, Messer B. Developing an intrasalivary gland botox service for patients receiving long-term non-invasive ventilation at home: a single-centre experience. BMJ Open Respir Res 2022; 9:9/1/e001188. [PMID: 35190461 PMCID: PMC8862502 DOI: 10.1136/bmjresp-2021-001188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 01/31/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Sialorrhoea is a debilitating symptom in neurological disease and there is a growing literature for the use of intrasalivary gland Botulinum Toxin (botox) injections in its management. However, provision of intrasalivary gland botox remains inconsistent and sialorrhoea is often poorly controlled in motor neuron disease (MND). Sialorrhoea in association with bulbar dysfunction can cause intolerance of non-invasive ventilation (NIV) and respiratory infection, so its treatment is critical within a home ventilation service (HVS). This treatment can also be used to enable tracheostomy cuff deflation to facilitate weaning from ventilation. We report on the outcomes of intrasalivary gland botox in our HVS. Methods In 2015, we set up an intrasalivary gland botox service for patients under our HVS. Under ultrasound guidance, we injected submandibular gland (SMG), parotid gland (PG) or both. Results 109 intrasalivary gland botox procedures were performed in 72 patients. Diagnostic groups included MND 32 Cerebral Palsy 8 and Weaning 14. Glands injected were, SMG (6%), PG (47%) and both (47%). The majority (84%) received the Dysport preparation with mean dose 273 units. 94% were ultrasound guided. 81% of injections resulted in a positive treatment effect, with 47% patients requesting repeat injections. Complications were angioedema (0.9%) and worsening dysphagia (3.7% following SMG injection). Mean survival following treatment was 40 months with 53% patients still alive. Conclusions Intrasalivary gland botox appears effective across a range of neurological conditions requiring long-term NIV with few complications. Dysphagia may be an important complication of SMG injection. A randomised controlled trial may help establish the evidence base.
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Affiliation(s)
- Jessica Harbottle
- School of Medical Education, Newcastle University, Newcastle upon Tyne, UK
| | - Hannah Carlin
- Respiratory Medicine, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK
| | - Thomas Payne-Doris
- North East Assisted Ventilation Service, Newcastle upon Tyne NHS Hospitals Foundation Trust, Newcastle upon Tyne, UK
| | - Hilary M I Tedd
- Respiratory Medicine, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK
| | - Anthony de Soyza
- Population Health Science Institutes, Newcastle University, Newcastle upon Tyne, UK
| | - Ben Messer
- North East Assisted Ventilation Service, Newcastle upon Tyne NHS Hospitals Foundation Trust, Newcastle upon Tyne, UK
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7
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Nafisa S, Messer B, Downie B, Ehilawa P, Kinnear W, Algendy S, Sovani M. A retrospective cohort study of idiopathic diaphragmatic palsy: a diagnostic triad, natural history and prognosis. ERJ Open Res 2021; 7:00953-2020. [PMID: 34527723 PMCID: PMC8435796 DOI: 10.1183/23120541.00953-2020] [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: 12/18/2020] [Accepted: 06/21/2021] [Indexed: 11/17/2022] Open
Abstract
Background Isolated diaphragmatic palsy in the absence of progressive neuromuscular disease is uncommon. It poses diagnostic challenges and limited data are available regarding prognosis. We present retrospective cohort data from two large teaching hospitals in the United Kingdom. Method 60 patients who were assessed either as inpatients or outpatients were included in this study. Patients with progressive neuromuscular disease were excluded. Clinical presentation, tests of respiratory muscle function (sitting/supine vital capacity, maximal expiratory pressure (MEP), maximal inspiratory pressure (MIP) and sniff nasal inspiratory pressure (SNIP)) and outcomes were recorded. Results For patients with diaphragmatic palsy, mean±sd seated and supine vital capacity pre-noninvasive ventilation (NIV) were reduced at 1.7±1.2 L and 1.1±0.9 L, respectively, with a mean±sd postural fall in vital capacity of 42±0.16%. The mean MEP/MIP and MEP/SNIP ratios for diaphragmatic palsy were 3 and 3.5, respectively. After a year of treatment with NIV, mean±sd upright and supine vital capacity had increased to 2.1±0.9 L and 1.8±1 L, respectively, and the mean±sd fall in vital capacity from sitting to supine reduced to 29±0.17%. MEP/MIP and MEP/SNIP ratios reduced to 2.6 and 2.9, respectively, from the pre-NIV values. The values of postural fall in vital capacity correlated (p<0.05) with MEP/MIP and MEP/SNIP ratio (r2=0.86 and r2=0.7, respectively). Conclusion Tests of respiratory muscle strength are valuable in the diagnostic workup of patients with unexplained dyspnoea. A triad of 1) orthopnoea, with 2) normal lung imaging and 3) MEP/MIP and/or MEP/SNIP ratio ≥2.7 points towards isolated diaphragmatic palsy. This needs to be confirmed by prospective studies. Tests of respiratory muscle strength are valuable in the diagnostic workup of patients with unexplained dyspnoea. A triad of 1) orthopnoea with 2) normal lung imaging and 3) MEP/MIP and/or MEP/SNIP ratios ≥2.7 points towards isolated diaphragmatic palsy.https://bit.ly/2SpOXW2
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Affiliation(s)
- Syeda Nafisa
- Respiratory Medicine, Nottingham University Hospitals, Nottingham, UK.,Dept of Respiratory Medicine, Sherwood Forest Hospital NHS Foundation Trust, Mansfield, UK
| | - Ben Messer
- North East Assisted Ventilation Service, Newcastle Upon Tyne Hospital NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Beatrice Downie
- Dept of Respiratory Medicine, Newcastle Upon Tyne Hospital NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Patience Ehilawa
- Respiratory Medicine, Nottingham University Hospitals, Nottingham, UK.,Dept of Respiratory Medicine, Sherwood Forest Hospital NHS Foundation Trust, Mansfield, UK
| | - William Kinnear
- Dept of Sport Science, Nottingham Trent University, Nottingham, UK
| | - Sherif Algendy
- Dept of Respiratory Medicine, Sherwood Forest Hospital NHS Foundation Trust, Mansfield, UK
| | - Milind Sovani
- Respiratory Medicine, Nottingham University Hospitals, Nottingham, UK
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8
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Avoseh M, Messer B, Armstrong A, Sovani M. Shielding, use of masks and hand hygiene: could this be the answer to winter pressures? J R Coll Physicians Edinb 2021; 51:199-207. [PMID: 34131684 DOI: 10.4997/jrcpe.2021.223] [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: 11/19/2022] Open
Affiliation(s)
- Michael Avoseh
- Department of Respiratory Medicine, Nottingham University Hospitals
| | - Ben Messer
- Newcastle upon Tyne Hospitals NHS Foundation Trust, North East Assisted Ventilation Service
| | - Alison Armstrong
- Newcastle upon Tyne Hospitals NHS Foundation Trust, North East Assisted Ventilation Service
| | - Milind Sovani
- Department of Respiratory Medicine, Kings Mill Hospital, Mansfield Rd, Sutton-in-Ashfield NG17 4JL,
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9
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Abstract
INTRODUCTION Evidence has suggested that when senior doctors are less approachable, junior staff are less likely to raise safety issues. There are limited existing data on whether the name by which junior doctors address their seniors reflects approachability and if this varies between grade and specialties. METHODS An online survey was conducted in a large teaching hospital. Respondents were asked about their use of first names when addressing consultants and whether they felt this reflected their perceptions of the consultants' approachability. RESULTS Four-hundred and twenty-three responses were received from a cohort of approximately 800 junior doctors. Of these, 410 were included in this analysis. Respondents came from 57 different subspecialties and all years of training. Overall, junior doctors addressed 43% of consultants by their first name; 71% of junior doctors perceived these consultants to be more approachable. There were significant differences in the results between grades and specialty of junior doctor. CONCLUSION Throughout all specialties, the majority of junior doctors consider the consultants that they address informally to be more approachable.
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Affiliation(s)
- Alice Graham
- Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Ben Messer
- Royal Victoria Infirmary, Newcastle upon Tyne, UK
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10
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Abstract
Introduction: Motor neurone disease (MND) is characterized by rapidly progressive motor neurone degeneration which leads to muscle wasting. Mortality and morbidity are due to respiratory muscle failure which may be offset by ventilation. The aim of this observational study was to quantify the number and characteristics of patients living with MND choosing tracheostomy ventilation (TV) in the UK. Methods: Long-term ventilation services in the UK were invited to undertake a retrospective 5-year audit of MND patients under their care between April 2013 and March 2018 who had TV. Patient characteristics, the time spent on ventilation, hospital length of stay, discharge destination, and survival data were collected. Results: Sixty-eight MND patients were initiated on TV over the 5-year period. Eighty-one percent of patients received TV in an emergency setting with more than a third of these undiagnosed at presentation. Patients choosing elective TV were more likely to be male (85%) have a bulbar presentation (54%) and an increased survival of 10 months over the observation period. The mean length of hospital stay post TV was 136 days. Two-thirds of patients were discharged to their own home. Conclusion: Very few patients living with MND in the UK are currently receiving TV. In those who choose TV, there may be a survival advantage to planning an elective procedure. Despite the long inpatient stay and high care costs involved a majority of patients survived and were discharged to their own home.
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Affiliation(s)
- Jonathan Palmer
- Department of Thoracic Medicine, University Hospitals NHS Trust, Derriford Hospital, Plymouth, UK
| | - Ben Messer
- North East Assisted Ventilation Service, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Royal Victoria Infirmary, Newcastle upon Tyne, UK, and
| | - Michelle Ramsay
- Lane Fox Respiratory Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK
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11
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Quinlivan R, Messer B, Murphy P, Astin R, Mukherjee R, Khan J, Emmanuel A, Wong S, Kulshresha R, Willis T, Pattni J, Willis D, Morgan A, Savvatis K, Keen R, Bourke J, Marini Bettolo C, Hewamadduma C. Adult North Star Network (ANSN): Consensus Guideline For The Standard Of Care Of Adults With Duchenne Muscular Dystrophy. J Neuromuscul Dis 2021; 8:899-926. [PMID: 34511509 PMCID: PMC8673515 DOI: 10.3233/jnd-200609] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
There are growing numbers of adults with Duchenne Muscular Dystrophy living well into their fourth decade. These patients have complex medical needs that to date have not been addressed in the International standards of care. We sought to create a consensus based standard of care through a series of multi-disciplinary workshops with specialists from a wide range of clinical areas: Neurology, Cardiology, Respiratory Medicine, Gastroenterology, Endocrinology, Palliative Care Medicine, Rehabilitation, Renal, Anaesthetics and Clinical Psychology. Detailed reports of evidence reviewed and the consensus building process were produced following each workshop and condensed into this final document which was approved by all members of the Adult North Star Network including service users. The aim of this document is to provide a framework to improve clinical services and multi-disciplinary care for adults living with Duchenne Muscular Dystrophy.
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Affiliation(s)
- R. Quinlivan
- MRC Centre for Neuromuscular Disease, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
| | - B. Messer
- Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - P. Murphy
- Lane Fox Unit, Guy’s and St Thomas’ Foundation Trust, London, UK
| | - R. Astin
- MRC Centre for Neuromuscular Disease, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
| | - R. Mukherjee
- Heart of England NHS Foundation Trust, Birmingham, UK
| | - J. Khan
- MRC Centre for Neuromuscular Disease, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
| | - A. Emmanuel
- MRC Centre for Neuromuscular Disease, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
| | - S.C. Wong
- University of Glasgow, Royal Hospital for Children, Glasgow, UK
| | - R. Kulshresha
- Robert Jones and Agnes Hunt Foundation NHS Trust, Oswestry, UK
| | - T. Willis
- Robert Jones and Agnes Hunt Foundation NHS Trust, Oswestry, UK
| | - J. Pattni
- MRC Centre for Neuromuscular Disease, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
| | - D. Willis
- Shrewsbury and Telford NHS Trust, Shropshire, UK
| | - A. Morgan
- South West Neuromuscular Operational Delivery Network, Bristol, UK
| | - K. Savvatis
- MRC Centre for Neuromuscular Disease, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
- St Bartholomew’s Hospital and Royal London NHS Trust, London UK
| | - R. Keen
- Royal National Orthopaedic Hospital, Stanmore, UK
| | - J. Bourke
- Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | | | - C. Hewamadduma
- Academic Neurology Department, Sheffield Teaching Hospitals Foundation Trust and Sheffield Institute for Translational Neurosciences (SITRAN), University of Sheffield, Sheffield, UK
| | - on behalf of the ANSN
- MRC Centre for Neuromuscular Disease, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
- Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle, UK
- Lane Fox Unit, Guy’s and St Thomas’ Foundation Trust, London, UK
- Heart of England NHS Foundation Trust, Birmingham, UK
- University of Glasgow, Royal Hospital for Children, Glasgow, UK
- Robert Jones and Agnes Hunt Foundation NHS Trust, Oswestry, UK
- Shrewsbury and Telford NHS Trust, Shropshire, UK
- South West Neuromuscular Operational Delivery Network, Bristol, UK
- St Bartholomew’s Hospital and Royal London NHS Trust, London UK
- Royal National Orthopaedic Hospital, Stanmore, UK
- Academic Neurology Department, Sheffield Teaching Hospitals Foundation Trust and Sheffield Institute for Translational Neurosciences (SITRAN), University of Sheffield, Sheffield, UK
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Messer B, Tedd H, Doris T, Mountain A, Gatilogo C, Sovani M. The variation of FiO 2 with circuit type and peak inspiratory flow rate during non-invasive respiratory support using domiciliary ventilators and its significance during the COVID-19 pandemic. J Intensive Care Soc 2020; 23:124-131. [PMID: 35607364 PMCID: PMC7750247 DOI: 10.1177/1751143720980280] [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] [Indexed: 11/17/2022] Open
Abstract
Background The COVID-19 pandemic has resulted in increased admissions with respiratory
failure and there have been reports of oxygen failure and shortages of
machines to deliver ventilation and Continuous Positive Airway Pressure
(CPAP). Domiciliary ventilators which entrain room air have been widely used
during the pandemic. Poor outcomes reported with non-invasive respiratory
support using ventilators which lack an oxygen blender could be related to
an unreliable Fraction of inspired O2 (FiO2).
Additionally, with concerns about oxygen failure, the variety of ventilator
circuits used as well as differing peak inspiratory flow rates (PIFR) could
impact on the FiO2 delivered during therapy with domiciliary
ventilators. Methods In a series of bench tests, we tested the effect of choice of circuit and
different PIFR on the FiO2 achieved during simulation of
ventilation and CPAP therapy using domiciliary ventilators. Results FiO2 was highly dependent upon the type of circuit used with
circuits with an active exhalation valve achieving similar FiO2
at lower oxygen flow rates than circuits using an exhalation port. During
CPAP therapy, high PIFR resulted in significantly lower FiO2 than
low PIFR. Conclusions This study has implications for oxygen usage as well as delivery of
non-invasive respiratory support during therapy with domiciliary ventilators
when these are used during the second wave of COVID-19.
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Affiliation(s)
- Ben Messer
- North East Assisted Ventilation Service, Royal Victoria Infirmary, Newcastle-upon-Tyne NHS Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, UK
| | - Hilary Tedd
- North East Assisted Ventilation Service, Royal Victoria Infirmary, Newcastle-upon-Tyne NHS Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, UK
| | - Tom Doris
- North East Assisted Ventilation Service, Royal Victoria Infirmary, Newcastle-upon-Tyne NHS Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, UK
| | - Andrew Mountain
- Electronics and Medical Engineering, Royal Victoria Infirmary, Newcastle-upon-Tyne NHS Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, UK
| | - Cris Gatilogo
- Electronics and Medical Engineering, Royal Victoria Infirmary, Newcastle-upon-Tyne NHS Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, UK
| | - Milind Sovani
- Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
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Dewhurst F, Elverson J, Mccleery A, Brown J, McConnell R, Lever O, Doris T, Messer B, Hughes A. Ventilator dependence complications in motor neuron disease. BMJ Support Palliat Care 2020:bmjspcare-2020-002560. [PMID: 32958503 DOI: 10.1136/bmjspcare-2020-002560] [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: 07/14/2020] [Accepted: 08/07/2020] [Indexed: 11/03/2022]
Abstract
Long-term dependence on non-invasive ventilation (NIV) without time for advance care planning can result in significant complications that may require innovative management strategies. We present the case of a man who was admitted with respiratory failure and required NIV. Despite effective treatment for community acquired pneumonia, attempts to wean NIV failed. While dependent on NIV, a diagnosis of motor neuron disease was made. Time without ventilation was not tolerated and consequently complications of: facial pressure ulceration, nasal septal prolapse, inspissated secretions and failure to feed occurred. This case illustrates the severity of complications that can result from NIV dependence; however, it also details how these can be effectively managed by the hospice multidisciplinary team, with support from experts both within and external to the hospice enabling the acquisition of appropriate skills and knowledge.
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Affiliation(s)
- Felicity Dewhurst
- Palliative Medicine, Newcastle University, Newcastle upon Tyne, UK
- Palliative Medicine, St Oswald's Hospice, Newcastle, UK
| | | | | | - Jolene Brown
- Palliative Medicine, St Oswald's Hospice, Newcastle, UK
| | | | - Owen Lever
- Palliative Medicine, St Oswald's Hospice, Newcastle, UK
| | - Thomas Doris
- Royal Victoria Infirmary Department of Anaesthesia, North East Assisted Ventilation Service, Newcastle upon Tyne, UK
| | - Ben Messer
- Royal Victoria Infirmary Department of Anaesthesia, North East Assisted Ventilation Service, Newcastle upon Tyne, UK
| | - Andrew Hughes
- Palliative Medicine, St Oswald's Hospice, Newcastle, UK
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Khanna A, Sovani M, Gosh D, Messer B, Wharton S. Should awake proning be used before continuous positive airway pressure therapy for respiratory support in COVID pneumonia. Lung India 2020; 37:558-559. [PMID: 33154229 PMCID: PMC7879858 DOI: 10.4103/lungindia.lungindia_516_20] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Messer B, Armstrong A, Doris T, Williams T. Requested withdrawal of mechanical ventilation in six patients with motor neuron disease. BMJ Support Palliat Care 2019; 10:10-13. [PMID: 30944120 DOI: 10.1136/bmjspcare-2017-001464] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 02/25/2019] [Accepted: 03/06/2019] [Indexed: 11/04/2022]
Abstract
ObjectivesMechanical ventilation (MV) has been shown to improve survival and quality of life in motor neuron disease (MND). However, during the progression of MND, there may come a point when MV is no longer felt appropriate. Association of Palliative Medicine Guidelines have been recently published to help clinicians withdraw MV at the request of patients with MND in a safe and compassionate manner to ensure that symptoms of distress and dyspnoea are minimised.MethodsIn this report, we discuss the palliative and ventilatory management of six ventilator-dependent patients with MND who had requested the withdrawal of MV as part of their end-of-life care.ResultsWe have withdrawn MV from six patients with MND at their request and our practice has been influenced by the Association of Palliative Medicine Guidelines.ConclusionWithdrawal of MV in MND at a patient’s request is challenging but is also a fundamental responsibility of healthcare teams. We discuss the lessons we have learnt which will influence our practice and help other teams in the future.
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Affiliation(s)
- Ben Messer
- Home Ventilation, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Alison Armstrong
- Home Ventilation, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Thomas Doris
- Home Ventilation, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Tim Williams
- Neurology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
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Doris T, Bowron A, Armstrong A, Messer B. Ketoacidosis in Duchenne muscular dystrophy: A report on 4 cases. Neuromuscul Disord 2018; 28:665-670. [DOI: 10.1016/j.nmd.2018.06.003] [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] [Received: 12/13/2017] [Revised: 06/05/2018] [Accepted: 06/08/2018] [Indexed: 10/14/2022]
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Messer B, Griffiths J, Baudouin SV. The prognostic variables predictive of mortality in patients with an exacerbation of COPD admitted to the ICU: an integrative review. QJM 2012; 105:115-26. [PMID: 22071965 DOI: 10.1093/qjmed/hcr210] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Chronic Obstructive Pulmonary Disease (COPD) frequently presents with an acute exacerbation (AECOPD). Debate exists as to whether these patients should be admitted to intensive care units (ICUs). An integrative review was performed to determine whether clinical variables available at the time of ICU admission are predictive of the intermediate-term mortality of patients with an AECOPD. METHODS An integrative review was structured to incorporate a five-stage review framework to facilitate data extraction, analysis and presentation. The quality of the studies contributing to the integrative review was assessed with a novel scoring system developed from previously published data and adapted to this setting. RESULTS The integrative review search strategy identified 28 studies assessing prognostic variables in this setting. Prognostic variables associated with intermediate-term mortality were low Glasgow Coma Scale (GCS) on admission to ICU, cardio-respiratory arrest prior to ICU admission, cardiac dysrhythmia prior to ICU admission, length of hospital stay prior to ICU admission and higher values of acute physiology scoring systems. Premorbid variables such as age, functional capacity, pulmonary function tests, prior hospital or ICU admissions, body mass index and long-term oxygen therapy were not found to be associated with intermediate-term mortality nor was the diagnosis attributed to the cause of the AECOPD. DISCUSSION Variables associated with intermediate-term mortality after AECOPD requiring ICU admission are those variables, which reflect underlying severity of acute illness. Premorbid and diagnostic data have not been shown to be predictive of outcome. A scoring system is proposed to assess studies of prognosis in AECOPD.
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Affiliation(s)
- B Messer
- Department of Anaesthetics, Royal Victoria Infirmary, Newcastle-upon-Tyne, UK.
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Hadjipavlou G, Hafeez A, Messer B, Hughes T. Management of lercanidipine overdose with hyperinsulinaemic euglycaemia therapy: case report. Scand J Trauma Resusc Emerg Med 2011; 19:8. [PMID: 21251326 PMCID: PMC3035020 DOI: 10.1186/1757-7241-19-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [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: 10/03/2010] [Accepted: 01/20/2011] [Indexed: 11/17/2022] Open
Abstract
This case report describes the first reported overdose of the dihydropyridine calcium channel blocker (CCB) lercanidipine. A 49 yr old male presented to the Emergency Department 3 hrs after the ingestion of 560 mg of lercanidipine. In the department he had a witnessed seizure within 15 minutes of arrival attributed to the overdose. Following immediate recovery of consciousness after the seizure, he had refractory hypotension and bradycardia which failed to respond to fluid resuscitation, glucagon therapy, and intravenous calcium. He went on to require vasopressor support with noradrenaline and was treated with high dose insulin therapy which was successful in achieving cardiovascular stability. Vasopressor therapy was no longer required within one half life of lercanidipine, and the total stay on intensive care was one day before transfer to a ward. Calcium channel blocker overdose is an uncommon but life-threatening overdose. Treatment for severe toxicity is similar to b-blocker overdose. Hypotension is treated with intravenous fluid therapy, intravenous calcium and possibly glucagon with vasopressor or inotropic support as required. Atropine is used to attempt reversal of bradycardia. High doses of intravenous insulin with intravenous dextrose as required (hyperinsulinaemic euglycaemia or HIET), has also been successfully reported. Experimental animal data suggests that HIET is of benefit and potentially superior to fluid therapy, calcium, glucagon and potentially vasopressor therapy. HIET effectively and sustainably reverses hypotension, bradycardia and improves myocardial contractility and metabolism. Current advice in calcium channel blocker overdose is to begin therapy early in toxicity, starting with a 1.0 IU/kg insulin bolus followed by an infusion of 0.5 IU/kg/hr of insulin and dextrose as required titrated to clinical response.
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Messer B, Weaver M. Anonymity must remain an option for reporters of critical incidents. Br J Anaesth 2011; 106:147-8; author reply 148. [DOI: 10.1093/bja/aeq354] [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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Affiliation(s)
- J H Song
- Department of Chemistry, University of California Materials Science Division, Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
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Song JH, Messer B, Wu Y, Kind H, Yang P. MMo(3)Se(3) (M = Li(+), Na(+), Rb(+), Cs(+), NMe(4)(+)) nanowire formation via cation exchange in organic solution. J Am Chem Soc 2001; 123:9714-5. [PMID: 11572709 DOI: 10.1021/ja016220+] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- J H Song
- Department of Chemistry, University of California, Berkeley, California 94720, USA
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Messer B. Total joint replacement preadmission programs. Orthop Nurs 1998; 17:31-3. [PMID: 9601410] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Patients begin to formulate their expectations of the postoperative hospitalization during the preadmission program. The challenge is to better understand the factors patients consider when formulating judgments about the quality of preadmission education. For example, it may be that perceptions of the preadmission program are influenced by what patients believe about their postoperative pain and functional abilities. Specific attention needs to be given both preoperatively and postoperatively to instructing patients on realistic expectations for recovery. One other method of measuring patient outcomes is with the Health Status Profile (SF-36) (Response Healthcare Information Management, 1995). The SF-36 approach emphasizes the outcome of medical care as the patient sees it, in addition to a clinical evaluation of successful health care. This form is currently initiated in the physician's office and returned for scanning at the preadmission class. The patient then completes another SF-36 at 6 months and every year thereafter to compare measurable outcomes. Patients intending to have elective total joint replacements experience anxiety and require much support and education. An effective preadmission program is a major investment in a patient's recovery, as well as a unique marketing tool to customers. Preadmission programs can be viewed as an opportunity to enhance customer satisfaction. Preadmission clinics are an excellent means for nurses to improve the quality of patient care through patient education. the overall goal of preadmission testing programs is to ensure patient preparedness while increasing quality health care and overall customer satisfaction. To enhance program effectiveness, health care providers must lead collaborative efforts to improve the efficiency of systems.
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Affiliation(s)
- B Messer
- Case Management, OSF Saint Anthony Medical Center in Rockford, Illinois, USA
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Messer B. Reducing lengths of stays in the total joint replacement population. Orthop Nurs 1998; 17:23-5. [PMID: 9601408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- B Messer
- OSF Saint Anthony Medical Center, Rockford, Illinois, USA
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Bock KD, Brittinger G, Goebell H, Hager W, Meesmann W, Messer B, Paar D, Reinwein D. [AIDS--watching or acting? A memorandum by the physicians in charge of the Center for Internal Medicine, the Essen University Hospital]. Krankenpfl J 1987; 25:32-5. [PMID: 3648314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Messer B. "What we have is a litigation lottery". Tex Hosp 1986; 42:16-8. [PMID: 10279956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Layer P, Eysselein VE, Messer B. [Clinicopathologic conference. Upper abdominal pain, postprandial vomiting and weight loss in a 50-year-old male: manifestation of an intraduodenal diverticulum]. Med Klin (Munich) 1986; 81:602-5. [PMID: 3097471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Cissewski K, Kirch W, Messer B, Schmid EN, Donhuijsen K, Ohnhaus EE. [Clinicopathologic conference. Severe disease picture with fever, cough, and lung infiltrations without response to antibiotics in a 38-year-old male (atypical mycobacteria infection)]. Med Klin (Munich) 1986; 81:166-9. [PMID: 3785072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Messer B. An interview with Rep Bill Messer. Tex Med 1981; 77:32-4. [PMID: 7342348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Messer B. [The urographic picture of kidney disease due to phenacetin abuse]. Med Welt 1975; 26:817-21. [PMID: 1177684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Bock KD, Nitzsche T, Messer B. [Chronic interstitial nephritis after long-term use of phenacetin-containing anti-asthma drugs (autor's transl)]. Dtsch Med Wochenschr 1973; 98:2234 passim. [PMID: 4202411 DOI: 10.1055/s-0028-1107230] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Jochem B, Messer B, Strotges W. [Isotope nephrogram in the diagnosis of renal artery stenosis]. Med Klin 1970; 65:1662-7. [PMID: 5513622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Cohnen G, Scholz N, Messer B, König E, Zimmerschitt E, Brittinger G. [Tumor-like intrathoracic extramedullary hematopoiesis in hemolytic anemia. Report on a case with review of the literature]. Acta Haematol 1970; 43:111-9. [PMID: 4986190 DOI: 10.1159/000208720] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Kanzler G, Messer B, Müller KM. [Wegener's granulomatosis]. Med Welt 1969; 11:590-4. [PMID: 5783656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Messer B, Müller KM, Merguet P. [Angioma with arteriovenous fistula and anuerysm of the kidney as cause of hypertension]. Med Klin 1968; 63:1032-7. [PMID: 5700950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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