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Claridge H, Price CA, Ali R, Cooke EA, de Lusignan S, Harvey-Sullivan A, Hodges C, Khalaf N, O'Callaghan D, Stunt A, Thomas SA, Thomson J, Lemanska A. Determining the feasibility of calculating pancreatic cancer risk scores for people with new-onset diabetes in primary care (DEFEND PRIME): study protocol. BMJ Open 2024; 14:e079863. [PMID: 38262635 PMCID: PMC10806670 DOI: 10.1136/bmjopen-2023-079863] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 01/04/2024] [Indexed: 01/25/2024] Open
Abstract
INTRODUCTION Worldwide, pancreatic cancer has a poor prognosis. Early diagnosis may improve survival by enabling curative treatment. Statistical and machine learning diagnostic prediction models using risk factors such as patient demographics and blood tests are being developed for clinical use to improve early diagnosis. One example is the Enriching New-onset Diabetes for Pancreatic Cancer (ENDPAC) model, which employs patients' age, blood glucose and weight changes to provide pancreatic cancer risk scores. These values are routinely collected in primary care in the UK. Primary care's central role in cancer diagnosis makes it an ideal setting to implement ENDPAC but it has yet to be used in clinical settings. This study aims to determine the feasibility of applying ENDPAC to data held by UK primary care practices. METHODS AND ANALYSIS This will be a multicentre observational study with a cohort design, determining the feasibility of applying ENDPAC in UK primary care. We will develop software to search, extract and process anonymised data from 20 primary care providers' electronic patient record management systems on participants aged 50+ years, with a glycated haemoglobin (HbA1c) test result of ≥48 mmol/mol (6.5%) and no previous abnormal HbA1c results. Software to calculate ENDPAC scores will be developed, and descriptive statistics used to summarise the cohort's demographics and assess data quality. Findings will inform the development of a future UK clinical trial to test ENDPAC's effectiveness for the early detection of pancreatic cancer. ETHICS AND DISSEMINATION This project has been reviewed by the University of Surrey University Ethics Committee and received a favourable ethical opinion (FHMS 22-23151 EGA). Study findings will be presented at scientific meetings and published in international peer-reviewed journals. Participating primary care practices, clinical leads and policy makers will be provided with summaries of the findings.
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Affiliation(s)
- Hugh Claridge
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
- National Physical Laboratory, Teddington, UK
| | - Claire A Price
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
- National Physical Laboratory, Teddington, UK
| | - Rofique Ali
- Tower Hamlets Network 1 Primary Care Network, London, UK
| | | | - Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Adam Harvey-Sullivan
- Tower Hamlets Network 1 Primary Care Network, London, UK
- Centre for Primary Care, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | | | - Natalia Khalaf
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
| | | | - Ali Stunt
- Pancreatic Cancer Action, Oakhanger, Hampshire, UK
| | | | | | - Agnieszka Lemanska
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
- National Physical Laboratory, Teddington, UK
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2
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Sutaria SR, Morris JD, Xie Z, Cooke EA, Silvers SM, Long GA, Balcom D, Marimuthu S, Parrish LW, Aliesky H, Arnold FW, Huang J, Fu XA, Nantz MH. A feasibility study on exhaled breath analysis using UV spectroscopy to detect COVID-19. J Breath Res 2023; 18:016004. [PMID: 37875100 PMCID: PMC10620812 DOI: 10.1088/1752-7163/ad0646] [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: 04/28/2023] [Revised: 09/14/2023] [Accepted: 10/24/2023] [Indexed: 10/26/2023]
Abstract
A 23-subject feasibility study is reported to assess how UV absorbance measurements on exhaled breath samples collected from silicon microreactors can be used to detect COVID-19. The silicon microreactor technology chemoselectively preconcentrates exhaled carbonyl volatile organic compounds and subsequent methanol elution provides samples for analysis. The underlying scientific rationale that viral infection will induce an increase in exhaled carbonyls appears to be supported by the results of the feasibility study. The data indicate statistically significant differences in measured UV absorbance values between healthy and symptomatic COVID-19 positive subjects in the wavelength range from 235 nm to 305 nm. Factors such as subject age were noted as potential confounding variables.
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Affiliation(s)
- Saurin R Sutaria
- Departments of Chemistry, University of Louisville, Louisville, KY 40292, United States of America
| | - James D Morris
- Chemical Engineering, University of Louisville, Louisville, KY 40292, United States of America
| | - Zhenzhen Xie
- Chemical Engineering, University of Louisville, Louisville, KY 40292, United States of America
| | - Elizabeth A Cooke
- Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, KY 40292, United States of America
| | - Shavonne M Silvers
- Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, KY 40292, United States of America
| | - Grace A Long
- Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, KY 40292, United States of America
| | - Dawn Balcom
- Division of Infectious Diseases, Department of Medicine, University of Louisville, Louisville, KY 40292, United States of America
| | - Subathra Marimuthu
- Division of Infectious Diseases, Department of Medicine, University of Louisville, Louisville, KY 40292, United States of America
| | - Leslie W Parrish
- Division of Infectious Diseases, Department of Medicine, University of Louisville, Louisville, KY 40292, United States of America
| | - Holly Aliesky
- Division of Infectious Diseases, Department of Medicine, University of Louisville, Louisville, KY 40292, United States of America
| | - Forest W Arnold
- Division of Infectious Diseases, Department of Medicine, University of Louisville, Louisville, KY 40292, United States of America
| | - Jiapeng Huang
- Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, KY 40292, United States of America
| | - Xiao-An Fu
- Chemical Engineering, University of Louisville, Louisville, KY 40292, United States of America
| | - Michael H Nantz
- Departments of Chemistry, University of Louisville, Louisville, KY 40292, United States of America
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3
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Cooke EA, Lemanska A, Thomas SA. Decreasing Admissions but Increasing Readmissions for Mental Health in-Patient Treatment in Scotland, UK. Stud Health Technol Inform 2023; 305:145-148. [PMID: 37386980 DOI: 10.3233/shti230446] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
We have analysed mental health data for in-patient admissions from 1997 to 2021 in Scotland. The number of patient admissions for mental health patients is declining despite population numbers increasing. This is driven by the adult population; child and adolescent numbers are consistent. We find that mental health in-patients are more likely to be from deprived areas: 33 % of patients are from the most deprived areas, compared to only 11 % from the least deprived. The average length of stay for a mental health in-patient is decreasing, with a rise in stays lasting less than a day. The number of mental health patients who have been readmitted within a month fell from 1997 to 2011, then increased to 2021. Despite the average stay length decreasing, the number of overall readmissions is increasing, suggesting patients are having more, shorter stays.
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Affiliation(s)
- Elizabeth A Cooke
- Data Science Department, National Physical Laboratory, Teddington, UK
| | - Agnieszka Lemanska
- Data Science Department, National Physical Laboratory, Teddington, UK
- School of Health Sciences, University of Surrey, Guildford, UK
| | - Spencer A Thomas
- Data Science Department, National Physical Laboratory, Teddington, UK
- Department of Computer Sciences, University of Surrey, Guildford, UK
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4
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Cooke EA, Lemanska A, Livings J, Thomas SA. The Impact of COVID-19 on Mental Health Services in Scotland, UK. Stud Health Technol Inform 2022; 295:59-62. [PMID: 35773806 DOI: 10.3233/shti220660] [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: 06/15/2023]
Abstract
There is a global emergency in relation to mental health (MH) and healthcare. In the UK each year, 1 in 4 people will experience MH problems. Healthcare services are increasingly oversubscribed, and COVID-19 has deepened the healthcare gap. We investigated the effect of COVID-19 on waiting times for MH services in Scotland. We used national registers of MH services provided by Public Health Scotland. The results show that waiting times for adults and children increased drastically during the pandemic. This was seen nationally and across most of the administrative regions of Scotland. We find, however, that child and adolescent services were comparatively less impacted by the pandemic than adult services. This is potentially due to prioritisation of paediatric patients, or due to an increasing demand on adult services triggered by the pandemic itself.
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Affiliation(s)
- Elizabeth A Cooke
- Data Science Department, National Physical Laboratory, Teddington, UK
| | | | - Jennifer Livings
- Chailey Neuropsychology Service, Sussex Community NHS Foundation Trust, UK
| | - Spencer A Thomas
- Data Science Department, National Physical Laboratory, Teddington, UK
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5
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McLeish KR, Shrestha R, Vashishta A, Rane MJ, Barati MT, Brier ME, Lau MG, Hu X, Chen O, Wessel CR, Spalding T, Bush SE, Ijemere K, Hopkins CD, Cooke EA, Tandon S, Manning T, Uriarte SM, Huang J, Yan J. Differential Functional Responses of Neutrophil Subsets in Severe COVID-19 Patients. Front Immunol 2022; 13:879686. [PMID: 35711435 PMCID: PMC9197482 DOI: 10.3389/fimmu.2022.879686] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 02/20/2022] [Accepted: 05/02/2022] [Indexed: 12/25/2022] Open
Abstract
Neutrophils play a significant role in determining disease severity following SARS-CoV-2 infection. Gene and protein expression defines several neutrophil clusters in COVID-19, including the emergence of low density neutrophils (LDN) that are associated with severe disease. The functional capabilities of these neutrophil clusters and correlation with gene and protein expression are unknown. To define host defense and immunosuppressive functions of normal density neutrophils (NDN) and LDN from COVID-19 patients, we recruited 64 patients with severe COVID-19 and 26 healthy donors (HD). Phagocytosis, respiratory burst activity, degranulation, neutrophil extracellular trap (NET) formation, and T-cell suppression in those neutrophil subsets were measured. NDN from severe/critical COVID-19 patients showed evidence of priming with enhanced phagocytosis, respiratory burst activity, and degranulation of secretory vesicles and gelatinase and specific granules, while NET formation was similar to HD NDN. COVID LDN response was impaired except for enhanced NET formation. A subset of COVID LDN with intermediate CD16 expression (CD16Int LDN) promoted T cell proliferation to a level similar to HD NDN, while COVID NDN and the CD16Hi LDN failed to stimulate T-cell activation. All 3 COVID-19 neutrophil populations suppressed stimulation of IFN-γ production, compared to HD NDN. We conclude that NDN and LDN from COVID-19 patients possess complementary functional capabilities that may act cooperatively to determine disease severity. We predict that global neutrophil responses that induce COVID-19 ARDS will vary depending on the proportion of neutrophil subsets.
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Affiliation(s)
- Kenneth R. McLeish
- Division of Nephrology and Hypertension, Department of Medicine, University of Louisville, KY, United States
- *Correspondence: Kenneth R. McLeish, ; Jun Yan,
| | - Rejeena Shrestha
- Department of Microbiology and Immunology, University of Louisville, KY, United States
| | - Aruna Vashishta
- Department of Oral Immunology and Infectious Diseases, School of Dentistry, University of Louisville, KY, United States
| | - Madhavi J. Rane
- Division of Nephrology and Hypertension, Department of Medicine, University of Louisville, KY, United States
| | - Michelle T. Barati
- Division of Nephrology and Hypertension, Department of Medicine, University of Louisville, KY, United States
| | - Michael E. Brier
- Division of Nephrology and Hypertension, Department of Medicine, University of Louisville, KY, United States
| | - Mario Gutierrez Lau
- Department of Oral Immunology and Infectious Diseases, School of Dentistry, University of Louisville, KY, United States
| | - Xiaoling Hu
- Division of Immunotherapy, The Hiram C. Polk, Jr., MD Department of Surgery, Immuno-Oncology Program, Brown Cancer Center, University of Louisville, Louisville, KY, United States
| | - Oscar Chen
- Department of Anesthesiology and Perioperative Medicine, University of Louisville, KY, United States
| | - Caitlin R. Wessel
- Department of Anesthesiology and Perioperative Medicine, University of Louisville, KY, United States
| | - Travis Spalding
- Department of Anesthesiology and Perioperative Medicine, University of Louisville, KY, United States
| | - Sarah E. Bush
- Department of Anesthesiology and Perioperative Medicine, University of Louisville, KY, United States
| | - Kenechi Ijemere
- Department of Anesthesiology and Perioperative Medicine, University of Louisville, KY, United States
| | - C. Danielle Hopkins
- Department of Anesthesiology and Perioperative Medicine, University of Louisville, KY, United States
| | - Elizabeth A. Cooke
- Department of Anesthesiology and Perioperative Medicine, University of Louisville, KY, United States
| | - Shweta Tandon
- Division of Nephrology and Hypertension, Department of Medicine, University of Louisville, KY, United States
| | - Terri Manning
- Division of Nephrology and Hypertension, Department of Medicine, University of Louisville, KY, United States
| | - Silvia M. Uriarte
- Department of Oral Immunology and Infectious Diseases, School of Dentistry, University of Louisville, KY, United States
| | - Jiapeng Huang
- Department of Anesthesiology and Perioperative Medicine, University of Louisville, KY, United States
| | - Jun Yan
- Department of Microbiology and Immunology, University of Louisville, KY, United States
- Division of Immunotherapy, The Hiram C. Polk, Jr., MD Department of Surgery, Immuno-Oncology Program, Brown Cancer Center, University of Louisville, Louisville, KY, United States
- *Correspondence: Kenneth R. McLeish, ; Jun Yan,
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6
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Morrissey SM, Geller AE, Hu X, Tieri D, Ding C, Klaes CK, Cooke EA, Woeste MR, Martin ZC, Chen O, Bush SE, Zhang HG, Cavallazzi R, Clifford SP, Chen J, Ghare S, Barve SS, Cai L, Kong M, Rouchka EC, McLeish KR, Uriarte SM, Watson CT, Huang J, Yan J. A specific low-density neutrophil population correlates with hypercoagulation and disease severity in hospitalized COVID-19 patients. JCI Insight 2021; 6:148435. [PMID: 33986193 PMCID: PMC8262329 DOI: 10.1172/jci.insight.148435] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 03/31/2021] [Indexed: 01/08/2023] Open
Abstract
SARS coronavirus 2 (SARS-CoV-2) is a novel viral pathogen that causes a clinical disease called coronavirus disease 2019 (COVID-19). Although most COVID-19 cases are asymptomatic or involve mild upper respiratory tract symptoms, a significant number of patients develop severe or critical disease. Patients with severe COVID-19 commonly present with viral pneumonia that may progress to life-threatening acute respiratory distress syndrome (ARDS). Patients with COVID-19 are also predisposed to venous and arterial thromboses that are associated with a poorer prognosis. The present study identified the emergence of a low-density inflammatory neutrophil (LDN) population expressing intermediate levels of CD16 (CD16Int) in patients with COVID-19. These cells demonstrated proinflammatory gene signatures, activated platelets, spontaneously formed neutrophil extracellular traps, and enhanced phagocytic capacity and cytokine production. Strikingly, CD16Int neutrophils were also the major immune cells within the bronchoalveolar lavage fluid, exhibiting increased CXCR3 but loss of CD44 and CD38 expression. The percentage of circulating CD16Int LDNs was associated with D-dimer, ferritin, and systemic IL-6 and TNF-α levels and changed over time with altered disease status. Our data suggest that the CD16Int LDN subset contributes to COVID-19-associated coagulopathy, systemic inflammation, and ARDS. The frequency of that LDN subset in the circulation could serve as an adjunct clinical marker to monitor disease status and progression.
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Affiliation(s)
- Samantha M Morrissey
- Department of Microbiology and Immunology.,Division of Immunotherapy, the Hiram C. Polk, Jr., MD, Department of Surgery, Immuno-Oncology Program, James Graham Brown Cancer Center
| | - Anne E Geller
- Department of Microbiology and Immunology.,Division of Immunotherapy, the Hiram C. Polk, Jr., MD, Department of Surgery, Immuno-Oncology Program, James Graham Brown Cancer Center
| | - Xiaoling Hu
- Division of Immunotherapy, the Hiram C. Polk, Jr., MD, Department of Surgery, Immuno-Oncology Program, James Graham Brown Cancer Center
| | - David Tieri
- Department of Biochemistry and Molecular Genetics
| | - Chuanlin Ding
- Division of Immunotherapy, the Hiram C. Polk, Jr., MD, Department of Surgery, Immuno-Oncology Program, James Graham Brown Cancer Center
| | | | | | - Matthew R Woeste
- Department of Microbiology and Immunology.,Division of Immunotherapy, the Hiram C. Polk, Jr., MD, Department of Surgery, Immuno-Oncology Program, James Graham Brown Cancer Center
| | | | - Oscar Chen
- Department of Anesthesiology and Perioperative Medicine
| | - Sarah E Bush
- Department of Anesthesiology and Perioperative Medicine
| | | | - Rodrigo Cavallazzi
- Division of Pulmonary, Critical Care and Sleep Disorders, Department of Medicine
| | | | - James Chen
- Department of Anesthesiology and Perioperative Medicine
| | - Smita Ghare
- University of Louisville Hepatobiology and Toxicology Center, Departments of Medicine and Pharmacology & Toxicology
| | - Shirish S Barve
- University of Louisville Hepatobiology and Toxicology Center, Departments of Medicine and Pharmacology & Toxicology
| | - Lu Cai
- Pediatric Research Institute, Department of Pediatrics
| | | | | | - Kenneth R McLeish
- Division of Nephrology and Hypertension, Department of Medicine, University of Louisville, Louisville, Kentucky, USA
| | - Silvia M Uriarte
- Department of Oral Immunology and Infectious Diseases, School of Dentistry
| | | | - Jiapeng Huang
- Department of Anesthesiology and Perioperative Medicine
| | - Jun Yan
- Department of Microbiology and Immunology.,Division of Immunotherapy, the Hiram C. Polk, Jr., MD, Department of Surgery, Immuno-Oncology Program, James Graham Brown Cancer Center
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Abstract
The effect of surgery for femoral neck fracture on lower limb venous blood flow and its relationship to deep vein thrombosis was investigated in 179 patients. Blood flow was measured using strain gauge plethysmography before surgery, in the 1st week after surgery, and at 6 week review. There was a significant reduction in both venous outflow and venous capacitance, affecting both fractured and non-fractured legs but significantly greater in the fractured leg. Venous function remained significantly impaired in both lower limbs 6 weeks after surgery. There was a significant correlation between the reduction in venous function and the development of deep vein thrombosis.
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Affiliation(s)
- D Wilson
- Department of Orthopaedic Surgery, Musgrave Park Hospital, Stockmans Lane, Belfast BT9 7JB, UK.
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8
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Abstract
The effect of surgery for femoral neck fracture on whole blood coagulation and the relationship of altered coagulation to deep venous thrombosis were investigated in 250 patients. Whole blood coagulation was measured using thrombelastography preoperatively, in the early postoperative period and at 6-week review. Significant hypercoagulability was demonstrated after surgery and persisted to 6-week review. A significant correlation between hypercoagulability and the development of deep venous thrombosis is demonstrated. Hypercoagulability is shown to be a major factor in thrombosis formation following proximal femoral neck fracture surgery.
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Affiliation(s)
- D Wilson
- Department of Orthopaedic Surgery, Musgrave Park Hospital, Stockman's Lane, BT97JB, Belfast, UK.
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9
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Benkö T, Cooke EA, McNally MA, Mollan RA. Graduated compression stockings: knee length or thigh length. Clin Orthop Relat Res 2001:197-203. [PMID: 11210954] [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: 01/31/2023]
Abstract
The mechanisms by which graduated compression stockings prevent deep venous thrombosis are not completely understood. In the current study the physiologic effect of low-pressure graduated compression stockings on the venous blood flow in the lower limb and the practical aspects of their use were assessed. Patients having elective orthopaedic surgery at a university orthopaedic department were randomized into five groups to wear two different types of graduated compression stockings in thigh and knee lengths. Patients in the fifth control group did not wear graduated compression stockings. Venous occlusion strain gauge plethysmography was used to measure venous flow. After 20-minutes bed rest there was a highly significant increase in venous capacitance and venous outflow in patients in all of the four groups wearing stockings. There was no difference in the mean of the percentage change of venous capacitance in patients in the four groups wearing stockings. The knee length Brevet stockings were less efficient in increasing the venous outflow. There was no significant change in the venous capacitance and venous outflow in patients in the control group. Visual assessment of the fit and use of stockings was done, and patients' subjective opinion of comfort was sought. The knee length graduated compression stockings wrinkled significantly less, and significantly fewer patients reported discomfort with them. All stockings were reported to be difficult to use. Thigh and knee length stockings have a significant effect on decreasing venous stasis of the lower limb. Knee length graduated compression stockings are similarly efficient in decreasing venous stasis, but they are more comfortable to wear, and they wrinkle less.
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Affiliation(s)
- T Benkö
- Department of Trauma Surgery, Semmelweis University, Budapest, Hungary
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Turner IC, McNally MA, O'Connell BM, Cooke EA, Kernohan WG, Mollan RA. Numerical model of deep venous thrombosis detection using venous occlusion strain gauge plethysmography. Med Biol Eng Comput 2000; 38:348-55. [PMID: 10912353 DOI: 10.1007/bf02347057] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Strain gauge plethysmography (SGP) is a non-invasive method used in the detection of deep venous thrombosis (DVT). The technique is based on the measurement of calf volume changes in response to venous occlusion by a thigh cuff, the volume changes reflecting the rates of arterial inflow and venous outflow. A numerical model of the blood circulation within the limb and the response of this to a SGP test has been derived, based on treating the different parts of the circulatory system in the leg as resistance and capacitance elements. The simulation results were compared with clinical studies and support the ability of SGP to detect non-occlusive clots of more than 50-60% of the lumen, as well detecting calf vein occlusion. The non-linear behaviour of the venous compliance with intra-luminal pressure appears to be a particularly important factor within the model. In addition, increases in venous tone due to post-operative venospasm were shown to be a potential source of false positive results.
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Affiliation(s)
- I C Turner
- Experimental Cardiac Electrophysiology Unit, Papworth Hospital, Cambridge.
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11
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Thompson NS, Cooke EA, Craig BF. Supracondylar nail failure: two case reports. Int J Clin Pract 1999; 53:308-9. [PMID: 10563078] [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: 02/14/2023] Open
Abstract
We describe two case reports of supracondylar nail failure in young patients who had sustained high energy, closed, comminuted supracondylar femoral fractures. These injuries had been successfully treated using retrograde intramedullary nails which failed several months later because of excessive activity on the part of the patient without the presence of full flexion at the knee. The failed implants were removed and dynamic condylar screws were inserted with bone graft to the fracture site. This revision procedure produced solid bony union. We recommend that these patients should not fully weight bear, or engage in strenuous physiotherapy after nailing, until the fracture has consolidated and a functional range of knee motion has been obtained. Failed implants should be managed by nail removal, bone grafting and insertion of a dynamic condylar screw.
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Affiliation(s)
- N S Thompson
- Fracture Unit, Belfast City Hospital, Northern Ireland, UK
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12
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Cooke EA. South Carolina bans partial-birth abortions. S C Law Rev 1998; 49:1041-57. [PMID: 15871154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
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13
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McNally MA, Cooke EA, Harding ML, Mollan RA. Attitudes to, and utilization of, low molecular weight heparins in joint replacement surgery. J R Coll Surg Edinb 1997; 42:407-9. [PMID: 9448398] [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] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
A postal survey was carried out to determine the attitudes to the use of low molecular weight heparin (LMWH) in joint replacement among two representative groups of orthopaedic surgeons practising in the UK. 72% of hip surgeons and 51% of knee surgeons replying had used LMWHs for deep vein thrombosis prophylaxis in joint replacement patients. Of these, 48% had discontinued LMWH use due to bleeding complications. Among those continuing to use LMWHs, 88% had witnessed excessive bruising around the wound and 53% had experienced increased wound bleeding or haematomas. Although LMWHs have been shown to reduce post-operative thromboembolism in these groups, clinical experience has revealed an increased incidence of bleeding complications associated with their use. This has prevented their routine use in joint replacement, as was the case with unfractionated heparin in the past.
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Affiliation(s)
- M A McNally
- Musgrave Park Hospital, Belfast and Leicester General Hospital, UK
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14
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Abstract
OBJECTIVE The aim of this study was to determine whether temporal patterns of food selection during binges in obese subjects with binge eating disorder (BED) differ from those of patients with bulimia nervosa (BN). METHOD Ten obese women with BED and 10 weight-matched women without BED each consumed a multiple-item meal identical to that used in previous studies with bulimics, and all subjects were instructed to binge. An experimenter recorded the subjects' food choices every 10 s throughout the meal via a closed-circuit TV camera. RESULTS Subjects with BED consumed significantly more meat than subjects without BED (397.78 vs. 270.64 kcal), but the food choices and percentages of time spent eating each of the foods were similar among BED, non-BED, and normal weight controls. While bulimics ate dessert foods earlier in the meals, all other groups ate meat towards the beginning of their meal and ate more dessert foods towards the end of the meal. DISCUSSION Food selection patterns during binges in subjects with BED are more similar to eating patterns of noneating disordered subjects, than to patterns seen in patients with BN. These data suggest that binge episodes between different groups of eating-disordered populations are qualitatively different.
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Affiliation(s)
- E A Cooke
- Obesity Research Center of St. Luke's/Roosevelt Hospital-Columbia University, New York, NY 10025, USA
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15
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Abstract
Surgeons often encourage patients to move their feet in an attempt to prevent venous stasis, but there is little evidence that this measure is beneficial. We investigated the effect of active movement of one foot on the venous blood flow four days after total hip replacement. The actual venous outflow at rest was measured with use of venous occlusion strain-gauge plethysmography in thirty-eight patients. The patients were randomly allocated to the control group (eighteen patients) or the exercise group (twenty patients). A baseline measurement was followed by a one-minute period of rest (control group) or of maximum plantar flexion and dorsiflexion of the foot, ankle, and toes at a rate of thirty cycles per minute (exercise group). The venous outflow was measured again at two, seven, twelve, and thirty minutes in both groups. Movement of the foot for one minute produced a significant and sustained increase (p < 0.002) in the venous outflow (mean maximum increase, 22 per cent). The value remained greater than the baseline level for thirty minutes (mean increase, 6.5 per cent) (p < 0.2). The increase was gradual, reaching a maximum twelve minutes after the completion of exercise. Our results confirm the beneficial hemodynamic effects of active movement of the foot in the postoperative period and suggest that patients should move the feet and ankles postoperatively as part of a prophylactic regimen directed at decreasing the risk of venous thrombosis.
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Affiliation(s)
- M A McNally
- Department of Orthopaedic Surgery, Musgrave Park Hospital, Belfast, Northern Ireland
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McNally MA, Bahadur R, Cooke EA, Mollan RA. Venous haemodynamics in both legs after total knee replacement. J Bone Joint Surg Br 1997; 79:633-7. [PMID: 9250754] [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] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We studied the effect of total knee replacement on venous flow in 110 patients. Resting venous blood flow was measured using strain-gauge plethysmography before operation, after surgery and after discharge from hospital. There was a significant reduction in mean venous capacitance (p < 0.001) and mean venous outflow (p < 0.004) affecting only the operated leg. Both improved significantly after mobilisation in the early postoperative period, returning to preoperative levels by six days after surgery and before discharge from hospital. Our findings showed that venous stasis may contribute to deep-vein thrombosis only in the first few days after total knee replacement. This would be the most important period for the use of flow-enhancing prophylactic devices. Comparison with changes in blood flow after total hip replacement identified different patterns of altered haemodynamics suggesting that there are different mechanisms of venous stasis and thrombogenesis in hip and knee arthritis and during surgery for these conditions.
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Affiliation(s)
- M A McNally
- Department of Orthopaedic Surgery, The Queen's University of Belfast, Musgrave Park Hospital, Belfast, Northern Ireland
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McNally MA, Cooke EA, Mollan RA. Femoral vein blood flow during THR. J Bone Joint Surg Br 1995; 77:335-6. [PMID: 7706366] [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: 01/26/2023]
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