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Dimagli A, Gaudino M, Harik L, Sinha S, Fudulu D, Chan J, Olaria RP, Soletti G, Alzghari T, Cancelli G, An KR, Benedetto U, Murphy G, Angelini G. Comparative Analysis of Coronary Artery Bypass Grafting Outcomes in Women Using Different Conduits in the National UK Data Set. Ann Thorac Surg 2024; 117:510-516. [PMID: 37977255 DOI: 10.1016/j.athoracsur.2023.11.012] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 10/08/2023] [Accepted: 11/06/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND There is limited report of outcomes in women undergoing isolated coronary artery bypass grafting (CABG) with left internal thoracic artery and different second conduits (saphenous vein graft [SVG], radial artery [RA], and right internal thoracic artery [RITA]). METHODS The National Adult Cardiac Surgery Audit database was queried for women undergoing isolated CABG with left internal thoracic artery graft in the United Kingdom from 1996 to 2019. Propensity score-based pairwise comparisons were performed between graft types. The primary outcome was in-hospital mortality. RESULTS The study included 58,063 women (SVG, n = 48,881 [84.2%]; RA, n = 6136 [10.6%]; RITA, n = 2445 [4.2%]). SVG use was stable over the years; RA and RITA use decreased. In-hospital mortality was similar between the RA and RITA grafts (2.3% vs 2.8%; odds ratio [OR], 0.80; 95% CI, 0.53-1.22; P = .39) and between the RA and SVG (2.3% vs 2.0%; OR, 1.20; 95% CI, 0.93-1.55; P = .17) but higher in the RITA group compared with the SVG (2.7% vs 1.4%; OR, 2.04; 95% CI, 1.27-3.36; P = .004). Women receiving the RITA graft were more likely to have sternal wound infection (SWI) compared with the RA (0.6% vs 0.06%; P = .004) and the SVG (0.6% vs 0.2%; P = .032). SWI was consistently associated with higher risk of in-hospital mortality. CONCLUSIONS Conduit selection may affect operative outcomes in women undergoing CABG. The RA shows similar mortality and risk of deep SWI as the SVG.
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Affiliation(s)
- Arnaldo Dimagli
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY; Bristol Heart Institute, University of Bristol, Bristol, United Kingdom.
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
| | - Lamia Harik
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
| | - Shubhra Sinha
- Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - Daniel Fudulu
- Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - Jeremy Chan
- Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | | | - Giovanni Soletti
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
| | - Talal Alzghari
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
| | - Gianmarco Cancelli
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
| | - Kevin R An
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
| | - Umberto Benedetto
- Bristol Heart Institute, University of Bristol, Bristol, United Kingdom; Department of Cardiac Surgery, Università degli Studi G. d'Annunzio, Chieti-Pescara, Italy
| | - Gavin Murphy
- Cardiovascular Research Centre, University of Leicester, Leicester, United Kingdom
| | - Gianni Angelini
- Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
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Omerovic E, Petrie M, Redfors B, Fremes S, Murphy G, Marquis-Gravel G, Lansky A, Velazquez E, Perera D, Reid C, Smith J, van der Meer P, Lipsic E, Juni P, McMurray J, Bauersachs J, Køber L, Rouleau JL, Doenst T. Pragmatic randomized controlled trials: strengthening the concept through a robust international collaborative network: PRIME-9-Pragmatic Research and Innovation through Multinational Experimentation. Trials 2024; 25:80. [PMID: 38263138 PMCID: PMC10807265 DOI: 10.1186/s13063-024-07935-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 01/15/2024] [Indexed: 01/25/2024] Open
Abstract
In an era focused on value-based healthcare, the quality of healthcare and resource allocation should be underpinned by empirical evidence. Pragmatic clinical trials (pRCTs) are essential in this endeavor, providing randomized controlled trial (RCT) insights that encapsulate real-world effects of interventions. The rising popularity of pRCTs can be attributed to their ability to mirror real-world practices, accommodate larger sample sizes, and provide cost advantages over traditional RCTs. By harmonizing efficacy with effectiveness, pRCTs assist decision-makers in prioritizing interventions that have a substantial public health impact and align with the tenets of value-based health care. An international network for pRCT provides several advantages, including larger and diverse patient populations, access to a broader range of healthcare settings, sharing knowledge and expertise, and overcoming ethical and regulatory barriers. The hypothesis and study design of pRCT answers the decision-maker's questions. pRCT compares clinically relevant alternative interventions, recruits participants from diverse practice settings, and collects data on various health outcomes. They are scarce because the medical products industry typically does not fund pRCT. Prioritizing these studies by expanding the infrastructure to conduct clinical research within the healthcare delivery system and increasing public and private funding for these studies will be necessary to facilitate pRCTs. These changes require more clinical and health policy decision-makers in clinical research priority setting, infrastructure development, and funding. This paper presents a comprehensive overview of pRCTs, emphasizing their importance in evidence-based medicine and the advantages of an international collaborative network for their execution. It details the development of PRIME-9, an international initiative across nine countries to advance pRCTs, and explores various statistical approaches for these trials. The paper underscores the need to overcome current challenges, such as funding limitations and infrastructural constraints, to leverage the full potential of pRCTs in optimizing healthcare quality and resource utilization.
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Affiliation(s)
- Elmir Omerovic
- Department of Cardiology, Sahlgrenska University Hospital, Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy at University of Gothenburg, Bruna Stråket 16, 41345, Gothenburg, Sweden.
| | - Mark Petrie
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, UK
| | - Björn Redfors
- Department of Cardiology, Sahlgrenska University Hospital, Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy at University of Gothenburg, Bruna Stråket 16, 41345, Gothenburg, Sweden
| | - Stephen Fremes
- Department of Surgery, University of Toronto, Toronto, ON, Canada
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Sunnybrook Research Institute, Toronto, ON, Canada
| | - Gavin Murphy
- Cardiovascular Research Centre, University of Leicester, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, UK
| | | | - Alexandra Lansky
- Division of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Eric Velazquez
- Division of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Divaka Perera
- British Heart Foundation Centre of Research Excellence and National Institute for Health and Care Research Biomedical Research Centre at the School of Cardiovascular and Metabolic Medicine and Sciences, King's College London, London, UK
| | - Christopher Reid
- Curtin School of Population Health, Faculty of Health Sciences, Curtin University, Kent Street, Bentley, WA, 6102, Australia
| | - Julian Smith
- Department of Surgery (School of Clinical Sciences at Monash Health), Monash University, Melbourne, VIC, Australia
- Department of Cardiothoracic Surgery, Monash Health, Melbourne, VIC, Australia
| | - Peter van der Meer
- Department of Cardiology, Center for Blistering Diseases, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Eric Lipsic
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, PO Box 30.001, 9700 RB, Groningen, the Netherlands
| | - Peter Juni
- Oxford Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, OX3 7LF, UK
| | - John McMurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, UK
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jean L Rouleau
- Institut de Cardiologie de Montréal, Université de Montréal, Montréal, Canada
| | - Torsten Doenst
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, University Hospital, Jena, Germany
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O'Farrell R, Maguire S, Moore L, Murray K, Gorman A, Ball E, Riddell C, O'Neill M, Jordan N, O'Shea F, Veale D, Donnelly S, Murphy G, Fitzgerald G. Delivering Care for Pregnant Women with Rheumatic and Musculoskeletal Diseases. Ir Med J 2024; 117:894. [PMID: 38259237] [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: 01/24/2024]
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Tanner J, Brierley Jones L, Rochon M, Westwood N, Wloch C, Vaja R, Rogers L, Dearling J, Wilson K, Magboo R, Aujla H, Page S, Whiting P, Murphy G, Brown C, Lamagni T, Harrington P. Barriers and facilitators for surgical site infection surveillance for adult cardiac surgery in a high-income setting: an in-depth exploration. J Hosp Infect 2023; 141:112-118. [PMID: 37734675 DOI: 10.1016/j.jhin.2023.08.023] [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: 06/25/2023] [Revised: 08/02/2023] [Accepted: 08/10/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Surgical site infection (SSI) surveillance aims to facilitate a reduction in SSIs through identifying infection rates, benchmarking, triggering clinical review and instituting infection control measures. Participation in surveillance is, however, variable suggesting opportunities to improve wider adoption. AIM To gain an in-depth understanding of the barriers and facilitators for SSI surveillance in a high-income European setting. METHODS Key informant interviews with 16 surveillance staff, infection prevention staff, nurses and surgeons from nine cardiac hospitals in England. Data were analysed thematically. FINDINGS SSI surveillance was reported to be resource intensive. Barriers to surveillance included challenges associated with data collection: data being located in numerous places, multiple SSI data reporting schemes, difficulty in finding denominator data, lack of interface between computerized systems, 'labour intensive' or 'antiquated' methods to collect data (e.g., using postal systems for patient questionnaires). Additional reported concerns included: relevance of definitions, perceived variability in data reporting, lack of surgeon engagement, unsupportive managers, low priority of SSIs among staff, and a 'blame culture' around high SSI rates. Facilitators were increased resources, better use of digital technologies (e.g., remote digital wound monitoring), integrating surveillance within routine clinical work, having champions, mandating surveillance, ensuring a closer relationship between surveillance and improved patient outcomes, increasing the focus on post-discharge surveillance, and integration with primary care data. CONCLUSION Using novel interviews with 'front-line' staff, identified opportunities for improving participation in SSI surveillance. Translating these findings into action will increase surveillance activity and bring patient safety benefits to a larger pool of surgical patients.
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Affiliation(s)
- J Tanner
- School of Health Sciences, University of Nottingham, Nottingham, UK.
| | - L Brierley Jones
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - M Rochon
- Directorate of Infection, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - C Wloch
- HCAI Fungal AMR AMU & Sepsis Division, UKHSA, London, UK
| | - R Vaja
- Department of Cardiothoracic Surgery, Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - L Rogers
- Department of Cardiothoracic Surgery, University Hospitals of Bristol and Weston NHS Foundation Trust
| | | | - K Wilson
- Patient and Public Representative, UK
| | - R Magboo
- Critical Care, Barts Health NHS Trust, London, UK
| | - H Aujla
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - S Page
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - P Whiting
- Bristol Medical School, University of Bristol, Bristol, UK
| | - G Murphy
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - C Brown
- HCAI Fungal AMR AMU & Sepsis Division, UKHSA, London, UK
| | - T Lamagni
- HCAI Fungal AMR AMU & Sepsis Division, UKHSA, London, UK
| | - P Harrington
- HCAI Fungal AMR AMU & Sepsis Division, UKHSA, London, UK
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Wallace N, Murphy G, Roche M, Rock K. Comparison of Four Software Packages for Automated Contouring. Int J Radiat Oncol Biol Phys 2023; 117:e731-e732. [PMID: 37786128 DOI: 10.1016/j.ijrobp.2023.06.2252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) We are an academic radiation oncology center and treat 1500-2000 patients annually. The majority of target volume definition and organ at risk (OAR) contouring is performed by radiation oncologists (RO) and is estimated to require 10-15 hours per week for each RO. Artificial intelligence (AI) solutions for contouring are a possible method of reducing the time required. Several packages are commercially available. The purpose of this exercise was to evaluate 4 packages to identify one which would meet our department's need. The primary objective was to calculate the potential time savings associated with each of the 4 packages. The second objective was to perform a qualitative evaluation and comparison. MATERIALS/METHODS Approval from the hospital's Research Ethics Committee was obtained. CT Simulation datasets for 15 patients were anonymized for use as test cases for AI contouring. This included 5 datasets from each of 3 sites - head and neck (H+N), breast/thorax, and prostate/pelvis. 4 potential vendors provided access to their product for automated contouring of OARs +/- target volumes of each of the 15 datasets. Analysis was as follows: 1. One RO used a stopwatch to assess the time taken for them to contour each of the OARs +/- targets on each dataset 2. The AI contours from each of the vendors for each of the datasets was reviewed. 3. The time taken to correct each auto-contoured organ to make it clinically useful was timed. These were summed to give a time for each vendor for each dataset. 4. The time saving was calculated by subtracting the result of step (3) from step (1) 5. For the purpose of qualitative assessment, 2 ROs reviewed each dataset and assigned an objective score of 1-5 to each auto-contoured organ (e.g., 5 = no, or almost no, edits required; clinically useful as is) 6. The scores for each organ in each of the 15 datasets were averaged to give a mean value for the software package. RESULTS Baseline contouring time was 32.8 minutes for H+N, 23.0 minutes for breast/thorax, and 64.8 minutes for prostate/pelvis. One package was removed from consideration after assessment of H+N only as it was deemed to be of insufficient standard to be of clinical use. The average time saving for each of the remaining 3 software packages ranged were 15.7, 17.9, and 12.8 minutes for H+N, 3.1, 13.1, and 11.0 minutes for breast/thorax, and 32.6, 35.2, and 36.2 minutes for prostate/pelvis. Percentage time savings ranged from 39-55% for H+N, 13-57% for breast/thorax, and 50-56% for prostate/pelvis. The overall qualitative assessments on a 5-point scale were 3.5, 4.0, and 3.6. CONCLUSION The AI contouring solutions were associated with meaningful savings in the time taken to contour. The introduction of one of these products into clinical practice within our department will permit ROs to focus more of their time on other clinical activities.
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Affiliation(s)
- N Wallace
- St.Luke's Radiation Oncology Network, Dublin, Ireland
| | - G Murphy
- Cork University Hospital, Cork, Ireland
| | - M Roche
- Cork University Hospital, Cork, Ireland
| | - K Rock
- Cork University Hospital, Cork, Ireland; University College Cork, Cork, Ireland
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Moore N, Maher M, Murphy G, O'Callaghan Maher M, O'Connor OJ, McEntee MF. CT in the detection of latent tuberculosis: a systematic review. Clin Radiol 2023; 78:568-575. [PMID: 37270335 DOI: 10.1016/j.crad.2023.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 04/07/2023] [Accepted: 04/23/2023] [Indexed: 06/05/2023]
Abstract
AIM To evaluate the use of computed tomography (CT) and low-dose CT in the detection of latent tuberculosis (TB). MATERIALS AND METHODS A systematic search of literature in adherence with the PRISMA guidelines was carried out. Quality assessment of the included studies was conducted. RESULTS The search strategy identified a total of 4,621 studies. Sixteen studies were considered eligible and included in the review. There was high heterogeneity among all studies. CT was identified as much more sensitive for the detection of latent TB in all studies despite chest radiography often being recommended in guidelines to assess patients for latent TB. Low-dose CT showed promising results in four of the studies; however, these results were limited due to small sample sizes. CONCLUSION CT is much superior to chest radiography consistently identifying additional cases of latent TB. There are limited high-quality publications available using low-dose CT but findings thus far suggest low-dose CT could be used as an alternative to standard-dose CT for the detection of latent TB. It is recommended that a randomised controlled trial investigating low-dose CT should be carried out.
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Affiliation(s)
- N Moore
- Medical Imaging and Radiation Therapy, University College Cork, Ireland.
| | - M Maher
- Department of Radiology, University College Cork, Cork, Ireland; Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
| | - G Murphy
- Department of Rheumatology, Cork University Hospital, Cork, Ireland
| | | | - O J O'Connor
- Department of Radiology, University College Cork, Cork, Ireland; Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
| | - M F McEntee
- Medical Imaging and Radiation Therapy, University College Cork, Ireland
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Bliss J, Brown J, Chalmers A, Lemoine N, Murphy G, Wydenbach K, Frame I. Now is Our Opportunity to Revolutionise Cancer Clinical Trials. Clin Oncol (R Coll Radiol) 2023; 35:139-142. [PMID: 36411142 DOI: 10.1016/j.clon.2022.10.018] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 09/28/2022] [Accepted: 10/27/2022] [Indexed: 11/19/2022]
Affiliation(s)
- J Bliss
- The Institute of Cancer Research, 15 Cotswold Road, Sutton, Surrey, SM2 5NG, UK.
| | - J Brown
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, Leeds, LS29JT, UK
| | - A Chalmers
- University of Glasgow, University Avenue, Glasgow, G12 8QQ, UK
| | - N Lemoine
- NIHR Clinical Research Network Coordinating Centre, Minerva House, 5 Montague Cl, London, SE1 9DF, UK
| | - G Murphy
- National Cancer Research Institute (NCRI), 2 Redman Place, London, E20 1JQ, UK
| | - K Wydenbach
- Medicines and Healthcare Products Regulatory Agency, 10 South Colonnade, Canary Wharf, London, E14 4PU, UK
| | - I Frame
- National Cancer Research Institute (NCRI), 2 Redman Place, London, E20 1JQ, UK
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Richards T, Miles LF, Clevenger B, Keegan A, Abeysiri S, Rao Baikady R, Besser MW, Browne JP, Klein AA, Macdougall IC, Murphy GJ, Anker SD, Dahly D, Besser M, Browne J, Clevenger B, Kegan A, Klein A, Miles L, MacDougall I, Baikady RR, Dahly D, Bradbury A, Richards T, Burley T, Van Loen S, Anker S, Klein A, MacDougall I, Murphy G, Besser M, Unsworth I, Clayton T, Collier T, Potter K, Abeysiri S, Evans R, Knight R, Swinson R, Van Dyck L, Keidan J, Williamson L, Crook A, Pepper J, Dobson J, Newsome S, Godec T, Dodd M, Richards T, Van Dyck L, Evans R, Abeysiri S, Clevenger B, Butcher A, Swinson R, Collier T, Potter K, Anker S, Kelly J, Morris S, Browne J, Keidan J, Grocott M, Chau M, Knight R, Collier T, Baikady RR, Black E, Lawrence H, Kouthra M, Horner K, Jhanji S, Todman E, Keon‐Cohen Z, Rooms M, Tomlinson J, Bailes I, Walker S, Pirie K, Gerstman M, Kasivisvanathan R, Uren S, Magee D, Eeles A, Anker R, McCanny J, O'Mahony M, Reynolds T, Batley S, Hegarty A, Trundle S, Mazzola F, Tatham K, Balint A, Morrison B, Evans M, Pang CL, Smith L, Wilson C, Sjorin V, Khatri P, Wilson M, Parkinson D, Crosbie J, Dawas K, Smyth D, Bercades G, Ryu J, Reyes A, Martir G, Gallego L, Macklin A, Rocha M, Tam DK, Brealey DD, Dhesi J, Morrison C, Hardwick J, Partridge J, Braude P, Rogerson A, Jahangir N, Thomson C, Biswell L, Cross J, Pritchard F, Mohammed A, Wallace D, Galat MG, Okello J, Symes R, Leon J, Gibbs C, Sanghera S, Dennis A, Kibutu F, Fofie J, Bird S, Alli A, Jackson Y, Albuheissi S, Brain C, Shiridzinomwa C, Ralph C, Wroath B, Hammonds F, Adams B, Faulds J, Staddon S, Hughes T, Saha S, Finney C, Harris C, Mellis C, Johnson L, Riozzi P, Yarnold A, Buchanan F, Hopkins P, Greig L, Noble H, Edwards M, Grocott M, Plumb J, Harvie D, Dushianthan A, Wakatsuki M, Leggett S, Salmon K, Bolger C, Burnish R, Otto J, Rayat G, Golder K, Bartlett P, Bali S, Seaward L, Wadams B, Tyrell B, Collins H, Tantony N, Geale R, Wilson A, Ball D, Lindsey I, Barker D, Thyseen M, Chiam P, Hannaway C, Colling K, Messer C, Verma N, Nasseri M, Poonawala G, Sellars A, Mainali P, Hammond T, Hughes A, O'Hara D, McNeela F, Shillito L, Kotze A, Moriarty C, Wilson J, Davies S, Yates D, Carter J, Redman J, Ma S, Howard K, Redfearn H, Wilcock D, Lowe J, Alexander T, Jose J, Hornzee G, Akbar F, Rey S, Patel A, Coulson S, Saini R, Santipillai J, McCretton T, McCanny J, Chima K, Collins K, Pathmanathan B, Chattersingh A, McLeavy L, Al‐Saadi Z, Patel M, Skampardoni S, Chinnadurai R, Thomas V, Keen A, Pagett K, Keatley C, Howard J, Greenhalgh M, Jenkins S, Gidda R, Watts A, Breaton C, Parker J, Mallett S, James S, Penny L, Chan K, Reeves T, Catterall M, Williams S, Birch J, Hammerton K, Williamson N, Thomas A, Evans M, Mercer L, Horsfield G, Hughes C, Cupitt J, Stoddard E, McNamara H, Birt C, Hardy A, Dennis R, Butcher D, O'Sullivan S, Pope A, Elhanash S, Preston S, Officer H, Stoker A, Moss S, Walker A, Gipson A, Melville J, Bradley‐Potts J, McCormac R, Benson V, Melia K, Fielding J, Guest W, Ford S, Murdoch H, Beames S, Townshend P, Collins K, Glass J, Cartwright B, Altemimi B, Berresford L, Jones C, Kelliher L, de Silva S, Blightman K, Pendry K, Pinto L, Allard S, Taylor L, Chishti A, Scott J, O'Hare D, Lewis M, Hussain Z, Hallett K, Dermody S, Corbett C, Morby L, Hough M, Williams S, Williams P, Horton S, Ashcroft P, Homer A, Lang A, Dawson H, Harrison E, Thompson J, Hariharan V, Goss V, Ravi R, Butt G, Vertue M, Acheson A, Ng O, Bush D, Dickson E, Ward A, Morris S, Taylor A, Casey R, Wilson L, Vimalachandran D, Faulkner M, Jeffrey H, Gabrielle C, Martin S, Bracewell A, Ritzema J, Sproates D, Alexander‐Sefre F, Kubitzek C, Humphreys S, Curtis J, Oats P, Swann S, Holden A, Adam C, Flintoff L, Paoloni C, Bobruk K. The association between iron deficiency and outcomes: a secondary analysis of the intravenous iron therapy to treat iron deficiency anaemia in patients undergoing major abdominal surgery (PREVENTT) trial. Anaesthesia 2023; 78:320-329. [PMID: 36477695 PMCID: PMC10107684 DOI: 10.1111/anae.15926] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2022] [Indexed: 12/13/2022]
Abstract
In the intravenous iron therapy to treat iron deficiency anaemia in patients undergoing major abdominal surgery (PREVENTT) trial, the use of intravenous iron did not reduce the need for blood transfusion or reduce patient complications or length of hospital stay. As part of the trial protocol, serum was collected at randomisation and on the day of surgery. These samples were analysed in a central laboratory for markers of iron deficiency. We performed a secondary analysis to explore the potential interactions between pre-operative markers of iron deficiency and intervention status on the trial outcome measures. Absolute iron deficiency was defined as ferritin <30 μg.l-1 ; functional iron deficiency as ferritin 30-100 μg.l-1 or transferrin saturation < 20%; and the remainder as non-iron deficient. Interactions were estimated using generalised linear models that included different subgroup indicators of baseline iron status. Co-primary endpoints were blood transfusion or death and number of blood transfusions, from randomisation to 30 days postoperatively. Secondary endpoints included peri-operative change in haemoglobin, postoperative complications and length of hospital stay. Most patients had iron deficiency (369/452 [82%]) at randomisation; one-third had absolute iron deficiency (144/452 [32%]) and half had functional iron deficiency (225/452 [50%]). The change in pre-operative haemoglobin with intravenous iron compared with placebo was greatest in patients with absolute iron deficiency, mean difference 8.9 g.l-1 , 95%CI 5.3-12.5; moderate in functional iron deficiency, mean difference 2.8 g.l-1 , 95%CI -0.1 to 5.7; and with little change seen in those patients who were non-iron deficient. Subgroup analyses did not suggest that intravenous iron compared with placebo reduced the likelihood of death or blood transfusion at 30 days differentially across subgroups according to baseline ferritin (p = 0.33 for interaction), transferrin saturation (p = 0.13) or in combination (p = 0.45), or for the number of blood transfusions (p = 0.06, 0.29, and 0.39, respectively). There was no beneficial effect of the use of intravenous iron compared with placebo, regardless of the metrics to diagnose iron deficiency, on postoperative complications or length of hospital stay.
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Affiliation(s)
- T Richards
- Division of Surgery, University of Western Australia, Perkins South Building, Fiona Stanley Hospital, Murdoch, Perth, WA, Australia.,Institute of Clinical Trials and Methodology and Division of Surgery, University College London, UK
| | - L F Miles
- Department of Critical Care, Melbourne Medical School, The University of Melbourne, VIC, Australia.,Department of Anaesthesia, Austin Health, Melbourne, VIC, Australia
| | - B Clevenger
- Department of Anaesthesia, Royal National Orthopaedic Hospital, Stanmore, UK
| | - A Keegan
- Department of Haematology, PathWest Laboratory Medicine, King Edward Memorial Hospital, Subiaco, WA, Australia
| | - S Abeysiri
- Division of Surgery, University of Western Australia, Perkins South Building, Fiona Stanley Hospital, Murdoch, Perth, WA, Australia
| | - R Rao Baikady
- Department of Anaesthesia, The Royal Marsden NHS Foundation Trust, London, UK
| | - M W Besser
- Department of Haematology, Addenbrooke's Hospital, Cambridge, UK
| | - J P Browne
- School of Public Health, University College Cork, Ireland
| | - A A Klein
- Department of Anaesthesia and Intensive Care, Royal Papworth Hospital, Cambridge, UK
| | - I C Macdougall
- Department of Renal Medicine, King's College Hospital, London, UK
| | - G J Murphy
- Department of Cardiovascular Sciences, University of Leicester, UK
| | - S D Anker
- Department of Cardiology, Berlin Institute of Health Centre for Regenerative Therapies; German Centre for Cardiovascular Research partner site Berlin; Charité Universitätsmedizin Berlin, Germany
| | - D Dahly
- School of Public Health, University College Cork, Ireland.,Health Research Board Clinical Research Facility, University College Cork, Ireland
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Wallace N, Murphy G, Roche M, Rock K. Comparative Evaluation of Four Software Packages for Automated Contouring. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Ladak S, McQueen L, Joeldavid L, Murphy G, Zakkar M. Acute arterial haemodynamics activation of endothelial to mesenchymal transition in long saphenous veins. Impact on vein graft disease. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.3084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
The long saphenous vein (LSV) is frequently used in cardiac surgery; however, its use is complicated by late stenosis or occlusion due to the development of intimal hyperplasia (IH). TGF-β has been implicated in the process of IH however the impact of acute haemodynamic changes on the activation of TGF-β endothelial-to mesenchymal transition (EndMT) has not been assessed and it's the focus of this study.
Purpose
To assess the role of acute haemodynamics changes in veins implanted into arterial circulation on EndMT.
Methods
Surplus LSV were exposed to acute arterial haemodynamics using a perfusion bioreactor. Changes in EndMT markers at the RNA and protein level evaluated by quantitative real time PCR, RNAScope and immunofluorescence.
Results
The acute exposure of veins to arterial haemodynamics ex-vivo induced significant increase in inflammatory marker IL-8 expression and transcription factor TWIST1 in LSV (both p≤0.01, Figure 1A) endothelium. Furthermore, immunostaining demonstrated the activation of pSMAD (p≤0.01, Figure 1B) acutely in endothelium after 45 minutes of exposure to arterial haemodynamics. This was followed by significant increase of SMC related markers (Vimentin and α-SMA; Figure 1C, both p≤0.001) and the suppression of endothelial cell related marker CD31 after 4 hours of LSV exposure to acute arterial haemodynamics. RNAScope and IHC results showed localisation of TWIST1 RNA and protein in CD31+ (p≤0.001) and VECAD+ (p≤0.001) cells respectively following exposure to acute arterial haemodynamics (Figure 1D). Furthermore, TGF-β pathway phosphorylation array identified the activation of Smad1 (p≤0.05) but not TAK1 in LSV endothelial cells indicating that acute arterial haemodynamics activates the TGF-β–SMAD pathway specifically (Figure 1E).
Conclusion
The exposure of LSV to acute arterial haemodynamics is associated with the activation of TGF-β–SMAD pathway leading to EndMT changes in the endothelium of vein grafts ex-vivo. This contributes to our understanding of the changes that occur in veins after implantation into arterial circulation and that the acute changes in the endothelium and suggests that strategies to modulate TGF-β–SMAD can be utilised to modulate IH in vein grafts.
Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Van Geest Foundation Heart and Cardiovascular Diseases Research Fund
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Affiliation(s)
- S Ladak
- University of Leicester, Department of Cardiovascular Sciences, Glenfield hospital , Leicester , United Kingdom
| | - L McQueen
- University of Leicester, Department of Cardiovascular Sciences, Glenfield hospital , Leicester , United Kingdom
| | - L Joeldavid
- NIHR Biomedical Research Unit in Cardiovascular Disease , Leicester , United Kingdom
| | - G Murphy
- University of Leicester, Department of Cardiovascular Sciences, Glenfield hospital , Leicester , United Kingdom
| | - M Zakkar
- University of Leicester, Department of Cardiovascular Sciences, Glenfield hospital , Leicester , United Kingdom
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Murphy G, Durand R, McCaughey C, Naughton A, Heron E, Pearson I. Drug-eluting balloons and drug-eluting stents in the treatment of small vessel coronary artery disease: a systematic review and metanalysis of long-term clinical and angiographic outcomes. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Coronary artery disease is a leading cause of mortality and morbidity worldwide. For those undergoing PCI, there are 20–30% with disease of the small coronary arteries on presentation [1]. Small coronary artery disease asserts a significant risk factor for adverse events. It is often diffuse and multi-vessel on presentation and confers higher rates of major adverse cardiac events, (MACE) and target lesion failure after intervention [2,3]. Best practice guidelines on the management of SvCAD interventions remain limited.
Drug-eluting balloons are a novel therapy, which has shown promise in treating in-stent restenosis (ISR), however their use in small coronary arteries when compared to drug-eluting stents remains unclear.
Purpose
This systematic review and meta-analysis compare long-term outcomes (>1 year), of drug-eluting balloons (DEB), vs. drug-eluting stents (DES), in the treatment of small coronary artery disease (<3mm).
Methods
A systematic review was completed within PRISMA guidelines. The primary outcome was non-inferiority of DEB Vs. DES in major adverse cardiac events (MACE). Secondary outcomes include all-cause mortality, MI, vessel thrombosis, major bleeding and target vessel revascularization at one, two and three years follow-up. Two independent reviewers extracted data. All outcomes used the Mantel-Haenszel and Random effect model. Odds ratios (OR), were presented with a 95% confidence interval (CI).
Result
Of 4661 articles, four RCTs were included (1414 patients). DEB demonstrated reduced rates of non-fatal MI at one year, OR 0.44 (95% CI 0.2, 0.94) and Basket-2 small reported a significant reduction in two-year bleeding rates OR 0.3 (95% CI 0.1, 0.91). DEBs were non-inferior to DES for all other outcomes.
Conclusion
Long duration follow-up of DEB and DES use in small coronary arteries demonstrates DEB to be non-inferior to DES in all outcomes across all years of follow-up. There was a significant reduction in rates of non-fatal MI at one year in the DEB arm and a reduction in major bleeding episodes at two years in the Basket Small 2 trial. These data highlight the potential utility and long-term safety of novel DEBs in small coronary artery disease revascularization.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- G Murphy
- St. James's Hospital , Dublin , Ireland
| | - R Durand
- St. James's Hospital , Dublin , Ireland
| | | | | | - E Heron
- St. James's Hospital , Dublin , Ireland
| | - I Pearson
- St. James's Hospital , Dublin , Ireland
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12
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Roman M, Fashina O, Tomassini S, Abbasciano RG, Lai F, Richards T, Murphy G. Reporting conflicts of interest in randomised trials of patient blood management interventions in patients requiring major surgery: a systematic review and meta-analysis. BMJ Open 2022; 12:e054582. [PMID: 35977767 PMCID: PMC9389106 DOI: 10.1136/bmjopen-2021-054582] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE This study aimed to systematically review the effects of declared and undeclared conflicts of interest on randomised controlled trials (RCTs) of patient blood management (PBM) interventions. DESIGN We performed a secondary analysis of a recently published meta-analysis of RCTs evaluating five common PBM interventions in patients undergoing major surgery. DATA SOURCES The databases searched by the original systematic reviews were searched using subject headings and Medical Subject Headings terms according to search strategies from the final search time-points until 1 June 2019. ELIGIBILITY CRITERIA RCTs on PBM irrespective of blinding, language, date of publication and sample size were included. Abstracts and unpublished trials were excluded. Conflicts of interest were defined as sponsorship, funding or authorship by industry, professional PBM advocacy groups or blood services. DATA EXTRACTION AND SYNTHESIS Three independent reviewers extracted the data and assessed the risk of bias. Pooled treatment effect estimates were reported as risk ratios (RRs) or standardised mean difference with 95% CIs. Heterogeneity was quantified using the I2 statistic. RESULTS Three hundred and eighty-nine RCTs totalling 53 635 participants were included. Thirty-two trials (8%) were considered free from important sources of bias. There was reporting bias favouring PBM interventions on transfusion across all analyses. In trials with no declared author conflicts of interest, the treatment effect on mortality was RR 1.12 (0.86 to 1.45). In trials where author conflicts of interest were declared, the treatment effect on mortality was RR 0.84 (0.69 to 1.03), with significant reporting bias favouring PBM interventions. Trials with declared conflicts linked to professional PBM advocacy groups (five studies, n=977 patients) reported statistically significant reductions in mortality RR 0.40 (0.17 to 0.92), unlike other groups. CONCLUSIONS Low certainty of the evidence that guides PBM implementation is confounded by evidence of reporting bias, and the effects of declared and undeclared conflicts of interest, favouring PBM on important trial outcomes.
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Affiliation(s)
- Marius Roman
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Unit in Cardiovascular Medicine, University of Leicester, Leicester, UK
| | - Oluwatomini Fashina
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Unit in Cardiovascular Medicine, University of Leicester, Leicester, UK
| | - Sara Tomassini
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Unit in Cardiovascular Medicine, University of Leicester, Leicester, UK
| | - Riccardo G Abbasciano
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Unit in Cardiovascular Medicine, University of Leicester, Leicester, UK
| | - Florence Lai
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Unit in Cardiovascular Medicine, University of Leicester, Leicester, UK
| | - Toby Richards
- Department of Vascular Surgery, The University of Western Australia, Perth, Western Australia, Australia
| | - Gavin Murphy
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Unit in Cardiovascular Medicine, University of Leicester, Leicester, UK
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13
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Adewuyi JO, Patel R, Abbasciano R, McCann G, Murphy G, Woźniak MJ, Singh A. A systematic review of micro-RNAs in aortic stenosis and cardiac fibrosis. Clin Transl Sci 2022; 15:1809-1817. [PMID: 35579611 PMCID: PMC9372411 DOI: 10.1111/cts.13303] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 01/13/2022] [Revised: 03/28/2022] [Accepted: 04/26/2022] [Indexed: 11/27/2022] Open
Abstract
Aortic stenosis (AS) is the commonest valve lesion requiring surgery in the Western world. The presence of myocardial fibrosis is associated with mortality even after valve replacement. MicroRNAs could serve as biomarkers of fibrosis and risk stratify patients for earlier intervention. This study aimed to systematically review reports of micro-RNA (miR) associated with fibrosis in AS and identify potential biomarkers. We searched EMBASE, Medline, and Web of Science up to May 2020. Studies that reported on the role of miRs in AS and cardiac fibrosis were included. Study quality was assessed using the Newcastle-Ottawa scale. Of 4230 reports screened, 25 were included. All studies were of low to moderate quality. MiRs were analyzed in myocardial tissue (n = 10), aortic valve tissue (n = 5), plasma (n = 5), and serum (n = 5). A total of 365 miRs were reported, of which only a few were reported in more than one paper (3 in the myocardium, 5 in the aortic valve, and 1 in plasma). miR-21 was upregulated in plasma and myocardial tissue. MiR-19b was downregulated in the myocardium. Papers reporting myocardial miR-1 contradicted each other, and miR-133a was associated with increased left ventricular mass regression post-surgery. In the aortic valve, miRs-665, 602 and 939 were downregulated, and miRs-193b and 214 were upregulated. The data on miR in fibrosis in AS is scarce and of low to moderate quality. Further studies are needed to identify novel miRs as biomarkers, especially at an earlier asymptomatic phase of the disease.
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Affiliation(s)
- Jemima Osekafore Adewuyi
- Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, Glenfield HospitalUniversity of LeicesterLeicesterUK
| | - Roshan Patel
- Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, Glenfield HospitalUniversity of LeicesterLeicesterUK
| | - Riccardo Abbasciano
- Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, Glenfield HospitalUniversity of LeicesterLeicesterUK
| | - Gerry P. McCann
- Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, Glenfield HospitalUniversity of LeicesterLeicesterUK
| | - Gavin Murphy
- Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, Glenfield HospitalUniversity of LeicesterLeicesterUK
| | - Marcin J. Woźniak
- Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, Glenfield HospitalUniversity of LeicesterLeicesterUK
| | - Anvesha Singh
- Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, Glenfield HospitalUniversity of LeicesterLeicesterUK
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O'Byrne L, Alqatari S, O'Sullivan A, Maher G, Khashan A, Murphy G, McCarthy F. P-432 Biologic use during conception and pregnancy and its impact on fetal and maternal outcomes: systematic review and meta-analysis. Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study question
To determine pregnancy outcomes in women with chronic inflammatory disease exposed to biologics during conception and pregnancy.
Summary answer
Meta-analysis of 11172 pregnancies exposed to biologic medications show no evidence of harm for the fetus or the mother.
What is known already
Chronic inflammatory diseases (CIDs) are a group of autoimmune diseases which affect between 5-7% of the population and include rheumatoid arthritis (RA), psoriatic arthritis and inflammatory bowel disease (IBD). Many CIDs have a female preponderance and are often associated with activity during reproductive years. Biologic medications, specifically the TNF-α inhibitors, have become increasingly prevalent in the treatment of chronic inflammatory disease (CID) in women of childbearing age.
Study design, size, duration
PubMed and EMBASE databases January 1998-July 2021.Peer reviewed, English language cohort, case-control, cross-sectional studies, and case series which contained original data. P- diagnosis of CID pregnancy. I- Biologic medication. C- diagnosis of CID without treatment with biologics and a CID free population. O- fetal:congenital malformations, preterm delivery (<37 weeks), severe neonatal infection requiring hospitalisation, low birth weight (<2.5Kg) and small for gestational age (<10th Centile). Maternal: severe maternal infection requiring hospitalisation, miscarriage and pre-eclampsia.
Participants/materials, setting, methods
Two authors independently conducted data extraction. A meta-analysis of proportions using a random-effects model was used to pool outcomes. Linear regression analysis was used to compare the mean of proportions of outcomes across exposure groups using the ‘treated’ group as the reference category. All studies were evaluated using an appropriate quality assessment tool described by McDonald et al. The GRADE approach was used to assess the overall certainty of evidence.
Main results and the role of chance
35 studies, 11172 pregnancies, were eligible for inclusion. Analysis showed pooled proportions for congenital malformations: treated 0.04(95% CI 0.03-0.04; I2 77) vs disease matched 0.04(0.03-0.05. I2 86) p = 0.238. Preterm delivery treated 0.04(0.10-0.14. I2 88) vs disease matched 0.10(0.09-0.12. I2 87) p = 0.250. Severe neonatal infection: treated 0.05(0.03-0.07. I2 88) vs disease matched 0.05(0.02-0.07. I2 94) p = 0.970. Low birth weight: treated 0.10(0.07-0.12. I2 93) vs disease matched 0.08(0.07-0.09. I2 0) p = 0.241. The pooled Miscarriage: treated 0.13(0.10-0.15. I2 77) vs disease matched 0.08(0.04-0.11. I2 5) p = 0.078. Pre-eclampsia; treated 0.01(0.01-0.02. I2 0) vs disease matched 0.01(0.00-0.01. I2 0). p = 0.193. No statistical differences in proportions were observed.
Limitations, reasons for caution
GRADE certainty of findings were low to very low.
Wider implications of the findings
We demonstrated comparable pregnancy outcomes in pregnancies exposed to biologics, disease matched controls and CID free pregnancies using the GRADE approach.
Trial registration number
NA
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Affiliation(s)
- L O'Byrne
- Department of Obstetrics and Gynaecology- Cork University Maternity Hospital INFANT research centre, , Cork, Ireland
| | - S Alqatari
- Cork University Hospital, Department of Rheumatology , Cork, Ireland
| | - A O'Sullivan
- Cork University Hospital, Department of Rheumatology , Cork, Ireland
| | - G Maher
- Department of Obstetrics and Gynaecology- Cork University Maternity Hospital INFANT research centre, , Cork, Ireland
| | - A Khashan
- Department of Obstetrics and Gynaecology- Cork University Maternity Hospital INFANT research centre, , Cork, Ireland
| | - G Murphy
- Cork University Hospital, Department of Rheumatology , Cork, Ireland
| | - F McCarthy
- Department of Obstetrics and Gynaecology- Cork University Maternity Hospital INFANT research centre, , Cork, Ireland
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Collins J, Horton K, Gale-St Ives E, Murphy G, Barnoux M. A Systematic Review of Autistic People and the Criminal Justice System: An Update of King and Murphy (2014). J Autism Dev Disord 2022:10.1007/s10803-022-05590-3. [PMID: 35637365 DOI: 10.1007/s10803-022-05590-3] [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] [Accepted: 04/25/2022] [Indexed: 10/18/2022]
Abstract
The purpose of this paper was to determine whether recommendations made by King & Murphy (Journal of Autism and Developmental Disorders 44:2717-2733, 2014) in their review of the evidence on autistic people in contact with the criminal justice system (CJS) have been addressed. Research published since 2013 was systematically examined and synthesised. The quality of 47 papers was assessed using the Mixed Methods Appraisal Tool. Findings suggest a limited amount of good quality research has been conducted that has focused on improving our understanding of autistic people in contact with the CJS since 2013. Methodological limitations make direct comparisons between autistic and non-autistic offenders difficult. Autistic people commit a range of crimes and appear to have unique characteristics that warrant further exploration (i.e., vulnerabilities, motivations for offending).
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Affiliation(s)
- J Collins
- Tizard Centre, University of Kent, Canterbury, CT2 7NF, UK.
| | - K Horton
- Tizard Centre, University of Kent, Canterbury, CT2 7NF, UK
| | - E Gale-St Ives
- Tizard Centre, University of Kent, Canterbury, CT2 7NF, UK
| | - G Murphy
- Tizard Centre, University of Kent, Canterbury, CT2 7NF, UK
| | - M Barnoux
- Tizard Centre, University of Kent, Canterbury, CT2 7NF, UK
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Abbasciano RG, Mariscalco G, Barwell J, Owens G, Zakkar M, Joel-David L, Pathak S, Adebayo A, Shannon N, Haines RL, Aujla H, Eagle-Hemming B, Kumar T, Lai F, Wozniak M, Murphy G. Evaluating the Feasibility of Screening Relatives of Patients Affected by Nonsyndromic Thoracic Aortic Diseases: The REST Study. J Am Heart Assoc 2022; 11:e023741. [PMID: 35383466 PMCID: PMC9238461 DOI: 10.1161/jaha.121.023741] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background Diseases of the thoracic aorta are characterized by a familial etiology in up to 30% of the cases. Nonsyndromic thoracic aorta diseases (NS‐TADs) lack overt clinical signs and systemic features, which hinder early detection and prompt surgical intervention. We hypothesize that tailored genetic testing and imaging of first‐degree and second‐degree relatives of patients affected by NS‐TADs may enable early diagnosis and allow appropriate surveillance or intervention. Methods and Results We conducted a feasibility study involving probands affected by familial or sporadic NS‐TADs who had undergone surgery, which also offered screening to their relatives. Each participant underwent a combined imaging (echocardiogram and magnetic resonance imaging) and genetic (whole exome sequencing) evaluation, together with physical examination and psychological assessment. The study population included 16 probands (8 sporadic, 8 familial) and 54 relatives (41 first‐degree and 13 second‐degree relatives) with median age 48 years (range: 18–85 years). No syndromic physical features were observed. Imaging revealed mild‐to‐moderate aortic dilation in 24% of relatives. A genetic variant of uncertain significance was identified in 3 families. Imaging, further phenotyping, or a form of secondary prevention was indicated in 68% of the relatives in the familial group and 54% in the sporadic group. No participants fulfilled criteria for aortic surgery. No differences between baseline and 3‐month follow‐up scores for depression, anxiety, and self‐reported quality of life were observed. Conclusions In NS‐TADs, imaging tests, genetic counseling, and family screening yielded positive results in up to 1 out of 4 screened relatives, including those in the sporadic NS‐TAD group. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03861741.
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Affiliation(s)
| | - Giovanni Mariscalco
- Department of Cardiac Surgery University Hospitals of Leicester NHS Trust Leicester UK
| | - Julian Barwell
- Department of Genetics and Genome Biology University of Leicester UK
| | - Gareth Owens
- Aortic Dissection Awareness UK & Ireland York UK
| | - Mustafa Zakkar
- Leicester NIHR Biomedical Research Centre & Department of Cardiovascular Sciences University of Leicester UK
| | - Lathishia Joel-David
- Department of Cardiac Surgery University Hospitals of Leicester NHS Trust Leicester UK
| | - Suraj Pathak
- Leicester NIHR Biomedical Research Centre & Department of Cardiovascular Sciences University of Leicester UK
| | - Adewale Adebayo
- Leicester NIHR Biomedical Research Centre & Department of Cardiovascular Sciences University of Leicester UK
| | - Nora Shannon
- Department of Clinical Genetics Nottingham University Hospitals Nottingham UK
| | | | - Hardeep Aujla
- Leicester NIHR Biomedical Research Centre & Department of Cardiovascular Sciences University of Leicester UK
| | - Bryony Eagle-Hemming
- Leicester NIHR Biomedical Research Centre & Department of Cardiovascular Sciences University of Leicester UK
| | - Tracy Kumar
- Leicester Clinical Trials Unit University of Leicester Leicester UK
| | - Florence Lai
- Leicester NIHR Biomedical Research Centre & Department of Cardiovascular Sciences University of Leicester UK
| | - Marcin Wozniak
- Leicester NIHR Biomedical Research Centre & Department of Cardiovascular Sciences University of Leicester UK
| | - Gavin Murphy
- Leicester NIHR Biomedical Research Centre & Department of Cardiovascular Sciences University of Leicester UK
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Earwaker M, Villar S, Fox-Rushby J, Duckworth M, Dawson S, Steele J, Chiu YD, Litton E, Kunst G, Murphy G, Martinez G, Zochios V, Brown V, Brown G, Klein A. Effect of high-flow nasal therapy on patient-centred outcomes in patients at high risk of postoperative pulmonary complications after cardiac surgery: a study protocol for a multicentre adaptive randomised controlled trial. Trials 2022; 23:232. [PMID: 35346339 PMCID: PMC8959074 DOI: 10.1186/s13063-022-06180-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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] [Received: 06/24/2021] [Accepted: 03/16/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND High-flow nasal therapy is a non-invasive form of respiratory support that delivers low-level, flow dependent positive airway pressure. The device can be better tolerated by patients than alternatives such as continuous positive airway pressure. The primary objective is to determine if prophylactic high-flow nasal therapy after tracheal extubation can result in an increase in the number of days alive and at home within the first 90 days after surgery, when compared with standard oxygen therapy. The co-primary objective is to estimate the incremental cost-effectiveness and cost-utility of high-flow nasal therapy vs standard oxygen therapy at 90 days, from the view-point of the public sector, the health service and patients. METHODS This is an adaptive, multicentre, international parallel-group, randomised controlled trial with embedded cost-effectiveness analysis comparing the use of high-flow nasal therapy with control in patients at high risk of respiratory complications following cardiac surgery. Participants will be randomised before tracheal extubation and allocated either high-flow nasal therapy or standard oxygen therapy for a minimum of 16 h immediately post extubation. Participants will be followed up until 90 days after surgery. The total sample size needed to detect a 2-day increase in DAH90 with 90% power with an intention to treat analysis is 850 patients. The adaptive design includes an interim sample size re-estimation which will provide protection against deviations from the original sample size assumptions made from the single-centre pilot study and will allow for a maximum sample size increase to 1152 patients. DISCUSSION Evidence to support routine use of high-flow nasal therapy will inform the development of effective enhanced recovery care bundles. Reducing complications should reduce length of stay and re-admission to hospital and provide an important focus for cost reduction. However; high-quality studies evaluating the clinical and cost effectiveness of high-flow nasal therapy after cardiothoracic surgery are lacking. TRIAL REGISTRATION The study has been registered with ISRCTN ( ISRCTN14092678 , 13/05/2020) Clinicaltrials.gov Registration Pending.
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Affiliation(s)
- Melissa Earwaker
- Papworth Trials Unit Collaboration, Royal Papworth Hospital, Cambridge, UK.
| | - Sofia Villar
- MRC Biostatistics Unit, Cambridge University, Cambridge, UK
| | | | - Melissa Duckworth
- Papworth Trials Unit Collaboration, Royal Papworth Hospital, Cambridge, UK
| | - Sarah Dawson
- MRC Biostatistics Unit, Cambridge University, Cambridge, UK
| | - Jo Steele
- Papworth Trials Unit Collaboration, Royal Papworth Hospital, Cambridge, UK
| | - Yi-da Chiu
- Papworth Trials Unit, Royal Papworth Hospital, Cambridge, UK
| | - Edward Litton
- Intensive Care Unit, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | | | | | | | | | - Val Brown
- Papworth Trials Unit Collaboration, Royal Papworth Hospital, Cambridge, UK
| | - Geoff Brown
- Papworth Trials Unit Collaboration, Royal Papworth Hospital, Cambridge, UK
| | - Andrew Klein
- Department of Anaesthesia, Royal Papworth Hospital, Cambridge, UK
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Abbasciano RG, Gradinariu G, Kourliouros A, Lai F, Langrish J, Murphy G, Quarto C, Radhakrishnan A, Raja S, Rogers LJ, Townend J, Tyson N, Vaja R, Verdichizzo D, Wynne R. Antithrombotic treatment following coronary artery bypass surgery: a network meta-analysis. Hippokratia 2021. [DOI: 10.1002/14651858.cd014817] [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: 11/11/2022]
Affiliation(s)
| | - George Gradinariu
- Department of Cardiothoracic Surgery; Golden Jubilee National Hospital; Glasgow UK
| | - Antonios Kourliouros
- Oxford Heart Centre; Oxford University Hospitals NHS Foundation Trust; Oxford UK
| | - Florence Lai
- Department of Cardiovascular Sciences; University of Leicester; Leicester UK
| | - Jeremy Langrish
- Oxford Heart Centre; Oxford University Hospitals NHS Foundation Trust; Oxford UK
| | - Gavin Murphy
- Department of Cardiovascular Sciences; University of Leicester; Leicester UK
| | - Cesare Quarto
- Department of Cardiac Surgery; Royal Brompton and Harefield Hospital; London UK
| | | | - Shahzad Raja
- Department of Cardiac Surgery; Royal Brompton and Harefield Hospital; London UK
| | - Luke J Rogers
- Bristol Heart Institute; University Hospitals Bristol and Weston NHS Foundation Trust; Bristol UK
| | - Jonathan Townend
- Department of Cardiology; Queen Elizabeth Hospital, University Hospitals Birmingham NHS Trust; Birmingham UK
| | - Nathan Tyson
- Trent Cardiac Centre; Nottingham University Hospitals NHS Trust; Nottingham UK
| | - Ricky Vaja
- Department of Cardiac Surgery; Royal Brompton and Harefield Hospital; London UK
| | - Danilo Verdichizzo
- Oxford Heart Centre; Oxford University Hospitals NHS Foundation Trust; Oxford UK
| | - Rochelle Wynne
- Western Sydney Nursing & Midwifery Research Centre; Western Sydney University; Sydney Australia
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Beretov J, Lam P, Marvi S, Murphy G, Murrell G. Glenoid Labral Tears are associated with Increased Neurofilament Innervation. J Sci Med Sport 2021. [DOI: 10.1016/j.jsams.2021.09.015] [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: 11/28/2022]
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Murphy G, Lam P, Murrell G. Does superior labrum anterior to posterior (SLAP) repair timing matter? J Sci Med Sport 2021. [DOI: 10.1016/j.jsams.2021.09.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kelly N, Hawkins E, O’leary H, Quinn K, Murphy G, Larkin L. POS1465-HPR THE RELATIONSHIP BETWEEN SEDENTARY BEHAVIOR AND SLEEP IN RHEUMATOID ARTHRITIS: A CROSS-SECTIONAL STUDY. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Rheumatoid arthritis (RA) is a chronic, autoimmune inflammatory condition that affects 0.5% of the adult population worldwide (1). Sedentary behavior (SB) is any waking behavior characterized by an energy expenditure of ≤1.5 METs (metabolic equivalent) and a sitting or reclining posture, e.g. computer use (2) and has a negative impact on health in the RA population (3). Sleep is an important health behavior, but sleep quality is an issue for people living with RA (4, 5). Poor sleep quality is associated with low levels of physical activity in RA (4) however the association between SB and sleep in people who have RA has not been examined previously.Objectives:The aim of this study was to investigate the relationship between SB and sleep in people who have RA.Methods:A cross-sectional study was conducted. Patients were recruited from rheumatology clinics in a large acute public hospital serving a mix of urban and rural populations. Inclusion criteria were diagnosis of RA by a rheumatologist according to the American College of Rheumatology criteria age ≥ 18 and ≤ 80 years; ability to mobilize independently or aided by a stick; and to understand written and spoken English. Demographic data on age, gender, disease duration and medication were recorded. Pain and fatigue were measured by the Visual Analogue Scale (VAS), anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS), and sleep quality was assessed using the Pittsburgh Sleep Quality Index. SB was measured using the ActivPAL4™ activity monitor, over a 7-day wear period. Descriptive statistics were calculated to describe participant characteristics. Relationships between clinical characteristics and SB were examined using Pearson’s correlation coefficients and regression analyses.Results:N=76 participants enrolled in the study with valid data provided by N=72 participants. Mean age of participants was 61.5years (SD10.6) and the majority 63% (n = 47) were female. Participant mean disease duration was 17.8years (SD10.9). Mean SB time was 533.7 (SD100.1) minutes (8.9 hours per day/59.9% of waking hours). Mean sleep quality score was 7.2 (SD5.0) (Table 1). Correlation analysis and regression analysis found no significant correlation between sleep quality and SB variables. Regression analysis demonstrated positive statistical associations for SB time and body mass index (p-value=0.03846, R2 = 0.05143), SB time and pain VAS (p-value=0.009261, R2 = 0.07987), SB time and HADS (p-value = 0.009721, R2 = 0.08097) and SB time and HADSD (p-value = 0.01932, R2 = 0.0643).Conclusion:We found high levels of sedentary behavior and poor sleep quality in people who have RA, however no statistically significant relationship was found in this study. Future research should further explore the complex associations between sedentary behavior and sleep quality in people who have RA.References:[1]Carmona L, et al. Rheumatoid arthritis. Best Pract Res Clin Rheumatol 2010;24:733–745.[2]Anon. Letter to the editor: standardized use of the terms “sedentary” and “sedentary behaviours”. Appl Physiol Nutr Metab = Physiol Appl Nutr Metab 2012;37:540–542.[3]Fenton, S.A.M. et al. Sedentary behaviour is associated with increased long-term cardiovascular risk in patients with rheumatoid arthritis independently of moderate-to-vigorous physical activity. BMC Musculoskelet Disord 18, 131 (2017).[4]McKenna S, et al. Sleep and physical activity: a cross-sectional objective profile of people with rheumatoid arthritis. Rheumatol Int. 2018 May;38(5):845-853.[5]Grabovac, I., et al. 2018. Sleep quality in patients with rheumatoid arthritis and associations with pain, disability, disease duration, and activity. Journal of clinical medicine, 7(10)336.Table 1.Sleep quality in people who have RASleep variableBed Time N(%) before 10pm13(18%) 10pm-12pm43 (60%) after 12pm16 (22%)Hours Sleep mean(SD)6.56 (1.54)Fall Asleep minutes mean(SD)33.3(27.7)Night Waking N(%)45(63%)Self-Rate Sleep mean(SD)2.74 (0.90)Hours Sleep mean(SD)6.56 (1.54)Disclosure of Interests:None declared
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Mccaughey C, Ranganathan D, Murphy G, Kerins M, Murphy R. Dyslipidaemia management in the cardiac rehabilitation clinic of a tertiary referral centre; analysis of the impact of new ESC guidance on LDL-C target achievement. Eur J Prev Cardiol 2021. [DOI: 10.1093/eurjpc/zwab061.280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Cardiac rehabilitation (CR) programs provide an opportunity to measure low density lipoprotein cholesterol (LDL-C) levels and optimise lipid lowering therapy (LLT) accordingly. New ESC guidelines released in August 2019 recommend lower absolute LDL-C target levels and an >50% reduction from baseline in those at the highest risk.
Purpose
This study investigated the proportion of those patients who finished CR in 2019 that reached both their absolute and relative reduction in LDL-C levels, before and after the introduction of these new guidelines. We also analysed the choice and appropriateness of LLT.
Methods
A retrospective chart review of 163 patients who completed CR in 2019. A database was created containing baseline patient characteristics and LDL-C levels both prior and post CR; as well as the patient’s contemporary LLT. Those patients who did not have a previous diagnosis of atherosclerotic cardiovascular disease (ASCVD) were risk stratified as per ESC guidance.
Baseline LDL-C levels were recorded, where possible, and otherwise calculated using pre-CR LDL profile with an adjustment made based on the projected effects of their LLT.
Results
Mean (SD) patient age was 62 (10) years, 123/163 (75%) were male and 142 (87%) patients had established ASCVD. 90/142 (63%) of very high-risk patients were treated with a high intensity LLT and 5/163 overall (3%) were prescribed ezetimibe.
Overall, 96/163 (59%) patients in 2019 met their absolute LDL-C targets; 62% of applicable patients achieved an >50% reduction in LDL-C levels. 104 (64%) of patients were treated in compliance with their contemporary guidelines.
Both pre (n = 112) and post (n = 51) September 2019 cohorts were well matched. Fewer patients who were treated under the August 2019 guidelines reached their absolute LDL-C (51% v 63%, p < 0.005) targets; achieved a >50% reduction in LDL-C from baseline (48% vs 61%, p < 0.005), or were compliant with the guidelines for their risk category (43% vs 73%, p < 0.005).
Conclusions
Both high intensity statin therapy and ezetimibe are under-prescribed. Fewer patients are meeting the lower absolute LDL-C targets set out in the 2019 ESC guidelines. For those at high risk, determining the reduction in LDL-C from baseline reveals that even those meeting their absolute LDL-C targets may still be undertreated.
LDL-C Target Achievement N Mean LDL Pre-CR (95% CI) Mean LDL-C Post CR (95% CI) Absolute LDL-C Target Met (%) Mean % LDL-C Reduction from Baseline (95% CI) > 50% Reduction (% of applicable patients) Guidelines Achieved Pre-Sept"20 112 2.7 (2.46-2.93) 1.64 (1.49- 1.79) 70 (63) 61 (56-66) 50 (65) 82 (73) Post Sept 20 51 2.83 (2.41-3.25) 1.83 (1.41-2.25) 26 (51) 48 (37-59) 11 (34) 22 (43) Total 163 2.72 (2.52- 2.91) 1.69 (1.57-1.82) 96 (59) 57 (52- 62) 61 (52) 104 (64 LDL-C targets met, stratified by contemporary guidelines followed.
Abstract Figure. Choice of lipid lowering therapy in 2019
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Affiliation(s)
| | | | - G Murphy
- St. James"s Hospital, Dublin, Ireland
| | - M Kerins
- St. James"s Hospital, Dublin, Ireland
| | - R Murphy
- St. James"s Hospital, Dublin, Ireland
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Angelini GD, Johnson T, Culliford L, Murphy G, Ashton K, Harris T, Edwards J, Clayton G, Kim Y, Newby AC, Reeves BC, Rogers CA. Comparison of alternate preparative techniques on wall thickness in coronary artery bypass grafts: The HArVeST randomized controlled trial. J Card Surg 2021; 36:1985-1995. [PMID: 33710658 DOI: 10.1111/jocs.15477] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 01/15/2021] [Revised: 01/21/2021] [Accepted: 01/22/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND The success of coronary artery bypass grafting surgery (CABG) is dependent on long-term graft patency, which is negatively related to early wall thickening. Avoiding high-pressure distension testing for leaks and preserving the surrounding pedicle of fat and adventitia during vein harvesting may reduce wall thickening. METHODS A single-centre, factorial randomized controlled trial was carried out to compare the impact of testing for leaks under high versus low pressure and harvesting the vein with versus without the pedicle in patients undergoing CABG. The primary outcomes were graft wall thickness, as indicator of medial-intimal hyperplasia, and lumen diameter assessed using intravascular ultrasound after 12 months. RESULTS Ninety-six eligible participants were recruited. With conventional harvest, low-pressure testing tended to yield a thinner vessel wall compared with high-pressure (mean difference [MD; low minus high] -0.059 mm, 95% confidence interval (CI) -0.12, +0.0039, p = .066). With high pressure testing, veins harvested with the pedicle fat tended to have a thinner vessel wall than those harvested conventionally (MD [pedicle minus conventional] -0.057 mm, 95% CI: -0.12, +0.0037, p = .066, test for interaction p = .07). Lumen diameter was similar across groups (harvest comparison p = .81; pressure comparison p = .24). Low-pressure testing was associated with fewer hospital admissions in the 12 months following surgery (p = .0008). Harvesting the vein with the pedicle fat was associated with more complications during the index admission (p = .0041). CONCLUSIONS Conventional saphenous vein graft preparation with low-pressure distension and harvesting the vein with a surrounding pedicle yielded similar graft wall thickness after 12 months, but low pressure was associated with fewer adverse events.
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Affiliation(s)
| | - Tom Johnson
- Bristol Heart Institute, University of Bristol, Bristol, UK
| | - Lucy Culliford
- Clinical Trials and Evaluation Unit, Bristol Trials Centre, University of Bristol, Bristol, UK
| | - Gavin Murphy
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Kate Ashton
- Clinical Trials and Evaluation Unit, Bristol Trials Centre, University of Bristol, Bristol, UK
| | - Tracy Harris
- Clinical Trials and Evaluation Unit, Bristol Trials Centre, University of Bristol, Bristol, UK
| | - Julia Edwards
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Gemma Clayton
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Yongcheol Kim
- Yongin Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Andrew C Newby
- Bristol Heart Institute, University of Bristol, Bristol, UK
| | - Barney C Reeves
- Clinical Trials and Evaluation Unit, Bristol Trials Centre, University of Bristol, Bristol, UK
| | - Chris A Rogers
- Clinical Trials and Evaluation Unit, Bristol Trials Centre, University of Bristol, Bristol, UK
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24
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Richards T, Baikady RR, Clevenger B, Butcher A, Abeysiri S, Chau M, Swinson R, Collier T, Dodd M, Dyck LV, Macdougall I, Murphy G, Browne J, Bradbury A, Klein A. Preoperative intravenous iron for anaemia in elective major open abdominal surgery: the PREVENTT RCT. Health Technol Assess 2021; 25:1-58. [PMID: 33632377 DOI: 10.3310/hta25110] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Anaemia affects 30-50% of patients before they undergo major surgery. Preoperative anaemia is associated with increased need for blood transfusion, postoperative complications and worse patient outcomes after surgery. International guidelines support the use of intravenous iron to correct anaemia in patients before surgery. However, the use of preoperative intravenous iron for patient benefit has not been assessed in the setting of a formal clinical trial. OBJECTIVES To assess if intravenous iron given to patients with anaemia before major abdominal surgery is beneficial by reducing transfusion rates, postoperative complications, hospital stay and re-admission to hospital, and improving quality of life outcomes. DESIGN A multicentre, double-blinded, randomised, controlled, Phase III clinical trial, with 1 : 1 randomisation comparing placebo (normal saline) with intravenous iron (intravenous ferric carboxymaltose 1000 mg). Randomisation and treatment allocation were by a secure web-based service. SETTING The study was conducted across 46 hospitals in England, Scotland and Wales between September 2013 and September 2018. PARTICIPANTS Patients aged > 18 years, undergoing elective major open abdominal surgery, with anaemia [Hb level of > 90 g/l and < 120 g/l (female patients) and < 130 g/l (male patients)] who could undergo randomisation and treatment 10-42 days before their operation. INTERVENTION Double-blinded study comparing placebo of normal saline with 1000 mg of ferric carboxymaltose administered 10-42 days prior to surgery. MAIN OUTCOME MEASURES Co-primary end points were risk of blood transfusion or death at 30 days postoperatively, and rate of blood transfusions at 30 days post operation. RESULTS A total of 487 patients were randomised (243 given placebo and 244 given intravenous iron), of whom 474 completed the trial and provided data for the analysis of the co-primary end points. The use of intravenous iron increased preoperative Hb levels (mean difference 4.7 g/l, 95% confidence interval 2.7 to 6.8 g/l; p < 0.0001), but had no effect compared with placebo on risk of blood transfusion or death (risk ratio 1.03, 95% confidence interval 0.78 to 1.37; p = 0.84; absolute risk difference +0.8%, 95% confidence interval -7.3% to 9.0%), or rates of blood transfusion (rate ratio 0.98, 95% confidence interval 0.68 to 1.43; p = 0.93; absolute rate difference 0.00, 95% confidence interval -0.14 to 0.15). There was no difference in postoperative complications or hospital stay. The intravenous iron group had higher Hb levels at the 8-week follow-up (difference in mean 10.7 g/l, 95% confidence interval 7.8 to 13.7 g/l; p < 0.0001). There were a total of 71 re-admissions to hospital for postoperative complications in the placebo group, compared with 38 re-admissions in the intravenous iron group (rate ratio 0.54, 95% confidence interval 0.34 to 0.85; p = 0.009). There were no differences between the groups in terms of mortality (two per group at 30 days post operation) or in any of the prespecified safety end points or serious adverse events. CONCLUSIONS In patients with anaemia prior to elective major abdominal surgery, there was no benefit from giving intravenous iron before the operation. FUTURE WORK The impact of iron repletion on recovery from postoperative anaemia, and the association with reduced re-admission to hospital for complications, should be investigated. LIMITATIONS In the preoperative intravenous iron to treat anaemia in major surgery (PREVENTT) trial, all patients included had anaemia and only 20% had their anaemia corrected before surgery. The definition and causality of iron deficiency in this setting is not clear. TRIAL REGISTRATION Current Controlled Trials ISRCTN67322816 and ClinicalTrials.gov NCT01692418. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25 No. 11. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Toby Richards
- Division of Surgery, University of Western Australia, Perth, WA, Australia.,Institute of Clinical Trial and Methodology, University College London, London, UK.,Division of Surgery, University College London, London, UK
| | | | - Ben Clevenger
- Division of Surgery, University College London, London, UK.,Department of Anaesthesia, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Anna Butcher
- Division of Surgery, University College London, London, UK
| | - Sandy Abeysiri
- Institute of Clinical Trial and Methodology, University College London, London, UK.,Division of Surgery, University College London, London, UK
| | - Marisa Chau
- Institute of Clinical Trial and Methodology, University College London, London, UK.,Division of Surgery, University College London, London, UK
| | - Rebecca Swinson
- Clinical Trials Unit, London School of Hygiene & Tropical Medicine, London, UK
| | - Tim Collier
- Clinical Trials Unit, London School of Hygiene & Tropical Medicine, London, UK
| | - Matthew Dodd
- Clinical Trials Unit, London School of Hygiene & Tropical Medicine, London, UK
| | - Laura Van Dyck
- Clinical Trials Unit, London School of Hygiene & Tropical Medicine, London, UK
| | - Iain Macdougall
- Department of Renal Medicine, King's College Hospital, London, UK
| | - Gavin Murphy
- NIHR Leicester Biomedical Research Centre, Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - John Browne
- School of Public Health, University College Cork, Cork, Ireland
| | - Andrew Bradbury
- University Department of Vascular Surgery (University of Birmingham), Solihull Hospital, Solihull, UK
| | - Andrew Klein
- Department of Anaesthesia and Intensive Care, Royal Papworth Hospital, Cambridge, UK
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Hancock HC, Maier RH, Kasim A, Mason J, Murphy G, Goodwin A, Owens WA, Akowuah E. Mini-sternotomy versus conventional sternotomy for aortic valve replacement: a randomised controlled trial. BMJ Open 2021; 11:e041398. [PMID: 33514577 PMCID: PMC7849899 DOI: 10.1136/bmjopen-2020-041398] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 12/04/2020] [Accepted: 12/07/2020] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To compare clinical and health economic outcomes after manubrium-limited mini-sternotomy (intervention) and conventional median sternotomy (usual care). DESIGN A single-blind, randomised controlled trial. SETTING Single centre UK National Health Service tertiary hospital. PARTICIPANTS Adult patients undergoing aortic valve replacement (AVR) surgery. INTERVENTIONS Intervention was manubrium-limited mini-sternotomy performed using a 5-7 cm midline incision. Usual care was median sternotomy performed using a midline incision from the sternal notch to the xiphisternum. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was the proportion of patients who received a red cell transfusion postoperatively and within 7 days of index surgery. Secondary outcomes included proportion of patients receiving a non-red cell blood component transfusion and number of units transfused within 7 days and during index hospital stay, quality of life and cost-effectiveness analyses. RESULTS 270 patients were randomised, received surgery and contributed to the intention to treat analysis. No difference between mini and conventional sternotomy in red-cell transfusion within 7 days was found; 23/135 patients in each arm received a transfusion, OR 1.0 (95% CI 0.5 to 2.0) and risk difference 0.0 (95% CI -0.1 to 0.1). Mini-sternotomy reduced chest drain losses (mean 181.6 mL (SD 138.7) vs conventional, mean 306·9 mL (SD 348.6)); this did not reduce red-cell transfusions. Mean valve size and postoperative valve function were comparable between mini-sternotomy and conventional groups; 23 mm vs 24 mm and 6/134 moderate or severe aortic regurgitation vs 3/130, respectively. Mini-sternotomy resulted in longer bypass (82.7 min (SD 23.5) vs 59.6 min (SD 15.1)) and cross-clamp times (64.1 min (SD 17.1) vs 46·3 min (SD 10.7)). Conventional sternotomy was more cost-effective with only a 5.8% probability of mini-sternotomy being cost-effective at a willingness to pay of £20 000/QALY (Quality Adjusted Life Years). CONCLUSIONS AVR via mini-sternotomy did not reduce red blood cell transfusion within 7 days following surgery when compared with conventional sternotomy. TRIAL REGISTRATION NUMBER ISRCTN29567910; Results.
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Affiliation(s)
- Helen C Hancock
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | - Rebecca H Maier
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | - Adetayo Kasim
- Wolfson Research Institute for Health and Wellbeing, Durham University, Stockton-on-Tees, Durham, UK
| | - James Mason
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Gavin Murphy
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Unit in Cardiovascular Medicine, University of Leicester, Leicester, UK
| | - Andrew Goodwin
- Department of Cardiothoracic Surgery, James Cook Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - W Andrew Owens
- Department of Cardiothoracic Surgery, James Cook Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - Enoch Akowuah
- Department of Cardiothoracic Surgery, James Cook Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
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26
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Richards T, Baikady RR, Clevenger B, Butcher A, Abeysiri S, Chau M, Macdougall IC, Murphy G, Swinson R, Collier T, Van Dyck L, Browne J, Bradbury A, Dodd M, Evans R, Brealey D, Anker SD, Klein A. Preoperative intravenous iron to treat anaemia before major abdominal surgery (PREVENTT): a randomised, double-blind, controlled trial. Lancet 2020; 396:1353-1361. [PMID: 32896294 PMCID: PMC7581899 DOI: 10.1016/s0140-6736(20)31539-7] [Citation(s) in RCA: 170] [Impact Index Per Article: 42.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/30/2020] [Accepted: 07/07/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Preoperative anaemia affects a high proportion of patients undergoing major elective surgery and is associated with poor outcomes. We aimed to test the hypothesis that intravenous iron given to anaemic patients before major open elective abdominal surgery would correct anaemia, reduce the need for blood transfusions, and improve patient outcomes. METHODS In a double-blind, parallel-group randomised trial, we recruited adult participants identified with anaemia at preoperative hospital visits before elective major open abdominal surgery at 46 UK tertiary care centres. Anaemia was defined as haemoglobin less than 130 g/L for men and 120 g/L for women. We randomly allocated participants (1:1) via a secure web-based service to receive intravenous iron or placebo 10-42 days before surgery. Intravenous iron was administered as a single 1000 mg dose of ferric carboxymaltose in 100 mL normal saline, and placebo was 100 mL normal saline, both given as an infusion over 15 min. Unblinded study personnel prepared and administered the study drug; participants and other clinical and research staff were blinded to treatment allocation. Coprimary endpoints were risk of the composite outcome of blood transfusion or death, and number of blood transfusions from randomisation to 30 days postoperatively. The primary analysis included all randomly assigned patients with data available for the primary endpoints; safety analysis included all randomly assigned patients according to the treatment received. This study is registered, ISRCTN67322816, and is closed to new participants. FINDINGS Of 487 participants randomly assigned to placebo (n=243) or intravenous iron (n=244) between Jan 6, 2014, and Sept 28, 2018, complete data for the primary endpoints were available for 474 (97%) individuals. Death or blood transfusion occurred in 67 (28%) of the 237 patients in the placebo group and 69 (29%) of the 237 patients in the intravenous iron group (risk ratio 1·03, 95% CI 0·78-1·37; p=0·84). There were 111 blood transfusions in the placebo group and 105 in the intravenous iron group (rate ratio 0·98, 95% CI 0·68-1·43; p=0·93). There were no significant differences between the two groups for any of the prespecified safety endpoints. INTERPRETATION Preoperative intravenous iron was not superior to placebo to reduce need for blood transfusion when administered to patients with anaemia 10-42 days before elective major abdominal surgery. FUNDING UK National Institute of Health Research Health Technology Assessment Program.
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Affiliation(s)
- Toby Richards
- Division of Surgery, University of Western Australia, Fiona Stanley Hospital, Perth, WA, Australia; Institute of Clinical Trials and Methodology, University College London, London, UK; Division of Surgery, University College London, London, UK.
| | | | - Ben Clevenger
- Department of Anaesthesia, Royal National Orthopaedic Hospital, London, UK
| | - Anna Butcher
- Division of Surgery, University College London, London, UK
| | - Sandy Abeysiri
- Institute of Clinical Trials and Methodology, University College London, London, UK; Division of Surgery, University College London, London, UK
| | - Marisa Chau
- Institute of Clinical Trials and Methodology, University College London, London, UK; Division of Surgery, University College London, London, UK
| | | | - Gavin Murphy
- NIHR Leicester Biomedical Research Centre, Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Rebecca Swinson
- Clinical Trials Unit, London School of Hygiene & Tropical Medicine, London, UK
| | - Tim Collier
- Clinical Trials Unit, London School of Hygiene & Tropical Medicine, London, UK
| | - Laura Van Dyck
- Clinical Trials Unit, London School of Hygiene & Tropical Medicine, London, UK
| | - John Browne
- School of Public Health, University College Cork, Cork, Ireland
| | - Andrew Bradbury
- University Department of Vascular Surgery, Birmingham University, Solihull Hospital, Solihull, UK
| | - Matthew Dodd
- Clinical Trials Unit, London School of Hygiene & Tropical Medicine, London, UK
| | - Richard Evans
- Clinical Trials Unit, London School of Hygiene & Tropical Medicine, London, UK
| | - David Brealey
- Institute of Clinical Trials and Methodology, University College London, London, UK; Division of Surgery, University College London, London, UK
| | - Stefan D Anker
- Department of Cardiology (CVK), Berlin Institute of Health Center for Regenerative Therapies, and German Centre for Cardiovascular Research partner site Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Andrew Klein
- Department of Anaesthesia and Intensive Care, Royal Papworth Hospital, Cambridge, UK
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Armstrong A, Jeevaratnam J, Murphy G, Pasha M, Tough A, Conway-Jones R, Mifsud RW, Tucker S. A plastic surgery service response to COVID-19 in one of the largest teaching hospitals in Europe. J Plast Reconstr Aesthet Surg 2020; 73:1174-1205. [PMID: 32359857 PMCID: PMC7195076 DOI: 10.1016/j.bjps.2020.03.027] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 03/25/2020] [Indexed: 01/08/2023]
Abstract
COVID-19 is presenting a colossal challenge to frontline NHS staff. This paper highlights how plastic surgery teams can use their diverse skills and resources in times of crisis. Through effective strategy and leadership we present how we are adapting as a department to serve our plastic surgery patients, other hospital teams and the Trust.
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Affiliation(s)
- A Armstrong
- Plastic Surgery Specialty Training Registrar, Oxford University Hospitals NHS Foundation Trust.
| | - J Jeevaratnam
- Plastic Surgery Specialty Training Registrar, Oxford University Hospitals NHS Foundation Trust; Major, Royal Army Medical Corps
| | - G Murphy
- Plastic Surgery Specialty Training Registrar, Oxford University Hospitals NHS Foundation Trust
| | - M Pasha
- Foundation Doctor, Oxford University Hospitals NHS Foundation Trust
| | - A Tough
- Medical Student, University of Oxford
| | | | | | - S Tucker
- Consultant Plastic Surgeon, Oxford University Hospitals NHS Foundation Trust
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Abbasciano RG, Roman MA, Rizzello A, Pathak S, Ramzi J, Lucarelli C, Layton G, Lai F, Kumar T, Wozniak MJ, Murphy G. Effects of interventions targeting the systemic inflammatory response to cardiac surgery on clinical outcomes in adults. Hippokratia 2020. [DOI: 10.1002/14651858.cd013584] [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: 11/07/2022]
Affiliation(s)
| | - Marius A Roman
- Department of Cardiothoracic Surgery / Cardiovascular Sciences; University Hospitals of Leicester / University of Leicester; Leicester UK
| | - Angelica Rizzello
- Department of Cardiovascular Sciences; University of Leicester; Leicester UK
| | - Suraj Pathak
- Department of Cardiothoracic Surgery; Glenfield Hospital; Leicester UK
| | - Joussi Ramzi
- Leicester Medical School; University of Leicester; Leicester UK
| | - Carla Lucarelli
- Department of Cardiac Surgery; University of Verona; Verona Italy
| | - Georgia Layton
- University Hospitals of Leicester NHS Trust; Leicester UK
| | - Florence Lai
- Leicester Clinical Trials Unit; University of Leicester, Glenfield Hospital; Leicester UK
| | - Tracy Kumar
- Department of Cardiovascular Sciences; University of Leicester; Leicester UK
| | - Marcin J Wozniak
- Department of Cardiovascular Sciences; University of Leicester; Leicester UK
| | - Gavin Murphy
- Department of Cardiovascular Sciences; University of Leicester; Leicester UK
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30
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Rogers L, Vaja R, Bleetman D, Ali JM, Rochon M, Sanders J, Tanner J, Lamagni TL, Talukder S, Quijano-Campos JC, Lai F, Loubani M, Murphy G. Interventions to prevent surgical site infection in adults undergoing cardiac surgery. Hippokratia 2019. [DOI: 10.1002/14651858.cd013332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
| | - Luke Rogers
- University Hospitals Plymouth NHS Trust; Plymouth UK
| | - Ricky Vaja
- Royal Brompton & Harefield Hospital NHS Foundation Trust; Department of Cardiothoracic Surgery; London UK
| | - David Bleetman
- St Bartholomew's Hospital, Barts Health NHS Trust; Department of Cardiothoracic Surgery; London UK
| | - Jason M Ali
- Royal Papworth Hospital; Department of Cardiothoracic Surgery; Papworth Everard UK
| | - Melissa Rochon
- Royal Brompton & Harefield Hospital NHS Foundation Trust; Department of Cardiothoracic Surgery; London UK
| | - Julie Sanders
- St Bartholomew’s Hospital, Barts Health NHS Trust; London UK
| | - Judith Tanner
- University of Nottingham; School of Health Sciences; Queens Medical Centre Nottingham UK NG7 2HA
| | - Theresa L Lamagni
- Public Health England; Healthcare-Associated Infection & Antimicrobial Resistance Division, National Infection Service; London UK
| | - Shagorika Talukder
- Royal Papworth Hospital; Department of Cardiothoracic Surgery; Papworth Everard UK
| | | | - Florence Lai
- University of Leicester, Glenfield Hospital; Leicester Clinical Trials Unit; Leicester UK
| | - Mahmoud Loubani
- Hull and East Yorkshire Hospitals NHS Trust; Department of Cardiothoracic Surgery; Hull UK
| | - Gavin Murphy
- University of Leicester; Department of Cardiovascular Sciences; Clinical Sciences Wing Glenfield General Hospital Leicester Leicestershire UK LE3 9QP
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Zakkar M, Benedetto U, Angelini GD, Murphy G, Shah R, Jahangiri M, Page R. Cardiothoracic surgery training in the United Kingdom. J Thorac Cardiovasc Surg 2018; 157:1948-1955. [PMID: 30661815 DOI: 10.1016/j.jtcvs.2018.11.076] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 11/02/2018] [Accepted: 11/12/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Mustafa Zakkar
- Bristol Heart Institute, University of Bristol, School of Clinical Sciences, Bristol, United Kingdom.
| | - Umberto Benedetto
- Bristol Heart Institute, University of Bristol, School of Clinical Sciences, Bristol, United Kingdom
| | - Gianni D Angelini
- Bristol Heart Institute, University of Bristol, School of Clinical Sciences, Bristol, United Kingdom
| | - Gavin Murphy
- Department of Cardiovascular Sciences, University of Leicester, Clinical Sciences Wing, Glenfield General Hospital, Leicester, United Kingdom
| | - Rajesh Shah
- Department of Cardiothoracic Surgery, University Hospital of South Manchester NHS Foundation Trust, Manchester, United Kingdom
| | - Marjan Jahangiri
- Department of Cardiothoracic Surgery, St George's Hospital, University of London, London, United Kingdom
| | - Richard Page
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
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Corazzari C, Monaghan A, Tutino C, Murphy G, Beghi C. OC73 SYSTEMATIC REVIEW OF THE PREDICTIVE ACCURACY OF POINT OF CARE TESTS OF COAGULOPATHY IN CARDIAC SURGERY. J Cardiovasc Med (Hagerstown) 2018. [DOI: 10.2459/01.jcm.0000549925.39078.59] [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: 11/05/2022]
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O’Sullivan A, Ghazi Al Qatari S, Murphy G. IgG4 Related Disease, A Case of Large Vessel Vasculitis. Ir Med J 2018; 111:824. [PMID: 30556672] [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: 06/09/2023]
Abstract
Aim This report describes a case of large vessel vasculitis highlighting diagnostic and therapeutic challenges. It describes the use of the B cell depleting agent Rituximab in this setting. This is the case of a 50 year old lady with bipolar disorder presenting with lower limb pain. Method PET CT and CT angiography were employed in the diagnosis of a large vessel vasculitic process. Serum IgG4 was elevated. Histological sampling was not clinically feasible. A presumptive diagnosis of IgG4 related disease was made. Results The patient responded well to steroids and later rituximab. A prompt taper of steroids was required due to labile mood and Rituximab proved to be effective in this case as a maintenance therapy. Conclusion This case demonstrates that a combination of clinical findings, laboratory results and radiological imaging may be necessary for diagnosis for IgG4 related disease, especially in the absence of a histological diagnosis. Rituximab was used in this case as a maintenance therapy allowing for a relatively rapidly reducing course of steroids.
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Affiliation(s)
- A O’Sullivan
- Rheumatology Department, Cork University Hospital
| | | | - G Murphy
- Rheumatology Department, Cork University Hospital
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Murphy G, Tzamaloukas A, Eisenberg B, Gibel L, Avasthi P. Intraperitoneal Thrombolytic Agents in Relapsing or Persistent Peritonitis of Patients on Continuous Ambulatory Peritoneal Dialysis. Int J Artif Organs 2018. [DOI: 10.1177/039139889101400206] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- G. Murphy
- Department of Medicine, University of New Mexico, New Mexico - U.S.A
| | | | | | - L.J. Gibel
- Urology Section, Albuquerque Veterans Administration Medical Center and University of New Mexico School of Medicine Albuquerque, New Mexico - U.S.A
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Tzamaloukas A, Murata G, Eisenberg B, Murphy G, Avasthi P. Hypoglycemia in Diabetics on Dialysis with Poor Glycemic Control: Hemodialysis versus Continuous Ambulatory Peritoneal Dialysis. Int J Artif Organs 2018. [DOI: 10.1177/039139889201500702] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Eight diabetic men with poor glycemic control, probably worsened by severe congestive heart failure and gastroparesis, were sequentially dialyzed by CAPD and hemodialysis. Mean blood glucose concentration, blood glycosylated hemoglobin, and insulin dose were higher during CAPD than during hemodialysis. Among blood glucose determinations, however, the frequency of hypoglycemia (glucose <3.3 mmol/L) was higher during hemodialysis (13.2 ± 8.9%) than during CAPD (2.8 ± 2.1% p = 0.012), whereas the frequencies of hyperglycemia (glucose >11.1 mmol/L) and euglycemia (glucose between 3.5 and 11.1 mmol/L) did not differ between the two dialysis modalities. Furthermore, hypoglycemia was severe during hemodialysis and was associated with two deaths. There were no deaths linked to abnormalities in blood glucose concentration during CAPD. When hypoglycemia is frequent in diabetics with poor glycemic control, CAPD is preferable to hemodialysis.
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Affiliation(s)
- A.H. Tzamaloukas
- Department of Medicine, Veterans Affairs Medical Center and University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - G.H. Murata
- Department of Medicine, Veterans Affairs Medical Center and University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - B. Eisenberg
- Department of Radiology, Virginia Mason Clinic, Seattle, Washington
| | - G. Murphy
- Division of Nephrology, Lovelace Medical Center, Albuquerque, New Mexico - USA
| | - P.S. Avasthi
- Department of Medicine, Veterans Affairs Medical Center and University of New Mexico School of Medicine, Albuquerque, New Mexico
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36
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Affiliation(s)
- A.H. Tzamaloukas
- Renal Section, Veterans Affairs Medical Center and University of New Mexico School of Medicine, Albuquerque
| | - G. Murphy
- Department of Nephrology, Lovelace Medical Center, Albuquerque, New Mexico
| | - B. Eisenberg
- Department of Radiology, Virginia Mason Clinic, Seattle, Washington - USA
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37
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Haldane V, Cervero-Liceras F, Ong SE, Murphy G, Balabanova D, Buse K, McKee M, Ledigo-Quigley H, Chuah F. Interventions and approaches to integrating HIV and mental health services: a systematic review. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx187.696] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- V Haldane
- National University of Singapore, Singapore, Singapore
| | | | - SE Ong
- National University of Singapore, Singapore, Singapore
| | - G Murphy
- University of Oxford, Oxford, UK
| | - D Balabanova
- London School of Hygiene and Tropical Medicine, London, UK
| | - K Buse
- UNAIDS, Geneva, Switzerland
| | - M McKee
- National University of Singapore, Singapore, Singapore
| | | | - F Chuah
- National University of Singapore, Singapore, Singapore
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38
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Cervero-Liceras F, Chuah FLH, Ong SE, Murphy G, Balabanova D, Buse K, McKee M, Legido-Quigley H, Haldane VE. Integrating HIV and Substance Use Services: A Systematic Review. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx189.042] [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: 11/13/2022] Open
Affiliation(s)
| | - FLH Chuah
- National University of Singapore, Singapore, Singapore
| | - SE Ong
- National University of Singapore, Singapore, Singapore
| | | | | | - K Buse
- UNAIDS, Geneva, Switzerland
| | | | | | - VE Haldane
- National University of Singapore, Singapore, Singapore
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39
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Clark LV, Buckland M, Murphy G, Taylor N, Vleck V, Mein C, Wozniak E, Smuk M, White PD. Cytokine responses to exercise and activity in patients with chronic fatigue syndrome: case-control study. Clin Exp Immunol 2017; 190:360-371. [PMID: 28779554 DOI: 10.1111/cei.13023] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2017] [Indexed: 01/08/2023] Open
Abstract
Chronic fatigue syndrome (CFS) is characterized by fatigue after exertion. A systematic review suggested that transforming growth factor (TGF)-β concentrations are often elevated in cases of CFS when compared to healthy controls. This study attempted to replicate this finding and investigate whether post-exertional symptoms were associated with altered cytokine protein concentrations and their RNA in CFS patients. Twenty-four patients fulfilling Centers for Disease Control criteria for CFS, but with no comorbid psychiatric disorders, were recruited from two CFS clinics in London, UK. Twenty-one healthy, sedentary controls were matched by gender, age and other variables. Circulating proteins and RNA were measured for TGF-β, tumour necrosis factor (TNF), interleukin (IL)-8, IL-6 and IL-1β. We measured six further cytokine protein concentrations (IL-2, IL-4, IL-5, IL-10, IL-12p70, and interferon (IFN)-γ). Measures were taken at rest, and before and after both commuting and aerobic exercise. CFS cases had higher TGF-β protein levels compared to controls at rest (median (quartiles) = 43·9 (19·2, 61·8) versus 18·9 (16·1, 30·0) ng/ml) (P = 0·003), and consistently so over a 9-day period. However, this was a spurious finding due to variation between different assay batches. There were no differences between groups in changes to TGF-β protein concentrations after either commuting or exercise. All other cytokine protein and RNA levels were similar between cases and controls. Post-exertional symptoms and perceived effort were not associated with any increased cytokines. We were unable to replicate previously found elevations in circulating cytokine concentrations, suggesting that elevated circulating cytokines are not important in the pathophysiology of CFS.
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Affiliation(s)
- L V Clark
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Queen Mary's School of Medicine and Dentistry, London, UK
| | - M Buckland
- UCL Centre for Immunodeficiency, Royal Free London NHS Foundation Trust, London, UK
| | - G Murphy
- UCL Centre for Immunodeficiency, Royal Free London NHS Foundation Trust, London, UK
| | - N Taylor
- UCL Centre for Immunodeficiency, Royal Free London NHS Foundation Trust, London, UK
| | - V Vleck
- CIPER, Faculty of Human Kinetics, University of Lisbon, Lisbon, Portugal
| | - C Mein
- Genome Centre, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - E Wozniak
- Genome Centre, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - M Smuk
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Queen Mary's School of Medicine and Dentistry, London, UK
| | - P D White
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Queen Mary's School of Medicine and Dentistry, London, UK
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Murphy G, McCormack V, Abedi-Ardekani B, Arnold M, Camargo MC, Dar NA, Dawsey SM, Etemadi A, Fitzgerald RC, Fleischer DE, Freedman ND, Goldstein AM, Gopal S, Hashemian M, Hu N, Hyland PL, Kaimila B, Kamangar F, Malekzadeh R, Mathew CG, Menya D, Mulima G, Mwachiro MM, Mwasamwaja A, Pritchett N, Qiao YL, Ribeiro-Pinto LF, Ricciardone M, Schüz J, Sitas F, Taylor PR, Van Loon K, Wang SM, Wei WQ, Wild CP, Wu C, Abnet CC, Chanock SJ, Brennan P. International cancer seminars: a focus on esophageal squamous cell carcinoma. Ann Oncol 2017; 28:2086-2093. [PMID: 28911061 PMCID: PMC5834011 DOI: 10.1093/annonc/mdx279] [Citation(s) in RCA: 133] [Impact Index Per Article: 19.0] [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] [Indexed: 02/06/2023] Open
Abstract
The International Agency for Research on Cancer (IARC) and the US National Cancer Institute (NCI) have initiated a series of cancer-focused seminars [Scelo G, Hofmann JN, Banks RE et al. International cancer seminars: a focus on kidney cancer. Ann Oncol 2016; 27(8): 1382-1385]. In this, the second seminar, IARC and NCI convened a workshop in order to examine the state of the current science on esophageal squamous cell carcinoma etiology, genetics, early detection, treatment, and palliation, was reviewed to identify the most critical open research questions. The results of these discussions were summarized by formulating a series of 'difficult questions', which should inform and prioritize future research efforts.
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Affiliation(s)
- G. Murphy
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda Maryland, USA
| | | | | | - M. Arnold
- Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - M. C. Camargo
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda Maryland, USA
| | - N. A. Dar
- Department of Biochemistry, University of Kashmir, Hazratbal, Srinagar, Jammu and Kashmir, India
| | - S. M. Dawsey
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda Maryland, USA
| | - A. Etemadi
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda Maryland, USA
| | - R. C. Fitzgerald
- MRC Cancer Unit, Hutchison-MRC Research Centre, University of Cambridge, Cambridge, UK
| | - D. E. Fleischer
- Department of Internal Medicine, Mayo Clinic, Scottsdale, Arizona, USA
| | - N. D. Freedman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda Maryland, USA
| | - A. M. Goldstein
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda Maryland, USA
| | - S. Gopal
- University of North Carolina Project-Malawi, Lilongwe, Malawi
| | - M. Hashemian
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda Maryland, USA
- Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - N. Hu
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda Maryland, USA
| | - P. L. Hyland
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda Maryland, USA
| | - B. Kaimila
- University of North Carolina Project-Malawi, Lilongwe, Malawi
| | - F. Kamangar
- Department of Public Health Analysis, School of Community Health and Policy, Morgan State University, Baltimore, Maryland, USA
| | - R. Malekzadeh
- Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - C. G. Mathew
- Department of Medical and Molecular Genetics, Kings College London
- Sydney Brenner Institute for Molecular Bioscience, University of Witwatersrand, Johannesburg, South Africa
| | - D. Menya
- School of Public Health, Moi University, Eldoret, Kenya
| | - G. Mulima
- University of North Carolina Project-Malawi, Lilongwe, Malawi
| | | | - A. Mwasamwaja
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - N. Pritchett
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda Maryland, USA
| | - Y.-L. Qiao
- Department of Etiology and Carcinogenesis & Department of Cancer Epidemiology, Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - L. F. Ribeiro-Pinto
- Molecular Carcinogenesis Program, Institute Nacional de Cancer, Sao Paulo, Brazil
| | - M. Ricciardone
- National Cancer Institute, Center for Global Health, National Institutes of Health, Bethesda, Maryland, USA
| | - J. Schüz
- Section of Environment and Radiation
| | - F. Sitas
- School of Public Health, University of Sydney, New South Wales, Australia
- School of Public Health & Community Medicine, University of New South Wales, Sydney, Australia
| | - P. R. Taylor
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda Maryland, USA
| | - K. Van Loon
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, California, USA
| | - S.-M. Wang
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda Maryland, USA
- Department of Etiology and Carcinogenesis & Department of Cancer Epidemiology, Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - W.-Q. Wei
- Department of Etiology and Carcinogenesis & Department of Cancer Epidemiology, Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - C. P. Wild
- Director's office, International Agency for Research on Cancer, Lyon, France
| | - C. Wu
- Department of Etiology and Carcinogenesis & Department of Cancer Epidemiology, Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - C. C. Abnet
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda Maryland, USA
| | - S. J. Chanock
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda Maryland, USA
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Soodla P, Simmons R, Huik K, Pauskar M, Jõgeda EL, Rajasaar H, Kallaste E, Maimets M, Avi R, Murphy G, Porter K, Lutsar I. HIV incidence in the Estonian population in 2013 determined using the HIV-1 limiting antigen avidity assay. HIV Med 2017; 19:33-41. [PMID: 28762652 DOI: 10.1111/hiv.12535] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2017] [Indexed: 01/30/2023]
Abstract
OBJECTIVES Estonia has one the highest number of new HIV diagnoses in the European Union, mainly among injecting drug users and heterosexuals. Little is known of HIV incidence, which is crucial for limiting the epidemic. Using a recent HIV infection testing algorithm (RITA) assay, we aimed to estimate HIV incidence in 2013. METHODS All individuals aged ≥18 years newly-diagnosed with HIV in Estonia January- December 2013, except blood donors and those undergoing antenatal screening, were included. Demographic and clinical data were obtained from the Estonian Health Board and the Estonian HIV-positive patient database. Serum samples were tested for recent infection using the LAg-avidity EIA assay. HIV incidence was estimated based on previously published methods. RESULTS Of 69,115 tested subjects, 286 (0.41%) were newly-diagnosed with HIV with median age of 33 years (IQR: 28-42) and 65% male. Self-reported routes of HIV transmission were mostly heterosexual contact (n = 157, 53%) and injecting drug use (n = 62, 21%); 64 (22%) were with unknown risk group. Eighty two (36%) were assigned recent, resulting in estimated HIV incidence of 0.06%, corresponding to 642 new infections in 2013 among the non-screened population. Incidence was highest (1.48%) among people who inject drugs. CONCLUSIONS These high HIV incidence estimates in Estonia call for urgent action of renewed targeted public health promotion and HIV testing campaigns.
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Affiliation(s)
- P Soodla
- Department of Microbiology, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - R Simmons
- University College London, London, UK
| | - K Huik
- Department of Microbiology, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - M Pauskar
- Department of Microbiology, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - E-L Jõgeda
- Department of Microbiology, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - H Rajasaar
- Department of Microbiology, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - E Kallaste
- Department of Microbiology, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - M Maimets
- Department of Infectious Diseases, Tartu University Hospital, Tartu, Estonia
| | - R Avi
- Department of Microbiology, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - G Murphy
- Public Health England, London, UK
| | - K Porter
- University College London, London, UK
| | - I Lutsar
- Department of Microbiology, Faculty of Medicine, University of Tartu, Tartu, Estonia
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42
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Akowuah E, Goodwin AT, Owens WA, Hancock HC, Maier R, Kasim A, Mellor A, Khan K, Murphy G, Mason J. Manubrium-limited ministernotomy versus conventional sternotomy for aortic valve replacement (MAVRIC): study protocol for a randomised controlled trial. Trials 2017; 18:46. [PMID: 28129780 PMCID: PMC5273792 DOI: 10.1186/s13063-016-1768-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 12/21/2016] [Indexed: 01/26/2023] Open
Abstract
Background Aortic valve replacement is one of the most common cardiac surgical procedures performed worldwide. Conventional aortic valve replacement surgery is performed via a median sternotomy; the sternum is divided completely from the sternal notch to the xiphisternum. Minimally invasive aortic valve replacement, using a new technique called manubrium-limited ministernotomy, divides only the manubrium from the sternal notch to 1 cm below the manubrio-sternal junction. More than one third of patients undergoing conventional sternotomy develop clinically significant bleeding requiring post-operative red blood cell transfusion. Case series data suggest a potentially clinically significant difference in red blood cell transfusion requirements between the two techniques. Given the implications for National Health Service resources and patient outcomes, a definitive trial is needed. Methods/design This is a single-centre, single-blind, randomised controlled trial comparing aortic valve replacement surgery using manubrium-limited ministernotomy (intervention) and conventional median sternotomy (usual care). Two hundred and seventy patients will be randomised in a 1:1 ratio between the intervention and control arms, stratified by baseline logistic EuroSCORE and haemoglobin value. Patients will be followed for 12 weeks from discharge following their index operation. The primary outcome is the proportion of patients who receive a red blood cell transfusion post-operatively within 7 days of surgery. Secondary outcomes include red blood cell and blood product transfusions, blood loss, re-operation rates, sternal wound pain, quality of life, markers of inflammatory response, hospital discharge, health care utilisation, cost and cost effectiveness and adverse events. Discussion This is the first trial to examine aortic valve replacement via manubrium-limited ministernotomy versus conventional sternotomy when comparing red blood cell transfusion rates following surgery. Surgical trials present significant challenges; strengths of this trial include a rigorous research design, standardised surgery performed by experienced consultant cardiothoracic surgeons, an agreed anaesthetic regimen, patient blinding and consultant-led patient recruitment. The MAVRIC trial will demonstrate that complex surgical trials can be delivered to exemplary standards and provide the community with the knowledge required to inform future care for patients requiring aortic valve replacement surgery. Trial registration International Standard Randomised Controlled Trial Number (ISRCTN) ISRCTN29567910. Registered on 3 February 2014. Electronic supplementary material The online version of this article (doi:10.1186/s13063-016-1768-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Enoch Akowuah
- Cardiothoracic Division, The James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Marton Road, Middlesbrough, TS4 3BW, UK
| | - Andrew T Goodwin
- Cardiothoracic Division, The James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Marton Road, Middlesbrough, TS4 3BW, UK
| | - W Andrew Owens
- Cardiothoracic Division, The James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Marton Road, Middlesbrough, TS4 3BW, UK
| | - Helen C Hancock
- Durham Clinical Trials Unit, School of Medicine, Pharmacy and Health, Durham University, Queen's Campus, University Boulevard, Thornaby, Stockton-on-Tees, TS17 6BH, UK.
| | - Rebecca Maier
- Durham Clinical Trials Unit, School of Medicine, Pharmacy and Health, Durham University, Queen's Campus, University Boulevard, Thornaby, Stockton-on-Tees, TS17 6BH, UK
| | - Adetayo Kasim
- Durham Clinical Trials Unit, School of Medicine, Pharmacy and Health, Durham University, Queen's Campus, University Boulevard, Thornaby, Stockton-on-Tees, TS17 6BH, UK
| | - Adrian Mellor
- Cardiothoracic Division, The James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Marton Road, Middlesbrough, TS4 3BW, UK
| | - Khalid Khan
- Cardiothoracic Division, The James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Marton Road, Middlesbrough, TS4 3BW, UK
| | - Gavin Murphy
- Department of Cardiovascular Sciences, University of Leicester, Clinical Sciences Wing, Glenfield General Hospital, Leicester, LE3 9QP, UK
| | - James Mason
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
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McCormack VA, Menya D, Munishi MO, Dzamalala C, Gasmelseed N, Leon Roux M, Assefa M, Osano O, Watts M, Mwasamwaja AO, Mmbaga BT, Murphy G, Abnet CC, Dawsey SM, Schüz J. Informing etiologic research priorities for squamous cell esophageal cancer in Africa: A review of setting-specific exposures to known and putative risk factors. Int J Cancer 2017; 140:259-271. [PMID: 27466161 PMCID: PMC5763498 DOI: 10.1002/ijc.30292] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [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: 06/29/2016] [Accepted: 07/08/2016] [Indexed: 12/30/2022]
Abstract
Esophageal squamous cell carcinoma (ESCC) is one of the most common cancers in most Eastern and Southern African countries, but its etiology has been understudied to date. To inform its research agenda, we undertook a review to identify, of the ESCC risk factors which have been established or strongly suggested worldwide, those with a high prevalence or high exposure levels in any ESCC-affected African setting and the sources thereof. We found that for almost all ESCC risk factors known to date, including tobacco, alcohol, hot beverage consumption, nitrosamines and both inhaled and ingested PAHs, there is evidence of population groups with raised exposures, the sources of which vary greatly between cultures across the ESCC corridor. Research encompassing these risk factors is warranted and is likely to identify primary prevention strategies.
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Affiliation(s)
- V A McCormack
- Section of Environment and Radiation, International Agency for Research on Cancer (IARC), Lyon, France
| | - D Menya
- School of Public Health, Moi University, Eldoret, Kenya
| | - M O Munishi
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - C Dzamalala
- College of Medicine, University of Malawi, Blantyre, Malawi
- Malawi Cancer Registry, Malawi
| | - N Gasmelseed
- National Cancer Institute, University of Gezira, Sudan
- Faculty of Science, University of Hafr Al Batin, Saudi Arabia
| | - M Leon Roux
- Section of Environment and Radiation, International Agency for Research on Cancer (IARC), Lyon, France
| | - M Assefa
- Radiotherapy Center, Addis-Ababa-University, Addis Ababa, Ethiopia
| | - O Osano
- School of Environmental Studies, University of Eldoret, Kenya
| | - M Watts
- Inorganic Chemistry, Centre for Environmental Geochemistry, British Geological Survey, Nottingham, United Kingdom
| | - A O Mwasamwaja
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - B T Mmbaga
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - G Murphy
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - C C Abnet
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - S M Dawsey
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - J Schüz
- Section of Environment and Radiation, International Agency for Research on Cancer (IARC), Lyon, France
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O'Leary C, Kroes J, Murphy G, Doyle M, Corrigan L, Rehman Z, Mannion J, Foley S, Rogan M, O'Connor M, Horgan A, Calvert P. 43: Non small cell lung cancer mutational testing in the South East of Ireland. Lung Cancer 2017. [DOI: 10.1016/s0169-5002(17)30093-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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45
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O'Leary C, Corrigan L, Rehman Z, Kroes J, Murphy G, Mannion J, O'Connor M, Horgan A, Calvert P. 13: Epidermal growth factor receptor (EGFR) mutated advanced squamous cell lung cancer – treatment beyond progression. Lung Cancer 2017. [DOI: 10.1016/s0169-5002(17)30063-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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46
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Malovic A, Murphy G, Coulton S. Finding the Right Assessment Measures for Young People with Intellectual Disabilities Who Display Harmful Sexual Behaviour. J Appl Res Intellect Disabil 2016; 33:101-110. [DOI: 10.1111/jar.12299] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2016] [Indexed: 11/29/2022]
Affiliation(s)
- A. Malovic
- Tizard Centre University of Kent Canterbury UK
| | - G. Murphy
- Tizard Centre University of Kent Canterbury UK
| | - S. Coulton
- Tizard Centre University of Kent Canterbury UK
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Cuevas-Núñez M, Woo S, Ramsey M, Chen X, Borges C, Xu V, Murphy G, Lian C. BIOLOGICAL SIGNIFICANCE OF 5-HYDROXYMETHYLCYTOSINE EXPRESSION IN ORAL MUCOSAL EPITHELIAL DYSPLASIA AND ORAL SQUAMOUS CELL CARCINOMA. Oral Surg Oral Med Oral Pathol Oral Radiol 2016. [DOI: 10.1016/j.oooo.2016.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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48
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Murphy G, Szokol J, Vender J, Greenberg S. Abstract PR523. Anesth Analg 2016. [DOI: 10.1213/01.ane.0000492906.38412.0d] [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: 11/05/2022]
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49
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Hassan J, Murphy G, Reid F, Tuite H, Igoe D, De Gascun C. HIV incidence assays: Evaluation of three HIV Avidity enzyme immunoassays. J Clin Virol 2016. [DOI: 10.1016/j.jcv.2016.08.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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50
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Marcowith A, Bret A, Bykov A, Dieckman ME, Drury LO, Lembège B, Lemoine M, Morlino G, Murphy G, Pelletier G, Plotnikov I, Reville B, Riquelme M, Sironi L, Novo AS. The microphysics of collisionless shock waves. Rep Prog Phys 2016; 79:046901. [PMID: 27007555 DOI: 10.1088/0034-4885/79/4/046901] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Collisionless shocks, that is shocks mediated by electromagnetic processes, are customary in space physics and in astrophysics. They are to be found in a great variety of objects and environments: magnetospheric and heliospheric shocks, supernova remnants, pulsar winds and their nebulæ, active galactic nuclei, gamma-ray bursts and clusters of galaxies shock waves. Collisionless shock microphysics enters at different stages of shock formation, shock dynamics and particle energization and/or acceleration. It turns out that the shock phenomenon is a multi-scale non-linear problem in time and space. It is complexified by the impact due to high-energy cosmic rays in astrophysical environments. This review adresses the physics of shock formation, shock dynamics and particle acceleration based on a close examination of available multi-wavelength or in situ observations, analytical and numerical developments. A particular emphasis is made on the different instabilities triggered during the shock formation and in association with particle acceleration processes with regards to the properties of the background upstream medium. It appears that among the most important parameters the background magnetic field through the magnetization and its obliquity is the dominant one. The shock velocity that can reach relativistic speeds has also a strong impact over the development of the micro-instabilities and the fate of particle acceleration. Recent developments of laboratory shock experiments has started to bring some new insights in the physics of space plasma and astrophysical shock waves. A special section is dedicated to new laser plasma experiments probing shock physics.
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Affiliation(s)
- A Marcowith
- Laboratoire Univers et Particules de Montpellier CNRS/Université de Montpellier, Place E. Bataillon, 34095 Montpellier, France
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