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Hutton G, Kawano T, Scheuermeyer FX, Panchal AR, Asamoah-Boaheng M, Christenson J, Grunau B. Out-of-Hospital Cardiac Arrests Terminated without full Resuscitation Attempts: Characteristics and Regional Variability. Resuscitation 2022; 172:47-53. [PMID: 35077855 DOI: 10.1016/j.resuscitation.2022.01.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 11/05/2021] [Revised: 01/11/2022] [Accepted: 01/16/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Out-of-hospital cardiac arrest (OHCA) investigations may elect to exclude cases with resuscitation terminated for reasons other than a full resuscitative attempt. We sought to examine characteristics of these cases and regional variability in classification. METHODS Using the North American Resuscitation Outcomes Consortium Epistry, we included adult emergency medical services (EMS)-treated cases, examining the rationale ("futility", do-not resuscitate (DNR) order, "verbal directive", or "obvious death") and timing of resuscitation termination, and the timing of ROSC among hospital-discharge survivors. We tested regional variability in EMS patient arrival-to-termination intervals with one-way ANOVA. RESULTS Of 63,554 included cases, 27,232 were declared dead in the prehospital setting: (1) 23,009 (36%) for futility (after a median of 24 minutes (IQR 19-31) of professional resuscitation); (2) 1622 (2.6%) for a DNR order (at 6.3 minutes [IQR 3.0-11]); (3) 1018 (1.6%) for a verbal directive (at 12 minutes [IQR 7.0-17]); and, (4) 1583 (2.5%) for obvious death (at 5.4 minutes [IQR 3.0-9.0]). The EMS patient arrival-to-ROSC interval among hospital-discharge survivors was 7.7 (3.8 - 13) minutes. Among regions, 0.20-12% and 0.20-5.3% were terminated to due to obvious death or verbal directives, respectively. There were significant regional differences in the EMS patient arrival-to-termination interval for futility (p<0.010) and obvious death (p<0.010). CONCLUSION There is significant variation in the rationale and interval until termination of resuscitation between regions. Cases terminated due to obvious death or DNR orders/verbal directives often are treated with similar durations of resuscitation as survivors. These data highlight a considerable risk of bias in between-region comparisons or observational analyses.
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Affiliation(s)
- Gillian Hutton
- Faculty of Medicine, University of British Columbia, British Columbia, Canada
| | - Takahisa Kawano
- Department of Emergency Medicine, University of Fukui Hospital, Fukui Prefecture, Japan; BC Resuscitation Research Collaborative, British Columbia, Canada
| | - Frank X Scheuermeyer
- Faculty of Medicine, University of British Columbia, British Columbia, Canada; BC Resuscitation Research Collaborative, British Columbia, Canada; Departments of Emergency Medicine and the Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital and the University of British Columbia, British Columbia, Canada
| | - Ashish R Panchal
- Department of Emergency Medicine, The Ohio State University, Columbus, OH, USA
| | - Michael Asamoah-Boaheng
- Faculty of Medicine, University of British Columbia, British Columbia, Canada; BC Resuscitation Research Collaborative, British Columbia, Canada; Faculty of Medicine, Clinical Epidemiology, Memorial University of Newfoundland, Newfoundland, Canada
| | - Jim Christenson
- Faculty of Medicine, University of British Columbia, British Columbia, Canada; BC Resuscitation Research Collaborative, British Columbia, Canada; Departments of Emergency Medicine and the Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital and the University of British Columbia, British Columbia, Canada
| | - Brian Grunau
- Faculty of Medicine, University of British Columbia, British Columbia, Canada; BC Resuscitation Research Collaborative, British Columbia, Canada; Departments of Emergency Medicine and the Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital and the University of British Columbia, British Columbia, Canada; British Columbia Emergency Health Services, British Columbia, Canada.
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2
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Sachdeva R, Hutton G, Marwaha AS, Krassioukov AV. Morphological maladaptations in sympathetic preganglionic neurons following an experimental high-thoracic spinal cord injury. Exp Neurol 2020; 327:113235. [PMID: 32044331 DOI: 10.1016/j.expneurol.2020.113235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 01/15/2020] [Accepted: 02/06/2020] [Indexed: 10/25/2022]
Abstract
Spinal cord injury (SCI) disrupts the supraspinal vasomotor pathways to sympathetic preganglionic neurons (SPNs) leading to impaired blood pressure (BP) control that often results in episodes of autonomic dysreflexia and orthostatic hypotension. The physiological cardiovascular consequences of SCI are largely attributed to the plastic changes in spinal SPNs induced by their partial deafferentation. While multiple studies have investigated the morphological changes in SPNs following SCI with contrasting reports. Here we investigated the morphological changes in SPNs rostral and caudal to a high thoracic (T3) SCI at 1-, 4- and 8-weeks post injury. SPNs were identified using Nicotinamide adenine dinucleotide hydrogen phosphate-diaphorase (NADPH- diaphorase) staining and were quantified for soma size and various dendritic measurements. We show that rostral to the lesion, soma size was increased at 1 week along with increased dendritic arbor. The total dendritic length was also increased at chronic stage (8 weeks post SCI). Caudal to the lesion, the soma size or dendritic lengths did not change with SCI. However, dendritic branching was enhanced within a week post SCI and remained elevated throughout the chronic stages. These findings demonstrate that SPNs undergo significant structural changes form sub-acute to chronic stages post-SCI that likely determines their functional consequences. These changes are discussed in context of physiological cardiovascular outcomes post-SCI.
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Affiliation(s)
- Rahul Sachdeva
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, Canada; Department of Medicine, Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, Canada
| | - Gillian Hutton
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, Canada; Department of Medicine, Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, Canada
| | - Arshdeep S Marwaha
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, Canada; Department of Medicine, Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, Canada
| | - Andrei V Krassioukov
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, Canada; Department of Medicine, Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, Canada; GF Strong Rehabilitation Center, Vancouver Coastal Health, Vancouver, Canada.
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Stosic M, De Jesus P, McCarthy J, Hutton G, Rivera V. Immune thrombocytopenic purpura in a patient with multiple sclerosis treated with natalizumab. Neurology 2011; 77:505-7. [DOI: 10.1212/wnl.0b013e318227b23f] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Vu T, Carrum G, Hutton G, Heslop HE, Brenner MK, Kamble R. Human herpesvirus-6 encephalitis following allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant 2007; 39:705-9. [PMID: 17401392 DOI: 10.1038/sj.bmt.1705666] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Immunosuppressive monoclonal antibodies directed to immune system cells may reduce rejection and graft versus host disease (GvHD) after allogeneic stem cell transplantation (SCT), but can increase the risks of viral infection. Here, we report human herpes virus-6 (HHV-6) encephalitis despite antiviral prophylaxis in 5 of 43 (11.6%) patients receiving alemtuzumab supported conditioning. Encephalitis occurred at 41-103 days (median 60 days) presenting with confusion in all patients, combined with amnesia (n=3) or seizures (n=2). MRI revealed non-specific white matter changes in two and a non-enhancing medial temporal lobe lesion in three patients. Cerebrospinal fluid (CSF) PCR amplification for HHV-6 was positive in all five patients, (600-2 25 000 (median 4700) copies/ml CSF), while analysis of peripheral blood revealed 100-22 500 (median 1200) viral copies/ml plasma. CSF protein was elevated in four patients, with minimal CSF pleocytosis. Intravenous foscarnet produced neurological improvement at 8-13 (median 11) days and negative plasma PCR at 30-66 (median 50) days. Four patients had complete neurological recovery, but one patient with persistent viral DNA in the CSF succumbed to progressive encephalopathy. Given this high incidence of HHV-6 and the possibility of successful outcome with prompt treatment, a high index of suspicion of this disorder is required in recipients of monoclonal antibody supported allografts.
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Affiliation(s)
- T Vu
- Center for Cell and Gene Therapy, Baylor College of Medicine and The Methodist Hospital, Houston, TX 77030, USA
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5
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Kayali U, Mindekem R, Hutton G, Ndoutamia AG, Zinsstag J. Cost-description of a pilot parenteral vaccination campaign against rabies in dogs in N'Djaména, Chad. Trop Med Int Health 2006; 11:1058-65. [PMID: 16827706 DOI: 10.1111/j.1365-3156.2006.01663.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In the discussion about policies and strategies for rabies prevention in developing countries, intervention costs arise as a major issue. In a pilot mass vaccination campaign against rabies in N'Djaména, Chad, 3000 dogs were vaccinated. We assessed vaccination coverage and cost, showing the cost per dog vaccinated for the public sector and for society. An extrapolation to city level calculated the approximate cost of vaccinating all 23 600 dogs in N'Djaména. In the pilot mass campaign with 3000 dogs the average cost per dog was 1.69 euro. to the public and the full societal cost was 2.45 euro. If all 23 600 dogs in N'Djaména were vaccinated, the average cost would fall to 1.16 euro to the public and 1.93 euro to society. Private sector costs account for 31% of the cost to vaccinate 3000 dogs, and 40% of the cost to vaccinate 23 600 dogs. Mass dog vaccination could be a comparatively cheap and ethical way to both control the disease in animals and prevent human cases and exposure, especially in developing countries. The cost-effectiveness of dog vaccination compared with treating victims of dog bites for prevention of human rabies should be further assessed and documented.
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Affiliation(s)
- U Kayali
- International Committee of the Red Cross, Geneva, Switzerland
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Abstract
This paper assesses the economic costs of AIDS at the household level in Chad, one of the poorest countries in the world. One hundred and ninety-three AIDS patients living in four different regions were found by case identification at hospital level and through community based organizations providing psycho-social relief. They were matched by age, sex, professional category and zone of residence with controls. Costs were evaluated through a standard questionnaire. Costs at household level attributable to AIDS up to death were US$836 per case. Costs related to productivity losses made up 28% of total costs. More than half of total costs (56%) were health care related expenditures and funeral costs contributed 16%. AIDS cases relied more often on borrowing and the selling of household assets than controls for treatment. Household expenditures of AIDS cases were much higher than control households mainly due to health related expenditure. The response of concerned families to HIV/AIDS implies high costs and for most households, especially in low-income settings, the consequences of AIDS are devastating. Innovative strategies on how best to assist households are thus requested and may include the strengthening of care and treatment services being offered to AIDS cases.
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Affiliation(s)
- K Wyss
- Swiss Centre for International Health Swiss Tropical Institute Basel, Switzerland.
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Villar J, Ba'aqeel H, Piaggio G, Lumbiganon P, Miguel Belizán J, Farnot U, Al-Mazrou Y, Carroli G, Pinol A, Donner A, Langer A, Nigenda G, Mugford M, Fox-Rushby J, Hutton G, Bergsjø P, Bakketeig L, Berendes H, Garcia J. WHO antenatal care randomised trial for the evaluation of a new model of routine antenatal care. Lancet 2001. [PMID: 11377642 DOI: 10.1016/s014-6736(00)04722-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
Abstract
BACKGROUND We undertook a multicentre randomised controlled trial that compared the standard model of antenatal care with a new model that emphasises actions known to be effective in improving maternal or neonatal outcomes and has fewer clinic visits. METHODS Clinics in Argentina, Cuba, Saudi Arabia, and Thailand were randomly allocated to provide either the new model (27 clinics) or the standard model currently in use (26 clinics). All women presenting for antenatal care at these clinics over an average of 18 months were enrolled. Women enrolled in clinics offering the new model were classified on the basis of history of obstetric and clinical conditions. Those who did not require further specific assessment or treatment were offered the basic component of the new model, and those deemed at higher risk received the usual care for their conditions; however, all were included in the new-model group for the analyses, which were by intention to treat. The primary outcomes were low birthweight (<2500 g), pre-eclampsia/eclampsia, severe postpartum anaemia (<90 g/L haemoglobin), and treated urinary-tract infection. There was an assessment of quality of care and an economic evaluation. FINDINGS Women attending clinics assigned the new model (n=12568) had a median of five visits compared with eight within the standard model (n=11958). More women in the new model than in the standard model were referred to higher levels of care (13.4% vs 7.3%), but rates of hospital admission, diagnosis, and length of stay were similar. The groups had similar rates of low birthweight (new model 7.68% vs standard model 7.14%; stratified rate difference 0.96 [95% CI -0.01 to 1.92]), postpartum anaemia (7.59% vs 8.67%; 0.32), and urinary-tract infection (5.95% vs 7.41%; -0.42 [-1.65 to 0.80]). For pre-eclampsia/eclampsia the rate was slightly higher in the new model (1.69% vs 1.38%; 0.21 [-0.25 to 0.67]). Adjustment by several confounding variables did not modify this pattern. There were negligible differences between groups for several secondary outcomes. Women and providers in both groups were, in general, satisfied with the care received, although some women assigned the new model expressed concern about the timing of visits. There was no cost increase, and in some settings the new model decreased cost. INTERPRETATIONS Provision of routine antenatal care by the new model seems not to affect maternal and perinatal outcomes. It could be implemented without major resistance from women and providers and may reduce cost.
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Affiliation(s)
- J Villar
- UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development, and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organisation, Geneva, Switzerland.
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8
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Villar J, Ba'aqeel H, Piaggio G, Lumbiganon P, Miguel Belizán J, Farnot U, Al-Mazrou Y, Carroli G, Pinol A, Donner A, Langer A, Nigenda G, Mugford M, Fox-Rushby J, Hutton G, Bergsjø P, Bakketeig L, Berendes H, Garcia J. WHO antenatal care randomised trial for the evaluation of a new model of routine antenatal care. Lancet 2001; 357:1551-64. [PMID: 11377642 DOI: 10.1016/s0140-6736(00)04722-x] [Citation(s) in RCA: 364] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND We undertook a multicentre randomised controlled trial that compared the standard model of antenatal care with a new model that emphasises actions known to be effective in improving maternal or neonatal outcomes and has fewer clinic visits. METHODS Clinics in Argentina, Cuba, Saudi Arabia, and Thailand were randomly allocated to provide either the new model (27 clinics) or the standard model currently in use (26 clinics). All women presenting for antenatal care at these clinics over an average of 18 months were enrolled. Women enrolled in clinics offering the new model were classified on the basis of history of obstetric and clinical conditions. Those who did not require further specific assessment or treatment were offered the basic component of the new model, and those deemed at higher risk received the usual care for their conditions; however, all were included in the new-model group for the analyses, which were by intention to treat. The primary outcomes were low birthweight (<2500 g), pre-eclampsia/eclampsia, severe postpartum anaemia (<90 g/L haemoglobin), and treated urinary-tract infection. There was an assessment of quality of care and an economic evaluation. FINDINGS Women attending clinics assigned the new model (n=12568) had a median of five visits compared with eight within the standard model (n=11958). More women in the new model than in the standard model were referred to higher levels of care (13.4% vs 7.3%), but rates of hospital admission, diagnosis, and length of stay were similar. The groups had similar rates of low birthweight (new model 7.68% vs standard model 7.14%; stratified rate difference 0.96 [95% CI -0.01 to 1.92]), postpartum anaemia (7.59% vs 8.67%; 0.32), and urinary-tract infection (5.95% vs 7.41%; -0.42 [-1.65 to 0.80]). For pre-eclampsia/eclampsia the rate was slightly higher in the new model (1.69% vs 1.38%; 0.21 [-0.25 to 0.67]). Adjustment by several confounding variables did not modify this pattern. There were negligible differences between groups for several secondary outcomes. Women and providers in both groups were, in general, satisfied with the care received, although some women assigned the new model expressed concern about the timing of visits. There was no cost increase, and in some settings the new model decreased cost. INTERPRETATIONS Provision of routine antenatal care by the new model seems not to affect maternal and perinatal outcomes. It could be implemented without major resistance from women and providers and may reduce cost.
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Affiliation(s)
- J Villar
- UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development, and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organisation, Geneva, Switzerland.
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Mugford M, Hutton G, Fox-Rushby J. Methods for economic evaluation alongside a multicentre trial in developing countries: a case study from the WHO Antenatal Care Randomised Controlled Trial. Paediatr Perinat Epidemiol 1998; 12 Suppl 2:75-97. [PMID: 9805724 DOI: 10.1046/j.1365-3016.1998.00008.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The WHO is testing a new rationalised programme of antenatal care in a multicentre randomised trial. The motivation for this trial arose from the current uncertainty about the effectiveness of different approaches to provision of routine antenatal care. Decision makers also lack information about the costs of providing routine antenatal care and the cost-effectiveness of one programme over another. Such information will be needed before the final choice of programme can be made. The WHO trial provides an ideal opportunity to estimate and compare the incremental costs and cost-effectiveness of the new programme in four countries (Argentina, Cuba, Saudi Arabia, Thailand). A separate economic component has been organised to measure the costs of antenatal care. Methods for cost identification and measurement, and methods for economic analysis in the context of an international study are based on current recommendations for the conduct of economic evaluations alongside trials. However, several aspects require further development. In particular, this includes defining standard methods for costing in different countries; measuring women's costs of access to care; and making comparisons across international settings. The economic evaluation will also inform similar multicentre international trials and investigate issues of generalisability beyond trial settings.
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Affiliation(s)
- M Mugford
- School of Health Policy and Practice, University of East Anglia, Norwich, UK
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Abstract
A numerical method for the generation of high-quality synthetic holograms has been developed. The method is based on the fast-Fourier-transform (FFT) algorithm. Recent results are presented here in the form of high-quality reconstructions together with our FFT holographic equations.
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Parlette N, Hutton G, Rosen M. Evaluative study of two versions of a seminar on mind-affecting drugs. HSMHA Health Rep 1971; 86:933-6. [PMID: 4109104 PMCID: PMC1937227] [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: 01/08/2023]
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12
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Hutton G. The Building Regulations: some suggestions. R Soc Health J 1968; 88:136-40. [PMID: 5656016 DOI: 10.1177/146642406808800310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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