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Jaques A, Hanrahan J, Islam S, Sofat R, Vella-Baldacchino M. Under the Weather: The Meteorological Effect on Orthopaedic Trauma in Hertfordshire. Cureus 2022; 14:e31146. [PMID: 36382318 PMCID: PMC9637454 DOI: 10.7759/cureus.31146] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2022] [Indexed: 11/07/2022] Open
Abstract
Background Effective and efficient use of operating theatres is essential to the smooth running of a trauma service. The paper aims to understand the effect of meteorological factors on the number of referrals and volume and nature of trauma operating cases within our local area. Methods Trauma data over two seasons were analysed in our database, a digital clinical platform that coordinates all admissions and trauma theatre activity. Data consisted of the number of referrals per day, patient age, mechanism of injury, and type of orthopaedic injury. Weather data were gathered from ‘Weather Underground’, https://www.wunderground.com/history, which records daily weather observations, located 12 miles away from our trauma unit. Results During the study period's last two seasons, 1160 consultations were analysed and 779 required operative intervention. The neck of femur fractures and ankle trauma were the two most common causes of trauma, accounting for 27% and 15%, respectively. The neck of femur fracture pathologies were not significantly correlated with any meteorological factor studied. On the contrary, ankle trauma was the only injury significantly correlating with temperature (p < 0.03) and dew point (p < 0.04). The most common mechanism of trauma was a ground-level fall (n = 590) whilst the least common was a motor vehicle accident (n = 39). Analysing the effect of weather and its effect on the age group of presentation, temperature (p < 0.01), sunlight (p < 0.002), and dew point (p < 0.03) were all significantly correlated with trauma in patients aged younger than 21 years of age. Conclusion The weather has no effect on the neck of femur fractures, the most common trauma pathology treated in our department. In all seasons, allocated specific trauma lists for the latter should be arranged irrelevant of the weather conditions. A strong correlation was identified between ankle trauma and weather. We identified that Tuesdays and Fridays received the highest referral rate and peaked between the months of October-November. These data lay the groundwork for local clinical directors to shape the future on-call trauma service.
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Centorame A, Dumut C, Youssef M, Ondra M, Kianicka I, Shah J, Paun R, Ozdian T, Hanrahan J, Gusev E, Petrof B, Hajduch M, Pislariu R, De Sanctis J, Radzioch D. 657 Combinatory treatment of LAU-7b with triple therapy results in improved lung physiology and restored fatty acid and lipid levels. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)01347-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Clark D, Joannides A, Adeleye AO, Bajamal AH, Bashford T, Biluts H, Budohoski K, Ercole A, Fernández-Méndez R, Figaji A, Gupta DK, Härtl R, Iaccarino C, Khan T, Laeke T, Rubiano A, Shabani HK, Sichizya K, Tewari M, Tirsit A, Thu M, Tripathi M, Trivedi R, Devi BI, Servadei F, Menon D, Kolias A, Hutchinson P, Abdallah OI, Abdel-Lateef A, Abdifatah K, Abdullateef A, Abeygunaratne R, Aboellil M, Adam A, Adams R, Adeleye A, Adeolu A, Adji NK, Afianti N, Agarwal S, Aghadi IK, Aguilar PMM, Ahmad SR, Ahmed D, Ahmed N, Aizaz H, Aji YK, Alamri A, Alberto AJM, Alcocer LA, Alfaro LG, Al-Habib A, Alhourani A, Ali SMR, Alkherayf F, AlMenabbawy A, Alshareef A, Aminullah MAS, Amjad M, Amorim RLOD, Anbazhagan S, Andrade A, Antar W, Anyomih TT, Aoun S, Apriawan T, Armocida D, Arnold P, Arraez M, Assefa T, Asser A, Athiththan S, Attanayake D, Aung MM, Avi A, Ayala VEA, Azab M, Azam G, Azharuddin M, Badejo O, Badran M, Baig AA, Baig RA, Bajaj A, Baker P, Bala R, Balasa A, Balchin R, Balogun J, Ban VS, Bandi BKR, Bandyopadhyay S, Bank M, Barthelemy E, Bashir MT, Basso LS, Basu S, Batista A, Bauer M, Bavishi D, Beane A, Bejell S, Belachew A, Belli A, Belouaer A, Bendahane NEA, Benjamin O, Benslimane Y, Benyaiche C, Bernucci C, Berra LV, Bhebe A, Bimpis A, Blanaru D, Bonfim JC, Borba LAB, Borcek AO, Borotto E, Bouhuwaish AEM, Bourilhon F, Brachini G, Breedon J, Broger M, Brunetto GMF, Bruzzaniti P, Budohoska N, Burhan H, Calatroni ML, Camargo C, Cappai PF, Cardali SM, Castaño-Leon AM, Cederberg D, Celaya M, Cenzato M, Challa LM, Charest D, Chaurasia B, Chenna R, Cherian I, Ching'o JH, Chotai T, Choudhary A, Choudhary N, Choumin F, Cigic T, Ciro J, Conti C, Corrêa ACDS, Cossu G, Couto MP, Cruz A, D'Silva D, D'Aliberti GA, Dampha L, Daniel RT, Dapaah A, Darbar A, Dascalu G, Dauda HA, Davies O, Delgado-Babiano A, Dengl M, Despotovic M, Devi I, Dias C, Dirar M, Dissanayake M, Djimbaye H, Dockrell S, Dolachee A, Dolgopolova J, Dolgun M, Dow A, Drusiani D, Dugan A, Duong DT, Duong TK, Dziedzic T, Ebrahim A, El Fatemi N, El Helou AE, El Maaqili RE, El Mostarchid BE, El Ouahabi AE, Elbaroody M, El-Fiki A, El-Garci A, El-Ghandour NM, Elhadi M, Elleder V, Elrais S, El-shazly M, Elshenawy M, Elshitany H, El-Sobky O, Emhamed M, Enicker B, Erdogan O, Ertl S, Esene I, Espinosa OO, Fadalla T, Fadelalla M, Faleiro RM, Fatima N, Fawaz C, Fentaw A, Fernandez CE, Ferreira A, Ferri F, Figaji T, Filho ELB, Fin L, Fisher B, Fitra F, Flores AP, Florian IS, Fontana V, Ford L, Fountain D, Frade JMR, Fratto A, Freyschlag C, Gabin AS, Gallagher C, Ganau M, Gandia-Gonzalez ML, Garcia A, Garcia BH, Garusinghe S, Gebreegziabher B, Gelb A, George JS, Germanò AF, Ghetti I, Ghimire P, Giammarusti A, Gil JL, Gkolia P, Godebo Y, Gollapudi PR, Golubovic J, Gomes JF, Gonzales J, Gormley W, Gots A, Gribaudi GL, Griswold D, Gritti P, Grobler R, Gunawan R, Hailemichael B, Hakkou E, Haley M, Hamdan A, Hammed A, Hamouda W, Hamzah NA, Han NL, Hanalioglu S, Haniffa R, Hanko M, Hanrahan J, Hardcastle T, Hassani FD, Heidecke V, Helseth E, Hernández-Hernández MÁ, Hickman Z, Hoang LMC, Hollinger A, Horakova L, Hossain-Ibrahim K, Hou B, Hoz S, Hsu J, Hunn M, Hussain M, Iacopino G, Ideta MML, Iglesias I, Ilunga A, Imtiaz N, Islam R, Ivashchenko S, Izirouel K, Jabal MS, Jabal S, Jabang JN, Jamjoom A, Jan I, Jarju LBM, Javed S, Jelaca B, Jhawar SS, Jiang TT, Jimenez F, Jiris J, Jithoo R, Johnson W, Joseph M, Joshi R, Junttila E, Jusabani M, Kache SA, Kadali SP, Kalkmann GF, Kamboh U, Kandel H, Karakus AK, Kassa M, Katila A, Kato Y, Keba M, Kehoe K, Kertmen HH, Khafaji S, Khajanchi M, Khan M, Khan MM, Khan SD, Khizar A, Khriesh A, Kierońska S, Kisanga P, Kivevele B, Koczyk K, Koerling AL, Koffenberger D, Kõiv K, Kõiv L, Kolarovszki B, König M, Könü-Leblebicioglu D, Koppala SD, Korhonen T, Kostkiewicz B, Kostyra K, Kotakadira S, Kotha AR, Kottakki MNR, Krajcinovic N, Krakowiak M, Kramer A, Krishnamoorthy S, Kumar A, Kumar P, Kumar P, Kumarasinghe N, Kuncha G, Kutty RK, Laeke T, Lafta G, Lammy S, Lapolla P, Lardani J, Lasica N, Lastrucci G, Launey Y, Lavalle L, Lawrence T, Lazaro A, Lebed V, Leinonen V, Lemeri L, Levi L, Lim JY, Lim XY, Linares-Torres J, Lippa L, Lisboa L, Liu J, Liu Z, Lo WB, Lodin J, Loi F, Londono D, Lopez PAG, López CB, Lotbiniere-Bassett MD, Lulens R, Luna FH, Luoto T, M.V. VS, Mabovula N, MacAllister M, Macie AA, Maduri R, Mahfoud M, Mahmood A, Mahmoud F, Mahoney D, Makhlouf W, Malcolm G, Malomo A, Malomo T, Mani MK, Marçal TG, Marchello J, Marchesini N, Marhold F, Marklund N, Martín-Láez R, Mathaneswaran V, Mato-Mañas DJ, Maye H, McLean AL, McMahon C, Mediratta S, Mehboob M, Meneses A, Mentri N, Mersha H, Mesa AM, Meyer C, Millward C, Mimbir SA, Mingoli A, Mishra P, Mishra T, Misra B, Mittal S, Mohammed I, Moldovan I, Molefe M, Moles A, Moodley P, Morales MAN, Morgan L, Morillo GDC, Moustafa W, Moustakis N, Mrichi S, Munjal SS, Muntaka AJM, Naicker D, Nakashima PEH, Nandigama PK, Nash S, Negoi I, Negoita V, Neupane S, Nguyen MH, Niantiarno FH, Noble A, Nor MAM, Nowak B, Oancea A, O'Brien F, Okere O, Olaya S, Oliveira L, Oliveira LM, Omar F, Ononeme O, Opšenák R, Orlandini S, Osama A, Osei-Poku D, Osman H, Otero A, Ottenhausen M, Otzri S, Outani O, Owusu EA, Owusu-Agyemang K, Ozair A, Ozoner B, Paal E, Paiva MS, Paiva W, Pandey S, Pansini G, Pansini L, Pantel T, Pantelas N, Papadopoulos K, Papic V, Park K, Park N, Paschoal EHA, Paschoalino MCDO, Pathi R, Peethambaran A, Pereira TA, Perez IP, Pérez CJP, Periyasamy T, Peron S, Phillips M, Picazo SS, Pinar E, Pinggera D, Piper R, Pirakash P, Popadic B, Posti JP, Prabhakar RB, Pradeepan S, Prasad M, Prieto PC, Prince R, Prontera A, Provaznikova E, Quadros D, Quintero NJR, Qureshi M, Rabiel H, Rada G, Ragavan S, Rahman J, Ramadhan O, Ramaswamy P, Rashid S, Rathugamage J, Rätsep T, Rauhala M, Raza A, Reddycherla NR, Reen L, Refaat M, Regli L, Ren H, Ria A, Ribeiro TF, Ricci A, Richterová R, Ringel F, Robertson F, Rocha CMSC, Rogério JDS, Romano AA, Rothemeyer S, Rousseau GRG, Roza R, Rueda KDF, Ruiz R, Rundgren M, Rzeplinski R, S.Chandran R, Sadayandi RA, Sage W, Sagerer ANJ, Sakar M, Salami M, Sale D, Saleh Y, Sánchez-Viguera C, Sandila S, Sanli AM, Santi L, Santoro A, Santos AKDD, Santos SCD, Sanz B, Sapkota S, Sasidharan G, Sasillo I, Satoskar R, Sayar AC, Sayee V, Scheichel F, Schiavo FL, Schupper A, Schwarz A, Scott T, Seeberger E, Segundo CNC, Seidu AS, Selfa A, Selmi NH, Selvarajah C, Şengel N, Seule M, Severo L, Shah P, Shahzad M, Shangase T, Sharma M, Shiban E, Shimber E, Shokunbi T, Siddiqui K, Sieg E, Siegemund M, Sikder SR, Silva ACV, Silva A, Silva PA, Singh D, Skadden C, Skola J, Skouteli E, Słoniewski P, Smith B, Solanki G, Solla DF, Solla D, Sonmez O, Sönmez M, Soon WC, Stefini R, Stienen MN, Stoica B, Stovell M, Suarez MN, Sulaiman A, Suliman M, Sulistyanto A, Sulubulut Ş, Sungailaite S, Surbeck M, Szmuda T, Taddei G, Tadele A, Taher ASA, Takala R, Talari KM, Tan BH, Tariciotti L, Tarmohamed M, Taroua O, Tatti E, Tenovuo O, Tetri S, Thakkar P, Thango N, Thatikonda SK, Thesleff T, Thomé C, Thornton O, Timmons S, Timoteo EE, Tingate C, Tliba S, Tolias C, Toman E, Torres I, Torres L, Touissi Y, Touray M, Tropeano MP, Tsermoulas G, Tsitsipanis C, Turkoglu ME, Uçkun ÖM, Ullman J, Ungureanu G, Urasa S, Ur-Rehman O, Uysal M, Vakis A, Valeinis E, Valluru V, Vannoy D, Vargas P, Varotsis P, Varshney R, Vats A, Veljanoski D, Venturini S, Verma A, Villa C, Villa G, Villar S, Villard E, Viruez A, Voglis S, Vulekovic P, Wadanamby S, Wagner K, Walshe R, Walter J, Waseem M, Whitworth T, Wijeyekoon R, Williams A, Wilson M, Win S, Winarso AWW, Ximenes AWP, Yadav A, Yadav D, Yakoub KM, Yalcinkaya A, Yan G, Yaqoob E, Yepes C, Yılmaz AN, Yishak B, Yousuf FB, Zahari MZ, Zakaria H, Zambonin D, Zavatto L, Zebian B, Zeitlberger AM, Zhang F, Zheng F, Ziga M. Casemix, management, and mortality of patients rreseceiving emergency neurosurgery for traumatic brain injury in the Global Neurotrauma Outcomes Study: a prospective observational cohort study. Lancet Neurol 2022; 21:438-449. [PMID: 35305318 DOI: 10.1016/s1474-4422(22)00037-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 12/19/2021] [Accepted: 01/17/2022] [Indexed: 12/17/2022]
Abstract
BACKGROUND Traumatic brain injury (TBI) is increasingly recognised as being responsible for a substantial proportion of the global burden of disease. Neurosurgical interventions are an important aspect of care for patients with TBI, but there is little epidemiological data available on this patient population. We aimed to characterise differences in casemix, management, and mortality of patients receiving emergency neurosurgery for TBI across different levels of human development. METHODS We did a prospective observational cohort study of consecutive patients with TBI undergoing emergency neurosurgery, in a convenience sample of hospitals identified by open invitation, through international and regional scientific societies and meetings, individual contacts, and social media. Patients receiving emergency neurosurgery for TBI in each hospital's 30-day study period were all eligible for inclusion, with the exception of patients undergoing insertion of an intracranial pressure monitor only, ventriculostomy placement only, or a procedure for drainage of a chronic subdural haematoma. The primary outcome was mortality at 14 days postoperatively (or last point of observation if the patient was discharged before this time point). Countries were stratified according to their Human Development Index (HDI)-a composite of life expectancy, education, and income measures-into very high HDI, high HDI, medium HDI, and low HDI tiers. Mixed effects logistic regression was used to examine the effect of HDI on mortality while accounting for and quantifying between-hospital and between-country variation. FINDINGS Our study included 1635 records from 159 hospitals in 57 countries, collected between Nov 1, 2018, and Jan 31, 2020. 328 (20%) records were from countries in the very high HDI tier, 539 (33%) from countries in the high HDI tier, 614 (38%) from countries in the medium HDI tier, and 154 (9%) from countries in the low HDI tier. The median age was 35 years (IQR 24-51), with the oldest patients in the very high HDI tier (median 54 years, IQR 34-69) and the youngest in the low HDI tier (median 28 years, IQR 20-38). The most common procedures were elevation of a depressed skull fracture in the low HDI tier (69 [45%]), evacuation of a supratentorial extradural haematoma in the medium HDI tier (189 [31%]) and high HDI tier (173 [32%]), and evacuation of a supratentorial acute subdural haematoma in the very high HDI tier (155 [47%]). Median time from injury to surgery was 13 h (IQR 6-32). Overall mortality was 18% (299 of 1635). After adjustment for casemix, the odds of mortality were greater in the medium HDI tier (odds ratio [OR] 2·84, 95% CI 1·55-5·2) and high HDI tier (2·26, 1·23-4·15), but not the low HDI tier (1·66, 0·61-4·46), relative to the very high HDI tier. There was significant between-hospital variation in mortality (median OR 2·04, 95% CI 1·17-2·49). INTERPRETATION Patients receiving emergency neurosurgery for TBI differed considerably in their admission characteristics and management across human development settings. Level of human development was associated with mortality. Substantial opportunities to improve care globally were identified, including reducing delays to surgery. Between-hospital variation in mortality suggests changes at an institutional level could influence outcome and comparative effectiveness research could identify best practices. FUNDING National Institute for Health Research Global Health Research Group.
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Affiliation(s)
- David Clark
- National Institute of Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK; Neurosurgery Division, University Teaching Hospital, Lusaka, Zambia.
| | - Alexis Joannides
- National Institute of Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
| | - Amos Olufemi Adeleye
- Department of Surgery, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Abdul Hafid Bajamal
- Department of Neurosurgery, Dr Soetomo Hospital, Surabaya, Jawa Timur, Indonesia
| | - Tom Bashford
- National Institute of Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
| | - Hagos Biluts
- Neurosurgery Unit, Department of Surgery, College of Health Sciences, Addis Ababa University, Addis Ababa, Oromia, Ethiopia
| | - Karol Budohoski
- National Institute of Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
| | - Ari Ercole
- National Institute of Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
| | - Rocío Fernández-Méndez
- National Institute of Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
| | - Anthony Figaji
- Division of Neurosurgery and Neurosciences Institute, University of Cape Town, Rondebosch, Western Cape, South Africa
| | - Deepak Kumar Gupta
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Roger Härtl
- Department of Neurological Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Corrado Iaccarino
- Neurosurgery Division, University Hospital of Parma, Parma, Emilia-Romagna, Italy
| | - Tariq Khan
- Department of Neurosurgery, North West General Hospital & Research Center, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Tsegazeab Laeke
- Neurosurgery Unit, Department of Surgery, College of Health Sciences, Addis Ababa University, Addis Ababa, Oromia, Ethiopia
| | - Andrés Rubiano
- Department of Neurosurgery, Universidad El Bosque, Bogota, Colombia
| | - Hamisi K Shabani
- Department of Neurological Surgery, Muhimbili Orthopaedic Institute and Muhimbili University College of Allied Health Sciences, Dar es Salaam, Tanzania
| | | | - Manoj Tewari
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research Chandigarh, Chandigarh, India
| | - Abenezer Tirsit
- Neurosurgery Unit, Department of Surgery, College of Health Sciences, Addis Ababa University, Addis Ababa, Oromia, Ethiopia
| | - Myat Thu
- Department of Neurosurgery, Yangon General Hospital, Yangon, Yangon Region, Myanmar
| | - Manjul Tripathi
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research Chandigarh, Chandigarh, India
| | - Rikin Trivedi
- National Institute of Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
| | - Bhagavatula Indira Devi
- Department of Neurosurgery, National Institute of Mental Health & Neurosciences, Bangalore, India
| | - Franco Servadei
- Humanitas Clinical and Research Center-IRCCS and Department of Biomedical Sciences, Humanitas University, Milano, Italy
| | - David Menon
- National Institute of Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
| | - Angelos Kolias
- National Institute of Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
| | - Peter Hutchinson
- National Institute of Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
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Centorame A, Ondra M, Dumut D, Shah J, Liao J, Hanrahan J, Sanctis JD, Hajduch M, Radzioch D. 627: Investigation of pharmacological correction of F508del-CFTR protein during chronic infections. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)02050-6] [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: 11/29/2022]
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Ondra M, Centorame A, Dumut D, Liao J, Hanrahan J, De Sanctis J, Hajduch M, Radzioch D. 678: Design and validation of luminescent HTS tool for discovery and optimization of novel combination of CFTR correctors and modifiers. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)02101-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Abstract
Background The paper aims to understand the effect of meteorological factors on the number of referrals and volume of trauma operating cases within our local area. Method Trauma data was analysed in our database: (eTrauma), a digital clinical platform that co-ordinates all admissions and: trauma theatre activity. Data consisted of number of referrals per day, patient: age, mechanism of injury and type of orthopaedic injury. Weather data was: gathered from a local weather station which: records daily weather observations. Results 1160 consultations wereanalysed, 779 required an operative intervention. Neck of femur fractures: and ankle trauma were the two most common cause of trauma, accounting for 27% and 15% respectively. Neck of femur fracture pathology were not significantly correlated with any meteorological factor studied. On the contrary, ankle trauma were the only injuries significantly correlating with temperature (p < 0.03) and due point (p < 0.04). Conclusion Weather has no effect on neck of femur fractures, the most common trauma pathology treated in our department. In all seasons allocated specific trauma lists for the latter should be arranged irrelevant of the weather conditions. We identified the days receiving highest referral rate, using this data to shape the future on call trauma service.
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Goonasekera C, Jones H, Lawrence R, Hanrahan J, Iyer P, Nijhawan A. Exploring the utility of neuro-monitoring in neurosurgery: The users' perspective in a single center. Saudi J Anaesth 2021; 15:7-13. [PMID: 33824636 PMCID: PMC8016046 DOI: 10.4103/sja.sja_862_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 09/01/2020] [Accepted: 09/13/2020] [Indexed: 11/05/2022] Open
Abstract
Background: The purpose of intraoperative neuro-monitoring (IONM) is to minimize injury to eloquent neural structures and optimize tumor resection. Method: We explored the utility of IONM using a qualitative approach in a single center. Eight experienced users of its use in spinal and cranial surgery in adults and children were the informants. Using a constant comparative method, the findings were collated by thematic analysis. Results: The user perspective is that of caution to minimize adverse effects whilst empowering the need for formal training to enhance its efficacy. The process of IONM needs standardization as practices vary amongst users. Most users expressed limited trust on its current capabilities but hoped for its advancement to achieve higher sensitivity and specificity. None were however prepared to abandon its use. Conclusion: IONM needs optimization. Its utility depends on user vigilance, multi-disciplinary validation, and individual expertise. This study draws out key issues from the user perspective that need to be addressed in order to enhance the utility of IONM.
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Affiliation(s)
- Chulananda Goonasekera
- Department of Anesthetics, King's College Hospital NHS Trust, Denmark Hill, London SE59RS, UK
| | - Holly Jones
- King's College London Faculty of Life Sciences and Medicine, School of Medicine, London, UK
| | - Rebekah Lawrence
- Department of Anesthetics, King's College Hospital NHS Trust, Denmark Hill, London SE59RS, UK
| | - John Hanrahan
- Department of Anesthetics, King's College Hospital NHS Trust, Denmark Hill, London SE59RS, UK
| | - Priyanka Iyer
- Department of Anesthetics, King's College Hospital NHS Trust, Denmark Hill, London SE59RS, UK
| | - Aditi Nijhawan
- Department of Anesthetics, King's College Hospital NHS Trust, Denmark Hill, London SE59RS, UK
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Burford C, Hanrahan J, Ansaripour A, Smith B, Sysum K, Rajwani K, Huett M, Vergani F, Zebian B. In Reply to the Letter to the Editor Regarding "Factors Influencing Medical Student Interest in a Career in Neurosurgery". World Neurosurg 2019; 126:693. [PMID: 31546328 DOI: 10.1016/j.wneu.2019.03.150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 03/04/2019] [Indexed: 11/20/2022]
Affiliation(s)
- Charlotte Burford
- Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom.
| | - John Hanrahan
- Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Ali Ansaripour
- Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Brandon Smith
- Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Katie Sysum
- Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Kapil Rajwani
- Department of Neurosurgery, King's College Hospital, London, United Kingdom
| | - Marian Huett
- Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Francesco Vergani
- Department of Neurosurgery, King's College Hospital, London, United Kingdom
| | - Bassel Zebian
- Department of Neurosurgery, King's College Hospital, London, United Kingdom
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Akhbari M, Hanrahan J, Ansaripour A, Burford C, Asnani KS, Boardman TM, Divecha YA, Pak HL, Sanghvi H, Sekhon PP, Smith BG, Stables IL, Vickers P, Zebian B. Proceedings of the KCL International Neurosurgical Conference 2018. Neurosurgery 2019; 84:E269-E274. [DOI: 10.1093/neuros/nyz001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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10
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Kennedy RR, French RA, Vesto G, Hanrahan J, Page J. The effect of fresh gas flow during induction of anaesthesia on sevoflurane usage: a quality improvement study. Anaesthesia 2019; 74:875-882. [DOI: 10.1111/anae.14669] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2019] [Indexed: 11/28/2022]
Affiliation(s)
- R. R. Kennedy
- University of Otago: Christchurch ChristchurchNew Zealand
| | - R. A. French
- Canterbury District Health Board ChristchurchNew Zealand
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Matloob SA, Hanrahan J, McKenna GS, Uff C, Paraskevopoulos D. P14 Management of traumatic skull base fractures and their complications – a seven-year experience. J Neurol Neurosurg Psychiatry 2019. [DOI: 10.1136/jnnp-2019-abn.92] [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] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
ObjectivesWe aim to present our experience of managing traumatic base of skull fractures and our outcomes.DesignRetrospective case note review.SubjectsAll patients in our trauma database with radiographic evidence of a skull base fracture from January 2010 to June 2017.MethodsSkull base fractures were classified according to their anatomical location. Evidence of vascular injury, CSF leak or cranial nerve injury were recorded. The mechanism of injury, length of follow up, interventions and outcomes were documented.Results872 cases had a skull base fracture diagnosed by head CT scan, of which 760 had sufficient radiological and clinic data to analyse. 79.4% of the cohort were male, with a mean age of 43 years. Median length of stay was 8 days and median length of follow up was 114 days. 40.1% were lost to follow up. The mortality rate was 14.9%. Injuries predominantly affected the middle cranial fossa. Vascular injury was the commonest complication (n=87), followed by CSF leak (n=38). 28 patients sustained injury to the facial nerve. Complications were managed conservatively in most cases.ConclusionsThere is little reported literature on the long term outcomes of patients who sustain CSF leak, vascular injury or cranial nerve deficit following a base of skull fracture. In our experience, many of these patients are lost to follow up and indeed, the nature of this study is limited by it’s retrospective nature. Further prospective work must be done in this patient group to better understand the history of these patients.
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Narbad V, Lavrador JP, Elhag A, Acharya S, Hanrahan J, Vergani F, Bhangoo R, Ashkan K. WP1-18 Risk factors and patterns of recurrence of low grade glioma: a systematic review. J Neurol Neurosurg Psychiatry 2019. [DOI: 10.1136/jnnp-2019-abn.19] [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] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
ObjectivesTo review the risk factors and patterns of progression/recurrence of low grade glioma (LGG).DesignSystematic review of the published literature.SubjectsInclusion criteria were peer reviewed publications of cohort studies of recurrent/progressive LGG. Studies of wider populations were included if relevant LGG data could be analysed separately.MethodsMedline and Cochrane databases were searched using MeSH and non-MeSH terms, including ‘glioma’, ‘astrocytoma’, ‘oligoastrocytoma’, ‘diffuse glioma’, ‘oligodendroglioma’, ‘low grade’ and ‘disease recurrence’ by two independent reviewers.ResultsOverall, 917 studies were screened, of which 57 studies met the inclusion criteria. The most frequently described risk factor for recurrent LGG was suboptimal extent of resection (EOR) of the initial tumour (in 20 studies); recurrence was also associated with the patient’s age (2), tumour location (4), neurological status (3), tumour volume (6), bihemispherical tumour (3) and astrocytic histology (6). IDH mutation was associated with recurrence in 1 out of 3 studies, but TP53 mutation (2 of 4) and MGMT methylation status (4) were not. Malignant transformation was associated with TP53 mutations (3), IDH mutation (1) and EOR (1). Favourable progression free survival (PFS) and/or overall survival (OS) were associated with greater EOR (16), oligodendroglioma histology (2 of 4), initial KPS (3) and the use of adjuvant therapies (9 of 14). IDH mutation was associated with improved PFS and OS (3 of 4). TP53 mutation improved PFS in 1 of 3 studies. MGMT methylation and 1 p/19q codeletion may predict treatment response but their effects on survival are unclear.ConclusionsAstrocytoma histology, IDH and TP53 mutation statuses and surgical treatment (EOR) are essential in determining the time to recurrence or progression in LGG.
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Ansaripour A, Burford C, Hanrahan J, Korkor A, Ashkan K, Zebian B. FP1-6 Factors influencing clinician’s participation in neurosurgical research – a multicentre cross-sectional study. J Neurol Psychiatry 2019. [DOI: 10.1136/jnnp-2019-abn.72] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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
ObjectivesResearch remains a foundation in advancing the field of neurosurgery. We explore attitudes and perceived barriers to conducting research in neurosurgery globally.DesignA 29-item questionnaire, consisting of multiple-choice questions, Likert scales and short answers.SubjectsClinicians at various stages of the Neurosurgical career.MethodsThe questionnaire was distributed through the Society of British Neurological Surgeons (SBNS) and European Association of Neurosurgical Societies (EANS).ResultsA total of 324 responses from 29 countries consisted of Clinical Fellows (n=26), Junior Trainees (n=48), Senior Trainees (n=46), Sub-specialty Fellows (n=18), Consultants (n=128) and Professors of Neurosurgery (n=58). Whilst 83% of participants believe research is a crucial aspect of a neurosurgeons’ career, only a third (33%) believed that neurosurgery as a speciality fosters a culture that promotes research. The top three perceived barriers to conducting research were lack of time (78%), insufficient access to funding (58%) and lack of mentorship (49%). Despite these, more than 87% of participants are interested in formal academic roles with 58% willing to interrupt clinical training to pursue research opportunities. The region of clinical practice had no correlation with respondents’ research output or their perceptions towards research barriers.ConclusionsThis study identified important barriers to research, elucidating which, allows the neurosurgical community to improve integration of research into clinical practice.
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Sideris M, Emin EI, Abdullah Z, Hanrahan J, Stefatou KM, Sevas V, Emin E, Hollingworth T, Odejinmi F, Papagrigoriadis S, Vimplis S, Willmott F. The Role of KRAS in Endometrial Cancer: A Mini-Review. Anticancer Res 2019; 39:533-539. [PMID: 30711927 DOI: 10.21873/anticanres.13145] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [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: 12/30/2018] [Revised: 01/16/2019] [Accepted: 01/22/2019] [Indexed: 11/10/2022]
Abstract
Endometrial cancer (EC) is the most common cancer of the female genital tract, resulting annually in 76,000 related deaths worldwide. EC originates either from oestrogen-related proliferative endometrium (type I, endometrioid), or from atrophic endometrium (type II, non-endometrioid). Each type of EC is characterized by different molecular profile alterations. The Kirsten rat sarcoma viral oncogene homolog (KRAS) gene encodes a signalling protein which moderates response to various extracellular signals via down-regulation of the mitogen-activated protein kinase (MAPK) or phosphoinositide-3-kinase/v-akt murine thymoma viral oncogene (PI3K/AKT) pathways. This article reviews the role of KRAS in predicting transition from hyperplastic endometrium to early-stage well-differentiated EC, as well as further invasive proliferation of the tumour to advanced-stage disease. KRAS seems to be directly associated with type I EC, and most studies support its early involvement in carcinogenesis. Current evidence correlates KRAS mutations with increased cell proliferation and apoptosis, as well as up-regulation of endometrial cell oestrogen receptors. Tumours positive for KRAS mutation can harbour hypermethylation-related changes in genome expression, and this can be the cause of concurrent loss of DNA repair proteins. Despite some evidence that KRAS mutation status affects cancer progression, a consensus is yet to be reached. Based on the available evidence, we suggest that screening for KRAS mutations in patients with hyperplastic endometrium or early-stage type I EC, may provide important information for prognosis stratification, and further provision of personalised treatment options.
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Affiliation(s)
- Michail Sideris
- Women's Health Research Unit, Queen Mary University of London, London, U.K.
| | | | - Ziena Abdullah
- Department of Obstetrics and Gynaecology, Whipps Cross University Hospital, Barts Health NHS Trust, London, U.K
| | - John Hanrahan
- Faculty of Life Sciences, King's College London, London, U.K
| | | | | | - Ece Emin
- School of Biosciences, Kingston University London, London, U.K
| | - Tony Hollingworth
- Department of Obstetrics and Gynaecology, Whipps Cross University Hospital, Barts Health NHS Trust, London, U.K
| | - Funlayo Odejinmi
- Department of Obstetrics and Gynaecology, Whipps Cross University Hospital, Barts Health NHS Trust, London, U.K
| | | | - Sotiris Vimplis
- Department of Obstetrics and Gynaecology, Whipps Cross University Hospital, Barts Health NHS Trust, London, U.K
| | - Fredric Willmott
- Department of Obstetrics and Gynaecology, Whipps Cross University Hospital, Barts Health NHS Trust, London, U.K
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Nicolaides M, Cardillo L, Theodoulou I, Hanrahan J, Tsoulfas G, Athanasiou T, Papalois A, Sideris M. Developing a novel framework for non-technical skills learning strategies for undergraduates: A systematic review. Ann Med Surg (Lond) 2018; 36:29-40. [PMID: 30370054 PMCID: PMC6199815 DOI: 10.1016/j.amsu.2018.10.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 05/30/2018] [Revised: 09/18/2018] [Accepted: 10/02/2018] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES There is substantial lack of guidance when it comes to the implementation of non-technical skills (NTS) in undergraduate medical education. This review aimed to identify and critically evaluate published literature on learning strategies for NTS in undergraduate medical education and to derive a training framework targeted towards standardizing future training interventions. METHODS A systematic review of the MEDLINE database was performed using a prospective protocol following PRISMA guidelines. Studies evaluating undergraduate medical students exposed to NTS interventions, which measured subjective or objective outcomes in selected attributes, were included. RESULTS Initial systematic search yielded a total of 5079 articles, out of which 68 fulfilled the inclusion criteria. A total of 24 NTS were identified, with communication skills being the most commonly reported skill evaluated (n = 37). A variety of educational tools were used (n = 32), noteworthy being the use of simulated patients. Great heterogeneity was also observed in measured outcomes and methods of assessment. A 'triad of outcomes' in NTS training was devised (knowledge, skill performance and attitude towards skills) and used for classification of all reported outcomes. Extracted data were used to design a non-technical skill training framework. CONCLUSIONS The existing literature describes a plethora of NTS interventions in undergraduate medical education, with varied outcomes and assessments. We hereby propose the 'NTS Training Framework', in an attempt to coordinate future research and catalyze the identification of an ideal NTS course structure to form tomorrow's physicians.
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Affiliation(s)
- Marios Nicolaides
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark St, Whitechapel, London, E1 2AT, United Kingdom
| | - Luca Cardillo
- Faculty of Life Sciences and Medicine, King's College London, Great Maze Pond, London, SE1 9RT, United Kingdom
| | - Iakovos Theodoulou
- Faculty of Life Sciences and Medicine, King's College London, Great Maze Pond, London, SE1 9RT, United Kingdom
| | - John Hanrahan
- Faculty of Life Sciences and Medicine, King's College London, Great Maze Pond, London, SE1 9RT, United Kingdom
| | - Georgios Tsoulfas
- Department of Surgery, Aristotle University of Thessaloniki, Thessaloniki, 54124, Greece
| | - Thanos Athanasiou
- Imperial College London, Faculty of Medicine, Department of Surgery and Cancer, South Kensington Campus, London, SW7 2AZ, UK
| | - Apostolos Papalois
- Experimental Research Centre ELPEN, 95 Marathonos Avenue, 19009, Pikermi, Greece
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Hanrahan J, Burford C, Ansaripour A, Smith B, Sysum K, Rajwani KM, Huett M, Zebian B. Undergraduate neurosurgical conferences - what role do they play? Br J Neurosurg 2018; 33:76-78. [PMID: 30451002 DOI: 10.1080/02688697.2018.1527288] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Undergraduate student conferences provide networking opportunities for students interested in exploring a speciality. The ability to meet with like-minded students, engage with senior clinicians and experience the practical side of a speciality are valuable in shaping the career trajectory of undergraduates. We report our experience of developing a national undergraduate neurosurgery conference - a combined project between the medical students of King's College London School of Medicine and the neurosurgery department at King's College Hospital NHS Foundation Trust. DESIGN Evaluation of conference design and student feedback. METHODS The conference was organised by medical students with support from a neurosurgical unit. Senior clinicians and trainees helped design practical workshops and a focused programme. Questionnaires were distributed before and after the conference to assess the quality of content and impact of the conference on students. RESULTS Prior to the conference, 80.7% of respondents stated they were interested in a career in neurosurgery. After the conference the figure rose to 88.9%. The percentage of students who felt they understood what a career in neurosurgery involves increased from 38.6% to 92.1% of respondents. 39.0% of participants had no neurosurgery exposure prior to the conference. 91.9% of participants agreed or strongly agreed they would be more confident engaging with a neurosurgical department following the conference. All participants agreed (29.0%) or strongly agreed (71.0%) that they would recommend this conference to a colleague. CONCLUSIONS Student conferences are a valuable method of increasing exposure to a career in neurosurgery. They serve a great purpose in demystifying the specialty and guiding those with an interest through the steps required to enter and progress.
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Affiliation(s)
- John Hanrahan
- a Faculty of Life Sciences and Medicine , King's College London , London , United Kingdom
| | - Charlotte Burford
- a Faculty of Life Sciences and Medicine , King's College London , London , United Kingdom
| | - Ali Ansaripour
- a Faculty of Life Sciences and Medicine , King's College London , London , United Kingdom
| | - Brandon Smith
- a Faculty of Life Sciences and Medicine , King's College London , London , United Kingdom
| | - Katie Sysum
- a Faculty of Life Sciences and Medicine , King's College London , London , United Kingdom
| | - Kapil Mohan Rajwani
- b Department of Neurosurgery , King's College Hospital NHS Foundation Trust , London , United Kingdom
| | - Marian Huett
- a Faculty of Life Sciences and Medicine , King's College London , London , United Kingdom
| | - Bassel Zebian
- b Department of Neurosurgery , King's College Hospital NHS Foundation Trust , London , United Kingdom
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Burford C, Hanrahan J, Ansaripour A, Smith B, Sysum K, Rajwani K, Huett M, Vergani F, Zebian B. Factors Influencing Medical Student Interest in a Career in Neurosurgery. World Neurosurg 2018; 122:e367-e374. [PMID: 30336295 DOI: 10.1016/j.wneu.2018.10.056] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 10/05/2018] [Accepted: 10/07/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Exposure to neurosurgery at the undergraduate level is an important factor in determining future interest in and applications to the specialty. Given the high competition for training posts, this exposure is also becoming an almost essential addition to an applicant's portfolio. We organized a neurosurgical conference aimed at undergraduate medical students. The aim of this study was to determine factors attracting and deterring students from the specialty before and after the conference. METHODS Responses were collected prospectively from students attending a national neurosurgical conference organized by medical students with support from the local neurosurgical unit. Questionnaires were distributed before and after the conference examining students' perceptions of a career in neurosurgery using free-text responses. RESULTS Poor lifestyle or work-life balance was the most important factor deterring students from a career in the specialty both before (29.7%) and after (60%) the conference. The most important factor attracting students to the specialty before the conference was the practical (surgical approaches and techniques) aspect (21.9%). After the conference, the most important attracting factor was the rewarding nature of the specialty (18.9%). CONCLUSIONS The most notable factor deterring students from a career in neurosurgery was work-life balance. Other deterring factors were much less prevalent following the conference. Understanding how exposure to neurosurgery influences students' perceptions is important for developing future initiatives to prevent misconceptions and allow students to make informed choices as well as encourage the right candidates to apply.
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Affiliation(s)
- Charlotte Burford
- Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom.
| | - John Hanrahan
- Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Ali Ansaripour
- Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Brandon Smith
- Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Katie Sysum
- Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Kapil Rajwani
- Department of Neurosurgery, King's College Hospital, London, United Kingdom
| | - Marian Huett
- Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Francesco Vergani
- Department of Neurosurgery, King's College Hospital, London, United Kingdom
| | - Bassel Zebian
- Department of Neurosurgery, King's College Hospital, London, United Kingdom
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Burford C, Guni A, Rajan K, Hanrahan J, Armitage M, Driscoll A, Southey C, Moon JH, Pandit AS. Designing undergraduate neurosurgical e-learning: medical students’ perspective. Br J Neurosurg 2018; 33:79. [DOI: 10.1080/02688697.2018.1520806] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- C. Burford
- GKT School of Medical Education, King’s College London, London, UK
| | - A. Guni
- GKT School of Medical Education, King’s College London, London, UK
| | - K. Rajan
- GKT School of Medical Education, King’s College London, London, UK
| | - J. Hanrahan
- GKT School of Medical Education, King’s College London, London, UK
| | - M. Armitage
- GKT School of Medical Education, King’s College London, London, UK
| | - A. Driscoll
- GKT School of Medical Education, King’s College London, London, UK
| | - C. Southey
- GKT School of Medical Education, King’s College London, London, UK
| | - J. H. Moon
- GKT School of Medical Education, King’s College London, London, UK
| | - A. S. Pandit
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
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Hanrahan J, Theodoulou I, Staikoglou N, Tsagkaraki IM, Pasha T, Plastiras A, Tsoulfas G, Velmahos GC, Sideris M, Papalois A. Evidence-Based Approach to Harmonize Core Performance Outcomes in Undergraduate Simulation-Based Education: The Integrated Generation 4 Model. J Am Coll Surg 2018. [DOI: 10.1016/j.jamcollsurg.2018.08.553] [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: 10/28/2022]
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20
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Nicolaides M, Cardillo L, Theodoulou I, Hanrahan J, Tsoulfas G, Athanasiou T, Papalois A, Sideris M. Standardizing Undergraduate Non-Technical Skills Learning Strategies and Outcomes: A Systematic Review. J Am Coll Surg 2018. [DOI: 10.1016/j.jamcollsurg.2018.08.571] [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: 10/28/2022]
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21
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Hanrahan J, Theodoulou I, Pasha T, Nicolaides M, Stagias G, Psychalakis N, Velmahos GC, Tsoulfas G, Sideris M, Papalois A. Optimizing Engagement of Medical Students in Surgical Education Research: The Medical Education Research Group Training Network. J Am Coll Surg 2018. [DOI: 10.1016/j.jamcollsurg.2018.07.491] [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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Hanrahan J, Sideris M, Pasha T, Tsitsopoulos PP, Theodoulou I, Nicolaides M, Georgopoulou EM, Kombogiorgas D, Bimpis A, Papalois A. Hands train the brain-what is the role of hand tremor and anxiety in undergraduate microsurgical skills? Acta Neurochir (Wien) 2018; 160:1673-1679. [PMID: 29968093 PMCID: PMC6105223 DOI: 10.1007/s00701-018-3609-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 05/21/2018] [Accepted: 06/25/2018] [Indexed: 01/28/2023]
Abstract
Introduction Physiological hand tremor occurs naturally, due to oscillations of the upper extremities. Tremor can be exacerbated by stress and anxiety, interfering with fine motor tasks and potentially impact on surgical performance, particularly in microsurgery. We investigated the link between tremor, anxiety and performance in a neurosurgical module as part of an international surgical course. Methods Essential Skills in the Management of Surgical Cases (ESMSC) course recruits medical students from European Union (EU) medical schools. Students are asked to suture the dura mater in an ex vivo swine model, of which the first suture completed was assessed. Questionnaires were distributed before and after the module, eliciting tremor risk factors, self-perception of tremor and anxiety. Johnson O’Connor dexterity pad was used to objectively measure dexterity. Direct Observation of Procedural Skills (DOPS) was used to assess skills-based performance. Anxiety was assessed using the Westside Test Anxiety Scale (WTAS). Tremor was evaluated by four qualified neurosurgeons. Results Forty delegates participated in the study. Overall performance decreased with greater subjective perception of anxiety (p = 0.032, rho = − 0.392). Although increasing scores for tremor at rest and overall WTAS score were associated with decreased performance, this was not statistically significant (p > 0.05). Tremor at rest did not affect dexterity (p = 0.876, rho = − 0.027). Conclusions Physiological tremor did not affect student performance and microsurgical dexterity in a simulation-based environment. Self-perception of anxiety affected performance in this module, suggesting that more confident students perform better in a simulated neurosurgical setting.
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Affiliation(s)
- John Hanrahan
- Faculty of Life Sciences and Medicine, King's College London, Strand, London, WC2R 2LS, UK.
| | - Michail Sideris
- Women's Health Research Unit, Queen Mary University of London, Mile End Rd, London, E1 4NS, UK
| | - Terouz Pasha
- Faculty of Life Sciences and Medicine, King's College London, Strand, London, WC2R 2LS, UK
| | - Parmenion P Tsitsopoulos
- Section of Neurosurgery, Department of Neuroscience, Uppsala University, 752 36, Uppsala, Sweden
| | - Iakovos Theodoulou
- Faculty of Life Sciences and Medicine, King's College London, Strand, London, WC2R 2LS, UK
| | - Marios Nicolaides
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Mile End Rd, London, E1 4NS, UK
| | | | | | - Alexios Bimpis
- Department of Neurosurgery, General Hospital of Tripoli, Erythrou Stavrou str., 22100, Tripoli, Greece
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Hanrahan J, Sideris M, Tsitsopoulos PP, Bimpis A, Pasha T, Whitfield PC, Papalois AE. Increasing motivation and engagement in neurosurgery for medical students through practical simulation-based learning. Ann Med Surg (Lond) 2018; 34:75-79. [PMID: 30271592 PMCID: PMC6160393 DOI: 10.1016/j.amsu.2018.08.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 04/15/2018] [Revised: 07/03/2018] [Accepted: 08/12/2018] [Indexed: 11/02/2022] Open
Abstract
Background Simulation-based learning (SBL) is an essential adjunct to modern surgical education. Our study aimed to evaluate the educational benefit and motivational impact of a pilot practical neurosurgical module. Materials and methods 38 clinical medical students from several EU Medical Schools attended an international surgical course focused on teaching and learning basic surgical skills. We designed a pilot neurosurgical workshop instructing students to insert an intracranial pressure bolt using an ex vivo pig model. Each delegate was assessed by two consultant neurosurgeons using a validated assessment tool. Structured questionnaires were distributed on completion of the module. Results Delegate performance increased (p < 0.001) with no difference in performance improvement across year of study (p = 0.676) or medical school (p = 0.647). All delegates perceived this workshop as a potential addition to their education (median 5/5, IQR = 0), and indicated that the course provided motivational value towards a neurosurgical career (median 4/5, IQR = 1), with no difference seen between year of study or medical school (p > 0.05). Conclusion Our pilot neurosurgical workshop demonstrated the educational value of practical SBL learning for motivating students towards a surgical career. Homogeneous views across year of study and medical school underline the value of developing a unified strategy to develop and standardise undergraduate surgical teaching with a practical focus.
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Affiliation(s)
- John Hanrahan
- Faculty of Life Sciences and Medicine, King's College London, Great Maze Pond, London, SE1 9RT, United Kingdom
| | - Michail Sideris
- Women's Health Research Unit, Queen Mary University of London, United Kingdom, Mile End Rd, London, E1 4NS, United Kingdom
| | - Parmenion P Tsitsopoulos
- Section of Neurosurgery, Department of Neuroscience, Uppsala University, Sweden, 751 05, Uppsala, Sweden
| | - Alexios Bimpis
- Department of Neurosurgery, General Hospital of Tripoli, Greece, Erythrou Stavrou Odos, Tripoli, 22100, Greece
| | - Terouz Pasha
- Faculty of Life Sciences and Medicine, King's College London, Great Maze Pond, London, SE1 9RT, United Kingdom
| | - Peter C Whitfield
- Southwest Neurosurgical Centre, Plymouth Hospitals NHS Trust, Plymouth, PL6 8DH, UK
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Zebian B, Kalyal N, Burford C, Hanrahan J, Ansaripour A, Al-Faiadh W. Letter to the Editor. Endoscopic ultrasonic aspirator for the removal of intraventricular tumors. J Neurosurg Pediatr 2018; 22:220-221. [PMID: 29799352 DOI: 10.3171/2018.1.peds1811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Burford C, Kalyal N, Hanrahan J, Ansaripour A, Al-Faiadh W, Oviedova A, Ghimire P, Bleil C, Zebian B. NSRG-26. ENDOSCOPIC RESECTION OF INTRAVENTRICULAR LESIONS USING AN ENDOSCOPIC ULTRASONIC ASPIRATOR. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy059.548] [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: 11/12/2022] Open
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26
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Sideris M, Hanrahan J, Staikoglou N, Pantelidis P, Pidgeon C, Psychalakis N, Andersen N, Pittaras T, Athanasiou T, Tsoulfas G, Papalois A. Optimizing engagement of undergraduate students in medical education research: The eMERG training network. Ann Med Surg (Lond) 2018; 31:6-10. [PMID: 29922460 PMCID: PMC6004769 DOI: 10.1016/j.amsu.2018.05.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 03/11/2018] [Revised: 05/16/2018] [Accepted: 05/23/2018] [Indexed: 02/08/2023] Open
Abstract
Background The practice of evidence-based medicine and critical appraisal are essential for the modern doctor. Early engagement of medical students in research methodology is considered as a rising need for most medical school curricula; however, few peer-reviewed initiatives have been reported so far. We developed a Medical Education Research Group (eMERG) as part of a novel undergraduate surgical masterclass, which aimed to train undergraduate students on basic research methodology, as well as to motivate them to pursue a clinical and academic career in surgical specialties. Methods: eMERG consists of an international structured network of senior academics, consultant-level clinicians, senior and junior trainees who support undergraduate trainees. Students are selected from a competitive pool of applicants. Several small prospective studies in skills-based education, as well as systematic reviews on similar topics, have run under the umbrella of this framework, in the form of scholarship awards. Structured feedback questionnaires were distributed to evaluate the experience of the first three years. Results 12 students have participated in this pilot initiative. 11 manuscripts have been submitted for publication and 8 were accepted following peer-review in MEDLINE-indexed journals. Delegates perceived this experience as an excellent training opportunity which improved their research productivity. Delegates also stated engagement in research developed interest in the relevant surgical speciality, impacting their career aspirations. Conclusions eMERG is one of the first reported European educational research networks for undergraduates. Research outcomes and students' perceptions conclude that eMERG enhances engagement with research methodology and motivation towards a career in surgery. eMERG is a pilot international research training network where medical students receive support to conduct research in Medical Education. eMERG structure can serve as a novel model to convey research experience from one generation to another, and in the same time, motivate and aspire students to develop leadership skills. eMERG was developed in a financial crisis environment with promising research outputs and positive students' feedback.
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Affiliation(s)
- Michail Sideris
- esmsc Medical Education Research Group (eMERG Collaboration), Experimental Research Center ELPEN, Greece.,Queen Mary University of London, Yvonne Carter Building, London E1 2AB, United Kingdom
| | - John Hanrahan
- esmsc Medical Education Research Group (eMERG Collaboration), Experimental Research Center ELPEN, Greece.,King's College London, Faculty of Life Sciences and Medicine, Strand, London WC2R 2LS, United Kingdom
| | - Nikolaos Staikoglou
- esmsc Medical Education Research Group (eMERG Collaboration), Experimental Research Center ELPEN, Greece.,Aristotle University of Thessaloniki, Thessaloniki 541 24, Greece
| | - Panteleimon Pantelidis
- esmsc Medical Education Research Group (eMERG Collaboration), Experimental Research Center ELPEN, Greece.,Aristotle University of Thessaloniki, Thessaloniki 541 24, Greece
| | - Connie Pidgeon
- esmsc Medical Education Research Group (eMERG Collaboration), Experimental Research Center ELPEN, Greece.,Royal London Hospital, Bartshealth NHS Trust, United Kingdom
| | - Nikolaos Psychalakis
- esmsc Medical Education Research Group (eMERG Collaboration), Experimental Research Center ELPEN, Greece.,Experimental Research Centre ELPEN, Athens, Greece
| | - Nikolai Andersen
- esmsc Medical Education Research Group (eMERG Collaboration), Experimental Research Center ELPEN, Greece.,PPA-International Medical, Denmark
| | - Theodore Pittaras
- esmsc Medical Education Research Group (eMERG Collaboration), Experimental Research Center ELPEN, Greece.,National and Kapodistrian University of Athens, Athens, 115 27, Greece
| | - Thanos Athanasiou
- esmsc Medical Education Research Group (eMERG Collaboration), Experimental Research Center ELPEN, Greece.,Imperial College London, London SW7 2AZ, United Kingdom
| | - Georgios Tsoulfas
- esmsc Medical Education Research Group (eMERG Collaboration), Experimental Research Center ELPEN, Greece.,Aristotle University of Thessaloniki, Thessaloniki 541 24, Greece
| | - Apostolos Papalois
- esmsc Medical Education Research Group (eMERG Collaboration), Experimental Research Center ELPEN, Greece.,Experimental Research Centre ELPEN, Athens, Greece
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Sideris M, Donaldson AN, Hanrahan J, Grunwald M, Papagrigoriadis S. Radiotherapy May Offer a Recurrence and Survival Benefit in Rectal Cancers Treated Surgically with Transanal Endoscopic Microsurgery: A Systematic Review and Meta-analysis. Anticancer Res 2018; 38:1879-1895. [PMID: 29599303 DOI: 10.21873/anticanres.12425] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 01/12/2018] [Revised: 02/02/2018] [Accepted: 02/06/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Several studies report outcomes of Transanal Endoscopic Microsurgery (TEMS) surgery in combination with radiotherapy, however the combination of those treatments is provided mostly on an adhoc individual basis and the role of radiotherapy remains unclear. The aim of this study was to identify the effect of neo-adjuvant or adjuvant radiotherapy in the oncological outcomes of rectal cancer treated surgically with TEMS. MATERIALS AND METHODS We performed a systematic review of the literature on MEDLINE and Pubmed databases. Data were extracted by two independent reviewers and meta-analyzed using an inverse variance heterogeneity model to calculate overall (pooled) effect sizes for survival or recurrence of disease against neo+/-adjuvant treatment. RESULTS A total of 48 studies were included in the qualitative meta-analysis which included 3,285 patients with rectal cancer. The overall survival odds ratio (OR), was 9.39 (95% CI=6.1-14.4) with a Cochran's Q variable of 151.7 on 47 degrees of freedom (d.f.) (p=0.000). Recurrence-free OR was 8.7 (95%CI=6.58-11.44) with a Cochran's Q variable of Q=145.2 on 44 d.f. (p=0.000). Studies which contained more than 10% of pT3 tumours, and provided neo+/-adjuvant treatment in more than 35% of cases, were associated with survival benefit, as demonstrated by an overall odds of survival of 32.2 (95%CI=16.3-63.5, p=0.001, Q=8.4, p=0.21). Studies that contained more than 10% of pT3 tumours and provided neo+/-adjuvant treatment in more than 20% of the cases had an overall effect size of recurrence-free odds of 20.23 (95%CI=13.84-29.57, p=0.000, Q=2.18, p=0.54). CONCLUSION There seems to be a benefit from radiotherapy on overall survival and recurrence-free odds, which is more apparent in cohorts with more than 10% of pT3 tumours. Our results suggest that neo-adjuvant or adjuvant radiotherapy should be considered for inclusion in formal treatment protocols for rectal cancers treated with TEMS as they offer a recurrence and survival benefit.
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Affiliation(s)
- Michail Sideris
- Women's Health Research Unit, Queen Mary University of London, London, U.K
| | - Ana Nora Donaldson
- Department of Applied Mathematics and Statistics, Stony Brook University, New York, NY, U.S.A
| | - John Hanrahan
- Faculty of Life Sciences and Medicine, King's College London, London, U.K
| | - Matthew Grunwald
- Department of Internal Medicine, SUNY Downstate Medical Centre, New York, U.S.A
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Sideris M, Hanrahan J, Tsoulfas G, Theodoulou I, Dhaif F, Papalois V, Papagrigoriadis S, Velmahos G, Turner P, Papalois A. Developing a novel international undergraduate surgical masterclass during a financial crisis: our 4-year experience. Postgrad Med J 2018. [PMID: 29519810 DOI: 10.1136/postgradmedj-2017-135479] [Citation(s) in RCA: 12] [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] [Indexed: 02/05/2023]
Abstract
BACKGROUND Essential Skills in the Management of Surgical Cases (ESMSC) is a novel 3-day international undergraduate surgical masterclass. Its current curriculum (Cores integrated for Research-Ci4R) is built on a tetracore, multiclustered architecture combining high-fidelity and low-fidelity simulation-based learning (SBL), with applied and basic science case-based workshops, and non-technical skills modules. We aimed to report our experience in setting up ESMSC during the global financial crisis. METHODS We report the evolution of our curriculum's methodology and summarised the research outcomes related to the objective performance improvement of delegates, the educational environment of the course and the use of mixed-fidelity SBL. Feedback from the last three series of the course was prospectively collected and analysed using univariate statistics on IBM SPSS V.23. RESULTS 311 medical students across the European Union (EU) were selected from a competitive pool of 1280 applicants during seven series of the course between 2014 and 2017. During this period, curriculum 14 s evolved to the final Ci4R version, which integrates a tetracore structure combining 32 stations of in vivo, ex vivo and dry lab SBL with small group teaching workshops. Ci4R was positively perceived across different educational background students (p>0.05 for any comparison). CONCLUSIONS ESMSC is considered an innovative and effective multidisciplinary teaching model by delegates, where it improves delegates objective performance in basic surgical skills. Our experience demonstrates provision of high-quality and free surgical education during a financial crisis, which evolved through a dynamic feedback mechanism. The prospective recording and subsequent analysis of curriculum evolution provides a blueprint to direct development of effective surgical education courses that can be adapted to local needs.
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Affiliation(s)
- Michail Sideris
- Women's Health Research Unit, Queen Mary University of London, London, UK
| | - John Hanrahan
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Georgios Tsoulfas
- Department of Surgery, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Iakovos Theodoulou
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Fatema Dhaif
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | | | - George Velmahos
- Department of Surgery, Division of Trauma, Emergency Surgery, and Surgical Critical Care, Harvard Medical School, Boston, Maryland, USA
| | - Patricia Turner
- American College of Surgeons, Chicago, Illinois, USA.,Department of Surgery, Section of General Surgery, The University of Chicago, Chicago, Illinois, USA
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Hanrahan J, Matloob S, Paraskevopoulos D. Management of Skull Base Fractures in a UK Major Trauma Centre. Skull Base Surg 2018. [DOI: 10.1055/s-0038-1633624] [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: 10/28/2022]
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Hanrahan J, Frantzias J, Lavrador JP, Bodi I, Zebian B. Posterior fossa arachnoid cyst causing torticollis and gastro-oesophageal reflux in an infant. Childs Nerv Syst 2018; 34:2519-2523. [PMID: 30062591 PMCID: PMC6224018 DOI: 10.1007/s00381-018-3917-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 07/18/2018] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Arachnoid cysts (ACs) account for a small proportion of all intracranial lesions. They are often incidental but can become symptomatic and even cause a threat to life. Symptoms are usually due to direct compression of neural elements and/or raised intracranial pressure. CASE REPORT We report the case of an infant with an enlarging posterior fossa arachnoid cyst (PFAC) causing torticollis and gastro-oesophageal reflux (GOR), the combination of which had been previously unreported in this context. Endoscopic fenestration and cyst decompression were followed by complete resolution of the symptoms. We discuss the possible mechanisms of torticollis and GOR in this context.
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Affiliation(s)
- John Hanrahan
- Faculty of Life Sciences and Medicine, King's College London, London, UK.
| | | | | | - Istvan Bodi
- Department of Clinical Neuropathology, King’s College Hospital, London, UK
| | - Bassel Zebian
- Department of Neurosurgery, King’s College Hospital, London, UK
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Dhaif F, Paparoidamis G, Sideris M, Hanrahan J, Georgopoulou EM, Tsagkaraki I, Staikoglou N, Saeed F, Michail T, Tzavelas A, Kenanidis E, Potoupnis M, Tsiridis E, Papalois A. The Role of Anxiety in Simulation-Based Dexterity and Overall Performance: Does It Really Matter? J INVEST SURG 2017; 32:164-169. [PMID: 29286827 DOI: 10.1080/08941939.2017.1387624] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 10/18/2022]
Abstract
BACKGROUND Essential Skills in the Management of Surgical Cases (ESMSC) is an international undergraduate surgical masterclass which combines ex vivo, dry lab and high fidelity in vivo simulation-based learning (SBL). It consists of 32 stations of skills-based learning, including open reduction internal fixation (ORIF) of fractures. Current literature suggests early involvement in skills-based learning at the undergraduate level is vital. AIMS To compare students' dexterity and skills-based performance with demographic and educational background parameters. METHODS 112 medical students from European Union countries including the United Kingdom, Germany, Greece, Cyprus, Germany, and Bulgaria were selected from a competitive pool of candidates to attend the course. Students undertook ORIF in an ex vivo swine model, and in a simulated fracture on a bamboo rod. Skills-based performance was assessed by two consultant surgeons with validated direct observation of procedural skills (DOPS) forms. Anxiety was self-assessed using the Westside Anxiety Scale prior to the ORIF stations. Dexterity was measured with the O'Connor tweezer dexterity test. RESULTS Female students had significantly higher dexterity scores (median difference 7, p =.003). Right-handed students achieved higher dexterity than left-handed students (median difference 7, p =.043). There was no difference in students' performance across different medical schools, and across year groups (p <.05 for any correlation). Self-reported anxiety was not correlated with high fidelity skills-based performance (r = 0.032, p =.74). CONCLUSION Anxiety does not seem to play a significant role in Simulation Skills-Based learning. Undergraduate surgical curricula should incorporate SBL-based modules to enhance practical skills learning and motivate future orthopedic surgeons.
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Affiliation(s)
| | | | | | | | | | | | | | - Ferha Saeed
- e Newham University Hospital, Bartshealth NHS Trust , London , UK
| | | | | | | | | | | | - Apostolos Papalois
- e Newham University Hospital, Bartshealth NHS Trust , London , UK.,f Experimental Research Centre ELPEN , Athens , Greece
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Hanrahan J, Burford C, Zebian B. Combined Endoscopic Third Ventriculostomy and Endoscopic Biopsy of Pineal Region Lesions: A Review of Diagnostic Yield and Complications. Int J Surg 2017. [DOI: 10.1016/j.ijsu.2017.08.328] [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: 10/18/2022]
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Hanrahan J, Wakefield J, Wilson P, Mihova M, Chickering J, Ruff D, Hall M, Milne T, Currie M, Profy A. Abstract P493: Multiple-ascending-dose Study of IW-1973, a Soluble Guanylate Cyclase Stimulator. Hypertension 2017. [DOI: 10.1161/hyp.70.suppl_1.p493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Soluble guanylate cyclase (sGC), an enzyme that catalyzes the formation of cyclic guanosine monophosphate (cGMP) in response to nitric oxide (NO) binding, is a key mediator of local blood flow, inflammation, and fibrosis. IW-1973 is an orally available sGC stimulator that enhances NOsGC-cGMP signaling and reduces blood pressure (BP) in animal models of hypertension, both alone and in combination with other antihypertensive agents.
Methods:
A Phase 1b placebo-controlled, randomized, multiple-ascending-dose study was conducted to assess safety, tolerability, pharmacokinetics (PK) and pharmacodynamics (BP, heart rate, platelet function, and plasma biomarkers) of IW-1973 in healthy subjects. Four successive cohorts of 11 subjects each (8 active and 3 placebo) were enrolled. Subjects received a starting dose once daily (QD) for 14 days followed by an up-titrated QD dose for 7 days.
Results:
IW-1973 doses ranging from 15 to 40 mg were tolerated. There were no serious adverse events (AEs), severe AEs, or discontinuations due to AEs. Among the 32 subjects who received IW-1973, the most common AEs (which occurred mainly at doses ≥30 mg) were headache (15 subjects), dizziness/postural dizziness (6) and orthostatic hypotension/BP decreased (4). AEs tended to resolve with continued dosing. The AE profile of higher doses was not clearly improved by up-titration from a lower starting dose. PK was dose proportional, both for C
max
and AUC, with a T
max
of 2-4 hours and an effective half-life of 24-37 hours. After 14 days of treatment, least squares mean change from baseline in 24-h ambulatory systolic BP (±SE) was -0.85±1.32 (placebo), -7.29±1.62 (15 mg), -3.27±1.61 (20 mg), -6.75±1.62 (30 mg), and -5.23±1.61 mmHg (≤40 mg, ≤0.5 mg/kg). After 21 days, the change from baseline was -4.81±1.19 (placebo), -8.21±1.46 (15 to 30 mg), -6.29±1.45 (20 to 40 mg), -9.05±1.56 (30 to 40 mg), and -6.58±1.45 mmHg (≤40 to ≥40 mg). IW-1973 produced a dose-related increase in plasma cGMP indicating target engagement. There was no clear effect of IW-1973 administration on platelet function as assessed by the PFA-100
®
system.
Conclusion:
Further clinical investigation of IW-1973 is ongoing or planned in multiple indications, including resistant hypertension.
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Blackman G, Dalrymple A, Hanrahan J, Peachey G, Curtis V. 24 Is it feasible to use routine clinical records to investigate biomarkers in schizophrenia and related disorders. J Neurol Neurosurg Psychiatry 2017. [DOI: 10.1136/jnnp-2017-bnpa.48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Burford C, Hanrahan J, Pasha T, Jung J, Zebian B. How does the publication fate of abstracts presented at the Society of British Neurological Surgeons meetings differ five years on? Br J Neurosurg 2017; 31:291-292. [DOI: 10.1080/02688697.2017.1319462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Charlotte Burford
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - John Hanrahan
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Terouz Pasha
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Josephine Jung
- Department of Neurosurgery, King's College London, London, UK
| | - Bassel Zebian
- Department of Neurosurgery, King's College London, London, UK
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Hanrahan J, Profy AT, Lavins BJ, Ruff D, Poirier G, Wakefield J, Wilson P, Hall M, Currie MG. FIRST-IN-HUMAN SINGLE-ASCENDING-DOSE STUDY OF IW-1973, A NEW SOLUBLE GUANYLATE CYCLASE STIMULATOR. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)31285-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Holz O, Biller H, Mueller M, Kane K, Rosano M, Hanrahan J, Hava DL, Hohlfeld JM. Efficacy and safety of inhaled calcium lactate PUR118 in the ozone challenge model--a clinical trial. BMC Pharmacol Toxicol 2015; 16:21. [PMID: 26265479 PMCID: PMC4533952 DOI: 10.1186/s40360-015-0021-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 07/24/2015] [Indexed: 12/03/2022] Open
Abstract
Background The ozone challenge model can be used to assess the efficacy of anti-inflammatory compounds in early phases of clinical drug development. PUR118, a calcium salt based formulation engineered in the iSPERSETM dry powder delivery technology, is a novel anti-inflammatory drug for COPD. Here we evaluated the efficacy and safety of three doses of PUR118 in attenuating ozone-induced airway inflammation in healthy volunteers. Methods In a single-blind, phase 1B proof of concept study, 24 subjects were enrolled to sequentially receive three doses of PUR118 (5.5 mg, n = 18; 11.0 mg, n = 18; 2.8 mg, n = 16). Each dose was inhaled 3 times (1, 13, 25 h, preceded by 2 puffs salbutamol) before the ozone exposure (250 ppb, 3 h intermittent exercise). Sputum was induced 3 h after the end of exposure. Results Sputum neutrophils, sputum CD14+ cells, as well as concentrations of IL1B, IL6, IL8, MMP9, and TNFA in sputum supernatant significantly increased after ozone exposure (n = 24). The percentage of sputum neutrophils (n = 12 who completed all treatments) did not change following treatment with different doses of PUR118. The high dose treatment group (n = 16) showed a decrease in the percentage and number of sputum macrophages (p ≤ 0.05) as well as a decrease in blood neutrophils (p = 0.04), and an increase in blood CD14 + cells (p = 0.04) compared to baseline. All dosages of PUR118 were safe and well tolerated. Conclusion Ozone challenge resulted in the expected and significant increase of sputum inflammatory parameters. Treatment with multiple rising doses of PUR118 was safe and three applications within 25 h prior to the ozone challenge had small effects on ozone-induced airway inflammation. Trial registration ClinicalTrials.gov: NCT01690949. Registered 12 September 2012. Electronic supplementary material The online version of this article (doi:10.1186/s40360-015-0021-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Olaf Holz
- Department of Clinical Airway Research, Fraunhofer Institute for Toxicology and Experimental Medicine, 30625, Hannover, Germany. .,Member of the German Center for Lung Research (BREATH), Hannover, Germany.
| | - H Biller
- Department of Clinical Airway Research, Fraunhofer Institute for Toxicology and Experimental Medicine, 30625, Hannover, Germany
| | - M Mueller
- Department of Clinical Airway Research, Fraunhofer Institute for Toxicology and Experimental Medicine, 30625, Hannover, Germany
| | - K Kane
- Pulmatrix, Inc., Lexington, MA, USA
| | - M Rosano
- Pulmatrix, Inc., Lexington, MA, USA
| | | | - D L Hava
- Pulmatrix, Inc., Lexington, MA, USA
| | - J M Hohlfeld
- Department of Clinical Airway Research, Fraunhofer Institute for Toxicology and Experimental Medicine, 30625, Hannover, Germany.,Member of the German Center for Lung Research (BREATH), Hannover, Germany
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Nair P, Denis S, Cancelliere L, Radford K, Efthimiadis A, Rosano M, Hanrahan J. The effects of an epithelial barrier protective cationic aerosol on allergen-induced airway inflammation in asthma: a randomized, placebo-controlled clinical trial. Clin Exp Allergy 2015; 44:1200-3. [PMID: 25132278 DOI: 10.1111/cea.12383] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 10/11/2014] [Indexed: 11/30/2022]
Abstract
Inhaled cationic airway lining modulator (iCALM) is a cationic aerosol therapy comprised of 1.29% calcium chloride dissolved in 0.9% isotonic saline that enhances the biophysical barrier function of the airway lining fluid and primes the host defense response. It's ability to attenuate bronchitis caused by inhaled particles was investigated using an allergen-inhalation model in a proof-of-concept study. In a randomized, double-blind, placebo-controlled cross-over trial of 6 mild atopic steroid-naïve asthmatic subjects, 3 doses of iCALM were well tolerated and they attenuated allergen-induced increase in sputum eosinophils, and levels of IL-5, MCP-1 and eotaxin. This study provides an opportunity to investigate the role of enhancing epithelial barrier to decrease airway inflammation provoked by inhaled particles in a variety of airway diseases.
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Affiliation(s)
- P Nair
- Firestone Institute for Respiratory Health, St Joseph's Healthcare & Department of Medicine, McMaster University, Hamilton, ON, Canada
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Mohamed BM, Verma NK, Prina-Mello A, Williams Y, Davies AM, Bakos G, Tormey L, Edwards C, Hanrahan J, Salvati A, Lynch I, Dawson K, Kelleher D, Volkov Y. Activation of stress-related signalling pathway in human cells upon SiO2 nanoparticles exposure as an early indicator of cytotoxicity. J Nanobiotechnology 2011; 9:29. [PMID: 21801388 PMCID: PMC3164618 DOI: 10.1186/1477-3155-9-29] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2011] [Accepted: 07/29/2011] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Nanomaterials such as SiO2 nanoparticles (SiO2NP) are finding increasing applications in the biomedical and biotechnological fields such as disease diagnostics, imaging, drug delivery, food, cosmetics and biosensors development. Thus, a mechanistic and systematic evaluation of the potential biological and toxic effects of SiO2NP becomes crucial in order to assess their complete safe applicability limits. RESULTS In this study, human monocytic leukemia cell line THP-1 and human alveolar epithelial cell line A549 were exposed to a range of amorphous SiO2NP of various sizes and concentrations (0.01, 0.1 and 0.5 mg/ml). Key biological indicators of cellular functions including cell population density, cellular morphology, membrane permeability, lysosomal mass/pH and activation of transcription factor-2 (ATF-2) were evaluated utilizing quantitative high content screening (HCS) approach and biochemical techniques. Despite the use of extremely high nanoparticle concentrations, our findings showed a low degree of cytotoxicity within the panel of SiO2NP investigated. However, at these concentrations, we observed the onset of stress-related cellular response induced by SiO2NP. Interestingly, cells exposed to alumina-coated SiO2NP showed low level, and in some cases complete absence, of stress response and this was consistent up to the highest dose of 0.5 mg/ml. CONCLUSIONS The present study demonstrates and highlights the importance of subtle biological changes downstream of primary membrane and endocytosis-associated phenomena resulting from high dose SiO2NP exposure. Increased activation of transcription factors, such as ATF-2, was quantitatively assessed as a function of i) human cell line specific stress-response, ii) SiO2NP size and iii) concentration. Despite the low level of cytotoxicity detected for the amorphous SiO2NP investigated, these findings prompt an in-depth focus for future SiO2NP-cell/tissue investigations based on the combined analysis of more subtle signalling pathways associated with accumulation mechanisms, which is essential for establishing the bio-safety of existing and new nanomaterials.
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Affiliation(s)
- Bashir Mustafa Mohamed
- Department of clinical medicine, Institute of Molecular Medicine, Trinity College Dublin, Dublin8, Ireland
| | - Navin Kumar Verma
- Department of clinical medicine, Institute of Molecular Medicine, Trinity College Dublin, Dublin8, Ireland
| | - Adriele Prina-Mello
- Department of clinical medicine, Institute of Molecular Medicine, Trinity College Dublin, Dublin8, Ireland
- Centre for Research on Adaptive Nanostructures and Nanodevices (CRANN), Naughton Institute, Trinity College Dublin, Dublin2, Ireland
| | - Yvonne Williams
- Department of clinical medicine, Institute of Molecular Medicine, Trinity College Dublin, Dublin8, Ireland
| | - Anthony M Davies
- Department of clinical medicine, Institute of Molecular Medicine, Trinity College Dublin, Dublin8, Ireland
| | - Gabor Bakos
- Department of clinical medicine, Institute of Molecular Medicine, Trinity College Dublin, Dublin8, Ireland
| | - Laragh Tormey
- Department of clinical medicine, Institute of Molecular Medicine, Trinity College Dublin, Dublin8, Ireland
| | - Connla Edwards
- Department of clinical medicine, Institute of Molecular Medicine, Trinity College Dublin, Dublin8, Ireland
| | - John Hanrahan
- Glantreo Ltd., Environmental Research Institute (ERI) Building, Lee Road, Cork, Ireland
| | - Anna Salvati
- Centre for BioNano Interactions, School of Chemistry and Chemical Biology, University College Dublin, Dublin4, Ireland
| | - Iseult Lynch
- Centre for BioNano Interactions, School of Chemistry and Chemical Biology, University College Dublin, Dublin4, Ireland
| | - Kenneth Dawson
- Centre for BioNano Interactions, School of Chemistry and Chemical Biology, University College Dublin, Dublin4, Ireland
| | - Dermot Kelleher
- Department of clinical medicine, Institute of Molecular Medicine, Trinity College Dublin, Dublin8, Ireland
| | - Yuri Volkov
- Department of clinical medicine, Institute of Molecular Medicine, Trinity College Dublin, Dublin8, Ireland
- Centre for Research on Adaptive Nanostructures and Nanodevices (CRANN), Naughton Institute, Trinity College Dublin, Dublin2, Ireland
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AbuArish A, Balghi H, Arane T, Wiseman P, Hanrahan J. CFTR Modulates Orai1 Dynamics. Biophys J 2011. [DOI: 10.1016/j.bpj.2010.12.2756] [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: 11/24/2022] Open
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Nair P, Hanrahan J, Hargreave FE. Clinical equivalence testing of inhaled bronchodilators. Pol Arch Med Wewn 2009; 119:731-735. [PMID: 19920798] [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: 05/28/2023]
Abstract
There are no standardized methods to demonstrate in-vivo bioequivalence of inhaled bronchodilators. The most practical method of showing therapeutic equivalence in vivo is by estimating their relative potencies (RP) in clinical efficacy studies. The RP of bronchodilators may be estimated by comparing either their bronchodilator or bronchoprotective properties. Bronchodilator studies are easier to perform and may better model the physiologic effect of many agents, including inhaled beta-agonists. However, it may be difficult to demonstrate steep dose-response for these outcomes, except in cumulative study designs. Bioequivalence trials may be especially challenging when involving pressurized metered-dose inhalers, as a single actuation - the lowest feasible dose to include in the evaluation, may already produce bronchodilation that is at or near the plateau of the dose-response curve. Protection against bronchoconstriction induced by a direct inhaled stimulus like methacholine or histamine affords a reliable and practical method of comparing inhaled bronchodilators and estimating their RP. Inhalational bronchoprovocation testing allows for easier repeatability and quantitation of the stimulus necessary to produce a predetermined degree of bronchoconstriction, and the degree of protection afforded by the bronchoprotection agent. RP studies using adequate methodology are necessary to compare long-acting bronchodilators and both short- and long-acting bronchodilators in patients who are also on inhaled corticosteroids.
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Affiliation(s)
- Parameswaran Nair
- Firestone Institute for Respiratory Health, St. Joseph's Healthcare and Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
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Sciurba F, Cote C, Sciarappa K, Goodwin E, Curry L, Hanrahan J. ASSESSMENT OF PATIENT SYMPTOM AND FUNCTIONING OUTCOMES AMONG COPD SUBJECTS TREATED WITH ARFORMOTEROL OR RACEMIC FORMOTEROL: A 6-MONTH CLINICAL TRIAL. Chest 2008. [DOI: 10.1378/chest.134.4_meetingabstracts.p16002] [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: 11/01/2022] Open
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Hanania N, Donohue J, Nelson H, Sciarappa K, Goodwin E, Baumgartner R, Hanrahan J. LONG-TERM SAFETY AND EFFICACY OF NEBULIZED ARFORMOTEROL IN SUBJECTS WITH COPD. Chest 2008. [DOI: 10.1378/chest.134.4_meetingabstracts.p106001] [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: 11/01/2022] Open
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Tashkin D, Donohue J, Mahler D, Huang H, Schaefer K, Hanrahan J, Andrews W. EFFECT OF ARFORMOTEROL TWICE DAILY, TIOTROPIUM ONCE DAILY, AND THEIR COMBINATION IN SUBJECTS WITH COPD. Chest 2008. [DOI: 10.1378/chest.134.4_meetingabstracts.p104003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Cote CG, Celli B, Sciarappa K, Baumgartner R, Hanrahan J. BASELINE BODE CORRELATES WITH BDI AND BASELINE SGRG, BUT NOT WITH CHANGES IN THESE MEASURES FOLLOWING LABA TREATMENT IN TWO 12-WEEK DOUBLE-BLIND TRIALS. Chest 2007. [DOI: 10.1378/chest.132.4_meetingabstracts.521] [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: 11/01/2022] Open
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Kharidia J, Fogarty C, LaForce C, Maier G, Hsu R, Dunnington S, Curry L, Baumgartner R, Hanrahan J. AN OPEN LABEL STUDY OF ARFORMOTEROL INHALATION SOLUTION AND RACEMIC FORMOTEROL DRY POWDER INHALER IN SUBJECTS WITH COPD. Chest 2007. [DOI: 10.1378/chest.132.4_meetingabstracts.533b] [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: 11/01/2022] Open
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Bauer A, McGlynn P, Bovet LL, Mims P, Curry L, Hanrahan J. THE INFLUENCE OF BREATHING PATTERN DURING NEBULIZATION ON THE EMITTED DOSE OF ARFORMOTEROL. Chest 2007. [DOI: 10.1378/chest.132.4_meetingabstracts.616b] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Jencson A, Hanrahan J, Amin S. A systematic approach to an infection control program's risk assessment. Am J Infect Control 2005. [DOI: 10.1016/j.ajic.2005.04.084] [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: 11/15/2022]
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