1
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Trammell AW, Ball J. Accumulating Evidence for Reduced-Dose Thrombolysis in Acute Pulmonary Embolism. Crit Care Med 2024; 52:847-850. [PMID: 38619343 DOI: 10.1097/ccm.0000000000006206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Affiliation(s)
- Aaron W Trammell
- Pulmonary, Allergy, Critical Care, and Sleep Medicine Division, Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Jonathan Ball
- General Intensive Care Unit, St George's Hospital, London, United Kingdom
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2
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Baxter MA, Denholm M, Kingdon SJ, Kathirgamakarthigeyan S, Parikh S, Shakir R, Johnson R, Martin H, Walton M, Yao W, Swan A, Samuelson C, Ren X, Cooper A, Gray HL, Clifton S, Ball J, Gullick G, Anderson M, Dodd L, Hayhurst H, Salama M, Shotton R, Britton F, Christodoulou T, Abdul-Hamid A, Eichholz A, Evans RM, Wallroth P, Gibson F, Poole K, Rowe M, Harris J. CAnceR IN PreGnancy (CARING) - a retrospective study of cancer diagnosed during pregnancy in the United Kingdom. Br J Cancer 2024; 130:1261-1268. [PMID: 38383704 PMCID: PMC11014900 DOI: 10.1038/s41416-024-02605-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 01/25/2024] [Accepted: 01/29/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND The incidence of cancer diagnosed during pregnancy is increasing. Data relating to investigation and management, as well as maternal and foetal outcomes is lacking in a United Kingdom (UK) population. METHODS In this retrospective study we report data from 119 patients diagnosed with cancer during pregnancy from 14 cancer centres in the UK across a five-year period (2016-2020). RESULTS Median age at diagnosis was 33 years, with breast, skin and haematological the most common primary sites. The majority of cases were new diagnoses (109 patients, 91.6%). Most patients were treated with radical intent (96 patients, 80.7%), however, gastrointestinal cancers were associated with a high rate of palliative intent treatment (63.6%). Intervention was commenced during pregnancy in 68 (57.1%) patients; 44 (37%) had surgery and 31 (26.1%) received chemotherapy. Live births occurred in 98 (81.7%) of the cases, with 54 (55.1%) of these delivered by caesarean section. Maternal mortality during the study period was 20.2%. CONCLUSIONS This is the first pan-tumour report of diagnosis, management and outcomes of cancer diagnosed during pregnancy in the UK. Our findings demonstrate proof of concept that data collection is feasible and highlight the need for further research in this cohort of patients.
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Affiliation(s)
- M A Baxter
- Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK.
- Tayside Cancer Centre, Ninewells Hospital and Medical School, NHS Tayside, Dundee, UK.
| | - M Denholm
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Early Cancer Institute, Department of Oncology, University of Cambridge, Cambridge, UK
| | - S J Kingdon
- Exeter Oncology Centre, Royal Devon University Hospitals NHS Trust, Exeter, UK
| | | | - S Parikh
- Department of Oncology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - R Shakir
- Oncology Department, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - R Johnson
- Oncology Department, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - H Martin
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Early Cancer Institute, Department of Oncology, University of Cambridge, Cambridge, UK
- Cancer Research UK Cambridge Institute, Cambridge University, Cambridge, UK
| | - M Walton
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - W Yao
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - A Swan
- Edinburgh Cancer Centre, Western General Hospital, NHS Lothian, Edinburgh, UK
| | - C Samuelson
- Edinburgh Cancer Centre, Western General Hospital, NHS Lothian, Edinburgh, UK
| | - X Ren
- Edinburgh Cancer Centre, Western General Hospital, NHS Lothian, Edinburgh, UK
| | - A Cooper
- Edinburgh Cancer Centre, Western General Hospital, NHS Lothian, Edinburgh, UK
| | - H-L Gray
- Tayside Cancer Centre, Ninewells Hospital and Medical School, NHS Tayside, Dundee, UK
| | - S Clifton
- Bristol Haematology and Oncology Centre, Bristol, UK
| | - J Ball
- Bristol Haematology and Oncology Centre, Bristol, UK
| | - G Gullick
- Oncology Department, Royal United Hospitals NHS Foundation Trust, Bath, UK
| | - M Anderson
- Northern Centre for Cancer Care, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, The Newcastle Upon Tyne, UK
| | - L Dodd
- Northern Centre for Cancer Care, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, The Newcastle Upon Tyne, UK
| | - H Hayhurst
- Northern Centre for Cancer Care, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, The Newcastle Upon Tyne, UK
| | - M Salama
- Department of Oncology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - R Shotton
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - F Britton
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - T Christodoulou
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - A Abdul-Hamid
- Department of Oncology, Royal Surrey County Hospital NHS Trust, Surrey, UK
| | - A Eichholz
- Department of Oncology, Buckinghamshire Healthcare NHS Trust, Buckinghamshire, UK
| | - R M Evans
- South West Wales Cancer Centre, Swansea Bay NHS Trust, Swansea, UK
| | | | - F Gibson
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - K Poole
- The Institute of Cancer Research, Clinical Trials and Statistics Unit, Belmont, Sutton, Surrey, UK
| | - M Rowe
- Sunrise Oncology Centre, Royal Cornwall Hospitals NHS Trust, Truro, UK
| | - J Harris
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
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3
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Ball J, Nehme Z, Stub D. At an intersection of public health crises: Drugs, a pandemic, and out-of-hospital cardiac arrest. Resuscitation 2024; 195:110127. [PMID: 38295897 DOI: 10.1016/j.resuscitation.2024.110127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 01/23/2024] [Indexed: 02/09/2024]
Affiliation(s)
- J Ball
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; Monash Alfred Baker Centre for Cardiovascular Research, Melbourne, Victoria, Australia; Ambulance Victoria, Melbourne, Victoria, Australia.
| | - Z Nehme
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Ambulance Victoria, Melbourne, Victoria, Australia; Department of Paramedicine, Monash University, Moorooduc Highway, Frankston, Victoria, Australia
| | - D Stub
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; Monash Alfred Baker Centre for Cardiovascular Research, Melbourne, Victoria, Australia; Ambulance Victoria, Melbourne, Victoria, Australia; Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia
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Ball J, Neumann JT, Tonkin AM, Kirchhof P, Freedman B, Brodtmann A, Reid C, Nelson MR, Beilin LJ, Fitzgerald S, Stub D, Woods RL, McNeil JJ. Low-dose aspirin and incident atrial fibrillation in healthy older individuals: a post-hoc analysis of the ASPREE trial. Eur Heart J Cardiovasc Pharmacother 2024; 10:81-82. [PMID: 37951294 PMCID: PMC10766903 DOI: 10.1093/ehjcvp/pvad082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 10/30/2023] [Accepted: 11/09/2023] [Indexed: 11/13/2023]
Affiliation(s)
- J Ball
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia
- Baker Heart and Diabetes Institute, Melbourne, Victoria 3004, Australia
| | - J T Neumann
- University Heart and Vascular Center Hamburg, University Medical Center Hamburg—Eppendorf, 20251 Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), 10785 Berlin, Germany
| | - A M Tonkin
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia
| | - P Kirchhof
- University Heart and Vascular Center Hamburg, University Medical Center Hamburg—Eppendorf, 20251 Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), 10785 Berlin, Germany
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - B Freedman
- Heart Rhythm and Stroke Group, Heart Research Institute, Sydney 2042, Australia
- Charles Perkins Centre, The University of Sydney, Sydney 2050, Australia
| | - A Brodtmann
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia
- Cognitive Health Initiative, Central Clinical School, Monash University, Melbourne 3004, Australia
| | - C Reid
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia
- School of Population Health, Curtin University, Perth, Western Australia 6102, Australia
| | - M R Nelson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania 7000, Australia
| | - L J Beilin
- UWA Medical School, University of Western Australia, Perth 6009, Australia
| | - S Fitzgerald
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia
| | - D Stub
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia
- Baker Heart and Diabetes Institute, Melbourne, Victoria 3004, Australia
- Department of Cardiology, Alfred Health, Melbourne, Victoria 3004, Australia
| | - R L Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia
| | - J J McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia
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Ghafari M, Sõmera M, Sarmiento C, Niehl A, Hébrard E, Tsoleridis T, Ball J, Moury B, Lemey P, Katzourakis A, Fargette D. Revisiting the origins of the Sobemovirus genus: A case for ancient origins of plant viruses. PLoS Pathog 2024; 20:e1011911. [PMID: 38206964 PMCID: PMC10807823 DOI: 10.1371/journal.ppat.1011911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 01/24/2024] [Accepted: 12/18/2023] [Indexed: 01/13/2024] Open
Abstract
The discrepancy between short- and long-term rate estimates, known as the time-dependent rate phenomenon (TDRP), poses a challenge to extrapolating evolutionary rates over time and reconstructing evolutionary history of viruses. The TDRP reveals a decline in evolutionary rate estimates with the measurement timescale, explained empirically by a power-law rate decay, notably observed in animal and human viruses. A mechanistic evolutionary model, the Prisoner of War (PoW) model, has been proposed to address TDRP in viruses. Although TDRP has been studied in animal viruses, its impact on plant virus evolutionary history remains largely unexplored. Here, we investigated the consequences of TDRP in plant viruses by applying the PoW model to reconstruct the evolutionary history of sobemoviruses, plant pathogens with significant importance due to their impact on agriculture and plant health. Our analysis showed that the Sobemovirus genus dates back over four million years, indicating an ancient origin. We found evidence that supports deep host jumps to Poaceae, Fabaceae, and Solanaceae occurring between tens to hundreds of thousand years ago, followed by specialization. Remarkably, the TDRP-corrected evolutionary history of sobemoviruses was extended far beyond previous estimates that had suggested their emergence nearly 9,000 years ago, a time coinciding with the Neolithic period in the Near East. By incorporating sequences collected through metagenomic analyses, the resulting phylogenetic tree showcases increased genetic diversity, reflecting a deep history of sobemovirus species. We identified major radiation events beginning between 4,600 to 2,000 years ago, which aligns with the Neolithic period in various regions, suggesting a period of rapid diversification from then to the present. Our findings make a case for the possibility of deep evolutionary origins of plant viruses.
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Affiliation(s)
- Mahan Ghafari
- Department of Biology, University of Oxford, Oxford, United Kingdom
| | - Merike Sõmera
- Department of Chemistry and Biotechnology, Tallinn University of Technology, Tallinn, Estonia
| | - Cecilia Sarmiento
- Department of Chemistry and Biotechnology, Tallinn University of Technology, Tallinn, Estonia
| | - Annette Niehl
- Julius Kühn Institute (JKI)–Federal Research Centre for Cultivated Plants, Institute for Epidemiology and Pathogen Diagnostics, Braunschweig, Germany
| | - Eugénie Hébrard
- PHIM Plant Health Institute, Univ Montpellier, IRD, CIRAD, INRAE, Institut Agro, Montpellier, France
| | - Theocharis Tsoleridis
- The Wolfson Centre for Global Virus Research and School of Life Sciences, The University of Nottingham, Queen’s Medical Centre, Nottingham, United Kingdom
| | - Jonathan Ball
- The Wolfson Centre for Global Virus Research and School of Life Sciences, The University of Nottingham, Queen’s Medical Centre, Nottingham, United Kingdom
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom
| | | | - Philippe Lemey
- Department of Microbiology, Immunology and Transplantation, Rega Institute, KU Leuven, Leuven, Belgium
| | - Aris Katzourakis
- Department of Biology, University of Oxford, Oxford, United Kingdom
| | - Denis Fargette
- PHIM Plant Health Institute, Univ Montpellier, IRD, CIRAD, INRAE, Institut Agro, Montpellier, France
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Hurt W, Youngs J, Ball J, Edgeworth J, Hopkins P, Jenkins DR, Leaver S, Mazzella A, Molloy SF, Schelenz S, Wise MP, White PL, Yusuff H, Wyncoll D, Bicanic T. COVID-19-associated pulmonary aspergillosis in mechanically ventilated patients: a prospective, multicentre UK study. Thorax 2023; 79:75-82. [PMID: 37657925 PMCID: PMC10804023 DOI: 10.1136/thorax-2023-220002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 06/22/2023] [Indexed: 09/03/2023]
Abstract
BACKGROUND Invasive pulmonary aspergillosis is a complication of severe COVID-19, with regional variation in reported incidence and mortality. We describe the incidence, risk factors and mortality associated with COVID-19-associated pulmonary aspergillosis (CAPA) in a prospective, multicentre UK cohort. METHODS From March 2020 to March 2021, 266 mechanically ventilated adults with COVID-19 were enrolled across 5 UK hospital intensive care units (ICUs). CAPA was defined using European Confederation for Medical Mycology and the International Society for Human and Animal Mycology criteria and fungal diagnostics performed on respiratory and serum samples. RESULTS Twenty-nine of 266 patients (10.9%) had probable CAPA, 14 (5.2%) possible CAPA and none proven CAPA. Probable CAPA was diagnosed a median of 9 (IQR 7-16) days after ICU admission. Factors associated with probable CAPA after multivariable logistic regression were cumulative steroid dose given within 28 days prior to ICU admission (adjusted OR (aOR) 1.16; 95% CI 1.01 to 1.43 per 100 mg prednisolone-equivalent), receipt of an interleukin (IL)-6 inhibitor (aOR 2.79; 95% CI 1.22 to 6.48) and chronic obstructive pulmonary disease (COPD) (aOR 4.78; 95% CI 1.13 to 18.13). Mortality in patients with probable CAPA was 55%, vs 46% in those without. After adjustment for immortal time bias, CAPA was associated with an increased risk of 90-day mortality (HR 1.85; 95% CI 1.07 to 3.19); however, this association did not remain statistically significant after further adjustment for confounders (adjusted HR 1.57; 95% CI 0.88 to 2.80). There was no difference in mortality between patients with CAPA prescribed antifungals (9 of 17; 53%) and those who were not (7 of 12; 58%) (p=0.77). INTERPRETATION In this first prospective UK study, probable CAPA was associated with corticosteroid use, receipt of IL-6 inhibitors and pre-existing COPD. CAPA did not impact mortality following adjustment for prognostic variables.
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Affiliation(s)
- William Hurt
- Institute of Infection and Immunity, St George's University of London, London, UK
- Clinical Infection Unit, St George's University Hospitals NHS Foundation Trust, London, UK
- Medical Research Council Centre for Medical Mycology, University of Exeter, Exeter, UK
| | - Jonathan Youngs
- Institute of Infection and Immunity, St George's University of London, London, UK
- Clinical Infection Unit, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Jonathan Ball
- Adult Critical Care, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Jonathan Edgeworth
- Clinical Infection and Microbiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Philip Hopkins
- Adult Critical Care, King's College Hospital NHS Foundation Trust, London, UK
| | - David R Jenkins
- Clinical Microbiology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Susannah Leaver
- Adult Critical Care, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Andrea Mazzella
- Institute of Infection and Immunity, St George's University of London, London, UK
| | - Síle F Molloy
- Institute of Infection and Immunity, St George's University of London, London, UK
| | - Silke Schelenz
- Medical Microbiology, King's College Hospital NHS Foundation Trust, London, UK
| | - Matt P Wise
- Adult Critical Care, University of Wales Hospital, Cardiff, UK
| | | | - Hakeem Yusuff
- Adult Critical Care, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Duncan Wyncoll
- Adult Critical Care, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Tihana Bicanic
- Institute of Infection and Immunity, St George's University of London, London, UK
- Clinical Infection Unit, St George's University Hospitals NHS Foundation Trust, London, UK
- Medical Research Council Centre for Medical Mycology, University of Exeter, Exeter, UK
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7
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Martin WT, Ball J, Patterson AK, Snyder KB, Bonds M, Stewart K, Sarwar Z, Raines AR, Cross A. Not all cholecystitis is created equal: Disparities contributing to ED presentation and failure of the outpatient algorithm. Am J Surg 2023; 226:835-839. [PMID: 37481409 DOI: 10.1016/j.amjsurg.2023.06.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 06/27/2023] [Accepted: 06/29/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND The majority of final surgical pathology (FSP) from both emergency department (ED) and outpatient clinic (OC) patients is chronic cholecystitis. We aimed to differentiate these presentations and identify disparities associated with ED utilization and OC failure. METHODS Retrospective chart review of single institution ED and OC cholecystectomies for cholelithiasis. Clinical presentation, FSP, demographics, and zip code poverty (ZCP) levels were evaluated. Data analysis by summary statistics, bivariate comparisons, and logistic regression. RESULTS Of 299 OC and 308 ED patients, OC was more likely to be Caucasian (78% vs 46%, p < 0.0001) and insured (89% vs. 32%, p < 0.0001). 71.8% of OC with ZCP <10% had insurance versus only 32.5% in ZCP >20%. Uninsured ED OR was 13.1 (95% CI 8.7-22.9). CONCLUSION Uninsured ED patients are vulnerable to fail the outpatient algorithm, especially when misdiagnosed by US. Clinical diagnosis of cholecystitis in this population should warrant offering of urgent cholecystectomy.
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Affiliation(s)
| | - Jonathan Ball
- University of Oklahoma General Surgery Department, USA.
| | | | | | - Morgan Bonds
- University of Oklahoma General Surgery Department, USA.
| | | | - Zoona Sarwar
- University of Oklahoma General Surgery Department, USA.
| | | | - Alisa Cross
- University of Oklahoma General Surgery Department, USA.
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8
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Snyder KB, Ball J, Lees J, Skaggs JC, Sami A, Hunter CJ, Landmann A. Anecdotes Drive Attitudes, Data Drives Decisions: Optimizing the Emergency Department Workup Prior to Surgical Consultations. J Surg Educ 2023; 80:1682-1686. [PMID: 37357106 DOI: 10.1016/j.jsurg.2023.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/25/2023] [Accepted: 05/30/2023] [Indexed: 06/27/2023]
Abstract
PURPOSE Emergency department (ED) wait times and ED length of stay (LOS) have a significant impact on patient morbidity and mortality and patient satisfaction. Consultation-to-decision time can contribute to increased wait times and LOS in the ED. Up to 40% of patients presenting to the ED require consultation from subspecialty services. We hypothesize that in surgical patients, completion of workup prior to consultation will decrease consultation-to-decision time, ED wait times, and LOS in the ED. METHODS A retrospective review was conducted at a single site including all overnight general surgery consultations from the ED over 2-months. Data collected included wait times, LOS, and workup completed prior to consultation. Summary statistics were calculated and bivariate tests were performed using t-tests for continuous variables. RESULTS Time to final surgical plan and LOS in ED were evaluated for 137 patients comparing "complete" and "incomplete" workups at time of consultation. It was considered a "complete" workup if labs and imaging were resulted prior to time of consult. If any baseline tests were not ordered prior to time of consult, it was considered an "incomplete" workup. Analysis demonstrated an average time of 4.9 and 2.5 hours for consultation-to-decision time for "incomplete" and "complete" workups respectively (p < 0.0001). For LOS in ED, there was an average of 11.4 and 7.9 hours for "incomplete" and "complete" workups respectively (p < 0.0001). CONCLUSIONS There is a significant difference in consultation-to-decision time and LOS in the ED when consultation is performed following a complete versus incomplete workup for surgical patients independent of inherent wait times for testing to result and the need for additional testing requested from consulting services. Developing strategies to optimize workups from the ED prior to surgical consultation, including the development of care pathways, could significantly decrease patient wait times and LOS in the ED.
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Affiliation(s)
- Katherine B Snyder
- Department of Surgery, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Jonathan Ball
- Department of Surgery, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Jason Lees
- Department of Surgery, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Joanne C Skaggs
- Department of Internal Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Areej Sami
- Department of Surgery, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Catherine J Hunter
- Department of Surgery, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Alessandra Landmann
- Department of Surgery, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
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Garside T, Stanford R, Flower O, Li T, Dababneh E, Hammond N, Bass F, Middleton J, Tang J, Ball J, Delaney A. Acute assessment of spinal cord injury in New South Wales: A retrospective study of current practice in two spinal cord injury referral centers. J Spinal Cord Med 2023:1-8. [PMID: 37707355 DOI: 10.1080/10790268.2023.2247625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/15/2023] Open
Abstract
INTRODUCTION Interventions provided in the early phases after spinal cord injury (SCI) may improve neurological recovery and provide for best possible functional outcomes. Knowing this relies on early and clear documentation of the level and grade of the spinal cord injury. Guidelines advocate for early documentation of neurological status within 72 h of injury to allow early prognostication and to help guide initial management. It is unclear whether this is current practice in New South Wales (NSW). METHODS Patients with acute SCI who were admitted to two SCI referral centers during 2018-2019 in NSW were included. Data relating to documentation of neurological status, timing of imaging, surgery and transfer to spinal cord injury center were collected and summarized using descriptive statistics. RESULTS Only 18 percent of patients had an acceptable neurological examination according to the International Standards for Classification of Spinal Cord Injury (ISNCSCI) within 72 h of injury (either not done, or unable to determine the neurological level of injury). At the first neurological examination, the neurological level of injury and grade was unable to be determined in 26.8% of patients and 29.9% of patients respectively. At discharge from acute care and transfer to rehabilitation, the neurological level was undetermined in 28.9% of patients and grade undetermined in 26.8%. ISNCSCI examination was most commonly performed by spinal rehabilitation doctors after patients were discharged from the intensive care unit (ICU). CONCLUSIONS Documentation of neurological level and grade of SCI within 72 h of injury is not being performed in the large majority of this cohort, which may impede evaluation of neurological improvement in response to acute treatment, and hinder prognostication.
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Affiliation(s)
- Tessa Garside
- Malcolm Fisher Department of Intensive Care Medicine, Royal North Shore Hospital, St Leonards, New South Wales, Australia
- The George Institute, Newtown, New South Wales, Australia
| | - Ralph Stanford
- Department of Orthopaedic Surgery, Prince of Wales Hospital, Randwick, New South Wales, Australia
- Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - Oliver Flower
- Malcolm Fisher Department of Intensive Care Medicine, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Trent Li
- Department of Orthopaedic Surgery, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Edward Dababneh
- Malcolm Fisher Department of Intensive Care Medicine, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Naomi Hammond
- Malcolm Fisher Department of Intensive Care Medicine, Royal North Shore Hospital, St Leonards, New South Wales, Australia
- The George Institute, Newtown, New South Wales, Australia
| | - Frances Bass
- Malcolm Fisher Department of Intensive Care Medicine, Royal North Shore Hospital, St Leonards, New South Wales, Australia
- The George Institute, Newtown, New South Wales, Australia
| | - James Middleton
- John Walsh Centre for Rehabilitation Research, Kolling Institute, Northern Sydney Local Health District and The University of Sydney, Sydney, Australia
| | - Jonathan Tang
- Department of Orthopaedic Surgery, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Jonathan Ball
- Department of Neurosurgery, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Anthony Delaney
- Malcolm Fisher Department of Intensive Care Medicine, Royal North Shore Hospital, St Leonards, New South Wales, Australia
- The George Institute, Newtown, New South Wales, Australia
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Knight H, Jia R, Ayling K, Blake H, Morling JR, Villalon AM, Corner J, Denning C, Ball J, Bolton K, Figueredo G, Morris D, Tighe P, Vedhara K. The changing vaccine landscape: rates of COVID-19 vaccine acceptance and hesitancy in young adults during vaccine rollout. Perspect Public Health 2023; 143:220-224. [PMID: 35575215 PMCID: PMC10467000 DOI: 10.1177/17579139221094750] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIMS Development and rollout of vaccines offers the best opportunity for population protection against the SARS-CoV-2 (COVID-19) virus. However, hesitancy towards the vaccines might impede successful uptake in the United Kingdom, particularly in young adults who demonstrate the highest rates of hesitancy. This prospective study explored COVID-19 vaccine hesitancy in young adults and whether the reasons behind these attitudes changed during the initial stages of the United Kingdom's vaccine rollout. METHOD Data on vaccination intention were collected from a British university student cohort at three time points: October 2020, February 2021, and March 2021. This online survey included items on intention to receive a vaccine and a free-text response for the reasons behind this intention. Cochran's Q tests examined changes in rates of hesitancy and acceptance over time and free-text responses were analysed thematically. RESULTS At baseline, 893 students provided data, with 476 participants completing all three time points. Hesitancy declined over time, with 29.4% of participants expressing hesitancy at baseline, reducing to 9.1% at wave 2 and 5.9% at wave 3. The most commonly endorsed themes for those willing to accept a vaccine were self-protection against COVID-19 and pro-social reasons, including protecting the population or unspecific others, and ending the pandemic/returning to normal life. The most commonly endorsed hesitancy themes related to 'confidence' in the vaccines and potential personal risk, including insufficient testing/scientific evidence, concern about side effects, and long-term effects. These reasons remained the most commonly endorsed at both waves 2 and 3. CONCLUSIONS While a decline in hesitancy was observed over time, the key reasons behind both vaccine acceptance and hesitancy remained consistent. Reasons behind hesitancy aligned with those of the general public, providing support for the use of generalist interventions. Pro-social reasons frequently underpinned vaccine acceptance, so cohort-specific interventions targeting those factors may be of benefit.
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Affiliation(s)
- H Knight
- School of Medicine, University of Nottingham, Nottingham NG7 2RD, UK
| | - R Jia
- School of Medicine, University of Nottingham, Nottingham, UK
| | - K Ayling
- School of Medicine, University of Nottingham, UK
| | - H Blake
- School of Health Sciences, University of Nottingham, Nottingham, UK; NIHR Nottingham Biomedical Research Centre, Nottingham, UK
| | - JR Morling
- School of Medicine, University of Nottingham, Nottingham, UK; NIHR Nottingham Biomedical Research Centre, Nottingham, UK
| | - AM Villalon
- Faculty of Engineering, University of Nottingham, Nottingham, UK
| | - J Corner
- University Executive Board, University of Nottingham, Nottingham, UK
| | - C Denning
- Biodiscovery Institute, University Park, University of Nottingham, Nottingham, UK
| | - J Ball
- Biodiscovery Institute, University Park, University of Nottingham, Nottingham, UK
| | - K Bolton
- School of Mathematical Sciences, University of Nottingham, Nottingham, UK
| | - G Figueredo
- School of Computer Sciences, University of Nottingham, Nottingham, UK
| | - D Morris
- Faculty of Engineering, University of Nottingham, Nottingham, UK
| | - P Tighe
- School of Life Sciences, University of Nottingham, Nottingham, UK
| | - K Vedhara
- School of Medicine, University of Nottingham, Nottingham, UK
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11
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Abstract
BACKGROUND Nurses working long shifts (≥12 h) experience higher levels of burnout. Yet other shift characteristics, including fixed versus rotating night work, weekly hours and breaks have not been considered. Choice over shift length may moderate the relationship; however, this has not been tested. AIMS To examine the association between shift work characteristics and burnout and exhaustion, and whether choice over shift length influences burnout and exhaustion. METHODS Cross-sectional online survey of nursing staff working in the UK and Ireland. We recruited two large National Health Service Trusts, through trade union membership, online/print nursing magazines and social media. We assessed associations using both univariable and multivariable generalized linear models. RESULTS We had 873 valid responses. Reports of inadequate staffing levels (odds ratio [OR] = 2.84; 95% confidence interval [CI] 2.08-3.90) and less choice over shift length (OR = 0.20; 95% CI 0.06-0.54) were associated with higher burnout in multivariable models. Similar associations were found for exhaustion, where rarely or never taking breaks was also a predictor (OR = 1.61; 95% CI 1.05-2.52). Nurses who worked long shifts had less choice than those working shifts of 8 h or less (66% of 12-h shift nurses versus 44% 8-h shift nurses reporting having no choice), but choice did not moderate the relationship between shift length and burnout and exhaustion. CONCLUSIONS The relationship between long shifts and increased burnout reported previously might have arisen from a lack of choice for those staff working long shifts. Whether limited choice for staff is intrinsically linked to long shifts is unclear.
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Affiliation(s)
- C Dall’Ora
- School of Health Sciences, University of Southampton, Southampton, UK
- National Institute for Health Research Applied Research Collaboration, Wessex SO16 7NP, UK
| | - O-Z Ejebu
- School of Health Sciences, University of Southampton, Southampton, UK
- National Institute for Health Research Applied Research Collaboration, Wessex SO16 7NP, UK
| | - J Ball
- School of Health Sciences, University of Southampton, Southampton, UK
| | - P Griffiths
- School of Health Sciences, University of Southampton, Southampton, UK
- National Institute for Health Research Applied Research Collaboration, Wessex SO16 7NP, UK
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12
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Fehlings MG, Moghaddamjou A, Harrop JS, Stanford R, Ball J, Aarabi B, Freeman B, Guest JD, Kurpad SN, Schuster JM, Nassr A, Schmitt KM, Wilson JR, Brodke DS, Ahmad FU, Yee A, Ray Z, Brooks NP, Wilson J, Kopjar B, Arnold PM. 186 A Multi-Center, Randomized, Placebo-Controlled, Double-Blinded Trial of Efficacy and Safety of Riluzole in Acute Spinal Cord Injury Study (RISCIS). Neurosurgery 2023. [DOI: 10.1227/neu.0000000000002375_186] [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: 03/18/2023] Open
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13
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Burch RF, Chander H, Saucier D, Ball J. Incorporation of a smart sock with the virtual immersive test for postural stability. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00177-5] [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: 01/28/2023]
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14
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Muscente P, Innocente P, Ball J, Gorno S. Analysis of edge transport in L-mode negative triangularity TCV discharges. Nuclear Materials and Energy 2023. [DOI: 10.1016/j.nme.2023.101386] [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: 02/12/2023]
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15
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Ball J. The Effects of RBC Concentration on the Viscoelastic Assessment of Coagulation. Crit Care Med 2023; 51:329-331. [PMID: 36661459 DOI: 10.1097/ccm.0000000000005737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Jonathan Ball
- General Intensive Care Unit, St George's Hospital, London, United Kingdom
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16
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Renninson E, Channell K, Ball J, Masson S, Challapalli A, Bahl A. Patient Experience and Impact of Rectal Spacers on Dosimetry and Acute Toxicity in Patients Undergoing Radical Radiotherapy for Prostate Cancer. Clin Oncol (R Coll Radiol) 2023. [DOI: 10.1016/j.clon.2022.11.042] [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: 01/13/2023]
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17
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Pironon S, Cantwell-Jones A, Forest F, Ball J, Diazgranados M, Douglas R, Hawkins J, Howes MJR, Ulian T, Vaitla B, Collar D. Towards an action plan for characterizing food plant diversity. Nat Plants 2023; 9:34-35. [PMID: 36543935 DOI: 10.1038/s41477-022-01300-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 10/31/2022] [Indexed: 06/17/2023]
Affiliation(s)
- S Pironon
- Royal Botanic Gardens, Kew, Richmond, UK.
- UN Environment Programme World Conservation Monitoring Centre, Cambridge, UK.
| | - A Cantwell-Jones
- Science and Solutions for a Changing Planet DTP, Imperial College London, Ascot, UK
- Department of Life Sciences, Imperial College London, Ascot, UK
| | - F Forest
- Royal Botanic Gardens, Kew, Richmond, UK
| | - J Ball
- Royal Botanic Gardens, Kew, Richmond, UK
| | | | | | - J Hawkins
- School of Biological Sciences, University of Reading, Reading, UK
| | | | - T Ulian
- Royal Botanic Gardens, Kew, Richmond, UK
| | - B Vaitla
- Department of Nutrition, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - D Collar
- Department of Organismal and Environmental Biology, Christopher Newport University, Newport News, VA, USA
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18
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Sharwood LN, King V, Ball J, Varma D, Stanford RW, Middleton JW. The influence of initial spinal cord haematoma and cord compression on neurological grade improvement in acute traumatic spinal cord injury: A prospective observational study. J Neurol Sci 2022; 443:120453. [PMID: 36308844 DOI: 10.1016/j.jns.2022.120453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 09/26/2022] [Accepted: 10/04/2022] [Indexed: 11/21/2022]
Abstract
STUDY DESIGN Prospective observational cohort study linked with administrative data. OBJECTIVES Magnetic Resonance Imaging (MRI) is routinely performed after traumatic spinal cord injury (TSCI), facilitating early, accurate diagnosis to optimize clinical management. Prognosis from early MRI post-injury remains unclear, yet if available could guide early intervention. The aim of this study was to determine the association of spinal cord intramedullary haematoma and/or extent of cord compression evident on initial spine MRI with neurological grade change after TSCI. METHODS Individuals with acute TSCI ≥16 years of age; MRI review. Neurological gradings (American Spinal Injury Association Impairment Scale (AIS)) were compared with initial MRI findings. Various MRI parameters were evaluated for prediction of neurological improvement pre-discharge. RESULTS 120 subjects; 79% male, mean (SD) age 51.0 (17.7) years. Motor vehicle crashes (42.5%) and falls (40.0%) were the most common injury mechanisms. Intramedullary spinal cord haematoma was identified by MRI in 40.0% of patients and was associated with more severe neurologic injury (58.3% initially AIS A). Generalised linear regression showed higher maximum spinal cord compression (MSCC) was associated with lower likelihood of neurological improvement from initial assessment to follow up prior to rehabilitation discharge. Combined thoracic level injury, intramedullary haematoma, and MSCC > 25% resulted in almost 90% probability of pre-discharge AIS (grade A) remaining unchanged from admission assessment. CONCLUSIONS MRI is a vital tool for evaluating the severity and extent of TSCI, assisting in appropriate management decision-making early in TSCI patient care. This study adds to the body of knowledge assisting clinicians in prognostication.
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Affiliation(s)
- L N Sharwood
- University of Sydney, Sydney Medical School, Northern, C/o Kolling Institute, 1 Reserve Road, St Leonards, NSW 2065, Australia; Faculty of Medicine and Health, University of New South Wales, Australia.
| | - V King
- Royal North Shore Hospital, Department of Neurosurgery, Australia
| | - J Ball
- Royal North Shore Hospital, Department of Neurosurgery, Australia.
| | - D Varma
- Radiology, Emergency & Trauma Radiology, The Alfred Health & Monash University, National Trauma Research Institute, Australia; Mission TBI, MRFF Aus Govt., Australia.
| | - R W Stanford
- Prince of Wales Hospital, Department of Orthopedics, Australia
| | - J W Middleton
- Rehabilitation Medicine, University of Sydney, Sydney Medical School, Northern Faculty of Medicine and Health, Australia.
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19
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Ball J, Nehme Z, Stub D. Preventive measures and public education programmes are needed to suck the marrow out of life, but avoid choking on the bone. Resuscitation 2022; 181:170-172. [PMID: 36455703 DOI: 10.1016/j.resuscitation.2022.11.019] [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] [Received: 11/20/2022] [Accepted: 11/21/2022] [Indexed: 11/29/2022]
Affiliation(s)
- J Ball
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.
| | - Z Nehme
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Paramedicine, Monash University, Moorooduc Highway, Frankston, Victoria, Australia; Ambulance Victoria, Melbourne, Victoria, Australia
| | - D Stub
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; Ambulance Victoria, Melbourne, Victoria, Australia; Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia
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20
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Espnes H, Ball J, Lochen ML, Wilsgaard T, Njolstad I, Mathiesen EB, Schnabel RB, Gerdts E, Sharashova E. Risk factors and prognosis for heart failure in atrial fibrillation subtypes in women and men. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Atrial fibrillation (AF) and heart failure (HF) are common diseases that often co-exist and substantially impact both morbidity, mortality, and quality of life. Although there has been an increasing amount of research on HF in AF patients, there is limited knowledge on the association of AF subtypes (paroxysmal/persistent, permanent) with HF in women and men.
Purpose
To explore the sex-specific association between incident AF subtypes and HF risk factors and mortality in AF participants in a general population.
Methods
A total of 14,798 women and 13,197 men aged 25 years and older were enrolled from 1994 to 2008 and followed up for incident AF and HF through 2016. Cox proportional hazards regression analysis was conducted to provide sex- and AF subtype-specific hazard ratios (HRs) for the risk of HF, risk factors for HF and joint influence on mortality when AF precedes HF. Participants without AF and HF were used as reference. In the analysis of risk factors for HF we included only those who developed AF, and the follow-up period started at the date of first detected AF. Models were adjusted for systolic blood pressure, body mass index (BMI), total cholesterol, current smoking, physical activity, and history of myocardial infarction, angina pectoris, stroke, and diabetes mellitus, as well as age, with age as the time scale in the regression models.
Results
Over a median follow-up of 21.6 years, incident AF occurred in 856 women (471 with paroxysmal/persistent AF and 385 with permanent AF) and 1,036 men (587 with paroxysmal/persistent AF and 449 with permanent AF). Incident HF occurred in 761 women and 930 men. In both sexes, there was an increased risk of HF when AF was present. For permanent AF, women had a significantly higher risk of HF than men (HR 10.50, 95% CI 8.72–12.66 vs. HR 8.11, 95% CI 6.81–9.67). Permanent AF, current smoking, and prevalent myocardial infarction were significant risk factors for HF in AF participants in both sexes, while hypertension was only associated with increased risk of HF in women and BMI and prevalent stroke in men. Higher physical activity level was associated with reduced risk of AF in both sexes. The risk of death increased when HF succeeded AF. For women the risk of mortality was higher for permanent AF (HR 3.83, 95% CI 3.19–4.61 vs. HR 2.98, 95% CI 2.34–3.80), while in men it was highest for paroxysmal/persistent AF (HR 3.67, 95% CI 2.94–4.58 vs. HR 2.91, 95% CI 2.37–3.57), but there was no significant difference between sexes.
Conclusions
All AF subtypes were associated with an increased risk of HF in both sexes. For permanent AF, women had a significantly higher risk than men. Several risk factors for HF in AF participants were similar between sexes. However, hypertension was only a risk factor in women, whereas BMI and prevalent stroke were only risk factors in men. In AF participants, subsequent development of HF was associated with increased mortality in both sexes.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): UiT The Arctic University of Norway
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Affiliation(s)
- H Espnes
- UiT The Arctic University of Norway, Department of Community Medicine , Tromso , Norway
| | - J Ball
- Monash University, Department of Epidemiology and Preventive Medicine , Melbourne , Australia
| | - M L Lochen
- UiT The Arctic University of Norway, Department of Community Medicine , Tromso , Norway
| | - T Wilsgaard
- UiT The Arctic University of Norway, Department of Community Medicine , Tromso , Norway
| | - I Njolstad
- UiT The Arctic University of Norway, Department of Community Medicine , Tromso , Norway
| | - E B Mathiesen
- UiT The Arctic University of Norway, Department of Clinical Medicine , Tromso , Norway
| | - R B Schnabel
- University Heart & Vascular Center Hamburg, Department of Cardiology , Hamburg , Germany
| | - E Gerdts
- University of Bergen, Center for research on cardiac disease in women, Department of Clinical Science , Bergen , Norway
| | - E Sharashova
- UiT The Arctic University of Norway, Department of Community Medicine , Tromso , Norway
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21
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Paratz E, Van Heusden A, Zentner D, Morgan N, Smith K, Ball J, Thompson T, James P, Connell V, Pflaumer A, Semsarian C, Ingles J, Stub D, Parsons S, La Gerche A. Prevalence of coronary artery anomalies in young sudden cardiac death: insights from a prospective state-wide registry. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Coronary artery anomalies (CAAs) have been previously implicated as a major cause of young sudden cardiac death (SCD), particularly in exercise-related SCD with a reported prevalence of up to 33%.
Methods
A state-wide prospective out-of-hospital cardiac arrest registry identified all patients aged 1–50 years who experienced an SCD and underwent autopsy from April 2019 to April 2021. Rates of normal anatomy, normal variants and CAAs were identified and circumstances and cause of death for patients with CAAs examined.
Results
Of 1,477 patients who experienced cardiac arrest during the study period, 490 underwent autopsy and were confirmed to have experienced SCD. Of these 490 patients, five (1.0%) had a CAA identified with three having anomalies of coronary origin and two having anomalies of coronary course. In no cases was the CAA deemed responsible for the SCD. In two cases, severe coronary disease and intra-coronary thrombus with histological evidence of acute myocardial infarction were identified, in the third critical coronary disease was found, the fourth had an unrelated thoracic aortic dissection and the fifth had cardiomegaly in the setting of illicit drug use. Of 27 patients who experienced their SCD during exercise, only one had a CAA identified (the patient with thoracic aortic dissection).
Conclusion
In this prospective cohort of consecutive young patients with SCD who underwent autopsy, CAAs occurred in 1.0% of patients and did not cause any deaths. The role of CAAs in causing young SCD appears to be less significant than previously hypothesised.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): NHMRC, NHF
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Affiliation(s)
- E Paratz
- Baker Heart and Diabetes Institute , Melbourne , Australia
| | - A Van Heusden
- Baker Heart and Diabetes Institute , Melbourne , Australia
| | - D Zentner
- Royal Melbourne Hospital , Melbourne , Australia
| | - N Morgan
- Victorian Institute of Forensic Medicine , Melbourne , Australia
| | - K Smith
- Ambulance Victoria , Melbourne , Australia
| | - J Ball
- Ambulance Victoria , Melbourne , Australia
| | - T Thompson
- Royal Melbourne Hospital , Melbourne , Australia
| | - P James
- Royal Melbourne Hospital , Melbourne , Australia
| | - V Connell
- Royal Children's Hospital , Melbourne , Australia
| | - A Pflaumer
- Royal Children's Hospital , Melbourne , Australia
| | - C Semsarian
- University of Sydney, Heart Research Institute , Sydney , Australia
| | - J Ingles
- Garvan Institute of Medical Research , Sydney , Australia
| | - D Stub
- The Alfred Hospital , Melbourne , Australia
| | - S Parsons
- Victorian Institute of Forensic Medicine , Melbourne , Australia
| | - A La Gerche
- Baker Heart and Diabetes Institute , Melbourne , Australia
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22
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McNaughton AL, Paton RS, Edmans M, Youngs J, Wellens J, Phalora P, Fyfe A, Belij-Rammerstorfer S, Bolton JS, Ball J, Carnell GW, Dejnirattisai W, Dold C, Eyre DW, Hopkins P, Howarth A, Kooblall K, Klim H, Leaver S, Lee LN, López-Camacho C, Lumley SF, Macallan DC, Mentzer AJ, Provine NM, Ratcliff J, Slon-Compos J, Skelly D, Stolle L, Supasa P, Temperton N, Walker C, Wang B, Wyncoll D, Simmonds P, Lambe T, Baillie JK, Semple MG, Openshaw PJ, Obolski U, Turner M, Carroll M, Mongkolsapaya J, Screaton G, Kennedy SH, Jarvis L, Barnes E, Dunachie S, Lourenço J, Matthews PC, Bicanic T, Klenerman P, Gupta S, Thompson CP. Fatal COVID-19 outcomes are associated with an antibody response targeting epitopes shared with endemic coronaviruses. JCI Insight 2022; 7:156372. [PMID: 35608920 PMCID: PMC9310533 DOI: 10.1172/jci.insight.156372] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [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: 11/09/2021] [Accepted: 05/18/2022] [Indexed: 11/17/2022] Open
Abstract
The role of immune responses to previously seen endemic coronavirus epitopes in severe acute respiratory coronavirus 2 (SARS-CoV-2) infection and disease progression has not yet been determined. Here, we show that a key characteristic of fatal outcomes with coronavirus disease 2019 (COVID-19) is that the immune response to the SARS-CoV-2 spike protein is enriched for antibodies directed against epitopes shared with endemic beta-coronaviruses and has a lower proportion of antibodies targeting the more protective variable regions of the spike. The magnitude of antibody responses to the SARS-CoV-2 full-length spike protein, its domains and subunits, and the SARS-CoV-2 nucleocapsid also correlated strongly with responses to the endemic beta-coronavirus spike proteins in individuals admitted to an intensive care unit (ICU) with fatal COVID-19 outcomes, but not in individuals with nonfatal outcomes. This correlation was found to be due to the antibody response directed at the S2 subunit of the SARS-CoV-2 spike protein, which has the highest degree of conservation between the beta-coronavirus spike proteins. Intriguingly, antibody responses to the less cross-reactive SARS-CoV-2 nucleocapsid were not significantly different in individuals who were admitted to an ICU with fatal and nonfatal outcomes, suggesting an antibody profile in individuals with fatal outcomes consistent with an "original antigenic sin" type response.
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Affiliation(s)
- Anna L. McNaughton
- Peter Medawar Building for Pathogen Research
- Nuffield Department of Medicine, and
| | - Robert S. Paton
- Peter Medawar Building for Pathogen Research
- Department of Zoology, University of Oxford, Oxford, United Kingdom
| | - Matthew Edmans
- Peter Medawar Building for Pathogen Research
- Nuffield Department of Medicine, and
- Department of Zoology, University of Oxford, Oxford, United Kingdom
| | - Jonathan Youngs
- Institute of Infection & Immunity, St George’s University of London, London, United Kingdom
| | - Judith Wellens
- Peter Medawar Building for Pathogen Research
- Translational Gastroenterology Unit, Experimental Medicine Division, Nuffield Department of Medicine, John Radcliffe Hospital, Oxford, United Kingdom
- Translational Research for Gastrointestinal Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Prabhjeet Phalora
- Peter Medawar Building for Pathogen Research
- Nuffield Department of Medicine, and
| | - Alex Fyfe
- Peter Medawar Building for Pathogen Research
- Department of Zoology, University of Oxford, Oxford, United Kingdom
| | | | - Jai S. Bolton
- Peter Medawar Building for Pathogen Research
- Department of Zoology, University of Oxford, Oxford, United Kingdom
| | - Jonathan Ball
- General Intensive Care service, St George’s University Hospital National Health Service (NHS) Trust, London, United Kingdom
| | - George W. Carnell
- Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
| | | | | | - David W. Eyre
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Philip Hopkins
- Centre for Human & Applied Physiological Sciences, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King’s College, London, United Kingdom
| | - Alison Howarth
- Department of Microbiology/Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Kreepa Kooblall
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, and
| | - Hannah Klim
- Peter Medawar Building for Pathogen Research
- Department of Zoology, University of Oxford, Oxford, United Kingdom
- Future of Humanity Institute, Department of Philosophy, and
| | - Susannah Leaver
- General Intensive Care service, St George’s University Hospital National Health Service (NHS) Trust, London, United Kingdom
| | - Lian Ni Lee
- Peter Medawar Building for Pathogen Research
- Nuffield Department of Medicine, and
| | | | - Sheila F. Lumley
- Peter Medawar Building for Pathogen Research
- Nuffield Department of Medicine, and
- Department of Microbiology/Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Derek C. Macallan
- Institute of Infection & Immunity, St George’s University of London, London, United Kingdom
| | | | - Nicholas M. Provine
- Translational Gastroenterology Unit, Experimental Medicine Division, Nuffield Department of Medicine, John Radcliffe Hospital, Oxford, United Kingdom
| | - Jeremy Ratcliff
- Peter Medawar Building for Pathogen Research
- Nuffield Department of Medicine, and
| | - Jose Slon-Compos
- Wellcome Centre for Human Genetics, Nuffield Department of Medicine
| | - Donal Skelly
- Peter Medawar Building for Pathogen Research
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Lucas Stolle
- Department of Biochemistry, University of Oxford, Oxford, United Kingdom
| | - Piyada Supasa
- Wellcome Centre for Human Genetics, Nuffield Department of Medicine
| | - Nigel Temperton
- Viral Pseudotype Unit, Medway School of Pharmacy, University of Kent, Chatham, United Kingdom
| | - Chris Walker
- Meso Scale Diagnostics, Rockville, Maryland, USA
| | - Beibei Wang
- Wellcome Centre for Human Genetics, Nuffield Department of Medicine
| | - Duncan Wyncoll
- Intensive Care Medicine, Guy’s and St Thomas’ Hospital NHS Foundation Trust, London, United Kingdom
| | | | | | - Peter Simmonds
- Peter Medawar Building for Pathogen Research
- Nuffield Department of Medicine, and
| | - Teresa Lambe
- The Jenner Institute Laboratories, University of Oxford, Oxford, United Kingdom
| | | | - Malcolm G. Semple
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
| | | | | | - Uri Obolski
- School of Public Health, Faculty of Medicine, and
- Porter School of the Environment and Earth Sciences, Faculty of Exact Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Marc Turner
- National Microbiology Reference Unit, Scottish National Blood Transfusion Service, Edinburgh, United Kingdom
| | - Miles Carroll
- Wellcome Centre for Human Genetics, Nuffield Department of Medicine
- National Infection Service, Public Health England (PHE), Salisbury, United Kingdom
| | - Juthathip Mongkolsapaya
- Wellcome Centre for Human Genetics, Nuffield Department of Medicine
- Siriraj Center of Research for Excellence in Dengue & Emerging Pathogens, Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand
- Chinese Academy of Medical Science (CAMS) Oxford Institute (COI), University of Oxford, Oxford, United Kingdom
| | - Gavin Screaton
- Wellcome Centre for Human Genetics, Nuffield Department of Medicine
- Chinese Academy of Medical Science (CAMS) Oxford Institute (COI), University of Oxford, Oxford, United Kingdom
| | - Stephen H. Kennedy
- Nuffield Department of Women’s & Reproductive Health, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
| | - Lisa Jarvis
- National Microbiology Reference Unit, Scottish National Blood Transfusion Service, Edinburgh, United Kingdom
| | - Eleanor Barnes
- Peter Medawar Building for Pathogen Research
- Nuffield Department of Medicine, and
- Translational Gastroenterology Unit, Experimental Medicine Division, Nuffield Department of Medicine, John Radcliffe Hospital, Oxford, United Kingdom
| | - Susanna Dunachie
- Peter Medawar Building for Pathogen Research
- Department of Microbiology/Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - José Lourenço
- Peter Medawar Building for Pathogen Research
- Department of Zoology, University of Oxford, Oxford, United Kingdom
| | - Philippa C. Matthews
- Peter Medawar Building for Pathogen Research
- Nuffield Department of Medicine, and
- Department of Microbiology/Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Tihana Bicanic
- Institute of Infection & Immunity, St George’s University of London, London, United Kingdom
| | - Paul Klenerman
- Peter Medawar Building for Pathogen Research
- Nuffield Department of Medicine, and
- Translational Research for Gastrointestinal Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Sunetra Gupta
- Peter Medawar Building for Pathogen Research
- Department of Zoology, University of Oxford, Oxford, United Kingdom
| | - Craig P. Thompson
- Peter Medawar Building for Pathogen Research
- Department of Zoology, University of Oxford, Oxford, United Kingdom
- Division of Biomedical Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
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Logan C, Hemsley C, Fife A, Edgeworth J, Mazzella A, Wade P, Goodman A, Hopkins P, Wyncoll D, Ball J, Planche T, Schelenz S, Bicanic T. A multisite evaluation of antifungal use in critical care: implications for antifungal stewardship. JAC Antimicrob Resist 2022; 4:dlac055. [PMID: 35756574 PMCID: PMC9217759 DOI: 10.1093/jacamr/dlac055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 04/28/2022] [Indexed: 12/02/2022] Open
Abstract
Background ICUs are settings of high antifungal consumption. There are few data on prescribing practices in ICUs to guide antifungal stewardship implementation in this setting. Methods An antifungal therapy (AFT) service evaluation (15 May-19 November 2019) across ICUs at three London hospitals, evaluating consumption, prescribing rationale, post-prescription review, de-escalation and final invasive fungal infection (IFI) diagnostic classification. Results Overall, 6.4% of ICU admissions (305/4781) received AFT, accounting for 11.41 days of therapy/100 occupied bed days (DOT/100 OBD). The dominant prescribing mode was empirical (41% of consumption), followed by targeted (22%), prophylaxis (18%), pre-emptive (12%) and non-invasive (7%). Echinocandins were the most commonly prescribed drug class (4.59 DOT/100 OBD). In total, 217 patients received AFT for suspected or confirmed IFI; 12%, 10% and 23% were classified as possible, probable or proven IFI, respectively. Hence, in 55%, IFI was unlikely. Proven IFI (n = 50) was mostly invasive candidiasis (92%), of which 48% had been initiated on AFT empirically before yeast identification. Where on-site (1 → 3)-β-d-glucan (BDG) testing was available (1 day turnaround), in those with suspected but unproven invasive candidiasis, median (IQR) AFT duration was 10 (7-15) days with a positive BDG (≥80 pg/mL) versus 8 (5-9) days with a negative BDG (<80 pg/mL). Post-prescription review occurred in 79% of prescribing episodes (median time to review 1 [0-3] day). Where suspected IFI was not confirmed, 38% episodes were stopped and 4% de-escalated within 5 days. Conclusions Achieving a better balance between promptly treating IFI patients and avoiding inappropriate antifungal prescribing in the ICU requires timely post-prescription review by specialist multidisciplinary teams and improved, evidence-based-risk prescribing strategies incorporating rapid diagnostics to guide AFT start and stop decisions.
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Affiliation(s)
- C Logan
- Corresponding author. E-mail:
| | - C Hemsley
- Department of Infectious Diseases, Guy’s & St Thomas’ NHS Foundation Trust, London, UK
| | - A Fife
- Infection Sciences, King’s College Hospital NHS Foundation Trust, London, UK
| | - J Edgeworth
- Department of Infectious Diseases, Guy’s & St Thomas’ NHS Foundation Trust, London, UK,Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, King’s College London Guy’s & St Thomas’ NHS Foundation Trust, London, UK
| | - A Mazzella
- Clinical Infection Group, St George’s University Hospitals NHS Foundation Trust, London, UK,Institute of Infection & Immunity, St George’s University of London, London, UK
| | - P Wade
- Department of Infectious Diseases, Guy’s & St Thomas’ NHS Foundation Trust, London, UK,Directorate of Pharmacy & Medicines Optimisation, Guy’s & St Thomas’s NHS Foundation Trust, London, UK
| | - A Goodman
- Department of Infectious Diseases, Guy’s & St Thomas’ NHS Foundation Trust, London, UK,Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, King’s College London Guy’s & St Thomas’ NHS Foundation Trust, London, UK,MRC Clinical Trials Unit at University College London, London, UK
| | - P Hopkins
- Department of Critical Care, King’s College Hospital NHS Foundation Trust, London, UK
| | - D Wyncoll
- Department of Critical Care, Guy’s & St Thomas’ NHS Foundation Trust, London, UK
| | - J Ball
- Department of Critical Care, St George’s University Hospitals NHS Foundation Trust, London, UK
| | - T Planche
- Clinical Infection Group, St George’s University Hospitals NHS Foundation Trust, London, UK,Institute of Infection & Immunity, St George’s University of London, London, UK
| | - S Schelenz
- Infection Sciences, King’s College Hospital NHS Foundation Trust, London, UK
| | - T Bicanic
- Clinical Infection Group, St George’s University Hospitals NHS Foundation Trust, London, UK,Institute of Infection & Immunity, St George’s University of London, London, UK
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24
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Turner L, Culliford D, Ball J, Kitson-Reynolds E, Griffiths P. The association between midwifery staffing levels and the experiences of mothers on postnatal wards: Cross sectional analysis of routine data. Women Birth 2022; 35:e583-e589. [DOI: 10.1016/j.wombi.2022.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 01/08/2022] [Accepted: 02/10/2022] [Indexed: 10/19/2022]
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Paratz E, van Heusden A, Ball J, Smith K, Thompson T, Zentner D, James P, Parsons S, Morgan N, Connell V, Pflaumer A, Semsarian C, Ingles J, Stub D, La Gerche A. Inconsistent Discharge Diagnoses for Young Cardiac Arrest Episodes: Insights From a State-wide Registry. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.169] [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: 10/16/2022]
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26
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Paratz E, van Heusden A, Ball J, Smith K, Zentner D, James P, Thompson T, Morgan N, Parsons S, Connell V, Pflaumer A, Semsarian C, Ingles J, Stub D, La Gerche A. Predictors and Outcomes of In-Hospital Referrals for Forensic Investigation After Young Sudden Cardiac Death. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.185] [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: 11/16/2022]
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27
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Paratz E, van Heusden A, Zentner D, Morgan N, Smith K, Ball J, Thompson T, James P, Connell V, Pflaumer A, Semsarian C, Ingles J, Parsons S, Stub D, La Gerche A. Prevalence of Coronary Artery Anomalies in Young Sudden Cardiac Death: Insights From a Prospective State-Wide Registry. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.034] [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: 10/16/2022]
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28
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Paratz E, van Heusden A, Smith K, Ball J, Zentner D, Morgan N, Thompson T, James P, Connell V, Pflaumer A, Semsarian C, Ingles J, Parsons S, Stub D, La Gerche A. Higher Rates But Similar Causes of Young Out-Of-Hospital Cardiac Arrest in Rural Australian Patients. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.503] [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: 10/16/2022]
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Azcui Aparicio R, Huynh Q, Ball J, Marwick T, Carrington M. Imaging-Guided and Nurse-Coordinated Disease Management Program for Primary Prevention of Cardiovascular Disease: Findings From the IMPRESS Randomised Controlled Trial. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.254] [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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Pijuan-Galito S, Tarantini FS, Tomlin H, Jenkins H, Thompson JL, Scales D, Stroud A, Tellechea Lopez A, Hassall J, McTernan PG, Coultas A, Arendt-Tranholm A, Reffin C, Hill I, Lee IN, Wu S, Porte J, Chappell J, Lis-Slimak K, Kaneko K, Doolan L, Ward M, Stonebridge M, Ilyas M, McClure P, Tighe P, Gwynne P, Hyde R, Ball J, Seedhouse C, Benest AV, Petrie M, Denning C. Saliva for COVID-19 Testing: Simple but Useless or an Undervalued Resource? Front Virol 2021. [DOI: 10.3389/fviro.2021.778790] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
During the COVID-19 pandemic, countries with robust population-based asymptomatic testing were generally successful in controlling virus spread, hence reducing hospitalizations and deaths. This effectiveness inspired widespread asymptomatic surveillance for COVID-19/SARS-CoV-2 globally. Polarized vaccination programs, coupled with the relatively short-lived immunity vaccines provide, mean that reciprocal cross-border exchanges of each new variant are likely, as evidenced by Delta and Gamma, and asymptomatic testing will be required for the foreseeable future. Reliance on nasopharyngeal swabs contributes to “testing fatigue” arising due to difficulties in standardizing administration, unpleasantness, and inappropriateness of use in younger people or individuals with special needs. There has also been erosion in confidence of testing due to variable and/or poor accuracy of lateral flow devices to detect COVID-19. Here, we question why saliva-based PCR assays are not being used more widely, given that standardization is easy and this non-invasive test is suitable for everyone, providing high sensitivity and accuracy. We reflect on our experience with the University of Nottingham COVID-19 Asymptomatic Testing, where (as of October 2021) 96,317 samples have been processed by RT-qPCR from 23,740 repeat saliva donors, yielding 465 positive cases. We challenge myths that saliva is difficult to process, concluding that it is an undervalued resource for both asymptomatic and symptomatic detection of SARS-CoV-2 genomes to an accuracy of >99% and a sensitivity of 1–10 viral copies/μl. In July 2021, our data enabled Nottingham to become the first UK University to gain accreditation and the first UK institute to gain this accolade for saliva.
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Knight H, Carlisle S, O’Connor M, Briggs L, Fothergill L, Al-Oraibi A, Yildirim M, Morling JR, Corner J, Ball J, Denning C, Vedhara K, Blake H. Impacts of the COVID-19 Pandemic and Self-Isolation on Students and Staff in Higher Education: A Qualitative Study. Int J Environ Res Public Health 2021; 18:10675. [PMID: 34682418 PMCID: PMC8535702 DOI: 10.3390/ijerph182010675] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 10/05/2021] [Indexed: 12/21/2022]
Abstract
This qualitative study explored the impact of COVID-19 self-isolation and social restriction measures on university students, through the perspectives of both students and the staff supporting them. The study comprised 11 focus groups (students) and 26 individual interviews (staff) at a higher education institution in England during a period of national lockdown (January-March 2021). Participants were university students (n = 52) with self-isolation experiences and university staff (n = 26) with student-facing support roles. Focus group and interview data were combined and analysed using an inductive thematic approach. Four themes emerged: 'Adaptation during the pandemic', 'Practical, environmental, and emotional challenges of self-isolating', 'Social factors and their impact on COVID-19 testing and self-isolation adherence', and 'Supporting self-isolation'. Students and staff struggled with the imposed restrictions and shift to online education. Students found it difficult to adapt to new expectations for university life and reported missing out on professional and social experiences. Students and staff noted concerns about the impact of online teaching on educational outcomes. Students endorsed varied emotional responses to self-isolation; some felt unaffected whilst others experienced lowered mood and loneliness. Students were motivated by pro-social attitudes; campaigns targeting these factors may encourage continued engagement in protective behaviours. Staff struggled to manage their increased workloads delivering support for self-isolating students. Universities must consider the support needs of students during self-isolation and prepare for the long-term impacts of the pandemic on student wellbeing and educational attainment. Greater support should be provided for staff during transitional periods, with ongoing monitoring of workforce stress levels warranted.
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Affiliation(s)
- Holly Knight
- School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK; (S.C.); (J.R.M.); (C.D.); (K.V.)
| | - Sophie Carlisle
- School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK; (S.C.); (J.R.M.); (C.D.); (K.V.)
| | - Mórna O’Connor
- School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK; (M.O.); (L.B.); (L.F.); (A.A.-O.); (M.Y.); (H.B.)
| | - Lydia Briggs
- School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK; (M.O.); (L.B.); (L.F.); (A.A.-O.); (M.Y.); (H.B.)
| | - Lauren Fothergill
- School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK; (M.O.); (L.B.); (L.F.); (A.A.-O.); (M.Y.); (H.B.)
| | - Amani Al-Oraibi
- School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK; (M.O.); (L.B.); (L.F.); (A.A.-O.); (M.Y.); (H.B.)
| | - Mehmet Yildirim
- School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK; (M.O.); (L.B.); (L.F.); (A.A.-O.); (M.Y.); (H.B.)
| | - Joanne R. Morling
- School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK; (S.C.); (J.R.M.); (C.D.); (K.V.)
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham NG7 2UH, UK
| | - Jessica Corner
- University Executive Board, University of Nottingham, Nottingham NG7 2RD, UK;
| | - Jonathan Ball
- Biodiscovery Institute, University of Nottingham, Nottingham NG7 2RD, UK;
- School of Life Sciences, University of Nottingham, Nottingham NG7 2UH, UK
| | - Chris Denning
- School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK; (S.C.); (J.R.M.); (C.D.); (K.V.)
- Biodiscovery Institute, University of Nottingham, Nottingham NG7 2RD, UK;
| | - Kavita Vedhara
- School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK; (S.C.); (J.R.M.); (C.D.); (K.V.)
| | - Holly Blake
- School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK; (M.O.); (L.B.); (L.F.); (A.A.-O.); (M.Y.); (H.B.)
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham NG7 2UH, UK
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Qaderi V, Ball J, Nehme Z, Neumann JT, Wolfe R, Woods R, Tonkin AM, Smith K, McNeil JJ. Out-of-hospital cardiac arrest in elderly individuals. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Out-of-hospital cardiac arrest (OHCA) is associated with poor outcome, particularly in elderly people. Due to the shift in global demographics towards an ageing population, understanding risk factors for OHCA is essential for the development of primary prevention strategies. Thus, we aimed to identify predictors for OHCA in a large, community-dwelling cohort of elderly individuals.
Methods
We analyzed data from 11,156 participants enrolled in a randomized, placebo-controlled primary prevention trial, investigating the effect of low-dose aspirin in individuals aged 70 years or above. At baseline all participants had no prior cardiovascular disease events, dementia or major physical disability. OHCA events occurring within 5 years were identified by probabilistic data-linkage with a state-wide out-of-hospital cardiac arrest registry. Possible predictors included age, sex, anthropometric measures, conventional cardiovascular risk factors, renal function and frailty. To evaluate the association with OHCA, we performed univariable and multivariable Cox regression analyses. In exploratory analyses we also evaluated the effect of low-dose aspirin on OHCA events.
Results
In the cohort 54.7% were female and median age was 74.1 years (Interquartile Range [IQR] 71.8–77.7). During a median follow up time of 4.7 years (IQR 3.4–6.0) we recorded 67 OHCA events with presumed cardiac cause. The incidence rate was 1.07 per 1,000 person-years (95% Confidence-Interval [CI] 0.80–1.40). The mortality rate following OHCA was 91.2% (n=62). Univariable Cox regression analyses identified age, sex, weight, abdominal circumference, serum creatinine, diabetes, arterial hypertension, intake of antihypertensive medication and pre-frailty as predictors for the outcome. In multivariable Cox regression analyses we identified age (Hazard Ratio [HR] 1.06, CI 1.00–1.13), female sex (HR 0.49, CI 0.26–0.94) and pre-frailty (HR 1.92, CI 1.03–3.58) to be independent predictors (Table). In exploratory analyses there was no effect of low-dose aspirin on OHCA (HR 1.52, CI 0.87–2.70).
Conclusion
In a large, contemporary cohort of healthy, elderly individuals we describe a significant incidence of OHCA events associated with a very high mortality. We identified age, sex and pre-frailty, but interestingly not conventional cardiovascular risk factors as independent predictors of OHCA. We could not show a benefit of low-dose aspirin treatment, although the number of events was small. Our findings emphasize the importance of preventive strategies for pre-frailty in elderly individuals.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): The ASPREE study was primarily funded by the National Institute of Aging and National Cancer Institute at the National Institutes of Health (grant number U01AG029824), the Australian National Health & Medical Research Council (grants 334047 & 1127060), Monash University (Australia) and the Victorian Cancer Agency (Australia). Multivariable Cox regression analyses
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Affiliation(s)
- V Qaderi
- Monash University, Department of Epidemiology and Preventive Medicine, Melbourne, Australia
| | - J Ball
- Ambulance Victoria, Centre for Research and Evaluation, Melbourne, Australia
| | - Z Nehme
- Ambulance Victoria, Centre for Research and Evaluation, Melbourne, Australia
| | - J T Neumann
- Monash University, Department of Epidemiology and Preventive Medicine, Melbourne, Australia
| | - R Wolfe
- Monash University, Department of Epidemiology and Preventive Medicine, Melbourne, Australia
| | - R Woods
- Monash University, Department of Epidemiology and Preventive Medicine, Melbourne, Australia
| | - A M Tonkin
- Monash University, Department of Epidemiology and Preventive Medicine, Melbourne, Australia
| | - K Smith
- Ambulance Victoria, Centre for Research and Evaluation, Melbourne, Australia
| | - J J McNeil
- Monash University, Department of Epidemiology and Preventive Medicine, Melbourne, Australia
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Haas LEM, Boumendil A, Flaatten H, Guidet B, Ibarz M, Jung C, Moreno R, Morandi A, Andersen FH, Zafeiridis T, Walther S, Oeyen S, Leaver S, Watson X, Boulanger C, Szczeklik W, Schefold JC, Cecconi M, Marsh B, Joannidis M, Nalapko Y, Elhadi M, Fjølner J, Artigas A, de Lange DW, Joannidis M, Eller P, Helbok R, Schmutz R, Nollet J, de Neve N, De Buysscher P, Oeyen S, Swinnen W, Mikačić M, Bastiansen A, Husted A, Dahle BES, Cramer C, Sølling C, Ørsnes D, Thomsen JE, Pedersen JJ, Enevoldsen MH, Elkmann T, Kubisz-Pudelko A, Pope A, Collins A, Raj AS, Boulanger C, Frey C, Hart C, Bolger C, Spray D, Randell G, Filipe H, Welters ID, Grecu I, Evans J, Cupitt J, Lord J, Henning J, Jones J, Ball J, North J, Salaunkey K, De Gordoa LOR, Bell L, Balasubramaniam M, Vizcaychipi M, Faulkner M, Mupudzi M, Lea-Hagerty M, Reay M, Spivey M, Love N, Spittle NSN, White N, Williams P, Morgan P, Wakefield P, Savine R, Jacob R, Innes R, Kapoor R, Humphreys S, Rose S, Dowling S, Leaver S, Mane T, Lawton T, Ogbeide V, Khaliq W, Baird Y, Romen A, Galbois A, Guidet B, Vinsonneau C, Charron C, Thevenin D, Guerot E, Besch G, Savary G, Mentec H, Chagnon JL, Rigaud JP, Quenot JP, Castaneray J, Rosman J, Maizel J, Tiercelet K, Vettoretti L, Hovaere MM, Messika M, Djibré M, Rolin N, Burtin P, Garcon P, Nseir S, Valette X, Rabe C, Barth E, Ebelt H, Fuest K, Franz M, Horacek M, Schuster M, Meybohm P, Bruno RR, Allgäuer S, Dubler S, Schaller SJ, Schering S, Steiner S, Dieck T, Rahmel T, Graf T, Koutsikou A, Vakalos A, Raitsiou B, Flioni EN, Neou E, Tsimpoukas F, Papathanakos G, Marinakis G, Koutsodimitropoulos I, Aikaterini K, Rovina N, Kourelea S, Polychronis T, Zidianakis V, Konstantinia V, Aidoni Z, Marsh B, Motherway C, Read C, Martin-Loeches I, Cracchiolo AN, Morigi A, Calamai I, Brusa S, Elhadi A, Tarek A, Khaled A, Ahmed H, Belkhair WA, Cornet AD, Gommers D, de Lange D, van Boven E, Haringman J, Haas L, van den Berg L, Hoiting O, de Jager P, Gerritsen RT, Dormans T, Dieperink W, Breidablik ABA, Slapgard A, Rime AK, Jannestad B, Sjøbøe B, Rice E, Andersen FH, Strietzel HF, Jensen JP, Langørgen J, Tøien K, Strand K, Hahn M, Klepstad P, Biernacka A, Kluzik A, Kudlinski B, Maciejewski D, Studzińska D, Hymczak H, Stefaniak J, Solek-Pastuszka J, Zorska J, Cwyl K, Krzych LJ, Zukowski M, Lipińska-Gediga M, Pietruszko M, Piechota M, Serwa M, Czuczwar M, Ziętkiewicz M, Kozera N, Nasiłowski P, Sendur P, Zatorski P, Galkin P, Gawda R, Kościuczuk U, Cyrankiewicz W, Gola W, Pinto AF, Fernandes AM, Santos AR, Sousa C, Barros I, Ferreira IA, Blanco JB, Carvalho JT, Maia J, Candeias N, Catorze N, Belskiy V, Lores A, Mira AP, Cilloniz C, Perez-Torres D, Maseda E, Rodriguez E, Prol-Silva E, Eixarch G, Gomà G, Aguilar G, Velasco GN, Jaimes MI, Villamayor MI, Fernández NL, Cubero PJ, López-Cuenca S, Tomasa T, Sjöqvist A, Brorsson C, Schiöler F, Westberg H, Nauska J, Sivik J, Berkius J, Thiringer KK, De Geer L, Walther S, Boroli F, Schefold JC, Hergafi L, Eckert P, Yıldız I, Yovenko I, Nalapko Y, Nalapko Y, Pugh R. Frailty is associated with long-term outcome in patients with sepsis who are over 80 years old: results from an observational study in 241 European ICUs. Age Ageing 2021; 50:1719-1727. [PMID: 33744918 DOI: 10.1093/ageing/afab036] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 10/20/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Sepsis is one of the most frequent reasons for acute intensive care unit (ICU) admission of very old patients and mortality rates are high. However, the impact of pre-existing physical and cognitive function on long-term outcome of ICU patients ≥ 80 years old (very old intensive care patients (VIPs)) with sepsis is unclear. OBJECTIVE To investigate both the short- and long-term mortality of VIPs admitted with sepsis and assess the relation of mortality with pre-existing physical and cognitive function. DESIGN Prospective cohort study. SETTING 241 ICUs from 22 European countries in a six-month period between May 2018 and May 2019. SUBJECTS Acutely admitted ICU patients aged ≥80 years with sequential organ failure assessment (SOFA) score ≥ 2. METHODS Sepsis was defined according to the sepsis 3.0 criteria. Patients with sepsis as an admission diagnosis were compared with other acutely admitted patients. In addition to patients' characteristics, disease severity, information about comorbidity and polypharmacy and pre-existing physical and cognitive function were collected. RESULTS Out of 3,596 acutely admitted VIPs with SOFA score ≥ 2, a group of 532 patients with sepsis were compared to other admissions. Predictors for 6-month mortality were age (per 5 years): Hazard ratio (HR, 1.16 (95% confidence interval (CI), 1.09-1.25, P < 0.0001), SOFA (per one-point): HR, 1.16 (95% CI, 1.14-1.17, P < 0.0001) and frailty (CFS > 4): HR, 1.34 (95% CI, 1.18-1.51, P < 0.0001). CONCLUSIONS There is substantial long-term mortality in VIPs admitted with sepsis. Frailty, age and disease severity were identified as predictors of long-term mortality in VIPs admitted with sepsis.
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Affiliation(s)
- Lenneke E M Haas
- Department of Intensive Care Medicine, Diakonessenhuis Utrecht, Utrecht, The Netherlands
| | - Ariane Boumendil
- Assistance Publique-Hôpital de Paris, Hôpital Saint-Antoine, Service de Réanimation Médicale. Paris F-75012, France
| | - Hans Flaatten
- Department of Clinical Medicine, University of Bergen, Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Bertrand Guidet
- Institut Pierre Louis d’Epidémiologie et de Santé Publique, AP-HP, Hôpital Saint-Antoine, Service de Réanimation, Sorbonne Université, INSERM, F75012 Paris, France
| | - Mercedes Ibarz
- Department of Intensive Care Medicine, Universitary Hospital Sagrat Cor Barcelona, Spain
| | - Christian Jung
- Division of Cardiology, Pulmonology and Vascular Medicine, University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
| | - Rui Moreno
- Unidade de Cuidados Intensivos Neurocríticos e Trauma. Hospital de São José, Centro Hospitalar, Faculdade de Ciências Médicas de Lisboa (Nova Medical School), Universitário de Lisboa Central, Lisbon, Portugal
| | - Alessandro Morandi
- Department of Rehabilitation and Aged Care, Hospital Ancelle, Cremona, Italy. Parc Sanitari Pere Virgili and Vall d’Hebrón Institute of Research, Barcelona, Spain
| | - Finn H Andersen
- Department of Anaesthesia and Intensive Care, Ålesund Hospital, Ålesund, Norway, Department of Circulation and Medical Imaging, NTNU, Trondheim, Norway
| | | | - Sten Walther
- Department of Cardiothoracic and Vascular Surgery, Heart Centre, Linköping University Hospital, Linköping, Sweden
| | - Sandra Oeyen
- Department of Intensive Care 1K12IC, Ghent University Hospital, Ghent, Belgium
| | - Susannah Leaver
- Research Lead Critical Care Directorate St George's University Hospital, NHS Foundation Trust, London, UK
| | | | - Carole Boulanger
- Chair NAHP Section ESICM, Intensive Care Unit, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
| | - Wojciech Szczeklik
- Intensive Care and Perioperative Medicine Division, Jagiellonian University Medical College, Kraków, Poland
| | - Joerg C Schefold
- Department of Intensive Care Medicine, Inselspital, Universitätsspital, University of Bern, Bern, Switzerland
| | - Maurizio Cecconi
- Department of Anesthesia and Intensive Care Medicine, Humanitas Clinical and Research Center - IRCCS, Via Alessandro Manzoni 56, 20089, Rozzano, MI, Italy. Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Rozzano, MI, Italy
| | - Brian Marsh
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - Michael Joannidis
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Yuriy Nalapko
- European Wellness International, ICU, Luhansk, Ukraine
| | | | - Jesper Fjølner
- Department of Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Antonio Artigas
- Department of Intensive Care Medicine, CIBER Enfermedades Respiratorias, Corporacion Sanitaria Universitaria Parc Tauli, Autonomous University of Barcelona. Sabadell, Spain
| | - Dylan W de Lange
- Department of Intensive Care Medicine, University Medical Center, University Utrecht, Utrecht, The Netherlands
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Youngs J, Provine NM, Lim N, Sharpe HR, Amini A, Chen YL, Luo J, Edmans MD, Zacharopoulou P, Chen W, Sampson O, Paton R, Hurt WJ, Duncan DA, McNaughton AL, Miao VN, Leaver S, Wyncoll DLA, Ball J, Hopkins P, Skelly DT, Barnes E, Dunachie S, Ogg G, Lambe T, Pavord I, Shalek AK, Thompson CP, Xue L, Macallan DC, Goulder P, Klenerman P, Bicanic T. Identification of immune correlates of fatal outcomes in critically ill COVID-19 patients. PLoS Pathog 2021; 17:e1009804. [PMID: 34529726 PMCID: PMC8445447 DOI: 10.1371/journal.ppat.1009804] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 07/16/2021] [Indexed: 12/15/2022] Open
Abstract
Prior studies have demonstrated that immunologic dysfunction underpins severe illness in COVID-19 patients, but have lacked an in-depth analysis of the immunologic drivers of death in the most critically ill patients. We performed immunophenotyping of viral antigen-specific and unconventional T cell responses, neutralizing antibodies, and serum proteins in critically ill patients with SARS-CoV-2 infection, using influenza infection, SARS-CoV-2-convalescent health care workers, and healthy adults as controls. We identify mucosal-associated invariant T (MAIT) cell activation as an independent and significant predictor of death in COVID-19 (HR = 5.92, 95% CI = 2.49-14.1). MAIT cell activation correlates with several other mortality-associated immunologic measures including broad activation of CD8+ T cells and non-Vδ2 γδT cells, and elevated levels of cytokines and chemokines, including GM-CSF, CXCL10, CCL2, and IL-6. MAIT cell activation is also a predictor of disease severity in influenza (ECMO/death HR = 4.43, 95% CI = 1.08-18.2). Single-cell RNA-sequencing reveals a shift from focused IFNα-driven signals in COVID-19 ICU patients who survive to broad pro-inflammatory responses in fatal COVID-19 -a feature not observed in severe influenza. We conclude that fatal COVID-19 infection is driven by uncoordinated inflammatory responses that drive a hierarchy of T cell activation, elements of which can serve as prognostic indicators and potential targets for immune intervention.
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Affiliation(s)
- Jonathan Youngs
- Institute for Infection & Immunity, St. George’s University of London, London, United Kingdom
- Clinical Academic Group in Infection and Immunity, St. George’s Hospital NHS Trust, London, United Kingdom
| | - Nicholas M. Provine
- Peter Medawar Building for Pathogen Research, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Translational Gastroenterology Unit, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Nicholas Lim
- Peter Medawar Building for Pathogen Research, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | | | - Ali Amini
- Peter Medawar Building for Pathogen Research, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Translational Gastroenterology Unit, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Yi-Ling Chen
- MRC Human Immunology Unit, Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, United Kingdom
| | - Jian Luo
- Respiratory Medicine Unit, and Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
| | - Matthew D. Edmans
- Peter Medawar Building for Pathogen Research, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Panagiota Zacharopoulou
- Peter Medawar Building for Pathogen Research, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Wentao Chen
- Respiratory Medicine Unit, and Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
| | - Oliver Sampson
- Peter Medawar Building for Pathogen Research, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Robert Paton
- Peter Medawar Building for Pathogen Research, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - William J. Hurt
- Institute for Infection & Immunity, St. George’s University of London, London, United Kingdom
- Clinical Academic Group in Infection and Immunity, St. George’s Hospital NHS Trust, London, United Kingdom
| | - David A. Duncan
- MRC Human Immunology Unit, Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, United Kingdom
- Diamond Light Source, Harwell Science and Innovation Campus, Didcot, United Kingdom
| | - Anna L. McNaughton
- Peter Medawar Building for Pathogen Research, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Vincent N. Miao
- Institute for Medical Engineering and Science, Department of Chemistry, and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, United States of America
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, Massachusetts, United States of America
| | - Susannah Leaver
- Intensive Care Medicine, St George’s University Hospital NHS Foundation Trust, London, United Kingdom
| | - Duncan L. A. Wyncoll
- Intensive Care Medicine, Guy’s and St Thomas’ Hospital NHS Foundation Trust, London, United Kingdom
| | - Jonathan Ball
- Intensive Care Medicine, St George’s University Hospital NHS Foundation Trust, London, United Kingdom
| | - Philip Hopkins
- Centre for Human & Applied Physiological Sciences, School of Basic & Medical Biosciences, Faculty of Life Sciences, & Medicine, King’s College, London, United Kingdom
| | | | | | - Donal T. Skelly
- Peter Medawar Building for Pathogen Research, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Eleanor Barnes
- Peter Medawar Building for Pathogen Research, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Translational Gastroenterology Unit, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Jenner Institute, University of Oxford, Oxford, United Kingdom
| | - Susanna Dunachie
- Peter Medawar Building for Pathogen Research, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Graham Ogg
- MRC Human Immunology Unit, Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, United Kingdom
| | - Teresa Lambe
- Jenner Institute, University of Oxford, Oxford, United Kingdom
| | - Ian Pavord
- Respiratory Medicine Unit, and Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
| | - Alex K. Shalek
- Institute for Medical Engineering and Science, Department of Chemistry, and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, United States of America
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, Massachusetts, United States of America
| | - Craig P. Thompson
- Peter Medawar Building for Pathogen Research, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Luzheng Xue
- Respiratory Medicine Unit, and Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
| | - Derek C. Macallan
- Institute for Infection & Immunity, St. George’s University of London, London, United Kingdom
- Clinical Academic Group in Infection and Immunity, St. George’s Hospital NHS Trust, London, United Kingdom
| | - Philip Goulder
- Peter Medawar Building for Pathogen Research, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Paul Klenerman
- Peter Medawar Building for Pathogen Research, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Translational Gastroenterology Unit, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Tihana Bicanic
- Institute for Infection & Immunity, St. George’s University of London, London, United Kingdom
- Clinical Academic Group in Infection and Immunity, St. George’s Hospital NHS Trust, London, United Kingdom
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Rovira A, Tricklebank S, Surda P, Whebell S, Zhang J, Takhar A, Yeung E, Fan K, Ahmed I, Hopkins P, Dawson D, Ball J, Kumar R, Khaliq W, Simo R, Arora A. Response to comments to "Open versus percutaneous tracheostomy in COVID-19: a multicentre comparison and recommendationfor future resource utilisation". Eur Arch Otorhinolaryngol 2021; 278:2165-2166. [PMID: 33830366 PMCID: PMC8026387 DOI: 10.1007/s00405-021-06775-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 03/20/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Aleix Rovira
- Department of Otolaryngology and Head and Neck Surgery, Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London, SE1 9RT, UK.
| | - Stephen Tricklebank
- Department of Critical Care, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Pavol Surda
- Department of Otolaryngology and Head and Neck Surgery, Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London, SE1 9RT, UK
| | - Stephen Whebell
- Department of Critical Care, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Joe Zhang
- Department of Critical Care, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Arun Takhar
- Department of Otolaryngology and Head and Neck Surgery, Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London, SE1 9RT, UK
| | - Elizabeth Yeung
- Department of Oral and Maxillofacial Surgery, Kings College Hospital NHS Foundation Trust, London, UK
| | - Kathleen Fan
- Department of Oral and Maxillofacial Surgery, Kings College Hospital NHS Foundation Trust, London, UK
| | - Imran Ahmed
- Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Phillip Hopkins
- Department of Critical Care, Kings College Hospital NHS Foundation Trust, London, UK
| | - Deborah Dawson
- Department of Critical Care, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Jonathan Ball
- Department of Critical Care, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Ram Kumar
- Department of Critical Care, Kingston Hospital NHS Foundation Trust, London, UK
| | - Waqas Khaliq
- Department of Critical Care, Lewisham and Greenwich NHS Trust, London, UK
| | - Ricard Simo
- Department of Otolaryngology and Head and Neck Surgery, Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London, SE1 9RT, UK
| | - Asit Arora
- Department of Otolaryngology and Head and Neck Surgery, Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London, SE1 9RT, UK
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Paratz E, Ross L, van Heusden A, Zentner D, Thompson T, James P, Smith K, Ball J, Pflaumer A, Stub D, La Gerche A, Morgan N, Bouwer H, Lynch M, Parsons S. Unrecognised Intracoronary IgG4-Related Disease: A Rare Cause of Two Sudden Cardiac Deaths. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Blake H, Corner J, Cirelli C, Hassard J, Briggs L, Daly JM, Bennett M, Chappell JG, Fairclough L, McClure CP, Tarr A, Tighe P, Favier A, Irving W, Ball J. Perceptions and Experiences of the University of Nottingham Pilot SARS-CoV-2 Asymptomatic Testing Service: A Mixed-Methods Study. Int J Environ Res Public Health 2020; 18:E188. [PMID: 33383781 PMCID: PMC7796111 DOI: 10.3390/ijerph18010188] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [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] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 12/18/2020] [Accepted: 12/20/2020] [Indexed: 01/01/2023]
Abstract
We aimed to explore student and staff perceptions and experiences of a pilot SARS-CoV-2 asymptomatic testing service (P-ATS) in a UK university campus setting. This was a mixed-method study comprised of an online survey, and thematic analysis of qualitative data from interviews and focus groups conducted at the mid-point and end of the 12-week P-ATS programme. Ninety-nine students (84.8% female, 70% first year; 93.9% P-ATS participants) completed an online survey, 41 individuals attended interviews or focus groups, including 31 students (21 first year; 10 final year) and 10 staff. All types of testing and logistics were highly acceptable (virus: swab, saliva; antibody: finger prick) and 94.9% would participate again. Reported adherence to weekly virus testing was high (92.4% completed ≥6 tests; 70.8% submitted all 10 swabs; 89.2% completed ≥1 saliva sample) and 76.9% submitted ≥3 blood samples. Students tested to "keep campus safe", "contribute to national efforts to control COVID-19", and "protect others". In total, 31.3% had high anxiety as measured by the Generalized Anxiety Disorder scale (GAD-7) (27.1% of first year). Students with lower levels of anxiety and greater satisfaction with university communications around P-ATS were more likely to adhere to virus and antibody tests. Increased adherence to testing was associated with higher perceived risk of COVID-19 to self and others. Qualitative findings revealed 5 themes and 13 sub-themes: "emotional responses to COVID-19", "university life during COVID-19", "influences on testing participation", "testing physical and logistical factors" and "testing effects on mental wellbeing". Asymptomatic COVID-19 testing (SARS-CoV-2 virus/antibodies) is highly acceptable to students and staff in a university campus setting. Clear communications and strategies to reduce anxiety are likely to be important for testing uptake and adherence. Strategies are needed to facilitate social connections and mitigate the mental health impacts of COVID-19 and self-isolation.
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Affiliation(s)
- Holly Blake
- School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK;
- NIHR Nottingham Biomedical Research Centre, Nottingham NG7 2UH/NG7 2RD, UK; (J.G.C.); (C.P.M.); (A.T.); (P.T.); (W.I.); (J.B.)
| | - Jessica Corner
- University Executive Board, University of Nottingham, Nottingham NG7 2RD, UK;
| | - Cecilia Cirelli
- School of Medicine, University of Nottingham, Nottingham NG7 2UH/NG7 2TU, UK; (C.C.); (J.H.)
| | - Juliet Hassard
- School of Medicine, University of Nottingham, Nottingham NG7 2UH/NG7 2TU, UK; (C.C.); (J.H.)
| | - Lydia Briggs
- School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK;
| | - Janet M. Daly
- School of Veterinary Medicine and Science, University of Nottingham, Loughborough LE12 5RD, UK; (J.M.D.); (M.B.)
| | - Malcolm Bennett
- School of Veterinary Medicine and Science, University of Nottingham, Loughborough LE12 5RD, UK; (J.M.D.); (M.B.)
| | - Joseph G. Chappell
- NIHR Nottingham Biomedical Research Centre, Nottingham NG7 2UH/NG7 2RD, UK; (J.G.C.); (C.P.M.); (A.T.); (P.T.); (W.I.); (J.B.)
- School of Life Sciences, University of Nottingham, Nottingham NG7 2RD/NG7 2UH, UK;
| | - Lucy Fairclough
- School of Life Sciences, University of Nottingham, Nottingham NG7 2RD/NG7 2UH, UK;
| | - C. Patrick McClure
- NIHR Nottingham Biomedical Research Centre, Nottingham NG7 2UH/NG7 2RD, UK; (J.G.C.); (C.P.M.); (A.T.); (P.T.); (W.I.); (J.B.)
- School of Life Sciences, University of Nottingham, Nottingham NG7 2RD/NG7 2UH, UK;
| | - Alexander Tarr
- NIHR Nottingham Biomedical Research Centre, Nottingham NG7 2UH/NG7 2RD, UK; (J.G.C.); (C.P.M.); (A.T.); (P.T.); (W.I.); (J.B.)
- School of Life Sciences, University of Nottingham, Nottingham NG7 2RD/NG7 2UH, UK;
| | - Patrick Tighe
- NIHR Nottingham Biomedical Research Centre, Nottingham NG7 2UH/NG7 2RD, UK; (J.G.C.); (C.P.M.); (A.T.); (P.T.); (W.I.); (J.B.)
- School of Life Sciences, University of Nottingham, Nottingham NG7 2RD/NG7 2UH, UK;
| | - Alex Favier
- Faculty of Registrars, University of Nottingham, Nottingham NG7 2RD, UK;
| | - William Irving
- NIHR Nottingham Biomedical Research Centre, Nottingham NG7 2UH/NG7 2RD, UK; (J.G.C.); (C.P.M.); (A.T.); (P.T.); (W.I.); (J.B.)
- School of Life Sciences, University of Nottingham, Nottingham NG7 2RD/NG7 2UH, UK;
| | - Jonathan Ball
- NIHR Nottingham Biomedical Research Centre, Nottingham NG7 2UH/NG7 2RD, UK; (J.G.C.); (C.P.M.); (A.T.); (P.T.); (W.I.); (J.B.)
- School of Life Sciences, University of Nottingham, Nottingham NG7 2RD/NG7 2UH, UK;
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Hoyberghs J, Bars C, Pype C, Foubert K, Ayuso Hernando M, Van Ginneken C, Ball J, Van Cruchten S. Refinement of the zebrafish embryo developmental toxicity assay. MethodsX 2020; 7:101087. [PMID: 33134094 PMCID: PMC7588703 DOI: 10.1016/j.mex.2020.101087] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 07/28/2020] [Accepted: 10/01/2020] [Indexed: 12/04/2022] Open
Abstract
Several pharmaceutical and chemical companies are using the zebrafish embryo as an alternative to animal testing for early detection of developmental toxicants. Unfortunately, the protocol of this zebrafish embryo assay varies between labs, resulting in discordant data for identical compounds. The assay also has some limitations, such as low biotransformation capacity and fewer morphological endpoints in comparison with the in vivo mammalian developmental toxicity studies. Consequently, there is a need to standardize and further optimize the assay for developmental toxicity testing. We developed a Zebrafish Embryo Developmental Toxicity Assay (ZEDTA) that can be extended with a metabolic activation system and/or skeletal staining to increase its sensitivity. As such, the ZEDTA can be used as a modular system depending on the compound of interest.Our protocol is customized with a metabolic activation system for test compounds, using human liver microsomes. This system ensures exposure of zebrafish embryos to metabolites that are relevant for human risk and safety assessment. As human liver microsomes are toxic for the zebrafish embryo, we developed a preincubation system with an ultracentrifugation and subsequent dilution step. Additionally, we developed a skeletal staining protocol that can be added to the ZEDTA modular system. Our live Alizarin Red staining method detects several bone structures in 5-day old zebrafish larvae in a consistent manner.
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Affiliation(s)
| | | | - Casper Pype
- University of Antwerp, Wilrijk, Belgium.,Anju Software, Berchem, Belgium
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Paratz E, Rowsell L, Ball J, Zentner D, Parsons S, Morgan N, Thompson T, James P, Pflaumer A, Semsarian C, Stub D, Liew D, Smith K, La Gerche A. Economic impact of sudden cardiac arrest. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Each year, there are approximately 5,000 out-of-hospital cardiac arrests (OHCAs) in the state of Victoria, Australia (population 6.4 million, state healthcare budget AUD$2.9 billion / €1.8billion). Mortality from OHCA approaches ninety percent. High mortality rates and survivors not returning to work is likely to have an adverse effect on the Victorian economy but this has not been previously investigated.
Purpose
To model the economic impact of OHCA mortality and survivors not returning to work.
Methods
Data on all OHCAs transported by Ambulance Victoria from July 2017- June 2018 in Victoria, Australia was collected, including age, gender, survival to hospital, survival to discharge, and survival to 12 months. Cases were excluded if arrest was precipitated by trauma, exsanguination, overdose, terminal illness, hanging, SIDS, electrocution, sepsis, respiratory causes, drowning, or neurological causes. Pre-arrest employment status of patients was modelled using the Australian Bureau of Statistics Economic Security dataset, which provides contemporary employment rates for gender-matched five-year cohorts for Australians aged 15–79 years. For survivors to 12 months, pre-arrest and post-arrest work status were confirmed. Economic impact was then calculated to a five year horizon utilizing a Markov model with probabilistic sensitivity analysis.
Results
4,934 arrests meeting the inclusion criteria were transported by Ambulance Victoria in twelve months, of whom 4,639 were determined to be cardiac arrests without any exclusion criteria as a precipitant. 695 patients survived to hospital (15.0%), and 325 to discharge (7.0%). At 12 months, 303 patients were alive (6.5% of overall cases, 93.2% of those discharged from hospital). Economic modelling of age and gender-matched data indicated that 1516 patients (35%) would have been employed pre-cardiac arrest, but only 216 survivors (4.7%) would be employed at five years post-arrest. Using Markov modelling incorporating estimated earnings and the pre-determined value of a statistical life, the annual economic burden of cardiac arrest approximated AUD$4 billion (€2.5 billion) at a five-year horizon.
Conclusion
The annual economic impact of cardiac arrest in Victoria, Australia is approximately AUD$4 billion (€2.5 billion) in a five-year horizon. As the annual Victorian state budget for all healthcare is AUD$2.93 billion (€1.8 billion), our data suggests that the economic impact of cardiac arrest is under-appreciated. Therefore, research in this area and providing state-of-the-art care for all cardiac arrest patients should be a healthcare priority.
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): NHMRC/NHF Postgraduate Scholarship, RACP JJ Billings Scholarship
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Affiliation(s)
- E Paratz
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - L Rowsell
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - J Ball
- Ambulance Victoria, Melbourne, Australia
| | - D Zentner
- Royal Melbourne Hospital, Cardiology, Melbourne, Australia
| | - S Parsons
- Victorian Institute of Forensic Medicine, Melbourne, Australia
| | - N Morgan
- Victorian Institute of Forensic Medicine, Melbourne, Australia
| | - T Thompson
- Royal Melbourne Hospital, Cardiology, Melbourne, Australia
| | - P James
- Royal Melbourne Hospital, Cardiology, Melbourne, Australia
| | - A Pflaumer
- Royal Children's Hospital, Cardiology, Melbourne, Australia
| | - C Semsarian
- University of Sydney, Centenary Institute, Sydney, Australia
| | - D Stub
- The Alfred Hospital, Cardiology, Melbourne, Australia
| | - D Liew
- Monash University, School of Public Health & Preventive Medicine, Melbourne, Australia
| | - K Smith
- Ambulance Victoria, Melbourne, Australia
| | - A La Gerche
- Baker Heart and Diabetes Institute, Melbourne, Australia
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Perkin MR, Heap S, Crerar-Gilbert A, Albuquerque W, Haywood S, Avila Z, Hartopp R, Ball J, Hutt K, Kennea N. Deaths in people from Black, Asian and minority ethnic communities from both COVID-19 and non-COVID causes in the first weeks of the pandemic in London: a hospital case note review. BMJ Open 2020; 10:e040638. [PMID: 33067300 PMCID: PMC7569709 DOI: 10.1136/bmjopen-2020-040638] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 10/02/2020] [Accepted: 10/05/2020] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To undertake a case review of deaths in a 6-week period during the COVID-19 pandemic commencing with the first death in the hospital from COVID-19 on 12th of March 2020 and contrast this with the same period in 2019. SETTING A large London teaching hospital. PARTICIPANTS Three groups were compared: group 1-COVID-19-associated deaths in the 6-week period (n=243), group 2-non-COVID deaths in the same period (n=136) and group 3-all deaths in a comparison period of the same 6 weeks in 2019 (n=194). PRIMARY AND SECONDARY OUTCOME MEASURES This was a descriptive analysis of death case series review and as such no primary or secondary outcomes were pre-stipulated. RESULTS Deaths in patients from the Black, Asian and minority ethnic (BAME) communities in the pandemic period significantly increased both in the COVID-19 group (OR=2.43, 95% CI=1.60-3.68, p<0.001) and the non-COVID group (OR=1.76, 95% CI=1.09-2.83, p=0.02) during this time period and the increase was independent of differences in comorbidities, sex, age or deprivation. While the absolute number of deaths increased in 2020 compared with 2019, across all three groups the distribution of deaths by age was very similar. Our analyses confirm major risk factors for COVID-19 mortality including male sex, diabetes, having multiple comorbidities and background from the BAME communities. CONCLUSIONS There was no evidence of COVID-19 deaths occurring disproportionately in the elderly compared with non-COVID deaths in this period in 2020 and 2019. Deaths in the BAME communities were over-represented in both COVID-19 and non-COVID groups, highlighting the need for detailed research in order to fully understand the influence of ethnicity on susceptibility to illness, mortality and health-seeking behaviour during the pandemic.
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Affiliation(s)
- Michael Richard Perkin
- Population Health Research Institute, St George's University of London, London, England, UK
| | - Sarah Heap
- The Medical Examiners' Service, St George's University Hospitals NHS Foundation Trust, London, England, UK
| | - Agatha Crerar-Gilbert
- The Medical Examiners' Service, St George's University Hospitals NHS Foundation Trust, London, England, UK
| | - Wendy Albuquerque
- The Medical Examiners' Service, St George's University Hospitals NHS Foundation Trust, London, England, UK
| | - Serena Haywood
- The Medical Examiners' Service, St George's University Hospitals NHS Foundation Trust, London, England, UK
| | - Zoe Avila
- The Medical Examiners' Service, St George's University Hospitals NHS Foundation Trust, London, England, UK
| | - Richard Hartopp
- The Medical Examiners' Service, St George's University Hospitals NHS Foundation Trust, London, England, UK
| | - Jonathan Ball
- The Medical Examiners' Service, St George's University Hospitals NHS Foundation Trust, London, England, UK
| | - Kate Hutt
- The Medical Examiners' Service, St George's University Hospitals NHS Foundation Trust, London, England, UK
| | - Nigel Kennea
- The Medical Examiners' Service, St George's University Hospitals NHS Foundation Trust, London, England, UK
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DiSilvestro J, DiSilvestro P, Pandey A, Gordon J, Ball J, Moxley K. Analysis of advanced quantitative computed tomography imaging features in predicting progression free survival of advanced epithelial ovarian cancer. Gynecol Oncol 2020. [DOI: 10.1016/j.ygyno.2020.05.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ball J, Nehme Z, Bernard S, Stub D, Stephenson M, Smith K. Collateral damage: Hidden impact of the COVID-19 pandemic on the out-of-hospital cardiac arrest system-of-care. Resuscitation 2020; 156:157-163. [PMID: 32961304 PMCID: PMC7501790 DOI: 10.1016/j.resuscitation.2020.09.017] [Citation(s) in RCA: 88] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 09/03/2020] [Accepted: 09/14/2020] [Indexed: 12/13/2022]
Abstract
AIM Out-of-hospital cardiac arrest (OHCA) during COVID-19 has been reported by countries with high case numbers and overwhelmed healthcare services. Imposed restrictions and treatment precautions may have also influenced OHCA processes-of-care. We investigated the impact of the COVID-19 pandemic period on incidence, characteristics, and survival from OHCA in Victoria, Australia. METHODS Using data from the Victorian Ambulance Cardiac Arrest Registry, we compared 380 adult OHCA patients who received resuscitation between 16th March 2020 and 12th May 2020, with 1218 cases occurring during the same dates in 2017-2019. No OHCA patients were COVID-19 positive. Arrest incidence, characteristics and survival rates were compared. Regression analysis was performed to understand the independent effect of the pandemic period on survival. RESULTS Incidence of OHCA did not differ during the pandemic period. However, initiation of resuscitation by Emergency Medical Services (EMS) significantly decreased (46.9% versus 40.6%, p = 0.001). Arrests in public locations decreased in the pandemic period (20.8% versus 10.0%; p < 0.001), as did initial shocks by public access defibrillation/first-responders (p = 0.037). EMS caseload decreased during the pandemic period, however, delays to key interventions (time-to-first defibrillation, time-to-first epinephrine) significantly increased. Survival-to-discharge decreased by 50% during the pandemic period (11.7% versus 6.1%; p = 0.002). Survivors per million person-years dropped in 2020, resulting in 35 excess deaths per million person-years. On adjusted analysis, the pandemic period remained associated with a 50% reduction in survival-to-discharge. CONCLUSION The COVID-19 pandemic period did not influence OHCA incidence but appears to have disrupted the system-of-care in Australia. However, this could not completely explain reductions in survival.
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Affiliation(s)
- J Ball
- Centre for Research and Evaluation, Ambulance Victoria, Blackburn North, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.
| | - Z Nehme
- Centre for Research and Evaluation, Ambulance Victoria, Blackburn North, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Paramedicine, Monash University, Frankston, Victoria, Australia
| | - S Bernard
- Centre for Research and Evaluation, Ambulance Victoria, Blackburn North, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; The Alfred Hospital, Prahran, Victoria, Australia
| | - D Stub
- Centre for Research and Evaluation, Ambulance Victoria, Blackburn North, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; The Alfred Hospital, Prahran, Victoria, Australia
| | - M Stephenson
- Centre for Research and Evaluation, Ambulance Victoria, Blackburn North, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Paramedicine, Monash University, Frankston, Victoria, Australia
| | - K Smith
- Centre for Research and Evaluation, Ambulance Victoria, Blackburn North, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Paramedicine, Monash University, Frankston, Victoria, Australia
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Youngs J, Wyncoll D, Hopkins P, Arnold A, Ball J, Bicanic T. Improving antibiotic stewardship in COVID-19: Bacterial co-infection is less common than with influenza. J Infect 2020; 81:e55-e57. [PMID: 32593654 PMCID: PMC7316044 DOI: 10.1016/j.jinf.2020.06.056] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 06/22/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Jonathan Youngs
- Dept of Infection & Immunity, St George's University of London, Cranmer Terrace, Tooting, London SW17 0RE UK.
| | - Duncan Wyncoll
- Critical Care, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH UK
| | - Philip Hopkins
- Critical Care, King's College Hospital NHS Foundation Trust, Denmark Hill, Brixton, London SE5 9RS UK
| | - Amber Arnold
- Medical Microbiology, St George's University NHS Foundation Trust, Blackshaw Rd, Tooting, London SW17 0QT UK
| | - Jonathan Ball
- Critical Care, St George's University NHS Foundation Trust, Blackshaw Rd, Tooting, London SW17 0QT UK
| | - Tihana Bicanic
- Dept of Infection & Immunity, St George's University of London, Cranmer Terrace, Tooting, London SW17 0RE UK.
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Gou X, Lei J, Kim BJ, Anurag M, Seker S, Rehman S, Lee AV, White K, Caldwell M, Ball J, Robinson DR, Ellis MJ. Abstract 5677: Recurrent transcriptionally active ESR1 fusions render therapeutic vulnerabilities to kinase inhibition in advanced breast cancer. Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-5677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: We recently reported two ESR1 fusions (ESR1-YAP1 and ESR1-PCDH11X) that drive endocrine therapy (ET) resistance and metastasis in estrogen receptor positive (ER+) metastatic breast cancer (MBC) (PMC6171747). Here we report additional ESR1 fusions with diverse C-terminal partner genes - ESR1-DAB2, ESR1-GYG1, ESR1-SOX9, ESR1-ARNT2, ESR1-PCMT1 and ESR1-ARID1B. Their functional characteristics and effects on kinase biology will be described.
Methods: ESR1 fusions were identified by RNA-seq in MBC using ChimeraScan to detect fusion junction reads. ESR1 fusion cDNA constructs were expressed in ER+ breast cancer cell lines. An alamarBlue assay assessed cell proliferation. RNA-seq followed by mRNA-qPCR assessed the transcriptional properties. A scratch wound assay assessed cell motility. A Kinase Inhibitor Pulldown (KIP) mass spectrometry-based assay was conducted to examine ESR1 fusion-driven druggable kinases.
Results: All fusions retained the first 6 exons (e6) of ESR1, fused in-frame to C-terminal sequences of diverse partner genes. In addition to ESR1-YAP1 and ESR1-PCDH11X fusions, ESR1-SOX9 and ESR1-ARNT2 drove fulvestrant-resistant growth. RNA-seq revealed fusion-specific transcriptional signatures indicating enrichment of estrogen responsive and epithelial-to-mesenchymal transition (EMT) pathways that were confirmed by mRNA-qPCR. Transcriptionally active ESR1 fusions also promoted hormone-independent cell motility. KIP profiling demonstrated an increase in protein abundance of multiple receptor tyrosine kinases including RET and insulin like growth factor 1 receptor (IGF1R) in T47D cells expressing active ESR1 fusion proteins, both of which have been previously implicated in driving ET and MBC. Both proteins were also elevated in a patient-derived xenograft naturally harboring the ESR1-YAP1 fusion. Combinatorial inhibition of RET and IGF1R significantly suppressed ESR1 fusion-driven cell growth in vitro. Neither transcriptional activation nor kinase upregulation was observed in other ESR1-e6 fusions. Lastly, we report recurrent examples of specific known active ESR1 fusions: ESR1-PCDH11X (3 examples) (TEMPUS unpublished data) and ESR1-ARNT2 (2 examples) (PMC6872491).
Conclusion: A subset of ESR1-e6 fusions are active, drive ET resistance and metastasis/EMT in experimental models. When ESR1 is fused in-frame with another transcriptional regulator, activity is predictable. However, recurrent partners that have non-transcriptional roles (PCDH11X) suggests cDNA expression-based functional screens should be continued. A common pattern of kinase activation indicates that ESR1 fusion specific therapeutic strategies could be devised.
Citation Format: Xuxu Gou, Jonathan Lei, Beom-Jun Kim, Meenakshi Anurag, Sinem Seker, Saif Rehman, Adrian V. Lee, Kevin White, Michael Caldwell, Jonathan Ball, Dan R. Robinson, Matthew J. Ellis. Recurrent transcriptionally active ESR1 fusions render therapeutic vulnerabilities to kinase inhibition in advanced breast cancer [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 5677.
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Affiliation(s)
- Xuxu Gou
- 1Baylor College of Medicine, Houston, TX
| | | | | | | | | | - Saif Rehman
- 2University of Cambridge, Cambridge, United Kingdom
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Baker EH, Patel K, Ball J, Edwards S, Harrison TS, Kaul A, Koh M, Krishna S, Leaver S, Kumar V, Forton DM. Insights from compassionate use of tocilizumab for COVID-19 to inform appropriate design of randomised controlled trials. Br J Clin Pharmacol 2020; 87:1584-1586. [PMID: 32656822 PMCID: PMC7405226 DOI: 10.1111/bcp.14466] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/12/2020] [Accepted: 06/15/2020] [Indexed: 11/10/2022] Open
Affiliation(s)
- Emma H Baker
- Institute of Infection and Immunity, St George's, University of London, London, UK.,Pharmacy and Medicines Directorate, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Kamal Patel
- Department of Gastroenterology and Hepatology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Jonathan Ball
- Adult Critical Care Directorate, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Sarah Edwards
- Department of Science and Technology Studies, University College London, London, UK
| | - Thomas S Harrison
- Institute of Infection and Immunity, St George's, University of London, London, UK.,Clinical Infection Unit, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Arvind Kaul
- Department of Rheumatology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Mickey Koh
- Department of Haematology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Sanjeev Krishna
- Institute of Infection and Immunity, St George's, University of London, London, UK.,Clinical Infection Unit, St George's University Hospitals NHS Foundation Trust, London, UK.,Institut für Tropenmedizin, Universitätsklinikum Tübingen, Tübingen, Germany.,Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
| | - Susannah Leaver
- Adult Critical Care Directorate, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Vinodh Kumar
- Pharmacy and Medicines Directorate, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Daniel M Forton
- Institute of Infection and Immunity, St George's, University of London, London, UK.,Department of Gastroenterology and Hepatology, St George's University Hospitals NHS Foundation Trust, London, UK
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Andersson M, Low N, French N, Greenhalgh T, Jeffery K, Brent A, Ball J, Pollock A, McCoy D, Iturriza-Gomara M, Buchan I, Salisbury H, Pillay D, Irving W. Rapid roll out of SARS-CoV-2 antibody testing-a concern. BMJ 2020; 369:m2420. [PMID: 32580928 DOI: 10.1136/bmj.m2420] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Monique Andersson
- Department of Microbiology, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Nicola Low
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Neil French
- University of Liverpool and Royal Liverpool and Broadgreen University Hospitals Trust, Liverpool, UK
| | - Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Katie Jeffery
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Andrew Brent
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Allyson Pollock
- Faculty of Medical Sciences, Newcastle University, Newcastle, UK
| | | | - Miren Iturriza-Gomara
- NIHR Health Protection Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
| | - Iain Buchan
- Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Helen Salisbury
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Will Irving
- University of Nottingham and Nottingham University Hospitals NHS Trust, Nottingham, UK
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Rovira A, Dawson D, Walker A, Tornari C, Dinham A, Foden N, Surda P, Archer S, Lonsdale D, Ball J, Ofo E, Karagama Y, Odutoye T, Little S, Simo R, Arora A. Tracheostomy care and decannulation during the COVID-19 pandemic. A multidisciplinary clinical practice guideline. Eur Arch Otorhinolaryngol 2020; 278:313-321. [PMID: 32556788 PMCID: PMC7299456 DOI: 10.1007/s00405-020-06126-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 06/09/2020] [Indexed: 12/11/2022]
Abstract
Purpose Traditional critical care dogma regarding the benefits of early tracheostomy during invasive ventilation has had to be revisited due to the risk of COVID-19 to patients and healthcare staff. Standard practises that have evolved to minimise the risks associated with tracheostomy must be comprehensively reviewed in light of the numerous potential episodes for aerosol generating procedures. We meet the urgent need for safe practise standards by presenting the experience of two major London teaching hospitals, and synthesise our findings into an evidence-based guideline for multidisciplinary care of the tracheostomy patient. Methods This is a narrative review presenting the extensive experience of over 120 patients with tracheostomy, with a pragmatic analysis of currently available evidence for safe tracheostomy care in COVID-19 patients. Results Tracheostomy care involves many potentially aerosol generating procedures which may pose a risk of viral transmission to staff and patients. We make a series of recommendations to ameliorate this risk through infection control strategies, equipment modification, and individualised decannulation protocols. In addition, we discuss the multidisciplinary collaboration that is absolutely fundamental to safe and effective practise. Conclusion COVID-19 requires a radical rethink of many tenets of tracheostomy care, and controversy continues to exist regarding the optimal techniques to minimise risk to patients and healthcare workers. Safe practise requires a coordinated multidisciplinary team approach to infection control, weaning and decannulation, with integrated processes for continuous prospective data collection and audit.
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Affiliation(s)
- Aleix Rovira
- Department of Otorhinolaryngology Head and Neck Surgery, St George's Hospital NHS Foundation Trust, London, UK.
| | - Deborah Dawson
- Department of Critical Care, St George's Hospital NHS Foundation Trust, London, UK
| | - Abigail Walker
- Department of Otorhinolaryngology Head and Neck Surgery, University Hospital Lewisham, London, UK
| | - Chrysostomos Tornari
- Department of Otorhinolaryngology Head and Neck Surgery, St George's Hospital NHS Foundation Trust, London, UK
| | - Alison Dinham
- Department of Physiotherapy, Guy's and St Thomas Hospital NHS Foundation Trust, London, UK
| | - Neil Foden
- Department of Otorhinolaryngology Head and Neck Surgery, St George's Hospital NHS Foundation Trust, London, UK
| | - Pavol Surda
- Department of Otorhinolayngology Head and Neck Surgery, Guy's and St Thomas Hospital NHS Foundation Trust, London, UK
| | - Sally Archer
- Speech and Language Therapy Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Dagan Lonsdale
- Critical Care Unit, St George's Hospital NHS Foundation Trust, London, UK
- St George's University of London, London, UK
| | - Jonathan Ball
- Critical Care Unit, St George's Hospital NHS Foundation Trust, London, UK
| | - Enyi Ofo
- Department of Otorhinolaryngology Head and Neck Surgery, St George's Hospital NHS Foundation Trust, London, UK
| | - Yakubu Karagama
- Department of Otorhinolayngology Head and Neck Surgery, Guy's and St Thomas Hospital NHS Foundation Trust, London, UK
| | - Tunde Odutoye
- Department of Otorhinolaryngology Head and Neck Surgery, St George's Hospital NHS Foundation Trust, London, UK
| | - Sarah Little
- Department of Otorhinolaryngology Head and Neck Surgery, St George's Hospital NHS Foundation Trust, London, UK
| | - Ricard Simo
- Department of Otorhinolayngology Head and Neck Surgery, Guy's and St Thomas Hospital NHS Foundation Trust, London, UK
| | - Asit Arora
- Department of Otorhinolayngology Head and Neck Surgery, Guy's and St Thomas Hospital NHS Foundation Trust, London, UK
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Ball J, Radunovic A, Scott C, Stevens M. AB1078 USE OF MYOSITIS SPECIFIC AUTOANTIBODIES TEST ACROSS A LARGE NHS HOSPITAL TRUST. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.4630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:The immunology laboratory at Barts Health supports a large clinical myopathy service, providing blood tests for myositis-specific autoantibodies (MSA) by a commercial line immunoblot panel for Jo1, PL7, PL12, SRP, Mi2, Ku, PM-Scl and Scl-70.As Idiopathic Inflammatory Myositis (IIM) disease subtype definitions have evolved from the 1975 Bohan & Peter criteria, the discovery of new antibodies has proven useful in the hands of neuromuscular clinicians whose patients have a high pre-test probability of disease. Ready availability of the test has led to increased demand from:Respiratory physicians with patients with severe Interstitial Lung Disease (ILD) whichcanbe a symptom of some IIMs.The connective tissue disease (CTD) screening section of the laboratory in which many patients are screened for antinuclear antibodies (ANA), which occasionally produces a pattern thatmaybe associated with an MSA.Objectives:Determine the frequency of MSA requests from different departments.To investigate the possibility of rejecting requests for MSAs at the laboratory in the absence of an elevated creatine kinase (CK), a hallmark of muscle damage associated with myositis (1).Methods:MSA were measured by a commercial line blot (Bluediver) which included Jo-1, PL-7, PL-12, Mi-2, Ku, SRP-54 and PM-Scl-100. Demographics and results for all MSA requested between September 2017 and November 2019 were pulled from laboratory records, together with CK results (if performed). CK was interpreted as low, normal or elevated according to reference ranges of 25-200 U/L (female) or 40-320 U/L (male).Results:597 tests were performed between 2017 and 2019. In total 59/597 (10%) were positive for the audited antibodies (Table 1). General Practitioner (GP) requests accounted for 41/597 (6.9%) tests, internal 464/597 (78%) and external 82/597 (14%). External requests were the most frequently positive at 10/82 (12%), internal requests 46/464 (10%), and GP requests only 3/41 (7%) of the time. Of all internal requesting sources, Respiratory accounted for the largest number at 108/597 (18%), followed by neurology with 85/597 (14%) (Figure 1). GPs constituted the 4thlargest source of requests.Table 1.Positive on polymyositis screen% positivityAll tests597Total599.9%Jo-140.7%PL-720.3%PL-1250.8%SRP-54101.7%Mi-240.7%Ku30.5%PM-Scl 100254.2%Scl-7071.2%Figure 1.MSAs had an associated CK result in 75% of internal and 12% of GP requests. A cohort of 17 patients had positive MSAs (3 x SRP, 1 x PL-7, 1 x Jo-1, 2 x Mi-2, 1 x Ku, 8 x PM-Scl100 and 1 x Scl-70) with normal CK.Of the 41 GP requests, MSA had been requested by the lab on the basis of ANA pattern for 33 (80%) of them, 3 of which were positive (2 x Scl-70, 1 x SRP-54).Conclusion:Demand for MSA from the Respiratory department (screening for ILD) currently exceeds demand from Neurology and from Rheumatology. In the GP cohort, 33 requests (80% of GPs, 5% of all requests) were generated by the laboratory.A cohort of patients with normal CK results had a positive MSA, implying CK alone cannot be used to limit test access. Interestingly, 10 positive results had no CK requested implying they were not being investigated for myositis.Further work is needed to determine the specificity and sensitivity of these antibodies for patients with clinically defined myositis, and the appropriateness of allowing the test to be applied in the absence of any clinical evidence of IIM.The findings of this audit need to be further extended to look at other myositis including other anti-synthetases, HMGCoAR, MDA5, TIF-1γ, NPX-2.References:[1]Dalakas MC, Hohlfeld R (2003) Polymyositis and dermatomyositis. Lancet 362:971–982Disclosure of Interests:None declared
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Stevens M, Proudlove N, Ball J, Scott C. AB1131 STATISTICAL PROCESS CONTROL AND PROCESS MAPPING QUANTIFY THE EFFECTS OF HISTORICAL CHANGES TO THE CONNECTIVE TISSUE DISEASE TESTING ALGORITHM AND IDENTIFY AREAS FOR FUTURE IMPROVEMENT IN A LARGE DIAGNOSTIC IMMUNOLOGY SERVICE. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Pathology test turnaround times (TATs) are a limiting factor in patient flow through rheumatology services. Quality improvement (QI) methodologies such as Lean use tools including statistical process control (SPC) and process mapping to study the performance of the whole of a clinical pipeline, expose unnecessary complexity (non-value-adding activity), and streamline processes and staff roles.Objectives:Understand effects of changes made to CTD testing algorithm over last 12 years by measuring some of the effects on TATs. Model current processes and suggest changes to workflow to improve TAT.Methods:High-level flow diagrams of the current testing algorithm, and low-level process maps of analyser and staff processes were drawn.Activity and TATs (working days between report and booking date) for ANA, ENA, DNA and CCP tests were plotted as XmR control charts.Results:Finding 1: Largest referral laboratory does not currently operate a separate DNA monitoring workstream, resulting in unnecessary ANA and ENA testing (figure 1).Figure 1.Current testing strategy (left) and suggested improvement (right)Finding 2:Samples are handed off between 3 different lab benches, each of which may be staffed by a different staff member on a different day, and results processing involves handoff to a further 2 different staff members.Finding 3:ANA demand is close to capacity, ENA demand exceeds current capacity (table 1).Table 1.Demand for ANA, ENA and DNA tests, compared to capacityTestMedian Demand(tests/ day)Approx. Capacity(tests/ day)NotesANA74100Close to 80% recommended by the ILGsENA3836*Less capacity than demand!!DNA34100PlentyFinding 4:Stopping screening DNA requests on ANA result increased the number of DNA tests performed by about 10 samples per day (30%), but decreased turnaround time by a similar proportion (3.3 to 2.3 days, figure 2). It also reduced turnaround times of ANA and ENA tests.Figure 2.Control chart of average TAT of dsDNA antibodies by request dateConclusion:Typically for a QI project, the initially simple CTD testing pipeline has accumulated many changes made without consideration of whole system performance, and is now a struggle to run.Improvement ideas to be explored from this work include:Liaising with main referral lab to develop a DNA monitoring workstream to reduce unnecessary ANA and ENA testingReduce handoffs, sample journey around lab analysers, and staff hands-on time by:changing ANA test methodology to same as DNAcreating new staff roles (analyser operators to perform validation/ authorisation steps)Create more capacity for ENA testing by increasing the frequency of this test on the weekly rotaCreate more capacity for service expansion by running analysers at weekends (staff consultation required)Reduce demand on service by engaging and educating requestorsImprove TAT for DNA by:processing samples the day they are booked in, instead of 1 day laterauto-validating runs…using control charts to measure improvementDisclosure of Interests:None declared
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