1
|
Kelly FE, Frerk C, Bailey CR, Cook TM, Ferguson K, Flin R, Fong K, Groom P, John C, Lang AR, Meek T, Miller KL, Richmond L, Sevdalis N, Stacey MR. Human factors in anaesthesia: a narrative review. Anaesthesia 2023; 78:479-490. [PMID: 36630729 DOI: 10.1111/anae.15920] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2022] [Indexed: 01/12/2023]
Abstract
Healthcare relies on high levels of human performance, as described by the 'human as the hero' concept. However, human performance varies and is recognised to fall in high-pressure situations, meaning that it is not a reliable method of ensuring safety. Other safety-critical industries embed human factors principles into all aspects of their organisations to improve safety and reduce reliance on exceptional human performance; there is potential to do the same in anaesthesia. Human factors is a broad-based scientific discipline which aims to make it as easy as possible for workers to do things correctly. The human factors strategies most likely to be effective are those which 'design out' the chance of an error or adverse event occurring. When errors or adverse events do happen, barriers are in place to trap them and reduce the risk of progression to patient and/or worker harm. If errors or adverse events are not trapped by these barriers, mitigations are in place to minimise the consequences. Non-technical skills form an important part of human factors barriers and mitigation strategies and include: situation awareness; decision-making; task management; and team working. Human factors principles are not a substitute for proper investment and appropriate staffing levels. Although applying human factors science has the potential to save money in the long term, its proper implementation may require investment before reward can be reaped. This narrative review describes what is known about human factors in anaesthesia to date.
Collapse
Affiliation(s)
- F E Kelly
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - C Frerk
- Department of Anaesthesia and Critical Care, Northampton General Hospital, Northampton, UK.,College of Life Sciences/Leicester Medical School, University of Leicester, UK
| | - C R Bailey
- Department of Anaesthetics, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - T M Cook
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK.,School of Medicine, Bristol University, Bristol, UK
| | - K Ferguson
- Department of Anaesthesia, Aberdeen Royal Infirmary, Aberdeen, UK
| | - R Flin
- School of Psychology, Aberdeen Business School, Robert Gordon University, Aberdeen, UK
| | - K Fong
- Department of Anaesthesia, University College London Hospitals NHS Foundation Trust, London, UK.,Department of Science, Technology, Engineering and Public Policy, University College London, UK
| | - P Groom
- Department of Anaesthesia, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - C John
- Department of Anaesthesia, University College Hospital's NHS Foundation Trust, London, UK
| | - A R Lang
- Human Factors Research Group, Faculty of Engineering, University of Nottingham, UK
| | - T Meek
- Department of Anaesthesia, James Cook University Hospital, Middlesbrough, UK
| | - K L Miller
- Department of Anaesthesia, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - L Richmond
- Department of Anaesthesia, Swansea Bay University Health Board, Swansea, UK
| | - N Sevdalis
- Centre for Implementation Science, King's College London, UK
| | - M R Stacey
- Department of Anaesthetics, Intensive Care and Pain Medicine, University Hospital of Wales, Cardiff, UK
| |
Collapse
|
2
|
Kelly FE, Frerk C, Bailey CR, Cook TM, Ferguson K, Flin R, Fong K, Groom P, John C, Lang AR, Meek T, Miller KL, Richmond L, Sevdalis N, Stacey MR. Implementing human factors in anaesthesia: guidance for clinicians, departments and hospitals: Guidelines from the Difficult Airway Society and the Association of Anaesthetists: Guidelines from the Difficult Airway Society and the Association of Anaesthetists. Anaesthesia 2023; 78:458-478. [PMID: 36630725 DOI: 10.1111/anae.15941] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2022] [Indexed: 01/12/2023]
Abstract
Human factors is an evidence-based scientific discipline used in safety critical industries to improve safety and worker well-being. The implementation of human factors strategies in anaesthesia has the potential to reduce the reliance on exceptional personal and team performance to provide safe and high-quality patient care. To encourage the adoption of human factors science in anaesthesia, the Difficult Airway Society and the Association of Anaesthetists established a Working Party, including anaesthetists and operating theatre team members with human factors expertise and/or interest, plus a human factors scientist, an industrial psychologist and an experimental psychologist/implementation scientist. A three-stage Delphi process was used to formulate a set of 12 recommendations: these are described using a 'hierarchy of controls' model and classified into design, barriers, mitigations and education and training strategies. Although most anaesthetic knowledge of human factors concerns non-technical skills, such as teamwork and communication, human factors is a broad-based scientific discipline with many other additional aspects that are just as important. Indeed, the human factors strategies most likely to have the greatest impact are those related to the design of safe working environments, equipment and systems. While our recommendations are primarily provided for anaesthetists and the teams they work with, there are likely to be lessons for others working in healthcare beyond the speciality of anaesthesia.
Collapse
Affiliation(s)
- F E Kelly
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - C Frerk
- Department of Anaesthesia and Critical Care, Northampton General Hospital, Northampton, UK.,University of Leicester, College of Life Sciences/Leicester Medical School, Leicester, UK
| | - C R Bailey
- Department of Anaesthetics, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - T M Cook
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK.,Bristol University, Bristol, UK
| | - K Ferguson
- Department of Anaesthesia, Aberdeen Royal Infirmary, Aberdeen, UK
| | - R Flin
- Aberdeen Business School, Robert Gordon University, Aberdeen, UK
| | - K Fong
- Department of Anaesthesia, University College London Hospitals NHS Foundation Trust, London, UK.,Department of Science, Technology, Engineering and Public Policy, University College London, UK
| | - P Groom
- Department of Anaesthesia, Liverpool University Hospitals NHS Foundation Trust, Aintree, Liverpool, UK
| | - C John
- University College Hospital's NHS Foundation Trust, London, UK
| | - A R Lang
- Human Factors Research Group, Faculty of Engineering, University of Nottingham, UK
| | - T Meek
- Department of Anaesthesia, James Cook University Hospital, Middlesbrough, UK
| | - K L Miller
- Department of Paediatric Anaesthesia, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - L Richmond
- Department of Anaesthesia, Swansea Bay University Health Board, Swansea, UK
| | - N Sevdalis
- Centre for Implementation Science, King's College London, UK
| | - M R Stacey
- Department of Anaesthetics, Intensive Care and Pain Medicine, University Hospital of Wales, Cardiff, UK
| |
Collapse
|
3
|
Fong K, Yap JJL, Chan YH, Ewe SH, Chao VTT, Rizwan M, Govindasamy SP, Aziz ZA, Tan VH, Ho KW. Comparison of transcatheter, minimally invasive and conventional surgical aortic valve replacement: a systematic review and network meta-analysis. Eur Heart J 2023. [DOI: 10.1093/eurheartj/ehac779.096] [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: 01/26/2023] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background/Introduction
The landscape of aortic valve replacement (AVR) has evolved dramatically over the years, but long-term outcomes have yet to be comprehensively explored.
Purpose
To compare long-term mortality among three AVR techniques: transcatheter (TAVI), minimally invasive (MIAVR), and conventional surgical AVR (CAVR).
Methods
An electronic literature search was performed for randomized controlled trials (RCTs) comparing TAVI to CAVR, and RCTs or propensity score-matched (PSM) studies comparing MIAVR to CAVR or MIAVR to TAVI. Individual patient data for all-cause mortality was derived from graphical reconstruction of digitized Kaplan-Meier curves. Pairwise comparisons followed by network meta-analysis were conducted. Sensitivity analyses were performed in the TAVI arm for high risk and low/intermediate risk as well as transfemoral (TF-TAVI) patients.
Results
A total of 27 studies involving 16,554 patients were included. In the pairwise comparison of TAVI versus CAVR, TAVI showed superior mortality to CAVR until 39.5 months, beyond which there was no significant difference in longer term mortality. When restricted to TF-TAVI versus CAVR, consistent mortality benefit favoring TAVI was seen (shared-frailty hazard ratio [HR]=1.17, 95%CI=1.03-1.33, p=0.016). In the network meta-analysis involving majority PSM data, MIAVR was associated with significantly lower mortality than TAVI (HR=0.69, 95%CI=0.59-0.82) and CAVR (HR=0.68, 95%CI=0.58-0.80); this significant association was not seen when compared to TF-TAVI patients.
Conclusions
An initial short-medium term mortality benefit for TAVI over CAVR was noted but this benefit was attenuated over the longer term. In the subset of TF-TAVI patients, this long-term mortality benefit persisted, suggesting that non-TF techniques are associated with higher mortality. Amongst majority PSM data, MIAVR showed improved mortality compared to TAVI and CAVR but this was not seen in the TF-TAVI subset. This suggests that MIAVR may have a role in treating patients who are ineligible for TF-TAVI in experienced centers, and future RCTs are needed to conclusively validate this.
Collapse
Affiliation(s)
- K Fong
- National University of Singapore, Yong Loo Lin School of Medicine , Singapore , Singapore
| | - J J L Yap
- National Heart Centre Singapore , Singapore , Singapore
| | - Y H Chan
- National University of Singapore, Biostatistics Unit , Singapore , Singapore
| | - S H Ewe
- National Heart Centre Singapore , Singapore , Singapore
| | - V T T Chao
- National Heart Centre Singapore , Singapore , Singapore
| | - M Rizwan
- National Heart Centre Singapore , Singapore , Singapore
| | | | - Z A Aziz
- National Heart Centre Singapore , Singapore , Singapore
| | - V H Tan
- Changi General Hospital , Singapore , Singapore
| | - K W Ho
- National Heart Centre Singapore , Singapore , Singapore
| |
Collapse
|
4
|
Vernon I, Owen J, Aylett-Bullock J, Cuesta-Lazaro C, Frawley J, Quera-Bofarull A, Sedgewick A, Shi D, Truong H, Turner M, Walker J, Caulfield T, Fong K, Krauss F. Bayesian emulation and history matching of JUNE. Philos Trans A Math Phys Eng Sci 2022; 380:20220039. [PMID: 35965471 PMCID: PMC9376712 DOI: 10.1098/rsta.2022.0039] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 06/07/2022] [Indexed: 05/21/2023]
Abstract
We analyze JUNE: a detailed model of COVID-19 transmission with high spatial and demographic resolution, developed as part of the RAMP initiative. JUNE requires substantial computational resources to evaluate, making model calibration and general uncertainty analysis extremely challenging. We describe and employ the uncertainty quantification approaches of Bayes linear emulation and history matching to mimic JUNE and to perform a global parameter search, hence identifying regions of parameter space that produce acceptable matches to observed data, and demonstrating the capability of such methods. This article is part of the theme issue 'Technical challenges of modelling real-life epidemics and examples of overcoming these'.
Collapse
Affiliation(s)
- I. Vernon
- Institute for Data Science, Durham University, Durham DH13LE, UK
- Department of Mathematical Sciences, Durham University, Durham DH13LE, UK
| | - J. Owen
- Institute for Data Science, Durham University, Durham DH13LE, UK
- Department of Mathematical Sciences, Durham University, Durham DH13LE, UK
| | - J. Aylett-Bullock
- Institute for Data Science, Durham University, Durham DH13LE, UK
- Institute for Particle Physics Phenomenology, Durham University, Durham DH13LE, UK
| | - C. Cuesta-Lazaro
- Institute for Data Science, Durham University, Durham DH13LE, UK
- Institute for Computational Cosmology, Durham University, Durham DH13LE, UK
| | - J. Frawley
- Institute for Data Science, Durham University, Durham DH13LE, UK
- Advanced Research Computing, Durham University, Durham DH13LE, UK
| | - A. Quera-Bofarull
- Institute for Data Science, Durham University, Durham DH13LE, UK
- Institute for Computational Cosmology, Durham University, Durham DH13LE, UK
| | - A. Sedgewick
- Institute for Data Science, Durham University, Durham DH13LE, UK
- Centre for Extragalactic Astronomy, Durham University, Durham DH13LE, UK
| | - D. Shi
- Institute for Data Science, Durham University, Durham DH13LE, UK
- Institute for Computational Cosmology, Durham University, Durham DH13LE, UK
| | - H. Truong
- Institute for Data Science, Durham University, Durham DH13LE, UK
- Institute for Particle Physics Phenomenology, Durham University, Durham DH13LE, UK
| | - M. Turner
- Institute for Data Science, Durham University, Durham DH13LE, UK
- Advanced Research Computing, Durham University, Durham DH13LE, UK
| | - J. Walker
- Institute for Data Science, Durham University, Durham DH13LE, UK
- Institute for Particle Physics Phenomenology, Durham University, Durham DH13LE, UK
| | - T. Caulfield
- Department of Computer Science, Durham University, Durham DH13LE, UK
| | - K. Fong
- Department of Science, Technology, Engineering and Public Policy, University College London, London WC1E6BT, UK
- Department of Anaesthesia, University College London Hospital, London NW12BU, UK
| | - F. Krauss
- Institute for Data Science, Durham University, Durham DH13LE, UK
- Institute for Particle Physics Phenomenology, Durham University, Durham DH13LE, UK
| |
Collapse
|
5
|
Fong K, Zhao JJ, Chan YH, Wang Y, Yeo C, Tan VH. Ablation therapies for paroxysmal atrial fibrillation: a systematic review and patient-level network meta-analysis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.579] [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
Despite numerous promising trials, catheter ablation is still regarded as a second-line alternative to antiarrhythmic drugs (AAD) in the treatment of paroxysmal atrial fibrillation (PAF). There remains a role for a broad comparison of the effectiveness of various ablation therapies against each other, and versus AAD.
Purpose
To conduct a systematic review and network meta-analysis of ablation therapies and AAD in the treatment of PAF. Ablation therapies were hypothesized to be superior to AAD in preventing atrial fibrillation (AF) recurrence.
Methods
An electronic literature search was conducted to retrieve randomized controlled trials or propensity score-matched studies comparing freedom from AF recurrence among any combination of ablation modalities or AAD. Kaplan-Meier curves and risk tables for this outcome were graphically reconstructed to extract individual patient data (IPD). A Frequentist network meta-analysis (NMA) was performed using the derived hazard ratios (HRs) of each study to compare various ablation therapies and AAD. Two separate NMAs were also conducted with restricted mean survival time (RMST) analysis, using RMST absolute differences and ratios, in light of violation of the proportional-hazards assumption. Treatment strategies were ranked using P-scores. Pairwise comparisons were also performed between treatment pairs with three or more studies reporting direct comparisons.
Results
Across 24 studies comparing six ablation therapies, comprising 5274 patients, Frequentist NMA-derived HRs of AF recurrence compared to AAD were 0.35 (95% CI: 0.26–0.48) for cryoballoon ablation (CBA), 0.33 (95% CI: 0.25–0.45) for radiofrequency ablation (RFA), 0.21 (95% CI: 0.09–0.49) for combined CBA and RFA, 0.20 (95% CI: 0.11–0.39) for hot-balloon ablation (HBA), 0.44 (95% CI: 0.16–1.22) for laser-balloon ablation, and 0.33 (95% CI: 0.19–0.56) for pulmonary vein ablation catheter. RMST-based NMAs similarly showed a significant benefit of all ablation therapies over AAD in preventing AF recurrence. Although none of the HRs between pairs of ablation modalities were significant, P-scores for HBA and combined CBA and RFA were consistently higher than those of other treatments. Independent pairwise comparisons of RFA and CBA versus AAD were greatly in favor of ablation (shared-frailty HR=0.24, 95% CI: 0.19–0.31, p<0.001; shared-frailty HR=0.44, 95% CI: 0.35–0.56, p<0.001, respectively).
Conclusions
To our knowledge, this is the first network meta-analysis comparing a wide range of ablation therapies to AAD, synthesizing IPD from high-quality studies in three separate NMA models. The advantage of ablation therapies over AAD in preventing AF recurrence was consistently found across all three models. This strongly suggests that ablation should replace AAD as the first-line treatment for PAF in patients who are fit for the procedure. Moreover, the promising results of HBA underscore the need for more high-quality trials to be conducted.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- K Fong
- National University of Singapore, Yong Loo Lin School of Medicine , Singapore , Singapore
| | - J J Zhao
- National University of Singapore, Yong Loo Lin School of Medicine , Singapore , Singapore
| | - Y H Chan
- National University of Singapore, Biostatistics Unit , Singapore , Singapore
| | - Y Wang
- Changi General Hospital , Singapore , Singapore
| | - C Yeo
- Changi General Hospital , Singapore , Singapore
| | - V H Tan
- Changi General Hospital , Singapore , Singapore
| |
Collapse
|
6
|
Vernon I, Owen J, Aylett-Bullock J, Cuesta-Lazaro C, Frawley J, Quera-Bofarull A, Sedgewick A, Shi D, Truong H, Turner M, Walker J, Caulfield T, Fong K, Krauss F. Bayesian emulation and history matching of JUNE. Philos Trans A Math Phys Eng Sci 2022; 380:20210039. [PMID: 35965471 DOI: 10.1098/rsta.2021.0039] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 12/06/2021] [Indexed: 05/21/2023]
Abstract
We analyze JUNE: a detailed model of COVID-19 transmission with high spatial and demographic resolution, developed as part of the RAMP initiative. JUNE requires substantial computational resources to evaluate, making model calibration and general uncertainty analysis extremely challenging. We describe and employ the uncertainty quantification approaches of Bayes linear emulation and history matching to mimic JUNE and to perform a global parameter search, hence identifying regions of parameter space that produce acceptable matches to observed data, and demonstrating the capability of such methods. This article is part of the theme issue 'Technical challenges of modelling real-life epidemics and examples of overcoming these'.
Collapse
Affiliation(s)
- I Vernon
- Institute for Data Science, Durham University, Durham DH13LE, UK
- Department of Mathematical Sciences, Durham University, Durham DH13LE, UK
| | - J Owen
- Institute for Data Science, Durham University, Durham DH13LE, UK
- Department of Mathematical Sciences, Durham University, Durham DH13LE, UK
| | - J Aylett-Bullock
- Institute for Data Science, Durham University, Durham DH13LE, UK
- Institute for Particle Physics Phenomenology, Durham University, Durham DH13LE, UK
| | - C Cuesta-Lazaro
- Institute for Data Science, Durham University, Durham DH13LE, UK
- Institute for Computational Cosmology, Durham University, Durham DH13LE, UK
| | - J Frawley
- Institute for Data Science, Durham University, Durham DH13LE, UK
- Advanced Research Computing, Durham University, Durham DH13LE, UK
| | - A Quera-Bofarull
- Institute for Data Science, Durham University, Durham DH13LE, UK
- Institute for Computational Cosmology, Durham University, Durham DH13LE, UK
| | - A Sedgewick
- Institute for Data Science, Durham University, Durham DH13LE, UK
- Centre for Extragalactic Astronomy, Durham University, Durham DH13LE, UK
| | - D Shi
- Institute for Data Science, Durham University, Durham DH13LE, UK
- Institute for Computational Cosmology, Durham University, Durham DH13LE, UK
| | - H Truong
- Institute for Data Science, Durham University, Durham DH13LE, UK
- Institute for Particle Physics Phenomenology, Durham University, Durham DH13LE, UK
| | - M Turner
- Institute for Data Science, Durham University, Durham DH13LE, UK
- Advanced Research Computing, Durham University, Durham DH13LE, UK
| | - J Walker
- Institute for Data Science, Durham University, Durham DH13LE, UK
- Institute for Particle Physics Phenomenology, Durham University, Durham DH13LE, UK
| | - T Caulfield
- Department of Computer Science, Durham University, Durham DH13LE, UK
| | - K Fong
- Department of Science, Technology, Engineering and Public Policy, University College London, London WC1E6BT, UK
- Department of Anaesthesia, University College London Hospital, London NW12BU, UK
| | - F Krauss
- Institute for Data Science, Durham University, Durham DH13LE, UK
- Institute for Particle Physics Phenomenology, Durham University, Durham DH13LE, UK
| |
Collapse
|
7
|
Behar Harpaz S, Weber M, Wade S, Ngo P, Vaneckova P, Sarich P, Cressman S, Tammemagi M, Fong K, Marshall H, McWilliams A, Zalcberg J, Caruana M, Canfell K. MA11.03 Updated Cost-Effectiveness Analysis of Lung Cancer Screening for Australia, Capturing Differences in the Impact of NELSON and NLST Outcomes. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.137] [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: 10/14/2022]
|
8
|
Chanchareonsook N, Ling ML, Sim QX, Teoh KH, Tan K, Tan BH, Fong KY, Poon CY. Failure of sterilization in a dental outpatient facility: Investigation, risk assessment, and management. Medicine (Baltimore) 2022; 101:e29815. [PMID: 35945734 PMCID: PMC9351878 DOI: 10.1097/md.0000000000029815] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
In 2017, an incident of failed sterilization of dental instruments occurred at a large dental outpatient facility in Singapore. We aim to describe findings of the investigation of the sterilization breach incident, factors related to risk of viral transmission to the potentially affected patients, and the contact tracing process, patient management, and blood test results at a 6-month follow-up. A full assessment of the incident was immediately carried out. The factors related to risk of viral transmission due to affected instruments were analyzed using 3 keys points: breached step(s) and scale of the incident, prevalence of underlying bloodborne diseases and immunity in the Singapore population, health status of potential source patients, and type of dental procedure performed, and health status of affected patients and type of dental procedure received. Up to 72 affected instrument sets were used in 714 potentially affected patients who underwent noninvasive dental procedures. The investigation revealed that there was a lapse in the final step of steam sterilization, resulting in the use of incompletely sterilized items. The assessment determined that there was an extremely low risk of bloodborne virus transmission of diseases to the patients. At the 6-month follow-up, there were no infected/colonized cases found related to the incident. Lapses in the sterilization process for medical and dental instruments can happen, but a risk assessment approach is useful to manage similar incidents. Quick response and proper documentation of the sterilization process can prevent similar incidents.
Collapse
Affiliation(s)
- N Chanchareonsook
- Department of Oral and Maxillofacial Surgery, National Dental Centre Singapore, Singapore
| | - ML Ling
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - QX Sim
- Department of Oral and Maxillofacial Surgery, National Dental Centre Singapore, Singapore
| | - KH Teoh
- Clinical and Regional Health, National Dental Centre Singapore, Singapore
| | - K Tan
- Clinical Governance and Quality Management, National Dental Centre Singapore, Singapore
| | - BH Tan
- Department of Infectious Disease, Singapore General Hospital, Singapore
| | | | - CY Poon
- Department of Oral and Maxillofacial Surgery, National Dental Centre Singapore, Singapore
- National Dental Centre Singapore, Singapore
- *Correspondence: CY Poon, Department of Oral and Maxillofacial Surgery, National Dental Centre Singapore, 5 Second Hospital Avenue, Singapore 168938, Singapore. (e-mail: )
| |
Collapse
|
9
|
Lim E, Traxer O, Madarriaga Y, Castellani D, Fong K, Chan VS, Tur A, Pietropaolo A, Ragoori D, Shrestha A, Vaddi C, Bhatia T, Mani M, Juliebø-Jones P, Griffin S, Rojo E, Corrales M, Sekerci C, Tanidir Y, Teoh JC, Gauhar V, Somani B. Outcomes from practice of Retrograde Intrarenal Surgery (RIRS) in a paediatric setting of various age groups: A global study across 8 centres. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00857-0] [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: 11/04/2022]
|
10
|
Tammemagi M, Myers R, Ruparel M, Tremblay A, Atkar-Khattra S, Marshall H, Brims F, Mcwilliams A, Fogarty P, Stone E, Manser R, Canfell K, Lim K, Rosell A, Weber M, Yee J, Mayo J, Berg C, Lam D, Janes S, Fong K, Lam S. OA19.01 Prospective Study of Lung Cancer Screening Criteria: USPSTF2013 vs PLCOm2012 – International Lung Screening Trial (ILST) Results. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.097] [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]
|
11
|
Abstract
BACKGROUND Staff working in intensive care units (ICUs) have faced significant challenges during the COVID-19 pandemic which have the potential to adversely affect their mental health. AIMS To identify the rates of probable mental health disorder in staff working in ICUs in nine English hospitals during June and July 2020. METHODS An anonymized brief web-based survey comprising standardized questionnaires examining depression, anxiety symptoms, symptoms of post-traumatic stress disorder (PTSD), well-being and alcohol use was administered to staff. RESULTS Seven hundred and nine participants completed the surveys comprising 291 (41%) doctors, 344 (49%) nurses and 74 (10%) other healthcare staff. Over half (59%) reported good well-being; however, 45% met the threshold for probable clinical significance on at least one of the following measures: severe depression (6%), PTSD (40%), severe anxiety (11%) or problem drinking (7%). Thirteen per cent of respondents reported frequent thoughts of being better off dead, or of hurting themselves in the past 2 weeks. Within the sample used in this study, we found that doctors reported better mental health than nurses across a range of measures. CONCLUSIONS We found substantial rates of probable mental health disorders, and thoughts of self-harm, amongst ICU staff; these difficulties were especially prevalent in nurses. Whilst further work is needed to better understand the real level of clinical need amongst ICU staff, these results indicate the need for a national strategy to protect the mental health, and decrease the risk of functional impairment, of ICU staff whilst they carry out their essential work during COVID-19.
Collapse
Affiliation(s)
- N Greenberg
- King’s Centre for Military Health Research, Institute of Psychology, Psychiatry and Neuroscience, King’s College London, London, UK
- Health Protection Research Unit, Institute of Psychology, Psychiatry and Neuroscience, King’s College London, London, UK
| | - D Weston
- Behavioural Science Team, Emergency Response Department Science & Technology, Public Health England, Salisbury, UK
| | - C Hall
- Behavioural Science Team, Emergency Response Department Science & Technology, Public Health England, Salisbury, UK
| | - T Caulfield
- Department of Computer Science, University College London, London, UK
| | - V Williamson
- King’s Centre for Military Health Research, Institute of Psychology, Psychiatry and Neuroscience, King’s College London, London, UK
- Department of Experimental Psychology, Anna Watts Building, University of Oxford, Oxford, UK
| | - K Fong
- Department of Science, Technology, Engineering and Public Policy (STEaPP), University College London, London, UK
- Department of Anaesthesia, University College London Hospital, London, UK
| |
Collapse
|
12
|
Patel N, Hopcraft K, O'Rourke R, Williamson A, Georgiou P, Yang I, Fong K, Marshall H. P44.05 Bone Density Measures Out-Perform Clinical Risk Scores in Detection of Vertebral Fractures in a Lung Cancer Screening Cohort. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.844] [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]
|
13
|
Chee T, Oey H, Fong K, Yang I, Krause L, Bowman R. MA23.09 Fusion Genes Identified from Whole Genome and Whole Transcriptome Sequencing of Malignant Pleural Mesothelioma Tumours. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.697] [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: 10/25/2022]
|
14
|
Senko C, Moore J, Hay K, Lwin Z, Pratt G, Fong K, Hughes B. P1.18-14 The Prognostic Significance of Significant Weight Loss in Stage III NSCLC Undergoing Definitive CRT After FDG-PET Staging. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1330] [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: 10/25/2022]
|
15
|
Fong K. S02.05 The Importance of Elucidating Genomic Events is Lung Premalignancy. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
16
|
Parris B, Yang I, Bowman R, Fong K. P1.03-11 Molecular Testing of Small Bronchoscopy Specimens Using NanoString Technology. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
17
|
Fong K, Stone E, Page B. IBS29.01 Can a Multidisciplinary Team Meetings Improve Lung Cancer Survival? J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.256] [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: 10/25/2022]
|
18
|
Fong K, Goh BK. Epidermal cellular grafting as a treatment for punctate leukoderma secondary to laser toning. J Eur Acad Dermatol Venereol 2019; 33:e396-e397. [PMID: 31120157 DOI: 10.1111/jdv.15699] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- K Fong
- National Skin Centre, 1 Mandalay Road, Singapore, 308205, Singapore
| | - B K Goh
- National Skin Centre, 1 Mandalay Road, Singapore, 308205, Singapore.,Skin Physicians, 3 Mount Elizabeth, #11-08 Mount Elizabeth Medical Centre, Singapore, 228510, Singapore
| |
Collapse
|
19
|
|
20
|
Lou V, Tang J, Lum T, Lau G, Fong K, Cheng C, Fu J. EFFECTIVENESS OF A FAMILY-BASED CARE MANAGEMENT MODEL FOR STROKE CAREGIVERS: A RANDOMIZED CONTROLLED TRIAL. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.1077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- V Lou
- The University of Hong Kong
| | - J Tang
- The University of Hong Kong
| | - T Lum
- The University of Hong Kong
| | - G Lau
- The University of Hong Kong
| | - K Fong
- The Hong Kong Polytechnic University
| | | | - J Fu
- The University of Hong Kong
| |
Collapse
|
21
|
Lam S, Myers R, Atkar-Khattra S, Yuan R, Yee J, English J, Grant K, Lee A, Mcguire A, McWilliams A, Brims F, Stone E, Chin V, Chantrill L, Connellan M, Plitt M, Marshall H, Yang I, Bowman R, Fong K, Mayo J. MA03.02 Prospective Evaluation of the Clinical Utility of the International Lung Screen Trial Lung Nodule Management Protocol. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.332] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
22
|
Fong K. MS06.02 The Role of Interventional Pulmonology and Radiology. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
23
|
Tang WW, McGee P, Lachin JM, Li DY, Hoogwerf B, Hazen SL, Nathan D, Zinman B, Crofford O, Genuth S, Brown‐Friday J, Crandall J, Engel H, Engel S, Martinez H, Phillips M, Reid M, Shamoon H, Sheindlin J, Gubitosi‐Klug R, Mayer L, Pendegast S, Zegarra H, Miller D, Singerman L, Smith‐Brewer S, Novak M, Quin J, Genuth S, Palmert M, Brown E, McConnell J, Pugsley P, Crawford P, Dahms W, Gregory N, Lackaye M, Kiss S, Chan R, Orlin A, Rubin M, Brillon D, Reppucci V, Lee T, Heinemann M, Chang S, Levy B, Jovanovic L, Richardson M, Bosco B, Dwoskin A, Hanna R, Barron S, Campbell R, Bhan A, Kruger D, Jones J, Edwards P, Bhan A, Carey J, Angus E, Thomas A, Galprin A, McLellan M, Whitehouse F, Bergenstal R, Johnson M, Gunyou K, Thomas L, Laechelt J, Hollander P, Spencer M, Kendall D, Cuddihy R, Callahan P, List S, Gott J, Rude N, Olson B, Franz M, Castle G, Birk R, Nelson J, Freking D, Gill L, Mestrezat W, Etzwiler D, Morgan K, Aiello L, Golden E, Arrigg P, Asuquo V, Beaser R, Bestourous L, Cavallerano J, Cavicchi R, Ganda O, Hamdy O, Kirby R, Murtha T, Schlossman D, Shah S, Sharuk G, Silva P, Silver P, Stockman M, Sun J, Weimann E, Wolpert H, Aiello L, Jacobson A, Rand L, Rosenzwieg J, Nathan D, Larkin M, Christofi M, Folino K, Godine J, Lou P, Stevens C, Anderson E, Bode H, Brink S, Cornish C, Cros D, Delahanty L, eManbey ., Haggan C, Lynch J, McKitrick C, Norman D, Moore D, Ong M, Taylor C, Zimbler D, Crowell S, Fritz S, Hansen K, Gauthier‐Kelly C, Service F, Ziegler G, Barkmeier A, Schmidt L, French B, Woodwick R, Rizza R, Schwenk W, Haymond M, Pach J, Mortenson J, Zimmerman B, Lucas A, Colligan R, Luttrell L, Lopes‐Virella M, Caulder S, Pittman C, Patel N, Lee K, Nutaitis M, Fernandes J, Hermayer K, Kwon S, Blevins A, Parker J, Colwell J, Lee D, Soule J, Lindsey P, Bracey M, Farr A, Elsing S, Thompson T, Selby J, Lyons T, Yacoub‐Wasef S, Szpiech M, Wood D, Mayfield R, Molitch M, Adelman D, Colson S, Jampol L, Lyon A, Gill M, Strugula Z, Kaminski L, Mirza R, Simjanoski E, Ryan D, Johnson C, Wallia A, Ajroud‐Driss S, Astelford P, Leloudes N, Degillio A, Schaefer B, Mudaliar S, Lorenzi G, Goldbaum M, Jones K, Prince M, Swenson M, Grant I, Reed R, Lyon R, Kolterman O, Giotta M, Clark T, Friedenberg G, Sivitz W, Vittetoe B, Kramer J, Bayless M, Zeitler R, Schrott H, Olson N, Snetselaar L, Hoffman R, MacIndoe J, Weingeist T, Fountain C, Miller R, Johnsonbaugh S, Patronas M, Carney M, Mendley S, Salemi P, Liss R, Hebdon M, Counts D, Donner T, Gordon J, Hemady R, Kowarski A, Ostrowski D, Steidl S, Jones B, Herman W, Martin C, Pop‐Busui R, Greene D, Stevens M, Burkhart N, Sandford T, Floyd J, Bantle J, Flaherty N, Terry J, Koozekanani D, Montezuma S, Wimmergren N, Rogness B, Mech M, Strand T, Olson J, McKenzie L, Kwong C, Goetz F, Warhol R, Hainsworth D, Goldstein D, Hitt S, Giangiacomo J, Schade D, Canady J, Burge M, Das A, Avery R, Ketai L, Chapin J, Schluter M, Rich J, Johannes C, Hornbeck D, Schutta M, Bourne P, Brucker A, Braunstein S, Schwartz S, Maschak‐Carey B, Baker L, Orchard T, Cimino L, Songer T, Doft B, Olson S, Becker D, Rubinstein D, Bergren R, Fruit J, Hyre R, Palmer C, Silvers N, Lobes L, Rath PP, Conrad P, Yalamanchi S, Wesche J, Bratkowksi M, Arslanian S, Rinkoff J, Warnicki J, Curtin D, Steinberg D, Vagstad G, Harris R, Steranchak L, Arch J, Kelly K, Ostrosaka P, Guiliani M, Good M, Williams T, Olsen K, Campbell A, Shipe C, Conwit R, Finegold D, Zaucha M, Drash A, Morrison A, Malone J, Bernal M, Pavan P, Grove N, Tanaka E, McMillan D, Vaccaro‐Kish J, Babbione L, Solc H, DeClue T, Dagogo‐Jack S, Wigley C, Ricks H, Kitabchi A, Chaum E, Murphy M, Moser S, Meyer D, Iannacone A, Yoser S, Bryer‐Ash M, Schussler S, Lambeth H, Raskin P, Strowig S, Basco M, Cercone S, Zinman B, Barnie A, Devenyi R, Mandelcorn M, Brent M, Rogers S, Gordon A, Bakshi N, Perkins B, Tuason L, Perdikaris F, Ehrlich R, Daneman D, Perlman K, Ferguson S, Palmer J, Fahlstrom R, de Boer I, Kinyoun J, Van Ottingham L, Catton S, Ginsberg J, McDonald C, Harth J, Driscoll M, Sheidow T, Mahon J, Canny C, Nicolle D, Colby P, Dupre J, Hramiak I, Rodger N, Jenner M, Smith T, Brown W, May M, Lipps Hagan J, Agarwal A, Adkins T, Lorenz R, Feman S, Survant L, White N, Levandoski L, Grand G, Thomas M, Joseph D, Blinder K, Shah G, Burgess D, Boniuk I, Santiago J, Tamborlane W, Gatcomb P, Stoessel K, Ramos P, Fong K, Ossorio P, Ahern J, Gubitosi‐Klug R, Meadema‐Mayer L, Beck C, Farrell K, Genuth S, Quin J, Gaston P, Palmert M, Trail R, Dahms W, Lachin J, Backlund J, Bebu I, Braffett B, Diminick L, Gao X, Hsu W, Klumpp K, Pan H, Trapani V, Cleary P, McGee P, Sun W, Villavicencio S, Anderson K, Dews L, Younes N, Rutledge B, Chan K, Rosenberg D, Petty B, Determan A, Kenny D, Williams C, Cowie C, Siebert C, Steffes M, Arends V, Bucksa J, Nowicki M, Chavers B, O'Leary D, Polak J, Harrington A, Funk L, Crow R, Gloeb B, Thomas S, O'Donnell C, Soliman E, Zhang Z, Li Y, Campbell C, Keasler L, Hensley S, Hu J, Barr M, Taylor T, Prineas R, Feldman E, Albers J, Low P, Sommer C, Nickander K, Speigelberg T, Pfiefer M, Schumer M, Moran M, Farquhar J, Ryan C, Sandstrom D, Williams T, Geckle M, Cupelli E, Thoma F, Burzuk B, Woodfill T, Danis R, Blodi B, Lawrence D, Wabers H, Gangaputra S, Neill S, Burger M, Dingledine J, Gama V, Sussman R, Davis M, Hubbard L, Budoff M, Darabian S, Rezaeian P, Wong N, Fox M, Oudiz R, Kim L, Detrano R, Cruickshanks K, Dalton D, Bainbridge K, Lima J, Bluemke D, Turkbey E, der Geest ., Liu C, Malayeri A, Jain A, Miao C, Chahal H, Jarboe R, Nathan D, Monnier V, Sell D, Strauch C, Hazen S, Pratt A, Tang W, Brunzell J, Purnell J, Natarajan R, Miao F, Zhang L, Chen Z, Paterson A, Boright A, Bull S, Sun L, Scherer S, Lopes‐Virella M, Lyons T, Jenkins A, Klein R, Virella G, Jaffa A, Carter R, Stoner J, Garvey W, Lackland D, Brabham M, McGee D, Zheng D, Mayfield R, Maynard J, Wessells H, Sarma A, Jacobson A, Dunn R, Holt S, Hotaling J, Kim C, Clemens Q, Brown J, McVary K. Oxidative Stress and Cardiovascular Risk in Type 1 Diabetes Mellitus: Insights From the DCCT/EDIC Study. J Am Heart Assoc 2018. [PMCID: PMC6015340 DOI: 10.1161/jaha.117.008368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background
Hyperglycemia leading to increased oxidative stress is implicated in the increased risk for the development of macrovascular and microvascular complications in patients with type 1 diabetes mellitus.
Methods and Results
A random subcohort of 349 participants was selected from the
DCCT
/
EDIC
(Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications) cohort. This included 320 controls and 29 cardiovascular disease cases that were augmented with 98 additional known cases to yield a case cohort of 447 participants (320 controls, 127 cases). Biosamples from
DCCT
baseline, year 1, and closeout of
DCCT
, and 1 to 2 years post‐
DCCT
(
EDIC
years 1 and 2) were measured for markers of oxidative stress, including plasma myeloperoxidase, paraoxonase activity, urinary F
2α
isoprostanes, and its metabolite, 2,3 dinor‐8
iso
prostaglandin F
2α
. Following adjustment for glycated hemoblobin and weighting the observations inversely proportional to the sampling selection probabilities, higher paraoxonase activity, reflective of antioxidant activity, and 2,3 dinor‐8
iso
prostaglandin F
2α
, an oxidative marker, were significantly associated with lower risk of cardiovascular disease (−4.5% risk for 10% higher paraoxonase,
P
<0.003; −5.3% risk for 10% higher 2,3 dinor‐8
iso
prostaglandin F
2α
,
P
=0.0092). In contrast, the oxidative markers myeloperoxidase and F
2α
isoprostanes were not significantly associated with cardiovascular disease after adjustment for glycated hemoblobin. There were no significant differences between
DCCT
intensive and conventional treatment groups in the change in all biomarkers across time segments.
Conclusions
Heightened antioxidant activity (rather than diminished oxidative stress markers) is associated with lower cardiovascular disease risk in type 1 diabetes mellitus, but these biomarkers did not change over time with intensification of glycemic control.
Clinical Trial Registration
URL
:
https://www.clinicaltrials.gov
. Unique identifiers:
NCT
00360815 and
NCT
00360893.
Collapse
Affiliation(s)
- W.H. Wilson Tang
- Department of Cellular and Molecular Medicine, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Paula McGee
- The Biostatistics Center, George Washington University, Rockville, MD
| | - John M. Lachin
- The Biostatistics Center, George Washington University, Rockville, MD
| | - Daniel Y. Li
- Department of Cellular and Molecular Medicine, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
| | | | - Stanley L. Hazen
- Department of Cellular and Molecular Medicine, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Fong K. MTE 22.01 Any Differences in the Management of Elderly Patients with Lung Cancer between East and West? J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
25
|
Quinlan J, Fong K, Rain M, Mar R. Finding sense in nonsense: Predicting reactions to the absurd using trait differences. Personality and Individual Differences 2016. [DOI: 10.1016/j.paid.2016.05.268] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
26
|
Fong K, Takeichi T, Liu L, Pramanik R, Lee J, Akiyama M, McGrath JA. Ichthyosis follicularis, atrichia, and photophobia syndrome associated with a new mutation inMBTPS2. Clin Exp Dermatol 2015; 40:529-32. [DOI: 10.1111/ced.12587] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2014] [Indexed: 11/29/2022]
Affiliation(s)
- K. Fong
- St John's Institute of Dermatology; King's College London (Guy's Campus); London UK
| | - T. Takeichi
- St John's Institute of Dermatology; King's College London (Guy's Campus); London UK
- Department of Dermatology; Nagoya University Graduate School of Medicine; Nagoya Japan
| | - L. Liu
- Viapath; St Thomas' Hospital; London UK
| | - R. Pramanik
- St John's Institute of Dermatology; King's College London (Guy's Campus); London UK
| | - J. Lee
- St John's Institute of Dermatology; King's College London (Guy's Campus); London UK
| | - M. Akiyama
- Department of Dermatology; Nagoya University Graduate School of Medicine; Nagoya Japan
| | - J. A. McGrath
- St John's Institute of Dermatology; King's College London (Guy's Campus); London UK
| |
Collapse
|
27
|
Takeichi T, Liu L, Fong K, Ozoemena L, McMillan JR, Salam A, Campbell P, Akiyama M, Mellerio JE, McLean WHI, Simpson MA, McGrath JA. Whole-exome sequencing improves mutation detection in a diagnostic epidermolysis bullosa laboratory. Br J Dermatol 2015; 172:94-100. [PMID: 24947307 DOI: 10.1111/bjd.13190] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [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] [Accepted: 06/08/2014] [Indexed: 01/01/2023]
Abstract
BACKGROUND Subtypes of inherited epidermolysis bullosa (EB) vary significantly in their clinical presentation and prognosis. Establishing an accurate diagnosis is important for genetic counselling and patient management. Current approaches in EB diagnostics involve skin biopsy for immunohistochemistry and transmission electron microscopy, and Sanger sequencing of candidate genes. Although informative in most cases, this approach can be expensive and laborious and may fail to identify pathogenic mutations in ~15% of cases. OBJECTIVES Next-generation DNA sequencing (NGS) technologies offer a fast and efficient complementary diagnostic strategy, but the value of NGS in EB diagnostics has yet to be explored. The aim of this study was to undertake whole-exome sequencing (WES) in nine cases of EB in which established diagnostic methods failed to make a genetic diagnosis. METHODS Whole-exome capture was performed using genomic DNA from each case of EB, followed by massively parallel sequencing. Resulting reads were mapped to the human genome reference hg19. Potentially pathogenic mutations were subsequently confirmed by Sanger sequencing. RESULTS Analysis of WES data disclosed biallelic pathogenic mutations in each case, with all mutations occurring in known EB genes (LAMB3, PLEC, FERMT1 and COL7A1). This study demonstrates that NGS can improve diagnostic sensitivity in EB compared with current laboratory practice. CONCLUSIONS With appropriate diagnostic platforms and bioinformatics support, WES is likely to increase mutation detection in cases of EB and improve EB diagnostic services, although skin biopsy remains an important diagnostic investigation in current clinical practice.
Collapse
Affiliation(s)
- T Takeichi
- St John's Institute of Dermatology, King's College London (Guy's Campus), London, U.K; Department of Dermatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Close RM, Maguire H, Etherington G, Brewin CR, Fong K, Saliba V, Barker RM, Leonardi GS. Preparedness for a major incident: creation of an epidemiology protocol for a health protection register in England. Environ Int 2014; 72:75-82. [PMID: 24928282 DOI: 10.1016/j.envint.2014.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [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: 10/17/2013] [Revised: 04/29/2014] [Accepted: 05/01/2014] [Indexed: 06/03/2023]
Abstract
Large incidents and natural disasters are on the increase globally. They can have a major impact lasting many years or decades; and can affect large groups of people including those that are more susceptible to adverse consequences. Following a major incident, it may be considered necessary to establish a register of those people affected by the incident to provide appropriate advice on relevant immediate and longer-term public health interventions that may be required, provide reassurance to the public that their care is paramount, to reassure the worried well to avoid them inappropriately overwhelming local services, and to facilitate epidemiological investigations. Arrangements for the prompt follow-up of populations after large incidents or disasters have been agreed in England and a protocol for establishing a register of individuals potentially affected by a large incident has been developed. It is important for countries to have a protocol for implementing a health register if the circumstances require one to be in place, and are supported by Public Health Authorities. Health registers facilitate the initial descriptive epidemiology of exposure and provide the opportunity of carrying out long term analytical studies on the affected population. Such epidemiological studies provide a greater understanding of the impact that a large incident can have on health, which in turn helps in the planning of health care provision. Registers can also assist more directly in providing access to individuals in need of physical and mental health interventions. The challenge that still remains is to formally pilot the register in the field and refine it based on that experience.
Collapse
Affiliation(s)
- R M Close
- Department of Epidemiology, Centre for Radiation, Chemical and Environmental Hazards, Public Health England, UK; Field Epidemiology Training Programme (FETP), Public Health England, UK; European Programme for Intervention Epidemiology Training, ECDC, Stockholm, Sweden.
| | - H Maguire
- European Programme for Intervention Epidemiology Training, ECDC, Stockholm, Sweden; Field Epidemiology Services, Public Health England, Victoria, London, UK
| | - G Etherington
- Department of Toxicology, Centre for Radiation, Chemical and Environmental Hazards, Public Health England, UK
| | - C R Brewin
- Department of Psychology, University College London, UK
| | - K Fong
- Department of Emergency Medicine, University College Hospital, London, UK
| | - V Saliba
- North East & North Central London Health Protection Team, Public Health England, London, UK
| | - R M Barker
- Emergency Response Department, Public Health England, UK
| | - G S Leonardi
- Department of Epidemiology, Centre for Radiation, Chemical and Environmental Hazards, Public Health England, UK; London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
29
|
Zwierzchoniewska M, Patel D, Fong K, Morales E, Wildbihler K, Mou L, Jeffrey G, Delriviere L. Low Blood Product Requirement During Liver Tranplantation Does Not Depend On MELD Score - Single Centre Experience. Transplantation 2014. [DOI: 10.1097/00007890-201407151-02505] [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: 11/25/2022]
|
30
|
Yang Y, Thumboo J, Earnest A, Yong SL, Fong KY. The effect of comorbidity on hospital mortality in patients with SLE from an Asian tertiary hospital. Lupus 2014; 23:714-20. [DOI: 10.1177/0961203314522340] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 01/08/2014] [Indexed: 01/04/2023]
Abstract
Objectives The objective of the study was to assess the disease burden of systemic lupus erythematosus (SLE) and the usefulness of the Charlson Comorbidity Index (CCI) as risk-adjusted hospital mortality predictors in patients with SLE using a hospital administrative database. Methods A historical cohort study of a hospital discharge database from 2004 to 2011 was used to identify cases with SLE and comorbidity using the International Statistical Classification of Diseases and Related Health Problems, ninth revision, Australian modification (ICD-9-AM) codes. Results Over the eight years, 841 patients met the criteria of SLE with a hospital mortality rate of 9.2%. The hospital mortality rates (2.4%, 15.7%, 25.0%, and 30.4%, respectively, p < 0.001) and hospital length of stay (geometric mean, 3.5, 5.6, 8.8, and 7.5 days, respectively, p < 0.001) were consistently increased for patients with CCI ranging from none, low, moderate to high grade, respectively. Cox proportional hazards model analysis showed that CCI (hazard ratio (HR) 7.8 high vs. none, p < 0.001) and infectious disease (HR 2.0, p = 0.016) were significant and independent predictors of hospital mortality. Similar results were also seen with hospital length of stay by zero-truncated negative binomial regression model analysis. Conclusion The SLE burden is high in this population. Comorbidities and infectious disease were some of the most important contributors to hospital mortality and resource utilization.
Collapse
Affiliation(s)
- Y Yang
- Department of Epidemiology, Medical Board, Singapore General Hospital, Singapore
- Centre for Quantitative Medicine, Office of Clinical Sciences, Duke-NUS Graduate Medical School, Singapore
| | - J Thumboo
- Department of Rheumatology & Immunology, Singapore General Hospital, Singapore
- Duke-NUS Graduate Medical School, Singapore
| | - A Earnest
- Centre for Quantitative Medicine, Office of Clinical Sciences, Duke-NUS Graduate Medical School, Singapore
| | - SL Yong
- Medical Board, Singapore General Hospital, Singapore
| | - KY Fong
- Department of Rheumatology & Immunology, Singapore General Hospital, Singapore
- Duke-NUS Graduate Medical School, Singapore
| |
Collapse
|
31
|
Fong K, Wedgeworth EK, Lai-Cheong JE, Tosi I, Mellerio JE, Powell AM, McGrath JA. MBTPS2 mutation in a British pedigree with keratosis follicularis spinulosa decalvans. Clin Exp Dermatol 2012; 37:631-4. [PMID: 22816986 DOI: 10.1111/j.1365-2230.2011.04288.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Keratosis follicularis spinulosa decalvans (KFSD; OMIM 308800) is an X-linked disorder characterized by widespread hyperkeratotic follicular papules (including keratosis pilaris-like lesions), facial erythema, hypotrichosis and scarring alopecia. KFSD results from mutations in the MBTPS2 gene. Mutations in this gene also underlie ichthyosis follicularis, alopecia and photophobia syndrome. We report a British pedigree with KFSD resulting from the mutation p.Asn508Ser. This particular mutation has been reported in three other pedigrees with KFSD (Dutch, American, British) and is the only pathogenic mutation reported in this disorder to date. However, the same mutation has also been reported in a Chinese pedigree with IFAP syndrome, highlighting the clinical heterogeneity and overlapping molecular pathology of these two disorders.
Collapse
Affiliation(s)
- K Fong
- St John's Institute of Dermatology, King's College London, (Guy's Campus), London, UK
| | | | | | | | | | | | | |
Collapse
|
32
|
Fong K, Rama Devi AR, Lai-Cheong JE, Chirla D, Panda SK, Liu L, Tosi I, McGrath JA. Infantile systemic hyalinosis associated with a putative splice-site mutation in the ANTXR2 gene. Clin Exp Dermatol 2012; 37:635-8. [PMID: 22300424 DOI: 10.1111/j.1365-2230.2011.04287.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [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] [Indexed: 11/30/2022]
Abstract
Infantile systemic hyalinosis (ISH) is a rare autosomal recessive genetic disorder characterized by dermal and subcutaneous fibromatosis, joint contractures and bone deformities. The condition usually presents at birth, resulting in death in infancy. ISH is caused by mutations in the anthrax toxin receptor 2 gene, ANTXR2, also known as CMG2. We report an Indian child with ISH in whom we identified a homozygous acceptor splice site mutation, IVS2-4G>A. In silico analysis of this sequence showed that it changed predicted cryptic splicing, leading to out-of-frame transcripts and little, if any, functional protein. Mutations in the ANTXR2 gene can also cause juvenile hyaline fibromatosis (JHF). Although there are currently no effective treatments for ISH or JHF, identification of pathogenetic mutations in the ANTXR2 gene makes DNA-based prenatal diagnosis feasible for subsequent pregnancies.
Collapse
Affiliation(s)
- K Fong
- St John's Institute of Dermatology, King's College London (Guy's Campus), London, UK
| | | | | | | | | | | | | | | |
Collapse
|
33
|
Tuan J, Ha T, Ong W, Siow T, Tham I, Yap S, Tan T, Chua E, Fong K, Wee J. PD-0295 LATE TOXICITIES IN 796 PATIENTS AFTER CONVENTIONAL RADIATION THERAPY ALONE FOR NASOPHARYNGEAL CARCINOMA. Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)70634-5] [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: 10/28/2022]
|
34
|
Rohana AG, Loh KC, Tin SK, Soh CH, Nazaimoon WMW, Fong KY, Azmi KN, Khalid BAK. HLA-DQ A1, -DQB1 and -DRB1 gene polymorphism--in Malay type 1 diabetes mellitus patients and their use for risk prediction. Med J Malaysia 2011; 66:133-137. [PMID: 22106694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
HLA-DQA1, -DQB1, and -DRB1 gene polymorphism were analyzed to study type 1 DM susceptibility in Malay patients from Southeast Asia (Malaysia and Singapore). Patients showed significant increases in the occurrence of DQA1*0501 (50.7% vs. 20.4%; RR = 3.97; Pc < 0.01), DQB1*0201 (48% vs. 19.1%; RR = 3.86; Pc < 0.05), and DRB1*0301 (38.7 vs. 6.8%; RR = 8.36; 95% Pc < 0.05). Conversely, significant decreases were noted in the occurrence of DQA1*0601 (14.7% vs. 35.2%; RR = 0.33; Pc = 0.008) and DQB1*0601 (4% vs. 23.5%; RR = 0.16; Pc < 0.05) in type 1 DM patients. Using a logistic regression model, we derived a risk prediction model for type 1 DM in our indigenous Malay population based on the identified HLA genotypes. The RR for type 1 DM increases by a factor of 5.68 for every unit increase in the number of DRB1*0301 allele (P < 0.001), and decreases by a factor of 0.18 per unit increase in the number of DQB1*0601 allele (P < 0.001). After adjusting for these two HLA genotypes, DQA1*0501, DQB1*0201 and DQA1*0601 were not statistically significant as risk predictors. The lower incidence of type 1 DM in the Malay population may be contributed by the genotypic combinations of DR and DQ genes as well as the linkage disequilibria between susceptible and protective alleles.
Collapse
Affiliation(s)
- A G Rohana
- Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia.
| | | | | | | | | | | | | | | |
Collapse
|
35
|
Abstract
Neurological manifestations in lupus can be due to active lupus disease affecting the brain or to other reasons. Reversible posterior leucoencephalopathy syndrome, primary lymphoma of the central nervous system, cerebral infections by bacteria (e.g. mycobacteria), viruses (e.g. JC virus), fungi (e.g. Cryptococcus) and parasites (e.g. Acanthamoeba), steroid-induced psychosis and reactive depression need to be excluded. Brain-reactive autoantibodies have been described as associating with neuropsychiatric lupus. The strongest associations described to date are with antiribosomal P protein and antiphospholipid antibodies. However these autoantibodies have not been shown to play significant roles in the pathogenesis. Treatment strategy for severe neuropsychiatric lupus include establishing definitive diagnosis, early identification and treatment of aggravating factors, appropriate symptomatic treatment, adequate immunosuppression, selective B-cell depletion and autologous haematopoietic stem cell transplant. Systematic reviews have shown that cyclophosphamide administration is superior to pulse methylprednisolone as a maintenance therapy. Mycophenolate mofetil has been shown to have modest effect and should only be considered if cyclophosphamide cannot be administered.
Collapse
Affiliation(s)
- K Y Fong
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore.
| | | |
Collapse
|
36
|
Fong K, Akdeniz S, Isi H, Taskesen M, McGrath JA, Lai-Cheong JE. New homozygous SPINK5 mutation, p.Gln333X, in a Turkish pedigree with Netherton syndrome. Clin Exp Dermatol 2010; 36:412-5. [DOI: 10.1111/j.1365-2230.2010.03976.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
37
|
Lin C, Ghamande S, Cho D, Silverman M, Fong K, Kuo M, Mach W, Tseng Y, Hsu S, Goel S. 571 TLC388, a novel topoisomerase-1 inhibitor with anti-hypoxia inducible factor-1 alpha activity: a phase I and pharmacokinetic study in patients with advanced solid malignancies. EJC Suppl 2010. [DOI: 10.1016/s1359-6349(10)72278-3] [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: 11/25/2022] Open
|
38
|
El-Kamah GY, Fong K, El-Ruby M, Afifi HH, Clements SE, Lai-Cheong JE, Amr K, El-Darouti M, McGrath JA. Spectrum of mutations in the ANTXR2 (CMG2) gene in infantile systemic hyalinosis and juvenile hyaline fibromatosis. Br J Dermatol 2010; 163:213-5. [PMID: 20331448 DOI: 10.1111/j.1365-2133.2010.09769.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
39
|
Lin C, Ghamande SA, Dezube BJ, Silverman MH, Fong K, Kuo M, Mach W, Tseng Y, Hsu S, Goel S. TLC388, a novel topoisomerase-1 inhibitor with antihypoxia inducible factor-1 alpha activity: A phase I and pharmacokinetic study in patients with advanced solid malignancies. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e13020] [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: 11/20/2022] Open
|
40
|
Low AHL, Su JW, Sin KYK, Fong KY, Thumboo J. Cogan's syndrome with recurrent carotid and aortic aneurysms: a potentially fatal disorder mimicking Marfan syndrome. Scand J Rheumatol 2009; 36:71-3. [PMID: 17454940 DOI: 10.1080/03009740600907923] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Cogan's syndrome (CS) is a rare multisystemic disease characterized by vestibuloauditory dysfunction, inflammatory eye disease and vasculitis. Aortic aneurysms due to aortitis are under-recognized in CS, and are potentially fatal, with two of eight reported cases dying from aneurysm/arterial rupture. The presence of aneurysms was not recognized antemortem in both cases, highlighting the importance of early detection to prevent this potentially fatal outcome. We report a 17-year-old Chinese male with recurrent carotid and aortic aneurysms, bilateral sensorineural hearing loss, and recurrent scleritis who was initially thought to have Marfan syndrome. The diagnosis of CS was made 4.5 years after initial presentation, during which time recurrent aneurysms due to active aortitis (with aneurysmal rupture on one occasion) necessitated four surgical procedures. Treatment with methotrexate and corticosteroids resulted in no recurrence of aneurysms over 2 years of follow-up. This case illustrates (i) the challenges in diagnosing CS when various manifestations occur separately over a relatively long time period, (ii) that detection of aortic aneurysms in young patients, especially if recurrent, should prompt investigations for vasculitis/aortitis to prevent potentially fatal aneurysm rupture, and (iii) that methotrexate and high-dose corticosteroids may be effective in preventing development of further aneurysms in CS patients.
Collapse
Affiliation(s)
- A H L Low
- Department of Rheumatology and Immunology, Singapore General Hospital, Outram Road, Singapore 169608. andrea.low.h.l.@singhealth.com.sg
| | | | | | | | | |
Collapse
|
41
|
Fratterelli J, Leondires M, Fong K, Theall A, Locatelli S, Scott R. Laser acupuncture before and after embryo transfer improves ART delivery rates: results of a prospective randomized double-blinded placebo controlled five-armed trial involving 1000 patients. Fertil Steril 2008. [DOI: 10.1016/j.fertnstert.2008.07.1252] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
42
|
Sivalingam SP, Thumboo J, Vasoo S, Fong KY. HLA-DRB1⁎04 gene polymorphisms and expressions profiles of interleukin-18 and interleukin-18 binding protein following in vitro stimulation in human peripheral blood mononuclear cells of healthy individuals and patients with rheumatoid arthritis. Life Sci 2007; 80:1887-96. [PMID: 17367819 DOI: 10.1016/j.lfs.2007.02.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2006] [Revised: 12/27/2006] [Accepted: 02/16/2007] [Indexed: 11/17/2022]
Abstract
Rheumatoid arthritis (RA) is a chronic arthritic condition that can lead to deformities and disabilities. Interleukin-18 (IL-18) is a proinflammatory cytokine known to play a role in the acute and chronic inflammatory phases of RA. IL-18 binding protein is the natural antagonist of IL-18 protein. We aim to identify the effect of HLA-DRB1*04 gene polymorphisms on IL-18 and IL-18BP gene expressions profiles as well as the time-course profiles following in vitro stimulation with mitogens. Peripheral blood mononuclear cells from 16 RA patients and 21 healthy controls were cultured for 1, 4, 8, 12, 24, 48 and 72 h following stimulation with either LPS or PHA. mRNA expression of IL-18 and IL 18BP were determined by quantitative real-time PCR using a comparative Ct (threshold cycle) method. IL-18 levels in supernatants were measured by enzyme-linked immunosorbent assay. Basal mRNA (4.5-fold) and protein levels of IL-18 were increased and IL-18BP mRNA expression was decreased (8-fold) in RA patients when compared to controls. Similarly, increased IL-18 levels were observed in active RA patients, whereas IL-18BP expression was increased in inactive patients. There was an increase in mRNA and protein levels of IL-18 in RA patients that peaked at 4 h and 8 h respectively following LPS stimulation. A similar profile was observed for IL-18BP; however, the expression level was higher in controls than RA patients. Persistent high production of IL-18 in RA is associated with disease progression and IL-18 BP seems to inhibit this activity.
Collapse
Affiliation(s)
- S P Sivalingam
- Department of Medicine, National University of Singapore, Republic of Singapore.
| | | | | | | |
Collapse
|
43
|
Chang PEJ, Cheng CL, Asok K, Fong KY, Chee SP, Tan CK. Visual disturbances in dengue fever: an answer at last? Singapore Med J 2007; 48:e71-3. [PMID: 17342274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Visual disturbances in dengue infection are uncommon but may result in permanent visual impairment. We report a 32-year-old Chinese woman with dengue infection and she developed retinal haemorrhage, retinal vasculitis and macular detachment. Autoimmune screen revealed a low C4 complement level, possibly due to partial C4 complement deficiency. The patient was treated with steroids and there was significant improvement in her vision. Partial C4 deficiency predisposes to autoimmune disease, and patients with pre-existing low C4 levels may be susceptible to ocular complications in dengue infection. Interestingly, previous case reports of ophthalmic complications of dengue infection occurred in young female patients, who are likewise predisposed to autoimmune disease. In conclusion, in individuals predisposed to autoimmune disease (females and patients with partial C4 deficiency), dengue infection may provide the antigenic trigger for immune complex deposition and retinal vasculitis. Steroids may have an important role in the treatment of this condition.
Collapse
Affiliation(s)
- P E J Chang
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Outram Road, Singapore 169608.
| | | | | | | | | | | |
Collapse
|
44
|
|
45
|
|
46
|
Coory M, Fong K, Bowman R, Hall L. Why we need a population-based approach to clinical indicators for cancer: a case study using microscopic confirmation of lung cancer in Queensland. Intern Med J 2006; 36:389-92. [PMID: 16732867 DOI: 10.1111/j.1445-5994.2006.01074.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
An important function of clinical cancer registries is to provide feedback to clinicians on various performance measures. To date, most clinical cancer registries in Australia are located in tertiary academic hospitals, where adherence to guidelines is probably already high. Microscopic confirmation is an important process measure for lung cancer care. We found that the proportion of patients with lung cancer without microscopic confirmation was much higher in regional public hospitals (27.1%) than in tertiary hospitals (7.5%), and this disparity remained after adjusting for age, sex and comorbidities. The percentage was also higher in the private than in the public sector. This case study shows that we need a population-based approach to measuring clinical indicators that includes regional public hospitals as a matter of priority and should ideally include the private sector.
Collapse
Affiliation(s)
- M Coory
- School of Population Health, Mayne Medical School, The University of Queensland, Queensland, Australia.
| | | | | | | |
Collapse
|
47
|
Tin SK, Xu Q, Thumboo J, Lee LY, Tse C, Fong KY. Novel brain reactive autoantibodies: Prevalence in systemic lupus erythematosus and association with psychoses and seizures. J Neuroimmunol 2005; 169:153-60. [PMID: 16146655 DOI: 10.1016/j.jneuroim.2005.07.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2005] [Accepted: 07/25/2005] [Indexed: 11/30/2022]
Abstract
Autoantibodies can cause neuropsychiatric manifestations in lupus patients by altering the physiological function of neuronal cells. In this study, we identified Brain Reactive Autoantibodies (BRAAs) against murine neuronal membrane proteins (M.W. 27.5 and 29.5 kD) and found them correlating with psychosis and/or seizures in lupus patients. They were specific to neuronal membrane tissues of mammalian origin and are significantly associated with psychosis and/or seizures (p<0.0001). These membrane proteins mass spectrometry profiles did not match to any published protein sequences. These BRAAs may play important roles in the pathophysiology of neuropsychiatric lupus.
Collapse
Affiliation(s)
- S K Tin
- Department of Rheumatology and Immunology, Singapore General Hospital Outram Road, Singapore 169608, Singapore
| | | | | | | | | | | |
Collapse
|
48
|
Tin SK, Lee LY, Thumboo J, Koh DR, Fong KY. PCR-RFLP genotyping for exon 1 and promoter region mutations of the human mannose binding lectin (MBL-2) gene. J Immunol Methods 2005; 303:148-51. [PMID: 16040048 DOI: 10.1016/j.jim.2005.06.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2005] [Revised: 05/17/2005] [Accepted: 06/10/2005] [Indexed: 11/16/2022]
Abstract
The Mannose Binding Lectin (MBL) plays an important role in innate immunity and its genetic deficiencies are associated with frequent and prolonged infections. Serum MBL determination may not accurately detect acute phase protein levels and it is also difficult to detect dysfunctional protein. Genotyping of the exon 1 and promoter regions in the MBL gene will provide useful information on the presence of deficiencies in patients. A reproducible PCR-RFLP method is described to accurately detect genotypes of exon 1 and polymorphic haplotypes of the promoter region in the MBL gene.
Collapse
Affiliation(s)
- S K Tin
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore
| | | | | | | | | |
Collapse
|
49
|
Larsen J, Pavey S, Passmore L, Bowman R, Hayward N, Zimmerman P, Fong K. P-074 Expression profiling of metastatic recurrence in primary bronchogenic squamous cell carcinomas. Lung Cancer 2005. [DOI: 10.1016/s0169-5002(05)80568-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
50
|
Leong S, Fong K, Toh C, Lim D, Yap S, Tay M, Tan E. P-213 A phase II trial of induction gemcitabine and vinorelbine followed by concurrent vinorelbine and radiotherapy in locally advanced non-small cell lung cancer; a non-platinum-based bimodality treatment schedule. Lung Cancer 2005. [DOI: 10.1016/s0169-5002(05)80707-x] [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]
|