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Wong YJ, Teng M, Sim A, Thet HM, Teoh X, De Roza MA, Sen Kew G, Koh JH, Loi PL, Lim K, Kang G, Kuang J, Low EXS, Ho JL, Cher LYG, Sze K, Wong GW, Kwek BYA, Yang WL, Abraldes JG, Chang J. Full adherence to cirrhosis quality indicators is associated with lower mortality in acute variceal bleeding: Nationwide audit. Hepatology 2024:01515467-990000000-00764. [PMID: 38381716 DOI: 10.1097/hep.0000000000000793] [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] [Received: 11/04/2023] [Accepted: 01/23/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND AND AIMS Acute variceal bleeding (AVB) is a major complication in patients with cirrhosis. Using a nationwide AVB audit, we performed a nested cohort study to determine whether full adherence to the AVB quality indicator (QI) improves clinical outcomes in patients with cirrhosis and AVB. APPROACH AND RESULTS We assessed real-world adherence to AVB QI among patients with cirrhosis admitted for AVB in all public hospitals in Singapore between January 2015 and December 2020. Full adherence was considered when all 5 QIs were fulfilled: prophylactic antibiotics, vasoactive agents, timely endoscopy, endoscopic hemostasis during index endoscopy, and nonselective beta-blockers after AVB. We compare 6-week mortality between the full adherence and suboptimal adherence groups using a propensity-matched cohort.A total of 989 patients with AVB were included. Full adherence to all AVB QI was suboptimal (56.5%). Analysis of the propensity-matched cohort with comparable baseline characteristics showed that full adherence was associated with a lower risk of early infection (20.0% vs. 26.9%), early rebleeding (5.2% vs. 10.2%), and mortality at 6 weeks (8.2% vs. 19.7%) and 1 year (21.3% vs. 35.4%) ( p <0.05 for all). While full adherence was associated with a lower 6-week mortality regardless of the MELD score, nonadherence was associated with a higher 6-week mortality despite a lower predicted risk of 6-week mortality. Despite high adherence to the recommended process measures, patients with CTP-C remain at a higher risk of rebleeding, 6-week and 1-year mortality. CONCLUSIONS Full adherence to the AVB QI should be the target for quality improvement in patients with cirrhosis.
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Affiliation(s)
- Yu Jun Wong
- Department of Gastroenterology & Hepatology, Changi General Hospital, Singapore
- Duke-NUS Academic Clinical Program, SingHealth, Singapore
- Liver unit, Division of Gastroenterology & Hepatology, University of Alberta, Canada
| | - Margaret Teng
- Division of Gastroenterology and Hepatology, National University Hospital, Singapore
| | - Alyssa Sim
- Department of Gastroenterology & Hepatology, Tan Tock Seng General Hospital, Singapore
| | - Htay Myat Thet
- Department of Medicine, Division of Gastroenterology & Hepatology, Ng Teng Fong Hospital, Singapore
| | - Xuhui Teoh
- Department of General Medicine, Division of Gastroenterology, Khoo Teck Puat Hospital, Singapore
| | | | - Guan Sen Kew
- Department of Medicine, Woodlands Health, Singapore
| | - Jia Hong Koh
- Division of Gastroenterology and Hepatology, National University Hospital, Singapore
| | - Pooi Ling Loi
- Department of Gastroenterology & Hepatology, Singapore General Hospital, Singapore
| | - Kai Lim
- Department of Gastroenterology & Hepatology, Singapore General Hospital, Singapore
| | - Garrett Kang
- Department of Gastroenterology & Hepatology, Changi General Hospital, Singapore
| | - Jonathan Kuang
- Department of Gastroenterology & Hepatology, Tan Tock Seng General Hospital, Singapore
| | - En Xian Sarah Low
- Department of Medicine, Division of Gastroenterology & Hepatology, Ng Teng Fong Hospital, Singapore
| | | | - Liu Yuan Gabriel Cher
- Department of General Medicine, Division of Gastroenterology, Khoo Teck Puat Hospital, Singapore
| | - Kenny Sze
- Department of General Medicine, Division of Gastroenterology, Khoo Teck Puat Hospital, Singapore
| | - Guan Wee Wong
- Department of Medicine, Division of Gastroenterology & Hepatology, Ng Teng Fong Hospital, Singapore
| | - Boon Yew Andrew Kwek
- Department of Gastroenterology & Hepatology, Changi General Hospital, Singapore
- Duke-NUS Academic Clinical Program, SingHealth, Singapore
| | - Wei Lyn Yang
- Department of Gastroenterology & Hepatology, Tan Tock Seng General Hospital, Singapore
| | - Juan G Abraldes
- Liver unit, Division of Gastroenterology & Hepatology, University of Alberta, Canada
| | - Jason Chang
- Duke-NUS Academic Clinical Program, SingHealth, Singapore
- Department of Gastroenterology & Hepatology, Singapore General Hospital, Singapore
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Fong P, Lim K, Gnanam A, Charn T. Role of probiotics in chronic rhinosinusitis: a systematic review of randomised, controlled trials. J Laryngol Otol 2023; 137:1300-1311. [PMID: 36999550 DOI: 10.1017/s0022215123000543] [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] [Indexed: 04/01/2023]
Abstract
OBJECTIVE This review evaluated the safety profile and efficacy of probiotics in chronic rhinosinusitis and was registered with Prospero (Centre for Reviews and Dissemination number: 42020193529). METHOD Literature databases were searched through inception to August 2022. Randomised, controlled trials exploring adjunctive probiotics in adult chronic rhinosinusitis patients were included. From 948 records screened, 4 randomised, controlled trials were included. RESULTS Probiotics-associated adverse effects comprised epistaxis and abdominal pain. No reduction in Sino-Nasal Outcome Test values before 4 weeks (p = 0.58) or beyond 8 weeks (p = 0.08) of treatment or reduction of severe symptom frequency (p = 0.75) was observed. Symptom relapse in probiotic-treated patients was significantly lower across all timepoints (p = 0.045). Lower sinusitis relapse risks during treatment (risk ratio = 0.49; p = 0.019) and 8 months post-treatment (risk ratio = 0.56, p = 0.013) were observed. Probiotics demonstrated potential in improving Sino-Nasal Outcome Test symptom subscales, including sleep, psychological and rhinology subscales. CONCLUSION The optimal mode of probiotic administration, treatment duration and target patient subgroups requires further study to evaluate the utility of probiotics.
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Affiliation(s)
- P Fong
- Department of Otorhinolaryngology - Head and Neck Surgery, Sengkang General Hospital, SingHealth, Singapore, Singapore
| | - K Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - A Gnanam
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - T Charn
- Department of Otorhinolaryngology - Head and Neck Surgery, Sengkang General Hospital, SingHealth, Singapore, Singapore
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Ng CF, Lim K, Yee CH, Chiu PKF, Teoh JYC, Lai FPT. Time for change? Feasibility of introducing micromodules into medical student education: a randomised controlled trial. Hong Kong Med J 2023; 29:208-213. [PMID: 37349137 DOI: 10.12809/hkmj219267] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023] Open
Abstract
INTRODUCTION Didactic lectures have been the foundation of learning for many medical students. However, in recent years, the flipped classroom model has become increasingly popular in medical education. This approach enhances pre-class learning, allowing the limited contact time between clinicians and medical students to be focused on practical issues. This study evaluated the effectiveness and non-inferiority of online micromodule teaching in terms of knowledge transfer concerning specific urology topics. METHODS Medical students without prior exposure to the urology subspecialty were enrolled in the study, then randomised to a traditional didactic lecture group or an online micromodule group. Knowledge transfer was assessed by pre-intervention and post-intervention multiple-choice questions and objective structured clinical examinations that involved the acquisition of medical histories from real patients. RESULTS In total, 45 medical students were enrolled (22 in the traditional didactic group and 23 in the online micromodule group). In terms of knowledge transfer (assessed by objective structured clinical examinations), the efficacy of online micromodules was comparable to traditional didactic lectures, although the difference was not statistically significant (P=0.823). There were no significant differences in terms of knowledge acquisition, retention, or clinical application between the two groups. CONCLUSION In terms of acquiring, retaining, and applying foundational urological knowledge, online micromodules can help medical students to achieve outcomes comparable with the outcomes of didactic lectures. Online micromodules may be a viable alternative to traditional didactic lectures in urology education.
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Affiliation(s)
- C F Ng
- Department of Surgery, SH Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - K Lim
- Department of Surgery, SH Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - C H Yee
- Department of Surgery, SH Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - P K F Chiu
- Department of Surgery, SH Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - J Y C Teoh
- Department of Surgery, SH Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - F P T Lai
- Department of Surgery, SH Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong SAR, China
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Motlaghian SM, Vahidi V, Belger A, Bustillo JR, Faghiri A, Ford JM, Iraji A, Lim K, Mathalon DH, Miller R, Mueller BA, O'Leary D, Potkin SG, Preda A, van Erp TG, Calhoun VD. A method for estimating and characterizing explicitly nonlinear dynamic functional network connectivity in resting-state fMRI data. J Neurosci Methods 2023; 389:109794. [PMID: 36652974 DOI: 10.1016/j.jneumeth.2023.109794] [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: 12/25/2022] [Accepted: 01/13/2023] [Indexed: 01/16/2023]
Abstract
The past 10 years have seen an explosion of approaches that focus on the study of time-resolved change in functional connectivity (FC). FC characterization among networks at a whole-brain level is frequently termed functional network connectivity (FNC). Time-resolved or dynamic functional network connectivity (dFNC) focuses on the estimation of transient, recurring, whole-brain patterns of FNC. While most approaches in this area have attempted to capture dynamic linear correlation, we are particularly interested in whether explicitly nonlinear relationships, above and beyond linear, are present and contain unique information. This study thus proposes an approach to assess explicitly nonlinear dynamic functional network connectivity (EN dFNC) derived from the relationship among independent component analysis time courses. Linear relationships were removed at each time point to evaluate, typically ignored, explicitly nonlinear dFNC using normalized mutual information (NMI). Simulations showed the proposed method estimated explicitly nonlinearity over time, even within relatively short windows of data. We then, applied our approach on 151 schizophrenia patients, and 163 healthy controls fMRI data and found three unique, highly structured, mostly long-range, functional states that also showed significant group differences. In particular, explicitly nonlinear relationships tend to be more widespread than linear ones. Results also highlighted a state with long range connections to the visual domain, which were significantly reduced in schizophrenia. Overall, this work suggests that quantifying EN dFNC may provide a complementary and potentially valuable tool for studying brain function by exposing relevant variation that is typically ignored.
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Affiliation(s)
- S M Motlaghian
- Tri-institutional Center for Translational Research in Neuroimaging and Data Science (Trends), Georgia State, Georgia Tech, and Emory, Atlanta, GA, USA.
| | - V Vahidi
- Department of Computer and Information Science, Spelman College, GA, USA
| | - A Belger
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - J R Bustillo
- Department of Psychiatry, University of New Mexico Albuquerque, NM, USA
| | - A Faghiri
- Tri-institutional Center for Translational Research in Neuroimaging and Data Science (Trends), Georgia State, Georgia Tech, and Emory, Atlanta, GA, USA
| | - J M Ford
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA; San Francisco VA Medical Center, San Francisco, CA, USA
| | - A Iraji
- Tri-institutional Center for Translational Research in Neuroimaging and Data Science (Trends), Georgia State, Georgia Tech, and Emory, Atlanta, GA, USA
| | - K Lim
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA
| | - D H Mathalon
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA; San Francisco VA Medical Center, San Francisco, CA, USA
| | - R Miller
- Tri-institutional Center for Translational Research in Neuroimaging and Data Science (Trends), Georgia State, Georgia Tech, and Emory, Atlanta, GA, USA
| | - B A Mueller
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA
| | - D O'Leary
- Department of Psychiatry, University of Iowa, Iowa City, IA, USA
| | - S G Potkin
- Department of Psychiatry and Human Behavior, University of California Irvine, Irvine, CA, USA
| | - A Preda
- Department of Psychiatry and Human Behavior, University of California Irvine, Irvine, CA, USA
| | - T G van Erp
- Department of Psychiatry and Human Behavior, University of California Irvine, Irvine, CA, USA
| | - V D Calhoun
- Tri-institutional Center for Translational Research in Neuroimaging and Data Science (Trends), Georgia State, Georgia Tech, and Emory, Atlanta, GA, USA
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James S, Chohan V, Lim K, Rees M. Sonographic assessment of the axilla in breast cancer: changing the threshold. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)01591-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: 11/20/2022]
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6
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Lo A, Chen L, Niu W, Lim K, Solomon J. 362 Recommendations from cross-sectional, Chinese-language survey of knowledge and prevention of skin cancer among chinese populations internationally. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.371] [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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Lim K, Kwon H, Cho J, Kim D, Kim S, Kang E. Utility of Liver Imaging Reporting and Data System v2018 Ancillary Features for the Diagnosis of Hepatocellular Carcinoma in LR-4 Lesions Using Contrast-enhanced Magnetic Resonance Imaging. Hong Kong Journal of Radiology 2022. [DOI: 10.12809/hkjr2217340] [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: 11/05/2022] Open
Affiliation(s)
- K Lim
- Department of Radiology, Dong-A University Hospital, Busan, Republic of Korea
| | - H Kwon
- Department of Radiology, Dong-A University Hospital, Busan, Republic of Korea
| | - J Cho
- Department of Radiology, Dong-A University Hospital, Busan, Republic of Korea
| | - D Kim
- Department of Radiology, Dong-A University Hospital, Busan, Republic of Korea
| | - S Kim
- Department of Radiology, Dong-A University Hospital, Busan, Republic of Korea
| | - E Kang
- Department of Radiology, Dong-A University Hospital, Busan, Republic of Korea
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Deng H, Wang W, Li S, Lim K. Can Positive Online Social Cues Always Reduce User Avoidance of Sponsored Search Results? MIS QUART 2022. [DOI: 10.25300/misq/2021/14962] [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: 11/13/2022]
Abstract
Online social cues that utilize user-generated data, such as user reviews and product ratings, have become one of the key factors influencing online user behavior and decisions. Online users who shared their reviews and ratings about a product (or a seller) become an abstract reference group to a focal user interested in the same product. This study focuses on sponsored search results (SSRs), a type of unsolicited information that matches users’ search queries and receives high evaluations from prior consumers. We investigate the effects of positive social cues on alleviating users’ avoidance responses toward an encountered SSR when searching for a product in a C2C e-commerce context. We synthesize the avoidance literature and identify three forms of SSR avoidance, namely, cognitive, behavioral, and affective avoidance. We apply users’ implicit concerns on SSRs to explain users’ avoidance of an encountered SSR. In addition, we extend social influence theory to online settings where abstract reference groups are posited to trigger social influence. We examine how and under what conditions the three forms of SSR avoidance can be reduced by various positive online social cues (i.e., product- and seller-related). We conduct three laboratory experiments. Results attest to users’ implicit concerns on SSRs and their avoidance of SSRs and reveal different effects of various social cues on reducing the three forms of SSR avoidance. This study uncovers the theoretical mechanisms of social influence on reducing SSR avoidance in online settings. It also offers practical implications for online search service providers to help online users’ decision making in their search process.
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Khaw P, Do V, Lim K, Cunninghame J, Dixon J, Vassie J, Bailey M, Johnson C, Kahl K, Gordon C, Cook O, Foo K, Fyles A, Powell M, Haie-Meder C, D'Amico R, Bessette P, Mileshkin L, Creutzberg CL, Moore A. Radiotherapy Quality Assurance in the PORTEC-3 (TROG 08.04) Trial. Clin Oncol (R Coll Radiol) 2021; 34:198-204. [PMID: 34903431 DOI: 10.1016/j.clon.2021.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 10/09/2021] [Accepted: 11/18/2021] [Indexed: 11/03/2022]
Abstract
AIMS Quality assurance in radiotherapy (QART) is essential to ensure the scientific integrity of a clinical trial. This paper reports the findings of the retrospective QART assessment for all centres that participated in PORTEC-3; a randomised controlled trial that compared pelvic radiotherapy with concurrent chemoradiotherapy to the pelvis followed by adjuvant chemotherapy. The trial showed an overall survival benefit for the addition of the chemotherapy in the management of women with high-risk endometrial cancer. MATERIALS AND METHODS Clinicians were invited to upload a randomly selected case/s treated at each of the participating sites. Panel reviewers analysed the contours to certify that the target volumes and organ at risk structures were contoured according to guidelines. The results were categorised into acceptable, minor variation, major variation or unevaluable. The radiotherapy plans were dosimetrically evaluated using the well-established Trans-Tasman Radiation Oncology Group (TROG) protocol. RESULTS Between August 2010 and January 2018, data from 146 patients of 686 consecutively treated patients were retrospectively reviewed. All 16 Australia and New Zealand and 71 of 77 international centres uploaded data for evaluation. In total, 3514 dosimetric and contour variables were reviewed. Of these, 3136 variables were deemed acceptable (89.2%), with 335 minor (9.6%) and 43 major variations (1.2%). Major contour variations included the clinical target volume vaginal vault, clinical target volume parametria and differential planning target volume vault expansion. CONCLUSION The results of the QART assessment confirmed high uniformity and low rates of both minor and major deviations in contouring and dosimetry in all sites. This supports the safe introduction of the PORTEC-3 treatment protocol into routine clinical practice.
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Affiliation(s)
- P Khaw
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; University of Melbourne, Melbourne, Victoria, Australia.
| | - V Do
- Liverpool Cancer Therapy Centre, Liverpool, New South Wales, Australia; South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - K Lim
- Liverpool Cancer Therapy Centre, Liverpool, New South Wales, Australia; South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - J Cunninghame
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - J Dixon
- Illawarra Cancer Care Centre, Wollongong, New South Wales, Australia
| | - J Vassie
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - M Bailey
- Illawarra Cancer Care Centre, Wollongong, New South Wales, Australia
| | - C Johnson
- Blood & Cancer Centre, Wellington Hospital, Wellington, New Zealand
| | - K Kahl
- Shoalhaven Cancer Care Centre, Nowra, New South Wales, Australia
| | - C Gordon
- Illawarra Cancer Care Centre, Wollongong, New South Wales, Australia
| | - O Cook
- Trans-Tasman Radiation Oncology Group (TROG), Waratah, New South Wales, Australia
| | - K Foo
- Institute of Medical Physics, School of Physics, University of Sydney, Sydney, New South Wales, Australia
| | - A Fyles
- Canadian Cancer Trials Group, Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - M Powell
- Department of Clinical Oncology, Barts Health NHS Trust, London, UK
| | - C Haie-Meder
- Department of Radiotherapy, Institut Gustave Roussy, Villejuif, France
| | - R D'Amico
- Division of Radiation Oncology, ASST-Lecco, Ospedale A. Manzoni, Lecco, Italy
| | - P Bessette
- Gynaecologic Oncology, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - L Mileshkin
- Division of Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - C L Creutzberg
- Department of Radiation Oncology, Leiden University Medical Centre, Leiden, the Netherlands
| | - A Moore
- Trans-Tasman Radiation Oncology Group (TROG), Waratah, New South Wales, Australia
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Durand C, Anderson H, Simpson D, Gull S, Oprean R, Lim K, Lee F, Kakos C, Cvasciuc T. 457 The Effect of Biochemical Adversity of Primary Hyperparathyroidism on Preoperative Imaging (SPECT-CT and US Parathyroids). Br J Surg 2021. [DOI: 10.1093/bjs/znab259.538] [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: 11/13/2022]
Abstract
Abstract
Aim
Primary hyperparathyroidism (PHPT) is a common endocrine disorder, with an estimated incidence of 1/500 women and 1/2000 men older than 40 years. Several factors influence the positivity of preoperative scans including serum calcium, PTH and vitamin D levels, and gland size. The aim of our study is to examine the effect of biochemical adversity of primary hyperparathyroidism on preoperative imaging (SPECT-CT and US parathyroids).
Method
Retrospective study of 176 parathyroidectomies (2017-2020) in a tertiary referral centre with biochemistry, SPECT-CT, US parathyroids and histology outcomes being recorded. Failed parathyroidectomies were excluded.
Results
Patients were divided into 4 groups based on the preoperative calcium levels (normocalcemia <2.6, 3.4%; mild 2.60-2.79, 51.1%; moderate 2.80-2.99, 31.2%; severe >3.0 mmol/l, 14.2% of patients). Age (p-0.0297), preoperative vitamin D (p-0.03) and PTH levels (p-0.0001) were different while SPECT-CT positivity (p-0.29) weight of gland (p-0.015) and US positivity (p-0.09) were similar within the subgroups. Looking at the whole group, patients with positive SPECT-CT have a larger weight (p < 0.0001) while preoperative PTH levels was higher for the positive SPECT-CT patients (p-0.0289). No relation was identified between calcium levels and SPECT-CT positivity (p-0.18). No significance between preoperative vitamin D and positivity of US and SPECT-CT within the study group were noted.
Conclusions
Serum PTH levels and weight of the gland are directly correlated with positivity of preoperative imaging. Preoperative calcium and vitamin D levels correlates indirectly with the severity of the disease but did not influence the preoperative imaging positivity.
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Affiliation(s)
- C Durand
- Royal Victoria Hospital, Belfast, United Kingdom
| | - H Anderson
- Royal Victoria Hospital, Belfast, United Kingdom
| | - D Simpson
- Royal Victoria Hospital, Belfast, United Kingdom
| | - S Gull
- Royal Victoria Hospital, Belfast, United Kingdom
| | - R Oprean
- Royal Victoria Hospital, Belfast, United Kingdom
| | - K Lim
- Royal Victoria Hospital, Belfast, United Kingdom
| | - F Lee
- Royal Victoria Hospital, Belfast, United Kingdom
| | - C Kakos
- Royal Victoria Hospital, Belfast, United Kingdom
| | - T Cvasciuc
- Royal Victoria Hospital, Belfast, United Kingdom
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11
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Lim K, Neal-Smith G, Mitchell C, Xerri J, Chuanromanee P. Perceptions of the use of artificial intelligence in the diagnosis of skin cancer: an outpatient survey. Clin Exp Dermatol 2021; 47:542-546. [PMID: 34610153 DOI: 10.1111/ced.14969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 05/04/2021] [Accepted: 10/04/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Convolutional neural networks (artificial intelligence, AI) are rapidly appearing within the field of dermatology, with diagnostic accuracy matching that of dermatologists. As technologies become available for use by both the health professionals and the general public, their uptake in healthcare will become more acceptable. National Health Service England recognizes the potential of AI for healthcare but emphasizes that patient-centred care should be at the forefront of these technological advancements. AIM To obtain opinions of patients on the use of AI in a dermatology setting, when aiding the diagnosis of skin cancers. METHODS A cross-sectional 14-point questionnaire was handed out to patients attending dermatology outpatient skin cancer clinics in two UK hospitals, between March and August 2018. RESULTS In total, 603 patient questionnaires were completed. Nearly half (47%; n = 282) of respondents were not concerned if AI technology was used by a skin specialist to aid skin cancer diagnosis. However, the majority (81%; n = 491) of respondents, considered it important for a dermatologist to examine and confirm a diagnosis and to be present for discussion of a cancer diagnosis. CONCLUSION Although the majority of respondents were not reluctant about the use of AI for skin cancer diagnosis, respondents still considered it important that dermatologists are involved in the diagnosis and/or confirmation of skin cancer. Furthermore, the study results demonstrate that personal interaction with a clinician is important. This is in keeping with proposals that AI be used as an adjunctive technology to increase accuracy of skin cancer diagnoses, but not as a substitute for a dermatologist.
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Affiliation(s)
- K Lim
- Department of Dermatology, Oxford University NHS Hospitals Trust, Oxford, UK
| | - G Neal-Smith
- Department of Dermatology, Oxford University NHS Hospitals Trust, Oxford, UK
| | - C Mitchell
- Department of Dermatology, St Mary's Hospital, Portsmouth NHS Hospital Trust, Portsmouth, UK
| | - J Xerri
- Department of Statistics, University of Oxford, Oxford, UK
| | - P Chuanromanee
- Department of Statistics, University of Oxford, Oxford, UK
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Ermongkonchai T, Khor R, Muralidharan V, Tebbutt N, Lim K, Kutaiba N, Ng S. PO-1207 Stereotactic radiotherapy and MR-guided adaptive techniques for locally advanced pancreatic cancer. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07658-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Gregorevic K, Maier A, Miranda R, Loveland P, Miller K, Buising K, Marshall C, O'Gorman B, Tan A, Staggard K, O'Halloran T, Nguyen HXT, Disler J, Crotty F, Lim K, Cianter J, Kelly C, Lim K. Presenting symptoms of COVID-19 and clinical outcomes in hospitalised older adults. Intern Med J 2021; 51:861-867. [PMID: 33724644 PMCID: PMC8250615 DOI: 10.1111/imj.15286] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 02/26/2021] [Accepted: 03/05/2021] [Indexed: 12/13/2022]
Abstract
Background In July 2020, a COVID‐19 outbreak was recognised in the geriatric wards at a subacute campus of the Royal Melbourne Hospital affecting patients and staff. Patients were also admitted to this site after diagnosis in residential care. Aims To describe the early symptoms and the outcomes of COVID‐19 in older adults. Methods Patients diagnosed with COVID‐19 at the facility in July or August 2020 were identified and their medical records were examined to identify symptoms present before and after their diagnosis and to determine their outcomes. Results Overall, 106 patients were identified as having COVID‐19, with median age of 84.3 years (range 41–104 years); 64 were diagnosed as hospital inpatients after a median length of stay of 49 days, 31 were transferred from residential aged care facilities with a known diagnosis and 11 were diagnosed after discharge. There were 95 patients included in an analysis of symptom type and timing onset. Overall, 61 (64.2%) were asymptomatic at the time of diagnosis of COVID‐19, having been diagnosed through screening initiated on site. Of these, 88.6% developed symptoms of COVID‐19 within 14 days. The most common initial symptom type was respiratory, but there was wide variation in presentation, including fever, gastrointestinal and neurological symptoms, many initially not recognised as being due to COVID‐19. Of 104 patients, 32 died within 30 days of diagnosis. Conclusions COVID‐19 diagnosis is challenging due to the variance in symptoms. In the context of an outbreak, asymptomatic screening can identify affected patients early in the disease course.
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Affiliation(s)
- Kate Gregorevic
- Department of Medicine and Aged Care, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Andrea Maier
- Department of Medicine and Aged Care, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Human Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit, Amsterdam
| | - Roeisa Miranda
- Department of Medicine and Aged Care, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Paula Loveland
- Department of Medicine and Aged Care, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Katherine Miller
- Department of Medicine and Aged Care, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Kirsty Buising
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Caroline Marshall
- Infection Prevention and Surveillance Service Melbourne Health, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Bronwyn O'Gorman
- Department of Medicine and Aged Care, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Amanda Tan
- Department of Medicine and Aged Care, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Kylie Staggard
- Department of Medicine and Aged Care, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Tessa O'Halloran
- Department of Medicine and Aged Care, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Huong Xuan Thi Nguyen
- Department of Medicine and Aged Care, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Jessica Disler
- Department of Medicine and Aged Care, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Frances Crotty
- Department of Medicine and Aged Care, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Kai Lim
- Department of Medicine and Aged Care, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Joseph Cianter
- Department of Medicine and Aged Care, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Cate Kelly
- Clinical Governance and Medical Services, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Kwang Lim
- Department of Medicine and Aged Care, Royal Melbourne Hospital, Melbourne, Victoria, Australia
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Chan J, Ng C, Yu P, Lim K, Siu I, Yuan E, Liu S, Choi J, Chu C, Lau R. MA02.04 Initial Experience of Hybrid Operating Room Cone-Beam CT Guided Bronchoscopic Microwave Thermal Ablation of Peripheral Small Lung Lesions. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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15
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Naureen G, Sanders KM, Busija L, Scott D, Lim K, Talevski J, Connaughton C, Brennan-Olsen SL. Prediction models and questionnaires developed to predict vitamin D status in adults: a systematic review. Osteoporos Int 2020; 31:2287-2302. [PMID: 32662035 DOI: 10.1007/s00198-020-05539-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 07/07/2020] [Indexed: 12/18/2022]
Abstract
A systematic review of prediction models/questionnaires developed to identify people with deficient/insufficient vitamin D status shows the potential of self-reported information to estimate vitamin D status. The objective is to identify and compare existing screening tools, developed to identify vitamin D deficiency or insufficiency in adults. A systematic search of literature was conducted using MEDLINE, Scopus, Web of Science and CINAHL databases. Risk of bias and applicability concerns were assessed by quality assessment of diagnostic accuracy studies (QUADAS-2). Data were extracted on socio-demographic, anthropometric, risk factors, serum 25 hydroxyvitamin D [25(OH)D] levels, statistical methods and predictive ability. A total of 12 studies were considered for inclusion for this systematic review after screening of 4851 abstracts and 15 full-text articles. Ten of twelve studies developed prediction models and 2 studies developed questionnaires. The majority of studies had low risk of bias and applicability as assessed by QUADAS-2. All studies included only self-reported predictors of vitamin D status in their final models and development of scores. Sunlight exposure and related factors were important significant contributors to the predictive ability of the models and/or questionnaires. Sensitivity and specificity of the prediction models or questionnaires ranged from 55 to 91% and 35 to 84%, respectively. Six out of twelve studies converted final models to scores associated with vitamin D status. There was no evidence that any of these existing tools have been translated into clinical practice. The prediction models or questionnaires identified in this systematic review were moderately sensitive and specific for identifying people with vitamin D deficiency or insufficiency. The substantial contribution of sunlight exposure to the prediction of vitamin D status highlights the importance of including this information when developing vitamin D screening tools.
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Affiliation(s)
- G Naureen
- Level 3, Department of Medicine-Western Health, The University of Melbourne, 176 Furlong Road, St Albans, VIC, 3021, Australia.
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, VIC, Australia.
| | - K M Sanders
- Level 3, Department of Medicine-Western Health, The University of Melbourne, 176 Furlong Road, St Albans, VIC, 3021, Australia
| | - L Busija
- School of Public Health and Preventive Medicine, Monash University, St Kilda, VIC, Australia
| | - D Scott
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, VIC, Australia
- School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Burwood, VIC, Australia
| | - K Lim
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
| | - J Talevski
- Level 3, Department of Medicine-Western Health, The University of Melbourne, 176 Furlong Road, St Albans, VIC, 3021, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, VIC, Australia
| | - C Connaughton
- Level 3, Department of Medicine-Western Health, The University of Melbourne, 176 Furlong Road, St Albans, VIC, 3021, Australia
- Academic Centre for Health, Royal Women's Hospital, The University of Melbourne, Parkville, VIC, Australia
| | - S L Brennan-Olsen
- Level 3, Department of Medicine-Western Health, The University of Melbourne, 176 Furlong Road, St Albans, VIC, 3021, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, VIC, Australia
- School of Health and Social Development, Deakin University, Melbourne, VIC, Australia
- Institute for Health Transformation, Deakin University, Melbourne, VIC, Australia
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Maruyama R, Lim K, Nguyen Q, Tsoumpra M, Takeda S, Aoki Y, Yokota T. DMD – ANIMAL MODELS & PRECLINICAL TREATMENT. Neuromuscul Disord 2020. [DOI: 10.1016/j.nmd.2020.08.215] [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: 10/23/2022]
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17
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Park H, Sanjeevaiah A, Suresh R, Mehta R, Trikalinos N, Bagegni N, Aranha O, Pedersen K, Nixon A, Jin R, Mills J, Fields R, Amin M, Lim K, Tan B, Grierson P, Jiang S, Rosario MD, Wang-Gillam A, Lockhart A. P-131 Ramucirumab and irinotecan in patients with previously treated gastroesophageal adenocarcinoma: Interim analysis of a phase II trial. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.04.213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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18
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Rischin A, Kathpal E, Vogrin S, Bentley L, Master V, Steward A, Le Marshall K, Lim K. AB1126 THE RELIABILITY AND DIAGNOSTIC ACCURACY OF DIGITAL TOMOSYNTHESIS COMPARED WITH CONVENTIONAL RADIOGRAPHY FOR THE INVESTIGATION OF SACROILIITIS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3521] [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:Conventional radiography remains part of the diagnosis of axial spondyloarthritis and determines qualification for biologic disease modifying anti-rheumatic drugs in many countries. The standard anteroposterior radiograph (XR) incompletely images the complex sacroiliac joint with recognised unacceptably low levels of agreement between readers. Digital tomosynthesis (DTS) uses conventional radiographic projections to create a three-dimensional image and is a potential alternative for the initial radiographic detection and grading of sacroiliitis.Objectives:To compare the level of agreement between two radiologists when reporting sacroiliac joint imaging with digital tomosynthesis versus conventional radiography, as well as to compare the diagnostic accuracy of each imaging modality.Methods:229 consecutive patients that had radiography and digital tomosynthesis performed at Footscray Hospital, Melbourne, Australia were included. Two blinded radiologists independently re-reported all images according to the modified New York criteria, or listed an alternative diagnosis. An overall assessment of each image as inflammatory sacroiliitis, normal or non-inflammatory disease was also recorded. Demographic and clinical data were extracted from medical records. Agreement between and within readers was evaluated using kappa (κ) statistic. Diagnostic accuracy was calculated by comparing each reader’s overall assessment against 2 reference standard comparators: most recent rheumatologist diagnosis and fulfillment of ASAS criteria at any time point.Results:The intra-reader agreement of reader 1 was almost perfect for the left, right and overall sacroiliac joint assessments (κ 0.77 - 0.94), with DTS outperforming XR. Reader 2 agreement was mostly moderate (κ 0.39 - 0.69), with DTS and XR better on the left and right sacroiliac joint respectively, but XR having better overall assessment. The inter-reader agreement of DTS for all patients was moderate and better than XR as shown in the Table. When excluding non-spondyloarthritis patients, inter-reader agreement improved (κ 0.50 to 0.58) but there was no significant difference between DTS and XR. Using reader 1, the sensitivity of DTS (64.8 - 66.7%) was better than XR (54.9 - 60.7%) but low, in keeping with what is known about radiographic sacroiliitis and axial spondyloarthritis. The specificity of XR (78.5 – 80.3%) was better than DTS (72.3 – 73.1%). There were no significant differences when fulfillment of modified New York Criteria was used as a reader’s positive test.Table.Inter-rater reliability between the readersAll patients(N=229)*Inflammatory sacroiliitis & normal patients (N=164)**Inflammatory sacroiliitis patients (N=92)**XR Right0.360.520.56DTS Right0.390.500.51XR Left0.340.550.56DTS Left0.420.550.58XR Overall0.40DTS Overall0.45*Non-weighted kappa statistic**Weighted kappa statisticConclusion:DTS demonstrated moderate reliability for assessment of sacroiliitis, marginally better than conventional radiography. Overall levels of agreement for both imaging modalities were however lower than radiography in previous studies, with several possible contributing factors. A prospective study in a selected spondyloarthritis cohort may better determine any benefit of DTS.References:[1]Christiansen AA, Hendricks O, Kuettel D, Horslev-Petersen K, Jurik AG, Nielsen S, et al. Limited Reliability of Radiographic Assessment of Sacroiliac Joints in Patients with Suspected Early Spondyloarthritis. The Journal of rheumatology. 2017;44(1):70-7.[2]van Tubergen A, Heuft-Dorenbosch L, Schulpen G, Landewe R, Wijers R, van der Heijde D, et al. Radiographic assessment of sacroiliitis by radiologists and rheumatologists: does training improve quality? Annals of the rheumatic diseases. 2003;62(6):519-25.Disclosure of Interests:None declared
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Lim K, Lim X, Hong Q, Yong E, Chandrasekar S, Tan GWL, Lo ZJ. Use of home negative pressure wound therapy in peripheral artery disease and diabetic limb salvage. Int Wound J 2020; 17:531-539. [PMID: 31972901 DOI: 10.1111/iwj.13307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 12/23/2019] [Accepted: 01/10/2020] [Indexed: 11/29/2022] Open
Abstract
Use of negative pressure wound therapy (NPWT) in peripheral artery disease (PAD) and diabetic limb salvage (DLS) improves wound healing by providing moist wound conditions, reducing exudate, controlling wound-bed infection, and stimulating granulation. NPWT duration may take several weeks, and home-based NPWT allows patient to recover in the community while minimising risks of prolonged hospitalisation. The aim of this study is to review the use and outcomes of home NPWT in PAD and DLS. The methodology is the retrospective review of patients who were discharged with home NPWT after in-patient PAD revascularisation and DLS debridement or minor amputations. The results included a total of 118 patients who received home NPWT between January 2017 and December 2017. The mean age was 62.8 years with 66% male and 34% female patients. The study population comprised 25% smokers, 98% patients with diabetics, 35% with ischemic heart disease, and 21% with end-stage renal failure (ESRF). Of which, 56% of patients required revascularisation while 31% of patients underwent foot debridement, 48% underwent toe amputations, and 20% underwent forefoot amputations. All patients received in-patient NPWT for a week before being discharged on home NPWT for 4 weeks. Then, 62% received targeted antibiotics regime while 36% received empirical antibiotics on discharge; 60% of patients achieved wound healing on home NPWT, with 9% requiring split-thickness skin graft; 4% required further surgical debridement, 16% required further minor amputation while 20% required major amputation. 9% required further home NPWT extension, with a mean length of 7.1 ± 4.7 weeks' extension. Overall survival of 1 year was 89%. Risk factors that predict the failure of home NPWT includes subjects with a background of ESRF and wet gangrene on presentation. Home NPWT is a useful adjunct in the management of PAD and DLS foot wounds.
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Affiliation(s)
- Kai Lim
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Xuxin Lim
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Qiantai Hong
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Enming Yong
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Sadhana Chandrasekar
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Glenn W L Tan
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Zhiwen J Lo
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
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Ma K, Lim K, Majumder K, Edi-Osagie E. Laparoscopic Uterine Cerclage: A 10 Year Experience at a Tertiary Referral Centre. J Minim Invasive Gynecol 2019. [DOI: 10.1016/j.jmig.2019.09.691] [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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21
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Ma K, Lim K, Edi-Osagie E, Majumder K. 1348 Caesarean Scar Ectopic Pregnancies: Tale of two Approaches. J Minim Invasive Gynecol 2019. [DOI: 10.1016/j.jmig.2019.09.129] [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]
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22
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Wan D, Halim A, Ho L, Lu T, Lim K. MYOCARDIAL CYTOSKELETAL DYSFUNCTION IN KIDNEY FAILURE: THE CAIN STUDY. Can J Cardiol 2019. [DOI: 10.1016/j.cjca.2019.07.173] [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: 12/01/2022] Open
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23
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Lo KL, Chui KL, Leung CH, Ma SF, Lim K, Ng T, Wong J, Li JKM, Mak SK, Ng CF. Outcomes of transperineal and transrectal ultrasound-guided prostate biopsy. Hong Kong Med J 2019; 25:209-215. [PMID: 31178436 DOI: 10.12809/hkmj187599] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To compare the clinical outcomes and pathological findings of transperineal ultrasound-guided prostate biopsy (TPUSPB) and transrectal ultrasound-guided prostate biopsy (TRUSPB) in a secondary referral hospital. METHODS This was a retrospective study of 100 TPUSPBs and 100 TRUSPBs performed in our centre. Pre-biopsy patient parameters (eg, patient age, clinical staging, serum prostate-specific antigen [PSA] level, prostate size, and PSA density), as well as pathological results and 30-day complication and readmission rates, were retrieved from the patients' medical records and compared between the two groups. RESULTS One hundred TPUSPBs performed from January 2018 to May 2018 and 100 TRUSPBs performed from January 2016 to April 2016 were included for analysis. Mean age did not significantly differ between the groups. The TPUSPB group had a higher mean PSA level, smaller prostate size, and higher PSA density, compared with the TRUSPB group. The overall prostate cancer detection rate was similar between the TPUSPB and TRUSPB groups (35% vs 25%, P=0.123). There were no significant differences between the groups in prostate cancer detection rates after stratification according to PSA density and clinical staging. With respect to complications, no patients developed fever in the TPUSPB group, while 4% of patients in the TRUSPB group had fever and required at least 1-week admission for intravenous antibiotic administration. CONCLUSION For prostate biopsy, TPUSPB is safer, with no infection complications, and has similar prostate cancer detection rate compared with TRUSPB.
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Affiliation(s)
- K L Lo
- Division of Urology, North District Hospital, New Territories East Cluster Urology Unit, Prince of Wales Hospital, Shatin, Hong Kong
| | - K L Chui
- Division of Urology, North District Hospital, New Territories East Cluster Urology Unit, Prince of Wales Hospital, Shatin, Hong Kong
| | - C H Leung
- SH Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - S F Ma
- Division of Urology, North District Hospital, New Territories East Cluster Urology Unit, Prince of Wales Hospital, Shatin, Hong Kong
| | - K Lim
- Division of Urology, North District Hospital, New Territories East Cluster Urology Unit, Prince of Wales Hospital, Shatin, Hong Kong
| | - T Ng
- Division of Urology, North District Hospital, New Territories East Cluster Urology Unit, Prince of Wales Hospital, Shatin, Hong Kong
| | - J Wong
- Division of Urology, North District Hospital, New Territories East Cluster Urology Unit, Prince of Wales Hospital, Shatin, Hong Kong
| | - J K M Li
- Division of Urology, North District Hospital, New Territories East Cluster Urology Unit, Prince of Wales Hospital, Shatin, Hong Kong
| | - S K Mak
- Division of Urology, North District Hospital, New Territories East Cluster Urology Unit, Prince of Wales Hospital, Shatin, Hong Kong
| | - C F Ng
- Division of Urology, North District Hospital, New Territories East Cluster Urology Unit, Prince of Wales Hospital, Shatin, Hong Kong.,SH Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong
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Soltani S, Nogaro MC, Rougelot C, Newell N, Lim K, Kieser DC. Spontaneous spinal epidural haematomas in children. Eur Spine J 2019; 28:2229-2236. [PMID: 30972569 DOI: 10.1007/s00586-019-05975-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 04/01/2019] [Accepted: 04/06/2019] [Indexed: 01/16/2023]
Abstract
PURPOSE To understand the typical presentation, risk factors, location and size, treatment, neurological recovery and survival of spontaneous spinal epidural haematomas (SSEH) in children. METHODS A systematic review of the English literature from 1 January 1960 to 1 March 2018 was performed on children aged 18 years and younger. Individual patient data were extracted and collated. Outcome measures were mode of presentation, risk factors, initial neurological findings, initial presumed diagnosis, diagnostic investigations, site and size of the SSEH, treatment, neurological recovery and survival. RESULTS Thirty-one publications and 36 patients were reviewed. All age groups were affected. 83% of patients did not have a known risk factor. Back pain was reported in 61% and neurological dysfunction in 97% of patients, although not all articles defined these parameters. Initially 28% of patients were suspected of having an alternative diagnosis. All patients had an MRI and/or CT scan confirming the diagnosis. The cervical-thoracic region was most commonly affected, and the average haematoma size extended across 6.3 vertebral levels. Surgical decompression was performed in 72% of patients. Neurological function improved in 83% of patients. Two patients died as a consequence of their SSEH. CONCLUSIONS SSEHs affect all paediatric age groups and typically present with neurological dysfunction and/or back pain. The initial diagnosis is incorrect in up to 28% of cases, but cross-sectional spinal imaging is diagnostic. Most SSEHs are located in the cervico-thoracic region and affect multiple spinal levels. The treatment depends on whether the patient has a bleeding disorder and their neurological status. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- S Soltani
- Division of Spinal Surgery, Oxford University NHS Foundation Trust, Oxford, England, UK
| | - M C Nogaro
- Division of Spinal Surgery, Oxford University NHS Foundation Trust, Oxford, England, UK
| | - C Rougelot
- Paediatric Department, Oxford University NHS Foundation Trust, Oxford, England, UK
| | - N Newell
- Department of Mechanical Engineering, Imperial College, London, England, UK
| | - K Lim
- Department of Orthopaedics and Musculoskeletal Medicine, Christchurch School of Medicine, University of Otago, Christchurch, New Zealand
| | - D C Kieser
- Department of Orthopaedics and Musculoskeletal Medicine, Christchurch School of Medicine, University of Otago, Christchurch, New Zealand.
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Sundman M, Lim K, Mizell J, That VT, Mennie W, Ugonna C, Lindley M, Fuglevand A, Chen N, Wilson R, Huang Y, Chou Y. Divergent effects on cortical excitability observed in healthy older adults during active voluntary contraction following motor cortex iTBS. Brain Stimul 2019. [DOI: 10.1016/j.brs.2018.12.684] [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: 10/27/2022] Open
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Camchong Y, Roy A, Gilmore C, Thao M, Kazynski M, Fiecas M, Mueller B, MacDonald A, Kushner M, Lim K. Using Brain Stimulation to Modify a Brain Network and Support Abstinence during Alcohol Use Disorder Recovery. Brain Stimul 2019. [DOI: 10.1016/j.brs.2018.12.673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Cullen K, Thai M, Lim K, Klimes-Dougan B. Targeting rumination with combined mindful breathing and tDCS in adolescents with suicidal thoughts. Brain Stimul 2019. [DOI: 10.1016/j.brs.2018.12.935] [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: 10/27/2022] Open
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Lee S, Lau L, Lim K, Cole D. Incentives that influence low income Filipinos with Tuberculosis symptoms to change health-seeking behaviour: a randomized controlled trial. Int J Infect Dis 2019. [DOI: 10.1016/j.ijid.2018.11.044] [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: 10/27/2022] Open
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Groom KM, Ganzevoort W, Alfirevic Z, Lim K, Papageorghiou AT. Reply. Ultrasound Obstet Gynecol 2019; 53:275. [PMID: 30741451 DOI: 10.1002/uog.20202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- K M Groom
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - W Ganzevoort
- Department of Obstetrics and Gynecology, Academisch Medisch Centrum, Amsterdam, The Netherlands
| | - Z Alfirevic
- Department of Women's and Children's Health, The University of Liverpool, Liverpool, UK
| | - K Lim
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada
| | - A T Papageorghiou
- Fetal Medicine Unit, St George's, University of London, London, UK
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
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McLean K, Glasbey J, Borakati A, Brooks T, Chang H, Choi S, Goodson R, Nielsen M, Pronin S, Salloum N, Sewart E, Vanniasegaram D, Drake T, Gillies M, Harrison E, Chapman S, Khatri C, Kong C, Claireaux H, Bath M, Mohan M, McNamee L, Kelly M, Mitchell H, Fitzgerald J, Bhangu A, Nepogodiev D, Antoniou I, Dean R, Davies N, Trecarten S, Henderson I, Holmes C, Wylie J, Shuttleworth R, Jindal A, Hughes F, Gouda P, Fleck R, Hanrahan M, Karunakaran P, Chen J, Sykes M, Sethi R, Suresh S, Patel P, Patel M, Varma R, Mushtaq J, Gundogan B, Bolton W, Khan T, Burke J, Morley R, Favero N, Adams R, Thirumal V, Kennedy E, Ong K, Tan Y, Gabriel J, Bakhsh A, Low J, Yener A, Paraoan V, Preece R, Tilston T, Cumber E, Dean S, Ross T, McCance E, Amin H, Satterthwaite L, Clement K, Gratton R, Mills E, Chiu S, Hung G, Rafiq N, Hayes J, Robertson K, Dynes K, Huang H, Assadullah S, Duncumb J, Moon R, Poo S, Mehta J, Joshi K, Callan R, Norris J, Chilvers N, Keevil H, Jull P, Mallick S, Elf D, Carr L, Player C, Barton E, Martin A, Ratu S, Roberts E, Phan P, Dyal A, Rogers J, Henson A, Reid N, Burke D, Culleton G, Lynne S, Mansoor S, Brennan C, Blessed R, Holloway C, Hill A, Goldsmith T, Mackin S, Kim S, Woin E, Brent G, Coffin J, Ziff O, Momoh Z, Debenham R, Ahmed M, Yong C, Wan J, Copley H, Raut P, Chaudhry F, Nixon G, Dorman C, Tan R, Kanabar S, Canning N, Dolaghan M, Bell N, McMenamin M, Chhabra A, Duke K, Turner L, Patel T, Chew L, Mirza M, Lunawat S, Oremule B, Ward N, Khan M, Tan E, Maclennan D, McGregor R, Chisholm E, Griffin E, Bell L, Hughes B, Davies J, Haq H, Ahmed H, Ungcharoen N, Whacha C, Thethi R, Markham R, Lee A, Batt E, Bullock N, Francescon C, Davies J, Shafiq N, Zhao J, Vivekanantham S, Barai I, Allen J, Marshall D, McIntyre C, Wilson H, Ashton A, Lek C, Behar N, Davis-Hall M, Seneviratne N, Esteve L, Sirakaya M, Ali S, Pope S, Ahn J, Craig-McQuaide A, Gatfield W, Leong S, Demetri A, Kerr A, Rees C, Loveday J, Liu S, Wijesekera M, Maru D, Attalla M, Smith N, Brown D, Sritharan P, Shah A, Charavanamuttu V, Heppenstall-Harris G, Ng K, Raghvani T, Rajan N, Hulley K, Moody N, Williams M, Cotton A, Sharifpour M, Lwin K, Bright M, Chitnis A, Abdelhadi M, Semana A, Morgan F, Reid R, Dickson J, Anderson L, McMullan R, Ahern N, Asmadi A, Anderson L, Boon Xuan JL, Crozier L, McAleer S, Lees D, Adebayo A, Das M, Amphlett A, Al-Robeye A, Valli A, Khangura J, Winarski A, Ali A, Woodward H, Gouldthrope C, Turner M, Sasapu K, Tonkins M, Wild J, Robinson M, Hardie J, Heminway R, Narramore R, Ramjeeawon N, Hibberd A, Winslow F, Ho W, Chong B, Lim K, Ho S, Crewdson J, Singagireson S, Kalra N, Koumpa F, Jhala H, Soon W, Karia M, Rasiah M, Xylas D, Gilbert H, Sundar-Singh M, Wills J, Akhtar S, Patel S, Hu L, Brathwaite-Shirley C, Nayee H, Amin O, Rangan T, Turner E, McCrann C, Shepherd R, Patel N, Prest-Smith J, Auyoung E, Murtaza A, Coates A, Prys-Jones O, King M, Gaffney S, Dewdney C, Nehikhare I, Lavery J, Bassett J, Davies K, Ahmad K, Collins A, Acres M, Egerton C, Cheng K, Chen X, Chan N, Sheldon A, Khan S, Empey J, Ingram E, Malik A, Johnstone M, Goodier R, Shah J, Giles J, Sanders J, McLure S, Pal S, Rangedara A, Baker A, Asbjoernsen C, Girling C, Gray L, Gauntlett L, Joyner C, Qureshi S, Mogan Y, Ng J, Kumar A, Park J, Tan D, Choo K, Raman K, Buakuma P, Xiao C, Govinden S, Thompson O, Charalambos M, Brown E, Karsan R, Dogra T, Bullman L, Dawson P, Frank A, Abid H, Tung L, Qureshi U, Tahmina A, Matthews B, Harris R, O'Connor A, Mazan K, Iqbal S, Stanger S, Thompson J, Sullivan J, Uppal E, MacAskill A, Bamgbose F, Neophytou C, Carroll A, Rookes C, Datta U, Dhutia A, Rashid S, Ahmed N, Lo T, Bhanderi S, Blore C, Ahmed S, Shaheen H, Abburu S, Majid S, Abbas Z, Talukdar S, Burney L, Patel J, Al-Obaedi O, Roberts A, Mahboob S, Singh B, Sheth S, Karia P, Prabhudesai A, Kow K, Koysombat K, Wang S, Morrison P, Maheswaran Y, Keane P, Copley P, Brewster O, Xu G, Harries P, Wall C, Al-Mousawi A, Bonsu S, Cunha P, Ward T, Paul J, Nadanakumaran K, Tayeh S, Holyoak H, Remedios J, Theodoropoulou K, Luhishi A, Jacob L, Long F, Atayi A, Sarwar S, Parker O, Harvey J, Ross H, Rampal R, Thomas G, Vanmali P, McGowan C, Stein J, Robertson V, Carthew L, Teng V, Fong J, Street A, Thakker C, O'Reilly D, Bravo M, Pizzolato A, Khokhar H, Ryan M, Cheskes L, Carr R, Salih A, Bassiony S, Yuen R, Chrastek D, Rosen O'Sullivan H, Amajuoyi A, Wang A, Sitta O, Wye J, Qamar M, Major C, Kaushal A, Morgan C, Petrarca M, Allot R, Verma K, Dutt S, Chilima C, Peroos S, Kosasih S, Chin H, Ashken L, Pearse R, O'Loughlin R, Menon A, Singh K, Norton J, Sagar R, Jathanna N, Rothwell L, Watson N, Harding F, Dube P, Khalid H, Punjabi N, Sagmeister M, Gill P, Shahid S, Hudson-Phillips S, George D, Ashwood J, Lewis T, Dhar M, Sangal P, Rhema I, Kotecha D, Afzal Z, Syeed J, Prakash E, Jalota P, Herron J, Kimani L, Delport A, Shukla A, Agarwal V, Parthiban S, Thakur H, Cymes W, Rinkoff S, Turnbull J, Hayat M, Darr S, Khan U, Lim J, Higgins A, Lakshmipathy G, Forte B, Canning E, Jaitley A, Lamont J, Toner E, Ghaffar A, McDowell M, Salmon D, O'Carroll O, Khan A, Kelly M, Clesham K, Palmer C, Lyons R, Bell A, Chin R, Waldron R, Trimble A, Cox S, Ashfaq U, Campbell J, Holliday R, McCabe G, Morris F, Priestland R, Vernon O, Ledsam A, Vaughan R, Lim D, Bakewell Z, Hughes R, Koshy R, Jackson H, Narayan P, Cardwell A, Jubainville C, Arif T, Elliott L, Gupta V, Bhaskaran G, Odeleye A, Ahmed F, Shah R, Pickard J, Suleman Y, North A, McClymont L, Hussain N, Ibrahim I, Ng G, Wong V, Lim A, Harris L, Tharmachandirar T, Mittapalli D, Patel V, Lakhani M, Bazeer H, Narwani V, Sandhu K, Wingfield L, Gentry S, Adjei H, Bhatti M, Braganza L, Barnes J, Mistry S, Chillarge G, Stokes S, Cleere J, Wadanamby S, Bucko A, Meek J, Boxall N, Heywood E, Wiltshire J, Toh C, Ward A, Shurovi B, Horth D, Patel B, Ali B, Spencer T, Axelson T, Kretzmer L, Chhina C, Anandarajah C, Fautz T, Horst C, Thevathasan A, Ng J, Hirst F, Brewer C, Logan A, Lockey J, Forrest P, Keelty N, Wood A, Springford L, Avery P, Schulz T, Bemand T, Howells L, Collier H, Khajuria A, Tharakan R, Parsons S, Buchan A, McGalliard R, Mason J, Cundy O, Li N, Redgrave N, Watson R, Pezas T, Dennis Y, Segall E, Hameed M, Lynch A, Chamberlain M, Peck F, Neo Y, Russell G, Elseedawy M, Lee S, Foster N, Soo Y, Puan L, Dennis R, Goradia H, Qureshi A, Osman S, Reeves T, Dinsmore L, Marsden M, Lu Q, Pitts-Tucker T, Dunn C, Walford R, Heathcote E, Martin R, Pericleous A, Brzyska K, Reid K, Williams M, Wetherall N, McAleer E, Thomas D, Kiff R, Milne S, Holmes M, Bartlett J, Lucas de Carvalho J, Bloomfield T, Tongo F, Bremner R, Yong N, Atraszkiewicz B, Mehdi A, Tahir M, Sherliker G, Tear A, Pandey A, Broyd A, Omer H, Raphael M, Chaudhry W, Shahidi S, Jawad A, Gill C, Fisher IH, Adeleja I, Clark I, Aidoo-Micah G, Stather P, Salam G, Glover T, Deas G, Sim N, Obute R, Wynell-Mayow W, Sait M, Mitha N, de Bernier G, Siddiqui M, Shaunak R, Wali A, Cuthbert G, Bhudia R, Webb E, Shah S, Ansari N, Perera M, Kelly N, McAllister R, Stanley G, Keane C, Shatkar V, Maxwell-Armstrong C, Henderson L, Maple N, Manson R, Adams R, Semple E, Mills M, Daoub A, Marsh A, Ramnarine A, Hartley J, Malaj M, Jewell P, Whatling E, Hitchen N, Chen M, Goh B, Fern J, Rogers S, Derbyshire L, Robertson D, Abuhussein N, Deekonda P, Abid A, Harrison P, Aildasani L, Turley H, Sherif M, Pandey G, Filby J, Johnston A, Burke E, Mohamud M, Gohil K, Tsui A, Singh R, Lim S, O'Sullivan K, McKelvey L, O'Neill S, Roberts H, Brown F, Cao Y, Buckle R, Liew Y, Sii S, Ventre C, Graham C, Filipescu T, Yousif A, Dawar R, Wright A, Peters M, Varley R, Owczarek S, Hartley S, Khattak M, Iqbal A, Ali M, Durrani B, Narang Y, Bethell G, Horne L, Pinto R, Nicholls K, Kisyov I, Torrance H, English W, Lakhani S, Ashraf S, Venn M, Elangovan V, Kazmi Z, Brecher J, Sukumar S, Mastan A, Mortimer A, Parker J, Boyle J, Elkawafi M, Beckett J, Mohite A, Narain A, Mazumdar E, Sreh A, Hague A, Weinberg D, Fletcher L, Steel M, Shufflebotham H, Masood M, Sinha Y, Jenvey C, Kitt H, Slade R, Craig A, Deall C, Reakes T, Chervenkoff J, Strange E, O'Bryan M, Murkin C, Joshi D, Bergara T, Naqib S, Wylam D, Scotcher S, Hewitt C, Stoddart M, Kerai A, Trist A, Cole S, Knight C, Stevens S, Cooper G, Ingham R, Dobson J, O'Kane A, Moradzadeh J, Duffy A, Henderson C, Ashraf S, McLaughin C, Hoskins T, Reehal R, Bookless L, McLean R, Stone E, Wright E, Abdikadir H, Roberts C, Spence O, Srikantharajah M, Ruiz E, Matthews J, Gardner E, Hester E, Naran P, Simpson R, Minhas M, Cornish E, Semnani S, Rojoa D, Radotra A, Eraifej J, Eparh K, Smith D, Mistry B, Hickling S, Din W, Liu C, Mithrakumar P, Mirdavoudi V, Rashid M, Mcgenity C, Hussain O, Kadicheeni M, Gardner H, Anim-Addo N, Pearce J, Aslanyan A, Ntala C, Sorah T, Parkin J, Alizadeh M, White A, Edozie F, Johnston J, Kahar A, Navayogaarajah V, Patel B, Carter D, Khonsari P, Burgess A, Kong C, Ponweera A, Cody A, Tan Y, Ng A, Croall A, Allan C, Ng S, Raghuvir V, Telfer R, Greenhalgh A, McKerr C, Edison M, Patel B, Dear K, Hardy M, Williams P, Hassan S, Sajjad U, O'Neill E, Lopes S, Healy L, Jamal N, Tan S, Lazenby D, Husnoo S, Beecroft S, Sarvanandan T, Weston C, Bassam N, Rabinthiran S, Hayat U, Ng L, Varma D, Sukkari M, Mian A, Omar A, Kim J, Sellathurai J, Mahmood J, O'Connell C, Bose R, Heneghan H, Lalor P, Matheson J, Doherty C, Cullen C, Cooper D, Angelov S, Drislane C, Smith A, Kreibich A, Palkhi E, Durr A, Lotfallah A, Gold D, Mckean E, Dhanji A, Anilkumar A, Thacoor A, Siddiqui Z, Lim S, Piquet A, Anderson S, McCormack D, Gulati J, Ibrahim A, Murray S, Walsh S, McGrath A, Ziprin P, Chua E, Lou C, Bloomer J, Paine H, Osei-Kuffour D, White C, Szczap A, Gokani S, Patel K, Malys M, Reed A, Torlot G, Cumber E, Charania A, Ahmad S, Varma N, Cheema H, Austreng L, Petra H, Chaudhary M, Zegeye M, Cheung F, Coffey D, Heer R, Singh S, Seager E, Cumming S, Suresh R, Verma S, Ptacek I, Gwozdz A, Yang T, Khetarpal A, Shumon S, Fung T, Leung W, Kwang P, Chew L, Loke W, Curran A, Chan C, McGarrigle C, Mohan K, Cullen S, Wong E, Toale C, Collins D, Keane N, Traynor B, Shanahan D, Yan A, Jafree D, Topham C, Mitrasinovic S, Omara S, Bingham G, Lykoudis P, Miranda B, Whitehurst K, Kumaran G, Devabalan Y, Aziz H, Shoa M, Dindyal S, Yates J, Bernstein I, Rattan G, Coulson R, Stezaker S, Isaac A, Salem M, McBride A, McFarlane H, Yow L, MacDonald J, Bartlett R, Turaga S, White U, Liew W, Yim N, Ang A, Simpson A, McAuley D, Craig E, Murphy L, Shepherd P, Kee J, Abdulmajid A, Chung A, Warwick H, Livesey A, Holton P, Theodoreson M, Jenkin S, Turner J, Entwisle J, Marchal S, O'Connor S, Blege H, Aithie J, Sabine L, Stewart G, Jackson S, Kishore A, Lankage C, Acquaah F, Joyce H, McKevitt K, Coffey C, Fawaz A, Dolbec K, O'Sullivan D, Geraghty J, Lim E, Bolton L, FitzPatrick D, Robinson C, Ramtoola T, Collinson S, Grundy L, McEnhill P, Harbhajan Singh G, Loughran D, Golding D, Keeling R, Williams R, Whitham R, Yoganathan S, Nachiappan R, Egan R, Owasil R, Kwan M, He A, Goh R, Bhome R, Wilson H, Teoh P, Raji K, Jayakody N, Matthams J, Chong J, Luk C, Greig R, Trail M, Charalambous G, Rocke A, Gardiner N, Bulley F, Warren N, Brennan E, Fergurson P, Wilson R, Whittingham H, Brown E, Khanijau R, Gandhi K, Morris S, Boulton A, Chandan N, Barthorpe A, Maamari R, Sandhu S, McCann M, Higgs L, Balian V, Reeder C, Diaper C, Sale T, Ali H, Archer C, Clarke A, Heskin J, Hurst P, Farmer J, O'Flynn L, Doan L, Shuker B, Stott G, Vithanage N, Hoban K, Nesargikar P, Kennedy H, Grossart C, Tan E, Roy C, Sim P, Leslie K, Sim D, Abul M, Cody N, Tay A, Woon E, Sng S, Mah J, Robson J, Shakweh E, Wing V, Mills H, Li M, Barrow T, Balaji S, Jordan H, Phillips C, Naveed H, Hirani S, Tai A, Ratnakumaran R, Sahathevan A, Shafi A, Seedat M, Weaver R, Batho A, Punj R, Selvachandran H, Bhatt N, Botchey S, Khonat Z, Brennan K, Morrison C, Devlin E, Linton A, Galloway E, McGarvie S, Ramsay N, McRobbie H, Whewell H, Dean W, Nelaj S, Eragat M, Mishra A, Kane T, Zuhair M, Wells M, Wilkinson D, Woodcock N, Sun E, Aziz N, Ghaffar MKA. Critical care usage after major gastrointestinal and liver surgery: a prospective, multicentre observational study. Br J Anaesth 2019; 122:42-50. [PMID: 30579405 DOI: 10.1016/j.bja.2018.07.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 07/19/2018] [Accepted: 07/23/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Patient selection for critical care admission must balance patient safety with optimal resource allocation. This study aimed to determine the relationship between critical care admission, and postoperative mortality after abdominal surgery. METHODS This prespecified secondary analysis of a multicentre, prospective, observational study included consecutive patients enrolled in the DISCOVER study from UK and Republic of Ireland undergoing major gastrointestinal and liver surgery between October and December 2014. The primary outcome was 30-day mortality. Multivariate logistic regression was used to explore associations between critical care admission (planned and unplanned) and mortality, and inter-centre variation in critical care admission after emergency laparotomy. RESULTS Of 4529 patients included, 37.8% (n=1713) underwent planned critical care admissions from theatre. Some 3.1% (n=86/2816) admitted to ward-level care subsequently underwent unplanned critical care admission. Overall 30-day mortality was 2.9% (n=133/4519), and the risk-adjusted association between 30-day mortality and critical care admission was higher in unplanned [odds ratio (OR): 8.65, 95% confidence interval (CI): 3.51-19.97) than planned admissions (OR: 2.32, 95% CI: 1.43-3.85). Some 26.7% of patients (n=1210/4529) underwent emergency laparotomies. After adjustment, 49.3% (95% CI: 46.8-51.9%, P<0.001) were predicted to have planned critical care admissions, with 7% (n=10/145) of centres outside the 95% CI. CONCLUSIONS After risk adjustment, no 30-day survival benefit was identified for either planned or unplanned postoperative admissions to critical care within this cohort. This likely represents appropriate admission of the highest-risk patients. Planned admissions in selected, intermediate-risk patients may present a strategy to mitigate the risk of unplanned admission. Substantial inter-centre variation exists in planned critical care admissions after emergency laparotomies.
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Sindone A, Audehm R, Haikerwal D, Lim K, Piazza P, Parsons R, Neville A, Liew D. A Retrospective Cohort Study of Heart Failure in the Australian Primary Care Setting – Clinical Characteristics of HF Patients (SHAPE Study). Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.055] [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: 10/26/2022]
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Sindone A, Audehm R, Haikerwal D, Lim K, Piazza P, Parsons R, Neville A, Liew D. A Retrospective Cohort Study of Heart Failure in the Australian Primary Care Setting – Method and Demographic Results (SHAPE study). Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.056] [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]
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Kenny LC, Alfirevic Z, Baker PN, Ganzevoort W, Gluud C, Groom KM, Jakobsen JC, Lim K, Magee LA, Papageorghiou AT, von Dadelszen P. Viagra for fetal growth restriction: STRIDER Consortium replies to letter by Symonds and Budge. BMJ 2018; 363:k4872. [PMID: 30467195 DOI: 10.1136/bmj.k4872] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
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- Division of Maternal-Fetal Medicine, University of British Columbia, Vancouver, Canada
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Lim K, Kim J. EFFECTS OF COGNITION ENHANCING PROGRAM AMONG COMMUNITY-DWELLING OLDER ADULTS. Innov Aging 2018. [DOI: 10.1093/geroni/igy031.3454] [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: 11/14/2022] Open
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Lim K, Hong Q, Leong Tan GW, Chandrasekar S, Lo ZJ. LEA 10. Use of Home Negative Pressure Wound Therapy in Peripheral Artery Disease and Diabetic Limb Salvage. J Vasc Surg 2018. [DOI: 10.1016/j.jvs.2018.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Kim J, Ryoo S, Sohn C, Seo D, Lim K, Kim W. 144 Risk Factors for Same Pathogen Sepsis Readmissions Following Hospitalization for Septic Shock. Ann Emerg Med 2018. [DOI: 10.1016/j.annemergmed.2018.08.149] [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]
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Huynh C, Puyraimond-Zemmour D, Maillefert JF, Conaghan PG, Davis AM, Gunther KP, Hawker G, Hochberg MC, Kloppenburg M, Lim K, Lohmander LS, Mahomed NN, March L, Pavelka K, Punzi L, Roos EM, Sanchez-Riera L, Singh JA, Suarez-Almazor ME, Dougados M, Gossec L. Factors associated with the orthopaedic surgeon's decision to recommend total joint replacement in hip and knee osteoarthritis: an international cross-sectional study of 1905 patients. Osteoarthritis Cartilage 2018; 26:1311-1318. [PMID: 30017727 DOI: 10.1016/j.joca.2018.06.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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] [Received: 01/31/2018] [Revised: 05/30/2018] [Accepted: 06/20/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine factors associated with orthopaedic surgeons' decision to recommend total joint replacement (TJR) in people with knee and hip osteoarthritis (OA). DESIGN Cross-sectional study in eleven countries. For consecutive outpatients with definite hip or knee OA consulting an orthopaedic surgeon, the surgeon's indication of TJR was collected, as well as patients' characteristics including comorbidities and social situation, OA symptom duration, pain, stiffness and function (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]), joint-specific quality of life, Osteoarthritis Research Society International (OARSI) joint space narrowing (JSN) radiographic grade (0-4), and surgeons' characteristics. Univariable and multivariable logistic regressions were performed to identify factors associated with the indication of TJR, adjusted by country. RESULTS In total, 1905 patients were included: mean age was 66.5 (standard deviation [SD], 10.8) years, 1082 (58.0%) were women, mean OA symptom duration was 5.0 (SD 7.0) years. TJR was recommended in 561/1127 (49.8%) knee OA and 542/778 (69.7%) hip OA patients. In multivariable analysis on 516 patients with complete data, the variables associated with TJR indication were radiographic grade (Odds Ratio, OR for one grade increase, for knee and hip OA, respectively: 2.90, 95% confidence interval [1.69-4.97] and 3.30 [2.17-5.03]) and WOMAC total score (OR for 10 points increase: 1.65 [1.32-2.06] and 1.38 [1.15-1.66], respectively). After excluding radiographic grade from the analyses, on 1265 patients, greater WOMAC total score was the main predictor for knee and hip OA; older age was also significant for knee OA. CONCLUSION Radiographic severity and patient-reported pain and function play a major role in surgeons' recommendation for TJR.
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Affiliation(s)
- C Huynh
- Sorbonne Universités, UPMC Univ Paris 06, Institut Pierre Louis d'Epidémiologie et de Santé Publique (UMRS 1136), Paris, France; Rheumatology Department, Hôpital Pitié Salpêtrière, AP-HP, PARIS, France
| | - D Puyraimond-Zemmour
- Sorbonne Universités, UPMC Univ Paris 06, Institut Pierre Louis d'Epidémiologie et de Santé Publique (UMRS 1136), Paris, France; Rheumatology Department, Hôpital Pitié Salpêtrière, AP-HP, PARIS, France
| | - J F Maillefert
- Department of Rheumatology, Dijon University Hospital, Dijon F 21078, France; INSERM U1093, University of Burgundy, Dijon F 21079, France
| | - P G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, NIHR Leeds Biomedical Research Centre, Leeds, United Kingdom
| | - A M Davis
- Division of Health Care and Outcomes Research, Krembil Research Institute, Toronto, Ontario, Canada; Department of Rehabilitation Science and Health Policy, University of Toronto, Canada; Department of Management and Evaluation, University of Toronto, Canada
| | - K-P Gunther
- University Center of Orthopaedics and Traumatology, Technische Universität, Dresden, Germany
| | - G Hawker
- Division of Rheumatology, Department of Medicine, Women's College Hospital, Women's College Research Institute, Canada; Faculty of Medicine, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Canada
| | - M C Hochberg
- Division of Rheumatology & Clinical Immunology, Department of Medicine and Division of Gerontology, Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - M Kloppenburg
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - K Lim
- University of Melbourne, Department of Medicine (Western), Dept of Rheumatology, Western Health, Australian Institute of Musculoskeletal Science, Melbourne, Australia
| | - L S Lohmander
- Department of Clinical Sciences Lund, Orthopaedics, Lund University, Lund, Sweden
| | - N N Mahomed
- Division of Orthopaedic Surgery, Toronto Western Hospital, University of Toronto, Arthritis Program, University Health Network, Toronto, Canada
| | - L March
- Institute of Bone and Joint Research, University of Sydney, Royal North Shore Hospital, St Leonards, Australia
| | - K Pavelka
- Institute of Rheumatology, Charles University Prague, Czech Republic
| | - L Punzi
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Italy
| | - E M Roos
- Institute of Sports and Clinical Biomechanics, University of Southern Denmark, Denmark
| | - L Sanchez-Riera
- University Hospital Bristol NHS Foundation Trust, Bristol, UK; Birmingham VA Medical Center, University of Alabama, Birmingham, AL, USA
| | - J A Singh
- Section of Rheumatology and Clinical Immunology, University of Texas, M.D. Anderson Cancer Center, Houston, TX, USA
| | - M E Suarez-Almazor
- Section of Rheumatology and Clinical Immunology, University of Texas, M.D. Anderson Cancer Center, Houston, TX, USA
| | - M Dougados
- Paris Descartes University, Department of Rheumatology, Hôpital Cochin, APHP, INSERM (U1153): Clinical epidemiology and biostatistics, PRES Sorbonne Paris-Cité, Paris 14, France
| | - L Gossec
- Sorbonne Universités, UPMC Univ Paris 06, Institut Pierre Louis d'Epidémiologie et de Santé Publique (UMRS 1136), Paris, France; Rheumatology Department, Hôpital Pitié Salpêtrière, AP-HP, PARIS, France.
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Groom KM, Ganzevoort W, Alfirevic Z, Lim K, Papageorghiou AT. Clinicians should stop prescribing sildenafil for fetal growth restriction (FGR): comment from the STRIDER Consortium. Ultrasound Obstet Gynecol 2018; 52:295-296. [PMID: 30079989 DOI: 10.1002/uog.19186] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- K M Groom
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - W Ganzevoort
- Department of Obstetrics and Gynecology, Academisch Medisch Centrum, Amsterdam, The Netherlands
| | - Z Alfirevic
- Department of Women's and Children's Health, The University of Liverpool, Liverpool, UK
| | - K Lim
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada
| | - A T Papageorghiou
- Fetal Medicine Unit, St George's, University of London, London, UK
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
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Rossi G, Wat P, Lim K, McNaughten J, Sitters S, Barnes A. Analytical Validation of Paraoxonase-1 (PON-1) Activity in Seminal Plasma of Horses. J Equine Vet Sci 2018. [DOI: 10.1016/j.jevs.2018.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Han S, Shin S, Jeon Y, Heo J, Kweon G, Park S, Park J, Lim K. PO-072 ω3-Polyunsaturated fatty acids inhibit cell growth and invasion of human hypopharyngeal carcinoma cells. ESMO Open 2018. [DOI: 10.1136/esmoopen-2018-eacr25.115] [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: 11/03/2022] Open
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Jing K, Shin S, Lim K. PO-123 Constitutive expression of FAT1 gene inhibits the invasion and tumorigenicity of cervical cancer cells through degradation of HPV E6/E7 oncoprotein via P53/RB in vitro and in vivo. ESMO Open 2018. [DOI: 10.1136/esmoopen-2018-eacr25.164] [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: 11/03/2022] Open
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Yin C, Sun Y, Fang Y, Lim K. Exploring the dual-role of cognitive heuristics and the moderating effect of gender in microblog information credibility evaluation. ITP 2018. [DOI: 10.1108/itp-12-2016-0300] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Although microblogs have become an important information source, the credibility of their postings is still a critical concern due to the open and unregulated nature. To understand the antecedents of microblog information credibility, the purpose of this paper is to investigate the dual-role of cognitive heuristics (i.e. the additivity and bias roles) and the effect of gender differences.
Design/methodology/approach
This study collected data via an online field survey of active microblog users, and a total of 204 valid responses was received.
Findings
This study demonstrates the dual-role of source credibility and vividness, the additivity role of microblog platform credibility, and the bias role of social endorsement. Furthermore, this study also found out gender difference that the additivity role of cognitive heuristics was stronger for men while bias role was stronger for women.
Research limitations/implications
This research enriches the microblog literature by examining the cognitive heuristic determinants as key predictors of microblog information credibility, and contributes to the information credibility literature by identifying and analyzing the dual-role effect of cognitive heuristics and corresponding gender differences.
Practical implications
This study can help organizations better manage their reputation, especially during the reputation crises, and also serves as a reminder to microblog platform operators of the importance of their microblog platform credibility.
Social implications
This study can help organizations better manage their reputation, especially during the reputation crises, and serves as a reminder to the microblog platform operators of the importance of their microblog platform credibility.
Originality/value
This study investigates the dual-role effect of cognitive heuristics (i.e. the additivity role and bias role) and corresponding gender differences that are less touched on before, and thus provides a more nuanced understanding of the more complex effects of cognitive heuristics.
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Burke S, Batumalai V, Lim K, Roach D, Dinsdale G, Mahoney L, Jameson M, Ochoa C, Veera J, Holloway L, Vinod S. EP-2369: Dosimetric impact of imaging modality (CT versus MRI) for cervical cancer radiotherapy. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)32677-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: 10/14/2022]
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Jahanfar S, Lim K. Placental pathology findings and birth weight discordance. CLIN EXP OBSTET GYN 2018. [DOI: 10.12891/ceog3740.2018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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El-Medany A, Wallace W, Mcrorie E, Tan S, Lim K. Giant cell aortitis leading to Stanford type B and type A aortic dissection. JRSM Open 2017; 8:2054270417715568. [PMID: 29051823 PMCID: PMC5638163 DOI: 10.1177/2054270417715568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This report provides a rare histological example and the appropriate management of spontaneous aortic dissection secondary to giant cell arteritis.
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Affiliation(s)
| | - W Wallace
- Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK
| | - E Mcrorie
- Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK
| | - Sy Tan
- Ninewells Hospital, Dundee DD1 9SY, Scotland
| | - K Lim
- Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK
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Sanders KM, Lim K, Stuart AL, Macleod A, Scott D, Nicholson GC, Busija L. Diversity in fall characteristics hampers effective prevention: the precipitants, the environment, the fall and the injury. Osteoporos Int 2017; 28:3005-3015. [PMID: 28725985 PMCID: PMC5624977 DOI: 10.1007/s00198-017-4145-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 07/04/2017] [Indexed: 01/19/2023]
Abstract
UNLABELLED Falls among the elderly are common and characteristics may differ between injurious and non-injurious falls. Among 887 older Australian women followed for 1.6 years, 32% fell annually. Only 8.5% resulted in fracture and/or hospital admission. The characteristics of those falls are indistinguishable from those not coming to medical attention. INTRODUCTION The precipitants and environment of all falls occurring among a large cohort of older Caucasian women were categorised by injury status to determine if the characteristics differed between injurious and non-injurious falls. METHODS Among 887 Australian women (70+ years), falls were ascertained using monthly postcard calendars and a questionnaire was administered for each fall. Hospital admissions and fractures were independently confirmed. RESULTS All falls were reported for a mean observation time of 577 (IQR 546-607) days per participant, equating to a total 1400 person-years. Thirty-two percent fell at least once per year. The most common features of a fall were that the faller was walking (61%) at home (61%) during the day (88%) and lost balance (32%). Only 12% of all falls occurred at night. Despite no difference in the type of injury between day and night, the likelihood of being hospitalised from a fall at night was 4.5 times greater than that of a daytime fall with adjustment for injury type and participant age (OR 4.5, 95% CI 2.1, 9.5; p < 0.001). Of all falls, approximately one third were associated with no injury to the faller (31%), one third reported a single injury (37%) and one third reported more than one injury (32%). In 95% of falls, the faller was not admitted to hospital. Only 5% of falls resulted in fracture(s). CONCLUSIONS Our findings demonstrate the significant diversity of precipitants and environment where falls commonly occur among older community-dwelling women. Falls resulting in fracture and/or hospital admission collectively represent 8.5% of all falls and their characteristics are indistinguishable from falls not coming to medical attention and incurring no apparent cost to the health system.
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Affiliation(s)
- K M Sanders
- Institute for Health & Ageing, Australian Catholic University, Level 6, 215 Spring Street, Melbourne, 3000, Australia.
| | - K Lim
- Institute for Health & Ageing, Australian Catholic University, Level 6, 215 Spring Street, Melbourne, 3000, Australia
| | | | - A Macleod
- Institute for Health & Ageing, Australian Catholic University, Level 6, 215 Spring Street, Melbourne, 3000, Australia
| | - D Scott
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | - G C Nicholson
- Rural Clinical School, School of Medicine, The University of Queensland, Toowoomba, Australia
| | - L Busija
- Institute for Health & Ageing, Australian Catholic University, Level 6, 215 Spring Street, Melbourne, 3000, Australia
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Amadoru S, Lim K, Tacey M, Aboltins C. Spinal infections in older people: an analysis of demographics, presenting features, microbiology and outcomes. Intern Med J 2017; 47:182-188. [PMID: 27753184 DOI: 10.1111/imj.13300] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 10/10/2016] [Accepted: 10/11/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Clinical features of infection can become more atypical as we age. Spinal infections can be insidious, and timely diagnosis and treatment are essential to prevent adverse outcomes. AIMS To explore differences in presentation and outcomes between younger and older patients with bacterial spinal infections. METHODS Clinical, microbiological and radiological information was collected for patients with spinal infections (spondylodiscitis, vertebral osteomyelitis, septic discitis, facet joint septic arthritis and spinal epidural abscess) at a single metropolitan hospital between January 2008 and January 2015. Patients were excluded if they were under 18 years of age or if clinical and imaging findings were inconsistent with the diagnosis. Presenting features, investigations and outcomes were compared for patients ≥65 (older) or <65 (younger) years old. RESULTS Of 53 identified patients, 34 (64%) were classified as older, with more males in both older (65%) and younger (79%) groups. Older patients presented later (median symptom duration 13 vs 4 days, P = 0.016). Back pain was nearly ubiquitous. Older patients presented less commonly with fevers (38 vs 63%) and rigors (24 vs 42%) but more commonly with hypotension (18 vs 5%), delirium (24 vs 11%), higher median inflammatory marker levels and variable microbiological findings, although these differences were not statistically significant. They had longer median lengths of stay (24 vs 14 days) and a higher likelihood of death or failure of medical treatment (HR 9.34, P = 0.031). Radicular pain was associated with poor outcome (HR 3.29, P = 0.046). CONCLUSION Older patients with spinal infections present later, with higher inflammatory markers and fewer typical infective symptoms and signs; these may contribute to poorer outcomes. A low threshold for promptly investigating older patients with new or worsening back pain should be set.
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Affiliation(s)
- S Amadoru
- Department of Geriatric Medicine, Northern Health, Melbourne, Victoria, Australia.,Department of Geriatric Medicine, Alfred Health, Melbourne, Victoria, Australia
| | - K Lim
- Department of Geriatric Medicine, Northern Health, Melbourne, Victoria, Australia.,Department of Geriatric Medicine, Melbourne Health, Melbourne, Victoria, Australia
| | - M Tacey
- Northern Centre for Health Education and Research (NCHER), Northern Health, Melbourne, Victoria, Australia.,Melbourne EpiCentre, Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - C Aboltins
- Department of Infectious Diseases, Northern Health, Melbourne, Victoria, Australia.,North West Academic Centre, Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
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Lim K, Jing K, Shin S, Han SH, Yoo YS, Jeon YJ, Heo JY, Kweon GR, Park SK, Park JI. Docosahexaenoic acid mediates susceptible cell death through differential regulation of p62/p-eIF2alpha/NRF2 in LMP1-expressing nasopnaryngeal carcinoma cells. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx361.049] [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: 11/13/2022] Open
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Martin-Khan M, Gray L, Edwards H, Wootton R, Varghese P, Lim K, Darzins P, Dakin L. COMPREHENSIVE GERIATRIC ASSESSMENT PROCEDURE ONLINE, INCORPORATING INTERRAI ACUTE CARE ASSESSMENT. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.1114] [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: 11/14/2022] Open
Affiliation(s)
- M. Martin-Khan
- The University of Queensland, Brisbane, Queensland, Australia,
| | - L.C. Gray
- Centre for Research in Geriatric Medicine, The University of Queensland, Woolloongabba, Queensland, Australia,
| | - H. Edwards
- Queensland University of Technology, Kelvin Grove, Queensland, Australia,
| | - R. Wootton
- Centre for Research in Geriatric Medicine, The University of Queensland, Woolloongabba, Queensland, Australia,
| | - P. Varghese
- Queensland Health, Brisbane, Queensland, Australia,
| | - K. Lim
- University of Melbourne, Melbourne, Victoria, Australia,
| | - P. Darzins
- Eastern Health, Box Hill, Victoria, Australia
| | - L. Dakin
- Queensland Health, Brisbane, Queensland, Australia,
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Lee J, Lee H, Park Y, Jang J, Choi J, Lim K, Choi W, Lee J. CARE NEEDS BY END-OF-LIFE STAGE AMONG NON-CANCER PATIENTS AT HOME. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.1337] [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: 11/14/2022] Open
Affiliation(s)
- J. Lee
- The Catholic University of Korea, Seoul, Korea (the Republic of),
| | - H. Lee
- The Catholic University of Korea, Seoul, Korea (the Republic of),
| | - Y. Park
- Seoul St.Mary Hospital, Seoul, Korea (the Republic of)
| | - J. Jang
- Seoul St.Mary Hospital, Seoul, Korea (the Republic of)
| | - J. Choi
- Seoul St.Mary Hospital, Seoul, Korea (the Republic of)
| | - K. Lim
- Seoul St.Mary Hospital, Seoul, Korea (the Republic of)
| | - W. Choi
- Seoul St.Mary Hospital, Seoul, Korea (the Republic of)
| | - J. Lee
- The Catholic University of Korea, Seoul, Korea (the Republic of),
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