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Sogbodjor LA, Razavi C, Williams K, Selman A, Pereira SMP, Davenport M, Moonesinghe SR. Risk factors for complications after emergency surgery for paediatric appendicitis: a national prospective observational cohort study. Anaesthesia 2024; 79:524-534. [PMID: 38387160 DOI: 10.1111/anae.16184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2023] [Indexed: 02/24/2024]
Abstract
Appendicectomy is a common procedure in children with a low risk of mortality, however, complication rates and risk factors are largely unknown. This study aimed to characterise the incidence and epidemiology of postoperative complications in children undergoing appendicectomy in the UK. This multicentre prospective observational cohort study, which included children aged 1-16 y who underwent surgery for suspected appendicitis, was conducted between November 2019 and January 2022. The primary outcome was 30-day postoperative morbidity. Data collected included: patient characteristics; comorbidities; and physiological status. Multivariable regression analysis was used to identify independent risk factors for poor outcomes. Data from 2799 children recruited from 80 hospitals were analysed, of which 185 (7%) developed postoperative complications. Children from black and 'other' minority ethnic groups were at significantly higher risk of poor outcomes: OR (95%CI) 4.13 (1.87-9.08), p < 0.001 and 2.08 (1.12-3.87), p = 0.021, respectively. This finding was independent of socio-economic status and type of appendicitis found on histology. Other risk factors for complications included: ASA physical status ≥ 3 (OR (95%CI) 4.05 (1.70-9.67), p = 0.002); raised C-reactive protein (OR 95%CI 1.01 (1.00-1.01), p < 0.001); pyrexia (OR (95%CI) 1.77(1.20-2.63), p = 0.004); and peri-operative oxygen supplementation (OR (95%CI) 4.20 (1.44-12.24), p = 0.009). In the UK NHS, which is a universally accessible healthcare system, ethnicity, but not socio-economic status, was associated with an increased risk of postoperative complications in children having surgery for acute appendicitis. Further evaluations and interventions are required to address this health inequality in keeping with NHS and international priorities.
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Affiliation(s)
- L A Sogbodjor
- Department of Anaesthesia and Pain Medicine, Great Ormond Street Hospital NHS Foundation Trust, London, UK
- Centre for Research and Improvement, Royal College of Anaesthetists, London, UK
| | - C Razavi
- Centre for Research and Improvement, Royal College of Anaesthetists, London, UK
- Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - K Williams
- Centre for Research and Improvement, Royal College of Anaesthetists, London, UK
| | - A Selman
- Department of Anaesthesia, Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - S M Pinto Pereira
- Centre for Peri-operative Medicine, Research Department for Targeted Intervention, UCL Division of Surgery and Interventional Science, London, UK
| | - M Davenport
- Department of Paediatric Surgery, King's College London NHS Foundation Trust, London, UK
| | - S R Moonesinghe
- Centre for Peri-operative Medicine, Research Department for Targeted Intervention, UCL Division of Surgery and Interventional Science, London, UK
- Central London National Institute for Health Research Patient Safety Research Collaboration, London, UK
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Y, Tamura R, Tamura Y, Tan CHH, Tan EZZ, Tanabe A, Tanabe K, Tanaka A, Tanaka A, Tanaka N, Tang S, Tang Z, Tanigaki K, Tarlac M, Tatsuzawa A, Tay JF, Tay LL, Taylor J, Taylor K, Taylor K, Te A, Tenbusch L, Teng KS, Terakawa A, Terry J, Tham ZD, Tholl S, Thomas G, Thong KM, Tietjen D, Timadjer A, Tindall H, Tipper S, Tobin K, Toda N, Tokuyama A, Tolibas M, Tomita A, Tomita T, Tomlinson J, Tonks L, Topf J, Topping S, Torp A, Torres A, Totaro F, Toth P, Toyonaga Y, Tripodi F, Trivedi K, Tropman E, Tschope D, Tse J, Tsuji K, Tsunekawa S, Tsunoda R, Tucky B, Tufail S, Tuffaha A, Turan E, Turner H, Turner J, Turner M, Tuttle KR, Tye YL, Tyler A, Tyler J, Uchi H, Uchida H, Uchida T, Uchida T, Udagawa T, Ueda S, Ueda Y, Ueki K, Ugni S, Ugwu E, Umeno R, Unekawa C, Uozumi K, Urquia K, Valleteau A, Valletta C, van Erp R, Vanhoy C, Varad V, Varma R, Varughese A, Vasquez P, Vasseur A, Veelken R, Velagapudi C, Verdel K, Vettoretti S, Vezzoli G, Vielhauer V, Viera R, Vilar E, Villaruel S, Vinall L, Vinathan J, Visnjic M, Voigt E, von-Eynatten M, Vourvou M, Wada J, Wada J, Wada T, Wada Y, Wakayama K, Wakita Y, Wallendszus K, Walters T, Wan Mohamad WH, Wang L, Wang W, Wang X, Wang X, Wang Y, Wanner C, Wanninayake S, Watada H, Watanabe K, Watanabe K, Watanabe M, Waterfall H, Watkins D, Watson S, Weaving L, Weber B, Webley Y, Webster A, Webster M, Weetman M, Wei W, Weihprecht H, Weiland L, Weinmann-Menke J, Weinreich T, Wendt R, Weng Y, Whalen M, Whalley G, Wheatley R, Wheeler A, Wheeler J, Whelton P, White K, Whitmore B, Whittaker S, Wiebel J, Wiley J, Wilkinson L, Willett M, Williams A, Williams E, Williams K, Williams T, Wilson A, Wilson P, Wincott L, Wines E, Winkelmann B, Winkler M, Winter-Goodwin B, Witczak J, Wittes J, Wittmann M, Wolf G, Wolf L, Wolfling R, Wong C, Wong E, Wong HS, Wong LW, Wong YH, Wonnacott A, Wood A, Wood L, Woodhouse H, Wooding N, Woodman A, Wren K, Wu J, Wu P, Xia S, Xiao H, Xiao X, Xie Y, Xu C, Xu Y, Xue H, Yahaya H, Yalamanchili H, Yamada A, Yamada N, Yamagata K, Yamaguchi M, Yamaji Y, Yamamoto A, Yamamoto S, Yamamoto S, Yamamoto T, Yamanaka A, Yamano T, Yamanouchi Y, Yamasaki N, Yamasaki Y, Yamasaki Y, Yamashita C, Yamauchi T, Yan Q, Yanagisawa E, Yang F, Yang L, Yano S, Yao S, Yao Y, Yarlagadda S, Yasuda Y, Yiu V, Yokoyama T, Yoshida S, Yoshidome E, Yoshikawa H, Young A, Young T, Yousif V, Yu H, Yu Y, Yuasa K, Yusof N, Zalunardo N, Zander B, Zani R, Zappulo F, Zayed M, Zemann B, Zettergren P, Zhang H, Zhang L, Zhang L, Zhang N, Zhang X, Zhao J, Zhao L, Zhao S, Zhao Z, Zhong H, Zhou N, Zhou S, Zhu D, Zhu L, Zhu S, Zietz M, Zippo M, Zirino F, Zulkipli FH. Effects of empagliflozin on progression of chronic kidney disease: a prespecified secondary analysis from the empa-kidney trial. Lancet Diabetes Endocrinol 2024; 12:39-50. [PMID: 38061371 PMCID: PMC7615591 DOI: 10.1016/s2213-8587(23)00321-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Sodium-glucose co-transporter-2 (SGLT2) inhibitors reduce progression of chronic kidney disease and the risk of cardiovascular morbidity and mortality in a wide range of patients. However, their effects on kidney disease progression in some patients with chronic kidney disease are unclear because few clinical kidney outcomes occurred among such patients in the completed trials. In particular, some guidelines stratify their level of recommendation about who should be treated with SGLT2 inhibitors based on diabetes status and albuminuria. We aimed to assess the effects of empagliflozin on progression of chronic kidney disease both overall and among specific types of participants in the EMPA-KIDNEY trial. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA), and included individuals aged 18 years or older with an estimated glomerular filtration rate (eGFR) of 20 to less than 45 mL/min per 1·73 m2, or with an eGFR of 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher. We explored the effects of 10 mg oral empagliflozin once daily versus placebo on the annualised rate of change in estimated glomerular filtration rate (eGFR slope), a tertiary outcome. We studied the acute slope (from randomisation to 2 months) and chronic slope (from 2 months onwards) separately, using shared parameter models to estimate the latter. Analyses were done in all randomly assigned participants by intention to treat. EMPA-KIDNEY is registered at ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and then followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroups of eGFR included 2282 (34·5%) participants with an eGFR of less than 30 mL/min per 1·73 m2, 2928 (44·3%) with an eGFR of 30 to less than 45 mL/min per 1·73 m2, and 1399 (21·2%) with an eGFR 45 mL/min per 1·73 m2 or higher. Prespecified subgroups of uACR included 1328 (20·1%) with a uACR of less than 30 mg/g, 1864 (28·2%) with a uACR of 30 to 300 mg/g, and 3417 (51·7%) with a uACR of more than 300 mg/g. Overall, allocation to empagliflozin caused an acute 2·12 mL/min per 1·73 m2 (95% CI 1·83-2·41) reduction in eGFR, equivalent to a 6% (5-6) dip in the first 2 months. After this, it halved the chronic slope from -2·75 to -1·37 mL/min per 1·73 m2 per year (relative difference 50%, 95% CI 42-58). The absolute and relative benefits of empagliflozin on the magnitude of the chronic slope varied significantly depending on diabetes status and baseline levels of eGFR and uACR. In particular, the absolute difference in chronic slopes was lower in patients with lower baseline uACR, but because this group progressed more slowly than those with higher uACR, this translated to a larger relative difference in chronic slopes in this group (86% [36-136] reduction in the chronic slope among those with baseline uACR <30 mg/g compared with a 29% [19-38] reduction for those with baseline uACR ≥2000 mg/g; ptrend<0·0001). INTERPRETATION Empagliflozin slowed the rate of progression of chronic kidney disease among all types of participant in the EMPA-KIDNEY trial, including those with little albuminuria. Albuminuria alone should not be used to determine whether to treat with an SGLT2 inhibitor. FUNDING Boehringer Ingelheim and Eli Lilly.
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Fuentes MMPB, Santos AJB, Abreu-Grobois A, Briseño-Dueñas R, Al-Khayat J, Hamza S, Saliba S, Anderson D, Rusenko KW, Mitchell NJ, Gammon M, Bentley BP, Beton D, Booth DTB, Broderick AC, Colman LP, Snape RTE, Calderon-Campuzano MF, Cuevas E, Lopez-Castro MC, Flores-Aguirre CD, Mendez de la Cruz F, Segura-Garcia Y, Ruiz-Garcia A, Fossette S, Gatto CR, Reina RD, Girondot M, Godfrey M, Guzman-Hernandez V, Hart CE, Kaska Y, Lara PH, Marcovaldi MAGD, LeBlanc AM, Rostal D, Liles MJ, Wyneken J, Lolavar A, Williamson SA, Manoharakrishnan M, Pusapati C, Chatting M, Mohd Salleh S, Patricio AR, Regalla A, Restrepo J, Garcia R, Santidrián Tomillo P, Sezgin C, Shanker K, Tapilatu F, Turkozan O, Valverde RA, Williams K, Yilmaz C, Tolen N, Nel R, Tucek J, Legouvello D, Rivas ML, Gaspar C, Touron M, Genet Q, Salmon M, Araujo MR, Freire JB, Castheloge VD, Jesus PR, Ferreira PD, Paladino FV, Montero-Flores D, Sozbilen D, Monsinjon JR. Adaptation of sea turtles to climate warming: Will phenological responses be sufficient to counteract changes in reproductive output? Glob Chang Biol 2024; 30:e16991. [PMID: 37905464 DOI: 10.1111/gcb.16991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 10/02/2023] [Accepted: 10/03/2023] [Indexed: 11/02/2023]
Abstract
Sea turtles are vulnerable to climate change since their reproductive output is influenced by incubating temperatures, with warmer temperatures causing lower hatching success and increased feminization of embryos. Their ability to cope with projected increases in ambient temperatures will depend on their capacity to adapt to shifts in climatic regimes. Here, we assessed the extent to which phenological shifts could mitigate impacts from increases in ambient temperatures (from 1.5 to 3°C in air temperatures and from 1.4 to 2.3°C in sea surface temperatures by 2100 at our sites) on four species of sea turtles, under a "middle of the road" scenario (SSP2-4.5). Sand temperatures at sea turtle nesting sites are projected to increase from 0.58 to 4.17°C by 2100 and expected shifts in nesting of 26-43 days earlier will not be sufficient to maintain current incubation temperatures at 7 (29%) of our sites, hatching success rates at 10 (42%) of our sites, with current trends in hatchling sex ratio being able to be maintained at half of the sites. We also calculated the phenological shifts that would be required (both backward for an earlier shift in nesting and forward for a later shift) to keep up with present-day incubation temperatures, hatching success rates, and sex ratios. The required shifts backward in nesting for incubation temperatures ranged from -20 to -191 days, whereas the required shifts forward ranged from +54 to +180 days. However, for half of the sites, no matter the shift the median incubation temperature will always be warmer than the 75th percentile of current ranges. Given that phenological shifts will not be able to ameliorate predicted changes in temperature, hatching success and sex ratio at most sites, turtles may need to use other adaptive responses and/or there is the need to enhance sea turtle resilience to climate warming.
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Affiliation(s)
- M M P B Fuentes
- Marine Turtle Research, Ecology, and Conservation Group, Department of Earth, Ocean and Atmospheric Science, Florida State University, Tallahassee, Florida, USA
| | - A J B Santos
- Marine Turtle Research, Ecology, and Conservation Group, Department of Earth, Ocean and Atmospheric Science, Florida State University, Tallahassee, Florida, USA
| | - A Abreu-Grobois
- Unidad Academica Mazatlan, Instituto de Ciencias del Mar y Limnologia, UNAM, Mazatlan, Sinaloa, Mexico
| | - R Briseño-Dueñas
- Unidad Academica Mazatlan, Instituto de Ciencias del Mar y Limnologia, UNAM, Mazatlan, Sinaloa, Mexico
| | - J Al-Khayat
- Environmental Science Centre, Qatar University, Doha, Qatar
| | - S Hamza
- Environmental Science Centre, Qatar University, Doha, Qatar
| | - S Saliba
- Environmental Science Centre, Qatar University, Doha, Qatar
| | - D Anderson
- Gumbo Limbo Nature Center, Boca Raton, Florida, USA
| | - K W Rusenko
- Gumbo Limbo Nature Center, Boca Raton, Florida, USA
| | - N J Mitchell
- School of Biological Sciences, The University of Western Australia, Crawley, Western Australia, Australia
| | - M Gammon
- School of Biological Sciences, The University of Western Australia, Crawley, Western Australia, Australia
| | - B P Bentley
- School of Biological Sciences, The University of Western Australia, Crawley, Western Australia, Australia
- Department of Environmental Conservation, University of Massachusetts, Amherst, Massachusetts, USA
| | - D Beton
- Society for Protection of Turtles, Gonyeli, Northern Cyprus
| | - D T B Booth
- School of Biological Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - A C Broderick
- Centre for Ecology and Conservation, University of Exeter, Penryn, UK
| | - L P Colman
- Centre for Ecology and Conservation, University of Exeter, Penryn, UK
| | - R T E Snape
- Society for Protection of Turtles, Gonyeli, Northern Cyprus
- Centre for Ecology and Conservation, University of Exeter, Penryn, UK
| | - M F Calderon-Campuzano
- Programa de Protección y Conservación de Tortugas Marinas, Convenio FONATUR-Instituto de Ciencias del Mar y Limnología-UNAM, Mazatlán, Sinaloa, Mexico
| | - E Cuevas
- Instituto de Investigaciones Oceanologicas, Universidad Autonoma de Baja California, Ensenada, Mexico
| | - M C Lopez-Castro
- Pronatura Península de Yucatán, A. C. Programa para la Conservación de la Tortuga Marina, Mérida, Yucatán, Mexico
| | - C D Flores-Aguirre
- Departamento de Zoología, Instituto de Biología, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
| | - F Mendez de la Cruz
- Departamento de Zoología, Instituto de Biología, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
| | - Y Segura-Garcia
- Departamento de Zoología, Instituto de Biología, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
| | - A Ruiz-Garcia
- Departamento de Zoología, Instituto de Biología, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
| | - S Fossette
- School of Biological Sciences, The University of Western Australia, Crawley, Western Australia, Australia
- Biodiversity and Conservation Science, Department of Biodiversity, Conservation and Attractions, Kensington, Western Australia, Australia
| | - C R Gatto
- School of Biological Sciences, Monash University, Clayton, Victoria, Australia
| | - R D Reina
- School of Biological Sciences, Monash University, Clayton, Victoria, Australia
| | - M Girondot
- Université Paris-Saclay, CNRS, AgroParisTech, Ecologie Systématique et Evolution, Gif-sur-Yvette, France
| | - M Godfrey
- North Carolina Wildlife Resources Commission, Beaufort, North Carolina, USA
- Duke Marine Laboratory, Nicholas School of Environment, Duke University, Beaufort, North Carolina, USA
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | | | - C E Hart
- Centro de Investigaciones Oceánicas del Mar de Cortés-Gran Acuario de Mazatlán, Mazatlán, Mexico
| | - Y Kaska
- Department of Biology, Faculty of Science, Pamukkale University, Denizli, Turkey
| | - P H Lara
- Fundação Projeto Tamar, Florianópolis, Brazil
| | | | - A M LeBlanc
- Georgia Southern University, Statesboro, Georgia, USA
| | - D Rostal
- Georgia Southern University, Statesboro, Georgia, USA
| | - M J Liles
- Asociacion ProCosta, San Salvador, El Salvador
| | - J Wyneken
- Department of Biological Sciences, Florida Atlantic University, Boca Raton, Florida, USA
| | - A Lolavar
- Department of Biological Sciences, Florida Atlantic University, Boca Raton, Florida, USA
| | - S A Williamson
- School of Biological Sciences, Monash University, Clayton, Victoria, Australia
- Department of Biological Sciences, Florida Atlantic University, Boca Raton, Florida, USA
| | | | | | - M Chatting
- Environmental Science Centre, Qatar University, Doha, Qatar
- School of Civil Engineering, University College Dublin, Dublin, Ireland
| | - S Mohd Salleh
- School of Biological Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - A R Patricio
- Centre for Ecology and Conservation, University of Exeter, Penryn, UK
- Marine and Environmental Sciences Centre/ARNET-Aquatic Research Network, Ispa-Instituto Universitário de Ciências Psicológicas, Lisbon, Portugal
| | - A Regalla
- Instituto da Biodiversidade e das Áreas Protegidas, Dr. Alfredo Simão da Silva (IBAP), Bissau, Guinea-Bissau
| | - J Restrepo
- Sea Turtle Conservancy, Gainesville, Florida, USA
| | - R Garcia
- Sea Turtle Conservancy, Gainesville, Florida, USA
| | | | - C Sezgin
- Sea Turtle Research, Rescue and Rehabilitation Center (DEKAMER), Mugla, Turkey
| | - K Shanker
- Dakshin Foundation, Bangalore, India
- Centre for Ecological Sciences, Indian Institute of Science, Bangalore, India
| | - F Tapilatu
- Research Center of Pacific Marine Resources-University of Papua (UNIPA), Manokwari, Papua Barat, Indonesia
| | - O Turkozan
- Department of Biology, Faculty of Science, Aydın Adnan Menderes University, Aydın, Turkey
| | - R A Valverde
- Sea Turtle Conservancy, Gainesville, Florida, USA
- Biological Sciences, Southeastern Louisiana University, Hammond, Louisiana, USA
| | - K Williams
- Caretta Research Project, Savannah, Georgia, USA
| | - C Yilmaz
- Hakkari University, Vocational School of Health Services, Hakkari, Turkey
| | - N Tolen
- Universiti Malaysia Terengganu, Kuala Nerus, Malaysia
| | - R Nel
- Department of Zoology, Institute for Coastal and Marine Research, Nelson Mandela University, Gqeberha, South Africa
| | - J Tucek
- Department of Zoology, Institute for Coastal and Marine Research, Nelson Mandela University, Gqeberha, South Africa
| | - D Legouvello
- Department of Zoology, Institute for Coastal and Marine Research, Nelson Mandela University, Gqeberha, South Africa
| | - M L Rivas
- Department of Biology, University of Cadiz, Cadiz, Spain
| | - C Gaspar
- Te Mana O Te Moana, Moorea-Maiao, French Polynesia
| | - M Touron
- Te Mana O Te Moana, Moorea-Maiao, French Polynesia
| | - Q Genet
- Te Mana O Te Moana, Moorea-Maiao, French Polynesia
| | - M Salmon
- Department of Biological Sciences, Florida Atlantic University, Boca Raton, Florida, USA
| | - M R Araujo
- Ministerio de Medio Ambiente y Recursos Naturales, San Salvador, El Salvador
| | - J B Freire
- Fundação Espírito Santense de Tecnologia-FEST, Vitória, Espírito Santo, Brazil
| | | | - P R Jesus
- Econservation Estudos e Projetos Ambientais, Vitória, Espírito Santo, Brazil
| | - P D Ferreira
- Departamento de Gemologia, Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil
| | - F V Paladino
- Purdue University Fort Wayne, Fort Wayne, Indiana, USA
| | | | - D Sozbilen
- Department of Veterinary, Acıpayam Vocational School, Pamukkale University, Denizli, Turkey
| | - J R Monsinjon
- Institut Français de Recherche pour l'Exploitation de la Mer (IFREMER), Délégation Océan Indien (DOI), Le Port, La Réunion, France
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Taboada M, Almeida X, Cariñena A, Costa J, Carmona-Monge J, Agilda A, Barreiro L, Castillo J, Williams K, Segurola J, Álvarez J, Seoane-Pillado T. Complications and degree of difficulty of orotracheal intubation in the Intensive Care Unit before and after the establishment of an intubation protocol for critically ill patients: a prospective, observational study. Rev Esp Anestesiol Reanim (Engl Ed) 2024; 71:17-27. [PMID: 38104962 DOI: 10.1016/j.redare.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 07/17/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVE The objective of our study was to compare the degree of difficulty and complications related to tracheal intubation in an Intensive Care Unit (ICU) before and after the introduction of an intubation protocol based on the Difficult Airway Society guidelines for the management of tracheal intubation in critically ill adults, published in 2018. METHODS Prospective, observational study comparing all intubations performed in our ICU over 2 periods: pre-protocol (January 2015-January 2019) and post-protocol (February 2019-July 2022). The material used for intubation, the degree of difficulty, and intubation-related complications were recorded. RESULTS During the study period, 661 patients were intubated - 437 in the pre-protocol period (96% by direct laryngoscopy) and 224 in the post-protocol period (53% with direct laryngoscopy, 46% with video laryngoscopy). We observed an improvement in laryngeal view in the post-protocol period compared to the pre-protocol period (Cormack-Lehane ≥ 2b in 7.6% vs. 29.8%, p < 0.001), and a decrease in the number of moderate-to-severely difficult intubations (6.7% vs. 17.4%, p < 0.001). The first-pass success rate was 92.8% in the post-protocol period compared to 90.2% pre-protocol (p = 0.508). We did not find significant differences in complications between the periods studied. CONCLUSIONS Intubations performed in the post-protocol period were associated with improved laryngeal view and fewer cases of difficult intubation compared with the pre-protocol period.
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Affiliation(s)
- M Taboada
- Unidad de Cuidados Intensivos, Servicio de Anestesia y Reanimación, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain; Fundación Instituto de Investigaciones Sanitarias (FIDIS), Santiago de Compostela, La Coruña, Spain.
| | - X Almeida
- Unidad de Cuidados Intensivos, Servicio de Anestesia y Reanimación, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain; Fundación Instituto de Investigaciones Sanitarias (FIDIS), Santiago de Compostela, La Coruña, Spain
| | - A Cariñena
- Unidad de Cuidados Intensivos, Servicio de Anestesia y Reanimación, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain; Fundación Instituto de Investigaciones Sanitarias (FIDIS), Santiago de Compostela, La Coruña, Spain
| | - J Costa
- Unidad de Cuidados Intensivos, Servicio de Anestesia y Reanimación, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain; Fundación Instituto de Investigaciones Sanitarias (FIDIS), Santiago de Compostela, La Coruña, Spain
| | - J Carmona-Monge
- Unidad de Cuidados Intensivos, Servicio de Anestesia y Reanimación, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain; Fundación Instituto de Investigaciones Sanitarias (FIDIS), Santiago de Compostela, La Coruña, Spain
| | - A Agilda
- Unidad de Cuidados Intensivos, Servicio de Anestesia y Reanimación, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain; Fundación Instituto de Investigaciones Sanitarias (FIDIS), Santiago de Compostela, La Coruña, Spain
| | - L Barreiro
- Unidad de Cuidados Intensivos, Servicio de Anestesia y Reanimación, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain; Fundación Instituto de Investigaciones Sanitarias (FIDIS), Santiago de Compostela, La Coruña, Spain
| | - J Castillo
- Unidad de Cuidados Intensivos, Servicio de Anestesia y Reanimación, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain; Fundación Instituto de Investigaciones Sanitarias (FIDIS), Santiago de Compostela, La Coruña, Spain
| | - K Williams
- Unidad de Cuidados Intensivos, Servicio de Anestesia y Reanimación, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain; Fundación Instituto de Investigaciones Sanitarias (FIDIS), Santiago de Compostela, La Coruña, Spain
| | - J Segurola
- Unidad de Cuidados Intensivos, Servicio de Anestesia y Reanimación, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain; Fundación Instituto de Investigaciones Sanitarias (FIDIS), Santiago de Compostela, La Coruña, Spain
| | - J Álvarez
- Unidad de Cuidados Intensivos, Servicio de Anestesia y Reanimación, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain; Fundación Instituto de Investigaciones Sanitarias (FIDIS), Santiago de Compostela, La Coruña, Spain
| | - T Seoane-Pillado
- Preventive Medicine and Public Health Unit, Department of Health Sciences, University of A Coruña-INIBIC, La Coruña, Spain
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Judge PK, Staplin N, Mayne KJ, Wanner C, Green JB, Hauske SJ, Emberson JR, Preiss D, Ng SYA, Roddick AJ, Sammons E, Zhu D, Hill M, Stevens W, Wallendszus K, Brenner S, Cheung AK, Liu ZH, Li J, Hooi LS, Liu WJ, Kadowaki T, Nangaku M, Levin A, Cherney D, Maggioni AP, Pontremoli R, Deo R, Goto S, Rossello X, Tuttle KR, Steubl D, Massey D, Landray MJ, Baigent C, Haynes R, Herrington WG, Abat S, Abd Rahman R, Abdul Cader R, Abdul Hafidz MI, Abdul Wahab MZ, Abdullah NK, Abdul-Samad T, Abe M, Abraham N, Acheampong S, Achiri P, Acosta JA, Adeleke A, Adell V, Adewuyi-Dalton R, Adnan N, Africano A, Agharazii M, Aguilar F, Aguilera A, Ahmad M, Ahmad MK, Ahmad NA, Ahmad NH, Ahmad NI, Ahmad Miswan N, Ahmad Rosdi H, Ahmed I, Ahmed S, Ahmed S, Aiello J, Aitken A, AitSadi R, Aker S, Akimoto S, Akinfolarin A, Akram S, Alberici F, Albert C, Aldrich L, Alegata M, Alexander L, Alfaress S, Alhadj Ali M, Ali A, Ali A, Alicic R, Aliu A, Almaraz R, Almasarwah R, Almeida J, Aloisi A, Al-Rabadi L, Alscher D, Alvarez P, Al-Zeer B, Amat M, Ambrose C, Ammar H, An Y, Andriaccio L, Ansu K, Apostolidi A, Arai N, Araki H, Araki S, Arbi A, Arechiga O, Armstrong S, Arnold T, Aronoff S, Arriaga W, Arroyo J, Arteaga D, Asahara S, Asai A, Asai N, Asano S, Asawa M, Asmee MF, Aucella F, Augustin M, Avery A, Awad A, Awang IY, Awazawa M, Axler A, Ayub W, Azhari Z, Baccaro R, Badin C, Bagwell B, Bahlmann-Kroll E, Bahtar AZ, Baigent C, Bains D, Bajaj H, Baker R, Baldini E, Banas B, Banerjee D, Banno S, Bansal S, Barberi S, Barnes S, Barnini C, Barot C, Barrett K, Barrios R, Bartolomei Mecatti B, Barton I, Barton J, Basily W, Bavanandan S, Baxter A, Becker L, Beddhu S, Beige J, Beigh S, Bell S, Benck U, Beneat A, Bennett A, Bennett D, Benyon S, Berdeprado J, Bergler T, Bergner A, Berry M, Bevilacqua M, Bhairoo J, Bhandari S, Bhandary N, Bhatt A, Bhattarai M, Bhavsar M, Bian W, Bianchini F, Bianco S, Bilous R, Bilton J, Bilucaglia D, Bird C, Birudaraju D, Biscoveanu M, Blake C, Bleakley N, Bocchicchia K, 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Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial. Lancet Diabetes Endocrinol 2024; 12:51-60. [PMID: 38061372 DOI: 10.1016/s2213-8587(23)00322-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND The EMPA-KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62-0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16-1·59), representing a 50% (42-58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1). INTERPRETATION In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease. FUNDING Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council.
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Evans SM, Ivanova K, Rome R, Cossio D, Pilgrim C, Zalcberg J, Antill Y, Blake L, Du Guesclin A, Garrett A, Giffard D, Golobic N, Moir D, Parikh S, Parisi A, Sanday K, Shadbolt C, Smith M, Te Marvelde L, Williams K. Registry-derived stage (RD-Stage) for capturing cancer stage at diagnosis for endometrial cancer. BMC Cancer 2023; 23:1222. [PMID: 38087227 PMCID: PMC10714535 DOI: 10.1186/s12885-023-11615-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 11/06/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Capture of cancer stage at diagnosis is important yet poorly reported by health services to population-based cancer registries. In this paper we describe current completeness of stage information for endometrial cancer available in Australian cancer registries; and develop and validate a set of rules to enable cancer registry medical coders to calculate stage using data available to them (registry-derived stage or 'RD-Stage'). METHODOLOGY Rules for deriving RD-stage (Endometrial carcinoma) were developed using the American Joint Commission on Cancer (AJCC) TNM (tumour, nodes, metastasis) Staging System (8th Edition). An expert working group comprising cancer specialists responsible for delivering cancer care, epidemiologists and medical coders reviewed and endorsed the rules. Baseline completeness of data fields required to calculate RD-Stage, and calculation of the proportion of cases for whom an RD stage could be assigned, was assessed across each Australian jurisdiction. RD-Stage (Endometrial cancer) was calculated by Victorian Cancer Registry (VCR) medical coders and compared with clinical stage recorded by the patient's treating clinician and captured in the National Gynae-Oncology Registry (NGOR). RESULTS The necessary data completeness level for calculating RD-Stage (Endometrial carcinoma) across various Australian jurisdictions varied from 0 to 89%. Three jurisdictions captured degree of spread of cancer, rendering RD-Stage unable to be calculated. RD-Stage (Endometrial carcinoma) could not be derived for 64/485 (13%) cases and was not captured for 44/485 (9%) cases in NGOR. At stage category level (I, II, III, IV), there was concordance between RD-Stage and NGOR captured stage in 393/410 (96%) of cases (95.8%, Kendall's coefficient = 0.95). CONCLUSION A lack of consistency in data captured by, and data sources reporting to, population-based cancer registries meant that it was not possible to provide national endometrial carcinoma stage data at diagnosis. In a sample of Victorian cases, where surgical pathology was available, there was very good concordance between RD-Stage (Endometrial carcinoma) and clinician-recorded stage data available from NGOR. RD-Stage offers promise in capturing endometrial cancer stage at diagnosis for population epidemiological purposes when it is not provided by health services, but requires more extensive validation.
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Affiliation(s)
- S M Evans
- Cancer Council Victoria, Melbourne, Australia.
| | - K Ivanova
- Cancer Council Victoria, Melbourne, Australia
| | - R Rome
- Epworth Health Care, Melbourne, Australia
| | - D Cossio
- Cancer Alliance Queensland, Woolloongabba, Australia
| | - Chc Pilgrim
- Central Clinical School, Department of Surgery, The Alfred, Monash University, Melbourne, Australia
| | - J Zalcberg
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Y Antill
- Monash University, Melbourne, Australia
| | - L Blake
- Cancer Council Victoria, Melbourne, Australia
| | - A Du Guesclin
- Department of Anatomical Pathology, The Alfred, Melbourne, Australia
| | - A Garrett
- Queensland Centre for Gynaecological Cancer, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - D Giffard
- Cancer Alliance Queensland, Woolloongabba, Australia
| | - N Golobic
- Cancer Alliance Queensland, Woolloongabba, Australia
| | - D Moir
- Department of Anatomical Pathology, The Alfred, Melbourne, Australia
| | - S Parikh
- Cancer Council Victoria, Melbourne, Australia
| | - A Parisi
- ACT Cancer Registry Australian Capital Territory Health, Deakin, Australia
| | - K Sanday
- Queensland Centre for Gynaecological Cancer, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - C Shadbolt
- Royal Women's Hospital, Melbourne, Australia
| | - M Smith
- ACT Cancer Registry Australian Capital Territory Health, Deakin, Australia
| | | | - K Williams
- Cancer Council Victoria, Melbourne, Australia
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7
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Wijayaratne PR, Williams K, Davey MJ, Horne RSC, Nixon GM. Prediction of obstructive sleep apnoea in children and adolescents with Down syndrome. J Intellect Disabil Res 2023; 67:880-892. [PMID: 37382027 DOI: 10.1111/jir.13065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 05/29/2023] [Accepted: 06/09/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND Obstructive sleep apnoea (OSA) is common in children and adolescents with Down syndrome (DS). Clinical guidelines recommend that all children with DS have polysomnography (PSG) for assessment of OSA by the age of 4 years, but access is limited and testing may be burdensome for children and families. METHODS The purpose of this prospective cross-sectional cohort study was to identify a model to predict OSA in this group that could be tested in an external population to triage children and adolescents with DS for PSG. These models were based on a comprehensive set of potential predictive demographic, anthropometric, quality of life and sleep-related variables. RESULTS The results of this study show the predictive power of a model based on the sleep disordered breathing subscale of the Pediatric Sleep Survey Instrument and sleep fragmentation quantified using actigraphy in determining moderate-severe OSA in children and adolescents with DS. This model exhibits high sensitivity (82%), specificity (80%), positive predictive value (75%) and negative predictive value (86%). CONCLUSIONS We demonstrate the utility of a tool containing the sleep disordered breathing subscale of the Pediatric Sleep Survey Instrument and sleep fragmentation quantified using actigraphy in identifying children and adolescents with DS who have moderate/severe OSA.
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Affiliation(s)
- P R Wijayaratne
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - K Williams
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
- Developmental Paediatrics, Monash Children's Hospital, Melbourne, Victoria, Australia
| | - M J Davey
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
- Melbourne Children's Sleep Centre, Monash Children's Hospital, Melbourne, Victoria, Australia
| | - R S C Horne
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - G M Nixon
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
- Melbourne Children's Sleep Centre, Monash Children's Hospital, Melbourne, Victoria, Australia
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Meyer CH, Grant A, Sola R, Gills K, Mora A, Tracy BM, Muralidharan VJ, Koganti D, Todd SR, Butler C, Nguyen J, Hurst S, Udobi K, Sciarretta J, Williams K, Davis M, Dente C, Benjamin E, Ayoung-Chee P, Smith RN. Corrigendum to "Presentation, clinical course and complications in trauma patients with concomitant COVID-19 infection" [Am J Surg 224 (1 Pt B) (2022) 607-611]. Am J Surg 2023; 226:297. [PMID: 36384987 PMCID: PMC9659325 DOI: 10.1016/j.amjsurg.2022.10.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- C H Meyer
- Grady Health System, Atlanta, GA, United States; Emory University School of Medicine, Atlanta, GA, United States; Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - A Grant
- Grady Health System, Atlanta, GA, United States; Emory University School of Medicine, Atlanta, GA, United States
| | - R Sola
- Grady Health System, Atlanta, GA, United States; Morehouse School of Medicine, Atlanta, GA, United States
| | - K Gills
- Grady Health System, Atlanta, GA, United States; Morehouse School of Medicine, Atlanta, GA, United States
| | - A Mora
- Emory University School of Medicine, Atlanta, GA, United States; Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - B M Tracy
- The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | | | - D Koganti
- Grady Health System, Atlanta, GA, United States; Emory University School of Medicine, Atlanta, GA, United States
| | - S R Todd
- Grady Health System, Atlanta, GA, United States; Emory University School of Medicine, Atlanta, GA, United States
| | - C Butler
- Grady Health System, Atlanta, GA, United States; Morehouse School of Medicine, Atlanta, GA, United States
| | - J Nguyen
- Grady Health System, Atlanta, GA, United States; Morehouse School of Medicine, Atlanta, GA, United States
| | - S Hurst
- Grady Health System, Atlanta, GA, United States; Morehouse School of Medicine, Atlanta, GA, United States
| | - K Udobi
- Grady Health System, Atlanta, GA, United States; Morehouse School of Medicine, Atlanta, GA, United States
| | - J Sciarretta
- Grady Health System, Atlanta, GA, United States; Emory University School of Medicine, Atlanta, GA, United States
| | - K Williams
- Grady Health System, Atlanta, GA, United States; Emory University School of Medicine, Atlanta, GA, United States
| | - M Davis
- Grady Health System, Atlanta, GA, United States; Emory University School of Medicine, Atlanta, GA, United States
| | - C Dente
- Grady Health System, Atlanta, GA, United States; Emory University School of Medicine, Atlanta, GA, United States
| | - E Benjamin
- Grady Health System, Atlanta, GA, United States; Emory University School of Medicine, Atlanta, GA, United States
| | - P Ayoung-Chee
- Grady Health System, Atlanta, GA, United States; Morehouse School of Medicine, Atlanta, GA, United States
| | - R N Smith
- Grady Health System, Atlanta, GA, United States; Emory University School of Medicine, Atlanta, GA, United States; Rollins School of Public Health, Emory University, Atlanta, GA, United States.
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Shields A, Bhurwani MMS, Williams K, Chivukula V, Bednarek DR, Rudin S, Ionita CN. 2D versus 3D comparison of angiographic imaging biomarkers using computational fluid dynamics simulations of contrast injections. Proc SPIE Int Soc Opt Eng 2023; 12463:124632A. [PMID: 37424835 PMCID: PMC10327468 DOI: 10.1117/12.2653119] [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] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Quantitative angiography (QAngio) may provide hemodynamic information during neurointerventional procedures through imaging biomarkers related to contrast flow. The standard clinical implementation of QAngio is limited by projection imaging: analysis of contrast motion within complex 3D geometries is restricted to 1-2 projection views, truncating the potential wealth of imaging biomarkers related to disease progression or efficacy of treatment. To understand the limitations of 2D biomarkers, we propose the use of in-silico contrast distributions to investigate the potential benefits of 3D-QAngio within the context of neurovascular hemodynamics. Ground-truth in-silico contrast distributions were generated in two patient-specific intracranial aneurysm models, accounting for the physical interactions of contrast media and blood. A short bolus of contrast was utilized to obtain full a wash-in/ wash-out cycle within the aneurysm ROI. Simulated angiograms mimicking clinical cone-beam CT (CBCT) acquisitions were then generated, and volumetric contrast distributions were reconstructed to analyze bulk contrast flow. The ground-truth 3D-CFD, reconstructed 3D-CBCT-DSA, and 2D-DSA projections were used to extract QAngio parameters related to contrast time dilution curves, such as area under the curve (AUC), peak height (PH), mean-transit-time (MTT), time-to-peak (TTP), and time to arrival (TTA). An initial comparison of quantitative flow parameters in both 2D and 3D, in a smaller and larger aneurysm, indicated that 3D-QAngio can provide a good description of bulk flow characteristics (TTA, TTP, MTT), but recovery of integral parameters (PH, AUC) aneurysms is limited. Nonetheless, incorporation of 3D-QAngio methods may provide additional insight into our understanding of abnormal vascular flow patterns.
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Affiliation(s)
- A Shields
- Canon Stroke and Vascular Research Center, University at Buffalo (SUNY), Buffalo, NY
| | | | - K Williams
- Canon Stroke and Vascular Research Center, University at Buffalo (SUNY), Buffalo, NY
| | - V Chivukula
- Florida Institute of Technology, Melbourne, FL
| | - D R Bednarek
- Canon Stroke and Vascular Research Center, University at Buffalo (SUNY), Buffalo, NY
| | - S Rudin
- Canon Stroke and Vascular Research Center, University at Buffalo (SUNY), Buffalo, NY
| | - C N Ionita
- Canon Stroke and Vascular Research Center, University at Buffalo (SUNY), Buffalo, NY
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Berridge C, Siriwardena L, Nanthakumar A, Nowers J, Basit A, Damola A, Bseikri K, Emin A, Krishnan A, Macdonald D, Jefferson K, Williams K, Omer A. Discharging after reassuring mpMRI Prostate? Caution from a prospective study comparing mpMRI Prostate with transpernieal biopsies and prostatectomy specimens. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00148-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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11
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Lopez AR, Nguyen AV, Williams K, Kwan L, Hwang LY, Rible RD. P069Adolescent patients’ comfort discussing contraception: Comparing physicians’ perceptions and adolescents’ self-reported preferences. Contraception 2022. [DOI: 10.1016/j.contraception.2022.09.093] [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: 11/19/2022]
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12
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McBride K, Alsultany G, Termaat J, Williams K. Perspectives of clinicians and patients on community-based maintenance care for adults with obesity. Eur J Public Health 2022. [PMCID: PMC9593929 DOI: 10.1093/eurpub/ckac131.304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background Tertiary metabolic health services are in high demand as people with severe obesity increase. Once predetermined health goals have been achieved patients must transition to community-based care to urgently free up capacity in tertiary services. Maintenance of successful outcomes achieved via tertiary services is therefore important to limit rates of relapse back to these services. Methods This qualitative project explored community-based care needs to help individuals living with obesity maintain health gains. An interview schedule guided one-on-one interviews with patients and staff from metabolic clinics in Sydney, Australia. Results We interviewed 22 patients and 13 clinicians. A lack of appropriate and consistent clinical support in the community was identified by patients and clinicians. Most clinicians agreed primary care was key to successful maintenance care. Lack of primary care understanding of appropriate management and support for patients with obesity, lack of bariatric equipment and limited funding for allied health were all seen barriers to appropriate support beyond their clinics. Patients were highly reluctant to transition from tertiary clinics and reluctant to engage with community-based care due to experience of limited clinical/social support and bariatric equipment, demeaning clinical interactions, lack of care coordination and being stigmatised. Support groups outside of the clinic were also identified important in mitigating social isolation and stigma. Both patients and clinicians felt support groups have potential to provide important supplementary help to individuals with obesity outside tertiary settings. Conclusions Currently, individuals aiming to maintain their weight are likely to struggle in the context of existing community care provisions. Integrated, community-based and affordable models of care are needed now to allow tertiary metabolic services discharge their patients safely. Key messages • Tertiary obesity services are at capacity. • Subsequent community care for people wth obesity needs to be mote appropriate tp promote weight maintenance.
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Affiliation(s)
- K McBride
- School of Medicine, Western Sydney University , Penrith, Australia
| | - G Alsultany
- School of Medicine, Western Sydney University , Penrith, Australia
| | - J Termaat
- School of Medicine, Western Sydney University , Penrith, Australia
| | - K Williams
- Nepean Family Metabolic Health Service, Nepean Local Health District , Penrith, Australia
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Meyer C, Zeidan A, Beshara G, Cortes J, Tibbetts C, Tracy BM, Jayaraman Muralidharan V, Sola R, Hernandez Irizarry R, Williams K, Thompson A, Todd S, Sciarretta J, Smith R. Characterizing injury patterns and outcomes in hospitalized trauma patients with non-English Language Preferences. Am J Surg 2022; 225:948-952. [DOI: 10.1016/j.amjsurg.2022.09.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 09/14/2022] [Accepted: 09/18/2022] [Indexed: 11/27/2022]
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14
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Wong N, Williams K, Tolliver S, Mehregan D. 669 Evaluation and efficacy of skin of color dermatology education among underserved adolescents. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.680] [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: 10/17/2022]
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15
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Davis SF, Woodward C, Greenfield B, Homer C, Williams K, Hameed W, Riley B, Roberts D, Bryan G. Bringing lived experience into research: good practices for public involvement in research. Perspect Public Health 2022; 142:205-208. [PMID: 35833558 PMCID: PMC9284079 DOI: 10.1177/17579139221102229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- S Fowler Davis
- Associate Professor, Advanced Wellbeing Research Centre (AWRC), Sheffield Hallam University (SHU), Sheffield, UK
| | - C Woodward
- Public Involvement in Research Group (PIRG) Co-ordinator, Advanced Wellbeing Research Centre (AWRC), Sheffield Hallam University (SHU), 2 Old Hall Road, Sheffield S9 3TU, UK
| | - B Greenfield
- PIRG Member Advanced Wellbeing Research Centre (AWRC), Sheffield Hallam University (SHU), 2 Old Hall Road, Sheffield S9 3TU, UK
| | - C Homer
- Early Career Researcher, Advanced Wellbeing Research Centre (AWRC), Sheffield Hallam University (SHU), Sheffield, UK
| | - K Williams
- PIRG Member Advanced Wellbeing Research Centre (AWRC), Sheffield Hallam University (SHU), 2 Old Hall Road, Sheffield S9 3TU, UK
| | - W Hameed
- PIRG Member Advanced Wellbeing Research Centre (AWRC), Sheffield Hallam University (SHU), 2 Old Hall Road, Sheffield S9 3TU, UK
| | - B Riley
- PIRG Member Advanced Wellbeing Research Centre (AWRC), Sheffield Hallam University (SHU), 2 Old Hall Road, Sheffield S9 3TU, Uk
| | - D Roberts
- PIRG Member Advanced Wellbeing Research Centre (AWRC), Sheffield Hallam University (SHU), 2 Old Hall Road, Sheffield S9 3TU, UK
| | - G Bryan
- PIRG Member Advanced Wellbeing Research Centre (AWRC), Sheffield Hallam University (SHU), 2 Old Hall Road, Sheffield S9 3TU, UK
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16
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Meyer CH, Grant A, Sola R, Gills K, Mora AN, Tracy BM, Muralidharan VJ, Koganti D, Todd SR, Butler C, Nguyen J, Hurst S, Udobi K, Sciarretta J, Williams K, Davis M, Dente C, Benjamin E, Ayoung-Chee P, Smith RN. Presentation, clinical course and complications in trauma patients with concomitant COVID-19 infection. Am J Surg 2022; 224:607-611. [PMID: 35534294 PMCID: PMC8978444 DOI: 10.1016/j.amjsurg.2022.03.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 03/20/2022] [Accepted: 03/23/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND This study investigated the impact of COVID-19 infection on hospitalized trauma patients. METHODS A retrospective review of hospitalized trauma patients at a level I trauma center was performed from March-December 2020. Data pertaining to patient demographics, presentation and hospital course was compared between COVID positive and negative trauma patients. RESULTS There were 4,912 patients and 179 (3.64%) were COVID-19 positive. Demographics and clinical presentation did not differ significantly between those with and without concomitant COVID-19. However, COVID positive trauma patients had higher rates of acute kidney injury (p = 0.016), sepsis (p = 0.016), unplanned intubation (p = 0.002) and unplanned return to the ICU (p = 0.01). The COVID positive cohort also had longer hospital stays (p < 0.01) with no significant difference in mortality. CONCLUSIONS In the setting of an ongoing pandemic, awareness of the complications COVID positive trauma patients are predisposed to is important for providers.
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Affiliation(s)
- C H Meyer
- Grady Health System, Atlanta, GA, USA; Emory University School of Medicine, Atlanta, GA, USA; Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | - A Grant
- Grady Health System, Atlanta, GA, USA; Emory University School of Medicine, Atlanta, GA, USA.
| | - Richard Sola
- Grady Health System, Atlanta, GA, USA; Morehouse School of Medicine, Atlanta, GA, USA.
| | - K Gills
- Grady Health System, Atlanta, GA, USA; Morehouse School of Medicine, Atlanta, GA, USA.
| | - Ariana N Mora
- Emory University School of Medicine, Atlanta, GA, USA; Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | - B M Tracy
- The Ohio State University Wexner Medical Center, Columbus, OH, USA.
| | | | - D Koganti
- Grady Health System, Atlanta, GA, USA; Emory University School of Medicine, Atlanta, GA, USA.
| | - S R Todd
- Grady Health System, Atlanta, GA, USA; Emory University School of Medicine, Atlanta, GA, USA.
| | - C Butler
- Grady Health System, Atlanta, GA, USA; Morehouse School of Medicine, Atlanta, GA, USA.
| | - J Nguyen
- Grady Health System, Atlanta, GA, USA; Morehouse School of Medicine, Atlanta, GA, USA.
| | - S Hurst
- Grady Health System, Atlanta, GA, USA; Emory University School of Medicine, Atlanta, GA, USA.
| | - K Udobi
- Grady Health System, Atlanta, GA, USA; Morehouse School of Medicine, Atlanta, GA, USA.
| | - J Sciarretta
- Grady Health System, Atlanta, GA, USA; Emory University School of Medicine, Atlanta, GA, USA.
| | - K Williams
- Grady Health System, Atlanta, GA, USA; Emory University School of Medicine, Atlanta, GA, USA.
| | - M Davis
- Grady Health System, Atlanta, GA, USA; Emory University School of Medicine, Atlanta, GA, USA.
| | - C Dente
- Grady Health System, Atlanta, GA, USA; Emory University School of Medicine, Atlanta, GA, USA.
| | - E Benjamin
- Grady Health System, Atlanta, GA, USA; Emory University School of Medicine, Atlanta, GA, USA.
| | - P Ayoung-Chee
- Grady Health System, Atlanta, GA, USA; Morehouse School of Medicine, Atlanta, GA, USA.
| | - R N Smith
- Grady Health System, Atlanta, GA, USA; Emory University School of Medicine, Atlanta, GA, USA; Rollins School of Public Health, Emory University, Atlanta, GA, USA.
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17
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Beesoon S, Joffe M, Bakal J, Williams K, Brindle M. Excess Deaths during COVID-19 pandemic in Alberta, Canada. Int J Infect Dis 2022. [PMCID: PMC8884811 DOI: 10.1016/j.ijid.2021.12.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Purpose To determine if there was excess mortality in Alberta, Canada during the pandemic. We sought to confirm if excess mortality affected all age groups equally and determine what proportion of excess deaths is directly related to COVID-19. Methods & Materials Excess mortality was calculated by comparing observed to expected number of deaths. Monthly Crude death rates (CDR) for 2015 to 2019 was calculated by dividing monthly deaths by the mid-year population. Expected deaths was calculated by multiplying mean monthly CDR by the mid-year population in 2020 and the projected mid-year population in 2021 to calculate expected deaths. Age-adjusted monthly mortality rates for January 2020 to March 2021 was compared to the previous 5 years. Results From January 2020 to May 2021 there was a 11% excess mortality corresponding to an average of 248 monthly excess deaths with a minimum of 49 deaths in January 2020 (no COVID-19-related deaths) and a maximum of 781 excess deaths in December 2020. COVID-19 related deaths (n=2266) account for 53.8 % of the total excess deaths (n=4214) that occurred in the 17 months. Increase in all cause -excess deaths was proportionately higher, and in significantly greater numbers, in the younger age groups. Deaths directly linked to COVID-19 were: 8 (20-29 years), 12 (30-39 years), 32 (40-49 years), 74 (50-59 years), 225 (60-69 years), 409 (70-79 years), and 1274 (>80 years) Statistically significant increases in monthly drug poisoning deaths from March 2020 to April 2021 with a total of 1819 deaths. Excess 731 drug poisoning deaths representing 18.2 % of total all-cause excess mortality affected mostly those age 25-60. 53.9 % of all excess deaths is directly related to COVID-19 and 18.2% are drug poisoning related excess deaths. The remaining 27.9 % of excess deaths are likely due other factors such as limited access to urgent medical care. Conclusion There was statistically significant increase in all-cause mortality. Although older adults are more likely to die of COVID-19, there was massive increase in non-COVID-19 related mortality among the youth. These should be factored in public policy decisions on epidemic/pandemic management.
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18
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Shields A, Williams K, Veeturi SS, Tutino V, Ionita C, Bednarek DR, Rudin S. Initial evaluation of 2D and 3D simulated high-speed 1000 fps vascular contrast-flow image sequences using computational fluid dynamics (CFD). Proc SPIE Int Soc Opt Eng 2022; 12036:120360F. [PMID: 35983493 PMCID: PMC9385176 DOI: 10.1117/12.2611170] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Digital subtraction angiography (DSA) remains the clinical standard for detailed visualization of the neurovasculature due to its high-spatial resolution; however, detailed blood-flow quantification is impaired by its low-temporal resolution. Advances in photon-counting detector technology have led us to develop High-Speed Angiography (HSA), where x-ray images are acquired at 1000 fps for more accurate visualization and quantification of blood flow. We have implemented a physics-based optical flow method to extract such information from HSA, but validation of the angiography-derived velocity distributions is not straightforward. Computational fluid dynamics (CFD) is widely regarded as the benchmark for hemodynamic analysis, as it provides a multitude of quantitative flow parameters throughout the volume of interest. However, there are several limitations with this method related to over-simplification of boundary conditions and suboptimal meshing (spatial resolution), that make CFD simulation results an inexact criterion for validation. To overcome this issue for HSA validation, CFD was used to generate both simulated high-speed angiograms and the corresponding ground-truth 3D flow fields to better understand the relationship between the 3D volumetric-flow distribution and the 2D projected-flow distribution as is obtained with angiography, and the subsequent 2D approximation of flow velocity. Several geometries were investigated, ranging from simple pipe models to complex patient-specific aneurysms. Simulated datasets were analyzed with the optical flow algorithm, and the effects of flow divergence, quantum mottle, and intensity gradient on the calculation were evaluated. From these simulations, we can evaluate whether flow fields reconstructed from HSA are representative of significant flow patterns in the 3D vasculature.
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Affiliation(s)
- A Shields
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY
| | - K Williams
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY
| | - S S Veeturi
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY
| | - V Tutino
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY
| | - C Ionita
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY
| | - D R Bednarek
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY
| | - S Rudin
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY
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Collins J, Troville J, Williams K, Rudin S, Bednarek DR. Real-time Detection of Patient Head Position and Cephalometric Landmarks from Neuro-Interventional Procedure Images Using Machine Learning for Patient Eye-Lens Dose Prediction. Proc SPIE Int Soc Opt Eng 2022; 12031:120314A. [PMID: 35982766 PMCID: PMC9385175 DOI: 10.1117/12.2611184] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
A deep learning (DL) model has been developed to estimate patient-lens dose in real-time for given exposure and geometric conditions during fluoroscopically-guided neuro-interventional procedures. Parameters input into the DL model for dose prediction include the patient head shift from isocenter and cephalometric landmark locations as a surrogate for head size. Machine learning (ML) models were investigated to automatically detect these parameters from the in-procedure fluoroscopic image. Fluoroscopic images of a Kyoto Kagaku anthropomorphic head phantom were taken at various known X (transverse) and Y (longitudinal) shifts, as well as different magnification modes, to create an image database. For each image, anatomical landmark coordinate locations were obtained manually using ImageJ and are used as ground-truth labels for training. This database was then used to train the two separate ML models. One ML model predicts the patient head shift in both the X and Y directions and the other model predicts the coordinates of the anatomical landmarks. From the coordinates, the distance between these anatomical landmarks is calculated, and input into the DL dose-prediction model. Model performance was evaluated using mean absolute error (MAE) and mean absolute percentage error (MAPE) for the head-shift and landmark-coordinate models, respectively. The goal is to implement these two separate models into the Dose Tracking System (DTS) developed by our group. This would allow the DTS to automatically detect the patient head size and position for eye-lens dose prediction and eliminate the need for manual input by the clinical staff.
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Affiliation(s)
- J Collins
- The State University of New York at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Canon Stroke and Vascular Research Center, 875 Ellicott St., Buffalo, NY 14203
| | - J Troville
- The State University of New York at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Canon Stroke and Vascular Research Center, 875 Ellicott St., Buffalo, NY 14203
| | - K Williams
- The State University of New York at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Canon Stroke and Vascular Research Center, 875 Ellicott St., Buffalo, NY 14203
| | - S Rudin
- The State University of New York at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Canon Stroke and Vascular Research Center, 875 Ellicott St., Buffalo, NY 14203
| | - D R Bednarek
- The State University of New York at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Canon Stroke and Vascular Research Center, 875 Ellicott St., Buffalo, NY 14203
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Orozovic O, Rajabnia H, Lavrinec A, Meylan M, Williams K, Jones M, Klinzing G. An inequality relating fundamental parameters of horizontal slug flow pneumatic conveying. Chem Eng Res Des 2022. [DOI: 10.1016/j.cherd.2021.11.037] [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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Fitzsimons M, Williams K, Knowles S, Caroll C. Peritonsillar Abscess at a Dedicated Otolaryngology Emergency Department. Ir Med J 2021; 114:489. [PMID: 37669121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
Aim Peritonsillar abscess (PTA) is the most common suppurative complication of acute tonsillitis. It requires urgent specialist treatment due to the risk of progression to airway compromise. We aimed to review referral pathways to a dedicated otolaryngology emergency department (ORL-ED), identify causative organisms and discuss COVID-19 implications. Methods A retrospective review of patients presenting to the ORL-ED between January 2018 and December 2019 was undertaken. Data extracted included demographics, referral source, treatment, microbiology results and length of stay. Statistical analysis of seasonal variation of presentation and causative organisms employed Chi-Square and Fisher's Exact Test, respectively. Results There were 53 PTA presentations. 51 were admitted accounting for 44.3% (51/115) of ED admissions. The median patient age was 31 years (IQR 20-40yrs). GP referral accounted for 48/53 (90.6%). There was no statistically significant seasonality (χ2=5.94, p=0.11) in presentation. Microbiology samples were available for 44 patients. Streptococcus was identified in 19/44 (43.2%) patients. 85% (45/53) of patients received Co-amoxiclav. Discussion PTA is a perennial condition with diverse causative organisms. Antibiotic choice should reflect this. The majority of patients are referred from primary care, emphasising the role of the GP in initial diagnosis and the importance of clinical education in this regard.
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Orozovic O, Rajabnia H, Lavrinec A, Alkassar Y, Meylan M, Williams K, Jones M, Klinzing G. A phenomenological model for the pressure drop applicable across both dilute and dense phase pneumatic conveying. Chem Eng Sci 2021. [DOI: 10.1016/j.ces.2021.116992] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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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Coombes J, Dalleck L, Drummond C, Mangahas J, Ramos J, Williams K. Effects of blood flow restriction and neuromuscular electrical stimulation on muscle hypertrophy in adults: a meta-analysis. J Sci Med Sport 2021. [DOI: 10.1016/j.jsams.2021.09.095] [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: 10/19/2022]
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Neukel C, Bermpohl F, Kaess M, Taubner S, Boedeker K, Williams K, Dempfle A, Herpertz SC. Understanding and breaking the intergenerational cycle of abuse in families enrolled in routine mental health services: study protocol for a randomized controlled trial and two non-interventional trials investigating mechanisms of change within the UBICA II consortium. Trials 2021; 22:749. [PMID: 34711261 PMCID: PMC8555002 DOI: 10.1186/s13063-021-05653-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 09/24/2021] [Indexed: 11/10/2022] Open
Abstract
Background Parents’ mental illness (MI) and parental history of early life maltreatment (ELM) are known to be significant risk factors for poor parenting while poor parenting is a crucial mediator of the intergenerational continuity of child maltreatment. Hence, maltreatment prevention programs for families with an MI parent, which pay particular attention to experiences of ELM in the parent, are urgently needed. Parental mentalizing was previously found to mediate successful parenting. Interventions aimed at improving the parental mentalizing capacity reduced maltreatment risk in parents. The aim of the present study is to investigate the effectiveness of a mentalization-based parenting-counseling in acutely mentally ill parents currently treated at a psychiatric hospital. Methods Mentalization-based parenting-counseling (MB-PC) vs. enhanced standard clinical care (SCC+) will be administered in a cluster-randomized-controlled trial (RCT). Patients treated at psychiatric hospitals with children between 1.5 and 15 years will be included in the trial. MB-PC will be administered as a 12-h combined individual and group program enriched by social counseling (over a course of 5 weeks) as add-on to standard clinical care, while the control condition will be standard clinical care plus a 90-min psychoeducation workshop on positive parenting. Primary efficacy endpoint is self-reported parenting practices at follow-up. Embedded within the RCT will be two sub-studies investigating social cognition and dyadic synchrony as biobehavioral mechanisms of change. Discussion The main goal of the present study is to investigate ways to break the intergenerational continuity of maltreatment by assessing the benefits of a prevention program which aims at improving parenting in vulnerable mothers and fathers. MB-PC is a short, low-cost intervention which can be delivered by nurses and social workers and is applicable to MI patients with children with a broad range of diagnoses. If it is shown to be effective, it can be directly implemented into standard psychiatric hospital care thereby providing help to prevent child maltreatment. Trial registration German Clinical Trials Register DRKS00017398. Registered on 5 July 2019
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Affiliation(s)
- C Neukel
- Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany.
| | - F Bermpohl
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Campus Charité Mitte, Berlin, Germany, Berlin, Germany
| | - M Kaess
- Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany.,University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - S Taubner
- Department of Psychosocial Prevention, University Hospital of Heidelberg, Heidelberg, Germany
| | - K Boedeker
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Campus Virchow-Klinikum, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Berlin, Germany
| | - K Williams
- Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany
| | - A Dempfle
- Institute of Medical Informatics and Statistics, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - S C Herpertz
- Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany
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van der Star A, Randall A, Calzo JP, Weersing VR, Rojas SA, Williams K, Alexander J, Blashill AJ, Wells KJ. Feasibility and Acceptability of a Patient Navigation Intervention to Prevent Suicide in LGBTQ Youth and Young Adults. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.473] [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: 11/14/2022] Open
Abstract
Abstract
Background
Across Western countries, young LGBTQ+ individuals are at a four to seven-fold increased risk of attempting suicide, compared to the general public. Despite these substantial health disparities, no known empirically supported suicide prevention programs exist for this highly vulnerable population. Patient navigation (PN), as an intervention to assist people in overcoming barriers to care, paired with the Safety Planning Intervention (SPI), may be a promising intervention to target mechanisms (e.g., thwarted belongingness and suicide-related coping skills) that theoretically underlie suicide. The purpose of this presentation is to describe the developed intervention and present initial data on its feasibility and acceptability.
Methods
In collaboration with a Participatory Planning Group (PPG), an iterative process was used to develop a PN+SPI intervention to prevent suicide among at-risk LGBTQ+ youth and young adults. A mixed-methods case series was used to examine feasibility and acceptability of implementing the PN+SPI intervention over a three-month period of time.
Results
Theoretical models regarding suicidality and LGBTQ+ mental health along with PPG feedback have informed the development of the PN+SPI intervention, with 7 modules included in feasibility evaluation: 1) Introduction + SPI; 2) Minority Stress Psychoeducation; 3) Barriers to Mental Health Services; 4) Barriers to Community Resources; 5) Decision Making; 6) Crisis Intervention; and 7) Wrap Up.
Conclusions
This project has the potential for reducing mortality and morbidity due to suicide attempts among LGBTQ+ youth/emerging adults, who are one of the most vulnerable groups for attempting suicide globally. Given the brevity of the PN+SPI intervention and its emphasis on safety planning and accessing community resources, the PN+SPI intervention has high potential for wide dissemination and public health impact, should it demonstrate feasibility, acceptability, and preliminary efficacy.
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Affiliation(s)
- A van der Star
- San Diego State University Research Foundation, San Diego, USA
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - A Randall
- San Diego State University Research Foundation, San Diego, USA
| | - JP Calzo
- School of Public Health, San Diego State University, San Diego, USA
| | - VR Weersing
- Department of Psychology, San Diego State University, San Diego, USA
- UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University, San Diego, USA
| | - SA Rojas
- Family Health Centers of San Diego, San Diego, UK
| | - K Williams
- Family Health Centers of San Diego, San Diego, UK
| | - J Alexander
- San Diego State University Research Foundation, San Diego, USA
| | - AJ Blashill
- Department of Psychology, San Diego State University, San Diego, USA
- UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University, San Diego, USA
| | - KJ Wells
- Department of Psychology, San Diego State University, San Diego, USA
- UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University, San Diego, USA
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Ikram MI, Hill KH, Williams K. Marketing mortality? Healthy vs. unhealthy food in television advertising. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Cardiovascular disease has been the leading killer of Americans since the Spanish flu pandemic of 1918, despite recent COVID-19 mortality. During this global pandemic, the social distancing and stay-at-home requests, there was increased television (TV) engagement, and media marketing has become more impactful in modifying consumer behaviors.
Purpose
We evaluated the healthfulness of food marketing in the United States (US), based on TV commercials most frequently aired on American primetime networks during the COVID-19 pandemic.
Methods
We reviewed a total of 104 TV commercials between 2020–2021 on network and cable programs dividing them into 4 categories: 1) fast-food chains, 2) brand-recognized individual items, 3) grocery chains, and 4) home-delivery meals. The food items displayed in each commercial were recorded and scored based on the previously validated healthful versus unhealthful nutrition scoring system (Sajita, et al., JACC 2017), assigning either positive or negative values for each food item in the commercial.
Results
We found that 58% of the commercials advertised food from fast-food chains (mean score = −2.82, indicating an average of nearly 3 more unhealthy items than healthy items per commercial), 27% were brand-recognized individual items (−0.86), 9% were grocery chains (−0.90), and 6% were for home-delivery meals (−0.33), with significant differences noted between fast-food and individual items, home deliveries and grocery chains (each p<0.0001).
Conclusions
This study demonstrated that commercial TV in the US routinely promotes the consumption of foods that are known in published medical literature to be unhealthy, particularly those underpinning cardiovascular disease and its risk factors. In order to prevent an increase in cardiovascular mortality during and after this global pandemic, we suggest regulation and or legislation to curtail the frequency and/or content of these commercials, and consider a ban on such advertising to children, similar to that previously employed in Canada and the European Union.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M I Ikram
- Loyola University Medical Center, Internal Medicine, Maywood, United States of America
| | - K H Hill
- Loyola University Medical Center, Internal Medicine, Maywood, United States of America
| | - K Williams
- Rush University Medical Center, Chicago, United States of America
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Williams K, De Freitas H, Llonch MV, Nestler-Parr S, Cubells L, Acaster S. Symptoms and impacts of familial chylomicronemia syndrome (FCS): A qualitative study and development of a patient-centered conceptual model. Atherosclerosis 2021. [DOI: 10.1016/j.atherosclerosis.2021.06.359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bennett C, Bill R, Kirk J, Ledsom D, Williams K. PO-1884 Determining a planning method for delivering Internal Mammary Nodal Chain radiotherapy. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)08335-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Anagnostopoulos A, Barden M, Tulloch J, Williams K, Griffiths B, Bedford C, Rudd M, Psifidi A, Banos G, Oikonomou G. A study on the use of thermal imaging as a diagnostic tool for the detection of digital dermatitis in dairy cattle. J Dairy Sci 2021; 104:10194-10202. [PMID: 34099304 DOI: 10.3168/jds.2021-20178] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 04/30/2021] [Indexed: 11/19/2022]
Abstract
Our aims were to (1) determine how interdigital skin temperature (IST), measured using infrared thermography, was associated with different stages of digital dermatitis (DD) lesions and (2) develop and validate models that can use IST measurements to identify cows with an active DD lesion. Between March 2019 and March 2020, infrared thermographic images of hind feet were taken from 2,334 Holstein cows across 4 farms. We recorded the maximum temperature reading from infrared thermographic images of the interdigital skin between the heel bulbs on the hind feet. Pregnant animals were enrolled approximately 1 to 2 mo precalving, reassessed 1 wk after calving, and again at approximately 50 to 100 d postpartum. At these time points, IST and the clinical stage of DD (M-stage scoring system: M1-M4.1) were recorded in addition to other data such as the ambient environmental temperature, height, body condition score, parity, and the presence of other foot lesions. A mixed effect linear regression model with IST as the dependent variable was fitted. Interdigital skin temperature was associated with DD lesions; compared to healthy feet, IST was highest in feet with M2 lesions, followed by M1 and M4.1 lesions. Subsequently, the capacity of IST measurements to detect the presence or absence of an active DD lesion (M1, M2, or M4.1) was explored by fitting logistic regression models, which were tested using 10-fold validation. A mixed effect logistic regression model with the presence of active DD as the dependent variable was fitted first. The average area under the curve for this model was 0.80 when its ability to detect presence of active DD was tested on 10% of the data that were not used for the model's training; an average sensitivity of 0.77 and an average specificity of 0.67 was achieved. This model was then restricted so that only explanatory variables that could be practically recorded in a nonresearch, external setting were included. Validation of this model demonstrated an average area under the curve of 0.78, a sensitivity of 0.88, and a specificity of 0.66 for 1 of the time points (precalving). Lower sensitivity and specificity were achieved for the other 2 time points. Our study adds further evidence to the relationship between DD and foot skin temperature using a large data set with multiple measurements per animal. Additionally, we highlight the potential for infrared thermography to be used for routine on-farm diagnosis of active DD lesions.
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Affiliation(s)
- A Anagnostopoulos
- Department of Livestock and One Health, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Chester High Road, CH64 7TE, United Kingdom
| | - M Barden
- Department of Livestock and One Health, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Chester High Road, CH64 7TE, United Kingdom
| | - J Tulloch
- Department of Livestock and One Health, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Chester High Road, CH64 7TE, United Kingdom
| | - K Williams
- Department of Livestock and One Health, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Chester High Road, CH64 7TE, United Kingdom
| | - B Griffiths
- Department of Livestock and One Health, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Chester High Road, CH64 7TE, United Kingdom
| | - C Bedford
- Department of Livestock and One Health, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Chester High Road, CH64 7TE, United Kingdom
| | - M Rudd
- Department of Livestock and One Health, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Chester High Road, CH64 7TE, United Kingdom
| | - A Psifidi
- Department of Clinical Science and Services, Royal Veterinary College, North Mymms, Hertfordshire, AL9 7TA, United Kingdom
| | - G Banos
- Animal and Veterinary Sciences, SRUC, Roslin Institute Building, Easter Bush, Midlothian EH25 9RG, United Kingdom
| | - G Oikonomou
- Department of Livestock and One Health, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Chester High Road, CH64 7TE, United Kingdom.
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Hobbs N, Touqan N, Williams K. 791 Using Audit Data to Inform and Guide COVID-19 Recovery: A Case for the Re-Introduction of Immediate Breast Cancer Reconstructions. Br J Surg 2021. [PMCID: PMC8135899 DOI: 10.1093/bjs/znab134.490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Introduction During the COVID-19 pandemic, operations performed in NHS hospitals were restricted. Breast cancer surgery remained vital, however, to reduce theatre capacity pressures and re-admission rates the procedures available were rationalised to keep the risk of complications low. Immediate breast reconstruction was stopped. COVID-19 recovery meant careful reintroduction of complex surgeries, with competing interests from different surgical specialities for theatre capacity within the Trust. The psychological effects of breast cancer are significant. Therefore, it was important to advocate for our patients and ensure the reintroduction of this service. Method To strengthen our case, a retrospective audit of all immediate breast reconstruction outcomes was performed for cases during the 12 months preceding COVID-19. Results 64 patients underwent immediate implant and Acellular Dermal Matrix (ADM) breast reconstruction. Five (7.8%) patients returned to theatre. One (1.5%) returned during their initial in-patient stay due to haematoma. Four patients (6.3%) returned between 3 and 12 weeks following their original surgery date. Infection rates were higher in smokers or those with a BMI >35. Conclusions These results were presented to management and the reconstruction services were re-introduced in our Trust with stringent inclusion criteria. We can therefore offer our patients an improved service that considers both physical and psychological health.
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Affiliation(s)
- N Hobbs
- North Manchester General Hospital, Manchester, United Kingdom
| | - N Touqan
- North Manchester General Hospital, Manchester, United Kingdom
| | - K Williams
- North Manchester General Hospital, Manchester, United Kingdom
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Linggonegoro D, Williams K, Huang J. 272 Access and usage of technology among patients with dermatologic conditions. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.02.294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Wesley S, Samuels N, Williams K, Danner O, Smith R, Butler C, Nguyen J, Udobi K, Childs E, Sola R. Early versus late tube feeding initiation after PEG tube placement: Does time to feeding matter? Injury 2021; 52:1198-1203. [PMID: 33726922 DOI: 10.1016/j.injury.2021.03.002] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 02/11/2021] [Accepted: 03/01/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Variation exists in the timing of tube feed initiation after percutaneous endoscopic gastrostomy (PEG) tube placement. The aim of our study was to review outcomes of early tube feed (ETF) versus late tube feed (LTF) initiation after PEG tube placement. METHODS We performed a retrospective review of all trauma patients who underwent PEG tube placement from 1/2014 to 12/2018. ETF was defined as initiation < 24 h and LTF > 24 h after placement. The primary outcome measure was feeding intolerance and secondary outcomes included post-operative complications. All statistical analyses were performed using standard statistical methods (e.g. Pearson's Chi-squared, Fisher's exact and Mann Whitney-U tests). RESULTS There were 295 patients (164 ETF and 131 LTF) that received a PEG tube at our level 1 trauma center. There was no difference with feeding intolerance at 12 h (5% vs. 4%; p = 0.88), 24 h (1% vs. 2%; p = 1.00), and 48 h (4% vs. 4%; p = 1.00). There was no difference when comparing intolerance symptoms such as nausea and vomiting (1% vs. 2%; p = 0.79), abdominal tenderness (2% vs. 3%; p = 0.76), high gastric residuals (2% vs. 2%; p = 1.00) and aspiration (0% vs. 2%; p = 0.39). There was no difference when comparing post-operative complications (4% vs. 8%; p = 0.21). CONCLUSIONS Early tube feeding after PEG placement is safe and equivalent to late tube feeding in the adult trauma population. Future prospective studies are warranted to establish the optimal timing for initiation of tube feeds after PEG tube placement.
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Affiliation(s)
- S Wesley
- Morehouse School of Medicine, Department of Surgery, 720 Westview Drive SW, Atlanta, GA 30310, USA.
| | - N Samuels
- Morehouse School of Medicine, Department of Surgery, 720 Westview Drive SW, Atlanta, GA 30310, USA.
| | - K Williams
- Morehouse School of Medicine, Department of Surgery, 720 Westview Drive SW, Atlanta, GA 30310, USA.
| | - O Danner
- Morehouse School of Medicine, Department of Surgery, 720 Westview Drive SW, Atlanta, GA 30310, USA.
| | - R Smith
- Emory School of Medicine, Department of Surgery, 69 Jesse Hill Jr. Dr. SE, 102, Atlanta, GA 30303, USA.
| | - C Butler
- Morehouse School of Medicine, Department of Surgery, 720 Westview Drive SW, Atlanta, GA 30310, USA.
| | - J Nguyen
- Morehouse School of Medicine, Department of Surgery, 720 Westview Drive SW, Atlanta, GA 30310, USA.
| | - K Udobi
- Morehouse School of Medicine, Department of Surgery, 720 Westview Drive SW, Atlanta, GA 30310, USA.
| | - E Childs
- Morehouse School of Medicine, Department of Surgery, 720 Westview Drive SW, Atlanta, GA 30310, USA.
| | - R Sola
- Morehouse School of Medicine, Department of Surgery, 720 Westview Drive SW, Atlanta, GA 30310, USA.
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Williams K, Selwyn C, Elkins C, Young S, Pancione K, Baker M, Getch Y. An integrated addictions nursing subspecialty to expand the opioid use disorder and substance use disorder workforce. Eur Psychiatry 2021. [PMCID: PMC9480147 DOI: 10.1192/j.eurpsy.2021.1521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction In the U.S. approximately11.4 million misused prescription pain relievers; 2.1 million had an OUD in 2017. The Addictions Nursing Subspecialty was created to address this epidemic by expanding a workforce trained in OUD/SUD screening, treatment, and prevention. A curriculum was developed that included integrated/telehealth health care settings in medical and mental health provider shortage areas during their last nine months of training. Courses were developed and taught by aninterprofessional team of university faculty and informed by evidence-based guidelines/clinical competencies for effective OUD/SUD screening/prevention, assessment, treatment, and recovery. Courses were also offered as electives for nursing, clinical-counseling, social work, and other health science disciplines emphasizing an interdisciplinary approach to healthcare. Objectives Expand the OUD/SUD trained workforce in areas with high OUD/SUD mortality rates and high mental health provider shortages emphasizing team-based integrated care and telehealth settings. Methods Program curriculum was informed by evidence-based guidelines/clinical competencies for effective OUD/SUD screening/prevention, assessment, treatment, and recovery using integrated care. Competencies included: Core Competencies for Integrated Behavioral Health and Primary Care that have been set forth by the Center for Integrated Health Solutions, telehealth competencies outlined in the recommended competencies by the National Organization of Nurse Practitioner Faculties (NONPF), and Core Competencies for Addictions Medicine by the American Board of Addictions Medicine. Results Approximately 11 students enrolled in courses received additions integrated/telehealth health care settings. Students responded positively to evaluations regarding timely feedback, unique approach (i.e. intrative content, short videos and discussions). Conclusions The Addictions Nursing subspecialty will continue to be offered allowing enrollment for nurses twice a year.
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Orozovic O, Lavrinec A, Rajabnia H, Williams K, Jones M, Klinzing G. Transport boundaries and prediction of the slug velocity and layer fraction in horizontal slug flow pneumatic conveying. Chem Eng Sci 2020. [DOI: 10.1016/j.ces.2020.115916] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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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Walker D, Gutierrez-Quintana R, Gomez-Roman N, Williams K, Durant S, Chalmers A. OC-0558: The brain penetrant ATM inhibitor, AZD1390, protects neural stem cells from radiation. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00580-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Butterworth K, Williams K, Van Herk M, McWilliam A, Aznar M, McMahon S, Vasques Osorio E, Edgar K, Walls G, Gill E, Ghita M. OC-0196: Cardiac sub-volume targeting demonstrates regional radiosensitivity in the mouse heart. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00220-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Bernie C, Williams K, O'Connor B, Rogers S, May T. Referral, Assessment and Use of Screening Measures Related to Autism Spectrum Disorder at a Tertiary Hospital Setting. J Autism Dev Disord 2020; 51:2673-2685. [PMID: 33034784 DOI: 10.1007/s10803-020-04725-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 11/27/2022]
Abstract
Children with developmental concerns in Australia continue to experience inequitable healthcare and service-related delays, even when diagnostic risk is identified. This study sought to explore service and demographic pathway factors leading up to autism spectrum disorder (ASD) assessment, including value of screening measures applied at triage. Following a trial of centralised intake for referred young children with suspected ASD, observational, retrospective pathway data was explored using bivariate and regression analyses. The mean age of 159 children referred with autism symptoms was 3.6 years, and 64% were diagnosed with ASD. Service allocation was associated with diagnosis, whilst screening tool results were not. Improved pathways are needed to limit wasted waiting times and direct each child to needs-based services.
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Affiliation(s)
- C Bernie
- Department of Paediatrics, The University of Melbourne, 50 Flemington Road, Parkville, 3058, Victoria, Australia.
- Department of Allied Health, The Royal Children's Hospital, Melbourne, VIC, Australia.
- Murdoch Children's Research Institute, Melbourne, VIC, Australia.
| | - K Williams
- Department of Paediatrics, The University of Melbourne, 50 Flemington Road, Parkville, 3058, Victoria, Australia
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Department of Paediatrics, Monash University, Clayton, VIC, Australia
- Department of Developmental Paediatrics, Monash Children's Hospital, Clayton, VIC, Australia
| | - B O'Connor
- Department of Allied Health, The Royal Children's Hospital, Melbourne, VIC, Australia
| | - S Rogers
- Department of Allied Health, The Royal Children's Hospital, Melbourne, VIC, Australia
- Department of Health and Human Services, Melbourne, VIC, Australia
| | - T May
- Department of Paediatrics, Monash University, Clayton, VIC, Australia
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Williams K, Samuels N, Wesely S, Danner O, Smith R, Nguyen J, Matthews L, Udobi K, Childs E, Sola R. Early vs Late Tube Feeding Initiation after PEG tube Placement: Does Time to Feeding Matter? J Natl Med Assoc 2020. [DOI: 10.1016/j.jnma.2020.09.047] [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: 10/22/2022]
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Brennan C, Gunasekaran T, Williams K, Sanders RA. Infective aortic valve endocarditis in a cat with patent ductus arteriosus and perimembranous ventricular septal defect. J Vet Cardiol 2020; 31:30-35. [PMID: 32956937 DOI: 10.1016/j.jvc.2020.08.002] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 08/06/2020] [Accepted: 08/18/2020] [Indexed: 11/27/2022]
Abstract
A 3-year-old, male neutered, domestic short-haired cat presented for evaluation of respiratory distress. Transthoracic echocardiography revealed a left-to-right shunting ventricular septal defect, a left-to-right shunting patent ductus arteriosus, and a vegetative growth on the aortic valve leaflet consistent with aortic valve endocarditis. Because of poor response to therapy, the owner elected euthanasia, and a necropsy was performed. Gross necropsy examination confirmed the congenital cardiac defects, and aortic valve endocarditis was noted on the echocardiogram. Histopathological examination revealed diffuse interstitial pneumonia and evidence for systemic septic embolism including renal infarcts and brain microabscesses. To the authors' knowledge, this is the first case report of aortic valve endocarditis in a cat in association with congenital cardiac malformations.
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Affiliation(s)
- C Brennan
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, 736 Wilson Rd, East Lansing, MI, 48824, United States
| | - T Gunasekaran
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, 736 Wilson Rd, East Lansing, MI, 48824, United States
| | - K Williams
- College of Veterinary Medicine, Veterinary Diagnostic Laboratory, Michigan State University, 4125 Beaumont Rd, Lansing, MI, USA 48910
| | - R A Sanders
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, 736 Wilson Rd, East Lansing, MI, 48824, United States.
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Gould M, Williams K, Rutherford K, Holland P, Adams E, Clemins S. Interprofessional Student Learning Lab for the International Dysphagia Diet Standardization Initiative. J Acad Nutr Diet 2020. [DOI: 10.1016/j.jand.2020.06.193] [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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41
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Patel S, Khanna R, Williams K, Choi J, Semenov Y, Kwatra S. 844 Increased urine phthalate metabolite levels associated with eczema diagnosis. J Invest Dermatol 2020. [DOI: 10.1016/j.jid.2020.03.860] [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: 10/24/2022]
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Almazan E, Belzberg M, Qin C, Williams K, Choi J, Kaffenberger B, Semenov Y, Alhariri J, Kwatra S. 494 Association of granuloma annulare with type II diabetes, cigarette smoking, and liver disease: A case-control study. J Invest Dermatol 2020. [DOI: 10.1016/j.jid.2020.03.503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Patel S, Choi J, Khanna R, Williams K, Semenov Y, Kwatra S. 897 Association of urine mono-benzyl phthalate levels with increased psoriasis severity. J Invest Dermatol 2020. [DOI: 10.1016/j.jid.2020.03.913] [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: 10/24/2022]
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Leland E, Semenov Y, Kaffenberger B, Williams K, Alhariri J, Kwatra S. 427 Leukocytoclastic vasculitis with and without IgA deposition is associated with renal damage: A case-control study. J Invest Dermatol 2020. [DOI: 10.1016/j.jid.2020.03.435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Shi G, Kaffenberger B, Semenov Y, Choi J, Williams K, Alhariri J, Kwatra S. 468 Clinical characteristics, etiology, and treatment of erythema multiforme at a tertiary care center. J Invest Dermatol 2020. [DOI: 10.1016/j.jid.2020.03.476] [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: 11/15/2022]
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Williams N, Williams K, Werth V. 541 Anchoring the CLASI-A, a clinical outcome assessment (COA), to the patients’ perspective of their disease. J Invest Dermatol 2020. [DOI: 10.1016/j.jid.2020.03.550] [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: 10/24/2022]
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Khanna R, Patel S, Williams K, Kwatra S. 910 Increased eosinophils as a biomarker for therapeutic response in patients with chronic pruritus of unknown origin. J Invest Dermatol 2020. [DOI: 10.1016/j.jid.2020.03.926] [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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Patel S, Khanna R, Choi J, Williams K, Kwatra S. 456 Sleep disturbances in chronic pruritic dermatoses are associated with increased C-reactive protein levels. J Invest Dermatol 2020. [DOI: 10.1016/j.jid.2020.03.464] [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: 10/24/2022]
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Aggarwal P, Semenov Y, Boozalis E, Choi J, Le T, Williams K, Kwatra S. 419 Clinical characteristics and quality of life burden in aquagenic pruritus: A global questionnaire-based study. J Invest Dermatol 2020. [DOI: 10.1016/j.jid.2020.03.427] [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: 10/24/2022]
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Kaur A, Reardon J, Williams K, Mckenzie J, Zuwallack R. CHALLENGES TO IMPLEMENTING A HOME-BASED PULMONARY REHABILITATION PROGRAM FOR CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) PATIENTS FOLLOWING DISCHARGE FROM AN ACADEMIC, COMMUNITY-BASED HOSPITAL. Chest 2020. [DOI: 10.1016/j.chest.2020.05.434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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