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Loh EN, Pearce L, Murray D. Exploring NoLap: redefining emergency laparotomy beyond surgical boundaries. Anaesthesia 2024; 79:437-438. [PMID: 38114265 DOI: 10.1111/anae.16212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2023] [Indexed: 12/21/2023]
Affiliation(s)
- E N Loh
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - L Pearce
- Salford Royal Hospital, Salford, UK
| | - D Murray
- James Cook University Hospital, Middlesbrough, UK
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Javanmard-Emamghissi H, Doleman B, Lund JN, Lockwood S, Hare S, Pearce L, Moug S, Tierney GM. Beyond high-risk: analysis of the outcomes of extreme-risk patients in the National Emergency Laparotomy Audit. Anaesthesia 2023; 78:1376-1385. [PMID: 37772642 DOI: 10.1111/anae.16130] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2023] [Indexed: 09/30/2023]
Abstract
Patients who require emergency laparotomy are defined as high risk if their 30-day predicted risk of mortality is ≥ 5%. Despite a large difference in the characteristics of patients with a mortality risk score of between 5% and 50%, these outcomes are aggregated by the National Emergency Laparotomy Audit (NELA). Our aim was to describe the outcomes of the cohort of patients at extreme risk of death, which we defined as having a NELA-predicted 30-day mortality of ≥ 50%. All patients enrolled in the NELA database between December 2012 and 2020 were included. We compared patient characteristics; length of hospital stay; rates of unplanned return to the operating theatre; and 90-day survival in extreme-risk groups (predicted ≥ 50%) and high-risk patients (predicted 5-49%). Of 161,337 patients, 5193 (3.2%) had a predicted mortality of ≥ 50%. When patients were further subdivided, 2437 (47%) had predicted mortality of 50-59% (group 50-59); 1484 (29%) predicted mortality of 60-69% (group 60-69); 840 (16%) predicted mortality of 70-79% (group 70-79); and 423 (8%) predicted mortality of ≥ 80% (group 80+). Extreme-risk patients were significantly more likely to have been admitted electively than high-risk patients (p < 0.001). Length of stay increased from a median (IQR [range]) of 26 (16-43 [0-271]) days in group 50-59 to 35 (21-56 [0-368]) days in group 80+, compared with 17 (10-30 [0-1136]) days for high-risk patients. Rates of unplanned return to the operating theatre were higher in extreme-risk groups compared with high-risk patients (11% vs. 8%). The 90-day survival was 43% in group 50-59, 34% in group 60-69, 27% in group 70-79 and 17% in group 80+. These data underscore the need for a differentiated approach when discussing risk with patients at extreme risk of mortality following an emergency laparotomy. Clinicians should focus on patient priorities on quantity and quality of life during informed consent discussions before surgery. Future work should extend beyond the immediate postoperative period to encompass the longer-term outcomes (survival and function) of patients who have emergency laparotomies.
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Affiliation(s)
- H Javanmard-Emamghissi
- Department of Medicine and Health Sciences, University of Nottingham at Derby, Royal Derby Hospital, Derby, UK
| | - B Doleman
- Department of Medicine and Health Sciences, University of Nottingham at Derby, Royal Derby Hospital, Derby, UK
| | - J N Lund
- Department of Medicine and Health Sciences, University of Nottingham at Derby, Royal Derby Hospital, Derby, UK
| | - S Lockwood
- Department of Colorectal Surgery, Bradford Royal Infirmary, Bradford, UK
| | - S Hare
- Department of Anaesthesia, William Harvey Hospital, East Kent University Hospitals, Ashford, UK
| | - L Pearce
- Department of Colorectal Surgery, Salford Royal Hospital, Salford, UK
| | - S Moug
- Department of Colorectal Surgery, Royal Alexandra Hospital, Paisley, UK
| | - G M Tierney
- Department of Colorectal Surgery, Royal Derby Hospital, Derby, UK
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Pearce L, Meizoso-Huesca A, Seng C, Lamboley CR, Singh DP, Launikonis BS. Ryanodine receptor activity and store-operated Ca 2+ entry: Critical regulators of Ca 2+ content and function in skeletal muscle. J Physiol 2023; 601:4183-4202. [PMID: 35218018 DOI: 10.1113/jp279512] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 01/28/2022] [Indexed: 11/08/2022] Open
Abstract
Store-operated Ca2+ entry (SOCE) is critical to cell function. In skeletal muscle, SOCE has evolved alongside excitation-contraction coupling (EC coupling); as a result, it displays unique properties compared to SOCE in other cells. The plasma membrane of skeletal muscle is mostly internalized as the tubular system, with the tubules meeting the sarcoplasmic reticulum (SR) terminal cisternae, forming junctions where the proteins that regulate EC coupling and SOCE are positioned. In this review, we describe the properties and roles of SOCE based on direct measurements of Ca2+ influx during SR Ca2+ release and leak. SOCE is activated immediately and locally as the [Ca2+ ] of the junctional SR terminal cisternae ([Ca2+ ]jSR ) depletes. [Ca2+ ]jSR changes rapidly and steeply with increasing activity of the SR ryanodine receptor isoform 1 (RyR1). The high fidelity of [Ca2+ ]jSR with RyR1 activity probably depends on the SR Ca2+ -buffer calsequestrin that is located immediately behind RyR1 inside the SR. This arrangement provides in-phase activation and deactivation of SOCE with a large dynamic range, allowing precise grading of SOCE flux. The in-phase activation of SOCE as the SR partially depletes traps Ca2+ in the cytoplasm, preventing net Ca2+ loss. Mild presentation of RyR1 leak can occur under physiological conditions, providing fibre Ca2+ redistribution without changing fibre Ca2+ content. This condition preserves normal contractile function at the same time as increasing basal metabolic rate. However, higher RyR1 leak drives excess cytoplasmic and mitochondrial Ca2+ load, setting a deleterious intracellular environment that compromises the function of the skeletal muscle.
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Affiliation(s)
- Luke Pearce
- School of Biomedical Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Aldo Meizoso-Huesca
- School of Biomedical Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Crystal Seng
- School of Biomedical Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Cedric R Lamboley
- School of Biomedical Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Daniel P Singh
- School of Biomedical Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Bradley S Launikonis
- School of Biomedical Sciences, The University of Queensland, Brisbane, QLD, Australia
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Thomas M, Baltatzis M, Price A, Fox J, Pearce L, Vilches-Moraga A. The influence of frailty on outcomes for older adults admitted to hospital with benign biliary disease: a single-centre, observational cohort study. Ann R Coll Surg Engl 2023; 105:231-240. [PMID: 35616268 PMCID: PMC9974336 DOI: 10.1308/rcsann.2021.0331] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2021] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The prevalence and complications of biliary disease increase with age. Frailty has been associated with adverse outcomes in the hospital setting. We describe the prevalence of frailty in older patients hospitalised with benign biliary disease and its association with duration of hospital stay, and 90-day and 1-year mortality. METHODS We performed a retrospective cohort study of patients aged 75 years and over admitted with acute biliary disease between 17 September 2014 and 20 March 2017. Clinical Frailty Scale (CFS) score was recorded on admission. RESULTS We included 200 patients with a median age of 82 (75-99) years, 60% were female; 154 (77%) were independent for personal activities of daily living (ADLs) and 99 (49.5%) for instrumental ADLs. Cholecystitis was the most common diagnosis (43%) followed by cholangitis (36%) and pancreatitis (21%). Ninety-nine patients were non frail (NF; CFS 1-4) and 101 were frail (F; CFS 5-9). Some 104 patients received medical treatment only. Surgery was more common in NF patients (11% vs F 2%), percutaneous drainage more frequently performed in F patients (15% vs NF 5%) and endoscopic cholangiopancreatography was similar in both groups (F 32% vs NF 31%). Frailty was associated with worse clinical outcomes in F vs NF: functional deconditioning (34% vs 11%), increased care level (19% vs 3%), length of stay (12 vs 7 days), 90-day mortality (8% vs 3%) and 1-year mortality (48% vs 24%). CONCLUSIONS Half of patients in our cohort were frail and spent longer in hospital, were less likely to undergo surgery and were less likely to remain alive at 1 year after discharge.
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Affiliation(s)
- M Thomas
- Salford Royal NHS Foundation Trust, Northern Care Alliance, UK
| | - M Baltatzis
- Salford Royal NHS Foundation Trust, Northern Care Alliance, UK
| | - A Price
- Salford Royal NHS Foundation Trust, Northern Care Alliance, UK
| | - J Fox
- Salford Royal NHS Foundation Trust, Northern Care Alliance, UK
| | - L Pearce
- Salford Royal NHS Foundation Trust, Northern Care Alliance, UK
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Shamsi S, Francis N, Masiga J, Barton DP, Zhu X, Pearce L, McLellan M. Occurrence and characterisation of Eustrongylides species in Australian native birds and fish. Food Waterborne Parasitol 2023; 30:e00189. [PMID: 36874397 PMCID: PMC9975212 DOI: 10.1016/j.fawpar.2023.e00189] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 01/22/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023] Open
Abstract
In Australia, nematodes belonging to the genus Eustrongylides were believed to be endemic species until the late 20th century when they were all considered to be E. excisus, invalid or inquirendae. Although these nematodes have frequently been reported in Australian fish, reptiles, and birds and cause disease or mortality among them, there has been no attempt to date to characterise them genetically. Globally, also, no one has validated or defined suitable genetic markers to distinguish between species of Eustrongylides. In this study, adult Eustrongylides from little black cormorant (Phalacrocorax sulcirostris; n = 3) and larvae from mountain galaxias (Galaxias olidus, n = 2) and a Murray cod (Maccullochella peelii, n = 1), and a Murray cod-trout cod hybrids (Maccullochella peelii x Maccullochella macquariensis, n = 1) were available for morphological examination and molecular characterisation. The adult nematodes from cormorants were identified as E. excisus. Sequences of the 18S and ITS regions were then obtained for all nematodes, which were identical among all specimens (larvae and adults) and also identical to those of E. excisus available in the GenBank. However, only one base pair difference exists between the 18S sequences of E. excisus and E. ignotus, with limited sequences available in GenBank accompanied with proper morphological data for the nematodes. With that limitation in mind, identifying our specimens as E. excisus suggests spill-over - that it is an introduced parasite species that has successfully established its life cycle among Australian native species - may have occurred. Our study is the first report of E. excisus in the little black cormorant, P. sulcirostris. Our results do not exclude the possibility of the occurrence of other species of Eustrongylides, either native or exotic, in Australia. This parasite is zoonotic and with increasing demand for fish and changing dietary preferences, such as the consumption of raw or undercooked fish, its occurrence in the flesh of the fish is concerning. This parasite is also associated with anthropogenic habitat alteration affecting the reproductive success of the infected hosts. Therefore, awareness among the relevant authorities of the presence of the parasite in Australia and its adverse impact on native animals is crucial for the success of conservation plans such as fish recovery and relocation efforts.
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Affiliation(s)
- Shokoofeh Shamsi
- School of Agricultural, Environmental and Veterinary Sciences, Charles Sturt University, Wagga Wagga, Australia
- Corresponding author.
| | - Nidhish Francis
- School of Agricultural, Environmental and Veterinary Sciences, Charles Sturt University, Wagga Wagga, Australia
| | - Juliet Masiga
- School of Agricultural, Environmental and Veterinary Sciences, Charles Sturt University, Wagga Wagga, Australia
- Kenya Veterinary Vaccines Production Institute(KEVEVAPI), Road A off Enterprise Road, Nairobi, Kenya
| | - Diane P. Barton
- School of Agricultural, Environmental and Veterinary Sciences, Charles Sturt University, Wagga Wagga, Australia
| | - Xiaocheng Zhu
- School of Agricultural, Environmental and Veterinary Sciences, Charles Sturt University, Wagga Wagga, Australia
- NSW Department of Primary Industries, Wagga Wagga Agricultural Institute, Wagga Wagga, NSW, Australia
| | - Luke Pearce
- NSW Department of Primary Industries, Fisheries, Habitat & Threatened Species Unit, Freshwater Environment Branch, Australia
| | - Matthew McLellan
- NSW Department of Primary Industries, Fisheries and Aquaculture Management, Narrandera Fisheries Centre, Narrandera, NSW 2700, Australia
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Seng C, Pearce L, Meizoso-Huesca A, Singh DP, Murphy RM, Lamboley C, Launikonis BS. Tiny changes in cytoplasmic [Ca 2+] cause large changes in mitochondrial Ca 2+: what are the triggers and functional implications? Am J Physiol Cell Physiol 2022; 323:C1285-C1289. [PMID: 36094438 DOI: 10.1152/ajpcell.00092.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Ca2+ is an integral component of the functional and developmental regulation of the mitochondria. In skeletal muscle, Ca2+ is reported to modulate the rate of ATP resynthesis, regulate the expression of PGC1α following exercise and drive the generation of reactive oxygen species (ROS). Due to the latter, mitochondrial Ca2+ overload is recognized as a pathophysiological event but the former events represent important physiological functions in need of tight regulation. Recently, we described the relationship between [Ca2+]mito and resting [Ca2+]cyto and other mitochondrial Ca2+-handling properties of skeletal muscle. An important next step is to understand the triggers for Ca2+ redistribution between intracellular compartments, which determine the mitochondrial Ca2+ load. These triggers in both physiological and pathophysiological scenarios can be traced to the coupled activity of the ryanodine receptor 1 (RyR1) and store-operated Ca2+ entry (SOCE) in the resting muscle. In this piece we will discuss some issues regarding Ca2+ measurements relevant to mitochondrial Ca2+-handling, the steady state relationship between cytoplasmic and mitochondrial Ca2+ and the potential implications for Ca2+ handling by muscle mitochondria and cellular function.
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Affiliation(s)
- Crystal Seng
- School of Biomedical Sciences, University of Queensland, Brisbane, QLD, Australia
| | - Luke Pearce
- School of Biomedical Sciences, University of Queensland, Brisbane, QLD, Australia
| | - Aldo Meizoso-Huesca
- School of Biomedical Sciences, University of Queensland, Brisbane, QLD, Australia
| | - Daniel P Singh
- School of Biomedical Sciences, University of Queensland, Brisbane, QLD, Australia
| | - Robyn M Murphy
- Department of Biochemistry and Chemistry, School of Agriculture, Biomedicine and Environment (SABE), La Trobe University, Melbourne, VIC, Australia
| | - Cedric Lamboley
- School of Biomedical Sciences, University of Queensland, Brisbane, QLD, Australia
| | - Bradley S Launikonis
- School of Biomedical Sciences, University of Queensland, Brisbane, QLD, Australia
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Evans RA, Leavy OC, Richardson M, Elneima O, McAuley HJC, Shikotra A, Singapuri A, Sereno M, Saunders RM, Harris VC, Houchen-Wolloff L, Aul R, Beirne P, Bolton CE, Brown JS, Choudhury G, Diar-Bakerly N, Easom N, Echevarria C, Fuld J, Hart N, Hurst J, Jones MG, Parekh D, Pfeffer P, Rahman NM, Rowland-Jones SL, Shah AM, Wootton DG, Chalder T, Davies MJ, De Soyza A, Geddes JR, Greenhalf W, Greening NJ, Heaney LG, Heller S, Howard LS, Jacob J, Jenkins RG, Lord JM, Man WDC, McCann GP, Neubauer S, Openshaw PJM, Porter JC, Rowland MJ, Scott JT, Semple MG, Singh SJ, Thomas DC, Toshner M, Lewis KE, Thwaites RS, Briggs A, Docherty AB, Kerr S, Lone NI, Quint J, Sheikh A, Thorpe M, Zheng B, Chalmers JD, Ho LP, Horsley A, Marks M, Poinasamy K, Raman B, Harrison EM, Wain LV, Brightling CE, Abel K, Adamali H, Adeloye D, Adeyemi O, Adrego R, Aguilar Jimenez LA, Ahmad S, Ahmad Haider N, Ahmed R, Ahwireng N, Ainsworth M, Al-Sheklly B, Alamoudi A, Ali M, Aljaroof M, All AM, Allan L, Allen RJ, Allerton L, Allsop L, Almeida P, Altmann D, Alvarez Corral M, Amoils S, Anderson D, Antoniades C, Arbane G, Arias A, Armour C, Armstrong L, Armstrong N, Arnold D, Arnold H, Ashish A, Ashworth A, Ashworth M, Aslani S, Assefa-Kebede H, Atkin C, Atkin P, Aung H, Austin L, Avram C, Ayoub A, Babores M, Baggott R, Bagshaw J, Baguley D, Bailey L, Baillie JK, Bain S, Bakali M, Bakau M, Baldry E, Baldwin D, Ballard C, Banerjee A, Bang B, Barker RE, Barman L, Barratt S, Barrett F, Basire D, Basu N, Bates M, Bates A, Batterham R, Baxendale H, Bayes H, Beadsworth M, Beckett P, Beggs M, Begum M, Bell D, Bell R, Bennett K, Beranova E, Bermperi A, Berridge A, Berry C, Betts S, Bevan E, Bhui K, Bingham M, Birchall K, Bishop L, Bisnauthsing K, Blaikely J, Bloss A, Bolger A, Bonnington J, Botkai A, Bourne C, Bourne M, Bramham K, Brear L, Breen G, Breeze J, Bright E, Brill S, Brindle K, Broad L, Broadley A, Brookes C, Broome M, Brown A, Brown A, Brown J, Brown J, Brown M, Brown M, Brown V, Brugha T, Brunskill N, Buch M, Buckley P, Bularga A, Bullmore E, Burden L, Burdett T, Burn D, Burns G, Burns A, Busby J, Butcher R, Butt A, Byrne S, Cairns P, Calder PC, Calvelo E, Carborn H, Card B, Carr C, Carr L, Carson G, Carter P, Casey A, Cassar M, Cavanagh J, Chablani M, Chambers RC, Chan F, Channon KM, Chapman K, Charalambou A, Chaudhuri N, Checkley A, Chen J, Cheng Y, Chetham L, Childs C, Chilvers ER, Chinoy H, Chiribiri A, Chong-James K, Choudhury N, Chowienczyk P, Christie C, Chrystal M, Clark D, Clark C, Clarke J, Clohisey S, Coakley G, Coburn Z, Coetzee S, Cole J, Coleman C, Conneh F, Connell D, Connolly B, Connor L, Cook A, Cooper B, Cooper J, Cooper S, Copeland D, Cosier T, Coulding M, Coupland C, Cox E, Craig T, Crisp P, Cristiano D, Crooks MG, Cross A, Cruz I, Cullinan P, Cuthbertson D, Daines L, Dalton M, Daly P, Daniels A, Dark P, Dasgin J, David A, David C, Davies E, Davies F, Davies G, Davies GA, Davies K, Dawson J, Daynes E, Deakin B, Deans A, Deas C, Deery J, Defres S, Dell A, Dempsey K, Denneny E, Dennis J, Dewar A, Dharmagunawardena R, Dickens C, Dipper A, Diver S, Diwanji SN, Dixon M, Djukanovic R, Dobson H, Dobson SL, Donaldson A, Dong T, Dormand N, Dougherty A, Dowling R, Drain S, Draxlbauer K, Drury K, Dulawan P, Dunleavy A, Dunn S, Earley J, Edwards S, Edwardson C, El-Taweel H, Elliott A, Elliott K, Ellis Y, Elmer A, Evans D, Evans H, Evans J, Evans R, Evans RI, Evans T, Evenden C, Evison L, Fabbri L, Fairbairn S, Fairman A, Fallon K, Faluyi D, Favager C, Fayzan T, Featherstone J, Felton T, Finch J, Finney S, Finnigan J, Finnigan L, Fisher H, Fletcher S, Flockton R, Flynn M, Foot H, Foote D, Ford A, Forton D, Fraile E, Francis C, Francis R, Francis S, Frankel A, Fraser E, Free R, French N, Fu X, Furniss J, Garner L, Gautam N, George J, George P, Gibbons M, Gill M, Gilmour L, Gleeson F, Glossop J, Glover S, Goodman N, Goodwin C, Gooptu B, Gordon H, Gorsuch T, Greatorex M, Greenhaff PL, Greenhalgh A, Greenwood J, Gregory H, Gregory R, Grieve D, Griffin D, Griffiths L, Guerdette AM, Guillen Guio B, Gummadi M, Gupta A, Gurram S, Guthrie E, Guy Z, H Henson H, Hadley K, Haggar A, Hainey K, Hairsine B, Haldar P, Hall I, Hall L, Halling-Brown M, Hamil R, Hancock A, Hancock K, Hanley NA, Haq S, Hardwick HE, Hardy E, Hardy T, Hargadon B, Harrington K, Harris E, Harrison P, Harvey A, Harvey M, Harvie M, Haslam L, Havinden-Williams M, Hawkes J, Hawkings N, Haworth J, Hayday A, Haynes M, Hazeldine J, Hazelton T, Heeley C, Heeney JL, Heightman M, Henderson M, Hesselden L, Hewitt M, Highett V, Hillman T, Hiwot T, Hoare A, Hoare M, Hockridge J, Hogarth P, Holbourn A, Holden S, Holdsworth L, Holgate D, Holland M, Holloway L, Holmes K, Holmes M, Holroyd-Hind B, Holt L, Hormis A, Hosseini A, Hotopf M, Howard K, Howell A, Hufton E, Hughes AD, Hughes J, Hughes R, Humphries A, Huneke N, Hurditch E, Husain M, Hussell T, Hutchinson J, Ibrahim W, Ilyas F, Ingham J, Ingram L, Ionita D, Isaacs K, Ismail K, Jackson T, James WY, Jarman C, Jarrold I, Jarvis H, Jastrub R, Jayaraman B, Jezzard P, Jiwa K, Johnson C, Johnson S, Johnston D, Jolley CJ, Jones D, Jones G, Jones H, Jones H, Jones I, Jones L, Jones S, Jose S, Kabir T, Kaltsakas G, Kamwa V, Kanellakis N, Kaprowska S, Kausar Z, Keenan N, Kelly S, Kemp G, Kerslake H, Key AL, Khan F, Khunti K, Kilroy S, King B, King C, Kingham L, Kirk J, Kitterick P, Klenerman P, Knibbs L, Knight S, Knighton A, Kon O, Kon S, Kon SS, Koprowska S, Korszun A, Koychev I, Kurasz C, Kurupati P, Laing C, Lamlum H, Landers G, Langenberg C, Lasserson D, Lavelle-Langham L, Lawrie A, Lawson C, Lawson C, Layton A, Lea A, Lee D, Lee JH, Lee E, Leitch K, Lenagh R, Lewis D, Lewis J, Lewis V, Lewis-Burke N, Li X, Light T, Lightstone L, Lilaonitkul W, Lim L, Linford S, Lingford-Hughes A, Lipman M, Liyanage K, Lloyd A, Logan S, Lomas D, Loosley R, Lota H, Lovegrove W, Lucey A, Lukaschuk E, Lye A, Lynch C, MacDonald S, MacGowan G, Macharia I, Mackie J, Macliver L, Madathil S, Madzamba G, Magee N, Magtoto MM, Mairs N, Majeed N, Major E, Malein F, Malim M, Mallison G, Mandal S, Mangion K, Manisty C, Manley R, March K, Marciniak S, Marino P, Mariveles M, Marouzet E, Marsh S, Marshall B, Marshall M, Martin J, Martineau A, Martinez LM, Maskell N, Matila D, Matimba-Mupaya W, Matthews L, Mbuyisa A, McAdoo S, Weir McCall J, McAllister-Williams H, McArdle A, McArdle P, McAulay D, McCormick J, McCormick W, McCourt P, McGarvey L, McGee C, Mcgee K, McGinness J, McGlynn K, McGovern A, McGuinness H, McInnes IB, McIntosh J, McIvor E, McIvor K, McLeavey L, McMahon A, McMahon MJ, McMorrow L, Mcnally T, McNarry M, McNeill J, McQueen A, McShane H, Mears C, Megson C, Megson S, Mehta P, Meiring J, Melling L, Mencias M, Menzies D, Merida Morillas M, Michael A, Milligan L, Miller C, Mills C, Mills NL, Milner L, Misra S, Mitchell J, Mohamed A, Mohamed N, Mohammed S, Molyneaux PL, Monteiro W, Moriera S, Morley A, Morrison L, Morriss R, Morrow A, Moss AJ, Moss P, Motohashi K, Msimanga N, Mukaetova-Ladinska E, Munawar U, Murira J, Nanda U, Nassa H, Nasseri M, Neal A, Needham R, Neill P, Newell H, Newman T, Newton-Cox A, Nicholson T, Nicoll D, Nolan CM, Noonan MJ, Norman C, Novotny P, Nunag J, Nwafor L, Nwanguma U, Nyaboko J, O'Donnell K, O'Brien C, O'Brien L, O'Regan D, Odell N, Ogg G, Olaosebikan O, Oliver C, Omar Z, Orriss-Dib L, Osborne L, Osbourne R, Ostermann M, Overton C, Owen J, Oxton J, Pack J, Pacpaco E, Paddick S, Painter S, Pakzad A, Palmer S, Papineni P, Paques K, Paradowski K, Pareek M, Parfrey H, Pariante C, Parker S, Parkes M, Parmar J, Patale S, Patel B, Patel M, Patel S, Pattenadk D, Pavlides M, Payne S, Pearce L, Pearl JE, Peckham D, Pendlebury J, Peng Y, Pennington C, Peralta I, Perkins E, Peterkin Z, Peto T, Petousi N, Petrie J, Phipps J, Pimm J, Piper Hanley K, Pius R, Plant H, Plein S, Plekhanova T, Plowright M, Polgar O, Poll L, Porter J, Portukhay S, Powell N, Prabhu A, Pratt J, Price A, Price C, Price C, Price D, Price L, Price L, Prickett A, Propescu J, Pugmire S, Quaid S, Quigley J, Qureshi H, Qureshi IN, Radhakrishnan K, Ralser M, Ramos A, Ramos H, Rangeley J, Rangelov B, Ratcliffe L, Ravencroft P, Reddington A, Reddy R, Redfearn H, Redwood D, Reed A, Rees M, Rees T, Regan K, Reynolds W, Ribeiro C, Richards A, Richardson E, Rivera-Ortega P, Roberts K, Robertson E, Robinson E, Robinson L, Roche L, Roddis C, Rodger J, Ross A, Ross G, Rossdale J, Rostron A, Rowe A, Rowland A, Rowland J, Roy K, Roy M, Rudan I, Russell R, Russell E, Saalmink G, Sabit R, Sage EK, Samakomva T, Samani N, Sampson C, Samuel K, Samuel R, Sanderson A, Sapey E, Saralaya D, Sargant J, Sarginson C, Sass T, Sattar N, Saunders K, Saunders P, Saunders LC, Savill H, Saxon W, Sayer A, Schronce J, Schwaeble W, Scott K, Selby N, Sewell TA, Shah K, Shah P, Shankar-Hari M, Sharma M, Sharpe C, Sharpe M, Shashaa S, Shaw A, Shaw K, Shaw V, Shelton S, Shenton L, Shevket K, Short J, Siddique S, Siddiqui S, Sidebottom J, Sigfrid L, Simons G, Simpson J, Simpson N, Singh C, Singh S, Sissons D, Skeemer J, Slack 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Clinical characteristics with inflammation profiling of long COVID and association with 1-year recovery following hospitalisation in the UK: a prospective observational study. Lancet Respir Med 2022; 10:761-775. [PMID: 35472304 PMCID: PMC9034855 DOI: 10.1016/s2213-2600(22)00127-8] [Citation(s) in RCA: 144] [Impact Index Per Article: 72.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/23/2022] [Accepted: 03/31/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND No effective pharmacological or non-pharmacological interventions exist for patients with long COVID. We aimed to describe recovery 1 year after hospital discharge for COVID-19, identify factors associated with patient-perceived recovery, and identify potential therapeutic targets by describing the underlying inflammatory profiles of the previously described recovery clusters at 5 months after hospital discharge. METHODS The Post-hospitalisation COVID-19 study (PHOSP-COVID) is a prospective, longitudinal cohort study recruiting adults (aged ≥18 years) discharged from hospital with COVID-19 across the UK. Recovery was assessed using patient-reported outcome measures, physical performance, and organ function at 5 months and 1 year after hospital discharge, and stratified by both patient-perceived recovery and recovery cluster. Hierarchical logistic regression modelling was performed for patient-perceived recovery at 1 year. Cluster analysis was done using the clustering large applications k-medoids approach using clinical outcomes at 5 months. Inflammatory protein profiling was analysed from plasma at the 5-month visit. This study is registered on the ISRCTN Registry, ISRCTN10980107, and recruitment is ongoing. FINDINGS 2320 participants discharged from hospital between March 7, 2020, and April 18, 2021, were assessed at 5 months after discharge and 807 (32·7%) participants completed both the 5-month and 1-year visits. 279 (35·6%) of these 807 patients were women and 505 (64·4%) were men, with a mean age of 58·7 (SD 12·5) years, and 224 (27·8%) had received invasive mechanical ventilation (WHO class 7-9). The proportion of patients reporting full recovery was unchanged between 5 months (501 [25·5%] of 1965) and 1 year (232 [28·9%] of 804). Factors associated with being less likely to report full recovery at 1 year were female sex (odds ratio 0·68 [95% CI 0·46-0·99]), obesity (0·50 [0·34-0·74]) and invasive mechanical ventilation (0·42 [0·23-0·76]). Cluster analysis (n=1636) corroborated the previously reported four clusters: very severe, severe, moderate with cognitive impairment, and mild, relating to the severity of physical health, mental health, and cognitive impairment at 5 months. We found increased inflammatory mediators of tissue damage and repair in both the very severe and the moderate with cognitive impairment clusters compared with the mild cluster, including IL-6 concentration, which was increased in both comparisons (n=626 participants). We found a substantial deficit in median EQ-5D-5L utility index from before COVID-19 (retrospective assessment; 0·88 [IQR 0·74-1·00]), at 5 months (0·74 [0·64-0·88]) to 1 year (0·75 [0·62-0·88]), with minimal improvements across all outcome measures at 1 year after discharge in the whole cohort and within each of the four clusters. INTERPRETATION The sequelae of a hospital admission with COVID-19 were substantial 1 year after discharge across a range of health domains, with the minority in our cohort feeling fully recovered. Patient-perceived health-related quality of life was reduced at 1 year compared with before hospital admission. Systematic inflammation and obesity are potential treatable traits that warrant further investigation in clinical trials. FUNDING UK Research and Innovation and National Institute for Health Research.
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G, Raheel F, Rajaseharan A, Ramgopal A, Risbrooke C, Selvaratnam K, Sethunath G, Tabassum R, Taylor J, Thakker A, Wijesingha N, Wybrew R, Yasin T, Ahmed Osman A, Alfadhel S, Carberry E, Chen JY, Drake I, Glen P, Jayasuriya N, Kawar L, Myatt R, Sinan LOH, Siu SSY, Tjen V, Adeboyejo O, Bacon H, Barnes R, Birnie C, D'Cunha Kamath A, Hughes E, Middleton S, Owen R, Schofield E, Short C, Smith R, Wang H, Willett M, Zimmerman M, Balfour J, Chadwick T, Coombe-Jones M, Do Le HP, Faulkner G, Hobson K, Shehata Z, Beattie M, Chmielewski G, Chong C, Donnelly B, Drusch B, Ellis J, Farrelly C, Feyi-Waboso J, Hibell I, Hoade L, Ho C, Jones H, Kodiatt B, Lidder P, Ni Cheallaigh L, Norman R, Patabendi I, Penfold H, Playfair M, Pomeroy S, Ralph C, Rottenburg H, Sebastian J, Sheehan M, Stanley V, Welchman J, Ajdarpasic D, Antypas A, Azouaghe O, Basi S, Bettoli G, Bhattarai S, Bommireddy L, Bourne K, Budding J, Cookey-Bresi R, Cummins T, Davies G, Fabelurin C, Gwilliam R, Hanley J, Hird A, Kruczynska A, Langhorne B, Lund J, Lutchman I, McGuinness R, Neary M, Pampapathi S, Pang E, Podbicanin S, Rai N, Redhouse White G, Sujith J, Thomas P, Walker I, Winterton R, Anderson P, Barrington M, Bhadra K, Clark G, Fowler G, Gibson C, Hudson S, Kaminskaite V, Lawday S, Longshaw A, MacKrill E, McLachlan F, Murdeshwar A, Nieuwoudt R, Parker P, Randall R, Rawlins E, Reeves SA, Rye D, Sirkis T, Sykes B, Ventress N, Wosinska N, Akram B, Burton L, Coombs A, Long R, Magowan D, Ong C, Sethi M, Williams G, Chan C, Chan LH, Fernando D, Gaba F, Khor Z, Les JW, Mak R, Moin S, Ng Kee Kwong KC, Paterson-Brown S, Tew YY, Bardon A, Burrell K, Coldwell C, Costa I, Dexter E, Hardy A, Khojani M, Mazurek J, Raymond T, Reddy V, Reynolds J, Soma A, Agiotakis S, Alsusa H, Desai N, Peristerakis I, Adcock A, Ayub H, Bennett T, Bibi F, Brenac S, Chapman T, Clarke G, Clark F, Galvin C, Gwyn-Jones A, Henry-Blake C, Kerner S, Kiandee M, Lovett A, Pilecka A, Ravindran R, Siddique H, Sikand T, Treadwell K, Akmal K, Apata A, Barton O, Broad G, Darling H, Dhuga Y, Emms L, Habib S, Jain R, Jeater J, Kan CYP, Kathiravelupillai A, Khatkar H, Kirmani S, Kulasabanathan K, Lacey H, Lal K, Manafa C, Mansoor M, McDonald S, Mittal A, Mustoe S, Nottrodt L, Oliver P, Papapetrou I, Pattinson F, Raja M, Reyhani H, Shahmiri A, Small O, Soni U, Aguirrezabala Armbruster B, Bunni J, Hakim MA, Hawkins-Hooker L, Howell KA, Hullait R, Jaskowska A, Ottewell L, Thomas-Jones I, Vasudev A, Clements B, Fenton J, Gill M, Haider S, Lim AJM, Maguire H, McMullan J, Nicoletti J, Samuel S, Unais MA, White N, Yao PC, Yow L, Boyle C, Brady R, Cheekoty P, Cheong J, Chew SJHL, Chow R, Ganewatta Kankanamge D, Mamer L, Mohammed B, Ng Chieng Hin J, Renji Chungath R, Royston A, Sharrad E, Sinclair R, Tingle S, Treherne K, Wyatt F, Maniarasu VS, Moug S, Appanna T, Bucknall T, Hussain F, Owen A, Parry M, Parry R, Sagua N, Spofforth K, Yuen ECT, Bosley N, Hardie W, Moore T, Regas C, Abdel-Khaleq S, Ali N, Bashiti H, Buxton-Hopley R, Constantinides M, D'Afflitto M, Deshpande A, Duque Golding J, Frisira E, Germani Batacchi M, Gomaa A, Hay D, Hutchison R, Iakovou A, Iakovou D, Ismail E, Jefferson S, Jones L, Khouli Y, Knowles C, Mason J, McCaughan R, Moffatt J, Morawala A, Nadir H, Neyroud F, Nikookam Y, Parmar A, Pinto L, Ramamoorthy R, Richards E, Thomson S, Trainer C, Valetopoulou A, Vassiliou A, Wantman A, Wilde S, Dickinson M, Rockall T, Senn D, Wcislo K, Zalmay P, Adelekan K, Allen K, Bajaj M, Gatumbu P, Hang S, Hashmi Y, Kaur T, Kawesha A, Kisiel A, Woodmass M, Adelowo T, Ahari D, Alhwaishel K, Atherton R, Clayton B, Cockroft A, Curtis Lopez C, Hilton M, Ismail N, Kouadria M, Lee L, MacConnachie A, Monks F, Mungroo S, Nikoletopoulou C, Pearce L, Sara X, Shahid A, Suresh G, Wilcha R, Atiyah A, Davies E, Dermanis A, Gibbons H, Hyde A, Lawson A, Lee C, Leung-Tack M, Li Saw Hee J, Mostafa O, Nair D, Pattani N, Plumbley-Jones J, Pufal K, Ramesh P, Sanghera J, Saram S, Scadding S, See S, Stringer H, Torrance A, Vardon H, Wyn-Griffiths F, Brew A, Kaur G, Soni D, Tickle A, Akbar Z, Appleyard T, Figg K, Jayawardena P, Johnson A, Kamran Siddiqui Z, Lacy-Colson J, Oatham R, Rowlands B, Sludden E, Turnbull C, Allin D, Ansar Z, Azeez Z, Dale VH, Garg J, Horner A, Jones S, Knight S, McGregor C, McKenna J, McLelland T, Packham-Smith A, Rowsell K, Spector-Hill I, Adeniken E, Baker J, Bartlett M, Chikomba L, Connell B, Deekonda P, Dhar M, Elmansouri A, Gamage K, Goodhew R, Hanna P, Knight J, Luca A, Maasoumi N, Mahamoud F, Manji S, Marwaha PK, Mason F, Oluboyede A, Pigott L, Razaq AM, Richardson M, Saddaoui I, Wijeyendram P, Yau S, Atkins W, Liang K, Miles N, Praveen B, Ashai S, Braganza J, Common J, Cundy A, Davies R, Guthrie J, Handa I, Iqbal M, Ismail R, Jones C, Jones I, Lee KS, Levene A, Okocha M, Olivier J, Smith A, Subramaniam E, Tandle S, Wang A, Watson A, Wilson C, Chan XHF, Khoo E, Montgomery C, Norris M, Pugalenthi PP, Common T, Cook E, Mistry H, Shinmar HS, Agarwal G, Bandyopadhyay S, Brazier B, Carroll L, Goede A, Harbourne A, Lakhani A, Lami M, Larwood J, Martin J, Merchant J, Pattenden S, Pradhan A, Raafat N, Rothwell E, Shammoon Y, Sudarshan R, Vickers E, Wingfield L, Ashworth I, Azizi S, Bhate R, Chowdhury T, Christou A, Davies L, Dwaraknath M, Farah Y, Garner J, Gureviciute E, Hart E, Jain A, Javid S, Kankam HK, Kaur Toor P, Kaz R, Kermali M, Khan I, Mattson A, McManus A, Murphy M, Nair K, Ngemoh D, Norton E, Olabiran A, Parry L, Payne T, Pillai K, Price S, Punjabi K, Raghunathan A, Ramwell A, Raza M, Ritehnia J, Simpson G, Smith W, Sodeinde S, Studd L, Subramaniam M, Thomas J, Towey S, Tsang E, Tuteja D, Vasani J, Vio M, Badran A, Adams J, Anthony Wilkinson J, Asvandi S, Austin T, Bald A, Bix E, Carrick M, Chander B, Chowdhury S, Cooper Drake B, Crosbie S, D Portela S, Francis D, Gallagher C, Gillespie R, Gravett H, Gupta P, Ilyas C, James G, Johny J, Jones A, Kinder F, MacLeod C, Macrow C, Maqsood-Shah A, Mather J, McCann L, McMahon R, Mitham E, Mohamed M, Munton E, Nightingale K, O'Neill K, Onyemuchara I, Senior R, Shanahan A, Sherlock J, Spyridoulias A, Stavrou C, Stokes D, Tamang R, Taylor E, Trafford C, Uden C, Waddington C, Yassin D, Zaman M, Bangi S, Cheng T, Chew D, Hussain N, Imani-Masouleh S, Mahasivam G, McKnight G, Ng HL, Ota HC, Pasha T, Ravindran W, Shah K, Vishnu K S, Zaman S, Carr W, Cope S, Eagles EJ, Howarth-Maddison M, Li CY, Reed J, Ridge A, Stubbs T, Teasdaled D, Umar R, Worthington J, Dhebri A, Kalenderov R, Alattas A, Arain Z, Bhudia R, Chia D, Daniel S, Dar T, Garland H, Girish M, Hampson A, Kyriacou H, Lehovsky K, Mullins W, Omorphos N, Vasdev N, Venkatesh A, Waldock W, Bhandari A, Brown G, Choa G, Eichenauer CE, Ezennia K, Kidwai Z, Lloyd-Thomas A, Macaskill Stewart A, Massardi C, Sinclair E, Skajaa N, Smith M, Tan I, Afsheen N, Anuar A, Azam Z, Bhatia P, Davies-kelly N, Dickinson S, Elkawafi M, Ganapathy M, Gupta S, Khoury EG, Licudi D, Mehta V, Neequaye S, Nita G, Tay VL, Zhao S, Botsa E, Cuthbert H, Elliott J, Furlepa M, Lehmann J, Mangtani A, Narayan A, Nazarian S, Parmar C, Shah D, Shaw C, Zhao Z, Beck C, Caldwell S, Clements JM, French B, Kenny R, Kirk S, Lindsay J, McClung A, McLaughlin N, Watson S, Whiteside E, Alyacoubi S, Arumugam V, Beg R, Dawas K, Garg S, Lloyd ER, Mahfouz Y, Manobharath N, Moonesinghe R, Morka N, Patel K, Prashar J, Yip S, Adeeko ES, Ajekigbe F, Bhat A, Evans C, Farrugia A, Gurung C, Long T, Malik B, Manirajan S, Newport D, Rayer J, Ridha A, Ross E, Saran T, Sinker A, Waruingi D, Allen R, Al Sadek Y, Alves do Canto Brum H, Asharaf H, Ashman M, Balakumar V, Barrington J, Baskaran R, Berry A, Bhachoo H, Bilal A, Boaden L, Chia WL, Covell G, Crook D, Dadnam F, Davis L, De Berker H, Doyle C, Fox C, Gruffydd-Davies M, Hafouda Y, Hill A, Hubbard E, Hunter A, Inpadhas V, Jamshaid M, Jandu G, Jeyanthi M, Jones T, Kantor C, Kwak SY, Malik N, Matt R, McNulty P, Miles C, Mohomed A, Myat P, Niharika J, Nixon A, O'Reilly D, Parmar K, Pengelly S, Price L, Ramsden M, Turnor R, Wales E, Waring H, Wu M, Yang T, Ye TTS, Zander A, Zeicu C, Bellam S, Francombe J, Kawamoto N, Rahman MR, Sathyanarayana A, Tang HT, Cheung J, Hollingshead J, Page V, Sugarman J, Wong E, Chiong J, Fung E, Kan SY, Kiang J, Kok J, Krahelski O, Liew MY, Lyell B, Sharif Z, Speake D, Alim L, Amakye NY, Chandrasekaran J, Chandratreya N, Drake J, Owoso T, Thu YM, Abou El Ela Bourquin B, Alberts J, Chapman D, Rehnnuma N, Ainsworth K, Carpenter H, Emmanuel T, Fisher T, Gabrel M, Guan Z, Hollows S, Hotouras A, Ip Fung Chun N, Jaffer S, Kallikas G, Kennedy N, Lewinsohn B, Liu FY, Mohammed S, Rutherfurd A, Situ T, Stammer A, Taylor F, Thin N, Urgesi E, Zhang N, Ahmad MA, Bishop A, Bowes A, Dixit A, Glasson R, Hatta S, Hatt K, Larcombe S, Preece J, Riordan E, Fegredo D, Haq MZ, Li C, McCann G, Stewart D, Baraza W, Bhullar D, Burt G, Coyle J, Deans J, Devine A, Hird R, Ikotun O, Manchip G, Ross C, Storey L, Tan WWL, Tse C, Warner C, Whitehead M, Wu F, Court EL, Crisp E, Huttman M, Mayes F, Robertson H, Rosen H, Sandberg C, Smith H, Al Bakry M, Ashwell W, Bajaj S, Bandyopadhyay D, Browlee O, Burway S, Chand CP, Elsayeh K, Elsharkawi A, Evans E, Ferrin S, Fort-Schaale A, Iacob M, I K, Impelliziere Licastro G, Mankoo AS, Olaniyan T, Otun J, Pereira R, Reddy R, Saeed D, Simmonds O, Singhal G, Tron K, Wickstone C, Williams R, Bradshaw E, De Kock Jewell V, Houlden C, Knight C, Metezai H, Mirza-Davies A, Seymour Z, Spink D, Wischhusen S. Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study. Lancet Digit Health 2022; 4:e520-e531. [PMID: 35750401 DOI: 10.1016/s2589-7500(22)00069-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 01/07/2022] [Accepted: 04/06/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications. METHODS We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC). FINDINGS In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]). INTERPRETATION In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required. FUNDING British Journal of Surgery Society.
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Lamboley CR, Pearce L, Seng C, Meizoso-Huesca A, Singh DP, Frankish BP, Kaura V, Lo HP, Ferguson C, Allen PD, Hopkins PM, Parton RG, Murphy RM, van der Poel C, Barclay CJ, Launikonis BS. Ryanodine receptor leak triggers fiber Ca 2+ redistribution to preserve force and elevate basal metabolism in skeletal muscle. Sci Adv 2021; 7:eabi7166. [PMID: 34705503 PMCID: PMC8550231 DOI: 10.1126/sciadv.abi7166] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Muscle contraction depends on tightly regulated Ca2+ release. Aberrant Ca2+ leak through ryanodine receptor 1 (RyR1) on the sarcoplasmic reticulum (SR) membrane can lead to heatstroke and malignant hyperthermia (MH) susceptibility, as well as severe myopathy. However, the mechanism by which Ca2+ leak drives these pathologies is unknown. Here, we investigate the effects of four mouse genotypes with increasingly severe RyR1 leak in skeletal muscle fibers. We find that RyR1 Ca2+ leak initiates a cascade of events that cause precise redistribution of Ca2+ among the SR, cytoplasm, and mitochondria through altering the Ca2+ permeability of the transverse tubular system membrane. This redistribution of Ca2+ allows mice with moderate RyR1 leak to maintain normal function; however, severe RyR1 leak with RYR1 mutations reduces the capacity to generate force. Our results reveal the mechanism underlying force preservation, increased ATP metabolism, and susceptibility to MH in individuals with gain-of-function RYR1 mutations.
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Affiliation(s)
- Cedric R. Lamboley
- School of Biomedical Sciences, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Luke Pearce
- School of Biomedical Sciences, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Crystal Seng
- School of Biomedical Sciences, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Aldo Meizoso-Huesca
- School of Biomedical Sciences, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Daniel P. Singh
- School of Biomedical Sciences, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Barnaby P. Frankish
- Department of Biochemistry and Genetics, La Trobe Institute for Molecular Science, La Trobe University, Melbourne, VIC 3086, Australia
| | - Vikas Kaura
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - Harriet P. Lo
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia
| | - Charles Ferguson
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia
| | - Paul D. Allen
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | | | - Robert G. Parton
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia
- Centre for Microscopy and Microanalysis, The University of Queensland, Brisbane, QLD, Australia
| | - Robyn M. Murphy
- Department of Biochemistry and Genetics, La Trobe Institute for Molecular Science, La Trobe University, Melbourne, VIC 3086, Australia
- Department of Physiology Anatomy and Microbiology, La Trobe University, Melbourne, VIC 3086, Australia
| | - Chris van der Poel
- Department of Physiology Anatomy and Microbiology, La Trobe University, Melbourne, VIC 3086, Australia
| | - Christopher J. Barclay
- School of Biomedical Sciences, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Bradley S. Launikonis
- School of Biomedical Sciences, The University of Queensland, Brisbane, QLD 4072, Australia
- Corresponding author.
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Thomas M, Baltatzis M, Price A, Pearce L, Fox J, Vilches-Moraga A. 513 THE INFLUENCE OF FRAILTY ON OUTCOMES FOR OLDER ADULTS ADMITTED TO HOSPITAL WITH BENIGN BILIARY AND PANCREATIC DISEASE. Age Ageing 2021. [DOI: 10.1093/ageing/afab119.14] [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: 11/12/2022] Open
Abstract
Abstract
Introduction
The prevalence and complications of biliary disease increase with age. We describe the prevalence of frailty in older patients hospitalised with benign biliary and pancreatic disease and establish its association with mortality and duration of hospital stay.
Methods
Prospective observational cohort study of patients aged 75 years and over admitted with a diagnosis of acute biliary disease to a surgical hospital unit between 17/09/2014 and 20/03/2017. Clinical Frailty Scale (CFS) score was recorded on admission.
Results
We included 200 patients with a median age of 82 (75–99), 60% females, 89% lived in their homes, 154 (77%) were independent for personal and 99 (49.5%) for instrumental ADLs, 95% mobilised independently, 17.5% had memory impairment and 8% low mood. Acute cholecystitis was the most common diagnosis (43%) followed by acute cholangitis (36%) and acute pancreatitis (21%). 99 patients were non-frail (NF = CFS 1–4) and 101 were frail (F = CFS ≥5). 104 patients received medical treatment only. Surgery was more common in non-frail (F 2% vs. NF 11%), percutaneous drainage more frequently carried out in frail patients (15% vs. NF 5%) and endoscopic cholangiopancreatography (ERCP) was similar in both groups (F 32%vs. NF 31%). Frailty was associated with worse clinical outcomes in F vs. NF: functional deconditioning (34% vs. 11%), increased care level (19% vs 3%), length of stay (12 vs. 7 days), 90-day (8% vs. 3%) and 1 year-mortality (48% vs. 24%).
Conclusion
Half of patients in our cohort of older adults hospitalised with acute biliary disease were frail. Higher scores of frailty are associated with increased mortality. Compared with non-frail patients, individuals living with frailty were less likely to undergo surgical treatment, spent longer in hospital and were less likely to remain alive at 12 months after hospital discharge.
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Affiliation(s)
- M Thomas
- Department of General Surgery, Salford Royal Foundation Trust, Salford, United Kingdom
| | - M Baltatzis
- Department of General Surgery, Salford Royal Foundation Trust, Salford, United Kingdom
| | - A Price
- Geriatric Medicine Unit, Salford Royal Foundation Trust, Salford, United Kingdom
| | - L Pearce
- Department of General Surgery, Salford Royal Foundation Trust, Salford, United Kingdom
| | - J Fox
- Geriatric Medicine Unit, Salford Royal Foundation Trust, Salford, United Kingdom
| | - A Vilches-Moraga
- Geriatric Medicine Unit, Salford Royal Foundation Trust, Salford, United Kingdom
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11
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Thomas M, Cookson K, Clark R, Pearce L, Fox J, Price A. 472 A PILOT COLORECTAL AND GERIATRIC MEDICINE (CGM) CLINIC FOR OLDER, FRAIL PATIENTS REFERRED VIA A 2 WEEK WAIT PATHWAY. Age Ageing 2021. [DOI: 10.1093/ageing/afab116.08] [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
Introduction
The two week wait (2ww) colorectal referral pathway was introduced to expedite referrals where cancer is suspected, facilitating prompt diagnosis +/− intervention. Older frail patients are referred via this 2ww pathway even when invasive testing and intervention may not be appropriate. These patients may benefit more from holistic assessment than a universally surgical approach. A Colorectal and Geriatric Medicine (CGM) 2ww referral clinic was piloted, delivered by an urgent referral colorectal specialist nurse and an advanced clinical practitioner in geriatric medicine.
Method
Patients >65 years with a Clinical Frailty Scale (CFS) score of 5 or more at referral were directed to the CGM clinic. A telephone consultation was undertaken, incorporating both 2ww assessment and aspects of comprehensive geriatric assessment.
Results
42-patients were reviewed in the clinic. Mean age was 86.1 years and mean CFS 6. 12-patients underwent CT, and 2 CT virtual colonoscopy. No patients underwent endoscopic investigation and 28-patients declined any investigation. Of those who underwent investigation, no cancers were identified. 1 patient was referred on for endosocpic mucosal resection of polyps. 5-patients had severe diverticular disease, which accounted for their symptoms. Medication recommendations were made for 30-patients, some of which led to symptom cessation. Onward referrals were made to a community geriatrician, diabetes and continence teams, and palliative care specialists. 9-patients were identified as meeting criteria for advance care planning. This was commenced during the consultation and communicated back to the referring clinician for further action.
Conclusion
Older, frail patients are often not able, nor wish to undergo, invasive investigations but should not be disadvantaged or delayed in their pathway. Further work is needed to determine the most appropriate referral pathway for this group of patients. Holistic assessment that leads to improvement in symptoms and future planning may not be achievable through a solely surgical assessment.
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Affiliation(s)
- M Thomas
- Department of Colorectal Surgery; Department of Colorectal Surgery; Department of Colorectal Surgery, Department of Colorectal Surgery; Department of Colorectal Surgery; Department of Colorectal Surgery, Department of Colorectal Surgery; Department of Ageing and Complex Medicine; Department of Ageing and Complex Medicine; Salford Royal Foundation NHS Trust
| | - K Cookson
- Department of Colorectal Surgery; Department of Colorectal Surgery; Department of Colorectal Surgery, Department of Colorectal Surgery; Department of Colorectal Surgery; Department of Colorectal Surgery, Department of Colorectal Surgery; Department of Ageing and Complex Medicine; Department of Ageing and Complex Medicine; Salford Royal Foundation NHS Trust
| | - R Clark
- Department of Colorectal Surgery; Department of Colorectal Surgery; Department of Colorectal Surgery, Department of Colorectal Surgery; Department of Colorectal Surgery; Department of Colorectal Surgery, Department of Colorectal Surgery; Department of Ageing and Complex Medicine; Department of Ageing and Complex Medicine; Salford Royal Foundation NHS Trust
| | - L Pearce
- Department of Colorectal Surgery; Department of Colorectal Surgery; Department of Colorectal Surgery, Department of Colorectal Surgery; Department of Colorectal Surgery; Department of Colorectal Surgery, Department of Colorectal Surgery; Department of Ageing and Complex Medicine; Department of Ageing and Complex Medicine; Salford Royal Foundation NHS Trust
| | - J Fox
- Department of Colorectal Surgery; Department of Colorectal Surgery; Department of Colorectal Surgery, Department of Colorectal Surgery; Department of Colorectal Surgery; Department of Colorectal Surgery, Department of Colorectal Surgery; Department of Ageing and Complex Medicine; Department of Ageing and Complex Medicine; Salford Royal Foundation NHS Trust
| | - A Price
- Department of Colorectal Surgery; Department of Colorectal Surgery; Department of Colorectal Surgery, Department of Colorectal Surgery; Department of Colorectal Surgery; Department of Colorectal Surgery, Department of Colorectal Surgery; Department of Ageing and Complex Medicine; Department of Ageing and Complex Medicine; Salford Royal Foundation NHS Trust
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Vilches-Moraga A, Price A, Braude P, Pearce L, Short R, Verduri A, Stechman M, Collins JT, Mitchell E, Einarsson AG, Moug SJ, Quinn TJ, Stubbs B, McCarthy K, Myint PK, Hewitt J, Carter B. Increased care at discharge from COVID-19: The association between pre-admission frailty and increased care needs after hospital discharge; a multicentre European observational cohort study. BMC Med 2020; 18:408. [PMID: 33334341 PMCID: PMC7746415 DOI: 10.1186/s12916-020-01856-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 11/17/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has placed significant pressure on health and social care. Survivors of COVID-19 may be left with substantial functional deficits requiring ongoing care. We aimed to determine whether pre-admission frailty was associated with increased care needs at discharge for patients admitted to hospital with COVID-19. METHODS Patients were included if aged over 18 years old and admitted to hospital with COVID-19 between 27 February and 10 June 2020. The Clinical Frailty Scale (CFS) was used to assess pre-admission frailty status. Admission and discharge care levels were recorded. Data were analysed using a mixed-effects logistic regression adjusted for age, sex, smoking status, comorbidities, and admission CRP as a marker of severity of disease. RESULTS Thirteen hospitals included patients: 1671 patients were screened, and 840 were excluded including, 521 patients who died before discharge (31.1%). Of the 831 patients who were discharged, the median age was 71 years (IQR, 58-81 years) and 369 (44.4%) were women. The median length of hospital stay was 12 days (IQR 6-24). Using the CFS, 438 (47.0%) were living with frailty (≥ CFS 5), and 193 (23.2%) required an increase in the level of care provided. Multivariable analysis showed that frailty was associated with an increase in care needs compared to patients without frailty (CFS 1-3). The adjusted odds ratios (aOR) were as follows: CFS 4, 1.99 (0.97-4.11); CFS 5, 3.77 (1.94-7.32); CFS 6, 4.04 (2.09-7.82); CFS 7, 2.16 (1.12-4.20); and CFS 8, 3.19 (1.06-9.56). CONCLUSIONS Around a quarter of patients admitted with COVID-19 had increased care needs at discharge. Pre-admission frailty was strongly associated with the need for an increased level of care at discharge. Our results have implications for service planning and public health policy as well as a person's functional outcome, suggesting that frailty screening should be utilised for predictive modelling and early individualised discharge planning.
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Affiliation(s)
- A Vilches-Moraga
- Faculty of Medical and Human Services, University of Manchester, Manchester, England
- Salford Royal Hospital Foundation Trust, Salford, England
| | - A Price
- Salford Royal Hospital Foundation Trust, Salford, England
| | - P Braude
- North Bristol NHS Trust, Bristol, England
| | - L Pearce
- Faculty of Medical and Human Services, University of Manchester, Manchester, England
- Salford Royal Hospital Foundation Trust, Salford, England
| | - R Short
- Department of Biostatistics and Health Informatics, King's College London, London, England
| | - A Verduri
- University Hospital of Modena Policlinico, University of Modena and Reggio Emilia, Modena, Italy
| | - M Stechman
- University Hospital of Wales, Cardiff University, Cardiff, Wales
| | - J T Collins
- Ysbyty Ystrad Fawr, Aneurin Bevan University Health Board, Newport, Wales
| | - E Mitchell
- North Bristol NHS Trust, Bristol, England
| | | | - S J Moug
- Royal Alexandra Hospital, Paisley, Scotland
| | - T J Quinn
- Glasgow Royal Infirmary, Glasgow, Scotland
| | - B Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London, UK
| | - K McCarthy
- North Bristol NHS Trust, Bristol, England
| | - P K Myint
- University of Aberdeen, Aberdeen, Scotland
| | - J Hewitt
- Aneurin Bevan Health Board, Cardiff University, Cardiff, Wales
| | - B Carter
- Department of Biostatistics and Health Informatics, King's College London, London, England.
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McCarthy K, Myint PK, Moug S, Pearce L, Braude P, Vilches-Moraga A, Hewitt J, Carter B. Resumption of elective colorectal surgery during COVID-19 and risk of death. Colorectal Dis 2020; 22:1026-1027. [PMID: 32726872 DOI: 10.1111/codi.15282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 07/17/2020] [Indexed: 02/08/2023]
Affiliation(s)
- K McCarthy
- Department of General Surgery, North Bristol NHS Trust, Bristol, UK
| | - P K Myint
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - S Moug
- General Surgery, Royal Alexandra Hospital, Paisley, UK
| | - L Pearce
- General Surgery, Salford Royal NHS Foundation Trust, Salford, UK
| | - P Braude
- Geriatric Medicine, North Bristol NHS Trust, Bristol, UK
| | - A Vilches-Moraga
- Ageing and Complex Medicine Department, Salford Royal NHS Foundation Trust, Salford, UK
| | - J Hewitt
- Geriatric Medicine, Cardiff University, Cardiff, UK
| | - B Carter
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, King's College London, London, UK
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Carter B, Collins JT, Barlow-Pay F, Rickard F, Bruce E, Verduri A, Quinn TJ, Mitchell E, Price A, Vilches-Moraga A, Stechman MJ, Short R, Einarsson A, Braude P, Moug S, Myint PK, Hewitt J, Pearce L, McCarthy K. Nosocomial COVID-19 infection: examining the risk of mortality. The COPE-Nosocomial Study (COVID in Older PEople). J Hosp Infect 2020; 106:376-384. [PMID: 32702463 PMCID: PMC7372282 DOI: 10.1016/j.jhin.2020.07.013] [Citation(s) in RCA: 112] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 07/13/2020] [Indexed: 01/08/2023]
Abstract
Background Hospital admissions for non-coronavirus disease 2019 (COVID-19) pathology have decreased significantly. It is believed that this may be due to public anxiety about acquiring COVID-19 infection in hospital and the subsequent risk of mortality. Aim To identify patients who acquire COVID-19 in hospital (nosocomial COVID-19 infection (NC)) and their risk of mortality compared to those with community-acquired COVID-19 (CAC) infection. Methods The COPE-Nosocomial Study was an observational cohort study. The primary outcome was the time to all-cause mortality (estimated with an adjusted hazard ratio (aHR)), and secondary outcomes were day 7 mortality and the time-to-discharge. A mixed-effects multivariable Cox's proportional hazards model was used, adjusted for demographics and comorbidities. Findings The study included 1564 patients from 10 hospital sites throughout the UK, and one in Italy, and collected outcomes on patients admitted up to April 28th, 2020. In all, 12.5% of COVID-19 infections were acquired in hospital; 425 (27.2%) patients with COVID died. The median survival time in NC patients was 14 days compared with 10 days in CAC patients. In the primary analysis, NC infection was associated with lower mortality rate (aHR: 0.71; 95% confidence interval (CI): 0.51–0.98). Secondary outcomes found no difference in day 7 mortality (adjusted odds ratio: 0.79; 95% CI: 0.47–1.31), but NC patients required longer time in hospital during convalescence (aHR: 0.49, 95% CI: 0.37–0.66). Conclusion The minority of COVID-19 cases were the result of NC transmission. No COVID-19 infection comes without risk, but patients with NC had a lower risk of mortality compared to CAC infection; however, caution should be taken when interpreting this finding.
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Affiliation(s)
- B Carter
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - J T Collins
- Department of Geriatric Medicine, Ysbyty Ystrad Fawr, Aneurin Bevan University Health Board, Cardiff, UK
| | | | - F Rickard
- North Bristol NHS Trust, Bristol, UK
| | - E Bruce
- Institute of Applied Health Sciences, University of Aberdeen, UK
| | - A Verduri
- Hospital of Modena Policlinico, Modena, Italy
| | - T J Quinn
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - E Mitchell
- Department of Geriatric Medicine, North Bristol NHS Trust, Bristol, UK
| | - A Price
- Salford Royal NHS Trust, Salford, UK
| | - A Vilches-Moraga
- Department of Ageing and Complex Medicine, Salford Royal NHS Foundation Trust, Salford, UK
| | - M J Stechman
- Department of Surgery, University Hospital of Wales, Cardiff, UK
| | - R Short
- Forensic & Neurodevelopmental Sciences, King's College London, London, UK
| | | | - P Braude
- Department of Geriatric Medicine, North Bristol NHS Trust, Bristol, UK
| | - S Moug
- Department of Surgery, Royal Alexandra Hospital, Paisley, UK
| | - P K Myint
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - J Hewitt
- Aneurin Bevan University Health Board, Cardiff, UK; Cardiff University, Cardiff, UK.
| | - L Pearce
- Department of Colorectal Surgery, Salford Royal NHS Foundation Trust, Manchester, UK
| | - K McCarthy
- Department of Surgery, North Bristol NHS Trust, Bristol, UK
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Lamboley CR, Pearce L, Launikonis BS. Total Calcium Content of Sarcoplasmic Reticulum and Mitochondria in Ryanodine Receptor Variant Muscle. Biophys J 2020. [DOI: 10.1016/j.bpj.2019.11.698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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16
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Carter B, Law J, Hewitt J, Parmar KL, Boyle JM, Casey P, Maitra I, Pearce L, Moug SJ, Ross B, Oleksiewicz J, Fearnhead N, Jump C, Boyle J, Shaw A, Barker J, Hughes J, Randall J, Tonga I, Kynaston J, Boal M, Eardley N, Kane E, Reader H, Mahapatra SR, Garner-Jones M, Tan JJ, Mohamed S, George R, Whiteman E, Malik K, Smart CJ, Bogdan M, Chaudhury MP, Sharma V, Subar D, Patel P, Chok SM, Lim E, Adhiyaman V, Davies G, Ross E, Maitra R, Steele CW, Roxburgh C, Griffiths S, Blencowe NS, Kirkham EN, Abraham JS, Griffiths K, Abdulaal Y, Iqbal MR, Tarazi M, Hill J, Khan A, Farrell I, Conn G, Patel J, Reddy H, Sarveswaran J, Arunachalam L, Malik A, Ponchietti L, Pawelec K, Goh YM, Vitish-Sharma P, Saad A, Smyth E, Crees A, Merker L, Bashir N, Williams G, Hayes J, Walters K, Harries R, Singh R, Henderson NA, Polignano FM, Knight B, Alder L, Kenchington A, Goh YL, Dicurzio I, Griffiths E, Alani A, Knight K, MacGoey P, Ng GS, Mackenzie N, Maitra I, Moug S, Ong K, McGrath D, Gammeri E, Lafaurie G, Faulkner G, Di Benedetto G, McGovern J, Subramanian B, Narang SK, Nowers J, Smart NJ, Daniels IR, Varcada M, Gala T, Cornish J, Barber Z, O'Neill S, McGregor R, Robertson AG, Paterson-Brown S, Raymond T, Thaha MA, English WJ, Forde CT, Paine H, Morawala A, Date R, Casey P, Bolton T, Gleaves X, Fasuyi J, Durakovic S, Dunstan M, Allen S, Riga A, Epstein J, Pearce L, Gaines E, Howe A, Choonara H, Dewi F, Bennett J, King E, McCarthy K, Taylor G, Harris D, Nageswaran H, Stimpson A, Siddiqui K, Lim LI, Ray C, Smith L, McColl G, Rahman M, Kler A, Sharma A, Parmar K, Patel N, Crofts P, Baldari C, Thomas R, Stechman M, Aldridge R, O'Kelly J, Wilson G, Gallegos N, Kalaiselvan R, Rajaganeshan R, Mackenzie A, Naik P, Singh K, Gandraspulli H, Wilson J, Hancorn K, Khawaja A, Nicholas F, Marks T, Abbott C, Chandler S. Association between preadmission frailty and care level at discharge in older adults undergoing emergency laparotomy. Br J Surg 2020; 107:218-226. [DOI: 10.1002/bjs.11392] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 07/20/2019] [Accepted: 09/12/2019] [Indexed: 12/14/2022]
Abstract
Abstract
Background
Older adults undergoing emergency abdominal surgery have significantly poorer outcomes than younger adults. For those who survive, the level of care required on discharge from hospital is unknown and such information could guide decision-making. The ELF (Emergency Laparotomy and Frailty) study aimed to determine whether preoperative frailty in older adults was associated with increased dependence at the time of discharge.
Methods
The ELF study was a UK-wide multicentre prospective cohort study of older patients (65 years or more) undergoing emergency laparotomy during March and June 2017. The objective was to establish whether preoperative frailty was associated with increased care level at discharge compared with preoperative care level. The analysis used a multilevel logistic regression adjusted for preadmission frailty, patient age, sex and care level.
Results
A total of 934 patients were included from 49 hospitals. Mean(s.d.) age was 76·2(6·8) years, with 57·6 per cent women; 20·2 per cent were frail. Some 37·4 per cent of older adults had an increased care level at discharge. Increasing frailty was associated with increased discharge care level, with greater predictive power than age. The adjusted odds ratio for an increase in care level was 4·48 (95 per cent c.i. 2·03 to 9·91) for apparently vulnerable patients (Clinical Frailty Score (CFS) 4), 5·94 (2·54 to 13·90) for those mildly frail (CFS 5) and 7·88 (2·97 to 20·79) for those moderately or severely frail (CFS 6 or 7), compared with patients who were fit.
Conclusion
Over 37 per cent of older adults undergoing emergency laparotomy required increased care at discharge. Frailty scoring was a significant predictor, and should be integrated into all acute surgical units to aid shared decision-making and discharge planning.
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Affiliation(s)
- B Carter
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - J Law
- Department of Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
- Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - J Hewitt
- Department of Population Medicine, Cardiff University, Cardiff, UK
| | - K L Parmar
- Manchester Cancer Research Centre, Manchester, NorthWest Deanery, UK
| | - J M Boyle
- Royal College of Surgeons of England, London, UK
| | - P Casey
- Health Education North West, Manchester, NorthWest Deanery, UK
| | - I Maitra
- Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - L Pearce
- Department of Surgery, Salford Royal NHS Foundation Trust, Salford, UK
| | - S J Moug
- Department of Surgery, Royal Alexandra Hospital, Paisley, UK
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Salter RS, Fitchen J, Bain B, Bella M, Bergman S, Biotelle AC, Bulthaus M, Butterworth F, Collins P, Davag R, Farrington D, Gaunt W, Greenwood M, Hickey B, High E, Irvine F, Lupi L, Martin G, Maturin L, Mode G, Nicholas M, O'Grady F, Pearce L, Reddy R, Robertson R, Schwartz J, Shelley S. Evaluation of a Chemiluminescence Method for Measuring Alkaline Phosphatase Activity in WholeMilk of Multiple Species and Bovine Dairy Drinks: Interlaboratory Study. J AOAC Int 2019. [DOI: 10.1093/jaoac/89.4.1061] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Alkaline phosphatase (ALP) is a ubiquitous enzyme in milk with timetemperature destruction similar to that of certain pathogens destroyed in pasteurization. Measurement of ALP to indicate proper pasteurization is a common practice. Recently the public health level for ALP was decreased to 350 mU/L, a level below the sensitivity of older colorimetric ALP methods. This study was conducted within the structure of the International Dairy Federation and the International Organization for Standardization to evaluate the reproducibility of the chemiluminescence method (Charm PasLite) for ALP at 50, 100, 350, and 500 mU/L in whole milk of multiple species to meet new regulations in the United States and proposed regulations in the European Union (EU). Fifteen laboratories from 8 countries evaluated bovine, goat, sheep, and buffalo milk, bovine skim milk, 20% fat cream, and 2% fat chocolate milk. At ALP levels of 350 and 500 mU/L, the average relative standard deviation for repeatability (RSDr) was 7.5%, and the average relative standard deviation of reproducibility was (RSDR) 15%. For ALP at 100 and 50 mU/L, the average RSDr values were 10.5 and 12.6%, respectively, and the average RSDR values were 18 and 25%, respectively. The limit of detection was 20 mU/L. Results are comparable to those obtained with other enzymatic photo-activated system methods such as the fluorometric method. Results indicate that the method is suitable for measuring ALP in the milk of multiple species and in dairy drinks at U.S. and proposed EU levels.
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Affiliation(s)
| | - John Fitchen
- Charm Sciences Inc., 659 Andover St, Lawrence, MA 01843
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18
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Parmar KL, Law J, Carter B, Hewitt J, Boyle JM, Casey P, Maitra I, Farrell I, Pearce L, Moug SJ. 98FRAILTY IN OLDER PATIENTS UNDERGOING EMERGENCY LAPAROTOMY: FURTHER RESULTS FROM THE ELF STUDY (EMERGENCY LAPAROTOMY AND FRAILTY). Age Ageing 2019. [DOI: 10.1093/ageing/afz063.07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | | | | | - S J Moug
- Royal Alexandra Hospital, Paisley
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Dancy L, Bromage D, Nabeebaccus A, O"gallagher K, Le K, Pearce L, Millin A, Kellman P, Gordon P, Sado D. P170A prospective longitudinal follow up study using T1 and T2 mapping sequences and twelve-segment myocardial assessment to identify and monitor myocardial inflammation in myositis. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez117.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- L Dancy
- Kings College London, London, United Kingdom of Great Britain & Northern Ireland
| | - D Bromage
- Kings College London, London, United Kingdom of Great Britain & Northern Ireland
| | - A Nabeebaccus
- Kings College London, London, United Kingdom of Great Britain & Northern Ireland
| | - K O"gallagher
- Kings College London, London, United Kingdom of Great Britain & Northern Ireland
| | - K Le
- Kings College Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - L Pearce
- Kings College Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - A Millin
- Kings College Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - P Kellman
- National Institute of Health (Home), Washington, United States of America
| | - P Gordon
- Kings College London, London, United Kingdom of Great Britain & Northern Ireland
| | - D Sado
- Kings College London, London, United Kingdom of Great Britain & Northern Ireland
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Pearce L, Dancy L, Le K, Bromage D, Nabeebaccus A, Harrison J, Sado D. P455Diagnostic applications of cardiac magnetic resonance with T1/2 tissue mapping in acute myocarditis patients at a London tertiary centre. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez118.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- L Pearce
- Kings College Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - L Dancy
- Kings College Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - K Le
- Kings College Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - D Bromage
- Kings College Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - A Nabeebaccus
- Kings College Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - J Harrison
- Kings College Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - D Sado
- Kings College Hospital, London, United Kingdom of Great Britain & Northern Ireland
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Hewitt J, Carter B, McCarthy K, Pearce L, Law J, Wilson FV, Tay HS, McCormack C, Stechman MJ, Moug SJ, Myint PK. Frailty predicts mortality in all emergency surgical admissions regardless of age. An observational study. Age Ageing 2019; 48:388-394. [PMID: 30778528 DOI: 10.1093/ageing/afy217] [Citation(s) in RCA: 97] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 10/09/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND frail patients in any age group are more likely to die than those that are not frail. We aimed to evaluate the impact of frailty on clinical mortality, readmission rate and length of stay for emergency surgical patients of all ages. METHODS a multi-centre prospective cohort study was conducted on adult admissions to acute surgical units. Every patient presenting as a surgical emergency to secondary care, regardless of whether they ultimately underwent a surgical procedure was included. The study was carried out during 2015 and 2016.Frailty was defined using the 7-point Clinical Frailty Scale. The primary outcome was mortality at Day 90. Secondary outcomes included: mortality at Day 30, length of stay and readmission within a Day 30 period. RESULTS the cohort included 2,279 patients (median age 54 years [IQR 36-72]; 56% female). Frailty was documented in patients of all ages: 1% in the under 40's to 45% of those aged 80+. We found that each incremental step of worsening frailty was associated with an 80% increase in mortality at Day 90 (OR 1.80, 95% CI: 1.61-2.01) supporting a linear dose-response relationship. In addition, the most frail patients were increasingly likely to stay in hospital longer, be readmitted within 30 days, and die within 30 days. CONCLUSIONS worsening frailty at any age is associated with significantly poorer patient outcomes, including mortality in unselected acute surgical admissions. Assessment of frailty should be integrated into emergency surgical practice to allow prognostication and implementation of strategies to improve outcomes.
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Affiliation(s)
- J Hewitt
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - B Carter
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - K McCarthy
- Department of General Surgery, North Bristol NHS Trust, Bristol, UK
| | - L Pearce
- Department of General Surgery, Manchester Royal Infirmary, Manchester, UK
| | - J Law
- Department of General Surgery, Blackpool Victoria Infirmary, Blackpool, UK
| | - F V Wilson
- Department of Geriatric Medicine, Sunderland Royal Hospital, Sunderland, UK
| | - H S Tay
- Department of Geriatric Medicine Aberdeen Royal Infirmary, Aberdeen, UK
| | - C McCormack
- Department of Geriatric Medicine Aberdeen Royal Infirmary, Aberdeen, UK
| | - M J Stechman
- Department of General Surgery, University Hospital of Wales, Cardiff, UK
| | - S J Moug
- Department of General Surgery, Royal Alexandra Hospital, Paisley, Greater Glasgow, UK
| | - P K Myint
- Ageing Clinical & Experimental Research (ACER) Team, Institute of Applied Health Research, University of Aberdeen, Aberdeen, UK
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22
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Ablett AD, McCarthy K, Carter B, Pearce L, Stechman M, Moug S, Ceelen W, Hewitt J, Myint PK. A practical risk scale for predicting morbidity and mortality in the emergency general surgical setting: A prospective multi-center study. Int J Surg 2018; 60:236-244. [PMID: 30481611 DOI: 10.1016/j.ijsu.2018.11.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 10/30/2018] [Accepted: 11/19/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Low albumin is a prognostic factor associated with poor surgical outcomes. We aimed to examine the predicative ability of easily obtainable point-of-care variables in combination, to derive a practical risk scale for predicting older adults at risk of poor outcomes on admission to the emergency general surgical setting. METHODS This is an international multi-center prospective cohort study conducted as part of the Older Persons Surgical Outcomes Collaboration (www.OPSOC.eu). The effect of having hypoalbuminemia (defined as albumin ≤3.5 g/dL) on selected outcomes was examined using fully adjusted multivariable models. In a subgroup of patients with hypoalbuminemia, we observed four risk characteristics (Male, Anemia, Low albumin, Eighty-five and over [MALE]). Subsequently, the impact of incremental increase in MALE score (each characteristic scoring 1 point (maximum score 4) on measured outcomes was assessed. RESULTS The cohort consisted of 1406 older patients with median (IQR) age of 76 (70-83) years. In fully adjusted models, hypoalbuminemia was significantly associated with undergoing emergency surgery (1.32 (95%CI 1.03-1.70); p = 0.03), 30-day mortality (4.23 (2.22-8.08); p < 0.001), 90-day mortality (3.36 (2.14-5.28); p < 0.001) (primary outcome), and increased hospital length of stay, irrespective of whether a patient received emergency surgical intervention. Every point increase in MALE score was associated with higher odds of mortality, with a MALE score of 4 being associated with 30-day mortality (adjusted OR(95% CI) = 33.38 (3.86-288.7); p = 0.001) and 90-day mortality (11.37 (3.85-33.59); p < 0.001) compared to the reference category of those with MALE score 0. CONCLUSIONS The easy to use and practical MALE risk score calculated at point of care identifies older adults at a greater risk of poor outcomes, thereby allowing clinicians to prioritize patients who may benefit from early comprehensive geriatric assessment in the emergency general surgical setting.
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Affiliation(s)
- A D Ablett
- Institute of Applied Health Sciences, University of Aberdeen & Aberdeen Royal Infirmary, NHS Grampian, United Kingdom
| | - K McCarthy
- Department of General Surgery, King's College London, United Kingdom
| | - B Carter
- Department of Biostatistics and Health Informatics, Institute of Psychology Psychiatry and Neuroscience, King's College London, United Kingdom
| | - L Pearce
- Department of General Surgery, Manchester Royal Infirmary, United Kingdom
| | - M Stechman
- Department of General Surgery, University Hospital of Wales, United Kingdom
| | - S Moug
- Department of General Surgery, Royal Alexandra Hospital, Paisley, United Kingdom
| | - W Ceelen
- Department of GI Surgery, University Hospital, Ghent, Belgium
| | - J Hewitt
- Department of Population Medicine, Cardiff University, United Kingdom
| | - P K Myint
- Institute of Applied Health Sciences, University of Aberdeen & Aberdeen Royal Infirmary, NHS Grampian, United Kingdom.
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Vilches-Moraga A, Fox J, Paracha A, Gomez-Quintanilla A, Epstein J, Pearce L. Predicting in-hospital mortality in older general surgical patients. Ann R Coll Surg Engl 2018; 100:529-533. [PMID: 29909664 DOI: 10.1308/rcsann.2018.0086] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Introduction A significant number of emergency general surgical admissions occur in older patients. Clinical decision making in this group is challenging and current risk prediction tools extrapolate data from cohorts of younger patients. This is the first UK study to examine risk factors predicting in-hospital mortality in older acute surgical patients undergoing comprehensive geriatric assessment. Methods This was a prospective study of consecutive patients aged ≥75 years admitted non-electively to general surgery wards between September 2014 and February 2017 who were reviewed by an elderly medicine in-reach service. Results A total of 577 patients were included with a mean age of 82.9 years. There was a female predominance (56%). The majority were living at home alone or with carers (93%) and most were independent in basic activities of daily living (79%). Over two-thirds (69%) were mobile with no walking aids or use of a walking stick and overt here-quarters (79%) had no cognitive impairment. Seventy-seven per cent of patients were managed non-operatively. The in-hospital mortality rate was 6.9%. Female sex (p=0.031), dependence in activities of daily living (p<0.001), cognitive impairment (p<0.001) and incontinence (p<0.001) were predictors of in-hospital mortality. ASA (American Society of Anesthesiologists) grade ≥3 was also associated with increased in-hospital mortality (odds ratio: 5.3, 95% confidence interval: 2.6-10.7). Conclusions Older general surgical patients present a high level of complexity. This study highlights the predictive role of mobility, functional and cognitive impairment when assessing this population. Accurate risk stratification requires global assessment by teams experienced in care of the older patient rather than the traditional focus on co-morbidities.
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Affiliation(s)
| | - J Fox
- Salford Royal NHS Foundation Trust , UK
| | - A Paracha
- Salford Royal NHS Foundation Trust , UK
| | | | - J Epstein
- Salford Royal NHS Foundation Trust , UK
| | - L Pearce
- Salford Royal NHS Foundation Trust , UK
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Manchanda R, Legood R, Antoniou AC, Pearce L, Menon U. Commentary on changing the risk threshold for surgical prevention of ovarian cancer. BJOG 2018; 125:541-544. [PMID: 28548227 DOI: 10.1111/1471-0528.14763] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2017] [Indexed: 12/12/2022]
Affiliation(s)
- R Manchanda
- Barts Cancer Institute, Queen Mary University of London, London, UK
- Department of Gynaecological Oncology, St Bartholomew's Hospital, London, UK
- Department of Women's Cancer, Gynaecological Cancer Research Centre, Institute for Women's Health, University College London, London, UK
| | - R Legood
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - A C Antoniou
- Strangeways Research Laboratory, Department of Public Health and Primary Care, Centre for Cancer Genetic Epidemiology, University of Cambridge, Cambridge, UK
| | - L Pearce
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
- Department of Preventive Medicine, USC Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - U Menon
- Department of Women's Cancer, Gynaecological Cancer Research Centre, Institute for Women's Health, University College London, London, UK
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Simons R, White S, Topen S, Snell L, Murphy C, Collins R, Davies J, Owen A, Barker J, Green L, Patel I, Ridgway J, Lenchner J, Faerber J, Pearce L, Meanwell H, Kominek N, Janik L, Best H, Stevens T, Hubbard G, Stratton R. A survey of bolus feeding practices in the UK home enteral feeding population. Clin Nutr ESPEN 2017. [DOI: 10.1016/j.clnesp.2017.07.019] [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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Sugrue M, Maier R, Moore EE, Boermeester M, Catena F, Coccolini F, Leppaniemi A, Peitzman A, Velmahos G, Ansaloni L, Abu-Zidan F, Balfe P, Bendinelli C, Biffl W, Bowyer M, DeMoya M, De Waele J, Di Saverio S, Drake A, Fraga GP, Hallal A, Henry C, Hodgetts T, Hsee L, Huddart S, Kirkpatrick AW, Kluger Y, Lawler L, Malangoni MA, Malbrain M, MacMahon P, Mealy K, O'Kane M, Loughlin P, Paduraru M, Pearce L, Pereira BM, Priyantha A, Sartelli M, Soreide K, Steele C, Thomas S, Vincent JL, Woods L. Proceedings of resources for optimal care of acute care and emergency surgery consensus summit Donegal Ireland. World J Emerg Surg 2017; 12:47. [PMID: 29075316 PMCID: PMC5651635 DOI: 10.1186/s13017-017-0158-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 10/13/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Opportunities to improve emergency surgery outcomes exist through guided better practice and reduced variability. Few attempts have been made to define optimal care in emergency surgery, and few clinically derived key performance indicators (KPIs) have been published. A summit was therefore convened to look at resources for optimal care of emergency surgery. The aim of the Donegal Summit was to set a platform in place to develop guidelines and KPIs in emergency surgery. METHODS The project had multidisciplinary global involvement in producing consensus statements regarding emergency surgery care in key areas, and to assess feasibility of producing KPIs that could be used to monitor process and outcome of care in the future. RESULTS Forty-four key opinion leaders in emergency surgery, across 7 disciplines from 17 countries, composed evidence-based position papers on 14 key areas of emergency surgery and 112 KPIs in 20 acute conditions or emergency systems. CONCLUSIONS The summit was successful in achieving position papers and KPIs in emergency surgery. While position papers were limited by non-graded evidence and non-validated KPIs, the process set a foundation for the future advancement of emergency surgery.
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Affiliation(s)
- M Sugrue
- Department of Surgery, Letterkenny University Hospital and Donegal Clinical Research Academy, Donegal, Ireland
| | - R Maier
- Department of Surgery, University of Washington, Seattle, USA.,Harborview Medical Center, Seattle, USA
| | | | - M Boermeester
- Department of Surgery, Academic Medical Center, Amsterdam, Netherlands
| | - F Catena
- Department of Emergency Surgery, Maggiore Hospital, Parma, Italy
| | - F Coccolini
- Department of Emergency, General and Transplant Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - A Leppaniemi
- Abdominal Center, University Hospital Meilahti, Helsinki, Finland
| | - A Peitzman
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA USA
| | - G Velmahos
- Department of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, MA USA
| | - L Ansaloni
- General Surgery Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - F Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
| | - P Balfe
- Department of Surgery, St. Luke's Hospital, Kilkenny, Ireland
| | - C Bendinelli
- Department of Surgery, John Hunter Hospital, Newcastle, NSW Australia
| | - W Biffl
- Acute Care Surgery, The Queens Medical Center, Honolulu, HI USA
| | - M Bowyer
- Department of Surgery, Uniformed Services University and Walter Reed National Military Medical Center, Bethesda, MD USA
| | - M DeMoya
- Department of Trauma/Critical Care, Massachusetts General Hospital, Boston, MA USA
| | - J De Waele
- Department of Critical Care Medicine, Ghent University Hospital, Ghent, Belgium
| | - S Di Saverio
- Maggiore Hospital of Bologna, AUSL, Bologna, Italy
| | - A Drake
- Letterkenny University Hospital and Donegal Clinical Research Academy, Donegal, Ireland
| | - G P Fraga
- Division of Trauma Surgery, Department of Surgery, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - A Hallal
- Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - C Henry
- National Clinical Advisor for the Acute Hospitals Division, Health Service Executive, Dublin, Ireland
| | - T Hodgetts
- Trauma Governance, UK Defence Medical Services, Lichfield, UK
| | - L Hsee
- Department of Trauma and Acute Care Surgery, Auckland City Hospital, Auckland, New Zealand
| | - S Huddart
- Department of Anaesthesiology, Royal Surrey County Hospital, Guildford, UK
| | - A W Kirkpatrick
- Department of Surgery, Critical Care Medicine and Regional Trauma Service, Foothills Medical Centre, Calgary, AB Canada
| | - Y Kluger
- Department of General Surgery, Division of Surgery, Rambam Health Care Campus, Haifa, Israel
| | - L Lawler
- Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | | | - M Malbrain
- Intensive Care Unit and High Burn Unit, ZNA "Ziekenhuis Netwerk Antwerpen" Stuivenberg and ZNA St-Erasmus hospitals, Antwerp, Belgium
| | - P MacMahon
- Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - K Mealy
- Department of Surgery, Wexford University Hospital, Wexford, Ireland
| | - M O'Kane
- Department of Pathology, Altnagelvin Hospital, Londonderry, UK
| | - P Loughlin
- Department of Surgery, Altnagelvin Hospital, Londonderry, UK
| | - M Paduraru
- Department of General and Emergency Surgery, Milton Keys, UK
| | - L Pearce
- Northwest Research Collaborative, Manchester, UK
| | - B M Pereira
- Division of Trauma Surgery, Department of Surgery, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - A Priyantha
- Department of Gastroenterology, Teaching Hospital, South, Colombo, Sri Lanka
| | - M Sartelli
- Department of Surgery, Macerata Hospital, Macerata, Italy
| | - K Soreide
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
| | - C Steele
- Department of Gastroenterology, Letterkenny University Hospital and Donegal Clinical Research Academy, Donegal, Ireland
| | - S Thomas
- Department of Trauma Services, Memorial Hospital of South Bend, Indiana, USA
| | - J L Vincent
- Department of Intensive Care, Erasme Hospital, Université libre de bruxelles, Brussels, Belgium
| | - L Woods
- Department of Acute Hospitals, Health Services Executive, Dublin, Ireland
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Evans L, Goeteyn J, Carter B, Greig M, Tay H, McCormack C, Ceelen W, Pearce L, McCarthy K, Myint P, Moug S, Stechman M, Hewitt J. Preoperative kidney function linked to mortality and readmission outcomes at Day 90 and 30 in older emergency surgical patients. Eur Geriatr Med 2017. [DOI: 10.1016/j.eurger.2017.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Tay HS, Wood AD, Hewitt J, Pearce L, Moug SJ, McCarthy K, Stechman MJ, Myint PK. 39DO OLDER SURGICAL PATIENTS WHO UNDERGO EMERGENCY OPERATION HAVE HIGHER MORTALITY AND LONGER LENGTH OF HOSPITALISATION COMPARED TO THOSE MANAGED CONSERVATIVELY? Age Ageing 2017. [DOI: 10.1093/ageing/afx055.39] [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: 11/14/2022] Open
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Yiannoullou P, Hall C, Newton K, Pearce L, Bouamra O, Jenks T, Scrimshire AB, Hughes J, Lecky F, Macdonald A. A review of the management of blunt splenic trauma in England and Wales: have regional trauma networks influenced management strategies and outcomes? Ann R Coll Surg Engl 2017; 99:63-69. [PMID: 27791418 PMCID: PMC5392813 DOI: 10.1308/rcsann.2016.0325] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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] [Accepted: 09/11/2016] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION The spleen remains one of the most frequently injured organs following blunt abdominal trauma. In 2012, regional trauma networks were launched across England and Wales with the aim of improving outcomes following trauma. This retrospective cohort study investigated the management and outcomes of blunt splenic injuries before and after the establishment of regional trauma networks. METHODS A dataset was drawn from the Trauma Audit Research Network database of all splenic injuries admitted to English and Welsh hospitals from 1 April 2010 to 31 March 2014. Demographic data, injury severity, treatment modalities and outcomes were collected. Management and outcomes were compared before and after the launch of regional trauma networks. RESULTS There were 1457 blunt splenic injuries: 575 between 2010 and 2012 and 882 in 2012-14. Following the introduction of the regional trauma networks, use of splenic artery embolotherapy increased from 3.5% to 7.6% (P = 0.001) and splenectomy rates decreased from 20% to 14.85% (P = 0.012). Significantly more patients with polytrauma and blunt splenic injury were treated with splenic embolotherapy following 2012 (61.2% vs. 30%, P < 0.0001). Increasing age, injury severity score, polytrauma and Charlson Comorbidity Index above 10 were predictors of increased mortality (P < 0.001). Increasing systolic blood pressure (odds ratio, OR, 0.757, 95% confidence interval, CI, 0.716-0.8) and Glasgow Coma Scale (OR 0.988, 95% CI 0.982-0.995) were protective. CONCLUSIONS This study demonstrates a reduction in splenectomy rate and an increased use of splenic artery embolotherapy since the introduction of the regional trauma networks. This may have resulted from improved access to specialist services and reduced practice variation since the establishment of these networks.
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Affiliation(s)
- P Yiannoullou
- Department of General Surgery, Central Manchester University Hospitals NHS Foundation Trust , Manchester , UK
- North West Research Collaborative , Manchester , UK
| | - C Hall
- Department of General Surgery, Central Manchester University Hospitals NHS Foundation Trust , Manchester , UK
- North West Research Collaborative , Manchester , UK
| | - K Newton
- Department of General Surgery, Central Manchester University Hospitals NHS Foundation Trust , Manchester , UK
- North West Research Collaborative , Manchester , UK
| | - L Pearce
- Department of General Surgery, Central Manchester University Hospitals NHS Foundation Trust , Manchester , UK
- North West Research Collaborative , Manchester , UK
| | - O Bouamra
- Trauma Audit Research Network, Salford Royal NHS Foundation Trust, University of Manchester , Manchester , UK
| | - T Jenks
- Trauma Audit Research Network, Salford Royal NHS Foundation Trust, University of Manchester , Manchester , UK
| | | | - J Hughes
- Department of General Surgery, Central Manchester University Hospitals NHS Foundation Trust , Manchester , UK
- North West Research Collaborative , Manchester , UK
| | - F Lecky
- Trauma Audit Research Network, Salford Royal NHS Foundation Trust, University of Manchester , Manchester , UK
- Emergency Medicine Research in Sheffield Group, Health Services Research Section, School of Health and Related Research, University of Sheffield , Manchester , UK
| | - Adh Macdonald
- North West Research Collaborative , Manchester , UK
- Department of General Surgery, University Hospital South Manchester , Manchester , UK
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Moug SJ, Stechman M, McCarthy K, Pearce L, Myint PK, Hewitt J. Frailty and cognitive impairment: Unique challenges in the older emergency surgical patient. Ann R Coll Surg Engl 2016; 98:165-9. [PMID: 26890834 DOI: 10.1308/rcsann.2016.0087] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Older patients (>65 years of age) admitted as general surgical emergencies increasingly require improved recognition of their specific needs relative to younger patients. Two such needs are frailty and cognitive impairment. These are evolving research areas that the emergency surgeon increasingly requires knowledge of to improve short- and long-term patient outcomes. METHODS This paper reviews the evidence for frailty and cognitive impairment in the acute surgical setting by defining frailty and cognitive impairment, introducing methods of diagnosis, discussing the influence on prognosis and proposing strategies to improve older patient outcomes. RESULTS Frailty is present in 25% of the older surgical population. Using frailty-scoring tools, frailty was associated with a significantly longer hospital stay and higher mortality at 30 and 90 days after admission to an acute surgical unit. Cognitive impairment is present in a high number of older acute surgical patients (approximately 70%), whilst acute onset cognitive impairment, termed delirium, is documented in 18%. However, patients with delirium had significantly longer hospital stays and higher in-hospital mortality than those with cognitive impairment. CONCLUSIONS Improved knowledge of frailty and delirium by the emergency surgeon allows the specialised needs of older surgical patients to be taken into account. Early recognition, and consideration of minimally invasive surgery or radiological intervention alongside potentially transferable successful elective interventions such as comprehensive geriatric assessment, may help to improve short- and long-term patient outcomes in this vulnerable population.
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Affiliation(s)
- S J Moug
- Royal Alexandra Hospital , Paisley , UK
| | - M Stechman
- University Hospital of Wales , Cardiff , UK
| | | | | | - P K Myint
- University of Aberdeen; Aberdeen Royal Infirmary , UK
| | - J Hewitt
- University Hospital Llandough , Cardiff , UK.,on behalf of The Older Persons Surgical Outcomes Collaboration (OPSOC)
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Bylemans J, Furlan EM, Pearce L, Daly T, Gleeson DM. Improving the containment of a freshwater invader using environmental DNA (eDNA) based monitoring. Biol Invasions 2016. [DOI: 10.1007/s10530-016-1203-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Abstract
Introduction Many older surgical patients are exposed to high risks of morbidity and mortality when undergoing both elective and emergency surgery. Methods We provide an overview of perioperative care teams and the educational opportunities available to surgeons who undertake surgery in the older person. Findings The number of older people undergoing surgery is increasing at a rate faster than the proportion of older people in the overall population. Management of the older surgical patient throughout the surgical pathway forms part of the Specialty Training Curriculum for Geriatric Medicine. While 'surgery in childhood' continues to form part of the general surgical higher training syllabus, surgery in the later years of life does not. There are limited postgraduate courses and training opportunities currently available to surgeons in this field. There is clear societal need to address perioperative care for older surgical patients, which has proved successful in some centers. Moreover, surgical trainees support the inclusion of geriatric medicine issues into their training. Conclusions The ageing population requires a multidisciplinary perioperative approach, with dedicated and appropriately trained clinicians and allied health care professionals to improve outcomes.
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Affiliation(s)
- L Pearce
- Manchester Royal Infirmary , Manchester , UK
| | - J Bunni
- Cheltenham General Hospital , Cheltenham , UK
| | | | - J Hewitt
- Cardiff University , Cardiff , UK
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Pearce L, Newton K, Smith SR, Barrow P, Smith J, Hancock L, Kirwan CC, Hill J. Multicentre observational study of outcomes after drainage of acute perianal abscess. Br J Surg 2016; 103:1063-8. [DOI: 10.1002/bjs.10154] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 02/10/2016] [Accepted: 02/11/2016] [Indexed: 12/31/2022]
Abstract
Abstract
Introduction
Management of perianal abscesses has remained largely unchanged for over 50 years. The evidence for postoperative wound packing is limited and may expose patients to painful procedures with no clinical benefit and at considerable increased cost.
Methods
Patients were recruited in 15 UK centres between December 2013 and October 2014. Outcome measures included number of dressing (pack) changes, healing, recurrence, return to work/normal function, postoperative fistula in ano and health utility scores (EQ-5D™). Pain was measured before, during and after dressing change on a visual analogue scale.
Results
Some 141 patients were recruited (median age 39 (range 18–86) years). The mean number of dressing changes in the first 3 weeks was 13 (range 0–21), equating to an annual cost to the National Health Service of €6 453 360 in England alone per annum. Some 43·8 per cent of wounds were healed by 8 weeks after surgery and 86 per cent of patients had returned to normal function. Some 7·6 per cent of abscesses had recurred and 26·7 per cent of patients developed a fistula in ano by 6 months following surgery. Patients reported a twofold to threefold increase in pain scores during and after dressing changes.
Conclusion
Recurrent abscess is rare and fistula occurs in one-quarter of the patients. Packing is painful and costly.
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Affiliation(s)
- L Pearce
- Department of General Surgery, Manchester Royal Infirmary, Manchester, UK
| | - K Newton
- Department of General Surgery, Manchester Royal Infirmary, Manchester, UK
| | - S R Smith
- Department of General Surgery, University Hospital South Manchester, Manchester, UK
| | - P Barrow
- Department of General Surgery, Salford Royal Hospital, Salford, UK
| | - J Smith
- Department of General Surgery, Royal Blackburn Hospital, Blackburn, UK
| | - L Hancock
- Department of General Surgery, Salford Royal Hospital, Salford, UK
| | - C C Kirwan
- Department of General Surgery, University Hospital South Manchester, Manchester, UK
- Department of General Surgery, Institute of Cancer Sciences, University of Manchester, Manchester, UK
| | - J Hill
- Department of General Surgery, Manchester Royal Infirmary, Manchester, UK
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Pearce L, Smith SR, Parkin E, Hall C, Kennedy J, Macdonald A. Emergency General Surgery: evolution of a subspecialty by stealth. World J Emerg Surg 2016; 11:2. [PMID: 26733342 PMCID: PMC4700620 DOI: 10.1186/s13017-015-0058-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Accepted: 12/31/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Emergency surgical patients account for around half of all NHS surgical workload and 80 % of surgical deaths. Few trainees opt to CCT in General Surgery, and there is no recognised subspecialty training program in Emergency General Surgery (EGS). Despite this lack of training and relevant assessment by examination, there appears to be an increasing number of EGS posts advertised. This study aims to provide information about potential future employment opportunities for surgical trainees. METHODS All consultant surgeon posts, advertised in the British Medical Journal between January 2009 and December 2014 were included. Data collected included specialty, region and institute of advertised post. For the purposes of statistical analysis, data was divided into two separate year bands: 2009-2011 and 2012-2014. Statistical analysis was by Chi-squared test; p <0.01 was considered statistically significant. An online tool was also used to determine experience and attitudes towards EGS amongst Consultant members of the ASGBI and all UK trainees in national training number (NTN) posts. RESULTS Over the six-year study period, there were 1240 consultant job adverts in a general surgical specialty. Nine hundred and 75 were substantive posts; the region with the most jobs was London and the South East (n = 278). There were 55 jobs advertised in EGS, either with (20) or without (35) another subspecialty. The number of EGS adverts increased significantly in 2012-14 compared to 2009-11 (p = 0.008). 229 (28 %) Consultants and 309 (22 %) trainees responded to the survey. 16 % of consultants work in NHS institutions with Emergency General Surgeons. Only 21 % of trainees believe EGS will be delivered by EGS consultants in the future whilst 8.2 % of trainees stated EGS as their career plan. Less than half of all UK consultant surgeons see EGS as a subspecialty. CONCLUSIONS This data demonstrates increasing societal need for EGS consultants over the last six years and the emergence of Emergency Surgery as a new subspecialty. In order to meet the EGS needs of the NHS, general surgical training and the examination system need to be revised.
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Affiliation(s)
- L Pearce
- Clinical Research Fellow, Department of General Surgery, Central Manchester University Hospitals Foundation Trust, Oxford Road, Manchester, M13 9WL UK
| | - S R Smith
- Clinical Research Fellow, Department of General Surgery, Central Manchester University Hospitals Foundation Trust, Oxford Road, Manchester, M13 9WL UK
| | - E Parkin
- Clinical Research Fellow, Department of General Surgery, Central Manchester University Hospitals Foundation Trust, Oxford Road, Manchester, M13 9WL UK
| | - C Hall
- Clinical Research Fellow, Department of General Surgery, Central Manchester University Hospitals Foundation Trust, Oxford Road, Manchester, M13 9WL UK
| | - J Kennedy
- Clinical Research Fellow, Department of General Surgery, Central Manchester University Hospitals Foundation Trust, Oxford Road, Manchester, M13 9WL UK
| | - A Macdonald
- Clinical Research Fellow, Department of General Surgery, Central Manchester University Hospitals Foundation Trust, Oxford Road, Manchester, M13 9WL UK
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Smith S, Pearce L, Newton K, Smith J, Hancock L, Barrow P. Packing of perianal abscess cavities (ppac) study: A multi-centre observational feasibility study, interim analysis. Int J Surg 2015. [DOI: 10.1016/j.ijsu.2015.07.036] [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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Sharrock AE, Gokani VJ, Harries RL, Pearce L, Smith SR, Ali O, Chu H, Dubois A, Ferguson H, Humm G, Marsden M, Nepogodiev D, Venn M, Singh S, Swain C, Kirkby-Bott J. Defining our destiny: trainee working group consensus statement on the future of emergency surgery training in the United Kingdom. World J Emerg Surg 2015; 10:26. [PMID: 26161133 PMCID: PMC4496942 DOI: 10.1186/s13017-015-0019-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 06/22/2015] [Indexed: 11/16/2022] Open
Abstract
The United Kingdom National Health Service treats both elective and emergency patients and seeks to provide high quality care, free at the point of delivery. Equal numbers of emergency and elective general surgical procedures are performed, yet surgical training prioritisation and organisation of NHS institutions is predicated upon elective care. The increasing ratio of emergency general surgery consultant posts compared to traditional sub-specialities has yet to be addressed. How should the capability gap be bridged to equip motivated, skilled surgeons of the future to deliver a high standard of emergency surgical care? The aim was to address both training requirements for the acquisition of necessary emergency general surgery skills, and the formation of job plans for trainee and consultant posts to meet the current and future requirements of the NHS. Twenty nine trainees and a consultant emergency general surgeon convened as a Working Group at The Association of Surgeons in Training Conference, 2015, to generate a united consensus statement to the training requirement and delivery of emergency general surgery provision by future general surgeons. Unscheduled general surgical care provision, emergency general surgery, trauma competence, training to meet NHS requirements, consultant job planning and future training challenges arose as key themes. Recommendations have been made from these themes in light of published evidence. Careful workforce planning, education, training and fellowship opportunities will provide well-trained enthusiastic individuals to meet public and societal need.
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Affiliation(s)
- A E Sharrock
- Association of Surgeons in Training (ASiT), Royal College of Surgeons England, 35 - 43 Lincoln's Inn Fields, London, WC2A 3P3 UK ; Department of Emergency Surgery, Southampton General Hospital, Tremona Road, Southampton, Hampshire, SO16 6YD UK
| | - V J Gokani
- Association of Surgeons in Training (ASiT), Royal College of Surgeons England, 35 - 43 Lincoln's Inn Fields, London, WC2A 3P3 UK
| | - R L Harries
- Association of Surgeons in Training (ASiT), Royal College of Surgeons England, 35 - 43 Lincoln's Inn Fields, London, WC2A 3P3 UK
| | - L Pearce
- Association of Surgeons in Training (ASiT), Royal College of Surgeons England, 35 - 43 Lincoln's Inn Fields, London, WC2A 3P3 UK
| | - S R Smith
- Association of Surgeons in Training (ASiT), Royal College of Surgeons England, 35 - 43 Lincoln's Inn Fields, London, WC2A 3P3 UK
| | - O Ali
- Association of Surgeons in Training (ASiT), Royal College of Surgeons England, 35 - 43 Lincoln's Inn Fields, London, WC2A 3P3 UK
| | - H Chu
- Association of Surgeons in Training (ASiT), Royal College of Surgeons England, 35 - 43 Lincoln's Inn Fields, London, WC2A 3P3 UK
| | - A Dubois
- Association of Surgeons in Training (ASiT), Royal College of Surgeons England, 35 - 43 Lincoln's Inn Fields, London, WC2A 3P3 UK
| | - H Ferguson
- Association of Surgeons in Training (ASiT), Royal College of Surgeons England, 35 - 43 Lincoln's Inn Fields, London, WC2A 3P3 UK
| | - G Humm
- Association of Surgeons in Training (ASiT), Royal College of Surgeons England, 35 - 43 Lincoln's Inn Fields, London, WC2A 3P3 UK
| | - M Marsden
- Association of Surgeons in Training (ASiT), Royal College of Surgeons England, 35 - 43 Lincoln's Inn Fields, London, WC2A 3P3 UK
| | - D Nepogodiev
- Association of Surgeons in Training (ASiT), Royal College of Surgeons England, 35 - 43 Lincoln's Inn Fields, London, WC2A 3P3 UK
| | - M Venn
- Association of Surgeons in Training (ASiT), Royal College of Surgeons England, 35 - 43 Lincoln's Inn Fields, London, WC2A 3P3 UK
| | - S Singh
- Association of Surgeons in Training (ASiT), Royal College of Surgeons England, 35 - 43 Lincoln's Inn Fields, London, WC2A 3P3 UK
| | - C Swain
- Association of Surgeons in Training (ASiT), Royal College of Surgeons England, 35 - 43 Lincoln's Inn Fields, London, WC2A 3P3 UK
| | - J Kirkby-Bott
- Department of Emergency Surgery, Southampton General Hospital, Tremona Road, Southampton, Hampshire, SO16 6YD UK
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De Grace M, Ericson D, Folz H, Greene W, Ho K, Pearce L. Proceedings for the 5th Asia-Pacific Conference on Disaster Medicine: Creating an Agenda for Action. Prehosp Disaster Med 2012; 16:18-21. [PMID: 11367932 DOI: 10.1017/s1049023x00025498] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractDisaster medicine has come to the forefront and has become the focus of interest not only in the medical community, but also in the eyes of the public. The 5th APCDM was convened in Vancouver, Canada, 27–30 September 2000. It brought together over 300 delegates from 32 countries to share their experiences and thoughts regarding disaster events and how to effectively manage them.The conference was devoted to the task of establishing priorities and creating an Agenda for Action. From the discussions, key actions required were defined:Communications: (1) Identify existing regional telehealth groups and gather lessons to be learned from them; (2) Form a telehealth advisory group to work with regional groups to compile telehealth initiatives, identify international protocols in telehealth already in existence, and solicit feedback before setting international standards; and (3) Increase corporate partnerships in the fields of telehealth and telecommunications, and invite corporations to send delegates to future APCDM meetings. This should be an initiative of the APCDM, the World Association of Disaster and Emergency Medicine (WADEM), or the European Society of Emergency Medicine.Education and research: (1) Formalize education in disaster medicine and management. The World Health Organization and WADEM should take a leadership role; (2) WADEM is requested to hold a conference with a focus on qualitative research; (3) WHO is requested to continue the provision of international research teams, but to advocate for the development of national disaster research infrastructure; (4) Make research findings and reports available on web sites of such organizations as WHO and PAHO; (5) Develop the translation of research for community utilization. The WHO and PAHO are organizations that are requested to consider this action; and (6) WADEM/APCDM are requested to focus future conferences on applied research.Information and data: (1) Create an “Information and Data Clearinghouse on Disaster Management” to collect, collate, and disseminate information; (2) Collect data using standardized tools, such as CAR or Hazmat indices; (3) Analyze incentives and disincentives for disaster readiness and establish mechanisms for addressing the obstacles to preparedness; and (4) WADEM is requested to develop a web site providing a resource list of interdisciplinary institutions and response activities, organized by country, topic, and research interests. Links to other pertinent web sites should be provided.Interdisciplinary development: (1) Focus on the interdisciplinary nature of disaster response through more conferences encompassing grassroots efforts and through WADEM publications; (2)Develop and apply a standardized template of Needs Assessment for use by multidisciplinary teams. Team Needs Assessment is essential to determine the following: (a) Local response and international assistance required; (b) Appropriate command system; and (c) Psychosocial impact and support necessary.Psychosocial aspects: (1) Incorporate relief for caregivers into action plans. This should include prime family members who also are caregivers; and (2) Implement measures that give survivors control over the recovery process.Response management. (1) Define relationships and roles between governments, military and security personnel, non-governmental organizations (NGOs), and civic groups. Use an international legal framework and liability to reinforce accountability of disaster responders; (2) Establish a more sophisticated use of the media during disasters; (3) Establish standards in key areas. WADEM is requested to write “White Papers” on standards for the following areas: (a) management, (b) health/public health, (c) education/training, (d) psychosocial, and (e) disaster plans; (4) Establish task forces to anticipate and resolve issues around evolving and emerging disasters (e.g., chemical and biological terrorism, landmines, emerging infectious diseases). WADEM was again identified as the vehicle for promoting this action.The responsibility of the next meeting of the Asia-Pacific Conference on Disaster Medicine will be to measure progress made in these areas by assessing how well these collective decisions have been implemented.
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Affiliation(s)
- M De Grace
- Vancouver Hospital and Health Sciences Centre, USA
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Leigh B, Desneves K, Rafferty J, Pearce L, King S, Woodward M, Brown D, Martin R, Crowe T. The effect of different doses of an arginine-containing supplement on the healing of pressure ulcers. J Wound Care 2012; 21:150-6. [DOI: 10.12968/jowc.2012.21.3.150] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- B. Leigh
- School of Exercise and Nutrition Sciences, Deakin University, Burwood, Australia
| | | | | | - L. Pearce
- Austin Health, Heidelberg, Australia
| | - S. King
- Austin Health, Heidelberg, Australia
| | | | - D. Brown
- Austin Health, Heidelberg, Australia
| | - R. Martin
- Austin Health, Heidelberg, Australia
| | - T.C. Crowe
- School of Exercise and Nutrition Sciences, Deakin University, Burwood, Australia
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Pepper C, Mahdi JG, Buggins AGS, Hewamana S, Walsby E, Mahdi E, Al-Haza'a A, Mahdi AJ, Lin TT, Pearce L, Morgan L, Bowen ID, Brennan P, Fegan C. Two novel aspirin analogues show selective cytotoxicity in primary chronic lymphocytic leukaemia cells that is associated with dual inhibition of Rel A and COX-2. Cell Prolif 2011; 44:380-90. [PMID: 21645153 DOI: 10.1111/j.1365-2184.2011.00760.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Non-steroidal anti-inflammatory drugs have been shown to induce apoptosis in primary B-cell chronic lymphocytic leukaemia (CLL) cells, but the molecular mechanisms that underpin this observation have not been fully elucidated. Here, we have analysed the effect two novel aspirin analogues, 2-hydroxy benzoate zinc (2HBZ) and 4-hydroxy benzoate zinc (4HBZ), on primary CLL samples. MATERIALS AND METHODS Cytotoxic effects of 2HBZ and 4HBZ were analysed in primary CLL cells derived from 52 patients, and normal B- and T-lymphocytes. Mechanisms of action of these agents were also elucidated. RESULTS Both analogues induced apoptosis in a dose-dependent and time-dependent manner. Apoptosis was associated with activation of caspase-3 that could be partially abrogated by the caspase-9 inhibitor (Z-LEHD.fmk). Importantly, both agents demonstrated preferential cytotoxicity in CLL cells when compared to normal B- and T-lymphocytes. In terms of their molecular mechanisms of action, 4HBZ and 2HBZ inhibited COX-2 transcription and protein expression and this was associated with upstream inhibition of transcription factor Rel A. Co-culture of CLL cells with CD40 ligand-expressing mouse fibroblasts significantly increased COX-2 expression and inhibited spontaneous apoptosis. Importantly, the most potent analogue, 4HBZ, overcame pro-survival effects of the co-culture system and significantly repressed COX-2. Finally, elevated COX-2 expression was associated with poor prognostic subsets and increased sensitivity to 4HBZ. CONCLUSIONS Our results demonstrate therapeutic potential of 4HBZ and are consistent with a mechanism involving suppression of Rel A nuclear translocation and inhibition of COX-2 transcription.
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Affiliation(s)
- C Pepper
- Department of Haematology, School of Medicine, Cardiff University, Heath Park, UK.
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Brunt A, Lupton S, Handley J, Thorley K, Pearce L. 735 poster A COMPARISON OF TECHNIQUES: CONVENTIONAL SIMULATOR VERSES CT-VOLUMED SUPRACLAVICULAR FOSSA RADIOTHERAPY FOR ADJUVANT BREAST CANCER. Radiother Oncol 2011. [DOI: 10.1016/s0167-8140(11)70857-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Brewer S, Desneves K, Pearce L, Mills K, Dunn L, Brown D, Crowe T. Effect of an arginine-containing nutritional supplement on pressure ulcer healing in community spinal patients. J Wound Care 2010; 19:311-6. [DOI: 10.12968/jowc.2010.19.7.48905] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- S. Brewer
- School of Exercise and Nutrition Sciences, Deakin University, Burwood, Australia
| | - K. Desneves
- Nutrition and Dietetics Department, Austin Health, Heidelberg, Australia
| | - L. Pearce
- Nutrition and Dietetics Department, Austin Health, Heidelberg, Australia
| | - K. Mills
- Nutrition and Dietetics Department, Austin Health, Heidelberg, Australia
| | - L. Dunn
- Spinal Outreach Risk Reduction Team, Austin Health, Heidelberg, Australia
| | - D. Brown
- Victorian Spinal Cord Service, Austin Health, Heidelberg, Australia
| | - T. Crowe
- School of Exercise and Nutrition Sciences, Deakin University, Burwood, Australia
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Brown WH, Pearce L, Witherbee WD. EXPERIMENTAL SYPHILIS IN THE RABBIT : VI. AFFECTIONS OF BONE, CARTILAGE, TENDONS, AND SYNOVIAL MEMBRANES. PART 2. CLINICAL ASPECTS OF SYPHILIS OF THE SKELETAL SYSTEM. AFFECTIONS OF THE FACIAL AND CRANIAL BONES AND THE BONES OF THE FOREARM. ACTA ACUST UNITED AC 2010; 33:515-23. [PMID: 19868513 PMCID: PMC2128200 DOI: 10.1084/jem.33.4.515] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- W H Brown
- Laboratories of The Rockefeller Institute for Medical Research
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Abstract
1. We have shown that the type of renal lesion produced by compounds of arsenic varies widely: while some arsenicals produce changes in which vascular injury predominates, others produce an equally dominant tubular injury. 2. In either of these groups the character and degree of the vascular or tubular injury produced by different compounds shows further variation, such that the lesions of different arsenicals of the same group are not identical. Each compound of arsenic that we have tested, therefore, produces a lesion-complex in the kidney that is relatively characteristic for that compound. 3. The mode and character of the action of arsenicals are dependent upon the chemical constitution of the compound.
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Affiliation(s)
- L Pearce
- Laboratories of The Rockefeller Institute for Medical Research
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Abstract
In a series of more than 200 rabbits in which generalized lesions were observed following local inoculation with Treponema pallidum, there were a number of animals in which characteristic lesions were noted upon mucous membranes or along mucocutaneous borders. These lesions were distributed with about equal frequency between the nose or nasolacrimal system and the eyelids on the one hand, and the genital and anal regions on the other. The lips and buccal mucosa appeared to be less subject to localized infections unless the papillomatous growths noted on the lips and under side of the tongue should prove to be in some way connected with such an infection. In many instances, the local reaction was initiated by an acute inflammatory process, and in the case of nasal and genital infections, a definite exudate was formed. The succeeding stages of the reaction consisted in an infiltration of the parts involved, together with a variable degree of proliferation of fixed tissue cells, leading eventually to necrosis and ulceration. The resulting lesions differed according to their location and the character of the reaction in the individual case. Localized infections of the nose occurred in several forms, first, as a rather diffuse affection of the nasal mucosa characterized by the presence of a mucopurulent exudate, second, as a more or less circumscribed process of infiltration with an especial predilection for the region of the anterior nares, and third, as a granulomatous process involving the alæ in particular. Involvement of the nasal mucosa was very commonly associated with lacrimal overflow and with some degree of conjunctivitis. The lesions of the eyelids were usually small, elevated papules or lesions of an ulcerative character some of which were surrounded by a zone of infiltration. In exceptional instances, large granulomatous lesions occurred along the margins of the lower lids. Infection of the penis and sheath gave rise to conditions analogous to those of the nose. In one group of animals, there was a diffuse affection characterized by redness and swelling of the parts with a mucopurulent exudate, in another there were circumscribed or diffuse infiltrations, while in a third the lesions formed were indurated granulomatous masses. Secondary necrosis with erosion or ulceration was a common feature of all these conditions. Localized infections in the region of the anus differed from those in other localities chiefly in the absence of an exudative group of affections and in the frequency with which lesions of a papillomatous type occurred. Lesions of mucous membranes and mucocutaneous borders developed at periods of time varying from a few weeks to several months after inoculation. Most of them were rather enduring and in several instances persisted in an active condition for considerably more than a year.
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Affiliation(s)
- W H Brown
- Laboratories of The Rockefeller Institute for Medical Research
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Abstract
Data from 645 normal rabbits were used as the basis of an investigation of the relation existing between body and organ weights. Actual and relative weights were correlated with both gross and net body weight. The results obtained varied with different classes of organs but it was found that, in general, there was an agreement between the form and degree of the correlation shown and the structural and functional properties of the organs concerned.
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Affiliation(s)
- W H Brown
- Laboratories of The Rockefeller Institute for Medical Research
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Pearce L. RECIPROCAL EFFECTS OF CONCOMITANT INFECTIONS : I. THE INFLUENCE OF VACCINIA ON THE REACTION TO INFECTION WITH EXPERIMENTAL SYPHILIS. ACTA ACUST UNITED AC 2010; 47:611-36. [PMID: 19869434 PMCID: PMC2131395 DOI: 10.1084/jem.47.4.611] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [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: 12/04/2022]
Abstract
Experiments are reported in which was studied the effect of a concomitant infection, vaccinia, upon the syphilitic reaction of rabbits. Vaccine virus was inoculated intracutaneously on the side of the body at the time of intratesticular inoculation with Treponema pallidum. The results showed clearly that the vaccination caused a profound disturbance in the syphilitic reaction, the ensuing syphilis being extremely severe. From an analysis of various features of the reaction, it appeared that the factor of host resistance was primarily concerned in the effects observed.
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Affiliation(s)
- L Pearce
- Laboratories of The Rockefeller Institute for Medical Research
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Hu CK, Rosahn PD, Pearce L. STUDIES ON THE ETIOLOGY OF RABBIT POX : III. TESTS OF THE RELATION OF RABBIT POX VIRUS TO OTHER VIRUSES BY CROSSED INOCULATION AND EXPOSURE EXPERIMENTS. ACTA ACUST UNITED AC 2010; 63:353-78. [PMID: 19870477 PMCID: PMC2133339 DOI: 10.1084/jem.63.3.353] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Experiments are reported in which it was shown that rabbits which had recovered from experimental or spontaneous rabbit pox were refractory to inoculation of pox virus injected by various routes, and in addition did not develop clinical manifestations of the disease under conditions of exposure to florid cases of pox. It was found that pox recovered rabbits were susceptible to inoculation with the virus of virus III disease of rabbits and that virus III recovered rabbits could be successfully inoculated with pox virus. Furthermore, virus III recovered rabbits developed pox when subjected to room exposure in the same manner as did normal rabbits. It thus appears that there is no specific relationship between the two viruses. Rabbits which had recovered from experimental or spontaneous pox were found to be just as susceptible to inoculation with the virus of infectious myxoma of rabbits as were normal rabbits, a result which demonstrates that there is no specific relationship between these viruses. Rabbits which had recovered from experimental or spontaneous pox were refractory to inoculation with culture dermovaccine virus, but vaccine recovered rabbits were not completely refractory to inoculation with pox virus. Under conditions of exposure to clinical cases of pox, adult vaccine immune rabbits did not develop clinical manifestations of pox, but young, recently weaned vaccinated rabbits did contract mild but definite clinical pox. Experimental pox recovered rabbits were partially refractory to inoculation with neurovaccine virus and neurovaccine recovered rabbits were partially refractory to inoculation with pox virus. The refractory condition of the pox immune rabbits appeared to be more pronounced than that of the neurovaccine immunes. The cutaneous lesions which developed from the intradermal injection of pox, neurovaccine, and culture vaccine viruses showed definite differences with respect to the rate and persistence of active growth, amount of edema, hemorrhage, and necrosis, and the degree of tissue destructiveness. These features were most pronounced in the lesions of pox virus and were least marked in the lesions of culture vaccine virus. The differences were particularly apparent in normal rabbits, but they were also present in the lesions which developed in immune animals. It was found that the calf was susceptible to inoculation with pox virus applied to a scarified skin area. There were many similarities in the appearance and course of the pox lesions to those resulting from culture vaccine virus, the New York Board of Health vaccine, and neurovaccine virus similarly inoculated. But the pox lesions were most numerous, much the largest and most destructive, and by far the most persistent while next in order were those of the Board of Health dermovaccine. The results of these various experiments showed that a close relationship obtains between pox virus, on the one hand, and vaccine virus and neurovaccine virus, on the other, but it cannot be said that pox virus is identical in all respects with either one of these viruses. The findings indicated that the relationship between pox and neurovaccine viruses is closer than that between pox and culture vaccine viruses. Upon the basis of the results observed in culture (dermo) vaccine immune rabbits inoculated with or exposed to pox, it appeared that vaccination with vaccine virus offered a method of protection against rabbit pox.
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Affiliation(s)
- C K Hu
- Laboratories of The Rockefeller Institute for Medical Research
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Pearce L, Brown WH. CHEMOTHERAPY OF TRYPANOSOME AND SPIROCHETE INFECTIONS : BIOLOGICAL SERIES. III. THE THERAPEUTIC ACTION OF N-PHENYLGLYCINEAMIDE-p-ARSONIC ACID IN EXPERIMENTAL TRYPANOSOMIASIS OF RABBITS. ACTA ACUST UNITED AC 2010; 30:455-81. [PMID: 19868371 PMCID: PMC2126692 DOI: 10.1084/jem.30.5.455] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [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: 11/24/2022]
Abstract
In the treatment of experimental trypanosomiasis of rabbits with subsequent appraisal of the value of the therapeutic agent used, there are certain experimental factors including uniform infecting strains of trypanosomes and the observation of general procedures of method and time of inoculation conditioned by the infection itself which must be taken into account. The conspicuous and characteristic clinical signs and symptoms seen in rabbit trypanosomiasis serve as criteria of the severity and duration of the disease, and it is obvious that the infection should be well established before treatment is instituted. For the same reason, before the question of a permanent cure can be established, treated rabbits should be kept under observation for a sufficient period of time, which with the species of organisms that we have used is at least 3 months. The therapeutic results with the amide of N-phenylglycine-p-arsonic acid were obtained in rabbits which showed well marked clinical signs of a definitely established disease, and in many instances the infection was extremely advanced and of prolonged duration. The five species which we have employed, Tr. brucei, Tr.gambiense, Tr. equinum, Tr. equiperdum, and Tr. evansi, are uniformly fatal in rabbits. With the usual acute, actively progressing infection of from I to 2 weeks duration produced by our strain of Tr. brucei, the drug has a curative range of from 0.2 to 0.35 gm. per kilo of body weight, when administered intravenously in single doses, or from one-third to one-half the minimal lethal dose. Of the twenty-nine rabbits treated with doses falling within this range, twenty-five, or 86 per cent, were permanently cured and there were no relapses observed with doses above 0.3 gm. The infection produced by our strain of Tr. gambiense is controlled by a slightly lower dose, since there were no relapses with single doses of 0.3 gm. and a single dose of 0.15 gm. effected a cure in one of three rabbits so treated. The therapeutic experiments with Tr. equinum, Tr. equiperdum, and Tr. evansi are too few to admit of final conclusions, but apparently from the evidence at hand, much the same curative range is operative in Tr. evansi infections, while larger doses or a different system of treatment should have been employed in the treatment of rabbits infected with our strains of Tr. equinum and Tr. equiperdum. In addition to the ultimate curative results obtained with single doses within the curative range, it is important to consider the marked therapeutic action with smaller single doses, as shown by the rapid regression and healing of the clinical lesions of the acute infections produced by all five species of trypanosomes together with a marked improvement in the general physical state of the animal. Moreover, large single doses, above those of the so called curative range, caused no disturbance of a toxic nature and were apparently well borne. A system of repeated dose therapy may be employed with advantage in the treatment of both initial and relapsed infections in rabbits, especially in those instances in which there is induration or even necrosis of tissues with weakness and emaciation of the animal host. The factor of time of repetition or the spacing of doses is in our experience as important as that of size of the dose employed and depends upon the rate, degree, and duration of action of the particular dose of the drug in question. Since the amide of N-phenylglycine-p-arsonic add apparently possesses the power of tissue penetration to a marked degree, it is desirable to give the second dose within a short time after the first in order that it may have a full opportunity for the immediate and complete development of its action. The repetition of small doses such as 0.15 gm. per kilo of body weight on successive or alternate days has given successful results as regards both the immediate regression and healing of lesions and ultimate permanent cures in severe, chronic infections. It is possible, however, to administer increasingly large doses, if this is necessary, since infected as well as normal rabbits exhibit a remarkable tolerance to repeated large doses of the drug. The therapeutic activity of small doses administered intramuscularly is quite comparable with that observed after similar doses given intravenously, as indicated by the rate of regression and healing of clinical lesions, while such effects proceed somewhat more slowly after subcutaneous injections. Permanent cures have been obtained in Tr. brucei infection with intramuscular and subcutaneous administration of single doses of from 0.2 to 0.5 gm. of the drug per kilo of body weight and in other instances with three repeated doses of 0.1 gm. per kilo given intramuscularly. One severely infected rabbit which received 0.75 gm. per kilo per os immediately following a small dose of sodium bicarbonate was also cured. The therapeutic experiments here reported represent only a portion of those carried out with N-phenylglycineamide-p-arsonic acid and the scope of the present paper does not permit a detailed description of the many phases of the experiments or a full discussion of the various factors involved and the results obtained, all of which we hope to publish at some future time.
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Affiliation(s)
- L Pearce
- Laboratories of The Rockefeller Institute for Medical Research
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49
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Pearce L, Van Allen CM. EFFECTS OF LIGHT ON NORMAL RABBITS, WITH ESPECIAL REFERENCE TO THE ORGANIC REACTION : I. CLINICAL AND POSTMORTEM OBSERVATIONS. ACTA ACUST UNITED AC 2010; 44:447-59. [PMID: 19869199 PMCID: PMC2131184 DOI: 10.1084/jem.44.4.447] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [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: 11/21/2022]
Abstract
A group of 50 normal male rabbits kept under conditions of constant light that had none of the shorter ultra-violet rays and another group kept in constant darkness for 2 to 12 weeks were observed clinically and subjected to postmortem examination for the purpose of determining the effect of these environmental conditions upon general body health and the weights of organs. A similar group of 50 rabbits caged in an ordinary animal room for the same period, and two groups of 40 and 20 rabbits respectively, which had recently been brought into the laboratory, served as controls. It was found that the general health of the rabbits was not impaired by the artificial light or the exclusion of light. The gain in body weight which occurred in all groups was especially marked in the case of those kept under conditions of constant light. The incidence of spontaneous disease recognizable clinically during the experiment was extremely low and of a mild character and did not obviously disturb the health of the animal. It was found at postmortem examination, on the other hand, that 59.3 per cent of the rabbits caged indoors, that is in the light, dark, or unaltered rooms, and 58.3 per cent of those recently brought to the laboratory had visible lesions of some kind. The great majority of these lesions, however, were of a slight grade, and none appeared to have any deleterious effects upon the general physical state of the animals.
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Affiliation(s)
- L Pearce
- Laboratories of The Rockefeller Institute for Medical Research
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Abstract
An achondroplastic condition in the rabbit has been described. It is present at birth and is characterized by size reduction, by a disproportion of bodily parts, most marked in the extremities, and by an invariably lethal effect. The animals are still-born or die very shortly after birth. In physical appearance and in the character of the skeletal changes as shown by x-ray photographs, achondroplasia in the rabbit has a remarkable resemblance to the disease in man and in cattle and dogs. The condition which first occurred in offspring of pure bred Havana rabbits is inherited. In anticipation of the later discussion of this phase of the study (13), it can be stated that the mode of inheritance is on the basis of a simple recessive unit factor and that the appearance of non-achondroplastic transmitters (heterozygotes) is that of normal animals.
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Affiliation(s)
- W H Brown
- Department of Animal and Plant Pathology of The Rockefeller Institute for Medical Research, Princeton, New Jersey
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