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Siju J, Anagboso U, Vernet E, Moss M, Javaid W, Cassano K. Implementation of a quality improvement project using the patient as the observer to improve hand hygiene compliance in ambulatory care practices. J Hosp Infect 2023; 140:34-39. [PMID: 37562594 DOI: 10.1016/j.jhin.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 07/31/2023] [Accepted: 08/04/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Monitoring hand hygiene compliance in the ambulatory setting remains a challenge because a healthcare trained observer loses line of sight once the examination room door closes. This quality improvement project focused on the implementation of a hand hygiene compliance improvement programme that is amenable to the routines and work flows of the ambulatory setting. METHODS After a review of the literature, nursing leadership and infection prevention implemented the 'patient as the observer' hand hygiene programme across 32 ambulatory practices. RESULTS Patients completed 281,000 observations with an overall compliance rate of ≥90%. The average overall compliance rate by role was 91% for providers, 89% for nurses, and 91% for medical assistants/technicians/others. A 92% compliance average was noted 'before caring for you' and 89% 'after caring for you' for providers, 90% and 87% for nurses, and 92% and 89% for medical assistants/technicians/others. DISCUSSION This study demonstrated that the implementation of a hand hygiene compliance improvement programme using the patient as the observer can be adopted successfully in the ambulatory setting. CONCLUSION Hand hygiene compliance can be monitored effectively in the ambulatory setting with the involvement of the patient as the observer.
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Affiliation(s)
- J Siju
- Ambulatory Care Nursing, Mount Sinai Health System, New York, USA.
| | - U Anagboso
- Ambulatory Care Nursing, Mount Sinai Health System, New York, USA
| | - E Vernet
- Ambulatory Care Nursing, Mount Sinai Health System, New York, USA
| | - M Moss
- Infection Prevention and Control, Mount Sinai Health System, New York, USA
| | - W Javaid
- Infection Prevention and Control, Mount Sinai Health System, New York, USA
| | - K Cassano
- Ambulatory Care Nursing, Mount Sinai Health System, New York, USA
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Man J, Lu Q, Moss M, Carvajal B, Baur W, Alcaide P, Jaffe I. The Mineralocorticoid Receptor in Myeloid Cells Promotes Vascular Inflammation and Atherosclerosis via Transcriptional Regulation of
Selplg. FASEB J 2021. [DOI: 10.1096/fasebj.2021.35.s1.01618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Joshua Man
- Molecular Cardiology Research InstituteTufts Medical CenterBostonMA
- Graduate School of Biomedical SciencesTufts Medical CenterBostonMA
| | - Qing Lu
- Molecular Cardiology Research InstituteTufts Medical CenterBostonMA
| | - M. Moss
- Molecular Cardiology Research InstituteTufts Medical CenterBostonMA
- Graduate School of Biomedical SciencesTufts Medical CenterBostonMA
| | - Brigett Carvajal
- Molecular Cardiology Research InstituteTufts Medical CenterBostonMA
- Graduate School of Biomedical SciencesTufts Medical CenterBostonMA
| | - Wendy Baur
- Molecular Cardiology Research InstituteTufts Medical CenterBostonMA
| | | | - Iris Jaffe
- Molecular Cardiology Research InstituteTufts Medical CenterBostonMA
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Abstract
INTRODUCTION Ability to access needed dental care may vary among population subgroups. We assessed 1) the differences in the proportions of adults who reported unmet dental care needs in the past 12 months and the associated barriers (structural, financial, and cognitive) in 2015 to 2016 versus 2003 to 2004 by race/ethnicity and 2) the subgroups that are more likely to report unmet dental care needs. METHODS Data of 10,029 respondents aged ≥19 y from the 2003-2004 and 2015-2016 National Health and Nutrition Examination Surveys were used. Chi-square tests assessed the differences in the proportions of adults who reported not getting the needed dental care between the periods. A multiple logistic regression model was run to identify characteristics that were significantly associated with unmet need after adjusting for other factors. RESULTS Overall, 19.4% of the adults reported an unmet dental care need in 2015 to 2016, as compared with 21% in 2003 to 2004. The overall unmet dental care need decreased only in the Hispanic groups (34% to 28%, P = 0.045) between 2003-2004 and 2015-2016. Between the periods, unmet need decreased among Hispanics aged 19 to 64 y (35% to 28%, P = 0.02), Hispanics with some college education or above (33.5% to 21.0%, P = 0.008), and nonpoor Hispanic adults (29.8% to 20.4%, P = 0.048). No significant differences were observed in the proportions of adults reporting structural (P = 0.09), financial (P = 0.86), or cognitive (P = 0.07) barriers between the periods. When compared with their counterparts, nonelderly adults, women, Hispanics, adults with a high school education, those with less than a high school education, and poor adults were significantly more likely to report unmet dental care needs. CONCLUSIONS Racial and ethnic disparities in accessing and receiving the needed dental care still exist. Financial barriers to dental care are the most commonly cited reasons for not getting the needed dental care. KNOWLEDGE TRANSFER STATEMENT The results of the study will inform policy makers, public health planners, and dental professionals about subgroups that still face difficulty in receiving the dental care they need. Policy makers should develop new policies to mitigate the financial barriers that are still prevalent. Dental professionals can mitigate the public's cognitive and financial barriers by educating the community through outreach programs and by providing services to low-income populations at reduced charges or through alternative payment plans.
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Affiliation(s)
- V Bhoopathi
- Department of Oral Health Sciences, Maurice H. Kornberg School of Dentistry, Temple University, Philadelphia, PA, USA
| | - H Luo
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - M Moss
- Department of Foundational Sciences, School of Dental Medicine, East Carolina University, Greenville, NC, USA
| | - P Bhagavatula
- Department of Clinical Services, School of Dentistry, Marquette University, Milwaukee, WI, USA
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Van Matre ET, Reynolds PM, MacLaren R, Mueller SW, Wright GC, Moss M, Burnham EL, Ho PM, Vandivier RW, Kiser TH. Evaluation of unfractionated heparin versus low-molecular-weight heparin and fondaparinux for pharmacologic venous thromboembolic prophylaxis in critically ill patients with cancer. J Thromb Haemost 2018; 16:2492-2500. [PMID: 30347498 DOI: 10.1111/jth.14317] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 07/17/2018] [Indexed: 11/27/2022]
Abstract
Essentials Critically ill cancer patients require pharmacologic prophylaxis for venous thromboembolism (VTE). Patients from 566 hospitals in the United States between 2010 and 2014 were included. Low-molecular-weight heparin (LMWH) prophylaxis was not associated in a reduction of VTE rates. LMWH prophylaxis was associated with a reduction in bleeding and heparin induced thrombocytopenia. SUMMARY: Background Critically ill patients with cancer are at increased risk of venous thromboembolism (VTE) from physical and cellular factors, requiring pharmacologic prophylaxis to reduce the risk of VTE. Objectives To assess whether low-molecular-weight heparin (LMWH) prophylaxis reduces in-hospital rates of VTE or improves clinical outcomes compared with unfractionated heparin (UFH) prophylaxis in critically ill patients with cancer. Methods We used a propensity-matched comparative-effectiveness cohort from the Premier Database. Patients aged 18 years or older with a primary diagnosis of cancer, intensive care unit admission and VTE prophylaxis within 2 days of admission between 1 January 2010 and 31 December 2014 were included. Patients were divided into LMWH or UFH prophylaxis groups. Results A total of 103 798 patients were included; 75 321 (72.6%) patients received LMWH and 28 477 (27.4%) patients received UFH. Propensity analysis matched (2 : 1) 42 343 LMWH patients and 21 218 UFH patients. Overall, LMWH was not associated with a decreased incidence of VTE (5.32% vs. 5.50%). LMWH prophylaxis was associated with a reduction in pulmonary embolism (0.70% vs. 0.99%), significant bleeding (13.3% vs. 14.8%) and heparin-induced thrombocytopenia (HIT) (0.06% vs. 0.19%). In non-metastatic solid disease, LMWH was associated with decreased VTE (4.27% vs. 4.84%) and PE (0.47% vs. 0.95%). Conclusions The use of an LMWH for VTE prophylaxis was not associated with a reduction in the incidence of in-hospital VTE as compared with UFH, but was associated with significant reductions in PE, clinically important bleeding events, and incidence of HIT in critically ill patients with cancer.
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Affiliation(s)
- E T Van Matre
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, Memphis, TN, USA
| | - P M Reynolds
- Department of Clinical Pharmacy, University of Colorado, Skaggs School of Pharmacy and Pharmaceutical Sciences, Anschutz Medical Campus, Aurora, CO, USA
| | - R MacLaren
- Department of Clinical Pharmacy, University of Colorado, Skaggs School of Pharmacy and Pharmaceutical Sciences, Anschutz Medical Campus, Aurora, CO, USA
| | - S W Mueller
- Department of Clinical Pharmacy, University of Colorado, Skaggs School of Pharmacy and Pharmaceutical Sciences, Anschutz Medical Campus, Aurora, CO, USA
| | - G C Wright
- Department of Clinical Pharmacy, University of Colorado, Skaggs School of Pharmacy and Pharmaceutical Sciences, Anschutz Medical Campus, Aurora, CO, USA
| | - M Moss
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - E L Burnham
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - P M Ho
- Colorado Pulmonary Outcomes Research Group (CPOR), University of Colorado, Anschutz Medical Campus, Aurora
- Division of Cardiology, Department of Medicine, VA Eastern Colorado Health Care System, Denver, CO, USA
| | - R W Vandivier
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - T H Kiser
- Department of Clinical Pharmacy, University of Colorado, Skaggs School of Pharmacy and Pharmaceutical Sciences, Anschutz Medical Campus, Aurora, CO, USA
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Moss M, Moss S. MULTIPLE SIBLINGS’ EXPERIENCES OF THEIR ELDERLY PARENT’S DEATH: A QUALITATIVE ANALYSIS. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Breathett K, Liu W, Allen L, Daugherty S, Blair I, Jones J, Grunwald G, Moss M, Kiser T, Burnham E, Vandivier R, Clark B, Lewis E, Mazimba S, Ho P, Peterson P. Racial Differences in Receipt of Care by a Cardiologist During a Critical Heart Failure Admission. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Abstract
Three large probability samples of older people are analyzed in terms of the relationships between marital status and living arrangements, on the one hand, and a variety of indicators of well-being including cognitive functioning, health, time use, family interaction, friend interaction, perceived time use, perceived quality family interaction, perceived quality friend interaction, perceived environment, and objective environmental quality. With other background factors controlled, the major effect of marital status was seen in the favorable situation of the presently married. Effects associated with living arrangements were stronger. Those living alone were healthier but notably lower in all types of subjective well-being. Living with children was associated with lower basic competence and subjective well-being, but being married had generally favorable consequences whether or not other people lived in the household.
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Chakravarty PD, Porter C, Cao H, Cairns L, Moss M, Duthie R, Ashcroft P, Jeffrey R, Gibson G, Buchan K, Erwig L, Barker RN, Vickers MA. Intraoperative salvage does not affect expression of markers for erythrophagocytosis. Transfus Med 2016; 26:147-9. [PMID: 27000682 DOI: 10.1111/tme.12288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Revised: 01/23/2016] [Accepted: 02/12/2016] [Indexed: 11/27/2022]
Affiliation(s)
- P D Chakravarty
- Division of Applied Medicine, Institute of Medical Sciences, University of Aberdeen, Aberdeen, UK
| | - C Porter
- Academic Transfusion Medicine Unit, Blood Transfusion Centre, Aberdeen, UK
| | - H Cao
- Division of Applied Medicine, Institute of Medical Sciences, University of Aberdeen, Aberdeen, UK
| | - L Cairns
- Academic Transfusion Medicine Unit, Blood Transfusion Centre, Aberdeen, UK
| | - M Moss
- Academic Transfusion Medicine Unit, Blood Transfusion Centre, Aberdeen, UK
| | - R Duthie
- Orthopaedic Surgery, Woodend Hospital, Aberdeen, UK
| | - P Ashcroft
- Orthopaedic Surgery, Woodend Hospital, Aberdeen, UK
| | - R Jeffrey
- Department of Cardiac Surgery, Aberdeen Royal Infirmary, Aberdeen, UK
| | - G Gibson
- Department of Cardiac Surgery, Aberdeen Royal Infirmary, Aberdeen, UK
| | - K Buchan
- Department of Cardiac Surgery, Aberdeen Royal Infirmary, Aberdeen, UK
| | - L Erwig
- Division of Applied Medicine, Institute of Medical Sciences, University of Aberdeen, Aberdeen, UK
| | - R N Barker
- Division of Applied Medicine, Institute of Medical Sciences, University of Aberdeen, Aberdeen, UK
| | - M A Vickers
- Division of Applied Medicine, Institute of Medical Sciences, University of Aberdeen, Aberdeen, UK.,Academic Transfusion Medicine Unit, Blood Transfusion Centre, Aberdeen, UK
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Lovell B, Moss M, Wetherell MA. The psychophysiological and health corollaries of child problem behaviours in caregivers of children with autism and ADHD. J Intellect Disabil Res 2015; 59:150-7. [PMID: 23889770 DOI: 10.1111/jir.12081] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/02/2013] [Indexed: 05/25/2023]
Abstract
BACKGROUND The positive relationship between problem behaviours of children with additional complex needs and psychological distress in their caregivers has been widely evidenced. Fewer studies, however, have assessed the relationship between care recipients' problem behaviours and key physiological processes, relevant for the physical health status of their care providers. This study examined the psychological, endocrine and health corollaries of child problem behaviours in caregivers of children with autism and attention deficit hyperactivity disorder. METHODS Caregivers (n = 18) completed self-report measures of psychological distress, child problem behaviours and incidences of commonly occurring ailments. To capture important parameters of the basal diurnal cortisol pattern, caregivers collected saliva samples at waking, 30 min post waking, 1200 h and 2200 h on two consecutive weekdays. RESULTS Data revealed a positive relationship between caregivers' perceived levels of stress and problems with child conduct behaviours. In addition, caregivers who reported more problems with child emotional and hyperactivity behaviours displayed atypical cortisol patterns characterised by flatter diurnal cortisol slopes and reduced cortisol awakening response magnitude. Subjective reports of commonly occurring ailments were also greater in caregivers experiencing more problems with child emotional behaviours. CONCLUSIONS These findings have implications for interventions that aim to improve the psychophysiological well-being of the caregiver by targeting problem behaviours of the care recipient.
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Affiliation(s)
- B Lovell
- Department of Psychology, Stress Research Group, Northumbria University, Newcastle upon Tyne, UK
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10
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Abstract
We report the results of revision total knee replacement (TKR) in 26 patients with major metaphyseal osteolytic defects using 29 trabecular metal cones in conjunction with a rotating hinged total knee prosthesis. The osteolytic defects were types II and III (A or B) according to the Anderson Orthopaedic Research Institute (AORI) classification. The mean age of the patients was 72 years (62 to 84) and there were 15 men and 11 women. In this series patients had undergone a mean of 2.34 previous total knee arthroplasties. The main objective was to restore anatomy along with stability and function of the knee joint to allow immediate full weight-bearing and active knee movement. Outcomes were measured using Knee Society scores, Oxford knee scores, range of movement of the knee and serial radiographs. Patients were followed for a mean of 36 months (24 to 49). The mean Oxford knee clinical scores improved from 12.83 (10 to 15) to 35.20 (32 to 38) (p < 0.001) and mean American Knee Society scores improved from 33.24 (13 to 36) to 81.12 (78 to 86) (p < 0.001). No radiolucent lines suggestive of loosening were seen around the trabecular metal cones, and by one year all the radiographs showed good osteo-integration. There was no evidence of any collapse or implant migration. Our early results confirm the findings of others that trabecular metal cones offer a useful way of managing severe bone loss in revision TKR. Cite this article: Bone Joint J 2013;95-B:1069–74.
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Affiliation(s)
- B. M. Rao
- St Richards Hospital, Orthopaedic
Department, Western Sussex Hospitals NHS Trust, Chichester, West
Sussex PO19 6SE, UK
| | - T. T. Kamal
- St Richards Hospital, Orthopaedic
Department, Western Sussex Hospitals NHS Trust, Chichester, West
Sussex PO19 6SE, UK
| | - J. Vafaye
- St Richards Hospital, Orthopaedic
Department, Western Sussex Hospitals NHS Trust, Chichester, West
Sussex PO19 6SE, UK
| | - M. Moss
- St Richards Hospital, Orthopaedic
Department, Western Sussex Hospitals NHS Trust, Chichester, West
Sussex PO19 6SE, UK
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Bosanko NC, Chauhan A, Brookes M, Moss M, Wilson PG. Presentations of pyogenic liver abscess in one UK centre over a 15-year period. J R Coll Physicians Edinb 2011; 41:13-7. [PMID: 21365060 DOI: 10.4997/jrcpe.2011.104] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND AIM Pyogenic liver abscess (PLA) has been a condition of high mortality, improving over recent decades with combined antibiotic and percutaneous drainage. We aimed to identify the presenting features, diagnosis, microbiology, treatment and outcome for patients over a 15-year period at an inner-city hospital. METHODS Patients with an appropriate discharge diagnosis were identified and case records retrospectively analysed. RESULTS A total of 73 patient records were analysed. Common presenting features were anorexia, abdominal pain, fever, vomiting and weight loss with raised white cell count, C-reactive protein, alkaline phosphatase and hypoalbuminaemia. The delay following symptom onset to presentation was a mean of 17.3 days. The inclusion of PLA as a possible diagnosis on admission was only considered in 1% of cases. Positive blood or abscess culture was achieved in 63% of cases. We recorded a hospital mortality rate of 11%. CONCLUSIONS In this sample, PLA was rarely considered as a possible diagnosis at presentation. There are common presenting features, which should prompt early investigation. Our microbiological yield was lower than in some studies and may be due to the early empirical use of antibiotics, without microbiological guidance. Percutaneous drainage and antibiotic treatment remain the mainstay of management. The underlying cause for PLA is often not identified. Emerging septicaemia or underlying malignancy were strong predictors of mortality.
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Affiliation(s)
- N C Bosanko
- Sandwell and West Birmingham NHS Trust, Birmingham, UK.
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Stewart JCM, Morse PF, Moss M, Horrobin Dphil DF, Burton JL, Douglas WS, Gould DJ, Grattan CEH, Hindson TC, Anderson J, Jansen CT, Kennedy CTC, Lindskov R, Strong AMM. Treatment of Severe and Moderately Severe Atopic Dermatitis with Evening Primrose Oil (Epogam): a Multi-centre Study. ACTA ACUST UNITED AC 2009. [DOI: 10.3109/13590849109084095] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Bosanko NC, Lewis MJV, Chan YS, Winkles CL, Moss M. An example of the healing powers of a human being. Case Reports 2009; 2009:bcr06.2008.0143. [DOI: 10.1136/bcr.06.2008.0143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Deja M, Hommel M, Weber-Carstens S, Moss M, von Dossow V, Sander M, Pille C, Spies C. Evidence-based therapy of severe acute respiratory distress syndrome: an algorithm-guided approach. J Int Med Res 2008; 36:211-21. [PMID: 18380929 DOI: 10.1177/147323000803600201] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Despite considerable research and constantly emerging treatment modalities, the mortality associated with acute respiratory distress syndrome (ARDS) has remained virtually unchanged over the last decade. Clinical studies have been unable to show a reduction in mortality for most therapeutic interventions except for low tidal volume ventilation. Failure to prove a mortality benefit might be a result of the varying severity of ARDS in the patients studied. Nevertheless, positive responses to single supportive measures (inhaled nitric oxide, prone positioning and extracorporeal membrane oxygenation) have been demonstrated in multiple trials. Criteria for administration, weaning and discontinuation of these supportive interventions have never been described in detail. In this context, implementation of an evidence-based algorithm might facilitate clinical management of severe ARDS. This review summarizes the current evidence base and proposes a new treatment algorithm that aims to prioritize the administration of advanced strategies in a multimodal approach for ARDS.
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Affiliation(s)
- M Deja
- Anaesthesiology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum and Campus Mitte, Berlin, Germany.
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Abstract
BACKGROUND Deficits in theory of mind (ToM), or the ability to infer what another person is thinking or feeling, have been reported in manic and euthymic adults with bipolar disorder. To date, there have been no investigations of ToM in pediatric bipolar disorder (PBD). The aim of the current study was to investigate this ability in PBD patients and healthy controls. METHOD PBD patients (n=26) and intellectually and demographically similar healthy comparison subjects (n=20) were administered two ToM tasks. In the Affective Story Task, subjects were read positive-, negative- and neutral-valenced stories, and were assessed on their ability to recognize that a misleading series of events could lead one character to develop a false belief about another character. On the Hinting Task, subjects were required to infer the real intentions behind subtle hints. RESULTS The PBD group performed significantly more poorly than controls on the Hinting Task and the positive and negative conditions of the Affective Story Task. In the PBD group only, younger age, earlier illness onset and manic symptoms were associated with poorer ToM performance. CONCLUSIONS Consistent with past findings in adult bipolar disorder (BD), PBD youth performed more poorly than controls on ToM tasks. Data suggest that ToM ability may be more impaired in affectively charged contexts. Additionally, an earlier onset of illness among PBD youth may interfere with the development of social-cognitive skills. ToM disturbances may be a useful treatment target in PBD, with the aim of facilitating more accurate assessment of social cues and better interpersonal functioning.
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Affiliation(s)
- L S Schenkel
- Center for Cognitive Medicine and the Institute for Juvenile Research, Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA.
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Daniel J, Pradhan A, Pradhan C, Ziaee H, Moss M, Freeman J, McMinn DJW. Multimodal thromboprophylaxis following primary hip arthroplasty. ACTA ACUST UNITED AC 2008; 90:562-9. [DOI: 10.1302/0301-620x.90b5.19744] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We report a retrospective review of the incidence of venous thromboembolism in 463 consecutive patients who underwent primary total hip arthroplasty (487 procedures). Treatment included both total hip replacement and hip resurfacing, and the patients were managed without anticoagulants. The thromboprophylaxis regimen included an antiplatelet agent, generally aspirin, hypotensive epidural anaesthesia, elastic compression stockings and early mobilisation. In 258 of these procedures (244 patients) performed in 2005 (cohort A) mechanical compression devices were not used, whereas in 229 (219 patients) performed during 2006 (cohort B) bilateral intermittent pneumatic calf compression was used. All operations were performed through a posterior mini-incision approach. Patients who required anticoagulation for pre-existing medical problems and those undergoing revision arthroplasty were excluded. Doppler ultrasonographic screening for deep-vein thrombosis was performed in all patients between the fourth and sixth post-operative days. All patients were reviewed at a follow-up clinic six to ten weeks after the operation. In addition, reponse to a questionnaire was obtained at the end of 12 weeks post-operatively. No symptomatic calf or above-knee deep-vein thrombosis or pulmonary embolism occurred. In 25 patients in cohort A (10.2%) and in ten patients in cohort B (4.6%) asymptomatic calf deep-vein thromboses were detected ultrasonographically. This difference was statistically significant (p = 0.03). The regimen followed by cohort B offers the prospect of a low incidence of venous thromboembolism without subjecting patients to the higher risk of bleeding associated with anticoagulant use.
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Affiliation(s)
- J. Daniel
- The McMinn Centre, 25 Highfield Road, Birmingham B15 3DP, UK
| | - A. Pradhan
- University Hospital North Staffordshire and City General Hospital, Newcastle Road, Stoke-on-Trent ST4 6QG, UK
| | - C. Pradhan
- The McMinn Centre, 25 Highfield Road, Birmingham B15 3DP, UK
| | - H. Ziaee
- The McMinn Centre, 25 Highfield Road, Birmingham B15 3DP, UK
| | - M. Moss
- Birmingham Nuffield Hospital, 22 Somerset Road, Birmingham B15 2QQ, UK
| | - J. Freeman
- Birmingham Nuffield Hospital, 22 Somerset Road, Birmingham B15 2QQ, UK
| | - D. J. W. McMinn
- The McMinn Centre, 25 Highfield Road, Birmingham B15 3DP, UK
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Hurst D, Moss M, Slater S, Sanders C. Can Healthcare Associated Infection (HAI) Rates Related to Clostridium difficile Be Reduced to Zero by Applying the Lessons Learned from the SENIC Project? Am J Infect Control 2007. [DOI: 10.1016/j.ajic.2007.04.217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Gao L, Grant A, Chi P, Gao P, Stockton M, Watson H, Hansel N, Diette G, Dunston G, Mathias R, Togias A, Brower R, Sevransky J, Maloney J, Moss M, Shanholtz C, Garcia J, Beaty T, Barnes K. Myosin Light Chain Kinase (MYLK) Variants that Confer Increased Risk of Sepsis and Acute Lung Injury are Associated with Asthma and Associated Phenotypes. J Allergy Clin Immunol 2007. [DOI: 10.1016/j.jaci.2006.11.511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Philippou H, Rice G, Bivins M, Moss M, Shivarajah V, Grant P. ID: 167 Proteolytic Regulation of Activated Coagulation Factor XIII by Plasmin: A Novel Mechanism to Regulate Thrombus Formation and Clot Stability. J Thromb Haemost 2006. [DOI: 10.1111/j.1538-7836.2006.00167.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: 11/29/2022]
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Khan J, Burnham EL, Moss M. Acquired weakness in the ICU: critical illness myopathy and polyneuropathy. Minerva Anestesiol 2006; 72:401-6. [PMID: 16682908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Illnesses commonly encountered in the ICU, such as sepsis, have frequently been associated with neuromuscular weakness and may play a role in the development of CIM and CIP, whose incidence in the critically ill is greater than initially reported. Although difficult to diagnose from history and clinical/laboratory findings alone, the use of electromyographic and nerve conduction testing is helpful in establishing these diagnoses. Information regarding prognosis of these disorders is limited, and there are no specific therapies that improve outcome. Acquired neuromuscular weakness in the ICU affects a significant number of patients and may continue to affect their quality of life long after discharge. Although diagnostic techniques are readily available, additional research is necessary to obtain adequate prognostic information and therapeutic options for these patients.
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Affiliation(s)
- J Khan
- Department of Neurology, Division of Pulmonary, Allergy and Critical Care Medicine, Emory University School of Medicine, Atlanta, GA, USA.
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Burnham E, Moss M. Progenitor cells in acute lung injury. Minerva Anestesiol 2006; 72:369-74. [PMID: 16682903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
AIM Acute lung injury (ALI) and the acute respiratory distress syndrome (ARDS) are common and serious pulmonary illnesses associated with a high morbidity and mortality. A specific therapy that improves outcomes in these disorders has not been forthcoming. There is growing interest to explore novel therapies, namely stem cells, to repair damage to the lung that is observed in these disorders. In this manuscript, stem cell investigations in the field of pulmonary medicine are delineated, with a focus on endothelial progenitor cells (EPCs) in the setting of ALI. METHODS A review of the pertinent literature in this field is presented, including recent investigations in animal models. Work related to the assessment of EPCs in human subjects after transplantation and in patients with pneumonia is described. The measurement of circulating EPCs in those with ALI is presented in detail. RESULTS Patients with ALI have an increased number of circulating EPCs than do healthy controls. Further, a greater number of circulating EPCs is associated with improved outcomes in a multivariable analysis correcting for the effects of age, gender, and severity of illness scores. CONCLUSIONS EPCs represent a rapidly expanding interest in critical care medicine. However, their specific properties and utilities with regards to lung injury need to be further delineated prior to their use in the therapy of ALI.
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Affiliation(s)
- E Burnham
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
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Esper A, Burnham EL, Moss M. The effect of alcohol abuse on ARDS and multiple organ dysfunction. Minerva Anestesiol 2006; 72:375-81. [PMID: 16682904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
A history of alcohol abuse is very common and many times unrecognized in critically ill patients. The consequences of alcohol abuse are multifactorial, and it is associated with excessive morbidity and increased mortality. Alcohol causes acute and chronic dysfunction in multiple organ systems, and the underlying mechanisms responsible for organ injury are complex. In adults with septic shock, a history of alcohol abuse is associated with an increased incidence of Acute Respiratory Distress Syndrome (ARDS) and the development of more severe organ dysfunction. This increased susceptibility to developing acute lung injury has been evaluated by many investigators, and the common variable appears to be oxidative stress. In this article, we review the epidemiology of alcohol abuse and its association with ARDS. In addition, we provide an overview of the mechanisms thought to contribute to ARDS and multiple organ dysfunction.
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Affiliation(s)
- A Esper
- Division of Pulmonary, Allergy and Critical Care Medicine, Grady Memorial Hospital, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
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Abstract
The current practice for CT scanning of paediatric patients in Australia has been assessed through a survey sent to the site of all CT scanners licensed in New South Wales and all dedicated children's hospitals in Australia. The survey addressed demographic details, CT scanner details and scanning parameters for four imaging scenarios (brain CT, chest CT, abdomen/pelvis CT and high-resolution chest CT for three different age groups (8 weeks, 5-7 years and adult patients). The effective dose for each imaging scenario and age group was calculated and compared for 52 sites representing 53 CT scanners. For any age group and imaging scenario, there was a large spread of effective dose. For comparable CT examinations, the effective dose varied by up to 36-fold between centres. There was a clear trend for centres that frequently carry out CT scans on paediatric patients to have the lowest radiation doses. Four age group/imaging scenarios showed significantly lower effective doses for hospital-based CT than for nonhospital sites. There was also a trend for doses to be lower at dedicated paediatric centres. Effective dose was closely associated with mAs, with most centres using lower mAs for younger patients, but few centres reduced the kVp for paediatric patients. The results of the survey emphasize the need for continuing education and protocol review, particularly in paediatric CT examinations, in a complex and fast changing environment.
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Affiliation(s)
- M Moss
- Department of Diagnostic Radiology, Royal North Shore Hospital, New South Wales, Australia.
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Sharma H, Singh GK, Gupta M, Moss M. Type IIIB tibial intercondylar eminence fracture associated with a complex knee dislocation in a grossly obese adult. Knee Surg Sports Traumatol Arthrosc 2005; 13:313-6. [PMID: 15875163 DOI: 10.1007/s00167-004-0520-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2003] [Accepted: 02/19/2004] [Indexed: 10/26/2022]
Abstract
Avulsion fractures of the intercondylar eminence or tibial spine mostly occur in children and adolescents, and are extremely uncommon in adults. A type IIIB intercondylar eminence fracture (i.e. completely displaced and rotated tibial spine) associated with a complex knee dislocation is an extremely rare combination.
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Affiliation(s)
- H Sharma
- Department of Trauma and Orthopaedics, Southern General Hospital, Glasgow, G51 4TF, UK.
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Selbitz HJ, Moss M. Tierärztliche Impfpraxis. SCHWEIZ ARCH TIERH 2004. [DOI: 10.1024/0036-7281.146.7.346a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Hani A, Moss M, Cooper D, Morroni C, Hoffman M. Informed choice--the timing of postpartum contraceptive initiation. S Afr Med J 2003; 93:862-4. [PMID: 14677513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND In South Africa injectable progestogen-only contraceptives (IPC) are typically administered to women immediately after delivery. Several guidelines advise that breast-feeding women should not commence IPC until 6 weeks postpartum on the basis of theoretical risks to the infant. OBJECTIVE We examined women's preferences regarding timing of postpartum IPC initiation, as well as women's contraceptive and breast-feeding behaviours and pregnancy risk in the early postpartum period. DESIGN AND DATA COLLECTION: A cross-sectional study was conducted among 200 antenatal clinic (ANC) attendees and 180 mothers attending a child health clinic (CHC). At the ANC, women were given information on the theoretical risks of IPC and re-interviewed about their postpartum contraceptive intentions. RESULTS Most ANC women planned to use IPCs (92%) and to breast-feed (98%) after delivery. Most CHC mothers had used IPCs (91%) and had breast-fed (83%) after delivery. When women at the ANC were provided with appropriate information they made decisions about when to initiate IPC by balancing the theoretical risks of IPC to their infant against their personal risk of pregnancy and ability to return to a clinic in the early postpartum period. CONCLUSION It is important to include informed choice in postpartum IPC initiation guidelines.
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Affiliation(s)
- A Hani
- Women's Health Research Unit, School of Public Health and Primary Health Care, University of Cape Town
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Bower EA, Moore JL, Moss M, Selby KA, Austin M, Meeves S. The effects of single-dose fexofenadine, diphenhydramine, and placebo on cognitive performance in flight personnel. Aviat Space Environ Med 2003; 74:145-52. [PMID: 12602446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
BACKGROUND Sedation and functional impairments are side effects associated with the use of first-generation antihistamines that preclude their use in aviation. Selected second-generation antihistamines do not have such side effects and have been proposed for use in aircrew. METHODS Forty-two healthy naval aviation personnel served as subjects in this double-blind, randomized, placebo-controlled crossover study. Subjective drowsiness, cognitive performance, and vigilance were measured under three conditions: 180 mg fexofenadine (F), 50 mg diphenhydramine (D) as a positive control, or placebo (P). RESULTS Subjects receiving F vs. D tended to have a faster mean hit reaction time (adjusted mean difference +/- SE, -10.5 +/- 6.8 ms, p = 0.127). Subjects performed faster and better with F vs. D on measures of omission errors and commission errors (p < 0.05). Variable symbol digit coding delayed recall accuracy was better for F vs. D (p = 0.023), and approached significance for shifting attention and divided attention tasks (p = 0.062 and p = 0.057, respectively). Subjects reported significantly more drowsiness (p < 0.005) with D than F. CONCLUSIONS Diphenhydramine administration resulted in significant psychomotor decrements compared with fexofenadine, while the effects of fexofenadine were similar to placebo. These results provide additional support for the safe use of fexofenadine by aviation personnel.
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Affiliation(s)
- E A Bower
- Department of Internal Medicine, Naval Hospital Pensacola, FL 32512-0003, USA.
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Neave N, Scholey AB, Emmett JR, Moss M, Kennedy DO, Wesnes KA. Water ingestion improves subjective alertness, but has no effect on cognitive performance in dehydrated healthy young volunteers. Appetite 2001; 37:255-6. [PMID: 11895329 DOI: 10.1006/appe.2001.0429] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- N Neave
- Human Cognitive Neuroscience Unit, Division of Psychology, University of Northumbria, Newcastle upon Tyne, NE1 8ST, UK.
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Conway JG, Andrews RC, Beaudet B, Bickett DM, Boncek V, Brodie TA, Clark RL, Crumrine RC, Leenitzer MA, McDougald DL, Han B, Hedeen K, Lin P, Milla M, Moss M, Pink H, Rabinowitz MH, Tippin T, Scates PW, Selph J, Stimpson SA, Warner J, Becherer JD. Inhibition of tumor necrosis factor-alpha (TNF-alpha) production and arthritis in the rat by GW3333, a dual inhibitor of TNF-alpha-converting enzyme and matrix metalloproteinases. J Pharmacol Exp Ther 2001; 298:900-8. [PMID: 11504783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023] Open
Abstract
Tumor necrosis factor-alpha (TNF)-converting enzyme (TACE) cleaves the precursor form of TNF, allowing the mature form to be secreted into the extracellular space. GW3333, a dual inhibitor of TACE and matrix metalloproteinases (MMPs), was compared with an anti-TNF antibody to evaluate the importance of soluble TNF and MMPs in rat models of arthritis. Oral administration of GW3333 completely blocked increases in plasma TNF after LPS for up to 12 h. In a model wherein intrapleural zymosan injection causes an increase in TNF in the pleural cavity, GW3333 completely inhibited the increase in TNF in the pleural cavity for 12 h. Under these dosing conditions, the plasma levels of unbound GW3333 were at least 50-fold above the IC(50) values for inhibition of individual MMPs in vitro. In a model wherein bacterial peptidoglycan polysaccharide polymers reactivate a local arthritis response in the ankle, a neutralizing anti-TNF antibody completely blocked the ankle swelling over the 3-day reactivation period. GW3333 administered b.i.d. over the same period also inhibited ankle swelling, with the highest dose of 80 mg/kg being slightly less active than the anti-TNF antibody. In a 21-day adjuvant arthritis model, the anti-TNF antibody did not inhibit the ankle swelling or the joint destruction, as assessed by histology or radiology. GW3333, however, showed inhibition of both ankle swelling and joint destruction. In conclusion, GW3333 is the first inhibitor with sufficient duration of action to chronically inhibit TACE and MMPs in the rat. The efficacy of GW3333 suggests that dual inhibitors of TACE and matrix metalloproteinases may prove therapeutic as antiarthritics.
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Affiliation(s)
- J G Conway
- Glaxo Wellcome Inc., Research Triangle Park, North Carolina 27709, USA.
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Moss M. Novel proteases for drug discovery. Drug Discov Today 2001; 6:770. [PMID: 11470583 DOI: 10.1016/s1359-6446(01)01902-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- M Moss
- Cognosci 2 Davis Drive PO Box 12076 Research 27709, Triangle Park NC, USA
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Chaky J, Anderson K, Moss M, Vaillancourt L. Surface Hydrophobicity and Surface Rigidity Induce Spore Germination in Colletotrichum graminicola. Phytopathology 2001; 91:558-564. [PMID: 18943944 DOI: 10.1094/phyto.2001.91.6.558] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
ABSTRACT We investigated the relationship between physical characteristics of artificial surfaces, spore attachment, and spore germination in Colletotrichum graminicola. Surface hydrophobicity and surface rigidity were both signals for breaking dormancy and initiating spore germination, but spore attachment alone was not an important inducing signal. The presence of a carbon source overrode the necessity for a rigid, hydrophobic substrate for spore germination. Spore attachment was typically stronger to more hydrophobic surfaces, but certain hydrophilic surfaces also proved to be good substrates for spore attachment. In contrast to spore germination, appressorial induction was more dependent on attachment to a rigid substrate than it was on surface hydrophobicity. Appressoria were induced efficiently on hydrophilic surfaces, as long as there was significant conidial attachment to those surfaces.
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Abstract
Confidential Enquiries into Stillbirths and Deaths in Infancy (CESDI) have pointed to a high frequency of suboptimal intrapartum fetal care of a kind that, in the event of an adverse outcome, is hard to defend in court. In an effort to minimize liability, various strategies were applied in a district hospital labour ward--guidelines, cyclical audit, monthly feedback meetings and training sessions in cardiotocography (CTG). The effects of these interventions on quality of care was assessed by use of the CESDI system in all babies born with an Apgar score of 4 or less at 1 min and/or 7 or less at 5 min. 540 babies (4.3%) had low Apgar scores, and neither the percentage nor gestational age differed significantly between audit periods. In the baseline audit, care was judged suboptimal (grade II/III) in 14 (74%) of 19 cases, and in the next four periods it was 23%, 27%, 27% and 32%. In the latest audit period, after further educational interventions, it was 9%. Many of the failures to recognize or act on abnormal events were related to CTG interpretation. After the interventions there was a significant increase in cord blood pH measurement. There were no differences between audit periods in the proportion of babies with cord pH < 7.2. These results indicate that substantial improvements in quality of intrapartum care can be achieved by a programme of clinical risk management.
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Affiliation(s)
- P Young
- North Staffordshire Hospital NHS Trust, Ward 59, Maternity Unit, Newcastle Road, Stoke-on-Trent, ST4 6QG
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Abstract
OBJECTIVE To identify specific comorbid factors that are present in US decedents with ARDS. DESIGN We searched the 1993 National Mortality Followback Study for all decedents who had a code for ARDS mentioned on their death certificate. We also searched for comorbid conditions both on the death certificates (sepsis, medical or surgical misadventures, cirrhosis) and in the study database (current or former smoking, use of alcohol at least 3 d/wk, race, gender, and age). We calculated proportional mortality ratios (PMRs) for these risk factors. RESULTS Of the 19,003 decedents for whom data were available, 252 decedents, representing an estimated 19,460 US decedents, had ARDS listed on their death certificate. PMRs among decedents with ARDS were significantly increased for medical or surgical misadventures (PMR, 11.8; 95% confidence interval [CI], 3.8 to 36.7), sepsis (PMR, 5.6; 95% CI, 2.0 to 16.0), nonwhite race (PMR, 2.6; 95% CI, 1.4 to 5.0), and cirrhosis (PMR, 2.2; 95% CI, 1.1 to 4.6). PMRs were increased but not statistically significant for current smokers (PMR, 1.2; 95% CI, 0.5 to 3.0) or former smokers (PMR, 1.8; 95% CI, 0.7 to 4.3) compared to never smokers, and drinking alcohol on > or = 3 d/wk in the year prior to death, when compared to drinking alcohol less than < 3 d/wk (PMR, 1.8; 95% CI, 0.6 to 4.9). CONCLUSIONS The results of this study confirm the positive associations between ARDS mortality and the presence of sepsis and cirrhosis, and suggest possible new relationships between ARDS mortality and nonwhite individuals and patients with medical or surgical misadventures.
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Affiliation(s)
- T TenHoor
- Division of Pulmonary and Critical Care Medicine, Departments of Medicine, Emory University School of Medicine and Crawford Long Hospital of Emory University, Atlanta, GA 30365-2225, USA
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Burnham E, Moss M. A potential new therapy for sepsis: learning from experience. Crit Care Med 2001; 29:690-1. [PMID: 11379545 DOI: 10.1097/00003246-200103000-00052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
OBJECTIVES The objective was to derive and test the psychometric characteristics of a scale to measure Valuation of Life (VOL). METHODS Four samples were used in successive phases of exploratory factor analysis, confirmatory factor analysis, reliability and validity testing, and exploration of response-error effects. Estimates of Years of Desired Life were obtained under a variety of hypothetical quality-of-life (QOL)-compromising conditions of poor health. RESULTS Confirmed 13-item (Positive VOL) and 6-item (Negative VOL) factors were obtained. A significant relationship between VOL and most Years of Desired Life estimates remained when demographic, health, quality of life, and mental health measures were controlled. Analysis of Negative VOL revealed that some respondents misunderstand the meaning of an agree response to negatively phrased items. DISCUSSION VOL is a cognitive-affective schema whose function as a mediator and moderator between health and end-of-life decisions deserves further research.
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Affiliation(s)
- M P Lawton
- Polisher Research Institute, Philadelphia Geriatric Center, USA
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Quasney MW, Goodman DM, Billow M, Chiu H, Easterling L, Frankel L, Habib D, Heitschmidt M, Kurachek S, Moler F, Montgomery V, Moss M, Murman S, Rice T, Richman B, Tilden S. Routine chest radiographs in pediatric intensive care units. Pediatrics 2001; 107:241-8. [PMID: 11158453 DOI: 10.1542/peds.107.2.241] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To determine whether interventions were performed based on portable routine morning chest x-rays (CXRs) in pediatric intensive care unit (PICU) patients and to identify patient subgroups for whom the routine CXR is most useful. DESIGN Prospective multiinstitutional study. Setting. PICUs of 15 tertiary care hospitals. Patients. PICU patients who received a routine morning CXR were included in the study. OUTCOME MEASURES Recorded data included: weight, diagnosis, presence of active cardiopulmonary problems, length of stay, and number and type of devices. The number and types of interventions based on the interpretation of the CXR were recorded. RESULTS Five hundred twelve routine CXRs were evaluated. The majority of the routine chest radiographs were obtained on patients who were admitted for cardiovascular disease (195/512; 38%) or respiratory failure (186/512; 36%), and 465/512 of the routine CXRs (91%) were performed on patients with one or more devices. Two hundred thirty-one of the 512 routine CXRs (45%) resulted in 1 or more interventions. One hundred fifty-five of the 284 routine CXRs (55%) obtained in children </=10 kg resulted in one or more interventions, compared with 61/152 (40%) and 15/76 (20%) of routine CXRs obtained in children 10 to 40 kg and >/=40 kg, respectively. The frequency of interventions increased from 19% in children with no devices to >50% in children with 2 or more devices. One or more interventions were performed in 27% of routine CXRs when no active cardiopulmonary problems were present, compared with 51% of routine CXRs when active cardiopulmonary problems were present. Diagnosis and length of intensive care unit stay at the time the routine CXR was obtained did not affect the percentage of CXRs that resulted in interventions. CONCLUSIONS Routine CXRs are more likely to result in interventions in the smaller, critically ill child with one or more devices and if active cardiopulmonary problems are present.
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Affiliation(s)
- M W Quasney
- Department of Pediatrics, Crippled Children's Foundation Research Center, Le Bonheur Children's Medical Center, University of Tennessee, Memphis, Tennessee 38103, USA.
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Neave N, Reid C, Scholey AB, Thompson JM, Moss M, Ayre G, Wesnes K, Girdler NM. Dose-dependent effects of flumazenil on cognition, mood, and cardio-respiratory physiology in healthy volunteers. Br Dent J 2000; 189:668-74. [PMID: 11191179 DOI: 10.1038/sj.bdj.4800860] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [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: 11/09/2022]
Abstract
OBJECTIVES To assess the possible effects of flumazenil on cognitive processing, physiology, and mood. Design A double-blind, placebo controlled, four-way cross-over study, using healthy volunteers. METHODS On each of 4 separate visits, 16 participants received 0.5 mg, 2.5 mg, 5.0 mg of flumazenil, or normal saline. They then performed a computerised test battery assessing cognitive function. Measures of pulse rate, arterial oxygen saturation and mean arterial pressure were also taken. Finally, participants completed visual analogue scales assessing their subjective mood state. RESULTS The majority of cognitive tasks showed dose-dependent declines in performance. Mean arterial pressure was significantly reduced, as was pulse rate. Subjective alertness showed a similar decline. CONCLUSIONS Flumazenil has been clinically described as an agent with few intrinsic properties, whose primary effect lies in its ability to reverse benzodiazepine-induced states. This study has shown that flumazenil does possess intrinsic activity which have a significant effect on cognition, cardiovascular physiology and mood. Clinicians need to be aware of these effects.
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Affiliation(s)
- N Neave
- Division of Psychology, University of Northumbria, Newcastle Upon Tyne, UK.
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Neave N, Reid C, Scholey A, Thompson J, Moss M, Ayre G, Wesnes K, Girdler N. Dose-dependent effects of Flumazenil on cognition, mood, and cardio-respiratory physiology in healthy volunteers. Br Dent J 2000. [DOI: 10.1038/sj.bdj.4800860a] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Maloney JP, Halbower AC, Fouty BF, Fagan KA, Balasubramaniam V, Pike AW, Fennessey PV, Moss M. Systemic absorption of food dye in patients with sepsis. N Engl J Med 2000; 343:1047-8. [PMID: 11023403 DOI: 10.1056/nejm200010053431416] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Abstract
Daughters and daughters-in-law of presently unmarried elders were studied longitudinally, and the data were analyzed to determine how two transitions in caregiving status affected the women of the younger generation. One transition compared noncaregivers who had become caregivers 1 year later ("caregiving entrants," n = 33) with continuing noncaregivers (n = 56) and with veteran continuing caregivers (n = 78) over the same period. The second transition followed Time 1 new caregivers as they became "new veteran" caregivers (n = 69), comparing them with "old veteran" caregivers (n = 189) over the same year. The transition to caregiving was marked by a decrease in the care receiver's competence and an increase in the amount of care received, but caregiving entrants' quality of life did not change significantly over 1 year, as compared with either continuing noncaregivers or veteran caregivers. Although longitudinal study shows little positive evidence for the wear-and-tear model of caregiving, methodological improvements are needed before discarding the hypothesis that caregiving erodes mental health.
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Affiliation(s)
- M P Lawton
- Polisher Research Institute, Temple Continuing Care Center, Philadelphia Geriatric Center, PA 19141-2996, USA.
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Moss M, Guidot DM, Steinberg KP, Duhon GF, Treece P, Wolken R, Hudson LD, Parsons PE. Diabetic patients have a decreased incidence of acute respiratory distress syndrome. Crit Care Med 2000; 28:2187-92. [PMID: 10921539 DOI: 10.1097/00003246-200007000-00001] [Citation(s) in RCA: 167] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Our ability to predict which critically ill patients will develop acute respiratory distress syndrome (ARDS) is imprecise. Based on the effects of diabetes mellitus on the inflammatory cascade, we hypothesized that a history of diabetes might alter the incidence of ARDS. DESIGN A prospective multicenter study. SETTING Intensive care units at four university medical centers. PATIENTS One hundred thirteen consecutive patients with septic shock. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS All patients were prospectively followed during their intensive care course for the development of ARDS. A history of diabetes was identified in 28% (32/113) of the patients. In this study, nondiabetics were more likely to develop septic shock from a pulmonary source (48%, 39/81) compared with diabetics (25%, 8/32) (p = .02). Forty-one percent (46/113) of the patients with septic shock developed ARDS. Forty-seven percent of the nondiabetic patients developed ARDS compared with only 25% of those with diabetes (p = .03, relative risk = 0.53, 95% confidence interval = 0.28-0.98). In a multivariate logistic regression analysis, when we adjusted for several variables including source of infection, the effect of diabetes on the incidence of ARDS remained significant (p = .03, odds ratio = 0.33, 95% confidence interval = 0.12-0.90). CONCLUSIONS In patients with septic shock, a history of diabetes is associated with a lower risk of developing ARDS compared with nondiabetics.
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Affiliation(s)
- M Moss
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
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Haubrock M, Moers M, Moss M. [Professional diploma course: nursing and health management--aim and profile of a course]. Pflege Z 2000; 53:343-4. [PMID: 11040743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
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Killiany RJ, Gomez-Isla T, Moss M, Kikinis R, Sandor T, Jolesz F, Tanzi R, Jones K, Hyman BT, Albert MS. Use of structural magnetic resonance imaging to predict who will get Alzheimer's disease. Ann Neurol 2000; 47:430-9. [PMID: 10762153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
We used magnetic resonance imaging (MRI) measurements to determine whether persons in the prodromal phase of Alzheimer's disease (AD) could be accurately identified before they developed clinically diagnosed dementia. Normal subjects (n = 24) and those with mild memory difficulty (n = 79) received an MRI scan at baseline and were then followed annually for 3 years to determine which individuals subsequently met clinical criteria for AD. Patients with mild AD at baseline were also evaluated (n = 16). Nineteen of the 79 subjects with mild memory difficulty "converted" to a diagnosis of probable AD after 3 years of follow-up. Baseline MRI measures of the entorhinal cortex, the banks of the superior temporal sulcus, and the anterior cingulate were most useful in discriminating the status of the subjects on follow-up examination. The accuracy of discrimination was related to the clinical similarity between groups. One hundred percent (100%) of normal subjects and patients with mild AD could be discriminated from one another based on these MRI measures. When the normals were compared with the individuals with memory impairments who ultimately developed AD (the converters), the accuracy of discrimination was 93%, based on the MRI measures at baseline (sensitivity = 0.95; specificity = 0.90). The discrimination of the normal subjects and the individuals with mild memory problems who did not progress to the point where they met clinical criteria for probable AD over the 3 years of follow-up (the "questionables") was 85% and the discrimination of the questionables and converters was 75%. The apolipoprotein E genotype did not improve the accuracy of discrimination. The specific regions selected for each of these discriminations provides information concerning the hierarchical fashion in which the pathology of AD may affect the brain during its prodromal phase.
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Affiliation(s)
- R J Killiany
- Department of Anatomy and Neurobiology, Boston University, MA, USA
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Moss M, Guidot DM, Wong-Lambertina M, Ten Hoor T, Perez RL, Brown LA. The effects of chronic alcohol abuse on pulmonary glutathione homeostasis. Am J Respir Crit Care Med 2000; 161:414-9. [PMID: 10673179 DOI: 10.1164/ajrccm.161.2.9905002] [Citation(s) in RCA: 175] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The incidence and severity of the acute respiratory distress syndrome (ARDS) is increased in critically ill patients with a prior history of chronic alcohol abuse; however, the specific mechanisms responsible for this association are unknown. Recently, we determined that chronic ethanol ingestion in rats decreased the alveolar epithelial lining fluid (ELF) concentration of the antioxidant glutathione (GSH), which is a characteristic finding in patients with ARDS. However, the effects of chronic alcohol abuse on the human alveolar epithelium are essentially unknown. Therefore, as a first step we asked if chronic alcohol abuse, independent of other comorbid conditions, decreases the concentration of GSH in the human lung. We determined that otherwise healthy chronic alcoholics had significantly decreased ELF concentrations of GSH compared with nonalcoholic control subjects (79 micromol [48 to 118 micromol] versus 576 micromol [493 to 728 mmol], p < 0.001). Furthermore, the percentage of GSH in the oxidized form was higher in the chronic alcoholics (9.8% [2.2 to 14.8%] versus 2.8% [0.4 to 4.0%] p = 0.05), indicative of increased utilization of GSH. This is the first report that chronic alcohol abuse alters GSH homeostasis in the human lung, and suggests a potential mechanism by which chronic alcohol abuse predisposes susceptible patients to develop ARDS.
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Affiliation(s)
- M Moss
- Department of Medicine, Division of Pulmonary and Critical Care, Emory University School of Medicine, Atlanta, Georgia 30365, USA.
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Abstract
STUDY OBJECTIVES To determine whether the type of paging system causes significant differences in the response time by physicians to their pages in an ICU setting. DESIGN AND SETTING Prospective cohort study performed in the ICU of two university-affiliated hospitals. All pages were classified by several different variables, including the type of paging system: direct paging if a nurse or hospital operator could directly place the page, or indirect paging if a nurse or hospital operator was required to contact the physician's office or a private answering service who would then independently contact the physician. The main outcome measure was physicians' response time, in minutes, to pages originating from the ICU. RESULTS During a 100-day period, 402 pages were sent and answered by 166 different physicians (87 attending physicians and 79 housestaff/physician assistants). The median response time for all pages was 3 min with a 25 to 75% quartile of 1 to 8 min. Twenty-five percent of the pages placed through an indirect system were associated with a response time of >/= 29 min. In a multivariate model with the response time dichotomized at >/= 15 min ("slow") or < 15 min ("adequate"), pages placed through an indirect system were answered significantly more slowly than pages placed through a direct system (p < 0.001; odds ratio, 4.36; 95% confidence interval, 2.05 to 9.29). Pages answered in an adequate amount of time were also associated with a significantly higher degree of overall nursing satisfaction with the care delivered by the physician in response to the specific page when compared with pages answered in a "slow" manner (p < 0.001). CONCLUSIONS Physicians who use an indirect paging system are significantly slower in their response to ICU pages when compared with physicians who utilize a direct paging system. These results may lead to improvements in paging systems used by physicians who care for patients in an ICU setting.
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Affiliation(s)
- M Moss
- Department of Medicine, Emory University School of Medicine, Atlanta, GA.
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Moss M, Freed DL. Survival trends, coronary event rates, and the MONICA project. Monitoring trends and determinants in cardiovascular disease. Lancet 1999; 354:862; author reply 863-4. [PMID: 10485744 DOI: 10.1016/s0140-6736(99)80043-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
This research investigated the relationship of an affective-cognitive schema, valuation of life (VOL), to older people's responses to a set of health utility (years of desired life) questions. Six hundred healthy and chronically ill elders aged 70 and older were interviewed to measure quality of life (QOL), mental health, and VOL. Valuation of life was significantly correlated with longer Years of Desired Life under 8 of 10 health conditions when background, health, QOL, and mental health states were controlled. We concluded that VOL is an internal representation of the many positive and negative features of the person and her everyday life that is necessary to comprehend how people may cling to life or welcome its end.
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Affiliation(s)
- M P Lawton
- Polisher Research Institute, Philadelphia Geriatric Center, PA 19141, USA
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