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Goodacre S, Sutton L, Ennis K, Thomas B, Hawksworth O, Iftikhar K, Croft SJ, Fuller G, Waterhouse S, Hind D, Stevenson M, Bradburn MJ, Smyth M, Perkins GD, Millins M, Rosser A, Dickson J, Wilson M. Prehospital early warning scores for adults with suspected sepsis: the PHEWS observational cohort and decision-analytic modelling study. Health Technol Assess 2024; 28:1-93. [PMID: 38551135 PMCID: PMC11017155 DOI: 10.3310/ndty2403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024] Open
Abstract
Background Guidelines for sepsis recommend treating those at highest risk within 1 hour. The emergency care system can only achieve this if sepsis is recognised and prioritised. Ambulance services can use prehospital early warning scores alongside paramedic diagnostic impression to prioritise patients for treatment or early assessment in the emergency department. Objectives To determine the accuracy, impact and cost-effectiveness of using early warning scores alongside paramedic diagnostic impression to identify sepsis requiring urgent treatment. Design Retrospective diagnostic cohort study and decision-analytic modelling of operational consequences and cost-effectiveness. Setting Two ambulance services and four acute hospitals in England. Participants Adults transported to hospital by emergency ambulance, excluding episodes with injury, mental health problems, cardiac arrest, direct transfer to specialist services, or no vital signs recorded. Interventions Twenty-one early warning scores used alongside paramedic diagnostic impression, categorised as sepsis, infection, non-specific presentation, or other specific presentation. Main outcome measures Proportion of cases prioritised at the four hospitals; diagnostic accuracy for the sepsis-3 definition of sepsis and receiving urgent treatment (primary reference standard); daily number of cases with and without sepsis prioritised at a large and a small hospital; the minimum treatment effect associated with prioritisation at which each strategy would be cost-effective, compared to no prioritisation, assuming willingness to pay £20,000 per quality-adjusted life-year gained. Results Data from 95,022 episodes involving 71,204 patients across four hospitals showed that most early warning scores operating at their pre-specified thresholds would prioritise more than 10% of cases when applied to non-specific attendances or all attendances. Data from 12,870 episodes at one hospital identified 348 (2.7%) with the primary reference standard. The National Early Warning Score, version 2 (NEWS2), had the highest area under the receiver operating characteristic curve when applied only to patients with a paramedic diagnostic impression of sepsis or infection (0.756, 95% confidence interval 0.729 to 0.783) or sepsis alone (0.655, 95% confidence interval 0.63 to 0.68). None of the strategies provided high sensitivity (> 0.8) with acceptable positive predictive value (> 0.15). NEWS2 provided combinations of sensitivity and specificity that were similar or superior to all other early warning scores. Applying NEWS2 to paramedic diagnostic impression of sepsis or infection with thresholds of > 4, > 6 and > 8 respectively provided sensitivities and positive predictive values (95% confidence interval) of 0.522 (0.469 to 0.574) and 0.216 (0.189 to 0.245), 0.447 (0.395 to 0.499) and 0.274 (0.239 to 0.313), and 0.314 (0.268 to 0.365) and 0.333 (confidence interval 0.284 to 0.386). The mortality relative risk reduction from prioritisation at which each strategy would be cost-effective exceeded 0.975 for all strategies analysed. Limitations We estimated accuracy using a sample of older patients at one hospital. Reliable evidence was not available to estimate the effectiveness of prioritisation in the decision-analytic modelling. Conclusions No strategy is ideal but using NEWS2, in patients with a paramedic diagnostic impression of infection or sepsis could identify one-third to half of sepsis cases without prioritising unmanageable numbers. No other score provided clearly superior accuracy to NEWS2. Research is needed to develop better definition, diagnosis and treatments for sepsis. Study registration This study is registered as Research Registry (reference: researchregistry5268). Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 17/136/10) and is published in full in Health Technology Assessment; Vol. 28, No. 16. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Steve Goodacre
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
- Emergency Department, Northern General Hospital, Sheffield, UK
| | - Laura Sutton
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Kate Ennis
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Ben Thomas
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Olivia Hawksworth
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | | | - Susan J Croft
- Emergency Department, Northern General Hospital, Sheffield, UK
| | - Gordon Fuller
- Emergency Department, Northern General Hospital, Sheffield, UK
| | - Simon Waterhouse
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Daniel Hind
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Matt Stevenson
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Mike J Bradburn
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Michael Smyth
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Gavin D Perkins
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Mark Millins
- Yorkshire Ambulance Service NHS Trust, Wakefield, UK
| | - Andy Rosser
- West Midlands Ambulance Service University NHS Foundation Trust, Midlands, UK
| | - Jon Dickson
- Academic Unit of Primary Medical Care, University of Sheffield, Sheffield, UK
| | - Matthew Wilson
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
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Berg KM, Bray JE, Ng KC, Liley HG, Greif R, Carlson JN, Morley PT, Drennan IR, Smyth M, Scholefield BR, Weiner GM, Cheng A, Djärv T, Abelairas-Gómez C, Acworth J, Andersen LW, Atkins DL, Berry DC, Bhanji F, Bierens J, Bittencourt Couto T, Borra V, Böttiger BW, Bradley RN, Breckwoldt J, Cassan P, Chang WT, Charlton NP, Chung SP, Considine J, Costa-Nobre DT, Couper K, Dainty KN, Dassanayake V, Davis PG, Dawson JA, Fernanda de Almeida M, De Caen AR, Deakin CD, Dicker B, Douma MJ, Eastwood K, El-Naggar W, Fabres JG, Fawke J, Fijacko N, Finn JC, Flores GE, Foglia EE, Folke F, Gilfoyle E, Goolsby CA, Granfeldt A, Guerguerian AM, Guinsburg R, Hatanaka T, Hirsch KG, Holmberg MJ, Hosono S, Hsieh MJ, Hsu CH, Ikeyama T, Isayama T, Johnson NJ, Kapadia VS, Daripa Kawakami M, Kim HS, Kleinman ME, Kloeck DA, Kudenchuk P, Kule A, Kurosawa H, Lagina AT, Lauridsen KG, Lavonas EJ, Lee HC, Lin Y, Lockey AS, Macneil F, Maconochie IK, John Madar R, Malta Hansen C, Masterson S, Matsuyama T, McKinlay CJD, Meyran D, Monnelly V, Nadkarni V, Nakwa FL, Nation KJ, Nehme Z, Nemeth M, Neumar RW, Nicholson T, Nikolaou N, Nishiyama C, Norii T, Nuthall GA, Ohshimo S, Olasveengen TM, Gene Ong YK, Orkin AM, Parr MJ, Patocka C, Perkins GD, Perlman JM, Rabi Y, Raitt J, Ramachandran S, Ramaswamy VV, Raymond TT, Reis AG, Reynolds JC, Ristagno G, Rodriguez-Nunez A, Roehr CC, Rüdiger M, Sakamoto T, Sandroni C, Sawyer TL, Schexnayder SM, Schmölzer GM, Schnaubelt S, Semeraro F, Singletary EM, Skrifvars MB, Smith CM, Soar J, Stassen W, Sugiura T, Tijssen JA, Topjian AA, Trevisanuto D, Vaillancourt C, Wyckoff MH, Wyllie JP, Yang CW, Yeung J, Zelop CM, Zideman DA, Nolan JP. 2023 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces. Resuscitation 2024; 195:109992. [PMID: 37937881 DOI: 10.1016/j.resuscitation.2023.109992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
The International Liaison Committee on Resuscitation engages in a continuous review of new, peer-reviewed, published cardiopulmonary resuscitation and first aid science. Draft Consensus on Science With Treatment Recommendations are posted online throughout the year, and this annual summary provides more concise versions of the final Consensus on Science With Treatment Recommendations from all task forces for the year. Topics addressed by systematic reviews this year include resuscitation of cardiac arrest from drowning, extracorporeal cardiopulmonary resuscitation for adults and children, calcium during cardiac arrest, double sequential defibrillation, neuroprognostication after cardiac arrest for adults and children, maintaining normal temperature after preterm birth, heart rate monitoring methods for diagnostics in neonates, detection of exhaled carbon dioxide in neonates, family presence during resuscitation of adults, and a stepwise approach to resuscitation skills training. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, using Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces list priority knowledge gaps for further research. Additional topics are addressed with scoping reviews and evidence updates.
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Berg KM, Bray JE, Ng KC, Liley HG, Greif R, Carlson JN, Morley PT, Drennan IR, Smyth M, Scholefield BR, Weiner GM, Cheng A, Djärv T, Abelairas-Gómez C, Acworth J, Andersen LW, Atkins DL, Berry DC, Bhanji F, Bierens J, Bittencourt Couto T, Borra V, Böttiger BW, Bradley RN, Breckwoldt J, Cassan P, Chang WT, Charlton NP, Chung SP, Considine J, Costa-Nobre DT, Couper K, Dainty KN, Dassanayake V, Davis PG, Dawson JA, de Almeida MF, De Caen AR, Deakin CD, Dicker B, Douma MJ, Eastwood K, El-Naggar W, Fabres JG, Fawke J, Fijacko N, Finn JC, Flores GE, Foglia EE, Folke F, Gilfoyle E, Goolsby CA, Granfeldt A, Guerguerian AM, Guinsburg R, Hatanaka T, Hirsch KG, Holmberg MJ, Hosono S, Hsieh MJ, Hsu CH, Ikeyama T, Isayama T, Johnson NJ, Kapadia VS, Kawakami MD, Kim HS, Kleinman ME, Kloeck DA, Kudenchuk P, Kule A, Kurosawa H, Lagina AT, Lauridsen KG, Lavonas EJ, Lee HC, Lin Y, Lockey AS, Macneil F, Maconochie IK, Madar RJ, Malta Hansen C, Masterson S, Matsuyama T, McKinlay CJD, Meyran D, Monnelly V, Nadkarni V, Nakwa FL, Nation KJ, Nehme Z, Nemeth M, Neumar RW, Nicholson T, Nikolaou N, Nishiyama C, Norii T, Nuthall GA, Ohshimo S, Olasveengen TM, Ong YKG, Orkin AM, Parr MJ, Patocka C, Perkins GD, Perlman JM, Rabi Y, Raitt J, Ramachandran S, Ramaswamy VV, Raymond TT, Reis AG, Reynolds JC, Ristagno G, Rodriguez-Nunez A, Roehr CC, Rüdiger M, Sakamoto T, Sandroni C, Sawyer TL, Schexnayder SM, Schmölzer GM, Schnaubelt S, Semeraro F, Singletary EM, Skrifvars MB, Smith CM, Soar J, Stassen W, Sugiura T, Tijssen JA, Topjian AA, Trevisanuto D, Vaillancourt C, Wyckoff MH, Wyllie JP, Yang CW, Yeung J, Zelop CM, Zideman DA, Nolan JP. 2023 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces. Circulation 2023; 148:e187-e280. [PMID: 37942682 PMCID: PMC10713008 DOI: 10.1161/cir.0000000000001179] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
The International Liaison Committee on Resuscitation engages in a continuous review of new, peer-reviewed, published cardiopulmonary resuscitation and first aid science. Draft Consensus on Science With Treatment Recommendations are posted online throughout the year, and this annual summary provides more concise versions of the final Consensus on Science With Treatment Recommendations from all task forces for the year. Topics addressed by systematic reviews this year include resuscitation of cardiac arrest from drowning, extracorporeal cardiopulmonary resuscitation for adults and children, calcium during cardiac arrest, double sequential defibrillation, neuroprognostication after cardiac arrest for adults and children, maintaining normal temperature after preterm birth, heart rate monitoring methods for diagnostics in neonates, detection of exhaled carbon dioxide in neonates, family presence during resuscitation of adults, and a stepwise approach to resuscitation skills training. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, using Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces list priority knowledge gaps for further research. Additional topics are addressed with scoping reviews and evidence updates.
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Smyth M, Drapeau DJ, Milne AD. Massive circuit leak due to a hidden cause: a fractured ventilator flow sensor. Can J Anaesth 2023; 70:2016-2017. [PMID: 37789218 DOI: 10.1007/s12630-023-02611-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 07/27/2023] [Accepted: 09/06/2023] [Indexed: 10/05/2023] Open
Affiliation(s)
- Michael Smyth
- Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, NS, Canada.
| | - Dennis J Drapeau
- Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, NS, Canada
| | - Andrew D Milne
- Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, NS, Canada
- School of Biomedical Engineering, Dalhousie University, Halifax, NS, Canada
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Shah MH, Mishra P, Smyth M. Reflective practices in medical education: fostering social responsibility and developing students' social consciousness. Adv Physiol Educ 2023; 47:757. [PMID: 37703410 DOI: 10.1152/advan.00106.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 07/14/2023] [Indexed: 09/15/2023]
Affiliation(s)
| | - Punyaslok Mishra
- School of Medicine, Queen's University Belfast, Belfast, United Kingdom
| | - Michael Smyth
- School of Medicine, Queen's University Belfast, Belfast, United Kingdom
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Michelet F, Smyth M, Lall R, Noordali H, Starr K, Berridge L, Yeung J, Fuller G, Petrou S, Walker A, Mark J, Canaway A, Khan K, Perkins GD. Randomised controlled trial of analgesia for the management of acute severe pain from traumatic injury: study protocol for the paramedic analgesia comparing ketamine and morphine in trauma (PACKMaN). Scand J Trauma Resusc Emerg Med 2023; 31:84. [PMID: 38001541 PMCID: PMC10668487 DOI: 10.1186/s13049-023-01146-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Prehospital analgesia is often required after traumatic injury, currently morphine is the strongest parenteral analgesia routinely available for use by paramedics in the United Kingdom (UK) when treating patients with severe pain. This protocol describes a multi-centre, randomised, double blinded trial comparing the clinical and cost-effectiveness of ketamine and morphine for severe pain following acute traumatic injury. METHODS A two arm pragmatic, phase III trial working with two large NHS ambulance services, with an internal pilot. Participants will be randomised in equal numbers to either (1) morphine or (2) ketamine by IV/IO injection. We aim to recruit 446 participants over the age of 16 years old, with a self-reported pain score of 7 or above out of 10. Randomised participants will receive a maximum of 20 mg of morphine, or a maximum of 30 mg of ketamine, to manage their pain. The primary outcome will be the sum of pain intensity difference. Secondary outcomes measure the effectiveness of pain relief and overall patient experience from randomisation to arrival at hospital as well as monitoring the adverse events, resource use and cost-effectiveness outcomes. DISCUSSION The PACKMAN study is the first UK clinical trial addressing the clinical and cost-effectiveness of ketamine and morphine in treating acute severe pain from traumatic injury treated by NHS paramedics. The findings will inform future clinical practice and provide insights into the effectiveness of ketamine as a prehospital analgesia. TRIAL REGISTRATION ISRCTN, ISRCTN14124474. Registered 22 October 2020, https://www.isrctn.com/ISRCTN14124474.
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Affiliation(s)
- F Michelet
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK.
| | - M Smyth
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - R Lall
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - H Noordali
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - K Starr
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - L Berridge
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - J Yeung
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
- Critical Care Directorate, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - G Fuller
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - S Petrou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - A Walker
- West Midlands Ambulance Services NHS Trust, Brierley Hill, Dudley, UK
| | - J Mark
- Yorkshire Ambulance Services NHS Trust, Wakefield, UK
| | - A Canaway
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - K Khan
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - G D Perkins
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
- Critical Care Directorate, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Lindsay JO, Picker N, Kromer D, Smyth M, Patel H. The incidence of remission and indicators of inadequate response to advanced therapy in patients with ulcerative colitis: results from medical charts in the United Kingdom. Curr Med Res Opin 2023; 39:681-689. [PMID: 36951899 DOI: 10.1080/03007995.2023.2194782] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
OBJECTIVE A considerable proportion of patients with moderate-to-severe ulcerative colitis (UC) treated with advanced therapies do not achieve remission, even after one year of treatment, and suboptimal response to advanced therapies is frequently observed in clinical practice. This study aims to analyze clinical practice data in the United Kingdom (UK) and assess the rates of clinical remission and inadequate response with advanced therapies among patients with UC. METHODS This retrospective chart review included patients with UC who initiated a new advanced therapy (i.e., adalimumab, infliximab, golimumab, tofacitinib, or vedolizumab) between January 2017 and September 2019 from eight clinics across the UK. At least 12 months of data before and after starting an advanced therapy were required. Remission was assessed using components of the Mayo score. Inadequate response was defined by therapeutic adjustment or emergency treatment. RESULTS Among 238 patients included (female: 46.6%; median age: 42.0 years; median follow-up: 28.8 months), 178 patients (74.8%) were biologic-naïve. At 12 months, 87 patients (53.9%) had achieved remission (median time to remission: 7.6 months); although 29 (33.3%) among them had required therapeutic modifications to achieve remission. At 12 months, 105 patients (44.3%) had at least one indicator of an inadequate response (median time to first indicator of inadequate response: 18.0 months). CONCLUSIONS Nearly half of patients did not achieve remission, and almost half of included patients had an inadequate response within 1 year after treatment initiation. More effective therapies are needed to effectively treat UC.
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Affiliation(s)
- James O Lindsay
- Centre for Immunobiology, Blizard Institute, Barts and the London School of Medicine, Queen Mary University of London, London, UK
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Smyth M, Lawrence S, Barakauskas V, Vallance H, Jacobson K. A37 FECAL CALPROTECTIN IN A PEDIATRIC, POPULATION-BASED STUDY: UTILITY IN DIAGNOSIS AND INFLAMMATORY BOWEL DISEASE MONITORING. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991393 DOI: 10.1093/jcag/gwac036.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Background Fecal calprotectin (FC) is a sensitive marker of intestinal inflammation, and is used to both discriminate inflammatory bowel disease (IBD) from non-IBD patients and to monitor patients with IBD. It is unclear whether normal values established in adult patients are applicable in pediatrics. Purpose To evaluate FC’s ability to differentiate IBD from non-IBD pediatric patients, and to understand factors influencing FC in pediatric IBD(pIBD). Method Stool FC samples collected on all patients<19 years of age in British Columbia(BC) from May 2020 to August 2022 were run using a Buhlmann ELISA at BC Children’s Hospital(BCCH). The BCCH GI database identified patients with IBD. FC’s ordered by adult IBD providers and patients awaiting endoscopy were excluded. The remaining samples were analysed as non-IBD. The sensitivity(Sn), negative predictive value(NPV) and false positive(FP) of FC were evaluated; comparisons were made using the Wilcoxon rank-sum test and chi-squared. Result(s) 3506 FC samples met inclusion criteria: 1853 IBD and 1653 non-IBD. 221 IBD samples were from prior to diagnosis, with median (IQR) FC 2615ug/g(1090-4183); median FC for non-IBD patients was 54ug/g(24-122). Using the Buhlmann "normal" cutoff of 80ug/g, the Sn was 0.991 (NPV 0.998) with a FP rate of 37%. Young patients were more likely to have FP's: <6yo's (n=305) had a FP rate of 42% vs 36% in those >6yo (n=1348)(p=0.035). With a FC cutoff of 160ug/g, Sn was 0.973 (NPV 0.996), with a FP rate of 20% (24% <6yo vs 19% >6yo, p=0.025). At a threshold of 250ug/g, Sn was 0.959 (NPV 0.994) with a FP rate of 13% (18% <6yo vs 12% >6yo, p=0.01). For patients <2yo, all 4 new IBD diagnosis had FC>1900ug/g. In the non-IBD population (n=69 samples <2yo), the FP rate was 52%, 30%, and 22% using a threshold of 80, 160, and 250ug/g, respectively. Evaluating FC as a disease-monitoring tool in IBD (667 patients, 1632 samples) found that at 6, 12, 18, and 24+ months post diagnosis, FC decreased from 750(159-1883), 505(110-1566), 351(87-1379), to 308ug/g(85-1129), respectively. Similarly, the proportion of FC’s <250ug/g increased from 4.1% at diagnosis to 30%, 39.7%, 41.5%, 47% during the follow up period. Patients with UC/IBD-U had higher FC’s, and were less likely to achieve FC<250ug/g. By 12 months post diagnosis, median FC of CD patients was 347ug/g(96-1150) and UC/IBD-U was 745ug/g(191-2017)(p=0.036), and at 18 months, CD 273ug/g(61-902) vs UC/IBD-U 932ug/g(144-2229)(p<0.001). At 2+yrs, median FC for CD patients was 259ug/g(76-1038) vs 387ug/g(108-1577) for UC/IC (p=0.017). Patients cared for by an IBD specialist had better FC outcomes vs those managed by non-IBD GIs: median FC at 12 months was 246ug/g(n=79) vs 677ug/g(n=153)(p=0.002), with 51% vs 34% achieving FC<250(p=0.014). Similarly, at 2+yrs post diagnosis, median FC was 243ug/g(n=437) vs 356ug/g(n=407)(p=0.02). Conclusion(s) Higher FC thresholds are likely required in younger populations compared to established adult cutoffs. In this pIBD cohort, <50% achieve FC levels <250ug/g. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared
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Affiliation(s)
| | | | | | - H Vallance
- University of British Columbia, Vancouver, Canada
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Considine J, Eastwood K, Webster H, Smyth M, Nation K, Greif R, Dainty K, Finn J, Bray J. Family presence during adult resuscitation from cardiac arrest: A systematic review. Resuscitation 2022; 180:11-23. [PMID: 36087636 DOI: 10.1016/j.resuscitation.2022.08.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/29/2022] [Accepted: 08/30/2022] [Indexed: 12/20/2022]
Abstract
AIM Objective: To conduct a systematic review of the published evidence related to family presence during adult resuscitation from cardiac arrest. METHODS This review, registered with PROSPERO (CRD42021242384) and reported according to PRISMA guidelines, included studies of adult cardiac arrest with family presence during resuscitation that reported one or more patient, family or provider outcomes. Three databases (Medline, CINAHL and EMBASE) were searched from inception to 10/05/2022. Two investigators screened the studies, extracted data, and assessed risks of bias using the Mixed Method Appraisal Tool (MMAT). The synthesis approach was guided by Synthesis Without Meta-Analysis (SWiM) reporting guidelines and a narrative synthesis method. RESULTS The search retrieved 9,459 citations of which 31 were included: 18 quantitative studies (including two RCTs), 12 qualitative studies, and one mixed methods study. The evidence was of very low or low certainty. There were four major findings. High-certainty evidence regarding the effect of family presence during resuscitation on patient outcomes is lacking. Family members had mixed outcomes in terms of depression, anxiety, post-traumatic stress disorder (PTSD) symptoms, and experience of witnessing resuscitation. Provider experience was variable and resuscitation setting, provider education, and provider experience were major influences on family presence during resuscitation. Finally, providers reported that a family support person and organisational guidelines were important for facilitating family presence during resuscitation. CONCLUSION The effect of family presence during resuscitation varies between individuals. There was variability in the effect of family presence during resuscitation on patient outcomes, family and provider outcomes and perceptions.
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Affiliation(s)
- Julie Considine
- School of Nursing and Midwifery and Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, Geelong, Australia; Centre for Quality and Patient Safety Research - Eastern Health Partnership, Box Hill, Australia.
| | - Kathryn Eastwood
- Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Ambulance Victoria, Victoria, Australia
| | - Hannah Webster
- Monash University, Epidemiology and Preventive Medicine, Melbourne, Australia
| | - Michael Smyth
- Warwick Clinical Trials Unit, University of Warwick, Coventry, United Kingdom
| | - Kevin Nation
- New Zealand Resuscitation Council, Wellington, New Zealand
| | - Robert Greif
- Department of Anesthesiology and Pain Therapy, Bern University Hospital, Inselspital, Bern, Switzerland; School of Medicine, Sigmund Freud University Vienna, Vienna Austria
| | - Katie Dainty
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; North York General Hospital, North York, Ontario, Canada
| | - Judith Finn
- Prehospital, Resuscitation & Emergency Care Research Unit (PRECRU), Curtin School of Nursing, Curtin University, Bentley, Western Australia, Australia; St John Western Australia, Australia
| | - Janet Bray
- Monash University, Epidemiology and Preventive Medicine, Melbourne, Australia; Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), Curtin School of Nursing, Curtin University, Bentley, Western Australia, Australia
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Smyth M, Baird R, Schreiber R. A222 BILIARY ATRESIA IN BRITISH COLUMBIA: THE ROLE OF REFERRAL AGE AND DIAGNOSITIC EVALUATION ON OUTCOME. J Can Assoc Gastroenterol 2022. [PMCID: PMC8859217 DOI: 10.1093/jcag/gwab049.221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Biliary atresia (BA), a newborn liver disease, is the leading cause of cirrhosis and liver-related death in children and the most common indication for pediatric liver transplantation (LT). The current standard of BA care is sequential surgery with an initial Kasai hepatoportoenterostomy (KP), followed by LT for those who progress to liver failure. Survival with native liver (SNL) correlates to infant age at KP with best outcome at early KP at <30 days of age. Novel screening tests and diagnostic algorithms have been proposed, however the variability of clinical presentation and lack of a diagnostic test challenge early diagnosis and timely KP. Aims To assess age at BA presentation and subsequent investigations to the timing of KP and outcome. Methods A retrospective study of all BA cases referred to BC Children’s Hospital January 1, 2000-December 31, 2018. Data collection included age at referral, clinical presentation, laboratory and imaging studies, age at KP and LT. SNL and overall survival rates were determined. Descriptive statistics and data analyses using SSPS were applied. Results In this 19-year study, there were 48 cases (58% female) of BA in BC (1:17,000 live births). KP was performed in 41 patients and 7 had primary LT. Following the initial KP, 23 cases had LT. Median age at presentation decreased from 55 to 42 days after introduction of the BC BA stool card screening program in 2014. The Median (IQR) age at KP was 62 days (48–87). Median delay from the age at first encounter to the KP was 10 days (4–21); early referral (youngest 3rd of cohort) had a mean delay to KP of 25 days (15–40) compared with the late group (oldest 3rd of cohort) with median delay to KP of 5 days (1–8). There were 2.4 and 1.4 investigations/patient before undergoing KP in the youngest and oldest age at presentation cohorts. HIDA scan was done in 41% and 19% of the youngest and oldest presentation cohorts respectively. Median LT age was 9.6 months (8-13months). Median age at KP for patients who received LT was 77 days (53–92), compared to 52 days (41–79) in those without LT (p=0.08). All KPs were completed by 7 surgeons, each completing 1- 10 KPs. Overall patient survival and SNL were 98% and 37.5%. Conclusions In this cohort, SNL rates were below SNL rates in other national studies. SNL rates were higher in patients who underwent KP at a younger age, and early findings from a provincial screening program show a shift in age at presentation, potentially owing in part to increased community awareness of BA. A diagnostic algorithm that accounts for age at presentation is needed achieve timely KP. Funding Agencies None
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Affiliation(s)
- M Smyth
- Pediatric Gastroenterology, The University of British Columbia, Vancouver, BC, Canada
| | - R Baird
- Pediatric Gastroenterology, The University of British Columbia, Vancouver, BC, Canada
| | - R Schreiber
- Pediatric Gastroenterology, The University of British Columbia, Vancouver, BC, Canada
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Goodacre S, Thomas B, Smyth M, Dickson JM. Should prehospital early warning scores be used to identify which patients need urgent treatment for sepsis? BMJ 2021; 375:n2432. [PMID: 34663583 DOI: 10.1136/bmj.n2432] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Steve Goodacre
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield S1 4DA, UK
| | - Ben Thomas
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield S1 4DA, UK
| | - Michael Smyth
- Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Jon M Dickson
- Faculty of Medicine Dentistry and Health, University of Sheffield, Sheffield S10 2HQ, UK
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Olasveengen TM, Semeraro F, Ristagno G, Castren M, Handley A, Kuzovlev A, Monsieurs KG, Raffay V, Smyth M, Soar J, Svavarsdóttir H, Perkins GD. [Basic life support]. Notf Rett Med 2021; 24:386-405. [PMID: 34093079 PMCID: PMC8170637 DOI: 10.1007/s10049-021-00885-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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] [Accepted: 04/19/2021] [Indexed: 12/13/2022]
Abstract
The European Resuscitation Council has produced these basic life support guidelines, which are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. The topics covered include cardiac arrest recognition, alerting emergency services, chest compressions, rescue breaths, automated external defibrillation (AED), cardiopulmonary resuscitation (CPR) quality measurement, new technologies, safety, and foreign body airway obstruction.
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Affiliation(s)
- Theresa M. Olasveengen
- Department of Anesthesiology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norwegen
| | - Federico Semeraro
- Department of Anaesthesia, Intensive Care and Emergency Medical Services, Maggiore Hospital, Bologna, Italien
| | - Giuseppe Ristagno
- Department of Anesthesiology, Intensive Care and Emergency, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Mailand, Italien
- Department of Pathophysiology and Transplantation, University of Milan, Mailand, Italien
| | - Maaret Castren
- Emergency Medicine, Helsinki University and Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finnland
| | | | - Artem Kuzovlev
- Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, V.A. Negovsky Research Institute of General Reanimatology, Moskau, Russland
| | - Koenraad G. Monsieurs
- Department of Emergency Medicine, Antwerp University Hospital and University of Antwerp, Antwerpen, Belgien
| | - Violetta Raffay
- Department of Medicine, School of Medicine, European University Cyprus, Nikosia, Zypern
| | - Michael Smyth
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, CV4 7AL Coventry, Großbritannien
- West Midlands Ambulance Service, DY5 1LX Brierly Hill, West Midlands Großbritannien
| | - Jasmeet Soar
- Southmead Hospital, North Bristol NHS Trust, Bristol, Großbritannien
| | - Hildigunnur Svavarsdóttir
- Akureyri Hospital, Akureyri, Island
- Institute of Health Science Research, University of Akureyri, Akureyri, Island
| | - Gavin D. Perkins
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, CV4 7AL Coventry, Großbritannien
- University Hospitals Birmingham, B9 5SS Birmingham, Großbritannien
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Dee R, Smith M, Rajendran K, Perkins GD, Smith CM, Vaillancourt C, Avis S, Brooks S, Castren M, Chung SP, Considine J, Escalante R, Han LS, Hatanaka T, Hazinski MF, Hung K, Kudenchuk P, Morley P, Ng KC, Nishiyama C, Semeraro F, Smyth M, Vaillancourt C. The effect of alternative methods of cardiopulmonary resuscitation - Cough CPR, percussion pacing or precordial thump - on outcomes following cardiac arrest. A systematic review. Resuscitation 2021; 162:73-81. [PMID: 33582257 DOI: 10.1016/j.resuscitation.2021.01.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 12/14/2020] [Accepted: 01/20/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Cardiopulmonary resuscitation (CPR) improves cardiac arrest survival. Cough CPR, percussion pacing and precordial thump have been reported as alternative CPR techniques. We aimed to summarise in a systematic review the effectiveness of these alternative CPR techniques. METHODS We searched Ovid MEDLINE, EMBASE and the Cochrane Library on 24/08/2020. We included randomised controlled trials, observational studies and case series with five or more patients. Two reviewers independently reviewed title and abstracts to identify studies for full-text review, and reviewed bibliographies and 'related articles' (using PubMed) of full-texts for further eligible studies. We extracted data and performed risk-of-bias assessments on studies included in the systematic review. We summarised data in a narrative synthesis, and used GRADE to assess evidence certainty. RESULTS We included 23 studies (cough CPR n = 4, percussion pacing n = 4, precordial thump n = 16; one study studied two interventions). Only two (both precordial thump) had a comparator group ('standard' CPR). For all techniques evidence certainty was very low. Available evidence suggests that precordial thump does not improve survival to hospital discharge in out-of-hospital cardiac arrest. The review did not find evidence that cough CPR or percussion pacing improve clinical outcomes following cardiac arrest. CONCLUSION Cough CPR, percussion pacing and precordial thump should not be routinely used in established cardiac arrest. In specific inpatient, monitored settings cough CPR (in conscious patients) or percussion pacing may be attempted at the onset of a potential lethal arrhythmia. These must not delay standard CPR efforts in those who lose cardiac output. PROSPERO REGISTRATION NUMBER CRD42019152925.
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Affiliation(s)
- Ryan Dee
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Michael Smith
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Kausala Rajendran
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Gavin D Perkins
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | | | | | - Suzanne Avis
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Steven Brooks
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Maaret Castren
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Sung Phil Chung
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Julie Considine
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Raffo Escalante
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Lim Swee Han
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Tetsuo Hatanaka
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | | | - Kevin Hung
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Peter Kudenchuk
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Peter Morley
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Kee-Chong Ng
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Chika Nishiyama
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Federico Semeraro
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Michael Smyth
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
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Olasveengen TM, Semeraro F, Ristagno G, Castren M, Handley A, Kuzovlev A, Monsieurs KG, Raffay V, Smyth M, Soar J, Svavarsdottir H, Perkins GD. European Resuscitation Council Guidelines 2021: Basic Life Support. Resuscitation 2021; 161:98-114. [PMID: 33773835 DOI: 10.1016/j.resuscitation.2021.02.009] [Citation(s) in RCA: 219] [Impact Index Per Article: 73.0] [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: 01/06/2023]
Abstract
The European Resuscitation Council has produced these basic life support guidelines, which are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. The topics covered include cardiac arrest recognition, alerting emergency services, chest compressions, rescue breaths, automated external defibrillation (AED), CPR quality measurement, new technologies, safety, and foreign body airway obstruction.
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Affiliation(s)
- Theresa M Olasveengen
- Department of Anesthesiology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway.
| | - Federico Semeraro
- Department of Anaesthesia, Intensive Care and Emergency Medical Services, Maggiore Hospital, Bologna, Italy
| | - Giuseppe Ristagno
- Department of Anesthesiology, Intensive Care and Emergency, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy; Department of Pathophysiology and Transplantation, University of Milan, Italy
| | - Maaret Castren
- Emergency Medicine, Helsinki University and Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland
| | | | - Artem Kuzovlev
- Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, V.A. Negovsky Research Institute of General Reanimatology, Moscow, Russia
| | - Koenraad G Monsieurs
- Department of Emergency Medicine, Antwerp University Hospital and University of Antwerp, Belgium
| | - Violetta Raffay
- Department of Medicine, School of Medicine, European University Cyprus, Nicosia, Cyprus
| | - Michael Smyth
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry CV4 7AL, United Kingdom; West Midlands Ambulance Service and Midlands Air Ambulance, Brierly Hill, West Midlands DY5 1LX, United Kingdom
| | - Jasmeet Soar
- Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom
| | - Hildigunnur Svavarsdottir
- Akureyri Hospital, Akureyri, Iceland; Institute of Health Science Research, University of Akureyri, Akureyri, Iceland
| | - Gavin D Perkins
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry CV4 7AL, United Kingdom; University Hospitals Birmingham, Birmingham B9 5SS, United Kingdom
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15
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Seefried L, Smyth M, Keen R, Harvengt P. Burden of disease associated with X-linked hypophosphataemia in adults: a systematic literature review. Osteoporos Int 2021; 32:7-22. [PMID: 32710160 PMCID: PMC7755619 DOI: 10.1007/s00198-020-05548-0] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 07/08/2020] [Indexed: 12/30/2022]
Abstract
UNLABELLED This systematic review collated evidence on the burden of XLH in adults. Data captured highlight the substantial ongoing burden of XLH in adulthood and identified unmet needs. Greater awareness and understanding of the impact of XLH in adulthood are needed to improve care and outcomes in adults with XLH. INTRODUCTION X-linked hypophosphataemia (XLH) is a rare metabolic bone disease characterized by renal phosphate wasting and musculoskeletal manifestations. Whilst the disease's impact in children is well documented, information on the effects of this progressive, debilitating condition on adults is lacking. This systematic review aimed to collate existing evidence on the burden of XLH in adulthood to identify unmet needs. METHODS MEDLINE, Embase and Cochrane Library databases and recent congress reports were searched on 19 February 2019 for English-language publications describing the medical, humanistic and socio-economic impact of XLH in adults (≥ 18 years old). In addition, a structured Internet search was conducted. RESULTS Of the 2351 articles identified, 91 met the selection criteria along with 44 congress abstracts. Data show that adults with XLH experience a range of clinical manifestations, particularly skeletal deformities and (pseudo)fractures, along with pain, dental abnormalities and impaired physical function and mobility. XLH in adulthood impacts on quality of life and places limitations on daily activities. The level of healthcare resource utilization among adults with XLH is indicative of substantial socio-economic burden; further research is needed to quantitate the economic impact on the healthcare system, society and patients. Adults with XLH may not receive appropriate care and treatment; a possible explanation for this is a lack of awareness among healthcare professionals. CONCLUSION XLH in adults is associated with considerable disease burden and unmet needs. Forthcoming studies and increased awareness of the impact of XLH in adulthood should help to improve management of XLH in adulthood and patient outcomes.
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Affiliation(s)
- L Seefried
- Orthopedic Institute, König-Ludwig Haus, University of Würzburg, Würzburg, Germany
| | - M Smyth
- Kyowa Kirin International, Galashiels, UK
| | - R Keen
- Royal National Orthopaedic Hospital, Stanmore, UK
| | - P Harvengt
- RVRH-XLH, French association of patients with XLH (a member of the International XLH Alliance), 20 rue Merlin de Thionville, Appt 120, 92150, Suresnes, France.
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16
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Huo B, MacNevin W, Smyth M, Miller SG. Medical Student Comfort With Procedural Skills Performance Based on Elective Experience and Career Interest. Cureus 2020; 12:e12374. [PMID: 33527055 PMCID: PMC7842240 DOI: 10.7759/cureus.12374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Introduction Despite increased efforts, studies suggest that exposure to procedural skills in undergraduate medical training is insufficient. As medical students have low self-reported competence in many skills, a significant concern is that medical students are underprepared for a clerkship. Furthermore, pre-clerkship electives selected based on student career interests can provide students with additional skills learning opportunities. The impact of career interest and elective choice on student comfort with procedural skills is unclear. This study examines the relationship between student procedural skills comfort, career interest, and elective choices. Materials and methods An evidence-based questionnaire was synthesized following a literature search using PubMed, Embase, and Google Scholar. Surveys were completed by second-year medical students. A Likert scale was used to evaluate students’ exposure, comfort, and motivation to learn common procedural skills. Descriptive, Pearson’s chi-square and Spearman’s rho correlation coefficient analyses were performed to evaluate the relationship between career interests, elective exposure, and procedural skills. Results Medical students (>60%) reported poor comfort levels for most skills, despite >80% of students displaying high motivation to learn. Elective choice impacted student comfort levels as students who completed electives in anesthesiology were more comfortable with performing intubation (23% vs 10%, p = 0.026) and IV insertion (38% vs 13%, p = 0.002). Those with surgical career interests were less comfortable performing Foley catheter insertion in males (7% vs 5%, p = 0.033) and in females (7% vs 5%, p = 0.008). Conclusions This study supports that medical students feel low levels of comfort with performing procedural skills despite high motivation for learning. Comfort was influenced by both career interest and elective experience. Programs aiming to increase students’ comfort levels in performing procedural skills should adapt curricula toward increasing early exposure to these skills.
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Lauridsen KG, Baldi E, Smyth M, Perkins GD, Greif R. Clinical decision rules for termination of resuscitation during in-hospital cardiac arrest: A systematic review of diagnostic test accuracy studies. Resuscitation 2020; 158:23-29. [PMID: 33197522 DOI: 10.1016/j.resuscitation.2020.10.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 09/29/2020] [Accepted: 10/27/2020] [Indexed: 02/01/2023]
Abstract
AIM To assess whether any clinical decision rule for patients sustaining an in-hospital cardiac arrest (IHCA) can predict mortality or survival with poor neurological outcome. METHODS We searched online databases from inception through July 2020 for randomized controlled trials and non-randomized studies. Two reviewers assessed studies for inclusion. We followed PRISMA guidelines for Diagnostic Test Accuracy Studies, used the Quality Assessment of Diagnostic Accuracy Studies framework to evaluate risk of bias, and Grading of Recommendations Assessment, Development and Evaluation methodology to evaluate certainty of evidence. We assessed predictive values for no return of spontaneous circulation (ROSC), death before hospital discharge, and survival with unfavorable neurological outcome. RESULTS Out of 6436 studies, 92 studies were selected for full-text screening. We included 3 observational studies describing the derivation and external validation for the UN10 rule (Unwitnessed arrest; Nonshockable rhythm; 10 min of resuscitation without ROSC) amongst patients suffering from IHCA. No studies were identified for clinical implementation. Positive Predicted Values (PPV) for death before hospital discharge for the three studies were 100% (95% CI: 97.1%-100%), 98.9% (95% CI: 96.5%-99.7%), and 93.7% (95% CI: 93.3%-94.0%). One study reported a PPV for prediction of survival with unfavorable neurological outcome, 95.2% (95% CI: 94.9%-95.6%). The level of evidence was rated as very low certainty. CONCLUSIONS We identified very low certainty evidence for one clinical decision rule (the UN-10 rule) that was unable to reliably predict mortality or survival with unfavorable neurological outcome for adults suffering from IHCA. We identified no evidence for children. PROSPERO CRD42020164091.
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Affiliation(s)
- Kasper G Lauridsen
- Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark; Department of Medicine, Randers Regional Hospital, Randers, Denmark; Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, USA.
| | - Enrico Baldi
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Molecular Medicine, Section of Cardiology, University of Pavia, Pavia, Italy
| | - Michael Smyth
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, United Kingdom
| | - Gavin D Perkins
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, United Kingdom
| | - Robert Greif
- Department of Anesthesiology and Pain Therapy, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland; School of Medicine, Sigmund Freud University Vienna, Vienna, Austria
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Nicholas O, Lewis G, Thomas B, Smyth M, Spezi E, Gwynne S. PD-0422: Evaluating inter-observer variation in oesophageal target volume delineation. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00444-8] [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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19
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Hewitt NM, Davenport M, Smyth M, Smith T. Optimizing the Availability of Enhanced Prehospital Care Team Resources. Air Med J 2020; 39:351-359. [PMID: 33012471 DOI: 10.1016/j.amj.2020.06.003] [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] [Received: 04/15/2020] [Accepted: 06/01/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE After recent developments within the North West Air Ambulance (NWAA), we undertook a service evaluation to determine if resource use could be improved. We sought to answer the following questions: (1) At what time of day do major trauma incidents occur in the North West of England? 2) Do current NWAA operating hours meet the needs of these major trauma patients? 3) Where do major trauma incidents occur in the North West of England? and 4) Are current NWAA resources optimally located to meet the needs of these major trauma patients? METHODS We reviewed records from the Trauma Audit and Research Network database for the North West of England (the counties of Cheshire, Merseyside, Greater Manchester, Cumbria, and Lancashire) between January 1, 2017, and December 31, 2017. These data were supplemented by incident records from the North West Ambulance Service National Health Service Trust. Analysis was undertaken using Excel (Microsoft, Redmond, WA) and MapInfo Pro (Pitney Bowes, Stamford, CT). A survey will be conducted to give insight into the level of cover provided by other UK helicopter emergency medical services. RESULTS Data from 2,318 incidents were analyzed. Major trauma occurs in higher numbers at certain times of day, varies from weekday to weekend, and takes place in higher concentrations in certain locations, appearing related to population density. CONCLUSION There is a significant difference between the current trauma care provision and the demand of major trauma incidents. The findings of this study suggest an expansion in cover provided by the NWAA may be appropriate.
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Affiliation(s)
- Nikki Marie Hewitt
- North West Air Ambulance, City Airport & Heliport, Manchester, UK; Warwick Medical School, The University of Warwick, Coventry, UK.
| | | | - Michael Smyth
- Warwick Medical School, The University of Warwick, Coventry, UK
| | - Tim Smith
- North West Air Ambulance, City Airport & Heliport, Manchester, UK
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20
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Padidela R, Nilsson O, Makitie O, Beck-Nielsen S, Ariceta G, Schnabel D, Brandi ML, Boot A, Levtchenko E, Smyth M, Jandhyala R, Mughal Z. The international X-linked hypophosphataemia (XLH) registry (NCT03193476): rationale for and description of an international, observational study. Orphanet J Rare Dis 2020; 15:172. [PMID: 32605590 PMCID: PMC7329472 DOI: 10.1186/s13023-020-01434-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 06/04/2020] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND X-linked hypophosphataemia (XLH) is a rare, hereditary, progressive and lifelong phosphate wasting disorder characterised by pathological elevations in fibroblast growth factor (FGF) 23 concentration and activity; XLH has an incidence of approximately 1 in 20-25,000 individuals. Excess FGF23 activity leads to increased phosphate excretion in the kidneys - mediated by downregulation of renal tubular phosphate transporters - and reduced phosphate absorption in the intestines - due to impaired vitamin D activation. This results in impaired bone growth and mineralisation, short and disproportionate stature, leg bowing, musculoskeletal pain, spontaneous dental abscesses, rickets, and osteomalacia. The spectrum of manifestations differs between paediatric and adult patients. Those involved in the treatment of this condition face many challenges, including a lack of robust natural history and demographic data. This multicentre, international, rare-disease patient registry (XLH Registry) was established to address the paucity of data in XLH and to help inform future clinical practice. RESULTS The XLH Registry collects standard diagnostic and monitoring practice data, including (where applicable) diagnosis and disease progression history, treatment regimens and family history; the protocol does not mandate any interventions or clinical assessments. The XLH Registry aims to recruit 1200 paediatric and adult patients with XLH over 10 years, and several data analyses and peer-reviewed publications are expected to be generated throughout this period. A post-authorisation safety study for Bburosumab, for which the registry Sponsor is the marketing authorisation holder, will be nested as a sub-study within the XLH Registry via a subsequent protocol amendment. CONCLUSION The data collected within this rare-disease patient registry will be utilised to synthesise real-world evidence to inform the management of XLH, to improve the quality of life and standard of care of patients living with this rare debilitating disease.
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Affiliation(s)
- Raja Padidela
- Royal Manchester Children's Hospital and Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Ola Nilsson
- Karolinska Institutet, Stockholm, Sweden
- Örebro University, Örebro, Sweden
| | - Outi Makitie
- Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | | | - Gema Ariceta
- Hospital Vall d'Hebron, Universitat Autonoma Barcelona, Barcelona, Spain
| | - Dirk Schnabel
- Center for Chronic Sick Children, Pediatric Endocrinology, Charité, University Medicine Berlin, Berlin, Germany
| | | | | | | | | | | | - Zulf Mughal
- Royal Manchester Children's Hospital and Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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21
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Olasveengen T, Castrén M, Handley A, Kuzovlev A, Monsieurs KG, Perkins G, Raffay V, Ristagno G, Semeraro F, Smyth M, Soar J, Svavarsdóttir H. Basismaßnahmen zur Wiederbelebung Erwachsener. Notf Rett Med 2020; 23:246-247. [PMID: 32536799 PMCID: PMC7284673 DOI: 10.1007/s10049-020-00719-2] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- T. Olasveengen
- European Resuscitation Council VZW, Emile Vanderveldelaan 35, 2845 Niel, Belgien
| | - M. Castrén
- European Resuscitation Council VZW, Emile Vanderveldelaan 35, 2845 Niel, Belgien
| | - A. Handley
- European Resuscitation Council VZW, Emile Vanderveldelaan 35, 2845 Niel, Belgien
| | - A. Kuzovlev
- European Resuscitation Council VZW, Emile Vanderveldelaan 35, 2845 Niel, Belgien
| | - K. G. Monsieurs
- European Resuscitation Council VZW, Emile Vanderveldelaan 35, 2845 Niel, Belgien
| | - G. Perkins
- European Resuscitation Council VZW, Emile Vanderveldelaan 35, 2845 Niel, Belgien
| | - V. Raffay
- European Resuscitation Council VZW, Emile Vanderveldelaan 35, 2845 Niel, Belgien
| | - G. Ristagno
- European Resuscitation Council VZW, Emile Vanderveldelaan 35, 2845 Niel, Belgien
| | - F. Semeraro
- European Resuscitation Council VZW, Emile Vanderveldelaan 35, 2845 Niel, Belgien
| | - M. Smyth
- European Resuscitation Council VZW, Emile Vanderveldelaan 35, 2845 Niel, Belgien
| | - J. Soar
- European Resuscitation Council VZW, Emile Vanderveldelaan 35, 2845 Niel, Belgien
| | - H. Svavarsdóttir
- European Resuscitation Council VZW, Emile Vanderveldelaan 35, 2845 Niel, Belgien
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de Oliveira AL, Madore J, O’donnell J, Johnston R, Eastgate M, Mallardo D, Ascierto P, Massi D, Merelli B, Mandala M, Wilmott J, Bald T, Stagg J, Routy B, Long G, Scolyer R, Waddell N, Dougall W, Teng M, Smyth M. Resistance to immunotherapy is associated with high parenchymal PD1+CD8+/CD8+ T cells (PD1tR) driven by tumour CD155. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz452] [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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Smyth M, Haupt TS, Gregoire MC. Retrospective Review of the Use of Transdermal Buprenorphine Patches (Butrans) in a Pediatric Population. J Palliat Med 2019; 23:1094-1097. [PMID: 31770045 DOI: 10.1089/jpm.2019.0381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Buprenorphine is an opioid medication used for the treatment of moderate to severe pain. In Canada, buprenorphine is not indicated for use in the pediatric population and literature surrounding its use in pediatrics is limited. Our aim was to evaluate the safety of transdermal buprenorphine in a pediatric palliative care setting. Methods: Our study was performed at the IWK Health Centre. Medical records of 11 patients were examined for specific clinical characteristics. The study focused primarily on descriptive results; standard data analyses were not performed. Results: Buprenorphine was found to be well tolerated in our patient population. There were no adverse effects reported in 8 of 11 patients during their treatment with buprenorphine. The remaining 3 patients described mild adverse effects in the form of skin irritation which resolved with topical steroid treatment. Efficacy was reported as anecdotal quotes from patient records. Conclusion: In this study, the use of buprenorphine in this setting was safe in a small group of patients, with the only mild adverse effect noted being a contact dermatitis in 3 patients which resolved quickly. Other studies have also demonstrated buprenorphine to be a safe and an effective opioid for the treatment of severe pain at the end of life in a pediatric population. Given these results, the implementation of buprenorphine in pediatrics may be safe for use in patients who are unable to tolerate traditional opioid analgesic therapies.
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Affiliation(s)
- Michael Smyth
- Dalhousie Medical School, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Thomas S Haupt
- Dalhousie Medical School, Dalhousie University, Halifax, Nova Scotia, Canada
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Sheppard E, Smyth M, Dow T, Haupt TS, McVeigh S. The Effect of a 2-Week Pre-clerkship Residency Exploration Program on Specialty Interest and Understanding of Physical Medicine and Rehabilitation. Arch Rehabil Res Clin Transl 2019; 2:100035. [PMID: 33543064 PMCID: PMC7853399 DOI: 10.1016/j.arrct.2019.100035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective To assess the effect the Pre-clerkship Residency Exploration Program (PREP) had on student career interest and improving understanding of physical medicine and rehabilitation (PMR). Design During a 2-week program, students were exposed to a PMR elective, workshop, career presentation, and panel discussion with PMR residents. Interest and understanding were assessed using pre- and postprogram questionnaires. Setting PREP was held at a Canadian medical school during the summer between the second and third years of undergraduate medical training. Participants Second-year medical student participants (N=40) (26 women and 14 men, aged 20 to >30 y) were randomly selected from 74 applicants at a Canadian medical school. Interventions Of the 40 program participants, 20 participated in a PMR elective and specialty-specific workshop. The full cohort of 40 participants participated in the PMR career presentation and PMR resident panel discussion. Main Outcome Measure Primary outcome measure was an increase in understanding of the PMR specialty. Results Understanding of the roles and responsibilities of physiatrists increased significantly, with larger trends in those with greater exposure time. After PREP, comfort level in common PMR procedures also significantly increased. Higher exposure time was correlated with an increased top 3 career selection. Student interest in PMR did not significantly change after the program. Conclusion Although no statistically significant effects were found from the 2-week PREP in this population in terms of career choice, benefits were found in the participants comfort with PMR procedures and understanding the roles and responsibilities of physiatrists. A brief exposure as part of a 2-week summer elective is beneficial for career decision planning and may be feasible to implement in medical curricula.
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Affiliation(s)
- Emily Sheppard
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Michael Smyth
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Todd Dow
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Sonja McVeigh
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.,Department of Physical Medicine & Rehabilitation, Dalhousie University, Halifax, Nova Scotia, Canada
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Abstract
A preliminary evaluation to review the scope and quality of evidence surrounding transdermal buprenorphine use in the pediatric setting for non-surgical pain was conducted. Our review revealed limited data available on the use of transdermal buprenorphine in pediatric patients. Most studies surrounding this subject involve accidental ingestion of buprenorphine and its use in the treatment of neonatal abstinence syndrome. While indicated for use only in adult populations, small studies have shown encouraging results in reducing pain in children with few, if any, adverse effects. This is reassuring from a clinical perspective, as we hope to highlight the available evidence and invite researchers to expand future studies. Through this review, we have identified significant gaps in the literature surrounding the safety and use of buprenorphine in the pediatric population. To our knowledge, there are no major studies investigating this subject, and it is our hope that future studies will explore the use of transdermal buprenorphine as an alternative pain management technique in pediatrics. The intent of our scoping review is to highlight the lack of research in this area; therefore, future studies may be conducted to support its use in North America.
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Affiliation(s)
- Thomas S Haupt
- Palliative Care Pediatrics, Dalhousie Medical School, Halifax, CAN
| | - Michael Smyth
- Palliative Care Pediatrics, Dalhousie Medical School, Halifax, CAN
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Haupt TS, Dow T, Smyth M, Roberts A, Raju K, Toguri JT, MacLeod A. 12 Tips for taking a Student Led Medical Education Program from Concept to Curriculum. MedEdPublish (2016) 2019; 8:190. [PMID: 38089264 PMCID: PMC10712485 DOI: 10.15694/mep.2019.000190.1] [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: 03/06/2024] Open
Abstract
This article was migrated. The article was marked as recommended. The choice of a future career specialty has always been a stressful decision for medical students. To mitigate this stress and assist students in making more informed career decisions we developed the Pre-clerkship Residency Exploration Program (PREP), a two-week summer elective program that provides students with the opportunity to gain exposure to specialities that traditionally do not receive a lot of attention in medical school. To initiate this student led program we faced many obstacles, suffered many failures, learned a tremendous amount and eventually found success. In this article, we offer 12 tips on how to create a medical education program that is sustainable, effective and receives strong buy-in from faculty and administration. Our tips come from the perspective of students starting their own program but are translatable to anyone interested in taking an innovative idea and seeing it through to fruition.
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Davies E, Wieboldt J, Stanley T, Maeda Y, Smyth M, Stanley S, Mcclean M, Evans W, Funston C, Millar BC, Goldsmith CE, Moore JE. Isolation and identification of ‘Mycobacterium angelicum’ from a patient with type II respiratory failure: suggested reporting guidelines to molecular clinical laboratories. Br J Biomed Sci 2019. [DOI: 10.1080/09674845.2012.12069140] [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: 10/26/2022]
Affiliation(s)
- E. Davies
- Departments of Microbiology, Causeway Hospital, Coleraine, Co. Londonderry
| | - J. Wieboldt
- Departments of Respiratory Medicine, Causeway Hospital, Coleraine, Co. Londonderry
| | - T. Stanley
- Northern Ireland Mycobacterium Reference Laboratory, Department of Medical Microbiology, Royal Group of Hospitals
| | - Y. Maeda
- Northern Ireland Public Health Laboratory, Department of Bacteriology, Belfast City Hospital
| | - M. Smyth
- Northern Ireland Mycobacterium Reference Laboratory, Department of Medical Microbiology, Royal Group of Hospitals
| | - S. Stanley
- Northern Ireland Mycobacterium Reference Laboratory, Department of Medical Microbiology, Royal Group of Hospitals
| | - M. Mcclean
- Northern Ireland Mycobacterium Reference Laboratory, Department of Medical Microbiology, Royal Group of Hospitals
| | - W. Evans
- Department of Microbiology, Antrim Area Hospital, Co. Antrim
| | - C. Funston
- Department of Microbiology, Antrim Area Hospital, Co. Antrim
| | - B. C. Millar
- Northern Ireland Public Health Laboratory, Department of Bacteriology, Belfast City Hospital
| | - C. E. Goldsmith
- Northern Ireland Public Health Laboratory, Department of Bacteriology, Belfast City Hospital
| | - J. E. Moore
- Northern Ireland Public Health Laboratory, Department of Bacteriology, Belfast City Hospital
- School of Biomedical Sciences, University of Ulster, Coleraine, Northern Ireland, UK
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Shen B, Blake A, Lasch K, Smyth M, Bhayat F. Vedolizumab use in patients with inflammatory bowel diseases undergoing surgery: clinical trials and post-marketing experience. Gastroenterol Rep (Oxf) 2019; 7:322-330. [PMID: 31687151 PMCID: PMC6821312 DOI: 10.1093/gastro/goz034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 05/06/2019] [Indexed: 12/14/2022] Open
Abstract
Background Patients with inflammatory bowel diseases frequently require surgery, but immunotherapies used in disease management may increase the risk of post-operative complications. We investigated frequencies of post-operative complications in patients who received vedolizumab-a gut-selective antibody approved for the treatment of moderately to severely active ulcerative colitis and Crohn's disease-in clinical-trial and post-marketing settings. Methods This post hoc analysis of safety data from GEMINI 1, GEMINI 2, and long-term safety studies included patients who had had colectomy or bowel surgery/resection. Data from the post-marketing Vedolizumab Global Safety Database were also analysed (data cutoff point: 19 May 2016). Adverse events relating to post-operative complications were identified using Medical Dictionary for Regulatory Activities preferred terms. Results Of 58 total surgeries in patients included in GEMINI 1 and GEMINI 2, post-operative complications were reported for 3/51 vedolizumab-treated patients (5.9%) and 1/7 placebo-treated patients (14.3%). In the long-term safety study, 157/2,243 patients (7%) had colectomy or bowel surgery/resection; of these 157 patients who underwent surgery, 11 (7%) experienced a post-operative complication. Median time between last pre-operative vedolizumab dose and surgery was 23 days in GEMINI 1, 20 days in GEMINI 2, and 39‒40 days in the long-term safety study. In the post-marketing setting, based on data covering approximately 46,978 patient-years of vedolizumab exposure, post-operative complications were reported in 19 patients. Conclusions In clinical trials, complications of colectomy and bowel surgery/resection appeared infrequent, with minimal difference between vedolizumab and placebo. The frequency of post-operative complications in the post-marketing setting appears low.
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Affiliation(s)
- Bo Shen
- Center for Inflammatory Bowel Disease, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Aimee Blake
- Global Patient Safety Evaluation, Takeda Pharmaceuticals International Co., Cambridge, MA, USA
| | - Karen Lasch
- US Medical Office, Takeda Pharmaceuticals USA Inc., Deerfield, IL, USA
| | - Michael Smyth
- Global Medical Affairs, Takeda Development Centre Europe Ltd, London, UK.,Kyowa Kirin International plc, Chertsey, UK
| | - Fatima Bhayat
- Global Patient Safety Evaluation, Takeda Pharmaceuticals International Co., Cambridge, MA, USA
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Stefoska-Needham A, Fildes K, Atkinson J, Nealon J, Charton K, Gutker M, Lambert K, Anna L, Smyth M, Walton K. SUN-247 Experiencing chronic kidney disease: perspectives of individuals living with chronic kidney disease, their family members, carers and health professionals. Kidney Int Rep 2019. [DOI: 10.1016/j.ekir.2019.05.652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Smyth M, Toguri JT, Dow T, Haupt TS, Roberts A, Raju K. Medical student exposure to anesthesiology through the Pre-clerkship Residency Exploration Program: impact on career interest and understanding of anesthesiology. Can J Anaesth 2019; 66:1126-1128. [PMID: 31114944 DOI: 10.1007/s12630-019-01403-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 05/13/2019] [Accepted: 05/14/2019] [Indexed: 11/28/2022] Open
Affiliation(s)
- Michael Smyth
- Dalhousie Medical School, Dalhousie University, Halifax, NS, Canada.
| | - J Thomas Toguri
- Dalhousie Medical School, Dalhousie University, Halifax, NS, Canada
| | - Todd Dow
- Dalhousie Medical School, Dalhousie University, Halifax, NS, Canada
| | | | - Alysha Roberts
- Dalhousie Medical School, Dalhousie University, Halifax, NS, Canada
| | - Kavita Raju
- Dalhousie Medical School, Dalhousie University, Halifax, NS, Canada
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Lamnatou C, Smyth M, Chemisana D. Building-Integrated Photovoltaic/Thermal (BIPVT): LCA of a façade-integrated prototype and issues about human health, ecosystems, resources. Sci Total Environ 2019; 660:1576-1592. [PMID: 30743949 DOI: 10.1016/j.scitotenv.2018.12.461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 12/12/2018] [Accepted: 12/30/2018] [Indexed: 06/09/2023]
Abstract
Building-Integrated Photovoltaic/Thermal (BIPVT) technology offers multiple advantages; however, these types of installations include materials such as Photovoltaic (PV) cells and metals which considerably influence BIPVT environmental impact. Therefore, there is a need to evaluate BIPVT environmental profile, for instance by means of Life Cycle Assessment (LCA). In light of the issues mentioned above, the present article is an LCA study that assesses the environmental performance of a BIPVT prototype that has been developed and patented at the Ulster University (Belfast, UK). The investigation places emphasis on material manufacturing, based on Cumulative Energy Demand (CED), Global Warming Potential (GWP), ReCiPe, Ecological footprint and USEtox. The results show that according to all the adopted methods/environmental indicators and based on primary materials, the PV cells and the two vessels (steel) are the components with the three highest impacts. Scenarios which include recycling of steel, plastics and brass (landfill for the other materials has been assumed), based on CED, GWP 100a and ReCiPe endpoint, have been examined. It was found that steel recycling offers a considerable impact reduction, ranging from 47% to 85%. Furthermore, the impact of the proposed BIPVT module per m2 of thermal absorber has been calculated. The results, based on primary materials, show 4.92 GJprim/m2 and 0.34 t CO2.eq/m2 (GWP 100a). In addition, according to USEtox/ecotoxicity, USEtox/human toxicity-non-cancer (scenario based on primary materials), the PV cells present the highest contributions to the total impact of the module: 55% in terms of ecotoxicity and 86% concerning human toxicity/non-cancer. A comparison with literature is provided. Moreover, a separate section of the article is about factors which influence BIPVT environmental profile, discussing parameters such as the storage materials and the end-of-life management.
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Affiliation(s)
- Chr Lamnatou
- Applied Physics Section of the Environmental Science Department, University of Lleida, Jaume II 69, 25001 Lleida, Spain.
| | - M Smyth
- Centre for Sustainable Technologies, Belfast School of Architecture and the Built Environment, Ulster University, Newtownabbey BT370QB, Northern Ireland, UK
| | - D Chemisana
- Applied Physics Section of the Environmental Science Department, University of Lleida, Jaume II 69, 25001 Lleida, Spain
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Haywood K, Whitehead L, Nadkarni VM, Achana F, Beesems S, Böttiger BW, Brooks A, Castrén M, Ong ME, Hazinski MF, Koster RW, Lilja G, Long J, Monsieurs KG, Morley PT, Morrison L, Nichol G, Oriolo V, Saposnik G, Smyth M, Spearpoint K, Williams B, Perkins GD. COSCA (Core Outcome Set for Cardiac Arrest) in Adults: An Advisory Statement From the International Liaison Committee on Resuscitation. Circulation 2018; 137:e783-e801. [PMID: 29700122 DOI: 10.1161/cir.0000000000000562] [Citation(s) in RCA: 130] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cardiac arrest effectiveness trials have traditionally reported outcomes that focus on survival. A lack of consistency in outcome reporting between trials limits the opportunities to pool results for meta-analysis. The COSCA initiative (Core Outcome Set for Cardiac Arrest), a partnership between patients, their partners, clinicians, research scientists, and the International Liaison Committee on Resuscitation, sought to develop a consensus core outcome set for cardiac arrest for effectiveness trials. Core outcome sets are primarily intended for large, randomized clinical effectiveness trials (sometimes referred to as pragmatic trials or phase III/IV trials) rather than for pilot or efficacy studies. A systematic review of the literature combined with qualitative interviews among cardiac arrest survivors was used to generate a list of potential outcome domains. This list was prioritized through a Delphi process, which involved clinicians, patients, and their relatives/partners. An international advisory panel narrowed these down to 3 core domains by debate that led to consensus. The writing group refined recommendations for when these outcomes should be measured and further characterized relevant measurement tools. Consensus emerged that a core outcome set for reporting on effectiveness studies of cardiac arrest (COSCA) in adults should include survival, neurological function, and health-related quality of life. This should be reported as survival status and modified Rankin scale score at hospital discharge, at 30 days, or both. Health-related quality of life should be measured with ≥1 tools from Health Utilities Index version 3, Short-Form 36-Item Health Survey, and EuroQol 5D-5L at 90 days and at periodic intervals up to 1 year after cardiac arrest, if resources allow.
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Rosario M, French JL, Dirks NL, Sankoh S, Parikh A, Yang H, Danese S, Colombel JF, Smyth M, Sandborn WJ, Feagan BG, Reinisch W, Sands BE, Sans M, Fox I. Corrigendum: Exposure-efficacy Relationships for Vedolizumab Induction Therapy in Patients with Ulcerative Colitis or Crohn's Disease. J Crohns Colitis 2018; 12:510. [PMID: 29385425 DOI: 10.1093/ecco-jcc/jjx168] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Maria Rosario
- Clinical Pharmacology Department, Millennium Pharmaceuticals Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Ltd, Cambridge, MA, USA
| | | | | | - Serap Sankoh
- Clinical Pharmacology Department, Millennium Pharmaceuticals Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Ltd, Cambridge, MA, USA
| | - Asit Parikh
- Clinical Pharmacology Department, Millennium Pharmaceuticals Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Ltd, Cambridge, MA, USA
| | - Huyuan Yang
- Clinical Pharmacology Department, Millennium Pharmaceuticals Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Ltd, Cambridge, MA, USA
| | - Silvio Danese
- Inflammatory Bowel Disease Clinical and Research Unit, Istituto Clinico Humanitas, Milan, Italy
| | | | | | - William J Sandborn
- Division of Gastroenterology, University of California San Diego, La Jolla, CA, USA
| | - Brian G Feagan
- Robarts Research Institute, University of Western Ontario, London, ON, Canada
| | - Walter Reinisch
- Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria, and Department of Internal Medicine, McMaster University, Hamilton, ON, Canada
| | - Bruce E Sands
- Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Miguel Sans
- Digestive Diseases Service, Centro Médico Teknon, Barcelona, Spain
| | - Irving Fox
- Clinical Pharmacology Department, Millennium Pharmaceuticals Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Ltd, Cambridge, MA, USA
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Chan JM, Carroll MW, Smyth M, Hamilton Z, Prosser R, Evans D, Rosenfeld G, Jacobson K. A215 CHANGING INCIDENCE OF INFLAMMATORY BOWEL DISEASE IN THE PEDIATRIC POPULATION OF BRITISH COLUMBIA. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy008.216] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- J M Chan
- University of British Columbia, Vancouver, BC, Canada
| | - M W Carroll
- Divison of Gastroenterology, Hepatology & Nutrition, BC Children’s Hospital, Vancouver, BC, Canada
| | - M Smyth
- Divison of Gastroenterology, Hepatology & Nutrition, BC Children’s Hospital, Vancouver, BC, Canada
| | - Z Hamilton
- Divison of Gastroenterology, Hepatology & Nutrition, BC Children’s Hospital, Vancouver, BC, Canada
| | - R Prosser
- Divison of Gastroenterology, Hepatology & Nutrition, BC Children’s Hospital, Vancouver, BC, Canada
| | - D Evans
- Divison of Gastroenterology, Hepatology & Nutrition, BC Children’s Hospital, Vancouver, BC, Canada
| | - G Rosenfeld
- University of British Columbia, Vancouver, BC, Canada
| | - K Jacobson
- BC Children’s Hospital, Vancouver, BC, Canada
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Wilson MR, Bergman A, Chevrou-Severac H, Selby R, Smyth M, Kerrigan MC. Cost-effectiveness of vedolizumab compared with infliximab, adalimumab, and golimumab in patients with ulcerative colitis in the United Kingdom. Eur J Health Econ 2018; 19:229-240. [PMID: 28271250 DOI: 10.1007/s10198-017-0879-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 02/16/2017] [Indexed: 05/22/2023]
Abstract
OBJECTIVE To examine the clinical and economic impact of vedolizumab compared with infliximab, adalimumab, and golimumab in the treatment of moderately to severely active ulcerative colitis (UC) in the United Kingdom (UK). METHODS A decision analytic model in Microsoft Excel was used to compare vedolizumab with other biologic treatments (infliximab, adalimumab, and golimumab) for the treatment of biologic-naïve patients with UC in the UK. Efficacy data were obtained from a network meta-analysis using placebo as the common comparator. Other inputs (e.g., unit costs, adverse-event disutilities, probability of surgery, mortality) were obtained from published literature. Costs were presented in 2012/2013 British pounds. Outcomes included quality-adjusted life-years (QALYs). Costs and outcomes were discounted by 3.5% per year. Incremental cost-effectiveness ratios were presented for vedolizumab compared with other biologics. Univariate and multivariate probabilistic sensitivity analyses were conducted to assess model robustness to parameter uncertainty. RESULTS The model predicted that anti-tumour necrosis factor-naïve patients on vedolizumab would accrue more QALY than patients on other biologics. The incremental results suggest that vedolizumab is a cost-effective treatment compared with adalimumab (incremental cost-effectiveness ratio of £22,735/QALY) and dominant compared with infliximab and golimumab. Sensitivity analyses suggest that results are most sensitive to treatment response and transition probabilities. However, vedolizumab is cost-effective irrespective of variation in any of the input parameters. CONCLUSIONS Our model predicted that treatment with vedolizumab improves QALY, increases time in remission and response, and is a cost-effective treatment option compared with all other biologics for biologic-naïve patients with moderately to severely active UC.
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Affiliation(s)
- Michele R Wilson
- RTI Health Solutions, 300 Park Offices Drive, Research Triangle Park, NC, 27709, USA.
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Boland K, Maher N, O'Hanlon C, O'Sullivan M, Smyth M, Reynolds J. Patients using home enteral nutrition in Ireland: Training, complications and satisfaction. Clin Nutr ESPEN 2017. [DOI: 10.1016/j.clnesp.2017.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Marti J, Hulme C, Ferreira Z, Nikolova S, Lall R, Kaye C, Smyth M, Kelly C, Quinn T, Gates S, Deakin CD, Perkins GD. The cost-effectiveness of a mechanical compression device in out-of-hospital cardiac arrest. Resuscitation 2017; 117:1-7. [DOI: 10.1016/j.resuscitation.2017.04.036] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 03/21/2017] [Accepted: 04/30/2017] [Indexed: 10/19/2022]
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Rosario M, French JL, Dirks NL, Sankoh S, Parikh A, Yang H, Danese S, Colombel JF, Smyth M, Sandborn WJ, Feagan BG, Reinisch W, Sands BE, Sans M, Fox I. Exposure-efficacy Relationships for Vedolizumab Induction Therapy in Patients with Ulcerative Colitis or Crohn's Disease. J Crohns Colitis 2017; 11:921-929. [PMID: 28333288 DOI: 10.1093/ecco-jcc/jjx021] [Citation(s) in RCA: 119] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS A positive relationship between vedolizumab trough serum concentrations and clinical outcomes in patients with ulcerative colitis [UC] or Crohn's disease [CD] has been reported. Here we further explore exposure-efficacy relationships for vedolizumab induction therapy in post hoc analyses of GEMINI study data. METHODS Vedolizumab trough concentrations at Week 6 or 10 were grouped in quartiles and clinical outcome rates calculated. Exposure-efficacy relationships at Week 6 and potential baseline covariate effects were explored using logistic regression and individual predicted cumulative average concentration through Week 6 [Caverage] as exposure measure. RESULTS Higher vedolizumab concentrations were associated with higher clinical remission rates; the exposure-efficacy relationship was steeper for UC than CD. Unadjusted analyses overestimated the relationship, more so for CD. From covariate-adjusted models, average probability of remission at Week 6 increased by approximately 15% for UC and 10% for CD between Caverage values of 35 and 84 µg/ml [5th and 95th percentiles, respectively]. On average, patients with higher albumin, lower faecal calprotectin [UC only], lower C-reactive protein [CD only], and no previous tumour necrosis factor-α [TNFα] antagonist use had a higher remission probability. Previous TNFα antagonist use had the greatest impact; remission probability was approximately 10% higher in treatment-naïve patients. CONCLUSIONS Higher vedolizumab serum concentrations were associated with higher remission rates after induction therapy in patients with moderately to severely active UC or CD. This relationship is affected by several factors, including previous TNFα antagonist use. Prospective studies are needed to assess vedolizumab dose individualisation and optimisation.
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Affiliation(s)
- Maria Rosario
- Clinical Pharmacology Department, Millennium Pharmaceuticals Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Ltd, Cambridge, MA, USA
| | | | | | - Serap Sankoh
- Clinical Pharmacology Department, Millennium Pharmaceuticals Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Ltd, Cambridge, MA, USA
| | - Asit Parikh
- Clinical Pharmacology Department, Millennium Pharmaceuticals Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Ltd, Cambridge, MA, USA
| | - Huyuan Yang
- Clinical Pharmacology Department, Millennium Pharmaceuticals Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Ltd, Cambridge, MA, USA
| | - Silvio Danese
- Inflammatory Bowel Disease Clinical and Research Unit, Istituto Clinico Humanitas, Milan, Italy
| | | | | | - William J Sandborn
- Division of Gastroenterology, University of California San Diego, La Jolla, CA, USA
| | - Brian G Feagan
- Robarts Research Institute, University of Western Ontario, London, ON, Canada
| | - Walter Reinisch
- Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria, and Department of Internal Medicine, McMaster University, Hamilton, ON, Canada
| | - Bruce E Sands
- Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Miguel Sans
- Digestive Diseases Service, Centro Médico Teknon, Barcelona, Spain
| | - Irving Fox
- Clinical Pharmacology Department, Millennium Pharmaceuticals Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Ltd, Cambridge, MA, USA
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Ji C, Lall R, Quinn T, Kaye C, Haywood K, Horton J, Gordon V, Deakin CD, Pocock H, Carson A, Smyth M, Rees N, Han K, Byers S, Brace-McDonnell S, Gates S, Perkins GD. Post-admission outcomes of participants in the PARAMEDIC trial: A cluster randomised trial of mechanical or manual chest compressions. Resuscitation 2017; 118:82-88. [PMID: 28689046 DOI: 10.1016/j.resuscitation.2017.06.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 06/26/2017] [Indexed: 01/06/2023]
Abstract
BACKGROUND The PARAMEDIC cluster randomised trial evaluated the LUCAS mechanical chest compression device, and did not find evidence that use of mechanical chest compression led to an improvement in survival at 30 days. This paper reports patient outcomes from admission to hospital to 12 months after randomisation. METHODS Information about hospital length of stay and intensive care management was obtained through linkage with Hospital Episode Statistics and the Intensive Care National Audit and Research Centre. Patients surviving to hospital discharge were approached to complete questionnaires (SF-12v2, EQ-5D, MMSE, HADS and PTSD-CL) at 90days and 12 months. The study is registered with Current Controlled Trials, number ISRCTN08233942. RESULTS 377 patients in the LUCAS arm and 658 patients in the manual chest compression were admitted to hospital. Hospital and intensive care length of stay were similar. Long term follow-up assessments were limited by poor response rates (53.7% at 3 months and 55.6% at 12 months). Follow-up rates were lower in those with worse neurological function. Among respondents, long term health related quality of life outcomes and emotional well-being was similar between groups. Cognitive function, measured by MMSE, was marginally lower in the LUCAS arm mean 26.9 (SD 3.7) compared to control mean 28.0 (SD 2.3), adjusted mean difference -1.5 (95% CI -2.6 to -0.4). CONCLUSION There were no clinically important differences identified in outcomes at long term follow-up between those allocated to the mechanical chest compression compared to those receiving manual chest compression.
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Affiliation(s)
- C Ji
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - R Lall
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - T Quinn
- Kingston University and St George's University of London Joint Faculty Health, Social Care and Education, London, UK
| | - C Kaye
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - K Haywood
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - J Horton
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - V Gordon
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - C D Deakin
- South Central Ambulance Service NHS Foundation Trust, Otterbourne, UK; NIHR Southampton Respiratory Biomedical Research Unit, Southampton, UK
| | - H Pocock
- South Central Ambulance Service NHS Foundation Trust, Otterbourne, UK
| | - A Carson
- West Midlands Ambulance Service NHS Foundation Trust, Brierley Hill, UK
| | - M Smyth
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK; West Midlands Ambulance Service NHS Foundation Trust, Brierley Hill, UK
| | - N Rees
- Welsh Ambulance Services NHS Trust, Denbighshire, Wales, UK
| | - K Han
- North East Ambulance Service NHS Foundation Trust, Newcastle upon Tyne, UK
| | - S Byers
- North East Ambulance Service NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | - S Gates
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - G D Perkins
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK; Heart of England NHS Foundation Trust, Birmingham, UK.
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Doyle S, Cahill D, Smyth M, Murphy S. Caring for Obese Children- A change in Paradigm. Ir Med J 2017; 110:543. [PMID: 28665082] [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: 06/07/2023]
Abstract
Childhood Obesity is a problem of epidemic proportions. The causes are complex and treatment results are variable with much research ongoing. We analysed the initial assessment forms of a group of patients attending the W82GO! Healthy Lifestyle service at The Children's University Hospital, Temple Street to look at the population and their specific needs. Our analysis revealed a high proportion of emotional and behavioural problems along with bullying. This group of patients are complex and a multi-disciplinary team approach is essential in their treatment.
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Affiliation(s)
- S Doyle
- The Children's University Hospital, Temple Street, Dublin 1
- Faculty Of Paediatrics, University College Dublin, Belfield, Dublin 4
| | - D Cahill
- Faculty Of Paediatrics, University College Dublin, Belfield, Dublin 4
| | - M Smyth
- Faculty Of Paediatrics, University College Dublin, Belfield, Dublin 4
| | - S Murphy
- The Children's University Hospital, Temple Street, Dublin 1
- Faculty Of Paediatrics, University College Dublin, Belfield, Dublin 4
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Vermeire S, Loftus EV, Colombel JF, Feagan BG, Sandborn WJ, Sands BE, Danese S, D'Haens GR, Kaser A, Panaccione R, Rubin DT, Shafran I, McAuliffe M, Kaviya A, Sankoh S, Mody R, Abhyankar B, Smyth M. Long-term Efficacy of Vedolizumab for Crohn's Disease. J Crohns Colitis 2017; 11:412-424. [PMID: 27683798 DOI: 10.1093/ecco-jcc/jjw176] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 09/27/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Vedolizumab is a gut-selective α4β7 integrin antagonist therapy for ulcerative colitis and Crohn's disease. The GEMINI long-term safety [LTS] trial is an ongoing open-label study investigating the safety of vedolizumab. We present interim exploratory analyses of efficacy in patients with Crohn's disease. METHODS Patients from the C13004, GEMINI 2 and GEMINI 3 studies and vedolizumab-naïve patients could enrol in GEMINI LTS and received vedolizumab every 4 weeks. Data were collected from May 22, 2009 to June 27, 2013. Outcomes of clinical response and remission, defined by the Harvey-Bradshaw Index, and health-related quality of life [HRQL] were assessed for up to 152 weeks of treatment in the efficacy population. RESULTS Among patients with response at week 6 in GEMINI 2 who received vedolizumab continuously, 83% [n=100/120] and 89% [n=62/70] of patients with available data were in remission after 104 and 152 weeks, respectively. Increased dosing frequency from every 8 weeks [GEMINI 2] to every 4 weeks [GEMINI LTS] improved outcomes in patients who had withdrawn early from GEMINI 2, with 47% [n=27/57] experiencing clinical response and 32% [n=18/57] in remission at week 52 of GEMINI LTS [up from 39% and 4% before the dose increase]. Similar improvements were observed regardless of prior tumour necrosis factor [TNF] antagonist exposure. Long-term benefits of HRQL were also observed. CONCLUSIONS The clinical benefits of vedolizumab continued with long-term treatment regardless of prior TNF antagonist exposure. Increased dosing frequency might improve outcomes in patients who lose response to conventional 8-weekly dosing.
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Affiliation(s)
| | - Edward V Loftus
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Brian G Feagan
- Robarts Clinical Trials, Robarts Research Institute, University of Western Ontario, London, Ontario, Canada
| | - William J Sandborn
- University of California San Diego and UC San Diego Health System, La Jolla, California, USA
| | - Bruce E Sands
- Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, New York, USA
| | | | | | - Arthur Kaser
- Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Remo Panaccione
- Inflammatory Bowel Disease Clinic, University of Calgary, Calgary, Alberta, Canada
| | - David T Rubin
- University of Chicago Inflammatory Bowel Disease Center, Chicago, Illinois, USA
| | - Ira Shafran
- Shafran Gastroenterology Center, Winter Park, Florida, USA
| | - Megan McAuliffe
- Takeda Pharmaceuticals International Co., Cambridge, Massachusetts, USA
| | | | - Serap Sankoh
- Takeda Pharmaceuticals International Co., Cambridge, Massachusetts, USA
| | - Reema Mody
- Takeda Pharmaceuticals International, Inc., Deerfield, Illinois, USA
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Loftus EV, Colombel JF, Feagan BG, Vermeire S, Sandborn WJ, Sands BE, Danese S, D'Haens GR, Kaser A, Panaccione R, Rubin DT, Shafran I, McAuliffe M, Kaviya A, Sankoh S, Mody R, Abhyankar B, Smyth M. Long-term Efficacy of Vedolizumab for Ulcerative Colitis. J Crohns Colitis 2017; 11:400-411. [PMID: 27683800 DOI: 10.1093/ecco-jcc/jjw177] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 09/27/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND AIMS The GEMINI long-term safety [LTS] study is a continuing phase 3 trial investigating the safety and efficacy of vedolizumab, an α4β7 integrin antagonist for ulcerative colitis [UC] and Crohn's disease. We provide an interim analysis of efficacy in patients with UC. METHODS Patients from the C13004 and GEMINI 1 studies and a cohort of vedolizumab-naïve patients received open-label vedolizumab every 4 weeks. Interim data were collected from May 22, 2009 to June 27, 2013. Clinical response and remission, evaluated using partial Mayo scores, and health-related quality of life [HRQL] were assessed for up to 152 weeks of cumulative treatment in the efficacy population. RESULTS As of June 27, 2013, 63% of the efficacy population [n = 532/845] were continuing treatment. Among patients who responded to vedolizumab induction and had data available, 88% [n = 120/136] were in remission after 104 weeks of exposure (96% [n = 70/73] after 152 weeks). Among patients who withdrew from every-8-week vedolizumab maintenance in GEMINI 1 [n = 32] before week 52, increased dosing to every 4 weeks in GEMINI LTS resulted in response and remission rates of 41% and 28%, respectively, after 52 weeks, an increase from 19% and 6%, respectively, from before the dose increase. Similar benefits were demonstrated regardless of prior tumour necrosis factor-antagonist exposure. Durable benefits on HRQL were also observed. CONCLUSIONS Patients with UC experienced clinical and HRQL improvements with continued vedolizumab treatment. Increased dosing frequency to every 4 weeks was beneficial in patients who had loss of response to 8-weekly dosing.
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Affiliation(s)
- Edward V Loftus
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Brian G Feagan
- Robarts Clinical Trials, Robarts Research Institute, University of Western Ontario, London, Ontario, Canada
| | | | - William J Sandborn
- University of California San Diego and UC San Diego Health System, La Jolla, California, USA
| | - Bruce E Sands
- Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, New York, USA
| | | | | | - Arthur Kaser
- Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Remo Panaccione
- Inflammatory Bowel Disease Clinic, University of Calgary, Calgary, Alberta, Canada
| | - David T Rubin
- University of Chicago Inflammatory Bowel Disease Center, Chicago, Illinois, USA
| | - Ira Shafran
- Shafran Gastroenterology Center, Winter Park, Florida, USA
| | - Megan McAuliffe
- Takeda Pharmaceuticals International Co., Cambridge, Massachusetts, USA
| | | | - Serap Sankoh
- Takeda Pharmaceuticals International Co., Cambridge, Massachusetts, USA
| | - Reema Mody
- Takeda Pharmaceuticals International, Inc., Deerfield, Illinois, USA
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Feagan BG, Rubin DT, Danese S, Vermeire S, Abhyankar B, Sankoh S, James A, Smyth M. Efficacy of Vedolizumab Induction and Maintenance Therapy in Patients With Ulcerative Colitis, Regardless of Prior Exposure to Tumor Necrosis Factor Antagonists. Clin Gastroenterol Hepatol 2017; 15:229-239.e5. [PMID: 27639327 DOI: 10.1016/j.cgh.2016.08.044] [Citation(s) in RCA: 130] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 08/05/2016] [Accepted: 08/16/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS The efficacy and safety of vedolizumab, a humanized immunoglobulin G1 monoclonal antibody against the integrin α4β7, were demonstrated in multicenter, phase 3, randomized, placebo-controlled trials in patients with moderately to severely active ulcerative colitis (UC) or Crohn's disease. We analyzed data from 1 of these trials to determine the effects of vedolizumab therapy in patients with UC, based on past exposure to anti-tumor necrosis factor-α (TNF) antagonists. METHODS We performed a post hoc analysis of data from the GEMINI 1 study, collected from 464 patients who received vedolizumab or placebo but had not received a previous TNF antagonist (naive to TNF antagonists) and 367 patients with an inadequate response, loss of response, or intolerance to TNF antagonists (failure of TNF antagonists). Predefined outcomes of GEMINI 1 were evaluated in these subpopulations. RESULTS At Week 6, there were greater absolute differences in efficacy between vedolizumab and placebo in patients naive to TNF antagonists than patients with failure of TNF antagonists, although the risk ratios (RRs) for efficacy were similar for each group. Week 6 rates of response to vedolizumab and placebo were 53.1% and 26.3%, respectively, among patients naive to TNF antagonists (absolute difference, 26.4%; 95% confidence interval [CI], 12.4-40.4; RR, 2.0; 95% CI, 1.3-3.0); these rates were 39.0% and 20.6%, respectively, in patients with failure of TNF antagonists (absolute difference, 18.1%; 95% CI, 2.8-33.5; RR, 1.9; 95% CI, 1.1-3.2). During maintenance therapy, the absolute differences were similar but the RR for efficacy was higher for patients with failure of TNF antagonists than for patients naive to TNF antagonists, for most outcomes. Week 52 rates of remission with vedolizumab and placebo were 46.9% and 19.0%, respectively, in patients naive to TNF antagonists (absolute difference, 28.0%; 95% CI, 14.9-41.1; RR, 2.5; 95% CI, 1.5-4.0) and 36.1% and 5.3%, respectively, in patients with failure of TNF antagonists (absolute difference, 29.5%; 95% CI, 12.8-46.1; RR, 6.6; 95% CI, 1.7-26.5). No differences in adverse events were observed among groups. CONCLUSIONS Vedolizumab demonstrated significantly greater efficacy as induction and maintenance therapy for UC than placebo in patients naive to TNF antagonists and patients with TNF antagonist failure. There were numerically greater treatment differences at Week 6 among patients receiving vedolizumab who were naive to TNF antagonists than patients with TNF antagonist failure. ClinicalTrials.gov no: NCT00783718.
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Affiliation(s)
- Brian G Feagan
- Robarts Clinical Trials, Robarts Research Institute, University of Western Ontario, London, Ontario, Canada.
| | - David T Rubin
- University of Chicago Medicine Inflammatory Bowel Disease Center, Chicago, Illinois
| | | | | | | | - Serap Sankoh
- Takeda Pharmaceuticals International Co, Cambridge, Massachusetts
| | - Alexandra James
- Takeda Development Centre Europe Ltd, London, United Kingdom
| | - Michael Smyth
- Takeda Development Centre Europe Ltd, London, United Kingdom
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Rajagopal S, Kaye C, Lall R, Deakin C, Gates S, Pocock H, Quinn T, Rees N, Smyth M, Perkins G. Characteristics of patients who are not resuscitated in out of hospital cardiac arrests and opportunities to improve community response to cardiac arrest. Resuscitation 2016; 109:110-115. [DOI: 10.1016/j.resuscitation.2016.09.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 09/14/2016] [Accepted: 09/14/2016] [Indexed: 01/25/2023]
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45
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Vickers AD, Ainsworth C, Mody R, Bergman A, Ling CS, Medjedovic J, Smyth M. Systematic Review with Network Meta-Analysis: Comparative Efficacy of Biologics in the Treatment of Moderately to Severely Active Ulcerative Colitis. PLoS One 2016; 11:e0165435. [PMID: 27776175 PMCID: PMC5077077 DOI: 10.1371/journal.pone.0165435] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 10/11/2016] [Indexed: 12/11/2022] Open
Abstract
Background Biological therapies are increasingly used to treat ulcerative colitis (UC). Aim To compare the efficacy of biologics in adults with moderately-to-severely active UC, stratified by prior exposure to anti-tumour necrosis factor (anti-TNF) therapy. Methods A systematic literature review was undertaken to identify studies of biologics approved for UC. Network meta-analysis was conducted for endpoints at induction and maintenance. Results Seven studies were included in the meta-analysis of induction treatment for anti-TNF therapy-naïve patients. All biologics were more effective than placebo in inducing clinical response, clinical remission, and mucosal healing. Infliximab demonstrated a statistically significant improvement over adalimumab in clinical response (odds ratio [OR] [95% credible interval (CrI)]: 2.19 [1.35–3.55]), clinical remission (OR [95% CrI]: 2.81 [1.49–5.49]), and mucosal healing (OR [95% CrI]: 2.23 [1.21–4.14]); there were no other significant differences between biologics for induction efficacy. Five studies were included in the meta-analysis of maintenance treatment, two studies rerandomised responder patients at end of induction, and three followed the same patients ‘straight through’. To account for design differences, the number of responders at end of induction was assumed to be equivalent to the number rerandomised. Vedolizumab showed significantly different durable clinical response from comparators (OR [95% CrI] infliximab 3.18 [1.14–9.20], golimumab 2.33 [1.04–5.41], and adalimumab 3.96 [1.67–9.84]). In anti-TNF therapy-experienced patients, only vedolizumab and adalimumab could be compared. At induction, no significant differences in efficacy were seen. During maintenance, vedolizumab showed significantly improved rates of mucosal healing versus adalimumab (OR [95% CrI]: 6.72 [1.36–41.0]). Conclusions This study expands the understanding of comparative efficacies of biologic treatments for UC, encompassing outcomes and populations not previously studied. All biologic treatments were effective for UC during induction. Vedolizumab demonstrated possible clinical benefits in the maintenance setting versus all comparators, irrespective of prior anti-TNF exposure and after adjusting for differences in study design.
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Affiliation(s)
| | | | - Reema Mody
- Takeda Development Center Americas, Inc., Deerfield, Illinois, United States of America
| | | | | | | | - Michael Smyth
- Takeda Development Centre Europe Ltd., London, United Kingdom
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Smyth M. Reconceptualizing Qualitative Research: Methodologies without Methodology, by Mirka Koro-Ljungberg. Qualitative Research in Psychology 2016. [DOI: 10.1080/14780887.2016.1149396] [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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Bowden NA, Smyth M, Jaaback K, Ashton KA, Scurry J. Genetic changes correlate with histopathology in a benign, borderline and malignant mucinous ovarian tumour. J OBSTET GYNAECOL 2015; 36:119-21. [PMID: 26440067 DOI: 10.3109/01443615.2015.1036406] [Citation(s) in RCA: 2] [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: 01/08/2023]
Affiliation(s)
- N A Bowden
- a The Centre for Information-Based Medicine, Hunter Medical Research Institute, New Lambton Heights, and The Discipline of Medical Genetics, School of Biomedical Sciences and Pharmacy, Faculty of Health, University of Newcastle , Callaghan , Australia
| | - M Smyth
- b School of Medicine and Public Health, University of Newcastle , Callaghan , Australia
| | - K Jaaback
- c Hunter Centre for Gynaecological Cancer, John Hunter Hospital , New Lambton Heights , Australia
| | - K A Ashton
- a The Centre for Information-Based Medicine, Hunter Medical Research Institute, New Lambton Heights, and The Discipline of Medical Genetics, School of Biomedical Sciences and Pharmacy, Faculty of Health, University of Newcastle , Callaghan , Australia
| | - J Scurry
- d Division of Anatomical Pathology, Hunter Area Pathology Service, John Hunter Hospital , New Lambton Heights , NSW , Australia
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Khot A, Ritchie D, Neeson P, Peinert S, Tai T, Kravets L, Chen K, Hoenemann D, Shin M, Tainton K, Westwood J, Kershaw M, Haurat J, Trapani J, Smyth M, Darcy P, Scott A, Wall D, Gambell P, Dickinson M, Westerman D, Hicks R, Prince M. Autologous peripheral blood T lymphocytes transduced with an anti lewisy chimeric receptor gene can be infused safely and persist in patients with lewisy positive acute myeloid leukaemia. Cytotherapy 2013. [DOI: 10.1016/j.jcyt.2013.01.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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50
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Mayne TJ, Benner D, Ricketts K, Burgess M, Wilson S, Poole L, Smyth M, Colson C, Krishnan M. Results of a Pilot Program to Improve Phosphorus Outcomes in Hemodialysis Patients. J Ren Nutr 2012; 22:472-9. [DOI: 10.1053/j.jrn.2011.08.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Revised: 08/11/2011] [Accepted: 08/27/2011] [Indexed: 11/11/2022] Open
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