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Chen Y, Shah A, Jani Y, Higgins D, Saleem N, Chafer K, Sydes MR, Asselbergs FW, Lumbers RT. Rationale and design of the THIRST Alert feasibility study: a pragmatic, single-centre, parallel-group randomised controlled trial of an interruptive alert for oral fluid restriction in patients treated with intravenous furosemide. BMJ Open 2024; 14:e080410. [PMID: 38216198 PMCID: PMC10806795 DOI: 10.1136/bmjopen-2023-080410] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 12/11/2023] [Indexed: 01/14/2024] Open
Abstract
INTRODUCTION Acute heart failure (HF) is a major cause of unplanned hospitalisation characterised by excess body water. A restriction in oral fluid intake is commonly imposed on patients as an adjunct to pharmacological therapy with loop diuretics, but there is a lack of evidence from traditional randomised controlled trials (RCTs) to support the safety and effectiveness of this intervention in the acute setting.This study aims to explore the feasibility of using computer alerts within the electronic health record (EHR) system to invite clinical care teams to enrol patients into a pragmatic RCT at the time of clinical decision-making. It will additionally assess the effectiveness of using an alert to help address the clinical research question of whether oral fluid restriction is a safe and effective adjunct to pharmacological therapy for patients admitted with fluid overload. METHODS AND ANALYSIS THIRST (Randomised Controlled Trial within the electronic Health record of an Interruptive alert displaying a fluid Restriction Suggestion in patients with the treatable Trait of congestion) Alert is a single-centre, parallel-group, open-label pragmatic RCT embedded in the EHR system that will be conducted as a feasibility study at an National Health Service (NHS) hospital in London. The clinical care team will be invited to enrol suitable patients in the study using a point-of-care alert with a target sample size of 50 patients. Enrolled patients will then be randomised to either restricted or unrestricted oral fluid intake. Two primary outcomes will be explored (1) the proportion of eligible patients enrolled in the study and (2) the mean difference in oral fluid intake between randomised groups. A series of secondary outcomes are specified to evaluate the effectiveness of the alert, adherence to the randomised treatment allocation and the quality of data generated from routine care, relevant to the outcomes of interest. ETHICS AND DISSEMINATION This study was approved by Riverside Research Ethics Committee (Ref: 22/LO/0889) and will be published on completion. TRIAL REGISTRATION NUMBER NCT05869656.
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Affiliation(s)
- Yang Chen
- Institute of Health Informatics, University College London, London, UK
- Clinical and Research Informatics Unit, NIHR UCLH Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK
| | - Anoop Shah
- Institute of Health Informatics, University College London, London, UK
- Clinical and Research Informatics Unit, NIHR UCLH Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK
| | - Yogini Jani
- Centre for Medicines Optimisation Research & Education - CMORE, University College London Hospitals NHS Foundation Trust, London, UK
| | - Daniel Higgins
- Clinical and Research Informatics Unit, NIHR UCLH Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK
| | - Nausheen Saleem
- Clinical and Research Informatics Unit, NIHR UCLH Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK
| | - Kris Chafer
- Clinical and Research Informatics Unit, NIHR UCLH Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK
| | - Matthew Robert Sydes
- Institute of Clinical Trials and Methodology, Medical Research Council Clinical Trials Unit at University College London, London, UK
- Health Data Research UK, London, UK
| | - Folkert W Asselbergs
- Institute of Health Informatics, University College London, London, UK
- Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, Netherlands
| | - R Thomas Lumbers
- Institute of Health Informatics, University College London, London, UK
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Wehbe H, Obaitan I, Al-Haddad MA, Tong Y, Mahendraker N, DeWitt JM, Bick B, Fogel E, Zyromski N, Gutta A, Sherman S, Watkins J, Gromski M, Saleem N, Easler JJ. Profile of and risk factors for early unplanned readmissions in patients with acute necrotizing pancreatitis. Pancreatology 2023; 23:465-472. [PMID: 37330391 DOI: 10.1016/j.pan.2023.05.014] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 05/04/2023] [Accepted: 05/28/2023] [Indexed: 06/19/2023]
Abstract
INTRODUCTION Acute necrotizing pancreatitis (ANP) complicates up to 15% of acute pancreatitis cases. ANP has historically been associated with a significant risk for readmission, but there are currently no studies exploring factors that associate with risk for unplanned, early (<30-day) readmissions in this patient population. METHODS We performed a retrospective review of all consecutive patients presenting to hospitals in the Indiana University (IU) Health system with pancreatic necrosis between December 2016 and June 2020. Patients younger than 18 years of age, without confirmed pancreatic necrosis and those that suffered in-hospital mortality were excluded. Logistic regression was performed to identify potential predictors of early readmission in this group of patients. RESULTS One hundred and sixty-two patients met study criteria. 27.7% of the cohort was readmitted within 30-days of index discharge. The median time to readmission was 10 days (IQR 5-17 days). The most frequent reason for readmission was abdominal pain (75.6%), followed by nausea and vomiting in (35.6%). Discharge to home was associated with 93% lower odds of readmission. We found no additional clinical factors that predicted early readmission. CONCLUSION Patients with ANP have a significant risk for early (<30 days) readmission. Direct discharge to home, rather than short or long-term rehabilitation facilities, is associated with lower odds of early readmission. Analysis was otherwise negative for independent, clinical predictors of early unplanned readmissions in ANP.
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Affiliation(s)
- H Wehbe
- Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - I Obaitan
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - M A Al-Haddad
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Y Tong
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - N Mahendraker
- Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - J M DeWitt
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - B Bick
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - E Fogel
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - N Zyromski
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - A Gutta
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - S Sherman
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - J Watkins
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - M Gromski
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - N Saleem
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - J J Easler
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA.
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Hufton M, Hussaini Y, Desai M, Saleem N, Srikantaiah R, Fairbank J, Cooper S, Paskin L. WS20.05 Cystic fibrosis, lockdown and CFTR modulators - a perfect storm. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)00271-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Trivedi S, Hathi K, Aslam N, Saleem N, Gyertson K, Whelan J. The role of an in-house audit group as an innovative tool to review clinical trials. Trials 2015. [PMCID: PMC4659190 DOI: 10.1186/1745-6215-16-s2-o50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Saleem N, Saczkowski R, Hudson C, Ruel M, Rubens F, Chan V, Hendry P, Boodhwani M. Normothermia Is Associated With Reduced Kidney and Brain Injury During Cardiopulmonary Bypass. Can J Cardiol 2013. [DOI: 10.1016/j.cjca.2013.07.691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Saleem N, Chaker A, Zissler U, Schmidt-Weber CB, Durham SR, Shamji MH. Local Nasal 'Protective' Immunoglobulin G4 (IgG4) Responses in Nasal Fluid Following Grass Pollen Sublingual Immunotherapy. J Allergy Clin Immunol 2013. [DOI: 10.1016/j.jaci.2012.12.1388] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Jan IA, Mirza F, Ali M, Arian A, Saleem N, Kumar D. Factors influencing the results of surgery for hypospadias: experience at NICH. J PAK MED ASSOC 2004; 54:577-9. [PMID: 15623186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
OBJECTIVE To evaluate the factors that may influence the results of surgery after hypospadias repair at National Institute of Child Health, Karachi. METHODS It was a retrospective observational study. Files of all patients who had Hypospadias repair were retrieved and analysed with a view to identify the factors which may influence the results of surgery for Hypospadias. Patients with complete record available were included in the study, whereas those with incomplete data were excluded. For most patients who had penile or distal hypospadias TIP (Tubularised Incised Plate) urethroplasty was performed. Patients with severe chordee had Duckett Island flap urethroplasty as a two stage procedure. Patients having moderate chordee were subjected to the Mustardee Procedure. Some underwent MAGPI and Mathieu's repairs. RESULTS One hundred four patients were operated. Files of only 46 patients with a mean age of 4 years could be retrieved and these were included in the study. Twenty five patients had TIP urethroplasty, 5 had island flap urethroplasty, 2 had Mustardee repair, 6 had MAGPI, 5 had Mathew's repair and 3 had Byers Staged Urethroplasty. Over all incidence of fistula formation was 26%. The frequency of fistula formation was less with TIP urethroplasty (16%) compared to those who received no dartos pedicle flap. Mathieu's repair gave good results with 20% incidence of fistula formation. Highest numbers of complications (60%) were seen in patients who had Island flap urethroplasty for proximal hypospadias with chordee. CONCLUSION TIP urethroplasty is a safe and reliable method of hypospadias repair. The results of surgery can however be improved by using dartos pedicle flap to protect the repair, meticulous surgical techniques, use of monofilamentous absorbable suture material and soft waterproof dressing.
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Affiliation(s)
- I A Jan
- Department of Paediatric Surgery, National Institute of Child Health, Karachi
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Saleem N, Mubarik A, Qureshi AH, Siddiq M, Ahmad M, Afzal S, Hussain AB, Hashmi SN. Is there a correlation between degree of viremia and liver histology in chronic hepatitis C? J PAK MED ASSOC 2004; 54:476-9. [PMID: 15518372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
OBJECTIVE To determine the correlation between degree of histological liver damage and serum HCV RNA level in patients of chronic hepatitis C, in order to evaluate the usefulness of HCV RNA estimation as an alternate to liver biopsy. METHODS This non-interventional descriptive study, was carried out at the department of Pathology, Army Medical College, Rawalpindi, Pakistan between April and September 2002. Core needle liver biopsies of fifty five patients of chronic hepatitis C were evaluated according to Knodell's histological activity index system. The patients were categorized into four subgroups depending upon the grade and stage of disease according to Desmet's classification, and into three groups according to degree of viremia. RESULTS Five patients had mild viremia, 43 moderate and 7 had severe viremia. Seven patients had minimal disease, 9 mild, 22 moderate and 17 had severe chronic hepatitis. Eight patients had no fibrosis, 20 had fibrous portal expansion, 19 bridging fibrosis, and 8 patients had cirrhosis. No significant correlation was found between serum HCV RNA levels and grade or stage of the disease, with correlation coefficients of rs = -.054 and rs = .034 respectively. Moreover, no individual component of the HAI correlated with serum HCV RNA levels. CONCLUSION Serum HCV RNA level does not determine the degree of hepatic injury precisely and liver biopsy is necessary to accurately evaluate the extent of liver damage.
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Affiliation(s)
- N Saleem
- Department of Pathology, Army Medical College, Military Hospital, Rawalpindi
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Afzal S, Ahmad M, Roshan E, Mubarik A, Qureshi AH, Saleem N, Khan SA. Morphological study of liver biopsy in Thalassaemia major. J PAK MED ASSOC 2004; 54:415-8. [PMID: 15461209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
OBJECTIVE To see the morphological changes in liver in transfusion dependent Thalassaemia major children undergoing bone marrow transplantation. METHODS This retrospective cross-sectional survey was conducted at Pathology department of Army Medical College and Paediatric department of Military Hospital, Rawalpindi from Jul 2000 to Aug 2003. Liver biopsies were done in 40 thalassaemic major children and histological changes including Knodell Histological activity index (HAI); grade, stage and score along with degree of haemosiderosis were noted. Serum ALT levels, ferritin assays and screening for HBsAg and Anti- HCV antibody were also carried out in these cases. RESULTS Forty children 1.5-10.5 years of age (mean 6.1 years) with a male to female ratio of 1.2:1 were included in the study. According to Knodell HAI scoring, 24 (60%) cases had Knodell HAI score between 13/22 to 18/22 and 18 patients (45%) in grade 9-12/18. Six children had fully developed cirrhotic changes whereas 22 and 12 patients showed stage 3 and 1 respectively. Twenty eight (70%) patients had grade 3-4 haemosiderosis. HBsAg was positive in 6 and anti- HCV antibody in 14 patients. Serum ferritin and ALT levels were markedly raised in most of the patients. CONCLUSION Seventy percent patients had moderate to severe haemosiderosis and high Knodell HAI score was found in children with severe haemosiderosis, raised ALT and Ferritin levels and with positive serology for HBsAg and anti- HCV antibody. Liver biopsy is useful in thalassaemic children to assess the stage of liver disease and selection of suitable cases for bone marrow transplantation (BMT).
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Affiliation(s)
- S Afzal
- Department of Pathology, Army Medical College, Rawalpindi
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Ahmad M, Afzal S, Saeed W, Mubarik A, Saleem N, Khan SA, Rafi S. Efficacy of bronchial wash cytology and its correlation with biopsy in lung tumours. J PAK MED ASSOC 2004; 54:13-6. [PMID: 15058635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
OBJECTIVE To evaluate bronchial wash cytology with histology in our set up. METHODS Seventy three specimens were obtained by flexible fiberoptic bronchoscope at pulmonology department of Military Hospital Rawalpindi. All the preserved samples were processed under standard conditions. The slides were stained with Papanicolaou and Haematoxylin and Eosin stains. RESULTS A total of 73 patients were studied. The age range was 21 to 80 years. Male to female ratio was 8:1. Complete cytological and biopsy consensus was found in 55 (77.4%) cases. Cytology revealed 24 cases as malignant and nine as atypical/suspicious. Benign and inadequate were 29 and 2 respectively. Histopathology of these cases confirmed 24 (32.9%) as malignant and 29 (39.8%) as benign. True positive alongwith suspicious/atypical were 33 and true negative cases were 29. False positive was one case only whereas false negative cases were eight. The bronchial wash cytology showed sensitivity (80.5%), specificity (96.6%) and accuracy (87.3%). Positive predictive value and negative predictive value were 97% and 78.4% respectively. The commonest types of tumours were squamous cell carcinoma and small cell carcinoma. CONCLUSION It is concluded that bronchial wash cytology is a valuable tool and yields almost same information as biopsy. It is useful in patients with evidence of obstruction or risk of haemorrhage.
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Affiliation(s)
- M Ahmad
- Department of Pathology, Army Medical College, Rawalpindi
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Saleem N, Moses B. Expert systems as computer assisted instruction systems for nursing education and training. Comput Nurs 1994; 12:35-45. [PMID: 8149301] [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: 05/22/2023]
Abstract
The ever-increasing specialization of nursing care may require nursing professionals to provide nursing care outside of their specialty. Nurses will have to familiarize themselves with a new specialization area at short notice. Fortunately, expert-systems technology can prove particularly helpful in achieving this familiarity. As such, this technology can prove a valuable tool for education and training of nursing professionals and students. This article describes the unique edge that expert systems technology provides in this context. Using VP-Expert, an expert system shell, the authors present two examples to illustrate the development of a computer aided instruction system and the unique benefits such a system offers.
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Affiliation(s)
- N Saleem
- Accounting, Legal Studies and IS Dept., University of Houston at Clear Lake, TX 77058
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Saleem N, Moses B. Successful implementation of computer systems: a planned organizational change approach. J Nurs Adm 1993; 23:12. [PMID: 8473936] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- N Saleem
- University of Houston-Clear Lake, TX
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Saleem M, Malik SA, Ahmed M, Saleem N. Isoniazid acetylation and polymorphism in humans. J PAK MED ASSOC 1989; 39:285-6. [PMID: 2516534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Phenotypes of slow and fast acetylators of isoniazid (INH) were determined in 157 subjects (80 normals and 77 patients with tuberculosis) from the twin cities of Rawalpindi and Islamabad. Plasma INH concentrations were determined chemically six hours after the drug ingestion. The findings indicate that 31.8% subjects were fast acetylators of the drug.
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Elias M, Begum A, Saleem N, Rahman MM, Ahmed RU, Dewan Z, Rahman AM, Sattar A. The biology of Toxorhynchites splendens (Wiedemann) (Diptera: Culicidae) and its potentiality as a biological control agent to other mosquitoes. Bangladesh Med Res Counc Bull 1988; 14:15-20. [PMID: 3245830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Abstract
Bone marrow biopsies of 15 patients with chronic renal failure (CRF) were compared with those of a control group matched for age and sex. Using a point-counting method for assessing cellularity, there was no significant difference in marrow cellularity between the CRF patients and the control group. There was a significant difference in the myeloid-erythroid ratio (p < 0.05) between the control group and the CRF patients, the latter group having a lower ratio. A point-counting method was used for the assessment of iron stores. Of 8 CRF patients who had not been given intravenous iron, oral iron or blood transfusion, 2 had greater iron stores than the control group.
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