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Soltani F, Bradley J, Bonandi A, Black N, Farrant JP, Pailing A, Orsborne C, Williams SG, Schelbert EB, Dodd S, Williams R, Peek N, Schmitt M, McDonagh T, Miller CA. Identification of heart failure hospitalization from NHS Digital data: comparison with expert adjudication. ESC Heart Fail 2024; 11:1022-1029. [PMID: 38232976 DOI: 10.1002/ehf2.14669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 12/19/2023] [Indexed: 01/19/2024] Open
Abstract
AIMS Population-wide, person-level, linked electronic health record data are increasingly used to estimate epidemiology, guide resource allocation, and identify events in clinical trials. The accuracy of data from NHS Digital (now part of NHS England) for identifying hospitalization for heart failure (HHF), a key HF standard, is not clear. This study aimed to evaluate the accuracy of NHS Digital data for identifying HHF. METHODS AND RESULTS Patients experiencing at least one HHF, as determined by NHS Digital data, and age- and sex-matched patients not experiencing HHF, were identified from a prospective cohort study and underwent expert adjudication. Three code sets commonly used to identify HHF were applied to the data and compared with expert adjudication (I50: International Classification of Diseases-10 codes beginning I50; OIS: Clinical Commissioning Groups Outcomes Indicator Set; and NICOR: National Institute for Cardiovascular Outcomes Research, used as the basis for the National Heart Failure Audit in England and Wales). Five hundred four patients underwent expert adjudication, of which 10 (2%) were adjudicated to have experienced HHF. Specificity was high across all three code sets in the first diagnosis position {I50: 96.2% [95% confidence interval (CI) 94.1-97.7%]; NICOR: 93.3% [CI 90.8-95.4%]; OIS: 95.6% [CI 93.3-97.2%]} but decreased substantially as the number of diagnosis positions expanded. Sensitivity [40.0% (CI 12.2-73.8%)] and positive predictive value (PPV) [highest with I50: 17.4% (CI 8.1-33.6%)] were low in the first diagnosis position for all coding sets. PPV was higher for the National Heart Failure Audit criteria, albeit modestly [36.4% (CI 16.6-62.2%)]. CONCLUSIONS NHS Digital data were not able to accurately identify HHF and should not be used in isolation for this purpose.
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Affiliation(s)
- Fardad Soltani
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Joshua Bradley
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Antonio Bonandi
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Nicholas Black
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
- Manchester University NHS Foundation Trust, Manchester, UK
| | - John P Farrant
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Adam Pailing
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Christopher Orsborne
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
- Manchester University NHS Foundation Trust, Manchester, UK
| | | | - Erik B Schelbert
- Minneapolis Heart Institute, United Hospital, Saint Paul, MN, USA
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Susanna Dodd
- Department of Health Data Science, University of Liverpool, Liverpool, UK
| | - Richard Williams
- Division of Informatics, Imaging and Data Science, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- NIHR Applied Research Collaboration Greater Manchester, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Niels Peek
- Division of Informatics, Imaging and Data Science, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- NIHR Applied Research Collaboration Greater Manchester, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Matthias Schmitt
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
- Manchester University NHS Foundation Trust, Manchester, UK
| | | | - Christopher A Miller
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
- Manchester University NHS Foundation Trust, Manchester, UK
- Wellcome Centre for Cell-Matrix Research, Division of Cell Matrix Biology and Regenerative Medicine, School of Biology, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
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Bradley J, Schelbert EB, Bonnett LJ, Lewis GA, Lagan J, Orsborne C, Brown PF, Black N, Naish JH, Williams SG, McDonagh T, Schmitt M, Miller CA. Growth differentiation factor-15 in patients with or at risk of heart failure but before first hospitalisation. Heart 2024; 110:195-201. [PMID: 37567614 PMCID: PMC10850645 DOI: 10.1136/heartjnl-2023-322857] [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: 04/21/2023] [Accepted: 07/13/2023] [Indexed: 08/13/2023] Open
Abstract
OBJECTIVE Identification of patients at risk of adverse outcome from heart failure (HF) at an early stage is a priority. Growth differentiation factor (GDF)-15 has emerged as a potentially useful biomarker. This study sought to identify determinants of circulating GDF-15 and evaluate its prognostic value, in patients at risk of HF or with HF but before first hospitalisation. METHODS Prospective, longitudinal cohort study of 2166 consecutive patients in stage A-C HF undergoing cardiovascular magnetic resonance and measurement of GDF-15. Multivariable linear regression investigated determinants of GDF-15. Cox proportional hazards modelling, Net Reclassification Improvement and decision curve analysis examined its incremental prognostic value. Primary outcome was a composite of first hospitalisation for HF or all-cause mortality. Median follow-up was 1093 (939-1231) days. RESULTS Major determinants of GDF-15 were age, diabetes and N-terminal pro-B-type natriuretic peptide, although despite extensive phenotyping, only around half of the variability of GDF-15 could be explained (R2 0.51). Log-transformed GDF-15 was the strongest predictor of outcome (HR 2.12, 95% CI 1.71 to 2.63) and resulted in a risk prediction model with higher predictive accuracy (continuous Net Reclassification Improvement 0.26; 95% CI 0.13 to 0.39) and with greater clinical net benefit across the entire range of threshold probabilities. CONCLUSION In patients at risk of HF, or with HF but before first hospitalisation, GDF-15 provides unique information and is highly predictive of hospitalisation for HF or all-cause mortality, leading to more accurate risk stratification that can improve clinical decision making. TRIAL REGISTRATION NUMBER NCT02326324.
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Affiliation(s)
- Joshua Bradley
- Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Erik B Schelbert
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Cardiovascular Magnetic Resonance Center, UPMC, Pittsburgh, Pennsylvania, USA
| | - Laura J Bonnett
- Department of Health Data Science, University of Liverpool, Liverpool, UK
| | - Gavin A Lewis
- Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Jakub Lagan
- Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Christopher Orsborne
- Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Pamela Frances Brown
- Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Nicholas Black
- Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester, UK
| | | | - Simon G Williams
- Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester, UK
| | | | - Matthias Schmitt
- Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Christopher A Miller
- Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester, UK
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3
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Orsborne C, Black N, Naish JH, Woolfson P, Reid AB, Schmitt M, Jovanovic A, Miller CA. Disease-specific therapy for the treatment of the cardiovascular manifestations of Fabry disease: a systematic review. Heart 2023; 110:19-26. [PMID: 37640453 PMCID: PMC10803963 DOI: 10.1136/heartjnl-2023-322712] [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: 03/22/2023] [Accepted: 06/08/2023] [Indexed: 08/31/2023] Open
Abstract
OBJECTIVE The cardiovascular manifestations of Fabry disease are common and represent the leading cause of death. Disease-specific therapy, including enzyme replacement therapy (ERT) and chaperone therapy (migalastat), is recommended for patients exhibiting cardiovascular involvement, but its efficacy for modulating cardiovascular disease expression and optimal timing of initiation remains to be fully established. We therefore aimed to systematically review and evaluate the effectiveness of disease-specific therapy compared with placebo, and to no intervention, for the cardiovascular manifestations of Fabry disease. METHODS Eight databases were searched from inception using a combination of relevant medical subject headings and keywords. Randomised, non-randomised studies with a comparator group and non-randomised studies without a comparator group were included. Studies were screened for eligibility and assessed for bias by two independent authors. The primary outcome comprised clinical cardiovascular events. Secondary outcomes included myocardial histology and measurements of cardiovascular structure, function and tissue characteristics. RESULTS 72 studies were included, comprising 7 randomised studies of intervention, 16 non-randomised studies of intervention with a comparator group and 49 non-randomised studies of intervention without a comparator group. Randomised studies were not at serious risk of bias, but the others were at serious risk. Studies were highly heterogeneous in their design, outcome measurements and findings, which made assessment of disease-specific therapy effectiveness difficult. CONCLUSION It remains unclear whether disease-specific therapy sufficiently impacts the cardiovascular manifestations of Fabry disease. Further work, ideally in larger cohorts, with more standardised clinical and phenotypic outcomes, the latter measured using contemporary techniques, are required to fully elucidate the cardiovascular impact of disease-specific therapy. PROSPERO REGISTRATION NUMBER CRD42022295989.
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Affiliation(s)
- Christopher Orsborne
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester, UK
- Northern Care Alliance, Salford Royal NHS Foundation Trust, Salford, UK
| | - Nicholas Black
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Josephine H Naish
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Peter Woolfson
- Northern Care Alliance, Salford Royal NHS Foundation Trust, Salford, UK
| | - Anna B Reid
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Matthias Schmitt
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Ana Jovanovic
- Northern Care Alliance, Salford Royal NHS Foundation Trust, Salford, UK
| | - Christopher A Miller
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester, UK
- Wellcome Centre for Cell-Matrix Research, Division of Cell-Matrix Biology & Regenerative Medicine, School of Biology, Faculty of Biology, Medicine & Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
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Brown MJM, Walker BE, Black N, Govaerts RHA, Ondo I, Turner R, Nic Lughadha E. rWCVP: a companion R package for the World Checklist of Vascular Plants. New Phytol 2023; 240:1355-1365. [PMID: 37289204 DOI: 10.1111/nph.18919] [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: 09/27/2022] [Accepted: 01/06/2023] [Indexed: 06/09/2023]
Abstract
The World Checklist of Vascular Plants (WCVP) is an extremely valuable resource that is being used to address many fundamental and applied questions in plant science, conservation, ecology and evolution. However, databases of this size require data manipulation skills that pose a barrier to many potential users. Here, we present rWCVP, an open-source R package that aims to facilitate the use of the WCVP by providing clear, intuitive functions to execute many common tasks. These functions include taxonomic name reconciliation, geospatial integration, mapping and generation of multiple different summaries of the WCVP in both data and report format. We have included extensive documentation and tutorials, providing step-by-step guides that are accessible even to users with minimal programming experience. rWCVP is available on cran and GitHub.
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Affiliation(s)
| | | | | | | | - Ian Ondo
- Royal Botanic Gardens, Kew, Richmond, TW9 3AB, UK
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5
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Saraf K, Black N, Garratt CJ, Muhyaldeen SA, Morris GM. Local impedance-guided ablation and ultra-high density mapping versus conventional or contact force-guided ablation with mapping for treatment of cavotricuspid isthmus dependent atrial flutter. Indian Pacing Electrophysiol J 2022; 22:188-194. [PMID: 35427782 PMCID: PMC9263660 DOI: 10.1016/j.ipej.2022.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 03/01/2022] [Accepted: 03/30/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION - Local impedance (LI) guided ablation as a method of judging lesion effectiveness for cavotricuspid isthmus dependent atrial flutter (CTI-AFL), and ultra-high density (UHD) mapping when breakthrough occurred across an ablation line has not previously been assessed. METHODS This retrospective observational study evaluated patients undergoing CTI-AFL ablation using conventional, contact force (CF) and LI guided strategies. Ablation metrics were collected, and in the LI cohort, the use of UHD mapping for breakthrough evaluated. RESULTS 30 patients were included, 10 per group. Mean total ablation time was significantly shorter with LI (3.2 ± 1.3min) vs conventional (5.6 ± 2.7min) and CF (5.7 ± 2.0min, p = 0.0042). Time from start of ablation to CTI block was numerically shorter with LI (14.2 ± 8.0min) vs conventional and CF (19.7 ± 14.1 and 22.5 ± 19.1min, p = 0.4408). Mean lesion duration was significantly shorter with LI, but there were no differences in the number of lesions required to achieve block, procedural success, complication rates or recurrence. 15/30 patients did not achieve block following first-pass ablation. UHD mapping rapidly identified breakthrough in the five LI patients, including epicardial-endocardial breakthrough (EEB). CONCLUSION - The use of LI during ablation for real-time lesion assessment was as efficacious as the conventional and CF methods. UHD mapping rapidly identified breakthrough, including EEB.
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Affiliation(s)
- Karan Saraf
- Division of Cardiovascular Sciences, The University of Manchester, Oxford Road, Manchester, M139PL, UK; Manchester Heart Centre, Manchester University NHS Foundation Trust, Oxford Road, Manchester, M139WL, UK
| | - Nicholas Black
- Division of Cardiovascular Sciences, The University of Manchester, Oxford Road, Manchester, M139PL, UK; Royal Oldham Hospital, Rochdale Road, Oldham, OL1 2JH, UK
| | - Clifford J Garratt
- Division of Cardiovascular Sciences, The University of Manchester, Oxford Road, Manchester, M139PL, UK; Manchester Heart Centre, Manchester University NHS Foundation Trust, Oxford Road, Manchester, M139WL, UK
| | - Sahrkaw A Muhyaldeen
- Manchester Heart Centre, Manchester University NHS Foundation Trust, Oxford Road, Manchester, M139WL, UK
| | - Gwilym M Morris
- Division of Cardiovascular Sciences, The University of Manchester, Oxford Road, Manchester, M139PL, UK; Manchester Heart Centre, Manchester University NHS Foundation Trust, Oxford Road, Manchester, M139WL, UK.
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6
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Ives Tallman C, Zhang Y, Black N, Lynch K, Fayed M, Armenian P. Refractory vasodilatory shock secondary to metformin overdose supported with VA ECMO. Toxicol Rep 2022; 9:64-67. [PMID: 35004183 PMCID: PMC8718576 DOI: 10.1016/j.toxrep.2021.12.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 12/14/2021] [Accepted: 12/18/2021] [Indexed: 01/27/2023] Open
Abstract
Metformin overdose can lead to vasodilatory shock refractory to medical management. Extracorporeal circulatory support with venoarterial ECMO is an effective way to manage profound shock associated with metformin overdose. We report the highest recorded serum metformin level in the literature to date.
Metformin overdose may result in vasodilatory shock, lactic acidosis and death. Hemodialysis is an effective means of extracorporeal elimination, but may be insufficient in the shock setting. We present a case of a 39 yo male who presented with hypotension, coma, hypoglycemia, and lactate of 6.5 mmol/L after ingesting an unknown medication. Metformin overdose was suspected, and he was started on hemodialysis. He developed profound vasoplegia refractory to high doses of norepinephrine, vasopressin, epinephrine and phenylephrine. Venoarterial extracorporeal membrane oxygenation (VA ECMO) was initiated and he had full recovery. Serum analysis with high resolution liquid chromatography mass spectrometry revealed a metformin level of 678 μg/mL and trazodone level of 2.1 μg/mL. This case is one of only a handful of reported cases of metformin overdose requiring ECMO support, and we report the highest serum metformin levels in the literature to date. We recommend early aggressive hemodialysis and vasopressor support in all suspected cases of metformin toxicity as well as VA ECMO if refractory to these therapies. Objective We present a case of vasodilatory shock secondary to metformin overdose requiring venoarterial extracorporeal membrane oxygenation (VA ECMO) support. This case is one of only a handful of reported cases of metformin overdose requiring ECMO support, and we report the highest serum metformin levels in the literature to date. Data sources University of San Francisco, Fresno. Study design Case report. Data extraction Clinical records and high resolution liquid chromatography mass spectroscopy analysis. Data synthesis None. Conclusions Venoarterial ECMO provided an effective means of hemodynamic support for a patient with severe metformin toxicity.
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Affiliation(s)
- Crystal Ives Tallman
- UCSF Fresno Department of Emergency Medicine, United States.,UCSF Fresno Department of Medicine, Pulmonary Critical Care Division, United States
| | - Yu Zhang
- UCSF Department of Laboratory Medicine, Division of Clinical Chemistry, San Francisco, CA, United States
| | - Nicholas Black
- UCSF Fresno Department of Emergency Medicine, United States
| | - Kara Lynch
- UCSF Department of Laboratory Medicine, Division of Clinical Chemistry, San Francisco, CA, United States
| | - Mohamed Fayed
- UCSF Fresno Department of Medicine, Pulmonary Critical Care Division, United States
| | - Patil Armenian
- UCSF Fresno Department of Emergency Medicine, United States
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Black N, Mohammad F, Saraf K, Morris G. Endothelial function and atrial fibrillation: A missing piece of the puzzle? J Cardiovasc Electrophysiol 2021; 33:109-116. [PMID: 34674346 DOI: 10.1111/jce.15277] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 04/28/2021] [Revised: 09/14/2021] [Accepted: 10/18/2021] [Indexed: 12/15/2022]
Abstract
Endothelial dysfunction, a term used to describe both the physical damage and dysregulated physiology of this endothelial lining, is an increasingly recognized pathophysiological state shared by many cardiovascular diseases. Historically, the role of endothelial dysfunction in atrial fibrillation (AF) was thought to be limited to mediating atrial thromboembolism. However, there is emerging evidence that endothelial dysfunction both promotes and maintains atrial arrhythmic substrate, predicts adverse outcomes, and identifies patients at high risk of recurrence following cardioversion and ablation therapy. Treatments targeted at improving endothelial function also represent a promising new therapeutic paradigm in AF. This review summarizes the current understanding of endothelial function in AF.
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Affiliation(s)
- Nicholas Black
- Division of Cardiovascular Sciences, University of Manchester, Manchester, UK
| | - Fahad Mohammad
- Division of Cardiovascular Sciences, University of Manchester, Manchester, UK
| | - Karan Saraf
- Division of Cardiovascular Sciences, University of Manchester, Manchester, UK
| | - Gwilym Morris
- Division of Cardiovascular Sciences, University of Manchester, Manchester, UK.,Manchester Heart Centre, Manchester Academic Health Science Centre, Manchester University Foundation Trust, Manchester, UK
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Govaerts R, Nic Lughadha E, Black N, Turner R, Paton A. The World Checklist of Vascular Plants, a continuously updated resource for exploring global plant diversity. Sci Data 2021; 8:215. [PMID: 34389730 PMCID: PMC8363670 DOI: 10.1038/s41597-021-00997-6] [Citation(s) in RCA: 84] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 07/16/2021] [Indexed: 11/30/2022] Open
Abstract
The World Checklist of Vascular Plants (WCVP) is a comprehensive list of scientifically described plant species, compiled over four decades, from peer-reviewed literature, authoritative scientific databases, herbaria and observations, then reviewed by experts. It is a vital tool to facilitate plant diversity research, conservation and effective management, including sustainable use and equitable sharing of benefits. To maximise utility, such lists should be accessible, explicitly evidence-based, transparent, expert-reviewed, and regularly updated, incorporating new evidence and emerging scientific consensus. WCVP largely meets these criteria, being continuously updated and freely available online. Users can browse, search, or download a user-defined subset of accepted species with corresponding synonyms and bibliographic details, or a date-stamped full dataset. To facilitate appropriate data reuse by individual researchers and global initiatives including Global Biodiversity Information Facility, Catalogue of Life and World Flora Online, we document data collation and review processes, the underlying data structure, and the international data standards and technical validation that ensure data quality and integrity. We also address the questions most frequently received from users. Measurement(s) | Vascular Plant • Species | Technology Type(s) | digital curation | Sample Characteristic - Organism | Tracheophyta | Sample Characteristic - Location | global |
Machine-accessible metadata file describing the reported data: 10.6084/m9.figshare.15035046
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Affiliation(s)
| | | | | | | | - Alan Paton
- Royal Botanic Gardens, Kew, Richmond, UK
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9
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Rimmer MP, Black N, Keay S, Quenby S, Wattar BH. P–394 Intralipid infusion at time of embryo transfer in women with history of recurrent implantation failure: a systematic review and meta-analysis. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Study question
What is the effectiveness of IV Intralipid (IVI) in improving pregnancy rates in women undergoing IVF with history of Recurrent implantation failure (RIF) to improve reproductive outcomes.
Summary answer
The evidence to support the use of IVI at the time of embryo transfer in women with RIF is limited. More RCTs are needed. What is known already: Optimising the implantation process following embryo transfer remains a clinical challenge with 10% of couples undergoing IVF affected by (RIF). Immunotherapy could help to optimise endometrial receptivity and increase the chances for successful conception in women with history of RIF. Intra-venous Intralipid (IVI), a fat-based emulsion of soybean oil, glycerine, phospholipids, egg, and polyunsaturated fatty acids, has been evaluated in several trials as a potential intervention to downregulate the uNK cells and macrophages as well as inhibit the pro-inflammatory mediators including T1 helper cells. Evidence synthesis is needed to evaluate the effectiveness of this intervention.
Study design, size, duration
We performed this systematic review using a prospectively registered protocol (CRD42019148517) and reported in accordance with the PRISMA guidelines. Participants/materials, setting, methods: We searched MEDLINE, EMBASE and CENTRAL for any randomised trials evaluating the use of IVI at the time of embryo transfer in women undergoing assisted conception until September 2020. We extracted data in duplicate and assessed risk of bias using the Cochrane Risk of Bias tools. We meta-analysed data using a random effect model and reported on dichotomous outcomes using risk ratio (RR) and 95% confidence interval (CI).
Main results and the role of chance
We included five randomised trials reporting on 843 women with an overall moderate risk of bias. All trials used 20% IVI solution at the time of embryo transfer compared to normal saline infusion or no intervention (routine care). The IVI group had a higher chance of clinical pregnancy (172 vs 119, RR 1.55, 95%CI 1.16–2.07, I2 44.2%) and live birth (132 vs 73, RR 1.83, 95%CI 1.42–2.35, I2 0%) post treatment compared to no intervention.
Limitations, reasons for caution
Our findings are limited by the small sample size and the variations in treatment protocols and population characteristics.
Wider implications of the findings: Our meta-analysis offers an overview on the value of IVI to help women affected by RIF. Given the limitations and the quality of included trials, adopting the use of IVI a-la-carte to couples undergoing IVF remains immature. IVI should not be offered until larger RCTs demonstrate a persistent benefit.
Trial registration number
CRD42019148517
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Affiliation(s)
- M P Rimmer
- University of Edinburgh, 1MRC Centre for Reproductive Health- Queens Medical Research Institute, Edinburgh, United Kingdom
| | - N Black
- University of Warwick, Warwick Medical School, Coventry, United Kingdom
| | - S Keay
- University Hospital Coventry and Warwickshire, Centre of Reproductive Medicine, Coventry, United Kingdom
| | - S Quenby
- University of Warwick, Warwick Medical School, Coventry, United Kingdom
| | - B. H.A Wattar
- University of Warwick, Warwick Medical School, London, United Kingdom
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10
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D'Souza A, Wang Y, Anderson C, Bucchi A, Baruscotti M, Olieslagers S, Mesirca P, Johnsen AB, Mastitskaya S, Ni H, Zhang Y, Black N, Cox C, Wegner S, Bano-Otalora B, Petit C, Gill E, Logantha SJRJ, Dobrzynski H, Ashton N, Hart G, Zhang R, Zhang H, Cartwright EJ, Wisloff U, Mangoni ME, da Costa Martins PA, Piggins HD, DiFrancesco D, Boyett MR. A circadian clock in the sinus node mediates day-night rhythms in Hcn4 and heart rate. Heart Rhythm 2020; 18:801-810. [PMID: 33278629 PMCID: PMC8073545 DOI: 10.1016/j.hrthm.2020.11.026] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 11/09/2020] [Accepted: 11/21/2020] [Indexed: 11/26/2022]
Abstract
Background Heart rate follows a diurnal variation, and slow heart rhythms occur primarily at night. Objective The lower heart rate during sleep is assumed to be neural in origin, but here we tested whether a day-night difference in intrinsic pacemaking is involved. Methods In vivo and in vitro electrocardiographic recordings, vagotomy, transgenics, quantitative polymerase chain reaction, Western blotting, immunohistochemistry, patch clamp, reporter bioluminescence recordings, and chromatin immunoprecipitation were used. Results The day-night difference in the average heart rate of mice was independent of fluctuations in average locomotor activity and persisted under pharmacological, surgical, and transgenic interruption of autonomic input to the heart. Spontaneous beating rate of isolated (ie, denervated) sinus node (SN) preparations exhibited a day-night rhythm concomitant with rhythmic messenger RNA expression of ion channels including hyperpolarization-activated cyclic nucleotide-gated potassium channel 4 (HCN4). In vitro studies demonstrated 24-hour rhythms in the human HCN4 promoter and the corresponding funny current. The day-night heart rate difference in mice was abolished by HCN block, both in vivo and in the isolated SN. Rhythmic expression of canonical circadian clock transcription factors, for example, Brain and muscle ARNT-Like 1 (BMAL1) and Cryptochrome (CRY) was identified in the SN and disruption of the local clock (by cardiomyocyte-specific knockout of Bmal1) abolished the day-night difference in Hcn4 and intrinsic heart rate. Chromatin immunoprecipitation revealed specific BMAL1 binding sites on Hcn4, linking the local clock with intrinsic rate control. Conclusion The circadian variation in heart rate involves SN local clock–dependent Hcn4 rhythmicity. Data reveal a novel regulator of heart rate and mechanistic insight into bradycardia during sleep.
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Affiliation(s)
- Alicia D'Souza
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom.
| | - Yanwen Wang
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
| | - Cali Anderson
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
| | - Annalisa Bucchi
- Department of Biosciences, University of Milan, Milan, Italy
| | | | - Servé Olieslagers
- Department of Cardiology, Maastricht University, Maastricht, The Netherlands
| | - Pietro Mesirca
- Institut de Génomique Fonctionnelle, Université de Montpellie, CNRS, Montpellier, France
| | - Anne Berit Johnsen
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Svetlana Mastitskaya
- Neuroscience, Physiology and Pharmacology, University College London, London, United Kingdom
| | - Haibo Ni
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
| | - Yu Zhang
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
| | - Nicholas Black
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
| | - Charlotte Cox
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
| | - Sven Wegner
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
| | - Beatriz Bano-Otalora
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
| | - Cheryl Petit
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
| | - Eleanor Gill
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
| | - Sunil Jit R J Logantha
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom; Liverpool Centre for Cardiovascular Sciences, University of Liverpool, Liverpool, UK
| | - Halina Dobrzynski
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
| | - Nick Ashton
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
| | - George Hart
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
| | - Rai Zhang
- School of Civil, Aerospace and Mechanical Engineering, University of Bristol, Bristol, United Kingdom
| | - Henggui Zhang
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
| | - Elizabeth J Cartwright
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
| | - Ulrik Wisloff
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Matteo E Mangoni
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Hugh D Piggins
- School of Physiology, Pharmacology & Neuroscience, University of Bristol, Bristol, United Kingdom
| | - Dario DiFrancesco
- Department of Biosciences, University of Milan, Milan, Italy; IBF-CNR, Milan, Italy
| | - Mark R Boyett
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom; Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Smith SC, Hendriks AAJ, Cano SJ, Black N. Proxy reporting of health-related quality of life for people with dementia: a psychometric solution. Health Qual Life Outcomes 2020; 18:148. [PMID: 32448322 PMCID: PMC7245851 DOI: 10.1186/s12955-020-01396-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 05/07/2020] [Indexed: 11/19/2022] Open
Abstract
Background The growing move towards personalised health and social care systems means that every effort needs to be made to generate patient-reported outcome data. However, the deteriorating nature of dementia can make it difficult for people with dementia to complete self-reported questionnaires and it is often necessary to rely on a family member (proxy) to report on their behalf. There is little evidence to guide how the difference between self- and proxy-reports of health reported quality of life (HRQL) in dementia can be interpreted. Methods We recruited people with dementia and their family carers from 78 memory Assessment Services in the UK. We used Rasch measurement methods to investigate whether a HRQL questionnaire known as DEMQOL (self-reported by the person with dementia) and DEMQOL-Proxy (proxy-reported by a family carer) can be placed on the same continuum and whether a revised scoring algorithm, based on this equated model, can be developed that takes account of the relationship between self- and proxy-reports. Results In a sample of 1434 patients and 1030 carers, our findings supported equating DEMQOL/DEMQOL-Proxy (overall fit to the model; no mis-fitting items) after addressing specific issues (eight disordered items requiring re-scoring, four pairs locally dependent items, and five items showing DIF). Cross walk tables have been produced. Conclusions We have established for the first time that DEMQOL and DEMQOL-Proxy can be placed on the same continuum and that patients and carer proxies are reporting on the same construct when they complete these questionnaires. Where possible both DEMQOL and DEMQOL-Proxy should still be administered together, using the improved scoring algorithm reported here. Where only DEMQOL-Proxy is available, the cross walk tables provide an estimate of DEMQOL for a particular person from their DEMQOL-Proxy score.
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Affiliation(s)
- S C Smith
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, WC1H 9SH, London, UK.
| | - A A J Hendriks
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, WC1H 9SH, London, UK
| | - S J Cano
- Modus Outcomes, Spirella Building, Letchworth Garden City, SG6 4ET, UK
| | - N Black
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, WC1H 9SH, London, UK
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Chrysanthaki T, Fernandes B, Smith S, Black N. Can Memory Assessment Services (MAS) in England be categorized? A national survey. J Public Health (Oxf) 2019; 39:828-840. [PMID: 28334926 DOI: 10.1093/pubmed/fdx018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 02/01/2017] [Indexed: 11/13/2022] Open
Abstract
Background The effectiveness and efficiency of memory assessment services (MASs) is unknown. Our aim was to determine if a typology can be constructed, based on shared structural and process characteristics, as a basis for a non-randomized evaluation of their effectiveness and cost-effectiveness. Methods Survey of random sample of 73 MASs in 2015; comparison of characteristics and investigation of inter-correlation. Results It was not possible to group characteristics to form the basis of a typology of MASs. However, there was considerable variation in staff numbers (20-fold), new patients per whole-time equivalent (WTE) staff (20-fold), skill mix and the nurse:doctor ratio (1-10). The operational performance also varied: first appointments (50-120 minutes); time for first follow-up (2-12 weeks); frequency of follow-up in first year (1-5). These differences were not associated with the number of new patients per WTE staff or the accreditation status of the MAS. Post diagnosis, all MASs provided pharmacological treatment but the availability of non-pharmacological support varied, with half providing none or only one intervention while others providing four or more. Conclusions In the absence of any clear typology, evaluation of MASs will need to focus on the impact of individual structural and process characteristics on outcomes.
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Affiliation(s)
- T Chrysanthaki
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK
| | - B Fernandes
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK
| | - S Smith
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK
| | - N Black
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK
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13
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Gilhooly D, Green SA, McCann C, Black N, Moonesinghe SR. Barriers and facilitators to the successful development, implementation and evaluation of care bundles in acute care in hospital: a scoping review. Implement Sci 2019; 14:47. [PMID: 31060625 PMCID: PMC6501296 DOI: 10.1186/s13012-019-0894-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 04/12/2019] [Indexed: 12/21/2022] Open
Abstract
Background Care bundles are small sets of evidence-based recommendations, designed to support the implementation of evidence-based best clinical practice. However, there is variation in the design and implementation of care bundles, which may impact on the fidelity of delivery and subsequently their clinical effectiveness. Methods A scoping review was carried out using the Arksey and O’Malley framework to identify the literature reporting on the design, implementation and evaluation of care bundles. The Embase, CINAHL, Cochrane and Ovid MEDLINE databases were searched for manuscripts published between 2001 and November 2017; hand-searching of references and citations was also undertaken. Data were initially assessed using a quality assessment tool, the Downs and Black checklist, prior to further analysis and narrative synthesis. Implementation strategies were classified using the Expert Recommendations for Implementing Change (ERIC) criteria. Results Twenty-eight thousand six hundred ninety-two publications were screened and 348 articles retrieved in full text. Ninety-nine peer-reviewed quantitative publications were included for data extraction. These consisted of one randomised crossover trial, one randomised cluster trial, one case-control study, 20 prospective cohort studies and 76 non-parallel cohort studies. Twenty-three percent of studies were classified as poor based on Downs and Black checklist, and reporting of implementation strategies lacked structure. Negative associations were found between the number of elements in a bundle and compliance (Spearman’s rho = − 0.47, non-parallel cohort and − 0.65, prospective cohort studies), and between the complexity of elements and compliance (p < 0.001, chi-squared = 23.05). Implementation strategies associated with improved compliance included evaluative and iterative approaches, development of stakeholder relationships and education and training strategies. Conclusion Care bundles with a small number of simple elements have better compliance rates. Standardised reporting of implementation strategies may help to implement care bundles into clinical practice with high fidelity. Trial Registration This review was registered on the PROSPERO database: CRD 42015029963 in December 2015. Electronic supplementary material The online version of this article (10.1186/s13012-019-0894-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- D Gilhooly
- UCLH NIHR Surgical Outcomes Research Centre, Department of Anaesthesia and Perioperative Medicine, University College Hospital, London, NW1 2BU, UK.
| | - S A Green
- NIHR CLAHRC Northwest London, Imperial College London Chelsea and Westminster Hospital, London, SW10 9NH, UK.,Department of Health Services Research Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - C McCann
- UCLH NIHR Surgical Outcomes Research Centre, Department of Anaesthesia and Perioperative Medicine, University College Hospital, London, NW1 2BU, UK
| | - N Black
- Department of Health Services Research Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - S R Moonesinghe
- Division of Surgery and Interventional Science Charles Bell House, University College London, London, W1W 7TS, UK.,Health Services Research Centre, National Institute for Academic Anaesthesia, Royal College of Anaesthetists, Churchill House, 35 Red Lion Square, London, WC1R 4SG, UK
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14
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O'Donnell C, Black N, McCourt K, McBrien M, Clarke M, Patterson C, Blackwood B, McAuley D, Shields M. Development of a Core Outcome Set for studies evaluating the effects of anaesthesia on perioperative morbidity and mortality following hip fracture surgery. Br J Anaesth 2019; 122:120-130. [DOI: 10.1016/j.bja.2018.08.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 08/02/2018] [Accepted: 08/17/2018] [Indexed: 12/31/2022] Open
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Choudhury M, Black N, Alghamdi A, D'Souza A, Wang R, Yanni J, Dobrzynski H, Kingston PA, Zhang H, Boyett MR, Morris GM. TBX18 overexpression enhances pacemaker function in a rat subsidiary atrial pacemaker model of sick sinus syndrome. J Physiol 2018; 596:6141-6155. [PMID: 30259525 PMCID: PMC6292813 DOI: 10.1113/jp276508] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 09/14/2018] [Indexed: 11/08/2022] Open
Abstract
KEY POINTS The sinoatrial node (SAN) is the primary pacemaker of the heart. SAN dysfunction, or 'sick sinus syndrome', can cause excessively slow heart rates and pauses, leading to exercise limitation and syncope, currently treated by implantation of an electronic pacemaker. 'Biopacemaking' utilises gene therapy to restore pacemaker activity by manipulating gene expression. Overexpressing the HCN pacemaker ion channel has been widely used with limited success. We utilised bradycardic rat subsidiary atrial pacemaker tissue to evaluate alternative gene targets: the Na+ /Ca2+ exchanger NCX1, and the transcription factors TBX3 and TBX18 known to be involved in SAN embryonic development. TBX18 overexpression restored normal SAN function, as assessed by increased rate, improved heart rate stability and restoration of isoprenaline response. TBX3 and NCX1 were not effective in accelerating the rate of subsidiary atrial pacemaker tissue. Gene therapy targeting TBX18 could therefore have the potential to restore pacemaker function in human sick sinus syndrome obviating electronic pacemakers. ABSTRACT The sinoatrial node (SAN) is the primary pacemaker of the heart. Disease of the SAN, sick sinus syndrome, causes heart rate instability in the form of bradycardia and pauses, leading to exercise limitation and syncope. Biopacemaking aims to restore pacemaker activity by manipulating gene expression, and approaches utilising HCN channel overexpression have been widely used. We evaluated alternative gene targets for biopacemaking to restore normal SAN pacemaker physiology within bradycardic subsidiary atrial pacemaker (SAP) tissue, using the Na+ /Ca2+ exchanger NCX1, and the transcription factors TBX3 and TBX18. TBX18 expression in SAP tissue restored normal SAN function, as assessed by increased rate (SAN 267.5 ± 13.6 bpm, SAP 144.1 ± 8.6 bpm, SAP-TBX18 214.4 ± 14.4 bpm; P < 0.001), improved heart rate stability (standard deviation of RR intervals fell from 39.3 ± 7.2 ms to 6.9 ± 0.8 ms, P < 0.01; root mean square of successive differences of RR intervals fell from 41.7 ± 8.2 ms to 6.1 ± 1.2 ms, P < 0.01; standard deviation of points perpendicular to the line of identity of Poincaré plots (SD1) fell from 29.5 ± 5.8 ms to 7.9 ± 2.0 ms, P < 0.05) and restoration of isoprenaline response (increases in rates of SAN 65.5 ± 1.3%, SAP 28.4 ± 3.4% and SAP-TBX18 103.3 ± 10.2%; P < 0.001). These changes were driven by a TBX18-induced switch in the dominant HCN isoform in SAP tissue, with a significant upregulation of HCN2 (from 1.01 × 10-5 ± 2.2 × 10-6 to 2.8 × 10-5 ± 4.3 × 10-6 arbitrary units, P < 0.001). Biophysically detailed computer modelling incorporating isoform-specific HCN channel electrophysiology confirmed that the measured changes in HCN abundance could account for the observed changes in beating rates. TBX3 and NCX1 were not effective in accelerating the rate of SAP tissue.
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Affiliation(s)
- M. Choudhury
- Institute of Cardiovascular SciencesUniversity of ManchesterManchesterUK
| | - N. Black
- Institute of Cardiovascular SciencesUniversity of ManchesterManchesterUK
| | - A. Alghamdi
- Institute of Cardiovascular SciencesUniversity of ManchesterManchesterUK
| | - A. D'Souza
- Institute of Cardiovascular SciencesUniversity of ManchesterManchesterUK
| | - R. Wang
- Institute of Cardiovascular SciencesUniversity of ManchesterManchesterUK
| | - J. Yanni
- Institute of Cardiovascular SciencesUniversity of ManchesterManchesterUK
| | - H. Dobrzynski
- Institute of Cardiovascular SciencesUniversity of ManchesterManchesterUK
| | - P. A. Kingston
- Institute of Cardiovascular SciencesUniversity of ManchesterManchesterUK
| | - H. Zhang
- Institute of Cardiovascular SciencesUniversity of ManchesterManchesterUK
| | - M. R. Boyett
- Institute of Cardiovascular SciencesUniversity of ManchesterManchesterUK
| | - G. M. Morris
- Institute of Cardiovascular SciencesUniversity of ManchesterManchesterUK
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Black N, D'Souza A, Wang Y, Piggins H, Dobrzynski H, Morris G, Boyett MR. Circadian rhythm of cardiac electrophysiology, arrhythmogenesis, and the underlying mechanisms. Heart Rhythm 2018; 16:298-307. [PMID: 30170229 PMCID: PMC6520649 DOI: 10.1016/j.hrthm.2018.08.026] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Indexed: 12/31/2022]
Abstract
Cardiac arrhythmias are a leading cause of cardiovascular death. It has long been accepted that life-threatening cardiac arrhythmias (ventricular tachycardia, ventricular fibrillation, and sudden cardiac death) are more likely to occur in the morning after waking. It is perhaps less well recognized that there is a circadian rhythm in cardiac pacemaking and other electrophysiological properties of the heart. In addition, there is a circadian rhythm in other arrhythmias, for example, bradyarrhythmias and supraventricular arrhythmias. Two mechanisms may underlie this finding: (1) a central circadian clock in the suprachiasmatic nucleus in the hypothalamus may directly affect the electrophysiology of the heart and arrhythmogenesis via various neurohumoral factors, particularly the autonomic nervous system; or (2) a local circadian clock in the heart itself (albeit under the control of the central clock) may drive a circadian rhythm in the expression of ion channels in the heart, which in turn varies arrhythmic substrate. This review summarizes the current understanding of the circadian rhythm in cardiac electrophysiology, arrhythmogenesis, and the underlying molecular mechanisms.
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Affiliation(s)
- Nicholas Black
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
| | - Alicia D'Souza
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
| | - Yanwen Wang
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
| | - Hugh Piggins
- Division of Diabetes, Endocrinology & Gastroenterology, University of Manchester, Manchester, United Kingdom
| | - Halina Dobrzynski
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
| | - Gwilym Morris
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
| | - Mark R Boyett
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom.
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17
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O'Donnell C, Black N, McCourt K, McBrien M, Clarke M, McAuley D, Shields M. Development of a Core Outcome Set for studies evaluating the effects of anaesthesia on perioperative morbidity and mortality within the hip fracture population. Br J Anaesth 2018. [DOI: 10.1016/j.bja.2017.11.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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18
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Abstract
An 80-year-old woman presented with a 5-week history of increasing confusion. Examination was remarkable only for deficits in short-term memory and paranoid thoughts. Blood tests revealed hyponatraemia, and further biochemical testing was consistent with syndrome of inappropriate antidiuretic hormone (SIADH). After an exhaustive diagnostic workup for causes of SIADH, the only abnormal finding was a mildly raised antivoltage-gated potassium channel (VGKC) titre of 185 pmol/L (0-69) consistent with possible anti-VGKC autoimmune limbic encephalitis. However, other diagnostic features were absent. She is currently undergoing outpatient investigation for other causes of memory loss.
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Affiliation(s)
- Nicholas Black
- Department of General and Geriatric Medicine, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Hazim Hamada
- Department of General and Geriatric Medicine, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
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Black N, Daiki T, Matsushita MM, Woollins JD, Awaga K, Robertson N. Giant negative magnetoresistance in Ni(quinoline-8-selenoate)2. Phys Chem Chem Phys 2018; 20:514-519. [DOI: 10.1039/c7cp06273g] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Ni(qs)2 shows giant negative magnetoresistance as a powder sample, attributed to S = 1 magnetic properties arising from a chain structure.
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Affiliation(s)
- Nicholas Black
- EaStCHEM School of Chemistry
- University of St Andrews
- St Andrews
- UK
| | - Tonouchi Daiki
- Research Centre for Materials Sciences & Department of Chemistry
- Nagoya University Furo-cho
- Chikusa
- Japan
| | - Michio M. Matsushita
- Research Centre for Materials Sciences & Department of Chemistry
- Nagoya University Furo-cho
- Chikusa
- Japan
| | | | - Kunio Awaga
- Research Centre for Materials Sciences & Department of Chemistry
- Nagoya University Furo-cho
- Chikusa
- Japan
| | - Neil Robertson
- EaStCHEM School of Chemistry University of Edinburgh
- Edinburgh
- UK
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Black N, Choudhury M, Yanni J, D'Souza A, Kingston P, Dobrzynski H, Boyett M, Morris G. 3881Restoration of normal sinus node physiology in a model of sick sinus syndrome; Tbx18 overexpression improves heart rate, rate stability and adrenergic response. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.3881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Greenhalgh J, Gooding K, Gibbons E, Dalkin S, Wright J, Valderas JM, Black N, Meads D, Wood L. OP09 For whom and in what circumstances does the use of patient reported outcome measures (PROMs) improve patient care? A realist synthesis. Br J Soc Med 2016. [DOI: 10.1136/jech-2016-208064.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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22
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Duprey S, Savonnet L, Black N, Wang X. Muscle force prediction: can we rely on musculoskeletal model estimations? A case study on push force exertions with the upper limb. Comput Methods Biomech Biomed Engin 2015; 18 Suppl 1:1934-5. [DOI: 10.1080/10255842.2015.1069575] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- S. Duprey
- Université de Lyon, Lyon, France
- Université Claude Bernard Lyon 1, Villeurbanne, France
- LBMC Laboratoire de Biomécanique et Mécanique des Chocs, IFSTTAR, Bron, France
| | - L. Savonnet
- Université de Lyon, Lyon, France
- Université Claude Bernard Lyon 1, Villeurbanne, France
- LBMC Laboratoire de Biomécanique et Mécanique des Chocs, IFSTTAR, Bron, France
| | - N. Black
- Département de génie mécanique, Faculté d’ingénierie, Université de Moncton, Moncton, Canada
| | - X. Wang
- Université de Lyon, Lyon, France
- Université Claude Bernard Lyon 1, Villeurbanne, France
- LBMC Laboratoire de Biomécanique et Mécanique des Chocs, IFSTTAR, Bron, France
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van der Wees P, Nijhuis-Van der Sanden M, Ayanian J, Black N, Westert G, Schneider E. Integrating the use of patient-reported outcomes for both clinical practice and for performance measurement: experts’ views from three countries. Physiotherapy 2015. [DOI: 10.1016/j.physio.2015.03.1573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Nejman PS, Morton-Fernandez B, Black N, Cordes DB, Slawin AM, Kilian P, Woollins JD. The preparation and characterisation of rhodium(III) and Iridium(III) half sandwich complexes with napthalene-1,8-dithiolate, acenaphthene-5,6-dithiolate and biphenyl-2,2′-dithiolate. J Organomet Chem 2015. [DOI: 10.1016/j.jorganchem.2014.10.023] [Citation(s) in RCA: 7] [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] [Indexed: 10/24/2022]
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Lim W, Black N, Rowan K, Mays N. Do generic measures fully capture health-related quality of life in adult, general critical care survivors? Crit Care 2014. [PMCID: PMC4068642 DOI: 10.1186/cc13201] [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: 12/02/2022] Open
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Bream E, Jha AK, Epstein AM, Black N. Views of the chairs of Scottish health boards on engagement with quality management and comparisons with English trusts. J R Coll Physicians Edinb 2013; 43:215-21. [PMID: 24087799 DOI: 10.4997/jrcpe.2013.305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To describe the views of the chairs of Scottish health boards on the engagement of their boards with healthcare quality and to compare them with the views of the chairs of boards of English acute trusts. The focus of the Scottish Health Boards is on providing and commissioning care, while in England the acute trusts only provide care. METHODS We mailed a questionnaire, based on one used in England, to the 14 health board chairs in NHS Scotland in January 2011. The results were compared with the results of a similar questionnaire given to English acute trust chairs in 2009. RESULTS Most chairs in Scotland (67%) prioritised oversight of quality. Quality is considered at most Board meetings (92%), taking over 20% of time for 69% of chairs. Most boards have local quality targets and feedback quality data to staff. Compared with England, boards in Scotland meet less frequently and focus less on quality (shorter discussions, less frequent data review, fewer local targets) but they are more optimistic about their board's performance. CONCLUSIONS Although most chairs of Scottish boards view quality as a priority, they pay less attention to it than chairs in England, possibly due to their additional role in commissioning care.
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Affiliation(s)
- E Bream
- E Bream, Department of Public Health, NHS Lothian, Waverley Gate, Waterloo Place, Edinburgh EH1 3EG, UK.
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Black N, Varagunam M, Hutchings A. Influence of surgical rate on patients' reported clinical need and outcomes in English NHS. J Public Health (Oxf) 2013; 36:497-503. [DOI: 10.1093/pubmed/fdt088] [Citation(s) in RCA: 5] [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: 11/14/2022] Open
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Affiliation(s)
- Nicholas Black
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London
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Affiliation(s)
- N. Black
- Department of Health Services Research and Policy; London School of Hygiene and Tropical Medicine; 15-17 Tavistock Place; London; WC1H 9SH; U.K
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Grosse Frie K, von der Meulen J, Black N. Relationship between patients’ reports of complications and symptoms, disability and quality of life after surgery. Dtsch Med Wochenschr 2012. [DOI: 10.1055/s-0032-1323266] [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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Neuburger J, Hutchings A, Black N, van der Meulen JH. Socioeconomic differences in patient-reported outcomes after a hip or knee replacement in the English National Health Service. J Public Health (Oxf) 2012; 35:115-24. [PMID: 22729275 DOI: 10.1093/pubmed/fds048] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND We investigated socioeconomic differences in patient-reported outcomes after a hip or knee replacement and the contribution of health differences beforehand. METHODS Our sample included 121 983 patients in England who had an operation in 2009-2011. Socioeconomic status was measured with quintiles of the ranking of areas by the English Index of Multiple Deprivation. Outcomes at 6 months were the Oxford hip or knee score (OHS or OKS) that measure pain and disability on a scale from 0 (worst) to 48 (best), and the percentage reporting no improvement in problems. Adjustment was made for age, sex, ethnicity, comorbidity, general health, revision surgery, primary diagnosis, preoperative OHS or OKS and having longstanding problems. RESULTS Comparing the most- with the least-deprived group, the mean OHS was 5.0 points lower and the OKS 5.4 lower. Adjusted differences, reflecting the differences in improvement in the condition, were 2.8 [95% confidence interval (CI): 2.5-3.0] on OHS and 2.4 (95% CI: 2.2-2.7) on OKS. Adjusted odds ratios for reporting no improvement were 1.4 (1.2-1.6) for the hip and 1.4 (1.3-1.5) for the knee. CONCLUSIONS On average, patients living in socioeconomically deprived areas had worse outcomes after surgery, partly related to preoperative differences in health and disease severity and partly to less postoperative improvement.
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Affiliation(s)
- J Neuburger
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK.
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Grosse Frie K, van der Meulen J, Black N. Relationship between patients' reports of complications and symptoms, disability and quality of life after surgery. Br J Surg 2012; 99:1156-63. [PMID: 22696080 DOI: 10.1002/bjs.8830] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2012] [Indexed: 11/07/2022]
Abstract
BACKGROUND Patient-reported complications are increasingly being used to compare the performance of surgical departments. The objectives of this study were to explore the validity of patient-reported complications and to determine their influence on patients' reports of the benefits of surgery (health gain). METHODS This was an observational study of patients in England who underwent hip replacement (68,391), knee replacement (77,705), inguinal hernia repair (48,199) or varicose vein surgery (16,535) during 2009-2011. Health gain was assessed with condition-specific measures of symptoms and disability (Oxford Hip Score, Oxford Knee Score, Aberdeen Varicose Vein Questionnaire), health-related quality of life (EQ-5D™ index) and a single item on the success of surgery. Adverse outcomes included four complications, readmission and further surgery. RESULTS There was evidence that patient-reported complications were valid. Patients with three or more co-morbid conditions reported more complications, whereas age, sex and socioeconomic status (adjusted for co-morbidity) had little, or no association. Complications were strongly associated with readmission and further surgery. Among patients reporting a complication, the Oxford Hip Score or Oxford Knee Score was about 3 points (or 15 per cent) lower than the value in patients not reporting a complication. The EQ-5D™ score was about 0·07 lower for joint replacement, 0·06 lower for hernia repair and 0·04 lower for varicose vein surgery. CONCLUSION Patients' reports of complications can be used for statistical comparisons of surgical departments. If the relationship between complications and health gain is causal, there is scope for improving health gain indicators after surgery by minimizing the risk of a complication.
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Affiliation(s)
- K Grosse Frie
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
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Nehls W, Delis S, Black N, Gabrijel S, Albrecht H, Bauer T. Bedarf für eine palliativmedizinische Versorgung in der Pneumologie bei nicht malignen Erkrankungen - ein Fallbericht. Pneumologie 2012; 66:231-4. [DOI: 10.1055/s-0032-1308913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- W. Nehls
- Lungenklinik Heckeshorn, Klinik für Pneumologie, HELIOS Klinikum Emil von Behring, Berlin (Leiter: Prof. Dr. med. Torsten T. Bauer)
| | - S. Delis
- Lungenklinik Heckeshorn, Klinik für Pneumologie, HELIOS Klinikum Emil von Behring, Berlin (Leiter: Prof. Dr. med. Torsten T. Bauer)
| | - N. Black
- Lungenklinik Heckeshorn, Klinik für Pneumologie, HELIOS Klinikum Emil von Behring, Berlin (Leiter: Prof. Dr. med. Torsten T. Bauer)
| | - S. Gabrijel
- Lungenklinik Heckeshorn, Klinik für Pneumologie, HELIOS Klinikum Emil von Behring, Berlin (Leiter: Prof. Dr. med. Torsten T. Bauer)
| | - H. Albrecht
- Klinik für Psychosomatische Medizin und Psychotherapie (Leiter: Dr. med. Dipl.-Psych. Helmut Albrecht)
| | - T. Bauer
- Lungenklinik Heckeshorn, Klinik für Pneumologie, HELIOS Klinikum Emil von Behring, Berlin (Leiter: Prof. Dr. med. Torsten T. Bauer)
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Neuburger J, Hutchings A, Allwood D, Black N, van der Meulen JH. Sociodemographic differences in the severity and duration of disease amongst patients undergoing hip or knee replacement surgery. J Public Health (Oxf) 2012; 34:421-9. [PMID: 22267293 DOI: 10.1093/pubmed/fdr119] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Differences in the use of hip and knee replacement by sex, age, ethnicity or socioeconomic status may lead to differences in disease severity between those who have surgery. METHODS Analyses used data collected from 117,736 patients in 2009-10 via the Patient Reported Outcome Measures (PROMs) programme in England. Adjusted differences were estimated in the Oxford Hip Score (OHS) or the Oxford Knee Score (OKS), both expressed on a scale from 0 to 48, and the proportion with longstanding problems (>5 years), expressed as odds ratios (ORs). RESULTS Women had more severe pain and disability than men on average (difference OHS 2.3 and OKS 3.3), but less often longstanding problems. Compared with white patients, average severity was higher in South Asian patients (difference OHS 2.7 and OKS 3.0) and in black patients (difference OHS 0.9 and OKS 1.6), who also more often had longstanding problems (OR 1.40 for hip and 1.54 for knee). Patients from deprived areas had more severe disease (difference OHS 3.6 and OKS 3.3 between least and most deprived quintile). CONCLUSIONS There is evidence that non-white and deprived patients tend to have hip and knee replacement surgery at a later stage in the course of their disease.
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Affiliation(s)
- J Neuburger
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK.
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Chard J, Kuczawski M, Black N, van der Meulen J. Outcomes of elective surgery undertaken in independent sector treatment centres and NHS providers in England: audit of patient outcomes in surgery. BMJ 2011; 343:d6404. [PMID: 22012180 PMCID: PMC3198262 DOI: 10.1136/bmj.d6404] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To compare characteristics of patients and outcomes after elective surgery in independent sector treatment centres (ISTCs) and NHS providers. DESIGN Follow-up study with outcomes reported by patients three to six months after surgery. SETTING 25 ISTCs and 72 NHS providers in England. Population Consecutive patients undergoing hip or knee replacement (5671 in ISTCs and 14,292 in NHS), inguinal hernia repair (640 and 2023, respectively), or surgery for varicose veins (248 and 1336, respectively). MAIN OUTCOMES Symptoms and disability reported by patients (Oxford hip and knee scores on a 48 point scale; Aberdeen varicose vein questionnaire) and quality of life (EuroQol EQ-5D score). RESULTS Patients in ISTCs were healthier than those in NHS providers, had less severe preoperative symptoms, and were more affluent, though the differences were small. With adjustment, patients undergoing joint replacements in NHS providers had poorer outcomes: difference of -1.7 (95% confidence interval -2.5 to -0.9) on the Oxford hip score and -0.9 (-1.6 to -0.2) on the Oxford knee score. They more often reported complications: odds ratio 1.3 (95% confidence interval 1.1 to 1.5) for hip and 1.4 (1.2 to 1.6) for knee. There were no significant differences in outcomes after surgery for hernia or varicose veins, except that NHS patients more often reported poor results after hernia repair (1.4, 1.0 to 1.9) and additional surgery after varicose vein surgery (2.8, 1.2 to 6.8). CONCLUSION Patients undergoing surgery in ISTCs were slightly healthier and had less severe conditions than those undergoing surgery in NHS providers. Some outcomes were better in ISTCs, but differences were small compared with the impact ISTCs could have on the provision of elective services.
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MESH Headings
- Arthroplasty, Replacement, Hip/adverse effects
- Arthroplasty, Replacement, Hip/standards
- Arthroplasty, Replacement, Knee/adverse effects
- Arthroplasty, Replacement, Knee/standards
- Elective Surgical Procedures/standards
- England
- Follow-Up Studies
- Health Facilities, Proprietary/standards
- Health Status
- Herniorrhaphy/adverse effects
- Herniorrhaphy/standards
- Humans
- Medical Audit
- Outcome Assessment, Health Care
- Postoperative Complications/etiology
- Quality of Life
- State Medicine/standards
- Treatment Outcome
- Varicose Veins/surgery
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Affiliation(s)
- J Chard
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London WC2A 3PE, UK
| | - M Kuczawski
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London WC2A 3PE, UK
| | - N Black
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London
| | - J van der Meulen
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London WC2A 3PE, UK
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London
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Angelow A, Black N. Authors' response. BMJ Qual Saf 2011. [DOI: 10.1136/bmjqs-2011-000140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Mullan K, Black N, Thiraviaraj A, Bell PM, Burgess C, Hunter SJ, McCance DR, Leslie H, Sheridan B, Atkinson AB. Is there value in routine screening for Cushing's syndrome in patients with diabetes? J Clin Endocrinol Metab 2010; 95:2262-5. [PMID: 20237165 DOI: 10.1210/jc.2009-2453] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
CONTEXT Subclinical Cushing's syndrome has been described among diabetic populations in recent years, but no consensus has emerged about the value of screening. METHODS We enrolled 201 consecutive patients attending our diabetes clinic and 79 controls. Patients with at least two of the following three criteria were offered screening using a 2300 h salivary cortisol test: glycosylated hemoglobin of at least 7%, body mass index of at least 25 kg/m(2), and a history of hypertension or blood pressure of at least 140/90 mm Hg. Results are expressed as mean +/- sem. RESULTS Mean nighttime salivary cortisol levels were similar in the two groups (8.5 +/- 1.0 nmol/liter for diabetic patients vs. 5.8 +/- 1.0 nmol/liter for controls). Forty-seven patients (23%) had a value of at least 10 nmol/liter, which was set as a conservative threshold above which further investigation would be performed. Thirty-five (75%) agreed to further testing with a 1-mg overnight dexamethasone test. Of the remaining 12 patients, 10 were followed up clinically for at least 1 yr, and no evidence was found of the syndrome evolving. In 28 patients, serum cortisol suppressed to 60 nmol/liter or less. Of the seven patients who failed this test, four agreed to a 2 mg/d 48-h dexamethasone test, with serum cortisol suppressing to 60 nmol/liter or less in all four. Three declined this test but had normal 24-h urinary free cortisol levels. No patient had clinical features of hypercortisolism. CONCLUSIONS The 1-3% detection rates of three recently published series have not been realized at our center where we studied a group using criteria making patients more likely to have hypercortisolism. Our results do not support the validity of screening patients without clinical features of Cushing's syndrome in the diabetes clinic.
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Affiliation(s)
- K Mullan
- Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital, Belfast BT12 6BA, United Kingdom
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Mouchtouri VA, Bartlett CLR, Jaremin B, Nichols G, Paux T, Riemer T, Black N, Varela-Martinez C, Swaan CM, Schlaich C, Rachiotis G, Kremastinou J, Hadjichristodoulou C. The decision making process on public health measures related to passenger ships: the example of influenza pandemic 2009. Int Marit Health 2010; 62:241-245. [PMID: 21348018] [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: 05/30/2023] Open
Abstract
BACKGROUND Public health measures at sea ports have posed a challenge for public health competent authorities, especially in the context of the influenza pandemic of 2009. This paper discusses the response of authorities to notifications of infectious diseases on passenger ships and the importance of assessing the risks related to cases of influenza. It further provides options for health measures and considerations for decision making during a pandemic such as the influenza pandemic of 2009. DISCUSSION Prevention and control of influenza have included action taken by both competent port authorities and ships' crews. Assessing the public health risk of each event reported from ships to competent authorities at ports is important before advice is given on implementation of control measures. Public health risk assessment involves appraisal of threats to passengers and crew on board the ship as well as to the population in the community. SUMMARY Any public health measures taken should be necessary and proportional to the threat. Measures at ports cannot alone be effective in the prevention of the spread of a disease to the community since other means of transport play a major role. Measures taken on board ships can be effective in containing the disease. Consistent policy based on common protocols and carried out by competent authorities at local, national, European, or international levels are essential.
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Affiliation(s)
- V A Mouchtouri
- Department of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly, Larissa, Greece
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Black N, Clarke A, Rowe P, Mott S, Howie K. A prospective cohort study of the clinical management of total abdominal hysterectomy for benign disease. J OBSTET GYNAECOL 2009. [DOI: 10.3109/01443619509009173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Mouchtouri V, Black N, Nichols G, Paux T, Riemer T, Rjabinina J, Schlaich C, Menel Lemos C, Kremastinou J, Hadjichristodoulou C. Preparedness for the prevention and control of influenza outbreaks on passenger ships in the EU: the SHIPSAN TRAINET project communication. ACTA ACUST UNITED AC 2009; 14. [PMID: 19480810 DOI: 10.2807/ese.14.21.19219-en] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Passenger ships carry a large number of people in confined spaces. A case of the new influenza A (H1N1) virus aboard a passenger ship is an expected event and would lead to rapid spread of the virus, if preventive measures are not in place. However, many cruise lines have detailed policies and procedures to deal with cases of influenza like illness (ILI). The EU SHIPSAN and SHIPSAN TRAINET projects include in their objectives guidelines for the prevention and control of communicable diseases aboard passenger ships. A literature review showed that from 1997 to 2005, nine confirmed outbreaks of influenza were linked to passenger ships, with attack rates up to 37%. It is important to establish and maintain a surveillance system for ILI aboard passenger ships, in order to systematically collect data that can help to determine the baseline illness levels. Monitoring these will enable early identification of outbreaks and allow timely implementation of control measures.
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Affiliation(s)
- Va Mouchtouri
- Department of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly, Larissa, Greece
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Black N, Browne J, van der Meulen J, Jamieson L, Copley L, Lewsey J. Is there overutilisation of cataract surgery in England? Br J Ophthalmol 2008; 93:13-7. [DOI: 10.1136/bjo.2007.136150] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
Both information retrieval and case-based reasoning systems rely on effective and efficient selection of relevant data. Typically, relevance in such systems is approximated by similarity or indexing models. However, the definition of what makes data items similar or how they should be indexed is often nontrivial and time-consuming. Based on growing cell structure artificial neural networks, this paper presents a method that automatically constructs a case retrieval model from existing data. Within the case-based reasoning (CBR) framework, the method is evaluated for two medical prognosis tasks, namely, colorectal cancer survival and coronary heart disease risk prognosis. The results of the experiments suggest that the proposed method is effective and robust. To gain a deeper insight and understanding of the underlying mechanisms of the proposed model, a detailed empirical analysis of the models structural and behavioral properties is also provided.
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Affiliation(s)
- F Azuaje
- Dept. of Comput. Sci., Trinity Coll., Dublin
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Black N. From trades to professions. J R Soc Med 2007. [DOI: 10.1258/jrsm.100.5.219] [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: 11/18/2022] Open
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Black N. A cradle of reform. J R Soc Med 2007. [DOI: 10.1258/jrsm.100.4.175] [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: 11/18/2022] Open
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Black LA, McTear M, Black N, Harper R, Lemon M. DI@L-log by design: an integrated tele-care communication infrastructure. Conf Proc IEEE Eng Med Biol Soc 2007; 2004:3290-3. [PMID: 17270984 DOI: 10.1109/iembs.2004.1403925] [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] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
A spoken dialogue system for the acquisition of type 2 diabetes mellitus (T2DM) home monitored patient data known as DI@L-log is presented. The purpose of the system is to collect weight, blood sugar and blood pressure readings from a cohort of hypertensive T2DM patients on a weekly basis using their home telephone. The recent voice-data convergence affords an arguably improved means for doctors to track patient health states at a distance in order to provide health institutions with more frequent and accurate patient profiles. Our system architecture integrates VoiceXML and the standard PSTN, with a Pan-European open source for hosting Internet telephony applications. This paper reports on recent developments in the design of DI@L-log, which aims to serve as a communication intervention that disparages the traditional paper logbook used to document readings by the patient.
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Affiliation(s)
- L A Black
- Faculty of Engineering,University of Ulster, Jordanstown, Belfast, Northern Ireland
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Black N. Church, Crown and City: changing fortunes in controlling health care. J R Soc Med 2007. [DOI: 10.1258/jrsm.100.2.85] [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: 11/18/2022] Open
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Affiliation(s)
- H J Sears
- Department of Bacteriology, University of Oregon Medical School, Portland
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