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Badger S, Watkins LV, Bassett P, Roy A, Eyeoyibo M, Sawhney I, Purandare K, Wood L, Pugh A, Hammett J, Sheehan R, Tromans S, Shankar R. The relationship between clinical presentation and the nature of care in adults with intellectual disability and epilepsy - national comparative cohort study. BJPsych Open 2024; 10:e94. [PMID: 38686441 PMCID: PMC11060072 DOI: 10.1192/bjo.2024.45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 02/26/2024] [Accepted: 02/27/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND A quarter of People with Intellectual Disabilities (PwID) have epilepsy compared with 1% of the general population. Epilepsy in PwID is a bellwether for premature mortality, multimorbidity and polypharmacy. This group depends on their care provider to give relevant information for management, especially epilepsy. There is no research on care status relationship and clinical characteristics of PwID and epilepsy. AIM Explore and compare the clinical characteristics of PwID with epilepsy across different care settings. METHOD A retrospective multicentre cohort study across England and Wales collected information on seizure characteristics, intellectual disability severity, neurodevelopmental/biological/psychiatric comorbidities, medication including psychotropics/anti-seizure medication, and care status. Clinical characteristics were compared across different care settings, and those aged over and younger than 40 years. RESULTS Of 618 adult PwID across six centres (male:female = 61%:39%), 338 (55%) received professional care whereas 258 (42%) lived with family. Significant differences between the care groups existed in intellectual disability severity (P = 0.01), autism presence (P < 0.001), challenging behaviour (P < 0.001) and comorbid physical conditions (P = 0.008). The two groups did not vary in intellectual disability severity/genetic conditions/seizure type and frequency/psychiatric disorders. The professional care cohort experienced increased polypharmacy (P < 0.001) and antipsychotic/psychotropic use (P < 0.001/P = 0.008).The over-40s cohort had lower autism spectrum disorder (ASD) and attention-deficit hyperactivity disorder (ADHD) comorbidity (P < 0.001/P = 0.007), increased psychiatric comorbidity and challenging behaviour (P < 0.05), physical multimorbidity (P < 0.001), polypharmacy (P < 0.001) and antipsychotic use (P < 0.001) but reduced numbers of seizures (P = 0.007). CONCLUSION PwID and epilepsy over 40 years in professional care have more complex clinical characteristics, increased polypharmacy and antipsychotic prescribing but fewer seizures.
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Affiliation(s)
- Sarah Badger
- Cornwall Partnership NHS Foundation Trust, Truro, UK
| | - Lance V Watkins
- University of South Wales, Pontypridd, UK; Cornwall Intellectual Disability Equitable Research (CIDER), University of Plymouth Peninsula School of Medicine, Truro, UK; and Swansea Bay University Health Board, Port Talbot, UK
| | | | - Ashok Roy
- Coventry and Warwickshire Partnership NHS Trust, Coventry, UK
| | | | - Indermeet Sawhney
- Hertfordshire Partnership University NHS Foundation Trust, St Albans, UK
| | - Kiran Purandare
- Central and Northwest London NHS Foundation Trust, London, UK
| | - Laurie Wood
- Swansea Bay University Health Board, Port Talbot, UK
| | - Andrea Pugh
- Swansea Bay University Health Board, Port Talbot, UK
| | | | - Rory Sheehan
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Samuel Tromans
- SAPPHIRE Group, Department of Population Health Sciences, University of Leicester, Leicester, UK; and Adult Learning Disability Service, Leicestershire Partnership NHS Trust, Leicester, UK
| | - Rohit Shankar
- Cornwall Partnership NHS Foundation Trust, Truro, UK; and Cornwall Intellectual Disability Equitable Research (CIDER), University of Plymouth Peninsula School of Medicine, Truro, UK
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Pace A, Watkins L, Fiott D, Bassett P, Laugharne R, James C, Shankar R. Identifying co-morbidities and risk in people with epilepsy: The Maltese experience. Epilepsy Behav 2024; 155:109795. [PMID: 38643661 DOI: 10.1016/j.yebeh.2024.109795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 02/24/2024] [Accepted: 04/14/2024] [Indexed: 04/23/2024]
Abstract
BACKGROUND People with epilepsy are at increased risk of multiple co-morbidities that may influence risk of adverse outcomes including impact on quality of life and premature mortality. These risk factors include potentially modifiable clinical characteristics associated with sudden unexpected death in epilepsy (SUDEP). For services to tackle risk, the clinical complexity of the target epilepsy population needs to be defined. While this has been comprehensively studied in large, economically developed countries little knowledge of these issues exist in small economically developed countries, like Malta (population: 500,000). METHODS This was a single centre study focused exclusively on patients attending Gozo General Hospital (GGH) Malta. STROBE guidance for reporting cross sectional studies was used to design and report the study. This was a retrospective review of standard care and SUDEP and seizure risks provided to all adults (over 18 years) with epilepsy attending GGH (2018-2021). RESULTS The review identified 68 people and 92% were compliant with their anti-seizure medication. A fifth (21%) had an intellectual disability. Despite only one patient having a psychotic illness, 19% were on antipsychotic medication. Only 18% of patients had a specific epilepsy care plan, 6% nocturnal surveillance and none had received advice on SUDEP. DISCUSSION Patient outcomes may be improved with increasing rates of personalized epilepsy care plans, appropriate nocturnal surveillance and reducing the prescription of antipsychotic medication as it is associated with greater risk of mortality. Issues such as stigma and shame appear to play a significant role in small communities and their access to care.
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Affiliation(s)
| | - Lance Watkins
- University of South Wales, Pontypridd, UK; Swansea Bay University Health Board, Port Talbot, UK; Cornwall Intellectual Disability Equitable Research (CIDER) University of Plymouth Peninsula School of Medicine, Truro, UK
| | | | | | - Richard Laugharne
- Cornwall Intellectual Disability Equitable Research (CIDER) University of Plymouth Peninsula School of Medicine, Truro, UK; Cornwall Intellectual Disability Equitable Research (CIDER), Cornwall Partnership NHS Foundation Trust Truro, UK
| | | | - Rohit Shankar
- Cornwall Intellectual Disability Equitable Research (CIDER) University of Plymouth Peninsula School of Medicine, Truro, UK; Statsconsultancy Ltd, Bucks, UK.
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Velayudhan L, Dugonjic M, Pisani S, Harborow L, Aarsland D, Bassett P, Bhattacharyya S. Cannabidiol for behavior symptoms in Alzheimer's disease (CANBiS-AD): a randomized, double-blind, placebo-controlled trial. Int Psychogeriatr 2024:1-3. [PMID: 38584388 DOI: 10.1017/s1041610224000516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Affiliation(s)
- Latha Velayudhan
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London & Maudsley NHS Foundation Trust, UK
| | - Marta Dugonjic
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Sara Pisani
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Dag Aarsland
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London & Maudsley NHS Foundation Trust, UK
| | | | - Sagnik Bhattacharyya
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London & Maudsley NHS Foundation Trust, UK
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Alshahrani NS, Hartley A, Howard J, Hajhosseiny R, Khawaja S, Seligman H, Akbari T, Alharbi BA, Bassett P, Al-Lamee R, Francis D, Kaura A, Kelshiker MA, Peters NS, Khamis R. Remote Acute Assessment of Cardiac Patients Post-Acute Coronary Syndrome (TELE-ACS): A Randomized Controlled Trial. J Am Coll Cardiol 2024:S0735-1097(24)06709-3. [PMID: 38588928 DOI: 10.1016/j.jacc.2024.03.398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 03/21/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND Telemedicine programmes can provide remote diagnostic information to aid clinical decision that could optimize care and reduce unplanned re-admissions post ACS. OBJECTIVES TELE-ACS is a randomized controlled trial which aims to compare a telemedicine-based approach versus standard care in patients following ACS. METHODS Patients were suitable for inclusion with at least one cardiovascular risk factor and presenting with ACS and were randomized (1:1) prior to discharge. The primary outcome was time to first readmission at 6-months. Secondary outcomes included emergency department (ED) visits, major adverse cardiovascular events and patient reported symptoms. The primary analysis was performed according to intention to treat. The trial was registered on ClinicalTrial.gov (NCT05015634). RESULTS 337 patients were randomized from January 2022 to April 2023, with a 3.6% drop-out rate. The mean age was 58.1 years. There was a reduced rate of readmission over 6-months (hazard ratio [HR] 0.24; 95% confidence interval [CI] 0.13 to 0.44; p < 0.001) and ED attendance (HR 0.59; 95% CI 0.59; 95% CI 0.40 to 0.89) in the telemedicine arm, and fewer unplanned coronary revascularizations (3% in telemedicine arm versus 9% in standard therapy arm). The occurrence of chest pain (9% versus 24%), breathlessness (21% versus 39%) and dizziness (6% versus 18%) at 6-months was lower in the telemedicine group. CONCLUSIONS The TELE-ACS study has shown that a telemedicine-based approach for the management of patients following ACS was associated with a reduction in hospital readmission, ED visits, unplanned coronary revascularization and patient reported symptoms.
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Affiliation(s)
- Nasser S Alshahrani
- National Heart and Lung Institute, Imperial College London, UK; King Khalid University, Abha, Saudi Arabia
| | - Adam Hartley
- National Heart and Lung Institute, Imperial College London, UK; Imperial College Healthcare NHS Trust, London, UK
| | - James Howard
- National Heart and Lung Institute, Imperial College London, UK; Imperial College Healthcare NHS Trust, London, UK
| | - Reza Hajhosseiny
- National Heart and Lung Institute, Imperial College London, UK; Imperial College Healthcare NHS Trust, London, UK
| | - Saud Khawaja
- Imperial College Healthcare NHS Trust, London, UK
| | | | - Tamim Akbari
- Imperial College Healthcare NHS Trust, London, UK
| | - Badr A Alharbi
- National Heart and Lung Institute, Imperial College London, UK; King Khalid University, Abha, Saudi Arabia
| | - Paul Bassett
- Statsconsultancy Ltd., Amersham, Buckinghamshire, UK
| | - Rasha Al-Lamee
- National Heart and Lung Institute, Imperial College London, UK; Imperial College Healthcare NHS Trust, London, UK
| | - Darrel Francis
- National Heart and Lung Institute, Imperial College London, UK; Imperial College Healthcare NHS Trust, London, UK
| | - Amit Kaura
- National Heart and Lung Institute, Imperial College London, UK; Imperial College Healthcare NHS Trust, London, UK
| | - Mihir A Kelshiker
- National Heart and Lung Institute, Imperial College London, UK; Imperial College Healthcare NHS Trust, London, UK
| | - Nicholas S Peters
- National Heart and Lung Institute, Imperial College London, UK; Imperial College Healthcare NHS Trust, London, UK
| | - Ramzi Khamis
- National Heart and Lung Institute, Imperial College London, UK; Imperial College Healthcare NHS Trust, London, UK.
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Batura D, Elsweefy M, Chouhan R, Bassett P, Gopal Rao G. Bacteriuria in patients with stented ureters: predictors of infection in patients presenting to the hospital and when not to treat. World J Urol 2024; 42:196. [PMID: 38530494 DOI: 10.1007/s00345-024-04900-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 02/21/2024] [Indexed: 03/28/2024] Open
Abstract
PURPOSE Patients with ureteric stents have symptoms that overlap with infection symptoms. Thus, clinicians unnecessarily give antibiotics to stented patients with bacteriuria despite guidelines. In stented patients, little is known about risk factors for developing bacteriuria or urosepsis. The objectives were to identify the frequency and risk factors for developing bacteriuria and urosepsis in patients with stents. METHODS In this retrospective cohort study, we reviewed patients with ureteric stents placed or exchanged over 1 year. We examined associations between bacteriuria or urosepsis and host risk factors. Univariable and multivariable logistic analyses were performed. RESULTS Of 286 patients (mean age: 57.2 years), 167 (58.4%) were male. The main stent indications were stone, stricture, cancer and extrinsic compression. The median stented period was 61 days. The frequency of bacteriuria was 59/286 (21%). ASA status 3 and 4 had 5 times the odds of having bacteriuria relative to ASA status 1. Stent duration > 2 months had 5.5 times the odds relative to ≤ 2 months. Urosepsis was infrequent, 13/286 (4.5%). Five patients had bacteraemia. A stent duration over 2 months had nearly 6 times the odds of urosepsis. CONCLUSION ASA status higher than 2 and stent time greater than 2 months raise the odds of developing bacteriuria. A stent duration longer than 2 months was the only predictor of urosepsis. Though 21% of patients had bacteriuria, 4.5% had urosepsis. Hence, bacteriuria without sepsis should not be treated with antibiotics, thus aiding antimicrobial stewardship.
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Affiliation(s)
- Deepak Batura
- Department of Urology, London North West University Healthcare NHS Trust, Watford Road, Harrow, London, HA1 3UJ, UK.
| | - Momin Elsweefy
- Department of Urology, London North West University Healthcare NHS Trust, Watford Road, Harrow, London, HA1 3UJ, UK
| | - Rhea Chouhan
- Department of Microbiology, London North West University Healthcare NHS Trust, Watford Road, Harrow, London, HA1 3UJ, UK
| | | | - Guduru Gopal Rao
- Department of Microbiology, London North West University Healthcare NHS Trust, Watford Road, Harrow, London, HA1 3UJ, UK
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Watkins L, Kulkarni A, Webber E, Bassett P, Lamb K, Sawhney I, Laugharne R, Heslop P, Jones A, Napier G, Crocker A, Sivan M, Shankar R. People with Intellectual Disabilities, Dysphagia and Post-Covid Syndrome. Dysphagia 2024:10.1007/s00455-024-10679-1. [PMID: 38498202 DOI: 10.1007/s00455-024-10679-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 02/01/2024] [Indexed: 03/20/2024]
Abstract
People with Intellectual Disability (ID) were more likely to contract COVID-19 infection and more likely to die from the consequences. However, there is no evidence on the long-term impact of COVID-19 infection in people with ID. Post-Covid Syndrome (PCS) is an established diagnosis that requires specialist clinical support. To date there is no data on how common PCS is in people with ID, or how symptoms present. Dysphagia is identified as a clinical marker because of the known association with PCS, and the clear objective diagnostic criteria applicable through specialist assessment. This investigation presents a cohort of people with ID, who developed dysphagia/worsening of dysphagia post diagnosis with COVID-19. Cases were identified through support from the Royal College of Speech and Language Therapists. Data was collected by electronic survey, including application of the COVID-19 Yorkshire Rehabilitation Scale-modified (C19-YRSm). The C19-YRSm is a validated assessment tool for PCS and it's impact upon functional disability. This case series identifies that symptoms consistent with PCS are present in people with ID, post-COVID-19 infection. The risk of diagnostic overshadowing or misdiagnosis is high due to the subjective nature and the quality of PCS symptoms. People with ID who develop PCS may not be readily identified by clinical services and therefore not be accessing the specialist medical support required. Furthermore, changes in behaviour secondary to PCS may lead to unnecessary increased prescribing of psychotropic medication which in itself risks worsening dysphagia. Dysphagia could be an important bellwether to identify PCS in people with ID.
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Affiliation(s)
- Lance Watkins
- University of South Wales, Pontypridd, UK
- Swansea Bay University Health Board, Port Talbot, UK
- Cornwall Intellectual Disability Equitable Research (CIDER), University of Plymouth Peninsula School of Medicine, Truro, UK
| | - Amit Kulkarni
- Royal College of Speech & Language Therapists, London, UK
- University of Central Lancashire, Preston, UK
| | - Emma Webber
- Royal College of Speech & Language Therapists, London, UK
| | | | - Kirsten Lamb
- Cornwall Intellectual Disability Equitable Research (CIDER), University of Plymouth Peninsula School of Medicine, Truro, UK
| | - Indermeet Sawhney
- Hertfordshire Partnership University NHS Foundation Trust, St Albans, UK
| | - Richard Laugharne
- Cornwall Intellectual Disability Equitable Research (CIDER), University of Plymouth Peninsula School of Medicine, Truro, UK
- Cornwall Partnership NHS Foundation Trust, Threemilestone Industrial Estate, Truro, TR 4 9LD, UK
| | - Pauline Heslop
- School for Policy Studies, University of Bristol, Bristol, UK
| | - Angela Jones
- Swansea Bay University Health Board, Port Talbot, UK
- Royal College of Speech & Language Therapists, London, UK
| | - Geraldine Napier
- Royal College of Speech & Language Therapists, London, UK
- South Eastern Health and Social Care Trust, Belfast, UK
| | - Angela Crocker
- Royal College of Speech & Language Therapists, London, UK
| | - Manoj Sivan
- School of Medicine, University of Leeds, Leeds, UK
| | - Rohit Shankar
- Cornwall Intellectual Disability Equitable Research (CIDER), University of Plymouth Peninsula School of Medicine, Truro, UK.
- Hertfordshire Partnership University NHS Foundation Trust, St Albans, UK.
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Laugharne R, Wilcock M, Rees J, Wainwright D, Newton N, Sterritt J, Badger S, Bishop R, Bassett P, Shankar R. Clinical characteristics of people with intellectual disability admitted to hospital with constipation: identifying possible specific high-risk factors. J Intellect Disabil Res 2024; 68:277-284. [PMID: 38031737 DOI: 10.1111/jir.13108] [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: 06/01/2023] [Revised: 10/29/2023] [Accepted: 10/30/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND People with intellectual disabilities (ID) die on an average 20 years earlier to the general population. They have higher rates of multimorbidity and polypharmacy. Around 25% of people with ID report chronic constipation. The England Learning Disabilities Mortality Review found that nearly 25% of deaths identified constipation as a long-term health problem. However, the likely risk factors for constipation related harm are poorly enumerated. We sought to identify possible specific high-risk factors by examining the clinical characteristics of people with ID admitted to hospital with constipation. METHODS Data of people with ID admitted with constipation in two general hospitals covering a population of 1.3 million from 2017 to 2022 were reported using the STROBE guideline for cohort studies. Collected data included age, gender, intellectual disability severity, recorded medication, presenting complaint and co-morbidities. The medication anticholinergic burden was calculated using the anticholinergic burden scale. Continuous variables were summarised by mean and standard deviation if normally distributed, with categorical variables summarised by the number and percentage in each category. RESULTS Of 46 admissions (males 52%), 57% had moderate to profound ID, 37% had epilepsy, 41% prescribed antiseizure medication (ASM) and 45% were on laxatives. Average age was 46 years. The anticholinergic burden score mean was 2.3 and median, one. CONCLUSIONS We can hypothesise that people with more severe ID, suffering from epilepsy and on ASM may be more at risk of developing severe constipation. Some admissions may be avoided with earlier use of laxatives in the community.
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Affiliation(s)
- R Laugharne
- Cornwall Intellectual Disability Equitable Research (CIDER), Cornwall Partnership NHS Foundation Trust, Truro, UK
- Cornwall Intellectual Disability Equitable Research (CIDER) University of Plymouth Peninsula School of Medicine, Truro, UK
| | - M Wilcock
- Pharmacy department Learning Disability Liasion service, Royal Cornwall Hospital NHS Trust, Truro, UK
| | - J Rees
- Pharmacy department Learning Disability Liasion service, Royal Cornwall Hospital NHS Trust, Truro, UK
| | - D Wainwright
- Adult Learning Disability Services, Devon Partnership NHS Trust, Exeter, UK
| | - N Newton
- Cornwall Intellectual Disability Equitable Research (CIDER), Cornwall Partnership NHS Foundation Trust, Truro, UK
| | - J Sterritt
- Cornwall Intellectual Disability Equitable Research (CIDER), Cornwall Partnership NHS Foundation Trust, Truro, UK
| | - S Badger
- Cornwall Intellectual Disability Equitable Research (CIDER), Cornwall Partnership NHS Foundation Trust, Truro, UK
| | - R Bishop
- Cornwall Intellectual Disability Equitable Research (CIDER), Cornwall Partnership NHS Foundation Trust, Truro, UK
- Cornwall Intellectual Disability Equitable Research (CIDER) University of Plymouth Peninsula School of Medicine, Truro, UK
| | - P Bassett
- Statsconsultancy Ltd. Bucks, London, UK
| | - R Shankar
- Cornwall Intellectual Disability Equitable Research (CIDER), Cornwall Partnership NHS Foundation Trust, Truro, UK
- Cornwall Intellectual Disability Equitable Research (CIDER) University of Plymouth Peninsula School of Medicine, Truro, UK
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Tromans S, Robinson G, Gabrielsson A, Bassett P, Sawhney I, Triantafyllopoulou P, Hassiotis A, Shankar R. The views of psychiatrists on proposed changes to the England and Wales Mental Health Act 1983 legislation for people with intellectual disability: A national study. Int J Soc Psychiatry 2024; 70:388-401. [PMID: 38001564 PMCID: PMC10913297 DOI: 10.1177/00207640231212112] [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] [Indexed: 11/26/2023]
Abstract
BACKGROUND The Draft Mental Health Bill proposes removal of both intellectual disability and autism from Section 3 of the Mental Health Act for England and Wales (MHA). This would lead to people with intellectual disability (PwID) and/or autism could not be detained beyond 28 days, in the absence of diagnosed co-occurring mental illness. AIM To obtain views of psychiatrists working with PwID in England and Wales regarding the proposed MHA changes. This study focusses specifically on the impact on PwID. METHODS A cross-sectional online mixed methodology survey of Likert and free-text response questions was developed, to ascertain perceptions of proposed legislative changes to the MHA. A non-discriminatory exponential snowballing technique leading to non-probability sampling was used to disseminate the survey. Quantitative data was analysed using descriptive statistics, Mann-Whitney and Fisher's exact tests. Thematic analysis was conducted on free text responses. RESULTS A total of 82 psychiatrists (33%) from approximately 250 eligible completed the survey. Nearly two-thirds (64%) reported good awareness of the proposed changes, with over half (55%) reporting disagreement with the changes. Psychiatrists working in inpatient settings for PwID reported increased awareness of the changes, less agreement with the reforms, and increased expectations of the reforms having negative unintended consequences, compared to their peers working exclusively in the community. Consultants reported greater disagreement with the changes compared to their non-consultant peers. Qualitative analysis identified five main themes: impact on diagnosis and treatment, seeking alternative options, introducing inequities, resources, and meeting holistic care goals through the Care, Education and Treatment Reviews (CETR) process. CONCLUSION Psychiatrists working with PwID report widespread disagreement with the proposed changes to the MHA for PwID, with greater levels of disagreement among those working in inpatient services. Caution with respect to the proposed changes, and monitoring of the impact of the changes if implemented, is advised.
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Affiliation(s)
- Samuel Tromans
- Department of Population Health Sciences, University of Leicester, UK
- Adult Learning Disability Service, Leicestershire Partnership NHS Trust, UK
| | - Gemma Robinson
- Forensic Community Learning Disability Team, Southern Health NHS Foundation Trust, Calmore, UK
| | | | | | | | | | | | - Rohit Shankar
- University of Plymouth Peninsula School of Medicine, UK
- Cornwall Partnership NHS Foundation Trust, Truro, UK
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Iqbal N, Fletcher J, Bassett P, Hart A, Lung P, Tozer P. Exploring methods of improving patient understanding and communication in a complex anal fistula clinic: results from a randomized controlled feasibility study. Colorectal Dis 2024; 26:518-526. [PMID: 38235831 DOI: 10.1111/codi.16861] [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: 08/31/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 01/19/2024]
Abstract
AIM Patient understanding of disease can guide decision-making in the management of anal fistula. This prospective feasibility study aimed to assess the acceptability and methods of assessing the impact of viewing realistic models on patients with anal fistula. METHODS New referrals to a tertiary clinic participated in this single-centre, parallel-group randomized controlled study. Baseline characteristics, Decisional Conflict Scale and understanding of disease were assessed pre-consultation. Participants were randomized to a standard consultation, where disease and treatment options were explained using magnetic resonance images and drawn diagrams, or a similar consultation supplemented with an appropriate generic three-dimensional (3D) printed model. Understanding of disease and proposed surgery, Decisional Conflict Scale and ratings of visual aids were assessed post-consultation, along with 3D model feedback. RESULTS All 52 patients who were approached agreed to be randomized (25 standard, 27 3D consultation). Understanding of disease increased post-consultation in both groups. Post-consultation decisional conflict (0, no; 100, high decisional conflict) was low (median 27 post-standard vs. 24 post-3D consultation). Patients scored highly on measures assessing understanding of proposed surgery. 3D models were rated highly, with 96% of patients wanting to see them again in future consultations. CONCLUSIONS Three-dimensional printed fistula models are a welcome addition to outpatient consultations with results suggesting that understanding of surgery is improved. A future trial should be powered to detect whether 3D models result in a significant improvement in understanding beyond traditional methods of explanation and explore the conditions in which models have their maximal utility. CLINICALTRIALS GOV REGISTRATION ID This study was registered on ClinicalTrials.gov (ID: NCT04069728). Registered on 23 August 2019.
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Affiliation(s)
- Nusrat Iqbal
- Robin Phillips' Fistula Research Unit, St Mark's Hospital, Harrow, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Jordan Fletcher
- Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Colorectal Surgery, St Mark's Hospital, Harrow, UK
| | - Paul Bassett
- Statsconsultancy Ltd, Longwood Lane, Amersham, UK
| | - Ailsa Hart
- Robin Phillips' Fistula Research Unit, St Mark's Hospital, Harrow, UK
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Phillip Lung
- Robin Phillips' Fistula Research Unit, St Mark's Hospital, Harrow, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Phil Tozer
- Robin Phillips' Fistula Research Unit, St Mark's Hospital, Harrow, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
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Laugharne R, Sawhney I, Perera B, Wainwright D, Bassett P, Caffrey B, O'Dwyer M, Lamb K, Wilcock M, Roy A, Oak K, Eustice S, Newton N, Sterritt J, Bishop R, Shankar R. Chronic constipation in people with intellectual disabilities in the community: cross-sectional study. BJPsych Open 2024; 10:e55. [PMID: 38425039 PMCID: PMC10951845 DOI: 10.1192/bjo.2024.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 12/20/2023] [Accepted: 01/16/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND One-third to half of people with intellectual disabilities suffer from chronic constipation (defined as two or fewer bowel movements weekly or taking regular laxatives three or more times weekly), a cause of significant morbidity and premature mortality. Research on risk factors associated with constipation is limited. AIMS To enumerate risk factors associated with constipation in this population. METHOD A questionnaire was developed on possible risk factors for constipation. The questionnaire was sent to carers of people with intellectual disabilities on the case-loads of four specialist intellectual disability services in England. Data analysis focused on descriptively summarising responses and comparing those reported with and without constipation. RESULTS Of the 181 people with intellectual disabilities whose carers returned the questionnaire, 42% reported chronic constipation. Constipation was significantly associated with more severe intellectual disability, dysphagia, cerebral palsy, poor mobility, polypharmacy including antipsychotics and antiseizure medication, and the need for greater toileting support. There were no associations with age or gender. CONCLUSIONS People with intellectual disabilities may be more vulnerable to chronic constipation if they are more severely intellectually disabled. The associations of constipation with dysphagia, cerebral palsy, poor mobility and the need for greater toileting support suggests people with intellectual disabilities with significant physical disabilities are more at risk. People with the above disabilities need closer monitoring of their bowel health. Reducing medication to the minimum necessary may reduce the risk of constipation and is a modifiable risk factor that it is important to monitor. By screening patients using the constipation questionnaire, individualised bowel care plans could be implemented.
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Affiliation(s)
- Richard Laugharne
- Cornwall Partnership NHS Foundation Trust, Truro, UK; and Cornwall Intellectual Disability Equitable Research (CIDER), University of Plymouth, Truro, UK
| | - Indermeet Sawhney
- Hertfordshire Partnership University NHS Foundation Trust, Hatfield, UK
| | - Bhathika Perera
- Department of Psychiatry, University College London, London, UK
| | | | | | | | - Maire O'Dwyer
- School of Pharmacy and Pharmaceutical Sciences, Trinity College, Dublin, Republic of Ireland
| | - Kirsten Lamb
- Cornwall Intellectual Disability Equitable Research (CIDER), University of Plymouth, Truro, UK
| | | | - Ashok Roy
- Coventry and Warwickshire Partnership NHS Trust, Birmingham, UK
| | - Katy Oak
- Royal Cornwall Hospitals Trust, Truro, UK
| | | | - Nick Newton
- Cornwall Partnership NHS Foundation Trust, Truro, UK
| | | | - Ruth Bishop
- Cornwall Partnership NHS Foundation Trust, Truro, UK; and Cornwall Intellectual Disability Equitable Research (CIDER), University of Plymouth, Truro, UK
| | - Rohit Shankar
- Cornwall Partnership NHS Foundation Trust, Truro, UK; and Cornwall Intellectual Disability Equitable Research (CIDER), University of Plymouth, Truro, UK
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11
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Mallick R, Solomon G, Bassett P, Zhang X, Patel P, Lepeshkina O. Subcutaneous immunoglobulin replacement therapy in patients with immunodeficiencies - impact of drug packaging and administration method on patient reported outcomes. BMC Immunol 2024; 25:18. [PMID: 38378441 PMCID: PMC10880328 DOI: 10.1186/s12865-024-00608-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 02/07/2024] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND Here, the perspective of patients with primary and secondary immunodeficiency receiving subcutaneous immunoglobulin (SCIg) via introductory smaller size pre-filled syringes (PFS) or vials were compared. METHODS An online survey was conducted in Canada by the Association des Patients Immunodéficients du Québec (APIQ) (10/2020-03/2021). Survey questions included: reasons for choosing SCIg packaging and administration methods, training experiences, infusion characteristics, and switching methods. The survey captured structured patient-reported outcomes: treatment satisfaction and its sub-domains, symptom state, general health perception, and physical and mental function. Respondents using PFS were compared with vial users, overall and stratified by their administration method (pump or manual push). RESULTS Of the 132 total respondents, 66 respondents used vials, with 38 using a pump and 28 using manual push. PFS (5 and 10 mL sizes) were being used by 120 respondents, with 38 using a pump and 82 using manual push. PFS users were associated with a 17% lower median (interquartile range) SCIg dose (10 [8, 12] vs. 12 [9, 16] g/week, respectively), a significantly shorter infusion preparation time (15 [10, 20] vs. 15 [10, 30] mins, respectively), and a trend for shorter length of infusion (60 [35, 90] vs. 70 [48, 90] mins, respectively) compared with those on vials. Patient-reported treatment satisfaction scores were overall similar between vial and PFS users (including on the domains of effectiveness and convenience), except for a higher score for vials over PFS on the domain of global satisfaction (p=0.02). CONCLUSIONS Consistent with prescribing that reflects a recognition of less wastage, PFS users were associated with a significantly lower SCIg dose compared with vial users. PFS users were also associated with shorter pre-infusion times, reflecting simpler administration mechanics compared with vial users. Higher global satisfaction with treatment among vial users compared with PFS users was consistent with users being limited to smaller PFS size options in Canada during the study period. Patient experience on PFS is expected to improve with the introduction of larger PFS sizes. Overall, treatment satisfaction for SCIg remains consistently high with the introduction of PFS packaging compared with vials.
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Affiliation(s)
- R Mallick
- CSL Behring, King of Prussia, PA, USA.
| | - G Solomon
- Association des Patients Immunodeficients du Québec, Québec, Canada
| | - P Bassett
- Meridian HealthComms Ltd, Manchester, UK
| | - X Zhang
- CSL Behring, King of Prussia, PA, USA
| | - P Patel
- Formerly of CSL Behring, King of Prussia, PA, USA
| | - O Lepeshkina
- Centre hospitalier de l'Université Laval, Québec, Canada
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12
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Jidong DE, Ike TJ, Husain N, Francis C, Husain MO, Mwankon SB, Murshed M, Jidong JE, Jack DB, Nyam PP, Bassett P, Pwajok JY, Taru MY, Nwoga CN. Perspectives on Self-Harm and Suicidal Ideation in Nigeria: A Mixed-Methods Study of Patients, Family Caregivers, Clinicians, and the Public. Arch Suicide Res 2024:1-15. [PMID: 38363148 DOI: 10.1080/13811118.2024.2314520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
BACKGROUND Suicide and self-harm are global disease burden that contributes significantly to years of lost life and mortality. Despite the increasing rates of suicide and self-harm in Nigeria, this topic is understudied. METHODS A mixed-methods design was adopted. Study 1 interviewed n = 18 participants (n = 11 clinicians; n = 5 patients with a history of self-harm and suicide ideation; and n = 2 caregivers). All interviews were audio-recorded, transcribed verbatim, and analyzed using IPA. Study 2 surveyed n = 562 non-clinical sample about their tolerance toward self-harm and the data was analyzed using One-way ANOVA in SPSS. RESULTS Study 1 qualitative findings showed substance use, perceived rejection and social isolation were considered predisposing factors for suicide and self-harm. Cultural and religious beliefs shaped help-seeking behaviours. Although Study 2 found no significant differences in demographic characteristics concerning public tolerance toward persons with a history of self-harm, 64% believed that individuals who died by suicide would face punishment after death; 51% believed that victims of attempted suicide are a source of shame to their families; and 33.8% agreed that dying by suicide is the correct behaviour. CONCLUSIONS Patients with a history of self-harm and suicidal ideation consider family members and close friends as valuable sources of support. Due to the potential clinical implication of cultural and religious beliefs, as shown in the present study's findings, the authors recommend a co-development of culturally appropriate psychological intervention for persons with a history of self-harm and suicidal ideation to be tested in randomized control trials.
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13
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Prezzi D, Muthuswamy K, Amlani A, Owczarczyk K, Elowaidy A, Mistry T, Bassett P, Goh V. Correction: Diffusion-weighted imaging complements T2-weighted MRI for tumour response assessment in squamous anal carcinoma. Eur Radiol 2024; 34:1408. [PMID: 37639052 PMCID: PMC10853076 DOI: 10.1007/s00330-023-10115-2] [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: 08/29/2023]
Affiliation(s)
- Davide Prezzi
- School of Biomedical Engineering and Imaging Sciences, King's College London, King's Health Partners, London, UK.
- Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
| | | | - Ashik Amlani
- Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Kasia Owczarczyk
- Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ahmed Elowaidy
- Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Tina Mistry
- Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Vicky Goh
- School of Biomedical Engineering and Imaging Sciences, King's College London, King's Health Partners, London, UK
- Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
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14
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Orlando A, Thomas G, Murphy J, Hotouras A, Bassett P, Vaizey C. A systematic review and a meta-analysis on the incidence of obstetric anal sphincter injuries during vaginal delivery. Colorectal Dis 2024; 26:227-242. [PMID: 38131640 DOI: 10.1111/codi.16831] [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: 06/15/2023] [Revised: 10/17/2023] [Accepted: 11/05/2023] [Indexed: 12/23/2023]
Abstract
AIM The incidence of obstetric anal sphincter injuries (OASIS) has increased in the past two decades despite improved awareness of the risk factors. This study aimed to define the incidence of OASIS in women with different features (instrumental delivery or other variables). METHODS A systematic review was conducted on articles reporting the incidence of OASIS. This review aims to examine the association of instrumentation and OASIS by performing a formal systematic review of the published literature. Databases used for the research were MEDLINE, Embase, CINAHL and 'Maternity and infant care' databases. RESULTS Two independent reviewers screened the selected articles. 2326 duplicates were removed from the total of 4907 articles. The remaining 2581 articles were screened for title and abstract. 1913 articles were excluded due to irrelevance. The remaining 300 were screened as full text. Primiparity associated with the use of forceps were the features associated with the highest incidence of OASIS in the selected articles (19.4%). OASIS in all women had an overall incidence of 3.8%. The incidence of OASIS in all women by geographical region was the highest (6.5%) in North America. CONCLUSIONS There are various factors that impact on the incidence of OASIS and the combination of some of these, such as the use of forceps in primiparas, resulted in the highest incidence of OASIS. The lack of international consensus is limiting the improvements that can be done to reduce OASIS rates and improve best clinical practice.
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15
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Crawford MJ, King JD, McQuaid A, Bassett P, Leeson VC, Tella O, Di Simplicio M, Tyrer P, Tyrer H, Watt RG, Barnicot K. Severe COVID anxiety among adults in the United Kingdom: cohort study and nested feasibility trial. BMC Psychiatry 2024; 24:27. [PMID: 38184524 PMCID: PMC10771646 DOI: 10.1186/s12888-023-05446-9] [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: 01/30/2023] [Accepted: 12/06/2023] [Indexed: 01/08/2024] Open
Abstract
BACKGROUND People with severe COVID anxiety have poor mental health and impaired functioning, but the course of severe COVID anxiety is unknown and the quality of evidence on the acceptability and impact of psychological interventions is low. METHODS A quantitative cohort study with a nested feasibility trial. Potential participants aged 18 and over, living in the UK with severe COVID anxiety, were recruited online and from primary care services. We examined levels of COVID anxiety in the six months after recruitment, and factors that influenced this, using linear regression. Those scoring above 20 on the short Health Anxiety Inventory were invited to participate in a feasibility trial of remotely delivered Cognitive Behavioural Therapy for Health Anxiety (CBT-HA). Exclusion criteria were recent COVID-19, current self-isolation, or current receipt of psychological treatment. Key outcomes for the feasibility trial were the level of uptake of CBT-HA and the rate of follow-up. RESULTS 204 (70.2%) of 285 people who took part in the cohort study completed the six month follow-up, for whom levels of COVID anxiety fell from 12.4 at baseline to 6.8 at six months (difference = -5.5, 95% CI = -6.0 to -4.9). Reductions in COVID anxiety were lower among older people, those living with a vulnerable person, those with lower baseline COVID anxiety, and those with higher levels of generalised anxiety and health anxiety at baseline. 36 (90%) of 40 participants enrolled in the nested feasibility trial were followed up at six months. 17 (80.9%) of 21 people in the active arm of the trial received four or more sessions of CBT-HA. We found improved mental health and social functioning among those in the active, but not the control arm of the trial (Mean difference in total score on the Work and Social Adjustment Scale between baseline and follow up, was 9.7 (95% CI = 5.8-13.6) among those in the active, and 1.0 (95% C.I. = -4.6 to 6.6) among those in the control arm of the trial. CONCLUSIONS While the mental health of people with severe COVID anxiety appears to improve over time, many continue to experience high levels of anxiety and poor social functioning. Health anxiety is highly prevalent among people with severe COVID anxiety and may provide a target for psychological treatment. TRIAL REGISTRATION Retrospectively registered at ISRCTN14973494 on 09/09/2021.
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Affiliation(s)
- Mike J Crawford
- Division of Psychiatry, Commonwealth Building, Imperial College London, Hammersmith Hospital Campus, Du Cane Road, London, W12 0NN, UK.
| | - Jacob D King
- Division of Psychiatry, Commonwealth Building, Imperial College London, Hammersmith Hospital Campus, Du Cane Road, London, W12 0NN, UK
| | - Aisling McQuaid
- Division of Psychiatry, Commonwealth Building, Imperial College London, Hammersmith Hospital Campus, Du Cane Road, London, W12 0NN, UK
| | - Paul Bassett
- Statsconsultancy Ltd, Amersham, Buckinghamshire, UK
| | - Verity C Leeson
- Division of Psychiatry, Commonwealth Building, Imperial College London, Hammersmith Hospital Campus, Du Cane Road, London, W12 0NN, UK
| | - Oluwaseun Tella
- Division of Psychiatry, Commonwealth Building, Imperial College London, Hammersmith Hospital Campus, Du Cane Road, London, W12 0NN, UK
| | - Martina Di Simplicio
- Division of Psychiatry, Commonwealth Building, Imperial College London, Hammersmith Hospital Campus, Du Cane Road, London, W12 0NN, UK
| | - Peter Tyrer
- Division of Psychiatry, Commonwealth Building, Imperial College London, Hammersmith Hospital Campus, Du Cane Road, London, W12 0NN, UK
| | - Helen Tyrer
- Division of Psychiatry, Commonwealth Building, Imperial College London, Hammersmith Hospital Campus, Du Cane Road, London, W12 0NN, UK
| | - Richard G Watt
- Department of Epidemiology & Public Health, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Kirsten Barnicot
- Division of Health Services Research and Management, City, University of London, Northampton Square, London, EC1V 0HB, UK
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16
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Marlow S, Laugharne R, Allard J, Bassett P, Priebe S, Ledger J, Kerr J, Priest D, Vanhoorn A, Boland C, Shankar R. A pragmatic randomized controlled exploratory trial of the effectiveness of Eye Movement Desensitization and Reprocessing therapy for psychotic disorder. J Psychiatr Res 2024; 169:257-263. [PMID: 38056231 DOI: 10.1016/j.jpsychires.2023.11.024] [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: 03/11/2023] [Revised: 11/04/2023] [Accepted: 11/15/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND People with severe mental illness are often excluded from trials related to Eye Movement Desensitization and Reprocessing (EMDR) therapy. Principal concerns are that they may not tolerate treatment, might risk relapse or that psychotic symptoms may worsen. There is however building evidence of a traumatogenic etiology of psychotic disorder that may benefit therapeutically from EMDR. However, EMDR in this role is done mainly in specialist tertiary settings. AIM To conduct a randomized exploratory trial of prospective treatment of EMDR for people with psychotic disorder and a history of trauma in an adult community mental health service. METHODS A randomized exploratory trial with a controlled pilot design was employed to conduct a prospective treatment and six-month follow-up study with an interim 10-week analysis in a rural county in the UK (population 538,000). We recruited participants with psychotic disorder who had a reported history of trauma and were interested in receiving trauma therapy. They were then randomized to either receive EMDR or treatment as usual (TAU). The primary instrument used was the Impact of Events Scale (IES) with secondary instruments of Positive and Negative Symptoms of Psychotic Disorder (PANSS), PTSD Checklist (PCL-C), and subjective Quality of Life (MANSA). RESULTS IES scores showed significant improvements in the EMDR group (n = 24, age 42.0 SD (14.5), 42% male) compared to the TAU group (n = 12, age 34.4 SD (11.3), 50% male) at 10 weeks and at six months (p < 0.05). There were significant improvements in PCL-C and PANSS negative symptoms scores associated with treatment (p < 0.05). All other scales showed positive trends. CONCLUSIONS This study demonstrates that EMDR can reduce the impact of traumatic events for patients with a psychotic disorder in a clinical setting in the UK. The improvements in psychotic disorder persisted for six months after treatment. TRIAL REGISTRATION ISRCTN43816889.
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Affiliation(s)
- Simon Marlow
- Cornwall Partnership NHS Foundation Trust, Truro, UK
| | - Richard Laugharne
- Cornwall Partnership NHS Foundation Trust, Truro, UK; Cornwall Intellectual Disability Equitable Research (CIDER) University of Plymouth Peninsula School of Medicine, Truro, UK
| | - Jon Allard
- Cornwall Partnership NHS Foundation Trust, Truro, UK
| | | | - Stefan Priebe
- Unit for Social and Community Psychiatry, Queen Mary's, University of London, UK
| | - Joanne Ledger
- Cornwall Partnership NHS Foundation Trust, Truro, UK
| | | | | | - Alje Vanhoorn
- Cornwall Partnership NHS Foundation Trust, Truro, UK
| | - Cailin Boland
- Cornwall Partnership NHS Foundation Trust, Truro, UK
| | - Rohit Shankar
- Cornwall Partnership NHS Foundation Trust, Truro, UK; Cornwall Intellectual Disability Equitable Research (CIDER) University of Plymouth Peninsula School of Medicine, Truro, UK.
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17
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Burgod C, Mazlan M, Pant S, Krishnan V, Garegrat R, Montaldo P, Muraleedharan P, Bandiya P, Kamalaratnam CN, Chandramohan R, Manerkar S, Jahan I, Moni SC, Shahidullah M, Rodrigo R, Sumanasena S, Sujatha R, Sathyanathan BP, Joshi AR, Pressler RR, Bassett P, Shankaran S, Thayyil S. Duration of birth depression and neurodevelopmental outcomes after whole-body hypothermia for hypoxic ischemic encephalopathy in India, Sri Lanka and Bangladesh - an exploratory analysis of the HELIX trial. Lancet Reg Health Southeast Asia 2024; 20:100284. [PMID: 38234698 PMCID: PMC10794099 DOI: 10.1016/j.lansea.2023.100284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/01/2023] [Accepted: 09/11/2023] [Indexed: 01/19/2024]
Abstract
Background Effect of duration of birth depression on neurodevelopmental outcomes in low- and middle-income countries (LMICs) is not known. We examined the association of birth depression with brain injury, neurodevelopmental outcomes, and hypothermia after hypoxic ischemic encephalopathy (HIE) in south Asia. Methods We compared cerebral magnetic resonance (MR) at 2 weeks, and adverse outcomes (death or moderate or severe disability) at 18 months in 408 babies with moderate or severe HIE who had long birth depression (positive pressure ventilation (PPV) >10 min or Apgar score<6 at 10 min or cord pH < 7.0) and short birth depression (PPV for 5-10 min or Apgar score<6 at 5 min, but ≥6 at 10 min). Findings Long depression group (n = 201) had more severe HIE (32.8% versus 6.8%), mortality (47.5% versus 26.4%), death or disability at 18 months (62.2% versus 35.4%) (all p < 0.001), MR injury (Odds ratio; 95% CI) to basal ganglia (2.4 (1.3, 4.1); p = 0.003), posterior limb of internal capsule (2.3 (1.3, 4.3); p < 0.001) and white matter (1.7 (1.1, 2.7); p = 0.021), and lower thalamic N-acetylaspartate levels (7.69 ± 1.84 versus 8.29 ± 1.60); p = 0.031) than short depression group (n = 207). Three babies had no heartbeat at 5 min, of which 1 died and 2 survived with severe disability. No significant interaction between the duration of birth depression and whole-body hypothermia was seen for any of the MR biomarker or clinical outcomes. Interpretation Long birth depression was associated with more brain injury and adverse outcomes than short depression. Effect of hypothermia was not modified by duration of birth depression. Funding National Institute for Health Research.
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Affiliation(s)
- Constance Burgod
- Centre for Perinatal Neuroscience, Imperial College, London, United Kingdom
| | - Munirah Mazlan
- Centre for Perinatal Neuroscience, Imperial College, London, United Kingdom
| | - Stuti Pant
- Centre for Perinatal Neuroscience, Imperial College, London, United Kingdom
| | - Vaisakh Krishnan
- Centre for Perinatal Neuroscience, Imperial College, London, United Kingdom
| | - Reema Garegrat
- Centre for Perinatal Neuroscience, Imperial College, London, United Kingdom
| | - Paolo Montaldo
- Centre for Perinatal Neuroscience, Imperial College, London, United Kingdom
| | | | - Prathik Bandiya
- Neonatal Unit, Indira Gandhi Institute of Child Health, Bangalore, India
| | | | | | - Swati Manerkar
- Neonatal Unit and Radiology, Lokmanya Tilak Municipal Medical College, Mumbai, India
| | - Ismat Jahan
- Neonatal Unit, Bangabandhu Sheikh Mujib Medical University, Bangladesh
| | - Sadeka C. Moni
- Neonatal Unit, Bangabandhu Sheikh Mujib Medical University, Bangladesh
| | | | | | | | - Radhika Sujatha
- Neonatal Unit, Sree Avittom Thirunal Hospital and Government Medical College, Thiruvananthapuram, India
| | | | - Anagha R. Joshi
- Neonatal Unit and Radiology, Lokmanya Tilak Municipal Medical College, Mumbai, India
| | - Ronit R. Pressler
- Department of Neurophysiology, Great Ormond Street Hospital, United Kingdom
| | | | - Seetha Shankaran
- Department of Neonatal-Perinatal Medicine, Wayne State University, Detroit, MI, USA
- University of Texas at Austin, Dell Children's Hospital, Austin, USA
| | - Sudhin Thayyil
- Centre for Perinatal Neuroscience, Imperial College, London, United Kingdom
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Grant B, Campbell J, Pradeep A, Burns AD, Bassett P, Abbara A, Saket P, Minhas S, Dhillo WS, McVeigh J, Bhasin S, Jayasena CN. Factors predicting normalization of reproductive hormones after cessation of anabolic-androgenic steroids in men: a single center retrospective study. Eur J Endocrinol 2023; 189:601-610. [PMID: 38102386 DOI: 10.1093/ejendo/lvad164] [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: 07/23/2023] [Revised: 10/05/2023] [Accepted: 10/09/2023] [Indexed: 12/17/2023]
Abstract
OBJECTIVE Symptomatic hypogonadism discourages men from stopping anabolic-androgenic steroids (AAS). Some men illicitly take drugs temporarily stimulating endogenous testosterone following AAS cessation (post-cycle therapy; PCT) to lessen hypogonadal symptoms. We investigated whether prior PCT use was associated with the normalization of reproductive hormones following AAS cessation. METHODS Retrospective analysis of 641 men attending a clinic between 2015-2022 for a single, nonfasting, random blood test <36 months following AAS cessation, with or without PCT. Normalized reproductive hormones (ie, a combination of reference range serum luteinizing hormone, follicle-stimulating hormone, and total testosterone levels) were the surrogate marker of biochemical recovery. RESULTS Normalization of reproductive hormones was achieved in 48.2% of men. PCT use was associated with faster biochemical recovery (13.0 (IQR8.0-19.0) weeks, PCT; 26.0 (IQR10.5-52) weeks, no-PCT; P < .001). Odds of biochemical recovery during multivariable analysis were: (1) higher with PCT (OR3.80) vs no-PCT (P = .001), in men stopping AAS ≤3 months previously; (2) reduced when 2 (OR0.55), 3 (OR0.46), or 4 (OR0.25) AAS were administered vs 1 drug (P = .009); (3) lower with AAS >6 vs ≤3 months previously (OR0.34, P = .01); (4) higher with last reported AAS >3 months (OR 5.68) vs ≤3 months (P = .001). PCT use was not associated with biochemical recovery in men stopping AAS >3 months previously. CONCLUSION Without evidence-based withdrawal protocols, men commonly try avoiding post-AAS hypogonadism with PCT, which is illicit, ill-defined, and not recommended. Only half of men had complete biochemical testicular recovery after stopping AAS. The surprising association of self-reported PCT use with short-term biochemical recovery from AAS-induced hypogonadism warrants further investigation.
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Affiliation(s)
- Bonnie Grant
- Section of Investigative Medicine, Imperial College London, Commonwealth Building, Hammersmith Hospital, Du Cane Road, London W12 0NN, United Kingdom
| | - John Campbell
- Glasgow Alcohol & Drug Recovery Services, NHS Greater Glasgow & Clyde, Glasgow G5 8BG, United Kingdom
| | - Anjali Pradeep
- Section of Investigative Medicine, Imperial College London, Commonwealth Building, Hammersmith Hospital, Du Cane Road, London W12 0NN, United Kingdom
| | - Angela D Burns
- Department of Clinical Biochemistry, Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow G51 4TF, United Kingdom
| | - Paul Bassett
- Statsconsultancy Ltd, 40 Longwood Lane, Amersham, Bucks HP7 9EN, United Kingdom
| | - Ali Abbara
- Section of Investigative Medicine, Imperial College London, Commonwealth Building, Hammersmith Hospital, Du Cane Road, London W12 0NN, United Kingdom
| | - Priyadarshi Saket
- Glasgow Alcohol & Drug Recovery Services, NHS Greater Glasgow & Clyde, Glasgow G5 8BG, United Kingdom
| | - Sukhbinder Minhas
- Department of Urology, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, United Kingdom
| | - Waljit S Dhillo
- Section of Investigative Medicine, Imperial College London, Commonwealth Building, Hammersmith Hospital, Du Cane Road, London W12 0NN, United Kingdom
| | - James McVeigh
- Department of Sociology, Manchester Metropolitan University, 4 Rosamund Street West, Manchester M15 6LL, United Kingdom
| | - Shalender Bhasin
- Brigham and Women's Hospital, Division of Endocrinology, Diabetes and Hypertension, 221 Longwood Avenue, Boston, MA 02115, United States
| | - Channa N Jayasena
- Section of Investigative Medicine, Imperial College London, Commonwealth Building, Hammersmith Hospital, Du Cane Road, London W12 0NN, United Kingdom
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19
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Batura D, Patel A, Gandhi A, Pradhan A, Bachoo S, Tetea AA, Bassett P, Hellawell G. Ethnic differences in prostate cancer presentation: a time for testing advocacy. World J Urol 2023; 41:3543-3549. [PMID: 37821779 DOI: 10.1007/s00345-023-04644-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 09/16/2023] [Indexed: 10/13/2023] Open
Abstract
PURPOSE It is recognised that there are ethnic variations in prostate cancer (PCa) epidemiology, affecting outcomes. South Asians (SA) are less likely to be diagnosed with PCa than others, although recent evidence shows PCa is rising amongst SA. This study examines the differences between ethnicities in PCa presentation, progression risk and prostate-specific antigen (PSA) testing use. METHODS This retrospective study is on biopsy-diagnosed PCa patients from a multi-ethnic area in London. We grouped ethnicities as SA, White, Black and others, compared presenting symptoms, PSA, Gleason score (GS), and clinical stage, and estimated the D'Amico risk across ethnicities. We also evaluated if the presentation was due to symptoms or an elevated PSA. RESULTS We studied 1176 patients with biopsy-proven PCa. Black patients were diagnosed about 3 years before others (65 ± 8.8 years, p = < 0.001). There was no significant difference between ethnicities in presenting PSAs. At presentation, 65-71% were in the high-risk D'Amico category across all ethnicities. SA were least likely to have PSA test-detected cancers (38%, p = 0.001) and had the highest proportion with advanced GS (30.6%). There was no significant difference in the risk of disease progression between groups. CONCLUSION Black men were diagnosed youngest. SA had the highest proportion with advanced GS. Most ethnicities had a high risk of progression. SA had the least PSA test-detected cases. The significance of the study lies in understanding ethnic variations in PCa, which could direct targeted prevention and management. We recommend further ethnicity studies and interventions encouraging SA men to embrace PSA testing.
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Affiliation(s)
- Deepak Batura
- Department of Urology, London North West University Healthcare NHS Trust, Watford Road, Harrow, London, HA1 3UJ, UK.
| | - Anish Patel
- Department of Urology, London North West University Healthcare NHS Trust, Watford Road, Harrow, London, HA1 3UJ, UK
| | - Akash Gandhi
- Department of Urology, London North West University Healthcare NHS Trust, Watford Road, Harrow, London, HA1 3UJ, UK
| | - Ameena Pradhan
- Department of Urology, London North West University Healthcare NHS Trust, Watford Road, Harrow, London, HA1 3UJ, UK
| | - Samsara Bachoo
- Department of Urology, London North West University Healthcare NHS Trust, Watford Road, Harrow, London, HA1 3UJ, UK
| | - Alina Alexandra Tetea
- Department of Urology, London North West University Healthcare NHS Trust, Watford Road, Harrow, London, HA1 3UJ, UK
| | - Paul Bassett
- Statsconsultancy Ltd, 40 Longwood Lane, Amersham, HP7 9EN, UK
| | - Giles Hellawell
- Department of Urology, London North West University Healthcare NHS Trust, Watford Road, Harrow, London, HA1 3UJ, UK
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20
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Ahmad A, Bassett P, Saunders BP. Reply to Spadaccini M. et al. Endoscopy 2023; 55:1152. [PMID: 38016461 DOI: 10.1055/a-2147-0532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Affiliation(s)
- Ahmir Ahmad
- Wolfson Unit for Endoscopy, St Mark's Hospital, London, United Kingdom
| | | | - Brian P Saunders
- Wolfson Unit for Endoscopy, St Mark's Hospital, London, United Kingdom
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21
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Husain MO, Chaudhry N, Kiran T, Taylor P, Tofique S, Khaliq A, Naureen A, Shakoor S, Bassett P, Zafar SN, Chaudhry IB, Husain N. Antecedents, clinical and psychological characteristics of a large sample of individuals who have self-harmed recruited from primary care and hospital settings in Pakistan. BJPsych Open 2023; 9:e216. [PMID: 37955044 PMCID: PMC10753970 DOI: 10.1192/bjo.2023.581] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 06/01/2023] [Accepted: 09/04/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND Suicide is one of the leading causes of mortality worldwide, and the majority of suicide deaths occur in low- and middle-income countries. AIMS To evaluate the demographic and clinical characteristics of individuals who have presented to health services following self-harm in Pakistan. METHOD This study is a cross-sectional baseline analysis of participants from a large multicentre randomised controlled trial of self-harm prevention in Pakistan. A total of 901 participants with a history of self-harm were recruited from primary care clinics, emergency departments and general hospitals in five major cities in Pakistan. The Beck Scale for Suicide Ideation (BSI), Beck Depression Inventory (BDI), Beck Hopelessness Scale (BHS) and Suicide Attempt Self Injury Interview assessment scales were completed. RESULTS Most participants recruited were females (n = 544, 60.4%) in their 20s. Compared with males, females had lower educational attainment and higher unemployment rates and reported higher severity scores on BSI, BDI and BHS. Interpersonal conflict was the most frequently cited antecedent to self-harm, followed by financial difficulties in both community and hospital settings. Suicide was the most frequently reported motive of self-harm (N = 776, 86.1%). Suicidal intent was proportionally higher in community-presenting patients (community: N = 318, 96.9% v. hospital: N = 458, 79.9%; P < 0.001). The most frequently reported methods of self-harm were ingestion of pesticides and toxic chemicals. CONCLUSIONS Young females are the dominant demographic group in this population and are more likely to attend community settings to seek help. Suicidal intent as the motivator of self-harm and use of potentially lethal methods may suggest that this population is at high risk of suicide.
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Affiliation(s)
- Muhammad Omair Husain
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Canada; and Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - Nasim Chaudhry
- Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - Tayyeba Kiran
- Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - Peter Taylor
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - Sehrish Tofique
- Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - Ayesha Khaliq
- Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - Amna Naureen
- Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - Suleman Shakoor
- Pakistan Institute of Living and Learning, Karachi, Pakistan
| | | | | | - Imran B. Chaudhry
- University of Manchester, UK; and Department of Psychiatry, Ziauddin Hospital, Karachi, Pakistan
| | - Nusrat Husain
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK
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22
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Prezzi D, Muthuswamy K, Amlani A, Owczarczyk K, Elowaidy A, Mistry T, Bassett P, Goh V. Diffusion-weighted imaging complements T2-weighted MRI for tumour response assessment in squamous anal carcinoma. Eur Radiol 2023; 33:7575-7584. [PMID: 37462820 PMCID: PMC10598114 DOI: 10.1007/s00330-023-09942-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Abstract
OBJECTIVES A published tumour regression grade (TRG) score for squamous anal carcinoma treated with definitive chemoradiotherapy based on T2-weighted MRI yields a high proportion of indeterminate responses (TRG-3). We investigate whether the addition of diffusion-weighted imaging (DWI) improves tumour response assessment in the early post treatment period. MATERIALS AND METHODS This retrospective observational study included squamous anal carcinoma patients undergoing MRI before and within 3 months of completing chemoradiotherapy from 2009 to 2020. Four independent radiologists (1-20 years' experience) scored MRI studies using a 5-point TRG system (1 = complete response; 5 = no response) based on T2-weighted sequences alone, and then after a 12-week washout period, using a 5-point DWI-TRG system based on T2-weighted and DWI. Scoring confidence was recorded on a 5-point scale (1 = low; 5 = high) for each reading and compared using the Wilcoxon test. Indeterminate scores (TRG-3) from each reading session were compared using the McNemar test. Interobserver agreement was assessed using kappa statistics. RESULTS Eighty-five patients were included (mean age, 59 years ± 12 [SD]; 55 women). T2-weighted TRG-3 scores from all readers combined halved from 24% (82/340) to 12% (41/340) with DWI (p < 0.001). TRG-3 scores changed most frequently (41%, 34/82) to DWI-TRG-2 (excellent response). Complete tumour response was recorded clinically in 77/85 patients (91%). Scoring confidence increased using DWI (p < 0.001), with scores of 4 or 5 in 84% (287/340). Interobserver agreement remained fair to moderate (kappa range, 0.28-0.58). CONCLUSION DWI complements T2-weighted MRI by reducing the number of indeterminate tumour responses (TRG-3). DWI increases radiologist's scoring confidence. CLINICAL RELEVANCE STATEMENT Diffusion-weighted imaging improves T2-weighted tumour response assessment in squamous anal cancer, halving the number of indeterminate responses in the early post treatment period, and increases radiologists' confidence. KEY POINTS Tumour response based on T2-weighted MRI is often indeterminate in squamous anal carcinoma. Diffusion-weighted imaging alongside T2-weighted MRI halved indeterminate tumour regression grade scores assigned by four radiologists from 24 to 12%. Scoring confidence of expert and non-expert radiologists increased with the inclusion of diffusion-weighted imaging.
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Affiliation(s)
- Davide Prezzi
- School of Biomedical Engineering and Imaging Sciences, King's College London, King's Health Partners, London, UK.
- Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
| | | | - Ashik Amlani
- Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Kasia Owczarczyk
- Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ahmed Elowaidy
- Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Tina Mistry
- Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Vicky Goh
- School of Biomedical Engineering and Imaging Sciences, King's College London, King's Health Partners, London, UK
- Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
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23
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Gabrielsson A, Moghaddassian M, Sawhney I, Shardlow S, Tromans S, Bassett P, Shankar R. The long-term psycho-social impact of the pandemic on people with intellectual disability and their carers. Int J Soc Psychiatry 2023; 69:1781-1789. [PMID: 37191298 PMCID: PMC10191827 DOI: 10.1177/00207640231174373] [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] [Indexed: 05/17/2023]
Abstract
BACKGROUND People with intellectual disabilities (PWID) are at six times higher risk of death due to COVID-19. To mitigate harm, as a high-risk group, significant social changes were imposed on PWID in the UK. Alongside these changes, the uncertainty of the pandemic influence, caused PWID and their carers to encounter significant stress. The evidence of the pandemic's psycho-social impact on PWID originates mainly from cross-sectional surveys conducted with professionals and carers. There is little research on the longitudinal psycho-social impact of the pandemic from PWID themselves. AIMS To examine the long-term psycho-social impact of the pandemic on PWID. METHODS A cross-sectional survey, following STROBE guidance, of 17 Likert scale statements (12 to PWID and 5 to their carers) to ascertain the pandemic's psychosocial impact was conducted. Every other PWID open to a specialist Intellectual Disability service serving half a UK County (pop:500,000) was selected. The same survey was re-run with the same cohort a year later. Descriptive statistics, Mann-Whitney, Chi-square and unpaired-t tests were used to compare responses. Significance is taken at p < .05. Comments were analysed using Clarke and Braun's approach. RESULTS Of 250 PWID contacted, 100 (40%) responded in 2020 and 127 (51%) in 2021. 69% (2020) and 58% (2021) reported seeking medical support. Carers, (88%, 2020 and 90%, 2021) noticed emotional changes in PWID they cared for. 13% (2020) and 20% (2021) of PWID had their regular psychotropics increased. 21% (2020) and 24% (2021) had their pro re nata (PRN) medication adjusted. PWID or carers demonstrated no statistically significant variation in responses between themselves from 2020 to 2021. PWID were more likely to report being upset/distressed compared to their carers' perceptions of them in both years (p < .001). Four themes were identified. CONCLUSION This longitudinal study highlights the diverse psycho-social impact of the pandemic on PWID in the UK. The Pandemic's psycho-social impact has been significantly underestimated.
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Affiliation(s)
| | | | | | - Sophie Shardlow
- Hertfordshire Partnership University NHS Trust, Hatfield, UK
| | - Samuel Tromans
- University of Leicester, UK
- Leicestershire Partnership NHS Trust, UK
| | | | - Rohit Shankar
- Peninsula School of Medicine, University of Plymouth, UK
- Cornwall Partnership NHS Foundation Trust, Truro, UK
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24
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Tirotta F, Fadel M, Baia M, Parente A, Messina V, Bassett P, Almond LM, Ford SJ, Desai A, van Houdt WJ, Strauss DC. ASO Visual Abstract: Risk Factors for the Development of Early Recurrence in Patients with Primary Retroperitoneal Sarcoma. Ann Surg Oncol 2023; 30:6884-6885. [PMID: 37530995 DOI: 10.1245/s10434-023-13988-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Affiliation(s)
- Fabio Tirotta
- Department of Sarcoma and General Surgery, Midlands Abdominal and Retroperitoneal Sarcoma Unit, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK.
| | - Michael Fadel
- Department of Academic Surgery, Sarcoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Marco Baia
- Department of Sarcoma and General Surgery, Midlands Abdominal and Retroperitoneal Sarcoma Unit, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
- Sarcoma Unit, Fondazione IRCCS Istituto Tumori di Milano, Milan, Italy
| | - Alessandro Parente
- Department of Sarcoma and General Surgery, Midlands Abdominal and Retroperitoneal Sarcoma Unit, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Valentina Messina
- Department of Sarcoma and General Surgery, Midlands Abdominal and Retroperitoneal Sarcoma Unit, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - L Max Almond
- Department of Sarcoma and General Surgery, Midlands Abdominal and Retroperitoneal Sarcoma Unit, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Samuel J Ford
- Department of Sarcoma and General Surgery, Midlands Abdominal and Retroperitoneal Sarcoma Unit, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Anant Desai
- Department of Sarcoma and General Surgery, Midlands Abdominal and Retroperitoneal Sarcoma Unit, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Winan J van Houdt
- Department of Surgical Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Dirk C Strauss
- Department of Academic Surgery, Sarcoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London, UK
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25
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Tirotta F, Fadel MG, Baia M, Parente A, Messina V, Bassett P, Almond LM, Ford SJ, Desai A, van Houdt WJ, Strauss DC. Risk Factors for the Development of Early Recurrence in Patients with Primary Retroperitoneal Sarcoma. Ann Surg Oncol 2023; 30:6875-6883. [PMID: 37423926 DOI: 10.1245/s10434-023-13754-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 05/31/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Disease recurrence after retroperitoneal sarcoma (RPS) surgery is common, and resection may offer no benefit for patients who experience recurrence early. This study examined the incidence of early recurrence (EREC) in RPS patients, and the association between EREC and prognosis, aiming to identify the factors associated with EREC. METHODS Patients undergoing surgery for primary RPS from 2008 to 2019 at two tertiary RPS centers were analyzed. The study defined EREC as any evidence of local recurrence and/or distant metastases on the CT scan up to 6 months after surgery. Overall survival (OS) was calculated using the Kaplan-Meier method. A multivariable analysis was performed to identify independent predictors of EREC. RESULTS Of the 692 patients who underwent surgery during the study period, 657 were included in the analysis. Sixty-five of these patients (9.9%; 95% confidence interval [CI], 7.7-12.4%) developed EREC. Five-year OS was 3% for the patients with EREC versus 76% for those without EREC (p < 0.001). Patient characteristics were compared between the EREC and non-EREC patients, and EREC was found to be significantly associated with Eastern Cooperative Oncology Group (ECOG) performance status (p = 0.006), tumor histology (p = 0.002), tumor grading (p < 0.001), radiotherapy (p = 0.04), and postoperative complications measured as a comprehensive complications index value (p = 0.003). However, the only significant independent predictor of EREC in the multivariable analysis was grade 3 tumors, with an odds ratio of 14.8 (95% CI, 4.44-49.2; p < 0.001). CONCLUSION Early recurrence is associated with a poor prognosis, and a high tumor grade is an independent predictor for the development of EREC. Patients with EREC may benefit the most from new therapeutic options such as neoadjuvant chemotherapy.
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Affiliation(s)
- Fabio Tirotta
- Department of Sarcoma and General Surgery, Midlands Abdominal and Retroperitoneal Sarcoma Unit, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK.
| | - Michael G Fadel
- Department of Academic Surgery, Sarcoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Marco Baia
- Department of Sarcoma and General Surgery, Midlands Abdominal and Retroperitoneal Sarcoma Unit, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
- Sarcoma Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Alessandro Parente
- Department of Sarcoma and General Surgery, Midlands Abdominal and Retroperitoneal Sarcoma Unit, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Valentina Messina
- Department of Sarcoma and General Surgery, Midlands Abdominal and Retroperitoneal Sarcoma Unit, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - L Max Almond
- Department of Sarcoma and General Surgery, Midlands Abdominal and Retroperitoneal Sarcoma Unit, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Samuel J Ford
- Department of Sarcoma and General Surgery, Midlands Abdominal and Retroperitoneal Sarcoma Unit, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Anant Desai
- Department of Sarcoma and General Surgery, Midlands Abdominal and Retroperitoneal Sarcoma Unit, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Winan J van Houdt
- Department of Surgical Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Plesmanlaan, Amsterdam, The Netherlands
| | - Dirk C Strauss
- Department of Academic Surgery, Sarcoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London, UK
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26
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Bhandari P, Abdelrahim M, Alkandari AA, Galtieri PA, Spadaccini M, Groth S, Pilonis ND, Subhramaniam S, Kandiah K, Hossain E, Arndtz S, Bassett P, Siggens K, Htet H, Maselli R, Kaminski MF, Seewald S, Repici A. Predictors of long-term outcomes of endoscopic submucosal dissection of early gastric neoplasia in the West: a multicenter study. Endoscopy 2023; 55:898-906. [PMID: 37230471 DOI: 10.1055/a-2100-2258] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND This study aimed to determine long-term outcomes of gastric endoscopic submucosal dissection (ESD) in Western settings based on the latest Japanese indication criteria, and to examine predictors of outcomes and complications. METHODS Data were collected from consecutive patients undergoing gastric ESD at four participating centers from 2009 to 2021. Retrospective analysis using logistic regression and survival analysis was performed. RESULTS 415 patients were included (mean age 71.7 years; 56.4 % male). Absolute indication criteria (2018 guideline) were met in 75.3 % of patients. Median follow-up was 52 months. Post-resection histology was adenocarcinoma, high grade dysplasia, and low grade dysplasia in 49.9 %, 22.7 %, and 17.1 %, respectively. Perforation, early and delayed bleeding occurred in 2.4 %, 4.3 %, and 3.4 %, respectively. Rates of en bloc and R0 resection, and recurrence on first endoscopic follow-up were 94.7 %, 83.4 %, and 2.7 %, respectively. Relative indication (2018 guideline) for ESD was associated with R1 outcome (P = 0.02). Distal location (P = 0.002) and increased procedure time (P = 0.04) were associated with bleeding, and scarring (P = 0.009) and increased procedure duration (P = 0.003) were associated with perforation. Recurrence-free survival at 2 and 5 years was 94 % and 83 %, respectively. CONCLUSION This is the largest Western multicenter cohort and suggests that gastric ESD is safe and effective in the Western setting. A quarter of patients fell outside the new absolute indications for ESD, suggesting that Western practice involves more advanced lesions. We identified the predictors of complications, which should help to inform future Western practice and research.
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Affiliation(s)
- Pradeep Bhandari
- Gastroenterology, Portsmouth Hospital University NHS Trust, Portsmouth, United Kingdom
| | - Mohamed Abdelrahim
- Gastroenterology, Portsmouth Hospital University NHS Trust, Portsmouth, United Kingdom
| | - Asma A Alkandari
- Gastroenterology, Portsmouth Hospital University NHS Trust, Portsmouth, United Kingdom
| | | | - Marco Spadaccini
- Endoscopy Unit, Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy
| | | | - Nastazja D Pilonis
- The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Sharmila Subhramaniam
- Gastroenterology, Portsmouth Hospital University NHS Trust, Portsmouth, United Kingdom
| | - Kesavan Kandiah
- Gastroenterology, Portsmouth Hospital University NHS Trust, Portsmouth, United Kingdom
| | - Ejaz Hossain
- Gastroenterology, Portsmouth Hospital University NHS Trust, Portsmouth, United Kingdom
| | - Sophie Arndtz
- Gastroenterology, Portsmouth Hospital University NHS Trust, Portsmouth, United Kingdom
| | | | - Katie Siggens
- Gastroenterology, Portsmouth Hospital University NHS Trust, Portsmouth, United Kingdom
| | - Hein Htet
- Gastroenterology, Portsmouth Hospital University NHS Trust, Portsmouth, United Kingdom
| | - Roberta Maselli
- Endoscopy Unit, Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy
| | - Michal F Kaminski
- The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | | | - Alessandro Repici
- Endoscopy Unit, Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy
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27
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Husain N, Kiran T, Chaudhry IB, Williams C, Emsley R, Arshad U, Ansari MA, Bassett P, Bee P, Bhatia MR, Chew-Graham C, Husain MO, Irfan M, Khaliq A, Minhas FA, Naeem F, Naqvi H, Nizami AT, Noureen A, Panagioti M, Rasool G, Saeed S, Bukhari SQ, Tofique S, Zadeh ZF, Zafar SN, Chaudhry N. A culturally adapted manual-assisted problem-solving intervention (CMAP) for adults with a history of self-harm: a multi-centre randomised controlled trial. BMC Med 2023; 21:282. [PMID: 37525207 PMCID: PMC10391745 DOI: 10.1186/s12916-023-02983-8] [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: 12/22/2022] [Accepted: 07/18/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Self-harm is an important predictor of a suicide death. Culturally appropriate strategies for the prevention of self-harm and suicide are needed but the evidence is very limited from low- and middle-income countries (LMICs). This study aims to investigate the effectiveness of a culturally adapted manual-assisted problem-solving intervention (CMAP) for patients presenting after self-harm. METHODS This was a rater-blind, multicenter randomised controlled trial. The study sites were all participating emergency departments, medical wards of general hospitals and primary care centres in Karachi, Lahore, Rawalpindi, Peshawar, and Quetta, Pakistan. Patients presenting after a self-harm episode (n = 901) to participating recruitment sites were assessed and randomised (1:1) to one of the two arms; CMAP with enhanced treatment as usual (E-TAU) or E-TAU. The intervention (CMAP) is a manual-assisted, cognitive behaviour therapy (CBT)-informed problem-focused therapy, comprising six one-to-one sessions delivered over three months. Repetition of self-harm at 12-month post-randomisation was the primary outcome and secondary outcomes included suicidal ideation, hopelessness, depression, health-related quality of life (QoL), coping resources, and level of satisfaction with service received, assessed at baseline, 3-, 6-, 9-, and 12-month post-randomisation. The trial is registered on ClinicalTrials.gov. NCT02742922 (April 2016). RESULTS We screened 3786 patients for eligibility and 901 eligible, consented patients were randomly assigned to the CMAP plus E-TAU arm (n = 440) and E-TAU arm (N = 461). The number of self-harm repetitions for CMAP plus E-TAU was lower (n = 17) compared to the E-TAU arm (n = 23) at 12-month post-randomisation, but the difference was not statistically significant (p = 0.407). There was a statistically and clinically significant reduction in other outcomes including suicidal ideation (- 3.6 (- 4.9, - 2.4)), depression (- 7.1 (- 8.7, - 5.4)), hopelessness (- 2.6 (- 3.4, - 1.8), and improvement in health-related QoL and coping resources after completion of the intervention in the CMAP plus E-TAU arm compared to the E-TAU arm. The effect was sustained at 12-month follow-up for all the outcomes except for suicidal ideation and hopelessness. On suicidal ideation and hopelessness, participants in the intervention arm scored lower compared to the E-TAU arm but the difference was not statistically significant, though the participants in both arms were in low-risk category at 12-month follow-up. The improvement in both arms is explained by the established role of enhanced care in suicide prevention. CONCLUSIONS Suicidal ideation is considered an important target for the prevention of suicide, therefore, CMAP intervention should be considered for inclusion in the self-harm and suicide prevention guidelines. Given the improvement in the E-TAU arm, the potential use of brief interventions such as regular contact requires further exploration.
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Affiliation(s)
- Nusrat Husain
- Division of Psychology and Mental Health, University of Manchester, Oxford Rd, Manchester, M13 9PL, England, UK
- Mersey Care NHS Foundation Trust, Kings Business Park, Trust Offices/V7 Buildings, Prescot, L34 1PJ, England, UK
| | - Tayyeba Kiran
- Pakistan Institute of Living and Learning, Suite No. 201, 2nd Floor, The Plaza, Do-Talwar, Khayaban-E-Iqbal, Clifton, Karachi, Pakistan.
| | - Imran Bashir Chaudhry
- Division of Psychology and Mental Health, University of Manchester, Oxford Rd, Manchester, M13 9PL, England, UK
- Department of Psychiatry, Ziauddin University and Hospital, 4/B Shahrah-E-Ghalib Rd, Block 6 Clifton, Karachi, Pakistan
| | - Christopher Williams
- Institute of Health and Well Being, University of Glasgow, Glasgow, G12 8QQ, Scotland, UK
| | - Richard Emsley
- Medical Statistics & Trials Methodology, Institute of Psychiatry, Kings College London, Strand, London, WC2R 2LS, England, UK
| | - Usman Arshad
- Pakistan Institute of Living and Learning, Suite No. 201, 2nd Floor, The Plaza, Do-Talwar, Khayaban-E-Iqbal, Clifton, Karachi, Pakistan
| | - Moin Ahmed Ansari
- Liaquat University of Medical and Health Sciences, C7PC+337, Hyderabad, Jamshoro, Pakistan
| | - Paul Bassett
- Statistical Consultancy, Hemel Hempstead, England, UK
| | - Penny Bee
- Division of Nursing, Midwifery and Social Work, University of Manchester, Oxford Rd, Manchester, M13 9PL, England, UK
| | - Moti Ram Bhatia
- Peoples University of Medical & Health Science for Women Nawabshah, 6CV3+7HW, Hospital Road, Shaheed Benazirabad, Nawabshah, Pakistan
| | | | - Muhammad Omair Husain
- Department of Psychiatry, University of Toronto, 399 Bathurst St, Toronto, ON, M5T 2S8, Canada
| | - Muhammad Irfan
- Department of Mental Health, Psychiatry and Behavioural Sciences, Peshawar Medical College, Riphah International University, Islamabad, Pakistan
| | - Ayesha Khaliq
- Pakistan Institute of Living and Learning, Suite No. 201, 2nd Floor, The Plaza, Do-Talwar, Khayaban-E-Iqbal, Clifton, Karachi, Pakistan
| | | | - Farooq Naeem
- CAMH, University of Toronto, 399 Bathurst St, Toronto, ON, M5T 2S8, Canada
| | - Haider Naqvi
- Department of Psychiatry, Dow University of Health Sciences, Mission Rd, New Labour Colony Nanakwara, Karachi, Pakistan
| | - Asad Tamizuddin Nizami
- Institute of Psychiatry, Benazir Bhutto Hospital, Near Chandni Chowk, Murree Rd, Chah Sultan, Rawalpindi, Pakistan
| | - Amna Noureen
- Pakistan Institute of Living and Learning, Suite No. 201, 2nd Floor, The Plaza, Do-Talwar, Khayaban-E-Iqbal, Clifton, Karachi, Pakistan
| | - Maria Panagioti
- Division of Population Health, Health Services Research & Primary Care, Institute for Health Policy and Organisation/Alliance Manchester Business School, University of Manchester, Oxford Rd, Manchester, M13 9PL, UK
| | - Ghulam Rasool
- Balochistan Institute of Psychiatry & Behavioural Sciences, Bolan Medical College, 5XRG+VGC, Brewery Rd, Quetta, Pakistan
| | - Sofiya Saeed
- Pakistan Institute of Living and Learning, Suite No. 201, 2nd Floor, The Plaza, Do-Talwar, Khayaban-E-Iqbal, Clifton, Karachi, Pakistan
| | - Sumira Qambar Bukhari
- Department of Psychiatry, Services Institute of Medical Sciences, G8QM+JWR, Jail Rd, Shadman 1 Shadman, Lahore, Pakistan
| | - Sehrish Tofique
- Pakistan Institute of Living and Learning, Suite No. 201, 2nd Floor, The Plaza, Do-Talwar, Khayaban-E-Iqbal, Clifton, Karachi, Pakistan
| | - Zainab F Zadeh
- Pakistan Institute of Living and Learning, Suite No. 201, 2nd Floor, The Plaza, Do-Talwar, Khayaban-E-Iqbal, Clifton, Karachi, Pakistan
| | - Shehla Naeem Zafar
- Institute of Nursing, Iqra University, G-16/1 Allama Rasheed Turabi Rd, Block-B Block B, North Nazimabad Town, Karachi, Pakistan
| | - Nasim Chaudhry
- Pakistan Institute of Living and Learning, Suite No. 201, 2nd Floor, The Plaza, Do-Talwar, Khayaban-E-Iqbal, Clifton, Karachi, Pakistan
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Ravindran S, Matharoo M, Marshall S, Robinson E, Bano M, Bassett P, Coleman M, Rutter M, Ashrafian H, Darzi A, Healey C, Thomas-Gibson S. Development, validation, and results of a national endoscopy safety attitudes questionnaire (Endo-SAQ). Endosc Int Open 2023; 11:E679-E689. [PMID: 37502673 PMCID: PMC10370487 DOI: 10.1055/a-2112-5105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 06/13/2023] [Indexed: 07/29/2023] Open
Abstract
Background and study aims Safety attitudes are linked to patient outcomes. The Joint Advisory Group on Gastrointestinal Endoscopy (JAG) identifies the need to improve our understanding of safety culture in endoscopy. We describe the development and validation of the Endo-SAQ (endoscopy safety attitudes questionnaire) and the results of a national survey of staff attitudes. Methods Questions from the original SAQ were adapted to reflect endoscopy-specific content. This was refined by an expert group, followed by a pilot study to assess acceptability. The refined Endo-SAQ (comprising 35 questions across six domains) was disseminated to endoscopy staff across the UK and Ireland. Outcomes were domain scores and the percentage of positive responses (score ≥75/100) per domain. Descriptive and comparative analyses were performed. Binary logistic regression identified staff and service factors associated with positive scores. Validity and reliability of Endo-SAQ were assessed through psychometric analysis. Results After expert review, four questions in the preliminary Endo-SAQ were adjusted. Sixty-one participants undertook the pilot study with good acceptability. A total of 453 participants completed the refined Endo-SAQ. There were positive responses in teamwork, safety climate, job satisfaction, and working conditions domains. Endoscopists had significantly more positive responses to stress recognition and working conditions than nursing staff. JAG accreditation was associated with positive scores in safety climate and job satisfaction domains. Endo-SAQ met thresholds of construct validity and reliability. Conclusions Endoscopy staff had largely positive safety attitudes scores but there were significant differences across domains and staff. There is evidence for the validity and reliability of Endo-SAQ. Endo-SAQ could complement current measures of patient safety in endoscopy and be used in evaluation and research.
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Affiliation(s)
- Srivathsan Ravindran
- Joint Advisory Group on Gastrointestinal Endoscopy, Royal College of Physicians, London, United Kingdom of Great Britain and Northern Ireland
- Wolfson Unit for Endoscopy, St Mark's Hospital and Academic Institute, Harrow, United Kingdom of Great Britain and Northern Ireland
- Surgery and Cancer, Imperial College London, London, United Kingdom of Great Britain and Northern Ireland
| | - Manmeet Matharoo
- Wolfson Unit for Endoscopy, St Mark's Hospital and Academic Institute, Harrow, United Kingdom of Great Britain and Northern Ireland
| | - Sarah Marshall
- Wolfson Unit for Endoscopy, St Mark's Hospital and Academic Institute, Harrow, United Kingdom of Great Britain and Northern Ireland
| | - Emma Robinson
- Joint Advisory Group on Gastrointestinal Endoscopy, Royal College of Physicians, London, United Kingdom of Great Britain and Northern Ireland
| | - Madeline Bano
- Joint Advisory Group on Gastrointestinal Endoscopy, Royal College of Physicians, London, United Kingdom of Great Britain and Northern Ireland
| | - Paul Bassett
- Statistics, Statsconsultancy Ltd, Amersham, United Kingdom of Great Britain and Northern Ireland
| | - Mark Coleman
- Department of Colorectal Surgery, University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom of Great Britain and Northern Ireland
| | - Matt Rutter
- Joint Advisory Group on Gastrointestinal Endoscopy, Royal College of Physicians, London, United Kingdom of Great Britain and Northern Ireland
- Gastroenterology, University Hospital of North Tees, Stockton-on-Tees, United Kingdom of Great Britain and Northern Ireland
| | - Hutan Ashrafian
- Surgery and Cancer, Imperial College London, London, United Kingdom of Great Britain and Northern Ireland
| | - Ara Darzi
- Surgery and Cancer, Imperial College London, London, United Kingdom of Great Britain and Northern Ireland
| | - Chris Healey
- Department of Gastroenterology, Airedale NHS Foundation Trust, Keighley, United Kingdom of Great Britain and Northern Ireland
| | - Siwan Thomas-Gibson
- Wolfson Unit for Endoscopy, St Mark's Hospital and Academic Institute, Harrow, United Kingdom of Great Britain and Northern Ireland
- Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom of Great Britain and Northern Ireland
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Gabrielsson A, Tromans S, Newman H, Triantafyllopoulou P, Hassiotis A, Bassett P, Watkins L, Sawhney I, Cooper M, Griffiths L, Pullen A, Roy A, Angus-Leppan H, Rh T, Kinney M, Tittensor P, Shankar R. Awareness of social care needs in people with epilepsy and intellectual disability. Epilepsy Behav 2023; 145:109296. [PMID: 37336133 DOI: 10.1016/j.yebeh.2023.109296] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 05/29/2023] [Accepted: 05/30/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND Nearly a quarter of people with intellectual disability (ID) have epilepsy with large numbers experiencing drug-resistant epilepsy, and premature mortality. To mitigate epilepsy risks the environment and social care needs, particularly in professional care settings, need to be met. PURPOSE To compare professional care groups as regards their subjective confidence and perceived responsibility when managing the need of people with ID and epilepsy. METHOD A multi-agency expert panel developed a questionnaire with embedded case vignettes with quantitative and qualitative elements to understand training and confidence in the health and social determinants of people with ID and epilepsy. The cross-sectional survey was disseminated amongst health and social care professionals working with people with ID in the UK using an exponential non-discriminative snow-balling methodology. Group comparisons were undertaken using suitable statistical tests including Fisher's exact, Kruskal-Wallis, and Mann-Whitney. Bonferroni correction was applied to significant (p < 0.05) results. Content analysis was conducted and relevant categories and themes were identified. RESULTS Social and health professionals (n = 54) rated their confidence to manage the needs of people with ID and epilepsy equally. Health professionals showed better awareness (p < 0.001) of the findings/recommendations of the latest evidence on premature deaths and identifying and managing epilepsy-related risks, including the relevance of nocturnal monitoring. The content analysis highlighted the need for clearer roles, improved care pathways, better epilepsy-specific knowledge, increased resources, and better multi-disciplinary work. CONCLUSIONS A gap exists between health and social care professionals in awareness of epilepsy needs for people with ID, requiring essential training and national pathways.
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Affiliation(s)
- A Gabrielsson
- Hertfordshire Partnership University NHS Trust, Hatfield, UK
| | - S Tromans
- University of Leicester, Leicester, UK; Leicestershire Partnership NHS Trust, Leicester, UK
| | - H Newman
- University of Plymouth Peninsula School of Medicine, Plymouth, UK
| | | | | | | | - L Watkins
- University of South Wales, Pontypridd, UK; Swansea Bay University Health Board, Port Talbot, UK
| | - I Sawhney
- Hertfordshire Partnership University NHS Trust, Hatfield, UK
| | - M Cooper
- National Development Team for Inclusion Bath, UK
| | - L Griffiths
- National Development Team for Inclusion Bath, UK
| | | | - A Roy
- Coventry and Warwickshire Partnership Trust, Birmingham, UK
| | | | | | - M Kinney
- Belfast Health and Social Trust, Belfast, UK
| | - P Tittensor
- Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - R Shankar
- University of Plymouth Peninsula School of Medicine, Plymouth, UK; Cornwall Partnership NHS Foundation Trust, Truro, UK.
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Qazi E, Ursani A, Patel N, Kennedy SA, Bassett P, Jaberi A, Rajan D, Tan KT, Mafeld S. Operator Intracranial Dose Protection During Fluoroscopic-Guided Interventions. Cardiovasc Intervent Radiol 2023:10.1007/s00270-023-03458-2. [PMID: 37280331 DOI: 10.1007/s00270-023-03458-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 04/27/2023] [Indexed: 06/08/2023]
Abstract
PURPOSE We utilized an anthropomorphic model made with a human skull to determine how different personal protective equipment influence operator intracranial radiation absorbed dose. MATERIALS AND METHODS A custom anthropomorphic phantom made with a human skull coated with polyurethane rubber, mimicking superficial tissues, and was mounted onto a plastic thorax. To simulate scatter, an acrylic plastic scatter phantom was placed onto the fluoroscopic table with a 1.5 mm lead apron on top. Two Radcal radiation detectors were utilized; one inside of the skull and a second outside. Fluoroscopic exposures were performed with and without radiation protective equipment in AP, 45-degree RAO, and 45-degree LAO projections. RESULTS The skull and soft tissues reduce intracranial radiation by 76% when compared to radiation outside the skull. LAO (308.95 μSv/min) and RAO projections (96.47μSv/min) result in significantly higher radiation exposure to the primary operator when compared to an AP projection (54 μSv/min). All tested radiation protection equipment demonstrated various reduction in intracranial radiation when compared to no protection. The hood (68% reduction in AP, 91% LAO, and 43% in RAO), full cover (53% reduction in AP, 76% in LAO, and 54% in RAO), and open top with ear coverage (43% reduction in AP, 77% reduction in LAO, and 22% in RAO) demonstrated the most reduction in intracranial radiation when compared to the control. CONCLUSION All tested equipment provided various degrees of additional intracranial protection. The skull and soft tissues attenuate a portion of intracranial radiation.
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Affiliation(s)
- Emmad Qazi
- Department of Vascular and Interventional Radiology, Joint Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, 200 Elizabeth St, Toronto, ON, M5G 2C4, Canada.
| | - Ali Ursani
- Department of Vascular and Interventional Radiology, Joint Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, 200 Elizabeth St, Toronto, ON, M5G 2C4, Canada
| | - Neeral Patel
- Department of Vascular and Interventional Radiology, Joint Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, 200 Elizabeth St, Toronto, ON, M5G 2C4, Canada
| | - Sean A Kennedy
- Department of Vascular and Interventional Radiology, Joint Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, 200 Elizabeth St, Toronto, ON, M5G 2C4, Canada
| | - Paul Bassett
- Statsconsultancy Ltd. Freelance Statistical Consultancy, Amersham, Bucks, UK
| | - Arash Jaberi
- Department of Vascular and Interventional Radiology, Joint Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, 200 Elizabeth St, Toronto, ON, M5G 2C4, Canada
| | - Dheeraj Rajan
- Department of Vascular and Interventional Radiology, Joint Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, 200 Elizabeth St, Toronto, ON, M5G 2C4, Canada
| | - Kong Teng Tan
- Department of Vascular and Interventional Radiology, Joint Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, 200 Elizabeth St, Toronto, ON, M5G 2C4, Canada
| | - Sebastian Mafeld
- Department of Vascular and Interventional Radiology, Joint Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, 200 Elizabeth St, Toronto, ON, M5G 2C4, Canada
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Thayyil S, Montaldo P, Krishnan V, Ivain P, Pant S, Lally PJ, Bandiya P, Benkappa N, Kamalaratnam CN, Chandramohan R, Manerkar S, Mondkar J, Jahan I, Moni SC, Shahidullah M, Rodrigo R, Sumanasena S, Sujatha R, Burgod C, Garegrat R, Mazlan M, Chettri I, Babu Peter S, Joshi AR, Swamy R, Chong K, Pressler RR, Bassett P, Shankaran S. Whole-Body Hypothermia, Cerebral Magnetic Resonance Biomarkers, and Outcomes in Neonates With Moderate or Severe Hypoxic-Ischemic Encephalopathy Born at Tertiary Care Centers vs Other Facilities: A Nested Study Within a Randomized Clinical Trial. JAMA Netw Open 2023; 6:e2312152. [PMID: 37155168 PMCID: PMC10167567 DOI: 10.1001/jamanetworkopen.2023.12152] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
Importance The association between place of birth and hypothermic neuroprotection after hypoxic-ischemic encephalopathy (HIE) in low- and middle-income countries (LMICs) is unknown. Objective To ascertain the association between place of birth and the efficacy of whole-body hypothermia for protection against brain injury measured by magnetic resonance (MR) biomarkers among neonates born at a tertiary care center (inborn) or other facilities (outborn). Design, Setting, and Participants This nested cohort study within a randomized clinical trial involved neonates at 7 tertiary neonatal intensive care units in India, Sri Lanka, and Bangladesh between August 15, 2015, and February 15, 2019. A total of 408 neonates born at or after 36 weeks' gestation with moderate or severe HIE were randomized to receive whole-body hypothermia (reduction of rectal temperatures to between 33.0 °C and 34.0 °C; hypothermia group) for 72 hours or no whole-body hypothermia (rectal temperatures maintained between 36.0 °C and 37.0 °C; control group) within 6 hours of birth, with follow-up until September 27, 2020. Exposure 3T MR imaging, MR spectroscopy, and diffusion tensor imaging. Main Outcomes and Measures Thalamic N-acetyl aspartate (NAA) mmol/kg wet weight, thalamic lactate to NAA peak area ratios, brain injury scores, and white matter fractional anisotropy at 1 to 2 weeks and death or moderate or severe disability at 18 to 22 months. Results Among 408 neonates, the mean (SD) gestational age was 38.7 (1.3) weeks; 267 (65.4%) were male. A total of 123 neonates were inborn and 285 were outborn. Inborn neonates were smaller (mean [SD], 2.8 [0.5] kg vs 2.9 [0.4] kg; P = .02), more likely to have instrumental or cesarean deliveries (43.1% vs 24.7%; P = .01), and more likely to be intubated at birth (78.9% vs 29.1%; P = .001) than outborn neonates, although the rate of severe HIE was not different (23.6% vs 17.9%; P = .22). Magnetic resonance data from 267 neonates (80 inborn and 187 outborn) were analyzed. In the hypothermia vs control groups, the mean (SD) thalamic NAA levels were 8.04 (1.98) vs 8.31 (1.13) among inborn neonates (odds ratio [OR], -0.28; 95% CI, -1.62 to 1.07; P = .68) and 8.03 (1.89) vs 7.99 (1.72) among outborn neonates (OR, 0.05; 95% CI, -0.62 to 0.71; P = .89); the median (IQR) thalamic lactate to NAA peak area ratios were 0.13 (0.10-0.20) vs 0.12 (0.09-0.18) among inborn neonates (OR, 1.02; 95% CI, 0.96-1.08; P = .59) and 0.14 (0.11-0.20) vs 0.14 (0.10-0.17) among outborn neonates (OR, 1.03; 95% CI, 0.98-1.09; P = .18). There was no difference in brain injury scores or white matter fractional anisotropy between the hypothermia and control groups among inborn or outborn neonates. Whole-body hypothermia was not associated with reductions in death or disability, either among 123 inborn neonates (hypothermia vs control group: 34 neonates [58.6%] vs 34 [56.7%]; risk ratio, 1.03; 95% CI, 0.76-1.41), or 285 outborn neonates (hypothermia vs control group: 64 neonates [46.7%] vs 60 [43.2%]; risk ratio, 1.08; 95% CI, 0.83-1.41). Conclusions and Relevance In this nested cohort study, whole-body hypothermia was not associated with reductions in brain injury after HIE among neonates in South Asia, irrespective of place of birth. These findings do not support the use of whole-body hypothermia for HIE among neonates in LMICs. Trial Registration ClinicalTrials.gov Identifier: NCT02387385.
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Affiliation(s)
- Sudhin Thayyil
- Centre for Perinatal Neuroscience, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Paolo Montaldo
- Centre for Perinatal Neuroscience, Department of Brain Sciences, Imperial College London, London, United Kingdom
- Neonatal Unit, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Vaisakh Krishnan
- Centre for Perinatal Neuroscience, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Phoebe Ivain
- Centre for Perinatal Neuroscience, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Stuti Pant
- Centre for Perinatal Neuroscience, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Peter J Lally
- Centre for Perinatal Neuroscience, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Prathik Bandiya
- Neonatal Unit, Indira Gandhi Institute of Child Health, Bengaluru, India
| | - Naveen Benkappa
- Neonatal Unit, Indira Gandhi Institute of Child Health, Bengaluru, India
| | | | | | - Swati Manerkar
- Neonatal Unit, Lokmanya Tilak Municipal Medical College, Mumbai, India
| | - Jayshree Mondkar
- Neonatal Unit, Lokmanya Tilak Municipal Medical College, Mumbai, India
| | - Ismat Jahan
- Neonatal Unit, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Sadeka C Moni
- Neonatal Unit, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | | | - Ranmali Rodrigo
- Department of Pediatrics, University of Kelaniya, Kelaniya, Sri Lanka
| | | | - Radhika Sujatha
- Neonatal Unit, Sree Avittom Thirunal Hospital, Government Medical College, Thiruvananthapuram, India
| | - Constance Burgod
- Centre for Perinatal Neuroscience, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Reema Garegrat
- Centre for Perinatal Neuroscience, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Munirah Mazlan
- Centre for Perinatal Neuroscience, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Ismita Chettri
- Centre for Perinatal Neuroscience, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | | | - Anagha R Joshi
- Department of Radiology, Lokmanya Tilak Municipal Medical College, Mumbai, India
| | - Ravi Swamy
- Centre for Perinatal Neuroscience, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Kling Chong
- Department of Neuroradiology, Great Ormond Street Hospital, London, United Kingdom
| | - Ronit R Pressler
- Department of Neurophysiology, Great Ormond Street Hospital, London, United Kingdom
| | | | - Seetha Shankaran
- Division of Neonatal-Perinatal Medicine, Wayne State University, Detroit, Michigan
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Yetiş Ö, Ali S, Karia K, Bassett P, Wilson P. Enhanced monitoring of healthcare shower water in augmented and non-augmented care wards showing persistence of Pseudomonas aeruginosa despite remediation work. J Med Microbiol 2023; 72. [PMID: 37255404 DOI: 10.1099/jmm.0.001698] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
Introduction. Pseudomonas aeruginosa in healthcare shower waters presents a high risk of infection to immune-suppressed patients; identifying the colonization-status of water outlets is essential in preventing acquisition.Hypothesis/Gap Statement. Testing frequencies may be insufficient to capture presence/absence of contamination in healthcare waters between sampling and remediation activities. Standardization of outlets may facilitate the management and control of P. aeruginosa.Aim. This study aims to monitor shower waters and drains for P. aeruginosa in augmented and non-augmented healthcare settings every 2 weeks for a period of 7 months during remedial actions.Methodology. All shower facilities were standardized to include antimicrobial silver-impregnated showerhead/hose units, hose-length fixed to 0.8 m and replaced every 3 months. Standard hospital manual decontamination/disinfection occurred daily. Thermostatic-mixer-valves (TMVs) were replaced and disinfected if standard remediation unsuccessful.Results. Of 560 shower and drain samples collected over 14 time-points covering 7 months, P. aeruginosa colonized 40 %(4/10; non-augmented) and 80 %(8/10; augmented-care) showers in the first week. For each week elapsed, new outlets became contaminated with P. aeruginosa by 18-19 % (P<0.001) in shower waters (OR=1.19; CI=1.09-1.31) and drains (OR=1.18; CI=1.09-1.30). P. aeruginosa occurrence in shower water was associated with subsequent colonization of the corresponding drain and vice versa (chi-square; P<0.001) with simultaneous contamination present in 31 %(87/280) of areas. TMV replacement was ineffective in eradicating colonisation in ~83 % of a subset (6/20; three per ward) of contaminated showers.Conclusions. We demonstrate the difficulties in eradicating P. aeruginosa from hospital plumbing, particularly when contamination is no longer sporadic. Non-augmented care settings are reservoirs of P. aeruginosa and should not be overlooked in outbreak investigations. Antimicrobial-impregnated materials may be ineffective once colonization with P. aeruginosa is established beyond the hose and head. Reducing hose-length insufficient to prevent cross-contamination from shower drains. P. aeruginosa colonization can be transient in both drain and shower hose/head. Frequent microbiological monitoring suggests testing frequencies following HTM04-01 guidelines are insufficient to capture the colonization-status of healthcare waters between samples. Disinfection/decontamination is recommended to minimize bioburden and the effect of remediation should be verified with microbiological monitoring. Where standard remediation did not remove P. aeruginosa contamination, intensive monitoring supported justifying replacement of showers and contiguous plumbing.
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Affiliation(s)
- Özge Yetiş
- University College London, Division of Infection and Immunity, London, UK
| | - Shanom Ali
- University College London Hospitals, Clinical Microbiology, UCLH Environmental Research Laboratory, London, UK
| | - Kush Karia
- University College London Hospitals, Clinical Microbiology, UCLH Environmental Research Laboratory, London, UK
| | | | - Peter Wilson
- University College London Hospitals, Clinical Microbiology, London, UK
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Johnson S, Marshall A, Hughes D, Holmes E, Henrich F, Nurmikko T, Sharma M, Frank B, Bassett P, Marshall A, Magerl W, Goebel A. Correction: Mechanistically informed non-invasive peripheral nerve stimulation for peripheral neuropathic pain: a randomised double-blind sham-controlled trial. J Transl Med 2023; 21:289. [PMID: 37120561 PMCID: PMC10148541 DOI: 10.1186/s12967-023-04131-5] [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: 05/01/2023] Open
Affiliation(s)
- Selina Johnson
- The Pain Management Programme, Walton Centre NHS Foundation Trust, Lower Lane, Liverpool, L9 7LJ, UK.
- Pain Research Institute, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK.
| | - Anne Marshall
- Pain Research Institute, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Dyfrig Hughes
- Centre for Health Economics and Medicines Evaluation (CHEME) Department, Bangor University, Bangor, Wales, UK
| | - Emily Holmes
- Centre for Health Economics and Medicines Evaluation (CHEME) Department, Bangor University, Bangor, Wales, UK
| | - Florian Henrich
- Department of Neurophysiology, Mannheim Centre for Translational Neurosciences, Medical Faculty Mannheim, Ruprecht Karls-University Heidelberg, Heidelberg, Germany
| | - Turo Nurmikko
- The Pain Management Programme, Walton Centre NHS Foundation Trust, Lower Lane, Liverpool, L9 7LJ, UK
| | - Manohar Sharma
- The Pain Management Programme, Walton Centre NHS Foundation Trust, Lower Lane, Liverpool, L9 7LJ, UK
| | - Bernhard Frank
- The Pain Management Programme, Walton Centre NHS Foundation Trust, Lower Lane, Liverpool, L9 7LJ, UK
- Pain Research Institute, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | | | - Andrew Marshall
- The Pain Management Programme, Walton Centre NHS Foundation Trust, Lower Lane, Liverpool, L9 7LJ, UK
- Pain Research Institute, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Walter Magerl
- Department of Neurophysiology, Mannheim Centre for Translational Neurosciences, Medical Faculty Mannheim, Ruprecht Karls-University Heidelberg, Heidelberg, Germany
| | - Andreas Goebel
- The Pain Management Programme, Walton Centre NHS Foundation Trust, Lower Lane, Liverpool, L9 7LJ, UK
- Pain Research Institute, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
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Parulekar P, Powys-Lybbe J, Bassett P, Roques S, Snazelle M, Millen G, Harris T. Comparison of cardiac index measurements in intensive care patients using continuous wave vs. pulsed wave echo-Doppler compared to pulse contour cardiac output. Intensive Care Med Exp 2023; 11:23. [PMID: 37106217 PMCID: PMC10140233 DOI: 10.1186/s40635-023-00499-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 02/10/2023] [Indexed: 04/29/2023] Open
Abstract
PURPOSE Cardiac index (CI) assessments are commonly used in critical care to define shock aetiology and guide resuscitation. Echocardiographic assessment is non-invasive and has high levels of agreement with thermodilution assessment of CI. CI assessment is derived from the velocity time integral (VTI) assessed using pulsed wave (PW) doppler at the level of the left ventricular outflow tract divided by body mass index. Continuous wave (CW) doppler through the aortic valve offers an alternative means to assess VTI and may offer better assessment at high velocities. METHODS We performed a single centre, prospective, observational study in a 15-bed intensive care unit in a busy district general hospital. Patients had simultaneous measurements of cardiac index by Pulse Contour Cardiac Output (PiCCO) (thermodilution), transthoracic echocardiographic PW-VTI and CW-VTI. Mean differences were measured with Bland-Altman limits of agreement and percentage error (PE) calculations. RESULTS Data were collected on 52 patients. 71% were supported with noradrenaline with or without additional inotropic or vasopressor agents. Mean CIs were: CW-VTI 2.7 L/min/m2 (range 0.78-5.11, SD 0.92). PW-VTI 2.33 L/min/m2 (range 0.77-5.40, SD 0.90) and PiCCO 2.86 L/min/m2 (range 1.50-5.56, SD 0.93). CW-VTI and PiCCO mean difference was - 0.16 L/min/m2 PE 43.5%. PW-VTI and PiCCO had a mean difference of - 0.54 L/min/m2 PE 38.6%. CW-VTI and PW-VTI had a mean difference of 0.38 L/min/m2 PE 46.0%. CONCLUSIONS CI derived from both CW-VTI and PW-VTI methods underestimate CI compared to PiCCO, with the CW-VTI method having closer values overall to PiCCO. CW-VTI may offer a more accurate assessment of CI. If using Critchley's PE cutoff of 30%, none of the doppler methods may accurately reflect the actual cardiac index.
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Affiliation(s)
- Prashant Parulekar
- Intensive Care and Acute Medicine, East Kent Hospitals University NHS Foundation Trust, William Harvey Hospital, London, UK.
| | | | | | - Seb Roques
- East Kent Hospitals University NHS Foundation Trust, William Harvey, London, UK
| | - Mark Snazelle
- East Kent Hospitals University NHS Foundation Trust, William Harvey, London, UK
| | - Gemma Millen
- East Kent Hospitals University NHS Foundation Trust, William Harvey, London, UK
| | - Tim Harris
- East Kent Hospitals University NHS Foundation Trust, William Harvey, London, UK
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Dervin H, Bassett P, Sweis R. Esophagogastric junction contractile integral (EGJ-CI) complements reflux disease severity and provides insight into the pathophysiology of reflux disease. Neurogastroenterol Motil 2023:e14597. [PMID: 37094069 DOI: 10.1111/nmo.14597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 02/27/2023] [Accepted: 03/29/2023] [Indexed: 04/26/2023]
Abstract
BACKGROUND Esophagogastric junction contractile integral (EGJ-CI) has not come into routine use due to methodological discrepancies and its unclear clinical utility. We aimed to determine which method of calculating EGJ-CI was best at discriminating between common reflux disease states. METHODS High-resolution manometry (HRM) and pH-Impedance measurements were acquired for 100 patients; 25 Barrett's esophagus (>3 cm/acid exposure time (AET) > 6), 25 endoscopy-negative reflux disease (ENRD; AET >6), 25 borderline reflux (AET 4-6), 25 functional heartburn (FH; AET <4), constituting the developmental cohort. EGJ-CI was calculated at 20 mmHg, 2 mmHg, and 0 mmHg isobaric contour. Empirical associations, univariable, multivariable and ROC analyses were performed between EGJ-CI and manometric/pH-impedance metrics. A validation cohort (n = 25) was used to test the new EGJ-CI cutoff. KEY RESULTS Significant correlations with AET were observed when EGJ-CI was calculated with an isobaric threshold of 20 mmHg (p < 0.001). Significant differences in EGJ-CI were observed between patients with FH and Barrett's esophagus (p = 0.004) and with ENRD (p = 0.01); however, LES basal pressure was unable to differentiate between these disease states (p = 0.09, p = 0.25, respectively). ROC analysis on the developmental cohort found that EGJ-CI 21.2 mmHg.cm demonstrated sensitivity 72% and specificity 72% between patients with reflux (Barrett's esophagus/ENRD) and FH. In the validation cohort, 92.8% with a low EGJ-CI had good/moderate improvement in symptoms following therapy compared to 54.5% with raised EGJ-CI (p = 0.026). CONCLUSIONS AND INFERENCES This study re-affirms EGJ-CI as a reliable discriminator between reflux disease (Barrett's esophagus/ENRD) and FH. In borderline reflux patients, patients with a lower EGJ-CI score (<21.2 mmHg) appear to respond better to anti-reflux therapies compared to those with a higher value.
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Affiliation(s)
- Humayra Dervin
- GI Physiology Unit, University College London, London, UK
| | | | - Rami Sweis
- GI Physiology Unit, University College London, London, UK
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Dodd C, Hashem F, Stephensen D, Bassett P. Wearable activity trackers in young people with haemophilia: What needs to be considered? Haemophilia 2023; 29:942-945. [PMID: 37060543 DOI: 10.1111/hae.14790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/09/2023] [Accepted: 03/29/2023] [Indexed: 04/16/2023]
Affiliation(s)
- Charlene Dodd
- Haemophilia and Thrombosis Centre, East Kent Hospitals University NHS Foundation Trust, Canterbury, Kent, UK
| | - Ferhana Hashem
- Centre for Health Service Studies, University of Kent, Canterbury, Kent, UK
| | - David Stephensen
- Haemophilia and Thrombosis Centre, East Kent Hospitals University NHS Foundation Trust, Canterbury, Kent, UK
| | - Paul Bassett
- Stats Consultancy Ltd, Freelance Statistical Consultancy, Bucks, Amersham, UK
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Ahmad A, Marshall S, Bassett P, Thiruvilangam K, Dhillon A, Saunders BP. Evaluation of bowel preparation regimens for colonoscopy including a novel low volume regimen (Plenvu): CLEANSE study. BMJ Open Gastroenterol 2023; 10:bmjgast-2022-001070. [PMID: 36944438 PMCID: PMC10032399 DOI: 10.1136/bmjgast-2022-001070] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 02/09/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Poor bowel preparation is the leading cause of failed colonoscopies and increases costs significantly. Several, split preparation, 2 day regimens are available and recently, Plenvu, a low-volume preparation which can be given on 1 day has been introduced. AIMS Assess efficacy and tolerability of commonly used purgative regimens including Plenvu. METHOD In this service evaluation, patients undergoing screening colonoscopy at St Mark's Hospital, London (February 2020-December 2021) were provided Plenvu (1 or 2 days), Moviprep (2 days) or Senna & Citramag (2 days).Boston Bowel Preparation Scale (BBPS) score, fluid volumes and procedure times were recorded. A patient experience questionnaire evaluated taste, volume acceptability, completion and side effects. RESULTS 563 patients were invited to participate and 553 included: 218 Moviprep 2 days, 108 Senna & Citramag 2 days, 152 Plenvu 2 days and 75 Plenvu 1 day.BBPS scores were higher with Plenvu 1 and 2 days vs Senna & Citramag (p=0.003 and 0.002, respectively) and vs Moviprep (p=0.003 and 0.001, respectively). No other significant pairwise BBPS differences and no difference in preparation adequacy was seen between the groups.Patients rated taste as most pleasant with Senna & Citramag and this achieved significance versus Plenvu 1 day and 2 days (p=0.002 and p<0.001, respectively) and versus Moviprep (p=0.04). CONCLUSION BBPS score was higher for 1 day and 2 days Plenvu versus both Senna & Citramag and Moviprep. Taste was not highly rated for Plenvu but it appears to offer effective cleansing even when given as a same day preparation.
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Affiliation(s)
- Ahmir Ahmad
- Wolfson Unit for Endoscopy, St Mark's Hospital, London, UK
| | - Sarah Marshall
- Wolfson Unit for Endoscopy, St Mark's Hospital, London, UK
| | | | | | - Angad Dhillon
- Queen Elizabeth Hospital, Lewisham and Greenwich NHS Trust, London, UK
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Grodon C, Bassett P, Shannon H. The 'heROIC' trial: Does the use of a robotic rehabilitation trainer change quality of life, range of movement and function in children with cerebral palsy? Child Care Health Dev 2023. [PMID: 36788457 DOI: 10.1111/cch.13101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 01/25/2023] [Accepted: 02/05/2023] [Indexed: 02/16/2023]
Abstract
BACKGROUND Children with severe cerebral palsy (CP) (GMFCS IV/V) can find it difficult to access equipment that allows them to exercise effectively, potentially impacting their quality of life. Physiotherapists working within special schools are well placed to facilitate increased physical activity as part of the school day. This study explored whether the Innowalk Pro, a robotic rehabilitation trainer, could influence quality of life (measured by the CPCHILD questionnaire), in children with CP, alongside, joint range of movement, spasticity and functional goals of the lower limbs, measured by goniometry, modified Tardieu scale and goal attainment scoring, GAS, respectively. METHODS A prospective single-arm, pre-post trial was undertaken. The Innowalk Pro was used four times a week for 30 min alongside usual physiotherapy care in a school setting over a 6-week period. Outcomes were evaluated immediately pre/post intervention and at 6 weeks and 3 months post intervention. Analysis also explored differences between primary and secondary age participants. RESULTS Twenty-seven participants aged 5-18 years with a diagnosis of CP GMFCS IV/V (10 female, 17 male, mean age 12 years) were included from a convenience sample in a special school. Quality of life improved in 36% of participants, the majority of these being secondary aged. Knee extension reduced significantly 3 months post intervention. There were no meaningful changes in spasticity. GAS goals improved in 88% of participants after using the Innowalk Pro. GAS goals tended to decline after a break from using the equipment, with 21% declining by two or more units at 3 months post intervention. CONCLUSION A 6-week course of the Innowalk Pro can improve quality of life and functional goals for children with CP aged 5-18 years. After a break of 6-12 weeks, functional goals tend to return to baseline. Further research is needed to explore different prescriptions of the Innowalk Pro, to see if increasing the time used/increasing the frequency or number of weeks it is used for can provide longer lasting benefits.
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Affiliation(s)
| | | | - Harriet Shannon
- UCL Great Ormond Street Institute of Child Health, London, UK
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Cook GJ, Wong WL, Sanghera B, Mangar S, Challapalli A, Bahl A, Bassett P, Leaning D, Schmidkonz C. Eligibility for 177Lu-PSMA Therapy Depends on the Choice of Companion Diagnostic Tracer: A Comparison of 68Ga-PSMA-11 and 99mTc-MIP-1404 in Metastatic Castration-Resistant Prostate Cancer. J Nucl Med 2023; 64:227-231. [PMID: 36302657 PMCID: PMC9902859 DOI: 10.2967/jnumed.122.264296] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 08/11/2022] [Accepted: 08/11/2022] [Indexed: 02/04/2023] Open
Abstract
177Lu-prostate-specific membrane antigen-617 (177Lu-PSMA-617) is an effective therapy for metastatic castration-resistant prostate cancer (mCRPC), with evidence of improved survival over standard care. The VISION trial inclusion criteria required a metastatic lesion-to-liver ratio of greater than 1 on 68Ga-PSMA-11 PET scans. We aimed to determine whether an equivalent ratio is suitable for a SPECT tracer, 99mTc-MIP-1404, and to compare lesion and lesion-to-normal-organ ratios between the 2 radiotracers. Methods: Two cohorts of patients with mCRPC matched for age, prostate-specific antigen level, and total Gleason score, with either 99mTc-MIP-1404 SPECT/CT (n = 25) or 68Ga-PSMA-11 PET/CT (n = 25) scans, were included for analysis. Up to 3 lesions in each site (prostate/prostate bed, lymph nodes, bone and soft-tissue metastases) as well as normal liver, parotid gland, spleen, and mediastinal blood-pool SUVmax were measured. Results: 99mTc-MIP-1404 SPECT lesion SUVmax was not significantly different from 68Ga-PSMA-11 PET (median, 18.2 vs. 17.3; P = 0.93). However, 99mTc-MIP-1404 liver SUVmax was higher (median, 8.5 vs. 5.8; P = 0.002) and lesion-to-liver ratios were lower (median, 2.7 vs. 3.5; P = 0.009). There was no significant difference in parotid gland or splenic SUVmax or lesion-to-parotid gland ratios between the 2 tracers although there was a small difference in lesion-to-spleen ratios (P = 0.034). Conclusion: There are differences in biodistribution and, in particular, liver activity, between 68Ga-PSMA-11 and 99mTc-MIP-1404. Therefore, if 99mTc-MIP-1404 is used to assess eligibility for 177Lu-PSMA-617 therapy, a lower adjusted lesion-to-liver ratio should be used.
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Affiliation(s)
- Gary J.R. Cook
- Cancer Imaging Department, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Wai-Lup Wong
- Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, Northwood, United Kingdom
| | - Bal Sanghera
- Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, Northwood, United Kingdom
| | - Stephen Mangar
- Department of Oncology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Amarnath Challapalli
- Department of Clinical Oncology, Bristol Cancer Institute, Bristol, United Kingdom
| | - Amit Bahl
- Department of Clinical Oncology, Bristol Cancer Institute, Bristol, United Kingdom
| | | | - Darren Leaning
- Department of Clinical Oncology, James Cook University Hospital, South Tees NHS Trust, Middlesbrough, United Kingdom
| | - Christian Schmidkonz
- Department of Nuclear Medicine, University Hospital Erlangen, Erlangen, Germany; and,Department of Industrial Engineering and Health, Technical University of Applied Sciences Amberg-Weiden, Weiden, Germany
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Parente A, Thompson JP, Crook C, Bassett P, Aspinall S, Melvin R, Stechman MJ, Perry H, Balasubramanian SP, Pannu A, Palazzo FF, Van Den Heede K, Eatock F, Anderson H, Doran H, Wang K, Hubbard J, Aldrees A, Shore SL, Fung C, Waghorn A, Ayuk J, Bennett D, Sutcliffe RP. Risk factors for postoperative hypotension after adrenalectomy for phaeochromocytoma: derivation of the PACS risk score. Eur J Surg Oncol 2023; 49:497-504. [PMID: 36602554 DOI: 10.1016/j.ejso.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/06/2022] [Accepted: 10/12/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Due to the risk of postoperative hypotension (PH), invasive monitoring is recommended for patients who undergo adrenalectomy for phaeochromocytoma. Due to high costs and limited availability of intensive care, our aim was to identify patients at low risk of PH who may not require invasive monitoring. METHODS Data for patients who underwent adrenalectomy for phaeochromocytoma between 2012 and 2020 were retrospectively collected by nine UK centres, including patient demographics, intraoperative and postoperative haemodynamic parameters. Independent risk factors for PH were analysed and used to develop a clinical risk score. RESULTS PH developed in 118 of 430 (27.4%) patients. On univariable analysis, female sex (p = 0.007), tumour size (p < 0.001), preoperative catecholamine level (p < 0.001), open surgery (p < 0.001) and epidural analgesia (p = 0.006) were identified as risk factors for PH. On multivariable analysis, female sex (OR 1.85, CI95%, 1.09-3.13, p = 0.02), preoperative catecholamine level (OR: 3.11, CI95%, 1.74-5.55, p < 0.001), open surgery (OR: 3.31, CI95%, 1.57-6.97, p = 0.002) and preoperative mean arterial blood pressure (OR: 0.59, CI95%, 0.48-1.02, p = 0.08) were independently associated with PH, and were incorporated into a clinical risk score (AUROC 0.69, C-statistic 0.69). The risk of PH was 25% and 68% in low and high risk patients, respectively. CONCLUSION The derived risk score allows stratification of patients at risk of postoperative hypotension after adrenalectomy for phaeochromocytoma. Postoperatively, low risk patients may be managed on a surgical ward, whilst high risk patients should undergo invasive monitoring.
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Affiliation(s)
| | | | | | | | | | - Ross Melvin
- Department of General Surgery, Aberdeen Royal Infirmary, Aberdeen, UK
| | | | - Helen Perry
- Department of Endocrine Surgery, University Hospital Wales, Cardiff, UK
| | | | - Arslan Pannu
- Department of General Surgery, Sheffield Teaching Hospitals Foundation Trust, Sheffield, UK
| | - Fausto F Palazzo
- Department of Endocrine Surgery, Hammersmith Hospital, London, UK
| | | | - Fiona Eatock
- Department of Endocrine Surgery, Royal Victoria Hospital, Belfast, UK
| | - Hannah Anderson
- Department of Endocrine Surgery, Royal Victoria Hospital, Belfast, UK
| | - Helen Doran
- Department of Endocrine Surgery, Salford Royal Hospital, Salford, UK
| | - Kelvin Wang
- Department of Endocrine Surgery, Salford Royal Hospital, Salford, UK
| | | | | | - Susannah L Shore
- Department of Endocrine and Breast Surgery, Royal Liverpool and Broadgreen University Hospitals Trust, Liverpool, UK
| | - Clare Fung
- Department of Endocrine and Breast Surgery, Royal Liverpool and Broadgreen University Hospitals Trust, Liverpool, UK
| | - Alison Waghorn
- Department of Endocrine and Breast Surgery, Royal Liverpool and Broadgreen University Hospitals Trust, Liverpool, UK
| | - John Ayuk
- Department of Endocrinology, Queen Elizabeth Hospital, Birmingham, UK
| | - Davinia Bennett
- Department of Anaesthetics, Queen Elizabeth Hospital, Birmingham, UK
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Kennedy MK, Kennedy SA, Tan KT, de Perrot M, Bassett P, McInnis MC, Thenganatt J, Donahoe L, Granton J, Mafeld S. Balloon Pulmonary Angioplasty for Chronic Thromboembolic Pulmonary Hypertension: A Systematic Review and Meta-analysis. Cardiovasc Intervent Radiol 2023; 46:5-18. [PMID: 36474104 DOI: 10.1007/s00270-022-03323-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 11/16/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE To perform a systematic review and meta-analysis assessing the safety and efficacy of balloon pulmonary angioplasty (BPA) in the treatment of chronic thromboembolic pulmonary hypertension (CTEPH). MATERIALS AND METHODS Systematic literature searches were performed from inception to June 2022 to identify studies assessing BPA for CTEPH. Outcomes of interest included the following functional and hemodynamic measures: (a) six-minute walk distance (6MWD), (b) New York Heart Association (NYHA) status, (c) World Health Organization (WHO)-Functional Class status, (d) cardiac index (CI), (e) mean pulmonary artery pressure (mPAP), (f) mean right atrial pressure (mRAP), and (g) pulmonary vascular resistance (PVR). Subgroup analysis was also performed for BPA in post-pulmonary endarterectomy (PEA) patients. All reported BPA-related complications were also recorded. Forty unique studies with a total of 1763 patients were identified for meta-analysis. RESULTS All functional and hemodynamic parameters improved significantly following BPA; 6MWD increased 70 m (95% CI 58-82; P < 0.001), NYHA class improved by - 0.9 classes (95% CI - 1.0 to - 0.8; P < 0.001), WHO-FC class improved by - 1 classes ((95% CI - 1.2 to - 0.9; P < 0.001), CI increased 0.26 L/min/m2 (95% CI 0.17-0.35; P < 0.001), mPAP decreased - 13.2 mmHg (95% CI - 14.7 to - 11.8; P < 0.001), mRAP decreased - 2.2 mmHg (95% CI - 2.8 to - 1.6; P < 0.001), and PVR decreased - 311 dyne/cm/s-5 (95% CI - 350 to - 271; P < 0.001). Meta-analysis of patients who underwent BPA for persistent pulmonary hypertension post-PEA demonstrated significant improvements in 6MWD, WHO-FC, PVR and mPAP. Most common complications included lung injury (8.16%), hemoptysis (7.07%) and vessel injury (5.05%). CONCLUSION BPA represents a safe and effective treatment option for select individuals with CTEPH with significant improvements in hemodynamic parameters, improved exercise tolerance and a relatively low risk of major complications.
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Affiliation(s)
- Mary K Kennedy
- Department of Medical Imaging, University of Toronto, 200 Elizabeth St, Toronto, ON, M5G 2C4, Canada
| | - Sean A Kennedy
- Department of Medical Imaging, University of Toronto, 200 Elizabeth St, Toronto, ON, M5G 2C4, Canada.
| | - Kong Teng Tan
- Department of Medical Imaging, University of Toronto, 200 Elizabeth St, Toronto, ON, M5G 2C4, Canada
| | - Marc de Perrot
- Division of Thoracic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Paul Bassett
- Statsconsultancy Ltd, Amersham, Buckinghamshire, UK
| | - Michael C McInnis
- Department of Medical Imaging, University of Toronto, 200 Elizabeth St, Toronto, ON, M5G 2C4, Canada
| | - John Thenganatt
- Division of Respirology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - John Granton
- Division of Respirology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sebastian Mafeld
- Department of Medical Imaging, University of Toronto, 200 Elizabeth St, Toronto, ON, M5G 2C4, Canada
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Shaw KA, Bassett P, Ramo BA, McClung A, Thornberg D, Jamnik A, Jo CH, Johnston CE, McIntosh AL. The evolving stall rate of magnetically controlled growing rods beyond 2 years follow-up. Spine Deform 2023; 11:487-493. [PMID: 36447049 PMCID: PMC9708129 DOI: 10.1007/s43390-022-00622-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 11/17/2022] [Indexed: 12/05/2022]
Abstract
PURPOSE Magnetically controlled growing rods (MCGR) have become the dominant distraction-based implant for the treatment of early onset scoliosis (EOS). Recent studies, however, have demonstrated rising rates of implant failure beyond short-term follow-up. We sought to evaluate a single-center experience with MCGR for the treatment of EOS to define the rate of MCGR failure to lengthen, termed implant stall, over time. METHODS A single-center, retrospective review was conducted identifying children with EOS undergoing primary MCGR implantation. The primary endpoint was the occurrence of implant stalling, defined as a failure of the MCGR to lengthen on three consecutive attempted lengthening sessions with minimum of 2 years follow-up. Clinical and radiographic variables were collected and compared between lengthening and stalled MCGRs. A Kaplan-Meier survival analysis was conducted to assess implant stalling over time. RESULTS A total of 48 children met inclusion criteria (mean age 6.3 ± 1.8 years, 64.6% female). After a mean 56.9 months (range of 27 to 90 months) follow-up, 25 (48%) of children experienced implant stalling at a mean of 26.0 ± 14.1 months post-implantation. Kaplan-Meier survival analysis demonstrated that only 50% of MCGR continue to successfully lengthen at 2 years post-implantation, decreasing to < 20% at 4 years post-implantation. CONCLUSION Only 50% of MCGR continue to successfully lengthen 2 years post-implantation, dropping dramatically to < 20% at 4 years, adding to the available knowledge regarding the long-term viability and cost-effectiveness of MCGR in the management of EOS. Further research is needed to validate these findings.
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Affiliation(s)
- K Aaron Shaw
- Department of Pediatric Orthopaedic Surgery, Scottish Rite for Children Hospital, Dallas, TX, USA
| | - Paul Bassett
- Department of Pediatric Orthopaedic Surgery, Eastern Maine Medical Center, Bangor, ME, USA
| | - Brandon A Ramo
- Department of Pediatric Orthopaedic Surgery, Scottish Rite for Children Hospital, Dallas, TX, USA
| | - Anna McClung
- Department of Pediatric Orthopaedic Surgery, Scottish Rite for Children Hospital, Dallas, TX, USA
| | - David Thornberg
- Department of Pediatric Orthopaedic Surgery, Scottish Rite for Children Hospital, Dallas, TX, USA
| | - Adam Jamnik
- Department of Pediatric Orthopaedic Surgery, Scottish Rite for Children Hospital, Dallas, TX, USA
| | - Chan-Hee Jo
- Department of Pediatric Orthopaedic Surgery, Scottish Rite for Children Hospital, Dallas, TX, USA
| | - Charlie E Johnston
- Department of Pediatric Orthopaedic Surgery, Scottish Rite for Children Hospital, Dallas, TX, USA
| | - Amy L McIntosh
- Department of Pediatric Orthopaedic Surgery, Scottish Rite for Children Hospital, Dallas, TX, USA.
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Buldu MT, Wigley C, Kapoor S, Bassett P, Gerrand C. Do frailty scores predict outcome after proximal femoral replacement for musculoskeletal tumours: a case series? Eur J Orthop Surg Traumatol 2023; 33:151-158. [PMID: 34825990 DOI: 10.1007/s00590-021-03170-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 11/15/2021] [Indexed: 01/07/2023]
Abstract
PURPOSE Frailty has a negative independent relationship with morbidity and mortality. A frail individual has low resilience and adaptive capacity to stressors with unfavourable consequences. The relationship between musculoskeletal tumour patients undergoing surgery and frailty is underrepresented in literature. This study's questions are; what is the prevalence of frailty in patients undergoing surgery for musculoskeletal tumours; what is the correlation between frailty and survival plus secondary outcome measures including length of hospital stay (LOS); can clinicians use frailty scoring to support preoperative decision-making? METHODS Patients over 60 years of age undergoing proximal femoral replacement for musculoskeletal tumours were included and classified as fit, vulnerable or frail using the modified frailty index (mFI), Rockwood and American Society of Anaesthesiologist's physical status classification (ASA) grading systems. Correlation with outcomes including survival and (LOS) was determined. RESULTS 85 patients were identified of mean age 72.6 years. Median follow-up was 18.9 months. The prevalence of frailty ranged between 55 to 76% and the overall median survival in frail groups were 19.8 months with all scoring systems used. Frail patients classified by the Rockwood score had a greater LOS and a trend to reduced survival. CONCLUSIONS There is a high prevalence of frailty in this cohort and frailty scores should be considered when planning surgery as part of holistic care. Moreover, a median survival greater than 18 months in frail patients supports the decision to offer surgery which may positively impact quality of life. Further research to identify the relationship between frailty and outcomes in musculoskeletal tumour patients is needed. LEVEL OF EVIDENCE IV, Retrospective Case Series.
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Affiliation(s)
- Metin Tolga Buldu
- Sarcoma Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK.
| | - Catrin Wigley
- Sarcoma Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK
| | - Smriti Kapoor
- Sarcoma Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK
| | - Paul Bassett
- Statsconsultancy Ltd., 40 Longwood Lane, Amersham, Bucks, HP7 9EN, UK
| | - Craig Gerrand
- Sarcoma Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK
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Mallick R, Solomon G, Bassett P, Zhang X, Patel P, Lepeshkina O. Immunoglobulin replacement therapy in patients with immunodeficiencies: impact of infusion method on patient-reported outcomes. Allergy Asthma Clin Immunol 2022; 18:110. [PMID: 36566213 PMCID: PMC9789520 DOI: 10.1186/s13223-022-00746-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 11/26/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Understanding the impact of different immunoglobulin (Ig) infusion methods (intravenous [IVIg] and subcutaneous [SCIg]) upon treatment experience can potentially facilitate optimization of patient outcomes. Here, the perspective of patients with primary and secondary immunodeficiency diseases (PID and SID, respectively) receiving IVIg and SCIg was evaluated, in terms of treatment satisfaction, accounting for treatment history, using Association des Patients Immunodéficients du Québec (APIQ) survey data. METHODS The online APIQ survey (shared October 2020-March 2021) of patients with immunodeficiencies in Canada contained 101 questions on: Ig use, history, and detailed infusion characteristics; as well as structured patient-reported outcomes such as treatment satisfaction (via TSQM-9), symptom state (via PASS), general health perception (via GHP), and physical and mental function (via PROMIS). Adult respondents (≥ 18 years old) currently using Ig were compared by their current Ig infusion method (IVIg or SCIg cohort) overall, and in a sub-analysis, the IVIg cohort was compared with the SCIg cohort after stratification by respondents who started SCIg when naïve to Ig ('SCIg naïve') or with previous IVIg experience ('SCIg switch'). RESULTS In total, 54 respondents currently used IVIg and 242 used SCIg. The average duration per infusion of a weekly SCIg infusion was significantly shorter compared with the average duration of a 3-4 weekly IVIg infusion (p < 0.001). The SCIg cohort was associated with significantly higher scores for the TSQM-9 effectiveness domain compared with the IVIg cohort. The scores for TSQM-9 convenience and global satisfaction domains were similar in the two cohorts. The SCIg cohort was also associated with a significantly higher proportion of respondents who were in an acceptable symptom state and a lower proportion who reported very poor or poor perception of health compared with the IVIg cohort. Further, the SCIg naïve subgroup was associated with significantly higher TSQM-9 effectiveness and convenience domain scores compared with the IVIg cohort, while there was no significant difference between the SCIg switch subgroup and the IVIg cohort in terms of convenience. CONCLUSIONS A better understanding of how different IgRT administration methods impact treatment experience and satisfaction may assist with informed treatment decision making and ultimately further improvements in patient outcomes.
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Affiliation(s)
- Rajiv Mallick
- grid.428413.80000 0004 0524 3511CSL Behring, King of Prussia, PA USA
| | | | | | - Xiang Zhang
- grid.428413.80000 0004 0524 3511CSL Behring, King of Prussia, PA USA
| | - Palak Patel
- grid.428413.80000 0004 0524 3511Formerly of CSL Behring, King of Prussia, PA USA
| | - Oleksandra Lepeshkina
- grid.411065.70000 0001 0013 6651Centre Hospitalier de l’Université Laval, Québec, Canada
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Ahmad A, Wilson A, Haycock A, Humphries A, Monahan K, Suzuki N, Thomas-Gibson S, Vance M, Bassett P, Thiruvilangam K, Dhillon A, Saunders BP. Evaluation of a real-time computer-aided polyp detection system during screening colonoscopy: AI-DETECT study. Endoscopy 2022; 55:313-319. [PMID: 36509103 DOI: 10.1055/a-1966-0661] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Polyp detection and resection during colonoscopy significantly reduce long-term colorectal cancer risk. Computer-aided detection (CADe) may increase polyp identification but has undergone limited clinical evaluation. Our aim was to assess the effectiveness of CADe at colonoscopy within a bowel cancer screening program (BCSP). METHODS This prospective, randomized controlled trial involved all eight screening-accredited colonoscopists at an English National Health Service (NHS) BCSP center (February 2020 to December 2021). Patients were randomized to CADe or standard colonoscopy. Patients meeting NHS criteria for bowel cancer screening were included. The primary outcome of interest was polyp detection rate (PDR). RESULTS 658 patients were invited and 44 were excluded. A total of 614 patients were randomized to CADe (n = 308) or standard colonoscopy (n = 306); 35 cases were excluded from the per-protocol analysis due to poor bowel preparation (n = 10), an incomplete procedure (n = 24), or a data issue (n = 1). Endocuff Vision was frequently used and evenly distributed (71.7 % CADe and 69.2 % standard). On intention-to-treat (ITT) analysis, there was a borderline significant difference in PDR (85.7 % vs. 79.7 %; P = 0.05) but no significant difference in adenoma detection rate (ADR; 71.4 % vs. 65.0 %; P = 0.09) for CADe vs. standard groups, respectively. On per-protocol analysis, no significant difference was observed in these rates. There was no significant difference in procedure times. CONCLUSIONS In high-performing colonoscopists in a BCSP who routinely used Endocuff Vision, CADe improved PDR but not ADR. CADe appeared to have limited benefit in a BCSP setting where procedures are performed by experienced colonoscopists.
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Affiliation(s)
- Ahmir Ahmad
- Wolfson Unit for Endoscopy, St Mark's Hospital, London, United Kingdom
| | - Ana Wilson
- Wolfson Unit for Endoscopy, St Mark's Hospital, London, United Kingdom
| | - Adam Haycock
- Wolfson Unit for Endoscopy, St Mark's Hospital, London, United Kingdom
| | - Adam Humphries
- Wolfson Unit for Endoscopy, St Mark's Hospital, London, United Kingdom
| | - Kevin Monahan
- Wolfson Unit for Endoscopy, St Mark's Hospital, London, United Kingdom
| | - Noriko Suzuki
- Wolfson Unit for Endoscopy, St Mark's Hospital, London, United Kingdom
| | | | - Margaret Vance
- Wolfson Unit for Endoscopy, St Mark's Hospital, London, United Kingdom
| | | | | | - Angad Dhillon
- Queen Elizabeth Hospital, Lewisham and Greenwich NHS Trust, London, United Kingdom
| | - Brian P Saunders
- Wolfson Unit for Endoscopy, St Mark's Hospital, London, United Kingdom
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46
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Jidong DE, Ike JT, Husain N, Murshed M, Francis C, Mwankon BS, Jack BD, Jidong JE, Pwajok YJ, Nyam PP, Kiran T, Bassett P. Culturally adapted psychological intervention for treating maternal depression in British mothers of African and Caribbean origin: A randomized controlled feasibility trial. Clin Psychol Psychother 2022. [PMID: 36478339 DOI: 10.1002/cpp.2807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 10/09/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Women are likely to suffer from maternal depression due to childbirth difficulties and parenting responsibilities, leading to long-term negative consequences on their children and families. British mothers of African/Caribbean origin uptake of mental healthcare is low due to the lack of access to culturally appropriate care. METHODS A mixed-methods randomized controlled feasibility trial was adopted to test the appropriateness and acceptability of Learning Through Play plus Culturally adapted Cognitive Behaviour Therapy (LTP+CaCBT) for treating maternal depression compared with Psychoeducation (PE). Mothers (N = 26) aged 20-55 were screened for depression using the Patient Health Questionnaire (PHQ-9). Those who scored >5 on PHQ-9 were further interviewed using the Revised Clinical Interview Schedule to confirm the diagnosis and randomized into LTP+CaCBT (n = 13) or PE (n = 13) groups. Assessments were taken at baseline, end of the intervention at 3- and 6-months post-randomization. N = 2 focus groups (LTP+CaCBT, n = 12; PE, n = 7) and N = 8 individual interviews were conducted (LTP+CaCBT, n = 4; PE, n = 4). RESULTS The LTP+CaCBT group showed higher acceptability, feasibility and satisfaction levels than the PE group. Participants experienced the intervention as beneficial to their parenting skills with reduced depression and anxiety in the LTP+CaCBT compared to the PE group. CONCLUSIONS This is the first feasibility trial of an integrated online parenting intervention for British African and Caribbean mothers. The results indicated that culturally adapted LTP+CaCBT is acceptable and feasible. There is a need to study the clinical and cost-effectiveness of LTP+CaCBT in an appropriately powered randomized control trial and include the child's outcomes. TRIAL REGISTRATION www. CLINICALTRIALS gov (no. NCT04820920).
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Affiliation(s)
| | - Juliet Tarela Ike
- Department of Criminology and Sociology, Teesside University, Middlesbrough, UK
| | - Nusrat Husain
- Department of Psychiatry, University of Manchester, Manchester, UK
| | - Maisha Murshed
- Department of Psychology, Nottingham Trent University, Nottingham, UK
| | | | | | - B David Jack
- Research Unit, Dung Jidong Foundation (DJF), Jos, Nigeria
| | | | | | - P Pam Nyam
- Department of Psychology, Nottingham Trent University, Nottingham, UK
| | - Tayyaba Kiran
- Pakistan Institute of Living and Learning (PILL), Islamabad, Pakistan
| | - Paul Bassett
- Pakistan Institute of Living and Learning (PILL), Islamabad, Pakistan
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Batura D, Gandhi A, Bassett P. Thirty-day morbidity and mortality of elective urological surgery in patients aged 80 years and over in a UK district general hospital. Urologia 2022; 90:11-19. [PMID: 36420831 DOI: 10.1177/03915603221137946] [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: 11/25/2022]
Abstract
Purpose: An ageing population has led to many people aged 80 and over requiring urological surgery. There are concerns that operating on octogenarians may be fraught with higher morbidity and mortality risk. Therefore, the purpose was to study postoperative outcomes in people aged 80 years and over undergoing elective urological surgery. Materials and methods: We retrospectively reviewed the 30-day readmissions and deaths in patients aged 80 years and over who had elective urological surgery over a seven and half year period from February 2011 to July 2018 in a district general hospital. Surgeries were stratified into minor, intermediate and major. Our data did not include supra-major surgeries like radical cystectomy as these are done in tertiary centres. We used logistic regression to examine factors associated with readmissions and death. Results: A total of 1239 patients had 2201 operations. The median age was 84.1 years. Procedures on the bladder were the most common, followed by prostate surgery. A 17.9% of operations resulted in an adverse outcome (death or readmission attributable to surgery) within 30 days. There were 21 deaths, equating to 1% of all surgeries undertaken. There was a significant difference in both readmissions and deaths by American Society of Anaesthesiologists (ASA) grade. The median time to readmission from surgery was 18 (IQR 13–23) days. The highest number of readmissions occurred in the third week after surgery. A 94% of the readmissions were for a minor complication (grade I Clavien Dindo), with haematuria and urinary retention being most common. Conclusions: This study informs hospitals, surgeons, patient advocacy groups and insurance, that the morbidity and mortality risks of non-supra major elective urological surgery in patients aged 80 and over are not disproportionately high.
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Affiliation(s)
- Deepak Batura
- Department of Urology, London North West University Healthcare NHS Trust, London, UK
| | - Akash Gandhi
- Department of Urology, London North West University Healthcare NHS Trust, London, UK
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Barnicot K, Welsh M, Kalwarowsky S, Stevens E, Iles J, Parker J, Miele M, Lawn T, O'Hanlon L, Sundaresh S, Ajala O, Bassett P, Jones C, Ramchandani P, Crawford M. Video feedback parent-infant intervention for mothers experiencing enduring difficulties in managing emotions and relationships: A randomised controlled feasibility trial. Br J Clin Psychol 2022; 61:1188-1210. [PMID: 36018275 DOI: 10.1111/bjc.12388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 07/26/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVES Parents experiencing mental health difficulties consistent with "personality disorder", often related to a history of complex trauma, may face increased challenges in parent-child relationships and child socioemotional development. There are no published randomised controlled trials (RCTs) evaluating perinatal parent-child interventions for this population. We evaluated the feasibility and acceptability of undertaking an RCT of the video feedback intervention for positive parenting adapted for perinatal mental health (VIPP-PMH). DESIGN Feasibility study incorporating a pilot RCT. METHODS Mothers with enduring difficulties in managing emotions and relationships, consistent with a "personality disorder", and their 6- to 36-month old infants were randomly allocated to receive six sessions of VIPP-PMH (n = 20) or usual care alone (n = 14). RESULTS 76% of eligible mothers consented to participate. Intervention uptake and completion rates were 95% (≥1 VIPP-PMH session) and 70% (6 sessions), respectively. Follow-up rates were 85% at month 5 and 65% at month 8 post-baseline. Blinded observer-ratings of maternal sensitivity in parent-child interaction favoured the intervention group at month 5 (RR = 1.94, 95% CI 0.67-5.63) and month 8 (RR = 1.91, 95% CI 0.68-5.33). Small changes over time in self-rated parenting confidence and stress favoured the intervention group. There were no clear intervention effects on maternal non-intrusiveness or mental health, or on child behaviour problems, emotional functioning, or self-regulation. CONCLUSIONS An RCT of VIPP-PMH is feasible and acceptable to implement with mothers experiencing difficulties consistent with perinatal "personality disorder". A fully powered definitive RCT should be undertaken.
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Affiliation(s)
- Kirsten Barnicot
- Research and Development/Perinatal Mental Health Service, Central & North West London NHS Foundation Trust, London, UK.,Division of Psychiatry, Imperial College London, London, UK.,Centre for Mental Health Research, City University of London, London, UK
| | - Morgan Welsh
- Department of Psychology, University of Surrey, Guildford, UK
| | - Sarah Kalwarowsky
- Research and Development/Perinatal Mental Health Service, Central & North West London NHS Foundation Trust, London, UK
| | - Eloise Stevens
- Research and Development/Perinatal Mental Health Service, Central & North West London NHS Foundation Trust, London, UK.,Division of Psychiatry, Imperial College London, London, UK
| | - Jane Iles
- Department of Psychology, University of Surrey, Guildford, UK
| | - Jennie Parker
- Research and Development/Perinatal Mental Health Service, Central & North West London NHS Foundation Trust, London, UK
| | - Maddalena Miele
- Research and Development/Perinatal Mental Health Service, Central & North West London NHS Foundation Trust, London, UK
| | - Tara Lawn
- Perinatal Mental Health Service, East London NHS Foundation Trust, London, UK
| | - Laura O'Hanlon
- Perinatal Mental Health Service, East London NHS Foundation Trust, London, UK
| | - Sushma Sundaresh
- Perinatal Mental Health Service, Oxleas NHS Foundation Trust, London, UK
| | - Ola Ajala
- Perinatal Mental Health Service, Camden & Islington NHS Foundation Trust, London, UK
| | | | - Christina Jones
- Department of Psychology, University of Surrey, Guildford, UK
| | | | - Mike Crawford
- Division of Psychiatry, Imperial College London, London, UK
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Thurston L, Hunjan T, Mills E, Wall M, Ertl N, Phylactou M, Muzi B, Patel B, Alexander E, Suladze S, Modi M, Eng PC, Bassett P, Abbara A, Goldmeier D, Comninos A, Dhillo W. RF01 | PMON43 Melanocortin-4 Receptor Agonism Enhances Sexual Brain Processing in Women with Hypoactive Sexual Desire Disorder. J Endocr Soc 2022. [PMCID: PMC9625176 DOI: 10.1210/jendso/bvac150.1196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Hypoactive sexual desire disorder (HSDD) is characterized by a persistent deficiency of sexual fantasies and desire for sexual activity, causing marked distress or interpersonal difficulty. It is the most prevalent female sexual health problem worldwide, affecting approximately 1 in 10 women, but has limited treatment options despite its substantial health, social, and economic burden. Melanocortin-4 receptor (MC4R) agonists have emerged as a promising therapy for women with HSDD, although, to date, their mechanism of action is unknown. This study aims to use functional MRI to delineate the reproductive neuroendocrine pathways involved and elucidate how MC4R agonists treat HSDD in women. Methods We conducted a randomized, double-blinded, placebo-controlled, crossover clinical study, using psychometric, functional neuroimaging and hormonal analyses, to assess the effects of MC4R agonism on sexual brain processing in 31 premenopausal women with HSDD. Participants attended on two occasions, receiving either a subcutaneous injection of an MC4R agonist (Bremelanotide 1.75 mg), or placebo, at each study visit, thereby acting as their own controls. Results 31 randomized women were included (mean age 32 years, mean duration of HSDD 41 months). MC4R agonism significantly increased self-reported sexual desire for up to 24-hours post administration, compared to placebo (P=0.007). During functional neuroimaging, MC4R agonism enhanced cerebellar and supplementary motor area activity, as well as deactivating the secondary somatosensory cortex, specifically in response to visual erotic videos, compared to placebo (Z=2.3, P<0.05). In addition, MC4R agonism enhanced functional connectivity between the amygdala-insula and amygdala-thalamus during prolonged visual erotic stimuli, compared to placebo (P=0.025). MC4R agonism resulted in a mean increase in LH of 1.1 iU/L (F [1,58] = 13.38, P=0.0005), and FSH of 0.35 iU/L (F [1,60] = 10.97, P=0.0016) across the 300-minute duration of the study, with no effect observed on circulating estradiol or progesterone levels. Interpretation of results and conclusions:We demonstrate that MC4R agonism deactivates the secondary somatosensory cortex which can reduce the detrimental self-monitoring process often observed in HSDD, thereby increasing sexual desire. Furthermore, cerebellar and supplementary motor area activation by MC4R agonism are associated with increased sexual arousal and sexual motor imagery respectively. Finally, MC4R agonism enhanced functional connectivity between key limbic structures which can be disrupted in HSDD. In summary, these data identify the previously undescribed neural substrates and connections through which MC4R agonism modulates sexual brain processing to increase sexual desire. These findings provide mechanistic insight for the action of MC4R agonism in sexual behaviour and are relevant to ongoing therapeutic development for HSDD and for MC4R agonist development more widely. Trial registration: ClinicalTrials.gov identifier NCT04179734.Funding: Investigator-sponsored study funded by AMAG Pharmaceuticals Inc, MRC and NIHR. Presentation: Saturday, June 11, 2022 1:00 p.m. - 1:05 p.m., Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.
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Abstract
Background and Objectives: This retrospective study provides preliminary qualitative assessment of the adverse events (AEs), focusing on pelvic and abdominal AEs and patient outcomes reported for three hemostatic agents used in gynecologic surgery. Methods: Utilization rates for oxidized regenerated cellulose powder (ORC), polysaccharide powder (PSP), and fibrin sealant solution (FSS) were obtained from hospitals via the Premier Healthcare databases for all surgical procedures from January 1, 2018 to September 30, 2020. All reported cases were extracted from the Food and Drug Administration (FDA) Manufacturer and User Facility Device Experience (MAUDE) database for ORC and PSP and from the FDA Adverse Event Reporting System (FAERS) database for FSS. Distributions of AEs by anatomical site (MAUDE/FAERS) and surgical procedures by specialty (Premier) were evaluated for each product. Number of cases and number and types of AEs were compared to the total utilization for each product. Results: PSP was the most used product during the period analyzed (n = 126,509 uses), followed by FSS (n = 80,628 uses), and ORC (n = 41,583 uses). Distribution of surgical procedures by anatomical site varied significantly between hemostatic agents (p < 0.001). ORC was associated with more patient cases with AEs and numbers of reported AEs compared with PSP and FSS (p < 0.001). ORC was associated with higher number of infections than PSP (p < 0.001) and FSS (p < 0.001). Conclusion: These findings suggest that ORC use in abdominal and pelvic surgery may result in more postoperative complications compared with non-ORC hemostatic agents. Further prospective randomized studies are needed to compare efficacy and safety of these products.
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