1
|
Bevens W, Davenport R, Neate S, Yu M, Jelinek P, Jelinek GA, Reece J. Web-Based Health Information Seeking by People Living With Multiple Sclerosis: Qualitative Investigation of the Multiple Sclerosis Online Course. J Med Internet Res 2024; 26:e53372. [PMID: 38335016 PMCID: PMC10891496 DOI: 10.2196/53372] [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: 10/06/2023] [Revised: 01/04/2024] [Accepted: 01/12/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Digital technologies have afforded people living with multiple sclerosis (MS) access to telehealth consultations, diagnostic tools, and monitoring. Although health care professionals remain the most trusted source of information, the internet has emerged as a valuable resource for providing MS-related information, particularly during the COVID-19 pandemic. Notably, people living with MS are increasingly seeking educational content for a range of topics related to the self-management of MS; however, web-based information seeking remains largely underevaluated. To address this gap and ensure that web-based health-related information is accessible and engaging, this study used qualitative methods to analyze the reflections from participants of web-based educational programs for people living with MS. OBJECTIVE This study aimed to explore the motivations, behaviors, and expectations of web-based health information seeking for people living with MS. METHODS We conducted semistructured interviews for 38 people living with MS 1 month after they completed the novel MS Online Course, which provided information on modifiable lifestyle-related risk factors for people living with MS. Of the 38 participants, 22 (58%) completed the intervention course and 16 (42%) completed the standard care course. Inductive thematic analysis was used within a qualitative paradigm, and 2 authors coded each interview separately and arrived at themes with consensus. RESULTS We identified 2 themes: motivation to learn and MS information on the web. The diagnosis of MS was described as a pivotal moment for precipitating web-based information seeking. People living with MS sought lifestyle-related information to facilitate self-management and increase control of their MS. Although social media sites and MS websites were considered useful for providing both support and information, discretion was needed to critically appraise information. Recognizable institutions were frequently accessed because of their trustworthiness. CONCLUSIONS This study provided novel insights into the motivations of people living with MS for seeking web-based health information. Furthermore, their preferences for the content and format of the web-based information accessed and their experiences and reactions to this information were explored. These findings may guide educators, researchers, and clinicians involved in MS care to optimize the engagement and processing of web-based health information seeking by people living with MS.
Collapse
Affiliation(s)
- William Bevens
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Australia
- Institute for Clinical and Translational Science, University of California, Irvine, Irvine, CA, United States
| | - Rebekah Davenport
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Australia
| | - Sandra Neate
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Australia
| | - Maggie Yu
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Australia
| | - Pia Jelinek
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Australia
| | - George Alexander Jelinek
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Australia
| | - Jeanette Reece
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Australia
| |
Collapse
|
2
|
Reece JC, Yu M, Bevens W, Simpson-Yap S, Jelinek G, Jelinek P, Davenport R, Nag N, Gray K, Neate S. Study protocol for an online lifestyle modification education course for people living with multiple sclerosis: the multiple sclerosis online course (MSOC). BMC Neurol 2023; 23:249. [PMID: 37386385 DOI: 10.1186/s12883-023-03298-0] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 06/20/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND People living with multiple sclerosis (plwMS) seek access to information on evidence-based lifestyle-related risk factors associated with multiple sclerosis (MS). As the internet has made delivery of lifestyle information increasingly accessible and cost-effective, we designed the Multiple Sclerosis Online Course (MSOC) to deliver a multimodal lifestyle modification program for plwMS. Two MS online courses were developed: the intervention course based on lifestyle recommendations of the Overcoming Multiple Sclerosis (OMS) program and the standard-care course representing standard lifestyle recommendations from other MS websites. We examined for feasibility in a pilot randomised controlled trial (RCT), where satisfactory completion and accessibility were achieved across both study arms. From this success, a protocol for a larger RCT was developed to examine the effectiveness of MSOC in improving health-related quality of life (HRQoL) and other health outcomes in plwMS. METHODS/DESIGN This single-blinded RCT will recruit n = 1,054 plwMS. Participants in the intervention arm will receive access to a MSOC with seven modules providing evidence-based information on the OMS program. Participants in the control group will receive access to a MSOC of identical format, with seven modules providing general MS-related information and lifestyle recommendations sourced from popular MS websites, e.g. MS societies. Participants will complete questionnaires at baseline and at 6, 12, and 30 months after course completion. The primary endpoint is HRQoL, as measured by MSQOL-54 (both physical and mental health domains) at 12 months following course completion. Secondary outcomes are changes to depression, anxiety, fatigue, disability, and self-efficacy as measured by Hospital Anxiety and Depression Scale, Patient-Determined Disease Steps and University of Washington Self-Efficacy Scale, respectively, assessed at each timepoint. Further assessments will include quantitative post-course evaluation, adoption and maintenance of behaviour change from follow-up survey data, and qualitative analysis of participants' outcomes and reasons for course completion or non-completion. DISCUSSION This RCT aims to determine whether an online intervention course delivering evidence-based lifestyle modification recommendations based on the Overcoming Multiple Sclerosis program to plwMS is more effective at improving HRQoL, and other health outcomes post-intervention, compared with an online standard-care course. TRIAL REGISTRATION This trial was registered prospectively with the Australian New Zealand Clinical Trials Registry, www.anzctr.org.au , identifier ACTRN12621001605886. DATE OF REGISTRATION 25 November 2021.
Collapse
Affiliation(s)
- Jeanette C Reece
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population & Global Health, The University of Melbourne, Level 3, 207 Bouverie St Carlton, Melbourne, VIC, 3053, Australia
| | - Maggie Yu
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population & Global Health, The University of Melbourne, Level 3, 207 Bouverie St Carlton, Melbourne, VIC, 3053, Australia
| | - William Bevens
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population & Global Health, The University of Melbourne, Level 3, 207 Bouverie St Carlton, Melbourne, VIC, 3053, Australia
| | - Steve Simpson-Yap
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population & Global Health, The University of Melbourne, Level 3, 207 Bouverie St Carlton, Melbourne, VIC, 3053, Australia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - George Jelinek
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population & Global Health, The University of Melbourne, Level 3, 207 Bouverie St Carlton, Melbourne, VIC, 3053, Australia
| | - Pia Jelinek
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population & Global Health, The University of Melbourne, Level 3, 207 Bouverie St Carlton, Melbourne, VIC, 3053, Australia
| | - Rebekah Davenport
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | - Nupur Nag
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population & Global Health, The University of Melbourne, Level 3, 207 Bouverie St Carlton, Melbourne, VIC, 3053, Australia
| | - Kathleen Gray
- Centre for Digital Transformation of Health, The University of Melbourne, Melbourne, Australia
| | - Sandra Neate
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population & Global Health, The University of Melbourne, Level 3, 207 Bouverie St Carlton, Melbourne, VIC, 3053, Australia.
| |
Collapse
|
3
|
Wong J, Mellor J, Memon G, Baker H, Allu S, Amin F, Sukthankar A, Mather S, Davenport R. 1301 OUTCOMES FROM A PILOT PROJECT OFFERING FRAIL OLDER ADULTS LIVING WITH HIV A VIRTUAL MDT COMPREHENSIVE GERIATRIC ASSESSMENT. Age Ageing 2023. [DOI: 10.1093/ageing/afac322.101] [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: 01/18/2023] Open
Abstract
Abstract
Introduction
Advancements in HIV treatment has resulted in an ageing population in people living with HIV (PLWH). Increasing prevalence of frailty in older PLWH has been demonstrated, giving rise to multi-morbidities, polypharmacy and consequently, complex medical and social needs. Approximately 5650 people are living with HIV across Greater Manchester. With increasing patient complexity, a pathway was developed to help provide holistic care and improve quality of life for older adults living with HIV.
Methods
A pilot involving multi-disciplinary professionals from the hospital frailty, HIV and community teams was established. Patients were screened using the Clinical Frailty Scale and patients with a CFS ≥ 4 were referred for completion of a comprehensive geriatric assessment (CGA). Patients would then be discussed at the Frailty MDT meeting, where action plans were devised.
Results
47 patients were assessed between October 2020 to December 2021, with 30 eligible for review in the frailty clinic. Commonly reported issues were mobility n=26 (86.6%), pain n=23 (76.6%), low mood n= 14 (46.6%), memory issues n=3 (43.3%) and falls n=12 (40%). Following MDT recommendations, 8 (26.6%) referrals were completed for social care, 1 (3%) referral for safeguarding and 9 (30%) referrals for active case management community teams for co-ordination of care in the community. Deprescribing recommendations were suggested for 16 (53.3%) patients and new medicine recommendations made for 24 (80%) patients.
Conclusion
A collaborative MDT approach to managing older PLWH can facilitate formulation of action plans to address patients physical, psychological and social needs.
Collapse
Affiliation(s)
- J Wong
- Manchester University NHS Foundation Trust
| | - J Mellor
- Manchester University NHS Foundation Trust
| | - G Memon
- Manchester University NHS Foundation Trust
| | - H Baker
- Manchester University NHS Foundation Trust
| | - S Allu
- Manchester University NHS Foundation Trust
| | - F Amin
- Manchester University NHS Foundation Trust
| | | | - S Mather
- Manchester University NHS Foundation Trust
| | | |
Collapse
|
4
|
Marsden M, Perkins Z, Marsh W, Christian M, Lyon R, Davenport R, Tai N. 92 Evaluation of an Artificial Intelligence (AI) System to Augment Clinical Risk Prediction of Trauma Induced Coagulopathy: A Prospective Observational Study. Br J Surg 2022. [DOI: 10.1093/bjs/znac041.005] [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: 11/15/2022]
Abstract
Abstract
Introduction
The potential of AI systems to support pre-hospital clinical decision-making is significant. However, whilst such algorithms are increasingly available, far less attention has been paid to understanding the impact of such systems on clinical performance. This study had two aims; first, to compare the performance of expert clinicians against an AI system in a real-world clinical setting and second, to assess the impact of augmenting expert clinical prediction with an AI system.
Method
We performed a prospective study at two UK Air Ambulances services over a six-month period. Expert pre-hospital clinicians’ judgement of the risk of Trauma Induced Coagulopathy (TIC) in injured patients was assessed and compared to the performance of an AI system. Two TIC risk predictions were generated for every patient: an AI prediction and a human prediction.
Results
Overall, 51 expert clinicians were enrolled in the study providing 184 patient interactions for analysis.
Aim 1
The AI system performed better than clinicians; higher discrimination [AUROC 0.87 (0.79, 0.95) versus 0.83 (0.74, 0.92)] better calibration [0.37 (-0.14, 0.89) versus -1.19 (-1.73, -0.65)] and more accurate [Brier Skill Score 0.34 (0.19, 0.48) versus 0.00 (-0.41, 0.30)].
Aim 2
Risk prediction was better in all performance metrics when clinicians were assisted with the AI system [AUROC 0.88 (0.80, 0.95) versus 0.83 (0.74, 0.92)]
Conclusions
AI systems can improve human risk prediction in the pre-hospital setting. In settings of low resources where a lack of senior clinical expertise may affect outcomes, the benefit of implementing predictive AI is substantial.
Collapse
Affiliation(s)
- M. Marsden
- Centre for Trauma Sciences, Queen Mary University of London, London, United Kingdom
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - Z. Perkins
- Centre for Trauma Sciences, Queen Mary University of London, London, United Kingdom
| | - W. Marsh
- School of Electronical Engineering and Computer Sciences, Queen Mary University of London, London, United Kingdom
| | | | - R. Lyon
- Air Ambulance Kent Surrey Sussex, Redhill, United Kingdom
| | - R. Davenport
- Centre for Trauma Sciences, Queen Mary University of London, London, United Kingdom
| | - N. Tai
- Centre for Trauma Sciences, Queen Mary University of London, London, United Kingdom
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, United Kingdom
| |
Collapse
|
5
|
Curry N, Foley C, Wong H, Mora A, Curnow E, Zarankaite A, Hodge R, Hopkins V, Deary A, Ray J, Moss P, Reed MJ, Kellett S, Davenport R, Stanworth S. The application of a haemorrhage assessment tool in evaluating control of bleeding in a pilot trauma haemorrhage trial. Transfus Med 2019; 29:454-459. [PMID: 31680331 DOI: 10.1111/tme.12644] [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: 05/01/2019] [Revised: 08/22/2019] [Accepted: 10/06/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To determine whether it was feasible to use a haemorrhage assessment tool (HAT) within a trauma trial and whether the data obtained could differentiate patients who had achieved haemostasis. BACKGROUND Major haemorrhage is one of the leading causes of death worldwide, affecting 40% of trauma patients. Clinical trials evaluating haemostatic interventions often use transfusion outcomes as a primary endpoint. Transfusion is highly dependent on local practice, limiting its reliability as a robust, transferable endpoint. METHODS A five-point HAT questionnaire was applied to participants enrolled into the EFIT-1 trial. This RCT evaluated the feasibility of administering a 6 g fibrinogen concentrate to patients with severe trauma haemorrhage. RESULTS Of participants, 98% completed a HAT; 75% participants had 'achieved haemostasis' at the time of tool completion, as determined by clinical acumen alone. HAT scores were able to differentiate which participants required transfusion after 3 h. Of participants, 56% were transfused red blood cells when they scored 0-2, compared to 17% with HAT scores between 3 and 5. CONCLUSION This study has confirmed the feasibility of using a HAT during the emergency care of patients suffering trauma haemorrhage, and future studies should be conducted to determine its value as an endpoint in haemostasis studies.
Collapse
Affiliation(s)
- N Curry
- Department of Haematology, Oxford University Hospitals NHS Trust, Oxford, UK.,NIHR BRC Blood Theme, Oxford University, Oxford, UK
| | - C Foley
- NHS Blood and Transplant Clinical Trials Unit, NHS Blood and Transplant, Cambridge and Bristol, UK
| | - H Wong
- Department of Haematology, Oxford University Hospitals NHS Trust, Oxford, UK.,NIHR BRC Blood Theme, Oxford University, Oxford, UK.,NHS Blood and Transplant, John Radcliffe Hospital, Oxford, UK
| | - A Mora
- NHS Blood and Transplant Clinical Trials Unit, NHS Blood and Transplant, Cambridge and Bristol, UK
| | - E Curnow
- NHS Blood and Transplant Clinical Trials Unit, NHS Blood and Transplant, Cambridge and Bristol, UK
| | - A Zarankaite
- NHS Blood and Transplant Clinical Trials Unit, NHS Blood and Transplant, Cambridge and Bristol, UK
| | - R Hodge
- NHS Blood and Transplant Clinical Trials Unit, NHS Blood and Transplant, Cambridge and Bristol, UK
| | - V Hopkins
- NHS Blood and Transplant Clinical Trials Unit, NHS Blood and Transplant, Cambridge and Bristol, UK
| | - A Deary
- NHS Blood and Transplant Clinical Trials Unit, NHS Blood and Transplant, Cambridge and Bristol, UK
| | - J Ray
- Department of Emergency Medicine, John Radcliffe Hospital, Oxford, UK
| | - P Moss
- Department of Emergency Medicine, St. George's Hospital, London, UK
| | - M J Reed
- Emergency Medicine Research Group Edinburgh (EMERGE), Royal Infirmary of Edinburgh, Edinburgh, UK
| | - S Kellett
- Department of Anaesthetics, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - R Davenport
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK
| | - S Stanworth
- Department of Haematology, Oxford University Hospitals NHS Trust, Oxford, UK.,NIHR BRC Blood Theme, Oxford University, Oxford, UK.,NHS Blood and Transplant, John Radcliffe Hospital, Oxford, UK
| |
Collapse
|
6
|
Marsden M, Benger J, Brohi K, Curry N, Foley C, Green L, Lucas J, Rossetto A, Stanworth S, Thomas H, Davenport R. Coagulopathy, cryoprecipitate and CRYOSTAT-2: realising the potential of a nationwide trauma system for a national clinical trial. Br J Anaesth 2018; 122:164-169. [PMID: 30686301 DOI: 10.1016/j.bja.2018.10.055] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 10/06/2018] [Accepted: 10/27/2018] [Indexed: 01/10/2023] Open
Affiliation(s)
- M Marsden
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK; Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK; Barts Health NHS Trust, London, UK.
| | - J Benger
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - K Brohi
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK; Barts Health NHS Trust, London, UK
| | - N Curry
- Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK; Radcliffe Department of Medicine, University of Oxford, UK
| | - C Foley
- NHS Blood and Transplant, Clinical Trials Unit, Cambridge, UK
| | - L Green
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary, University of London, London, UK; Barts Health NHS Trust, London, UK
| | - J Lucas
- NHS Blood and Transplant, Clinical Trials Unit, Cambridge, UK
| | - A Rossetto
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK; Barts Health NHS Trust, London, UK
| | - S Stanworth
- Oxford NIHR BRC Haematology Theme, Oxford Centre for Haematology, University of Oxford, UK; NHS Blood and Transplant, Transfusion Medicine, Oxford, UK; Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK; Radcliffe Department of Medicine, University of Oxford, UK
| | - H Thomas
- NHS Blood and Transplant, Clinical Trials Unit, Bristol, UK; NHS Blood and Transplant, Transfusion Medicine, Oxford, UK
| | - R Davenport
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK; Barts Health NHS Trust, London, UK
| | | |
Collapse
|
7
|
Hann M, Alderton W, Davenport R, Williams P. Recent disclosures of clinical candidates: Highlights from the Society of Medicines Research Symposium. The National Heart and Lung Institute, London, U.K. - December 1, 2016. DRUG FUTURE 2017. [DOI: 10.1358/dof.2017.042.02.2592800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
8
|
Tarasev M, Chakraborty S, Light L, Davenport R. Impact of environment on Red Blood Cell ability to withstand mechanical stress. Clin Hemorheol Microcirc 2016; 64:21-33. [DOI: 10.3233/ch-152037] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- M. Tarasev
- Blaze Medical Devices, Ann Arbor, MI, USA
| | | | | | | |
Collapse
|
9
|
Maegele M, Inaba K, Rizoli S, Veigas P, Callum J, Davenport R, Fröhlich M, Hess J. [Early viscoelasticity-based coagulation therapy for severely injured bleeding patients: Report of the consensus group on the consensus conference 2014 for formulation of S2k guidelines]. Anaesthesist 2016; 64:778-94. [PMID: 26136120 DOI: 10.1007/s00101-015-0040-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Although there is increasing interest in the use of a viscoelastic test procedure (ROTEM/TEG) for diagnostics and therapy guidance of severely injured and bleeding patients, currently no uniformly accepted guidelines exist for how this technology should be integrated into clinical treatment. In September 2014 an international multidisciplinary group of opinion leaders in the field of trauma-induced coagulopathy and other disciplines involved in the treatment of severely injured patients were assembled for a 2-day consensus conference in Philadelphia (USA). This panel included trauma/accident surgeons, general/abdominal surgeons, vascular surgeons, emergency/intensive care surgeons, hematologists, transfusion specialists, anesthesiologists, laboratory physicians, pathobiologists/pathophysiologists and the lay public. A total of nine questions regarding the impact of viscoelastic testing in the early treatment of trauma patients were developed prior to the conference by a panel consensus. Early use was defined as baseline viscoelastic test result thresholds obtained within the first minutes of hospital arrival, when conventional laboratory results are not yet available. The available data for each question were then reviewed in person using standardized presentations by the expert panel. A consensus summary document was then developed and reviewed by the panel in an open forum. Finally, a 2-round Delphi poll was administered to the panel of experts regarding viscoelastic thresholds for triggering the initiation of specific treatments including fibrinogen (concentrates), platelet concentrates, blood plasma products and prothrombin complex concentrates (PCC). This report summarizes the findings and recommendations of this consensus conference, which correspond to a S2k guideline according to the system of the Association of the Scientific Medical Societies in Germany (AWMF) and taking formal consensus findings including Delphi methods into consideration.
Collapse
Affiliation(s)
- M Maegele
- Klinik für Orthopädie, Unfallchirurgie und Sporttraumatologie, Kliniken der Stadt Köln-Merheim, Institut für Forschung in der Operativen Medizin (IFOM), Private Universität Witten/Herdecke (UW/H), Ostmerheimerstr. 200, 51109, Köln, Deutschland.
| | - K Inaba
- Division of Trauma and Surgical Critical Care, University of Southern California, Los Angeles, California, USA
| | - S Rizoli
- Departments of Surgery & Critical Care Medicine, St. Michael's Hospital and University of Toronto, Toronto, Ontario, Kanada
| | - P Veigas
- Department of Surgery, Sunnybrook Health Sciences Center and Institute of Medical Science, University of Toronto, Toronto, Ontario, Kanada
| | - J Callum
- Department of Clinical Pathology, Sunnybrook Health Sciences Center Toronto, Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Kanada
| | - R Davenport
- Centre for Trauma Sciences, Blizard Institute, Bart's and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - M Fröhlich
- Klinik für Orthopädie, Unfallchirurgie und Sporttraumatologie, Kliniken der Stadt Köln-Merheim, Institut für Forschung in der Operativen Medizin (IFOM), Private Universität Witten/Herdecke (UW/H), Ostmerheimerstr. 200, 51109, Köln, Deutschland
| | - J Hess
- Department of Laboratory Medicine, School of Medicine, University of Washington, Seattle, WA, USA
| | | |
Collapse
|
10
|
Stanworth SJ, Davenport R, Curry N, Seeney F, Eaglestone S, Edwards A, Martin K, Allard S, Woodford M, Lecky FE, Brohi K. Mortality from trauma haemorrhage and opportunities for improvement in transfusion practice. Br J Surg 2016; 103:357-65. [DOI: 10.1002/bjs.10052] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 06/15/2015] [Accepted: 10/12/2015] [Indexed: 12/18/2022]
Abstract
Abstract
Background
The aim of this study was to describe the prevalence, patterns of blood use and outcomes of major haemorrhage in trauma.
Methods
This was a prospective observational study from 22 hospitals in the UK, including both major trauma centres and smaller trauma units. Eligible patients received at least 4 units of packed red blood cells (PRBCs) in the first 24 h of admission with activation of the massive haemorrhage protocol. Case notes, transfusion charts, blood bank records and copies of prescription/theatre charts were accessed and reviewed centrally. Study outcomes were: use of blood components, critical care during hospital stay, and mortality at 24 h, 30 days and 1 year. Data were used to estimate the national trauma haemorrhage incidence.
Results
A total of 442 patients were identified during a median enrolment interval of 20 (range 7–24) months. Based on this, the national incidence of trauma haemorrhage was estimated to be 83 per million. The median age of patients in the study cohort was 38 years and 73·8 per cent were men. The incidence of major haemorrhage increased markedly in patients aged over 65 years. Thirty-six deaths within 24 h of admission occurred within the first 3 h. At 24 h, 79 patients (17·9 per cent) had died, but mortality continued to rise even after discharge. Patients who received a cumulative ratio of fresh frozen plasma to PRBCs of at least 1 : 2 had lower rates of death than those who received a lower ratio. There were delays in administration of blood. Platelets and cryoprecipitate were either not given, or transfused well after initial resuscitation.
Conclusion
There is a high burden of trauma haemorrhage that affects all age groups. Research is required to understand the reasons for death after the first 24 h and barriers to timely transfusion support.
Collapse
Affiliation(s)
- S J Stanworth
- NHS Blood and Transplant/Oxford University Hospitals NHS Trust, John Radcliffe Hospital, and Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - R Davenport
- Centre for Trauma Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - N Curry
- Department of Haematology, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - F Seeney
- NHS Blood and Transplant, Statistics and Clinical Studies, Bristol, UK
| | - S Eaglestone
- Centre for Trauma Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - A Edwards
- Trauma Audit and Research, Academic Health Science Centre, Institute of Population Health, University of Manchester, Salford Royal Hospitals NHS Foundation Trust, Salford, UK
| | - K Martin
- NHS Blood and Transplant, Statistics and Clinical Studies, Bristol, UK
| | - S Allard
- University of Sheffield/University of Manchester/Salford Royal Hospitals NHS Foundation Trust, EMRiS Group, Health Services Research Section, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - M Woodford
- Trauma Audit and Research, Academic Health Science Centre, Institute of Population Health, University of Manchester, Salford Royal Hospitals NHS Foundation Trust, Salford, UK
| | - F E Lecky
- University of Sheffield/University of Manchester/Salford Royal Hospitals NHS Foundation Trust, EMRiS Group, Health Services Research Section, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - K Brohi
- Centre for Trauma Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| |
Collapse
|
11
|
Maegele M, Inaba K, Rizoli S, Veigas P, Callum J, Davenport R, Fröhlich M, Hess J. Frühe viskoelastizitätsbasierte Gerinnungstherapie bei blutenden Schwerverletzten. Notf Rett Med 2015. [DOI: 10.1007/s10049-015-0071-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
12
|
Curry N, Rourke C, Davenport R, Beer S, Pankhurst L, Deary A, Thomas H, Llewelyn C, Green L, Doughty H, Nordmann G, Brohi K, Stanworth S. Early cryoprecipitate for major haemorrhage in trauma: a randomised controlled feasibility trial. Br J Anaesth 2015; 115:76-83. [PMID: 25991760 DOI: 10.1093/bja/aev134] [Citation(s) in RCA: 110] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Low fibrinogen (Fg) concentrations in trauma haemorrhage are associated with poorer outcomes. Cryoprecipitate is the standard source for Fg administration in the UK and USA and is often given in the later stages of transfusion therapy. It is not known whether early cryoprecipitate therapy improves clinical outcomes. The primary aim of this feasibility study was to determine whether it was possible to administer cryoprecipitate, within 90 min of admission to hospital. Secondary aims were to evaluate laboratory measures of Fg and clinical outcomes including thrombotic events, organ failure, length of hospital stay and mortality. METHODS This was an unblinded RCT, conducted at two civilian UK major trauma centres of adult trauma patients (age ≥16 yrs), with active bleeding and requiring activation of the major haemorrhage protocol. Participants were randomised to standard major haemorrhage therapy (STANDARD) (n=22), or to standard haemorrhage therapy plus two early pools of cryoprecipitate (CRYO) (n=21). RESULTS 85% (95% CI: 69-100%) CRYO participants received cryoprecipitate within 90 min, median time 60 min (IQR: 57-76) compared with 108 min (67-147), CRYO and STANDARD arms respectively (P=0.002). Fg concentrations were higher in the CRYO arm and were maintained above 1.8 g litre(-1) at all time-points during active haemorrhage. All-cause mortality at 28 days was not significantly different (P=0.14). CONCLUSIONS Early Fg supplementation using cryoprecipitate is feasible in trauma patients. This study supports the need for a definitive RCT to determine the effect of early Fg supplementation on mortality and other clinical outcomes. TRIAL REGISTRY NUMBER ISRCTN55509212.
Collapse
Affiliation(s)
- N Curry
- Department of Haematology, Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Oxford, UK
| | - C Rourke
- Centre for Trauma Sciences, Barts and the London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - R Davenport
- Centre for Trauma Sciences, Barts and the London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - S Beer
- Department of Haematology, Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Oxford, UK
| | - L Pankhurst
- NHS Blood and Transplant Clinical Trials Unit, NHS Blood & Transplant, Cambridge and Bristol, UK
| | - A Deary
- NHS Blood and Transplant Clinical Trials Unit, NHS Blood & Transplant, Cambridge and Bristol, UK
| | - H Thomas
- NHS Blood and Transplant Clinical Trials Unit, NHS Blood & Transplant, Cambridge and Bristol, UK
| | - C Llewelyn
- NHS Blood and Transplant Clinical Trials Unit, NHS Blood & Transplant, Cambridge and Bristol, UK
| | - L Green
- Department of Haematology, Barts Health NHS Trust, London, UK
| | - H Doughty
- NHS Blood and Transplant, Birmingham, UK
| | - G Nordmann
- Plymouth Hospitals NHS Trust, Plymouth, UK The Academic Department of Military Anaesthesia and Critical Care, Royal Centre for Defence Medicine, Birmingham, UK
| | - K Brohi
- Centre for Trauma Sciences, Barts and the London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - S Stanworth
- Department of Haematology, Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Oxford, UK
| |
Collapse
|
13
|
Brown K, Davenport R, Ward S. Effective and emerging strategies for utilizing structure in drug discovery. Cambridge, UK - March 19, 2015. DRUG FUTURE 2015. [DOI: 10.1358/dof.2015.040.04.2314768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
14
|
Lumley R, Davenport R, Williams A. Most Scottish neurologists do not apply the 2010 McDonald criteria when diagnosing multiple sclerosis. J R Coll Physicians Edinb 2015; 45:23-6. [DOI: 10.4997/jrcpe.2015.106] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
15
|
Haddow JB, Adwan H, Clark SE, Tayeh S, Antonowicz SS, Jayia P, Chicken DW, Wiggins T, Davenport R, Kaptanis S, Fakhry M, Knowles CH, Elmetwally AS, Geddoa E, Nair MS, Naeem I, Adegbola S, Muirhead LJ. Use of the surgical Apgar score to guide postoperative care. Ann R Coll Surg Engl 2014; 96:352-8. [PMID: 24992418 PMCID: PMC4473931 DOI: 10.1308/003588414x13946184900840] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [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] [Accepted: 01/25/2014] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION The surgical Apgar score (SAS) can predict 30-day major complications or death after surgery. Studies have validated the score in different patient populations and suggest it should be used to objectively guide postoperative care. We aimed to see whether using the SAS in a decisive approach in a future randomised controlled trial (RCT) would be likely to demonstrate an effect on postoperative care and clinical outcome. METHODS A total of 143 adults undergoing general/vascular surgery in 9 National Health Service hospitals were recruited to a pilot single blinded RCT and the data for 139 of these were analysed. Participants were randomised to a control group with standard postoperative care or to an intervention group with care influenced (but not mandated) by the SAS (decisive approach). The notional primary outcome was 30-day major complications or death. RESULTS Incidence of major complications was similar in both groups (control: 20/69 [29%], intervention: 23/70 [33%], p=0.622). Immediate admissions to the critical care unit was higher in the intervention group, especially in the SAS 0-4 subgroup (4/6 vs 2/7) although this was not statistically significant (p=0.310). Validity was also confirmed in area under the curve (AUC) analysis (AUC: 0.77). CONCLUSIONS This pilot study found that a future RCT to investigate the effect of using the SAS in a decisive approach may demonstrate a difference in postoperative care. However, significant changes to the design are needed if differences in clinical outcome are to be achieved reliably. These would include a wider array of postoperative interventions implemented using a quality improvement approach in a stepped wedge cluster design with blinded collection of outcome data.
Collapse
Affiliation(s)
| | - H Adwan
- London Surgical Research Group
| | | | - S Tayeh
- London Surgical Research Group
| | | | - P Jayia
- London Surgical Research Group
| | | | | | | | | | | | | | | | | | - MS Nair
- London Surgical Research Group
| | - I Naeem
- London Surgical Research Group
| | | | | |
Collapse
|
16
|
Davenport R, Chillala J, Newbold S, Smith A, Morris S, Ward G. 58 * A SURVEY INTO TOILET FACILITIES ACCORDING TO NATIONAL AND LOCAL SAFETY STANDARDS IN A DISTRICT GENERAL HOSPITAL. Age Ageing 2014. [DOI: 10.1093/ageing/afu036.58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
17
|
Waddell B, Heath CA, Manji H, Smith C, Davenport R. Progressive cognitive decline and neuropathy in a sailor. Pract Neurol 2013; 14:110-8. [PMID: 24226093 DOI: 10.1136/practneurol-2013-000661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- B Waddell
- Department of Neurology, Ninewells Hospital, , Dundee, UK
| | | | | | | | | |
Collapse
|
18
|
Frith D, Lima-Baptista M, Davenport R, Rourke C, Manson J, De-Ath H, Khan S, Raza I, Brohi K. Thromboelastometry diagnosed Acute Traumatic Coagulopathy (ATC) identifies trauma patients with poor clinical outcomes better than Disseminated Intravascular Coagulation (DIC) scoring. Scand J Trauma Resusc Emerg Med 2013. [PMCID: PMC3665486 DOI: 10.1186/1757-7241-21-s1-s30] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- D Frith
- Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK
| | - M Lima-Baptista
- Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK
| | - R Davenport
- Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK
| | - C Rourke
- Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK
| | - J Manson
- Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK
| | - H De-Ath
- Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK
| | - S Khan
- Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK
| | - I Raza
- Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK
| | - K Brohi
- Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK
| |
Collapse
|
19
|
Raza I, Davenport R, Rourke C, Platton S, Manson J, Spoors C, Khan S, De'Ath HD, Allard S, Hart DP, Pasi KJ, Hunt BJ, Stanworth S, MacCallum PK, Brohi K. The incidence and magnitude of fibrinolytic activation in trauma patients. J Thromb Haemost 2013; 11:307-14. [PMID: 23176206 DOI: 10.1111/jth.12078] [Citation(s) in RCA: 340] [Impact Index Per Article: 30.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Trauma is a global disease, with over 2.5 million deaths annually from hemorrhage and coagulopathy. Overt hyperfibrinolysis is rare in trauma, and is associated with massive fatal injuries. Paradoxically, clinical trials suggest a much broader indication for antifibrinolytics. OBJECTIVE To determine the incidence and magnitude of fibrinolytic activation in trauma patients and its relationship to clot lysis as measured by thromboelastometry. METHODS A prospective cohort study of 303 consecutive trauma patients admitted between January 2007 and June 2009 was performed. Blood was drawn on arrival for thromboelastometry (TEM) and coagulation assays. Follow-up was until hospital discharge or death. TEM hyperfibrinolysis was defined as maximum clot lysis of > 15%. Fibrinolytic activation (FA) was determined according to plasmin-antiplasmin (PAP) complex and D-dimer levels. Data were collected on demographics, mechanism, severity of injury, and baseline vital signs. The primary outcome measure was 28-day mortality. The secondary outcome measures were 28-day ventilator-free days and 24-h transfusion requirement. RESULTS Only 5% of patients had severe fibrinolysis on TEM, but 57% of patients had evidence of 'moderate' fibrinolysis, with PAP complex levels elevated to over twice normal (> 1500 μg L(-1)) without lysis on TEM. TEM detected clot lysis only when PAP complex levels were increased to 30 times normal (P < 0.001) and antiplasmin levels were < 75% of normal. Patients with FA had increased 28-day mortality as compared with those with no FA (12% vs. 1%, P < 0.001), fewer ventilator-free days, and longer hospital stay. CONCLUSIONS FA occurs in the majority of trauma patients, and the magnitude of FA correlates with poor clinical outcome. This was not detected by conventional TEM, which is an insensitive measure of endogenous fibrinolytic activity.
Collapse
Affiliation(s)
- I Raza
- Centre for Trauma Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of, London, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Alavijeh M, Davenport R, Brown K, Ward S. Kinases: new horizons. Highlights from the Society of Medicines Research Symposium, held on October 3rd, 2013 - National Heart and Lung Institute, Kensington, London, UK. DRUG FUTURE 2013. [DOI: 10.1358/dof.2013.038.11.2072090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
21
|
Cole EM, West A, Davenport R, Naganathar S, Kanzara T, Carey M, Brohi K. Can residents be effective trauma team leaders in a major trauma centre? Injury 2013; 44:18-22. [PMID: 21999937 DOI: 10.1016/j.injury.2011.09.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [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] [Received: 07/27/2011] [Revised: 08/25/2011] [Accepted: 09/19/2011] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The overall objective of this study was to compare senior Emergency Department (ED) trainees (residents) with consultant trauma team leaders, assessing their influence on trauma team performance and patient outcomes. We aimed to identify the effect of seniority of leader on time-based performance measures and clinical outcomes. METHODS This retrospective study of prospectively collected data was conducted in an urban Major Trauma Centre which has a well-established trauma team. For the period covered by this study the trauma team was led by either an ED consultant or specialist registrar having completed a local trauma team leader development programme. Data from all adult trauma team activations for seriously injured trauma patients (ISS - Injury Severity Score >15) presenting between 1st January 2008 and 31st October 2009 were included. Performance measures included time to FAST, time to CT scan and time to haemorrhage control. Patient outcomes were mortality, critical care and hospital length of stay. RESULTS There were 579 patients seriously injured in the study period. Trainees led 126 (22%) of the trauma teams. Significant differences in times to diagnostics or haemorrhage control between trainees and consultants were only seen in patients presenting with shock. Compared with trainees, consultant team leaders were significantly more likely to achieve targets for diagnostic imaging (FAST <15 min: consultants 97% vs. 33% trainees, p<0.01; CT scan <60 min: 76% vs. 50%, p<0.01) and haemorrhage control (surgery or angiography <60 min: 82% vs. 54%, p<0.001). There was no significant difference in overall mortality between consultants and trainees (consultants 25% vs. trainees 27%, p 1.00). Critical care length of stay was also the same for both (consultants median 5 days vs. trainees median 5 days). CONCLUSIONS Consultant team leaders improve team performance, resulting in shorter times to diagnostic imaging, and faster transfer to haemorrhage control. The greatest benefit seems to be for bleeding patients. Clinical outcomes were similar for trainees and consultants in our major trauma centre.
Collapse
Affiliation(s)
- E M Cole
- Trauma Outcomes Core, Centre for Neuroscience and Trauma Science, Barts and the London School of Medicine & Dentistry, Queen Mary University of London, London, United Kingdom.
| | | | | | | | | | | | | |
Collapse
|
22
|
Rourke C, Curry N, Khan S, Taylor R, Raza I, Davenport R, Stanworth S, Brohi K. Fibrinogen levels during trauma hemorrhage, response to replacement therapy, and association with patient outcomes. J Thromb Haemost 2012; 10:1342-51. [PMID: 22519961 DOI: 10.1111/j.1538-7836.2012.04752.x] [Citation(s) in RCA: 370] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Low fibrinogen levels are known to occur in trauma. However, the extent of fibrinogen depletion during trauma hemorrhage, the response to replacement therapy and association with patient outcomes remain unclear. OBJECTIVES The study aims were to: characterize admission fibrinogen level and correlate it with factors associated with injury; describe the time course of fibrinogen depletion and response to replacement therapy; determine the correlation of fibrinogen level with rotational thromboelastography (ROTEM) parameters; evaluate the effect of fibrinogen supplementation ex vivo; and establish the association between fibrinogen level and clinical outcomes. METHODS This was a prospective cohort study of 517 patients. Blood samples were drawn on admission and after admistration of every 4 units of packed red blood cells. Fibrinogen levels were determined with the Clauss method, and global hemostatic competence was assessed with thromboelastometry. The effect of fibrinogen supplementation was assessed in a subgroup of coagulopathic patients. RESULTS Low admission fibrinogen level was independently associated with injury severity score (P < 0.01), shock (P < 0.001), and prehospital fluid volume (P < 0.001). Fibrinogen supplementation during transfusion maintained but did not augment fibrinogen levels. Administration of cryoprecipitate was associated with improved survival. ROTEM parameters correlated with fibrinogen level, and ex vivo fibrinogen administration reversed coagulopathic ROTEM parameters. Fibrinogen level was an independent predictor of mortality at 24 h and 28 days (P < 0.001). CONCLUSIONS Fibrinogen level is decreased in injured patients on admission and is associated with poor outcomes. ROTEM is a rapid means of assessing hypofibrinogenemia. Earlier administration of specific fibrinogen replacement may improve outcomes, and prospective controlled trials are urgently needed.
Collapse
Affiliation(s)
- C Rourke
- Trauma Sciences, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | | | | | | | | | | | | |
Collapse
|
23
|
Chana MS, Manson J, Davenport R, De'Ath HD, Spoors C, Raza I, Khan S, Coates A, Rourke C, Brohi K. Time course of lactate clearance in trauma and its relevance to outcomes. Scand J Trauma Resusc Emerg Med 2012; 20. [PMCID: PMC3311005 DOI: 10.1186/1757-7241-20-s1-o9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- MS Chana
- The Blizard Institute of Cell and Molecular Science, Barts and The London School of Medicine and Dentistry, UK
| | - J Manson
- The Blizard Institute of Cell and Molecular Science, Barts and The London School of Medicine and Dentistry, UK
| | - R Davenport
- The Blizard Institute of Cell and Molecular Science, Barts and The London School of Medicine and Dentistry, UK
| | - HD De'Ath
- The Blizard Institute of Cell and Molecular Science, Barts and The London School of Medicine and Dentistry, UK
| | - C Spoors
- The Blizard Institute of Cell and Molecular Science, Barts and The London School of Medicine and Dentistry, UK
| | - I Raza
- The Blizard Institute of Cell and Molecular Science, Barts and The London School of Medicine and Dentistry, UK
| | - S Khan
- The Blizard Institute of Cell and Molecular Science, Barts and The London School of Medicine and Dentistry, UK
| | - A Coates
- The Blizard Institute of Cell and Molecular Science, Barts and The London School of Medicine and Dentistry, UK
| | - C Rourke
- The Blizard Institute of Cell and Molecular Science, Barts and The London School of Medicine and Dentistry, UK
| | - K Brohi
- The Blizard Institute of Cell and Molecular Science, Barts and The London School of Medicine and Dentistry, UK
| |
Collapse
|
24
|
De'Ath HD, Rourke C, Davenport R, Manson J, Renfrew I, Uppal R, Davies LC, Brohi K. Clinical and biomarker profile of trauma-induced secondary cardiac injury. Br J Surg 2012; 99:789-97. [PMID: 22437496 DOI: 10.1002/bjs.8728] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2012] [Indexed: 11/06/2022]
Abstract
BACKGROUND Secondary cardiac injury has been demonstrated in critical illness and is associated with worse outcomes. The aim of this study was to establish the existence of trauma-induced secondary cardiac injury, and investigate its impact on outcomes in injured patients. METHODS Injured adult patients eligible for enrolment in the Activation of Coagulation and Inflammation in Trauma 2 study, and admitted to the intensive care unit between January 2008 and January 2010, were selected retrospectively for the study. Markers of cardiac injury (brain natriuretic peptide (BNP), heart-type fatty acid binding protein (H-FABP) and troponin I) were measured on admission, and after 24 and 72 h in blood samples from injured patients. Individual records were reviewed for adverse cardiac events and death. RESULTS During the study period, 135 patients were enrolled (106 male, 78·5 per cent) with a median age of 40 (range 16-89) years. Eighteen patients (13·3 per cent) had an adverse cardiac event during admission and these events were not associated with direct thoracic injury. The in-hospital mortality rate was higher among the adverse cardiac event cohort: 44 per cent (8 of 18) versus 17·1 per cent (20 of 117) (P = 0·008). Raised levels of H-FABP and BNP at 0, 24 and 72 h, and troponin I at 24 and 72 h, were associated with increased adverse cardiac events. BNP levels were higher in non-survivors on admission (median 550 versus 403 fmol/ml; P = 0·022), after 24 h (794 versus 567 fmol/ml; P = 0·033) and after 72 h (1043 versus 753 fmol/ml; P = 0·036), as were admission troponin I levels. CONCLUSION Clinical and cardiac biomarker characteristics support the existence of trauma-induced secondary cardiac injury, which is associated with death, and unrelated to direct thoracic injury.
Collapse
Affiliation(s)
- H D De'Ath
- Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK.
| | | | | | | | | | | | | | | |
Collapse
|
25
|
Davenport R, Karran E, MacDonald G, Ward S. Alzheimer's disease therapeutics - Are we winning or losing? Highlights from the Society for Medicines Research Symposium, held on March 16, 2012, Brussels, Belgium. DRUG FUTURE 2012. [DOI: 10.1358/dof.2012.037.05.1799818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
26
|
Newton N, Davenport R, Tai NRM. Extremity compartment syndrome with Sickle Cell Trait. J ROY ARMY MED CORPS 2011; 157:418. [PMID: 22319994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
|
27
|
Davenport R, Armour R, Ward S. Trends in pain research: The Society for Medicines Research Pain Meeting. March 24, 2011, Girton College, Cambridge, UK. DRUG FUTURE 2011. [DOI: 10.1358/dof.2011.036.12.1738058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
28
|
Konig T, Davenport R, Sapsford W, Walsh M, Brohi K, Tai N. Emergent Thoracotomy for Blunt Trauma-Is the Outcome so Bad? Int J Surg 2010. [DOI: 10.1016/j.ijsu.2010.07.270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
29
|
Alderton W, Davenport R, Fish P. Regenerative medicine: A new frontier for therapeutic intervention. Highlights from the Society for Medicines Research Symposium. DRUG FUTURE 2010. [DOI: 10.1358/dof.2010.035.06.1508037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
30
|
|
31
|
Heath CA, Smith C, Davenport R, Donnan GA. Progressive cognitive decline and myoclonus in a young woman: clinicopathological conference at the Edinburgh Advanced Neurology Course, 2007. Variant CJD. Subacute sclerosing panencephalitis. Pract Neurol 2008; 8:296-302. [PMID: 18796584 DOI: 10.1136/jnnp.2008.156844] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
32
|
Davenport R. Shaky older men (and now women). Pract Neurol 2006. [DOI: 10.1136/jnnp.2006.101295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
33
|
Radlinski A, Kennard J, Edwards D, Hinde A, Davenport R. HYDROCARBON GENERATION AND EXPULSION FROM EARLY CRETACEOUS SOURCE ROCKS IN THE BROWSE BASIN, NORTH WEST SHELF, AUSTRALIA: A SMALL ANGLE NEUTRON SCATTERING STUDY. ACTA ACUST UNITED AC 2004. [DOI: 10.1071/aj03005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Small Angle Neutron Scattering (SANS) analyses were carried out on 165 potential source rocks of Late Jurassic–Early Cretaceous age from nine wells in the Browse Basin (Adele–1, Argus–1, Brecknock South–1, Brewster–1A, Carbine–1, Crux–1, Dinichthys–1, Gorgonichthys–1 and Titanichthys–1). Samples from Brewster–1A and Dinichthys–1 were also analysed using the Ultra Small Angle Neutron Scattering (USANS) technique.The SANS/USANS data detect the presence of generated bitumen and mobile hydrocarbons in pores and are pore-size specific. As the pore-size range in mudstones extends from about 0.001–30 μm, the presence of bitumen in the small pores detected by SANS indicates the depth of onset of hydrocarbon generation, whereas the presence of bitumen and mobile hydrocarbons in the largest pores detected by USANS indicates a significant saturation and the onset of expulsion.Although geochemical data imply the existence of a potential gas and oil source rock in the Lower Cretaceous section (Echuca Shoals and Jamieson Formations), the SANS/USANS data indicate significant generation but little or no expulsion. This source limitation may explain poor exploration success for liquid hydrocarbons in the area. The SANS/USANS data provide evidence of intra- and inter-formational hydrocarbon migration or kerogen kinetics barriers. There is no evidence of an oil charge to the Berriasian Brewster Sandstone from the Echuca Shoals Formation, although some gas charge in Brewster–1A is possible. This novel microstructural technique can be used to independently calibrate and refine source rock generation/expulsion scenarios derived from geochemistry modelling.
Collapse
|
34
|
Dunn BM, Scarborough PE, Davenport R, Swietnicki W. Analysis of proteinase specificity by studies of peptide substrates. The use of UV and fluorescence spectroscopy to quantitate rates of enzymatic cleavage. Methods Mol Biol 2003; 36:225-43. [PMID: 7697110 DOI: 10.1385/0-89603-274-4:225] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- B M Dunn
- Department of Biochemistry and Molecular Biology, College of Medicine, University of Florida, Gainesville
| | | | | | | |
Collapse
|
35
|
Reddy P, Davenport R, Ratanatharathorn V, Reynolds C, Silver S, Ayash L, Ferrara JLM, Uberti JP. West Nile virus encephalitis causing fatal CNS toxicity after hematopoietic stem cell transplantation. Bone Marrow Transplant 2003; 33:109-12. [PMID: 14566328 DOI: 10.1038/sj.bmt.1704293] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We describe here a patient who died of progressive CNS deterioration following allogeneic stem cell transplant with West Nile virus as the sole pathogen on the cerebrospinal fluid and brain tissue analysis. A 50-year-old male with Philadelphia chromosome-positive acute lymphocytic leukemia (ALL) underwent allogeneic PBSCT from his HLA identical sister. After engraftment, the patient developed fever with progressive and ultimately fatal neurological deterioration. Imaging studies of the brain including CT and MRI scans were remarkable for mild low attenuation lesions of the white matter. CSF analysis was negative for neoplastic cells, bacteria, AFB, CMV, HSV, fungal infections and leukemic relapse. However, serological analysis of both the serum and CSF was positive for West Nile virus-specific IgM antibodies. At autopsy, West Nile virus PCR and cultures were positive in the mid-brain tissue. Electron micrographs showed evidence of viral particles. Given the recent increase in the spread of West Nile virus infections and the increased susceptibility of BMT patients to infectious complications, West Nile virus encephalitis should be considered in patients undergoing transplantation.
Collapse
Affiliation(s)
- P Reddy
- Blood and Marrow Transplantation Program, Department of Internal Medicine, Ann Arbor, MI 48109, USA
| | | | | | | | | | | | | | | |
Collapse
|
36
|
Abstract
Congenital lumbar hernias are rare and associated with other malformations. There have been 42 cases reported to date. The authors report the first case in the literature of isolated bilateral congenital lumbar hernias.
Collapse
Affiliation(s)
- S Karmani
- Department of Paediatric Surgery, King's College School of Medicine and Dentistry, Denmark Hill, Camberwell, London, England
| | | | | |
Collapse
|
37
|
Abstract
Reciprocal interordinal crosses were made between the sea urchins Strongylocentrotus purpuratus and Lytechinus pictus. Previous research indicated that the expression of many L. pictus genes is reduced in the hybrid embryos. The S. purpuratus gene encoding the spicule matrix protein SM50 and the L. pictus gene encoding its orthologue LSM34 were both expressed at normal levels per gene copy in hybrid embryos, and in about 32 skeletogenic primary mesenchyme cells (PMCs) in hybrid and natural gastrulae. In many embryos of all crosses, 16 PMCs initially ingressed, while 32-64 PMCs were present in gastrulae. The skeletal spicules of most hybrid plutei were predominantly like those of S. purpuratus, consistent with the predominance of expression of S. purpuratus genes in hybrid embryos. The spicules of some hybrid plutei showed features characteristic of L. pictus, such as recurrent rods, branched body rod tips, or convergent ventral transverse rods; a few hybrid spicules were predominantly like those of L. pictus. Based on our observations and the literature, we propose the following. Cues from the ectodermal epithelium position the PMCs as they elaborate the initial triradiate spicules. Their orientation and outgrowth appears to be responsible for the convergence of the tips of body rods in most S. purpuratus and hybrid embryos, unlike in most L. pictus embryos. Variations among hybrid and natural embryos in skeletal branching pattern reflect differences in interpretation by PMCs of patterning cues produced by the ectodermal epithelium that probably have similar spatial distributions in the two species.
Collapse
Affiliation(s)
- B P Brandhorst
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC, Canada.
| | | |
Collapse
|
38
|
Marth G, Yeh R, Minton M, Donaldson R, Li Q, Duan S, Davenport R, Miller RD, Kwok PY. Single-nucleotide polymorphisms in the public domain: how useful are they? Nat Genet 2001; 27:371-2. [PMID: 11279516 DOI: 10.1038/86864] [Citation(s) in RCA: 111] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
There is a concerted effort by a number of public and private groups to identify a large set of human single-nucleotide polymorphisms (SNPs). As of March 2001, 2.84 million SNPs have been deposited in the public database, dbSNP, at the National Center for Biotechnology Information (http://www.ncbi.nlm.nih.gov/SNP/). The 2.84 million SNPs can be grouped into 1.65 million non-redundant SNPs. As part of the International SNP Map Working Group, we recently published a high-density SNP map of the human genome consisting of 1.42 million SNPs (ref. 3). In addition, numerous SNPs are maintained in proprietary databases. Our survey of more than 1,200 SNPs indicates that more than 80% of TSC and Washington University candidate SNPs are polymorphic and that approximately 50% of the candidate SNPs from these two sources are common SNPs (with minor allele frequency of > or =20%) in any given population.
Collapse
Affiliation(s)
- G Marth
- National Center for Biotechnology Information, Bethesda, Maryland, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Sachidanandam R, Weissman D, Schmidt SC, Kakol JM, Stein LD, Marth G, Sherry S, Mullikin JC, Mortimore BJ, Willey DL, Hunt SE, Cole CG, Coggill PC, Rice CM, Ning Z, Rogers J, Bentley DR, Kwok PY, Mardis ER, Yeh RT, Schultz B, Cook L, Davenport R, Dante M, Fulton L, Hillier L, Waterston RH, McPherson JD, Gilman B, Schaffner S, Van Etten WJ, Reich D, Higgins J, Daly MJ, Blumenstiel B, Baldwin J, Stange-Thomann N, Zody MC, Linton L, Lander ES, Altshuler D. A map of human genome sequence variation containing 1.42 million single nucleotide polymorphisms. Nature 2001; 409:928-33. [PMID: 11237013 DOI: 10.1038/35057149] [Citation(s) in RCA: 1862] [Impact Index Per Article: 81.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
We describe a map of 1.42 million single nucleotide polymorphisms (SNPs) distributed throughout the human genome, providing an average density on available sequence of one SNP every 1.9 kilobases. These SNPs were primarily discovered by two projects: The SNP Consortium and the analysis of clone overlaps by the International Human Genome Sequencing Consortium. The map integrates all publicly available SNPs with described genes and other genomic features. We estimate that 60,000 SNPs fall within exon (coding and untranslated regions), and 85% of exons are within 5 kb of the nearest SNP. Nucleotide diversity varies greatly across the genome, in a manner broadly consistent with a standard population genetic model of human history. This high-density SNP map provides a public resource for defining haplotype variation across the genome, and should help to identify biomedically important genes for diagnosis and therapy.
Collapse
|
40
|
Kumar JV, Green EL, Coluccio C, Davenport R. Oral health status of second grade school children in upstate New York. N Y State Dent J 2001; 67:26-31. [PMID: 11280142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
This report summarizes the results of a survey of second grade children conducted in upstate New York. The survey was designed to monitor progress toward achieving Healthy People 2000 objectives and Maternal and Child Health Services Block Grant performance measures. Data on oral health status, use of preventive measures and insurance coverage were collected on 2,474 children from 76 schools. In addition to obtaining population estimates, disparities in oral health between poor and nonpoor children were assessed. The results showed that approximately 52% of second grade children had dental caries, and 35% had untreated disease. Approximately 43% received fluoridated water, and 44% of children living in non-fluoridated areas used fluoride supplements on a regular basis. Only 25% of the children had dental sealants. The percentage of children covered by comprehensive and basic insurance plans was approximately 19% and 41%, respectively. Many of the national oral health objectives were not met primarily because of the higher rate of disease among the poor and their lower use of preventive services. These findings regarding oral health status and use of preventive services are similar to the national data.
Collapse
Affiliation(s)
- J V Kumar
- School of Public Health, University at Albany, USA
| | | | | | | |
Collapse
|
41
|
|
42
|
Lanuza MA, Li MX, Jia M, Kim S, Davenport R, Dunlap V, Nelson PG. Protein kinase C-mediated changes in synaptic efficacy at the neuromuscular junction in vitro: the role of postsynaptic acetylcholine receptors. J Neurosci Res 2000; 61:616-25. [PMID: 10972958 DOI: 10.1002/1097-4547(20000915)61:6<616::aid-jnr5>3.0.co;2-n] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Activation of a mouse in vitro neuromuscular synapse produces a reduction in synaptic efficacy which is greater for nonactivated than for activated inputs to the myotubes. This has been shown to require thrombin and thrombin receptor activation and to involve a protein kinase C (PKC)-mediated step. We show in the present work that phorbol ester activation of PKC produces physiological loss of synapses in a time- and dose-related manner. We observe, using quantitative imaging methods, a parallel loss of acetylcholine receptors (AChR) from synaptically functional neurite-associated receptor aggregates in nerve-muscle cocultures. Biochemical measurements of total AChR show that PKC activation reduces both AChR stability (increases receptor loss) and receptor insertion into the surface membrane. Taken together, the data suggest that PKC activation decreases the stability of AChR aggregates in the muscle surface membrane. We conclude that PKC plays a crucial role in activity-dependent synapse reduction and does so, at least in part, by altering AChR stability.
Collapse
Affiliation(s)
- M A Lanuza
- Unitat díHistologia i Neurobiologia, Facultat Medicina i Ciencies de la Salut, Universitat Rovira i Virgili, Reus, Spain
| | | | | | | | | | | | | |
Collapse
|
43
|
Abstract
Stroke causes a vast amount of death and disability throughout the world, yet for many healthcare professionals it remains an area of therapeutic nihilism, and thus uninteresting. This negative perception is shared by the general public, who often have a poor understanding of the early symptoms and significance of a stroke. Yet within the past few years there have been many important developments in the approach to caring for stroke patients, for both the acute management and secondary prevention. After the completion of numerous clinical trials, there is now robust evidence to either support or discredit various interventions. Even more exciting is the prospect of yet more data becoming available in the near future, testing a whole array of treatments, as clinical interest in stroke expands exponentially. In this review an evidence based approach to the management of acute stroke within the first few days is presented, including ischaemic and haemorrhagic events, but not subarachnoid haemorrhage. It is explained why stroke is regarded as a medical emergency, and the importance of a rational, methodic approach to the initial assessment, which is the key to accurate diagnosis and subsequent management, is emphasised. The potential early problems associated with stroke are identified and specific interventions for different stroke types are discussed. The review ends with a brief discussion of the implications that the evolving treatments have for the organisation of modern stroke services.
Collapse
Affiliation(s)
- R Davenport
- Department of Clinical Neurosciences, Western General Hospital, Crewe Road, Edinburgh EH4 2XU, UK.
| | | |
Collapse
|
44
|
Khan SQ, Wardlaw JM, Davenport R, Slattery J, Lewis S. Use of a neonatal blood pressure cuff to monitor blood pressure in the adult finger--comparison with a standard adult arm cuff. J Clin Monit Comput 1998; 14:233-8. [PMID: 9754611 DOI: 10.1023/a:1009934032524] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND There are few suitable methods for monitoring blood pressure continuously (or intermittently) for research in adult stroke patients, who are ill but do not justify invasive intensive care monitoring. METHOD We tested a neonatal arm blood pressure in adults by placing it on the forefinger ("finger cuff"). We compared the repeatability of the finger cuff with blood pressure measured by a standard adult arm cuff using the oscillometric technique in 168 ambulatory outpatients attending a cerebrovascular disease clinic. RESULTS The mean difference between sequential mean blood pressure readings with the finger cuff was 0.55 mm Hg (95% confidence interval (CI) -14.36 to 15.47 mm Hg), and for the arm cuff was 3.31 mm Hg (95% CI -23.33 to 16.71 mm Hg). Measurements made with the arm cuff were shown to affect subsequent arm cuff readings made within a few minutes of the first. The mean difference between the finger cuff and arm cuff mean blood pressure readings was 0.03 mm Hg (95% CI -26.07 to 26.14 mm Hg) and agreement was better when the blood pressure was measured with the finger cuff first rather than the arm cuff. However, although there was no difference in the mean blood pressure recordings both systolic and diastolic blood pressure measurements differed systematically between arm and finger cuff. CONCLUSION The reproducibility of sequential blood pressure measurements made with the finger cuff was better than with the arm cuff. The performance of the finger cuff compared with that of the arm cuff was sufficiently good to encourage use of the finger cuff in research involving automatic intermittent monitoring to observe sequential blood pressures over time in stroke patients. However, measurements of systolic and diastolic pressure were not the same with the two cuffs and further work on calibration of the finger cuff would be useful.
Collapse
Affiliation(s)
- S Q Khan
- Department of Clinical Neurosciences, Western General Hospital, Edinburgh, UK
| | | | | | | | | |
Collapse
|
45
|
Chen BH, Nie JY, Singh M, Davenport R, Pike VW, Kirk KL. Fluorinated dihydroxyphenylserines as potential biological precursors of fluorinated norepinephrines. Adv Pharmacol 1997; 42:862-5. [PMID: 9328034 DOI: 10.1016/s1054-3589(08)60883-2] [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] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- B H Chen
- Laboratory of Bioorganic Chemistry, NIDDK, National Institutes of Health, Bethesda, Maryland 20892, USA
| | | | | | | | | | | |
Collapse
|
46
|
Geiger TL, Perrotta PL, Davenport R, Baril L, Snyder EL. Removal of anaphylatoxins C3a and C5a and chemokines interleukin 8 and RANTES by polyester white cell-reduction and plasma filters. Transfusion 1997; 37:1156-62. [PMID: 9426639 DOI: 10.1046/j.1537-2995.1997.37111298088045.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND A few bedside polyester white cell (WBC)-reduction filters have been shown to scavenge C3a anaphylatoxin from stored blood components. One has been shown to remove the chemokines interleukin (IL)-8 and RANTES, but not the proinflammatory cytokines IL-1, IL-6, and tumor necrosis factor alpha. Removal by any filter of the anaphylatoxin C5a or the soluble membrane attack complex (SC5b-9) has not been studied. Further, the ability of other filters to scavenge these biologic response modifiers (BRM) is not known. Four WBC-reduction filters and one plasma filter were studied for their ability to remove IL-8, RANTES, IL-1 beta, C3a, C5a, and SC5b-9. STUDY DESIGN AND METHODS Plasma was obtained either as freshly thawed fresh-frozen plasma, fresh-frozen plasma thawed and stored for 5 days, or platelet-poor supernatant. Cell-poor plasma was obtained and samples were taken before and after filtration through the various filters Levels of IL-1 beta, IL-8, RANTES, C3a, and SC5b9 were quantitated by enzyme immunoassay. To evaluate filter scavenging of C5a, an in vitro model was developed to generate high levels of C5a in plasma by activating plasma with zymosan. RESULTS Levels of C3a, C5a, IL-8, and RANTES were reduced by filtration through two bedside platelet WBC-reduction filters, a plasma filter, and a prestorage red cell WBC-reduction filter, but not following filtration through a prestorage platelet WBC-reduction filter. For some BRMs and filters, however, evidence of filter saturation was seen. IL-1 beta was not removed by any of the filters tested. CONCLUSION Some, but not all, bedside polyester filters and prestorage polyester filters can remove IL-8, RANTES, C3a, and C5a from units of plasma or platelets. Improved biomaterial engineering of these and other filters could maximize scavenging of BRMs and potentially diminish the adverse reactions associated with their infusion during transfusion.
Collapse
Affiliation(s)
- T L Geiger
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | | | | | | | | |
Collapse
|
47
|
|
48
|
Abstract
BACKGROUND Biologic response modifiers infused with stored platelet concentrates (PCs) are believed to contribute to symptoms seen during transfusion reactions. Although prestorage white cell reduction is known to decrease the production of some biologic response modifiers during storage, the possibility that poststorage (bedside) white cell reduction could reduce the amount of biologic response modifiers already present in stored PCs during bedside filtration has not been well studied. STUDY DESIGN AND METHODS Individual PCs were pooled on storage Days 2 and 5 and passed through a third-generation white cell-reduction filter. The results from a series of in vitro PC assays were studied, before and immediately after filtration, as were levels of C3a and interleukin 8 (n = 5). Levels of other biologic response modifiers-C5a, interleukin 1 beta, interleukin 6, tumor necrosis factor alpha, and RANTES-were also studied. Removal of interleukin 8 and RANTES was studied further by using serial filtration of units of PC. RESULTS For the in vitro platelet assays studied, pH was unchanged after filtration from prefiltration values in units of PCs pooled on storage Day 2 or 5. A 4 log10 reduction in white cells was reliably seen after filtration in Day 2 and 5 pooled PCs. Postfiltration platelet loss was 14.8 percent for Day 2 pooled PCs and 9.6 percent for Day 5 pooled PCs. For pools of both Day 2 and Day 5 platelets, postfiltration levels of CD62 (P-selectin, CD62P) were unchanged from prefiltration levels, as were results for morphology scores. Levels of C3a decreased after filtration in both the Day 2 pooled PCs (448 ng/mL before filtration vs. 20 ng/mL after filtration) and the Day 5 pooled PCs (1976 ng/mL before filtration vs. 124 ng/mL after filtration). Levels of interleukin 8 were similarly reduced after filtration in the Day 2 pooled platelets (188 pg/mL before filtration vs. 27 pg/mL after filtration) and the Day 5 pooled platelets (2234 pg/mL before filtration vs. 799 pg/mL after filtration). Levels of interleukin 8 in other components evaluated after filtration declined similarly. However, levels of the proinflammatory cytokines interleukin 1 beta and interleukin 6 did not decline after filtration. Serial filtration studies showed that, although levels of interleukin 8 and RANTES were initially lowered by filtration, they returned to prefiltration values with increases in the volume of filtration. CONCLUSION The third-generation bedside filter used in this study reliably reduced the level of white cell contamination to 4 log10 white cells per PC. It also lowered the levels of interleukin 8, RANTES, and C3a. The filter did not, however, remove (scavenge) the proinflammatory cytokines interleukin 1 beta and 6. The mechanism of chemokine and C3a removal by the filter is unknown, but it may be related to ionic interactions between these biologic response modifiers and the filter medium.
Collapse
Affiliation(s)
- E L Snyder
- Department of Laboratory Medicine, Yale University School of Medicine, Yale-New Haven Hospital, CT, USA
| | | | | | | |
Collapse
|
49
|
Abstract
OBJECTIVE The health-related quality of life of patients with obsessive-compulsive disorder was compared to published norms for the general U.S. population and for patients with either depressive disorders or diabetes. METHOD Sixty medication-free outpatients with moderate to severe obsessive-compulsive disorder were evaluated by using the Structured Clinical Interview for DSM-III-R and the Yale-Brown Obsessive Compulsive Scale. Health-related quality of life was measured with the self-rated Medical Outcomes Study 36-Item Short-Form Health Survey. RESULTS The instrumental role performance and social functioning of the patients with obsessive-compulsive disorder were worse than those of the general population and of diabetes patients. The more severe the obsessive-compulsive disorder, the lower were the patients' social functioning scores, even after depression ratings were controlled for; scores on instrumental role performance did not correlate with severity of obsessive-compulsive disorder. The ratings of the obsessive-compulsive disorder patients on physical health domains resembled those of the general population and exceeded those of the diabetes patients. The general health and physical health ratings of the obsessive-compulsive disorder patients exceeded those of the depressed patients. In mental health domains, after adjustment for differences in gender distribution, quality of life ratings were similar for the patients with obsessive-compulsive disorder and those with depressive disorders. CONCLUSIONS Moderate to severe obsessive-compulsive disorder is associated with impaired social functioning and impaired instrumental role performance, but only impairment in social functioning is linearly related to severity of obsessive-compulsive disorder.
Collapse
Affiliation(s)
- L M Koran
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, CA, USA
| | | | | |
Collapse
|
50
|
Davenport R. Cytokines and erythrocyte incompatibility. Curr Opin Hematol 1994; 1:452-6. [PMID: 9371322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The strong resemblance between the clinical manifestations of hemolytic transfusion reactions and sepsis, in which cytokine production has a central role, suggests that similar pathophysiologic mechanisms are involved. There is an expanding body of clinical and experimental evidence that cytokines, especially interleukin-1, tumor necrosis factor, interleukin-6, and interleukin-8, are principle mediators of immune responses to erythrocyte incompatibility. Recent studies have further suggested that the monocyte chemotactic and activating factor, monocyte chemoattractant protein-1, and the anti-inflammatory cytokine interleukin-1 receptor antagonist are produced in experimental models of hemolytic transfusion reactions. Differing levels and patterns of expression of these cytokines may be seen in models of intravascular hemolysis due to ABO incompatibility and extravascular hemolysis due to Rh incompatibility, which correlate with the recognized clinical differences between these two types of reactions. Furthermore, recent studies have demonstrated that several of these same cytokines are produced during the storage of platelet concentrates, which may account for some febrile reactions that are not prevented by the use of leukocyte reduction filters.
Collapse
Affiliation(s)
- R Davenport
- University of Michigan Medical School, Ann Arbor, USA
| |
Collapse
|