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Roaldsen MB, Eltoft A, Wilsgaard T, Christensen H, Engelter ST, Indredavik B, Jatužis D, Karelis G, Kõrv J, Lundström E, Petersson J, Putaala J, Søyland MH, Tveiten A, Bivard A, Johnsen SH, Mazya MV, Werring DJ, Wu TY, De Marchis GM, Robinson TG, Mathiesen EB, Valente M, Chen A, Sharobeam A, Edwards L, Blair C, Christensen L, Ægidius K, Pihl T, Fassel-Larsen C, Wassvik L, Folke M, Rosenbaum S, Gharehbagh SS, Hansen A, Preisler N, Antsov K, Mallene S, Lill M, Herodes M, Vibo R, Rakitin A, Saarinen J, Tiainen M, Tumpula O, Noppari T, Raty S, Sibolt G, Nieminen J, Niederhauser J, Haritoncenko I, Puustinen J, Haula TM, Sipilä J, Viesulaite B, Taroza S, Rastenyte D, Matijosaitis V, Vilionskis A, Masiliunas R, Ekkert A, Chmeliauskas P, Lukosaitis V, Reichenbach A, Moss TT, Nilsen HY, Hammer-Berntzen R, Nordby LM, Weiby TA, Nordengen K, Ihle-Hansen H, Stankiewiecz M, Grotle O, Nes M, Thiemann K, Særvold IM, Fraas M, Størdahl S, Horn JW, Hildrum H, Myrstad C, Tobro H, Tunvold JA, Jacobsen O, Aamodt N, Baisa H, Malmberg VN, Rohweder G, Ellekjær H, Ildstad F, Egstad E, Helleberg BH, Berg HH, Jørgensen J, Tronvik E, Shirzadi M, Solhoff R, Van Lessen R, Vatne A, Forselv K, Frøyshov H, Fjeldstad MS, Tangen L, Matapour S, Kindberg K, Johannessen C, Rist M, Mathisen I, Nyrnes T, Haavik A, Toverud G, Aakvik K, Larsson M, Ytrehus K, Ingebrigtsen S, Stokmo T, Helander C, Larsen IC, Solberg TO, Seljeseth YM, Maini S, Bersås I, Mathé J, Rooth E, Laska AC, Rudberg AS, Esbjörnsson M, Andler F, Ericsson A, Wickberg O, Karlsson JE, Redfors P, Jood K, Buchwald F, Mansson K, Gråhamn O, Sjölin K, Lindvall E, Cidh Å, Tolf A, Fasth O, Hedström B, Fladt J, Dittrich TD, Kriemler L, Hannon N, Amis E, Finlay S, Mitchell-Douglas J, McGee J, Davies R, Johnson V, Nair A, Robinson M, Greig J, Halse O, Wilding P, Mashate S, Chatterjee K, Martin M, Leason S, Roberts J, Dutta D, Ward D, Rayessa R, Clarkson E, Teo J, Ho C, Conway S, Aissa M, Papavasileiou V, Fry S, Waugh D, Britton J, Hassan A, Manning L, Khan S, Asaipillai A, Fornolles C, Tate ML, Chenna S, Anjum T, Karunatilake D, Foot J, VanPelt L, Shetty A, Wilkes G, Buck A, Jackson B, Fleming L, Carpenter M, Jackson L, Needle A, Zahoor T, Duraisami T, Northcott K, Kubie J, Bowring A, Keenan S, Mackle D, England T, Rushton B, Hedstrom A, Amlani S, Evans R, Muddegowda G, Remegoso A, Ferdinand P, Varquez R, Davis M, Elkin E, Seal R, Fawcett M, Gradwell C, Travers C, Atkinson B, Woodward S, Giraldo L, Byers J, Cheripelli B, Lee S, Marigold R, Smith S, Zhang L, Ghatala R, Sim CH, Ghani U, Yates K, Obarey S, Willmot M, Ahlquist K, Bates M, Rashed K, Board S, Andsberg G, Sundayi S, Garside M, Macleod MJ, Manoj A, Hopper O, Cederin B, Toomsoo T, Gross-Paju K, Tapiola T, Kestutis J, Amthor KF, Heermann B, Ottesen V, Melum TA, Kurz M, Parsons M, Valente M, Chen A, Sharobeam A, Edwards L, Blair C. Safety and efficacy of tenecteplase in patients with wake-up stroke assessed by non-contrast CT (TWIST): a multicentre, open-label, randomised controlled trial. Lancet Neurol 2023; 22:117-126. [PMID: 36549308 DOI: 10.1016/s1474-4422(22)00484-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/18/2022] [Accepted: 11/21/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Current evidence supports the use of intravenous thrombolysis with alteplase in patients with wake-up stroke selected with MRI or perfusion imaging and is recommended in clinical guidelines. However, access to advanced imaging techniques is often scarce. We aimed to determine whether thrombolytic treatment with intravenous tenecteplase given within 4·5 h of awakening improves functional outcome in patients with ischaemic wake-up stroke selected using non-contrast CT. METHODS TWIST was an investigator-initiated, multicentre, open-label, randomised controlled trial with blinded endpoint assessment, conducted at 77 hospitals in ten countries. We included patients aged 18 years or older with acute ischaemic stroke symptoms upon awakening, limb weakness, a National Institutes of Health Stroke Scale (NIHSS) score of 3 or higher or aphasia, a non-contrast CT examination of the head, and the ability to receive tenecteplase within 4·5 h of awakening. Patients were randomly assigned (1:1) to either a single intravenous bolus of tenecteplase 0·25 mg per kg of bodyweight (maximum 25 mg) or control (no thrombolysis) using a central, web-based, computer-generated randomisation schedule. Trained research personnel, who conducted telephone interviews at 90 days (follow-up), were masked to treatment allocation. Clinical assessments were performed on day 1 (at baseline) and day 7 of hospital admission (or at discharge, whichever occurred first). The primary outcome was functional outcome assessed by the modified Rankin Scale (mRS) at 90 days and analysed using ordinal logistic regression in the intention-to-treat population. This trial is registered with EudraCT (2014-000096-80), ClinicalTrials.gov (NCT03181360), and ISRCTN (10601890). FINDINGS From June 12, 2017, to Sept 30, 2021, 578 of the required 600 patients were enrolled (288 randomly assigned to the tenecteplase group and 290 to the control group [intention-to-treat population]). The median age of participants was 73·7 years (IQR 65·9-81·1). 332 (57%) of 578 participants were male and 246 (43%) were female. Treatment with tenecteplase was not associated with better functional outcome, according to mRS score at 90 days (adjusted OR 1·18, 95% CI 0·88-1·58; p=0·27). Mortality at 90 days did not significantly differ between treatment groups (28 [10%] patients in the tenecteplase group and 23 [8%] in the control group; adjusted HR 1·29, 95% CI 0·74-2·26; p=0·37). Symptomatic intracranial haemorrhage occurred in six (2%) patients in the tenecteplase group versus three (1%) in the control group (adjusted OR 2·17, 95% CI 0·53-8·87; p=0·28), whereas any intracranial haemorrhage occurred in 33 (11%) versus 30 (10%) patients (adjusted OR 1·14, 0·67-1·94; p=0·64). INTERPRETATION In patients with wake-up stroke selected with non-contrast CT, treatment with tenecteplase was not associated with better functional outcome at 90 days. The number of symptomatic haemorrhages and any intracranial haemorrhages in both treatment groups was similar to findings from previous trials of wake-up stroke patients selected using advanced imaging. Current evidence does not support treatment with tenecteplase in patients selected with non-contrast CT. FUNDING Norwegian Clinical Research Therapy in the Specialist Health Services Programme, the Swiss Heart Foundation, the British Heart Foundation, and the Norwegian National Association for Public Health.
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Affiliation(s)
- Melinda B Roaldsen
- Department of Clinical Research, University Hospital of North Norway, Tromsø, Norway
| | - Agnethe Eltoft
- Department of Neurology, University Hospital of North Norway, Tromsø, Norway; Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Tom Wilsgaard
- Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Hanne Christensen
- Department of Neurology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Stefan T Engelter
- Department of Neurology, University Hospital Basel, Basel, Switzerland; Department of Neurology and Neurorehabilitation, University of Basel, Basel, Switzerland; University Department of Geriatric Medicine Felix Platter, University of Basel, Basel, Switzerland
| | - Bent Indredavik
- Department of Medicine, St Olavs Hospital Trondheim University Hospital, Trondheim, Norway; Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Dalius Jatužis
- Faculty of Medicine, Vilnius University, Center of Neurology, Vilnius, Lithuania
| | - Guntis Karelis
- Department of Neurology and Neurosurgery, Riga East University Hospital, Riga, Latvia; Rīga Stradiņš University, Riga, Latvia
| | - Janika Kõrv
- Department of Neurology and Neurosurgery, University of Tartu, Tartu, Estonia
| | - Erik Lundström
- Department of Medicine and Neurology, Uppsala University, Uppsala, Sweden
| | - Jesper Petersson
- Department of Neurology, Lund University, Institute for Clinical Sciences Lund, Lund, Sweden
| | - Jukka Putaala
- Department of Neurology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Mary-Helen Søyland
- Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway; Department of Neurology, Hospital of Southern Norway, Kristiansand, Norway
| | - Arnstein Tveiten
- Department of Neurology, Hospital of Southern Norway, Kristiansand, Norway
| | - Andrew Bivard
- Department of Medicine, Royal Melbourne Hospital, Melbourne Brain Centre, Melbourne, VIC, Australia
| | - Stein Harald Johnsen
- Department of Neurology, University Hospital of North Norway, Tromsø, Norway; Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Michael V Mazya
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - David J Werring
- Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK
| | - Teddy Y Wu
- Department of Neurology, Christchurch Hospital, Christchurch, New Zealand
| | - Gian Marco De Marchis
- Department of Neurology, University Hospital Basel, Basel, Switzerland; Department of Neurology, University of Basel, Basel, Switzerland
| | - Thompson G Robinson
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Ellisiv B Mathiesen
- Department of Neurology, University Hospital of North Norway, Tromsø, Norway; Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway.
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Finlay S, Judd J, Roe Y, Fredericks B, Smith J, Foley D, Boulton A, Cargo M. Decolonising the commissioning of Indigenous health and wellbeing program evaluations in Australia. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Significant financial investments have been made to improve the life expectancy gap between Indigenous people and other Australians over the last 10 years. Despite the investment, few evaluations have been commissioned to assess program effectiveness. Indigenous leaders have been calling for a more active role in the commissioning of Indigenous program evaluations. This project aims to identify how government and non-government commissioning practices can better support Indigenous engagement and leadership in the evaluation of health and wellbeing programs in Australia. This presentation reports on the different commissioning models that support Indigenous program evaluations, from the perspectives of commissioners, evaluators and program providers.
Methods
Semi-structured interviews were conducted with 20 Indigenous and non-Indigenous commissioners, evaluators and program providers. A mixed coding procedure was used. Interviews were coded using deductively derived codes reflecting best practice principles in Indigenous evaluation and inductively derived codes from participant stories. Interviews were analysed using NVivo qualitative software. A collaborative group-based approach to data analysis was used guided by Indigenous Standpoint Theory.
Results
The commissioning of Indigenous-specific program evaluations in Australia reflects top-down, participatory, co-design and Indigenous-led approaches. Top-down approaches were considered 'extractive' and had limited or token Indigenous input. Indigenous models were more strongly aligned with best practice and reflected authentic Indigenous engagement. There was agreement across the stakeholder groups on the value of Indigenous engagement in the commissioning process. The presentation will elaborate on the different approaches, their characteristics, strengths/ limitations.
Conclusions
Diverse approaches to commissioning are used and reflect different levels of Indigenous engagement and leadership.
Key messages
In the commissioning of Indigenous evaluations there needs to be governance structures to support Indigenous engagement. In the commissioning of Indigenous evaluations there needs to be greater input by Indigenous people.
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Affiliation(s)
- S Finlay
- Health Research Institute, University of Canberra, Canberra, Australia
| | - J Judd
- Centre for Indigenous, Health Equity Research Central Queensland University, Bundaberg, Australia
- Central Queensland University, School of Health Medical and Applied Science, Bundaberg, Australia
| | - Y Roe
- Molly Wardaguga Research Centre, Charles Darwin University, Brisbane, Australia
| | - B Fredericks
- Office of the Pro-Vice Chancellor (Indigenous Engagement), University of Queensland Brisbane, Brisbane, Australia
| | - J Smith
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Darwin, Australia
| | - D Foley
- School of Management, University of Canberra, Canberra, Australia
| | - A Boulton
- Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
- Health Services Research Centre, Victoria University of Wellington, Wellington, New Zealand
| | - M Cargo
- Health Research Institute, University of Canberra, Canberra, Australia
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Williams M, Sweet M, Finlay S, Mohamed J, Armstrong R, McInerney M. Threats to public interest journalism: A call to action to public health. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.062] [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: 11/13/2022] Open
Abstract
Abstract
Public interest journalism is an important determinant of health, due to its roles in accountability and holding power to account, empowering communities, and contributing to health literacy. The capacity of public interest journalism to contribute to planetary health and health equity, as well as healthier people, societies, and systems of governance is under attack. Reasons include the collapse of the underpinning business model, the market power of digital platforms, neoliberalism, the rise of authoritarianism, and attacks on press freedom and safety. This paper presents an ecological analysis of the upstream determinants of a healthy and sustainable public interest journalism sector, which is informed by Aboriginal ways of knowing, being and doing, and a decolonising methodology. It also presents a case study of innovation in health-related public interest journalism in Australia, and includes clear calls to action for public health practitioners, researchers and advocates, as well as wider policy making.
Key messages
Public interest journalism is an important determinant of health. Threats to public interest journalism are a threat to public health. Collaborations strengthen public interest journalism: this presentation provides an example.
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Affiliation(s)
- M Williams
- National Centre for Cultural Competence, Croakey Health Media, Camperdown, Australia
- Croakey Health Media, Cygnet, Australia
- Croakey.org, Cygnet, Australia
| | - M Sweet
- Croakey Health Media, Cygnet, Australia
- Croakey.org, Cygnet, Australia
| | - S Finlay
- Croakey.org, Cygnet, Australia
- School of Health and Society, University of Wollongong, Wollongong, Australia
| | - J Mohamed
- Croakey Health Media, Cygnet, Australia
- Lowitja Institute, Melbourne, Australia
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Abstract
Abstract
Concerns about poor quality media reporting of climate change has led to many initiatives seeking to influence coverage. In 2019/2020, a global media collaboration was established with the aim of generating a sustained media focus on key climate-related events. This paper reports an analysis of an Australian health media organisation's contribution to the collaboration, and the opportunities this provided for public health advocates, Aboriginal and Torres Strait Islander researchers and communities, and the wider community. It presents key reflections from Croakey Health Media's contribution to the global #CoveringClimateNow collaboration, with the aim of providing practical advice to enable further such collaborations and activities in other countries. This project was run on a very small budget, and this presentation is likely to be particularly relevant for low-budget organisations and contexts.
Key messages
Poor quality media coverage of climate change has stimulated innovation. Collaboration locally and globally can convey solutions to climate change.
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Affiliation(s)
- M Williams
- National Centre for Cultural Competence, University of Wollongong, Camperdown, Australia
- Croakey.org, Cygnet, Australia
- Croakey Health Media, Cygnet, Australia
| | - M Sweet
- Croakey.org, Cygnet, Australia
- Croakey Health Media, Cygnet, Australia
| | | | - S Finlay
- Croakey.org, Cygnet, Australia
- School of Health and Society, University of Wollongong, Wollongong, Australia
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Finlay S, Williams M, Judd J, Brown A. What are the perceptions of Indigenous organisation staff on the utility of the nKPIs? Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.763] [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: 11/13/2022] Open
Abstract
Abstract
Background
This presentation will outline the results of five Aboriginal Community Controlled Health Organisation (ACCHO) case studies which sought to understand the impact of national key performance indicators (nKPIs) at the local level. The nKPI framework attempts to collect data to assist the Commonwealth Government to monitor the Closing the Gap Framework and to aid local ACCHOs to monitor and review their service delivery. Understanding how the nKPIs have been implemented and their impact across the various sites is essential to understanding their usefulness.
Methods
A multi-case study approach with a variety of ACCHOs was used. Site recruitment was conducted using a purposive sampling framework with an expression of interest, and/or a direct approach. At each site, several semi-structured interviews were conducted, documents were reviewed, and observations made. Data analysis was conducted using the computer program NVivo.
Results
Case studies (n = 5) were conducted at the five sites between in 2017. Data collection included semi-structured interviews ACCHO staff (n = 24), nKPI site-specific documents (n = 12) and observational. A number of key themes emerged from case studies relating to: • Workforce The usefulness of the nKPIsSelf-determinationWay ForwardACCHO Governance
Conclusions
Across the case studies, it is clear there are a variety perception about the utility of the nKPIs and the barriers/enablers which impact their capacity to report, collect and utilise the nKPIs. All Case Study sites saw the value of data to measure their success and to identify emerging issues among their clients. Their attitudes to the nKPIs varied though, due to issues relating to the design and implementation. The stability and size of the service also influenced their ability to use the data. More work needs to be done by the Commonwealth Government in collaboration with ACCHOs to improve the usability and utility of the nKPIs.
Key messages
Indigenous people need to be involved in the design and implmnetation of monitoring sytems. The nKPIs only report on a small subset of services delivered by Aboriginal Community Controlled Health Organisations.
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Affiliation(s)
- S Finlay
- Wardliparringa, South Australian Health and Medical Research Institute, Adelaide, Australia
- School of Health Sciences, University of South Australia, Adelaide, Australia
- School of Health and Society, University of Wollongong, Wollongong, Australia
| | - M Williams
- School of Health and Society, University of Wollongong, Wollongong, Australia
| | - J Judd
- Centre for Indigenous Health Equity Research, Central Queensland University, Bunadaberg, Australia
- School of Health Medical and Applied Science, Central Queensland University, Bundaberg, Australia
| | - A Brown
- Wardliparringa, South Australian Health and Medical Research Institute, Adelaide, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
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Finlay S. Engaging the youth: co-designing health promotion messages. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.1294] [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: 11/13/2022] Open
Abstract
Abstract
We were all young once, right? Moreover, many of us still feel young despite our birth certificate suggesting otherwise. Does that mean we understand what health promotion messages are going to resonate with young people today? Does it mean we know which platforms messages for young people should be used?
The short answer is no. This is particularly true for marginalised communities whose needs are often very different and therefore require tailored communication. Marginalised communities such as Indigenous people, the LGBTQI community, migrant populations and refugees.
Youth is a perfect time to communicate prevention, sexual and reproductive health and other health promotion messages. Young people are our future leaders. As health professionals, we want to make sure they transition to adulthood as healthy in mind and body as we can. Part of that is developing health promotion messages which reach with young people.
However, too frequently, messages are not tailored for young people; therefore, not equipping them with the knowledge and skill to make healthy choices. To ensure that as health professionals that we are maximising our impact with young people, we need to co-design health promotion messages with them.
Like with many Indigenous people in colonised countries, half of the Aboriginal and Torres Strait Islander population, Australia's Indigenous people are under the age of 30. Young Australian Indigenous people's health and wellbeing needs are distinctive because of the uniqueness of their culture as well as the historical, political and social context (Azzopardi 2017). To ensure that health promotion effectively reaches its target audience, a co-design methodology is often employed with Aboriginal and Torres Strait Islander people. This presentation will detail the development of co-designed quit smoking and suicide prevention health promotion campaigns to demonstrate their effectiveness. A method that can be applied with other young people for maximum impact.
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Affiliation(s)
- S Finlay
- School of Health and Society, University of Wollongong, Wollongong, Australia
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Abstract
Abstract
Aboriginal and Torres Strait Islander people, Australia's Indigenous peoples, make up three percent of the population of Australia. Like many other Indigenous peoples in colonised countries, they suffer the worst health and social status of any population group. Australian Indigenous people have a lower life expectancy (8.6 years lower for men and 7.8 years for women) compared with other Australians (ABS 2018a). The reasons for the poorer health outcomes are complex and include historical, political and social factors (AIHW 2015a).
The health disparity has driven a high number of research projects with a focus on Australian Indigenous people or mainstream research projects where Australian Indigenous people are overrepresented. Given the uniqueness of Australian Indigenous cultures as well as the historical, political and social context, in 1998, the Aboriginal Health and Medical Research Council of New South Wales (AH&MRC) established an Australian Indigenous-specific human research ethics committee (HREC). The AH&MRC is the Indigenous peak health body of New South Wales.
This presentation will outline the role and benefit of the AH&MRC HREC as a specialised HREC. The AH&MRC HREC is fully constituted and registered under the National Health and Medical Research Council (NHMRC). The NHMRC is the leading expert body in health and medical research in Australia and develops health research guidelines. The AH&MRC HREC is one of three AHRECs in Australia. The AH&MRC Ethics Committee not only guarantees that research is conducted ethically but also ensures research involving Indigenous people is undertaken in a culturally appropriate manner. One of the key elements required by the AH&MRC is that researchers consult Indigenous communities across all stages of the project from the design, implementation, analysis and write up.
The AH&MRC HREC is essential, ensuring the research is of benefit to the Indigenous community in NSW and is conducted in a culturally safe manner.
Key messages
Specialised Indigenous human resarch ethics committees are vital to enuring research is culturally appropriate. Spscialised human resarch ethics committees can be of benefit for other disctinct populations.
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Affiliation(s)
- S Finlay
- Health and Society, University of Wollongong, Wollongong, Australia
- Ethics and Research, Aboriginal Health and Medical Research Council of NSW Ethics Committee, Sydney, Australia
| | - V Keed
- Ethics and Research, Aboriginal Health and Medical Research Council of NSW Ethics Committee, Sydney, Australia
| | - D Kelly
- Ethics and Research, Aboriginal Health and Medical Research Council of NSW Ethics Committee, Sydney, Australia
| | - M Cashman
- Ethics Committee, Aboriginal Health and Medical Research Council of NSW, Sydney, Australia
| | - S Green
- Ethics Committee, Aboriginal Health and Medical Research Council of NSW, Sydney, Australia
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Finlay S, Williams M, Judd J, Brown A. What are the perceptions of stakeholders on the utility of the nKPIs for Indigenous services? Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.1237] [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: 11/14/2022] Open
Abstract
Abstract
Background
The Australian Commonwealth Government has introduced national key Performance Indicators, (nKPIs), for Indigenous primary health care services, including Aboriginal Community Controlled Health Organisations (ACCHOs). The nKPIs aim to assist in the monitoring of Indigenous people's health and aid ACCHOs to monitor their service delivery. The nKPI development and its ongoing implementation have involved stakeholders including the Council of Australian Governments; national and jurisdictional ACCHO peak bodies; government departments; software developers, and researchers. While high-level information is available about the nKPIs, there is very little publicly available information about how they were developed and implemented. This presentation discusses perspectives from stakeholders on the development and implementation of the nKPIs.
Methods
Stakeholder interviews (n = 15) aimed to understand the utility and appropriateness of the nKPIs and barriers/enablers to implementation. Stakeholders with knowledge of the development, management or reporting of the nKPIs were recruited. The analysis was conducted inductively and deductively and organised using NVivo.
Results
The interviews focused on the history of the nKPIs and the context within which these are collected and managed. Several key themes and sub-themes arose from the stakeholder interviews. These themes included the nKPI purpose, development, implementation, and appropriateness. Several interviewees considered the nKPI development process to be flawed, leading to poor data quality and an increased burden on ACCHOs.
Conclusions
The ACCHO sectors' needs and perspectives were mostly ignored in the development process. Numerous research papers and government documents highlight the need for active engagement of Indigenous people to be actively engaged in the design of policies, programs, and frameworks seeking to improve the health of Indigenous people.
Key messages
The nKPI implmentation issues could have been avoided had they been developed in partnership with Indigenous organisations. Indigenous policy development needs to be developed in partnership with Indigenous people.
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Affiliation(s)
- S Finlay
- Wardlinparringa, South Australian Health and Medical Research Institute, Adelaide, Australia
- School of Health Sciences, University of South Australia, Adelaide, Australia
- School of Health and Society, University of Wollongong, Wollongong, Australia
| | - M Williams
- School of Health Sciences, University of South Australia, Adelaide, Australia
| | - J Judd
- Centre for Indigenous Health Equity Research, Central Queensland University, Bundaberg, Australia
- School of Health Medical and Applied Science, Central Queensland University, Bundaberg, Australia
| | - A Brown
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
- Wardlinparringa, South Australian Health and Medical Research Institute, Adelaide, Australia
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Alivernini S, MacDonald L, Elmesmari A, Finlay S, Tolusso B, Gigante MR, Petricca L, Di Mario C, Bui L, Perniola S, Attar M, Gessi M, Fedele AL, Chilaka S, Somma D, Sansom SN, Filer A, McSharry C, Millar NL, Kirschner K, Nerviani A, Lewis MJ, Pitzalis C, Clark AR, Ferraccioli G, Udalova I, Buckley CD, Gremese E, McInnes IB, Otto TD, Kurowska-Stolarska M. Distinct synovial tissue macrophage subsets regulate inflammation and remission in rheumatoid arthritis. Nat Med 2020; 26:1295-1306. [PMID: 32601335 DOI: 10.1038/s41591-020-0939-8] [Citation(s) in RCA: 268] [Impact Index Per Article: 67.0] [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] [Received: 09/23/2019] [Accepted: 05/12/2020] [Indexed: 12/28/2022]
Abstract
Immune-regulatory mechanisms of drug-free remission in rheumatoid arthritis (RA) are unknown. We hypothesized that synovial tissue macrophages (STM), which persist in remission, contribute to joint homeostasis. We used single-cell transcriptomics to profile 32,000 STMs and identified phenotypic changes in patients with early/active RA, treatment-refractory/active RA and RA in sustained remission. Each clinical state was characterized by different frequencies of nine discrete phenotypic clusters within four distinct STM subpopulations with diverse homeostatic, regulatory and inflammatory functions. This cellular atlas, combined with deep-phenotypic, spatial and functional analyses of synovial biopsy fluorescent activated cell sorted STMs, revealed two STM subpopulations (MerTKposTREM2high and MerTKposLYVE1pos) with unique remission transcriptomic signatures enriched in negative regulators of inflammation. These STMs were potent producers of inflammation-resolving lipid mediators and induced the repair response of synovial fibroblasts in vitro. A low proportion of MerTKpos STMs in remission was associated with increased risk of disease flare after treatment cessation. Therapeutic modulation of MerTKpos STM subpopulations could therefore be a potential treatment strategy for RA.
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MESH Headings
- Arthritis, Rheumatoid/genetics
- Arthritis, Rheumatoid/immunology
- Arthritis, Rheumatoid/metabolism
- Arthritis, Rheumatoid/pathology
- Biopsy
- Cell Lineage/genetics
- Humans
- Inflammation/genetics
- Inflammation/immunology
- Inflammation/metabolism
- Inflammation/pathology
- Joints/immunology
- Joints/metabolism
- Joints/pathology
- Lectins, C-Type/genetics
- Lectins, C-Type/immunology
- Macrophages/immunology
- Macrophages/metabolism
- Mannose Receptor
- Mannose-Binding Lectins/genetics
- Mannose-Binding Lectins/immunology
- Receptors, Cell Surface/genetics
- Receptors, Cell Surface/immunology
- Receptors, Immunologic/genetics
- Receptors, Immunologic/immunology
- Synovial Fluid/immunology
- Synovial Fluid/metabolism
- Synovial Membrane
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Affiliation(s)
- Stefano Alivernini
- Research into Inflammatory Arthritis Centre Versus Arthritis (RACE), .
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
- Institute of Rheumatology, Università Cattolica del Sacro Cuore, Rome, Italy.
- Institute of Infection, Immunity, and Inflammation, University of Glasgow, Glasgow, UK.
| | - Lucy MacDonald
- Research into Inflammatory Arthritis Centre Versus Arthritis (RACE)
- Institute of Infection, Immunity, and Inflammation, University of Glasgow, Glasgow, UK
| | - Aziza Elmesmari
- Research into Inflammatory Arthritis Centre Versus Arthritis (RACE)
- Institute of Infection, Immunity, and Inflammation, University of Glasgow, Glasgow, UK
| | - Samuel Finlay
- Research into Inflammatory Arthritis Centre Versus Arthritis (RACE)
- Institute of Infection, Immunity, and Inflammation, University of Glasgow, Glasgow, UK
| | - Barbara Tolusso
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Maria Rita Gigante
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Luca Petricca
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Clara Di Mario
- Institute of Rheumatology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Laura Bui
- Division of Pathology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Simone Perniola
- Institute of Rheumatology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Moustafa Attar
- The Kennedy Institute of Rheumatology, University of Oxford, Oxford, UK
| | - Marco Gessi
- Division of Pathology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Anna Laura Fedele
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Sabarinadh Chilaka
- Institute of Infection, Immunity, and Inflammation, University of Glasgow, Glasgow, UK
| | - Domenico Somma
- Institute of Infection, Immunity, and Inflammation, University of Glasgow, Glasgow, UK
| | - Stephen N Sansom
- Research into Inflammatory Arthritis Centre Versus Arthritis (RACE)
- The Kennedy Institute of Rheumatology, University of Oxford, Oxford, UK
| | - Andrew Filer
- Research into Inflammatory Arthritis Centre Versus Arthritis (RACE)
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, University of Birmingham, Birmingham, UK
| | - Charles McSharry
- Institute of Infection, Immunity, and Inflammation, University of Glasgow, Glasgow, UK
| | - Neal L Millar
- Institute of Infection, Immunity, and Inflammation, University of Glasgow, Glasgow, UK
| | | | - Alessandra Nerviani
- Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Myles J Lewis
- Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Costantino Pitzalis
- Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Andrew R Clark
- Research into Inflammatory Arthritis Centre Versus Arthritis (RACE)
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | | | - Irina Udalova
- Research into Inflammatory Arthritis Centre Versus Arthritis (RACE)
- The Kennedy Institute of Rheumatology, University of Oxford, Oxford, UK
| | - Christopher D Buckley
- Research into Inflammatory Arthritis Centre Versus Arthritis (RACE)
- The Kennedy Institute of Rheumatology, University of Oxford, Oxford, UK
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, University of Birmingham, Birmingham, UK
| | - Elisa Gremese
- Research into Inflammatory Arthritis Centre Versus Arthritis (RACE)
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Institute of Rheumatology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Iain B McInnes
- Research into Inflammatory Arthritis Centre Versus Arthritis (RACE)
- Institute of Infection, Immunity, and Inflammation, University of Glasgow, Glasgow, UK
| | - Thomas D Otto
- Research into Inflammatory Arthritis Centre Versus Arthritis (RACE), .
- Institute of Infection, Immunity, and Inflammation, University of Glasgow, Glasgow, UK.
| | - Mariola Kurowska-Stolarska
- Research into Inflammatory Arthritis Centre Versus Arthritis (RACE), .
- Institute of Infection, Immunity, and Inflammation, University of Glasgow, Glasgow, UK.
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10
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Campbell MA, Finlay S, Lucas K, Neal N, Williams R. Kick the habit: a social marketing campaign by Aboriginal communities in NSW. Aust J Prim Health 2016; 20:327-33. [PMID: 25265360 DOI: 10.1071/py14037] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 09/01/2014] [Indexed: 11/23/2022]
Abstract
Tackling smoking is an integral component of efforts to improve health outcomes in Aboriginal communities. Social marketing is an effective strategy for promoting healthy attitudes and influencing behaviours; however, there is little evidence for its success in reducing smoking rates in Aboriginal communities. This paper outlines the development, implementation and evaluation of Kick the Habit Phase 2, an innovative tobacco control social marketing campaign in Aboriginal communities in New South Wales (NSW). The Aboriginal Health & Medical Research Council worked with three Aboriginal communities and a creative agency to develop locally tailored, culturally relevant social marketing campaigns. Each community determined the target audience and main messages, and identified appropriate local champions and marketing tools. Mixed methods were used to evaluate the campaign, including surveys and interviews with community members and Aboriginal Community Controlled Health Service staff. Community survey participants demonstrated high recall of smoking cessation messages, particularly for messages and images specific to the Kick the Habit campaign. Staff participating in interviews reported an increased level of interest from community members in smoking cessation programs, as well as increased confidence and skills in developing further social marketing campaigns. Aboriginal community-driven social marketing campaigns in tobacco control can build capacity, are culturally relevant and lead to high rates of recall in Aboriginal communities.
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Affiliation(s)
- M A Campbell
- Aboriginal Health & Medical Research Council of New South Wales, Level 3, 66 Wentworth Avenue, Surry Hills, NSW 2010, Australia
| | - S Finlay
- Aboriginal Health & Medical Research Council of New South Wales, Level 3, 66 Wentworth Avenue, Surry Hills, NSW 2010, Australia
| | - K Lucas
- Aboriginal Health & Medical Research Council of New South Wales, Level 3, 66 Wentworth Avenue, Surry Hills, NSW 2010, Australia
| | - N Neal
- Aboriginal Health & Medical Research Council of New South Wales, Level 3, 66 Wentworth Avenue, Surry Hills, NSW 2010, Australia
| | - R Williams
- Aboriginal Health & Medical Research Council of New South Wales, Level 3, 66 Wentworth Avenue, Surry Hills, NSW 2010, Australia
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11
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Rayment M, Rae C, Ghooloo F, Doku E, Hardie J, Finlay S, Gidwani S, Atkins M, Roberts P, Sullivan AK. Routine HIV testing in the emergency department: tough lessons in sustainability. HIV Med 2014; 14 Suppl 3:6-9. [PMID: 24033895 DOI: 10.1111/hiv.12069] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Routine HIV testing in nonspecialist settings has been shown to be acceptable to patients and staff in pilot studies. The question of how to embed routine HIV testing, and make it sustainable, remains to be answered. METHODS We established a service of routine HIV testing in an emergency department (ED) in London, delivered by ED staff as part of routine clinical care. All patients aged 16 to 65 years were offered an HIV test (latterly the upper age limit was removed). Meetings were held weekly and two outcome measures examined: test offer rate (coverage) and test uptake. Sustainability methodology (process mapping; plan-do-study-act (PDSA) cycles) was applied to maximize these outcome measures. RESULTS Over 30 months, 44,582 eligible patients attended the ED. The mean proportion offered an HIV test was 14%, varying from 6% to 54% per month over the testing period. The mean proportion accepting a test was 63% (range 33-100%). A total of 4327 HIV tests have been performed. Thirteen patients have been diagnosed with HIV infection (0.30%). PDSA cycles having the most positive and sustained effects on the outcome measures include the expansion to offer blood-based HIV tests in addition to the original oral fluid tests, and the engagement of ED nursing staff in the programme. CONCLUSIONS HIV testing can be delivered in the ED, but constant innovation and attention have been required to maintain it over 30 months. Patient uptake remains high, suggesting acceptability, but time will be required before true embedding in routine clinical practice is achieved.
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Affiliation(s)
- M Rayment
- Directorate of HIV/GU Medicine, Chelsea and Westminster Hospital NHS Foundation Trust
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12
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Stevens M, Troscianko J, Marshall KLA, Finlay S. What is camouflage through distractive markings? A reply to Merilaita et al. (2013). Behav Ecol 2013. [DOI: 10.1093/beheco/art053] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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13
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Finlay S, Bray B, Lewington AJ, Hunter-Rowe CT, Banerjee A, Atkinson JM, Jones MC. Identification of risk factors associated with acute kidney injury in patients admitted to acute medical units. Clin Med (Lond) 2013; 13:233-8. [PMID: 23760694 PMCID: PMC5922664 DOI: 10.7861/clinmedicine.13-3-233] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
In 2009, the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) report identified significant deficiencies in the management of acute kidney injury (AKI) in hospitals in the UK. Many errors arose from failure to recognise patients with AKI and those at risk of developing AKI. Currently, there is no universally accepted risk factor assessment for identifying such patients on admission to acute medical units (AMUs). A multicentre prospective observational study was performed in the AMUs of 10 hospitals in England and Scotland to define the risk factors associated with AKI and to assess quality of care. Data were collected on consecutive acute medical admissions over two separate 24-h periods. Acute kidney injury was present in 55/316 (17.7%) patients, with sepsis, hypovolaemia, chronic kidney disease (CKD) and diabetes mellitus identified as the major risk factors. Deficiencies in patient care were identified, reinforcing the continuing need to improve the management of AKI.
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Affiliation(s)
- S Finlay
- Department of Medicine, Dumfries and Galloway Royal Infirmary, Dumfries, Scotland.
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14
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Finlay S, Rayment M, Rae C, Roberts P, Sullivan A. 014 Routine HIV testing in the Emergency Department: a tale of two trials. Arch Emerg Med 2011. [DOI: 10.1136/emermed-2011-200617.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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15
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Kluth DC, Ainslie CV, Pearce WP, Finlay S, Clarke D, Anegon I, Rees AJ. Macrophages transfected with adenovirus to express IL-4 reduce inflammation in experimental glomerulonephritis. J Immunol 2001; 166:4728-36. [PMID: 11254734 DOI: 10.4049/jimmunol.166.7.4728] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Nephrotoxic nephritis (NTN) is characterized by acute macrophage-dependent inflammation and serves as a model of human glomerulonephritis. In this study we have transfected rat macrophages with recombinant adenovirus expressing IL-4 (Ad-IL4) and demonstrated that these transfected macrophages develop fixed properties as a result of transfection, as shown by reduced NO production in response to IFN-gamma and TNF. Ad-IL4-transfected macrophages localized with enhanced efficiency to inflamed glomeruli after renal artery injection in rats with NTN compared with adenovirus expressing beta-galactosidase (Ad-beta gal)-transfected macrophages and produced elevated levels of the cytokine in glomeruli in vivo for up to 4 days. The delivery of IL-4-expressing macrophages produced a marked reduction in the severity of albuminuria (day 2 albuminuria, 61 +/- 15 mg/24 h) compared with unmodified NTN (day 2 albuminuria, 286 +/- 40 mg/24 h; p < 0.01), and this was matched by a reduction in the number of ED1-positive macrophages infiltrating the glomeruli. Interestingly, the injection of IL-4-expressing macrophages into single kidney produced a marked reduction in the numbers of ED1-positive macrophages in the contralateral noninjected kidney, an effect that could not be mimicked by systemic delivery of IL-4-expressing macrophages. This implies that the presence of IL-4-expressing macrophages in a single kidney can alter the systemic development of the inflammatory response. Macrophage transfection and delivery provide a valuable system to study and modulate inflammatory disease and highlight the feasibility of macrophage-based gene therapy.
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Affiliation(s)
- D C Kluth
- Department of Medicine and Therapeutics, University of Aberdeen, Foresterhill, Aberdeen, United Kingdom.
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16
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Hendry PJ, Masters RG, Mussivand TV, Smith S, Davies RA, Finlay S, Keon WJ. Circulatory support for cardiogenic shock due to acute myocardial infarction: a Canadian experience. Can J Cardiol 1999; 15:1090-4. [PMID: 10523475] [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: 02/14/2023] Open
Abstract
BACKGROUND Cardiogenic shock due to acute myocardial infarction (AMI) is associated with high mortality. Circulatory support devices may be used to assist these patients while they await cardiac transplantation. METHODS AND RESULTS From 1986 to 1997, 25 patients in cardiogenic shock complicating AMI within 3.6+/-0.7 days of the event were supported with artificial hearts. Of the 25 patients, 21 were men with a mean age of 48.4 +/- 1.8 years. The age range was 26 to 62 years. Patients were considered for a device when the following criteria were met: cardiac index less than 1.8 L/min/m2, wedge pressure greater than 20 mmHg despite one or two inotropes and/or intra-aortic balloon support. They received either a CardioWest total artificial heart (n=13), a Thoratec biventricular assist device (n=6) or left ventricular assist device (LVAD) (n=6). Three patients were not considered transplant candidates and died while on the devices (two with multiorgan failure and one found to have a bronchogenic carcinoma after implant), with 22 undergoing cardiac transplantation within 8.6+/-2.2 days of device implant. Six patients died in hospital after the transplants (27.3% mortality). Complications included bleeding or tamponade in seven (28%), pneumonia in six (24%) and right ventricular failure in three LVAD patients (12%). Post-transplant actuarial one-, two- and five-year survival rates were 71.4%, 71.4% and 51%, respectively. CONCLUSIONS Circulatory support devices offer a means to maintain organ perfusion in patients who develop cardiogenic shock due to AMI. Patients can then undergo transplantation with a reasonable expectation for survival when the alternative is death. Eventually the availability of permanent support devices may obviate the need for transplant in these patients.
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Affiliation(s)
- P J Hendry
- University of Ottawa Heart Institute, Ottawa, Canada.
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17
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Abstract
BACKGROUND The risk and efficacy of using an arterial conduit to bypass an endarterectomized coronary artery remain incompletely defined. To address this question we analyzed retrospectively 74 patients from 1989 to 1994 in whom bypass grafting using the left internal thoracic artery to an endarterectomized left anterior descending artery was performed. METHODS There were 60 men and 14 women with a mean age of 60.1 +/- 8.6 years. Of this cohort, 55 patients (74.3%) had a previous infarction, 18 (24.3%) were diabetic, and 5 (6.7%) had reoperations; 25 patients (34%) had a totally occluded left anterior descending artery and the average ejection fraction was 45%. Each patient had 2.95 +/- 0.52 grafts with 48 patients (65%) requiring multiple endarterectomies. The average length of the endarterectomized segment was 3.1 +/- 1.6 cm. Average anoxia time was 49 +/- 13 minutes. Postoperatively 19 patients (25.6%) required intraaortic balloon and 18 (24.3%) required inotropic support. Perioperative infarction in the left anterior descending artery distribution occurred in 5 patients (6.7%). RESULTS There were 3 (4.0%) early and 4 (5.4%) late deaths at a mean follow-up of 36 +/- 16 months. Recurrent angina was present in 9 patients (14.7%). Actuarial 5-year survival was 84.5%. Angiographic follow-up obtained in 23 patients (37.4%) demonstrated 74% anastomotic patency, with good distal run-off in 13 (65%). The anterior segmental wall motion was preserved. CONCLUSIONS The use of the left internal thoracic artery bypass and adjunctive left anterior descending artery endarterectomy to expand the scope of myocardial revascularization in carefully selected circumstances appears to be beneficial.
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Affiliation(s)
- I S Gill
- Department of Cardiothoracic Surgery and Cardiology, University of Ottawa Heart Institute, Ontario, Canada
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Farrer M, Game F, Finlay S, Laker M, Albertii K. Assessment of commercial monoclonal and polyclonal antibodies to human serum lipoprotein LP(A) phenotypes. Atherosclerosis 1990. [DOI: 10.1016/0021-9150(90)90195-o] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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