1
|
Richards T, Miles LF, Clevenger B, Keegan A, Abeysiri S, Rao Baikady R, Besser MW, Browne JP, Klein AA, Macdougall IC, Murphy GJ, Anker SD, Dahly D, Besser M, Browne J, Clevenger B, Kegan A, Klein A, Miles L, MacDougall I, Baikady RR, Dahly D, Bradbury A, Richards T, Burley T, Van Loen S, Anker S, Klein A, MacDougall I, Murphy G, Besser M, Unsworth I, Clayton T, Collier T, Potter K, Abeysiri S, Evans R, Knight R, Swinson R, Van Dyck L, Keidan J, Williamson L, Crook A, Pepper J, Dobson J, Newsome S, Godec T, Dodd M, Richards T, Van Dyck L, Evans R, Abeysiri S, Clevenger B, Butcher A, Swinson R, Collier T, Potter K, Anker S, Kelly J, Morris S, Browne J, Keidan J, Grocott M, Chau M, Knight R, Collier T, Baikady RR, Black E, Lawrence H, Kouthra M, Horner K, Jhanji S, Todman E, Keon‐Cohen Z, Rooms M, Tomlinson J, Bailes I, Walker S, Pirie K, Gerstman M, Kasivisvanathan R, Uren S, Magee D, Eeles A, Anker R, McCanny J, O'Mahony M, Reynolds T, Batley S, Hegarty A, Trundle S, Mazzola F, Tatham K, Balint A, Morrison B, Evans M, Pang CL, Smith L, Wilson C, Sjorin V, Khatri P, Wilson M, Parkinson D, Crosbie J, Dawas K, Smyth D, Bercades G, Ryu J, Reyes A, Martir G, Gallego L, Macklin A, Rocha M, Tam DK, Brealey DD, Dhesi J, Morrison C, Hardwick J, Partridge J, Braude P, Rogerson A, Jahangir N, Thomson C, Biswell L, Cross J, Pritchard F, Mohammed A, Wallace D, Galat MG, Okello J, Symes R, Leon J, Gibbs C, Sanghera S, Dennis A, Kibutu F, Fofie J, Bird S, Alli A, Jackson Y, Albuheissi S, Brain C, Shiridzinomwa C, Ralph C, Wroath B, Hammonds F, Adams B, Faulds J, Staddon S, Hughes T, Saha S, Finney C, Harris C, Mellis C, Johnson L, Riozzi P, Yarnold A, Buchanan F, Hopkins P, Greig L, Noble H, Edwards M, Grocott M, Plumb J, Harvie D, Dushianthan A, Wakatsuki M, Leggett S, Salmon K, Bolger C, Burnish R, Otto J, Rayat G, Golder K, Bartlett P, Bali S, Seaward L, Wadams B, Tyrell B, Collins H, Tantony N, Geale R, Wilson A, Ball D, Lindsey I, Barker D, Thyseen M, Chiam P, Hannaway C, Colling K, Messer C, Verma N, Nasseri M, Poonawala G, Sellars A, Mainali P, Hammond T, Hughes A, O'Hara D, McNeela F, Shillito L, Kotze A, Moriarty C, Wilson J, Davies S, Yates D, Carter J, Redman J, Ma S, Howard K, Redfearn H, Wilcock D, Lowe J, Alexander T, Jose J, Hornzee G, Akbar F, Rey S, Patel A, Coulson S, Saini R, Santipillai J, McCretton T, McCanny J, Chima K, Collins K, Pathmanathan B, Chattersingh A, McLeavy L, Al‐Saadi Z, Patel M, Skampardoni S, Chinnadurai R, Thomas V, Keen A, Pagett K, Keatley C, Howard J, Greenhalgh M, Jenkins S, Gidda R, Watts A, Breaton C, Parker J, Mallett S, James S, Penny L, Chan K, Reeves T, Catterall M, Williams S, Birch J, Hammerton K, Williamson N, Thomas A, Evans M, Mercer L, Horsfield G, Hughes C, Cupitt J, Stoddard E, McNamara H, Birt C, Hardy A, Dennis R, Butcher D, O'Sullivan S, Pope A, Elhanash S, Preston S, Officer H, Stoker A, Moss S, Walker A, Gipson A, Melville J, Bradley‐Potts J, McCormac R, Benson V, Melia K, Fielding J, Guest W, Ford S, Murdoch H, Beames S, Townshend P, Collins K, Glass J, Cartwright B, Altemimi B, Berresford L, Jones C, Kelliher L, de Silva S, Blightman K, Pendry K, Pinto L, Allard S, Taylor L, Chishti A, Scott J, O'Hare D, Lewis M, Hussain Z, Hallett K, Dermody S, Corbett C, Morby L, Hough M, Williams S, Williams P, Horton S, Ashcroft P, Homer A, Lang A, Dawson H, Harrison E, Thompson J, Hariharan V, Goss V, Ravi R, Butt G, Vertue M, Acheson A, Ng O, Bush D, Dickson E, Ward A, Morris S, Taylor A, Casey R, Wilson L, Vimalachandran D, Faulkner M, Jeffrey H, Gabrielle C, Martin S, Bracewell A, Ritzema J, Sproates D, Alexander‐Sefre F, Kubitzek C, Humphreys S, Curtis J, Oats P, Swann S, Holden A, Adam C, Flintoff L, Paoloni C, Bobruk K. The association between iron deficiency and outcomes: a secondary analysis of the intravenous iron therapy to treat iron deficiency anaemia in patients undergoing major abdominal surgery (PREVENTT) trial. Anaesthesia 2023; 78:320-329. [PMID: 36477695 PMCID: PMC10107684 DOI: 10.1111/anae.15926] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2022] [Indexed: 12/13/2022]
Abstract
In the intravenous iron therapy to treat iron deficiency anaemia in patients undergoing major abdominal surgery (PREVENTT) trial, the use of intravenous iron did not reduce the need for blood transfusion or reduce patient complications or length of hospital stay. As part of the trial protocol, serum was collected at randomisation and on the day of surgery. These samples were analysed in a central laboratory for markers of iron deficiency. We performed a secondary analysis to explore the potential interactions between pre-operative markers of iron deficiency and intervention status on the trial outcome measures. Absolute iron deficiency was defined as ferritin <30 μg.l-1 ; functional iron deficiency as ferritin 30-100 μg.l-1 or transferrin saturation < 20%; and the remainder as non-iron deficient. Interactions were estimated using generalised linear models that included different subgroup indicators of baseline iron status. Co-primary endpoints were blood transfusion or death and number of blood transfusions, from randomisation to 30 days postoperatively. Secondary endpoints included peri-operative change in haemoglobin, postoperative complications and length of hospital stay. Most patients had iron deficiency (369/452 [82%]) at randomisation; one-third had absolute iron deficiency (144/452 [32%]) and half had functional iron deficiency (225/452 [50%]). The change in pre-operative haemoglobin with intravenous iron compared with placebo was greatest in patients with absolute iron deficiency, mean difference 8.9 g.l-1 , 95%CI 5.3-12.5; moderate in functional iron deficiency, mean difference 2.8 g.l-1 , 95%CI -0.1 to 5.7; and with little change seen in those patients who were non-iron deficient. Subgroup analyses did not suggest that intravenous iron compared with placebo reduced the likelihood of death or blood transfusion at 30 days differentially across subgroups according to baseline ferritin (p = 0.33 for interaction), transferrin saturation (p = 0.13) or in combination (p = 0.45), or for the number of blood transfusions (p = 0.06, 0.29, and 0.39, respectively). There was no beneficial effect of the use of intravenous iron compared with placebo, regardless of the metrics to diagnose iron deficiency, on postoperative complications or length of hospital stay.
Collapse
Affiliation(s)
- T Richards
- Division of Surgery, University of Western Australia, Perkins South Building, Fiona Stanley Hospital, Murdoch, Perth, WA, Australia.,Institute of Clinical Trials and Methodology and Division of Surgery, University College London, UK
| | - L F Miles
- Department of Critical Care, Melbourne Medical School, The University of Melbourne, VIC, Australia.,Department of Anaesthesia, Austin Health, Melbourne, VIC, Australia
| | - B Clevenger
- Department of Anaesthesia, Royal National Orthopaedic Hospital, Stanmore, UK
| | - A Keegan
- Department of Haematology, PathWest Laboratory Medicine, King Edward Memorial Hospital, Subiaco, WA, Australia
| | - S Abeysiri
- Division of Surgery, University of Western Australia, Perkins South Building, Fiona Stanley Hospital, Murdoch, Perth, WA, Australia
| | - R Rao Baikady
- Department of Anaesthesia, The Royal Marsden NHS Foundation Trust, London, UK
| | - M W Besser
- Department of Haematology, Addenbrooke's Hospital, Cambridge, UK
| | - J P Browne
- School of Public Health, University College Cork, Ireland
| | - A A Klein
- Department of Anaesthesia and Intensive Care, Royal Papworth Hospital, Cambridge, UK
| | - I C Macdougall
- Department of Renal Medicine, King's College Hospital, London, UK
| | - G J Murphy
- Department of Cardiovascular Sciences, University of Leicester, UK
| | - S D Anker
- Department of Cardiology, Berlin Institute of Health Centre for Regenerative Therapies; German Centre for Cardiovascular Research partner site Berlin; Charité Universitätsmedizin Berlin, Germany
| | - D Dahly
- School of Public Health, University College Cork, Ireland.,Health Research Board Clinical Research Facility, University College Cork, Ireland
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
2
|
Ford S. Alfentanil-based TIVA during remifentanil shortages: a need for guidance. Anaesthesia 2023; 78:259-260. [PMID: 35921080 DOI: 10.1111/anae.15837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2022] [Indexed: 01/11/2023]
Affiliation(s)
- S Ford
- Addenbrooke's Hospital, Cambridge, UK
| |
Collapse
|
3
|
Kingston M, Jones J, Black S, Evans B, Ford S, Foster T, Goodacre S, Jones ML, Jones S, Keen L, Longo M, Lyons RA, Pallister I, Rees N, Siriwardena AN, Watkins A, Williams J, Wilson H, Snooks H. Clinical and cost-effectiveness of paramedic administered fascia iliaca compartment block for emergency hip fracture (RAPID 2)-protocol for an individually randomised parallel-group trial. Trials 2022; 23:677. [PMID: 35978361 PMCID: PMC9385096 DOI: 10.1186/s13063-022-06522-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 07/06/2022] [Indexed: 11/17/2022] Open
Abstract
Background Approximately 75,000 people fracture a hip each year in the UK. This painful injury can be devastating—with a high associated mortality rate—and survivors likely to be more dependent and less mobile. Pain relief at the scene of injury is known to be inadequate. Intravenous morphine is usually given by paramedics, but opioids are less effective for dynamic pain and can cause serious side effects, including nausea, constipation, delirium and respiratory depression. These may delay surgery, require further treatment and worsen patient outcomes. We completed a feasibility study of paramedic-provided fascia iliaca compartment block (FICB), testing the intervention, trial methods and data collection. The study (RAPID) demonstrated that a full trial was feasible. In this subsequent study, we aim to test safety, clinical and cost-effectiveness of paramedic-provided FICB as pain relief to patients with suspected hip fracture in the prehospital environment. Methods We will conduct a pragmatic multi-centre individually randomised parallel-group trial, with a 1:1 allocation between usual care (control) and FICB (intervention). Hospital clinicians in five sites (paired ambulance services and receiving hospitals) in England and Wales will train 220 paramedics to administer FICB. The primary outcome is change in pain score from pre-randomisation to arrival at the emergency department. One thousand four hundred patients are required to find a clinically important difference between trial arms in the primary outcome (standardised statistical effect ~ 0.2; 90% power, 5% significance). We will use NHS Digital (England) and the SAIL (Secure Anonymised Information Linkage) databank (Wales) to follow up patient outcomes using routine anonymised linked data in an efficient study design, and questionnaires to capture patient-reported outcomes at 1 and 4 months. Secondary outcomes include mortality, length of hospital stay, job cycle time, prehospital medications including morphine, presence of hip fracture, satisfaction, mobility, and NHS costs. We will assess safety by monitoring serious adverse events (SAEs). Discussion The trial will help to determine whether paramedic administered FICB is a safe, clinically and cost-effective treatment for suspected hip fracture in the pre-hospital setting. Impact will be shown if and when clinical guidelines either recommend or reject the use of FICB in routine practice in this context. Trial registration ISRCTN15831813. Registered on 22 September 2021.
Collapse
Affiliation(s)
| | | | - Sarah Black
- South Western Ambulance Service NHS Foundation Trust, Exeter, UK
| | | | - Simon Ford
- Swansea Bay University Health Board, Port Talbot, UK
| | - Theresa Foster
- East of England Ambulance Service NHS Trust, Melbourn, UK
| | | | | | | | - Leigh Keen
- Welsh Ambulance Services NHS Trust, St Asaph, UK
| | | | | | - Ian Pallister
- Swansea Bay University Health Board, Port Talbot, UK
| | - Nigel Rees
- Welsh Ambulance Services NHS Trust, St Asaph, UK
| | | | | | - Julia Williams
- South East Coast Ambulance Services NHS Foundation Trust, Crawley, UK
| | - Helen Wilson
- Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | | |
Collapse
|
4
|
Mohamed I, Egeler C, Ford S, White T, Harris D, Harries R. TH5.8 Use of Botulinum Toxin A infiltration in conjunction with negative pressure wound dressing and mesh-mediated traction in the management of the ‘open abdomen’. Br J Surg 2022. [DOI: 10.1093/bjs/znac248.234] [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: 11/07/2022]
Abstract
Abstract
Aims
Botulinum Toxin A (BTA) is widely used in complex abdominal wall reconstruction (CAWR). It temporarily paralyses the oblique muscles allowing medialisation of the rectus sheath and decreases tension on the closure. This analysis presents the use of BTA in management of the ‘open abdomen’ (OA).
Methods
Retrospective series of patients with OA where BTA was used in conjunction with AbtheraTM negative pressure wound therapy (NPWT) and polypropylene mesh-mediated traction (MMT) to attempt fascial closure. BTA was performed by Anaesthetists with experience of BTA use in CAWR using Dysport® 600 IU.
Results
We include 5 patients since 2020. Median age at index operation was 55 years (range 39–81); four were male. Index operations were intra-abdominal catastrophe where fascia closure impossible (n=2), dehiscence after Vertical Rectus Abdominis Myocutaneous (VRAM) flap for pelvic malignancy (n=2) and colectomy for obstructing colorectal cancer complicated by rectus sheath necrotising fasciitis (n=1). There were no immediate complications from BTA infiltration. All patients achieved primary fascial closure with a median of five re-looks (range 3–7). There were no full-thickness dehiscences after final closure. One patient died within 1 month from unrelated cause. One patient had no clinically palpable incisional hernia at six months and a further two had no incisional hernia at six and 12 months, respectively, on cancer surveillance CT.
Conclusion
BTA in the setting of the OA in conjunction with NPWT and MMT appears safe and effective in achieving fascial closure, and can potentially reduce the risk of incisional hernia. Further studies are welcomed.
Collapse
|
5
|
Washington A, Chabaan J, Fakih A, Ford S, Rutledge L, Lilly J, Clemons P, Thompson H. "Should I Give it to My Kids?": Factors that Influence HPV Vaccine Hesitancy Among African American Parents. Cancer Epidemiol Biomarkers Prev 2022. [PMID: 35775209 DOI: 10.1158/1055-9965.epi-22-0478] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE The purpose of our study was to describe the influences that impact vaccine hesitancy in African American parents who have previously delayed or denied vaccinating their children against HPV. METHODS We conducted three focus groups, approx. 90 minutes each. Participants were recruited from various community clinics and organizations in Michigan. Using thematic analysis and the Vaccine Hesitancy Determinants framework, we described the experiences of parents who have delayed or denied vaccinating their children against HPV. RESULTS Twenty parents participated in the focus groups; the majority of the parents had Medicaid (75%), were employed full-time (55%), and had some college education but no degree (50%). Several contextual factors influenced decision-making: historical events, perceptions of both pharmaceutical and governmental figures, and perceived discrimination based on race and socioeconomic status. Whether it was the result of mistrust due to the ongoing Flint water crisis or concern over the profit-driven industry of pharmaceutical companies, these parents were deeply mistrustful of the motivations behind vaccination programs. Parental beliefs and attitudes focused on ensuring the health and safety of their children, which involved being hesitant to vaccinate. Some parents were swayed by vaccination experiences of personal acquaintances, while others maintained their hesitancy status. Knowledge and awareness in this group were mixed regarding the HPV vaccine. Most struggled to articulate the purpose of the vaccine thoroughly and often refused to vaccinate their children. Meanwhile, only a few vaccine-specific issues were relevant in group discussions, such as vaccination schedule and provider recommendation. Some parents viewed weak recommendations as a subtle signal to not vaccinate their children, while others viewed too strong of a recommendation as a cause for concern. CONCLUSION Findings highlight parents' willingness to stick with their strong beliefs, despite recommendations from healthcare providers and personal acquaintances. Effective communications strategies are essential for health education and establishing a trustworthy patient-provider relationship.
Collapse
|
6
|
Mohamed I, Egeler C, Ford S, White T, Harris DA, Harries RL. Botulinum Toxin A infiltration in conjunction with negative-pressure wound dressing and mesh-mediated traction in management of the open abdomen. Br J Surg 2022; 109:780-781. [PMID: 35543277 DOI: 10.1093/bjs/znac150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 04/11/2022] [Accepted: 04/23/2022] [Indexed: 11/13/2022]
Affiliation(s)
- Imran Mohamed
- Department of General Surgery, Swansea Bay University Health Board, Swansea, UK
| | - Christian Egeler
- Department of Anaesthesia, Swansea Bay University Health Board, Swansea, UK
| | - Simon Ford
- Department of Anaesthesia, Swansea Bay University Health Board, Swansea, UK
| | - Thomas White
- Department of Anaesthesia, Swansea Bay University Health Board, Swansea, UK
| | - Dean A Harris
- Department of General Surgery, Swansea Bay University Health Board, Swansea, UK
| | - Rhiannon L Harries
- Department of General Surgery, Swansea Bay University Health Board, Swansea, UK
| |
Collapse
|
7
|
Lithgow K, Venkataraman H, Hughes S, Shah H, Kemp-Blake J, Vickrage S, Smith S, Humphries S, Elshafie M, Taniere P, Diaz-Cano S, Dasari BVM, Almond M, Ford S, Ayuk J, Shetty S, Shah T, Geh I. Well-differentiated gastroenteropancreatic G3 NET: findings from a large single centre cohort. Sci Rep 2021; 11:17947. [PMID: 34504148 PMCID: PMC8429701 DOI: 10.1038/s41598-021-97247-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 06/21/2021] [Indexed: 11/14/2022] Open
Abstract
Neuroendocrine neoplasms are known to have heterogeneous biological behavior. G3 neuroendocrine tumours (NET G3) are characterized by well-differentiated morphology and Ki67 > 20%. The prognosis of this disease is understood to be intermediate between NET G2 and neuroendocrine carcinoma (NEC). Clinical management of NET G3 is challenging due to limited data to inform treatment strategies. We describe clinical characteristics, treatment, and outcomes in a large single centre cohort of patients with gastroenteropancreatic NET G3. Data was reviewed from 26 cases managed at Queen Elizabeth Hospital, Birmingham, UK, from 2012 to 2019. Most commonly the site of the primary tumour was unknown and majority of cases with identifiable primaries originated in the GI tract. Majority of cases demonstrated somatostatin receptor avidity. Median Ki67 was 30%, and most cases had stage IV disease at diagnosis. Treatment options included surgery, somatostatin analogs (SSA), and chemotherapy with either platinum-based or temozolomide-based regimens. Estimated progression free survival was 4 months following initiation of SSA and 3 months following initiation of chemotherapy. Disease control was observed following treatment in 5/11 patients treated with chemotherapy. Estimated median survival was 19 months; estimated 1 year survival was 60% and estimated 2 year survival was 13%. NET G3 is a heterogeneous group of tumours and patients which commonly have advanced disease at presentation. Prognosis is typically poor, though select cases may respond to treatment with SSA and/or chemotherapy. Further study is needed to compare efficacy of different treatment strategies for this disease.
Collapse
Affiliation(s)
- K Lithgow
- Division of Endocrinology, Department of Medicine, Cumming School of Medicine, 1820 Richmond Rd SW, Calgary, AB, T2T 5C7, Canada.
| | - H Venkataraman
- Department of Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - S Hughes
- Department of Radiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - H Shah
- Department of Liver Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - J Kemp-Blake
- Department of Liver Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - S Vickrage
- Department of Liver Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - S Smith
- Department of Liver Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - S Humphries
- Department of Liver Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - M Elshafie
- Department of Pathology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - P Taniere
- Department of Pathology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - S Diaz-Cano
- Department of Pathology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - B V M Dasari
- Department of Liver Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - M Almond
- Department of General Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - S Ford
- Department of General Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - J Ayuk
- Department of Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - S Shetty
- Department of Liver Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - T Shah
- Department of Liver Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - I Geh
- Department of Oncology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| |
Collapse
|
8
|
Tyler R, Lee M, Ierodiakonou V, Hodson J, Taniere P, Almond M, Ford S, Desai A. Prognostic implications of histological organ involvement in retroperitoneal sarcoma. BJS Open 2021; 5:6369780. [PMID: 34518873 PMCID: PMC8438256 DOI: 10.1093/bjsopen/zrab080] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 08/03/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The prognostic significance of histological organ involvement by retroperitoneal sarcoma subtype is unknown. The present study aimed to describe organ involvement across the subtypes, and the implications for survival. METHODS Patients undergoing surgery for primary retroperitoneal sarcoma at the Queen Elizabeth Hospital, Birmingham from April 2005 to September 2018 were identified retrospectively. Histological organ involvement was classed as pushing, infiltrative or neither. Univariable and multivariable Cox regression models were produced to analyse the association between histological organ involvement and both overall (OS) and recurrence-free (RFS) survival for the cohort as a whole, and by histological subtype. RESULTS Data were available for a total of 197 patients, of whom 171 (86.8 per cent) had at least one organ resected. Infiltrative organ behaviour was seen in 37 patients (18.8 per cent), and pushing behaviour in 67 (34.0 per cent). For the cohort as a whole, infiltration (hazard ratio (HR) 4.32, 95 per cent c.i. 2.35 to 7.93; P < 0.001), but not pushing (HR 1.62, 0.90 to 2.92; P = 0.106), was associated with significantly shorter OS, in comparisons with a group with neither of these behaviours. However, this effect was found to differ significantly by histological subtype (P = 0.009). For patients with dedifferentiated liposarcoma, there was no significant association between tumour behaviour and either OS (P = 0.508) or RFS (P = 0.313). However, in leiomyosarcoma, infiltrative behaviour was associated with shorter OS (P = 0.002), and both infiltrative (P < 0.001) and pushing (P = 0.010) behaviours were associated with shorter RFS, compared with tumours with neither behaviour. Multivariable analyses of both OS and RFS returned similar results. CONCLUSION The prognostic implications of organ involvement in retroperitoneal sarcoma vary by histological subtype.
Collapse
Affiliation(s)
- R Tyler
- College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - M Lee
- College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - V Ierodiakonou
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, UK
| | - J Hodson
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, UK
| | - P Taniere
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, UK
| | - M Almond
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, UK
| | - S Ford
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, UK
| | - A Desai
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, UK
| |
Collapse
|
9
|
RAO N, Kumar R, Ford S, Goodman D, Ierino F, Mayer R, Lahham Y, Michell I, Gock H. SUN-299 FACTORS ASSOCIATED WITH POSTOPERATIVE BLOOD TRANSFUSIONS FOLLOWING RENAL TRANSPLANTATION. Kidney Int Rep 2020. [DOI: 10.1016/j.ekir.2020.02.836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
10
|
Evans BA, Brown A, Fegan G, Ford S, Guy K, Jones J, Jones S, Keen L, Khanom A, Longo M, Pallister I, Rees N, Russell IT, Seagrove AC, Watkins A, Snooks H. Is fascia iliaca compartment block administered by paramedics for suspected hip fracture acceptable to patients? A qualitative study. BMJ Open 2019; 9:e033398. [PMID: 31862740 PMCID: PMC6937129 DOI: 10.1136/bmjopen-2019-033398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 10/15/2019] [Accepted: 10/23/2019] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To explore patients' experience of receiving pain relief injection for suspected hip fracture from paramedics at the location of the injury. DESIGN Qualitative interviews within a feasibility trial about an alternative to routine prehospital pain management for patients with suspected hip fracture. SETTING Patients treated by paramedics in the catchment area of one emergency department in South Wales. PARTICIPANTS Six patients and one carer of a patient who received fascia iliaca compartment block (FICB). INTERVENTION FICB administered to patients with suspected hip fracture by trained paramedics. We randomly allocated eligible patients to FICB-a local anaesthetic injection directly into the hip region-or usual care-most commonly morphine-using audited scratch cards. OUTCOMES Acceptability and experience of receiving FICB, assessed through interview data. We audio-recorded, with participants' consent, and conducted thematic analysis of interview transcripts. The analysis team comprised two researchers, one paramedic and one lay member. RESULTS Patients had little or no memory of being offered, consenting to or receiving FICB. They recalled the reassuring manner and high quality of care received. They accepted FICB without question. Partial or confused memory characterised experience of subsequent hospital care until surgery. They said their priorities when calling for emergency help were to receive effective care. After hospital treatment, they wanted to regain their health and mobility and resume the quality of life they experienced before their injury. CONCLUSIONS This study did not raise any concerns about the acceptability of FICB administered at the scene of injury by paramedics to people with suspected hip fracture. It adds to existing evidence about patient and carer experience of on-scene care for people with suspected hip fracture. Further research is needed to assess safety, effectiveness and cost effectiveness of this health technology in a new setting. TRIAL REGISTRATION NUMBER ISRCTN60065373.
Collapse
Affiliation(s)
| | - Alan Brown
- Public contributor c/o Swansea University, Swansea, UK
| | - Greg Fegan
- Medical School, Swansea University, Swansea, UK
| | - Simon Ford
- Abertawe Bro Morgannwg University Health Board, Port Talbot, UK
| | - Katy Guy
- Abertawe Bro Morgannwg University Health Board, Port Talbot, UK
| | - Jenna Jones
- Medical School, Swansea University, Swansea, UK
| | - Sian Jones
- Public contributor c/o Swansea University, Swansea, UK
| | - Leigh Keen
- Welsh Ambulance Services NHS Trust, Swansea, UK
| | | | - Mirella Longo
- Marie Curie Palliative Care Research Centre, Cardiff University School of Medicine, Cardiff, UK
| | - Ian Pallister
- Abertawe Bro Morgannwg University Health Board, Port Talbot, UK
| | - Nigel Rees
- Welsh Ambulance Services NHS Trust, Swansea, UK
| | | | | | | | | |
Collapse
|
11
|
Jones JK, Evans BA, Fegan G, Ford S, Guy K, Jones S, Keen L, Khanom A, Longo M, Pallister I, Rees N, Russell IT, Seagrove AC, Watkins A, Snooks HA. Rapid Analgesia for Prehospital hip Disruption (RAPID): findings from a randomised feasibility study. Pilot Feasibility Stud 2019; 5:77. [PMID: 31210961 PMCID: PMC6560881 DOI: 10.1186/s40814-019-0454-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 05/06/2019] [Indexed: 11/29/2022] Open
Abstract
Background In managing hip fracture, effective pain relief before admission to hospital is difficult without risking side effects. Although emergency departments routinely use fascia iliaca compartment block (FICB), there has been little evaluation of its use by paramedics before hospital admission. We aimed to assess whether a multi-centre randomised trial to evaluate FICB was feasible. Methods Volunteer paramedics used scratchcards to allocate patients with hip fracture at random between FICB and pain relief as usual. Primary outcomes were mortality and quality of life. We also measured adverse events, costs, final diagnosis, length of stay in hospital, pain scores and quality of care and collected qualitative data about acceptability to patients in interviews, and paramedics in focus groups. We pre-specified criteria for deciding whether to progress to a fully powered trial based on the recruitment of paramedics and patients, delivery of FICB, retrieval of outcome data, safety, acceptability, and diagnostic accuracy of hip fracture. Results We effectively met all progression criteria: we recruited 19 paramedics who randomly allocated 71 patients between trial arms between 28 June 2016 and 31 July 2017; 57 (31 experimental arm, 26 usual care arm, 80% overall) retrospectively consented to follow-up. Just over half (17/31) of experimental participants received FICB; all others had contraindications, including nine taking anticoagulants. Four of the 31 participants assigned FICB and six of the 26 assigned usual care died within 6 months of hospital admission. Serious adverse events were also similar: 3/35 experimental versus 4/36 in usual care. Paramedics’ recognition of hip fracture had sensitivity of 49/64 (77%) with a positive predictive value of 46/57 (81%). We received quality of life questionnaires for 30 of 49 patients (61%) at 1 month and 12 of 17 (71%) at 6 months. Patient satisfaction was similar: experimental mean 3.4 (n = 20) versus 3.5 (n = 13) for usual care. Conclusions RAPID met all progression criteria within reasonable limits. As equipoise remains, we plan to undertake a fully powered multi-centre trial to test clinical and cost effectiveness of paramedic-administered FICB at the scene of hip fracture. Trial registration ISRCTN 60065373 sought 5 November 2015. Electronic supplementary material The online version of this article (10.1186/s40814-019-0454-1) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
| | | | - Greg Fegan
- 1Swansea University Medical School, Swansea, UK
| | - Simon Ford
- Swansea Bay University Health Board, Swansea, UK
| | - Katy Guy
- Swansea Bay University Health Board, Swansea, UK
| | - Sian Jones
- 3Patient and public representative, c/o Swansea University Medical School, Swansea, UK
| | - Leigh Keen
- 4Welsh Ambulance Services NHS Trust, Saint Asaph, UK
| | | | | | - Ian Pallister
- 1Swansea University Medical School, Swansea, UK.,Swansea Bay University Health Board, Swansea, UK
| | - Nigel Rees
- 4Welsh Ambulance Services NHS Trust, Saint Asaph, UK
| | | | | | | | | |
Collapse
|
12
|
Bouzyk M, Bryant S, Evans C, Guioli S, Ford S, Schmidt K, Goodfellow P, Povey S, Rebello M, Rousseaux S, Spurr NK. Integrated Radiation Hybrid and Yeast Artificial Chromosome Map of Chromosome 9p. Eur J Hum Genet 2019. [DOI: 10.1159/000484781] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
13
|
Evans BA, Brown A, Bulger J, Fegan G, Ford S, Guy K, Jones SI, Keen L, Khanom A, Longo M, Pallister I, Rees N, Russell IT, Seagrove AC, Watkins A, Snooks H. Paramedics' experiences of administering fascia iliaca compartment block to patients in South Wales with suspected hip fracture at the scene of injury: results of focus groups. BMJ Open 2019; 9:e026073. [PMID: 30772863 PMCID: PMC6398707 DOI: 10.1136/bmjopen-2018-026073] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES To explore paramedics' experience of delivering fascia iliaca compartment block (FICB) to patients with suspected hip fracture at the scene of injury. DESIGN Focus groups within a randomised controlled trial. SETTING Paramedics based at ambulance stations in the catchment area of one Emergency Department in South Wales, recruited and trained in a feasibility study about an alternative to routine prehospital pain management for patients with suspected hip fracture. PARTICIPANTS 11 paramedics. INTERVENTION Paramedic-administered FICB to patients with suspected hip fracture. We randomly allocated eligible patients to FICB, a local anaesthetic injection directly into the hip region-or usual care, most commonly morphine - using audited scratch cards. OUTCOMES Paramedics' experiences of administering FICB gathered through thematic analysis of interview transcripts by two researchers, one paramedic and one lay member. RESULTS Respondents believed that FICB was a suitable intervention for paramedics to deliver. It aligned with routine practice and was within people's capabilities. They said it took up to 10 minutes longer than usual care to prepare and deliver, in part due to nervousness and unfamiliarity with a new procedure. They praised the training provided but said they were anxious about causing harm by injecting into the wrong location. Confidence increased after one paramedic team successfully treated a patient for local anaesthetic toxicity. Reported challenges related to the emergency context: patients often waited many hours for ambulance arrival; moving patients exacerbated their pain; family and neighbours were present as paramedics administered treatment. CONCLUSIONS Paramedics are willing and able to administer FICB to patients with suspected hip fracture before ambulance transport to hospital. Feasibility study findings will inform further research. TRIAL REGISTRATION NUMBER ISRCTN60065373; Pre results.
Collapse
Affiliation(s)
| | - Alan Brown
- Public contributor, c/o Swansea University, Swansea, UK
| | | | - Greg Fegan
- Medical School, Swansea University, Swansea, UK
| | - Simon Ford
- Abertawe Bro Morgannwg University Health Board, Port Talbot, UK
| | - Katy Guy
- Abertawe Bro-Morgannwg University Health Board, Cardiff, UK
| | - SIan Jones
- Public contributor, c/o Swansea University, Swansea, UK
| | - Leigh Keen
- The Welsh Ambulance Services NHS Trust, Swansea, UK
| | | | | | - Ian Pallister
- Abertawe Bro Morgannwg University Health Board, Port Talbot, UK
| | - Nigel Rees
- Pre-hospital Emergency Research Unit, Welsh Ambulance Services NHS Trust, Cardiff, UK
| | | | | | | | | |
Collapse
|
14
|
Evans B, Brown A, Bulger J, Fegan G, Ford S, Guy K, Jones S, Keen L, Khanom A, Pallister I, Rees N, Russell I, Seagrove A, Snooks H. PP30 ‘I can’t remember’ – patients views of receiving pain management from paramedics for suspected hip fracture. Arch Emerg Med 2019. [DOI: 10.1136/emermed-2019-999.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundUp to 40% of patients with suspected hip fracture report inadequate or no pre-hospital pain management. Morphine may raise risk of complications and may be avoided by paramedics. Fascia Iliaca Compartment Block (FICB) is used in Emergency Department and orthopaedic wards. The RAPID trial tested feasibility of paramedics administering FICB to patients with suspected hip fracture.ObjectiveTo explore patients’ views and experience of care received for suspected hip fracture and in particular FICB before ambulance transport to hospital.MethodWe interviewed six patients and the daughter of a patient who received FICB to manage their suspected hip fracture. Interviews, by telephone or face-to-face, were audio-recorded with consent. We conducted thematic analysis of transcripts. Two researchers, one paramedic and one lay member were in the analysis teamResultsRespondents’ memory of prehospital care was dominated by their experience of extreme pain. While they recalled events before falling, they only had partial memory of care prior to hip surgery. Although they recalled paramedics’ arrival, which they reported was up to six hours after their injury, respondents said they remembered little else. Just one recalled consenting to receiving FICB and could describe the process. Other respondents said they were in too much pain to comprehend what occurred or respond coherently. They explained their priority was to receive pain management and they expected the paramedics to treat them safely and effectively. Respondents appeared to be a stoical and trusting group who accepted the treatment they were offered. They did recall high quality of care and praised paramedics for their reassuring and calm manner.ConclusionsHip fracture patients’ overwhelming memory of injury and treatment was of pain and their priority was to receive pain relief. The quality of care, reassurance and administration of pain management was more important to patients than the mechanism of delivering the intervention.
Collapse
|
15
|
Keen L, Bulger J, Rees N, Snooks H, Fegan G, Ford S, Evans B, Longo M. 03 The use of scratchcards for allocation concealment and treatment allocation in a prehospital randomised controlled trial. Arch Emerg Med 2019. [DOI: 10.1136/emermed-2019-999.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundRAPID (Rapid Analgesia for Prehospital Hip Disruption) study was a small study to determine the feasibility of undertaking a randomised controlled trial to test the clinical and cost-effectiveness of paramedics administering Fascia Iliaca Compartment Block (FICB) as early pain relief to patients who have fractured a hip at the scene of their injury.ObjectivesTo devise a simple and effective method of random allocation concealment suitable for use by Paramedics whilst in the mobile emergency prehospital setting.MethodsTraditional Methods of randomly allocating patients were considered, however none were suitable for paramedics to use during their shift. Scratchcards have been used successfully in other studies, though not prehospitally to our knowledge. Scratchcards were produced using scratch-off silver stickers which concealed the trial arm allocation. Paramedics were each allocated a unique range of consecutive numbers, used as both the scratchcard number and patient’s study ID. The cards were designed to allow the paramedic to write on the incident number, date and signature. A small envelope holding the cards was prepared for each paramedic.ResultsNineteen trial paramedics used 71 scratchcards throughout the study and reported no problems randomly allocating patients using the scratchcards. Five protocol deviations reported in relation to scratchcard use. On auditing the scratchcards, all unused cards were located and no evidence of tampering with the silver panel was found.ConclusionParamedics can use scratchcards as a method of randomly allocating patients in trials in prehospital care. In future a method that allows only the top card to be selected should be sought. Also a more protective method of storing the cards should be used. Scratchcards can be considered for wider use in randomised controlled trials in the emergency prehospital setting.
Collapse
|
16
|
Bulger J, Brown A, Evans B, Fegan G, Ford S, Guy K, Jones S, Keen L, Khanom A, Pallister I, Rees N, Russell I, Seagrove A, Snooks H. OP5 Rapid analgesia for prehospital hip disruption (RAPID): findings from a randomised feasibility study. Arch Emerg Med 2019. [DOI: 10.1136/emermed-2019-999.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundAdequate pain relief in prehospital care is a major challenge in all acute traumas, especially for those with hip fractures, whose injuries are difficult to immobilise and whose long term outcomes may be adversely affected by administration of opiate analgesics. Fascia Iliaca Compartment Block (FICB) is routinely undertaken by clinicians in the emergency department for patients with hip fracture, but has not been fully evaluated for use by paramedics in prehospital care.We aimed to test whether FICB for hip fracture pain relief carried out by paramedics in prehospital care was feasible, safe and acceptable, and whether trial Methods were viable, so that we could decide whether to proceed to a fully-powered RCT to evaluate clinical and cost effectiveness.MethodsNineteen paramedics were trained to administer FICB. They randomly allocated eligible patients to FICB or usual care using audited scratchcards. Patients were followed up to assess availability of key outcomes including quality of life, length of hospital stay, pain scores, and adverse events. Findings were analysed against pre-specified feasibility criteria to determine whether it was appropriate to progress to a fully-powered trial.ResultsSeventy-one patients were randomised by paramedics between 28/6/16 and 31/7/17; 57 of these patients consented to follow up. The only outcome which reached a statistically significant difference between groups was the proportion of participants who received morphine (38% difference between groups 95% CI −61.88 to −15.79). There was a difference of approximately nine days in the length of stay between trial arms (mean difference 9.12 (95% CI −20.51 to 2.27).ConclusionsRAPID met its pre-specified progression criteria; a funding application for a fully-powered RCT will therefore be submitted. We will consider the use of length of stay as the primary outcome measure, as feasibility study findings indicated that there was a difference between groups without reaching statistical significance.
Collapse
|
17
|
Evans B, Brown A, Bulger J, Fegan G, Ford S, Guy K, Jones S, Keen L, Khanom A, Pallister I, Rees N, Russell I, Seagrove A, Snooks H. PP29 Paramedics’ experiences of administering fascia iliaca compartment block to patients with suspected hip fracture. Arch Emerg Med 2019. [DOI: 10.1136/emermed-2019-999.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundRoutine pre-hospital pain management for hip fracture is inadequate, with risk of potentially fatal complications, particularly from morphine. Fascia Iliaca Compartment Block (FICB) is used in Emergency Department and orthopaedic wards. The RAPID trial tested feasibility of paramedics administering FICB to patients with suspected hip fracture at the scene of injury.ObjectiveTo explore paramedics’ experience of delivering FICB pre-hospitally.MethodsWe held three focus groups with 11 paramedics serving one district hospital, audio-recorded with participants’ consent. We conducted thematic analysis of interview transcripts. Two researchers, one paramedic and one lay member were in the analysis team.ResultsRespondents believed FICB was a suitable intervention for paramedics to deliver. It aligned with their routine practice and was within people’s capabilities to administer, they reported. They said it took up to 10 min longer than usual care to prepare and deliver, in part due to nervousness and unfamiliarity with a new procedure. They praised the training provided but said they were anxious about causing harm by injecting into the wrong location. Confidence increased after one paramedic team successfully treated a patient for toxic reaction. Reported challenges related to the emergency context: patients often waited many hours for ambulance arrival; they sometimes needed to be moved from awkward locations which exacerbated pain; family and neighbours were present as paramedics administered treatment. Most respondents treated few or just one patient with FICB. Although uncertain whether FICB reduced patients’ pain more effectively than other pain relief options, respondents believed it was safer for elderly people at risk of pneumonia.ConclusionsParamedics are willing and able to administer FICB to patients with suspected hip fracture before ambulance transport to hospital. Feasibility study findings will inform a research proposal for a definitive multi-centre trial of paramedic administered prehospital FICB.
Collapse
|
18
|
Keen L, Bulger JK, Rees N, Snooks H, Fegan G, Ford S, Evans BA, Longo M. Use of scratchcards for allocation concealment in a prehospital randomised controlled trial. Emerg Med J 2018; 35:708-710. [PMID: 30209073 PMCID: PMC6225792 DOI: 10.1136/emermed-2018-207881] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 08/08/2018] [Accepted: 08/14/2018] [Indexed: 12/04/2022]
Abstract
Background Rapid Analgesia for Prehospital Hip Disruption was a small study designed to determine the feasibility of undertaking a randomised controlled trial (RCT) to test the clinical and cost-effectiveness of paramedics administering Fascia Iliaca Compartment Block as early prehospital pain relief to patients with a fractured hip. The objective was to devise a simple and effective method of random allocation concealment suitable for use by paramedics while in the emergency prehospital setting. Methods Scratchcards were produced using scratch-off silver stickers which concealed the trial arm allocation. Paramedics were each allocated a unique range of consecutive numbers, used as both the scratchcard number and the patient’s study ID. The cards were designed to allow the paramedic to write on the incident number, date and signature. A small envelope holding the cards was prepared for each paramedic. The study took place between 28 June 2016 and 31 July 2017 in the Swansea area. Results Nineteen trial paramedics used 71 scratchcards throughout the study and reported no problems randomly allocating patients using the scratchcards. Five protocol deviations were reported in relation to scratchcard use. On auditing the scratchcards, all unused cards were located, and no evidence of tampering with the silver panel was found. Conclusion Paramedics can use scratchcards as a method of randomly allocating patients in trials in prehospital care. In the future, a method that allows only the top card to be selected and a more protective method of storing the cards should be used. Scratchcards can be considered for wider use in RCTs in the emergency prehospital setting. Trial registration number ISRCTN60065373; Post-results.
Collapse
Affiliation(s)
- Leigh Keen
- Central and West Region, The Welsh Ambulance Services NHS Trust, Swansea, UK
| | | | - Nigel Rees
- Central and West Region, The Welsh Ambulance Services NHS Trust, Swansea, UK
| | | | - Greg Fegan
- Swansea University Medical School, Swansea, UK
| | - Simon Ford
- Abertawe Bro Morgannwg University Health Board, Port Talbot, UK
| | | | | |
Collapse
|
19
|
Zaidat OO, Bozorgchami H, Ribó M, Saver JL, Mattle HP, Chapot R, Narata AP, Francois O, Jadhav AP, Grossberg JA, Riedel CH, Tomasello A, Clark WM, Nordmeyer H, Lin E, Nogueira RG, Yoo AJ, Jovin TG, Siddiqui AH, Bernard T, Claffey M, Andersson T, Ribo M, Hetts S, Hacke W, Mehta B, Hacein-Bey L, Kim A, Abou-Chebl A, Shabe P, Hetts S, Hacein-Bey L, Kim A, Abou-Chebl A, Dix J, Gurian J, Zink W, Dabus G, O’Leary, N, Reilly A, Lee K, Foley J, Dolan M, Hartley E, Clark T, Nadeau K, Shama J, Hull L, Brown B, Priest R, Nesbit G, Horikawa M, Hoak D, Petersen B, Beadell N, Herrick K, White C, Stacey M, Ford S, Liu J, Ribó M, Sanjuan, E, Sanchis M, Molina C, Rodríguez-Luna, D, Boned Riera S, Pagola J, Rubiera M, Juega J, Rodríguez N, Muller N, Stauder M, Stracke P, Heddier M, Charron V, Decock A, Herbreteau D, Bibi R, De Sloovere A, Doutreloigne I, Pieters D, Dewaele T, Bourgeois P, Vanhee F, Vanderdouckt P, Vancaster E, Baxendell L, Gilchrist V, Cannon Y, Graves C, Armbruster K, Jovin T, Jankowitz B, Ducruet A, Aghaebrahim A, Kenmuir C, Shoirah H, Molyneaux B, Tadi P, Walker G, Starr M, Doppelheuer S, Schindler K, Craft L, Schultz M, Perez H, Park J, Hall A, Mitchell A, Webb L, Haussen D, Frankel M, Bianchi N, Belagaje S, Mahdi N, Lahoti S, Katema A, Winningham M, Anderson A, Tilley D, Steinhauser T, Scott D, Thacker A, Calderon V, Lin E, Becke S, Krieter S, Jansen O, Wodarg F, Larsen N, Binder A, Wiesen C, Hartney M, Bookhagan L, Ross H, Gay J, Snyder K, Levy E, Davies J, Sonig A, Rangel-Castilla L, Mowla A, Shakir H, Fennell V, Atwal G, Natarajan S, Beecher J, Thornton J, Cullen A, Brennan P, O’Hare A, Asadi H, Budzik R, Taylor M, Jennings M, Laube F, Jackson J, Gatrell R, Reebel L, Albon A, Gerniak J, Groezinger K, Lauf M, Voraco N, Pema P, Davis T, Hicks W, Mejilla J, Teleb M, Sunenshine P, Russo E, Flynn R, Twyford J, Ver Hage A, Smith E, Apolinar L, Blythe S, Maxan J, Carter J, Taschner T, Bergmann U, Meckel S, Elsheik S, Urbach H, Maurer C, Egger K, Niesen W, Baxter B, Knox, A, Hazelwood B, Quarfordt S, Calvert J, Hawk H, Malek, R, Padidar A, Tolley U, Gutierrez A, Mordasini P, Seip T, Balasubramaniam R, Gralla J, Fischer U, Zibold F, Piechowiak E, DeLeacy R, Apruzzeses R, Alfonso C, Haslett J, Fifi J, Mocco J, Starkman S, Guzy, J, Grunberg N, Szeder V, Tateshima S, Duckwiler G, Nour M, Liebeskind D, Tang X, Hinman J, Tipirneni A, Yavagal D, Guada L, Bates K, Balladeras S, Bokka S, Suir S, Caplan J, Kandewall P, Peterson E, Starke R, Puri A, Hawk M, Brooks C, L’Heurex J, Ty K, Rex D, Massari F, Wakhloo A, Lozano D, Rodrigua K, Pierot L, Fabienne M, Sebastien S, Emmoinoli M. Primary Results of the Multicenter ARISE II Study (Analysis of Revascularization in Ischemic Stroke With EmboTrap). Stroke 2018; 49:1107-1115. [DOI: 10.1161/strokeaha.117.020125] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 02/05/2018] [Accepted: 02/26/2018] [Indexed: 02/04/2023]
Affiliation(s)
- Osama O. Zaidat
- From the Department of Neuroscience, Mercy St. Vincent Medical Center, Toledo, OH (O.O.Z., E.L.)
| | | | - Marc Ribó
- Department of Neuroradiology, Vall d’Hebron University Hospital, Barcelona, Spain (M.R., A.T.)
| | - Jeffrey L. Saver
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles (J.L.S.)
| | - Heinrich P. Mattle
- Department of Neurology, Inselspital, University of Bern, Switzerland (H.P.M.)
| | - René Chapot
- Department of Radiology and Neuroradiology, Alfried Krupp Krankenhaus, Essen, Germany (R.C., H.N.)
| | - Ana Paula Narata
- Centre Hospitalier Régional Universitaire, Hôpitaux de Tours, France (A.P.N.)
| | | | - Ashutosh P. Jadhav
- Department of Neurology, University of Pittsburgh Medical Center, PA (A.P.J., T.G.J.)
| | - Jonathan A. Grossberg
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA (J.A.G., R.G.N.)
| | | | - Alejandro Tomasello
- Department of Neuroradiology, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden (T.A.)
| | - Wayne M. Clark
- Oregon Health and Science University Hospital, Portland (H.B., W.M.C.)
| | - Hannes Nordmeyer
- Department of Radiology and Neuroradiology, Alfried Krupp Krankenhaus, Essen, Germany (R.C., H.N.)
| | - Eugene Lin
- From the Department of Neuroscience, Mercy St. Vincent Medical Center, Toledo, OH (O.O.Z., E.L.)
| | - Raul G. Nogueira
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA (J.A.G., R.G.N.)
| | - Albert J. Yoo
- Department of Interventional Radiology, Texas Stroke Institute, Dallas–Fort Worth (A.J.Y.)
| | - Tudor G. Jovin
- Department of Neurology, University of Pittsburgh Medical Center, PA (A.P.J., T.G.J.)
| | | | | | | | - Tommy Andersson
- Department of Neuroradiology, Vall d’Hebron University Hospital, Barcelona, Spain (M.R., A.T.)
- AZ Groeninge, Kortrijk, Belgium (O.F., T.A.)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Feinberg L, Srinivasan A, Singh JK, Parry M, Stevenson J, Jeys L, Grimer R, Peart F, Warner R, Ford S, Gourevitch D, Hallissey M, Desai A. Impact of specialist management on survival from radiation-associated angiosarcoma of the breast. Br J Surg 2018; 105:401-409. [PMID: 29405251 DOI: 10.1002/bjs.10696] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 05/26/2017] [Accepted: 08/20/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Radiation-associated angiosarcoma of the breast (RAAS) is a rare complication of adjuvant radiotherapy associated with poor survival. The British Sarcoma Group guidelines recommend that all angiosarcomas are referred to a sarcoma multidisciplinary team, although there is no recommendation that patients are managed within a sarcoma service. The aims of this study were to compare survival, complete excision rates and local recurrence rates of patients managed within a sarcoma service and those managed within local hospitals. METHODS All patients with RAAS referred to a regional sarcoma service between 1998 and 2015 were identified from prospective databases. Patient records, and radiology, pathology and operation notes were reviewed retrospectively. RESULTS Thirty-six patients were operated on with curative intent; 26 were managed by the sarcoma service (of whom 21 underwent radical excision of the irradiated field followed by chest wall reconstruction) and ten were managed locally. Median age was 69·5 (range 43-85) years. Disease-specific survival was significantly longer in patients managed by the sarcoma service than in those managed locally: median 91·1 (range 69·2-113·0) versus 48·8 (18·6-79·1) months respectively (P = 0·012). Overall survival rates were similar (P = 0·112). There was no difference in complete excision rate (18 of 26 in sarcoma service versus 5 of 10 in local services; P = 0·456), although the local recurrence rate was significantly lower among patients managed by the sarcoma service (9 of 26 versus 8 of 10; P = 0·015). CONCLUSION Specialist management of RAAS leads to fewer local recurrences and improved disease-specific survival. Early referral and management within specialist units is recommended.
Collapse
Affiliation(s)
- L Feinberg
- Department of Upper Gastrointestinal Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - A Srinivasan
- Department of Upper Gastrointestinal Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - J K Singh
- Department of Upper Gastrointestinal Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - M Parry
- Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - J Stevenson
- Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - L Jeys
- Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - R Grimer
- Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - F Peart
- Department of Plastic Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - R Warner
- Department of Plastic Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - S Ford
- Midland Abdominal and Retroperitoneal Sarcoma Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - D Gourevitch
- Midland Abdominal and Retroperitoneal Sarcoma Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - M Hallissey
- Department of Upper Gastrointestinal Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - A Desai
- Midland Abdominal and Retroperitoneal Sarcoma Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| |
Collapse
|
21
|
Bulger J, Seagrove A, Snooks H, Evans B, Fegan G, Ford S, Pallister I, Guy K, Brown A, Jones S, Keen L, Khanom A, Rees N. PP30 Rapid analgesia for prehospital hip disruption (rapid: feasibility study progress). Arch Emerg Med 2017. [DOI: 10.1136/emermed-2017-207114.30] [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]
|
22
|
Comfort A, Frey M, Musselman K, Chern J, Lee J, Joo L, Radford M, Ford S, Blank S, Boyd L, Curtin J, Pothuri B. Predictors of port site hernia necessitating operative intervention in patients undergoing robotic surgery. Gynecol Oncol 2017. [DOI: 10.1016/j.ygyno.2017.03.399] [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: 10/19/2022]
|
23
|
Bulger JK, Brown A, Evans BA, Fegan G, Ford S, Guy K, Jones S, Keen L, Khanom A, Pallister I, Rees N, Russell IT, Seagrove AC, Snooks HA. Rapid analgesia for prehospital hip disruption (RAPID): protocol for feasibility study of randomised controlled trial. Pilot Feasibility Stud 2017; 3:8. [PMID: 28163926 PMCID: PMC5282771 DOI: 10.1186/s40814-016-0115-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 12/08/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adequate pain relief at the point of injury and during transport to hospital is a major challenge in all acute traumas, especially for those with hip fractures, whose injuries are difficult to immobilise and whose long-term outcomes may be adversely affected by administration of opiate analgesics. Fascia iliaca compartment block (FICB) is a procedure routinely undertaken by doctors and nurses in the emergency department for patients with hip fracture but not yet evaluated for use by paramedics at the scene of emergency calls. In this feasibility study, we aim to test whether FICB administered by paramedics at the scene of participants' hip fractures is feasible, safe and acceptable. This will enable us to decide whether to proceed to a fully powered, multi-centre pragmatic randomised trial to evaluate whether the procedure is effective for patients and worthwhile for the NHS. METHODS/DESIGN In this study, we propose to recruit ten paramedics in an urban area of South Wales. We will train them to carry out FICB when they attend patients with hip fracture. We will randomly allocate eligible patients to FICB or usual care using audited scratch cards. We will follow up participants to assess measurability of key outcomes including quality of life, pain scores, adverse events, length of stay in hospital, acceptability to patients and compliance of paramedics. We will assess whether the findings meet specified feasibility criteria and, if so, plan a full trial. DISCUSSION This study will enable us to recommend whether to undertake a definitive trial of FICB by paramedics for hip fracture. TRIAL REGISTRATION ISRCTN60065373.
Collapse
Affiliation(s)
- Jenna K. Bulger
- Swansea University Medical School, ILS2, Singleton Campus, Swansea University, SA2 8PP Swansea, UK
| | | | - Bridie A. Evans
- Swansea University Medical School, ILS2, Singleton Campus, Swansea University, SA2 8PP Swansea, UK
| | - Greg Fegan
- Swansea University Medical School, ILS2, Singleton Campus, Swansea University, SA2 8PP Swansea, UK
| | - Simon Ford
- Abertawe Bro Morgannwg University Health Board, Swansea, UK
| | - Katy Guy
- Abertawe Bro Morgannwg University Health Board, Swansea, UK
| | | | - Leigh Keen
- Welsh Ambulance Services NHS Trust, Swansea, UK
| | - Ashrafunnesa Khanom
- Swansea University Medical School, ILS2, Singleton Campus, Swansea University, SA2 8PP Swansea, UK
| | - Ian Pallister
- Abertawe Bro Morgannwg University Health Board, Swansea, UK
| | - Nigel Rees
- Welsh Ambulance Services NHS Trust, Swansea, UK
| | - Ian T. Russell
- Swansea University Medical School, ILS2, Singleton Campus, Swansea University, SA2 8PP Swansea, UK
| | - Anne C. Seagrove
- Swansea University Medical School, ILS2, Singleton Campus, Swansea University, SA2 8PP Swansea, UK
| | - Helen A. Snooks
- Swansea University Medical School, ILS2, Singleton Campus, Swansea University, SA2 8PP Swansea, UK
| |
Collapse
|
24
|
Mitchell K, Weaver J, Becker K, Watson E, Ford S, Montgomery J, Giddins M, Vincent-Pennisi C, Alderson S. Identifying Complications in Outpatients Post Elective Angiography and Angioplasty. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.641] [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: 10/19/2022]
|
25
|
|
26
|
Bulger J, Ford S, Pallister I, Rees N, Russell D, Russell I, Snooks H. PRE-HOSPITAL ANALGESIA FOR PATIENTS WITH FEMORAL FRACTURE: A SYSTEMATIC REVIEW OF THE LITERATURE. Arch Emerg Med 2016. [DOI: 10.1136/emermed-2016-206139.23] [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]
|
27
|
Bulger J, Seagrove A, Snooks H, Evans B, Ford S, Pallister I, Guy K, Brown A, Jones S, Keen L, Rees N. RAPID ANALGESIA FOR PREHOSPITAL HIP DISRUPTION (RAPID): A FEASIBILITY STUDY. Arch Emerg Med 2016. [DOI: 10.1136/emermed-2016-206139.24] [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]
|
28
|
Mallett A, Hughes P, Szer J, Tuckfield A, Van Eps C, Cambell SB, Hawley C, Burke J, Kausman J, Hewitt I, Parnham A, Ford S, Isbel N. Atypical haemolytic uraemic syndrome treated with the complement inhibitor eculizumab: the experience of the Australian compassionate access cohort. Intern Med J 2015; 45:1054-65. [DOI: 10.1111/imj.12864] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 07/19/2015] [Indexed: 02/03/2023]
Affiliation(s)
- A. Mallett
- Department of Renal Medicine; Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
- Centre for Kidney Disease Research; Centre for Chronic Disease; CKD.QLD; School of Medicine; University of Queensland; Brisbane Queensland Australia
| | - P. Hughes
- Department of Nephrology; Royal Melbourne Hospital; Melbourne Victoria Australia
| | - J. Szer
- Department of Clinical Haematology and BMT Service; Royal Melbourne Hospital; Melbourne Victoria Australia
| | - A. Tuckfield
- Department of Clinical Haematology and BMT Service; Royal Melbourne Hospital; Melbourne Victoria Australia
| | - C. Van Eps
- Centre for Kidney Disease Research; Centre for Chronic Disease; CKD.QLD; School of Medicine; University of Queensland; Brisbane Queensland Australia
- Department of Nephrology; Princess Alexandra Hospital; Brisbane Queensland Australia
| | - S. B. Cambell
- Centre for Kidney Disease Research; Centre for Chronic Disease; CKD.QLD; School of Medicine; University of Queensland; Brisbane Queensland Australia
- Department of Nephrology; Princess Alexandra Hospital; Brisbane Queensland Australia
| | - C. Hawley
- Centre for Kidney Disease Research; Centre for Chronic Disease; CKD.QLD; School of Medicine; University of Queensland; Brisbane Queensland Australia
- Department of Nephrology; Princess Alexandra Hospital; Brisbane Queensland Australia
| | - J. Burke
- Centre for Kidney Disease Research; Centre for Chronic Disease; CKD.QLD; School of Medicine; University of Queensland; Brisbane Queensland Australia
- Department of Nephrology; Princess Alexandra Hospital; Brisbane Queensland Australia
| | - J. Kausman
- Department of Nephrology; The Royal Children's Hospital Melbourne; Melbourne Victoria Australia
| | - I. Hewitt
- Department of Nephrology; Princess Margaret Hospital for Children; Perth Western Australia Australia
| | - A. Parnham
- Department of Nephrology; Gold Coast Hospital; Gold Coast Queensland Australia
| | - S. Ford
- Department of Nephrology; Monash Medical Centre; Melbourne Victoria Australia
| | - N. Isbel
- Centre for Kidney Disease Research; Centre for Chronic Disease; CKD.QLD; School of Medicine; University of Queensland; Brisbane Queensland Australia
- Department of Nephrology; Princess Alexandra Hospital; Brisbane Queensland Australia
| |
Collapse
|
29
|
Emmett L, Jaleel H, Bakar MSA, Stookes D, Payne K, Ford S, Reacher M, Salimee S. P20 Investigation into an increase of diagnoses of gonorrhoea in southend-on-sea. Br J Vener Dis 2015. [DOI: 10.1136/sextrans-2015-052126.64] [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]
|
30
|
Adam S, Akroyd R, Bernabei S, Bollhalder S, Boocock S, Burlina A, Coote T, Corthouts K, Dalmau J, Dawson S, Defourny S, De Meyer A, Desloovere A, Devlin Y, Diels M, Dokoupil K, Donald S, Evans S, Fasan I, Ferguson C, Ford S, Forga M, Gallo G, Grünert SC, Heddrich-Ellerbrok M, Heidenborg C, Jonkers C, Lefebure K, Luyten K, MacDonald A, Meyer U, Micciche A, Müller E, Portnoi P, Ripley S, Robert M, Robertson LV, Rosenbaum-Fabian S, Sahm K, Schultz S, Singleton K, Sjöqvist E, Stoelen L, Terry A, Thompson S, Timmer C, Vande Kerckhove K, van der Ploeg L, Van Driessche M, van Rijn M, van Teeffelen-Heithoff A, Vitoria I, Voillot C, Wenz J, Westbrook M, Wildgoose J, Zweers H. How strict is galactose restriction in adults with galactosaemia? International practice. Mol Genet Metab 2015; 115:23-6. [PMID: 25873073 DOI: 10.1016/j.ymgme.2015.03.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 03/29/2015] [Accepted: 03/30/2015] [Indexed: 10/23/2022]
Abstract
Dietary management of 418 adult patients with galactosaemia (from 39 centres/12 countries) was compared. All centres advised lactose restriction, 6 restricted galactose from galactosides ± fruits and vegetables and 12 offal. 38% (n=15) relaxed diet by: 1) allowing traces of lactose in manufactured foods (n=13) or 2) giving fruits, vegetables and galactosides (n=2). Only 15% (n=6) calculated dietary galactose. 32% of patients were lost to dietetic follow-up. In adult galactosaemia, there is limited diet relaxation.
Collapse
Affiliation(s)
- S Adam
- Royal Hospital for Sick Children, Glasgow, UK
| | - R Akroyd
- National Metabolic Service, Starship Children's Health and Auckland City Hospital, Auckland, New Zealand
| | - S Bernabei
- Ospedale pediatrico Bambino Gesù, Rome, Italy
| | | | - S Boocock
- University Hospitals Birmingham NHS Foundation Trust, UK
| | - A Burlina
- Division of Inherited Metabolic Diseases, Reference Centre Expanded Newborn Screening, Department of Pediatrics, University Hospital, Padova, Italy
| | - T Coote
- National Metabolic Service, Starship Children's Health and Auckland City Hospital, Auckland, New Zealand
| | - K Corthouts
- University Hospitals Leuven, Center of Metabolic Diseases, Belgium
| | | | - S Dawson
- Royal Hospital for Sick Children Edinburgh, UK
| | - S Defourny
- Hôpital Universitaire des Enfants, Reine fabiola, Bruxelles, Belgium
| | - A De Meyer
- Center of Metabolic Diseases, University Hospital, Antwerp, Belgium
| | | | - Y Devlin
- Royal Victoria Hospital, Newcastle, UK
| | - M Diels
- University Hospitals Leuven, Center of Metabolic Diseases, Belgium
| | - K Dokoupil
- Dr. von Hauner Children's Hospital, Munich, Germany
| | | | - S Evans
- Birmingham Children's Hospital, Birmingham, UK
| | - I Fasan
- Division of Inherited Metabolic Diseases, Reference Centre Expanded Newborn Screening, Department of Pediatrics, University Hospital, Padova, Italy
| | | | - S Ford
- North Bristol NHS Trust Southmead and Frenchay, UK
| | - M Forga
- Hospital Clinic Barcelona, Spain
| | - G Gallo
- Ospedale pediatrico Bambino Gesù, Rome, Italy
| | - S C Grünert
- University Children's Hospital Freiburg, Germany
| | | | - C Heidenborg
- Karolinska University Hospital Stockholm, Sweden
| | - C Jonkers
- Academic Medical Hospital, Amsterdam, Netherlands
| | - K Lefebure
- Royal Melbourne Hospital, Melbourne, Australia
| | - K Luyten
- Center of Metabolic Diseases, University Hospital, Antwerp, Belgium
| | - A MacDonald
- Birmingham Children's Hospital, Birmingham, UK.
| | - U Meyer
- Clinic of Paediatric Kidney, Liver- and Metabolic Diseases Medical School Hannover, Germany
| | | | - E Müller
- Children's Hospital Heidelberg, Germany
| | | | | | - M Robert
- Hôpital Universitaire des Enfants, Reine fabiola, Bruxelles, Belgium
| | - L V Robertson
- University Hospitals Birmingham NHS Foundation Trust, UK
| | | | - K Sahm
- Children's Hospital Heidelberg, Germany
| | - S Schultz
- Universitätsklinikum Hamburg-Eppendorf, Germany
| | | | - E Sjöqvist
- Children's Hospital, University Hospital Skåne, Sweden
| | - L Stoelen
- Oslo University Hospital Rikshospitalet, Norway
| | - A Terry
- Alderhey Children's Hospital, Liverpool, UK
| | - S Thompson
- Children's Hospital, Westmead, Sydney, Australia
| | | | | | | | | | - M van Rijn
- University of Groningen, University Medical Center Groningen, Netherlands
| | | | | | | | - J Wenz
- CHU Bicëtre Hospital, Paris, France
| | | | | | | |
Collapse
|
31
|
Aguiar A, Ahring K, Almeida MF, Assoun M, Belanger Quintana A, Bigot S, Bihet G, Blom Malmberg K, Burlina A, Bushueva T, Caris A, Chan H, Clark A, Clark S, Cochrane B, Corthouts K, Dalmau J, Dassy M, De Meyer A, Didycz B, Diels M, Dokupil K, Dubois S, Eftring K, Ekengren J, Ellerton C, Evans S, Faria A, Fischer A, Ford S, Freisinger P, Giżewska M, Gokmen-Ozel H, Gribben J, Gunden F, Heddrich-Ellerbrok M, Heiber S, Heidenborg C, Jankowski C, Janssen-Regelink R, Jones I, Jonkers C, Joerg-Streller M, Kaalund-Hansen K, Kiss E, Lammardo AM, Lang K, Lier D, Lilje R, Lowry S, Luyten K, MacDonald A, Meyer U, Moor D, Pal A, Robert M, Robertson L, Rocha JC, Rohde C, Ross K, Saruhan S, Sjöqvist E, Skeath R, Stoelen L, Ter Horst NM, Terry A, Timmer C, Tuncer N, Vande Kerckhove K, van der Ploeg L, van Rijn M, van Spronsen FJ, van Teeffelen-Heithoff A, van Wegberg A, van Wyk K, Vasconcelos C, Vitoria I, Wildgoose J, Webster D, White FJ, Zweers H. Practices in prescribing protein substitutes for PKU in Europe: No uniformity of approach. Mol Genet Metab 2015; 115:17-22. [PMID: 25862610 DOI: 10.1016/j.ymgme.2015.03.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 03/18/2015] [Accepted: 03/19/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND There appears little consensus concerning protein requirements in phenylketonuria (PKU). METHODS A questionnaire completed by 63 European and Turkish IMD centres from 18 countries collected data on prescribed total protein intake (natural/intact protein and phenylalanine-free protein substitute [PS]) by age, administration frequency and method, monitoring, and type of protein substitute. Data were analysed by European region using descriptive statistics. RESULTS The amount of total protein (from PS and natural/intact protein) varied according to the European region. Higher median amounts of total protein were prescribed in infants and children in Northern Europe (n=24 centres) (infants <1 year, >2-3g/kg/day; 1-3 years of age, >2-3 g/kg/day; 4-10 years of age, >1.5-2.5 g/kg/day) and Southern Europe (n=10 centres) (infants <1 year, 2.5 g/kg/day, 1-3 years of age, 2 g/kg/day; 4-10 years of age, 1.5-2 g/kg/day), than by Eastern Europe (n=4 centres) (infants <1 year, 2.5 g/kg/day, 1-3 years of age, >2-2.5 g/kg/day; 4-10 years of age, >1.5-2 g/kg/day) and with Western Europe (n=25 centres) giving the least (infants <1 year, >2-2.5 g/kg/day, 1-3 years of age, 1.5-2 g/kg/day; 4-10 years of age, 1-1.5 g/kg/day). Total protein prescription was similar in patients aged >10 years (1-1.5 g/kg/day) and maternal patients (1-1.5 g/kg/day). CONCLUSIONS The amounts of total protein prescribed varied between European countries and appeared to be influenced by geographical region. In PKU, all gave higher than the recommended 2007 WHO/FAO/UNU safe levels of protein intake for the general population.
Collapse
Affiliation(s)
- A Aguiar
- Hospital de Santo Espirito da Ilha Terceira, Portugal
| | - K Ahring
- Kennedy Centre, Department of Clinical Genetics, Rigshospitalet, University of Copenhagen, Glostrup, Denmark
| | - M F Almeida
- Centro de Genética Médica Doutor Jacinto de Magalhães, CHP EPE, Porto, Portugal; Multidisciplinary Unit for Biomedical Research, UMIB-FCT, Porto, Portugal
| | - M Assoun
- Service des Maladies Héréditaires du Métabolisme, Hospital Necker Enfants Malades, Paris, France
| | | | - S Bigot
- Centre Hospitalier Universitaire de Rennes, France
| | - G Bihet
- Centre Hospitalier Chrétien, Centre Pinocchio Liège, Belgium
| | | | - A Burlina
- Division of Inherited Metabolic Diseases, Department of Pediatrics, University Hospital of Padova, Italy
| | - T Bushueva
- Scientific Center of Children's Health, Moscow, Russian Federation
| | - A Caris
- Centre Wallon de Génétique Humaine, Maladies Métaboliques, CHU de Liège Sart-Tilman, Belgium
| | - H Chan
- Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - A Clark
- National Centre for Inherited Metabolic Disorders, Dublin, Ireland
| | - S Clark
- Addenbrooke's Hospital, Cambridge, UK
| | - B Cochrane
- Royal Hospital for Sick Children, Glasgow, Scotland, UK
| | - K Corthouts
- University Hospitals Leuven, Center of Metabolic Diseases, Leuven, Belgium
| | | | - M Dassy
- Cliniques Universitaires St Luc, Brussels, Belgium
| | - A De Meyer
- Center of Metabolic Diseases, University Hospital, Antwerp, Belgium
| | - B Didycz
- University Children's Hospital, Cracow, Poland
| | - M Diels
- University Hospitals Leuven, Center of Metabolic Diseases, ZOL, Genk, Belgium
| | - K Dokupil
- Dr. von Hauner Children's Hospital, Munich, Germany
| | - S Dubois
- Service des Maladies Héréditaires du Métabolisme, Hospital Necker Enfants Malades, Paris, France
| | - K Eftring
- Queen Silvia's Children Hospital, Gothenburg, Sweden
| | - J Ekengren
- Queen Silvia's Children Hospital, Gothenburg, Sweden
| | | | - S Evans
- Birmingham Children's Hospital, Birmingham, UK
| | - A Faria
- Hospital Pediatrico, Centro Hospitalar e Universitário de Coimbra, EPE, Portugal
| | - A Fischer
- Klinikum am Steinenberg, Klinik für Kinder- und Jugendmedizin Reutlingen, Germany
| | - S Ford
- North Bristol NHS Trust Southmead and Frenchay, UK
| | - P Freisinger
- Klinikum am Steinenberg, Klinik für Kinder- und Jugendmedizin Reutlingen, Germany
| | - M Giżewska
- Pomeranian Medical University, Szczecin, Poland
| | - H Gokmen-Ozel
- Haccettepe University Children's Hospital, Ankara, Turkey
| | - J Gribben
- Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - F Gunden
- Uludag University Medical Faculty, Bursa, Turkey
| | | | - S Heiber
- University Hospital, Basel, Switzerland
| | - C Heidenborg
- Karolinska University Hospital, Stockholm, Sweden
| | - C Jankowski
- University Hospitals Bristol NHS Foundation Trust, UK
| | | | - I Jones
- Center of Metabolic Diseases, University Hospital, Antwerp, Belgium
| | - C Jonkers
- Academic Medical Hospital, Amsterdam, Netherlands
| | - M Joerg-Streller
- Medical University of Innsbruck, Clinic for Pediatrics, Inherited Metabolic Disorders, Austria
| | | | - E Kiss
- Semmelweis University, Hungary
| | | | - K Lang
- Ninewells Hospital, Dundee, Scotland, UK
| | - D Lier
- Klinikum am Steinenberg, Klinik für Kinder- und Jugendmedizin Reutlingen, Germany
| | - R Lilje
- Oslo University Hospital Rikshospitalet, Norway
| | - S Lowry
- Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - K Luyten
- Center of Metabolic Diseases, University Hospital, Antwerp, Belgium
| | - A MacDonald
- Birmingham Children's Hospital, Birmingham, UK.
| | - U Meyer
- Clinic of Paediatric Kidney, Liver and Metabolic Diseases Medical School Hannover, Germany
| | - D Moor
- Kinderspital Zürich, Switzerland
| | - A Pal
- Akademiska University Hospital (Children's Centre), Sweden
| | - M Robert
- Hôpital Universitaire des Enfants, Reine Fabiola, Bruxelles, Belgium
| | | | - J C Rocha
- Centro de Genética Médica Doutor Jacinto de Magalhães, CHP EPE, Porto, Portugal; Faculdade de Ciências da Saúde, Universidade Fernando Pessoa, Porto, Portugal; Center for Health Technology and Services Research (CINTESIS), Portugal
| | - C Rohde
- Hospital for Children and Adolescents, University Hospitals, University of Leipzig, Germany
| | - K Ross
- Royal Aberdeen Children's Hospital, Scotland, UK
| | - S Saruhan
- Haccettepe University Children's Hospital, Ankara, Turkey
| | - E Sjöqvist
- Children's Hospital, University Hospital Skåne, Sweden
| | - R Skeath
- Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - L Stoelen
- Oslo University Hospital Rikshospitalet, Norway
| | | | - A Terry
- Alderhey Children's Hospital, Liverpool, UK
| | | | - N Tuncer
- Dokuz Eylül University Nevvar-Salih İşgören Children Hospital, Turkey
| | - K Vande Kerckhove
- University Hospitals Leuven, Center of Metabolic Diseases, Leuven, Belgium
| | | | - M van Rijn
- University of Groningen, University Medical Center, Groningen, Netherlands
| | - F J van Spronsen
- University of Groningen, University Medical Center, Groningen, Netherlands
| | | | - A van Wegberg
- Radboud University Nijmegen Medical Centre, Netherlands
| | - K van Wyk
- Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - C Vasconcelos
- Centro Hospitalar São João - Unidade de Doenças Metabólicas, Porto, Portugal
| | | | | | - D Webster
- University Hospitals Bristol NHS Foundation Trust, UK
| | - F J White
- Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - H Zweers
- Radboud University Nijmegen Medical Centre, Netherlands
| |
Collapse
|
32
|
Patil JJ, Ford S, Egeler C, Williams DJ. The effect of needle dimensions and infusion rates on injection pressures in regional anaesthesia needles: a bench-top study. Anaesthesia 2014; 70:183-9. [PMID: 25290190 DOI: 10.1111/anae.12869] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2014] [Indexed: 11/27/2022]
Abstract
Animal studies have shown that injection pressures > 75 kPa indicate probable intrafascicular needle tip position. This study describes the flow/pressure characteristics of seven common needle systems. A syringe pump delivered flow rates of 5, 6.67, 10, 13.3, 15 and 20 ml.min(-1) through these needle systems, while keeping the needle tips open to atmosphere. A pressure transducer connected between the syringe and needle provided a real-time graphical display for analysis. Mean plateau pressures increased linearly with flow and with decreasing needle diameter (2.7-92 kPa). Flow rates > 17 ml.min(-1) and needle sizes 22 G and smaller produced mean plateau pressures > 75 kPa. Pressure monitors upstream from the needle may produce false-positive alarms at high flow rates due to needle resistance, and unreliable readings due to non-laminar flow. We recommend injection rates ≤ 15 ml.min(-1) (0.25 ml.s(-1) ) to reduce the effect of factors upstream from the needle tip as a cause of high pressure readings.
Collapse
Affiliation(s)
- J J Patil
- Department of Anaesthesia and Intensive Care, Airedale General Hospital, Steeton, UK
| | | | | | | |
Collapse
|
33
|
Sankar MS, Vega MA, Defoe PP, Kibria MG, Ford S, Telfeyan K, Neal A, Mohajerin TJ, Hettiarachchi GM, Barua S, Hobson C, Johannesson K, Datta S. Elevated arsenic and manganese in groundwaters of Murshidabad, West Bengal, India. Sci Total Environ 2014; 488-489:570-9. [PMID: 24694939 DOI: 10.1016/j.scitotenv.2014.02.077] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2013] [Revised: 02/14/2014] [Accepted: 02/14/2014] [Indexed: 05/02/2023]
Abstract
High levels of geogenic arsenic (As) and manganese (Mn) in drinking water has led to widespread health problems for the population of West Bengal, India. Here we delineate the extent of occurrences of As and Mn in Murshidabad, where the contaminated aquifers occur at shallow depths between 35 and 40 m and where access to safe drinking water is a critical issue for the local population. A total of 78 well-water samples were taken in 4 blocks on either side of the river Bhagirathi: Nabagram and Kandi (west, Pleistocene sediments), Hariharpara and Beldanga (east, Holocene sediments). High As, total iron (FeT) and low Mn concentrations were found in waters from the Holocene gray sediment aquifers east of the river Bhagirathi, while the opposite was found in the Pleistocene reddish-brown aquifer west of the river Bhagirathi in Murshidabad. Speciation of As in water samples from Holocene sediments revealed the dominant species to be As(III), with ratios of As(III):AsT ranging from 0.55 to 0.98 (average 0.74). There were indications from saturation index estimations that Mn solubility is limited by the precipitation of MnCO3. Tubewells from high As areas in proximity to anthropogenic waste influx sources showing high molar Cl/Br ratios, low SO4(2-) and low NO3(-) demonstrate relatively lower As concentrations, thereby reducing As pollution in those wells. Analyses of core samples (2 in each of the blocks) drilled to a depth of 45 m indicate that there is no significant variation in bulk As (5-20mg/kg) between the Holocene and Pleistocene sediments, indicating that favorable subsurface redox conditions conducive to mobilization are responsible for the release of As. The same applies to Mn, but concentrations vary more widely (20-2000 mg/kg). Sequential extraction of Holocene sediments showed As to be associated with 'specifically sorbed-phosphate-extractable' phases (10-15%) and with 'amorphous and well crystalline Fe-oxyhydroxide' phases (around 37%) at As-contaminated well depths, suggesting that the main As release mechanisms could be either competitive ion exchange with PO4(3-), or the dissolution of Fe oxyhydroxides. In the Pleistocene sediments Mn is predominantly found in the easily exchangeable fraction.
Collapse
Affiliation(s)
- M S Sankar
- Department of Geology, Kansas State University, Manhattan, KS 66506, USA
| | - M A Vega
- Department of Geology, Kansas State University, Manhattan, KS 66506, USA
| | - P P Defoe
- Department of Agronomy, Kansas State University, Manhattan, KS 66506, USA
| | - M G Kibria
- Department of Geology, Kansas State University, Manhattan, KS 66506, USA
| | - S Ford
- Department of Geology, Kansas State University, Manhattan, KS 66506, USA
| | - K Telfeyan
- Department of Earth and Environmental Sciences, Tulane University, New Orleans 70118, USA
| | - A Neal
- Virginia Water Resources Research Center, Virginia Tech, VA 24061, USA
| | - T J Mohajerin
- Department of Earth and Environmental Sciences, Tulane University, New Orleans 70118, USA
| | - G M Hettiarachchi
- Department of Agronomy, Kansas State University, Manhattan, KS 66506, USA
| | - S Barua
- Department of Geology, Kansas State University, Manhattan, KS 66506, USA
| | - C Hobson
- Department of Geology, Kansas State University, Manhattan, KS 66506, USA
| | - K Johannesson
- Department of Earth and Environmental Sciences, Tulane University, New Orleans 70118, USA
| | - S Datta
- Department of Geology, Kansas State University, Manhattan, KS 66506, USA.
| |
Collapse
|
34
|
Affiliation(s)
- S. Ford
- National Hospital for Neurology and Neurosurgery; London UK
| |
Collapse
|
35
|
|
36
|
French L, Ford S. TAP block--what is the endpoint? Anaesthesia 2013; 68:867. [PMID: 24044444 DOI: 10.1111/anae.12350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
37
|
Affiliation(s)
- C. Egeler
- Abertawe Bro Morgannwg University Health Board; Swansea; Wales
| | - A. Jayakumar
- Abertawe Bro Morgannwg University Health Board; Swansea; Wales
| | - S. Ford
- Abertawe Bro Morgannwg University Health Board; Swansea; Wales
| |
Collapse
|
38
|
Nguyen RH, Ford S, Calhoun AH, Holden JK, Gracely RH, Tommerdahl M. Neurosensory assessments of migraine. Brain Res 2013; 1498:50-8. [PMID: 23298830 DOI: 10.1016/j.brainres.2012.12.043] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Revised: 12/17/2012] [Accepted: 12/29/2012] [Indexed: 11/26/2022]
Abstract
Headache medicine is primarily dependent on patients' subjective reports of pain, which are assessed at diagnosis and throughout the duration of treatment. There is a need for an objective, quantitative biological measurement of headache pain severity. In this study, quantitative sensory testing (QST) was conducted via multi-site vibrotactile stimulation in patients with migraine. The purpose was to investigate the sensitivity of the method and to determine if the metrics obtained from migraineurs could be differentiated from controls. Metrics reflecting sensory percepts of baseline measures of stimulus amplitude discrimination, temporal order judgment, and duration discrimination were significantly different. Additional measures previously demonstrated to be sensitive to alterations in centrally-mediated information processing features such as adaptation and synchronization were also significantly different from control values. In contrast, reaction times and vibrotactile detection thresholds of migraineurs failed to differentiate them from controls, indicating that the results are not due to peripheral neuropathy or some other primary afferent mechanism. The long-term objective of the study is to develop methods that can improve diagnosis and enable more accurate assessments of treatment efficacy in migraine.
Collapse
Affiliation(s)
- R H Nguyen
- Department of Biomedical Engineering, University of North Carolina at Chapel Hill, USA
| | - S Ford
- Carolina Headache Institute, USA
| | | | - J K Holden
- Department of Biomedical Engineering, University of North Carolina at Chapel Hill, USA
| | - R H Gracely
- School of Dentistry, University of North Carolina at Chapel Hill, USA
| | - M Tommerdahl
- Department of Biomedical Engineering, University of North Carolina at Chapel Hill, USA.
| |
Collapse
|
39
|
|
40
|
Green S, Phoenix B, Thompson J, Ngoga D, Detta A, James N, Doran J, Graham N, Ghani Z, Wojnecki C, Halbert G, Elliott M, Ford S, Sheehan T, Vickerman J, Lockyer N, Croswell G, Boddy A, King A, Parker D, Edgecock T, Bennett J, Scott M, Skoro G, Cruickshank G. 308 THE BIRMINGHAM BNCT PROJECT: DEVELOPMENTS TOWARDS SELECTIVE INTERNAL PARTICLE THERAPY. Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)70269-4] [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: 10/28/2022]
|
41
|
Garrett CR, Siu LL, El-Khoueiry A, Buter J, Rocha-Lima CM, Marshall J, LoRusso P, Major P, Chemidlin J, Mokliatchouk O, Velasquez L, Hayes W, Feltquate D, Syed S, Ford S, Kollia G, Galbraith S, Nuyten DSA. Phase I dose-escalation study to determine the safety, pharmacokinetics and pharmacodynamics of brivanib alaninate in combination with full-dose cetuximab in patients with advanced gastrointestinal malignancies who have failed prior therapy. Br J Cancer 2011; 105:44-52. [PMID: 21629245 PMCID: PMC3137402 DOI: 10.1038/bjc.2011.182] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background: The objectives of this phase I study were to determine the safety, pharmacokinetics (PK), pharmacodynamics and efficacy of brivanib combined with full-dose cetuximab in patients with advanced gastrointestinal malignancies. Methods: Patients with advanced gastrointestinal malignancies who had failed prior therapies received brivanib (320, 600 or 800 mg daily) plus cetuximab (400 mg m–2 loading dose then 250 mg m–2 weekly). Assessments included adverse events, PK, tumour response, 2[18F]fluoro-2-deoxyglucose positron-emitting tomography and K-Ras mutation analyses. Results: Toxicities observed were manageable; the most common treatment-related toxicities (>10% of patients) were fatigue, diarrhoea, anorexia, increase in aspartate aminotransferase and alanine aminotransferase, acneiform dermatitis, headache, mucosal inflammation, nausea, dry skin, vomiting, hypertension, pruritus, proteinuria and weight loss. Of 62 patients, 6 (9.7%) had objective radiographic partial responses, with an overall response rate of 10%. Median duration of response was 9.2 months; median progression-free survival was 3.9 months. Conclusions: The acceptable toxicity profile and efficacy of brivanib observed in this study were promising. These findings are being further evaluated in a phase III study of brivanib plus cetuximab vs cetuximab alone in patients previously treated with combination chemotherapy for K-Ras wild-type advanced metastatic colorectal cancer.
Collapse
Affiliation(s)
- C R Garrett
- Department of Gastrointestinal Oncology, Unit 426, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030-4009, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Green S, Phoenix B, Mill A, Hill M, Charles M, Thompson J, Jones B, Ngoga D, Detta A, James N, Doran J, Graham N, Ghani Z, Wojnecki C, Halbert G, Elliott M, Ford S, Sheehan T, Vickerman J, Lockyer N, Croswell G, Boddy A, King A, Cruickshank G. The Birmingham Boron Neutron Capture Therapy (BNCT) Project:. Clin Oncol (R Coll Radiol) 2011. [DOI: 10.1016/j.clon.2011.01.378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
43
|
|
44
|
Thompson WC, Ford S, Gilder JR, Inman K, Jamieson A, Koppl R, Kornfield IL, Krane DE, Mnookin JL, Risinger DM, Rudin N, Saks MJ, Zabell SL. Commentary on: Thornton JI. Letter to the editor-a rejection of “working blind” as a cure for contextual bias. J Forensic Sci 2010;55(6):1663. J Forensic Sci 2011; 56:562-3. [DOI: 10.1111/j.1556-4029.2010.01679.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
45
|
Weems C, Weems Y, Arreguin-Arevalo J, Nett T, Jeoung M, Bridges P, Vann R, Ford S, Neuendorff D, Lewis A, Welsh T, Randel R. Prostaglandin (PG) E1 or E2 (PGE1, PGE2) Intra-luteal Implants Alters mRNA for PG Receptors and mRNA for LH and Its Receptors to Prevent Luteolysis in Cows. Biol Reprod 2010. [DOI: 10.1093/biolreprod/83.s1.227] [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: 11/13/2022] Open
|
46
|
Krane DE, Ford S, Gilder JR, Inman K, Jamieson A, Koppl R, Kornfield IL, Michael Risinger D, Rudin N, Taylor MS, Thompson WC. Commentary on: Budowle B, Bottrell MC, Bunch SG, Fram R, Harrison D, Meagher S, Oien CT, Peterson PE, Seiger DP,Smith MB, Smrz MA, Soltis GL, Stacey RB. A perspective on errors, bias, and interpretation in the forensic sciences and direction for continuing advancement. J Forensic Sci 2009;54(4):798-809. J Forensic Sci 2010; 55:273-4; author reply 275-6. [PMID: 20412161 DOI: 10.1111/j.1556-4029.2009.01259.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
47
|
Abstract
BACKGROUND Patient monitoring displays are designed to improve patient safety, and yet little is known about how anesthesiologists interact with these displays. Previous studies of clinician behavior used an observer in the operating room, which may have altered behavior. We describe a covert observation technique to determine how often and for how long anesthesiologists actually look at the monitoring display during different segments of the maintenance phase of anesthesia, and to determine whether this changed with more than 1 anesthesia provider or during concomitant activities such as reading. METHODS Five staff anesthesiologists, 2 anesthesia fellows, 3 anesthesia residents, and 2 medical students were covertly videotaped across 10 dual anesthesia provider cases and 10 solo cases. Videotapes were later segmented (5 minutes postinduction [early maintenance], mid-maintenance, and immediately before the drapes came down [late maintenance]) and coded for looking behavior at the patient monitor, anesthesia chart, and other reading material. RESULTS Anesthesiologists looked at the monitor in 1- to 2-second glances, performed frequently throughout the 3 segments of maintenance anesthesia. Overall, the patient monitor was looked at only 5 of the analyzed time, which is less than has previously been reported. Monitoring behavior was constant across the segments of maintenance anesthesia and was not significantly affected by the number of anesthesia providers or role (trainee vs. senior). In contrast, charting behavior and other reading material viewing changed significantly over the analyzed segments of maintenance anesthesia. CONCLUSIONS The presence of "at-a-glance monitoring" has implications for the design of patient monitoring displays. Displays should be developed to optimize the information obtained from brief glances at the monitor.
Collapse
Affiliation(s)
- Simon Ford
- Department of Anesthesia, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | | | | | | | | |
Collapse
|
48
|
Krane DE, Bahn V, Balding D, Barlow B, Cash H, Desportes BL, D'Eustachio P, Devlin K, Doom TE, Dror I, Ford S, Funk C, Gilder J, Hampikian G, Inman K, Jamieson A, Kent PE, Koppl R, Kornfield I, Krimsky S, Mnookin J, Mueller L, Murphy E, Paoletti DR, Petrov DA, Raymer M, Risinger DM, Roth A, Rudin N, Shields W, Siegel JA, Slatkin M, Song YS, Speed T, Spiegelman C, Sullivan P, Swienton AR, Tarpey T, Thompson WC, Ungvarsky E, Zabell S. Time for DNA disclosure. Science 2010; 326:1631-2. [PMID: 20019271 DOI: 10.1126/science.326.5960.1631] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
|
49
|
|
50
|
Ford S, Dosani M, Robinson AJ, Campbell GC, Ansermino JM, Lim J, Lauder GR. Defining the Reliability of Sonoanatomy Identification by Novices in Ultrasound-Guided Pediatric Ilioinguinal and Iliohypogastric Nerve Blockade. Anesth Analg 2009; 109:1793-8. [DOI: 10.1213/ane.0b013e3181bce5a5] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|