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Dooney M, Saba T. Supporting the case for a targeted approach for elexacaftor/tezacaftor/ivacaftor in people with cystic fibrosis with no F508del CFTR variant: further analysis for the French compassionate use programme. Eur Respir J 2024; 63:2301392. [PMID: 38423592 DOI: 10.1183/13993003.01392-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 12/08/2023] [Indexed: 03/02/2024]
Affiliation(s)
- Michael Dooney
- Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool Adult Cystic Fibrosis Service, Blackpool Victoria Hospital, Blackpool, UK
| | - Tarek Saba
- Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool Adult Cystic Fibrosis Service, Blackpool Victoria Hospital, Blackpool, UK
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Bedawi EO, Stavroulias D, Hedley E, Blyth KG, Kirk A, De Fonseka D, Edwards JG, Internullo E, Corcoran JP, Marchbank A, Panchal R, Caruana E, Kadwani O, Okiror L, Saba T, Purohit M, Mercer RM, Taberham R, Kanellakis N, Condliffe AM, Lewis LG, Addala DN, Asciak R, Banka R, George V, Hassan M, McCracken D, Sundaralingam A, Wrightson JM, Dobson M, West A, Barnes G, Harvey J, Slade M, Chester-Jones M, Dutton S, Miller RF, Maskell NA, Belcher E, Rahman NM. Early Video-assisted Thoracoscopic Surgery or Intrapleural Enzyme Therapy in Pleural Infection: A Feasibility Randomized Controlled Trial. The Third Multicenter Intrapleural Sepsis Trial-MIST-3. Am J Respir Crit Care Med 2023; 208:1305-1315. [PMID: 37820359 PMCID: PMC10765402 DOI: 10.1164/rccm.202305-0854oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 10/11/2023] [Indexed: 10/13/2023] Open
Abstract
Rationale: Assessing the early use of video-assisted thoracoscopic surgery (VATS) or intrapleural enzyme therapy (IET) in pleural infection requires a phase III randomized controlled trial (RCT). Objectives: To establish the feasibility of randomization in a surgery-versus-nonsurgery trial as well as the key outcome measures that are important to identify relevant patient-centered outcomes in a subsequent RCT. Methods: The MIST-3 (third Multicenter Intrapleural Sepsis Trial) was a prospective multicenter RCT involving eight U.K. centers combining on-site and off-site surgical services. The study enrolled all patients with a confirmed diagnosis of pleural infection and randomized those with ongoing pleural sepsis after an initial period (as long as 24 h) of standard care to one of three treatment arms: continued standard care, early IET, or a surgical opinion with regard to early VATS. The primary outcome was feasibility based on >50% of eligible patients being successfully randomized, >95% of randomized participants retained to discharge, and >80% of randomized participants retained to 2 weeks of follow-up. The analysis was performed per intention to treat. Measurements and Main Results: Of 97 eligible patients, 60 (62%) were randomized, with 100% retained to discharge and 84% retained to 2 weeks. Baseline demographic, clinical, and microbiological characteristics of the patients were similar across groups. Median times to intervention were 1.0 and 3.5 days in the IET and surgery groups, respectively (P = 0.02). Despite the difference in time to intervention, length of stay (from randomization to discharge) was similar in both intervention arms (7 d) compared with standard care (10 d) (P = 0.70). There were no significant intergroup differences in 2-month readmission and further intervention, although the study was not adequately powered for this outcome. Compared with VATS, IET demonstrated a larger improvement in mean EuroQol five-dimension health utility index (five-level edition) from baseline (0.35) to 2 months (0.83) (P = 0.023). One serious adverse event was reported in the VATS arm. Conclusions: This is the first multicenter RCT of early IET versus early surgery in pleural infection. Despite the logistical challenges posed by the coronavirus disease (COVID-19) pandemic, the study met its predefined feasibility criteria, demonstrated potential shortening of length of stay with early surgery, and signals toward earlier resolution of pain and a shortened recovery with IET. The study findings suggest that a definitive phase III study is feasible but highlights important considerations and significant modifications to the design that would be required to adequately assess optimal initial management in pleural infection.The trial was registered on ISRCTN (number 18,192,121).
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Affiliation(s)
- Eihab O. Bedawi
- Oxford Respiratory Trials Unit, Nuffield Department of Medicine
- National Institute for Health and Care Research Oxford Biomedical Research Centre
- Oxford Centre for Respiratory Medicine and
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
- Academic Directorate of Respiratory Medicine
| | - Dionisios Stavroulias
- Department of Cardiothoracic Surgery, John Radcliffe Hospital, Oxford University Hospitals National Health Service (NHS) Foundation Trust, Oxford, United Kingdom
| | - Emma Hedley
- Oxford Respiratory Trials Unit, Nuffield Department of Medicine
| | - Kevin G. Blyth
- School of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom
- Department of Respiratory Medicine, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Alan Kirk
- Department of Thoracic Surgery, Golden Jubilee National Hospital, Glasgow, United Kingdom
| | | | - John G. Edwards
- Department of Thoracic Surgery, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Eveline Internullo
- Department of Thoracic Surgery, Bristol Royal Infirmary, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | | | - Adrian Marchbank
- Department of Cardiothoracic Surgery, Derriford Hospital, University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom
| | - Rakesh Panchal
- Department of Respiratory Medicine, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Edward Caruana
- Department of Thoracic Surgery, Glenfield Hospitals, University Hospitals of Leicester, Leicester, United Kingdom
| | | | - Lawrence Okiror
- Department of Thoracic Surgery, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | | | - Manoj Purohit
- Department of Cardiothoracic Surgery, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, United Kingdom
| | - Rachel M. Mercer
- Portsmouth Hospitals NHS Trust, Queen Alexandra Hospital, Portsmouth, United Kingdom
| | - Rhona Taberham
- Department of Cardiothoracic Surgery, John Radcliffe Hospital, Oxford University Hospitals National Health Service (NHS) Foundation Trust, Oxford, United Kingdom
| | - Nikolaos Kanellakis
- Oxford Respiratory Trials Unit, Nuffield Department of Medicine
- National Institute for Health and Care Research Oxford Biomedical Research Centre
- Laboratory of Pleural and Lung Cancer Translational Research
- Chinese Academy of Medical Sciences Oxford Institute, Nuffield Department of Medicine, and
| | - Alison M. Condliffe
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
- Academic Directorate of Respiratory Medicine
| | | | - Dinesh N. Addala
- Oxford Respiratory Trials Unit, Nuffield Department of Medicine
- National Institute for Health and Care Research Oxford Biomedical Research Centre
- Oxford Centre for Respiratory Medicine and
| | - Rachelle Asciak
- Portsmouth Hospitals NHS Trust, Queen Alexandra Hospital, Portsmouth, United Kingdom
| | - Radhika Banka
- Department of Respiratory Medicine, PD Hinduja National Hospital, Mumbai, India
| | - Vineeth George
- Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Maged Hassan
- Chest Diseases Department, Alexandria University, Alexandria, Egypt
| | - David McCracken
- Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, Northern Ireland
| | - Anand Sundaralingam
- Oxford Respiratory Trials Unit, Nuffield Department of Medicine
- Oxford Centre for Respiratory Medicine and
| | - John M. Wrightson
- Oxford Respiratory Trials Unit, Nuffield Department of Medicine
- Oxford Centre for Respiratory Medicine and
| | - Melissa Dobson
- Oxford Respiratory Trials Unit, Nuffield Department of Medicine
- National Institute for Health and Care Research Oxford Biomedical Research Centre
| | - Alex West
- Department of Respiratory Medicine and
| | | | - John Harvey
- Department of Respiratory Medicine, North Bristol NHS Trust, Bristol, United Kingdom
- Academic Respiratory Unit, University of Bristol, Bristol, United Kingdom
| | - Mark Slade
- Department of Respiratory Medicine, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, United Kingdom; and
| | - Mae Chester-Jones
- Oxford Centre for Statistics in Medicine, University of Oxford, Oxford, United Kingdom
| | - Susan Dutton
- Oxford Centre for Statistics in Medicine, University of Oxford, Oxford, United Kingdom
| | - Robert F. Miller
- Institute for Global Health, University College London, London, United Kingdom
| | - Nick A. Maskell
- Department of Respiratory Medicine, North Bristol NHS Trust, Bristol, United Kingdom
- Academic Respiratory Unit, University of Bristol, Bristol, United Kingdom
| | - Elizabeth Belcher
- Department of Cardiothoracic Surgery, John Radcliffe Hospital, Oxford University Hospitals National Health Service (NHS) Foundation Trust, Oxford, United Kingdom
| | - Najib M. Rahman
- Oxford Respiratory Trials Unit, Nuffield Department of Medicine
- National Institute for Health and Care Research Oxford Biomedical Research Centre
- Laboratory of Pleural and Lung Cancer Translational Research
- Chinese Academy of Medical Sciences Oxford Institute, Nuffield Department of Medicine, and
- Oxford Centre for Respiratory Medicine and
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Martin FL, Morais CLM, Dickinson AW, Saba T, Bongers T, Singh MN, Bury D. Point-of-Care Disease Screening in Primary Care Using Saliva: A Biospectroscopy Approach for Lung Cancer and Prostate Cancer. J Pers Med 2023; 13:1533. [PMID: 38003848 PMCID: PMC10672293 DOI: 10.3390/jpm13111533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 10/17/2023] [Accepted: 10/23/2023] [Indexed: 11/26/2023] Open
Abstract
Saliva is a largely unexplored liquid biopsy that can be readily obtained noninvasively. Not dissimilar to blood plasma or serum, it contains a vast array of bioconstituents that may be associated with the absence or presence of a disease condition. Given its ease of access, the use of saliva is potentially ideal in a point-of-care screening or diagnostic test. Herein, we developed a swab "dip" test in saliva obtained from consenting patients participating in a lung cancer-screening programme being undertaken in north-west England. A total of 998 saliva samples (31 designated as lung-cancer positive and 17 as prostate-cancer positive) were taken in the order in which they entered the clinic (i.e., there was no selection of participants) during the course of this prospective screening programme. Samples (sterile Copan blue rayon swabs dipped in saliva) were analysed using attenuated total reflection Fourier-transform infrared (ATR-FTIR) spectroscopy. In addition to unsupervised classification on resultant infrared (IR) spectra using principal component analysis (PCA), a range of feature selection/extraction algorithms were tested. Following preprocessing, the data were split between training (70% of samples, 22 lung-cancer positive versus 664 other) and test (30% of samples, 9 lung-cancer positive versus 284 other) sets. The training set was used for model construction and the test set was used for validation. The best model was the PCA-quadratic discriminant analysis (QDA) algorithm. This PCA-QDA model was built using 8 PCs (90.4% of explained variance) and resulted in 93% accuracy for training and 91% for testing, with clinical sensitivity at 100% and specificity at 91%. Additionally, for prostate cancer patients amongst the male cohort (n = 585), following preprocessing, the data were split between training (70% of samples, 12 prostate-cancer positive versus 399 other) and test (30% of samples, 5 prostate-cancer positive versus 171 other) sets. A PCA-QDA model, again the best model, was built using 5 PCs (84.2% of explained variance) and resulted in 97% accuracy for training and 93% for testing, with clinical sensitivity at 100% and specificity at 92%. These results point to a powerful new approach towards the capability to screen large cohorts of individuals in primary care settings for underlying malignant disease.
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Affiliation(s)
- Francis L. Martin
- Biocel UK Ltd., Hull HU10 6TS, UK;
- Department of Cellular Pathology, Blackpool Teaching Hospitals NHS Foundation Trust, Whinney Heys Road, Blackpool FY3 8NR, UK; (A.W.D.); (T.S.); (T.B.)
| | - Camilo L. M. Morais
- Center for Education, Science and Technology of the Inhamuns Region, State University of Ceará, Tauá 63660-000, Brazil;
| | - Andrew W. Dickinson
- Department of Cellular Pathology, Blackpool Teaching Hospitals NHS Foundation Trust, Whinney Heys Road, Blackpool FY3 8NR, UK; (A.W.D.); (T.S.); (T.B.)
| | - Tarek Saba
- Department of Cellular Pathology, Blackpool Teaching Hospitals NHS Foundation Trust, Whinney Heys Road, Blackpool FY3 8NR, UK; (A.W.D.); (T.S.); (T.B.)
| | - Thomas Bongers
- Department of Cellular Pathology, Blackpool Teaching Hospitals NHS Foundation Trust, Whinney Heys Road, Blackpool FY3 8NR, UK; (A.W.D.); (T.S.); (T.B.)
| | - Maneesh N. Singh
- Biocel UK Ltd., Hull HU10 6TS, UK;
- Chesterfield Royal Hospital, Chesterfield Road, Calow, Chesterfield S44 5BL, UK
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Saba T. Using positive matrix factorization to unmix PAH fingerprints in contaminated sediments. Environ Monit Assess 2023; 195:1003. [PMID: 37500981 DOI: 10.1007/s10661-023-11615-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 07/17/2023] [Indexed: 07/29/2023]
Abstract
Some of the challenges to apportioning PAH-related remedy costs at contaminated sediment sites include the lack of source samples, different PAH signatures associated with the same source, historical PAH sources long removed, mixing of urban sediment by boat traffic, and, in turn, PAHs mixing and weathering. Unmixing of PAH fingerprints in sediment sites to PAH source classes (petrogenic, pyrogenic, and runoff) is typically a first step to tracking PAH upland sources and ultimately, responsible parties. This work demonstrates using positive matrix factorization (PMF) as a method to unmix PAH fingerprints to its source classes.A large PAH dataset (over 700 samples) assembled from contaminated urban sediment sites was used as an input to PMF. Using a 3-factor PMF analysis, a petrogenic, pyrogenic, and runoff/weathered PAH end-member fingerprints were identified. Different numerical mixing percentages of the PMF-identified end-member sources were able to replicate the sediment-measured PAH fingerprints, with the percent contribution of each of the end members to each sediment sample calculated. The demonstrated work provides a method to satisfy the unmixing of PAH fingerprints to its source classes, as a step towards apportioning of PAH contamination.
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Affiliation(s)
- Tarek Saba
- Exponent, Inc, 1 Mill and Main, Suite 150, Maynard, MA, 01754, Maynard, USA.
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Martin FL, Dickinson AW, Saba T, Bongers T, Singh MN, Bury D. ATR-FTIR Spectroscopy with Chemometrics for Analysis of Saliva Samples Obtained in a Lung-Cancer-Screening Programme: Application of Swabs as a Paradigm for High Throughput in a Clinical Setting. J Pers Med 2023; 13:1039. [PMID: 37511652 PMCID: PMC10381591 DOI: 10.3390/jpm13071039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 06/18/2023] [Accepted: 06/19/2023] [Indexed: 07/30/2023] Open
Abstract
There is an increasing need for inexpensive and rapid screening tests in point-of-care clinical oncology settings. Herein, we develop a swab "dip" test in saliva obtained from consenting patients participating in a lung-cancer-screening programme being undertaken in North West England. In a pilot study, a total of 211 saliva samples (n = 170 benign, 41 designated cancer-positive) were randomly taken during the course of this prospective lung-cancer-screening programme. The samples (sterile Copan blue rayon swabs dipped in saliva) were analysed using attenuated total reflection Fourier-transform infrared (ATR-FTIR) spectroscopy. An exploratory analysis using principal component analysis (PCA,) with or without linear discriminant analysis (LDA), was then undertaken. Three pairwise comparisons were undertaken including: (1) benign vs. cancer following swab analysis; (2) benign vs. cancer following swab analysis with the subtraction of dry swab spectra; and (3) benign vs. cancer following swab analysis with the subtraction of wet swab spectra. Consistent and remarkably similar patterns of clustering for the benign control vs. cancer categories, irrespective of whether the swab plus saliva sample was analysed or whether there was a subtraction of wet or dry swab spectra, was observed. In each case, MANOVA demonstrated that this segregation of categories is highly significant. A k-NN (using three nearest neighbours) machine-learning algorithm also showed that the specificity (90%) and sensitivity (75%) are consistent for each pairwise comparison. In detailed analyses, the swab as a substrate did not alter the level of spectral discrimination between benign control vs. cancer saliva samples. These results demonstrate a novel swab "dip" test using saliva as a biofluid that is highly applicable to be rolled out into a larger lung-cancer-screening programme.
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Affiliation(s)
- Francis L Martin
- Biocel UK Ltd., Hull HU10 6TS, UK
- Department of Cellular Pathology, Blackpool Teaching Hospitals NHS Foundation Trust, Whinney Heys Road, Blackpool FY3 8NR, UK
| | - Andrew W Dickinson
- Department of Cellular Pathology, Blackpool Teaching Hospitals NHS Foundation Trust, Whinney Heys Road, Blackpool FY3 8NR, UK
| | - Tarek Saba
- Department of Cellular Pathology, Blackpool Teaching Hospitals NHS Foundation Trust, Whinney Heys Road, Blackpool FY3 8NR, UK
| | - Thomas Bongers
- Department of Cellular Pathology, Blackpool Teaching Hospitals NHS Foundation Trust, Whinney Heys Road, Blackpool FY3 8NR, UK
| | - Maneesh N Singh
- Biocel UK Ltd., Hull HU10 6TS, UK
- Chesterfield Royal Hospital, Chesterfield Road, Calow, Chesterfield S44 5BL, UK
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6
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Dooney M, Saba T. P082 Reduced-dose Kaftrio® can significantly improve respiratory health for those intolerant of the recommended dosing schedule. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)00415-5] [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: 10/18/2022]
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Mercer RM, Mishra E, Banka R, Corcoran JP, Daneshvar C, Panchal RK, Saba T, Caswell M, Johnstone S, Menzies D, Ahmer S, Shahidi M, Clive AO, Gautam M, Cox G, Orton C, Lyons J, Maddekar N, De Fonseka D, Prior K, Barnes S, Robinson G, Brown L, Munavvar M, Shah PL, Hallifax RJ, Blyth KG, Hedley E, Maskell NA, Gerry S, Miller RF, Rahman NM, Kemp SV. A randomised controlled trial of intrapleural balloon intercostal chest drains to prevent drain displacement. Eur Respir J 2021; 60:13993003.01753-2021. [PMID: 34949702 DOI: 10.1183/13993003.01753-2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 11/23/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND Chest drain displacement is a common clinical problem, occurring in 9-42% of cases and results in treatment failure or additional pleural procedures conferring unnecessary risk. A novel chest drain with an integrated intrapleural balloon may reduce the risk of displacement. METHODS Prospective randomised controlled trial comparing the balloon drain to standard care (12 F chest drain with no balloon) with the primary outcome of objectively-defined unintentional or accidental chest drain displacement. RESULTS 267 patients were randomised (primary outcome data available in 257, 96.2%). Displacement occurred less frequently using the balloon drain (displacement 5/128, 3.9%; standard care displacement 13/129, 10.1%) but this was not statistically significant (Odds Ratio (OR) for drain displacement 0.36, 95% CI 0.13 to 1.0, χ2 1df=2.87, p=0.09). Adjusted analysis to account for minimisation factors and use of drain sutures demonstrated balloon drains were independently associated with reduced drain fall out rate (adjusted OR 0.27, 95% CI 0.08 to 0.87, p=0.028). Adverse events were higher in the balloon arm than the standard care arm (balloon drain 59/131, 45.0%; standard care 18/132, 13.6%; χ2 1df=31.3, p<0.0001). CONCLUSION Balloon drains reduce displacement compared with standard drains independent of the use of sutures but are associated with increased adverse events specifically during drain removal. The potential benefits of the novel drain should be weighed against the risks, but may be considered in practices where sutures are not routinely used.
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Affiliation(s)
- Rachel M Mercer
- University of Oxford Respiratory Trials Unit, Churchill Hospital, Oxford, UK.,Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Eleanor Mishra
- Department of Respiratory Medicine, Norfolk and Norwich University Hospitals, Norwich, UK
| | - Radhika Banka
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, UK.,Department of Respiratory Medicine, Norfolk and Norwich University Hospitals, Norwich, UK
| | | | | | - Rakesh K Panchal
- Institute for Lung Health, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Tarek Saba
- Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - Melanie Caswell
- Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - Sarah Johnstone
- Institute for Lung Health, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | | | | | - Amelia O Clive
- Academic Respiratory Unit, Bristol Medical School, Southmead Hospital, University of Bristol, Bristol, UK
| | - Manish Gautam
- Department of Respiratory Medicine, Royal Liverpool and Broadgreen University Hospital, Liverpool, UK
| | | | | | - Judith Lyons
- North West Lung Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | | | - Duneesha De Fonseka
- Department of Respiratory Medicine, Sheffield Teaching Hospitals, Sheffield, UK
| | | | - Simon Barnes
- Somerset Lung Centre, Musgrove Park Hospital, Taunton, UK
| | | | - Louise Brown
- North Manchester General Hospital, Manchester, UK
| | | | - Palav L Shah
- Royal Brompton Hospital, London, UK.,National Heart and Lung Institute, Imperial College, London, UK
| | - Robert J Hallifax
- University of Oxford Respiratory Trials Unit, Churchill Hospital, Oxford, UK.,Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Kevin G Blyth
- Queen Elizabeth University Hospital, Glasgow/Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Emma Hedley
- University of Oxford Respiratory Trials Unit, Churchill Hospital, Oxford, UK.,Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Nick A Maskell
- Academic Respiratory Unit, Bristol Medical School, Southmead Hospital, University of Bristol, Bristol, UK
| | - Stephen Gerry
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Robert F Miller
- Institute for Global Health, University College London, London, UK
| | - Najib M Rahman
- University of Oxford Respiratory Trials Unit, Churchill Hospital, Oxford, UK .,Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, UK.,NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK.,NMR and SVK contributed jointly
| | - Samuel V Kemp
- Royal Brompton Hospital, London, UK.,National Heart and Lung Institute, Imperial College, London, UK
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Bradley P, Nixon J, Wilson J, Redfern J, Saba T, Nuttall E, Bongers T. Continuous positive airway pressure (CPAP) as a ceiling of care treatment for hypoxaemic respiratory failure due to COVID-19. Clin Med (Lond) 2021; 21:21-22. [PMID: 34078682 DOI: 10.7861/clinmed.21-2-s21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Patrick Bradley
- Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - Jennifer Nixon
- Lancashire Teaching Hospitals NHS Foundation Trust, Lancashire, UK
| | - James Wilson
- Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - James Redfern
- Lancashire Teaching Hospitals NHS Foundation Trust, Lancashire, UK
| | - Tarek Saba
- Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - Emily Nuttall
- Lancashire Teaching Hospitals NHS Foundation Trust, Lancashire, UK
| | - Thomas Bongers
- Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
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Bradley P, Nixon J, Wilson J, Redfern J, Saba T, Nuttall E, Bongers T. Continuous positive airway pressure (CPAP) as a ceiling of care treatment for hypoxemic respiratory failure due to COVID-19. J Intensive Care Soc 2021; 23:366-368. [PMID: 36033250 PMCID: PMC9403526 DOI: 10.1177/1751143721996538] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Patrick Bradley
- Respiratory Department, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - Jennifer Nixon
- Respiratory Department, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - James Wilson
- Respiratory Department, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - James Redfern
- Respiratory Department, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Tarek Saba
- Respiratory Department, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - Emily Nuttall
- Respiratory Department, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Thomas Bongers
- Respiratory Department, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
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Dooney M, Saba T. P045 Are people with cystic fibrosis reducing their medication since Kaftrio® initiation? J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01072-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Pickering N, Saba T. P092 Embedding an electronic patient record into a developing UK service and impact during the COVID-19 pandemic - Blackpool Adult Cystic Fibrosis Service (BACFS). J Cyst Fibros 2021. [PMCID: PMC8192176 DOI: 10.1016/s1569-1993(21)01119-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Dooney M, Saba T. P046 Menstrual abnormalities linked to Kaftrio®. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01073-0] [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: 11/28/2022]
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Sanderson-Thomas A, Pickering N, Saba T. P231 Patient experience of accessing a virtual cystic fibrosis service during the 2020 SARS-CoV-2 pandemic in Blackpool, North West of England. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01256-x] [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: 11/27/2022]
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Cheng A, Saba T, Duncan T, Grundy S, Evison M. Pulmonary passport: a service evaluation study of a standardised web-based procedure logbook to aid specialist respiratory training and appraisal. BMJ Open Respir Res 2020; 7:7/1/e000690. [PMID: 33184058 PMCID: PMC7662433 DOI: 10.1136/bmjresp-2020-000690] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 06/24/2020] [Revised: 10/18/2020] [Accepted: 10/28/2020] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The pulmonary passport (PP) is a secure web-based procedural logbook for specialist respiratory trainees with enhanced functionality that includes automated analysis to provide key performance metrics and in-platform interactions with supervisors. METHODS This service evaluation study used preimplementation and postimplementation online surveys in both trainees and supervisors along with analysis of recorded data within the PP to evaluate the impact of this service on data capture, training, appraisal and quality assurance. RESULTS From August 2017 to August 2019, 69/73 (95%) specialist respiratory trainees eligible to use the PP across two UK health education deaneries registered with the system and logged 7352 procedures. 3105 thoracic ultrasound procedures identified 2145 pleural effusions and resulted in 1253 pleural procedures of which 96% were successful. 4% of ultrasounds required referral to a more expert sonographer. Iatrogenic bleeding and pneumothorax both occurred in ≤1% of all pleural procedures. 1909 basic diagnostic bronchoscopies were recorded including 1236 bronchial washes, 328 brushes and 221 endobronchial biopsies where definite tumour was identified (biopsy sensitivity 74%). Preimplementation and postimplementation survey data confirmed the PP had increased the consistency of logging procedures by trainees, the depth of data captured, the review of procedural performance metrics in appraisal and the frequency of formal supervisor feedback. DISCUSSION In this regional project, the implementation of a web-based procedural logbook has been feasible with excellent uptake and has enhanced procedural recording, supervision and appraisal. Furthermore, it provides unprecedented quality assurance at an individual trainee, trust and deanery level and has a number of potential wider applications in the future.
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Affiliation(s)
- Andrew Cheng
- North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Tarek Saba
- Respiratory Medicine, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - Tracy Duncan
- Respiratory Medicine, North Manchester General Hospital, Pennine Acute Hospitals NHS Trust, Manchester, UK
| | - Seamus Grundy
- Respiratory Medicine, Salford Royal Hospitals NHS Trust, Salford, UK
| | - Matthew Evison
- North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
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15
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Corcoran JP, Psallidas I, Gerry S, Piccolo F, Koegelenberg CF, Saba T, Daneshvar C, Fairbairn I, Heinink R, West A, Stanton AE, Holme J, Kastelik JA, Steer H, Downer NJ, Haris M, Baker EH, Everett CF, Pepperell J, Bewick T, Yarmus L, Maldonado F, Khan B, Hart-Thomas A, Hands G, Warwick G, De Fonseka D, Hassan M, Munavvar M, Guhan A, Shahidi M, Pogson Z, Dowson L, Popowicz ND, Saba J, Ward NR, Hallifax RJ, Dobson M, Shaw R, Hedley EL, Sabia A, Robinson B, Collins GS, Davies HE, Yu LM, Miller RF, Maskell NA, Rahman NM. Prospective validation of the RAPID clinical risk prediction score in adult patients with pleural infection: the PILOT study. Eur Respir J 2020; 56:2000130. [PMID: 32675200 DOI: 10.1183/13993003.00130-2020] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 06/06/2020] [Indexed: 11/05/2022]
Abstract
BACKGROUND Over 30% of adult patients with pleural infection either die and/or require surgery. There is no robust means of predicting at baseline presentation which patients will suffer a poor clinical outcome. A validated risk prediction score would allow early identification of high-risk patients, potentially directing more aggressive treatment thereafter. OBJECTIVES To prospectively assess a previously described risk score (the RAPID (Renal (urea), Age, fluid Purulence, Infection source, Dietary (albumin)) score) in adults with pleural infection. METHODS Prospective observational cohort study that recruited patients undergoing treatment for pleural infection. RAPID score and risk category were calculated at baseline presentation. The primary outcome was mortality at 3 months; secondary outcomes were mortality at 12 months, length of hospital stay, need for thoracic surgery, failure of medical treatment and lung function at 3 months. RESULTS Mortality data were available in 542 out of 546 patients recruited (99.3%). Overall mortality was 10% at 3 months (54 out of 542) and 19% at 12 months (102 out of 542). The RAPID risk category predicted mortality at 3 months. Low-risk mortality (RAPID score 0-2): five out of 222 (2.3%, 95% CI 0.9 to 5.7%); medium-risk mortality (RAPID score 3-4): 21 out of 228 (9.2%, 95% CI 6.0 to 13.7%); and high-risk mortality (RAPID score 5-7): 27 out of 92 (29.3%, 95% CI 21.0 to 39.2%). C-statistics for the scores at 3 months and 12 months were 0.78 (95% CI 0.71-0.83) and 0.77 (95% CI 0.72-0.82), respectively. CONCLUSIONS The RAPID score stratifies adults with pleural infection according to increasing risk of mortality and should inform future research directed at improving outcomes in this patient population.
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Affiliation(s)
- John P Corcoran
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK
- Joint first authors, with equal contribution to study recruitment and manuscript writing
| | - Ioannis Psallidas
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK
- Joint first authors, with equal contribution to study recruitment and manuscript writing
| | - Stephen Gerry
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Francesco Piccolo
- Dept of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Australia
| | | | - Tarek Saba
- Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | | | | | | | - Alex West
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Jayne Holme
- University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
| | | | - Henry Steer
- Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK
| | - Nicola J Downer
- Sherwood Forest Hospitals NHS Foundation Trust, Mansfield, UK
| | - Mohammed Haris
- University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Emma H Baker
- Institute of Infection and Immunity, St George's, University of London, London, UK
| | | | | | - Thomas Bewick
- Derby Teaching Hospitals NHS Foundation Trust, Derby, UK
| | - Lonny Yarmus
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Fabien Maldonado
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Burhan Khan
- Dartford and Gravesham NHS Trust, Dartford, UK
| | - Alan Hart-Thomas
- Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, UK
| | | | | | | | - Maged Hassan
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK
- Chest Diseases Dept, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | | | - Anur Guhan
- University Hospital Ayr, NHS Ayrshire and Arran, Ayr, UK
| | | | - Zara Pogson
- United Lincolnshire Hospitals NHS Trust, Lincoln, UK
| | - Lee Dowson
- Royal Wolverhampton Hospital NHS Trust, Wolverhampton, UK
| | - Natalia D Popowicz
- Dept of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Australia
| | - Judith Saba
- Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - Neil R Ward
- University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Rob J Hallifax
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK
| | - Melissa Dobson
- Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK
| | - Rachel Shaw
- Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK
| | - Emma L Hedley
- Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK
| | - Assunta Sabia
- Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK
| | - Barbara Robinson
- Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK
| | - Gary S Collins
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | | | - Ly-Mee Yu
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Robert F Miller
- Institute for Global Health, University College London, London, UK
| | - Nick A Maskell
- Academic Respiratory Unit, University of Bristol, Bristol, UK
| | - Najib M Rahman
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK
- Oxford NIHR Biomedical Research Centre, Oxford, UK
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16
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Pickering N, Saba T. P331 Successful development of physiotherapy within a new Adult Cystic Fibrosis Service at Blackpool, UK. J Cyst Fibros 2020. [DOI: 10.1016/s1569-1993(20)30660-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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17
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Mercer RM, Macready J, Jeffries H, Speck N, Kanellakis NI, Maskell NA, Pepperell J, Saba T, West A, Ali N, Corcoran JP, Hallifax RJ, Psallidas I, Asciak R, Hassan M, Miller RF, Rahman NM. Clinically important associations of pleurodesis success in malignant pleural effusion: Analysis of the TIME1 data set. Respirology 2019; 25:750-755. [PMID: 31846131 DOI: 10.1111/resp.13755] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 10/21/2019] [Accepted: 11/05/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND AND OBJECTIVE Chemical pleurodesis is performed for patients with MPE with a published success rate of around 80%. It has been postulated that inflammation is key in achieving successful pleural symphysis, as evidenced by higher amounts of pain or detected inflammatory response. Patients with mesothelioma are postulated to have a lower rate of successful pleurodesis due to lack of normal pleural tissue enabling an inflammatory response. METHODS The TIME1 trial data set, in which pleurodesis success and pain were co-primary outcome measures, was used to address a number of these assumptions. Pain score, systemic inflammatory parameters as a marker of pleural inflammation and cancer type were analysed in relation to pleurodesis success. RESULTS In total, 285 patients were included with an overall success rate of 81.4%. There was a significantly higher rise in CRP in the Pleurodesis Success group compared with the Pleurodesis Failure group (mean difference: 19.2, 95% CI of the difference: 6.2-32.0, P = 0.004) but no significant change in WCC. There was no significant difference in pain scores or analgesia requirements between the groups. Patients with mesothelioma had a lower rate of pleurodesis success than non-mesothelioma patients (73.3% vs 84.9%, χ2 = 5.1, P = 0.023). CONCLUSION Change in CRP during pleurodesis is associated with successful pleurodesis but higher levels of pain are not associated. Patients with mesothelioma appear less likely to undergo successful pleurodesis than patients with other malignancies, but there is still a significant rise in systemic inflammatory markers. The mechanisms of these findings are unclear but warrant further investigation.
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Affiliation(s)
- Rachel M Mercer
- University of Oxford Respiratory Trials Unit, Churchill Hospital, Oxford, UK.,Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Jessica Macready
- University of Oxford Respiratory Trials Unit, Churchill Hospital, Oxford, UK
| | - Hannah Jeffries
- University of Oxford Respiratory Trials Unit, Churchill Hospital, Oxford, UK
| | | | - Nikolaos I Kanellakis
- University of Oxford Respiratory Trials Unit, Churchill Hospital, Oxford, UK.,Laboratory of Pleural and Lung Cancer Translational Research, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Nick A Maskell
- Academic Respiratory Unit, Bristol Medical School, Southmead Hospital, University of Bristol, Bristol, UK
| | | | - Tarek Saba
- Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - Alex West
- Guys and St Thomas Hospital, London, UK
| | | | - John P Corcoran
- University of Oxford Respiratory Trials Unit, Churchill Hospital, Oxford, UK.,Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Robert J Hallifax
- University of Oxford Respiratory Trials Unit, Churchill Hospital, Oxford, UK.,Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Ioannis Psallidas
- University of Oxford Respiratory Trials Unit, Churchill Hospital, Oxford, UK.,Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Rachelle Asciak
- University of Oxford Respiratory Trials Unit, Churchill Hospital, Oxford, UK.,Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Maged Hassan
- University of Oxford Respiratory Trials Unit, Churchill Hospital, Oxford, UK.,Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, UK.,Chest Diseases Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Robert F Miller
- Institute for Global Health, University College London, London, UK
| | - Najib M Rahman
- University of Oxford Respiratory Trials Unit, Churchill Hospital, Oxford, UK.,Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, UK.,NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
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18
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Mishra EK, Clive AO, Wills GH, Davies HE, Stanton AE, Al-Aloul M, Hart-Thomas A, Pepperell J, Evison M, Saba T, Harrison RN, Guhan A, Callister ME, Sathyamurthy R, Rehal S, Corcoran JP, Hallifax R, Psallidas I, Russell N, Shaw R, Dobson M, Wrightson JM, West A, Lee YCG, Nunn AJ, Miller RF, Maskell NA, Rahman NM. Randomized Controlled Trial of Urokinase versus Placebo for Nondraining Malignant Pleural Effusion. Am J Respir Crit Care Med 2019; 197:502-508. [PMID: 28926296 DOI: 10.1164/rccm.201704-0809oc] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Patients with malignant pleural effusion experience breathlessness, which is treated by drainage and pleurodesis. Incomplete drainage results in residual dyspnea and pleurodesis failure. Intrapleural fibrinolytics lyse septations within pleural fluid, improving drainage. OBJECTIVES To assess the effects of intrapleural urokinase on dyspnea and pleurodesis success in patients with nondraining malignant effusion. METHODS We conducted a prospective, double-blind, randomized trial. Patients with nondraining effusion were randomly allocated in a 1:1 ratio to intrapleural urokinase (100,000 IU, three doses, 12-hourly) or matched placebo. MEASUREMENTS AND MAIN RESULTS Co-primary outcome measures were dyspnea (average daily 100-mm visual analog scale scores over 28 d) and time to pleurodesis failure to 12 months. Secondary outcomes were survival, hospital length of stay, and radiographic change. A total of 71 subjects were randomized (36 received urokinase, 35 placebo) from 12 U.K. centers. The baseline characteristics were similar between the groups. There was no difference in mean dyspnea between groups (mean difference, 3.8 mm; 95% confidence interval [CI], -12 to 4.4 mm; P = 0.36). Pleurodesis failure rates were similar (urokinase, 13 of 35 [37%]; placebo, 11 of 34 [32%]; adjusted hazard ratio, 1.2; P = 0.65). Urokinase was associated with decreased effusion size visualized by chest radiography (adjusted relative improvement, -19%; 95% CI, -28 to -11%; P < 0.001), reduced hospital stay (1.6 d; 95% CI, 1.0 to 2.6; P = 0.049), and improved survival (69 vs. 48 d; P = 0.026). CONCLUSIONS Use of intrapleural urokinase does not reduce dyspnea or improve pleurodesis success compared with placebo and cannot be recommended as an adjunct to pleurodesis. Other palliative treatments should be used. Improvements in hospital stay, radiographic appearance, and survival associated with urokinase require further evaluation. Clinical trial registered with ISRCTN (12852177) and EudraCT (2008-000586-26).
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Affiliation(s)
- Eleanor K Mishra
- 1 Norfolk and Norwich Pleural Unit, Norfolk and Norwich University Hospital NHS Foundation Trust, Norfolk, United Kingdom
| | - Amelia O Clive
- 2 Academic Respiratory Unit, School of Clinical Sciences, Southmead Hospital, University of Bristol, Bristol, United Kingdom
| | | | - Helen E Davies
- 4 Cardiff and Vale University Health Board, Cardiff, United Kingdom
| | | | - Mohamed Al-Aloul
- 6 University Hospital of South Manchester NHS Foundation Trust, Manchester, United Kingdom
| | - Alan Hart-Thomas
- 7 Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, United Kingdom
| | - Justin Pepperell
- 8 Somerset Lung Centre, Musgrove Park Hospital, Taunton, United Kingdom
| | - Matthew Evison
- 6 University Hospital of South Manchester NHS Foundation Trust, Manchester, United Kingdom
| | - Tarek Saba
- 9 Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, United Kingdom
| | - Richard Neil Harrison
- 10 North Tees and Hartlepool Hospitals NHS Foundation Trust, North Tees, United Kingdom
| | - Anur Guhan
- 11 University Hospital Ayr, Ayr, United Kingdom
| | | | | | - Sunita Rehal
- 3 Medical Research Council Clinical Trials Unit and
| | - John P Corcoran
- 14 Oxford Respiratory Trials Unit and Oxford Pleural Diseases Unit, Churchill Hospital, Oxford, United Kingdom
| | - Robert Hallifax
- 14 Oxford Respiratory Trials Unit and Oxford Pleural Diseases Unit, Churchill Hospital, Oxford, United Kingdom
| | - Ioannis Psallidas
- 14 Oxford Respiratory Trials Unit and Oxford Pleural Diseases Unit, Churchill Hospital, Oxford, United Kingdom
| | - Nicky Russell
- 14 Oxford Respiratory Trials Unit and Oxford Pleural Diseases Unit, Churchill Hospital, Oxford, United Kingdom
| | - Rachel Shaw
- 14 Oxford Respiratory Trials Unit and Oxford Pleural Diseases Unit, Churchill Hospital, Oxford, United Kingdom
| | - Melissa Dobson
- 14 Oxford Respiratory Trials Unit and Oxford Pleural Diseases Unit, Churchill Hospital, Oxford, United Kingdom
| | - John M Wrightson
- 14 Oxford Respiratory Trials Unit and Oxford Pleural Diseases Unit, Churchill Hospital, Oxford, United Kingdom
| | - Alex West
- 15 Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Y C Gary Lee
- 16 School of Medicine and Pharmacology, University of Western Australia, Perth, Australia; and
| | | | - Robert F Miller
- 17 Research Department of Infection and Population Health, Institute of Epidemiology and Healthcare, University College London, London, United Kingdom
| | - Nick A Maskell
- 2 Academic Respiratory Unit, School of Clinical Sciences, Southmead Hospital, University of Bristol, Bristol, United Kingdom
| | - Najib M Rahman
- 14 Oxford Respiratory Trials Unit and Oxford Pleural Diseases Unit, Churchill Hospital, Oxford, United Kingdom.,18 National Institute for Health Research Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
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19
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Thomas A, Bradley J, Pickering N, Saba T. P464 Patient experience of transition to a newly established cystic fibrosis service in the North West of England. J Cyst Fibros 2019. [DOI: 10.1016/s1569-1993(19)30756-8] [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: 10/26/2022]
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20
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Saba T, Rowlands A, Etumi M, Webb A, Bright-Thomas R, Jones A. P086 Successful development of a new independent adult cystic fibrosis service in Blackpool, UK. J Cyst Fibros 2019. [DOI: 10.1016/s1569-1993(19)30380-7] [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: 10/26/2022]
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21
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Evison M, Blyth KG, Bhatnagar R, Corcoran J, Saba T, Duncan T, Hallifax R, Ahmed L, West A, Pepperell JCT, Roberts M, Sivasothy P, Psallidas I, Clive AO, Latham J, Stanton AE, Maskell N, Rahman N. Providing safe and effective pleural medicine services in the UK: an aspirational statement from UK pleural physicians. BMJ Open Respir Res 2018; 5:e000307. [PMID: 30116537 PMCID: PMC6089266 DOI: 10.1136/bmjresp-2018-000307] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 07/05/2018] [Accepted: 07/06/2018] [Indexed: 12/30/2022] Open
Abstract
Physicians face considerable challenges in ensuring safe and effective care for patients admitted to hospital with pleural disease. While subspecialty development has driven up standards of care, this has been tempered by the resulting loss of procedural experience in general medical teams tasked with managing acute pleural disease. This review aims to define a framework though which a minimum standard of care might be implemented. This review has been written by pleural clinicians from across the UK representing all types of secondary care hospital. Its content has been formed on the basis of literature review, national guidelines, National Health Service England policy and consensus opinion following a round table discussion. Recommendations have been provided in the broad themes of procedural training, out-of-hours management and pleural service specification. Procedural competences have been defined into descriptive categories: emergency, basic, intermediate and advanced. Provision of emergency level operators at all times in all trusts is the cornerstone of out-of-hours recommendations, alongside readily available escalation pathways. A proposal for minimum standards to ensure the safe delivery of pleural medicine have been described with the aim of driving local conversations and providing a framework for service development, review and risk assessment.
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Affiliation(s)
- Matthew Evison
- Manchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK
| | - Kevin G Blyth
- Pleural Disease Unit, Queen Elizabeth Hospital, Glasgow, UK.,Institute of Infection, Immunity of Inflammation, University of Glasgow, Glasgow, UK
| | - Rahul Bhatnagar
- Academic Respiratory Unit, University of Bristol, Bristol, UK.,North Bristol Lung Centre, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - John Corcoran
- Interventional Pulmonology Service, Plymouth Hospitals NHS Trust, Plymouth, UK
| | - Tarek Saba
- Respiratory Medicine, Blackpool Victoria Hospital, Blackpool, UK
| | - Tracy Duncan
- Pleural Service, North Manchester General Hospital, Pennine Acute Hospitals NHS Trust, Manchester, UK
| | - Rob Hallifax
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Churchill Hospital, Oxford, UK
| | - Liju Ahmed
- Respiratory Medicine, Guys and St. Thomas NHS Foundation Trust, London, UK.,Respiratory Medicine, Kings College School of Medicine, London, UK
| | - Alex West
- Respiratory Medicine, Guys and St. Thomas NHS Foundation Trust, London, UK
| | | | - Mark Roberts
- Respiratory Medicine, Sherwood Forest Hospitals NHS Foundation Trust, Nottingham, UK
| | | | - Ioannis Psallidas
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Churchill Hospital, Oxford, UK
| | - Amelia O Clive
- Academic Respiratory Unit, University of Bristol, Bristol, UK.,North Bristol Lung Centre, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | | | | | - Nick Maskell
- Academic Respiratory Unit, University of Bristol, Bristol, UK.,North Bristol Lung Centre, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Najib Rahman
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Churchill Hospital, Oxford, UK.,Oxford NIHR Biomedical Research Centre, Oxford, UK
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22
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Rahman NM, Pepperell J, Rehal S, Saba T, Tang A, Ali N, West A, Hettiarachchi G, Mukherjee D, Samuel J, Bentley A, Dowson L, Miles J, Ryan CF, Yoneda KY, Chauhan A, Corcoran JP, Psallidas I, Wrightson JM, Hallifax R, Davies HE, Lee YCG, Dobson M, Hedley EL, Seaton D, Russell N, Chapman M, McFadyen BM, Shaw RA, Davies RJO, Maskell NA, Nunn AJ, Miller RF. Effect of Opioids vs NSAIDs and Larger vs Smaller Chest Tube Size on Pain Control and Pleurodesis Efficacy Among Patients With Malignant Pleural Effusion: The TIME1 Randomized Clinical Trial. JAMA 2015; 314:2641-53. [PMID: 26720026 DOI: 10.1001/jama.2015.16840] [Citation(s) in RCA: 115] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE For treatment of malignant pleural effusion, nonsteroidal anti-inflammatory drugs (NSAIDs) are avoided because they may reduce pleurodesis efficacy. Smaller chest tubes may be less painful than larger tubes, but efficacy in pleurodesis has not been proven. OBJECTIVE To assess the effect of chest tube size and analgesia (NSAIDs vs opiates) on pain and clinical efficacy related to pleurodesis in patients with malignant pleural effusion. DESIGN, SETTING, AND PARTICIPANTS A 2×2 factorial phase 3 randomized clinical trial among 320 patients requiring pleurodesis in 16 UK hospitals from 2007 to 2013. INTERVENTIONS Patients undergoing thoracoscopy (n = 206; clinical decision if biopsy was required) received a 24F chest tube and were randomized to receive opiates (n = 103) vs NSAIDs (n = 103), and those not undergoing thoracoscopy (n = 114) were randomized to 1 of 4 groups (24F chest tube and opioids [n = 28]; 24F chest tube and NSAIDs [n = 29]; 12F chest tube and opioids [n = 29]; or 12F chest tube and NSAIDs [n = 28]). MAIN OUTCOMES AND MEASURES Pain while chest tube was in place (0- to 100-mm visual analog scale [VAS] 4 times/d; superiority comparison) and pleurodesis efficacy at 3 months (failure defined as need for further pleural intervention; noninferiority comparison; margin, 15%). RESULTS Pain scores in the opiate group (n = 150) vs the NSAID group (n = 144) were not significantly different (mean VAS score, 23.8 mm vs 22.1 mm; adjusted difference, -1.5 mm; 95% CI, -5.0 to 2.0 mm; P = .40), but the NSAID group required more rescue analgesia (26.3% vs 38.1%; rate ratio, 2.1; 95% CI, 1.3-3.4; P = .003). Pleurodesis failure occurred in 30 patients (20%) in the opiate group and 33 (23%) in the NSAID group, meeting criteria for noninferiority (difference, -3%; 1-sided 95% CI, -10% to ∞; P = .004 for noninferiority). Pain scores were lower among patients in the 12F chest tube group (n = 54) vs the 24F group (n = 56) (mean VAS score, 22.0 mm vs 26.8 mm; adjusted difference, -6.0 mm; 95% CI, -11.7 to -0.2 mm; P = .04) and 12F chest tubes vs 24F chest tubes were associated with higher pleurodesis failure (30% vs 24%), failing to meet noninferiority criteria (difference, -6%; 1-sided 95% CI, -20% to ∞; P = .14 for noninferiority). Complications during chest tube insertion occurred more commonly with 12F tubes (14% vs 24%; odds ratio, 1.91; P = .20). CONCLUSIONS AND RELEVANCE Use of NSAIDs vs opiates resulted in no significant difference in pain scores but was associated with more rescue medication. NSAID use resulted in noninferior rates of pleurodesis efficacy at 3 months. Placement of 12F chest tubes vs 24F chest tubes was associated with a statistically significant but clinically modest reduction in pain but failed to meet noninferiority criteria for pleurodesis efficacy. TRIAL REGISTRATION isrctn.org Identifier: ISRCTN33288337.
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Affiliation(s)
- Najib M Rahman
- Oxford Respiratory Trials Unit and Oxford Pleural Diseases Unit, Churchill Hospital, Oxford, England2National Institute for Health Research Oxford Biomedical Research Centre, University of Oxford, Oxford, England
| | | | - Sunita Rehal
- Medical Research Council Clinical Trials Unit at University College London, London, England
| | - Tarek Saba
- Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, England
| | - Augustine Tang
- Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, England
| | - Nabeel Ali
- King's Mill Hospital, Mansfield, England
| | - Alex West
- Medway Maritime Hospital, Gillingham, England
| | | | | | | | - Andrew Bentley
- University Hospital of South Manchester NHS Foundation Trust, Manchester, England
| | - Lee Dowson
- Royal Wolverhampton Hospital NHS Trust, Wolverhampton, England
| | | | - C Frank Ryan
- Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Ken Y Yoneda
- University of California, Davis, Medical Center, Sacramento
| | | | - John P Corcoran
- Oxford Respiratory Trials Unit and Oxford Pleural Diseases Unit, Churchill Hospital, Oxford, England
| | - Ioannis Psallidas
- Oxford Respiratory Trials Unit and Oxford Pleural Diseases Unit, Churchill Hospital, Oxford, England
| | - John M Wrightson
- Oxford Respiratory Trials Unit and Oxford Pleural Diseases Unit, Churchill Hospital, Oxford, England2National Institute for Health Research Oxford Biomedical Research Centre, University of Oxford, Oxford, England
| | - Rob Hallifax
- Oxford Respiratory Trials Unit and Oxford Pleural Diseases Unit, Churchill Hospital, Oxford, England
| | - Helen E Davies
- Cardiff and Vale University Health Board, Cardiff, Wales
| | - Y C Gary Lee
- School of Medicine and Centre for Asthma, Allergy, and Respiratory Research, University of Western Australia, Crawley, Australia
| | - Melissa Dobson
- Oxford Respiratory Trials Unit and Oxford Pleural Diseases Unit, Churchill Hospital, Oxford, England
| | - Emma L Hedley
- Oxford Respiratory Trials Unit and Oxford Pleural Diseases Unit, Churchill Hospital, Oxford, England
| | - Douglas Seaton
- Department of Respiratory Medicine, Ipswich Hospital, Ipswich, England
| | - Nicky Russell
- Oxford Respiratory Trials Unit and Oxford Pleural Diseases Unit, Churchill Hospital, Oxford, England
| | - Margaret Chapman
- Oxford Respiratory Trials Unit and Oxford Pleural Diseases Unit, Churchill Hospital, Oxford, England
| | - Bethan M McFadyen
- Oxford Respiratory Trials Unit and Oxford Pleural Diseases Unit, Churchill Hospital, Oxford, England
| | - Rachel A Shaw
- Oxford Respiratory Trials Unit and Oxford Pleural Diseases Unit, Churchill Hospital, Oxford, England
| | - Robert J O Davies
- Oxford Respiratory Trials Unit and Oxford Pleural Diseases Unit, Churchill Hospital, Oxford, England
| | - Nick A Maskell
- Academic Respiratory Unit, Department of Clinical Sciences, Southmead Hospital, University of Bristol, Bristol, England
| | - Andrew J Nunn
- Medical Research Council Clinical Trials Unit at University College London, London, England
| | - Robert F Miller
- Research Department of Infection and Population Health, Institute of Epidemiology and Healthcare, University College London, London, England
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23
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Rahman NM, Pepperell J, Rehal S, Saba T, Tang A, Ali N, West A, Hettiarachchi G, Mukherjee D, Samuel J, Bentley A, Dowson L, Miles J, Ryan F, Yoneda K, Chauhan A, Corcoran J, Psallidas I, Wrightson JM, Hallifax R, Davies HE, Lee YCG, Hedley EL, Seaton D, Russell N, Chapman M, McFadyen BM, Shaw RA, Davies RJO, Maskell NA, Nunn AJ, Miller RF. S20 Primary Result of the 1st Therapeutic Interventions in Malignant Effusion (TIME1) Trial: A 2 × 2 factorial, randomised trial of chest tube size and analgesic strategy for pleurodesis in malignant pleural effusion. Thorax 2015. [DOI: 10.1136/thoraxjnl-2015-207770.26] [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: 11/04/2022]
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24
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Husain N, Rahim M, Khan A, Al-Rodhaan M, Al-Dhelaan A, Saba T. Iterative adaptive subdivision surface approach to reduce memory consumption in rendering process (IteAS). Journal of Intelligent & Fuzzy Systems 2015. [DOI: 10.3233/ifs-141308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- N.A. Husain
- Faculty of Computing, Universiti Teknologi Malaysia (UTM), Skudai, Johor, Malaysia
| | - M.S.M. Rahim
- Faculty of Computing, Universiti Teknologi Malaysia (UTM), Skudai, Johor, Malaysia
| | - A.R. Khan
- MIS Department CBA Salman bin Abdul, Aziz University, Alkharj, KSA
| | - Mznah Al-Rodhaan
- Computer Science Department, College of Computer & Information Sciences, King Saud University, Riyadh, KSA
| | - Abdullah Al-Dhelaan
- Computer Science Department, College of Computer & Information Sciences, King Saud University, Riyadh, KSA
| | - T. Saba
- College of Computer and Information Sciences (CCIS), Prince Sultan University, Riyadh, KSA
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25
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Harouni M, Rahim MSM, Al-Rodhaan M, Saba T, Rehman A, Al-Dhelaan A. Online Persian/Arabic script classification without contextual information. The Imaging Science Journal 2014. [DOI: 10.1179/1743131x14y.0000000083] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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26
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Berry P, Jackson C, Saba T, Au GI, Martin M, Bennie M, Tymon L, Whitfield A. DEVELOPMENT OF AN INTEGRATED END OF LIFE CARE PATHWAY FOR PATIENTS WITH COPD. BMJ Support Palliat Care 2014. [DOI: 10.1136/bmjspcare-2014-000654.268] [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]
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27
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Muhsin ZF, Rehman A, Altameem A, Saba T, Uddin M. Improved quadtree image segmentation approach to region information. The Imaging Science Journal 2013. [DOI: 10.1179/1743131x13y.0000000063] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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28
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Rehman A, Kurniawan F, Saba T. An automatic approach for line detection and removal without smash-up characters. The Imaging Science Journal 2013. [DOI: 10.1179/136821910x12863758415649] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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29
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Saba T, Su S. Tracking polychlorinated biphenyls (PCBs) congener patterns in Newark Bay surface sediment using principal component analysis (PCA) and positive matrix factorization (PMF). J Hazard Mater 2013; 260:634-643. [PMID: 23831929 DOI: 10.1016/j.jhazmat.2013.05.046] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [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: 02/28/2013] [Revised: 05/08/2013] [Accepted: 05/23/2013] [Indexed: 06/02/2023]
Abstract
PCB congener data for Newark Bay surface sediments were analyzed using PCA and PMF, and relationships between the outcomes from these two techniques were explored. The PCA scores plot separated the Lower Passaic River Mouth samples from North Newark Bay, thus indicating dissimilarity. Although PCA was able to identify subareas in the Bay system with specific PCB congener patterns (e.g., higher chlorinated congeners in Elizabeth River), further conclusions reading potential PCB source profiles or potential upland source areas were not clear for the PCA scores plot. PMF identified five source factors, and explained the Bay sample congener profiles as a mix of these Factors. This PMF solution was equivalent to (1) defining an envelope that encompasses all samples on the PCA scores plot, (2) defining source factors that plot on that envelope, and (3) explaining the congener profile for each Bay sediment sample (inside the scores plot envelope) as a mix of factors. PMF analysis allowed identifying characteristic features in the source factor congener distributions that allowed tracking of source factors to shoreline areas where PCB inputs to the Bay may have originated. The combined analysis from PCA and PMF showed that direct discharges to the Bay are likely the dominant sources of PCBs to the sediment. Review of historical upland activities and regulatory files will be needed, in addition to the PCA and PMF analysis, to fully reconstruct the history of operations and PCB releases around the Newark Bay area that impacted the Bay sediment.
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Affiliation(s)
- Tarek Saba
- Exponent, Inc., 1 Clock Tower Place, Suite 150, Maynard, MA 01754, USA.
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30
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Welsh EJ, Spencer S, Saba T, Evans DJ, Fowler SJ. Interventions for bronchiectasis: an overview of Cochrane systematic reviews. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2013. [DOI: 10.1002/14651858.cd010337] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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31
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Saba T, Boehm PD. Congener-based analysis of the weathering of PCB Aroclor 1242 in paper mill sludge. Chemosphere 2011; 82:1321-1328. [PMID: 21190710 DOI: 10.1016/j.chemosphere.2010.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Revised: 11/24/2010] [Accepted: 12/03/2010] [Indexed: 05/30/2023]
Abstract
Aroclor 1242 contains a high percentage of lightly chlorinated congeners, which makes it susceptible to congener profile alterations as a result of physical-chemical environmental weathering by water washing, evaporation, and volatilization. The analysis of the variability of congener profiles in paper sludge samples using PCA, mixing models, and correlation (R(2)) analysis, provided an integrated description of the behavior of Aroclor 1242 after its release in the environment. The results showed that the total PCB concentration decreased as the sample experienced weathering, with the congener profile of Aroclor 1242 shifting towards resembling heavier Aroclors as lighter congeners were lost. Mixing model analysis confirmed that a sample containing weathered Aroclor 1242 could easily be misidentified by laboratories as containing a mix of heavier Aroclors. The R(2) analysis showed that the profile of the congeners within a homologue group remained the same after weathering. This analysis showed that congeners that belong to the same level of chlorination behave similarly in such a manner that retains their overall profile when exposed to physical weathering.
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Affiliation(s)
- Tarek Saba
- Exponent, Inc., 1 Clock Tower Place, Suite 150, Maynard, MA 01754, United States.
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33
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Blyth KG, Syyed R, Chalmers J, Foster JE, Saba T, Naeije R, Melot C, Peacock AJ. Pulmonary arterial pulse pressure and mortality in pulmonary arterial hypertension. Respir Med 2007; 101:2495-501. [PMID: 17719764 DOI: 10.1016/j.rmed.2007.07.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2007] [Revised: 06/05/2007] [Accepted: 07/05/2007] [Indexed: 11/20/2022]
Abstract
In the Framingham studies, systemic arterial pulse pressure correlated linearly with morbidity and mortality. Right ventricular (RV) systolic dysfunction and pulmonary circulation stiffening result in abnormalities of pulmonary arterial (PA) pulse pressure in PA hypertension (PAH). We investigated the prognostic potential of PA pulse pressure in 67 patients with PAH diagnosed between January 1996 and March 2004 (33 idiopathic PAH, 34 PAH-connective tissue disease). The population was arbitrarily divided into tertiles of PA pulse pressure (= systolic-diastolic PA pressure) and 5-year mortality was assessed using the Kaplan-Meier method. The extent of RV systolic dysfunction and pulmonary circulation stiffening within each tertile was assessed by comparing the mean cardiac index and alpha (a recently described measure of pulmonary circulation distensibility) in each. Independent predictors of mortality were identified by Cox regression. Five-year mortality rates in patients with low, intermediate and high pulse pressures were 40%, 91% and 54%, respectively. Pulse pressure did not independently predict mortality, but cardiac index, 6-min walk test distance and mixed venous oxygen saturation did. Pulse pressure correlated with circulation stiffening (alpha) but did not correlate with cardiac index which tended to be lower in patients with intermediate pulse pressure and high mortality. PA pulse pressure correlated with pulmonary circulation stiffening but did not predict mortality in this study. RV dysfunction provided better prognostic information and probably explains the higher mortality seen in patients with intermediate pulse pressure.
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Affiliation(s)
- Kevin G Blyth
- Scottish Pulmonary Vascular Unit, Western Infirmary, Dumbarton Road, G11 6NT Glasgow, UK
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34
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Guerin G, Wills T, Saba T, St-jacques N. [Early retirement or prolonged working life? Aspirations of unionized professionals aged 50 years and over]. Cah Que Demogr 2002; 24:245-83. [PMID: 12320569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
"Two opposing retirement options--early retirement or prolonged working life--are being presented in the burgeoning literature related to the ineluctable ageing of the work force. Both are allegedly proposed for economic reasons and claim to meet the expectations and needs of ageing workers. But what in reality are the retirement goals of older workers and which factors, individual and organizational, affect the decision to retire? In tackling this question, the article draws on a survey conducted among workers from 15 unions, mostly affiliated with the Quebec Council of Managers and Professionals. Based on data from 1,319 respondents, the findings indicate that the majority of professionals would prefer to retire earlier, that 60 is much more considered a normal retirement age than 65, and that only 8% of the respondents wish to continue working after 65--and this mostly out of economic necessity, not choice. The factors that underlie this preference for early retirement are then identified and discussed." (SUMMARY IN ENG AND SPA)
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Saba T, Illangasekare TH, Ewing J. Investigation of surfactant-enhanced dissolution of entrapped nonaqueous phase liquid chemicals in a two-dimensional groundwater flow field. J Contam Hydrol 2001; 51:63-82. [PMID: 11530927 DOI: 10.1016/s0169-7722(01)00122-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Because of their low solubility, waste chemicals in the form of nonaqueous phase liquids (NAPLs) that are entrapped in subsurface formations act as long-term sources of groundwater contamination. In the design of remediation schemes that use surfactants, it is necessary to estimate the mass transfer rate coefficients under multi-dimensional flow fields that exit at field sites. In this study, we investigate mass transfer under a two-dimensional flow field to obtain an understanding of the basic mechanisms of surfactant-enhanced dissolution and to quantify the mass transfer rates. Enhanced dissolution experiments in a two-dimensional test cell were conducted to measure rates of mass depletion from entrapped NAPLs to a flowing aqueous phase containing a surfactant. In situ measurement of transient saturation changes using a gamma attenuation system revealed dissolution patterns that are affected by the dimensionality of the groundwater flow field. Numerical modeling of local flow fields that changed with time, due to depletion of NAPL sources, enabled the examination of the basic mechanisms of NAPL dissolution in complex groundwater systems. Through nonlinear regression analysis, mass transfer rates were correlated to porous media properties, NAPL saturation and aqueous phase velocity. Results from the experiments and numerical analyses were used to identify deficiencies in existing methods of analysis that uses assumptions of one-dimensional flow, homogeneity of aquifer properties, local equilibrium and idealized transient mass transfer.
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Affiliation(s)
- T Saba
- Mantech Environmental Engineering, Dover National Test Site, Dover AFB 19902, USA.
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37
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Abstract
Foreign body aspiration occurs most commonly in children and can have serious consequences. In adults, it is associated with surgery, trauma and accidents. We report four unusual cases of foreign body inhalation. In one case a spike of wild barley entered the trachea through a tracheostomy cannula and migrated from the chest wall. In the second case a piece of coarse cloth which was introduced through a tracheostomy stoma aided by a wood sliver was retained in the trachea. In another patient an inhaled sewing needle migrated to the pericardium, and in the fourth case the head of a metal stud penetrated the trachea percutaneously through the neck and lodged in the right main bronchus. The incidence, causes, complications and management of such cases are discussed and the literature is briefly reviewed.
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Affiliation(s)
- K Dogan
- Department of Thoracic and Cardiovascular Surgery, School of Medicine, Cumhuriyet University, Sivas, Turkey
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38
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Abstract
In Japan, tea (Camellia sinenis (L.) Kuntze) seedlings are propagated by cutting. A root system of clonal plants by cutting consists of adventitious roots and lateral roots. Most of the roots grow horizontally, which results in a shallow distribution of the root system. Such a shallow root system could be one of the factors contributing to the deterioration of nutrient uptake and resistance to water stress. Gravitropism of the roots is considered to be a decisive factor that controls the depth of a root system. The authors have investigated changes in the growth direction of roots to gravitative stimulus, using several kinds of roots (seminal roots, lateral roots and adventitious roots). Furthermore, amyloplasts in the root-cap cells, which are considered to be an equipment sensing gravistimulus, were observed. Seminal roots prominently showed orthogravitropism and contained many amyloplast particles in their root cap cells. Most lateral and adventitious roots showed plagiogravitropism, growing in an angle to gravistimulus, and lacked observable amyloplast particles in their root cap cells. The results suggest that the shallowing of root systems of elonal tea plants could be attributed to a gravitropic reaction of the adventitious and lateral roots composing the root system. There could also be a close relationship between the growth direction of roots and the presence of amyloplasts in root-cap cells.
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Affiliation(s)
- M Yamashita
- Kurume Branch, National Research Institute of Vegetables, Ornamental Plants and Tea, Kagoshima, Japan
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