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Murphy T, Stewart P, Nestor CC, Irwin MG. Handling injectable medications: mixing drugs. Anaesthesia 2024; 79:436-437. [PMID: 38306490 DOI: 10.1111/anae.16240] [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: 01/05/2024] [Indexed: 02/04/2024]
Affiliation(s)
- T Murphy
- University Hospital Tallaght, Dublin, Ireland
| | - P Stewart
- University Hospital Tallaght, Dublin, Ireland
| | - C C Nestor
- University Hospital Tallaght, Dublin, Ireland
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McAtee TB, Renter DG, Murphy T, Betts NB, Depenbusch BE. Cattle, carcass, economic, and estimated emission impacts of feeding finishing steers lubabegron or ractopamine hydrochloride. Transl Anim Sci 2024; 8:txae031. [PMID: 38707257 PMCID: PMC11067785 DOI: 10.1093/tas/txae031] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 03/06/2024] [Indexed: 05/07/2024] Open
Abstract
Lubabegron (Experior; Elanco, Greenfield, IN, USA) is the first U.S. Food and Drug Administration approved feed additive for reducing gas emissions from feedlot animals or their waste; it does not have live or carcass performance claims. Our primary objective was to determine the effect of lubabegron on feedlot performance and carcass traits in finishing beef steers compared to ractopamine hydrochloride (Optaflexx; Elanco, Greenfield, IN, USA). A commercial feedlot trial using cross-bred beef steers (n = 2,117; 373 ± 15 kg initial body weight [BW]) was completed with a randomized complete block design. Treatments consisted of two feed additives: (1) OPT targeted to deliver 300 mg/animal/d of ractopamine hydrochloride for 28 ± 7 d out from harvest and (2) EXP targeted to deliver 36 mg/animal/d of lubabegron 56 ± 7 d out from harvest and a 4-d preslaughter withdrawal period. Twenty 70 to 142 hd pens with 10 pens per treatment were used. Cattle were weighed at arrival processing and at harvest and fed for an average of 167 d. Data were used to calculate production metrics, partial budgets, and estimated greenhouse gas emissions using published methods, and were analyzed using linear mixed models with pen as the experimental unit and block as a random intercept. A statistical significance threshold of α = 0.05 was determined a priori. There was no evidence for statistically significant differences between treatments for initial BW (P = 0.70), health-related outcomes (P values ≥ 0.43), or mobility scores (P = 0.09). Cattle-fed EXP had increased final BW, ADG, G:F, and decreased dry matter intake (P values ≤ 0.01) compared to OPT. Carcasses were 11 ± 1.76 kg (hot carcass weight) heavier in EXP group (P < 0.01), and differed between treatments for both yield grades (YG) and quality grades distributions (P values ≤ 0.01). Cattle-fed EXP had a shift toward more YG 1 and 2, select and sub-select carcasses compared to OPT, which had as shift toward more YG 3, 4, 5, prime and choice carcasses. With increased beef production and efficiency compared to OPT, the estimated CO2 equivalent emissions from production were reduced by 6.2% per unit of carcass weight for EXP (P ≤ 0.01). Estimated net returns/animal shipped were $56.61 ± 9.37 more for EXP than OPT (P ≤ 0.01). In conclusion, when cattle were fed for the same total number of days, feeding EXP compared to OPT increased net returns, feedlot performance, and efficiency, but resulted in carcass yield and quality characteristics that may impact marketing programs.
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Affiliation(s)
- T B McAtee
- The Center for Outcomes Research and Epidemiology, Department of Diagnostic Medicine and Pathobiology, Kansas State University, College of Veterinary Medicine, Manhattan, KS 66506, USA
| | - D G Renter
- The Center for Outcomes Research and Epidemiology, Department of Diagnostic Medicine and Pathobiology, Kansas State University, College of Veterinary Medicine, Manhattan, KS 66506, USA
| | - T Murphy
- High Plains Consulting, Inc., Dodge City, KS 67801, USA
| | - N B Betts
- Elanco Animal Health, Greenfield, IN 46140, USA
| | - B E Depenbusch
- Innovative Livestock Services, Inc., Great Bend, KS 67530, USA
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Affleck E, Sutherland E, Lindeman C, Golonka R, Price T, Murphy T, Williamson T, Chapman A, Layton A, Fraser C. Human Factor Health Data Interoperability. Healthc Pap 2024; 21:47-55. [PMID: 38482657 DOI: 10.12927/hcpap.2024.27272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
Comprehensive health data interoperability is recognized as an essential element of high-functioning and accountable health service. Canada is lagging in health data interoperability compared to international comparators, and lacks a comprehensive approach to human factor interoperability, defined as system-level relationships that impact the capacity of health sector stakeholders to adopt harmonized health data standards and technology. Without addressing these system-level relationships, the adoption of harmonized health data standards and technology will be obstructed and Canadians will be underserved. The proposed health data interoperability framework articulates the factors that Canada needs to address to optimize health data design to support quality health programs and services.
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Affiliation(s)
- Ewan Affleck
- Senior Medical Advisor- Health Informatics, College of Physicians and Surgeons of Alberta, Edmonton, AB
| | - Eric Sutherland
- Senior Health Economist, Organisation for Economic Co-operation and Development, Paris, France
| | - Cliff Lindeman
- Department of Family Medicine, University of Alberta, Edmonton, AB
| | - Richard Golonka
- Senior Analyst, School of Public Health, University of Alberta, Edmonton, AB
| | - Teri Price
- Executive Director, Greg's Wings Projects, Calgary, AB
| | - Tim Murphy
- Vice President, Health, Alberta Innovates, Edmonton, AB
| | - Tyler Williamson
- Associate Professor, Centre for Health Informatics, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB
| | - Ann Chapman
- Director, Health Spending and Primary Care, Canadian Institute for Health Information, Ottawa, ON
| | - Anita Layton
- Professor of Applied Mathematics, Computer Science, Pharmacy and Biology, University of Waterloo, Kitchener, ON
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Wilkinson K, Taylor D, Murphy T. Pediatric Cardiac Anesthesia Training and Staffing in the National Health Service. Paediatr Anaesth 2023; 33:1029-1033. [PMID: 37470207 DOI: 10.1111/pan.14729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 07/04/2023] [Accepted: 07/10/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND Considerable importance is attached to the process of training, appointing and retaining highly specialized pediatric anesthetists, such as those with a congenital heart disease practice. AIMS For the 10-year period from April 2012 to March 2022, we wished to establish changes in the absolute number of consultant pediatric cardiac anesthetic posts in NHS Level 1 Centres, turnover in such posts, and what training appointees had received. METHODS An email survey was sent to the Centre Representative from the Congenital Cardiac Anesthesia Network in each of the eleven NHS Level 1 Pediatric Congenital Heart Disease Centre. Further follow up was completed in order to confirm accuracy of responses. We defined a pediatric cardiac anesthetist as a consultant with a clinical practice including provision of anesthetic management for children undergoing cardiac surgery incorporating the use of cardiopulmonary bypass. RESULTS The response rate to our survey was 100%. Over the study period the number of consultants increased from 69 to 81, though three posts were unfilled as at March 2022. There were 55 departures and 65 appointees. Five consultants moved between NHS Units. 52 consultants received formal fellowship training and 13 switched into pediatric cardiac anesthesia from an existing general pediatric anesthetic post, with a period of supplementary training within their institution. Appointees reported extensive additional training variably including fellowships in general pediatric anesthesia, adult cardiac anesthesia and pediatric intensive care, both within and outside the United Kingdom. CONCLUSIONS There has been both an expansion in the number of posts, as well as considerable turnover in consultant posts in the last 10 years. Training standards which support and guide individuals as they develop a practice in this highly specialized field should reflect different routes into the speciality and could be established with the support and advice of the Congenital Cardiac Anesthesia Network.
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Affiliation(s)
- Kirstin Wilkinson
- Department of Anaesthesia, Southampton General Hospital, Southampton, UK
| | - Dan Taylor
- Department of Anaesthesia, Evelina London Children's Hospital, London, UK
| | - Tim Murphy
- Department of Anaesthesia, Bristol Royal Hospital for Children, Bristol, UK
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Murphy T, Brown M, Sale S, Nasr V. Challenges to the Wider Implementation of Pediatric Cardiac Surgical Enhanced Recovery Programs: 'What's in a Name?'. J Cardiothorac Vasc Anesth 2023; 37:2191-2193. [PMID: 37598035 DOI: 10.1053/j.jvca.2023.07.035] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 07/24/2023] [Indexed: 08/21/2023]
Affiliation(s)
- Tim Murphy
- Department of Paediatric Cardiac Anaesthesia, Bristol Royal Hospital for Children, Bristol, United Kingdom
| | - Morgan Brown
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Steven Sale
- Department of Paediatric Cardiac Anaesthesia, Bristol Royal Hospital for Children, Bristol, United Kingdom
| | - Viviane Nasr
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, MA
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Brooke N, Elliott J, Murphy T, Vera Stimpson L. Development of a radiographic technique for porcine head ballistic research. Radiography (Lond) 2023; 29:980-983. [PMID: 37595528 DOI: 10.1016/j.radi.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 08/20/2023]
Abstract
INTRODUCTION The porcine model shows structural features comparable to that of humans and are routinely used within research, due to the ethical, legal, and practical use of post-mortem human samples. Methods for obtaining high quality and comparable reference data using standardised acquisition protocols are essential. METHODS The decapitated heads of three adult white sows were subjected to radiographic imaging before and after cranial trauma (9 mm, Heckler and Koch MP5). Digital radiographs were generated using a Siemens MULTIX TOP system with an Agfa digital detector, with foam blocks and sandbags as ancillary equipment. An iterative approach was adopted by the authors to generate reproducible radiographic views from two perpendicular angles. Specimens were kept at 5 °C and wrapped in polythene bags to reduce the impact of putrefaction. RESULTS Standardised head radiography technique was developed for superior-inferior and lateral views demonstrating porcine anatomy. Key parameters included: automatic exposure control for tube current (∼4 mAs), tube voltage of 73 kVp, 100 cm source to image receptor distance, and an anti-scatter grid. Slight variances in specimen morphology, developmental status, and soft tissue changes did not affect imaging outcomes. CONCLUSION The technique and positioning proposed in this study allows for the acquisition of high quality and reproducible radiographic images for comparable ballistic research datasets. Specimen positioning and centring of the primary beam may be applied across porcine breeds, although individual radiographic parameters may differ according to equipment specifications and specimen size. IMPLICATIONS FOR PRACTICE Development of a reproducible radiographic technique of porcine heads in forensic and veterinary research.
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Affiliation(s)
- N Brooke
- School of Law, Policing and Social Sciences, Canterbury Christ Church University, Kent, United Kingdom
| | - J Elliott
- School of Allied and Public Health Professions, Canterbury Christ Church University, Kent, United Kingdom
| | - T Murphy
- Kent Police Tactical Firearms Unit, Kent, United Kingdom
| | - L Vera Stimpson
- School of Law, Policing and Social Sciences, Canterbury Christ Church University, Kent, United Kingdom.
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Beringer R, Keith A, Jones E, Murphy T, White P. A prospective comparison of invasive and non-invasive blood pressure in children undergoing cardiac catheterization. Paediatr Anaesth 2023; 33:816-822. [PMID: 37391941 DOI: 10.1111/pan.14723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/08/2023] [Accepted: 06/22/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND Blood pressure measurement is a standard of monitoring during general anesthesia. Invasive measurement is considered the gold standard but is less commonly used than non-invasive. Automated oscillometric blood pressure devices measure the mean arterial pressure (MAP) and use an algorithm to determine the systolic and diastolic pressures. Few devices have been validated in children, particularly during anesthesia. Few studies have assessed the agreement between invasive and non-invasive blood pressure measurements in children. METHODS This was a multi-center prospective observational study of children under 16 years undergoing cardiac catheterization with general anesthesia. Paired invasive and non-invasive blood pressure measurements were recorded for each patient during stable periods of the procedure. Correlation within and between sites was assessed with Pearson's correlation coefficient, and agreement was examined using Bland-Altman methodology to determine bias. Agreement during episodes of hypotension and for age and weight was also determined. Bias greater than 5 mmHg and standard deviation greater than 8 mmHg was considered clinically significant. The primary end point was agreement of MAP measurements. RESULTS A total of 683 paired blood pressure values were collected from 254 children in three pediatric hospitals. Median [IQR] age and weight were 3 [1-7] years and 13.9 [8-23] Kg. The overall bias (SD) for mean arterial pressure values was 7.2 (11.4) mmHg. During hypotension (190 readings), the bias (SD) was 15 (11.0) mmHg. The non-invasive MAP was frequently higher than invasive MAP during infancy, and lower in older children. CONCLUSION Automated oscillometric blood pressure measurement is unreliable in anesthetized children during cardiac catheterization. Invasive pressure measurement should be considered for high-risk cases.
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Affiliation(s)
| | | | - Elin Jones
- Birmingham Children's Hospital, Birmingham, UK
| | - Tim Murphy
- Bristol Royal Hospital for Children, Bristol, UK
| | - Paul White
- University of the West of England, Bristol, UK
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Hutton D, Booker P, Shuttleworth S, Hall T, Cain M, Murphy T, Woods L, Saunders D. The Patient's perspective: A review of the results from a radiotherapy patient experience survey in the North-West of England. Radiography (Lond) 2023; 29 Suppl 1:S59-S67. [PMID: 36934026 DOI: 10.1016/j.radi.2023.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/17/2023] [Accepted: 02/21/2023] [Indexed: 03/19/2023]
Abstract
INTRODUCTION A patient experience survey was undertaken for patients completing radiotherapy at the three Northwest of England Radiotherapy Providers. METHODS A previously reported National Radiotherapy Patient Experience Survey was adapted and undertaken in the Northwest of England. Quantitative data was analysed to establish trends. Frequency distribution was applied to appraise the number of participants selecting each of the pre-determined responses. Thematic analysis of free text responses was conducted. RESULTS The questionnaire received 653 responses from the 3 providers across seven departments. Thematic analysis revealed 3 themes; logistics, information and operational. CONCLUSION The results indicate that the majority of patients are satisfied with their treatment and care. Patients' responses indicate areas for improvements. Expectancy theory states that an individual's satisfaction is related to the difference between expected service and the service received. Consequently, when reviewing services and developing improvement it is important to understand patients' expectations. This regional survey starts to capture what people receiving radiotherapy expect from the service and the professionals delivering their treatment. IMPLICATIONS FOR PRACTICE This survey responses make a case for reviewing the information provision pre and post radiotherapy. This includes clarifying the understanding of consent for treatment including the intended benefits and potential late effects. There is an argument to offer information sessions prior to radiotherapy to achieve more relaxed and informed patients. A recommendation from this work is for the radiotherapy community undertake a national radiotherapy patient experience survey, facilitated via the 11 Radiotherapy ODNs. A national radiotherapy survey has multiple benefits to inform improvements in practice. This includes benchmarking services against national averages. This approach is aligned with the principles of the service specification in terms of reducing variation and increasing quality.
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Affiliation(s)
- D Hutton
- NW Radiotherapy ODN, United Kingdom.
| | - P Booker
- Lancashire Teaching Hospitals, United Kingdom
| | | | - T Hall
- NW Radiotherapy ODN, United Kingdom
| | - M Cain
- The Clatterbridge Cancer Centre NHS FT, United Kingdom
| | - T Murphy
- NW Radiotherapy ODN, United Kingdom
| | - L Woods
- The Clatterbridge Cancer Centre NHS FT, United Kingdom
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Nazir M, Murphy T, Poku N, Wheen P, Nowbar A, Andres M, Ramalingham S, Rosen S, Nicol E, Lyon A. Clinical Utility And Prognostic Value Of Coronary Computed Tomography Angiography In Cancer Patients. J Cardiovasc Comput Tomogr 2023. [DOI: 10.1016/j.jcct.2023.01.015] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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Moorthy A, Eochagain AN, Dempsey E, Wall V, Marsh H, Murphy T, Fitzmaurice G, Naughton R, Buggy D. Ultrasound-guided erector spinae plane catheter versus video-assisted paravertebral catheter in video-assisted thoracic surgery: comparing continuous infusion analgesic techniques on quality of recovery. Br J Anaesth 2022. [DOI: 10.1016/j.bja.2022.06.002] [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
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Kamarajah S, Evans R, Nepogodiev D, Hodson J, Bundred J, Gockel I, Gossage J, Isik A, Kidane B, Mahendran H, Negoi I, Okonta K, Sayyed R, van Hillegersberg R, Vohra R, Wijnhoven B, Singh P, Griffiths E, Kamarajah S, Hodson J, Griffiths E, Alderson D, Bundred J, Evans R, Gossage J, Griffiths E, Jefferies B, Kamarajah S, McKay S, Mohamed I, Nepogodiev D, Siaw-Acheampong K, Singh P, van Hillegersberg R, Vohra R, Wanigasooriya K, Whitehouse T, Gjata A, Moreno J, Takeda F, Kidane B, Guevara Castro R, Harustiak T, Bekele A, Kechagias A, Gockel I, Kennedy A, Da Roit A, Bagajevas A, Azagra J, Mahendran H, Mejía-Fernández L, Wijnhoven B, El Kafsi J, Sayyed R, Sousa M, Sampaio A, Negoi I, Blanco R, Wallner B, Schneider P, Hsu P, Isik A, Gananadha S, Wills V, Devadas M, Duong C, Talbot M, Hii M, Jacobs R, Andreollo N, Johnston B, Darling G, Isaza-Restrepo A, Rosero G, Arias-Amézquita F, Raptis D, Gaedcke J, Reim D, Izbicki J, Egberts J, Dikinis S, Kjaer D, Larsen M, Achiam M, Saarnio J, Theodorou D, Liakakos T, Korkolis D, Robb W, Collins C, Murphy T, Reynolds J, Tonini V, Migliore M, Bonavina L, Valmasoni M, Bardini R, Weindelmayer J, Terashima M, White R, Alghunaim E, Elhadi M, Leon-Takahashi A, Medina-Franco H, Lau P, Okonta K, Heisterkamp J, Rosman C, van Hillegersberg R, Beban G, Babor R, Gordon A, Rossaak J, Pal K, Qureshi A, Naqi S, Syed A, Barbosa J, Vicente C, Leite J, Freire J, Casaca R, Costa R, Scurtu R, Mogoanta S, Bolca C, Constantinoiu S, Sekhniaidze D, Bjelović M, So J, Gačevski G, Loureiro C, Pera M, Bianchi A, Moreno Gijón M, Martín Fernández J, Trugeda Carrera M, Vallve-Bernal M, Cítores Pascual M, Elmahi S, Halldestam I, Hedberg J, Mönig S, Gutknecht S, Tez M, Guner A, Tirnaksiz M, Colak E, Sevinç B, Hindmarsh A, Khan I, Khoo D, Byrom R, Gokhale J, Wilkerson P, Jain P, Chan D, Robertson K, Iftikhar S, Skipworth R, Forshaw M, Higgs S, Gossage J, Nijjar R, Viswanath Y, Turner P, Dexter S, Boddy A, Allum W, Oglesby S, Cheong E, Beardsmore D, Vohra R, Maynard N, Berrisford R, Mercer S, Puig S, Melhado R, Kelty C, Underwood T, Dawas K, Lewis W, Al-Bahrani A, Bryce G, Thomas M, Arndt A, Palazzo F, Meguid R, Fergusson J, Beenen E, Mosse C, Salim J, Cheah S, Wright T, Cerdeira M, McQuillan P, Richardson M, Liem H, Spillane J, Yacob M, Albadawi F, Thorpe T, Dingle A, Cabalag C, Loi K, Fisher O, Ward S, Read M, Johnson M, Bassari R, Bui H, Cecconello I, Sallum R, da Rocha J, Lopes L, Tercioti V, Coelho J, Ferrer J, Buduhan G, Tan L, Srinathan S, Shea P, Yeung J, Allison F, Carroll P, Vargas-Barato F, Gonzalez F, Ortega J, Nino-Torres L, Beltrán-García T, Castilla L, Pineda M, Bastidas A, Gómez-Mayorga J, Cortés N, Cetares C, Caceres S, Duarte S, Pazdro A, Snajdauf M, Faltova H, Sevcikova M, Mortensen P, Katballe N, Ingemann T, Morten B, Kruhlikava I, Ainswort A, Stilling N, Eckardt J, Holm J, Thorsteinsson M, Siemsen M, Brandt B, Nega B, Teferra E, Tizazu A, Kauppila J, Koivukangas V, Meriläinen S, Gruetzmann R, Krautz C, Weber G, Golcher H, Emons G, Azizian A, Ebeling M, Niebisch S, Kreuser N, Albanese G, Hesse J, Volovnik L, Boecher U, Reeh M, Triantafyllou S, Schizas D, Michalinos A, Balli E, Mpoura M, Charalabopoulos A, Manatakis D, Balalis D, Bolger J, Baban C, Mastrosimone A, McAnena O, Quinn A, Ó Súilleabháin C, Hennessy M, Ivanovski I, Khizer H, Ravi N, Donlon N, Cervellera M, Vaccari S, Bianchini S, Sartarelli L, Asti E, Bernardi D, Merigliano S, Provenzano L, Scarpa M, Saadeh L, Salmaso B, De Manzoni G, Giacopuzzi S, La Mendola R, De Pasqual C, Tsubosa Y, Niihara M, Irino T, Makuuchi R, Ishii K, Mwachiro M, Fekadu A, Odera A, Mwachiro E, AlShehab D, Ahmed H, Shebani A, Elhadi A, Elnagar F, Elnagar H, Makkai-Popa S, Wong L, Tan Y, Thannimalai S, Ho C, Pang W, Tan J, Basave H, Cortés-González R, Lagarde S, van Lanschot J, Cords C, Jansen W, Martijnse I, Matthijsen R, Bouwense S, Klarenbeek B, Verstegen M, van Workum F, Ruurda J, van der Sluis P, de Maat M, Evenett N, Johnston P, Patel R, MacCormick A, Young M, Smith B, Ekwunife C, Memon A, Shaikh K, Wajid A, Khalil N, Haris M, Mirza Z, Qudus S, Sarwar M, Shehzadi A, Raza A, Jhanzaib M, Farmanali J, Zakir Z, Shakeel O, Nasir I, Khattak S, Baig M, MA N, Ahmed H, Naeem A, Pinho A, da Silva R, Bernardes A, Campos J, Matos H, Braga T, Monteiro C, Ramos P, Cabral F, Gomes M, Martins P, Correia A, Videira J, Ciuce C, Drasovean R, Apostu R, Ciuce C, Paitici S, Racu A, Obleaga C, Beuran M, Stoica B, Ciubotaru C, Negoita V, Cordos I, Birla R, Predescu D, Hoara P, Tomsa R, Shneider V, Agasiev M, Ganjara I, Gunjić D, Veselinović M, Babič T, Chin T, Shabbir A, Kim G, Crnjac A, Samo H, Díez del Val I, Leturio S, Ramón J, Dal Cero M, Rifá S, Rico M, Pagan Pomar A, Martinez Corcoles J, Rodicio Miravalles J, Pais S, Turienzo S, Alvarez L, Campos P, Rendo A, García S, Santos E, Martínez E, Fernández Díaz M, Magadán Álvarez C, Concepción Martín V, Díaz López C, Rosat Rodrigo A, Pérez Sánchez L, Bailón Cuadrado M, Tinoco Carrasco C, Choolani Bhojwani E, Sánchez D, Ahmed M, Dzhendov T, Lindberg F, Rutegård M, Sundbom M, Mickael C, Colucci N, Schnider A, Er S, Kurnaz E, Turkyilmaz S, Turkyilmaz A, Yildirim R, Baki B, Akkapulu N, Karahan O, Damburaci N, Hardwick R, Safranek P, Sujendran V, Bennett J, Afzal Z, Shrotri M, Chan B, Exarchou K, Gilbert T, Amalesh T, Mukherjee D, Mukherjee S, Wiggins T, Kennedy R, McCain S, Harris A, Dobson G, Davies N, Wilson I, Mayo D, Bennett D, Young R, Manby P, Blencowe N, Schiller M, Byrne B, Mitton D, Wong V, Elshaer A, Cowen M, Menon V, Tan L, McLaughlin E, Koshy R, Sharp C, Brewer H, Das N, Cox M, Al Khyatt W, Worku D, Iqbal R, Walls L, McGregor R, Fullarton G, Macdonald A, MacKay C, Craig C, Dwerryhouse S, Hornby S, Jaunoo S, Wadley M, Baker C, Saad M, Kelly M, Davies A, Di Maggio F, McKay S, Mistry P, Singhal R, Tucker O, Kapoulas S, Powell-Brett S, Davis P, Bromley G, Watson L, Verma R, Ward J, Shetty V, Ball C, Pursnani K, Sarela A, Sue Ling H, Mehta S, Hayden J, To N, Palser T, Hunter D, Supramaniam K, Butt Z, Ahmed A, Kumar S, Chaudry A, Moussa O, Kordzadeh A, Lorenzi B, Wilson M, Patil P, Noaman I, Willem J, Bouras G, Evans R, Singh M, Warrilow H, Ahmad A, Tewari N, Yanni F, Couch J, Theophilidou E, Reilly J, Singh P, van Boxel Gijs, Akbari K, Zanotti D, Sgromo B, Sanders G, Wheatley T, Ariyarathenam A, Reece-Smith A, Humphreys L, Choh C, Carter N, Knight B, Pucher P, Athanasiou A, Mohamed I, Tan B, Abdulrahman M, Vickers J, Akhtar K, Chaparala R, Brown R, Alasmar M, Ackroyd R, Patel K, Tamhankar A, Wyman A, Walker R, Grace B, Abbassi N, Slim N, Ioannidi L, Blackshaw G, Havard T, Escofet X, Powell A, Owera A, Rashid F, Jambulingam P, Padickakudi J, Ben-Younes H, Mccormack K, Makey I, Karush M, Seder C, Liptay M, Chmielewski G, Rosato E, Berger A, Zheng R, Okolo E, Singh A, Scott C, Weyant M, Mitchell J. The influence of anastomotic techniques on postoperative anastomotic complications: Results of the Oesophago-Gastric Anastomosis Audit. J Thorac Cardiovasc Surg 2022; 164:674-684.e5. [PMID: 35249756 DOI: 10.1016/j.jtcvs.2022.01.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 12/22/2021] [Accepted: 01/18/2022] [Indexed: 12/08/2022]
Abstract
BACKGROUND The optimal anastomotic techniques in esophagectomy to minimize rates of anastomotic leakage and conduit necrosis are not known. The aim of this study was to assess whether the anastomotic technique was associated with anastomotic failure after esophagectomy in the international Oesophago-Gastric Anastomosis Audit cohort. METHODS This prospective observational multicenter cohort study included patients undergoing esophagectomy for esophageal cancer over 9 months during 2018. The primary exposure was the anastomotic technique, classified as handsewn, linear stapled, or circular stapled. The primary outcome was anastomotic failure, namely a composite of anastomotic leakage and conduit necrosis, as defined by the Esophageal Complications Consensus Group. Multivariable logistic regression modeling was used to identify the association between anastomotic techniques and anastomotic failure, after adjustment for confounders. RESULTS Of the 2238 esophagectomies, the anastomosis was handsewn in 27.1%, linear stapled in 21.0%, and circular stapled in 51.9%. Anastomotic techniques differed significantly by the anastomosis sites (P < .001), with the majority of neck anastomoses being handsewn (69.9%), whereas most chest anastomoses were stapled (66.3% circular stapled and 19.3% linear stapled). Rates of anastomotic failure differed significantly among the anastomotic techniques (P < .001), from 19.3% in handsewn anastomoses, to 14.0% in linear stapled anastomoses, and 12.1% in circular stapled anastomoses. This effect remained significant after adjustment for confounding factors on multivariable analysis, with an odds ratio of 0.63 (95% CI, 0.46-0.86; P = .004) for circular stapled versus handsewn anastomosis. However, subgroup analysis by anastomosis site suggested that this effect was predominantly present in neck anastomoses, with anastomotic failure rates of 23.2% versus 14.6% versus 5.9% for handsewn versus linear stapled anastomoses versus circular stapled neck anastomoses, compared with 13.7% versus 13.8% versus 12.2% for chest anastomoses. CONCLUSIONS Handsewn anastomoses appear to be independently associated with higher rates of anastomotic failure compared with stapled anastomoses. However, this effect seems to be largely confined to neck anastomoses, with minimal differences between techniques observed for chest anastomoses. Further research into standardization of anastomotic approach and techniques may further improve outcomes.
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Anis L, Letourneau N, Ross KM, Hart M, Graham I, Lalonde S, Varro S, Baldwin A, Soulsby A, Majnemer A, Donnelly C, Piotrowski C, Collier C, Lindeman C, Goldowitz D, Isaac D, Thomson D, Serré D, Citro E, Zimmermann G, Pliszka H, Mann J, Baumann J, Piekarski J, Dalton JA, Johnson-Green J, Wood K, Bruce M, Santana M, Mayer M, Gould M, Kobor M, Flowers M, Haywood M, Koerner M, Parker N, Muhajarine N, Fairie P, Chrishti R, Perry R, Merrill S, Pociuk S, StephanieTaylor, Cole S, Murphy T, Marchment T, Xavier V, Shajani Z, West Z. Study protocol for Attachment & Child Health (ATTACHTM) program: promoting vulnerable Children’s health at scale. BMC Pediatr 2022; 22:491. [PMID: 35986306 PMCID: PMC9388995 DOI: 10.1186/s12887-022-03439-3] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 06/22/2022] [Indexed: 11/11/2022] Open
Abstract
Background Children’s exposure to toxic stress (e.g., parental depression, violence, poverty) predicts developmental and physical health problems resulting in health care system burden. Supporting parents to develop parenting skills can buffer the effects of toxic stress, leading to healthier outcomes for those children. Parenting interventions that focus on promoting parental reflective function (RF), i.e., parents’ capacity for insight into their child’s and their own thoughts, feelings, and mental states, may understand help reduce societal health inequities stemming from childhood stress exposures. The Attachment and Child Health (ATTACHTM) program has been implemented and tested in seven rapid-cycling pilot studies (n = 64) and found to significantly improve parents’ RF in the domains of attachment, parenting quality, immune function, and children’s cognitive and motor development. The purpose of the study is to conduct an effectiveness-implementation hybrid (EIH) Type II study of ATTACHTM to assess its impacts in naturalistic, real-world settings delivered by community agencies rather than researchers under more controlled conditions. Methods The study is comprised of a quantitative pre/post-test quasi-experimental evaluation of the ATTACHTM program, and a qualitative examination of implementation feasibility using thematic analysis via Normalization Process Theory (NPT). We will work with 100 families and their children (birth to 36-months-old). Study outcomes include: the Parent Child Interaction Teaching Scale to assess parent-child interaction; the Parental Reflective Function and Reflective Function Questionnaires to assess RF; and the Ages and Stages Questionnaire – 3rd edition to examine child development, all administered pre-, post-, and 3-month-delayed post-assessment. Blood samples will be collected pre- and post- assessment to assess immune biomarkers. Further, we will conduct one-on-one interviews with study participants, health and social service providers, and administrators (total n = 60) from each collaborating agency, using NPT to explore perceptions and experiences of intervention uptake, the fidelity assessment tool and e-learning training as well as the benefits, barriers, and challenges to ATTACHTM implementation. Discussion The proposed study will assess effectiveness and implementation to help understand the delivery of ATTACHTM in community agencies. Trial registration Name of registry: https://clinicaltrials.gov/. Registration number: NCT04853888. Date of registration: April 22, 2021. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-022-03439-3.
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Curtin M, Pomeroy E, Grigoras M, Murphy T, Rowan FE. A prospective osseointegration retrieval analysis of second generation cementless shells. J Clin Orthop Trauma 2022; 30:101914. [PMID: 35734018 PMCID: PMC9207567 DOI: 10.1016/j.jcot.2022.101914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 05/22/2022] [Accepted: 06/02/2022] [Indexed: 11/20/2022] Open
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Murphy T, Sale SM, Gonzalez Barlatay F, Armstrong C, Parry A, Houghton E, Jerrom T, Schadenberg A. Initial results from an enhanced recovery program for pediatric cardiac surgical patients. Paediatr Anaesth 2022; 32:647-653. [PMID: 35156262 DOI: 10.1111/pan.14418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 01/07/2022] [Accepted: 02/04/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Over recent years, a number of enhanced recovery programs have appeared in first, adult colorectal surgery, and subsequently many other adult surgical specialties. Increasing interest in this approach to perioperative management in children culminated in the recent development of the first enhanced recovery pathway for pediatric intestinal surgery, endorsed by Enhanced Recovery after Surgery Society (ERAS®). In parallel, there has been increasing interest in the refinement of perioperative management of selected pediatric cardiac surgical patients, invariably referred to as "fast track" management. Initiatives have largely focused on duration of postoperative ventilation rather than on a much wider range of perioperative interventions to optimize recovery and ensure timely discharge after surgery. In our institution, a "Level 1" pediatric cardiac surgical center, we assembled a multidisciplinary team to design a comprehensive enhanced recovery pathway, based on ERAS® methodology, for selected cardiac surgical patients. After a lengthy period of planning, staff education, and preparation, we implemented the pathway at the end of November 2019. METHODS We conducted a prospective audit of the perioperative management and outcomes of the first 88 patients managed according to this enhanced recovery pathway over a 25-month period in our institution. RESULTS The mean age of the patients was 5.8 years (range 0.5-17.9), and the mean weight was 22.4 kg (range 6.6-57.2). Sixty-eight of the 88 patients were cardiopulmonary bypass cases. A total of 54% of patients received all four defined intraoperative anesthetic interventions (intravenous paracetamol, non-steroidal anti-inflammatory drug, antiemetic if aged more than 4 years, and use of a local anesthetic technique). A total of 89% of patients met the target extubation time of 6 h after administration of protamine. Median postoperative intensive care unit length of stay was 23.5 h (range 15.2-89.5). When compared to a historic control group, this represented a 22% reduction in median intensive care unit stay, although the total hospital length of stay remained unchanged. A total of 83% of patients met the target hospital discharge target of the fifth postoperative day. CONCLUSIONS These preliminary results suggest that enhanced recovery pathway implementation for selected pediatric cardiac surgical patients is feasible, with acceptable outcomes. They suggest areas for further development and the potential for wider implementation.
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Affiliation(s)
- Tim Murphy
- Pediatric Cardiac Anesthesia, Bristol Royal Hospital for Children, Bristol, UK
| | - Steven M Sale
- Pediatric Cardiac Anesthesia, Bristol Royal Hospital for Children, Bristol, UK
| | | | | | - Andrew Parry
- Congenital Cardiac Surgery, Bristol Royal Hospital for Children, Bristol, UK
| | | | - Tom Jerrom
- Pediatric Intensive Care, Bristol Royal Hospital for Children, Bristol, UK
| | - Alvin Schadenberg
- Pediatric Intensive Care, Bristol Royal Hospital for Children, Bristol, UK
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Booth K, Murphy T, O'Connor R, McGuire A. P.89 Management of refractory thrombotic thrombocytopenic purpura presenting in the pregnancy. Int J Obstet Anesth 2022. [DOI: 10.1016/j.ijoa.2022.103385] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Kamarajah SK, Evans RPT, Nepogodiev D, Hodson J, Bundred JR, Gockel I, Gossage JA, Isik A, Kidane B, Mahendran HA, Negoi I, Okonta KE, Sayyed R, van Hillegersberg R, Vohra RS, Wijnhoven BPL, Singh P, Griffiths EA, Kamarajah SK, Hodson J, Griffiths EA, Alderson D, Bundred J, Evans RPT, Gossage J, Griffiths EA, Jefferies B, Kamarajah SK, McKay S, Mohamed I, Nepogodiev D, Siaw-Acheampong K, Singh P, van Hillegersberg R, Vohra R, Wanigasooriya K, Whitehouse T, Gjata A, Moreno JI, Takeda FR, Kidane B, Guevara Castro R, Harustiak T, Bekele A, Kechagias A, Gockel I, Kennedy A, Da Roit A, Bagajevas A, Azagra JS, Mahendran HA, Mejía-Fernández L, Wijnhoven BPL, El Kafsi J, Sayyed RH, Sousa M M, Sampaio AS, Negoi I, Blanco R, Wallner B, Schneider PM, Hsu PK, Isik A, Gananadha S, Wills V, Devadas M, Duong C, Talbot M, Hii MW, Jacobs R, Andreollo NA, Johnston B, Darling G, Isaza-Restrepo A, Rosero G, Arias-Amézquita F, Raptis D, Gaedcke J, Reim D, Izbicki J, Egberts JH, Dikinis S, Kjaer DW, Larsen MH, Achiam MP, Saarnio J, Theodorou D, Liakakos T, Korkolis DP, Robb WB, Collins C, Murphy T, Reynolds J, Tonini V, Migliore M, Bonavina L, Valmasoni M, Bardini R, Weindelmayer J, Terashima M, White RE, Alghunaim E, Elhadi M, Leon-Takahashi AM, Medina-Franco H, Lau PC, Okonta KE, Heisterkamp J, Rosman C, van Hillegersberg R, Beban G, Babor R, Gordon A, Rossaak JI, Pal KMI, Qureshi AU, Naqi SA, Syed AA, Barbosa J, Vicente CS, Leite J, Freire J, Casaca R, Costa RCT, Scurtu RR, Mogoanta SS, Bolca C, Constantinoiu S, Sekhniaidze D, Bjelović M, So JBY, Gačevski G, Loureiro C, Pera M, Bianchi A, Moreno Gijón M, Martín Fernández J, Trugeda Carrera MS, Vallve-Bernal M, Cítores Pascual MA, Elmahi S, Halldestam I, Hedberg J, Mönig S, Gutknecht S, Tez M, Guner A, Tirnaksiz MB, Colak E, Sevinç B, Hindmarsh A, Khan I, Khoo D, Byrom R, Gokhale J, Wilkerson P, Jain P, Chan D, Robertson K, Iftikhar S, Skipworth R, Forshaw M, Higgs S, Gossage J, Nijjar R, Viswanath YKS, Turner P, Dexter S, Boddy A, Allum WH, Oglesby S, Cheong E, Beardsmore D, Vohra R, Maynard N, Berrisford R, Mercer S, Puig S, Melhado R, Kelty C, Underwood T, Dawas K, Lewis W, Bryce G, Thomas M, Arndt AT, Palazzo F, Meguid RA, Fergusson J, Beenen E, Mosse C, Salim J, Cheah S, Wright T, Cerdeira MP, McQuillan P, Richardson M, Liem H, Spillane J, Yacob M, Albadawi F, Thorpe T, Dingle A, Cabalag C, Loi K, Fisher OM, Ward S, Read M, Johnson M, Bassari R, Bui H, Cecconello I, Sallum RAA, da Rocha JRM, Lopes LR, Tercioti Jr V, Coelho JDS, Ferrer JAP, Buduhan G, Tan L, Srinathan S, Shea P, Yeung J, Allison F, Carroll P, Vargas-Barato F, Gonzalez F, Ortega J, Nino-Torres L, Beltrán-García TC, Castilla L, Pineda M, Bastidas A, Gómez-Mayorga J, Cortés N, Cetares C, Caceres S, Duarte S, Pazdro A, Snajdauf M, Faltova H, Sevcikova M, Mortensen PB, Katballe N, Ingemann T, Morten B, Kruhlikava I, Ainswort AP, Stilling NM, Eckardt J, Holm J, Thorsteinsson M, Siemsen M, Brandt B, Nega B, Teferra E, Tizazu A, Kauppila JH, Koivukangas V, Meriläinen S, Gruetzmann R, Krautz C, Weber G, Golcher H, Emons G, Azizian A, Ebeling M, Niebisch S, Kreuser N, Albanese G, Hesse J, Volovnik L, Boecher U, Reeh M, Triantafyllou S, Schizas D, Michalinos A, Balli E, Mpoura M, Charalabopoulos A, Manatakis DK, Balalis D, Bolger J, Baban C, Mastrosimone A, McAnena O, Quinn A, Ó Súilleabháin CB, Hennessy MM, Ivanovski I, Khizer H, Ravi N, Donlon N, Cervellera M, Vaccari S, Bianchini S, Asti E, Bernardi D, Merigliano S, Provenzano L, Scarpa M, Saadeh L, Salmaso B, De Manzoni G, Giacopuzzi S, La Mendola R, De Pasqual CA, Tsubosa Y, Niihara M, Irino T, Makuuchi R, Ishii K K, Mwachiro M, Fekadu A, Odera A, Mwachiro E, AlShehab D, Ahmed HA, Shebani AO, Elhadi A, Elnagar FA, Elnagar HF, Makkai-Popa ST, Wong LF, Tan YR, Thannimalai S, Ho CA, Pang WS, Tan JH, Basave HNL, Cortés-González R, Lagarde SM, van Lanschot JJB, Cords C, Jansen WA, Martijnse I, Matthijsen R, Bouwense S, Klarenbeek B, Verstegen M, van Workum F, Ruurda JP, van der Sluis PC, de Maat M, Evenett N, Johnston P, Patel R, MacCormick A, Smith B, Ekwunife C, Memon AH, Shaikh K, Wajid A, Khalil N, Haris M, Mirza ZU, Qudus SBA, Sarwar MZ, Shehzadi A, Raza A, Jhanzaib MH, Farmanali J, Zakir Z, Shakeel O, Nasir I, Khattak S, Baig M, Noor MA, Ahmed HH, Naeem A, Pinho AC, da Silva R, Bernardes A, Campos JC, Matos H, Braga T, Monteiro C, Ramos P, Cabral F, Gomes MP, Martins PC, Correia AM, Videira JF, Ciuce C, Drasovean R, Apostu R, Ciuce C, Paitici S, Racu AE, Obleaga CV, Beuran M, Stoica B, Ciubotaru C, Negoita V, Cordos I, Birla RD, Predescu D, Hoara PA, Tomsa R, Shneider V, Agasiev M, Ganjara I, Gunjić D, Veselinović M, Babič T, Chin TS, Shabbir A, Kim G, Crnjac A, Samo H, Díez del Val I, Leturio S, Ramón JM, Dal Cero M, Rifá S, Rico M, Pagan Pomar A, Martinez Corcoles JA, Rodicio Miravalles JL, Pais SA, Turienzo SA, Alvarez LS, Campos PV, Rendo AG, García SS, Santos EPG, Martínez ET, Fernández Díaz MJ, Magadán Álvarez C, Concepción Martín V, Díaz López C, Rosat Rodrigo A, Pérez Sánchez LE, Bailón Cuadrado M, Tinoco Carrasco C, Choolani Bhojwani E, Sánchez DP, Ahmed ME, Dzhendov T, Lindberg F, Rutegård M, Sundbom M, Mickael C, Colucci N, Schnider A, Er S, Kurnaz E, Turkyilmaz S, Turkyilmaz A, Yildirim R, Baki BE, Akkapulu N, Karahan O, Damburaci N, Hardwick R, Safranek P, Sujendran V, Bennett J, Afzal Z, Shrotri M, Chan B, Exarchou K, Gilbert T, Amalesh T, Mukherjee D, Mukherjee S, Wiggins TH, Kennedy R, McCain S, Harris A, Dobson G, Davies N, Wilson I, Mayo D, Bennett D, Young R, Manby P, Blencowe N, Schiller M, Byrne B, Mitton D, Wong V, Elshaer A, Cowen M, Menon V, Tan LC, McLaughlin E, Koshy R, Sharp C, Brewer H, Das N, Cox M, Al Khyatt W, Worku D, Iqbal R, Walls L, McGregor R, Fullarton G, Macdonald A, MacKay C, Craig C, Dwerryhouse S, Hornby S, Jaunoo S, Wadley M, Baker C, Saad M, Kelly M, Davies A, Di Maggio F, McKay S, Mistry P, Singhal R, Tucker O, Kapoulas S, Powell-Brett S, Davis P, Bromley G, Watson L, Verma R, Ward J, Shetty V, Ball C, Pursnani K, Sarela A, Sue Ling H, Mehta S, Hayden J, To N, Palser T, Hunter D, Supramaniam K, Butt Z, Ahmed A, Kumar S, Chaudry A, Moussa O, Kordzadeh A, Lorenzi B, Wilson M, Patil P, Noaman I, Bouras G, Evans R, Singh M, Warrilow H, Ahmad A, Tewari N, Yanni F, Couch J, Theophilidou E, Reilly JJ, Singh P, van Boxel G, Akbari K, Zanotti D, Sanders G, Wheatley T, Ariyarathenam A, Reece-Smith A, Humphreys L, Choh C, Carter N, Knight B, Pucher P, Athanasiou A, Mohamed I, Tan B, Abdulrahman M, Vickers J, Akhtar K, Chaparala R, Brown R, Alasmar MMA, Ackroyd R, Patel K, Tamhankar A, Wyman A, Walker R, Grace B, Abbassi N, Slim N, Ioannidi L, Blackshaw G, Havard T, Escofet X, Powell A, Owera A, Rashid F, Jambulingam P, Padickakudi J, Ben-Younes H, Mccormack K, Makey IA, Karush MK, Seder CW, Liptay MJ, Chmielewski G, Rosato EL, Berger AC, Zheng R, Okolo E, Singh A, Scott CD, Weyant MJ, Mitchell JD. Textbook outcome following oesophagectomy for cancer: international cohort study. Br J Surg 2022. [DOI: https://doi.org/10.1093/bjs/znac016] [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: 11/06/2022]
Abstract
Abstract
Background
Textbook outcome has been proposed as a tool for the assessment of oncological surgical care. However, an international assessment in patients undergoing oesophagectomy for oesophageal cancer has not been reported. This study aimed to assess textbook outcome in an international setting.
Methods
Patients undergoing curative resection for oesophageal cancer were identified from the international Oesophagogastric Anastomosis Audit (OGAA) from April 2018 to December 2018. Textbook outcome was defined as the percentage of patients who underwent a complete tumour resection with at least 15 lymph nodes in the resected specimen and an uneventful postoperative course, without hospital readmission. A multivariable binary logistic regression model was used to identify factors independently associated with textbook outcome, and results are presented as odds ratio (OR) and 95 per cent confidence intervals (95 per cent c.i.).
Results
Of 2159 patients with oesophageal cancer, 39.7 per cent achieved a textbook outcome. The outcome parameter ‘no major postoperative complication’ had the greatest negative impact on a textbook outcome for patients with oesophageal cancer, compared to other textbook outcome parameters. Multivariable analysis identified male gender and increasing Charlson comorbidity index with a significantly lower likelihood of textbook outcome. Presence of 24-hour on-call rota for oesophageal surgeons (OR 2.05, 95 per cent c.i. 1.30 to 3.22; P = 0.002) and radiology (OR 1.54, 95 per cent c.i. 1.05 to 2.24; P = 0.027), total minimally invasive oesophagectomies (OR 1.63, 95 per cent c.i. 1.27 to 2.08; P < 0.001), and chest anastomosis above azygous (OR 2.17, 95 per cent c.i. 1.58 to 2.98; P < 0.001) were independently associated with a significantly increased likelihood of textbook outcome.
Conclusion
Textbook outcome is achieved in less than 40 per cent of patients having oesophagectomy for cancer. Improvements in centralization, hospital resources, access to minimal access surgery, and adoption of newer techniques for improving lymph node yield could improve textbook outcome.
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Kamarajah SK, Evans RPT, Nepogodiev D, Hodson J, Bundred JR, Gockel I, Gossage JA, Isik A, Kidane B, Mahendran HA, Negoi I, Okonta KE, Sayyed R, van Hillegersberg R, Vohra RS, Wijnhoven BPL, Singh P, Griffiths EA, Kamarajah SK, Hodson J, Griffiths EA, Alderson D, Bundred J, Evans RPT, Gossage J, Griffiths EA, Jefferies B, Kamarajah SK, McKay S, Mohamed I, Nepogodiev D, Siaw-Acheampong K, Singh P, van Hillegersberg R, Vohra R, Wanigasooriya K, Whitehouse T, Gjata A, Moreno JI, Takeda FR, Kidane B, Guevara Castro R, Harustiak T, Bekele A, Kechagias A, Gockel I, Kennedy A, Da Roit A, Bagajevas A, Azagra JS, Mahendran HA, Mejía-Fernández L, Wijnhoven BPL, El Kafsi J, Sayyed RH, Sousa M M, Sampaio AS, Negoi I, Blanco R, Wallner B, Schneider PM, Hsu PK, Isik A, Gananadha S, Wills V, Devadas M, Duong C, Talbot M, Hii MW, Jacobs R, Andreollo NA, Johnston B, Darling G, Isaza-Restrepo A, Rosero G, Arias-Amézquita F, Raptis D, Gaedcke J, Reim D, Izbicki J, Egberts JH, Dikinis S, Kjaer DW, Larsen MH, Achiam MP, Saarnio J, Theodorou D, Liakakos T, Korkolis DP, Robb WB, Collins C, Murphy T, Reynolds J, Tonini V, Migliore M, Bonavina L, Valmasoni M, Bardini R, Weindelmayer J, Terashima M, White RE, Alghunaim E, Elhadi M, Leon-Takahashi AM, Medina-Franco H, Lau PC, Okonta KE, Heisterkamp J, Rosman C, van Hillegersberg R, Beban G, Babor R, Gordon A, Rossaak JI, Pal KMI, Qureshi AU, Naqi SA, Syed AA, Barbosa J, Vicente CS, Leite J, Freire J, Casaca R, Costa RCT, Scurtu RR, Mogoanta SS, Bolca C, Constantinoiu S, Sekhniaidze D, Bjelović M, So JBY, Gačevski G, Loureiro C, Pera M, Bianchi A, Moreno Gijón M, Martín Fernández J, Trugeda Carrera MS, Vallve-Bernal M, Cítores Pascual MA, Elmahi S, Halldestam I, Hedberg J, Mönig S, Gutknecht S, Tez M, Guner A, Tirnaksiz MB, Colak E, Sevinç B, Hindmarsh A, Khan I, Khoo D, Byrom R, Gokhale J, Wilkerson P, Jain P, Chan D, Robertson K, Iftikhar S, Skipworth R, Forshaw M, Higgs S, Gossage J, Nijjar R, Viswanath YKS, Turner P, Dexter S, Boddy A, Allum WH, Oglesby S, Cheong E, Beardsmore D, Vohra R, Maynard N, Berrisford R, Mercer S, Puig S, Melhado R, Kelty C, Underwood T, Dawas K, Lewis W, Bryce G, Thomas M, Arndt AT, Palazzo F, Meguid RA, Fergusson J, Beenen E, Mosse C, Salim J, Cheah S, Wright T, Cerdeira MP, McQuillan P, Richardson M, Liem H, Spillane J, Yacob M, Albadawi F, Thorpe T, Dingle A, Cabalag C, Loi K, Fisher OM, Ward S, Read M, Johnson M, Bassari R, Bui H, Cecconello I, Sallum RAA, da Rocha JRM, Lopes LR, Tercioti Jr V, Coelho JDS, Ferrer JAP, Buduhan G, Tan L, Srinathan S, Shea P, Yeung J, Allison F, Carroll P, Vargas-Barato F, Gonzalez F, Ortega J, Nino-Torres L, Beltrán-García TC, Castilla L, Pineda M, Bastidas A, Gómez-Mayorga J, Cortés N, Cetares C, Caceres S, Duarte S, Pazdro A, Snajdauf M, Faltova H, Sevcikova M, Mortensen PB, Katballe N, Ingemann T, Morten B, Kruhlikava I, Ainswort AP, Stilling NM, Eckardt J, Holm J, Thorsteinsson M, Siemsen M, Brandt B, Nega B, Teferra E, Tizazu A, Kauppila JH, Koivukangas V, Meriläinen S, Gruetzmann R, Krautz C, Weber G, Golcher H, Emons G, Azizian A, Ebeling M, Niebisch S, Kreuser N, Albanese G, Hesse J, Volovnik L, Boecher U, Reeh M, Triantafyllou S, Schizas D, Michalinos A, Balli E, Mpoura M, Charalabopoulos A, Manatakis DK, Balalis D, Bolger J, Baban C, Mastrosimone A, McAnena O, Quinn A, Ó Súilleabháin CB, Hennessy MM, Ivanovski I, Khizer H, Ravi N, Donlon N, Cervellera M, Vaccari S, Bianchini S, Asti E, Bernardi D, Merigliano S, Provenzano L, Scarpa M, Saadeh L, Salmaso B, De Manzoni G, Giacopuzzi S, La Mendola R, De Pasqual CA, Tsubosa Y, Niihara M, Irino T, Makuuchi R, Ishii K K, Mwachiro M, Fekadu A, Odera A, Mwachiro E, AlShehab D, Ahmed HA, Shebani AO, Elhadi A, Elnagar FA, Elnagar HF, Makkai-Popa ST, Wong LF, Tan YR, Thannimalai S, Ho CA, Pang WS, Tan JH, Basave HNL, Cortés-González R, Lagarde SM, van Lanschot JJB, Cords C, Jansen WA, Martijnse I, Matthijsen R, Bouwense S, Klarenbeek B, Verstegen M, van Workum F, Ruurda JP, van der Sluis PC, de Maat M, Evenett N, Johnston P, Patel R, MacCormick A, Smith B, Ekwunife C, Memon AH, Shaikh K, Wajid A, Khalil N, Haris M, Mirza ZU, Qudus SBA, Sarwar MZ, Shehzadi A, Raza A, Jhanzaib MH, Farmanali J, Zakir Z, Shakeel O, Nasir I, Khattak S, Baig M, Noor MA, Ahmed HH, Naeem A, Pinho AC, da Silva R, Bernardes A, Campos JC, Matos H, Braga T, Monteiro C, Ramos P, Cabral F, Gomes MP, Martins PC, Correia AM, Videira JF, Ciuce C, Drasovean R, Apostu R, Ciuce C, Paitici S, Racu AE, Obleaga CV, Beuran M, Stoica B, Ciubotaru C, Negoita V, Cordos I, Birla RD, Predescu D, Hoara PA, Tomsa R, Shneider V, Agasiev M, Ganjara I, Gunjić D, Veselinović M, Babič T, Chin TS, Shabbir A, Kim G, Crnjac A, Samo H, Díez del Val I, Leturio S, Ramón JM, Dal Cero M, Rifá S, Rico M, Pagan Pomar A, Martinez Corcoles JA, Rodicio Miravalles JL, Pais SA, Turienzo SA, Alvarez LS, Campos PV, Rendo AG, García SS, Santos EPG, Martínez ET, Fernández Díaz MJ, Magadán Álvarez C, Concepción Martín V, Díaz López C, Rosat Rodrigo A, Pérez Sánchez LE, Bailón Cuadrado M, Tinoco Carrasco C, Choolani Bhojwani E, Sánchez DP, Ahmed ME, Dzhendov T, Lindberg F, Rutegård M, Sundbom M, Mickael C, Colucci N, Schnider A, Er S, Kurnaz E, Turkyilmaz S, Turkyilmaz A, Yildirim R, Baki BE, Akkapulu N, Karahan O, Damburaci N, Hardwick R, Safranek P, Sujendran V, Bennett J, Afzal Z, Shrotri M, Chan B, Exarchou K, Gilbert T, Amalesh T, Mukherjee D, Mukherjee S, Wiggins TH, Kennedy R, McCain S, Harris A, Dobson G, Davies N, Wilson I, Mayo D, Bennett D, Young R, Manby P, Blencowe N, Schiller M, Byrne B, Mitton D, Wong V, Elshaer A, Cowen M, Menon V, Tan LC, McLaughlin E, Koshy R, Sharp C, Brewer H, Das N, Cox M, Al Khyatt W, Worku D, Iqbal R, Walls L, McGregor R, Fullarton G, Macdonald A, MacKay C, Craig C, Dwerryhouse S, Hornby S, Jaunoo S, Wadley M, Baker C, Saad M, Kelly M, Davies A, Di Maggio F, McKay S, Mistry P, Singhal R, Tucker O, Kapoulas S, Powell-Brett S, Davis P, Bromley G, Watson L, Verma R, Ward J, Shetty V, Ball C, Pursnani K, Sarela A, Sue Ling H, Mehta S, Hayden J, To N, Palser T, Hunter D, Supramaniam K, Butt Z, Ahmed A, Kumar S, Chaudry A, Moussa O, Kordzadeh A, Lorenzi B, Wilson M, Patil P, Noaman I, Bouras G, Evans R, Singh M, Warrilow H, Ahmad A, Tewari N, Yanni F, Couch J, Theophilidou E, Reilly JJ, Singh P, van Boxel G, Akbari K, Zanotti D, Sanders G, Wheatley T, Ariyarathenam A, Reece-Smith A, Humphreys L, Choh C, Carter N, Knight B, Pucher P, Athanasiou A, Mohamed I, Tan B, Abdulrahman M, Vickers J, Akhtar K, Chaparala R, Brown R, Alasmar MMA, Ackroyd R, Patel K, Tamhankar A, Wyman A, Walker R, Grace B, Abbassi N, Slim N, Ioannidi L, Blackshaw G, Havard T, Escofet X, Powell A, Owera A, Rashid F, Jambulingam P, Padickakudi J, Ben-Younes H, Mccormack K, Makey IA, Karush MK, Seder CW, Liptay MJ, Chmielewski G, Rosato EL, Berger AC, Zheng R, Okolo E, Singh A, Scott CD, Weyant MJ, Mitchell JD. Textbook outcome following oesophagectomy for cancer: international cohort study. Br J Surg 2022; 109:439-449. [PMID: 35194634 DOI: 10.1093/bjs/znac016] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 10/08/2021] [Accepted: 01/04/2022] [Indexed: 11/14/2022]
Abstract
BACKGROUND Textbook outcome has been proposed as a tool for the assessment of oncological surgical care. However, an international assessment in patients undergoing oesophagectomy for oesophageal cancer has not been reported. This study aimed to assess textbook outcome in an international setting. METHODS Patients undergoing curative resection for oesophageal cancer were identified from the international Oesophagogastric Anastomosis Audit (OGAA) from April 2018 to December 2018. Textbook outcome was defined as the percentage of patients who underwent a complete tumour resection with at least 15 lymph nodes in the resected specimen and an uneventful postoperative course, without hospital readmission. A multivariable binary logistic regression model was used to identify factors independently associated with textbook outcome, and results are presented as odds ratio (OR) and 95 per cent confidence intervals (95 per cent c.i.). RESULTS Of 2159 patients with oesophageal cancer, 39.7 per cent achieved a textbook outcome. The outcome parameter 'no major postoperative complication' had the greatest negative impact on a textbook outcome for patients with oesophageal cancer, compared to other textbook outcome parameters. Multivariable analysis identified male gender and increasing Charlson comorbidity index with a significantly lower likelihood of textbook outcome. Presence of 24-hour on-call rota for oesophageal surgeons (OR 2.05, 95 per cent c.i. 1.30 to 3.22; P = 0.002) and radiology (OR 1.54, 95 per cent c.i. 1.05 to 2.24; P = 0.027), total minimally invasive oesophagectomies (OR 1.63, 95 per cent c.i. 1.27 to 2.08; P < 0.001), and chest anastomosis above azygous (OR 2.17, 95 per cent c.i. 1.58 to 2.98; P < 0.001) were independently associated with a significantly increased likelihood of textbook outcome. CONCLUSION Textbook outcome is achieved in less than 40 per cent of patients having oesophagectomy for cancer. Improvements in centralization, hospital resources, access to minimal access surgery, and adoption of newer techniques for improving lymph node yield could improve textbook outcome.
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Murphy T, McCheyne A. Prospective national audit of major gastrointestinal complications of transesophageal echocardiography studies in children. Ann Card Anaesth 2022; 25:178-181. [PMID: 35417964 PMCID: PMC9244277 DOI: 10.4103/aca.aca_275_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background: Perioperative trans-esophageal echocardiography ('TEE') is widely used for the assessment of anatomy/repair of congenital cardiac defects. It is recognised that there are risks associated with its use. Aims: We wished, by means of a contemporaneous prospective national audit over a six-month period, to establish what proportion of TEE studies in children are complicated by major upper gastrointestinal or upper aerodigestive tract trauma. Methods: After obtaining appropriate local institutional ethics committee approval, a national prospective audit of the rate and severity of gastrointestinal complications of trans-esophageal echocardiography studies in anaesthetised adult cardiology and cardiac surgical patients was conducted by the Association of Cardiothoracic Anaesthesia and Critical Care in the United Kingdom and Ireland during the twelve months of 2017. During the second six months of the audit, the Congenital Cardiac Anaesthesia Network (an organisation including anaesthetists with a paediatric cardiac anaesthetic practice in all the United Kingdom cardiac surgical centres) prospectively audited the incidence of such complications of TEE studies in children. Results: A total of 1,059 studies were included in this six-month paediatric audit. There were no reports of the specified major complication. Statistical Analysis: The zero incidence of the major complication is consistent with a worst possible incidence of five per thousand TEE examinations. Conclusions: Such potentially reassuring information could be included in discussions with patients or families about the risk of trans-esophageal studies in children.
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Murphy B, Laffan S, Sullivan SO, Ballester GW, Meagher MK, Noone I, Cassidy T, Murphy T, Cooke J, Pope G, Mulcahy R, O'Regan N. 79 SIMULATION-BASED MEDICAL EDUCATION: A ‘HIP’ WAY TO LEARN ABOUT ORTHO-GERIATRICS! Age Ageing 2021. [PMCID: PMC8690087 DOI: 10.1093/ageing/afab219.79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Simulation-based medical education (SBME) is emerging as a key method of medical education, particularly in the setting of the COVID-19 pandemic. As part of a simulation development competition (SimStars) run by the National Doctors Training and Planning Unit and the South–South West Hospital Group, we brought together an inter-disciplinary team to develop a simulation scenario on hip fracture. Methods Our development team consisted of members of the Geriatric Medicine and Orthopaedic Departments. We developed a scenario that can be adapted to suit the needs of learners in orthopaedics, medicine, or nursing. We ran the simulation on a medical ward with one candidate and four facilitators from the Geriatric Medicine Department. The candidate (medical SHO) was presented with a patient (facilitator one), who had sustained a hip fracture following a fall. The candidate was directed to elicit a falls and bone health history, screen for delirium, and suggest further investigations and management. Subsequently, feedback was sought from all participants. Results The simulation took twenty minutes, debriefing took fifteen minutes. All considered, the simulation an enjoyable and feasible method for teaching and learning, and a novel way to promote team-building. The candidate felt competent in some areas, reporting that the scenario provided positive reinforcement. She reported feeling supported in identifying areas for further learning. The facilitators also considered this method a useful way to highlight a candidate’s learning needs and direct further teaching. The candidate requested further SBME-based sessions. Conclusion This SBME session in Ortho-Geriatrics was well-received by the candidate and facilitators. All participants enjoyed teaching and learning through this medium. Areas of high competency were reinforced and areas for future learning were identified. Further SBME was requested across more topics and for simulation training to be brought in as part of formal training.
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Affiliation(s)
- B Murphy
- Department of Geriatric Medicine, Waterford Intergratred Care for Older People, University Hospital Waterford, Waterford, Ireland,Department of Geriatric Medicine, St Vincents University Hospital, Dublin, Ireland
| | - S Laffan
- Department of Geriatric Medicine, Waterford Intergratred Care for Older People, University Hospital Waterford, Waterford, Ireland
| | - S O Sullivan
- Department of Orthopaedic Surgery, University Hospital Waterford, Waterford, Ireland
| | - G W Ballester
- Department of Geriatric Medicine, St Vincents University Hospital, Dublin, Ireland
| | - M K Meagher
- Department of Geriatric Medicine, St Vincents University Hospital, Dublin, Ireland
| | - I Noone
- Department of Geriatric Medicine, St Vincents University Hospital, Dublin, Ireland
| | - T Cassidy
- Department of Geriatric Medicine, St Vincents University Hospital, Dublin, Ireland
| | - T Murphy
- Department of Orthopaedic Surgery, University Hospital Waterford, Waterford, Ireland
| | - J Cooke
- Department of Geriatric Medicine, Waterford Intergratred Care for Older People, University Hospital Waterford, Waterford, Ireland
| | - G Pope
- Department of Geriatric Medicine, Waterford Intergratred Care for Older People, University Hospital Waterford, Waterford, Ireland
| | - R Mulcahy
- Department of Geriatric Medicine, Waterford Intergratred Care for Older People, University Hospital Waterford, Waterford, Ireland
| | - N O'Regan
- Department of Geriatric Medicine, Waterford Intergratred Care for Older People, University Hospital Waterford, Waterford, Ireland
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Evans RPT, Kamarajah SK, Bundred J, Nepogodiev D, Hodson J, van Hillegersberg R, Gossage J, Vohra R, Griffiths EA, Singh P, Evans RPT, Hodson J, Kamarajah SK, Griffiths EA, Singh P, Alderson D, Bundred J, Evans RPT, Gossage J, Griffiths EA, Jefferies B, Kamarajah SK, McKay S, Mohamed I, Nepogodiev D, Siaw- Acheampong K, Singh P, van Hillegersberg R, Vohra R, Wanigasooriya K, Whitehouse T, Gjata A, Moreno JI, Takeda FR, Kidane B, Guevara Castro R, Harustiak T, Bekele A, Kechagias A, Gockel I, Kennedy A, Da Roit A, Bagajevas A, Azagra JS, Mahendran HA, Mejía-Fernández L, Wijnhoven BPL, El Kafsi J, Sayyed RH, Sousa M, Sampaio AS, Negoi I, Blanco R, Wallner B, Schneider PM, Hsu PK, Isik A, Gananadha S, Wills V, Devadas M, Duong C, Talbot M, Hii MW, Jacobs R, Andreollo NA, Johnston B, Darling G, Isaza-Restrepo A, Rosero G, Arias-Amézquita F, Raptis D, Gaedcke J, Reim D, Izbicki J, Egberts JH, Dikinis S, Kjaer DW, Larsen MH, Achiam MP, Saarnio J, Theodorou D, Liakakos T, Korkolis DP, Robb WB, Collins C, Murphy T, Reynolds J, Tonini V, Migliore M, Bonavina L, Valmasoni M, Bardini R, Weindelmayer J, Terashima M, White RE, Alghunaim E, Elhadi M, Leon-Takahashi AM, Medina-Franco H, Lau PC, Okonta KE, Heisterkamp J, Rosman C, van Hillegersberg R, Beban G, Babor R, Gordon A, Rossaak JI, Pal KMI, Qureshi AU, Naqi SA, Syed AA, Barbosa J, Vicente CS, Leite J, Freire J, Casaca R, Costa RCT, Scurtu RR, Mogoanta SS, Bolca C, Constantinoiu S, Sekhniaidze D, Bjelović M, So JBY, Gačevski G, Loureiro C, Pera M, Bianchi A, Moreno Gijón M, Martín Fernández J, Trugeda Carrera MS, Vallve-Bernal M, Cítores Pascual MA, Elmahi S, Hedberg J, Mönig S, Gutknecht S, Tez M, Guner A, Tirnaksiz TB, Colak E, Sevinç B, Hindmarsh A, Khan I, Khoo D, Byrom R, Gokhale J, Wilkerson P, Jain P, Chan D, Robertson K, Iftikhar S, Skipworth R, Forshaw M, Higgs S, Gossage J, Nijjar R, Viswanath YKS, Turner P, Dexter S, Boddy A, Allum WH, Oglesby S, Cheong E, Beardsmore D, Vohra R, Maynard N, Berrisford R, Mercer S, Puig S, Melhado R, Kelty C, Underwood T, Dawas K, Lewis W, Al-Bahrani A, Bryce G, Thomas M, Arndt AT, Palazzo F, Meguid RA, Fergusson J, Beenen E, Mosse C, Salim J, Cheah S, Wright T, Cerdeira MP, McQuillan P, Richardson M, Liem H, Spillane J, Yacob M, Albadawi F, Thorpe T, Dingle A, Cabalag C, Loi K, Fisher OM, Ward S, Read M, Johnson M, Bassari R, Bui H, Cecconello I, Sallum RAA, da Rocha JRM, Lopes LR, Tercioti V, Coelho JDS, Ferrer JAP, Buduhan G, Tan L, Srinathan S, Shea P, Yeung J, Allison F, Carroll P, Vargas-Barato F, Gonzalez F, Ortega J, Nino-Torres L, Beltrán-García TC, Castilla L, Pineda M, Bastidas A, Gómez-Mayorga J, Cortés N, Cetares C, Caceres S, Duarte S, Pazdro A, Snajdauf M, Faltova H, Sevcikova M, Mortensen PB, Katballe N, Ingemann T, Morten B, Kruhlikava I, Ainswort AP, Stilling NM, Eckardt J, Holm J, Thorsteinsson M, Siemsen M, Brandt B, Nega B, Teferra E, Tizazu A, Kauppila JS, Koivukangas V, Meriläinen S, Gruetzmann R, Krautz C, Weber G, Golcher H, Emons G, Azizian A, Ebeling M, Niebisch S, Kreuser N, Albanese G, Hesse J, Volovnik L, Boecher U, Reeh M, Triantafyllou S, Schizas D, Michalinos A, Baili E, Mpoura M, Charalabopoulos A, Manatakis DK, Balalis D, Bolger J, Baban C, Mastrosimone A, McAnena O, Quinn A, Súilleabháin CBÓ, Hennessy MM, Ivanovski I, Khizer H, Ravi N, Donlon N, Cervellera M, Vaccari S, Bianchini S, Sartarelli L, Asti E, Bernardi D, Merigliano S, Provenzano L, Scarpa M, Saadeh L, Salmaso B, De Manzoni G, Giacopuzzi S, La Mendola R, De Pasqual CA, Tsubosa Y, Niihara M, Irino T, Makuuchi R, Ishii K, Mwachiro M, Fekadu A, Odera A, Mwachiro E, AlShehab D, Ahmed HA, Shebani AO, Elhadi A, Elnagar FA, Elnagar HF, Makkai-Popa ST, Wong LF, Yunrong T, Thanninalai S, Aik HC, Soon PW, Huei TJ, Basave HNL, Cortés-González R, Lagarde SM, van Lanschot JJB, Cords C, Jansen WA, Martijnse I, Matthijsen R, Bouwense S, Klarenbeek B, Verstegen M, van Workum F, Ruurda JP, van der Veen A, van den Berg JW, Evenett N, Johnston P, Patel R, MacCormick A, Young M, Smith B, Ekwunife C, Memon AH, Shaikh K, Wajid A, Khalil N, Haris M, Mirza ZU, Qudus SBA, Sarwar MZ, Shehzadi A, Raza A, Jhanzaib MH, Farmanali J, Zakir Z, Shakeel O, Nasir I, Khattak S, Baig M, Noor MA, Ahmed HH, Naeem A, Pinho AC, da Silva R, Matos H, Braga T, Monteiro C, Ramos P, Cabral F, Gomes MP, Martins PC, Correia AM, Videira JF, Ciuce C, Drasovean R, Apostu R, Ciuce C, Paitici S, Racu AE, Obleaga CV, Beuran M, Stoica B, Ciubotaru C, Negoita V, Cordos I, Birla RD, Predescu D, Hoara PA, Tomsa R, Shneider V, Agasiev M, Ganjara I, Gunjić D, Veselinović M, Babič T, Chin TS, Shabbir A, Kim G, Crnjac A, Samo H, Díez del Val I, Leturio S, Díez del Val I, Leturio S, Ramón JM, Dal Cero M, Rifá S, Rico M, Pagan Pomar A, Martinez Corcoles JA, Rodicio Miravalles JL, Pais SA, Turienzo SA, Alvarez LS, Campos PV, Rendo AG, García SS, Santos EPG, Martínez ET, Fernández Díaz MJ, Magadán Álvarez C, Concepción Martín V, Díaz López C, Rosat Rodrigo A, Pérez Sánchez LE, Bailón Cuadrado M, Tinoco Carrasco C, Choolani Bhojwani E, Sánchez DP, Ahmed ME, Dzhendov T, Lindberg F, Rutegård M, Sundbom M, Mickael C, Colucci N, Schnider A, Er S, Kurnaz E, Turkyilmaz S, Turkyilmaz A, Yildirim R, Baki BE, Akkapulu N, Karahan O, Damburaci N, Hardwick R, Safranek P, Sujendran V, Bennett J, Afzal Z, Shrotri M, Chan B, Exarchou K, Gilbert T, Amalesh T, Mukherjee D, Mukherjee S, Wiggins TH, Kennedy R, McCain S, Harris A, Dobson G, Davies N, Wilson I, Mayo D, Bennett D, Young R, Manby P, Blencowe N, Schiller M, Byrne B, Mitton D, Wong V, Elshaer A, Cowen M, Menon V, Tan LC, McLaughlin E, Koshy R, Sharp C, Brewer H, Das N, Cox M, Al Khyatt W, Worku D, Iqbal R, Walls L, McGregor R, Fullarton G, Macdonald A, MacKay C, Craig C, Dwerryhouse S, Hornby S, Jaunoo S, Wadley M, Baker C, Saad M, Kelly M, Davies A, Di Maggio F, McKay S, Mistry P, Singhal R, Tucker O, Kapoulas S, Powell-Brett S, Davis P, Bromley G, Watson L, Verma R, Ward J, Shetty V, Ball C, Pursnani K, Sarela A, Sue Ling H, Mehta S, Hayden J, To N, Palser T, Hunter D, Supramaniam K, Butt Z, Ahmed A, Kumar S, Chaudry A, Moussa O, Kordzadeh A, Lorenzi B, Wilson M, Patil P, Noaman I, Willem J, Bouras G, Evans R, Singh M, Warrilow H, Ahmad A, Tewari N, Yanni F, Couch J, Theophilidou E, Reilly JJ, Singh P, van Boxel G, Akbari K, Zanotti D, Sgromo B, Sanders G, Wheatley T, Ariyarathenam A, Reece-Smith A, Humphreys L, Choh C, Carter N, Knight B, Pucher P, Athanasiou A, Mohamed I, Tan B, Abdulrahman M, Vickers J, Akhtar K, Chaparala R, Brown R, Alasmar MMA, Ackroyd R, Patel K, Tamhankar A, Wyman A, Walker R, Grace B, Abbassi N, Slim N, Ioannidi L, Blackshaw G, Havard T, Escofet X, Powell A, Owera A, Rashid F, Jambulingam P, Padickakudi J, Ben-Younes H, McCormack K, Makey IA, Karush MK, Seder CW, Liptay MJ, Chmielewski G, Rosato EL, Berger AC, Zheng R, Okolo E, Singh A, Scott CD, Weyant MJ, Mitchell JD. Postoperative outcomes in oesophagectomy with trainee involvement. BJS Open 2021; 5:zrab132. [PMID: 35038327 PMCID: PMC8763367 DOI: 10.1093/bjsopen/zrab132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 11/15/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The complexity of oesophageal surgery and the significant risk of morbidity necessitates that oesophagectomy is predominantly performed by a consultant surgeon, or a senior trainee under their supervision. The aim of this study was to determine the impact of trainee involvement in oesophagectomy on postoperative outcomes in an international multicentre setting. METHODS Data from the multicentre Oesophago-Gastric Anastomosis Study Group (OGAA) cohort study were analysed, which comprised prospectively collected data from patients undergoing oesophagectomy for oesophageal cancer between April 2018 and December 2018. Procedures were grouped by the level of trainee involvement, and univariable and multivariable analyses were performed to compare patient outcomes across groups. RESULTS Of 2232 oesophagectomies from 137 centres in 41 countries, trainees were involved in 29.1 per cent of them (n = 650), performing only the abdominal phase in 230, only the chest and/or neck phases in 130, and all phases in 315 procedures. For procedures with a chest anastomosis, those with trainee involvement had similar 90-day mortality, complication and reoperation rates to consultant-performed oesophagectomies (P = 0.451, P = 0.318, and P = 0.382, respectively), while anastomotic leak rates were significantly lower in the trainee groups (P = 0.030). Procedures with a neck anastomosis had equivalent complication, anastomotic leak, and reoperation rates (P = 0.150, P = 0.430, and P = 0.632, respectively) in trainee-involved versus consultant-performed oesophagectomies, with significantly lower 90-day mortality in the trainee groups (P = 0.005). CONCLUSION Trainee involvement was not found to be associated with significantly inferior postoperative outcomes for selected patients undergoing oesophagectomy. The results support continued supervised trainee involvement in oesophageal cancer surgery.
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Husselbury T, Godec T, Murphy T, Hughes RR, Omahony C, Moon J, Dhinoja MB, Petersen SE, Mohiddin SA, Malcolmson JW. Multi-modality imaging in hypertrophic cardiomyopathy: intermodal discrepancies in key prognostic parameters. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1617] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background/Introduction
Multi-modality imaging is crucial for confirming diagnosis and assessing prognosis in patients with hypertrophic cardiomyopathy (HCM). However, inter-modality discrepancies in key parameters are commonly reported.
Purpose
To assess real-world inter-modal reporting discrepancies between transthoracic echocardiography (TTE) and cardiac magnetic resonance (CMR) imaging in the measurement of four key parameters in HCM patients.
Methods
Consecutive HCM patients with TTE and CMR performed within 6 months of each other at a tertiary centre were retrospectively assessed for reported maximum wall thickness (MWT), left atrial diameter (LAd), left ventricular ejection fraction (LVEF) and presence of left ventricular apical aneurysm (LVAA). The CMR report was considered gold standard. Data are reported as mean ± standard deviation (SD) or median and interquartile range (IQR) as appropriate.
Results
353 consecutive HCM patients (72% male, median age 60.9 years, IQR 49.8–71.6 years) with TTE and CMR within 6 months (median difference 1.7 months, IQR 1.1–3.4 months) were assessed between 4th January 2018 and 9th April 2019. Of 284 patients with paired MWT data, median difference was 0.0 mm (IQR −1.0 to 3.0 mm, p=0.02), likely representing a difference in distributions of MWT. TTE both over and underestimated MWT (in 36% and 46% cases respectively).
Of the 94 patients with paired LAd data, mean difference was 0.4±5.7 mm (95% CI −0.8010 to 1.546, p=0.5).
N=320 patients with paired LVEF data (after excluding patients with atrial fibrillation (n=20)). Median difference in LVEF was 12% (IQR 5–19% p<0.0001). TTE underestimated LVEF in 88% of cases. CMR and TTE both identified 14 (5%) patients as having LVEF <50%. There were however 8 cases of disagreement in classification of LVEF <50%, due to over (n=4) or underestimation (n=4) by TTE.
LVAA was accurately identified by TTE in only 9/30 (30%) of those patients with demonstrable LVAA by CMR (p=0.0008). TTE evidence of a discreet apical chamber (paradoxical jet on spectral or colour Doppler) was present in 16/21 (76%) cases where TTE failed to overtly identify LVAA. However, apical or mid-cavity obliteration was reported in 15/21 (71%) cases where TTE failed to identify LVAA.
Conclusion(s)
Echocardiography and CMR measurements are often used interchangeably in clinical practice but inter-modality discrepancies can affect diagnosis and sudden cardiac death (SCD) risk assessment. This is particularly important for binary risk factors such as LVEF<50% or LVAA which are considered major SCD risk factors in the latest American Heart Association guidelines. 25 (7%) patients in our cohort had major risk factors identified by CMR that were not identified on TTE. CMR is an important, recommended tool where TTE imaging is suboptimal, but attention to more subtle elements of abnormal intracavity blood flow may be able to increase LVAA detection during TTE.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- T Husselbury
- Barts Health NHS Trust, Cardiology, London, United Kingdom
| | - T Godec
- William Harvey Research Institute, London, United Kingdom
| | - T Murphy
- Barts Health NHS Trust, Cardiology, London, United Kingdom
| | - R R Hughes
- Barts Health NHS Trust, Cardiology, London, United Kingdom
| | - C Omahony
- Barts Health NHS Trust, Cardiology, London, United Kingdom
| | - J Moon
- Barts Health NHS Trust, Cardiology, London, United Kingdom
| | - M B Dhinoja
- Barts Health NHS Trust, Cardiology, London, United Kingdom
| | - S E Petersen
- Barts Health NHS Trust, Cardiology, London, United Kingdom
| | - S A Mohiddin
- Barts Health NHS Trust, Cardiology, London, United Kingdom
| | - J W Malcolmson
- Barts Health NHS Trust, Cardiology, London, United Kingdom
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Murphy T, Gill H. Sugammadex Use in Pediatric Cardiac Anesthesia. J Cardiothorac Vasc Anesth 2021; 36:635-636. [PMID: 34503892 DOI: 10.1053/j.jvca.2021.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/07/2021] [Accepted: 08/10/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Tim Murphy
- Bristol Royal Hospital for Children, Bristol, United Kingdom.
| | - Hannah Gill
- Bristol Royal Hospital for Children, Bristol, United Kingdom; School of physiology, pharmacology and neuroscience, Bristol University, Bristol, United Kingdom
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Murphy T, Jones D, Friebel R, Uchegbu I, Mohiddin S, Petersen S. A cost analysis of cardiac magnetic resonance imaging in the diagnostic pathway of a population with unexplained acute myocardial injury and normal coronary angiography. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeab090.132] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): National Institute for Health Research (NIHR) Biomedical Research Centre at St Bartholomew"s Hospital London. Irish Cardiac Society
OnBehalf
European Association of Cardiovascular Imaging (EACVI) -Task Force for Cost Effectiveness.
Background
Acute presentations with myocardial injury that occur despite culprit-free coronary angiography were first reported over 70 years ago, with a prevalence between 5-9%. 1-3 There is increasing evidence that a more accurate diagnosis is available and that CMR is a key tool to determine the underlying pathology. This is reflected with the most recent international guidelines advocating for the use of CMR in the diagnostic pathways of this heterogeneous population. However, to date there is no formal assessment of the financial implications of adopting these new guidelines.
Purpose
To determine the financial impact of implementing cardiac magnetic resonance imaging in the diagnostic pathway of a population with unexplained acute myocardial injury and normal coronary angiography in comparison to existing clinical practice.
Methods
We performed a focused cost-benefit analysis using a hypothetical population of 2,000 patients with unexplained acute myocardial injury and normal coronary angiography. The population was split evenly into two groups of either standard, or CMR guided management, and extrapolated over a ten-year period. Standard management was defined as 66% of the population receiving dual antiplatelet therapy (ticagrelor and aspirin) for one year followed by aspirin for life, and the remaining 34% of the population receiving aspirin for life. CMR guided management determined antiplatelet therapy according to the imaging findings. This analysis focused on CMR’s ability to accurately identify those patients who may have had an MI and facilitate tailored treatment with evidence based dual antiplatelet therapy. Costs and rates were defined in Table 1. A one-way sensitivity analysis was also performed to determine the variables with largest impact on the costs. Each variable was varied by +/- 20% and the change in cost determined at year 10.
Results
Using CMR in the diagnostic pathway resulted in an increased cost of £72,656 in the first year. After year 7, CMR guided practice becomes cost neutral, resulting in cost saving of £24,054 over a ten-year period in a population of 1000 patients. Figure 1. Utilizing CMR in this population also resulted in 7 fewer myocardial infarctions and 14 fewer major bleeding events over a ten-year time horizon.
The three most sensitive variables were, in decreasing order, the cost of CMR, the cost of ticagrelor and the percentage of the population with MI requiring DAPT. A 20% change from baseline resulted in a 320%, 247% and 162% change in costs at 10 years, respectively.
Conclusion
Utilizing CMR in this population may be associated with reduced costs in the medium to long term. The initial increased cost of CMR is offset over time, by delivering a more personalised, higher quality level of care to patients.
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Affiliation(s)
- T Murphy
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - D Jones
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - R Friebel
- LONDON SCHOOL OF ECONOMICS AND POLITICAL SCIENCE, London, United Kingdom of Great Britain & Northern Ireland
| | - I Uchegbu
- Queen Mary University of London, London, United Kingdom of Great Britain & Northern Ireland
| | - S Mohiddin
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - S Petersen
- Queen Mary University of London, London, United Kingdom of Great Britain & Northern Ireland
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Hartley P, Murphy T. P.145 Birt-Hogg-Dube syndrome: a rare case of pneumothorax. Int J Obstet Anesth 2021. [DOI: 10.1016/j.ijoa.2021.103143] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Kamarajah S, Nepogodiev D, Bekele A, Cecconello I, Evans R, Guner A, Gossage J, Harustiak T, Hodson J, Isik A, Kidane B, Leon-Takahashi A, Mahendran H, Negoi I, Okonta K, Rosero G, Sayyed R, Singh P, Takeda F, van Hillegersberg R, Vohra R, White R, Griffiths E, Alderson D, Bundred J, Evans R, Gossage J, Griffiths E, Jefferies B, Kamarajah S, McKay S, Mohamed I, Nepogodiev D, Siaw- Acheampong K, Singh P, van Hillegersberg R, Vohra R, Wanigasooriya K, Whitehouse T, Gjata A, Moreno J, Takeda F, Kidane B, Guevara CR, Harustiak T, Bekele A, Kechagias A, Gockel I, Kennedy A, Da Roit A, Bagajevas A, Azagra J, Mahendran H, Mejía-Fernández L, Wijnhoven B, El Kafsi J, Sayyed R, Sousa M, Sampaio A, Negoi I, Blanco R, Wallner B, Schneider P, Hsu P, Isik A, Gananadha S, Wills V, Devadas M, Duong C, Talbot M, Hii M, Jacobs R, Andreollo N, Johnston B, Darling G, Isaza-Restrepo A, Rosero G, Arias- Amézquita F, Raptis D, Gaedcke J, Reim D, Izbicki J, Egberts J, Dikinis S, Kjaer D, Larsen M, Achiam M, Saarnio J, Theodorou D, Liakakos T, Korkolis D, Robb W, Collins C, Murphy T, Reynolds J, Tonini V, Migliore M, Bonavina L, Valmasoni M, Bardini R, Weindelmayer J, Terashima M, White R, Alghunaim E, Elhadi M, Leon-Takahashi A, Medina-Franco H, Lau P, Okonta K, Heisterkamp J, Rosman C, van Hillegersberg R, Beban G, Babor R, Gordon A, Rossaak J, Pal K, Qureshi A, Naqi S, Syed A, Barbosa J, Vicente C, Leite J, Freire J, Casaca R, Costa R, Scurtu R, Mogoanta S, Bolca C, Constantinoiu S, Sekhniaidze D, Bjelović M, So J, Gačevski G, Loureiro C, Pera M, Bianchi A, Moreno GM, Martín Fernández J, Trugeda Carrera M, Vallve-Bernal M, Cítores Pascual M, Elmahi S, Halldestam I, Hedberg J, Mönig S, Gutknecht S, Tez M, Guner A, Tirnaksiz M, Colak E, Sevinç B, Hindmarsh A, Khan I, Khoo D, Byrom R, Gokhale J, Wilkerson P, Jain P, Chan D, Robertson K, Iftikhar S, Skipworth R, Forshaw M, Higgs S, Gossage J, Nijjar R, Viswanath Y, Turner P, Dexter S, Boddy A, Allum W, Oglesby S, Cheong E, Beardsmore D, Vohra R, Maynard N, Berrisford R, Mercer S, Puig S, Melhado R, Kelty C, Underwood T, Dawas K, Lewis W, Al-Bahrani A, Bryce G, Thomas M, Arndt A, Palazzo F, Meguid R, Fergusson J, Beenen E, Mosse C, Salim J, Cheah S, Wright T, Cerdeira M, McQuillan P, Richardson M, Liem H, Spillane J, Yacob M, Albadawi F, Thorpe T, Dingle A, Cabalag C, Loi K, Fisher O, Ward S, Read M, Johnson M, Bassari R, Bui H, Cecconello I, Sallum R, da Rocha J, Lopes L, Tercioti V, Coelho J, Ferrer J, Buduhan G, Tan L, Srinathan S, Shea P, Yeung J, Allison F, Carroll P, Vargas-Barato F, Gonzalez F, Ortega J, Nino-Torres L, Beltrán-García T, Castilla L, Pineda M, Bastidas A, Gómez-Mayorga J, Cortés N, Cetares C, Caceres S, Duarte S, Pazdro A, Snajdauf M, Faltova H, Sevcikova M, Mortensen P, Katballe N, Ingemann T, Morten B, Kruhlikava I, Ainswort A, Stilling N, Eckardt J, Holm J, Thorsteinsson M, Siemsen M, Brandt B, Nega B, Teferra E, Tizazu A, Kauppila J, Koivukangas V, Meriläinen S, Gruetzmann R, Krautz C, Weber G, Golcher H, Emons G, Azizian A, Ebeling M, Niebisch S, Kreuser N, Albanese G, Hesse J, Volovnik L, Boecher U, Reeh M, Triantafyllou S, Schizas D, Michalinos A, Mpali E, Mpoura M, Charalabopoulos A, Manatakis D, Balalis D, Bolger J, Baban C, Mastrosimone A, McAnena O, Quinn A, Ó Súilleabháin C, Hennessy M, Ivanovski I, Khizer H, Ravi N, Donlon N, Cervellera M, Vaccari S, Bianchini S, Sartarelli L, Asti E, Bernardi D, Merigliano S, Provenzano L, Scarpa M, Saadeh L, Salmaso B, De Manzoni G, Giacopuzzi S, La Mendola R, De Pasqual C, Tsubosa Y, Niihara M, Irino T, Makuuchi R, Ishii K, Mwachiro M, Fekadu A, Odera A, Mwachiro E, AlShehab D, Ahmed H, Shebani A, Elhadi A, Elnagar F, Elnagar H, Makkai-Popa S, Wong L, Tan Y, Thannimalai S, Ho C, Pang W, Tan J, Basave H, Cortés-González R, Lagarde S, van Lanschot J, Cords C, Jansen W, Martijnse I, Matthijsen R, Bouwense S, Klarenbeek B, Verstegen M, van Workum F, Ruurda J, van der Sluis P, de Maat M, Evenett N, Johnston P, Patel R, MacCormick A, Young M, Smith B, Ekwunife C, Memon A, Shaikh K, Wajid A, Khalil N, Haris M, Mirza Z, Qudus S, Sarwar M, Shehzadi A, Raza A, Jhanzaib M, Farmanali J, Zakir Z, Shakeel O, Nasir I, Khattak S, Baig M, Noor M, Ahmed H, Naeem A, Pinho A, da Silva R, Bernardes A, Campos J, Matos H, Braga T, Monteiro C, Ramos P, Cabral F, Gomes M, Martins P, Correia A, Videira J, Ciuce C, Drasovean R, Apostu R, Ciuce C, Paitici S, Racu A, Obleaga C, Beuran M, Stoica B, Ciubotaru C, Negoita V, Cordos I, Birla R, Predescu D, Hoara P, Tomsa R, Shneider V, Agasiev M, Ganjara I, Gunjić D, Veselinović M, Babič T, Chin T, Shabbir A, Kim G, Crnjac A, Samo H, Díez del Val I, Leturio S, Ramón J, Dal Cero M, Rifá S, Rico M, Pagan Pomar A, Martinez Corcoles J, Rodicio Miravalles J, Pais S, Turienzo S, Alvarez L, Campos P, Rendo A, García S, Santos E, Martínez E, Fernández DMJ, Magadán ÁC, Concepción MV, Díaz LC, Rosat RA, Pérez SLE, Bailón CM, Tinoco CC, Choolani Bhojwani E, Sánchez D, Ahmed M, Dzhendov T, Lindberg F, Rutegård M, Sundbom M, Mickael C, Colucci N, Schnider A, Er S, Kurnaz E, Turkyilmaz S, Turkyilmaz A, Yildirim R, Baki B, Akkapulu N, Karahan O, Damburaci N, Hardwick R, Safranek P, Sujendran V, Bennett J, Afzal Z, Shrotri M, Chan B, Exarchou K, Gilbert T, Amalesh T, Mukherjee D, Mukherjee S, Wiggins T, Kennedy R, McCain S, Harris A, Dobson G, Davies N, Wilson I, Mayo D, Bennett D, Young R, Manby P, Blencowe N, Schiller M, Byrne B, Mitton D, Wong V, Elshaer A, Cowen M, Menon V, Tan L, McLaughlin E, Koshy R, Sharp C, Brewer H, Das N, Cox M, Al Khyatt W, Worku D, Iqbal R, Walls L, McGregor R, Fullarton G, Macdonald A, MacKay C, Craig C, Dwerryhouse S, Hornby S, Jaunoo S, Wadley M, Baker C, Saad M, Kelly M, Davies A, Di Maggio F, McKay S, Mistry P, Singhal R, Tucker O, Kapoulas S, Powell-Brett S, Davis P, Bromley G, Watson L, Verma R, Ward J, Shetty V, Ball C, Pursnani K, Sarela A, Sue LH, Mehta S, Hayden J, To N, Palser T, Hunter D, Supramaniam K, Butt Z, Ahmed A, Kumar S, Chaudry A, Moussa O, Kordzadeh A, Lorenzi B, Wilson M, Patil P, Noaman I, Willem J, Bouras G, Evans R, Singh M, Warrilow H, Ahmad A, Tewari N, Yanni F, Couch J, Theophilidou E, Reilly J, Singh P, van Boxel G, Akbari K, Zanotti D, Sgromo B, Sanders G, Wheatley T, Ariyarathenam A, Reece-Smith A, Humphreys L, Choh C, Carter N, Knight B, Pucher P, Athanasiou A, Mohamed I, Tan B, Abdulrahman M, Vickers J, Akhtar K, Chaparala R, Brown R, Alasmar M, Ackroyd R, Patel K, Tamhankar A, Wyman A, Walker R, Grace B, Abbassi N, Slim N, Ioannidi L, Blackshaw G, Havard T, Escofet X, Powell A, Owera A, Rashid F, Jambulingam P, Padickakudi J, Ben-Younes H, Mccormack K, Makey I, Karush M, Seder C, Liptay M, Chmielewski G, Rosato E, Berger A, Zheng R, Okolo E, Singh A, Scott C, Weyant M, Mitchell J. Mortality from esophagectomy for esophageal cancer across low, middle, and high-income countries: An international cohort study. Eur J Surg Oncol 2021; 47:1481-1488. [PMID: 33451919 DOI: 10.1016/j.ejso.2020.12.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 12/09/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND No evidence currently exists characterising global outcomes following major cancer surgery, including esophageal cancer. Therefore, this study aimed to characterise impact of high income countries (HIC) versus low and middle income countries (LMIC) on the outcomes following esophagectomy for esophageal cancer. METHOD This international multi-center prospective study across 137 hospitals in 41 countries included patients who underwent an esophagectomy for esophageal cancer, with 90-day follow-up. The main explanatory variable was country income, defined according to the World Bank Data classification. The primary outcome was 90-day postoperative mortality, and secondary outcomes were composite leaks (anastomotic leak or conduit necrosis) and major complications (Clavien-Dindo Grade III - V). Multivariable generalized estimating equation models were used to produce adjusted odds ratios (ORs) and 95% confidence intervals (CI95%). RESULTS Between April 2018 to December 2018, 2247 patients were included. Patients from HIC were more significantly older, with higher ASA grade, and more advanced tumors. Patients from LMIC had almost three-fold increase in 90-day mortality, compared to HIC (9.4% vs 3.7%, p < 0.001). On adjusted analysis, LMIC were independently associated with higher 90-day mortality (OR: 2.31, CI95%: 1.17-4.55, p = 0.015). However, LMIC were not independently associated with higher rates of anastomotic leaks (OR: 1.06, CI95%: 0.57-1.99, p = 0.9) or major complications (OR: 0.85, CI95%: 0.54-1.32, p = 0.5), compared to HIC. CONCLUSION Resections in LMIC were independently associated with higher 90-day postoperative mortality, likely reflecting a failure to rescue of these patients following esophagectomy, despite similar composite anastomotic leaks and major complication rates to HIC. These findings warrant further research, to identify potential issues and solutions to improve global outcomes following esophagectomy for cancer.
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Harris JM, Sheehan K, Rogers CA, Murphy T, Caputo M, Mumford AD. Prediction of Bleeding in Pediatric Cardiac Surgery Using Clinical Characteristics and Prospective Coagulation Test Results. Semin Thorac Cardiovasc Surg 2021; 34:277-288. [PMID: 33444767 DOI: 10.1053/j.semtcvs.2021.01.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 01/05/2021] [Indexed: 11/11/2022]
Abstract
Bleeding caused by coagulopathy is common in children undergoing cardiac surgery and causes adverse outcomes. Coagulation testing assists selection of treatments to stop bleeding but has an uncertain role for predicting bleeding. We aimed to evaluate how well prospective coagulation testing predicted excessive bleeding during and after cardiac surgery compared to prediction using clinical characteristics alone. The study was a single-center, prospective cohort study in children having a range of cardiac surgery procedures with coagulation testing at anesthetic induction and immediately after cardiopulmonary bypass. The primary outcome was clinical concern about bleeding (CCB), a composite of either administration of prohemostatic treatments in response to bleeding or a high chest drain volume after surgery. In 225 children, CCB occurred in 26 (12%) during surgery and in 68 (30%) after surgery. Multivariable fractional polynomial models using the clinical characteristics of the children alone predicted CCB during surgery (c-statistic 0.64; 95% confidence interval 0.53, 0.76) and after surgery (0.74; 0.67, 0.82). Incorporating coagulation test results into these models improved prediction (c-statistics 0.79; 0.70, 0.87, and 0.80; 0.74, 0.87, respectively). However, this increased the overall proportion of children classified correctly as CCB or not CCB during surgery by only 0.9% and after surgery by only 0.4%. Incorporating coagulation test results into predictive models had no effect on prediction of blood transfusion or postoperative complications. Prospective coagulation testing marginally improves prediction of CCB during and after cardiac surgery but the clinical impact of this is small when compared to prediction using clinical characteristics.
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Affiliation(s)
- Jessica M Harris
- Bristol Trials Centre, Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - Karen Sheehan
- Department of Paediatric Cardiac Surgery, Bristol Royal Hospital for Children, University Hospitals Bristol, Bristol, UK
| | - Chris A Rogers
- Bristol Trials Centre, Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - Tim Murphy
- Department of Paediatric Cardiac Surgery, Bristol Royal Hospital for Children, University Hospitals Bristol, Bristol, UK
| | - Massimo Caputo
- Department of Paediatric Cardiac Surgery, Bristol Royal Hospital for Children, University Hospitals Bristol, Bristol, UK; Bristol Heart Institute, University Hospitals Bristol, Bristol, UK; Department of Paediatric Cardiac Surgery, School of Translational Sciences, University of Bristol, Bristol, UK
| | - Andrew D Mumford
- Department of Haematology, School of Cellular and Molecular Medicine, University of Bristol, Bristol, UK.
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Abstract
The exponential character of the recent Covid-19 outbreak requires a change in strategy from containment to mitigation. Meanwhile, most countries apply social distancing with the objective to keep the number of critical cases below the capabilities of the health care system. Due to the novelty and rapid spread of the virus, an a priori assessment of this strategy was not possible. In this study, we present a model-based systems analysis to assess the effectiveness of social distancing measures in terms of intensity and duration of application. Results show a super-linear scaling between intensity (percent contact reduction) and required duration of application to have an added value (a lower number of fatalities). This holds true for an effective reproduction of [Formula: see text] and is reverted for [Formula: see text]. If R is not reduced below 1, secondary effects of required long-term isolation are likely to unravel the added value of disease mitigation. If an extinction is not feasible, we recommend moderate social-distancing that is well balanced against capability limits of national health-care systems.
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Affiliation(s)
- C Neuwirth
- Department of Geoinformatics - Z_GIS, University of Salzburg, Salzburg, Austria.
| | - C Gruber
- Center for Computational Material Science, Institute of Applied Physics, Vienna University of Technology, Vienna, Austria
| | - T Murphy
- Department of Geoinformatics - Z_GIS, University of Salzburg, Salzburg, Austria
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Murphy T, Akehurst H, Mutimer J. Impact of the 2020 COVID-19 pandemic on the workload of the orthopaedic service in a busy UK district general hospital. Injury 2020; 51:2142-2147. [PMID: 32654849 PMCID: PMC7338859 DOI: 10.1016/j.injury.2020.07.001] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 06/21/2020] [Accepted: 07/02/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The COVID -19 outbreak has had a profound effect on the management of healthcare service provision in the UK. Orthopaedic departments have been no exception to this and have needed to adapt to the changing circumstances by releasing resources and focusing on 'essential' activity. The aim of this study is to quantify the reduction in trauma and, in addition, describe any changes in the type of referrals to the trust which may have been affected by the pandemic itself and the social distancing measures employed by the UK government. METHODS The study was performed in a UK District Hospital which is also a Trauma Unit providing trauma and orthopaedic care to a population of 625,000 people. The trust based electronic database of trauma referrals was used to compare the numbers of, and types of referral to our trauma service during the COVID-19 pandemic and the corresponding time periods in the previous 3 years. RESULTS The mean number of referrals per week to the service reduced by 33% in the time period following the confirmation of the outbreak as a pandemic (p<0.0001). Number of operations performed per week reduced by 26% (p = 0.001). There was no change in the number of referrals relating to domestic abuse or non-accidental injury. In addition, numbers of hip fractures, periprosthetic fractures and prosthetic joint dislocations were unchanged. There was a significant reduction in the number of referrals for simple fractures, native joint dislocations, wounds and soft tissue injuries. Within the paediatric population, similarly, a reduction in simple fracture referrals was demonstrated. DISCUSSION An association between the outbreak of the pandemic and a reduction in referral numbers to our department has been demonstrated. The direct cause of this may be multifactorial but proposing that it is, in part, due to the social distancing measures introduced by the government is certainly conceivable. The patterns of injury would reflect this also with low energy and fragility trauma persisting whilst injuries associated with younger people have reduced. We would suggest that information such as this could be useful in healthcare planning and resource allocation in future pandemic situations.
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Alipoor E, Yaseri M, Mehrdadi P, Mahdavi-Mazdeh M, Murphy T, Hosseinzadeh-Attar MJ. The relationship between serum adipokines and glucose homeostasis in normal-weight and obese patients on hemodialysis: a preliminary study. Int Urol Nephrol 2020; 52:2179-2187. [PMID: 32761485 DOI: 10.1007/s11255-020-02582-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 07/25/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Insulin resistance (IR) is a prevalent disorder in advanced renal failure irrespective of diabetes. Adipokines might play a role in IR, which has not been well-documented in uremic conditions. This study investigated the relationship of Zinc-α2-glycoprotein (ZAG), adipose triglyceride lipase (ATGL), and adipolin with glucose-insulin homeostasis in normal weight (NW) and obese (OB) patients with hemodialysis. METHODS In this cross-sectional study, 59 patients (29 NW; 18.5 ≤ BMI < 25 kg/m2, and 30 OB; BMI ≥ 30 kg/m2) were studied. Anthropometries, circulating ZAG, adipolin, ATGL, free fatty acids (FFAs), fasting blood glucose (FBG), insulin, and homeostasis model assessment of IR (HOMA)-IR were assessed. RESULTS There were no significant differences in age, gender, hemodialysis duration, dialysis adequacy and diabetes between the two groups. ZAG (100.9 ± 37.1 vs. 107.5 ± 30.5 ng/mL, P = 0.03) and adipolin (12.4 ± 1.6 vs. 13.2 ± 2.8 ng/mL, P = 0.002) concentrations were significantly lower, and FFAs (228.1 ± 112.6 vs. 185 ± 119 ng/mL, P = 0.014) were significantly higher in the OB than NW group. No significant differences were observed in ATGL, FBG, insulin and HOMA-IR between the two groups. Patients with lower IR had higher ZAG (112.9 ± 31.7 vs. 94.9 ± 34.5 ng/mL; P = 0.046), lower FFAs (167.8 ± 98.4 vs. 249.9 ± 120.8 ng/mL; P = 0.004), and marginally lower ATGL (9.1 ± 5.2 vs. 12.3 ± 9.6 mIU/mL; P = 0.079) concentrations than those with higher IR. ZAG was negatively (r = - 0.323, P = 0.018 and r = - 0.266, P = 0.054) and FFAs were positively (r = 0.321, P = 0.019 and r = 0.353, P = 0.009) correlated with insulin and HOMA-IR, respectively. ATGL was directly correlated with FFAs (r = 0.314, P = 0.018). CONCLUSIONS Novel adipokines, ZAG and ATGL, might contribute to glucose-insulin homeostasis in hemodialysis. Understanding potential causative, diagnostic or therapeutic roles of adipokines in IR require further studies.
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Affiliation(s)
- Elham Alipoor
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.,Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Mehdi Yaseri
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Parvaneh Mehrdadi
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Mitra Mahdavi-Mazdeh
- Iranian Tissue Bank and Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Tim Murphy
- Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia
| | - Mohammad Javad Hosseinzadeh-Attar
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran. .,Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, No#44, Hojjatdoust St., Naderi St., Keshavarz Blvd., Tehran, Iran.
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Gray S, Clough T, Mcgee Y, Murphy T, Poulikakos D. Increased risk of COVID-19 in haemodialysis healthcare workers in a tertiary centre in the North West of England. J Hosp Infect 2020; 106:390-391. [PMID: 32763332 PMCID: PMC7403103 DOI: 10.1016/j.jhin.2020.07.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 07/21/2020] [Indexed: 01/19/2023]
Affiliation(s)
- S Gray
- Renal Services, Salford Royal NHS Foundation Trust, UK
| | - T Clough
- Renal Services, Salford Royal NHS Foundation Trust, UK
| | - Y Mcgee
- Renal Services, Salford Royal NHS Foundation Trust, UK
| | - T Murphy
- Renal Services & Tertiary Medicine, Salford Royal NHS Foundation Trust, UK
| | - D Poulikakos
- Renal Services, Salford Royal NHS Foundation Trust, UK.
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Abstract
The clinical phenotype of pediatric OCD and tic disorders in relation to streptococcal antibody patterns will be discussed. Also, cellular and other immune findings will be presented on a group of children with OCD and tic disorders taking into account clinical phenotype data.
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Murphy T. In defense of common sense. Paediatr Anaesth 2020; 30:390-391. [PMID: 32323432 DOI: 10.1111/pan.13812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 12/27/2019] [Accepted: 12/28/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Tim Murphy
- Department of Paediatric Anaesthesia, Bristol Children's Hospital, Bristol, UK
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Abstract
OBJECTIVE To review and highlight significant advances made towards vaccine development and understanding of the immunology of otitis media (OM) since the 19th International Symposium on Recent Advances in Otitis Media (ISOM) in 2015, as well as identify future research directions and knowledge gaps. DATA SOURCES PubMed database, National Library of Medicine. REVIEW METHODS Key topics were assigned to each panel member for detailed review. Draft reviews were collated, circulated, and thoroughly discussed when the panel met at the 20th ISOM in June 2019. The final manuscript was prepared with input from all panel members. CONCLUSIONS Since 2015 there have been a number of studies assessing the impact of licensed pneumococcal vaccines on OM. While these studies have confirmed that these vaccines are effective in preventing carriage and/or disease caused by vaccine serotypes, OM caused by non-vaccine serotype pneumococci and other otopathogens remains a significant health care burden globally. Development of multi-species vaccines is challenging but essential to reducing the global burden of OM. Influenza vaccination has been shown to prevent acute OM, and with novel vaccines against nontypeable Haemophilus influenzae (NTHi), Moraxella catarrhalis and Respiratory Syncytial Virus (RSV) in clinical trials, the potential to significantly prevent OM is within reach. Research into alternative vaccine delivery strategies has demonstrated the power of maternal and mucosal vaccination for OM prevention. Future OM vaccine trials must include molecular diagnostics of middle ear effusion, for detection of viruses and bacteria that are persisting in biofilms and to enable accurate assessment of vaccine impact on OM etiology. Understanding population differences in natural and vaccine-induced immune responses to otopathogens is also important for development of the most effective OM vaccines. Improved understanding of the interaction between otopathogens will also advance development of effective therapies and encourage the assessment of the indirect benefits of vaccination. IMPLICATIONS FOR PRACTICE While NTHi and M. catarrhalis are the predominant otopathogens, funding opportunities to drive vaccine development for these species are limited due to a focus on prevention of childhood mortality rather than morbidity. Delivery of a comprehensive report on the high financial and social costs of OM, including the potential for OM vaccines to reduce antibiotic use and subsequent development of antimicrobial resistance (AMR), would likely assist in engaging stakeholders to recognize the value of prevention of OM and increase support for efforts on OM vaccine development. Vaccine trials with OM prevention as a clinical end-point are challenging, however a focus on developing assays that measure functional correlates of protection would facilitate OM vaccine development.
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Affiliation(s)
| | - Tim Murphy
- Clinical and Translational Research Center, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Stephen I Pelton
- Boston University School of Public Health, Boston University, Boston, MA, USA
| | - Laura A Novotny
- The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Laura L Hammitt
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Arwa Kurabi
- Division of Otolaryngology, Department of Surgery, University of California, San Diego, CA, USA
| | - Jian-Dong Li
- Center for Inflammation, Immunity & Infection, Institute for Biomedical Sciences, Georgia State University, GA, USA
| | - Ruth B Thornton
- School of Biomedical Sciences, University of Western Australia, Australia and Wesfarmers Centre for Vaccines and Infectious Diseases Research, Telethon Kids Institute, Perth, Australia
| | - Lea-Ann S Kirkham
- Wesfarmers Centre for Vaccines and Infectious Diseases Research, Telethon Kids Institute, Australia and Centre for Child Health Research, University of Western Australia, Perth, Australia
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Khan K, Hollis C, Hall CL, Davies EB, Mataix-Cols D, Andrén P, Murphy T, Brown BJ, Murray E, Glazebrook C. Protocol for the Process Evaluation of the Online Remote Behavioural Intervention for Tics (ORBIT) randomized controlled trial for children and young people. Trials 2020; 21:6. [PMID: 31898510 PMCID: PMC6941346 DOI: 10.1186/s13063-019-3974-3] [Citation(s) in RCA: 11] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 12/09/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Process evaluations are an important component in the interpretation and understanding of outcomes in trials. The Online Remote Behavioural Intervention for Tics (ORBIT) study is a randomized controlled trial evaluating the effectiveness of an Internet-delivered behavioural intervention (called BIP TIC) compared to an Internet-delivered education programme aimed at children and young people with tics. A process evaluation will be undertaken alongside the main trial to determine precisely how the behavioural intervention works and ascertain whether, and if so, how, the intervention could be successfully implemented in standard clinical practice. This protocol paper describes the rationale, aims, and methodology of the ORBIT trial process evaluation. METHODS The process evaluation will have a mixed-methods design following the UK Medical Research Council 2015 guidelines, comprising both quantitative and qualitative data collection. This will include analysing data usage of participants in the intervention arm; purposively sampled, semi-structured interviews of parents and children, therapists and supervisors, and referring clinicians of the ORBIT trial, as well as analysis of qualitative comments put into the online therapy platform by participants at the end of treatment. Qualitative data will be analysed thematically. Quantitative and qualitative data will be integrated in a triangulation approach, to provide an understanding of how the intervention works, and what resources are needed for effective implementation, uptake and use in routine clinical care. DISCUSSION This process evaluation will explore the experiences of participants, therapists and supervisors and referring clinicians of a complex online intervention. By contextualising trial efficacy results, this will help understand how and if the intervention worked and what may be required to sustain the implementation of the treatment long term. The findings will also aid in our understanding of factors that can affect the success of complex interventions. This will enable future researchers developing online behavioural interventions for children and young people with mental health and neurological disorders to gain invaluable information from this process evaluation. TRIAL REGISTRATION International Standard Randomised Controlled Trials Number, ISRCTN70758207. Registered on 20 March 2018. ClinicalTrials.gov, NCT03483493. Registered on 30 March 2018.
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Affiliation(s)
- K Khan
- Division of Psychiatry and Applied Psychology, Institute of Mental Health, School of Medicine, University of Nottingham, Innovation Park, Triumph Road, Nottingham, NG7 2TU, UK.
| | - C Hollis
- Division of Psychiatry and Applied Psychology, Institute of Mental Health, School of Medicine, University of Nottingham, Innovation Park, Triumph Road, Nottingham, NG7 2TU, UK
- NIHR MindTech Medtech Co-operative, Institute of Mental Health, University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK
| | - C L Hall
- Division of Psychiatry and Applied Psychology, Institute of Mental Health, School of Medicine, University of Nottingham, Innovation Park, Triumph Road, Nottingham, NG7 2TU, UK
| | - E B Davies
- Division of Psychiatry and Applied Psychology, Institute of Mental Health, School of Medicine, University of Nottingham, Innovation Park, Triumph Road, Nottingham, NG7 2TU, UK
- NIHR MindTech Medtech Co-operative, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - D Mataix-Cols
- Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - P Andrén
- Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - T Murphy
- Tic Disorder Clinic, Psychological Medicine Team, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - B J Brown
- NIHR MindTech Medtech Co-operative, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - E Murray
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - C Glazebrook
- Division of Psychiatry and Applied Psychology, Institute of Mental Health, School of Medicine, University of Nottingham, Innovation Park, Triumph Road, Nottingham, NG7 2TU, UK
- NIHR MindTech Medtech Co-operative, Institute of Mental Health, University of Nottingham, Nottingham, UK
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Gore A, Truche P, Kartik A, Iskerkiy A, Lopez G, Murphy T, Hanna J, Peck G. Defining the Influence of Inaccurately Reported Ethnicity on Adjusted Outcomes Models in Trauma Research. J Am Coll Surg 2019. [DOI: 10.1016/j.jamcollsurg.2019.08.326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Murphy T, Windermere S, Holtzman L, Slish J, Morris T, Becker T. 305 Bystander Cardiopulmonary Resuscitation in the Courtroom: Legal Risk of Return of Spontaneous Circulation. Ann Emerg Med 2019. [DOI: 10.1016/j.annemergmed.2019.08.264] [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: 11/17/2022]
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Stephens M, Murphy T, Hendry D. Anaesthesia for retroperitoneal lymph node dissection in the treatment of testicular cancer. BJA Educ 2019; 19:283-289. [DOI: 10.1016/j.bjae.2019.04.003] [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] [Accepted: 04/30/2019] [Indexed: 11/24/2022] Open
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Murphy T. Anesthetist-delivered intraoperative transesophageal echocardiography in pediatric cardiac surgery. Paediatr Anaesth 2019; 29:499-505. [PMID: 30592106 DOI: 10.1111/pan.13572] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 12/03/2018] [Accepted: 12/24/2018] [Indexed: 11/30/2022]
Abstract
This article reviews the evidence for anesthetist-delivered perioperative transesophageal echocardiography for children undergoing cardiac surgery. It addresses the additional issues of training, developing practice, accreditation, and the requirement for collaboration with pediatric cardiologists, surgeons and other members of the perioperative team. Finally an overview of the potential structure of an anesthetist-delivered perioperative transesophageal echocardiography service is presented.
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Affiliation(s)
- Tim Murphy
- Bristol Royal Hospital for Children, Bristol, UK
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Whitney T, Kerth C, Murphy T, Stewart W, Boles J, Miller R. 487 Effects of plant secondary compounds found in Juniperus spp. on yearling Rambouillet wethers feedlot performance, carcass characteristics, adipose tissue fatty acid composition, and sensory panel traits. J Anim Sci 2018. [DOI: 10.1093/jas/sky404.595] [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: 11/13/2022] Open
Affiliation(s)
- T Whitney
- Texas A&M AgriLife Research, San Angelo, TX, United States
| | - C Kerth
- Texas A&M University,College Station, TX, United States
| | - T Murphy
- Montana State Univ.,Bozeman, MT, United States
| | - W Stewart
- Univ. of WY, Dept. of Anim. Sci.,Laramie, WY, United States
| | - J Boles
- Montana State Univ.,Bozem, MT, United States
| | - R Miller
- Texas A&M University,College Station, TX, United States
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Tisminetzky M, Gurwitz J, Fan D, Reynolds K, Smith D, Sung S, Murphy T, Go A. MULTIMORBIDITY BURDEN AND ADVERSE OUTCOMES IN OLDER ADULTS WITH HEART FAILURE. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.2611] [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: 11/14/2022] Open
Affiliation(s)
| | - J Gurwitz
- Meyers Primary Care Institute, a joint endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester, Massachusetts
| | - D Fan
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - K Reynolds
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - D Smith
- Center for Health Research, Kaiser Permanente Northwest, Portland Oregon
| | - S Sung
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - T Murphy
- Department of Internal Medicine, Section of Geriatrics, Yale University School of Medicine, New Haven, CT, USA
| | - A Go
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
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Harte J, Murphy T, Lynch N, Moneley D. The Use of Routine Troponins Following Endovascular Repair of Abdominal Aortic Aneurysms to Detect Perioperative Cardiovascular Events. Eur J Vasc Endovasc Surg 2018. [DOI: 10.1016/j.ejvs.2018.06.018] [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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Murphy T, Messina J, Carothers J, Djupesland P, Mahmoud R. P440 Exhalation delivery system with fluticasone (EDS-FLU) improves sleep in patients with CRS with nasal polyps. Ann Allergy Asthma Immunol 2017. [DOI: 10.1016/j.anai.2017.09.036] [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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Hallinan G, Corsi A, Mooley KP, Hotokezaka K, Nakar E, Kasliwal MM, Kaplan DL, Frail DA, Myers ST, Murphy T, De K, Dobie D, Allison JR, Bannister KW, Bhalerao V, Chandra P, Clarke TE, Giacintucci S, Ho AYQ, Horesh A, Kassim NE, Kulkarni SR, Lenc E, Lockman FJ, Lynch C, Nichols D, Nissanke S, Palliyaguru N, Peters WM, Piran T, Rana J, Sadler EM, Singer LP. A radio counterpart to a neutron star merger. Science 2017; 358:1579-1583. [PMID: 29038372 DOI: 10.1126/science.aap9855] [Citation(s) in RCA: 325] [Impact Index Per Article: 46.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Accepted: 10/09/2017] [Indexed: 11/02/2022]
Abstract
Gravitational waves have been detected from a binary neutron star merger event, GW170817. The detection of electromagnetic radiation from the same source has shown that the merger occurred in the outskirts of the galaxy NGC 4993, at a distance of 40 megaparsecs from Earth. We report the detection of a counterpart radio source that appears 16 days after the event, allowing us to diagnose the energetics and environment of the merger. The observed radio emission can be explained by either a collimated ultrarelativistic jet, viewed off-axis, or a cocoon of mildly relativistic ejecta. Within 100 days of the merger, the radio light curves will enable observers to distinguish between these models, and the angular velocity and geometry of the debris will be directly measurable by very long baseline interferometry.
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Affiliation(s)
- G Hallinan
- Division of Physics, Mathematics and Astronomy, California Institute of Technology, Pasadena, CA 91125, USA.
| | - A Corsi
- Department of Physics and Astronomy, Texas Tech University, Lubbock, TX 79409, USA
| | - K P Mooley
- Astrophysics, Department of Physics, University of Oxford, Oxford OX1 3RH, UK
| | - K Hotokezaka
- Center for Computational Astrophysics, Flatiron Institute, 162 5th Avenue, New York, NY 10010, USA.,Department of Astrophysical Sciences, Princeton University, Princeton, NJ 08544, USA
| | - E Nakar
- Raymond and Beverly Sackler School of Physics and Astronomy, Tel Aviv University, Tel Aviv 69978, Israel
| | - M M Kasliwal
- Division of Physics, Mathematics and Astronomy, California Institute of Technology, Pasadena, CA 91125, USA
| | - D L Kaplan
- Department of Physics, University of Wisconsin, Milwaukee, WI 53201, USA
| | - D A Frail
- National Radio Astronomy Observatory, Socorro, NM 87801, USA
| | - S T Myers
- National Radio Astronomy Observatory, Socorro, NM 87801, USA
| | - T Murphy
- Sydney Institute for Astronomy, School of Physics, University of Sydney, Sydney, NSW 2006, Australia.,Australian Research Council Centre of Excellence for All-sky Astrophysics (CAASTRO)
| | - K De
- Division of Physics, Mathematics and Astronomy, California Institute of Technology, Pasadena, CA 91125, USA
| | - D Dobie
- Sydney Institute for Astronomy, School of Physics, University of Sydney, Sydney, NSW 2006, Australia.,Australian Research Council Centre of Excellence for All-sky Astrophysics (CAASTRO).,Australia Telescope National Facility, Commonwealth Scientific and Industrial Research Organisation, Astronomy and Space Science, Epping, NSW 1710, Australia
| | - J R Allison
- Sydney Institute for Astronomy, School of Physics, University of Sydney, Sydney, NSW 2006, Australia.,Australian Research Council Centre of Excellence for All-sky Astrophysics in 3 Dimensions (ASTRO 3D)
| | - K W Bannister
- Australia Telescope National Facility, Commonwealth Scientific and Industrial Research Organisation, Astronomy and Space Science, Epping, NSW 1710, Australia
| | - V Bhalerao
- Department of Physics, Indian Institute of Technology Bombay, Mumbai 400076, India
| | - P Chandra
- National Centre for Radio Astrophysics, Tata Institute of Fundamental Research, Pune University Campus, Ganeshkhind Pune 411007, India
| | - T E Clarke
- Remote Sensing Division, Naval Research Laboratory, Washington, DC 20375, USA
| | - S Giacintucci
- Remote Sensing Division, Naval Research Laboratory, Washington, DC 20375, USA
| | - A Y Q Ho
- Division of Physics, Mathematics and Astronomy, California Institute of Technology, Pasadena, CA 91125, USA
| | - A Horesh
- Racah Institute of Physics, Hebrew University of Jerusalem, Jerusalem 91904, Israel
| | - N E Kassim
- Remote Sensing Division, Naval Research Laboratory, Washington, DC 20375, USA
| | - S R Kulkarni
- Division of Physics, Mathematics and Astronomy, California Institute of Technology, Pasadena, CA 91125, USA
| | - E Lenc
- Sydney Institute for Astronomy, School of Physics, University of Sydney, Sydney, NSW 2006, Australia.,Australian Research Council Centre of Excellence for All-sky Astrophysics (CAASTRO)
| | - F J Lockman
- Green Bank Observatory, Green Bank, WV 24944, USA
| | - C Lynch
- Sydney Institute for Astronomy, School of Physics, University of Sydney, Sydney, NSW 2006, Australia.,Australian Research Council Centre of Excellence for All-sky Astrophysics (CAASTRO)
| | - D Nichols
- Institute of Mathematics, Astrophysics and Particle Physics, Radboud University, 6525 AJ Nijmegen, Netherlands
| | - S Nissanke
- Institute of Mathematics, Astrophysics and Particle Physics, Radboud University, 6525 AJ Nijmegen, Netherlands
| | - N Palliyaguru
- Department of Physics and Astronomy, Texas Tech University, Lubbock, TX 79409, USA
| | - W M Peters
- Remote Sensing Division, Naval Research Laboratory, Washington, DC 20375, USA
| | - T Piran
- Racah Institute of Physics, Hebrew University of Jerusalem, Jerusalem 91904, Israel
| | - J Rana
- Inter University Centre for Astronomy and Astrophysics, Pune University Campus, Pune, Maharashtra 411007, India
| | - E M Sadler
- Sydney Institute for Astronomy, School of Physics, University of Sydney, Sydney, NSW 2006, Australia.,Australian Research Council Centre of Excellence for All-sky Astrophysics (CAASTRO)
| | - L P Singer
- Astroparticle Physics Laboratory, NASA Goddard Space Flight Center, Greenbelt, MD 20771, USA
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Kasliwal MM, Nakar E, Singer LP, Kaplan DL, Cook DO, Van Sistine A, Lau RM, Fremling C, Gottlieb O, Jencson JE, Adams SM, Feindt U, Hotokezaka K, Ghosh S, Perley DA, Yu PC, Piran T, Allison JR, Anupama GC, Balasubramanian A, Bannister KW, Bally J, Barnes J, Barway S, Bellm E, Bhalerao V, Bhattacharya D, Blagorodnova N, Bloom JS, Brady PR, Cannella C, Chatterjee D, Cenko SB, Cobb BE, Copperwheat C, Corsi A, De K, Dobie D, Emery SWK, Evans PA, Fox OD, Frail DA, Frohmaier C, Goobar A, Hallinan G, Harrison F, Helou G, Hinderer T, Ho AYQ, Horesh A, Ip WH, Itoh R, Kasen D, Kim H, Kuin NPM, Kupfer T, Lynch C, Madsen K, Mazzali PA, Miller AA, Mooley K, Murphy T, Ngeow CC, Nichols D, Nissanke S, Nugent P, Ofek EO, Qi H, Quimby RM, Rosswog S, Rusu F, Sadler EM, Schmidt P, Sollerman J, Steele I, Williamson AR, Xu Y, Yan L, Yatsu Y, Zhang C, Zhao W. Illuminating gravitational waves: A concordant picture of photons from a neutron star merger. Science 2017; 358:1559-1565. [PMID: 29038373 DOI: 10.1126/science.aap9455] [Citation(s) in RCA: 441] [Impact Index Per Article: 63.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 10/05/2017] [Indexed: 11/02/2022]
Abstract
Merging neutron stars offer an excellent laboratory for simultaneously studying strong-field gravity and matter in extreme environments. We establish the physical association of an electromagnetic counterpart (EM170817) with gravitational waves (GW170817) detected from merging neutron stars. By synthesizing a panchromatic data set, we demonstrate that merging neutron stars are a long-sought production site forging heavy elements by r-process nucleosynthesis. The weak gamma rays seen in EM170817 are dissimilar to classical short gamma-ray bursts with ultrarelativistic jets. Instead, we suggest that breakout of a wide-angle, mildly relativistic cocoon engulfing the jet explains the low-luminosity gamma rays, the high-luminosity ultraviolet-optical-infrared, and the delayed radio and x-ray emission. We posit that all neutron star mergers may lead to a wide-angle cocoon breakout, sometimes accompanied by a successful jet and sometimes by a choked jet.
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Affiliation(s)
- M M Kasliwal
- Division of Physics, Math and Astronomy, California Institute of Technology, 1200 East California Boulevard, Pasadena, CA 91125, USA.
| | - E Nakar
- The Raymond and Beverly Sackler School of Physics and Astronomy, Tel Aviv University, Tel Aviv 69978, Israel
| | - L P Singer
- Astroparticle Physics Laboratory, NASA Goddard Space Flight Center, Mail Code 661, Greenbelt, MD 20771, USA.,Joint Space-Science Institute, University of Maryland, College Park, MD 20742, USA
| | - D L Kaplan
- Department of Physics, University of Wisconsin, Milwaukee, WI 53201, USA
| | - D O Cook
- Division of Physics, Math and Astronomy, California Institute of Technology, 1200 East California Boulevard, Pasadena, CA 91125, USA
| | - A Van Sistine
- Department of Physics, University of Wisconsin, Milwaukee, WI 53201, USA
| | - R M Lau
- Division of Physics, Math and Astronomy, California Institute of Technology, 1200 East California Boulevard, Pasadena, CA 91125, USA
| | - C Fremling
- Division of Physics, Math and Astronomy, California Institute of Technology, 1200 East California Boulevard, Pasadena, CA 91125, USA
| | - O Gottlieb
- The Raymond and Beverly Sackler School of Physics and Astronomy, Tel Aviv University, Tel Aviv 69978, Israel
| | - J E Jencson
- Division of Physics, Math and Astronomy, California Institute of Technology, 1200 East California Boulevard, Pasadena, CA 91125, USA
| | - S M Adams
- Division of Physics, Math and Astronomy, California Institute of Technology, 1200 East California Boulevard, Pasadena, CA 91125, USA
| | - U Feindt
- The Oskar Klein Centre, Department of Physics, Stockholm University, AlbaNova, SE-106 91 Stockholm, Sweden
| | - K Hotokezaka
- Center for Computational Astrophysics, Simons Foundation, Flatiron Institute, 162 5th Avenue, New York, NY 10010, USA.,Department of Astrophysical Sciences, Princeton University, Peyton Hall, Princeton, NJ 08544, USA
| | - S Ghosh
- Department of Physics, University of Wisconsin, Milwaukee, WI 53201, USA
| | - D A Perley
- Astrophysics Research Institute, Liverpool John Moores University, IC2, Liverpool Science Park, 146 Browlow Hill, Liverpool L3 5RF, UK
| | - P-C Yu
- Graduate Institute of Astronomy, National Central University, No. 300, Zhongda Road, Zhongli District, Taoyuan City 32001, Taiwan
| | - T Piran
- Racah Institute of Physics, The Hebrew University of Jerusalem, Jerusalem 91904, Israel
| | - J R Allison
- Sydney Institute for Astronomy, School of Physics A28, The University of Sydney, New South Wales 2006, Australia.,Australian Research Council Centre of Excellence for All-sky Astrophysics in 3 Dimensions, Australia
| | - G C Anupama
- Indian Institute of Astrophysics, II Block Koramangala, Bangalore 560034, India
| | - A Balasubramanian
- Indian Institute of Science Education and Research, Dr. Homi Bhabha Road, Pashan, Pune 411008, India
| | - K W Bannister
- Australia Telescope National Facility, Astronomy and Space Science, Commonwealth Scientific and Industrial Research Organisation, Post Office Box 76, Epping, New South Wales 1710, Australia
| | - J Bally
- Department of Astrophysical and Planetary Sciences, University of Colorado, Boulder, CO 80305, USA
| | - J Barnes
- Columbia Astrophysics Laboratory, Columbia University, New York, NY 10027, USA
| | - S Barway
- South African Astronomical Observatory, Post Office Box 9, Observatory, Cape Town 7935, South Africa
| | - E Bellm
- Department of Astronomy, University of Washington, Seattle, WA 98195, USA
| | - V Bhalerao
- Department of Physics, Indian Institute of Technology Bombay, Mumbai 400076, India
| | - D Bhattacharya
- Inter-University Centre for Astronomy and Astrophysics, Post Office Bag 4, Ganeshkhind, Pune 411007, India
| | - N Blagorodnova
- Division of Physics, Math and Astronomy, California Institute of Technology, 1200 East California Boulevard, Pasadena, CA 91125, USA
| | - J S Bloom
- Department of Astronomy, University of California, Berkeley, CA 94720-3411, USA.,Lawrence Berkeley National Laboratory, 1 Cyclotron Road, MS 50B-4206, Berkeley, CA 94720, USA
| | - P R Brady
- Department of Physics, University of Wisconsin, Milwaukee, WI 53201, USA
| | - C Cannella
- Division of Physics, Math and Astronomy, California Institute of Technology, 1200 East California Boulevard, Pasadena, CA 91125, USA
| | - D Chatterjee
- Department of Physics, University of Wisconsin, Milwaukee, WI 53201, USA
| | - S B Cenko
- Astroparticle Physics Laboratory, NASA Goddard Space Flight Center, Mail Code 661, Greenbelt, MD 20771, USA.,Joint Space-Science Institute, University of Maryland, College Park, MD 20742, USA
| | - B E Cobb
- Department of Physics, George Washington University, Washington, DC 20052, USA
| | - C Copperwheat
- Astrophysics Research Institute, Liverpool John Moores University, IC2, Liverpool Science Park, 146 Browlow Hill, Liverpool L3 5RF, UK
| | - A Corsi
- Department of Physics and Astronomy, Texas Tech University, Box 41051, Lubbock, TX 79409-1051, USA
| | - K De
- Division of Physics, Math and Astronomy, California Institute of Technology, 1200 East California Boulevard, Pasadena, CA 91125, USA
| | - D Dobie
- Sydney Institute for Astronomy, School of Physics A28, The University of Sydney, New South Wales 2006, Australia.,Australian Research Council Centre of Excellence for All-sky Astrophysics, Australia.,Australia Telescope National Facility, Astronomy and Space Science, Commonwealth Scientific and Industrial Research Organisation, Post Office Box 76, Epping, New South Wales 1710, Australia
| | - S W K Emery
- University College London, Mullard Space Science Laboratory, Holmbury St. Mary, Dorking RH5 6NT, UK
| | - P A Evans
- X-ray and Observational Astronomy Research Group, Leicester Institute for Space and Earth Observation, Department of Physics and Astronomy, University of Leicester, University Road, Leicester, LE1 7RH, UK
| | - O D Fox
- Space Telescope Science Institute, 3700 San Martin Drive, Baltimore, MD 21218, USA
| | - D A Frail
- National Radio Astronomy Observatory, Socorro, NM 87825, USA
| | - C Frohmaier
- Department of Physics and Astronomy, University of Southampton, Southampton, Hampshire SO17 1BJ, UK.,Institute of Cosmology and Gravitation, Dennis Sciama Building, University of Portsmouth, Burnaby Road, Portsmouth PO1 3FX, UK
| | - A Goobar
- The Oskar Klein Centre, Department of Physics, Stockholm University, AlbaNova, SE-106 91 Stockholm, Sweden
| | - G Hallinan
- Division of Physics, Math and Astronomy, California Institute of Technology, 1200 East California Boulevard, Pasadena, CA 91125, USA
| | - F Harrison
- Division of Physics, Math and Astronomy, California Institute of Technology, 1200 East California Boulevard, Pasadena, CA 91125, USA
| | - G Helou
- Infrared Processing and Analysis Center, California Institute of Technology, Pasadena, CA 91125, USA
| | - T Hinderer
- Institute of Mathematics, Astrophysics and Particle Physics, Radboud University, Heyendaalseweg 135, 6525 AJ Nijmegen, Netherlands
| | - A Y Q Ho
- Division of Physics, Math and Astronomy, California Institute of Technology, 1200 East California Boulevard, Pasadena, CA 91125, USA
| | - A Horesh
- Racah Institute of Physics, The Hebrew University of Jerusalem, Jerusalem 91904, Israel
| | - W-H Ip
- Department of Astrophysical Sciences, Princeton University, Peyton Hall, Princeton, NJ 08544, USA
| | - R Itoh
- Department of Physics, Tokyo Institute of Technology, 2-12-1 Ookayama, Meguro-ku, Tokyo 152-8551, Japan
| | - D Kasen
- Department of Astronomy, University of California, Berkeley, CA 94720-3411, USA.,Department of Physics, University of California, Berkeley, CA 94720, USA
| | - H Kim
- Gemini Observatory, Casilla 603, La Serena, Chile
| | - N P M Kuin
- University College London, Mullard Space Science Laboratory, Holmbury St. Mary, Dorking RH5 6NT, UK
| | - T Kupfer
- Division of Physics, Math and Astronomy, California Institute of Technology, 1200 East California Boulevard, Pasadena, CA 91125, USA
| | - C Lynch
- Sydney Institute for Astronomy, School of Physics A28, The University of Sydney, New South Wales 2006, Australia.,Australian Research Council Centre of Excellence for All-sky Astrophysics, Australia
| | - K Madsen
- Division of Physics, Math and Astronomy, California Institute of Technology, 1200 East California Boulevard, Pasadena, CA 91125, USA
| | - P A Mazzali
- Astrophysics Research Institute, Liverpool John Moores University, IC2, Liverpool Science Park, 146 Browlow Hill, Liverpool L3 5RF, UK.,Max-Planck Institute for Astrophysics, Garching, Germany
| | - A A Miller
- Center for Interdisciplinary Exploration and Research in Astrophysics and Department of Physics and Astronomy, Northwestern University, Evanston, IL 60208, USA.,The Adler Planetarium, Chicago, IL 60605, USA
| | - K Mooley
- Astrophysics, Department of Physics, University of Oxford, Keble Road, Oxford OX1 3RH, UK
| | - T Murphy
- Sydney Institute for Astronomy, School of Physics A28, The University of Sydney, New South Wales 2006, Australia.,Australian Research Council Centre of Excellence for All-sky Astrophysics, Australia
| | - C-C Ngeow
- Graduate Institute of Astronomy, National Central University, No. 300, Zhongda Road, Zhongli District, Taoyuan City 32001, Taiwan
| | - D Nichols
- Institute of Mathematics, Astrophysics and Particle Physics, Radboud University, Heyendaalseweg 135, 6525 AJ Nijmegen, Netherlands
| | - S Nissanke
- Institute of Mathematics, Astrophysics and Particle Physics, Radboud University, Heyendaalseweg 135, 6525 AJ Nijmegen, Netherlands
| | - P Nugent
- Department of Astronomy, University of California, Berkeley, CA 94720-3411, USA.,Lawrence Berkeley National Laboratory, 1 Cyclotron Road, MS 50B-4206, Berkeley, CA 94720, USA
| | - E O Ofek
- Department of Particle Physics and Astrophysics, Weizmann Institute of Science, Rehovot 7610001, Israel
| | - H Qi
- Department of Physics, University of Wisconsin, Milwaukee, WI 53201, USA
| | - R M Quimby
- Department of Astronomy, San Diego State University, San Diego, CA 92182, USA.,Kavli Institute for the Physics and Mathematics of the Universe (WPI), The University of Tokyo Institutes for Advanced Study, The University of Tokyo, Kashiwa, Chiba 277-8583, Japan
| | - S Rosswog
- The Oskar Klein Centre, Department of Astronomy, Stockholm University, AlbaNova, SE-106 91 Stockholm, Sweden
| | - F Rusu
- School of Engineering (EECS), University of California, Merced, CA 95343, USA
| | - E M Sadler
- Sydney Institute for Astronomy, School of Physics A28, The University of Sydney, New South Wales 2006, Australia.,Australian Research Council Centre of Excellence for All-sky Astrophysics, Australia
| | - P Schmidt
- Institute of Mathematics, Astrophysics and Particle Physics, Radboud University, Heyendaalseweg 135, 6525 AJ Nijmegen, Netherlands
| | - J Sollerman
- The Oskar Klein Centre, Department of Astronomy, Stockholm University, AlbaNova, SE-106 91 Stockholm, Sweden
| | - I Steele
- Astrophysics Research Institute, Liverpool John Moores University, IC2, Liverpool Science Park, 146 Browlow Hill, Liverpool L3 5RF, UK
| | - A R Williamson
- Institute of Mathematics, Astrophysics and Particle Physics, Radboud University, Heyendaalseweg 135, 6525 AJ Nijmegen, Netherlands
| | - Y Xu
- Division of Physics, Math and Astronomy, California Institute of Technology, 1200 East California Boulevard, Pasadena, CA 91125, USA
| | - L Yan
- Division of Physics, Math and Astronomy, California Institute of Technology, 1200 East California Boulevard, Pasadena, CA 91125, USA.,Infrared Processing and Analysis Center, California Institute of Technology, Pasadena, CA 91125, USA
| | - Y Yatsu
- Department of Physics, Tokyo Institute of Technology, 2-12-1 Ookayama, Meguro-ku, Tokyo 152-8551, Japan
| | - C Zhang
- Department of Physics, University of Wisconsin, Milwaukee, WI 53201, USA
| | - W Zhao
- School of Engineering (EECS), University of California, Merced, CA 95343, USA
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Affiliation(s)
- Tim Murphy
- Paediatric Anaesthesia, Bristol Royal Hospital for Children, Bristol, UK
| | - Ian A Jenkins
- Paediatric Cardiac Anaesthesia & Intensive Care, Bristol Royal Hospital for Children, Bristol, UK
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Affiliation(s)
- T. Murphy
- Department of Anaesthesia; Bristol Royal Hospital for Children; Bristol UK
| | - B. Howes
- Department of Anaesthesia; Bristol Royal Infirmary; University Hospitals Bristol NHS Foundation Trust; Bristol UK
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Williams R, Murphy T, Kerwin G, Kuhlman C, Panah S, Rao A, Silverstein M, Zuckerman A. Initial experience with trans radial artery access for management of high-grade splenic trauma at a major metropolitan trauma center. J Vasc Interv Radiol 2017. [DOI: 10.1016/j.jvir.2016.12.914] [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: 11/30/2022] Open
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Heath EM, Chan SM, Minden MD, Murphy T, Shlush LI, Schimmer AD. Biological and clinical consequences of NPM1 mutations in AML. Leukemia 2017; 31:798-807. [PMID: 28111462 DOI: 10.1038/leu.2017.30] [Citation(s) in RCA: 105] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 01/09/2017] [Accepted: 01/13/2017] [Indexed: 12/16/2022]
Abstract
Acute myeloid leukemia (AML) is characterized by accumulation of myeloid cells in the bone marrow because of impaired differentiation and proliferation, resulting in hematopoietic insufficiency. NPM1 is one of the most commonly mutated genes in AML, present in 20-30% of cases. Mutations in NPM1 represent a distinct entity in the World Health Organization (WHO) classification and commonly indicate a better risk prognosis. In this review, we discuss the many functions of NPM1, the consequence of mutations in NPM1 and possible mechanisms through which mutations lead to leukemogenesis. We also discuss clinical consequences of mutations, associated gene expression patterns and the role of NPM1 mutations in informing prognosis and therapeutic decisions and predicting relapse in AML.
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Affiliation(s)
- E M Heath
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Ontario, Canada
| | - S M Chan
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - M D Minden
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Ontario, Canada
| | - T Murphy
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Ontario, Canada
| | - L I Shlush
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Department of Immunology, Weizmann Institute of Science, Rehovot, Israel
| | - A D Schimmer
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Ontario, Canada
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Murphy T, Forgie R, MacLeod J, Brown C, Hassan A, Pelletier M. SEVERE COAGULOPATHY AFTER CARDIAC SURGERY: IS FEIBA A VIABLE THERAPY? Can J Cardiol 2016. [DOI: 10.1016/j.cjca.2016.07.165] [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: 11/16/2022] Open
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50
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Healy L, Doyle S, Ni Buchalla E, Cushen S, Murphy T, Ryan A, Ravi N, Reynolds J. OR43: Double Blinded, Placebo Controlled Eicosapentaenoic Acid (EPA) Enriched Enteral Nutrition in the Surgical Treatment of Oesophageal Cancer Patients. Clin Nutr 2016. [DOI: 10.1016/s0261-5614(16)30282-5] [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: 10/21/2022]
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