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Padilla C, Ortner C, Dennis A, Zieleskiewicz L. The need for maternal critical care education, point-of-care ultrasound and critical care echocardiography in obstetric anesthesiologists training. Int J Obstet Anesth 2023; 55:103880. [PMID: 37105833 DOI: 10.1016/j.ijoa.2023.103880] [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: 01/21/2023] [Revised: 03/23/2023] [Accepted: 03/27/2023] [Indexed: 04/05/2023]
Abstract
Globally, the increase in medically complex obstetric patients is challenging the educational approach and clinical management of critically ill obstetric patients. This increase in medical complexity calls into question the educational paradigm in which future physicians are trained. Obstetric anesthesiologists, physician experts in the perio-perative planning and management of complex obstetric patients, represent an essential workforce in the strategies to address maternal mortality. Unfortunately, the development of peri-operative medicine and maternal critical care curricula has only received minor attention in most countries. Proposed guidelines and models highlight the existing need for tiered maternity care services in which critical care infrastructure plays a central role in the delivery of high-risk peripartum care. Therefore, the development of maternal critical care models designed to prepare obstetric anesthesiologists for the clinical challenges of a medically complex patient are warranted. Key critical care topics such as advanced ultrasonography, with the inclusion of quantitative echocardiographic assessments into obstetric anesthesiology educational curricula, will serve to better prepare physicians for the realities of an increasingly complex pregnant patient population, and further reinforce the critical care infrastructure detailed in the Levels of Maternal Care consensus. Despite an increasingly complex obstetric patient population, heterogeneity of maternal critical care practices exists across the globe, warranting standardization and further development of proposed curricula.
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Affiliation(s)
- C Padilla
- Department of Anesthesiology, Stanford University School of Medicine, Stanford, CA, USA.
| | - C Ortner
- Department of Anesthesiology, Stanford University School of Medicine, Stanford, CA, USA
| | - A Dennis
- Departments of Critical Care, Obstetrics and Gynecology, and Pharmacology, University of Melbourne, Australia
| | - L Zieleskiewicz
- Département d'Anesthésie-Réanimation, Médecine Péri-opératoire, Hôpital Nord, AP-HM Marseille, France
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Richards T, Miles LF, Clevenger B, Keegan A, Abeysiri S, Rao Baikady R, Besser MW, Browne JP, Klein AA, Macdougall IC, Murphy GJ, Anker SD, Dahly D, Besser M, Browne J, Clevenger B, Kegan A, Klein A, Miles L, MacDougall I, Baikady RR, Dahly D, Bradbury A, Richards T, Burley T, Van Loen S, Anker S, Klein A, MacDougall I, Murphy G, Besser M, Unsworth I, Clayton T, Collier T, Potter K, Abeysiri S, Evans R, Knight R, Swinson R, Van Dyck L, Keidan J, Williamson L, Crook A, Pepper J, Dobson J, Newsome S, Godec T, Dodd M, Richards T, Van Dyck L, Evans R, Abeysiri S, Clevenger B, Butcher A, Swinson R, Collier T, Potter K, Anker S, Kelly J, Morris S, Browne J, Keidan J, Grocott M, Chau M, Knight R, Collier T, Baikady RR, Black E, Lawrence H, Kouthra M, Horner K, Jhanji S, Todman E, Keon‐Cohen Z, Rooms M, Tomlinson J, Bailes I, Walker S, Pirie K, Gerstman M, Kasivisvanathan R, Uren S, Magee D, Eeles A, Anker R, McCanny J, O'Mahony M, Reynolds T, Batley S, Hegarty A, Trundle S, Mazzola F, Tatham K, Balint A, Morrison B, Evans M, Pang CL, Smith L, Wilson C, Sjorin V, Khatri P, Wilson M, Parkinson D, Crosbie J, Dawas K, Smyth D, Bercades G, Ryu J, Reyes A, Martir G, Gallego L, Macklin A, Rocha M, Tam DK, Brealey DD, Dhesi J, Morrison C, Hardwick J, Partridge J, Braude P, Rogerson A, Jahangir N, Thomson C, Biswell L, Cross J, Pritchard F, Mohammed A, Wallace D, Galat MG, Okello J, Symes R, Leon J, Gibbs C, Sanghera S, Dennis A, Kibutu F, Fofie J, Bird S, Alli A, Jackson Y, Albuheissi S, Brain C, Shiridzinomwa C, Ralph C, Wroath B, Hammonds F, Adams B, Faulds J, Staddon S, Hughes T, Saha S, Finney C, Harris C, Mellis C, Johnson L, Riozzi P, Yarnold A, Buchanan F, Hopkins P, Greig L, Noble H, Edwards M, Grocott M, Plumb J, Harvie D, Dushianthan A, Wakatsuki M, Leggett S, Salmon K, Bolger C, Burnish R, Otto J, Rayat G, Golder K, Bartlett P, Bali S, Seaward L, Wadams B, Tyrell B, Collins H, Tantony N, Geale R, Wilson A, Ball D, Lindsey I, Barker D, Thyseen M, Chiam P, Hannaway C, Colling K, Messer C, Verma N, Nasseri M, Poonawala G, Sellars A, Mainali P, Hammond T, Hughes A, O'Hara D, McNeela F, Shillito L, Kotze A, Moriarty C, Wilson J, Davies S, Yates D, Carter J, Redman J, Ma S, Howard K, Redfearn H, Wilcock D, Lowe J, Alexander T, Jose J, Hornzee G, Akbar F, Rey S, Patel A, Coulson S, Saini R, Santipillai J, McCretton T, McCanny J, Chima K, Collins K, Pathmanathan B, Chattersingh A, McLeavy L, Al‐Saadi Z, Patel M, Skampardoni S, Chinnadurai R, Thomas V, Keen A, Pagett K, Keatley C, Howard J, Greenhalgh M, Jenkins S, Gidda R, Watts A, Breaton C, Parker J, Mallett S, James S, Penny L, Chan K, Reeves T, Catterall M, Williams S, Birch J, Hammerton K, Williamson N, Thomas A, Evans M, Mercer L, Horsfield G, Hughes C, Cupitt J, Stoddard E, McNamara H, Birt C, Hardy A, Dennis R, Butcher D, O'Sullivan S, Pope A, Elhanash S, Preston S, Officer H, Stoker A, Moss S, Walker A, Gipson A, Melville J, Bradley‐Potts J, McCormac R, Benson V, Melia K, Fielding J, Guest W, Ford S, Murdoch H, Beames S, Townshend P, Collins K, Glass J, Cartwright B, Altemimi B, Berresford L, Jones C, Kelliher L, de Silva S, Blightman K, Pendry K, Pinto L, Allard S, Taylor L, Chishti A, Scott J, O'Hare D, Lewis M, Hussain Z, Hallett K, Dermody S, Corbett C, Morby L, Hough M, Williams S, Williams P, Horton S, Ashcroft P, Homer A, Lang A, Dawson H, Harrison E, Thompson J, Hariharan V, Goss V, Ravi R, Butt G, Vertue M, Acheson A, Ng O, Bush D, Dickson E, Ward A, Morris S, Taylor A, Casey R, Wilson L, Vimalachandran D, Faulkner M, Jeffrey H, Gabrielle C, Martin S, Bracewell A, Ritzema J, Sproates D, Alexander‐Sefre F, Kubitzek C, Humphreys S, Curtis J, Oats P, Swann S, Holden A, Adam C, Flintoff L, Paoloni C, Bobruk K. The association between iron deficiency and outcomes: a secondary analysis of the intravenous iron therapy to treat iron deficiency anaemia in patients undergoing major abdominal surgery (PREVENTT) trial. Anaesthesia 2023; 78:320-329. [PMID: 36477695 PMCID: PMC10107684 DOI: 10.1111/anae.15926] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2022] [Indexed: 12/13/2022]
Abstract
In the intravenous iron therapy to treat iron deficiency anaemia in patients undergoing major abdominal surgery (PREVENTT) trial, the use of intravenous iron did not reduce the need for blood transfusion or reduce patient complications or length of hospital stay. As part of the trial protocol, serum was collected at randomisation and on the day of surgery. These samples were analysed in a central laboratory for markers of iron deficiency. We performed a secondary analysis to explore the potential interactions between pre-operative markers of iron deficiency and intervention status on the trial outcome measures. Absolute iron deficiency was defined as ferritin <30 μg.l-1 ; functional iron deficiency as ferritin 30-100 μg.l-1 or transferrin saturation < 20%; and the remainder as non-iron deficient. Interactions were estimated using generalised linear models that included different subgroup indicators of baseline iron status. Co-primary endpoints were blood transfusion or death and number of blood transfusions, from randomisation to 30 days postoperatively. Secondary endpoints included peri-operative change in haemoglobin, postoperative complications and length of hospital stay. Most patients had iron deficiency (369/452 [82%]) at randomisation; one-third had absolute iron deficiency (144/452 [32%]) and half had functional iron deficiency (225/452 [50%]). The change in pre-operative haemoglobin with intravenous iron compared with placebo was greatest in patients with absolute iron deficiency, mean difference 8.9 g.l-1 , 95%CI 5.3-12.5; moderate in functional iron deficiency, mean difference 2.8 g.l-1 , 95%CI -0.1 to 5.7; and with little change seen in those patients who were non-iron deficient. Subgroup analyses did not suggest that intravenous iron compared with placebo reduced the likelihood of death or blood transfusion at 30 days differentially across subgroups according to baseline ferritin (p = 0.33 for interaction), transferrin saturation (p = 0.13) or in combination (p = 0.45), or for the number of blood transfusions (p = 0.06, 0.29, and 0.39, respectively). There was no beneficial effect of the use of intravenous iron compared with placebo, regardless of the metrics to diagnose iron deficiency, on postoperative complications or length of hospital stay.
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Affiliation(s)
- T Richards
- Division of Surgery, University of Western Australia, Perkins South Building, Fiona Stanley Hospital, Murdoch, Perth, WA, Australia.,Institute of Clinical Trials and Methodology and Division of Surgery, University College London, UK
| | - L F Miles
- Department of Critical Care, Melbourne Medical School, The University of Melbourne, VIC, Australia.,Department of Anaesthesia, Austin Health, Melbourne, VIC, Australia
| | - B Clevenger
- Department of Anaesthesia, Royal National Orthopaedic Hospital, Stanmore, UK
| | - A Keegan
- Department of Haematology, PathWest Laboratory Medicine, King Edward Memorial Hospital, Subiaco, WA, Australia
| | - S Abeysiri
- Division of Surgery, University of Western Australia, Perkins South Building, Fiona Stanley Hospital, Murdoch, Perth, WA, Australia
| | - R Rao Baikady
- Department of Anaesthesia, The Royal Marsden NHS Foundation Trust, London, UK
| | - M W Besser
- Department of Haematology, Addenbrooke's Hospital, Cambridge, UK
| | - J P Browne
- School of Public Health, University College Cork, Ireland
| | - A A Klein
- Department of Anaesthesia and Intensive Care, Royal Papworth Hospital, Cambridge, UK
| | - I C Macdougall
- Department of Renal Medicine, King's College Hospital, London, UK
| | - G J Murphy
- Department of Cardiovascular Sciences, University of Leicester, UK
| | - S D Anker
- Department of Cardiology, Berlin Institute of Health Centre for Regenerative Therapies; German Centre for Cardiovascular Research partner site Berlin; Charité Universitätsmedizin Berlin, Germany
| | - D Dahly
- School of Public Health, University College Cork, Ireland.,Health Research Board Clinical Research Facility, University College Cork, Ireland
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Arora N, Dennis A, Willson J, Norrie J, Tunstall M. Delivery of oxygen by standard oxygen flowmeters. Anaesthesia 2021; 76:1546-1547. [PMID: 34309005 PMCID: PMC8444714 DOI: 10.1111/anae.15548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- N Arora
- University Hospitals Birmingham, Birmingham, UK
| | - A Dennis
- University Hospitals Birmingham, Birmingham, UK
| | - J Willson
- University Hospitals Birmingham, Birmingham, UK
| | - J Norrie
- University Hospitals Birmingham, Birmingham, UK
| | - M Tunstall
- University Hospitals Birmingham, Birmingham, UK
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Leo CA, Cavazzoni E, Leeuwenburgh MMN, Thomas GP, Dennis A, Bassett P, Hodgkinson JD, Warusavitarne J, Murphy J, Vaizey CJ. Comparison between high-resolution water-perfused anorectal manometry and THD ® Anopress anal manometry: a prospective observational study. Colorectal Dis 2020; 22:923-930. [PMID: 31994307 PMCID: PMC7496679 DOI: 10.1111/codi.14992] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 12/18/2019] [Accepted: 01/22/2020] [Indexed: 12/13/2022]
Abstract
AIM Anorectal physiology tests provide a functional assessment of the anal canal. The aim of this study was to compare the results generated by standard high-resolution water-perfused manometry (WPM) with the newer THD® Anopress manometry system. METHOD This was a prospective observational study. Conventional manometry was carried out using a water-perfused catheter with high-resolution manometry and compared with the Anopress system with air-filled catheters. All patients underwent the two procedures successively in a randomized order. Time to arrive at the resting pressure plateau, resting, squeeze, straining pressure and visual analogue scale (VAS) scores for pain were recorded. A qualitative analysis of the two devices was performed. RESULTS Between 2016 and 2017, 60 patients were recruited. The time from insertion of the catheter to arriving at the resting pressure plateau was significantly lower with the Anopress compared with WPM: 12 s [interquartile range (IQR) 10-17 s] versus 100 s (IQR 67-121 s) (P < 0.001). A strong correlation between the manometric values of WPM and the Anopress was observed. Both procedures were well tolerated, although the VAS score for insertion of the WPM catheter was significantly higher. The Anopress was easier to use and more time-efficient than the WPM. CONCLUSION The pressure values obtained with Anopress correlated well with those of conventional manometry. The Anopress has the advantage of being less time-consuming, user-friendly and better tolerated by patients.
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Affiliation(s)
- C. A. Leo
- Sir Alan Park’s Physiology UnitSt Mark’s Hospital Academic InstituteHarrowUK,Imperial College of LondonLondonUK,The Royal London HospitalLondonUK
| | - E. Cavazzoni
- Santa Maria della Misericordia HospitalUniversità degli Studi di PerugiaPerugiaItaly
| | | | - G. P. Thomas
- Sir Alan Park’s Physiology UnitSt Mark’s Hospital Academic InstituteHarrowUK
| | - A. Dennis
- Sir Alan Park’s Physiology UnitSt Mark’s Hospital Academic InstituteHarrowUK
| | | | - J. D. Hodgkinson
- Sir Alan Park’s Physiology UnitSt Mark’s Hospital Academic InstituteHarrowUK,Imperial College of LondonLondonUK
| | - J. Warusavitarne
- Sir Alan Park’s Physiology UnitSt Mark’s Hospital Academic InstituteHarrowUK
| | | | - C. J. Vaizey
- Sir Alan Park’s Physiology UnitSt Mark’s Hospital Academic InstituteHarrowUK
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Basaric B, Robar J, Orbovic R, Dennis A, Majcher C. EP-1891 A new hotspot correction algorithm in Modulated Electron Radiation Therapy utilizing 3D printed boli. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)32311-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Ewa I, Ewa I, DeFina R, Maeve O, Dennis A. Medical Education in the Long-Term Care Setting: Exploring Residents’ Experience of Learning in This Environment. J Am Med Dir Assoc 2019. [DOI: 10.1016/j.jamda.2019.01.106] [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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Myles PS, Myles DB, Galagher W, Boyd D, Chew C, MacDonald N, Dennis A. Measuring acute postoperative pain using the visual analog scale: the minimal clinically important difference and patient acceptable symptom state. Br J Anaesth 2018; 118:424-429. [PMID: 28186223 DOI: 10.1093/bja/aew466] [Citation(s) in RCA: 427] [Impact Index Per Article: 71.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2016] [Indexed: 12/16/2022] Open
Abstract
Background The 100 mm visual analog scale (VAS) score is widely used to measure pain intensity after surgery. Despite this widespread use, it is unclear what constitutes the minimal clinically important difference (MCID); that is, what minimal change in score would indicate a meaningful change in a patient's pain status. Methods We enrolled a sequential, unselected cohort of patients recovering from surgery and used a VAS to quantify pain intensity. We compared changes in the VAS with a global rating-of-change questionnaire using an anchor-based method and three distribution-based methods (0.3 sd , standard error of the measurement, and 5% range). We then averaged the change estimates to determine the MCID for the pain VAS. The patient acceptable symptom state (PASS) was defined as the 25th centile of the VAS corresponding to a positive patient response to having made a good recovery from surgery. Results We enrolled 224 patients at the first postoperative visit, and 219 of these were available for a second interview. The VAS scores improved significantly between the first two interviews. Triangulation of distribution and anchor-based methods resulted in an MCID of 9.9 for the pain VAS, and a PASS of 33. Conclusions Analgesic interventions that provide a change of 10 for the 100 mm pain VAS signify a clinically important improvement or deterioration, and a VAS of 33 or less signifies acceptable pain control (i.e. a responder), after surgery.
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Affiliation(s)
- P S Myles
- Department of Anaesthesia and Perioperative Medicine, Alfred Hospital and Monash University, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - D B Myles
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - W Galagher
- Department of Anaesthesia and Perioperative Medicine, Alfred Hospital and Monash University, Melbourne, Victoria, Australia
| | - D Boyd
- Department of Anaesthesia and Perioperative Medicine, Alfred Hospital and Monash University, Melbourne, Victoria, Australia
| | - C Chew
- Department of Anaesthesia and Perioperative Medicine, Alfred Hospital and Monash University, Melbourne, Victoria, Australia
| | - N MacDonald
- Department of Anaesthesia, Royal Women's Hospital, Parkville, Victoria, Australia
| | - A Dennis
- Department of Anaesthesia, Royal Women's Hospital, Parkville, Victoria, Australia
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Meester D, Al-Yahya E, Dennis A, Collett J, Wade DT, Ovington M, Liu F, Meaney A, Cockburn J, Johansen-Berg H, Dawes H. A randomized controlled trial of a walking training with simultaneous cognitive demand (dual-task) in chronic stroke. Eur J Neurol 2018; 26:435-441. [PMID: 30308699 DOI: 10.1111/ene.13833] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 10/04/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE The aim was to evaluate the tolerability of, adherence to and efficacy of a community walking training programme with simultaneous cognitive demand (dual-task) compared to a control walking training programme without cognitive distraction. METHODS Adult stroke survivors at least 6 months after stroke with a visibly obvious gait abnormality or reduced 2-min walk distance were included in a two-arm parallel randomized controlled trial of complex intervention with blinded assessments. Participants received a 10 week, bi-weekly, 30 min treadmill programme at an aerobic training intensity (55%-85% heart rate maximum), either with or without simultaneous cognitive demands. Outcome was measured at 0, 11 and 22 weeks. The primary assessment involved 2-min walk tests with and without cognitive distraction to investigate the dual-task effect on walking and cognition; secondary results were the Short Form Health Survey 36, EuroQol-5D-5L, the Physical Activity Scale for the Elderly (PASE) and step activity. RESULTS Fifty stroke patients were included; 43 received allocated training and 45 completed all assessments. The experimental group (n = 26) increased their mean (SD) 2-min walking distance from 90.7 (8.2) to 103.5 (8.2) m, compared with 86.7 (8.5) to 92.8 (8.6) m in the control group, and their PASE score from 74.3 (9.1) to 89.9 (9.4), compared with 94.7 (9.4) to 77.3 (9.9) in the control group. Statistically, only the change in the PASE differed between the groups (P = 0.029), with the dual-task group improving more. There were no differences in other measures. CONCLUSIONS Walking with specific additional cognitive distraction (dual-task training) might increase activity more over 12 weeks, but the data are not conclusive.
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Affiliation(s)
- D Meester
- Movement Science Group, School of Life Sciences, Oxford Brookes University, Oxford, UK
| | - E Al-Yahya
- Movement Science Group, School of Life Sciences, Oxford Brookes University, Oxford, UK.,Department of Physiotherapy, Faculty of Rehabilitation Sciences, University of Jordan, Amman, Jordan
| | - A Dennis
- Nuffield Department of Clinical Neurosciences, Oxford Centre for Functional Magnetic Resonance Imaging of the Brain (FMRIB Centre), University of Oxford, Oxford, UK
| | - J Collett
- Movement Science Group, School of Life Sciences, Oxford Brookes University, Oxford, UK
| | - D T Wade
- Movement Science Group, School of Life Sciences, Oxford Brookes University, Oxford, UK.,UK Oxford Centre for Enablement, Oxford University Hospital NHS Trust, Oxford, UK
| | - M Ovington
- Movement Science Group, School of Life Sciences, Oxford Brookes University, Oxford, UK
| | - F Liu
- Movement Science Group, School of Life Sciences, Oxford Brookes University, Oxford, UK
| | - A Meaney
- Movement Science Group, School of Life Sciences, Oxford Brookes University, Oxford, UK
| | | | - H Johansen-Berg
- Nuffield Department of Clinical Neurosciences, Oxford Centre for Functional Magnetic Resonance Imaging of the Brain (FMRIB Centre), University of Oxford, Oxford, UK
| | - H Dawes
- Movement Science Group, School of Life Sciences, Oxford Brookes University, Oxford, UK
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Steventon JJ, Collett J, Furby H, Hamana K, Foster C, O'Callaghan P, Dennis A, Armstrong R, Németh AH, Rosser AE, Murphy K, Quinn L, Busse M, Dawes H. Alterations in the metabolic and cardiorespiratory response to exercise in Huntington's Disease. Parkinsonism Relat Disord 2018; 54:56-61. [PMID: 29705557 DOI: 10.1016/j.parkreldis.2018.04.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 04/04/2018] [Accepted: 04/12/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND Limited data suggests that an altered metabolic and cardiorespiratory exercise response may affect exercise performance in individuals with Huntington's disease (HD). There is no clear exploration of the response in individuals at different stages of the disease or in relation to genetic markers. This study aimed to examine the exercise response and recovery of HD participants, and the relationship to genetic and clinical markers. METHOD HD gene-positive participants (n = 31; 9 pre-manifest; 22 manifest HD) and a healthy control group (n = 29) performed an incremental exercise test until exhaustion. Performance, cardiorespiratory, metabolic and perceptual responses to exercise were determined from a maximal cycle ergometer test throughout the exercise test and during a recovery period. RESULTS During sub-maximal exercise, metabolic (lactate levels, oxygen uptake) and cardiorespiratory markers (heart rate) were elevated in HD participants compared to controls. Lactate elevation was specific to pre-manifest HD participants. Work capacity was reduced in both pre-manifest and manifest HD participants with tests terminated with no difference in metabolic, perceptual or cardiorespiratory markers. Submaximal oxygen uptake was correlated with motor score, whilst peak measures were unrelated to genetic or clinical markers. Heart rate recovery was attenuated in pre-manifest and manifest HD participants. CONCLUSIONS Our findings confirm metabolic and cardiorespiratory deficits reduce exercise performance and affect recovery from an early stage in HD, with submaximal deficits related to phenotypic expression. Exercise capacity appears to be limited by an altered movement economy, thus clinicians should consider an altered exercise response and recovery may affect prescription in HD.
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Affiliation(s)
- J J Steventon
- School of Physics and Astronomy, Cardiff University, UK; NMHRI, School of Medicine, Cardiff University, UK; CUBRIC, School of Psychology, Cardiff University, UK.
| | - J Collett
- Centre for Movement, Occupation and Rehabilitation Sciences, OxINMAHR, Oxford Brookes University, Oxford, UK; Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - H Furby
- NMHRI, School of Medicine, Cardiff University, UK; CUBRIC, School of Psychology, Cardiff University, UK
| | - K Hamana
- School of Healthcare Sciences, Cardiff University, UK
| | - C Foster
- CUBRIC, School of Psychology, Cardiff University, UK
| | - P O'Callaghan
- Cardiology Department, University Hospital of Wales, Cardiff, UK
| | - A Dennis
- FMRIB Centre, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, OX3 9DU, UK
| | - R Armstrong
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - A H Németh
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - A E Rosser
- IPMCN, School of Medicine, Cardiff University, UK
| | - K Murphy
- School of Physics and Astronomy, Cardiff University, UK; CUBRIC, School of Psychology, Cardiff University, UK
| | - L Quinn
- Department of Biobehavioral Sciences, Teachers College, Columbia University, USA
| | - M Busse
- Centre for Trials Research, Cardiff University, UK
| | - H Dawes
- Centre for Movement, Occupation and Rehabilitation Sciences, OxINMAHR, Oxford Brookes University, Oxford, UK; Department of Clinical Neurology, University of Oxford, Oxford, UK
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Affiliation(s)
- H Abdulameer
- Florida Atlantic University, Boca Raton, FL; Midwestern University, Downers Grove, IL; Cook County Hospital and Health System, Chicago, IL
| | - J Swartzendruber
- Florida Atlantic University, Boca Raton, FL; Midwestern University, Downers Grove, IL; Cook County Hospital and Health System, Chicago, IL
| | - A Dennis
- Florida Atlantic University, Boca Raton, FL; Midwestern University, Downers Grove, IL; Cook County Hospital and Health System, Chicago, IL
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Mizzi D, Zarb F, Dennis A. A retrospective audit of the first screening round of the Maltese breast screening programme. Radiography (Lond) 2017; 23:60-66. [DOI: 10.1016/j.radi.2016.09.008] [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] [Received: 02/12/2016] [Revised: 09/23/2016] [Accepted: 09/26/2016] [Indexed: 11/15/2022]
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Meadows J, Gutierrez H, Hannum CPS, Douglas-Durham E, Blanchard K, Dennis A. Mixed-methods study of women's experiences with second-trimester abortion care. Contraception 2016. [DOI: 10.1016/j.contraception.2016.07.162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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13
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Burns B, Dennis A, Douglas-Durham E. Comparison of state regulations for abortion with those for other health procedures. Contraception 2015. [DOI: 10.1016/j.contraception.2015.06.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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14
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Rutstein SE, Pettifor A, Phiri S, Pasquale D, Dennis A, Hosseinipour M, Kamanga G, Nsona D, Hoffman I, Miller WC. LB1.2 Pilot study of immediate antiretrovirals and behavioural intervention for persons with acute hiv infection: opportunity for interrupting transmission. Br J Vener Dis 2015. [DOI: 10.1136/sextrans-2015-052270.207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Egan R, Philippe M, Wera L, Fagnard JF, Vanderheyden B, Dennis A, Shi Y, Cardwell DA, Vanderbemden P. A flux extraction device to measure the magnetic moment of large samples; application to bulk superconductors. Rev Sci Instrum 2015; 86:025107. [PMID: 25725888 DOI: 10.1063/1.4907903] [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] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
We report the design and construction of a flux extraction device to measure the DC magnetic moment of large samples (i.e., several cm(3)) at cryogenic temperature. The signal is constructed by integrating the electromotive force generated by two coils wound in series-opposition that move around the sample. We show that an octupole expansion of the magnetic vector potential can be used conveniently to treat near-field effects for this geometrical configuration. The resulting expansion is tested for the case of a large, permanently magnetized, type-II superconducting sample. The dimensions of the sensing coils are determined in such a way that the measurement is influenced by the dipole magnetic moment of the sample and not by moments of higher order, within user-determined upper bounds. The device, which is able to measure magnetic moments in excess of 1 A m(2) (1000 emu), is validated by (i) a direct calibration experiment using a small coil driven by a known current and (ii) by comparison with the results of numerical calculations obtained previously using a flux measurement technique. The sensitivity of the device is demonstrated by the measurement of flux-creep relaxation of the magnetization in a large bulk superconductor sample at liquid nitrogen temperature (77 K).
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Affiliation(s)
- R Egan
- SUPRATECS and Department of Electrical Engineering and Computer Science B28, Sart-Tilman, B-4000 Liège, Belgium
| | - M Philippe
- SUPRATECS and Department of Electrical Engineering and Computer Science B28, Sart-Tilman, B-4000 Liège, Belgium
| | - L Wera
- SUPRATECS and Department of Electrical Engineering and Computer Science B28, Sart-Tilman, B-4000 Liège, Belgium
| | - J F Fagnard
- SUPRATECS and Department of Electrical Engineering and Computer Science B28, Sart-Tilman, B-4000 Liège, Belgium
| | - B Vanderheyden
- SUPRATECS and Department of Electrical Engineering and Computer Science B28, Sart-Tilman, B-4000 Liège, Belgium
| | - A Dennis
- Bulk Superconductivity Group, Engineering Department, Cambridge University, Cambridge CB2 1PZ, United Kingdom
| | - Y Shi
- Bulk Superconductivity Group, Engineering Department, Cambridge University, Cambridge CB2 1PZ, United Kingdom
| | - D A Cardwell
- Bulk Superconductivity Group, Engineering Department, Cambridge University, Cambridge CB2 1PZ, United Kingdom
| | - P Vanderbemden
- SUPRATECS and Department of Electrical Engineering and Computer Science B28, Sart-Tilman, B-4000 Liège, Belgium
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Fuentes L, Dennis A, Douglas-Durham E, Grossman D. Exploring best practices for transitioning to outpatient miscarriage management. Contraception 2014. [DOI: 10.1016/j.contraception.2014.05.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Manski R, Dennis A. Perceptions of pregnancy and parenting among female teens with epilepsy. Contraception 2014. [DOI: 10.1016/j.contraception.2014.05.171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Chu PH, Dennis A, Fu CB, Gao H, Khatiwada R, Laskaris G, Li K, Smith E, Snow WM, Yan H, Zheng W. Searches for possible T-odd and P-odd short range interactions using polarized nuclei. EPJ Web of Conferences 2014. [DOI: 10.1051/epjconf/20146605003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Nickerson A, Manski R, Dennis A. A qualitative investigation of low-income abortion clients' attitudes toward public funding for abortion. Contraception 2012. [DOI: 10.1016/j.contraception.2012.05.025] [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: 11/16/2022]
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22
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Dennis A. Challenges implementing informed contraceptive decisions for women with epilepsy: a qualitative investigation. Contraception 2012. [DOI: 10.1016/j.contraception.2012.05.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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McCarthy T, Telec N, Dennis A, Griffiths J, Buettner A. Ability of non-invasive intermittent blood pressure monitoring and a continuous non-invasive arterial pressure monitor (CNAP™) to provide new readings in each 1-min interval during elective caesarean section under spinal anaesthesia. Anaesthesia 2012; 67:274-9. [PMID: 22321084 DOI: 10.1111/j.1365-2044.2011.06996.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We compared the ability of automated non-invasive intermittent oscillometric blood pressure monitoring with a new device, CNAP(TM) (continuous non-invasive arterial pressure) to provide a new blood pressure reading in each 1-min interval between spinal anaesthesia and delivery during caesarean section. We also compared the accuracy of continuous non-invasive arterial pressure readings with non-invasive blood pressure measurements before spinal anaesthesia. Fifty-nine women participated. The non-invasive and continuous non-invasive monitors displayed new blood pressure readings in a mean of 82% (11%) and 83% (13%) (p = 0.97) of the one-minute intervals between spinal anaesthesia and delivery, respectively. Continuous non-invasive arterial pressure was more likely to fail on two or more consecutive minutes (p=0.001). From the pre-spinal readings, the mean bias, defined as non-invasive-continuous non-invasive arterial pressure, and limits of agreement (±2SD mean bias) for systolic, diastolic and mean blood pressure respectively were +1.3 (±26.0), -2.9 (±21.8) and +2.6 (±20.4) mmHg. The new monitor has disadvantages compared with conventional non-invasive intermittent blood pressure monitoring.
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Affiliation(s)
- T McCarthy
- Department of Anaesthesia, The Royal Women's Hospital, Melbourne, Australia.
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Dennis A, Blanchard K, Córdova D, Clark J, Wahlin B, McIntosh J, Tsikitas L, Edlund K. Beyond stopping Stupak: emerging challenges to abortion access under health care reform. Contraception 2011. [DOI: 10.1016/j.contraception.2011.05.042] [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: 11/15/2022]
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25
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Dennis A, Manski R, Blanchard K. Barriers to timely access to abortion: opportunities for immediate improvements while working for systemic change. Contraception 2011. [DOI: 10.1016/j.contraception.2011.05.040] [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: 10/17/2022]
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Khalafallah A, Dennis A, Bates J, Bates G, Robertson IK, Smith L, Ball MJ, Seaton D, Brain T, Rasko JEJ. A prospective randomized, controlled trial of intravenous versus oral iron for moderate iron deficiency anaemia of pregnancy. J Intern Med 2010; 268:286-95. [PMID: 20546462 DOI: 10.1111/j.1365-2796.2010.02251.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [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: 11/29/2022]
Abstract
BACKGROUND Iron deficiency anaemia is the most common deficiency disorder in the world, affecting more than one billion people, with pregnant women at particular risk. OBJECTIVES AND DESIGN We conducted a single site, prospective, nonblinded randomized-controlled trial to compare the efficacy, safety, tolerability and compliance of standard oral daily iron versus intravenous iron. SUBJECTS We prospectively screened 2654 pregnant women between March 2007 and January 2009 with a full blood count and iron studies, of which 461 (18%) had moderate IDA. Two hundred women matched for haemoglobin concentration and serum ferritin level were recruited. INTERVENTIONS Patients were randomized to daily oral ferrous sulphate 250 mg (elemental iron 80 mg) with or without a single intravenous iron polymaltose infusion. RESULTS Prior to delivery, the intravenous plus oral iron arm was superior to the oral iron only arm as measured by the increase in haemoglobin level (mean of 19.5 g/L vs. 12 g/L; P < 0.001); the increase in mean serum ferritin level (222 microg/L vs. 18 ug/L; P < 0.001); and the percentage of mothers with ferritin levels below 30 microg/L (4.5% vs. 79%; P < 0.001). A single dose of intravenous iron polymaltose was well tolerated without significant side effects. CONCLUSIONS Our data indicate that intravenous iron polymaltose is safe and leads to improved efficacy and iron stores compared to oral iron alone in pregnancy-related IDA.
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Affiliation(s)
- A Khalafallah
- Launceston General Hospital (LGH), University of Tasmania, Tasmania, Australia.
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Dennis A, Blanchard K. “Are we even speaking the same language?”: contested definitions of rape, incest and life endangerment under the Hyde Amendment. Contraception 2010. [DOI: 10.1016/j.contraception.2010.04.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Abstract
Hypotensive resuscitation in the trauma setting can be defined as deliberately allowing blood pressure to remain below normal until any active bleeding has been controlled. The dangers of aggressive fluid resuscitation in trauma were recognised as long ago as the First World War, in the intervening time, aggressive fluid resuscitation has become a mainstay of trauma management. More recently this trend of aggressive fluid resuscitation for trauma management seems to be reversing. Aggressive fluid resuscitation in trauma is based on animal studies from the 1950s and 1960s. These studies used models of controlled haemorrhage rather than uncontrolled haemorrhage. More recent studies using models of uncontrolled haemorrhage suggest an improved outcome with hypotensive resuscitation. Should there be a potential for uncontrolled haemorrhage a permissive hypotensive resuscitation strategy should be pursued until the haemorrhage has been controlled, but in certain types of trauma including blunt trauma and brain trauma the data is unclear as to the best fluid resuscitation strategy.
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Affiliation(s)
- J. Geoghegan
- Anaesthetics, University Hospital Birmingham, NHS Foundation Trust, Edgbaston, Birmingham, UK
| | - A. Dennis
- Anaesthetics, University Hospital Birmingham, NHS Foundation Trust, Edgbaston, Birmingham, UK
| | - M. Manji
- University Hospital Birmingham, NHS Foundation Trust, Edgbaston, Birmingham, UK,
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Abstract
Hereditary haemorrhagic telangiectasia is a genetic condition which results in arteriovenous malformations involving the skin, mucous membranes, lung, brain, gastrointestinal tract, liver and spinal canal. The shunting of blood through arteriovenous malformations, especially in the liver,; leads to maldistribution of cardiac output. In order to supply blood to vital organs, cardiac output is increased through vasodilation, elevated stroke volume and elevated heart rate. Pregnancy can worsen the effects of the arteriovenous malformations. We present the peripartum management of a woman with hereditary haemorrhagic telangiectasia predominantly involving the liver that resulted in high output cardiac failure during two consecutive pregnancies.
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Affiliation(s)
- C F Lai
- Department of Anaesthesia, Austin Health, Heidelberg, Victoria, Australia.
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Dennis A, Arhanghelschi I, Simmons S, Royse C. Prospective observational study of serial cardiac output by transthoracic echocardiography in healthy pregnant women undergoing elective caesarean delivery. Int J Obstet Anesth 2010; 19:142-8. [DOI: 10.1016/j.ijoa.2009.06.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2009] [Revised: 04/28/2009] [Accepted: 06/25/2009] [Indexed: 11/15/2022]
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Dennis A, Walker S, Drinkwater P, Crowhurst J. Intravenous labetalol is available in Australia. Anaesth Intensive Care 2010; 38:397. [PMID: 20369784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Abstract
The clinical picture in severe cases of pandemic (H1N1) 2009 influenza is markedly different from the disease pattern seen during epidemics of seasonal influenza, in that many of those affected were previously healthy young people. Current predictions estimate that, during a pandemic wave, 12-30% of the population will develop clinical influenza (compared with 5-15% for seasonal influenza) with 4% of those patients requiring hospital admissions and one in five requiring critical care. This review covers the background, clinical presentation, diagnosis, and treatment. The role of immunization and antiviral drugs is discussed. Experience from the first wave of pandemic (H1N1) 2009 influenza suggests that a number of infected patients become critically ill and require intensive care admission. These patients rapidly develop severe progressive respiratory failure which is often associated with failure of other organs, or marked worsening of underlying airways disease. The critical care management of these patients and the implications for resources is reviewed. Guidance from a range of bodies has been produced in a relatively short period of time in response to pandemic (H1N1) 2009 influenza. Disease severity has the potential to change, especially if there is virus mutation. Clinicians must be prepared for the unexpected and continue to share their experiences to maximize patient outcomes.
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Affiliation(s)
- M Patel
- Department of Anaesthesia and Critical Care City Hospital, Sandwell and West Birmingham NHS Trust, Dudley Road, Birmingham B18 7QH, UK
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Patel M, Dennis A, Flutter C, Thornton S, D’Mello O, Sherwood N. Pandemic (H1N1) 2009 influenza: experience from the critical care unit. Anaesthesia 2009; 64:1241-5. [DOI: 10.1111/j.1365-2044.2009.06128.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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35
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Dennis A, Blanchard K, Cordova D, Wahlin B. Impact of mandatory insurance coverage on family planning providers in Massachusetts. Contraception 2009. [DOI: 10.1016/j.contraception.2009.05.018] [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: 10/20/2022]
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Abstract
Placebo respiratory devices, such as inhalers, large volume spacers and peak flow meters provide reli able methods of teaching patients effective drug able methods of teaching patients effective drug delivery techniques and monitoring compliance and treatment progress. Concern has been raised that using such demonstration devices on more than one person may expose patients to the risk of cross-infection with pathogenic organisms. The lack of regulation and guidance on the use and decontamination of placebo devices prompted us to complete a risk assessment, examining the likelihood and consequence of acquisition of pathogens and resultant illness in our respiratory patient group.
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Affiliation(s)
- M. Richardson
- Portsmouth Hospitals NHS Trust, Queen Alexandra Hospital, Cosham, Hampshire PO6 3LY UK.4
| | - S. Wyllie
- Microbiology Department, Portsmouth Hospitals NHS Trust
| | - A. Dennis
- Children's Outpatients Department, Portsmouth Hospitals NHS Trust
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Valentino D, Walter R, Dennis A, Margeta B, Nagy K, Winners J, Bokhari F, Wiley D, Joseph K, Roberts R. TASER Discharges Capture Cardiac Rhythm in a Swine Model. Acad Emerg Med 2007. [DOI: 10.1197/j.aem.2007.03.992] [Citation(s) in RCA: 2] [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: 11/10/2022]
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Valentino D, Walter R, Nagy K, Dennis A, Winners J, Bokhari F, Wiley D, Joseph K, Roberts R. Repeated Thoracic Discharges from a Stun Device. Acad Emerg Med 2007. [DOI: 10.1197/j.aem.2007.03.1097] [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: 11/10/2022]
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Drotleff S, Lungwitz U, Breunig M, Dennis A, Blunk T, Tessmar J, Göpferich A. Biomimetic polymers in pharmaceutical and biomedical sciences. Eur J Pharm Biopharm 2004; 58:385-407. [PMID: 15296963 DOI: 10.1016/j.ejpb.2004.03.018] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2004] [Accepted: 03/05/2004] [Indexed: 10/26/2022]
Abstract
This review describes recent developments in the emerging field of biomimetic polymeric biomaterials, which signal to cells via biologically active entities. The described biological effects are, in contrast to many other known interactions, receptor mediated and therefore very specific for certain cell types. As an introduction into this field, first some biological principles are illustrated such as cell attachment, cytokine signaling and endocytosis, which are some of the mechanisms used to control cells with biomimetic polymers. The next topics are then the basic design rules for the creation of biomimetic materials. Here, the major emphasis is on polymers that are assembled in separate building blocks, meaning that the biologically active entity is attached to the polymer in a separate chemical reaction. In that respect, first individual chemical standard reactions that may be used for this step are briefly reviewed. In the following chapter, the emphasis is on polymer types that have been used for the development of several biomimetic materials. There is, thereby, a delineation made between materials that are processed to devices exceeding cellular dimensions and materials predominantly used for the assembly of nanostructures. Finally, we give a few current examples for applications in which biomimetic polymers have been applied to achieve a better biomaterial performance.
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Affiliation(s)
- S Drotleff
- Department of Pharmaceutical Technology, University of Regensburg, Regensburg, Germany
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Bakhru A, Padovan G, Dauria D, Dennis A, Schiffhauer L, Ahrendt G. Reporting of pathologic factors influencing local recurrence in ductal carcinoma in situ and invasive mammary carcinoma. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.9581] [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: 11/20/2022] Open
Affiliation(s)
- A. Bakhru
- University of Rochester, Rochester, NY
| | | | - D. Dauria
- University of Rochester, Rochester, NY
| | - A. Dennis
- University of Rochester, Rochester, NY
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Abstract
AIMS OF THE STUDY The aim of this research was to find out who supports older people at home after discharge from hospital and if sources of support have changed between the 1980s and the 1990s. BACKGROUND More and more older people are being discharged from hospital earlier and this creates additional pressures on families, community health and social services and the independent care sector. The research was concerned with how sources of support may have changed in a 10-year period. METHODS A comparison is made of two separate nonrandom samples, taken 10 years apart, of older people following discharge from hospital. Interviews were conducted in participants' homes to establish levels of dependence and the source of support given in response to the need for help with personal and domestic activities of daily living. RESULTS Although limited by the use of relatively small, nonrandom samples, the research found that proportions needing help with domestic activities were higher than those needing help with personal activities of daily living. Although dependence for help with bathing had declined between the 1980s and 1990s, help was still needed with bathing and dressing. Unmet need for help with bathing remained a problem in the 1990s. A growing role for home helps was identified, especially in personal care (bathing and dressing), where support from district nurses had declined. By the 1990s, home helps were doing less cooking and housework, including heavy laundry. Relatives were doing more of most domestic activities except shopping, which was being carried out by home helps. CONCLUSIONS The paper concludes by arguing that hospitals should consider if pressures to discharge older people more quickly might hinder the discharge planning process and communication between hospital and community sectors.
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Affiliation(s)
- K Waters
- School of Nursing, Midwifery and Health Visiting, University of Manchester, UK
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Abstract
BACKGROUND The congenital long-QT syndrome (LQTS) is a genetically heterogeneous disease characterized by prolonged ventricular repolarization and life-threatening arrhythmias. Mutations of the KVLQT1 gene, a cardiac potassium channel, generate two allelic diseases: the Romano-Ward syndrome, inherited as a dominant trait, and the Jervell and Lange-Nielsen syndrome, inherited as an autosomal recessive trait. METHODS AND RESULTS A consanguineous family with the clinical phenotype of LQTS was screened for mutations in the KVLQT1 gene. Complementary RNAs for injection into Xenopus oocytes were prepared, and currents were recorded with the double microelectrode technique. A homozygous missense mutation, leading to an alanine-to-threonine substitution at the beginning of the pore domain of the KVLQT1 channel, was found in the proband, a 9-year-old boy with normal hearing, a prolonged QT interval, and syncopal episodes during physical exercise. The parents of the proband were heterozygous for the mutation and had a normal QT interval. The functional evaluation of the mutant channel activity showed reduction in total current, a hyperpolarizing shift in activation, and a faster activation rate consistent with a mild mutation likely to require homozygosity to manifest the phenotype. CONCLUSIONS These findings provide the first evidence for a recessive form of the Romano-Ward long-QT syndrome and indicate that homozygous mutations on KVLQT1 do not invariably produce the Jervell and Lange-Nielsen syndrome. The implications of this observation prompt a reconsideration of the penetrance of different mutations responsible for LQTS and suggest that mild mutations in LQTS genes may be present among the general population and may predispose to drug-induced ventricular arrhythmias.
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Affiliation(s)
- S G Priori
- Telethon Institute of Genetics and Medicine, San Raffaele Biomedical Science Park, Milan, Italy
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D'Emanuele A, Dennis A, McCann D, Muir I. The imaging of a controlled-release pellet formulation using scanning electron microscopy--potential for artefact generation. Pharm Dev Technol 1998; 3:135-9. [PMID: 9532609 DOI: 10.3109/10837459809028488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- A D'Emanuele
- School of Pharmacy and Pharmaceutical Sciences, University of Manchester, UK.
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Rampe D, Roy ML, Dennis A, Brown AM. A mechanism for the proarrhythmic effects of cisapride (Propulsid): high affinity blockade of the human cardiac potassium channel HERG. FEBS Lett 1997; 417:28-32. [PMID: 9395068 DOI: 10.1016/s0014-5793(97)01249-0] [Citation(s) in RCA: 234] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Cisapride (Propulsid) is a gastrointestinal prokinetic agent commonly used to treat nocturnal heartburn as well as a variety of other gastrointestinal disorders. The use of cisapride has been associated with acquired long QT syndrome and ventricular arrhythmias such as torsades de pointes which produces sudden cardiac death. These cardiotoxic effects can be due to blockade of one or more types of K+ channel currents in the human heart. For this reason we compared the effects of cisapride on two cloned human cardiac K+ channels, Kv1.5 and the human ether-a-go-go-related gene (HERG) stably transfected into mammalian cells. Using patch clamp electrophysiology, we found that cisapride was a potent inhibitor of HERG displaying an IC50 value of 44.5 nmol/l when tail currents at -40 mV were measured following a 2 s test depolarization to +20 mV. When HERG currents were measured at the end of prolonged (20 s) depolarizing steps to +20 mV, the apparent affinity of cisapride was increased and measured 6.70 nmol/l. The main effect of cisapride was to enhance the rate of HERG current decay thereby reducing current at the end of the voltage clamp pulse. Furthermore, the potency of cisapride for the HERG channel was similar to that observed for the class III antiarrhythmic agent dofetilide (IC50 = 15.3 nmol/l) and the nonsedating antihistamine terfenadine (IC50 = 56.0 nmol/l). In contrast to its effects on HERG, cisapride inhibited Kv1.5 channel currents weakly displaying an IC50 value of 21.2 micromol/l. It is concluded that cisapride displays specific, high affinity block of the human cardiac K+ channel HERG. It is likely that this interaction underlies the proarrhythmic effects of the drug observed under certain clinical settings.
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Affiliation(s)
- D Rampe
- Hoechst Marion Roussel, Inc., Cincinnati, OH 45215, USA.
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Abstract
A 2-year-old child presented with pharyngeal perforation following a peroral injury with a toothbrush. Direct force applied to an object such as a toothbrush in the mouth may cause either superficial or penetrating injury within the oropharynx. A high index of suspicion is sometimes necessary to identify a pharyngeal perforation and if this is diagnosed we would advocate admission to hospital, restriction of oral intake, intravenous fluids and antibiotics, with close observation to ensure that healing occurs without development of further complications.
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Affiliation(s)
- H Rowley
- Department of Otolaryngology, Our Lady's Hospital for Sick Children, Crumlin, Dublin
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47
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Abstract
It is said that cigarette smokers suffer stormy induction of anaesthesia; although plausible, this is unsubstantiated. We have studied the incidence of adverse events during induction, together with peripheral oxygen saturation (SpO2), in active and passive smokers, and in non-smokers. During induction, both active and passive smokers had a higher incidence of adverse events than non-smokers (P < 0.01 and P < 0.05, respectively). Irrespective of smoking status, those suffering adverse events had greater concentrations of carboxyhaemoglobin and suffered more oxygen desaturation than those not suffering such events. Although we were unable to demonstrate a direct link between smoking status and oxygen desaturation during induction, our study gives a firmer basis for exhorting patients not only to stop smoking before anaesthesia but also to avoid passive smoking.
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Affiliation(s)
- A Dennis
- Department of Anaesthesia, City Hospital, Nottingham
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48
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Abstract
Proponents of injection molding systems have claimed a number of benefits over conventional press-pack dough molding systems. The aim of this study was to evaluate a recently developed injection (dry heat) procedure of processing compared with press-pack dough molding utilizing three curing cycles. The dimensional accuracy and stability of acrylic resin bases produced by the two molding procedures were compared. Dimensional changes were assessed over a period of 4 months using an optical comparator. The results demonstrate that baseplates produced by the injection molding procedure exhibit less shrinkage than those produced by the conventional press-pack procedures.
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Affiliation(s)
- R Huggett
- Department of Prosthetic Dentistry and Dental Care of the Elderly, University of Bristol, Dental School, England
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49
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Shuster JR, Moyer DL, Lee H, Dennis A, Smith B, Merryweather JP. Yeast mutants conferring resistance to toxic effects of cloned human insulin-like growth factor I. Gene 1989; 83:47-55. [PMID: 2687116 DOI: 10.1016/0378-1119(89)90402-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The production of extracellular human insulin-like growth factor I (IGF-I) in yeast is deleterious to the growth of the host organism. Mutants resistant to the toxic effects of IGF-I production were isolated. A subset of these mutants produced levels of IGF-I greater than the parent strain and were due to chromosomal recessive mutations at a single locus, hpx1. The overproduction of IGF-I was independent of the original promoter and vector expression system. The mutant strains also displayed enhanced extracellular production of other heterologous proteins.
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50
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Dennis A. Word processing: a key to increased productivity in medical record departments. Tex Hosp 1982; 38:32-5. [PMID: 10257728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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