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Gwilym BL, Pallmann P, Waldron CA, Thomas-Jones E, Milosevic S, Brookes-Howell L, Harris D, Massey I, Burton J, Stewart P, Samuel K, Jones S, Cox D, Clothier A, Prout H, Edwards A, Twine CP, Bosanquet DC. Long-term risk prediction after major lower limb amputation: 1-year results of the PERCEIVE study. BJS Open 2024; 8:zrad135. [PMID: 38266124 PMCID: PMC10807997 DOI: 10.1093/bjsopen/zrad135] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 10/22/2023] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Decision-making when considering major lower limb amputation is complex and requires individualized outcome estimation. It is unknown how accurate healthcare professionals or relevant outcome prediction tools are at predicting outcomes at 1-year after major lower limb amputation. METHODS An international, multicentre prospective observational study evaluating healthcare professional accuracy in predicting outcomes 1 year after major lower limb amputation and evaluation of relevant outcome prediction tools identified in a systematic search of the literature was undertaken. Observed outcomes at 1 year were compared with: healthcare professionals' preoperative predictions of death (surgeons and anaesthetists), major lower limb amputation revision (surgeons) and ambulation (surgeons, specialist physiotherapists and vascular nurse practitioners); and probabilities calculated from relevant outcome prediction tools. RESULTS A total of 537 patients and 2244 healthcare professional predictions of outcomes were included. Surgeons and anaesthetists had acceptable discrimination (C-statistic = 0.715), calibration and overall performance (Brier score = 0.200) when predicting 1-year death, but performed worse when predicting major lower limb amputation revision and ambulation (C-statistics = 0.627 and 0.662 respectively). Healthcare professionals overestimated the death and major lower limb amputation revision risks. Consultants outperformed trainees, especially when predicting ambulation. Allied healthcare professionals marginally outperformed surgeons in predicting ambulation. Two outcome prediction tools (C-statistics = 0.755 and 0.717, Brier scores = 0.158 and 0.178) outperformed healthcare professionals' discrimination, calibration and overall performance in predicting death. Two outcome prediction tools for ambulation (C-statistics = 0.688 and 0.667) marginally outperformed healthcare professionals. CONCLUSION There is uncertainty in predicting 1-year outcomes following major lower limb amputation. Different professional groups performed comparably in this study. Two outcome prediction tools for death and two for ambulation outperformed healthcare professionals and may support shared decision-making.
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Affiliation(s)
- Brenig Llwyd Gwilym
- School of Medicine, Cardiff University, Cardiff, UK
- Gwent Vascular Institute, Royal Gwent Hospital, Aneurin Bevan University Health Board, Newport, UK
| | | | | | | | | | | | - Debbie Harris
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Ian Massey
- Artificial Limb and Appliance Centre, Rookwood Hospital, Cardiff and Vale University Health Board, Cardiff, UK
| | - Jo Burton
- Artificial Limb and Appliance Centre, Rookwood Hospital, Cardiff and Vale University Health Board, Cardiff, UK
| | - Phillippa Stewart
- Artificial Limb and Appliance Centre, Rookwood Hospital, Cardiff and Vale University Health Board, Cardiff, UK
| | - Katie Samuel
- Department of Anaesthesia, North Bristol NHS Trust, Bristol, UK
| | - Sian Jones
- C/O INVOLVE Health and Care Research Wales, Cardiff, UK
| | - David Cox
- C/O INVOLVE Health and Care Research Wales, Cardiff, UK
| | | | - Hayley Prout
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Adrian Edwards
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Christopher P Twine
- Bristol, Bath and Weston Vascular Network, North Bristol NHS Trust, Southmead Hospital, Bristol, UK
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Bellew B, St-Laurent DB, Shaw M, Ashken T, Womack J, Debenham J, Getty M, Kajal S, Verma N, Samuel K, Macfarlane AJ, Kearns RJ. Regional anaesthesia training in the UK - a national survey. BJA Open 2023; 8:100241. [PMID: 38089849 PMCID: PMC10714329 DOI: 10.1016/j.bjao.2023.100241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/23/2023] [Accepted: 11/06/2023] [Indexed: 02/08/2024]
Abstract
Background Adequate training of anaesthetists in regional anaesthesia is important to ensure optimal patient access to regional anaesthesia. Methods We undertook a national survey of UK trainee anaesthetists and Royal College of Anaesthetists (RCoA) tutors to assess experiences of training in regional anaesthesia. We performed descriptive statistics for baseline characteristics, and logistic regression of training indices and tutor confidence that their hospital could provide regional anaesthesia training at all three stages of the RCoA 2021 curriculum. Results A total of 492 trainees (19.2%) and 114 tutors (45.2%) completed the survey. Trainees were less likely to have received training in chest/abdominal wall compared with upper/lower limb blocks {erector spinae vs femoral block (odds ratio [OR] 0.25, 95% confidence interval [CI] 0.16-0.39), P<0.001}, or achieved >20 chest/abdominal wall blocks by Stage 3 of training (chest vs lower limb block [OR 0.09, 95% CI 0.05-0.15, P<0.001]. There was a strong association between training received, number of blocks performed (>20 vs 0-5 blocks), and self-reported ability to perform blocks independently, OR 20.9 (95% CI 9.38-53.2). 24/182 (13%) and 10/182 (5.5%) of trainees had performed ≥50 non-obstetric lumbar and thoracic epidurals, respectively, by Stage 3 training. There was a positive association between having a lead clinician for regional anaesthesia, particularly those with paid sessions, and reported confidence to provide regional anaesthesia training at all stages of the curriculum (Stage 3 OR 7.27 [95% CI 2.64-22.0]). Conclusion Our results confirm the importance of clinical experience and access to training in regional anaesthesia, and support the introduction of departmental regional anaesthesia leads to improve equity and quality in training opportunities.
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Affiliation(s)
- Boyne Bellew
- Department of Anaesthesia, Royal National Orthopaedic Hospital, Stanmore, UK
- Imperial College Healthcare NHS Trust, London, UK
| | | | - Martin Shaw
- Department of Medical Physics, NHS Greater Glasgow and Clyde, UK
- School of Medicine, University of Glasgow, UK
| | - Toby Ashken
- Department of Anaesthesia, University College London, London, UK
| | - Jonathan Womack
- Department of Anaesthesia, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Jonathan Debenham
- Department of Anaesthesia, Royal Cornwall Hospitals NHS Trust, Truro, UK
| | - Michael Getty
- Department of Anaesthesia, Royal Cornwall Hospitals NHS Trust, Truro, UK
| | - Shveta Kajal
- The Hillingdon Hospitals NHS Foundation Trust, UK
| | - Neil Verma
- The Hillingdon Hospitals NHS Foundation Trust, UK
| | - Katie Samuel
- Department of Anaesthesia, North Bristol NHS Trust, Bristol, UK
| | - Alan J.R. Macfarlane
- School of Medicine, University of Glasgow, UK
- Department of Anaesthesia, Glasgow Royal Infirmary, Glasgow, UK
| | - Rachel J. Kearns
- School of Medicine, University of Glasgow, UK
- Department of Anaesthesia, Glasgow Royal Infirmary, Glasgow, UK
| | - Regional Anaesthesia UK Research Network‡
- Department of Anaesthesia, Royal National Orthopaedic Hospital, Stanmore, UK
- Imperial College Healthcare NHS Trust, London, UK
- Department of Anaesthesia, Royal Cornwall Hospitals NHS Trust, Truro, UK
- Department of Medical Physics, NHS Greater Glasgow and Clyde, UK
- School of Medicine, University of Glasgow, UK
- Department of Anaesthesia, University College London, London, UK
- Department of Anaesthesia, Royal Victoria Infirmary, Newcastle upon Tyne, UK
- The Hillingdon Hospitals NHS Foundation Trust, UK
- Department of Anaesthesia, North Bristol NHS Trust, Bristol, UK
- Department of Anaesthesia, Glasgow Royal Infirmary, Glasgow, UK
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3
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Samuel K, Nickell K, Morgan P. Rapid upskilling through simulation to provide a safe COVID-19 inpatient mobile emergency rapid intubating team. J Intensive Care Soc 2023; 24:35-36. [PMID: 37928097 PMCID: PMC10621514 DOI: 10.1177/1751143720961677] [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: 11/07/2023] Open
Affiliation(s)
- Katie Samuel
- Katie Samuel, North Bristol NHS Trust, Westbury on Trym, Bristol BS10 5NB, UK.
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4
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Watkins S, Chowdhury FJ, Norman C, Brett SJ, Couper K, Goodwin L, Gould DW, AE. Harrison D, Hossain A, Lall R, Mason J, Nolan JP, Nwankwo H, Perkins GD, Samuel K, Schofield B, Soar J, Starr K, Thomas M, Voss S, Benger JR. Randomised trial of the clinical and cost effectiveness of a supraglottic airway device compared with tracheal intubation for in-hospital cardiac arrest (AIRWAYS-3): Protocol, design and implementation. Resusc Plus 2023; 15:100430. [PMID: 37519411 PMCID: PMC10371816 DOI: 10.1016/j.resplu.2023.100430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 06/28/2023] [Accepted: 07/03/2023] [Indexed: 08/01/2023] Open
Abstract
Survival from in-hospital cardiac arrest is approximately 18%, but for patients who require advanced airway management survival is lower. Those who do survive are often left with significant disability. Traditionally, resuscitation of cardiac arrest patients has included tracheal intubation, however insertion of a supraglottic airway has gained popularity as an alternative approach to advanced airway management. Evidence from out-of-hospital cardiac arrest suggests no significant differences in mortality or morbidity between these two approaches, but there is no randomised evidence for airway management during in-hospital cardiac arrest. The aim of the AIRWAYS-3 randomised trial, described in this protocol paper, is to determine the clinical and cost effectiveness of a supraglottic airway versus tracheal intubation during in-hospital cardiac arrest. Patients will be allocated randomly to receive either a supraglottic airway or tracheal intubation as the initial advanced airway management. We will also estimate the relative cost-effectiveness of these two approaches. The primary outcome is functional status, measured using the modified Rankin Scale at hospital discharge or 30 days post-randomisation, whichever occurs first. AIRWAYS-3 presents ethical challenges regarding patient consent and data collection. These include the enrolment of unconscious patients without prior consent in a way that avoids methodological bias. Other complexities include the requirement to randomise patients efficiently during a time-critical cardiac arrest. Many of these challenges are encountered in other emergency care research; we discuss our approaches to addressing them. Trial registration: ISRCTN17720457. Prospectively registered on 29/07/2022.
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Affiliation(s)
- Scott Watkins
- Faculty of Health & Applied Sciences, University of the West of England, Bristol, UK
| | | | - Chloe Norman
- Warwick Clinical Trials Unit, University of Warwick, UK
| | | | - Keith Couper
- Warwick Clinical Trials Unit, University of Warwick, UK
| | - Laura Goodwin
- Faculty of Health & Applied Sciences, University of the West of England, Bristol, UK
| | - Doug W. Gould
- Intensive Care National Audit & Research Centre, London, UK
| | | | | | - Ranjit Lall
- Warwick Clinical Trials Unit, University of Warwick, UK
| | - James Mason
- Warwick Clinical Trials Unit, University of Warwick, UK
| | - Jerry P. Nolan
- Warwick Clinical Trials Unit, University of Warwick, UK
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK
| | - Henry Nwankwo
- Warwick Clinical Trials Unit, University of Warwick, UK
| | | | | | - Behnaz Schofield
- Faculty of Health & Applied Sciences, University of the West of England, Bristol, UK
| | | | - Kath Starr
- Warwick Clinical Trials Unit, University of Warwick, UK
| | - Matthew Thomas
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Sarah Voss
- Faculty of Health & Applied Sciences, University of the West of England, Bristol, UK
| | - Jonathan R. Benger
- Faculty of Health & Applied Sciences, University of the West of England, Bristol, UK
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
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5
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Denaro F, Samuel K, Zella D, Benedetti F, Davis H, Bryant J. Training the Next Generation of HIV/AIDS Researchers. Microsc Microanal 2023; 29:2123-2124. [PMID: 37612903 DOI: 10.1093/micmic/ozad067.1100] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Affiliation(s)
- F Denaro
- Department of Biology Morgan State University, Baltimore, MD, USA
| | - K Samuel
- Department of Biology Morgan State University, Baltimore, MD, USA
| | - D Zella
- Institute of Human Virology, Baltimore, MD, USA
| | - F Benedetti
- Institute of Human Virology, Baltimore, MD, USA
| | - H Davis
- Institute of Human Virology, Baltimore, MD, USA
| | - J Bryant
- Institute of Human Virology, Baltimore, MD, USA
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6
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Jarvis MS, Samuel K. Impact of the COVID-19 pandemic on anaesthesia training, recruitment and examinations: a survey of UK trainees. Br J Anaesth 2023:S0007-0912(23)00141-1. [PMID: 37080871 PMCID: PMC10067451 DOI: 10.1016/j.bja.2023.03.018] [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] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 02/24/2023] [Accepted: 03/06/2023] [Indexed: 04/05/2023] Open
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Kane AD, Armstrong RA, Kursumovic E, Cook TM, Oglesby FC, Cortes L, Moppett IK, Moonesinghe SR, Agarwal S, Bouch DC, Cordingley J, Davies MT, Dorey J, Finney SJ, Kunst G, Lucas DN, Nickols G, Mouton R, Nolan JP, Patel B, Pappachan VJ, Plaat F, Samuel K, Scholefield BR, Smith JH, Varney L, Vindrola‐Padros C, Martin S, Wain EC, Kendall SW, Ward S, Drake S, Lourtie J, Taylor C, Soar J. Methods of the 7 th National Audit Project (NAP7) of the Royal College of Anaesthetists: peri-operative cardiac arrest. Anaesthesia 2022; 77:1376-1385. [PMID: 36111390 PMCID: PMC9826156 DOI: 10.1111/anae.15856] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2022] [Indexed: 01/11/2023]
Abstract
Cardiac arrest in the peri-operative period is rare but associated with significant morbidity and mortality. Current reporting systems do not capture many such events, so there is an incomplete understanding of incidence and outcomes. As peri-operative cardiac arrest is rare, many hospitals may only see a small number of cases over long periods, and anaesthetists may not be involved in such cases for years. Therefore, a large-scale prospective cohort is needed to gain a deep understanding of events leading up to cardiac arrest, management of the arrest itself and patient outcomes. Consequently, the Royal College of Anaesthetists chose peri-operative cardiac arrest as the 7th National Audit Project topic. The study was open to all UK hospitals offering anaesthetic services and had a three-part design. First, baseline surveys of all anaesthetic departments and anaesthetists in the UK, examining respondents' prior peri-operative cardiac arrest experience, resuscitation training and local departmental preparedness. Second, an activity survey to record anonymised details of all anaesthetic activity in each site over 4 days, enabling national estimates of annual anaesthetic activity, complexity and complication rates. Third, a case registry of all instances of peri-operative cardiac arrest in the UK, reported confidentially and anonymously, over 1 year starting 16 June 2021, followed by expert review using a structured process to minimise bias. The definition of peri-operative cardiac arrest was the delivery of five or more chest compressions and/or defibrillation in a patient having a procedure under the care of an anaesthetist. The peri-operative period began with the World Health Organization 'sign-in' checklist or first hands-on contact with the patient and ended either 24 h after the patient handover (e.g. to the recovery room or intensive care unit) or at discharge if this occured earlier than 24 h. These components described the epidemiology of peri-operative cardiac arrest in the UK and provide a basis for developing guidelines and interventional studies.
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Gwilym BL, Pallmann P, Waldron CA, Thomas-Jones E, Milosevic S, Brookes-Howell L, Harris D, Massey I, Burton J, Stewart P, Samuel K, Jones S, Cox D, Clothier A, Edwards A, Twine CP, Bosanquet DC, Benson R, Birmpili P, Blair R, Bosanquet DC, Dattani N, Dovell G, Forsythe R, Gwilym BL, Hitchman L, Machin M, Nandhra S, Onida S, Preece R, Saratzis A, Shalhoub J, Singh A, Forget P, Gannon M, Celnik A, Duguid M, Campbell A, Duncan K, Renwick B, Moore J, Maresch M, Kamal D, Kabis M, Hatem M, Juszczak M, Dattani N, Travers H, Shalan A, Elsabbagh M, Rocha-Neves J, Pereira-Neves A, Teixeira J, Lyons O, Lim E, Hamdulay K, Makar R, Zaki S, Francis CT, Azer A, Ghatwary-Tantawy T, Elsayed K, Mittapalli D, Melvin R, Barakat H, Taylor J, Veal S, Hamid HKS, Baili E, Kastrisios G, Maltezos C, Maltezos K, Anastasiadou C, Pachi A, Skotsimara A, Saratzis A, Vijaynagar B, Lau S, Velineni R, Bright E, Montague-Johnstone E, Stewart K, King W, Karkos C, Mitka M, Papadimitriou C, Smith G, Chan E, Shalhoub J, Machin M, Agbeko AE, Amoako J, Vijay A, Roditis K, Papaioannou V, Antoniou A, Tsiantoula P, Bessias N, Papas T, Dovell G, Goodchild F, Nandhra S, Rammell J, Dawkins C, Lapolla P, Sapienza P, Brachini G, Mingoli A, Hussey K, Meldrum A, Dearie L, Nair M, Duncan A, Webb B, Klimach S, Hardy T, Guest F, Hopkins L, Contractor U, Clothier A, McBride O, Hallatt M, Forsythe R, Pang D, Tan LE, Altaf N, Wong J, Thurston B, Ash O, Popplewell M, Grewal A, Jones S, Wardle B, Twine C, Ambler G, Condie N, Lam K, Heigberg-Gibbons F, Saha P, Hayes T, Patel S, Black S, Musajee M, Choudhry A, Hammond E, Costanza M, Shaw P, Feghali A, Chawla A, Surowiec S, Encalada RZ, Benson R, Cadwallader C, Clayton P, Van Herzeele I, Geenens M, Vermeir L, Moreels N, Geers S, Jawien A, Arentewicz T, Kontopodis N, Lioudaki S, Tavlas E, Nyktari V, Oberhuber A, Ibrahim A, Neu J, Nierhoff T, Moulakakis K, Kakkos S, Nikolakopoulos K, Papadoulas S, D'Oria M, Lepidi S, Lowry D, Ooi S, Patterson B, Williams S, Elrefaey GH, Gaba KA, Williams GF, Rodriguez DU, Khashram M, Gormley S, Hart O, Suthers E, French S. Short-term risk prediction after major lower limb amputation: PERCEIVE study. Br J Surg 2022; 109:1300-1311. [PMID: 36065602 DOI: 10.1093/bjs/znac309] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 05/06/2022] [Accepted: 07/31/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND The accuracy with which healthcare professionals (HCPs) and risk prediction tools predict outcomes after major lower limb amputation (MLLA) is uncertain. The aim of this study was to evaluate the accuracy of predicting short-term (30 days after MLLA) mortality, morbidity, and revisional surgery. METHODS The PERCEIVE (PrEdiction of Risk and Communication of outcomE following major lower limb amputation: a collaboratIVE) study was launched on 1 October 2020. It was an international multicentre study, including adults undergoing MLLA for complications of peripheral arterial disease and/or diabetes. Preoperative predictions of 30-day mortality, morbidity, and MLLA revision by surgeons and anaesthetists were recorded. Probabilities from relevant risk prediction tools were calculated. Evaluation of accuracy included measures of discrimination, calibration, and overall performance. RESULTS Some 537 patients were included. HCPs had acceptable discrimination in predicting mortality (931 predictions; C-statistic 0.758) and MLLA revision (565 predictions; C-statistic 0.756), but were poor at predicting morbidity (980 predictions; C-statistic 0.616). They overpredicted the risk of all outcomes. All except three risk prediction tools had worse discrimination than HCPs for predicting mortality (C-statistics 0.789, 0.774, and 0.773); two of these significantly overestimated the risk compared with HCPs. SORT version 2 (the only tool incorporating HCP predictions) demonstrated better calibration and overall performance (Brier score 0.082) than HCPs. Tools predicting morbidity and MLLA revision had poor discrimination (C-statistics 0.520 and 0.679). CONCLUSION Clinicians predicted mortality and MLLA revision well, but predicted morbidity poorly. They overestimated the risk of mortality, morbidity, and MLLA revision. Most short-term risk prediction tools had poorer discrimination or calibration than HCPs. The best method of predicting mortality was a statistical tool that incorporated HCP estimation.
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Affiliation(s)
- Brenig L Gwilym
- South East Wales Vascular Network, Aneurin Bevan University Health Board, Royal Gwent Hospital, Newport, UK
| | | | | | | | | | | | - Debbie Harris
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Ian Massey
- Artificial Limb and Appliance Centre, Rookwood Hospital, Cardiff and Vale University Health Board, Cardiff, UK
| | - Jo Burton
- Artificial Limb and Appliance Centre, Rookwood Hospital, Cardiff and Vale University Health Board, Cardiff, UK
| | - Phillippa Stewart
- Artificial Limb and Appliance Centre, Rookwood Hospital, Cardiff and Vale University Health Board, Cardiff, UK
| | - Katie Samuel
- Department of Anaesthesia, North Bristol NHS Trust, Bristol, UK
| | - Sian Jones
- c/o INVOLVE Health and Care Research Wales, Cardiff, UK
| | - David Cox
- c/o INVOLVE Health and Care Research Wales, Cardiff, UK
| | - Annie Clothier
- South East Wales Vascular Network, Aneurin Bevan University Health Board, Royal Gwent Hospital, Newport, UK
| | - Adrian Edwards
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Christopher P Twine
- Bristol, Bath and Weston Vascular Network, North Bristol NHS Trust, Southmead Hospital, Bristol, UK
| | - David C Bosanquet
- South East Wales Vascular Network, Aneurin Bevan University Health Board, Royal Gwent Hospital, Newport, UK
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Moonesinghe SR, McGuckin D, Martin P, Bedford J, Wagstaff D, Gilhooly D, Santos C, Wilson J, Dorey J, Leeman I, Smith H, Vindrola-Padros C, Edwards K, Singleton G, Swart M, Baumber R, Sahni A, Warnakulasuriya S, Vohra R, Ellicott H, Bougeard AM, Chazapis M, Ignacka A, Cripps M, Brent A, Drake S, Goodwin J, Martinez D, Williams K, Singh P, Bedford M, Vallance AE, Samuel K, Lourtie J, Olive D, Taylor C, Tucker O, Aresu G, Swift A, Fulop N, Grocott M. The Perioperative Quality Improvement Programme (PQIP patient study): protocol for a UK multicentre, prospective cohort study to measure quality of care and outcomes after major surgery. Perioper Med (Lond) 2022; 11:37. [PMID: 35941603 PMCID: PMC9361526 DOI: 10.1186/s13741-022-00262-3] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 04/28/2022] [Indexed: 12/03/2022] Open
Abstract
Introduction Major surgery accounts for a substantial proportion of health service activity, due not only to the primary procedure, but the longer-term health implications of poor short-term outcome. Data from small studies or from outside the UK indicate that rates of complications and failure to rescue vary between hospitals, as does compliance with best practice processes. Within the UK, there is currently no system for monitoring postoperative complications (other than short-term mortality) in major non-cardiac surgery. Further, there is variation between national audit programmes, in the emphasis placed on quality assurance versus quality improvement, and therefore the principles of measurement and reporting which are used to design such programmes. Methods and analysis The PQIP patient study is a multi-centre prospective cohort study which recruits patients undergoing major surgery. Patient provide informed consent and contribute baseline and outcome data from their perspective using a suite of patient-reported outcome tools. Research and clinical staff complete data on patient risk factors and outcomes in-hospital, including two measures of complications. Longer-term outcome data are collected through patient feedback and linkage to national administrative datasets (mortality and readmissions). As well as providing a uniquely granular dataset for research, PQIP provides feedback to participating sites on their compliance with evidence-based processes and their patients’ outcomes, with the aim of supporting local quality improvement. Ethics and dissemination Ethical approval has been granted by the Health Research Authority in the UK. Dissemination of interim findings (non-inferential) will form a part of the improvement methodology and will be provided to participating centres at regular intervals, including near-real time feedback of key process measures. Inferential analyses will be published in the peer-reviewed literature, supported by a comprehensive multi-modal communications strategy including to patients, policy makers and academic audiences as well as clinicians.
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Affiliation(s)
- S Ramani Moonesinghe
- Centre for Perioperative Medicine, Research Department for Targeted Intervention, UCL, London, UK. .,Health Services Research Centre, Royal College of Anaesthetists, London, UK. .,Department of Anaesthesia and Perioperative Medicine, University College London Hospitals NHS Foundation Trust, London, UK.
| | - Dermot McGuckin
- Centre for Perioperative Medicine, Research Department for Targeted Intervention, UCL, London, UK
| | - Peter Martin
- Department for Applied Health Research, UCL, London, UK
| | - James Bedford
- Centre for Perioperative Medicine, Research Department for Targeted Intervention, UCL, London, UK.,Health Services Research Centre, Royal College of Anaesthetists, London, UK.,Department of Anaesthesia and Perioperative Medicine, University College London Hospitals NHS Foundation Trust, London, UK
| | - Duncan Wagstaff
- Centre for Perioperative Medicine, Research Department for Targeted Intervention, UCL, London, UK.,Health Services Research Centre, Royal College of Anaesthetists, London, UK.,Department of Anaesthesia and Perioperative Medicine, University College London Hospitals NHS Foundation Trust, London, UK
| | - David Gilhooly
- Centre for Perioperative Medicine, Research Department for Targeted Intervention, UCL, London, UK.,Health Services Research Centre, Royal College of Anaesthetists, London, UK.,Department of Anaesthesia and Perioperative Medicine, University College London Hospitals NHS Foundation Trust, London, UK
| | - Cristel Santos
- Health Services Research Centre, Royal College of Anaesthetists, London, UK
| | - Jonathan Wilson
- Department of Anaesthesia, York Teaching Hospitals NHS Foundation Trust, York, UK
| | | | | | - Helena Smith
- Department of Anaesthesia, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Cecilia Vindrola-Padros
- Centre for Perioperative Medicine, Research Department for Targeted Intervention, UCL, London, UK.,Health Services Research Centre, Royal College of Anaesthetists, London, UK
| | - Kylie Edwards
- Health Services Research Centre, Royal College of Anaesthetists, London, UK
| | - Georgina Singleton
- Health Services Research Centre, Royal College of Anaesthetists, London, UK
| | - Michael Swart
- Department of Anaesthesia, Torbay Hospital, Torquay, UK
| | - Rachel Baumber
- Centre for Perioperative Medicine, Research Department for Targeted Intervention, UCL, London, UK.,Department of Anaesthesia, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Arun Sahni
- Health Services Research Centre, Royal College of Anaesthetists, London, UK
| | - Samantha Warnakulasuriya
- Department of Anaesthesia and Perioperative Medicine, University College London Hospitals NHS Foundation Trust, London, UK
| | - Ravi Vohra
- Department of Upper GI Surgery, Nottingham University Hospitals, Nottingham, UK
| | - Helen Ellicott
- Health Services Research Centre, Royal College of Anaesthetists, London, UK
| | | | - Maria Chazapis
- Department of Anaesthesia and Perioperative Medicine, University College London Hospitals NHS Foundation Trust, London, UK
| | - Aleksandra Ignacka
- Department of Anaesthesia and Perioperative Medicine, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Alexandra Brent
- Health Services Research Centre, Royal College of Anaesthetists, London, UK
| | | | | | - Dorian Martinez
- Health Services Research Centre, Royal College of Anaesthetists, London, UK
| | - Karen Williams
- Health Services Research Centre, Royal College of Anaesthetists, London, UK
| | - Pritam Singh
- Trent Oesophago-Gastric Unit, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Matthew Bedford
- Department of Colorectal Surgery, Birmingham Heartlands Hospital, Birmingham, UK
| | | | - Katie Samuel
- Department of Anaesthesia, North Bristol NHS Foundation Trust , Bristol, UK
| | - Jose Lourtie
- Health Services Research Centre, Royal College of Anaesthetists, London, UK
| | - Dominic Olive
- Health Services Research Centre, Royal College of Anaesthetists, London, UK
| | - Christine Taylor
- Health Services Research Centre, Royal College of Anaesthetists, London, UK
| | - Olga Tucker
- Department of Upper Gastrointestinal Surgery, Heartlands Hospital, Birmingham, UK
| | - Giuseppe Aresu
- Department of Cardiothoracic Surgery, Papworth Hospital, Cambridge, UK
| | | | - Naomi Fulop
- Department for Applied Health Research, UCL, London, UK
| | - Mike Grocott
- Division of Critical Care, University of Southampton, Southampton, UK
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Evans RA, Leavy OC, Richardson M, Elneima O, McAuley HJC, Shikotra A, Singapuri A, Sereno M, Saunders RM, Harris VC, Houchen-Wolloff L, Aul R, Beirne P, Bolton CE, Brown JS, Choudhury G, Diar-Bakerly N, Easom N, Echevarria C, Fuld J, Hart N, Hurst J, Jones MG, Parekh D, Pfeffer P, Rahman NM, Rowland-Jones SL, Shah AM, Wootton DG, Chalder T, Davies MJ, De Soyza A, Geddes JR, Greenhalf W, Greening NJ, Heaney LG, Heller S, Howard LS, Jacob J, Jenkins RG, Lord JM, Man WDC, McCann GP, Neubauer S, Openshaw PJM, Porter JC, Rowland MJ, Scott JT, Semple MG, Singh SJ, Thomas DC, Toshner M, Lewis KE, Thwaites RS, Briggs A, Docherty AB, Kerr S, Lone NI, Quint J, Sheikh A, Thorpe M, Zheng B, Chalmers JD, Ho LP, Horsley A, Marks M, Poinasamy K, Raman B, Harrison EM, Wain LV, Brightling CE, Abel K, Adamali H, Adeloye D, Adeyemi O, Adrego R, Aguilar Jimenez LA, Ahmad S, Ahmad Haider N, Ahmed R, Ahwireng N, Ainsworth M, Al-Sheklly B, Alamoudi A, Ali M, Aljaroof M, All AM, Allan L, Allen RJ, Allerton L, Allsop L, Almeida P, Altmann D, Alvarez Corral M, Amoils S, Anderson D, Antoniades C, Arbane G, Arias A, Armour C, Armstrong L, Armstrong N, Arnold D, Arnold H, Ashish A, Ashworth A, Ashworth M, Aslani S, Assefa-Kebede H, Atkin C, Atkin P, Aung H, Austin L, Avram C, Ayoub A, Babores M, Baggott R, Bagshaw J, Baguley D, Bailey L, Baillie JK, Bain S, Bakali M, Bakau M, Baldry E, Baldwin D, Ballard C, Banerjee A, Bang B, Barker RE, Barman L, Barratt S, Barrett F, Basire D, Basu N, Bates M, Bates A, Batterham R, Baxendale H, Bayes H, Beadsworth M, Beckett P, Beggs M, Begum M, Bell D, Bell R, Bennett K, Beranova E, Bermperi A, Berridge A, Berry C, Betts S, Bevan E, Bhui K, Bingham M, Birchall K, Bishop L, Bisnauthsing K, Blaikely J, Bloss A, Bolger A, Bonnington J, Botkai A, Bourne C, Bourne M, Bramham K, Brear L, Breen G, Breeze J, Bright E, Brill S, Brindle K, Broad L, Broadley A, Brookes C, Broome M, Brown A, Brown A, Brown J, Brown J, Brown M, Brown M, Brown V, Brugha T, Brunskill N, Buch M, Buckley P, Bularga A, Bullmore E, Burden L, Burdett T, Burn D, Burns G, Burns A, Busby J, Butcher R, Butt A, Byrne S, Cairns P, Calder PC, Calvelo E, Carborn H, Card B, Carr C, Carr L, Carson G, Carter P, Casey A, Cassar M, Cavanagh J, Chablani M, Chambers RC, Chan F, Channon KM, Chapman K, Charalambou A, Chaudhuri N, Checkley A, Chen J, Cheng Y, Chetham L, Childs C, Chilvers ER, Chinoy H, Chiribiri A, Chong-James K, Choudhury N, Chowienczyk P, Christie C, Chrystal M, Clark D, Clark C, Clarke J, Clohisey S, Coakley G, Coburn Z, Coetzee S, Cole J, Coleman C, Conneh F, Connell D, Connolly B, Connor L, Cook A, Cooper B, Cooper J, Cooper S, Copeland D, Cosier T, Coulding M, Coupland C, Cox E, Craig T, Crisp P, Cristiano D, Crooks MG, Cross A, Cruz I, Cullinan P, Cuthbertson D, Daines L, Dalton M, Daly P, Daniels A, Dark P, Dasgin J, David A, David C, Davies E, Davies F, Davies G, Davies GA, Davies K, Dawson J, Daynes E, Deakin B, Deans A, Deas C, Deery J, Defres S, Dell A, Dempsey K, Denneny E, Dennis J, Dewar A, Dharmagunawardena R, Dickens C, Dipper A, Diver S, Diwanji SN, Dixon M, Djukanovic R, Dobson H, Dobson SL, Donaldson A, Dong T, Dormand N, Dougherty A, Dowling R, Drain S, Draxlbauer K, Drury K, Dulawan P, Dunleavy A, Dunn S, Earley J, Edwards S, Edwardson C, El-Taweel H, Elliott A, Elliott K, Ellis Y, Elmer A, Evans D, Evans H, Evans J, Evans R, Evans RI, Evans T, Evenden C, Evison L, Fabbri L, Fairbairn S, Fairman A, Fallon K, Faluyi D, Favager C, Fayzan T, Featherstone J, Felton T, Finch J, Finney S, Finnigan J, Finnigan L, Fisher H, Fletcher S, Flockton R, Flynn M, Foot H, Foote D, Ford A, Forton D, Fraile E, Francis C, Francis R, Francis S, Frankel A, Fraser E, Free R, French N, Fu X, Furniss J, Garner L, Gautam N, George J, George P, Gibbons M, Gill M, Gilmour L, Gleeson F, Glossop J, Glover S, Goodman N, Goodwin C, Gooptu B, Gordon H, Gorsuch T, Greatorex M, Greenhaff PL, Greenhalgh A, Greenwood J, Gregory H, Gregory R, Grieve D, Griffin D, Griffiths L, Guerdette AM, Guillen Guio B, Gummadi M, Gupta A, Gurram S, Guthrie E, Guy Z, H Henson H, Hadley K, Haggar A, Hainey K, Hairsine B, Haldar P, Hall I, Hall L, Halling-Brown M, Hamil R, Hancock A, Hancock K, Hanley NA, Haq S, Hardwick HE, Hardy E, Hardy T, Hargadon B, Harrington K, Harris E, Harrison P, Harvey A, Harvey M, Harvie M, Haslam L, Havinden-Williams M, Hawkes J, Hawkings N, Haworth J, Hayday A, Haynes M, Hazeldine J, Hazelton T, Heeley C, Heeney JL, Heightman M, Henderson M, Hesselden L, Hewitt M, Highett V, Hillman T, Hiwot T, Hoare A, Hoare M, Hockridge J, Hogarth P, Holbourn A, Holden S, Holdsworth L, Holgate D, Holland M, Holloway L, Holmes K, Holmes M, Holroyd-Hind B, Holt L, Hormis A, Hosseini A, Hotopf M, Howard K, Howell A, Hufton E, Hughes AD, Hughes J, Hughes R, Humphries A, Huneke N, Hurditch E, Husain M, Hussell T, Hutchinson J, Ibrahim W, Ilyas F, Ingham J, Ingram L, Ionita D, Isaacs K, Ismail K, Jackson T, James WY, Jarman C, Jarrold I, Jarvis H, Jastrub R, Jayaraman B, Jezzard P, Jiwa K, Johnson C, Johnson S, Johnston D, Jolley CJ, Jones D, Jones G, Jones H, Jones H, Jones I, Jones L, Jones S, Jose S, Kabir T, Kaltsakas G, Kamwa V, Kanellakis N, Kaprowska S, Kausar Z, Keenan N, Kelly S, Kemp G, Kerslake H, Key AL, Khan F, Khunti K, Kilroy S, King B, King C, Kingham L, Kirk J, Kitterick P, Klenerman P, Knibbs L, Knight S, Knighton A, Kon O, Kon S, Kon SS, Koprowska S, Korszun A, Koychev I, Kurasz C, Kurupati P, Laing C, Lamlum H, Landers G, Langenberg C, Lasserson D, Lavelle-Langham L, Lawrie A, Lawson C, Lawson C, Layton A, Lea A, Lee D, Lee JH, Lee E, Leitch K, Lenagh R, Lewis D, Lewis J, Lewis V, Lewis-Burke N, Li X, Light T, Lightstone L, Lilaonitkul W, Lim L, Linford S, Lingford-Hughes A, Lipman M, Liyanage K, Lloyd A, Logan S, Lomas D, Loosley R, Lota H, Lovegrove W, Lucey A, Lukaschuk E, Lye A, Lynch C, MacDonald S, MacGowan G, Macharia I, Mackie J, Macliver L, Madathil S, Madzamba G, Magee N, Magtoto MM, Mairs N, Majeed N, Major E, Malein F, Malim M, Mallison G, Mandal S, Mangion K, Manisty C, Manley R, March K, Marciniak S, Marino P, Mariveles M, Marouzet E, Marsh S, Marshall B, Marshall M, Martin J, Martineau A, Martinez LM, Maskell N, Matila D, Matimba-Mupaya W, Matthews L, Mbuyisa A, McAdoo S, Weir McCall J, McAllister-Williams H, McArdle A, McArdle P, McAulay D, McCormick J, McCormick W, McCourt P, McGarvey L, McGee C, Mcgee K, McGinness J, McGlynn K, McGovern A, McGuinness H, McInnes IB, McIntosh J, McIvor E, McIvor K, McLeavey L, McMahon A, McMahon MJ, McMorrow L, Mcnally T, McNarry M, McNeill J, McQueen A, McShane H, Mears C, Megson C, Megson S, Mehta P, Meiring J, Melling L, Mencias M, Menzies D, Merida Morillas M, Michael A, Milligan L, Miller C, Mills C, Mills NL, Milner L, Misra S, Mitchell J, Mohamed A, Mohamed N, Mohammed S, Molyneaux PL, Monteiro W, Moriera S, Morley A, Morrison L, Morriss R, Morrow A, Moss AJ, Moss P, Motohashi K, Msimanga N, Mukaetova-Ladinska E, Munawar U, Murira J, Nanda U, Nassa H, Nasseri M, Neal A, Needham R, Neill P, Newell H, Newman T, Newton-Cox A, Nicholson T, Nicoll D, Nolan CM, Noonan MJ, Norman C, Novotny P, Nunag J, Nwafor L, Nwanguma U, Nyaboko J, O'Donnell K, O'Brien C, O'Brien L, O'Regan D, Odell N, Ogg G, Olaosebikan O, Oliver C, Omar Z, Orriss-Dib L, Osborne L, Osbourne R, Ostermann M, Overton C, Owen J, Oxton J, Pack J, Pacpaco E, Paddick S, Painter S, Pakzad A, Palmer S, Papineni P, Paques K, Paradowski K, Pareek M, Parfrey H, Pariante C, Parker S, Parkes M, Parmar J, Patale S, Patel B, Patel M, Patel S, Pattenadk D, Pavlides M, Payne S, Pearce L, Pearl JE, Peckham D, Pendlebury J, Peng Y, Pennington C, Peralta I, Perkins E, Peterkin Z, Peto T, Petousi N, Petrie J, Phipps J, Pimm J, Piper Hanley K, Pius R, Plant H, Plein S, Plekhanova T, Plowright M, Polgar O, Poll L, Porter J, Portukhay S, Powell N, Prabhu A, Pratt J, Price A, Price C, Price C, Price D, Price L, Price L, Prickett A, Propescu J, Pugmire S, Quaid S, Quigley J, Qureshi H, Qureshi IN, Radhakrishnan K, Ralser M, Ramos A, Ramos H, Rangeley J, Rangelov B, Ratcliffe L, Ravencroft P, Reddington A, Reddy R, Redfearn H, Redwood D, Reed A, Rees M, Rees T, Regan K, Reynolds W, Ribeiro C, Richards A, Richardson E, Rivera-Ortega P, Roberts K, Robertson E, Robinson E, Robinson L, Roche L, Roddis C, Rodger J, Ross A, Ross G, Rossdale J, Rostron A, Rowe A, Rowland A, Rowland J, Roy K, Roy M, Rudan I, Russell R, Russell E, Saalmink G, Sabit R, Sage EK, Samakomva T, Samani N, Sampson C, Samuel K, Samuel R, Sanderson A, Sapey E, Saralaya D, Sargant J, Sarginson C, Sass T, Sattar N, Saunders K, Saunders P, Saunders LC, Savill H, Saxon W, Sayer A, Schronce J, Schwaeble W, Scott K, Selby N, Sewell TA, Shah K, Shah P, Shankar-Hari M, Sharma M, Sharpe C, Sharpe M, Shashaa S, Shaw A, Shaw K, Shaw V, Shelton S, Shenton L, Shevket K, Short J, Siddique S, Siddiqui S, Sidebottom J, Sigfrid L, Simons G, Simpson J, Simpson N, Singh C, Singh S, Sissons D, Skeemer J, Slack K, Smith A, Smith D, Smith S, Smith J, Smith L, Soares M, Solano TS, Solly R, Solstice AR, Soulsby T, Southern D, Sowter D, Spears M, Spencer LG, Speranza F, Stadon L, Stanel S, Steele N, Steiner M, Stensel D, Stephens G, Stephenson L, Stern M, Stewart I, Stimpson R, Stockdale S, Stockley J, Stoker W, Stone R, Storrar W, Storrie A, Storton K, Stringer E, Strong-Sheldrake S, Stroud N, Subbe C, Sudlow CL, Suleiman Z, Summers C, Summersgill C, Sutherland D, Sykes DL, Sykes R, Talbot N, Tan AL, Tarusan L, Tavoukjian V, Taylor A, Taylor C, Taylor J, Te A, Tedd H, Tee CJ, Teixeira J, Tench H, Terry S, Thackray-Nocera S, Thaivalappil F, Thamu B, Thickett D, Thomas C, Thomas S, Thomas AK, Thomas-Woods T, Thompson T, Thompson AAR, Thornton T, Tilley J, Tinker N, Tiongson GF, Tobin M, Tomlinson J, Tong C, Touyz R, Tripp KA, Tunnicliffe E, Turnbull A, Turner E, Turner S, Turner V, Turner K, Turney S, Turtle L, Turton H, Ugoji J, Ugwuoke R, Upthegrove R, Valabhji J, Ventura M, Vere J, Vickers C, Vinson B, Wade E, Wade P, Wainwright T, Wajero LO, Walder S, Walker S, Walker S, Wall E, Wallis T, Walmsley S, Walsh JA, Walsh S, Warburton L, Ward TJC, Warwick K, Wassall H, Waterson S, Watson E, Watson L, Watson J, Welch C, Welch H, Welsh B, Wessely S, West S, Weston H, Wheeler H, White S, Whitehead V, Whitney J, Whittaker S, Whittam B, Whitworth V, Wight A, Wild J, Wilkins M, Wilkinson D, Williams N, Williams N, Williams J, Williams-Howard SA, Willicombe M, Willis G, Willoughby J, Wilson A, Wilson D, Wilson I, Window N, Witham M, Wolf-Roberts R, Wood C, Woodhead F, Woods J, Wormleighton J, Worsley J, Wraith D, Wrey Brown C, Wright C, Wright L, Wright S, Wyles J, Wynter I, Xu M, Yasmin N, Yasmin S, Yates T, Yip KP, Young B, Young S, Young A, Yousuf AJ, Zawia A, Zeidan L, Zhao B, Zongo O. Clinical characteristics with inflammation profiling of long COVID and association with 1-year recovery following hospitalisation in the UK: a prospective observational study. Lancet Respir Med 2022; 10:761-775. [PMID: 35472304 PMCID: PMC9034855 DOI: 10.1016/s2213-2600(22)00127-8] [Citation(s) in RCA: 144] [Impact Index Per Article: 72.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/23/2022] [Accepted: 03/31/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND No effective pharmacological or non-pharmacological interventions exist for patients with long COVID. We aimed to describe recovery 1 year after hospital discharge for COVID-19, identify factors associated with patient-perceived recovery, and identify potential therapeutic targets by describing the underlying inflammatory profiles of the previously described recovery clusters at 5 months after hospital discharge. METHODS The Post-hospitalisation COVID-19 study (PHOSP-COVID) is a prospective, longitudinal cohort study recruiting adults (aged ≥18 years) discharged from hospital with COVID-19 across the UK. Recovery was assessed using patient-reported outcome measures, physical performance, and organ function at 5 months and 1 year after hospital discharge, and stratified by both patient-perceived recovery and recovery cluster. Hierarchical logistic regression modelling was performed for patient-perceived recovery at 1 year. Cluster analysis was done using the clustering large applications k-medoids approach using clinical outcomes at 5 months. Inflammatory protein profiling was analysed from plasma at the 5-month visit. This study is registered on the ISRCTN Registry, ISRCTN10980107, and recruitment is ongoing. FINDINGS 2320 participants discharged from hospital between March 7, 2020, and April 18, 2021, were assessed at 5 months after discharge and 807 (32·7%) participants completed both the 5-month and 1-year visits. 279 (35·6%) of these 807 patients were women and 505 (64·4%) were men, with a mean age of 58·7 (SD 12·5) years, and 224 (27·8%) had received invasive mechanical ventilation (WHO class 7-9). The proportion of patients reporting full recovery was unchanged between 5 months (501 [25·5%] of 1965) and 1 year (232 [28·9%] of 804). Factors associated with being less likely to report full recovery at 1 year were female sex (odds ratio 0·68 [95% CI 0·46-0·99]), obesity (0·50 [0·34-0·74]) and invasive mechanical ventilation (0·42 [0·23-0·76]). Cluster analysis (n=1636) corroborated the previously reported four clusters: very severe, severe, moderate with cognitive impairment, and mild, relating to the severity of physical health, mental health, and cognitive impairment at 5 months. We found increased inflammatory mediators of tissue damage and repair in both the very severe and the moderate with cognitive impairment clusters compared with the mild cluster, including IL-6 concentration, which was increased in both comparisons (n=626 participants). We found a substantial deficit in median EQ-5D-5L utility index from before COVID-19 (retrospective assessment; 0·88 [IQR 0·74-1·00]), at 5 months (0·74 [0·64-0·88]) to 1 year (0·75 [0·62-0·88]), with minimal improvements across all outcome measures at 1 year after discharge in the whole cohort and within each of the four clusters. INTERPRETATION The sequelae of a hospital admission with COVID-19 were substantial 1 year after discharge across a range of health domains, with the minority in our cohort feeling fully recovered. Patient-perceived health-related quality of life was reduced at 1 year compared with before hospital admission. Systematic inflammation and obesity are potential treatable traits that warrant further investigation in clinical trials. FUNDING UK Research and Innovation and National Institute for Health Research.
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Milosevic S, Brookes-Howell L, Gwilym BL, Waldron CA, Thomas-Jones E, Preece R, Pallmann P, Harris D, Massey I, Stewart P, Samuel K, Jones S, Cox D, Twine CP, Edwards A, Bosanquet DC. PrEdiction of Risk and Communication of outcomE followIng major lower limb amputation: a collaboratiVE study (PERCEIVE)-protocol for the PERCEIVE qualitative study. BMJ Open 2022; 12:e053159. [PMID: 35039292 PMCID: PMC8765029 DOI: 10.1136/bmjopen-2021-053159] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Deciding whether to proceed with a major lower limb amputation is life-changing and complex, and it is crucial that the right decision is made at the right time. However, medical specialists are known to poorly predict risk when assessing patients for major surgery, and there is little guidance and research regarding decisions about amputation. The process of shared decision-making between doctors and patients during surgical consultations is also little understood. Therefore, the aim of this study is to analyse in depth the communication, consent, risk prediction and decision-making process in relation to major lower limb amputation. METHODS AND ANALYSIS Consultations between patients and surgeons at which major lower limb amputation is discussed will be audio-recorded for 10-15 patients. Semi-structured follow-up interviews with patients (and relatives/carers) will then be conducted at two time points: as soon as possible/appropriate after a decision has been reached regarding surgery, and approximately 6 months later. Semi-structured interviews will also be conducted with 10-15 healthcare professionals working in the UK National Health Service (NHS) involved in amputation decision-making. This will include surgeons, anaesthetists and specialist physiotherapists at 2-4 NHS Health Boards/Trusts in Wales and England. Discourse analysis will be used to analyse the recorded consultations; interviews will be analysed thematically. Finally, workshops will be held with patients and healthcare professionals to help synthesise and interpret findings. ETHICS AND DISSEMINATION The study has been approved by Wales REC 7 (20/WA/0351). Study findings will be published in international peer-reviewed journal(s) and presented at national and international scientific meetings. Findings will also be disseminated to a wide NHS and lay audience via presentations at meetings and written summaries for key stakeholder groups.
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Affiliation(s)
| | | | - Brenig Llwyd Gwilym
- Gwent Vascular Institute, Royal Gwent Hospital, Aneurin Bevan University Health Board, Newport, UK
| | | | | | - Ryan Preece
- Department of General Surgery, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | | | - Debbie Harris
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Ian Massey
- Artifical Limb and Appliance Centre, Rookwood Hospital, Cardiff and Vale University Health Board, Cardiff, UK
| | - Philippa Stewart
- Vascular Department, Cardiff and Vale University Health Board, Cardiff, UK
| | - Katie Samuel
- Department of Anaesthesia, North Bristol NHS Trust, Bristol, UK
| | - Sian Jones
- C/O INVOLVE, Health and Care Research Wales, Cardiff, UK
| | - David Cox
- C/O INVOLVE, Health and Care Research Wales, Cardiff, UK
| | | | - Adrian Edwards
- PRIME Centre Wales, Division of Population Medicine, Cardiff University, Cardiff, UK
| | - David C Bosanquet
- Gwent Vascular Institute, Royal Gwent Hospital, Aneurin Bevan University Health Board, Newport, UK
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Gwilym BL, Waldron CA, Thomas-Jones E, Preece R, Milosevic S, Brookes-Howell L, Pallmann P, Harris D, Massey I, Burton J, Stewart P, Samuel K, Jones S, Cox D, Edwards A, Twine C, Bosanquet DC. The PERCEIVE quantitative study: PrEdiction of Risk and Communication of outcome following major lower-limb amputation: protocol for a collaboratiVE study. BJS Open 2021; 5:zrab118. [PMID: 34849576 PMCID: PMC8634116 DOI: 10.1093/bjsopen/zrab118] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 08/21/2021] [Accepted: 10/19/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Accurate prediction of outcomes following surgery with high morbidity and mortality rates is essential for informed shared decision-making between patients and clinicians. It is unknown how accurately healthcare professionals predict outcomes following major lower-limb amputation (MLLA). Several MLLA outcome-prediction tools have been developed. These could be valuable in clinical practice, but most require validation in independent cohorts before routine clinical use can be recommended. The primary aim of this study is to evaluate the accuracy of healthcare professionals' predictions of outcomes in adult patients undergoing MLLA for complications of chronic limb-threatening ischaemia (CLTI) or diabetes. Secondary aims include the validation of existing outcome-prediction tools. METHOD This study is an international, multicentre prospective observational study including adult patients undergoing a primary MLLA for CLTI or diabetes. Healthcare professionals' accuracy in predicting outcomes at 30-days (death, morbidity and MLLA revision) and 1-year (death, MLLA revision and ambulation) will be evaluated. Sixteen existing outcome-prediction tools specific to MLLA will be examined for validity. Data collection began on 1 October 2020; the end of follow-up will be 1 May 2022. The C-statistic, Hosmer-Lemeshow test, reclassification tables and Brier score will be used to evaluate the predictive performance of healthcare professionals and prediction tools, respectively. STUDY REGISTRATION AND DISSEMINATION This study will be registered locally at each centre in accordance with local policies before commencing data collection, overseen by local clinician leads. Results will be disseminated to all centres, and any subsequent presentation(s) and/or publication(s) will follow a collaborative co-authorship model.
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Affiliation(s)
- Brenig L Gwilym
- Gwent Vascular Institute, Royal Gwent Hospital, Aneurin Bevan University Health Board, Newport, UK
| | | | | | - Ryan Preece
- Department of Vascular Surgery, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | | | | | | | - Debbie Harris
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Ian Massey
- Artificial Limb and Appliance Centre, Rookwood Hospital, Cardiff and Vale University Health Board, Cardiff, UK
| | - Jo Burton
- Artificial Limb and Appliance Centre, Rookwood Hospital, Cardiff and Vale University Health Board, Cardiff, UK
| | - Philippa Stewart
- Artificial Limb and Appliance Centre, Rookwood Hospital, Cardiff and Vale University Health Board, Cardiff, UK
| | - Katie Samuel
- Department of Anaesthesia, North Bristol NHS Trust, Bristol, UK
| | - Sian Jones
- C/O INVOLVE Health and Care Research Wales, Cardiff, UK
| | - David Cox
- C/O INVOLVE Health and Care Research Wales, Cardiff, UK
| | - Adrian Edwards
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Chris Twine
- Bristol, Bath and Weston Vascular Network, North Bristol NHS Trust, Southmead Hospital, Bristol, UK
| | - David C Bosanquet
- Gwent Vascular Institute, Royal Gwent Hospital, Aneurin Bevan University Health Board, Newport, UK
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Goodwin L, Samuel K, Schofield B, Voss S, Brett SJ, Couper K, Gould D, Harrison D, Lall R, Nolan JP, Perkins GD, Soar J, Thomas M, Benger J. Airway management during in-hospital cardiac arrest in adults: UK national survey and interview study with anaesthetic and intensive care trainees. J Intensive Care Soc 2021; 22:192-197. [PMID: 34422100 PMCID: PMC8373281 DOI: 10.1177/1751143720949458] [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] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The optimal airway management strategy for in-hospital cardiac arrest is unknown. METHODS An online survey and telephone interviews with anaesthetic and intensive care trainee doctors identified by the United Kingdom Research and Audit Federation of Trainees. Questions explored in-hospital cardiac arrest frequency, grade and specialty of those attending, proportion of patients receiving advanced airway management, airway strategies immediately available, and views on a randomised trial of airway management strategies during in-hospital cardiac arrest. RESULTS Completed surveys were received from 128 hospital sites (76% response rate). Adult in-hospital cardiac arrests were attended by anaesthesia staff at 40 sites (31%), intensive care staff at 37 sites (29%) and a combination of specialties at 51 sites (40%). The majority (123/128, 96%) of respondents reported immediate access to both tracheal intubation and supraglottic airways. A bag-mask technique was used 'very frequently' or 'frequently' during in-hospital cardiac arrest by 111/128 (87%) of respondents, followed by supraglottic airways (101/128, 79%) and tracheal intubation (69/128, 54%). The majority (60/100, 60%) of respondents estimated that ≤30% of in-hospital cardiac arrest patients undergo tracheal intubation, while 34 (34%) estimated this to be between 31% and 70%. Most respondents (102/128, 80%) would be 'likely' or 'very likely' to recruit future patients to a trial of alternative airway management strategies during in-hospital cardiac arrest. Interview data identified several barriers and facilitators to conducting research on airway management in in-hospital cardiac arrest. CONCLUSIONS There is variation in airway management strategies for adult in-hospital cardiac arrest across the UK. Most respondents would be willing to take part in a randomised trial of airway management during in-hospital cardiac arrest.
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Affiliation(s)
- Laura Goodwin
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK,Laura Goodwin, University of the West of England, Faculty of Health and Applied Sciences, Room 1H14, Glenside Campus, Bristol, BS16 1DD, UK.
| | | | - Behnaz Schofield
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Sarah Voss
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Stephen J Brett
- Faculty of Medicine, Department of Surgery & Cancer, Imperial College London, London, UK
| | - Keith Couper
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK,University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Doug Gould
- Intensive Care National Audit and Research Centre (ICNARC), London, UK
| | - David Harrison
- Intensive Care National Audit and Research Centre (ICNARC), London, UK
| | - Ranjit Lall
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Jerry P Nolan
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK,Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - Gavin D Perkins
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK,University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Matthew Thomas
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Jonathan Benger
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK,University Hospitals Bristol NHS Foundation Trust, Bristol, UK
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Roberts T, Daniels J, Hulme W, Hirst R, Horner D, Lyttle MD, Samuel K, Graham B, Reynard C, Barrett M, Foley J, Cronin J, Umana E, Vinagre J, Carlton E. Psychological distress and trauma in doctors providing frontline care during the COVID-19 pandemic in the United Kingdom and Ireland: a prospective longitudinal survey cohort study. BMJ Open 2021; 11:e049680. [PMID: 34244282 PMCID: PMC8275363 DOI: 10.1136/bmjopen-2021-049680] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 06/15/2021] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES The psychological impact of the COVID-19 pandemic on doctors is a significant concern. Due to the emergence of multiple pandemic waves, longitudinal data on the impact of COVID-19 are vital to ensure an adequate psychological care response. The primary aim was to assess the prevalence and degree of psychological distress and trauma in frontline doctors during the acceleration, peak and deceleration of the COVID-19 first wave. Personal and professional factors associated with psychological distress are also reported. DESIGN A prospective online three-part longitudinal survey. SETTING Acute hospitals in the UK and Ireland. PARTICIPANTS Frontline doctors working in emergency medicine, anaesthetics and intensive care medicine during the first wave of the COVID-19 pandemic in March 2020. PRIMARY OUTCOME MEASURES Psychological distress and trauma measured using the General Health Questionnaire-12 and the Impact of Events-Revised. RESULTS The initial acceleration survey distributed across networks generated a sample of 5440 doctors. Peak and deceleration response rates from the original sample were 71.6% (n=3896) and 56.6% (n=3079), respectively. Prevalence of psychological distress was 44.7% (n=1334) during the acceleration, 36.9% (n=1098) at peak and 31.5% (n=918) at the deceleration phase. The prevalence of trauma was 23.7% (n=647) at peak and 17.7% (n=484) at deceleration. The prevalence of probable post-traumatic stress disorder was 12.6% (n=343) at peak and 10.1% (n=276) at deceleration. Worry of family infection due to clinical work was the factor most strongly associated with both distress (R2=0.06) and trauma (R2=0.10). CONCLUSION Findings reflect a pattern of elevated distress at acceleration and peak, with some natural recovery. It is essential that policymakers seek to prevent future adverse effects through (a) provision of vital equipment to mitigate physical and psychological harm, (b) increased awareness and recognition of signs of psychological distress and (c) the development of clear pathways to effective psychological care. TRIAL REGISTRATION NUMBER ISRCTN10666798.
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Affiliation(s)
- Tom Roberts
- TERN, The Royal College of Emergency Medicine, London, UK
- Emergency Department, Bristol Royal Hospital for Children, Bristol, UK
| | - Jo Daniels
- Department of Psychology, University of Bath, Bath, UK
| | | | - Robert Hirst
- Department of Anaesthesia, North Bristol NHS Trust, Westbury on Trym, UK
| | - Daniel Horner
- Department of Intensive Care, Salford Royal Hospitals NHS Trust, Salford, UK
| | - Mark David Lyttle
- Emergency Department, Bristol Royal Hospital for Children, Bristol, UK
- Faculty of Health and Applied Science, University of the West of England, Bristol, UK
| | - Katie Samuel
- Department of Anaesthesia, North Bristol NHS Trust, Westbury on Trym, UK
| | - Blair Graham
- Emergency Department, Plymouth Hospitals NHS Foundation Trust, Plymouth, UK
- Urgent and Emergency Care, University of Plymouth, Plymouth, UK
| | | | - Michael Barrett
- School of Medicine, University College Dublin, Dublin, Ireland
- Emergency Department, Children's Health Ireland at Crumlin, Crumlin, Ireland
| | - James Foley
- Emergency Department, University Hospital Waterford, Waterford, Ireland
| | - John Cronin
- Emergency Department, St Vincent's University Hospital, Dublin, Ireland
| | - Etimbuk Umana
- Emergency Department, Connolly Hospital Blanchardstown, Blanchardstown, Ireland
| | - Joao Vinagre
- College of Anaesthesiologists of Ireland, Dublin, Ireland
| | - Edward Carlton
- Emergency Department, North Bristol NHS Trust, Westbury on Trym, UK
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15
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Roberts T, Daniels J, Hulme W, Hirst R, Horner D, Lyttle MD, Samuel K, Graham B, Reynard C, Barrett M, Foley J, Cronin J, Umana E, Vinagre J, Carlton E. Psychological distress during the acceleration phase of the COVID-19 pandemic: a survey of doctors practising in emergency medicine, anaesthesia and intensive care medicine in the UK and Ireland. Emerg Med J 2021; 38:450-459. [PMID: 33832926 PMCID: PMC8042593 DOI: 10.1136/emermed-2020-210438] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [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: 07/20/2020] [Revised: 02/24/2021] [Accepted: 03/03/2021] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To quantify psychological distress experienced by emergency, anaesthetic and intensive care doctors during the acceleration phase of COVID-19 in the UK and Ireland. METHODS Initial cross-sectional electronic survey distributed during acceleration phase of the first pandemic wave of COVID-19 in the UK and Ireland (UK: 18 March 2020-26 March 2020 and Ireland: 25 March 2020-2 April 2020). Surveys were distributed via established specialty research networks, within a three-part longitudinal study. Participants were doctors working in emergency, anaesthetic and intensive medicine during the first pandemic wave of COVID-19 in acute hospitals across the UK and Ireland. Primary outcome measures were the General Health Questionnaire-12 (GHQ-12). Additional questions examined personal and professional characteristics, experiences of COVID-19 to date, risk to self and others and self-reported perceptions of health and well-being. RESULTS 5440 responses were obtained, 54.3% (n=2955) from emergency medicine and 36.9% (n=2005) from anaesthetics. All levels of doctor seniority were represented. For the primary outcome of GHQ-12 score, 44.2% (n=2405) of respondents scored >3, meeting the criteria for psychological distress. 57.3% (n=3045) had never previously provided clinical care during an infectious disease outbreak but over half of respondents felt somewhat prepared (48.6%, n=2653) or very prepared (7.6%, n=416) to provide clinical care to patients with COVID-19. However, 81.1% (n=4414) either agreed (31.1%, n=2709) or strongly agreed (31.1%, n=1705) that their personal health was at risk due to their clinical role. CONCLUSIONS Findings indicate that during the acceleration phase of the COVID-19 pandemic, almost half of frontline doctors working in acute care reported psychological distress as measured by the GHQ-12. Findings from this study should inform strategies to optimise preparedness and explore modifiable factors associated with increased psychological distress in the short and long term. TRIAL REGISTRATION NUMBER ISRCTN10666798.
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Affiliation(s)
- Tom Roberts
- TERN, Royal College of Emergency Medicine, London, UK
- Emergency Department, Bristol Royal Hospital for Children, Bristol, UK
| | - Jo Daniels
- Department of Psychology, University of Bath, Bath, Somerset, UK
| | | | - Robert Hirst
- Department of Anaesthesia, North Bristol NHS Trust, Bristol, UK
| | - Daniel Horner
- TERN, Royal College of Emergency Medicine, London, UK
- Department of Intensive Care and Emergency Department, Salford Royal NHS Foundation Trust, Salford, UK
| | - Mark D Lyttle
- Emergency Department, Bristol Royal Hospital for Children, Bristol, UK
- UWE Faculty of Health and Applied Sciences, Bristol, UK
| | - Katie Samuel
- Department of Anaesthesia, North Bristol NHS Trust, Westbury on Trym, Bristol, UK
| | - Blair Graham
- Faculty of Health and Human Sciences, University of Plymouth Faculty of Health and Human Sciences, Plymouth, UK
- Emergency Department, Derriford Hospital, Plymouth, UK
| | - Charlie Reynard
- Division of Cardiovascular Sciences, University of Manchester, Manchester, UK
| | - Michael Barrett
- Department of Emergency Medicine, Our Lady's Children's Hospital, Dublin, Ireland
- Department of Women's and Children's Health, University College Dublin, Dublin, Ireland
| | - James Foley
- Department of Emergency Medicine, University Hospital Waterford, Waterford, Ireland
| | - John Cronin
- Department of Emergency Medicine, St Vincents University Hospital, Dublin, Ireland
- Department of Women's and Children's Health, University College Dublin School of Medicine, Dublin, Ireland
| | - Etimbuk Umana
- Emergency Department, Connolly Hospital Blanchardstown, Blanchardstown, Dublin, Ireland
| | - Joao Vinagre
- College of Anaesthesiologists of Ireland, Dublin, Ireland
| | - Edward Carlton
- Emergency Department, North Bristol NHS Trust, Westbury on Trym, UK
- School of Health and Social Care, University of the West of England Bristol, Bristol, UK
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16
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Roberts T, Hirst R, Sammut-Powell C, Reynard C, Daniels J, Horner D, Lyttle MD, Samuel K, Graham B, Barrett MJ, Foley J, Cronin J, Umana E, Vinagre J, Carlton E. Psychological distress and trauma during the COVID-19 pandemic: survey of doctors practising anaesthesia, intensive care medicine, and emergency medicine in the United Kingdom and Republic of Ireland. Br J Anaesth 2021; 127:e78-e80. [PMID: 34176596 PMCID: PMC9339913 DOI: 10.1016/j.bja.2021.05.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 05/16/2021] [Accepted: 05/17/2021] [Indexed: 01/12/2023] Open
Affiliation(s)
- Tom Roberts
- Royal College of Emergency Medicine, London, UK; Emergency Department, North Bristol NHS Trust, Bristol, UK.
| | - Robert Hirst
- Royal College of Emergency Medicine, London, UK; Emergency Department, Musgrove Park Hospital, Somerset NHS, Somerset, UK
| | - Camilla Sammut-Powell
- Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Charles Reynard
- Department of Cardiovascular Sciences, University of Manchester, Manchester, UK
| | - Jo Daniels
- Department of Psychology, University of Bath, Bath, UK
| | - Daniel Horner
- Royal College of Emergency Medicine, London, UK; Department of Intensive Care and Emergency Department, Salford Royal Hospital NHS Foundation Trust, Salford, UK
| | - Mark D Lyttle
- Bristol Royal Hospital for Children, Bristol, UK; Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Katie Samuel
- Department of Anaesthesia, North Bristol NHS Trust, Bristol, UK
| | - Blair Graham
- Faculty of Health, University of Plymouth, Plymouth, UK; Emergency Department, University Hospitals Plymouth, UK
| | - Michael J Barrett
- Department of Emergency Medicine, Children's Health Ireland at Crumlin, Crumlin, Ireland; School of Medicine, Women's and Children's Health, University College Dublin, Dublin, Ireland
| | - James Foley
- Emergency Department, University Hospital Waterford, Waterford, Ireland
| | - John Cronin
- School of Medicine, Women's and Children's Health, University College Dublin, Dublin, Ireland; Department of Emergency Medicine, St Vincent's University Hospital, Dublin, Ireland
| | - Etimbuk Umana
- Emergency Department, Connolly Hospital Blanchardstown, Dublin, Ireland
| | - Joao Vinagre
- College of Anaesthesiologists of Ireland, Dublin, Ireland
| | - Edward Carlton
- Royal College of Emergency Medicine, London, UK; Emergency Department, North Bristol NHS Trust, Bristol, UK
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17
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Gwilym B, Waldron C, Thomas-Jones E, Pallmann P, Preece R, Brookes-Howell L, Milosevic S, Edwards A, Twine C, Massey I, Burton J, Harris D, Samuel K, Dilaver N, Day S, Bosanquet D. P90 PERCEIVE: PrEdiction of Risk and Communication of outcome following major lower limb amputation - a collaboratIVE study. BJS Open 2021. [PMCID: PMC8030154 DOI: 10.1093/bjsopen/zrab032.089] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Introduction Major Lower Limb Amputation (MLLA) is a life changing event with significant morbidity and mortality. Inaccurate risk prediction can lead to poor decision making, resulting in delay to definitive surgery, or undertaking amputation when not in the patient’s best interest. We aim to answer: In adult patients undergoing MLLA for chronic limb threatening ischaemia or diabetes, how accurately do health care professionals prospectively predict outcomes after MLLA, and how does this compare to existing prediction tools? Methods A multicentre prospective observational cohort study is being delivered through the Vascular and Endovascular Research Network. Dissemination was via an existing network of contacts and social media. Consecutive data will be collected for seven months from site launch date, including demographic data and pre-operative outcome predictions from surgeons, anaesthetists, and allied healthcare professionals. Follow-up data will comprise 30-day (mortality, morbidity, MLLA revision, surgical site infection, and blood transfusion) and 1-year (mortality, MLLA revision and ambulation). The accuracy of surgeons’ predictions will be evaluated and compared to pre-existing risk prediction scoring tools. Results PERCEIVE launched on 01/10/2020 with 23 centres (16 UK, 7 international) registered to collect data. 50 other centres (27 UK, 23 international) have expressed interest/are pursuing local audit/ethical approval. We aim to collect data on clinicians estimate of outcomes for over 500 patients. Discussion This study will utilise a trainee research network to provide data on the accuracy of healthcare professionals’ predictions of outcomes following MLLA and compare this to the utility of existing prediction tools in this patient cohort.
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Affiliation(s)
- B Gwilym
- South East Wales Vascular Network
| | | | | | | | - R Preece
- South East Wales Vascular Network
| | | | | | | | - C Twine
- South East Wales Vascular Network
| | - I Massey
- South East Wales Vascular Network
| | - J Burton
- South East Wales Vascular Network
| | - D Harris
- South East Wales Vascular Network
| | - K Samuel
- South East Wales Vascular Network
| | | | - S Day
- South East Wales Vascular Network
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18
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Roberts T, Daniels J, Hulme W, Horner D, Lyttle MD, Samuel K, Graham B, Hirst R, Reynard C, Barrett M, Carlton E. COVID-19 emergency response assessment study: a prospective longitudinal survey of frontline doctors in the UK and Ireland: study protocol. BMJ Open 2020; 10:e039851. [PMID: 32788191 PMCID: PMC7422647 DOI: 10.1136/bmjopen-2020-039851] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/22/2020] [Accepted: 07/23/2020] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION The COVID-19 pandemic is putting an unprecedented strain on healthcare systems globally. The psychological impact on frontline doctors of dealing with the COVID-19 pandemic is currently unknown. This longitudinal professional survey aims to understand the evolving and cumulative effects of working during the COVID-19 outbreak on the psychological well-being of doctors working in emergency departments (ED), intensive care units (ICU) and anaesthetics during the pandemic. METHODS AND ANALYSIS This study is a longitudinal questionnaire-based study with three predefined time points spanning the acceleration, peak and deceleration phases of the COVID-19 pandemic.The primary outcomes are psychological distress and post-trauma stress as measured by the General Health Questionnaire-12 (GHQ-12) and Impact of Events Scale-Revised (IES-R). Data related to personal and professional characteristics will also be collected. Questionnaires will be administered prospectively to all doctors working in ED, ICU and anaesthetics in the UK and Ireland via existing research networks during the sampling period. Data from the questionnaires will be analysed to assess the prevalence and degree of psychological distress and trauma, and the nature of the relationship between personal and professional characteristics and the primary outcomes. Data will be described, analysed and disseminated at each time point; however, the primary endpoint will be psychological distress and trauma at the final time point. ETHICS AND DISSEMINATION Ethical approval was obtained from the University of Bath, UK (ref: 4421), and Children's Health Ireland at Crumlin, Ethics Committee. Regulatory approval from the Health Regulation Authority (UK), Health and Care Research Wales (IRAS: 281944).This study is limited by the fact that it focuses on doctors only and is survey based without further qualitative interviews of participants. It is expected this study will provide clear evidence of the psychological impact of COVID-19 on doctors and will allow present and future planning to mitigate against any psychological impact. TRIAL REGISTRATION NUMBER ISRCTN10666798.
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Affiliation(s)
- Tom Roberts
- Trainee Emergency Research Network, The Royal College of Emergency Medicine, London, UK
- Emergency Department, Bristol Royal Hospital for Children, Bristol, UK
| | - Jo Daniels
- Department of Psychology, University of Bath, Bath, Somerset, UK
| | | | - Daniel Horner
- Trainee Emergency Research Network, The Royal College of Emergency Medicine, London, UK
- Department of Intensive Care, Salford Royal Hospitals NHS Trust, Salford, UK
| | - Mark David Lyttle
- Emergency Department, Bristol Royal Hospital for Children, Bristol, UK
- Faculty of Health and Applied Science, University of the West of England, Bristol, UK
| | - Katie Samuel
- Department of Anaesthesia, North Bristol NHS Trust, Westbury on Trym, Bristol, UK
| | - Blair Graham
- Faculty of Health, University of Plymouth, Plymouth, Devon, UK
- Emergency Department, Plymouth Hospitals NHS Foundation Trust, Plymouth, UK
| | - Robert Hirst
- Department of Anaesthesia, North Bristol NHS Trust, Westbury on Trym, Bristol, UK
| | - Charles Reynard
- Department of Cardviovascular Sciences, The University of Manchester, Manchester, UK
| | - Michael Barrett
- School of Medicine, Women's and Children's Health, University College Dublin, Dublin, Ireland
| | - Edward Carlton
- Trainee Emergency Research Network, The Royal College of Emergency Medicine, London, UK
- Emergency Department, North Bristol NHS Trust, Westbury on Trym, UK
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Cooper R, Wilkie G, Samuel K, McMillan L, Vickers M, Turner M, Campbell J, Fraser A. Therapeutic EBV-specific T cell cytotoxicity against allogeneic LCLs in vitro directly correlates to intracellular IFNγ/TNFα expression in response to EBV peptide stimulation. Cytotherapy 2020. [DOI: 10.1016/j.jcyt.2020.03.230] [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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Samuel K, Ellicott H. Gender inequality in research: does UK trainee-led research herald an equal future? Br J Anaesth 2020; 124:e77-e78. [DOI: 10.1016/j.bja.2019.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 12/13/2019] [Accepted: 12/15/2019] [Indexed: 11/29/2022] Open
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Affiliation(s)
- Katie Samuel
- ST7 Anaesthetics, Southmead Hospital, North Bristol Trust, Bristol BS10 5NB
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22
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Affiliation(s)
- Katie Samuel
- ST6 Anaesthesia and Perioperative Medicine Fellow, Department of Anaesthesia and Critical Care, University College London Hospitals NHS Foundation Trust, London W1G 8PH
| | - Andrew Rogerson
- POPS Clinical Fellow, Department of Geriatrics, Guys and St Thomas' Hospital, London
| | - Ana-Catarina Pinho-Gomes
- ST2 Cardiothoracic Surgery, Department of Cardiothoracic Surgery, University Hospital of South Manchester NHS Foundation Trust, Manchester
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Samuel K, Mead K, Cominos T, Weale N. Spinal anaesthesia for elective caesarean section in a patient with hereditary neuropathy with liability to pressure palsies. Int J Obstet Anesth 2019; 40:162-163. [PMID: 31229414 DOI: 10.1016/j.ijoa.2019.05.004] [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: 04/14/2019] [Revised: 04/25/2019] [Accepted: 05/08/2019] [Indexed: 10/26/2022]
Affiliation(s)
- K Samuel
- Department of Anaesthesia, North Bristol NHS Trust, Bristol, UK.
| | - K Mead
- Department of Anaesthesia, North Bristol NHS Trust, Bristol, UK
| | - T Cominos
- Department of Anaesthesia, North Bristol NHS Trust, Bristol, UK
| | - N Weale
- Department of Anaesthesia, North Bristol NHS Trust, Bristol, UK
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24
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Morgan K, Fassoula V, Samuel K, Morley SD, Hayes PC, Plevris JN. Letter to the editor: 'Human based systems: Mechanistic NASH modelling just around the corner?'. Pharmacol Res 2018; 137:280-281. [PMID: 30315964 DOI: 10.1016/j.phrs.2018.09.028] [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: 09/17/2018] [Accepted: 09/28/2018] [Indexed: 11/25/2022]
Affiliation(s)
- K Morgan
- University of Edinburgh Hepatology Laboratory, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, United Kingdom.
| | - V Fassoula
- University of Edinburgh Hepatology Laboratory, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, United Kingdom.
| | - K Samuel
- Scottish National Blood Transfusion Service, Advanced Therapeutics, Jack Copland Centre, 52 Research Avenue North, Edinburgh, EH14 4BE, United Kingdom.
| | - S D Morley
- University of Edinburgh Hepatology Laboratory, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, United Kingdom.
| | - P C Hayes
- University of Edinburgh Hepatology Laboratory, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, United Kingdom.
| | - J N Plevris
- University of Edinburgh Hepatology Laboratory, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, United Kingdom.
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25
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Paulus A, Akhtar S, Caulfield TR, Samuel K, Yousaf H, Bashir Y, Paulus SM, Tran D, Hudec R, Cogen D, Jiang J, Edenfield B, Novak A, Ansell SM, Witzig T, Martin P, Coleman M, Roy V, Ailawadhi S, Chitta K, Linder S, Chanan-Khan A. Coinhibition of the deubiquitinating enzymes, USP14 and UCHL5, with VLX1570 is lethal to ibrutinib- or bortezomib-resistant Waldenstrom macroglobulinemia tumor cells. Blood Cancer J 2016; 6:e492. [PMID: 27813535 PMCID: PMC5148058 DOI: 10.1038/bcj.2016.93] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 07/21/2016] [Accepted: 08/22/2016] [Indexed: 01/30/2023] Open
Abstract
The survival of Waldenstrom macroglobulinemia (WM) tumor cells hinges on aberrant B-cell receptor (BCR) and MYD88 signaling. WM cells upregulate the proteasome function to sustain the BCR-driven growth while maintaining homeostasis. Clinically, two treatment strategies are used to disrupt these complementary yet mutually exclusive WM survival pathways via ibrutinib (targets BTK/MYD88 node) and bortezomib (targets 20 S proteasome). Despite the success of both agents, WM patients eventually become refractory to treatment, highlighting the adaptive plasticity of WM cells and underscoring the need for development of new therapeutics. Here we provide a comprehensive preclinical report on the anti-WM activity of VLX1570, a novel small-molecule inhibitor of the deubiquitinating enzymes (DUBs), ubiquitin-specific protease 14 (USP14) and ubiquitin carboxyl-terminal hydrolase isozyme L5 (UCHL5). Both DUBs reside in the 19 S proteasome cap and their inhibition by VLX1570 results in rapid and tumor-specific apoptosis in bortezomib- or ibrutinib-resistant WM cells. Notably, treatment of WM cells with VLX1570 downregulated BCR-associated elements BTK, MYD88, NFATC, NF-κB and CXCR4, the latter whose dysregulated function is linked to ibrutinib resistance. VLX1570 administered to WM-xenografted mice resulted in decreased tumor burden and prolonged survival (P=0.0008) compared with vehicle-treated mice. Overall, our report demonstrates significant value in targeting USP14/UCHL5 with VLX1570 in drug-resistant WM and carries a high potential for clinical translation.
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Affiliation(s)
- A Paulus
- Department of Cancer Biology, Mayo Clinic, Jacksonville, FL, USA.,Division of Hematology and Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - S Akhtar
- Department of Cancer Biology, Mayo Clinic, Jacksonville, FL, USA
| | - T R Caulfield
- Department of Molecular Neuroscience, Mayo Clinic, Jacksonville, FL, USA
| | - K Samuel
- Department of Cancer Biology, Mayo Clinic, Jacksonville, FL, USA
| | - H Yousaf
- Department of Cancer Biology, Mayo Clinic, Jacksonville, FL, USA
| | - Y Bashir
- Department of Cancer Biology, Mayo Clinic, Jacksonville, FL, USA
| | - S M Paulus
- Department of Cancer Biology, Mayo Clinic, Jacksonville, FL, USA
| | - D Tran
- Department of Cancer Biology, Mayo Clinic, Jacksonville, FL, USA
| | - R Hudec
- Department of Molecular Neuroscience, Mayo Clinic, Jacksonville, FL, USA
| | - D Cogen
- Department of Cancer Biology, Mayo Clinic, Jacksonville, FL, USA
| | - J Jiang
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, FL, USA
| | - B Edenfield
- Department of Cancer Biology, Mayo Clinic, Jacksonville, FL, USA
| | - A Novak
- Department of Hematology and Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - S M Ansell
- Department of Hematology and Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - T Witzig
- Department of Hematology and Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - P Martin
- Department of Medicine, Weill Cornell Medical College, Cornell, NY, USA
| | - M Coleman
- Department of Medicine, Weill Cornell Medical College, Cornell, NY, USA
| | - V Roy
- Division of Hematology and Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - S Ailawadhi
- Division of Hematology and Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - K Chitta
- Department of Cancer Biology, Mayo Clinic, Jacksonville, FL, USA
| | - S Linder
- Institute for Oncology-Pathology, Cancer Center Karolinska, Karolinska Institute, Stockholm, Sweden
| | - A Chanan-Khan
- Department of Cancer Biology, Mayo Clinic, Jacksonville, FL, USA.,Division of Hematology and Oncology, Mayo Clinic, Jacksonville, FL, USA
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Krjutškov K, Katayama S, Saare M, Vera-Rodriguez M, Lubenets D, Samuel K, Laisk-Podar T, Teder H, Einarsdottir E, Salumets A, Kere J. Single-cell transcriptome analysis of endometrial tissue. Hum Reprod 2016; 31:844-53. [PMID: 26874359 PMCID: PMC4791917 DOI: 10.1093/humrep/dew008] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 01/11/2016] [Indexed: 12/22/2022] Open
Abstract
STUDY QUESTION How can we study the full transcriptome of endometrial stromal and epithelial cells at the single-cell level? SUMMARY ANSWER By compiling and developing novel analytical tools for biopsy, tissue cryopreservation and disaggregation, single-cell sorting, library preparation, RNA sequencing (RNA-seq) and statistical data analysis. WHAT IS KNOWN ALREADY Although single-cell transcriptome analyses from various biopsied tissues have been published recently, corresponding protocols for human endometrium have not been described. STUDY DESIGN, SIZE, DURATION The frozen-thawed endometrial biopsies were fluorescence-activated cell sorted (FACS) to distinguish CD13-positive stromal and CD9-positive epithelial cells and single-cell transcriptome analysis performed from biopsied tissues without culturing the cells. We studied gene transcription, applying a modern and efficient RNA-seq protocol. In parallel, endometrial stromal cells were cultured and global expression profiles were compared with uncultured cells. PARTICIPANTS/MATERIALS, SETTING, METHODS For method validation, we used two endometrial biopsies, one from mid-secretory phase (Day 21, LH+8) and another from late-secretory phase (Day 25). The samples underwent single-cell FACS sorting, single-cell RNA-seq library preparation and Illumina sequencing. MAIN RESULTS AND THE ROLE OF CHANCE Here we present a complete pipeline for single-cell gene-expression studies, from clinical sampling to statistical data analysis. Tissue manipulation, starting from disaggregation and cell-type-specific labelling and ending with single-cell automated sorting, is managed within 90 min at low temperature to minimize changes in the gene expression profile. The single living stromal and epithelial cells were sorted using CD13- and CD9-specific antibodies, respectively. Of the 8622 detected genes, 2661 were more active in cultured stromal cells than in biopsy cells. In the comparison of biopsy versus cultured cells, 5603 commonly expressed genes were detected, with 241 significantly differentially expressed genes. Of these, 231 genes were up- and 10 down-regulated in cultured cells, respectively. In addition, we performed a gene ontology analysis of the differentially expressed genes and found that these genes are mainly related to cell cycle, translational processes and metabolism. LIMITATIONS, REASONS FOR CAUTION Although CD9-positive single epithelial cells sorting was successfully established in our laboratory, the amount of transcriptome data per individual epithelial cell was low, complicating further analysis. This step most likely failed due to the high dose of RNases that are released by the cells' natural processes, or due to rapid turnaround time or the apoptotic conditions in freezing- or single-cell solutions. Since only the cells from the late-secretory phase were subject to more focused analysis, further studies including larger sample size from the different time-points of the natural menstrual cycle are needed. The methodology also needs further optimization to examine different cell types at high quality. WIDER IMPLICATIONS OF THE FINDINGS The symbiosis between clinical biopsy and the sophisticated laboratory and bioinformatic protocols described here brings together clinical diagnostic needs and modern laboratory and bioinformatic solutions, enabling us to implement a precise analytical toolbox for studying the endometrial tissue even at the single-cell level.
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Affiliation(s)
- K Krjutškov
- Competence Centre on Health Technologies, Tartu 50410, Estonia Department of Biosciences and Nutrition, and Center for Innovative Medicine, Karolinska Institutet, Huddinge 141 83, Sweden
| | - S Katayama
- Department of Biosciences and Nutrition, and Center for Innovative Medicine, Karolinska Institutet, Huddinge 141 83, Sweden
| | - M Saare
- Competence Centre on Health Technologies, Tartu 50410, Estonia Department of Obstetrics and Gynaecology, University of Tartu, Tartu 51014, Estonia
| | | | - D Lubenets
- Institute of Molecular and Cell Biology, University of Tartu, Tartu 51010, Estonia
| | - K Samuel
- Competence Centre on Health Technologies, Tartu 50410, Estonia
| | - T Laisk-Podar
- Competence Centre on Health Technologies, Tartu 50410, Estonia Department of Obstetrics and Gynaecology, University of Tartu, Tartu 51014, Estonia
| | - H Teder
- Competence Centre on Health Technologies, Tartu 50410, Estonia
| | - E Einarsdottir
- Department of Biosciences and Nutrition, and Center for Innovative Medicine, Karolinska Institutet, Huddinge 141 83, Sweden Molecular Neurology Research Program, University of Helsinki and Folkhälsan Institute of Genetics, Helsinki 00014, Finland
| | - A Salumets
- Competence Centre on Health Technologies, Tartu 50410, Estonia Department of Obstetrics and Gynaecology, University of Tartu, Tartu 51014, Estonia Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu 50411, Estonia
| | - J Kere
- Department of Biosciences and Nutrition, and Center for Innovative Medicine, Karolinska Institutet, Huddinge 141 83, Sweden Molecular Neurology Research Program, University of Helsinki and Folkhälsan Institute of Genetics, Helsinki 00014, Finland
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Brzeszczynska J, Samuel K, Greenhough S, Ramaesh K, Dhillon B, Hay DC, Ross JA. Differentiation and molecular profiling of human embryonic stem cell-derived corneal epithelial cells. Int J Mol Med 2014; 33:1597-606. [PMID: 24676408 DOI: 10.3892/ijmm.2014.1714] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 02/14/2014] [Indexed: 11/06/2022] Open
Abstract
It has been suggested that the isolation of scalable populations of limbal stem cells may lead to radical changes in ocular therapy. In particular, the derivation and transplantation of corneal stem cells from these populations may result in therapies providing clinical normality of the diseased or damaged cornea. Although feasible in theory, the lack of donor material in sufficient quantity and quality currently limits such a strategy. A potential scalable source of corneal cells could be derived from pluripotent stem cells (PSCs). We developed an in vitro and serum-free corneal differentiation model which displays significant promise. Our stepwise differentiation model was designed with reference to development and gave rise to cells which displayed similarities to epithelial progenitor cells which can be specified to cells displaying a corneal epithelial phenotype. We believe our approach is novel, provides a robust model of human development and in the future, may facilitate the generation of corneal epithelial cells that are suitable for clinical use. Additionally, we demonstrate that following continued cell culture, stem cell-derived corneal epithelial cells undergo transdifferentiation and exhibit squamous metaplasia and therefore, also offer an in vitro model of disease.
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Affiliation(s)
- J Brzeszczynska
- Tissue Injury and Repair Group, MRC Centre for Regenerative Medicine, Chancellor's Building, University of Edinburgh, Edinburgh EH16 4SB, Scotland, UK
| | - K Samuel
- SNBTS Cellular Therapy Group, MRC Centre for Regenerative Medicine, Chancellor's Building, University of Edinburgh, Edinburgh EH16 4SB, Scotland, UK
| | - S Greenhough
- Pluripotent Stem Cell Hepatocyte Development Group, MRC Centre for Regenerative Medicine, Chancellor's Building, University of Edinburgh, Edinburgh EH16 4SB, Scotland, UK
| | - K Ramaesh
- Tennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow G12 0YN, Scotland, UK
| | - B Dhillon
- Department of Clinical and Surgical Sciences, Ophthalmology Section, Princess Alexandra Eye Pavilion, Royal Infirmary of Edinburgh, Edinburgh EH3 9HA, Scotland, UK
| | - D C Hay
- Pluripotent Stem Cell Hepatocyte Development Group, MRC Centre for Regenerative Medicine, Chancellor's Building, University of Edinburgh, Edinburgh EH16 4SB, Scotland, UK
| | - J A Ross
- Tissue Injury and Repair Group, MRC Centre for Regenerative Medicine, Chancellor's Building, University of Edinburgh, Edinburgh EH16 4SB, Scotland, UK
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Liu J, Samuel K, Turner ML, Gallagher RCJ. Use of IL3 and chromatin-modifying reagents valproic acid and 5-aza-2′-deoxycytidine to affect mobilized peripheral blood CD34+cell fate decisions. Vox Sang 2014; 107:83-9. [DOI: 10.1111/vox.12124] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 11/08/2013] [Accepted: 11/14/2013] [Indexed: 01/13/2023]
Affiliation(s)
- J. Liu
- Scottish National Blood Transfusion Service (SNBTS) Cell Therapy Group; MRC Centre for Regenerative Medicine; Edinburgh UK
| | - K. Samuel
- Scottish National Blood Transfusion Service (SNBTS) Cell Therapy Group; MRC Centre for Regenerative Medicine; Edinburgh UK
| | - M. L. Turner
- Scottish National Blood Transfusion Service (SNBTS) Cell Therapy Group; MRC Centre for Regenerative Medicine; Edinburgh UK
| | - R. C. J. Gallagher
- Scottish National Blood Transfusion Service (SNBTS) Cell Therapy Group; MRC Centre for Regenerative Medicine; Edinburgh UK
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Mylonas KJ, McGregor K, White C, Brooker G, Samuel K, Borthwick G, Hadoke PWF, Chapman KC, Walker BR, Gray GA. MYELOID CELL 11β-HSD1 REGULATES THE INFLAMMATORY RESPONSE DURING MYOCARDIAL INFARCT HEALING AND PROTECTS THE HEART FROM DETRIMENTAL REMODELLING AFTER IRRADIATION AND BONE MARROW TRANSFER. Heart 2012. [DOI: 10.1136/heartjnl-2012-303148a.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] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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30
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Blacking TM, Waterfall M, Samuel K, Argyle DJ. Flow cytometric techniques for detection of candidate cancer stem cell subpopulations in canine tumour models. Vet Comp Oncol 2011; 10:252-73. [DOI: 10.1111/j.1476-5829.2011.00293.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Reddy VBG, Doss GA, Karanam BV, Samuel K, Lanza TJ, Lin LS, Yu NX, Zhang AS, Raab CE, Stearns RA, Kumar S. In vitro and in vivo metabolism of a novel cannabinoid-1 receptor inverse agonist, taranabant, in rats and monkeys. Xenobiotica 2011; 40:650-62. [PMID: 20608842 DOI: 10.3109/00498254.2010.501117] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The metabolism and excretion of taranabant (MK-0364, N-[(1S,2S)-3-(4-chlorophenyl)-2-(3-cyanophenyl)-1-methylpropyl]-2-methyl-2{[5-(trifluoromethyl)pyridine-2-yl]oxy}propanamide), a potent cannabinoid-1 receptor inverse agonist, were evaluated in rats and rhesus monkeys. Following administration of [¹⁴C]taranabant, the majority of the radioactivity was excreted within 72 h. In both rats and rhesus monkeys, taranabant was eliminated primarily via oxidative metabolism, followed by excretion of metabolites into bile. Major pathways of metabolism that were common to rats and rhesus monkeys included hydroxylation at the benzylic carbon adjacent to the cyanophenyl ring to form a biologically active circulating metabolite M1, and oxidation of one of the two geminal methyl groups of taranabant or M1 to the corresponding diastereomeric carboxylic acids. Oxidation of the cyanophenyl ring, followed by conjugation with glutathione or glucuronic acid, was a major pathway of metabolism only in the rat and was not detected in the rhesus monkey. Metabolism profiles of taranabant in liver microsomes in vitro were qualitatively similar in rats, rhesus monkeys and humans and included formation of M1 and oxidation of taranabant or M1 to the corresponding carboxylic acids via oxidation of a geminal methyl group. In human liver microsomes, metabolism of taranabant was mediated primarily by CYP3A4.
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Affiliation(s)
- V B G Reddy
- Drug Metabolism and Pharmacokinetics, Merck Research Laboratories, Rahway, NJ 07065, USA.
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Tura O, Crawford J, Barclay GR, Samuel K, Hadoke PWF, Roddie H, Davies J, Turner ML. Granulocyte colony-stimulating factor (G-CSF) depresses angiogenesis in vivo and in vitro: implications for sourcing cells for vascular regeneration therapy. J Thromb Haemost 2010; 8:1614-23. [PMID: 20456757 PMCID: PMC3404501 DOI: 10.1111/j.1538-7836.2010.03900.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
SUMMARY BACKGROUND The most common source of hematopoietic progenitor cells (HPCs) for hematopoietic reconstitution comprises granulocyte colony-stimulating factor (G-CSF)-mobilized peripheral blood stem cells (PBSCs). It has been proposed that endothelial progenitor cells (EPCs) share precursors with HPCs, and that EPC release may accompany HPC mobilization to the circulation following G-CSF administration. OBJECTIVE To investigate EPC activity following HPC mobilization, and the direct effects of exogenous G-CSF administration on human umbilical vein endothelial cells (HUVECs) and endothelial outgrowth cells (EOCs), using in vitro and in vivo correlates of angiogenesis. PATIENTS/METHODS Heparinized venous blood samples were collected from healthy volunteers and from cord blood at parturition. G-CSF-mobilized samples were collected before administration, at apheresis harvest, and at follow-up. PBSCs were phenotyped by flow cytometry, and cultured in standard colony-forming unit (CFU)-EPC and EOC assays. The effect of exogenous G-CSF was investigated by addition of it to HUVECs and EOCs in standard tubule formation and aortic ring assays, and in an in vivo sponge implantation model. RESULTS Our data show that G-CSF mobilization of PBSCs produces a profound, reversible depression of circulating CFU-EPCs. Furthermore, G-CSF administration did not mobilize CD34+CD133- cells, which include precursors of EOCs. No EOCs were cultured from any mobilized PBSCs studied. Exogenous G-CSF inhibited CFU-EPC generation, HUVEC and EOC tubule formation, microvessel outgrowth, and implanted sponge vascularization in mice. CONCLUSIONS G-CSF administration depresses both endothelial cell angiogenesis and monocyte proangiogenic activity, and we suggest that any angiogenic benefit observed following implantation of cells mobilized by G-CSF may come only from a paracrine effect from HPCs.
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Affiliation(s)
- O Tura
- SNBTS Cell Therapy Group, MRC Centre for Regenerative Medicine, The University of Edinburgh, Edinburgh, UK.
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Gallagher RCJ, Waterfall M, Samuel K, Turner ML. Blood donor derived dendritic cells and cytotoxic T cells for specific fusion-gene adoptive immunotherapy. Vox Sang 2007; 92:351-60. [PMID: 17456159 DOI: 10.1111/j.1423-0410.2006.00873.x] [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: 12/01/2022]
Abstract
BACKGROUND AND OBJECTIVES Therapeutic immunological reagents tailored to individual patients have been shown to be a viable treatment strategy for some forms of leukaemia. This work investigates the possibility of using blood donations as a source of leukaemia-specific immune therapeutics. MATERIALS AND METHODS The acute promyelocytic cell line NB4 carrying the PML-RAR alpha fusion was used as a target for cytotoxic T lymphocytes (CTL) stimulated to recognize the fusion. Stimulation of CTL was by production of dendritic cells pulsed with plasmid vectors containing polymerase chain reaction (PCR)-generated sequences of PML-RAR alpha derived from NB4 cells. PCR primer design included a Kozak consensus sequence to allow correct translation of the nucleic acid into protein. Identification of specific cytotoxicity was by both Granzyme B ELISPOT and by (51)Cr-release assays. RESULTS Specific CTL activity targeting NB4 cells can be generated from donor-derived peripheral blood mononuclear cells. However, individual donors appear to respond differently to the length of stimulatory sequence encoded in the vector. Use of an internal methionine in the PML gene, which also satisfies the Kozak rules, allows translation in vitro and, thus, might provide a suitable start site for stimulation using acute promyelocytic leukaemia-specific sequence. CONCLUSION The work presented here suggests that blood donor derived dendritic cells can be used to stimulate leukaemia-specific CTL from the same donation ex vivo. This would enable the generation of patient-specific therapeutics from major histocompatibility (MHC)-matched allogeneic donors. However, different MHC-matched donors might vary in their response depending on the length of the antigenic sequence.
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MESH Headings
- Amino Acid Sequence
- Blood Donors
- Cell Line, Tumor
- Coculture Techniques
- Cytotoxicity, Immunologic
- Dendritic Cells/immunology
- Gene Fusion
- Humans
- Immunotherapy, Adoptive/methods
- Leukemia, Promyelocytic, Acute/genetics
- Leukemia, Promyelocytic, Acute/immunology
- Leukemia, Promyelocytic, Acute/therapy
- Molecular Sequence Data
- Oncogene Proteins, Fusion/genetics
- Oncogene Proteins, Fusion/immunology
- T-Lymphocytes, Cytotoxic/immunology
- Transfection
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Affiliation(s)
- R C J Gallagher
- SNBTS Cell Therapy Group, Centre for Regenerative Medicine, Edinburgh, UK.
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Roddie H, Klammer M, Thomas C, Thomson R, Atkinson A, Sproul A, Waterfall M, Samuel K, Yin J, Johnson P, Turner M. Phase I/II study of vaccination with dendritic-like leukaemia cells for the immunotherapy of acute myeloid leukaemia. Br J Haematol 2006; 133:152-7. [PMID: 16611305 DOI: 10.1111/j.1365-2141.2006.05997.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.9] [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: 11/28/2022]
Abstract
Twenty-two patients with acute myeloid leukaemia were recruited into a phase I/II clinical trial investigating the vaccination of patients in complete remission (CR) with autologous dendritic-like leukaemia cells (DLLC). At trial entry, leukaemia cells were harvested and tested for their ability to undergo cytokine-induced dendritic cell differentiation. Patients were then treated with intensive chemotherapy. Five patients achieved both CR and had leukaemia cells that successfully underwent differentiation and therefore proceeded to vaccination. Four escalating doses of DLLC were administered weekly by subcutaneous injection. Vaccination was generally well tolerated although one patient developed extensive eczema and an increased antinuclear factor titre possibly indicating induction of autoimmunity. Development of anti-leukaemic T-cell responses was assessed by enzyme-linked immunospot analysis of gamma-interferon secreting T lymphocytes and by human leucocyte antigen tetramer analysis for WT1-specific T cells. Increases in anti-leukaemic T-cell responses were demonstrated in four patients, but only two of the five remained in remission more than 12 months postvaccination. The study has demonstrated that generation of DLLC is feasible in only a subgroup of patients and is currently neither broadly applicable or clinically effective.
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Affiliation(s)
- H Roddie
- Haematology Department, Western General Hospital, Crewe Road, Edinburgh EH4 2XU, UK.
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Klammer M, Waterfall M, Samuel K, Turner ML, Roddie PH. Fusion hybrids of dendritic cells and autologous myeloid blasts as a potential cellular vaccine for acute myeloid leukaemia. Br J Haematol 2005; 129:340-9. [PMID: 15842657 DOI: 10.1111/j.1365-2141.2005.05477.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [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: 10/25/2022]
Abstract
We assessed the potential of tumour cell/dendritic cell fusion hybrids to generate in vitro anti-leukaemic T-cell responses following co-culture with autologous remission lymphocytes in six patients with acute myeloid leukaemia (AML). Comparison was made to anti-leukaemic responses induced by mature dendritic cells (mDC) co-cultured with autologous, irradiated myeloid blasts. Fusion hybrids induced anti-leukaemic T-cell immune responses in three of six patients. Tumour-pulsed mDC induced T-cellular responses in two other patients. Only one of six patients remission lymphocytes failed to develop leukaemia-directed immune responses following stimulation with either construct. Anti-proliferative properties of fusion hybrids against allogeneic lymphocytes were observed in mixed lymphocyte-leukaemia reactions and were found not to be specific to the cell fusion partners and did not prevent the ability of AML-mDC heterokaryons to induce autologous anti-leukaemic cytotoxicity. We conclude that tumour cell/dendritic cell fusion hybrids hold promise as a cellular vaccine for AML.
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Affiliation(s)
- M Klammer
- University of Edinburgh-Leukaemia Research Fund, John Hughes Bennett Laboratory, Western General Hospital, Edinburgh EH4 2XU, UK.
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Holyoake TL, Freshney MG, Samuel K, Ansell J, Watson GE, Wright EG, Graham GJ, Pragnell IB. In vivo expansion of the endogenous B-cell compartment stimulated by radiation and serial bone marrow transplantation induces B-cell leukaemia in mice. Br J Haematol 2001; 114:49-56. [PMID: 11472344 DOI: 10.1046/j.1365-2141.2001.02903.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [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: 11/20/2022]
Abstract
Chronic lymphocytic leukaemia (CLL) is a malignancy of CD5(+) B cells. This B-cell lineage is established during ontogeny and replenished by the process of self-renewal. Spontaneous and induced leukaemias that frequently affect this lineage are thought to arise as a result of the frequent cell division required to maintain the population throughout adulthood and in response to repeated exposure to environmental antigens. In a series of bone marrow transplant (BMT) experiments performed in B6D2F1 mice, B-cell leukaemia occurred in recipients of serially transplanted syngeneic bone marrow. This study was therefore designed to determine the frequency and phenotype of the observed leukaemia. Male donor cells were initially transplanted into lethally irradiated female hosts and secondary (2 degrees ) BMT was performed at 3 months. At 1, 2, 3 and 16 months following primary (1 degrees ) BMT, and when 2 degrees BMT recipients developed leukaemia, animals were sacrificed and their tissues extensively examined. These analyses confirmed a host-derived CD5(+) transplantable B-cell leukaemia that was initiated in 50% of 1 degrees BMT recipients. With serial passage, the leukaemia became more aggressive and lost CD5 expression, suggesting transformation to a high-grade leukaemia/lymphoma. This previously unreported observation suggests that the combination of radiation and subsequent serial transplantation induces a proliferative stress to the host B-cell compartment that is causative in leukaemic transformation.
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MESH Headings
- Animals
- B-Lymphocytes/immunology
- Blotting, Southern
- Bone Marrow Transplantation/adverse effects
- CD5 Antigens
- Female
- In Situ Hybridization, Fluorescence
- Leukemia, Lymphocytic, Chronic, B-Cell/etiology
- Leukemia, Lymphocytic, Chronic, B-Cell/immunology
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Male
- Mice
- Mice, Inbred Strains
- Models, Animal
- Reoperation
- Spleen/pathology
- Transplantation Conditioning
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Affiliation(s)
- T L Holyoake
- Beatson Institute for Cancer Research, Glasgow, UK.
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Abstract
In the present study, the P2Y receptor(s) mediating the effects of the pyrimidines UTP and UDP on phospholipase C activation in the mouse neuroblastoma x rat glioma hybrid cell line NG108-15 was investigated. Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR) analysis detected transcripts for the P2Y(6) and P2Y(2) receptors, but not for P2Y(1) and P2Y(4.) UTP and UDP were equipotent agonists and their effects were partially additive. Suramin, reactive blue 2 and pyridoxal phosphate-6-azophenyl-2',4'disulfonic acid (PPADS) antagonised the phospholipase C response to both UTP and UDP. High micromolar concentrations of adenosine, 2-p-(2-carboxyethyl)phenethylamino-5'-N-ethylcarboxamidoadenosine (CGS-21680), 2',3'-O-isopropylideneadenosine (iPAdo) and adenosine 3':5'-cyclic monophosphate (3',5'-cAMP) were able to antagonise the effect of UTP on phospholipase C but not that of UDP. The additivity of the UTP and UDP responses, novel P2 receptor antagonist profile and the distinguishing action of adenosine may indicate the expression of a pyrimidine selective P2Y receptor in addition to the P2Y(6) type in these cells.
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Affiliation(s)
- K Sak
- Institute of Chemical Physics, Tartu University, 2 Jakobi St., 51014, Tartu, Estonia.
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Abstract
The role of IFN-induced 2-5A system in cell differentiation has not been elucidated. While studying differentiation of PC12 cells we found that the simultaneous treatment of cells with NGF and IFN-gamma in serum-containing medium resulted first in the extension of neurites and then apoptosis. On the contrary, in serum-free medium the cells underwent a more rapid neuronal differentiation. Only the doses of NGF which induced the outgrowth of neurites from the cells were able to induce rapid cell death in combined treatment. When the cells were treated subsequently with NGF and IFN-gamma, the induction of death was observed with NGF post-treatment, but not with NGF pretreatment. Relying on these alternative biological responses, we studied the changes in 2-5A synthetase activity and its 43 kDa isoform expression in the course of differentiation and death of PC12 cells. The results of the present work showed that NGF-induced differentiation of the cells did not evoke any increase in 2-5A synthetase activity or any increase in the expression of its 43 kDa isoform. Moreover, the obtained results demonstrated that NGF could not significantly affect the IFN-induced signalling pathway leading to the activation of 2-5A synthetase gene, at least regarding the studied enzyme activity.
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Affiliation(s)
- A Lopp
- Laboratory of Molecular Genetics, Institute of Chemical Physics and Biophysics, Tallinn, Estonia.
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Thompson EJ, Brass ED, Samuel K, Bullock SR, Lindesay J, Lyons DR. Formation of phase gratings on the end of gradient-index lenses with ultraviolet ablation at 193 nm. Appl Opt 1999; 38:6494-6497. [PMID: 18324180 DOI: 10.1364/ao.38.006494] [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: 05/26/2023]
Abstract
We present a simple, cost-effective method for creating diffractive optical elements on the surfaces of optical fibers and fiber-optic components by use of 193-nm ablation techniques. It is an outgrowth of a more fundamental investigation of the effects of intense UV radiation fields on SiO2- and Ge-SiO2-based structures (specifically optical fibers and preforms) and allows the inexpensive fabrication of structures such as the suggested evanescent-field-based sensing device.
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Affiliation(s)
- E J Thompson
- Research Center for Optical Physics, Hampton University, Hampton, Virginia 23668, USA
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Mann DR, Lunn SF, Akinbami MA, Samuel K, Waterfall M, Fraser HM. Effect of neonatal treatment with a GnRH antagonist on development of the cell-mediated immune response in marmosets. Am J Reprod Immunol 1999; 42:175-86. [PMID: 10517178 DOI: 10.1111/j.1600-0897.1999.tb00482.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
PROBLEM We examined the effect of neonatal treatment with a gonadotropin-releasing hormone (GnRH) antagonist (antide) on the development of cell-mediated immunity in male marmosets. METHOD OF STUDY Neonatal marmoset twins were treated with either vehicle or antide, and the proliferative response (PR) of lymphoid tissue to mitogens was assessed during infancy, the peripubertal period, and adulthood. RESULTS Basal proliferation of peripheral blood mononuclear cells (PBMC) from treated peripubertal twins was elevated above control values, but the PR of the cells to T and B cell mitogens was subnormal. Conversely, PBMC from treated infants exhibited an enhanced PR to some of the mitogens employed. In vitro culturing of thymocytes (control or treated) from the three developmental stages with either antide or a GnRH agonist increased basal proliferation, but decreased the PR to mitogens by 60-80%. CONCLUSION Neonatal treatment with antide alters development of, but does not permanently impair, cell-mediated immunity in the marmoset. GnRH appears to modulate immune responses throughout development in the primate.
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Affiliation(s)
- D R Mann
- Department of Physiology, Morehouse School of Medicine, Atlanta, GA 30310-1495, USA
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Sak K, Webb TE, Samuel K, Kelve M, Järv J. Only pyrimidinoceptors are functionally expressed in mouse neuroblastoma cell lines. Mol Cell Biol Res Commun 1999; 1:203-8. [PMID: 10425227 DOI: 10.1006/mcbr.1999.0134] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The ability of UTP, UDP, ATP, and ADP to influence inositol phospholipid hydrolysis in neuroblastoma origin cell lines was assessed. The mouse neuroblastoma lines N1E 115, Neuro 2a, and NB4 1A3 and the rat glioma/mouse neuroblastoma hybrid line NG108-15 gave robust responses to both UTP and UDP, which were essentially equipotent. Thus a range of cell lines of mouse neuroblastoma origin express a pyrimidine-selective P2Y receptor. The NG108-15 cells were the only cell type tested at which ATP and ADP displayed activity with EC50 values of greater than 100 microM, compared with values of 0.58 and 1.25 microM for UTP and UDP, respectively. In contrast to the cell lines derived from mouse neuroblastoma, the human neuroblastoma lines SH-SY5Y and SK-N-SH did not respond to any nucleotides, although both responded well to carbachol.
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Affiliation(s)
- K Sak
- Institute of Chemical Physics, Tartu University, Estonia.
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42
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Bentley D, Selfridge J, Millar JK, Samuel K, Hole N, Ansell JD, Melton DW. DNA ligase I is required for fetal liver erythropoiesis but is not essential for mammalian cell viability. Nat Genet 1996; 13:489-91. [PMID: 8696349 DOI: 10.1038/ng0896-489] [Citation(s) in RCA: 97] [Impact Index Per Article: 3.5] [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: 02/01/2023]
Abstract
Four distinct DNA ligase activities (I-IV) have been identified within mammalian cells. Evidence has indicated that DNA ligase I is central to DNA replication, as well as being involved in DNA repair processes. A patient with altered DNA ligase I displayed a phenotype similar to Bloom's syndrome, being immunodeficient, growth retarded and predisposed to cancer. Fibroblasts isolated from this patient (46BR) exhibited abnormal lagging strand synthesis and repair deficiency. It has been reported that DNA ligase I is essential for cell viability, but here we show that cells lacking DNA ligase I are in fact viable. Using gene targeting in embryonic stem (ES) cells, we have produced DNA ligase I-deficient mice. Embryos develop normally to mid-term when haematopoiesis usually switches to the fetal liver. Thereupon acute anaemia develops, despite the presence of erythroid-committed progenitor cells in the liver. Thus DNA ligase I is required for normal development, but is not essential for replication. Hence a previously unsuspected redundancy must exist between mammalian DNA ligases.
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Affiliation(s)
- D Bentley
- Institute of Cell and Molecular Biology, University of Edinburgh, UK
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Kulkarni ML, Samuel K, Bhagyavathi M, Sureshkumar C. Skeletal dysplasias in a hospital in southern India. Indian Pediatr 1995; 32:657-65. [PMID: 8613334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
A hospital based study of skeletal dysplasias was conducted over a period of 2 years in Davangere, Karnataka, in which 169 cases of skeletal dysplasias were studied. One hundred were osteochondrodysplasias and were grouped according to international classification of osteochondrodysplasias. Among the individual cases, osteogenesis imperfecta (13 cases) had the maximum representation. Several cases of rare disorders were also identified. Eighty eight cases of skeletal dysplasias were in the pediatric age group and of these 41 were newborns. The incidence of skeletal dysplasia among newborns was 19.6 per 10,000 deliveries and lethal dysplasias 5.2 per 10,000 deliveries. In 7 cases of skeletal dysplasia, an antenatal diagnosis was possible by ultrasonography.
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Affiliation(s)
- M L Kulkarni
- Department of Pediatrics, J.J.M. Medical College, Karnataka
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45
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Lopp A, Pihlak A, Paves H, Samuel K, Koljak R, Samel N. The effect of 9,11-secosterol, a newly discovered compound from the soft coral Gersemia fruticosa, on the growth and cell cycle progression of various tumor cells in culture. Steroids 1994; 59:274-81. [PMID: 7915861 DOI: 10.1016/0039-128x(94)90113-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
A new 9,11-secosterol, 24-nor-9,11-seco-11-acetoxy-3 beta,6 alpha-dihydroxycholest-7,22(E)-dien-9-one, was found to exhibit growth inhibitory (IC50 below 10 microM) and cytotoxic activities against human leukemia K562, human cervical cancer HeLa, and Ehrlich ascites tumor cells in vitro. The cytostatic concentrations of the compound generally caused the G2/M block in the cell cycle progression, but differences between the three tumor cell lines in the events leading to cell death were remarkable. While inhibiting cell proliferation, 9,11-secosterol caused accumulation of HeLa and K562 cells in the metaphase of mitosis. So, abnormal mitosis can play an important role in the cytotoxicity of 9,11-secosterol in these cell lines. In the Ehrlich ascites tumor cell line the increasing concentrations of the drug (up to 40 microM) did not cause an immediate cell killing. Instead, due to continued DNA synthesis without entry into mitosis, cells with high DNA ploidy were produced. It was shown that the cytoskeletal systems such as microtubules and microfilaments were not damaged by the action of 9,11-secosterol. Further studies are necessary to elucidate the mechanism of the cytotoxic effect of 9,11-secosterol.
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Affiliation(s)
- A Lopp
- Department of Bioorganic Chemistry, Estonian Academy of Sciences, Tallinn
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Deckers CL, Lyons AB, Samuel K, Sanderson A, Maddy AH. Alternative pathways of apoptosis induced by methylprednisolone and valinomycin analyzed by flow cytometry. Exp Cell Res 1993; 208:362-70. [PMID: 8375466 DOI: 10.1006/excr.1993.1257] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.0] [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: 01/30/2023]
Abstract
Apoptosis of murine thymocytes induced by either methylprednisolone or valinomycin was studied by flow cytometry. The apoptosis induced by methylprednisolone followed three stages: an initial decrease in cell volume, indicated by a fall in forward scatter accompanied by faint ethidium bromide staining, a second stage in which the cells became brightly stained by ethidium bromide, and a final stage when the cells were apparently less fluorescent as the nuclei disintegrated into apoptotic bodies. As the forward scatter of cells decreased there was a simultaneous depolarization of the cells and an elevation of intracellular calcium. These early changes preceded the fragmentation of the DNA which also preceded the intense staining of the cells by ethidium bromide. Methylprednisolone-induced apoptosis was inhibited by low concentrations (1 x 10(-7) M) of valinomycin and nonactin, neither of which could themselves induce apoptosis at these low concentrations. Cadmidazolium and cycloheximide arrested the program at an early stage. Okadaic acid allowed volume loss and ethidium bromide staining to proceed in the absence of DNA fragmentation. At high concentrations (1 x 10(-5) M) valinomycin induced a form of apoptosis, but nonactin only caused the cells to fragment. The valinomycin-induced apoptosis, although it involved the degradation of DNA and the disintegration of the nuclei into apoptotic bodies, differed from the methylprednisolone apoptosis as it did not involve a decrease of cell volume and was not inhibited by cycloheximide or affected by okadaic acid.
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Affiliation(s)
- C L Deckers
- Institute of Cell Animal and Population Biology, University of Edinburgh, Ashworth Laboratory, United Kingdom
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Samuel K, Clarke AR, Ansell JD, Hooper ML. Age-dependent selection against hypoxanthine phosphoribosyl transferase-deficient cells in mouse haematopoiesis. Development 1993; 118:859-63. [PMID: 8076522 DOI: 10.1242/dev.118.3.859] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [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: 12/22/2022]
Abstract
The basis of a previously observed difference in the level of contribution of hypoxanthine phosphoribosyltransferase-deficient cells between the haematopoietic and non-haematopoietic tissues of chimaeric and heterozygous mice has been clarified by studying two populations of female mice that differ only in that one is heterozygous for a null allele at the hprt locus and the other is wild type at this locus. Both populations are heterozygous for an electrophoretic variant allele at the X-linked Pgk-1 locus, so that X-chromosome inactivation generates cells expressing different isozymes of phosphoglycerate kinase which can be assayed to monitor cell selection. The results show that hypoxanthine phosphoribosyltransferase deficiency itself, rather than an effect of another X-linked gene, causes a reduced level of contribution to haematopoietic tissues. Further, the extent of the depletion increases significantly with age, and this effect is due to a progressive reduction in the level of contribution to haematopoietic tissues rather than to an increase in the level of contribution to non-haematopoietic tissues.
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Affiliation(s)
- K Samuel
- Institute of Cell, Animal and Population Biology, Ashworth Laboratories, University of Edinburgh, UK
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48
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Abstract
We describe a polycystic lesion of the kidney in the CBA/N mouse with an X-linked recessive immunodeficient syndrome. There is progressive cystic dilatation affecting all parts of the nephron. The cyst lining is composed of a single layered epithelium with focal nuclear crowding and the formation of micropapillary structures. The cystic epithelial cells show subnuclear vacuolation. Focal basement membrane thickening is also a feature. There is no significant inflammatory infiltrate present within these kidneys. Electron microscopic examination reveals that the subnuclear vacuolation is due to loss of the membrane infoldings at the basal pole of the epithelial cell with fluid accumulation within the extracellular space. The basement membrane thickening is due to expansion of the lamina densa. These changes are not present at birth but develop progressively with age. The finding of a polycystic kidney lesion in these mice offers an opportunity to investigate the relationship between the immune system and renal cyst formation.
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Affiliation(s)
- M A Rahilly
- Department of Pathology, University of Edinburgh, U.K
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49
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Lyons AB, Samuel K, Sanderson A, Maddy AH. Simultaneous analysis of immunophenotype and apoptosis of murine thymocytes by single laser flow cytometry. Cytometry 1992; 13:809-21. [PMID: 1458998 DOI: 10.1002/cyto.990130803] [Citation(s) in RCA: 75] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The study of the role of apoptosis in thymocyte development has been hampered by the lack of a means of directly immunophenotyping cells undergoing the early phase of apoptosis. This restriction has been overcome by single laser flow cytometry in which apoptosis is detected by Ethidium Bromide (EBr) staining and cell phenotype by binding of FITC-labelled antibody. The initial phase of apoptosis is observed as a cell population that stains faintly with EBr preceding the characteristically bright EBr-staining normally associated with cell death. Here we directly demonstrate using single laser flow cytometry that CD4+ CD8+ CD3low/CD3intermediate thymocytes undergo apoptosis in vitro in response to glucocorticoid treatment.
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Affiliation(s)
- A B Lyons
- Immunobiology Unit, University of Edinburgh, Scotland
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50
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Ansell JD, Samuel K, Whittingham DG, Patek CE, Hardy K, Handyside AH, Jones KW, Muggleton-Harris AL, Taylor AH, Hooper ML. Hypoxanthine phosphoribosyl transferase deficiency, haematopoiesis and fertility in the mouse. Development 1991; 112:489-98. [PMID: 1794318 DOI: 10.1242/dev.112.2.489] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [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: 11/20/2022]
Abstract
We have looked for effects of deficiency in hypoxanthine phosphoribosyl transferase (HPRT) in the mouse comparable to non-behavioural consequences of HPRT-deficiency in humans. HPRT-deficient humans show abnormalities in haematopoiesis and, in heterozygotes, there is strong selection in haematopoietic tissues against HPRT-deficient cells arising as a result of X-chromosome inactivation. We have examined two situations in mice in which HPRT- and HPRT+ cells occur in the same individual. First, in chimaeras resulting from the injection of HPRT- embryonal stem cells into HPRT+ blastocysts the fate of HPRT- and HPRT+ cell populations was monitored by their expression of different isozymes of glucose phosphate isomerase and also, in those chimaeras that resulted from injecting the male ES cells into female blastocysts, by in situ hybridisation using a Y-chromosome-specific repetitive DNA probe. There was a small statistically significant selection against the HPRT- population in haematopoietic tissues in both XX in equilibrium with XY and XY in equilibrium with XY chimaeras. Second, in female mice doubly heterozygous for HPRT-deficiency and for an electrophoretic variant of the X-linked enzyme phosphoglycerate kinase, there was a similar small statistically significant selection against the HPRT- population in haematopoietic tissues. While further work is required to establish whether this selection is a consequence of the HPRT mutation, it is clear that any selection against cells in the haematopoietic system as a consequence of HPRT-deficiency is at most small compared with the effect seen in humans. In HPRT-deficient human males surviving beyond the normal age of puberty, there is testicular atrophy. However, we find no effect of HPRT-deficiency on the fertility of either male or female mice. Thus, as with effects on behaviour, the consequences of HPRT-deficiency for haematopoiesis and testis development in the mouse are at most small compared with those in the human. We conclude that the reason for the difference in effects between the two species lies in a difference in purine-related intermediary metabolism per se, rather than in its interaction with brain amine biochemistry.
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Affiliation(s)
- J D Ansell
- Department of Zoology, University of Edinburgh, UK
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