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Sharif S, Kang J, Sadeghirad B, Rizvi F, Forestell B, Greer A, Hewitt M, Fernando SM, Mehta S, Eltorki M, Siemieniuk R, Duffett M, Bhatt M, Burry L, Perry JJ, Petrosoniak A, Pandharipande P, Welsford M, Rochwerg B. Pharmacological agents for procedural sedation and analgesia in the emergency department and intensive care unit: a systematic review and network meta-analysis of randomised trials. Br J Anaesth 2024; 132:491-506. [PMID: 38185564 DOI: 10.1016/j.bja.2023.11.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/29/2023] [Accepted: 11/30/2023] [Indexed: 01/09/2024] Open
Abstract
BACKGROUND We aimed to evaluate the comparative effectiveness and safety of various i.v. pharmacologic agents used for procedural sedation and analgesia (PSA) in the emergency department (ED) and ICU. We performed a systematic review and network meta-analysis to enable direct and indirect comparisons between available medications. METHODS We searched Medline, EMBASE, Cochrane, and PubMed from inception to 2 March 2023 for RCTs comparing two or more procedural sedation and analgesia medications in all patients (adults and children >30 days of age) requiring emergent procedures in the ED or ICU. We focused on the outcomes of sedation recovery time, patient satisfaction, and adverse events (AEs). We performed frequentist random-effects model network meta-analysis and used the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach to rate certainty in estimates. RESULTS We included 82 RCTs (8105 patients, 78 conducted in the ED and four in the ICU) of which 52 studies included adults, 23 included children, and seven included both. Compared with midazolam-opioids, recovery time was shorter with propofol (mean difference 16.3 min, 95% confidence interval [CI] 8.4-24.3 fewer minutes; high certainty), and patient satisfaction was better with ketamine-propofol (mean difference 1.5 points, 95% CI 0.3-2.6 points, high certainty). Regarding AEs, compared with midazolam-opioids, respiratory AEs were less frequent with ketamine (relative risk [RR] 0.55, 95% CI 0.32-0.96; high certainty), gastrointestinal AEs were more common with ketamine-midazolam (RR 3.08, 95% CI 1.15-8.27; high certainty), and neurological AEs were more common with ketamine-propofol (RR 3.68, 95% CI 1.08-12.53; high certainty). CONCLUSION When considering procedural sedation and analgesia in the ED and ICU, compared with midazolam-opioids, sedation recovery time is shorter with propofol, patient satisfaction is better with ketamine-propofol, and respiratory adverse events are less common with ketamine.
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Affiliation(s)
- Sameer Sharif
- Department of Medicine, Division of Emergency Medicine, McMaster University, Hamilton, ON, Canada; Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
| | - Jasmine Kang
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Behnam Sadeghirad
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada; Department of Anesthesia, McMaster University, Hamilton, ON, Canada
| | - Fayyaz Rizvi
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Ben Forestell
- Department of Medicine, Division of Emergency Medicine, McMaster University, Hamilton, ON, Canada
| | - Alisha Greer
- Department of Medicine, Division of Emergency Medicine, McMaster University, Hamilton, ON, Canada; Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada
| | - Mark Hewitt
- Department of Medicine, Division of Emergency Medicine, McMaster University, Hamilton, ON, Canada; Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada
| | - Shannon M Fernando
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada; Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Sangeeta Mehta
- Department of Medicine, Sinai Health System; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Mohamed Eltorki
- Department of Pediatrics, Division of Pediatric Emergency Medicine, McMaster University, Ottawa, ON, Canada
| | - Reed Siemieniuk
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Mark Duffett
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Maala Bhatt
- Department of Medicine, Sinai Health System, Interdepartmental Division of Critical Care Medicine, Toronto, ON, Canada
| | - Lisa Burry
- Department of Medicine, Sinai Health System; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Department of Pharmacy, Sinai Health System, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Jeffrey J Perry
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Andrew Petrosoniak
- Department of Medicine, Division of Emergency Medicine, University of Toronto, Toronto, ON, Canada
| | - Pratik Pandharipande
- Department of Anesthesiology, Division of Critical Care, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Michelle Welsford
- Department of Medicine, Division of Emergency Medicine, McMaster University, Hamilton, ON, Canada
| | - Bram Rochwerg
- Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
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Lannon M, Duda T, Greer A, Hewitt M, Sharma A, Martyniuk A, Owen J, Amin F, Sharma S. Intracranial hemorrhage in patients treated for SARS-CoV-2 with extracorporeal membrane oxygenation: A systematic review and meta-analysis. J Crit Care 2023; 77:154319. [PMID: 37178492 PMCID: PMC10173703 DOI: 10.1016/j.jcrc.2023.154319] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 12/21/2022] [Accepted: 04/24/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Extracorporeal membrane oxygenation (ECMO) is routinely used in patients with severe respiratory failure and has been increasingly needed during the COVID-19 pandemic. In patients treated with ECMO, significant intracranial hemorrhage (ICH) risk exists due to circuit characteristics, anticoagulation, and disease characteristics. ICH risk may be substantially higher in COVID-19 patients than patients treated with ECMO for other indications. METHODS We systematically reviewed current literature regarding ICH during ECMO treatment of COVID-19. We utilized Embase, MEDLINE, and Cochrane Library databases. Meta-analysis was performed for included comparative studies. Quality assessment was performed using MINORS criteria. RESULTS A total of 54 studies with 4000 ECMO patients were included, all retrospective. Risk of bias was increased via MINORS score primarily due to retrospective designs. ICH was more likely in COVID-19 patients (RR 1.72, 95% CI 1.23, 2.42). Mortality among COVID patients on ECMO with ICH was 64.0%, compared with 41% in patients without ICH (RR1.9, 95% 1.44, 2.51). CONCLUSION This study suggests increased hemorrhage rates in COVID-19 patients on ECMO compared to similar controls. Hemorrhage reduction strategies may include atypical anticoagulants, conservative anticoagulation strategies, or biotechnology advances in circuit design and surface coatings.
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Affiliation(s)
- Melissa Lannon
- Division of Neurosurgery, McMaster University, Hamilton, Ontario, Canada.
| | - Taylor Duda
- Division of Neurosurgery, McMaster University, Hamilton, Ontario, Canada.
| | - Alisha Greer
- Division of Emergency Medicine, Department of Medicine, Division of Critical Care, McMaster University, Hamilton, Ontario, Canada.
| | - Mark Hewitt
- Division of Emergency Medicine, Department of Medicine, Division of Critical Care, McMaster University, Hamilton, Ontario, Canada.
| | - Arjun Sharma
- Department of Medicine, Division of Critical Care, McMaster University, Hamilton, Ontario, Canada.
| | - Amanda Martyniuk
- Division of Neurosurgery, McMaster University, Hamilton, Ontario, Canada.
| | - Julian Owen
- Division of Emergency Medicine, Department of Medicine, Division of Critical Care, McMaster University, Hamilton, Ontario, Canada.
| | - Faizan Amin
- Department of Medicine, Divisions of Critical Care and Cardiology, McMaster University, Hamilton, Ontario, Canada.
| | - Sunjay Sharma
- Division of Neurosurgery, McMaster University, Hamilton, Ontario, Canada.
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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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Ellison C, Hewitt M, Przybylak K. In Silico Models for Hepatotoxicity. Methods Mol Biol 2022; 2425:355-392. [PMID: 35188639 DOI: 10.1007/978-1-0716-1960-5_14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
In this chapter, we review the state of the art of predicting human hepatotoxicity using in silico techniques. There has been significant progress in this area over the past 20 years but there are still some challenges ahead. Principally, these challenges are our partial understanding of a very complex biochemical system and our ability to emulate that in a predictive capacity. Here, we provide an overview of the published modeling approaches in this area to date and discuss their design, strengths and weaknesses. It is interesting to note the diversity in modeling approaches, whether they be statistical algorithms or evidenced-based approaches including structural alerts and pharmacophore models. Irrespective of modeling approach, it appears a common theme of access to appropriate, relevant, and high-quality data is a limitation to all and is likely to continue to be the focus of future research.
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Affiliation(s)
- Claire Ellison
- Human and Natural Sciences Directorate, School of Science, Engineering and Environment, University of Salford, Manchester, UK
| | - Mark Hewitt
- School of Pharmacy, Faculty of Science and Engineering, University of Wolverhampton, Wolverhampton, UK.
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Klowak JA, Hewitt M, Catenacci V, Duffett M, Rochwerg B, Jones K, Choong K. Levetiracetam Versus Phenytoin or Fosphenytoin for Second-Line Treatment of Pediatric Status Epilepticus: A Meta-Analysis. Pediatr Crit Care Med 2021; 22:e480-e491. [PMID: 33710073 DOI: 10.1097/pcc.0000000000002703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To synthesize the available evidence examining the efficacy and safety of levetiracetam compared with phenytoin or fosphenytoin in benzodiazepine-refractory pediatric status epilepticus. DATA SOURCES We searched (from inception until April 27, 2020) Ovid MEDLINE, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials. STUDY SELECTION Two reviewers, independently and in duplicate, screened citations and manuscripts for eligible randomized controlled trials. DATA EXTRACTION AND SYNTHESIS Independently and in duplicate, we performed data abstraction, risk of bias assessment, and certainty assessment using Grading of Recommendations, Assessment, Development, and Evaluation. We performed meta-analyses using random-effect models or, if insufficient data, presented findings narratively. RESULTS We identified seven randomized controlled trials (n = 1,575). Pooled analysis demonstrated low certainty evidence for no difference of levetiracetam on time to seizure cessation (mean difference, -3.11 min; 95% CI, -6.67 to 0.45), early seizure cessation (relative risk, 1.09, 95% CI, 0.95-1.26), or late seizure cessation (relative risk, 1.05; 95% CI, 0.93-1.18). Adverse event outcomes were limited by low event numbers. We found low certainty evidence for less respiratory depression with levetiracetam (relative risk, 0.28; 95% CI, 0.12-0.69). CONCLUSIONS The efficacy of levetiracetam is comparable with phenytoin or fosphenytoin in children with benzodiazepine-refractory status epilepticus (low certainty evidence). Levetiracetam may cause less respiratory depression. Clinicians and guideline developers should weigh safety profiles when choosing between these agents.
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Affiliation(s)
- Jennifer Ann Klowak
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- McMaster Children's Hospital, Hamilton, ON, Canada
- Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON, Canada
- Division of Critical Care, Department of Medicine, McMaster University, Hamilton, ON, Canada
- Division of Pediatric Neurology, Department of Pediatrics, McMaster University, Hamilton, ON, Canada
- Division of Pediatric Critical Care, Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Mark Hewitt
- Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Vanessa Catenacci
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON, Canada
| | - Mark Duffett
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- McMaster Children's Hospital, Hamilton, ON, Canada
- Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON, Canada
- Division of Critical Care, Department of Medicine, McMaster University, Hamilton, ON, Canada
- Division of Pediatric Neurology, Department of Pediatrics, McMaster University, Hamilton, ON, Canada
- Division of Pediatric Critical Care, Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Bram Rochwerg
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Division of Critical Care, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Kevin Jones
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
- Division of Pediatric Neurology, Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Karen Choong
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Division of Pediatric Critical Care, Department of Pediatrics, McMaster University, Hamilton, ON, Canada
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6
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Shorafa Y, Halawa I, Hewitt M, Nitsche MA, Antal A, Paulus W. Isometric agonist and antagonist muscle activation interacts differently with 140-Hz transcranial alternating current stimulation aftereffects at different intensities. J Neurophysiol 2021; 126:340-348. [PMID: 34191638 DOI: 10.1152/jn.00065.2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
During transcranial electric stimulation, increasing intracellular Ca2+ levels beyond those needed for inducing long term potentiation (LTP) may collapse aftereffects. State-dependent plastic aftereffects are reduced when applied during muscle activation as compared with rest. Cortical surround inhibition by antagonistic muscle activation inhibits the center-innervated agonist. The objective of this study is to determine the interaction of state dependency of transcranial alternating current stimulation (tACS) aftereffects at rest and under activation of agonist and antagonist muscles during stimulation with different intensities. In 13 healthy participants, we measured motor-evoked potential (MEP) amplitudes before and after applying tACS at 140 Hz over the motor cortex in nine single-blinded sessions using sham, 1 mA, and 2 mA stimulation intensities during rest and activation of agonist and antagonist muscles. During rest, only 1 mA tACS produced a significant MEP increase, whereas the 2 mA stimulation produced no significant MEP size shift. During agonist activation 1 mA did not induce MEP changes; after 2 mA, first a decrease and later an increase of MEPs were observed. Antagonist activation under sham tACS led to an inhibition, which was restored to baseline by 1 and 2 mA tACS. Increasing stimulation intensity beyond 1 mA does not increase excitability, compatible with too strong intracellular Ca2+ increase. Antagonist innervation leads to MEP inhibition, supporting the concept of surround inhibition, which can be overcome by tACS at both intensities. During agonist innervation, a tACS dose-dependent relationship exists. Our results integrate concepts of "leaky membranes" under activation, surround inhibition, intracellular Ca2+ increase, and their role in the aftereffects of tACS.NEW & NOTEWORTHY Stimulation intensity and activation of center versus surround muscles affect cortical excitability alterations generated by 140-Hz tACS. At rest, excitatory aftereffects were induced by tACS with 1 mA, but not 2 mA stimulation intensity. With agonistic muscle activation, excitability first decreases, and then increases with 2 mA. For antagonist activation, the MEP amplitude reduction observed in the sham condition is counteracted upon by 1 and 2 mA tACS. This reflects the relation of LTP-like aftereffects to Ca2+ concentration alterations.
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Affiliation(s)
- Y Shorafa
- Department of Clinical Neurophysiology, University Medical Centre Göttingen, Göttingen, Germany
| | - I Halawa
- Department of Clinical Neurophysiology, University Medical Centre Göttingen, Göttingen, Germany.,Medical Research Division, National Research Center, Cairo, Egypt
| | - M Hewitt
- Department of Clinical Neurophysiology, University Medical Centre Göttingen, Göttingen, Germany
| | - M A Nitsche
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany.,Department of Neurology, University Hospital Bergmannsheil, Bochum, Germany
| | - A Antal
- Department of Clinical Neurophysiology, University Medical Centre Göttingen, Göttingen, Germany
| | - W Paulus
- Department of Clinical Neurophysiology, University Medical Centre Göttingen, Göttingen, Germany
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7
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Dearden JC, Hewitt M. Prediction of Human Lethal Doses and Concentrations of MEIC Chemicals from Rodent LD 50 Values: An Attempt to Make Some Reparation. Altern Lab Anim 2021; 49:10-21. [PMID: 33626883 DOI: 10.1177/0261192921994754] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The prediction of human toxicities from animal toxicity tests is often poor, and is now discouraged and in some cases banned, especially those involving the LD50 test. However, there is a vast number of historical LD50 data in both public and in-house repositories that are being put to little use. This study examined the correlations between human lethality (doses and concentrations) of 36 MEIC chemicals and the median values of a large number of mouse and rat LD50 values obtained for four different routes of administration. The best correlations were found with mouse and rat intraperitoneal LD50 values (r2 = 0.838 and 0.810 for human lethal dose, and r2 = 0.753 and 0.785 for human lethal concentration). The results show that excellent prediction of human lethal dose and concentration can be made, for this series of chemicals at least, by using uncurated rodent LD50 values, thus offering some reparation for the millions of rodent lives sacrificed in LD50 testing.
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Affiliation(s)
- John C Dearden
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, UK
| | - Mark Hewitt
- School of Pharmacy, University of Wolverhampton, Wolverhampton, UK
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8
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Kozica-Olenski S, Treleaven E, Hewitt M, McRae P, Young A, Walsh Z, Mudge A. Patient-reported experiences of mealtime care and food access in acute and rehabilitation hospital settings: a cross-sectional survey. J Hum Nutr Diet 2021; 34:687-694. [PMID: 33491875 DOI: 10.1111/jhn.12854] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 12/08/2020] [Accepted: 12/14/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Nutrition and mealtime interventions can improve nutritional intake amongst hospital inpatients; however, patient-reported experience is rarely considered in their development and evaluation. The present study aimed to measure patient-reported food and mealtime experience to evaluate and inform continuous quality improvement of hospital nutrition care. METHODS A cross-sectional survey with inpatients in seven acute care and rehabilitation wards was conducted. A 27-item validated questionnaire measured five domains of patient experience: food choices, organisational barriers, feeling hungry, physical barriers to eating and food quality. Responses were summarised descriptively and compared between settings (acute versus rehabilitation), patient demographics (age, gender) and time in hospital. RESULTS Responses from 143 participants (mean age 67 years, 57% male, 28% rehabilitation, median 6 days into hospitalisation) showed that 10% or fewer respondents reported difficulties with food choices, feeling hungry or food quality. The most common difficulties were opening packets (36%), insufficient menu information provided (29%), being interrupted by staff when eating (28%), being disturbed when eating (27%), being in an uncomfortable position when eating (24%) and difficulty reaching food (21%). There were no significant differences in domain patterns by sex, age group or time in hospital. Organisational barriers were reported less frequently amongst rehabilitation participants compared to acute care (P = 0.01). CONCLUSIONS This survey highlights areas of positive patient-reported experience with nutrition care and suggests that local improvement efforts should focus on physical assistance needs and organisational barriers, especially in acute care wards. The questionnaire may be useful for informing and evaluating systematic nutrition care improvements.
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Affiliation(s)
- S Kozica-Olenski
- Internal Medicine Research Unit, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - E Treleaven
- Internal Medicine Research Unit, Royal Brisbane and Women's Hospital, Herston, QLD, Australia.,Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - M Hewitt
- Internal Medicine Research Unit, Royal Brisbane and Women's Hospital, Herston, QLD, Australia.,Mater Health, Brisbane, QLD, Australia
| | - P McRae
- Internal Medicine Research Unit, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - A Young
- Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Z Walsh
- Nutrition and Dietetics, Brighton Health Campus, Brighton, QLD, Australia
| | - A Mudge
- Internal Medicine Research Unit, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
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9
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Sun Y, Hewitt M, Wilkinson SC, Davey N, Adams RG, Gullick DR, Moss GP. Development of a Gaussian Process - feature selection model to characterise (poly)dimethylsiloxane (Silastic ® ) membrane permeation. J Pharm Pharmacol 2020; 72:873-888. [PMID: 32246470 DOI: 10.1111/jphp.13263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 03/08/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The current study aims to determine the effect of physicochemical descriptor selection on models of polydimethylsiloxane permeation. METHODS A total of 2942 descriptors were calculated for a data set of 77 chemicals. Data were processed to remove redundancy, single values, imbalanced and highly correlated data, yielding 1363 relevant descriptors. For four independent test sets, feature selection methods were applied and modelled via a variety of Machine Learning methods. KEY FINDINGS Two sets of molecular descriptors which can provide improved predictions, compared to existing models, have been identified. Best permeation predictions were found with Gaussian Process methods. The molecular descriptors describe lipophilicity, partial charge and hydrogen bonding as key determinants of PDMS permeation. CONCLUSIONS This study highlights important considerations in the development of relevant models and in the construction and use of the data sets used in such studies, particularly that highly correlated descriptors should be removed from data sets. Predictive models are improved by the methodology adopted in this study, notably the systematic evaluation of descriptors, rather than simply using any and all available descriptors, often based empirically on in vitro experiments. Such findings also have clear relevance to a number of other fields.
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Affiliation(s)
- Yi Sun
- School of Computer Science, University of Hertfordshire, Hatfield, UK
| | - Mark Hewitt
- School of Pharmacy, University of Wolverhampton, Wolverhampton, UK
| | - Simon C Wilkinson
- School of Biomedical, Nutritional and Sports Sciences, Medical School, University of Newcastle-upon-Tyne, Newcastle-upon-Tyne, UK
| | - Neil Davey
- School of Computer Science, University of Hertfordshire, Hatfield, UK
| | - Roderick G Adams
- School of Computer Science, University of Hertfordshire, Hatfield, UK
| | - Darren R Gullick
- School of Pharmacy & Biomedical Sciences, University of Portsmouth, Portsmouth, UK
| | - Gary P Moss
- The School of Pharmacy, Keele University, Keele, UK
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10
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Marshall-Sheppard J, Kam A, Hewitt M. Pediatric ovarian torsion: A diagnosis with a twist. Journal of Obstetrics and Gynaecology Canada 2020. [DOI: 10.1016/j.jogc.2020.02.065] [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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11
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Meincke J, Hewitt M, Liebetanz D. Assessing the focality of transcranial magnetic stimulation (tms). Brain Stimul 2019. [DOI: 10.1016/j.brs.2018.12.650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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12
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Abstract
A short-cut review was carried out to establish whether a normal gait examination can rule out cerebellar stroke in patients with acute vertigo. 16 studies were relevant to the question. The author, year and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. The clinical bottom line is that a normal gait examination cannot rule out a cerebellar stroke but the presence of an abnormal gait can be associated.
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Affiliation(s)
- Alisha Greer
- Emergency Medicine, McMaster University, Ontario, Canada
| | - Mark Hewitt
- Emergency Medicine, McMaster University, Ontario, Canada
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13
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Hewitt M, Sproul E, Hudson JA, Emberley J. IMPACT OF A QUALITY IMPROVEMENT INITIATIVE ON UNPLANNED EXTUBATION (UE) RATE IN THE NEONATAL INTENSIVE CARE UNIT (NICU). Paediatr Child Health 2018. [DOI: 10.1093/pch/pxy054.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND
Unplanned extubations (UEs) refer to any removal of an endotracheal tube not directly ordered or intended by the medical team. It is the fourth most common adverse event in the neonatal intensive care unit (NICU) and can lead to significant morbidity in this vulnerable population. A large proportion of UEs in the NICU are deemed preventable and UE rates are increasingly being recognized as an important quality of care metric.
OBJECTIVES
To examine the effectiveness of an education-based quality improvement initiative to decrease UE rate in a level II/III NICU with a high rate of UEs
DESIGN/METHODS
Pre-intervention UE rate was determined by retrospective chart review for all intubated neonates admitted to a 25 bed level II/III NICU from January 2013 until December 2013. UEs were recorded along with demographic information including reason for extubation.
UE rate was calculated by number of UEs/100 ventilator days and the data was analyzed to determine any significantly associated risk factors. The UE quality improvement initiative included: multi-disciplinary NICU staff education sessions, placement of educational posters in the NICU and identification of high risk neonates as defined by the pre-intervention study. High risk neonates were given additional signage to alert care providers. Standardized documentation was implemented to track and record UEs prospectively. Six months post-implementation, all UE events were reviewed from December 2015 until May 2016 and the post-intervention UE rate was calculated.
RESULTS
The UE rate was 3.28 UEs/100 ventilator days in the pre-intervention cohort with neonatal movement and adhesive failure accounting for over 50% of the documented UEs. Regression analysis revealed total ventilation time to be the only significant (p<0.05) risk factor for an UE. In the post-intervention cohort the UE rate was 1.45 UEs/100 ventilator days, a 56% decrease from the pre-intervention rate. Rates of re-intubation following an UE were 78.3% and 50% for the pre- and post-implementation cohorts respectively.
CONCLUSION
Reduction in UE rate from 3.28 to 1.45 was achieved with an education-based multi-disciplinary quality improvement initiative. Rates of re-intubation following an UE were similar between cohorts. Further study is necessary to evaluate whether the effectiveness of this intervention will persist over time and whether results are generalizable to other NICUs.
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14
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Affiliation(s)
- M Hewitt
- Southmead Hospital, Westbury-on-Trym, Bristol
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15
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Skipworth JRA, Fanshawe AE, Hewitt M, Raptis DA, Efthimiou E, Smellie WJB. Laparoscopic Adjustable Gastric Band Slippage Rates Following Laparoscopic Gastric Band Insertion: a Single Centre Experience. Obes Surg 2017; 26:1511-6. [PMID: 26660915 DOI: 10.1007/s11695-015-1962-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Laparoscopic adjustable gastric bands (LAGB) are placed around the superior aspect of the stomach to aid weight loss and co-morbidity resolution in morbidly obese patients. Slippage of the LAGB from its original position to lower in the fundus of the stomach leads to gastric obstruction, and sometimes ischaemia or perforation, necessitating LAGB repositioning or removal. This study aimed to identify the incidence of LAGB slippage, as well as predisposing factors that may influence its development. METHODS All LAGBs inserted at one centre, via a pars flaccida technique, by four Bariatric specialist consultants, were reviewed utilising a prospectively maintained Bariatric database, computer records and case notes review. RESULTS Seven hundred nineteen LAGBs were inserted and 33 slips treated; however, only 22 slips had their LAGB inserted at our centre (local slip rate 3.1 %). Multivariate analysis demonstrated a significant association between LAGB slip and younger median age at LAGB insertion (41 years slip vs. 45 years non-slip; p = 0.027), higher median total excess weight loss (64 % slip vs. 36 % non-slip; p < 0.001) and higher mean excess weight loss per month (2.41 % slip vs. 1.00 % non-slip; p < 0.001). There was no significant effect by sex, BMI at insertion or band type. CONCLUSIONS Band slips are associated with greater excess weight loss and younger age. Larger studies may be necessary to further elucidate the risk factors contributing to, and mechanisms of, band slippage.
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Affiliation(s)
- J R A Skipworth
- Department of Bariatric Surgery, Chelsea and Westminster Hospital NHS Trust, 369 Fulham Road, London, SW10 9NH, UK.
| | - A E Fanshawe
- Department of Bariatric Surgery, Chelsea and Westminster Hospital NHS Trust, 369 Fulham Road, London, SW10 9NH, UK
| | - M Hewitt
- Department of Bariatric Surgery, Chelsea and Westminster Hospital NHS Trust, 369 Fulham Road, London, SW10 9NH, UK
| | - D A Raptis
- University of Zurich, Zurich, Switzerland.,Canto Hospital Olten, Zurich, Switzerland
| | - E Efthimiou
- Department of Bariatric Surgery, Chelsea and Westminster Hospital NHS Trust, 369 Fulham Road, London, SW10 9NH, UK
| | - W J B Smellie
- Department of Bariatric Surgery, Chelsea and Westminster Hospital NHS Trust, 369 Fulham Road, London, SW10 9NH, UK
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16
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Dearden JC, Hewitt M, Bresnen GM, Gregg CN. Improved correlation between animal and human potency of non-steroidal anti-inflammatory drugs using quantitative structure-activity relationships (QSARs). SAR QSAR Environ Res 2017; 28:557-565. [PMID: 28738688 DOI: 10.1080/1062936x.2017.1351391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 07/03/2017] [Indexed: 06/07/2023]
Abstract
Animal models are known not to predict human responses well, in general. However, we have been able to demonstrate that, for a series of non-steroidal anti-inflammatory drugs that are or were in clinical use, the incorporation of two simple physicochemical properties results in excellent correlations between human and rodent potencies for anti-inflammatory, analgesic and anti-pyretic activities. This has the potential to allow the use of historical data to improve drug development.
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Affiliation(s)
- J C Dearden
- a School of Pharmacy & Biomolecular Sciences , Liverpool John Moores University , Liverpool , UK
| | - M Hewitt
- b School of Pharmacy , University of Wolverhampton , Wolverhampton , UK
| | - G M Bresnen
- a School of Pharmacy & Biomolecular Sciences , Liverpool John Moores University , Liverpool , UK
| | - C N Gregg
- a School of Pharmacy & Biomolecular Sciences , Liverpool John Moores University , Liverpool , UK
- c Present address: Health & Safety Executive , Bootle , UK
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17
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Putman DM, Cooper TT, Sherman SE, Seneviratne AK, Hewitt M, Bell GI, Hess DA. Expansion of Umbilical Cord Blood Aldehyde Dehydrogenase Expressing Cells Generates Myeloid Progenitor Cells that Stimulate Limb Revascularization. Stem Cells Transl Med 2017; 6:1607-1619. [PMID: 28618138 PMCID: PMC5689765 DOI: 10.1002/sctm.16-0472] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 03/30/2017] [Accepted: 05/03/2017] [Indexed: 12/19/2022] Open
Abstract
Uncompromised by chronic disease‐related comorbidities, human umbilical cord blood (UCB) progenitor cells with high aldehyde dehydrogenase activity (ALDHhi cells) stimulate blood vessel regeneration after intra‐muscular transplantation. However, implementation of cellular therapies using UCB ALDHhi cells for critical limb ischemia, the most severe form of severe peripheral artery disease, is limited by the rarity (<0.5%) of these cells. Our goal was to generate a clinically‐translatable, allogeneic cell population for vessel regenerative therapies, via ex vivo expansion of UCB ALDHhi cells without loss of pro‐angiogenic potency. Purified UCB ALDHhi cells were expanded >18‐fold over 6‐days under serum‐free conditions. Consistent with the concept that ALDH‐activity is decreased as progenitor cells differentiate, only 15.1% ± 1.3% of progeny maintained high ALDH‐activity after culture. However, compared to fresh UCB cells, expansion increased the total number of ALDHhi cells (2.7‐fold), CD34+/CD133+ cells (2.8‐fold), and hematopoietic colony forming cells (7.7‐fold). Remarkably, injection of expanded progeny accelerated recovery of perfusion and improved limb usage in immunodeficient mice with femoral artery ligation‐induced limb ischemia. At 7 or 28 days post‐transplantation, mice transplanted with expanded ALDHhi cells showed augmented endothelial cell proliferation and increased capillary density compared to controls. Expanded cells maintained pro‐angiogenic mRNA expression and secreted angiogenesis‐associated growth factors, chemokines, and matrix modifying proteins. Coculture with expanded cells augmented human microvascular endothelial cell survival and tubule formation under serum‐starved, growth factor‐reduced conditions. Expanded UCB‐derived ALDHhi cells represent an alternative to autologous bone marrow as an accessible source of pro‐angiogenic hematopoietic progenitor cells for the refinement of vascular regeneration‐inductive therapies. Stem Cells Translational Medicine2017;6:1607–1619
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Affiliation(s)
- David M Putman
- Molecular Medicine Research Laboratories, Krembil Centre for Stem Cell Biology, Robarts Research Institute, London, Ontario, Canada.,Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Tyler T Cooper
- Molecular Medicine Research Laboratories, Krembil Centre for Stem Cell Biology, Robarts Research Institute, London, Ontario, Canada.,Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Stephen E Sherman
- Molecular Medicine Research Laboratories, Krembil Centre for Stem Cell Biology, Robarts Research Institute, London, Ontario, Canada.,Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Ayesh K Seneviratne
- Molecular Medicine Research Laboratories, Krembil Centre for Stem Cell Biology, Robarts Research Institute, London, Ontario, Canada.,Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Mark Hewitt
- Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Gillian I Bell
- Molecular Medicine Research Laboratories, Krembil Centre for Stem Cell Biology, Robarts Research Institute, London, Ontario, Canada
| | - David A Hess
- Molecular Medicine Research Laboratories, Krembil Centre for Stem Cell Biology, Robarts Research Institute, London, Ontario, Canada.,Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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18
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Meincke J, Hewitt M, Liebetanz D. P101 Impact of coil rotation on TMS threshold. Clin Neurophysiol 2017. [DOI: 10.1016/j.clinph.2016.10.225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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19
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Mody N, Ramsay S, Ferraro C, Hewitt M, Gill E, Holliday L, Ikharia A, Reeves I. Audit of HIV testing in a multispecialty acute admissions unit in a London general hospital. Br J Vener Dis 2016; 92:239. [DOI: 10.1136/sextrans-2015-052458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 12/06/2015] [Indexed: 11/04/2022]
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20
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O’Sullivan OE, O’Sullivan S, Hewitt M, O’Reilly BA. Da Vinci robot emergency undocking protocol. J Robot Surg 2016; 10:251-3. [DOI: 10.1007/s11701-016-0590-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 03/28/2016] [Indexed: 12/01/2022]
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21
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Schmalfuß L, Rupp R, Tuga MR, Kogut A, Hewitt M, Meincke J, Klinker F, Duttenhoefer W, Eck U, Mikut R, Reischl M, Liebetanz D. Steer by ear: Myoelectric auricular control of powered wheelchairs for individuals with spinal cord injury. Restor Neurol Neurosci 2015; 34:79-95. [PMID: 26599475 DOI: 10.3233/rnn-150579] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE Providing mobility solutions for individuals with tetraplegia remains challenging. Existing control devices have shortcomings such as varying or poor signal quality or interference with communication. To overcome these limitations, we present a novel myoelectric auricular control system (ACS) based on bilateral activation of the posterior auricular muscles (PAMs). METHODS Ten able-bodied subjects and two individuals with tetraplegia practiced PAM activation over 4 days using visual feedback and software-based training for 1 h/day. Initially, half of these subjects were not able to voluntarily activate their PAMs. This ability was tested with regard to 8 parameters such as contraction rate, lateralized activation, wheelchair speed and path length in a virtual obstacle course. In session 5, all subjects steered an electric wheelchair with the ACS. RESULTS Performance of all subjects in controlling their PAMs improved steadily over the training period. By day 5, all subjects successfully generated basic steering commands using the ACS in a powered wheelchair, and subjects with tetraplegia completed a complex real-world obstacle course. This study demonstrates that the ability to activate PAM on both sides together or unilaterally can be learned and used intuitively to steer a wheelchair. CONCLUSIONS With the ACS we can exploit the untapped potential of the PAMs by assigning them a new, complex function. The inherent advantages of the ACS, such as not interfering with oral communication, robustness, stability over time and proportional and continuous signal generation, meet the specific needs of wheelchair users and render it a realistic alternative to currently available assistive technologies.
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Affiliation(s)
| | - R Rupp
- Heidelberg University Hospital, Spinal Cord Injury Center, Heidelberg, Germany
| | - M R Tuga
- Karlsruhe Institute of Technology, Institute for Applied Computer Science/Automation Technology, Karlsruhe, Germany
| | - A Kogut
- Heidelberg University Hospital, Spinal Cord Injury Center, Heidelberg, Germany
| | - M Hewitt
- Georg-August-University Göttingen, Department of Clinical Neurophysiology, Göttingen, Germany
| | - J Meincke
- Georg-August-University Göttingen, Department of Clinical Neurophysiology, Göttingen, Germany
| | - F Klinker
- Georg-August-University Göttingen, Department of Clinical Neurophysiology, Göttingen, Germany
| | - W Duttenhoefer
- Georg-August-University Göttingen, Department of Clinical Neurophysiology, Göttingen, Germany
| | - U Eck
- Heidelberg University Hospital, Spinal Cord Injury Center, Heidelberg, Germany
| | - R Mikut
- Karlsruhe Institute of Technology, Institute for Applied Computer Science, Karlsruhe, Germany
| | - M Reischl
- Karlsruhe Institute of Technology, Institute for Applied Computer Science, Karlsruhe, Germany
| | - D Liebetanz
- Georg-August-University Göttingen, Department of Clinical Neurophysiology, Göttingen, Germany
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22
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Dearden JC, Hewitt M, Roberts DW, Enoch SJ, Rowe PH, Przybylak KR, Vaughan-Williams GD, Smith ML, Pillai GG, Katritzky AR. Mechanism-Based QSAR Modeling of Skin Sensitization. Chem Res Toxicol 2015; 28:1975-86. [PMID: 26382665 DOI: 10.1021/acs.chemrestox.5b00197] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Many chemicals can induce skin sensitization, and there is a pressing need for non-animal methods to give a quantitative indication of potency. Using two large published data sets of skin sensitizers, we have allocated each sensitizing chemical to one of 10 mechanistic categories and then developed good QSAR models for the seven categories that have a sufficient number of chemicals to allow modeling. Both internal and external validation checks showed that each model had good predictivity.
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Affiliation(s)
- J C Dearden
- School of Pharmacy & Biomolecular Sciences, Liverpool John Moores University , Byrom Street, Liverpool L3 3AF, United Kingdom
| | - M Hewitt
- School of Pharmacy, University of Wolverhampton , Wulfruna Street, Wolverhampton WV1 1LY, United Kingdom
| | - D W Roberts
- School of Pharmacy & Biomolecular Sciences, Liverpool John Moores University , Byrom Street, Liverpool L3 3AF, United Kingdom
| | - S J Enoch
- School of Pharmacy & Biomolecular Sciences, Liverpool John Moores University , Byrom Street, Liverpool L3 3AF, United Kingdom
| | - P H Rowe
- School of Pharmacy & Biomolecular Sciences, Liverpool John Moores University , Byrom Street, Liverpool L3 3AF, United Kingdom
| | - K R Przybylak
- School of Pharmacy & Biomolecular Sciences, Liverpool John Moores University , Byrom Street, Liverpool L3 3AF, United Kingdom
| | - G D Vaughan-Williams
- School of Pharmacy & Biomolecular Sciences, Liverpool John Moores University , Byrom Street, Liverpool L3 3AF, United Kingdom
| | - M L Smith
- School of Pharmacy & Biomolecular Sciences, Liverpool John Moores University , Byrom Street, Liverpool L3 3AF, United Kingdom
| | - G G Pillai
- Department of Chemistry, University of Florida , Gainsville, Florida 32611-7200, United States.,Institute of Chemistry, University of Tartu , 50411 Tartu, Estonia
| | - A R Katritzky
- Department of Chemistry, University of Florida , Gainsville, Florida 32611-7200, United States
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23
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Hewitt M, Ellison CM, Cronin MTD, Pastor M, Steger-Hartmann T, Munoz-Muriendas J, Pognan F, Madden JC. Ensuring confidence in predictions: A scheme to assess the scientific validity of in silico models. Adv Drug Deliv Rev 2015; 86:101-11. [PMID: 25794480 DOI: 10.1016/j.addr.2015.03.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 03/05/2015] [Accepted: 03/11/2015] [Indexed: 11/28/2022]
Abstract
The use of in silico tools within the drug development process to predict a wide range of properties including absorption, distribution, metabolism, elimination and toxicity has become increasingly important due to changes in legislation and both ethical and economic drivers to reduce animal testing. Whilst in silico tools have been used for decades there remains reluctance to accept predictions based on these methods particularly in regulatory settings. This apprehension arises in part due to lack of confidence in the reliability, robustness and applicability of the models. To address this issue we propose a scheme for the verification of in silico models that enables end users and modellers to assess the scientific validity of models in accordance with the principles of good computer modelling practice. We report here the implementation of the scheme within the Innovative Medicines Initiative project "eTOX" (electronic toxicity) and its application to the in silico models developed within the frame of this project.
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Affiliation(s)
- Mark Hewitt
- School of Pharmacy, Faculty of Science and Engineering, University of Wolverhampton, City Campus, Wulfruna Street, WV1 1SB, England, United Kingdom; School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Byrom Street, Liverpool, L3 3AF, England, United Kingdom.
| | - Claire M Ellison
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Byrom Street, Liverpool, L3 3AF, England, United Kingdom.
| | - Mark T D Cronin
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Byrom Street, Liverpool, L3 3AF, England, United Kingdom.
| | - Manuel Pastor
- Research Programme on Biomedical Informatics (GRIB), Department of Experimental and Health Sciences, Universitat Pompeu Fabra, IMIM (Hospital del Mar Medical Research Institute), Dr. Aiguader 88, E-08003 Barcelona, Spain.
| | - Thomas Steger-Hartmann
- Bayer HealthCare, Bayer Pharma AG, Investigational Toxicology, Müllerstraße 178, 13352 Berlin, Germany.
| | - Jordi Munoz-Muriendas
- Chemical Sciences, Computational Chemistry, GlaxoSmithKline, Stevenage, SG1 2NY, England, United Kingdom.
| | - Francois Pognan
- Biochemical & Cellular Toxicology, Discovery Investigative Safety - PreClinical Safety, Novartis Pharma AG, Werk Klybeck, Postfach, CH-4002 Basel, Switzerland.
| | - Judith C Madden
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Byrom Street, Liverpool, L3 3AF, England, United Kingdom.
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24
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Abstract
Sulphonylureas are widely used anti-hyperglycaemic drugs for the treatment of type 2 diabetes. The only published quantitative structure-activity relationship (QSAR) models for sulphonylurea drugs have been found to be questionable, for a number of reasons. We have re-analysed the human anti-hyperglycaemic potencies, acute mouse intraperitoneal toxicities (LD50) and plasma protein-binding abilities of the 15 drugs using multiple linear regression and obtained good QSAR models for each endpoint. The obtained QSARs all comply well with the Organisation for Economic Co-operation and Development (OECD) Guidelines for the Validation of (Q)SARs. We could not carry out external validation of our models for acute toxicity and plasma protein-binding because of the very small datasets available.
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Affiliation(s)
- J C Dearden
- a School of Pharmacy & Biomolecular Sciences, Liverpool John Moores University , Liverpool , UK
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25
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Hewitt M, Sproul E, Emberley J. 69: Identifying Risk Factors for Unplanned Extubations in the NICU: Laying the Groundwork for a Quality Improvement Initiative. Paediatr Child Health 2015. [DOI: 10.1093/pch/20.5.e58b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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26
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O'Sullivan OE, Hewitt M, O'Reilly BA. Economic evaluation of robot-assisted hysterectomy: a cost-minimisation analysis. BJOG 2014; 122:144-5. [PMID: 25545909 DOI: 10.1111/1471-0528.13141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2014] [Indexed: 11/28/2022]
Affiliation(s)
- O E O'Sullivan
- Department of Robotic Surgery, Cork University Maternity Hospital, Cork, Ireland
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27
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Richarz AN, Enoch S, Hewitt M, Madden J, Nelms M, Przybylak K, Yang C, Berthold M, Meinl T, Ohl P, Cronin M. In silico workflows for toxicity prediction implemented into KNIME. Toxicol Lett 2013. [DOI: 10.1016/j.toxlet.2013.05.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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28
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Hewitt M, Enoch SJ, Madden JC, Przybylak KR, Cronin MTD. Hepatotoxicity: A scheme for generating chemical categories for read-across, structural alerts and insights into mechanism(s) of action. Crit Rev Toxicol 2013; 43:537-58. [DOI: 10.3109/10408444.2013.811215] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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29
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Piechota P, Cronin MTD, Hewitt M, Madden JC. Pragmatic Approaches to Using Computational Methods To Predict Xenobiotic Metabolism. J Chem Inf Model 2013; 53:1282-93. [DOI: 10.1021/ci400050v] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Przemyslaw Piechota
- School of Pharmacy and Biomolecular
Sciences, Liverpool John Moores University, Byrom Street, Liverpool
L3 3AF, England
| | - Mark T. D. Cronin
- School of Pharmacy and Biomolecular
Sciences, Liverpool John Moores University, Byrom Street, Liverpool
L3 3AF, England
| | - Mark Hewitt
- School of Pharmacy and Biomolecular
Sciences, Liverpool John Moores University, Byrom Street, Liverpool
L3 3AF, England
| | - Judith C. Madden
- School of Pharmacy and Biomolecular
Sciences, Liverpool John Moores University, Byrom Street, Liverpool
L3 3AF, England
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30
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Yang L, Neagu D, Cronin MTD, Hewitt M, Enoch SJ, Madden JC, Przybylak K. Towards a Fuzzy Expert System on Toxicological Data Quality Assessment. Mol Inform 2013; 32:65-78. [DOI: 10.1002/minf.201200082] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Accepted: 11/26/2012] [Indexed: 11/07/2022]
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31
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Przybylak KR, Madden JC, Cronin MTD, Hewitt M. Assessing toxicological data quality: basic principles, existing schemes and current limitations. SAR QSAR Environ Res 2012; 23:435-459. [PMID: 22507180 DOI: 10.1080/1062936x.2012.664825] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Existing toxicological data may be used for a variety of purposes such as hazard and risk assessment or toxicity prediction. The potential use of such data is, in part, dependent upon their quality. Consideration of data quality is of key importance with respect to the application of chemicals legislation such as REACH. Whether data are being used to make regulatory decisions or build computational models, the quality of the output is reflected by the quality of the data employed. Therefore, the need to assess data quality is an important requirement for making a decision or prediction with an appropriate level of confidence. This study considers the biological and chemical factors that may impact upon toxicological data quality and discusses the assessment of data quality. Four general quality criteria are introduced and existing data quality assessment schemes are discussed. Two case study datasets of skin sensitization data are assessed for quality providing a comparison of existing assessment methods. This study also discusses the limitations and difficulties encountered during quality assessment, including the use of differing quality schemes and the global versus chemical-specific assessments of quality. Finally, a number of recommendations are made to aid future data quality assessments.
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Affiliation(s)
- K R Przybylak
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, UK
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32
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Schindel J, Muruganandham M, Eagle A, Hewitt M, Stockman T, Pigge C, Kim Y. PO-339 MRI-DUMMY MARKERS OF MRI-GUIDED HDR BRACHYTHERAPY FOR INTERSTITIAL PROSTATE AND INTRACAVITARY GYN CANCERS. Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)72305-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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33
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Schindel J, Eagle A, Hewitt M, Stockman T, Muruganandham M, Pigge C, Kim Y. PO-268 NOVEL MRI-MARKER-FLANGE FOR MRI-GUIDED BRACHYTHERAPY FOR GYNECOLOGICAL CANCER. Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)72234-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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34
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Madden JC, Hewitt M, Przybylak K, Vandebriel RJ, Piersma AH, Cronin MTD. Strategies for the optimisation of in vivo experiments in accordance with the 3Rs philosophy. Regul Toxicol Pharmacol 2012; 63:140-54. [PMID: 22446816 DOI: 10.1016/j.yrtph.2012.03.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Revised: 02/28/2012] [Accepted: 03/12/2012] [Indexed: 11/25/2022]
Abstract
There are a large number of chemicals in current use for which adequate toxicity data are not available. Whilst there are clear ethical and legal obligations to obtain data from sources other than in vivo experiments wherever possible, in certain cases in vivo assays may be deemed necessary. In such circumstances, it is essential to ensure that the maximum amount of high quality data is obtained from the minimum number of animals, using the most humane procedures, in accordance with the philosophy of reduction, refinement and replacement (3Rs). The aim of this report is to provide a strategy for anyone involved in animal experimentation, for either toxicological or pharmacological purposes, as to how in vivo experiments may be optimised. The impact of generic and endpoint specific sources of variability has been highlighted in a proof-of-principle analysis considering the variation in protocols for assays for four human health endpoints (skin sensitisation, reproductive/developmental toxicity, mutagenicity and carcinogenicity). Other factors such as operator training, experimental/statistical design, use of lower species and use of combined assays are also discussed. Recommendations for optimisation of in vivo assays, in terms of the 3Rs philosophy, applied to performing tests, harvesting data and appropriate reporting are summarised as a checklist of issues to be addressed prior to undertaking such assays.
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Affiliation(s)
- Judith C Madden
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, James Parsons Building, Byrom Street, Liverpool L3 3AF, England, UK.
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35
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Cronin C, Hewitt M, Harley I, O’Donoghue K, O’Reilly BA. Robot-assisted laparoscopic cervical cerclage as an interval procedure. ACTA ACUST UNITED AC 2012. [DOI: 10.1007/s10397-012-0725-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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36
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Abstract
Accurate fitting of a lower-limb prosthetic socket is the most important factor affecting amputee satisfaction and rehabilitation. The technology is now available to allow real-time monitoring of in-service pressure distribution of prosthetic limbs. This paper proposes a remote interfacial pressure monitoring system necessary for the assessment of fit. The suitability of a wireless ZigBee network due to its relevant technical specification is investigated. The system enables remote monitoring of a prosthetic socket and its fit under different operating conditions thereby improving design, efficiency and effectiveness. The data can be used by prosthetists and may also be recorded for future training or for patient progress monitoring. This can minimize the number of iterations by getting it right first time, thereby minimizing the number of replacement prostheses.
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Affiliation(s)
- R Sahandi
- School of Design, Engineering & Computing, Bournemouth University, Talbot Campus, Fern Barrow, Poole, Dorset, BH12 5BB, UK.
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37
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Mazeika Bilbao A, Carrano A, Hewitt M, Thorn B. On the environmental impacts of pallet management operations. Management Research Review 2011. [DOI: 10.1108/01409171111178765] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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38
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Hewitt M, Cronin MTD, Rowe PH, Schultz TW. Repeatability analysis of the Tetrahymena pyriformis population growth impairment assay. SAR QSAR Environ Res 2011; 22:621-637. [PMID: 21830879 DOI: 10.1080/1062936x.2011.604100] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Assessments necessary to ensure the safety of both humans and the environment are challenged by the sheer number of chemicals in use today. Chemical legislation, such as REACH, aims to use alternative methods to reduce the reliance on in vivo animal testing. Consequently, databases such as the TETRATOX database, containing data from the Tetrahymena pyriformis population growth impairment assay, have been used extensively to develop computational models which aid in priority setting and initial hazard assessments. To use any toxicological data, an assessment of quality is required. One important aspect of quality is the repeatability of the assay. This study considered TETRATOX assay data for 85 structurally and mechanistically diverse compounds. The repeatability of replicate determinations was assessed and factors relating to repeatability are discussed. Despite the majority of compounds demonstrating excellent repeatability, it was found that the mechanism of action is likely to be a modulating factor, with compounds acting via electrophilic mechanisms being more likely to exhibit reduced repeatability than those acting via narcotic mechanisms. It is evident from this study that the TETRATOX assay is a robust and highly repeatable assay, suitable for use in toxicological modelling studies and priority setting.
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Affiliation(s)
- M Hewitt
- School of Pharmacy and Chemistry, Liverpool John Moores University, Liverpool, UK
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39
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Cronin MTD, Enoch SJ, Hewitt M, Madden JC. Formation of mechanistic categories and local models to facilitate the prediction of toxicity. ALTEX 2011; 28:45-9. [PMID: 21311849 DOI: 10.14573/altex.2011.1.045] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
There is a range of in silico techniques that can be applied to predict the toxicity of chemicals. This paper discusses the use of methods to create "local" models, particularly based around category formation and read-across, to predict toxicity. Specifically, this is illustrated with regard to categories for predicting skin sensitisation and teratogenicity. These were formed using mechanistic and structural similarity techniques to group chemicals. Local QSAR models based on grouping chemicals have the advantage that they are transparent, simple and mechanistically derived. In addition, there are a number of freely available software tools to assist in their derivation. The disadvantages include that they are labour-intensive to develop and restricted to local areas of chemistry.
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Affiliation(s)
- Mark T D Cronin
- School of Pharmacy and Chemistry, Liverpool John Moores University, Liverpool, UK.
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40
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Schwöbel JAH, Koleva YK, Enoch SJ, Bajot F, Hewitt M, Madden JC, Roberts DW, Schultz TW, Cronin MTD. Measurement and Estimation of Electrophilic Reactivity for Predictive Toxicology. Chem Rev 2011; 111:2562-96. [DOI: 10.1021/cr100098n] [Citation(s) in RCA: 149] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Johannes A. H. Schwöbel
- School of Pharmacy and Chemistry, Liverpool John Moores University, Byrom Street, Liverpool L3 3AF, England
| | - Yana K. Koleva
- School of Pharmacy and Chemistry, Liverpool John Moores University, Byrom Street, Liverpool L3 3AF, England
| | - Steven J. Enoch
- School of Pharmacy and Chemistry, Liverpool John Moores University, Byrom Street, Liverpool L3 3AF, England
| | - Fania Bajot
- School of Pharmacy and Chemistry, Liverpool John Moores University, Byrom Street, Liverpool L3 3AF, England
| | - Mark Hewitt
- School of Pharmacy and Chemistry, Liverpool John Moores University, Byrom Street, Liverpool L3 3AF, England
| | - Judith C. Madden
- School of Pharmacy and Chemistry, Liverpool John Moores University, Byrom Street, Liverpool L3 3AF, England
| | - David W. Roberts
- School of Pharmacy and Chemistry, Liverpool John Moores University, Byrom Street, Liverpool L3 3AF, England
| | - Terry W. Schultz
- College of Veterinary Medicine, Department of Comparative Medicine, The University of Tennessee, 2407 River Drive, Knoxville, Tennessee 37996-4543, United States
| | - Mark T. D. Cronin
- School of Pharmacy and Chemistry, Liverpool John Moores University, Byrom Street, Liverpool L3 3AF, England
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41
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Slade I, Bacchelli C, Davies H, Murray A, Abbaszadeh F, Hanks S, Barfoot R, Burke A, Chisholm J, Hewitt M, Jenkinson H, King D, Morland B, Pizer B, Prescott K, Saggar A, Side L, Traunecker H, Vaidya S, Ward P, Futreal PA, Vujanic G, Nicholson AG, Sebire N, Turnbull C, Priest JR, Pritchard-Jones K, Houlston R, Stiller C, Stratton MR, Douglas J, Rahman N. DICER1 syndrome: clarifying the diagnosis, clinical features and management implications of a pleiotropic tumour predisposition syndrome. J Med Genet 2011; 48:273-8. [DOI: 10.1136/jmg.2010.083790] [Citation(s) in RCA: 268] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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43
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Gagné F, André C, Douville M, Talbot A, Parrott J, McMaster M, Hewitt M. An examination of the toxic properties of water extracts in the vicinity of an oil sand extraction site. ACTA ACUST UNITED AC 2011; 13:3075-86. [DOI: 10.1039/c1em10591d] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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44
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Abstract
The past two decades has seen the rapid growth in the development and utilisation of computational technologies to predict the toxicity of chemicals. Most notably, widespread pressure to both reduce and replace current animal testing regimes has led to in silico modelling becoming a widely utilised tool in toxicological screening. Unfortunately, given that computational models are open to misuse, there has been, and still is, significant reluctance to accept them for regulatory use. In an effort to combat this, the validation of both model and predictions is now at the forefront of research, with the concept of applicability domain being central to the validation process.
In this chapter the applicability domain concept is defined and numerous methods for its characterisation are detailed and explored with the aid of a case study example. These approaches are shown to span from relatively simple descriptor-based methods to more complex approaches based upon structural similarity or mechanism of action. Given the wealth of differing approaches available and the different information each method yields about the model, a stepwise scheme which considers numerous methods is recommended. With appreciation of model architecture and subsequent utilisation, this chapter shows that a robust and multifaceted applicability domain can be generated. Once defined, the applicability domain serves as a critical screening stage ensuring that a model is fit-for-purpose and predictions are made with maximal confidence.
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Affiliation(s)
- M. Hewitt
- School of Pharmacy and Chemistry, Liverpool John Moores University Byrom Street, Liverpool L3 3AF UK
| | - C. M. Ellison
- School of Pharmacy and Chemistry, Liverpool John Moores University Byrom Street, Liverpool L3 3AF UK
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45
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Nendza M, Aldenberg T, Benfenati E, Benigni R, Cronin M, Escher S, Fernandez A, Gabbert S, Giralt F, Hewitt M, Hrovat M, Jeram S, Kroese D, Madden JC, Mangelsdorf I, Rallo R, Roncaglioni A, Rorije E, Segner H, Simon-Hettich B, Vermeire T. Data Quality Assessment for In Silico Methods: A Survey of Approaches and Needs. In Silico Toxicology 2010. [DOI: 10.1039/9781849732093-00059] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
As indicated in Chapter 3, there are a large number of potential sources of data now available for modelling purposes. These range from historical literature references for a few compounds to highly curated databases of hundreds of thousands of compounds, available via the internet. Before including any data in an in silico model, the question of data quality must be addressed. Although it is difficult to define the quality of data in absolute terms, it is possible to assess the suitability of data for a given purpose. There are many reasons for variability within data and the degree of error that is acceptable for one model may not be the same as for another. For example generating a global model intended to pre-screen large numbers of compounds does not require the same degree of accuracy as performing an individual risk assessment for a chemical of interest. In this chapter, sources of data variability and error will be discussed and formal methods to score data quality, such as use of the Klimisch criteria, will be described. Examples of data quality issues will be given for specific endpoints relating to both environmental and human health effects. Mathematical approaches (Dempster-Schafer theory and Bayesian networks) demonstrating how this information relating to confidence in the data can be incorporated into in silico models is also discussed.
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Affiliation(s)
- M. Nendza
- Analytisches Laboratorium Luhnstedt Germany
| | | | | | - R. Benigni
- Environment and Health Department, Istituto Superiore di Sanita Rome Italy
| | - M.T.D. Cronin
- School of Pharmacy and Chemistry, Liverpool John Moores University Liverpool UK
| | - S. Escher
- School of Pharmacy and Chemistry, Liverpool John Moores University Liverpool UK
| | | | | | | | - M. Hewitt
- School of Pharmacy and Chemistry, Liverpool John Moores University Liverpool UK
| | - M. Hrovat
- Institute of Public Health of the Republic of Slovenia
| | - S. Jeram
- Institute of Public Health of the Republic of Slovenia
| | | | - J. C. Madden
- School of Pharmacy and Chemistry, Liverpool John Moores University Liverpool UK
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Dearden JC, Hewitt M. QSAR modelling of bioconcentration factor using hydrophobicity, hydrogen bonding and topological descriptors. SAR QSAR Environ Res 2010; 21:671-680. [PMID: 21120755 DOI: 10.1080/1062936x.2010.528235] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Bioconcentration factor (BCF) is an important step in the uptake of environmental pollutants in the food chain. It is expensive and time-consuming to measure, so predictive methods are of value. We have used an artificial neural network QSAR approach involving descriptors for hydrophobicity, hydrogen bonding and molecular topology, obtained from commercially available software, to predict the fish BCF values of a diverse data set of 624 chemicals. The training set statistics were: r²= 0.765, q²= 0.763, s = 0.610, and those of the external test set were: r²= 0.739, s = 0.627. The model complies with the OECD Principles for the Validation of (Q)SARs.
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Affiliation(s)
- J C Dearden
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, UK.
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Hewitt M, Ellison C, Enoch S, Madden J, Cronin M. Integrating (Q)SAR models, expert systems and read-across approaches for the prediction of developmental toxicity. Reprod Toxicol 2010; 30:147-60. [DOI: 10.1016/j.reprotox.2009.12.003] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2009] [Revised: 12/03/2009] [Accepted: 12/04/2009] [Indexed: 11/29/2022]
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48
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Dewhurst C, Brennan C, Breen M, Barry J, Hewitt M. Staging of cervical cancer using transvaginal ultrasound. Cancer Imaging 2010. [DOI: 10.1102/1470-7330.2010.9066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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49
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Hewitt M, Cronin MTD, Enoch SJ, Madden JC, Roberts DW, Dearden JC. In Silico Prediction of Aqueous Solubility: The Solubility Challenge. J Chem Inf Model 2009; 49:2572-87. [DOI: 10.1021/ci900286s] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- M. Hewitt
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Byrom Street, Liverpool, L3 3AF, England
| | - M. T. D. Cronin
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Byrom Street, Liverpool, L3 3AF, England
| | - S. J. Enoch
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Byrom Street, Liverpool, L3 3AF, England
| | - J. C. Madden
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Byrom Street, Liverpool, L3 3AF, England
| | - D. W. Roberts
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Byrom Street, Liverpool, L3 3AF, England
| | - J. C. Dearden
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Byrom Street, Liverpool, L3 3AF, England
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50
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Vonk JA, Benigni R, Hewitt M, Nendza M, Segner H, van de Meent D, Cronin MT. The use of Mechanisms and Modes of Toxic Action in Integrated Testing Strategies: The Report and Recommendations of a Workshop held as part of the European Union OSIRIS Integrated Project. Altern Lab Anim 2009; 37:557-71. [DOI: 10.1177/026119290903700512] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This report on The Potential of Mode of Action (MoA) Information Derived from Non-testing and Screening Methodologies to Support Informed Hazard Assessment, resulted from a workshop organised within OSIRIS (Optimised Strategies for Risk Assessment of Industrial Chemicals through Integration of Non-test and Test Information), a project partly funded by the EU Commission within the Sixth Framework Programme. The workshop was held in Liverpool, UK, on 30 October 2008, with 35 attendees. The goal of the OSIRIS project is to develop integrated testing strategies (ITS) fit for use in the REACH system, that would enable a significant increase in the use of non-testing information for regulatory decision making, and thus minimise the need for animal testing. One way to improve the evaluation of chemicals may be through categorisation by way of mechanisms or modes of toxic action. Defining such groups can enhance read-across possibilities and priority settings for certain toxic modes or chemical structures responsible for these toxic modes. Overall, this may result in a reduction of in vivo testing on organisms, through combining available data on mode of action and a focus on the potentially most-toxic groups. In this report, the possibilities of a mechanistic approach to assist in and guide ITS are explored, and the differences between human health and environmental areas are summarised.
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Affiliation(s)
- J. Arie Vonk
- Laboratory for Ecological Risk Assessment, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Romualdo Benigni
- Laboratory of Comparative Toxicology, Environment and Health Department, Istituto Superiore di Sanita, Rome, Italy
| | - Mark Hewitt
- School of Pharmacy and Chemistry, Liverpool John Moores University, Liverpool, UK
| | | | - Helmut Segner
- Centre for Fish and Wildlife Health, Vetsuisse Faculty, University of Berne, Berne, Switzerland
| | - Dik van de Meent
- Laboratory for Ecological Risk Assessment, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Mark T.D. Cronin
- School of Pharmacy and Chemistry, Liverpool John Moores University, Liverpool, UK
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