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Nicolson C, Burke A, Gardiner D, Harvey D, Munshi L, Shaw M, Tsanas A, Lone N, Puxty K. Predicting time to asystole following withdrawal of life-sustaining treatment: a systematic review. Anaesthesia 2024; 79:638-649. [PMID: 38301032 DOI: 10.1111/anae.16222] [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] [Accepted: 12/04/2023] [Indexed: 02/03/2024]
Abstract
The planned withdrawal of life-sustaining treatment is a common practice in the intensive care unit for patients where ongoing organ support is recognised to be futile. Predicting the time to asystole following withdrawal of life-sustaining treatment is crucial for setting expectations, resource utilisation and identifying patients suitable for organ donation after circulatory death. This systematic review evaluates the literature for variables associated with, and predictive models for, time to asystole in patients managed on intensive care units. We conducted a comprehensive structured search of the MEDLINE and Embase databases. Studies evaluating patients managed on adult intensive care units undergoing withdrawal of life-sustaining treatment with recorded time to asystole were included. Data extraction and PROBAST quality assessment were performed and a narrative summary of the literature was provided. Twenty-three studies (7387 patients) met the inclusion criteria. Variables associated with imminent asystole (<60 min) included: deteriorating oxygenation; absence of corneal reflexes; absence of a cough reflex; blood pressure; use of vasopressors; and use of comfort medications. We identified a total of 20 unique predictive models using a wide range of variables and techniques. Many of these models also underwent secondary validation in further studies or were adapted to develop new models. This review identifies variables associated with time to asystole following withdrawal of life-sustaining treatment and summarises existing predictive models. Although several predictive models have been developed, their generalisability and performance varied. Further research and validation are needed to improve the accuracy and widespread adoption of predictive models for patients managed in intensive care units who may be eligible to donate organs following their diagnosis of death by circulatory criteria.
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Affiliation(s)
- C Nicolson
- Department of Critical Care, NHS Greater Glasgow and Clyde, Glasgow Royal Infirmary, Glasgow, UK
- School of Informatics, University of Edinburgh, Edinburgh, UK
| | - A Burke
- Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
| | - D Gardiner
- Critical Care, Nottingham University Hospitals NHS Trust, Nottingham, UK
- NHS Blood and Transplant, Watford, UK
| | - D Harvey
- Critical Care, Nottingham University Hospitals NHS Trust, Nottingham, UK
- NHS Blood and Transplant, Watford, UK
| | - L Munshi
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Department of Medicine, Sinai Health System and University Health Network, Toronto, ON, Canada
| | - M Shaw
- Department of Clinical Physics & Bioengineering, NHS Greater Glasgow and Clyde, Glasgow Royal Infirmary, Glasgow, UK
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - A Tsanas
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - N Lone
- Usher Institute, University of Edinburgh, Edinburgh, UK
- Department of Critical Care, NHS Lothian, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - K Puxty
- Department of Critical Care, NHS Greater Glasgow and Clyde, Glasgow Royal Infirmary, Glasgow, UK
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
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Livesey JA, Lone N, Black E, Broome R, Syme A, Keating S, Elliott L, McCahill C, Simpson G, Grant H, Auld F, Garrioch S, Hay A, Craven TH. Neurological outcome following out of hospital cardiac arrest: Evaluation of performance of existing risk prediction models in a UK cohort. J Intensive Care Soc 2024; 25:131-139. [PMID: 38737314 PMCID: PMC11086724 DOI: 10.1177/17511437231214146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024] Open
Abstract
Introduction Out of hospital cardiac arrest (OHCA) is a common problem. Rates of survival are low and a proportion of survivors are left with an unfavourable neurological outcome. Four models have been developed to predict risk of unfavourable outcome at the time of critical care admission - the Cardiac Arrest Hospital Prognosis (CAHP), MIRACLE2, Out of Hospital Cardiac Arrest (OHCA), and Targeted Temperature Management (TTM) models. This evaluation evaluates the performance of these four models in a United Kingdom population and provides comparison to performance of the Acute Physiology and Chronic Health Evaluation II (APACHE-II) score. Methods A retrospective evaluation of the performance of the models was conducted over a 43-month period in 414 adult, non-pregnant patients presenting consecutively following non-traumatic OHCA to the five units in our regional critical care network. Scores were generated for each model for where patients had complete data (CAHP = 347, MIRACLE2 = 375, OHCA = 356, TTM = 385). Cerebral Performance Category (CPC) outcome was calculated for each patient at last documented follow up and an unfavourable outcome defined as CPC ⩾ 3. Performance for discrimination of unfavourable outcome was tested by generating receiver operating characteristic (ROC) curves for each model and comparing the area under the curve (AUC). Results Best performance for discrimination of unfavourable outcome was demonstrated by the high risk group of the CAHP score with an AUC of 0.87 [95% CI 0.83-0.91], specificity of 97.1% [95% CI 93.8-100] and positive predictive value (PPV) of 96.3% [95% CI 92.2-100]. The high risk group of the MIRACLE2 model, which is significantly easier to calculate, had an AUC of 0.81 [95% CI 0.76-0.86], specificity of 92.3% [95% CI 87.2-97.4] and PPV of 95.2% [95% CI 91.9-98.4]. Conclusion The CAHP, MIRACLE2, OHCA and TTM scores all perform comparably in a UK population to the original development and validation cohorts. All four scores outperform APACHE-II in a population of patients resuscitated from OHCA. CAHP and TTM perform best but are more complex to calculate than MIRACLE2, which displays inferior performance.
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Affiliation(s)
- John A Livesey
- Edinburgh Critical Care Research Group, Department of Critical Care, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Nazir Lone
- Edinburgh Critical Care Research Group, Department of Critical Care, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Emily Black
- Department of Critical Care, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Richard Broome
- Department of Critical Care, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Alastair Syme
- Department of Critical Care, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Sean Keating
- Department of Critical Care, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Laura Elliott
- Department of Critical Care, Victoria Hospital Kirkcaldy, Kirkcaldy, UK
| | - Cara McCahill
- Department of Critical Care, Victoria Hospital Kirkcaldy, Kirkcaldy, UK
| | - Gavin Simpson
- Department of Critical Care, Victoria Hospital Kirkcaldy, Kirkcaldy, UK
| | - Helen Grant
- Department of Critical Care, St John’s Hospital, Livingston, UK
| | - Fiona Auld
- Department of Critical Care, Western General Hospital, Edinburgh, UK
| | - Sweyn Garrioch
- Department of Critical Care, Borders General Hospital, Melrose, UK
| | - Alasdair Hay
- Edinburgh Critical Care Research Group, Department of Critical Care, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Thomas H Craven
- Edinburgh Critical Care Research Group, Department of Critical Care, Royal Infirmary of Edinburgh, Edinburgh, UK
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Tirupakuzhi Vijayaraghavan BK, Rashan A, Ranganathan L, Venkataraman R, Tripathy S, Jayakumar D, Ramachandran P, Mohamed ZU, Balakrishnan S, Ramakrishnan N, Haniffa R, Beane A, Adhikari NKJ, de Keizer N, Lone N. Prevalence of frailty and association with patient centered outcomes: A prospective registry-embedded cohort study from India. J Crit Care 2024; 80:154509. [PMID: 38134715 PMCID: PMC10830405 DOI: 10.1016/j.jcrc.2023.154509] [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: 04/25/2023] [Revised: 08/15/2023] [Accepted: 11/30/2023] [Indexed: 12/24/2023]
Abstract
PURPOSE We aimed to study the prevalence of frailty, evaluate risk factors, and understand impact on outcomes in India. METHODS This was a prospective registry-embedded cohort study across 7 intensive care units (ICUs) and included adult patients anticipated to stay for at least 48 h. Primary exposure was frailty, as defined by a score ≥ 5 on the Clinical Frailty Scale and primary outcome was ICU mortality. Secondary outcomes included in-hospital mortality and resource utilization. We used generalized linear models to evaluate risk factors and model association between frailty and outcomes. RESULTS 838 patients were included, with median (IQR) age 57 (42,68) yrs.; 64.8% were male. Prevalence of frailty was 19.8%. Charlson comorbidity index (OR:1.73 (95%CI:1.39,2.15)), Subjective Global Assessment categories mild/moderate malnourishment (OR:1.90 (95%CI:1.29, 2.80)) and severe malnourishment (OR:4.76 (95% CI:2.10,10.77)) were associated with frailty. Frailty was associated with higher odds of ICU mortality (adjusted OR:2.04 (95% CI:1.25,3.33)), hospital mortality (adjusted OR:2.36 (95%CI:1.45,3.84)), development of stage2/3 AKI (unadjusted OR:2.35 (95%CI:1.60, 3.43)), receipt of non-invasive ventilation (unadjusted OR:2.68 (95%CI:1.77, 4.03)), receipt of vasopressors (unadjusted OR:1.47 (95%CI:1.04, 2.07)), and receipt of kidney replacement therapy (unadjusted OR:3.15 (95%CI:1.90, 5.17)). CONCLUSIONS Frailty is common among critically ill patients in India and is associated with worse outcomes. STUDY REGISTRATION CTRI/2021/02/031503.
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Affiliation(s)
| | - Aasiyah Rashan
- Network for Improving Critical care Systems and Training, Colombo, Sri Lanka; University College, London
| | | | | | - Swagata Tripathy
- Department of Anaesthesia and Critical Care Medicine, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Devachandran Jayakumar
- Department of Critical Care Medicine, Apollo Specialty Hospital, Chennai, India; Department of Critical Care Medicine, Dr. Kamakshi Memorial Hospital, Chennai, India
| | | | - Zubair Umer Mohamed
- Department of Anaesthesia and Critical Care Medicine, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Sindhu Balakrishnan
- Department of Anaesthesia and Critical Care Medicine, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
| | | | - Rashan Haniffa
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand; Centre for Inflammation Research, University of Edinburgh, United Kingdom
| | - Abi Beane
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand; Centre for Inflammation Research, University of Edinburgh, United Kingdom
| | - Neill K J Adhikari
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Canada; Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Nicolette de Keizer
- Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, the Netherlands
| | - Nazir Lone
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
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Swets MC, Kerr S, Scott-Brown J, Brown AB, Gupta R, Millar JE, Spata E, McCurrach F, Bretherick AD, Docherty A, Harrison D, Rowan K, Young N, Groeneveld GH, Dunning J, Nguyen-Van-Tam JS, Openshaw P, Horby PW, Harrison E, Staplin N, Semple MG, Lone N, Baillie JK. Evaluation of pragmatic oxygenation measurement as a proxy for Covid-19 severity. Nat Commun 2023; 14:7374. [PMID: 37968269 PMCID: PMC10651917 DOI: 10.1038/s41467-023-42205-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 10/04/2023] [Indexed: 11/17/2023] Open
Abstract
Choosing optimal outcome measures maximizes statistical power, accelerates discovery and improves reliability in early-phase trials. We devised and evaluated a modification to a pragmatic measure of oxygenation function, the [Formula: see text] ratio. Because of the ceiling effect in oxyhaemoglobin saturation, [Formula: see text] ratio ceases to reflect pulmonary oxygenation function at high [Formula: see text] values. We found that the correlation of [Formula: see text] with the reference standard ([Formula: see text]/[Formula: see text] ratio) improves substantially when excluding [Formula: see text] and refer to this measure as [Formula: see text]. Using observational data from 39,765 hospitalised COVID-19 patients, we demonstrate that [Formula: see text] is predictive of mortality, and compare the sample sizes required for trials using four different outcome measures. We show that a significant difference in outcome could be detected with the smallest sample size using [Formula: see text]. We demonstrate that [Formula: see text] is an effective intermediate outcome measure in COVID-19. It is a non-invasive measurement, representative of disease severity and provides greater statistical power.
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Affiliation(s)
- Maaike C Swets
- Roslin Institute, University of Edinburgh, Edinburgh, UK
- Department of Infectious Diseases, Leiden University Medical Center, Leiden University, Leiden, The Netherlands
| | - Steven Kerr
- Roslin Institute, University of Edinburgh, Edinburgh, UK
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | | | - Adam B Brown
- Roslin Institute, University of Edinburgh, Edinburgh, UK
| | - Rishi Gupta
- Institute for Global Health, University College London, London, UK
| | | | - Enti Spata
- Medical Research Council Population Health Research Unit at the University of Oxford, Nuffield Department of Population Health (NDPH), Oxford, UK
| | - Fiona McCurrach
- EMERGE, NHS Lothian, Royal Infirmary Edinburgh, Edinburgh, UK
| | - Andrew D Bretherick
- MRC Human Genetics Unit, Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital, Edinburgh, UK
| | - Annemarie Docherty
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - David Harrison
- Intensive Care National Audit & Research Centre, London, UK
| | - Kathy Rowan
- Intensive Care National Audit & Research Centre, London, UK
| | - Neil Young
- Department of Anaesthesia, Critical Care and Pain Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Geert H Groeneveld
- Department of Infectious Diseases, Leiden University Medical Center, Leiden University, Leiden, The Netherlands
| | - Jake Dunning
- Pandemic Sciences Institute, University of Oxford, Oxford, UK
| | | | - Peter Openshaw
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Peter W Horby
- Pandemic Sciences Institute, University of Oxford, Oxford, UK
| | - Ewen Harrison
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Natalie Staplin
- Medical Research Council Population Health Research Unit at the University of Oxford, Nuffield Department of Population Health (NDPH), Oxford, UK
| | - Malcolm G Semple
- Institute of Infection, Veterinary and Ecological Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
- Department of Respiratory Medicine, Alder Hey Children's Hospital, Liverpool, UK
| | - Nazir Lone
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
- Intensive Care Unit, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, UK
| | - J Kenneth Baillie
- Roslin Institute, University of Edinburgh, Edinburgh, UK.
- Intensive Care Unit, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, UK.
- Baillie Gifford Pandemic Science Hub, Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK.
- MRC Human Genetics Unit, Institute for Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK.
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5
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Arakelyan S, Mikula-Noble N, Ho L, Lone N, Anand A, Lyall MJ, Mercer SW, Guthrie B. Effectiveness of holistic assessment-based interventions for adults with multiple long-term conditions and frailty: an umbrella review of systematic reviews. Lancet Healthy Longev 2023; 4:e629-e644. [PMID: 37924844 DOI: 10.1016/s2666-7568(23)00190-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 09/04/2023] [Accepted: 09/04/2023] [Indexed: 11/06/2023] Open
Abstract
Holistic assessment-based interventions (HABIs) are effective in older people admitted to hospital, but it is unclear whether similar interventions are effective in adults with multiple long-term conditions or frailty in the community. We conducted an umbrella review to comprehensively evaluate the literature on HABIs for adults (aged ≥18 years) with multiple long-term conditions, and frailty. We searched eight databases for systematic reviews reporting on experimental or quasi-experimental studies. Of 9803 titles screened, we identified 29 eligible reviews (14 with meta-analysis) reporting on 14 types of HABIs. The evidence for the effectiveness of HABIs was largely inconsistent across different types of interventions, settings, and outcomes. We found evidence of no benefit from hospital HABIs on health-related quality of life (HRQoL) and emergency department re-attendance, and evidence of no benefit from community HABIs on overall health-care utilisation rates, emergency department attendance, nursing home admissions, and mortality. The best evidence of effectiveness was for hospital comprehensive geriatric assessment (CGA) on nursing home admissions, keeping patients alive and in their own homes. There was some evidence of benefit from community CGA on hospital admissions, and from CGA spanning community and hospital settings on HRQoL. Patient-centred medical homes had beneficial effects on HRQoL, mental health, self-management, and hospital admissions.
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Affiliation(s)
- Stella Arakelyan
- Advanced Care Research Centre, Usher Institute, University of Edinburgh, Edinburgh, UK.
| | | | - Leonard Ho
- Advanced Care Research Centre, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Nazir Lone
- NHS Lothian, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Atul Anand
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK; NHS Lothian, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Marcus J Lyall
- NHS Lothian, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Stewart W Mercer
- Advanced Care Research Centre, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Bruce Guthrie
- Advanced Care Research Centre, Usher Institute, University of Edinburgh, Edinburgh, UK
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Lyall MJ, Dear J, Simpson J, Lone N. Duration of consultant experience and patient outcome following acute medical unit admission: an observational cohort study. Clin Med (Lond) 2023; 23:458-466. [PMID: 37775159 PMCID: PMC10541280 DOI: 10.7861/clinmed.2022-0546] [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: 10/01/2023]
Abstract
BACKGROUND The effect of the duration of consultant experience on clinical outcomes in the acute medical unit (AMU) model remains unknown. METHODS Unscheduled AMU admissions (n=66,929) admitted by 56 consultant physicians between 2017 and 2020 to two large teaching hospital AMUs in Lothian, Scotland were examined. The associations of consultant experience on AMU with patient discharge, mortality, readmission and postdischarge death were calculated adjusting for clinical acuity, pathology and comorbidity. RESULTS Increasing consultant experience was associated with a continuous increase in likelihood of early AMU discharge (odds ratio (OR) 1.08; 95% confidence interval (CI) 1.07-1.10; p<0.001 per 5 years' experience), which persisted after adjustment for confounders (OR 1.06; 95% CI: 1.01-1.11; p=0.01). There was no association with early readmission, death after discharge or 30-day inpatient mortality. The marginal effect estimate translates into 31 (95% CI: 25-36), 41 (95% CI: 30-53) and 52 (95% CI: 35-71) additional safe discharges per 1,000 admissions for clinicians of 15, 20 and 25 years' experience, respectively compared with those recently completing training. CONCLUSIONS Increasing consultant physician experience associates with early safe discharge after AMU admission. These data suggest that the support and retention of experienced clinicians is vital if escalating pressures on unscheduled medical care are to be addressed.
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Affiliation(s)
- Marcus J Lyall
- Usher Institute for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - James Dear
- Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Johanne Simpson
- Department of Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Nazir Lone
- Usher Institute for Population Health Sciences, University of Edinburgh, Edinburgh, UK
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Arakelyan S, Lone N, Anand A, Mikula-Noble N, J Lyall M, De Ferrari L, Mercer SW, Guthrie B. Effectiveness of holistic assessment-based interventions in improving outcomes in adults with multiple long-term conditions and/or frailty: an umbrella review protocol. JBI Evid Synth 2023; 21:1863-1878. [PMID: 37139933 PMCID: PMC10464880 DOI: 10.11124/jbies-22-00406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
OBJECTIVE This umbrella review will synthesize evidence on the effectiveness of holistic assessment-based interventions in improving health outcomes in adults (aged ≥18) with multiple long-term conditions and/or frailty. INTRODUCTION Health systems need effective, evidence-based interventions to improve health outcomes for adults with multiple long-term conditions. Holistic assessment-based interventions are effective in older people admitted to hospital (usually called "comprehensive geriatric assessments" in that context); however, the evidence is inconclusive on whether similar interventions are effective in community settings. INCLUSION CRITERIA We will include systematic reviews examining the effectiveness of community and/or hospital holistic assessment-based interventions in improving health outcomes for community-dwelling and hospitalized adults aged ≥ 18 with multiple long-term conditions and/or frailty. METHODS The review will follow the JBI methodology for umbrella reviews. MEDLINE, Embase, PsycINFO, CINAHL Plus, Scopus, ASSIA, Cochrane Library, and the TRIP Medical Database will be searched to identify reviews published in English from 2010 till the present. This will be followed by a manual search of reference lists of included reviews to identify additional reviews. Two reviewers will independently screen titles and abstracts against the selection criteria, followed by screening of full texts. Methodological quality will be assessed using the JBI critical appraisal checklist for systematic reviews and research syntheses and data will be extracted using an adapted and piloted JBI data extraction tool. The summary of findings will be presented in tabular format, with narrative descriptions and visual indications. The citation matrix will be generated and the corrected covered area calculated to analyze the overlap in primary studies across the reviews. REVIEW REGISTRATION PROSPERO CRD42022363217.
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Affiliation(s)
- Stella Arakelyan
- Advanced Care Research Centre, Centre of Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Nazir Lone
- NHS Lothian, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Atul Anand
- NHS Lothian, Royal Infirmary of Edinburgh, Edinburgh, UK
- Centre for Cardiovascular Science, University of Edinburgh, UK
| | - Nataysia Mikula-Noble
- School of Medicine, The Chancellor's Building, University of Edinburgh, Edinburgh, UK
| | - Marcus J Lyall
- NHS Lothian, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Luna De Ferrari
- School of Informatics, Informatics Forum, University of Edinburgh, Edinburgh, UK
| | - Stewart W. Mercer
- Advanced Care Research Centre, Centre of Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Bruce Guthrie
- Advanced Care Research Centre, Centre of Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UK
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8
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Puxty KA, Blayney M, Kaye C, McPeake J, Stewart N, Paton M, Hall R, Donaldson L, Lone N. Use of protracted CPAP as supportive treatment for COVID-19 pneumonitis and associated outcomes: a national cohort study. Br J Anaesth 2023; 131:617-625. [PMID: 37349238 PMCID: PMC10209449 DOI: 10.1016/j.bja.2023.05.012] [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: 11/17/2022] [Revised: 05/15/2023] [Accepted: 05/18/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Continuous positive airway pressure (CPAP) has been increasingly deployed to manage patients with COVID-19 and acute respiratory failure, often for protracted periods. However, concerns about protracted CPAP have been raised. This study aimed to examine the use of CPAP for patients with COVID-19 and the outcomes after protracted use. METHODS This was a national cohort study of all adults admitted to Scottish critical care units with COVID-19 from March 1, 2020 to December 25, 2021 who received CPAP. Protracted CPAP was defined as ≥ 5 continuous days of CPAP. Outcomes included CPAP failure rate (institution of invasive mechanical ventilation [IMV] or death), mortality, and outcomes after institution of IMV. Multivariable logistic regression was performed to assess the impact of protracted CPAP on mortality after IMV. RESULTS A total of 1961 patients with COVID-19 received CPAP for COVID-19 pneumonitis, with 733 patients (37.4%) receiving protracted CPAP. CPAP failure occurred in 891 (45.4%): 544 patients (27.7%) received IMV and 347 patients (17.7%) died in critical care without IMV. Hospital mortality rate was 41.3% for the population. For patients who subsequently commenced IMV, hospital mortality was 58.7% for the standard duration CPAP group and 73.9% for the protracted duration CPAP group (P=0.003); however, there was no statistical difference in hospital mortality after adjustment for confounders (odds ratio 1.4, 95% confidence interval 0.84-2.33, P=0.195). CONCLUSIONS Protracted CPAP was used frequently for managing patients with COVID-19. Whilst it was not associated with worse outcomes for those patients who subsequently required IMV, this might be due to residual confounding and differences in processes of care.
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Affiliation(s)
- Kathryn A Puxty
- Department of Critical Care, NHS Greater Glasgow and Clyde, Glasgow Royal Infirmary, Glasgow, UK; School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK.
| | | | - Callum Kaye
- Department of Critical Care, NHS Grampian, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Joanne McPeake
- Healthcare Improvement Scotland (Improvement Hub), Glasgow, UK; The Institute of Healthcare Improvement Studies, University of Cambridge, Cambridge, UK
| | - Neil Stewart
- Department of Critical Care, NHS Forth Valley, Forth Valley Royal Hospital, Larbert, UK
| | | | | | | | - Nazir Lone
- Usher Institute, University of Edinburgh, Edinburgh, UK; Department of Critical Care, NHS Lothian, Edinburgh Royal Infirmary, UK
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9
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MacRae C, Morales D, Mercer SW, Lone N, Lawson A, Jefferson E, McAllister D, van den Akker M, Marshall A, Seth S, Rawlings A, Lyons J, Lyons RA, Mizen A, Abubakar E, Dibben C, Guthrie B. Impact of data source choice on multimorbidity measurement: a comparison study of 2.3 million individuals in the Welsh National Health Service. BMC Med 2023; 21:309. [PMID: 37582755 PMCID: PMC10426056 DOI: 10.1186/s12916-023-02970-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 07/03/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Measurement of multimorbidity in research is variable, including the choice of the data source used to ascertain conditions. We compared the estimated prevalence of multimorbidity and associations with mortality using different data sources. METHODS A cross-sectional study of SAIL Databank data including 2,340,027 individuals of all ages living in Wales on 01 January 2019. Comparison of prevalence of multimorbidity and constituent 47 conditions using data from primary care (PC), hospital inpatient (HI), and linked PC-HI data sources and examination of associations between condition count and 12-month mortality. RESULTS Using linked PC-HI compared with only HI data, multimorbidity was more prevalent (32.2% versus 16.5%), and the population of people identified as having multimorbidity was younger (mean age 62.5 versus 66.8 years) and included more women (54.2% versus 52.6%). Individuals with multimorbidity in both PC and HI data had stronger associations with mortality than those with multimorbidity only in HI data (adjusted odds ratio 8.34 [95% CI 8.02-8.68] versus 6.95 (95%CI 6.79-7.12] in people with ≥ 4 conditions). The prevalence of conditions identified using only PC versus only HI data was significantly higher for 37/47 and significantly lower for 10/47: the highest PC/HI ratio was for depression (14.2 [95% CI 14.1-14.4]) and the lowest for aneurysm (0.51 [95% CI 0.5-0.5]). Agreement in ascertainment of conditions between the two data sources varied considerably, being slight for five (kappa < 0.20), fair for 12 (kappa 0.21-0.40), moderate for 16 (kappa 0.41-0.60), and substantial for 12 (kappa 0.61-0.80) conditions, and by body system was lowest for mental and behavioural disorders. The percentage agreement, individuals with a condition identified in both PC and HI data, was lowest in anxiety (4.6%) and highest in coronary artery disease (62.9%). CONCLUSIONS The use of single data sources may underestimate prevalence when measuring multimorbidity and many important conditions (especially mental and behavioural disorders). Caution should be used when interpreting findings of research examining individual and multiple long-term conditions using single data sources. Where available, researchers using electronic health data should link primary care and hospital inpatient data to generate more robust evidence to support evidence-based healthcare planning decisions for people with multimorbidity.
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Affiliation(s)
- Clare MacRae
- Advanced Care Research Centre, University of Edinburgh, Bio Cube 1, Edinburgh BioQuarter, 13 Little France Road, Edinburgh, UK.
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK.
| | - Daniel Morales
- Division of Population Health and Genomics, University of Dundee, Dundee, UK
- Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Stewart W Mercer
- Advanced Care Research Centre, University of Edinburgh, Bio Cube 1, Edinburgh BioQuarter, 13 Little France Road, Edinburgh, UK
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Nazir Lone
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Andrew Lawson
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, USA
| | - Emily Jefferson
- Division of Population Health and Genomics, University of Dundee, Dundee, UK
| | - David McAllister
- Public Health, Institute of Health and Wellbeing, University of Glasgow, Glasgow, G12 9LX, UK
| | - Marjan van den Akker
- Institute of General Practice, Goethe University Frankfurt, Frankfurt Am Main, Germany
- Department of Public Health and Primary Care, Academic Center for General Practice, KU Leuven, Louvain, Belgium
- Department of Family Medicine, School CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Alan Marshall
- School of Social and Political Science, University of Edinburgh, Chrystal Macmillan Building, Edinburgh, EH8 9LD, UK
| | - Sohan Seth
- School of Informatics, The University of Edinburgh, Edinburgh, UK
| | - Anna Rawlings
- Swansea University Medical School, Data Science Building, Singleton Campus, Swansea, UK
| | - Jane Lyons
- Swansea University Medical School, Data Science Building, Singleton Campus, Swansea, UK
| | - Ronan A Lyons
- Swansea University Medical School, Data Science Building, Singleton Campus, Swansea, UK
| | - Amy Mizen
- Swansea University Medical School, Data Science Building, Singleton Campus, Swansea, UK
| | - Eleojo Abubakar
- Public Health, Institute of Health and Wellbeing, University of Glasgow, Glasgow, G12 9LX, UK
| | - Chris Dibben
- University of Edinburgh Institute of Geography, Institute of Geography Edinburgh, Edinburgh, UK
| | - Bruce Guthrie
- Advanced Care Research Centre, University of Edinburgh, Bio Cube 1, Edinburgh BioQuarter, 13 Little France Road, Edinburgh, UK
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
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10
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Zheng B, Vivaldi G, Daines L, Leavy OC, Richardson M, Elneima O, McAuley HJ, Shikotra A, Singapuri A, Sereno M, Saunders RM, Harris VC, Houchen-Wolloff L, Greening NJ, Pfeffer PE, Hurst JR, Brown JS, Shankar-Hari M, Echevarria C, De Soyza A, Harrison EM, Docherty AB, Lone N, Quint JK, Chalmers JD, Ho LP, Horsley A, Marks M, Poinasamy K, Raman B, Heaney LG, Wain LV, Evans RA, Brightling CE, Martineau A, Sheikh A. Determinants of recovery from post-COVID-19 dyspnoea: analysis of UK prospective cohorts of hospitalised COVID-19 patients and community-based controls. Lancet Reg Health Eur 2023; 29:100635. [PMID: 37261214 PMCID: PMC10145209 DOI: 10.1016/j.lanepe.2023.100635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 03/17/2023] [Accepted: 03/27/2023] [Indexed: 06/02/2023]
Abstract
Background The risk factors for recovery from COVID-19 dyspnoea are poorly understood. We investigated determinants of recovery from dyspnoea in adults with COVID-19 and compared these to determinants of recovery from non-COVID-19 dyspnoea. Methods We used data from two prospective cohort studies: PHOSP-COVID (patients hospitalised between March 2020 and April 2021 with COVID-19) and COVIDENCE UK (community cohort studied over the same time period). PHOSP-COVID data were collected during hospitalisation and at 5-month and 1-year follow-up visits. COVIDENCE UK data were obtained through baseline and monthly online questionnaires. Dyspnoea was measured in both cohorts with the Medical Research Council Dyspnoea Scale. We used multivariable logistic regression to identify determinants associated with a reduction in dyspnoea between 5-month and 1-year follow-up. Findings We included 990 PHOSP-COVID and 3309 COVIDENCE UK participants. We observed higher odds of improvement between 5-month and 1-year follow-up among PHOSP-COVID participants who were younger (odds ratio 1.02 per year, 95% CI 1.01-1.03), male (1.54, 1.16-2.04), neither obese nor severely obese (1.82, 1.06-3.13 and 4.19, 2.14-8.19, respectively), had no pre-existing anxiety or depression (1.56, 1.09-2.22) or cardiovascular disease (1.33, 1.00-1.79), and shorter hospital admission (1.01 per day, 1.00-1.02). Similar associations were found in those recovering from non-COVID-19 dyspnoea, excluding age (and length of hospital admission). Interpretation Factors associated with dyspnoea recovery at 1-year post-discharge among patients hospitalised with COVID-19 were similar to those among community controls without COVID-19. Funding PHOSP-COVID is supported by a grant from the MRC-UK Research and Innovation and the Department of Health and Social Care through the National Institute for Health Research (NIHR) rapid response panel to tackle COVID-19. The views expressed in the publication are those of the author(s) and not necessarily those of the National Health Service (NHS), the NIHR or the Department of Health and Social Care.COVIDENCE UK is supported by the UK Research and Innovation, the National Institute for Health Research, and Barts Charity. The views expressed are those of the authors and not necessarily those of the funders.
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Affiliation(s)
- Bang Zheng
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Giulia Vivaldi
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Luke Daines
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Olivia C. Leavy
- Department of Population Health Sciences, University of Leicester, Leicester, UK
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Matthew Richardson
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Omer Elneima
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Hamish J.C. McAuley
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Aarti Shikotra
- NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Amisha Singapuri
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Marco Sereno
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Ruth M. Saunders
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Victoria C. Harris
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Linzy Houchen-Wolloff
- Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre-Respiratory, University of Leicester, Leicester, UK
- Therapy Department, University Hospitals of Leicester, NHS Trust, Leicester, UK
| | - Neil J. Greening
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Paul E. Pfeffer
- Barts Health NHS Trust, London, UK
- Queen Mary University of London, London, UK
| | - John R. Hurst
- UCL Respiratory, University College London, London, UK
| | | | - Manu Shankar-Hari
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
| | - Carlos Echevarria
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle, UK
| | - Anthony De Soyza
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
- Population Health Science Institute, Newcastle University, Newcastle, UK
| | - Ewen M. Harrison
- Centre for Medical Informatics, The Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Annemarie B. Docherty
- Centre for Medical Informatics, The Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Nazir Lone
- Usher Institute, University of Edinburgh, Edinburgh, UK
- Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
| | | | - James D. Chalmers
- University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Ling-Pei Ho
- Medical Research Council (MRC) Human Immunology Unit, University of Oxford, Oxford, UK
| | - Alex Horsley
- Division of Infection, Immunity & Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Michael Marks
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
- Hospital for Tropical Diseases, University College London Hospital, London, UK
- Division of Infection and Immunity, University College London, London, UK
| | | | - Betty Raman
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Liam G. Heaney
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University, Belfast, UK
| | - Louise V. Wain
- Department of Population Health Sciences, University of Leicester, Leicester, UK
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Rachael A. Evans
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Christopher E. Brightling
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Adrian Martineau
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Asthma UK Centre for Applied Research, Queen Mary University of London, London, UK
| | - Aziz Sheikh
- Usher Institute, University of Edinburgh, Edinburgh, UK
- Asthma UK Centre for Applied Research, University of Edinburgh, Edinburgh, UK
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11
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Stewart I, Jacob J, George PM, Molyneaux PL, Porter JC, Allen RJ, Aslani S, Baillie JK, Barratt SL, Beirne P, Bianchi SM, Blaikley JF, Chalmers JD, Chambers RC, Chadhuri N, Coleman C, Collier G, Denneny EK, Docherty A, Elneima O, Evans RA, Fabbri L, Gibbons MA, Gleeson FV, Gooptu B, Greening NJ, Guio BG, Hall IP, Hanley NA, Harris V, Harrison EM, Heightman M, Hillman TE, Horsley A, Houchen-Wolloff L, Jarrold I, Johnson SR, Jones MG, Khan F, Lawson R, Leavy O, Lone N, Marks M, McAuley H, Mehta P, Parekh D, Hanley KP, Platé M, Pearl J, Poinasamy K, Quint JK, Raman B, Richardson M, Rivera-Ortega P, Saunders L, Saunders R, Semple MG, Sereno M, Shikotra A, Simpson AJ, Singapuri A, Smith DJF, Spears M, Spencer LG, Stanel S, Thickett DR, Thompson AAR, Thorpe M, Walsh SLF, Walker S, Weatherley ND, Weeks ME, Wild JM, Wootton DG, Brightling CE, Ho LP, Wain LV, Jenkins GR. Residual Lung Abnormalities after COVID-19 Hospitalization: Interim Analysis of the UKILD Post-COVID-19 Study. Am J Respir Crit Care Med 2023; 207:693-703. [PMID: 36457159 PMCID: PMC10037479 DOI: 10.1164/rccm.202203-0564oc] [Citation(s) in RCA: 29] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 12/01/2022] [Indexed: 12/04/2022] Open
Abstract
Rationale: Shared symptoms and genetic architecture between coronavirus disease (COVID-19) and lung fibrosis suggest severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection may lead to progressive lung damage. Objectives: The UK Interstitial Lung Disease Consortium (UKILD) post-COVID-19 study interim analysis was planned to estimate the prevalence of residual lung abnormalities in people hospitalized with COVID-19 on the basis of risk strata. Methods: The PHOSP-COVID-19 (Post-Hospitalization COVID-19) study was used to capture routine and research follow-up within 240 days from discharge. Thoracic computed tomography linked by PHOSP-COVID-19 identifiers was scored for the percentage of residual lung abnormalities (ground-glass opacities and reticulations). Risk factors in linked computed tomography were estimated with Bayesian binomial regression, and risk strata were generated. Numbers within strata were used to estimate posthospitalization prevalence using Bayesian binomial distributions. Sensitivity analysis was restricted to participants with protocol-driven research follow-up. Measurements and Main Results: The interim cohort comprised 3,700 people. Of 209 subjects with linked computed tomography (median, 119 d; interquartile range, 83-155), 166 people (79.4%) had more than 10% involvement of residual lung abnormalities. Risk factors included abnormal chest X-ray (risk ratio [RR], 1.21; 95% credible interval [CrI], 1.05-1.40), percent predicted DlCO less than 80% (RR, 1.25; 95% CrI, 1.00-1.56), and severe admission requiring ventilation support (RR, 1.27; 95% CrI, 1.07-1.55). In the remaining 3,491 people, moderate to very high risk of residual lung abnormalities was classified at 7.8%, and posthospitalization prevalence was estimated at 8.5% (95% CrI, 7.6-9.5), rising to 11.7% (95% CrI, 10.3-13.1) in the sensitivity analysis. Conclusions: Residual lung abnormalities were estimated in up to 11% of people discharged after COVID-19-related hospitalization. Health services should monitor at-risk individuals to elucidate long-term functional implications.
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Affiliation(s)
- Iain Stewart
- National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | | | - Peter M. George
- Royal Brompton and Harefield Clinical Group, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Philip L. Molyneaux
- National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | | | - Richard J. Allen
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
- Leicester NIHR Biomedical Research Centre, Leicester, United Kingdom
| | | | | | | | - Paul Beirne
- Leeds Teaching Hospitals NHS Foundation Trust, Leeds, United Kingdom
| | - Stephen M. Bianchi
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | | | | | | | | | | | | | | | | | - Omer Elneima
- Leicester NIHR Biomedical Research Centre, Leicester, United Kingdom
| | - Rachael A. Evans
- Leicester NIHR Biomedical Research Centre, Leicester, United Kingdom
| | - Laura Fabbri
- National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | | | - Fergus V. Gleeson
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Bibek Gooptu
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Neil J. Greening
- Leicester NIHR Biomedical Research Centre, Leicester, United Kingdom
| | - Beatriz Guillen Guio
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Ian P. Hall
- University of Nottingham, Nottingham, United Kingdom
| | | | - Victoria Harris
- Leicester NIHR Biomedical Research Centre, Leicester, United Kingdom
| | | | | | | | - Alex Horsley
- University of Manchester, Manchester, United Kingdom
| | | | | | | | - Mark G. Jones
- Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Fasihul Khan
- University of Nottingham, Nottingham, United Kingdom
| | - Rod Lawson
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Olivia Leavy
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | | | - Michael Marks
- University College London Hospital, London, United Kingdom
| | - Hamish McAuley
- Leicester NIHR Biomedical Research Centre, Leicester, United Kingdom
| | - Puja Mehta
- University College London Hospital, London, United Kingdom
| | - Dhruv Parekh
- University of Birmingham, Brimingham, United Kingdom
| | - Karen Piper Hanley
- University of Manchester, Manchester, United Kingdom
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Manuela Platé
- University College London Hospital, London, United Kingdom
| | - John Pearl
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | | | - Jennifer K. Quint
- National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | - Betty Raman
- University of Oxford, Oxford, United Kingdom
| | | | | | | | - Ruth Saunders
- Leicester NIHR Biomedical Research Centre, Leicester, United Kingdom
| | | | - Marco Sereno
- Leicester NIHR Biomedical Research Centre, Leicester, United Kingdom
| | - Aarti Shikotra
- Leicester NIHR Biomedical Research Centre, Leicester, United Kingdom
| | | | - Amisha Singapuri
- Leicester NIHR Biomedical Research Centre, Leicester, United Kingdom
| | - David J. F. Smith
- Royal Brompton and Harefield Clinical Group, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Mark Spears
- Perth Royal Infirmary, NHS Tayside, Perth, United Kingdom; and
| | - Lisa G. Spencer
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Stefan Stanel
- University of Manchester, Manchester, United Kingdom
| | | | | | | | - Simon L. F. Walsh
- National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | | | | | - Mark E. Weeks
- National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | - Jim M. Wild
- University of Sheffield, Sheffield, United Kingdom
| | | | | | - Ling-Pei Ho
- University of Oxford, Oxford, United Kingdom
| | - Louise V. Wain
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
- Leicester NIHR Biomedical Research Centre, Leicester, United Kingdom
| | - Gisli R. Jenkins
- National Heart & Lung Institute, Imperial College London, London, United Kingdom
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12
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Gillon S, Zheng C, Feng Z, Fleig M, Scquizzato T, Belohlavek J, Lorusso R, Lone N, Swol J. GEospatial aNalysis of ExtRacorporeal membrane oxygenATion in Europe (GENERATE). Perfusion 2023; 38:24-39. [PMID: 36879353 DOI: 10.1177/02676591231160471] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
INTRODUCTION A cross-sectional survey GENERATE (GEospatial aNalysis of ExtRacorporeal membrane oxygenATion in Europe) initiated on behalf of the European chapter of the Extracorporeal Life Support Organization (EuroELSO), aims to provide a systematic, detailed description of contemporary Extracorporeal Life Support (ECLS) provision in Europe, map the spatial distribution of ECLS centers, and the accessibility of ECLS. METHODS Structured data collection forms were used to create a narrative description of ECLS provision in EuroELSO affiliated countries. This consisted of both center-specific data and relevant national infrastructure. Data was provided by a network of local and national representatives. Spatial accessibility analysis was conducted where appropriate geographical data were available. RESULTS 281 centers from 37 countries affiliated to EuroELSO were included in the geospatial analysis and demonstrate heterogeneous patterns of ECLS provision. Accessibility of ECLS services within 1 hour of drive-time is available for 50% of the adult population in 8 of 37 countries (21.6%). This proportion is reached within 2 hours in 21 of 37 countries (56.8%) and within 3 hours in 24 of 37 countries (64.9%). For pediatric centers, accessibility is similar with 9 of 37 countries (24.3%) reached the covering of 50% of the population aged 0-14 within 1 hour and 23 of 37 countries (62.2%) within 2 hours and 3 hours. CONCLUSIONS ECLS services are accessible in most of the European countries, but their provision differs across the continent. There is still no solid evidence given regarding the optimal ECLS provision model. The spatial disparity in ECLS provision demonstrated in our analysis requires governments, healthcare professionals and policy makers to consider how to develop existing provision to accommodate the anticipated increase in need for time critical access to this advanced support modality.
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Affiliation(s)
- Stuart Gillon
- Department of Critical Care, 59843Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, UK
| | - Chunyu Zheng
- Institute of Geography, School of Geosciences, 70448University of Edinburgh, Edinburgh, UK
| | - Zhiqiang Feng
- Institute of Geography, School of Geosciences, 70448University of Edinburgh, Edinburgh, UK
| | - Marcel Fleig
- Department of Respiratory Medicine, 470426Paracelsus Medical University, Nuremberg, Germany
| | - Tommaso Scquizzato
- Department of Anesthesia and Intensive Care, 9372IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Jan Belohlavek
- 2nd Department of Internal Cardiovascular Medicine, 48230General University Hospital, Prague, Czech Republic
| | - Roberto Lorusso
- ECLS Center, Cardio-Thoracic Surgery Department, Heart & Vascular Center, 199236Maastricht University Medical Center (MUMC), Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Nazir Lone
- Department of Critical Care, 59843Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, UK.,Usher Institute, 59843University of Edinburgh, Edinburgh, UK
| | - Justyna Swol
- Department of Respiratory Medicine, 470426Paracelsus Medical University, Nuremberg, Germany
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13
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Daynes E, Baldwin M, Greening NJ, Yates T, Bishop NC, Mills G, Roberts M, Hamrouni M, Plekhanova T, Vogiatzis I, Echevarria C, Nathu R, McAuley HJC, Latimer L, Glennie J, Chambers F, Penfold R, Hume E, Megaritis D, Alexiou C, Potthof S, Hogg MJ, Haighton C, Nichol B, Leavy OC, Richardson M, Elneima O, Singapuri A, Sereno M, Saunders RM, Harris VC, Nolan CM, Bolton C, Houchen-Wolloff L, Harrison EM, Lone N, Quint J, Chalmers JD, Ho LP, Horsley A, Marks M, Poinasamy K, Ramen B, Wain LV, Brightling C, Man WDC, Evans R, Singh SJ. Correction: The effect of COVID rehabilitation for ongoing symptoms Post HOSPitalisation with COVID-19 (PHOSP-R): protocol for a randomised parallel group controlled trial on behalf of the PHOSP consortium. Trials 2023; 24:98. [PMID: 36750957 PMCID: PMC9904254 DOI: 10.1186/s13063-023-07132-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Affiliation(s)
- Enya Daynes
- NIHR Leicester Biomedical Research Centre-Respiratory, Leicester, UK. .,Department of Respiratory Sciences, University of Leicester, Leicester, UK.
| | - Molly Baldwin
- grid.511501.1NIHR Leicester Biomedical Research Centre-Respiratory, Leicester, UK
| | - Neil J. Greening
- grid.511501.1NIHR Leicester Biomedical Research Centre-Respiratory, Leicester, UK ,grid.9918.90000 0004 1936 8411Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Thomas Yates
- grid.511501.1NIHR Leicester Biomedical Research Centre- Diabetes, Leicester, UK ,grid.9918.90000 0004 1936 8411Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK
| | - Nicolette C. Bishop
- grid.6571.50000 0004 1936 8542National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - George Mills
- grid.511501.1NIHR Leicester Biomedical Research Centre-Respiratory, Leicester, UK
| | - Matthew Roberts
- grid.511501.1NIHR Leicester Biomedical Research Centre-Respiratory, Leicester, UK ,grid.6571.50000 0004 1936 8542National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Malik Hamrouni
- grid.511501.1NIHR Leicester Biomedical Research Centre-Respiratory, Leicester, UK ,grid.6571.50000 0004 1936 8542National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Tatiana Plekhanova
- grid.511501.1NIHR Leicester Biomedical Research Centre- Diabetes, Leicester, UK ,grid.9918.90000 0004 1936 8411Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK
| | - Ioannis Vogiatzis
- grid.42629.3b0000000121965555Faculty of Health and Life Sciences, Northumbria University Newcastle, Newcastle upon Tyne, UK
| | - Carlos Echevarria
- grid.420004.20000 0004 0444 2244The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Rashmita Nathu
- grid.511501.1NIHR Leicester Biomedical Research Centre-Respiratory, Leicester, UK ,grid.9918.90000 0004 1936 8411Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Hamish J. C. McAuley
- grid.511501.1NIHR Leicester Biomedical Research Centre-Respiratory, Leicester, UK ,grid.9918.90000 0004 1936 8411Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Lorna Latimer
- grid.511501.1NIHR Leicester Biomedical Research Centre-Respiratory, Leicester, UK ,grid.9918.90000 0004 1936 8411Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Jennifer Glennie
- grid.420004.20000 0004 0444 2244The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Francesca Chambers
- grid.420004.20000 0004 0444 2244The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Ruth Penfold
- grid.420004.20000 0004 0444 2244The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Emily Hume
- grid.42629.3b0000000121965555Faculty of Health and Life Sciences, Northumbria University Newcastle, Newcastle upon Tyne, UK
| | - Dimitrios Megaritis
- grid.42629.3b0000000121965555Faculty of Health and Life Sciences, Northumbria University Newcastle, Newcastle upon Tyne, UK
| | - Charikleia Alexiou
- grid.42629.3b0000000121965555Faculty of Health and Life Sciences, Northumbria University Newcastle, Newcastle upon Tyne, UK
| | - Sebastian Potthof
- grid.42629.3b0000000121965555Department of Social Work, Education, and Community Wellbeing, Northumbria University Newcastle, Newcastle upon Tyne, UK
| | - Mitchell James Hogg
- grid.42629.3b0000000121965555Faculty of Health and Life Sciences, Northumbria University Newcastle, Newcastle upon Tyne, UK
| | - Catherine Haighton
- grid.42629.3b0000000121965555Faculty of Health and Life Sciences, Northumbria University Newcastle, Newcastle upon Tyne, UK
| | - Bethany Nichol
- grid.42629.3b0000000121965555Faculty of Health and Life Sciences, Northumbria University Newcastle, Newcastle upon Tyne, UK
| | - Olivia C. Leavy
- grid.9918.90000 0004 1936 8411Department of Health Sciences, University of Leicester, Leicester, UK
| | - Matthew Richardson
- grid.511501.1NIHR Leicester Biomedical Research Centre-Respiratory, Leicester, UK
| | - Omer Elneima
- grid.511501.1NIHR Leicester Biomedical Research Centre-Respiratory, Leicester, UK ,grid.9918.90000 0004 1936 8411Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Amisha Singapuri
- grid.511501.1NIHR Leicester Biomedical Research Centre-Respiratory, Leicester, UK ,grid.9918.90000 0004 1936 8411Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Marco Sereno
- grid.511501.1NIHR Leicester Biomedical Research Centre-Respiratory, Leicester, UK ,grid.9918.90000 0004 1936 8411Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Ruth M. Saunders
- grid.511501.1NIHR Leicester Biomedical Research Centre-Respiratory, Leicester, UK ,grid.9918.90000 0004 1936 8411Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Victoria C. Harris
- grid.511501.1NIHR Leicester Biomedical Research Centre-Respiratory, Leicester, UK
| | - Claire M. Nolan
- grid.7728.a0000 0001 0724 6933College of Health, Medicine and Life Sciences, Brunel University, London, UK ,grid.420545.20000 0004 0489 3985Harefield Respiratory Research Group, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Charlotte Bolton
- grid.4563.40000 0004 1936 8868School of Medicine, The University of Nottingham, Nottingham, UK
| | - Linzy Houchen-Wolloff
- grid.511501.1NIHR Leicester Biomedical Research Centre-Respiratory, Leicester, UK ,grid.9918.90000 0004 1936 8411Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Ewen M. Harrison
- grid.9918.90000 0004 1936 8411Department of Health Sciences, University of Leicester, Leicester, UK
| | - Nazir Lone
- grid.4305.20000 0004 1936 7988Centre for Medical Informatics, The Usher Institute, University of Edinburgh, Edinburgh, UK ,grid.4305.20000 0004 1936 7988Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Jennifer Quint
- grid.7445.20000 0001 2113 8111National Heart and Lung Institute, Imperial College London, London, UK
| | - James D. Chalmers
- grid.418716.d0000 0001 0709 1919Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
| | - Ling-Pei Ho
- grid.4991.50000 0004 1936 8948MRC Human Immunology Unit, University of Oxford, Oxford, UK
| | - Alex Horsley
- grid.5379.80000000121662407Division of Infection, Immunity & Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Michael Marks
- grid.439749.40000 0004 0612 2754Hospital for Tropical Diseases, University College London Hospitals, London, UK ,grid.83440.3b0000000121901201Division of Infection & Immunity, University College London, London, UK
| | - Krisnah Poinasamy
- grid.512915.b0000 0000 8744 7921Asthma UK and British Lung Foundation, London, UK
| | - Betty Ramen
- grid.4991.50000 0004 1936 8948Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Louise V. Wain
- grid.511501.1NIHR Leicester Biomedical Research Centre-Respiratory, Leicester, UK ,grid.9918.90000 0004 1936 8411Department of Health Sciences, University of Leicester, Leicester, UK
| | - Christopher Brightling
- grid.511501.1NIHR Leicester Biomedical Research Centre-Respiratory, Leicester, UK ,grid.9918.90000 0004 1936 8411Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - William D.-C. Man
- grid.420545.20000 0004 0489 3985Harefield Respiratory Research Group, Guy’s and St Thomas’ NHS Foundation Trust, London, UK ,grid.416266.10000 0000 9009 9462University of Dundee, Ninewells Hospital and Medical School, Dundee, UK ,grid.420545.20000 0004 0489 3985Harefield Respiratory Research Group, Heart, Lung and Critical Care Clinical Group, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Rachael Evans
- grid.511501.1NIHR Leicester Biomedical Research Centre-Respiratory, Leicester, UK ,grid.9918.90000 0004 1936 8411Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Sally J. Singh
- grid.511501.1NIHR Leicester Biomedical Research Centre-Respiratory, Leicester, UK ,grid.9918.90000 0004 1936 8411Department of Respiratory Sciences, University of Leicester, Leicester, UK
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14
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Cafferkey J, Ferguson A, Grahamslaw J, Oatey K, Norrie J, Lone N, Walsh T, Horner D, Appelboam A, Hall P, Skipworth R, Bell D, Rooney K, Shankar-Hari M, Corfield A, Gray A. Albumin versus balanced crystalloid for resuscitation in the treatment of sepsis: A protocol for a randomised controlled feasibility study, "ABC-Sepsis". J Intensive Care Soc 2023; 24:78-84. [PMID: 36860553 PMCID: PMC9157259 DOI: 10.1177/17511437221103692] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Patients presenting with suspected sepsis to secondary care often require fluid resuscitation to correct hypovolaemia and/or septic shock. Existing evidence signals, but does not demonstrate, a benefit for regimes including albumin over balanced crystalloid alone. However, interventions may be started too late, missing a critical resuscitation window. Methods ABC Sepsis is a currently recruiting randomised controlled feasibility trial comparing 5% human albumin solution (HAS) with balanced crystalloid for fluid resuscitation in patients with suspected sepsis. This multicentre trial is recruiting adult patients within 12 hours of presentation to secondary care with suspected community acquired sepsis, with a National Early Warning Score ≥5, who require intravenous fluid resuscitation. Participants are randomised to 5% HAS or balanced crystalloid as the sole resuscitation fluid for the first 6 hours. Objectives Primary objectives are feasibility of recruitment to the study and 30-day mortality between groups. Secondary objectives include in-hospital and 90-day mortality, adherence to trial protocol, quality of life measurement and secondary care costs. Discussion This trial aims to determine the feasibility of conducting a trial to address the current uncertainty around optimal fluid resuscitation of patients with suspected sepsis. Understanding the feasibility of delivering a definitive study will be dependent on how the study team are able to negotiate clinician choice, Emergency Department pressures and participant acceptability, as well as whether any clinical signal of benefit is detected.
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Affiliation(s)
- John Cafferkey
- Emergency Medicine Research Group
Edinburgh (EMERGE), Department of Emergency Medicine, Royal Infirmary of
Edinburgh, Edinburgh, UK
| | - Andrew Ferguson
- Emergency Medicine Research Group
Edinburgh (EMERGE), Department of Emergency Medicine, Royal Infirmary of
Edinburgh, Edinburgh, UK
| | - Julia Grahamslaw
- Emergency Medicine Research Group
Edinburgh (EMERGE), Department of Emergency Medicine, Royal Infirmary of
Edinburgh, Edinburgh, UK
| | - Katherine Oatey
- Edinburgh Clinical Trials Unit,
Usher Institute, University of Edinburgh, Edinburgh, UK
| | - John Norrie
- Department of Critical Care, Royal
Infirmary of Edinburgh, Usher Institute, University of
Edinburgh, Edinburgh, UK
| | - Nazir Lone
- Department of Critical Care, Royal
Infirmary of Edinburgh, Usher Institute, University of
Edinburgh, Edinburgh, UK
| | - Timothy Walsh
- Department of Critical Care, Royal
Infirmary of Edinburgh, Usher Institute, University of
Edinburgh, Edinburgh, UK
| | - Daniel Horner
- Emergency Department, Salford Royal NHS Foundation
Trust, Salford, UK,Division of Infection, Immunity and
Respiratory Medicine, University of
Manchester, Manchester, UK
| | - Andy Appelboam
- Academic Department of Emergency
Medicine Exeter (ACADEMEx), Royal Devon and Exeter Hospital NHS
Foundation Trust, Exeter Devon
| | - Peter Hall
- Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, UK
| | | | - Derek Bell
- Department of Acute Medicine, Chelsea and Westminster
Campus, Imperial College London, London
| | | | - Manu Shankar-Hari
- The Queen’s Medical Research
Institute, Edinburgh BioQuarter, Centre for
Inflammation Research, University of Edinburgh, UK
| | - Alasdair Corfield
- Emergency Department, Royal Alexandra
Hospital, NHS Greater Glasgow and Clyde, UK
| | - Alasdair Gray
- Emergency Medicine Research Group
Edinburgh (EMERGE), Department of Emergency Medicine, Royal Infirmary of
Edinburgh, Edinburgh, UK,Acute Care Edinburgh, Centre for
Population and Health Sciences, Usher Institute, University of
Edinburgh, Edinburgh UK,Professor Alasdair Gray, Emergency Medicine
Research Group Edinburgh (EMERGE), Department of Emergency Medicine, Royal
Infirmary of Edinburgh, Edinburgh EH16 4SA, UK.
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15
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Swets MC, Russell C, Harrison E, Docherty A, Lone N, Girvan M, Hardwick H, Visser L, Openshaw P, Groeneveld G, Semple C, Baillie K. 260. Corticosteroid treatment in influenza virus and SARS-CoV-2 co-infected patients. Open Forum Infect Dis 2022. [PMCID: PMC9752261 DOI: 10.1093/ofid/ofac492.338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Co-infections with SARS-CoV-2 and influenza virus may become more prevalent now that many countries are easing restrictions to reduce the spread of SARS-CoV-2. Co-infected patients are more likely to receive invasive mechanical ventilation (IMV) and have higher odds of in-hospital mortality. In the RECOVERY trial, dexamethasone was found to reduce the risk of 28-day mortality in hospitalised COVID-19 patients. On June 16, 2020, corticosteroids were included in clinical guidelines for the treatment of COVID-19 patients requiring supplemental oxygen. However, corticosteroid treatment in severe influenza virus infection may increase mortality. The effect of steroids in influenza and COVID-19 co-infected patients is unknown. Methods Adult patients with RT-PCR confirmed SARS-CoV-2 and influenza virus co-infection were evaluated. Patients without supplemental oxygen during admission were excluded. Patients who were hospitalised prior to June 16, 2020 were included in the ‘early’ group and patients who were hospitalised on or after June 16, 2020 were included in the ‘late’ group. Results 171 co-infected patients were included, 123 patients in the early group (table 1) and 48 in the late group (table 2). In the early group, 25 patients received steroids. In the late group, 40 patients received steroids. In the early group, the proportion of patients who were admitted to critical care was slightly lower in the group that received steroids. IMV was similar in both groups. In-hospital mortality was slightly higher in the group treated with steroids. In the late group, critical care admission and receipt of IMV were higher in the group not treated with corticosteroids than the group with corticosteroid treatment. In-hospital mortality was slightly lower in the group not treated with steroids.
![]() ![]() Conclusion There are differences between co-infected patients who were treated and not treated with corticosteroids and differences between the early and late groups. A limitation is that no dates were collected for the start of steroid treatment, making it impossible to draw conclusions on the causality of the need for IMV and treatment with steroids in this analysis. Future research should focus on the effect of steroids in COVID-19 and influenza co-infected patients. Disclosures Peter Openshaw, PhD, Bavarian Nordic: Advisor/Consultant|Cepheid: Advisor/Consultant|GlaxoSmithKline: Advisor/Consultant|Janssen: Advisor/Consultant|Pfizer: Advisor/Consultant Calum Semple, PhD, Integrum Scientific: Scientific Advisory Board|Integrum Scientific: Stocks/Bonds.
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Affiliation(s)
- Maaike C Swets
- Leiden University Medical Center, Amsterdam, Noord-Holland, Netherlands
| | - Clark Russell
- University of Edinburgh, Edinburgh, Scotland, United Kingdom
| | - Ewen Harrison
- University of Edinburgh, Edinburgh, Scotland, United Kingdom
| | | | - Nazir Lone
- University of Edinburgh, Edinburgh, Scotland, United Kingdom
| | | | | | - Leonardus Visser
- Leiden University Medical Centre, Leiden, Zuid-Holland, Netherlands
| | - Peter Openshaw
- Imperial College London, London, England, United Kingdom
| | | | - Calum Semple
- University of Liverpool, Liverpool, England, United Kingdom
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16
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Lyall MJ, Beckett D, Price A, Strachan MWJ, Jamieson C, Morton C, Begg D, Simpson J, Lone N, Cameron A. Variation in general practice referral rate to acute medicine services and association with hospital admission. A retrospective observational study. Fam Pract 2022; 40:233-240. [PMID: 36063441 PMCID: PMC10047615 DOI: 10.1093/fampra/cmac097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Variation in general practice (GP) referral rates to outpatient services is well described however variance in rates of referral to acute medical units is lacking. OBJECTIVE To investigate variance in GP referral rate for acute medical assessment and subsequent need for hospital admission. METHODS A retrospective cohort study of acute medical referrals from 88 GPs in Lothian, Scotland between 2017 and 2020 was performed using practice population size, age, deprivation, care home residence, and distance from hospital as explanatory variables. Patient-level analysis of demography, deprivation, comorbidity, and acuity markers was subsequently performed on referred and clinically assessed acute medical patients (n = 42,424) to examine how practice referral behaviour reflects clinical need for inpatient hospital care. RESULTS Variance in GP referral rates for acute medical assessment was high (2.53-fold variation 1st vs. 4th quartile) and incompletely explained by increasing age and deprivation (adjusted R2 0.67, P < 0.001) such that significant variance remained after correction for confounders (2.15-fold). Patients from the highest referring quartile were significantly less likely to require hospital admission than those from the third, second, or lowest referring quartiles (adjusted odds ratio 1.28 [1.21-1.36, P < 0.001]; 1.30 [1.23-1.37, P < 0.001]; 1.53 [1.42-1.65, P < 0.001]). CONCLUSIONS High variation in GP practice referral rate for acute medical assessment is incompletely explained by practice population socioeconomic factors and negatively associates with need for urgent inpatient care. Identifying modifiable factors influencing referral rate may provide opportunities to facilitate community-based care and reduce congestion on acute unscheduled care pathways.
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Affiliation(s)
- Marcus J Lyall
- Department of Medicine, Royal Infirmary of Edinburgh, 51 Little France Cres, Edinburgh EH16 4SA, United Kingdom
| | - Dan Beckett
- Department of Acute Medicine, Forth Valley Royal Hospital, Stirling Rd, Larbert FK5 4WR, United Kingdom
| | - Anna Price
- Department of Public Health, Medical Statistician, Western General Hospital, Crewe Rd S, Edinburgh EH4 2XU, United Kingdom
| | - Mark W J Strachan
- Metabolic Unit, Western General Hospital, Crewe Rd S, Edinburgh EH4 2XU, United Kingdom
| | - Clare Jamieson
- Gullane Medical Practice, Hamilton Road, Gullane, East Lothian EH31 2HP, United Kingdom
| | - Catriona Morton
- Craigmillar Medical Group, 106 Niddrie Mains Road, Edinburgh EH16 4DT, United Kingdom
| | - Drummond Begg
- Penicuik Medical Practice, 37 Imrie Place, Penicuik EH26 8LF, United Kingdom
| | - Johanne Simpson
- Department of Medicine, Royal Infirmary of Edinburgh, 51 Little France Cres, Edinburgh EH16 4SA, United Kingdom
| | - Nazir Lone
- Usher Institute, University of Edinburgh, Edinburgh EH8 9AG, United Kingdom
| | - Allan Cameron
- Department of Acute Medicine, Acute Assessment Unit, Jubilee Building, Glasgow Royal Infirmary, Glasgow G4 0SF, United Kingdom
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17
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Dongelmans DA, Quintairos A, Buanes EA, Aryal D, Bagshaw S, Bendel S, Bonney J, Burghi G, Fan E, Guidet B, Haniffa R, Hashimi M, Hashimoto S, Ichihara N, Vijayaraghavan BKT, Lone N, Del Pilar Arias Lopez M, Mazlam MZ, Okamoto H, Perren A, Rowan K, Sigurdsson M, Silka W, Soares M, Viana G, Pilcher D, Beane A, Salluh JIF. Worldwide clinical intensive care registries response to the pandemic: An international survey. J Crit Care 2022; 71:154111. [PMID: 35816947 PMCID: PMC9265234 DOI: 10.1016/j.jcrc.2022.154111] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 06/14/2022] [Accepted: 06/28/2022] [Indexed: 11/01/2022]
Affiliation(s)
- Dave A Dongelmans
- Amsterdam UMC location University of Amsterdam, Department of Intensive Care Medicine, Meibergdreef 9, Amsterdam, the Netherlands; National Intensive Care Evaluation (NICE) foundation, Amsterdam, the Netherlands
| | - Amanda Quintairos
- D'OR Institute for research and Education, Rio de janeiro, Brazil; Department of Critical and Intensive Care Medicine, Academic Hospital Fundación Santa Fe de Bogota, Bogota, Colombia.
| | - Eirik Alnes Buanes
- Norwegian Intensive Care and Pandemic Registry, Helse Bergen Health Trust, Bergen, Norway
| | - Diptesh Aryal
- Nepal Intensive Care Research Foundation, Kathmandu, Nepal
| | - Sean Bagshaw
- Department of Medicine, Faculty of Medicine and Dentistry (Ling, Bagshaw), University of Alberta and Alberta Health Services; Department of Critical Care Medicine, Faculty of Medicine and Dentistry and School of Public Health, Division of Internal Medicine (Villeneuve), University of Alberta and Grey Nuns Hospitals, Edmonton, Alta, Canada
| | | | - Joe Bonney
- Komfo Anokye Teaching Hospital, Ghana; Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Eddy Fan
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| | - Bertrand Guidet
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpital Saint-Antoine, service de réanimation, Paris, France
| | - Rashan Haniffa
- Crit Care Asia, Network for Improving Critical Care Systems and Training, Colombo, Sri Lanka; Centre for Tropical Medicine and Global Health, University of Oxford, UK; University College Hospital, London, UK
| | | | - Satoru Hashimoto
- Division of Intensive Care, Department of Anesthesiology & Intensive Care Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Nao Ichihara
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | | | - Nazir Lone
- Usher Institute, University of Edinburgh, UK; Scottish Intensive Care Society Audit Group, UK
| | - Maria Del Pilar Arias Lopez
- Argentine Society of Intensive Care (SATI). SATI-Q Program Buenos Aires, Argentina; Hospital de Niños Ricardo Gutierrez, Intermediate Care Unit, Argentina
| | - Mohd Zulfakar Mazlam
- Department Anaesthesiology and Intensive Care, School of Medical Sciences, Kelantan, Malaysia
| | - Hiroshi Okamoto
- Department of Critical Care Medicine, St. Luke's International Hospital, Tokyo, Japan
| | - Andreas Perren
- Intensive Care Unit, Department of Intensive Care Medicine- Ente Ospedaliero Cantonale, Ospedale Regionale Bellinzona e Valli, Bellinzona, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland; Faculty of Biomedical Sciences, Università Svizzera Italiana, Lugano, Switzerland
| | - Kathy Rowan
- Intensive Care National Audit and Research Centre, London, UK
| | - Martin Sigurdsson
- University of Iceland, Faculty of Medicine, Department of Anesthesia and Critical Care, Landspitali University Hospital, Reykjavik, Iceland
| | - Wangari Silka
- Dr Wangari Silka, Intensive Care Unit at Aga Khan Hospital, Nairobi, Kenya
| | - Marcio Soares
- D'OR Institute for research and Education, Rio de janeiro, Brazil; Post Graduation Program, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Grazielle Viana
- D'OR Institute for research and Education, Rio de janeiro, Brazil
| | - David Pilcher
- Department of Intensive Care, Alfred Health, Commercial Road, Prahran, VIC 3004, Australia; The Australian and New Zealand Intensive Care Society (ANZICS) Centre for Outcome and Resource Evaluation, Camberwell, Australia
| | - Abigail Beane
- Critical Care, Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand; Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Jorge I F Salluh
- D'OR Institute for research and Education, Rio de janeiro, Brazil; Post Graduation Program, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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18
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Tirupakuzhi Vijayaraghavan BK, Gupta E, Ramakrishnan N, Beane A, Haniffa R, Lone N, de Keizer N, Adhikari NKJ. Barriers and facilitators to the conduct of critical care research in low and lower-middle income countries: A scoping review. PLoS One 2022; 17:e0266836. [PMID: 35511911 PMCID: PMC9071139 DOI: 10.1371/journal.pone.0266836] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 03/28/2022] [Indexed: 11/18/2022] Open
Abstract
Background
Improvements in health-related outcomes for critically ill adults in low and lower-middle income countries need systematic investments in research capacity and infrastructure. High-quality research has been shown to strengthen health systems; yet, research contributions from these regions remain negligible or absent. We undertook a scoping review to describe barriers and facilitators for the conduct of critical care research.
Methods
We searched MEDLINE and EMBASE up to December 2021 using a strategy that combined keyword and controlled vocabulary terms. We included original studies that reported on barriers or facilitators to the conduct of critical care research in these settings. Two reviewers independently reviewed titles and abstracts, and where necessary, the full-text to select eligible studies. For each study, reviewers independently extracted data using a standardized data extraction form. Barriers and facilitators were classified along the lines of a previous review and based on additional themes that emerged. Study quality was assessed using appropriate tools.
Results
We identified 2693 citations, evaluated 49 studies and identified 6 for inclusion. Of the included studies, four were qualitative, one was a cross-sectional survey and one was reported as an ‘analysis’. The total number of participants ranged from 20–100 and included physicians, nurses, allied healthcare workers and researchers. Barriers identified included limited funding, poor institutional & national investment, inadequate access to mentors, absence of training in research methods, limited research support staff, and absence of statistical support. Our review identified potential solutions such as developing a mentorship network, streamlining of regulatory processes, implementing a centralized institutional research agenda, developing a core-outcome dataset and enhancing access to low-cost technology.
Conclusion
Our scoping review highlights important barriers to the conduct of critical care research in low and lower-middle income countries, identifies potential solutions, and informs researchers, policymakers and governments on the steps necessary for strengthening research systems.
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Affiliation(s)
| | - Ena Gupta
- Department of Pulmonary and Critical Care Medicine, Einstein Health Network, Philadelphia, Pennsylvania, United States of America
| | | | - Abi Beane
- Mahidol-Oxford Tropical Research Unit, Bangkok, Thailand
| | - Rashan Haniffa
- Mahidol-Oxford Tropical Research Unit, Bangkok, Thailand
- Department of Anaesthesia and Critical Care Medicine, University College London, London, United Kingdom
| | - Nazir Lone
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Nicolette de Keizer
- Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Neill K. J. Adhikari
- Interdepartmental Division of Critical Care Medicine, Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
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19
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Swets MC, Russell CD, Harrison EM, Docherty AB, Lone N, Girvan M, Hardwick HE, Visser LG, Openshaw PJM, Groeneveld GH, Semple MG, Baillie JK. SARS-CoV-2 co-infection with influenza viruses, respiratory syncytial virus, or adenoviruses. Lancet 2022; 399:1463-1464. [PMID: 35344735 PMCID: PMC8956294 DOI: 10.1016/s0140-6736(22)00383-x] [Citation(s) in RCA: 157] [Impact Index Per Article: 78.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 02/18/2022] [Accepted: 02/22/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Maaike C Swets
- Roslin Institute, University of Edinburgh, Edinburgh EH25 9RG, UK; Department of Infectious Diseases, Leiden University Medical Centre, Leiden University, Leiden, Netherlands
| | - Clark D Russell
- Centre for Inflammation Research, University of Edinburgh, Edinburgh EH25 9RG, UK
| | - Ewen M Harrison
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh EH25 9RG, UK
| | - Annemarie B Docherty
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh EH25 9RG, UK
| | - Nazir Lone
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh EH25 9RG, UK
| | - Michelle Girvan
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Hayley E Hardwick
- Institute of Infection, Veterinary and Ecological Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Leonardus G Visser
- Department of Infectious Diseases, Leiden University Medical Centre, Leiden University, Leiden, Netherlands
| | | | - Geert H Groeneveld
- Department of Infectious Diseases, Leiden University Medical Centre, Leiden University, Leiden, Netherlands
| | - Malcolm G Semple
- Institute of Infection, Veterinary and Ecological Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK; Department of Respiratory Medicine, Alder Hey Children's Hospital, Liverpool, UK
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20
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Mayes J, McLachlan S, Carduff E, McPeake J, Boyd KJ, Pattison N, Lone N. Deaths in critical care and hospice-prevalence, trends, influences: a national decedent cohort study. BMJ Support Palliat Care 2021:bmjspcare-2021-003157. [PMID: 34380665 DOI: 10.1136/bmjspcare-2021-003157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 07/30/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVES End-of-life and bereavement care support services differ in critical care and inpatient hospice settings. There are limited population-level data comparing deaths in these two locations. We aimed to compare the characteristics of people who die in critical care units and in hospices, identify factors associated with place of death and report 12-year trends in Scotland. METHODS We undertook a cohort study of decedents aged ≥16 years in Scotland (2005-2017). Location of death was identified from linkage to the Scottish Intensive Care Society Audit Group database and National Records of Scotland Death Records. We developed a multinomial logistic regression model to identify factors independently associated with location of death. RESULTS There were 710 829 deaths in Scotland, of which 36 316 (5.1%) occurred in critical care units and 42 988 (6.1%) in hospices. As a proportion of acute hospital deaths, critical care deaths increased from 8.0% to 11.2%. Approximately one in eight deaths in those aged under 40 years occurred in critical care. Factors independently associated with hospice death included living in less deprived areas, cancer as the cause of death and presence of comorbidities. In contrast, liver disease and accidents as the cause of death and absence of comorbidities were associated with death in critical care. CONCLUSIONS Similar proportions of deaths in Scotland occur in critical care units and hospices. Given the younger age profile and unexpected nature of deaths occurring in critical care units, there is a need for a specific focus on end-of-life and bereavement support services in critical care units.
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Affiliation(s)
- Jonathan Mayes
- Usher Institute, The University of Edinburgh, Edinburgh, UK
- NHS Lothian, Edinburgh, UK
| | | | | | - Joanne McPeake
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Kirsty J Boyd
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | | | - Nazir Lone
- Usher Institute, The University of Edinburgh, Edinburgh, UK
- NHS Lothian, Edinburgh, UK
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21
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McKeigue PM, McAllister DA, Caldwell D, Gribben C, Bishop J, McGurnaghan S, Armstrong M, Delvaux J, Colville S, Hutchinson S, Robertson C, Lone N, McMenamin J, Goldberg D, Colhoun HM. Relation of severe COVID-19 in Scotland to transmission-related factors and risk conditions eligible for shielding support: REACT-SCOT case-control study. BMC Med 2021; 19:149. [PMID: 34158021 PMCID: PMC8219469 DOI: 10.1186/s12916-021-02021-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/01/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Clinically vulnerable individuals have been advised to shield themselves during the COVID-19 epidemic. The objectives of this study were to investigate (1) the rate ratio of severe COVID-19 associated with eligibility for the shielding programme in Scotland across the first and second waves of the epidemic and (2) the relation of severe COVID-19 to transmission-related factors in those in shielding and the general population. METHODS In a matched case-control design, all 178,578 diagnosed cases of COVID-19 in Scotland from 1 March 2020 to 18 February 2021 were matched for age, sex and primary care practice to 1,744,283 controls from the general population. This dataset (REACT-SCOT) was linked to the list of 212,702 individuals identified as eligible for shielding. Severe COVID-19 was defined as cases that entered critical care or were fatal. Rate ratios were estimated by conditional logistic regression. RESULTS With those without risk conditions as reference category, the univariate rate ratio for severe COVID-19 was 3.21 (95% CI 3.01 to 3.41) in those with moderate risk conditions and 6.3 (95% CI 5.8 to 6.8) in those eligible for shielding. The highest rate was in solid organ transplant recipients: rate ratio 13.4 (95% CI 9.6 to 18.8). Risk of severe COVID-19 increased with the number of adults but decreased with the number of school-age children in the household. Severe COVID-19 was strongly associated with recent exposure to hospital (defined as 5 to 14 days before presentation date): rate ratio 12.3 (95% CI 11.5 to 13.2) overall. The population attributable risk fraction for recent exposure to hospital peaked at 50% in May 2020 and again at 65% in December 2020. CONCLUSIONS The effectiveness of shielding vulnerable individuals was limited by the inability to control transmission in hospital and from other adults in the household. Mitigating the impact of the epidemic requires control of nosocomial transmission.
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Affiliation(s)
- Paul M McKeigue
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, Scotland
- Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, Scotland
| | - David A McAllister
- Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, Scotland
- Institute of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8RZ, Scotland
| | - David Caldwell
- Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, Scotland
| | - Ciara Gribben
- Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, Scotland
| | - Jen Bishop
- Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, Scotland
| | - Stuart McGurnaghan
- Institute of Genetics and Molecular Medicine, College of Medicine and Veterinary Medicine, University of Edinburgh, Western General Hospital Campus, Crewe Road, Edinburgh, EH4 2XUC, Scotland
| | - Matthew Armstrong
- Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, Scotland
| | - Joke Delvaux
- Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, Scotland
| | - Sam Colville
- Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, Scotland
| | - Sharon Hutchinson
- Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, Scotland
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland
| | - Chris Robertson
- Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, Scotland
- Department of Mathematics and Statistics, University of Strathclyde, 16 Richmond Street, Glasgow, G1 1XQ, Scotland
| | - Nazir Lone
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, Scotland
| | - Jim McMenamin
- Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, Scotland
| | - David Goldberg
- Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, Scotland
| | - Helen M Colhoun
- Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, Scotland.
- Institute of Genetics and Molecular Medicine, College of Medicine and Veterinary Medicine, University of Edinburgh, Western General Hospital Campus, Crewe Road, Edinburgh, EH4 2XUC, Scotland.
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22
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Spagnolello O, Gallagher B, Lone N, Ceccarelli G, D'Ettorre G, Reed MJ. The Role of Targeted HIV Screening in the Emergency Department: A Scoping Review. Curr HIV Res 2021; 19:106-120. [PMID: 33231157 DOI: 10.2174/1570162x18666201123113905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 10/22/2020] [Accepted: 10/26/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Human immunodeficiency virus (HIV) infection continues to expand worldwide, and a significant proportion of infection is still undiagnosed. Recent studies have addressed the impact and feasibility of 'opt-out' HIV screening in Emergency Departments (EDs) in urban settings at high HIV prevalence, whereas little is known about the yield of implementing 'targeted' HIV testing, especially in low-prevalence areas. OBJECTIVE The present study undertakes a scoping review of research carried out on the implementation of targeted HIV screening of adult in EDs to determine the impact, feasibility and acceptability of HIV testing in different HIV prevalence settings. DESIGN Online databases (EMBASE, MEDLINE) were used to identify papers published between 2000 to 2020. A three-concept search was employed with HIV (HIV, Human immunodeficiency virus infection, HIV infections), targeted testing (Target, screening or testing) and emergency medicine (Emergency Service, emergency ward, A&E, accident and emergency or Emergency Department) (28th February 2020). Only full-text articles written in English, French, Spanish or Italian and using impact and/or feasibility and/or acceptability of the program as primary or secondary outcomes were analysed. RESULTS The search provided 416 articles. Of these, 12 met inclusion criteria and were included in the final review. Most of the included studies were carried out in the United States (n=8; 67%) and in areas of high HIV prevalence (n=11; 92%). Three (20%) were randomized control studies. While the rate of newly diagnosed HIV cases varied widely (0.03-2.2%), likely due to methodological heterogeneity between studies, the linkage of new HIV diagnosis was often high (80-100%) and median CD4+ cell count was always greater than 200 cells per microliter. Targeted HIV screening was found to be cost-effective (out of 2 studies) and well accepted by participants (out 2 studies). CONCLUSIONS Targeted HIV screening at the ED can be impactful, feasible and well accepted, but often requires extra funding and staff. Most previous work has focused on areas of high disease prevalence.
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Affiliation(s)
- Ornella Spagnolello
- Department of Public Health and Infectious Diseases, University of Rome Sapienza, Rome, Italy
| | - Bernadette Gallagher
- Emergency Medicine Research Group Edinburgh (EMERGE), Department of Emergency Medicine, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, United Kingdom
| | - Nazir Lone
- Department of Critical Care, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, EH16 4SA, United Kingdom
| | - Giancarlo Ceccarelli
- Department of Public Health and Infectious Diseases, University of Rome Sapienza, Rome, Italy
| | - Gabriella D'Ettorre
- Department of Public Health and Infectious Diseases, University of Rome Sapienza, Rome, Italy
| | - Matthew J Reed
- Emergency Medicine Research Group Edinburgh (EMERGE), Department of Emergency Medicine, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, United Kingdom
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23
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McKeigue PM, Kennedy S, Weir A, Bishop J, McGurnaghan SJ, McAllister D, Robertson C, Wood R, Lone N, Murray J, Caparrotta TM, Smith-Palmer A, Goldberg D, McMenamin J, Guthrie B, Hutchinson S, Colhoun HM. Relation of severe COVID-19 to polypharmacy and prescribing of psychotropic drugs: the REACT-SCOT case-control study. BMC Med 2021; 19:51. [PMID: 33612113 PMCID: PMC7897516 DOI: 10.1186/s12916-021-01907-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 01/11/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The objective of this study was to investigate the relation of severe COVID-19 to prior drug prescribing. METHODS Severe cases were defined by entry to critical care or fatal outcome. For this matched case-control study (REACT-SCOT), all 4251 cases of severe COVID-19 in Scotland since the start of the epidemic were matched for age, sex and primary care practice to 36,738 controls from the population register. Records were linked to hospital discharges since June 2015 and dispensed prescriptions issued in primary care during the last 240 days. RESULTS Severe COVID-19 was strongly associated with the number of non-cardiovascular drug classes dispensed. This association was strongest in those not resident in a care home, in whom the rate ratio (95% CI) associated with dispensing of 12 or more drug classes versus none was 10.8 (8.8, 13.3), and in those without any of the conditions designated as conferring increased risk of COVID-19. Of 17 drug classes postulated at the start of the epidemic to be "medications compromising COVID", all were associated with increased risk of severe COVID-19 and these associations were present in those without any of the designated risk conditions. The fraction of cases in the population attributable to exposure to these drug classes was 38%. The largest effect was for antipsychotic agents: rate ratio 4.18 (3.42, 5.11). Other drug classes with large effects included proton pump inhibitors (rate ratio 2.20 (1.72, 2.83) for = 2 defined daily doses/day), opioids (3.66 (2.68, 5.01) for = 50 mg morphine equivalent/day) and gabapentinoids. These associations persisted after adjusting for covariates and were stronger with recent than with non-recent exposure. CONCLUSIONS Severe COVID-19 is associated with polypharmacy and with drugs that cause sedation, respiratory depression, or dyskinesia; have anticholinergic effects; or affect the gastrointestinal system. These associations are not easily explained by co-morbidity. Measures to reduce the burden of mortality and morbidity from COVID-19 should include reinforcing existing guidance on reducing overprescribing of these drug classes and limiting inappropriate polypharmacy. REGISTRATION ENCEPP number EUPAS35558.
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Affiliation(s)
- Paul M McKeigue
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, Scotland. .,Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, Scotland.
| | - Sharon Kennedy
- NHS Information Services Division (Public Health Scotland), Gyle Square, 1 South Gyle Crescent, Edinburgh, EH12 9EB, Scotland
| | - Amanda Weir
- Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, Scotland
| | - Jen Bishop
- Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, Scotland
| | - Stuart J McGurnaghan
- Institute of Genetics and Molecular Medicine, College of Medicine and Veterinary Medicine, University of Edinburgh, Western General Hospital Campus, Crewe Road, Edinburgh, EH4 2XUC, Scotland
| | - David McAllister
- Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, Scotland.,Institute of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8RZ, Scotland
| | - Chris Robertson
- Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, Scotland.,Department of Mathematics and Statistics, University of Strathclyde, 16 Richmond Street, Glasgow, G1 1XQ, Scotland
| | - Rachael Wood
- NHS Information Services Division (Public Health Scotland), Gyle Square, 1 South Gyle Crescent, Edinburgh, EH12 9EB, Scotland
| | - Nazir Lone
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, Scotland
| | - Janet Murray
- Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, Scotland
| | - Thomas M Caparrotta
- Institute of Genetics and Molecular Medicine, College of Medicine and Veterinary Medicine, University of Edinburgh, Western General Hospital Campus, Crewe Road, Edinburgh, EH4 2XUC, Scotland
| | - Alison Smith-Palmer
- Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, Scotland
| | - David Goldberg
- Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, Scotland
| | - Jim McMenamin
- Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, Scotland
| | - Bruce Guthrie
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, Scotland
| | - Sharon Hutchinson
- Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, Scotland.,School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland
| | - Helen M Colhoun
- Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, Scotland.,Institute of Genetics and Molecular Medicine, College of Medicine and Veterinary Medicine, University of Edinburgh, Western General Hospital Campus, Crewe Road, Edinburgh, EH4 2XUC, Scotland
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24
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McGurnaghan SJ, Weir A, Bishop J, Kennedy S, Blackbourn LAK, McAllister DA, Hutchinson S, Caparrotta TM, Mellor J, Jeyam A, O'Reilly JE, Wild SH, Hatam S, Höhn A, Colombo M, Robertson C, Lone N, Murray J, Butterly E, Petrie J, Kennon B, McCrimmon R, Lindsay R, Pearson E, Sattar N, McKnight J, Philip S, Collier A, McMenamin J, Smith-Palmer A, Goldberg D, McKeigue PM, Colhoun HM. Risks of and risk factors for COVID-19 disease in people with diabetes: a cohort study of the total population of Scotland. Lancet Diabetes Endocrinol 2021; 9:82-93. [PMID: 33357491 PMCID: PMC7832778 DOI: 10.1016/s2213-8587(20)30405-8] [Citation(s) in RCA: 203] [Impact Index Per Article: 67.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 11/24/2020] [Accepted: 11/25/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND We aimed to ascertain the cumulative risk of fatal or critical care unit-treated COVID-19 in people with diabetes and compare it with that of people without diabetes, and to investigate risk factors for and build a cross-validated predictive model of fatal or critical care unit-treated COVID-19 among people with diabetes. METHODS In this cohort study, we captured the data encompassing the first wave of the pandemic in Scotland, from March 1, 2020, when the first case was identified, to July 31, 2020, when infection rates had dropped sufficiently that shielding measures were officially terminated. The participants were the total population of Scotland, including all people with diabetes who were alive 3 weeks before the start of the pandemic in Scotland (estimated Feb 7, 2020). We ascertained how many people developed fatal or critical care unit-treated COVID-19 in this period from the Electronic Communication of Surveillance in Scotland database (on virology), the RAPID database of daily hospitalisations, the Scottish Morbidity Records-01 of hospital discharges, the National Records of Scotland death registrations data, and the Scottish Intensive Care Society and Audit Group database (on critical care). Among people with fatal or critical care unit-treated COVID-19, diabetes status was ascertained by linkage to the national diabetes register, Scottish Care Information Diabetes. We compared the cumulative incidence of fatal or critical care unit-treated COVID-19 in people with and without diabetes using logistic regression. For people with diabetes, we obtained data on potential risk factors for fatal or critical care unit-treated COVID-19 from the national diabetes register and other linked health administrative databases. We tested the association of these factors with fatal or critical care unit-treated COVID-19 in people with diabetes, and constructed a prediction model using stepwise regression and 20-fold cross-validation. FINDINGS Of the total Scottish population on March 1, 2020 (n=5 463 300), the population with diabetes was 319 349 (5·8%), 1082 (0·3%) of whom developed fatal or critical care unit-treated COVID-19 by July 31, 2020, of whom 972 (89·8%) were aged 60 years or older. In the population without diabetes, 4081 (0·1%) of 5 143 951 people developed fatal or critical care unit-treated COVID-19. As of July 31, the overall odds ratio (OR) for diabetes, adjusted for age and sex, was 1·395 (95% CI 1·304-1·494; p<0·0001, compared with the risk in those without diabetes. The OR was 2·396 (1·815-3·163; p<0·0001) in type 1 diabetes and 1·369 (1·276-1·468; p<0·0001) in type 2 diabetes. Among people with diabetes, adjusted for age, sex, and diabetes duration and type, those who developed fatal or critical care unit-treated COVID-19 were more likely to be male, live in residential care or a more deprived area, have a COVID-19 risk condition, retinopathy, reduced renal function, or worse glycaemic control, have had a diabetic ketoacidosis or hypoglycaemia hospitalisation in the past 5 years, be on more anti-diabetic and other medication (all p<0·0001), and have been a smoker (p=0·0011). The cross-validated predictive model of fatal or critical care unit-treated COVID-19 in people with diabetes had a C-statistic of 0·85 (0·83-0·86). INTERPRETATION Overall risks of fatal or critical care unit-treated COVID-19 were substantially elevated in those with type 1 and type 2 diabetes compared with the background population. The risk of fatal or critical care unit-treated COVID-19, and therefore the need for special protective measures, varies widely among those with diabetes but can be predicted reasonably well using previous clinical history. FUNDING None.
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Affiliation(s)
- Stuart J McGurnaghan
- Health Protection Scotland, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK; Institute of Genetics and Molecular Medicine, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Amanda Weir
- Health Protection Scotland, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Jen Bishop
- Health Protection Scotland, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Sharon Kennedy
- Health Protection Scotland, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Luke A K Blackbourn
- Institute of Genetics and Molecular Medicine, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | | | - Sharon Hutchinson
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Thomas M Caparrotta
- Institute of Genetics and Molecular Medicine, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Joseph Mellor
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Anita Jeyam
- Institute of Genetics and Molecular Medicine, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Joseph E O'Reilly
- Institute of Genetics and Molecular Medicine, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Sarah H Wild
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Sara Hatam
- Institute of Genetics and Molecular Medicine, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Andreas Höhn
- Institute of Genetics and Molecular Medicine, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Marco Colombo
- Institute of Genetics and Molecular Medicine, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Chris Robertson
- Health Protection Scotland, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK; Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - Nazir Lone
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Janet Murray
- Health Protection Scotland, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Elaine Butterly
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - John Petrie
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Brian Kennon
- Queen Elizabeth University Hospital, Glasgow, UK
| | | | - Robert Lindsay
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | | | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - John McKnight
- Western General Hospital, National Health Service Lothian Edinburgh, UK
| | - Sam Philip
- Grampian Diabetes Research Unit, Diabetes Centre, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Andrew Collier
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Jim McMenamin
- Health Protection Scotland, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Alison Smith-Palmer
- Health Protection Scotland, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - David Goldberg
- Health Protection Scotland, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Paul M McKeigue
- Health Protection Scotland, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK; Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Helen M Colhoun
- Health Protection Scotland, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK; Institute of Genetics and Molecular Medicine, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK; Department of Public Health, National Health Service Fife, Kirkcaldy, UK.
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25
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Kichloo A, Kumar A, Amir R, Aljadah M, Farooqi N, Albosta M, Singh J, Jamal S, El-Amir Z, Kichloo A, Lone N. Utilization of extracorporeal membrane oxygenation during the COVID-19 pandemic. World J Crit Care Med 2021; 10:1-11. [PMID: 33505868 PMCID: PMC7805254 DOI: 10.5492/wjccm.v10.i1.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 12/07/2020] [Accepted: 12/23/2020] [Indexed: 02/06/2023] Open
Abstract
The ongoing outbreak of severe acute respiratory syndrome coronavirus-2 [SARS-CoV-2, or coronavirus disease 2019 (COVID-19)] was declared a pandemic by the World Health Organization on March 11, 2020. Worldwide, more than 65 million people have been infected with this SARS-CoV-2 virus, and over 1.5 million people have died due to the viral illness. Although a tremendous amount of medical progress has been made since its inception, there continues to be ongoing research regarding the pathophysiology, treatments, and vaccines. While a vast majority of those infected develop only mild to moderate symptoms, about 5% of people have severe forms of infection resulting in respiratory failure, myocarditis, septic shock, or multi-organ failure. Despite maximal cardiopulmonary support and invasive mechanical ventilation, mortality remains high. Extracorporeal membrane oxygenation (ECMO) remains a valid treatment option when maximal conventional strategies fail. Utilization of ECMO in the pandemic is challenging from both resource allocation and ethical standpoints. This article reviews the rationale behind its use, current status of utilization, and future considerations for ECMO in critically ill COVID-19 patients.
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Affiliation(s)
- Asim Kichloo
- Department of Internal Medicine, Central Michigan University, Saginaw, MI 48603, United States
| | - Akshay Kumar
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA 15260, United States
| | - Rawan Amir
- Department of Internal Medicine, University of Maryland, Baltimore, MD 20742, United States
| | - Michael Aljadah
- Department of Internal Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, United States
| | - Najiha Farooqi
- Department of Surgery, Central Michigan University, Saginaw, MI 48603, United States
| | - Michael Albosta
- Department of Internal Medicine, Central Michigan University, Saginaw, MI 48603, United States
| | - Jagmeet Singh
- Department of Nephrology and Transplant Nephrology, Guthrie Robert Packer Hospital, Sayre, PA 18840, United States
| | - Shakeel Jamal
- Department of Internal Medicine, Central Michigan University, Saginaw, MI 48603, United States
| | - Zain El-Amir
- Department of Internal Medicine, Central Michigan University, Saginaw, MI 48603, United States
| | - Akif Kichloo
- Department of Anesthesiology and Critical Care, Saraswathi Institute of Medical Sciences, Uttar Pradesh 245304, India
| | - Nazir Lone
- Department of Pulmonology and Critical Care, Northwell Health, Riverhead, NY 11901, United States
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26
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Kichloo A, Khan A, Siddiqui N, Ejaz H, Albosta MS, Wani F, Lone N. Habit Mimics the Illness: EVALI During the Era of the COVID-19 Pandemic. J Investig Med High Impact Case Rep 2020; 8:2324709620972243. [PMID: 33174465 PMCID: PMC7673050 DOI: 10.1177/2324709620972243] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Globally, health care providers have been challenged to provide adequate care during the coronavirus disease-2019 (COVID-19) pandemic. Due to the ever changing and rapidly evolving nature of the novel coronavirus, there is increased public anxiety and knowledge gaps that have created major dilemmas in health care delivery. In this environment, there is tremendous pressure on clinicians to diagnose each and every case of COVID-19. This has led to a situation in which clinicians are primed to suspect all respiratory illness is due to COVID-19 infection until proven otherwise. Because of this, providers may misdiagnose patients who have illnesses that are distinct from COVID-19 but present in a similar manner. In the current article, we present the case of e-cigarette- and vaping-associated acute lung injury (EVALI) mimicking pneumonia secondary to the novel coronavirus. It is unknown if vaping puts patients at higher risk of respiratory failure if coinfected with COVID-19. Therefore, exposure history in patients presenting with pneumonia-like syndrome is important. Physicians should be aware of the overlap between these conditions and should pay particular attention during history taking to distinguish EVALI from COVID-19 pneumonia.
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Affiliation(s)
| | - Azkia Khan
- Bassett Medical Center, Cooperstown, NY, USA
| | | | - Hashim Ejaz
- Bassett Medical Center, Cooperstown, NY, USA
| | | | - Farah Wani
- Central Michigan University, Saginaw, MI, USA
| | - Nazir Lone
- Bassett Medical Center, Cooperstown, NY, USA
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27
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Turnbull AJ, Donaghy E, Salisbury L, Ramsay P, Rattray J, Walsh T, Lone N. Polypharmacy and emergency readmission to hospital after critical illness: a population-level cohort study. Br J Anaesth 2020; 126:415-422. [PMID: 33138965 DOI: 10.1016/j.bja.2020.09.035] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 09/08/2020] [Accepted: 09/27/2020] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Polypharmacy is common and closely linked to drug interactions. The impact of polypharmacy has not been previously quantified in survivors of critical illness who have reduced resilience to stressors. Our aim was to identify factors associated with preadmission polypharmacy and ascertain whether polypharmacy is an independent risk factor for emergency readmission to hospital after discharge from a critical illness. METHODS A population-wide cohort study consisting of patients admitted to all Scottish general ICUs between January 1, 2011 and December 31, 2013, whom survived their ICU stay. Patients were stratified by presence of preadmission polypharmacy, defined as being prescribed five or more regular medications. The primary outcome was emergency hospital readmission within 1 yr of discharge from index hospital stay. RESULTS Of 23 844 ICU patients, 29.9% were identified with polypharmacy (n=7138). Factors associated with polypharmacy included female sex, increasing age, and social deprivation. Emergency 1-yr hospital readmission was significantly higher in the polypharmacy cohort (51.8% vs 35.8%, P<0.001). After confounder adjustment, patients with polypharmacy had a 22% higher hazard of emergency 1-yr readmission (adjusted hazard ratio 1.22, 95% confidence interval 1.16-1.28, P<0.001). On a linear scale of polypharmacy each additional prescription conferred a 3% increase in hazard of emergency readmission by 1 yr (adjusted hazard ratio 1.03, 95% confidence interval 1.02-1.03, P<0.001). CONCLUSIONS This national cohort study of ICU survivors demonstrates that preadmission polypharmacy is an independent risk factor for emergency readmission. In an ever-growing era of polypharmacy, this risk factor may represent a substantial burden in the at-risk post-intensive care population.
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Affiliation(s)
- Angus J Turnbull
- University Department of Anaesthesia, Critical Care and Pain Medicine, Deanery of Clinical Sciences, University of Edinburgh, Edinburgh, UK.
| | - Eddie Donaghy
- University Department of Anaesthesia, Critical Care and Pain Medicine, Deanery of Clinical Sciences, University of Edinburgh, Edinburgh, UK; Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Lisa Salisbury
- School of Health Sciences, Queen Margaret University Edinburgh, Musselburgh, UK
| | - Pamela Ramsay
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Janice Rattray
- School of Nursing and Health Sciences, University of Dundee, Dundee, UK
| | - Timothy Walsh
- University Department of Anaesthesia, Critical Care and Pain Medicine, Deanery of Clinical Sciences, University of Edinburgh, Edinburgh, UK; Usher Institute, University of Edinburgh, Edinburgh, UK; MRC Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
| | - Nazir Lone
- University Department of Anaesthesia, Critical Care and Pain Medicine, Deanery of Clinical Sciences, University of Edinburgh, Edinburgh, UK; Usher Institute, University of Edinburgh, Edinburgh, UK
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Choi Y, Lone N, Bethuel N. ILEOCOLIC INTUSSUSCEPTION: A RARE CASE REPORT OF MULTI-SYSTEMIC SARCOIDOSIS. Chest 2020. [DOI: 10.1016/j.chest.2020.08.1730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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McKeigue PM, Weir A, Bishop J, McGurnaghan SJ, Kennedy S, McAllister D, Robertson C, Wood R, Lone N, Murray J, Caparrotta TM, Smith-Palmer A, Goldberg D, McMenamin J, Ramsay C, Hutchinson S, Colhoun HM. Rapid Epidemiological Analysis of Comorbidities and Treatments as risk factors for COVID-19 in Scotland (REACT-SCOT): A population-based case-control study. PLoS Med 2020; 17:e1003374. [PMID: 33079969 PMCID: PMC7575101 DOI: 10.1371/journal.pmed.1003374] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 09/18/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The objectives of this study were to identify risk factors for severe coronavirus disease 2019 (COVID-19) and to lay the basis for risk stratification based on demographic data and health records. METHODS AND FINDINGS The design was a matched case-control study. Severe COVID-19 was defined as either a positive nucleic acid test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the national database followed by entry to a critical care unit or death within 28 days or a death certificate with COVID-19 as underlying cause. Up to 10 controls per case matched for sex, age, and primary care practice were selected from the national population register. For this analysis-based on ascertainment of positive test results up to 6 June 2020, entry to critical care up to 14 June 2020, and deaths registered up to 14 June 2020-there were 36,948 controls and 4,272 cases, of which 1,894 (44%) were care home residents. All diagnostic codes from the past 5 years of hospitalisation records and all drug codes from prescriptions dispensed during the past 240 days were extracted. Rate ratios for severe COVID-19 were estimated by conditional logistic regression. In a logistic regression using the age-sex distribution of the national population, the odds ratios for severe disease were 2.87 for a 10-year increase in age and 1.63 for male sex. In the case-control analysis, the strongest risk factor was residence in a care home, with rate ratio 21.4 (95% CI 19.1-23.9, p = 8 × 10-644). Univariate rate ratios for conditions listed by public health agencies as conferring high risk were 2.75 (95% CI 1.96-3.88, p = 6 × 10-9) for type 1 diabetes, 1.60 (95% CI 1.48-1.74, p = 8 × 10-30) for type 2 diabetes, 1.49 (95% CI 1.37-1.61, p = 3 × 10-21) for ischemic heart disease, 2.23 (95% CI 2.08-2.39, p = 4 × 10-109) for other heart disease, 1.96 (95% CI 1.83-2.10, p = 2 × 10-78) for chronic lower respiratory tract disease, 4.06 (95% CI 3.15-5.23, p = 3 × 10-27) for chronic kidney disease, 5.4 (95% CI 4.9-5.8, p = 1 × 10-354) for neurological disease, 3.61 (95% CI 2.60-5.00, p = 2 × 10-14) for chronic liver disease, and 2.66 (95% CI 1.86-3.79, p = 7 × 10-8) for immune deficiency or suppression. Seventy-eight percent of cases and 52% of controls had at least one listed condition (51% of cases and 11% of controls under age 40). Severe disease was associated with encashment of at least one prescription in the past 9 months and with at least one hospital admission in the past 5 years (rate ratios 3.10 [95% CI 2.59-3.71] and 2.75 [95% CI 2.53-2.99], respectively) even after adjusting for the listed conditions. In those without listed conditions, significant associations with severe disease were seen across many hospital diagnoses and drug categories. Age and sex provided 2.58 bits of information for discrimination. A model based on demographic variables, listed conditions, hospital diagnoses, and prescriptions provided an additional 1.07 bits (C-statistic 0.804). A limitation of this study is that records from primary care were not available. CONCLUSIONS We have shown that, along with older age and male sex, severe COVID-19 is strongly associated with past medical history across all age groups. Many comorbidities beyond the risk conditions designated by public health agencies contribute to this. A risk classifier that uses all the information available in health records, rather than only a limited set of conditions, will more accurately discriminate between low-risk and high-risk individuals who may require shielding until the epidemic is over.
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Affiliation(s)
- Paul M. McKeigue
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, Scotland
- Public Health Scotland, Glasgow, Scotland
| | | | - Jen Bishop
- Public Health Scotland, Glasgow, Scotland
| | - Stuart J. McGurnaghan
- Institute of Genetics and Molecular Medicine, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, Scotland
| | - Sharon Kennedy
- NHS Information Services Division (Public Health Scotland), Edinburgh, Scotland
| | - David McAllister
- Public Health Scotland, Glasgow, Scotland
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Chris Robertson
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, Scotland
| | - Rachael Wood
- NHS Information Services Division (Public Health Scotland), Edinburgh, Scotland
| | - Nazir Lone
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, Scotland
| | | | - Thomas M. Caparrotta
- Institute of Genetics and Molecular Medicine, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, Scotland
| | | | | | | | | | - Sharon Hutchinson
- Public Health Scotland, Glasgow, Scotland
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland
| | - Helen M. Colhoun
- Public Health Scotland, Glasgow, Scotland
- Institute of Genetics and Molecular Medicine, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, Scotland
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Choi Y, Bethuel N, Lone N. ILEOCOLIC INTUSSUSCEPTION: A RARE CASE REPORT OF MULTI-SYSTEMIC SARCOIDOSIS. Chest 2020. [DOI: 10.1016/j.chest.2020.05.420] [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: 11/24/2022] Open
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31
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Vipparla N, Kichloo A, Albosta MS, Aljadah M, Wani F, Lone N. Resistant Hypertension Secondary to Severe Renal Artery Stenosis With Negative Duplex Ultrasound: A Brief Review of Different Diagnostic Modalities. J Investig Med High Impact Case Rep 2020; 8:2324709620914793. [PMID: 32202154 PMCID: PMC7092649 DOI: 10.1177/2324709620914793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Renal artery stenosis is a cause of resistant hypertension, which can present with several features such as severe hypertension, deterioration of renal function (with or without associated angiotensin-converting inhibitor or angiotensin receptor blocker therapy), and flash pulmonary edema. When evaluating for the presence of renal artery stenosis, the most widely utilized imaging modalities are duplex ultrasonography and computed tomography angiography. In this article, we discuss the case of a 77-year-old female who presented with shortness of breath and mild pulmonary edema, secondary to hypertensive emergency. Later, she was diagnosed with renal artery stenosis and underwent stent placement in the left renal artery. Our case highlights the different diagnostic modalities and emphasizes that the most commonly used screening, which is duplex ultrasonography, was performed on our patient but gave a false-negative result, despite high-grade stenosis, which was later diagnosed on computed tomography angiography.
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Affiliation(s)
| | - Asim Kichloo
- St. Mary's of Saginaw Hospital, Saginaw, MI, USA.,Central Michigan University, Saginaw, MI, USA
| | | | | | - Farah Wani
- St. Mary's of Saginaw Hospital, Saginaw, MI, USA
| | - Nazir Lone
- Bassett Medical Center, Cooperstown, NY, USA
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Young IJB, Luz S, Lone N. A systematic review of natural language processing for classification tasks in the field of incident reporting and adverse event analysis. Int J Med Inform 2019; 132:103971. [PMID: 31630063 DOI: 10.1016/j.ijmedinf.2019.103971] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 08/06/2019] [Accepted: 09/14/2019] [Indexed: 12/26/2022]
Abstract
CONTEXT Adverse events in healthcare are often collated in incident reports which contain unstructured free text. Learning from these events may improve patient safety. Natural language processing (NLP) uses computational techniques to interrogate free text, reducing the human workload associated with its analysis. There is growing interest in applying NLP to patient safety, but the evidence in the field has not been summarised and evaluated to date. OBJECTIVE To perform a systematic literature review and narrative synthesis to describe and evaluate NLP methods for classification of incident reports and adverse events in healthcare. METHODS Data sources included Medline, Embase, The Cochrane Library, CINAHL, MIDIRS, ISI Web of Science, SciELO, Google Scholar, PROSPERO, hand searching of key articles, and OpenGrey. Data items were manually abstracted to a standardised extraction form. RESULTS From 428 articles screened for eligibility, 35 met the inclusion criteria of using NLP to perform a classification task on incident reports, or with the aim of detecting adverse events. The majority of studies used free text from incident reporting systems or electronic health records. Models were typically designed to classify by type of incident, type of medication error, or harm severity. A broad range of NLP techniques are demonstrated to perform these classification tasks with favourable performance outcomes. There are methodological challenges in how these results can be interpreted in a broader context. CONCLUSION NLP can generate meaningful information from unstructured data in the specific domain of the classification of incident reports and adverse events. Understanding what or why incidents are occurring is important in adverse event analysis. If NLP enables these insights to be drawn from larger datasets it may improve the learning from adverse events in healthcare.
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Affiliation(s)
- Ian James Bruce Young
- Department of Anaesthesia, Critical Care and Pain Medicine, Edinburgh Royal Infirmary, 51 Little France Crescent, Edinburgh, Scotland, EH16 4SA, United Kingdom.
| | - Saturnino Luz
- Usher Institute of Population Health Sciences & Informatics, The University of Edinburgh, 9 Little France Rd, Edinburgh, Scotland EH16 4UX, United Kingdom.
| | - Nazir Lone
- Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, United Kingdom.
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33
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Hodgson CL, Walsh TS, Lone N. The long road home: are outcomes different for patients with sepsis? Intensive Care Med 2018; 44:1556-1557. [PMID: 30022235 DOI: 10.1007/s00134-018-5301-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 07/02/2018] [Indexed: 10/28/2022]
Affiliation(s)
- C L Hodgson
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia.
| | - T S Walsh
- University of Edinburgh, Edinburgh, UK
| | - N Lone
- University of Edinburgh, Edinburgh, UK
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34
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Abid H, Khan J, Lone N. Hodgkin's Lymphoma presenting as an obstructing endobronchial mass-A rare presentation. BMJ Case Rep 2018. [PMID: 29523516 DOI: 10.1136/bcr-2017-223809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report a case of Hodgkin's lymphoma presenting as an endobronchial mass in a 40-year-old man with history of 8 months of non-specific symptoms like cough, fatigue and weight loss. Initially he was treated with broad-spectrum antibiotics for suspicion of pneumonia without recovery. Radiographic work-up showed cavitary consolidation of the upper lobe of the left lung, followed by bronchoscopy which showed obstructing mass of the upper lobe of the left lung mimicking primary lung carcinoma. Immunohistochemical staining of the specimen was suggestive of Hodgkin's lymphoma. The patient responded well to the chemotherapy regimen.
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Affiliation(s)
- Haisam Abid
- Internal Medicine, Bassett Healthcare, Cooperstown, New York, USA
| | - Junaid Khan
- Pulmonary and Critical Care, Bassett Healthcare, Cooperstown, New York, USA
| | - Nazir Lone
- Pulmonary and Critical Care, Bassett Healthcare, Cooperstown, New York, USA
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35
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Griffith DM, Salisbury L, Lee RJ, Lone N, Merriweather JL, Walsh T. The Burden of Specific Symptoms Reported by Survivors After Critical Illness. Am J Respir Crit Care Med 2017. [PMID: 28650202 DOI: 10.1164/rccm.201702-0398le] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- David M Griffith
- University of Edinburgh , MRC Centre for Inflammation Research, Edinburgh, Lothian, United Kingdom of Great Britain and Northern Ireland ;
| | - Lisa Salisbury
- Queen Margaret University Edinburgh, 3122, School of Health Sciences, Edinburgh, United Kingdom of Great Britain and Northern Ireland ;
| | - Robert J Lee
- University of Edinburgh, 3124, Usher Institute for Population Health Sciences and Informatics, Edinburgh, Edinburgh, United Kingdom of Great Britain and Northern Ireland ;
| | - Nazir Lone
- University of Edinburgh, Centre for Population Health Sciences, Edinburgh, United Kingdom of Great Britain and Northern Ireland ;
| | - Judith L Merriweather
- Edinburgh Royal Infirmary, Anaesthetics, Critical Care and Pain Medicine, Edinburgh, United Kingdom of Great Britain and Northern Ireland ;
| | - Timothy Walsh
- Edinburgh Royal Infirmary, Anaesthetics, Critical Care and Pain Medicine, Edinburgh, United Kingdom of Great Britain and Northern Ireland ;
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Abstract
Aripiprazole is an atypical antipsychotic agent commonly used in the management of schizophrenia. Aripiprazole has not been reported to have an association with interstitial lung disease. We describe a case of a 36-year-old woman who began to experience respiratory issues shortly after starting aripiprazole and presented to us 4 years later with progressive exertional shortness of breath. High-resolution CT of the chest showed a bilateral ground glass pattern. Video-assisted thoracoscopy with biopsy revealed alveolar septal thickening and an inflammatory infiltrate composed mainly of lymphocytes, suggestive of chronic hypersensitivity pneumonitis. After discontinuing aripiprazole and initiating prednisolone therapy, the patient's pulmonary symptoms improved. This case highlights that aripiprazole can cause hypersensitivity pneumonitis in susceptible individuals.
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Affiliation(s)
| | - Swetha Murthi
- Internal Medicine, Sinai Grace Hospital, Detroit, USA
| | - Jeffrey Jennings
- Division of Pulmonary and Critical Care, Henry Ford Health System, Detroit, USA
| | - Nazir Lone
- Internal Medicine, Pulmonary and Critical Care, Bassett Healthcare, Cooperstown, USA
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37
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Gunasekaran K, Rudd KM, Murthi S, Kaatz S, Lone N. Spontaneous Thyroid Hemorrhage on Chronic Anticoagulation Therapy. Clin Pract 2017; 7:932. [PMID: 28243434 PMCID: PMC5304264 DOI: 10.4081/cp.2017.932] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 12/14/2016] [Accepted: 01/25/2017] [Indexed: 11/23/2022] Open
Abstract
Even though highly vascularized, the thyroid gland rarely has spontaneous bleeding. Bleeding into the thyroid gland can result in potentially lethal acute airway compromise. This case report describes an elderly patient on warfarin for atrial fibrillation, who presented with swelling on the right side of her neck causing acute airway obstruction. An urgent computed tomography of the neck showed an enlarging hemorrhage into the right lobe of the thyroid gland. She was initially intubated for airway protection and her anticoagulation was reversed to stop the bleeding. She was closely monitored in the intensive care unit. After an uncomplicated tracheal extubation and recovery, she was discharged and scheduled for an elective total thyroidectomy. We desire that physicians be aware of this rare, potentially lethal bleeding complication.
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Affiliation(s)
- Kulothungan Gunasekaran
- Department of Internal Medicine, Bassett Medical Center, Cooperstown, NY, USA; Division of Hospital Medicine, Henry Ford Hospital, Detroit, MI, USA
| | - Kelly M Rudd
- Department of Pharmaceutical Care Services, Section of Clinical Pharmacy, Bassett Medical Center , Cooperstown, NY, USA
| | - Swetha Murthi
- Department of Internal Medicine, Sinai Grace Hospital , Detroit, MI, USA
| | - Scott Kaatz
- Division of Hospital Medicine, Henry Ford Hospital , Detroit, MI, USA
| | - Nazir Lone
- Department of Internal Medicine, Bassett Medical Center , Cooperstown, NY, USA
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38
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Gunasekaran K, Lone N, Edmonds P, Murthi S, Lloyd S. Contralateral Pneumothorax: An Unexpected Complication of EBUS-TBNA. Chest 2016. [DOI: 10.1016/j.chest.2016.08.1139] [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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39
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Walsh TS, Salisbury L, Donaghy E, Ramsay P, Lee R, Rattray J, Lone N. PReventing early unplanned hOspital readmission aFter critical ILlnEss (PROFILE): protocol and analysis framework for a mixed methods study. BMJ Open 2016; 6:e012590. [PMID: 27354086 PMCID: PMC4932276 DOI: 10.1136/bmjopen-2016-012590] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Survivors of critical illness experience multidimensional disabilities that reduce quality of life, and 25-30% require unplanned hospital readmission within 3 months following index hospitalisation. We aim to understand factors associated with unplanned readmission; develop a risk model to identify intensive care unit (ICU) survivors at highest readmission risk; understand the modifiable and non-modifiable readmission drivers; and develop a risk assessment tool for identifying patients and areas for early intervention. METHODS AND ANALYSIS We will use mixed methods with concurrent data collection. Quantitative data will comprise linked healthcare records for adult Scottish residents requiring ICU admission (1 January 2000-31 December 2013) who survived to hospital discharge. The outcome will be unplanned emergency readmission within 90 days of index hospital discharge. Exposures will include pre-ICU demographic data, comorbidities and health status, and critical illness variables representing illness severity. Regression analyses will be used to identify factors associated with increased readmission risk, and to develop and validate a risk prediction model. Qualitative data will comprise recorded/transcribed interviews with up to 60 patients and carers recently experiencing unplanned readmissions in three health board regions. A deductive and inductive thematic analysis will be used to identify factors contributing to readmissions and how they may interact. Through iterative triangulation of quantitative and qualitative data, we will develop a construct/taxonomy that captures reasons and drivers for unplanned readmission. We will validate and further refine this in focus groups with patients/carers who experienced readmissions in six Scottish health board regions, and in consultation with an independent expert group. A tool will be developed to screen for ICU survivors at risk of readmission and inform anticipatory interventions. ETHICS AND DISSEMINATION Data linkage has approval but does not require ethical approval. The qualitative study has ethical approval. Dissemination with key healthcare stakeholders and policymakers is planned. TRIAL REGISTRATION NUMBER UKCRN18023.
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Affiliation(s)
- Timothy S Walsh
- University Department of Anaesthesia, Critical Care, and Pain Medicine, School of Clinical Sciences, University of Edinburgh, Edinburgh, UK
- MRC Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
| | - Lisa Salisbury
- University Department of Anaesthesia, Critical Care, and Pain Medicine, School of Clinical Sciences, University of Edinburgh, Edinburgh, UK
| | - Eddie Donaghy
- University Department of Anaesthesia, Critical Care, and Pain Medicine, School of Clinical Sciences, University of Edinburgh, Edinburgh, UK
- MRC Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
| | - Pamela Ramsay
- University Department of Anaesthesia, Critical Care, and Pain Medicine, School of Clinical Sciences, University of Edinburgh, Edinburgh, UK
| | - Robert Lee
- Usher Institute, Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Janice Rattray
- Department of Nursing Studies, University of Dundee, Dundee, UK
| | - Nazir Lone
- University Department of Anaesthesia, Critical Care, and Pain Medicine, School of Clinical Sciences, University of Edinburgh, Edinburgh, UK
- Usher Institute, Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
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Simpson CR, Lone N, McMenamin J, Gunson R, Robertson C, Ritchie LD, Sheikh A. Early estimation of pandemic influenza Antiviral and Vaccine Effectiveness (EAVE): use of a unique community and laboratory national data-linked cohort study. Health Technol Assess 2016; 19:1-32. [PMID: 26450686 DOI: 10.3310/hta19790] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND After the introduction of any new pandemic influenza, population-level surveillance and rapid assessment of the effectiveness of a new vaccination will be required to ensure that it is targeted to those at increased risk of serious illness or death from influenza. OBJECTIVE We aimed to build a pandemic influenza reporting platform that will determine, once a new pandemic is under way: the uptake and effectiveness of any new pandemic vaccine or any protective effect conferred by antiviral drugs once available; the clinical attack rate of pandemic influenza; and the existence of protection provided by previous exposure to, and vaccination from, A/H1N1 pandemic or seasonal influenza/identification of susceptible groups. DESIGN An observational cohort and test-negative study design will be used (post pandemic). SETTING A national linkage of patient-level general practice data from 41 Practice Team Information general practices, hospitalisation and death certification, virological swab and serology-linked data. PARTICIPANTS We will study a nationally representative sample of the Scottish population comprising 300,000 patients. Confirmation of influenza using reverse transcription polymerase chain reaction and, in a subset of the population, serology. INTERVENTIONS Future available pandemic influenza vaccination and antivirals will be evaluated. MAIN OUTCOME MEASURES To build a reporting platform tailored towards the evaluation of pandemic influenza vaccination. This system will rapidly measure vaccine effectiveness (VE), adjusting for confounders, estimated by determining laboratory-confirmed influenza; influenza-related morbidity and mortality, including general practice influenza-like illnesses (ILIs); and hospitalisation and death from influenza and pneumonia. Once a validated haemagglutination inhibition assay has been developed (and prior to the introduction of any vaccination), cross-reactivity with previous exposure to A/H1N1 or A/H1N1 vaccination, other pandemic influenza or other seasonal influenza vaccination or exposure will be measured. CONCLUSIONS A new sentinel system, capable of rapidly determining the estimated incidence of pandemic influenza, and pandemic influenza vaccine and antiviral uptake and effectiveness in preventing influenza and influenza-related clinical outcomes, has been created. We have all of the required regulatory approvals to allow rapid activation of the sentinel systems in the event of a pandemic. Of the 41 practices expressing an interest in participating, 40 have completed all of the necessary paperwork to take part in the reporting platform. The data extraction tool has been installed in these practices. Data extraction and deterministic linkage systems have been tested. Four biochemistry laboratories have been recruited, and systems for serology collection and linkage of samples to general practice data have been put in place. FUTURE WORK The reporting platform has been set up and is ready to be activated in the event of any pandemic of influenza. Building on this infrastructure, there is now the opportunity to extend the network of general practices to allow important subgroup analyses of VE (e.g. for patients with comorbidities, at risk of serious ILI) and to link to other data sources, in particular to test for maternal outcomes in pregnant patients. STUDY REGISTRATION This study is registered as ISRCTN55398410. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Colin R Simpson
- Centre for Medical Informatics, The Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Nazir Lone
- Centre for Medical Informatics, The Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | | | - Rory Gunson
- West of Scotland Specialist Virology Centre, Glasgow, UK
| | - Chris Robertson
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - Lewis D Ritchie
- Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK
| | - Aziz Sheikh
- Centre for Medical Informatics, The Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
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41
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Walker J, Halbesma N, Lone N, McAllister D, Weir CJ, Wild SH. Socioeconomic status, comorbidity and mortality in patients with type 2 diabetes mellitus in Scotland 2004-2011: a cohort study. J Epidemiol Community Health 2015; 70:596-601. [PMID: 26681293 PMCID: PMC4893140 DOI: 10.1136/jech-2015-206702] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 11/29/2015] [Indexed: 11/11/2022]
Abstract
Background Mortality in people with and without diabetes often exhibits marked social patterning, risk of death being greater in deprived groups. This may reflect deprivation-related differences in comorbid disease (conditions additional to diabetes itself). This study sought to determine whether the social patterning of mortality in a population with type 2 diabetes mellitus (T2DM) is explained by differential comorbidity. Methods Hospital records for 70 197 men and 56 451 women diagnosed with T2DM at 25 years of age and above in Scotland during the period 2004–2011 were used to construct comorbidity histories. Sex-specific logistic models were fitted to predict mortality at 1 year after diagnosis with T2DM, predicted initially by age and socioeconomic status (SES) then extended to incorporate in turn 5 representations of comorbidity (including the Charlson Index). The capacity of comorbidity to explain social mortality gradients was assessed by observing the change in regression coefficients for SES following the addition of comorbidity. Results After adjustment for age and Charlson Index, the OR for the contrast between the least deprived and most deprived quintiles of SES for men was 0.79 (95% CI 0.67 to 0.94). For women, the OR was 0.81 (0.67 to 0.97). Similar results were obtained for the 4 other comorbidity measures used. Conclusions The social patterning of mortality in people with T2DM is not fully explained by differing levels of comorbid disease additional to T2DM itself. Other dimensions of deprivation are implicated in the elevated death rates observed in deprived groups of people with T2DM.
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Affiliation(s)
- Jeremy Walker
- Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, UK
| | - Nynke Halbesma
- Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, UK
| | - Nazir Lone
- Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, UK
| | - David McAllister
- Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, UK
| | - Christopher J Weir
- Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, UK
| | - Sarah H Wild
- Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, UK
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Gunasekaran K, Murthi S, Panneerselvam N, Lone N, McGinnis K. Rare Presentation of Pleuritic Chest Pain. Chest 2015. [DOI: 10.1378/chest.2270703] [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: 11/01/2022] Open
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Docherty A, Lone N, Anderson N, Walsh T. Epidemiology and outcomes of older patients admitted to Scottish intensive care units: a national database linkage study. Lancet 2015; 385 Suppl 1:S33. [PMID: 26312855 DOI: 10.1016/s0140-6736(15)60348-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND As the general population ages and life expectancy increases, health-care use by elderly people increases, including intensive care. Rationing and variation of access are ethically and politically challenging. We aimed to characterise the population-based incidence of intensive care unit (ICU) admissions of elderly people in Scotland; compare ICU admission and mortality between elderly and younger populations; and compare treatment intensity between these groups. METHODS We extracted complete, national 6-year cohort Scottish ICU admissions (Jan 1, 2005, to Dec 31, 2010) from the Scottish Intensive Care Society Audit Group database, which we linked to hospital Scottish Morbidity Record (SMR01) and death records. Annual incidence of ICU admissions of people aged 80 years or older was standardised for sex and socioeconomic status to the standard Scottish population (≥80 years) 2005-10. We compared mortality of elderly and younger people (<65 years) using the log-rank test. FINDINGS During 2005-10, 47 779 people were admitted to ICU (4561 patients ≥80 years [9·5%, 35·0/10 000 population], 26 784 patients <65 years [56·1%, 13·2/10 000]). Incidence of ICU admissions of elderly people fell from 36·6/10 000 population (95%CI 34·0-39·2) in 2005 to 30·3/10 000 (28·0-32·5) in 2010. ICU mortality was higher in elderly than in younger people (26·4% vs 16·1%, p<0·0001) as was 6-year mortality (68·0% vs 34·5%, p<0·0001). 2110 (80%) of 2627 elderly survivors were discharged home (younger 92%, 19 221/20 902), with a further 373 (14·2%) given rehabilitation (younger 1063, 5·1%) (χ(2)=525, p<0·0001). Age was an independent predictor of mortality (odds ratio 1·46, 95% CI 1·23-1·73, p<0·0001) after adjustment for confounders. In the pneumonia subgroup (elderly 294, younger 2167), mean acute physiology scores were similar (17·0 [SD 6·4] vs 17·6 [6·6]), organ support was higher in the elderly patients (77·0% vs 68·1%, p<0·0001), and median ICU length of stay was lower (6 days [IQR 3-13] vs 8 [3-16], p<0·0001). INTERPRETATION This study has shown that, by contrast with previously published research, admission rates of elderly people in Scotland fell between 2005 and 2010. Only the fittest elderly individuals were admitted to ICU, where initially they received a higher intensity of treatment than did younger patients; however, duration of ICU stay was shorter. Mortality rates were high, and age was an independent predictor of mortality. FUNDING Funding assistance for AD's MPH from Scottish Intensive Care Society, Scottish Society of Anaesthetists, Edinburgh Anaesthetics Research and Education Fund.
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Affiliation(s)
- Annemarie Docherty
- Centre for Population Health Sciences, Edinburgh University, Edinburgh, UK; Royal Infirmary of Edinburgh, Edinburgh, UK.
| | - Nazir Lone
- Centre for Population Health Sciences, Edinburgh University, Edinburgh, UK; Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Niall Anderson
- Centre for Population Health Sciences, Edinburgh University, Edinburgh, UK
| | - Timothy Walsh
- Critical Care, Royal Infirmary Edinburgh, Edinburgh, UK
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McAllister DA, Hughes KA, Lone N, Mills NL, Sattar N, McKnight J, Wild SH. Stress hyperglycaemia in hospitalised patients and their 3-year risk of diabetes: a Scottish retrospective cohort study. PLoS Med 2014; 11:e1001708. [PMID: 25136809 PMCID: PMC4138030 DOI: 10.1371/journal.pmed.1001708] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 07/17/2014] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Hyperglycaemia during hospital admission is common in patients who are not known to have diabetes and is associated with adverse outcomes. The risk of subsequently developing type 2 diabetes, however, is not known. We linked a national database of hospital admissions with a national register of diabetes to describe the association between admission glucose and the risk of subsequently developing type 2 diabetes. METHODS AND FINDINGS In a retrospective cohort study, patients aged 30 years or older with an emergency admission to hospital between 2004 and 2008 were included. Prevalent and incident diabetes were identified through the Scottish Care Information (SCI)-Diabetes Collaboration national registry. Patients diagnosed prior to or up to 30 days after hospitalisation were defined as prevalent diabetes and were excluded. The predicted risk of developing incident type 2 diabetes during the 3 years following hospital discharge by admission glucose, age, and sex was obtained from logistic regression models. We performed separate analyses for patients aged 40 and older, and patients aged 30 to 39 years. Glucose was measured in 86,634 (71.0%) patients aged 40 and older on admission to hospital. The 3-year risk of developing type 2 diabetes was 2.3% (1,952/86,512) overall, was <1% for a glucose ≤ 5 mmol/l, and increased to approximately 15% at 15 mmol/l. The risks at 7 mmol/l and 11.1 mmol/l were 2.6% (95% CI 2.5-2.7) and 9.9% (95% CI 9.2-10.6), respectively, with one in four (21,828/86,512) and one in 40 (1,798/86,512) patients having glucose levels above each of these cut-points. For patients aged 30-39, the risks at 7 mmol/l and 11.1 mmol/l were 1.0% (95% CI 0.8-1.3) and 7.8% (95% CI 5.7-10.7), respectively, with one in eight (1,588/11,875) and one in 100 (120/11,875) having glucose levels above each of these cut-points. The risk of diabetes was also associated with age, sex, and socio-economic deprivation, but not with specialty (medical versus surgical), raised white cell count, or co-morbidity. Similar results were obtained for pre-specified sub-groups admitted with myocardial infarction, chronic obstructive pulmonary disease, and stroke. There were 25,193 deaths (85.8 per 1,000 person-years) over 297,122 person-years, of which 2,406 (8.1 per 1,000 person-years) were attributed to vascular disease. Patients with glucose levels of 11.1 to 15 mmol/l and >15 mmol/l had higher mortality than patients with a glucose of <6.1 mmol/l (hazard ratio 1.54; 95% CI 1.42-1.68 and 2.50; 95% CI 2.14-2.95, respectively) in models adjusting for age and sex. Limitations of our study include that we did not have data on ethnicity or body mass index, which may have improved prediction and the results have not been validated in non-white populations or populations outside of Scotland. CONCLUSION Plasma glucose measured during an emergency hospital admission predicts subsequent risk of developing type 2 diabetes. Mortality was also 1.5-fold higher in patients with elevated glucose levels. Our findings can be used to inform patients of their long-term risk of type 2 diabetes, and to target lifestyle advice to those patients at highest risk. Please see later in the article for the Editors' Summary.
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Affiliation(s)
- David A. McAllister
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Katherine A. Hughes
- University of Edinburgh/BHF Centre for Cardiovascular Health Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Nazir Lone
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Nicholas L. Mills
- University of Edinburgh/BHF Centre for Cardiovascular Health Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - John McKnight
- Metabolic Unit and Acute Medicine Departments, NHS Lothian, Edinburgh, United Kingdom
| | - Sarah H. Wild
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, United Kingdom
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Simpson CR, Lone N, Kavanagh K, Ritchie LD, Robertson C, Sheikh A, McMenamin J. Seasonal Influenza Vaccine Effectiveness (SIVE): an observational retrospective cohort study – exploitation of a unique community-based national-linked database to determine the effectiveness of the seasonal trivalent influenza vaccine. Health Services and Delivery Research 2013. [DOI: 10.3310/hsdr01100] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundGlobally, seasonal influenza is responsible for an estimated 3 to 5 million cases of severe illness and 250,000 to 500,000 deaths per year. It is uncertain to what extent national vaccination programmes can prevent this morbidity and mortality.ObjectiveTo determine the effectiveness of the seasonal trivalent inactivated influenza vaccine.DesignWe undertook a retrospective observational cohort study. A propensity score model was constructed and adjusted odds ratios (ORs) were calculated to assess differences in vaccine uptake according to a number of patient characteristics. Adjusted illness and mortality hazard ratios (HRs) were estimated from a Cox proportional hazards model adjusted for sex, age, socioeconomic status, smoking status, urban/rural location, clinical at-risk groups (i.e. patients with chronic respiratory, heart, kidney, liver or neurological disease, immunosuppression and diabetes), Charlson comorbidity index, previous pneumococcal and influenza vaccination, and number of previous primary care consultations, prescribed drugs and hospital admissions. We also included nursing home residence and social care support. Vaccine effectiveness (VE) was expressed as a percentage, and represents a reduction in risk provided by the vaccine for a given outcome (e.g. laboratory-confirmed influenza). This was calculated as 1 − HR, where HR is that of the measured clinical outcome in vaccinated compared with unvaccinated individuals. For estimates of VE derived from linked virological swab data, we carried out a nested case–control study design.SettingA national linkage of patient-level primary care, hospital, death certification and virological swab-linked data across nine influenza seasons (2000–9).ParticipantsA nationally representative sample of the Scottish population during 1,767,919 person-seasons of observation. Cases of influenza were confirmed using reverse transcription-polymerase chain reaction (RT-PCR) in a subset of the population (n = 3323).InterventionsTrivalent inactivated seasonal influenza vaccination (n = 274,071).Main outcome measuresVE, pooled across seasons and adjusting for confounders, was estimated by determining laboratory-confirmed influenza, influenza-related morbidity and mortality including primary care influenza-like illnesses, hospitalisation and death from influenza and pneumonia.ResultsMost vaccines (93.6%;n = 256,474 vaccines) were administered to at-risk patients targeted for vaccination, with a 69.3% uptake among those aged ≥ 65 years (178,754 vaccinations during 258,100 person-seasons). For at-risk patients aged < 65 years there was a 26.2% uptake (77,264 vaccinations during 295,116 person-seasons). VE in preventing RT-PCR laboratory-confirmed influenza was 57.1% [95% confidence interval (CI) 31.3% to 73.3%]. VE was 18.8% (95% CI –103.7% to 67.6%) in patients aged ≥ 65 years and 59.6% (95% CI 21.9% to 79.1%) in those aged < 65 years at risk of serious complications from influenza. In the matched analysis (156,096 person-seasons), adjusted VE for reducing primary care consultations for influenza-like illnesses was 16.3% (95% CI 5.7% to 26.0%). VE in reducing hospitalisations was 19.3% for influenza and pneumonia (95% CI 8.3% to 29.1%) and 26.7% for pneumonia and chronic obstructive pulmonary disease (95% CI 19.8% to 32.9%). VE in reducing death due to influenza and pneumonia was 37.9% (95% CI 29.5% to 45.4%).ConclusionsFew countries' health systems allow for the integrated and accessible data recording that made this study possible and made it feasible to collate centrally almost all hospitalisations and deaths attributed to influenza, thereby allowing completeness of reporting. Using these data, we found most influenza vaccines were administered to those at risk of serious complications from influenza. In a nationally representative cohort we found that the vaccine was associated with a significant decrease in the risk of RT-PCR-confirmed influenza (the decrease was substantial particularly for at-risk patients aged < 65 years) and complications arising from influenza (where more modest decreases were found). Although the modest size of our cohort made it possible to collate centrally almost all cases of influenza-related disease, analysis of subgroups (in particular older age groups) or by individual season resulted in poorer precision and wide CIs. Any future work should therefore aim to address this issue by ensuring adequate power to test VE in these subgroups of patients, while minimising the effect of bias, such as health-seeking behaviour.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- CR Simpson
- Allergy and Respiratory Research Group, Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - N Lone
- Allergy and Respiratory Research Group, Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - K Kavanagh
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - LD Ritchie
- Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK
| | - C Robertson
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
- Health Protection Scotland, Glasgow, UK
- International Prevention Research Institute, Lyon, France
| | - A Sheikh
- Allergy and Respiratory Research Group, Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
- School of Public Health and Primary Care (CAPHRI), University of Maastricht, Maastricht, the Netherlands
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Lone N, Oba Y, Whitacret T, Parker W, Sangha H, Wang Y, Hofmann H. “Ubi Pus, Ibi Evacua.” A Case of Complex Pleuroparenchymal Disease and Late Onset Empyema After Severe ARDS and Prolonged Mechanical Ventilation. Chest 2013. [DOI: 10.1378/chest.1699697] [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: 11/01/2022] Open
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Affiliation(s)
- Nazir Lone
- University of Missouri, School of Medicine, Division of Pulmonary, Critical Care and Environmental Medicine, One Hospital Drive, CE 412, MO 65212, Columbia
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Esmadi M, Lone N, Ahmad DS, Onofrio J, Brush RG. Multiloculated pleural effusion detected by ultrasound only in a critically-ill patient. Am J Case Rep 2013; 14:63-6. [PMID: 23569565 PMCID: PMC3614381 DOI: 10.12659/ajcr.883816] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [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: 11/14/2012] [Accepted: 01/10/2013] [Indexed: 11/22/2022]
Abstract
Background: Multiloculated pleural effusion is a life-threatening condition that needs early recognition. Drainage by chest tube might be difficult which necessitates a surgical intervention. While x-ray typically does not show loculations, CT scan might not also identify the loculations. Ultrasound has a high sensitivity in detecting pleural diseases including multiloculated pleural effusion. Case Report: A 55-year-old female presented with dyspnea, cough and yellowish sputum for 3 days. Her heart rate was 136 bpm ,O2 saturation 88%, and WBC 21,000/mcL. Chest x-ray showed complete opacification of right lung. A chest tube insertion was unsuccessful. CT scan of the chest showed large pleural effusion occupying the right hemithorax with collapse of the right lung. Bedside ultra-sound showed a multiloculated pleural effusion with septations of different thickness. The patient subsequently underwent thoracotomy which showed multiple, fluid-filled loculations with significant adhesions. The loculations were dissected along with decortications of thick a pleural rind. Blood and pleural fluid cultures grew Streptococcus pneumoniae and the patient was treated successfully with Penicillin G. Conclusions: We advocate bedside ultrasound in patients with complete or near complete opacification of a hemithorax on chest x-ray. CT scan is less likely to show septations within pleural effusions compared to ultrasounnd. Therefore, CT scan and ultrasound are complementary for the diagnosis of empyema and multiloculated pleural effusion.
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Affiliation(s)
- Mohammad Esmadi
- Department of Internal Medicine, University of Missouri School of Medicine, Columbia, MO, U.S.A
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Abstract
The management of trauma-related coagulopathy and haemorrhage is changing from a reactive strategy to a proactive early intervention with blood products and haemostatic agents. Although major haemorrhage and massive transfusion are associated with higher mortality, the pattern of this association with modern trauma care is poorly described. In addition, early predictors of massive transfusion, which might trigger a proactive haemostatic resuscitation strategy, are not currently available. We review recent literature relating to predictors of massive transfusions and the relationship between transfusion and mortality.
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Affiliation(s)
- Matthew J Reed
- Emergency Department, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, UK
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Mehra A, Jadhav A, Lone N, Syed S, Bade BC, Hess B, Fancher W, Shea N, Thomas TS, Holliday Z, Custer J, Redel J, Parikh V, Bunch J, Ditch S, Sheets L, Gupta D, Sabharwal M, Balla S, Dabbagh O. Gender Variations in Venous Thromboembolism Pharmacologic Prophylaxis and Clinical Outcomes. Chest 2010. [DOI: 10.1378/chest.10956] [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: 11/01/2022] Open
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