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1. Adoption of Lung Protective ventilation IN patients undergoing Emergency laparotomy: the ALPINE study. A prospective multicentre observational study

Author

Johnston, C., Huddart, S., Woods, J., Hadi, N., Ali, S., Thorning, G., Gill, P., Boomers, O., Rope, T., Bartlett, R., Kuttler, A., O'Carroll-Kuehn, B., Dickinson, M., Lyness, C., Jha, R., Patel, S., Raj, A., Tanqueray, T., Cox, M., Khader, A., Vashisht, S., Liyanage, S., Ahmed, K., Whitehead, J., Patel, N., Liu, S., Patel, C., Hayward, L., Leonard, S., Hare, S., Saha, R., de Bois, J., Winterbottom, T., Choo, Y., Oliver, C.M., Timbrell, D., Sinnott, M., Yip, E., Trask, N., Sothisrihar, S., Shaw, M., Thorat, P., Shah, D., Leir, S., Farag, M., Duffen, A., McCretton, T., Wojcikiewicz, T., King, C., Pennington, J., Patel, M., Kok, W., Gunarathna, D., Carter, L., Spence, E., Chambers, K., Cervi, E., Cummins, J., Shah, N., Eeles, A., Chu, A., Webb, C., Nolan, L., McHugh, B., Walls, A., Lakhani, R., Matthews, S., Hussein, Z., Wang, S., Weisskopf, R., Talbot, H., Verney, C., Nurmi, E., Henderson, K., Beesley, O.R., Hunter, J., Nicholls, L., Robles, A., Lee, S., Hawkins, R., Patel, K., Kwok, A., Han, J., Allana, A., Kestner, S., Roopra, A., Edwards, L., O'Dell, T., Selby, J., Bickmore, E., Remeta, P., Karsten, E., Daum, P., Loughnan, A., Heggarty, A., Bowes, H., Gunaratna, D., Cronin, J., Post, B., Blunt, N., Gilbert-Kawai, E., Gray, M., Highton, D., Finlay, C., Clancy, O., Bampoe, S., O'Carroll, J., Wickham, A., Wordsworth, H., Williams, F., Hackney, J., Marsh, V., Davies, O., Bird, R., Patel, R., Philips, S., Laycock, H., Morkane, C., Grailey, K., El-Boghdadly, K., Hansen, T.P., Watson, X., Chereshneva, M., Odor, P.M., Chis Ster, I., and Cecconi, M.

Published
2018
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2. Conditioned pain modulation is more efficient in painful than in non-painful diabetic polyneuropathy patients

Author

Granovsky, Y, Topaz, LS, Laycock, H, Zubidat, R, Crystal, S, Buxbaum, C, Bosak, N, Hadad, R, Domany, E, Khamaisi, M, Sprecher, E, Bennett, DL, Rice, A, and Yarnitsky, D

Subjects
Anesthesiology, 11 Medical and Health Sciences, 17 Psychology and Cognitive Sciences
Abstract

Endogenous pain modulation, as tested by the conditioned pain modulation (CPM) protocol, is typically less efficient in chronic pain patients compared to healthy controls. We aimed to assess whether CPM is less efficient in painful compared to non-painful diabetic polyneuropathy (DPN) patients. Characterization of the differences in central pain processing between these two groups might provide a central nervous system explanation to the presence or absence of pain in diabetic neuropathy in addition to the peripheral one.271 patients with DPN underwent CPM testing and clinical assessment, including quantitative sensory testing. Two modalities of the test stimuli (heat and pressure) conditioned to cold noxious water were assessed and compared between painful and non-painful DPN patients. No significant difference was found between the groups for pressure pain CPM, however painful DPN patients demonstrated unexpectedly more efficient CPMHEAT ( -7.4±1.0 vs. -2.3±1.6; p=0.008). Efficient CPMHEAT was associated with higher clinical pain experienced in the 24 hours prior to testing (r=-0.15; P=0.029) and greater loss of mechanical sensation (r=-0.135; P=0.042). Moreover, patients who had mechanical hypoesthesia demonstrated more efficient CPMHEAT (p=0.005). More efficient CPM among painful patients might result from central changes in pain modulation, but also from altered sensory messages coming from tested affected body sites. This calls for the use of intact sites for proper assessment of pain modulation in neuropathy patients.

Published
2021

4. General anaesthetic and airway management practice for obstetric surgery in England: a prospective, multicentre observational study

Author

Odor, P. M., Bampoe, S., Moonesinghe, S. R., Andrade, J., Pandit, J. J., Lucas, D. N., A’Court, A., Abdel-Gadir, D., Abdu, A., Abisogun, C., Aboud, Z., Abrams, J., Ackerman, A., Adamson, C., Addison, R., Adeyeye, A., Adler, R., Aduse-Poku, M., Adyanthaya, S., Ahmad, N., Ahmed, D., Ahmed, A., Akindele, B., Akindele, O., Akrimi, S., Al-Rawi, S., Ali, Y., Allam, J., Allana, A., Allen, K., Allen, O., Amaradasa, N., Amarasekara, L., Amoakwa-adu, F., Anandageetha, P., Anandakrishnan, S., Anandanadesan, R., Anderson, M., Apps, S., Aquilina, A., Arbane, G., Arch, A., Armstrong, S., Arya, R., Ashiru, G., Ashpole, K., Atkinson, C., Atkinson, F., Auer, E., Avery, B., Babio-Galan, M., Bader, H., Badham, G., Bagchi, S., Bailey, S., Baird, Y., Balaka, C., Baldwin, M., Balfour, P., Bali, S., Banks, S., Barclay, P., Barnes, L., Barnes, T., Barot, N., Barrett, S., Barrett, V., Barrett, K., Bates, L., Batte, K., Baytug, B., Behravesh, M., Bell, S., Benloch, R., Bentley, R., Berg, J., Berwick, C., Berwick, R., Bhadange, R., Bhattacharyya, S., Bielskute, E., Birch, S., Bird, S., Bird, Ruth, Birts, William, Black, Becky, Blagova, Tatyana, Blake, Holly, Blightman, Oliver, Blunden, Susara, Bolton, R., Borkett-Jones, C., Boselli, J., Bowen, M., Bowen, R., Bowyer, J., Boyle, H., Brar, Z., Bray, J., Brayshaw, S., Bressington, C., Brewer, A., Brice, N., Bridge, L., Briscoe, J., Brocklesby, S., Brown, H., Brown, S., Brunnen, D., Burijintichenna, K., Burnard, S., Burtt, A., Buswell, V., Bykar, H., Cairney, M., Calvert, C., Camarasa, L., Campbell, N., Campbell-Jones, F., Cantliffe, J., Carrol, W., Carvalho, J., Cashell, C., Cassie, S., Cassim, K., Chandler, M., Chapman, R., Charles, R., Chen, P., Cheyne, D., Chima, K., Chin, F., Chirvasuta, R., Shao Chong, M., Choudhury, S., Chowdhury, P., Christmas, T., Chughwani, S., Ciechanowicz, S., Clarey, E., Coe, R., Cohen, J., Coker, N., Collins, K., Collis, L., Comar, J., Conroy, M., Constantin, K., Corfe, J., Coulborn, E., Cowie, V., Crone, R., Cronin, J., Crooks, J., Crowther, N., Crowther, E., Cruz, C., Curtis, A., Curtis, S., Dabrowicz, A., Daines, N., Dalal, V., Dannatt, P., Das, D., Dash, J., Davidson, K., Davies, S., Davis, Y., Dawson, J., Dean, J., Dean, C., Denman, J., Desai, N., Dewan, P., Dimont, S., Donovan, C., Doraiswami, M., Doughty, K., Douglass, J., Dower, M., Downing, S., Duberry, W., Duckham, E., Dudgeon, L., Dukes, S., Dunn, L., Duraiswamy, V., Dwyer, A. O., Dyer, K., Eapen, S., Earl, M., Eason, S., Edwards, K., Edwards, Z., Egole, O., Ekpa, J., el-Amin, O., el-Boghdadly, K., Elbasir, O., Eldridge, J., Elgie, L., Ellington, M., Elliott, K., Elliott, J., Elmi, M., Elnoumeir, R., Emeakaraoha, E., Evans, M., Everett, M., Fabb, P., Farooq, H., Farrimond, R., Faulds, F., Fawcett, E., Feneley, A., Fernando, D., Ferns, J., Finlay, C., Fitzgerald, S., O’Flaherty, D., Fleet, M., Fletcher, L., Fludder, V., Follet, T., Forbes, J., Forth, M., Foster, G., Francis, J., Fraser, K., Friedman, L., Fruggeri, L., Fulton, L., Funnell, S., Gadre, A., Gandhi, A., Gardiner, H., Garner, Z., Garvey, G., Gately, T., George, R., Gillespie, S., Glover, S., Goddard, J., Goodman, B., Gopal, T., Graham, G., Green, D., Griffin, D., Griffith, J., Grigsby, S., Grindey, J., Griffiths, H., Groome, J., Grother, C., Grounds, G., Groves, A., Guha, A., Gunawardhana, A., Gupta, A., Gupta, R., Gutsell, J., Haddon, R., Hadi, D., Hadjipavlou, N., Hammerbeck, H., Hammon, L., Hammond, S., Hampanna, H., Hancock, H., Handapangoda, H., Haroon-Mowahed, Y., Harpham, D., Harris, G., Harrison, A., Harshan, D., Hartopp, A., Harty, E., Haslam, N., Hawkins, G., Hawkins, E., Hawksey, S., Hays, C., Hazelton, T., Heavyside, A., Hemeson, C., Henderson, K., Henry, O., Herbert, L., Higgins, N., Hilton, J., Hindmoor, C., Hitchcock, R., Hobbs, L., Homsy, M., Honeywell, C., Hoque, N., House, K., Howle, R., Tiller, A., Huniak, M., Hunte, J., Husain, T., Huson, C., Hussain, C., Hussain, T., Hussein, Z., Hyams, J., Hyde, E., Laverdino, M., Ignacka, A., Innes, E., Ioannidis, S., Iqbal, R., Ismail, F., Jackson, J., Jackson, M., Jackson, G., Jacobs, R., Jadhav, P., Jalaly, A., James, L., James, M., Jani, S., Jeganathan, C., Joannides, C., Johnson, R., Johnson, T., Johnston, C., Jones, R., Jones, T., Kadr, M., Kainth, R., Kane, J., Kanji, R., Kannanparambil, S., Kar, G., Kasianandan, T., Kaskos, H., Kavanagh, L., Kaye, R., Kelliher, L., Kelliot, S., Kelly, J., Kenyon, C., Kessack, L., Kestner, S., Khaku, M., Khaleeq, S., Khan, P., Khan, S., Kidwai, U., King, C., King, H., Kingston, E., Kok, W., Konig, R., Konstantinova, Z., Krishnan, P., Kua, J., Kuntumalla, K., Kursumovic, E., Kurzatkowski, K., Kuttambakam, H., Lane, K., Lane, S., Langton, A., Latif, H., Lau, N., Laxman, S., Laycock, H., Lee, R., Leonardi, S., Light, K., Lightfoot, H., Liu, S., Liyanage, S., Lowe, J., Lucas, N., Lungu, M., Lunn, M., Lynes, H., Machavarapu, K., Mackenzie, M., Magee, D., Major, J., Male, V., Malik, Z., Manso, K., Maquinana, M., Marciniak, K., Maronge, L., Marsh, C., Martella, C., Martin, N., Martins, N., Marway, J., Mason, L., Masood, N., Masters, J., Maton-Howarth, M., Mazzola, F., McAllister, T., McCarthy, R., McCormick, C., McCready, S., McDougall, S., Mcewan, L., McGarry, J., McKevitt, H., Mckinley, S., Mckskeane, A., McMaster, E., McMonagle, M., McNamara, H., McPhee, H., McRae, L., Mead, D., Meadows, E., Mehta, M., Meikle, J., Metodiev, Y., Michael, C., Millar, V., Miller, S., Miller, G., Milne, S., Miltsios, K., Misquita, L., Misquita, S., Mittal, M., Mohamed, M., Powell Monaghan, K., Monk, J., Monkhouse, A., Monks, D., Montague, L., Moon, A., Moran, J., Moreton, A., Morgan, E., Morgan, O., Morland, D., Morosan, M., Morris, K., Morris, A., Moser, C., Mount, M., Muir, C., Mupudzi, M., Murali, M., Murdoch, I., Murray, H., Murray, T., Murrell, K., Narasimha Murthy, G., Neeley, D., Nei, H., Neil, K., Nejim, T., Nel, M., Nicholson, A., Nicklin, A., Nolan, C., Nolan, T., Nurmi, E., O’Neill, B., Oakes, C., Oakes, N., Ochoa-Ferraro, M., Odeleye, N., Oliver, K., Oliver, M., Onslow, J., Onwochei, D., Oommen, T., Orr, T., Osagie, O., Osborn, H., Overend, J., Owston, H., Pack, E., Padhi, P., Palani, P., Pandey, R., Pandya, D., Panesar, N., Papageorgiou, C., Papanastasiou, G., Papoutsos, C., Pararajasingham, S., Parry, J., Patel, H., Patel, J., Patel, K., Patel, M., Patel, R., Patel, N., Pathak, S., Pearson, F., Peciulene, V., Peers, B., Peirce, B., Pepper, S., Perinpanayagam, J., Perry, H., Petrova, N., Phillips, T., Phillips, S., Phylactides, L., Pilkington, F., Plumb, J., Poimenidi, E., Sau Kuk Poon, A., Potter, T., Poultney, U., Powell, L., Prenter, A., Preston, K., Price, A., Pritchard, N., Pullen, J., Purohit, M., Quamina, C., Qureshi, J., Rajput, Z., Ramage, S., Ramanathan, T., Ranasinghe, U., Ranatunga, K., Rand, A., Randive, S., Rangarajan, D., Rao, C., Rao Pelluri, S., Ratnasingham, A., Razzaque, J., Reddy, A., Redington, K., Reel, E., Remeta, P., Ricco, F., Riccoboni, A., Rice, P., Rich, M., Richards, N., Riches, J., Ripoll, S., Roberts, F., Roberts, K., Robins, K., Robinson, S., Roche, S., Rojo, M., Carmela Romano, N., Rosser, H., Roughley, L., Routley, C., Rowley, C., Rudra, P., Russell, R., Ryan, C., Saad, C., Sadeghi, A., Salberg, A., Salota, V., Samuel, M., Samuels, R., Sanapala, S., Sanusi, S., Sarao, S., Sathyabhama, S., Saunders, Z., Sawarzynska-ryszka, B., Sceales, P., Schumacher, N., Schwartz, N., Sellers, C., Sellers, H., Sellick, J., Sen, S., Senaratne, D., Senbeto, S., Seneviratna, D., Setty, T., Shah, R., Shah, S., Shambly, J., Sharafudeen, S., Sharieff, I., Sharifi, L., Sharpe, L., Shaw, M., Sheldrake, I., Shinde, P., Shonfeld, A., Short, J., Siah, J., Sibug, S., Siddique, O., Siew, S., Simpson, M., Singleton, G., Sinha, K., Sinha, A., Sinnott, M., Sivadhas, H., Sivakumar, S., Sivarajan, B., Sivarajan, S., Skeoch, C., Slade, S., Slater, P., Smith, C., Smith, E., Smith, J., Smith, L., Smith, A., Smith, R., Smith, S., Smith, T., Smithers, H., Smolen, S., Smyth, C., Snel, T., Snipe, C., Soltanifar, S., Sonawane, N., Soundararaja, A., Spence, E., Spiliopoulos, M., Srivastava, C., Stacey, K., Stafford, H., Staines, N., Stead, R., Stevens, E., Stilwell, A., Stocks, G., Stokes, A., Stone, C., Straughan, B., Subbarathnam, V., Sudunagunta, S., Sultan, P., Suppiah, P., Surve, P., Sutherland, A., Swanton, R., Swarbrick, C., Swinson, A., Syrrakou, E., Tadbiri, S., Tamhane, P., Tamilselvan, P., Tan, A., Tanna, S., Tarft, H., Tarry, L., Taylor, I., Taylor, S., Tebbot, J., Theron, S., Thomas, M., Todd, S., Tolliday, H., Topham, C., Tovell, N., Traves, M., Trodd, D., Tufchi, A., Turley, K., Turnbull, M., Turnbull, C., Turner, O., Turner, W., Turney, S., Tyagi, E., Uncles, D., Unsworth, V., Vadnere, P., Varadan, R., Vasishta, V., Veal, A., Vedham, L., Venkaya, J., Verghese, M., Veronica, I., Vidanagamage, D., Vincent, R., Vyapury, V., Wain, H., Walbridge, F., Walker, E., Walsh, P., Walshe, E., Walters, M., Wan, Y., Wang, C., Wankhade, K., Waters, G., Watts, C., Webber, A., Wedgwood, T., Wee, M., Wellstead, S., White, A., Whitear, M., Whitefield, L., Wilkinson, S., Williams, L., Williams, R., Wilson, D., Wilson, S., Wimble, K., Winkley, E., Winslow, L., Winwright, P., Wloch, K., Wong, G., Wong, H., Man Wong, J., Wood, T., Wray, S., Wrench, I., Wu, J., Wynn, K., Yap, Y., Kuan Yeow, C., Young, E., Yusaf, A., Uz Zafar, S., Zeinali, D., Zhang, S., Zope, S., Zucco, L., Anwar, S., Blunt, N., Grover, V., Grailey, K., Gray, M., Highton, D., Hopkins, P., Kemp, H., Lo, Q., Martin, D., Morkane, C., O’Carroll, J., Oliver, C., Post, B., Visram, A., Wickham, A., General Paediatrics, Graduate School, Adult Psychiatry, and Pulmonology

Subjects
medicine.medical_specialty, medicine.medical_treatment, Population, 03 medical and health sciences, 0302 clinical medicine, 030202 anesthesiology, medicine, Caesarean section, General anaesthesia, general anaesthesia, 030212 general & internal medicine, Rocuronium, General anaesthetic, education, Neuromuscular Blockade, education.field_of_study, airway management, obstetrics, business.industry, Tracheal intubation, Surgery, Anesthesiology and Pain Medicine, caesarean section, Airway management, business, medicine.drug
Abstract

There are no current descriptions of general anaesthesia characteristics for obstetric surgery, despite recent changes to patient baseline characteristics and airway management guidelines. This analysis of data from the direct reporting of awareness in maternity patients' (DREAMY) study of accidental awareness during obstetric anaesthesia aimed to describe practice for obstetric general anaesthesia in England and compare with earlier surveys and best-practice recommendations. Consenting patients who received general anaesthesia for obstetric surgery in 72 hospitals from May 2017 to August 2018 were included. Baseline characteristics, airway management, anaesthetic techniques and major complications were collected. Descriptive analysis, binary logistic regression modelling and comparisons with earlier data were conducted. Data were collected from 3117 procedures, including 2554 (81.9%) caesarean deliveries. Thiopental was the induction drug in 1649 (52.9%) patients, compared with propofol in 1419 (45.5%). Suxamethonium was the neuromuscular blocking drug for tracheal intubation in 2631 (86.1%), compared with rocuronium in 367 (11.8%). Difficult tracheal intubation was reported in 1 in 19 (95%CI 1 in 16-22) and failed intubation in 1 in 312 (95%CI 1 in 169-667). Obese patients were over-represented compared with national baselines and associated with difficult, but not failed intubation. There was more evidence of change in practice for induction drugs (increased use of propofol) than neuromuscular blocking drugs (suxamethonium remains the most popular). There was evidence of improvement in practice, with increased monitoring and reversal of neuromuscular blockade (although this remains suboptimal). Despite a high risk of difficult intubation in this population, videolaryngoscopy was rarely used (1.9%).

Published
2020

7. Chronic pain in critical care survivors

Author

Kemp, H, Laycock, H, Costello, A, and Brett, S

Subjects
Anesthesiology, 1103 Clinical Sciences
Abstract

Chronic pain is an important problem following critical care admission. Estimates of prevalence of chronic pain in the year following discharge range from 14-77% depending on the type of cohort, the tool used to measure pain and the time point when pain was assessed. The majority of data available comefrom studies using health-related quality of life tools,although some have included pain-specific tools. Nociceptive, neuropathic and nociplastic pain can occur in critical caresurvivors butlimited information about aetiology, body site and temporal trajectory of pain is currently available. Older age, pre-existing pain andmedicalco-morbidity have been associated with pain after critical careadmission. No trials were identified of interventions to target chronic pain in survivors specifically. Larger studies, using pain-specific tools, over an extended follow up period are required to confirm prevalence, identify risk factors, explore anyassociation between acute and chronic pain in this setting, determine underlying pathological mechanisms and inform the development of future analgesic interventions.

Published
2019

8. Adoption of Lung Protective ventilation IN patients undergoing Emergency laparotomy: the ALPINE study. A prospective multicentre observational study

Author

Watson, X., primary, Chereshneva, M., additional, Odor, P.M., additional, Chis Ster, I., additional, Cecconi, M., additional, Johnston, C., additional, Huddart, S., additional, Woods, J., additional, Hadi, N., additional, Ali, S., additional, Thorning, G., additional, Gill, P., additional, Boomers, O., additional, Rope, T., additional, Bartlett, R., additional, Kuttler, A., additional, O'Carroll-Kuehn, B., additional, Dickinson, M., additional, Lyness, C., additional, Jha, R., additional, Patel, S., additional, Raj, A., additional, Tanqueray, T., additional, Cox, M., additional, Khader, A., additional, Vashisht, S., additional, Liyanage, S., additional, Ahmed, K., additional, Whitehead, J., additional, Patel, N., additional, Liu, S., additional, Patel, C., additional, Hayward, L., additional, Leonard, S., additional, Hare, S., additional, Saha, R., additional, de Bois, J., additional, Winterbottom, T., additional, Choo, Y., additional, Oliver, C.M., additional, Timbrell, D., additional, Sinnott, M., additional, Yip, E., additional, Trask, N., additional, Sothisrihar, S., additional, Shaw, M., additional, Thorat, P., additional, Shah, D., additional, Leir, S., additional, Farag, M., additional, Duffen, A., additional, McCretton, T., additional, Wojcikiewicz, T., additional, King, C., additional, Pennington, J., additional, Patel, M., additional, Kok, W., additional, Gunarathna, D., additional, Carter, L., additional, Spence, E., additional, Chambers, K., additional, Cervi, E., additional, Cummins, J., additional, Shah, N., additional, Eeles, A., additional, Chu, A., additional, Webb, C., additional, Nolan, L., additional, McHugh, B., additional, Walls, A., additional, Lakhani, R., additional, Matthews, S., additional, Hussein, Z., additional, Wang, S., additional, Weisskopf, R., additional, Talbot, H., additional, Verney, C., additional, Nurmi, E., additional, Henderson, K., additional, Beesley, O.R., additional, Hunter, J., additional, Nicholls, L., additional, Robles, A., additional, Lee, S., additional, Hawkins, R., additional, Patel, K., additional, Kwok, A., additional, Han, J., additional, Allana, A., additional, Kestner, S., additional, Roopra, A., additional, Edwards, L., additional, O'Dell, T., additional, Selby, J., additional, Bickmore, E., additional, Remeta, P., additional, Karsten, E., additional, Daum, P., additional, Loughnan, A., additional, Heggarty, A., additional, Bowes, H., additional, Gunaratna, D., additional, Cronin, J., additional, Post, B., additional, Blunt, N., additional, Gilbert-Kawai, E., additional, Gray, M., additional, Highton, D., additional, Finlay, C., additional, Clancy, O., additional, Bampoe, S., additional, O'Carroll, J., additional, Wickham, A., additional, Wordsworth, H., additional, Williams, F., additional, Hackney, J., additional, Marsh, V., additional, Davies, O., additional, Bird, R., additional, Patel, R., additional, Philips, S., additional, Laycock, H., additional, Morkane, C., additional, Grailey, K., additional, El-Boghdadly, K., additional, and Hansen, T.P., additional

Published
2018
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12. Acute Lung Injury and Acute Respiratory Distress Syndrome : A review article

Author

Laycock, H and Raja, A

Abstract

Acute lung injury is a syndrome with a diagnostic criteria base on hypoxaemia and a classical radiological appearance, with acute respiratory distress syndrome at the severe end of the disease spectrum. Its incidence is common, it is likely to exist outside the intensive care setting and therefore is a condition relevant to all clinicians. Genetically predisposed individuals are subject to environmental triggers which can be intra or extrapulmonary in nature. An inflammatory response causes damage to alveolar epithelial cells and vasculature, impairing gas exchange and can lead to multiple organ failure. Management centres around supportive care and treating the cause, but evidence supports use of low tidal volume ventilatory settings and conservative intravenous fluid strategies. Long term outcomes are related to neuromuscular, cognitive and psychological issues rather than pulmonary, and rehabilitation during recovery needs to focus on this.

Published
2010

13. PAIN ASSESSMENT IN INTENSIVE CARE: WHO PUTS PEN TO PAPER?

Author

Laycock, H, Wordsworth, H, and Pan-London Peri-operative Research and Audit Network (PLAN) and South East Anaesthetic Research CHain (SEARCH)

Subjects
medicine.medical_specialty, business.industry, Critically ill, Analgesic, Critical Care and Intensive Care Medicine, Documentation, Patient satisfaction, Pain assessment, Intensive care, Critical care nursing, Poster Presentation, medicine, Intensive care medicine, business, Pan-London Peri-operative Research and Audit Network (PLAN) and South East Anaesthetic Research CHain (SEARCH)
Abstract

Pain is common in intensive care units (ICUs)[1]. Regular pain assessment can improve patient satisfaction and clinical outcomes. It is commonly performed by nurses [2], yet physician-led assessment can improve analgesic management. Using pain documentation as a surrogate for assessment, a review showed physiological parameters i.e. cardiovascular assessment, were more frequently documented by doctors than pain in critically ill patients [3].

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19. Classification of painful or painless diabetic peripheral neuropathy and identification of the most powerful predictors using machine learning models in large cross-sectional cohorts.

Author

Baskozos G, Themistocleous AC, Hebert HL, Pascal MMV, John J, Callaghan BC, Laycock H, Granovsky Y, Crombez G, Yarnitsky D, Rice ASC, Smith BH, and Bennett DLH

Subjects
Humans, Bayes Theorem, Cross-Sectional Studies, Glycated Hemoglobin, Machine Learning, Pain, Quality of Life, Diabetes Mellitus, Diabetic Neuropathies diagnosis, Diabetic Neuropathies epidemiology
Abstract

Background: To improve the treatment of painful Diabetic Peripheral Neuropathy (DPN) and associated co-morbidities, a better understanding of the pathophysiology and risk factors for painful DPN is required. Using harmonised cohorts (N = 1230) we have built models that classify painful versus painless DPN using quality of life (EQ5D), lifestyle (smoking, alcohol consumption), demographics (age, gender), personality and psychology traits (anxiety, depression, personality traits), biochemical (HbA1c) and clinical variables (BMI, hospital stay and trauma at young age) as predictors., Methods: The Random Forest, Adaptive Regression Splines and Naive Bayes machine learning models were trained for classifying painful/painless DPN. Their performance was estimated using cross-validation in large cross-sectional cohorts (N = 935) and externally validated in a large population-based cohort (N = 295). Variables were ranked for importance using model specific metrics and marginal effects of predictors were aggregated and assessed at the global level. Model selection was carried out using the Mathews Correlation Coefficient (MCC) and model performance was quantified in the validation set using MCC, the area under the precision/recall curve (AUPRC) and accuracy., Results: Random Forest (MCC = 0.28, AUPRC = 0.76) and Adaptive Regression Splines (MCC = 0.29, AUPRC = 0.77) were the best performing models and showed the smallest reduction in performance between the training and validation dataset. EQ5D index, the 10-item personality dimensions, HbA1c, Depression and Anxiety t-scores, age and Body Mass Index were consistently amongst the most powerful predictors in classifying painful vs painless DPN., Conclusions: Machine learning models trained on large cross-sectional cohorts were able to accurately classify painful or painless DPN on an independent population-based dataset. Painful DPN is associated with more depression, anxiety and certain personality traits. It is also associated with poorer self-reported quality of life, younger age, poor glucose control and high Body Mass Index (BMI). The models showed good performance in realistic conditions in the presence of missing values and noisy datasets. These models can be used either in the clinical context to assist patient stratification based on the risk of painful DPN or return broad risk categories based on user input. Model's performance and calibration suggest that in both cases they could potentially improve diagnosis and outcomes by changing modifiable factors like BMI and HbA1c control and institute earlier preventive or supportive measures like psychological interventions., (© 2022. The Author(s).)

Published
2022
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20. The use of high dose topical capsaicin in the management of peripheral neuropathy: narrative review and local experience.

Author

Thomas SE and Laycock H

Abstract

Capsaicin, derived from the chilli pepper plant, is available in high concentration (8%) patches to provide topical therapy for neuropathic pain. Its analgesic effects relate to defunctionalisation and nerve terminal retraction of predominantly C fibres in the dermis and epidermis. Systematic reviews and meta-analysis support its use for the management of post-herpetic neuralgia and HIV neuropathy with some evidence for use in painful peripheral diabetic neuropathy. The article concludes with advice on the practicalities of running a topical 8% capsaicin clinic for peripheral neuropathic pain., Competing Interests: Conflict of interest: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Dr H.L. is an editor of the journal Anaesthesia and the trainee representative for the Faculty of Pain Medicine. S.E.T. has acted as a paid consultant for Grunenthal Ltd., (© The British Pain Society 2020.)

Published
2020
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21. Leptin and fractalkine: novel subcutaneous cytokines in burn injury.

Author

Friston D, Junttila S, Lemes JBP, Laycock H, Torres-Perez JV, Want E, Gyenesei A, and Nagy I

Subjects
Animals, Burns genetics, Burns pathology, Gene Expression Regulation, Janus Kinases metabolism, Male, Protein Interaction Maps, Rats, Sprague-Dawley, STAT Transcription Factors metabolism, Signal Transduction, Skin pathology, Burns metabolism, Chemokine CX3CL1 metabolism, Leptin metabolism
Abstract

Burn injury is a pathology underpinned by progressive and aberrant inflammation. It is a major clinical challenge to survival and quality of life. Although the complex local and disseminating pathological processes of a burn injury ultimately stem from local tissue damage, to date relatively few studies have attempted to characterise the local inflammatory mediator profile. Here, cytokine content and associated transcriptional changes were measured in rat skin for three hours immediately following induction of a scald-type (60°C, 2 min) burn injury model. Leptin ( P =0.0002) and fractalkine ( P =0.0478) concentrations were significantly elevated post-burn above pre-burn and control site values, coinciding with the development of burn site oedema and differential expression of leptin mRNA ( P =0.0004). Further, gene sequencing enrichment analysis indicated cytokine-cytokine receptor interaction ( P =1.45×10 -6 ). Subsequent behavioural studies demonstrated that, following subcutaneous injection into the dorsum of the paw, both leptin and fractalkine induced mechanical allodynia, heat hyperalgesia and the recruitment of macrophages. This is the first report of leptin elevation specifically at the burn site, and the first report of fractalkine elevation in any tissue post-burn which, together with the functional findings, calls for exploration of the influence of these cytokines on pain, inflammation and burn wound progression. In addition, targeting these signalling molecules represents a therapeutic potential as early formative mediators of these pathological processes., Competing Interests: Competing interestsH.L. is an editor at the Journal of Anaesthesia. Other authors declare no competing or financial interests., (© 2020. Published by The Company of Biologists Ltd.)

Published
2020
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22. Chronic pain in critical care survivors: a narrative review.

Author

Kemp HI, Laycock H, Costello A, and Brett SJ

Subjects
Chronic Pain diagnosis, Humans, Chronic Pain physiopathology, Chronic Pain therapy, Critical Care, Survivors
Abstract

Chronic pain is an important problem after critical care admission. Estimates of the prevalence of chronic pain in the year after discharge range from 14% to 77% depending on the type of cohort, the tool used to measure pain, and the time point when pain was assessed. The majority of data available come from studies using health-related quality of life tools, although some have included pain-specific tools. Nociceptive, neuropathic, and nociplastic pain can occur in critical care survivors, but limited information about the aetiology, body site, and temporal trajectory of pain is currently available. Older age, pre-existing pain, and medical co-morbidity have been associated with pain after critical care admission. No trials were identified of interventions to target chronic pain in survivors specifically. Larger studies, using pain-specific tools, over an extended follow-up period are required to confirm the prevalence, identify risk factors, explore any association between acute and chronic pain in this setting, determine the underlying pathological mechanisms, and inform the development of future analgesic interventions., (Copyright © 2019 British Journal of Anaesthesia. All rights reserved.)

Published
2019
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23. Chronic Pain and Chronic Opioid Use After Intensive Care Discharge - Is It Time to Change Practice?

Author

Stamenkovic DM, Laycock H, Karanikolas M, Ladjevic NG, Neskovic V, and Bantel C

Abstract

Almost half of patients treated on intensive care unit (ICU) experience moderate to severe pain. Managing pain in the critically ill patient is challenging, as their pain is complex with multiple causes. Pharmacological treatment often focuses on opioids, and over a prolonged admission this can represent high cumulative doses which risk opioid dependence at discharge. Despite analgesia the incidence of chronic pain after treatment on ICU is high ranging from 33-73%. Measures need to be taken to prevent the transition from acute to chronic pain, whilst avoiding opioid overuse. This narrative review discusses preventive measures for the development of chronic pain in ICU patients. It considers a number of strategies that can be employed including non-opioid analgesics, regional analgesia, and non-pharmacological methods. We reason that individualized pain management plans should become the cornerstone for critically ill patients to facilitate physical and psychological well being after discharge from critical care and hospital.

Published
2019
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24. Lessons learnt from establishing a high dose opioid review clinic for people living with HIV.

Author

Laycock H, Crawford V, Rice AS, and Cox S

Subjects
Adult, Chronic Pain etiology, Female, Humans, Male, Middle Aged, Analgesics, Opioid administration & dosage, Chronic Pain drug therapy, Drug Prescriptions standards, HIV Infections complications
Abstract

People living with HIV represent a unique aging population, living with a chronic condition associated with significant pain. A number take high dose, long-term opioids to manage moderate to severe chronic pain, presenting specific risks. This article highlights the size and impact of this problem and outlines the service objectives and set up of a specialist clinic to manage people living with HIV on high dose opioids, alongside its successes and learning points.

Published
2019
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