797 results on '"Cockburn, A."'
Search Results
2. Valve-in-Valve Transcatheter Aortic Valve Implantation for the Failing Surgical Perceval Bioprosthesis
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David Hildick-Smith, Michael Michail, Stanislav Hadjivassilev, Tariq Suleiman, Sandeep Arunothayaraj, Kristoffer Vincent Tanseco, and James Cockburn
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medicine.medical_specialty ,Transcatheter aortic ,business.industry ,medicine.medical_treatment ,Hemodynamics ,General Medicine ,Regurgitation (circulation) ,medicine.disease ,Prosthesis ,Valve in valve ,Surgery ,Stenosis ,Aortic valve replacement ,Heart team ,medicine ,Cardiology and Cardiovascular Medicine ,business - Abstract
Introduction The Perceval Valve has been increasingly used in Surgical Aortic Valve Replacement (SAVR) recently due to ease of implantation. However, we have seen some cases of relatively early haemodynamic failure of the Perceval valve and these patients may then present for valve-in-valve transcatheter aortic valve implantation (ViV-TAVI). Experience of ViV-TAVI in the Perceval valve is limited. Methods We report our experience of VIV-TAVI in four cases of early-failing Perceval valves, two with stenosis and two with regurgitation. We also review the literature with regard to ViV-TAVI for this indication. Results Four patients aged between 66 and 78 years presented with Perceval valve dysfunction an average of 4.6 years following SAVR. All cases underwent Heart Team discussion and a ViV-TAVI procedure was planned thereafter. Strategies to ensure crossing through the centre of the valve and not outside any portion of the frame were found to be essential. Three patients had self-expanding valves implanted and one had a balloon-expandable prosthesis. The average aortic valve area (AVA) improved from 0.8 cm 2 pre-procedure to 1.5 cm2 post-procedure*. The mean gradient (MG) improved from 35.5 mmHg (range 19.7–53 mmHg) pre-procedure to 14.8 mmHg (range 7–30 mmHg) post-procedure. In one patient a MG of 30 mmHg persisted following valve deployment. There were no significant peri-procedural complications. Conclusions ViV-TAVI is a useful option for failed Perceval prostheses and appears safe and effective in this small series. Crossing inside the whole frame of the Perceval valve is essential.
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- 2022
3. Severity of Severe Acute Respiratory System Coronavirus 2 (SARS-CoV-2) Alpha Variant (B.1.1.7) in England
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Daniel Grint, Stephen J. W. Evans, Kevin Wing, John Parry, David M. Evans, Emily Nightingale, Ben Goldacre, John Tazare, Christopher M. Bates, Elizabeth Williamson, Frank Hester, Hamish Gibbs, Christopher T Rentsch, Simon Davy, Alex J Walker, Nicholas J DeVito, Anna Schultze, George Hickman, Amir Mehrkar, Helen Mcdonald, Sam Harper, Ian J. Douglas, Krishnan Bhaskaran, Richard Croker, Rohini Mathur, Catherine F Houlihan, Angel Y S Wong, Liam Smeeth, Caroline E Morton, Laurie A. Tomlinson, William J Hulme, Rosalind M Eggo, Brian MacKenna, Sebastian Bacon, Helen J Curtis, Peter Ingelsby, and Jonathan Cockburn
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Microbiology (medical) ,medicine.medical_specialty ,business.industry ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Incidence (epidemiology) ,Alpha (ethology) ,Disease ,Confidence interval ,Virus ,Infectious Diseases ,Increased risk ,Internal medicine ,Cox proportional hazards regression ,medicine ,business - Abstract
Background The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) alpha variant (B.1.1.7) is associated with higher transmissibility than wild-type virus, becoming the dominant variant in England by January 2021. We aimed to describe the severity of the alpha variant in terms of the pathway of disease from testing positive to hospital admission and death. Methods With the approval of NHS England, we linked individual-level data from primary care with SARS-CoV-2 community testing, hospital admission, and Office for National Statistics all-cause death data. We used testing data with S-gene target failure as a proxy for distinguishing alpha and wild-type cases, and stratified Cox proportional hazards regression to compare the relative severity of alpha cases with wild-type diagnosed from 16 November 2020 to 11 January 2021. Results Using data from 185 234 people who tested positive for SARS-CoV-2 in the community (alpha = 93 153; wild-type = 92 081), in fully adjusted analysis accounting for individual-level demographics and comorbidities as well as regional variation in infection incidence, we found alpha associated with 73% higher hazards of all-cause death (adjusted hazard ratio [aHR]: 1.73; 95% confidence interval [CI]: 1.41–2.13; P Conclusions The SARS-CoV-2 alpha variant is associated with an increased risk of both hospitalization and mortality than wild-type virus.
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- 2021
4. Radioguided Surgery for Gastroenteropancreatic Neuroendocrine Tumours: a Systematic Literature Review
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Zaher Toumi, Katrina Clair Cockburn, Alison Mackie, and Peter Julyan
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Radioisotope ,medicine.medical_specialty ,English language ,Review Article ,Stomach Neoplasms ,Intestinal Neoplasms ,medicine ,Humans ,Gastrointestinal tract ,Gastrinoma ,Diagnostic techniques ,Lesion detection ,business.industry ,Gastroenterology ,Radioguided Surgery ,medicine.disease ,Pancreatic Neoplasms ,Neuroendocrine Tumors ,medicine.anatomical_structure ,Systematic review ,Surgery, Computer-Assisted ,Neuroendocrine tumours/surgery ,Radiopharmaceutical ,Surgery ,Radiology ,Pancreas ,business - Abstract
Background Radioguided surgery (RGS) for gastroenteropancreatic neuroendocrine tumours (GEP-NETs) has been suggested as a way to improve intraoperative lesion detection. This systematic literature review of reports of the use of RGS for GEP-NETs was performed to determine if there is a benefit. Methods A literature search was conducted using Google Scholar and PubMed, and snowballing from any relevant literature. Full-text studies were included if they were published in the English language and reported outcomes of RGS on human subjects with GEP-NETs. Qualitative data synthesis was performed. Results Twenty-six papers including a total of 209 patients were included. The tracers used were predominantly indium-111 pentetreotide, gallium-68 DOTA-peptides, and technetium-99m EDDA/HYNIC-peptides. Heterogeneous protocols make comparisons difficult, but most papers reported a benefit from the use of RGS in tumours in the gastrointestinal tract; utility in localisation of pancreatic tumours was less clear. Time between tracer administration and operation varied: from 16 h to 8 days with indium-111, 0–24 h with technetium-99m, and 19–193 min with gallium-68. Eight teams reported the thresholding technique used for discrimination—four used a ratio, four statistical methods, and one looked at the sensitivity and specificity of different cut-offs. Six teams performed follow-up of 24 patients (three pancreas, eight gastrinoma, 13 gastrointestinal tract) for between 3 months and 3 years. Two patients relapsed (one pancreas, one gastrinoma) between 6 and 12 months post-surgery. Conclusions RGS appears to aid in localisation of gastrointestinal NETs, but the benefit is more equivocal in pancreatic NETs. Further work into outcomes is warranted.
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- 2021
5. Clinical coding of long COVID in English primary care: a federated analysis of 58 million patient records in situ using OpenSAFELY
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William J Hulme, Rosalind M Eggo, George Hickman, Ian J. Douglas, David M. Evans, Alex Eavis, Ben Goldacre, Angel Y S Wong, Chris Bates, Simon Davy, Laurie A. Tomlinson, John Tazare, Anna Schultze, Elizabeth A. Williamson, Nasreen Parkes, Richard Jarvis, John Parry, Krishnan Bhaskaran, Frank Hester, Helen Mcdonald, Liam Smeeth, Christopher T Rentsch, Rohini Mathur, Alex J Walker, Paul D. Griffiths, Amir Mehrkar, Stephen J. W. Evans, Richard Croker, Helen J Curtis, Caroline E Morton, Peter Inglesby, Jessica Morley, Tom Ward, Jonathan Cockburn, Sam Harper, Aaron Fowles, Kevin Wing, Brian MacKenna, Shaun O'Hanlon, Harriet Forbes, Sebastian Bacon, and Dima Avramov
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Male ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Population ,Coding (therapy) ,Primary care ,030204 cardiovascular system & hematology ,Cohort Studies ,03 medical and health sciences ,Post-Acute COVID-19 Syndrome ,0302 clinical medicine ,Electronic health record ,medicine ,Humans ,Letters ,030212 general & internal medicine ,long COVID ,education ,general practice ,education.field_of_study ,SARS-CoV-2 ,business.industry ,Research ,Clinical Coding ,COVID-19 ,Confidence interval ,primary health care ,electronic health records ,England ,Family medicine ,General practice ,Female ,Diagnosis code ,Family Practice ,business ,Demography ,Cohort study ,Coding (social sciences) - Abstract
BackgroundLong COVID describes new or persistent symptoms at least 4 weeks after onset of acute COVID-19. Clinical codes to describe this phenomenon were recently created.AimTo describe the use of long-COVID codes, and variation of use by general practice, demographic variables, and over time.Design and settingPopulation-based cohort study in English primary care.MethodWorking on behalf of NHS England, OpenSAFELY data were used encompassing 96% of the English population between 1 February 2020 and 25 May 2021. The proportion of people with a recorded code for long COVID was measured overall and by demographic factors, electronic health record software system (EMIS or TPP), and week.ResultsLong COVID was recorded for 23 273 people. Coding was unevenly distributed among practices, with 26.7% of practices having never used the codes. Regional variation ranged between 20.3 per 100 000 people for East of England (95% confidence interval [CI] = 19.3 to 21.4) and 55.6 per 100 000 people in London (95% CI = 54.1 to 57.1). Coding was higher among females (52.1, 95% CI = 51.3 to 52.9) than males (28.1, 95% CI = 27.5 to 28.7), and higher among practices using EMIS (53.7, 95% CI = 52.9 to 54.4) than those using TPP (20.9, 95% CI = 20.3 to 21.4).ConclusionCurrent recording of long COVID in primary care is very low, and variable between practices. This may reflect patients not presenting; clinicians and patients holding different diagnostic thresholds; or challenges with the design and communication of diagnostic codes. Increased awareness of diagnostic codes is recommended to facilitate research and planning of services, and also surveys with qualitative work to better evaluate clinicians’ understanding of the diagnosis.
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- 2021
6. Interferon-gamma release assays for latent tuberculosis infection screening in Canadian federal correctional facilities
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A Beckon, Courtney Heffernan, Rabia Ahmed, S Cockburn, A Agostinis, and Richard Long
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Male ,Pulmonary and Respiratory Medicine ,Canada ,medicine.medical_specialty ,Concordance ,Population ,Tuberculin ,Disease ,Logistic regression ,Latent Tuberculosis ,Internal medicine ,medicine ,Humans ,Interferon gamma ,education ,education.field_of_study ,Latent tuberculosis ,Tuberculin Test ,business.industry ,Correctional Facilities ,bacterial infections and mycoses ,medicine.disease ,Vaccination ,Infectious Diseases ,business ,Interferon-gamma Release Tests ,medicine.drug - Abstract
BACKGROUND: The correctional setting presents an opportunity for latent TB infection (LTBI) screening in an otherwise difficult to reach demographic. We evaluate factors associated with the fidelity of the tuberculin skin test (TST) and interferon-gamma release assay (IGRA), specifically the QuantiFERON®-TB Gold In-Tube assay (QFT-GIT), explain factors associated with discordance, and report LTBI treatment outcomes.METHODS: We describe the association between demographic and clinical variables, and predictors of concordance with IGRA using univariate logistic regression in a population of TST-positive inmates. We report outcomes among those offered LTBI treatment.RESULTS: We observed concordance between TST and QFT-GIT in 90 of 306 (29.4%) inmates. Persons with TST+/QFT-GIT+ results were less likely to be male (OR 3.94, 95% CI 1.73–8.97) or have a BCG vaccination history (OR 0.34, 95% CI 0.12–0.95), and more likely to be foreign-born (P < 0.001). Of the 108 inmates offered LTBI treatment, 65 (60.1%) accepted and 51 (78.0%) completed. TST/QFT-GIT discordance has not been associated with disease during follow-up.CONCLUSION: Our findings suggest that TST/QFT-GIT discordance in Canadian federal inmates is common; however, low-risk of disease progression in those with discordance suggests that a shift towards IGRA-based screening is warranted and feasible.
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- 2021
7. The European bifurcation club Left Main Coronary Stent study: a randomized comparison of stepwise provisional vs. systematic dual stenting strategies (EBC MAIN)
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Thomas Schmitz, Evgeny Kretov, David Hildick-Smith, Francesco Burzotta, Adrian Wlodarczak, Adrian P. Banning, James Cockburn, Mohaned Egred, Goran Stankovic, Philippe Brunel, Jens Flensted Lassen, Marc Silvestri, Yves Louvard, Miroslaw Ferenc, Olivier Darremont, Andreis Erglis, Manuel Pan, Thierry Lefèvre, Alaide Chieffo, Thomas Hovasse, and Marie-Claude Morice
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Male ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Coronary artery ,Coronary Angiography ,Revascularization ,03 medical and health sciences ,Percutaneous Coronary Intervention ,0302 clinical medicine ,Left coronary artery ,medicine.artery ,Coronary stent ,Humans ,Medicine ,030212 general & internal medicine ,Myocardial infarction ,Left main stem ,business.industry ,Surrogate endpoint ,Hazard ratio ,Stent ,Angina ,medicine.disease ,Surgery ,Stenosis ,Treatment Outcome ,Settore MED/11 - MALATTIE DELL'APPARATO CARDIOVASCOLARE ,Bifurcation ,Stents ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background Patients with non-left-main coronary bifurcation lesions are usually best treated with a stepwise provisional approach. However, patients with true left main stem bifurcation lesions have been shown in one dedicated randomized study to benefit from systematic dual stent implantation. Methods and results Four hundred and sixty-seven patients with true left main stem bifurcation lesions requiring intervention were recruited to the EBC MAIN study in 11 European countries. Patients were aged 71 ± 10 years; 77% were male. Patients were randomly allocated to a stepwise layered provisional strategy (n = 230) or a systematic dual stent approach (n = 237). The primary endpoint (a composite of death, myocardial infarction, and target lesion revascularization at 12 months) occurred in 14.7% of the stepwise provisional group vs. 17.7% of the systematic dual stent group (hazard ratio 0.8, 95% confidence interval 0.5–1.3; P = 0.34). Secondary endpoints were death (3.0% vs. 4.2%, P = 0.48), myocardial infarction (10.0% vs. 10.1%, P = 0.91), target lesion revascularization (6.1% vs. 9.3%, P = 0.16), and stent thrombosis (1.7% vs. 1.3%, P = 0.90), respectively. Procedure time, X-ray dose and consumables favoured the stepwise provisional approach. Symptomatic improvement was excellent and equal in each group. Conclusions Among patients with true bifurcation left main stem stenosis requiring intervention, fewer major adverse cardiac events occurred with a stepwise layered provisional approach than with planned dual stenting, although the difference was not statistically significant. The stepwise provisional strategy should remain the default for distal left main stem bifurcation intervention. Study registration http://clinicaltrials.gov NCT02497014.
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- 2021
8. Dual-task walking and automaticity after Stroke: Insights from a secondary analysis and imaging sub-study of a randomised controlled trial
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Johnny Collett, Daan Meester, Melanie K. Fleming, Joanna Dawes, Derick T Wade, Andy Meaney, Helen Dawes, Emad Al-Yahya, Heidi Johansen-Berg, Piergiorgio Salvan, Janet Cockburn, and Andrea Dennis
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Adult ,030506 rehabilitation ,medicine.medical_specialty ,medicine.medical_treatment ,Automaticity ,Physical Therapy, Sports Therapy and Rehabilitation ,Walking ,gait ,law.invention ,rehabilitation ,03 medical and health sciences ,0302 clinical medicine ,Physical medicine and rehabilitation ,Gait (human) ,Randomized controlled trial ,law ,Secondary analysis ,Dual task walking ,medicine ,Humans ,dual-task interference ,Stroke ,Rehabilitation ,business.industry ,Evaluative Studies ,medicine.disease ,Walking Speed ,Preferred walking speed ,Exercise Test ,functional MRI ,0305 other medical science ,business ,human activities ,030217 neurology & neurosurgery - Abstract
Objective: To test the extent to which initial walking speed influences dual-task performance after walking intervention, hypothesising that slow walking speed affects automatic gait control, limiting executive resource availability. Design: A secondary analysis of a trial of dual-task (DT) and single-task (ST) walking interventions comparing those with good (walking speed ⩾0.8 m s−1, n = 21) and limited (walking speed −1, n = 24) capacity at baseline. Setting: Community. Subjects: Adults six-months post stroke with walking impairment. Interventions: Twenty sessions of 30 minutes treadmill walking over 10 weeks with (DT) or without (ST) cognitive distraction. Good and limited groups were formed regardless of intervention received. Main measures: A two-minute walk with (DT) and without (ST) a cognitive distraction assessed walking. fNIRS measured prefrontal cortex activation during treadmill walking with (DT) and without (ST) Stroop and planning tasks and an fMRI sub-study used ankle-dorsiflexion to simulate walking. Results: ST walking improved in both groups (∆baseline: Good = 8.9 ± 13.4 m, limited = 5.3±8.9 m, Group × time = P Conclusion: In individual who walk slowly it may be difficult to improve dual-task walking ability. Registration: ISRCTN50586966
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- 2021
9. Amplatzer Post-Infarction Ventricular Septal Defect Closure via Retrograde Transarterial Access: Easier and Better
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Natalia Briceno, Thomas R. Keeble, James Cockburn, Andrew Hill, Gerald J. Clesham, Arionilson Gomes, Osama Alsanjari, and David Hildick-Smith
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medicine.medical_specialty ,Percutaneous ,business.industry ,Closure (topology) ,medicine.disease ,Post-infarction ventricular septal defect ,Internal medicine ,cardiovascular system ,medicine ,Cardiology ,cardiovascular diseases ,Myocardial infarction ,Cardiology and Cardiovascular Medicine ,business - Abstract
Percutaneous closure of postinfarction ventricular septal defect (PIVSD) after myocardial infarction is one of the most demanding interventional procedures. Patients are usually hemodynamically bri...
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- 2021
10. Looking Back to Move Forward: Canadian Occupational Therapy In Public Health, 1914–2019
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Michelle J. Lehman, Lynn Cockburn, and Kathryn E. Lewis
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Occupational therapy ,Canada ,History ,030506 rehabilitation ,medicine.medical_specialty ,030504 nursing ,Original Articles / Articles originaux ,Public health ,Collaborator ,Revendication des droits ,Advocacy ,Collaboration ,Histoire ,Health knowledge / attitudes / practice ,03 medical and health sciences ,Policy ,Occupational Therapy ,Nursing ,Political science ,medicine ,Humans ,Public Health ,Connaissances / attitudes / practiques en santé ,0305 other medical science ,Politique - Abstract
Background. Decades of literature demonstrate that occupational therapy is well-suited to collaborate with public health due to overlapping views of health. However, there has been little collaboration between these professions with few examinations of why they remain distinct. Purpose. This study examines historical events that have led to the present-day separation of occupational therapy and public health. Method. This narrative review and thematic analysis of the scholarly, archival, and grey literature was conducted to examine the development of both fields. Findings. Fifty texts were analyzed revealing four themes: the influence of structural and social forces; professional, societal, and institutional hindrances; potential for a shared vision; and next steps for integration. These themes highlight historical barriers to collaboration and provide evidence that occupational therapy could benefit public health. Implications. Collaboration between occupational therapy and public health has many potential benefits, however new approaches to bridge the divide are needed to advance collaboration.
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- 2021
11. Use of non-steroidal anti-inflammatory drugs and risk of death from COVID-19: an OpenSAFELY cohort analysis based on two cohorts
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Laurie A. Tomlinson, Chris Bates, Seb Bacon, Elizabeth A. Williamson, Amir Mehrkar, Krishnan Bhaskaran, Henry Drysdale, Richard Croker, Liam Smeeth, Angel Y S Wong, William J Hulme, Rosalind M Eggo, Jonathan Cockburn, Ben Goldacre, Stephen J. W. Evans, Caroline E Morton, Helen J Curtis, Peter Inglesby, Sam Harper, John Parry, Frank Hester, Anna Schultze, Helen Mcdonald, Christopher T Rentsch, Kevin Wing, Alex J Walker, Ian J. Douglas, Harriet Forbes, David M. Evans, Rohini Mathur, Brian MacKenna, and Jeremy P Brown
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Adult ,Male ,medicine.medical_specialty ,rheumatoid ,Immunology ,Population ,Arthritis ,030204 cardiovascular system & hematology ,Lower risk ,Drug Prescriptions ,State Medicine ,General Biochemistry, Genetics and Molecular Biology ,Arthritis, Rheumatoid ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Rheumatology ,Risk Factors ,Internal medicine ,Osteoarthritis ,Epidemiology ,medicine ,Humans ,Immunology and Allergy ,030212 general & internal medicine ,Medical prescription ,education ,Aged ,education.field_of_study ,SARS-CoV-2 ,Proportional hazards model ,business.industry ,Anti-Inflammatory Agents, Non-Steroidal ,COVID-19 ,Covid19 ,Middle Aged ,medicine.disease ,osteoarthritis ,England ,arthritis ,Rheumatoid arthritis ,Female ,epidemiology ,business ,Cohort study - Abstract
Objectives To assess the association between routinely prescribed non-steroidal anti-inflammatory drugs (NSAIDs) and deaths from COVID-19 using OpenSAFELY, a secure analytical platform.Methods We conducted two cohort studies from 1 March to 14 June 2020. Working on behalf of National Health Service England, we used routine clinical data in England linked to death data. In study 1, we identified people with an NSAID prescription in the last 3 years from the general population. In study 2, we identified people with rheumatoid arthritis/osteoarthritis. We defined exposure as current NSAID prescription within the 4 months before 1 March 2020. We used Cox regression to estimate HRs for COVID-19 related death in people currently prescribed NSAIDs, compared with those not currently prescribed NSAIDs, accounting for age, sex, comorbidities, other medications and geographical region.Results In study 1, we included 536 423 current NSAID users and 1 927 284 non-users in the general population. We observed no evidence of difference in risk of COVID-19 related death associated with current use (HR 0.96, 95% CI 0.80 to 1.14) in the multivariable-adjusted model. In study 2, we included 1 708 781 people with rheumatoid arthritis/osteoarthritis, of whom 175 495 (10%) were current NSAID users. In the multivariable-adjusted model, we observed a lower risk of COVID-19 related death (HR 0.78, 95% CI 0.64 to 0.94) associated with current use of NSAID versus non-use.Conclusions We found no evidence of a harmful effect of routinely prescribed NSAIDs on COVID-19 related deaths. Risks of COVID-19 do not need to influence decisions about the routine therapeutic use of NSAIDs.https://creativecommons.org/licenses/by/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.http://dx.doi.org/10.1136/annrheumdis-2020-219517
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- 2021
12. Prevalence of asymptomatic <scp>SARS‐CoV</scp> ‐2 infection in elective surgical patients in Australia: a prospective surveillance study
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Gary Lum, Nicholas Coatsworth, Ian A. Cockburn, Elizabeth E. Gardiner, Allen C. Cheng, Andrew Forbes, Graham J. Mann, Russell L. Gruen, and Paul S. Myles
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Adult ,Male ,medicine.medical_specialty ,Asymptomatic ,COVID-19 Serological Testing ,Special Article ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Pandemic ,Epidemiology ,Prevalence ,medicine ,Humans ,Infection control ,Seroprevalence ,Prospective Studies ,Elective surgery ,Prospective cohort study ,Aged ,Aged, 80 and over ,Reverse Transcriptase Polymerase Chain Reaction ,business.industry ,Australia ,COVID-19 ,health policy ,General Medicine ,Middle Aged ,infection control ,Hospitalization ,elective surgery ,Elective Surgical Procedures ,COVID-19 Nucleic Acid Testing ,030220 oncology & carcinogenesis ,Carrier State ,Special Articles ,Female ,030211 gastroenterology & hepatology ,Surgery ,medicine.symptom ,business ,Elective Surgical Procedure ,COVID 19 - Abstract
Background The study aimed to estimate the prevalence of active or previous SARS‐CoV‐2 infection in asymptomatic adults admitted for elective surgery in Australian hospitals. This surveillance activity was established as part of the National Pandemic Health Intelligence Plan. Methods Participants (n = 3037) were recruited from 11 public and private hospitals in four states (NSW, Vic, SA and WA) between 2 June and 17 July 2020, with an overall 66% participation rate. Presence of SARS‐CoV‐2 viral RNA was assessed by Reverse Transcriptase ‐ Polymerase Chain Reaction (RT‐PCR) analysis of nasopharyngeal swabs taken after induction of anaesthesia. Presence of anti‐SARS‐CoV‐2 antibodies was assessed by analysis of serum collected at the same time using a novel dual‐antigen ELISA assay. Results No patient (0/3010) returned a positive RT‐PCR result. The Bayesian estimated prevalence of active infection of 0.02% (95% probability interval 0.00–0.11%), with the upper endpoint being 1 in 918. Positive serology (IgG) was observed in 15 of 2991 patients, with a strong positive in five of those individuals (Bayesian estimated seroprevalence 0.16%; 95% probability interval 0.00–0.47%). Conclusion These results confirm that during periods of low community prevalence of SARS‐CoV‐2 elective surgery patients without fever or respiratory symptoms had a very low prevalence of active SARS‐CoV‐2 infection., During the COVID 19 pandemic decisions regarding elective surgery cessation had significant impact on patients and practitioners. This study formed part of the National Pandemic Health Intelligence Plan, and finds that in areas where community transmission of SARS Cov‐2 is low, the risk of an asymptomatic patient undergoing elective surgery having SARS CoV‐2 is very low.
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- 2021
13. Transcatheter Aortic Valve Replacement With the LOTUS Edge System
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Thomas Pilgrim, Fiachra McHugh, Liesbeth Rosseel, Nicole Gilgen, Lars Søndergaard, Mark S. Spence, James Cockburn, Jubin Joseph, Jan Malte Sinning, Georg Nickenig, Marco Angelillis, Brian McGrath, Marek Grygier, Anna Sonia Petronio, Thijmen Hokken, Noman Ali, Daniel J. Blackman, Xavier Armario, Christian Frerker, Nicolas M. Van Mieghem, Nicolas Dumonteil, Darren Mylotte, Saib Khogali, Taishi Okuno, Serdar Farhan, Deepu Balakrishnan, Mohamed Abdel-Wahab, Gaetan Charbonnier, David Hildick-Smith, Rajesh K. Kharbanda, Didier Tchetche, Raban Jeger, Henrik Bjursten, James Cotton, Rui Campante Teles, and Ole De Backer
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medicine.medical_specialty ,Transcatheter aortic ,business.industry ,Incidence (epidemiology) ,medicine.medical_treatment ,Hemodynamics ,030204 cardiovascular system & hematology ,medicine.disease ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,Valve replacement ,Aortic valve stenosis ,Cohort ,Medicine ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,Adverse effect ,business ,Stroke - Abstract
Objectives The aim of this study was to evaluate the short-term safety and efficacy of transcatheter aortic valve replacement (TAVR) with the LOTUS Edge system. Background The LOTUS Edge system was commercially re-released in April 2019. The authors report the first European experience with this device. Methods A multicenter, single-arm, retrospective registry was initiated to evaluate short-term clinical outcomes. Included cases are the first experience with this device and new implantation technique in Europe. Clinical, echocardiographic, and computed tomographic data were analyzed. Endpoints were defined according to Valve Academic Research Consortium-2 and were site reported. Results Between April and November 2019, 286 consecutive patients undergoing TAVR with the LOTUS Edge system at 18 European centers were included. The mean age and Society of Thoracic Surgeons score were 81.2 ± 6.9 years and 5.2 ± 5.4%, respectively. Nearly one-half of all patients (47.9%) were considered to have complex anatomy. Thirty-day major adverse events included death (2.4% [n = 7]) and stroke (3.5% [n = 10]). After TAVR, the mean aortic valve area was 1.9 ± 0.9 cm2, and the mean transvalvular gradient was 11.9 ± 5.7 mm Hg. None or trace paravalvular leak (PVL) occurred in 84.4% and moderate PVL in 2.0%. There were no cases of severe PVL. New permanent pacemaker (PPM) implantation was required in 25.9% among all patients and 30.8% among PPM-naive patients. Conclusions Early experience with the LOTUS Edge system demonstrated satisfactory short-term safety and efficacy, favorable hemodynamic data, and very low rates of PVL in an anatomically complex cohort. New PPM implantation remained high. Further study will evaluate if increasing operator experience with the device and new implantation technique can reduce the incidence of PPM implantation.
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- 2021
14. Advanced adenomas may be a red flag for hereditary cancer syndromes
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Derek E. Smith, Heather Hampel, Fay Kastrinos, Swati G. Patel, Myles Cockburn, and Dexiang Gao
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Colorectal polyps ,medicine.medical_specialty ,Genetic testing ,Adenoma ,lcsh:QH426-470 ,medicine.medical_treatment ,lcsh:RC254-282 ,03 medical and health sciences ,0302 clinical medicine ,Germline mutation ,Internal medicine ,medicine ,Family history ,Genetics (clinical) ,medicine.diagnostic_test ,business.industry ,Research ,Cancer ,medicine.disease ,lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,Colorectal cancer ,Adenomas ,Lynch syndrome ,Polypectomy ,digestive system diseases ,lcsh:Genetics ,Oncology ,030220 oncology & carcinogenesis ,Colorectal Polyp ,030211 gastroenterology & hepatology ,business - Abstract
Background 16–25% of colorectal cancers (CRCs) diagnosed under age 50 are associated with hereditary cancer syndromes. Advanced adenomas are considered precursors to CRC. Although polyp removal prevents cancer, polypectomy does not change underlying genetic risk. Patients with isolated advanced polyps do not currently qualify for genetic testing unless they have a personal or family history of cancer. Aim Describe the prevalence of hereditary cancer syndromes among patients with advanced colorectal polyps. Methods We performed a single center retrospective review from 2015 to 2019 of patients who underwent germline genetic testing with indication for testing listed as colorectal polyp. We excluded patients with a personal history of CRC and those with ≥10 cumulative polyps. We collected patient demographics, polyp characteristics, family history data and genetic testing results from the medical record. Discrete variables were reported as frequency and percentages and continuous variables reported as mean with range. Results A total of 42 patients underwent genetic testing due to a personal history of advanced adenoma. 17% of patients met current genetic testing criteria. All patients underwent multi-gene panel testing. Two patients (4.8%) had a germline pathogenic mutation (one in MLH1 and one in CHEK2). The patient with an MLH1 mutation met current criteria for genetic testing (PREMM5 score 5.8), however the patient with the CHEK2 mutation did not. Both mutation carriers had a personal history of synchronous or metachronous advanced adenomas. 38% had a variant of uncertain significance. Conclusions 5% of patients with advanced adenomas in our retrospective series had a pathogenic germline mutation in a cancer predisposition gene. Though the patient with a pathogenic mutation in MLH1 met current clinical criteria for genetic testing, this was not recognized prior to referral; he was referred based on a personal history of advanced adenoma. Advanced polyps may be a red flag to identify patients who are at risk for hereditary cancer syndromes.
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- 2021
15. Percutaneous coronary intervention in octogenarians: A risk scoring system to predict 30‐day outcomes in the elderly
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Peter Ludman, David Hildick-Smith, Tiffany Kemp, Adam de Belder, Tim Kinnaird, Mamas A. Mamas, Nick Curzen, James Cockburn, Thomas E. Johnson, and Derek Robinson
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Acute coronary syndrome ,medicine.medical_specialty ,Octogenarians ,medicine.medical_treatment ,Population ,030204 cardiovascular system & hematology ,Logistic regression ,Ventricular Function, Left ,03 medical and health sciences ,Percutaneous Coronary Intervention ,0302 clinical medicine ,Risk Factors ,Internal medicine ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,030212 general & internal medicine ,education ,Aged ,Aged, 80 and over ,education.field_of_study ,Framingham Risk Score ,business.industry ,Unstable angina ,Percutaneous coronary intervention ,Stroke Volume ,General Medicine ,medicine.disease ,Treatment Outcome ,Conventional PCI ,Cohort ,Cardiology and Cardiovascular Medicine ,business - Abstract
OBJECTIVE Octogenarians are a high-risk group presenting for percutaneous coronary intervention (PCI). We aimed to create a 30-day mortality risk model for octogenarians presenting with both acute coronary syndrome (ACS) and chronic stable angina (CSA), using comprehensive mandatory UK data submissions to the UK National database. BACKGROUND Octogenarians are a high-risk group presenting for percutaneous coronary intervention, and decisions on whether or not to undertake intervention in this cohort can be challenging. The increasing number of octogenarians in the general population means they represent an important high-risk subgroup of patients. METHODS The data group consisted of 425,897 PCI procedures undertaken in the UK between 2008 and 2012 during which time there was comprehensive data linkage to mortality via the Office of National Statistics. Of these procedures, 44,221 (10.4%) were in patients aged ≥80. These comprised the model group. Logistic regression was used to create a predictive score which ultimately consisted of the following weightings: age 80-89 (n = 1); age > 90 (n = 2); unstable angina/non-ST-elevation myocardial infraction (NSTEMI) (n = 1); STEMI (n = 2); creatinine >200 mmol/L (n = 1); preprocedural ventilation (n = 1); left ventricular ejection fraction
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- 2020
16. Can non-invasive features including limited joint mobility be used to predict glucose control?
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Andrew Dhanoo, Sterling Ramroach, B. N. Cockburn, and Ajay Joshi
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medicine.medical_specialty ,Glucose control ,business.industry ,030209 endocrinology & metabolism ,General Medicine ,Type 2 diabetes ,Anthropometry ,medicine.disease ,Limited joint mobility ,Correlation ,03 medical and health sciences ,0302 clinical medicine ,Diabetes mellitus ,Internal medicine ,medicine ,Finger joint ,030212 general & internal medicine ,business ,Body mass index - Abstract
IntroductionLimited joint mobility (LJM) has been linked to deficient glycaemic control but is an understudied area of type 2 diabetes research. We set out to investigate the correlation between glycated haemoglobin (HbA1c) and the quantification of LJM of finger joints and non-invasive anthropometrics.MethodsBlood samples were taken from 170 participants at diabetes awareness drives in Trinidad. These participants were aged 59.61 ± 15.46, with a body mass index (BMI) of 29.73 ± 7.65 and HbA1c levels of 8.42 ± 2.22. There were 110 women and 60 men. Finger joint angles were recorded using a goniometer.ResultsThe K-Nearest Neighbour machine learning model was tested via 10-fold cross validation to differentiate good from poor glycaemic control (HbA1c ≤ 6.5%) using non-invasive features. There is some correlation between LJM and HbA1c. Our model scored a mean accuracy of 74.71% ± 1.81 (p=0.01) classifying the full dataset, 82.14% ± 2.20 (p=0.01) and 72.76% ± 1.41 (p=0.059) on the male/female subsets, respectively.DiscussionThe time since diagnosis, age and BMI were important features linked to glucose control. Our results support the notion that the first signs of LJM in the fingers occur in the first and fifth fingers as these particular angles were ranked highly in the list of most important features.ConclusionOur results show that LJM has some role to play in monitoring HbA1c, although not as important as more conventional anthropometrics. Our results support the idea that there should be a separate test for each sex.
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- 2020
17. Transcatheter Aortic Valve Implantation in Patients With Symptomatic Severe Aortic Regurgitation Using the Self-Expanding Acurate neo Valve
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David Kirtchuk, David Hildick-Smith, Timothy Williams, and James Cockburn
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medicine.medical_specialty ,Transcatheter aortic ,business.industry ,Team meeting ,General Medicine ,Regurgitation (circulation) ,030204 cardiovascular system & hematology ,medicine.disease ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,Aortic valve replacement ,Cardiac haemodynamics ,Medicine ,In patient ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,business - Abstract
Introduction This case series describes use of the Acurate Neo transcatheter aortic valve in patients with symptomatic severe native aortic regurgitation (AR). TAVI is not currently mentioned in either the European Society of Cardiology or American College of Cardiology guidance for management of severe symptomatic AR. There are no randomised trials comparing the outcomes of patients with pure severe AR treated with a TAVI valve vs surgical aortic valve replacement (sAVR). Method We present a case series of four patients with isolated AR treated using the Acurate Neo valve (Boston Scientific). Each case had been turned down for sAVR but deemed suitable for TAVI after review at the structural heart multi-disciplinary team meeting. TAVI implantation was successful in each case with reduction or resolution of their AR and improved cardiac haemodynamics. Results Three of the patients had significant symptomatic improvement, one had limited symptomatic improvement despite resolution of her AR on aortogram post TAVI. Conclusion Our case series adds to the growing literature that TAVI is a viable option for patients with pure AR but further long-term follow-up is required to assess the longevity and robustness of the valves.
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- 2020
18. Safety of hospital discharge before return of bowel function after elective colorectal surgery
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J Chapman, S, Blanco-Colino, R, Pérez-Ajates, S, O Anabitarte Bautista, Hodson, J, C Glasbey, J, Pata, F, Pellino, G, Sgrò, A, Soares, A, T van Elst, S Van Straten, Nepogodiev, D, Borakati, A, F Bath, M, H Yasin, I, Mclean, K, Arthur, T, Kovacevic, M, Delibegovic, S, Karamanliev, M, Swamad, M, Žebrák, R, Paramasivam, R, Martensen, A, M Larsen, H, Rädeker, L, E Frey, P, Kechagias, A, Venara, A, Duchalais, E, Ioannidis, A, Pasquali, S, Simioni, A, Farina, V, Podda, M, Lorenzon, L, Schaeff, V, Otto, A, Jakubauskas, M, R van Elst, T, Chu, M, Pvb, Fagan, I Wells, C, A Alagoa João, Juloski, J, Y El Kasmy El Kasmi, Espin-Basany, E, Clerc, D, Ciubotaru, C, Popescu, S, Yanishev, A, Lee, S, B Ozkan, B, A Yagız Sen, K Aktas, M, E Baki, B, Yüksek, B, Kamarajah, S, A Khaw, R, Mills, E, Goodson, R, Thakral, N, D Ablett, A, Adra, M, Kwek, I, M Khan, S, Quinn, P, R Manley, L, Badran, A, Ramjeeawon, A, Campbell, A, L Tan, H, S Rye, D, Rajaraman, N, G Norman, J, Vutipongsatorn, K, Solomou, G, Akhbari, M, Ali, A, Murray, V, M Baker, D, D Brandao, B, Stainer, B, Thavayogan, R, Jones, D, O Onafowokan, O, Gharooni, A, Dabab, N, Carlton-Carew, S, Kungwengwe, G, Gabriel, M, Sewart, E, C Shortland, T, Lawday, S, Pockney, P, Dawson, A, D Brumfitt, C, Stewart, P, B, Ng, K Luong, J, Ivanov, V, Borisova, A, Neykov, V, Kunčarová, K, Kološová, B, Antonova, T, Farkašová, M, L Harbjerg, J, Brandsborg, S, Brinck, S, D Kjaer, M, Mark-Christensen, A, P Unbehaun, K, Dalsgaard, P, D Lycke, K, Lenaoures, P, Brigand, C, Dumange, E, Gout, M, Moehwald, C, Prem, M, Alhalabi, O, Sliwinski, S, Krupp, J, Gablenz, E, Schmitzer, L, Kopp, A, Steinle, J, Gsenger, J, J Pohl, L, Riccardi, M, M Christodoulou, I, Konstantinidis, M, Machairas, N, Zoikas, A, Balalis, D, K Manatakis, D, L Aguilera, M, Marano, L, Fleres, F, Lovisetto, F, Sasia, D, Segalini, E, Pata, G, Lucchi, A, Sagnotta, A, Campagnaro, T, Petrelli, F, Gallo, G, Papandrea, M, Testa, V, Sinibaldi, G, F Di Candido, Colombo, F, Perrone, G, Aresu, S, Biancafarina, A, Canonico, G, Pagnanelli, M, Curletti, G, Bini, R, A de Manzoni Garberini, Impellizzeri, H, Cillara, N, Tutino, R, Picciariello, A, Coletta, D, Savino, G, Ferrara, F, Tamini, N, Talamo, G, Parini, D, Giamundo, P, A Lo Conte, Pagano, G, Ripetti, V, Pesce, A, Menduni, N, Giudicissi, R, Goldin, E, Rega, D, Belli, A, Andriola, V, Gordini, L, Foppa, C, Piccolo, G, Birindelli, A, Ferrari, C, Ballarini, Z, Tirelli, F, Milone, M, M De Rosa, S Pipitone Federico, N, Molteni, B, L Tilocca, P, Sancini, G, N Piozzi, G, Lauretta, A, Poillucci, G, Mulas, S, Simcikas, D, Portelli, L, Jwm van Wijnbergen, L Dinger, T, Sfh Ten Doesschate, Ashm van Dalen, D van den Bos, D, Hansmann, M, J Medina Feliz, Z Kuiper, S, Abdulrahman, Z, R Pruijssers, S, Farik, S, M Elliott, B, P Geneta, V, Wilton, S, Kandelaki, H, L Peng, S, Campbell, S, K Lim, Y, S Yassaie, S, Murray, M, Haran, C, Tan, J, Castro, J, Laranjeira, A, Catarino, S, Neves-Marques, C, G Correia, J, N Vieira, B, C Quintela, A, L Serra, M, Maciel, J, Cunha, M, J Aparício, D, Neves, J, Azevedo, J, Romano, M, Eiró, F, Romano, J, Monteiro, C, Claro, M, R Almeida, M, Peyroteo, M, D Machado, N, Capote, H, Ferreira, M, Sousa, X, Devesa, H, Cavadas, D, Guerreiro, I, Costa, M, Rosete, M, Salman, M, English, C, Mohammed, N, Litvin, A, V Ćuk, V, Mészárosová, K, Jaich, R, H De Lima, Brooks, S, Marx, M, M Nshalati Salvation, J García Cardo, Mora-Guzmán, I, J Sancho Muriel, U de Andres Olabarria, Muriel, P, C Jimenez Viñas, Alconchel, F, O Esteban Sinovas, C Fairén Oro, M López Otero, S Figueroa Jiménez, O Claramonte Bellmunt, J Martínez Caballero, Rubio-Pérez, I, M Aguilar-Martínez, M, J Segura-Sampedro, J, C Olmedo Moreno, D Negre Parra, M Estévez Diz, A, Martín-Balbuena, R, C Bustamante Recuenco, E Licardie Bolaños, R, Fernández, P, A Díaz Padillo, Forero-Torres, A, I Alberdi San Román, H Salvador Rosés, M Merayo Álvarez, P Villarejo Campos, C Lopes Moreira, C, P Uriol Peralta, M Serrano Navidad, Ripollés-Melchor, J, Garcea, A, H Gómez Facundo, P Troncoso Pereira, V Pérez Guarinos, C, Blaser, B, Piazza, G, Gagliardi, B, Serin, H, S Yurdaor, S, Arslan, E, Kopac, O, Uyanik, A, B Ozmen, B, Tiftik, E, Aksoy, B, Yalcinkaya, A, Ozoglu, F, D Kocer, M, Bilicen, G, N Cinar, E, Uslu, Ö, Kaya, Y, Demirci, K, Wong, J, Mmh, Farhan-Alanie, Suresh, G, Asif, A, J Finch, B, Bhahirathan, Y, Herron, J, Z Yi Tew, Obukofe, R, Russell, C, Suchett-Kay, I, Netke, T, Williams, L, Kisiel, A, Y Liu, F, Claireaux, H, James, P, Mondal, A, Kalderon, R, H Nadama, H, Al-Saraff, Z, Jph, Tam, Powell-Chandler, A, Wood, F, Rebecca, Gorgievska, Ragavoodoo, A, Thakrar, C, Rojoa, D, Palmer, C, Davidson, K, Giacci, L, Hale, J, W Gan, F, Makin-Taylor, R, Y Hey, C, Toh, C, M Findlay, J, Griffiths, N, Ganesananthan, S, Jasionowska, S, Poustie, M, Wong, C, Turner, T, Pyc, W, Sloper, W, Warner, C, Coey, J, Mason, D, Sait, S, Kowal, M, Owen, M, Saiyed, A, Ashworth, I, Akbari, K, Curran, M, Martin, P, Parker, D, Kwok, K, Lye, C, Ghaly, M, Sammour, T, Lewis, D, Mundasad, R, Wilkes, A, Ctercteko, G, Maslyankov, S, Dimov, R, Iliev, S, Dimitrov, D, Marek, F, Örhalmi, J, Skalický, P, Skalický, T, Chrz, K, Christensen, P, Worsøe, J, S Kristensen, E, J Emmertsen, K, S Loeve, U, L Mihaljevic, A, Herrle, F, M Konstantinidis, K, Korkolis, D, Karanikas, I, Vincenti, L, Anania, G, Borghi, F, Agresta, F, Maretto, I, Parisi, A, Bucci, L, G De Palma, Guglielmi, A, Cucinotta, E, F La Torre, Cianchi, F, Guerrieri, M, Trompetto, M, Persiani, R, Micheletto, G, Delrio, P, Cantafio, S, Ronconi, M, Pag, Bisagni, M De Prizio, Franceschi, A, Galleano, R, Cavallini, M, Brescia, A, D'Ambra, L, Benevento, A, Niolu, P, Calgaro, M, Colangelo, E, Grottola, T, F Altomare, D, Puleo, S, Salamone, G, Pietrabissa, A, Poggioli, G, Erdas, E, Ottonello, R, Tonini, V, Selvaggi, F, Sammarco, G, Ceccarelli, G, C De Nisco, Surgo, D, Taglietti, L, Ozolins, A, Sivinš, A, Poskus, T, Psaila, J, A Bemelman, W, J Graat, L, Langenhoff, B, Bpl, Wijnhoven, Ahw van de Ven, Poelman, M, Lps, Stassen, Slooter, G, Yiz, Acherman, Hoff, C, F Gerhards, M, Mwj, Stommel, J Hazebroek, E, Aaw van Geloven, A Schasfoort, R, L van Leeuwen, B, B Tuynman, J, Mwa van Tilburg, G Boerma, E, Sharma, P, Jenkins, B, P Bissett, I, Herd, A, Gordon, A, Vernon, D, Omundsen, M, J, Ly, Reddy, A, Bonnet, G, Harmston, C, Morales, M, Francisco, V, Costa, S, Manso, A, Amorim, E, Pereira, J, Cardoso, J, Ourô, S, Caratão, M, Nascimento, C, B Ribeiro da Silva, Taranu, V, Dias, R, Mendes, J, Allen, M, Silva, A, Carlos, S, Barbosa, E, Carneiro, C, Ramos, L, Lencastre, L, Martins, R, Silva-Vaz, P, F Ridgway, P, A McNamara, D, Cahill, R, Hogan, A, Larkin, J, R O'Connell, P, Negoi, I, Abelevich, A, M Ćuk, V, Vician, M, Ede, C, Sardiwalla, I, Mulira, S, Montwedi, D, Oyomno, M, Sabia, D, V Portugal Porras, Vigorita, V, G Sanz Ortega, García, J, A Espí Macías, F Blanco Antona, A Luján Mompeán, J, S Salvans Ruiz, Villarejo-Campos, P, M Romero Simó, Sánchez-Guillén, L, M Jiménez-Gómez, L, A Sánchez López, Golda, T, D Julià Bergkvist, Nevado, C, F Noguera Aguilar, J, B Ricardo Felipe, Septiem, J, A Rodríguez Sánchez, Cañete-Gómez, J, I Ruiz Montesinos, Millán-Scheiding, M, Prieto-Nieto, I, Frasson, M, D García Olmo, Hübner, M, Petermann, D, O Sauvain, M, Ozben, V, E Geçim, I, Disçi, E, Rencuzogullari, A, Kurt, A, Bisgin, T, Pehlivan, M, Isik, A, Onur, E, Leventoglu, S, C Haksal, M, S Erturk, M, Keskin, M, Guner, A, S Tutcu Sahin, S Ozbalci, G, Pergel, A, Albayrak, D, Bruce, D, Fearnhead, N, Arthur, J, Harron, M, Beattie, G, Titu, L, Saunders, M, Phillips, J, Dindyal, S, Cresswell, B, Gercek, Y, Lee, J, Linn, T, Faulkner, G, Lockwood, S, Rees, J, Charalabopoulos, A, Campbell, B, Kontovounisios, C, Amarnath, T, Johnson, M, Epanomeritakis, E, Vigs, S, Nastro, P, Gilliam, A, Smolarek, S, Wilson, T, Orbell, J, Mcintyre, R, Agarwal, T, Hainsworth, P, Patel, P, Vijay, J, Liu, B, P Dhruva Rao, Roxburgh, C, Vipond, M, Youssef, H, Thorn, C, Schizas, A, Denley, S, Bowley, D, Das, K, Cuming, T, Saha, A, Chung, L, Pitt, J, Davis, P, Jones, O, Taylor, M, Bhargava, A, Haji, A, Watson, N, Bloom, I, Singh, B, Norwood, M, Gurjar, S, Stylianides, N, Mirza, S, Evans, M, Williams, G, Patil, P, Hernon, J, Finch, G, Green, S, Chapple, K, Fafemi, O, Warusavitarne, J, Samee, A, Carden, C, Ong, L, Verma, K, Joseph, A, Rawat, N, Pinkney, T, Oke, O, Glen, P, Maxwell-Armstrong, C, Oliphant, R, Garner, J, J Moug, S, Middleton, S, N Lund, J, J Smart, N, Osborn, G, Moore, T, Raymond, T, H Knowles, C, S Hany, T, Clarke, R, Khera, G, Brady, R, Sellahewa, C, Mason, C, Torrance, A, Lasithiotakis, K, Knight, J, Pullybank, A, Ainsworth, P, Reid, F, Ramwell, A, Maslekar, S, George, R, Skull, A, Holtham, S, Muhammad, K, Lal, R, Varcada, M, M Smith, F, Howlader, M, Defriend, D, Kirk, S, Richards, T, Evans, C, M Borg, C, Telford, K, Sarfraz, N, Busby, K, Hollingshead, J, Speake, D, Pawa, N, West, D, Chadwick, M, Komolafe, O, Richardson, S, Thornton, M, Goede, A, Osborne, C, Bandyopadhyay, D, Foong, J, J Lee, Y, Liebenberg, P, Mijalkov, D, Wells, A, Bull, N, Ajmera, A, Warburton, T, Morgan, S, Mahmoud, A, Schachtel, M, Mikhail, B, Fomin, I, Mekaeil, B, Taylor, N, Stevenson, C, Drane, A, Pahalawatta, U, T Lai, L, Debiasio, A, Hjs, Jun, Hengpoonthana, R, M Mendis, D, M Robb, P, J Lee, H, Aab, Wyche, T Davis, L, Chrimes, A, Agarwal, A, Zhao, J, Williams, S, Jmsn, Jayalath, Khor, S, Muddasani, T, Childs, S, Ridgway, S, Nda, Blefari, Tam, H, Puchalski, N, Ngai, C, Mackenzie, J, Johnson, N, Holmes, M, Zuzek, R, Saluja, T, Gould, T, K Goh, Y, Selvaraj, T, Z Beh, Y, N Dudi-Venkata, N, Horne, D, L Borrow, J, Campbell, C, Cousins, G, Jackson, L, Maheepala, K, Zhao, S, Holden, E, Tutt, L, Thompson, B, Collins, H, Louie, F, Buckland, B, Smith, D, Chong, C, H Chua, T, Nayak, C, Redmond, J, R Tan, R, Gramlick, M, S Teh, J, Y Ng, S, Britten-Jones, P, R Mohd Rosli, Hdv, Pham, Jegathees, T, Smcj, Coulter-Nile, P Gosselink, M, L Wang, Y, Maciaszek, M, S Chrapko, P, Nair, A, Thirugnanasundralingam, V, Muir, K, Salibasic, M, Pavlov, V, Paycheva, T, Lyulenina, E, Kolev, N, Nguen, D, Mitkov, Y, Mitkov, E, Vladova, P, Dimitrov, V, Hussain, M, Gabarski, A, Ivanov, T, Yotsov, T, Ilieva, I, Akisheva, A, Shoshkova, M, Nawaz, E, Feradova, H, Mladenov, T, Jozaf, V, Klail, T, Pös, M, Adel, A, Sotona, O, Bartoš, M, Amjad, T, Malý, O, Berec, S, Hanušová, M, Hurný, M, Riško, J, Ludvik, M, Stercz, M, Treskoň, R, Pospíšil, M, Hlaváčová, L, Tomanová, D, Chodora, S, Houdek, O, Novický, R, Sobotková, K, Cha, S, K Šuta Kimle, Jirankova, K, Bujda, M, Paclík, A, Trap, A, Jürgens-Lahnstein, J, Storm, M, Damgaard, I, Olawi, F, Ehlern, F, Raos, M, P Kristensen, F, Bønnerup, K, Amiri, S, Enevoldsen, M, J Højgaard Pedersen, N Jepsen, B, K Hillgaard, T, B Erichsen, S, V Nielsen, C, P Madsen, C, Bjerke, J, D Skejø, C, R Aabling, R, S Sørensen, J, Turunen, A, Katunin, J, Niskakangas, M, Vignaud, T, Frey, S, Ricolleau, C, Chanut, F, Magnin, J, Seiboldt, T, Beck, L, Zamzow, K, Betge, F, Poncelet, A, Truant, M, Hauschild, H, Neugebauer, N, Schöning, L, S Cs Simon, Galata, C, Karampinis, I, Thäwel, T, M Seckler, A, Kerem, C, Durdevic, S, Antonakopoulos, F, Mathioulaki, A, Chrysoheris, P, G Athanasopoulos, P, Kalles, V, Spyrou, I, Barkolias, C, Paspala, A, Papaconstantinou, D, Spartalis, E, Arkadopoulos, N, Prodromidou, A, Garoufalia, Z, Mendez, D, Rosales, J, Flores, M, Garcia, M, Garcia, A, Noriega, Z, Torselli, D, Rodriguez, J, Lafranceschina, S, Artioli, E, Giaccari, S, Nevoso, V, Schimera, A, Marino, S, Geretto, P, Pellegrino, L, Borghi, B, Marano, A, Corino, C, Cannata, G, C Giuffrida, M, Landra, F, Ongaro, D, Baronio, G, Raimondo, S, Casiraghi, S, Salvadori, R, Finotti, E, Ciccioli, E, Galgano, A, Zuin, M, Bettella, A, Barina, A, Vendramin, E, Palano, G, Schiavone, D, A Di Cintio, Gemini, A, Trastulli, S, M De Luca, Desiderio, J, Gubbiotti, F, Cigognini, M, Zaffaroni, G, Maffioli, A, Colombo, S, Bondurri, A, Sampietro, G, Foschi, D, Manigrasso, M, Danzi, M, Amato, R, Anastasio, L, 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L., Mccusker, C., Hlukha, L., Pike, G., Kamel, F., Thakkar, R., Donaldson, C., Campos, M. S., Bradbury, M., Osunronbi, T., Tam, L. Y. C., Kaabneh, A. K., Lawther, J., Fisher, P., Tribedi, T., Moosa, A., Ramdin, A., Goble, M., Downs, E., Wheldon, L., Baggus, E., Mandal, A., Nayeem, A., Ahmed, S., Fradley, W., Wilson, C., Gallagher, S., Criswell, T., Ward, J., Mukkavilli, A., Stubbs, B., Fordyce, W., Suchdev, N., Lim, S. W., Sookramanien, S. R., Chan, A., Bointas, G., Paul, M., Ward, K. L., Bagnall, M., Pherwani, S. A., Wang, K., Mitchell, L., Heyworth, J., Ayyar, S., Polson, R., Mackenzie, E., Doyle, N., Habib, Z., Zardab, M., Sartaj, F., Farooq, H., Tabibi, M., Drury, D. J., James, S. J., Barnett, R., Cahya, E., Lou, G., Coyle, M., Homyer, K., Zhu, L. Y., Woods, M., Chang, J., O'Callaghan, H., Suchett-Kaye, I., Mihailidis, T. H., Alawattegama, H., Seite, E., Barrett, A., Riordan, E., Lam, W., Dowdeswell, M., Mulvenna, C., Awokoya, O., Gurowich, L., Dhera, K., Hayat, S., Tincknell, L., Spazzapan, M., Teeling, F., Sysum, K., Latter, J., Latter, M., Khan, S., Woodmass, M., Hayden, H., Ali, Y., Husain, S., Arnold, A., Pedersen, A. C., Cunha, P., Ahmed, M., Al Zawawi, S., Kudva, V., Theodoropoulou, K., Miscampbell, M., Robinson, A. V., Johnston, J., Dharni, A., Lamb, S., Westerman, T., Evans, E., Campbell, L., Gillespie, M., Cheong, C. M., Kulathevanayagam, K., Varghese, A., Ike, S. I., Chu, T. S. M., Baljer, B., Mogg, J. A. W., Rai, P., Claireaux, H. A., Williams, M., Smillie, R., Goetz, J., Appleby, E., Fadipe, T., Vaughan-Burleigh, S., Jovaisaite, A., Shah, S. M., Khalid, N., Gutmann, D., Davison, S., Alame, Y. J., Syed, L., Owen, W. J., Ahsan, S. D., Anthony-Uzoeto, U., Hall, C. M., Zheng, S., Wynter, K., James, C., Sapre, D., Ghosh, R., Baird, J., Cockburn, L., Blackwood, O., Simpson, W., Jeong, S., Bishop, S., Bate, R., Hobson, C., Adam, A. H., Redclift, C., Do, J., Adeleye, O., Poli, F., Batterham, A., Brown, S., Parekh, J. N., Clay, W., Pieri, K., Jackson, A., Saxena, A., Gurung, B., Oyebola, T., O'Brien, F., Djeugam, B., Gardezi, S., Ul-Hasan, S., Martin-Hernandez, M. P., Sisley, M., Modi, S., Antakia, R., Elbayouk, A., Soh, Y. J., Mather, J., Yusuf, Z., Al-Sarraf, Z., Naja, M., Rassool, S. B., Convill, J., Nikookam, Y., Warsame, A., Pace, C., Kiandee, M., Ridwan, R., Carey, C., Hirri, F., Mcmillan, M. J. A., Ling, J. J., Pendelbury, L., Kerimzade, K., Tang, A., Howard, E. O., Humayun, S., Wadsworth, O. J., Tan, K., Abdelhameed, F., Haglund, C., Radnaeva, I., Hu, N., Rambhatla, S., Waldron, D., Madahar, P., Malik, S., Meney, L. C., Ibrahim, I., Kang, C. K., Chiu, J. Z. J., Livie, V., Ibrahim, B., Khalil, M., Pooley, G., Shishkin, B., Docherty, J., Southgate, A., Coomes, A., Mcgee, F., Flanagan, S., Tan, Q. J., Anwar, H., Clough, R., Chrisp, B., Cassels, J., Cross, G. W. V., Mercer, L., Mercer, C., Refalo, A., Hadley, R., Mctighe, A., Farrow, F., Brodie, A., Davis, G., Shah, D. R., Bowers, C., Patel, S., Morice, O., Burzic, A., Cheung, J., Shashidhara, A., Theodoraki, G., Birk, J., Ong, A., Ng, M. P. E., Wong, R. T. W., Maese, S., Yeap, B., Iqbal, Z., Melaugh, T., Perchard, W., Scurr, T., Campbell, E., Kelk, L., Ghosh, A., Gibbins, A., Mala, D., Loizidou, A., Hall, O., Mecia, L., Hew, C., Varathan, K., Tong, L., Chandrasekar, B., Buchanan, E., O'Connell, M., Kwak, S. Y., Ong, E. H., Gardner, S., Lim, J., Maden, C., Illahi, M., Tan, Z. X., Edwards, S., Stahl, R., Stahl, J., Hickman, A., Collett, D., Goolam-Mahomed, Z., Allen, B., Atiyah, A., Ahmad, H., Jones, J., Mcgregor, O., Ogundiya, E., Boulbadaoui, A., Kirnon-Jackman, O., Lim, Q. X., Peckham, H., Yeoh, T., Yong, S. Q., Chen, J. Y., Siva, S., Sam, Z. H., Gilani, M., Goh, Y. N., Muthukumar, M. G., Phillips, S., Tjoakarfa, J., Giri, A., Suresan, S., Thomas, P., Johnson, T. A., Williams, R. I., Rashid, A., Kushairi, A., Rais, A., James, A., Bugelli, M., Chechelnitskaya, Y., Sandhu, N., Tandon, R., Gray, M., Kumar, A., Ciurleo, C., Nyamali, I., Hiremath, S., Sinha, S., Chowdhary, M., Bradley, E., Mctiernan, M., Macdonald, S., Sharkey, S., Mclaughlin, N., Amey, C., Kraria, L., Skan, O., Kind, C., Tupper, P., Van Rhee, C., Honeyman, S. I., Menon, G., Jegatheeswaran, L., Madhavan, A., Warne, M., Malcolm, F. L., Lessware, T., Wilkerson, H. T., Chatterjee-Woolman, S., Yoong, A., Ahmed, W. U. R., Longshaw, A., Flannery, O., Green, R., Leaning, M., Cragg, J., Sharriff, H., Doherty, C., Kwan, K. W. L., Sanders-Crook, L., Bhatia, S., Eames, S., Lewis, F., Kirupananthan, P., Boh, Z. Y., Dass, S., Soma, A., Newton, A., Hill, M., Shafiq, Y., Brkljac, M., Boyce, L., English, W. J., Lam, S., Chipeta, C., Jain, C., Garofalidou, T., Novotny, S. A., Locke, S., Bowman, C., Begaj, A., Murphy, C., Radcliffe, K., Chong, J. T., Jeffrey, E., Chaudhury, N., Rajendran, K., Akbar, Z., Walters, B., Kulendrarajah, B., Tran, N., Shrestha, S., Parmar, S., Gallagher, C., Hennessy, L., Pentti, E., Badhrinarayanan, S., Fung, A., Mansoor, M., Kenny, R., Kan, P., Lee, D. E., Khosla, S., Samake, M., Shaban, F., Aftab, R., Gough, M., Woodburn, B., Vayalapra, S., Mcmurrugh, K., Jimulia, D., Deol, S., Pike, S., Embury-Young, Y., Patel, M., Kilgallon, E., Keating, R., Walsh, A., Khan, H., Logue, G., Orekoya, M., Alasmar, M., Charalambides, M., Llavall, A. C., Williamson, E., Bharwada, Y., Zearmal, S., Evans, H., Panikkar, M., de la Cruz, G., Caplan, J., Ruparelia, A., Tanvir, T., Soare, C., Pang, Y. L., Trotter, J., Zaidi, A., Thakrar, V., Pulickal, P., Ahmed, H., Parnell, J., Lennock, S., Ford, V., Brignall, R., O'Neill, D., Hanna, R., Kane, R., Nicola, M., Rajput, K., Xiao, Y., Michael, S., Wright, E., Juniper, S., Thompson, E., Hoskyns, L., Kanitkar, A., Ross, C., Unsworth, A., Rshaidat, H., Demarre, K., Chiang, A., Bareh, A., van Dellen, J., Faqihinejad, C., Gadhvi, A., Grant, R., Lewsey, J., Morris, A., Martin, H., Mcclarty, C., Sanyal, S., Alsaif, A., Palkhi, A., Bhopal, S., Burford, C., Huq, T., Irwin, E., Matthews, L., Ngu, W. S., Hosfield, T., Muneeb, F., Page, O., Zeb, E., Al-Azzawi, A., Mcintosh, J., Vucicevic, A., Hughes, M., Brooks, L., Fanibi, B., Dixon, M., Njoku, P., Morris, D., Jobson, J., Chowdhury, H., Joseph, N., Zulkefley, N., Hunt, G., Christodoulou, T., Wright, O., Soman, S., Jamal, M., Beqiri, S., Borgas, P., Christie, S., Pereira, F., Browne, S., Yiu, J., Dworkin, A., Brayley, J., Palmer, A., Charalambos, M., Jones, C. S., Toner, S., Cowden, R., Lee, L., Nicol, P., Holman, O., Imtiaz, M., Albert, V., Leung, S. P., Erotocritou, M., Stroud, R., Wilkin, R., Thomson, W., Mackee, L., Kler, A., Reynolds, L., Mohamed, S. H., Majeed, Y., Fakim, B., Jones, A., Liversedge, G., Carrington, Z., Windebank, J., Izzarina, A., Akbani, U., Craven, J., Aldarragi, A., Harding, S., Millward, A., Bedford, M., Gopalan, V., Midgen, A., Khadka, P., Cheng, O., Taneja, S., Manobharath, N., Kok, J. Y., Lim, D. W. E., Buick, T., Boland, M., Piya, S., Devlin, R., Fairfield, C. J., George, R. J., Rahi, M., Zaman, S., Hajiev, S., Ross, T., Crisp, E., Thompson, C., Charalambous, A., Hollywood, J. L., Hammond, R. F. L., Matthews, J., Mendonca, V., Spinty, J., Khan, K., Cheng, J., Glynn, N., Muhammad, U., Khan, M., Anderson, L., Mccormack, K., Mak, J., Patrawala, S., Milinkovic, N., Schofield, R., Chauhan, M., Hartley, L., Hind, J., Nelson, L., Ratnasingham, D., Whitehead, T., Dimitriadis, S., Marshall, K., Flint, E. J., Horner, C., Heybourne, A., Morgan, H., Wickstone, C., Panagiotou, D., O'Connell, E., Dean, K., Iqbal, R., Walsh, L., Yu, N., Rana, N., Massie, E., Ng, J., Jung, M., Lee, Y. D., Harris, M., White, S., Boev, B., Tonchev, P., Prochazka, V., Risko, J., Skalicky, A., Ravn, S., Ojakaar, A., Dorr-Harim, C., Koutserimpas, C., Giraudo, G., Armellini, A., Ruzzenente, A., Mazzeo, C., De Padua, C., Luc, A. R., Maroli, A., Vitali, M., Gusai, G. P., Quattromani, R., Virgilio, E., Berti, S., Di Mola, F. F., Papagni, V., Tuminello, F., Vittori, L., Longheu, A., Loche, G. A., Braccio, B., De Luca, E., Resta, G., Ancans, G., Tamosiunas, A., Petrulionis, M., Abdulrahman, N., van de Pas, K. G. H., Thomas, G., Brandsma, A. M., Davids, J., Rottier, S. J., de Roy van Zuidewijn, D., Hawkins, R., Ong, H. I., Li, Y., Desmond, B., Winstanley, J., Martins, M., Americano, M., Frade, S., Senhorinho, R., Peixoto, R., Alves-Vale, C., Lamas, M., O'Connor, D. B., Hoo, M., Gopaul, A., Scanlon, K., O'Dwyer, N., Jovanovic, M., Panyko, A., Van Vuuren, S., Centeno, A., Bernado, I. R., Senorans, M. P. G., Amor, L. G., Ramirez, A. C., Abrisqueta, J., Gomez, M. E., Arroyo, A., Cerdan, C., Romeu, N. G., Enriquez-Navascues, J. M., Collado-Roura, F., Curchod, P., Gaspar, S., Imadalou, L., Mutlu, D., Akyol, C., Uygur, F. A., Eray, I. C., Biyiklioglu, O., Cetin, M. F., Isik, A. E., Karip, B., Dogan, H., Sarigul, L., Tunc, E., Aydin, T., Bodur, S., Karabulut, K., Francis, A. A., Al-hadithi, A., Lau, I. S. F., Smith, E., Mahapatra, S., Mcauliffe, O., Imam, L., Akram, B., Hossaini, S., Davies, R., Ko, M., Collins, J., Pandya, A., Reilly, S., Archer, J., Livie, J., Chaudhry, F. A., Ntakomyti, E., Diallo, R., Bylinski, T., Wright, J., Masiha, E., Tung, J., Shirazi, B., Neilson, A., Epton, S., Patel, N., Trussell, S., Couldrey, A., and Donnelly, C.
- Subjects
operative ,Male ,postoperative discharge ,Postoperative Complications ,0302 clinical medicine ,Colostomy ,CRITERIA ,Prospective Studies ,Bowel function ,Colectomy ,IMAGINE ,stoma ,intestines ,Proctectomy ,Ileostomy ,digestive, oral, and skin physiology ,patient discharge ,colorectal surgery, hospital discharge, bowel function ,RECOVERY ,Middle Aged ,adult ,colostomy ,elective surgical procedures ,female ,follow-up studies ,humans ,ileostomy ,ileus ,male ,middle aged ,multivariate analysis ,patient readmission ,patient safety ,postoperative complications ,prospective studies ,recovery of function ,colectomy ,proctectomy ,Patient Discharge ,Colorectal surgery ,ileus - - discharge - bowel function - elective - colorectal surgery ,Elective Surgical Procedures ,030220 oncology & carcinogenesis ,Female ,030211 gastroenterology & hepatology ,Patient Safety ,Cohort study ,safety ,Adult ,medicine.medical_specialty ,Ileus ,Patient Readmission ,defecation ,03 medical and health sciences ,medicine ,Hospital discharge ,Humans ,colorectal surgery ,colorectal resection ,Colorectal resection ,defecation, postoperative complications, colorectal surgery, intestines, patient discharge, patient readmission, safety, surgical procedures, operative, colorectal resection, ileus ,business.industry ,Recovery of Function ,Odds ratio ,medicine.disease ,digestive system diseases ,surgical procedures ,Surgery ,Multivariate Analysis ,Defecation ,business ,Follow-Up Studies - Abstract
Ileus is common after colorectal surgery and is associated with an increased risk of postoperative complications. Identifying features of normal bowel recovery and the appropriateness for hospital discharge is challenging. This study explored the safety of hospital discharge before the return of bowel function.A prospective, multicentre cohort study was undertaken across an international collaborative network. Adult patients undergoing elective colorectal resection between January and April 2018 were included. The main outcome of interest was readmission to hospital within 30 days of surgery. The impact of discharge timing according to the return of bowel function was explored using multivariable regression analysis. Other outcomes were postoperative complications within 30 days of surgery, measured using the Clavien-Dindo classification system.A total of 3288 patients were included in the analysis, of whom 301 (9·2 per cent) were discharged before the return of bowel function. The median duration of hospital stay for patients discharged before and after return of bowel function was 5 (i.q.r. 4-7) and 7 (6-8) days respectively (P 0·001). There were no significant differences in rates of readmission between these groups (6·6 versus 8·0 per cent; P = 0·499), and this remained the case after multivariable adjustment for baseline differences (odds ratio 0·90, 95 per cent c.i. 0·55 to 1·46; P = 0·659). Rates of postoperative complications were also similar in those discharged before versus after return of bowel function (minor: 34·7 versus 39·5 per cent; major 3·3 versus 3·4 per cent; P = 0·110).Discharge before return of bowel function after elective colorectal surgery appears to be safe in appropriately selected patients.El íleo es frecuente tras la cirugía colorrectal y se asocia con un aumento del riesgo de las complicaciones postoperatorias. Identificar las características de una recuperación normal del tránsito y la idoneidad para el alta hospitalaria es una tarea difícil. Este estudio examinó la seguridad del alta hospitalaria antes del restablecimiento de la función intestinal. MÉTODOS: Se llevó a cabo un estudio de cohortes prospectivo y multicéntrico a través de una red de colaboración internacional. Se incluyeron pacientes adultos sometidos a resección electiva colorrectal entre enero y abril 2018. El objetivo principal fue el reingreso hospitalario durante los 30 primeros días tras la intervención. Se utilizó un análisis de regresión multivariable para evaluar el impacto del momento del alta en función del restablecimiento de la función intestinal. El objetivo secundario fue las complicaciones postoperatorias en los primeros 30 días después de la cirugía, valoradas mediante el sistema de clasificación de Clavien-Dindo.Se incluyeron en el análisis 3.288 pacientes, de los cuales 301 (9,2%) fueron dados de alta antes del restablecimiento de la función intestinal. La mediana de la estancia hospitalaria de los pacientes dados de alta antes y después del restablecimiento de la función intestinal fue 5 (rango intercuartílico: 4-7) y 7 (6-8) días, respectivamente (P 0,001). No hubo diferencias significativas en las tasas de reingreso entre estos grupos (6,6% versus 8,0%; P = 0,499), y este resultado se mantuvo en el análisis multivariable tras el ajuste por diferencias basales (razón de opotunidades, odds ratio, OR 0,90; i.c. del 95% 0,55-1,46, P = 0,659). Las tasas de complicaciones postoperarorias fueron similares en aquellos dados de alta antes o después del restablecimiento de la función intestinal (complicaciones menores: 34,7% versus 39,5%; complicaciones mayores 3,3% versus 3,4%; P = 0,110). CONCLUSIÓN: Dar de alta antes del restablecimiento de la función intestinal tras cirugía colorrectal electiva parece ser seguro en pacientes debidamente seleccionados.
- Published
- 2020
19. Timing of nasogastric tube insertion and the risk of postoperative pneumonia: an international, prospective cohort study
- Author
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Glasbey J. C., Bibi S., Pata F., Ozkan B. B., Van Straten S., Hodson J., Chapman S. J., Blanco-Colino R., Pellino G., Sgro A., Soares A., van Elst T., Nepogodiev D., Borakati A., Bath M. F., Yasin I. H., Mclean K., Arthur T., Kovacevic M., Delibegovic S., Karamanliev M., Swamad M., Zebrak R., Paramasivam R., Martensen A., Larsen H. M., Radeker L., Frey P. E., Kechagias A., Venara A., Duchalais E., Ioannidis A., Pasquali S., Simioni A., Farina V., Podda M., Lorenzon L., ItSURG I., Schaeff V., Otto A., Jakubauskas M., van Elst T. R., Chu M., Fagan P. V. B., Wells C. I., Alagoa Joao A., Juloski J., Perez-Ajates S., Anabitarte Bautista O., El Kasmy Y., Espin-Basany E., Clerc D., Ciubotaru C., Popescu S., Yanishev A., Lee S., Yagiz Sen A., Aktas M. K., Baki B. E., Yuksek B., Kamarajah S., Khaw R. A., Mills E., Goodson R., Thakral N., Collaborative S., Ablett A. D., Adra M., Kwek I., Khan S. M., Quinn P., Manley L. R., Badran A., Ramjeeawon A., Campbell A., Tan H. L., Rye D. S., Rajaraman N., Norman J. G., Vutipongsatorn K., Solomou G., Akhbari M., Ali A., Murray V., Baker D. M., Brandao B. D., Stainer B., Thavayogan R., Jones D., Onafowokan O. O., Gharooni A., Dabab N., Carlton-Carew S., Kungwengwe G., Gabriel M., Sewart E., Shortland T. C., Lawday S., Pockney P., Dawson A., Brumfitt C. D., Stewart P., Ng B., Luong J. K., Ivanov V., Borisova A., Neykov V., Kuncarova K., Kolosova B., Antonova T., Farkasova M., Harbjerg J. L., Brandsborg S., Brinck S., Kjaer M. D., Mark-Christensen A., Unbehaun K. P., Dalsgaard P., Lycke K. D., LeNaoures P., Brigand C., Dumange E., Gout M., Moehwald C., Prem M., Alhalabi O., Sliwinski S., Krupp J., Gablenz E., Schmitzer L., Kopp A., Steinle J., Gsenger J., Pohl L. J., Riccardi M., Christodoulou I. M., Konstantinidis M., Machairas N., Zoikas A., Balalis D., Manatakis D. K., Aguilera M. L., Marano L., Fleres F., Lovisetto F., Sasia D., Segalini E., Pata G., Lucchi A., Sagnotta A., Campagnaro T., Petrelli F., Gallo G., Papandrea M., Testa V., Sinibaldi G., Di Candido F., Colombo F., Perrone G., Biancafarina A., Canonico G., Pagnanelli M., Curletti G., Bini R., de Manzoni Garberini A., Impellizzeri H., Cillara N., Tutino R., Picciariello A., Coletta D., Savino G., Ferrara F., Tamini N., Talamo G., Parini D., Giamundo P., lo Conte A., Pagano G., Ripetti V., Pesce A., Menduni N., Giudicissi R., Goldin E., Rega D., Belli A., Andriola V., Gordini L., Foppa C., Piccolo G., Birindelli A., Ferrari C., Ballarini Z., Tirelli F., Milone M., De Rosa M., Pipitone Federico N. S., Molteni B., Tilocca P. L., Sancini G., Piozzi G. N., Lauretta A., Poillucci G., Mulas S., Simcikas D., Portelli L., van Wijnbergen J. W. M., Dinger T. L., ten Doesschate S. F. H., van Dalen A. S. H. M., van den Bos D. D., Hansmann M., Medina Feliz J., Kuiper S. Z., Abdulrahman Z., Pruijssers S. R., Farik S., Elliott B. M., Geneta V. P., Wilton S., Kandelaki H., Peng S. L., Campbell S., Lim Y. K., Yassaie S. S., Murray M., Haran C., Tan J., Castro J., Laranjeira A., Catarino S., Neves-Marques C., Correia J. G., Vieira B. N., Quintela A. C., Serra M. L., Maciel J., Cunha M., Aparicio D. J., Neves J., Azevedo J., Romano M., Eiro F., Romano J., Monteiro C., Claro M., Almeida M. R., Peyroteo M., Machado N. D., Capote H., Ferreira M., Sousa X., Devesa H., Cavadas D., Guerreiro I., Costa M., Rosete M., Salman M., English C., Mohammed N., Litvin A., Cuk V. V., Meszarosova K., Jaich R., De Lima H., Brooks S., Marx M., Nshalati Salvation M., Garcia Cardo J., Mora-Guzman I., Sancho Muriel J., de Andres Olabarria U., Muriel P., Jimenez Vinas C., Alconchel F., Esteban Sinovas O., Gomez del Pulgar A., Fairen Oro C., Lopez Otero M., Figueroa Jimenez S., Claramonte Bellmunt O., Martinez Caballero J., Rubio-Perez I., Aguilar-Martinez M. M., Segura-Sampedro J. J., Olmedo Moreno C., Negre Parra D., Estevez Diz A. M., Martin-Balbuena R., Bustamante Recuenco C., Licardie Bolanos R. E., Fernandez P., Diaz Padillo A., Forero-Torres A., Alberdi San Roman I., Salvador Roses H., Merayo Alvarez M., Villarejo Campos P., Lopes Moreira C. C., Uriol Peralta P., Serrano Navidad M., Ripolles-Melchor J., Garcea A., Gomez Facundo H., Troncoso Pereira P., V Perez Guarinos C., Blaser B., Piazza G., Gagliardi B., Serin H., Yurdaor S. S., Arslan E., Kopac O., Uyanik A., Ozmen B. B., Tiftik E., Aksoy B., Yalcinkaya A., Ozoglu F., Kocer M. D., Bilicen G., Cinar E. N., Uslu O., Kaya Y., Demirci K., Wong J., Farhan-Alanie M. M. H., Suresh G., Asif A., Finch B. J., Bhahirathan Y., Herron J., Yi Tew Z., Obukofe R., Russell C., Suchett-Kay I., Netke T., Williams L., Kisiel A., Liu F. Y., Claireaux H., James P., Mondal A., Kalderon R., Nadama H. H., Al-Saraff Z., Tam J. P. H., Powell-Chandler A., Wood F., Gorgievska R., Ragavoodoo A., Thakrar C., Rojoa D., Palmer C., Davidson K., Giacci L., Hale J., Gan F. W., Makin-Taylor R., Hey C. Y., Toh C., Findlay J. M., Griffiths N., Ganesananthan S., Jasionowska S., Poustie M., Wong C., Turner T., Pyc W., Sloper W., Warner C., Coey J., Mason D., Sait S., Kowal M., Owen M., Saiyed A., Ashworth I., Akbari K., Curran M., Martin P., Parker D., Kwok K., Lye C., Ghaly M., Sammour T., Lewis D., Mundasad R., Wilkes A., Ctercteko G., Maslyankov S., Dimov R., Iliev S., Dimitrov D., Marek F., Orhalmi J., Skalicky P., Skalicky T., Chrz K., Christensen P., Worsoe J., Kristensen E. S., Emmertsen K. J., Loeve U. S., Mihaljevic A. L., Herrle F., Konstantinidis K. 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I., Ortega J., Vivas Angeles P., Vives Figueras R., Baena Sanfeliu E., Campillo Alonso B., Alberich Prats M., Duran Arrocha J., Cornella Garceso N., Uribe Galeano C., Delisau Puig O., Castro A., Codony Bassols C., Fernandes N., Garcia Adamez J., Caula Freixa C., Sanchez M. J., Martin-Borregon P., Quevedo A., Martinez J., Marin J. M., Rodriguez P., Garcia Orozco J. J., Ferrusola Diaz D. A., Garcia Jimenez M. L., Castro Diez L., Mosquera Fernandez C., Alonso Batanero E., Cifrian Canales I., Calzada M. G., Recuenco C. B., Martin M. C., Esteban Avendano I., Jimenez Relimpio C., Lancho Lavilla P., Blanco Bartolome I., Gomez Cano I., Blasco Andres C., Alonso-Poza A., Dieguez B., Losada M., Gilsanz C., Garcia-Vico A., Roman-Rando A., Sanchez-Galvez M. A., Bersabe-Alonso I. M., Vadillo-Bohorquez A., Gutierrez Rios R. D., Eizaguirre Ubegun M., Novo Sukia I., Uribe Isado M., Ibanez Alda M., Pastor Idoate C., Abad-Motos A., Marinez-Hurtado E., Salvachua-Fernandez R., Padilla Zegarra E. D., Franco M., Martinez A., Ramos Martin P., Mate Mate P., Marcano Chavez C., Ayllon H., Jeri-McFarlane S., Soldevila-Verdeguer C., Pineno-Flores C., Ambrona-Zafra D., Fernandez-Vega L., Gil-Catalan A., Craus-Miguel A., Pujol-Cano N., Sena-Ruiz F., Gomez Jurado M. J., Alberti Delgado P., Bordanova Reverter A., Belzunce-Capo J. F., Verdaguer Tremolosa M., Lin Q., Muniesa C., Avelino L., Cholewa H., Sancho-Muriel J., Navasquillo M., Navio A., Abello D., De Jesus M., Alvarez E., Garcia J. M., Gil A., Giordano H. E., Mignon G., Vanoni A., Henkens A., Jarrar G., Odovic M., Willemin M., Milliet O., Hahnloser D., Demartines N., Teixeira H., Pittet O., Haller M. L., Huot A., Kefleyesus A., Bugmann A., Piotet L. M., Meijers L., Kurtoglu G. K., Sel E. K., Isler V. C., Yilmaz B. S., Adiyaman C., Kara M., Demirkaya H. C., Korkmaz H. K., Pektas A. M., Guner B., Islek E. C., Tombul H. B., Boztug C. Y., Tinaz A., Yilmaz M., Karaman Y., Akin F. A., Dansuk S., Bascavus M., Kaya M., Kutlu B., Seker M. C., Erten V., Memis U., Kocak Z. B., Karapinar Y. E., Fakirullahoglu M., Koseoglu E., Yeni M., Aykun N., Agca M. H., Bilen C., Kilinc I., Atar C., Kilic V., Aktuna C., Aba M., Alim Y. E., Binbuga M., Kurklu O., Ceylan C., Yilmaz S., Calar S. N., Yildirim N., Yavuz G., Can B., Cesmeli E., Kus D., Kavar R. C., Cevlik A. D., Cengiz U., Turk E. G., Yilmaz I., Erdonmez H., Gursoy F., Kara H., Onsal U., Ozbek M., Kasar P. A., Ipor A., Ozen D., Olmez M., Altintas E., Toklu R., Saricicek T., Tipi O. U., Benli G. E., Tasdelen I., Tura A., Ucar A., Ekci B., Bilgili A. C., Kiraz I. N., Aksoy H., Basak A., Erdem M., Kayacan S., Sahin C., Uysal M., Karakus K., Altiner S., Demirci Z. S., Eren E., Yavas M., Aksoy A. B., Karagoz E., Sabanci R., Tumer S. S., Kargici K., Banaz T., Abdulrahman S. M. F., Yesilsancak M., Yanikoglu E., Karabulut A., Yilmaz D., Kuyumcu O. F., Kutluk F., Emiroglu B., Mollavelioglu B., Gereklioglu D., Guler M., Toprak S., Afsar H. B., Guler S. E., Alizade E., Alemdag G., Ulusahin M., Gul E. B., Yildirim R., Semiz A., Bektur G., Tomas K., Yarenci E., Demiroglu Y., Sunal A., Baykan B., Abbasguliyev H., Mutlu V., Mahmoudi Y., Dossa S. A. A., Mizan S. R., Demirtas B., Cavus T., Yuksek A., Mazlum S. S., Yelkenci C., Baran T., Satilmisoglu M., Sahin A. Z., Kilinc A., Isik K., Yumurtaci O., Emin A., Girit C., Yildirak M. K., Senyigit E., Guldag A., Soyleyici B., Aytin Y. E., Akay F. E., Iskan N. G., Mutlu B., Sunay A. O., Tie-Gill T., Ramsay G., De Paola L., McGuckin S., Alshakhs A., Ahmeidat A., Goergen N., Ali Z., Mullarkey L., Walshe R., Lewis E., Berry B., Moneim J., Mookerjee S., Christy S., Ojofeitimi O., Carroll L., Hylands A., Delaugere L. P., Reveendran D., Coulter C., Ralston C., Laverty L., Gallagher P., Ahmed A., Yeo Y. Q., Elliott D., Bennett J., Mcnamara M., Sivarajah S., Dunmore C., Aitken G., Nair M., Aly M. H., Buari M., Ahmed K., Sheikh Z., Monks M., Lehmann J., Rotimi O., Bell T., Limnatitou D., Gormley S., Taleongpong P., Patel V., Macgregor L., Amini S., Turner C., Dwyer-Hemmings L., Busuttil A., Powell J., Hensher C., Vivian F., Wcislo K., Millar Z., Hirosue S., Ogunmwonyi I., Nakakande D., Gaze H., Nirmalanantha A., Bin Amran M. A., Foulkes A., Jones N., Pillai S., Khoury G., Powell T., Maleyko I., Sangheli A., Ransome M., Isse M., Aromolaran O., Bholah H., Anbarasan J., Rehman S., Hu E., Timms S., Reynolds W., Hotchkies A., Misra V., Theocharidou L., Malik T., Janmohamed I., Carhart B., Khan A., Hullait R., Rylance A., Butt S., Leathes J., Philip Rajathasan T., Jeddy H., Kyaw H. A., Wong N., Karelia S., Clements J. M., Rainey M., Joshi N., Rahman A., Gallagher M., Rebuffa N., Abdelgalil R., Siaw Yen Lai R., Laurence N., Thomas S., Green C., Frostick R., Khera R., Povey M., Wong H. L., McCusker C., Hlukha L., Pike G., Kamel F., Thakkar R., Donaldson C., Sequeira Campos M., Armitage M. N., Hussain A. S., Hardy B., Hassan Serry M. Y., Bradbury M., Osunronbi T., Tam L. Y. C., Khanan Kaabneh A., Lawther J., Fisher P., Tribedi T., Moosa A., Ramdin A., Goble M., Downs E., Wheldon L., Baggus E., Mandal A., Nayeem A., Ahmed S., Fradley W., Wilson C., Gallagher S., Criswell T., Ward J., Mukkavilli A., Stubbs B., Fordyce W., Suchdev N., Wei Lim S., Sookramanien S. R., Chan A., Bointas G., Paul M., Ward K. L., Bagnall M., Pherwani S. A., Wang K., Mitchell L., Heyworth J., Ayyar S., Polson R., Mackenzie E., Doyle N., Habib Z., Zardab M., Sartaj F., Farooq H., Tabibi M., Drury D. J., James S. J., Barnett R., Teasdale A. B., Richardson E. T. J., Thomas D. A., Williams R. L., Najabat-Lattif H. F., Cahya E., Lou G., Coyle M., Homyer K., Zhu L. Y., Woods M., Chang J., O'Callaghan H., Suchett-Kaye I., Mihailidis T. H., Alawattegama H., Seite E., Barrett A., Riordan E., Lam W., Dowdeswell M., Mulvenna C., Awokoya O., Gurowich L., Dhera K., Hayat S., Tincknell L., Spazzapan M., Teeling F., Sysum K., Latter J., Latter M., Khan S., Guruswamy M., Beedham W., Brazier E., Elghobashy M., Bajaj M., Mann H., Etel E., Woodmass M., Hayden H., Ali Y., Husain S., Arnold A., Pedersen A. C., Cunha P., Ahmed M., Al Zawawi S., Kudva V., Theodoropoulou K., Miscampbell M., Robinson A. V., Johnston J., Dharni A., Lamb S., Westerman T., Evans E., Campbell L., Gillespie M., Cheong C. M., Kulathevanayagam K., Varghese A., Ike S. I., Chu T. S. M., Baljer B., Mogg J. A. W., Rai P., Claireaux H. A., Williams M., Smillie R., Goetz J., Appleby E., Fadipe T., Vaughan-Burleigh S., Puri G., Hussain P., Flather R., Cutler A., Pathak S., Sheldon J., Collicott T., al-Ausi M., Jovaisaite A., Shah S. M., Khalid N., Gutmann D., Davison S., Alame Y. J., Syed L., Owen W. J., Ahsan S. D., Anthony-Uzoeto U., Macleod Hall C., Zheng S., Wynter K., James C., Sapre D., Ghosh R., Baird J., Cockburn L., Blackwood O., Simpson W., Jeong S., Bishop S., Bate R., Hobson C., Adam A. H., Redclift C., Do J., Adeleye O., Poli F., Batterham A., Brown S., Parekh J. N., Clay W., Pieri K., Jackson A., Saxena A., Gurung B., Oyebola T., O'Brien F., Djeugam B., Gardezi S., Ul-Hasan S., Martin-Hernandez M. P., Sisley M., Modi S., Antakia R., Elbayouk A., Soh Y. J., Mather J., Yusuf Z., Al-Sarraf Z., Naja M., Rassool S. B., Convill J., Nikookam Y., Warsame A., Pace C., Kiandee M., Ridwan R., Carey C., Hirri F., McMillan M. J. A., Ling J. J., Pendelbury L., Kerimzade K., Tang A., Howard E. O., Humayun S., Wadsworth O. J., Tan K., Abdelhameed F., Haglund C., Radnaeva I., Hu N., Rambhatla S., Waldron D., Madahar P., Malik S., Meney L. C., Ibrahim I., Kang C. K., Chiu J. Z. J., Livie V., Ibrahim B., Khalil M., Pooley G., Shishkin B., Docherty J., Southgate A., Coomes A., McGee F., Flanagan S., Tan Q. J., Anwar H., Clough R., Chrisp B., Cassels J., Cross G. W. V., Mercer L., Mercer C., Refalo A., Hadley R., McTighe A., Farrow F., Brodie A., Davis G., Shah D. R., Bowers C., Patel S., Morice O., Burzic A., Cheung J., Shashidhara A., Theodoraki G., Birk J., Ong A., Ng M. P. E., Wong R. T. W., Maese S., Yeap B., Iqbal Z., Rojoa D. M., Cabaleiro Barciela C., Ruddy C. M., Lindwe S., Qamar Y., Chuita S., Melaugh T., Hall J. D., Kouli O., Hassane A. S. I., Azhar A. W., Tan T. K., Perchard W., Scurr T., Campbell E., Kelk L., Ghosh A., Gibbins A., Mala D., Loizidou A., Hall O., Mecia L., Hew C., Varathan K., Tong L., Chandrasekar B., Buchanan E., O'Connell M., Kwak S. Y., Ong E. H., Gardner S., Lim J., Maden C., Illahi M., Xuan Tan Z., Stahl R., Stahl J., Hickman A., Collett D., Goolam-Mahomed Z., Allen B., Atiyah A., Ahmad H., Jones J., McGregor O., Ogundiya E., Boulbadaoui A., Kirnon-Jackman O., Lim Q. X., Peckham H., Yeoh T., Yong S. Q., Chen J. Y., Siva S., Sam Z. H., Gilani M., Goh Y. N., Muthukumar M. G., Phillips S., Tjoakarfa J., Giri A., Suresan S., Thomas P., Johnson T. A., Williams R. I., Rashid A., Kushairi A., Rais A., James A., Bugelli M., Chechelnitskaya Y., Sandhu N., Tandon R., Gray M., Kumar A., Ciurleo C., Nyamali I., Hiremath S., Sinha S., Chowdhary M., Bradley E., McTiernan M., Macdonald S., Sharkey S., McLaughlin N., Amey C., Kraria L., Skan O., Kind C., Tupper P., Van Rhee C., Honeyman S. I., Menon G., Jegatheeswaran L., Madhavan A., Warne M., Malcolm F. L., Lessware T., Wilkerson H. T., Chatterjee-Woolman S., Yoong A., Ahmed W. U. R., Longshaw A., Flannery O., Green R., Leaning M., Cragg J., Sharriff H., Doherty C., Kwan K. W. L., Sanders-Crook L., Bhatia S., Eames S., Lewis F., Kirupananthan P., Boh Z. Y., Dass S., Soma A., Newton A., Hill M., Shafiq Y., Brkljac M., Boyce L., English W. J., Lam S., Chipeta C., Jain C., Garofalidou T., Novotny S. A., Locke S., Bowman C., Begaj A., Murphy C., Radcliffe K., Chong J. T., Jeffrey E., Chaudhury N., Rajendran K., Akbar Z., Walters B., Kulendrarajah B., Tran N., Shrestha S., Parmar S., Gallagher C., Hennessy L., Pentti E., Badhrinarayanan S., Fung A., Mansoor M., Kenny R., Kan P., Lee D. E., Khosla S., Samake M., Shaban F., Aftab R., Gough M., Woodburn B., Vayalapra S., McMurrugh K., Jimulia D., Deol S., Pike S., Embury-Young Y., Patel M., Kilgallon E., Keating R., Walsh A., Khan H., Logue G., Orekoya M., Alasmar M., Charalambides M., Clave Llavall A., Williamson E., Bharwada Y., Zearmal S., Evans H., Panikkar M., de la Cruz G., Caplan J., Ruparelia A., Tanvir T., Soare C., Pang Y. L., Trotter J., Zaidi A., Thakrar V., Pulickal P., Ahmed H., Parnell J., Lennock S., Ford V., Brignall R., O'Neill D., Hanna R., Kane R., Nicola M., Rajput K., Xiao Y., Michael S., Wright E., Juniper S., Thompson E., Hoskyns L., Kanitkar A., Ross C., Unsworth A., Rshaidat H., Demarre K., Chiang A., Bareh A., van Dellen J., Faqihinejad C., Gadhvi A., Grant R., Lewsey J., Morris A., Martin H., McClarty C., Sanyal S., Alsaif A., Palkhi A., Bhopal S., Vishnu K S., Papanikolaou A., Mitra A., Nur A., Ali F., Burford C., Huq T., Irwin E., Matthews L., Ngu W. S., Hosfield T., Muneeb F., Page O., Zeb E., Al-Azzawi A., McIntosh J., Vucicevic A., Hughes M., Brooks L., Fanibi B., Dixon M., Njoku P., Morris D., Jobson J., Chowdhury H., Alawode D. O. T., Wynell-Mayow W., Udayachandran V., Alsoof D., Ekert J., Joseph N., Zulkefley N., Hunt G., Christodoulou T., Wright O., Soman S., Jamal M., Beqiri S., Borgas P., Christie S., Pereira F., Browne S., Yiu J., Dworkin A., Brayley J., Palmer A., Charalambos M., Jones C. S., Toner S., Cowden R., Lee L., Nicol P., Holman O., Imtiaz M., Albert V., Leung S. P., Erotocritou M., Stroud R., Wilkin R., Thomson W., Mackee L., G N., Bei Y., Mckenna Favier S., Ibrahim A., Kler A., Reynolds L., Mohamed S. H., Majeed Y., Fakim B., Jones A., Liversedge G., Carrington Z., Windebank J., Izzarina A., Akbani U., Craven J., Aldarragi A., Harding S., Millward A., Bedford M., Gopalan V., Midgen A., Khadka P., Cheng O., Taneja S., Manobharath N., Kok J. Y., Lim D. W. E., Buick T., Boland M., Piya S., Devlin R., Fairfield C. J., George R. J., Rahi M., Zaman S., Hajiev S., Ross T., Crisp E., Thompson C., Charalambous A., Hollywood J. L., Hammond R. F. L., Matthews J., Mendonca V., Spinty J., Khan K., Cheng J., Glynn N., Muhammad U., Khan M., Anderson L., Mccormack K., Mak J., Patrawala S., Milinkovic N., Schofield R., Chauhan M., Hartley L., Hind J., Nelson L., Ratnasingham D., Whitehead T., Dimitriadis S., Marshall K., Flint E. J., Horner C., Heybourne A., Morgan H., Wickstone C., Panagiotou D., O'Connell E., Dean K., Iqbal R., Walsh L., Yu N., Rana N., Massie E., Ng J., Jung M., Lee Y. D., Harris M., White S., Boev B., Tonchev P., Prochazka V., Skalicky A., Ravn S., Ojakaar A., Dorr-Harim C., Koutserimpas C., Giraudo G., Armellini A., Ruzzenente A., Mazzeo C., De Padua C., Realis Luc A., Maroli A., Giani I., Cufari M. E., Vitali M., Gusai G. P., Quattromani R., Virgilio E., Berti S., Di Mola Ospedale SS Annunziata F. F., Papagni V., Tuminello F., Vittori L., Longheu A., Loche G. A., Braccio B., De Luca E., Resta G., Ancans G., Tamosiunas A., Petrulionis M., Andrejevic P., Stellingwerf M. E., Abdulrahman N., van de Pas K. G. H., Thomas G., Brandsma A. M., Davids J., Rottier S. J., de Roy van Zuidewijn D., Hawkins R., Ong H. I., Li Y., Desmond B., Winstanley J., Martins M., Americano M., Frade S., Senhorinho R., Peixoto R., Alves-Vale C., Lamas M., O'Connor D. B., Hoo M., Gopaul A., Scanlon K., O'Dwyer N., Jovanovic M., Panyko A., Van Vuuren S., Centeno A., Bernado I. R., Paniagua Garcia Senorans M., Gonzalez Amor L., Cuenca Ramirez A., Abrisqueta J., Estaire Gomez M., Arroyo A., Cerdan C., Gomez Romeu N., Enriquez-Navascues J. M., Collado-Roura F., Curchod P., Gaspar S., Imadalou L., Mutlu D., Akyol C., Uygur F. A., Eray I. C., Biyiklioglu O., Cetin M. F., Isik A. E., Karip B., Dogan H., Sarigul L., Tunc E., Aydin T., Bodur S., Karabulut K., Francis A. A., Al-hadithi A., To N., Lau I. S. F., Smith E., Mahapatra S., McAuliffe O., Imam L., Akram B., Hossaini S., Davies R., Ko M., Collins J., Pandya A., Reilly S., Archer J., Auty C., Roche C. D., Livie J., Chaudhry F. A., Ntakomyti E., Diallo R., Bylinski T., Wright J., Masiha E., Tung J., Shirazi B., Neilson A., Epton S., Patel N., Trussell S., Couldrey A., Donnelly C., Eftychiou S., Glasbey J.C., Bibi S., Pata F., Ozkan B.B., Van Straten S., Hodson J., Chapman S.J., Blanco-Colino R., Pellino G., Sgro A., Soares A., van Elst T., Nepogodiev D., Borakati A., Bath M.F., Yasin I.H., Mclean K., Arthur T., Kovacevic M., Delibegovic S., Karamanliev M., Swamad M., Zebrak R., Paramasivam R., Martensen A., Larsen H.M., Radeker L., Frey P.E., Kechagias A., Venara A., Duchalais E., Ioannidis A., Pasquali S., Simioni A., Farina V., Podda M., Lorenzon L., ItSURG I., Schaeff V., Otto A., Jakubauskas M., van Elst T.R., Chu M., Fagan P.V.B., Wells C.I., Alagoa Joao A., Juloski J., Perez-Ajates S., Anabitarte Bautista O., El Kasmy Y., Espin-Basany E., Clerc D., Ciubotaru C., Popescu S., Yanishev A., Lee S., Yagiz Sen A., Aktas M.K., Baki B.E., Yuksek B., Kamarajah S., Khaw R.A., Mills E., Goodson R., Thakral N., Collaborative S., Ablett A.D., Adra M., Kwek I., Khan S.M., Quinn P., Manley L.R., Badran A., Ramjeeawon A., Campbell A., Tan H.L., Rye D.S., Rajaraman N., Norman J.G., Vutipongsatorn K., Solomou G., Akhbari M., Ali A., Murray V., Baker D.M., Brandao B.D., Stainer B., Thavayogan R., Jones D., Onafowokan O.O., Gharooni A., Dabab N., Carlton-Carew S., Kungwengwe G., Gabriel M., Sewart E., Shortland T.C., Lawday S., Pockney P., Dawson A., Brumfitt C.D., Stewart P., Ng B., Luong J.K., Ivanov V., Borisova A., Neykov V., Kuncarova K., Kolosova B., Antonova T., Farkasova M., Harbjerg J.L., Brandsborg S., Brinck S., Kjaer M.D., Mark-Christensen A., Unbehaun K.P., Dalsgaard P., Lycke K.D., LeNaoures P., Brigand C., Dumange E., Gout M., Moehwald C., Prem M., Alhalabi O., Sliwinski S., Krupp J., Gablenz E., Schmitzer L., Kopp A., Steinle J., Gsenger J., Pohl L.J., Riccardi M., Christodoulou I.M., Konstantinidis M., Machairas N., Zoikas A., Balalis D., Manatakis D.K., Aguilera M.L., Marano L., Fleres F., Lovisetto F., Sasia D., Segalini E., Pata G., Lucchi A., Sagnotta A., Campagnaro T., Petrelli F., Gallo G., Papandrea M., Testa V., Sinibaldi G., Di Candido F., Colombo F., Perrone G., Biancafarina A., Canonico G., Pagnanelli M., Curletti G., Bini R., de Manzoni Garberini A., Impellizzeri H., Cillara N., Tutino R., Picciariello A., Coletta D., Savino G., Ferrara F., Tamini N., Talamo G., Parini D., Giamundo P., lo Conte A., Pagano G., Ripetti V., Pesce A., Menduni N., Giudicissi R., Goldin E., Rega D., Belli A., Andriola V., Gordini L., Foppa C., Piccolo G., Birindelli A., Ferrari C., Ballarini Z., Tirelli F., Milone M., De Rosa M., Pipitone Federico N.S., Molteni B., Tilocca P.L., Sancini G., Piozzi G.N., Lauretta A., Poillucci G., Mulas S., Simcikas D., Portelli L., van Wijnbergen J.W.M., Dinger T.L., ten Doesschate S.F.H., van Dalen A.S.H.M., van den Bos D.D., Hansmann M., Medina Feliz J., Kuiper S.Z., Abdulrahman Z., Pruijssers S.R., Farik S., Elliott B.M., Geneta V.P., Wilton S., Kandelaki H., Peng S.L., Campbell S., Lim Y.K., Yassaie S.S., Murray M., Haran C., Tan J., Castro J., Laranjeira A., Catarino S., Neves-Marques C., Correia J.G., Vieira B.N., Quintela A.C., Serra M.L., Maciel J., Cunha M., Aparicio D.J., Neves J., Azevedo J., Romano M., Eiro F., Romano J., Monteiro C., Claro M., Almeida M.R., Peyroteo M., Machado N.D., Capote H., Ferreira M., Sousa X., Devesa H., Cavadas D., Guerreiro I., Costa M., Rosete M., Salman M., English C., Mohammed N., Litvin A., Cuk V.V., Meszarosova K., Jaich R., De Lima H., Brooks S., Marx M., Nshalati Salvation M., Garcia Cardo J., Mora-Guzman I., Sancho Muriel J., de Andres Olabarria U., Muriel P., Jimenez Vinas C., Alconchel F., Esteban Sinovas O., Gomez del Pulgar A., Fairen Oro C., Lopez Otero M., Figueroa Jimenez S., Claramonte Bellmunt O., Martinez Caballero J., Rubio-Perez I., Aguilar-Martinez M.M., Segura-Sampedro J.J., Olmedo Moreno C., Negre Parra D., Estevez Diz A.M., Martin-Balbuena R., Bustamante Recuenco C., Licardie Bolanos R.E., Fernandez P., Diaz Padillo A., Forero-Torres A., Alberdi San Roman I., Salvador Roses H., Merayo Alvarez M., Villarejo Campos P., Lopes Moreira C.C., Uriol Peralta P., Serrano Navidad M., Ripolles-Melchor J., Garcea A., Gomez Facundo H., Troncoso Pereira P., V Perez Guarinos C., Blaser B., Piazza G., Gagliardi B., Serin H., Yurdaor S.S., Arslan E., Kopac O., Uyanik A., Ozmen B.B., Tiftik E., Aksoy B., Yalcinkaya A., Ozoglu F., Kocer M.D., Bilicen G., Cinar E.N., Uslu O., Kaya Y., Demirci K., Wong J., Farhan-Alanie M.M.H., Suresh G., Asif A., Finch B.J., Bhahirathan Y., Herron J., Yi Tew Z., Obukofe R., Russell C., Suchett-Kay I., Netke T., Williams L., Kisiel A., Liu F.Y., Claireaux H., James P., Mondal A., Kalderon R., Nadama H.H., Al-Saraff Z., Tam J.P.H., Powell-Chandler A., Wood F., Gorgievska R., Ragavoodoo A., Thakrar C., Rojoa D., Palmer C., Davidson K., Giacci L., Hale J., Gan F.W., Makin-Taylor R., Hey C.Y., Toh C., Findlay J.M., Griffiths N., Ganesananthan S., Jasionowska S., Poustie M., Wong C., Turner T., Pyc W., Sloper W., Warner C., Coey J., Mason D., Sait S., Kowal M., Owen M., Saiyed A., Ashworth I., Akbari K., Curran M., Martin P., Parker D., Kwok K., Lye C., Ghaly M., Sammour T., Lewis D., Mundasad R., Wilkes A., Ctercteko G., Maslyankov S., Dimov R., Iliev S., Dimitrov D., Marek F., Orhalmi J., Skalicky P., Skalicky T., Chrz K., Christensen P., Worsoe J., Kristensen E.S., Emmertsen K.J., Loeve U.S., Mihaljevic A.L., Herrle F., Konstantinidis K.M., Korkolis D., Karanikas I., Vincenti L., Anania G., Borghi F., Agresta F., Maretto I., Parisi A., Bucci L., De Palma G., Guglielmi A., Cucinotta E., La Torre F., Cianchi F., Guerrieri M., Trompetto M., Persiani R., Micheletto G., Delrio P., Cantafio S., Ronconi M., Bisagni P.A.G., De Prizio M., Franceschi A., Galleano R., Cavallini M., Brescia A., D'Ambra L., Benevento A., Niolu P., Calgaro M., Colangelo E., Grottola T., Altomare D.F., Puleo S., Salamone G., 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Clerico G., De Santi G., Bitonti M.F., Frattalone M., Fico V., Santullo F., Belia F., Spinelli A., Marco M., Bevilacqua M., Tringali D., Bevilacqua E., Panizzo V., La Manna V., Migliore G., Aversano A., Fares Bucci A., Marino F., Carbone F., Incollingo P., Romano F.M., Zalla T., Baraghini M., Romoli L., Calussi M., Vellei S., Genzano C., Feroci F., Vita M., Barberis A., Serra D., Grassia M., Romelli M., Ruggiero S., Percassi A., Magri Piccinini A., Monti M., Magnoli M., Romano S., Gaetano P., Pilotta F., Baldassarre L., Bonati E., Aresu S., Saba A., Moretto G., Bacchion M., Casaril A., Inama M., Creciun M., Stella M., Gobatti D., Angelini M., Andolfi E., Miranda E., Scricciolo M., Provenza G., Cavallina G., Frezza B., Fontani A., Malatesti R., Pellicano G.A., Anania M., Pulighe F., Cruccu A., Murru M.L., Massaiu C., Balestra F., Pazzona M., Giannella A., Santangelo M., Frangella F., Magagnano D., Liberatore P., Brenna R., Giani A., Tirotta F., Famularo S., Angrisani M., Ceresoli M., Rondelli F., Angelucci G.P., Scaramuzzo R., Larcinese A., Fioriti C., Picone E., Nardi M., Castagnoli G., Bartoli A., Bellochi R., Spaziani A., Conti D., Poponesi V., Trippetti M., Amicucci S., Tazza G., Procacci P., Giovannini F., Basile E., Caristo G., De Nardi P., Rosati R., Marcocci G., Vignali A., Malerba M., Percivale A., Ghazouani O., Reggiani L., Spirito C., Moschetta G., Cosmi F., Romeo G., Gasparrini M., Sucameli F., Gennai A., Moggia E., Bianchi C., Bonfante P., Macina S., Feleppa C., Imperatore M., Tenconi S.M., Rausei S., Maioli D., Marchionini V., Sparta C., Mura F.A., Barmina M., Lorettu A., Rettaroli C., Mastino G., Ruggiu G.V., Mura G.A., Perrone B.A., De Angelis M., Mereu A., Adamo V., Bianco C., Ricciardiello M., Campanaro C., Panaccio P., Esposito L.M., D'Ascanio F., Pietroletti R., Chetta N., Aquilino F., Di Marco F., Amico A., Schembari E., Puglisi S., Licari L., Campanella S., Profita G., Falco N., Rotolo G., Venturelli P., De Marco P., Marciano M., Argenti F., 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Castro B., Fonseca S., Carvalho L., Torre A.P., Amado A., Leite M., Miranda P., Cunha C., Silva R., Pina S., Paixao I., Orelhas L., Santos J., Pacheco A., Rocha A.F., Jervis M.J., Pedro V., Paixao V., Guerreiro A., Melo D., Correia D., Capella V., Moinhos T., Silva M., Silva A.G., Galvao D., Mora A., Bettencourt R., Costa F., Gil I., Morgado J., Monica I., Oliveira S., Ribeiro H., Guimaraes N., Duarte M., Miranda J., Martins S.F., Parreira R., Faustino A., Medeiros N., Castro R., Soares B., Resendes M., Almeida P., Cruz A., Vaz Pinto G., Sousa D., Costa Santos D., Silva F., Fialho G., Reia M., Pratas N., Costa C., Costa J., Morais S., Machado A., Horta V., Rocha-Melo M., Patricio J., Pereira M., Lima R., Cinza A.M., Oliveira J., Velez C., Borges F., Simoes J., Botelho P., Cismasiu B., Alves D., Dias B., Goncalves J.P., Valente P., Freire L., Saraiva R., Moreira M., Fragoso M., Guimaraes J., Cruz G., Ribeiro J., Borges da Ponte I., Almeida S., Martins A.R., Louro T., Morgado M., 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Kakodkar P., Balasubramanian I., Al-Salihi A., Vyas V., Vedadi A., Popescu S.S., Piras K., Ciubotaru C.I., Romanova E., Ponomarev N., Savchenko A., Luzan R., Lutovinova E., Gavrilina A., Barkovskaya A., Kudelkina N., Topchubaev D., Radulovic R., Milosevic K., Bojicic J., Gencic M., Jankovic U., Zubowicz M., Suchan P.K., Gerstmeier J., Brazitikou E., Fytrou E., Celik M., Dubovsky M., Schmalenbeck J., Sautter S.C., Ceyran H., Fitchat N., Mathebula S., Chauke J., Mculu W., Ngwenya Z., Withey K., Piperidis A., Toyi Y., Nicolaides A., Jaffer T., Sparke A., Van Staden N., McDuling C.R., Claassen L., Kruger C., Weyers J., Lecler J., Yebes A., Mana O.C., Gomez H., Riba L., Perez J., Casaval Cornejo L., Vicente Rodriguez I., Jimenez Escovar F., Calvo Fernandez M., Portugal Martinez A., Badiola Bergara I., Landaluce Olavarria A., del Pozo Andres E., Samartin Toimil C., Primo Alvarez J.C., Rodriguez Fernandez L., Ortega C., Ossola M.E., Camarero E., Martinez Illan M., Aranda Garcia L., Lazaro Cardona M., Montalvo Olmedo C., Livianos Arias-Camison P., Nieto Arranz J.M., Mateos Sexmero M.J., Diego Alonso E., Izquierdo Moreno A., Margarida A., Pando B., Liquete Marin L., Perez Calle M., Ramos Cordero M.J., Sagredo Cuartango A., Sanchez E., Marcos Rodrigo A., Martinez Diaz J.M., Ruiz Manzanera J.J., Navarro Barrios A., Rodriguez Pedreno L., Garcia Moreno P., Garcia Gomez M., Rodrigues K., Platero Diago J., Veras Lista M., Rifa Terricabras S., Butler Sanz L., Alberch Camprubi E., Rico Ferrandez M., Puig Lao E., De Pablo Miro M., Alberca-Paramo A., Alia Verdejo T., Canete-Manzanares J., Molina-Florez M., Garcia Hernandez L.C., Orozco Nunez S., Suarez-Sanchez M., Martin-Fernandez J., Soriano Liebana M.M., Campo Betancourth C.F., Sevila Mico S., Fernandez A., Curtis C., Bosch M., Triguero D., Bosch Ramirez M., Ramayo Diaz N., Gonzalez Caraballo I., Pascual Vicente T., Orue-Echebarria M.I., Sanchez-Calvo L., Wang D., Trueba-Collado C., Morales Bernaldo de Quiros J.T., Lima Pinto F., Nunez OSullivan S., Ramos Jimenez F.A., Perez Ortega A., Trujillo Barbadillo A., Romero Pujana E., Fernandez Illera M.V., De La Llave Serralvo A., Mestres N., Cuello E., Merichal M., Sierra J.E., Escoll J., Rufas M., Pinillos A.I., Ortega J., Vivas Angeles P., Vives Figueras R., Baena Sanfeliu E., Campillo Alonso B., Alberich Prats M., Duran Arrocha J., Cornella Garceso N., Uribe Galeano C., Delisau Puig O., Castro A., Codony Bassols C., Fernandes N., Garcia Adamez J., Caula Freixa C., Sanchez M.J., Martin-Borregon P., Quevedo A., Martinez J., Marin J.M., Rodriguez P., Garcia Orozco J.J., Ferrusola Diaz D.A., Garcia Jimenez M.L., Castro Diez L., Mosquera Fernandez C., Alonso Batanero E., Cifrian Canales I., Calzada M.G., Recuenco C.B., Martin M.C., Esteban Avendano I., Jimenez Relimpio C., Lancho Lavilla P., Blanco Bartolome I., Gomez Cano I., Blasco Andres C., Alonso-Poza A., Dieguez B., Losada M., Gilsanz C., Garcia-Vico A., Roman-Rando A., Sanchez-Galvez M.A., Bersabe-Alonso I.M., 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M., Demirkaya H.C., Korkmaz H.K., Pektas A.M., Guner B., Islek E.C., Tombul H.B., Boztug C.Y., Tinaz A., Yilmaz M., Karaman Y., Akin F.A., Dansuk S., Bascavus M., Kaya M., Kutlu B., Seker M.C., Erten V., Memis U., Kocak Z.B., Karapinar Y.E., Fakirullahoglu M., Koseoglu E., Yeni M., Aykun N., Agca M.H., Bilen C., Kilinc I., Atar C., Kilic V., Aktuna C., Aba M., Alim Y.E., Binbuga M., Kurklu O., Ceylan C., Yilmaz S., Calar S.N., Yildirim N., Yavuz G., Can B., Cesmeli E., Kus D., Kavar R.C., Cevlik A.D., Cengiz U., Turk E.G., Yilmaz I., Erdonmez H., Gursoy F., Kara H., Onsal U., Ozbek M., Kasar P.A., Ipor A., Ozen D., Olmez M., Altintas E., Toklu R., Saricicek T., Tipi O.U., Benli G.E., Tasdelen I., Tura A., Ucar A., Ekci B., Bilgili A.C., Kiraz I.N., Aksoy H., Basak A., Erdem M., Kayacan S., Sahin C., Uysal M., Karakus K., Altiner S., Demirci Z.S., Eren E., Yavas M., Aksoy A.B., Karagoz E., Sabanci R., Tumer S.S., Kargici K., Banaz T., Abdulrahman S.M.F., Yesilsancak M., Yanikoglu E., Karabulut A., Yilmaz D., Kuyumcu O.F., Kutluk F., Emiroglu B., Mollavelioglu B., Gereklioglu D., Guler M., Toprak S., Afsar H.B., Guler S.E., Alizade E., Alemdag G., Ulusahin M., Gul E.B., Yildirim R., Semiz A., Bektur G., Tomas K., Yarenci E., Demiroglu Y., Sunal A., Baykan B., Abbasguliyev H., Mutlu V., Mahmoudi Y., Dossa S.A.A., Mizan S.R., Demirtas B., Cavus T., Yuksek A., Mazlum S.S., Yelkenci C., Baran T., Satilmisoglu M., Sahin A.Z., Kilinc A., Isik K., Yumurtaci O., Emin A., Girit C., Yildirak M.K., Senyigit E., Guldag A., Soyleyici B., Aytin Y.E., Akay F.E., Iskan N.G., Mutlu B., Sunay A.O., Tie-Gill T., Ramsay G., De Paola L., McGuckin S., Alshakhs A., Ahmeidat A., Goergen N., Ali Z., Mullarkey L., Walshe R., Lewis E., Berry B., Moneim J., Mookerjee S., Christy S., Ojofeitimi O., Carroll L., Hylands A., Delaugere L.P., Reveendran D., Coulter C., Ralston C., Laverty L., Gallagher P., Ahmed A., Yeo Y.Q., Elliott D., Bennett J., Mcnamara M., Sivarajah S., Dunmore C., Aitken G., Nair M., Aly M.H., Buari M., Ahmed K., Sheikh Z., Monks M., Lehmann J., Rotimi O., Bell T., Limnatitou D., Gormley S., Taleongpong P., Patel V., Macgregor L., Amini S., Turner C., Dwyer-Hemmings L., Busuttil A., Powell J., Hensher C., Vivian F., Wcislo K., Millar Z., Hirosue S., Ogunmwonyi I., Nakakande D., Gaze H., Nirmalanantha A., Bin Amran M.A., Foulkes A., Jones N., Pillai S., Khoury G., Powell T., Maleyko I., Sangheli A., Ransome M., Isse M., Aromolaran O., Bholah H., Anbarasan J., Rehman S., Hu E., Timms S., Reynolds W., Hotchkies A., Misra V., Theocharidou L., Malik T., Janmohamed I., Carhart B., Khan A., Hullait R., Rylance A., Butt S., Leathes J., Philip Rajathasan T., Jeddy H., Kyaw H.A., Wong N., Karelia S., Clements J.M., Rainey M., Joshi N., Rahman A., Gallagher M., Rebuffa N., Abdelgalil R., Siaw Yen Lai R., Laurence N., Thomas S., Green C., Frostick R., Khera R., Povey M., Wong H.L., McCusker C., Hlukha L., Pike G., Kamel F., Thakkar R., Donaldson C., Sequeira Campos M., Armitage M.N., Hussain A.S., Hardy B., Hassan Serry M.Y., Bradbury M., Osunronbi T., Tam L.Y.C., Khanan Kaabneh A., Lawther J., Fisher P., Tribedi T., Moosa A., Ramdin A., Goble M., Downs E., Wheldon L., Baggus E., Mandal A., Nayeem A., Ahmed S., Fradley W., Wilson C., Gallagher S., Criswell T., Ward J., Mukkavilli A., Stubbs B., Fordyce W., Suchdev N., Wei Lim S., Sookramanien S.R., Chan A., Bointas G., Paul M., Ward K.L., Bagnall M., Pherwani S.A., Wang K., Mitchell L., Heyworth J., Ayyar S., Polson R., Mackenzie E., Doyle N., Habib Z., Zardab M., Sartaj F., Farooq H., Tabibi M., Drury D.J., James S.J., Barnett R., Teasdale A.B., Richardson E.T.J., Thomas D.A., Williams R.L., Najabat-Lattif H.F., Cahya E., Lou G., Coyle M., Homyer K., Zhu L.Y., Woods M., Chang J., O'Callaghan H., Suchett-Kaye I., Mihailidis T.H., Alawattegama H., Seite E., Barrett A., Riordan E., Lam W., Dowdeswell M., Mulvenna C., Awokoya O., Gurowich L., Dhera K., Hayat S., Tincknell L., Spazzapan M., Teeling F., Sysum K., Latter J., Latter M., Khan S., Guruswamy M., Beedham W., Brazier E., Elghobashy M., Bajaj M., Mann H., Etel E., Woodmass M., Hayden H., Ali Y., Husain S., Arnold A., Pedersen A.C., Cunha P., Ahmed M., Al Zawawi S., Kudva V., Theodoropoulou K., Miscampbell M., Robinson A.V., Johnston J., Dharni A., Lamb S., Westerman T., Evans E., Campbell L., Gillespie M., Cheong C.M., Kulathevanayagam K., Varghese A., Ike S.I., Chu T.S.M., Baljer B., Mogg J.A.W., Rai P., Claireaux H.A., Williams M., Smillie R., Goetz J., Appleby E., Fadipe T., Vaughan-Burleigh S., Puri G., Hussain P., Flather R., Cutler A., Pathak S., Sheldon J., Collicott T., al-Ausi M., Jovaisaite A., Shah S.M., Khalid N., Gutmann D., Davison S., Alame Y.J., Syed L., Owen W.J., Ahsan S.D., Anthony-Uzoeto U., Macleod Hall C., Zheng S., Wynter K., James C., Sapre D., Ghosh R., Baird J., Cockburn L., Blackwood O., Simpson W., Jeong S., Bishop S., Bate R., Hobson C., Adam A.H., Redclift C., Do J., Adeleye O., Poli F., Batterham A., Brown S., Parekh J.N., Clay W., Pieri K., Jackson A., Saxena A., Gurung B., Oyebola T., O'Brien F., Djeugam B., Gardezi S., Ul-Hasan S., Martin-Hernandez M.P., Sisley M., Modi S., Antakia R., Elbayouk A., Soh Y.J., Mather J., Yusuf Z., Al-Sarraf Z., Naja M., Rassool S.B., Convill J., Nikookam Y., Warsame A., Pace C., Kiandee M., Ridwan R., Carey C., Hirri F., McMillan M.J.A., Ling J.J., Pendelbury L., Kerimzade K., Tang A., Howard E.O., Humayun S., Wadsworth O.J., Tan K., Abdelhameed F., Haglund C., Radnaeva I., Hu N., Rambhatla S., Waldron D., Madahar P., Malik S., Meney L.C., Ibrahim I., Kang C.K., Chiu J.Z.J., Livie V., Ibrahim B., Khalil M., Pooley G., Shishkin B., Docherty J., Southgate A., Coomes A., McGee F., Flanagan S., Tan Q.J., Anwar H., Clough R., Chrisp B., Cassels J., Cross G.W.V., Mercer L., Mercer C., Refalo A., Hadley R., McTighe A., Farrow F., Brodie A., Davis G., Shah D.R., Bowers C., Patel S., Morice O., Burzic A., Cheung J., Shashidhara A., Theodoraki G., Birk J., Ong A., Ng M.P.E., Wong R.T.W., Maese S., Yeap B., Iqbal Z., Rojoa D.M., Cabaleiro Barciela C., Ruddy C.M., Lindwe S., Qamar Y., Chuita S., Melaugh T., Hall J.D., Kouli O., Hassane A.S.I., Azhar A.W., Tan T.K., Perchard W., Scurr T., Campbell E., Kelk L., Ghosh A., Gibbins A., Mala D., Loizidou A., Hall O., Mecia L., Hew C., Varathan K., Tong L., Chandrasekar B., Buchanan E., O'Connell M., Kwak S.Y., Ong E.H., Gardner S., Lim J., Maden C., Illahi M., Xuan Tan Z., Stahl R., Stahl J., Hickman A., Collett D., Goolam-Mahomed Z., Allen B., Atiyah A., Ahmad H., Jones J., McGregor O., Ogundiya E., Boulbadaoui A., Kirnon-Jackman O., Lim Q.X., Peckham H., Yeoh T., Yong S.Q., Chen J.Y., Siva S., Sam Z.H., Gilani M., Goh Y.N., Muthukumar M.G., Phillips S., Tjoakarfa J., Giri A., Suresan S., Thomas P., Johnson T.A., Williams R.I., Rashid A., Kushairi A., Rais A., James A., Bugelli M., Chechelnitskaya Y., Sandhu N., Tandon R., Gray M., Kumar A., Ciurleo C., Nyamali I., Hiremath S., Sinha S., Chowdhary M., Bradley E., McTiernan M., Macdonald S., Sharkey S., McLaughlin N., Amey C., Kraria L., Skan O., Kind C., Tupper P., Van Rhee C., Honeyman S.I., Menon G., Jegatheeswaran L., Madhavan A., Warne M., Malcolm F.L., Lessware T., Wilkerson H.T., Chatterjee-Woolman S., Yoong A., Ahmed W.U.R., Longshaw A., Flannery O., Green R., Leaning M., Cragg J., Sharriff H., Doherty C., Kwan K.W.L., Sanders-Crook L., Bhatia S., Eames S., Lewis F., Kirupananthan P., Boh Z.Y., Dass S., Soma A., Newton A., Hill M., Shafiq Y., Brkljac M., Boyce L., English W.J., Lam S., Chipeta C., Jain C., Garofalidou T., Novotny S.A., Locke S., Bowman C., Begaj A., Murphy C., Radcliffe K., Chong J.T., Jeffrey E., Chaudhury N., Rajendran K., Akbar Z., Walters B., Kulendrarajah B., Tran N., Shrestha S., Parmar S., Gallagher C., Hennessy L., Pentti E., Badhrinarayanan S., Fung A., Mansoor M., Kenny R., Kan P., Lee D.E., Khosla S., Samake M., Shaban F., Aftab R., Gough M., Woodburn B., Vayalapra S., McMurrugh K., Jimulia D., Deol S., Pike S., Embury-Young Y., Patel M., Kilgallon E., Keating R., Walsh A., Khan H., Logue G., Orekoya M., Alasmar M., Charalambides M., Clave Llavall A., Williamson E., Bharwada Y., Zearmal S., Evans H., Panikkar M., de la Cruz G., Caplan J., Ruparelia A., Tanvir T., Soare C., Pang Y.L., Trotter J., Zaidi A., Thakrar V., Pulickal P., Ahmed H., Parnell J., Lennock S., Ford V., Brignall R., O'Neill D., Hanna R., Kane R., Nicola M., Rajput K., Xiao Y., Michael S., Wright E., Juniper S., Thompson E., Hoskyns L., Kanitkar A., Ross C., Unsworth A., Rshaidat H., Demarre K., Chiang A., Bareh A., van Dellen J., Faqihinejad C., Gadhvi A., Grant R., Lewsey J., Morris A., Martin H., McClarty C., Sanyal S., Alsaif A., Palkhi A., Bhopal S., Vishnu K S., Papanikolaou A., Mitra A., Nur A., Ali F., Burford C., Huq T., Irwin E., Matthews L., Ngu W.S., Hosfield T., Muneeb F., Page O., Zeb E., Al-Azzawi A., McIntosh J., Vucicevic A., Hughes M., Brooks L., Fanibi B., Dixon M., Njoku P., Morris D., Jobson J., Chowdhury H., Alawode D.O.T., Wynell-Mayow W., Udayachandran V., Alsoof D., Ekert J., Joseph N., Zulkefley N., Hunt G., Christodoulou T., Wright O., Soman S., Jamal M., Beqiri S., Borgas P., Christie S., Pereira F., Browne S., Yiu J., Dworkin A., Brayley J., Palmer A., Charalambos M., Jones C.S., Toner S., Cowden R., Lee L., Nicol P., Holman O., Imtiaz M., Albert V., Leung S.P., Erotocritou M., Stroud R., Wilkin R., Thomson W., Mackee L., G N., Bei Y., Mckenna Favier S., Ibrahim A., Kler A., Reynolds L., Mohamed S.H., Majeed Y., Fakim B., Jones A., Liversedge G., Carrington Z., Windebank J., Izzarina A., Akbani U., Craven J., Aldarragi A., Harding S., Millward A., Bedford M., Gopalan V., Midgen A., Khadka P., Cheng O., Taneja S., Manobharath N., Kok J.Y., Lim D.W.E., Buick T., Boland M., Piya S., Devlin R., Fairfield C.J., George R.J., Rahi M., Zaman S., Hajiev S., Ross T., Crisp E., Thompson C., Charalambous A., Hollywood J.L., Hammond R.F.L., Matthews J., Mendonca V., Spinty J., Khan K., Cheng J., Glynn N., Muhammad U., Khan M., Anderson L., Mccormack K., Mak J., Patrawala S., Milinkovic N., Schofield R., Chauhan M., Hartley L., Hind J., Nelson L., Ratnasingham D., Whitehead T., Dimitriadis S., Marshall K., Flint E.J., Horner C., Heybourne A., Morgan H., Wickstone C., Panagiotou D., O'Connell E., Dean K., Iqbal R., Walsh L., Yu N., Rana N., Massie E., Ng J., Jung M., Lee Y.D., Harris M., White S., Boev B., Tonchev P., Prochazka V., Skalicky A., Ravn S., Ojakaar A., Dorr-Harim C., Koutserimpas C., Giraudo G., Armellini A., Ruzzenente A., Mazzeo C., De Padua C., Realis Luc A., Maroli A., Giani I., Cufari M.E., Vitali M., Gusai G.P., Quattromani R., Virgilio E., Berti S., Di Mola Ospedale SS Annunziata F.F., Papagni V., Tuminello F., Vittori L., Longheu A., Loche G.A., Braccio B., De Luca E., Resta G., Ancans G., Tamosiunas A., Petrulionis M., Andrejevic P., Stellingwerf M.E., Abdulrahman N., van de Pas K.G.H., Thomas G., Brandsma A.M., Davids J., Rottier S.J., de Roy van Zuidewijn D., Hawkins R., Ong H.I., Li Y., Desmond B., Winstanley J., Martins M., Americano M., Frade S., Senhorinho R., Peixoto R., Alves-Vale C., Lamas M., O'Connor D.B., Hoo M., Gopaul A., Scanlon K., O'Dwyer N., Jovanovic M., Panyko A., Van Vuuren S., Centeno A., Bernado I.R., Paniagua Garcia Senorans M., Gonzalez Amor L., Cuenca Ramirez A., Abrisqueta J., Estaire Gomez M., Arroyo A., Cerdan C., Gomez Romeu N., Enriquez-Navascues J.M., Collado-Roura F., Curchod P., Gaspar S., Imadalou L., Mutlu D., Akyol C., Uygur F.A., Eray I.C., Biyiklioglu O., Cetin M.F., Isik A.E., Karip B., Dogan H., Sarigul L., Tunc E., Aydin T., Bodur S., Karabulut K., Francis A.A., Al-hadithi A., To N., Lau I.S.F., Smith E., Mahapatra S., McAuliffe O., Imam L., Akram B., Hossaini S., Davies R., Ko M., Collins J., Pandya A., Reilly S., Archer J., Auty C., Roche C.D., Livie J., Chaudhry F.A., Ntakomyti E., Diallo R., Bylinski T., Wright J., Masiha E., Tung J., Shirazi B., Neilson A., Epton S., Patel N., Trussell S., Couldrey A., Donnelly C., Eftychiou S., Glasbey, J. C., Bibi, S., Pata, F., Ozkan, B. B., Van Straten, S., Hodson, J., Chapman, S. J., Blanco-Colino, R., Pellino, G., Sgro, A., Soares, A., van Elst, T., Nepogodiev, D., Borakati, A., Bath, M. F., Yasin, I. H., Mclean, K., Arthur, T., Kovacevic, M., Delibegovic, S., Karamanliev, M., Swamad, M., Zebrak, R., Paramasivam, R., Martensen, A., Larsen, H. M., Radeker, L., Frey, P. E., Kechagias, A., Venara, A., Duchalais, E., Ioannidis, A., Pasquali, S., Simioni, A., Farina, V., Podda, M., Lorenzon, L., Itsurg, I., Schaeff, V., Otto, A., Jakubauskas, M., van Elst, T. R., Chu, M., Fagan, P. V. B., Wells, C. I., Alagoa Joao, A., Juloski, J., Perez-Ajates, S., Anabitarte Bautista, O., El Kasmy, Y., Espin-Basany, E., Clerc, D., Ciubotaru, C., Popescu, S., Yanishev, A., Lee, S., Yagiz Sen, A., Aktas, M. K., Baki, B. E., Yuksek, B., Kamarajah, S., Khaw, R. A., Mills, E., Goodson, R., Thakral, N., Collaborative, S., Ablett, A. D., Adra, M., Kwek, I., Khan, S. M., Quinn, P., Manley, L. R., Badran, A., Ramjeeawon, A., Campbell, A., Tan, H. L., Rye, D. S., Rajaraman, N., Norman, J. G., Vutipongsatorn, K., Solomou, G., Akhbari, M., Ali, A., Murray, V., Baker, D. M., Brandao, B. D., Stainer, B., Thavayogan, R., Jones, D., Onafowokan, O. O., Gharooni, A., Dabab, N., Carlton-Carew, S., Kungwengwe, G., Gabriel, M., Sewart, E., Shortland, T. C., Lawday, S., Pockney, P., Dawson, A., Brumfitt, C. D., Stewart, P., Ng, B., Luong, J. K., Ivanov, V., Borisova, A., Neykov, V., Kuncarova, K., Kolosova, B., Antonova, T., Farkasova, M., Harbjerg, J. L., Brandsborg, S., Brinck, S., Kjaer, M. D., Mark-Christensen, A., Unbehaun, K. P., Dalsgaard, P., Lycke, K. D., Lenaoures, P., Brigand, C., Dumange, E., Gout, M., Moehwald, C., Prem, M., Alhalabi, O., Sliwinski, S., Krupp, J., Gablenz, E., Schmitzer, L., Kopp, A., Steinle, J., Gsenger, J., Pohl, L. J., Riccardi, M., Christodoulou, I. M., Konstantinidis, M., Machairas, N., Zoikas, A., Balalis, D., Manatakis, D. K., Aguilera, M. L., Marano, L., Fleres, F., Lovisetto, F., Sasia, D., Segalini, E., Pata, G., Lucchi, A., Sagnotta, A., Campagnaro, T., Petrelli, F., Gallo, G., Papandrea, M., Testa, V., Sinibaldi, G., Di Candido, F., Colombo, F., Perrone, G., Biancafarina, A., Canonico, G., Pagnanelli, M., Curletti, G., Bini, R., de Manzoni Garberini, A., Impellizzeri, H., Cillara, N., Tutino, R., Picciariello, A., Coletta, D., Savino, G., Ferrara, F., Tamini, N., Talamo, G., Parini, D., Giamundo, P., lo Conte, A., Pagano, G., Ripetti, V., Pesce, A., Menduni, N., Giudicissi, R., Goldin, E., Rega, D., Belli, A., Andriola, V., Gordini, L., Foppa, C., Piccolo, G., Birindelli, A., Ferrari, C., Ballarini, Z., Tirelli, F., Milone, M., De Rosa, M., Pipitone Federico, N. S., Molteni, B., Tilocca, P. L., Sancini, G., Piozzi, G. N., Lauretta, A., Poillucci, G., Mulas, S., Simcikas, D., Portelli, L., van Wijnbergen, J. W. M., Dinger, T. L., ten Doesschate, S. F. H., van Dalen, A. S. H. M., van den Bos, D. D., Hansmann, M., Medina Feliz, J., Kuiper, S. Z., Abdulrahman, Z., Pruijssers, S. R., Farik, S., Elliott, B. M., Geneta, V. P., Wilton, S., Kandelaki, H., Peng, S. L., Campbell, S., Lim, Y. K., Yassaie, S. S., Murray, M., Haran, C., Tan, J., Castro, J., Laranjeira, A., Catarino, S., Neves-Marques, C., Correia, J. G., Vieira, B. N., Quintela, A. C., Serra, M. L., Maciel, J., Cunha, M., Aparicio, D. J., Neves, J., Azevedo, J., Romano, M., Eiro, F., Romano, J., Monteiro, C., Claro, M., Almeida, M. R., Peyroteo, M., Machado, N. D., Capote, H., Ferreira, M., Sousa, X., Devesa, H., Cavadas, D., Guerreiro, I., Costa, M., Rosete, M., Salman, M., English, C., Mohammed, N., Litvin, A., Cuk, V. 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J., Navarro Barrios, A., Rodriguez Pedreno, L., Garcia Moreno, P., Garcia Gomez, M., Rodrigues, K., Platero Diago, J., Veras Lista, M., Rifa Terricabras, S., Butler Sanz, L., Alberch Camprubi, E., Rico Ferrandez, M., Puig Lao, E., De Pablo Miro, M., Alberca-Paramo, A., Alia Verdejo, T., Canete-Manzanares, J., Molina-Florez, M., Garcia Hernandez, L. C., Orozco Nunez, S., Suarez-Sanchez, M., Martin-Fernandez, J., Soriano Liebana, M. M., Campo Betancourth, C. F., Sevila Mico, S., Fernandez, A., Curtis, C., Bosch, M., Triguero, D., Bosch Ramirez, M., Ramayo Diaz, N., Gonzalez Caraballo, I., Pascual Vicente, T., Orue-Echebarria, M. I., Sanchez-Calvo, L., Wang, D., Trueba-Collado, C., Morales Bernaldo de Quiros, J. T., Lima Pinto, F., Nunez OSullivan, S., Ramos Jimenez, F. A., Perez Ortega, A., Trujillo Barbadillo, A., Romero Pujana, E., Fernandez Illera, M. V., De La Llave Serralvo, A., Mestres, N., Cuello, E., Merichal, M., Sierra, J. E., Escoll, J., Rufas, M., Pinillos, A. 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Pektas, A.M., Güner, B., İşlek, E.C., Tombul, H.B., Boztuğ, C.Y., Tınaz, A., Yılmaz, M., Akın, F.A., Başçavuş, M., Seker, M.C., Koçak, Z.B., Karapinar, Y.E., Köseoglu, E., Agca, M.H., Alim, Y.E., Kürklü, Ö., Çalar, S.N., Kavar, R.C., Cevlik, A.D., Turk, E.G., Erdönmez, H., Gürsoy, F., Önsal, U., Özbek, M., Kasar, P.A., Özen, D., Ölmez, M., Sariçiçek, T., Tipi, O.U., Benli, G.E., Bilgili, A.C., Kiraz, I.N., Demirci, Z.S., Aksoy, A.B., Karagöz, E., Tümer, S.S., Abdulrahman, S., Kuyumcu, O.F., Afsar, H.B., Guler, S.E., Gul, E.B., Dossa, S., Mizan, S.R., Mazlum, S.S., Sahin, A.Z., Kilinç, A., Yumurtaci, Ö., Girit, Ç., Yildirak, M.K., Güldag, A., Söyleyici, B., Aytin, Y.E., Akay, F.E., Iskan, N.G., Sunay, A.O., McGuckin, S., Delaugere, L.P., Yeo, Y.Q., Aly, M.H., Bin Amran, M.A., Kyaw, H.A., Clements, J.M., Wong, H.L., McCusker, C., Armitage, M.N., Hussain, A.S., Hassan Serry, M.Y., Tam, L., Sookramanien, S.R., Ward, K.L., Pherwani, S.A., Drury, D.J., James, S.J., Teasdale, A.B., Richardson, E., Thomas, D.A., Williams, R.L., Najabat-Lattif, H.F., Zhu, L.Y., Mihailidis, T.H., Pedersen, A.C., Robinson, A.V., Cheong, C.M., Ike, S.I., Chu, T., Mogg, J., Claireaux, H.A., Al-Ausi, M., Shah, S.M., Alame, Y.J., Owen, W.J., Ahsan, S.D., Adam, A.H., Parekh, J.N., Martin-Hernandez, M.P., Soh, Y.J., Rassool, S.B., McMillan, M., Ling, J.J., Howard, E.O., Wadsworth, O.J., Meney, L.C., Kang, C.K., Chiu, J., McGee, F., Tan, Q.J., Cross, G., McTighe, A., Shah, D.R., Ng, M., Wong, R., Rojoa, D.M., Ruddy, C.M., Hall, J.D., Hassane, A., Azhar, A.W., Tan, T.K., Kwak, S.Y., Ong, E.H., McGregor, O., Lim, Q.X., Yong, S.Q., Chen, J.Y., Sam, Z.H., Goh, Y.N., Muthukumar, M.G., Johnson, T.A., Williams, R.I., McTiernan, M., McLaughlin, N., Honeyman, S.I., Malcolm, F.L., Wilkerson, H.T., Ahmed, W., Kwan, K., Boh, Z.Y., English, W.J., Novotny, S.A., Chong, J.T., Lee, D.E., McMurrugh, K., Clavé Llavall, A., Pang, Y.L., McClarty, C., Ngu, W.S., McIntosh, J., Alawode, D., Jones, C.S., Leung, S.P., Mohamed, S.H., Kok, J.Y., Lim, D., Fairfield, C.J., George, R.J., Hollywood, J.L., Hammond, R., Flint, E.J., Lee, Y.D., Skalický, A., Ojakäär, A., Dörr-Harim, C., Cufari, M.E., Gusai, G.P., Di Mola Ospedale Ss Annunziata, F.F., Loche, G.A., Stellingwerf, M.E., van de Pas, K., Brandsma, A.M., Rottier, S.J., Ong, H.I., O'Connor, D.B., Jovanović, M., Bernado, I.R., Paniagua Garcia Señorans, M., González Amor, L., Cuenca Ramírez, A., Cerdán, C., Gómez Romeu, N., Enriquez-Navascues, J.M., Uygur, F.A., Eray, I.C., Çetin, M.F., Isik, A.E., Sarıgül, L., Francis, A.A., Al-Hadithi, A., Lau, I., McAuliffe, O., Roche, C.D., Chaudhry, F.A., Amsterdam Gastroenterology Endocrinology Metabolism, Other Research, Graduate School, Surgery, Oncology, AII - Infectious diseases, and ACS - Microcirculation
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medicine.medical_specialty ,endocrine system ,general surgery ,Gastrointestinal ,endocrine system diseases ,Settore MED/18 - CHIRURGIA GENERALE ,pulmonary complications ,03 medical and health sciences ,0302 clinical medicine ,Ileus ,Nasogastric tube insertion ,Medicine ,pulmonary complication ,pneumonia ,EPIDEMIOLOGY ,Humans ,Prospective Studies ,colorectal surgery ,nasogastric tube ,Prospective cohort study ,Intubation, Gastrointestinal ,OUTCOMES ,VENTILATOR-ASSOCIATED PNEUMONIA ,business.industry ,Elective Surgical Procedures ,Pneumonia ,Confounding ,Gastroenterology ,nutritional and metabolic diseases ,Odds ratio ,Postoperative pneumonia ,medicine.disease ,Colorectal surgery ,Surgery ,body regions ,Intubation, Gastrointestinal/adverse effects ,Pneumonia/epidemiology ,Pneumonia/etiology ,Pneumonia/prevention & control ,030220 oncology & carcinogenesis ,Vomiting ,030211 gastroenterology & hepatology ,medicine.symptom ,business ,Intubation ,hormones, hormone substitutes, and hormone antagonists - Abstract
© 2020 The Association of Coloproctology of Great Britain and IrelandAim: Aspiration is a common cause of pneumonia in patients with postoperative ileus. Insertion of a nasogastric tube (NGT) is often performed, but this can be distressing. The aim of this study was to determine whether the timing of NGT insertion after surgery (before versus after vomiting) was associated with reduced rates of pneumonia in patients undergoing elective colorectal surgery. Method: This was a preplanned secondary analysis of a multicentre, prospective cohort study. Patients undergoing elective colorectal surgery between January 2018 and April 2018 were eligible. Those receiving a NGT were divided into three groups, based on the timing of the insertion: routine NGT (inserted at the time of surgery), prophylactic NGT (inserted after surgery but before vomiting) and reactive NGT (inserted after surgery and after vomiting). The primary outcome was the development of pneumonia within 30 days of surgery, which was compared between the prophylactic and reactive NGT groups using multivariable regression analysis. Results: A total of 4715 patients were included in the analysis and 1536 (32.6%) received a NGT. These were classified as routine in 926 (60.3%), reactive in 461 (30.0%) and prophylactic in 149 (9.7%). Two hundred patients (4.2%) developed pneumonia (no NGT 2.7%; routine NGT 5.2%; reactive NGT 10.6%; prophylactic NGT 11.4%). After adjustment for confounding factors, no significant difference in pneumonia rates was detected between the prophylactic and reactive NGT groups (odds ratio 1.03, 95% CI 0.56–1.87, P = 0.932). Conclusion: In patients who required the insertion of a NGT after surgery, prophylactic insertion was not associated with fewer cases of pneumonia within 30 days of surgery compared with reactive insertion.
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- 2020
20. Pre-procedural pacing bias among transcatheter aortic valves with higher post-procedure pacing rates: evidence from the UK TAVI Registry
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P MacCarthy, James Cockburn, P Ludman, S Redwood, A. de Belder, D.J. Blackman, Roland Hilling-Smith, Adrian P. Banning, J Smethurst, Saib Khogali, David Hildick-Smith, Uday Trivedi, and Timothy Williams
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Medtronic corevalve ,medicine.medical_specialty ,education.field_of_study ,British cardiovascular intervention society ,Transcatheter aortic ,business.industry ,Population ,030204 cardiovascular system & hematology ,Vascular surgery ,Cardiac surgery ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Cardiology ,In patient ,030212 general & internal medicine ,Permanent pacemaker ,Cardiology and Cardiovascular Medicine ,education ,business - Abstract
Rates of permanent pacemaker (PPM) implantation following transcatheter aortic valve implantation (TAVI) are higher than following surgery and are dependent on patient factors and valve type. There is an increasing trend towards pre-emptive PPM insertion in patients with significant conduction disease prior to TAVI. We report results from the British Cardiovascular Intervention Society (BCIS) on pre- and post-procedural PPM implantation in the TAVI population. All centres in the United Kingdom performing TAVI are required to submit data on all TAVI procedures to the National database which are then reported annually. During 2015, there were 2373 TAVI procedures in the UK. 22.4% of TAVI patients had a PPM implanted either pre-procedure (including the distant past), or during the in-hospital procedural episode. Of these, 7.9% were pre-procedure and 14.5% post-procedure. Overall PPM rates were Edwards Sapien (13.5%), Medtronic CoreValve (28.2%) and Boston Lotus (42.1%; p
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- 2020
21. Prognostic implications of the rapid recruitment of coronary collaterals during ST elevation myocardial infarction (STEMI): a meta-analysis of over 14,000 patients
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James Cockburn, Yasuhiko Sakata, James C. Weaver, Daniel Nour, Usaid K. Allahwala, Osama Alsanjari, David Hildick-Smith, Michael R. Ward, Ravinay Bhindi, Kunwardeep S Bhatia, Vinayak Nagaraja, and Jaikirshan Khatri
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medicine.medical_specialty ,Ejection fraction ,medicine.diagnostic_test ,business.industry ,MEDLINE ,Hematology ,030204 cardiovascular system & hematology ,Cochrane Library ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,Systematic review ,Meta-analysis ,Internal medicine ,Angiography ,medicine ,Cardiology ,Observational study ,cardiovascular diseases ,030212 general & internal medicine ,Myocardial infarction ,Cardiology and Cardiovascular Medicine ,business - Abstract
Acute coronary collateralisation of an infarct-related arterial (IRA) territory may be identified during angiography for ST elevation myocardial infarction (STEMI). Whether the presence or absence of these collaterals affects outcomes remains uncertain. A search of EMBASE, MEDLINE and Cochrane Library, using the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines was conducted to identify studies which reported on the association between coronary collaterals and in-hospital and longer term mortality, left ventricular ejection fraction (LVEF), risk of repeat acute myocardial infarction (AMI) and repeat revascularisation. Patients with Rentrop grade 0 or 1 were defined as poor collaterals whilst those with Rentrop grade two or three were defined as those with robust collaterals. Studies were eligible if they included patients ≥ 18 years of age who had immediate coronary angiography for STEMI. Included studies were observational which recorded the degree of collateral blood flow to the IRA. Two investigators reviewed all citations using a predefined protocol with final consensus for all studies, the data from which was then independently entered to ensure fidelity of results. Inverse variance random effects model for the meta-analysis along with risk of bias assessment was performed. 20 studies with a total of 14,608 patients were identified and included in the analysis. Patients with robust collaterals had lower mortality (OR 0.55, 95% CI 0.48–0.64), both in-hospital (OR 0.47, 95% CI 0.35–0.63) and longer term (OR 0.58, 95% CI 0.46–0.75). Patients with robust collaterals also had a higher mean LVEF (SMD 0.23, 95% CI 0.10–0.37). There was no difference in the rates of AMI or repeat revascularisation between patients with robust or poor collaterals. The presence of robust collaterals during STEMI is associated with reduced in-hospital and longer term mortality and improved left ventricular function. These findings have implications for prognostication and identifying patients who require close monitoring following STEMI.
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- 2020
22. Renal pelvic rupture, intrapelvic haematoma and retroperitoneal haemorrhage associated with obstructive ureterolithiasis in a cat
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Ian Battersby, E. Cockburn, and R. S. Doyle
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medicine.medical_specialty ,business.industry ,Retroperitoneal haemorrhage ,Echogenicity ,Distension ,urologic and male genital diseases ,Renal pelvic ,medicine.anatomical_structure ,Medicine ,Histopathology ,Neutered female ,Radiology ,Ureterolithiasis ,Small Animals ,business ,Renal pelvis - Abstract
A neutered female cat presented with a 9-day history of hyporexia and depression. The referring veterinarian had identified moderate non-regenerative anaemia, haematuria and suspected unilateral obstructive ureterolithiasis. Subsequent ultrasonography revealed moderate distension of the left renal pelvis with echogenic material, ureteral distension and ureterolithiasis. A partial ureteral obstruction was suspected. After 4 days of medical management, there was further distension of the renal pelvis with well-delineated echogenic material and an accumulation of perinephric fluid. A left nephroureterectomy was performed. Renal pelvic rupture with intrapelvic haematoma and retroperitoneal haemorrhage was confirmed by histopathology. Eighteen months following surgery, the cat remained clinically well with normal renal values.
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- 2020
23. Contemporary management of anaemia, erythropoietin resistance and cardiovascular risk in patients with advanced chronic kidney disease: a nationwide analysis
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Hannah Bower, Marie Evans, Juan Jesus Carrero, Stefan H. Jacobson, Peter Bárány, and Elinor Cockburn
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medicine.medical_specialty ,Anemia ,medicine.medical_treatment ,030232 urology & nephrology ,Context (language use) ,ESA ,03 medical and health sciences ,iron ,0302 clinical medicine ,hemic and lymphatic diseases ,Internal medicine ,Epidemiology ,medicine ,030212 general & internal medicine ,AcademicSubjects/MED00340 ,Dialysis ,anaemia ,Transplantation ,business.industry ,Hazard ratio ,Original Articles ,medicine.disease ,haemoglobin ,inflammation ,Nephrology ,dialysis ,epidemiology ,Hemodialysis ,business ,chronic kidney disease ,Mace ,Kidney disease - Abstract
BackgroundOptimal management of chronic kidney disease (CKD) anaemia remains controversial and few studies have evaluated real-world management of anaemia in advanced CKD in the context of guideline recommendations.MethodsWe performed an observational study from the Swedish Renal Registry evaluating the epidemiology and treatment patterns of anaemia across Stages 3b–5 in non-dialysis (ND) and dialysis-dependent (DD) CKD patients during 2015. Logistic regression and Cox models explored the associations between anaemia treatments, inflammation, erythropoietin resistance index (ERI) and subsequent 1-year risk of major adverse cardiovascular events (MACEs).ResultsData from 14 415 (ND, 11 370; DD, 3045) patients were included. Anaemia occurred in 60% of ND and 93% of DD patients. DD patients used more erythropoiesis-stimulating agents (ESAs; 82% versus 24%) and iron (62% versus 21%) than ND patients. All weekly ESA doses were converted to a weight-adjusted weekly epoetin equivalent dose. The prescribed ESA doses were low to moderate [median 48.2 IU/kg/week (ND), 78.6 IU/kg/week (DD)]. Among ESA-treated patients, 6–21% had haemoglobin (Hb) >13 g/dL and 2–6% had Hb 5 mg/L) was highly prevalent and associated with ERI and higher ESA doses. Higher (>88 IU/kg/week) versus lower (ConclusionsAnaemia remains highly prevalent in advanced CKD. Patients with anaemia received moderate ESA doses with a relatively low prevalence of iron use. Higher doses of ESA were associated with inflammation and a higher risk of MACE.
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- 2020
24. The potential population‐based impact of an HPV vaccination intervention in Colorado
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Jessica R. Cataldi, Amy Anderson-Mellies, Amanda F. Dempsey, Marian Håbesland, and Myles Cockburn
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Adult ,0301 basic medicine ,Cancer Research ,medicine.medical_specialty ,Pediatrics ,Colorado ,Adolescent ,cervical cancer ,Immunization registry ,Uterine Cervical Neoplasms ,preventive medicine ,Mass Vaccination ,lcsh:RC254-282 ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Registries ,Child ,Health Education ,Original Research ,Preventive healthcare ,Cervical cancer ,Information Dissemination ,business.industry ,Incidence ,Public health ,Number needed to vaccinate ,Papillomavirus Infections ,Health Plan Implementation ,Cancer ,Middle Aged ,medicine.disease ,vaccination ,lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,3. Good health ,Vaccination ,human papillomavirus vaccines ,030104 developmental biology ,Oncology ,Communication Intervention ,030220 oncology & carcinogenesis ,Female ,business ,Cancer Prevention ,Program Evaluation - Abstract
Background Human papillomavirus (HPV) infection is the most common cause of cervical cancer and can be prevented with vaccination, but HPV vaccination rates remain low. An intervention to improve health care provider communication about vaccination has been shown to increase HPV vaccination rates in an initial trial in Colorado, where about 160 cases of cervical cancer are diagnosed each year. Methods Census data were combined with Colorado cancer and immunization registry data to identify clinics in locations that would most benefit from implementation of this intervention to improve HPV vaccination rates. ArcGIS Pro was used to map cervical cancer incidence, immunization rates, population data, and location of clinics participating in practice‐based research networks (PBRNs). Results from the provider communication intervention trial and published estimates of the number needed to vaccinate to prevent a case of cervical cancer were used to predict the number of cervical cancer cases prevented based on increased vaccination due to the intervention. Results Ninety‐eight Colorado PBRN clinics were analyzed. For the 10 clinics with the highest predicted number of cervical cancer cases prevented, 5218 additional patients would be vaccinated and 43 cervical cancer cases prevented with implementation of the intervention. If implemented in all 98 clinics, the intervention would lead to 20 490 additional patients vaccinated (range 7‐658/clinic) and 171 cases of cervical cancer prevented (range 0.05‐5.48/clinic). Conclusions Geographic data from cancer and immunization registries can inform the dissemination of evidence‐based practices like the provider communication intervention for HPV vaccination to maximize impact on public health., A model predicting the number of cervical cancer cases prevented with implementation of an evidence‐based intervention to increase HPV vaccination was developed using cancer and immunization registry data and published estimates of the number needed to vaccinate to prevent one case of cervical cancer. Population, cervical cancer incidence, immunization rates, and clinic locations across Colorado were analyzed to identify clinics that would benefit most from the intervention. This analysis demonstrates how spatial data from existing registries can identify clinics with the highest predicted number of cervical cancer cases prevented, thus maximizing the public health impact of an HPV vaccination intervention.
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- 2020
25. Factors affecting lymph node sampling patterns and the impact on survival of lymph node density in patients with Wilms tumor: a Surveillance, Epidemiology, and End Result (SEER) database review
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Jared S. Johnson, Amanda F. Saltzman, Jonathan P. Walker, Myles Cockburn, Megan Eguchi, and Nicholas G. Cost
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Male ,Oncology ,medicine.medical_specialty ,Databases, Factual ,Urology ,medicine.medical_treatment ,030232 urology & nephrology ,Wilms Tumor ,Article ,Specimen Handling ,03 medical and health sciences ,symbols.namesake ,0302 clinical medicine ,030225 pediatrics ,Internal medicine ,Epidemiology ,medicine ,Humans ,In patient ,Poisson regression ,Stage (cooking) ,Lymph node ,Survival analysis ,business.industry ,Infant ,Wilms' tumor ,medicine.disease ,Survival Analysis ,Kidney Neoplasms ,Nephrectomy ,medicine.anatomical_structure ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,symbols ,Female ,Lymph Nodes ,business ,SEER Program - Abstract
Summary Background Lymph node (LN) involvement is an important prognostic indicator for patients with Wilms tumor (WT), and there have been previous reports of utilizing LN density (LND = positive LN/LNs examined) as an advanced metric to risk-stratify patients with WT. Objective The purpose of this study was to describe patient characteristics that affect LN yield and assess the effect of LND on the overall survival (OS) in patients with WT, with the expectation that patients with LNDs above a critical cut-point would demonstrate lower OS. Study design The Surveillance, Epidemiology, and End Result (SEER) database was queried for all patients diagnosed with unilateral WT from 2004 to 2015. Patient and disease characteristics were collected, and Poisson regression was used to identify characteristics correlated with LN yield. LND was calculated for LN-positive patients, and multivariable survival analysis was performed, including patient demographics and LND as variables. Results 1489 patients with unilateral WT were identified for analysis, 231 (15.51%) of whom were LN-positive. Median patient age at diagnosis was three years (IQR 1–5). On Poisson regression, the year of diagnosis, patient age, tumor size and laterality, and stage were found to impact LN yield. For patients with positive LNs, five-year OS of patients with LNDs above 0.4 was worse than those below 0.4 (76.1% vs 89.6%, p = 0.041). On multivariable analysis, tumor size and LND remained significant predictors of OS. Discussion Administrative databases such as SEER provide an excellent resource for studying conditions where large patient numbers for analysis are difficult to obtain. Unfortunately, the SEER database is unable to account for every factor that could affect LN sampling patterns. Additionally, favorable vs unfavorable histology is not available in SEER, and SEER utilizes its own staging system, which makes comparison to Children's Oncology Group staging difficult. Despite these limitations, the findings of this study are similar to those previously published using administrative databases analyzing LN sampling patterns and the effect of LND on OS in WT. Conclusions Analysis of the SEER database confirms that there are several patient- and disease-specific factors that affect the number of LNs sampled during nephrectomy for WT, and that LND may be a predictor of OS. These findings highlight the need for standardization of LN sampling patterns for pediatric renal tumors and support the investigation of LND in future studies to further risk-stratify WT patients to tailor therapy intensity.
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- 2020
26. Angiographically visible coronary artery collateral circulation improves prognosis in patients presenting with acute ST segment‐elevation myocardial infarction
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Lucy Blows, Osama Alsanjari, Nalyaka Sambu, Tarak Chouari, Adam de Belder, Timothy Williams, James Cockburn, David Hildick-Smith, and Aung Myat
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Male ,medicine.medical_specialty ,Time Factors ,Databases, Factual ,medicine.medical_treatment ,Shock, Cardiogenic ,Collateral Circulation ,030204 cardiovascular system & hematology ,Coronary Angiography ,03 medical and health sciences ,Coronary circulation ,Percutaneous Coronary Intervention ,0302 clinical medicine ,Predictive Value of Tests ,Risk Factors ,Coronary Circulation ,medicine.artery ,Internal medicine ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,030212 general & internal medicine ,Myocardial infarction ,Aged ,medicine.diagnostic_test ,business.industry ,Cardiogenic shock ,Percutaneous coronary intervention ,General Medicine ,Middle Aged ,Collateral circulation ,medicine.disease ,Treatment Outcome ,medicine.anatomical_structure ,Right coronary artery ,Angiography ,Cardiology ,ST Elevation Myocardial Infarction ,Female ,Cardiology and Cardiovascular Medicine ,business ,TIMI - Abstract
Background Coronary collaterals are often seen supplying retrograde flow to an acutely occluded arterial territory. Whether this early collateralization offers prognostic benefit is not well established. Methods We analyzed data from all patients presenting to our regional cardiac unit with acute ST-elevation myocardial infarction requiring immediate angiography (years 1999-2017). Data on all patients is entered prospectively into a bespoke tailored database prior to knowledge of patient outcome. Only patients with TIMI 0 or 1 flow in the infarct-related vessel were included in the analysis. In-hospital and long-term outcome were assessed according to the presence or absence of angiographically visible collateral flow prior to treatment of the occluded vessel. Results Two thousand five hundred and forty-two patients were included in the analysis. 76% of these (n = 1944) had TIMI 0/1 flow at angiography. Angiographically-visible collateralization was seen in 17% (n = 322) and was more commonly observed in the right coronary artery (64%) than in the left anterior descending (25%) or Cx (6%). Cardiogenic shock (10.8%) and use of an intra-aortic balloon pump (5.4%) were more frequent in patients without coronary collateralisation (p = .04 and p = .02, respectively). The presence of collaterals improved long term survival (95% CI 11.4-18.7 months; p Conclusion One-sixth of patients with STEMI have angiographically visible collaterals to the infarcted territory. Patients without collaterals are more likely to present in cardiogenic shock. The presence of angiographically visible collaterals at the time of STEMI is associated with an improved long-term survival.
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- 2019
27. Trends and clinical characteristics of COVID-19 vaccine recipients: a federated analysis of 57.9 million patients’ primary care records in situ using OpenSAFELY
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Harriet Forbes, Laurie A. Tomlinson, Nasreen Parkes, Kevin Wing, Richard Croker, Elizabeth A. Williamson, Dima Avramov, Tom Ward, Alex Eavis, Helen J Curtis, Ben Goldacre, Peter Inglesby, William J Hulme, Chris Bates, Anna Rowan, Caroline E Morton, Louis Fisher, Amir Mehrkar, Rosalind M Eggo, Henry Drysdale, George Hickman, Sam Harper, John Parry, Aaron Fowles, Seb Bacon, Richard Jarvis, Ian J. Douglas, Frank Hester, Stephen J. W. Evans, Liam Smeeth, Krishnan Bhaskaran, Jonathan Cockburn, David M. Evans, Jessica Morley, Christopher T Rentsch, Rohini Mathur, Alex J Walker, Amelia Green, Helen Mcdonald, Angel Y S Wong, Paul D. Griffiths, Simon Davy, Anna Schultze, Brian MacKenna, and Shaun O'Hanlon
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medicine.medical_specialty ,COVID-19 Vaccines ,Coronavirus disease 2019 (COVID-19) ,Population ,Ethnic group ,Primary care ,Ethnic groups ,ethnic groups ,Cohort Studies ,Electronic health record ,parasitic diseases ,Global health ,medicine ,Humans ,Letters ,education ,general practice ,education.field_of_study ,Primary Health Care ,Descriptive statistics ,SARS-CoV-2 ,business.industry ,Research ,Vaccination ,COVID-19 ,Retrospective cohort study ,vaccination ,Mental illness ,medicine.disease ,Family medicine ,General practice ,Cohort ,Mass vaccination ,NHS England ,Family Practice ,business ,Cohort study - Abstract
Background On December 8th 2020, NHS England administered the first COVID-19 vaccination as part of an ambitious vaccination programme during a global health emergency. Aims To develop a framework for detailed near-real-time monitoring of COVID-19 vaccine roll-out; to describe trends and variation in coverage by geographic area, and between key clinical and demographic patient groups. Methods Working on behalf of NHS England we used routine clinical data from 23.4 million patients to conduct a retrospective cohort study of comprehensive electronic health record data in NHS England, using the OpenSAFELY-TPP platform which covers approximately 40% of the general population in England with weekly data updates. We developed algorithms to identify key demographic and clinical sub-groups within this population and generated descriptive statistics on proportion of eligible patients receiving the vaccine among key Joint Committee on Vaccination and Immunisation (JCVI) target groups. Results Between December 8th and January 13th 961,580 people out of 23.4m in our dataset received a COVID-19 vaccine. Of 1,160,062 patients aged 80 or over and not living in a care home (currently targeted by JCVI) 476,375 had been vaccinated in total (41.1%). We observed a substantial divergence in vaccination by ethnicity within this group (White 42.5% vaccinated, Black 20.5%) and across rankings of deprivation (least deprived 44.7%, most deprived 37.9%). Patients with pre-existing medical conditions were equally likely, or more likely, to have received a vaccine across most co-morbidity groups with two exceptions: severe mental illness (30.3% vaccinated) and learning disability (28.1%). We identify substantial variation in vaccination among the over-80s between Sustainability and Transformation Partnerships (STPs; Range 12%-74%); lower vaccination rates among ethnic minority and deprived groups was observed in most but not all STPs. In the 70-79 age cohort 74,108 people (3.6%) had been vaccinated. 378,921 vaccine recipients under 70 and not identifiably resident in a care home were presumed to be health or social care workers; 32,174 recipients were identified as older aged care home residents (33.2% coverage). Of all those vaccinated, 169,472 had received a second dose (17.6%). Conclusions The NHS in England has rapidly delivered mass vaccination. We were able to deploy a data monitoring framework across small clinical subgroups using linked patient-level NHS data on 23.4 million people with very short delays from vaccine administration to completed analysis. Targeted activity may be needed to address lower vaccination rates observed among certain key groups: ethnic minorities, people living in areas of higher deprivation, and those with severe mental illness or learning disabilities. However we note that this data is only from the first preliminary weeks of the vaccination programme. Variation in vaccination coverage between groups and regions will have many complex drivers, the figures presented in this manuscript require thoughtful interpretation to support a rapidly evolving NHS vaccination campaign; we are sharing local level data with national and regional NHS teams on request.
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- 2021
28. OpenSAFELY NHS Service Restoration Observatory 1: primary care clinical activity in England during the first wave of COVID-19
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Simon Davy, Brian MacKenna, Anna Schultze, Henry Drysdale, Rohini Mathur, Frank Hester, Laurie A. Tomlinson, David M. Evans, Christopher T Rentsch, Alex J Walker, Seb Bacon, George Hickman, Amir Mehrkar, Elizabeth A. Williamson, John Parry, Stephen J. W. Evans, Harriet Forbes, Kevin Wing, Ian J. Douglas, Liam Smeeth, Krishnan Bhaskaran, Chris Bates, Helen Mcdonald, Rosalind M Eggo, William J Hulme, Tom Ward, Jessica Morley, Jonathan Cockburn, Angel Y S Wong, Richard Croker, Caroline E Morton, Helen J Curtis, Peter Inglesby, Ben Goldacre, and Sam Harper
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medicine.medical_specialty ,State Medicine ,Cohort Studies ,Pandemic ,Health care ,Medicine ,Electronic health records ,Humans ,Pandemics ,Asthma ,Blood coagulation test ,Primary health care ,general practice ,COPD ,Respiratory tract infections ,business.industry ,SARS-CoV-2 ,Research ,Respiratory disease ,COVID-19 ,medicine.disease ,primary health care ,electronic health records ,England ,Scale (social sciences) ,Emergency medicine ,Family Practice ,business ,General practice - Abstract
Background The COVID-19 pandemic has disrupted healthcare activity globally. The NHS in England stopped most non-urgent work by March 2020, but later recommended that services should be restored to near-normal levels before winter where possible. The authors are developing the OpenSAFELY NHS Service Restoration Observatory , using data to describe changes in service activity during COVID-19, and reviewing signals for action with commissioners, researchers and clinicians. Here we report phase one: generating, managing, and describing the data. Objective To describe the volume and variation of coded clinical activity in English primary care across 23.8 million patients’ records, taking respiratory disease and laboratory procedures as key examples. Methods Working on behalf of NHS England we developed an open source software framework for data management and analysis to describe trends and variation in clinical activity across primary care EHR data on 23.8 million patients; and conducted a population cohort-based study to describe activity using CTV3 coding hierarchy and keyword searches from January 2019-September 2020. Results Much activity recorded in general practice declined to some extent during the pandemic, but largely recovered by September 2020, with some exceptions. There was a large drop in coded activity for commonly used laboratory tests, with broad recovery to pre-pandemic levels by September. One exception was blood coagulation tests such as International Normalised Ratio (INR), with a smaller reduction (median tests per 1000 patients in 2020: February 8.0; April 6.2; September 7.0). The overall pattern of recording for respiratory symptoms was less affected, following an expected seasonal pattern and classified as “no change” from the previous year. Respiratory tract infections exhibited a sustained drop compared with pre-pandemic levels, not returning to pre-pandemic levels by September 2020. Various COVID-19 codes increased through the period. We observed a small decline associated with high level codes for long-term respiratory conditions such as chronic obstructive pulmonary disease (COPD) and asthma. Asthma annual reviews experienced a small drop but since recovered, while COPD annual reviews remain below baseline. Conclusions We successfully delivered an open source software framework to describe trends and variation in clinical activity across an unprecedented scale of primary care data. The COVD-19 pandemic led to a substantial change in healthcare activity. Most laboratory tests showed substantial reduction, largely recovering to near-normal levels by September 2020, with some important tests less affected. Records of respiratory infections decreased with the exception of codes related to COVID-19, whilst activity of other respiratory disease codes was mixed. We are expanding the NHS Service Restoration Observatory in collaboration with clinicians, commissioners and researchers and welcome feedback.
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- 2021
29. EPV063/#357 The impact of surgical approach in cases with no residual disease on hysterectomy specimen: a 4C (Canadian cervical cancer collaborative) working group study
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T Feigenberg, D Vicus, S Shamiya, L Helpman, J Sabourin, N Sadeq, S Lau, Vanessa Samouëlian, K Willows, Gregg Nelson, L Elit, S Piedimonte, A Altman, C Aubrey, N Cockburn, J Kwon, Marie Plante, SR Kim, L-A Teo-Fortin, and G Pond
- Subjects
Cervical cancer ,medicine.medical_specialty ,Hysterectomy ,Surgical approach ,Group study ,business.industry ,medicine.medical_treatment ,General surgery ,medicine ,Disease ,Residual ,medicine.disease ,business - Published
- 2021
30. EPV062/#354 Comparison of outcomes between abdominal, minimally invasive and combined vaginal- laparoscopic hysterectomy in patients with stage IAI/IA2 cervical cancer: 4C (Canadian cervical cancer collaborative) study
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Marie Plante, S Shamiya, L Elit, D Vicus, RS Kim, S Lau, Vanessa Samouëlian, L Helpman, N-B Saunders, N Cockburn, J Kwon, G Pond, S Piedimonte, L-A Teo-Fortin, Gregg Nelson, K Willows, C Aubrey, A Altman, J Sabourin, and T Feigenberg
- Subjects
Cervical cancer ,medicine.medical_specialty ,business.industry ,Laparoscopic hysterectomy ,Medicine ,In patient ,Stage (cooking) ,business ,medicine.disease ,Surgery - Published
- 2021
31. OP005/#352 Safety of vaginal hysterectomy for cervical cancer: a multicenter cohort study on behalf of the 4C (Canadian cervical cancer collaborative) working group
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D Vicus, N Sadeq, J Sabourin, L Helpman, S Piedimonte, L Elit, L-A Teo-Fortin, C Aubrey, Gregg Nelson, T Feigenberg, Vanessa Samouëlian, S Lau, N Cockburn, A Altman, N-B Saunders, G Pond, J Kwon, K Willows, and Marie Plante
- Subjects
Cervical cancer ,medicine.medical_specialty ,Obstetrics ,business.industry ,Hysterectomy vaginal ,medicine ,medicine.disease ,business ,Cohort study - Published
- 2021
32. Association between warfarin and COVID-19-related outcomes compared with direct oral anticoagulants: population-based cohort study
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The OpenSAFELY Collaborative, Angel Y. S. Wong, Laurie A. Tomlinson, Jeremy P. Brown, William Elson, Alex J. Walker, Anna Schultze, Caroline E. Morton, David Evans, Peter Inglesby, Brian MacKenna, Krishnan Bhaskaran, Christopher T. Rentsch, Emma Powell, Elizabeth Williamson, Richard Croker, Seb Bacon, William Hulme, Chris Bates, Helen J. Curtis, Amir Mehrkar, Jonathan Cockburn, Helen I. McDonald, Rohini Mathur, Kevin Wing, Harriet Forbes, Rosalind M. Eggo, Stephen J. W. Evans, Liam Smeeth, Ben Goldacre, and Ian J. Douglas
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Adult ,Cancer Research ,medicine.medical_specialty ,Adolescent ,medicine.drug_class ,Population ,Administration, Oral ,Lower risk ,Direct oral anticoagulants ,Cohort Studies ,Young Adult ,Internal medicine ,Thromboembolism ,medicine ,Humans ,Diseases of the blood and blood-forming organs ,education ,Molecular Biology ,RC254-282 ,Aged ,Aged, 80 and over ,education.field_of_study ,business.industry ,Proportional hazards model ,SARS-CoV-2 ,Research ,Hazard ratio ,Anticoagulant ,Warfarin ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,COVID-19 ,Anticoagulants ,Atrial fibrillation ,Hematology ,Middle Aged ,medicine.disease ,COVID-19 Drug Treatment ,Treatment Outcome ,Oncology ,England ,RC633-647.5 ,business ,Cohort study ,medicine.drug - Abstract
Background Thromboembolism has been reported as a consequence of severe COVID-19. Although warfarin is a commonly used anticoagulant, it acts by antagonising vitamin K, which is low in patients with severe COVID-19. To date, the clinical evidence on the impact of regular use of warfarin on COVID-19-related thromboembolism is lacking. Methods On behalf of NHS England, we conducted a population-based cohort study investigating the association between warfarin and COVID-19 outcomes compared with direct oral anticoagulants (DOACs). We used the OpenSAFELY platform to analyse primary care data and pseudonymously linked SARS-CoV-2 antigen testing data, hospital admissions and death records from England. We used Cox regression to estimate hazard ratios (HRs) for COVID-19-related outcomes comparing warfarin with DOACs in people with non-valvular atrial fibrillation. We also conducted negative control outcome analyses (being tested for SARS-CoV-2 and non-COVID-19 death) to assess the potential impact of confounding. Results A total of 92,339 warfarin users and 280,407 DOAC users were included. We observed a lower risk of all outcomes associated with warfarin versus DOACs [testing positive for SARS-CoV-2, HR 0.73 (95% CI 0.68–0.79); COVID-19-related hospital admission, HR 0.75 (95% CI 0.68–0.83); COVID-19-related deaths, HR 0.74 (95% CI 0.66–0.83)]. A lower risk of negative control outcomes associated with warfarin versus DOACs was also observed [being tested for SARS-CoV-2, HR 0.80 (95% CI 0.79–0.81); non-COVID-19 deaths, HR 0.79 (95% CI 0.76–0.83)]. Conclusions Overall, this study shows no evidence of harmful effects of warfarin on severe COVID-19 disease.
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- 2021
33. Mobility aids predict mortality after transcatheter aortic valve implantation
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Timothy Williams, David Kirtchuk, Reshma Amin, Sandeep Arunothayaraj, James Cockburn, Michael Michail, David Hildick-Smith, Uday Trivedi, and Kristoffer V. Tanseco
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medicine.medical_specialty ,Transcatheter aortic ,Single Center ,Transcatheter Aortic Valve Replacement ,Acquired immunodeficiency syndrome (AIDS) ,Risk Factors ,Internal medicine ,Medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,In patient ,Mobility aid ,Aged ,Aged, 80 and over ,business.industry ,General Medicine ,Odds ratio ,Aortic Valve Stenosis ,medicine.disease ,Gait ,Treatment Outcome ,Aortic Valve ,Fluoroscopy ,Cohort ,Cardiology and Cardiovascular Medicine ,business - Abstract
BACKGROUND Selection of appropriate patients for transcatheter aortic valve implantation (TAVI) can be challenging. Many factors can influence post-procedure outcomes. Traditional surgical scoring systems do not discriminate effectively. Medical parameters and functional indices can characterize mortality risk. Mobility is an important predictive functional index but is largely defined using subjective criteria. AIM To describe the relationship between mobility, objectively defined by the requirement for gait aids to ambulate, and all-cause 30-day and long-term mortality in patients undergoing TAVI. METHODS Mobility aid use was assessed in 1444 consecutive patients undergoing TAVI in a single center. Patients were categorized into "unaided," "1-stick," and "higher aid" groups based on the Brighton Mobility Index. Mortality tracking was obtained via the NHS Spine Portal in February 2021. RESULTS Patients were aged 82 (IQR 78-86). 66% of patients walked unaided, 26% walked with 1 stick, and 8% required more assistance (e.g., 2 sticks, a Rollator, a Zimmer frame, or a wheelchair). Overall 30-day mortality for the whole cohort was 3.5%; 1-year mortality was 12.2%. Mobility was a significant predictor of 30-day mortality (p = 0.025). Use of a higher aid was associated with a mortality odds ratio of 2.83 (95% CI: 1.39-5.74). Mobility was also a significant predictor of long-term mortality (p
- Published
- 2021
34. Risk of severe COVID-19 outcomes associated with immune-mediated inflammatory diseases and immune modifying therapies: a nationwide cohort study in the OpenSAFELY platform
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John Tazare, George Hickman, Ian J. Douglas, David G. Harrison, Katie Bechman, Catherine H. Smith, Helen Mcdonald, Helen J Curtis, Amir Mehkar, Julian Matthewman, Sam Norton, Peter Inglesby, Stephen J. W. Evans, John Parry, Mark Yates, Charlie W. Lees, Seb Bacon, Caroline E Morton, James Galloway, Rosalind M Eggo, Louis Fisher, Nicholas A. Kennedy, Harriet Forbes, Liam Smeeth, Ben Goldacre, William J Hulme, Tom Ward, Richard Croker, Laurie A. Tomlinson, Jonathan Cockburn, Brian MacKenna, Christopher M. Bates, Elizabeth Williamson, Anna Rowan, Jeremy P Brown, Sinead Langan, David M. Evans, Simon Davy, Anna Schultze, Rohini Mathur, Sam Harper, Frank Hester, Christopher T Rentsch, Alex J Walker, Amelia Green, Angel Y S Wong, Krishnan Bhaskaran, and Kathryn E. Mansfield
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medicine.medical_specialty ,education.field_of_study ,business.industry ,Hazard ratio ,Population ,Context (language use) ,Disease ,medicine.disease ,Internal medicine ,Rheumatoid arthritis ,medicine ,Rituximab ,Immune-mediated inflammatory diseases ,business ,education ,medicine.drug ,Cohort study - Abstract
BackgroundIt is unclear if people with immune-mediated inflammatory diseases (IMIDs) (joint, bowel and skin) and on immune modifying therapy have increased risk of serious COVID-19 outcomes.MethodsWith the approval of NHS England we conducted a cohort study, using OpenSAFELY, analysingroutinely-collected primary care data linked to hospital admission, death and previously unavailable hospital prescription data. We used Cox regression (adjusting for confounders) to estimate hazard ratios (HR) comparing risk of COVID-19-death, death/critical care admission, and hospitalisation (March to September 2020) in: 1) people with IMIDs compared to the general population; and 2) people with IMIDs on targeted immune modifying drugs (e.g., biologics) compared to standard systemic treatment (e.g., methotrexate).FindingsWe identified 17,672,065 adults; of 1,163,438 (7%) with IMIDs, 19,119 people received targeted immune modifying drugs, and 200,813 received standard systemics. We saw evidence of increased COVID-19-death (HR 1.23, 95%CI 1.20, 1.27), and COVID-19 hospitalisation (HR 1.32, 95%CI 1.29, 1.35) in individuals with IMIDs overall compared to individuals without IMIDs of the same age, sex, deprivation and smoking status. We saw no evidence of increased COVID-19 deaths with targeted compared to standard systemic treatments (HR 1.03, 95%CI 0.80, 1.33). There was no evidence of increased COVID-19-related death in those prescribed TNF inhibitors, IL-12/23, IL7, IL-6 or JAK inhibitors compared to standard systemics. Rituximab was associated with increased COVID-19 death (HR 1.68, 95%CI 1.11, 2.56); however, this finding may relate to confounding.InterpretationCOVID-19 death and hospitalisation was higher in people with IMIDs. We saw no increased risk of adverse COVID-19 outcomes in those on most targeted immune modifying drugs for IMIDs compared to standard systemics.RESEARCH IN CONTEXTEvidence before this studyWe searched PubMed on May 19th, 2021, using the terms “COVID-19”, “SARS-CoV-2” and “rheumatoid arthritis”, “psoriatic arthritis” “ankylosing spondylitis”, “Crohn’s disease” “ulcerative colitis” “hidradenitis suppurativa” and “psoriasis”, to identify primary research articles examining severe COVID-19 outcome risk in individuals with immune-mediated inflammatory diseases (IMIDs) and those on immune modifying therapy. The studies identified (including matched cohort studies and studies in disease-specific registries) were limited by small sample sizes and number of outcomes. Most studies did not show a signal of increased adverse COVID-19 outcomes in those on targeted therapies, with the exception of rituximab. Additionally, disease-specific registries are subject to selection bias and lack denominator populations.Added value of the studyIn our large population-based study of 17 million individuals, including 1 million people with IMIDs and just under 200,000 receiving immune modifying medications, we saw evidence that people with IMIDs had an increased risk of COVID-19-related death compared to the general population after adjusting for potential confounders (age, sex, deprivation, smoking status) (HR 1.23, 95%CI 1.20, 1.27). We saw differences by IMID type, with COVID-19-related death being increased by the most in people with inflammatory joint disease (HR 1.47, 95%CI 1.40, 1.54). We also saw some evidence that those with IMIDs were more likely, compared to the general population, to have COVID-19-related critical care admission/death (HR 1.24, 95%CI 1.21, 1.28) and hospitalisation (HR 1.32, 95%CI 1.29, 1.35).Compared to people with IMIDs taking standard systemics, we saw no evidence of differences in severe COVID-19-related outcomes with TNF inhibitors, IL-17 inhibitors, IL-12/23 inhibitors, IL-6 inhibitors and JAK inhibitors. However, there was some evidence that rituximab was associated with an increased risk of COVID-19-related death (HR 1.68, 95%CI 1.11, 2.56) and death/critical care admission (HR 1.92, 95%CI 1.31, 2.81). We also saw evidence of an increase in COVID-19-related hospital admissions in people prescribed rituximab (HR 1.59, 95%CI 1.16, 2.18) or JAK inhibition (HR 1.81, 95%CI 1.09, 3.01) compared to those on standard systemics, although this could be related to worse underlying health rather than the drugs themselves, and numbers of events were small.This is the first study to our knowledge to use high-cost drug data on medicines supplied by hospitals at a national scale in England (to identify targeted therapies). The availability of these data fills an important gap in the medication record of those with more specialist conditions treated by hospitals creating an important opportunity to generate insights to these conditions and these medicationsImplications of all of the available evidenceOur study offers insights into future risk mitigation strategies and SARS-CoV-2 vaccination priorities for individuals with IMIDs, as it highlights that those with IMIDs and those taking rituximab may be at risk of severe COVID-19 outcomes. Critically, our study does not show a link between most targeted immune modifying medications compared to standard systemics and severe COVID-19 outcomes. However, the increased risk of adverse COVID-19 outcomes that we saw in people with IMIDs and those treated with rituximab merits further study.
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- 2021
35. Using Twitter to Understand the Effects of the Cameroon Anglophone Crisis on Social Determinants of Health
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Soomin Lee, Julius T. Nganji, and Lynn Cockburn
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medicine.medical_specialty ,Data collection ,business.industry ,Social Determinants of Health ,Public health ,Armed conflict ,Public relations ,Pathology and Forensic Medicine ,Political science ,medicine ,Humans ,Social media ,Social determinants of health ,Cameroon ,Public Health ,business ,Social Media - Abstract
Insufficient opportunities to collect data on public health exist in armed conflict regions. Increased use of social media during war and conflict has allowed for data collection in situations where information is usually difficult to obtain. In this study, Twitter, a public social media platform, was used as a source of data and information to gain insight into how the Cameroon Anglophone Crisis impacts public health in the population. Our findings revealed that Twitter was being used to share information and call for action. Analysis of tweets revealed 8 distinct themes, which illustrated the impact of the crisis on the social determinants of health: neglect from government related to the social determinants of health; education; loss of employment; increased poverty; housing and homelessness; social exclusion and oppression; women and gender inequality; and health services. This study provides insight into the significant impact on public health in Cameroon caused by the Anglophone Crisis, and demonstrates the potential benefits of social media for gathering information about public health in crisis situations.
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- 2021
36. Assessment of prescribing patterns of antibiotics using National Treatment Guidelines and World Health Organization prescribing indicators at the Ghana Police Hospital: a pilot study
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Jacqueline Sneddon, Daniel Kwame Afriyie, Mercy Naa Aduele Opare-Addo, Thomas Opoku Darkwah, Alison Cockburn, Seth Kwabena Amponsah, and Benjamin Tagoe
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Adult ,Male ,medicine.medical_specialty ,Adolescent ,medicine.drug_class ,Antibiotics ,Inappropriate Prescribing ,Pilot Projects ,prescription pattern ,Ghana ,Antimicrobial Stewardship ,Young Adult ,Antibiotic resistance ,Clavulanic acid ,Health care ,medicine ,Global health ,Humans ,antimicrobial resistance ,infections ,Medical prescription ,Practice Patterns, Physicians' ,WHO “aware” classification ,Child ,Aged ,Quality Indicators, Health Care ,Antimicrobials ,WHO ,business.industry ,Public health ,Research ,Infant ,General Medicine ,Amoxicillin ,Middle Aged ,Hospitals ,Anti-Bacterial Agents ,Cross-Sectional Studies ,Family medicine ,Child, Preschool ,Practice Guidelines as Topic ,Female ,business ,medicine.drug - Abstract
Introduction:irrational or inappropriate prescribing of antibiotics is a major problem in healthcare and leads to antibiotic resistance. There is the need to understand the prescribing patterns and antibiotic stewardship in health facilities to support appropriate antibiotic use. A study was carried out to evaluate prescribing pattern of antibiotics at the Ghana Police Hospital using National Standard Treatment Guidelines (STG) and World Health Organization (WHO) prescribing indicators. Methods:a cross-sectional descriptive study was conducted at the Ghana Police Hospital. Data on prescriptions of antibiotics for both out-patients and in-patients was collected between December 2019 and March 2020. A pretested self-designed tool was used for data collection. All sampled prescriptions were assessed for appropriateness using the STG of 2017 and WHO “AWaRe” classification. The criteria used in assessment included dose, frequency, duration of treatment and choice of antibiotic prescribed for disease condition. Descriptive statistics were used in data analysis. Results:a total of 184 patient prescriptions (286 antibiotics) were included in this study. Results showed that antibiotics were mostly prescribed for dental and dental-related conditions (20.7%) and obstetric post-delivery prophylaxis (18.1%). Appropriateness of indicators for antibiotics prescribed assessed ranged between 89.2% to 97.6%. The most frequently prescribed antibiotics were metronidazole (25.9%), amoxicillin with clavulanic acid (22.0%), amoxicillin (16.4%) and ciprofloxacin (10.1%). Based on WHO “AWaRe” classification, the “access” group of antibiotics (74%) was the most prescribed, followed by “watch” group (24%). There were no antibiotics prescribed from the “reserve” group of antibiotics and another 2% that was not part of AwaRe classification. Conclusion:study revealed that the level of appropriateness for prescribing indicators assessed was relatively high and majority of prescribed antibiotics were from the “access” and “watch” group. These observations suggest responsible prescribing of antibiotics at the Ghana Police Hospital and effective antibiotic stewardship should be sustained and improved.
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- 2021
37. Cold Water Immersion Offers No Functional or Perceptual Benefit Compared to a Sham Intervention During a Resistance Training Program
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Taylor Rivkin, Emma Cockburn, Frank Hills, Marcela B. Gondek, Laura J. Wilson, Lygeri Dimitriou, Paul Jarvis, Alex Villiere, Stuart C. Miller, Vlad Turek, Aléchia van Wyk, and Anthony N. Turner
- Subjects
Male ,medicine.medical_specialty ,media_common.quotation_subject ,Muscle Fibers, Skeletal ,Physical Therapy, Sports Therapy and Rehabilitation ,Squat ,Isometric exercise ,Perception ,Immersion ,Medicine ,Humans ,Orthopedics and Sports Medicine ,Muscle, Skeletal ,media_common ,biology ,business.industry ,Athletes ,Sham Intervention ,Resistance training ,Water ,Resistance Training ,General Medicine ,biology.organism_classification ,Adaptation, Physiological ,Cold Temperature ,Water immersion ,Physical therapy ,business ,Muscle architecture - Abstract
Wilson, LJ, Dimitriou, L, Hills, FA, Gondek, MB, van Wyk, A, Turek, V, Rivkin, T, Villiere, A, Jarvis, P, Miller, S, Turner, A, and Cockburn, E. Cold water immersion offers no functional or perceptual benefit compared to a sham intervention during a resistance training program. J Strength Cond Res 35(10): 2720-2727, 2021-Cold water immersion (CWI) is regularly used by athletes as a postexercise recovery strategy, but relatively little is understood about potential training adaptations associated with habitual use. The aim of this study was to investigate the influence of repeated CWI or a sham intervention on adaptations to a lower body resistance training program. Thirteen men (26 ± 6 years; 83.6 ± 15.7 kg) familiar with resistance training were allocated into a CWI (10 minutes at 10° C) or sham group and completed 2 × 4-week blocks of lower body resistance training. Subjects completed a total of 16 training sessions (2 × session·week-1), with each session immediately followed by their allocated recovery intervention. Measures of perceptual markers, muscle function, and muscle architecture were recorded at baseline, midpoint, and post-training. Data were analyzed using factorial analysis of variances. The training program resulted in significant increases in muscle fibre pennation angle (p = 0.009), isometric peak force (p = 0.018), and 1/4 squat (p0.001) with no differences between groups (all p0.05). There were no differences in perceptual responses between groups. Despite the popularity of CWI as a postexercise recovery intervention, the findings from the present study demonstrated no functional or perceptual benefit compared with a sham intervention during progressive strength and power training. Furthermore, there was no detrimental impact of CWI on morphological adaptations after 16 exposures. These findings are important for athletes and practitioners wishing to use CWI as an acute recovery strategy after training, without blunting potential training adaptations.
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- 2021
38. Potentially inappropriate prescribing of DOACs to people with mechanical heart valves: a federated analysis of 57.9 million patients’ primary care records in situ using OpenSAFELY
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Christopher M. Bates, Elizabeth Williamson, Jonathan Meadows, Laurie A. Tomlinson, Kevin Wing, Rosalind M Eggo, John Tazare, Stephen J. W. Evans, David M. Evans, Richard Jarvis, Krishnan Bhaskaran, Frank Hester, Simon Davy, John Parry, Marion Wood, Seb Bacon, Aaron Fowles, Louis Fisher, Richard Croker, Anna Schultze, Becky Smith, Nasreen Parkes, Victoria Speed, Christopher T Rentsch, Alex J Walker, Alex Eavis, Ben Goldacre, Helen J Curtis, Caroline E Morton, Amir Mehrkar, George Hickman, Sam Harper, Jonathan Cockburn, Helen Mcdonald, Ian J. Douglas, Tom Ward, Peter Inglesby, Brian MacKenna, Shaun O'Hanlon, Rohini Mathur, Paul D. Griffiths, Jessica Morley, Harriet Forbes, Jon Massey, Amelia Green, Dima Avramov, Angel Y S Wong, William J Hulme, and Liam Smeeth
- Subjects
education.field_of_study ,medicine.medical_specialty ,business.industry ,Population ,On warfarin ,Retrospective cohort study ,Primary care ,Mechanical heart-valve ,Mechanical heart ,Risk groups ,Emergency medicine ,medicine ,Blood testing ,education ,business - Abstract
National guidance was issued during the COVID-19 pandemic to switch patients on warfarin to direct oral anticoagulants (DOACs) where appropriate as these require less frequent blood testing. DOACs are not recommended for patients with mechanical heart valves. We conducted a retrospective cohort study of DOAC prescribing in people with a record of a mechanical heart valve between September 2019 and May 2021, and describe the characteristics of this population. We identified 15,457 individuals with a mechanical heart valve recorded in their records, of whom 1058 (6.8%) had been prescribed a DOAC during the study period. 767 individuals with a record of a mechanical heart valve were currently prescribed a DOAC as of May 31st 2021. This is suggestive of inappropriate prescribing of DOACs in individuals with mechanical heart valves. Direct alerts have been issued to clinicians through their EHR software informing the issue. We show that the OpenSAFELY platform can be used for rapid audit and feedback to mitigate the indirect health impacts of COVID-19 on the NHS. We will monitor changes in prescribing for this risk group over the following months.
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- 2021
39. Overall and cause-specific hospitalisation and death after COVID-19 hospitalisation in England: cohort study in OpenSAFELY using linked primary care, secondary care and death registration data
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Frank Hester, Christopher T Rentsch, Alex J Walker, Helen J Curtis, Peter Inglesby, Laurie A. Tomlinson, Elizabeth A. Williamson, Sam Harper, Ben Goldacre, Caroline E Morton, Amir Mehrkar, John Parry, Wong Ay, Anna Schultze, William J Hulme, Seb Bacon, Rosalind M Eggo, Charlotte Warren-Gash, Krishnan Bhaskaran, Rohini Mathur, Brian MacKenna, Liam Smeeth, V Mahalingasivam, Daniel Grint, David M. Evans, Chris Bates, Evans Sjw., Kevin Wing, George Hickman, Ian J. Douglas, Helen Mcdonald, and Jonathan Cockburn
- Subjects
medicine.medical_specialty ,education.field_of_study ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Proportional hazards model ,Population ,medicine.disease ,Mental health ,Lower respiratory tract infection ,Health care ,Emergency medicine ,Medicine ,Dementia ,business ,education ,Cohort study - Abstract
BackgroundThere is concern about medium to long-term adverse outcomes following acute COVID-19, but little relevant evidence exists. We aimed to investigate whether risks of hospital admission and death, overall and by specific cause, are raised following discharge from a COVID-19 hospitalisation.Methods and FindingsWorking on behalf of NHS-England, we used linked primary care and hospital data in OpenSAFELY to compare risks of hospital admission and death, overall and by specific cause, between people discharged from COVID-19 hospitalisation (February-December 2020), and (i) demographically-matched controls from the 2019 general population; (ii) people discharged from influenza hospitalisation in 2017-19. We used Cox regression adjusted for personal and clinical characteristics.24,673 post-discharge COVID-19 patients, 123,362 general population controls, and 16,058 influenza controls were followed for ≤315 days. Overall risk of hospitalisation or death (30968 events) was higher in the COVID-19 group than general population controls (adjusted-HR 2.23, 2.14-2.31) but similar to the influenza group (adjusted-HR 0.94, 0.91-0.98). All-cause mortality (7439 events) was highest in the COVID-19 group (adjusted-HR 4.97, 4.58-5.40 vs general population controls and 1.73, 1.60-1.87 vs influenza controls). Risks for cause-specific outcomes were higher in COVID-19 survivors than general population controls, and largely comparable between COVID-19 and influenza patients. However, COVID-19 patients were more likely than influenza patients to be readmitted/die due to their initial infection/other lower respiratory tract infection (adjusted-HR 1.37, 1.22-1.54), and to experience mental health or cognitive-related admission/death (adjusted-HR 1.36, 1.01-2.83); in particular, COVID-19 survivors with pre-existing dementia had higher risk of dementia death. One limitation of our study is that reasons for hospitalisation/death may have been misclassified in some cases due to inconsistent use of codes.ConclusionsPeople discharged from a COVID-19 hospital admission had markedly higher risks for rehospitalisation and death than the general population, suggesting a substantial extra burden on healthcare. Most risks were similar to those observed after influenza hospitalisations; but COVID-19 patients had higher risks of all-cause mortality, readmissions/death due to the initial infection, and dementia death, highlighting the importance of post-discharge monitoring.
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- 2021
40. TFH-derived dopamine accelerates productive synapses in germinal centres
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Salvatore Valvo, Pablo F. Canete, Ilenia Papa, Michael Meyer-Hermann, David Saliba, Claudio Doglioni, Carola G. Vinuesa, Maurilio Ponzoni, Hayley A. McNamara, Michele A. Grimbaldeston, Paula Gonzalez-Figueroa, Rebecca A. Sweet, Ian A. Cockburn, Harpreet Vohra, Sonia Bustamante, Michael L. Dustin, Papa, Ilenia, Saliba, David, Ponzoni, Maurilio, Bustamante, Sonia, Canete, Pablo F., Gonzalez-Figueroa, Paula, Mcnamara, Hayley A., Valvo, Salvatore, Grimbaldeston, Michele, Sweet, Rebecca A., Vohra, Harpreet, Cockburn, Ian A., Meyer-Hermann, Michael, Dustin, Michael L., Doglioni, Claudio, Vinuesa, Carola G., Canete, Pablo F, McNamara, Hayley A, Sweet, Rebecca A, Cockburn, Ian A, Dustin, Michael L, and Vinuesa, Carola G
- Subjects
0301 basic medicine ,medicine.medical_specialty ,Immunological Synapses ,Secretory Vesicle ,Dopamine ,CD40 Ligand ,Immunological Synapse ,Neurotransmission ,Article ,germinal centres ,immunology ,Synapse ,Inducible T-Cell Co-Stimulator Ligand ,Mice ,Neurotransmitter Agent ,03 medical and health sciences ,Internal medicine ,medicine ,Animals ,Humans ,Child ,Receptor ,B-Lymphocytes ,Neurotransmitter Agents ,Multidisciplinary ,CD40 ,biology ,Animal ,Secretory Vesicles ,B-Lymphocyte ,Models, Immunological ,Germinal center ,T-Lymphocytes, Helper-Inducer ,Germinal Center ,Up-Regulation ,Cell biology ,030104 developmental biology ,Endocrinology ,biology.protein ,Female ,Chromogranin B ,Human ,medicine.drug - Abstract
Protective high-affinity antibody responses depend on competitive selection of B cells carrying somatically mutated B-cell receptors by follicular helper T (T FH ) cells in germinal centres. The rapid T-B-cell interactions that occur during this process are reminiscent of neural synaptic transmission pathways. Here we show that a proportion of human T FH cells contain dense-core granules marked by chromogranin B, which are normally found in neuronal presynaptic terminals storing catecholamines such as dopamine. T FH cells produce high amounts of dopamine and release it upon cognate interaction with B cells. Dopamine causes rapid translocation of intracellular ICOSL (inducible T-cell co-stimulator ligand, also known as ICOSLG) to the B-cell surface, which enhances accumulation of CD40L and chromogranin B granules at the human T FH cell synapse and increases the synapse area. Mathematical modelling suggests that faster dopamine-induced T-B-cell interactions increase total germinal centre output and accelerate it by days. Delivery of neurotransmitters across the T-B-cell synapse may be advantageous in the face of infection. Refereed/Peer-reviewed
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- 2017
41. Comparative effectiveness of ChAdOx1 versus BNT162b2 covid-19 vaccines in health and social care workers in England: cohort study using OpenSAFELY
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William J Hulme, Elizabeth J Williamson, Amelia C A Green, Krishnan Bhaskaran, Helen I McDonald, Christopher T Rentsch, Anna Schultze, John Tazare, Helen J Curtis, Alex J Walker, Laurie A Tomlinson, Tom Palmer, Elsie M F Horne, Brian MacKenna, Caroline E Morton, Amir Mehrkar, Jessica Morley, Louis Fisher, Sebastian C J Bacon, David Evans, Peter Inglesby, George Hickman, Simon Davy, Tom Ward, Richard Croker, Rosalind M Eggo, Angel Y S Wong, Rohini Mathur, Kevin Wing, Harriet Forbes, Daniel J Grint, Ian J Douglas, Stephen J W Evans, Liam Smeeth, Chris Bates, Jonathan Cockburn, John Parry, Frank Hester, Sam Harper, Jonathan A C Sterne, Miguel A Hernán, and Ben Goldacre
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medicine.medical_specialty ,COVID-19 Vaccines ,Health Personnel ,Population ,Cohort Studies ,Health care ,medicine ,Humans ,Cumulative incidence ,education ,BNT162 Vaccine ,COVID-19/epidemiology ,education.field_of_study ,business.industry ,SARS-CoV-2 ,Incidence (epidemiology) ,Attendance ,COVID-19 ,Social Support ,Viral Vaccines ,General Medicine ,Vaccination ,Cohort ,Emergency medicine ,business ,Cohort study - Abstract
ObjectiveTo compare the effectiveness of the BNT162b2 mRNA (Pfizer-BioNTech) and the ChAdOx1 (Oxford-AstraZeneca) covid-19 vaccines against infection and covid-19 disease in health and social care workers.DesignCohort study, emulating a comparative effectiveness trial, on behalf of NHS England.SettingLinked primary care, hospital, and covid-19 surveillance records available within the OpenSAFELY-TPP research platform, covering a period when the SARS-CoV-2 Alpha variant was dominant.Participants317 341 health and social care workers vaccinated between 4 January and 28 February 2021, registered with a general practice using the TPP SystmOne clinical information system in England, and not clinically extremely vulnerable.InterventionsVaccination with either BNT162b2 or ChAdOx1 administered as part of the national covid-19 vaccine roll-out.Main outcome measuresRecorded SARS-CoV-2 positive test, or covid-19 related attendance at an accident and emergency (A&E) department or hospital admission occurring within 20 weeks of receipt of the first vaccine dose.ResultsOver the duration of 118 771 person-years of follow-up there were 6962 positive SARS-CoV-2 tests, 282 covid-19 related A&E attendances, and 166 covid-19 related hospital admissions. The cumulative incidence of each outcome was similar for both vaccines during the first 20 weeks after vaccination. The cumulative incidence of recorded SARS-CoV-2 infection 20 weeks after first-dose vaccination with BNT162b2 was 21.7 per 1000 people (95% confidence interval 20.9 to 22.4) and with ChAdOx1 was 23.7 (21.8 to 25.6), representing a difference of 2.04 per 1000 people (0.04 to 4.04). The difference in the cumulative incidence per 1000 people of covid-19 related A&E attendance at 20 weeks was 0.06 per 1000 people (95% CI −0.31 to 0.43). For covid-19 related hospital admission, this difference was 0.11 per 1000 people (−0.22 to 0.44).ConclusionsIn this cohort of healthcare workers where we would not anticipate vaccine type to be related to health status, we found no substantial differences in the incidence of SARS-CoV-2 infection or covid-19 disease up to 20 weeks after vaccination. Incidence dropped sharply at 3-4 weeks after vaccination, and there were few covid-19 related hospital attendance and admission events after this period. This is in line with expected onset of vaccine induced immunity and suggests strong protection against Alpha variant covid-19 disease for both vaccines in this relatively young and healthy population of healthcare workers.
- Published
- 2022
42. Safety and efficacy of non-steroidal anti-inflammatory drugs to reduce ileus after colorectal surgery
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al-Ausi M., Jovaisaite A., Shah S.M., Khalid N., Gutmann D., Davison S., Alame Y.J., Syed L., Owen W.J., Ahsan S.D., Anthony-Uzoeto U., Macleod Hall C., Zheng S., Wynter K., James C., Sapre D., Ghosh R., Baird J., Cockburn L., Blackwood O., Simpson W., Jeong S., Bishop S., Bate R., Hobson C., Adam A.H., Redclift C., Do J., Adeleye O., Poli F., Batterham A., Brown S., Parekh J.N., Clay W., Pieri K., Jackson A., Saxena A., Gurung B., Oyebola T., O'Brien F., Djeugam B., Gardezi S., Ul-Hasan S., Martin-Hernandez M.P., Sisley M., Modi S., Antakia R., Elbayouk A., Soh Y.J., Mather J., Yusuf Z., Al-Sarraf Z., Naja M., Rassool S.B., Convill J., Nikookam Y., Warsame A., Pace C., Kiandee M., Ridwan R., Carey C., Hirri F., McMillan M.J.A., Ling J.J., Pendelbury L., Kerimzade K., Tang A., Howard E.O., Humayun S., Wadsworth O.J., Tan K., Abdelhameed F., Haglund C., Radnaeva I., Hu N., Rambhatla S., Waldron D., Madahar P., Malik S., Meney L.C., Ibrahim I., Kang C.K., Chiu J.Z.J., Livie V., Ibrahim 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Craven J., Aldarragi A., Harding S., Millward A., Bedford M., Gopalan V., Midgen A., Khadka P., Cheng O., Taneja S., Manobharath N., Kok J.Y., Lim D.W.E., Buick T., Boland M., Piya S., Devlin R., Fairfield C.J., George R.J., Rahi M., Zaman S., Hajiev S., Ross T., Crisp E., Thompson C., Charalambous A., Hollywood J.L., Hammond R.F.L., Matthews J., Mendonca V., Spinty J., Khan K., Cheng J., Glynn N., Muhammad U., Khan M., Anderson L., Mccormack K., Mak J., Patrawala S., Milinkovic N., Schofield R., Chauhan M., Hartley L., Hind J., Nelson L., Ratnasingham D., Whitehead T., Dimitriadis S., Marshall K., Flint E.J., Horner C., Heybourne A., Morgan H., Wickstone C., Panagiotou D., O'Connell E., Dean K., Iqbal R., Walsh L., Yu N., Rana N., Massie E., Ng J., Jung M., Lee Y.D., Harris M., White S., Boev B., Tonchev P., Prochazka V., Skalicky A., Ravn S., Ojakaar A., Dorr-Harim C., Koutserimpas C., Giraudo G., Armellini A., Ruzzenente A., Mazzeo C., De Padua C., Realis Luc A., Maroli A., Giani 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L., Matthews, J., Mendonca, V., Spinty, J., Khan, K., Cheng, J., Glynn, N., Muhammad, U., Khan, M., Anderson, L., Mccormack, K., Mak, J., Patrawala, S., Milinkovic, N., Schofield, R., Chauhan, M., Hartley, L., Hind, J., Nelson, L., Ratnasingham, D., Whitehead, T., Dimitriadis, S., Marshall, K., Flint, E. J., Horner, C., Heybourne, A., Morgan, H., Wickstone, C., Panagiotou, D., O'Connell, E., Dean, K., Iqbal, R., Walsh, L., Yu, N., Rana, N., Massie, E., Ng, J., Jung, M., Lee, Y. D., Harris, M., White, S., Boev, B., Tonchev, P., Prochazka, V., Skalicky, A., Ravn, S., Ojakaar, A., Dorr-Harim, C., Koutserimpas, C., Giraudo, G., Armellini, A., Ruzzenente, A., Mazzeo, C., De Padua, C., Realis Luc, A., Maroli, A., Giani, I., Cufari, M. E., Vitali, M., Gusai, G. P., Quattromani, R., Virgilio, E., Berti, S., Di Mola, F. F., Papagni, V., Tuminello, F., Vittori, L., Longheu, A., Loche, G. A., Braccio, B., De Luca, E., Resta, G., Ancans, G., Tamosiunas, A., Petrulionis, M., Andrejevic, P., Stellingwerf, M. E., Abdulrahman, N., van de Pas, K. G. H., Thomas, G., Brandsma, A. M., Davids, J., Rottier, S. J., de Roy van Zuidewijn, D., Hawkins, R., Ong, H. I., Li, Y., Desmond, B., Winstanley, J., Martins, M., Americano, M., Frade, S., Senhorinho, R., Peixoto, R., Alves-Vale, C., Lamas, M., O'Connor, D. B., Hoo, M., Gopaul, A., Scanlon, K., O'Dwyer, N., Jovanovic, M., Panyko, A., Van Vuuren, S., Curchod, P., Gaspar, S., Imadalou, L., Mutlu, D., Akyol, C., Uygur, F. A., Eray, I. C., Biyiklioglu, O., Cetin, M. F., Isik, A. E., Karip, B., Dogan, H., Sarigul, L., Tunc, E., Aydin, T., Bodur, S., Karabulut, K., Al-hadithi, A., To, N., Lau, I. S. F., Smith, E., Mahapatra, S., Mcauliffe, O., Imam, L., Akram, B., Hossaini, S., Davies, R., Ko, M., Collins, J., Pandya, A., Reilly, S., Archer, J., Auty, C., Roche, C. D., Livie, J., Chaudhry, F. A., Ntakomyti, E., Diallo, R., Bylinski, T., Wright, J., Masiha, E., Tung, J., Shirazi, B., Neilson, A., Epton, S., Patel, N., Trussell, S., Couldrey, A., Donnelly, C., Eftychiou, S., Surgery, AGEM - Digestive immunity, AGEM - Re-generation and cancer of the digestive system, Graduate School, APH - Methodology, ACS - Heart failure & arrhythmias, Eurosurg, Collaborative, Ajmera A., Chapman, Sj, Blanco‐colino, R, Žebrák, R, Glasbey, Jc, Sgrò, A, Elst, T, Knowles, Ch, Bath, Mf, Yasin, Ih, Larsen, Hm, Rädeker, L, Frey, Pe, Elst, Tr, Fagan, Pvb, Wells, Ci, Alagoa João, A, Ozkan, Bb, Yagız Sen, A, Aktas, Mk, Baki, Be, Yüksek, B, Khaw, Ra, Ablett, Ad, Khan, Sm, Manley, Lr, Tan, Hl, Norman, Jg, Baker, Dm, Brandao, Bd, Onafowokan, Oo, Carlton‐carew, S, Shortland, Tc, Brumfitt, Cd, Luong, Jk, Kunčarová, K, Kološová, B, Farkašová, M, Harbjerg, Jl, Kjaer, Md, Mark‐christensen, A, Unbehaun, Kp, Lycke, Kd, Pohl, Lj, Christodoulou, Im, Manatakis, Dk, Aguilera, Ml, Manzoni Garberini, A, Tilocca, Pl, Piozzi, Gn, Wijnbergen, Jwm, Dinger, Tl, Doesschate, Sfh, Dalen, Ashm, Bos, Dd, Kuiper, Sz, Pruijssers, Sr, Elliott, Bm, Geneta, Vp, Peng, Sl, Lim, Yk, Neves‐marques, C, Correia, Jg, Vieira, Bn, Quintela, Ac, Serra, Ml, Aparício, Dj, Eiró, F, Almeida, Mr, Machado, Nd, Ćuk, Vv, Mészárosová, K, Ozmen, Bb, Kocer, Md, Cinar, En, Uslu, Ö, Farhan‐alanie, Mmh, Finch, Bj, Suchett‐kay, I, Liu, Fy, Nadama, Hh, Al‐saraff, Z, Tam, Jph, Powell‐chandler, A, Gorgievska, Rebecca, Gan, Fw, Makin‐taylor, R, Hey, Cy, Findlay, Jm, Örhalmi, J, Skalický, P, Skalický, T, Worsøe, J, Emmertsen, Kj, Mihaljevic, Al, Konstantinidis, Km, Bisagni, Pag, Altomare, Df, Sivinš, A, Bemelman, Wa, Graat, Lj, Wijnhoven, Bpl, Ven, Ahw, Stassen, Lp, Acherman, Yiz, Gerhards, Mf, Stommel, Mwj, Hazebroek, Ej, Geloven, Aaw, Schasfoort, Ra, Leeuwen, Bl, Tuynman, Jb, Tilburg, Mwa, Boerma, Eg, Bissett, Ip, Francisco, V, Ourô, S, Caratão, M, Silva‐vaz, P, Ridgway, Pf, Mcnamara, Da, O'Connell, Pr, Ćuk, Vm, Hübner, M, Sauvain, Mo, Geçim, Ie, Disçi, E, Haksal, Mc, Agarwal, T, Maxwell‐armstrong, C, Moug, Sj, Lund, Jn, Smart, Nj, Smith, Fm, Lee, Yj, Lai, Lt, Jun, Hj, Mendis, Dm, Robb, Pm, Lee, Hj, Wyche, Aab, Davis, Lt, Jayalath, Jmsn, Blefari, Nda, Goh, Yk, Beh, Yz, Dudi‐venkata, Nn, Borrow, Jl, Chua, Th, Tan, Rr, Ng, Sy, Britten‐jones, P, Pham, Hdv, Coulter‐nile, Smcj, Gosselink, Mp, Wang, Yl, Pös, M, Bartoš, M, Malý, O, Hanušová, M, Hurný, M, Riško, J, Treskoň, R, Pospíšil, M, Hlaváčová, L, Tomanová, D, Novický, R, Sobotková, K, šuta Kimle, K, Paclík, A, Jürgens‐lahnstein, J, Kristensen, Fp, Bønnerup, K, Højgaard Pedersen, J, Jepsen, Bn, Hillgaard, Tk, Erichsen, Sb, Nielsen, Cv, Madsen, Cp, Skejø, Cd, Aabling, Rr, Sørensen, J, Schöning, L, Simon, S CS, Thäwel, T, Seckler, Am, Athanasopoulos, Pg, Giuffrida, Mc, Billo, Me, Marrosu, Ag, Ruggiu, Mw, Antona, Ad, Bitonti, Mf, Romano, Fm, Pellicanò, Ga, Murru, Ml, Angelucci, Gp, Tenconi, Sm, Mura, Fa, Ruggiu, Gv, Mura, Ga, Perrone, Ba, Esposito, Lm, Marcianò, M, Aru, Ac, Figà, F, Truškovs, A, Machatschek, Mj, Wiemann, Am, Müller, Nl, Samalavicius, Ne, Poškus, E, Kryžauskas, M, Poškus, T, Looyen, R, Becker, Maj, Molder, L, Tissen, Ym, Vries, H, Smaalen, Tc, Veen, Oc, Dingemans, Sa, Brink, Lc, Vijgen, Ghej, Voort, Emf, Pool, A, Rest, Klc, Sluijpers, Nrf, Molenaar, Cjl, Gordinou de Gouberville, Mc, Mens, Ma, Hoeks, Em, Praag, Em, Smit, Mpcm, Lely, Sj, Stijns, Rch, Leow, Ty, Ruiter, A, Aarts, Cam, Jonge, J, Alqethami, Hj, Elst, Pc, Tissink, Mw, Grüter, A, Voeten, Dm, Boon, Cl, Franssen, Rjm, Jense, Mtf, Lau, Wk, Adams, Sib, Chen, Sy, Kim, Dh, Mclaughlin, Sjp, Chapman, Da, Mcintosh, Nd, Tewhaiti‐smith, J, Yam, St, Tomé, M, Santos, Tc, Lages, Rr, Sá, Tc, Bernardes, Fm, Cunha, Mf, Veiga, Dn, Loureiro, Ar, Torre, Ap, Paixão, I, Rocha, Af, Jervis, Mj, Paixão, V, Silva, Ag, Galvão, D, Mónica, I, Guimarães, N, Martins, Sf, Rocha‐melo, M, Patrício, J, Cinza, Am, Simões, J, Gonçalves, Jp, Guimarães, J, Martins, Ar, Lérias, R, Bártolo, J, Correia, Am, Martins, Pc, Jardim, Jam, Domingos, Sp, Baião, Jm, Lopes, Nmro, Jordão, Dm, Ângelo, Md, Caroço, T, Gomes, Jr, Monteiro, Rg, Colon, Lf, Dockry, É, Aly, Ak, Kang, Sj, Pentony, Ar, Piong, Cl, Eow, Sy, Kamath, Pj, Soh, Tbw, Dyer, Ah, Chee, Sy, Tan, Ixh, Jones, Mr, Al‐salihi, A, Ciubotaru, Ci, Radulović, R, Miloševic, K, Bojičić, J, Genčić, M, Janković, U, Sucháň, Pk, Dubovský, M, Sautter, Sc, Mcduling, Cr, Haller, Ml, Piotet, Lm, Kurtoglu, Gk, Sel, Ek, Isler, Vc, Demirkaya, Hc, Korkmaz, Hk, Pektas, Am, Güner, B, İşlek, Ec, Tombul, Hb, Boztuğ, Cy, Tınaz, A, Yılmaz, M, Akın, Fa, Başçavuş, M, Seker, Mc, Koçak, Zb, Karapinar, Ye, Köseoglu, E, Agca, Mh, Alim, Ye, Kürklü, Ö, Çalar, Sn, Kavar, Rc, Cevlik, Ad, Turk, Eg, Erdönmez, H, Gürsoy, F, Önsal, U, Özbek, M, Kasar, Pa, Özen, D, Ölmez, M, Sariçiçek, T, Tipi, Ou, Benli, Ge, Bilgili, Ac, Kiraz, In, Aksoy, Ab, Karagöz, E, Tümer, S, Abdulrahman, Smf, Kuyumcu, Of, Afsar, Hb, Guler, Se, Gul, Eb, Dossa, Saa, Mizan, Sr, Sahin, Az, Kilinç, A, Yumurtaci, Ö, Girit, Çagri, Yildirak, Mk, Güldag, A, Söyleyici, B, Aytin, Ye, Akay, Fe, Iskan, Ng, Sunay, Ao, Tie‐gill, T, Delaugere, Lp, Yeo, Yq, Aly, Mh, Dwyer‐hemmings, L, Bin Amran, Am, Kyaw, Ha, Clements, Jm, Wong, Hl, Armitage, Mn, Hassan Serry, My, Tam, Lyc, Sookramanien, Sr, Ward, Kl, Pherwani, Sa, Drury, Dj, James, Sj, Teasdale, Ab, Richardson, Etj, Thomas, Da, Williams, Rl, Najabat‐lattif, Hf, Zhu, Ly, Suchett‐kaye, I, Mihailidis, Th, Pedersen, Ac, Robinson, Av, Cheong, Cm, Ike, Si, Chu, Tsm, Mogg, Jaw, Claireaux, Ha, Vaughan‐burleigh, S, Al‐ausi, M, Shah, Sm, Alame, Yj, Owen, Wj, Ahsan, Sd, Anthony‐uzoeto, U, Adam, Ah, Parekh, Jn, Ul‐hasan, S, Martin‐hernandez, Mp, Soh, Yj, Al‐sarraf, Z, Rassool, Sb, Mcmillan, Mja, Ling, Jj, Howard, Eo, Wadsworth, Oj, Meney, Lc, Kang, Ck, Chiu, Jzj, Tan, Qj, Cross, Gwv, Shah, Dr, Ng, Mpe, Wong, Rtw, Rojoa, Dm, Ruddy, Cm, Hall, Jd, Hassane, Asi, Azhar, Aw, Tan, Tk, Kwak, Sy, Ong, Eh, Goolam‐mahomed, Z, Kirnon‐jackman, O, Lim, Qx, Yong, Sq, Chen, Jy, Sam, Zh, Goh, Yn, Muthukumar, Mg, Johnson, Ta, Williams, Ri, Honeyman, Si, Malcolm, Fl, Wilkerson, Ht, Chatterjee‐woolman, S, Ahmed, Wur, Kwan, Kwl, Sanders‐crook, L, Boh, Zy, English, Wj, Novotny, Sa, Chong, Jt, Lee, De, Embury‐young, Y, Clavé Llavall, A, Pang, Yl, Dellen, J, Al‐azzawi, A, Alawode, Dot, Wynell‐mayow, W, Christodoulou, T, Jones, Cj, Leung, Sp, Mohamed, Sh, Kok, Jy, Lim, Dwe, Fairfield, Cj, George, Rj, Hollywood, Jl, Hammond, Rfl, Flint, Ej, Lee, Yd, Skalický, A, Ojakäär, A, Dörr‐harim, C, Cufari, Me, Gusai, Gp, Di Mola, Ff, Loche, Ga, Stellingwerf, Me, Pas, Kgh, Brandsma, Am, Rottier, Sj, Roy van Zuidewijn, D, Ong, Hi, Alves‐vale, C, O'Connor, Db, Jovanović, M, Uygur, Fa, Eray, Ic, Çetin, Mf, Isik, Ae, Sarıgül, L, Francis, Aa, Al‐hadithi, A, Lau, Isf, Roche, Cd, and Chaudhry, Fa
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Male ,renal failure ,Time Factors ,medicine.medical_treatment ,Adult ,Aged ,Anti-Inflammatory Agents, Non-Steroidal ,Elective Surgical Procedures ,Female ,Humans ,Ileus ,Kaplan-Meier Estimate ,Middle Aged ,Patient Safety ,Postoperative Care ,Postoperative Complications ,Proportional Hazards Models ,Prospective Studies ,Recovery of Function ,Treatment Outcome ,Colectomy ,Proctectomy ,Anti-Inflammatory Agents ,colorectal surgery ,ileus ,non-steroidal anti-inflammatory drugs ,NSAIDS ,030230 surgery ,Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14] ,0302 clinical medicine ,Prospective cohort study ,Colorectal ,RISK ,Hazard ratio ,Acute kidney injury ,Colorectal surgery ,NSAID ,030220 oncology & carcinogenesis ,Non-Steroidal ,Cohort study ,colorectal Surgery, ileus, non-steroidal anti-inflammatory drugs ,medicine.medical_specialty ,Non‐steroidal anti‐inflammatory drugs. NSAIDs. Postoperative ileus. Colorectal surgery ,ACUTE KIDNEY INJURY ,anti-inflammatory agents ,03 medical and health sciences ,Internal medicine ,medicine ,Adverse effect ,non-steroidal anti-inflammatory drugs - ileus - colorectal surgery ,business.industry ,medicine.disease ,Settore MED/18 - Chirurgia Generale ,colorectal cancer ,Surgery ,business - Abstract
Ileus is common after elective colorectal surgery, and is associated with increased adverse events and prolonged hospital stay. The aim was to assess the role of non-steroidal anti-inflammatory drugs (NSAIDs) for reducing ileus after surgery.A prospective multicentre cohort study was delivered by an international, student- and trainee-led collaborative group. Adult patients undergoing elective colorectal resection between January and April 2018 were included. The primary outcome was time to gastrointestinal recovery, measured using a composite measure of bowel function and tolerance to oral intake. The impact of NSAIDs was explored using Cox regression analyses, including the results of a centre-specific survey of compliance to enhanced recovery principles. Secondary safety outcomes included anastomotic leak rate and acute kidney injury.A total of 4164 patients were included, with a median age of 68 (i.q.r. 57-75) years (54·9 per cent men). Some 1153 (27·7 per cent) received NSAIDs on postoperative days 1-3, of whom 1061 (92·0 per cent) received non-selective cyclo-oxygenase inhibitors. After adjustment for baseline differences, the mean time to gastrointestinal recovery did not differ significantly between patients who received NSAIDs and those who did not (4·6 versus 4·8 days; hazard ratio 1·04, 95 per cent c.i. 0·96 to 1·12; P = 0·360). There were no significant differences in anastomotic leak rate (5·4 versus 4·6 per cent; P = 0·349) or acute kidney injury (14·3 versus 13·8 per cent; P = 0·666) between the groups. Significantly fewer patients receiving NSAIDs required strong opioid analgesia (35·3 versus 56·7 per cent; P 0·001).NSAIDs did not reduce the time for gastrointestinal recovery after colorectal surgery, but they were safe and associated with reduced postoperative opioid requirement.El ileo es frecuente tras cirugía colorrectal electiva y se asocia con un incremento de los eventos adversos y de la duración de la estancia hospitalaria. El objetivo fue evaluar el papel de los fármacos antiinflamatorios no esteroideos (non-steroidal anti-inflammatory drugs, NSAIDs) para reducir el ileo tras la cirugía. MÉTODOS: Estudio de cohortes prospectivo y multicéntrico efecuado por un grupo colaborativo dirigido por estudiantes y cirujanos en formación. Se incluyeron pacientes adultos sometidos a cirugía colorectal electiva entre enero y abril 2018. El resultado primario fue el tiempo hasta la recuperaciòn gastrointestinal, medido por una variable compuesta de función intestinal y tolerancia a la alimentación oral. El impacto de los NSAIDs se exploró utilizando un análisis de regresión de Cox, que incluía los resultados de una encuesta específica dirigida a los centros sobre la adherencia a los principios de la recuperación intensificada. Los resultados secundarios de seguridad incluyeron la dehiscencia anastomótica y la insuficiencia renal aguda.Se incluyeron 4.164 pacientes con una mediana de edad de 68 años (rango intercuartílico: 57-75; 54,9% varones). Un total de 1.153 (27,7%) pacientes fueron tratados con NSAIDs en los días postoperarorios 1-3, de los cuales 1.061 (92,0%) recibieron inhibidores no selectivos de la ciclooxigenasa. Tras los ajustes por las diferencias basales, el tiempo medio hasta la recuperación gastrointestinal no difería significativamente entre pacientes que recibieron o no recibieron NSAIDs (4,6 versus 4,8 días; cociente de riesgos instantáneos, hazard ratio, HR 1,04, i.c. del 95%: 0,96-1,12, P = 0,360). No hubo diferencias significativas en la tasa de dehiscencias anastomóticas (5,4% versus 4,6%; P = 0,349) o insuficiencia renal aguda (14,3% versus 13,8%; P = 0,666) entre los grupos. Sin embargo, significativamente menos pacientes de los que recibieron NSAIDs precisaron una analgesia intensa con opioides (35,3% versus 56,7%; P 0,001). CONCLUSIÓN: La administración de NSAIDs no redujo el tiempo hasta la recuperación gastrointestinal tras cirugía colorrectal, pero fueron seguros y se asociaron con una reducción en la necesidad de opioides postoperarorios.
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- 2019
43. Electrosurgical Removal of a Central Venous Catheter Inadvertently Sutured Into the Superior Vena Cava
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Jonathon Hyde, James Cockburn, Michael Michail, Kristoffer Vincent Tanseco, David Hildick-Smith, Andrew Hill, Sandeep Arunothayaraj, and Anna-Lucia Koerling
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medicine.medical_specialty ,Catheterization, Central Venous ,Electrosurgery ,Vena Cava, Superior ,business.industry ,medicine.medical_treatment ,Surgery ,Treatment Outcome ,Superior vena cava ,medicine ,Central Venous Catheters ,Humans ,Cardiology and Cardiovascular Medicine ,business ,Central venous catheter - Published
- 2021
44. Barriers to Physician-Based Skin Examinations for Adolescent and Young Adult Survivors of Melanoma in the Project Forward Study
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Joel Milam, Ann S. Hamilton, Kimberly A. Miller, Ashley Wysong, Myles Cockburn, Michael R. Cousineau, and Katherine Y. Wojcik
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medicine.medical_specialty ,Skin Neoplasms ,Adolescent ,business.industry ,Melanoma ,Dermatology ,medicine.disease ,Young Adult ,Family medicine ,Physicians ,Research Letter ,Medicine ,Humans ,Self-Examination ,Survivors ,Young adult ,business - Abstract
This cross-sectional study examines associations between barriers and lack of physician-based skin examinations in a population-based sample of young melanoma survivors.
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- 2021
45. MO543ASSESSMENT OF RISK FACTORS FOR CARDIOVASCULAR EVENTS AND MORTALITY IN DIALYSIS PATIENTS IN THE AURORA STUDY, A RETROSPECTIVE ANALYSIS
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Bengt Fellström, Ana Filipa Alexandre, James Young, Alina Jiletcovici, Knut Smerud, Niclas Eriksson, Antonia Morga, Elinor Cockburn, and Wim Wilpshaar
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Transplantation ,medicine.medical_specialty ,biology ,business.industry ,medicine.disease ,Dialysis patients ,Coronary revascularization ,Ferritin ,Nephrology ,AURORA trial ,Hepcidin ,Diabetes mellitus ,Internal medicine ,medicine ,biology.protein ,Retrospective analysis ,business ,Risk assessment - Abstract
Background and Aims Patients with chronic kidney disease (CKD) are at higher risk of cardiovascular disease (CVD), which can also lead to end-stage renal disease (ESRD).1 As anaemia is an independent risk factor for CVD,2 treating anaemia might reduce CV events in this patient population. This study aimed to evaluate the impact of anaemia and other risk factors on long-term CV risk in haemodialysis (HD) patients with CKD. A secondary aim was to establish a CV risk equation for this patient population. Method This retrospective study used data from the Phase 3 AURORA study (NCT04042350) of 2776 ESRD patients aged 50–80 years receiving regular HD/haemofiltration, for a mean 3.2 year follow up.3 The primary endpoint of our analysis was time to first major adverse cardiovascular event (CV MACE; non-fatal stroke, non-fatal myocardial infarction, and CV mortality; n=804). Secondary endpoints included time to non-fatal stroke (ischaemic or haemorrhagic; n=98), coronary revascularisation therapy (n=300) and all-cause mortality (n=1296), and development of a CV risk equation. Ferritin and transferrin baseline values were determined for this analysis using the original frozen AURORA study patient samples (>10 years old). Statistical analyses were performed using univariate and multiple Cox regression models. For each outcome a full model was estimated and then simplified by approximation with fewer factors. This was done using linear regression against the linear predictor of the full Cox regression model. In a stepwise manner, the least contributing variable was removed until the subset of variables approximated the full model to 95%. Model performance was measured using the C-statistic, and internally validated using bootstrap. Results Incidence rates for CV MACE, non-fatal stroke, coronary revascularisation, and all-cause mortality were 9.36, 1.11, 3.57, and 13.73 per 100 patient-years, respectively. Certain established risk factors among HD patients, such as age, gender, previous history of CVD, diabetes mellitus, smoking, blood pressure, high phosphate and C-reactive protein levels, and low albumin levels, were also findings for this study, although non-fatal stroke was underpowered to show significance (Table). Elevated haemoglobin levels (≥127 g/L) demonstrated a protective effect on the risk of all-cause mortality (hazard ratio [HR] 0.916, p=0.010 for 127 g/L [upper quartile] versus 107 g/L [lower quartile]), but were also associated with an increased risk of coronary revascularisations (HR 1.164, p=0.011 for 127 g/L versus 107 g/L). Haemoglobin levels ≤107 g/L were associated with an approximately 9% increased annual risk of mortality (HR 1/0.916=1.092). Elevated ferritin and transferrin levels were significant and independent risk factors for CV MACE (HR [95% CI] 1.130 [1.025, 1.246] and 1.202 [0.987, 1.464], respectively), and all-cause mortality (HR [95% CI] 1.088 [1.008, 1.174] and 1.402 [1.198,1.641], respectively), but further analyses of iron metabolism markers, such as hepcidin, are needed to draw meaningful conclusions. The age of the samples may have also impacted the results. Risk prediction models were developed, and the predictive ability was 0.66–0.68 (C-statistic). Conclusion This analysis confirmed that this cohort is representative of a HD population. Moreover, elevated haemoglobin levels were associated with increased survival, concomitantly with coronary revascularisation. Elevated ferritin and transferrin levels were identified as potential risk factors for CV MACE and all-cause mortality, but further studies are required to better understand their value in estimating CV risk. Risk predication models were developed and performed well but require validation against an independent patient cohort.
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- 2021
46. 631 The Time to Therapeutic Serum Levels of Vancomycin in Orthopaedic Patients
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E Palenzuela, A Cockburn, C Rankin, C McCann, and P Robinson
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medicine.medical_specialty ,business.industry ,Internal medicine ,medicine ,Vancomycin ,Surgery ,business ,medicine.drug - Abstract
Introduction Vancomycin is a commonly used antibiotic in the treatment of deep-seated infections. However, the current dosing calculator utilized in NHS Lothian may not adequately achieve therapeutic vancomycin serum concentrations (VSC), of 15-20mg/L, in a timely manner. We aimed to reaudit the length of time for vancomycin to reach therapeutic levels in orthopaedic patients using the new Lothian calculator. A previous audit loop looked at the current calculator in 2018. Method Inclusion criteria orthopaedic patients who were treated with vancomycin at the Royal Infirmary Edinburgh, data collection to finish mid-September. The duration to reach the therapeutic SVC, initial trough SVC and serial levels were recorded. A life-table analysis will be used to examine the data. Results First audit had Twenty-three patients. The mean initial trough VSC was 12.7mg/L. The mean duration to therapeutic VSC was 5.2 (± 1.3) days. Statistics not completed for second cycle, but initial data shows improvement in time to VSC. Conclusions A delay in reaching therapeutic concentrations was observed in a significant proportion of patients using the current calculator. A more rapid achievement of therapeutic levels is required to maximize the period of antibiotic delivery and subsequently improve patient outcomes. The new calculator pilot will hopefully show that improvement.
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- 2021
47. MO540CARDIOVASCULAR OUTCOMES ASSOCIATED WITH ACHIEVED HAEMOGLOBIN LEVEL IN POOLED PHASE 3 STUDIES OF ROXADUSTAT IN NON-DIALYSIS-DEPENDENT PATIENTS WITH ANAEMIA
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Nada Dimkovic, James Young, Elinor Cockburn, Jonathan Barratt, Władysław Sułowicz, and Michael Reusch
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Transplantation ,medicine.medical_specialty ,Randomization ,Anemia ,business.industry ,Roxadustat ,030232 urology & nephrology ,030204 cardiovascular system & hematology ,medicine.disease ,Gastroenterology ,3. Good health ,03 medical and health sciences ,0302 clinical medicine ,Nephrology ,Non dialysis dependent ,Heart failure ,Internal medicine ,medicine ,Procollagen-proline dioxygenase ,business - Abstract
Background and Aims Randomised clinical trials evaluating anaemia correction using erythropoietin-stimulating agents (ESAs) in chronic kidney disease (CKD) patients have demonstrated an association between ESA use and increased risk of cardiovascular (CV) complications and mortality. Although the mechanism for this increased risk remains unclear, possibilities include rapid rates of rise (ROR) in haemoglobin (Hb), exposure to high ESA dose and dose escalation, a high Hb target range, and off-target effects of ESAs. Thus, current recommendations generally state that Hb levels should be maintained between 10 and 12 g/dL. Roxadustat, a hypoxia-inducible factor prolyl hydroxylase inhibitor (HIF-PHI), is used for the treatment of anaemia of CKD; roxadustat stimulates endogenous production of erythropoietin and enhances iron availability, thereby supporting red blood cell production. In this pooled analysis, we explored the relationship between 1) achieved Hb levels and 2) preliminary data for ROR of Hb and subsequent incidence rates of CV events in non–dialysis-dependent (NDD) CKD patients who received roxadustat. Method We analysed pooled data from four phase 3 studies in NDD patients (placebo-controlled: ALPS, ANDES, OLYMPUS; ESA-controlled: DOLOMITES) with anaemia of CKD who received any dose of roxadustat. The reported events occurred during the treatment period and within 7 days of the last dose of roxadustat. Incidence rates of adjudicated major adverse CV events (MACE: all-cause mortality [ACM], myocardial infarction, and stroke), MACE+ (MACE plus heart failure and unstable angina requiring hospitalisation), and ACM were examined relative to 1) most recent Hb level before the event and 2) the preliminary data for ROR of Hb within the 4 weeks of treatment immediately prior to the event. Results Overall, 2709 patients were randomised and received roxadustat. Incidence rates of MACE, MACE+, and ACM were 3- or 4-fold higher in patients with lower reported Hb levels (Hb 2 g/dL in Hb within the 4-week period prior to the event compared to those with a change of ≤2 g/dL within the same period (Table). However, it should be noted that patient-exposure years (PEY) were low for the subgroup of patients with ROR >2 g/dL (∼3.3% of overall PEY), and patients with a decreasing Hb were included in the ≤2 g/dL/4 weeks subgroup. Conclusion In this analysis of roxadustat-treated patients with NDD CKD, incidence rates of MACE, MACE+, and ACM were lower in patients who achieved target Hb levels of 10-12 g/dL compared with patients who achieved Hb
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- 2021
48. Association between oral anticoagulants and COVID-19 related outcomes: two cohort studies
- Author
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Richard Croker, William J Hulme, Elson W, Ian J. Douglas, Laurie A. Tomlinson, Jeremy P Brown, Wong Ay, Christopher T Rentsch, Alex J Walker, Ben Goldacre, Brian MacKenna, Caroline E Morton, Krishnan Bhaskaran, Harriet Forbes, Liam Smeeth, Helen J Curtis, Peter Inglesby, Christopher M. Bates, Sebastian Bacon, Elizabeth Williamson, Jonathan Cockburn, Helen Mcdonald, Anna Schultze, Rosalind M Eggo, S J W Evans, Amir Mehrkar, Rohini Mathur, Kevin Wing, Emma Powell, and David M. Evans
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medicine.medical_specialty ,medicine.drug_class ,business.industry ,Warfarin ,Low molecular weight heparin ,Atrial fibrillation ,Vitamin K antagonist ,medicine.disease ,Lower risk ,Pulmonary embolism ,Internal medicine ,medicine ,business ,Stroke ,medicine.drug ,Cohort study - Abstract
ObjectivesWe investigated the role of routinely prescribed oral anticoagulants (OACs) in COVID-19 outcomes, comparing current OAC use versus non-use in Study 1; and warfarin versus direct oral anticoagulants (DOACs) in Study 2.DesignTwo cohort studies, on behalf of NHS England.SettingPrimary care data and pseudonymously-linked SARS-CoV-2 antigen testing data, hospital admissions, and death records from England.ParticipantsStudy 1: 70,464 people with atrial fibrillation (AF) and CHA□DS□-VASc score of 2. Study 2: 372,746 people with non-valvular AF.Main outcome measuresTime to test for SARS-CoV-2, testing positive for SARS-CoV-2, COVID-19 related hospital admission, COVID-19 deaths or non-COVID-19 deaths in Cox regression.ResultsIn Study 1, we included 52,416 current OAC users and 18,048 non-users. We observed no difference in risk of being tested for SARS-CoV-2 associated with current use (adjusted HR, 1.01, 95%CI, 0.96 to 1.05) versus non-use. We observed a lower risk of testing positive for SARS-CoV-2 (adjusted HR, 0.73, 95%CI, 0.60 to 0.90), and COVID-19 deaths (adjusted HR, 0.69, 95%CI, 0.49 to 0.97) associated with current use versus non-use. In Study 2, we included 92,339 warfarin users and 280,407 DOAC users. We observed a lower risk of COVID-19 deaths (adjusted HR, 0.79, 95%CI, 0.76 to 0.83) associated with warfarin versus DOACs. Similar associations were found for all other outcomes.ConclusionsAmong people with AF and a CHA□DS□-VASc score of 2, those receiving OACs had a lower risk of receiving a positive COVID-19 test and severe COVID-19 outcomes than non-users; this might be explained by a causal effect of OACs in preventing severe COVID-19 outcomes or more cautious behaviours leading to reduced infection risk. There was no evidence of a higher risk of severe COVID-19 outcomes associated with warfarin versus DOACs in people with non-valvular AF regardless of CHA□DS□-VASc score.Key pointsWhat is already known on this topicCurrent studies suggest that prophylactic or therapeutic anticoagulant use, particularly low molecular weight heparin, lower the risk of pulmonary embolism and mortality during hospitalisation among patients with COVID-19.Reduced vitamin K status has been reported to be correlated with severity of COVID-19. This could mean that warfarin, as a vitamin K antagonist, is associated with more severe COVID-19 disease than non-vitamin K anticoagulants.What this study addsIn 70,464 people with atrial fibrillation, at the threshold of being treated with an OAC based on risk of stroke, we observed a lower risk of testing positive for SARS-CoV-2 and COVID-19 related deaths associated with routinely prescribed OACs, relative to non-use.This might be explained by OACs preventing severe COVID-19 outcomes, or more cautious behaviours and environmental factors reducing the risk of SARS-CoV-2 infection in those taking OACs.In 372,746 people with non-valvular atrial fibrillation, there was no evidence of a higher risk of severe COVID-19 outcomes associated with warfarin compared with DOACs.
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- 2021
49. Exploring Risk, Antecedents and Human Costs of Living with a Retained Surgical Item: A Narrative Synthesis of Australian Case Law 1981-2018
- Author
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Juliet Davis, Tina Cockburn, and Sonya Osborne
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Advanced and Specialized Nursing ,medicine.medical_specialty ,unintended retained foreign object ,Legal doctrine ,Common law ,retained surgical item ,Appeal ,adverse event ,General Medicine ,Review ,Coroner ,Medical–Surgical Nursing ,Tribunal ,Family medicine ,Agency (sociology) ,medicine ,retained surgical instrument ,Psychology ,sentinel event ,Inclusion (education) ,Psychosocial ,General Nursing ,retained surgical sponge ,gossypiboma - Abstract
Objective(s): This study aimed to critically examine the circumstances contributing to, and the human costs arising from, the retention of surgical items through the lens of Australian case law. Design, Setting and Participants: We reviewed Australian cases from 1981 to 2018 to establish a pattern of antecedents and identify long-term patient impacts (human costs) of retained surgical items. We used a modified four-step process to conduct a systematic review of legal doctrine, combined with a narrative synthesis approach to bring the information together for understanding. We searched LexisNexis, AustLII, Coroner Court websites, Australian Health Practitioner Regulation Agency Tribunal Decisions and Panel Hearings, Civil and Administrative Tribunal summaries, and other online sources for publicly available civil cases, medical disciplinary cases, coronial cases, and criminal cases across all Australian jurisdictions. Results: Ten cases met the inclusion criteria, including one coronial case, three civil appeal cases, and six civil first instance cases. Time from item retention to discovery ranged from 12 days to 20 years, with surgical sponges the most frequently retained item. Five case reports indicated possible deviations from standard protocols regarding counting procedures and record-keeping. In the four cases that reported on count status, the count was deemed correct at the end of surgery. Case reports also showed the human costs of retained surgical items, that is, the long-term impacts on patients associated with a retained surgical item. In eight of the nine civil cases, ongoing pain was the most frequently reported physical symptom; in three cases, patients suffered psychosocial symptoms requiring treatment. Conclusion: While there was little uniformity in the items retained or how items came to be retained, we identified significant time delays between item retention and item discovery, coupled with long-lasting physical and psychosocial harms suffered by patients living with a retained surgical item. Current prevention strategies, including national standards-based professional practices, are not always effective in preventing retained surgical items. An internationally standardised taxonomy and reporting criteria, more consistent reporting, and open access to event and risk data could inform a more accurate global estimate of risk and incidence of this hospital-acquired complication.
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- 2021
50. Identifying Care Home Residents in Electronic Health Records - An OpenSAFELY Short Data Report
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Frank Hester, Sam Harper, Ben Goldacre, Christopher T Rentsch, Alex J Walker, Nicholas J DeVito, Jonathan Cockburn, Rohini Mathur, Seb Bacon, Laurie A. Tomlinson, Stephen J. W. Evans, Elizabeth A. Williamson, Angel Y S Wong, Krishnan Bhaskaran, David M. Evans, Amir Mehrkar, Helen Mcdonald, Daniel Grint, Kevin Wing, Helen J Curtis, Harriet Forbes, Peter Inglesby, Chris Bates, John Tazare, Tom Ward, Simon Davy, Anna Schultze, Robert McManus, Brian MacKenna, Caroline E Morton, William J Hulme, Liam Smeeth, Richard Croker, Rosalind M Eggo, John Parry, Emily Nightingale, Louis Fisher, George Hickman, and Ian J. Douglas
- Subjects
medicine.medical_specialty ,2019-20 coronavirus outbreak ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Care homes ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Address Linkage ,Medicine (miscellaneous) ,Articles ,Health records ,Care Homes ,General Biochemistry, Genetics and Molecular Biology ,03 medical and health sciences ,0302 clinical medicine ,Family medicine ,Health care ,Pandemic ,Medicine ,Vulnerable population ,Electronic Health Records ,030212 general & internal medicine ,business ,030217 neurology & neurosurgery ,Research Article - Abstract
Background: Care home residents have been severely affected by the COVID-19 pandemic. Electronic Health Records (EHR) hold significant potential for studying the healthcare needs of this vulnerable population; however, identifying care home residents in EHR is not straightforward. We describe and compare three different methods for identifying care home residents in the newly created OpenSAFELY-TPP data analytics platform. Methods: Working on behalf of NHS England, we identified individuals aged 65 years or older potentially living in a care home on the 1st of February 2020 using (1) a complex address linkage, in which cleaned GP registered addresses were matched to old age care home addresses using data from the Care and Quality Commission (CQC); (2) coded events in the EHR; (3) household identifiers, age and household size to identify households with more than 3 individuals aged 65 years or older as potential care home residents. Raw addresses were not available to the investigators. Results: Of 4,437,286 individuals aged 65 years or older, 2.27% were identified as potential care home residents using the complex address linkage, 1.96% using coded events, 3.13% using household size and age and 3.74% using either of these methods. 53,210 individuals (32.0% of all potential care home residents) were classified as care home residents using all three methods. Address linkage had the largest overlap with the other methods; 93.3% of individuals identified as care home residents using the address linkage were also identified as such using either coded events or household age and size. Conclusion: We have described the partial overlap between three methods for identifying care home residents in EHR, and provide detailed instructions for how to implement these in OpenSAFELY-TPP to support research into the impact of the COVID-19 pandemic on care home residents.
- Published
- 2021
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