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102. List of Contributors

Author

Abbas, Mohamed, Adlam, Michael, Antcliffe, David, Arora, Sumesh, Ashraf, Hafiz Hamad, Aswani, Andrew, Barlow, Christopher Jake, Barrett, Nicholas A, Bellomo, Rinaldo, Bersten, Andrew D, Bihari, Shailesh, Bowles, Tim, Brame, Aimée L, Brown, Sarah E, O'Callaghan, David, O'Callaghan, Gerry, Campbell, Jeremy P, Carr, Alaistair Craig, Cattlin, (Charlotte) Stephanie, Chan, Kai Man, Chapman, Marianne J, Choi, Gordon YS, Christie, Linsey Emma, Chung, Christine, Cohen, Jeremy, Collins, David, Cooper, D Jamie, Corner, Evelyn, Cosgrave, David William, Cottam, Simon, Cox, Sarah, Critchley, Lester AH, Damodaran, Anand, Davies, Andrew R, Davies, Nicholas WS, de Beer, Thearina, De Gaudio, A Raffaele, De Maria, Sophia, Delaney, Anthony, Dhillon, Rishi H-P, Dorofaeff, Tavey, Duke, Graeme J, Edibam, Cyrus, Evans, David, Everest, Evan R, Eynon, Colin Andrew, Farag, Mena, Ferry, Tristan, Finfer, Simon, Fischer, Roy, Fletcher, Nick, Flower, Oliver, French, Craig, Galluccio, Steven T, Gin, Tony, Gomersall, Charles David, Green, Alice, Gruber, Pascale, Gupta, Anish, Gupta, Sachin, Hakko, Elif, Handy, Jonathan M, Hanna, Sara, Hartle, Andrew, Hawker, Felicity H, Hatcher, James, Hené, Ilanit Z, Hew, Mark, Higgins, Alisa M, Holt, Andrew William, Hsee, Li C, Ioannou, Nicholas, Isbister, James P, James, Paul, Jansz, Paul C, Jones, Mandy, Joynt, Gavin M, Keays, Richard T, Kerridge, Ian, Lam, Stephen W, Leonard, Richard, Lewington, Andrew, Li, Alex, Lipman, Jeffrey, Macdonald, Peter S, Maiden, Matthew J, McCaffery, Kevin, McGloughlin, Steve, McMenamin, Luke, McNeilly, Sarah, Millar, Johnny, Moffatt, Fiona, Morgan, Thomas J, Morley, Peter Thomas, Murfin, Brendan R, Myburgh, John A, Nair, Priya, Naughton, Matthew T, Nichol, Alistair D, Opdam, Helen I, Opel, Aaisha, Padiglione, Alexander A, Padley, Simon PG, Peake, Sandra L, Pellegrino, Vincent, Petros, Andy, Pilcher, David, Pillai, Vivekanandan M, Pittet, Didier, Platt, Peter R, Plit, Marshall, Power, Bradley, Puthucheary, Zudin, Rasheed, Shahnawaz, Reade, Michael C, Richardson, Alexander (Sacha), Riphagen, Shelley D, Robinson, Hayley, Romagnoli, Stefano, Sadleir, Paul HM, Sampson, Brett, Sarode, Vineet V, Saxena, Manoj K, Segal, Oliver R, Seppelt, Ian, Simillis, Constantinos, Sinha, Ayush, Sivakumar, Ramachandran, Skellett, Sophie, Slater, Anthony J, Smith, Martin, Streat, Stephen J, Strickland, Richard, Sturgess, David J, Subbe, Christian P, Tan, Chee Wee, Thomas, Peter D (Toby), Tibballs, James, Toledano, Michel, Torre, Luke E, Tuxen, David V, Uçkay, Ilker, Urwin, Kate, Venkatesh, Balasubramanian, Vet, Jacqueline EHM, Vizcaychipi, Marcela Paola, Ming Wai, Joey Ka, Waldmann, Carl S, Wan, Winnie TP, Ward, Christopher M, Ward, Phil, Watson, Edward, Watts, Ryan P, Welch, John R, Wendon, Julia, White, Hayden, Wiersema, Ubbo F, Wigmore, Timothy, Willars, Chris, Wong, Patrick MT, Wyncoll, Duncan LA, and Yentis, Steve M

Published
2019
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104. Intracardiac Right-to-Left Shunt Impeding Liberation From Veno-Venous Extracorporeal Membrane Oxygenation: Two Case Studies

Author

Gillon, Stuart A., primary, Barrett, Nicholas A., additional, Ioannou, Nicholas, additional, Camporota, Luigi, additional, Victor, Kelly, additional, Gowland, Abigail, additional, Meadows, Christopher I. S., additional, Langrish, Christopher, additional, Tricklebank, Stephen, additional, and Wyncoll, Duncan, additional

Published
2016
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107. Prevalence of Venous Thrombosis Following Venovenous Extracorporeal Membrane Oxygenation in Patients With Severe Respiratory Failure

Author

Cooper, Eve, primary, Burns, Janis, additional, Retter, Andrew, additional, Salt, Gavin, additional, Camporota, Luigi, additional, Meadows, Christopher I. S., additional, Langrish, Christopher C. J., additional, Wyncoll, Duncan, additional, Glover, Guy, additional, Ioannou, Nicholas, additional, Daly, Kathleen, additional, and Barrett, Nicholas A., additional

Published
2015
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108. A Pilot Study to Assess Safety and Feasibility of Intrathecal Immunoglobulin for the Treatment of Adults with Tetanus.

Author

Huynh Thi Loan, Lam Minh Yen, Kestelyn, Evelyne, Van Hao, Nguyen, Nguyen Thi Hoang Mai, Duong Bich Thuy, Ha Thi Hai Duong, Nguyen Thi Phuong Dung, Nguyen Hoan Phu, Pham Thi Lieu, Tran Tan Thanh, Geskus, Ronald, van Doorn, H. Rogier, Le Van Tan, Wyncoll, Duncan, Day, Nicholas P. J., Hien, Tran Tinh, Thwaites, Guy E., Nguyen Van Vinh Chau, and Thwaites, C. Louise

Published
2018
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110. Compassionate Use of Cefiderocol as Adjunctive Treatment of Native Aortic Valve Endocarditis Due to Extremely Drug-resistant Pseudomonas aeruginosa.

Author

Edgeworth, Jonathan D, Merante, Domenico, Patel, Sanjay, Young, Christopher, Jones, Paul, Vithlani, Seema, Wyncoll, Duncan, Roberts, Peter, Jones, Andrew, Nagata, Tsutae Den, Ariyasu, Mari, Livermore, David M, and Beale, Richard

Subjects
CEPHALOSPORINS, COLISTIN, ENDOCARDITIS, DRUG resistance in microorganisms, HYDROLASES, PSEUDOMONAS diseases, TREATMENT effectiveness, DISEASE complications, THERAPEUTICS
Abstract

Serious infections such as endocarditis due to extremely drug-resistance gram-negative bacteria are an increasing challenge. Here, we present successful adjunctive use of cefiderocol for a patient with persistently bacteremic healthcare-associated native aortic valve endocarditis due to an extended-spectrum beta-lactamase–positive Pseudomonas aeruginosa susceptible in vitro only to colistin, following failure of conventional therapeutic options. [ABSTRACT FROM AUTHOR]

Published
2019
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111. Adjunctive rifampicin for Staphylococcus aureusbacteraemia (ARREST): a multicentre, randomised, double-blind, placebo-controlled trial

Author

Thwaites, Guy E, Scarborough, Matthew, Szubert, Alexander, Nsutebu, Emmanuel, Tilley, Robert, Greig, Julia, Wyllie, Sarah A, Wilson, Peter, Auckland, Cressida, Cairns, Janet, Ward, Denise, Lal, Pankaj, Guleri, Achyut, Jenkins, Neil, Sutton, Julian, Wiselka, Martin, Armando, Gonzalez-Ruiz, Graham, Clive, Chadwick, Paul R, Barlow, Gavin, Gordon, N Claire, Young, Bernadette, Meisner, Sarah, McWhinney, Paul, Price, David A, Harvey, David, Nayar, Deepa, Jeyaratnam, Dakshika, Planche, Tim, Minton, Jane, Hudson, Fleur, Hopkins, Susan, Williams, John, Török, M Estee, Llewelyn, Martin J, Edgeworth, Jonathan D, Walker, A Sarah, Scarborough, Matthew, Kamfose, Musa, de Veciana, Ana, Gordon, Nicola Claire, Peto, Leon, Pill, Gemma, Clarke, Tiphanie, Watson, Laura, Young, Bernadette, Griffiths, Dai, Vaughn, Ali, Anson, Luke, Liu, Elian, Perera, Sanuki, Rylance-Knight, Lydia, Cantell, Carmen, Moroney, Ruth, Edgeworth, Jonathan D, Thwaites, Guy, Bisnauthsing, Karen, Querol-Rubiera, Antonio, Gibbs, Charlotte, Patel, Amita, Hemsley, Carolyn, Goodman, Anna L, Wyncoll, Duncan, Biswas, Jason, Fitzpatrick, Jennifer, Roberts, Lizzie, Millard, James, Stone, Neil, Cape, Angela, Hurley, Lisa, Tam, Chi Kai, Nsutebu, Emmanuel, Hoyle, Marie-Claire, Maitland, Kate, Trainor, Leona, Reynolds, Helen, Harrison, Jennifer, Anson, Jim, Lewis, Joseph, Folb, Jonathan, Goodwin, Lynsey, Beeching, Nicholas, Dyas, Sarah, Winslow, Helen, Foote, Elizabeth, Roberts, Paul, Natarajan, Pavithra, Chrdle, Alex, Fenech, Manuel, Allsop, Hannah, Tilley, Robert, Austin-Hutchison, Rachel, Barrett, Louise, Brookes, Karen, Carwithen, Leanne, Conbeer, Andrew, Cunningham, Richard, Eglinton, Charlotte, Fok, Rosie, Gott, Hannah, Hughes, Shona, Jones, Lewis, Kalita, Maggie, King, Angela, March, Linda, Marner, Mike, Mynes, Tracey, Plant, Aiden, Price, Suzanne, Sercombe, Judy, Stolton, Alison, Wallis, Mark, West, Marie-Claire, Westcott, Jackie, Williams, Claire, Wosley, Rob, Yabsley, Leona, Greig, Julia, Butland, Laura, Sorrell, Julie, Mitchell, Tamara, Alli, Abiola, Meiring, James, Masake, Boingotlo, Rowson, Carlene, Smart, Lynne, Makey, Laura, Moll, Sarah, Cunningham, Jane, Ryalls, Kim, Birchall, Kathryn, Middle, Janet, Jackson, Yvonne, Swift, Diane, Cole, Joby, Subramanian, Bala, Okhuoya, Faith, Edwards, Maria, Bailey, Cheryl, Warren, Rebecca, Islam, Gayti, Ankcorn, Michael, Birchall, Sarah, Jones, Paul, Humphries, John, Booth, Stephen, Evan, Cariad, Wyllie, Sarah, Flatt, Andrew, Strakova, Lenka, Hayes, Maria, Valentine, Stacey, James, Clare, Wands, Mary, Cortes, Nicolas, Khan, Nisa, Porter, Robert, Martin, Zoe, Yip, Keith, Preedy, Helen, Chesterfield, Helen, Dobson, Tracey, Walker, Colin, Llewelyn, Martin, Dunne, Angela, Latter, Laura, Porges, Alison, Price, James, Paul, John, Behar, Laura, Robinson, Louise, Murray, Amy, Fitzpatrick, Jennifer, Sargent, Tenessa, Ridley, Carrie, de Gordoa, Laura Ortiz-Ruiz, Gilliam, Deborah, McPherson, Carole, Matthews, Simon, Foreman, Emma, Jarghese, Rajesh, Beddoe, Alisha, Martin, Sebastien, Shaw, Sephora, Wlazly, Dominika, Cole, Maggie, Gihawi, Abraham, Cole, Kevin, Török, M Estée, Gouliouris, Theodore, Bedford, Luke, Saunderson, Rebecca B, Mariolis, Ilias, Bousfield, Rachel, Ramsay, Isobel, Greaves, Daniel, Aliyu, Sani, Cox, Kim, Mlemba, Lois, Whitehead, Lynne, Vyse, Naval, Bolton, Mark, Williams, John, Lambert, Pauline, Chadwick, David, Baillie, Kirsty, Cain, Martyn, Bellamy, Richard, Wong, Jason, Thompson, Jane, Vassallo, Helen, Skotnicka, Agnieszka, Boyce, Andrea, Donnelly, Anthony, Wilson, Peter, FitzGerald, Graham, Dean, Victoria, Warnes, Kristian, Reyes, Anna, Rahman, Saadia, Tsang, Lillian, Williams, Joanne, Morris-Jones, Stephen, Hopkins, Susan, Witness, Elen, Brady, Orla, Woodford, Elizabeth, Pettifer, Teresa, McCadden, Angela, Marks, Ben, Collier, Sophie, Mack, Damien, Warren, Simon, Brown, Colin, Lyons, Adrian, Taiyari, Sara, Mepham, Stephen, Sweeney, Anna, Brown, Li-An, Auckland, Cressida, Potter, Alison, Mandiza, Jess, Hough, Maxine, Williams, Sue, Renton, Caroline, Walters, Fiona, Nadolski, Maria, Evans, Andree, Tarrant, Polly, Curley, Katherine, Whiteley, Sophie, Halpin, Julia, Hutchings, Melanie, Todd, Shirley, Lohan, Christop, Chapter, Tamika, Folland, Emma, Colville, Alaric, Marden, Katy, Morgan, Marina, Fok, Rosie, Porter, Rob, Baxter, Mel, Minton, Jane, Rippon, Sarah, Cevik, Muge, Chapman, Judith, Kemp, Tim, Vincent, Rachel, Osborne, Dave, Platt, Tracey, Calderwood, James, Cook, Bernadette, Bedford, Caroline, Galloway-Browne, Leanne, Abberley, Nadine, Attack, Kelly, Allen, Joanna, Lal, Pankaj, Harrison, Melanie, Stevenson, Sarah, Brooks, Carol, Harlow, Paula, Ewing, Jordan, Cooper, Shirley, Balancio-Tolentino, Roderick, O'Neil, Laura, Tagney, Rebecca, Shackcloth, Daniela, Planche, Tim, Fellows, James, Millett, Ruth, Studham, Jo, de Souza, Cherrelle, Howell, Geoffrey, Greaves, Hezron, Foncel, Ella, Kurup, Rahul, Briggs, Jack, Smith, Melody, Suarez, Cristina, Sorrentino, Giordana, Scobie, Antonia, Houston, Angela, Ahmad, Fozia, Breathnach, Aodhan, Chahuan, Rakhee, Wilkins, Katie, Guleri, Achyut, Waddington, Natalia, Sharma, Rashmi, Flegg, Peter, Kollipara, Veenu, Alam, Mazhar, Potter, Andrew, Donaldson, Stacey, Armer, Charlote, Frudd, Julie, Jeyaratnam, Dakshika, Joy, Manju, Mathews, Asha, Glass, Stephen K, Ajayi, Ayodele, Fife, Amanda, Qaiser, Saba, Sheehan, Sharon, Muñoz-Villaverde, Sergio, Yogo, Noah, De Abreu, Ines, Notcheva, Gaynor, Flanagan, Joanna, Watson, Cordelia, Sais, Efisia, Adedayo, Adetunji, Chu, Vicky, Shaw, Georgina, Graver, Michelle A, Palmer, Rebecca, Palmer, Donna, Haile, Senait, Gordon, Joanne, Tam, Chi Kai, Mandar, Kirandip, Szypura, Weronika, Jenkins, Neil, Marange, Josephine, Shabangu, Vusumuzi, Moore, Katy, Lyons, Jill, Munang, Melinda, Sangombe, Mirriam, Moran, Ed, Hussain, Abid, Wiselka, Martin, Lewszuk, Adam, Batham, Sally, Ellis, Kate, Bahadur, Leila, White, Helena, Pareek, Manish, Sahota, Amandip, Coleman, Stephen, Pateman, Hilary, Kotecha, Atul, Sim, Christopher, Rosser, Andrew, Deane, Jill, Nendick, Richard, Aldridge, Catherine, Clarke, Anne, Wood, Michelle, Marshall, Adele, Stephenson, Lynsey, Matheson-Smith, Tracy, Sloss, John, Potts, Kathryn, Malkin, Joanne, Ftika, Lemonia, Raviprakash, Veena, Sutton, Julian, Malachira, Ahalya, Kean, Miranda, Criste, Kristine, Gladas, Kirsty, Andrews, Caroline, Hutchison, Clare, Adams, Ellen, Andrews, Janet, Romans, Belinda, Ridley, Nicola, Ekani, Melanie, Mitchell, Julie, Smith, Nicola, Clark, Tristan, Glover, Sarah, Reed, Robert, Yam, Tat, Burton, Holly, Said, Rasha, Harvey, David, Janvier, Amy, Jacob, Reni, Smalley, Chris, Fair, Alison, Lord, Susan, Ripalda, Kate, Wooldridge, Helen, Cotter, Luis, Cardoso, Gus, Strachan, Elaine, Kaler, Gagan, Mohamoodally, Adam, Lawrence, Emma, Prime, Zoe, Abrahams, Rachel, Price, David Ashley, Rigden, Lesley, Shewan, Laura, Cullen, Katherine, Emmerson, Ingrid, Martin, Karen, Wilson, Hesther, Higham, Charley, Taylor, Kathryn Louise, Ong, Edmund, Patel, Bijal, Bond, Helena, Gradwell, Janine, Widdrington, John, Graham, Clive, Thornthwaite, Sarah, Prentice, Scott, Poultney, Una, Crowther, Hannah, Fairlamb, Helen, Hetherington, Emily, Brewer, Chris, Banerjee, Suryabrata, Hamson, Clare, McSkeane, Anna, McWhinney, Paul, Sharratt, Paula, Thorpe, Joanne, Kimachia, Sue, Wilson, Helen, Jeffs, Benjamin, Masters, Leslie, Wilson, Jonathan, Platt, Judith, Burgess, Lisa, Chadwick, Paul, Jeans, Adam, Keatley, Claire, Moran, Amanda, Swann, Zoe, Pagett, Katherine, Peel, Alex, Howard, Jason, Meisner, Sarah, Maloney, Kate, Masdin, Avril, Wright, Louise, Barlow, Gavin, Crossman, Samantha, Lowthorpe, Vicki, Moore, Emma, Moss, Peter, Parkin, Angela, Wolstencroft, Adam, Warner, Bev, Tarbotton, Clare, Eyre, Alison, Anderson, Anne, Burdett, Tina, Driffill, Amy, Walker, Ann Sarah, Hudson, Fleur, Szubert, Alex, Cairns, Janet, Ward, Denise, Webb, Helen, Russell, Charlotte, Jackson, Brooke, Otiko, Damilola, Borg, Chiara, Masters, Lindsey, Islam, Zaheer, Díaz-Montaña, Carlos, and Johnson, Debbie

Abstract

Staphylococcus aureusbacteraemia is a common cause of severe community-acquired and hospital-acquired infection worldwide. We tested the hypothesis that adjunctive rifampicin would reduce bacteriologically confirmed treatment failure or disease recurrence, or death, by enhancing early S aureuskilling, sterilising infected foci and blood faster, and reducing risks of dissemination and metastatic infection.

Published
2018
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114. Randomized trial evaluating serial protein C levels in severe sepsis patients treated with variable doses of drotrecogin alfa (activated).

Author

Shorr, Andrew F, Janes, Jonathan, Artigas, Antonio, Tenhunen, Jyrki, Wyncoll, Duncan L A, Mercier, Emmanuelle, François, Bruno, Vincent, Jean Louis, Vangerow, Burkhard, Heiselman, Darell, Leishman, Amy G, Zhu, Yajun E, Reinhart, Konrad, RESPOND investigators, Shorr, Andrew F, Janes, Jonathan, Artigas, Antonio, Tenhunen, Jyrki, Wyncoll, Duncan L A, Mercier, Emmanuelle, François, Bruno, Vincent, Jean Louis, Vangerow, Burkhard, Heiselman, Darell, Leishman, Amy G, Zhu, Yajun E, Reinhart, Konrad, and RESPOND investigators

Abstract

Serial alterations in protein C levels appear to correlate with disease severity in patients with severe sepsis, and it may be possible to tailor severe sepsis therapy with the use of this biomarker. The purpose of this study was to evaluate the dose and duration of drotrecogin alfa (activated) treatment using serial measurements of protein C compared to standard therapy in patients with severe sepsis., Clinical Trial, Phase II, Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't, SCOPUS: ar.j, info:eu-repo/semantics/published

Published
2010

115. Restrictive Versus Liberal Transfusion Strategies for Older Mechanically Ventilated Critically Ill Patients

Author

Walsh, Timothy S., primary, Boyd, Julia A., additional, Watson, Douglas, additional, Hope, David, additional, Lewis, Steff, additional, Krishan, Ashma, additional, Forbes, John F., additional, Ramsay, Pamela, additional, Pearse, Rupert, additional, Wallis, Charles, additional, Cairns, Christopher, additional, Cole, Stephen, additional, and Wyncoll, Duncan, additional

Published
2013
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125. Randomized trial evaluating serial protein C levels in severe sepsis patients treated with variable doses of drotrecogin alfa (activated)

Author

Shorr, Andrew F, primary, Janes, Jonathan M, additional, Artigas, Antonio, additional, Tenhunen, Jyrki, additional, Wyncoll, Duncan LA, additional, Mercier, Emmanuelle, additional, Francois, Bruno, additional, Vincent, Jean-Louis, additional, Vangerow, Burkhard, additional, Heiselman, Darell, additional, Leishman, Amy G, additional, Zhu, Yajun E, additional, Reinhart, Konrad, additional, and Investigators, for the RESPOND, additional

Published
2010
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145. Leukoreduced blood transfusion does not increase circulating soluble markers of inflammation: a randomized controlled trial.

Author

Jiwaji, Zoeb, Nunn, Kieran P., Conway‐Morris, Andrew, Simpson, A. John, Wyncoll, Duncan, Rossi, Adriano G., and Walsh, Timothy S.

Subjects
BLOOD transfusion, ERYTHROCYTES, INFLAMMATORY mediators, HEMOGLOBINS, INTERLEUKIN-1, TUMOR necrosis factors, RANDOMIZED controlled trials, ENZYME-linked immunosorbent assay
Abstract

Background Transfused blood may have immunomodulatory and proinflammatory effects. We report the first randomized study exploring whether leukoreduced red blood cell ( RBC) transfusion increases circulating proinflammatory mediators, markers of neutrophil activation, and the acute-phase response in critically ill adults. Study Design and Methods Eighty-four patients were recruited from six general intensive care units in the United Kingdom as part of a laboratory study nested within a parallel-group randomized trial comparing restrictive and liberal leukoreduced RBC transfusion strategies in critically ill patients aged more than 55 years with measured hemoglobin concentrations of not more than 90 g/L (ClinicalTrials.gov NCT00944112). Forty-one patients received transfusion and 43 did not receive transfusion. Plasma was sampled at baseline, 6 hours, and 24 hours after randomization or transfusion, and concentrations of interleukin ( IL)-1β, IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, IL-12-p70, interferon-γ, tumor necrosis factor-α, human neutrophil elastase, soluble L-selectin, and C-reactive protein were measured using cytokine bead array analysis and an enzyme-linked immunosorbent assay. Results Patients who received transfusion did not have significantly different inflammatory biomarker plasma concentrations at the time points compared to those who did not receive transfusion, with the exception of IL-8 concentrations at 24 hours, which were reduced in the transfused group (p = 0.02). After adjustment for baseline inflammatory biomarker concentrations, there were no significant differences between patients who received transfusion and those who did not. Conclusion Concentrations of measured biomarkers were not significantly increased during the first 24 hours after leukoreduced RBC transfusion. These data do not support the contention that leukoreduced RBC transfusion is associated with a proinflammatory response in the general adult critically ill population. [ABSTRACT FROM AUTHOR]

Published
2014
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146. Point-of-Care Testing for Clostridium DifficileInfection: A Real-World Feasibility Study of a Rapid Molecular Test in Two Hospital Settings

Author

Goldenberg, Simon, Bisnauthsing, Karen, Patel, Amita, Postulka, Anne, Wyncoll, Duncan, Schiff, Rebekah, and French, Gary

Abstract

In the developed world, Clostridium difficileinfection (CDI) is the most important cause of nosocomial infectious diarrhea. In addition to providing epidemiological data and helping to indicate that a local outbreak may be occurring, laboratory tests are used to augment clinical decisions on individual patients. Very rarely do diagnostic tests provide results at the point of decision making; in the intervening period between requesting investigations on a patient with suspected CDI and return of the laboratory result, decisions must be made regarding patient isolation and treatment. A 22-month, real-world feasibility study was conducted in patients with clinically significant diarrhea, in a London Hospital between March 2011 and January 2013, in three older persons’ wards and two intensive care units (ICUs) to determine acceptability, ease of use, change in turnaround time and clinical utility of a rapid, polymerase chain reaction (PCR)-based point-of-care test (POCT) (Cepheid GeneXpert®, Sunnyvale, California, USA) for diagnosis of Clostridium difficile. Nurses in the older persons’ ward and laboratory technicians in the ICU were trained to perform the test. Residual samples were sent to the centralized laboratory for parallel testing using a two-step algorithm. A total of 335 samples were tested using the POCT with a median turnaround time of 1.85 h compared with 18 h for the centralized laboratory test. Overall agreement with centralized laboratory testing was 98.1%. Discrepant samples were more frequent on elderly wards than ICU. Overall 20/335 (6%) processing errors were encountered and were highest in the first few months of the study. Significantly more processing errors occurred on the older persons’ wards 13/102 (12.7%) than on ICU 7/271 (2.6%). Older persons’ patients who had POCT were significantly less likely to have a test requested for bacterial stool culture (3.1% vs. 10.9% p= 0.044). This difference was not observed in the ICU patients. No other differences in ancillary test requesting, mortality or length of stay were observed. The majority of users reported that the POCT was easy to perform and was an acceptable part of their job. POCT using this system is feasible and acceptable to nursing staff and technicians working within these two hospital-based settings.

Published
2014
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147. Prevalence, management and clinical challenges associated with acute faecal incontinence in the ICU and critical care settings: The FIRST™ cross-sectional descriptive survey.

Author

Bayón García, Cristina, Binks, Rachel, De Luca, Enrico, Dierkes, Christine, Franci, Andrea, Gallart, Elisabet, Niederalt, Georg, and Wyncoll, Duncan

Abstract

Summary: Objective: To evaluate the prevalence, awareness and management of acute faecal incontinence with diarrhoea (AFId) in the Intensive Care Unit. Design: Cross-sectional descriptive survey design of intensive care units across Germany, Italy, Spain and the United Kingdom. Results: 962 questionnaires were completed by nurses (60%), physicians (29%) and pharmacists or purchasing personnel (11%). The estimated prevalence of AFId ranged from 9 to 37% of patients on the day of the survey. The majority of respondents reported a low-moderate awareness of the clinical challenges associated with AFId. Patients with AFId commonly had compromised skin integrity, which included perineal dermatitis, moisture lesions or sacral pressure ulcers. Reducing the risk of cross-infection and protecting skin integrity were rated as the most important clinical challenges. 49% had no hospital protocol or guideline for AFId management. There was also a low awareness of nursing time spent managing AFId; 60% of respondents estimated that 10–20 minutes are required for managing an AFId episode by 2–3 healthcare staff. Conclusions: AFId in the critical care setting may be an underestimated problem which is associated with a high use of nursing time. [ABSTRACT FROM AUTHOR]

Published
2012
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148. Efficacy and Limitation of a Chlorhexidine-Based Decolonization Strategy in Preventing Transmission of Methicillin-Resistant Staphylococcus aureus in an Intensive Care Unit.

Author

Batra, Rahul, Cooper, Ben S., Whiteley, Craig, Patel, Amita K., Wyncoll, Duncan, and Edgeworth, Jonathan D.

Subjects
CHLORHEXIDINE, STAPHYLOCOCCUS aureus infections, STAPHYLOCOCCUS aureus, METHICILLIN resistance, DRUG resistance in microorganisms, ANTI-infective agents, GENES, ANTISEPTICS, CONFIDENCE intervals
Abstract

Background. Surface-active antiseptics, such as chlorhexidine, are increasingly being used as part of intervention programs to prevent methicillin-resistant Staphylococcus aureus (MRSA) transmission, despite limited evidence and potential for resistance. We report on the effect of an antiseptic protocol on acquisition of both endemic MRSA and an outbreak strain of MRSA sequence type 239 (designated TW). Methods. Interrupted time-series data on MRSA acquisitions in two 15-bed intensive care units were analyzed using segmented regression models to estimate the effects of sequential introduction of an educational campaign, cohorting, and a chlorhexidine-based antiseptic protocol on transmission of TW and non-TW MRSA strains. Representative TW and non-TW MRSA strains were assessed for carriage of qacA/B genes and antiseptic susceptibility. Results. The antiseptic protocol was associated with a highly significant, immediate 70% reduction in acquisition of non-TW MRSA strains (estimated model-averaged incidence rate ratio, 0.3; 95% confidence interval, 0.19-0.47) and an increase in acquisition of TW MRSA strains (estimated model-averaged incidence rate ratio, 3.85; 95% confidence interval, 0.80-18.59). There was only weak evidence of an effect of other interventions on MRSA transmission. All TW MRSA strains (21 of 21 isolates) and <5% (1 of 21 isolates) of non-TW MRSA strains tested carried the chlorhexidine resistance loci qacA/B. In vitro chlorhexidine minimum bactericidal concentrations of TW strains were 3-fold higher than those of non-TW MRSA strains, and in vivo, only patients with non-TW MRSA demonstrated a reduction in the number of colonization sites in response to chlorhexidine treatment. Conclusion. A chlorhexidine-based surface antiseptic protocol can interrupt transmission of MRSA in the intensive care unit, but strains carrying qacA/B genes may be unaffected or potentially spread more rapidly. [ABSTRACT FROM AUTHOR]

Published
2010
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149. Management of the critically ill obstetric patient.

Author

Price, Laura Claire, Germain, Sarah, Wyncoll, Duncan, and Nelson-Piercy, Catherine

Subjects
CRITICALLY ill, PRENATAL care, INTENSIVE care units, MATERNAL mortality, HEART diseases, THROMBOEMBOLISM, PREECLAMPSIA
Abstract

Abstract: Obstetric critical illnesses represent a small but important proportion of all intensive care unit (ICU) admissions in the UK. They are challenging to the critical care team because of the unique physiology and specific medical disorders seen in this population. Maternal mortality is fortunately rare, but devastating when it occurs, with the commonest causes of death being cardiac disease and venous thromboembolism. Massive obstetric haemorrhage, pre-eclampsia and genital tract sepsis are also important causes, and these are reflected in the reasons for ICU admission in the obstetric population. Maternal mortality may be reduced by prompt recognition of critical illness in the pregnant woman, earlier initiation of intensive care, and increased input from senior clinicians. ICU management involves resuscitation, monitoring \and assessment of deranged physiology, and the provision of safe organ support. The overall aims are to ensure adequate oxygen delivery and tissue perfusion, and to stabilise the patient while awaiting investigations which may guide further disease-specific management. The normal physiological adaptations to pregnancy and the effects of any drugs or procedures on the fetus should be taken into account. [Copyright &y& Elsevier]

Published
2009
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150. Intracranial Hemorrhage Occurs Early in Patients With Severe Respiratory Failure Requiring Venovenous Extracorporeal Membrane Oxygenation.

Author

Taylor, Daniel and Wyncoll, Duncan

Subjects
*EXTRACORPOREAL membrane oxygenation, *RESPIRATORY insufficiency, *CEREBRAL hemorrhage
Abstract

We read with great interest the review article published in a recent issue of I Critical Care Medicine i by Cho et al ([1]) summarizing neurocritical care aspects of patients receiving extracorporeal membrane oxygenation (ECMO). To conclude, we feel that there is a sufficient body of evidence to demonstrate that ICH occurs early in patients on venovenous ECMO; therefore, all patients should undergo screening neuroimaging at the earliest opportunity. [Extracted from the article]

Published
2020
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