276 results on '"Brett, SJ"'
Search Results
2. Assessing COVID-19 vaccine uptake and effectiveness through the north west London vaccination program: retrospective cohort study
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Glampson, B, Brittain, J, Kaura, A, Mulla, A, Mercuri, L, Brett, SJ, Aylin, P, Sandall, T, Goodman, I, Redhead, J, Saravanakumar, K, Mayer, EK, Imperial College Healthcare NHS Trust- BRC Funding, National Institute for Health Research, Imperial College Healthcare NHS Trust, and NHS North West London CCG
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Background: Real world data supporting the effectiveness of the COVID-19 vaccination strategy in the UK population is needed to guide health policy. This real-word data-driven evidence study of the UK COVID-19 Vaccination Programme in the Northwest London (NWL) population used a unique dataset established as part of the Gold Command Covid-19 response in NWL (iCARE https://imperialbrc.nihr.ac.uk/facilities/icare/), which included the pre-established Whole System Integrated Care (WSIC) data collated for the purposes of population health in the sector. Objective: To assess the early vaccine administration coverage and vaccine effectiveness and outcome data across an integrated care system of eight CCGs leveraging a unique population-level care dataset Methods: Design - Retrospective cohort study. Setting - Individuals eligible for COVID 19 vaccination in North West London based on linked primary and secondary care data. Participants - 2,183,939 individuals eligible for COVID 19 vaccination Results: During the NWL vaccine programme study time period 5.88% of individuals declined and did not receive a vaccination. Black or black British individuals had the highest rate of declining a vaccine at 16.14% (4,337). There was a strong negative association between deprivation and rate of declining vaccination (r=-0.94, p
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- 2021
3. Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study (vol 47, pg 160, 2021)
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Labeau, SO, Afonso, E, Benbenishty, J, Blackwood, B, Boulanger, C, Brett, SJ, Calvino-Gunther, S, Chaboyer, W, Coyer, F, Deschepper, M, Francois, G, Honore, PM, Jankovic, R, Khanna, AK, Llaurado-Serra, M, Lin, F, Rose, L, Rubulotta, F, Saager, L, Williams, G, and Blot, SI
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DecubICUs Study Team ,European Society of Intensive Care Medicine (ESICM) Trials Group Collaborators ,Science & Technology ,Critical Care Medicine ,General & Internal Medicine ,1103 Clinical Sciences ,Life Sciences & Biomedicine ,Emergency & Critical Care Medicine ,1117 Public Health and Health Services - Published
- 2021
4. Progression of whole blood transcriptional signatures from interferon-induced to neutrophil-associated patterns in patients with severe influenza
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Dunning, J, Blankley, S, Hoang, LT, Cox, M, Graham, CM, James, PL, Bloom, CI, Chaussabel, D, Banchereau, J, Brett, SJ, Moffatt, MF, Habibi, MS, Johnston, SL, Hansel, TT, Levin, M, Thwaites, RS, Warner, JO, Cookson, WO, Gazzard, BG, Hay, A, McCauley, J, Aylin, P, Ashby, D, Barclay, WS, Elderfield, RA, Nadel, S, Herberg, JA, Drumright, LN, Garcia-Alvarez, L, Holmes, AH, Kon, OM, Aston, SJ, Gordon, SB, Hussell, T, Thompson, C, Zambon, MC, Baillie, KJ, Hume, DA, Simmonds, P, Hayward, A, Smyth, RL, McNamara, PS, Semple, MG, Nguyen-Van-Tam, JS, Ho, LP, McMichael, AJ, Kellam, P, Adamson, WE, Carman, WF, Griffiths, MJ, O'Garra, A, Openshaw, PJM, Wellcome Trust, National Institute for Health Research, Medical Research Council (MRC), and Asthma UK
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0301 basic medicine ,Male ,Neutrophils ,Disease ,DISEASE ,Procalcitonin ,Transcriptome ,Pathogenesis ,0302 clinical medicine ,MARKERS ,Interferon ,Immunology and Allergy ,Medicine ,MOSAIC Investigators ,Young adult ,UNITED-KINGDOM ,Middle Aged ,3. Good health ,1107 Immunology ,030220 oncology & carcinogenesis ,Disease Progression ,Female ,Life Sciences & Biomedicine ,medicine.drug ,Adult ,Adolescent ,Immunology ,CIRCULATION ,BIOLOGY ,VIRUS-INFECTION ,Lung injury ,Antiviral Agents ,Article ,03 medical and health sciences ,Young Adult ,Influenza, Human ,Humans ,RNA, Messenger ,PROCALCITONIN ,METAANALYSIS ,Aged ,Science & Technology ,business.industry ,Human genetics ,030104 developmental biology ,Interferons ,business ,LUNG INJURY ,Biomarkers - Abstract
© 2018 The Author(s). Transcriptional profiles and host-response biomarkers are used increasingly to investigate the severity, subtype and pathogenesis of disease. We now describe whole-blood mRNA signatures and concentrations of local and systemic immunological mediators in 131 adults hospitalized with influenza, from whom extensive clinical and investigational data were obtained by MOSAIC investigators. Signatures reflective of interferon-related antiviral pathways were common up to day 4 of symptoms in patients who did not require mechanical ventilator support; in those who needed mechanical ventilation, an inflammatory, activated-neutrophil and cell-stress or death ('bacterial') pattern was seen, even early in disease. Identifiable bacterial co-infection was not necessary for this 'bacterial' signature but was able to enhance its development while attenuating the early 'viral' signature. Our findings emphasize the importance of timing and severity in the interpretation of host responses to acute viral infection and identify specific patterns of immune-system activation that might enable the development of novel diagnostic and therapeutic tools for severe influenza.
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- 2018
5. Variation in renal responses to exercise in the heat with progressive acclimatisation
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Omassoli, J, Hill, NE, Woods, DR, Delves, S, Fallowfield, J, Brett, SJ, Wilson, D, Corbett, RW, Allsopp, AJ, Staceyb, MJ, Omassoli, J, Hill, NE, Woods, DR, Delves, S, Fallowfield, J, Brett, SJ, Wilson, D, Corbett, RW, Allsopp, AJ, and Staceyb, MJ
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- 2019
6. Heat acclimatization blunts copeptin responses to hypertonicity from dehydrating exercise in humans
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Stacey, MJ, Woods, DR, Brett, SJ, Britland, SE, Fallowfield, JL, Allsopp, AJ, and Delves, SK
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Acclimatization favors greater extracellular tonicity from lower sweat sodium, yet hyperosmolality may impair thermoregulation during heat stress. Enhanced secretion or action of vasopressin could mitigate this through increased free water retention. Aims were to determine responses of the vasopressin surrogate copeptin to dehydrating exercise and investigate its relationships with tonicity during short and long-term acclimatization. Twenty-three participants completed a structured exercise programme following arrival from a temperate to a hot climate. A Heat Tolerance Test (HTT) was conducted on Day-2, 6, 9 and 23, consisting of 60-min block-stepping at 50% VO2 peak, with no fluid intake. Resting sweat [Na+ ] was measured by iontophoresis. Changes in body mass (sweat loss), core temperature, heart rate, osmolality (serum and urine) and copeptin and aldosterone (plasma) were measured with each Test. From Day 2 to Day 23, sweat [Na+ ] decreased significantly (adjusted P
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- 2018
7. Heat acclimatisation blunts copeptin responses to hypertonicity from dehydrating exercise in humans
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Stacey, M, Woods, DR, Brett, SJ, Britland, SE, Fallowfield, JL, Allsopp, AJ, Delves, SK, and Society for Endocrinology
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THERMOREGULATORY RESPONSES ,THIRST ,Science & Technology ,OSMOLALITY ,BLOOD-FLOW ,Physiology ,CUTANEOUS VASODILATION ,iontophoresis ,nanoduct ,VASOPRESSIN SECRETION ,WATER-BALANCE ,VOLUME ,PLASMA-ALDOSTERONE ,RENIN-ACTIVITY ,Life Sciences & Biomedicine ,Aldosterone ,arginine vasopressin - Abstract
Physiological Reports Volume 6, Issue 18 Original Research Open Access Heat acclimatization blunts copeptin responses to hypertonicity from dehydrating exercise in humans Michael J. Stacey David R. Woods Stephen J. Brett Sophie E. Britland Joanne L. Fallowfield Adrian J. Allsopp Simon K. Delves First published: 17 September 2018 https://doi.org/10.14814/phy2.13851 Funding InformationThis work was supported by the National Institute for Health Research (NIHR) Comprehensive Biomedical Research Centre at Imperial College Healthcare NHS Trust and Imperial College London. About Sections Abstract Acclimatization favors greater extracellular tonicity from lower sweat sodium, yet hyperosmolality may impair thermoregulation during heat stress. Enhanced secretion or action of vasopressin could mitigate this through increased free water retention. Aims were to determine responses of the vasopressin surrogate copeptin to dehydrating exercise and investigate its relationships with tonicity during short and long‐term acclimatization. Twenty‐three participants completed a structured exercise programme following arrival from a temperate to a hot climate. A Heat Tolerance Test (HTT) was conducted on Day‐2, 6, 9 and 23, consisting of 60‐min block‐stepping at 50% VO2peak, with no fluid intake. Resting sweat [Na+] was measured by iontophoresis. Changes in body mass (sweat loss), core temperature, heart rate, osmolality (serum and urine) and copeptin and aldosterone (plasma) were measured with each Test. From Day 2 to Day 23, sweat [Na+] decreased significantly (adjusted P < 0.05) and core temperature and heart rate fell. Over the same interval, HTT‐associated excursions were increased for serum osmolality (5 [−1, 9] vs. 9 [5, 12] mosm·kg−1), did not differ for copeptin (9.6 [6.0, 15.0] vs. 7.9 [4.3, 14.7] pmol·L−1) and were reduced for aldosterone (602 [415, 946] vs. 347 [263, 537] pmol·L−1). Urine osmolality was unchanging and related consistently to copeptin at end‐exercise, whereas the association between copeptin and serum osmolality was right‐shifted (P = 0.0109) with acclimatization. Unchanging urine:serum osmolality argued against increased renal action of vasopressin. In conclusion, where exercise in the heat is performed without fluid replacement, heat acclimatization does not appear to enhance AVP‐mediated free water retention in humans.
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- 2018
8. Heart rate variability and plasma nephrines in the evaluation of heat acclimatisation status
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Stacey, MMJ, Delves, SK, Woods, DR, Britland, SE, Macconnachie, L, Allsopp, AJ, Brett, SJ, Fallowfield, JL, and Boos, C
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PURPOSE: Heat adaptation (HA) is critical to performance and health in a hot environment. Transition from short-term heat acclimatisation (STHA) to long-term heat acclimatisation (LTHA) is characterised by decreased autonomic disturbance and increased protection from thermal injury. A standard heat tolerance test (HTT) is recommended for validating exercise performance status, but any role in distinguishing STHA from LTHA is unreported. The aims of this study were to (1) define performance status by serial HTT during structured natural HA, (2) evaluate surrogate markers of autonomic activation, including heart rate variability (HRV), in relation to HA status. METHODS: Participants (n = 13) were assessed by HTT (60-min block-stepping, 50% VO2peak) during STHA (Day 2, 6 and 9) and LTHA (Day 23). Core temperature (Tc) and heart rate (HR) were measured every 5 min. Sampling for HRV indices (RMSSD, LF:HF) and sympathoadrenal blood measures (cortisol, nephrines) was undertaken before and after (POST) each HTT. RESULTS: Significant (P
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- 2018
9. Pre-Straining Effect on the Creep Behavior of Impression Creep Tests for a P91 Steel at 600 °C
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Brett, SJ, additional, Dyson, C, additional, Maskill, S, additional, Sun, W, additional, and Bridges, A, additional
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- 2019
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10. The effect of intensive care unit out-of-hours admission on mortality A systematic review and meta-analysis
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Galloway, M, Hegarty, A, McGill, S, Arulkumaran, N, Brett, SJ, and Harrison, DA
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1117 Public Health And Health Services ,1103 Clinical Sciences ,1110 Nursing ,Emergency & Critical Care Medicine - Abstract
Objectives: Organizational factors are associated with outcome of critically ill patients and may vary by time of day and day of week. We aimed to identify the association between out-of-hours admission to critical care and mortality. Data Sources: MEDLINE (via Ovid) and EMBASE (via Ovid). Study Selection: We performed a systematic search of the literature for studies on out-of-hours adult general ICU admission on patient mortality. Data Extraction: Meta-analyses were performed and Forest plots drawn using RevMan software. Data are presented as odds ratios ([95% CIs], p values). Data Synthesis: A total of 16 studies with 902,551 patients were included in the analysis with a crude mortality of 18.2%. Fourteen studies with 717,331 patients reported mortality rates by time of admission and 11 studies with 835,032 patients by day of admission. Admission to ICU at night was not associated with an increased odds of mortality compared with admissions during the day (odds ratio, 1.04 [0.98–1.11]; p = 0.18). However, admissions during the weekend were associated with an increased odds of death compared with ICU admissions during weekdays (1.05 [1.01–1.09]; p = 0.006). Increased mortality associated with weekend ICU admissions compared with weekday ICU admissions was limited to North American countries (1.08 [1.03–1.12]; p = 0.0004). The absence of a routine overnight on-site intensivist was associated with increased mortality among weekend ICU admissions compared with weekday ICU admissions (1.11 [1.00–1.22]; p = 0.04) and nighttime admissions compared with daytime ICU admissions (1.11 [1.00–1.23]; p = 0.05). Conclusions: Adjusted risk of death for ICU admission was greater over the weekends compared with weekdays. The absence of a dedicated intensivist on-site overnight may be associated with increased mortality for acute admissions. These results need to be interpreted in context of the organization of local healthcare resources before changes to healthcare policy are implemented.
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- 2017
11. The Faculty of Intensive Care Medicine Workforce Survey – What impacts on our working lives?
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Grailey, KE, primary, Bryden, DC, additional, and Brett, SJ, additional
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- 2018
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12. P143 Using big data to investigate physiology: retention of co2 does not impact the oxygen-haemoglobin dissociation curve of critically ill adults
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Rosculet, N, primary, Samata, R, additional, Dixit, A, additional, Harris, S, additional, MacCallum, NS, additional, Brearley, DA, additional, Watkinson, PJ, additional, Jones, A, additional, Ashworth, S, additional, Beale, R, additional, Brett, SJ, additional, Young, JD, additional, Singer, M, additional, Summers, C, additional, and Ercole, A, additional
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- 2017
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13. S136 Lung protective mechanical ventilation for acute respiratory failure is not being implemented in uk clinical practice
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Samanta, R, primary, Dixit, A, additional, Harris, S, additional, MacCallum, NS, additional, Brearley, DA, additional, Watkinson, PJ, additional, Jones, A, additional, Ashworth, S, additional, Beale, R, additional, Brett, SJ, additional, Young, JD, additional, Singer, M, additional, Summers, C, additional, and Ercole, A, additional
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- 2017
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14. Long-term perspective on the relationship between phytoplankton and nutrient concentrations in a southeastern Australian estuary
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Larsson, ME, Ajani, PA, Rubio, AM, Guise, K, McPherson, RG, Brett, SJ, Davies, KP, Doblin, MA, Larsson, ME, Ajani, PA, Rubio, AM, Guise, K, McPherson, RG, Brett, SJ, Davies, KP, and Doblin, MA
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© 2016 Elsevier Ltd Sixteen years (1997–2013) of physicochemical, nutrient and phytoplankton biomass (Chlorophyll-a (Chl-a)) data and a decade (2003-2013) of phytoplankton composition and abundance data were analyzed to assess how the algal community in a temperate southeastern Australian estuary has responded to decreased chronic point source nitrogen loading following effluent treatment upgrade works in 2003. Nitrogen concentrations were significantly lower (P < 0.05) following enhanced effluent treatment and Chl-a levels decreased (P < 0.05) during the warmer months. Temperature and nutrient concentrations significantly influenced temporal changes of Chl-a (explaining 55% of variability), while salinity, temperature, pH and nutrient concentrations influenced phytoplankton abundance and composition (25% explained). Harmful Algal Bloom (HAB) dynamics differed between sites likely influenced by physical attributes of the estuary. This study demonstrates that enhanced effluent treatment can significantly decrease chronic point source nitrogen loading and that Chl-a concentrations can be lowered during the warmer months when the risk of blooms and HABs is greatest.
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- 2017
15. Effect of Early Vasopressin vs Norepinephrine on Kidney Failure in Patients With Septic Shock: The VANISH Randomized Clinical Trial
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Gordon, AC, Mason, AJ, Thirunavukkarasu, N, Perkins, GD, Cecconi, M, Cepkova, M, Pogson, DG, Aya, HD, Anjum, A, Frazier, GJ, Santhakumaran, S, Ashby, D, Brett, SJ, VANISH Investigators, COLLABORATORS, Warwick, J, Griffiths, S, Cross, M, Mason, A, Frazier, G, Das, N, Bellingan, G, Gordon, A, Brett, S, Perkins, G, Beale, R, Banks, F, Watts, T, Andrews, P, McAuley, D, Collier, T, Templeton, M, Errington, E, Gladas, K, Banach, D, Kitson, D, Matthew-Thomas, R, Hauer, V, Ochelli-Okpue, A, Stotz, M, Ostermann, M, Lei, K, Chan, K, Smith, J, Shankar-Hari, M, Carungcong, J, Handy, J, Hopkins, P, Harris, CL, Wade-Smith, F, Birch, S, Hurst, T, Mellinghoff, J, Di Tomasso, N, Ebm, C, Iannucceli, F, Kirwan, CJ, Creary, T, Correia, C, Prowle, JR, Jaques, N, Brown, A, Walden, A, Joscak, J, Bangalan, J, Tamm, T, Snow, L, Stapleton, C, Pahary, SM, Gould, T, Bewley, J, Sweet, K, Grimmer, L, Shah, S, Williams, S, Pulletz, M, Golder, K, Bolger, C, Salmon, K, Skinner, B, Vickers, E, Scott, M, Rose, S, Lamb, N, Mouland, J, Pogson, D, Bullock, L, Bland, M, Harrison-Briggs, D, Wilkinson, K, Krige, A, Ward, G, Ting, J, and Bassford, C
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Norepinephrine is currently recommended as the first-line vasopressor in septic shock; however, early vasopressin use has been proposed as an alternative. To compare the effect of early vasopressin vs norepinephrine on kidney failure in patients with septic shock. A factorial (2×2), double-blind, randomized clinical trial conducted in 18 general adult intensive care units in the United Kingdom between February 2013 and May 2015, enrolling adult patients who had septic shock requiring vasopressors despite fluid resuscitation within a maximum of 6 hours after the onset of shock. Patients were randomly allocated to vasopressin (titrated up to 0.06 U/min) and hydrocortisone (n = 101), vasopressin and placebo (n = 104), norepinephrine and hydrocortisone (n = 101), or norepinephrine and placebo (n = 103). The primary outcome was kidney failure-free days during the 28-day period after randomization, measured as (1) the proportion of patients who never developed kidney failure and (2) median number of days alive and free of kidney failure for patients who did not survive, who experienced kidney failure, or both. Rates of renal replacement therapy, mortality, and serious adverse events were secondary outcomes. A total of 409 patients (median age, 66 years; men, 58.2%) were included in the study, with a median time to study drug administration of 3.5 hours after diagnosis of shock. The number of survivors who never developed kidney failure was 94 of 165 patients (57.0%) in the vasopressin group and 93 of 157 patients (59.2%) in the norepinephrine group (difference, -2.3% [95% CI, -13.0% to 8.5%]). The median number of kidney failure-free days for patients who did not survive, who experienced kidney failure, or both was 9 days (interquartile range [IQR], 1 to -24) in the vasopressin group and 13 days (IQR, 1 to -25) in the norepinephrine group (difference, -4 days [95% CI, -11 to 5]). There was less use of renal replacement therapy in the vasopressin group than in the norepinephrine group (25.4% for vasopressin vs 35.3% for norepinephrine; difference, -9.9% [95% CI, -19.3% to -0.6%]). There was no significant difference in mortality rates between groups. In total, 22 of 205 patients (10.7%) had a serious adverse event in the vasopressin group vs 17 of 204 patients (8.3%) in the norepinephrine group (difference, 2.5% [95% CI, -3.3% to 8.2%]). Among adults with septic shock, the early use of vasopressin compared with norepinephrine did not improve the number of kidney failure-free days. Although these findings do not support the use of vasopressin to replace norepinephrine as initial treatment in this situation, the confidence interval included a potential clinically important benefit for vasopressin, and larger trials may be warranted to assess this further. clinicaltrials.gov Identifier: ISRCTN 20769191.
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- 2016
16. Protocol for a randomised control trial of methylnaltrexone for the treatment of opioid-induced constipation and gastrointestinal stasis in intensive care patients (MOTION)
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Brett, SJ, O'Callaghan, D, Anjum, A, Cross, M, Warwick, J, Gordon, AC, and National Institute for Health Research
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Gastrointestinal dysmotility and constipation are common problems in intensive care patients. The majority of critical care patients are sedated with opioids to facilitate tolerance of endotracheal tubes and mechanical ventilation, which inhibit gastrointestinal motility and lead to adverse outcomes. Methylnaltrexone is a peripheral opioid antagonist that does not cross the blood-brain barrier and can reverse the peripheral side effects of opioids without affecting the desired central properties. This trial will investigate whether methylnaltrexone can reverse opioid-induced constipation and gastrointestinal dysmotility.This is a single-centre, multisite, double-blind, randomised, placebo-controlled trial. 84 patients will be recruited from 4 intensive care units (ICUs) within Imperial College Healthcare NHS Trust. Patients will receive intravenous methylnaltrexone or placebo on a daily basis if they are receiving opioid infusion to facilitate mechanical ventilation and have not opened their bowels for 48 hours. All patients will receive standard laxatives as per the clinical ICU bowel protocol prior to randomisation. The primary outcome of the trial will be time to significant rescue-free laxation following randomisation. Secondary outcomes will include tolerance of enteral feed, gastric residual volumes, incidence of pneumonia, blood stream and Clostridium difficile infection, and any reversal of central opioid effects.The trial protocol, the patient/legal representative information sheets and consent forms have been reviewed and approved by the Harrow Research Ethics Committee (REC Reference 14/LO/2004). An independent Trial Steering Committee and Data Monitoring Committee are in place, with patient representation. On completion, the trial results will be published in peer-reviewed journals and presented at national and international scientific meetings.2014-004687-37; Pre-results.
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- 2016
17. eLearning to facilitate the education and implementation of the Chelsea Critical Care Physical Assessment: a novel measure of function in critical illness
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Corner, EJ, Handy, JM, Brett, SJ, and Westminster Medical School Research Trust
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Models, Educational ,Critical Care ,Research ,Reproducibility of Results ,Medical Education and Training ,Respiration, Artificial ,EDUCATION & TRAINING (see Medical Education & Training) ,Disability Evaluation ,Predictive Value of Tests ,Surveys and Questionnaires ,Outcome Assessment, Health Care ,Humans ,Glasgow Coma Scale ,Prospective Studies ,Program Development ,Physical Examination - Abstract
Objective: To evaluate the efficacy of eLearning in the widespread standardised teaching, distribution and implementation of the Chelsea Critical Care Physical Assessment (CPAx) tool—a validated tool to assess physical function in critically ill patients. Design: Prospective educational study. An eLearning module was developed through a conceptual framework, using the four-stage technique for skills teaching to teach clinicians how to use the CPAx. Example and test video case studies of CPAx assessments were embedded within the module. The CPAx scores for the test case studies and demographic data were recorded in a secure area of the website. Data were analysed for inter-rater reliability using intraclass correlation coefficients (ICCs) to see if an eLearning educational package facilitated consistent use of the tool. A utility and content validity questionnaire was distributed after 1 year to eLearning module registrants (n=971). This was to evaluate uptake of the CPAx in clinical practice and content validity of the CPAx from the perspective of clinical users. Setting: The module was distributed for use via professional forums (n=2) and direct contacts (n=95). Participants: Critical care clinicians. Primary outcome measure: ICC of the test case studies. Results: Between July and October 2014, 421 candidates from 15 countries registered for the eLearning module. The ICC for case one was 0.996 (95% CI 0.990 to 0.999; n=207). The ICC for case two was 0.988 (0.996 to 1.000; n=184). The CPAx has a strong total scale content validity index (s-CVI) of 0.94 and is well used. Conclusions: eLearning is a useful and reliable way of teaching psychomotor skills, such as the CPAx. The CPAx is a well-used measure with high content validity rated by clinicians.
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- 2016
18. Susceptibility to exertional heat illness and hospitalisation risk in United Kingdom military personnel
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Stacey, MJ, Parsons, I, Woods, DR, Taylor, PN, Ross, D, and Brett, SJ
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- 2015
19. pRotective vEntilation with veno-venouS lung assisT in respiratory failure: A protocol for a multicentre randomised controlled trial of extracorporeal carbon dioxide removal in patients with acute hypoxaemic respiratory failure
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McNamee, JJ, primary, Gillies, MA, additional, Barrett, NA, additional, Agus, AM, additional, Beale, R, additional, Bentley, A, additional, Bodenham, A, additional, Brett, SJ, additional, Brodie, D, additional, Finney, SJ, additional, Gordon, AJ, additional, Griffiths, M, additional, Harrison, D, additional, Jackson, C, additional, McDowell, C, additional, McNally, C, additional, Perkins, GD, additional, Tunnicliffe, W, additional, Vuylsteke, A, additional, Walsh, TS, additional, Wise, MP, additional, Young, D, additional, and McAuley, DF, additional
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- 2016
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20. Changes in gut hormones and leptin in military personnel during operational deployment in Afghanistan
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Hill, NE, Fallowfield, JL, Delves, SK, Ardley, C, Stacey, M, Ghatei, M, Bloom, SR, Frost, G, Brett, SJ, Wilson, DR, and Murphy, KG
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- 2015
21. The Faculty of Intensive Care Medicine Workforce Survey – What impacts on our working lives?
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Grailey, KE, Bryden, DC, and Brett, SJ
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- 2019
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22. Randomised trials of human albumin for adults with sepsis: systematic review and meta-analysis with trial sequential analysis of all-cause mortality
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Patel, A, Laffan, MA, Waheed, U, and Brett, SJ
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- 2014
23. Risk factors for heat illness among British soldiers in the hot Collective Training Environment.
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Moore, AC, Stacey, MJ, Bailey, KG, Bunn, RJ, Woods, DR, Haworth, KJ, Brett, SJ, Folkes, SE, Moore, AC, Stacey, MJ, Bailey, KG, Bunn, RJ, Woods, DR, Haworth, KJ, Brett, SJ, and Folkes, SE
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BACKGROUND: Heat illness is a preventable disorder in military populations. Measures that protect vulnerable individuals and contribute to effective Immediate Treatment may reduce the impact of heat illness, but depend upon adequate understanding and awareness among Commanders and their troops. OBJECTIVE: To assess risk factors for heat illness in British soldiers deployed to the hot Collective Training Environment (CTE) and to explore awareness of Immediate Treatment responses. METHODS: An anonymous questionnaire was distributed to British soldiers deployed in the hot CTEs of Kenya and Canada. Responses were analysed to determine the prevalence of individual (Intrinsic) and Command-practice (Extrinsic) risk factors for heat illness and the self-reported awareness of key Immediate Treatment priorities (recognition, first aid and casualty evacuation). RESULTS: The prevalence of Intrinsic risk factors was relatively low in comparison with Extrinsic risk factors. The majority of respondents were aware of key Immediate Treatment responses. The most frequently reported factors in each domain were increased risk by body composition scoring, inadequate time for heat acclimatisation and insufficient briefing about casualty evacuation. CONCLUSIONS: Novel data on the distribution and scale of risk factors for heat illness are presented. A collective approach to risk reduction by the accumulation of 'marginal gains' is proposed for the UK military. This should focus on limiting Intrinsic risk factors before deployment, reducing Extrinsic factors during training and promoting timely Immediate Treatment responses within the hot CTE.
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- 2015
24. Case ascertainment of heat illness in the British Army: evidence of under-reporting from analysis of Medical and Command notifications, 2009-2013.
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Stacey, MJ, Brett, SJ, Woods, D, Jackson, S, Ross, D, Stacey, MJ, Brett, SJ, Woods, D, Jackson, S, and Ross, D
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Heat illness in the Armed Forces is considered preventable. The UK military relies upon dual Command and Medical reporting for case ascertainment, investigation of serious incidents and improvement of preventive practices and policy. This process could be vulnerable to under-reporting.To establish whether heat illness in the British Army has been under-reported, by reviewing concordance of reporting to the Army Incident Notification Cell (AINC) and the Army Health Unit (AHU) and to characterise the burden of heat illness reported by these means.Analysis of anonymised reporting databases held by the AHU and AINC, for the period 2009-2013.565 unique cases of heat illness were identified. Annual concordance of reporting ranged from 9.6% to 16.5%. The overall rate was 13.3%. July was the month with the greatest number of heat illness reports (24.4% of total reporting) and the highest concordance rate (30%). Reports of heat illness from the UK (n=343) exceeded overseas notifications (n=221) and showed better concordance (17.1% vs 12.8%). The annual rate of reported heat illness varied widely, being greater in full-time than reservist personnel (87 vs 23 per100 000) and highest in full-time untrained personnel (223 per100 000).The risk of heat illness was global, year-round and showed dynamic local variation. Failure to dual-report casualties impaired case ascertainment of heat illness across Command and Medical chains. Current preventive guidance, as applied in training and on operations, should be critically evaluated to ensure that risk of heat illness is reduced as low as possible. Clear procedures for casualty notification and surveillance are required in support of this and should incorporate communication within and between the two reporting chains.
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- 2015
25. The gonadotrophic response of Royal Marines during an operational deployment in Afghanistan.
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Hill, NE, Woods, DR, Delves, SK, Murphy, KG, Davison, AS, Brett, SJ, Quinton, R, Turner, S, Stacey, M, Allsopp, AJ, Fallowfield, JL, Hill, NE, Woods, DR, Delves, SK, Murphy, KG, Davison, AS, Brett, SJ, Quinton, R, Turner, S, Stacey, M, Allsopp, AJ, and Fallowfield, JL
- Abstract
Military training has been associated with changes in the hypothalamic-pituitary-gonadal axis consistent with central hypogonadism. Often such changes have been associated with body mass loss, though sleep deprivation and other psychological stress may also contribute. The effects of deployment in a combat zone on the hypothalamic-pituitary-gonadal axis in military personnel are not known. The objective was to investigate the hypothalamic-pituitary-gonadal axis in male military personnel deployed in Afghanistan. Eighty-nine Royal Marines were investigated pre-deployment, following 3 months in Afghanistan and following 2 weeks mid-tour leave. Testosterone, sex hormone-binding globulin (SHBG), follicle-stimulating hormone (FSH), luteinising hormone (LH), 17-hydroxyprogesterone, androstenedione (AD) and insulin were assayed and body mass recorded. The results showed that body mass (kg) dropped from 83.2 ± 9.2 to 79.2 ± 8.2 kg during the first 3 months of deployment (p < 0.001). Total testosterone did not change, but SHBG increased (30.7 ± 9.7 vs. 42.3 ± 14.1 nmol/L, p < 0.001), resulting in a significant (p < 0.001) fall in calculated free testosterone (435.2 ± 138 vs. 375.1 ± 98 pmol/L). Luteinising hormone and FSH increased by 14.3% (p < 0.001) and 4.9% (p = 0.003) respectively. Free testosterone, SHBG, LH and FSH returned to baseline following 2 weeks of mid-tour leave. Androstenedione (AD) decreased by 14.5% (p = 0.024), and insulin decreased by 26% (p = 0.039), over the course of deployment. In this study of lean Royal Marines, free testosterone decreased during operational deployment to Afghanistan. There was no evidence to suggest major stress-induced central hypogonadism. We postulate that reduced body mass, accompanied by a decrease in insulin and AD synthesis, may have contributed to an elevated SHBG, leading to a decrease in free testosterone.
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- 2015
26. IFITM3 restricts the morbidity and mortality associated with influenza
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Everitt, AR, Clare, S, Pertel, T, John, SP, Wash, RS, Smith, SE, Chin, CR, Feeley, EM, Sims, JS, Adams, DJ, Wise, HM, Kane, L, Goulding, D, Digard, P, Anttila, V, Baillie, JK, Walsh, TS, Hume, DA, Palotie, A, Xue, Y, Colonna, V, Tyler-Smith, C, Dunning, J, Gordon, SB, Everingham, K, Dawson, H, Hope, D, Ramsay, P, Walsh Local Lead Investigator, TS, Campbell, A, Kerr, S, Harrison, D, Rowan, K, Addison, J, Donald, N, Galt, S, Noble, D, Taylor, J, Webster Local Lead Investigator, N, Taylor Local Lead Investigator, I, Aldridge Local Lead Investigator, J, Dornan, R, Richard, C, Gilmour, D, Simmons Local Lead Investigator, R, White Local Lead Investigator, R, Jardine, C, Williams Local Lead Investigator, D, Booth Local Lead Investigator, M, Quasim, T, Watson, V, Henry, P, Munro, F, Bell, L, Ruddy Local Lead Investigator, J, Cole Local Lead Investigator, S, Southward, J, Allcoat, P, Gray, S, McDougall Local Lead Investigator, M, Matheson, J, Whiteside Local Lead Investigator, J, Alcorn, D, Rooney Local Lead Investigator, K, Sundaram, R, Imrie Local Lead Investigator, G, Bruce, J, McGuigan, K, Moultrie Local Lead Investigator, S, Cairns Local Lead Investigator, C, Grant, J, Hughes, M, Murdoch Local Lead Investigator, C, Davidson Local Lead Investigator, A, Harris, G, Paterson, R, Wallis Local Lead Investigator, C, Binning Local Lead Investigator, S, Pollock, M, Antonelli, J, Duncan, A, Gibson, J, McCulloch, C, Murphy, L, Haley, C, Faulkner, G, Freeman, T, Baillie Principal Investigator, JK, Chaussabel, D, Adamson, WE, Carman, WF, Thompson, C, Zambon, MC, Aylin, P, Ashby, D, Barclay, WS, Brett, SJ, Cookson, WO, Drumright, LN, Elderfield, RA, Garcia-Alvarez, L, Gazzard, BG, Griffiths, MJ, Habibi, MS, Hansel, TT, Herberg, JA, Holmes, AH, Hussell, T, Johnston, SL, Kon, OM, Levin, M, Moffatt, MF, Nadel, S, Openshaw, PJ, Warner, JO, Aston, SJ, Hay, A, McCauley, J, O'Garra, A, Banchereau, J, Hayward, A, Kellam, P, Simmonds, P, McNamara, PS, Semple, MG, Smyth, RL, Nguyen-Van-Tam, JS, Ho, L-P, Mcmichael, AJ, Dougan, G, and Brass, AL
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- 2012
27. Risk factors for hospitalisation and poor outcome with pandemic A/H1N1 influenza: United Kingdom first wave (May-September 2009)
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Nguyen-Van-Tam, JS, Openshaw, PJM, Hashim, A, Gadd, EM, Lim, WS, Semple, MG, Read, RC, Taylor, BL, Brett, SJ, McMenamin, J, Enstone, JE, Armstrong, C, Nicholson, KG, and Influenza Clinical Information Network (FLU-CIN)
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respiratory tract diseases - Abstract
BACKGROUND: During the first wave of pandemic H1N1 influenza in 2009, most cases outside North America occurred in the UK. The clinical characteristics of UK patients hospitalised with pandemic H1N1 infection and risk factors for severe outcome are described. METHODS: A case note-based investigation was performed of patients admitted with confirmed pandemic H1N1 infection. RESULTS: From 27 April to 30 September 2009, 631 cases from 55 hospitals were investigated. 13% were admitted to a high dependency or intensive care unit and 5% died; 36% were aged or = 65 years. Non-white and pregnant patients were over-represented. 45% of patients had at least one underlying condition, mainly asthma, and 13% received antiviral drugs before admission. Of 349 with documented chest x-rays on admission, 29% had evidence of pneumonia, but bacterial co-infection was uncommon. Multivariate analyses showed that physician-recorded obesity on admission and pulmonary conditions other than asthma or chronic obstructive pulmonary disease (COPD) were associated with a severe outcome, as were radiologically-confirmed pneumonia and a raised C-reactive protein (CRP) level (> or = 100 mg/l). 59% of all in-hospital deaths occurred in previously healthy people. CONCLUSIONS: Pandemic H1N1 infection causes disease requiring hospitalisation of previously fit individuals as well as those with underlying conditions. An abnormal chest x-ray or a raised CRP level, especially in patients who are recorded as obese or who have pulmonary conditions other than asthma or COPD, indicate a potentially serious outcome. These findings support the use of pandemic vaccine in pregnant women, children
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- 2010
28. Team performance in resuscitation teams: comparison and critique of two recently developed scoring tools.
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McKay, A, Walker, ST, Brett, SJ, Vincent, C, Sevdalis, N, McKay, A, Walker, ST, Brett, SJ, Vincent, C, and Sevdalis, N
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BACKGROUND AND AIM: Following high profile errors resulting in patient harm and attracting negative publicity, the healthcare sector has begun to focus on training non-technical teamworking skills as one way of reducing the rate of adverse events. Within the area of resuscitation, two tools have been developed recently aiming to assess these skills - TEAM and OSCAR. The aims of the study reported here were: METHODS: The study consisted of two phases - reliability assessment; and content comparison, and correlation. Assessments were made by two resuscitation experts, who watched 24 pre-recorded resuscitation simulations, and independently rated team behaviours using both tools. The tools were critically appraised, and correlation between overall score surrogates was assessed. RESULTS: Both OSCAR and TEAM achieved high levels of inter-rater reliability (in the form of adequate intra-class coefficients) and minor significant differences between Wilcoxon tests. Comparison of the scores from both tools demonstrated a high degree of correlation (and hence concurrent validity). Finally, critique of each tool highlighted differences in length and complexity. CONCLUSION: Both OSCAR and TEAM can be used to assess resuscitation teams in a simulated environment, with the tools correlating well with one another. We envisage a role for both tools - with TEAM giving a quick, global assessment of the team, but OSCAR enabling more detailed breakdown of the assessment, facilitating feedback, and identifying areas of weakness for future training.
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- 2012
29. Low serum mannose-binding lectin level increases the risk of death due to pneumococcal infection
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Eisen, DP, Dean, MM, Boermeester, MA, Fidler, KJ, Gordon, AC, Kronborg, G, Kun, JFJ, Lau, YL, Payeras, A, Valdimarsson, H, Brett, SJ, Ip, WKE, Mila, J, Peters, MJ, Saevarsdottir, S, van Till, JWO, Hinds, CJ, McBryde, ES, Eisen, DP, Dean, MM, Boermeester, MA, Fidler, KJ, Gordon, AC, Kronborg, G, Kun, JFJ, Lau, YL, Payeras, A, Valdimarsson, H, Brett, SJ, Ip, WKE, Mila, J, Peters, MJ, Saevarsdottir, S, van Till, JWO, Hinds, CJ, and McBryde, ES
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BACKGROUND: Previous studies have shown associations between low mannose-binding lectin (MBL) level or variant MBL2 genotype and sepsis susceptibility. However, MBL deficiency has not been rigorously defined, and associations with sepsis outcomes have not been subjected to multivariable analysis. METHODS: We reanalyzed MBL results in a large cohort with use of individual data from 4 studies involving a total of 1642 healthy control subjects and systematically defined a reliable deficiency cutoff. Subsequently, data were reassessed to extend previous MBL and sepsis associations, with adjustment for known outcome predictors. We reanalyzed individual data from 675 patients from 5 adult studies and 1 pediatric study of MBL and severe bacterial infection. RESULTS: XA/O and O/O MBL2 genotypes had the lowest median MBL concentrations. Receiver operating characteristic analysis revealed that an MBL cutoff value of 0.5 microg/mL was a reliable predictor of low-producing MBL2 genotypes (sensitivity, 82%; specificity, 82%; negative predictive value, 98%). MBL deficiency was associated with increased likelihood of death among patients with severe bacterial infection (odds ratio, 2.11; 95% confidence interval, 1.30-3.43). In intensive care unit-based studies, there was a trend toward increased risk of death among MBL-deficient patients (odds ratio, 1.58; 95% confidence interval, 0.90-2.77) after adjustment for Acute Physiology and Chronic Health Enquiry II score. The risk of death was increased among MBL-deficient patients with Streptococcus pneumoniae infection (odds ratio, 5.62; 95% confidence interval, 1.27-24.92) after adjustment for bacteremia, comorbidities, and age. CONCLUSIONS: We defined a serum level for MBL deficiency that can be used with confidence in future studies of MBL disease associations. The risk of death was increased among MBL-deficient patients with severe pneumococcal infection, highlighting the pathogenic significance of this innate immune defence protei
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- 2008
30. Postprandial ghrelin suppression is exaggerated following major surgery; implications for nutritional recovery
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Nematy, M, Brynes, AE, Hornick, PI, Patterson, M, Ghatei, MA, Bloom, SR, Brett, SJ, Frost, GS, Nematy, M, Brynes, AE, Hornick, PI, Patterson, M, Ghatei, MA, Bloom, SR, Brett, SJ, and Frost, GS
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- 2007
31. pRotective vEntilation with veno-venouS lung assisT in respiratory failure: A protocol for a multicentre randomised controlled trial of extracorporeal carbon dioxide removal in patients with acute hypoxaemic respiratory failure
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McNamee, JJ, Gillies, MA, Barrett, NA, Agus, AM, Beale, R, Bentley, A, Bodenham, A, Brett, SJ, Brodie, D, Finney, SJ, Gordon, AJ, Griffiths, M, Harrison, D, Jackson, C, McDowell, C, McNally, C, Perkins, GD, Tunnicliffe, W, Vuylsteke, A, Walsh, TS, Wise, MP, Young, D, and McAuley, DF
- Abstract
One of the few interventions to demonstrate improved outcomes for acute hypoxaemic respiratory failure is reducing tidal volumes when using mechanical ventilation, often termed lung protective ventilation. Veno-venous extracorporeal carbon dioxide removal (vv-ECCO2R) can facilitate reducing tidal volumes. pRotective vEntilation with veno-venouS lung assisT (REST) is a randomised, allocation concealed, controlled, open, multicentre pragmatic trial to determine the clinical and cost-effectiveness of lower tidal volume mechanical ventilation facilitated by vv-ECCO2R in patients with acute hypoxaemic respiratory failure. Patients requiring intubation and mechanical ventilation for acute hypoxaemic respiratory failure will be randomly allocated to receive either vv-ECCO2R and lower tidal volume mechanical ventilation or standard care with stratification by recruitment centre. There is a need for a large randomised controlled trial to establish whether vv-ECCO2R in acute hypoxaemic respiratory failure can allow the use of a more protective lung ventilation strategy and is associated with improved patient outcomes.
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- 2017
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32. The invasin of Yersinia spp. provides co-stimulatory activity to human T-cells through interaction with beta1- integrins
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Brett, SJ, Mazurov, AV, Charles, IG, and Tite, JP
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Immunology ,biochemical phenomena, metabolism, and nutrition - Abstract
The invasin proteins of Yersinia spp. are outer membrane proteins which are involved in the penetration of these bacteria into mammalian cells (Cell 1990. 60: 861). Invasin binds to several different beta1 integrins with extremely high affinity, the integrin-binding domain of invasin has been mapped to the C-terminal 192 amino-acids of the molecule (J. Biol. Chem. 1991. 266: 24367). Expression of this fragment alone on the cell surface of non-invasive bacteria is enough to confer the invasive phenotype on these strains (EMBO J. 1990. 9: 1979). Here we show that the carboxy-terminal 192 amino acids of invasin expressed as a fusion protein with the maltose binding protein of E. coli is capable of delivering co-stimulatory signals to human T cells through the beta1 integrins. Co-stimulation was assayed by the ability of invasin to augment the response of highly purified CD4+ and CD8+ T cells to co-immobilized anti-CD3 antibody. Antibody blocking studies indicated that the co-stimulation was mediated through beta1 integrins. The proliferation induced by co-stimulation of CD4+ T cells was accompanied by the synthesis of the cytokines tumor necrosis factor-alpha and interferon-gamma, whereas the activation of CD8+ T cells led to the generation of cytotoxic effectors. The region of the invasin molecule involved in T cell activation was further mapped using synthetic peptides. A region of the invasin molecule containing the residues TAKSKKFPSY could substitute for invasin in T cell activation. The co-stimulation by peptide could also be inhibited by anti-integrin antibodies. The observation that an outer membrane protein of a bacterium which is associated with reactive arthritis and other autoimmune spondyloarthropathies can act as a T cell co-stimulus may have implications for the etiology of these diseases.
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- 1993
33. Cognitive dysfunction in intensive care survivors
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Chapman, RJ, primary and Brett, SJ, additional
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- 2007
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34. The use of vasopressors in pulmonary hypertension on the intensive care unit
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Price, LC, primary, Brett, SJ, additional, and Howard, LS, additional
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- 2007
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35. Changes in appetite related gut hormones in intensive care unit patients: a pilot cohort study
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Nematy, M, O'Flynn, JE, Wandrag, L, Brynes, AE, Brett, SJ, Patterson, M, Ghatei, MA, Bloom, SR, and Frost, GS
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Adult ,FOOD-INTAKE ,Peptide Hormones ,Appetite ,Nutritional Status ,Pilot Projects ,DISEASE ,Body Mass Index ,Cohort Studies ,Critical Care Medicine ,Reference Values ,General & Internal Medicine ,Humans ,Peptide YY ,PLASMA GHRELIN LEVELS ,Aged ,Aged, 80 and over ,Science & Technology ,Research ,digestive, oral, and skin physiology ,11 Medical And Health Sciences ,MALNUTRITION ,Middle Aged ,Emergency & Critical Care Medicine ,Ghrelin ,Intensive Care Units ,MEAL ,WEIGHT ,Energy Intake ,Life Sciences & Biomedicine ,OBESE SUBJECTS ,PEPTIDE-YY ,RESPONSES - Abstract
Introduction The nutritional status of patients in the intensive care unit (ICU) appears to decline not only during their stay in the ICU but also after discharge from the ICU. Recent evidence suggests that gut released peptides, such as ghrelin and peptide YY (PYY) regulate the initiation and termination of meals and could play a role in the altered eating behaviour of sick patients. The aim of this study was to assess the patterns of ghrelin and PYY levels during the stay of ICU patients in hospital. Methods Sixteen ICU patients (60 ± 4.7 years, body mass index (BMI) 28.1 ± 1.7 kg/m2 (mean ± standard error of the mean)) underwent fasting blood sample collections on days 1, 3, 5, 14, 21 and 28 of their stay at Hammersmith and Charing Cross Hospitals. Changes in appetite and biochemical and anthropometric markers of nutritional status were recorded. A comparison was made to a group of 36 healthy volunteers matched for age and BMI (54.3 ± 2.9 years, p = 0.3; BMI 25.8 ± 0.8 kg/m2 p = 0.2). Results Compared to healthy subjects, ICU patients exhibited a significantly lower level of ghrelin (day one 297.8 ± 76.3 versus 827.2 ± 78.7 pmol/l, p < 0.001) during their stay in the ICU. This tended to rise to the normal level during the last three weeks of hospital stay. Conversely, ICU patients showed a significantly higher level of PYY (day one 31.5 ± 9.6 versus 11.3 ± 1.0 pmol/l, p < 0.05) throughout their stay in the ICU and on the ward, with a downward trend to the normal level during the last three weeks of stay. Conclusions Results from our study show high levels of PYY and low levels of ghrelin in ICU patients compared to healthy controls. There appears to be a relationship between the level of these gut hormones and nutritional intake.
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- 2005
36. The "Resus:Station": the use of clinical simulations in a randomised crossover study to evaluate a novel resuscitation trolley.
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Walker ST, Brett SJ, McKay A, Aggarwal R, Vincent C, Walker, Susanna T, Brett, Stephen J, McKay, Anthony, Aggarwal, Rajesh, and Vincent, Charles
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Background and Aim: Inadequately designed equipment has been implicated in poor efficiency and critical incidents associated with resuscitation. A novel resuscitation trolley (Resus:Station) was designed and evaluated for impact on team efficiency, user opinion, and teamwork, compared with the standard trolley, in simulated cardiac arrest scenarios.Methods: Fifteen experienced cardiac arrest teams were recruited (45 participants). Teams performed recorded resuscitation simulations using new and conventional trolleys, with order of use randomised. After each simulation, efficiency ("time to drugs", un-locatable equipment, unnecessary drawer opening) and team performance (OSCAR) were assessed from the video recordings and participants were asked to complete questionnaires scoring various aspects of the trolley on a Likert scale.Results: Time to locate the drugs was significantly faster (p=0.001) when using the Resus:Station (mean 5.19s (SD 3.34)) than when using the standard trolley (26.81s (SD16.05)). There were no reports of missing equipment when using the Resus:Station. However, during four of the fifteen study sessions using the standard trolley participants were unable to find equipment, with an average of 6.75 unnecessary drawer openings per simulation. User feedback results clearly indicated a highly significant preference for the newly designed Resus:Station for all aspects. Teams performed equally well for all dimensions of team performance using both trolleys, despite it being their first exposure to the Resus:Station.Conclusion: We conclude that in this simulated environment, the new design of trolley is safe to use, and has the potential to improve efficiency at a resuscitation attempt. [ABSTRACT FROM AUTHOR]- Published
- 2012
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37. Predictors of clinical outcome in a national hospitalised cohort across both waves of the influenza A/H1N1 pandemic 2009-2010 in the UK.
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Myles PR, Semple MG, Lim WS, Openshaw PJ, Gadd EM, Read RC, Taylor BL, Brett SJ, McMenamin J, Enstone JE, Armstrong C, Bannister B, Nicholson KG, Nguyen-Van-Tam JS, Influenza Clinical Information Network (FLU-CIN), Myles, Puja R, Semple, Malcolm G, Lim, Wei Shen, Openshaw, Peter J M, and Gadd, Elaine M
- Abstract
Background: Although generally mild, the 2009-2010 influenza A/H1N1 pandemic caused two major surges in hospital admissions in the UK. The characteristics of patients admitted during successive waves are described.Methods: Data were systematically obtained on 1520 patients admitted to 75 UK hospitals between May 2009 and January 2010. Multivariable analyses identified factors predictive of severe outcome.Results: Patients aged 5-54 years were over-represented compared with winter seasonal admissions for acute respiratory infection, as were non-white ethnic groups (first wave only). In the second wave patients were less likely to be school age than in the first wave, but their condition was more likely to be severe on presentation to hospital and they were more likely to have delayed admission. Overall, 45% had comorbid conditions, 16.5% required high dependency (level 2) or critical (level 3) care and 5.3% died. As in 1918-1919, the likelihood of severe outcome by age followed a W-shaped distribution. Pre-admission antiviral drug use decreased from 13.3% to 10% between the first and second waves (p=0.048), while antibiotic prescribing increased from 13.6% to 21.6% (p<0.001). Independent predictors of severe outcome were age 55-64 years, chronic lung disease (non-asthma, non-chronic obstructive pulmonary disease), neurological disease, recorded obesity, delayed admission (≥5 days after illness onset), pneumonia, C-reactive protein ≥100 mg/litre, and the need for supplemental oxygen or intravenous fluid replacement on admission.Conclusions: There were demographic, ethnic and clinical differences between patients admitted with pandemic H1N1 infection and those hospitalised during seasonal influenza activity. Despite national policies favouring use of antiviral drugs, few patients received these before admission and many were given antibiotics. [ABSTRACT FROM AUTHOR]- Published
- 2012
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38. S136 Lung protective mechanical ventilation for acute respiratory failure is not being implemented in uk clinical practice
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Samanta, R, Dixit, A, Harris, S, MacCallum, NS, Brearley, DA, Watkinson, PJ, Jones, A, Ashworth, S, Beale, R, Brett, SJ, Young, JD, Singer, M, Summers, C, and Ercole, A
- Abstract
IntroductionThe benefits of lung protective ventilation have been replicated in multiple trials.1,2However, we suspected that adherence to this standard of care remained poor. Using the NIHR critical care Health Informatics Collaborative (ccHIC) database, we analysed data from 11 teaching hospital intensive care units (22 524 patient episodes) to investigate real-world clinical practice.Methods1248 patient episodes, where ventilation was continued for ≥48 hours, with 232,600 hours of concurrent mechanical ventilation and blood gas data were identified as suitable for analysis. Short gaps in ventilation (<6 hours) were imputed based on the median of nearest known values, and only the single longest period of ventilation from each patient episode was analysed.ResultsThe median tidal volume received by patients was 7.3 ml/kg-1PBW (IQR:5.7–8.8). Female patients, especially those with higher BMI (≥30 kgm-2) consistently received higher tidal volumes than males. Patients with severe respiratory failure (PaO2:FiO2<13 kPa) received a median tidal volume of 7.1 ml/kg-1PBW, and had 71% ICU mortality (Table 1). Patients with respiratory failure sufficient to qualify for recruitment into recent clinical trials (PaO2:FiO2<20 kPa with PEEP ≥5 cm/H20), who were exposed to tidal volumes≥12 ml/kg-1PBW for longer than two hours had significantly increased risk of ICU mortality (odds ratio=2.89 [1.25–7.2]; p=0.007); This was not observed for patients with PaO2:FiO2≥40 kPa (odds ratio=0.95 [0.58–1.56], p=0.91).ConclusionsMore than 15 years after the ARMA study1demonstrated a mortality benefit from lung protective ventilation, we are still not implementing 6 ml/kg-1PBW ventilation into clinical practice, and are exposing even patients with a severe respiratory failure (PaO2:FiO2<13 kPa) to higher than recommended tidal volumes, with females and higher BMI patients at particular risk. We have also demonstrated that failure to institute lung protective ventilation in patients with a PaO2:FiO2<20 kPa leads to increased ICU mortality, which is not present in patients with PaO2:FiO2≥40 kPa.ReferencesARDS Network. Ventilation with lower tidal volumes as compared with traditional tidal volumes for ALI and ARDS. NEJM2000;342:1301–1308.Futier Eet al. A trial of intraoperative low tidal volume ventilation in abdominal surgery. NEJM2013;369:428–437.Abstract S136 Table 1Patient characteristics, outcomes and mechanical ventilation stratified by severity of respiratory failureAll episodesPaO2:FiO2<13 kPa SeverePaO2:FiO213–26.7 kPa ModeratePaO2:FiO226.7–40 kPa MildPaO2:FiO2>40 kPa No respiratory failuren1248110102321004No. Female (%)451 (36%)45 (41%)35 (34%)15 (47%)356 (35%)APACHE II Score, median (IQR)18 (10 – 26)25 (20 – 30)22 (16 – 28)20 (15 – 25)18 (15 – 22)ICU Mortality%31%71%39%19%26%Median duration of mechanical ventilation, days, (IQR)6.2 (2.3–10.2)7.3 (2.1–12.6)5.1 (1.3–8.8)3 (1.8–4.2)6.2 (2.3–10.1)Median duration of ICU stay days, (IQR)12.4 (5.9–18.9)19.3 (9.9–28.7)15 (9.8–20.2)10.2 (4.4–15.9)12 [5.5–18.4]Median tidal volume mL kg-1PBW (IQR)7.3 (5.7–8.8)7.1 (5.7–8.5)7.4 (6.1–8.6)7.5 (5.7–9.3)7.3 (5.7–9.0)Median PEEP cm H2O (IQR)8 (5.5–10.5)8 (6.5–9.5)6 (4.5–7.5)6 (4.5–7.5)8 (5.5–10.5)APACHE II=Acute Physiology and Chronic Health Score II, PBW=predicted body weight, PEEP=positive end expiratory pressure
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- 2017
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39. Rehabilitation after critical illness: summary of NICE guidance.
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Tan T, Brett SJ, Stokes T, and Guideline Development Group
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- 2009
40. P143 Using big data to investigate physiology: retention of co2 does not impact the oxygen-haemoglobin dissociation curve of critically ill adults
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Rosculet, N, Samata, R, Dixit, A, Harris, S, MacCallum, NS, Brearley, DA, Watkinson, PJ, Jones, A, Ashworth, S, Beale, R, Brett, SJ, Young, JD, Singer, M, Summers, C, and Ercole, A
- Abstract
IntroductionSince its initial description in 1904, the oxygen-haemoglobin dissociation curve (ODC) has been well described under physiological conditions.1,2However, the impact of pathology has been less well characterised, with most data arising from small clinical studies of anaesthetized adults/patients (<100 subjects), or experimentally-induced hypoxaemia/hypercapnia. Routinely collected clinical data, including arterial blood gas analyses, are now available from many thousands of critically ill patients. We sought to investigate the impact of pCO2on the ODC of critically ill adults, and hypothesised that pCO2would not significantly alter the relationship between pO2and haemoglobin saturation.MethodsData was extracted from the National Institute for Health Research Critical Care Health Informatics Collaborative (NIHR ccHIC). Statistical analysis was undertaken on 3 99 000 blood gases from 13 942 patients, using R version 3.4.0. After data cleaning, the predicted oxygen saturation for each arterial blood gas sample was calculated using both the Severinghaus1and Dash, Kroman and Bassingthwaighte2equations. Non-linear regression modelling was undertaken to construct ODCs based on both the predicted and observed data, to allow comparison. Observed data was stratified into strata based on pCO2 to investigate the influence of hypercapnia on the ODC.ResultsNo clinically significant impact of pCO2 on the relationship between pO2and oxygen saturation was observed in samples obtained from critically ill adults (mean difference 0.35 kPa (SD=0.2 kPa) for a given oxygen saturation). Interestingly, we did not observe “right shift” of the ODC in response to elevated arterial pCO2, and there was no impact of either acute (HCO3<28 mmol/L) or chronic (HCO3≥28 mmol/L) hypercapnia on the relationship between haemoglobin saturation and pO2.ConclusionsThese data suggest that the relationship between haemoglobin saturation and pO2 described by data from small scale studies may not reflect physiology observed in critically ill adults, and further that the right shift of the ODC reported in experimental hypercapnia, induced in healthy subjects, is not reproduced in the critically ill.[Figure]ReferencesSeveringhaus JW. J Appl Physiol Respir Environ Exerc Physiol1979;46:599.Dash RK, Kroman B, Baasingthwaighte JB. Eur J Appl Physiol2016;116:97.
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- 2017
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41. Cytokine storm in a phase 1 trial of the anti-CD28 monoclonal antibody TGN1412.
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Suntharalingam G, Perry MR, Ward S, Brett SJ, Castello-Cortes A, Brunner MD, and Panoskaltsis N
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- 2006
42. Shared decision-making with older people on TReatment Escalation planning for Acute deterioration in the emergency Medical Setting: a qualitative study of Clinicians' perspectives (STREAMS-C).
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Warner BE, Wells M, Vindrola-Padros C, and Brett SJ
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- Humans, Male, Female, Aged, Patient Participation, Middle Aged, Interviews as Topic, Adult, Physician-Patient Relations, Age Factors, Clinical Decision-Making, Qualitative Research, Decision Making, Shared, Attitude of Health Personnel
- Abstract
Background: Shared decision-making (SDM) is increasingly expected in healthcare systems prioritising patient autonomy. Treatment escalation plans (TEPs) outline contingency for medical intervention in the event of patient deterioration. This study aimed to understand clinicians' perspectives on SDM in TEP for older patients in the acute medical setting., Methods: This was a qualitative study following a constructivist approach. Semistructured interviews with vignettes were conducted with 26 consultant and registrar doctors working in emergency medicine, general internal medicine, intensive care medicine and palliative care medicine. Reflexive thematic analysis was performed., Results: There were three themes: 'An unequal partnership', 'Options without equipoise' and 'Decisions with shared understanding'. Clinicians' expertise in synthesising complex, uncertain clinical information was contrasted with perceived patient unfamiliarity with future health planning and medical intervention. There was a strong sense of morality underpinning decision-making and little equipoise about appropriate TEP decisions. Communication around the TEP was important, and clinicians sought control over the high-stakes decision whilst avoiding conflict and achieving shared understanding., Conclusions: Clinicians take responsibility for securing a 'good' TEP decision for older patients in the acute medical setting. They synthesise clinical data with implicit ethical reasoning according to their professional predictions of qualitative and quantitative success following medical intervention. SDM is seldom considered a priority for this context. Nonetheless, avoidance of conflict, preserving the clinical relationship and shared understanding with the patient and family are important., (© The Author(s) 2024. Published by Oxford University Press on behalf of the British Geriatrics Society.)
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- 2024
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43. Continuous vs Intermittent β-Lactam Antibiotic Infusions in Critically Ill Patients With Sepsis: The BLING III Randomized Clinical Trial.
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Dulhunty JM, Brett SJ, De Waele JJ, Rajbhandari D, Billot L, Cotta MO, Davis JS, Finfer S, Hammond NE, Knowles S, Liu X, McGuinness S, Mysore J, Paterson DL, Peake S, Rhodes A, Roberts JA, Roger C, Shirwadkar C, Starr T, Taylor C, Myburgh JA, and Lipman J
- Subjects
- Aged, Female, Humans, Male, Middle Aged, Critical Illness, Drug Administration Schedule, Infusions, Intravenous, Adult, Hospital Mortality, Intensive Care Units, Meropenem administration & dosage, Piperacillin, Tazobactam Drug Combination administration & dosage, Sepsis drug therapy, Sepsis mortality, beta Lactam Antibiotics administration & dosage
- Abstract
Importance: Whether β-lactam antibiotics administered by continuous compared with intermittent infusion reduces the risk of death in patients with sepsis is uncertain., Objective: To evaluate whether continuous vs intermittent infusion of a β-lactam antibiotic (piperacillin-tazobactam or meropenem) results in decreased all-cause mortality at 90 days in critically ill patients with sepsis., Design, Setting, and Participants: An international, open-label, randomized clinical trial conducted in 104 intensive care units (ICUs) in Australia, Belgium, France, Malaysia, New Zealand, Sweden, and the United Kingdom. Recruitment occurred from March 26, 2018, to January 11, 2023, with follow-up completed on April 12, 2023. Participants were critically ill adults (≥18 years) treated with piperacillin-tazobactam or meropenem for sepsis., Intervention: Eligible patients were randomized to receive an equivalent 24-hour dose of a β-lactam antibiotic by either continuous (n = 3498) or intermittent (n = 3533) infusion for a clinician-determined duration of treatment or until ICU discharge, whichever occurred first., Main Outcomes and Measures: The primary outcome was all-cause mortality within 90 days after randomization. Secondary outcomes were clinical cure up to 14 days after randomization; new acquisition, colonization, or infection with a multiresistant organism or Clostridioides difficile infection up to 14 days after randomization; ICU mortality; and in-hospital mortality., Results: Among 7202 randomized participants, 7031 (mean [SD] age, 59 [16] years; 2423 women [35%]) met consent requirements for inclusion in the primary analysis (97.6%). Within 90 days, 864 of 3474 patients (24.9%) assigned to receive continuous infusion had died compared with 939 of 3507 (26.8%) assigned intermittent infusion (absolute difference, -1.9% [95% CI, -4.9% to 1.1%]; odds ratio, 0.91 [95% CI, 0.81 to 1.01]; P = .08). Clinical cure was higher in the continuous vs intermittent infusion group (1930/3467 [55.7%] and 1744/3491 [50.0%], respectively; absolute difference, 5.7% [95% CI, 2.4% to 9.1%]). Other secondary outcomes were not statistically different., Conclusions and Relevance: The observed difference in 90-day mortality between continuous vs intermittent infusions of β-lactam antibiotics did not meet statistical significance in the primary analysis. However, the confidence interval around the effect estimate includes the possibility of both no important effect and a clinically important benefit in the use of continuous infusions in this group of patients., Trial Registration: ClinicalTrials.gov Identifier: NCT03213990.
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- 2024
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44. Prolonged vs Intermittent Infusions of β-Lactam Antibiotics in Adults With Sepsis or Septic Shock: A Systematic Review and Meta-Analysis.
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Abdul-Aziz MH, Hammond NE, Brett SJ, Cotta MO, De Waele JJ, Devaux A, Di Tanna GL, Dulhunty JM, Elkady H, Eriksson L, Hasan MS, Khan AB, Lipman J, Liu X, Monti G, Myburgh J, Novy E, Omar S, Rajbhandari D, Roger C, Sjövall F, Zaghi I, Zangrillo A, Delaney A, and Roberts JA
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- Adult, Humans, Critical Illness, Drug Administration Schedule, Infusions, Intravenous, Intensive Care Units, Randomized Controlled Trials as Topic, Time Factors, beta Lactam Antibiotics administration & dosage, Sepsis drug therapy, Sepsis mortality, Shock, Septic drug therapy, Shock, Septic mortality
- Abstract
Importance: There is uncertainty about whether prolonged infusions of β-lactam antibiotics improve clinically important outcomes in critically ill adults with sepsis or septic shock., Objective: To determine whether prolonged β-lactam antibiotic infusions are associated with a reduced risk of death in critically ill adults with sepsis or septic shock compared with intermittent infusions., Data Sources: The primary search was conducted with MEDLINE (via PubMed), CINAHL, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and ClinicalTrials.gov from inception to May 2, 2024., Study Selection: Randomized clinical trials comparing prolonged (continuous or extended) and intermittent infusions of β-lactam antibiotics in critically ill adults with sepsis or septic shock., Data Extraction and Synthesis: Data extraction and risk of bias were assessed independently by 2 reviewers. Certainty of evidence was evaluated with the Grading of Recommendations Assessment, Development and Evaluation approach. A bayesian framework was used as the primary analysis approach and a frequentist framework as the secondary approach., Main Outcomes and Measures: The primary outcome was all-cause 90-day mortality. Secondary outcomes included intensive care unit (ICU) mortality and clinical cure., Results: From 18 eligible randomized clinical trials that included 9108 critically ill adults with sepsis or septic shock (median age, 54 years; IQR, 48-57; 5961 men [65%]), 17 trials (9014 participants) contributed data to the primary outcome. The pooled estimated risk ratio for all-cause 90-day mortality for prolonged infusions of β-lactam antibiotics compared with intermittent infusions was 0.86 (95% credible interval, 0.72-0.98; I2 = 21.5%; high certainty), with a 99.1% posterior probability that prolonged infusions were associated with lower 90-day mortality. Prolonged infusion of β-lactam antibiotics was associated with a reduced risk of intensive care unit mortality (risk ratio, 0.84; 95% credible interval, 0.70-0.97; high certainty) and an increase in clinical cure (risk ratio, 1.16; 95% credible interval, 1.07-1.31; moderate certainty)., Conclusions and Relevance: Among adults in the intensive care unit who had sepsis or septic shock, the use of prolonged β-lactam antibiotic infusions was associated with a reduced risk of 90-day mortality compared with intermittent infusions. The current evidence presents a high degree of certainty for clinicians to consider prolonged infusions as a standard of care in the management of sepsis and septic shock., Trial Registration: PROSPERO Identifier: CRD42023399434.
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- 2024
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45. Characteristics and outcomes of patients with COVID-19 at high risk of disease progression receiving sotrovimab, oral antivirals or no treatment in England: a retrospective cohort study.
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Patel V, Yarwood MJ, Levick B, Gibbons DC, Drysdale M, Kerr W, Watkins JD, Young S, Pierce BF, Lloyd EJ, Birch HJ, Kamalati T, and Brett SJ
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- Humans, Middle Aged, Retrospective Studies, Male, Female, Adult, Aged, Adolescent, Young Adult, England epidemiology, Hospitalization statistics & numerical data, Antibodies, Monoclonal, Humanized therapeutic use, Antibodies, Monoclonal, Humanized administration & dosage, Treatment Outcome, Ritonavir therapeutic use, Ritonavir administration & dosage, Betacoronavirus, Administration, Oral, Cytidine analogs & derivatives, Hydroxylamines, Antiviral Agents therapeutic use, Antiviral Agents administration & dosage, COVID-19 epidemiology, SARS-CoV-2 isolation & purification, COVID-19 Drug Treatment, Disease Progression
- Abstract
Objective: To describe characteristics and acute clinical outcomes for patients with COVID-19 treated with sotrovimab, nirmatrelvir/ritonavir or molnupiravir, or untreated patients at highest risk per National Health Service (NHS) criteria., Methods: Retrospective study of non-hospitalized patients between 1 December 2021 and 31 May 2022, using data from the Discover-NOW dataset (North-West London). Included patients were aged ≥12 years and treated with sotrovimab, nirmatrelvir/ritonavir or molnupiravir, or untreated but expected to be eligible for early treatment per NHS highest-risk criteria. COVID-19-related and all-cause hospitalizations were reported for 28 days from COVID-19 diagnosis (index). Subgroup analyses were conducted in patients with advanced renal disease, those aged 18-64 and ≥65 years, and by period of Omicron BA.1, BA.2 and BA.5 (post-hoc exploratory) predominance., Results: Overall, 1503 treated and 4044 eligible high-risk untreated patients were included. A high proportion of patients on sotrovimab had advanced renal disease (29.3%), ≥3 high-risk comorbidities (47.6%) and were aged ≥65 years (36.9%). Five of 696 (0.7%) patients on sotrovimab, <5/337 (0.3-1.2%) on nirmatrelvir/ritonavir, 10/470 (2.1%) on molnupiravir and 114/4044 (2.8%) untreated patients were hospitalized with COVID-19. Similar results were observed across all subgroups. The proportion of patients dying within 28 days of the index period was similarly low across all cohorts (<2%)., Conclusion: Patients receiving sotrovimab appeared to show evidence of multiple high-risk comorbidities. Low hospitalization rates were observed for all treated cohorts across subgroups and periods of predominant variants of concern. These results require confirmation with comparative effectiveness analyses adjusting for differences in underlying patient characteristics.
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- 2024
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46. Impact of isotype on the mechanism of action of agonist anti-OX40 antibodies in cancer: implications for therapeutic combinations.
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Willoughby JE, Dou L, Bhattacharya S, Jackson H, Seestaller-Wehr L, Kilian D, Bover L, Voo KS, Cox KL, Murray T, John M, Shi H, Bojczuk P, Jing J, Niederer H, Shepherd AJ, Hook L, Hopley S, Inzhelevskaya T, Penfold CA, Mockridge CI, English V, Brett SJ, Srinivasan R, Hopson C, Smothers J, Hoos A, Paul E, Martin SL, Morley PJ, Yanamandra N, and Cragg MS
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- Animals, Humans, Mice, Antibodies, Monoclonal pharmacology, Antibodies, Monoclonal therapeutic use, Neoplasms drug therapy, Neoplasms immunology, Cell Line, Tumor, T-Lymphocytes, Regulatory immunology, T-Lymphocytes, Regulatory drug effects, Disease Models, Animal, Receptors, OX40 agonists
- Abstract
Background: OX40 has been widely studied as a target for immunotherapy with agonist antibodies taken forward into clinical trials for cancer where they are yet to show substantial efficacy. Here, we investigated potential mechanisms of action of anti-mouse (m) OX40 and anti-human (h) OX40 antibodies, including a clinically relevant monoclonal antibody (mAb) (GSK3174998) and evaluated how isotype can alter those mechanisms with the aim to develop improved antibodies for use in rational combination treatments for cancer., Methods: Anti-mOX40 and anti-hOX40 mAbs were evaluated in a number of in vivo models, including an OT-I adoptive transfer immunization model in hOX40 knock-in (KI) mice and syngeneic tumor models. The impact of FcγR engagement was evaluated in hOX40 KI mice deficient for Fc gamma receptors (FcγR). Additionally, combination studies using anti-mouse programmed cell death protein-1 (mPD-1) were assessed. In vitro experiments using peripheral blood mononuclear cells (PBMCs) examining possible anti-hOX40 mAb mechanisms of action were also performed., Results: Isotype variants of the clinically relevant mAb GSK3174998 showed immunomodulatory effects that differed in mechanism; mIgG1 mediated direct T-cell agonism while mIgG2a acted indirectly, likely through depletion of regulatory T cells (Tregs) via activating FcγRs. In both the OT-I and EG.7-OVA models, hIgG1 was the most effective human isotype, capable of acting both directly and through Treg depletion. The anti-hOX40 hIgG1 synergized with anti-mPD-1 to improve therapeutic outcomes in the EG.7-OVA model. Finally, in vitro assays with human peripheral blood mononuclear cells (hPBMCs), anti-hOX40 hIgG1 also showed the potential for T-cell stimulation and Treg depletion., Conclusions: These findings underline the importance of understanding the role of isotype in the mechanism of action of therapeutic mAbs. As an hIgG1, the anti-hOX40 mAb can elicit multiple mechanisms of action that could aid or hinder therapeutic outcomes, dependent on the microenvironment. This should be considered when designing potential combinatorial partners and their FcγR requirements to achieve maximal benefit and improvement of patient outcomes., Competing Interests: Competing interests: MSC is a retained consultant for BioInvent International and has performed educational and advisory roles for Baxalta and Boehringer Ingelheim. He has consulted for GSK, Radiant, iTeos Therapeutics, Surrozen, Hanall and Mestag and received research funding from BioInvent, Surrozen, GSK, UCB and iTeos. SB, HJ, LS-W, DK, HS, PB, JJ, HN, AJS, LH, SH, SJB, RS, JS, AH, EP, SLM, PJM and NY are (or were at the time the work was conducted) employees of GSK., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2024
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47. Health care professionals' experiences of pain management in the intensive care unit: a qualitative study.
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Bhattacharyya A, Laycock H, Brett SJ, Beatty F, and Kemp HI
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- Humans, Male, Female, Adult, Middle Aged, Attitude of Health Personnel, Critical Care methods, Pain Measurement methods, Intensive Care Units, Pain Management methods, Qualitative Research, Health Personnel psychology
- Abstract
Despite the existence of evidence-based guidelines for the assessment and management of pain in the critical care setting, the prevalence of acute pain remains high. Inadequate pain management is associated with longer duration of mechanical ventilation, reduced capacity for rehabilitation and long-term psychological sequelae. This study aimed to describe the experiences of pain management from healthcare professionals working in intensive care units. Healthcare professionals were recruited from intensive care units in London, UK using a purposive sampling technique. Semi-structured interviews were transcribed verbatim. Transcripts were analysed using an inductive thematic analysis technique. Thirty participants were recruited from eight diverse intensive care units. Five themes were identified. First, there was a lack of consensus in pain assessment in the ICU where nursing staff described more knowledge and confidence of validated pain measures than physicians, and concerns over validity and usability were raised. Second, there was a universal perception of resource availability impacting the quality of pain management including high clinical workload, staff turnover and availability of certain pain management techniques. Third, acknowledgement of the importance of pain management was highest in those with experience of interacting with critical care survivors. Fourth, participants described their own emotional reaction to managing those in pain which influenced their learning. Finally, there was a perception that, due to the complexity of the intensive care unit population, pain was de-prioritised and there were conflicting views as to whether standardised analgosedation algorithms were useful. This study provides evidence to suggest interdisciplinary training, collaboratively designed decision-making tools, prioritisation initiatives and research priorities are areas that could be targeted to improve pain management in critical care., (© 2023 The Authors. Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of Anaesthetists.)
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- 2024
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48. Comparative effectiveness of sotrovimab versus no treatment in non-hospitalised high-risk COVID-19 patients in north west London: a retrospective cohort study.
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Drysdale M, Galimov ER, Yarwood MJ, Patel V, Levick B, Gibbons DC, Watkins JD, Young S, Pierce BF, Lloyd EJ, Kerr W, Birch HJ, Kamalati T, and Brett SJ
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- Humans, London epidemiology, Retrospective Studies, State Medicine, COVID-19 Drug Treatment, COVID-19, Antibodies, Neutralizing, Antibodies, Monoclonal, Humanized
- Abstract
Background: We assessed the effectiveness of sotrovimab vs no early COVID-19 treatment in highest-risk COVID-19 patients during Omicron predominance., Methods: Retrospective cohort study using the Discover dataset in North West London. Included patients were non-hospitalised, aged ≥12 years and met ≥1 National Health Service highest-risk criterion for sotrovimab treatment. We used Cox proportional hazards models to compare HRs of 28-day COVID-19-related hospitalisation/death between highest-risk sotrovimab-treated and untreated patients. Age, renal disease and Omicron subvariant subgroup analyses were performed., Results: We included 599 sotrovimab-treated patients and 5191 untreated patients. Compared with untreated patients, the risk of COVID-19 hospitalisation/death (HR 0.50, 95% CI 0.24, 1.06; p=0.07) and the risk of COVID-19 hospitalisation (HR 0.43, 95% CI 0.18, 1.00; p=0.051) were both lower in the sotrovimab-treated group; however, statistical significance was not reached. In the ≥65 years and renal disease subgroups, sotrovimab was associated with a significantly reduced risk of COVID-19 hospitalisation, by 89% (HR 0.11, 95% CI 0.02, 0.82; p=0.03) and 82% (HR 0.18, 95% CI 0.05, 0.62; p=0.007), respectively., Conclusions: Risk of COVID-19 hospitalisation in sotrovimab-treated patients aged ≥65 years and with renal disease was significantly lower compared with untreated patients. Overall, risk of hospitalisation was also lower for sotrovimab-treated patients, but statistical significance was not reached., Competing Interests: Competing interests: MD, DCG, EJL, WK and HJB are employees of, and/or shareholders in, GSK. VP was an employee of GSK at the time of the study and is now an employee of KVM Analytics. ERG, MJY, JDW, SY, BFP and TK are (or were at time of study) employees of Imperial College Health Partners, which received funding from GSK and Vir Biotechnology to conduct the study. BL is an employee of OPEN Health, which received funding from GSK and Vir Biotechnology, Inc, to conduct the study. A consultancy fee was paid to SJB’s institutional account., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2024
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49. UK clinicians' attitudes towards the application of molecular diagnostics to guide antibiotic use in ICU patients with pneumonias: a quantitative study.
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Stewart SF, Pandolfo AM, Moon Z, Jani Y, Brett SJ, Brealey D, Singh S, Enne VI, Livermore DM, Gant V, and Horne R
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- Humans, Pathology, Molecular, Cross-Sectional Studies, Intensive Care Units, United Kingdom, Anti-Bacterial Agents therapeutic use, Pneumonia, Ventilator-Associated drug therapy
- Abstract
Background: Molecular diagnostic tests may improve antibiotic prescribing by enabling earlier tailoring of antimicrobial therapy. However, clinicians' trust and acceptance of these tests will determine their application in practice., Objectives: To examine ICU prescribers' views on the application of molecular diagnostics in patients with suspected hospital-acquired and ventilator-associated pneumonia (HAP/VAP)., Methods: Sixty-three ICU clinicians from five UK hospitals completed a cross-sectional questionnaire between May 2020 and July 2020 assessing attitudes towards using molecular diagnostics to inform initial agent choice and to help stop broad-spectrum antibiotics early., Results: Attitudes towards using molecular diagnostics to inform initial treatment choices and to stop broad-spectrum antibiotics early were nuanced. Most (83%) were positive about molecular diagnostics, agreeing that using results to inform broad-spectrum antibiotic prescribing is good practice. However, many (58%) believed sick patients are often too unstable to risk stopping broad-spectrum antibiotics based on a negative result., Conclusions: Positive attitudes towards the application of molecular diagnostics to improve antibiotic stewardship were juxtapositioned against the perceived need to initiate and maintain broad-spectrum antibiotics to protect unstable patients., (© The Author(s) 2023. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy.)
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- 2024
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50. Clinician and patient perspectives on the barriers and facilitators to physical rehabilitation in intensive care: a qualitative interview study.
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Woodbridge HR, Norton C, Jones M, Brett SJ, Alexander CM, and Gordon AC
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- Humans, Qualitative Research, Intensive Care Units, Occupational Therapists, Critical Care, Physical Therapists
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Objectives: The objective of this study is to explore patient, relative/carer and clinician perceptions of barriers to early physical rehabilitation in intensive care units (ICUs) within an associated group of hospitals in the UK and how they can be overcome., Design: Qualitative study using semi-structured interviews and thematic framework analysis., Setting: Four ICUs over three hospital sites in London, UK., Participants: Former ICU patients or their relatives/carers with personal experience of ICU rehabilitation. ICU clinicians, including doctors, nurses, physiotherapists and occupational therapists, involved in the delivery of physical rehabilitation or decisions over its initiation., Primary and Secondary Outcomes Measures: Views and experiences on the barriers and facilitators to ICU physical rehabilitation., Results: Interviews were carried out with 11 former patients, 3 family members and 16 clinicians. The themes generated related to: safety and physiological concerns, patient participation and engagement, clinician experience and knowledge, teamwork, equipment and environment and risks and benefits of rehabilitation in intensive care. The overarching theme for overcoming barriers was a change in working model from ICU clinicians having separate responsibilities (a multidisciplinary approach) to one where all parties have a shared aim of providing patient-centred ICU physical rehabilitation (an interdisciplinary approach)., Conclusions: The results have revealed barriers that can be modified to improve rehabilitation delivery in an ICU. Interdisciplinary working could overcome many of these barriers to optimise recovery from critical illness., Competing Interests: Competing interests: HRW reports personal lecture fees from Brunel University and the University of East London. CN reports personal lecture fees from Janssen Pharmaceuticals and Web MD. CMA is a National Institute of Health Research PhD fellowship committee member, although not at the time that funding was awarded for this study. ACG reports salary support from an NIHR Research Professorship (RP-2015-06-018) and research support from the NIHR Imperial BRC., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.)
- Published
- 2023
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