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917 results on '"Cousins, Michael"'

6. ECAP-Controlled Closed-Loop Spinal Cord Stimulation Efficacy and Opioid Reduction Over 24-Months: Final Results of the Prospective, Multicenter, Open-Label Avalon Study.

Author

Brooker, Charles, Russo, Marc, Cousins, Michael, Taylor, Nathan, Holford, Lewis, Martin, Rebecca, Boesel, Tillman, Sullivan, Richard, Hanson, Erin, Gmel, Gerrit, Shariati, Nastaran, Poree, Lawrence, and Parker, John

Subjects
Chronic, closed-loop SCS, evoke, evoked compound action potential, feedback, opioid, pain, spinal cord stimulation, Analgesics, Opioid, Chronic Pain, Humans, Prospective Studies, Quality of Life, Spinal Cord, Spinal Cord Stimulation, Treatment Outcome
Abstract

INTRODUCTION: Chronic pain is a major public health concern, as is the associated use of opioid medications, highlighting the importance of alternative treatments, such as spinal cord stimulation (SCS). Here, we present the final 24-month results of the Avalon study, which investigated the use of the first closed-loop SCS system in patients with chronic pain. The system measures the evoked compound action potentials (ECAPs) elicited by each stimulus pulse and drives a feedback loop to maintain the ECAP amplitude near constant. METHODS: Fifty patients were implanted with the Evoke system (Saluda Medical) and followed over 24-months. Pain, quality of life (QOL), function, sleep, and medication use were collected at baseline and each scheduled visit. ECAP amplitudes and programming adjustments were also monitored. RESULTS: At 24 months, responder rates (≥ 50% pain reduction) and high responder rates (≥ 80% pain reduction) for overall pain were 89.5% and 68.4%, respectively, the latter up from 42.2% at 3 months. Significant improvements from baseline were observed in QOL, function, and sleep over the 24 months, including ≥ 80% experiencing a minimally important difference in QOL and > 50% experiencing a clinically significant improvement in sleep. At 24 months, 82.8% of patients with baseline opioid use eliminated or reduced their opioid intake. Over the course of the study, reprogramming need fell to an average of less than once a year. CONCLUSION: Over a 24-month period, the Evoke closed-loop SCS maintained its therapeutic efficacy despite a marked reduction in opioid use and steady decrease in the need for reprogramming.

Published
2021

7. Respiratory health outcomes in neonates : lung function, exercise and airway mechanics

Author

Cousins, Michael

Abstract

My thesis uses data collected during the course of the Respiratory Outcomes in Neonates study, which aimed to identify, investigate mechanisms and establish potential treatments for lung disease in a population of preterm-born children in South Wales. As part of this study, 241 children attended our research unit where they underwent in-depth lung function testing, as reported in my thesis. My results observed preterm-born children with low lung function had increased air trapping on lung volume testing, functional exercise impairment, and greater response to post-exercise bronchodilator. When classifying preterm-born children with low lung function by obstructive versus non-obstructive lung disease, those children with obstructive disease had greater impairment of forced expiratory volume in one second (FEV1) and greater post-exercise reversibility. On oscillometry testing, preterm-born children with low lung function, in particular those with obstructive lung disease, had impaired resistance and compliance, with evidence of peripheral airways being most affected. Post-exercise bronchodilator was effective in improving airway mechanical properties in children with low lung function. Intra-breath oscillometry, unexplored in the preterm population to date, demonstrated impairment throughout the respiratory cycle in children with low lung function, and was not limited to expiration, suggesting a different disease process to that seen in other childhood wheeze disorders. I demonstrated that my method for classification of obstructive and non-obstructive lung disease was appropriate in my population for identification of children with postexercise bronchodilator reversibility, and was comparative to other established methods of defining obstructive lung disease. Finally, I explored differences between two methods of spirometry, and noted systematic bias towards higher results using a pneumotachograph system compared to an infra-red turbine spirometry, with implications for clinical practice.

Published
2021

9. Sustained Long-Term Outcomes With Closed-Loop Spinal Cord Stimulation: 12-Month Results of the Prospective, Multicenter, Open-Label Avalon Study.

Author

Russo, Marc, Brooker, Charles, Cousins, Michael, Taylor, Nathan, Boesel, Tillman, Sullivan, Richard, Holford, Lewis, Hanson, Erin, Gmel, Gerrit, Shariati, Nastaran, Poree, Lawrence, and Parker, John

Subjects
Action potentials, Back pain, Chronic pain, Electric stimulation, Feedback, Pain management, Spinal cord stimulation, Adult, Aged, Chronic Pain, Female, Humans, Male, Middle Aged, Pain Management, Pain Measurement, Prospective Studies, Quality of Life, Spinal Cord, Spinal Cord Stimulation, Time Factors, Treatment Outcome
Abstract

BACKGROUND: Spinal cord stimulation (SCS) activates the dorsal column fibers using electrical stimuli. Current SCS systems function in fixed-output mode, delivering the same stimulus regardless of spinal cord (SC) activation. OBJECTIVE: To present long-term outcomes of a novel closed-loop SCS system that aims to maintain the SC activation near a set target level and within a therapeutic window for each patient. SC activation is measured through the evoked compound action potential (ECAP) generated by each stimulus pulse. METHODS: Fifty patients with lower back and/or leg pain who were successfully trialed received a permanent system (Evoke; Saluda Medical, Sydney, Australia). Ratings of pain (visual analog scale), quality of life, function, sleep, and medication use were collected at baseline and at each visit. SC activation levels were reported in summary statistics. The therapeutic window for each individual patient was defined as the range of ECAP amplitudes between sensation threshold and uncomfortably strong stimulation. RESULTS: At 12 mo, the proportion of patients with ≥50% relief was 76.9% (back), 79.3% (leg), and 81.4% (overall), and the proportion with ≥80% pain relief was 56.4% (back), 58.6% (leg), and 53.5% (overall). Patients spent a median of 84.9% of their time with stimulation in their therapeutic window, and 68.8% (22/32) eliminated or reduced their opioid intake. Statistically significant improvements in secondary outcomes were observed. CONCLUSION: The majority of patients experienced more than 80% pain relief with stable SC activation, as measured by ECAP amplitude at 12 mo, providing evidence for the long-term effectiveness of the Evoke closed-loop SCS system.

Published
2020

12. The diffuse sound object

Author

Cousins, Michael Patrick and Fazi, Filippo

Subjects
620.2
Abstract

The theoretical diffuse sound field is one that is generated using an infinite number of uncorrelated plane waves from all directions. Spatial audio, in contrast, is generally delivered using a finite number of loudspeakers, potentially as few as only two. Therefore there is a reduction in the diffuseness of the sound field when reproducing diffuse sound fields using loudspeakers. It is therefore important that sound fields such as reverberation, rain or audience noise - that are approximations of a theoretical diffuse sound field - are reproduced with minimal perceptual degradation to maximise the spatial audio experience. In this research, the perception of diffuseness has been investigated thoroughly using a series of listening tests. Additionally, the relationships between the subjective perceived diffuseness and objective metrics for measuring diffuseness have been investigated leading to a simple metric for perceived diffuseness based on the spatial coherence.

Published
2019

22. Tubular Function

Author

Kam, Peter, primary, Power, Ian, additional, Cousins, Michael J., additional, and Siddal, Philip J., additional

Published
2020
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24. Cerebral Circulation

Author

Kam, Peter, primary, Power, Ian, additional, Cousins, Michael J., additional, and Siddal, Philip J., additional

Published
2020
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26. Liver Blood Flow

Author

Kam, Peter, primary, Power, Ian, additional, Cousins, Michael J., additional, and Siddal, Philip J., additional

Published
2020
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29. Pain Sensitization

Author

Kam, Peter, primary, Power, Ian, additional, Cousins, Michael J., additional, and Siddal, Philip J., additional

Published
2020
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38. Smooth Muscle

Author

Kam, Peter, primary, Power, Ian, additional, Cousins, Michael J., additional, and Siddal, Philip J., additional

Published
2020
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50. Metabolism

Author

Kam, Peter, primary, Power, Ian, additional, Cousins, Michael J., additional, and Siddal, Philip J., additional

Published
2020
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