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1. Multidisciplinary Team Decisions in Management of Abdominal Aortic Aneurysm: A Service and Quality Evaluation

Author

Daniel J. Drayton, Susannah Howard, Christopher Hammond, Hilary L. Bekker, David A. Russell, and Simon J. Howell

Subjects
Aortic aneurysm, Abdominal, Clinical decision making, Multidisciplinary team, Vascular surgical procedures, Diseases of the circulatory (Cardiovascular) system, RC666-701, Surgery, RD1-811
Abstract

Objective: To investigate whether decisions made by the multidisciplinary team (MDT) were implemented and review the MDT process to identify areas for improvement. Methods: This was a retrospective service evaluation project. Consecutive cases of abdominal aortic aneurysm (AAA) from vascular surgery MDT meetings were reviewed. MDT outputs were extracted and compared with implemented clinical management obtained from the electronic health record (EHR) to determine concordance. Cases were re-reviewed to understand reasons why planned management was not implemented. Results: From 42 MDT meetings, 106 patients were identified. Twenty four patients were discussed at two MDTs and four patients were discussed three times. Of the 106 patients, 91 (85.8%) were treated as planned, seven (6.6%) declined planned management and opted for conservative management, four (3.8%) patients died before treatment, and four (3.8%) had alternative management for individual reasons. Of the patients discussed multiple times, 15 (53.6%) needed review by a consultant anaesthetist or additional investigations. Conclusion: This service evaluation found a similar proportion of cases as in existing oncology literature where the MDT decision was not implemented. However, the natural history of AAA brings nuance to this finding. Facilitating patient preference is an important problem that will require future study. This evaluation resulted in local improvements to the MDT process for AAA.

Published
2022
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2. Conceptualising and Understanding Artistic Creativity in the Dementias: Interdisciplinary Approaches to Research and Practise

Author

Paul M. Camic, Sebastian J. Crutch, Charlie Murphy, Nicholas C. Firth, Emma Harding, Charles R. Harrison, Susannah Howard, Sarah Strohmaier, Janneke Van Leewen, Julian West, Gill Windle, Selina Wray, and Hannah Zeilig

Subjects
dementia, creativity, dance, visual art, music, poetry, Psychology, BF1-990
Abstract

Creativity research has a substantial history in psychology and related disciplines; one component of this research tradition has specifically examined artistic creativity. Creativity theories have tended to concentrate, however, on creativity as an individual phenomenon that results in a novel production, and on cognitive aspects of creativity, often limiting its applicability to people with cognitive impairments, including those with a dementia. Despite growing indications that creativity is important for the wellbeing of people living with dementias, it is less well understood how creativity might be conceptualised, measured and recognised in this population, and how this understanding could influence research and practise. This paper begins by exploring prevailing concepts of creativity and assesses their relevance to dementia, followed by a critique of creativity and dementia research related to the arts. Perspectives from researchers, artists, formal and informal caregivers and those with a dementia are addressed. We then introduce several novel psychological and physiological approaches to better understand artistic-related creativity in this population and conclude with a conceptualisation of artistic creativity in the dementias to help guide future research and practise.

Published
2018
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3. Transforming research and relationships through collaborative tribal-university partnerships on Manoomin (wild rice)

Author

Rich Robinson, Daniel J. Larkin, Laura Matson, Darren Vogt, John Johnson, Amy Myrbo, Diana Dalbotten, Susannah Howard, T. Howes, Roger LaBine, Mae A. Davenport, Perry Bunting, J. Torgeson, Michael Northbird, Alexander Waheed, Michael J. Dockry, William (Joe) Graveen, Katherine Hagsten, Riley Schmitter, Hannah Jo King, Kari Hedin, Cara M. Santelli, Donovan Strong, Robert Shimek, Melonee Montano, McKaylee Duquain, G.-H. Crystal Ng, Nancy Schuldt, Eric Chapman, Erik Kojola, Madeline Nyblade, Karen Diver, Seth Moore, Jeremy Bloomquist, Meghan A. Porter, Mark Bellcourt, Allison Smart, and Shannon Kesner

Subjects
Environmental justice, 010504 meteorology & atmospheric sciences, Commodification, business.industry, Geography, Planning and Development, Context (language use), 010501 environmental sciences, Management, Monitoring, Policy and Law, Public relations, 01 natural sciences, Natural resource, Indigenous, General partnership, Sustenance, Stewardship, business, 0105 earth and related environmental sciences
Abstract

Manoomin, the Ojibwe word for wild rice, grows in shallow lakes and streams and provides physical, spiritual, and cultural sustenance as a sacred food and relative for Indigenous peoples across the Great Lakes region of North America. Unfortunately, Manoomin has been declining due to multiple environmental stressors. In 2018, an interdisciplinary group from the University of Minnesota came together with natural resource managers from tribes and inter-tribal organizations to understand Manoomin within its socio-environmental context. This partnership grew despite a history fraught with settler colonial structures of knowledge production and commodification. Based on lessons learned from building this transformational partnership, this paper describes ten tenets for responsible research: 1) Honor Indigenous sovereignty and rights; 2) Address past and present harms; 3) Be on the path together with researchers and Indigenous partners; 4) Recognize, respect, and value Indigenous participation and intellectual labor; 5) Encourage the robust exchange of ideas; 6) Recognize that documents formalizing a relationship are not the whole relationship; 7) Make a plan for identifying and protecting sensitive Indigenous data; 8) Be prepared to navigate institutional obstacles; 9) Seek, support, and collaborate with diverse students; and 10) Actively listen and be open to different ways of engaging with the world. These lessons can serve as tools to form accountable partnerships that enable robust, nuanced, and effective environmental science, policy, and stewardship.

Published
2021
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4. Early elevation in plasma high-sensitivity troponin T and morbidity after elective noncardiac surgery: prospective multicentre observational cohort study

Author

Gareth L. Ackland, Tom E.F. Abbott, Timothy F. Jones, Martin Leuwer, Rupert M. Pearse, Rupert Pearse, Edyta Niebrzegowska, Andrew Wragg, Andrew Archbold, Elisa Kam, Kirsty Everingham, Phoebe Bodger, Thais Creary, Ben Bloom, Alice Carter, Neil MacDonald, Nirav Shah, Katarzyna Mrozek, Amy Richardson, Alex Fowler, Zakaria Rob, Gareth Ackland, Robert Stephens, Anna Reyes, Laura Gallego Paredes, Pervez Sultan, David Cain, John Whittle, Mark Edwards, Simon Woldman, Ana Gutierrez del Arroyo, Shamir Karmali, Colin Williams, A. Rushton, I. Welters, Jane Parker, Robert J. Sapsford, Julian Barth, Julian Scott, Alistair Hall, Simon Howell, Michaela Lobley, Janet Woods, Susannah Howard, Joanne Fletcher, and Nikki Dewhirst

Subjects
Male, medicine.medical_specialty, Critical Care, Myocardial Infarction, Kaplan-Meier Estimate, Cardiovascular, Sensitivity and Specificity, Cohort Studies, Primary outcome, Postoperative Complications, Troponin T, Internal medicine, medicine, Cluster Analysis, Humans, cardiovascular diseases, Postoperative Period, Prospective Studies, Aged, Postoperative Care, biology, business.industry, Organ dysfunction, Perioperative, Length of Stay, Middle Aged, High Sensitivity Troponin T, Troponin, United Kingdom, Hospitalization, Anesthesiology and Pain Medicine, biology.protein, Cardiology, Observational study, Female, medicine.symptom, Morbidity, business, Noncardiac surgery, Biomarkers, Cohort study
Abstract

BACKGROUND: Elevated high-sensitivity troponin (hsTnT) after noncardiac surgery is associated with higher mortality, but the temporal relationship between early elevated troponin and the later development of noncardiac morbidity remains unclear. METHODS: Prospective observational study of patients aged ≥45 yr undergoing major noncardiac surgery at four UK hospitals (two masked to hsTnT). The exposure of interest was early elevated troponin, as defined by hsTnT >99th centile (≥15 ng L(−1)) within 24 h after surgery. The primary outcome was morbidity 72 h after surgery, defined by the Postoperative Morbidity Survey (POMS). Secondary outcomes were time to become morbidity-free and Clavien–Dindo ≥grade 3 complications. RESULTS: Early elevated troponin (median 21 ng L(−1) [16–32]) occurred in 992 of 4335 (22.9%) patients undergoing elective noncardiac surgery (mean [standard deviation, sd] age, 65 [11] yr; 2385 [54.9%] male). Noncardiac morbidity was more frequent in 494/992 (49.8%) patients with early elevated troponin compared with 1127/3343 (33.7%) patients with hsTnT

Published
2019

6. Myocardial Injury after Noncardiac Surgery

Author

Pierre Coriat, Patricia Cruz, Bogusz Kaczmarek, Gabriel Cusati, Wendy Lim, Saeed Darvish-Kazim, Rupert Pearse, Finlay A. McAlister, Cheryl Ramballi, Robert C M Stephens, R.M. Pearse, Jeff Weitz, Germán Málaga, Alexander Y. Fu, Eleanor McAlees, Alberto Varela, Maria Palencia, James Zacharias, Ryan J. J. Amadeo, Bruce M Biccard, Janet Woods, Catherine M. Clase, Patrick S Finnegan, Laura Gallego Paredes, Alistair Hall, Mariana Vargas Furtado, Alben Sigamani, José Villamor, Alex Torborg, Maria De Los Angeles Lazo, Tony Gin, Pavel S Roshanov, Carmen Fernández, Andrea Kurz, Hertzel C. Gerstein, Stephen Li, R.N. Rodseth, P. Naidoo, Mitchell Winemaker, Parminder Raina, Gordon Y.S. Choi, Lalita Afzal, Richard Mizera, Sean M. Bagshaw, Marta Januszewska, Yannick LeManach, Sultana Furruqh, Robert J. Sapsford, Peter Lovrics, B M Biccard, Cecilia Martínez, Faisal Siddiqui, J. Mooney, Carisi Anne Polanczyk, Ina Ismiarti Shariffuddin, Mark Crowther, Elizabeth Ling, Adrià Font, Mark Soth, Maria Stella Chaparro, Maria José Membrillo, Ekaterina Popova, Denis Monneret, Richard P. Whitlock, Amit Garg, Andrew Archbold, Vascular Events In Noncardiac Surgery Patients Cohort Evaluation (Vision) Investigators, M Leuwer, Vincent W. Lee, Zhuo Sun, Patricia Piñeiro, César A. Jardim, Clare D. Ramsey, Krit Panjasawatwong, James Paul, David W. Gibson, Philip St John, Peter Nagele, Jose Amalth do Espirirto Santo, Pablo Alonso-Coello, Jacek Musial, Jacques G. Tittley, Fernando Botto, Georges Daas, Hou Yee Lai, Ana Gutierrez del Arroyo, Edmunds Reineks, Martin Leuwer, Clive Kearon, Jane Blood, Mari Luz Maestre, Neesh Pannu, Marta De Antonio, Ameen Patel, Aida Rotta-Rotta, Noorjahan Haneem Md Hashim, Amal Bessissow, Hélio Penna Guimarães, Norman Buckley, Mateusz Kózka, Maria José Ferré, Gerard Urrútia, Lydia C.W. Lit, Matthew T. V. Chan, Philip J. Devereaux, Ushananthini Ki, Jesús Alvarez García, Shaveta Mala, Juan Carlos Villar, Andrew McKay, Silvia Moreira Ayub Ferreira, Angeles de Miguel, Gordon H. Guyatt, David Orozco, A. Rushton, Michael J Jacka, Holger J Schünemann, Diane Heels-Ansdell, Guillaume Paré, Stephen Hill, Amit X Garg, Hooman Honar, Pervez Sultan, Miquel Santaló, Zubin Punthakee, Sihe Wang, Katia R. M. Leite, Holger Schünemann, Hilary P Grocott, Aram Shahinyan, Sebastian Ribas, Jackie Bosch, Amanda Smith, Giovanna Luratibuse, Joseph Cherian, Maciej Chwała, Heather McDonald, Rey R. Acedillo, Manuel Muñoz, Sally Benton, Michael Walsh, Vikas Tandon, Shirley Pettit, Javier D Loza-Herrera, Paul M. O'Bryne, Joanne Fletcher, Richard Halliwell, Clara K Chow, Jacek Górka, Michelle M. Graham, Alvaro Castañeda, Ainslie Hildebrand, Patrick Magloire, Skarlett Vásquez, Gareth L Ackland, P. George, Sergio Mazzadi, Susannah Howard, Simon J. Howell, Rubeshan Naidoo, William Orovan, Megan Kalin, Anna Reyes, Anthony Adili, Frederick A. Spencer, Laurel Thorlacius, Jehonathan H. Pinthus, Michaela Lobley, Justin DeBeer, Theroshnie Kisten, Dean Gopalan, John W. Eikelboom, Eliana Vieira Santucci, Derek R. Townsend, Raúl Gonzalez, Tomas VanHelder, Sean McMurtry, Susana Díaz, Catherine Royer, Hussein Cassimjee, James D. Douketis, Ahsun Khan, V Vasanthan, Chew Yin Wang, Sadeesh Srinathan, A. Wahab Undok, Deven Reddy, Paola Muti, Paul Jackson, Javier Ganame, Danielle MacNeil, Pilar Paniagua, Graham S. Hillis, Wojciech Szczeklik, Azim S. Gangji, Stephen D. Walter, Andrew Worster, Matthew B. McQueen, Sadeesh K Srinathan, Otavio Berwanger, Cameron Egan, Aine Mugabi, Neil MacDonald, Erica Aranha Suzumura, Matthew J. McQueen, Reitze N. Rodseth, Maria Del Barrio, Peter A. Kavsak, Cristina Ibanez Esteve, David Szalay, Olga L. Cortés, Fidel Reyes, John Whittle, Gracie Ong, Troy S. Wildes, Ngan N. Lam, Karen Raymer, C. Williams, G.L. Ackland, Enrico Vizza, Salim Yusuf, Wan Azman Ahmad, Radhika Dhanpal, Barbara Sokołowska, David Cain, Andre Lamy, Alexandre Biasi Cavalcanti, Marko Mrkobrada, James Hankinson, Emmanuelle Duceppe, Julian Scott, Maria Tiboni, Tomasz Mrowiecki, Vanessa Valderrama-Victoria, Paweł Iwaszczuk, Robert Sapsford, Andrew Wragg, Atiya Faruqui, Edyta Niebrzegowska, Mohit Bhandari, Teresa Del Castillo, Jean Pierre Goarin, Marko Simunovic, Omid Salehian, Smitha Almeida, Ingeborg Welters, Lehana Thabane, D.L. Skinner, Tej Sheth, Alvin S.B. Tan, Ignacio Garutti, Daniel I. Sessler, Sabu Thomas, Sarah D. McDonald, Trevor W R Lee, Marzida Mansor, Julian H. Barth, Nikki Dewhirst, Xavier Pelaez, Valsa Abraham, Jill Rudkowski, Sanjit S. Jolly, Azad Hassan Abdul Razack, Marcin Raczek, Duane J. Funk, Deborah J. Cook, Martin O'Donnell, and Denis Xavier

Subjects
medicine.medical_specialty, biology, Troponin T, business.industry, Hazard ratio, Infarction, Perioperative, medicine.disease, Troponin, Surgery, Anesthesiology and Pain Medicine, Internal medicine, medicine, biology.protein, Cardiology, Myocardial infarction, Prospective cohort study, business, Cohort study
Abstract

Background: Myocardial injury after noncardiac surgery (MINS) was defined as prognostically relevant myocardial injury due to ischemia that occurs during or within 30 days after noncardiac surgery. The study’s four objectives were to determine the diagnostic criteria, characteristics, predictors, and 30-day outcomes of MINS. Methods: In this international, prospective cohort study of 15,065 patients aged 45 yr or older who underwent in-patient noncardiac surgery, troponin T was measured during the first 3 postoperative days. Patients with a troponin T level of 0.04 ng/ml or greater (elevated “abnormal” laboratory threshold) were assessed for ischemic features (i.e., ischemic symptoms and electrocardiography findings). Patients adjudicated as having a nonischemic troponin elevation (e.g., sepsis) were excluded. To establish diagnostic criteria for MINS, the authors used Cox regression analyses in which the dependent variable was 30-day mortality (260 deaths) and independent variables included preoperative variables, perioperative complications, and potential MINS diagnostic criteria. Results: An elevated troponin after noncardiac surgery, irrespective of the presence of an ischemic feature, independently predicted 30-day mortality. Therefore, the authors’ diagnostic criterion for MINS was a peak troponin T level of 0.03 ng/ml or greater judged due to myocardial ischemia. MINS was an independent predictor of 30-day mortality (adjusted hazard ratio, 3.87; 95% CI, 2.96–5.08) and had the highest population-attributable risk (34.0%, 95% CI, 26.6–41.5) of the perioperative complications. Twelve hundred patients (8.0%) suffered MINS, and 58.2% of these patients would not have fulfilled the universal definition of myocardial infarction. Only 15.8% of patients with MINS experienced an ischemic symptom. Conclusion: Among adults undergoing noncardiac surgery, MINS is common and associated with substantial mortality.

Published
2014
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10. Myocardial Injury after Noncardiac Surgery: A Large, International, Prospective Cohort Study Establishing Diagnostic Criteria, Characteristics, Predictors, and 30-day Outcomes

Author

Fernando, Botto, Pablo, Alonso-Coello, Matthew T V, Chan, Juan Carlos, Villar, Denis, Xavier, Sadeesh, Srinathan, Gordon, Guyatt, Patricia, Cruz, Michelle, Graham, C Y, Wang, Otavio, Berwanger, Rupert M, Pearse, Bruce M, Biccard, Valsa, Abraham, German, Malaga, Graham S, Hillis, Reitze N, Rodseth, Deborah, Cook, Carisi A, Polanczyk, Wojciech, Szczeklik, Daniel I, Sessler, Tej, Sheth, Gareth L, Ackland, Martin, Leuwer, Amit X, Garg, Yannick, Lemanach, Shirley, Pettit, Diane, Heels-Ansdell, Giovanna, Luratibuse, Michael, Walsh, Robert, Sapsford, Holger J, Schünemann, Andrea, Kurz, Sabu, Thomas, Marko, Mrkobrada, Lehana, Thabane, Hertzel, Gerstein, Pilar, Paniagua, Peter, Nagele, Parminder, Raina, Salim, Yusuf, P J, Devereaux, Matthew J, McQueen, Mohit, Bhandari, Jackie, Bosch, Norman, Buckley, Clara K, Chow, Richard, Halliwell, Stephen, Li, Vincent W, Lee, John, Mooney, Mariana V, Furtado, Erica, Suzumura, Eliana, Santucci, Katia, Leite, Jose Amalth do Espirirto, Santo, Cesar A P, Jardim, Alexandre Biasi, Cavalcanti, Helio Penna, Guimaraes, Michael J, Jacka, Finlay, McAlister, Sean, McMurtry, Derek, Townsend, Neesh, Pannu, Sean, Bagshaw, Amal, Bessissow, Emmanuelle, Duceppe, John, Eikelboom, Javier, Ganame, James, Hankinson, Stephen, Hill, Sanjit, Jolly, Andre, Lamy, Elizabeth, Ling, Patrick, Magloire, Guillaume, Pare, Deven, Reddy, David, Szalay, Jacques, Tittley, Jeff, Weitz, Richard, Whitlock, Saeed, Darvish-Kazim, Justin, Debeer, Peter, Kavsak, Clive, Kearon, Richard, Mizera, Martin, O'Donnell, Matthew, McQueen, Jehonathan, Pinthus, Sebastian, Ribas, Marko, Simunovic, Vikas, Tandon, Tomas, Vanhelder, Mitchell, Winemaker, Sarah, McDonald, Paul, O'Bryne, Ameen, Patel, James, Paul, Zubin, Punthakee, Karen, Raymer, Omid, Salehian, Fred, Spencer, Stephen, Walter, Andrew, Worster, Anthony, Adili, Catherine, Clase, Mark, Crowther, James, Douketis, Azim, Gangji, Paul, Jackson, Wendy, Lim, Peter, Lovrics, Sergio, Mazzadi, William, Orovan, Jill, Rudkowski, Mark, Soth, Maria, Tiboni, Rey, Acedillo, Amit, Garg, Ainslie, Hildebrand, Ngan, Lam, Danielle, Macneil, Pavel S, Roshanov, Sadeesh K, Srinathan, Clare, Ramsey, Philip St, John, Laurel, Thorlacius, Faisal S, Siddiqui, Hilary P, Grocott, Andrew, McKay, Trevor W R, Lee, Ryan, Amadeo, Duane, Funk, Heather, McDonald, James, Zacharias, Olga Lucía, Cortés, Maria Stella, Chaparro, Skarlett, Vásquez, Alvaro, Castañeda, Silvia, Ferreira, Pierre, Coriat, Denis, Monneret, Jean Pierre, Goarin, Cristina Ibanez, Esteve, Catherine, Royer, Georges, Daas, Gordon Y S, Choi, Tony, Gin, Lydia C W, Lit, Alben, Sigamani, Atiya, Faruqui, Radhika, Dhanpal, Smitha, Almeida, Joseph, Cherian, Sultana, Furruqh, Lalita, Afzal, Preetha, George, Shaveta, Mala, Holger, Schünemann, Paola, Muti, Enrico, Vizza, G S Y, Ong, Marzida, Mansor, Alvin S B, Tan, Ina I, Shariffuddin, V, Vasanthan, N H M, Hashim, A Wahab, Undok, Ushananthini, Ki, Hou Yee, Lai, Wan Azman, Ahmad, Azad H A, Razack, Vanessa, Valderrama-Victoria, Javier D, Loza-Herrera, Maria, De Los Angeles Lazo, Aida, Rotta-Rotta, Barbara, Sokolowska, Jacek, Musial, Jacek, Gorka, Pawel, Iwaszczuk, Mateusz, Kozka, Maciej, Chwala, Marcin, Raczek, Tomasz, Mrowiecki, Bogusz, Kaczmarek, Bruce, Biccard, Hussein, Cassimjee, Dean, Gopalan, Theroshnie, Kisten, Aine, Mugabi, Prebashini, Naidoo, Rubeshan, Naidoo, Reitze, Rodseth, David, Skinner, Alex, Torborg, Gerard, Urrutia, Mari Luz, Maestre, Miquel, Santaló, Raúl, Gonzalez, Adrià, Font, Cecilia, Martínez, Xavier, Pelaez, Marta, De Antonio, Jose Marcial, Villamor, Jesús Alvarez, García, Maria José, Ferré, Ekaterina, Popova, Ignacio, Garutti, Carmen, Fernández, Maria, Palencia, Susana, Díaz, Teresa, Del Castillo, Alberto, Varela, Angeles, de Miguel, Manuel, Muñoz, Patricia, Piñeiro, Gabriel, Cusati, Maria, Del Barrio, Maria José, Membrillo, David, Orozco, Fidel, Reyes, Robert J, Sapsford, Julian, Barth, Julian, Scott, Alistair, Hall, Simon, Howell, Michaela, Lobley, Janet, Woods, Susannah, Howard, Joanne, Fletcher, Nikki, Dewhirst, C, Williams, A, Rushton, I, Welters, M, Leuwer, Rupert, Pearse, Gareth, Ackland, Ahsun, Khan, Edyta, Niebrzegowska, Sally, Benton, Andrew, Wragg, Andrew, Archbold, Amanda, Smith, Eleanor, McAlees, Cheryl, Ramballi, Neil, Macdonald, Marta, Januszewska, Robert, Stephens, Anna, Reyes, Laura Gallego, Paredes, Pervez, Sultan, David, Cain, John, Whittle, Ana Gutierrez, Del Arroyo, Zhuo, Sun, Patrick S, Finnegan, Cameron, Egan, Hooman, Honar, Aram, Shahinyan, Krit, Panjasawatwong, Alexander Y, Fu, Sihe, Wang, Edmunds, Reineks, Jane, Blood, Megan, Kalin, David, Gibson, and Troy, Wildes

Subjects
Male, Myocardial Ischemia, surgical technique, Article, Cohort Studies, Age Distribution, Postoperative Complications, Troponin T, Humans, preoperative care, human, Prospective Studies, outcome assessment, Aged, Hardware_MEMORYSTRUCTURES, troponin T, ComputingMilieux_THECOMPUTINGPROFESSION, predictive value, Research Diagnostic Criteria, heart muscle injury, Middle Aged, Prognosis, major clinical study, mortality, clinical feature, Patient Outcome Assessment, peroperative complication, priority journal, Surgical Procedures, Operative, prognosis, purl.org/pe-repo/ocde/ford#3.02.09 [https]
Abstract

Background: Myocardial injury after noncardiac surgery (MINS) was defined as prognostically relevant myocardial injury due to ischemia that occurs during or within 30 days after noncardiac surgery. The study's four objectives were to determine the diagnostic criteria, characteristics, predictors, and 30-day outcomes of MINS. Methods: In this international, prospective cohort study of 15,065 patients aged 45 yr or older who underwent in-patient noncardiac surgery, troponin T was measured during the first 3 postoperative days. Patients with a troponin T level of 0.04 ng/ml or greater (elevated abnormal laboratory threshold) were assessed for ischemic features (i.e., ischemic symptoms and electrocardiography findings). Patients adjudicated as having a nonischemic troponin elevation (e.g., sepsis) were excluded. To establish diagnostic criteria for MINS, the authors used Cox regression analyses in which the dependent variable was 30-day mortality (260 deaths) and independent variables included preoperative variables, perioperative complications, and potential MINS diagnostic criteria. Results: An elevated troponin after noncardiac surgery, irrespective of the presence of an ischemic feature, independently predicted 30-day mortality. Therefore, the authors' diagnostic criterion for MINS was a peak troponin T level of 0.03 ng/ml or greater judged due to myocardial ischemia. MINS was an independent predictor of 30-day mortality (adjusted hazard ratio, 3.87; 95% CI, 2.96-5.08) and had the highest population-attributable risk (34.0%, 95% CI, 26.6-41.5) of the perioperative complications. Twelve hundred patients (8.0%) suffered MINS, and 58.2% of these patients would not have fulfilled the universal definition of myocardial infarction. Only 15.8% of patients with MINS experienced an ischemic symptom. Conclusion: Among adults undergoing noncardiac surgery, MINS is common and associated with substantial mortality.

Published
2014

11. Association between Atherosclerotic Diseases and Carboxyhaemoglobin Levels in Tobacco Smokers

Author

Knud Kjeldsen, Nicholas J. Wald, Pete Smith, and Susannah Howard

Subjects
Male, medicine.medical_specialty, Arteriosclerosis, Smoking habit, Myocardial Infarction, Age and sex, Smoking history, Angina Pectoris, Hemoglobins, Internal medicine, Humans, Medicine, Myocardial infarction, General Environmental Science, Analysis of Variance, Carbon Monoxide, business.industry, Smoking, Age Factors, General Engineering, Tobacco Smokers, Papers and Originals, General Medicine, Intermittent Claudication, Middle Aged, medicine.disease, Intermittent claudication, Confidence interval, Cholesterol, Physical therapy, General Earth and Planetary Sciences, Female, Ischaemic heart disease, medicine.symptom, business
Abstract

In a cross-sectional study carboxyhaemoglobin (COHb) levels in tobacco smokers were found to provide a better indication of a person's risk of having developed certain atherosclerotic diseases, including ischaemic heart disease, than the smoking history. In the age group 30-69 years a person with a COHb level of 5% or more was found to be 21 times (lower 95% confidence limit 3.3 times) as likely to be affected by these diseases as another person of the same age and sex with similar smoking history and current smoking habits but with a COHb level of less than 3%.

Published
1973
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12. HLA typing in multiple sclerosis

Author

Susannah Howard and Alastair Compston

Subjects
Canada, Multiple Sclerosis, business.industry, Multiple sclerosis, General Medicine, Computational biology, Human leukocyte antigen, Gene Pool, medicine.disease, Text mining, HLA Antigens, Medicine, Humans, business
Published
1982

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