Search

Your search keyword '"Vimal Grover"' showing total 15 results
Start Over Author "Vimal Grover"
15 results on '"Vimal Grover"'

1. A Wolf in Sheep's Clothing: Systemic Immune Activation Post Immunotherapy

Author

Crescens Tiu, Rajiv Shinde, Abhijit Pal, Andrea Biondo, Alex Lee, Nina Tunariu, Shaman Jhanji, Vimal Grover, Kate Tatham, Pascale Gruber, Udai Banerji, Johann S. De Bono, Emma Nicholson, Anna R. Minchom, and Juanita S. Lopez

Subjects
immune checkpoint inhibitor, immune-related adverse events, toxicity, systemic immune activation, hlh, fever, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282, Immunologic diseases. Allergy, RC581-607
Abstract

Introduction: Immune checkpoint inhibitors (ICIs) are increasingly a standard of care for many cancers; these agents can result in immune-related adverse events (irAEs) including fever, which is common but can rarely be associated with systemic immune activation (SIA or acquired HLH). Methods: All consecutive patients receiving ICIs in the Drug Development Unit of the Royal Marsden Hospital between May 2014 and November 2019 were retrospectively reviewed. Patients with fever ≥ 38°C or chills/rigors (without fever) ≤ 6 weeks of commencing ICIs were identified for clinical data collection. Results: Three patients met diagnostic criteria for SIA/HLH with median time to onset of symptoms of 10 days. We describe the clinical evolution, treatment used, and outcomes for these patients. High-dose steroids are used first-line with other treatments, such as tocilizumab, immunoglobulin and therapeutic plasmapheresis can be considered for steroid-refractory SIA/HLH. Conclusion: SIA/HLH post ICI is a rare but a potentially fatal irAE that presents with fever and a constellation of nonspecific symptoms. Early recognition and timely treatment are key to improving outcomes.

Published
2021
Full Text
View/download PDF

2. A biomarker panel (Bioscore) incorporating monocytic surface and soluble TREM-1 has high discriminative value for ventilator-associated pneumonia: a prospective observational study.

Author

Vimal Grover, Panagiotis Pantelidis, Neil Soni, Masao Takata, Pallav L Shah, Athol U Wells, Don C Henderson, Peter Kelleher, and Suveer Singh

Subjects
Medicine, Science
Abstract

Ventilator-associated pneumonia (VAP) increases mortality in critical illness. However, clinical diagnostic uncertainty persists. We hypothesised that measuring cell-surface and soluble inflammatory markers, incorporating Triggering Receptor Expressed by Myeloid cells (TREM)-1, would improve diagnostic accuracy.A single centre prospective observational study, set in a University Hospital medical-surgical intensive Care unit, recruited 91 patients into 3 groups: 27 patients with VAP, 33 ventilated controls without evidence of pulmonary sepsis (non-VAP), and 31 non-ventilated controls (NVC), without clinical infection, attending for bronchoscopy. Paired samples of Bronchiolo-alveolar lavage fluid (BALF) and blood from each subject were analysed for putative biomarkers of infection: Cellular (TREM-1, CD11b and CD62L) and soluble (IL-1β, IL-6, IL-8, sTREM-1, Procalcitonin). Expression of cellular markers on monocytes and neutrophils were measured by flow cytometry. Soluble inflammatory markers were determined by ELISA. A biomarker panel ('Bioscore'), was constructed, tested and validated, using Fisher's discriminant function analysis, to assess its value in distinguishing VAP from non VAP.The expression of TREM-1 on monocytes (mTREM-1) and neutrophils (nTREM-1) and concentrations of IL-1β, IL-8, and sTREM-1 in BALF were significantly higher in VAP compared with non-VAP and NVC (p

Published
2014
Full Text
View/download PDF

3. Protocol for direct reporting of awareness in maternity patients (DREAMY): a prospective, multicentre cohort study of accidental awareness during general anaesthesia

Author

P.M. Odor, S. Bampoe, D.N. Lucas, S.R. Moonesinghe, J. Andrade, J.J. Pandit, Alicja A'Court, Dina Abdel-Gadir, Ayman Abdu, Caroline Abisogun, Zainab Aboud, Judith Abrams, Andrea Ackerman, Christine Adamso, Rachel Addison, Adedayo Adeyeye, Rachel Adler, Maame Aduse-Poku, Siddharth Adyanthaya, Najmiah Ahmad, Dabeeruddeen Ahmed, Atif Ahmed, Bucky Akindele, Olubukola Akindele, Sonia Akrimi, Samar Al-Rawi, Yousif Ali, Jo Allam, Alisha Allana, Kellie Allen, Orlanda Allen, Natasha Amaradasa, Lareina Amarasekara, Freda Amoakwa-adu, Padmanabhan Anandageetha, Suresh Anandakrishnan, Rathai Anandanadesan, Michelle Anderson, Simon Apps, Audrey Aquilina, Gill Arbane, Alice Arch, Sarah Armstrong, Rita Arya, Gloria Ashiru, Keri Ashpole, Claire Atkinson, Francesca Atkinson, Elizabeth Auer, Ben Avery, Maite Babio-Galan, Hareth Bader, George Badham, Subha Bagchi, Sarah Bailey, Yolanda Baird, Cristina Balaka, Melissa Baldwin, Paul Balfour, Shreya Bali, Samantha Banks, Philip Barclay, Lucy Barnes, Thomas Barnes, Niraj Barot, Stephen Barrett, Venetia Barrett, Kate Barrett, Louise Bates, Katherine Batte, Beki Baytug, Mona Behravesh, Suzanne Bell, Raul Benloch, Richard Bentley, Jennifer Berg, Charlotte Berwick, Richard Berwick, Rashmi Bhadange, Sanjoy Bhattacharyya, Egidija Bielskute, Sian Birch, Scott Bird, Ruth Bird, William Birts, Becky Black, Tatyana Blagova, Holly Blake, Oliver Blightman, Susara Blunden, Richard Bolton, Caroline Borkett-Jones, John Boselli, Manuella Bowen, Ruth Bowen, James Bowye, Henry Boyle, Zameen Brar, Jo Bray, Samantha Brayshaw, Catherine Bressington, Alison Brewer, Naomi Brice, Laura Bridge, James Briscoe, Sonia Brocklesby, Harry Brown, Sarah Brown, Derek Brunnen, Keshavareddy Burijintichenna, Sara Burnard, Agnieszka Burtt, Victoria Buswell, Hannah Bykar, Matthew Cairney, Clare Calvert, Laura Camarasa, Natasha Campbell, Frederick Campbell-Jones, Jane Cantliffe, William Carrol, Joanna Carvalho, Catherine Cashell, Sarah Cassie, Kadu Cassim, Marika Chandler, Rachel Chapman, Robert Charles, Ping Chen, Deanne Cheyne, Kiran Chima, Floju Chin, Radu Chirvasuta, Martin Shao Chong, Sadia Choudhury, Priyakam Chowdhury, Tracey Christmas, Shilpa Chughwani, Sarah Ciechanowicz, Emma Clarey, Rob Coe, Jolyon Cohen, Nicholas Coker, Karen Collins, Lauren Collis, Jasna Comar, Marianne Conroy, Kathy Constantin, Jeremy Corfe, Elaine Coulborn, Vanessa Cowie, Rachel Crone, James Cronin, Jennifer Crooks, Nicola Crowther, Elizabeth Crowther, Carina Cruz, Alexa Curtis, Sarah Curtis, Sam Curtis, Adrian Dabrowicz, Nick Daines, Viral Dalal, Peter Dannatt, Dinesh Das, Jennifer Dash, Katherine Davidson, Sarah Davies, Yvette Davis, James Dawson, Jonathan Dean, Caroline Dean, Jane Denman, Neel Desai, Preeti Dewan, Sarah Dimont, Clare Donovan, Mano Doraiswami, Kate Doughty, Jamie Douglass, Michelle Dower, Samantha Downing, Wendy Duberry, Emily Duckham, Lucy Dudgeon, Stephanie Dukes, Leigh Dunn, Venkat Duraiswamy, Anthony O' Dwyer, Kristyn Dyer, Suresh Eapen, Mark Earl, Sally Eason, Kylie-Ellen Edwards, Zara Edwards, Osinachi Egole, John Ekpa, Olivia El-Amin, Kariem El-Boghdadly, Okba Elbasir, James Eldridge, Laura Elgie, Matt Ellington, Katharine Elliott, Justine Elliott, Mohamed Elmi, Ramy Elnoumeir, Eunice Emeakaraoha, Matt Evans, Mary Everett, Philippa Fabb, Hadia Farooq, Rohan Farrimond, Fiona Faulds, Erik Fawcett, Andrew Feneley, Dinushi Fernando, Janis Ferns, Claire Finlay, Simon Fitzgerald, Doireann O'Flaherty, Mark Fleet, Lydia Fletcher, Vanessa Fludder, Terri Follet, Jane Forbes, Mark Forth, Greg Foster, John Francis, Kate Fraser, Lauren Friedman, Luca Fruggeri, Laura Fulton, Sam Funnell, Amit Gadre, Ajay Gandhi, Harriet Gardiner, Zoe Garner, Gráinne Garvey, Tom Gately, Richard George, Siobhan Gillespie, Stephanie Glover, Jennifer Goddard, Ben Goodman, Tarikere Gopal, George Graham, David Green, Denise Griffin, Jessica Griffith, Stephanie Grigsby, Julie Grindey, Huw Griffiths, Jonathan Groome, Christine Grother, Gabrielle Grounds, Alice Groves, Abhik Guha, Amila Gunawardhana, Aman Gupta, Rekha Gupta, James Gutsell, Richard Haddon, Dina Hadi, Nicola Hadjipavlou, Henry Hammerbeck, Laura Hammon, Sarah Hammond, Hampesh Hampanna, Holly Hancock, Hemantha Handapangoda, Yumna Haroon-Mowahed, Dawn Harpham, Grant Harris, Abigail Harrison, Divya Harshan, Andrew Hartopp, Eoin Harty, Nick Haslam, Gemma Hawkins, Edith Hawkins, Sarah Hawksey, Carole Hays, Tracy Hazelton, Andrew Heavyside, Chibuzo Hemeson, Katrina Henderson, Oliver Henry, Lara Herbert, Nikki Higgins, James Hilton, Claire Hindmoor, Rachael Hitchcock, Laura Hobbs, Michele Homsy, Cassandra Honeywell, Nazima Hoque, Kirsty House, Ryan Howle, Amanda Tiller, Matthew Huniak, Jeremy Hunte, Tauqeer Husain, Coralie Huson, Catriona Hussain, Tawhida Hussain, Zainab Hussein, Jeremy Hyams, Eleanor Hyde, Marina Iaverdino, Alex Ignacka, Erin Innes, Stefanos Ioannidis, Rehana Iqbal, Fahja Ismail, Jenny Jackson, Michael Jackson, Guy Jackson, Robyn Jacobs, Poonam Jadhav, Aisha Jalaly, Lorraine James, Monica James, Surekha Jani, Chandran Jeganathan, Claire Joannides, Robert Johnson, Thosa Johnson, Carolyn Johnston, Reeanne Jones, Tom Jones, Miran Kadr, Rasmeet Kainth, Jenna Kane, Rafiq Kanji, Sunil Kannanparambil, Girish Kar, Theanalli Kasianandan, Husam Kaskos, Lisa Kavanagh, Richard Kaye, Leith Kelliher, Serena Kelliot, Jemma Kelly, Jenna Kelly, Carol Kenyon, Laura Kessack, Samuel Kestner, Mohammed Khaku, Sophia Khaleeq, Pervaz Khan, Sabeen Khan, Usamah Kidwai, Christopher King, Helen King, Elizabeth Kingston, Waisun Kok, Rebekka Konig, Zheyna Konstantinova, Priya Krishnan, Justin Kua, Kavitha Kuntumalla, Emira Kursumovic, Krzysztof Kurzatkowski, Hariprasad Kuttambakam, Katherine Lane, Sophie Lane, Andrew Langton, Hamad Latif, Norlan Lau, Shyam Laxman, Helen Laycock, Rachel Lee, Silvia Leonardi, Karen Light, Heidi Lightfoot, Shuang Liu, Sanduni Liyanage, Jessica Lowe, Nuala Lucas, Miyoba Lungu, Marianne Lunn, Heather Lynes, Kishore Machavarapu, Matthew Mackenzie, Jonathan Major, Victoria Male, Zain Malik, Katarina Manso, Myrna Maquinana, Katarzyna Marciniak, Lizzie Maronge, Chris Marsh, Carmela Martella, Nicki Martin, Nicole Martins, Jaspreet Marway, Louisa Mason, Lucy Mason, Nadia Masood, James Masters, Matthew Maton-Howarth, Francesca Mazzola, Tamsin McAllister, Rachel McCarthy, Claire McCormick, Sharon McCready, Steffan McDougall, Lorna Mcewan, Jon McGarry, Helen McKevitt, Stephanie Mckinley, Anna Mckskeane, Eloise McMaster, Martina McMonagle, Helen McNamara, Hannah McPhee, Laura McRae, Dee Mead, Emma Meadows, Madhur Mehta, Joanne Meikle, Yavor Metodiev, Chloe Michael, Victoria Millar, Sarah Miller, Gregg Miller, Sezanne Milne, Kostas Miltsios, Lucia Misquita, Simone Misquita, Manasi Mittal, Mohamed Mohamed, Katherine Powell Monaghan, Joanna Monk, Alexandra Monkhouse, David Monks, Laura Montague, Angela Moon, Jennifer Moran, Annette Moreton, Endaf Morgan, Oliver Morgan, Danny Morland, Monica Morosan, Kimberley Morris, Andrea Morris, Clare Moser, Manulella Mount, Carol Muir, McDonald Mupudzi, Mayur Murali, Iona Murdoch, Heather Murray, Theresa Murray, Karen Murrell, Girish Narasimha Murthy, Diana Neeley, Hannah Nei, Kerry Neil, Tara Nejim, Mark Nel, Anne Nicholson, Angela Nicklin, Catherine Nolan, Tracey Nolan, Eveliina Nurmi, Bridie O'Neill, Christie Oakes, Neil Oakes, Maria Ochoa-Ferraro, Nike Odeleye, Katy Oliver, Mark Oliver, Julie Onslow, Desire Onwochei, Thomas Oommen, Tim Orr, Osato Osagie, Hannah Osborn, Jennie Overend, Hazel Owston, Emma Pack, Pulak Padhi, Prabvathy Palani, Rajesh Pandey, Dhruti Pandya, Navjot Panesar, Con Papageorgiou, Georgios Papanastasiou, Costas Papoutsos, Suji Pararajasingham, James Parry, Hasita Patel, Jaishel Patel, Jiten Patel, Kaumudi Patel, Kiran Patel, Mitul Patel, Reshma Patel, Ruchira Patel, Nimisha Patel, Sangeeta Pathak, Fiona Pearson, Viktorija Peciulene, Beth Peers, Benjamin Peirce, Stacey Pepper, Jasmina Perinpanayagam, Hollie Perry, Nadya Petrova, Trudie Phillips, Sioned Phillips, Leonidas Phylactides, Felicity Pilkington, James Plumb, Evangelia Poimenidi, Anna Sau Kuk Poon, Thomas Potter, Una Poultney, Lucy Powell, Andrew Prenter, Katie Preston, Anna Price, Naomi Pritchard, Jenny Pullen, Manishi Purohit, Charlotte Quamina, Jibran Qureshi, Zahra Rajput, Stephen Ramage, Tamilselvi Ramanathan, Upeka Ranasinghe, Kalum Ranatunga, Abby Rand, Seema Randive, Desikan Rangarajan, Chandana Rao, Sambasiva Rao Pelluri, Antony Ratnasingham, Jamil Razzaque, Anuvidya Reddy, Katie Redington, Emma Reel, Peter Remeta, Francesca Ricco, Anna Riccoboni, Polly Rice, Mel Rich, Nicole Richards, Joanne Riches, Simon Ripoll, Fleur Roberts, Kitty Roberts, Kay Robins, Susie Robinson, Samantha Roche, Maria Rojo, Milena Carmela Romano, Hilary Rosser, Lindsay Roughley, Catriona Routley, Christine Rowley, Pallab Rudra, Robin Russell, Christine Ryan, Chloe Saad, Abtin Sadeghi, Armorel Salberg, Matt Samuel, Rebecca Samuels, Suresh Sanapala, Seliat Sanusi, Sarbpreet Sarao, Sathyabhama Sathyabhama, Zoe Saunders, Bernadetta Sawarzynska-ryszka, Panagiota Sceales, Penny Sceales, Natasha Schumacher, Nuala Schwartz, Claudia Sellers, Heather Sellers, Jessica Sellick, Soumen Sen, Dhaneesha Senaratne, Sarah Senbeto, Dineth Seneviratna, Thunga Setty, Raj Shah, Sonia Shah, James Shambly, Saju Sharafudeen. Imran Sharieff, Laurence Sharifi, Lisa Sharpe, Michael Shaw, Ian Sheldrake, Priya Shinde, Adam Shonfeld. Jonathon Short, Julian Siah, Sheena Sibug. Omar Siddique, Sara Siew, Matthew Simpson, Georgina Singleton, Kathryn Sinha, Aneeta Sinha, Matthew Sinnott, Harry Sivadhas, Sivanth Sivakumar, Boopathi Sivarajan, Sinduja Sivarajan, Chris Skeoch, Samuel Slade, Paul Slater, Camilla Smith, Carys Smith, Christopher Smith, James Smith, Lorraine Smith, Annika Smith, Edward Smith, Ruth Smith, Sue Smith, Tim Smith, Helen Smithers, Sue Smolen, Claire Smyth, Toni Snel, Carol Snipe, Sam Soltanifar, Nilesh Sonawane, Andal Soundararaja, Emily Spence, Mark Spiliopoulos, Chhavi Srivastava, Karen Stacey, Helena Stafford, Nikki Staines, Richard Stead, Emma Stevens, Alex Stilwell, Gary Stocks, Aaron Stokes, Christopher Stone, Ben Straughan, Vanitha Subbarathnam, Srinath Sudunagunta, Pervez Sultan, Puvan Suppiah, Priyanka Surve, Angus Sutherland, Rob Swanton, Claire Swarbrick, Amy Swinson, Eleni Syrrakou, Shahrzad Tadbiri, Preetam Tamhane, Perumal Tamilselvan, Andrew Tan, Shamil Tanna, Hayley Tarft, Laura Tarry, Ian Taylor, Suzanne Taylor, Julie Tebbot, Svetlana Theron, Megan Thomas, Sarah Todd, Hermione Tolliday, Charlotte Topham, Nicholas Tovell, Martyn Traves, Dawn Trodd, Aseem Tufchi, Katie Turley, Marc Turnbull, Chris Turnbull, Oliver Turner, William Turner, Sharon Turney, Eleanor Tyagi, David Uncles, Vanessa Unsworth, Pradnya Vadnere, Rama Varadan, Vik Vasishta, Andrew Veal, Lalitha Vedham, Jessica Venkaya, Miriam Verghese, Icel Veronica, Dinesh Vidanagamage, Rachel Vincent, Vinodhan Vyapury, Harris Wain, Fiona Walbridge, Elaine Walker, Pete Walsh, Eleanor Walshe, Michelle Walters, Yize Wan, Cherry Wang, Kavita Wankhade, Gareth Waters, Christopher Watts, Alex Webber, Tom Wedgwood, Michael Wee, Susan Wellstead, Alison White, Michael Whitear, Lucy Whitefield, Sarah Wilkinson, Lauren Williams, Rhys Williams, Dawn Wilson, Samantha Wilson, Katie Wimble, Elaine Winkley, Luke Winslow, Paul Winwright, Karolina Wloch, Gideon Wong, Hannah Wong, Jan Man Wong, Tim Wood, Sarah Wray, Ian Wrench, James Wu, Kynn Wynn, Yeng Yap, Chia Kuan Yeow, Emily Young, Alex Yusaf, Saeed Uz Zafar, Darius Zeinali, Sheldon Zhang, Sarvesh Zope, Liana Zucco, Sibtain Anwar, Nadia Blunt, John Cronin, Vimal Grover, Kate Grailey, Martin Grey, David Highton, Phil Hopkins, Harriet Kemp, Queenie Lo, Daniel Martin, Clare Morkane, James O'Carroll, Charles Oliver, Benjamin Post, Anil Visram, and Alex Wickham

Subjects
Adult, One year follow up, Trial protocol, Guidelines as Topic, Anesthesia, General, Intraoperative Awareness, Cohort Studies, Interviews as Topic, 03 medical and health sciences, 0302 clinical medicine, 030202 anesthesiology, Anesthesia, Obstetrical, Humans, Medicine, General anaesthesia, Prospective Studies, 030219 obstetrics & reproductive medicine, business.industry, Obstetrics and Gynecology, medicine.disease, United Kingdom, Anesthesiology and Pain Medicine, Accidental, Cohort, Structured interview, Female, Medical emergency, business, Surgical patients, Cohort study
Abstract

Background Accidental awareness during general anaesthesia (AAGA) is a complex and rare outcome to investigate in surgical patient populations, particularly obstetric patients. We report the protocol of the Direct Reporting of Awareness in Maternity patients (DREAMY) study, illustrating how the research was designed to address practical and methodological challenges for investigating AAGA in an obstetric cohort. Methods This is the trial protocol of a prospective, multicentre cohort study of patients undergoing obstetric surgery under general anaesthesia. Accidental awareness during general anaesthesia will be detected using three repetitions of standardised direct questioning over 30 days, with responses indicating memories during general anaesthesia verified using structured interviews. Reports will be adjudicated, then classified, in accordance with pre-defined and pre-validated structures, including the Michigan Awareness Classification tool. Quantitative data will be collected on general anaesthesia conduct for all participants. This descriptive study is being conducted in England and aims to recruit a minimum of 2015 patients. Results The DREAMY study was prospectively registered (ClinicalTrials.gov Identifier: NCT03100396) and ethical approval granted. Participant recruitment began in May 2017 and one year follow up concluded in August 2019. Publication of the results is anticipated in 2020. Conclusions The DREAMY study will provide data on incidence, experience and implications of AAGA for obstetric patients, using a robust methodology that will reliably detect and translate subjective AAGA reports into objective outcomes. In addition, the study is expected to improve vigilance for AAGA in participating hospitals and encourage adoption of recommendations for support of patients experiencing AAGA.

Published
2020

4. A wolf in sheep's clothing: systemic immune activation post immunotherapy

Author

Udai Banerji, Juanita Lopez, Abhijit Pal, Kate Tatham, A. Biondo, Anna Minchom, Johann S. de Bono, Emma Nicholson, Rajiv Shinde, Alex Lee, Crescens Tiu, Vimal Grover, Shaman Jhanji, Nina Tunariu, and Pascale Gruber

Subjects
Cancer Research, business.industry, medicine.medical_treatment, Immunology, fungi, Immunotherapy, Clothing, Oncology, Immunology and Allergy, Medicine, business, hormones, hormone substitutes, and hormone antagonists, Immune activation
Abstract

Introduction Immune checkpoint inhibitors (ICIs) are increasingly a standard of care for many cancers; these agents can result in immune-related adverse events (irAEs) including fever, which is common but can rarely be associated with systemic immune activation (SIA or acquired HLH). Methods All consecutive patients receiving ICIs in the Drug Development Unit of the Royal Marsden Hospital between May 2014 and November 2019 were retrospectively reviewed. Patients with fever ≥ 38°C or chills/rigors (without fever) ≤ 6 weeks of commencing ICIs were identified for clinical data collection. Results Three patients met diagnostic criteria for SIA/HLH with median time to onset of symptoms of 10 days. We describe the clinical evolution, treatment used, and outcomes for these patients. High-dose steroids are used first-line with other treatments, such as tocilizumab, immunoglobulin and therapeutic plasmapheresis can be considered for steroid-refractory SIA/HLH. Conclusion SIA/HLH post ICI is a rare but a potentially fatal irAE that presents with fever and a constellation of nonspecific symptoms. Early recognition and timely treatment are key to improving outcomes.

Published
2021

5. Creation of a multidisciplinary team electronic audit database: a service improvement project

Author

Pranev Sharma and Vimal Grover

Subjects
Surgical critical care, ComputingMilieux_MANAGEMENTOFCOMPUTINGANDINFORMATIONSYSTEMS, Database, Interview, Business, Audit, Audit and Data Systems, Service improvement, Multidisciplinary team, computer.software_genre, computer, Unit (housing)
Abstract

To compile a central audit database, conducted by different multidisciplinary team members on a mixed medical and surgical critical care unit, in order to improve both record-keeping and trainee awareness of current and past audit projects. Data on audits conducted on the unit over the last 2 years (2012–13) were collected by interviewing key staff members from the various …

Published
2019

6. Advanced Critical Care Practitioners – Practical experience of implementing the Advanced Critical Care Practitioner Faculty of Intensive Care Medicine Curriculum in a London Critical Care Unit

Author

Jo-Anne Gilroy, Alistair Ritchie, Keetje Gull, Pascale Gruber, Vimal Grover, and Geraldine Lee

Subjects
medicine.medical_specialty, education, Economic shortage, Critical Care and Intensive Care Medicine, Critical Care Nursing, Patient care, law.invention, 03 medical and health sciences, 0302 clinical medicine, Nursing, law, Intensive care, Health care, medicine, Advanced practice, 030212 general & internal medicine, Single institution, Intensive care medicine, Curriculum, 030504 nursing, business.industry, Intensive care unit, critical care, Workforce, Special Articles, 0305 other medical science, business
Abstract

With a chronic shortage of doctors in intensive care, alternative roles are being explored. One of these is the role of the Advanced Critical Care Practitioner. The Advanced Critical Care Practitioner Curriculum was developed by the Faculty of Intensive Care Medicine and is used to provide a structured programme of training. The Advanced Critical Care Practitioner programme consists of an academic and clinical component. This article outlines a practical approach of how the programme was developed and is currently being delivered at a single institution. This new advanced practice role offers opportunities to fill gaps in the medical workforce, improve continuity of patient care, provide mentoring and training for less experienced staff as well as offering a rewarding clinical role.

Published
2018

7. Viral Hepatitis

Author

Vimal Grover and Richard Keays

Subjects
Anesthesiology and Pain Medicine, Critical Care and Intensive Care Medicine
Published
2011

8. Gonadoblastoma-Dysgerminoma in Streak Ovaries in a 46 XY Individual

Author

Vimal Grover, Sudeshna Deb Burman, Kali Rama Devi, Subhash K. Gupta, and Kamala Dhall

Subjects
Adult, Male, Ovarian Neoplasms, Gynecology, medicine.medical_specialty, Hormonal activity, Pathology, Streak, Obstetrics and Gynecology, Gonadoblastoma, Dysgerminoma, Biology, Gonadal Dysgenesis, Y chromosome, medicine.disease, Ovarian tumor, Y Chromosome, medicine, Humans, Female
Abstract

A case of bilateral gonadoblastoma overgrown with dysgermi-noma on one side in streak ovaries in a phenotypic female with a chromosomal XY pattern has been presented. The neoplastic potential of dysgenetic gonads in an individual with a Y chromosome has been reviewed and the need therefore for complete bilateral gonadectomy in such cases has been stressed upon. The hormonal activity of these tumors has also been discussed.

Published
2010

9. Viral hepatitis and transmissible spongiform encephalopathies

Author

R. Keays and Vimal Grover

Subjects
medicine.medical_specialty, Iatrogenic transmission, Cirrhosis, business.industry, Transmission (medicine), medicine.medical_treatment, Liver transplantation, Critical Care and Intensive Care Medicine, medicine.disease, Anesthesiology and Pain Medicine, Hepatocellular carcinoma, Immunology, Medicine, Fatal disease, Prion Proteins, business, Intensive care medicine, Viral hepatitis
Abstract

Here, we provide an overview of viral hepatitis, the risks of transmission and new developments in the treatment of infected individuals. Acute hepatitis is a potentially fatal disease and, when not fatal, can lead to a chronic viral carrier status with the attendant risks of cirrhosis and hepatocellular carcinoma. Liver transplantation is often the only hope for survival, but advances in antiviral therapies are improving the outlook for those with chronic viral hepatitis. There are challenges to the anaesthetist who necessarily undertakes invasive procedures in such patients and may need to anesthetize them at any stage of their illness. There are complications relevant to intensive care management, and safety measures that clinicians need to adopt in the clinical environment. The majority of infectious agents, including the hepatitides, contain either DNA or RNA. In recent years, however, prion proteins have emerged as novel transmissible agents, lacking in nucleic acids. Transmissible spongiform encephalopathies are rare but, owing to the durability of prions, the associated mortality and the potential for iatrogenic transmission, significant changes to medical practice have ensued.

Published
2010

10. Immune cell expression of GABAA receptors and the effects of diazepam on influenza infection

Author

John Goulding, Mervyn Maze, Tracy Hussell, Stefan Gurney, Alexandra Godlee, Vimal Grover, Suveer Singh, Daqing Ma, Robert J. Snelgrove, and Robert D. Sanders

Subjects
Time Factors, Neutrophils, Cell, Lipopolysaccharide Receptors, Inbred C57BL, Monocytes, Mice, GABA, Receptors, Immunology and Allergy, 2.2 Factors relating to the physical environment, 2.1 Biological and endogenous factors, Aetiology, Receptor, Lung, Benzodiazepine, GABAA receptor, Orthomyxoviridae, medicine.anatomical_structure, Infectious Diseases, Neurology, Pneumonia & Influenza, Female, Infection, Viral load, Human, medicine.drug_class, Immunology, Biology, Alveolar, Vaccine Related, Immune system, Biodefense, Influenza, Human, Macrophages, Alveolar, medicine, Animals, Humans, GABA Modulators, Diazepam, Neurology & Neurosurgery, Animal, GABA-A, Macrophages, Prevention, Body Weight, Neurosciences, Receptors, GABA-A, Influenza, Mice, Inbred C57BL, Immune, Disease Models, Animal, Emerging Infectious Diseases, Gene Expression Regulation, Disease Models, Alveolar macrophage, Leukocyte Common Antigens, Neurology (clinical), CD8
Abstract

Benzodiazepines increase vulnerability to infection through α1 subunit dependent Υ-amino-butyric-type-A (GABAA) signalling. Immune cell expression of GABAA receptors and the effect of diazepam on influenza infection was investigated. In patients with pneumonia, α1 GABAA subunits were expressed on alveolar macrophages and blood monocytes. In mice, influenza induced dynamic changes in immune cell GABAA subunit expression: α1 subunits decreased on alveolar macrophage, but increased on monocytes, CD4+ and CD8+ T cells. Following influenza viral infection, diazepam delayed weight loss on day 3 but later increased weight loss. Viral load was unaffected but increased bacterial superinfection was noted on day 10.

Published
2015

11. Management of cyclical menorrhagia with prostaglandin synthetase inhibitor

Author

S. Kalra, Vimal Grover, R. Usha, and Usha Gupta

Subjects
Adult, medicine.medical_specialty, Mefenamic acid, Prostaglandin, Placebo, Gastroenterology, Double blind, chemistry.chemical_compound, Mefenamic Acid, Secretory endometrium, Double-Blind Method, Internal medicine, medicine, Humans, Prospective Studies, Menorrhagia, business.industry, Obstetrics and Gynecology, Middle Aged, female genital diseases and pregnancy complications, Surgery, Menstruation, chemistry, Prospective trial, Female, business, After treatment, medicine.drug
Abstract

A well controlled double blind prospective trial was undertaken to determine the efficacy of mefenamic acid in the treatment of menorrhagia. Eighty patients who had unexplained cyclical menorrhagia with secretory endometrium received mefenamic acid orally in a dose of 500 mg 8 hourly or a placebo tablet thrice daily starting from day-one of the cycle for 5 days or till cessation of menses. Mefenamic acid administration caused a statistically significant reduction in the number of days of bleeding from 9.7 +/- 3.1 days before treatment to 4.1 +/- 0.6 days after treatment. It also brought about significant reduction in the amount of bleeding in terms of number of pads used per day, that is from 15.2 +/- 3.1 before treatment to 6.5 +/- 0.02 after treatment. Eighty-six percent patients in the treatment group had control of menorrhagia with the drug compared to 20% in the control group without drugs and this difference was statistically significant. Mefenamic acid proved to be a potent and efficacious agent in the control of unexplained menorrhagia.

Published
1990

12. Childbirth following primary cesarean section - evaluation of a scoring system

Author

Kamala Dhall, G.I. Dhall, Vimal Grover, and S. C. Mittal

Subjects
Reoperation, Risk, medicine.medical_specialty, Section (typography), Fetal Distress, Pregnancy, Infant Mortality, Surgical Wound Dehiscence, medicine, Humans, Childbirth, reproductive and urinary physiology, Gynecology, Labor, Obstetric, Cesarean Section, Vaginal delivery, business.industry, Wound dehiscence, Incidence (epidemiology), Obstetrics and Gynecology, General Medicine, medicine.disease, female genital diseases and pregnancy complications, Infant mortality, Obstetric Labor Complications, surgical procedures, operative, Gestation, Female, business
Abstract

Of 1184 cases with previous cesarean section, 590 were selected for trial of vaginal delivery and 594 for repeat cesarean section. Of the former group, 76.6% had successful vaginal delivery. Incidence of uterine wound dehiscence and of perinatal mortality was highest in cases with primary classical cesarean section. Factors like indications for previous cesarean section, history of intercurrent vaginal delivery, weight of baby and period of gestation had positive correlation with delivery outcome.

Published
1987

13. Problems of Rudimentary Horn Pregnancy

Author

Kamala Dhall, G.I. Dhall, M. Dogra, and Vimal Grover

Subjects
Adult, Gynecology, Fetus, Pregnancy, medicine.medical_specialty, Ectopic pregnancy, business.industry, Obstetrics, Uterus, Obstetrics and Gynecology, medicine.disease, Rudimentary horn pregnancy, Pregnancy, Ectopic, Intrauterine death, Reproductive Medicine, medicine, Humans, Female, Labor, Induced, RUPTURED ECTOPIC PREGNANCY, business, Fetal Death
Abstract

Five cases of rudimentary horn pregnancy are discussed. Two presented as acute ruptured ectopic pregnancy, whereas in 3 the pregnancy was advanced and intact with intrauterine death of the fetuses. The diagnostic difficulties are discussed and in centres where ultrasound facilities are not available, a high index of suspicion in nonresponders to oxytocin induction is emphasized.

Published
1986

14. Etiological aspects of ectopic pregnancy in nulliparous women

Author

G.I. Dhall, S. C. Mittal, Kamala Dhall, and Vimal Grover

Subjects
Adult, Pregnancy, medicine.medical_specialty, Ectopic pregnancy, Obstetrics, business.industry, Endometriosis, Obstetrics and Gynecology, Retrospective cohort study, medicine.disease, Pregnancy, Ectopic, Parity, Etiology, medicine, Retrospective analysis, Humans, Female, business, Fallopian Tubes, Pelvic Inflammatory Disease, Retrospective Studies
Abstract

This presentation gives retrospective analysis of 47 cases of ectopic pregnancy in nulliparous women, admitted in the Gynaecological Emergency services of Nehru Hospital attached to the Postgraduate Institute of Medical Education and Research, Chandigarh. Etiological factors leading to ectopic pregnancy in these patients have been presented. Tubal damage in young patients as a result of ascending infections possibly due to sexually transmitted diseases have been discussed. Preventive measures for reducing the incidence of ectopic pregnancy have been emphasized.

Published
1986

15. Culdocentesis in Tubal Pregnancy

Author

S. C. Mittal, Vimal Grover, Kamala Dhall, G.I. Dhall, and A. N. Gupta

Subjects
medicine.medical_specialty, animal structures, Tubal Pregnancies, medicine.medical_treatment, Punctures, Culdocentesis, Pregnancy, Laparotomy, medicine, Humans, reproductive and urinary physiology, Gynecology, medicine.diagnostic_test, Ectopic pregnancy, urogenital system, business.industry, Obstetrics, Obstetrics and Gynecology, General Medicine, medicine.disease, Tubal Abortions, female genital diseases and pregnancy complications, Female, Pregnancy, Tubal, business
Abstract

Summary: Culdocentesis was carried out in 92 suspected cases of ectopic pregnancy and was positive in 90%. Laparotomy confirmed the accuracy of culdocentesis in 97.5% of the cases of acute tubal rupture, 87.5% of tubal abortions and 80% of ‘intact’ tubal pregnancies.

Published
1985

Catalog

Books, media, physical & digital resources
See catalog results