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2.
Anaesthesia ; 77(2): 143-152, 2022 02.
Article in English | MEDLINE | ID: mdl-34542168

ABSTRACT

Pulse oximetry is used widely to titrate oxygen therapy and for triage in patients who are critically ill. However, there are concerns regarding the accuracy of pulse oximetry in patients with COVID-19 pneumonitis and in patients who have a greater degree of skin pigmentation. We aimed to determine the impact of patient ethnicity on the accuracy of peripheral pulse oximetry in patients who were critically ill with COVID-19 pneumonitis by conducting a retrospective observational study comparing paired measurements of arterial oxygen saturation measured by co-oximetry on arterial blood gas analysis (SaO2 ) and the corresponding peripheral oxygenation saturation measured by pulse oximetry (Sp O2 ). Bias was calculated as the mean difference between SaO2 and Sp O2 measurements and limits of agreement were calculated as bias ±1.96 SD. Data from 194 patients (135 White ethnic origin, 34 Asian ethnic origin, 19 Black ethnic origin and 6 other ethnic origin) were analysed consisting of 6216 paired SaO2 and Sp O2 measurements. Bias (limits of agreement) between SaO2 and Sp O2 measurements was 0.05% (-2.21-2.30). Patient ethnicity did not alter this to a clinically significant degree: 0.28% (1.79-2.35), -0.33% (-2.47-2.35) and -0.75% (-3.47-1.97) for patients of White, Asian and Black ethnic origin, respectively. In patients with COVID-19 pneumonitis, Sp O2 measurements showed a level of agreement with SaO2 values that was in line with previous work, and this was not affected by patient ethnicity.


Subject(s)
COVID-19/physiopathology , Ethnicity/statistics & numerical data , Oximetry/methods , Oximetry/standards , Oxygen Saturation/physiology , COVID-19/therapy , Critical Care/methods , Female , Humans , Male , Middle Aged , Oxygen Inhalation Therapy/methods , Reproducibility of Results , Retrospective Studies , SARS-CoV-2
3.
Anaesthesia ; 72(12): 1528-1531, 2017 Dec.
Article in English | MEDLINE | ID: mdl-29130275

ABSTRACT

The aim of this study was to investigate the relationship between nursing staff emotions and their surrounding environment, using the ancient system of feng shui. Two orientations of critical care bed spaces (wind and water groups, respectively) were mapped using a western bagua. Energy or 'chi' scores for nine emotions were calculated based on the positive or negative flow of chi in each of the two groups. During a two-week period, nursing staff were allocated to work in a bed space in either the wind or water groups; nursing staff who were not allocated to a study bed space acted as a control group. Participating nursing staff completed a questionnaire, ranking nine emotional states and their overall inner harmony, using a 11-point chi scale. In total, 108 questionnaires were completed. Critical bed space orientation according to feng shui principles was not related to nurse-reported chi scores or inner harmony (p > 0.05 for all measurements). There was also poor correlation between the bagua-predicted and reported chi scores for both the wind and water groups (R2  = 0.338 and 0.093, respectively). The use of feng shui to guide the layout of critical care bed spaces does not improve the emotional well-being of nursing staff.


Subject(s)
Attitude of Health Personnel , Emotions , Intensive Care Units , Interior Design and Furnishings/methods , Nursing Staff, Hospital/psychology , Critical Care Nursing , Humans , Nursing Staff, Hospital/statistics & numerical data , Surveys and Questionnaires
4.
Anaesthesia ; 71(1): 58-66, 2016 Jan.
Article in English | MEDLINE | ID: mdl-26526934

ABSTRACT

Large-scale audit and research projects demand robust, efficient systems for accurate data collection, handling and analysis. We utilised a multiplatform 'bring your own device' (BYOD) electronic data collection app to capture observational audit data on theatre efficiency across seven hospital Trusts in South Yorkshire in June-August 2013. None of the participating hospitals had a dedicated information governance policy for bring your own device. Data were collected by 17 investigators for 392 individual theatre lists, capturing 14,148 individual data points, 12, 852 (91%) of which were transmitted to a central database on the day of collection without any loss of data. BYOD technology enabled accurate collection of a large volume of secure data across multiple NHS organisations over a short period of time. Bring your own device technology provides a method for collecting real-time audit, research and quality improvement data within healthcare systems without compromising patient data protection.


Subject(s)
Biomedical Research , Computer Security , Data Collection/methods , Medical Audit/methods , Feasibility Studies , Humans
6.
J Cancer Res Clin Oncol ; 135(3): 477-84, 2009 Mar.
Article in English | MEDLINE | ID: mdl-18802723

ABSTRACT

PURPOSE: More intensive and novel therapy options in multiple myeloma (MM) hold the promise to improve treatment outcome. However, disease evolution, induced with long disease duration and extensive pretreatment, has resulted in changes in the biological behaviour of MM and unusual relapse emergence, such as of extramedullary (EM) disease or a shift in secretion from intact immunoglobulin (Ig) to free-light chains (FLCs) only. METHODS: We studied ten patients since 2004, thoroughly assessed relevant patient characteristics, prominent similarities, SFLC-changes, therapy response, mode and speed of progression, and the incidence of light-chain escape (LCE)-MM within our entire myeloma patient cohort. Serum FLCs (SFLCs) were determined via Freelite-assay (Dade-Behringer Nephelometer). RESULTS: This report summarizes the to date largest series of ten patients, whose MM appeared stable, as judged by conventional monitoring of intact Ig levels, but developed severe organ dysfunction as a consequence of initially undetected LC-progression. Median number of anti-MM cycles before LCE occurrence was six, including autologous and/or allogeneic stem cell transplants and novel drugs, predominantly thalidomide, in 4/10. Classic diagnostics, such as electrophoresis and quantitative Ig measurement proved futile to detect LC-progression, whereas SFLCs were reliable markers. The LCE-MM prevalence within 407 MM patients treated in our institution between 2004 and 2007 was 2.46%. CONCLUSIONS: Our report suggests that early detection of LCE-MM by means of serial SFLC measurements may prevent unnecessary complications, allows to detect unusual relapse manifestations in the era of intensive and biological therapy options and possibly also permits to improve treatment results in LCE-MM.


Subject(s)
Immunoglobulin Light Chains/immunology , Multiple Myeloma/drug therapy , Multiple Myeloma/immunology , Adult , Aged , Bone Marrow/pathology , Female , Humans , Immunoglobulin A/immunology , Immunoglobulin G/immunology , Immunoglobulin kappa-Chains/immunology , Immunoglobulin lambda-Chains/immunology , Male , Middle Aged , Multiple Myeloma/pathology , Neoplasm Staging
7.
Ann Oncol ; 18(5): 950-8, 2007 May.
Article in English | MEDLINE | ID: mdl-17351260

ABSTRACT

BACKGROUND: Renal impairment (RI) has been shown to be one major risk factor in a number of diseases and is associated with a dismal clinical outcome. However, the influence of milder degrees of renal disease is less well defined, particularly not in patients with malignant diseases. PATIENTS AND METHODS: We analyzed 167 patients with solid tumors and hematological malignancies. Besides disease-specific parameters, serum creatinine, cystatin C and the estimated glomerular filtration rate (eGFR) ['modification of diet in renal disease' equation (MDRD)/Cockcroft-Gault (CG)] were determined. Patients were compared within eGFR, creatinine and cystatin C groups. RESULTS: The median MDRD, CG, creatinine and cystatin C levels of all patients were 88 ml/min/1.73 m2, 89 ml/min, 1 mg/dl and 0.9 mg/l, respectively. Patients with chronic kidney disease stage 2 still showed normal creatinine and cystatin levels of 1 mg/dl and 1.1 mg/l, respectively, although mild RI was frequent. Those cancer patients with decreased eGFR (MDRD) (<60 ml/min/1.73 m2) had increased odds ratios (ORs) to have more concurrent diagnoses [OR 3.4; 95% confidence interval (CI) 1.5-8.1], a body mass index >24 kg/m2 (OR 2.1; 95% CI 1.0-4.5) and an elevated (> 245 pg/ml) pro-brain natriuretic peptide level (proBNP) (OR 9.2; 95% CI 3.0-28.3). CONCLUSIONS: These observations suggest that grouping cancer patients according to renal function, especially eGFR, may be one way to determine specific risk groups.


Subject(s)
Glomerular Filtration Rate/physiology , Hematologic Neoplasms/pathology , Kidney Diseases/physiopathology , Monitoring, Physiologic , Neoplasms/pathology , Adolescent , Adult , Aged , Aged, 80 and over , Biomarkers/blood , Body Mass Index , Chronic Disease , Creatinine/blood , Cystatin C , Cystatins/blood , Female , Humans , Kidney Diseases/classification , Kidney Diseases/therapy , Kidney Function Tests , Male , Middle Aged , Natriuretic Peptide, Brain/blood , Neoplasms/classification , Protein Precursors/blood
9.
Gut ; 55(5): 719-27, 2006 May.
Article in English | MEDLINE | ID: mdl-16322111

ABSTRACT

BACKGROUND: Bile acid induced apoptosis in hepatocytes can be antagonised by nuclear factor kappaB (NFkappaB) dependent survival pathways. Sulfasalazine modulates NFkappaB in different cell types. We aimed to determine the effects of sulfasalazine and its metabolites sulfapyridine and 5-aminosalicylic acid (5-ASA) on bile acid induced apoptosis in hepatocytes. METHODS: Apoptosis was determined by caspase assays and immunoblotting, NFkappaB activation by electrophoretic mobility shift assay and reporter gene assays, generation of reactive oxygen species (ROS) fluorometrically, bile secretion gravimetrically, and bile acid uptake radiochemically and by gas chromatography in HepG2-Ntcp cells and isolated perfused rat livers. RESULTS: Glycochenodeoxycholic acid (GCDCA 75 micromol/l) induced apoptosis was reduced by sulfasalazine dose dependently (1-1000 micromol/l) in HepG2-Ntcp cells whereas its metabolites 5-ASA and sulfapyridine had no effect. Sulfasalazine significantly reduced GCDCA induced activation of caspases 9 and 3. In addition, sulfasalazine activated NFkappaB and decreased GCDCA induced generation of ROS. Bile acid uptake was competitively inhibited by sulfasalazine. In perfused rat livers, GCDCA (25 micromol/l) induced liver injury and extensive hepatocyte apoptosis were significantly reduced by simultaneous administration of 100 micromol/l sulfasalazine: lactate dehydrogenase and glutamate-pyruvate transaminase activities were reduced by 82% and 87%, respectively, and apoptotic hepatocytes were observed only occasionally. GCDCA uptake was reduced by 45 (5)% when sulfasalazine was coadministered. However, when 50% of GCDCA (12.5 micromol/l) was administered alone, marked hepatocyte apoptosis and liver injury were again observed, questioning the impact of reduced GCDCA uptake for the antiapoptotic effect of sulfasalazine. CONCLUSION: Sulfasalazine is a potent inhibitor of GCDCA induced hepatocyte apoptosis in vitro and in the intact liver.


Subject(s)
Anti-Inflammatory Agents, Non-Steroidal/pharmacology , Glycochenodeoxycholic Acid/pharmacology , Hepatocytes/pathology , Sulfasalazine/pharmacology , Animals , Anti-Inflammatory Agents, Non-Steroidal/metabolism , Apoptosis/drug effects , Caspase 3 , Caspase 9 , Caspases/metabolism , Cell Line, Tumor , Depression, Chemical , Dose-Response Relationship, Drug , Fluorescent Antibody Technique , Hepatocytes/drug effects , Hepatocytes/metabolism , Humans , Liver/drug effects , Liver/metabolism , Liver/pathology , Male , Mesalamine/pharmacology , NF-kappa B/metabolism , Perfusion , Rats , Rats, Sprague-Dawley , Sulfapyridine/pharmacology , Sulfasalazine/metabolism
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