3,484 research outputs found
Peter Walsh, double bass, February 17, 2018
Full text linkThis is the concert program of the Peter Walsh, double bass performance on Saturday, February 17, 2018 at 4:30 p.m., at the Marshall Room, 855 Commonwealth Avenue. Works performed were Arpeggione Sonata by Franz Schubert, S. Biagio 9 Agnosto ore 1207 by Hans Werner Henze, and String Quartet No. 2 by Anton Arensky. Digitization for Boston University Concert Programs was supported by the Boston University Humanities Library Endowed Fund
Red cell transfusion triggers in critically ill patients:time for some new TRICCs?
No full textCurrent evidence suggests that critically ill patients tolerate anaemia well and that blood transfusions may increase the risk of adverse outcomes. Dr Sakr and colleagues present a contradictory analysis of a surgical ICU cohort, finding an association between blood transfusions and lower hospital mortality after adjustment for a range of potential confounders. Analyses of this kind are interesting and provocative, but are limited by residual confounding and bias by indication. The data emphasise the need for additional high quality trials of transfusion practice in critical care
INC900099 Supplemental Material - Supplemental material for Community prescribing of potentially nephrotoxic drugs and risk of acute kidney injury requiring renal replacement therapy in critically ill adults: A national cohort study
No full textSupplemental material, INC900099 Supplemental Material for Community prescribing of potentially nephrotoxic drugs and risk of acute kidney injury requiring renal replacement therapy in critically ill adults: A national cohort study by Steven Tominey, Alan Timmins, Robert Lee, Timothy S Walsh and Nazir I Lone in Journal of the Intensive Care Society</p
Supplemental material for The association between ICU admission and emergency hospital readmission following emergency general surgery
No full textSupplemental Material for The association between ICU admission and emergency hospital readmission following emergency general surgery by Michael A Gillies, Sadia Ghaffar, Ewen Harrison, Catriona Haddow, Lorraine Smyth, Timothy S Walsh, Rupert M Pearse and Nazir I Lone in Journal of the Intensive Care Society</p
A Natural History Study of Timothy Syndrome
No full textAbstract Background Timothy syndrome (OMIM #601005) is a rare disease caused by variants in the gene CACNA1C. Initially, Timothy syndrome was characterized by a cardiac presentation of long QT syndrome and syndactyly of the fingers and/or toes, all associated with the CACNA1C variant, Gly406Arg. However, subsequent identification of diverse variants in CACNA1C has expanded the clinical spectrum, revealing various cardiac and extra-cardiac manifestations. It remains underexplored whether individuals with the canonical Gly406Arg variants in mutually exclusive exon 8A (Timothy syndrome 1) or exon 8 (Timothy syndrome 2) exhibit overlapping symptoms. Moreover, case reports have indicated that some CACNA1C variants may produce a cardiac-selective form of Timothy syndrome often referred to as non-syndromic long QT type 8 or cardiac-only Timothy syndrome, however few reports follow up on these patients to confirm the cardiac selectivity of the phenotype over time. Methods A survey was administered to the parents of patients with Timothy syndrome, querying a broad range of symptoms and clinical features. Study participants were organized into 5 separate categories based on genotype and initial diagnosis, enabling comparison between groups of patients which have been described differentially in the literature. Results Our findings reveal that Timothy syndrome patients commonly exhibit both cardiac and extra-cardiac features, with long QT syndrome, neurodevelopmental impairments, hypoglycemia, and respiratory issues being frequently reported. Notably, the incidence of these features was similar across all patient categories, including those diagnosed with non-syndromic long QT type 8, suggesting that the ‘non-syndromic’ classification may be incomplete. Conclusions This study represents the first Natural History Study of Timothy syndrome, offering a comprehensive overview of the disease’s clinical manifestations. We demonstrate that both cardiac and extra-cardiac features are prevalent across all patient groups, underscoring the syndromic nature of CACNA1C variants. While the critical role of long QT syndrome and cardiac arrhythmias in Timothy syndrome has been well recognized, our findings indicate that hypoglycemia and respiratory dysfunction also pose significant life-threatening risks, emphasizing the need for comprehensive therapeutic management of affected individuals
Relative and bedside nurse assessment of comfort and communication during propofol, dexmedetomidine, or clonidine-based sedation: pre-planned analysis within the A2B RCT
No full textBackground: optimising comfort and ability to communicate for mechanically ventilated (MV) intensive care (ICU) patients is a priority for clinicians, ICU patients and their relatives. Current usual care is propofol-based sedation plus an opioid analgesic. The alpha2-agonists dexmedetomidine and clonidine are potential alternative sedatives. Objective(s): to explore whether nurses and relatives perceive patients sedated with dexmedetomidine and/or clonidine appear more awake, comfortable, and cooperative than patients receiving only propofol-based sedation.Design and methods: sub-study within an open-label three-arm trial. Setting and participants: 41 ICUs in the United Kingdom. 1437 adults receiving propofol ±opioid for sedation-analgesia within 48 hours of starting MV, expected to require ≥48 total hours of MV.Interventions: light sedation was targeted in all patients unless clinicians requested deeper sedation. In intervention groups algorithms promoted alpha2-agonist up-titration and propofol down-titration followed by sedation primarily with allocated alpha2-agonist. Usual care was propofol-based sedation. Intervention continued until patients were successfully extubated (primary outcome), or other pre-defined end-points. Outcomes: for each 12-hours care period nurses responded to two ‘yes/no’ questions: Is the patient able to communicate pain? Is the patient able to cooperate with care? When the patients’ personal legal representative visited, they were asked for ‘yes/no’ responses to three questions: does the patient appear awake? Does the patient appear comfortable? Does the visitor feel they can communicate with the patient? Intervention versus propofol group responses were compared fitting a generalised linear mixed model, with results expressed as Odds Ratios (OR; 95% confidence intervals); ORs >1 indicated greater probability of a ‘yes’ response.Results: nurse responses were available for >90% of trial patients (mean (SD) 12 (12) care periods per patient). Comparing dexmedetomidine versus propofol groups, the OR for a ‘yes’ response to ‘communicate pain’ was 1.38 (1.08 to 1.75), and for clonidine versus propofol was 1.13 (0.89 to 1.43). For ‘cooperate with care’ comparing dexmedetomidine versus propofol groups, OR was 1.14 (0.98 to 1.32), and for clonidine versus propofol 0.96 (0.83 to 1.12). Relative responses were available for 32-34% of trial patients across groups (mean (SD) 3 (3) days per patient). For the ‘appear awake’ question, the dexmedetomidine versus propofol group OR was 1.48 (1.04 to 2.10), and clonidine versus propofol 1.35 (0.95 to 1.91). For ‘appear comfortable’ the dexmedetomidine versus propofol group OR was 0.64 (0.38 to 1.09), and for clonidine versus propofol 0.78 (0.45 to 1.34). For the ‘feel they can communicate’ comparison the dexmedetomidine versus propofol group OR was 1.00 (0.68 to 1.47), and for clonidine versus propofol 1.05 (0.71 to 1.54).Limitations: interventions were unblinded, with risk of bias; missing data may not have been at random.Conclusions: nurses perceived patients receiving dexmedetomidine-based sedation could better communicate pain than with propofol-based sedation, and relatives perceived patients appeared more awake. No differences for the other questions were found, or for the clonidine versus propofol comparisons, although some uncertainty remains due to the wide confidence intervals.<br/
Exercise rehabilitation following intensive care unit discharge for recovery from critical illness
Full text linkAt this time, we are unable to determine an overall effect on functional exercise capacity, or on health-related quality of life, of an exercise-based intervention initiated after ICU discharge for survivors of critical illness. Meta-analysis of findings was not appropriate because the number of studies and the quantity of data were insufficient. Individual study findings were inconsistent. Some studies reported a beneficial effect of the intervention on functional exercise capacity, and others did not. No effect on health-related quality of life was reported. Methodological rigour was lacking across several domains, influencing the quality of the evidence. Wide variability was noted in the characteristics of interventions, outcome measures and associated metrics and data reporting.If further trials are identified, we may be able to determine the effects of exercise-based intervention following ICU discharge on functional exercise capacity and health-related quality of life among survivors of critical illness
Evaluating Research Impact through Open Access to Scholarly Communication
Full text linkScientific research is a competitive business – in order to secure funding, promotion and tenure researchers must demonstrate their work has impact in their field. To maximise impact researchers undertake high priority research, aim to get results first, and publish in the highest impact journals. The Internet now presents a new opportunity to the scholarly author seeking higher impact: s/he can now make their work instantly accessible on the Web through author self-archiving. This growing body of open access literature (coupled with new publishing models that make journals available for-free to the reader) maximises research impact by maximising the number of people who can read it, and making it available sooner. Open access also provides a new opportunity for bibliometric research. This thesis describes the relatively recent phenomenon of open access to research literature, tools that were built to collect and analyse that literature, and the results of analyses of the effect of open access and its effect on author behaviour. It shows that articles self-archived by authors receive between 50-250% more citations, that rapid pre-printing on the Web has dramatically reduced the peak citation rate from over a year to virtually instant and how citation-impact – now widely used for evaluation – can be expanded to include a new web metric of download impact
Dexmedetomidine- or clonidine-based sedation compared with propofol in critically ill patients the A2B randomized clinical trial
No full textImportance: whether α2-adrenergic receptor agonist–based sedation, compared with propofol-based sedation, reduces time to extubation in patients receiving mechanical ventilation in the intensive care unit (ICU) is uncertain.Objective: to evaluate whether dexmedetomidine- or clonidine-based sedation reduces duration of mechanical ventilation compared with propofol-based sedation (usual care).Design, Setting, and Participants: pragmatic, open-label randomized clinical trial conducted at 41 ICUs in the UK including adults who were within 48 hours of starting mechanical ventilation, were receiving propofol plus an opioid for sedation and analgesia, and were expected to require mechanical ventilation for 48 hours or longer. The median time from intubation to randomization was 21.0 (IQR, 13.2-31.3) hours. Recruitment occurred from December 2018 to October 2023; the last follow-up occurred on December 10, 2023.Interventions: the bedside algorithms used targeted a Richmond Agitation-Sedation Scale score of −2 to 1 (unless clinicians requested deeper sedation). The algorithms supported uptitration in the dexmedetomidine- and clonidine-based sedation intervention groups and supported downtitration for propofol-based sedation followed by sedation primarily with the allocated sedation (dexmedetomidine or clonidine). If required, supplemental use of propofol was permitted.Main Outcomes and Measures: the primary outcome was time from randomization to successful extubation. The secondary outcomes included mortality, sedation quality, rates of delirium, and cardiovascular adverse events.Results: among the 1404 patients in the analysis population (mean age, 59.2 [SD, 14.9] years; 901 [64%] were male; and the mean APACHE II score was 20.3 [SD, 8.2]), the subdistribution hazard ratio (HR) for time to successful extubation was 1.09 (95% CI, 0.96-1.25; P = .20) for dexmedetomidine (n = 457) vs propofol (n = 471) and was 1.05 (95% CI, 0.95-1.17; P = .34) for clonidine (n = 476) vs propofol (n = 471). The median time from randomization to successful extubation was 136 (95% CI, 117-150) hours for dexmedetomidine, 146 (95% CI, 124-168) hours for clonidine, and 162 (95% CI, 136-170) hours for propofol. In the predefined subgroup analyses, there were no interactions with age, sepsis status, median Sequential Organ Failure Assessment score, or median delirium risk score. Among the secondary outcomes, agitation occurred at a higher rate with dexmedetomidine vs propofol (risk ratio [RR], 1.54 [95% CI, 1.21-1.97]) and with clonidine vs propofol (RR, 1.55 [95% CI, 1.22-1.97]). Compared with propofol, the rates of severe bradycardia (heart rate <50/min) were higher with dexmedetomidine (RR, 1.62 [95% CI, 1.36-1.93]) and clonidine (RR, 1.58 [95% CI, 1.33-1.88]). Compared with propofol, mortality was similar over 180 days for dexmedetomidine (HR, 0.98 [95% CI, 0.77-1.24]) and clonidine (HR, 1.04 [95% CI, 0.82-1.31]).Conclusions and Relevance: in critically ill patients, neither dexmedetomidine nor clonidine was superior to propofol in reducing time to successful extubation
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