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  • 1
    Online Resource
    Online Resource
    Fluid Optimisation in Emergency Laparotomy (FLO-ELA) Trial: study protocol for a multi-centre randomised trial of cardiac output-guided fluid therapy compared to usual care in patients undergoing major emergency gastrointestinal surgery
    Springer Science and Business Media LLC ; 2023
    In:  Trials Vol. 24, No. 1 ( 2023-05-06)
    Details
    In: Trials, Springer Science and Business Media LLC, Vol. 24, No. 1 ( 2023-05-06)
    Abstract: Postoperative morbidity and mortality in patients undergoing major emergency gastrointestinal surgery are a major burden on healthcare systems. Optimal management of perioperative intravenous fluids may reduce mortality rates and improve outcomes from surgery. Previous small trials of cardiac-output guided haemodynamic therapy algorithms in patients undergoing gastrointestinal surgery have suggested this intervention results in reduced complications and a modest reduction in mortality. However, this existing evidence is based mainly on elective (planned) surgery, with little evaluation in the emergency setting. There are fundamental clinical and pathophysiological differences between the planned and emergency surgical setting which may influence the effects of this intervention. A large definitive trial in emergency surgery is needed to confirm or refute the potential benefits observed in elective surgery and to inform widespread clinical practice. Methods The FLO-ELA trial is a multi-centre, parallel-group, open, randomised controlled trial. 3138 patients aged 50 and over undergoing major emergency gastrointestinal surgery will be randomly allocated in a 1:1 ratio using minimisation to minimally invasive cardiac output monitoring to guide protocolised administration of intra-venous fluid, or usual care without cardiac output monitoring. The trial intervention will be carried out during surgery and for up to 6 h postoperatively. The trial is funded through an efficient design call by the National Institute for Health and Care Research Health Technology Assessment (NIHR HTA) programme and uses existing routinely collected datasets for the majority of data collection. The primary outcome is the number of days alive and out of hospital within 90 days of randomisation. Participants and those delivering the intervention will not be blinded to treatment allocation. Participant recruitment started in September 2017 with a 1-year internal pilot phase and is ongoing at the time of publication. Discussion This will be the largest contemporary randomised trial examining the effectiveness of perioperative cardiac output-guided haemodynamic therapy in patients undergoing major emergency gastrointestinal surgery. The multi-centre design and broad inclusion criteria support the external validity of the trial. Although the clinical teams delivering the trial interventions will not be blinded, significant trial outcome measures are objective and not subject to detection bias. Trial registration ISRCTN 14729158. Registered on 02 May 2017.
    Type of Medium: Online Resource
    ISSN: 1745-6215
    URL: Article
    DOI: 10.1186/s13063-023-07275-3
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2023
    detail.hit.zdb_id: 2040523-6
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  • 2
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    Online Resource
    The value of open-source clinical science in pandemic response: lessons from ISARIC
    Elsevier BV ; 2021
    In:  The Lancet Infectious Diseases Vol. 21, No. 12 ( 2021-12), p. 1623-1624
    Details
    In: The Lancet Infectious Diseases, Elsevier BV, Vol. 21, No. 12 ( 2021-12), p. 1623-1624
    Type of Medium: Online Resource
    ISSN: 1473-3099
    URL: Article
    DOI: 10.1016/S1473-3099(21)00565-X
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2021
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  • 3
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    Online Resource
    Neurological manifestations of COVID-19 in adults and children
    Oxford University Press (OUP) ; 2023
    In:  Brain Vol. 146, No. 4 ( 2023-04-19), p. 1648-1661
    Details
    In: Brain, Oxford University Press (OUP), Vol. 146, No. 4 ( 2023-04-19), p. 1648-1661
    Abstract: Different neurological manifestations of coronavirus disease 2019 (COVID-19) in adults and children and their impact have not been well characterized. We aimed to determine the prevalence of neurological manifestations and in-hospital complications among hospitalized COVID-19 patients and ascertain differences between adults and children. We conducted a prospective multicentre observational study using the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) cohort across 1507 sites worldwide from 30 January 2020 to 25 May 2021. Analyses of neurological manifestations and neurological complications considered unadjusted prevalence estimates for predefined patient subgroups, and adjusted estimates as a function of patient age and time of hospitalization using generalized linear models. Overall, 161 239 patients (158 267 adults; 2972 children) hospitalized with COVID-19 and assessed for neurological manifestations and complications were included. In adults and children, the most frequent neurological manifestations at admission were fatigue (adults: 37.4%; children: 20.4%), altered consciousness (20.9%; 6.8%), myalgia (16.9%; 7.6%), dysgeusia (7.4%; 1.9%), anosmia (6.0%; 2.2%) and seizure (1.1%; 5.2%). In adults, the most frequent in-hospital neurological complications were stroke (1.5%), seizure (1%) and CNS infection (0.2%). Each occurred more frequently in intensive care unit (ICU) than in non-ICU patients. In children, seizure was the only neurological complication to occur more frequently in ICU versus non-ICU (7.1% versus 2.3%, P & lt; 0.001). Stroke prevalence increased with increasing age, while CNS infection and seizure steadily decreased with age. There was a dramatic decrease in stroke over time during the pandemic. Hypertension, chronic neurological disease and the use of extracorporeal membrane oxygenation were associated with increased risk of stroke. Altered consciousness was associated with CNS infection, seizure and stroke. All in-hospital neurological complications were associated with increased odds of death. The likelihood of death rose with increasing age, especially after 25 years of age. In conclusion, adults and children have different neurological manifestations and in-hospital complications associated with COVID-19. Stroke risk increased with increasing age, while CNS infection and seizure risk decreased with age.
    Type of Medium: Online Resource
    ISSN: 0006-8950 , 1460-2156
    URL: Article
    DOI: 10.1093/brain/awac332
    RVK:
    XA 10000
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2023
    detail.hit.zdb_id: 1474117-9
    SSG: 12
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  • 4
    Online Resource
    Online Resource
    2022 American College of Rheumatology/European Alliance of Associations for Rheumatology classification criteria for granulomatosis with polyangiitis
    BMJ ; 2022
    In:  Annals of the Rheumatic Diseases Vol. 81, No. 3 ( 2022-03), p. 315-320
    Details
    In: Annals of the Rheumatic Diseases, BMJ, Vol. 81, No. 3 ( 2022-03), p. 315-320
    Abstract: To develop and validate revised classification criteria for granulomatosis with polyangiitis (GPA). Methods Patients with vasculitis or comparator diseases were recruited into an international cohort. The study proceeded in five phases: (1) identification of candidate criteria items using consensus methodology, (2) prospective collection of candidate items present at the time of diagnosis, (3) data-driven reduction of the number of candidate items, (4) expert panel review of cases to define the reference diagnosis and (5) derivation of a points-based risk score for disease classification in a development set using least absolute shrinkage and selection operator logistic regression, with subsequent validation of performance characteristics in an independent set of cases and comparators. Results The development set for GPA consisted of 578 cases of GPA and 652 comparators. The validation set consisted of an additional 146 cases of GPA and 161 comparators. From 91 candidate items, regression analysis identified 26 items for GPA, 10 of which were retained. The final criteria and their weights were as follows: bloody nasal discharge, nasal crusting or sino-nasal congestion (+3); cartilaginous involvement (+2); conductive or sensorineural hearing loss (+1); cytoplasmic antineutrophil cytoplasmic antibody (ANCA) or anti-proteinase 3 ANCA positivity (+5); pulmonary nodules, mass or cavitation on chest imaging (+2); granuloma or giant cells on biopsy (+2); inflammation or consolidation of the nasal/paranasal sinuses on imaging (+1); pauci-immune glomerulonephritis (+1); perinuclear ANCA or antimyeloperoxidase ANCA positivity (−1); and eosinophil count ≥1×10 9  /L (−4). After excluding mimics of vasculitis, a patient with a diagnosis of small- or medium-vessel vasculitis could be classified as having GPA if the cumulative score was ≥5 points. When these criteria were tested in the validation data set, the sensitivity was 93% (95% CI 87% to 96%) and the specificity was 94% (95% CI 89% to 97%). Conclusion The 2022 American College of Rheumatology/European Alliance of Associations for Rheumatology classification criteria for GPA demonstrate strong performance characteristics and are validated for use in research.
    Type of Medium: Online Resource
    ISSN: 0003-4967 , 1468-2060
    URL: Article
    DOI: 10.1136/annrheumdis-2021-221795
    RVK:
    XA 10000
    Language: English
    Publisher: BMJ
    Publication Date: 2022
    detail.hit.zdb_id: 1481557-6
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  • 5
    Online Resource
    Online Resource
    2022 American College of Rheumatology/European Alliance of Associations for Rheumatology classification criteria for microscopic polyangiitis
    BMJ ; 2022
    In:  Annals of the Rheumatic Diseases Vol. 81, No. 3 ( 2022-03), p. 321-326
    Details
    In: Annals of the Rheumatic Diseases, BMJ, Vol. 81, No. 3 ( 2022-03), p. 321-326
    Abstract: To develop and validate classification criteria for microscopic polyangiitis (MPA). Methods Patients with vasculitis or comparator diseases were recruited into an international cohort. The study proceeded in five phases: (1) identification of candidate items using consensus methodology, (2) prospective collection of candidate items present at the time of diagnosis, (3) data-driven reduction of the number of candidate items, (4) expert panel review of cases to define the reference diagnosis and (5) derivation of a points-based risk score for disease classification in a development set using least absolute shrinkage and selection operator logistic regression, with subsequent validation of performance characteristics in an independent set of cases and comparators. Results The development set for MPA consisted of 149 cases of MPA and 408 comparators. The validation set consisted of an additional 142 cases of MPA and 414 comparators. From 91 candidate items, regression analysis identified 10 items for MPA, 6 of which were retained. The final criteria and their weights were as follows: perinuclear antineutrophil cytoplasmic antibody (ANCA) or anti-myeloperoxidase-ANCA positivity (+6), pauci-immune glomerulonephritis (+3), lung fibrosis or interstitial lung disease (+3), sino-nasal symptoms or signs (−3), cytoplasmic ANCA or anti-proteinase 3 ANCA positivity (−1) and eosinophil count ≥1×10 9 /L (−4). After excluding mimics of vasculitis, a patient with a diagnosis of small- or medium-vessel vasculitis could be classified as having MPA with a cumulative score of ≥5 points. When these criteria were tested in the validation data set, the sensitivity was 91% (95% CI 85% to 95%) and the specificity was 94% (95% CI 92% to 96%). Conclusion The 2022 American College of Rheumatology/European Alliance of Associations for Rheumatology classification criteria for MPA are now validated for use in clinical research.
    Type of Medium: Online Resource
    ISSN: 0003-4967 , 1468-2060
    URL: Article
    DOI: 10.1136/annrheumdis-2021-221796
    RVK:
    XA 10000
    Language: English
    Publisher: BMJ
    Publication Date: 2022
    detail.hit.zdb_id: 1481557-6
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  • 6
    Online Resource
    Online Resource
    Association of Country Income Level With the Characteristics and Outcomes of Critically Ill Patients Hospitalized With Acute Kidney Injury and COVID-19
    Elsevier BV ; 2023
    In:  Kidney International Reports Vol. 8, No. 8 ( 2023-08), p. 1514-1530
    Details
    In: Kidney International Reports, Elsevier BV, Vol. 8, No. 8 ( 2023-08), p. 1514-1530
    Type of Medium: Online Resource
    ISSN: 2468-0249
    URL: Article
    DOI: 10.1016/j.ekir.2023.05.015
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2023
    detail.hit.zdb_id: 2887223-X
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  • 7
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    Online Resource
    A comprehensive review of motor movement challenges and rehabilitative robotics
    Elsevier BV ; 2023
    In:  Smart Health Vol. 29 ( 2023-09), p. 100402-
    Details
    In: Smart Health, Elsevier BV, Vol. 29 ( 2023-09), p. 100402-
    Type of Medium: Online Resource
    ISSN: 2352-6483
    URL: Article
    DOI: 10.1016/j.smhl.2023.100402
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2023
    detail.hit.zdb_id: 2891639-6
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  • 8
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    Online Resource
    Fuzzy inference system (FIS) - long short-term memory (LSTM) network for electromyography (EMG) signal analysis
    IOP Publishing ; 2022
    In:  Biomedical Physics & Engineering Express Vol. 8, No. 6 ( 2022-11-01), p. 065032-
    Details
    In: Biomedical Physics & Engineering Express, IOP Publishing, Vol. 8, No. 6 ( 2022-11-01), p. 065032-
    Abstract: A wide range of application domains,s such as remote robotic control, rehabilitation, and remote surgery, require capturing neuromuscular activities. The reliability of the application is highly dependent on an ability to decode intentions accurately based on captured neuromuscular signals. Physiological signals such as Electromyography (EMG) and Electroencephalography (EEG) generated by neuromuscular activities contain intrinsic patterns for users’ particular actions. Such actions can generally be classified as motor states, such as Forward, Reverse, Hand-Grip, and Hand-Release. To classify these motor states truthfully, the signals must be captured and decoded correctly. This paper proposes a novel classification technique using a Fuzzy Inference System (FIS) and a Long Short-Term Memory (LSTM) network to classify the motor states based on EMG signals. Existing EMG signal classification techniques generally rely on features derived from data captured at a specific time instance. This typical approach does not consider the temporal correlation of the signal in the entire window. This paper proposes an LSTM with a Fuzzy Logic method to classify four major hand movements: forward, reverse, raise, and lower. Features associated with the pattern generated throughout the motor state movement were extracted by exploring published data within a given time window. The classification results can achieve a 91.3% accuracy for the 4-way action (Forward/Reverse/GripUp/RelDown) and 95.1% (Forward/Reverse Action) and 96.7% (GripUp/RelDown action) for 2-way actions. The proposed mechanism demonstrates high-level, human-interpretable results that can be employed in rehabilitation or medical-device industries.
    Type of Medium: Online Resource
    ISSN: 2057-1976
    URL: Article
    DOI: 10.1088/2057-1976/ac9e04
    Language: Unknown
    Publisher: IOP Publishing
    Publication Date: 2022
    detail.hit.zdb_id: 2844309-3
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  • 9
    Online Resource
    Online Resource
    2022 American College of Rheumatology/EULAR Classification Criteria for Takayasu Arteritis
    Wiley ; 2022
    In:  Arthritis & Rheumatology Vol. 74, No. 12 ( 2022-12), p. 1872-1880
    Details
    In: Arthritis & Rheumatology, Wiley, Vol. 74, No. 12 ( 2022-12), p. 1872-1880
    Abstract: To develop and validate new classification criteria for Takayasu arteritis (TAK). Methods Patients with vasculitis or comparator diseases were recruited into an international cohort. The study proceeded in 6 phases: 1) identification of candidate criteria items, 2) collection of candidate items present at diagnosis, 3) expert panel review of cases, 4) data‐driven reduction of candidate items, 5) derivation of a points‐based classification score in a development data set, and 6) validation in an independent data set. Results The development data set consisted of 316 cases of TAK and 323 comparators. The validation data set consisted of an additional 146 cases of TAK and 127 comparators. Age ≤60 years at diagnosis and imaging evidence of large‐vessel vasculitis were absolute requirements to classify a patient as having TAK. The final criteria items and weights were as follows: female sex (+1), angina (+2), limb claudication (+2), arterial bruit (+2), reduced upper extremity pulse (+2), reduced pulse or tenderness of a carotid artery (+2), blood pressure difference between arms of ≥20 mm Hg (+1), number of affected arterial territories (+1 to +3), paired artery involvement (+1), and abdominal aorta plus renal or mesenteric involvement (+3). A patient could be classified as having TAK with a cumulative score of ≥5 points. When these criteria were tested in the validation data set, the model area under the curve was 0.97 (95% confidence interval [95% CI] 0.94–0.99) with a sensitivity of 93.8% (95% CI 88.6–97.1%) and specificity of 99.2% (95% CI 96.7–100.0%). Conclusion The 2022 American College of Rheumatology/EULAR classification criteria for TAK are now validated for use in research.
    Type of Medium: Online Resource
    ISSN: 2326-5191 , 2326-5205
    URL: Issue
    URL: Article
    DOI: 10.1002/art.v74.12
    DOI: 10.1002/art.42324
    RVK:
    XA 10000
    RVK:
    XA 30325
    Language: English
    Publisher: Wiley
    Publication Date: 2022
    detail.hit.zdb_id: 2754614-7
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  • 10
    Online Resource
    Online Resource
    2022 American College of Rheumatology/European Alliance of Associations for Rheumatology Classification Criteria for Microscopic Polyangiitis
    Wiley ; 2022
    In:  Arthritis & Rheumatology Vol. 74, No. 3 ( 2022-03), p. 400-406
    Details
    In: Arthritis & Rheumatology, Wiley, Vol. 74, No. 3 ( 2022-03), p. 400-406
    Abstract: To develop and validate classification criteria for microscopic polyangiitis (MPA). Methods Patients with vasculitis or comparator diseases were recruited into an international cohort. The study proceeded in 5 phases: 1) identification of candidate items using consensus methodology, 2) prospective collection of candidate items present at the time of diagnosis, 3) data‐driven reduction of the number of candidate items, 4) expert panel review of cases to define the reference diagnosis, and 5) derivation of a points‐based risk score for disease classification in a development set using least absolute shrinkage and selection operator logistic regression, with subsequent validation of performance characteristics in an independent set of cases and comparators. Results The development set for MPA consisted of 149 cases of MPA and 408 comparators. The validation set consisted of an additional 142 cases of MPA and 414 comparators. From 91 candidate items, regression analysis identified 10 items for MPA, 6 of which were retained. The final criteria and their weights were as follows: perinuclear antineutrophil cytoplasmic antibody (ANCA) or anti–myeloperoxidase‐ANCA positivity (+6), pauci‐immune glomerulonephritis (+3), lung fibrosis or interstitial lung disease (+3), sino‐nasal symptoms or signs (−3), cytoplasmic ANCA or anti–proteinase 3 ANCA positivity (−1), and eosinophil count ≥1 × 10 9 /liter (−4). After excluding mimics of vasculitis, a patient with a diagnosis of small‐ or medium‐vessel vasculitis could be classified as having MPA with a cumulative score of ≥5 points. When these criteria were tested in the validation data set, the sensitivity was 91% (95% confidence interval [95% CI] 85–95%) and the specificity was 94% (95% CI 92–96%). Conclusion The 2022 American College of Rheumatology/European Alliance of Associations for Rheumatology classification criteria for MPA are now validated for use in clinical research.
    Type of Medium: Online Resource
    ISSN: 2326-5191 , 2326-5205
    URL: Issue
    URL: Article
    DOI: 10.1002/art.v74.3
    DOI: 10.1002/art.41983
    RVK:
    XA 10000
    RVK:
    XA 30325
    Language: English
    Publisher: Wiley
    Publication Date: 2022
    detail.hit.zdb_id: 2754614-7
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