2 - Schools incorporating the Life Sciences and Medicine
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Item Using the theory of planned behaviour as a process evaluation tool in randomised trials of knowledge translation strategies : A case study from UK primary care(2010-09-29) Ramsay, Craig R.; Thomas, Ruth E.; Croal, Bernard L.; Grimshaw, Jeremy M.; Eccles, Martin P.; University of Aberdeen.Other Applied Health Sciences; University of Aberdeen.Institute of Applied Health SciencesItem The utility of B-type natriuretic peptide in predicting postoperative cardiac events and mortality in patients undergoing major emergency non-cardiac surgery(Blackwell, 2007-09) Cuthbertson, Brian; Card, Gemma; Croal, Bernard L.; McNeilly, Jane; Hillis, Graham; University of Aberdeen, School of Medicine & Dentistry, Division of Applied Health SciencesB-type natriuretic peptide (BNP) levels predict cardiovascular risk in several settings. We hypothesized that they would identify individuals at increased risk of complications and mortality following major emergency non-cardiac surgery.Forty patients were studied with a primary end-point of a new post-operative cardiac event, and/or development of significant ECG changes, and/or cardiac death. The main secondary outcome was all cause mortality at 6 months. Preoperative BNP levels were higher in 11 patients who suffered a new postoperative cardiac event (p=0.001) and predicted this outcome with an area under the receiver operating characteristic curve of 0.85 (CI=0.72-0.98,p=0.001). A pre-operative BNP value >170pg.ml-1 has a sensitivity of 82% and a specificity of 79% for the primary end-point. In this small study, pre-operative BNP levels identify patients undergoing major emergency non-cardiac surgery who are at increased risk of early post-operative cardiac events. Larger studies are required to confirm these data.Item Renal function, revascularization and risk(OUP, 2007) Hillis, Graham S.; Cuthbertson, Brian; Croal, Bernard L.; University of Aberdeen, School of Medicine & Dentistry, Division of Applied Medicine; University of Aberdeen, School of Medicine & Dentistry, Division of Applied Health SciencesItem Preoperative neutrophil-lymphocyte ratio and outcome from coronary artery bypass grafting(Elsevier, 2007-11) Gibson, Patrick H.; Croal, Bernard L.; Small, Gary R.; Ifezulike, Ada I.; Gibson, George; Jeffrey, Robert R.; Buchan, Keith G.; El-Shafei, Hussein; Hillis, Graham S.; Cuthbertson, Brian; University of Aberdeen, School of Medicine & Dentistry, Division of Applied Medicine; University of Aberdeen, School of Medicine & Dentistry, Division of Applied Health SciencesBackground: An elevated preoperative white blood cell count has been associated with a worse outcome after coronary artery bypass grafting (CABG). Leukocyte subtypes, and particularly the neutrophil-lymphocyte (N/L) ratio, may however, convey superior prognostic information. We hypothesized that the N/L ratio would predict the outcome of patients undergoing surgical revascularization. Methods: Baseline clinical details were obtained prospectively in 1938 patients undergoing CABG. The differential leukocyte was measured before surgery, and patients were followed-up 3.6 years later. The primary end point was all-cause mortality. Results: The preoperative N/L ratio was a powerful univariable predictor of mortality (hazard ratio [HR] 1.13 per unit, P < .001). In a backward conditional model, including all study variables, it remained a strong predictor (HR 1.09 per unit, P = .004). In a further model, including the European system for cardiac operative risk evaluation, the N/L ratio remained an independent predictor (HR 1.08 per unit, P = .008). Likewise, it was an independent predictor of cardiovascular mortality and predicted death in the subgroup of patients with a normal white blood cell count. This excess hazard was concentrated in patients with an N/L ratio in the upper quartile (>3.36). Conclusion: An elevated N/L ratio is associated with a poorer survival after CABG. This prognostic utility is independent of other recognized risk factors.Item Randomised trial of glutamine and selenium supplemented parenteral nutrition for critically ill patients(BioMed Central, 2007-09-20) Andrews, Peter J.D.; Avenell, Alison; Noble, David W.; Campbell, Marion Kay; Battison, Claire G.; Croal, Bernard L.; Simpson, William G.; Norrie, John David; Vale, Luke David; Cook, Jonathan Alistair; De Verteuil, Robyn; Milne, Anne Catherine; Trials Management Group; University of Aberdeen, School of Medicine & Dentistry, Division of Applied Health SciencesBackground: Mortality rates in the Intensive Care Unit and subsequent hospital mortality rates in the UK remain high. Infections in Intensive Care are associated with a 2–3 times increased risk of death. It is thought that under conditions of severe metabolic stress glutamine becomes "conditionally essential". Selenium is an essential trace element that has antioxidant and anti-inflammatory properties. Approximately 23% of patients in Intensive Care require parenteral nutrition and glutamine and selenium are either absent or present in low amounts. Both glutamine and selenium have the potential to influence the immune system through independent biochemical pathways. Systematic reviews suggest that supplementing parenteral nutrition in critical illness with glutamine or selenium may reduce infections and mortality. Pilot data has shown that more than 50% of participants developed infections, typically resistant organisms. We are powered to show definitively whether supplementation of PN with either glutamine or selenium is effective at reducing new infections in critically ill patients. Methods/design: 2 × 2 factorial, pragmatic, multicentre, double-blind, randomised controlled trial. The trial has an enrolment target of 500 patients. Inclusion criteria include: expected to be in critical care for at least 48 hours, aged 16 years or over, patients who require parenteral nutrition and are expected to have at least half their daily nutritional requirements given by that route. Allocation is to one of four iso-caloric, iso-nitrogenous groups: glutamine, selenium, both glutamine & selenium or no additional glutamine or selenium. Trial supplementation is given for up to seven days on the Intensive Care Unit and subsequent wards if practicable. The primary outcomes are episodes of infection in the 14 days after starting trial nutrition and mortality. Secondary outcomes include antibiotic usage, length of hospital stay, quality of life and cost-effectiveness. Discussion: To date more than 285 patients have been recruited to the trial from 10 sites in Scotland. Recruitment is due to finish in August 2008 with a further six months follow up. We expect to report the results of the trial in summer 2009. Trial registration: This trial is registered with the International Standard Randomised Controlled Trial Number system. ISRCTN87144826Item Utility of B-type natriuretic peptide in predicting medium-term mortality in patients undergoing major non-cardiac surgery(Elsevier, 2007) Cuthbertson, Brian; Amiri, Amir R.; Croal, Bernard L.; Rajagopalan, Sriram; Brittenden, Julie; Hillis, Graham S.; University of Aberdeen, School of Medicine & Dentistry, Division of Applied Health Sciences; University of Aberdeen, School of Medicine & Dentistry, Division of Applied MedicineWe assessed the ability of pre-operative B-type natriuretic peptide (BNP) levels to predict medium-term mortality in patients undergoing major noncardiac surgery. During a median 654 days follow-up 33 patients from a total cohort of 204 patients (16%) died. The optimal cut-off in this cohort, determined using a receiver operating characteristic curve, was >35pg.mL-1. This was associated with a 3.47-fold increase in the hazard of death (p=0.001) and had a sensitivity of 70% and a specificity of 68% for this outcome. These findings extend recent work demonstrating that BNP levels obtained before major noncardiac surgery can be used to predict peri-operative morbidity, and indicate that they also forecast medium-term mortality.Item The effect of enhanced feedback and brief educational reminder messages on laboratory test requesting in primary care: a cluster randomised trial.(Elsevier, 2006-06-17) Thomas, Ruth Elizabeth; Croal, Bernard L.; Ramsay, Craig R; Eccles, Martin P.; Grimshaw, Jeremy