Publications by authors named "Deakin C"
Juvenile systemic lupus erythematosus (JSLE) is an autoimmune condition which causes significant morbidity in children and young adults and is more severe in its presentation than adult-onset SLE. While many aspects of immune dysfunction have been studied extensively in adult-onset SLE, there is limited and contradictory evidence of how cytotoxic CD8+ T cells contribute to disease pathogenesis and studies exploring cytotoxicity in JSLE are virtually non-existent. Here, we report that CD8+ T cell cytotoxic capacity is reduced in JSLE versus healthy controls, irrespective of treatment or disease activity.
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- The eighth annual summary from the International Liaison Committee on Resuscitation (ILCOR) focuses on the latest findings in cardiopulmonary resuscitation (CPR) and emergency cardiovascular care, building on a comprehensive review from 2020.
- This summary is based on the evaluation of recent resuscitation evidence by experts from six different ILCOR task forces, who utilized specific criteria to assess the quality of evidence and reached consensus treatment recommendations.
- The document also identifies key areas where more research is needed, sharing insights into the task forces’ discussions through sections like Justification and Evidence-to-Decision Framework Highlights.
This is the eighth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations; a more comprehensive review was done in 2020. This latest summary addresses the most recent published resuscitation evidence reviewed by the International Liaison Committee on Resuscitation task force science experts. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, using Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations.
View Article and Find Full Text PDFBackground: In patients with out-of-hospital cardiac arrest, the effectiveness of drugs such as epinephrine is highly time-dependent. An intraosseous route of drug administration may enable more rapid drug administration than an intravenous route; however, its effect on clinical outcomes is uncertain.
Methods: We conducted a multicenter, open-label, randomized trial across 11 emergency medical systems in the United Kingdom that involved adults in cardiac arrest for whom vascular access for drug administration was needed.
Article Synopsis
- The study created a comprehensive reference atlas of human prenatal skin (7-17 weeks post-conception) using advanced techniques like single-cell and spatial transcriptomics to explore the roles of immune cells, specifically macrophages, in skin development.
- It was found that interactions between immune and non-immune cells are essential for key processes in skin development, such as hair follicle formation, scarless wound healing, and blood vessel growth.
- Additionally, while a skin organoid model mimicked certain features of prenatal skin, it lacked immune cells and showed limited blood vessel diversity, highlighting the important roles of macrophages and their derived factors in skin morphology and development.
Objective: This review summarises the current evidence base for combinations of neuroprotective CPR adjuncts (active compression-decompression chest compressions, impedance threshold devices, and head-up positioning) during out-of-hospital cardiac arrest.
Methods: A systematic search (PROSPERO registration CRD42023432302) was performed in English on MEDLINE, EMBASE, and the Cochrane Library in August 2023, and repeated in February 2024. All randomised and observational studies (not abstracts) reporting on any combination of the aforementioned CPR adjuncts were included.
Background: Early cardiopulmonary resuscitation and defibrillation is key to increasing survival following an out-of-hospital-cardiac-arrest (OHCA). However, automated external defibrillators (AEDs) are used in a very small percentage of cases. Despite large numbers of AEDs in the community, the absence of a unified system for registering their locations across the UK's ambulance services may have resulted in missed opportunities to save lives.
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- Dual antiplatelet therapy with P2Y12 inhibitors and aspirin after acute myocardial infarction is common, but patients with atrial fibrillation may also need oral anticoagulants, increasing their bleeding risk.
- A study in New South Wales examined the post-discharge prescribing patterns for 1,330 patients with a history of atrial fibrillation who were hospitalized for acute myocardial infarction, finding that 74.3% were prescribed an OAC, but issues like underprescribing and prolonged P2Y12i usage were noted.
- Recommendations include closer monitoring and adherence to guidelines to prevent overdosing on therapies associated with increased bleeding and address gaps in therapy management for patients transitioning from hospital to community care.
Objectives: To describe use and treatment persistence for Janus kinase inhibitors (JAKi) in rheumatoid arthritis (RA) by line of therapy, and the mechanism of action for the drug switched to after JAKi discontinuation.
Methods: This was a retrospective, observational analysis using the OPAL dataset, a large collection of deidentified electronic medical records from 112 rheumatologists around Australia. Adult patients with RA were included if they initiated tofacitinib (TOF), baricitinib (BARI) or upadacitinib (UPA) between 1 October 2015 and 30 September 2021.
Article Synopsis
- An implantable left ventricular assist device (LVAD) is used in the UK mainly as a temporary solution for patients awaiting heart transplants or recovery.
- LVADs create a unique hemodynamic state, making standard measurements like blood pressure and pulse difficult to obtain, leading to challenges in patient assessment.
- To address these challenges, UK experts developed specific guidelines for managing emergencies in LVAD patients, aimed at healthcare providers in advanced heart failure centers, ensuring appropriate care during critical situations.
Article Synopsis
- The study aimed to assess the feasibility of a large-scale trial in UK ambulance services to determine the optimal defibrillation shock energy for patients experiencing out-of-hospital cardiac arrests.
- Conducted in southern England, the study randomized 38 patients into three different shock energy groups using Zoll X series defibrillators, focusing on recruitment rates and treatment adherence.
- Results showed that while most patient data was complete, challenges emerged in tracking defibrillation data and achieving higher recruitment rates, highlighting the potential for this trial despite the logistical issues identified.
Aims: The PARAMEDIC-3 trial evaluates the clinical and cost-effectiveness of an intraosseous first strategy, compared with an intravenous first strategy, for drug administration in adults who have sustained an out-of-hospital cardiac arrest.
Methods: PARAMEDIC-3 is a pragmatic, allocation concealed, open-label, multi-centre, superiority randomised controlled trial. It will recruit 15,000 patients across English and Welsh ambulance services.
Objectives: To evaluate oxygen saturation and vital signs measured in the community by emergency medical services (EMS) as clinical markers of COVID-19-positive patient deterioration.
Design: A retrospective data analysis.
Setting: Patients were conveyed by EMS to two hospitals in Hampshire, UK, between 1 March 2020 and 31 July 2020.
Standardized reporting of data is crucial for out-of-hospital cardiac arrest (OHCA) research. While the implementation of first responder systems dispatching volunteers to OHCA is encouraged, there is currently no uniform reporting standard for describing these systems. A steering committee established a literature search to identify experts in smartphone alerting systems.
View Article and Find Full Text PDFBackground And Aims: This study aimed to assess the comparative effectiveness of the etanercept (ETN) originator (Enbrel) and ETN biosimilar SB4 (Brenzys) as first-line treatment in patients with rheumatoid arthritis (RA), while also exploring the potential cost-savings associated with this approach in Australia.
Methods: Clinical data were obtained from the Optimising Patient outcomes in rheumatoLogy Australian real-world data set. Adult patients with RA who had initiated treatment with the ETN originator or biosimilar as their first-recorded biologic or targeted synthetic disease-modifying antirheumatic drug between 1 April 2017 and 31 December 2020 were included.
Attitudes of South Australian psychiatrists towards attention deficit hyperactivity disorder in adults.
Australas Psychiatry
February 2024
Objective: A lack of access to psychiatric services for adult ADHD is a recognised issue in South Australia and nationally. This study aims to explore the practices of local psychiatrists and their attitudes towards adult ADHD, with a view to determining any barriers influencing accessibility to treatment.
Methods: We developed an online survey to examine the aims of the study.
The International Liaison Committee on Resuscitation engages in a continuous review of new, peer-reviewed, published cardiopulmonary resuscitation and first aid science. Draft Consensus on Science With Treatment Recommendations are posted online throughout the year, and this annual summary provides more concise versions of the final Consensus on Science With Treatment Recommendations from all task forces for the year. Topics addressed by systematic reviews this year include resuscitation of cardiac arrest from drowning, extracorporeal cardiopulmonary resuscitation for adults and children, calcium during cardiac arrest, double sequential defibrillation, neuroprognostication after cardiac arrest for adults and children, maintaining normal temperature after preterm birth, heart rate monitoring methods for diagnostics in neonates, detection of exhaled carbon dioxide in neonates, family presence during resuscitation of adults, and a stepwise approach to resuscitation skills training.
View Article and Find Full Text PDFThe International Liaison Committee on Resuscitation engages in a continuous review of new, peer-reviewed, published cardiopulmonary resuscitation and first aid science. Draft Consensus on Science With Treatment Recommendations are posted online throughout the year, and this annual summary provides more concise versions of the final Consensus on Science With Treatment Recommendations from all task forces for the year. Topics addressed by systematic reviews this year include resuscitation of cardiac arrest from drowning, extracorporeal cardiopulmonary resuscitation for adults and children, calcium during cardiac arrest, double sequential defibrillation, neuroprognostication after cardiac arrest for adults and children, maintaining normal temperature after preterm birth, heart rate monitoring methods for diagnostics in neonates, detection of exhaled carbon dioxide in neonates, family presence during resuscitation of adults, and a stepwise approach to resuscitation skills training.
View Article and Find Full Text PDFDespite low out of hospital cardiac arrest (OOHCA) survival rates within the UK, animal studies hint at improved cerebral blood flow via a bundled neuroprotective CPR approach. The CABARET study introduces three key devices: the Head Up Position (HUP), Active Compression/Decompression (ACD) CPR, and the Impedance Threshold Device (ITD). A survey involving 27 UK pre-hospital critical care services indicated none are using these interventions widely, either alone or bundled.
View Article and Find Full Text PDFBackground: Despite children and young people (CYP) having a low risk for severe coronavirus disease 2019 (COVID-19) outcomes, there is still a degree of uncertainty related to their risk in the context of immunodeficiency or immunosuppression, primarily due to significant reporting bias in most studies, as CYP characteristically experience milder or asymptomatic COVID-19 infection and the severe outcomes tend to be overestimated.
Methods: A comprehensive systematic review to identify globally relevant studies in immunosuppressed CYP and CYP in general population (defined as younger than 25 years of age) up to 31 October 2021 (to exclude vaccinated populations) was performed. Studies were included if they reported the two primary outcomes of our study, admission to intensive therapy unit (ITU) and mortality, while data on other outcomes, such as hospitalization and need for mechanical ventilation were also collected.
Article Synopsis
- The study examines the changing use of intraosseous versus intravenous drug administration during out-of-hospital cardiac arrests in England from 2015 to 2020.
- Data from 75,343 adult patients showed that intraosseous access significantly increased from 22.8% in 2015 to 42.5% in 2020, with a consistent rise in odds each month.
- The findings suggest a shift towards intraosseous access, indicating a need for further research through randomized controlled trials to determine the effectiveness of these different drug delivery methods during cardiac arrest.