42 results on '"Prin, Meghan"'
Search Results
2. Tracheostomy Practices for Mechanically Ventilated Patients in Malawi
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Prin, Meghan, Kaizer, Alex, Cardenas, Jesus, Mtalimanja, Onias, Kadyaudzu, Clement, Charles, Anthony, and Ginde, Adit
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- 2021
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3. Social distancing: implications for the operating room in the face of COVID-19
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Prin, Meghan and Bartels, Karsten
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- 2020
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4. 435: ECMO IN A PATIENT WITH LATENT DRESS SYNDROME-ASSOCIATED FULMINANT MYOCARDITIS
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Williams, Cynthia, Prin, Meghan, Gilliland, Samuel, Blaine, Caitlin, and Vossler, Kristen
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- 2022
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5. Development of a Malawi Intensive care Mortality risk Evaluation (MIME) model, a prospective cohort study
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Prin, Meghan, Pan, Stephanie, Kadyaudzu, Clement, Li, Guohua, and Charles, Anthony
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- 2018
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6. ICU Risk Stratification Models Feasible for Use in Sub-Saharan Africa Show Poor Discrimination in Malawi: A Prospective Cohort Study
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Prin, Meghan, Pan, Stephanie, Kadyaudzu, Clement, Li, Guohua, and Charles, Anthony
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- 2019
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7. Drug Label Ribbons to Improve Patient Safety in Low-resource Environments
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Prin, Meghan, Algeo, Clare Evans, Kalonga, Lucy, and Mkwezalamba, Christophe
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- 2019
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8. Emergency-to-Elective Surgery Ratio: A Global Indicator of Access to Surgical Care
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Prin, Meghan, Guglielminotti, Jean, Mtalimanja, Onias, Li, Guohua, and Charles, Anthony
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- 2018
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9. High Elective Surgery Cancellation Rate in Malawi Primarily Due to Infrastructural Limitations
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Prin, Meghan, Eaton, Jessica, Mtalimanja, Onias, and Charles, Anthony
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- 2018
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10. Intraoperative Mortality in Malawi
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Prin, Meghan, Pan, Stephanie, Phelps, Janey, Phiri, Godfrey, Li, Guohua, and Charles, Anthony
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- 2019
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11. Complications and in-hospital mortality in trauma patients treated in intensive care units in the United States, 2013
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Prin, Meghan and Li, Guohua
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- 2016
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12. Critical Care in a Tertiary Hospital in Malawi
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Prin, Meghan, Itaye, Takondwa, Clark, Sarah, Fernando, Rohesh J., Namboya, Felix, Pollach, Gregor, Mkandawire, Nyengo, and Sobol, Julia
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- 2016
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13. In reply: Physical distancing or social distancing: that is the question
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Prin, Meghan and Bartels, Karsten
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- 2020
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14. Epidemiology of admissions to 11 stand-alone high-dependency care units in the UK
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Prin, Meghan, Harrison, David, Rowan, Kathryn, and Wunsch, Hannah
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Medical research ,Medicine, Experimental ,Mortality -- United Kingdom ,Epidemiology -- Research ,Health care industry - Abstract
Purpose High-dependency care units (HDUs) are a focus of research to optimize critical care resource allocation. HDUs provide a level of care between the general ward and the intensive care unit (ICU). However, few data report on the case mix and outcomes of patients in these units. Methods Retrospective observational cohort study of patients admitted to 11 stand-alone HDUs in the UK from 2008 to 2011. We stratified patients by location prior to HDU admission and location on discharge from HDU, and we summarized the case mix, transitions of care, and mortality. Results Of 9008 patients admitted to 11 stand-alone HDUs, 56.5 % were male and the mean age was 62.7 ± 17.9 years. The majority of patients admitted to HDUs were non-surgical (59.3 %), with 22.4 and 20.1 % admitted from the ICU and general ward, respectively; 41.3 % were admitted from the operating room or recovery suite. The median length of stay in HDU was 1.8 days (IQR 0.9-3.5) and in-HDU mortality was 5.1 %. Among HDU survivors (n = 8551), 8.5 % were discharged to an ICU, 80.9 % to a general ward, and 10.6 % to other care areas. For patients admitted to HDU from an ICU, only 5.8 % were readmitted to ICU. Hospital mortality for the HDU population was 14.8 %; for patients discharged to an ICU, hospital mortality was 43.6 %. Conclusions In a sample of 11 stand-alone HDUs in the UK, patients are from many different hospital locations. Hospital mortality for patients requiring HDU care is high, particularly for patients who require transfer to an ICU., Author(s): Meghan Prin [sup.1], David Harrison [sup.2], Kathryn Rowan [sup.2], Hannah Wunsch [sup.1] [sup.3] [sup.4] Author Affiliations: (1) grid.21729.3f, 0000000419368729, Department of Anesthesiology, Columbia University, , New York, NY, USA [...]
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- 2015
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15. The Role of Stepdown Beds in Hospital Care
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Prin, Meghan and Wunsch, Hannah
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- 2014
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16. Year in Review 2021: Noteworthy Literature in Cardiothoracic Anesthesia.
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Smoroda, Aaron, Douin, David, Morabito, Joseph, Lyman, Matthew, Prin, Meghan, Ahlgren, Bryan, Young, Andrew, Christensen, Elijah, Abrams, Benjamin A, Weitzel, Nathaen, and Clendenen, Nathan
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In 2021, progress in clinical science related to Cardiac Anesthesiology continued, but at a slower rate due to the ongoing pandemic and disruptions to clinical research. Most progress was incremental and addressed persistent questions related to our field. To identify articles for this review, we completed a structured review using our previously reported methods (1). Specifically, we used the search terms: "cardiac anesthesiology and outcomes" (n = 177), "cardiothoracic anesthesiology" (n = 34), "cardiac anesthesia," and "clinical outcomes" (n = 42) filtered on clinical trials and the year 2021 in PubMed. We also reviewed clinical trials from the most prominent clinical journals to identify additional studies for a narrative review. We then selected the most noteworthy publications for inclusion in this review and identified key themes. [ABSTRACT FROM AUTHOR]
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- 2022
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17. Meeting Report: First Cardiovascular Outcomes Research in Perioperative Medicine Conference.
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Bartels, Karsten, Howard-Quijano, Kimberly, Prin, Meghan, Shaefi, Shahzad, Steppan, Jochen, Sun, Eric C., Williams, Brittney, Fox, Amanda A., Namuyonga, Judith, Shaw, Andrew D., Vavilala, Monica S., and Sessler, Daniel I.
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- 2023
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18. Challenging Paradigms and Trusting Evidence: New Approaches to Perioperative Care.
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Prin, Meghan, Clendenen, Nathan, Lum, Hillary, Kertai, Miklos D., and Abrams, Benjamin A.
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- 2022
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19. Using research to prepare for outbreaks of severe acute respiratory infection
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Mich, Vann, Pho, Yaty, Bory, Sotharith, Vann, Mich, Teav, Bunlor, Som, Leakhann, Jarrvisalo, Mikko J, Pulkkinen, Anni, Kuitunen, Anne, Ala-kokko, Tero, Melto, Sari, Daix, Thomas, Philippart, Francois, Antoine, Marchalot, Tiercelet, Kelly, Bruel, Cedric, Nicholas, Sedillot, Siami, Shidasp, Fabienne, Taimon, Bruyere, Raomi, Forceville, Xavier, Erickson, Simon, Campbell, Lewis, Sonawane, Ravikiran, Santamaria, John, Kol, Mark, Awasthi, Shally, Powis, Jeff, Hall, Richard, McCarthy, Anne E, Jouvet, Philippe, Opaysky, Mary Anne, Gilfoyle, Elaine, Farshait, Nataly, Martin, Dori-Ann, Griesdale, Donald, Katz, Kevin, Ruberto, Aaron J, Carrier, Francois Martin, Lamontagne, Francois, Muscedere, John, Rishu, Asgar, Sin, Wai Ching, Ngai, Wallace Chun Wai, Young, Paul, Forrest, Annette, Kazemi, Alex, Henderson, Seton, Browne, Troy, Ganeshalingham, Anusha, McConnochie, Rachael, Cho, Jae Hwa, Park, Tai Sun, Sim, Yun Su, Chang, Youjin, Lee, Heung Bum, Park, Seung Yong, Chan, Wai Ming, Lee, Won-Yeon, Wallace, David J, Angus, Derek C, Charles, Anthony G, van Doom, H Rogier, Kinh, Nguyen Van, Trung, Nguyen Vu, Prin, Meghan, Twagirumugabe, Theogene, Umuhire, Olivier Felix, Sylvain, Habarurema, Al Qasim, Eman, Heraud, Jean-Michel, Raberahona, Mihaja, Rabarison, Joelinotahiana Hasina, Patrigeon, Santiago Perez, Ramirez-Venegas, Alejandra, Melendez, Javier Araujo, Guerrero, M Lourdes, Mambule, Ivan, Ochieng, Otieno George, Nadjm, Behzad, Li, Iris Wai Sum, Choi, Won-Il, Florence, Komurian-Pradel, Arabi, Yaseen M, West, T Eoin, Riviello, Elisabeth D, Parke, Rachael, Djillali, Annane E, Fowler, Robert, Murthy, Srinivas, Nichol, Alistair, Cheng, Allen C, Semple, Calum, George, Maya, Valkonen, Miia, McArthur, Colin, Carson, Gail, O'Neill, Genevieve, Cobb, J Perren, Dunning, Jake, Chiche, Jean-Daniel, Huh, Jin-Won, Marshall, John, Rello, Jordi, Guillebaud, Julia, Razanazatovo, Norosoa, Otieno, Juilett Wambura, Green, Karen, Rowan, Kathy, Baillie, John Kenneth, Merson, Laura, Hsu, Li Yang, Christian, Michael D, Egi, Moritoki, Shindo, Nahoko, Horby, Peter, Pardinaz-Solis, Raul, Ubiergo, Sebastian Ugarte, Webb, Steve AR, Uyeki, Timothy M, Gordon, Anthony C, Paterson, David L, Everett, Dean, Giamarellos-Bourboulis, Evangelos J, Longuere, Kajsa-Stina, Maslove, David, Ohuma, Eric, Growl, Gloria, PedutemHumber, Theresa, EllazarHumber, Edward, Bahinskaya, Ilona, Osbourne-Townsend, Joan, Bentley, Andrew, Goodson, Jennifer, Welters, Ingeborg, Malik, Nadia, Browne, TS, Mahesh, Vinaya, Investigators, SPRINT-SARI, HUS Perioperative, Intensive Care and Pain Medicine, University of Helsinki, Anestesiologian yksikkö, University College Dublin [Dublin] (UCD), Monash University [Melbourne], We acknowledge support from the National Health and Medical Research Council in Australia, the Australia New Zealand Intensive Care Society Clinical Trials Group and the Seventh Framework Program in Europe, which have facilitated the progress that has been made for central project infrastructure. Data collection was funded locally by local research coordinators and investigators, including the International Respiratory and Severe Illness Center, University of Washington., Collaborators Vann Mich, Khmer Soviet Friend Hospital. Yaty Pho, Khmer Soviet Friend Hospital. Sotharith Bory, Calmette Hospital and University of Health Sciences. Mich Vann, Khmer-Soviet Friendship Hospital and University of Health Sciences. Bunlor Teav, Takeo Provincial Hospital. Leakhann Som, National Pediatric Hospital. Mikko J Jarrvisalo, Turku university hospital, ICU. Anni Pulkkinen, Central Hospital of Central Finland. Anne Kuitunen, Tampere University Hospital. Tero Ala-kokko, Oulu University Hospital, Research Group of Anesthesiology, Surgery and Intensive Care Medicine. Sari. Melto, South Karelia Central Hospital. Thomas DAIX, Reanimation polyvalente, CHU Dupuytren, Limoges, France and Inserm CIC 1435, CHU Dupuytren, Limoges, France. Francois Philippart, Intensive Care Unit. Marchalot Antoine, Dieppe General Hospital. Kelly Tiercelet, Groupe hospitalier Paris Saint Joseph. Cedric Bruel, Groupe hospitalier Paris Saint Joseph. BRUYERE Remi, Centre Hospitalier Fleyriat. Sedillot Nicholas, Centre Hospitalier Fleyriat. Shidasp SIAMI, General Intensive Care Medicine, Sud Essonne Hospital Etampes. Marchalot Antoine, Centre Hospitalier Dieppe. Taimon Fabienne, Service de Medecine Intensive et Reanimation, Rouen University Hospital (G.B.), and Normandie University, Universite de Rouen, U1096, Rouen University Hospital. Philippart, Groupe hospitalier Paris Saint joseph. Raomi Bruyere, Service de reanimation. Centre Hospitalier Fleyriat. Xavier Forceville, Grand Hopital de l'Est Francilien. Simon Erickson, Perth Children's Hospital. Lewis Campbell, Royal Darwin Hospital. Ravikiran Sonawane, Rockingham General Hospital. John Santamaria, St Vincent's Hospital (Melbourne). Mark Kol, Concord Hospital. Shally Awasthi, King George's Medical University. Jeff Powis, Michael Garron Hospital. Richard Hall, Dalhousie University. Anne E McCarthy, University of Ottawa and the Ottawa Hospital. Philippe Jouvet, Ste-Justine Hospital and Research Center. Mary Anne Opavsky, Joseph Brant Hospital. Elaine Gilfoyle, University of Calgary. Nataly Farshait, Humber River Hospital. Dori-Ann Martin, University of Calgary. Donald Griesdale, Department of Anesthesiology, Pharmacology & Therapeutics Department of Medicine, Divisions of Critical Care Medicine & Neurology University of British Columbia. Kevin Katz, North York General Hospital. Aaron J. Ruberto, Queen's University & Kingston Health Sciences Centre. Francois Martin Carrier, Centre Hospitalier de l'Universite de Montreal. Francois Lamontagne, Universite de Sherbrooke. John Muscedere, Queens University. Asgar Rishu, Sunnybrook Health Sciences Centre. Wai Ching Sin, Department of Adult Intensive Care Unit, Queen Mary Hospital. Wallace Chun Wai Ngai, Department of Adult Intensive Care Unit, Queen Mary Hospital. Paul Young, Medical Research Institute of New Zealand. Dr Annette Forrest, Waikato Hospital. Alex Kazemi, Middlemore Hospital. Seton Henderson, Christchurch Hospital. Troy Browne, Tauranga Hospital. Anusha Ganeshalingham, Starship Hospital. Rachael McConnochie, Department of Critical Care Medicine, Auckland City Hospital. Jae Hwa Cho, Yonsei University. Tai Sun Park, Hanyang University Guri Hospital. Yun Su Sim, Hallym University Kangnam Sacred Hospital. Youjin Chang, Inje University, College of Medicine, Sanggye Paik Hospital. Heung Bum Lee, Chonbuk National University Hospital. Seung Yong Park, Chonbuk National University Hospital. Wai Ming Chan, Department of Adult Intensive Care Unit, Queen Mary Hospital, Hong Kong. Won-Yeon Lee, Yonsei University Wonju College of Medicine. David J. Wallace, University of Pittsburgh School of Medicine. Derek C. Angus, University of Pittsburgh School of Medicine. Anthony G Charles, University of North Carolina at Chapel Hill. H Rogier van Doorn, Oxford University Clinical Research Unit. Nguyen Van Kinh, National Hospital for Tropical Diseases. Nguyen Vu Trung, National Hospital for Tropical Diseases. Meghan Prin, Columbia University College of Physicians & Surgeons. Theogene Twagirumugabe, University of Rwanda /College of Medicine and Health Sciences. Olivier Felix Umuhire, Department of Anesthesia, Emergency Medicine and Critical Care. University of Rwanda. Habarurema Sylvain, Centre hospitalier Universitaire de Butare(CHUB). Eman Al Qasim, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center. Jean-Michel Heraud, Institut Pasteur de Madagascar. Mihaja Raberahona, University Hospital Joseph Raseta Befelatanana. Joelinotahiana Hasina Rabarison, Insttut Pasteur de Madagascar. Santiago Perez Patrigeon, Instituto Nacional de Ciencias Medicas y Nutrición Salvador Subirán. Alejandra Ramirez-Venegas, Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas. Javier Araujo Meléndez, Hospital Central 'Dr. Ignacio Morones Prieto'. M. Lourdes Guerrero, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiren. Ivan Mambule, Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health University of Liverpool and Malawi-Liverpool-Wellcome Trust, Clinical Research Programme. Otieno George Ochieng, Kijabe Mission Hospital. Behzad Nadjm, Imperial College Healthcare NHS Trust, GBR. Iris Wai Sum Li, Queen Mary Hospital, School of Public Health, the University of Hong Kong. Won-Il Choi, Department of Medicine, Keimyung University, Dongsan Hospital. Komurian-Pradel Florence, Fondation Merieux. Yaseen M Arabi, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Intensive Care Department, King Abdulaziz Medical City. T. Eoin West, University of Washington. Elisabeth D Riviello, Harvard Medical School and Beth Israel Deaconess Medical Center. Rachael Parke, Cardiothoracic and Vascular ICU, Auckland City Hospital. AnnaneE Djillali, Raymond Poincare Hospital (APHP) Unievrsity of Versailles SQY/University Paris Saclay. Robert Fowler, Interdepartmental Division of Critical Care Medicine, University of Toronto. Srinivas Murthy, Department of Pediatrics. Alistair Nichol, University College Dublin / Monash University. Allen C Cheng, School of Public Health and Preventive Medicine, Monash University. Calum Semple, University of Liverpool. Maya George, Australian and New Zealand Intensive Care Research Centre, Monash University. Miia Valkonen, University of Helsinki and Helsinki University Hospital. Colin McArthur, Auckland City Hospital (DCCM 82). Gail Carson, University of Oxford. Genevieve O'Neill, Australian and New Zealand Intensive Care Research Centre, Monash University. J. Perren Cobb, University of Southern California. Jake Dunning, University of Oxford, Imperial College London. Jean-Daniel Chiche, Hopitaux Universitaire Paris Centre, site Cochin. Jin-Won Huh, ASAN Medical Center. John Marshall, St. Michael's Hospital. Jordi Rello, Ciberes & Vall d'Hebron University Hospital, Barcelona, Spain. Julia Guillebaud, Institut Pasteur de Madagascar. Norosoa Razanazatovo, Institut Pasteur de Madagascar. Juilett Wambura Otieno, KEMRI-Wellcome Trust Research Programme. Karen Green, Toronto Invasive Bacterial Diseases Network. Kathy Rowan, Intensive Care National Audit and Research Centre. John Kenneth Baillie, Roslin Institute, University of Edinburgh. Laura Merson, Infectious Diseases Data Observatory, Oxford, UK, Centre for Tropical Medicine & Global Health, Nuffield Department of Medicine, Oxford University, Oxford UK. Li Yang Hsu, National University of Singapore. Michael D. Christian, Essex & Herts Air Ambulance Trust. Miia Valkonen, Helsinki University Central Hospital. Moritoki Egi, Kobe University Hospital. Nahoko Shindo, World Health Organization. Peter Horby, University of Oxford. Raul Pardinaz-Solis, Nuffield Department of Medicine, University of Oxford. Sebastián Ugarte Ubiergo, Universidad Andrés Bello. Steve AR Webb, Monash University. Timothy M. Uyeki, Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia USA. Anthony C Gordon, Imperial College London. David L Paterson, University of Queensland Centre. Dean Everett, University of Edinburgh, The Queens Medical Research Institute and Malawi-Liverpool-Wellcome Trust, Clinical Research Programme. Evangelos J. Giamarellos-Bourboulis, National and Kapodistrian University of Athens, Medical School. Kajsa-Stina Longuere, University of Oxford. David Maslove, Queens University. Eric Ohuma, Oxford University. Gloria Crowl, Michael Garron Hospital. Theresa PedutemHumber, River Hospital. Edward EllazarHumber, River Hospital. Ilona Bahinskaya, University Health Network TGH MOT. Joan Osbourne-Townsend, Humber River Hospital. Andrew Bentley, University of Manchester. Ingeborg Welters, University of Liverpool. Nadia Malik, MountSinai Hospital/ William Osler Health Centre. Dr T S Browne, Tauranga Hospital. Jennifer Goodson, Tauranga Hospital. Vinaya Mahesh, North York General Hospital., and Carson, G
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medicine.medical_specialty ,INTENSIVE-CARE-UNIT ,global health ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,law ,[SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases ,Intensive care ,Case fatality rate ,Epidemiology ,Global health ,medicine ,pneumonia ,030212 general & internal medicine ,Public, Environmental & Occupational Health ,[SDV.MHEP.ME]Life Sciences [q-bio]/Human health and pathology/Emerging diseases ,Practice ,OUTCOMES ,Science & Technology ,business.industry ,Health Policy ,Public Health, Environmental and Occupational Health ,Outbreak ,030208 emergency & critical care medicine ,[SDV.BBM.BM]Life Sciences [q-bio]/Biochemistry, Molecular Biology/Molecular biology ,3126 Surgery, anesthesiology, intensive care, radiology ,Intensive care unit ,3. Good health ,critical care ,REAL-TIME SURVEILLANCE ,[SDV.MP.VIR]Life Sciences [q-bio]/Microbiology and Parasitology/Virology ,Observational study ,SOFA score ,[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie ,SPRINT-SARI investigators ,business ,influenza ,Life Sciences & Biomedicine ,Demography ,outbreak preparedness - Abstract
International audience; Severe acute respiratory infections (SARI) remain one of the leading causes of mortality around the world in all age groups. There is large global variation in epidemiology, clinical management and outcomes, including mortality. We performed a short period observational data collection in critical care units distributed globally during regional peak SARI seasons from 1 January 2016 until 31 August 2017, using standardised data collection tools. Data were collected for 1 week on all admitted patients who met the inclusion criteria for SARI, with follow-up to hospital discharge. Proportions of patients across regions were compared for microbiology, management strategies and outcomes. Regions were divided geographically and economically according to World Bank definitions. Data were collected for 682 patients from 95 hospitals and 23 countries. The overall mortality was 9.5%. Of the patients, 21.7% were children, with case fatality proportions of 1% for those less than 5 years. The highest mortality was in those above 60 years, at 18.6%. Case fatality varied by region: East Asia and Pacific 10.2% (21 of 206), Sub-Saharan Africa 4.3% (8 of 188), South Asia 0% (0 of 35), North America 13.6% (25 of 184), and Europe and Central Asia 14.3% (9 of 63). Mortality in low-income and low-middle-income countries combined was 4% as compared with 14% in high-income countries. Organ dysfunction scores calculated on presentation in 560 patients where full data were available revealed Sequential Organ Failure Assessment (SOFA) scores on presentation were significantly associated with mortality and hospital length of stay. Patients in East Asia and Pacific (48%) and North America (24%) had the highest SOFA scores of >12. Multivariable analysis demonstrated that initial SOFA score and age were independent predictors of hospital survival. There was variability across regions and income groupings for the critical care management and outcomes of SARI. Intensive care unit-specific factors, geography and management features were less reliable than baseline severity for predicting ultimate outcome. These findings may help in planning future outbreak severity assessments, but more globally representative data are required.
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- 2019
20. Using research to prepare for outbreaks of severe acute respiratory infection
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Mich, Vann Pho, Yaty Bory, Sotharith Vann, Mich Teav, Bunlor Som, Leakhann Jarrvisalo, Mikko J. Pulkkinen, Anni and Kuitunen, Anne Ala-kokko, Tero Melto, Sari Daix, Thomas and Philippart, Francois Antoine, Marchalot Tiercelet, Kelly and Bruel, Cedric Nicholas, Sedillot Siami, Shidasp Fabienne, Taimon Bruyere, Raomi Forceville, Xavier Erickson, Simon and Campbell, Lewis Sonawane, Ravikiran Santamaria, John Kol, Mark Awasthi, Shally Powis, Jeff Hall, Richard McCarthy, Anne E. Jouvet, Philippe Opaysky, Mary Anne Gilfoyle, Elaine and Farshait, Nataly Martin, Dori-Ann Griesdale, Donald and Katz, Kevin Ruberto, Aaron J. Carrier, Francois Martin and Lamontagne, Francois Muscedere, John Rishu, Asgar Sin, Wai Ching Ngai, Wallace Chun Wai Young, Paul Forrest, Annette and Kazemi, Alex Henderson, Seton Browne, Troy and Ganeshalingham, Anusha McConnochie, Rachael Cho, Jae Hwa and Park, Tai Sun Sim, Yun Su Chang, Youjin Lee, Heung Bum and Park, Seung Yong Chan, Wai Ming Lee, Won-Yeon Wallace, David J. Angus, Derek C. Charles, Anthony G. van Doom, H. Rogier and Nguyen Van Kinh Nguyen Vu Trung Prin, Meghan and Twagirumugabe, Theogene Umuhire, Olivier Felix Sylvain, Habarurema Al Qasim, Eman Heraud, Jean-Michel Raberahona, Mihaja Rabarison, Joelinotahiana Hasina Patrigeon, Santiago Perez Ramirez-Venegas, Alejandra Melendez, Javier Araujo and Guerrero, M. Lourdes Mambule, Ivan Ochieng, Otieno George and Nadjm, Behzad Li, Iris Wai Sum Choi, Won-Il Florence, Komurian-Pradel Arabi, Yaseen M. West, T. Eoin Riviello, Elisabeth D. Parke, Rachael Djillali, Annane E. Fowler, Robert Murthy, Srinivas Nichol, Alistair Cheng, Allen C. and Semple, Calum George, Maya Valkonen, Miia McArthur, Colin and Carson, Gail O'Neill, Genevieve Cobb, J. Perren Dunning, Jake Chiche, Jean-Daniel Huh, Jin-Won Marshall, John and Rello, Jordi Guillebaud, Julia Razanazatovo, Norosoa Otieno, Juilett Wambura Green, Karen Rowan, Kathy Baillie, John Kenneth Merson, Laura Hsu, Li Yang Christian, Michael D. and Egi, Moritoki Shindo, Nahoko Horby, Peter Pardinaz-Solis, Raul Ubiergo, Sebastian Ugarte Webb, Steve A. R. Uyeki, Timothy M. Gordon, Anthony C. Paterson, David L. Everett, Dean Giamarellos-Bourboulis, Evangelos J. Longuere, Kajsa-Stina and Maslove, David Ohuma, Eric Growl, Gloria PedutemHumber, Theresa EllazarHumber, Edward Bahinskaya, Ilona and Osbourne-Townsend, Joan Bentley, Andrew Goodson, Jennifer and Welters, Ingeborg Malik, Nadia Browne, T. S. Mahesh, Vinaya and SPRINT-SARI Investigators
- Abstract
Severe acute respiratory infections (SARI) remain one of the leading causes of mortality around the world in all age groups. There is large global variation in epidemiology, clinical management and outcomes, including mortality. We performed a short period observational data collection in critical care units distributed globally during regional peak SARI seasons from 1 January 2016 until 31 August 2017, using standardised data collection tools. Data were collected for 1 week on all admitted patients who met the inclusion criteria for SARI, with follow-up to hospital discharge. Proportions of patients across regions were compared for microbiology, management strategies and outcomes. Regions were divided geographically and economically according to World Bank definitions. Data were collected for 682 patients from 95 hospitals and 23 countries. The overall mortality was 9.5%. Of the patients, 21.7% were children, with case fatality proportions of 1% for those less than 5 years. The highest mortality was in those above 60 years, at 18.6%. Case fatality varied by region: East Asia and Pacific 10.2% (21 of 206), Sub-Saharan Africa 4.3% (8 of 188), South Asia 0% (0 of 35), North America 13.6% (25 of 184), and Europe and Central Asia 14.3% (9 of 63). Mortality in low-income and low-middle-income countries combined was 4% as compared with 14% in high-income countries. Organ dysfunction scores calculated on presentation in 560 patients where full data were available revealed Sequential Organ Failure Assessment (SOFA) scores on presentation were significantly associated with mortality and hospital length of stay. Patients in East Asia and Pacific (48%) and North America (24%) had the highest SOFA scores of >12. Multivariable analysis demonstrated that initial SOFA score and age were independent predictors of hospital survival. There was variability across regions and income groupings for the critical care management and outcomes of SARI. Intensive care unit-specific factors, geography and management features were less reliable than baseline severity for predicting ultimate outcome. These findings may help in planning future outbreak severity assessments, but more globally representative data are required.
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- 2019
21. Anemia at Intensive Care Unit Admission and Hospital Mortality Among Patients at a Referral Hospital in Malawi.
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Prin, Meghan, Rui, Shumin, Pan, Stephanie, Kadyaudzu, Clement, Mehta, Parth S., Guohua Li, Charles, Anthony, and Li, Guohua
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HOSPITAL mortality , *INTENSIVE care units , *HOSPITAL admission & discharge , *MEDICAL referrals , *HOSPITAL patients - Abstract
Background: Anemia is associated with intensive care unit (ICU) outcomes, but data describing this association in sub-Saharan Africa are scarce. Patients in this region are at risk for anemia due to endemic conditions like malaria and because transfusion services are limited.Methods: This was a prospective cohort study of ICU patients at Kamuzu Central Hospital (KCH) in Malawi. Exclusion criteria included age <5 years, pregnancy, ICU readmission, or admission for head injury. Cumulative incidence functions and Fine-Gray competing risk models were used to evaluate hemoglobin (Hgb) at ICU admission and hospital mortality.Results: Of 499 patients admitted to ICU, 359 were included. The median age was 28 years (interquartile ranges (IQRs) 20-40) and 37.5% were men. Median Hgb at ICU admission was 9.9 g/dL (IQR 7.5-11.4 g/dL; range 1.8-18.1 g/dL). There were 61 (19%) patients with Hgb < 7.0 g/dL, 59 (19%) with Hgb 7.0-8.9 g/dL, and 195 (62%) with Hgb ≥ 9.0 g/dL. Hospital mortality was 51%, 59%, and 54%, respectively. In adjusted analyses, anemia was associated with hospital mortality but was not statistically significant.Conclusions: This study provides preliminary evidence that anemia at ICU admission may be an independent predictor of hospital mortality in Malawi. Larger studies are needed to confirm this association. [ABSTRACT FROM AUTHOR]- Published
- 2021
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22. Two success stories in the management of Guillain–Barré syndrome illustrate the challenges of intensive care unit care in Malawi.
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Onofrey, Lauren, Naus, Claire, Thakur, Kiran T, Kadyaudzu, Clement, and Prin, Meghan
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INTENSIVE care units ,NEUROLOGICAL disorders ,MENTAL health ,MEDICAL care ,SOCIAL context - Abstract
The management of critical illness is especially challenging in low-resource environments, and early recognition and supportive care are essential, regardless of the ability to employ advanced or invasive therapy. In this report, we discuss two patients with Guillain–Barré syndrome who were managed successfully in the intensive care unit of a tertiary hospital in Malawi. Both patients recovered and were discharged home. The management and outcomes of these patients provide case-based lessons for improving intensive care unit medicine in low-resource contexts. [ABSTRACT FROM AUTHOR]
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- 2021
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23. Outcomes Following Intensive Care Unit Admission in a Pediatric Cohort in Malawi.
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Purcell, Laura N, Prin, Meghan, Sincavage, John, Kadyaudzu, Clement, Phillips, Michael R, and Charles, Anthony
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INTENSIVE care units , *CRITICALLY ill children , *LOW-income countries , *ADULT respiratory distress syndrome , *PEDIATRIC intensive care , *EPINEPHRINE autoinjectors - Abstract
Introduction: The burden of critical illness in low- and middle-income countries (LMICs) is high; however, there is a paucity of data describing pediatric critical care outcomes in this setting.Methods: We performed a prospective observational study of the pediatric (≤18 years) intensive care population in Malawi, from August 2016 to May 2018. Data collected include patient demographics and clinical data, admission criteria and outcome. A multivariate Poisson regression was performed to determine risk factors for mortality.Results: Over the study period, 499 patients were admitted to the intensive care unit (ICU) and 105 (21.0%) were children. The average age was 10.6 ± 5.4 years. Primary indications for ICU admission were sepsis (n = 30, 30.3%) and traumatic brain injury (TBI, n = 23, 23.2%). Of those who died, sepsis (n = 18, 32.7%), acute respiratory failure (n = 11, 20.0%) and TBI (n = 11, 20.0%) were the primary admission diagnoses. Overall, ICU mortality was 54.3% (n = 57). Multivariate regression for increased ICU mortality revealed: age ≤5 years [risk ratio (RR) 1.96, 95% CI 1.10-2.26, p < 0.001], hemoglobin < 10 g/dl (RR 1.58, 95% CI 1.08-2.01, p = 0.01) and shock requiring epinephrine support (RR 2.76, 95% CI 1.80-4.23, p < 0.001).Conclusions: Pediatric ICU mortality is high. Predictors of mortality were age ≤5 years, anemia at ICU admission and the need for epinephrine support. Training of pediatric intensive care specialists and increased blood product availability may attenuate the high mortality for critically ill children in Malawi. [ABSTRACT FROM AUTHOR]- Published
- 2020
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24. Intensive Care Unit Bed Utilization and Head Injury Burden in a Resource-Poor Setting.
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Wong, Abby, Prin, Meghan, Purcell, Laura N., Kadyaudzu, Clement, and Charles, Anthony
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INTENSIVE care units , *HEAD injuries , *BEDS , *BRAIN death , *HIGH-income countries , *HOSPITAL utilization statistics , *LENGTH of stay in hospitals , *LONGITUDINAL method ,DEVELOPING countries - Abstract
Introduction: In high-income countries (HICs), the intensive care unit (ICU) bed density is approximately 20-32 beds/100 000 population compared with countries in sub-Saharan Africa, like Malawi, with an ICU bed density of 0.1 beds/100 000 population. We hypothesize that the ICU bed utilization in Malawi will be high.Methods: This is an observational study at a tertiary care center in Malawi from August 2016 to May 2018. Variables used to evaluate ICU bed utilization include ICU length of stay (LOS), bed occupancy rates (average daily ICU census/number of ICU beds), bed turnover (total number of admissions/number of ICU beds), and turnover intervals (number of ICU bed days/total number of admissions - average ICU LOS).Results: 494 patients were admitted to the ICU during the study period. The average LOS during the study period was 4.8 ± 6.0 days. Traumatic brain injury patients had the most extended LOS (8.7 ± 6.8 days) with a 49.5% ICU mortality. The bed occupancy rate per year was 74.7%. The calculated bed turnover was 56.5 persons treated per bed per year. The average turnover interval, defined as the number of days for a vacant bed to be occupied by the successive patient admission, was 1.63 days.Conclusion: Despite the high burden of critical illness, the bed occupancy rates, turn over days, and turnover interval reveal significant underutilization of the available ICU beds. ICU bed underutilization may be attributable to the absence of an admission and discharge protocols. A lack of brain death policy further impedes appropriate ICU utilization. [ABSTRACT FROM AUTHOR]- Published
- 2020
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25. Associations of day of week and time of day of ICU admission with hospital mortality in Malawi.
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Prin, Meghan, Ji, Ruoyu, Kadyaudzu, Clement, Li, Guohua, and Charles, Anthony
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INTENSIVE care units ,HOSPITAL mortality ,HOSPITAL care ,LONGITUDINAL method - Abstract
This prospective cohort study evaluated the associations of day and time of admission to the Intensive Care Unit (ICU) with hospital mortality at a referral hospital in Malawi, a low-income country in sub-Saharan Africa. Patients admitted to the ICU during the day (08:00-16:00) were compared to those admitted at night (16:01-07:59); patients admitted on weekdays (Monday-Friday) were compared to admissions on weekends/holidays. The primary outcome was hospital mortality. Most patients were admitted during daytime (56%) and on weekdays (72%). There was no difference in mortality between night and day admissions (58% vs. 56%, P = 0.8828; hazard ratio [HR] = 1.09, 95% confidence interval [CI = 0.82-1.44, P = 0.5614) or weekend/holiday versus weekday admissions (56% vs. 57%, P = 0.9011; HR = 0.87, 95% CI = 0.62-1.21, P = 0.4133). No interaction between time and day was found. These results may be affected by high overall hospital mortality. [ABSTRACT FROM AUTHOR]
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- 2020
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26. Prevalence, Etiology, and Outcome of Sepsis among Critically Ill Patients in Malawi.
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Prin, Meghan, Onofrey, Lauren, Purcell, Laura, Kadyaudzu, Clement, and Charles, Anthony
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- 2020
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27. Implications de la distanciation sociale en salle d’opération face à la COVID-19.
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Prin, Meghan and Bartels, Karsten
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- 2020
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28. Brain death in low-income countries: a report from Malawi.
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Prin, Meghan, Quinsey, Caroline, Kadyaudzu, Clement, Hadar, Eldad, and Charles, Anthony
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BRAIN death ,LOW-income countries ,INTENSIVE care patients - Abstract
Most low-income nations have no practice guidelines for brain death; data describing brain death in these regions is absent. Our retrospective study describes the prevalence of brain death among patients treated in an intensive care unit (ICU) at a referral hospital in Malawi. The primary outcome was designation of brain death in the medical chart. Of 449 ICU patients included for analysis between September 2016 and May 2018, 43 (9.6%) were diagnosed with brain death during the ICU admission. The most common diagnostic reasons for admission among these patients were trauma (49%), malaria (16%) and postoperative monitoring after general abdominal surgery (19%). All patients diagnosed with brain death were declared dead in the hospital, after cardiac death. In conclusion, the incidence of brain death in a Malawi ICU is substantially higher than that seen in high-income ICU settings. Brain death is not treated as clinical death in Malawi. [ABSTRACT FROM AUTHOR]
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- 2019
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29. High Sepsis-Related Mortality and Antimicrobial Resistance at a Referral Hospital in Malawi
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Prin, Meghan, Onofrey, Lauren, Purcell, Laura N., and Charles, Anthony G.
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- 2019
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30. Comment on: Potentially inappropriate medications in older adults visiting a geriatric emergency department.
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Prin, Meghan and Ginde, Adit
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INTENSIVE care units , *HOSPITAL emergency services , *INAPPROPRIATE prescribing (Medicine) , *ELDER care , *ANTIPSYCHOTIC agents , *OLD age - Abstract
See the reply by Martini et al [ABSTRACT FROM AUTHOR]
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- 2022
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31. tPA or not tPA? Lysis therapy in the setting of COVID‐19 and ECMO.
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Cromartie, Anjelica and Prin, Meghan
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- 2022
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32. Cancellation of Scheduled Surgery at a Tertiary Hospital in Sub-Saharan Africa: A Barrier to Access to Surgical Care
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Prin, Meghan, Eaton, Jessica, Mtalimanja, Onias, and Charles, Anthony G.
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- 2017
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33. Viral load monitoring and antiretroviral treatment outcomes in a pediatric HIV cohort in Ghana.
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Kukoyi, Omobolawa, Renner, Lorna, Powell, Jonathan, Barry, Oliver, Prin, Meghan, Kusah, Jonas, Xiangyu Cong, Paintsil, Elijah, and Cong, Xiangyu
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VIRAL load ,HIV ,HIV infections ,ANTIRETROVIRAL agents ,ANTIVIRAL agents ,HIV infection epidemiology ,COMPARATIVE studies ,DISEASES ,HOSPITAL care ,LONGITUDINAL method ,RESEARCH methodology ,MEDICAL cooperation ,OPPORTUNISTIC infections ,PEDIATRICS ,RESEARCH ,RESEARCH funding ,EVALUATION research ,TREATMENT effectiveness ,VIREMIA ,ANTI-HIV agents - Abstract
Background: HIV-infected children in sub-Saharan Africa may be at a high risk of staying on a failing first-line regimen and developing drug-resistance HIV variants due to lack of routine viral load monitoring. We investigated whether cumulative viral load, measured as viremia copy-years (VCY) could predict morbidity in a setting where viral load is not routinely monitored.Methods: This was a single-center prospective observational longitudinal study of HIV-infected children initiating antiretroviral therapy (ART) at the Pediatric HIV/AIDS Care program at Korle-Bu Teaching Hospital in Accra, Ghana. The main outcome was morbidity measured as frequency of hospitalizations, opportunistic infections, and outpatient sick visits. The main explanatory variable was viral load measured as VCY.Results: The study included 140 children who initiated ART between September 2009 and May 2013 and had at least 2 viral load measurements. There were 184 hospitalizations, with pneumonia being the most common cause (22.8 %). A total of 102 opportunistic infections was documented, with tuberculosis being the most common opportunistic infection (68 %). A total of 823 outpatient sick visits was documented, with upper respiratory infections (14.2 %) being the most common cause. Forty-four percent of our study participants had >4 log10 VCY. Children in this sub-cohort had a higher frequency of sick visits compared with those with <4 log10 VCY (p = 0.03). Only 6.5 % of children with >4 log10 VCY had been identified as treatment failure using WHO clinical and immunological treatment failure criteria.Conclusions: High level of cumulative viral load may translate to virological failure and subsequent increased all-cause morbidity. Our finding of potential utility of VCY in pediatrics warrants further investigations. VCY may be a good alternate to routine viral load measurement as its determination may be less frequent and could be personalized to save cost. [ABSTRACT FROM AUTHOR]- Published
- 2016
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34. Prophylactic Ondansetron for the Prevention of Intrathecal Fentanyl- or Sufentanil-Mediated Pruritus: A Meta-Analysis of Randomized Trials.
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Prin, Meghan, Guglielminotti, Jean, Moitra, Vivek, and Li, Guohua
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- 2016
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35. Effectiveness of first-line antiretroviral therapy and correlates of longitudinal changes in CD4 and viral load among HIV-infected children in Ghana.
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Barry, Oliver, Powell, Jonathan, Renner, Lorna, Bonney, Evelyn Y., Prin, Meghan, Ampofo, William, Kusah, Jonas, Goka, Bamenla, Sagoe, Kwamena W. C., Shabanova, Veronika, and Paintsil, Elijah
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HIGHLY active antiretroviral therapy ,HIV-positive children ,CD4 antigen ,VIRAL load ,LONGITUDINAL method ,PEDIATRIC clinics - Abstract
Background Antiretroviral therapy (ART) scale-up in resource-limited countries, with limited capacity for CD4 and HIV viral load monitoring, presents a unique challenge. We determined the effectiveness of first-line ART in a real world pediatric HIV clinic and explored associations between readily obtainable patient data and the trajectories of change in CD4 count and HIV viral load. Methods We performed a longitudinal study of a cohort of HIV-infected children initiating ART at the Korle-Bu Teaching Hospital Pediatric HIV clinic in Accra, Ghana, aged 0-13 years from 2009-2012. CD4 and viral load testing were done every 4 to 6 months and genotypic resistance testing was performed for children failing therapy. A mixed linear modeling approach, combining fixed and random subject effects, was employed for data analysis. Results Ninety HIV-infected children aged 0 to 13 years initiating ART were enrolled. The effectiveness of first-line regimen among study participants was 83.3%, based on WHO criteria for virologic failure. Fifteen of the 90 (16.7%) children met the criteria for virologic treatment failure after at least 24 weeks on ART. Sixty-seven percent virologic failures harbored viruses with ⩾ 1 drug resistant mutations (DRMs); M184V/K103N was the predominant resistance pathway. Age at initiation of therapy, child's gender, having a parent as a primary care giver, severity of illness, and type of regimen were associated with treatment outcomes. Conclusions First-line ART regimens were effective and well tolerated. We identified predictors of the trajectories of change in CD4 and viral load to inform targeted laboratory monitoring of ART among HIV-infected children in resource-limited countries. [ABSTRACT FROM AUTHOR]
- Published
- 2013
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36. International comparisons of intensive care: informing outcomes and improving standards.
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Prin, Meghan and Wunsch, Hannah
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- 2012
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37. For whole blood research, look to the whole world.
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Prin, Meghan, Mfune, Thomas, Njolomole, Stephen, Moore, Ernest Eugene, and Ginde, Adit
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HEMAPHERESIS , *HEALTH facilities , *DONOR blood supply - Abstract
Many countries in sub-Saharan Africa have utilized whole blood transfusion for haemorrhaging patients for decades. We read with interest the recent review from the Biomedical Excellence for Safer Transfusion (BEST) collaborative, which described the history, storage, and safety of whole blood for traumatic haemorrhage. Demographic characteristics of blood and blood components transfusion recipients and pattern of blood utilization in a tertiary health institution in southern Nigeria. [Extracted from the article]
- Published
- 2022
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38. Enhancing circadian rhythms-the circadian MEGA bundle as novel approach to treat critical illness.
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Prin M, Bertazzo J, Walker LA, Scott B, and Eckle T
- Abstract
Circadian rhythms are essential to physiological homeostasis, but often disrupted in the intensive care unit (ICU) due to the absence of natural zeitgebers and exposure to treatments which affect circadian regulators. This is increasingly recognized as a contributor to morbidity and mortality across a variety of medical conditions including critical illness. Maintenance of circadian rhythms is particularly relevant to critically ill patients, who are restricted not only to the ICU environment but often bed bound. Circadian rhythms have been evaluated in several ICU studies, but effective therapies to maintain, restore, or amplify circadian rhythms have not been fully established yet. Circadian entrainment and circadian amplitude enhancement are integral to patients' overall health and well-being, and likely even more important during response to and recovery from critical illness. In fact, studies have shown that enhancing the amplitude of circadian cycles has significant beneficial effects on health and wellbeing. In this review, we discuss up-to-date literature on novel circadian mechanism that could not only restore but enhance circadian rhythms in critical illness by using a MEGA bundle consisting of intense light therapy each morning, cyclic nutrition support, timed physical therapy, nighttime melatonin administration, morning administration of circadian rhythm amplitude enhancers, cyclic temperature control and a nocturnal sleep hygiene bundle., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://atm.amegroups.com/article/view/10.21037/atm-22-5127/coif). The series “Highlights in Anesthesia and Critical Care Medicine” was commissioned by the editorial office without any funding or sponsorship. TE served as the unpaid Guest Editor of the series and serves as an unpaid editorial board member of Annals of Translational Medicine from November 2021 to October 2023. BS served as the unpaid Guest Editor of the series. The authors have no other conflicts of interest to declare., (2023 Annals of Translational Medicine. All rights reserved.)
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- 2023
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39. Time-of-day dependent effects of midazolam administration on myocardial injury in non-cardiac surgery.
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Prin M, Pattee J, Douin DJ, Scott BK, Ginde AA, and Eckle T
- Abstract
Background: Animal studies have shown that midazolam can increase vulnerability to cardiac ischemia, potentially via circadian-mediated mechanisms. We hypothesized that perioperative midazolam administration is associated with an increased incidence of myocardial injury in patients undergoing non-cardiac surgery (MINS) and that circadian biology may underlie this relationship., Methods: We analyzed intraoperative data from the Multicenter Perioperative Outcomes Group for the occurrence of MINS across 50 institutions from 2014 to 2019. The primary outcome was the occurrence of MINS. MINS was defined as having at least one troponin-I lab value ≥0.03 ng/ml from anesthesia start to 72 h after anesthesia end. To account for bias, propensity scores and inverse probability of treatment weighting were applied., Results: A total of 1,773,118 cases were available for analysis. Of these subjects, 951,345 (53.7%) received midazolam perioperatively, and 16,404 (0.93%) met criteria for perioperative MINS. There was no association between perioperative midazolam administration and risk of MINS in the study population as a whole (odds ratio (OR) 0.98, confidence interval (CI) [0.94, 1.01]). However, we found a strong association between midazolam administration and risk of MINS when surgery occurred overnight (OR 3.52, CI [3.10, 4.00]) or when surgery occurred in ASA 1 or 2 patients (OR 1.25, CI [1.13, 1.39])., Conclusion: Perioperative midazolam administration may not pose a significant risk for MINS occurrence. However, midazolam administration at night and in healthier patients could increase MINS, which warrants further clinical investigation with an emphasis on circadian biology., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Prin, Pattee, Douin, Scott, Ginde and Eckle.)
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- 2022
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40. International Elective Opportunities in United States Anesthesia Residency Programs.
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Prin M and Phelps J
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Background: Global health is a recognized component of medical education and is increasingly included in residency programs. International electives have the potential to improve global health training by providing exposure to different populations and the challenges of health disparities. The objective of this study was to describe international elective opportunities in US anesthesiology residency training programs, including an assessment the types of programs offered and the obstacles to providing this type of training., Methods: An electronic survey was sent to 122 anesthesiology programs. The survey defined an international experience as "a time in which a current US anesthesiology resident traveled outside of the US to pursue a healthcare-related experience." Details describing international opportunities were collected. Responses were stratified by geographic region, program size, and by the availability of international electives. The websites of all surveyed programs were then reviewed to determine specific mention of international or global health programs. These results were compared to the survey responses., Results: In the website review, 33.6% of programs' websites described international electives for residents. Among all surveyed programs, 56 (45.9%) completed surveys were returned, with 39 (69.6%) of these programs offering international electives. Not all programs with electives described the offering on their websites. There was no relationship between program size or location and the availability of an elective. At most programs with international electives, at least 4 residents participated annually. Funding was the primary barrier to providing international electives. Perceptions of international electives were generally positive., Conclusions: A large proportion of US anesthesia residency programs offer international electives, and perceptions of global health in anesthesiology are positive. This is consistent with developments in global health in other subspecialty fields., Competing Interests: Conflicts of Interest: None.
- Published
- 2017
41. Hepatosplanchnic circulation in cirrhosis and sepsis.
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Prin M, Bakker J, and Wagener G
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- Animals, Hemodynamics, Humans, Liver Cirrhosis epidemiology, Liver Cirrhosis therapy, Prognosis, Risk Factors, Sepsis epidemiology, Sepsis therapy, Hepatic Artery physiopathology, Liver Circulation, Liver Cirrhosis physiopathology, Portal Vein physiopathology, Sepsis physiopathology, Splanchnic Circulation
- Abstract
Hepatosplanchnic circulation receives almost half of cardiac output and is essential to physiologic homeostasis. Liver cirrhosis is estimated to affect up to 1% of populations worldwide, including 1.5% to 3.3% of intensive care unit patients. Cirrhosis leads to hepatosplanchnic circulatory abnormalities and end-organ damage. Sepsis and cirrhosis result in similar circulatory changes and resultant multi-organ dysfunction. This review provides an overview of the hepatosplanchnic circulation in the healthy state and in cirrhosis, examines the signaling pathways that may play a role in the physiology of cirrhosis, discusses the physiology common to cirrhosis and sepsis, and reviews important issues in management.
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- 2015
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42. Time to and Predictors of CD4+ T-Lymphocytes Recovery in HIV-Infected Children Initiating Highly Active Antiretroviral Therapy in Ghana.
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Renner L, Prin M, Li FY, Goka B, Northrup V, and Paintsil E
- Abstract
Background. CD4+ T-lymphocyte monitoring is not routinely available in most resource-limited settings. We investigated predictors of time to CD4+ T-lymphocyte recovery in HIV-infected children on highly active antiretroviral (HAART) at Korle-Bu Teaching Hospital, Ghana. Methods. Time to CD4+ T-lymphocyte recovery was defined as achieving percent CD4+ T-lymphocytes of 25%. We used Cox proportional hazard models for identifying significant predictor variables. Results. Of the 233 children with complete CD4+ T-lymphocyte data, the mean age at HAART initiation was 5.5 (SD = 3.1) years. The median recovery time was 60 weeks (95% CL: 55-65). Evidence at baseline of severe suppression in CD4+ T-lymphocyte count adjusted for age, age at HAART initiation, gender, and having parents alive were statistically significant in predicting time to CD4+ T-lymphocyte recovery. Conclusions. A targeted approach based on predictors of CD4+ T-lymphocyte recovery can be a viable and cost-effective way of monitoring HAART in HIV-infected children in resource-limited settings.
- Published
- 2011
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