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2. RACHS-ANZ: A Modified Risk Adjustment in Congenital Heart Surgery Model for Outcome Surveillance in Australia and New Zealand

Author

McSharry, B, Straney, L, Alexander, J, Gentles, T, Winlaw, D, Beca, J, Millar, J, Shann, F, Wilkins, B, Numa, A, Stocker, C, Erickson, S, Slater, A, McSharry, B, Straney, L, Alexander, J, Gentles, T, Winlaw, D, Beca, J, Millar, J, Shann, F, Wilkins, B, Numa, A, Stocker, C, Erickson, S, and Slater, A

Abstract

Background Outcomes for pediatric cardiac surgery are commonly reported from international databases compiled from voluntary data submissions. Surgical outcomes for all children in a country or region are less commonly reported. We aimed to describe the bi-national population-based outcome for children undergoing cardiac surgery in Australia and New Zealand and determine whether the Risk Adjustment for Congenital Heart Surgery ( RACHS ) classification could be used to create a model that accurately predicts in-hospital mortality in this population. Methods and Results The study was conducted in all children's hospitals performing cardiac surgery in Australia and New Zealand between January 2007 and December 2015. The performance of the original RACHS -1 model was assessed and compared with an alternative RACHS - ANZ (Australia and New Zealand) model, developed balancing discrimination with parsimonious variable selection. A total of 14 324 hospital admissions were analyzed. The overall hospital mortality was 2.3%, ranging from 0.5% for RACHS category 1 procedures, to 17.0% for RACHS category 5 or 6 procedures. The original RACHS -1 model was poorly calibrated with death overpredicted (1161 deaths predicted, 289 deaths observed). The RACHS - ANZ model had better performance in this population with excellent discrimination (Az- ROC of 0.830) and acceptable Hosmer and Lemeshow goodness-of-fit ( P=0.216). Conclusions The original RACHS -1 model overpredicts mortality in children undergoing heart surgery in the current era. The RACHS - ANZ model requires only 3 risk variables in addition to the RACHS procedure category, can be applied to a wider range of patients than RACHS -1, and is suitable to use to monitor regional pediatric cardiac surgery outcomes.

Published
2019

6. British Society of Haematology, Slide Session presented at the Annual Scientific Meeting, Brighton 2009

Author

McLORNAN, D. P., primary, BURTHEM, J., additional, DUNCOMBE, A., additional, HATTON, C., additional, HUTCHINSON, C. V., additional, MARSDEN, K., additional, MACARTNEY, C. M., additional, SMITH-STRANEY, T., additional, UPRICHARD, J., additional, WALLIS, J., additional, WEBB, S., additional, WILKINS, B. S., additional, and McMULLIN, M. F., additional

Published
2010
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44. Validity and feasibility of remote measurement systems for functional movement and posture assessments in people with axial spondylarthritis.

Author

Hannink E, Mansoubi M, Cronin N, Wilkins B, Najafi AA, Waller B, and Dawes H

Abstract

Introduction: This study aimed to estimate the criterion validity of functional movement and posture measurement using remote technology systems in people with and without Axial spondylarthritis (axSpA)., Methods: Validity and agreement of the remote-technology measurement of functional movement and posture were tested cross-sectionally and compared to a standard clinical measurement by a physiotherapist. The feasibility of remote implementation was tested in a home environment. There were two cohorts of participants: people with axSpA and people without longstanding back pain. In addition, a cost-consequence analysis was performed., Results: Sixty-two participants (31 with axSPA, 53% female, age = 45(SD14), BMI = 26.6(SD4.6) completed the study. In the axSpA group, cervical rotation, lumbar flexion, lumbar side flexion, shoulder flexion, hip abduction, tragus-to-wall and thoracic kyphosis showed a significant moderate to strong correlation; in the non-back pain group, the same measures showed significant correlation ranging from weak to strong., Conclusions: Although not valid for clinical use in its current form, the remote technologies demonstrated moderate to strong correlation and agreement in most functional and postural tests measured in people with AxSA. Testing the CV-aided system in a home environment suggests it is a safe and feasible method. Yet, validity testing in this environment still needs to be performed., Competing Interests: Erin Hannink helped design the trial design as a paid consultant of Good Boost Wellbeing Ltd during the project but was not directly involved in data analysis. Neil Cronin developed the CV approach as a paid consultant of Good Boost Wellbeing Ltd during the project but was not directly involved in data collection. Benjamin Waller and Benjamin Wilkins were paid employees of Good Boost Wellbeing Ltd during the project but were not involved in data analysis or interpretation. All statistical comparisons between methods were performed independently by researchers at Oxford Brookes University and University of Exeter., (© 2022 The Authors. Healthcare Technology Letters published by John Wiley & Sons Ltd on behalf of The Institution of Engineering and Technology.)

Published
2022
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45. Autonomic cardiovascular control during a novel pharmacologic alternative to ganglionic blockade.

Author

Wilkins BW, Hesse C, Charkoudian N, Nicholson WT, Sviggum HP, Moyer TP, Joyner MJ, and Eisenach JH

Subjects
Adrenergic alpha-Agonists administration & dosage, Adult, Autonomic Nerve Block methods, Baroreflex drug effects, Baroreflex physiology, Cardiac Output drug effects, Cardiovascular System innervation, Catecholamines metabolism, Female, Heart Rate drug effects, Humans, Male, Muscarinic Antagonists administration & dosage, Phenylephrine administration & dosage, Sympathetic Nervous System drug effects, Cardiovascular System drug effects, Dexmedetomidine administration & dosage, Ganglionic Blockers administration & dosage, Glycopyrrolate administration & dosage, Trimethaphan administration & dosage
Abstract

The purpose of this study was to compare ganglionic blockade with trimethaphan (TMP) and an alternative drug strategy using combined muscarinic antagonist (glycopyrrolate, GLY) and alpha-2 agonist (dexmedetomidine, DEX). Protocol 1: incremental phenylephrine was administered during control and combined GLY-DEX, or control and TMP on two control combined GLY and DEX or TMP infusion on two randomized days. Protocol 2: muscle sympathetic nerve activity (MSNA) and the baroreflex MSNA relationship was determined before and after GLY-DEX. Blood pressure was higher with GLY-DEX (99+/-3 mm Hg) and lower with TMP (78+/-3 mm Hg) relative to control (GLY-DEX: 90+/-2 mm Hg; TMP: 91+/-2 mm Hg; P<0.05). Incremental phenylephrine increased pressure during GLY-DEX (P<0.01 vs control) and TMP (P<0.01 vs control) to a similar degree. Both GLY-DEX and TMP infusion inhibited norepinephrine release (P<0.01 vs control). GLY-DEX inhibited baseline MSNA (P<0.05) and baroreflex changes in MSNA (P<0.01). We conclude that the GLY-DEX alternative drug strategy can be used as a reasonable alternative to pharmacologic ganglionic blockade to examine autonomic cardiovascular control.

Published
2008
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