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1. Albumin Versus Balanced Crystalloid for the Early Resuscitation of Sepsis: An Open Parallel-Group Randomized Feasibility Trial. The ABC-Sepsis Trial

Author

Gray, Alasdair J., Oatey, Katherine, Grahamslaw, Julia, Irvine, Sîan, Cafferkey, John, Kennel, Titouan, Norrie, John, Walsh, Tim, Lone, Nazir, Horner, Daniel, Appelboam, Andy, Hall, Peter, Skipworth, Richard J. E., Bell, Derek, Rooney, Kevin, Shankar-Hari, Manu, Corfield, Alasdair R., Newcombe, Virginia, Chapman, Robert, Hutton, Corinne, Perkins, Gavin, Gordon, Anthony, Keating, Liza, Pallmann, Philip, Armstrong, Ruth, Pollock, Roz, Wackett, Tony, Chapman, Robert, Hutton, Corrine, Kale, Jane, Kale, Neville, Anderson, Rory, Birrell, David, Black, Polly, Blackstock, Caroline, Carter, Jonathan, Clark, Donna, Davidson, Craig, Davie, Carlyn, Rollo, Nicola Di, Ferguson, Andrew, Fethers, Nicholas, Freeman, Nicola, Gibson, Louise, Grant, Alison, Harris, Marie-Clare, James, Ed, Letham, Katy, Lynch, Stephen, McCurrach, Fiona, McKenzie, Suzi, McLaughlin, Connor, Miell, Anna, Moncur, Lyle, O’Brien, Rachel, Pickering, Gillian, Reed, Matt, Rezai, Roozbeh, Robinson, Sara, Skinner, Janet, Walker, Craig, Williams, Alison, Wilson, Emma-Beth, Di Rollo, Nicola, Carruthers, Jennifer, Cheyne, Claire, McGeough, Angela, Lidstone-Scott, Rebecca, Lynch, Stephen, Abel, Lynn, Bongale, Santosh, Currie, Susie, Kane, Donna, Keen, Rachel, Orlikowska, Izabella, Rodden, Natalie, Tait, Jennifer, Thomson, Nicola, Walker, Lauren, Smith, Kate, Brown, Ammani, Cathcart, Susanne, Maguire, Donogh, O’Mailley, Patrick, Rimmer, Dominic, Ward, Catherine, Baxter, Nicola, Denny, Fraser, Doran, Kayleigh, Dunlop, Lisa, Dunn, Jessica, Finnen, Lisa, Green, Darren, Hughes, Emma, Lowe, David, McArthur, Courtney, McLaren, Barbara, McLeish, Kirsty, McMunigal, Linda, McParland, Chris, O’Shaughnessy, Ornagh, Wilson, Mark, Armes, Roland, Brown, Craig, Cooper, Jamie, Connor, David, Collier-Wakefield, Otto, Coutts, Mandi, Cruickshank, Mairi, Ebtehadj, Bianca, Ganley, Pauline, Hiscox, John, Hartman, Catharina, Kane, Leia, Kastora, Stavroula, Lamb, Sarah, McCarthy, Sinead, Mulholland, Conal, Nadim, Imran, Noble, Jennifer, Patton, Gareth, Savage, David, Spowage-Delaney, Benjamin, Doonan, Reece, Lee, Stephanie, Strange, Joshua, Barham, Ffion, Bosanko, Clare, Bullough, Richard, Danglosi, Joan, Freeman, Elaine, Jackson, Luci-Adele, James, Robert, Jose, Louise, Lowe, Fionna, Lowther, Ashleigh, McCarthy, Ian, McConnell, David, Parry, Richard, Shirreff, Henry, Smith, Jason, Squire, Rosalyn, Battishill, Wayne, Boggaram, Girish, Chilcott, Gemma, Gagg, James, Machin, Emma, Shovelton, Charmaine, Purnell, Rebecca, Crosthwaite-Eyre, Richard, Page, George, Pitt, Andrew, Riou, Peter, Sykes, Daisy, Worth, Cassie, Zitter, Lily, Baron, Tanya, Baskaran, Dineshbabu, Beer, Sally, Bhargav, Akshay, Blamey, Helen, Brown, Charlotte, Clare-Gray, Benjamin, Davies, Matthew, Dawson, Neil, Dineen, Karen, Edgar, Iain, Erasu, Vishakha, Faisal, Muhammad, Georgiou, Dominique, Gibson, Alice, Ghataoura, Rashpal, Glover, Samuel, Gordon, Olivia, Ilyas, Sadaf, Jeffs, Aimee, Knott, Henry, Kundoor, Sneha, Martinez, Jose, McCallum, Andrew, Novak, Alex, Panduro, Tine, Pattanshetty, Ravi, Paul, Immanuel, Magallano, Rufino Roger, Razdan, Pamposh, Sambo, Tinelly, Shah, Sumaiyah, Shaikh, Ayisha, Smith, Simon, Thraves, Hannah, Tickle, Charlotte, Ang, Justin, Boyle, Adrian, Hardwick, Susie, Meynell, Kerry, Miller, Samuel, Charsley, Julia, Jolly, Sarah, Mahony, Faye, Moseley-Rodgers, Jade, Sivayoham, Narani, Sheerin, Thomas, Seel, Claire, Abdalla, Mohamed, Cameron, Gregor, Harnett, James, Ramos, Daryl, Perez, Fabiola Sevilla, White, Rachel, Abdullah, Wajiha, Ballard, Suzanna, Barnes, Katie, Clegg, Rebecca, Cousins, Elisha, Cumiskey, Simon, Elwir, Bashar, Ferriman, Alexander, Fletcher, Alison, Griffiths, Charlotte, Guiling, Paolyn, Johnson, Graham, Loach, Benjamin, Matthews, Alison, May-Moulden, Lucy, Norman, Rebecca, Seelly, Helen, Smith, Richard, Tabner, Andrew, Tilbury, Nicholas, Ward, Thomas, Wright, Lianne, Wroblewski, Heather, and Zawadzka, Marcelina

Published
2024
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2. A Machine Learning Approach for Colles’ Fracture Treatment Diagnosis

Author

Ngan, Kwun Ho, Garcez, Artur d’Avila, Knapp, Karen M., Appelboam, Andy, Reyes-Aldasoro, Constantino Carlos, Filipe, Joaquim, Editorial Board Member, Ghosh, Ashish, Editorial Board Member, Kotenko, Igor, Editorial Board Member, Prates, Raquel Oliveira, Editorial Board Member, Zhou, Lizhu, Editorial Board Member, Papież, Bartłomiej W., editor, Namburete, Ana I. L., editor, Yaqub, Mohammad, editor, and Noble, J. Alison, editor

Published
2020
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3. Levetiracetam versus phenytoin for second-line treatment of paediatric convulsive status epilepticus (EcLiPSE): a multicentre, open-label, randomised trial

Author

Pereira, Matthew, Hardwick, Susie, Messahel, Shrouk, Noblet, Joanne, Lee, Elizabeth D, Greenwood-Bibby, Rachel, Buchanan, Mark, Lewis, Lucy, Hughes, Sharon, Hartshorn, Stuart, Rogers, Louise, Hopkins, Juliet, Lyttle, Mark D, Fernandez, Daphin, Potter, Sarah, Lavigne-Smith, Holly R, Moulsdale, Phoebe, Smith, Alice, Bingham, Tracey, Ross, James, Ramsey, Natasha, Hacking, Jo, Mullen, Niall, Corrigan, Paul P, Prudhoe, Sarah, Faza, Hani, Robinson, Gisela, Sunley, Rachel C, Smith, Coral J, Unsworth, Vanessa, Criddle, John, Laque, Martin, Sheedy, Alyce B, Anderson, Mark, Bell, Kathryn, Devine, Kirsty, Scott, Alex, Kumar, Ramesh, Armstrong, Sonia, Sutherland, Emer, Cantle, Fleur, Helyer, Sinead, Riozzi, Paul, Cotton, Hannah, Downes, Alice J, Mollard, Helen, Roland, Damian, Hay, Felix, Gough, Christopher, Finucane, Sonya, Bevan, Catherine, Ramsay, Rebecca, Walton, Emily, Maney, Julie-Ann, Dalzell, Elizabeth, Millar, Muriel, Howells, Rachel J, Appelboam, Andy, Mackle, Daisy, Small, Jennie, Neil, Ashleigh, Choudhery, Vince, MacLeod, Stewart, Browning, Jen, O'Neill, Thomas, Grahamslaw, Julia, Parikh, Ami, Skene, Imogen, Thomas, Rhys, Potier de la Morandiere, Katherine, Wilson, Jill L, Danziger, Donna, Burke, Derek, Ramlakhan, Shammi, Evans, Jayne, Morcombe, Julie, Gormley, Stuart, Barling, Jason M, Cathie, Katrina, Bayreuther, Jane, Ensom, Ruth, Iqbal, Yasser, Rounding, Sarah, Mulligan, Joanne, Bell, Claire, McLellan, Shona, Leighton, Shona, Sajjanhar, Tina, Nyirenda, Maggie, Crome, Laura, Williamson, Neil, Alcock, Anastasia, Edwards, Sara, Morgan, Jeff, Powell, Colin VE, Ramesh, Chaniyil A, Kamal-Uddin, Solomon, Linney, Mike, Vamvakiti, Katia, Floyd, Sharon, Hobden, Gill, Rainford, Naomi E A, Gamble, Carrol, Humphreys, Amy, Hickey, Helen, Woolfall, Kerry, Roper, Louise, Tate, Paul, Iyer, Anand, Evans, Vicki, and Appleton, Richard E

Published
2019
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4. Supplemental Material - Albumin versus balanced crystalloid for resuscitation in the treatment of sepsis: A protocol for a randomised controlled feasibility study, 'ABC-Sepsis'

Author

Cafferkey, John, Ferguson, Andrew, Grahamslaw, Julia, Oatey, Katherine, Norrie, John, Lone, Nazir, Walsh, Timothy, Horner, Daniel, Appelboam, Andy, Hall, Peter, Skipworth, Richard, Bell, Derek, Rooney, Kevin, Shankar-Hari, Manu, Corfield, Alasdair, and Gray, Alasdair

Subjects
111708 Health and Community Services, FOS: Clinical medicine, Cardiology, 110323 Surgery, FOS: Health sciences, 110305 Emergency Medicine
Abstract

Supplemental Material for Albumin versus balanced crystalloid for resuscitation in the treatment of sepsis: A protocol for a randomised controlled feasibility study, “ABC-Sepsis” by John Cafferkey, Andrew Ferguson, Julia Grahamslaw, Katherine Oatey, John Norrie, Timothy Walsh, Nazir Lone, Daniel Horner, Andy Appelboam, Peter Hall, Richard Skipworth, Derek Bell, Kevin Rooney, Manu Shankar-Hari, Alasdair Corfield and Alasdair Gray in Journal of the Intensive Care Society

Published
2023
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5. Albumin versus balanced crystalloid for resuscitation in the treatment of sepsis: A protocol for a randomised controlled feasibility study, “ABC-Sepsis”

Author

Cafferkey, John, primary, Ferguson, Andrew, additional, Grahamslaw, Julia, additional, Oatey, Katherine, additional, Norrie, John, additional, Lone, Nazir, additional, Walsh, Timothy, additional, Horner, Daniel, additional, Appelboam, Andy, additional, Hall, Peter, additional, Skipworth, Richard, additional, Bell, Derek, additional, Rooney, Kevin, additional, Shankar-Hari, Manu, additional, Corfield, Alasdair, additional, and Gray, Alasdair, additional

Published
2022
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8. Levetiracetam versus phenytoin for second-line treatment of paediatric convulsive status epilepticus (EcLiPSE): a multicentre, open-label, randomised trial

Author

Lyttle, Mark D., Rainford, Naomi E.A., Gamble, Carrol, Messahel, Shrouk, Humphreys, Amy, Hickey, Helen, Woolfall, Kerry, Roper, Louise, Noblet, Joanne, Lee, Elizabeth D., Potter, Sarah, Tate, Paul, Iyer, Anand, Evans, Vicki, Appleton, Richard E., Pereira, Matthew, Hardwick, Susie, Greenwood-Bibby, Rachel, Buchanan, Mark, Lewis, Lucy, Hughes, Sharon, Hartshorn, Stuart, Rogers, Louise, Hopkins, Juliet, Fernandez, Daphin, Lavigne-Smith, Holly R., Moulsdale, Phoebe, Smith, Alice, Bingham, Tracey, Ross, James, Ramsey, Natasha, Hacking, Jo, Mullen, Niall, Corrigan, Paul P., Prudhoe, Sarah, Faza, Hani, Robinson, Gisela, Sunley, Rachel C., Smith, Coral J., Unsworth, Vanessa, Criddle, John, Laque, Martin, Sheedy, Alyce B., Anderson, Mark, Bell, Kathryn, Devine, Kirsty, Scott, Alex, Kumar, Ramesh, Armstrong, Sonia, Sutherland, Emer, Cantle, Fleur, Helyer, Sinead, Riozzi, Paul, Cotton, Hannah, Downes, Alice J., Mollard, Helen, Roland, Damian, Hay, Felix, Gough, Christopher, Finucane, Sonya, Bevan, Catherine, Ramsay, Rebecca, Walton, Emily, Maney, Julie Ann, Dalzell, Elizabeth, Millar, Muriel, Howells, Rachel J., Appelboam, Andy, Mackle, Daisy, Small, Jennie, Neil, Ashleigh, Choudhery, Vince, MacLeod, Stewart, Browning, Jen, O'Neill, Thomas, Grahamslaw, Julia, Parikh, Ami, Skene, Imogen, Thomas, Rhys, Potier de la Morandiere, Katherine, Wilson, Jill L., Danziger, Donna, Burke, Derek, Ramlakhan, Shammi, Evans, Jayne, Morcombe, Julie, Gormley, Stuart, Barling, Jason M., Cathie, Katrina, Bayreuther, Jane, Ensom, Ruth, Iqbal, Yasser, Rounding, Sarah, Mulligan, Joanne, Bell, Claire, McLellan, Shona, Leighton, Shona, Sajjanhar, Tina, Nyirenda, Maggie, and Crome, Laura

Subjects
Centre for Health and Clinical Research, levetiracetam, phenytoin, convulsive status epilepticus, epilepsy, paediatric
Abstract

Background Phenytoin is the recommended second-line intravenous anticonvulsant for treatment of paediatric convulsive status epilepticus in the UK; however, some evidence suggests that levetiracetam could be an effective and safer alternative. This trial compared the efficacy and safety of phenytoin and levetiracetam for second-line management of paediatric convulsive status epilepticus.Methods This open-label, randomised clinical trial was undertaken at 30 UK emergency departments at secondary and tertiary care centres. Participants aged 6 months to under 18 years, with convulsive status epilepticus requiring second-line treatment, were randomly assigned (1:1) using a computer-generated randomisation schedule to receive levetiracetam (40 mg/kg over 5 min) or phenytoin (20 mg/kg over at least 20 min), stratified by centre. The primary outcome was time from randomisation to cessation of convulsive status epilepticus, analysed in the modified intention-to-treat population (excluding those who did not require second-line treatment after randomisation and those who did not provide consent). This trial is registered with ISRCTN, number ISRCTN22567894.Findings Between July 17, 2015, and April 7, 2018, 1432 patients were assessed for eligibility. After exclusion of ineligible patients, 404 patients were randomly assigned. After exclusion of those who did not require second-line treatment and those who did not consent, 286 randomised participants were treated and had available data: 152 allocated to levetiracetam, and 134 to phenytoin. Convulsive status epilepticus was terminated in 106 (70%) children in the levetiracetam group and in 86 (64%) in the phenytoin group. Median time from randomisation to cessation of convulsive status epilepticus was 35 min (IQR 20 to not assessable) in the levetiracetam group and 45 min (24 to not assessable) in the phenytoin group (hazard ratio 1·20, 95% CI 0·91–1·60; p=0·20). One participant who received levetiracetam followed by phenytoin died as a result of catastrophic cerebral oedema unrelated to either treatment. One participant who received phenytoin had serious adverse reactions related to study treatment (hypotension considered to be immediately life-threatening [a serious adverse reaction] and increased focal seizures and decreased consciousness considered to be medically significant [a suspected unexpected serious adverse reaction]). Interpretation Although levetiracetam was not significantly superior to phenytoin, the results, together with previously reported safety profiles and comparative ease of administration of levetiracetam, suggest it could be an appropriate alternative to phenytoin as the first-choice, second-line anticonvulsant in the treatment of paediatric convulsive status epilepticus.

Published
2019

13. Testing of a novel Valsalva Assist Device with supine and modified positions in healthy volunteers.

Author

FitzGerald, Isabel, Ewings, Paul, Lang, Iain, and Appelboam, Andy

Abstract

Background The Valsalva manoeuvre (VM) is used to treat supraventricular tachycardia (SVT) by inducing a vagal response (drop in HR). There is debate as to the best position in which to carry out the VM and how the strain should be delivered in practice. We aimed to compare vagal responses induced with supine and modified VMs using strains delivered with a standardised manometer or novel Valsalva Assist Device (VAD), a simple device to provide resistance to exhalation. Methods We conducted a repeated measures randomised trial of four VMs (two supine VM and two modified VMs), in healthy adult volunteers, with strains delivered using an adapted sphygmomanometer (manometer) or a VAD. Changes in HR, pressure and duration of strain and adverse events were monitored and compared between the techniques and devices. The trial was approved by the University of Exeter Medical School Research ethics committee. Results 75 healthy participants aged 19-55 years were recruited over a 4-month period. A mixed-effects linear regression showed the modified VM resulted in a 3.8 beats per min (bpm) greater drop in HR compared with the supine VM (p=0.002, 95% CI 2.2 to 5.4). VM strains produced by the VAD were of a similar pressure but of slightly shorter duration and resulted in a 1.9 bpm smaller drop in HR compared with the manometer (p=0.01, 95% CI 0.4 to 3.4). There were no differences in adverse events. Conclusions Modified VM was associated with a greater drop in HR than a supine VM with no increase in adverse events in healthy volunteers. The VAD can be used to safely generate the recommended VM strain pressure, but produced a smaller drop in HR compared with a manometer and requires modification to enable the recommended strain duration to be achieved consistently. [ABSTRACT FROM AUTHOR]

Published
2019
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19. Do patients with minimally displaced distal radial fractures need a plaster cast?

Author

Costa ML, Appelboam A, Johnson NA, Mechlenburg I, and Gundtoft PH

Subjects
Humans, Splints, Casts, Surgical, Radius Fractures therapy
Abstract

Traditionally, patients with a fracture of the distal radius are treated in a cast if they do not require surgery. If the fracture requires manipulation, the cast is moulded to hold the reduction and maintain normal anatomical alignment during healing. However, is a cast necessary for patients whose fracture does not require manipulation? Removable splints are an alternative treatment option. Such splints have the advantage that they can be adjusted to improve fit around the wrist as swelling reduces, and can be removed and reapplied for the purpose of washing or, in some cases, exercise. However, evidence for their safety and effectiveness in the management of distal radius fractures is lacking. DRAFT3 is a multicentre randomized non-inferiority trial and economic analysis designed to determine the safety and effectiveness of removable splints as an alternative to casts in the treatment of distal radius fractures that do not require manipulation., Competing Interests: M. L. Costa's employer, the University of Oxford, receives research grant funding from the National Institute for Health and Care Research (NIHR) and Wellcome Trust for research into musculoskeletal trauma. A. Appelboam reports that the time spent on the related DRAFT3 study was covered by a study grant from the NIHR, but that this grant was unrelated to this article. A. Appelboam also holds unpaid positions on data monitoring committees for the Concept and Aspired trials – unrelated trials looking at detection of cardiac arrythmia and management of pneumothorax. N. Johnson is a co-applicant on the NIHR HTA grant for this study (NIHR134681). I. Mechlenburg reports royalties from FADL's Forlag, institutional funding from Karen Elise Jensens Fond exercise in femoroacetabular impingement, MRFF, and Danmarks Fri Forskningsfond, unrelated to this study. I. Mechlenburg is also a member of the steering committee for the Danish Hip Arthroplasty Registry., (© 2025 The British Editorial Society of Bone & Joint Surgery.)

Published
2025
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20. Testing of a novel Valsalva Assist Device with supine and modified positions in healthy volunteers.

Author

FitzGerald I, Ewings P, Lang I, and Appelboam A

Subjects
Adult, Female, Healthy Volunteers, Humans, Male, Middle Aged, Supine Position physiology, Vagus Nerve physiology, Vagus Nerve Stimulation methods, Equipment Design standards, Heart Rate physiology, Vagus Nerve Stimulation instrumentation, Valsalva Maneuver physiology
Abstract

Background: The Valsalva manoeuvre (VM) is used to treat supraventricular tachycardia (SVT) by inducing a vagal response (drop in HR). There is debate as to the best position in which to carry out the VM and how the strain should be delivered in practice. We aimed to compare vagal responses induced with supine and modified VMs using strains delivered with a standardised manometer or novel Valsalva Assist Device (VAD), a simple device to provide resistance to exhalation., Methods: We conducted a repeated measures randomised trial of four VMs (two supine VM and two modified VMs), in healthy adult volunteers, with strains delivered using an adapted sphygmomanometer (manometer) or a VAD. Changes in HR, pressure and duration of strain and adverse events were monitored and compared between the techniques and devices. The trial was approved by the University of Exeter Medical School Research ethics committee., Results: 75 healthy participants aged 19-55 years were recruited over a 4-month period. A mixed-effects linear regression showed the modified VM resulted in a 3.8 beats per min (bpm) greater drop in HR compared with the supine VM (p=0.002, 95% CI 2.2 to 5.4). VM strains produced by the VAD were of a similar pressure but of slightly shorter duration and resulted in a 1.9 bpm smaller drop in HR compared with the manometer (p=0.01, 95% CI 0.4 to 3.4). There were no differences in adverse events., Conclusions: Modified VM was associated with a greater drop in HR than a supine VM with no increase in adverse events in healthy volunteers. The VAD can be used to safely generate the recommended VM strain pressure, but produced a smaller drop in HR compared with a manometer and requires modification to enable the recommended strain duration to be achieved consistently., Trial Registration Number: NCT03298880., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Published
2019
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