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1. Psychological distress and trauma in doctors providing frontline care during the COVID-19 pandemic in the United Kingdom and Ireland: a prospective longitudinal survey cohort study

Author

Daniel Horner, Jo Daniels, Charles Reynard, James Foley, Blair Graham, Mark David Lyttle, M Anderson, J Browning, M Clark, S Foster, S Hartshorn, M Jacobs, S Messahel, N Mullen, J Brown, Michael Barrett, S Subramaniam, S Williams, A Ahmed, E Williams, S Hall, Edward Carlton, C Bi, M Khan, R Hannah, S Taylor, L Dunlop, J Gumley, K Knight, C Williams, J Turner, B Taylor, R Mills, M Lim, J Evans, C O’Connell, Tom Roberts, A Rai, P Singh, M Williams, S Graham, Etimbuk Umana, R Taylor, S Rahman, J Wright, J Lynch, S Lewis, P Fitzpatrick, J Ng, V Talwar, N Ali, G Pells, P Ellis, J Bailey, John Cronin, J Morgan, K Samuel, A Ali, M Patel, R Evans, S Morgan, A Hill, S Rao, S Currie, C Thomas, K Thomas, William Hulme, Katie Samuel, Robert Hirst, H Cooper, L McKechnie, S Pradhan, A Brookes, W Niven, L Kane, C Rimmer, K Kaur, R Stewart, T Hussan, P Cuthbert, M Alex, F Barham, R Macfarlane, M Jee Poh Hock, C Ward, C Weegenaar, O Williams, S Manou, MH Elwan, C Nunn, C Reynard, L How, D McConnell, J Muller, H Malik, K Challen, C Magee, S Pintus, S Langston, C Szekeres, L Kehler, C Leech, Y Moulds, A Mackay, R Wright, A Saunders, S Naeem, N Cherian, C Boulind, L Brown, E Grocholski, A Tabner, M Colmar, D Raffo, L Somerset, C Holmes, L Armstrong, S Collins, J Lowe, J Ritchie, F Wood, M Mohammad, S Wilson, R O'Sullivan, R Ellis, M MacKenzie, B Johnson, R Das, L Robinson, P Turton, L Robertson, A Robertson, J Hunt, João Vinagre, H Millar, R Freeman, A Corfield, R McQuillan, A Hormis, L Mackenzie, S Sharma Hajela, J Phizacklea, J Maney, K Malik, D Metcalfe, N Mathai, S Timmis, A Sattout, R Newport, E Fadden, D Bawden, B O'Hare, C Roe, D Bewick, F Taylor, L Barnicott, A Charlton, L McCrae, C Munday, E Godden, A Turner, R Sainsbury, A Lawrence-Ball, R House, S Patil, I Skene, M Winstanley, N Tambe, D Mawhinney, M Elkanzi, T Perry, W Kan, M Cheema, A Clarey, R Greenhalgh, A Gulati, S Marimuthu, K Webster, A Howson, R Doonan, B Shrestha, L Stanley, A Trimble, E Colley, J Lockwood, T Mohamed, H Jarman, S Ramraj, V Worsnop, N Masood, R McLatchie, A Peasley, S Bongale, U Bait, S Nagendran, A Hay, F Mendes, H Raybould, T Baron, C Ponmani, M Depante, R Sneep, Z Al-Janabi, A Rainey, N Marriage, B Mallon, J McLaren, S Hart, M Elsheikh, L Cocker, S Keers, K L Vincent, D Craver, N Sarja, N Moultrie, M Viegas, S Purvis, E Wooffinden, C Davies, S Foreman, A Da-Costa, C Ngua, S Duckitt, N Hoskins, J Fryer, T Hine, F Ihsan, L Frost, H Abdullah, K Bader, K Gray, M Manoharan, R Muswell, P Amiri, M Bonsano, S Shrivastava, F Raza, E Christmas, M Riyat, L O'Rourke, H Knott, K Adeboye, M Ramazany, K Iftikhar, N Abela, R Darke, D Maasdorp, H Murphy, H Edmundson, c Orjioke, L Harwood, D Worley, K Lines, W Collier, J Everson, D Ranasinghe, N Maleki, A Stafford, S Gokani, M Charalambos, A Olajide, H Ahmad, K Holzman, A Patton, S Gilmartin, S Uí Bhroin, S Kukaswadia, C Prendergast, C Dalla Vecchia, M Grummell, I Grossi, B MacManus, A Boyle, A Waite, J Vinagre, D George, C Battle, J Anandarajah, I Hancock, D Manthalapo, Ramesh Babu, FM Burton, I Musliam, Veettil Asif, and M JeePoh Hock

Subjects
Medicine
Abstract

Objectives The psychological impact of the COVID-19 pandemic on doctors is a significant concern. Due to the emergence of multiple pandemic waves, longitudinal data on the impact of COVID-19 are vital to ensure an adequate psychological care response. The primary aim was to assess the prevalence and degree of psychological distress and trauma in frontline doctors during the acceleration, peak and deceleration of the COVID-19 first wave. Personal and professional factors associated with psychological distress are also reported.Design A prospective online three-part longitudinal survey.Setting Acute hospitals in the UK and Ireland.Participants Frontline doctors working in emergency medicine, anaesthetics and intensive care medicine during the first wave of the COVID-19 pandemic in March 2020.Primary outcome measures Psychological distress and trauma measured using the General Health Questionnaire-12 and the Impact of Events-Revised.Results The initial acceleration survey distributed across networks generated a sample of 5440 doctors. Peak and deceleration response rates from the original sample were 71.6% (n=3896) and 56.6% (n=3079), respectively. Prevalence of psychological distress was 44.7% (n=1334) during the acceleration, 36.9% (n=1098) at peak and 31.5% (n=918) at the deceleration phase. The prevalence of trauma was 23.7% (n=647) at peak and 17.7% (n=484) at deceleration. The prevalence of probable post-traumatic stress disorder was 12.6% (n=343) at peak and 10.1% (n=276) at deceleration. Worry of family infection due to clinical work was the factor most strongly associated with both distress (R2=0.06) and trauma (R2=0.10).Conclusion Findings reflect a pattern of elevated distress at acceleration and peak, with some natural recovery. It is essential that policymakers seek to prevent future adverse effects through (a) provision of vital equipment to mitigate physical and psychological harm, (b) increased awareness and recognition of signs of psychological distress and (c) the development of clear pathways to effective psychological care.Trial registration number ISRCTN10666798.

Published
2021
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2. Psychological distress and trauma during the COVID-19 pandemic: survey of doctors practising anaesthesia, intensive care medicine, and emergency medicine in the United Kingdom and Republic of Ireland

Author

Tom Roberts, Robert Hirst, Camilla Sammut-Powell, Charles Reynard, Jo Daniels, Daniel Horner, Mark D. Lyttle, Katie Samuel, Blair Graham, Michael J. Barrett, James Foley, John Cronin, Etimbuk Umana, Joao Vinagre, Edward Carlton, L. Kane, L. Mackenzie, S. Sharma Hajela, J. Phizacklea, K. Malik, N. Mathai, A. Sattout, S. Messahel, E. Fadden, R. McQuillan, B. O'Hare, S. Lewis, D. Bewick, R. Taylor, I. Hancock, D. Manthalapo Ramesh Babu, S. Hartshorn, M. Williams, A. Charlton, L. Somerset, C. Munday, A. Turner, R. Sainsbury, E. Williams, S. Patil, R. Stewart, M. Winstanley, N. Tambe, C. Magee, D. Raffo, D. Mawhinney, B. Taylor, T. Hussan, G. Pells, F. Barham, F. Wood, C. Szekeres, R. Greenhalgh, S. Marimuthu, R. Macfarlane, M. Alex, B. Shrestha, L. Stanley, J. Gumley, K. Thomas, M. Anderson, C. Weegenaar, J. Lockwood, T. Mohamed, S. Ramraj, M. Mackenzie, A. Robertson, W. Niven, M. Patel, S. Subramaniam, C. Holmes, S. Bongale, U. Bait, S. Nagendran, S. Rao, F. Mendes, P. Singh, T. Baron, C. Ponmani, M. Depante, R. Sneep, A. Brookes, S. Williams, A. Rainey, J. Brown, N. Marriage, S. Manou, S. Hart, M. Elsheikh, L. Cocker, M.H. Elwan, K.L. Vincent, C. Nunn, N. Sarja, M. Viegas, E. Wooffinden, C. Reynard, N. Cherian, A. Da-Costa, S. Duckitt, J. Bailey, L. How, T. Hine, F. Ihsan, H. Abdullah, K. Bader, S. Pradhan, M. Manoharan, L. Kehler, R. Muswell, M. Bonsano, J. Evans, E. Christmas, K. Knight, L. O'Rourke, K. Adeboye, K. Iftikhar, R. Evans, R. Darke, R. Freeman, E. Grocholski, K. Kaur, H. Cooper, M. Mohammad, L. Harwood, K. Lines, C. Thomas, D. Ranasinghe, S. Hall, J. Wright, N. Ali, J. Hunt, H. Ahmad, C. Ward, M. Khan, K. Holzman, J. Ritchie, A. Hormis, R. Hannah, A. Corfield, J. Maney, D. Metcalfe, S. Timmis, C. Williams, R. Newport, D. Bawden, A. Tabner, H. Malik, C. Roe, D. McConnell, F. Taylor, R. Ellis, S. Morgan, L. Barnicott, S. Foster, J. Browning, L. McCrae, E. Godden, A. Saunders, A. Lawrence-Ball, R. House, J. Muller, I. Skene, M. Lim, H. Millar, A. Rai, K. Challen, S. Currie, M. Elkanzi, T. Perry, W. Kan, L. Brown, M. Cheema, A. Clarey, A. Gulati, K. Webster, A. Howson, R. Doonan, A. Trimble, C. O’Connell, R. Wright, E. Colley, C. Rimmer, S. Pintus, H. Jarman, V. Worsnop, S. Collins, M. Colmar, N. Masood, R. McLatchie, A. Peasley, S. Rahman, N. Mullen, L. Armstrong, A. Hay, R. Mills, J. Lowe, H. Raybould, A. Ali, P. Cuthbert, S. Taylor, V. Talwar, Z. Al-Janabi, C. Leech, J. Turner, L. McKechnie, B. Mallon, J. McLaren, Y. Moulds, L. Dunlop, F.M. Burton, S. Keers, L. Robertson, D. Craver, N. Moultrie, O. Williams, S. Purvis, M. Clark, C. Davies, S. Foreman, C. Ngua, J. Morgan, N. Hoskins, J. Fryer, L. Frost, P. Ellis, A. Mackay, K. Gray, M. Jacobs, I. Musliam Veettil Asif, P. Amiri, S. Shrivastava, F. Raza, S. Wilson, M. Riyat, H. Knott, M. Ramazany, S. Langston, N. Abela, L. Robinson, D. Maasdorp, H. Murphy, H. Edmundson, R. Das, C. Orjioke, D. Worley, W. Collier, J. Everson, N. Maleki, A. Stafford, S. Gokani, M. Charalambos, A. Olajide, C. Bi, J. Ng, S. Naeem, A. Hill, C. Boulind, R. O'Sullivan, S. Gilmartin, S. Uí Bhroin, P. Fitzpatrick, A. Patton, M. Jee Poh Hock, S. Graham, S. Kukaswadia, C. Prendergast, A. Ahmed, C. Dalla Vecchia, J. Lynch, M. Grummell, I. Grossi, B. MacManus, P. Turton, C. Battle, K. Samuel, A. Boyle, A. Waite, D. George, B. Johnston, J. Anandarajah, and J. Vinagre

Subjects
Adult, Male, medicine.medical_specialty, Critical Care, Coronavirus disease 2019 (COVID-19), Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Psychological Distress, Cohort Studies, Stress Disorders, Post-Traumatic, SDG 3 - Good Health and Well-being, emergency medicine, Physicians, Surveys and Questionnaires, Intensive care, Pandemic, medicine, Humans, Anesthesia, Longitudinal Studies, Prospective Studies, Pandemics, intensive care, business.industry, COVID-19, Psychological distress, anaesthesia, medicine.disease, Mental health, United Kingdom, Anesthesiology and Pain Medicine, Family medicine, Emergency Medicine, Female, business, psychological trauma, Ireland, mental health, Cohort study, Psychological trauma
Abstract

Received 12th May 2021. Accepted 17th May 2021. Published online 28th May 2021. Issue published 1st August 2021.

Published
2021
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3. Cigarette smoke inhibits macrophage sensing of Gram-negative bacteria and lipopolysaccharide: relative roles of nicotine and oxidant stress

Author

Mark J. Paul-Clark, M Fleet, Jane A. Mitchell, Matthew J. Walters, J Anandarajah, Shaun K. McMaster, and Shiranee Sriskandan

Subjects
Pharmacology, Toll-like receptor, Gram-negative bacteria, Lipopolysaccharide, biology, biology.organism_classification, Nitric oxide, Nicotine, chemistry.chemical_compound, Immune system, chemistry, Immunology, medicine, Macrophage, Tumor necrosis factor alpha, medicine.drug
Abstract

Background and purpose: Smoking cigarettes is a major risk factor for the development of cardiovascular and respiratory disease. Moreover, smokers are more prone to infections. This has been associated with a suppression of the immune system by smoke. However, it is not clear how cigarette smoke affects the ability of immune cells to sense pathogens. Cigarette smoke contains a large number of molecules which may mediate responses on immune cells and of these, nicotine and oxidants have both been identified as inhibitory for the sensing of bacterial lipopolysaccharide (LPS). Nitric oxide synthase (NOS) and tumour necrosis factor (TNF)-α are both induced in macrophages on stimulation with Gram negative bacteria or LPS.

Published
2008
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4. Predictive value of peak systolic velocity for the development of graft limb complications after endovascular aneurysm repair

Author

Matt M. Thompson, Peter J. Holt, Robert J. Hinchliffe, Janakan J. Anandarajah, Jan Poloniecki, Alan Karthikesalingam, and Sharanya Kumar

Subjects
Male, Reoperation, medicine.medical_specialty, Time Factors, genetic structures, Systole, medicine.medical_treatment, Hemodynamics, Endovascular aneurysm repair, Risk Assessment, Aortic aneurysm, Blood Vessel Prosthesis Implantation, Aneurysm, Blood vessel prosthesis, Predictive Value of Tests, Risk Factors, London, medicine, Humans, Radiology, Nuclear Medicine and imaging, cardiovascular diseases, Aged, Proportional Hazards Models, Retrospective Studies, Aged, 80 and over, Ultrasonography, Doppler, Duplex, business.industry, Ultrasound, Endovascular Procedures, Graft Occlusion, Vascular, Vascular surgery, medicine.disease, Blood Vessel Prosthesis, Treatment Outcome, Regional Blood Flow, Predictive value of tests, cardiovascular system, Surgery, Female, Stents, Radiology, Cardiology and Cardiovascular Medicine, business, Blood Flow Velocity, Aortic Aneurysm, Abdominal
Abstract

To determine the role of peak systolic velocity (PSV) data provided by duplex ultrasound (DUS) surveillance in the prediction of endograft limb complications after endovascular aneurysm repair (EVAR).All 478 consecutive patients (425 men; mean age 75±7 years) who underwent infrarenal EVAR between 2004 and 2010 had DUS scans at 1.5, 3, 6, 9, 12, and 18 months and annually thereafter over a median follow-up of 43 months (range 1-92). In a retrospective study, the PSV recorded from the proximal and distal regions of each stent-graft limb was extracted from each postoperative DUS scan for each patient up to the penultimate scan before diagnosis of a limb complication (limb occlusion, symptomatic or hemodynamically significant kinking, or hemodynamically significant DUS-defined stenosis) requiring reintervention. The median (range) PSV readings from the proximal and distal regions of each stent-graft limb over the course of follow-up were compared between patients who developed a limb complication (n = 38) and those who did not (n = 440). Time-dependent Cox proportional hazards modeling was performed after risk adjustment; results are presented as the hazard ratio (HR) and 95% confidence interval (CI).In the proximal stent-graft limb segment, the median PSV was 106 cm/s (42-308) in patients without limb complications vs. 121 cm/s (50-281) in those with limb complications. Corresponding values in the distal segment of the endograft limb were 113 cm/s (35-400) vs. 129 cm/s (58-420). After risk adjustment, increased PSV over time within both the proximal and distal segments of the stent-graft limb was significantly associated with the risk of limb complications (proximal HR 1.015, 95% CI 1.003 to 1.028, p = 0.014; distal HR 1.010, 95% CI 1.001 to 1.020, p = 0.025).Increases in the peak systolic velocity in stent-graft limbs were associated with an increased risk of limb complication, though no predictive threshold could be identified from scans prior to the development of a complication. This observation requires external validation and further investigation to define its clinical utility.

Published
2012

5. Predictive value of peak systolic velocity for the development of graft limb complications after endovascular aneurysm repair

Author

Jan Poloniecki, Robert J. Hinchliffe, Alan Karthikesalingam, Janakan J. Anandarajah, Nida Pasha, Matthew Thompson, Peter J. Holt, and Sharanya Kumar

Subjects
medicine.medical_specialty, business.industry, medicine.medical_treatment, medicine, Surgery, General Medicine, Radiology, business, Endovascular aneurysm repair, Predictive value
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6. Differential effects of Gram-positive versus Gram-negative bacteria on NOSII and TNFalpha in macrophages: role of TLRs in synergy between the two.

Author

Paul-Clark MJ, McMaster SK, Belcher E, Sorrentino R, Anandarajah J, Fleet M, Sriskandan S, and Mitchell JA

Subjects
Animals, Base Sequence, Blotting, Western, Cell Line, DNA Primers, Macrophage Activation, Macrophages enzymology, Macrophages microbiology, Mice, Toll-Like Receptor 2 metabolism, Toll-Like Receptor 4 metabolism, Gram-Negative Bacteria physiology, Gram-Positive Bacteria physiology, Macrophages metabolism, Nitric Oxide Synthase Type II metabolism, Tumor Necrosis Factor-alpha metabolism
Abstract

1. Gram-negative and Gram-positive bacteria are sensed by Toll-like receptor (TLR)4 and TLR2, respectively. TLR4 recruits MyD88 and TRIF, whereas TLR2 recruits MyD88 without TRIF. NOSII and TNFalpha are central genes in innate immunity and are thought to be differentially regulated by the MyD88 versus TRIF signalling pathways. Here, we have used Gram-positive Staphylococcus aureus, Gram-negative Escherichia coli and highly selective TLR ligands to establish the precise relationship between TLR2, TLR1, TLR6 and TLR4 for NOSII versus TNFalpha induction. 2. In murine macrophages at 24 h, E. coli or LPS (TLR4) induced NO and TNFalpha release. In contrast, S. aureus (TLR2/TLR1/TLR6) or Pam(3)CSK4 (TLR2/TLR1), or FSL-1 and LTA (TLR2/TLR6) induced TNFalpha without an effect on NO. 3. At later time points (48-72 h), S. aureus induced NO release. The ability of S. aureus, but not E. coli or LPS, to induce NO release was inhibited by anti-TNFalpha-binding antibodies. 4. At 24 h, LPS synergised with TLR2 ligands to induce NO release and NOSII protein expression. LPS also induced the expression of TLR2 gene expression without affecting levels of TLR4. 5. Using cells from TLR2(-/-) or TLR4(-/-) mice, the ability of LPS to synergise with S. aureus or Pam(3)CSK4 was found to be dependent on both TLR2 and TLR4. 6. These observations are the first to clearly delineate the role of separately activating TLR2 and TLR4 in the induction of NOSII and TNFalpha genes compared with their coinduction when both receptor pathways are activated.

Published
2006
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