ORCID Profile
0000-0003-1533-1809
Current Organisations
Abertay University
,
University of Abertay Dundee
,
University of Aberdeen
,
Institute of Chemical Technology
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Publications
Global outbreak research: harmony not hegemony
Publisher: Elsevier BV
Date: 07-2020
Examining the Electrochemical Nature of an Ionogel Based on the Ionic Liquid [P66614][TFSI] and TiO2: Synthesis, Characterization, and Quantum Chemical Calculations
Publisher: American Chemical Society (ACS)
Date: 14-06-2022
Prolonged infusion of sedatives and analgesics in adult intensive care patients: A systematic review of pharmacokinetic data reporting and quality of evidence
Publisher: Elsevier BV
Date: 03-2017
DOI: 10.1016/J.PHRS.2016.12.028
Abstract: Although pharmacokinetic (PK) data for prolonged sedative and analgesic agents in intensive care unit (ICU) has been described, the number of publications in this important area appear relatively few, and PK data presented is not comprehensive. Known pathophysiological changes in critically ill patients result in altered drug PK when compared with non-critically ill patients. ClinPK Statement was recently developed to promote consistent reporting in PK studies, however, its applicability to ICU specific PK studies is unclear. In this systematic review, we assessed the overall ClinPK Statement compliance rate, determined the factors affecting compliance rate, graded the level of PK evidence and assessed the applicability of the ClinPK Statement to future ICU PK studies. Of the 33 included studies (n=2016), 22 (67%) were low evidence quality descriptive studies (Level 4). Included studies had a median compliance rate of 80% (IQR 66% to 86%) against the ClinPK Statement. Overall pooled compliance rate (78%, 95% CI 73% to 83%) was stable across time (P=0.38), with higher compliance rates found in studies fitting three compartments models (88%, P<0.01), two compartments models (83%, P<0.01) and one compartment models (77%, P=0.17) than studies fitting noncompartmental or unspecified models (69%) (P<0.01). Data unique to the interpretation of PK data in critically ill patients, such as illness severity (48%), organ dysfunction (36%) and renal replacement therapy use (32%), were infrequently reported. Discrepancy between the general compliance rate with ClinPK Statement and the under-reporting of ICU specific parameters suggests that the applicability of the ClinPK Statement to ICU PK studies may be limited in its current form.
Altered Pharmacokinetics in Prolonged Infusions of Sedatives and Analgesics Among Adult Critically Ill Patients: A Systematic Review
Publisher: Elsevier BV
Date: 09-2018
DOI: 10.1016/J.CLINTHERA.2018.07.021
Abstract: The pharmacokinetic (PK) parameters of many drugs are altered as a consequence of the pathophysiological changes associated with critical illness. The critically ill population presents challenges when titrating infusions of sedatives and analgesics to maintain optimal sedation and pain levels. This systematic review examined the PK data in critically ill adult patients with prolonged infusions (>24 hours) of commonly used sedatives and analgesics to highlight possible altered PK parameters compared with noncritically ill patients. A literature search of PK studies was performed by using MEDLINE (1946-December 2017) and EMBASE (1910-December 2017) we identified further studies by citation tracking (Web of Science) and checked references of retrieved studies and review articles. All studies were included that were published in English, Chinese, or German conducted in critically ill adult patients receiving lorazepam, midazolam, propofol, dexmedetomidine, sufentanil, alfentanil, remifentanil, morphine, or fentanyl infusion for ≥24 hours and reported PK parameters. When appropriate, we conducted a meta-analysis on volume of distribution at steady state (V Thirty-three randomized controlled trials and prospective cohort studies were identified involving 1803 adult critically ill patients with 35 drug treatment arms: fifteen midazolam (n = 906) studies, three dexmedetomidine (n = 561), nine propofol (n = 165), four lorazepam (n = 86), one morphine (n = 20), two remifentanil (n = 55), and one sufentanil (n = 10). Each study showed large variations in V These findings show a marked difference in many PK parameters from those reported for noncritically ill patients. Initiatives to improve the delivery of prolonged sedatives and analgesic infusions should be informed by PK parameters (Vd
Nursing and midwifery students' encounters with poor clinical practice: A systematic review
Publisher: Elsevier BV
Date: 03-2017
DOI: 10.1016/J.NEPR.2017.02.010
Abstract: The aim of this paper was to systematically review evidence about nursing and midwifery students' encounters with poor clinical care. We undertook a systematic review of English language empirical research using multiple databases from inception to April 2016. Hand searching was also undertaken. Included papers contained accounts of empirical research which reported on students' encounters with poor care. These were quality-assessed, information was extracted into tables, and study results were synthesized using thematic analysis. N = 14 papers met inclusion criteria study quality was moderate to good. Study synthesis revealed four themes: i) encounters with poor practice: students encounter poor practice that is likely to be worthy of professional sanction ii) while intention to report is high in hypothetical scenarios, this appears not always to translate to actual practice iii) a range of influencing factors impact the likelihood of reporting iv) the consequences of encountering and subsequently reporting poor practice appeared to have a lasting effect on students. Research is required to determine the frequency and nature of students' encounters with poor care, when and where they encounter it, how to increase the likelihood that they will report it, and how they can be supported in doing so.
Therapeutic drug monitoring of carbapenem antibiotics in critically ill patients: an overview of principles, recommended dosing regimens, and clinical outcomes
Publisher: Informa UK Limited
Date: 27-03-2023
The Effect of a Freely Available Flipped Classroom Course on Health Care Worker Patient Safety Culture: A Prospective Controlled Study
Publisher: JMIR Publications Inc.
Date: 05-07-2016
DOI: 10.2196/JMIR.5378
A surveillance method to identify patients with sepsis from electronic health records in Hong Kong: a single centre retrospective study
Publisher: Springer Science and Business Media LLC
Date: 07-09-2020
DOI: 10.1186/S12879-020-05330-X
Abstract: Currently there are only two population studies on sepsis incidence in Asia. The burden of sepsis in Hong Kong is unknown. We developed a sepsis surveillance method to estimate sepsis incidence from a population electronic health record (EHR) in Hong Kong using objective clinical data. The study objective was to assess our method’s performance in identifying sepsis using a retrospective cohort. We compared its accuracy to administrative sepsis surveillance methods such as Angus’ and Martin’s methods. In this single centre retrospective study we applied our sepsis surveillance method on adult patients admitted to a tertiary hospital in Hong Kong. Two clinicians independently reviewed the clinical notes to determine which patients had sepsis. Performance was assessed by sensitivity, specificity, positive predictive value, negative predictive value and area under the curve (AUC) of Angus’, Martin’s and our surveillance methods using clinical review as “gold standard.” Between January 1 and February 28, 2018, our sepsis surveillance method identified 1352 adult patients hospitalised with suspected infection. We found that 38.9% (95%CI 36.3–41.5) of these patients had sepsis. Using a 490 patient validation cohort, two clinicians had good agreement with weighted kappa of 0.75 (95% CI 0.69–0.81) before coming to consensus on diagnosis of uncomplicated infection or sepsis for all patients. Our method had sensitivity 0.93 (95%CI 0.89–0.96), specificity 0.86 (95%CI 0.82–0.90) and an AUC 0.90 (95%CI 0.87–0.92) when validated against clinician review. In contrast, Angus’ and Martin’s methods had AUCs 0.56 (95%CI 0.53–0.58) and 0.56 (95%CI 0.52–0.59), respectively. A sepsis surveillance method based on objective data from a population EHR in Hong Kong was more accurate than administrative methods. It may be used to estimate sepsis population incidence and outcomes in Hong Kong. This study was retrospectively registered at clinicaltrials.gov on October 3, 2019 ( NCT04114214 ).
Population sepsis incidence, mortality, and trends in Hong Kong between 2009–2018 using clinical and administrative data
Publisher: Oxford University Press (OUP)
Date: 19-08-2023
DOI: 10.1093/CID/CIAD491
Abstract: Sepsis surveillance using electronic health record (EHR)-based data may provide more accurate epidemiologic estimates than administrative data, but experience with this approach to estimate population-level sepsis burden is lacking. This was a retrospective cohort study including all adults admitted to publicly-funded hospitals in Hong Kong between 2009-2018. Sepsis was defined as clinical evidence of presumed infection (clinical cultures and treatment with antibiotics) and concurrent acute organ dysfunction (≥2 point increase in baseline SOFA score). Trends in incidence, mortality, and case fatality risk (CFR) were modelled by exponential regression. Performance of the EHR-based definition was compared with 4 administrative definitions using 500 medical record reviews. Among 13,550,168 hospital episodes during the study period, 485,057 (3.6%) had sepsis by EHR-based criteria with 21.5% CFR. In 2018, age- and sex-adjusted standardized sepsis incidence was 759 per 100,000 (relative +2.9%/year [95%CI 2.0, 3.8%] between 2009-2018) and standardized sepsis mortality was 156 per 100,000 (relative +1.9%/year [95%CI 0.9,2.9%]). Despite decreasing CFR (relative -0.5%/year [95%CI -1.0, -0.1%]), sepsis accounted for an increasing proportion of all deaths (relative +3.9%/year [95%CI 2.9, 4.9%]). Medical record reviews demonstrated that the EHR-based definition more accurately identified sepsis than administrative definitions (AUC 0.91 vs 0.52–0.55, p & 0.001). An objective EHR-based surveillance definition demonstrated an increase in population-level standardized sepsis incidence and mortality in Hong Kong between 2009-2018 and was much more accurate than administrative definitions. These findings demonstrate the feasibility and advantages of an EHR-based approach for widescale sepsis surveillance.
Comparison of high-flow nasal cannula versus oxygen face mask for environmental bacterial contamination in critically ill pneumonia patients: a randomized controlled crossover trial
Publisher: Elsevier BV
Date: 2019
DOI: 10.1016/J.JHIN.2018.10.007
Abstract: Whereas high-flow nasal cannula use is gaining prevalence, its high gas flow raises concerns about aerosolization of infectious particles and spread of infection. This randomized controlled crossover non-inferiority trial (N = 20) evaluated the degree of environmental contamination by viable bacteria associated with the use of high-flow nasal cannula compared with conventional oxygen mask for critically ill patients with Gram-negative pneumonia. The results show that high-flow nasal cannula use was not associated with increased air or contact surface contamination by either Gram-negative bacteria or total bacteria, suggesting that additional infection control measures are not required.
Medical students and professionalism - Do the hidden curriculum and current role models fail our future doctors?
Publisher: Informa UK Limited
Date: 21-12-2018
Survival of mechanically ventilated ward patients and association with organisational factors: a multicentre prospective study
Publisher: BMJ
Date: 12-2021
DOI: 10.1136/BMJOPEN-2021-052462
Abstract: Determine 90-day mortality of mechanically ventilated ward patients outside the intensive care unit (ICU) and its association with organisational factors. Multicentre prospective observational study of mechanically ventilated ward patients. Modified Poisson regression was used to assess association between nurse to patient ratio (NPR) and 90-day mortality, adjusted for designated medical team, Society of Critical Care Medicine (SCCM) triage priority and centre effect. NPR was ided into low (1:9.6 to 1:10), medium (1:6 to 1:8) and high (1:2.6). Sensitivity analysis was conducted for pneumonia with or without acute respiratory distress syndrome (ARDS) to assess magnitude of association. 7 acute public hospitals in Hong Kong. All 485 mechanically ventilated patients in wards from participating hospitals between 18 January 2016 and 17 April 2016 were recruited. Three hundred patients were included after excluding patients with limitation of therapy within 24 hours of intubation. 90-day mortality, Mortality Prediction Model III Standardised mortality ratio (MPMIII 0 SMR). 201 patients died within 90 days after intubation (67.0%, 95% CI 61.5% to 72.1%), with MPMIII 0 SMR 1.88, 95% CI 1.63 to 2.17. Compared with high NPR, medium and low NPRs were associated with higher risk of 90-day mortality (adjusted relative risk (RR adj ) 1.84, 95% CI 1.70 to 1.99 and 1.64, 95% CI 1.47 to 1.83, respectively). For 114 patients with pneumonia with or without ARDS, low to medium NPR, too sick to benefit from ICU (SCCM priority 4b), no ICU consultation and designated medical team were associated with risk of 90-day mortality (RR adj 1.49, 95% CI 1.40 to 1.58 RR adj 1.60, 95% CI 1.49 to 1.72 RR adj 1.34, 95% CI 1.27 to 1.40 RR adj 0.85, 95% CI 0.78 to 0.93, respectively). The 90-day mortality rates of mechanically ventilated ward patients were high. NPR was an independent predictor of survival for mechanically ventilated ward patients.
Abstract PR525
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2016
Genetic mechanisms of critical illness in Covid-19
Publisher: Cold Spring Harbor Laboratory
Date: 25-09-2020
DOI: 10.1101/2020.09.24.20200048
Abstract: The subset of patients who develop critical illness in Covid-19 have extensive inflammation affecting the lungs 1 and are strikingly different from other patients: immunosuppressive therapy benefits critically-ill patients, but may harm some non-critical cases. 2 Since susceptibility to life-threatening infections and immune-mediated diseases are both strongly heritable traits, we reasoned that host genetic variation may identify mechanistic targets for therapeutic development in Covid-19. 3 GenOMICC (Genetics Of Mortality In Critical Care, genomicc.org ) is a global collaborative study to understand the genetic basis of critical illness. Here we report the results of a genome-wide association study (GWAS) in 2244 critically-ill Covid-19 patients from 208 UK intensive care units (ICUs), representing % of all ICU beds. Ancestry-matched controls were drawn from the UK Biobank population study and results were confirmed in GWAS comparisons with two other population control groups: the 100,000 genomes project and Generation Scotland. We identify and replicate three novel genome-wide significant associations, at chr19p13.3 (rs2109069, p = 3.98 × 10 −12 ), within the gene encoding dipeptidyl peptidase 9 ( DPP9 ), at chr12q24.13 (rs10735079, p =1.65 × 10 −8 ) in a gene cluster encoding antiviral restriction enzyme activators ( OAS1, OAS2, OAS3 ), and at chr21q22.1 (rs2236757, p = 4.99 × 10 −8 ) in the interferon receptor gene IFNAR2 . Consistent with our focus on extreme disease in younger patients with less comorbidity, we detect a stronger signal at the known 3p21.31 locus than previous studies (rs73064425, p = 4.77 × 10 −30 ). We identify potential targets for repurposing of licensed medications. Using Mendelian randomisation we found evidence in support of a causal link from low expression of IFNAR2 , and high expression of TYK2 , to life-threatening disease. Transcriptome-wide association in lung tissue revealed that high expression of the monocyte/macrophage chemotactic receptor CCR2 is associated with severe Covid-19. Our results identify robust genetic signals relating to key host antiviral defence mechanisms, and mediators of inflammatory organ damage in Covid-19. Both mechanisms may be amenable to targeted treatment with existing drugs. Large-scale randomised clinical trials will be essential before any change to clinical practice.
Related Organisations
King's College London
Location: United Kingdom of Great Britain and Northern Ireland
Abertay University
Location: United Kingdom of Great Britain and Northern Ireland
University Of Abertay Dundee
Location: United Kingdom of Great Britain and Northern Ireland
University Of St Andrews
Location: United Kingdom of Great Britain and Northern Ireland
University Of Aberdeen
Location: United Kingdom of Great Britain and Northern Ireland
Open University
Location: United Kingdom of Great Britain and Northern Ireland
University Of Cambridge
Location: United Kingdom of Great Britain and Northern Ireland
Related Funding Activities
No related grants have been discovered for Debashis Kundu.