Incidental renal artery stenosis is an independent predictor of mortality in patients with peripheral vascular disease

In patients with peripheral vascular disease (PVD), mortality is high and renal artery stenosis (RAS) is a frequent incidental finding. RAS carries a high risk for mortality, but whether incidentally discovered RAS is a risk factor for mortality is unknown. The prognostic impact of incidental RAS for mortality was studied in 550 consecutive patients who underwent intra-arterial digital subtraction angiography for PVD in a single center between 1997 and 2000. In 491 patients (336 men, 155 women; mean follow-up 3.8 +/- 1.9 yr), the renal arteries were visualized and follow-up data were available. RAS (diameter reduction > 50%) was present in 26% of the patients. Mortality in the RAS group was 59 versus 28% in the non-RAS group (odds ratio 3.8; 95% confidence interval 2.5 to 5.7; P <0.0001). Diabetes, previous myocardial infarction, history of PVD, stroke, and hypertension were more frequent in the RAS group; age was higher and GFR was lower in the RAS group. Therefore, RAS was associated with elevated mortality and increased prevalence of cardiovascular risk factors. Cox regression analysis showed that RAS was an independent predictor for mortality (P = 0.005), along with age, diabetes, smoking, previous myocardial infarction, history of PVD, and stroke. In patients who were evaluated for PVD by digital subtraction angiography, mortality was high. Incidental RAS was a frequent finding and an independent predictor for mortality. Whether RAS is a marker for or, alternatively, a mediator of the poor prognosis and whether prognosis can be improved by specific intervention should be the subject of future prospective studies

Efficacy of magnesium-amiodarone step-up scheme in critically ill patients with new-onset atrial fibrillation:a prospective observational study

Amiodarone is considered a first-choice antiarrhythmic drug in critically ill patients with new-onset atrial fibrillation (AF). However, evidence supporting the use of this potentially toxic drug in critically ill patients is scarce. Magnesium sulphate (MgSO4) has shown to be effective for both rate and rhythm control, to act synergistically with antiarrhythmic drugs, and to prevent proarrhythmia. Treatment with MgSO4 may reduce the need for antiarrhythmic drugs such as amiodarone in critically ill patients with new-onset atrial fibrillation. The efficacy of a new institutional protocol was evaluated. Patients were treated with a new institutional protocol for new-onset atrial fibrillation in critically ill patients. An MgSO4 bolus (0.037 g/kg body weight in 15 minutes) was followed by continuous infusion (0.025 g/kg body weight/h). Intravenous amiodarone (loading dose 300 mg, followed by continuous infusion of 1200 mg/24 h) was given to those not responding to MgSO4 within 1 hour. Clinical response was defined as conversion to sinus rhythm or decrease in heart rate <110 beats/min. Sixteen of the 29 patients responded to MgSO4 monotherapy, whereas the addition of amiodarone was needed in 13 patients. Median (range) time until conversion to sinus rhythm after MgSO4 was 2 (1-45) hours. Median (range) conversion time in patients requiring amiodarone was 4 (2-78) hours, and median (range) conversion time in all patients was 3 (1-78) hours. The 24-hour conversion rate was 90%. Relapse atrial fibrillation was seen in 7 patients. The magnesium-amiodarone step-up scheme reduces the need for amiodarone, effectively converts new-onset atrial fibrillation into a sinus rhythm within 24 hours, and seems to be safe in critically ill patients

Designing with information and empathy: Delivering human information to designers

This paper detailed research by McGinley into information and empathy resources to support people-centred design. It was published in a special edition of The Design Journal, an INT1-rated journal in the European Reference Index for the Humanities. The paper reported on the concept of information and empathy combinations and detailed a case study in which the author undertook the role of lead researcher. The reported case study was the design of safer drinks vessels for the UK pub industry, a project commissioned by the Home Office and managed by the Design Council. The case study reported on the process undertaken to explore glass-related assaults. Human information resources (i.e. mixed-media outputs, including reports, video and interactive software) were created to communicate the range of perspectives and insights obtained through design ethnography methods. The research was used by a design consultancy commissioned to re-design the pint glass, leading to a new concept that was developed and trialled in UK bars. McGinley and Caroline Till also wrote an accompanying publication that consolidated findings based on four months of research into alcohol-related violence. Design Out Crime: Using Design to Reduce Injuries from Alcohol-Related Violence in Pubs and Clubs (2010) was published by the Design Council and launched alongside resulting designs by the Home Secretary at the Design Council. The project received national media coverage and featured extensively in the national press (e.g. BBC News, Guardian, Metro, Daily Mail, Creative Review) Further to this work, McGinley was invited to become a ‘design ambassador’ for the Design Council’s ‘Keeping Connected’ Design Challenge (2011), which engaged high-school students with older communities. McGinley was also invited to present his work at Central Saint Martins Service Design Summer School (2012)