Publications by authors named "Daniel Weiand"

6 Publications

  • Page 1 of 1

Preventing sepsis; how can artificial intelligence inform the clinical decision-making process? A systematic review.

Int J Med Inform 2021 Apr 10;150:104457. Epub 2021 Apr 10.

School of Pharmacy, Newcastle University, King George VI Building, Newcastle upon Tyne, NE1 7RU, UK. Electronic address:

Background And Objectives: Sepsis is a life-threatening condition that is associated with increased mortality. Artificial intelligence tools can inform clinical decision making by flagging patients at risk of developing infection and subsequent sepsis. This systematic review aims to identify the optimal set of predictors used to train machine learning algorithms to predict the likelihood of an infection and subsequent sepsis.

Methods: This systematic review was registered in PROSPERO database (CRD42020158685). We conducted a systematic literature review across 3 large databases: Medline, Cumulative Index of Nursing and Allied Health Literature, and Embase. Quantitative primary research studies that focused on sepsis prediction associated with bacterial infection in adults in all care settings were eligible for inclusion.

Results: Seventeen articles met our inclusion criteria. We identified 194 predictors that were used to train machine learning algorithms, with 13 predictors used on average across all included studies. The most prevalent predictors included age, gender, smoking, alcohol intake, heart rate, blood pressure, lactate level, cardiovascular disease, endocrine disease, cancer, chronic kidney disease (eGFR<60 mL/min), white blood cell count, liver dysfunction, surgical approach (open or minimally invasive), and pre-operative haematocrit < 30 %. All included studies used artificial intelligence techniques, with average sensitivity 75.7 ± 17.88, and average specificity 63.08 ± 22.01.

Conclusion: The type of predictors influenced the predictive power and predictive timeframe of the developed machine learning algorithm. Predicting the likelihood of sepsis through artificial intelligence can help concentrate finite resources to those patients who are most at risk. Future studies should focus on developing more sensitive and specific algorithms.
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April 2021

Typhimurium gastroenteritis leading to chronic prosthetic vascular graft infection.

JMM Case Rep 2017 Aug 8;4(8):e005104. Epub 2017 Aug 8.

Freeman Hospital, Freeman Road, Newcastle Upon Tyne NE7 7DN, UK.

It is estimated up to 6 % of prosthetic vascular grafts become infected. is predominant in early infection and coagulase-negative staphylococci are predominant in late infections. cause 14-40 % of prosthetic vascular graft infections. This is, to our knowledge the first reported case of gastroenteritis causing chronic prosthetic vascular graft infection (PVGI). A 57 years old lady presented with signs and symptoms of prosthetic vascular graft infection. Three years earlier, she had undergone a prosthetic axillo-femoral bypass graft for critical limb ischaemia. The infected prosthetic vascular graft was removed and Typhimurium was isolated on culture. In the intervening period, Typhimurium was isolated from a faecal specimen, collected during an episode of acute gastroenteritis. Whole-genome sequencing (WGS) showed that the respective Typhimurium isolates differed by only a single nucleotide polymorphism (SNP). Typhimurium was not isolated on culture of a faecal specimen collected five days following cessation of antimicrobial therapy. Six months after removal of the prosthetic graft, the patient remains under follow-up for her peripheral vascular disease, which currently requires no further surgical intervention. This case has clear implications for the management of chronic PVGI. It is vital to collect high-quality surgical specimens for microbiological analysis and empirical choices of antibiotics are unlikely to cover all potential pathogens. It may also be prudent to enquire about a history of acute gastroenteritis when assessing patients presenting with chronic PVGI.
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August 2017

Crystals seen on CSF microscopy in a case of suspected subarachnoid haemorrhage.

BMJ Case Rep 2015 Jul 2;2015. Epub 2015 Jul 2.

Department of Medical Microbiology, Hull Royal Infirmary, Hull, East Riding of Yorkshire, UK.

Although crystals are rarely identified on cerebrospinal fluid (CSF) microscopy, their presence can be of significant diagnostic value. We report a case of oxalate crystals seen on CSF microscopy of a 43-year-old woman. The patient presented with headaches, nausea and vomiting. CT of the head showed a small focus of hyper-density, suspicious of haemorrhage, in the right side of the pontine cistern. CSF cell count was within the normal range. Although no organisms were seen on microscopy, copious oxalate crystals were seen. The same crystals were seen on microscopy of CSF collected in a fluoride oxalate container used for glucose analysis. A follow-up contrast-enhanced CT angiogram did not demonstrate any abnormalities. It transpired that excess CSF had been collected into a fluoride oxalate container. This had subsequently been decanted into a plain container for microbiological analysis. Correct specimen collection should be emphasised when teaching lumbar puncture technique.
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July 2015

The rising tide of bloodstream infections with Actinomyces species: bimicrobial infection with Actinomyces odontolyticus and Escherichia coli in an intravenous drug user.

Oxf Med Case Reports 2014 Dec 23;2014(9):156-8. Epub 2014 Dec 23.

Infectious Diseases , Castle Hill Hospital , Castle Road, Cottingham, East Yorkshire , HU16 5JQ.

Clinicians of all specialties need to be aware of a recent, nationwide increase in the number of Actinomyces bloodstream infections. We report a case of bimicrobial bloodstream infection with Actinomyces odontolyticus and Escherichia coli in an intravenous drug user. A 36-year-old, male intravenous drug user was admitted with acute-onset pleuritic chest pain, back pain, pyrexia, tachycardia, tachypnoea and hypotension. Chest CT showed multiple, bilateral, cavitating lung lesions, most likely the result of septic emboli originating from an infected deep venous thrombosis (DVT). Blood cultures led to a mixed growth of A. odontolyticus, identified by matrix-assisted laser desorption ionization time-of-flight (MALDI-TOF), and E. coli. The rising tide of bloodstream infections with Actinomyces species is likely to continue with the increasing availability of sophisticated molecular identification techniques, including MALDI-TOF. In this case, the results of antimicrobial susceptibility tests were particularly important because the E. coli was susceptible to ciprofloxacin, whereas the A. odontolyticus was resistant.
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December 2014

Assessing and improving adherence with multidrug therapy.

Lepr Rev 2012 Sep;83(3):282-91

Specialty Trainee in Medical Microbiology, York Teaching Hospital NHS Foundation Trust, UK.

Introduction: Adherence with multidrug therapy (MDT) in the treatment of leprosy is important to minimise the risk of relapse and avoid the emergence of drug resistance. Adherence is defined as the extent to which the patient's behaviour matches recommendations from the prescriber. This paper reviews the methods for assessing adherence with MDT in leprosy, and community approaches to improving adherence based on evidence from the treatment of tuberculosis (TB) and HIV, as well as leprosy.

Methods: To identify and summarise the available literature regarding the assessment of treatment regularity in leprosy, a literature search of MEDLINE was conducted using the following search terms: 'leprosy' AND ('adherence' OR 'compliance' OR 'concordance'). To identify evidence for interventions that have involved community members in HIV, TB or leprosy adherence support, a literature search was conducted using the key terms and medical subject headings 'treatment or adherence' 'community,' 'HIV, TB or Leprosy' and 'low and middle income countries' combined using Boolean operators.

Results: Leprosy programmes routinely use defaulting and treatment completion as proxy measures of adherence as recommended by the WHO global strategy. However, a number of other methods have been used to assess adherence including questionnaires, pill counts, as well as direct measures based on testing urine for the presence of dapsone. Direct methods were extensively used during the dapsone mono-therapy era but there is little evidence of their use in MDT. Use of multiple methods of assessing adherence improves the accuracy and reliability of the results. Community activities in TB and HIV such as variants of treatment observation, and/or wider programmes of counselling or direct support to the patient or their family or to increase community or social support were shown to improve treatment outcomes. Outcomes evaluated included treatment default and completion, clinical indicators, and adherence (pill-count, self report).

Conclusions: Adherence is very important in leprosy and regular assessment of medication adherence together with constructive feedback and counselling of patients is likely to be beneficial. Leprosy programme can learn from adherence support interventions developed by both TB and HIV programmes.
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September 2012

Qualitative assessment of medication adherence at an urban leprosy outpatient clinic in Hyderabad, India.

Lepr Rev 2011 Mar;82(1):70-3

Medical Microbiology, Hull Royal Infirmary, Hull and East Yorkshire Hospitals NHS Trust, UK.

Objectives: The objective of this study was to measure medication adherence amongst outpatients attending an urban leprosy clinic in Hyderabad, India.

Design: In this study of observational design, the urine spot test and Morisky Scale questionnaire were concurrently used as qualitative measures of medication adherence.

Results: Fifty two patients met the inclusion criteria for this study; 13 patients (25%) were non-adherent according to the Morisky scale questionnaire and 17 patients (33%) according to the urine spot test. 48% of patients were non-adherent on the basis of the urine spot test and/or the Morisky scale questionnaire.

Conclusion: The results suggest that poor medication adherence remains an ongoing issue in the management of outpatients with leprosy.
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March 2011