51
|
Kostikas M, Kiiskinen U, Puri T, Jen MH, Williams R, Rider A, Hess L. 1753P REarranged during Transfection [RET] gene fusion testing patterns for patients [pts] with papillary thyroid cancer [PTC] across five European countries. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
|
52
|
Rider A, Hess L, Puri T, Jen MH, Williams R, Sanderson I, Kiiskinen U. 1752P Characteristics and treatment [tx] patterns in patients [pts] with medullary thyroid cancer [MTC] with and without REarranged during Transfection [RET] mutations in Europe. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
53
|
Rider A, Bennett B, Williams R, Gillespie-Akar L, Gogate A. 160P The relationship between employment status, work productivity and activity impairment (WPAI) and health-related quality of life (HRQoL) for patients (pts) with HR+/HER2- early stage breast cancer (BC). Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
|
54
|
Williams R, Hess L, Puri T, Jen MH, Kostikas M, Rider A, Kiiskinen U. 1751P Real-world study of REarranged during Transfection [RET] testing in patients [pts] with medullary thyroid cancer [MTC] in Europe [EU5]. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
55
|
Singh K, Borghol K, Williams R, McMillan K. Oral ulceration in Stüve-Wiedemann syndrome: a new presentation. BMJ Case Rep 2021; 14:14/8/e241530. [PMID: 34344643 PMCID: PMC8336181 DOI: 10.1136/bcr-2020-241530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Stüve-Wiedemann syndrome (SWS) is a rare, autosomal recessive disorder, causing dysautonomia and multisystem failure. Symptoms include skeletal malformations, restricted joint mobility and desensitisation to pain. Patients with SWS presenting with intraoral lesions are extremely rare and this is probably due to their shortened lifespan. We present a case of a 9-month-old patient who presented to our Oral and Maxillofacial Surgery (OMFS)Unit with a chronic inflamed ulcer affecting the tongue, secondary to trauma from erupting central incisors. We believe that depapillation in conjunction with an increased pain threshold contributed to its development. The patient was successfully treated by extraction of the lower central incisors and intralesional steroid injections under general anaesthetic. This case highlights that patients with SWS can present to the OMFS clinician with oral lesions and that they can be safely managed under general anaesthesia.
Collapse
Affiliation(s)
- Kiran Singh
- Oral and Maxillofacial Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Khaled Borghol
- Oral and Maxillofacial Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Rhodri Williams
- Oral and Maxillofacial Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Kevin McMillan
- Oral and Maxillofacial Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| |
Collapse
|
56
|
Ahmed A, Wu E, Sarai R, Williams R, Breeze J. Potentially modifiable patient factors in mandible fracture complications: a systematic review and meta-analysis. Br J Oral Maxillofac Surg 2021; 60:266-270. [PMID: 35183372 DOI: 10.1016/j.bjoms.2021.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 07/04/2021] [Indexed: 11/30/2022]
Abstract
The mandible is the most common bone to develop complications following treatment of facial fractures. This is due to a complex interaction of both fracture specific and patient factors. Our aim was to identify those patient factors, with a specific focus on those that may be potentially modifiable to reduce the incidence of complications. A systematic review of the literature was undertaken using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology to identify patient factors ascribed to an increased risk of complications following the treatment of mandibular fracture. These were divided into non- modifiable and potentially modifiable factors. A meta-analysis was performed to weight those factors for which statistical analysis had been performed. Twenty-two pertinent papers were identified, of which eight described non-modifiable and seven potentially modifiable factors. The most common potentially modifiable factor identified was smoking. Meta-analysis established that tobacco smoking demonstrated an increased risk of complications in three studies (Odds Ratio: 4.04 - 8.09). Division of patient factors into those that are potentially modifiable and those that are not will enable clinicians to focus on those in which change within the immediate postoperative period can be instigated. This includes smoking cessation assistance, education as to the need for a soft diet, and facilitating postoperative clinic attendance. It also enables stratification of risk in terms of consent, and choice of treatment. Further research should use standardised terminology, particularly in stopping the use of generalisable terms such as patient compliance and instead describing its individual components.
Collapse
Affiliation(s)
- Asad Ahmed
- Department of Maxillofacial Surgery, University Hospitals Birmingham, Mindelsohn Way, Birmingham B15 2TH, United Kingdom.
| | - Eiling Wu
- Department of Maxillofacial Surgery, University Hospitals Birmingham, Mindelsohn Way, Birmingham B15 2TH, United Kingdom.
| | - Rupinder Sarai
- Department of Maxillofacial Surgery, University Hospitals Birmingham, Mindelsohn Way, Birmingham B15 2TH, United Kingdom.
| | - Rhodri Williams
- Department of Maxillofacial Surgery, University Hospitals Birmingham, Mindelsohn Way, Birmingham B15 2TH, United Kingdom.
| | - John Breeze
- Department of Maxillofacial Surgery, University Hospitals Birmingham, Mindelsohn Way, Birmingham B15 2TH, United Kingdom; Royal Centre for Defence Medicine, University Hospitals Birmingham, Mindelsohn Way, Birmingham B15 2TH, United Kingdom.
| |
Collapse
|
57
|
Rogers A, Fowler W, Williams R, Haslam P, Rix D, Suntharisavam T, Thomas D, Dorkin T, Shaw M. The use of allium metal ureteric stents in the treatment of ureteric obstruction or injury. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01273-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
58
|
Ferreira RJO, Costa C, Marques A, Barata Cavaleiro AJ, Makri S, Parperis K, Psarelis S, Williams R, Fragoulis GE, Lempp H, Nikiphorou E. OP0264-HPR “I LITERALLY CONVINCED MYSELF I WAS GOING TO CATCH IT AND DIE”: LIVED EXPERIENCES OF THE COVID-19 PANDEMIC BY PEOPLE WITH RHEUMATIC DISEASES FROM FOUR EUROPEAN COUNTRIES. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:The COVID-19 pandemic has resulted in unforeseen challenges for humanity, taking a significant toll, especially the immune-suppressed individuals. In this regard, the health and general well-being of people with rheumatic diseases, the great majority users of immunosuppressives, have been at stake.Objectives:To explore the impact of the COVID-19 pandemic on people with rheumatic diseases on immunosuppression during the first wave, concerning a) (self-)management of their disease; b) interaction with the health care team; c) emotional well-being and d) overall health.Methods:A qualitative study was conducted following a phenomenological approach. Adults (>18 years) with a rheumatic disease from four European countries (Cyprus, England, Greece, Portugal). Patients were recruited through patient’s associations and social media and were invited to participate in semi-structured, audio-recorded interview or focus groups, between July - August 2020. Following a pilot study the information provided was transcribed verbatim, anonymized and translated into English where necessary. An inductive approach was adopted to carry out a thematic framework analysis with the assistance of ATLAS.ti to identify key themes and subthemes. Data validation strategies were employed, and Ethical approval and informed consent were obtained.Results:Participants were 24 patients (21 women, age range 33 to 74 years) divided by 7 focus-groups and 1 individual interview. Most frequent diagnoses were rheumatoid arthritis (n=7), lupus (n=4), juvenile idiopathic arthritis (n=3).Three key themes with 3-7 subthemes were identified within the analytical framework, centred around the impact of the Covid-19 on patients’ lives (Figure 1): i) individual person (e.g. fear for myself and family, social isolation and lack of personal freedom, more time with family) ii) health settings (e.g. (un)clear information about risks of contamination, fear or risk of shortages of medication, remote consultations), and iii) work and community (e.g. persistent stress due to mass media exposure, lack of awareness by others about patients’ rheumatic disease and its disclosure, hope and suspicion about new vaccine development: “I hear that they will ask vulnerable groups to have the vaccine first (...) Why is that? we will be again the innocent victims”). Findings were similar across countries, except for spirituality (i.e. the pandemic as “the hand of God”), a coping subtheme particular to Portugal. These main themes resonated well with the social ecological model and Walsh’s Family Resilience Process [1,2].Conclusion:When experiencing a significant life-event people require some time to process the different lived experiences. This study provides insights on how patients from four countries coped with the new challenges. Such insights are invaluable for health care providers and policy makers, in guiding more meaningful support tailored to individual needs, especially at times of crisis. The study highlights the impact of COVID-19 on the lives of people with rheumatic disease. A follow-up study is currently underway to examine the effect of subsequent waves of the pandemic.References:[1]Golden SD, Earp JA. Social ecological approaches to individuals and their contexts: twenty years of health education & behavior health promotion interventions. Health Educ Behav. 2012;39(3):364-72. doi: 10.1177/1090198111418634.[2]Walsh F. Family resilience: a framework for clinical practice. Fam Process. 2003;42(1):1-18. doi: 10.1111/j.1545-5300.2003.00001.Acknowledgements:We thank the participants of this study.Disclosure of Interests:None declared
Collapse
|
59
|
Keates N, Mclaren O, Perkins C, Finnie C, Williams R. 639 ENT Telephone Follow Up in The Era of Covid-19: A Retrospective Qualitative Analysis Utilising Semi structured focus groups. Br J Surg 2021. [PMCID: PMC8135961 DOI: 10.1093/bjs/znab134.462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Introduction Covid-19 and social distancing has triggered a seismic shift in clinical work especially during the first part of lockdown. This work looks to evaluate the experience and opinions of key stakeholders who took part in the process and use this to improve follow up in the future. Method 3 Focus groups following the same semi structured format discussed key considerations in follow up in general, telephone follow up, key aspects in its delivery and how this could benefit the service provided to patients. The focus groups involved Juniors (registrar level doctors), Consultants and support staff (clinical and non-clinical). Results Several themes and subthemes were identified. Key points were that patients were universally in favour of telephone consultations; they find them convenient and enjoy not attending the hospital. All clinicians agreed that although Covid-19 lead us to review New patients via telephone this increased workload as they needed to attend later for an examination and felt it did not provide safe care. Conclusions There is certainly an increasing role for telephone follow ups in the wake of Covid-19 which can benefit ongoing patient care and aid in managing the departments follow up capacity. Further work is needed to review this.
Collapse
Affiliation(s)
- N Keates
- University Hospital Plymouth, Plymouth, United Kingdom
| | - O Mclaren
- University Hospital Plymouth, Plymouth, United Kingdom
| | - C Perkins
- University Hospital Plymouth, Plymouth, United Kingdom
| | - C Finnie
- University Hospital Plymouth, Plymouth, United Kingdom
| | - R Williams
- University Hospital Plymouth, Plymouth, United Kingdom
| |
Collapse
|
60
|
Pivot X, Chartier F, Chouaki N, Brown J, Williams R, Rider A. Real-world study on HR+, HER2−, node-positive, high-risk early breast cancer (EBC) in France: patient profiles, management and treatment patterns. Breast 2021. [DOI: 10.1016/s0960-9776(21)00135-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|
61
|
Rebolledo-Ojeda L, Tweed J, Williams R, Aygeman J, Khalid O, Da Costa MP. Care pathways and healthcare management in a COVID-19 triage psychiatric inpatient ward at south london and maudsley nhs foundation trust. Eur Psychiatry 2021. [PMCID: PMC9471825 DOI: 10.1192/j.eurpsy.2021.812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction The COVID-19 pandemic has enforced the restructuring of inpatient psychiatric services. In the UK, the South London and Maudsley NHS Foundation Trust has introduced a triage ward system to ensure all patients have a COVID test prior to admission to the general ward with the aim to reduce COVID transmission amongst psychiatric inpatients. Objectives To characterise the flow of patients through a COVID-19 psychiatric triage ward and the protocol of assessment and management used. Methods Descriptive analysis of patients admitted to a COVID-19 triage ward since its creation. Results The caseload of patients admitted to the COVID-19 triage ward since its inception will be presented. This will include the profile of patients admitted, their status (formal/informal) and their acceptance of COVID-19 tests. The protocol followed at this COVID-19 triage ward will be presented, and the challenges faced and suggestions to overcome them will be discussed. Conclusions This presentation aims to share the workflow and protocols adopted at a COVID-19 triage ward in the UK, discussing challenges experienced as well as good practices. Conflict of interest No significant relationships.
Collapse
|
62
|
Evans VJ, Lawrence M, Whitley J, Johns C, Pillai S, Hawkins K, Power K, Morris K, Williams R, Evans PA. The treatment effect of rivaroxaban on clot characteristics in patients who present acutely with first time deep vein thrombosis. Clin Hemorheol Microcirc 2021; 80:139-151. [PMID: 33682699 DOI: 10.3233/ch-201030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND The acute vascular disease deep vein thrombosis (DVT) requires oral anticoagulants to prevent progression. Monitoring therapeutic efficacy of direct oral anticoagulants (DOAC), including rivaroxaban, is problematic as no reliable test is available. Advances in rheometry have led to the development of a functional coagulation biomarker using Gel Point (GP) analysis which assesses clot structure formation. The biomarker measures incipient clot formation time (TGP) and quantifies fibrin clot structure in terms of fractal dimension (df). OBJECTIVE This study aimed to investigate clot structure formation in first time DVT and the effect of rivaroxaban treatment. METHODS This prospective observational cohort study measured the GP and standard laboratory markers at three sample points: pre-treatment and at 20 and 60 days following 15 mg BD and 20 mg OD rivaroxaban respectively. RESULTS Forty DVT patients (mean age 64 years [SD±14.8]; 23 males, 17 female) were recruited. The results show that DVT vs non-DVT patients did not have a significantly different GP profile (df: 1.72±0.06 vs 1.70±0.06 and TGP: 267±68 sec vs 262±73 sec) with both within the defined healthy index. In addition, rivaroxaban therapy increased TGP to 392 s (±135 s) after 20 days, and subsequently increased to 395 s (±194 s) at 60 days but did not significantly increase df (from 1.69±0.05 to 1.71±0.06). CONCLUSIONS The results indicate in this cohort of DVT patients there was no underlying hypercoagulable effect as determined by gel point analysis. Furthermore, the anticoagulant effect of rivaroxaban prolonged clotting, suggesting a protective effect against clot formation, without significantly reducing clot microstructural properties.
Collapse
Affiliation(s)
- V J Evans
- Welsh Centre for Emergency Medicine Research, Morriston Hospital, Swansea Bay University Health Board, Swansea, UK.,Swansea University, Swansea, UK
| | - M Lawrence
- Welsh Centre for Emergency Medicine Research, Morriston Hospital, Swansea Bay University Health Board, Swansea, UK.,Swansea University, Swansea, UK
| | - J Whitley
- Welsh Centre for Emergency Medicine Research, Morriston Hospital, Swansea Bay University Health Board, Swansea, UK.,Swansea University, Swansea, UK
| | - C Johns
- Swansea Bay University Health Board, Swansea, UK
| | - S Pillai
- Welsh Centre for Emergency Medicine Research, Morriston Hospital, Swansea Bay University Health Board, Swansea, UK.,Swansea University, Swansea, UK
| | | | - K Power
- Swansea Bay University Health Board, Swansea, UK
| | - K Morris
- Cardiff Metropolitan University, Cardiff, UK
| | | | - P A Evans
- Welsh Centre for Emergency Medicine Research, Morriston Hospital, Swansea Bay University Health Board, Swansea, UK.,Swansea University, Swansea, UK
| |
Collapse
|
63
|
Baldwin DS, Dang M, Farquharson L, Fitzpatrick N, Lindsay N, Quirk A, Rhodes E, Shah P, Williams R, Crawford MJ. Quality of English inpatient mental health services for people with anxiety or depressive disorders: Findings and recommendations from the core audit of the National Clinical Audit of Anxiety and Depression. Compr Psychiatry 2021; 104:152212. [PMID: 33160123 DOI: 10.1016/j.comppsych.2020.152212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 09/04/2020] [Accepted: 09/17/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Clinical audit is a sustained cyclical quality improvement process seeking to improve patient care and outcomes by evaluating services against explicit standards and implementing necessary changes. National audits aim to improve population-level clinical care by identifying unwarranted variations and making recommendations for clinicians, managers and service commissioners. The National Clinical Audit of Anxiety and Depression aimed to improve clinical care for people admitted to English hospitals for treatment of anxiety and depression, to provide comparative data on quality of care, and to support local quality improvement initiatives by identifying and sharing examples of best practice. PROCEDURES Thirteen standards were developed based on NICE guidelines, literature review and feedback from a steering committee and reference group of service users and carers. All providers of NHS inpatient mental health services in England were asked to submit details of between 20 and 100 eligible service users/patients admitted between April 2017 and September 2018. To ascertain data reliability, participating services re-audited 5 sets of case-notes with a second auditor, and the coordinating team checked 10 randomly-selected sets of case-notes from 3 services, also selected at random. The reference group and steering committee identified key findings and developed a series of recommendations, which were discussed in regional quality improvement workshops and on-line webinars. FINDINGS Data from 3795 case notes were analysed. A sizeable proportion of records indicated that at least one important aspect of initial assessment was not documented. Many service users/patients who could have benefited from an intervention targeted at optimising physical health did not receive it. Only a minority (39%) were referred for psychological therapy. Use of outcome measures varied considerably but no single outcome measure was being used routinely. Most individuals had a care plan recorded in the notes, but a review date was documented in only two-thirds, and almost half of individuals had not received a copy. CONCLUSIONS There was considerable variation between English mental health services across many variables, and much scope for improvement. Clinicians should ensure that care plans are developed collaboratively with service users/patients and identified carers should be provided with information about support services. Health services should investigate the reasons for low referral rates for psychological therapies. Clinicians should ensure all service users have jointly developed crisis plans in place at discharge. Service managers should agree outcome measures to evaluate the treatment provided and clinicians should use these measures at initial assessment and review appointments. The implementation of such changes provides an opportunity for collaborative research into mental health service delivery and quality.
Collapse
Affiliation(s)
- D S Baldwin
- NCAAD Clinical Lead, Royal College of Psychiatrists, United Kingdom; Psychiatry, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, United Kingdom; University Department of Psychiatry and Mental Health, University of Cape Town, Cate Town, South Africa.
| | - M Dang
- NCAAD Programme Manager, Royal College of Psychiatrists, United Kingdom
| | - L Farquharson
- Clinical Advisor to the Spotlight Audits, Royal College of Psychiatrists, United Kingdom; Clinical Psychology, University of East London, United Kingdom
| | - N Fitzpatrick
- NCAAD Project Officer, Royal College of Psychiatrists, United Kingdom
| | - N Lindsay
- NCAAD Project Officer, Royal College of Psychiatrists, United Kingdom
| | - A Quirk
- CCQI Head of Clinical Audit and Research, Royal College of Psychiatrists, United Kingdom
| | - E Rhodes
- NCAAD Deputy Programme Manager, Royal College of Psychiatrists, United Kingdom
| | - P Shah
- NCAAD Service User Advisor, Royal College of Psychiatrists, United Kingdom
| | - R Williams
- CCQI Clinical Fellow, Royal College of Psychiatrists, United Kingdom; Department of Brain Sciences, Imperial College London, United Kingdom
| | - M J Crawford
- College Centre for Quality Improvement, Royal College of Psychiatrists, United Kingdom; Mental Health Research, Faculty of Medicine, Imperial College London, United Kingdom
| |
Collapse
|
64
|
Aslam A, Monaghan A, Williams R. Sensitivity of surveillance imaging (MRI vs OPG) in odontogentic keratocyst detection in patients with nevoid basal cell carcinoma syndrome (Gorlin syndrome). Br J Oral Maxillofac Surg 2020. [DOI: 10.1016/j.bjoms.2020.10.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
65
|
Goggins E, Williams R, Kim T, Adams J, Davis M, McIntosh M, Uzor M, Geary F, Jamieson D, Boulet S. Assessing influenza vaccination behaviors among medically underserved obstetric patients. Am J Obstet Gynecol 2020. [DOI: 10.1016/j.ajog.2020.08.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
66
|
Affiliation(s)
- C R Brewin
- University College London, Gower Street, London WC1E 6BT, UK
| | - J DePierro
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - P Pirard
- Agence Nationale de santé Publique, Saint-Maurice, France
| | - C Vazquez
- Universidad Complutense de Madrid, Madrid, Spain
| | - R Williams
- University of South Wales, Pontypridd, UK
| |
Collapse
|
67
|
Geia L, Baird K, Bail K, Barclay L, Bennett J, Best O, Birks M, Blackley L, Blackman R, Bonner A, Bryant AO R, Buzzacott C, Campbell S, Catling C, Chamberlain C, Cox L, Cross W, Cruickshank M, Cummins A, Dahlen H, Daly J, Darbyshire P, Davidson P, Denney-Wilson E, De Souza R, Doyle K, Drummond A, Duff J, Duffield C, Dunning T, East L, Elliott D, Elmir R, Fergie OAM D, Ferguson C, Fernandez R, Flower AM D, Foureur M, Fowler C, Fry M, Gorman E, Grant J, Gray J, Halcomb E, Hart B, Hartz D, Hazelton M, Heaton L, Hickman L, Homer AO CSE, Hungerford C, Hutton A, Jackson AO D, Johnson A, Kelly MA, Kitson A, Knight S, Levett-Jones T, Lindsay D, Lovett R, Luck L, Molloy L, Manias E, Mannix J, Marriott AMR, Martin M, Massey D, McCloughen A, McGough S, McGrath L, Mills J, Mitchell BG, Mohamed J, Montayre J, Moroney T, Moyle W, Moxham L, Northam OAM H, Nowlan S, O'Brien AP, Ogunsiji O, Paterson C, Pennington K, Peters K, Phillips J, Power T, Procter N, Ramjan L, Ramsay N, Rasmussen B, Rihari-Thomas J, Rind B, Robinson M, Roche M, Sainsbury K, Salamonson Y, Sherwood J, Shields L, Sim J, Skinner I, Smallwood G, Smallwood R, Stewart L, Taylor S, Usher AM K, Virdun C, Wannell J, Ward R, West C, West R, Wilkes L, Williams R, Wilson R, Wynaden D, Wynne R. A unified call to action from Australian nursing and midwifery leaders: ensuring that Black lives matter. Contemp Nurse 2020; 56:297-308. [DOI: 10.1080/10376178.2020.1809107] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- L. Geia
- James Cook University, Townsville, QLD, Australia
| | - K. Baird
- University of Technology Sydney, Sydney, NSW, Australia
| | - K. Bail
- University of Canberra, Canberra, ACT, Australia
| | - L. Barclay
- University of Sydney, Sydney, NSW, Australia
| | - J. Bennett
- University of Newcastle, Callaghan, NSW, Australia
| | - O. Best
- University of Southern Queensland, Darling Heights, QLD, Australia
| | - M. Birks
- James Cook University, Townsville, QLD, Australia
| | - L. Blackley
- Queensland Health, Joyce Palmer Health Service, Palm Island, QLD, Australia
| | - R. Blackman
- Gidgee Healing Mt Isa, Mount Isa, QLD, Australia
| | - A. Bonner
- Griffith University, Brisbane, QLD, Australia
| | - R. Bryant AO
- Rosemary Bryant Foundation, South Australia, Australia
| | - C. Buzzacott
- Rhodanthe Lipsett Indigenous Midwifery Charitable Fund, Caringbah, NSW, Australia
| | - S. Campbell
- Charles Darwin University, Darwin, NT, Australia
| | - C. Catling
- University of Technology Sydney, Sydney, NSW, Australia
| | | | - L. Cox
- Queensland University of Technology, Brisbane, QLD, Australia
| | - W. Cross
- Federation University, Ballarat, VIC, Australia
| | - M. Cruickshank
- University of Technology Sydney, Sydney, NSW, Australia
- Sydney Children’s Hospital Network, Sydney, NSW, Australia
| | - A. Cummins
- University of Technology Sydney, Sydney, NSW, Australia
| | - H. Dahlen
- Western Sydney University, Sydney, NSW, Australia
| | - J. Daly
- University of Sydney, Sydney, NSW, Australia
| | - P. Darbyshire
- Philip Darbyshire Consulting, Highbury, South Australia, Australia
| | - P. Davidson
- University of Technology Sydney, Sydney, NSW, Australia
- Western Sydney University, Sydney, NSW, Australia
- John Hopkins University, Baltimore, USA
| | | | | | - K. Doyle
- Western Sydney University, Sydney, NSW, Australia
| | - A. Drummond
- Queensland University of Technology, Brisbane, QLD, Australia
| | - J. Duff
- Queensland University of Technology, Brisbane, QLD, Australia
| | - C. Duffield
- University of Technology Sydney, Sydney, NSW, Australia
- Edith Cowan University, Perth, Western Australia, Australia
| | - T. Dunning
- Deakin University, Melbourne, VIC, Australia
| | - L. East
- University of New England, Armidale, NSW, Australia
| | - D. Elliott
- University of Technology Sydney, Sydney, NSW, Australia
| | - R. Elmir
- Western Sydney University, Sydney, NSW, Australia
| | - D. Fergie OAM
- Australian Catholic University, Fitzroy, VIC, Australia
| | - C. Ferguson
- Western Sydney University, Sydney, NSW, Australia
| | - R. Fernandez
- University of Wollongong, Keiraville, NSW, Australia
| | | | - M. Foureur
- University of Newcastle, Callaghan, NSW, Australia
| | - C. Fowler
- University of Technology Sydney, Sydney, NSW, Australia
| | - M. Fry
- University of Technology Sydney, Sydney, NSW, Australia
| | - E. Gorman
- New South Wales Health, Sydney, NSW, Australia
| | - J. Grant
- Charles Sturt University, Dubbo, NSW, Australia
| | - J. Gray
- University of Technology Sydney, Sydney, NSW, Australia
| | - E. Halcomb
- University of Wollongong, Keiraville, NSW, Australia
| | - B. Hart
- University of Notre Dame, Darlinghurst, NSW, Australia
| | - D. Hartz
- Charles Darwin University, Darwin, NT, Australia
| | - M. Hazelton
- University of Newcastle, Callaghan, NSW, Australia
| | - L. Heaton
- Western Sydney University, Sydney, NSW, Australia
| | - L. Hickman
- University of Technology Sydney, Sydney, NSW, Australia
- Contemporary Nurse Journal
| | | | | | - A. Hutton
- University of Newcastle, Callaghan, NSW, Australia
| | - D. Jackson AO
- University of Technology Sydney, Sydney, NSW, Australia
| | - A. Johnson
- University of Newcastle, Callaghan, NSW, Australia
| | - M. A. Kelly
- Sydney Children’s Hospital Network, Sydney, NSW, Australia
| | - A. Kitson
- Western Sydney University, Sydney, NSW, Australia
| | - S. Knight
- James Cook University, Townsville, QLD, Australia
| | | | - D. Lindsay
- James Cook University, Townsville, QLD, Australia
| | - R. Lovett
- Australian National University, Canberra, Australian Capital Territory, Australia
| | - L. Luck
- Western Sydney University, Sydney, NSW, Australia
| | - L. Molloy
- University of Wollongong, Keiraville, NSW, Australia
| | - E. Manias
- Deakin University, Melbourne, VIC, Australia
| | - J. Mannix
- Western Sydney University, Sydney, NSW, Australia
| | | | - M. Martin
- Queensland Aboriginal and Islander Health Council, Brisbane, QLD, Australia
| | - D. Massey
- Southern Cross University, Gold Coast Campus, QLD, Australia
| | | | - S. McGough
- Curtin University, Perth, Western Australia, Australia
| | - L. McGrath
- Aboriginal Medical Service Redfern, Sydney, NSW, Australia
| | - J. Mills
- La Trobe University, Melbourne, VIC, Australia
| | | | - J. Mohamed
- Lowitja Institute, Melbourne, VIC, Australia
| | - J. Montayre
- Western Sydney University, Sydney, NSW, Australia
| | - T. Moroney
- University of Wollongong, Keiraville, NSW, Australia
| | - W. Moyle
- Griffith University, Brisbane, QLD, Australia
| | - L. Moxham
- University of Wollongong, Keiraville, NSW, Australia
| | | | - S. Nowlan
- Queensland Health, Joyce Palmer Health Service, Palm Island, QLD, Australia
| | | | - O. Ogunsiji
- Western Sydney University, Sydney, NSW, Australia
| | - C. Paterson
- University of Canberra, Canberra, ACT, Australia
| | - K. Pennington
- Flinders University, Adelaide, South Australia, Australia
| | - K. Peters
- Western Sydney University, Sydney, NSW, Australia
| | - J. Phillips
- University of Technology Sydney, Sydney, NSW, Australia
| | - T. Power
- University of Technology Sydney, Sydney, NSW, Australia
| | - N. Procter
- University of South Australia, Adelaide, South Australia, Australia
| | - L. Ramjan
- Western Sydney University, Sydney, NSW, Australia
| | - N. Ramsay
- Queensland Health, Joyce Palmer Health Service, Palm Island, QLD, Australia
| | | | | | - B. Rind
- Aboriginal Health Unit Mt Druitt Hospital, Sydney, NSW, Australia
| | - M. Robinson
- Murdoch University, Perth, Western Australia, Australia
| | - M. Roche
- University of Technology Sydney, Sydney, NSW, Australia
| | - K. Sainsbury
- University of Canberra, Canberra, ACT, Australia
| | | | - J. Sherwood
- Charles Sturt University, Dubbo, NSW, Australia
| | - L. Shields
- University of Queensland, Brisbane, QLD, Australia
| | - J. Sim
- University of Wollongong, Keiraville, NSW, Australia
| | - I. Skinner
- James Cook University, Townsville, QLD, Australia
| | - G. Smallwood
- James Cook University, Townsville, QLD, Australia
| | - R. Smallwood
- University of Newcastle, Callaghan, NSW, Australia
- University of New England, Armidale, NSW, Australia
| | - L. Stewart
- James Cook University, Townsville, QLD, Australia
| | - S. Taylor
- Top End Health, Northern Territory, Darwin, NT, Australia
| | - K. Usher AM
- University of Technology Sydney, Sydney, NSW, Australia
- University of New England, Armidale, NSW, Australia
| | - C. Virdun
- University of Technology Sydney, Sydney, NSW, Australia
| | - J. Wannell
- Melbourne Poche Centre for Indigenous Health, Melbourne, VIC, Australia
| | - R. Ward
- University of Southern Queensland, Darling Heights, QLD, Australia
| | - C. West
- James Cook University, Townsville, QLD, Australia
| | - R. West
- Griffith University, Brisbane, QLD, Australia
| | - L. Wilkes
- Western Sydney University, Sydney, NSW, Australia
| | - R. Williams
- Charles Darwin University, Darwin, NT, Australia
| | - R. Wilson
- University of Newcastle, Callaghan, NSW, Australia
- University of New England, Armidale, NSW, Australia
| | - D. Wynaden
- Curtin University, Perth, Western Australia, Australia
| | - R. Wynne
- Western Sydney University, Sydney, NSW, Australia
| |
Collapse
|
68
|
Abstract
The changes in platelet-related haemostatic parameters have been studied during haemoperfusion of eleven patients with acute liver failure. Five patients were treated by haemoperfusion with an albumin-coated resin column and six with a polymer-coated charcoal column. The platelet and white cell losses over four hours’ haemoperfusion were small in both groups. Significant increases in β-thromboglobulin (mean 341 ± SE 145 ng/ml) were seen after one hour in the patients treated by charcoal haemoperfusion. One patient in the charcoal group with the greatest rises in β-thromboglobulin (860 hg/ml) and screen filtration pressure (205 mmHg) developed severe hypotension and haemoperfusion was terminated after 1 hour. One patient in the resin group showed rapid consumption of heparin after 2 hours. Measurement of β-thromboglobulin is a sensitive assay of platelet activation during haemoperfusion. Albumin-coated resin haemoperfusion appears to be a more blood-compatible procedure with respect to platelets than charcoal haemoperfusion.
Collapse
Affiliation(s)
- R.D. Hughes
- King's College Hospital and Medical School, Denmark Hill, London, England
| | - D.A. Lane
- Liver Unit and Thrombosis Research Unit
| | - G. Cella
- Liver Unit and Thrombosis Research Unit
| | | | - P.G. Langley
- King's College Hospital and Medical School, Denmark Hill, London, England
| | - R. Williams
- King's College Hospital and Medical School, Denmark Hill, London, England
| |
Collapse
|
69
|
|
70
|
Williams R, Brown J, Rider A, Wild R, Clayton E, Method M. 239P Impact of clinical characteristics, patients' perception of treatment goals and endocrine therapy history on HRQOL in HR+, HER2- early stage breast cancer patients. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
71
|
Elledge R, Williams R, Fowell C, Green J. Maxillofacial education in the time of COVID-19: the West Midlands experience. Br J Oral Maxillofac Surg 2020; 60:52-57. [PMID: 32807595 PMCID: PMC7392048 DOI: 10.1016/j.bjoms.2020.07.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 07/21/2020] [Indexed: 12/11/2022]
Abstract
COVID-19 has accelerated a reliance on virtual technology for the delivery of postgraduate surgical education. We sought to develop a regional teaching programme with robust quality assurance. Webinars were delivered on a weekly basis by subspecialty experts using Zoom™ augmented with interactive polling software. Trainee feedback comprised Likert item rating on content and delivery, free text comments and self-assessed confidence levels using visual analogue scale (VAS) scores. A focus group was also convened and transcripts assessed with grounded theory analysis. Likert items revealed 442 (93.2%) positive responses regarding content and 642 (96.7%) positive responses regarding trainer delivery. There were statistically significant improvements in VAS scores across all programme content. Key themes from the focus group analysis were the pragmatics of delivering online education, issues surrounding trainer interactivity in the virtual world, the identification of the FRCS as a driving factor and a desire for case-based content and pre-learning of information (the ‘flipped classroom’). We are continuing to be reactive to trainee feedback in developing our online learning programme which will also include a regional Moodle-based virtual learning environment (VLE), the subject of future educational research in our region.
Collapse
Affiliation(s)
- R Elledge
- University Hospitals Birmingham NHS Foundation Trust, University of Birmingham; College of Medical and Dental Sciences, University of Birmingham.
| | - R Williams
- University Hospitals Birmingham NHS Foundation Trust, University of Birmingham.
| | - C Fowell
- Cambridge University Hospitals NHS Foundation Trust.
| | - J Green
- University Hospitals Birmingham NHS Foundation Trust, University of Birmingham.
| |
Collapse
|
72
|
Miles LF, Chuen J, Edwards L, Hohmann JD, Williams R, Peyton P, Grayden DB. The design and manufacture of 3D-printed adjuncts for powered air-purifying respirators. Anaesth Rep 2020; 8:e12055. [PMID: 32705085 PMCID: PMC7369400 DOI: 10.1002/anr3.12055] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2020] [Indexed: 11/21/2022] Open
Abstract
Spurred in part by literature published in the immediate aftermath of the severe acute respiratory syndrome epidemic in 2003, powered air‐purifying respirators have seen increased use worldwide during the COVID‐19 pandemic. Whereas these devices provide excellent protection of the user, there is an added element of risk during doffing and cleaning of the device. An additional layer of barrier protection, in the form of a polypropylene gown, to be worn over the hood and motor belt, can be used to minimise this risk. However, the device entrains air perpendicular to the lie of the gown, resulting in the impermeable material being sucked into the air intake, and partial occlusion of flow. In this report, we describe a clinical‐academic partnership whereby a bespoke filter guard was designed to disrupt airflow and prevent gown entrainment, thereby enabling full barrier protection of both the device and user. This intervention was simple, cheap, scalable and able to be mass produced.
Collapse
Affiliation(s)
- L F Miles
- Department of Anaesthesia Austin Health Melbourne Vic Australia
| | - J Chuen
- 3DMedLab Austin Health Melbourne Vic Australia
| | - L Edwards
- MSD Robotics Lab Melbourne School of Design Melbourne Vic Australia
| | - J D Hohmann
- Technician NExT Lab Melbourne School of Design Melbourne Vic Australia
| | - R Williams
- Melbourne Brain Centre Imaging Unit Melbourne Vic Australia
| | - P Peyton
- Department of Anaesthesia Austin Health Melbourne Vic Australia
| | - D B Grayden
- Department of Biomedical Engineering The University of Melbourne Vic Australia
| |
Collapse
|
73
|
Abstract
The NIST Center for Neutron Research (NCNR) operates a 20 MW research reactor that produces neutrons for a suite of 30 neutron scattering instruments. 70% of these instruments use cold neutrons (E<5 meV), which are moderated by two separate cold neutron sources. The cold moderator for both sources is liquid hydrogen (LH2), which is in turn cooled by a recently commissioned 7 kW, 14K helium refrigerator. NCNR plans to replace the larger cold source with a new one operating with liquid deuterium (LD2). This report focuses on progress towards the upgrade to liquid deuterium, and options to address the particular challenges of designing and operating a cooling system that simultaneously supports operation with both LH2 and LD2.
Collapse
Affiliation(s)
- J Jurns
- NIST Center for Neutron Research, Gaithersburg, MD 20899, USA
| | - M Middleton
- NIST Center for Neutron Research, Gaithersburg, MD 20899, USA
| | - R Williams
- NIST Center for Neutron Research, Gaithersburg, MD 20899, USA
| |
Collapse
|
74
|
Abbas Y, Abdelkader M, Adams M, Addison A, Advani R, Ahmed T, Alexander V, Alexander V, Alli B, Alvi S, Amiraraghi N, Ashman A, Balakumar R, Bewick J, Bhasker D, Bola S, Bowles P, Campbell N, Can Guru Naidu N, Caton N, Chapman J, Chawdhary G, Cherko M, Coates M, Conroy K, Coyle P, Cozar O, Cresswell M, Dalton L, Danino J, Daultrey C, Davies K, Carrie S, Dick D, Dimitriadis PA, Doddi N, Dowling M, Easto R, Edmiston R, Ellul D, Erskine S, Evans A, Farboud A, Forde C, Fussey J, Gaunt A, Gilchrist J, Gohil R, Gosnell E, Grech Marguerat D, Green R, Grounds R, Hall A, Hardman J, Harris A, Harrison L, Hone R, Hoskison E, Howard J, Ioannidis D, Iqbal I, Janjua N, Jolly K, Kamal S, Kanzara T, Keates N, Kelly A, Khan H, Korampalli T, Kuet M, Kul‐loo P, Lakhani R, Lambert A, Lancer H, Leonard C, Lloyd G, Lowe E, Mair J, Maughan E, Gao C, Mayberry T, McCadden L, McClenaghan F, McKenzie G, Mcleod R, Meghji S, Mian M, Millington A, Mirza O, Mistry S, Molena E, Morris J, Myuran T, Navaratnam A, Noon E, Okonkwo O, Oremule B, Pabla L, Papesch E, Puranik V, Roplekar R, Ross E, Rudd J, Schechter E, Senior A, Sethi N, Sharma S, Sharma R, Shelton F, Sherazi Z, Tahir A, Tikka T, Tkachuk Hlinicanova O, To K, Tse A, Toll E, Ubayasiri K, Unadkat S, Upile N, Vijendren A, Walijee H, Wilkie M, Williams R, Williams M, Wilson G, Wong W, Wong G, Xie C, Yao A, Zhang H, Ellis M, Mehta N, Milinis K, Tikka T, Slovick A, Swords C, Hutson K, Smith ME, Hopkins C, Ng Kee Kwong F. Nasal Packs for Epistaxis: Predictors of Success. Clin Otolaryngol 2020; 45:659-666. [DOI: 10.1111/coa.13555] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 03/08/2020] [Accepted: 04/13/2020] [Indexed: 11/30/2022]
|
75
|
Yang C, Williams R, Swerdel J, Jani M, Duarte-Salles T, Chatzidionysiou K, Prieto-Alhambra D, Ryan P, Rijnbeek P. OP0216 DEVELOPMENT AND VALIDATION OF PATIENT-LEVEL PREDICTION MODELS FOR ADVERSE HEALTH OUTCOMES AMONGST ADULT RA PATIENTS INITIATING FIRST-LINE TREATMENT OF METHOTREXATE MONOTHERAPY: A MULTINATIONAL REAL-WORLD COHORT ANALYSIS INCLUDING 164,735 SUBJECTS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:EULAR guidelines recommend the early initiation of methotrexate (MTX) monotherapy as soon as possible after the diagnosis of rheumatoid arthritis (RA). Evaluating patient-level risks for adverse outcomes after MTX initiation would allow clinicians to provide more personalised care.Objectives:To develop and validate patient-level prediction models for adverse health outcomes including leukopenia, pancytopenia, infection (serious, opportunistic, all), cardiovascular disease (CVD) (myocardial infarction (MI), stroke), and cancer (breast, colorectal, uterus) in adult RA patients initiating first-line treatment of MTX monotherapyMethods:Health data from claims and electronic health records were used including patients from 7 European countries (Spain, Estonia, Netherlands, Belgium, Germany, France, and the UK), the United States of America, Australia, and Japan. All RA patients initiating first-line treatment of MTX monotherapy with at least one year of prior observation were included. Prediction models for the outcomes were developed for a time at risk of 3 months (infections, leukopenia, pancytopenia), 2 years (MI and stroke), and 5 years (cancers) on the Optum© De-Identified Clinformatics® Data Mart Database. Models were developed using LASSO logistic regression and were evaluated using the area under the receiver operator characteristic curve (AUROC) for discrimination and graphically assessed for calibration. The models were externally validated on all other databases.Results:A total of 21,307 subjects were used for training and validated against 143,427 patients from 14 sites. MI (AUROC internal 0.77, AUROC external ranging from 0.49 to 0.78), stroke (AUROC internal 0.78, AUROC external ranging from 0.68 to 0.79) and serious infection (AUROC internal 0.75, AUROC external ranging from 0.63 to 0.79) had good predictive validity [Table 1]. Discrimination for all other outcomes was lower, with all AUC<0.7 in internal validation. For detailed results see:https://data.ohdsi.org/ehdenRaPrediction/Table 1.Internal (Optum) and external validation results: AUC ROC for discriminationDatabaseAcute MI within 2yStroke within 2ySerious Infection within 3mOptum (internal)0.770.780.75PanTher0.760.780.74IQVIA_AMBEMR0.760.72CCAE0.730.730.66IQVIA_GERMANY0.640.70IQVIA_THIN0.620.65MDCR0.680.680.67IQVIA_HOSPITAL0.670.630.61MDCD0.720.790.63JMDC0.490.750.71IQVIA_LPDFRANCE0.69Estonia0.670.770.82IQVIA_AUS0.58IPCI0.68SIDIAP0.650.75Conclusion:Clinical tools were developed that successfully identify subjects at risk of MI, stroke and serious infection at the initiation of first-line MTX therapy. The developed algorithms had good transportability and generally, the models with high AUROC had adequate internal calibration although some external validations show they could benefit from recalibration. For short-term opportunistic and all infections, as well as 5-year cancer models, we were unable to achieve a high enough AUROC to warrant validating externally.Disclosure of Interests:Cynthia Yang: None declared, Ross Williams: None declared, Joel Swerdel Shareholder of: J&J shares, Grant/research support from: Full-time employment salary from Janssen, Consultant of: Janssen employee, Employee of: Janssen, Paid instructor for: Janssen employee, have instructed at conferences, Speakers bureau: Janssen employee, have spoken at conferences, Meghna Jani Speakers bureau: Grifols, Talita Duarte-Salles: None declared, Katerina Chatzidionysiou Consultant of: AbbVie, Pfizer, Lilly., Daniel Prieto-Alhambra Grant/research support from: Professor Prieto-Alhambra has received research Grants from AMGEN, UCB Biopharma and Les Laboratoires Servier, Consultant of: DPA’s department has received fees for consultancy services from UCB Biopharma, Speakers bureau: DPA’s department has received fees for speaker and advisory board membership services from Amgen, Patrick Ryan: None declared, Peter Rijnbeek: None declared
Collapse
|
76
|
De Souza S, Williams R, Johansson E, Zabalan C, Esterine T, Bakkers M, Roth W, MC Carthy N, Blake M, Karlfeldt S, Johannesson M, Raza K. PARE0007 PATIENT AND PUBLIC INVOLVEMENT IN CLINICAL TRIAL DESIGN. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Patient and public involvement (PPI) is gaining increasing recognition as important in ensuring research is relevant and acceptable to participants. Rheuma Tolerance for Cure (RTCure) is a 5 year international collaboration between academia and industry; focusing on earlier detection and prevention of rheumatoid arthritis (RA) through the use of immune-tolerising treatments.Objectives:To bring lived experience and insight into scientific discussions; and to evolve collaboration between lay representatives and academia/industry.Methods:9 Patient Research Partners (PRPs) from 5 European countries were recruited via the EULAR PARE Network and institutions within the RTCure Consortium (8 PRPs with RA and 1 ‘at risk’). They were asked to enter into a legal agreement with the Consortium. PRPs participated in teleconferences (TCs) and were invited to attend face-to-face (F2F) meetings at least annually. Requests for input/feedback were sent from researchers to PRPs via the project’s Patient Engagement Expert [SK].Results:PRP involvement has given researchers and industry partners a new perspective on patient priorities, and focused thought on the ethics of recruitment for and participation in clinical trials of people ‘at risk’ of developing RA. PRPs have helped define the target populations, given their thoughts on what types of treatments are acceptable to people ‘at risk’ and have aided the development of a survey (sent to EULAR PARE members) regarding the use of animal models in biomedical research. Positive informal feedback has been received from researchers and industry regarding the contribution of PRPs to the ongoing project (formal evaluation of PPI in RTCure will be carried out in 2020 and at the project end in 2022).Challenges:Legal agreements- Many PRPs refused to sign the Consortium’s complex PRP Agreement; feeling it unnecessary, incomprehensible and inequitable. After extensive consultation with various parties (including EULAR and the Innovative Medicines Initiative) no similar contract was found. Views for its requirement even varied between legal experts. After 2 years of intense discussion, a simple non-disclosure agreement was agreed upon. Ideally any contract, if required, should be approved prior to project onset.Meeting logistics- Other improvements identified were to locate the meeting venue and accommodation on the same site to minimise travel, and to make it easier for PRPs to take breaks when required. This also facilitates informal discussions and patient inclusivity. We now have agreed a policy to fund PRPs extra nights before and after meetings, and to bring a carer if needed.Enabling understanding– Future annual meetings will start with a F2F meeting between PRPs and Work Package Leads. Researchers will be encouraged to start presentations with a summary slide in lay language. Additionally, an RTCure Glossary is in development.Enabling participation– SK will provide monthly project updates and PRP TCs will be held in the evening (as some PRPs remain employed). PRPs will be invited to all project TCs and F2F meetings. Recruitment is underway to increase the number of ‘at risk’ PRPs as their viewpoint is vital to this study.Conclusion:Currently PPI in RTCure is an ongoing mutual learning process. Universal guidance regarding what types of contracts are needed for PPI would be useful. Communication, trust and fruitful discussions have evolved through F2F meetings (both formal and informal) between PRPs, academia and industry. It is important that all parties can be open with each other in order to make PPI more meaningful.Acknowledgments:This work has received support from the EU/EFPIA Innovative Medicines Initiative 2 Joint Undertaking RTCure grant number 777357.Disclosure of Interests:Savia de Souza: None declared, Ruth Williams: None declared, Eva Johansson: None declared, Codruta Zabalan: None declared, Tom Esterine: None declared, Margôt Bakkers: None declared, Wolfgang Roth: None declared, Neil Mc Carthy: None declared, Meryll Blake: None declared, Susanne Karlfeldt: None declared, Martina Johannesson: None declared, Karim Raza Grant/research support from: KR has received research funding from AbbVie and Pfizer, Consultant of: KR has received honoraria and/or consultancy fees from AbbVie, Sanofi, Lilly, Bristol-Myers Squibb, UCB, Pfizer, Janssen and Roche Chugai, Speakers bureau: KR has received honoraria and/or consultancy fees from AbbVie, Sanofi, Lilly, Bristol-Myers Squibb, UCB, Pfizer, Janssen and Roche Chugai
Collapse
|
77
|
Gleeson M, Kentwell M, Meiser B, Do J, Nevin S, Taylor N, Barlow-Stewart K, Kirk J, James P, Scott CL, Williams R, Gamet K, Burke J, Murphy M, Antill YC, Pearn A, Pachter N, Ebzery C, Poplawski N, Friedlander M, Tucker KM. The development and evaluation of a nationwide training program for oncology health professionals in the provision of genetic testing for ovarian cancer patients. Gynecol Oncol 2020; 158:431-439. [PMID: 32451123 DOI: 10.1016/j.ygyno.2020.05.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 05/03/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND BRCA1/2 mutation status has increasing relevance for ovarian cancer treatments, making traditional coordination of genetic testing by genetic services unsustainable. Consequently alternative models of genetic testing have been developed to improve testing at the initial diagnosis for all eligible women. METHODS A training module to enable mainstreamed genetic testing by oncology healthcare professionals was developed by genetic health professionals. Oncology healthcare professionals completed questionnaires before and 12 months post-training to assess perceived skills, competence and barriers to their coordinating genetic testing for women with high-grade non-mucinous epithelial ovarian cancer. Genetic health professionals were surveyed 12 months post-training to assess perceived barriers to implementation of mainstreaming. RESULTS 185 oncology healthcare professionals were trained in 42 workshops at 35 Australasian hospitals. Of the 273 tests ordered by oncology healthcare professionals post-training, 241 (93.1%) met national testing guidelines. The number of tests ordered by genetic health professionals reduced significantly (z = 45.0, p = 0.008). Oncology healthcare professionals' perceived barriers to mainstreamed testing decreased from baseline to follow-up (t = 2.39, p = 0.023), particularly perceived skills, knowledge and attitudes. However, only 58% reported either 'always' or 'nearly always' having ordered BRCA testing for eligible patients at 12 months, suggesting oncology healthcare professionals' perceived barriers were not systematically addressed through training. CONCLUSIONS Oncology healthcare professionals have demonstrated a willingness to be involved in the provision of genetic testing in a mainstreaming model. If oncology services are to hold responsibility for coordinating genetic testing, their readiness will require understanding of barriers not addressed by training alone to inform future intervention design.
Collapse
Affiliation(s)
- M Gleeson
- Hunter Family Cancer Service, Newcastle, Australia.
| | - M Kentwell
- Parkville Familial Cancer Clinic, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia; The Royal Women's Hospital, Oncology and Dysplasia, Melbourne, Australia
| | - B Meiser
- Prince of Wales Clinical School, UNSW Sydney, Australia
| | - J Do
- Prince of Wales Clinical School, UNSW Sydney, Australia
| | - S Nevin
- Prince of Wales Clinical School, UNSW Sydney, Australia
| | - N Taylor
- The Cancer Council New South Wales, Sydney and Faculty of Health Science, University of Sydney, Australia
| | | | - J Kirk
- Familial Cancer Service, Westmead Hospital, Sydney Medical School, University of Sydney and Centre for Cancer Research, The Westmead Institute for Medical Research, Australia
| | - P James
- Parkville Familial Cancer Clinic, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia
| | - C L Scott
- Parkville Familial Cancer Clinic, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia; Department of Obstetrics and Gynaecology and Department of Medical Biology, University of Melbourne, Australia
| | - R Williams
- Prince of Wales Clinical School, UNSW Sydney, Australia; Hereditary Cancer Centre, Prince of Wales Hospital, Sydney, Australia
| | - K Gamet
- Genetic Health Service NZ Northern Hub, Auckland City Hospital, Auckland, New Zealand
| | - J Burke
- Tasmanian Clinical Genetics Service, Royal Hobart Hospital, Hobart, Australia
| | - M Murphy
- Parkville Familial Cancer Clinic, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia; Bendigo Health Cancer Centre, Bendigo, Australia
| | - Y C Antill
- Parkville Familial Cancer Clinic, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia; Familial Cancer Centre, Monash Health, Victoria, Australia
| | - A Pearn
- Genetic Services of Western Australia, King Edward Memorial Hospital, Perth, Australia
| | - N Pachter
- Genetic Services of Western Australia, King Edward Memorial Hospital, Perth, Australia; School of Medicine, University of Western Australia, Perth, Australia
| | - C Ebzery
- Genetic Health Queensland, Royal Brisbane and Women's Hospital, Queensland, Australia
| | - N Poplawski
- Adult Genetics Unit, Royal Adelaide Hospital, Adelaide and School of Medicine, University of Adelaide, Australia
| | - M Friedlander
- Dept Medical Oncology, Prince of Wales Hospital, Sydney, Australia
| | - K M Tucker
- Prince of Wales Clinical School, UNSW Sydney, Australia; Hereditary Cancer Centre, Prince of Wales Hospital, Sydney, Australia
| | | |
Collapse
|
78
|
Criscitiello C, Spurden D, Rider A, Williams R, Corsaro M, Pike J, Law E. 87P Patient-reported and cancer-specific health-related quality of life among patients with early stage HR+/HER2- breast cancer (BC). Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
|
79
|
Criscitiello C, Spurden D, Rider A, Williams R, Corsaro M, Pike J, Law E. 82P A multinational study of real-world treatment patterns among patients with early stage HR+/HER2- breast cancer (BC). Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
80
|
Glover G, Williams R, Oyinlola J. An observational cohort study of numbers and causes of preventable general hospital admissions in people with and without intellectual disabilities in England. J Intellect Disabil Res 2020; 64:331-344. [PMID: 32141168 DOI: 10.1111/jir.12722] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 02/04/2020] [Accepted: 02/06/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Hospital admissions for preventable reasons [ambulatory care sensitive (ACS) conditions] can indicate gaps in access to or quality of primary care. This paper seeks to document the numbers and causes of these admissions in England for people with intellectual disabilities (ID) compared with those without. METHODS Observational cohort study of number and duration of emergency admitted patient episodes for ACS conditions, overall and by cause, using the Clinical Practice Research Datalink GOLD primary care database and the linked Hospital Episode Statistics Admitted Patient Care dataset. RESULTS The study covered 5.2% of the population of England from April 2010 to March 2014 giving a total population base of 59 280 person-years for people with ID and 11 103 910 for people without identified ID. The rate of emergency admissions for ACS conditions for people with ID was 77.5 per 1000 person-years. As a crude comparison, this was 3.0 times the rate for those without ID, but standardising for the distinct demography of this group, the number of episodes was 4.8 times that expected if they had the same age-specific and sex-specific rates. Stay durations for these episodes were longer for both young-age and working-age people with ID. Overall people with ID used 399.8 bed-days per 1000 person-years. As a crude comparison, this is 2.8 times the figure for people without ID. Standardising for their age and sex profile, it is 5.4 times the number expected if they had the same age-specific and sex-specific rates. For patients with ID, 16.6% (one in six) of all admitted patient episodes and 24.3% (one in four) of in-patient care days for people with ID were for ACS conditions. Corresponding figures for those without ID were 8.3% (one in 12) and 14.4% (one in seven). The difference in rates between those with and without ID was most marked in people of working age. The three most common causes of emergency episodes for ACS conditions in people with ID were convulsions and epilepsy, influenza pneumonia and aspiration pneumonitis. Influenza pneumonia was also a common cause for people without ID. Episodes for convulsions and epilepsy and aspiration pneumonitis were specifically associated with people with ID. CONCLUSIONS Rates of hospital admissions for ACS conditions provide an important indicator of health literacy, basic self-care (or support by carers) and the accessibility of primary care. High rates are seen for some conditions specifically associated with premature death in people with ID. Local monitoring of these figures could be used to indicate the effectiveness of local primary health services in providing support to people with ID.
Collapse
Affiliation(s)
- G Glover
- Centre for Disability Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - R Williams
- Clinical Practice Research Datalink Group, Medicines and Healthcare Products Regulatory Agency, London, UK
| | - J Oyinlola
- Clinical Practice Research Datalink Group, Medicines and Healthcare Products Regulatory Agency, London, UK
| |
Collapse
|
81
|
Williams R, Hull K, Clarke D, Graham L, Hawkins R, Cundill B, Ellwood A, Farrin A, Fisher J, Goodwin M, Holland M, Hulme C, Kelly C, Forster A. Process evaluation exploring the delivery and uptake of a posture and mobility training package in care homes. Physiotherapy 2020. [DOI: 10.1016/j.physio.2020.03.270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
82
|
Forster A, Cundill B, Ellwood A, Fisher J, Goodwin M, Graham L, Hawkins R, Holland M, Hull K, Hulme C, Kelly C, Williams R, Farrin A. A posture and mobility (skilful care) training package for care home staff: results of a cluster randomised controlled feasibility trial. Physiotherapy 2020. [DOI: 10.1016/j.physio.2020.03.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
83
|
Williamson M, Iliopoulos E, Williams R, Trompeter A. Intra-operative fluoroscopy time and radiation dose during suprapatellar tibial nailing versus infrapatellar tibial nailing. Injury 2020; 51:1133. [PMID: 32081394 DOI: 10.1016/j.injury.2020.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 02/08/2020] [Indexed: 02/02/2023]
Affiliation(s)
- M Williamson
- Trauma & Orthopaedics, St George's University Hospitals NHS Foundation Trust, London, SW17 0QT U.K..
| | - E Iliopoulos
- Brighton & Sussex University Hospitals NHS Trust, Brighton, BN2 5BE U.K
| | - R Williams
- Radiology Department, St George's University Hospitals NHS Foundation Trust, London, SW17 0QT, U.K
| | - A Trompeter
- Trauma & Orthopaedics, St George's University Hospitals NHS Foundation Trust, London, SW17 0QT U.K
| |
Collapse
|
84
|
Borton Z, Shivji F, Simeen S, Williams R, Tambe A, Espag M, Cresswell T, Clark D. Diabetic patients are almost twice as likely to experience complications from arthroscopic rotator cuff repair. Shoulder Elbow 2020; 12:109-113. [PMID: 32313560 PMCID: PMC7153207 DOI: 10.1177/1758573219831691] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 01/25/2019] [Indexed: 11/15/2022]
Abstract
AIMS Large population-based studies have demonstrated increased prevalence of rotator cuff disease amongst diabetics. Recent studies have suggested comparable clinical outcomes from rotator cuff repair despite suggestions of increased complication rates amongst diabetics. However, there is a relative paucity of studies considering the effect of diabetes upon complication rate. We aim to report and quantify the effect of diabetes on complication rates following arthroscopic rotator cuff repair. MATERIALS AND METHODS A retrospective review of a consecutive series of patients undergoing arthroscopic rotator cuff repair between January 2011 and December 2014 was performed. Diabetic status and complication data defined as infection, frozen shoulder, re-tear or re-operation were collected and interrogated. RESULTS A total of 462 patients were included at median follow-up of 5.6 years. Diabetics were significantly more likely to experience frozen shoulder (15.8% vs. 4.4%, p = 0.001), re-tear (26.3% vs. 15.6%, p = 0.042) or at least one complication following surgery (35.1% vs. 22.7%, p = 0.041) compared to non-diabetics. These equated to odds ratios of 4.03, 1.94 and 1.84, respectively. CONCLUSIONS Diabetic patients are almost twice as likely to experience complications following arthroscopic rotator cuff repair, including double the risk of repair failure and more than four times the risk of frozen shoulder.
Collapse
Affiliation(s)
- Z Borton
- Z Borton, C/o Mr D Clark, Royal Derby Hospital, Uttoxeter Road, Derby, DE22 3NE, UK.
| | | | | | | | | | | | | | | |
Collapse
|
85
|
Pounder KC, Mukhida F, Brown RP, Carter D, Daltry JC, Fleming T, Goetz M, Halsey LG, Hughes G, Questel K, Saccheri IJ, Williams R, Soanes LM. Testing for hybridisation of the Critically Endangered Iguana delicatissima on Anguilla to inform conservation efforts. CONSERV GENET 2020. [DOI: 10.1007/s10592-020-01258-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AbstractThe Caribbean Island of Anguilla in the north-eastern Lesser Antilles is home to one of the last populations of the Critically Endangered Lesser Antillean iguana Iguana delicatissima. This population is highly threatened primarily because of hybridisation with non-native Iguana iguana. This study assesses the degree of hybridisation between Anguilla’s Iguana species firstly using morphological characteristics and then genetic analysis to validate the genetic integrity of morphologically identified I. delicatissima. We also examined the genetic diversity of Anguilla’s I. delicatissima population, and that of a population on the nearby island of Îlet Fourchue, St Barthélemy. Forty-five iguanas were captured in Anguilla and 10 in St Barthélemy, and sequences from 3 nuclear and 1 mtDNA genes were obtained for each. Of the 45 iguanas captured in Anguilla, 22 were morphologically identified as I. delicatissima, 12 as I. iguana and the remainder were identified as hybrids. Morphological assignments were all confirmed by genetic analyses except for one I. iguana and one hybrid individual. These two individuals appeared likely to have originated following ancestral hybridisation events several generations ago. A significant paucity of genetic diversity was found within Anguillan and St Barthélemy I. delicatissima populations, with a single haplotype being identified for each of the three nuclear genes and the mtDNA sequence. This study highlights the urgency for immediate action to conserve Anguilla’s remnant I. delicatissima population. Protection from hybridisation will require translocation to I. iguana-free offshore cays, with supplementary individuals being sourced from neighbouring islands to enhance the genetic diversity of the population.
Collapse
|
86
|
Kelley WN, Andrews J, Appelt AW, Barber R, Barnett J, Barta L, Bass B, Bone E, Breske L, Bryant HH, Case RA, Coleman K, Cyr R, Dewald SK, Dombroski P, Dubs EL, Feldstein FF, Gay BE, Ginn RE, Gottomoller C, Grant H, Heady J, Hills DG, Jerrod L, Jones K, Kaus C, Lane AL, Leslie JE, Marchette D, Misup M, Morris L, Mullen RN, Payton C, Schmidt J, Schneider D, Share R, Sierck M, Wehr HM, Williams R. Qualitative Ampule and Multitest for Beta-Lactam Residues in Fluid Milk Products: Collaborative Study. J AOAC Int 2020. [DOI: 10.1093/jaoac/65.5.1193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
A collaborative study was performed on a rapid Bacillus stearothermophilus agar diffusion ampule method to detect low levels of penicillin G in 7 types of fluid milk products. A multitest technique for processing a large number of samples simultaneously was also studied. Slight modifications were made in the original method to establish more uniformity and to eliminate doubtful responses by specifying a confirmation procedure. Twenty samples spiked with penicillin G (0.000 to 0.008 IU/mL) and tetracycline hydrochloride were frozen and sent to 20 laboratories in the ampule test, and 16 laboratories in the multitest. Each analyst was asked to do a screening run and a confirmation run. Results were reported by color reaction and also as positive or negative for β-lactam inhibitors. The concentrations (penicillin G) where percent positive results equal 100 or not significantly less than 100 (α = 0.05) ranged from 0.005 to 0.007 IU/mi in the ampule test and from 0.004 to 0.007 IU/mL in the multitest. Both techniques have been adopted official first action.
Collapse
|
87
|
Williams R, Clarke D, Graham L, Hawkins R, Cundill B, Ellwood A, Farrin A, Fisher J, Goodwin M, Holland M, Hull K, Hulme C, Kelly C, Forster A. 102 Process Evaluation Exploring the Delivery and Uptake of Posture and Mobility Training for Staff in Care Homes. Age Ageing 2020. [DOI: 10.1093/ageing/afz196.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Provision of care for care home residents with complex needs is challenging. Physiotherapists can play a major role in enhancing the confidence, skills and abilities of care home staff. The Skilful Care Training Package (SCTP) aims to provide staff with an understanding of good posture and training in skilled facilitation of movement. This process evaluation explored barriers and facilitators to delivery and uptake of the SCTP within the context of a feasibility cluster randomised controlled trial (cRCT) in 10 care homes.
Methods
A mixed methods process evaluation, incorporating non-participant observations and interviews, conducted in the five care homes receiving the SCTP intervention. Interviews were audio recorded and transcribed verbatim; resident conversations were captured via a Dictaphone and/or field-notes. Data analysis used the Framework approach.
Results
Fourteen staff training sessions were observed. Interviews with 22 staff and four trainers, and 13 conversations with residents were completed. Five factors influenced delivery and uptake of the SCTP:Organisational factors: strategies to publicise and facilitate access to training improved attendance; a convenient training location and trainer flexibility encouraged attendance and staff engagement.Intervention delivery: a practical participatory element to the training was highly valued; adapting the training to meet the needs of the homes was well-received.Engagement and interaction: relating training to workplace and residents’ experiences engaged staff; high levels of engagement and positive interaction within the training sessions were reported; challenges relating to staff hierarchy affected training delivery in some homes.Intervention content: posture and mobility elements were seen as important; however, some repetition with prior training was highlighted.Training impact: there were indications that staff adopted SCTP techniques. Staff reported an increase in their wellbeing and confidence in movement facilitation; cascade training was reported in some homes.
Conclusions
Training was well-received, and feedback on its impact was largely positive. Practical elements were viewed favourably over classroom-based learning. Intervention content should be revised to optimise focus and avoid overlap with other training.
Collapse
Affiliation(s)
- R Williams
- Academic Unit of Elderly Care and Rehabilitation, Bradford Institute for Health Research
| | - D Clarke
- Leeds Institute of Health Sciences, University of Leeds
| | - L Graham
- Academic Unit of Elderly Care and Rehabilitation, Bradford Institute for Health Research
| | - R Hawkins
- Leeds Institute of Health Sciences, University of Leeds
| | - B Cundill
- Clinical Trials Research Unit, University of Leeds
| | - A Ellwood
- Academic Unit of Elderly Care and Rehabilitation, Bradford Institute for Health Research
| | - A Farrin
- Clinical Trials Research Unit, University of Leeds
| | | | - M Goodwin
- Clinical Trials Research Unit, University of Leeds
| | - M Holland
- Clinical Trials Research Unit, University of Leeds
| | | | - C Hulme
- Institute of Health Research, University of Exeter
| | - C Kelly
- Leeds Institute of Health Sciences, University of Leeds
| | - A Forster
- Academic Unit of Elderly Care and Rehabilitation, Bradford Institute for Health Research
- Leeds Institute of Health Sciences, University of Leeds
| |
Collapse
|
88
|
Graham L, Cundill B, Ellwood A, Fisher J, Goodwin M, Hawkins R, Holland M, Hull K, Hulme C, Kelly C, Williams R, Farrin A, Forster A. 101 A Posture and Mobility Training Package for Care Home Staff: Results of A Cluster Randomised Controlled Feasibility Trial. Age Ageing 2020. [DOI: 10.1093/ageing/afz196.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Provision of care for care home residents with complex needs is challenging. Physiotherapy and activity interventions can improve physical well-being but are often time-limited and resource intensive. A sustainable approach is to enhance the confidence, skills and abilities of care home staff. This trial assessed the feasibility of undertaking a definitive evaluation of the Skilful Care Training Package (SCTP) - a posture and mobility training programme developed by physiotherapists for care home staff.
Methods
A parallel-group, cluster randomised controlled feasibility trial was undertaken in ten care homes in Yorkshire. Five were randomised to receive SCTP, five to usual care. SCTP was delivered by specialist physiotherapists, with the intention of training all direct care staff. Following consent, data were collected from and about residents with restricted mobility (those fulfilling the eligibility criteria) at baseline, three and six months post-randomisation by blinded researchers. Outcome measurement included resident mobility, posture, pain and quality of life. The feasibility of recruitment, retention, data collection and intervention delivery was assessed.
Results
All residents (348) at participating homes were screened for eligibility. 250 were eligible and 146 took part. Follow-up was balanced between arms, with an overall loss-to-follow-up rate of 28.8% at six months. Where residents were available for six-month follow-up, proxy data provision was excellent (97.1% - 100% of expected data). Difficulty collecting data directly from residents was experienced (43.3% of expected data) due to high levels of cognitive impairment. Staff attendance at training met or was close to pre-specified criteria for acceptability in three homes, with 63.0%, 63.6% and 65.8% direct care staff attending all sessions, and >85% attending at least one session across all three homes. However attendance fell short of acceptability in two homes, with only 21.4% and 12.5% staff attending all sessions.
Conclusions
It is feasible to recruit and follow-up residents in a randomised trial comparing SCTP and usual care. Proxy data collection is a successful method, but collection of data from residents is difficult. Intervention delivery success was variable, illustrating heterogeneity between care homes. Future research will be informed by learning from those homes with greater intervention compliance. Work should be undertaken to investigate how best to collect meaningful data from residents.
Collapse
Affiliation(s)
- L Graham
- Academic Unit of Elderly Care and Rehabilitation, Bradford Institute for Health Research
| | - B Cundill
- Clinical Trials Research Unit, University of Leeds
| | - A Ellwood
- Academic Unit of Elderly Care and Rehabilitation, Bradford Institute for Health Research
| | | | - M Goodwin
- Clinical Trials Research Unit, University of Leeds
| | - R Hawkins
- Leeds Institute of Health Sciences, University of Leeds
| | - M Holland
- Clinical Trials Research Unit, University of Leeds
| | | | - C Hulme
- Institute of Health Research, University of Exeter
| | - C Kelly
- Leeds Institute of Health Sciences, University of Leeds
| | - R Williams
- Academic Unit of Elderly Care and Rehabilitation, Bradford Institute for Health Research
| | - A Farrin
- Clinical Trials Research Unit, University of Leeds
| | - A Forster
- Academic Unit of Elderly Care and Rehabilitation, Bradford Institute for Health Research
- Leeds Institute of Health Sciences, University of Leeds
| |
Collapse
|
89
|
Tan R, Wang A, Malpass-Evans R, Williams R, Zhao EW, Liu T, Ye C, Zhou X, Darwich BP, Fan Z, Turcani L, Jackson E, Chen L, Chong SY, Li T, Jelfs KE, Cooper AI, Brandon NP, Grey CP, McKeown NB, Song Q. Author Correction: Hydrophilic microporous membranes for selective ion separation and flow-battery energy storage. Nat Mater 2020; 19:251. [PMID: 31866669 DOI: 10.1038/s41563-019-0593-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
An amendment to this paper has been published and can be accessed via a link at the top of the paper.
Collapse
Affiliation(s)
- Rui Tan
- Barrer Centre, Department of Chemical Engineering, Imperial College London, London, UK
| | - Anqi Wang
- Barrer Centre, Department of Chemical Engineering, Imperial College London, London, UK
| | | | - Rhodri Williams
- EaStChem School of Chemistry, University of Edinburgh, Edinburgh, UK
| | - Evan Wenbo Zhao
- Department of Chemistry, University of Cambridge, Cambridge, UK
| | - Tao Liu
- Department of Chemistry, University of Cambridge, Cambridge, UK
- Shanghai Key Laboratory of Chemical Assessment and Sustainability, Department of Chemistry, Tongji University, Shanghai, China
| | - Chunchun Ye
- EaStChem School of Chemistry, University of Edinburgh, Edinburgh, UK
| | - Xiaoqun Zhou
- Barrer Centre, Department of Chemical Engineering, Imperial College London, London, UK
| | | | - Zhiyu Fan
- Barrer Centre, Department of Chemical Engineering, Imperial College London, London, UK
| | - Lukas Turcani
- Department of Chemistry, Imperial College London, London, UK
| | - Edward Jackson
- Department of Chemistry, Imperial College London, London, UK
| | - Linjiang Chen
- Leverhulme Research Centre for Functional Materials Design, Materials Innovation Factory and Department of Chemistry, University of Liverpool, Liverpool, UK
| | - Samantha Y Chong
- Leverhulme Research Centre for Functional Materials Design, Materials Innovation Factory and Department of Chemistry, University of Liverpool, Liverpool, UK
| | - Tao Li
- Department of Chemistry and Biochemistry, Northern Illinois University, DeKalb, IL, USA
- X-ray Science Division, JCESR, Argonne National Laboratory, Lemont, IL, USA
| | - Kim E Jelfs
- Department of Chemistry, Imperial College London, London, UK
| | - Andrew I Cooper
- Leverhulme Research Centre for Functional Materials Design, Materials Innovation Factory and Department of Chemistry, University of Liverpool, Liverpool, UK
| | - Nigel P Brandon
- Department of Earth Science and Engineering, Imperial College London, London, UK
| | - Clare P Grey
- Department of Chemistry, University of Cambridge, Cambridge, UK
| | - Neil B McKeown
- EaStChem School of Chemistry, University of Edinburgh, Edinburgh, UK.
| | - Qilei Song
- Barrer Centre, Department of Chemical Engineering, Imperial College London, London, UK.
| |
Collapse
|
90
|
Tan R, Wang A, Malpass-Evans R, Williams R, Zhao EW, Liu T, Ye C, Zhou X, Darwich BP, Fan Z, Turcani L, Jackson E, Chen L, Chong SY, Li T, Jelfs KE, Cooper AI, Brandon NP, Grey CP, McKeown NB, Song Q. Hydrophilic microporous membranes for selective ion separation and flow-battery energy storage. Nat Mater 2020; 19:195-202. [PMID: 31792424 DOI: 10.1038/s41563-019-0536-8] [Citation(s) in RCA: 126] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 10/18/2019] [Indexed: 06/10/2023]
Abstract
Membranes with fast and selective ion transport are widely used for water purification and devices for energy conversion and storage including fuel cells, redox flow batteries and electrochemical reactors. However, it remains challenging to design cost-effective, easily processed ion-conductive membranes with well-defined pore architectures. Here, we report a new approach to designing membranes with narrow molecular-sized channels and hydrophilic functionality that enable fast transport of salt ions and high size-exclusion selectivity towards small organic molecules. These membranes, based on polymers of intrinsic microporosity containing Tröger's base or amidoxime groups, demonstrate that exquisite control over subnanometre pore structure, the introduction of hydrophilic functional groups and thickness control all play important roles in achieving fast ion transport combined with high molecular selectivity. These membranes enable aqueous organic flow batteries with high energy efficiency and high capacity retention, suggesting their utility for a variety of energy-related devices and water purification processes.
Collapse
Affiliation(s)
- Rui Tan
- Barrer Centre, Department of Chemical Engineering, Imperial College London, London, UK
| | - Anqi Wang
- Barrer Centre, Department of Chemical Engineering, Imperial College London, London, UK
| | | | - Rhodri Williams
- EaStChem School of Chemistry, University of Edinburgh, Edinburgh, UK
| | - Evan Wenbo Zhao
- Department of Chemistry, University of Cambridge, Cambridge, UK
| | - Tao Liu
- Department of Chemistry, University of Cambridge, Cambridge, UK
- Shanghai Key Laboratory of Chemical Assessment and Sustainability, Department of Chemistry, Tongji University, Shanghai, China
| | - Chunchun Ye
- EaStChem School of Chemistry, University of Edinburgh, Edinburgh, UK
| | - Xiaoqun Zhou
- Barrer Centre, Department of Chemical Engineering, Imperial College London, London, UK
| | | | - Zhiyu Fan
- Barrer Centre, Department of Chemical Engineering, Imperial College London, London, UK
| | - Lukas Turcani
- Department of Chemistry, Imperial College London, London, UK
| | - Edward Jackson
- Department of Chemistry, Imperial College London, London, UK
| | - Linjiang Chen
- Leverhulme Research Centre for Functional Materials Design, Materials Innovation Factory and Department of Chemistry, University of Liverpool, Liverpool, UK
| | - Samantha Y Chong
- Leverhulme Research Centre for Functional Materials Design, Materials Innovation Factory and Department of Chemistry, University of Liverpool, Liverpool, UK
| | - Tao Li
- Department of Chemistry and Biochemistry, Northern Illinois University, DeKalb, IL, USA
- X-ray Science Division, JCESR, Argonne National Laboratory, Lemont, IL, USA
| | - Kim E Jelfs
- Department of Chemistry, Imperial College London, London, UK
| | - Andrew I Cooper
- Leverhulme Research Centre for Functional Materials Design, Materials Innovation Factory and Department of Chemistry, University of Liverpool, Liverpool, UK
| | - Nigel P Brandon
- Department of Earth Science and Engineering, Imperial College London, London, UK
| | - Clare P Grey
- Department of Chemistry, University of Cambridge, Cambridge, UK
| | - Neil B McKeown
- EaStChem School of Chemistry, University of Edinburgh, Edinburgh, UK.
| | - Qilei Song
- Barrer Centre, Department of Chemical Engineering, Imperial College London, London, UK.
| |
Collapse
|
91
|
Johnson R, Williams R, Shaw M. Conservative feeding versus eucaloric feeding in critical care. Clin Nutr ESPEN 2020. [DOI: 10.1016/j.clnesp.2019.12.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
92
|
Warren RB, Barker JNWB, Finlay AY, Burden AD, Kirby B, Armendariz Y, Williams R, Hatchard C, Khare S, Griffiths CEM. Secukinumab for patients failing previous tumour necrosis factor-α inhibitor therapy: results of a randomized open-label study (SIGNATURE). Br J Dermatol 2019; 183:60-70. [PMID: 31628677 DOI: 10.1111/bjd.18623] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Efficacy data on therapies for patients with psoriasis who have failed tumour necrosis factor (TNF)-α inhibitor therapy is limited. OBJECTIVES To determine the effectiveness and tolerability of secukinumab, an interleukin (IL)-17A inhibitor, in patients with moderate/severe chronic plaque psoriasis with documented efficacy failure of TNF-α inhibitor therapy (SIGNATURE study). METHODS This was a randomized, open-label, noncomparator study in 53 dermatology centres in the U.K. and Republic of Ireland. Patients were randomized 1 : 1 to receive secukinumab 300 mg or 150 mg subcutaneously every week for 4 weeks, then 4-weekly thereafter. Patients were stratified by their prior efficacy failure with TNF-α inhibitors. Only patients who started and stayed on the same dose at each time point were included for efficacy assessments. RESULTS In total, 233 patients were analysed. The primary end point was met, with a statistically significant improvement in response rates [75% reduction in Psoriasis Area and Severity Index (PASI 75)] from baseline to week 16 in both secukinumab 300 mg and 150 mg dose groups [77 of 118 patients (65·3%) and 51 of 115 patients (44·3%), respectively; P < 0·0001]. After 72 weeks, in patients starting and remaining on 300 mg, 77% (54 of 70) achieved PASI 75. Improvements in Dermatology Life Quality Index from baseline to week 16 occurred and were maintained up to 72 weeks. The safety profile was generally consistent with previous secukinumab studies, although a higher incidence of some adverse events (e.g. candida infections) was observed. CONCLUSIONS This study provides evidence of efficacy and safety of secukinumab for treatment of patients with psoriasis who failed prior TNF-α inhibitor therapy. This study represents a 'real-world' population, providing reassurance that secukinumab is a treatment option in this difficult-to-treat population. What's already known about this topic? Conventional systemic nonbiological and tumour necrosis factor (TNF)-α inhibitor therapies for plaque psoriasis have not fully met patients' needs. There is a lack of data to support the treatment pathways for patients with psoriasis who have inadequate responses to TNF-α inhibitor therapy. Secukinumab, a recombinant high-affinity fully human monoclonal anti-human interleukin-17A antibody of the IgG1/κ-class, has shown excellent safety and efficacy in the treatment of moderate-to-severe psoriasis. What does this study add? This is the first study evaluating treatment with biologics after prior efficacy failure of TNF-α inhibitor therapy as defined by the U.K. National Institute for Health and Care Excellence criteria. Secukinumab is an effective treatment in this difficult-to-treat patient population. This study provides important practical information for clinicians managing psoriasis. Adverse events were consistent with the phase III programme for secukinumab, although some adverse events, e.g. candida, were increased.
Collapse
Affiliation(s)
- R B Warren
- Centre for Dermatology Research, University of Manchester, NIHR Manchester Biomedical Research Centre, Manchester, U.K.,Salford Royal NHS Foundation Trust, Manchester, U.K
| | - J N W B Barker
- St John's Institute of Dermatology, King's College London, London, U.K
| | - A Y Finlay
- Division of Infection and Immunity, Cardiff University, Cardiff, U.K
| | - A D Burden
- Centre for Dermatology Research, University of Manchester, NIHR Manchester Biomedical Research Centre, Manchester, U.K.,Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, U.K
| | - B Kirby
- St Vincent's University Hospital and the Charles Institute, University College Dublin, Dublin, Ireland
| | | | - R Williams
- Novartis Pharmaceuticals U.K. Ltd, Frimley, U.K
| | - C Hatchard
- Novartis Pharmaceuticals U.K. Ltd, Frimley, U.K
| | - S Khare
- Novartis Pharmaceuticals U.K. Ltd, Frimley, U.K
| | - C E M Griffiths
- Centre for Dermatology Research, University of Manchester, NIHR Manchester Biomedical Research Centre, Manchester, U.K.,Salford Royal NHS Foundation Trust, Manchester, U.K
| |
Collapse
|
93
|
Swingler A, Williams R, Monaghan A. Recurrent Odontogenic Keratocysts - should we be following up with MRI scans. Br J Oral Maxillofac Surg 2019. [DOI: 10.1016/j.bjoms.2019.10.172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
94
|
Al-Azzani W, Kinghorn A, Williams R. Increased fracture incidence in snow and ice conditions; a model for escalation. Int J Health Plann Manage 2019; 35:625-630. [PMID: 31693202 DOI: 10.1002/hpm.2947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 10/09/2019] [Indexed: 11/07/2022] Open
Abstract
Several studies have shown that the incidence of fractures during periods of snow and ice increases significantly and continues to persist despite preventative measures. The studies discussed in this article suggest that these predominantly consist of "walking wounded" with significant increase in demands in specific services such as the emergency department and the trauma and orthopaedic department. Traditionally, the only formal mechanism in place for most hospitals to react to extreme events is to declare a major incident. This is a binary, all or nothing response, and it is questionable whether an increase of snow and ice-related fractures would be justified in triggering such an extreme response. On the other end is the "do nothing" approach, which relies heavily on the professionalism, adaptability, and resilience of the staff to deal with the additional demand. The authors present a graded surge plan model for escalation in key resources, such as staff, space, and supplies in order to achieve the most efficient response ensuring good clinical outcome for patients.
Collapse
Affiliation(s)
- Waheeb Al-Azzani
- Prince Philip Hospital, Trauma and Orthopaedic Department, Hywel Dda University Health Board, UK
| | - Alison Kinghorn
- Prince Philip Hospital, Trauma and Orthopaedic Department, Hywel Dda University Health Board, UK
| | - Rhodri Williams
- Prince Philip Hospital, Trauma and Orthopaedic Department, Hywel Dda University Health Board, UK
| |
Collapse
|
95
|
Cacciottolo TM, Perikari A, van der Klaauw A, Henning E, Stadler LKJ, Keogh J, Farooqi IS, Tenin G, Keavney B, Ryan E, Budd R, Bewley M, Coelho P, Rumsey W, Sanchez Y, McCafferty J, Dockrell D, Walmsley S, Whyte M, Liu Y, Choy MK, Tenin G, Abraham S, Black G, Keavney B, Ford T, Stanley B, Good R, Rocchiccioli P, McEntegart M, Watkins S, Eteiba H, Shaukat A, Lindsay M, Robertson K, Hood S, McGeoch R, McDade R, Sidik N, McCartney P, Corcoran D, Collison D, Rush C, McConnachie A, Touyz R, Oldroyd K, Berry C, Gazdagh G, Diver L, Marshall J, McGowan R, Ahmed F, Tobias E, Curtis E, Parsons C, Maslin K, D'Angelo S, Moon R, Crozier S, Gossiel F, Bishop N, Kennedy S, Papageorghiou A, Fraser R, Gandhi S, Prentice A, Inskip H, Godfrey K, Schoenmakers I, Javaid MK, Eastell R, Cooper C, Harvey N, Watt ER, Howden A, Mirchandani A, Coelho P, Hukelmann JL, Sadiku P, Plant TM, Cantrell DA, Whyte MKB, Walmsley SR, Mordi I, Forteath C, Wong A, Mohan M, Palmer C, Doney A, Rena G, Lang C, Gray EH, Azarian S, Riva A, Edwards H, McPhail MJW, Williams R, Chokshi S, Patel VC, Edwards LA, Page D, Miossec M, Williams S, Monaghan R, Fotiou E, Santibanez-Koref M, Keavney B, Badat M, Mettananda S, Hua P, Schwessinger R, Hughes J, Higgs D, Davies J. Scientific Business Abstracts of the 113th Annual Meeting of the Association of Physicians of Great Britain and Ireland. QJM 2019; 112:724-729. [PMID: 31505685 DOI: 10.1093/qjmed/hcz175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - A Perikari
- University of Cambridge Metabolic Research Laboratories
| | | | - E Henning
- University of Cambridge Metabolic Research Laboratories
| | - L K J Stadler
- University of Cambridge Metabolic Research Laboratories
| | - J Keogh
- University of Cambridge Metabolic Research Laboratories
| | - I S Farooqi
- University of Cambridge Metabolic Research Laboratories
| | - G Tenin
- From University of Manchester
| | | | - E Ryan
- Department of Respiratory Medicine, Centre for Inflammation Research, University of Edinburgh
| | - R Budd
- Department of Infection Immunity and Cardiovascular Disease, The Florey Institute for Host-Pathogen Interactions, University of Sheffield
| | - M Bewley
- Department of Infection Immunity and Cardiovascular Disease, The Florey Institute for Host-Pathogen Interactions, University of Sheffield
| | - P Coelho
- Department of Respiratory Medicine, Centre for Inflammation Research, University of Edinburgh
| | - W Rumsey
- Stress and Repair Discovery Performance Unit, Respiratory Therapy Area
| | - Y Sanchez
- Stress and Repair Discovery Performance Unit, Respiratory Therapy Area
| | - J McCafferty
- Department of Respiratory Medicine, Centre for Inflammation Research, University of Edinburgh
| | - D Dockrell
- Department of Respiratory Medicine, Centre for Inflammation Research, University of Edinburgh
| | - S Walmsley
- Department of Respiratory Medicine, Centre for Inflammation Research, University of Edinburgh
| | - M Whyte
- Department of Respiratory Medicine, Centre for Inflammation Research, University of Edinburgh
| | - Y Liu
- From the University of Manchester
| | - M-K Choy
- From the University of Manchester
| | - G Tenin
- From the University of Manchester
| | | | - G Black
- From the University of Manchester
| | | | - T Ford
- BHF Centre of Excellence in Vascular Science and Medicine, University of Glasgow
- Golden Jubilee National Hospital
| | | | - R Good
- Golden Jubilee National Hospital
| | - P Rocchiccioli
- BHF Centre of Excellence in Vascular Science and Medicine, University of Glasgow
- Golden Jubilee National Hospital
| | - M McEntegart
- BHF Centre of Excellence in Vascular Science and Medicine, University of Glasgow
- Golden Jubilee National Hospital
| | | | - H Eteiba
- Golden Jubilee National Hospital
| | | | | | | | - S Hood
- Golden Jubilee National Hospital
| | | | - R McDade
- Golden Jubilee National Hospital
| | - N Sidik
- BHF Centre of Excellence in Vascular Science and Medicine, University of Glasgow
- Golden Jubilee National Hospital
| | - P McCartney
- BHF Centre of Excellence in Vascular Science and Medicine, University of Glasgow
- Golden Jubilee National Hospital
| | - D Corcoran
- BHF Centre of Excellence in Vascular Science and Medicine, University of Glasgow
- Golden Jubilee National Hospital
| | - D Collison
- BHF Centre of Excellence in Vascular Science and Medicine, University of Glasgow
- Golden Jubilee National Hospital
| | - C Rush
- BHF Centre of Excellence in Vascular Science and Medicine, University of Glasgow
- Golden Jubilee National Hospital
| | | | - R Touyz
- BHF Centre of Excellence in Vascular Science and Medicine, University of Glasgow
| | - K Oldroyd
- BHF Centre of Excellence in Vascular Science and Medicine, University of Glasgow
- Golden Jubilee National Hospital
| | - Colin Berry
- BHF Centre of Excellence in Vascular Science and Medicine, University of Glasgow
- Golden Jubilee National Hospital
| | - G Gazdagh
- School of Medicine, Dentistry & Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow
| | - L Diver
- West of Scotland Regional Genetics Service, Laboratory Medicine Building, Queen Elizabeth University Hospital
| | - J Marshall
- Institute of Cancer Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow
| | - R McGowan
- West of Scotland Regional Genetics Service, Laboratory Medicine Building, Queen Elizabeth University Hospital
| | - F Ahmed
- Developmental Endocrinology Research Group, Royal Hospital for Children, University of Glasgow
| | - E Tobias
- Academic Unit of Medical Genetics and Clinical Pathology, Laboratory Medicine Building, Queen Elizabeth University Hospital, University of Glasgow
| | - E Curtis
- MRC Lifecourse Epidemiology Unit, University of Southampton
| | - C Parsons
- MRC Lifecourse Epidemiology Unit, University of Southampton
| | - K Maslin
- MRC Lifecourse Epidemiology Unit, University of Southampton
| | - S D'Angelo
- MRC Lifecourse Epidemiology Unit, University of Southampton
| | - R Moon
- MRC Lifecourse Epidemiology Unit, University of Southampton
| | - S Crozier
- MRC Lifecourse Epidemiology Unit, University of Southampton
| | - F Gossiel
- Academic Unit of Bone Metabolism, University of Sheffield
| | - N Bishop
- Academic Unit of Child Health, University of Sheffield
| | - S Kennedy
- Nuffield Department of Women's & Reproductive Health, John Radcliffe Hospital, University of Oxford
| | - A Papageorghiou
- Nuffield Department of Women's & Reproductive Health, John Radcliffe Hospital, University of Oxford
| | - R Fraser
- Department of Obstetrics and Gynaecology, Sheffield Hospitals NHS Trust, University of Sheffield
| | - S Gandhi
- Department of Obstetrics and Gynaecology, Sheffield Hospitals NHS Trust, University of Sheffield
| | | | - H Inskip
- MRC Lifecourse Epidemiology Unit, University of Southampton
| | - K Godfrey
- MRC Lifecourse Epidemiology Unit, University of Southampton
| | - I Schoenmakers
- Department of Medicine, Faculty of Medicine and Health Sciences, University of East Anglia
| | - M K Javaid
- NIHR Oxford Biomedical Research Centre, University of Oxford
| | - R Eastell
- Academic Unit of Bone Metabolism, University of Sheffield
| | - C Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton
| | - N Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton
| | | | - A Howden
- School of Life Sciences, University of Dundee
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - E H Gray
- Institute of Hepatology, Foundation for Liver Research
- School of Immunology and Microbial Sciences, King's College London
| | - S Azarian
- Institute of Hepatology, Foundation for Liver Research
| | - A Riva
- Institute of Hepatology, Foundation for Liver Research
- School of Immunology and Microbial Sciences, King's College London
| | - H Edwards
- Institute of Hepatology, Foundation for Liver Research
- School of Immunology and Microbial Sciences, King's College London
| | - M J W McPhail
- School of Immunology and Microbial Sciences, King's College London
- Institute of Liver Studies & Transplantation, King's College Hospital
| | - R Williams
- Institute of Hepatology, Foundation for Liver Research
- School of Immunology and Microbial Sciences, King's College London
| | - S Chokshi
- Institute of Hepatology, Foundation for Liver Research
- School of Immunology and Microbial Sciences, King's College London
| | - V C Patel
- Institute of Hepatology, Foundation for Liver Research
- School of Immunology and Microbial Sciences, King's College London
- Institute of Liver Studies & Transplantation, King's College Hospital
| | - L A Edwards
- Institute of Hepatology, Foundation for Liver Research
- School of Immunology and Microbial Sciences, King's College London
| | - D Page
- University of Manchester
- Manchester Metropolitan University
| | - M Miossec
- Manchester Metropolitan University
- University of Newcastle
| | | | | | | | | | | | - M Badat
- MRC Molecular Haematology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital
| | - S Mettananda
- Department of Paediatrics, Faculty of Medicine, University of Kelaniya
| | - P Hua
- MRC Molecular Haematology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital
| | - R Schwessinger
- MRC Molecular Haematology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital
| | - J Hughes
- MRC Molecular Haematology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital
| | - D Higgs
- MRC Molecular Haematology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital
| | - J Davies
- MRC Molecular Haematology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital
| |
Collapse
|
96
|
Williams R, Duvall R, Kilaru V, Hagler G, Hassinger L, Benedict K, Rice J, Kaufman A, Judge R, Pierce G, Allen G, Bergin M, Cohen R, Fransioli P, Gerboles M, Habre R, Hannigan M, Jack D, Louie P, Martin N, Penza M, Polidori A, Subramanian R, Ray K, Schauer J, Seto E, Thurston G, Turner J, Wexler A, Ning Z. Deliberating performance targets workshop: Potential paths for emerging PM 2.5 and O 3 air sensor progress. Atmos Environ X 2019; 2:100031. [PMID: 34322666 PMCID: PMC8314253 DOI: 10.1016/j.aeaoa.2019.100031] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
The United States Environmental Protection Agency held an international two-day workshop in June 2018 to deliberate possible performance targets for non-regulatory fine particulate matter (PM2.5) and ozone (O3) air sensors. The need for a workshop arose from the lack of any market-wide manufacturer requirement for Ozone documented sensor performance evaluations, the lack of any independent third party or government-based sensor performance certification program, and uncertainty among all users as to the general usability of air sensor data. A multi-sector subject matter expert panel was assembled to facilitate an open discussion on these issues with multiple stakeholders. This summary provides an overview of the workshop purpose, key findings from the deliberations, and considerations for future actions specific to sensors. Important findings concerning PM2.5 and O3 sensors included the lack of consistent performance indicators and statistical metrics as well as highly variable data quality requirements depending on the intended use. While the workshop did not attempt to yield consensus on any topic, a key message was that a number of possible future actions would be beneficial to all stakeholders regarding sensor technologies. These included documentation of best practices, sharing quality assurance results along with sensor data, and the development of a common performance target lexicon, performance targets, and test protocols.
Collapse
Affiliation(s)
- R. Williams
- U.S. Environmental Protection Agency, Office of Research
and Development, Research Triangle Park, NC, USA
| | - R. Duvall
- U.S. Environmental Protection Agency, Office of Research
and Development, Research Triangle Park, NC, USA
- Corresponding author. U.S. Environmental
Protection Agency, 109 T.W. Alexander Drive, MD E343-02, Research Triangle Park,
NC 27711, USA. (R. Duvall)
| | - V. Kilaru
- U.S. Environmental Protection Agency, Office of Research
and Development, Research Triangle Park, NC, USA
| | - G. Hagler
- U.S. Environmental Protection Agency, Office of Research
and Development, Research Triangle Park, NC, USA
| | - L. Hassinger
- Former Oak Ridge Institute for Science and Education
(ORISE) staff assigned to the U.S. Environmental Protection Agency, Office of
Research and Development, Research Triangle Park, NC, USA
| | - K. Benedict
- U.S. Environmental Protection Agency, Office of Air Quality
Planning and Standards, Research Triangle Park, NC, USA
| | - J. Rice
- U.S. Environmental Protection Agency, Office of Air Quality
Planning and Standards, Research Triangle Park, NC, USA
| | - A. Kaufman
- U.S. Environmental Protection Agency, Office of Air Quality
Planning and Standards, Research Triangle Park, NC, USA
| | - R. Judge
- U.S. Environmental Protection Agency, Region 1, North
Chelmsford, MA, USA
| | - G. Pierce
- Colorado Department of Public Health and the Environment,
Denver, CO, USA
| | - G. Allen
- Northeast States for Coordinated Air Use Management,
Boston, MA, USA
| | - M. Bergin
- Pratt School of Engineering, Duke University, Durham, NC,
USA
| | - R.C. Cohen
- College of Chemistry, University of California-Berkeley,
Berkeley, CA, USA
| | - P. Fransioli
- Clark County Department of Air Quality (Nevada), Las Vegas,
NV, USA
| | - M. Gerboles
- European Commission, Joint Research Centre, Ispra,
Italy
| | - R. Habre
- Keck School of Medicine, University of Southern
California, Los Angeles, CA, USA
| | - M. Hannigan
- Mechanical Engineering Department, University of
Colorado-Boulder, Boulder, CO, USA
| | - D. Jack
- Mailman School of Public Health, Columbia University, New
York, NY, USA
| | - P. Louie
- Hong Kong Environmental Protection Department, Hong Kong,
China
| | - N.A. Martin
- National Physical Laboratory, Teddington, Middlesex,
United Kingdom
| | - M. Penza
- Italian National Agency for New Technologies, Energy and
Sustainable Economic Development (ENEA), Brindisi Research Center, Brindisi,
Italy
- European Network on New Sensing Technologies for
Air-Pollution Control and Environmental Sustainability (EuNetAir), Brindisi,
Italy
| | - A. Polidori
- South Coast Air Quality Management District, Diamond Bar,
CA, USA
| | - R. Subramanian
- Center for Atmospheric Particle Studies, Carnegie Mellon
University, Pittsburgh, PA, USA
| | - K. Ray
- Confederated Tribes of the Colville Reservation, Nespelem,
WAashington, USA
| | - J. Schauer
- College of Engineering, University of Wisconsin-Madison,
Madison, WI, USA
| | - E. Seto
- School of Public Health, University of Washington,
Seattle, WA, USA
| | - G. Thurston
- School of Medicine, New York University, New York, NY,
USA
| | - J. Turner
- School of Engineering and Applied Sciences, Washington
University, St. Louis, MO, USA
| | - A.S. Wexler
- Air Quality Research Center, University of
California-Davis, Davis, CA, USA
| | - Z. Ning
- Hong Kong University of Science and Technology, Hong Kong,
China
| |
Collapse
|
97
|
Abstract
Malignant infantile osteopetrosis (MIOP), an autosomal-recessive disorder, is extremely rare, presenting early in life with extreme sclerosis of the skeleton and reduced activity of osteoclasts. It was first described by Albers Schonberg in 1904. Disease manifestations include compensatory extramedullary haematopoiesis at sites such as the liver and spleen, hepatosplenomegaly, anaemia and thrombocytopaenia. Neurological manifestations can also occur due to narrowing of osseous foramina resulting in visual impairment, hearing loss, facial palsy and hydrocephalus. In addition, growth retardation and recurrent infections requiring long-term antibiotic use are common. The incidence of MIOP is 1/2 000 000 and if untreated, then it has a fatal outcome, with the majority of cases occurring within the first 5 years of life. At present, the only potentially curative option is a haematopoietic stem cell transplant. We present a 21-year-old woman, diagnosed with malignant infantile osteopetrosis, due to a mutation in the T-cell immune regulator 1 gene when aged 6 weeks, presenting with chronic osteomyelitis of her left mandible. As malignant infantile osteopetrosis has a high mortality in infancy, we felt it prudent to report this rare case in a patient surviving to adulthood.
Collapse
Affiliation(s)
- Louise Dunphy
- Department of Surgery, Milton Keynes University Hospital, Milton Keynes, UK
| | - Adrian Warfield
- Department of Histopathology, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Rhodri Williams
- Department of Oral and Maxillofacial Surgery, The Queen Elizabeth Hospital, Birmingham, UK
| |
Collapse
|
98
|
Abstract
The role of extracellular vesicles (EV) in osteoarthritis has become the focus of much research. These vesicles were isolated from several cell types found in synovial joint including chondrocytes and synovium. As articular cartilage is an avascular tissue surrounded by synovial fluid, it is believed that EV might play a crucial role in the homeostasis of cartilage and also could hold key information in the pathogenesis of osteoarthritis. This is thought to be due to activation of pro-inflammatory factors leading to a catabolic state and degradation of cartilage. In addition, due to the nature of articular cartilage lacking neuronal innervation, knowledge of EV can contribute to identification of novel biomarkers in this debilitating condition. This can be either directly isolated from aspirate of synovial fluid or from peripheral blood. Finally, EVs are known to shuttle important signalling molecules which can be utilised as unique modality in transferring therapeutic compounds in a cell free manner.
Collapse
Affiliation(s)
- A Esa
- School of Bioscience, Cardiff University, Cardiff, United Kingdom.,Swansea University Medical School, Swansea University, Swansea, United Kingdom.,School of Chemistry, Cardiff University, Cardiff, United Kingdom
| | - K D Connolly
- Swansea University Medical School, Swansea University, Swansea, United Kingdom
| | - R Williams
- School of Chemistry, Cardiff University, Cardiff, United Kingdom
| | - C W Archer
- Swansea University Medical School, Swansea University, Swansea, United Kingdom
| |
Collapse
|
99
|
Glover G, Williams R, Tompkins G, Oyinlola J. An observational study of the use of acute hospital care by people with intellectual disabilities in England. J Intellect Disabil Res 2019; 63:85-99. [PMID: 30221429 DOI: 10.1111/jir.12544] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 10/01/2017] [Accepted: 07/16/2018] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Providing safe, high-quality admitted-patient care for people with intellectual disabilities (IDs) requires consideration for their special needs particularly in relation to communication and consent. To make allowance for these special requirements, it would be helpful for hospitals to know how often they are likely to arise. This study set out to identify the amount and patterns of use of acute, non-psychiatric hospital admitted-patient care in England by people with ID. Patterns are considered in relation to clinical specialties, modes of admission (emergency or planned) and life stages (children and young people, working age and older adults). In each case, patterns for people with ID are compared with patterns for those without. METHODS Descriptive observational study using a major general practitioner (GP) research database (Clinical Practice Research Datalink GOLD) linked to routine national statistical records of admitted-patient care. RESULTS Overall people identified by their GP as having ID had higher rates of admitted-patient care episodes and longer durations of stay than those without. Differences varied considerably between clinical specialties with rates more elevated in medical and paediatric than surgical specialties. Admitted-patient care rates for women with ID in obstetrics and gynaecology were lower than for other women, while rates for admitted-patient dental care were much higher for both men and women with ID. In an average English health administrative area with a local population of 250 000 people, at any time, there are likely to be approximately 670 people receiving acute admitted-patient care. Approximately six of these are likely to have been identified by their GP as having ID. At 0.9% of hospital in-patients, this is just under twice the proportion in the population. CONCLUSION AND IMPLICATIONS Our figures are likely to be an underestimate as GP identification of people with ID is known to be far from complete. However, they indicate that the number of people with ID in acute hospital settings is likely to be substantially more than a recent survey of English health services indicated they were aware of. The study is intended to help guide expectations for acute hospitals seeking to audit the completeness of their identification of people with ID and to indicate their likely distribution between clinical specialties.
Collapse
Affiliation(s)
- G Glover
- Public Health England Learning Disabilities Observatory, West Wing, Victoria House, Capital Park, Fulbourn, Cambridge, UK
| | - R Williams
- Clinical Practice Research Datalink Group, Medicines and Healthcare Products Regulatory Agency, London, UK
| | - G Tompkins
- Public Health in Gateshead, Gateshead Council, Gateshead, UK
| | - J Oyinlola
- Clinical Practice Research Datalink Group, Medicines and Healthcare Products Regulatory Agency, London, UK
| |
Collapse
|
100
|
Abstract
Gingival bleeding is a common intraoral finding, typically associated with inflamed tissues and periodontal disease. It is easily provoked by periodontal probing or toothbrushing. Spontaneous gingival bleeding rarely occurs and may be the only sign of systemic bleeding problems such as thrombocytopenia, leukaemia or coagulopathy. In pregnancy, acute onset of thrombocytopenia may occur in systemic disorders such as severe pre-eclampsia, HELLP syndrome (haemolysis, elevated liver enzymes, low platelets) or the acute fatty liver of pregnancy. The diagnosis and management of such conditions may challenge physicians. It requires a systematic approach with a comprehensive history to exclude causes of gingival haemorrhage such as periodontal disease, anticoagulant therapy, maxillofacial trauma, haematological disorders or a bacterial infection. The authors describe a case of immune thrombocytopenic purpura presenting with spontaneous gingival haemorrhage in pregnancy. This case highlights the fact that medical intervention to correct the underlying aberration of haemostasis is necessary for local measures to stop the gingival bleeding successfully.
Collapse
Affiliation(s)
- Louise Dunphy
- Department of Surgery, Milton Keynes University Hospital, Milton Keynes, UK
| | - Rhodri Williams
- Department of Oral and Maxillofacial Surgery, The Queen Elizabeth Hospital, Birmingham, UK
| |
Collapse
|