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Ghazarian M, Leung KK, Yu LW, Sullivan K, Samman A, Deeb M, Steel A, James P. A67 RISK FACTORS ASSOCIATED WITH CRITICAL CARE AFTER INPATIENT GASTROINTESTINAL ENDOSCOPY: A 5-YEAR TERTIARY HOSPITAL STUDY. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991249 DOI: 10.1093/jcag/gwac036.067] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Background A subset of hospitalized patients will require critical care after their gastrointestinal endoscopy (GIE) and predicting which patients are at high risk of requiring critical care remains an important challenge. Purpose To identify protective and aggravating clinical risk factors associated with critical care involvement within 7 days of inpatient GIE in adults and to develop a tool that could assist in risk-stratifying patients at high risk of requiring critical care post-endoscopy. Method This was a single-centre retrospective case-control study of adult patients who underwent inpatient GIE while admitted to ward-level care at Toronto General Hospital from years 2015 to 2019. Cases were defined by inpatients who required critical care response team and/or critical care admission within 7 days of GIE, compared to control patients who did not require critical care throughout admission. Chart review and linked secondary sources were used with defined inclusion and exclusion criteria. Both univariate and multivariate analyses were performed comparing patient baseline, clinical history (including cardiovascular, respiratory, other co-morbidities) and endoscopy characteristics. Result(s) We identified a total of 275 patients with 302 endoscopies as cases and 2069 patient controls who satisfied inclusion criteria. Critical care involvement was most commonly due to cardiovascular-related complications (n=175, 58%) followed by respiratory complications (n=117, 39%). Amongst cases, death occurred in 9 (3%), 25 (9%) and 67 (22%) within 72 hours, 7 days and 30 days respectively post endoscopy. The strongest associations with critical care involvement within 7 days after GIE included a history of discharge from critical care (OR 2.29 CI 1.70-3.04) and/or recent mechanical ventilatory support (OR 2.27 CI 1.30-3.91) in the 30 days prior to endoscopy, having several co-morbidities involving major organ systems (elevated troponin OR 3.20 CI 2.26-4.52, cirrhosis OR 2.5 CI 1.80-3.46, renal dysfunction 2.09 CI 1.57-2.78) and patients admitted under surgical (OR 3.82 CI 2.54-5.71) or transplant services (OR 4.63 CI 2.94-7.26). The majority of adverse events among cases were not found to be complications directly related to GIE (64% unlikely, 20% possible, 9% probable, 7% definite). Patients with a history of pulmonary hypertension (OR 5.68 CI 0.53-60.70) and ASA score III/IV (OR 3.28 CI 1.01-10.73) had the highest odds of probable or definite endoscopy-related adverse events. Conclusion(s) This study is the largest to date to examine risk factors associated with critical care requirements post GIE in the tertiary care inpatient setting. The risk factors we have identified can be used to create a tool to determine which inpatients may benefit from anesthesia consultation and support during their endoscopic procedure. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared
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Affiliation(s)
| | - K K Leung
- Division of Gastroenterology and Hepatology
| | | | | | | | - M Deeb
- Division of Gastroenterology and Hepatology
| | - A Steel
- Department of Anesthesiology, University Health Network, University of Toronto, Toronto, Canada
| | - P James
- Division of Gastroenterology and Hepatology
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Barnard A, Petra H, Owen L, Goffe K, Bergbaum C, Wickham H, Fox O, Pleming J, Steel A. 1286 IS VIRTUAL ADVANCE CARE PLANNING SIMULATION AS EFFECTIVE AS FACE-TO-FACE LEARNING? Age Ageing 2023. [DOI: 10.1093/ageing/afac322.013] [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: 01/19/2023] Open
Abstract
Abstract
Introduction
Advance care planning (ACP) is about what matters to patients, enabling their wishes to be respected, even when they become unable to engage in decision-making. Evidence shows ACP improves end of life care for patients and reduces relatives’ bereavement reactions (Detering KM et al. BMJ. 2010; 340:1345). A simulation course for multidisciplinary healthcare professionals, using actors, was developed to improve understanding of ACP, and confidence in having these conversations. In response to the COVID-19 pandemic, the course was adapted to an online format.
Method
Participants were asked about their ACP confidence and understanding pre- and post-course, using a Likert scale (1-Not at all to 5-Very confident). Data between 2018-2022 was analysed to compare face-to-face and online course responses. Free-text responses to ‘How do you feel about attending the course online?’ were analysed qualitatively. Ethics approval was not required.
Results
Five face-to-face and five virtual sessions trained 128 and 133 attendees respectively. Confidence in having ACP discussions improved significantly following the course in both cohorts; from a mean Likert rating of 2.77 (95% CI 2.60-2.94, n=132) to 4.11 following face-to-face training (95% CI 3.97-4.25, n=128), and from 2.79 (95% CI 2.66-2.91, n=149) to 4.11 following the online course (95% CI 4.01-4.21, n=133). Additionally, 97% (n=132) of face-to-face attendees and 99.2% (n=133) of virtual attendees said their practice would change because of the course. Following the training, 100% of participants across both cohorts reported that they ‘fully understood’ what was meant by ACP, from a baseline of 77.3% (n=132) in the face-to-face cohort and 81.9% (n=149) of virtual participants. Free-text analysis highlighted the convenience of attending online (n=22, 21%), and only a minority reported technical difficulties (n=8,8%).
Conclusion
This course was successfully adapted to a virtual format, improving participants’ ACP confidence and understanding as effectively as in-person training, whilst being more accessible.
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Affiliation(s)
- A Barnard
- East Surrey Hospital Dept of Respiratory
| | - H Petra
- Barnet Hospital Dept of Acute Medicine
| | - L Owen
- Barnet Hospital Dept of Geriatric Medicine
| | - K Goffe
- Barnet Hospital Dept of Neurology
| | - C Bergbaum
- Barnet Hospital Dept of Geriatric Medicine
| | - H Wickham
- Royal Free Hospital Dept of Geriatric Medicine
| | - O Fox
- University College London
| | - J Pleming
- Barnet Hospital Dept of Geriatric Medicine
| | - A Steel
- Barnet Hospital Dept of Geriatric Medicine
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Nemchand P, Hassan D, Steel A. 88 Improving Clinical Effectiveness At Identifying Patients Requiring Advanced Care Plans. Age Ageing 2021. [DOI: 10.1093/ageing/afab030.49] [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
Our project was conducted in a district general hospital across five acute geriatric wards. Our team included consultants, registrars, and ward matrons. The project focused on improvement of care for geriatric inpatients, with moderate to severe frailty. Advanced care planning (ACP) columns are displayed on white boards. They indicate whether ACPs are required/initiated for each patient. When previously utilised, ACPs were initiated for 78% of appropriate patients [1]. Following a change in staff and reduction in awareness/education, the ACP column use reduced with fewer ACPs established.
Our goals were to ensure completion of the ACP column, encourage junior doctor/nurse involvement and trigger a greater number of appropriate ACPs initiated Improvement in ACP practice was addressed by daily board round review of appropriate patients for ACP, increasing awareness of ACP triggers and education around discussion content. Interventions consisted of: 1, a flow-chart adjacent to white boards prompting “Do not attempt resuscitation (DNAR)” and ACP processes. This signposted staff to information on ACP triggers and “how to start a conversation”. 2 Involving registrar “champions” on each ward. We explained our intervention to all team members to encourage engagement.
Data from the ACP columns were audited prior to intervention, 2 weeks and 6 weeks after intervention. There was a 54% increase in ACP documentation after 6 weeks across the wards.
The improvement in the use of the ACP column correlated with a greater number of ACPs initiated. This facilitated an increase in consideration of patient wishes towards the end of life. Increasing use of a daily ACP prompts on board rounds triggers an increase in ACP implementation for appropriate patients. Sustainability was achieved by recruitment of ward “ACP champions”. Junior doctors/matrons were more empowered to discuss ACPs. Results were presented at departmental teaching to reinforce the positive impact of the intervention.
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Affiliation(s)
| | - D Hassan
- Dept of Elderly care, Barnet Hospital
| | - A Steel
- University College London Hospital
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4
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Foley H, Steel A, Adams J. Person-centred care in complementary medicine for individuals with chronic conditions in Australia. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.484] [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: 11/15/2022] Open
Abstract
Abstract
Background
Increasing chronic condition diagnoses burden public health systems, individuals and communities. The duration and complexity of chronic conditions require ongoing, multifaceted care - such as person-centred care (PCC) - to address the individual needs and quality of life for patients. Many patients with chronic conditions seek additional care outside mainstream medicine, often consulting complementary medicine (CM) practitioners. This study examines the extent of PCC being experienced by patients with chronic conditions who consult CM practitioners.
Methods
Cross-sectional survey (n = 191), conducted nationally, November 2018 to March 2019, in clinics of the five CM professions most commonly consulted by individuals with chronic conditions in Australia (massage, chiropractic, osteopathy, acupuncture, naturopathy). Participants with chronic conditions (n = 153) were surveyed about experiences of PCC during CM consultation, and regarding consultation with medical doctors, using four validated measures.
Results
During consultation with CM practitioners, patient perceptions of PCC were consistently high. Ratings of PCC were consistently higher for consultations with any CM practitioners (summary mean 3.33) than consultations with medical doctors (summary mean 2.95). The highest mean scores for PCC were reported by patients of naturopaths (summary mean 4.04). Variations in perceived PCC for different items between professions indicate nuance in the experience of consultation across different CM professions.
Conclusions
This study indicates PCC is characteristic of CM consultation, which may reflect CM philosophies such as holism. CM practitioners may present an existing resource of PCC. Further attention should be given to CM professions regarding the potential to address unmet needs of individuals with chronic conditions, and subsequently to better manage the public health burden associated with chronic conditions.
Key messages
Person-centred care appears to be a consistent characteristic of complementary medicine clinical care for individuals with chronic conditions. Due to rising rates of chronic conditions and the associated burden on public health systems, complementary medicine professions should be considered as a resource to optimise chronic illness care.
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Affiliation(s)
- H Foley
- ARCCIM, Faculty of Health, University of Technology Sydney, Ultimo, Australia
- Office of Research, Endeavour College of Natural Health, Brisbane, Australia
| | - A Steel
- ARCCIM, Faculty of Health, University of Technology Sydney, Ultimo, Australia
| | - J Adams
- ARCCIM, Faculty of Health, University of Technology Sydney, Ultimo, Australia
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Steel A. Preconception care from a public health perspective. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.852] [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
Public health researchers and practitioners are committed to developing, implementing and supporting initiatives that improve the health of the population. This presentation will provide an overview of the alignment between public health and preconception health. It will also overview ideas, theories and models that are central to the contemporary understanding of preconception health, such as epigenetics, the diverse preconception health behaviours and exposures that impact on outcomes, and the known barriers affecting the delivery of preconception care services. The presentation will draw on the principles of health promotion, health services research and epidemiology to provide a high-level understanding of the levers underpinning effective preconception health interventions at a policy, health services and grass-roots level.
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Affiliation(s)
- A Steel
- Australian Centre for Public and Population Health Research, University of Technology Sydney, Ultimo, Australia
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6
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McIntyre E, Harnett J, Adams J, Steel A. The role of complementary medicine health literacy in health communication and decision-making. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.031] [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: 11/13/2022] Open
Abstract
Abstract
Background
Globally, complementary medicine (CM) product use is high-including vitamins, minerals and herbal medicines. The overuse of CM raises concerns about medicine sustainability that are critical considerations for human and planetary health. Poor CM health literacy may lead to the unnecessary use of CM. This is the first study to explore associations between CM use, CM health literacy, and concurrent use of CM with conventional health care in an Australian population with a view to identifying priority areas for intervention.
Methods
Cross-sectional online study of Australian adults (N = 2019). A 50-item survey measured demographic and health characteristics, health care and treatment use, medicine use disclosure to health care providers, and CM health literacy. Descriptive statistics, Spearman's correlations and Chi-square analysis were used to analyse preliminary findings.
Results
In the previous year 49.1% of participants used a CM product. A greater proportion of those who used CM products (88.7%, <0.001), compared to those who did not, used a prescription or over-the-counter pharmaceutical. Lower levels of CM health literacy were associated with herbal supplement use (not vitamin/mineral supplement use) and with disclosing CM use to a medical doctor or pharmacist (p < 0.01). Those who consulted with a GP, specialist or pharmacist, who self-prescribed CM, or used both CM and pharmaceutical medicines had better CM health literacy (p < 0.001) than those who did not. Conversely, those who consulted a CM practitioner had lower CM health literacy than those who did not (p < 0.001).
Conclusions
The findings suggest that people with lower CM health literacy may be unsure about using CM products, while those with better CM health literacy may have more self-efficacy for making treatment decisions. Interventions are needed to improve public CM health literacy and encourage shared decision-making to ensure safe, effective and sustainable treatment decisions.
Key messages
People with higher levels of CM health literacy appear to have greater self-efficacy for making treatment decisions, while those with lower CM health literacy are more likely to seek treatment advice. Interventions are needed to ensure people using CM products are communicating with health practitioners about their treatment choices to facilitate safe, effective and sustainable treatment decisions.
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Affiliation(s)
- E McIntyre
- Faculty of Health, University of Technology Sydney, Broadway, Australia
| | - J Harnett
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - J Adams
- Faculty of Health, University of Technology Sydney, Broadway, Australia
| | - A Steel
- Faculty of Health, University of Technology Sydney, Broadway, Australia
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Steel A, Foley H, Schloss J, Redmond R. Characteristics of patients visiting naturopathic practitioners for maternal and reproductive health. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.1140] [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
Background
Naturopathy, recognised by the World Health Organisation as a European traditional medicine system, is practiced in every world region. Patients in countries where naturopathy is practiced visit a naturopathic practitioner for a range of health concerns including maternal and reproductive health; recognised as a global health priority area. This study aims to examine the characteristics of patients visiting naturopathic practitioners for their maternal and reproductive health concerns, and the clinical care provided by naturopathic practitioners to those patients.
Methods
An international cross-sectional survey of typical naturopathic practices and their associated patients, conducted in naturopathic clinics in 14 countries and 4 world regions. Naturopathic practitioners(n = 54) were invited to prospectively complete an online survey for up to 20 consecutive cases within the study period. Univariate relationships were examined through chi-square tests. Backwards stepwise logistic regression was employed to explore the characteristics most likely to be associated with individuals visiting a naturopath for maternal and reproductive health.
Results
Naturopathic practitioners provided data for 852 patients, with 43 (5.0%) visiting a naturopath for maternal and reproductive health concerns such as fertility (54.8%), pregnancy (26.2%), preconception health (11.9%), and lactation, breastfeeding or other postnatal care (7.1%). The regression analysis indicates the practitioners are more likely to prescribe acupuncture (OR 2.71, p<.001) and more likely to identify gynecological (OR 4.31, p<.001) or endocrine (OR 3.30, p=.01) systems as important in the management of the health of these patients.
Conclusions
Individuals are accessing naturopathic practitioners for maternal and reproductive health. An examination of the motivations influencing this population to access naturopathic care and the outcomes of this care is urgently needed.
Key messages
Naturopathic practitioners throughout the world are being visited for assistance with maternal and reproductive health issues including fertility, pregnancy, preconception and postnatal care. Naturopathic practitioners are prescribing acupuncture, as well as a wide range of other treatments, for maternal and reproductive health issues.
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Affiliation(s)
- A Steel
- ARCCIM, University of Technology Sydney, Ultimo, Australia
| | - H Foley
- ARCCIM, University of Technology Sydney, Ultimo, Australia
- Office of Research, Endeavour College of Natural Health, Brisbane, Australia
| | - J Schloss
- Office of Research, Endeavour College of Natural Health, Brisbane, Australia
| | - R Redmond
- ARCCIM, University of Technology Sydney, Ultimo, Australia
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8
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Hall D, Steel A, Heij R, Eley A, Young P. Videolaryngoscopy increases 'mouth-to-mouth' distance compared with direct laryngoscopy. Anaesthesia 2020; 75:822-823. [PMID: 32221979 DOI: 10.1111/anae.15047] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- D Hall
- Queen Elizabeth Hospital NHS Foundation Trust, King's Lynn, UK
| | - A Steel
- Queen Elizabeth Hospital NHS Foundation Trust, King's Lynn, UK
| | - R Heij
- Queen Elizabeth Hospital NHS Foundation Trust, King's Lynn, UK
| | - A Eley
- Queen Elizabeth Hospital NHS Foundation Trust, King's Lynn, UK
| | - P Young
- Queen Elizabeth Hospital NHS Foundation Trust, King's Lynn, UK
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Goodwin E, Bacarese-Hamilton T, Steel A, Patel A. 43 A Model of Interdisciplinary Working to Enhance the Care of Residential Home Patients. Age Ageing 2020. [DOI: 10.1093/ageing/afz185.06] [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: 11/13/2022] Open
Abstract
Abstract
Introduction
291,000 patients in the UK live within the care home setting. The King’s Fund reports that the average residential home patient is an 85-year-old female with a 12-30 month life expectancy. Care needs are complex with six or more diagnosed conditions, seven or more prescribed medications and a combination of physical frailty, disability and mental health conditions. In line with the NHS Long Term plan 2019 the Care Home project sought to promote ageing well through interdisciplinary working.
Aims
Provide cost neutral interdisciplinary review of care home residents Review the medication of all residents Review resuscitation status and initiate anticipatory care plans for appropriate residents To further the education and professional relationships across primary, secondary and mental health interface. Reduction of transitions between care settings for residents.
Methods
12 sessions in 1 care home over a year (2018-2019) Team consisted of GPs, Geriatric Registrars, Old Age Psychiatry Registrar, care home staff and CCG pharmacist 2-4 patients per session chosen on the basis of complex physical and/or psychological needs Format of session consisted of: o Pre-assessment discussion of patient o Interdisciplinary patient review o Debriefing and formulation of management plan Sessions concluded with teaching from the different disciplines.
Results
We reviewed 25 residents with an average Clinical Frailty Scale score of 7. 100% patients had a medication and psychiatric review. 100% had review of DNAR status with 40% increase in DNAR forms completed. There was a 60% increase in anticipatory care plans initiated. There was a reduction in acute admissions from the care home with a resultant cost saving of over £45,000. 100% of participants would strongly recommend the project and reported improved relationships. 90% of care home staff thought the project was beneficial to the residents and staff felt more supported.
Conclusions
Interdisciplinary working within the patient’s own setting provides patient centred care, promotes sharing of professional expertise, enhances clinical skills and builds professional relationships. This model of project is easily scalable and is a cost-effective way of providing high quality care for patients in their own residence.
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Affiliation(s)
| | | | - A Steel
- Barnet CEPN and Barnet Hospital
| | - A Patel
- Barnet CEPN and Barnet Hospital
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10
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Goldstein N, Steel A, Koster M, Wright M, Trottier Z, Jones K, Gao B, Ward B, Lambert K, Robinson W, Shellman Y, Fujita M, Roop D, Norris D, Birlea S. 814 RHOJ knockdown modulates the migration and differentiation of normal human melanocytes and the expression of pro-apoptotic markers after UV exposure. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.03.890] [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: 10/27/2022]
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11
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James PB, Wardle J, Steel A, Adams J. Post-Ebola psychosocial experiences and coping mechanisms among Ebola survivors: a systematic review. Trop Med Int Health 2019; 24:671-691. [PMID: 30843627 DOI: 10.1111/tmi.13226] [Citation(s) in RCA: 90] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE A myriad of physical and psychosocial sequelae have been reported among Ebola survivors from previous Ebola virus disease (EVD) outbreaks, including the most recent in West Africa. This review examines the various forms of psychological distress experienced by EVD survivors, family and community reactions to EVD survivors and EVD survivors' coping mechanisms. METHODS We conducted a literature search of original articles employing Medline (Ovid), PubMed, Web of Science, Scopus, CINAHL, EBSCO host academic search complete, PsycINFO (EBSCO) and Embase databases. RESULTS Our search identified 1890 articles of which 24 met our inclusion criteria. Various forms of psychological distress were prevalent among EVD survivors including depression, anxiety, anger, grief, guilt, flashbacks, sadness, worthlessness, substance addiction, suicidal tendencies and self-stigmatisation. Family and community responses to EVD survivors ranged from acceptance to rejection, isolation, stigmatisation and discrimination. EVD survivors' coping strategies included engagement with religious faith, EVD survivors associations and involvement in EVD prevention and control interventions. CONCLUSION Psychological distress, including that resulting from family and community stigma and discrimination, appears common among EVD survivors. Community-based mental health and psychosocial interventions integrated within a broader package of care for EVD survivors that also recognises the physical health challenges are required. Well-designed longitudinal studies can provide clear insights on the nature and trajectory of the psychosocial issues currently experienced by EVD survivors.
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Affiliation(s)
- P B James
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia.,Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - J Wardle
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - A Steel
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - J Adams
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
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12
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Foley H, Steel A, Cramer H, Wardle J, Adams J. Disclosure of complementary medicine use to medical providers: a systematic review and meta-analysis. Sci Rep 2019; 9:1573. [PMID: 30733573 PMCID: PMC6367405 DOI: 10.1038/s41598-018-38279-8] [Citation(s) in RCA: 103] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 12/20/2018] [Indexed: 12/03/2022] Open
Abstract
Concomitant complementary medicine (CM) and conventional medicine use is frequent and carries potential risks. Yet, CM users frequently neglect to disclose CM use to medical providers. Our systematic review examines rates of and reasons for CM use disclosure to medical providers. Observational studies published 2003-2016 were searched (AMED, CINAHL, MEDLINE, PsycINFO). Eighty-six papers reporting disclosure rates and/or reasons for disclosure/non-disclosure of CM use to medical providers were reviewed. Fourteen were selected for meta-analysis of disclosure rates of biologically-based CM. Overall disclosure rates varied (7-80%). Meta-analysis revealed a 33% disclosure rate (95%CI: 24% to 43%) for biologically-based CM. Reasons for non-disclosure included lack of inquiry from medical providers, fear of provider disapproval, perception of disclosure as unimportant, belief providers lacked CM knowledge, lacking time, and belief CM was safe. Reasons for disclosure included inquiry from medical providers, belief providers would support CM use, belief disclosure was important for safety, and belief providers would give advice about CM. Disclosure appears to be influenced by the nature of patient-provider communication. However, inconsistent definitions of CM and lack of a standard measure for disclosure created substantial heterogeneity between studies. Disclosure of CM use to medical providers must be encouraged for safe, effective patient care.
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Affiliation(s)
- H Foley
- Faculty of Health, University of Technology Sydney, Ultimo, Australia.
| | - A Steel
- Faculty of Health, University of Technology Sydney, Ultimo, Australia
| | - H Cramer
- Faculty of Health, University of Technology Sydney, Ultimo, Australia
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| | - J Wardle
- Faculty of Health, University of Technology Sydney, Ultimo, Australia
| | - J Adams
- Faculty of Health, University of Technology Sydney, Ultimo, Australia
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Robinson PN, Steel A, Hopwood H, Chindo L, Agbenyegah C, Patel A, Gluck T. 41CARE HOMES LEARNING TOGETHER INITIATIVE: A COLLABORATIVE APPROACH TO CARE HOME MEDICINE. Age Ageing 2019. [DOI: 10.1093/ageing/afy211.41] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - A Steel
- Barts NHS Trust - Royal London Hospital
| | - H Hopwood
- Barts NHS Trust - Royal London Hospital
| | - L Chindo
- Barts NHS Trust - Royal London Hospital
| | | | - A Patel
- Barts NHS Trust - Royal London Hospital
| | - T Gluck
- Barts NHS Trust - Royal London Hospital
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14
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Steel A, Wardle J, Frawley J, Adams J, Sibbritt D, Lauche R. Associations between complementary medicine utilisation and the use of contraceptive methods: Results of a national cross-sectional survey. Complement Ther Clin Pract 2018; 33:100-106. [PMID: 30396606 DOI: 10.1016/j.ctcp.2018.09.002] [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] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 08/24/2018] [Accepted: 09/08/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND PURPOSE This study examines the relationship between the use of complementary medicine (CM) interventions or consultations with CM practitioners and women's choice of contraceptive method. MATERIALS AND METHODS A secondary analysis of a cross-sectional survey of Australian Women aged 34-39 years from the Australian Longitudinal Study on Women's Health (ALSWH) was conducted. Associations between use of CM and contraception were analysed using Chi-squared tests and multivariate logistic regression. RESULTS Based on the responses from the included women (n = 7299), women who consulted a naturopath/herbalist were less likely to use implant contraceptives (OR 0.56; 95% confidence interval (CI) 0.33; 0.95). Those consulting a chiropractor (OR 1.54; 95%CI 1.05; 2.25) or an osteopath (OR 2.16; 95% CI 1.32; 3.54) were more likely to use natural contraception. CONCLUSION There may be a link between women's choice of contraceptive method and their use of CM, in particular, with CM practitioner consultations.
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Affiliation(s)
- A Steel
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia; Office of Research, Endeavour College of Natural Health, Level 2, 269 Wickham Street, Fortitude Valley, QLD, 4006, Australia.
| | - J Wardle
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia.
| | - J Frawley
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia.
| | - J Adams
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia.
| | - D Sibbritt
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia.
| | - R Lauche
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia.
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Mohammed A, Cormack S, Penahi P, Das R, Egred M, Steel A, Chadwick T, Bryant A, Spyridopoulos I. P3670Effect of cyclosporine on lymphocyte kinetics and left ventricular remodelling in patients with acute myocardial infarction. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- A Mohammed
- Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - S Cormack
- Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - P Penahi
- Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - R Das
- Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - M Egred
- Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - A Steel
- Newcastle University, Newcastle upon Tyne, United Kingdom
| | - T Chadwick
- Newcastle University, Newcastle upon Tyne, United Kingdom
| | - A Bryant
- Newcastle University, Newcastle upon Tyne, United Kingdom
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Galliano A, Ye C, Su F, Wang C, Wang Y, Liu C, Wagle A, Guerin M, Flament F, Steel A. Particulate matter adheres to human hair exposed to severe aerial pollution: consequences for certain hair surface properties. Int J Cosmet Sci 2017; 39:610-616. [PMID: 28748540 DOI: 10.1111/ics.12416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 04/26/2017] [Accepted: 06/29/2017] [Indexed: 01/23/2023]
Abstract
BACKGROUND The deposit and adherence of particulate matter (PM) from aerial pollution onto the surface of human hair is a poorly studied phenomenon. OBJECTIVES (i) To reproduce in vitro the deposit of known PM on standardized hair swatches in a closed box, (ii) to compare in vitro data with those obtained under 'real-life' conditions of severe aerial pollution and (iii) to assess the changes of the hair surface properties, potentially caused by the adherence of airborne PM onto the hair. METHODS In vitro: a PM was sprayed onto untreated or sebum-coated hair swatches. Real-life conditions: other swatches were exposed to a severely polluted environment, for 24 to 72 h, in Baoding (PR China). In both cases, swatches were examined using scanning electron microscopy. The shine, the frictional properties and the level of metals were measured and compared to those same properties for the unexposed swatches. RESULTS This work clearly indicates that, under real-life conditions, a large number of PM of various sizes are deposited onto the hair surface. This phenomenon is increased by the presence of sebum and longer exposure times. The in vitro level of PM deposited onto the hair surface is comparable to the in vivo level. The presence of sebum seems to favour the deposit of larger PM. The shine of the exposed swatches is significantly decreased, whereas their respective friction coefficients are significantly increased. Both the presence of sebum and length of exposure time increased the amount of analysed metals present on the exposed hair surface (Al, Fe, Cu, Ba and Zn). CONCLUSION This work indicates that a very high amount (e.g. billions) of PM can be deposited on a full head of hair for subjects living in a severely aerially polluted environment. This process can be reproduced in vitro. In real-life, pollution has a strong impact on hair surface properties, leading to a modification of the visual aspect (loss of shine) and the alteration of hair surface (increase in friction force). This work may be used to pave the way for prevention and cleansing studies in the field of hair care.
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Affiliation(s)
- A Galliano
- L'Oréal Research and Innovation, Centre Charles Zviak, Saint-Ouen, France
| | - C Ye
- L'OREAL (China) R&D Center Pudong, Shanghai, China
| | - F Su
- L'OREAL (China) R&D Center Pudong, Shanghai, China
| | - C Wang
- L'OREAL (China) R&D Center Pudong, Shanghai, China
| | - Y Wang
- L'OREAL (China) R&D Center Pudong, Shanghai, China
| | - C Liu
- L'OREAL (China) R&D Center Pudong, Shanghai, China
| | - A Wagle
- L'OREAL (India) R&D Center Maharashtra, Mumbai, India
| | - M Guerin
- L'Oréal Research and Innovation, Centre Charles Zviak, Saint-Ouen, France
| | - F Flament
- L'Oréal Research and Innovation, Centre Charles Zviak, Saint-Ouen, France
| | - A Steel
- L'OREAL (China) R&D Center Pudong, Shanghai, China
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Wardle J, Steel A, Lauche R, Adams J. Collaborating with medicine? Perceptions of Australian naturopaths on integrating within the conventional medical system. J Interprof Care 2017; 31:734-743. [DOI: 10.1080/13561820.2017.1351424] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- J. Wardle
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - A. Steel
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
- Office of Research, Endeavour College of Natural Health, Fortitude Valley, QLD, Australia
| | - R. Lauche
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - J. Adams
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
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Steel A, Sundberg T, Reid R, Ward L, Bishop F, Leach M, Cramer H, Wardle J, Adams J. Corrigendum to "Osteopathic manipulative treatment: A systematic review and critical appraisal of comparative effectiveness and health economics research" [Musculoskelet. Sci. Pract. 27 165-175]. Musculoskelet Sci Pract 2017; 30:86. [PMID: 28283320 DOI: 10.1016/j.msksp.2017.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- A Steel
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia; Endeavour College of Natural Health, Level 2, 269 Wickham St, Fortitude Valley, QLD, 4006, Australia.
| | - T Sundberg
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia; Research Unit for Studies of Integrative Health Care, Karolinska Institutet (NVS/OMV), Alfred Nobels Alle 23, 141 83, Stockholm, Sweden
| | - R Reid
- Endeavour College of Natural Health, Level 2, 269 Wickham St, Fortitude Valley, QLD, 4006, Australia
| | - L Ward
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia; Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), B4495, OX3 7LD, University of Oxford, Oxford, United Kingdom
| | - F Bishop
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia; Centre for Applications of Health Psychology, Faculty of Social Human and Mathematical Sciences, Building 44 Highfield Campus, University of Southampton, Southampton, SO17 1BJ, United Kingdom
| | - M Leach
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia; School of Nursing & Midwifery, Health Economics & Social Policy Group, University of South Australia, 101 Currie St, Adelaide, Australia
| | - H Cramer
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia; Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, 45141, Duisburg, Germany
| | - J Wardle
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia
| | - J Adams
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia
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Schloss J, Steel A. Medical synopsis: Yoga may assist females with multiple sclerosis by influencing cortisol and adrenocorticotropic hormone (ACTH) levels. Advances in Integrative Medicine 2016. [DOI: 10.1016/j.aimed.2017.02.001] [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: 11/26/2022]
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Steel A, Frawley J, Sibbritt D, Broom A, Adams J. The characteristics of women who use hypnotherapy for intrapartum pain management: Preliminary insights from a nationally-representative sample of Australian women. Complement Ther Med 2016; 25:67-70. [PMID: 27062951 DOI: 10.1016/j.ctim.2016.01.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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] [Received: 08/11/2015] [Revised: 01/09/2016] [Accepted: 01/11/2016] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES This manuscript presents a preliminary examination of the characteristics of women who choose intrapartum hypnosis for pain management. DESIGN Cross-sectional analysis of 2445 women (31-36 years) from a sub-study of the Australian Longitudinal Study on Women's Health (ALSWH), employing Fisher exact tests. SETTING Australia. MAIN OUTCOME MEASURES Use of intrapartum hypnosis, or hypnobirthing, for pain management during labour and birth. RESULTS Women using hypnobirthing were more likely to have consulted with an acupuncturist or naturopath, or attended yoga/meditation classes during pregnancy (p<0.0001). Use of CM products such as herbal medicines, aromatherapy oils, homoeopathy, herbal teas or flower essences (p<0.001) was also more common amongst these women. Women choosing hypnotherapy for intrapartum pain management less commonly identified as feeling safer knowing that an obstetrician is providing their care (p<0.001), and were more likely to labour in a birth centre or in a community centre (i.e. at home). CONCLUSIONS This analysis provides preliminary analysis into an as yet unexamined topic in contemporary maternity health service utilisation. The findings from this analysis may be useful for maternity health professionals and policy makers when responding to the needs of women choosing to use hypnotherapy for intrapartum pain management.
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Affiliation(s)
- A Steel
- Endeavour College of Natural Health, Level 2, 269 Wickham St, Fortitude Valley, QLD 4006, Australia; Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Ultimo, NSW 2006, Australia.
| | - J Frawley
- Endeavour College of Natural Health, Level 2, 269 Wickham St, Fortitude Valley, QLD 4006, Australia; Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Ultimo, NSW 2006, Australia
| | - D Sibbritt
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Ultimo, NSW 2006, Australia
| | - A Broom
- School of Social Sciences, Faculty of Arts and Social Sciences, University of New South Wales, Sydney, NSW 2052, Australia
| | - J Adams
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Ultimo, NSW 2006, Australia
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Frawley J, Sibbritt D, Broom A, Gallois C, Steel A, Adams J. Women's attitudes towards the use of complementary and alternative medicine products during pregnancy. J OBSTET GYNAECOL 2015; 36:462-7. [DOI: 10.3109/01443615.2015.1072804] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- J. Frawley
- University of Technology Sydney, Faculty of Health, Ultimo, Sydney, Australia
| | - D. Sibbritt
- University of Technology Sydney, Faculty of Health, Ultimo, Sydney, Australia
| | - A. Broom
- University of New South Wales, School of Social Sciences, Sydney, Australia
| | - C. Gallois
- Faculty of Social and Behavioural Science, University of Queensland, Brisbane, Australia
| | - A. Steel
- University of Technology Sydney, Faculty of Health, Ultimo, Sydney, Australia
- Endeavour College of Natural Health, Fortitude Valley, Brisbane, Australia
| | - J. Adams
- University of Technology Sydney, Faculty of Health, Ultimo, Sydney, Australia
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Affiliation(s)
- A Steel
- CT2 General Medicine in the Department of Medicine, Grove Centre, Royal Free Hospital, London NW3 2QG
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Steel A, Ansaripour A, Collett S, Wick C, Wagih S, Bakhai A. Unmet Needs And Solutions For Heart Failure Admission. Value Health 2014; 17:A494. [PMID: 27201476 DOI: 10.1016/j.jval.2014.08.1468] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- A Steel
- Barnet & Chase Farm Hospitals NHS Trust, London, UK
| | - A Ansaripour
- Barnet & Chase Farm Hospitals NHS Trust, London, UK
| | - S Collett
- Barnet & Chase Farm Hospitals NHS Trust, London, UK
| | - C Wick
- Barnet & Chase Farm Hospitals NHS Trust, London, UK
| | - S Wagih
- Barnet & Chase Farm Hospitals NHS Trust, London, UK
| | - A Bakhai
- Barnet & Chase Farm Hospitals NHS Trust, London, UK
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Vyas V, Duran J, Ansaripour A, Niedzielko M, Steel A, Bakhai A. Does A 12-Lead Ecg More Reliably Detect Atrial Fibrilation Than A Rhythm Strip Only Ecg? Value Health 2014; 17:A485-A486. [PMID: 27201425 DOI: 10.1016/j.jval.2014.08.1421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- V Vyas
- Barnet & Chase Farm Hospitals NHS Trust, London, UK
| | - J Duran
- Barnet & Chase Farm Hospitals NHS Trust, London, UK
| | - A Ansaripour
- Barnet & Chase Farm Hospitals NHS Trust, London, UK
| | - M Niedzielko
- Barnet & Chase Farm Hospitals NHS Trust, London, UK
| | - A Steel
- Barnet & Chase Farm Hospitals NHS Trust, London, UK
| | - A Bakhai
- Barnet & Chase Farm Hospitals NHS Trust, London, UK
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Steel A, Bakhai A. Proposal for routine use of mortality risk prediction tools to promote early end of life planning in heart failure patients and facilitate integrated care. Int J Cardiol 2013. [DOI: 10.1016/j.ijcard.2012.09.211] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Steel A, Sibbritt D, Adams J, Daley J. P04.80. Navigating the divide: women's engagement with conventional and complementary medicine in pregnancy. BMC Complement Altern Med 2012. [PMCID: PMC3373792 DOI: 10.1186/1472-6882-12-s1-p350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Frawley J, Sibbritt D, Adams J, Steel A, Wardle J, Broom A, Lui C, Murthy V. OA16.04. Women’s sources of information for CAM use during pregnancy. BMC Complement Altern Med 2012. [PMCID: PMC3373324 DOI: 10.1186/1472-6882-12-s1-o65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Steel A, Diezel H, Sibbritt D, Adams J. OA13.03. Promoting safe and integrated maternity care through interprofessional education. Altern Ther Health Med 2012. [PMCID: PMC3373336 DOI: 10.1186/1472-6882-12-s1-o51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Russell T, Steel A. Dantrolene preparation. Anaesth Intensive Care 2011; 39:1150-1151. [PMID: 22165375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Steel A. Equipment design in a safety critical industry. Anaesthesia 2011; 66:953-4. [PMID: 21916874 DOI: 10.1111/j.1365-2044.2011.06880.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Evans G, Bevan A, Evans A, Kinsey T, Steel A, Ashworth J. Pilot study to examine the association between angiotensin-converting enzyme genotype and fluid retention in humans. Br J Sports Med 2010. [DOI: 10.1136/bjsm.2010.078972.48] [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: 11/04/2022]
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Steel A, Fakokunde A, Yoong W. Management of complicated second stage of labour in stillbirths: A review of the literature and lessons learnt from two cases in the UK. J OBSTET GYNAECOL 2010; 29:464-6. [DOI: 10.1080/01443610902980860] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Batchelder AJ, Steel A, Mackenzie R, Hormis AP, Daniels TS, Holding N. Simulation as a tool to improve the safety of pre-hospital anaesthesia--a pilot study. Anaesthesia 2009; 64:978-83. [PMID: 19686483 DOI: 10.1111/j.1365-2044.2009.05990.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We conducted a pilot study of the effects of simulation as a tool for teaching doctor-paramedic teams to deliver pre-hospital anaesthesia safely. Participants undertook a course including 43 full immersion, high-fidelity simulations. Twenty videos taken from day 4 and days 9/10 of the course were reviewed by a panel of experienced pre-hospital practitioners. Participants' performance at the beginning and the end of the course was compared. The total time from arrival to inflation of the tracheal tube cuff was longer on days 9/10 than on day 4 (mean (SD) 14 min 52 s (2 min 6 s) vs 11 min 28 s (1 min 54 s), respectively; p = 0.005), while the number of safety critical events per simulation were fewer (median (IQR [range]) 1.0 (0-1.8 [0-2]) vs 3.5 (1.5-4.8 [0-8], respectively; p = 0.011). Crew resource management behaviours also improved in later simulations. On a personal training needs analysis, participants reported increased confidence after the course.
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Mackenzie R, Steel A, French J, Wharton R, Lewis S, Bates A, Daniels T, Rosenfeld M. Views regarding the provision of prehospital critical care in the UK. Emerg Med J 2009; 26:365-70. [PMID: 19386879 DOI: 10.1136/emj.2008.062588] [Citation(s) in RCA: 8] [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: 11/03/2022]
Abstract
AIMS There is a lack of consensus regarding the role for critical care in the prehospital environment in the UK. It was hypothesised that this related to differences in views and understanding among opinion leaders within influential prehospital care organisations. METHODS A 38-item survey was developed by an established paramedic-physician prehospital critical care service. The survey was distributed to individuals in senior positions within seven organisations that have a major influence on UK prehospital services. Analysis comprised a description of the distribution of results, assessment of the level of agreement with each statement by professional background and current involvement in prehospital critical care and evaluation of the overall consistency of responses. Free-text comments were invited to illustrate the reasoning behind each response. RESULTS There were 32 respondents. The estimated response rate was 40%. The consistency of the questionnaire responses was very high. Overall, all individuals agreed with most of the statements. Paramedic respondents were more likely to disagree with statements that suggested that critical care involved interventions that exceed the current capability of the NHS ambulance service (p<0.05). Free-text comments revealed wide differences of opinion. CONCLUSION Although there appears to be broad agreement among opinion leaders regarding the concepts underpinning existing prehospital critical care services, areas of contention are highlighted that may help explain the current lack of consensus. Cooperative efforts to assess the current demand and clinical evidence would assist in the creation of a joint consensus and allow effective future planning for the provision of prehospital critical care throughout the UK.
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Fleischmann G, Steel A, Yoong W, Fakokunde A. Demographics and outcome of elective cerclage in a multi-ethnic London district general hospital. J OBSTET GYNAECOL 2009; 29:17-20. [PMID: 19280489 DOI: 10.1080/01443610802628809] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Elective cerclage is a rare procedure, but is reported to be relatively more common in developing countries. This variation in rate may be reflected in a multi-ethnic population as seen in London. Our study analysed the epidemiology and rate of elective cerclage performed in a London district general hospital. Factors contributing to the outcome of the procedures were also reviewed. A total of 41 elective cerclages were performed in the hospital between 2000 and 2007. Data from these were collected retrospectively, including maternal history, operative details, and gestational age at delivery. Fisher's exact test was used for statistical analysis. Of the 41 cases, 19 pregnancies were carried to term (>or=37 weeks' gestation), nine were pre-term (24-36 weeks' gestation) and seven miscarried (<24 weeks' gestation); six cases had not yet delivered. All of the patients were immigrants from developing countries but ethnicity did not affect the operative outcome (p = 0.89, Fisher's exact). The other factors studied were also noted to have no significant impact on success. These included cervical length at insertion (p = 1.00, Fisher's exact), type of suture (p = 0.90, Fisher's exact) and average gestation at insertion (p = 0.20, Fisher's exact). In conclusion, all patients requiring intervention in this study originated from developing countries. This is a disproportionately high figure relative to the demographic breakdown of the study population. Such a finding may be due to geographical variation of risk factors for cervical incompetence but may also be influenced by observer bias. Additional studies are needed to further investigate the influence of ethnicity on the rate of elective cerclage. None of the variables analysed in this study significantly affected the outcome of the procedure.
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Affiliation(s)
- G Fleischmann
- Royal Free and University College Medical School, London, UK
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Steel A, Wharton R, Bates A, French J, Lewis S, Mackenzie R. Ketamine use in prehospital critical care. Emerg Med J 2008; 25:618-619. [PMID: 18723729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Steel A, John L, Shamji MH, Henderson DC, Gotch FM, Gazzard BG, Kelleher P. CD38 expression on CD8 T cells has a weak association with CD4 T-cell recovery and is a poor marker of viral replication in HIV-1-infected patients on antiretroviral therapy. HIV Med 2008; 9:118-25. [PMID: 18257774 DOI: 10.1111/j.1468-1293.2007.00528.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of the study was to determine whether the expression of CD38 on CD8 T cells can identify patients with virological failure on antiretroviral therapy (ART). DESIGN This was a cross-sectional study of patients attending a single HIV clinic in London. METHODS The expression of CD38 on CD8 T cells was assessed using a biologically calibrated flow cytometry protocol. Patients were characterized by lymphocyte subset and viral load measurements. Characteristics including historical CD4 T cell counts, therapeutic history, co-infections and demographics were obtained from medical records. RESULTS Elevated levels of CD8 CD38(high) T cells were found in HIV-1-infected patients who failed to suppress viral replication with ART; however, this parameter lacked sufficient sensitivity and specificity to replace viral load testing in assessing the efficacy of ART. Increased levels of CD8 CD38(high) cells were associated with reduced CD4 T cell counts in HIV-1-infected patients on ART after correcting for known determinants of CD4 T-cell recovery. CONCLUSIONS The expression of CD38 on CD8 T cells lacks sufficient sensitivity and specificity to be used as a surrogate marker for viral load to monitor HIV-1 infection. T-cell activation is associated with reduced CD4 T-cell reconstitution in patients receiving ART.
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Affiliation(s)
- A Steel
- Department of Immunology, Imperial College, Chelsea & Westminster Hospital, London, UK
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Steel A, Varley J. Administering a glyceryl trinitrate infusion: faster is better than slower. Arch Emerg Med 2008; 25:60. [DOI: 10.1136/emj.2007.054478] [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: 11/04/2022]
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Clark SA, Martin SL, Pozniak A, Steel A, Ward B, Dunning J, Henderson DC, Nelson M, Gazzard B, Kelleher P. Tuberculosis antigen-specific immune responses can be detected using enzyme-linked immunospot technology in human immunodeficiency virus (HIV)-1 patients with advanced disease. Clin Exp Immunol 2007; 150:238-44. [PMID: 17672869 PMCID: PMC2219352 DOI: 10.1111/j.1365-2249.2007.03477.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
There are limited data on the efficacy of T cell-based assays to detect tuberculosis (TB) antigen-specific responses in immune-deficient human immunodeficiency virus (HIV) patients. The aim of this study is to determine whether TB antigen-specific immune responses can be detected in patients with HIV-1 infection, especially in those with advanced disease (CD4 T cell count < 300 cells/microl). An enzyme-linked immunospot (ELISPOT) assay, which detects interferon (IFN)-gamma secreted by T cells exposed to TB antigens, was used to assess specific immune responses in a prospective study of 201 HIV-1-infected patients with risk factors for TB infection, attending a single HIV unit. The performance of the ELISPOT assay to detect TB antigen-specific immune responses is independent of CD4 T cell counts in HIV-1 patients. The sensitivity and specificity of this assay for the diagnosis of active tuberculosis does not differ significantly from values obtained in immunocompetent subjects. The negative predictive value of the TB ELISPOT test is 98.2%. A positive predictive value of 86% for the diagnosis of active tuberculosis was found when the combined number of early secretory antigen target-6 (ESAT-6) and culture filtrate protein-10 (CFP-10) IFN-gamma spots to CD4 T cell count ratio was > 1.5. TB antigen-specific immune responses can be detected in HIV patients with low CD4 T cell counts using ELISPOT technology in a routine diagnostic laboratory and is a useful test to exclude TB infection in immune-deficient HIV-1 patients. A combination of TB antigen-specific IFN-gamma responses and CD4 T cell counts has the potential to distinguish active tuberculosis from latent infection.
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Affiliation(s)
- S A Clark
- Department of Immunology, Imperial College, Chelsea & Westminster HospitalLondon, UK
| | - S L Martin
- Division of Immunology Hammersmith Hospitals NHS TrustLondon, UK
| | - A Pozniak
- HIV/GUM Directorate, Chelsea & Westminster NHS Foundation TrustLondon, UK
| | - A Steel
- Department of Immunology, Imperial College, Chelsea & Westminster HospitalLondon, UK
| | - B Ward
- HIV/GUM Directorate, Chelsea & Westminster NHS Foundation TrustLondon, UK
| | - J Dunning
- HIV/GUM Directorate, Chelsea & Westminster NHS Foundation TrustLondon, UK
| | - D C Henderson
- Division of Immunology Hammersmith Hospitals NHS TrustLondon, UK
| | - M Nelson
- HIV/GUM Directorate, Chelsea & Westminster NHS Foundation TrustLondon, UK
| | - B Gazzard
- HIV/GUM Directorate, Chelsea & Westminster NHS Foundation TrustLondon, UK
| | - P Kelleher
- Department of Immunology, Imperial College, Chelsea & Westminster HospitalLondon, UK
- Division of Immunology Hammersmith Hospitals NHS TrustLondon, UK
- HIV/GUM Directorate, Chelsea & Westminster NHS Foundation TrustLondon, UK
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Steel A, Yoong W, Okolo S, Fakokunde A. Is there still a role for emergency cerclage in the developed world? An experience from a London district hospital. Arch Gynecol Obstet 2007; 277:139-42. [PMID: 17653737 DOI: 10.1007/s00404-007-0422-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2007] [Accepted: 07/05/2007] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Cervical incompetence appears to have a greater prevalence in the developing world, which possibly extends to multi-ethnic communities in the UK. Emergency cerclage has been found to have a relative degree of success in patients detected on ultrasound or presenting clinically. Our study aimed to look at the emergency cerclage outcome in the multi-ethnic population of our district hospital. METHODS Sixty-two cases of cervical cerclage were reviewed retrospectively from 2000 to 2006 with 16 cases being emergencies. Maternal history, presentation, operation details and outcome were recorded. RESULTS Of the 16 emergency cases, 8 were successful (delivery over 24 weeks gestation), 7 failed and 1 had not yet delivered. The failure rate was found to be significantly higher in the black African women (P = 0.04). Diagnosis by ultrasound as opposed to clinical presentation was associated with a better outcome (P = 0.03). The most significant determinant of outcome was the presence of coliforms on presentation, all of which failed (P = 0.007). CONCLUSION In this small sample of patients requiring emergency cerclage, findings are suggestive of a poor outcome in black African women, which may be related to previous obstetric history. Similarly the presence of infection especially coliforms is also associated with poor prognosis, while ultrasound diagnosis of dilating cervix rather than clinical diagnosis had a better outcome. Early screening for infection, use of prophylactic antibiotics and sonographic monitoring are likely to improve the success rate of emergency cervical cerclage.
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Affiliation(s)
- A Steel
- Royal Free and University College Medical School, London, UK
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Abstract
Kaposi's sarcoma (KS) is an AIDS-defining condition in individuals with human immunodeficiency virus type 1 infection. We investigated the phenotype and function of the NKG2C+ NK cell population in individuals with AIDS and Kaposi's sarcoma. The staging of AIDS KS patients according to the AIDS Clinical Trial Group criteria revealed that patients with the S1 disease stage have a significantly higher proportion of NKG2C+ cells than those with the S0 disease stage. NKG2C+ cells from S1-stage patients are highly enriched for the expression of KIR3DL1, are depleted of NKp46, and respond poorly to major histocompatibility complex class I-positive target cells. These data demonstrate a link between NK cell phenotype and function and disease prognosis in AIDS.
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Affiliation(s)
- Martin R Goodier
- Department of Immunology, Imperial College London, United Kingdom.
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French J, Steel A, Clements R, Lewis S, Wilson M, Teasdale B, Mackenzie R, Black J. Best BETS: a call for scrutiny. Emerg Med J 2006; 23:490. [PMID: 16714533 PMCID: PMC2564366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
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Affiliation(s)
- A Steel
- MAGPAS, 105 Needingworth Road, St Ives, Cambridgeshire PE27 5WF, UK.
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Morris-Stiff G, Steel A, Savage P, Devlin J, Griffiths D, Portman B, Mason M, Jurewicz WA. Transmission of donor melanoma to multiple organ transplant recipients. Am J Transplant 2004; 4:444-6. [PMID: 14962000 DOI: 10.1111/j.1600-6143.2004.00335.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Malignant melanoma represents the most common tumour responsible for donor-derived post transplantation malignancies. We report the varied presentation and outcome of three graft recipients (two kidney and hepatic) who developed metastatic melanoma following cadaveric organ transplantation from a single multiorgan donor. Two of the recipients presented with symptomatic metastatic lesions and the third patient, despite being carefully monitored, developed evidence of metastatic cutaneous melanoma. Two of the patients died as a direct result of their melanomas. The recipients of corneal and cardiac grafts remain disease-free. We conclude that despite careful screening, donor-derived tumours remain a not uncommon clinical entity. The identification of a lesion in one recipient should prompt immediate examination and investigation of the remaining recipients of multiorgan donations.
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Affiliation(s)
- G Morris-Stiff
- University of Wales College of Medicine, Cardiff, Wales, UK
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Steel A, Pathak H, Crawfurd J, Burchett K, Young P, Blunt M. Crit Care 2004; 8:P120. [DOI: 10.1186/cc2587] [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: 11/10/2022] Open
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Pathak H, Steel A, Crawfurd J, Burchett K, Blunt M, Young P. Crit Care 2004; 8:P122. [DOI: 10.1186/cc2589] [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: 11/10/2022] Open
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Greaves GN, Barrett NT, Antonini GM, Thornley FR, Willis BTM, Steel A. Glancing-angle x-ray absorption spectroscopy of corroded borosilicate glass surfaces containing uranium. J Am Chem Soc 2002. [DOI: 10.1021/ja00194a024] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Benoit V, Steel A, Torres M, Yu YY, Yang H, Cooper J. Evaluation of three-dimensional microchannel glass biochips for multiplexed nucleic acid fluorescence hybridization assays. Anal Chem 2001; 73:2412-20. [PMID: 11403280 DOI: 10.1021/ac000946r] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Three-dimensional, flow-through microchannel glass substrates have a potential for enhanced performance, including increased sensitivity and dynamic range, over traditional planar substrates used in medium-density microarray platforms. This paper presents a methodology for the implementation of multiplexed nucleic acid hybridization fluorescence assays on microchannel glass substrates. Fluorescence detection was achieved, in a first instance, using conventional low-magnification microscope objective lenses, as imaging optics whose depth-of-field characteristics match the thickness of the microchannel glass chip. The optical properties of microchannel glass were shown, through experimental results and simulations, to be compatible with the quantitative detection of heterogeneous hybridization events taking place along the microchannel sidewalls, with detection limits for oligonucleotide targets in the low-attomole range.
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Affiliation(s)
- V Benoit
- Department of Electronics and Electrical Engineering, University of Glasgow, Scotland, UK
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