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Creer R, Boonarpha N, Gould G, Rajai A, Chhabra R. Real-world experience of using stereotactic radiotherapy combined with anti-vascular endothelial growth factor to treat neovascular AMD. Graefes Arch Clin Exp Ophthalmol 2024:10.1007/s00417-024-06429-6. [PMID: 38446199 DOI: 10.1007/s00417-024-06429-6] [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: 08/31/2023] [Revised: 02/15/2024] [Accepted: 02/27/2024] [Indexed: 03/07/2024] Open
Abstract
INTRODUCTION Adjunctive treatment or longer-acting drugs are required to treat nAMD to help ease burdens for patients and hospital clinics alike. Stereotactic therapy is one such option, providing a reduction in the number of injections over time. OBJECTIVE To determine the clinical outcomes in a cohort of patients with nAMD receiving a combination therapy of stereotactic radiotherapy (SRT) with intravitreal anti-VEGF injections (IVI). METHOD A retrospective analysis of 74 patients with nAMD, who had received IVI and SRT (16 Gray maximum dose to the macula) at a large tertiary university eye hospital, between March 2018 and September 2019 was performed. The number of IVIs, visual acuity (VA), and central retinal thickness (CRT) were evaluated at 12, 24, and 36 months after patients received SRT and compared to the same time interval prior to SRT. RESULTS Follow-up data at 12, 24, and 36 months following and prior to SRT was available for 74, 48, and 22 patients respectively. Overall there was a significant reduction in the number of injections post-SRT. Twelve months following SRT, the median number of IVI was reduced by 1 (p < 0.05). The reduction in the median number of IVI was significantly reduced by 3 and 6 injections at 24- and 36-month follow-up respectively (p < 0.05). The CRT was significantly reduced post-SRT compared to the baseline values at all time periods. There was no statistically significant difference in VA at 12-month follow-up compared to baseline. The VA, however, significantly decreased at 24- and 36-month follow-up (p < 0.05). CONCLUSION A therapy combining SRT with IVI has shown an overall reduction in the number of injections required in nAMD patients at 12, 24, and 36 months following SRT compared to IVI treatment alone. These real-world outcomes are comparable to other studies while also confirming the maintenance of the reduced frequency of required IVI for patients with nAMD.
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Affiliation(s)
- Rosalind Creer
- Manchester Royal Eye Hospital and Manchester Academic Health Sciences Centre, Manchester University NHS Foundation Trust Manchester, Manchester, M13 9WL, UK.
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
| | - Nattapon Boonarpha
- Manchester Royal Eye Hospital and Manchester Academic Health Sciences Centre, Manchester University NHS Foundation Trust Manchester, Manchester, M13 9WL, UK
| | - Gemma Gould
- Manchester Royal Eye Hospital and Manchester Academic Health Sciences Centre, Manchester University NHS Foundation Trust Manchester, Manchester, M13 9WL, UK
| | - Azita Rajai
- Manchester Royal Eye Hospital and Manchester Academic Health Sciences Centre, Manchester University NHS Foundation Trust Manchester, Manchester, M13 9WL, UK
| | - Ramandeep Chhabra
- Manchester Royal Eye Hospital and Manchester Academic Health Sciences Centre, Manchester University NHS Foundation Trust Manchester, Manchester, M13 9WL, UK
- School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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Heward E, Saeed H, Bate S, Rajai A, Molloy J, Isba R, Ashcroft DM, Hay AD, Nichani JR, Bruce IA. Risk factors associated with the development of chronic suppurative otitis media in children: Systematic review and meta-analysis. Clin Otolaryngol 2024; 49:62-73. [PMID: 37794685 DOI: 10.1111/coa.14102] [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] [Received: 12/03/2022] [Revised: 08/08/2023] [Accepted: 09/21/2023] [Indexed: 10/06/2023]
Abstract
OBJECTIVES Chronic suppurative otitis media (CSOM) is defined as persistent discharge through a tympanic membrane perforation for greater than 2 weeks. It is associated with a significant disease burden, including hearing loss, and reducing its incidence could significantly improve short- and long-term health. We aimed to identify risk factors associated with the development of CSOM in children. DESIGN AND SETTING Systematic review and meta-analysis of studies set in community, primary and secondary care settings, identified from Medline, Embase and Cochrane databases from 2000 to 2022. PARTICIPANTS Children 16 years old and below. MAIN OUTCOME MEASURES Clinical diagnosis of CSOM. RESULTS In total, 739 papers were screened, with 12 deemed eligible for inclusion in the systematic review, of which, 10 were included in the meta-analysis. Risk factors examined included perinatal, patient, dietary, environmental and parental factors. Meta-analysis results indicate that atopy (RR = 1.18, 95% CI [1.01-1.37], p = .04, 2 studies); and birth weight <2500 g (RR = 1.79 [1.27-2.50], p < .01, 2 studies) are associated with an increased risk of CSOM development. Factors not associated were male sex (RR = 0.96 [0.82-1.13], p = .62, 8 studies); exposure to passive smoking (RR = 1.27 [0.81-2.01], p = .30, 3 studies); and parental history of otitis media (RR = 1.14 [0.59-2.20], p = .69, 2 studies). CONCLUSION Optimal management of risk factors associated with CSOM development will help reduce the burden of disease and prevent disease progression or recurrence. The current quality of evidence in the literature is variable and heterogeneous. Future studies should aim to use standardised classification systems to define risk factors to allow meta-analysis.
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Affiliation(s)
- Elliot Heward
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, School of Biological Sciences, University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Research and Innovation, Manchester University NHS Foundation Trust, Manchester, UK
| | - Haroon Saeed
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, School of Biological Sciences, University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Research and Innovation, Manchester University NHS Foundation Trust, Manchester, UK
| | - Sebastian Bate
- Manchester Academic Health Science Centre, Research and Innovation, Manchester University NHS Foundation Trust, Manchester, UK
- Division of Population Health, Health Services Research, and Primary Care, Centre for Biostatistics, School of Health Sciences, University of Manchester, Manchester, UK
| | - Azita Rajai
- Manchester Academic Health Science Centre, Research and Innovation, Manchester University NHS Foundation Trust, Manchester, UK
- Division of Population Health, Health Services Research, and Primary Care, Centre for Biostatistics, School of Health Sciences, University of Manchester, Manchester, UK
| | - John Molloy
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, School of Biological Sciences, University of Manchester, Manchester, UK
- Royal Manchester Children's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Rachel Isba
- Royal Manchester Children's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
- Lancaster Medical School, Lancaster University, Health Innovation One, Lancaster, UK
| | - Darren M Ashcroft
- Division of Pharmacy & Optometry, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre (PSTRC), University of Manchester, Manchester, UK
| | - Alastair D Hay
- Centre for Academic Primary Care, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | - Jaya R Nichani
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, School of Biological Sciences, University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Research and Innovation, Manchester University NHS Foundation Trust, Manchester, UK
- Royal Manchester Children's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Iain A Bruce
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, School of Biological Sciences, University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Research and Innovation, Manchester University NHS Foundation Trust, Manchester, UK
- Royal Manchester Children's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
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Bruce I, Schaefer S, Kluk K, Nichani J, Odriscoll M, Rajai A, Sladen M. Children using a unilateral cochlear implant and contralateral hearing aid: bimodal hearing outcomes when one ear is outside the UK (NICE 2009) audiological criteria for cochlear implantation - a single site case-control study. BMJ Open 2023; 13:e071168. [PMID: 37339839 DOI: 10.1136/bmjopen-2022-071168] [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] [Indexed: 06/22/2023] Open
Abstract
INTRODUCTION In the new revised National Institute for Health & Care Excellence (NICE, TA566, 2019) guidelines for cochlear implantation (CI) have clearly stipulated that the hearing loss must be bilateral. Prior to this revision, children and young people (CYP) with asymmetrical thresholds have been considered for unilateral CI when one ear was in audiological criteria. Children with asymmetrical hearing loss represent an important cohort of potential CI candidates, who will continue to be prevented from benefiting from CI unless evidence is produced to support implantation and maximise subsequent benefit.The aim of this study is to evaluate the 'real-life' hearing performance in a group of children who have received a unilateral CI and who have hearing thresholds in the contralateral ear that are outside the current UK NICE 2019 audiological criteria for CI. The contralateral ear will be aided using a conventional hearing aid (HA). The outcomes from this 'bimodal' group will be compared with a group of children who have received bilateral CI, and a group of children using bilateral HA, to extend the current knowledge about the different performance levels between bilateral CI, bilateral HA and bimodal hearing in CYP. METHODS AND ANALYSIS Thirty CYP aged 6-17 years old, 10 bimodal users, 10 bilateral HA users and 10 bilateral cochlear implant users will be subjected to a test battery consisting of: (1) spatial release from masking, (2) complex pitch direction discrimination, (3) melodic identification, (4) perception of prosodic features in speech and (5) TEN test. Subjects will be tested in their optimal device modality. Standard demographic and hearing health information will be collected. In the absence of comparable published data to power the study, sample size was determined on pragmatic grounds. Tests are exploratory and for hypothesis generating purposes. Therefore, the standard criterion of p<0.05 will be used. ETHICS AND DISSEMINATION This has been approved by the Health Research Authority and NHS REC within the UK (22/EM/0104). Industry funding was secured via a competitive researcher-led grant application process. Trial results will be subject to publication according to the definition of the outcome presented in this protocol.
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Affiliation(s)
- Iain Bruce
- Paediatric ENT Department, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Simone Schaefer
- Paediatric ENT Department, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Karolina Kluk
- Manchester Centre for Audiology and Deafness, University of Manchester, Manchester, UK
| | - Jaya Nichani
- Paediatric ENT Department, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | | | - Azita Rajai
- Medical Statistician, Institute of Population Health, Faculty of Medical and Human Sciences, Department of Research & Innovation, Manchester Academic Health Sciences Centre, Central Manchester University Hospitals NHS Foundation Trust, University of Manchester, Manchester, UK
| | - Mark Sladen
- Manchester University NHS Foundation Trust, Manchester, UK
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Saeed HS, Rajai A, Dixon R, Kapadia T, Bruce IA, Stivaros S. Can MRI biomarkers for hearing loss in enlarged vestibular aqueduct be measured reproducibly? Br J Radiol 2023:20220274. [PMID: 37162001 DOI: 10.1259/bjr.20220274] [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: 05/11/2023] Open
Abstract
OBJECTIVE Morphological features of an enlarged endolymphatic duct (ED) and sac (ES) are imaging biomarkers for genotype and hearing loss phenotype. We determine which biomarkers can be measured in a reproducible manner, facilitating further clinical prediction studies in enlarged vestibular aqueduct hearing loss. METHODS A rater reproducibility study. Three consultant radiologists independently measured previously reported MRI ED & ES biomarkers (ED midpoint width, maximal ED diameter closest to the vestibule, ES length, ES width and presence of ES signal heterogeneity) and presence of incomplete partition Type 2 from 80 ears (T2 weighted axial MRI). Interclass correlation coefficients (ICC) and Gwet's Agreement Coefficients (AC) were generated to give a measure of reproducibility for both continuous and categorical feature measures respectively. RESULTS ES length, width and sac signal heterogeneity showed adequate reproducibility (ICC 95% confidence intervals 0.77-0.95, Gwet's AC for sac heterogeneity 0.64). When determining ED midpoint width, measurements from multiple raters are required for "good" reliability (ICC 95% CI 0.75-0.89). Agreement on the presence of incomplete partition Type 2 ranged from "moderate" to "substantial". CONCLUSIONS Regarding MR imaging, the opinion of multiple expert raters should be sought when determining the presence of an enlarged ED defined by midpoint width. ED midpoint, ES length, width and signal heterogeneity have adequate reproducibility to be further explored as clinical predictors for audiological phenotype. ADVANCES IN KNOWLEDGE We report which ED & ES biomarkers are reproducibly measured. Researchers can confidently utilise these specific biomarkers when modelling progressive hearing loss associated with enlarged vestibular aqueduct.
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Affiliation(s)
- Haroon S Saeed
- Department of Paediatric Otolaryngology, Royal Manchester Children's Hospital, Manchester University Hospitals NHS Foundation Trust, Oxford Road, Manchester, UK
| | - Azita Rajai
- Research & Innovation, Manchester University NHS Foundation Trust. Oxford Road, Manchester, UK
- Centre of Biostatistics, Division of Population Health, University of Manchester, Oxford Road Manchester, Oxford, United Kingdom
| | - Rachel Dixon
- Academic Unit of Paediatric Radiology, Royal Manchester Children's Hospital, Manchester University Hospitals NHS Foundation Trust, Oxford Road, Manchester, UK
| | - Tejas Kapadia
- Academic Unit of Paediatric Radiology, Royal Manchester Children's Hospital, Manchester University Hospitals NHS Foundation Trust, Oxford Road, Manchester, UK
| | - Iain A Bruce
- Department of Paediatric Otolaryngology, Royal Manchester Children's Hospital, Manchester University Hospitals NHS Foundation Trust, Oxford Road, Manchester, UK
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, Oxford Road, Manchester, United Kingdom
| | - Stavros Stivaros
- Academic Unit of Paediatric Radiology, Royal Manchester Children's Hospital, Manchester University Hospitals NHS Foundation Trust, Oxford Road, Manchester, UK
- Division of Informatics, Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, medicine & Health, The University of Manchester, Oxford Road, Manchester, United Kingdom
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Bruce I, Schaefer S, Kluk K, Nichani J, Odriscoll M, Rajai A, Sladen M. 'Real-life' benefit of hearing preservation cochlear implantation in the paediatric population: a single-site case-control study. BMJ Open 2023; 13:e067248. [PMID: 37156582 PMCID: PMC10173958 DOI: 10.1136/bmjopen-2022-067248] [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] [Indexed: 05/10/2023] Open
Abstract
INTRODUCTION Cochlear implantation with hearing preservation (HPCI) has allowed a cochlear implant (CI) electrode to be implanted while trying to preserve residual acoustic low-frequency hearing. The concept arises from the importance of this low-frequency information and the limitations of a CI in several auditory domains. The combination of electrical hearing with either preserved acoustic hearing or amplified 'natural' hearing has the potential to address these issues and enable children with HPCI to closely follow normal auditory development.The aim of this study is to evaluate the 'real-life' benefit of preserved acoustic low-frequency hearing in children with a CI, understand the benefits of preserved natural hearing in complex listening situations and so enable parents and children to make an informed choice about implantation. Ultimately, helping to ensure the maximum number of children benefit from this life-changing intervention. METHODS AND ANALYSIS Nineteen ears in children and young people aged 6-17 years old with 'successful' HPCI will be subjected to a test battery consisting of: (1) spatial release from masking; (2) complex pitch direction discrimination; (3) melodic identification; (4) perception of prosodic features in speech and (5) threshold equalising noise test. Subjects will be tested in the electro-acoustic stimulation (EAS)/electro-natural stimulation (ENS) and the electric-only (ES) condition, thereby acting as their own control group. Standard demographic and hearing health information will be collected. In the absence of comparable published data to power the study, sample size was determined on pragmatic grounds. Tests are exploratory and for hypothesis-generating purposes. Therefore, the standard criterion of p<0.05 will be used. ETHICS AND DISSEMINATION This study has been approved by the Health Research Authority and NHS Research Ethics Committee (REC) within the UK (22/EM/0017). Industry funding was secured via a competitive researcher-led grant application process. Trial results will be subject to publication according to the definition of the outcome presented in this protocol.
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Affiliation(s)
- Iain Bruce
- Paediatric ENT Department, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | | | | | - Jaya Nichani
- Manchester University NHS Foundation Trust, Manchester, UK
| | | | - Azita Rajai
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Mark Sladen
- Manchester University NHS Foundation Trust, Manchester, UK
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Bibby N, Rajai A, O'Reilly DA. From prehab to rehab: Nutritional support for people undergoing pancreatic cancer surgery. J Hum Nutr Diet 2023; 36:493-503. [PMID: 35607759 DOI: 10.1111/jhn.13040] [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] [Received: 01/12/2022] [Accepted: 05/17/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND There is an urgent need to identify and treat potentially modifiable factors that may improve quality of life and influence survival of people with pancreatic cancer. The present study aimed to assess nutritional status at diagnosis and in the early and later stages of postoperative recovery and to evaluate the feasibility of optimising nutritional status and symptoms in patients undergoing surgery, as part of a multidisciplinary prehabilitation intervention. METHODS Nutritional data collection and intervention took place at four time points: (1) baseline at diagnosis; (2) prior to surgery; (3) first postoperative review (within 6 weeks); and (4) at 6-12 months postoperatively. The 'Patient Generated Subjective Global Assessment' (PG-SGA) tool was used to undertake a detailed nutritional assessment and the modified 'Gastrointestinal Symptom Rating Scale' (GISRS) was completed for all patients. Handgrip strength was measured by dynamometry. RESULTS During the period between April 2016 and April 2018, 137 patients scheduled for pancreatic cancer surgery were included who had a baseline dietetic assessment and at least one further review. Baseline assessment demonstrated that malnutrition was highly prevalent, with 62.3% experiencing more than 5% and 29.2% experiencing more than 10% weight loss over the prior 6 months. With dietetic assessment and support for at least 14 days, these patients gained a mean 1.8% body weight during this period and a mean improved handgrip of 7.9%. Symptoms also improved, with absolute change in PG-SGA scores reduced by a mean of 6.19 and a 6.3 reduction of GISRS. CONCLUSIONS Dietetic assessment and intervention for all patients undergoing pancreatic resection ensures timely identification of nutritional deficiencies and correction of avoidable causes of weight loss, such as pancreatic enzyme insufficiency.
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Affiliation(s)
- Neil Bibby
- Department of Nutrition and Dietetics, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
| | - Azita Rajai
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Derek A O'Reilly
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- Department of Surgery, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
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Shields CA, Sladen M, Rajai A, Guest H, Bruce I, Kluk K, Nichani J. Listening effort and downstream effects due to hearing loss in children and young people: an online quantitative questionnaire-based observational study. BMJ Open 2023; 13:e069719. [PMID: 36806144 PMCID: PMC9943826 DOI: 10.1136/bmjopen-2022-069719] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
INTRODUCTION The clinical application of listening effort (LE) is challenging due to the lack of consensus regarding measuring the concept. Correlational analysis between different measuring instruments shows conditional and weak relationships, indicating they capture different dimensions of LE. Current research has suggested possible links between LE and downstream consequences such as fatigue, stress and confidence. One way to clinically measure LE would be to focus on its corollaries. Further research is needed to explore whether tools used to measure these downstream effects can be applied to capture LE. This study explores using existing questionnaire-based outcome instruments to evaluate LE and its associated consequences in children and young people (CYP), with and without hearing loss. METHODS AND ANALYSIS One hundred CYP aged 12-17 years with normal hearing and a range of hearing loss levels will be invited to complete a series of online questionnaires (Speech, Spatial and Qualities, Vanderbilt Fatigue Scale-Child, Perceived Stress Scale and Rosenberg Self-Esteem Scale) and a hearing test (Digits in Noise). They will complete the questionnaires at two time points (1) at the end of a rest day and (2) at the end of a workday. Standard demographic and hearing health information will be collected. The sample size was determined pragmatically due to a lack of comparable published data to power the study. Tests are exploratory and for generating hypotheses; therefore, the standard criterion of p<0.05 will be used. ETHICS AND DISSEMINATION This study has been reviewed within the funding organisation (Cochlear Research and Development Limited) by an independent and relevant peer reviewer/committee. This study has had a favourable ethics committee review by both NHS ethics and University of Manchester ethics. The study will be disseminated through newsletters, publication and presentations at conferences. The results will be made available to participants on request.
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Affiliation(s)
- Callum Andrew Shields
- ENT Department, Royal Machester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Mark Sladen
- ENT Department, Royal Machester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Azita Rajai
- ENT Department, Royal Machester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Hannah Guest
- Manchester Centre for Audiology and Deafness (ManCAD), The University of Manchester, Manchester, UK
| | - Iain Bruce
- ENT Department, Royal Machester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Karolina Kluk
- Manchester Centre for Audiology and Deafness (ManCAD), The University of Manchester, Manchester, UK
| | - Jaya Nichani
- ENT Department, Royal Machester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
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Buswell H, Majeed-Ariss R, Rajai A, White C, Mills H. Identifying the prevalence of genito-anal injuries amongst clients attending St Mary's Sexual Assault Referral Centre following an allegation of anal penetration. J Forensic Leg Med 2022; 90:102392. [DOI: 10.1016/j.jflm.2022.102392] [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] [Received: 01/20/2022] [Revised: 06/13/2022] [Accepted: 06/16/2022] [Indexed: 11/17/2022]
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Stivaros S, Paddock M, Rajai A, Cliffe H, Connolly DJ, Dineen RA, Dixon R, Edwards H, Evans E, Halliday K, Jackson K, Landes C, Oates AJ, Stoodley N, Offiah AC. Rate and severity of radiological features of physical abuse in children during the first UK-wide COVID-19 enforced national lockdown. Arch Dis Child 2022; 107:575-581. [PMID: 35177407 PMCID: PMC8882637 DOI: 10.1136/archdischild-2021-323444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 12/28/2021] [Indexed: 11/03/2022]
Abstract
Rate and severity of radiological features of physical abuse in children during the first UK-wide COVID-19 enforced national lockdown. OBJECTIVE To assess the number, type and outcome of radiological investigations for children presenting to hospital with suspected physical abuse (SPA; including abusive head trauma) during the first national COVID-19 enforced lockdown compared with the prelockdown period. DESIGN Multicentre, retrospective, observational, interrupted time series analysis. SETTING Eight secondary/tertiary paediatric centres between January 2018 and July 2020 inclusive. PARTICIPANTS 1587 hospital assessed children undergoing radiographic skeletal surveys (SkS) and head CT imaging performed for SPA/child protection concerns. MAIN OUTCOME MEASURES Incidence and severity of fractures identified on SkS; head injury (composed of incidence rates and ratios of skull fracture, intracranial haemorrhage (ICH) and hypoxic ischaemic injury (HII)) on head CT imaging; and ratio of antemortem and postmortem SkS. RESULTS 1587 SkS were performed: 1282 (81%) antemortem, 762 (48%) male, and positive findings in 582 (37%). Median patient age was 6 months. There were 1.7 fractures/child prelockdown versus 1.1 fractures/child during lockdown. There was no difference between positive/negative SkS rates, the absolute ratio of antemortem/postmortem SkS or absolute numbers of head injury occurring between January 2018 and February 2020 and the lockdown period April-July 2020. Likewise, prelockdown incidence and rates of skull fracture 30/244 (12%), ICH 28/220 (13%) and HIE 10/205 (5%) were similar to lockdown, 142/1304 (11%), 171/1152 (15%) and 68/1089 (6%), respectively. CONCLUSION The first UK COVID-19 lockdown did not lead to an increase in either the number of antemortem or postmortem radiological investigations performed for SPA, or the number or severity of fractures and intracranial injuries identified by these investigations.
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Affiliation(s)
- Stavros Stivaros
- Academic Unit of Paediatric Radiology, Royal Manchester Children's Hospital, Manchester, UK
- Division of Informatics, Imaging, and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine, and Health, The University of Manchester, Manchester, UK
| | - Michael Paddock
- Department of Medical Imaging, Barnsley Hospital NHS Foundation Trust, Barnsley, South Yorkshire, UK
- Department of Oncology & Metabolism, Damer Street Building, The University of Sheffield, Sheffield, South Yorkshire, UK
| | - Azita Rajai
- Centre for Biostatistics, Division of Population Health, Manchester Academic Science Centre, The University of Manchester, Manchester, UK
- Department of Research & Innovation, Manchester University NHS Foundation Trust, Manchester, UK
| | - Helen Cliffe
- Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, West Yorkshire, UK
| | - Daniel Ja Connolly
- Department of Radiology, Sheffield Children's NHS Foundation Trust, Sheffield, South Yorkshire, UK
| | - Robert A Dineen
- Department of Radiology, Nottingham University Hospitals NHS Trust, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK
| | - Rachel Dixon
- Department of Paediatric Radiology, Manchester University NHS Foundation Trust, Manchester, UK
| | - Harriet Edwards
- Department of Radiology, Alder Hey Children's NHS Foundation Trust, Liverpool, Merseyside, UK
- Department of Radiology, Aintree University Hospital, Liverpool, Merseyside, UK
| | - Emily Evans
- Department of Radiology, University Hospital Coventry, Coventry, UK
| | - Katherine Halliday
- Department of Radiology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Kandise Jackson
- Department of Radiology, Royal Oldham Hospital, Oldham, Greater Manchester, UK
| | - Caren Landes
- Department of Radiology, Alder Hey Children's NHS Foundation Trust, Liverpool, Merseyside, UK
| | - Adam J Oates
- Department of Radiology, Birmingham Women's and Children's Hospitals NHS Foundation Trust, Birmingham, UK
| | - Neil Stoodley
- Department of Radiology, Bristol Royal Hospital for Children, Bristol, UK
| | - Amaka C Offiah
- Department of Oncology & Metabolism, Damer Street Building, The University of Sheffield, Sheffield, South Yorkshire, UK
- Department of Radiology, Sheffield Children's NHS Foundation Trust, Sheffield, South Yorkshire, UK
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Heward E, Bateman N, Schaefer S, Bruce IA, Rajai A, Vetuz G, Ormandy D, Doherty C. Improving safety for day case adenotonsillectomy in paediatric obstructive sleep apnoea. Clin Otolaryngol 2021; 47:181-186. [PMID: 34331413 DOI: 10.1111/coa.13842] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/28/2021] [Accepted: 07/27/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Elliot Heward
- Paediatric Otolaryngology Department, Manchester Academic Health Science Centre, Royal Manchester Children's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Neil Bateman
- Paediatric Otolaryngology Department, Manchester Academic Health Science Centre, Royal Manchester Children's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Simone Schaefer
- Paediatric Otolaryngology Department, Manchester Academic Health Science Centre, Royal Manchester Children's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Iain A Bruce
- Paediatric Otolaryngology Department, Manchester Academic Health Science Centre, Royal Manchester Children's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Azita Rajai
- Centre for Biostatistics, Manchester Academic Health Science Centre, Division of Population Health, University of Manchester, Manchester, UK.,Research and Innovation, Manchester Academic Health Science Centre, Manchester University NHS foundation Trust, Manchester, UK
| | - Glenn Vetuz
- Paediatric Anaesthetic Department, Manchester Academic Health Science Centre, Royal Manchester Children's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Danielle Ormandy
- Paediatric Anaesthetic Department, Manchester Academic Health Science Centre, Royal Manchester Children's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Catherine Doherty
- Paediatric Anaesthetic Department, Manchester Academic Health Science Centre, Royal Manchester Children's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
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11
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Krishnamoorthy B, Zacharias J, Critchley WR, Rochon M, Stalpinskaya I, Rajai A, Venkateswaran RV, Raja SG, Bahrami T. A multicentre review comparing long term outcomes of endoscopic vein harvesting versus open vein harvesting for coronary artery bypass surgery. NIHR Open Res 2021; 1:11. [PMID: 35098131 PMCID: PMC7612280 DOI: 10.3310/nihropenres.13215.1] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/24/2021] [Indexed: 11/22/2022]
Abstract
Background Utilisation of the Endoscopic Vein Harvesting (EVH) technique has been increasing for coronary artery bypass grafting (CABG) for the last two decades. Some surgeons remain concerned about the long-term patency of the long saphenous vein harvested endoscopically compared to traditional Open Vein Harvesting (OVH). The aim of this study was to perform a retrospective analysis of the outcomes between EVH and OVH from three UK centres with 10 years follow-up. Methods 27,024 patients underwent CABG with long saphenous vein harvested by EVH (n=13,794) or OVH (n=13,230) in three UK centres between 2007 and 2019. Propensity modelling was used to calculate the Inverse Probability of Treatment Weights (IPTW). The primary endpoint was mortality from all causes and secondary endpoints were length of hospital stay, postoperative complications, and incidence of repeat coronary re-vascularisation for symptomatic patients. IPTW was used to balance the two intervention groups for baseline and preoperative co-morbidities. Results Median follow-up time was 4.54 years for EVH and 6.00 years for OVH. Death from any cause occurred in 13.8% of the EVH group versus 20.8% in the OVH group over the follow-up period. The hazard ratio of death (EVH to OVH) was 0.823 (95% CI: 0.767, 0.884). Length of hospital stay was similar between the groups (p=0.86). Post-operative pulmonary complications were more common in EVH vs OVH (14.7% vs. 12.8%, p<0.001), but repeat coronary re-vascularisation was similar between the groups. Conclusions This large retrospective multicentre analysis indicates that EVH has a lower risk of mortality compared with OVH during the follow-up period of the study. The observed benefits of EVH may outweigh the risks but should be considered on a case-by-case basis. We hope this review gives confidence to other cardiac centres that offering an EVH approach to conduit harvesting does not affect long term patient outcomes.
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Affiliation(s)
- Bhuvaneswari Krishnamoorthy
- Department of Cardiovascular Sciences, Faculty of Health, Biology and Medicine, The University of Manchester, Manchester, UK
- Department of Allied Health Professions, Faculty of Health and Social Service, Edge hill University, Ormskirk, UK
- Department of Cardiothoracic surgery, Manchester Foundation Trust, Wythenshawe Hospital, Manchester, UK
| | - Joesph Zacharias
- Department of Cardiothoracic surgery, Blackpool Victoria NHS trust, Blackpool, UK
| | - William R. Critchley
- Endothelial Cell Biology, School of Molecular Medicine, University of Leeds, Leeds, England, UK
| | - Melissa Rochon
- Department of Cardiothoracic surgery, Royal Brompton & Harefield NHS Trust, London, UK
| | - Iryna Stalpinskaya
- Department of Cardiothoracic surgery, Blackpool Victoria NHS trust, Blackpool, UK
| | - Azita Rajai
- Centre for Biostatitics, Division of Population Health, University of Manchester, Manchester, UK
| | - Rajamiyer V. Venkateswaran
- Department of Allied Health Professions, Faculty of Health and Social Service, Edge hill University, Ormskirk, UK
| | - Shahzad G. Raja
- Department of Cardiothoracic surgery, Royal Brompton & Harefield NHS Trust, London, UK
| | - Toufan Bahrami
- Department of Cardiothoracic surgery, Royal Brompton & Harefield NHS Trust, London, UK
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12
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Metryka A, Cuniffe C, Evans HJ, Gavlak JG, Hudson N, Kirby N, Lakhanpaul M, Lin YL, Murray C, Rajai A, Robson H, Schilder A, Walsh T, Bruce I. Study protocol for randomised clinical trial comparing the effectiveness of side-lying sleep positioning to back-lying at reducing oxygen desaturation resulting from obstructive sleep apnoea in infants with cleft palate (SLUMBRS2). BMJ Open 2021; 11:e049290. [PMID: 33827851 PMCID: PMC8031693 DOI: 10.1136/bmjopen-2021-049290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION The craniofacial abnormalities found in infants with cleft palate (CP) decrease their airway patency and increase their risk of obstructive sleep apnoea (OSA). We hypothesise that optimising sleep position in infants with CP may improve airway patency and offer a 'low-cost, high-impact' intervention to prevent the negative impacts of OSA. Because cleft centres give inconsistent advice about sleep position: some recommend back-lying and others side-lying, we will compare these in a randomised controlled trial. METHODS AND ANALYSIS The aim is to determine the clinical effectiveness of side-lying as compared with back-lying sleep positioning in terms of reducing oxygen desaturation resulting from OSA in 244 infants aged 3-5 weeks of age, diagnosed with an isolated CP in/by UK cleft centres. Primary outcome is the 4% Oxygen Desaturation Index measured using pulse oximetry during sleep. RESEARCH PLAN 1. Multicentre randomised controlled trial of side-lying compared with back-lying sleep positioning in reducing oxygen desaturation resulting from OSA in infants with CP at one month of age. 2. Internal pilot questionnaire-based study to support parents and clinicians regarding study participation, seeking to identify and address any barriers to recruitment. Monitoring data from the internal pilot will be used in the final analysis. 3. Co-development of new UK recommendations with Cleft Lip and Palate Association (CLAPA) regarding sleep position for infants with CP. ETHICS AND DISSEMINATION The study protocol has received the favourable opinion of the West Midlands-South Birmingham Research Ethics Committee. Study results will be published on affiliated webpages and in peer-reviewed publications and conference contributions. TRIAL REGISTRATION NUMBER NCT04478201.
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Affiliation(s)
- Aleksandra Metryka
- Research and Innovation, Manchester University NHS Foundation Trust, Manchester, Manchester, UK
| | | | - Hazel J Evans
- Department of Respiratory Paediatrics, Southampton Children's Hospital, Southampton, UK
| | - Johanna G Gavlak
- Department of Respiratory Paediatrics, Southampton Children's Hospital, Southampton, UK
| | - Nichola Hudson
- Salisbury NHS Foundation Trust, Salisbury, Wiltshire, UK
| | - Nigel Kirby
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Monica Lakhanpaul
- Policy & Practice Department, UCL Great Ormond Street Institute of Child Health Population Policy and Practice, London, UK
- Community Paediatrics, Whittington Health NHS Trust, London, UK
| | - Yin-Ling Lin
- School of Dentistry, The University of Manchester, Manchester, UK
| | - Clare Murray
- Royal Manchester Children's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- Division of Infection, Immunity and Respiratory Medicine, The University of Manchester Faculty of Biology Medicine and Health, Manchester, Manchester, UK
| | - Azita Rajai
- Research and Innovation, Manchester University NHS Foundation Trust, Manchester, Manchester, UK
| | - Helen Robson
- Royal Manchester Children's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Anne Schilder
- evidENT, UCL Ear Institute, London, UK
- NIHR University College London Hospitals Biomedical Research Centre, London, UK
| | - Tanya Walsh
- School of Dentistry, The University of Manchester, Manchester, UK
| | - Iain Bruce
- Royal Manchester Children's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- Division of Infection, Immunity and Respiratory Medicine, The University of Manchester Faculty of Biology Medicine and Health, Manchester, Manchester, UK
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13
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Stokes V, Rajai A, Mukherjee D, Mukherjee A. Transfusion-associated necrotizing enterocolitis (NEC) in extremely preterm infants: experience of a tertiary neonatal center in UK. J Matern Fetal Neonatal Med 2021; 35:5054-5059. [PMID: 33472464 DOI: 10.1080/14767058.2021.1874910] [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] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To compare the characteristics and short-term outcomes in extremely preterm infants, who developed necrotizing enterocolitis (NEC) following a packed red blood cell transfusion (pRBC) within 48 h (TANEC), with those who developed NEC beyond 48 h (non-TANEC). SETTING A single-center retrospective cohort study in a Tertiary neonatal intensive care unit in the UK over a 5-year period. PATIENTS AND METHODS Extremely premature infants (23-27 weeks gestation) were selected. TANEC and non-TANEC incidence were calculated from the confirmed NEC group (defined as modified Bell's stage II and beyond). The characteristics and short-term outcomes of infants with TANEC in the first 8 weeks of life were compared to infants with non-TANEC. RESULTS AND INTERPRETATION Incidence of confirmed NEC was 14% (28/207). On further subgroup analysis of the confirmed NEC cases, 46% (13/28) of infants were identified with TANEC and 54% (15/28) with non-TANEC. The incidence of TANEC did not correlate with the number of antecedent pRBC transfusions or the pre-transfusion median hemoglobin (Hb) levels. There were no significant differences in characteristics between the TANEC and non-TANEC groups. Infants within the TANEC group required more intensive neonatal care support, greater surgical intervention (p-value 0.043) with loss of gut integrity and an increase in number of TPN dependency days (p-value 0.014). CONCLUSIONS A significantly worse clinical course and short-term outcome was observed in the TANEC group when compared with the non-TANEC group.
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Affiliation(s)
| | - Azita Rajai
- Centre for Biostatistics, Division of Population Health, University of Manchester, Manchester Academic Health Science Centre, Research and Innovation, Manchester University NHS Foundation Trust, Manchester, UK
| | - Devdeep Mukherjee
- Department of Neonatology, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Arindam Mukherjee
- Consultant Neonatologist, Honorary Senior Lecturer (University of Manchester), St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
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14
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Al Harby L, Ali Z, Rajai A, Roberts SA, Peto T, Leung I, Gray J, Hay G, Arora AK, Keane PA, Cohen VML, Sagoo M, Balaskas K. Prospective validation of a virtual clinic pathway in the management of choroidal naevi: the NAEVUS study Report no. 1: safety assessment. Br J Ophthalmol 2020; 106:128-134. [PMID: 33037007 DOI: 10.1136/bjophthalmol-2020-317371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 06/29/2020] [Revised: 09/19/2020] [Accepted: 09/21/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Choroidal naevi are a common incidental finding prompting specialist referrals to ocular oncology. Rarely, such lesions have sufficient suspicious features to diagnose a small melanoma. The aim of the study is to show that 'virtual' imaging-based pathways are a safe and efficient option to manage such referrals. METHODS A prospective cohort study at the Manchester Royal Eye Hospital and Moorfields Eye Hospital between June 2016 and July 2017 of the management decision of 400 patients reviewed by an ophthalmologist in a face-to-face consultation (gold standard) supported by fundus photography, optical coherence tomography, autofluorescence (AF) and B-mode ultrasound. The images were also read independently by blinded graders (non-medical) and blinded ophthalmologists, and a management decision was made based on image review alone (virtual pathway). The two pathways were compared for safety. RESULTS The agreement for management decisions between face-to-face and virtual pathways was 83.1% (non-medical) and 82.6% (medical). There were more over-referrals in the virtual pathway (non-medical 24.3%, medical 23.3% of gold standard discharge) and only two under-referrals (10.5% of gold standard referrals), both borderline cases with minimal clinical risk. The agreement for risk factors of growth (orange pigment, subretinal fluid, hyper-AF) ranged between 82.3% and 97.3%. CONCLUSIONS We prospectively validated a virtual clinic model for the safe management of choroidal naevi. Such a model of care is feasible with low rate of under-referral. An over-referral rate of almost 24% from the vitrual pathway needs to be factored into designing such pathways in conjunction with evidence on their cost-effectiveness.
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Affiliation(s)
- Lamis Al Harby
- Ocular Oncology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Zaria Ali
- Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Azita Rajai
- Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Manchester, UK.,Centre for Biostatistics, School of Health Sciences, University of Manchester, Manchester, UK
| | - Stephen A Roberts
- Centre for Biostatistics, School of Health Sciences, University of Manchester, Manchester, UK
| | - Tunde Peto
- Centre for Public Health, Blackwell's Queen's University Belfast, Belfast, UK
| | - Irene Leung
- Moorfields Ophthalmic Reading Centre, NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK
| | - Jane Gray
- Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Gordon Hay
- Medical Retina, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Amit K Arora
- Ocular Oncology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Pearse A Keane
- Moorfields Ophthalmic Reading Centre, NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK.,Medical Retina, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | | | - Mandeep Sagoo
- Moorfields Ophthalmic Reading Centre, NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK.,Barts Health NHS Trust, London, UK
| | - Konstantinos Balaskas
- Moorfields Ophthalmic Reading Centre, NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK .,Medical Retina, Moorfields Eye Hospital NHS Foundation Trust, London, UK
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15
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Ooi MWX, Rajai A, Patel R, Gerova N, Godhamgaonkar V, Liong SY. Pulmonary thromboembolic disease in COVID-19 patients on CT pulmonary angiography - Prevalence, pattern of disease and relationship to D-dimer. Eur J Radiol 2020; 132:109336. [PMID: 33069986 PMCID: PMC7537636 DOI: 10.1016/j.ejrad.2020.109336] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [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] [Received: 07/07/2020] [Revised: 09/21/2020] [Accepted: 10/03/2020] [Indexed: 12/21/2022]
Abstract
Prevalence of pulmonary thromboembolic disease (PTE) is 38 % in COVID-19 patients who underwent CTPA. Patients with more severe COVID-19 changes are more likely to have PTE. Majority of PTE is observed within smaller pulmonary vessels (75 %) and lungs demonstrated COVID-19 changes (72 %). Subsegmental vessels should be scrutinized for presence of PTE. D-dimer values may have potential in guiding anticoagulation therapy and evaluating prognosis in these patients.
Objectives To define the prevalence of pulmonary thromboembolic (PTE) disease diagnosed on CT pulmonary angiography (CTPA) in COVID-19 patients. To assess distribution of PTE and to evaluate for association between severity of COVID-19 disease, D-dimer values and incidence of PTE. Methods Patients with diagnosis of COVID-19 presenting to 5 different hospitals across Greater Manchester between 1st March 2020 and 30th April 2020 who had CTPA were included. CTPA images were evaluated for presence of PTE, distribution of PTE (in small and/or large vessels) and distribution of PTE within lungs with or without COVID-19 CT changes. Severity of COVID lung changes were graded. D-dimer values within 72 h of CTPA were obtained. Statistical analyses were performed to evaluate for any significant association between variables. p values of ≤0.05 were regarded as statistically significant. Results A total of 974 patients presented across five hospital sites with COVID-19 infection. Eighty-four (n = 84) COVID-19 patients underwent CTPA. Of these, 38 % (32/84) had PTE. PTE was seen in small vessels in 75 % (24/32) and in lungs demonstrating COVID-19 changes in 72 % (23/32). 84 % (27/32) of PTE positive patients had disease severity of moderate or higher score (p = 0.005). D-dimer values were significantly higher (p ≤ 0.001) in PTE patients, median value in PTE group was 6441mcg/L (range 219-90925). A D-dimer cut off value of 2247mcg/L provides sensitivity of 0.72 and specificity of 0.74. Conclusion There is increased prevalence of PTE in patients with moderate to severe COVID-19 disease. D-dimer values may have potential in guiding anticoagulation therapy and prognostication.
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Affiliation(s)
- M W X Ooi
- Manchester University NHS Foundation Trust, Department of Radiology, Wythenshawe Hospital, Southmoor Road, Manchester, M23 9LT, United Kingdom.
| | - A Rajai
- Centre for Biostatistics, Division of Population Health, University of Manchester, Manchester Academic Health Science Centre, United Kingdom; Research and Innovation, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Nowgen Building, Grafton Street, Manchester, M13 9WU, United Kingdom
| | - R Patel
- Manchester University NHS Foundation Trust, Department of Radiology, Wythenshawe Hospital, Southmoor Road, Manchester, M23 9LT, United Kingdom
| | - N Gerova
- Manchester University NHS Foundation Trust, Department of Radiology, Wythenshawe Hospital, Southmoor Road, Manchester, M23 9LT, United Kingdom
| | - V Godhamgaonkar
- Manchester University NHS Foundation Trust, Department of Radiology, Wythenshawe Hospital, Southmoor Road, Manchester, M23 9LT, United Kingdom
| | - S Y Liong
- Manchester University NHS Foundation Trust, Department of Radiology, Wythenshawe Hospital, Southmoor Road, Manchester, M23 9LT, United Kingdom
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16
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Dwyer L, Stewart E, Rajai A. A service evaluation to determine where and who delivers pessary care in the UK. Int Urogynecol J 2020; 32:1001-1006. [PMID: 32945903 DOI: 10.1007/s00192-020-04532-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 06/27/2020] [Accepted: 09/02/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Pessaries offer effective conservative management for symptoms of pelvic organ prolapse and are frequently used in the UK. Previous publications have highlighted a lack of evidence-based pessary guidelines. There is also a dearth of evidence regarding who UK pessary practitioners are and the training received. METHODS A Freedom of Information request was sent to 167 healthcare organisations in the UK. Requested information included the number of pessaries inserted or changed, the grade and profession of pessary practitioners and training requirements at the organisation. RESULTS Responses were received from 128 organisations. One hundred and ten had provided information for practitioners managing pessaries. At 66% (72) of organisations, pessary care was provided by both doctors and nurses of varying grades. At 23% of organisations either solely doctors or solely nurses provided pessary care. At the remaining 9% there was a multidisciplinary approach to pessary care. At 3 hospitals, unregistered healthcare professionals provided pessary care. At the majority of organisations, respondents undertook supervised practise to gain skills in pessary management. Additional methods of training cited were learning through observation or achieving set competencies. Twenty-six percent received didactic training. At 21% of organisations there were no training requirements. CONCLUSIONS At most organisations, there was a multidisciplinary approach to pessary care. It is questionable whether unregistered healthcare professionals should be delegated responsibility for pessary care. A standardised approach to pessary practitioner training is advocated to ensure that women receive safe, evidence-based pessary care. The UK Clinical Guidance Group for the Use of Pessaries in Vaginal Prolapse is currently developing national evidence-based guidelines to support pessary practitioners in their practice, including training requirements.
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Affiliation(s)
- Lucy Dwyer
- Saint Mary's Hospital, Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Hathersage Road, Manchester, M13 9WL, UK
| | - Ellie Stewart
- Department of Gynaecology, West Suffolk NHS Foundation Trust, Hardwick Lane, Bury St Edmunds, Suffolk, IP33 2QZ, UK.
| | - Azita Rajai
- Centre for Biostatistics, Division of Population Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.,Research and Innovation, Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Nowgen Building, Grafton Street, Manchester, M13 9WL, UK
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17
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Dwyer L, Weaver E, Rajai A, Cox S, Reid F. "Voice your choice": a study of women's choice of surgery for primary stress urinary incontinence. Int Urogynecol J 2019; 31:769-777. [PMID: 31853598 PMCID: PMC7170975 DOI: 10.1007/s00192-019-04202-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 11/27/2019] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND HYPOTHESIS This was an observational study aiming to determine factors which influence women's choice of surgery for primary stress urinary incontinence (SUI). METHODS Two hundred twelve women undergoing a primary SUI procedure were recruited to this study from 12 hospitals in the north of England. After choosing a procedure, women were asked to complete a standardized semi-structured questionnaire about their health, demographics and a free text box to record factors important to them when choosing their procedure. Statistical analysis was performed to determine the impact of demographic, lifestyle or healthcare factors on women's decision-making. Thematic analysis of the free text data was performed to identify factors important for women when choosing a surgical procedure. RESULTS Sixty-four percent of women chose urethral bulking. There was no significant difference among age, BMI, smoking status or previous laparotomy between women choosing the four types of surgery. Women were less likely to choose urethral bulking if seen in a tertiary centre compared with a secondary centre (p < 001). Major themes in decision-making were efficacy, invasiveness, recovery, risk of complications, use of mesh, the clinician, the media, hierarchy of treatments and type of anaesthetic. Some women expressed a hierarchical approach to treatment. CONCLUSIONS Our findings suggest decision-making is not influenced by patient factors such as age, BMI, smoking status or previous laparotomies. Women's choices are a complex mix of factors and not simply related to efficacy.
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Affiliation(s)
- Lucy Dwyer
- The Warrell Unit, Saint Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Hathersage Road, Manchester, M13 9WL, UK.
| | - Emily Weaver
- Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Hathersage Road, Manchester, M13 9WL, UK
| | - Azita Rajai
- Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Hathersage Road, Manchester, M13 9WL, UK
| | - Samantha Cox
- The Warrell Unit, Saint Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Hathersage Road, Manchester, M13 9WL, UK
| | - Fiona Reid
- The Warrell Unit, Saint Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Hathersage Road, Manchester, M13 9WL, UK
- Institute of Human Development, Faculty of Medical & Human Sciences, University of Manchester, Manchester Academic Health Science Centre, Oxford Road, Manchester, M13 9PL, UK
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18
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Siriwardena AK, Jegatheeswaran S, Mason JM, Baltatzis M, Chan A, Sheen AJ, O'Reilly D, Jamdar S, Deshpande R, de Liguori Carino N, Satyadas T, Qamruddin A, Hayden K, Parker MJ, Butler J, Rajai A, McIntyre B. PROCalcitonin-based algorithm for antibiotic use in Acute Pancreatitis (PROCAP): study protocol for a randomised controlled trial. Trials 2019; 20:463. [PMID: 31358032 PMCID: PMC6664733 DOI: 10.1186/s13063-019-3549-3] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 06/29/2019] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Differentiating infection from inflammation in acute pancreatitis is difficult, leading to overuse of antibiotics. Procalcitonin (PCT) measurement is a means of distinguishing infection from inflammation as levels rise rapidly in response to a pro-inflammatory stimulus of bacterial origin and normally fall after successful treatment. Algorithms based on PCT measurement can differentiate bacterial sepsis from a systemic inflammatory response. The PROCalcitonin-based algorithm for antibiotic use in Acute Pancreatitis (PROCAP) trial tests the hypothesis that a PCT-based algorithm to guide initiation, continuation and discontinuation of antibiotics will lead to reduced antibiotic use in patients with acute pancreatitis and without an adverse effect on outcome. METHODS This is a single-centre, randomised, controlled, single-blind, two-arm pragmatic clinical and cost-effectiveness trial. Patients with a clinical diagnosis of acute pancreatitis will be allocated on a 1:1 basis to intervention or standard care. Intervention will involve the use of a PCT-based algorithm to guide antibiotic use. The primary outcome measure will be the binary outcome of antibiotic use during index admission. Secondary outcome measures include: safety non-inferiority endpoint all-cause mortality; days of antibiotic use; clinical infections; new isolates of multiresistant bacteria; duration of inpatient stay; episode-related mortality and cause; quality of life (EuroQol EQ-5D); and cost analysis. A 20% absolute change in antibiotic use would be a clinically important difference. A study with 80% power and 5% significance (two-sided) would require 97 patients in each arm (194 patients in total): the study will aim to recruit 200 patients. Analysis will follow intention-to-treat principles. DISCUSSION When complete, PROCAP will be the largest randomised trial of the use of a PCT algorithm to guide initiation, continuation and cessation of antibiotics in acute pancreatitis. PROCAP is the only randomised trial to date to compare standard care of acute pancreatitis as defined by the International Association of Pancreatology/American Pancreatic Association guidelines to patients having standard care but with all antibiotic prescribing decisions based on PCT measurement. TRIAL REGISTRATION International Standard Randomised Controlled Trial Number, ISRCTN50584992. Registered on 7 February 2018.
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Affiliation(s)
- Ajith K Siriwardena
- Regional Hepato-Pancreato-Biliary Unit, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL, UK. .,Faculty of Biology, Health and Life Sciences, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK.
| | | | - James M Mason
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Minas Baltatzis
- Regional Hepato-Pancreato-Biliary Unit, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL, UK
| | - Anthony Chan
- Regional Hepato-Pancreato-Biliary Unit, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL, UK
| | - Aali J Sheen
- Regional Hepato-Pancreato-Biliary Unit, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL, UK.,Centre for Biomedicine, Manchester Metropolitan University, Manchester, UK
| | - Derek O'Reilly
- Regional Hepato-Pancreato-Biliary Unit, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL, UK.,Faculty of Biology, Health and Life Sciences, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Saurabh Jamdar
- Regional Hepato-Pancreato-Biliary Unit, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL, UK
| | - Rahul Deshpande
- Regional Hepato-Pancreato-Biliary Unit, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL, UK
| | - Nicola de Liguori Carino
- Regional Hepato-Pancreato-Biliary Unit, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL, UK
| | - Thomas Satyadas
- Regional Hepato-Pancreato-Biliary Unit, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL, UK
| | - Ahmed Qamruddin
- Department of Microbiology, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL, UK
| | - Katharine Hayden
- Department of Clinical Biochemistry, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL, UK
| | - Michael J Parker
- Critical Care Unit, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL, UK
| | - John Butler
- Critical Care Unit, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL, UK
| | - Azita Rajai
- Faculty of Biology, Health and Life Sciences, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Ben McIntyre
- Pharmacy Department, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL, UK
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Tanney K, Mahaveer A, Dockery K, Booth N, Chadwick CA, Chaloner CM, Rajai A. Non-reassuring results in agreement trial comparing glass and plastic capillary tubes for neonatal blood gas sampling. Acta Paediatr 2019; 108:1055-1060. [PMID: 30456830 DOI: 10.1111/apa.14653] [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: 08/24/2018] [Revised: 11/14/2018] [Accepted: 11/16/2018] [Indexed: 11/29/2022]
Abstract
AIM To determine agreement between neonatal capillary blood gases taken with plastic and glass tubes. METHODS An agreement study was carried out in a regional tertiary neonatal unit. Inpatient babies ≥1 kg were recruited to the study when parents gave consent. After taking the routine glass capillary tube sample, a plastic tube sample was taken and run if the heel continued to bleed. Successful sample pairs were recorded and analysed against pre-defined acceptable differences. Assessment was also made of differences in failure rates between tube types for each parameter. RESULTS Twenty-eight babies provided 135 blood gas pairs, of which five pairs were excluded. Successful pairing of results was achieved for pH in 105 valid samples. There were more failed plastic samples than glass, reaching significance for almost all parameters. pH, pO2 and pCO2 showed poor agreement (<80%) between glass and plastic tubes. On limited analysis of one successful blood gas pair per neonate to minimise bias, results remained non-reassuring. CONCLUSION The findings of this study do not advocate switching from glass to plastic capillary tubes in our Newborn Intensive Care Unit. Further studies are required to assess agreement of glass and plastic capillary tubes for neonatal blood gas sampling.
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Affiliation(s)
- Kristin Tanney
- Newborn Intensive Care Unit St. Mary's Hospital Manchester University NHS Foundation Trust Manchester UK
| | - Ajit Mahaveer
- Newborn Intensive Care Unit St. Mary's Hospital Manchester University NHS Foundation Trust Manchester UK
| | - Karen Dockery
- Newborn Intensive Care Unit St. Mary's Hospital Manchester University NHS Foundation Trust Manchester UK
| | - Nicola Booth
- Newborn Intensive Care Unit St. Mary's Hospital Manchester University NHS Foundation Trust Manchester UK
| | - Carol A. Chadwick
- Department of Clinical Biochemistry Manchester University NHS Foundation Trust Manchester UK
| | - Chris M. Chaloner
- Department of Clinical Biochemistry Manchester University NHS Foundation Trust Manchester UK
| | - Azita Rajai
- Faculty of Medical and Human Sciences Institute of Population Health University of Manchester Manchester UK
- Department of Research & Innovation Manchester University NHS Foundation Trust Manchester Academic Health Sciences Centre Manchester UK
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Luckson M, Duncan F, Rajai A, Haigh C. Exploring the research culture of nurses and allied health professionals (AHPs) in a research-focused and a non-research-focused healthcare organisation in the UK. J Clin Nurs 2018; 27:e1462-e1476. [DOI: 10.1111/jocn.14264] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Manju Luckson
- NIHR Manchester Biomedical Research Centre; Manchester University NHS Foundation Trust; Manchester Academic Health Science Centre; Manchester UK
- Faculty of Health, Psychology and Social care; Manchester Metropolitan University; Manchester UK
| | - Fiona Duncan
- Faculty of Health, Psychology and Social care; Manchester Metropolitan University; Manchester UK
| | - Azita Rajai
- NIHR Manchester Biomedical Research Centre; Manchester University NHS Foundation Trust; Manchester Academic Health Science Centre; Manchester UK
- Institute of Population Health; Faculty of Medical and Human Sciences; University of Manchester; Manchester UK
| | - Carol Haigh
- Nursing Department; Health, Rehabilitation and Psychology; Manchester Metropolitan University; Manchester UK
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Mukherjee A, Mukherjee D, Rajai A, Senthil S, Edi-Osagie N. MenB (Bexsero) immunisation side effects in extremely premature infants (<28 weeks). Arch Dis Child Fetal Neonatal Ed 2018; 103:F85. [PMID: 28942434 DOI: 10.1136/archdischild-2017-314009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/07/2017] [Indexed: 11/03/2022]
Affiliation(s)
- Arindam Mukherjee
- Department of Neonatology, St Marys Hospital, Central Manchester University Hospitals NHS Foundation Trust, University of Manchester, Manchester, UK
| | - Devdeep Mukherjee
- Department of Neonatology, St Marys Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Azita Rajai
- Department of Research and Innovation, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Srividhya Senthil
- Department of Neonatology, St Marys Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Ngozi Edi-Osagie
- Department of Neonatology, St Marys Hospital, Central Manchester University Hospitals NHS Foundation Trust, University of Manchester, Manchester, UK
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Russell MH, Yusuf S, Rajai A. Characteristics and survey of keratoconic contact lens wearers who are lost to follow up. Clin Exp Optom 2017; 100:616-622. [PMID: 28702953 DOI: 10.1111/cxo.12558] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 01/27/2017] [Accepted: 03/16/2017] [Indexed: 11/29/2022] Open
Affiliation(s)
- Martyn Ha Russell
- Optometry Department, Manchester Royal Eye Hospital, Central Manchester Foundation Trust, Manchester, UK.,School of Optometry, The University of New South Wales, Kensington, New South Wales, Australia
| | - Sabera Yusuf
- Optometry Department, Manchester Royal Eye Hospital, Central Manchester Foundation Trust, Manchester, UK
| | - Azita Rajai
- Institute of Population Health, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK.,Research and Innovation, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK
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Ali ZC, Silvioli R, Rajai A, Aslam TM. Feasibility of Use of a Mobile Application for Nutrition Assessment Pertinent to Age-Related Macular Degeneration (MANAGER2). Transl Vis Sci Technol 2017; 6:4. [PMID: 28138414 PMCID: PMC5270627 DOI: 10.1167/tvst.6.1.4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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] [Received: 06/20/2016] [Accepted: 11/16/2016] [Indexed: 01/20/2023] Open
Abstract
Purpose This is a feasibility study assessing use of a mobile phone application (app.) to measure nutrient intake relevant to age-related macular degeneration (AMD). Methods Inclusion criteria were age over 40 and ownership of a smartphone. Participants included healthy volunteers and those with ophthalmic conditions. They were asked to record daily food intake for a minimum of 3 days in a paper food diary and the app. A dietician analyzed the food diaries, and an independent researcher analyzed data from the app. Average daily intake of nutrients relevant to AMD (docosahexaenoic acid [DHA], eicosapentaenoic acid [EPA], vitamins E and C, copper, zinc, and lutein + zeaxanthin) were calculated for both and then compared. Results A total of 54 participants completed the app. and food diary. Male-to-female ratio was 7:20. Median (interquartile range [IQR]) age was 57 years (45.3–68.7 years). More than 90% of all values were within the limits of agreement for all micronutrients. Bland Altman agreement plots demonstrated clinically acceptable agreement between the two systems of analysis. Conclusions This study has demonstrated that the app. is a feasible alternative to the food diary for assessing nutrient intake relevant to AMD. Further studies are suggested to assess long-term adherence and effect of the app. on nutrient intake in AMD patients. Translational Relevance After smoking, nutritional modification is the key modifiable factor to reduce incidence of AMD. Use of the app. could be an efficient, easy way to monitor and improve dietary intake of required nutrients pertinent to AMD.
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Affiliation(s)
- Zaria Christine Ali
- Manchester Royal Eye Hospital, CMFT, Manchester Academic Health Sciences Centre, Manchester, UK
| | | | - Azita Rajai
- Institute of Population Health, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK ; Research & Innovation, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Tariq Mehmood Aslam
- Manchester Royal Eye Hospital, CMFT, Manchester Academic Health Sciences Centre, Manchester, UK ; Division of Pharmacy and Optometry, School of Health Sciences, University of Manchester, Manchester, UK ; University of Manchester, Manchester, UK ; Heriot Watt University, Edinburgh Campus, Edinburgh, UK
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Oshan V, Plant N, Gopal P, Rajai A, Roberts SA, Walker RWM. The effect of age and increasing head-up tilt on pre-oxygenation times in children: a randomised exploratory study. Anaesthesia 2016; 71:429-36. [DOI: 10.1111/anae.13379] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2015] [Indexed: 11/29/2022]
Affiliation(s)
- V. Oshan
- Royal Manchester Children's Hospital; Manchester UK
| | - N. Plant
- Royal Manchester Children's Hospital; Manchester UK
| | - P. Gopal
- Royal Manchester Children's Hospital; Manchester UK
| | - A. Rajai
- Department of Research and Innovation; Central Manchester University Hospitals NHS Foundation Trust; Manchester Academic Health Science Centre; Manchester UK
| | - S. A. Roberts
- Centre for Biostatistics; Manchester Academic Health Science Centre; University of Manchester; Manchester UK
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Balaskas K, Gray J, Blows P, Rajai A, Flaye D, Peto T, Sagoo MS. Management of choroidal naevomelanocytic lesions: feasibility and safety of a virtual clinic model. Br J Ophthalmol 2015; 100:665-70. [PMID: 26347525 DOI: 10.1136/bjophthalmol-2015-307168] [Citation(s) in RCA: 12] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 08/11/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND Choroidal naevomelanocytic lesions are often identified as an incidental finding by community optometrists and referred for expert evaluation in hospital eye units or specialist ocular oncology centres. Optimal management strategy is undecided and most centres err on the side of caution. Our aim was to test a virtual model of service delivery relying on interpretation of imaging test results by non-medically trained graders. METHODS Patients with naevomelanocytic lesions referred to Manchester Royal Eye Hospital and Moorfields Eye Hospital were retrospectively included in this study. All patients underwent imaging tests including optical coherence tomography and ultrasound and management was subsequently decided clinically. Images were anonymised and transferred to the Moorfields Eye Hospital Reading Centre and were reviewed by a trained, masked grader who reached a management decision on the basis of a specific grading protocol. Agreement between decisions made on the basis of clinical examination and imaging ('gold standard') by an expert ophthalmologist in the clinic was compared with the decisions made by a masked ophthalmologist and a masked non-medical grader based on imaging tests alone. RESULTS There were 102 consecutive patients included in this study. Agreement between gold-standard clinical management and decisions made by masked, non-medical grader and masked ophthalmologist on the basis of imaging test results alone was 96.1% (κ=0.97) and 100%, respectively. CONCLUSIONS In this pilot study, a streamlined, dedicated, virtual service for rapid assessment (within 2 weeks of referral) of choroidal naevomelanocytic lesions was shown to be feasible and safe. Such a model of service delivery may prove cost-efficient while optimising patient experience. Further prospective studies are required for formal validation of the proposed service model.
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Affiliation(s)
- Konstantinos Balaskas
- The Royal Eye Hospital, Manchester, UK Centre for Hearing and Vision Research, University of Manchester, Manchester, UK NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and at UCL Institute of Ophthalmology, London, UK
| | - Jane Gray
- The Royal Eye Hospital, Manchester, UK
| | - Peter Blows
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and at UCL Institute of Ophthalmology, London, UK
| | - Azita Rajai
- Department of Research and Innovation, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Deidre Flaye
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and at UCL Institute of Ophthalmology, London, UK
| | - Tunde Peto
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and at UCL Institute of Ophthalmology, London, UK
| | - Mandeep S Sagoo
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and at UCL Institute of Ophthalmology, London, UK
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Russell M, Yusuf S, Rajai A. Movement measures: Predicting contact lens clinic attendance discontinuation in keratoconus. Cont Lens Anterior Eye 2015. [DOI: 10.1016/j.clae.2014.11.093] [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]
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