1
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Schofield C, Lopez P, Cohen PA, Taaffe DR, Newton RU, Galvão DA, Jeffery E, Meniawy TM, Peddle-McIntyre CJ. Skeletal muscle morphology in patients receiving primary versus interval cytoreductive surgery for advanced high-grade serous ovarian cancer. Int J Gynecol Cancer 2023; 33:1587-1594. [PMID: 37220950 DOI: 10.1136/ijgc-2023-004425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
OBJECTIVE Our primary aim was to compare muscle morphology (skeletal muscle mass and density) between patients who underwent primary cytoreductive surgery versus interval cytoreductive surgery for advanced high-grade serous ovarian cancer. Secondarily, we explored the associations of muscle morphology with survival outcomes. METHODS We retrospectively analysed computed tomography (CT) images for 88 ovarian cancer patients (aged 38-89 years) to calculate skeletal muscle index (cm2/m2) and skeletal muscle density (Hounsfield units (HU)). A skeletal muscle index of <38.5 cm2/m2 and skeletal muscle density of <33.7 HU were classified as low. Analyses included repeated measures analysis of covariance and multivariable Cox proportional hazards regression. RESULTS At baseline, 44.3% of patients had low skeletal muscle index and 50.6% had low skeletal muscle density, with interval surgery patients having significantly lower mean skeletal muscle density than primary surgery patients (32.2±8.9 vs 37.3±8.6 HU, p=0.014). Although both groups had similar reductions in skeletal muscle index following treatment (p=0.49), primary surgery patients had a greater reduction in skeletal muscle density compared with interval surgery patients (-2.4 HU, 95% CI -4.3 to -0.5, p=0.016). Patients who experienced skeletal muscle density loss >2% during treatment (HR 5.16, 95% CI 1.33 to 20.02) and had low skeletal muscle density post-treatment (HR 58.87, 95% CI 3.70 to 935.68) had significantly worse overall survival. CONCLUSION Low skeletal muscle index and skeletal muscle density were prevalent at ovarian cancer diagnosis. While both groups experienced muscle mass loss, greater reductions in skeletal muscle density occurred in patients undergoing primary surgery. In addition, skeletal muscle density loss during treatment and low skeletal muscle density post-treatment were associated with poorer overall survival. Supportive care involving resistance exercise targeting muscle hypertrophic drive, and nutrition counseling during and after ovarian cancer treatment may help preserve/enhance muscle mass and density.
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Affiliation(s)
- Christelle Schofield
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Pedro Lopez
- Pleural Medicine Unit, Institute for Respiratory Health, Nedlands, Western Australia, Australia
| | - Paul A Cohen
- St John of God Subiaco Hospital, Subiaco, Western Australia, Australia
- School of Medicine, University of Western Australia, Crawley, Western Australia, Australia
| | - Dennis R Taaffe
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Robert Usher Newton
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Daniel A Galvão
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Emily Jeffery
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia
- School of Population Health, Curtin University, Bentley, Western Australia, Australia
| | - Tarek M Meniawy
- School of Medicine, University of Western Australia, Crawley, Western Australia, Australia
- Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Carolyn J Peddle-McIntyre
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
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2
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Andrews SL, Ghaderi-Najafabadi M, Gong P, Shamkhi N, Carleton L, Schofield C, Kessler T, Samani NJ, Webb TR, Morris GE. SVEP1 influences monocyte to macrophage differentiation via integrin α4β1/α9β1 and Rho/Rac signalling. Biochim Biophys Acta Mol Cell Res 2023; 1870:119479. [PMID: 37100352 DOI: 10.1016/j.bbamcr.2023.119479] [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] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 03/09/2023] [Accepted: 04/15/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND The large extracellular matrix protein SVEP1 mediates cell adhesion via integrin α9β1. Recent studies have identified an association between a missense variant in SVEP1 and increased risk of coronary artery disease (CAD) in humans and in mice Svep1 deficiency alters the development of atherosclerotic plaques. However how SVEP1 functionally contributes to CAD pathogenesis is not fully understood. Monocyte recruitment and differentiation to macrophages is a key step in the development of atherosclerosis. Here, we investigated the requirement for SVEP1 in this process. METHODS SVEP1 expression was measured during monocyte-macrophage differentiation in primary monocytes and THP-1 human monocytic cells. SVEP1 knockout THP-1 cell lines and the dual integrin α4β1/α9β1 inhibitor, BOP, were utilised to investigate the effect of these proteins in THP-1 cell adhesion, migration and cell spreading assays. Subsequent activation of downstream integrin signalling intermediaries was quantified by western blotting. RESULTS SVEP1 gene expression increases in monocyte to macrophage differentiation in human primary monocytes and THP-1 cells. Using two SVEP1 knockout THP-1 cells we observed reduction in monocyte adhesion, migration, and cell spreading compared to control cells. Similar results were found with integrin α4β1/α9β1 inhibition. We demonstrate reduced activity of Rho and Rac1 in SVEP1 knockout THP-1 cells. CONCLUSIONS SVEP1 regulates monocyte recruitment and differentiation phenotypes through an integrin α4β1/α9β1 dependent mechanism. GENERAL SIGNIFICANCE These results describe a novel role for SVEP1 in monocyte behaviour relevant to CAD pathophysiology.
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Affiliation(s)
- S L Andrews
- Department of Cardiovascular Sciences, University of Leicester and National Institute for Health Research Leicester Biomedical Research Centre, Glenfield Hospital, Leicester LE3 9QP, United Kingdom.
| | - M Ghaderi-Najafabadi
- Department of Cardiovascular Sciences, University of Leicester and National Institute for Health Research Leicester Biomedical Research Centre, Glenfield Hospital, Leicester LE3 9QP, United Kingdom.
| | - P Gong
- Department of Cardiovascular Sciences, University of Leicester and National Institute for Health Research Leicester Biomedical Research Centre, Glenfield Hospital, Leicester LE3 9QP, United Kingdom.
| | - N Shamkhi
- Department of Cardiovascular Sciences, University of Leicester and National Institute for Health Research Leicester Biomedical Research Centre, Glenfield Hospital, Leicester LE3 9QP, United Kingdom.
| | - L Carleton
- Horizon Discovery Ltd., 8100 Cambridge Research Park, Cambridge CB25 9TL, United Kingdom.
| | - C Schofield
- Horizon Discovery Ltd., 8100 Cambridge Research Park, Cambridge CB25 9TL, United Kingdom.
| | - T Kessler
- Department of Cardiology, German Heart Centre Munich, Technical University of Munich, Munich, Germany.; German Centre of Cardiovascular Research (DZHK e. V.), Partner Site Munich Heart Alliance, Munich, Germany.
| | - N J Samani
- Department of Cardiovascular Sciences, University of Leicester and National Institute for Health Research Leicester Biomedical Research Centre, Glenfield Hospital, Leicester LE3 9QP, United Kingdom.
| | - T R Webb
- Department of Cardiovascular Sciences, University of Leicester and National Institute for Health Research Leicester Biomedical Research Centre, Glenfield Hospital, Leicester LE3 9QP, United Kingdom.
| | - G E Morris
- Department of Cardiovascular Sciences, University of Leicester and National Institute for Health Research Leicester Biomedical Research Centre, Glenfield Hospital, Leicester LE3 9QP, United Kingdom.
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3
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Schofield C, Newton RU, Taaffe DR, Galvão DA, Cohen PA, Meniawy TM, Peddle-McIntyre CJ. Supervised resistance exercise for women with ovarian cancer who have completed first-line treatment: a pragmatic study. Support Care Cancer 2023; 31:304. [PMID: 37101013 PMCID: PMC10132425 DOI: 10.1007/s00520-023-07754-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 12/22/2022] [Accepted: 04/13/2023] [Indexed: 04/28/2023]
Abstract
OBJECTIVES In ovarian cancer (OC), suboptimal muscle morphology (i.e., low muscle mass and density) is associated with poor clinical outcomes, yet little is known about the effect of interventions aimed at improving these measures. We investigated the effect of resistance exercise after first-line treatment on muscle mass and density, muscle strength and physical function, health-related quality of life (QoL), and pelvic-floor function in advanced-stage OC survivors. METHODS Fifteen OC survivors participated in supervised resistance exercise twice weekly for 12 weeks (in-clinic or by telehealth). Assessments included muscle mass and density (dual-energy X-ray absorptiometry, peripheral quantitative computed tomography), muscle strength (1-repetition maximum [1RM] chest press, 5RM leg press, handgrip strength), physical function (400-m walk, timed up-and-go [TUG]), QoL (QLQ-C30 questionnaire), and self-reported pelvic floor function (Australian Pelvic Floor Questionnaire). RESULTS The median age was 64 (range 33-72) years, 10 women underwent neoadjuvant chemotherapy and five underwent adjuvant chemotherapy. All participants completed the intervention (median attendance = 92%; range 79-100%). Post-intervention improvements were observed for whole-body lean mass (1.0 ± 1.4 kg, p = 0.015), appendicular lean mass (0.6 ± 0.9 kg, p = 0.013), muscle density (p = 0.011), upper and lower body strength (p ≤ 0.001), 400-m walk (p = 0.001), TUG (p = 0.005), and social and cognitive QoL domains (p = 0.002 and 0.007), with no change to pelvic floor symptoms (p > 0.05). CONCLUSION In this study, supervised resistance exercise effectively improved muscle mass and density, muscle strength, and physical functioning without deleterious effects on the pelvic floor. Considering the prognostic value of these outcomes, larger studies are needed to confirm the benefits of resistance exercise in OC supportive care.
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Affiliation(s)
- Christelle Schofield
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia.
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia.
| | - Robert U Newton
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Dennis R Taaffe
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Daniel A Galvão
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Paul A Cohen
- School of Medicine, University of Western Australia, Crawley, WA, Australia
- St John of God Hospital, Subiaco, WA, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Tarek M Meniawy
- School of Medicine, University of Western Australia, Crawley, WA, Australia
- St John of God Hospital, Subiaco, WA, Australia
- Sir Charles Gairdner Hospital, Nedlands, WA, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Carolyn J Peddle-McIntyre
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
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4
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Mavropalias G, Cormie P, Peddle-McIntyre CJ, Galvão DA, Taaffe DR, Schofield C, Ray S, Zissiadis Y, Newton RU. The effects of home-based exercise therapy for breast cancer-related fatigue induced by radical radiotherapy. Breast Cancer 2023; 30:139-150. [PMID: 36239907 DOI: 10.1007/s12282-022-01408-3] [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: 06/03/2022] [Accepted: 10/05/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Radiotherapy (RT) can lead to cancer-related fatigue (CRF) and decreased health-related quality of life (HRQoL) in breast cancer patients. The purpose of this trial was to examine the feasibility and efficacy of a home-based resistance and aerobic exercise intervention for reducing CRF and improving HRQoL in breast cancer patients during RT. METHODS Women with breast cancer (N = 106) commencing RT were randomized to 12 weeks of home-based resistance and aerobic exercise (EX) or usual care/control (CON). The primary endpoint was CRF, with secondary endpoints of HRQoL, sleep duration and quality, and physical activity. Measurements were undertaken prior to RT, at completion of RT (~ 6 weeks), at completion of the intervention (12 weeks), and 6 and 12 months after RT completion, while CRF was also measured weekly during RT. RESULTS Eighty-nine women completed the study (EX = 43, CON = 46). Over the 12-week intervention, EX completed 1-2 resistance training sessions and accumulated 30-40 min of aerobic exercise weekly. For CRF, EX had a quicker recovery both during and post-RT compared to CON (p < 0.05). Moreover, there was a significant difference in HRQoL between groups at RT completion, with HRQoL unchanged in CON and higher in EX (p < 0.05). There was no change in sleep duration or quality for either group and there were no exercise-related adverse effects. CONCLUSIONS Home-based resistance and aerobic exercise during RT is safe, feasible, and effective in accelerating CRF recovery and improving HRQoL. Improvements in CRF and HRQoL for these patients can be achieved with smaller exercise dosages than stated in the generic recommendations for breast cancer.
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Affiliation(s)
- Georgios Mavropalias
- Exercise Medicine Research Institute, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia.,School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia.,Centre for Molecular Medicine and Innovative Therapeutics, and Centre for Healthy Aging, Health Futures Institute, Murdoch University, Perth, Australia.,Discipline of Exercise Science, Murdoch University, Perth, Australia
| | - Prue Cormie
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Carolyn J Peddle-McIntyre
- Exercise Medicine Research Institute, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia.,School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
| | - Daniel A Galvão
- Exercise Medicine Research Institute, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia.,School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
| | - Dennis R Taaffe
- Exercise Medicine Research Institute, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia.,School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
| | - Christelle Schofield
- Exercise Medicine Research Institute, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia.,School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
| | - Sharon Ray
- Department of Radiation Oncology, Genesis Cancer Care, Perth, Australia
| | - Yvonne Zissiadis
- Department of Radiation Oncology, Genesis Cancer Care, Perth, Australia
| | - Robert U Newton
- Exercise Medicine Research Institute, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia. .,School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia. .,School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Australia.
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5
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Schofield C. Time-resolved studies on oxygenase catalysis. Acta Cryst Sect A 2022. [DOI: 10.1107/s2053273322096255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
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6
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Slimmen L, Schofield C, Horati H, Giacalone V, Kicic A, Stick S, Tirouvanziam R, Garratt L, Janssens H, Unger W. 377: Airway macrophages in early CF lung disease show signs of immune paralysis. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01801-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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7
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Laucirica D, Schofield C, McLean S, Margaroli C, Agudelo-Romero P, Stick S, Tirouvanziam R, Kicic A, Garratt L. 348: Pseudomonas aeruginosa infection modulates primary granule exocytosis. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01772-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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8
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Murray V, Burke J, Hughes M, Schofield C, Young A. 1020 Delay to Surgery in Acute Perforated and Ischaemic Gastrointestinal Pathology. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.942] [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]
Abstract
Abstract
Introduction
Patients with acute abdominal pathology requiring emergency laparotomy who experience a delay to theatre have an increased risk of morbidity, mortality, and complications. The timeline between symptom onset and operation is ill-defined with international variance in assessment and management. This systematic review aims to define where delays to surgery occur and assess the evidence for previous interventions.
Method
A systematic review was performed searching MEDLINE and EMBASE databases (January 1st 2005 to May 6th 2020). All studies assessing the impact of time to theatre in patients with acute abdominal pathology requiring emergency laparotomy were considered.
Results
Eighty-five results were assessed to include 19 papers in the analysis. Fifteen unique timepoints were identified in the patient pathway between symptom onset and operation which could be classified into four distinct phases. Time from admission to theatre (1 to 72 hours), and mortality rate (10.6-74.5%) varied greatly between studies. Mean time to surgery was significantly higher in deceased patients compared to survivors. Delays were related to imaging, diagnosis, decision-making, theatre availability and staffing. Four of five interventional studies showed a reduced mortality following introduction of an acute laparotomy pathway.
Conclusions
There is wide variation in the definition and measurement of time delays prior to emergency surgery with few studies exploring interventions. Given the heterogenous nature of the patient population and pathologies, an assessment and management framework from onset of symptoms to operation is proposed. This could be incorporated into national mortality prediction and audit tools and assist in the assessment of interventions.
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Affiliation(s)
- V Murray
- University of Leeds, Leeds, United Kingdom
| | - J Burke
- St. James’s University Hospital, Leeds, United Kingdom
| | - M Hughes
- St. James’s University Hospital, Leeds, United Kingdom
| | - C Schofield
- St. James’s University Hospital, Leeds, United Kingdom
| | - A Young
- St. James’s University Hospital, Leeds, United Kingdom
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9
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Misbert E, Hughes M, Burke J, Schofield C, Young A. 1308 Investigating the Use of a Novel Pre-Hospital Triage Tool for Acute Abdominal Surgical Emergencies – A Two-Phase Single Centre Cohort Study. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.530] [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]
Abstract
Abstract
Background
Despite the recent improvements in mortality in patients undergoing emergency laparotomy(EL) within the UK, delay to theatre continues to be associated with increased mortality. This study aimed to assess if patients requiring urgent surgical intervention for acute abdominal surgical pathology could be identified in the pre-hospital setting.
Method
A two-phase, single-centre, cohort study was performed. Phase 1 retrospectively investigated patients who underwent emergency laparotomy between 01/01/2019-31/12/2019 at Leeds Teaching Hospital Trust (LTHT) through the NELA database. Phase 2 prospectively assessed NEWS2 for all patients presenting to LTHT Surgical Admissions Unit with abdominal pain between 01/01/2020-31/01/2020.
Results
Phase 1: 45 patients were coded through NELA and confirmed through operation note review as undergoing EL for gastrointestinal perforation. 66%(n = 30) were assessed by the ambulance service and 80% (n = 24) had a NEWS2 of 3 or greater. Phase 2: 319 patients were assessed in SAU/ED, of which 69 initially treated by the ambulance service. 30% (n = 21) of these patients had an initial NEWS2 of 3 or above. Sensitivity of a NEWS2 score of >/3 in predicting the need for immediate surgical intervention including EL was 95%(95%CI, 74-99) and specificity was 95% (95%CI, 83-99) with a PPV of 86%(95%CI 67-95) and NPV of 98% (95%CI, 87-99).
Conclusions
A NEWS2 score of >/3 predicts the need for emergency surgical intervention including laparotomy for gastrointestinal perforation with reasonable sensitivity in this cohort. A pre-hospital triage tool for patients presenting with abdominal pain could utilise NEWS2 as an adjunct to decision-making in an acute abdominal pathway.
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Affiliation(s)
- E Misbert
- Leeds Teaching Hospital Trust, Leeds, United Kingdom
| | - M Hughes
- Leeds Teaching Hospital Trust, Leeds, United Kingdom
| | - J Burke
- Leeds Teaching Hospital Trust, Leeds, United Kingdom
| | - C Schofield
- Leeds Teaching Hospital Trust, Leeds, United Kingdom
| | - A Young
- Leeds Teaching Hospital Trust, Leeds, United Kingdom
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10
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Skinner H, Williams P, Greenlees G, Ilyas C, Schofield C, Lotia S, Amtul N. 1161 Streamlining the Patient Journey for Operative Management During COVID 19. Br J Surg 2021. [PMCID: PMC8524530 DOI: 10.1093/bjs/znab259.768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Aim
Leeds, UK is a high-volume acute surgery unit. Emergency operating was drastically affected by the pandemic and time from admission to definitive procedure significantly increased. This intervention aimed to streamline the patient journey from acute admission to the operating theatre.
Method
An audit considering delays to transfer, theatre access and recovery discharge, along with the criteria used for ‘Hot’ theatre was undertaken. Data was collected prospectively between 02/06/2020-06/07/2020 via a standardised proforma. Preliminary results suggested a geographically remote ‘hot’ theatre was associated with multi-factorial delays so was relocated to more familiar surroundings. This was re-audited between 06/07/2020-06/08/2020 aiming to characterise factors contributing to delay. A dedicated in-hours acute theatres porter was introduced for a trial period. Data was collected retrospectively between 24/08/2020-14/09/2020 and prospectively between 14/09-05/10/2020 via hospital electronic systems.
Results
Initially the average time from patient transfer to leaving theatre recovery was 4h6m55s (N = 52). Relocating theatres reduced this to 2h48m04s (N = 74)- an average reduction of 1h18m51s. The greatest reduction was seen in anaesthetic time between 1h17m54s to 41m29s. The introduction of a dedicated porter reduced the average transfer time to theatre from 36 minutes (N = 53) to 21 minutes (N = 68) (p < 0.05).
Conclusions
Delay to theatre has a high cost financially and in its effect on patient outcomes. Delays are often multifactorial and robust systems are essential to minimise delays. Patients are best served by well-trained, dedicated ‘Acute’ team in familiar surroundings. Long-term implementation of dedicated portering service will save time, money and improve patient care.
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Affiliation(s)
- H Skinner
- Leeds Teaching Hospitals Trust, Leeds, United Kingdom
| | - P Williams
- Leeds Teaching Hospitals Trust, Leeds, United Kingdom
| | - G Greenlees
- Leeds Teaching Hospitals Trust, Leeds, United Kingdom
| | - C Ilyas
- Leeds Teaching Hospitals Trust, Leeds, United Kingdom
| | - C Schofield
- Leeds Teaching Hospitals Trust, Leeds, United Kingdom
| | - S Lotia
- Leeds Teaching Hospitals Trust, Leeds, United Kingdom
| | - N Amtul
- Leeds Teaching Hospitals Trust, Leeds, United Kingdom
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11
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Misbert E, Hughes M, Burke J, Schofield C, Young A. 1404 NELA Risk Mortality Scores from Admission to Theatre in Emergency Gastrointestinal Perforation – A Retrospective Cohort Study. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.531] [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]
Abstract
Abstract
Background
Patients with acute abdominal pathology requiring emergency laparotomy who experience a delay to theatre have an increased risk of morbidity, mortality and complications. The aim of this study was to assess delay, from symptom onset to theatre in patients with gastrointestinal perforation and its effect on perioperative risk.
Method
A single-centre retrospective study was performed in the Leeds Trust Hospitals, UK investigating the NELA database for patients requiring emergency laparotomy for perforated gastrointestinal viscus who presented to the acute surgical unit or emergency department between 1st February 2018 and 31st January 2020.
Results
101 patients met the inclusion criteria (47% F and 53% M), mean age 59 [21-91]. 37% of patients’ NELA scores worsened from admission to pre-op (median change of + 5.9% IQR 1.3-11.5]), 14% stayed the same and 49% improved (median change of -4.4%[IQR 0.4-9.1]) 3% had their NELA score documented at the time of consent. 18% did not wait for a CT report or went straight to theatre. Mean time from admission to scan report was 9.3 hours (0.9-22.0). Median time from symptom onset to presentation (2 days [IQR 1-13]) was greater in patients with an Index of Multiple Deprivation Decile of 1-5, (n = 64, median 2 days [IQR 1-6]) compared to those in deciles 6-10, (n = 37, median 1 day[IQR 1-3]), p = 0.097.
Conclusions
NELA mortality risk score changes from presentation to surgery in patients with acute gastrointestinal perforation requiring emergency laparotomy. There is suggestion that delay in symptom onset to presentation may correlate with Index of Multiple Deprivation Decile.
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Affiliation(s)
- E Misbert
- Leeds Teaching Hospital Trust, Leeds, United Kingdom
| | - M Hughes
- Leeds Teaching Hospital Trust, Leeds, United Kingdom
| | - J Burke
- Leeds Teaching Hospital Trust, Leeds, United Kingdom
| | - C Schofield
- Leeds Teaching Hospital Trust, Leeds, United Kingdom
| | - A Young
- Leeds Teaching Hospital Trust, Leeds, United Kingdom
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12
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Murray V, Burke JR, Hughes M, Schofield C, Young A. Delay to surgery in acute perforated and ischaemic gastrointestinal pathology: a systematic review. BJS Open 2021; 5:6363074. [PMID: 34476466 PMCID: PMC8413368 DOI: 10.1093/bjsopen/zrab072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/24/2021] [Accepted: 06/29/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Patients with acute abdominal pathology requiring emergency laparotomy who experience a delay to theatre have an increased risk of morbidity, mortality and complications. The timeline between symptom onset and operation is ill defined with international variance in assessment and management. This systematic review aims to define where delays to surgery occur and assess the evidence for interventions trialled across Europe. METHODS A systematic review was performed searching MEDLINE and EMBASE databases (1 January 2005 to 6 May 2020). All studies assessing the impact of time to theatre in patients with acute abdominal pathology requiring emergency laparotomy were considered. RESULTS Sixteen papers, involving 50 653 patients, were included in the analysis. Fifteen unique timepoints were identified in the patient pathway between symptom onset and operation which are classified into four distinct phases. Time from admission to theatre (1-72 hours) and mortality rate (10.6-74.5 per cent) varied greatly between studies. Mean time to surgery was significantly higher in deceased patients compared with that in survivors. Delays were related to imaging, diagnosis, decision making, theatre availability and staffing. Four of five interventional studies showed a reduced mortality rate following introduction of an acute laparotomy pathway. CONCLUSION Given the heterogeneous nature of the patient population and pathologies, an assessment and management framework from onset of symptoms to operation is proposed. This could be incorporated into mortality prediction and audit tools and assist in the assessment of interventions.
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Affiliation(s)
- V Murray
- The University of Leeds Medical School, Leeds, UK
| | - J R Burke
- The John Golligher Colorectal Surgery Unit, St. James's University Hospital, Leeds, UK.,Leeds Institute of Biomedical & Clinical Sciences, Clinical Sciences Building, St James's University Hospital, Leeds, UK
| | - M Hughes
- The John Golligher Colorectal Surgery Unit, St. James's University Hospital, Leeds, UK.,Leeds Institute of Biomedical & Clinical Sciences, Clinical Sciences Building, St James's University Hospital, Leeds, UK
| | - C Schofield
- Department of Anaesthetics, St James's University Hospital, Leeds, UK
| | - A Young
- Department of Pancreatic Surgery, St James's University Hospital, Leeds, UK
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13
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Schofield C, Evans K, Young H, Paguinto SG, Carroll K, Townsend E, Kiefer M, McGuire M, Sodhi J, Bray P, Bayley K, Vorster NM, Downs J. The development of a consensus statement for the prescription of powered wheelchair standing devices in Duchenne muscular dystrophy. Disabil Rehabil 2020; 44:1889-1897. [DOI: 10.1080/09638288.2020.1810786] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- C. Schofield
- Telethon Kids Institute, University of Western Australia, Perth, Australia
| | | | - H. Young
- The Children’s Hospital at Westmead, Westmead, Australia
| | | | - K. Carroll
- The Royal Children’s Hospital, Parkville, Australia
- Murdoch Children’s Research Institute, Melbourne, Australia
| | - E. Townsend
- School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA, USA
| | - M. Kiefer
- School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA, USA
| | - M. McGuire
- Division of Occupational Therapy and Physical Therapy, Cincinnati Children’s Hospital, Cincinnati, OH, USA
| | - J. Sodhi
- Institute of Genetic Medicine, International Centre for Life, John Walton Muscular Dystrophy Research Centre, Newcastle Upon Tyne, UK
| | - P. Bray
- The Children’s Hospital at Westmead, Westmead, Australia
- School of Health Sciences, The University of Sydney, Sydney, Australia
| | - K. Bayley
- Centre for Community-Driven Research, Perth, Australia
| | - N. M. Vorster
- Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - J. Downs
- Telethon Kids Institute, University of Western Australia, Perth, Australia
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
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14
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Zayer A, Smith H, Pillai M, Sekirnik R, Zak J, Lu X, Schofield C, Bix M, Ratcliffe P, Coleman M. Tumour suppression by a protein hydroxylase. Eur J Cancer 2016. [DOI: 10.1016/s0959-8049(16)61319-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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15
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McCauley K, Cross W, Moss C, Walsh K, Schofield C, Handley C, Fitzgerald M, Hardy S. What does practice development (PD) offer mental health-care contexts? A comparative case study of PD methods and outcomes. J Psychiatr Ment Health Nurs 2014; 21:724-37. [PMID: 24698157 DOI: 10.1111/jpm.12134] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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] [Accepted: 12/26/2013] [Indexed: 11/30/2022]
Abstract
Practice development (PD) in mental health nursing has been progressing over the last decade; however, the level and impact of PD activity in the field of mental health remains poorly understood outside localized project impact. More specific reporting and comparative analysis of PD outcomes will improve this situation. In response, this paper presents three case scenarios from work taking place in Australia and New Zealand, as working examples of how PD methodologies have been applied within mental health practice settings. Using a comparative framework that captures the contributing assumptions, practices, processes and conditions imperative to effective PD work within a mental health-care context, three case vignettes are reviewed. The critical question driving this paper is 'what mental health-care services does PD offer in terms of transformational change approaches and the promotion of effective workplace cultures?' Conditions considered necessary for successful PD initiatives within mental health contexts are explored such as how PD converges and diverges with mental health-related theories, plus where and how PD activity best integrates with the specific elements associated with mental health-care provision. The findings are further reviewed in line with reports of PD outcomes from other fields of health care.
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Affiliation(s)
- K McCauley
- School of Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton Campus, Melbourne, Vic
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16
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Aboagye EO, Aigbirhio FI, Allen P, Arent R, Arrowsmith RL, Banci G, Bagley MC, Bailey CD, Blake T, Bunt AJ, Bushby N, Carroll L, Cons BD, Cortezon F, Dilworth JR, Dorff PN, Eggleston IM, Ellames G, Elmore CS, Ernst G, Estrela P, Faithfull J, Ge H, Geach NJ, Hall J, Harding J, Harwood LM, Hickey MJ, Heys JR, Hogg C, Hudson MJ, James T, Kerr WJ, Killick D, Kingston LP, Kociok-Köhn G, Landvatter S, Lewis F, Lockley WJS, Marken F, Mudd RJ, Pascu SI, Pheko T, Powell ME, Reid M, Riss PJ, Ruhl T, Rustidge DC, Schenk DJ, Schofield C, Schweiger L, Sharma P, Smith D, Tuttle CTT, Testa A, Tyson JA, Tyrrell RM, Urbanek R, Wilkinson DJ, Willis CL, Zanda M. Abstracts of the 22nd International Isotope Society (UK Group) Symposium: synthesis and applications of labelled compounds 2013. J Labelled Comp Radiopharm 2014. [DOI: 10.1002/jlcr.3173] [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] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- E. O. Aboagye
- Department of Chemistry, Faculty of Engineering and Physical Sciences; University of Surrey; Guildford Surrey GU2 7XH UK
| | - F. I. Aigbirhio
- Department of Chemistry, Faculty of Engineering and Physical Sciences; University of Surrey; Guildford Surrey GU2 7XH UK
| | - P. Allen
- Department of Chemistry, Faculty of Engineering and Physical Sciences; University of Surrey; Guildford Surrey GU2 7XH UK
| | - R. Arent
- Department of Chemistry, Faculty of Engineering and Physical Sciences; University of Surrey; Guildford Surrey GU2 7XH UK
| | - R. L. Arrowsmith
- Department of Chemistry, Faculty of Engineering and Physical Sciences; University of Surrey; Guildford Surrey GU2 7XH UK
| | - G. Banci
- Department of Chemistry, Faculty of Engineering and Physical Sciences; University of Surrey; Guildford Surrey GU2 7XH UK
| | - M. C. Bagley
- Department of Chemistry, Faculty of Engineering and Physical Sciences; University of Surrey; Guildford Surrey GU2 7XH UK
| | - C. D. Bailey
- Department of Chemistry, Faculty of Engineering and Physical Sciences; University of Surrey; Guildford Surrey GU2 7XH UK
| | - T. Blake
- Department of Chemistry, Faculty of Engineering and Physical Sciences; University of Surrey; Guildford Surrey GU2 7XH UK
| | - A. J. Bunt
- Department of Chemistry, Faculty of Engineering and Physical Sciences; University of Surrey; Guildford Surrey GU2 7XH UK
| | - N. Bushby
- Department of Chemistry, Faculty of Engineering and Physical Sciences; University of Surrey; Guildford Surrey GU2 7XH UK
| | - L. Carroll
- Department of Chemistry, Faculty of Engineering and Physical Sciences; University of Surrey; Guildford Surrey GU2 7XH UK
| | - B. D. Cons
- Department of Chemistry, Faculty of Engineering and Physical Sciences; University of Surrey; Guildford Surrey GU2 7XH UK
| | - F. Cortezon
- Department of Chemistry, Faculty of Engineering and Physical Sciences; University of Surrey; Guildford Surrey GU2 7XH UK
| | - J. R. Dilworth
- Department of Chemistry, Faculty of Engineering and Physical Sciences; University of Surrey; Guildford Surrey GU2 7XH UK
| | - P. N. Dorff
- Department of Chemistry, Faculty of Engineering and Physical Sciences; University of Surrey; Guildford Surrey GU2 7XH UK
| | - I. M. Eggleston
- Department of Chemistry, Faculty of Engineering and Physical Sciences; University of Surrey; Guildford Surrey GU2 7XH UK
| | - G. Ellames
- Department of Chemistry, Faculty of Engineering and Physical Sciences; University of Surrey; Guildford Surrey GU2 7XH UK
| | - C. S. Elmore
- Department of Chemistry, Faculty of Engineering and Physical Sciences; University of Surrey; Guildford Surrey GU2 7XH UK
| | - G. Ernst
- Department of Chemistry, Faculty of Engineering and Physical Sciences; University of Surrey; Guildford Surrey GU2 7XH UK
| | - P. Estrela
- Department of Chemistry, Faculty of Engineering and Physical Sciences; University of Surrey; Guildford Surrey GU2 7XH UK
| | - J. Faithfull
- Department of Chemistry, Faculty of Engineering and Physical Sciences; University of Surrey; Guildford Surrey GU2 7XH UK
| | - H. Ge
- Department of Chemistry, Faculty of Engineering and Physical Sciences; University of Surrey; Guildford Surrey GU2 7XH UK
| | - N. J. Geach
- Department of Chemistry, Faculty of Engineering and Physical Sciences; University of Surrey; Guildford Surrey GU2 7XH UK
| | - J. Hall
- Department of Chemistry, Faculty of Engineering and Physical Sciences; University of Surrey; Guildford Surrey GU2 7XH UK
| | - J. Harding
- Department of Chemistry, Faculty of Engineering and Physical Sciences; University of Surrey; Guildford Surrey GU2 7XH UK
| | - L. M. Harwood
- Department of Chemistry, Faculty of Engineering and Physical Sciences; University of Surrey; Guildford Surrey GU2 7XH UK
| | - M. J. Hickey
- Department of Chemistry, Faculty of Engineering and Physical Sciences; University of Surrey; Guildford Surrey GU2 7XH UK
| | - J. R. Heys
- Department of Chemistry, Faculty of Engineering and Physical Sciences; University of Surrey; Guildford Surrey GU2 7XH UK
| | - C. Hogg
- Department of Chemistry, Faculty of Engineering and Physical Sciences; University of Surrey; Guildford Surrey GU2 7XH UK
| | - M. J. Hudson
- Department of Chemistry, Faculty of Engineering and Physical Sciences; University of Surrey; Guildford Surrey GU2 7XH UK
| | - T. James
- Department of Chemistry, Faculty of Engineering and Physical Sciences; University of Surrey; Guildford Surrey GU2 7XH UK
| | - W. J. Kerr
- Department of Chemistry, Faculty of Engineering and Physical Sciences; University of Surrey; Guildford Surrey GU2 7XH UK
| | - D. Killick
- Department of Chemistry, Faculty of Engineering and Physical Sciences; University of Surrey; Guildford Surrey GU2 7XH UK
| | - L. P. Kingston
- Department of Chemistry, Faculty of Engineering and Physical Sciences; University of Surrey; Guildford Surrey GU2 7XH UK
| | - G. Kociok-Köhn
- Department of Chemistry, Faculty of Engineering and Physical Sciences; University of Surrey; Guildford Surrey GU2 7XH UK
| | - S. Landvatter
- Department of Chemistry, Faculty of Engineering and Physical Sciences; University of Surrey; Guildford Surrey GU2 7XH UK
| | - F. Lewis
- Department of Chemistry, Faculty of Engineering and Physical Sciences; University of Surrey; Guildford Surrey GU2 7XH UK
| | - W. J. S. Lockley
- Department of Chemistry, Faculty of Engineering and Physical Sciences; University of Surrey; Guildford Surrey GU2 7XH UK
| | - F. Marken
- Department of Chemistry, Faculty of Engineering and Physical Sciences; University of Surrey; Guildford Surrey GU2 7XH UK
| | - R. J. Mudd
- Department of Chemistry, Faculty of Engineering and Physical Sciences; University of Surrey; Guildford Surrey GU2 7XH UK
| | - S. I. Pascu
- Department of Chemistry, Faculty of Engineering and Physical Sciences; University of Surrey; Guildford Surrey GU2 7XH UK
| | - T. Pheko
- Department of Chemistry, Faculty of Engineering and Physical Sciences; University of Surrey; Guildford Surrey GU2 7XH UK
| | - M. E. Powell
- Department of Chemistry, Faculty of Engineering and Physical Sciences; University of Surrey; Guildford Surrey GU2 7XH UK
| | - M Reid
- Department of Chemistry, Faculty of Engineering and Physical Sciences; University of Surrey; Guildford Surrey GU2 7XH UK
| | - P. J. Riss
- Department of Chemistry, Faculty of Engineering and Physical Sciences; University of Surrey; Guildford Surrey GU2 7XH UK
| | - T. Ruhl
- Department of Chemistry, Faculty of Engineering and Physical Sciences; University of Surrey; Guildford Surrey GU2 7XH UK
| | - D. C. Rustidge
- Department of Chemistry, Faculty of Engineering and Physical Sciences; University of Surrey; Guildford Surrey GU2 7XH UK
| | - D. J. Schenk
- Department of Chemistry, Faculty of Engineering and Physical Sciences; University of Surrey; Guildford Surrey GU2 7XH UK
| | - C. Schofield
- Department of Chemistry, Faculty of Engineering and Physical Sciences; University of Surrey; Guildford Surrey GU2 7XH UK
| | - L. Schweiger
- Department of Chemistry, Faculty of Engineering and Physical Sciences; University of Surrey; Guildford Surrey GU2 7XH UK
| | - P. Sharma
- Department of Chemistry, Faculty of Engineering and Physical Sciences; University of Surrey; Guildford Surrey GU2 7XH UK
| | - D. Smith
- Department of Chemistry, Faculty of Engineering and Physical Sciences; University of Surrey; Guildford Surrey GU2 7XH UK
| | - C. T. T. Tuttle
- Department of Chemistry, Faculty of Engineering and Physical Sciences; University of Surrey; Guildford Surrey GU2 7XH UK
| | - A. Testa
- Department of Chemistry, Faculty of Engineering and Physical Sciences; University of Surrey; Guildford Surrey GU2 7XH UK
| | - J. A. Tyson
- Department of Chemistry, Faculty of Engineering and Physical Sciences; University of Surrey; Guildford Surrey GU2 7XH UK
| | - R. M. Tyrrell
- Department of Chemistry, Faculty of Engineering and Physical Sciences; University of Surrey; Guildford Surrey GU2 7XH UK
| | - R. Urbanek
- Department of Chemistry, Faculty of Engineering and Physical Sciences; University of Surrey; Guildford Surrey GU2 7XH UK
| | - D. J. Wilkinson
- Department of Chemistry, Faculty of Engineering and Physical Sciences; University of Surrey; Guildford Surrey GU2 7XH UK
| | - C. L. Willis
- Department of Chemistry, Faculty of Engineering and Physical Sciences; University of Surrey; Guildford Surrey GU2 7XH UK
| | - M. Zanda
- Department of Chemistry, Faculty of Engineering and Physical Sciences; University of Surrey; Guildford Surrey GU2 7XH UK
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Skov LR, Lourenço S, Hansen GL, Mikkelsen BE, Schofield C. Choice architecture as a means to change eating behaviour in self-service settings: a systematic review. Obes Rev 2013; 14:187-96. [PMID: 23164089 DOI: 10.1111/j.1467-789x.2012.01054.x] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [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] [Received: 07/20/2012] [Revised: 09/14/2012] [Accepted: 09/14/2012] [Indexed: 11/27/2022]
Abstract
The primary objective of this review was to investigate the current evidence base for the use of choice architecture as a means to change eating behaviour in self-service eating settings, hence potentially reduce calorie intake. Twelve databases were searched systematically for experimental studies with predefined choice architecture interventions in the period of June 2011-March 2012. The 12 included studies were grouped according to type of interventions and underwent a narrative synthesis. The evidence indicates that (i) health labelling at point of purchase is associated with healthier food choice, while (ii) manipulating the plate and cutlery size has an inconclusive effect on consumption volume. Finally, (iii) assortment manipulation and (iv) payment option manipulation was associated with healthier food choices. The majority of studies were of very weak quality and future research should emphasize a real-life setting and compare their results with the effect of other more well-established interventions on food behaviour in self-service eating settings.
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Affiliation(s)
- L R Skov
- MENU Research Group, Aalborg University, Copenhagen, Denmark.
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18
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Tan SC, Yeoh KK, Carr CA, Heather LC, Ambrose L, Tan JJ, Schofield C, Clarke K. 37 Use of prolyl hydroxylase inhibitors to induce HIF-related metabolic changes and increase c-Kit expression in cardiosphere-derived cells. Heart 2011. [DOI: 10.1136/heartjnl-2011-300920b.37] [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] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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19
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Plesa Skwerer D, Borum L, Verbalis A, Schofield C, Crawford N, Ciciolla L, Tager-Flusberg H. Autonomic responses to dynamic displays of facial expressions in adolescents and adults with Williams syndrome. Soc Cogn Affect Neurosci 2008; 4:93-100. [PMID: 19047076 DOI: 10.1093/scan/nsn041] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [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
The behavioral phenotype characteristic of Williams syndrome (WS) is marked by strong interest in social interaction, manifested in attention to human faces, empathy, approach behavior and social disinhibition, often coexisting with generalized anxiety. Despite their heightened social interest, people with WS show deficits in explicit emotion recognition tasks similar to those of people with other developmental disabilities. In the current study we explored whether individuals with WS show distinctive autonomic responsiveness to social-emotional information, using skin conductance response and heart rate measures. Autonomic activation was investigated in response to facial expressions of emotion in adolescents and adults with WS, compared to age-matched normal controls and to age-, IQ- and language-matched individuals with learning or intellectual disabilities (LID). Overall participants with WS were less electrodermally responsive to dynamically presented face stimuli than the age- and IQ-matched LID group, and showed more heart rate deceleration when viewing emotional faces than the controls. These findings, indicating hypoarousal but increased interest in response to the dynamic presentation of facial emotions in WS, are consistent with the behavioral profile of high approachability toward social stimuli in this population.
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Affiliation(s)
- D Plesa Skwerer
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA 02118-2526, USA.
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20
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Abstract
The Mental Capacity Act 2005 was partially implemented in April 2007. Doctors should be aware of the Act and what implications it has on their clinical practice. This survey looked at the knowledge of physicians and psychiatrists regarding assessing capacity within the Act by means of a questionnaire. The results showed that 100% of physicians and 70% of the psychiatrists answered questions wrongly in the questionnaire. Also, 97% of physicians and 70% of psychiatrists did not have some aspects of knowledge about capacity. Statistically significant differences in responses between physicians and psychiatrists were in relation to their knowledge of the existence and implementation of the Act. Answers were related to active schizophrenia, weighing up pros and cons, and recent assessment of incapability in relation to being by definition incapable. This study shows that psychiatrists do slightly better in answering questions about the Mental Capacity Act 2005 and about capacity when compared with physicians, however both groups could improve their knowledge. With the full implementation of the Act in October 2007, this study shows the urgency and importance of training in the area of capacity for all doctors.
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21
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Abstract
From April 2007 there will be two acts of parliament that govern the legal detention of patients in hospitahl: the Mental Health Act 1983 and the Mental Capacity Act 2005. This article addresses common questions posed to liaison psychiatrists by hospital doctors: how to legally detain patients on general wards and how these Acts are applied.
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22
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Schofield C. Structures and mechanisms of human oxygenases. Acta Crystallogr A 2006. [DOI: 10.1107/s0108767306099375] [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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23
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Lines J, Harpham T, Leake C, Schofield C. Trends, priorities and policy directions in the control of vector-borne diseases in urban environments. Health Policy Plan 2005; 9:113-29. [PMID: 15726774 DOI: 10.1093/heapol/9.2.113] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [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: 11/14/2022] Open
Abstract
The habitats available in urban environments tend to be rather lacking in diversity compared to those in the countryside, and relatively few species are able to exploit them. Those that can, however, often find themselves relatively well provided with food and places to live, and relatively free of competitors and predators. This applies not only to such well-known species as the house-sparrow, but also to most of the important mosquito vectors of human disease in urban areas. Human city dwellers thus tend to be exposed to a different spectrum of disease than their rural counterparts. This review describes how the physical and social changes associated with urbanization have altered the transmission of vector-borne disease. It concentrates on the important mosquito-borne infections: malaria, dengue and filariasis. Dengue virus vectors breed in relatively clean water in man-made containers, while urban filariasis vectors breed in highly polluted water, and these mosquitoes have now been spread by man's activities to almost every tropical city. With important exceptions, anopheline malaria vectors have not generally succeeded in adapting to urban life, but malaria can still be a problem where there are rural pockets in the middle of town. Each of these problems requires control using different technologies and timing. The following policy implications are stressed. The areas of responsibility between different sectors of the local services (health, water supply, sanitation), and between these and the public, need to be clearly defined. Due to the biological complexities of vector-borne disease, decentralized primary health care systems are generally incapable of ensuring that control efforts are adequately targeted in time and space. Community support is essential but specialized technical skills are also required.
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Affiliation(s)
- J Lines
- Dept of Medical Parasitology, LSHTM, UK
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24
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Dias J, Schofield C. The evolution of Chagas disease (American trypanosomiasis) control after 90 years since Carlos Chagas discovery. Mem Inst Oswaldo Cruz 2000; 94 Suppl 1:103-21. [PMID: 10677697 DOI: 10.1590/s0074-02761999000700011] [Citation(s) in RCA: 107] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- J Dias
- Centro de Pesquisas René Rachou, Fiocruz, Belo Horizonte, MG, 30190-002, Brazil.
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25
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Monteiro FA, Pérez R, Panzera F, Dujardin JP, Galvão C, Rocha D, Noireau F, Schofield C, Beard CB. Mitochondrial DNA variation of Triatoma infestans populations and its implication on the specific status of T. melanosoma. Mem Inst Oswaldo Cruz 2000; 94 Suppl 1:229-38. [PMID: 10677723 DOI: 10.1590/s0074-02761999000700037] [Citation(s) in RCA: 88] [Impact Index Per Article: 3.7] [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: 11/22/2022] Open
Abstract
DNA sequence comparison of 412 base-pairs fragments of the mitochondrial cytochrome B gene was used to infer the genetic structure of nine geographical Triatoma infestans populations and their phylogenetic relationship with T. melanosoma and T. brasiliensis. T. infestans and T. melanosoma were compared by morphometry, allozyme and cytogenetic analyses, as well as subjected to reciprocal crosses, in order to clarify the taxonomic status of the latter. No differences were found to distinguish the two species and the crosses between them yielded progeny. T. infestans populations presented four haplotypes that could be separated in two clusters: one formed by the samples from Bolivia (Andes and Chaco) and the other formed by samples from Argentina and Brazil. Silvatic and domestic T. infestans populations from Bolivia (Andes) were genetically identical.
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Affiliation(s)
- F A Monteiro
- Centers for Disease Control and Prevention, Atlanta, GA, USA.
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Abstract
Trypanosoma cruzi and the majority of its insect vectors (Hemiptera, Reduviidae, Triatominae) are confined to the Americas. But while recent molecular studies indicate a relatively ancient origin for the parasite ( approximately 65 million years ago) there is increasing evidence that the blood-sucking triatomine vectors have evolved comparatively recently (<5 mya). This review examines the evidence for these ideas, and attempts to reconcile the apparent paradox by suggesting that marsupial opossums (Didelphidae) may have played a role, not just as original reservoir hosts, but also as original vectors of the parasite.
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Affiliation(s)
- C Schofield
- London School of Hygiene and Tropical Medicine, UK.
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27
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Mordenti J, Thomsen K, Licko V, Berleau L, Kahn JW, Cuthbertson RA, Duenas ET, Ryan AM, Schofield C, Berger TW, Meng YG, Cleland J. Intraocular pharmacokinetics and safety of a humanized monoclonal antibody in rabbits after intravitreal administration of a solution or a PLGA microsphere formulation. Toxicol Sci 1999; 52:101-6. [PMID: 10568703 DOI: 10.1093/toxsci/52.1.101] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Poly(lactic-co-glycolic) acid (PLGA) bioresorbable microspheres are used for controlled-release drug delivery and are particularly promising for ocular indications. The objective of the current study was to evaluate the pharmacokinetics and safety of a recombinant human monoclonal antibody (rhuMAb HER2) in rabbits after bolus intravitreal administration of a solution or a PLGA-microsphere formulation. On Day 0, forty-eight male New Zealand white rabbits (2.3-2.6 kg) were immobilized with intramuscular ketamine/xylazine, and the test materials were injected directly into the vitreous compartment. Group 1 animals received rhuMAb HER2 in 50:50 lactide: glycolide PLGA microspheres; Group 2 animals received rhuMAb HER2 in solution (n = 24/group). The dose for each eye was 25 microg (50 microl). After dosing, animals were sacrificed at 2 min, and on 1, 2, 4, 7, 14, 23, 29, 37, 44, 50, and 56 days (n = 2/timepoint/group). Safety assessment included direct ophthalmoscopy, clinical observations, body weight, and hematology and clinical chemistry panels. At necropsy, vitreous and plasma were collected for pharmacokinetics and analysis for antibodies to rhuMAb HER2, and the vitreal pellet (Group 1) was prepared for histologic evaluation. All animals completed the study per protocol-both treatments were well tolerated, and no suppurative or mixed inflammatory cell reaction was observed in the vitreal samples (Group 1) at any of the time points examined. Antibodies to rhuMAb HER2 were detected in plasma samples by Day 7 in both treatment groups, but infrequently in vitreous samples. There were no safety implications associated with this immune response. The in vitro characterization of the PLGA microspheres provided reasonable projections of the in vivo rhuMAb HER2 release kinetics (Group 1). The total amount of antibody that was released was similar in vitro (25.9%) and in vivo (32.4%). RhuMAb HER2 (Group 2) was cleared slowly from the vitreous compartment, with initial and terminal half-lives of 0.9 and 5.6 days, respectively. The volume of distribution approximated the vitreous volume in a rabbit eye.
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Affiliation(s)
- J Mordenti
- Department of Experimental Therapeutics, Genentech, Inc., South San Francisco, California 94080, USA.
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28
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Dujardin J, Steinden M, Chavez T, Machane M, Schofield C. Changes in the sexual dimorphism of triatominae in the transition from natural to artificial habitats. Mem Inst Oswaldo Cruz 1999; 94:565-9. [PMID: 10446020 DOI: 10.1590/s0074-02761999000400024] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.2] [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: 11/22/2022] Open
Abstract
A shift from large to small average sizes was observed in Triatoma infestans and Rhodnius domesticus between field and domestic (or laboratory) conditions of life. It was more pronounced in the female specimens, leading to a subsequent reduction of sexual size dimorphism. This feature is discussed in terms of genetic and populational changes occurring from natural to artificial habitats, in particular those related to population densities. Sexual size dimorphism is then recommended as a new character to be used in the study of species of Triatominae adapting to domestic ecotopes.
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Schofield C, Ashworth A. Severe malnutrition in children: high case-fatality rates can be reduced. Afr Health 1997; 19:17-8. [PMID: 12321237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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Rees DC, Rochette J, Schofield C, Green B, Morris M, Parker NE, Sasaki H, Tanaka A, Ohba Y, Clegg JB. A novel silent posttranslational mechanism converts methionine to aspartate in hemoglobin Bristol (beta 67[E11] Val-Met->Asp). Blood 1996; 88:341-8. [PMID: 8704193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
The first reported case of congenital Heinz body hemolytic anemia was subsequently shown to be caused by an unstable hemoglobin, Hb Bristol [beta 67(E11) Val-Asp]. This has become one of the classic models of an unstable hemoglobin, the hydrophilic aspartate disrupting the hydrophobic heme pocket. We have restudied this original case, who remains clinically well after nearly 50 years of severe hemolysis with a hemoglobin level of about 7 g/dL and two unrelated Japanese cases. Surprisingly, all three cases show the same DNA changes, predicting a valine to methionine change at beta 67, rather than the expected aspartate. Further analysis with electrospray ionization mass spectrometry and globin chain biosynthesis strongly suggests that this anomaly is because of a novel posttranslational mechanism, with slow conversion of the translated methionine into an aspartate residue. The proximity of the heme and oxygen may be important in facilitating the reaction. These findings show the importance of complete characterization of variant hemoglobins using protein, DNA, and biosynthetic analyses.
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Affiliation(s)
- D C Rees
- MRC Molecular Haematology Unit, John Radcliffe Hospital, Headington, Oxford, UK
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Affiliation(s)
- J P Dujardin
- UMR CNRS-ORSTOM 9926, 'Génétique Moléculaire des Parasites et des Vecteurs', ORSTOM, Montpellier, France
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Ashworth A, Jackson A, Khanum S, Schofield C. Ten steps to recovery. Child Health Dialogue 1996:10-2. [PMID: 12292167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
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Schofield C, Ashworth A. Why have mortality rates for severe malnutrition remained so high? Bull World Health Organ 1996; 74:223-9. [PMID: 8706239 PMCID: PMC2486901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
A review of the literature that has appeared over the past five decades indicates that the median case fatality from severe malnutrition has remained unchanged over this period and is typically 20-30%, with the highest levels (50-60%) being among those with oedematous malnutrition. A likely cause of this continuing high mortality is faulty case-management. A survey of treatment centres worldwide (n = 79) showed that for acutely ill children, inappropriate diets that are high in protein, energy and sodium and low in micronutrients are commonplace. Practices that could have fatal consequences, such as prescribing diuretics for oedema, were found to be widespread. Evidence of outmoded and conflicting teaching manuals also emerged. Since low mortality levels from malnutrition can be achieved using appropriate treatment regimens, updated treatment guidelines, which are practical and prescriptive rather than descriptive, need to be implemented as part of a comprehensive training programme.
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Affiliation(s)
- C Schofield
- Centre for Human Nutrition, London School of Hygiene and Tropical Medicine, England
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Nasserzadeh V, Swithenbank J, Schofield C, Scott DW, Loader A. Effects of high speed jets and internal baffles on the gas residence times in large municipal incinerators. ACTA ACUST UNITED AC 1994. [DOI: 10.1002/ep.670130216] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Schofield C, Stewart J, Wheeler E. The diets of pregnant and post-pregnant women in different social groups in London and Edinburgh: calcium, iron, retinol, ascorbic acid and folic acid. Br J Nutr 1989; 62:363-77. [PMID: 2819020 DOI: 10.1079/bjn19890037] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [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: 01/02/2023]
Abstract
Dietary records were obtained twice in pregnancy and once post-partum, from 265 women in all social classes in London and Edinburgh. Some Edinburgh women, and lactating women, showed the higher levels of calcium intake. For iron, retinol, ascorbic acid and folic acid, there was a consistent and significant regional and social class gradient in intakes. This favoured English women in 'non-manual' social groups, leaving the Scottish 'manual' class, after pregnancy, with the lowest intakes. Mean intakes of Ca and Fe were consistently below the current UK recommended daily amount (RDA). Intakes of retinol were all above it, and ascorbic acid intakes ranged above and below the RDA.
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Affiliation(s)
- C Schofield
- Department of Human Nutrition, London School of Hygiene and Tropical Medicine
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Schofield C, Wheeler E, Stewart J. The diets of pregnant and post-pregnant women in different social groups in London and Edinburgh: energy, protein, fat and fibre. Br J Nutr 1987; 58:369-81. [PMID: 2825764 DOI: 10.1079/bjn19870106] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.6] [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: 01/02/2023]
Abstract
1. Dietary records were obtained twice in pregnancy and once post-partum from 265 women from all social classes in London and Edinburgh. 2. The London women always had higher mean energy, protein, fat and fibre intakes. Significant between-region differences emerged. 3. Some between-social classes differences occurred, but were not consistently significant. 4. All mean energy and fibre intakes were lower, and protein and fat intakes were higher, than current recommendations. 5. Of lactating women 15% claimed to be dieting. 6. The percentage dietary energy derived from fat varied from 36 (in a dieting group) to 42.
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Affiliation(s)
- C Schofield
- Department of Human Nutrition, London School of Hygiene and Tropical Medicine
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