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Donohoe E, Courtney R, McManus E, Cheng J, Barry T. The impact of COVID-19 on Oral and Maxillofacial Surgery patient presentations to the emergency department: A West of Ireland experience. Advances in Oral and Maxillofacial Surgery 2021. [PMCID: PMC7931733 DOI: 10.1016/j.adoms.2021.100061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Following the outbreak of COVID-19 and subsequent restrictions in the Republic of Ireland, the number of Emergency Department attendances have reduced nationally. Concurrently, it would be expected that there would be a reduction in the number of patients attending the emergency department with specific oral and maxillofacial concerns. A retrospective analysis of Oral and Maxillofacial patients attending the Emergency Department in University Hospital Galway during the first three-month period of COVID-19 lockdown in 2020 was compared to patients presenting to the Emergency Department during the equivalent period in the preceding year. The analysis confirmed a 46% reduction in attendances during the COVID-19 lockdown period. There was also a significant decrease in the number of young patients attending due to maxillofacial trauma. Contributing factors to this reduction may include working from home, reducing face-to-face social activities and the closure of social settings. It must be noted that there was a two-fold increase in the number of patients attending with dental pain during the lockdown period in comparison to the preceding year. Similarly, there was a proportional increase in the number of those attending due to infection and requiring subsequent admission during the COVID-19 lockdown period. Patient anxiety related to contracting the virus may have contributed to patients presenting with infection during the COVID-19 lockdown period.
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Chatzi G, Mason T, Chandola T, Whittaker W, Howarth E, Cotterill S, Ravindrarajah R, McManus E, Sutton M, Bower P. Sociodemographic disparities in non-diabetic hyperglycaemia and the transition to type 2 diabetes: evidence from the English Longitudinal Study of Ageing. Diabet Med 2020; 37:1536-1544. [PMID: 32531074 DOI: 10.1111/dme.14343] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/05/2020] [Indexed: 01/05/2023]
Abstract
AIM To explore whether there are social inequalities in non-diabetic hyperglycaemia (NDH) and in transitions to type 2 diabetes mellitus and NDH low-risk status in England. METHODS Some 9143 men and women aged over 50 years were analysed from waves 2, 4, 6 and 8 (2004-2016) of the English Longitudinal Study of Ageing (ELSA). Participants were categorized as: NDH 'low-risk' [HbA1c < 42 mmol/mol (< 6.0%)], NDH [HbA1c 42-47 mmol/mol (6.0-6.4%)] and type 2 diabetes [HbA1c > 47 mmol/mol (> 6.4%)]. Logistic regression models estimated the association between sociodemographic characteristics and NDH, and the transitions from NDH to diagnosed or undiagnosed type 2 diabetes and low-risk status in future waves. RESULTS NDH was more prevalent in older participants, those reporting a disability, those living in deprived areas and in more disadvantaged social classes. Older participants with NDH were less likely to progress to undiagnosed type 2 diabetes [odds ratio (OR) 0.27, 95% confidence interval (CI) 0.08, 0.96]. NDH individuals with limiting long-standing illness (OR 1.72, 95% CI 1.16, 2.53), who were economically inactive (OR 1.60, 95% CI 1.02, 2.51) or from disadvantaged social classes (OR 1.63, 95% CI 1.02, 2.61) were more likely to progress to type 2 diabetes. Socially disadvantaged individuals were less likely (OR 0.64, 95% CI 0.41, 0.98) to progress to NDH low-risk status. CONCLUSIONS There were socio-economic differences in NDH prevalence, transition to type 2 diabetes and transition to NDH low-risk status. Disparities in transitions included the greater likelihood of disadvantaged social groups with NDH developing type 2 diabetes and greater likelihood of advantaged social groups with NDH becoming low-risk. These socio-economic differences should be taken into account when targeting prevention initiatives.
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Affiliation(s)
- G Chatzi
- Manchester Centre for Health Economics, University of , Manchester, UK
| | - T Mason
- Manchester Centre for Health Economics, University of , Manchester, UK
| | - T Chandola
- Cathie Marsh Institute for Social Research, University of Manchester, Manchester, UK
| | - W Whittaker
- Manchester Centre for Health Economics, University of , Manchester, UK
| | - E Howarth
- Manchester Centre for Health Economics, University of , Manchester, UK
| | - S Cotterill
- Centre for Biostatistics, University of Manchester, Manchester, UK
| | - R Ravindrarajah
- Centre for Primary Care and Health Services Research, University of Manchester, Manchester, UK
| | - E McManus
- Centre for Primary Care and Health Services Research, University of Manchester, Manchester, UK
| | - M Sutton
- Centre for Primary Care and Health Services Research, University of Manchester, Manchester, UK
| | - P Bower
- Centre for Primary Care and Health Services Research, University of Manchester, Manchester, UK
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Sach T, McManus E, Levell N. Economic evidence for the prevention and treatment of atopic eczema. Br J Dermatol 2019. [DOI: 10.1111/bjd.18391] [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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Sach T, McManus E, Levell N. 特应性湿疹预防和治疗的经济学证据. Br J Dermatol 2019. [DOI: 10.1111/bjd.18402] [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: 11/27/2022]
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McManus E, Sach TH, Levell NJ. An introduction to the methods of decision-analytic modelling used in economic evaluations for Dermatologists. J Eur Acad Dermatol Venereol 2019; 33:1829-1836. [PMID: 31127965 DOI: 10.1111/jdv.15713] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 05/17/2019] [Indexed: 01/06/2023]
Abstract
Economic evaluations are used to identify which health treatments or preventions offer the most effective use of resources, or value for money. This is achieved by identifying, measuring and valuing the inputs and outcomes of alternative interventions. These evaluations are often conducted alongside clinical trials; however, these trials may end before the outcomes of economic interest have been observed and measured. An alternative to within trial economic evaluation is to use decision modelling, which can model the cost-effectiveness of interventions over an extended time period. This paper aims to provide an overview for clinicians of the different modelling techniques used within health economic evaluations and to introduce methods for critical appraisal. The most common modelling approaches, and their associated strengths and weaknesses, were discussed. Alongside this, practical examples specific to dermatology were given. These examples include studies where the model chosen or the methods used may not have been the most appropriate. Methods for critical appraisal were also highlighted. Common modelling approaches include Decision Trees, Markov Cohort, extensions to the Markov model (Monte Carlo Simulation) and Discrete Event Simulation models. Items of the Philips Checklist were discussed in the context of performing critical appraisal. Health economic decision models are multi-faceted and can often be complex. Full critical appraisal requires clinicians' unique knowledge, which is complementary to the knowledge of health economists.
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Affiliation(s)
- E McManus
- Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, UK
| | - T H Sach
- Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, UK
| | - N J Levell
- Dermatology Department, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
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Sach TH, McManus E, Levell NJ. Understanding economic evidence for the prevention and treatment of atopic eczema. Br J Dermatol 2019; 181:707-716. [PMID: 30693473 PMCID: PMC6790711 DOI: 10.1111/bjd.17696] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2019] [Indexed: 12/25/2022]
Abstract
Background Atopic eczema is an inflammatory skin condition, with a similar impact on health‐related quality of life as other chronic diseases. Increasing pressures on resources within the National Health Service increase the importance of having good economic evidence to inform their allocation. Objectives To educate dermatologists about economic methods with reference to currently available economic evidence on eczema. Methods The role of different types of economic evidence is illustrated by evidence found in a systematic literature search conducted across 12 online databases up to 22 May 2017. Primary empirical studies either reporting the results of a cost‐of‐illness study or evaluating the cost, utility or full economic evaluation of interventions for preventing or treating eczema were included. Two reviewers independently assessed studies for eligibility and performed data abstraction, with disagreements resolved by a third reviewer. Evidence tables of results were produced for narrative discussion. The reporting quality of economic evaluations was assessed. Results Seventy‐eight studies (described in 80 papers) were deemed eligible. Thirty‐three (42%) were judged to be economic evaluations, 12 (15%) cost analyses, six (8%) utility analyses, 26 (33%) cost‐of‐illness studies and one a feasibility study (1%). The calcineurin inhibitors tacrolimus and pimecrolimus, as well as barrier creams, had the most economic evidence available. Partially hydrolysed infant formula was the most commonly evaluated prevention. Conclusions The current level of economic evidence for interventions aimed at preventing and treating eczema is limited compared with that available for clinical outcomes, suggesting that greater collaboration between clinicians and economists might be beneficial. What's already known about this topic? Resources available for health care are limited and their efficient allocation should be informed by robust economic evidence about value for money. The scale and quality of economic evidence available for atopic eczema has not previously been examined.
What does this study add? By comparison with the considerable clinical evidence for interventions to prevent and treat eczema, there is limited economic evidence available. The economic evidence available is limited in scope with regard to the types and range of interventions evaluated. The quality of future economic studies could be improved by greater collaboration between economists and clinicians.
https://doi.org/10.1111/bjd.18391 available online
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Affiliation(s)
- T H Sach
- Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, U.K
| | - E McManus
- Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, U.K
| | - N J Levell
- Dermatology Department, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich, NR4 7UY, U.K
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Affiliation(s)
- E McManus
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, NR4 7TJ, U.K
| | - T Sach
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, NR4 7TJ, U.K
| | - N J Levell
- Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, U.K
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Alessi D, McManus E, Collins B, Mora A. 32 Functional analysis of PDK1 signalling pathway using knockout and knockin approaches; evaluation of PDK1 as a cancer target. EJC Suppl 2004. [DOI: 10.1016/s1359-6349(04)80040-5] [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: 11/27/2022] Open
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Abstract
The use of interferon beta-1a to treat multiple sclerosis in a child of 7 years of age is discussed. To date, there is only one other published report of the use of interferon beta in a child as young as this. One year after commencing treatment she had shown significant clinical improvement, with a marked reduction in number of relapses. In her second year of treatment she suffered a major relapse from which she slowly recovered.
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Cuckler AC, McManus E, Garzillo M, Malanga C, Ott WH, Dickinson AM, Van Iderstine A. ANTIPARASITIC DRUGS. III. THIAMINE-REVERSIBLE COCCIDIOSTATS. J Am Chem Soc 2002. [DOI: 10.1021/ja01496a083] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Heerding DA, Chan G, DeWolf WE, Fosberry AP, Janson CA, Jaworski DD, McManus E, Miller WH, Moore TD, Payne DJ, Qiu X, Rittenhouse SF, Slater-Radosti C, Smith W, Takata DT, Vaidya KS, Yuan CC, Huffman WF. 1,4-Disubstituted imidazoles are potential antibacterial agents functioning as inhibitors of enoyl acyl carrier protein reductase (FabI). Bioorg Med Chem Lett 2001; 11:2061-5. [PMID: 11514139 DOI: 10.1016/s0960-894x(01)00404-8] [Citation(s) in RCA: 108] [Impact Index Per Article: 4.7] [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: 11/30/2022]
Abstract
1,4-Disubstituted imidazole inhibitors of Staphylococcus aureus and Escherichia coli enoyl acyl carrier protein reductase (FabI) have been identified. Crystal structure data shows the inhibitor 1 bound in the enzyme active site of E. coli FabI.
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Affiliation(s)
- D A Heerding
- GlaxoSmithKline Pharmaceuticals, Antibacterials and Host Defense, 1250 S. Collegeville Road, Collegeville, PA 19426, USA.
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Wilson J, Woods I, Fawcett J, Whall R, Dibb W, Morris C, McManus E. Reducing the risk of major elective surgery: randomised controlled trial of preoperative optimisation of oxygen delivery. BMJ 1999; 318:1099-103. [PMID: 10213716 PMCID: PMC27840 DOI: 10.1136/bmj.318.7191.1099] [Citation(s) in RCA: 415] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/18/1999] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To determine whether preoperative optimisation of oxygen delivery improves outcome after major elective surgery, and to determine whether the inotropes, adrenaline and dopexamine, used to enhance oxygen delivery influence outcome. DESIGN Randomised controlled trial with double blinding between inotrope groups. SETTING York District Hospital, England. SUBJECTS 138 patients undergoing major elective surgery who were at risk of developing postoperative complications either because of the surgery or the presence of coexistent medical conditions. INTERVENTIONS Patients were randomised into three groups. Two groups received invasive haemodynamic monitoring, fluid, and either adrenaline or dopexamine to increase oxygen delivery. Inotropic support was continued during surgery and for at least 12 hours afterwards. The third group (control) received routine perioperative care. MAIN OUTCOME MEASURES Hospital mortality and morbidity. RESULTS Overall, 3/92 (3%) preoptimised patients died compared with 8/46 controls (17%) (P=0.007). There were no differences in mortality between the treatment groups, but 14/46 (30%) patients in the dopexamine group developed complications compared with 24/46 (52%) patients in the adrenaline group (difference 22%, 95% confidence interval 2% to 41%) and 28 patients (61%) in the control group (31%, 11% to 50%). The use of dopexamine was associated with a decreased length of stay in hospital. CONCLUSION Routine preoperative optimisation of patients undergoing major elective surgery would be a significant and cost effective improvement in perioperative care.
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Affiliation(s)
- J Wilson
- Department of Anaesthetics, York District Hospital, York YO31 8HE.
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Kan VL, Bennett JE, Amantea MA, Smolskis MC, McManus E, Grasela DM, Sherman JW. Comparative safety, tolerance, and pharmacokinetics of amphotericin B lipid complex and amphotericin B desoxycholate in healthy male volunteers. J Infect Dis 1991; 164:418-21. [PMID: 1856491 DOI: 10.1093/infdis/164.2.418] [Citation(s) in RCA: 71] [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: 12/29/2022] Open
Abstract
Amphotericin B lipid complex (ABLC), a lipid complex formulation of amphotericin B, and amphotericin B desoxycholate (AB) were compared for safety, tolerance, and pharmacokinetics in two groups of eight healthy male volunteers. After a 1-mg test dose, study drug was infused at 0.1, 0.25, and 0.5 mg/kg; the 0.5-mg/kg dose was not given to subjects receiving AB. ABLC caused few acute adverse effects except for mild somnolence (drowsiness) in six volunteers. In addition, three of eight ABLC recipient had asymptomatic, transient serum transaminase elevations that resolved spontaneously. The AB recipients experienced more acute side effects, but only one had a mild shaking chill: three of eight also experienced sleepiness. No significant changes in vital signs, electrocardiogram, oximetry, pulmonary function, or clinical status were observed in either group. Due to its increased estimate volume of distribution and estimated clearance. ABLC yielded decreased amphotericin B levels and area under the serum concentration versus time curve relative to AB.
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Affiliation(s)
- V L Kan
- Clinical Mycology Section, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
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Carson C, Johnson RL, Stanford P, Louis-Jacques J, McManus E, Vanhook C. Deep vein thrombosis and pulmonary embolism of unknown etiology in a 16-year-old male. J Adolesc Health Care 1982; 3:51-2. [PMID: 7118687 DOI: 10.1016/s0197-0070(82)80030-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Parsons J, McManus E, Johnson E. THE ALTERATION OF THE VISCOELASTIC MECHANICAL PROPERTIES OF ARTICULAR CARTILAGE WITH JOINT SEPSIS. Bioengineering (Basel) 1981. [DOI: 10.1016/b978-0-08-027207-8.50073-4] [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: 10/26/2022] Open
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