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Smith H, Al-Jawahiri R, Stokes L, Freeth M, Fricke S, Matthews D, McNeill A. Impaired communication ability in SOX11 syndrome. J Intellect Disabil Res 2024; 68:285-292. [PMID: 37916390 DOI: 10.1111/jir.13105] [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: 06/18/2023] [Revised: 09/29/2023] [Accepted: 10/17/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND Speech and language skills are important for social interaction and learning. This study characterised the communication abilities of verbal individuals with SOX11 syndrome using a standardised parent/carer questionnaire, the Children's Communication Checklist (CCC-2). METHOD Thirteen parent/carers of verbal individuals (aged 5-19 years) diagnosed with SOX11 syndrome completed the CCC-2. In order to contextualise findings, responses were compared to norms and to data from Noonan syndrome, a relatively well-known genetic diagnosis associated with communication impairment. RESULTS For all individuals, the CCC-2 composite score indicated significant communication difficulties. Language structure (speech, syntax, semantics and coherence), pragmatic language (inappropriate initiation, stereotyped language use of context and non-verbal communication) and autistic features (social relations and interests) scores were lower than typically developing norms. Subscale comparisons revealed relative difference in use of context compared to other pragmatic domains (stereotyped language and inappropriate initiation). Individual scores showed substantial variation, particularly in regard to language structure profile. Differences were more pronounced than for Noonan syndrome, specifically in domains of speech, syntax, non-verbal communication and social relations. CONCLUSIONS SOX11 syndrome is associated with communication impairment. It is important to assess communication abilities as part of the management of individuals with SOX11 syndrome and understand individual strengths and difficulties in order to provide targeted support.
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Affiliation(s)
- H Smith
- Division of Neuroscience, The University of Sheffield, Sheffield, UK
- Department of Psychology, The University of Sheffield, Sheffield, UK
| | - R Al-Jawahiri
- Division of Neuroscience, The University of Sheffield, Sheffield, UK
| | - L Stokes
- Division of Neuroscience, The University of Sheffield, Sheffield, UK
| | - M Freeth
- Department of Psychology, The University of Sheffield, Sheffield, UK
| | - S Fricke
- Human Communication Sciences, School of Allied Health Professions, Nursing and Midwifery, The University of Sheffield, Sheffield, UK
| | - D Matthews
- Human Communication Sciences, School of Allied Health Professions, Nursing and Midwifery, The University of Sheffield, Sheffield, UK
| | - A McNeill
- Division of Neuroscience, The University of Sheffield, Sheffield, UK
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2
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Smith H, Townsend LT, Mohun R, Mosselmans JFW, Kvashnina K, Hyatt NC, Corkhill CL. Fabrication, defect chemistry and microstructure of Mn-doped UO 2. Sci Rep 2024; 14:1656. [PMID: 38238405 PMCID: PMC10796358 DOI: 10.1038/s41598-023-50676-2] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 12/22/2023] [Indexed: 01/22/2024] Open
Abstract
Mn-doped UO2 is under consideration for use as an accident tolerant nuclear fuel. We detail the synthesis of Mn-doped UO2 prepared via a wet co-precipitation method, which was refined to improve the yield of incorporated Mn. To verify the Mn-doped UO2 defect chemistry, X-ray absorption spectroscopy at the Mn K-edge was performed, in addition to X-ray diffraction, Raman spectroscopy and high-energy resolved fluorescence detection X-ray absorption near edge spectroscopy at the U M4-edge. It was established that Mn2+ directly substitutes for U4+ in the UO2 lattice, accompanied by oxygen vacancy (Ov) charge compensation. In contrast to other divalent-element doped UO2 materials, compelling evidence for U5+ in a charge compensating role was not found. This work furthers understanding of the structure and crystal chemistry of Mn-doped UO2, which could show potential advantages as a novel efficient advanced nuclear fuel.
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Affiliation(s)
- H Smith
- Department of Materials Science and Engineering, The University of Sheffield, Sheffield, UK
| | - L T Townsend
- Department of Materials Science and Engineering, The University of Sheffield, Sheffield, UK
| | - R Mohun
- Department of Materials Science and Engineering, The University of Sheffield, Sheffield, UK
| | - J F W Mosselmans
- Diamond Light Source, Harwell Science and Innovation Campus, Didcot, UK
| | - K Kvashnina
- Institute of Resource Ecology, Helmholtz-Zentrum Dresden-Rossendorf (HZDR), P.O. Box 510119, 01314, Dresden, Germany
- The Rossendorf Beamline at ESRF, The European Synchrotron, CS40220, 38043, Grenoble Cedex 9, France
| | - Neil C Hyatt
- School of Mechanical and Materials Engineering, Washington State University, Pullman, WA, 99164, USA
- School of Earth Science, The University of Bristol, Bristol, UK
| | - C L Corkhill
- Department of Materials Science and Engineering, The University of Sheffield, Sheffield, UK.
- School of Earth Science, The University of Bristol, Bristol, UK.
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3
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Sharifi N, Smith H, Madden D, Kehoe T, Wu G, Yang L, Welbourn RJL, G Fernandez E, Clarke SM. Diamond-Like Carbon: A Surface for Extreme, High-Wear Environments. Langmuir 2024; 40:52-61. [PMID: 38113451 PMCID: PMC10786025 DOI: 10.1021/acs.langmuir.3c01438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 11/14/2023] [Accepted: 12/04/2023] [Indexed: 12/21/2023]
Abstract
In this study, we present an in-depth characterization of a diamond-like carbon (DLC) film, using a range of techniques to understand the structure and chemistry of the film both in the interior and particularly at the DLC/air surface and DLC/liquid interface. The DLC film is found to be a combination of sp2 and sp3 carbon, with significant oxygen present at the surface. The oxygen seems to be present as OH groups, making the DLC somewhat hydrophilic. Quartz-Crystal Microbalance (QCM) isotherms and complementary neutron reflectivity data indicate significant adsorption of a model additive, bis(2-ethylhexyl) sulfosuccinate sodium salt (AOT) surfactant, onto the DLC from water solutions and indicate the adsorbed film is a bilayer. This initial study of the structure and composition of a model surfactant is intended to give a clearer insight into how DLC and additives function as antiwear systems.
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Affiliation(s)
- N. Sharifi
- Institute
for Energy and Environmental Flows and Yusuf Hamied Department of
Chemistry, University of Cambridge, Cambridge CB2 1EW, U.K.
| | - H. Smith
- Institute
for Energy and Environmental Flows and Yusuf Hamied Department of
Chemistry, University of Cambridge, Cambridge CB2 1EW, U.K.
| | - D. Madden
- Institute
for Energy and Environmental Flows and Yusuf Hamied Department of
Chemistry, University of Cambridge, Cambridge CB2 1EW, U.K.
| | - T. Kehoe
- Institute
for Energy and Environmental Flows and Yusuf Hamied Department of
Chemistry, University of Cambridge, Cambridge CB2 1EW, U.K.
| | - G. Wu
- Institute
of Functional Surfaces, School of Mechanical Engineering, University of Leeds, Leeds LS2 9JT, U.K.
| | - L. Yang
- Institute
of Functional Surfaces, School of Mechanical Engineering, University of Leeds, Leeds LS2 9JT, U.K.
| | - R. J. L. Welbourn
- Rutherford
Appleton Laboratory, STFC, Chilton, ISIS
Neutron & Muon Source, Didcot, Oxon OX11 0QX, U.K.
| | - E. G Fernandez
- XMaS/BM28-ESRF, 71 Avenue Des Martyrs, F-38043 Grenoble, Cedex, France
- Department
of Physics, University of Warwick, Gibbet Hill Road, Coventry CV4 7AL, U.K.
| | - S. M. Clarke
- Institute
for Energy and Environmental Flows and Yusuf Hamied Department of
Chemistry, University of Cambridge, Cambridge CB2 1EW, U.K.
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4
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Morgan D, Spiess C, Millington G, Schmidt A, Smith H, Okwuone DDD, Berggren K, Lominska CE, Markiewicz MA, Yelder T, Gao H, Wang J, Gan GN. Investigating the Role of MK2 in Head and Neck Squamous Cell Carcinoma Growth, Metastasis and STING Pathway Activation. Int J Radiat Oncol Biol Phys 2023; 117:S159. [PMID: 37784399 DOI: 10.1016/j.ijrobp.2023.06.587] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Our prior work demonstrated that inhibition of MAPKAPK2 (MK2) can enhance radiation (RT)-mediated in vivo head and neck squamous cell carcinoma (HNSCC) tumor control and survival in preclinical immune incompetent models. The cytosolic DNA sensor cyclic GMP-AMP synthetase (cGAS) and its downstream adaptor protein, stimulator of interferon genes (STING), are conserved proteins within the innate immune signaling pathways and are important for mediating host defense against microbial infection and can play a role in anti-cancer immunity. We hypothesized that loss of MK2 enhances radiation-induced cGAS-STING pathway activation leading to improved tumor control and survival. MATERIALS/METHODS MK2 shRNA knockdown human (Tu167, CAL27) and MK2 Cas9/CRISPR knockout (KO) syngeneic murine (Ly2, MLM3) HNSCC cell lines were treated with 10 Gy irradiation. Micronuclei were quantitated by DAPI-immunofluorescence (IF). Protein changes in cGAS-STING were evaluated by immunoblot. Inflammatory cytokine production including Type I IFNβ1 were evaluated by RT-qPCR. Ly2 and MLM3 cells were orthotopically or flank engrafted into immune competent mice (Balb/c, C57Bl/6, respectively) for animal tumor control-survival studies. Tumor immune cell infiltrate was examined using FACS and immunohistochemistry. Selected drug studies using the MK2 inhibitor, ATI-450, were performed with RT. RESULTS Loss of MK2 in HNSCC (Tu167, CAL27, Ly2, MLM3) treated with RT led to a significant increase in micronuclei formation compared to control cells. MK2-enhanced micronuclei generation following RT could be inhibited with the actin filament polymerization inhibitor, cytochalasin B. RT treatment of MK2 shRNA cells led to increased cGAS and phospho-STING levels compared to either treatment alone. IFNβ1 levels were significantly higher in HNSCC cell lines treated with RT and with MK2 inhibited by an MK2 inhibitor (ATI-450) or genetic reduction compared to either treatment alone. In-vivo implantation of MLM3 cells into C57Bl/6 comparing control vs MK2 KO tumors treated with ±8 Gy RT demonstrated improved mouse survival favoring RT+MK2 KO over RT, MK2 KO or parental (63, 58, 58.5, 35 days, respectively). FACS analysis of MLM3 WT v KO tumors 3 days post RT showed an overall increase in the number of CD3/CD8 T-cells infiltrating into the tumor in all groups except for parental tumors. Further analysis demonstrated that loss of MK2 reversed CD8 T-cell exhaustion and when combined with radiotherapy led to increased CD8 T-cell activation. Furthermore, activated CD4 and CD8 T cells were reduced in WT+RT cells compared to WT tumors whereas no reduction was seen in the KO or KO+RT. CONCLUSION HNSCC tumor MK2 inhibition enhances RT-mediated micronuclei formation and subsequent cGAS-STING-IFNβ1 levels. Loss of HNSCC MK2 leads to increased CD4-CD8 T-cell infiltration into the tumor and this effect is enhanced following RT. Targeting tumor MK2 may facilitate improved tumor control.
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Affiliation(s)
- D Morgan
- Department of Radiation Oncology, University of Kansas Medical Center, Kansas City, KS
| | | | - G Millington
- Department of Radiation Oncology, University of Kansas Medical Center, Kansas City, KS
| | - A Schmidt
- Department of Radiation Oncology, University of Kansas Medical Center, Kansas City, KS
| | - H Smith
- Tulane University, New Orleans, KS
| | | | - K Berggren
- University of New Mexico School of Medicine, Albuquerque, NM
| | - C E Lominska
- Department of Radiation Oncology, University of Kansas School of Medicine, Kansas City, KS
| | - M A Markiewicz
- Department of Microbiology, Molecular Genetics and Immunology, University of Kansas Medical Center, Kansas City, KS
| | - T Yelder
- KUCC Masonic Cancer Alliance, Kansas City, KS
| | - H Gao
- Department of Radiation Oncology, University of Kansas Medical Center, Kansas City, KS
| | - J Wang
- Department of Medicinal Chemistry, The University of Kansas, Kansas City, KS
| | - G N Gan
- Department of Radiation Oncology, University of Kansas School of Medicine, Kansas City, KS
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5
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Dixon A, Steinman HK, Kyrgidis A, Smith H, Sladden M, Zouboulis C, Argenziano G, Apalla Z, Lallas A, Longo C, Nirenberg A, Popescu C, Tzellos T, Cleaver L, Zachary C, Anderson S, Thomas JM. Online prediction tools for melanoma survival: A comparison. J Eur Acad Dermatol Venereol 2023; 37:1999-2003. [PMID: 37210649 DOI: 10.1111/jdv.19219] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 04/26/2023] [Indexed: 05/22/2023]
Abstract
BACKGROUND Breslow thickness, patient age and ulceration are the three most valuable clinical and pathological predictors of melanoma survival. A readily available reliable online tool that accurately considers these and other predictors could be valuable for clinicians managing melanoma patients. OBJECTIVE To compare online melanoma survival prediction tools that request user input on clinical and pathological features. METHODS Search engines were used to identify available predictive nomograms. For each, clinical and pathological predictors were compared. RESULTS Three tools were identified. The American Joint Committee on Cancer tool inappropriately rated thin tumours as higher risk than intermediate tumours. The University of Louisville tool was found to have six shortcomings: a requirement for sentinel node biopsy, unavailable input of thin melanoma or patients over 70 years of age and less reliable hazard ratio calculations for age, ulceration and tumour thickness. The LifeMath.net tool was found to appropriately consider tumour thickness, ulceration, age, sex, site and tumour subtype in predicting survival. LIMITATIONS The authors did not have access to the base data used to compile various prediction tools. CONCLUSION The LifeMath.net prediction tool is the most reliable for clinicians in counselling patients with newly diagnosed primary cutaneous melanoma regarding their survival prospects.
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Affiliation(s)
- A Dixon
- Australasian College of Cutaneous Oncology, Victoria, Melbourne, Australia
| | - H K Steinman
- Campbell University, Buies Creek, North Carolina, USA
| | - A Kyrgidis
- Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - H Smith
- Oxford Dermatology, Western Australia, Perth, Australia
| | - M Sladden
- University of Tasmania, Tasmania, Launceston, Australia
| | - C Zouboulis
- Staedtisches Klinikum Dessau, Brandenburg Medical School, Dessau, Germany
| | - G Argenziano
- Dermatology, University of Campania, Naples, Italy
| | - Z Apalla
- Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - A Lallas
- Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - C Longo
- University of Modena and Reggio Emilia, Modena, Italy
- Azienda Unita Sanitaria Locale, IRCCS di Reggio Emilia, Skin Cancer Center, Regio Emilia, Italy
| | - A Nirenberg
- Australasian College of Cutaneous Oncology, Victoria, Melbourne, Australia
| | - C Popescu
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - T Tzellos
- Arctic University of Norway, Tromsø, Norway
| | - L Cleaver
- AT Still University, Missouri, Kirksville, USA
| | - C Zachary
- University of California Irvine, California, Irvine, USA
| | - S Anderson
- Australasian College of Cutaneous Oncology, Victoria, Melbourne, Australia
| | - J M Thomas
- Formerly of Royal Marsden Hospital, Chelsea, London, UK
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6
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Smith H, Good M, Sunna S, Frenk N. Abstract No. 519 Early Initiation of Tube Feeding after Percutaneous Gastrostomy in Inpatients: A Prospective Pilot Study. J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.377] [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: 02/26/2023] Open
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7
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Dixon AJ, Steinman HK, Kyrgidis A, Smith H, Sladden M, Zouboulis C, Argenziano G, Apalla Z, Lallas A, Longo C, Nirenberg A, Popescu C, Dixon JB, Tzellos T, Zachary C, Cleaver L, Anderson S, Zagarella S, Thomas JM. Improved methodology in determining melanoma mortality and selecting patients for immunotherapy. J Eur Acad Dermatol Venereol 2023. [PMID: 36785984 DOI: 10.1111/jdv.18951] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 02/08/2023] [Indexed: 02/15/2023]
Affiliation(s)
- A J Dixon
- Australasian College of Cutaneous Oncology, Melbourne, Victoria, Australia
| | - H K Steinman
- Campbell University, Buies Creek, North Carolina, USA
| | - A Kyrgidis
- Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - H Smith
- Oxford Dermatology, Perth, Western Australia, Australia
| | - M Sladden
- University of Tasmania, Launceston, Tasmania, Australia
| | - C Zouboulis
- Dessau Medical Center, Brandenburg Medical School, Dessau, Germany
| | | | - Z Apalla
- Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - A Lallas
- Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - C Longo
- University of Modena and Reggio Emilia, Modena, Italy
| | - A Nirenberg
- Australasian College of Cutaneous Oncology, Melbourne, Victoria, Australia
| | - C Popescu
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - J B Dixon
- Swinburne University of Technology, Melbourne, Victoria, Australia
| | - T Tzellos
- Arctic University of Norway, Tromsø, Norway
| | - C Zachary
- University of California, Irvine, California, USA
| | - L Cleaver
- A.T. Still University, Kirksville, Missouri, USA
| | - S Anderson
- Australasian College of Cutaneous Oncology, Melbourne, Victoria, Australia
| | - S Zagarella
- University of Sydney, Sydney, New South Wales, Australia
| | - J M Thomas
- Formerly of Royal Marsden Hospital, London, UK
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Tomlinson J, Turner E, Beba H, Smith H. The barriers and facilitators to research in practice: the experiences of a medicines optimisation team within a clinical commissioning group. International Journal of Pharmacy Practice 2022. [DOI: 10.1093/ijpp/riac089.065] [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: 12/02/2022]
Abstract
Abstract
Introduction
Research active healthcare organisations and staff have been shown to significantly improve performance and patient outcomes1. Undertaking research is a core element of the pharmacist role, however many pharmacists report not having the skills, knowledge and/or resources to take part2. There are many opportunities for the delivery of transformational research within primary care, however pharmacy team engagement is lacking.
Aim
To explore the barriers and facilitators to research engagement within a Clinical Commissioning Group (CCG) Medicines Optimisation team.
Methods
Twelve focus groups, guided by a semi-structured topic guide, were held over MS Teams between October 2021 and February 2022. 37 participants (pharmacists, pharmacy technicians and administrative support roles) attended and discussed topics relating to their experiences of engaging with research, as well as what helped or hindered them. Detailed notes were taken and analysed using Thematic Analysis. Following this inductive analysis, which aimed to capture all themes arising from the data, the Consolidated Framework for Implementation Research (CFIR)3 was applied. This helped to categorise the barriers and facilitators into domains which influence to what extent research is undertaken. The analysis was validated by the CCG team. This study was deemed to be service evaluation and therefore no ethical approval was needed.
Results
Three core themes emerged: People, Place and Practicalities. Individuals felt they had limited knowledge and capabilities in the field of research, despite having an internal motivation to engage in research activity. The perception of research was often linked in peoples’ thoughts to academia or secondary care/ acute Trusts or lab-based, and therefore not really something they would engage with in their current role. A lack of research culture, leadership and visibility of projects were all thought to hinder the team. A clear need for training and education in research (what it is, how it can be done, and available tools) was expressed, as well as appropriate resource allocation. Mapping to the CFIR illustrated that most barriers fell within the inner setting (i.e. the organisation itself) and with the process of conducting research, such as limited time, lack of encouragement from champions and poor feedback from projects. Enablers were also identified which included advice offered by external organisations, dissemination about work conducted in other primary care organisations and beliefs about the benefits of being research active.
Discussion/Conclusion
Participants perceived there to be many more barriers to research engagement than enablers, and these ranged from challenges with the individual projects, the process of conducting research within the organisation, things about the person themselves, their organisation or the wider setting of primary care. Areas for improvement were identified, mainly through increased training, visibility of projects and interested people, development of champions and role models, and stronger links with academia. This study was conducted with only one CCG and therefore further work needs to explore the experience within other integrated care boards and across secondary and community practice.
References
1. Hanney, S., Boaz, A., Soper, B. and Jones, T. Engagement in research: an innovative three-stage review of the benefits for health-care performance. Health Services and Delivery Research, 2013;1(8). ISSN (print) 2050-4349
2. Crilly P, Patel N, Ogunrinde A, Berko D, Kayyali R. Community Pharmacists’ Involvement in Research in the United Kingdom. Pharmacy. 2017;5(3):48. https://doi.org/10.3390/pharmacy5030048
3. Damschroder, L.J., Aron, D.C., Keith, R.E. et al. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implementation Sci 2009;4:50. https://doi.org/10.1186/1748-5908-4-50
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Affiliation(s)
| | - E Turner
- NHS West Yorkshire Integrated Care Board
| | - H Beba
- Leeds Health and Care Partnership Medicines Optimisation Team
| | - H Smith
- NHS West Yorkshire Integrated Care Board
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9
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Smith H, Orr R. The female athlete and the menstrual cycle: Physical and psychological factors influencing participation, training and competition. J Sci Med Sport 2022. [DOI: 10.1016/j.jsams.2022.09.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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10
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Li N, DiPlacido N, Barnes R, Shah A, Smith H, Verplancken E, Stem C, Moake M, Oliva C, Cummings E. 345 Creating a Deep Learning Classifier for the Detection of Soft Tissue Infections Using Point-of-Care Ultrasound Images. Ann Emerg Med 2022. [DOI: 10.1016/j.annemergmed.2022.08.372] [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: 11/15/2022]
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11
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Nair V, Loganathan PK, Smith H, Lal MK. Outcomes of Preterm Infants Who Experienced Unplanned Extubation. Respir Care 2022; 67:1320-1326. [PMID: 35790395 PMCID: PMC9994326 DOI: 10.4187/respcare.10005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Unplanned extubation (UE) is associated with adverse outcomes. The aim of the study was to compare the clinical outcomes in preterm infants who experienced at least one UE to those who did not experience any UE. METHODS The matched cohort study compared ventilated preterm infants < 32 weeks who experienced UE to those who did not experience any UE. The main outcomes were duration of mechanical ventilation after matching, duration of hospital stay, retinopathy of prematurity (ROP) requiring intervention, and bronchopulmonary dysplasia (BPD). RESULTS Forty-seven infants were included in each group. The groups were matched for mechanical ventilation duration before UE, birth gestation, and birthweight. The duration of mechanical ventilation after matching (adjusted odds ratio [aOR] 14.8 [11.2-18.4], P = <.001), the total length of stay in the hospital (aOR 16.4 [3.7-29.2], P = .01), and severe ROP (aOR 6.7 [1.7-27.0], P = .007) were significantly higher in infants who experienced UE. After adjusting for mechanical ventilation duration, UE was not associated with ROP or BPD. However, infants who spent longer time on mechanical ventilation had higher odds of developing ROP (aOR 1.1 [1.0-1.2], P = .004) and BPD (aOR 1.5 [1.1-2.1], P = .01). Sensitivity analysis including infants who had UE and managed on noninvasive respiratory support showed significant association between UE and the outcomes of duration of mechanical ventilation, hospital length of stay, ROP, and BPD. CONCLUSIONS Infants who experienced UE had higher odds of spending longer time on mechanical ventilation and spent significantly more days in the hospital.
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Affiliation(s)
- Vrinda Nair
- Neonatal Unit, James Cook University Hospital, Middlesbrough, England, United Kingdom; and Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, England, United Kingdom.
| | - Prakash Kannan Loganathan
- Neonatal Unit, James Cook University Hospital, Middlesbrough, England, United Kingdom; Clinical Academic Office, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, England, United Kingdom; and Department of Physics, University of Durham, Durham, England, United Kingdom
| | - Helena Smith
- Neonatal Unit, James Cook University Hospital, Middlesbrough, England, United Kingdom
| | - Mithilesh Kumar Lal
- Neonatal Unit, James Cook University Hospital, Middlesbrough, England, United Kingdom
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12
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Moonesinghe SR, McGuckin D, Martin P, Bedford J, Wagstaff D, Gilhooly D, Santos C, Wilson J, Dorey J, Leeman I, Smith H, Vindrola-Padros C, Edwards K, Singleton G, Swart M, Baumber R, Sahni A, Warnakulasuriya S, Vohra R, Ellicott H, Bougeard AM, Chazapis M, Ignacka A, Cripps M, Brent A, Drake S, Goodwin J, Martinez D, Williams K, Singh P, Bedford M, Vallance AE, Samuel K, Lourtie J, Olive D, Taylor C, Tucker O, Aresu G, Swift A, Fulop N, Grocott M. The Perioperative Quality Improvement Programme (PQIP patient study): protocol for a UK multicentre, prospective cohort study to measure quality of care and outcomes after major surgery. Perioper Med (Lond) 2022; 11:37. [PMID: 35941603 PMCID: PMC9361526 DOI: 10.1186/s13741-022-00262-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 04/28/2022] [Indexed: 12/03/2022] Open
Abstract
Introduction Major surgery accounts for a substantial proportion of health service activity, due not only to the primary procedure, but the longer-term health implications of poor short-term outcome. Data from small studies or from outside the UK indicate that rates of complications and failure to rescue vary between hospitals, as does compliance with best practice processes. Within the UK, there is currently no system for monitoring postoperative complications (other than short-term mortality) in major non-cardiac surgery. Further, there is variation between national audit programmes, in the emphasis placed on quality assurance versus quality improvement, and therefore the principles of measurement and reporting which are used to design such programmes. Methods and analysis The PQIP patient study is a multi-centre prospective cohort study which recruits patients undergoing major surgery. Patient provide informed consent and contribute baseline and outcome data from their perspective using a suite of patient-reported outcome tools. Research and clinical staff complete data on patient risk factors and outcomes in-hospital, including two measures of complications. Longer-term outcome data are collected through patient feedback and linkage to national administrative datasets (mortality and readmissions). As well as providing a uniquely granular dataset for research, PQIP provides feedback to participating sites on their compliance with evidence-based processes and their patients’ outcomes, with the aim of supporting local quality improvement. Ethics and dissemination Ethical approval has been granted by the Health Research Authority in the UK. Dissemination of interim findings (non-inferential) will form a part of the improvement methodology and will be provided to participating centres at regular intervals, including near-real time feedback of key process measures. Inferential analyses will be published in the peer-reviewed literature, supported by a comprehensive multi-modal communications strategy including to patients, policy makers and academic audiences as well as clinicians.
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Affiliation(s)
- S Ramani Moonesinghe
- Centre for Perioperative Medicine, Research Department for Targeted Intervention, UCL, London, UK. .,Health Services Research Centre, Royal College of Anaesthetists, London, UK. .,Department of Anaesthesia and Perioperative Medicine, University College London Hospitals NHS Foundation Trust, London, UK.
| | - Dermot McGuckin
- Centre for Perioperative Medicine, Research Department for Targeted Intervention, UCL, London, UK
| | - Peter Martin
- Department for Applied Health Research, UCL, London, UK
| | - James Bedford
- Centre for Perioperative Medicine, Research Department for Targeted Intervention, UCL, London, UK.,Health Services Research Centre, Royal College of Anaesthetists, London, UK.,Department of Anaesthesia and Perioperative Medicine, University College London Hospitals NHS Foundation Trust, London, UK
| | - Duncan Wagstaff
- Centre for Perioperative Medicine, Research Department for Targeted Intervention, UCL, London, UK.,Health Services Research Centre, Royal College of Anaesthetists, London, UK.,Department of Anaesthesia and Perioperative Medicine, University College London Hospitals NHS Foundation Trust, London, UK
| | - David Gilhooly
- Centre for Perioperative Medicine, Research Department for Targeted Intervention, UCL, London, UK.,Health Services Research Centre, Royal College of Anaesthetists, London, UK.,Department of Anaesthesia and Perioperative Medicine, University College London Hospitals NHS Foundation Trust, London, UK
| | - Cristel Santos
- Health Services Research Centre, Royal College of Anaesthetists, London, UK
| | - Jonathan Wilson
- Department of Anaesthesia, York Teaching Hospitals NHS Foundation Trust, York, UK
| | | | | | - Helena Smith
- Department of Anaesthesia, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Cecilia Vindrola-Padros
- Centre for Perioperative Medicine, Research Department for Targeted Intervention, UCL, London, UK.,Health Services Research Centre, Royal College of Anaesthetists, London, UK
| | - Kylie Edwards
- Health Services Research Centre, Royal College of Anaesthetists, London, UK
| | - Georgina Singleton
- Health Services Research Centre, Royal College of Anaesthetists, London, UK
| | - Michael Swart
- Department of Anaesthesia, Torbay Hospital, Torquay, UK
| | - Rachel Baumber
- Centre for Perioperative Medicine, Research Department for Targeted Intervention, UCL, London, UK.,Department of Anaesthesia, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Arun Sahni
- Health Services Research Centre, Royal College of Anaesthetists, London, UK
| | - Samantha Warnakulasuriya
- Department of Anaesthesia and Perioperative Medicine, University College London Hospitals NHS Foundation Trust, London, UK
| | - Ravi Vohra
- Department of Upper GI Surgery, Nottingham University Hospitals, Nottingham, UK
| | - Helen Ellicott
- Health Services Research Centre, Royal College of Anaesthetists, London, UK
| | | | - Maria Chazapis
- Department of Anaesthesia and Perioperative Medicine, University College London Hospitals NHS Foundation Trust, London, UK
| | - Aleksandra Ignacka
- Department of Anaesthesia and Perioperative Medicine, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Alexandra Brent
- Health Services Research Centre, Royal College of Anaesthetists, London, UK
| | | | | | - Dorian Martinez
- Health Services Research Centre, Royal College of Anaesthetists, London, UK
| | - Karen Williams
- Health Services Research Centre, Royal College of Anaesthetists, London, UK
| | - Pritam Singh
- Trent Oesophago-Gastric Unit, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Matthew Bedford
- Department of Colorectal Surgery, Birmingham Heartlands Hospital, Birmingham, UK
| | | | - Katie Samuel
- Department of Anaesthesia, North Bristol NHS Foundation Trust , Bristol, UK
| | - Jose Lourtie
- Health Services Research Centre, Royal College of Anaesthetists, London, UK
| | - Dominic Olive
- Health Services Research Centre, Royal College of Anaesthetists, London, UK
| | - Christine Taylor
- Health Services Research Centre, Royal College of Anaesthetists, London, UK
| | - Olga Tucker
- Department of Upper Gastrointestinal Surgery, Heartlands Hospital, Birmingham, UK
| | - Giuseppe Aresu
- Department of Cardiothoracic Surgery, Papworth Hospital, Cambridge, UK
| | | | - Naomi Fulop
- Department for Applied Health Research, UCL, London, UK
| | - Mike Grocott
- Division of Critical Care, University of Southampton, Southampton, UK
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Loveday K, Malik H, McKenna O, Noor A, Onsiong C, Patel B, Radcliffe N, Shah P, Tye L, Verma K, Walford R, Yusufi U, Zachariah M, Casey A, Doré C, Fludder V, Fortescue L, Kalapu SS, Karel E, Khera G, Smith C, Appleton B, Ashaye A, Boggon E, Evans A, Faris Mahmood H, Hinchcliffe Z, Marei O, Silva I, Spooner C, Thomas G, Timlin M, Wellington J, Yao SL, Abdelrazek M, Abdelrazik Y, Bee F, Joseph A, Mounce A, Parry G, Vignarajah N, Biddles D, Creissen A, Kolhe S, K T, Lea A, Ledda V, O'Loughlin P, Scanlon J, Shetty N, Weller C, Abdalla M, Adeoye A, Bhatti M, Chadda KR, Chu J, Elhakim H, Foster-Davies H, Rabie M, Tailor B, Webb S, Abdelrahim ASA, Choo SY, Jiwa A, Mangam S, Murray S, Shandramohan A, Aghanenu O, Budd W, Hayre J, Khanom S, Liew ZY, McKinney R, Moody N, Muhammad-Kamal H, Odogwu J, Patel D, Roy C, Sattar Z, Shahrokhi N, Sinha I, Thomson E, Wonga L, Bain J, Khan J, Ricardo D, Bevis R, Cherry C, Darkwa S, Drew W, Griffiths E, Konda N, Madani D, Mak JKC, Meda B, Odunukwe U, Preest G, Raheel F, Rajaseharan A, Ramgopal A, Risbrooke C, Selvaratnam K, Sethunath G, Tabassum R, Taylor J, Thakker A, Wijesingha N, Wybrew R, Yasin T, Ahmed Osman A, Alfadhel S, Carberry E, Chen JY, Drake I, Glen P, Jayasuriya N, Kawar L, Myatt R, Sinan LOH, Siu SSY, Tjen V, Adeboyejo O, Bacon H, Barnes R, Birnie C, D'Cunha Kamath A, Hughes E, Middleton S, Owen R, Schofield E, Short C, Smith R, Wang H, Willett M, Zimmerman M, Balfour J, Chadwick T, Coombe-Jones M, Do Le HP, Faulkner G, Hobson K, Shehata Z, Beattie M, Chmielewski G, Chong C, Donnelly B, Drusch B, Ellis J, Farrelly C, Feyi-Waboso J, Hibell I, Hoade L, Ho C, Jones H, Kodiatt B, Lidder P, Ni Cheallaigh L, Norman R, Patabendi I, Penfold H, Playfair M, Pomeroy S, Ralph C, Rottenburg H, Sebastian J, Sheehan M, Stanley V, Welchman J, Ajdarpasic D, Antypas A, Azouaghe O, Basi S, Bettoli G, Bhattarai S, Bommireddy L, Bourne K, Budding J, Cookey-Bresi R, Cummins T, Davies G, Fabelurin C, Gwilliam R, Hanley J, Hird A, Kruczynska A, Langhorne B, Lund J, Lutchman I, McGuinness R, Neary M, Pampapathi S, Pang E, Podbicanin S, Rai N, Redhouse White G, Sujith J, Thomas P, Walker I, Winterton R, Anderson P, Barrington M, Bhadra K, Clark G, Fowler G, Gibson C, Hudson S, Kaminskaite V, Lawday S, Longshaw A, MacKrill E, McLachlan F, Murdeshwar A, Nieuwoudt R, Parker P, Randall R, Rawlins E, Reeves SA, Rye D, Sirkis T, Sykes B, Ventress N, Wosinska N, Akram B, Burton L, Coombs A, Long R, Magowan D, Ong C, Sethi M, Williams G, Chan C, Chan LH, Fernando D, Gaba F, Khor Z, Les JW, Mak R, Moin S, Ng Kee Kwong KC, Paterson-Brown S, Tew YY, Bardon A, Burrell K, Coldwell C, Costa I, Dexter E, Hardy A, Khojani M, Mazurek J, Raymond T, Reddy V, Reynolds J, Soma A, Agiotakis S, Alsusa H, Desai N, Peristerakis I, Adcock A, Ayub H, Bennett T, Bibi F, Brenac S, Chapman T, Clarke G, Clark F, Galvin C, Gwyn-Jones A, Henry-Blake C, Kerner S, Kiandee M, Lovett A, Pilecka A, Ravindran R, Siddique H, Sikand T, Treadwell K, Akmal K, Apata A, Barton O, Broad G, Darling H, Dhuga Y, Emms L, Habib S, Jain R, Jeater J, Kan CYP, Kathiravelupillai A, Khatkar H, Kirmani S, Kulasabanathan K, Lacey H, Lal K, Manafa C, Mansoor M, McDonald S, Mittal A, Mustoe S, Nottrodt L, Oliver P, Papapetrou I, Pattinson F, Raja M, Reyhani H, Shahmiri A, Small O, Soni U, Aguirrezabala Armbruster B, Bunni J, Hakim MA, Hawkins-Hooker L, Howell KA, Hullait R, Jaskowska A, Ottewell L, Thomas-Jones I, Vasudev A, Clements B, Fenton J, Gill M, Haider S, Lim AJM, Maguire H, McMullan J, Nicoletti J, Samuel S, Unais MA, White N, Yao PC, Yow L, Boyle C, Brady R, Cheekoty P, Cheong J, Chew SJHL, Chow R, Ganewatta Kankanamge D, Mamer L, Mohammed B, Ng Chieng Hin J, Renji Chungath R, Royston A, Sharrad E, Sinclair R, Tingle S, Treherne K, Wyatt F, Maniarasu VS, Moug S, Appanna T, Bucknall T, Hussain F, Owen A, Parry M, Parry R, Sagua N, Spofforth K, Yuen ECT, Bosley N, Hardie W, Moore T, Regas C, Abdel-Khaleq S, Ali N, Bashiti H, Buxton-Hopley R, Constantinides M, D'Afflitto M, Deshpande A, Duque Golding J, Frisira E, Germani Batacchi M, Gomaa A, Hay D, Hutchison R, Iakovou A, Iakovou D, Ismail E, Jefferson S, Jones L, Khouli Y, Knowles C, Mason J, McCaughan R, Moffatt J, Morawala A, Nadir H, Neyroud F, Nikookam Y, Parmar A, Pinto L, Ramamoorthy R, Richards E, Thomson S, Trainer C, Valetopoulou A, Vassiliou A, Wantman A, Wilde S, Dickinson M, Rockall T, Senn D, Wcislo K, Zalmay P, Adelekan K, Allen K, Bajaj M, Gatumbu P, Hang S, Hashmi Y, Kaur T, Kawesha A, Kisiel A, Woodmass M, Adelowo T, Ahari D, Alhwaishel K, Atherton R, Clayton B, Cockroft A, Curtis Lopez C, Hilton M, Ismail N, Kouadria M, Lee L, MacConnachie A, Monks F, Mungroo S, Nikoletopoulou C, Pearce L, Sara X, Shahid A, Suresh G, Wilcha R, Atiyah A, Davies E, Dermanis A, Gibbons H, Hyde A, Lawson A, Lee C, Leung-Tack M, Li Saw Hee J, Mostafa O, Nair D, Pattani N, Plumbley-Jones J, Pufal K, Ramesh P, Sanghera J, Saram S, Scadding S, See S, Stringer H, Torrance A, Vardon H, Wyn-Griffiths F, Brew A, Kaur G, Soni D, Tickle A, Akbar Z, Appleyard T, Figg K, Jayawardena P, Johnson A, Kamran Siddiqui Z, Lacy-Colson J, Oatham R, Rowlands B, Sludden E, Turnbull C, Allin D, Ansar Z, Azeez Z, Dale VH, Garg J, Horner A, Jones S, Knight S, McGregor C, McKenna J, McLelland T, Packham-Smith A, Rowsell K, Spector-Hill I, Adeniken E, Baker J, Bartlett M, Chikomba L, Connell B, Deekonda P, Dhar M, Elmansouri A, Gamage K, Goodhew R, Hanna P, Knight J, Luca A, Maasoumi N, Mahamoud F, Manji S, Marwaha PK, Mason F, Oluboyede A, Pigott L, Razaq AM, Richardson M, Saddaoui I, Wijeyendram P, Yau S, Atkins W, Liang K, Miles N, Praveen B, Ashai S, Braganza J, Common J, Cundy A, Davies R, Guthrie J, Handa I, Iqbal M, Ismail R, Jones C, Jones I, Lee KS, Levene A, Okocha M, Olivier J, Smith A, Subramaniam E, Tandle S, Wang A, Watson A, Wilson C, Chan XHF, Khoo E, Montgomery C, Norris M, Pugalenthi PP, Common T, Cook E, Mistry H, Shinmar HS, Agarwal G, Bandyopadhyay S, Brazier B, Carroll L, Goede A, Harbourne A, Lakhani A, Lami M, Larwood J, Martin J, Merchant J, Pattenden S, Pradhan A, Raafat N, Rothwell E, Shammoon Y, Sudarshan R, Vickers E, Wingfield L, Ashworth I, Azizi S, Bhate R, Chowdhury T, Christou A, Davies L, Dwaraknath M, Farah Y, Garner J, Gureviciute E, Hart E, Jain A, Javid S, Kankam HK, Kaur Toor P, Kaz R, Kermali M, Khan I, Mattson A, McManus A, Murphy M, Nair K, Ngemoh D, Norton E, Olabiran A, Parry L, Payne T, Pillai K, Price S, Punjabi K, Raghunathan A, Ramwell A, Raza M, Ritehnia J, Simpson G, Smith W, Sodeinde S, Studd L, Subramaniam M, Thomas J, Towey S, Tsang E, Tuteja D, Vasani J, Vio M, Badran A, Adams J, Anthony Wilkinson J, Asvandi S, Austin T, Bald A, Bix E, Carrick M, Chander B, Chowdhury S, Cooper Drake B, Crosbie S, D Portela S, Francis D, Gallagher C, Gillespie R, Gravett H, Gupta P, Ilyas C, James G, Johny J, Jones A, Kinder F, MacLeod C, Macrow C, Maqsood-Shah A, Mather J, McCann L, McMahon R, Mitham E, Mohamed M, Munton E, Nightingale K, O'Neill K, Onyemuchara I, Senior R, Shanahan A, Sherlock J, Spyridoulias A, Stavrou C, Stokes D, Tamang R, Taylor E, Trafford C, Uden C, Waddington C, Yassin D, Zaman M, Bangi S, Cheng T, Chew D, Hussain N, Imani-Masouleh S, Mahasivam G, McKnight G, Ng HL, Ota HC, Pasha T, Ravindran W, Shah K, Vishnu K S, Zaman S, Carr W, Cope S, Eagles EJ, Howarth-Maddison M, Li CY, Reed J, Ridge A, Stubbs T, Teasdaled D, Umar R, Worthington J, Dhebri A, Kalenderov R, Alattas A, Arain Z, Bhudia R, Chia D, Daniel S, Dar T, Garland H, Girish M, Hampson A, Kyriacou H, Lehovsky K, Mullins W, Omorphos N, Vasdev N, Venkatesh A, Waldock W, Bhandari A, Brown G, Choa G, Eichenauer CE, Ezennia K, Kidwai Z, Lloyd-Thomas A, Macaskill Stewart A, Massardi C, Sinclair E, Skajaa N, Smith M, Tan I, Afsheen N, Anuar A, Azam Z, Bhatia P, Davies-kelly N, Dickinson S, Elkawafi M, Ganapathy M, Gupta S, Khoury EG, Licudi D, Mehta V, Neequaye S, Nita G, Tay VL, Zhao S, Botsa E, Cuthbert H, Elliott J, Furlepa M, Lehmann J, Mangtani A, Narayan A, Nazarian S, Parmar C, Shah D, Shaw C, Zhao Z, Beck C, Caldwell S, Clements JM, French B, Kenny R, Kirk S, Lindsay J, McClung A, McLaughlin N, Watson S, Whiteside E, Alyacoubi S, Arumugam V, Beg R, Dawas K, Garg S, Lloyd ER, Mahfouz Y, Manobharath N, Moonesinghe R, Morka N, Patel K, Prashar J, Yip S, Adeeko ES, Ajekigbe F, Bhat A, Evans C, Farrugia A, Gurung C, Long T, Malik B, Manirajan S, Newport D, Rayer J, Ridha A, Ross E, Saran T, Sinker A, Waruingi D, Allen R, Al Sadek Y, Alves do Canto Brum H, Asharaf H, Ashman M, Balakumar V, Barrington J, Baskaran R, Berry A, Bhachoo H, Bilal A, Boaden L, Chia WL, Covell G, Crook D, Dadnam F, Davis L, De Berker H, Doyle C, Fox C, Gruffydd-Davies M, Hafouda Y, Hill A, Hubbard E, Hunter A, Inpadhas V, Jamshaid M, Jandu G, Jeyanthi M, Jones T, Kantor C, Kwak SY, Malik N, Matt R, McNulty P, Miles C, Mohomed A, Myat P, Niharika J, Nixon A, O'Reilly D, Parmar K, Pengelly S, Price L, Ramsden M, Turnor R, Wales E, Waring H, Wu M, Yang T, Ye TTS, Zander A, Zeicu C, Bellam S, Francombe J, Kawamoto N, Rahman MR, Sathyanarayana A, Tang HT, Cheung J, Hollingshead J, Page V, Sugarman J, Wong E, Chiong J, Fung E, Kan SY, Kiang J, Kok J, Krahelski O, Liew MY, Lyell B, Sharif Z, Speake D, Alim L, Amakye NY, Chandrasekaran J, Chandratreya N, Drake J, Owoso T, Thu YM, Abou El Ela Bourquin B, Alberts J, Chapman D, Rehnnuma N, Ainsworth K, Carpenter H, Emmanuel T, Fisher T, Gabrel M, Guan Z, Hollows S, Hotouras A, Ip Fung Chun N, Jaffer S, Kallikas G, Kennedy N, Lewinsohn B, Liu FY, Mohammed S, Rutherfurd A, Situ T, Stammer A, Taylor F, Thin N, Urgesi E, Zhang N, Ahmad MA, Bishop A, Bowes A, Dixit A, Glasson R, Hatta S, Hatt K, Larcombe S, Preece J, Riordan E, Fegredo D, Haq MZ, Li C, McCann G, Stewart D, Baraza W, Bhullar D, Burt G, Coyle J, Deans J, Devine A, Hird R, Ikotun O, Manchip G, Ross C, Storey L, Tan WWL, Tse C, Warner C, Whitehead M, Wu F, Court EL, Crisp E, Huttman M, Mayes F, Robertson H, Rosen H, Sandberg C, Smith H, Al Bakry M, Ashwell W, Bajaj S, Bandyopadhyay D, Browlee O, Burway S, Chand CP, Elsayeh K, Elsharkawi A, Evans E, Ferrin S, Fort-Schaale A, Iacob M, I K, Impelliziere Licastro G, Mankoo AS, Olaniyan T, Otun J, Pereira R, Reddy R, Saeed D, Simmonds O, Singhal G, Tron K, Wickstone C, Williams R, Bradshaw E, De Kock Jewell V, Houlden C, Knight C, Metezai H, Mirza-Davies A, Seymour Z, Spink D, Wischhusen S. Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study. Lancet Digit Health 2022; 4:e520-e531. [PMID: 35750401 DOI: 10.1016/s2589-7500(22)00069-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 01/07/2022] [Accepted: 04/06/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications. METHODS We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC). FINDINGS In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]). INTERPRETATION In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required. FUNDING British Journal of Surgery Society.
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Henry M, Abutaleb A, Jeevanandam V, Smith H, Belkin M, Husain A, Pinney S, Ota T, Mor-Avi V, Lang RM, Addetia K. Intracardiac device associated interference with tricuspid valve apparatus on echocardiography: What can we learn from pathology? Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
New or worsening tricuspid regurgitation (TR) is associated with right-sided heart failure and worsened outcomes. Cardiac Implantable Electronic Devices (CIEDs), which are being implanted at growing rates worldwide, are increasingly being recognized as associated with TR occurrence related to interference with the tricuspid valve (TV) apparatus. Purpose: We sought to identify echocardiographic features in the right ventricle and TV that differentiate patients who have anatomically demonstrated interference with the TV on direct pathology inspection.
Methods
Explanted hearts from 44 consecutive patients undergoing orthotopic heart transplant (55 ±13 yrs, 68% men) with known implanted CIEDs were dissected to assess the presence (n = 18) or absence (n = 26) of CIED interference with the TV (Figure). Echocardiographic measurements performed prior to transplantation, including left and right ventricular (LV, RV) size and performance metrics as well as TR severity, were compared between both groups using non-parametric testing.
Results
Echocardiographic features of patients with and without anatomically demonstrated TV interference are shown in the Table. Although overall LV dimensions and volumes were not different between the two groups and LV ejection fraction was severely reduced in both groups, patients demonstrating CIED interference trended towards larger right atrial volumes (Table) and also larger RV and tricuspid annular sizes. Importantly, however, they were more than 4 times likely to have abnormal right ventricular function. Lastly, patients with tricuspid apparatus interference tended to have more significant TR, although these differences have not reached statistical significance (Table).
Conclusion
CIED interreference with tricuspid valve apparatus occurs frequently (41%) among patients with CIEDs, who undergo orthotopic heart transplantation. This may be associated with worsening TV function with subsequent changes in right atrial and ventricular geometry and function. In light of prior data showing poor outcomes with CIED associated TR, this study emphasizes the importance of non-invasive assessment of CIED interference with the tricuspid valve, in order to improve device placement and patient outcomes. Abstract Figure Abstract Table
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Affiliation(s)
- M Henry
- The University of Chicago Medical Center, Chicago, United States of America
| | - A Abutaleb
- The University of Chicago Medical Center, Chicago, United States of America
| | - V Jeevanandam
- The University of Chicago Medical Center, Chicago, United States of America
| | - H Smith
- The University of Chicago Medical Center, Chicago, United States of America
| | - M Belkin
- The University of Chicago Medical Center, Chicago, United States of America
| | - A Husain
- The University of Chicago Medical Center, Chicago, United States of America
| | - S Pinney
- The University of Chicago Medical Center, Chicago, United States of America
| | - T Ota
- The University of Chicago Medical Center, Chicago, United States of America
| | - V Mor-Avi
- The University of Chicago Medical Center, Chicago, United States of America
| | - RM Lang
- The University of Chicago Medical Center, Chicago, United States of America
| | - K Addetia
- The University of Chicago Medical Center, Chicago, United States of America
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Chimoyi L, Smith H, Hausler H, Fielding K, Hoffmann CJ, Herce ME, Charalambous S. Delivery of TB preventive therapy to incarcerated people living with HIV in southern African correctional facilities. Public Health Action 2021; 11:171-173. [PMID: 34956843 DOI: 10.5588/pha.21.0056] [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: 06/06/2021] [Accepted: 11/06/2021] [Indexed: 11/10/2022] Open
Abstract
TB preventive treatment (TPT) is recommended for high-risk and hard-to-reach populations such as incarcerated people living with HIV (PLHIV). To assess implementation of TPT delivery in correctional settings, we conducted an exploratory analysis of data from a multisite cohort study in South Africa and Zambia. From 975 participants, 648 were screened for TB, and 409 initiated TPT mostly within a month after initiation of antiretroviral therapy (190/409, 46.5%). We observed a median gap of one month (IQR 0.6-4.7) in TPT delivery to incarcerated PLHIV. Future research should examine standardised quality improvement tools and new strategies such as short-course regimens to improve TPT initiation in this population.
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Affiliation(s)
- L Chimoyi
- The Aurum Institute, Parktown, Johannesburg, South Africa
| | - H Smith
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.,School of Population Health, University of New South Wales, Sydney, NSW, Australia
| | - H Hausler
- TB HIV Care, Cape Town, South Africa
| | - K Fielding
- London School of Tropical Hygiene & Medicine, London, UK
| | - C J Hoffmann
- The Aurum Institute, Parktown, Johannesburg, South Africa.,Johns Hopkins University, Baltimore, MD, USA
| | - M E Herce
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.,Institute for Global Health & Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - S Charalambous
- The Aurum Institute, Parktown, Johannesburg, South Africa.,School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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van Wifferen F, de Jonge L, Worthington J, Greuter MJ, Lew JB, Nadeau C, van den Puttelaar R, Feletto E, Yong JH, Lansdorp-Vogelaar I, Canfell K, Coupé VM, Anderson L, Besó Delgado M, Binefa G, Cust A, Dekker E, Dell’Anna V, Essue B, Espinas J, Flander L, Garcia M, Hahn A, Idigoras I, Katanoda K, Laghi L, Lamrock F, McFerran E, Majek O, Molina-Barceló A, Ledger M, Musa O, Njor S, O’Connor K, Portillo I, Salas D, Senore C, Smith H, Symonds E, Tachecí I, Taksler G, Tolani M, Treby M, Zauber A, Zheng Y. Prioritisation of colonoscopy services in colorectal cancer screening programmes to minimise impact of COVID-19 pandemic on predicted cancer burden: A comparative modelling study. J Med Screen 2021; 29:72-83. [PMID: 35100894 PMCID: PMC9087314 DOI: 10.1177/09691413211056777] [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] [Indexed: 12/22/2022]
Abstract
Objectives Colorectal cancer (CRC) screening with a faecal immunochemical test (FIT) has
been disrupted in many countries during the COVID-19 pandemic. Performing
catch-up of missed screens while maintaining regular screening services
requires additional colonoscopy capacity that may not be available. This
study aimed to compare strategies that clear the screening backlog using
limited colonoscopy resources. Methods A range of strategies were simulated using four country-specific CRC
natural-history models: Adenoma and Serrated pathway to Colorectal CAncer
(ASCCA) and MIcrosimulation SCreening ANalysis for CRC (MISCAN-Colon) (both
in the Netherlands), Policy1-Bowel (Australia) and OncoSim (Canada).
Strategies assumed a 3-month screening disruption with varying recovery
period lengths (6, 12, and 24 months) and varying FIT thresholds for
diagnostic colonoscopy. Increasing the FIT threshold reduces the number of
referrals to diagnostic colonoscopy. Outcomes for each strategy were
colonoscopy demand and excess CRC-related deaths due to the disruption. Results Performing catch-up using the regular FIT threshold in 6, 12 and 24 months
could prevent most excess CRC-related deaths, but required 50%, 25% and
12.5% additional colonoscopy demand, respectively. Without exceeding usual
colonoscopy demand, up to 60% of excess CRC-related deaths can be prevented
by increasing the FIT threshold for 12 or 24 months. Large increases in FIT
threshold could lead to additional deaths rather than preventing them. Conclusions Clearing the screening backlog in 24 months could avert most excess
CRC-related deaths due to a 3-month disruption but would require a small
increase in colonoscopy demand. Increasing the FIT threshold slightly over
24 months could ease the pressure on colonoscopy resources.
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Affiliation(s)
- Francine van Wifferen
- Decision Modeling Center, Department of Epidemiology and Data Science, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Lucie de Jonge
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Joachim Worthington
- The Daffodil Centre, The University of Sydney, A Joint Venture With Cancer Council NSW, Sydney, Australia
| | - Marjolein J.E. Greuter
- Decision Modeling Center, Department of Epidemiology and Data Science, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Jie-Bin Lew
- The Daffodil Centre, The University of Sydney, A Joint Venture With Cancer Council NSW, Sydney, Australia
| | - Claude Nadeau
- Health Analysis Division, Statistics Canada, Ottawa, Canada
| | | | - Eleonora Feletto
- The Daffodil Centre, The University of Sydney, A Joint Venture With Cancer Council NSW, Sydney, Australia
| | | | - Iris Lansdorp-Vogelaar
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Karen Canfell
- The Daffodil Centre, The University of Sydney, A Joint Venture With Cancer Council NSW, Sydney, Australia
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Veerle M.H. Coupé
- Decision Modeling Center, Department of Epidemiology and Data Science, Amsterdam University Medical Center, Amsterdam, The Netherlands
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Smith H, Hargest R. 477 Surgical Solutions and Problems in An Adult Patient with VACTERL Association. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Background
We report an adult patient with features of VACTERL - oesophageal and anal atresia, with cardiac malformation. In infancy he underwent colonic interposition for oesophageal atresia using the transverse colon as a conduit. As a teenager he underwent formation of a Koch continent ileostomy after previous stoma formation for anal atresia. Eventual failure of the Koch pouch nipple valve necessitated a laparotomy for attempted refashioning. Unfortunately, this operation was beset by life-threatening complications and a protracted post-operative course. He presented to our hospital with a laparostomy, high output enterocutaneous fistulae (ECF) necessitating home total parenteral nutrition (TPN), severe cachexia and deconditioning.
Method
Conservative therapy was utilised to improve the nutritional and physiological status of the patient. Simultaneously, attempts were made to define the anatomy of his abdomen in relation to previous surgery. However, operation notes for the original procedures (oesophageal reconstruction and Koch pouch formation) were lost due to closure of the hospital which he attended at the time.
A laparotomy was subsequently performed to manage the ECFs. Most of the small intestine was unsalvageable due to multiple fistulae and adhesions, leaving 35cm of small bowel terminating in an end ileostomy. A cholecystectomy was performed to mitigate gallstone formation.
Conclusions
Efficient communication is imperative in the management of complex patients. The loss of original operation notes made interpretation of subsequent imaging and planning of surgery troublesome. In contrast, efficient communication between teams involved in his peri-operative care, particularly the respiratory and intensive care teams facilitated a smooth post-operative course and successful discharge from hospital.
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Affiliation(s)
- H Smith
- University Hospital of Wales, Cardiff, United Kingdom
| | - R Hargest
- University Hospital of Wales, Cardiff, United Kingdom
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Smith H, Lim CS, Evans N, Papadopoulou A, Khalifa M, Tsui J, Hamilton G, Brookes J. Incidence of major complications from embolo-sclerotherapy of head and neck vascular malformations in a single specialist centre. Vascular 2021; 30:952-959. [PMID: 34311627 DOI: 10.1177/17085381211035279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Current data on the nature and rate of major complications for embolo-sclerotherapy (EST) of vascular malformations are scarce. However, even fewer studies focus on vascular malformations specific to the head and neck, which confer an increased specific risk of airway compromise, neurologic and ophthalmologic injury. More understanding is required surrounding the type and incidence of complications to improve treatment planning and informed consent. Therefore, this study aimed to review major complications secondary to EST of head and neck vascular malformations over a 5-year period in a single specialized multidisciplinary centre for vascular anomalies. METHODS All interventions were decided by the multidisciplinary team. Demographic, procedural and complication data between 1st January 2013 and 31st December 2017 were prospectively documented in a dedicated database and analysed. EST of high-flow vascular malformations (HFVMs) was performed by selective catheter angiography or direct injection, and by direct injection only for low-flow vascular malformations (LFVMs). Major complications were defined as any tissue or functional damage caused by direct injection, distal embolization or tissue reaction and were decided by the multidisciplinary team. RESULTS Forty-eight patients (median age of 35 years; range of 14-70 years; 18 men and 30 women) had 100 EST procedures for head and neck vascular malformation. Of these, 14 patients had EST for HFVM and 34 patients for LFVM, total 43 and 57 procedures, respectively. Overall, five patients with HFVM developed major complications from EST when compared with two patients with LFVM (p = 0.0167). Two patients required pre-emptive tracheostomy due to risk of post-operative airway compromise. Overall, seven (14.6%) patients experienced major complication from EST. In the HFVM group, major complications from EST occurred in five patients; four cases of tissue ulceration and necrosis (two needed debridement, one healed with resultant fibrosis that impeded speech and one resolved spontaneously) and one post-procedural airway compromise requiring tracheostomy. Meanwhile, in the LFVM group, major complications occurred in two patients; one case of severe necrosis involving the alar cartilage, lip and cheek requiring debridement and reconstruction under plastics and one simple cellulitis. No patients sustained stroke or vision impairment. CONCLUSIONS EST is relatively safe for head and neck vascular malformations in a high-volume experienced centre. Our major complication rate of 14.6% per patient (35.7% for HFVM; 5.9% for LFVM) or 7% per procedure (11.6% for HFVM; 3.5% LFVM) compares favourably with published data from other centres. These data will improve treatment planning and informed consent for EST for both HFVM and LFVM of the head and neck.
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Affiliation(s)
- Helena Smith
- Department of Vascular Surgery, 4965Royal Free London NHS Foundation Trust, London, UK
| | - Chung Sim Lim
- Department of Vascular Surgery, 4965Royal Free London NHS Foundation Trust, London, UK.,Department of Surgical Biotechnology, Division of Surgery and Interventional Science, Faculty of Medical Sciences, University College London, UK.,National Institute for Health Research, UCLH Biomedical Research Center, London, UK
| | - Nicholas Evans
- Department of Vascular Surgery, 4965Royal Free London NHS Foundation Trust, London, UK
| | - Anthie Papadopoulou
- Department of Interventional Radiology, 4965Royal Free London NHS Foundation Trust, London, UK
| | - Mohamed Khalifa
- Department of Interventional Radiology, 4965Royal Free London NHS Foundation Trust, London, UK
| | - Janice Tsui
- Department of Vascular Surgery, 4965Royal Free London NHS Foundation Trust, London, UK.,Department of Surgical Biotechnology, Division of Surgery and Interventional Science, Faculty of Medical Sciences, University College London, UK.,National Institute for Health Research, UCLH Biomedical Research Center, London, UK
| | - George Hamilton
- Department of Vascular Surgery, 4965Royal Free London NHS Foundation Trust, London, UK.,Department of Surgical Biotechnology, Division of Surgery and Interventional Science, Faculty of Medical Sciences, University College London, UK
| | - Jocelyn Brookes
- Department of Vascular Surgery, 4965Royal Free London NHS Foundation Trust, London, UK.,Department of Interventional Radiology, 4965Royal Free London NHS Foundation Trust, London, UK
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19
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Smith H. Evolution of the recommendations of the International Commission on Radiological Protection / Entwicklung der Empfehlungen der Internationalen Kommission für Strahlenschutz. KERNTECHNIK 2021. [DOI: 10.1515/kern-1993-580405] [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: 11/15/2022]
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20
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Tomlinson J, Silcock J, Fylan B, Smith H, Karban K, Dyson J. Identifying behaviour change techniques to support medicines management for older people at care transitions. International Journal of Pharmacy Practice 2021. [DOI: 10.1093/ijpp/riab016.001] [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
Older patients are at significant risk of medicines-related harm following a hospital to home transition [1]. Strategies, such as information transfer and medicines reconciliation, have been suggested to promote successful transitions through better medicines management [2]. These interventions, however, are not often underpinned by patient experience or grounded in theory, and therefore have variable effects in real-world contexts.
Aim
To identify which behaviour change techniques (BCTs) could be combined within a complex intervention to support post-discharge medicines management.
Methods
Barriers and facilitators to post-discharge medicines management behaviours were identified from an analysis of interviews with twenty-seven older people (aged 75 years plus) and mapped to the Theoretical Domains Framework (TDF). These participants were recruited during a stay in two large hospitals in the North of England. All potential BCTs targeting the identified TDF domains were found using validated mapping exercises and refined by panel consensus. The panel consisted of two pharmacists, two health services researchers, a social work academic and a patient representative. Next, a convenience sample of key stakeholders (n=40; patients and family carers, healthcare professionals and researchers) were invited to take part in an online survey to prioritise remaining techniques. A total score for each BCT was calculated based on its potential i) effectiveness, ii) acceptability and iii) ability to cause unintended consequences. The BCTs were ranked from lowest to highest scores. As validation, the final selection of BCTs was assessed using the APEASE criteria and mapped back to the behavioural determinants to check the components would enhance facilitators and overcome barriers (Figure 1).
Results
Forty-six behavioural determinants were identified within interviews and classified as barriers (n=19), facilitators (n=10), or both (n=17). These were deductively mapped onto 11 domains of the TDF. Following the mapping, 50 discrete BCTs were identified, which were reduced to 35 after subsequent consensus discussions between panel members to remove any deemed inappropriate. The survey resulted in 25 responses (62.5% response rate). Following visual inspection of the ranking, a natural cut-off was identified by panel consensus at 88% of the total score. This, and further assessment using the APEASE criteria, prioritised eight BCTs that were highly rated to be effective in promoting post-discharge medicines management when combined within a complex intervention. These were: practical social support, goal/ target specified, prompts, triggers or cues, social processes of encouragement, motivational interviewing, rehearsal, review goals, and comparative imagining of future outcomes.
Conclusion
This study has identified eight BCTs that could be valuable when combined within a complex intervention to support post-discharge medicines management for older people. Consensus allowed prioritisation of BCTs that were likely to be effective, acceptable to older people, practical and cost-effective to deliver within current healthcare organisations. Limitations included challenges of coding complex behavioural determinants to the TDF, defining the BCTs within the medicines management context and modest survey sample size. To overcome these limitations, input was sought from a health psychologist with expertise and consensus involved all relevant stakeholders.
References
1. Parekh, N., Ali, K., Stevenson, J. M., et al. Incidence and cost of medication harm in older adults following hospital discharge: a multicentre prospective study in the UK. British journal of clinical pharmacology 2018;84(8):1789–1797.
2. Tomlinson, J., Cheong, V., Fylan, B., et al. Successful care transitions for older people: a systematic review and meta-analysis of the effects of interventions that support medication continuity. Age and Ageing 2020;00:1–12.
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Affiliation(s)
- J Tomlinson
- School of Pharmacy and Medical Sciences, University of Bradford, UK
- Medicines Management and Pharmacy Services, St James’ Hospital, Leeds Teaching Hospitals NHS Trust, UK
| | - J Silcock
- School of Pharmacy and Medical Sciences, University of Bradford, UK
| | - B Fylan
- School of Pharmacy and Medical Sciences, University of Bradford, UK
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - H Smith
- Medicines Management and Pharmacy Services, St James’ Hospital, Leeds Teaching Hospitals NHS Trust, UK
| | - K Karban
- Faculty of Life Sciences, University of Bradford, UK
| | - J Dyson
- School of Health Sciences, City, University of London, UK
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21
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Tomlinson J, Smith H, Silcock J, Karban K, Fylan B. 22 Coping with Medicines After Hospital Discharge; the Invisible Work of Older Patients and Their Care-Givers. Age Ageing 2021. [DOI: 10.1093/ageing/afab029.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Older patients often experience medication-related problems following discharge from hospital. These can be categorised as issues with obtaining medication, taking medication, medication effects or problems with communication or care co-ordination (Nicosia et al., Journal of General Internal Medicine, 2019, https://doi.org/10.1007/s11606-019-05463-z). The aim of this study was to explore older adults’ experiences of post-discharge medicines management, including the strategies they use to safely manage their changed medicines.
Methods
Following ethical approval, patients aged 75 and above, with a change in their long term medicines, were recruited during admission to one of two hospitals in Yorkshire. Semi-structured interviews took place with the participants in their own homes, approximately two weeks after discharge. Interviews were audio recorded and transcribed. Data were analysed using the Framework method.
Results
Twenty-seven patients (mean age 85 years; 6 males) consented to be interviewed. They described multiple self-management and safety strategies used to support medicines management in the early post-discharge phase. The work done included adaptations (to routines, the home environment and action plans), scaffolding (where patients and their care-givers support the primary care system by providing additional documentation or prompts to ensure medicines were supplied on time and were correct) and error avoidance (seeking information, performing checks and balances).
Conclusion
Older patients experience gaps in their post-discharge medicines-related care which they had to bridge through implementing their own strategies or by enlisting support from others. This study shines a spotlight on to the invisible work that patients have to do in order to make post-discharge medicines management fit for purpose. Further work should consider those patients who are not able to carry out these tasks or who do not have any care-givers available for support and how this potential gap in care can be addressed.
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Affiliation(s)
- J Tomlinson
- University of Bradford
- Medicines Management and Pharmacy Services, Leeds Teaching Hospitals NHS Trust
| | - H Smith
- Medicines Management and Pharmacy Services, Leeds Teaching Hospitals NHS Trust
| | | | | | - B Fylan
- University of Bradford
- Bradford Institute for Health Research
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22
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Schmid K, Effenberg F, Dinklage A, Rudischhauser L, Gao Y, Mayer M, Brezinsek S, Geiger J, Fuchert G, Miklos V, Smith H, Turkin Y, Rahbarnia K, Stange T, Ipp K, Brunner J, Neuner U, Pavone A, Hoefel U, Ipp H. Integrated modelling: Coupling of surface evolution and plasma-impurity transport. Nuclear Materials and Energy 2020. [DOI: 10.1016/j.nme.2020.100821] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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23
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March DT, Marshall K, Swan G, Gerlach T, Smith H, Blyde D, Ariel E, Christidis L, Kelaher BP. The use of echocardiography as a health assessment tool in green sea turtles (Chelonia mydas). Aust Vet J 2020; 99:46-54. [PMID: 33227826 DOI: 10.1111/avj.13039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 10/25/2020] [Indexed: 12/13/2022]
Abstract
There are limited techniques available to assess the health of sea turtles as physical examination has little correlation to clinical findings, and blood reference intervals are broad and provide limited prognostic significance. Advances in the portability of ultrasound machines allow echocardiography to be increasingly used in the health assessments of wild animals. This study performed blood analysis and echocardiograms on 11 green sea turtles upon admission to a rehabilitation clinic and six animals before release. Significant differences were seen between groups, with admission animals having significantly smaller diameters of the cavum arteriosum at systole and diastole, smaller E-waves and an increased fractional shortening. Pre-release animals displayed significant increases in the maximum blood velocities of both the pulmonary artery and the left aorta. Significant negative correlations were seen between fractional shortening and uric acid and between the velocity time integral of the pulmonary artery and urea. The pulmonary artery velocity time integral was also significantly correlated to the E wave. Furthermore, there was asynchrony between the cavum arteriosum and the cavum pulmonale and the detection of a parasitic granuloma in the ventricular outflow tract of one animal. Overall, the results suggest that cardiac function in stranded green sea turtles is significantly impaired and that echocardiography has applications in the health assessments of green sea turtles.
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Affiliation(s)
- D T March
- National Marine Science Centre, School of Environment, Science and Engineering, Southern Cross University, Coffs Harbour, New South Wales, Australia.,Dolphin Marine Rescue, Veterinary Department, Coffs Harbour, New South Wales, Australia
| | - K Marshall
- Dolphin Marine Rescue, Veterinary Department, Coffs Harbour, New South Wales, Australia
| | - G Swan
- Mid North Coast Cardiac Services, Medical Imaging Department, Coffs Harbour, New South Wales, Australia
| | - T Gerlach
- Veterinary Specialty Centre, Cardiology Department, Chicago, Illinois, USA
| | - H Smith
- Massey University, College of Sciences, Palmerston North, New Zealand
| | - D Blyde
- Veterinary Department, Sea World, Sea World Drive, Gold Coast, Queensland, Australia
| | - E Ariel
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - L Christidis
- National Marine Science Centre, School of Environment, Science and Engineering, Southern Cross University, Coffs Harbour, New South Wales, Australia
| | - B P Kelaher
- National Marine Science Centre, School of Environment, Science and Engineering, Southern Cross University, Coffs Harbour, New South Wales, Australia
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24
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Brocklehurst A, Barker CL, Mukherjee S, Aitken K, Macdonald C, Lakey A, Smith H, Radhakrishna G. Stereotactic Ablative Body Radiotherapy for Locally Advanced Unresectable Pancreatic Cancer: Current Views of the Public and Professionals. Clin Oncol (R Coll Radiol) 2020; 33:e198. [PMID: 33158725 DOI: 10.1016/j.clon.2020.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 10/19/2020] [Indexed: 10/23/2022]
Affiliation(s)
| | | | | | - K Aitken
- Royal Marsden Hospital, London, UK
| | | | - A Lakey
- Pancreatic Cancer UK, London, UK
| | - H Smith
- Pancreatic Cancer UK, London, UK
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25
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Smith H, Morgan D, Berggren K, Hixon M, Shen X, Woolbright B, Taylor J, Gan G. The MAPKAPK2 Pathway Mediates Radiation-Induced Tumor Inflammation And Proliferation In Bladder Cancer. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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26
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McLean KA, Ahmed WUR, Akhbari M, Claireaux HA, English C, Frost J, Henshall DE, Khan M, Kwek I, Nicola M, Rehman S, Varghese S, Drake TM, Bell S, Nepogodiev D, McLean KA, Drake TM, Glasbey JC, Borakati A, Drake TM, Kamarajah S, McLean KA, Bath MF, Claireaux HA, Gundogan B, Mohan M, Deekonda P, Kong C, Joyce H, Mcnamee L, Woin E, Burke J, Khatri C, Fitzgerald JE, Harrison EM, Bhangu A, Nepogodiev D, Arulkumaran N, Bell S, Duthie F, Hughes J, Pinkney TD, Prowle J, Richards T, Thomas M, Dynes K, Patel M, Patel P, Wigley C, Suresh R, Shaw A, Klimach S, Jull P, Evans D, Preece R, Ibrahim I, Manikavasagar V, Smith R, Brown FS, Deekonda P, Teo R, Sim DPY, Borakati A, Logan AE, Barai I, Amin H, Suresh S, Sethi R, Bolton W, Corbridge O, Horne L, Attalla M, Morley R, Robinson C, Hoskins T, McAllister R, Lee S, Dennis Y, Nixon G, Heywood E, Wilson H, Ng L, Samaraweera S, Mills A, Doherty C, Woin E, Belchos J, Phan V, Chouari T, Gardner T, Goergen N, Hayes JDB, MacLeod CS, McCormack R, McKinley A, McKinstry S, Milligan W, Ooi L, Rafiq NM, Sammut T, Sinclair E, Smith M, Baker C, Boulton APR, Collins J, Copley HC, Fearnhead N, Fox H, Mah T, McKenna J, Naruka V, Nigam N, Nourallah B, Perera S, Qureshi A, Saggar S, Sun L, Wang X, Yang DD, Caroll P, Doyle C, Elangovan S, Falamarzi A, Perai KG, Greenan E, Jain D, Lang-Orsini M, Lim S, O'Byrne L, Ridgway P, Van der Laan S, Wong J, Arthur J, Barclay J, Bradley P, Edwin C, Finch E, Hayashi E, Hopkins M, Kelly D, Kelly M, McCartan N, Ormrod A, Pakenham A, Hayward J, Hitchen C, Kishore A, Martins T, Philomen J, Rao R, Rickards C, Burns N, Copeland M, Durand C, Dyal A, Ghaffar A, Gidwani A, Grant M, Gribbon C, Gruhn A, Leer M, Ahmad K, Beattie G, Beatty M, Campbell G, Donaldson G, Graham S, Holmes D, Kanabar S, Liu H, McCann C, Stewart R, Vara S, Ajibola-Taylor O, Andah EJE, Ani C, Cabdi NMO, Ito G, Jones M, Komoriyama A, Patel P, Titu L, Basra M, Gallogly P, Harinath G, Leong SH, Pradhan A, Siddiqui I, Zaat S, Ali A, Galea M, Looi WL, Ng JCK, Atkin G, Azizi A, Cargill Z, China Z, Elliot J, Jebakumar R, Lam J, Mudalige G, Onyerindu C, Renju M, Babu VS, Hussain M, Joji N, Lovett B, Mownah H, Ali B, Cresswell B, Dhillon AK, Dupaguntla YS, Hungwe C, Lowe-Zinola JD, Tsang JCH, Bevan K, Cardus C, Duggal A, Hossain S, McHugh M, Scott M, Chan F, Evans R, Gurung E, Haughey B, Jacob-Ramsdale B, Kerr M, Lee J, McCann E, O'Boyle K, Reid N, Hayat F, Hodgson S, Johnston R, Jones W, Khan M, Linn T, Long S, Seetharam P, Shaman S, Smart B, Anilkumar A, Davies J, Griffith J, Hughes B, Islam Y, Kidanu D, Mushaini N, Qamar I, Robinson H, Schramm M, Tan CY, Apperley H, Billyard C, Blazeby JM, Cannon SP, Carse S, Göpfert A, Loizidou A, Parkin J, Sanders E, Sharma S, Slade G, Telfer R, Huppatz IW, Worley E, Chandramoorthy L, Friend C, Harris L, Jain P, Karim MJ, Killington K, McGillicuddy J, Rafferty C, Rahunathan N, Rayne T, Varathan Y, Verma N, Zanichelli D, Arneill M, Brown F, Campbell B, Crozier L, Henry J, McCusker C, Prabakaran P, Wilson R, Asif U, Connor M, Dindyal S, Math N, Pagarkar A, Saleem H, Seth I, Sharma S, Standfield N, Swartbol T, Adamson R, Choi JE, El Tokhy O, Ho W, Javaid NR, Kelly M, Mehdi AS, Menon D, Plumptre I, Sturrock S, Turner J, Warren O, Crane E, Ferris B, Gadsby C, Smallwood J, Vipond M, Wilson V, Amarnath T, Doshi A, Gregory C, Kandiah K, Powell B, Spoor H, Toh C, Vizor R, Common M, Dunleavy K, Harris S, Luo C, Mesbah Z, Kumar AP, Redmond A, Skulsky S, Walsh T, Daly D, Deery L, Epanomeritakis E, Harty M, Kane D, Khan K, Mackey R, McConville J, McGinnity K, Nixon G, Ang A, Kee JY, Leung E, Norman S, Palaniappan SV, Sarathy PP, Yeoh T, Frost J, Hazeldine P, Jones L, Karbowiak M, Macdonald C, Mutarambirwa A, Omotade A, Runkel M, Ryan G, Sawers N, Searle C, Suresh S, Vig S, Ahmad A, McGartland R, Sim R, Song A, Wayman J, Brown R, Chang LH, Concannon K, Crilly C, Arnold TJ, Burgin A, Cadden F, Choy CH, Coleman M, Lim D, Luk J, Mahankali-Rao P, Prudence-Taylor AJ, Ramakrishnan D, Russell J, Fawole A, Gohil J, Green B, Hussain A, McMenamin L, McMenamin L, Tang M, Azmi F, Benchetrit S, Cope T, Haque A, Harlinska A, Holdsworth R, Ivo T, Martin J, Nisar T, Patel A, Sasapu K, Trevett J, Vernet G, Aamir A, Bird C, Durham-Hall A, Gibson W, Hartley J, May N, Maynard V, Johnson S, Wood CM, O'Brien M, Orbell J, Stringfellow TD, Tenters F, Tresidder S, Cheung W, Grant A, Tod N, Bews-Hair M, Lim ZH, Lim SW, Vella-Baldacchino M, Auckburally S, Chopada A, Easdon S, Goodson R, McCurdie F, Narouz M, Radford A, Rea E, Taylor O, Yu T, Alfa-Wali M, Amani L, Auluck I, Bruce P, Emberton J, Kumar R, Lagzouli N, Mehta A, Murtaza A, Raja M, Dennahy IS, Frew K, Given A, He YY, Karim MA, MacDonald E, McDonald E, McVinnie D, Ng SK, Pettit A, Sim DPY, Berthaume-Hawkins SD, Charnley R, Fenton K, Jones D, Murphy C, Ng JQ, Reehal R, Robinson H, Seraj SS, Shang E, Tonks A, White P, Yeo A, Chong P, Gabriel R, Patel N, Richardson E, Symons L, Aubrey-Jones D, Dawood S, Dobrzynska M, Faulkner S, Griffiths H, Mahmood F, Patel P, Perry M, Power A, Simpson R, Ali A, Brobbey P, Burrows A, Elder P, Ganyani R, Horseman C, Hurst P, Mann H, Marimuthu K, McBride S, Pilsworth E, Powers N, Stanier P, Innes R, Kersey T, Kopczynska M, Langasco N, Patel N, Rajagopal R, Atkins B, Beasley W, Lim ZC, Gill A, Ang HL, Williams H, Yogeswara T, Carter R, Fam M, Fong J, Latter J, Long M, Mackinnon S, McKenzie C, Osmanska J, Raghuvir V, Shafi A, Tsang K, Walker L, Bountra K, Coldicutt O, Fletcher D, Hudson S, Iqbal S, Bernal TL, Martin JWB, Moss-Lawton F, Smallwood J, Vipond M, Cardwell A, Edgerton K, Laws J, Rai A, Robinson K, Waite K, Ward J, Youssef H, Knight C, Koo PY, Lazarou A, Stanger S, Thorn C, Triniman MC, Botha A, Boyles L, Cumming S, Deepak S, Ezzat A, Fowler AJ, Gwozdz AM, Hussain SF, Khan S, Li H, Morrell BL, Neville J, Nitiahpapand R, Pickering O, Sagoo H, Sharma E, Welsh K, Denley S, Khan S, Agarwal M, Al-Saadi N, Bhambra R, Gupta A, Jawad ZAR, Jiao LR, Khan K, Mahir G, Singagireson S, Thoms BL, Tseu B, Wei R, Yang N, Britton N, Leinhardt D, Mahfooz M, Palkhi A, Price M, Sheikh S, Barker M, Bowley D, Cant M, Datta U, Farooqi M, Lee A, Morley G, Amin MN, Parry A, Patel S, Strang S, Yoganayagam N, Adlan A, Chandramoorthy S, Choudhary Y, Das K, Feldman M, France B, Grace R, Puddy H, Soor P, Ali M, Dhillon P, Faraj A, Gerard L, Glover M, Imran H, Kim S, Patrick Y, Peto J, Prabhudesai A, Smith R, Tang A, Vadgama N, Dhaliwal R, Ecclestone T, Harris A, Ong D, Patel D, Philp C, Stewart E, Wang L, Wong E, Xu Y, Ashaye T, Fozard T, Galloway F, Kaptanis S, Mistry P, Nguyen T, Olagbaiye F, Osman M, Philip Z, Rembacken R, Tayeh S, Theodoropoulou K, Herman A, Lau J, Saha A, Trotter M, Adeleye O, Cave D, Gunwa T, Magalhães J, Makwana S, Mason R, Parish M, Regan H, Renwick P, Roberts G, Salekin D, Sivakumar C, Tariq A, Liew I, McDade A, Stewart D, Hague M, Hudson-Peacock N, Jackson CES, James F, Pitt J, Walker EY, Aftab R, Ang JJ, Anwar S, Battle J, Budd E, Chui J, Crook H, Davies P, Easby S, Hackney E, Ho B, Imam SZ, Rammell J, Andrews H, Perry C, Schinle P, Ahmed P, Aquilina T, Balai E, Church M, Cumber E, Curtis A, Davies G, Dennis Y, Dumann E, Greenhalgh S, Kim P, King S, Metcalfe KHM, Passby L, Redgrave N, Soonawalla Z, Waters S, Zornoza A, Gulzar I, Hole J, Hull K, Ishaq H, Karaj J, Kelkar A, Love E, Patel S, Thakrar D, Vine M, Waterman A, Dib NP, Francis N, Hanson M, Ingleton R, Sadanand KS, Sukirthan N, Arnell S, Ball M, Bassam N, Beghal G, Chang A, Dawe V, George A, Huq T, Hussain A, Ikram B, Kanapeckaite L, Khan M, Ramjas D, Rushd A, Sait S, Serry M, Yardimci E, Capella S, Chenciner L, Episkopos C, Karam E, McCarthy C, Moore-Kelly W, Watson N, Ahluwalia V, Barnfield J, Ben-Gal O, Bloom I, Gharatya A, Khodatars K, Merchant N, Moonan A, Moore M, Patel K, Spiers H, Sundaram K, Turner J, Bath MF, Black J, Chadwick H, Huisman L, Ingram H, Khan S, Martin L, Metcalfe M, Sangal P, Seehra J, Thatcher A, Venturini S, Whitcroft I, Afzal Z, Brown S, Gani A, Gomaa A, Hussein N, Oh SY, Pazhaniappan N, Sharkey E, Sivagnanasithiyar T, Williams C, Yeung J, Cruddas L, Gurjar S, Pau A, Prakash R, Randhawa R, Chen L, Eiben I, Naylor M, Osei-Bordom D, Trenear R, Bannard-Smith J, Griffiths N, Patel BY, Saeed F, Abdikadir H, Bennett M, Church R, Clements SE, Court J, Delvi A, Hubert J, Macdonald B, Mansour F, Patel RR, Perris R, Small S, Betts A, Brown N, Chong A, Croitoru C, Grey A, Hickland P, Ho C, Hollington D, McKie L, Nelson AR, Stewart H, Eiben P, Nedham M, Ali I, Brown T, Cumming S, Hunt C, Joyner C, McAlinden C, Roberts J, Rogers D, Thachettu A, Tyson N, Vaughan R, Verma N, Yasin T, Andrew K, Bhamra N, Leong S, Mistry R, Noble H, Rashed F, Walker NR, Watson L, Worsfold M, Yarham E, Abdikadir H, Arshad A, Barmayehvar B, Cato L, Chan-lam N, Do V, Leong A, Sheikh Z, Zheleniakova T, Coppel J, Hussain ST, Mahmood R, Nourzaie R, Prowle J, Sheik-Ali S, Thomas A, Alagappan A, Ashour R, Bains H, Diamond J, Gordon J, Ibrahim B, Khalil M, Mittapalli D, Neo YN, Patil P, Peck FS, Reza N, Swan I, Whyte M, Chaudhry S, Hernon J, Khawar H, O'Brien J, Pullinger M, Rothnie K, Ujjal S, Bhatte S, Curtis J, Green S, Mayer A, Watkinson G, Chapple K, Hawthorne T, Khaliq M, Majkowski L, Malik TAM, Mclauchlan K, En BNW, Parton S, Robinson SD, Saat MI, Shurovi BN, Varatharasasingam K, Ward AE, Behranwala K, Bertelli M, Cohen J, Duff F, Fafemi O, Gupta R, Manimaran M, Mayhew J, Peprah D, Wong MHY, Farmer N, Houghton C, Kandhari N, Khan K, Ladha D, Mayes J, McLennan F, Panahi P, Seehra H, Agrawal R, Ahmed I, Ali S, Birkinshaw F, Choudhry M, Gokani S, Harrogate S, Jamal S, Nawrozzadeh F, Swaray A, Szczap A, Warusavitarne J, Abdalla M, Asemota N, Cullum R, Hartley M, Maxwell-Armstrong C, Mulvenna C, Phillips J, Yule A, Ahmed L, Clement KD, Craig N, Elseedawy E, Gorman D, Kane L, Livie J, Livie V, Moss E, Naasan A, Ravi F, Shields P, Zhu Y, Archer M, Cobley H, Dennis R, Downes C, Guevel B, Lamptey E, Murray H, Radhakrishnan A, Saravanabavan S, Sardar M, Shaw C, Tilliridou V, Wright R, Ye W, Alturki N, Helliwell R, Jones E, Kelly D, Lambotharan S, Scott K, Sivakumar R, Victor L, Boraluwe-Rallage H, Froggatt P, Haynes S, Hung YMA, Keyte A, Matthews L, Evans E, Haray P, John I, Mathivanan A, Morgan L, Oji O, Okorocha C, Rutherford A, Spiers H, Stageman N, Tsui A, Whitham R, Amoah-Arko A, Cecil E, Dietrich A, Fitzpatrick H, Guy C, Hair J, Hilton J, Jawad L, McAleer E, Taylor Z, Yap J, Akhbari M, Debnath D, Dhir T, Elbuzidi M, Elsaddig M, Glace S, Khawaja H, Koshy R, Lal K, Lobo L, McDermott A, Meredith J, Qamar MA, Vaidya A, Acquaah F, Barfi L, Carter N, Gnanappiragasam D, Ji C, Kaminski F, Lawday S, Mackay K, Sulaiman SK, Webb R, Ananthavarathan P, Dalal F, Farrar E, Hashemi R, Hossain M, Jiang J, Kiandee M, Lex J, Mason L, Matthews JH, McGeorge E, Modhwadia S, Pinkney T, Radotra A, Rickard L, Rodman L, Sales A, Tan KL, Bachi A, Bajwa DS, Battle J, Brown LR, Butler A, Calciu A, Davies E, Gardner I, Girdlestone T, Ikogho O, Keelan G, O'Loughlin P, Tam J, Elias J, Ngaage M, Thompson J, Bristow S, Brock E, Davis H, Pantelidou M, Sathiyakeerthy A, Singh K, Chaudhry A, Dickson G, Glen P, Gregoriou K, Hamid H, Mclean A, Mehtaji P, Neophytou G, Potts S, Belgaid DR, Burke J, Durno J, Ghailan N, Hanson M, Henshaw V, Nazir UR, Omar I, Riley BJ, Roberts J, Smart G, Van Winsen K, Bhatti A, Chan M, D'Auria M, Green S, Keshvala C, Li H, Maxwell-Armstrong C, Michaelidou M, Simmonds L, Smith C, Wimalathasan A, Abbas J, Cairns C, Chin YR, Connelly A, Moug S, Nair A, Svolkinas D, Coe P, Subar D, Wang H, Zaver V, Brayley J, Cookson P, Cunningham L, Gaukroger A, Ho M, Hough A, King J, O'Hagan D, Widdison A, Brown R, Brown B, Chavan A, Francis S, Hare L, Lund J, Malone N, Mavi B, McIlwaine A, Rangarajan S, Abuhussein N, Campbell HS, Daniels J, Fitzgerald I, Mansfield S, Pendrill A, Robertson D, Smart YW, Teng T, Yates J, Belgaumkar A, Katira A, Kossoff J, Kukran S, Laing C, Mathew B, Mohamed T, Myers S, Novell R, Phillips BL, Thomas M, Turlejski T, Turner S, Varcada M, Warren L, Wynell-Mayow W, Church R, Linley-Adams L, Osborn G, Saunders M, Spencer R, Srikanthan M, Tailor S, Tullett A, Ali M, Al-Masri S, Carr G, Ebhogiaye O, Heng S, Manivannan S, Manley J, McMillan LE, Peat C, Phillips B, Thomas S, Whewell H, Williams G, Bienias A, Cope EA, Courquin GR, Day L, Garner C, Gimson A, Harris C, Markham K, Moore T, Nadin T, Phillips C, Subratty SM, Brown K, Dada J, Durbacz M, Filipescu T, Harrison E, Kennedy ED, Khoo E, Kremel D, Lyell I, Pronin S, Tummon R, Ventre C, Walls L, Wootton E, Akhtar A, Davies E, El-Sawy D, Farooq M, Gaddah M, Griffiths H, Katsaiti I, Khadem N, Leong K, Williams I, Chean CS, Chudek D, Desai H, Ellerby N, Hammad A, Malla S, Murphy B, Oshin O, Popova P, Rana S, Ward T, Abbott TEF, Akpenyi O, Edozie F, El Matary R, English W, Jeyabaladevan S, Morgan C, Naidu V, Nicholls K, Peroos S, Prowle J, Sansome S, Torrance HD, Townsend D, Brecher J, Fung H, Kazmi Z, Outlaw P, Pursnani K, Ramanujam N, Razaq A, Sattar M, Sukumar S, Tan TSE, Chohan K, Dhuna S, Haq T, Kirby S, Lacy-Colson J, Logan P, Malik Q, McCann J, Mughal Z, Sadiq S, Sharif I, Shingles C, Simon A, Burnage S, Chan SSN, Craig ARJ, Duffield J, Dutta A, Eastwood M, Iqbal F, Mahmood F, Mahmood W, Patel C, Qadeer A, Robinson A, Rotundo A, Schade A, Slade RD, De Freitas M, Kinnersley H, McDowell E, Moens-Lecumberri S, Ramsden J, Rockall T, Wiffen L, Wright S, Bruce C, Francois V, Hamdan K, Limb C, Lunt AJ, Manley L, Marks M, Phillips CFE, Agnew CJF, Barr CJ, Benons N, Hart SJ, Kandage D, Krysztopik R, Mahalingam P, Mock J, Rajendran S, Stoddart MT, Clements B, Gillespie H, Lee S, McDougall R, Murray C, O'Loane R, Periketi S, Tan S, Amoah R, Bhudia R, Dudley B, Gilbert A, Griffiths B, Khan H, McKigney N, Roberts B, Samuel R, Seelarbokus A, Stubbing-Moore A, Thompson G, Williams P, Ahmed N, Akhtar R, Chandler E, Chappelow I, Gil H, Gower T, Kale A, Lingam G, Rutler L, Sellahewa C, Sheikh A, Stringer H, Taylor R, Aglan H, Ashraf MR, Choo S, Das E, Epstein J, Gentry R, Mills D, Poolovadoo Y, Ward N, Bull K, Cole A, Hack J, Khawari S, Lake C, Mandishona T, Perry R, Sleight S, Sultan S, Thornton T, Williams S, Arif T, Castle A, Chauhan P, Chesner R, Eilon T, Kamarajah S, Kambasha C, Lock L, Loka T, Mohammad F, Motahariasl S, Roper L, Sadhra SS, Sheikh A, Toma T, Wadood Q, Yip J, Ainger E, Busti S, Cunliffe L, Flamini T, Gaffing S, Moorcroft C, Peter M, Simpson L, Stokes E, Stott G, Wilson J, York J, Yousaf A, Borakati A, Brown M, Goaman A, Hodgson B, Ijeomah A, Iroegbu U, Kaur G, Lowe C, Mahmood S, Sattar Z, Sen P, Szuman A, Abbas N, Al-Ausi M, Anto N, Bhome R, Eccles L, Elliott J, Hughes EJ, Jones A, Karunatilleke AS, Knight JS, Manson CCF, Mekhail I, Michaels L, Noton TM, Okenyi E, Reeves T, Yasin IH, Banfield DA, Harris R, Lim D, Mason-Apps C, Roe T, Sandhu J, Shafiq N, Stickler E, Tam JP, Williams LM, Ainsworth P, Boualbanat Y, Doull C, Egan E, Evans L, Hassanin K, Ninkovic-Hall G, Odunlami W, Shergill M, Traish M, Cummings D, Kershaw S, Ong J, Reid F, Toellner H, Alwandi A, Amer M, George D, Haynes K, Hughes K, Peakall L, Premakumar Y, Punjabi N, Ramwell A, Sawkins H, Ashwood J, Baker A, Baron C, Bhide I, Blake E, De Cates C, Esmail R, Hosamuddin H, Kapp J, Nguru N, Raja M, Thomson F, Ahmed H, Aishwarya G, Al-Huneidi R, Ali S, Aziz R, Burke D, Clarke B, Kausar A, Maskill D, Mecia L, Myers L, Smith ACD, Walker G, Wroe N, Donohoe C, Gibbons D, Jordan P, Keogh C, Kiely A, Lalor P, McCrohan M, Powell C, Foley MP, Reynolds J, Silke E, Thorpe O, Kong JTH, White C, Ali Q, Dalrymple J, Ge Y, Khan H, Luo RS, Paine H, Paraskeva B, Parker L, Pillai K, Salciccioli J, Selvadurai S, Sonagara V, Springford LR, Tan L, Appleton S, Leadholm N, Zhang Y, Ahern D, Cotter M, Cremen S, Durrigan T, Flack V, Hrvacic N, Jones H, Jong B, Keane K, O'Connell PR, O'sullivan J, Pek G, Shirazi S, Barker C, Brown A, Carr W, Chen Y, Guillotte C, Harte J, Kokayi A, Lau K, McFarlane S, Morrison S, Broad J, Kenefick N, Makanji D, Printz V, Saito R, Thomas O, Breen H, Kirk S, Kong CH, O'Kane A, Eddama M, Engledow A, Freeman SK, Frost A, Goh C, Lee G, Poonawala R, Suri A, Taribagil P, Brown H, Christie S, Dean S, Gravell R, Haywood E, Holt F, Pilsworth E, Rabiu R, Roscoe HW, Shergill S, Sriram A, Sureshkumar A, Tan LC, Tanna A, Vakharia A, Bhullar S, Brannick S, Dunne E, Frere M, Kerin M, Kumar KM, Pratumsuwan T, Quek R, Salman M, Van Den Berg N, Wong C, Ahluwalia J, Bagga R, Borg CM, Calabria C, Draper A, Farwana M, Joyce H, Khan A, Mazza M, Pankin G, Sait MS, Sandhu N, Virani N, Wong J, Woodhams K, Croghan N, Ghag S, Hogg G, Ismail O, John N, Nadeem K, Naqi M, Noe SM, Sharma A, Tan S, Begum F, Best R, Collishaw A, Glasbey J, Golding D, Gwilym B, Harrison P, Jackman T, Lewis N, Luk YL, Porter T, Potluri S, Stechman M, Tate S, Thomas D, Walford B, Auld F, Bleakley A, Johnston S, Jones C, Khaw J, Milne S, O'Neill S, Singh KKR, Smith R, Swan A, Thorley N, Yalamarthi S, Yin ZD, Ali A, Balian V, Bana R, Clark K, Livesey C, McLachlan G, Mohammad M, Pranesh N, Richards C, Ross F, Sajid M, Brooke M, Francombe J, Gresly J, Hutchinson S, Kerrigan K, Matthews E, Nur S, Parsons L, Sandhu A, Vyas M, White F, Zulkifli A, Zuzarte L, Al-Mousawi A, Arya J, Azam S, Yahaya AA, Gill K, Hallan R, Hathaway C, Leptidis I, McDonagh L, Mitrasinovic S, Mushtaq N, Pang N, Peiris GB, Rinkoff S, Chan L, Christopher E, Farhan-Alanie MMH, Gonzalez-Ciscar A, Graham CJ, Lim H, McLean KA, Paterson HM, Rogers A, Roy C, Rutherford D, Smith F, Zubikarai G, Al-Khudairi R, Bamford M, Chang M, Cheng J, Hedley C, Joseph R, Mitchell B, Perera S, Rothwell L, Siddiqui A, Smith J, Taylor K, Wright OW, Baryan HK, Boyd G, Conchie H, Cox L, Davies J, Gardner S, Hill N, Krishna K, Lakin F, Scotcher S, Alberts J, Asad M, Barraclough J, Campbell A, Marshall D, Wakeford W, Cronbach P, D'Souza F, Gammeri E, Houlton J, Hall M, Kethees A, Patel R, Perera M, Prowle J, Shaid M, Webb E, Beattie S, Chadwick M, El-Taji O, Haddad S, Mann M, Patel M, Popat K, Rimmer L, Riyat H, Smith H, Anandarajah C, Cipparrone M, Desai K, Gao C, Goh ET, Howlader M, Jeffreys N, Karmarkar A, Mathew G, Mukhtar H, Ozcan E, Renukanthan A, Sarens N, Sinha C, Woolley A, Bogle R, Komolafe O, Loo F, Waugh D, Zeng R, Crewe A, Mathias J, Mills A, Owen A, Prior A, Saunders I, Baker A, Crilly L, McKeon J, Ubhi HK, Adeogun A, Carr R, Davison C, Devalia S, Hayat A, Karsan RB, Osborne C, Scott K, Weegenaar C, Wijeyaratne M, Babatunde F, Barnor-Ahiaku E, Beattie G, Chitsabesan P, Dixon O, Hall N, Ilenkovan N, Mackrell T, Nithianandasivam N, Orr J, Palazzo F, Saad M, Sandland-Taylor L, Sherlock J, Ashdown T, Chandler S, Garsaa T, Lloyd J, Loh SY, Ng S, Perkins C, Powell-Chandler A, Smith F, Underhill R. Perioperative intravenous contrast administration and the incidence of acute kidney injury after major gastrointestinal surgery: prospective, multicentre cohort study. Br J Surg 2020; 107:1023-1032. [PMID: 32026470 DOI: 10.1002/bjs.11453] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 09/21/2019] [Accepted: 11/08/2019] [Indexed: 01/14/2023]
Abstract
BACKGROUND This study aimed to determine the impact of preoperative exposure to intravenous contrast for CT and the risk of developing postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. METHODS This prospective, multicentre cohort study included adults undergoing gastrointestinal resection, stoma reversal or liver resection. Both elective and emergency procedures were included. Preoperative exposure to intravenous contrast was defined as exposure to contrast administered for the purposes of CT up to 7 days before surgery. The primary endpoint was the rate of AKI within 7 days. Propensity score-matched models were adjusted for patient, disease and operative variables. In a sensitivity analysis, a propensity score-matched model explored the association between preoperative exposure to contrast and AKI in the first 48 h after surgery. RESULTS A total of 5378 patients were included across 173 centres. Overall, 1249 patients (23·2 per cent) received intravenous contrast. The overall rate of AKI within 7 days of surgery was 13·4 per cent (718 of 5378). In the propensity score-matched model, preoperative exposure to contrast was not associated with AKI within 7 days (odds ratio (OR) 0·95, 95 per cent c.i. 0·73 to 1·21; P = 0·669). The sensitivity analysis showed no association between preoperative contrast administration and AKI within 48 h after operation (OR 1·09, 0·84 to 1·41; P = 0·498). CONCLUSION There was no association between preoperative intravenous contrast administered for CT up to 7 days before surgery and postoperative AKI. Risk of contrast-induced nephropathy should not be used as a reason to avoid contrast-enhanced CT.
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Livermore P, Finney D, Begum J, Wyllie R, Cornell T, Smith H, Howie L, Parker L. AB1357-HPR DESIGNING THE ROYAL COLLEGE OF NURSING COMPETENCY FRAMEWORK FOR RHEUMATOLOGY NURSES. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.6681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:The 1st Edition of the RCN Competency Framework for Rheumatology Nurse Specialists (RNS) will be published in March 2020. The role of the RNS is complex, and can include caring for children and young people. The importance of RNS’s was highlighted by the National Rheumatoid Arthritis Society (NRAS 2017). The British Society for Rheumatology (BSR) outlined the need for education, training supervision and work force development. Education for RNS isn’t currently centralized but is key to improving skills and developing workforce for the future. RNS are in short supply resulting in problems of access to services and delays in care (BSR 2019). In all 4 UK nations the titles of RNS and proficiency vary greatly (Titrate trial 2019) This is likely to have an impact on patient experience and outcomes. The European League Against Rheumatism (EULAR) developed recommendations for the role of the RNS which were recently updated (Beech et al, 2019). This framework maps all of these requirements.Objectives:This work supports the development of roles, improve access for patients and reduce. This document will act as a foundation for building sustainability and a more robust education and role development strategy. This work will strengthen rheumatology nursing and support all 4 UK nation’s issues regarding recruitment, retention, sustainability, succession planning and benchmarking. Dissemination is key and we will work hard with stakeholders to ensure centralization of a nationally adopted framework. This abstract submission will increase dissemination opportunities.Methods:Online data sources were searched for the most relevant and current evidence. Where research evidence wasn’t available, existing and new knowledge was utilised from a consensus of clinical expert and patient opinions, several rounds of discussions took place virtually and face to face. RCN Rheumatology Nurse Forum Workshop attendees in June 2019 also answered a questionnaire to elicit views and demographic information regarding roles.Results:The questionnaire results demonstrated 100% (n37) agreement with the development of the framework and that only 2 respondents had completed a competency process. 60% were RNS. Of these 52% (n13) were band 6, 47% (n9) were band 7, and 1% were band 8 consultant nurses. The questionnaire highlighted the need to develop the framework. Results were fed back to the working party to inform the domains to be included.Conclusion:Document will be at BSR 2020 having successfully submitted a session proposal and abstract. Evaluation will begin later in the year 6 to 12 months from launch. We will measure impact using a variety of methods including membership Facebook pages and the questionnaire at point of download request. We will measure where and how the competency is being used and adoption of the framework throughout the UK.References:[1]Beech B, Primdahl J, van Tubergen A, et al., (2019) 2019 update of the EULAR recommendations for the role of the nurse in the management of chronic inflammatory arthritis. Ann Rheum Dis.http://dx.doi.org/10.1136/annrheumdis-2019-215458 (accessed 13 December 2019). Benner, P (1984) From novice to expert, excellence[2]British Society of Rheumatology (2019) State of Play, London: BSR. Available at: www. rheumatology.org.uk/Portals/0/Documents/ Policy/BSR_State_Of_Play_Scotland2018. pdf?ver=2019-03-11-094117-440 (accessed 13 December 2019).[3]Martin N, Ibrahim F, Tom B, et al., (2017) Does intensive management improve remission rates in patients with intermediate rheumatoid arthritis? (the TITRATE trial): study protocol for a randomized controlled trial. Trials. 2017;18:591. doi.org/10.1186/s13063-017-2330-8.Disclosure of Interests:Polly Livermore: None declared, Diana Finney Speakers bureau: NordicAbbvie, Julie Begum: None declared, Ruth Wyllie: None declared, Trish Cornell Employee of: Consultant Nurse for Abbvie, Helen Smith: None declared, Lisa Howie: None declared, Louise Parker: None declared
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Parker AE, Christen JA, Lorenz L, Smith H. Optimal surface estimation and thresholding of confocal microscope images of biofilms using Beer's Law. J Microbiol Methods 2020; 174:105943. [PMID: 32433995 DOI: 10.1016/j.mimet.2020.105943] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/08/2020] [Accepted: 05/08/2020] [Indexed: 11/17/2022]
Abstract
Beer's Law explains how light attenuates into thick specimens, including thick biofilms. We use a Bayesian optimality criterion, the maximum of the posterior probability distribution, and computationally efficiently fit Beer's Law to the 3D intensity data collected from thick living biofilms by a confocal scanning laser microscope. Using this approach the top surface of the biofilm and an optimal image threshold can be estimated. Biofilm characteristics, such as bio-volumes, can be calculated from this surface. Results from the Bayesian approach are compared to other approaches including the method of maximum likelihood or simply counting bright pixels. Uncertainty quantification (i.e., error bars) can be provided for the parameters of interest. This approach is applied to confocal images of stained biofilms of a common lab strain of Pseudomonas aeruginosa, stained biofilms of Janthinobacterium isolated from the Antarctic, and biofilms of Staphylococcusaureus that have been genetically modified to fluoresce green.
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Affiliation(s)
- A E Parker
- Center for Biofilm Engineering, Montana State University, Bozeman, MT, USA; Department of Mathematical Sciences, Montana State University, Bozeman, MT, USA.
| | - J A Christen
- Centro de Investigación en Matemáticas, Jalisco S/N, Valenciana, GTO, Guanajuato 36023, MEXICO
| | - L Lorenz
- Center for Biofilm Engineering, Montana State University, Bozeman, MT, USA
| | - H Smith
- Center for Biofilm Engineering, Montana State University, Bozeman, MT, USA; Department of Microbiology and Immunology, Montana State University, Bozeman, MT, USA
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Abstract
BACKGROUND Unplanned extubation (UE) is a common adverse event and is an important measure of quality and patient safety in the neonatal ICU. It is well recognized that UEs occur more frequently in neonates than in any other group of ventilated patients. The objective of this study was to evaluate the effectiveness of the quality improvement interventions in reducing the rates of UE in a tertiary neonatal ICU. METHODS A retrospective audit performed on ventilated infants showed a rate of 7.2 unplanned extubations per 100 ventilation days in a 12-month period (April 2016 to March 2017). We evaluated the common factors associated with UEs, with the primary reasons being loose fixation and providing care without assistance. We introduced sequential interventions focusing on better practices. Standardizing endotracheal tube fixation, continuous scrutiny of fixation through checks, 2-person technique for providing care, and adverse event reporting were a few of the important interventions. Rates of UE for each month were collected and analyzed. RESULTS With interventions, UE rates reduced by 80% (from 7.2 per 100 ventilated days in the pre-implementation period to 1.4 per 100 ventilated days in the post-implementation period) in 12-18 months. CONCLUSIONS Significant reductions in UE rates were achieved by implementing quality improvement interventions. It is important to analyze critical event rates continuously and for longer periods of time to determine the true change.
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Affiliation(s)
- Vrinda Nair
- South Tees National Health Service Trust, Middlesbrough, United Kingdom. .,Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Helena Smith
- South Tees National Health Service Trust, Middlesbrough, United Kingdom
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Affiliation(s)
- H Smith
- Department of Dermatology, Nottingham NHS Treatment Centre, Nottingham NG7 2FT, UK
| | - A Wernham
- Department of Dermatology, Nottingham NHS Treatment Centre, Nottingham NG7 2FT, UK
| | - A Patel
- Department of Dermatology, Nottingham NHS Treatment Centre, Nottingham NG7 2FT, UK
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Veitch D, Smith H, Olabi B, Lam M, Patel A, Varma S. Response to ‘Long‐term outcomes of imiquimod‐treated lentigo maligna’. Clin Exp Dermatol 2020; 45:274. [DOI: 10.1111/ced.14090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2019] [Indexed: 11/27/2022]
Affiliation(s)
- D. Veitch
- Department of Dermatology NHS Treatment Centre Nottingham UK
| | - H. Smith
- Department of Dermatology NHS Treatment Centre Nottingham UK
| | - B. Olabi
- Department of Dermatology NHS Treatment Centre Nottingham UK
| | - M. Lam
- Department of Dermatology NHS Treatment Centre Nottingham UK
| | - A. Patel
- Department of Dermatology NHS Treatment Centre Nottingham UK
| | - S. Varma
- Department of Dermatology NHS Treatment Centre Nottingham UK
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Meenaghan S, Breatnach C, Smith H. Risk Factors for Respiratory Syncytial Virus Bronchiolitis Admissions. Ir Med J 2020; 113:9. [PMID: 32298565] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Aim Determine the seasonal incidence of hospital Respiratory Syncytial Virus (RSV) bronchiolitis and explore the variables associated with admission to ward versus the Paediatric Intensive Care Unit (PICU). Method Retrospective case-control study. Children, aged ≤2 years, between November and March, over a 3 year period with a positive RSV nasopharyngeal aspirate test. Results A total of 557 children were included; 19% (n=106) required PICU admission. Children admitted to the PICU were younger in age, median (IQR) 6.93 (3.96, 11.89) weeks compared to children who remained on the wards 11.00 (5.86, 24.14) weeks. Being underweight at the point of admission (adjusted odds ratio 3.15, 95% 1.46, 6.70, p=0.003) was associated with a PICU admission. Conclusion Number of RSV bronchiolitis hospitalisations are increasing each year. Age, weight and the use of HFNC were independent predictors for PICU admission.
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Affiliation(s)
- S Meenaghan
- Children's Health Ireland at Crumlin (CHI@Crumlin), Dublin, Ireland
| | - C Breatnach
- Children's Health Ireland at Crumlin (CHI@Crumlin), Dublin, Ireland
- Paediatrics, Trinity College Dublin, Ireland
| | - H Smith
- Children's Health Ireland at Crumlin (CHI@Crumlin), Dublin, Ireland
- Paediatrics, Trinity College Dublin, Ireland
- School of Nursing, Midwifery and Health Systems, University College Dublin, Ireland
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Capps KL, McLaughlin EM, Murray AWA, Aldus CF, Wyatt GM, Peck MW, Van Amerongen A, Ariëns RMC, Wichers JH, Baylis CL, Wareing DRA, Bolton FJ, Aird H, Allen R, Anderson P, Boughtflower M, Chen Q, Davies A, Dennis J, Gibson SJ, Green RA, Hilton J, Jorgensen F, Leuschner R, Loder C, Mackey B, Meldrum R, Millar I, Reid T, Robinson AJ, Robinson; I, Smith H, Surman S, Vickers D, Wood M. Validation of Three Rapid Screening Methods for Detection of Verotoxin-Producing Escherichia coli in Foods: Interlaboratory Study. J AOAC Int 2019. [DOI: 10.1093/jaoac/87.1.68] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
An interlaboratory study was conducted for the validation of 3 methods for the detection of all verotoxin-producing Escherichia coli (VTEC) in foods. The methods were a multi-analyte 1-step lateral flow immunoassay (LFIA) for detection of E. coli O157 and verotoxin (VT); an enzyme-linked immunosorbent assay targeted against VT1, VT2, and VT2c (VT-ELISA); and a polymerase chain reaction (PCR) method for detection of VT genes (VT-PCR). Aliquots (25 g or 25 mL) of 4 food types (raw minced [ground] beef, unpasteurized milk, unpasteurized apple juice [cider], and salami) were individually inoculated with low numbers (<9 to 375 cells/25 g) of 6 test strains of E. coli (serogroups O26, O103, O111, O145, and O157) with differing VT-producing capabilities. Five replicates for each test strain and 5 uninoculated samples were prepared for each food type. Fourteen participating laboratories analyzed samples using the LFIA, 9 analyzed the samples by ELISA, and 9 by PCR. The LFIA for O157 and VT had a specificity (correct identification of negative samples) of 92 and 94%, respectively, and a sensitivity (correct identification of positive samples) of 94 and 55%, respectively. The VT-ELISA and VT-PCR
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Affiliation(s)
- Katherine L Capps
- Central Science Laboratory, Sand Hutton, York, North Yorkshire, YO41 1LZ, United Kingdom
| | - Emiline M McLaughlin
- Central Science Laboratory, Sand Hutton, York, North Yorkshire, YO41 1LZ, United Kingdom
| | - Alistair W A Murray
- Central Science Laboratory, Sand Hutton, York, North Yorkshire, YO41 1LZ, United Kingdom
| | - Clare F Aldus
- Institute of Food Research, Norwich Research Park, Colney, Norwich, NR4 7UA, United Kingdom
| | - Gary M Wyatt
- Institute of Food Research, Norwich Research Park, Colney, Norwich, NR4 7UA, United Kingdom
| | - Michael W Peck
- Institute of Food Research, Norwich Research Park, Colney, Norwich, NR4 7UA, United Kingdom
| | - Aart Van Amerongen
- Agrotechnology and Food Innovations A&F B.V., Bornsesteeg 59, 6708 PD Wageningen, The Netherlands
| | - Renata M C Ariëns
- Agrotechnology and Food Innovations A&F B.V., Bornsesteeg 59, 6708 PD Wageningen, The Netherlands
| | - Jan H Wichers
- Agrotechnology and Food Innovations A&F B.V., Bornsesteeg 59, 6708 PD Wageningen, The Netherlands
| | - Christopher L Baylis
- Campden & Chorleywood Food Research Association, Chipping Campden, Gloucestershire, GL55 6LD, United Kingdom
| | - David R A Wareing
- Preston Public Health Laboratory, Royal Preston Hospital, PO Box 202, Sharoe Green LN, Fulwood, Preston, Lancashire, PR2 9HG, United Kingdom
| | - Frederick J Bolton
- Preston Public Health Laboratory, Royal Preston Hospital, PO Box 202, Sharoe Green LN, Fulwood, Preston, Lancashire, PR2 9HG, United Kingdom
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Monteiro De Barros J, Hodson J, Glasbey J, Massey R, Rintoul-Hoad O, Chetan M, Desai A, Almond LM, Gourevitch D, Ford SJ, Strauss D, Smith H, Hayes A, Cardona K, Lopez-Aguiar A, Johnson A, Swallow C, Burtenshaw S, Nessim C, Weng R, Purgin B, Gronchi A, Fiore M, Callegaro D, Raut CP, Fairweather M, Bagaria S, Novak M, Gyorki D, Reid F, Mullinax J, Gonzalez RJ, Van Coevorden F, Van Houdt W, Haas RLM, Van Boven H, Heeres B. Intercontinental collaborative experience with abdominal, retroperitoneal and pelvic schwannomas. Br J Surg 2019; 107:452-463. [DOI: 10.1002/bjs.11376] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 07/09/2019] [Accepted: 08/30/2019] [Indexed: 11/09/2022]
Abstract
Abstract
Background
Schwannomas are rare tumours that pose a significant management challenge in the abdomen, retroperitoneum and pelvis. No data are available to inform management strategy.
Methods
A collaborative international cohort study, across specialist sarcoma units, was conducted to include adults presenting between 2000 and 2017 with histopathologically confirmed schwannomas within the abdomen, retroperitoneum or pelvis.
Results
Of 485 patients across 12 centres, 38 (7·8 per cent) were discharged without follow-up, 199 (41·0 per cent) underwent early resection and 248 (51·1 per cent) had radiological monitoring. Of these 248 patients, 96 (38·7 per cent) eventually had surgery, giving an overall resection rate of 60·8 per cent (295 of 485). At baseline, median tumour volume was 90·1 (i.q.r. 26·5–262·0) cm3. The estimated growth rate was 10·5 (95 per cent c.i. 9·4 to 11·6) per cent per year, and was consistent in the short term (within 2 years of diagnosis) and long term (beyond 2 years) (ρ = 0·405, P = 0·021). A decision to operate was more common in symptomatic patients (P < 0·001) and for rapidly growing tumours (growth rate more than 20 per cent per year) (P = 0·025). R0/R1 resection was achieved in 91·6 per cent of patients (263 of 287). Kaplan–Meier long-term recurrence rates after R0/R1 resection were 2·3 and 6·7 per cent at 3 and 5 years respectively.
Conclusion
Specific recommendations include: indications for early surgery, prediction of growth from radiological monitoring, promotion of selective submacroscopic resection and cessation of postoperative imaging surveillance.
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Affiliation(s)
| | | | - J Hodson
- Queen Elizabeth Hospital, Birmingham, UK
| | - J Glasbey
- Queen Elizabeth Hospital, Birmingham, UK
| | - R Massey
- Queen Elizabeth Hospital, Birmingham, UK
| | | | - M Chetan
- Queen Elizabeth Hospital, Birmingham, UK
| | - A Desai
- Queen Elizabeth Hospital, Birmingham, UK
| | - L M Almond
- Queen Elizabeth Hospital, Birmingham, UK
| | | | - S J Ford
- Queen Elizabeth Hospital, Birmingham, UK
| | | | - H Smith
- Royal Marsden Hospital, London, UK
| | - A Hayes
- Royal Marsden Hospital, London, UK
| | - K Cardona
- Emory University Hospital, Atlanta, Georgia, USA
| | | | - A Johnson
- Emory University Hospital, Atlanta, Georgia, USA
| | - C Swallow
- Mount Sinai Hospital, Toronto, Ontario, Canada
| | | | - C Nessim
- Ottawa Hospital Research Institute, Ottawa, Quebec, Canada
| | - R Weng
- Ottawa Hospital Research Institute, Ottawa, Quebec, Canada
| | - B Purgin
- Ottawa Hospital Research Institute, Ottawa, Quebec, Canada
| | - A Gronchi
- Istituto Nazionale dei Tumori, Milan, Italy
| | - M Fiore
- Istituto Nazionale dei Tumori, Milan, Italy
| | | | - C P Raut
- Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - M Fairweather
- Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - S Bagaria
- Mayo Clinic, Jacksonville, Florida, USA
| | - M Novak
- Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - D Gyorki
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - F Reid
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - J Mullinax
- Moffitt Cancer Centre, Tampa, Florida, USA
| | | | | | - W Van Houdt
- Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - R L M Haas
- Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - H Van Boven
- Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - B Heeres
- Netherlands Cancer Institute, Amsterdam, the Netherlands
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Smith H, Mohd Mustapa MF, Cheung ST, de Berker DAR. National audit on the management of bullous pemphigoid. Clin Exp Dermatol 2019; 45:289-294. [PMID: 31502666 DOI: 10.1111/ced.14086] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Bullous pemphigoid (BP) is an autoimmune, subepidermal, blistering condition that typically affects elderly people. AIM To undertake a national clinical audit based on standards derived from the British Association of Dermatologists (BAD) clinical guidelines on the management of BP. METHODS In 2018, BAD members were invited to submit data for five consecutive adults with BP per centre, who had been under hospital supervision for at least 12 months, in a national audit over an 11-week period. RESULTS In total, 123 responders from 120 hospitals provided data for 524 cases. Diagnosis was made either clinically (10.7%; 56 of 524) or through histology with direct immunofluorescence (41.6%; 218 of 524), indirect immunofluorescence (10.3%; 54 of 524) or both (37.4%; 196 of 524). Most patients had very mild baseline disease (63.9%; 225 of 352) with 21.9% (77 of 352) considered mild, 9.8% (31 of 352) moderate and 5.4% (19 of 352) severe. Documentation of diabetes, glycated haemoglobin (HbA1c), blood pressure and hypertension was available for 54.1% (283 of 523), 51% (267 of 524), 44.2% (231 of 522) and 61.5% (321 of 522) of cases, respectively. Oral corticosteroids were commenced in 85.5% (448 of 524) of patients, with 38.4% (172 of 448) of these having documented risk of osteoporosis; data regarding prescription of bone-protection therapies were available for 99.7% (447 of 448) of cases, with 75.6% (338 of 447) of these having a bone-protection prescription. Patient satisfaction was documented in 59.3% (310 of 523) of cases. Systemic treatment was commenced in 95.9% (502 of 524) of cases during the 12-month assessment period, with baseline blood test and follow-up data available for 96.6% (485 of 502) and 95.6% (480 of 502), respectively. Documentation of baseline blood tests was available for 87.4% (424 of 485) of cases, with follow-up tests recorded in 69.8% (335 of 480). CONCLUSION Overall, compliance with elements of documentation was moderate or low, whereas standards pertaining to direct care were high.
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Affiliation(s)
- H Smith
- Department of Dermatology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | | | - D A R de Berker
- Department of Dermatology, Bristol Royal Infirmary, Bristol, UK
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Figueroa-Ramos MI, Arroyo-Novoa CM, García-DeJesús RL, Sepúlveda-Santiago CS, Solís-Báez SS, Ely EW, Smith H. Translation and cultural adaptation process to Spanish of the Preschool Confusion Assessment Method for the Intensive Care Unit. Med Intensiva 2019; 44:453-456. [PMID: 31345601 DOI: 10.1016/j.medin.2019.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 06/19/2019] [Accepted: 06/25/2019] [Indexed: 10/26/2022]
Affiliation(s)
- M I Figueroa-Ramos
- Escuela de Enfermería, Recinto de Ciencias Médicas, Universidad de Puerto Rico, San Juan, PR.
| | - C M Arroyo-Novoa
- Escuela de Enfermería, Recinto de Ciencias Médicas, Universidad de Puerto Rico, San Juan, PR
| | - R L García-DeJesús
- Escuela de Medicina, Recinto de Ciencias Médicas, Universidad de Puerto Rico, San Juan, PR
| | - C S Sepúlveda-Santiago
- Escuela de Enfermería, Recinto de Ciencias Médicas, Universidad de Puerto Rico, San Juan, PR
| | - S S Solís-Báez
- Escuela de Enfermería, Recinto de Ciencias Médicas, Universidad de Puerto Rico, San Juan, PR
| | - E W Ely
- Departamento de Medicina, Vanderbilt University Medical Center, Nashville, TN
| | - H Smith
- Departamento de Anestesiología y Pediatría, Vanderbilt University Medical Center, Nashville, TN
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Smith H, Lim CS, Evans N, Papadopoulou A, Khalifa M, Tsui J, Hamilton G, Brookes JA. IYSC10. Review of Serious Complications from Embolosclerotherapy of Head and Neck Vascular Malformations in a Single Specialist Center. J Vasc Surg 2019. [DOI: 10.1016/j.jvs.2019.04.044] [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]
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Scadding GK, Kariyawasam HH, Scadding G, Mirakian R, Buckley RJ, Dixon T, Durham SR, Farooque S, Jones N, Leech S, Nasser SM, Powell R, Roberts G, Rotiroti G, Simpson A, Smith H, Clark AT. BSACI guideline for the diagnosis and management of allergic and non-allergic rhinitis (Revised Edition 2017; First edition 2007). Clin Exp Allergy 2019; 47:856-889. [PMID: 30239057 DOI: 10.1111/cea.12953] [Citation(s) in RCA: 135] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 05/01/2017] [Accepted: 05/04/2017] [Indexed: 12/12/2022]
Abstract
This is an updated guideline for the diagnosis and management of allergic and non-allergic rhinitis, first published in 2007. It was produced by the Standards of Care Committee of the British Society of Allergy and Clinical Immunology, using accredited methods. Allergic rhinitis is common and affects 10-15% of children and 26% of adults in the UK, it affects quality of life, school and work attendance, and is a risk factor for development of asthma. Allergic rhinitis is diagnosed by history and examination, supported by specific allergy tests. Topical nasal corticosteroids are the treatment of choice for moderate to severe disease. Combination therapy with intranasal corticosteroid plus intranasal antihistamine is more effective than either alone and provides second line treatment for those with rhinitis poorly controlled on monotherapy. Immunotherapy is highly effective when the specific allergen is the responsible driver for the symptoms. Treatment of rhinitis is associated with benefits for asthma. Non-allergic rhinitis also is a risk factor for the development of asthma and may be eosinophilic and steroid-responsive or neurogenic and non- inflammatory. Non-allergic rhinitis may be a presenting complaint for systemic disorders such as granulomatous or eosinophilic polyangiitis, and sarcoidoisis. Infective rhinitis can be caused by viruses, and less commonly by bacteria, fungi and protozoa.
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Affiliation(s)
- G K Scadding
- The Royal National Throat Nose and Ear Hospital, London, UK
| | - H H Kariyawasam
- The Royal National Throat Nose and Ear Hospital, London, UK.,UCLH NHS Foundation Trust, London, UK
| | - G Scadding
- Department of Upper Respiratory Medicine, Imperial College NHLI, London, UK
| | - R Mirakian
- The Royal National Throat Nose and Ear Hospital, London, UK
| | - R J Buckley
- Vision and Eye Research Unit, Anglia Ruskin University, Cambridge, UK
| | - T Dixon
- Royal Liverpool and Broad green University Hospital NHS Trust, Liverpool, UK
| | - S R Durham
- Department of Upper Respiratory Medicine, Imperial College NHLI, London, UK
| | - S Farooque
- Chest and Allergy Department, St Mary's Hospital, Imperial College NHS Trust, London, UK
| | - N Jones
- The Park Hospital, Nottingham, UK
| | - S Leech
- Department of Child Health, King's College Hospital, London, UK
| | - S M Nasser
- Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
| | - R Powell
- Department of Clinical Immunology and Allergy, Nottingham University, Nottingham UK
| | - G Roberts
- Department of Child Health, University of Southampton Hospital, Southampton, UK
| | - G Rotiroti
- The Royal National Throat Nose and Ear Hospital, London, UK
| | - A Simpson
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, UK
| | - H Smith
- Division of Primary Care and Public Health, University of Sussex, Brighton, UK
| | - A T Clark
- Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
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Carter A, Smith H, Shridharani A. 182 Simultaneous Placement of Virtue Male Sling and Titan Inflatable Penile Prosthesis in Men Following Radical Prostatectomy. J Sex Med 2019. [DOI: 10.1016/j.jsxm.2019.01.191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Affiliation(s)
- H Smith
- Department of Dermatology, NHS Treatment Centre, Nottingham, U.K
| | - B Olabi
- Department of Dermatology, NHS Treatment Centre, Nottingham, U.K.,Department of Dermatology, Lauriston Buildings, Edinburgh, U.K
| | - M Lam
- Department of Dermatology, NHS Treatment Centre, Nottingham, U.K
| | - A Patel
- Department of Dermatology, NHS Treatment Centre, Nottingham, U.K
| | - S Varma
- Department of Dermatology, NHS Treatment Centre, Nottingham, U.K
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Sabir F, Tomlinson J, Strickland-Hodge B, Smith H. 60EXAMINING THE UTILITY OF THE CONNECT WITH PHARMACY (CWP) INTERVENTION IN REDUCING ELDERLY READMISSION. Age Ageing 2019. [DOI: 10.1093/ageing/afy211.60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- F Sabir
- Medicines Management and Pharmacy Service, St James University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, West Yorkshire
| | - J Tomlinson
- Medicines Management and Pharmacy Service, St James University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, West Yorkshire
- University of Bradford
| | | | - H Smith
- Medicines Management and Pharmacy Service, St James University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, West Yorkshire
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Tomlinson J, Silcock J, Karban K, Blenkinsopp A, Smith H. 109A GROUNDED THEORY APPROACH TO UNDERSTANDING THE ROLE OF MEDICATION SAFETY WITHIN A HOSPITAL EARLY DISCHARGE TEAM. Age Ageing 2019. [DOI: 10.1093/ageing/afy204.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- J Tomlinson
- Medicines Management and Pharmacy Services, Leeds Teaching Hospitals Trust
- University of Bradford
| | | | | | | | - H Smith
- Medicines Management and Pharmacy Services, Leeds Teaching Hospitals Trust
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Weston-Price S, Copley V, Smith H, Davies GM. A multi-variable analysis of four factors affecting caries levels among five-year-old children; deprivation, ethnicity, exposure to fluoridated water and geographic region. Community Dent Health 2018; 35:217-222. [PMID: 30188616 DOI: 10.1922/cdh_4383weston-price06] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To assess the role of factors posited to affect population caries levels across England. BASIC RESEARCH DESIGN Multivariable regression analysis assessing four potential determinants of caries severity and prevalence: deprivation, exposure to fluoridated water, ethnicity and geographic region Participants: Random sample of 121,875 five-year-old children in England in the 2014/15 academic year. MAIN OUTCOME MEASURES Decayed, missing and filled teeth, with decay measured at the dentinal level, (d₃mft), presented as prevalence (dmft⟩0) and extent of decay among children who have any (d₃mft if d₃mft>0). INDEPENDENT VARIABLES Parental reported ethnicity from school records, index of multiple deprivation (IMD) scores, region and exposure to water fluoridation calculated utilising home postcodes. RESULTS The data support wider literature displaying associations between caries and deprivation across a social gradient. The important, new findings are deprivation, some ethnic groups and lack of exposure to water fluoridation are all associated with increased prevalence and severity of caries when considered together and independently. New evidence supports the impact of water fluoridation on health inequalities in that the greatest impact of exposure to fluoridated water was seen in the most deprived children and those from an Asian / Asian British ethnic group. CONCLUSIONS Five-year-old children who were from the most deprived areas, not exposed to fluoridated water, of an Eastern European ethnic group and living in the North West demonstrated the highest prevalence and severity of caries in the survey under scrutiny. This is of public health importance, providing evidence for population groups to target with health improvement activities.
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Affiliation(s)
- S Weston-Price
- Speciality Registrar in Dental Public Health, Public Health England (London)
| | - V Copley
- Principal Analyst, Risk Factors Intelligence, Public Health England
| | - H Smith
- Head of Health Intelligence - National Child and Maternal Health Intelligence Network, Public Health England
| | - G M Davies
- Consultant in Dental Public Health, Public Health England
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Menezes D, Woolrych R, Makita M, Sixsmith J, Murray M, Smith H, Reddy S, Duvvuru J. EXPLORING TRANSNATIONAL UNDERSTANDINGS OF AGE-FRIENDLY CITIES AND COMMUNITIES. Innov Aging 2018. [DOI: 10.1093/geroni/igy031.3468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Lawthom R, Woolrych R, Fisher J, Murray M, Smith H, Garcia-Ferrari S, Portella A, Pereira G. MAKING METHODS AGE FRIENDLY: METHODS, MOVEMENT, AND MAPPING. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- R Lawthom
- Manchester Metropolitan University, Manchester, England, United Kingdom
| | - R Woolrych
- Heriot-Watt University, Edinburgh, Scotl
| | - J Fisher
- Manchester Metropolitan University, Manchester, Engl
| | | | - H Smith
- Heriot-Watt University, Scotl
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Dillon M, Bergerhoff K, Pedersen M, Whittock H, Patin E, Smith H, Paget J, Patel R, Bozhanova G, Foo S, Campbell J, Ragulan C, Fontana E, Wilkins A, Sadanandam A, Melcher A, McLaughlin M, Harrington K. ATR inhibition with radiation creates an inflammatory tumour microenvironment. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy303.019] [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: 11/14/2022] Open
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Smith H, Lam M, Patel A. First reported case of dermatofibrosarcoma in siblings. Clin Exp Dermatol 2018; 44:466-467. [PMID: 30267446 DOI: 10.1111/ced.13788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2018] [Indexed: 11/28/2022]
Affiliation(s)
- H Smith
- Dermatology Department, Gateway A, The Treatment Centre, Circle Nottingham, Lister Road, Nottingham, NG7 2FT, UK
| | - M Lam
- Dermatology Department, Gateway A, The Treatment Centre, Circle Nottingham, Lister Road, Nottingham, NG7 2FT, UK
| | - A Patel
- Dermatology Department, Gateway A, The Treatment Centre, Circle Nottingham, Lister Road, Nottingham, NG7 2FT, UK
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P, Dinning L, Rahman S, Ray S, Dimicri C, Guppy S, Nielsen H, Vogel C, Ariza C, Morales L, Chang Y, Gabbay R, Ambrocio L, Manley L, Nemery R, Charlton W, Smith P, Kerr L, Steindel-Kopp B, Alamaguer M, Tabisola-Nuesca E, Pendersen A, Larson N, Cooper-Olviver H, Chan D, Fitz-Patrick D, Carreira T, Park Y, Ruhaak R, Liljenquist D. A Type 1 Diabetes Genetic Risk Score Predicts Progression of Islet Autoimmunity and Development of Type 1 Diabetes in Individuals at Risk. Diabetes Care 2018; 41:1887-1894. [PMID: 30002199 PMCID: PMC6105323 DOI: 10.2337/dc18-0087] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 06/06/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We tested the ability of a type 1 diabetes (T1D) genetic risk score (GRS) to predict progression of islet autoimmunity and T1D in at-risk individuals. RESEARCH DESIGN AND METHODS We studied the 1,244 TrialNet Pathway to Prevention study participants (T1D patients' relatives without diabetes and with one or more positive autoantibodies) who were genotyped with Illumina ImmunoChip (median [range] age at initial autoantibody determination 11.1 years [1.2-51.8], 48% male, 80.5% non-Hispanic white, median follow-up 5.4 years). Of 291 participants with a single positive autoantibody at screening, 157 converted to multiple autoantibody positivity and 55 developed diabetes. Of 953 participants with multiple positive autoantibodies at screening, 419 developed diabetes. We calculated the T1D GRS from 30 T1D-associated single nucleotide polymorphisms. We used multivariable Cox regression models, time-dependent receiver operating characteristic curves, and area under the curve (AUC) measures to evaluate prognostic utility of T1D GRS, age, sex, Diabetes Prevention Trial-Type 1 (DPT-1) Risk Score, positive autoantibody number or type, HLA DR3/DR4-DQ8 status, and race/ethnicity. We used recursive partitioning analyses to identify cut points in continuous variables. RESULTS Higher T1D GRS significantly increased the rate of progression to T1D adjusting for DPT-1 Risk Score, age, number of positive autoantibodies, sex, and ethnicity (hazard ratio [HR] 1.29 for a 0.05 increase, 95% CI 1.06-1.6; P = 0.011). Progression to T1D was best predicted by a combined model with GRS, number of positive autoantibodies, DPT-1 Risk Score, and age (7-year time-integrated AUC = 0.79, 5-year AUC = 0.73). Higher GRS was significantly associated with increased progression rate from single to multiple positive autoantibodies after adjusting for age, autoantibody type, ethnicity, and sex (HR 2.27 for GRS >0.295, 95% CI 1.47-3.51; P = 0.0002). CONCLUSIONS The T1D GRS independently predicts progression to T1D and improves prediction along T1D stages in autoantibody-positive relatives.
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Affiliation(s)
- Maria J. Redondo
- Texas Children’s Hospital, Baylor College of Medicine, Houston, TX
| | | | - Andrea K. Steck
- Barbara Davis Center for Childhood Diabetes, University of Colorado School of Medicine, Aurora, CO
| | - Seth Sharp
- Institute of Biomedical and Clinical Science, University of Exeter, Exeter, U.K
| | - John M. Wentworth
- Walter and Eliza Hall Institute of Medical Research and Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Michael N. Weedon
- Institute of Biomedical and Clinical Science, University of Exeter, Exeter, U.K
| | | | | | | | | | - Richard A. Oram
- Institute of Biomedical and Clinical Science, University of Exeter, Exeter, U.K
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Loerbroks A, Tolksdorf S, Wagenmann M, Smith H. Food allergy knowledge and attitudes among restaurant staff in Germany. Das Gesundheitswesen 2018. [DOI: 10.1055/s-0038-1667693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- A Loerbroks
- Universität Düsseldorf, Institut für Arbeits-, Sozial- und Umweltmedizin, Düsseldorf, Deutschland
| | - S Tolksdorf
- Universität Düsseldorf, Institut für Arbeits-, Sozial- und Umweltmedizin, Düsseldorf, Deutschland
| | - M Wagenmann
- Universitätsklinikum Düsseldorf, Klinik für Hals-Nasen-Ohrenheilkunde, Düsseldorf, Deutschland
| | - H Smith
- Nanyang Technological University, Lee Kong Chian School of Medicine, Singapore, Singapur
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Dahly D, Li X, Smith H, Khashan A, Deirdre M, Kiely M. Associations between maternal lifestyle factors and neonatal body composition in the screening for pregnancy endpoints (CORK) cohort study. Rev Epidemiol Sante Publique 2018. [DOI: 10.1016/j.respe.2018.05.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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