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Tucker A, Norrish AR, Fendius S, Uzoho C, Thorne T, Del Hoyo E, Nightingale J, Taylor A, Ollivere BJ. Definitive Taylor Spatial Frame management for the treatment of high-energy open tibial fractures: Clinical and patient-reported outcomes. Injury 2022; 53:4104-4113. [PMID: 36424690 DOI: 10.1016/j.injury.2022.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 10/02/2022] [Accepted: 10/17/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND High energy open tibial fractures are complex injuries with no consensus on the optimal method of fixation. Treatment outcomes are often reported with union and re-operation rates, often without specific definitions being provided. We sought to describe union, reoperation rates, and patient reported outcomes, using the validated EQ-VAS and Disability Rating Index (DRI) scores, following stabilisation with a Taylor Spatial Frame (TSF) and a combined orthoplastic approach for the management of soft tissues. A literature review is also provided. METHOD A prospective cross-sectional follow up of open tibial fractures, treated at a level 1 major trauma centre, managed with a TSF using a one ring per segment technique between January 2014 and December 2019 were identified. Demographic, injury and operative data were recorded, along with Patient Reported Outcome Measures (PROM) scores, specifically the EQ-VAS and Disability Rating Index (DRI). Union rates, defined by radiographic union scale in tibia (RUST) scores, and re-operation rates were recorded. Appropriate statistical analyses were performed, with a p<0.05 considered statistically significant. RESULTS Overall, 51 patients were included. Mean age was 51.2 ± 17.4 years, with a 4:1 male preponderance. Diaphyseal and distal fractures accounted for 76% of cases. Mean time in frame was 206.7 ± 149.4 days. Union was defined and was achieved in 41/51 (80.4%) patients. Deep infection occurred in 6/51 (11.8%) patients. Amputation was performed in 1 case (1.9%). Overall re-operation rate was 33%. Time to union were significantly longer if re-operation was required for any reason (uncomplicated 204±189 vs complicated 304±155 days; p = 0.0017) . EQ-VAS and DRI scores significantly deteriorated at 1 year follow-up (EQVAS 87.5 ± 11.7 vs 66.5 ± 20.4;p<0.0001 and DRI 11.9 ± 17.8 vs 39.3 ± 23.3;p<0.0001). At 1 year post op, 23/51(45.1%) required a walking aid, and 17/29 (58.6%) of those working pre-injury had returned to work. CONCLUSION Open tibial fracture have significant morbidity and long recovery periods as determined by EQVAS and DRI outcome measures. We report the largest series of open tibial feature treated primarily with a TSF construct, which has similar outcomes to other techniques, and should therefore be considered as a useful technique for managing these injuries.
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Affiliation(s)
- A Tucker
- Queens Medical Centre, Nottingham University Hospitals Trust, Nottingham UK
| | - A R Norrish
- Academic Orthopaedics, Trauma and Sports Medicine, University of Nottingham, Nottingham, UK; Queen Elizabeth Hospital, Kings Lynn, UK
| | - S Fendius
- Queens Medical Centre, Nottingham University Hospitals Trust, Nottingham UK
| | - C Uzoho
- Queens Medical Centre, Nottingham University Hospitals Trust, Nottingham UK
| | - T Thorne
- University of Nottingham, Nottingham, UK
| | - E Del Hoyo
- University of Nottingham, Nottingham, UK
| | - J Nightingale
- Queens Medical Centre, Nottingham University Hospitals Trust, Nottingham UK; Academic Orthopaedics, Trauma and Sports Medicine, University of Nottingham, Nottingham, UK
| | - A Taylor
- Queens Medical Centre, Nottingham University Hospitals Trust, Nottingham UK
| | - B J Ollivere
- Queens Medical Centre, Nottingham University Hospitals Trust, Nottingham UK; University of Nottingham, Nottingham, UK; NIHR Nottingham Biomedical research Unit, Nottingham, UK
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Murphy L, Nightingale J, Calder P. Difficulties associated with Reporting Radiographer working practices - A narrative evidence synthesis. Radiography (Lond) 2022; 28:1101-1109. [PMID: 36075163 DOI: 10.1016/j.radi.2022.08.007] [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: 06/01/2022] [Revised: 07/28/2022] [Accepted: 08/17/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVES This narrative synthesis of evidence identifies and explores issues that impact upon the expansion or effectiveness of Reporting Radiographers working in all diagnostic modalities within the United Kingdom (UK). The publication focuses on working practices affecting trainees and qualified Reporting Radiographers. KEY FINDINGS Fourteen studies informed the themes of this article, they were published between 2014 and 2021. Delays to commencement of reporting roles and variance in performance monitoring was common. Lack of formalisation, overly restrictive and out of date scopes of practice were also found. Whilst, staffing shortages contributed to underutilisation. Failure to utilise skills was most prevalent in cross sectional imaging modalities. Considerable variance in practice was also found between centres. Meanwhile, Reporting Radiographer involvement in professional development, education and research is far from universal and often dependant on individuals sacrificing their own time. CONCLUSION Governance in many centres would benefit from renewal and standardisation, particularly relating to scopes of practice and performance monitoring audits. Measures are also required to encourage compliance with guidance, address staffing issues and reduce variation between centres. Failure to address these issues has the potential to impair collaboration, delay patient care and increase economic inefficiencies whilst negatively impacting satisfaction for service users and staff. Lack of involvement in professional development, education and research suggests Reporting Radiographers are not accomplishing their full potential, educating the next generation of the reporting workforce and driving evidence-based change for further development of the specialism. IMPLICATIONS FOR PRACTICE Better use of the existing workforce is essential to increase productivity, value, and security of Reporting Radiographer services, which are essential to improve patient outcomes and efficiency.
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Affiliation(s)
- L Murphy
- Radiology Department, Newcastle Upon Tyne NHS Foundation Trust, UK.
| | - J Nightingale
- Dept of Allied Health Professions, Sheffield Hallam University, UK
| | - P Calder
- Radiology Department, Newcastle Upon Tyne NHS Foundation Trust, UK
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3
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Ali N, Saunders J, Ibbotson R, Shute E, Burke G, Cadman V, Elkington M, Nightingale J. The changing role of pre-admission work experience (clinical visits) in Therapeutic Radiography, Diagnostic Radiography and Operating Department Practice: Student perspectives (Part 1). Radiography (Lond) 2022; 28 Suppl 1:S77-S83. [PMID: 36038464 DOI: 10.1016/j.radi.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 07/20/2022] [Accepted: 08/02/2022] [Indexed: 10/15/2022]
Abstract
INTRODUCTION Clinical visits (work experience opportunities) are a recommended part of admissions processes for many diagnostic and therapeutic radiography courses but not for operating department practice (ODP) where observational visits are challenging for applicants to obtain. The Covid-19 pandemic interrupted access to visits for all prospective students; this study presents a review of the value of clinical visits and alternatives. METHODS This article reports the initial qualitative phase of a three-phase mixed methods study. Using a critical realist approach, focus groups explored first year student experiences of the 'ideal' pre-admission clinical visit and alternative resources. A structured review of Online Prospectus (OLP) entries was undertaken by two student researchers to ascertain the requirements for clinical visits for the three professions. RESULTS Four focus groups included 25 first year students interviewed prior to their first clinical placement (14 therapeutic radiography, 5 diagnostic radiography and 6 ODP students). Three themes were constructed, namely: informing career choices, the clinical visit experience, and the value of clinical visits. Clinical visits affirmed rather than inspired career choices. The best timing for a visit was before admission interviews and optimal duration was a full day. Interacting with current students was the most valued aspect. Videos and simulations provided in-depth information about the professional role and allowed replay, but some participants found the videos uninspiring. OLP entries present a confusing picture for applicants who may be researching several Universities and professions. CONCLUSION Clinical visits were deemed 'vital' to radiography student career choices, yet ODPs who could not access visits were comfortable with videos. Simulated visits are a safe option amidst the pandemic but must capture the dynamic and patient-centred nature of practice to accurately inform career choices.
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Affiliation(s)
- N Ali
- Sheffield Hallam University, Dept of Allied Health Professions, Sheffield, United Kingdom
| | - J Saunders
- Sheffield Hallam University, College of Health, Wellbeing and Life Sciences, Sheffield, United Kingdom
| | - R Ibbotson
- Sheffield Hallam University, Dept of Allied Health Professions, Sheffield, United Kingdom
| | - E Shute
- Sheffield Hallam University, Dept of Allied Health Professions, Sheffield, United Kingdom
| | - G Burke
- Sheffield Hallam University, Dept of Allied Health Professions, Sheffield, United Kingdom
| | - V Cadman
- Sheffield Hallam University, Dept of Allied Health Professions, Sheffield, United Kingdom
| | - M Elkington
- Sheffield Hallam University, Dept of Allied Health Professions, Sheffield, United Kingdom
| | - J Nightingale
- Sheffield Hallam University, Dept of Allied Health Professions, Sheffield, United Kingdom.
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Ibbotson R, Ali N, Cadman V, Burke G, Shute E, Elkington M, Nightingale J. The changing role of pre-admission work experience (clinical visits) in therapeutic radiography, diagnostic radiography and operating department practice: Academic perspectives (part 2). Radiography (Lond) 2022; 28 Suppl 1:S84-S92. [PMID: 36031518 PMCID: PMC9413848 DOI: 10.1016/j.radi.2022.08.003] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 07/22/2022] [Accepted: 08/02/2022] [Indexed: 11/19/2022]
Abstract
Introduction A clinical visit (work experience) provides an opportunity for prospective students, prior to registration, to visit a clinical department to observe health professionals in practice. The Covid-19 pandemic interrupted access to clinical visits; this article explores the value of clinical visits and the alternatives implemented as a response to Covid-19 restrictions from an academic perspective. Methods This article reports the quantitative phase of a three-phase mixed methods study. A survey was distributed to Higher Education Institution (HEI) education leaders for onward distribution to academics supporting recruitment for diagnostic radiography, therapeutic radiography and operating department practice programmes. Qualtrics online survey software was used to administer the survey which was launched in October 2020. Descriptive statistics summarised the data. Results Representing 37.7% (n = 18/49) of eligible universities, 34 responses from 18 HEIs across England and Wales were received Seventy-eight percent of respondents strongly agreed that they are vital in confirming career choices. Prior to the Covid-19 pandemic, 64% of respondents’ programmes had a clinical visit requirement, yet with improvements in simulation and online learning alternatives, 48% agreed that in the longer-term clinical visits will become obsolete. Conclusion Requirements for clinical visits vary between professions and HEIs; academics welcome an opportunity to standardise work experience. Regardless of prospective student background and selected profession/university, all should have equitable and easily available access to high quality resources to support career decision-making. Implications for practice The enforced withdrawal of clinical visits may impact upon subsequent attrition associated with ‘misinformed career choice’. Alternatives to clinical visits, while less onerous for students, admissions staff and clinical colleagues alike, need to be carefully evaluated to ensure they offer prospective students a realistic understanding of the profession.
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Affiliation(s)
- R Ibbotson
- Sheffield Hallam University, Department of Allied Health Professions, Sheffield, United Kingdom
| | - N Ali
- Sheffield Hallam University, Department of Allied Health Professions, Sheffield, United Kingdom
| | - V Cadman
- Sheffield Hallam University, Department of Allied Health Professions, Sheffield, United Kingdom
| | - G Burke
- Sheffield Hallam University, Department of Allied Health Professions, Sheffield, United Kingdom
| | - E Shute
- Sheffield Hallam University, Department of Allied Health Professions, Sheffield, United Kingdom
| | - M Elkington
- Sheffield Hallam University, Department of Allied Health Professions, Sheffield, United Kingdom
| | - J Nightingale
- Sheffield Hallam University, Department of Allied Health Professions, Sheffield, United Kingdom.
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Murphy L, Nightingale J, Calder P. Difficulties associated with access to training and clinical support for Reporting Radiographers - A narrative evidence synthesis. Radiography (Lond) 2022; 28:1071-1079. [PMID: 35998381 DOI: 10.1016/j.radi.2022.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 07/28/2022] [Accepted: 08/02/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVES This narrative synthesis of evidence identifies and explores issues that impact upon the expansion or effectiveness of Reporting Radiographers working in all diagnostic modalities within the United Kingdom (UK). The publication focuses on accessibility to training for prospective Reporting Radiographers as well as clinical support within and beyond training. KEY FINDINGS Fifteen studies informed the themes of this article, they were published between 2014 and 2021. Reporting Radiographers often found it difficult find support during training and once qualified, this was usually due to the availability and workload of supervising staff. Although resistance and obstruction were experienced by many. Concerns relating to pay, promotion and interest were expressed by some respondents whilst access to courses and finance were highlighted as areas of variance across the UK. CONCLUSION Inadequate support of Reporting Radiographers is impairing expansion of the specialism, whilst impacting capability and morale. This increases risk of patient harm, delays to care and inefficiency, it also threatens the sustainability of services. Negative interactions between Reporting Radiographers and Radiologists or managers is disappointing considering development of the specialism; evidence of Reporting Radiographer effectiveness and current collaboration between Royal College of Radiologists and Society of Radiographers. Issues raised in relation to pay/promotion and litigation could be clarified with ease, this should be considered when guidance is updated. Access to finance and courses is a major barrier in some regions of the UK. Scope exists for further exploration of training. England has used grants to facilitate uptake, these may prove to be an important tool in other countries. IMPLICATIONS FOR PRACTICE Drivers to increase recruitment should be implemented alongside measures to facilitate accessibility to training and improvements to support infrastructure.
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Affiliation(s)
- L Murphy
- Radiology Department, Newcastle Upon Tyne NHS Foundation Trust, UK.
| | - J Nightingale
- Dept of Allied Health Professions, Sheffield Hallam University, UK
| | - P Calder
- Radiology Department, Newcastle Upon Tyne NHS Foundation Trust, UK
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6
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Nightingale J, Gandhi M, Helena J, Bowman J, McGrath M, Coward J, Porceddu S, Ladwa R, Panizza B. Immunotherapy for the treatment of perineural spread in cutaneous head and neck squamous cell carcinoma: Time to rethink treatment paradigms. Head Neck 2022; 44:1099-1105. [PMID: 35156249 DOI: 10.1002/hed.27005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 12/29/2021] [Accepted: 02/03/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Immune checkpoint inhibitors have shown promising antitumour activity. Application in head and neck cutaneous squamous cell carcinoma (cSCC) large nerve perineural spread (PNS) is limited. METHODS Retrospective review of 13 patients with PNS receiving anti-PD-1 therapy from September 2017 to May 2021 is presented. Primary endpoints were objective response (complete or partial response) and median time to progression, determined by Head and Neck Multi-Disciplinary Team (MDT) and independent radiology review of magnetic resonance imaging (MRI) and/or computed tomography/positron emission tomography (CT/PET). RESULTS Objective response was observed in 9/13 patients (69%), with complete response in 6 (46%) and partial response in 3 patients (23%). Median time to response was 2.1 months (IQR 1.8-2.7 months). There were 3 (23%) patients with progressive disease, with median time to progression of 3.5 months. There were no grade 3-4 treatment related adverse events. CONCLUSIONS This case series supports developing evidence for anti-PD-1 checkpoint inhibitor therapy for perineural spread, supporting future prospective clinical trials in this patient population.
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Affiliation(s)
- James Nightingale
- Department of Otolaryngology - Head and Neck Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Mitesh Gandhi
- Department of Radiology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Jonathan Helena
- Department of Otolaryngology - Head and Neck Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - James Bowman
- Department of Otolaryngology - Head and Neck Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Margaret McGrath
- Cancer Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Jermaine Coward
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.,ICON Cancer Centre, Level 5, Mater Medical Centre, Brisbane, Queensland, Australia
| | - Sandro Porceddu
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Rahul Ladwa
- Cancer Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Benedict Panizza
- Department of Otolaryngology - Head and Neck Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
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8
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Sevens T, Nightingale J, Ali N. Degree apprenticeships for the radiography profession; are clinical departments ready? Radiography (Lond) 2021; 28:75-79. [PMID: 34456136 DOI: 10.1016/j.radi.2021.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 07/28/2021] [Accepted: 08/03/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The recently approved degree apprenticeships for diagnostic and therapeutic radiography and sonography offer a new route into the professions in the UK. The work based nature of apprenticeships is reliant on employers embracing the positive impacts they can offer; however recent studies highlight there is still a lack of understanding around radiography apprenticeships. This study investigated diagnostic and therapeutic radiography and sonography managers' perceptions of and readiness for degree apprenticeships. METHODS Qualitative and quantitative data was collated by an online questionnaire survey to capture employers' perspectives of degree apprenticeships. Participants (n = 17) were recruited through social media and advertisements in professional journals and websites. The numerical data was analysed using descriptive statistics and framework analysis was used to analyse textual data. RESULTS Almost all the participants were planning to employ apprentices, believing they would increase the diversity and sustainability of the workforce. Three themes emerged; barriers and facilitators to employing apprentices, impact of apprentices on the local workforce and impact of apprentices on the wider workforce. Managers raised concerns about the cost of apprentice training however, encouragingly, none of the participants identified extreme challenges in employing apprentices. CONCLUSION Recommendations were formulated to increase awareness, understanding and employment of apprentices. Further clarity was needed on the role of mentors and the academic and practice education split and strong collaborations between clinical departments and higher education institutions was imperative. IMPLICATIONS FOR PRACTICE With careful implementation, degree apprenticeships can help widen participation, grow the workforce, and facilitate support worker career development.
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Affiliation(s)
- T Sevens
- Robert Winston Building, Collegiate Crescent Campus, Sheffield Hallam University, Broomhall Road, Sheffield, S10 2BP, UK.
| | - J Nightingale
- Robert Winston Building, Collegiate Crescent Campus, Sheffield Hallam University, Broomhall Road, Sheffield, S10 2BP, UK.
| | - N Ali
- Montgomery House, Collegiate Crescent Campus, Sheffield Hallam University, 32 Collegiate Crescent, Sheffield, S10 2BP, UK.
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Allan PJ, Ambrose T, Mountford C, Bond A, Donnellan C, Boyle R, Calvert C, Cernat E, Clarke E, Cooper SC, Donnelly S, Evans B, Glynn M, Hewett R, Holohan AS, Leitch EF, Louis-Auguste J, Mehta S, Naik S, Nightingale J, Rafferty G, Rodrigues A, Sharkey L, Small M, Teubner A, Urs A, Wyer N, Lal S. COVID-19 infection in patients with intestinal failure: UK experience. JPEN J Parenter Enteral Nutr 2021; 45:1369-1375. [PMID: 33586170 PMCID: PMC8013499 DOI: 10.1002/jpen.2087] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 02/05/2021] [Accepted: 02/09/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND The direct effect of the coronavirus disease 2019 (COVID-19) pandemic on patients with intestinal failure (IF) has not been described. METHODS We conducted a nationwide study of UK IF centers to evaluate the infection rates, presentations, and outcomes in patients with types 2 and 3 IF. RESULTS A total of 45 patients with IF contracted COVID-19 between March and August 2020; this included 26 of 2191 (1.2%) home parenteral nutrition (HPN)-dependent adults and 19 of 298 (6.4%) adults hospitalized with type 2 IF. The proportion of patients receiving nursing care for HPN administration was higher in those with community-acquired COVID-19 (66.7%) than the proportion in the entire HPN cohort (26.1%; P < .01). Two HPN-dependent and 1 hospitalized patient with type 2 IF died as a direct consequence of the virus (6.7% of 45 patients with types 2 or 3 infected). CONCLUSION This is the first study to describe the outcomes of COVID-19 in a large cohort of patients requiring long-term PN. Methods to reduce hospital and community nosocomial spread would likely be beneficial.
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Affiliation(s)
- P J Allan
- Translational Gastroenterology Unit, NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - T Ambrose
- Translational Gastroenterology Unit, NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - C Mountford
- Department of Gastroenterology, Freeman Hospital, Newcastle, UK
| | - A Bond
- Department of Gastroenterology, Royal Liverpool and Broadgreen Hospitals, Liverpool, UK
| | - C Donnellan
- St James' and Leeds Gastroenterology Institute, St James' Hospital, Leeds, UK
| | - R Boyle
- Department of Biochemistry, Aberdeen Royal Infirmary, Aberdeen, UK
| | - C Calvert
- Department of Gastroenterology, Royal Devon and Exeter Hospital, Exeter, UK
| | - E Cernat
- Department of Paediatric Gastroenterology, Leeds General Infirmary, Leeds, UK
| | - E Clarke
- Department of Gastroenterology, Southampton University Hospital, Southampton, UK
| | - S C Cooper
- GI Medicine, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - S Donnelly
- Leonard Jones' Intestinal Rehabilitation Unit, St Mark's Hospital, Harrow, UK
| | - B Evans
- Department of Gastroenterology, Bristol Royal Infirmary, Bristol, UK
| | - M Glynn
- Centre for Digestive Diseases, Royal London Hospital, London, UK
| | - R Hewett
- Department of Gastroenterology, University of Wales Hospital, Cardiff, UK
| | - A S Holohan
- Nutrition, Leicester Royal Infirmary, Leicester, UK
| | - E F Leitch
- Intestinal Failure Surgery, Glasgow Royal Infirmary, Glasgow, UK
| | | | - S Mehta
- Intestinal Failure Unit, University College London Hospitals, London, UK
| | - S Naik
- Department of Paediatric Gastroenterology, Royal London Children's Hospital, London, UK
| | | | - G Rafferty
- Department of Gastroenterology, Belfast City Hospital, Belfast, UK
| | - A Rodrigues
- Department of Paediatric Gastroenterology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - L Sharkey
- Intestinal Failure and Transplant, Cambridge University Hospitals, Cambridge, UK
| | - M Small
- Leonard Jones' Intestinal Rehabilitation Unit, St Mark's Hospital, Harrow, UK
| | - A Teubner
- Intestinal Failure Unit, Salford Royal Hospital, Salford, UK
| | - A Urs
- Paediatric Gastroenterology, Sheffield Children's Hospital, Sheffield, UK
| | - N Wyer
- Intestinal Failure and Nutrition Support, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - S Lal
- Intestinal Failure Unit, Salford Royal Hospital, Salford, UK.,Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester and Manchester Academic Health Sciences Centre, Manchester, UK
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Huang J, Phillips N, Nightingale J, Kondalsamy-Chennakesavan S, Grigg R, Mahendran S. Trans-oral robotic surgery: a safe and effective tool in head and neck surgery in an Australian rural setting. ANZ J Surg 2021; 91:2345-2351. [PMID: 33844420 DOI: 10.1111/ans.16731] [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: 10/29/2020] [Accepted: 02/19/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Trans-oral robotic surgery (TORS) facilitates surgical resection of tumours as an alternative to open surgery and has demonstrated favourable oncological results. Given the novelty of TORS and the paucity of evidence on TORS-specific complications in a rural setting, we report our experience with TORS at an Australian rural head and neck centre. METHODS A retrospective review of all robotic cases performed at a regional head and neck centre in Queensland was undertaken from 2014 to 2019. Patient demographics, pre-operative surgical risk, complications and outcomes such as margins and cancer recurrence were recorded. Complications were graded based on the Clavien-Dindo grading system. Descriptive statistics were used to present patient characteristics and statistical analyses were performed using Stata. RESULTS Forty-two TORS surgeries were performed. Twenty-one had histology confirming malignancy. There were no adverse intraoperative effects. Overall, seven patients (16.7%) had at least one complication. Four were recorded as a Clavien-Dindo 3b (post-operative bleed, wound infection and drain dislodgment). Of two cases with residual positive margins, one declined further surgery, and another received chemoradiotherapy. One patient recurred with distant metastatic disease, and another had locoregional nodal recurrence. The distribution of complications was significant across the pre-operative risk categories for both American Society of Anaesthesiologists and surgical risk score (P = 0.02). CONCLUSION TORS in a rural head and neck centre is a safe and viable treatment option for patients so long as this is undertaken with appropriate training, mentorship and teamwork.
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Affiliation(s)
- Johnson Huang
- Ear, Nose and Throat Department, Toowoomba Hospital, Toowoomba, Queensland, Australia
| | - Nicholas Phillips
- Ear, Nose and Throat Department, Toowoomba Hospital, Toowoomba, Queensland, Australia
| | - James Nightingale
- Ear, Nose and Throat Department, Toowoomba Hospital, Toowoomba, Queensland, Australia
| | | | - Roger Grigg
- Ear, Nose and Throat Department, Toowoomba Hospital, Toowoomba, Queensland, Australia.,Ear, Nose and Throat Department, St Andrew's Toowoomba Hospital, Toowoomba, Queensland, Australia
| | - Suresh Mahendran
- Ear, Nose and Throat Department, Toowoomba Hospital, Toowoomba, Queensland, Australia.,Ear, Nose and Throat Department, St Andrew's Toowoomba Hospital, Toowoomba, Queensland, Australia
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Abstract
INTRODUCTION The weekend effect has been defined as a real or perceived decline in patient care provided on weekends and that provided on weekdays. The primary aim of this study was to investigate the association between day of surgery and length of stay for patients receiving elective lower limb joint arthroplasty in a large NHS teaching hospital. MATERIALS AND METHODS Data were obtained from a prospectively collected database of consecutive patients undergoing elective primary total knee and hip arthroplasty. Patient and clinical variables were collected alongside length of hospital stay. Data were anonymised and analysed using a multiple linear regression model. RESULTS A total of 3,544 knee and 3,277 hip replacements were included. No association was found between length of stay and day of surgery for either procedure. A significant association was noted between longer length of stay and increasing age, higher American Society of Anesthesiologists grade and male compared with female gender. DISCUSSION No evidence of a weekend effect was identified. Certain patient factors predicted longer hospital stay and focussing additional resources on these patient groups may prove a useful strategy in reducing overall length of stay. CONCLUSIONS Length of stay reduced across the time period included in this review while maintaining equality between the days of the week, which represents the successful management of weekend services.
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Affiliation(s)
- M Higgins
- Trauma and Orthopaedics, Nottingham City Hospitals NHS Trust, Nottingham, UK
| | - J Nightingale
- Trauma and Orthopaedics, Nottingham City Hospitals NHS Trust, Nottingham, UK
| | - K Sehat
- Trauma and Orthopaedics, Nottingham City Hospitals NHS Trust, Nottingham, UK
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Nightingale J, Burton M, Appleyard R, Sevens T, Campbell S. Retention of radiographers: A qualitative exploration of factors influencing decisions to leave or remain within the NHS. Radiography (Lond) 2021; 27:795-802. [PMID: 33423914 DOI: 10.1016/j.radi.2020.12.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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: 10/30/2020] [Revised: 12/02/2020] [Accepted: 12/23/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION In many countries a widening imbalance exists between radiographer workforce supply and demand. Improving retention is a rapid method of workforce expansion which is gaining importance with policy makers and providers. To better understand the current leaver profile, this study aimed to identify why radiographers leave the NHS early, and what incentives are important in their decision to stay. METHODS A qualitative framework methodology used semi-structured telephone interviews to explore the perspectives of radiography managers, radiographers who have left the NHS, and those considering leaving. Purposive sampling ensured representation across radiography professional groups, geographical and organisational diversity, and stages of career. RESULTS Three over-arching themes were identified across all radiographer professional groups (n = 44): 1) Challenging working patterns and the impact on employee health and wellbeing; 2) Lack of flexibility in working terms and conditions; 3) Lack of timely career progression and access to CPD, and the need to feel valued. Radiographers were keen to express how they 'loved being a radiographer'; small concessions and changes to workplace culture might be the incentive to remain in radiography that some were clearly searching for. Manager participants recognised the need to offer greater flexibility in working patterns but this was challenging within financial and service delivery constraints. CONCLUSIONS While some influencing factors varied between radiographer professional groups, the three themes were consistent across participants. Failure to address these concerns will exacerbate the loss of experienced and highly trained staff from the NHS at a time when demand for services continues to rise. IMPACT ON PRACTICE Recommendations are presented related to three primary themes which will be a catalyst for sharing of best practice between radiology and radiotherapy centres.
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Affiliation(s)
- J Nightingale
- Dept of Allied Health Professions, Sheffield Hallam University, UK.
| | - M Burton
- Dept of Allied Health Professions, Sheffield Hallam University, UK
| | - R Appleyard
- Dept of Allied Health Professions, Sheffield Hallam University, UK
| | - T Sevens
- Dept of Allied Health Professions, Sheffield Hallam University, UK
| | - S Campbell
- Breast Imaging Department, Yeovil District Hospital NHS Foundation Trust, UK
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Boaden E, Nightingale J, Hives L, Bradbury C, Benfield J, Patel T, Georgiou R. Current videofluoroscopy practice in the United Kingdom: A survey of imaging professionals. Radiography (Lond) 2020; 27:499-504. [PMID: 33234485 DOI: 10.1016/j.radi.2020.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 10/28/2020] [Accepted: 11/05/2020] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Videofluoroscopy (VFSS) is a frequently used radiological investigation for dysphagia and is conducted within a radiology setting by speech and language therapists (SLTs) working alongside imaging personnel (radiologists and/or radiographers). Previous surveys of SLT practice have reported variability in VFSS protocols and procedures. The aim of this study was to explore current clinical practice for VFSS from the perspective of imaging personnel engaged in VFSS within the United Kingdom. METHODS A comprehensive online survey enabled exploration of current practices of imaging professionals. Target participants were diagnostic imaging personnel (radiographers and radiologists) with experience of working in VFSS clinics. Descriptive statistics describe and summarise the data alongside inferential statistics where appropriate. RESULTS 54 survey participants represented 40 unique acute healthcare organisations in the UK, in addition to two respondents from the Republic of Ireland. The survey demonstrated high variance in clinical practice across all stages of the VFSS procedure. Clinicians were not always compliant with current UK guidelines and the roles and responsibilities of different professionals working within the clinics were often not clearly defined. CONCLUSION Further research is required to develop new international, interprofessional VFSS guidelines to standardise service delivery for VFSS, improving diagnostic accuracy, efficiency and patient experience. IMPLICATIONS FOR PRACTICE In the absence of VFSS guidelines for imaging personnel, practitioners should familiarise themselves with the UK Royal College of Speech and Language Therapists VFSS Position paper; IR (ME)R guidelines and DRLs for the client groups with which they work to guide clinics and improve practice. Clinicians should revisit protocols and clinical governance regarding safe practice in order to improve the quality of care within the VFSS clinic.
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Affiliation(s)
- E Boaden
- University of Central Lancashire, Preston, Lancashire, UK
| | - J Nightingale
- Dept of Allied Health Professions, Sheffield Hallam University, Sheffield, UK.
| | - L Hives
- University of Central Lancashire, Preston, Lancashire, UK
| | - C Bradbury
- Royal Stoke University Hospital, University Hospitals of North Midlands NHS Trust, Staffordshire, UK
| | - J Benfield
- Division of Medical Sciences, School of Medicine, University of Nottingham, UK; Derbyshire Community Health Services NHS Foundation Trust, UK
| | - T Patel
- University of Central Lancashire, Preston, Lancashire, UK
| | - R Georgiou
- University of Central Lancashire, Preston, Lancashire, UK
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Nightingale J, Travers L, Campbell J, Huang J, Green M, Warren T, Fitzgerald G. Outpatient surgical management of non-melanoma skin cancers of the head and neck in a regional centre: an analysis of costs and outcomes. ANZ J Surg 2020; 91:139-144. [PMID: 33205533 DOI: 10.1111/ans.16433] [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: 09/11/2020] [Revised: 10/28/2020] [Accepted: 10/29/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Non-melanoma skin cancer is the most commonly diagnosed malignancy in Australia. Lesions of the head and neck are often outside the scope of primary care providers. The challenges of cancer care in regional Australia necessitate careful resource planning. This study presents an outpatient model that minimizes health service cost with local general practitioner follow-up. METHODS A retrospective review of 105 patients with 122 skin lesions in a dedicated Facial Lesion Assessment Management and Excision clinic was performed from July 2018 to 2019. Clinical outcomes, patient travel and cost analysis/comparison were recorded. RESULTS There were 85 malignant cases with 59 basal cell carcinomas and 25 squamous cell carcinomas. For basal cell carcinoma, clear margins (≥3 mm), close margins (<3 mm) and positive margins were achieved in 24 (48%), 23 (46%) and three (6%) cases, respectively. For squamous cell carcinoma, clear margins (≥5 mm), close margins (<5 mm) and positive margins were achieved in seven (38.8%), 11 (61.1%) and none (0%) of the cases, respectively. Complications included one haematoma and two wound infections. For 37% of patients living >100 km from the department, 72.3% had local general practitioner follow-up. Inpatient cost was $2870, $5697 and $9300 for primary closure, local flap and full-thickness skin graft, respectively, and outpatient cost was $746 for a single facial lesion. CONCLUSION This study presents a cost-effective model for the management of non-melanoma skin cancers with improved departmental efficiency and streamlined patient care in an outpatient skin cancer management model in a regional centre.
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Affiliation(s)
- James Nightingale
- Ear, Nose and Throat, Head and Neck Surgery, Darling Downs Hospital and Health Service, Toowoomba, Queensland, Australia.,School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | - Liam Travers
- Ear, Nose and Throat, Head and Neck Surgery, Darling Downs Hospital and Health Service, Toowoomba, Queensland, Australia
| | - Jakob Campbell
- Ear, Nose and Throat, Head and Neck Surgery, Darling Downs Hospital and Health Service, Toowoomba, Queensland, Australia
| | - Johnson Huang
- Ear, Nose and Throat, Head and Neck Surgery, Darling Downs Hospital and Health Service, Toowoomba, Queensland, Australia
| | - Megan Green
- Ear, Nose and Throat, Head and Neck Surgery, Darling Downs Hospital and Health Service, Toowoomba, Queensland, Australia
| | - Tim Warren
- Ear, Nose and Throat, Head and Neck Surgery, Darling Downs Hospital and Health Service, Toowoomba, Queensland, Australia
| | - Garret Fitzgerald
- School of Medicine, Griffith University, Gold Coast, Queensland, Australia
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Nightingale J, Fowler-Davis S, Grafton K, Kelly S, Langham C, Lewis R, Bianco B, Harrop D. The role of Allied Health Professions and Nursing Research Internships in developing a research culture: a mixed-methods exploration of stakeholder perspectives. Health Res Policy Syst 2020; 18:122. [PMID: 33076912 PMCID: PMC7574343 DOI: 10.1186/s12961-020-00638-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 09/29/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Developing research capability and capacity within the healthcare professions is a challenge throughout diverse international settings. Within England, the National Institute for Health Research aimed to address these challenges through the Integrated Clinical Academic (ICA) research careers escalator for nurses, midwives and allied health professionals. Poor academic progression has been identified in the advanced stages of the pathway, though progression from the earlier entry point (Internship) has not previously been investigated. A national evaluation of four completed Internship cohorts was undertaken to explore stakeholder perspectives and progression beyond the Internship programme. METHODS A mixed methods project used sequential qualitative and quantitative data collection phases commencing with two stakeholder focus groups (n = 10); the findings informed the development of an online survey distributed to previous cohorts of interns (n = 104), their managers (n = 12) and academic mentors (n = 36). Eight semi-structured interviews subsequently explored the challenges and opportunities afforded by the internships. Thematic analysis was used to review qualitative data from focus groups and interviews, with survey data analysed and displayed using descriptive statistics. Synthesis of data from each phase is displayed within the four level evaluation framework outlined within the New World Kirkpatrick® Training Evaluation Model. RESULTS Important regional differences exist yet the internships are highly valued by all stakeholders. Representation varied between different professions, with nursing and some service-based professions poorly represented. All interns successfully completed the programme (n = 104), with evidence of positive impacts on interns, colleagues and patient care. Balancing research commitments with clinical activity was challenging; middle managers were seen as gatekeepers to programme success. Progression to the next stage of the ICA pathway is highly competitive and was achieved by only a quarter of interns; access to mentors outside of the funded programme is vital for a successful transition. CONCLUSIONS The Internship programme succeeds in providing a range of important early experiences in research, though progression beyond the programme is challenging due, in part, to a widening gap between Internship and the next level of the ICA framework. Vital mentorship support to bridge this gap is threatened by a lack of time and funding; therefore, the pursuit of a clinical-academic career will continue to be elusive for many nurses and allied health professionals. A partnership approach to clinical academic support at institutional level is needed with several international models offering alternative strategies for consideration.
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Affiliation(s)
- J Nightingale
- Department of Allied Health Professions, Sheffield Hallam University, Sheffield, UK.
| | - S Fowler-Davis
- Department of Allied Health Professions, Sheffield Hallam University, Sheffield, UK
| | | | - S Kelly
- Department of Allied Health Professions, Sheffield Hallam University, Sheffield, UK
| | - C Langham
- University of Sheffield, Sheffield, UK
| | - R Lewis
- Department of Allied Health Professions, Sheffield Hallam University, Sheffield, UK
| | - B Bianco
- Manchester University NHS Foundation Trust, Manchester, UK
| | - D Harrop
- Department of Allied Health Professions, Sheffield Hallam University, Sheffield, UK
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Matthews P, Scammell B, Ali A, Nightingale J, Coughlin T, Khan T, Ollivere B. Early motion and directed exercise (EMADE) versus usual-care, following ankle fracture stabilisation surgery; a pragmatic randomised controlled trial. Physiotherapy 2020. [DOI: 10.1016/j.physio.2020.03.020] [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: 10/24/2022]
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Boaden E, Nightingale J, Bradbury C, Hives L, Georgiou R. Clinical practice guidelines for videofluoroscopic swallowing studies: A systematic review. Radiography (Lond) 2020; 26:154-162. [DOI: 10.1016/j.radi.2019.10.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 10/24/2019] [Accepted: 10/25/2019] [Indexed: 12/24/2022]
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Morgan L, McKeever TM, Nightingale J, Deakin DE, Moppett IK. Spinal or general anaesthesia for surgical repair of hip fracture and subsequent risk of mortality and morbidity: a database analysis using propensity score-matching. Anaesthesia 2020; 75:1173-1179. [PMID: 32337715 DOI: 10.1111/anae.15042] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2020] [Indexed: 11/30/2022]
Abstract
Around 76,000 people fracture their hip annually in the UK at a considerable personal, social and financial cost. Despite longstanding debate, the optimal mode of anaesthesia (general or spinal) remains unclear. Our aim was to assess whether there is a significant difference in mortality and morbidity between patients undergoing spinal anaesthesia compared with general anaesthesia during hip fracture surgery. A secondary analysis examined whether a difference exists in mortality for patients with pre-existing cardiovascular disease or chronic obstructive pulmonary disease. This was a clinical database analysis of patients treated for hip fracture in Nottingham, UK between 2004 and 2015. Propensity score-matching was used to generate matched pairs of patients, one of whom underwent each mode of anaesthesia. Data were analysed using conditional logistic regression, with 7164 patients successfully matched. There was no difference in 30- or 90-day mortality in patients who had spinal rather than general anaesthesia (OR [95%CI] 0.97 [0.8-1.15]; p = 0.764 and 0.93 [0.82-1.05]; p = 0.247 respectively). Patients who had a spinal anaesthetic had a lower-risk of blood transfusion (OR [95%CI] 0.84 [0.75-0.94]; p = 0.003) and urinary tract infection (OR [95%CI] 0.72 [0.61-0.84]; p < 0.001), but were more likely to develop a chest infection (OR [95%CI] 1.23 [1.07-1.42]; p = 0.004), deep vein thrombosis (OR [95%CI] 2.18 [1.07-4.45]; p = 0.032) or pulmonary embolism (OR [95%CI] 2.23 [1.16-4.29]; p = 0.016). The mode of anaesthesia for hip fracture surgery resulted in no significant difference in mortality, but there was a significant difference in several measures of postoperative morbidity.
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Affiliation(s)
- L Morgan
- Division of Epidemiology and Public Health, University of Nottingham, UK
| | - T M McKeever
- Division of Epidemiology and Public Health, University of Nottingham, UK
| | - J Nightingale
- Department of Trauma and Orthopaedics, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - D E Deakin
- Department of Trauma and Orthopaedics, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - I K Moppett
- Anaesthesia and Critical Care, Division of Clinical Neuroscience, University of Nottingham, UK
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Haber M, Drake A, Nightingale J. Is there an advantage to using computer aided detection for the early detection of pulmonary nodules within chest X-Ray imaging? Radiography (Lond) 2020; 26:e170-e178. [PMID: 32052750 DOI: 10.1016/j.radi.2020.01.002] [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: 06/02/2019] [Revised: 12/25/2019] [Accepted: 01/03/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Using published literature, this research examines whether Computer-aided Detection (CAD) identifies more Pulmonary Nodules (PN) within Chest X-ray (CXR) systems, compared to radiologist diagnosis without CAD. KEY FINDINGS Although the primary papers were pointing to CAD being a beneficial system in the diagnosis of PN detection, a regression analysis of the data available within these papers showed no correlation between the higher sensitivity of CAD against the detrimental high False Positives (FP) of CAD. Findings of the studies were deemed inconclusive. CONCLUSION Further research is recommended to review the potential of CAD on CXR PN detection. IMPLICATIONS FOR PRACTICE CAD acting as a second reader could potentially reduce interpreter error rate.
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Affiliation(s)
- M Haber
- Sheffield Hallam University, UK.
| | - A Drake
- Sheffield Hallam University, UK.
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Kamperidis N, Tesser L, Wolfson P, Toms C, Katechia K, Robinson D, Nightingale J. Prevalence of malnutrition in medical and surgical gastrointestinal outpatients. Clin Nutr ESPEN 2019; 35:188-193. [PMID: 31987115 DOI: 10.1016/j.clnesp.2019.10.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 01/27/2019] [Revised: 07/21/2019] [Accepted: 10/02/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND UK NICE guidelines, state that patients attending an outpatient clinic for the first time, should be screened for malnutrition. AIMS To determine the prevalence of malnutrition in the medical and surgical gastroenterology outpatient department (OPD) using body mass index (BMI) and % weight loss (%WL) and to assess the physicians'/surgeons' response to malnutrition being detected. METHODS The BMI and the %WL were determined for every patient over a 2 week period before the clinician saw the patient. The BMI and %WL were scored as in the Malnutrition Universal Screening Tool (MUST). RESULTS 605 patients (316 females) of mean age 54 years were included. 150 (25%) were new patients. 519 (86%) had a normal BMI and %WL. 86 (14%) had a BMI <20 kg/m2 or had 5% WL. 61 (10%) were in MUST "medium risk" and 25 (4%) were in MUST "high risk" of malnutrition. 15 (60%) of the "high risk" patients were under the care of or had been referred to a dietitian compared to 19 (28%) of "medium risk" patients. The prevalence of malnutrition was independent of sex, age, history of previous surgery or underlying comorbidities. There was no difference in the prevalence of malnutrition between new and follow up patients. Malnutrition was more common in patients with IBD (38, 18%) vs non-IBD (48, 12%) and patients with cancer (11, 25%) vs non cancer (75, 13%) (p < 0.05). CONCLUSIONS The prevalence of malnutrition in medical and surgical gastrointestinal outpatients was 14%. IBD and cancer patients had the highest prevalence. Most patients with malnutrition (52, 61%) were not being seen by a dietitian.
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Affiliation(s)
- N Kamperidis
- St Mark's Hospital, Harrow, Middlesex HA1 3UJ, UK.
| | - L Tesser
- St Mark's Hospital, Harrow, Middlesex HA1 3UJ, UK
| | - P Wolfson
- St Mark's Hospital, Harrow, Middlesex HA1 3UJ, UK
| | - C Toms
- St Mark's Hospital, Harrow, Middlesex HA1 3UJ, UK
| | - K Katechia
- St Mark's Hospital, Harrow, Middlesex HA1 3UJ, UK
| | - D Robinson
- St Mark's Hospital, Harrow, Middlesex HA1 3UJ, UK
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Tan E, Pappa A, Pitsalidis C, Nightingale J, Wood S, Castro FA, Owens RM, Kim J. A highly sensitive molecular structural probe applied to in situ biosensing of metabolites using PEDOT:PSS. Biotechnol Bioeng 2019; 117:291-299. [DOI: 10.1002/bit.27187] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 08/23/2019] [Accepted: 10/04/2019] [Indexed: 12/12/2022]
Affiliation(s)
- Ellasia Tan
- Department of Physics and Centre for Plastic ElectronicsImperial College London London United Kingdom
| | - Anna‐Maria Pappa
- Department of Chemical Engineering and BiotechnologyPhilippa Fawcett Drive Cambridge United Kingdom
| | - Charalampos Pitsalidis
- Department of Chemical Engineering and BiotechnologyPhilippa Fawcett Drive Cambridge United Kingdom
| | - James Nightingale
- Department of Physics and Centre for Plastic ElectronicsImperial College London London United Kingdom
| | | | | | - Róisín M. Owens
- Department of Chemical Engineering and BiotechnologyPhilippa Fawcett Drive Cambridge United Kingdom
| | - Ji‐Seon Kim
- Department of Physics and Centre for Plastic ElectronicsImperial College London London United Kingdom
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Mitchell P, Nightingale J, Reeves P. Competence to capability: An integrated career framework for sonographers. Radiography (Lond) 2019; 25:378-384. [PMID: 31582248 DOI: 10.1016/j.radi.2019.05.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 05/28/2019] [Accepted: 05/29/2019] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Within the United Kingdom sonographers, with ultrasound as their core role, currently have a primary registration as a radiographer or another health professional. Entering with masters level qualifications, and often exhibiting a higher career banding, the sonographer career structure does not align comfortably with the existing health professional frameworks. This study aimed to explore the attitudes and opinions of a sample of practicing sonographers concerning a potential graduate sonographer role and the development of a clinical competence framework required to provide a skills escalator. METHODS A qualitative study using an interpretative framework was undertaken using semi-structured interviews. A homogeneous sample population of ten participants was selected using theoretical purposive sampling. The interview transcripts were thematically analyzed and coded. RESULTS The themes of implementing change and clinical frameworks were identified along with a sub-theme of clinical competence boundaries. All participants found it challenging to identify a role or clinical competences that a band 5/graduate sonographer could undertake, though more suggestions were offered for a band 6 sonographer. CONCLUSION Whilst, within the literature, clinical competences were agreed to provide the cornerstone for defining clinical roles there was some dispute as to the appropriateness of the use of core clinical competences for defining the scope of practice of health professionals above entry level to the profession. The data collected in this study demonstrated that there were skills development between graduate, specialist, advanced and consultant practitioners. Participants were focussed on clinical skills rather than wider capability skills. It is recommended that in order for advanced practice sonographers to map to the new ACP framework less focus on competence and a greater consideration of capabilities is required.
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Affiliation(s)
- P Mitchell
- Sheffield Hallam University, Sheffield, South Yorkshire, SB10 2BQ, England, UK.
| | - J Nightingale
- Sheffield Hallam University, Sheffield, South Yorkshire, SB10 2BQ, England, UK.
| | - P Reeves
- Sheffield Hallam University, Sheffield, South Yorkshire, SB10 2BQ, England, UK.
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Nightingale J, McNamara J, Posnett J. Challenges in recruitment and retention: Securing the therapeutic radiography workforce of the future. Radiography (Lond) 2019; 25:1-3. [DOI: 10.1016/j.radi.2018.12.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Buss L, McKeever T, Nightingale J, Akyea R, Ollivere B, Moppett I, Bolton C. Hip fracture outcomes in patients with chronic obstructive pulmonary disease. Br J Anaesth 2018; 121:1377-1379. [DOI: 10.1016/j.bja.2018.09.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 08/29/2018] [Accepted: 09/11/2018] [Indexed: 10/28/2022] Open
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Abstract
We are now living in an era of multimedia data. The past decades have witnessed an unprecedented upsurge in “big data” in China. Mobile multimedia devices are becoming mainstream, promoting the conversion of big data technologies into practices. The deployment of big data provides people with great opportunities to deal with what were formerly great challenges.
Against this background, research is ongoing to explore further possibilities in mobile multimedia developing. Mobile Multimedia Big Data Embedded Systems are transforming science, engineering, healthcare, medicine, finance, business, and ultimately our society itself. This special issue focuses on the state-of-the-art initiatives and the great promise in this field.
We thank all of the authors who submitted papers for this special section. We are also highly appreciative of the reviewers who provided valuable review feedback on the submissions. The editor hopes that this special issue will attract researchers’ interest and contribute to further developments in this field.
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Beattie WS, Wijeysundera DN, Chan MTV, Peyton PJ, Leslie K, Paech MJ, Sessler DI, Wallace S, Myles PS, Galagher W, Farrington C, Ditoro A, Baulch S, Sidiropoulos S, Bulach R, Bryant D, O’Loughlin E, Mitteregger V, Bolsin S, Osborne C, McRae R, Backstrom M, Cotter R, March S, Silbert B, Said S, Halliwell R, Cope J, Fahlbusch D, Crump D, Thompson G, Jefferies A, Reeves M, Buckley N, Tidy T, Schricker T, Lattermann R, Iannuzzi D, Carroll J, Jacka M, Bryden C, Badner N, Tsang MWY, Cheng BCP, Fong ACM, Chu LCY, Koo EGY, Mohd N, Ming LE, Campbell D, McAllister D, Walker S, Olliff S, Kennedy R, Eldawlatly A, Alzahrani T, Chua N, Sneyd R, McMillan H, Parkinson I, Brennan A, Balaji P, Nightingale J, Kunst G, Dickinson M, Subramaniam B, Banner-Godspeed V, Liu J, Kurz A, Hesler B, Fu AY, Egan C, Fiffick AN, Hutcherson MT, Turan A, Naylor A, Obal D, Cooke E. Implication of Major Adverse Postoperative Events and Myocardial Injury on Disability and Survival. Anesth Analg 2018. [DOI: 10.1213/ane.0000000000003310] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Al Bakir I, Adaba F, Patel K, Nightingale J. Topical magnesium therapy treats hypomagnesaemia in some ileostomy patients. Clin Nutr 2018. [DOI: 10.1016/j.clnu.2018.06.1284] [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: 10/28/2022]
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Nightingale J, Hardy M, Snaith B. Embedding consultant radiographer roles within radiology departments: A framework for success. Radiography (Lond) 2018; 24:289-297. [PMID: 30292496 DOI: 10.1016/j.radi.2018.06.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 06/15/2018] [Accepted: 06/18/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Many organisations struggle to clearly differentiate the radiographer consultant role from advanced or specialist practice, with newly appointed consultant practitioners often ill-prepared for working at this level. This article discusses the design, implementation and validation of an outcomes framework for benchmarking competencies for trainee or new-in-post consultant radiographers. METHODS Five experienced radiographers from different clinical specialisms were seconded to a twelve month consultant trainee post, guided by a locally-devised outcomes framework. A longitudinal qualitative study explored, from the radiographers' perspective, the impact of the outcomes framework on the transition to consultant practice and beyond. Data collection included semi-structured interviews (months 1, 6 and 12), validation via a focus group (month 18) and a group interview (5 years). RESULTS Early interactions with framework objectives were mechanistic, but as participants better understood the role more creative approaches emerged. Despite diverse clinical expertise, the framework facilitated parity between participants, promoting transparency and credibility which was important in how the consultant role was perceived. All participants achieved all framework outcomes and were subsequently appointed to substantive consultant radiographer positions. CONCLUSION This outcomes framework facilitates experienced radiographers to successfully transition into consultant radiographers, enabling them to meet multiple non-clinical targets while continuing to work effectively within a changing clinical environment. It is the first validated benchmarking tool designed to support the transition to radiographer consultant practice. Adoption of the tool will provide a standardised measure of consultant radiographer outcomes that will promote inter-organisational transferability hitherto unseen in the UK.
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Affiliation(s)
| | | | - B Snaith
- University of Bradford / Mid Yorkshire NHS Trust, UK.
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Nightingale J. Editors' choice paper (Volume 23, 2017). Radiography (Lond) 2018; 24:95. [PMID: 29605118 DOI: 10.1016/j.radi.2018.03.004] [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: 11/27/2022]
Affiliation(s)
- J Nightingale
- Prof. of Diagnostic Imaging Education, Department of Allied Health Professions, Sheffield Hallam University, UK.
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Nightingale J. Celebrating Marie Curie and Röntgen – The pioneers of our professions. Radiography (Lond) 2017; 23:271-272. [DOI: 10.1016/j.radi.2017.09.003] [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: 10/18/2022]
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Nightingale J, Stebbing P, Sibley P, Brown O, Rushbrook B, Jones G. A review of the use of ark sites and associated conservation measures to secure the long-term survival of White-clawed crayfish Austropotamobius pallipes
in the United Kingdom and Ireland. ACTA ACUST UNITED AC 2017. [DOI: 10.1111/izy.12161] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- J. Nightingale
- Bristol Zoological Society; Clifton; Bristol BS8 3HA United Kingdom
- University of Bristol; Life Sciences Building 24 Tyndall Avenue Bristol BS8 1TQ United Kingdom
| | - P. Stebbing
- Cefas; Barrack Road Weymouth DT4 8UB United Kingdom
| | - P. Sibley
- Environment Agency; Wessex (North) Office Rivers House East Quay Bridgwater TA6 4YS United Kingdom
| | - O. Brown
- Natural Resources Wales; Cynrig Hatchery Brecon LD3 7AX United Kingdom
| | - B. Rushbrook
- Hampshire & Isle of Wight Wildlife Trust; Beechcroft House Vicarage Lane Curdridge SO32 2DP United Kingdom
| | - G. Jones
- University of Bristol; Life Sciences Building 24 Tyndall Avenue Bristol BS8 1TQ United Kingdom
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Abstract
OBJECTIVES To determine if the introduction of the best practice tariff (BPT) has improved survival of the elderly hip fracture population, or if achieving BPT results in improved survival for an individual. SETTING A single university-affiliated teaching hospital. PARTICIPANTS 2541 patients aged over 60 admitted with a neck of femur fracture between 2008 and 2010 and from 2012 to 2014 were included, to create two cohorts of patients, before and after the introduction of BPT. The post-BPT cohort was divided into two groups, those who achieved the criteria and those who did not. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcomes of interest were differences in mortality across cohorts. Secondary analysis was performed to identify associations between individual BPT criteria and mortality. RESULTS The introduction of BPT did not significantly alter overall 30-mortality in the hip fracture population (8.3% pre-BPT vs 10.0% post-BPT; p=0.128). Neither was there a significant reduction in length of stay (15 days (IQR 9-21) pre-BPT vs 14 days (IQR 11-22); p=0.236). However, the introduction of BPT was associated with a reduction in the time from admission to theatre (median 44 hours pre-BPT (IQR 24-44) vs 23 hours post-BPT (IQR 17-30); p<0.005). 30-day mortality in those who achieved BPT was significantly lower (6.0% vs 21.0% in those who did not achieve-BPT; p<0.005). There was a survival benefit at 1 year for those who achieved BPT (28.6% vs 42.0% did not achieve-BPT; p<0.005). Multivariate logistic regression revealed that of the BPT criteria, AMT monitoring and expedited surgery were the only BPT criteria that significantly influenced survival. CONCLUSIONS The introduction of the BPT has not led to a demonstrable improvement in outcomes at organisational level, though other factors may have confounded any benefits. However, patients where BPT criteria are met appear to have improved outcomes.
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Affiliation(s)
- B Oakley
- Department of Trauma and Orthopaedics, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - J Nightingale
- Department of Trauma and Orthopaedics, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - CG Moran
- Department of Trauma and Orthopaedics, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - IK Moppett
- Anaesthesia and Critical Care Section, Division of Clinical Neuroscience, Queen's Medical Centre, University of Nottingham, Nottingham, UK
- Department of Anaesthesia, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
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Nightingale J, Snaith B. A tribute to a patient safety pioneer – Mr Robert L. Law. Radiography (Lond) 2016. [DOI: 10.1016/j.radi.2016.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Lawal O, Murphy F, Hogg P, Irurhe N, Nightingale J. Mammography screening in Nigeria – A critical comparison to other countries. Radiography (Lond) 2015. [DOI: 10.1016/j.radi.2015.03.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Adaba F, Gabe S, Vaizey C, Warusavitarne J, Nightingale J. PP119-MON: The Risk of Chronic Cholestasis is Reduced in Patients with Short Bowel Due to Mesenteric Infarction Following Restoration of Bowel Continuity. Clin Nutr 2014. [DOI: 10.1016/s0261-5614(14)50454-2] [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: 10/24/2022]
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Meertens R, Brealey S, Nightingale J, McCoubrie P. Diagnostic accuracy of radiographer reporting of computed tomography colonography examinations: A systematic review. Clin Radiol 2013; 68:e177-90. [DOI: 10.1016/j.crad.2012.11.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Revised: 11/10/2012] [Accepted: 11/20/2012] [Indexed: 10/27/2022]
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O'Driscoll M, Pearson C, Arden N, Carroll M, Daniels T, Nightingale J. WS13.5 Effectiveness of a high-dose vitamin D supplementation regimen. J Cyst Fibros 2012. [DOI: 10.1016/s1569-1993(12)60095-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Fillmore B, Lankford DE, Nightingale J, Herb E, Pence C, Porter R. Differences in Glucose Uptake Following High Intensity and Low Intensity Cardiovascular Exercise. J Strength Cond Res 2010. [DOI: 10.1097/01.jsc.0000367106.20908.fd] [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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Tonkin DM, Tandon R, Vaizey CJ, Philips RKS, Gabe S, Nightingale J. GS09�RESULTS OF SURGERY FOR INTESTINAL FAILURE. ANZ J Surg 2009. [DOI: 10.1111/j.1445-2197.2009.04917_9.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Hansen E, Sclafani J, Liu P, Nightingale J. The Effect of Water on a New Binary Transdermal Flux Enhancer (Peg3-Me/IPP): An In Vitro Evaluation Using Estradiol. Drug Dev Ind Pharm 2008. [DOI: 10.3109/03639049709148476] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Richards S, Duff A, Morton A, Gumery L, Ketchell I, Nightingale J, Conway S. Gene therapy (GT); what adults with CF really think. A multi-centred study. J Cyst Fibros 2008. [DOI: 10.1016/s1569-1993(08)60420-8] [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: 10/22/2022]
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Radauceanu S, Nightingale J. User damage to the tracheal tube used with the Intubating Laryngeal Mask Airway. Anaesthesia 2006; 61:724-5. [PMID: 16792636 DOI: 10.1111/j.1365-2044.2006.04698.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Affiliation(s)
- M Stroud
- Institute of Human Nutrition, Southampton General Hospital, Southampton, UK.
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