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Graham LE, Leggett P, Steele K, Gilliland A, O'reilly D, Stevenson M, Wootton R, Taggart AJ. Do all outpatients need a face-to-face consultation in rheumatology? J Telemed Telecare 2016. [DOI: 10.1258/1357633001934681] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- L E Graham
- Rheumatology Department, Belfast City Hospital, Belfast
| | - P Leggett
- Department of General Practice, Queen's University Belfast
| | - K Steele
- Department of General Practice, Queen's University Belfast
| | - A Gilliland
- Department of General Practice, Queen's University Belfast
| | - D O'reilly
- Department of Epidemiology and Statistics, Royal Group of Hospitals, Belfast
| | - M Stevenson
- Department of Epidemiology and Statistics, Royal Group of Hospitals, Belfast
| | - R Wootton
- Institute of Telemedicine and Telecare, Royal Group of Hospitals, Belfast, UK
| | - A J Taggart
- Rheumatology Department, Belfast City Hospital, Belfast
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Ferson K, Montgomery J, Moore RE, Millar BC, Leggett P, Coulter WA, Goldsmith CE, Moore JE. Reliability of self-reporting of antibiotic consumption in the community - Index of Reliability. J Clin Pharm Ther 2014; 39:468-70. [PMID: 24912052 DOI: 10.1111/jcpt.12184] [Citation(s) in RCA: 3] [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: 10/23/2013] [Accepted: 05/12/2014] [Indexed: 11/30/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE To date, there is no evidence to indicate the reliability of how patients self-report their own antibiotic usage in the community. Such data are fundamental in supporting antimicrobial stewardship practices, and so there is a need to determine its accuracy and reliability. COMMENT Patients in the community (n = 476) were required to recollect their antibiotic usage in the past three months. Simultaneously, similar information was obtained by careful extraction from their respective medical notes, which was qualitatively compared with the patient's recollection. Overall, concordance was high (88·1%), but age (<20 and >80 years) and sex (female) were significant factors of reliability. WHAT IS NEW AND CONCLUSION This study suggests that basic self-reporting of antibiotic usage amongst patients is relatively reliable, with increasing accuracy with years until 80 years. Where such information is critical, the current study can help decide who to interview and whose notes to interrogate, in the quest to obtain reliable and accurate information.
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Affiliation(s)
- K Ferson
- Northern Ireland Public Health Laboratory, Department of Bacteriology, Belfast City Hospital, Belfast, UK; Durham University, Durham, UK
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Mason CK, Goldsmith CE, Moore JE, McCarron P, Leggett P, Montgomery J, Coulter WA. Optimisation of storage conditions for maintaining culturability of penicillin-susceptible and penicillin-resistant isolates of Streptococcus pneumoniae in transport medium. Br J Biomed Sci 2010; 67:1-4. [PMID: 20373674 DOI: 10.1080/09674845.2010.11730281] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Methods employed by the World Health Organization (WHO) are used during this study to determine the optimum storage conditions for maintaining the culturability of Streptococcus pneumoniae in skimmed milk, tryptone, glucose and glycerin (STGG) transport medium. A comparison of S. pneumoniae strains sensitive and resistant to penicillin showed no significant difference in their survival ability in STGG medium. Furthermore, it is confirmed that storage at -70 degrees C remains most effective for maintaining viability by culture of S. pneumoniae. Storage at -20 degrees C would only be acceptable in the short-term, while storage at +4 degrees C is not recommended. Of note, this study has shown STGG medium at room temperature to be an efficient growth medium for pneumococci in the short-term. This work will help to establish robust sampling protocols when performing community studies to ensure culturability of comparison between community and laboratory pneumococci survival.
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Affiliation(s)
- C K Mason
- Oral Research Centre, School of Dentistry, Queen's University, Belfast, Northern Ireland, UK
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Moore JE, Mason CK, Coulter WA, McCarron P, Leggett P, Montgomery J, Goldsmith CE. Comparison of clustered, regularly interspaced short palindrome repeats (CRISPRs) in viridans streptococci (Streptococcus gordonii, S. mutans, S. sanguinis, S. thermophilus) and in S. pneumoniae. Br J Biomed Sci 2009; 65:104-8. [PMID: 19055116 DOI: 10.1080/09674845.2008.11978109] [Citation(s) in RCA: 3] [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] [Indexed: 10/18/2022]
Affiliation(s)
- J E Moore
- Northern Ireland Public Health Laboratory, Department of Bacteriology, Belfast City Hospital, Northern Ireland.
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Leggett P, Gilliland AEW, Cupples ME, McGlade K, Corbett R, Stevenson M, O'Reilly D, Steele K. A randomized controlled trial using instant photography to diagnose and manage dermatology referrals. Fam Pract 2004; 21:54-6. [PMID: 14760045 DOI: 10.1093/fampra/cmh112] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Fifteen percent of GP consultations are for dermatological conditions; 4% of these are referred to a dermatologist. There are long waiting lists for dermatology appointments. This study examines the value of instant photography in managing dermatology referrals. OBJECTIVE The purpose of our study was to compare outcomes of referral for dermatology appointments between patients whose referral letters do or do not include instant photograph(s). METHODS Patients (136), referred to a dermatologist by GPs in two urban health centres, were randomly allocated to study and control groups. Instant photographs, taken by the GP, were included in the referral letters. Control group patients were given out-patient appointments in the usual way. The numbers of study group patients needing an appointment for diagnosis or management and with a changed diagnosis after face-to-face consultation were recorded. Waiting time from referral to appointment or management plan was recorded for both groups. RESULTS For 63% of the study group (45/71), a diagnosis and a management plan were made without the patient requiring an appointment. This included 38% (27/71) who, after diagnosis and initial management, needed an appointment and 25% (18/71) who did not. The remainder of the study group (37%; 26/71) required a face-to-face consultation. The mean time for formulation of a management plan for patients without an appointment was 17 days (SD = 11); waiting times for appointments in study and control groups were similar (mean 55 days; SD = 40). CONCLUSIONS Instant photography is helpful in managing dermatology referrals and offers the potential to reduce numbers requiring an out-patient appointment by 25%.
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Affiliation(s)
- P Leggett
- Department of General Practice, Queen's University, Royal Victoria Hospital, Belfast, UK.
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Gormley GJ, Steele WK, Gilliland A, Leggett P, Wright GD, Bell AL, Matthews C, Meenagh G, Wylie E, Mulligan R, Stevenson M, O'Reilly D, Taggart AJ. Can diagnostic triage by general practitioners or rheumatology nurses improve the positive predictive value of referrals to early arthritis clinics? Rheumatology (Oxford) 2003; 42:763-8. [PMID: 12730536 DOI: 10.1093/rheumatology/keg213] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To determine whether diagnostic triage by general practitioners (GPs) or rheumatology nurses (RNs) can improve the positive predictive value of referrals to early arthritis clinics (EACs). METHODS Four GPs and two RNs were trained in the assessment of early inflammatory arthritis (IA) by four visits to an EAC supervised by hospital rheumatologists. Patients referred to one of three EACs were recruited for study and assessed independently by a GP, an RN and one of six rheumatologists. Each assessor was asked to record their clinical findings and whether they considered the patient to have IA. Each was then asked to judge the appropriateness of the referral according to predetermined guidelines. The rheumatologists had been shown previously to have a satisfactory level of agreement in the assessment of IA. RESULTS Ninety-six patients were approached and all consented to take part in the study. In 49 cases (51%), the rheumatologist judged that the patient had IA and that the referral was appropriate. The assessments of GPs and RNs were compared with those of the rheumatologists. Levels of agreement were measured using the kappa value, where 1.0 represents total unanimity. The kappa value was 0.77 for the GPs when compared with the rheumatologists and 0.79 for the RNs. Significant stiffness in the morning or after rest and objective joint swelling were the most important clinical features enabling the GPs and RNs to discriminate between IA and non-IA conditions. CONCLUSION Diagnostic triage by GPs or RNs improved the positive predictive value of referrals to an EAC with a degree of accuracy approaching that of a group of experienced rheumatologists.
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Affiliation(s)
- G J Gormley
- Department of General Practice, Queens University of Belfast, Northern Ireland, UK.
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Leggett P, Atwa H, Hamat H. Use of endoscopic retrograde cholangiopancreatography to dislodge clip impingement on the common hepatic duct. Surg Endosc 2001; 15:1490. [PMID: 11965477 DOI: 10.1007/s004640041023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [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: 02/27/2001] [Accepted: 03/20/2001] [Indexed: 10/25/2022]
Abstract
Despite advances in technical skill, bile duct injury during laparoscopic cholecystectomy is not an uncommon complication. We describe a technique of using ERCP, sphincterotomy, and balloon dilatation to dislodge clip impingement on the common hepatic duct after laparoscopic cholecystectomy.
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Affiliation(s)
- P Leggett
- Houston Health Science Center, University of Texas-Houston, 800 Peakwood, Suite 8B, Houston, TX 77090, USA.
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Leggett P, Graham L, Steele K, Gilliland A, Stevenson M, O'Reilly D, Wootton R, Taggart A. Telerheumatology--diagnostic accuracy and acceptability to patient, specialist, and general practitioner. Br J Gen Pract 2001; 51:746-8. [PMID: 11593837 PMCID: PMC1314104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023] Open
Abstract
This study examines the diagnostic accuracy and acceptability of telemedicine in the field of rheumatology. One hundred patients had a telephone and televisual consultation and the results were compared with a face-to-face consultation. While the telephone consultations were often unsatisfactory, the televisual consultations were highly accurate (97%) and acceptable to patients, general practitioners, and specialists.
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Affiliation(s)
- P Leggett
- Department of General Practice, Queen's University of Belfast.
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Yassin MM, Barros D'Sa AA, Parks TG, McCaigue MD, Leggett P, Halliday MI, Rowlands BJ. Lower limb ischaemia-reperfusion injury alters gastrointestinal structure and function. Br J Surg 1997. [PMID: 9361604 DOI: 10.1111/j.1365-2168.1997.02772.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND It has been suggested that bowel permeability is altered following abdominal aortic aneurysm surgery. The effect of ischaemia-reperfusion injury to the lower limb on the morphological structure, neutrophil infiltration and permeability of the bowel was investigated. METHODS Histological assessment of the bowel was undertaken in five groups of Wistar rats: control, 3 h of bilateral hind limb ischaemia and 3 h of bilateral hind limb ischaemia followed by 1, 2 or 3 h of reperfusion. Using an everted gut sac model and 14C-labelled polyethylene glycol, the effect of ischaemia-reperfusion on small bowel permeability was studied. RESULTS The small bowel showed a significant decrease in mucosal thickness, villus height and crypt depth in animals subjected to ischaemia followed by 2-hr reperfusion (mean(s.e.m.) 420(15), 217(9) and 163(6) microns respectively) compared with controls (481(11), 245(6) and 195(6) microns) (P < 0.05). Neutrophil count within the lamina propria was similar in the different groups. A significant increase in mean(s.e.m.) 14C-labelled polyethylene glycol translocation was detected in animals subjected to ischaemia-reperfusion compared with controls (760(40) versus 560(27) c.p.m. per ml per h) (P < 0.05). CONCLUSION These data suggest that reperfusion of acutely ischaemic extremities produces structural and functional changes in the small intestine, although these changes are not associated with increased neutrophil infiltration within the bowel wall.
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Affiliation(s)
- M M Yassin
- Department of Surgery, Queen's University of Belfast, UK
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Yassin MMI, D'Sa AABB, Parks TG, McCaigue MD, Leggett P, Halliday MI, Rowlands BJ. Lower limb ischaemia-reperfusion injury alters gastrointestinal structure and function. Br J Surg 1997. [DOI: 10.1002/bjs.1800841023] [Citation(s) in RCA: 32] [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: 11/08/2022]
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Heaney LG, Leggett P, Maxwell P, Bharucha H, Ennis M. A comparison of three standard methods of identifying mast cells in endobronchial biopsies in normal and asthmatic subjects. Allergy 1997; 52:836-43. [PMID: 9284983 DOI: 10.1111/j.1398-9995.1997.tb02155.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Reported mast-cell counts in endobronchial biopsies from asthmatic subjects are conflicting, with different methodologies often being used. This study compared three standard methods of counting mast cells in endobronchial biopsies from asthmatic and normal subjects. Endobronchial biopsies were obtained from atopic asthmatic subjects (n = 17), atopic nonasthmatic subjects (n = 6), and nonatopic nonasthmatic control subjects (n = 5). After overnight fixation in Carnoy's fixative, mast cells were stained by the short and long toluidine blue methods and antitryptase immunohistochemistry and were counted by light microscopy. Method comparison was made according to Bland & Altman. The limits of agreement were unacceptable for each of the comparisons, suggesting that the methods are not interchangeable. Coefficients of repeatability were excellent, and not different for the individual techniques. These results suggest that some of the reported differences in mast-cell numbers in endobronchial biopsies in asthma may be due to the staining method used, making direct comparisons between studies invalid. Agreement on a standard method is required for counting mast cells in bronchial biopsies, and we recommend the immunohistochemical method, since fixation is less critical and the resultant tissue sections facilitate clear, accurate, and rapid counts.
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Affiliation(s)
- L G Heaney
- Department of Respiratory Medicine, Royal Victoria Hospital, Belfast, Northern Ireland, UK
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Fleshman JW, Nelson H, Peters WR, Kim HC, Larach S, Boorse RR, Ambroze W, Leggett P, Bleday R, Stryker S, Christenson B, Wexner S, Senagore A, Rattner D, Sutton J, Fine AP. Early results of laparoscopic surgery for colorectal cancer. Retrospective analysis of 372 patients treated by Clinical Outcomes of Surgical Therapy (COST) Study Group. Dis Colon Rectum 1996; 39:S53-8. [PMID: 8831547 DOI: 10.1007/bf02053806] [Citation(s) in RCA: 208] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
UNLABELLED This study was undertaken to determine the early experience of the embers of the COST Study Group with colorectal cancer treated by laparoscopic approaches. METHOD A retrospective review was performed of all patients with colorectal cancer treated with laparoscopy by the COST Study Group before August 1994. Tumor site, stage, differentiation, procedure completion, presence of recurrence (local, distant, trocar site), and cause of death were analyzed. RESULTS A total of 372 patients with adenocarcinoma of the colon and rectum were treated by laparoscopic approach between October 1991 and August 1994 (170 men and 192 women): right colectomy, 170; sigmoid colectomy, 55; low anterior resection, 56; abdominoperineal resection, 44; left colectomy, 22; colostomy, 8; total colectomy, 6; transverse colectomy, 7; exploration, 2. Conversion to an open procedure was required in 15.6 percent of cases. Operative mortality was 2 percent. Tumor characteristics were as follows: TNM state: I, 40 percent; II, 25 percent; III, 18 percent; IV, 17 percent; Differentiation: well-moderate, 88 percent; poor, 12 percent; carcinomatosis, 5 percent. Local (3.6 percent) and distant implantation occurred in four patients (1.1 percent). Only one of these patients died a cancer-related death (Stage III at 36 months). Cancer-related death rates increased with increasing stage of tumor: I, -4 percent; II, 17 percent; III, 31 percent; IV, 70 percent. CONCLUSION A laparoscopic approach to colorectal cancer results in early outcome after treatment that is comparable with conventional therapy for colorectal cancer. A randomized trial is needed to compare long-term outcomes of open and laparoscopic approaches with colorectal cancer.
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Leggett P, Ancalmo N. Traumatic rupture of the descending thoracic aorta. J La State Med Soc 1984; 136:33-7. [PMID: 6563054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
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