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Hutchings HA, Rahman M, Carter K, Islam S, O'Neill C, Roberts S, John A, Fegan G, Dave U, Hawkes N, Ahmed F, Hasan M, Azad AK, Rahman MM, Kibria MG, Rahman MM, Mia T, Akhter M, Williams JG. Did the COVID-19 pandemic affect levels of burnout, anxiety and depression among doctors and nurses in Bangladesh? A cross-sectional survey study. BMJ Open 2024; 14:e079350. [PMID: 38453200 PMCID: PMC10921535 DOI: 10.1136/bmjopen-2023-079350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 02/14/2024] [Indexed: 03/09/2024] Open
Abstract
INTRODUCTION COVID-19 has caused severe disruption to clinical services in Bangladesh but the extent of this, and the impact on healthcare professionals is unclear. We aimed to assess the perceived levels of anxiety, depression and burnout among doctors and nurses during COVID-19 pandemic. METHODS We undertook an online survey using RedCap, directed at doctors and nurses across four institutions in Bangladesh (The Sheikh Russel Gastro Liver Institute & Hospital (SRNGIH), Dhaka Medical College Hospital (DMCH), Mugda Medical College Hospital (MMCH) and M Abdur Rahim Medical College (MARMC) Hospital). We collected information on demographics, awareness of well-being services, COVID-19-related workload, as well as anxiety, depression and burnout using two validated questionnaires: the Hospital Anxiety and Depression Scale (HADS) and the Maslach Burnout Inventory (MBI). RESULTS Of the 3000 participants approached, we received responses from 2705 (90.2%). There was a statistically significant difference in anxiety, depression and burnout scores across institutions (p<0.01). Anxiety, depression and burnout scores were statistically worse in COVID-19 active staff compared with those not working on COVID-19 activities (p<0.01 for HADS anxiety and depression and MBI emotional exhaustion (EE), depersonalisation (DP) and personal accomplishment (PA)). Over half of the participants exhibited some level of anxiety (SRNGIH: 52.2%; DMCH: 53.9%; MMCH: 61.3%; MARMC: 68%) with a high proportion experiencing depression (SRNGIH: 39.5%; DMCH: 38.7%; MMCH: 53.7%; MARMC: 41.1%). Although mean burnout scores were within the normal range for each institution, a high proportion of staff (almost 20% in some instances) were shown to be classified as experiencing burnout by their EE, DP and PA scores. CONCLUSION We identified a high prevalence of perceived anxiety, depression and burnout among doctors and nurses during the COVID-19 pandemic. This was worse in staff engaged in COVID-19-related activities. These findings could help healthcare organisations to plan for future similar events.
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Affiliation(s)
| | - Mesbah Rahman
- Swansea Bay University Health Board, Port Talbot, UK
| | | | | | | | | | | | | | - Umakant Dave
- Swansea Bay University Health Board, Port Talbot, UK
| | - Neil Hawkes
- Cwm Taf Morgannwg University Health Board, Abercynon, UK
| | - Faruque Ahmed
- Department of Gastroenterology, Sheikh Russel National Gastroliver Institute and Hospital, Dhaka, Bangladesh
| | | | | | | | - Md Golam Kibria
- Sheikh Russel National Gastroliver Institute, Dhaka, Bangladesh
| | | | - Titu Mia
- Mugda Medical College and Hospital, Dhaka, Bangladesh
| | | | - John G Williams
- Faculty of Medicine, Health and Life Science, Swansea University, Swansea, UK
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Dave U, Taylor-Robinson SD. Maintaining Resilience in Today’s Medical Environment: Personal Perspectives on Self-Care. Int J Gen Med 2022; 15:2475-2478. [PMID: 35282651 PMCID: PMC8904941 DOI: 10.2147/ijgm.s354928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 02/22/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Umakant Dave
- Department of Gastroenterology, Morriston Hospital, Swansea, Wales, SA6 6NL, UK
| | - Simon D Taylor-Robinson
- Department of Surgery and Cancer, Imperial College London, St Mary’s Hospital Campus, London, W2 1NY, UK
- Correspondence: Simon D Taylor-Robinson, Department of Surgery and Cancer, Imperial College London, St Mary’s Hospital Campus, London, W2 1NY, UK, Tel +44 203 312 6254, Email
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Hawkes N, Dave U, Rahman M, Richards D, Hasan M, Rowshon AHM, Ahmed F, Rahman MM, Kibria MG, Dodds P, Hawkes B, Goddard S, Rahman I, Neville P, Feeney M, Jenkins G, Lloyd K, Ragunath K, Edwards C, Taylor-Robinson SD. The Role of National Specialist Societies in Influencing Transformational Change in Low-Middle Income Countries - Reflections on the Model of Implementation for a National Endoscopy Training Programme in Bangladesh. Clin Exp Gastroenterol 2021; 14:103-111. [PMID: 33790613 PMCID: PMC7997947 DOI: 10.2147/ceg.s297667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 03/02/2021] [Indexed: 12/03/2022] Open
Abstract
The British Society of Gastroenterology (BSG) and the Bangladesh Gastroenterology Society (BGS) have collaborated on an endoscopy training programme, which has grown up over the past decade from a small scheme borne out of the ideas of consultant gastroenterologists in Swansea, South Wales (United Kingdom) to improve gastroenterology services in Bangladesh to become a formalised training programme with broad reach. In this article, we document the socioeconomic and historical problems that beset Bangladesh, the current training needs of doctors and how the BSG-BGS collaboration has made inroads into changing outcomes both for gastroenterologists in Bangladesh, but also for the populations they serve.
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Affiliation(s)
- Neil Hawkes
- Department of Gastroenterology, Cwm Taf Morgannwg University Health Board, Llantrisant, South Wales, UK
- British Society of Gastroenterology Central Office, London, UK
| | - Umakant Dave
- Department of Gastroenterology, Swansea Bay University Health Board, Swansea, UK
| | - Mesbah Rahman
- British Society of Gastroenterology Central Office, London, UK
- Department of Gastroenterology, Swansea Bay University Health Board, Swansea, UK
| | - Dafydd Richards
- Department of Gastroenterology, Swansea Bay University Health Board, Swansea, UK
| | - Mahmud Hasan
- Office of the Central Secretariat, Bangladesh Gastroenterology Society, Dhaka, Bangladesh
- Office of Central Secretariat, Gastroliver Foundation, Dhaka, Bangladesh
| | - A H M Rowshon
- Office of the Central Secretariat, Bangladesh Gastroenterology Society, Dhaka, Bangladesh
| | - Faruque Ahmed
- Office of the Central Secretariat, Bangladesh Gastroenterology Society, Dhaka, Bangladesh
- Department of Gastroenterology, Sheikh Russel National Gastroliver Institute and Hospital, Dhaka, Bangladesh
| | - M Masudur Rahman
- Department of Gastroenterology, Sheikh Russel National Gastroliver Institute and Hospital, Dhaka, Bangladesh
| | - M G Kibria
- Department of Gastroenterology, Sheikh Russel National Gastroliver Institute and Hospital, Dhaka, Bangladesh
| | - Phedra Dodds
- Department of Endoscopy Nursing, Office of the JAG GRS Team, Powys Health Board, Brecon, UK
| | - Bethan Hawkes
- Office of the Wales Cancer Network Pathway, Welsh Cancer Network, Cardiff, UK
| | - Stuart Goddard
- Welsh Institute of Minimal Access Therapy, Cardiff MediCentre, Welsh Institute for Minimal Access Therapy, Cardiff University, Cardiff, UK
| | - Imdadur Rahman
- Department of Gastroenterology, Southampton NHS Trust, Southampton, UK
| | - Peter Neville
- Department of Gastroenterology, Cwm Taf Morgannwg University Health Board, Llantrisant, South Wales, UK
| | - Mark Feeney
- Department of Gastroenterology and Liver Medicine, Torbay and South Devon NHS Foundation Trust, Devon, UK
| | - Gareth Jenkins
- Faculty of Health and Life Sciences, Medicine, Swansea University, Swansea, UK
| | - Keith Lloyd
- Faculty of Health and Life Sciences, Medicine, Swansea University, Swansea, UK
| | - Krish Ragunath
- Office of the Provost, Faculty of Health Sciences, Bentley Campus, Curtin Medical School, Curtin University, Perth, Western Australia, Australia
| | - Cathryn Edwards
- British Society of Gastroenterology Central Office, London, UK
- Department of Gastroenterology and Liver Medicine, Torbay and South Devon NHS Foundation Trust, Devon, UK
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Dave U, Dave A, Taylor-Robinson SD. Mindfulness in Gastroenterology Training and Practice: A Personal Perspective. Clin Exp Gastroenterol 2020; 13:497-502. [PMID: 33177857 PMCID: PMC7650088 DOI: 10.2147/ceg.s278590] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 10/07/2020] [Indexed: 12/30/2022] Open
Abstract
Background Work-related stress is becoming an increasingly recognised occupational hazard that can have detrimental effects on the health of both patient and doctor. The practice of gastroenterology not only includes the demands of clinics and in-patient work faced by other medical specialities but also the additional burden of complex, and often high-risk, endoscopic interventions. Mindfulness, a secular form of meditation, can relieve stress, even if only practiced for a few minutes a day. Methods and Results We present a personal perspective of the burnout experienced in stressful gastroenterology careers and the personal use of mindfulness in the daily routine to provide a source of calm when surrounded by many different pressures. We review some of the literature exploring the role of mindfulness in clinical practice with an emphasis on gastroenterology. While the practice of mindfulness is not designed to obviate immediacy and quick decisions in a rapidly changing clinical environment, it has been held widely useful to mitigate the stress involved in making those decisions. Conclusion Practicing mindfulness, meditation and mindful living offers many advantages to gastroenterologists’ wellbeing as well improved patient care. We advocate its teaching to both gastroenterology trainees and consultants who are not familiar with the technique.
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Affiliation(s)
- Umakant Dave
- Department of Gastroenterology, Morriston Hospital, Swansea, Wales SA6 6NL, UK
| | - Anjali Dave
- Department of Psychology, Birmingham University, Birmingham B15 2TT, UK
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Abstract
Some 0.55 million people living in semi-urban and slum populations were screened for mental retardation by trained primary health centre (PHC) doctors, nurses and community health volunteers (CHVs). The staff were provided with prior training on the detection, prevention and diagnosis of mental retardation, prenatal diagnosis, and reproductive responsibilities. Field visits were employed to confirm diagnosed developmental disabilities, and demographic data incorporating social maps of 14 PHCs were prepared. Cases with high-risk genetic factors detected by PHC staff were referred to the Centre for Research in Mental Retardation (CREMERE) for cytogenetic and metabolic investigations, thus linking the study population and the Referral Centre. A genetic team interacted with the patient and family members for genetic counselling. Mental retardation was confirmed in 511 of the 525 cases reported, reflecting the positive impact of training on the CHVs. Potentially preventable environmental factors, such as birth asphyxia, infections, and low birth weight were identified in 251 cases (49%), 137 (27%) of which had additional genetic factors. Genetic causes were found in 186 (36%) individuals, the most common being Down syndrome. The study illustrates the urgent need for the integration of genetic screening into the public health services in India.
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Affiliation(s)
- U Dave
- Centre for Research in Mental Retardation (CREMERE), Mumbai, India.
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Dave U, Taylor-Robinson SD, Walker MM, Mahon M, Puri BK, Thursz MR, DeSouza NM, Cox IJ. In vitro 1H-magnetic resonance spectroscopy of Barrett's esophageal mucosa using magic angle spinning techniques. Eur J Gastroenterol Hepatol 2004; 16:1199-205. [PMID: 15489582 DOI: 10.1097/00042737-200411000-00019] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [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: 12/10/2022]
Abstract
OBJECTIVES In vitro proton magnetic resonance spectroscopy (MRS) allows changes in cell membrane lipid structure associated with dysplasia and malignant transformation to be investigated. Magic angle spinning (MAS) MRS allows small esophageal tissue specimens to be studied directly without the need to extract the tissue, but it is not known how intact the tissue architecture remains after MAS. We report the first prospective MAS MRS study of Barrett's esophagus using endoscopic biopsies with direct histological correlation. METHODS Biopsies were obtained during surveillance esophagoscopy from Barrett's epithelium and adjacent normal squamous epithelium in 16 patients (34 samples). High-resolution MAS MRS was performed at 500 MHz. Following MRS, the histology was evaluated. A further, separate group of 14 biopsies were examined histologically to assess architectural damage caused by tissue preservation alone. RESULTS For squamous and Barrett's epithelium, respectively, metabolite ratios of choline-containing compounds to creatine plus phosphocreatine (Cho/Cr) were 1.99 and 5.65 (P < 10) and methyl lipid to creatine plus phosphocreatine ratios (lipid-CH3/Cr) were 4.07 and 7.4 (P < 10). There was no significant difference in histological preservation between the squamous and Barrett's mucosa without MRS (z = 0.67, P = 0.61), but significant differences were found post-MAS MRS (z = 4.06, P < 0.0001). CONCLUSIONS Squamous and Barrett's epithelium can be distinguished metabolically, based on Cho/Cr and lipid-CH3/Cr ratios. Although MAS does affect the histological architecture in Barrett's epithelium, compared with squamous epithelium, direct histological assessment was possible in the majority of samples.
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Affiliation(s)
- Umakant Dave
- Division of Medicine A, Faculty of Medicine, Imperial College London, Hammersmith Hospital Campus, London, UK
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Hodson K, Dave U, Lewis A. Meningococcal Chest Pain. Med Chir Trans 2004; 97:434-5. [PMID: 15340024 PMCID: PMC1079586 DOI: 10.1177/014107680409700907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Kenneth Hodson
- Department of Medicine, Morriston Hospital, Swansea SA6 6NL, Wales, UK.
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Hodson K, Dave U, Lewis A. Meningococcal chest pain. J R Soc Med 2004. [DOI: 10.1258/jrsm.97.9.434] [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: 11/18/2022] Open
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Dave U, Thursz MR, Ebrahim HY, Burke MM, Townsend ER, Walker MM. Distribution of laminins in the basement membranes of the upper gastrointestinal tract and Barrett's oesophagus. J Pathol 2004; 202:299-304. [PMID: 14991894 DOI: 10.1002/path.1526] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [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: 11/07/2022]
Abstract
Barrett's oesophagus predisposes to oesophageal adenocarcinoma. In vitro, laminin, a component of the epithelial basement membrane (BM), is important in regulation of cell differentiation. There is limited information on the distribution of laminin chains in the upper gastrointestinal tract (GIT) and none in Barrett's oesophagus. This study aimed to investigate qualitatively the distribution of laminins in the normal upper GIT mucosa and Barrett's oesophagus in order to understand the role of laminins in metaplasia. Immunoperoxidase staining for laminin chains alpha1, alpha2, alpha3, alpha5, beta1, beta2, beta3, gamma1, and gamma2 was performed on frozen endoscopic squamous and Barrett's oesophageal biopsies and surgical resection specimens from squamous oesophagus (in resection specimens for oesophageal cancer), and in oesophageal and gastric biopsies from control subjects. alpha1 laminin was expressed in the BM of submucosal glands and ducts in squamous oesophagus and Brunner's glands in the duodenum, but not in Barrett's oesophagus or elsewhere in the upper GIT. alpha2 laminin chain was expressed in a granular distribution in the BM of squamous epithelium. In columnar epithelium, including Barrett's oesophagus, alpha2 laminin chain was expressed continuously in the BM of glands and deeper pits, but expression was reduced and granular in the surface epithelial BM. beta2 laminin was continuous in squamous epithelial BM, but in Barrett's and cardia, gastric body, and duodenum, it was expressed faintly in the surface but continuously in the BM of glands and deeper pits. The constituents of laminin-5 were continuously expressed in the BM of squamous epithelium, but in the cardia, gastric body, duodenum, and Barrett's, they were expressed only in the BM of surface epithelium, with a sharp decline in the glandular and deeper pit BM. Site-specific distribution of the alpha2 and beta2 laminin chains may therefore have an important role in Barrett's metaplasia. However, the absence of alpha1 laminin in Barrett's mucosa suggests that this is unlikely to play an important role in columnar metaplasia.
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Affiliation(s)
- U Dave
- Department of Medicine, Imperial College London, St Mary's Campus, London, UK
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Abstract
The incidence of adenocarcinoma of the oesophagus is increasing; this type of carcinoma commonly arises on Barrett's oesophagus. We report a case of in-situ adenocarcinoma of the lower oesophagus arising in submucosal oesophageal mucous glands without intestinal metaplasia. We describe the histological findings, discuss the difficulties of differentiating this from invasive disease and review the current literature regarding this rare condition.
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Affiliation(s)
- Aurélie Fabre
- Department of Histopathology, St Mary's Hospital, Imperial School of Medicine, London, UK
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Gilderdale DJ, Williams AD, Dave U, deSouza NM. An inductively-coupled, detachable receiver coil system for use with magnetic resonance compatible endoscopes. J Magn Reson Imaging 2003; 18:131-5. [PMID: 12815649 DOI: 10.1002/jmri.10321] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To construct an inductively-coupled receiver coil system for use with a magnetic resonance (MR) compatible endoscope, and to evaluate its use in a pilot group of patients with esophageal cancer. MATERIALS AND METHODS An inductively-coupled coil system, comprising a saddle geometry cylindrical receiver coil fitted as a sleeve around the endoscope tip and a pick-up coil housed within a channel of an MR-compatible endoscope, was designed and developed for use at 0.5 T. Twenty-three patients with esophageal cancer were recruited for MR endoscopy. In 17 cases, the endoscopic coil system was used in conjunction with an external surface coil in order to obtain information from the surrounding mediastinum. The examination took 40-50 minutes. RESULTS MR imaging using the inductively-coupled endoscopic coil was successful in 21 cases (one failed intubation and one artifact from unrelated external source). Image artifact was largely due to respiration and global patient motion in sedated individuals undergoing endoscopy. CONCLUSION Inductively-coupled coil systems may be used with endoscopes to allow improved safety through increased patient-system isolation and detachability of coils and electronics for repair or replacement with coils tuned for different frequencies.
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Abstract
BACKGROUND If areas of specialized intestinal metaplasia (SIM) or dysplasia in Barrett's esophagus can be identified at endoscopy, the number of biopsies could be reduced and the sensitivity of biopsy surveillance would increase. It has been suggested that methylene blue (MB) dye staining may be useful for this purpose. METHODS Nine patients were prospectively studied with Barrett's esophagus. Staining involved sequential spraying of 10% N-acetylcysteine, 0.5% MB and water. Quadrantic biopsies were obtained from Barrett's epithelium and collected in separate containers depending on whether they were taken from stained or unstained areas. Seven patients undergoing yearly surveillance were asked to compare the discomfort of this endoscopy with that of previous surveillance endoscopies. Biopsies were analyzed for the presence and the percentage of SIM and dysplasia by a nonblinded pathologist. RESULTS MB staining prolonged endoscopy by a mean of 8 minutes (47% increase in procedure time) and was associated with significant vomiting during the procedure in 2 patients. Staining was observed in all 9 patients. All 7 patients undergoing yearly endoscopic surveillance indicated more discomfort with endoscopy plus MB staining. Of 37 biopsies from stained mucosa, 20 contained SIM; of 23 from unstained mucosa, 15 contained SIM (57% sensitivity, 32% specificity for MB staining). CONCLUSIONS In this small, nonblinded study MB staining was associated with prolongation of endoscopy, increased patient discomfort, and potentially serious complications and was neither very sensitive nor specific for SIM. It is our recommendation that this technique should not be routinely used in endoscopic surveillance of patients with Barrett's esophagus. Further studies of MB staining are needed.
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Affiliation(s)
- U Dave
- Department of Gastroenterology, Chelsea & Westminster Hospital, London, United Kingdom
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Abstract
The purpose of this investigation was to determine the short-term stability of butorphanol tartrate in presence of diluents. A 10-mg/mL solution of butorphanol tartrate was diluted to 5 mg/mL using normal saline, 5% dextrose in water (D5W), or sterile water for injection. The diluted solutions were divided into two groups. The effect of temperature was tested by placing one group of sealed amber vials at room temperature and at 37 degrees C. The effect of light was studied by placing a second group in amber and clear vials, then exposing them directly to light. At regular time intervals over a period of 5 weeks, the solutions were analyzed for butorphanol tartrate and degradation products using a high-performance liquid chromatography assay. The concentration of butorphanol tartrate remained practically unchanged, indicating that butorphanol tartrate is not affected by heat or light in the presence of any of the diluents over a period of 5 weeks.
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Affiliation(s)
- A Desai
- Department of Pharmaceutical Sciences, Chicago College of Pharmacy, Midwestern University, Downers Grove, IL 60515, USA
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Dave U, Barrison I. Nutrition and malabsorption. Nurs Times 1998; 94:suppl 1-6. [PMID: 9510762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- U Dave
- Chelsea & Westminster Hospital
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Chiotakakou-Faliakou E, Dave U, Forbes A. Wheelchair use: a physical sign in gastroenterological practice. J R Soc Med 1996; 89:490-2. [PMID: 8949515 PMCID: PMC1295910 DOI: 10.1177/014107689608900904] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Diagnosis of functional abdominal pain requires exclusion of organic causes, and many patients undergo considerable investigation. A positive physical sign supporting a functional diagnosis could therefore be of benefit. Wheelchair use specifically for abdominal symptoms was suspected to represent such a sign. Review of 300 consecutive new referrals to a gastroenterology clinic revealed 10 wheelchair users. In four women the chair was used because of the abdominal condition. The final diagnosis (with follow-up to at least 12 months) was functional abdominal pain in each of these cases. All four had had surgery without symptom relief, and all had used their chairs intermittently (mainly for social occasions and hospital visits) for at least 12 months. They believed that normal walking was rendered impossible by abdominal pain whereas the other six wheelchair users gave a clear account of lower limb pain or weakness. Secondary gain with reinforcement of the 'sick role' was felt to be the probable explanation for wheelchair use in the former group. Wheelchair attendance at the gastroenterology clinic, in the absence of lower limb symptoms, is a rare observation but one that may usefully be added to criteria for diagnosis of a functional disorder.
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Marlowe FI, Goodman RS, Mobini J, Dave U. Cystic metastasis from occult tonsillar primary simulating branchiogenic carcinoma: the case for tonsillectomy as a "grand biopsy". Laryngoscope 1984; 94:833-5. [PMID: 6727522 DOI: 10.1288/00005537-198406000-00021] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The occult primary is a problem well known to head and neck surgeons. Less frequently discussed, but well documented, is cystic degeneration of metastatic nodes. When these conditions combine, they can suggest tumor arising in a pre-existing cervical cyst. This is a controversial condition, rare if it occurs at all, and is not to be invoked lightly.
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Abstract
Giant osteoma of the mastoid is a rare benign neoplasm that produces symptoms by encroachment on adjacent structures. An unusual feature of this case was impending encroachment on the main trunk of the facial nerve.
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Wolfson RJ, Del Polito G, Dave U. Vertigo. Otolaryngol Clin North Am 1978; 11:777-89. [PMID: 733259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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