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225 The Management of Acute Cholecystitis in a District General setting: An Audit of Practice. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Aim
The benefits of laparoscopic cholecystectomy during index admission with acute cholecystitis (AC) are multiple. As such, current NICE guidelines dictate that adults with AC undergo laparoscopic cholecystectomy within 1 week of diagnosis. However, significant variation exists with regards to the management of such patients. Here we present the results of an audit of practice at a UK district general hospital and suggest that this standard can be achieved regardless of hospital.
Method
Electronic database search at Salisbury District Hospital over a period of 12 months to identify all patients with a coded diagnosis of AC. Electronic Discharge System (EDS) was consulted to assess whether patients underwent laparoscopic cholecystectomy within 7 days of diagnosis. Notes were reviewed for all patients who failed to meet this target to ascertain reasons why.
Results
Of the 336 patients coded as AC 8 were excluded due to incorrect coding leaving 328. 285 patients (87%) underwent laparoscopic cholecystectomy within 7 days. Of the 43 that did not, 31 (65%) had clinically justified reasons for delay. 285/297 (96%) patients met the NICE standard.
Conclusions
At Salisbury District Hospital 87% patients presenting with AC underwent laparoscopic cholecystectomy within 7 days. Common reasons for failure included: Awaiting further investigation (i.e., ERCP / MRCP), unfit for operative management, patient choice. Excluding justifiable reasons 96% of patients met NICE standards. Poor documentation was the most common cause for failure. Subsequent education and re-audit showed significant improvement. This audit exemplifies that NICE standards for the management of AC can be achieved in a district general setting.
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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] [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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Evaluation of internet derived patient information for Acute Pancreatitis. THE ULSTER MEDICAL JOURNAL 2021; 90:7-9. [PMID: 33642626 PMCID: PMC7907905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Possibly In the UK there are currently over 26,000 patients admitted to hospital for acute pancreatitis per annum and the incidence is rising. 55% of patients consult the internet for information regarding their medical condition. As the number of people using the internet has increased 57% since 2006, it is increasingly important for medical professionals to direct patients to accurate online sources of information. This paper aims to evaluate the quality of information available online for acute pancreatitis. METHODS The term 'acute pancreatitis' was searched using http://www.google.com, http://www.bing.com, and http://www.yahoo.com. The top 10 results of each of these websites were assessed using the University of Michigan consumer health website evaluation checklist. RESULTS Of the 30 websites found, 4 were excluded from the evaluation. Within the 26 evaluated websites there was high variability in website quality. However, the authors would have used 18 of the websites again for the purpose of finding out information on acute pancreatitis. 15 websites had a named author of which 11 displayed their credentials. 8 of the websites had been updated within the last year. 10 websites displayed a bias or conflict of interest. Generally, the layout and design of websites was good, however 7 of the websites contained distracting graphics and 9 of the websites had no search facility. DISCUSSION Doctors should give patients the information they want and need. With a high percentage of patients using the internet, medical professionals should recommend good quality websites to their patients. Engaging in this process could improve the consenting process as patients would be better informed. Good quality websites allows patients to explore conditions by themselves, with a re-consultation facilitating further discussion. Failure to engage in internet-based information risks patients making misinformed decisions due to bias and conflict of interest.
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Important marine areas for the conservation of northern rockhopper penguins within the Tristan da Cunha Exclusive Economic Zone. ENDANGER SPECIES RES 2020. [DOI: 10.3354/esr01076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The designation of Marine Protected Areas has become an important approach to conserving marine ecosystems that relies on robust information on the spatial distribution of biodiversity. We used GPS tracking data to identify marine Important Bird and Biodiversity Areas (IBAs) for the Endangered northern rockhopper penguin Eudyptes moseleyi within the Exclusive Economic Zone (EEZ) of Tristan da Cunha in the South Atlantic. Penguins were tracked throughout their breeding season from 3 of the 4 main islands in the Tristan da Cunha group. Foraging trips remained largely within the EEZ, with the exception of those from Gough Island during the incubation stage. We found substantial variability in trip duration and foraging range among breeding stages and islands, consistent use of areas among years and spatial segregation of the areas used by neighbouring islands. For colonies with no or insufficient tracking data, we defined marine IBAs based on the mean maximum foraging range and merged the areas identified to propose IBAs around the Tristan da Cunha archipelago and Gough Island. The 2 proposed marine IBAs encompass 2% of Tristan da Cunha’s EEZ, and are used by all northern rockhopper penguins breeding in the Tristan da Cunha group, representing ~90% of the global population. Currently, one of the main threats to northern rockhopper penguins within the Tristan da Cunha EEZ is marine pollution from shipping, and the risk of this would be reduced by declaring waters within 50 nautical miles of the coast as ‘areas to be avoided’.
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Reducing 30-day post gastrostomy insertion mortality with a feeding issues multidisciplinary team meeting. Clin Nutr ESPEN 2020; 40:282-287. [DOI: 10.1016/j.clnesp.2020.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 09/03/2020] [Accepted: 09/06/2020] [Indexed: 12/24/2022]
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National health screening may reduce cardiovascular morbidity and mortality among the elderly. Public Health 2020; 187:172-176. [PMID: 32992163 DOI: 10.1016/j.puhe.2020.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 08/04/2020] [Accepted: 08/09/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Since 2007, the Korean government has provided a free health screening to the elderly starting at the age of 66 years. The purpose of this study was to evaluate the association between this general health screening and the incidences of stroke and myocardial infarction and mortality. STUDY DESIGN The study design used in this study is a retrospective cohort study. METHODS The study was conducted using the universe of insurance claims data of Korea and followed a cohort of individuals aged 66 years in 2009 from 2006 through 2016 (n = 354,194). We assessed the association between receipt of the national health screening and health outcomes using propensity matching and Cox proportional hazard models. RESULTS We found that the receipt of the national health screening was associated with a reduction in negative health outcomes. The hazard ratio for stroke was 0.89 (P < 0.001), 0.88 (P < 0.001) for myocardial infarction and 0.58 for death (P < 0.001). CONCLUSION Korea's national health screening was associated with reductions in cardiovascular morbidity and mortality in the elderly.
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A Horizon Scan of research priorities to inform policies aimed at reducing the harm of plastic pollution to biota. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 733:139381. [PMID: 32446089 DOI: 10.1016/j.scitotenv.2020.139381] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 05/02/2020] [Accepted: 05/10/2020] [Indexed: 06/11/2023]
Abstract
Plastic pollution in the oceans is a priority environmental issue. The recent increase in research on the topic, coupled with growing public awareness, has catalyzed policymakers around the world to identify and implement solutions that minimize the harm caused by plastic pollution. To aid and coordinate these efforts, we surveyed experts with scientific experience identified through their peer-reviewed publications. We asked experts about the most pressing research questions relating to how biota interact with plastic pollution that in turn can inform policy decisions and research agendas to best contribute to understanding and reducing the harm of plastic pollution to biota. We used a modified Horizon Scan method that first used a subgroup of experts to generate 46 research questions on aquatic biota and plastics, and then conducted an online survey of researchers globally to prioritize questions in terms of their importance to inform policy development. One hundred and fifteen experts from 29 countries ranked research questions in six themes. The questions were ranked by urgency, indicating which research should be addressed immediately, which can be addressed later, and which are of limited relevance to inform action on plastics as an environmental pollutant. We found that questions relating to the following four themes were the most commonly top-ranked research priorities: (i) sources, circulation and distribution of plastics, (ii) type of harm from plastics, (iii) detection of ingested plastics and the associated problems, and (iv) related economies and policy to ingested plastics. While there are many research questions on the topic of impacts of plastic pollution on biota that could be funded and investigated, our results focus collective priorities in terms of research that experts believe will inform effective policy and on-the-ground conservation.
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Home parenteral nutrition and the older adult: Experience from a national intestinal failure unit. Clin Nutr 2020; 39:1418-1422. [DOI: 10.1016/j.clnu.2019.06.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 06/19/2019] [Accepted: 06/22/2019] [Indexed: 12/18/2022]
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Panic patients in the non-panic state: physiological and cognitive dysfunction. Eur Psychiatry 2020; 13:18-25. [DOI: 10.1016/s0924-9338(97)86747-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/1997] [Accepted: 01/08/1998] [Indexed: 11/27/2022] Open
Abstract
SummaryPanic attacks and the antipanic effect of antidepressants are claimed to distinguish panic disorder (PD) from generalised anxiety disorder. However, most studies showing neurochemical disturbances in PD overlook the non-panic state. We compared panic patients in the non-panic state with controls on biochemical, psychological and physiological measures. There were no differences on the neuroendocrine tests. Self-ratings of bodily and psychological symptoms of anxiety were significantly higher in patients and they scored worse on word recall. Patients had significantly more skin conductance fluctuations and slow wave activity in the electroencephalogram, a sign of hyperventilation which may have implications for brain activity. Discrepancies between patients' self-ratings and objective measures of pulse rate and psychomotor performance indicated that panic patients have distorted perceptions of both physical and mental functioning. Hyperventilation and cognitive distortions in the non-panic state may facilitate panic attacks and are part of the pathophysiology of PD.
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Implementation of a feeding issues multidisciplinary team meeting in a university teaching hospital. Clin Nutr ESPEN 2020. [DOI: 10.1016/j.clnesp.2019.12.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Cross-sectional study of the prevalence, causes and management of hospital-onset diarrhoea. J Hosp Infect 2019; 103:200-209. [PMID: 31077777 DOI: 10.1016/j.jhin.2019.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 05/01/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND The National Health Service in England advises hospitals collect data on hospital-onset diarrhoea (HOD). Contemporaneous data on HOD are lacking. AIM To investigate prevalence, aetiology and management of HOD on medical, surgical and elderly-care wards. METHODS A cross-sectional study in a volunteer sample of UK hospitals, which collected data on one winter and one summer day in 2016. Patients admitted ≥72 h were screened for HOD (definition: ≥2 episodes of Bristol Stool Type 5-7 the day before the study, with diarrhoea onset >48 h after admission). Data on HOD aetiology and management were collected prospectively. FINDINGS Data were collected on 141 wards in 32 hospitals (16 acute, 16 teaching). Point-prevalence of HOD was 4.5% (230/5142 patients; 95% confidence interval (CI) 3.9-5.0%). Teaching hospital HOD prevalence (5.9%, 95% CI 5.1-6.9%) was twice that of acute hospitals (2.8%, 95% CI 2.1-3.5%; odds ratio 2.2, 95% CI 1.7-3.0). At least one potential cause was identified in 222/230 patients (97%): 107 (47%) had a relevant underlying condition, 125 (54%) were taking antimicrobials, and 195 (85%) other medication known to cause diarrhoea. Nine of 75 tested patients were Clostridium difficile toxin positive (4%). Eighty (35%) patients had a documented medical assessment of diarrhoea. Documentation of HOD in medical notes correlated with testing for C. difficile (78% of those tested vs 38% not tested, P<0.001). One-hundred and forty-four (63%) patients were not isolated following diarrhoea onset. CONCLUSION HOD is a prevalent symptom affecting thousands of patients across the UK health system each day. Most patients had multiple potential causes of HOD, mainly iatrogenic, but only a third had medical assessment. Most were not tested for C. difficile and were not isolated.
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SUN-PO262: Sensitivity of Differential Time to Positivity Compared to Pour Plates for Diagnosing Catheter-Related Blood Stream Infection: An Evaluation in Patients with Chronic Intestinal Failure. Clin Nutr 2019. [DOI: 10.1016/s0261-5614(19)32892-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Sexual and geographic dimorphism in northern rockhopper penguins breeding in the South Atlantic Ocean. ENDANGER SPECIES RES 2019. [DOI: 10.3354/esr00970] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Catheter-related infections in patients with acute type II intestinal failure admitted to a national centre: Incidence and outcomes. Clin Nutr 2019; 38:1828-1832. [DOI: 10.1016/j.clnu.2018.07.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 07/18/2018] [Indexed: 01/09/2023]
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A novel discharge pathway for patients with advanced cancer requiring home parenteral nutrition. J Hum Nutr Diet 2019; 32:492-500. [PMID: 31006921 DOI: 10.1111/jhn.12650] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND The use of home parenteral nutrition (HPN) for palliative indications is increasing internationally and is the leading indication in some countries. Discharge on HPN can be complex in metabolically unstable patients and requires intestinal failure expertise. METHODS Between 2012 and 2018, we performed a retrospective analysis aiming to assess the impact of a novel remote discharge pathway for palliative HPN patients. This was evaluated using a quality improvement approach. RESULTS One hundred and twenty-five patients with active malignancy [mean (range) age 58 (25-80) years] were referred to the intestinal failure unit (IFU) for remote discharge. Of 82 patients were discharged from the oncology Centre on HPN using the pathway. The remaining 43 patients either declined HPN or the Oncology team felt that the patient became too unwell for HPN or died prior to discharge. There was an increase in patients referred for remote discharge from 13 in 2012 to 43 in 2017. The mean number of days between receipt of referral by the IFU to discharge on HPN from the oncology centre reduced from 29.4 days to 10.1 days. Following remote discharge, the mean number of days on HPN was 215.9 days. Catheter-related blood stream infection rates in this cohort were very low at 0.169 per 1000 catheter days. CONCLUSIONS This is the first study to demonstrate the remote safe, effective and rapid discharge of patients requiring palliative HPN between two hospital sites. This allows patients with a short prognosis more time in their desired location.
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Home parenteral nutrition in the elderly: experience from a national intestinal failure centre. Clin Nutr ESPEN 2019. [DOI: 10.1016/j.clnesp.2018.12.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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A novel discharge pathway for patients requiring palliative home parenteral nutrition. Clin Nutr ESPEN 2019. [DOI: 10.1016/j.clnesp.2018.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Assessing the impact of quality improvement measures on catheter related blood stream infections and catheter salvage: Experience from a national intestinal failure unit. Clin Nutr 2018; 37:2097-2101. [DOI: 10.1016/j.clnu.2017.10.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Revised: 09/21/2017] [Accepted: 10/03/2017] [Indexed: 10/18/2022]
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Reversal of intestinal failure associated liver disease fibrosis in a patient receiving long term home parenteral nutrition. Clin Nutr ESPEN 2018; 28:228-231. [PMID: 30390886 DOI: 10.1016/j.clnesp.2018.09.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 07/19/2018] [Accepted: 09/11/2018] [Indexed: 12/24/2022]
Abstract
Intestinal failure associated liver disease (IFALD) is frequent problem encountered when managing patients receiving parenteral nutrition (PN). Its occurrence is often multifactorial and modification of these factors is vital for the management of such hepatic dysfunction. The use of novel lipid preparations can form part of this management strategy. We present a case whereby such modification of contributing factors, including lipid preparations, led to improvements in IFALD and reversal of hepatic fibrosis.
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Successful implementation of remote video consultations for patients receiving home parenteral nutrition. Clin Nutr 2018. [DOI: 10.1016/j.clnu.2018.06.1600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Catheter related infections in patients with acute type ii intestinal failure admitted to a national centre: Incidence and outcomes. Clin Nutr 2018. [DOI: 10.1016/j.clnu.2018.06.1136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Infective endocarditis as a complication of central venous catheters used for home parenteral nutrition: Experience from a national intestinal failure centre. Clin Nutr 2018. [DOI: 10.1016/j.clnu.2018.06.1137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Factors influencing parenteral nutrition requirements and glucogan like peptide-2 analogue suitability in a type three intestinal failure cohort: Experience from a national U.K. intestinal failure unit. Clin Nutr 2018. [DOI: 10.1016/j.clnu.2018.06.1096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Examining the pathophysiology of short bowel syndrome and glucagon-like peptide 2 analogue suitability in chronic intestinal failure: experience from a national intestinal failure unit. Eur J Clin Nutr 2018; 73:751-756. [PMID: 30111847 DOI: 10.1038/s41430-018-0278-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 07/16/2018] [Accepted: 07/18/2018] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Short bowel syndrome (SBS) is a leading cause of intestinal failure (IF). Home parenteral nutrition (HPN) remains the standard treatment, with small intestinal transplantation reserved for cases with severe complications to HPN. There have recently been significant developments in growth factor therapy. We aimed to develop a greater contemporary understanding of our SBS-IF subset. METHOD We performed a retrospective observational study of a prospectively maintained HPN audit database in October 2017. Intestinal anatomical details and parenteral requirements were recorded. Each case was assessed for eligibility for growth factor therapy using recently published trials. RESULTS Of 273 patients receiving HPN, 152 (55.7%) had type three IF as a result of SBS (SBS-IF), with a mean duration of HPN of 61 months (range 4-416). Mean length of small intestine was 98 cm. Furthermore, 114 (41.8%) patients had an end jejunostomy (SBS-J), 18 (6.6%) had an end ileostomy, and 7.3% of patients had all or part of the colon-in-continuity. Crohn's disease was the most common underlying pathology. Univariate analysis for the whole HPN cohort demonstrated SBS-IF and a longer duration of HPN to be associated with higher PN energy requirements, p ≤ 0.0001. Of all, 73 (48%) patients with SBS-IF were deemed suitable for GLP-2 analogue therapy, with co-morbidity being the most frequent cause of non-suitability (29.1%). CONCLUSION We describe a large U.K. HPN cohort using ESPEN pathophysiological and clinical severity classification. The majority of patients with SBS-IF had a jejunostomy and relatively few had colon-in-continuity. Co-morbidity is the most common contra-indication to GLP-2 analogue therapy. CLINICAL RELEVANCY GLP-2 analogues are emerging as an important treatment for patients with short bowel syndrome. Our study explores patient suitability in a large HPN cohort managed in a national IF centre. Furthermore, the international variation in the pathophysiology of SBS-IF varies significantly, which can have a bearing on PN requirements and outcomes when GLP-2 analogues are used.
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Clinical Pathology of the Vulnerable Gough Moorhen (Gallinula comeri). J Comp Pathol 2017; 157:246-255. [PMID: 29169618 DOI: 10.1016/j.jcpa.2017.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 08/01/2017] [Accepted: 08/07/2017] [Indexed: 10/18/2022]
Abstract
The Gough moorhen (Gallinula comeri) is native to Gough Island, Tristan da Cunha, and listed as Vulnerable by the International Union for Conservation of Nature due to its restricted range and susceptibility to introduced predators. A planned ecosystem restoration by eradication of introduced house mice (Mus musculus) via aerially delivered rodenticide requires a reproductively balanced population of Gough moorhens to be held in captivity to avoid primary and secondary poisoning. To aid disease detection during the period of captivity, Gough moorhens (n = 43; 25 adult females and 18 adult males) were captured, measured and sampled to determine ease of sexing by morphometrics, to establish reference ranges for routine haematological and biochemical parameters and to identify any intestinal and haemoparasites as well as determine which faecal bacteria were present. Male Gough moorhens had significantly greater mean body mass (P = 0.019) and head and bill length (P = 0.001) compared with females, but the overlapping ranges showed genetic identification of sex was required for accurate determination. Plasma globulin and total protein concentrations were significantly greater in female compared with male birds (P = 0.032 and P = 0.012, respectively) and probably related to egg yolk production. No haemoparasites or gastrointestinal parasites were found in any bird and there were no sex-related differences in the haematology. Multiple bacterial taxa were isolated from the faeces of all birds including Enterococcus spp. (n = 42), Klebsiella spp. (n = 40), Staphylococcus aureus (n = 33), Staphylococcus intermedius (n = 16), Escherichia coli (n = 41) and Pseudomonas spp. (n = 7). No clinical or subclinical disease was found in any of the birds examined, suggesting they are suitable for short-term captivity but rapid on-island genetic-based sex determination will be essential to ensure a reproductively balanced population.
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Use of the school setting during the summer holidays: formative process evaluation of ‘Food and Fun’. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx187.441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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OR23: Occurrence & Salvage of Infected Central Venous Catheters in Home Parenteral Nutrition: Experience from a National UK Centre. Clin Nutr 2017. [DOI: 10.1016/s0261-5614(17)30764-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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P4491Proteomics matched with clinical outcome in right ventricular hypertrophy due to congenital heart disease. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Effects of Ground Cardamom on the Functional Properties of Restructured Ground Turkey. MEAT AND MUSCLE BIOLOGY 2017. [DOI: 10.22175/rmc2017.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Erratum to: 36th International Symposium on Intensive Care and Emergency Medicine: Brussels, Belgium. 15-18 March 2016. Crit Care 2016; 20:347. [PMID: 31268434 PMCID: PMC5078922 DOI: 10.1186/s13054-016-1358-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 05/13/2016] [Indexed: 11/27/2022] Open
Abstract
[This corrects the article DOI: 10.1186/s13054-016-1208-6.].
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IMPACT OF TRIALS ON CLINICAL PRACTICE: INTERVENTIONS IN SEPTIC SHOCK PATIENTS BETWEEN 2005 AND 2013. Intensive Care Med Exp 2015. [PMCID: PMC4796746 DOI: 10.1186/2197-425x-3-s1-a430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Review article: cytomegalovirus and inflammatory bowel disease. Aliment Pharmacol Ther 2015; 41:725-33. [PMID: 25684400 DOI: 10.1111/apt.13124] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 09/04/2014] [Accepted: 01/27/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND The association between ulcerative colitis and cytomegalovirus (CMV) has been recognised for over 50 years; and the role of CMV in ulcerative colitis in general, and steroid resistance in particular, remains a topic of ongoing controversy. The outcome for patients with CMV reactivation appears worse than that for patients without reactivation, but it is not entirely clear whether CMV is a contributor or a bystander and if treatment with anti-virals alters the course of inflammatory bowel disease (IBD). AIM To review the role of CMV associated with IBD, including epidemiology, clinical features, diagnosis and management strategies. METHODS By reviewing literature available on CMV associated with IBD in adult patients. A PubMed literature search was performed using the following terms individually or in combination: CMV colitis, cytomegalovirus colitis, IBD and CMV, CMV treatment. RESULTS Cytomegalovirus reactivation is common in patients with severe colitis, with a reported prevalence of 4.5-16.6%, and as high as 25% in patients requiring colectomy for severe colitis. The outcome for this group of patients appears worse than that for patients without reactivation; however, reported remission rates following treatment with anti-viral therapy are as high as 71-86%. CONCLUSIONS Evidence, although not conclusive, supports testing for CMV colonic disease in cases of moderate to severe colitis, by processing biopsies for haematoxylin and eosin staining with immunohistochemistry and/or, CMV DNA real-time polymerase chain reaction; and if present treating with ganciclovir.
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2013 SYR Accepted Poster Abstracts. Int J Yoga Therap 2013; 23:32-53. [PMID: 24016822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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CrysAlisPRO: facilitating variable temperature experiments. Acta Crystallogr A 2011. [DOI: 10.1107/s0108767311093056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Percutaneous endoscopic sigmoid colostomy for irrigation in the management of bowel dysfunction of adults with central neurologic disease. Surg Endosc 2011; 25:3253-9. [DOI: 10.1007/s00464-011-1701-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2010] [Accepted: 03/15/2011] [Indexed: 11/29/2022]
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A simple field technique for estimation of body surface area in horses and ponies. ACTA ACUST UNITED AC 2007. [DOI: 10.1079/ecp20035] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AbstractThis study aimed to produce a weight-independent algorithm for determination of body surface area (BSA; cm2) to within 5% accuracy of the directly determined value in selected horses and ponies under field conditions. Quantification of BSA in equines has applications in the fields of energy budgeting, growth, thermoregulation, conformation and drug kinetics. A simple algorithm for determining BSA to ±5% accuracy was produced for Shetland ponies, Shire horses, Welsh Mountain Section A ponies and Hanoverian mature horses and foals. The accuracy of the method was ±8% for Welsh Mountain-type ponies and Hanoverian two-year-olds. The data were produced by tiling of the shoulder region on one side of the animal with chalk and adapting a simple geometrical integrative technique. Linear anthropometric measurements were of limited use in predicting BSA in that they produced algorithms of ±5% accuracy for ponies of uniform conformation only (Welsh Mountain Section A ponies). The relevant equations were:
for Arab-based breeds (Welsh Mountain-type and Section A ponies and Hanoverian horses and foals) and
for UK native breeds (Shetland ponies and Shire horses), where ‘surface area of shoulder region on one side’ was defined by the anterior margins of the supraspinatus and deep pectoral, and the posterior margin of the triceps muscles. This tiling procedure fulfilled the aim of the study and also provided quantitative information on proportional differences in areas of body regions between and within these selected breeds.
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Neuroprotective Actions of Novel and Potent Agonists of Group II Metabotropic Glutamate Receptors. CNS DRUG REVIEWS 2006. [DOI: 10.1111/j.1527-3458.2000.tb00180.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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The cascading pebble divertor for the spherical tokamak power plant. FUSION ENGINEERING AND DESIGN 2006. [DOI: 10.1016/j.fusengdes.2005.08.090] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Evidence-based guidelines for the pharmacological treatment of anxiety disorders: recommendations from the British Association for Psychopharmacology. J Psychopharmacol 2005; 19:567-96. [PMID: 16272179 DOI: 10.1177/0269881105059253] [Citation(s) in RCA: 355] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
These British Association for Psychopharmacology guidelines cover the range and aims of treatment for anxiety disorders. They are based explicitly on the available evidence and are presented as recommendations to aid clinical decision making in primary and secondary medical care. They may also serve as a source of information for patients and their carers. The recommendations are presented together with a more detailed review of the available evidence. A consensus meeting involving experts in anxiety disorders reviewed the main subject areas and considered the strength of evidence and its clinical implications. The guidelines were constructed after extensive feedback from participants and interested parties. The strength of supporting evidence for recommendations was rated. The guidelines cover the diagnosis of anxiety disorders and key steps in clinical management, including acute treatment, relapse prevention and approaches for patients who do not respond to first-line treatments.
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Homeopathic proving symptoms: result of a local, non-local, or placebo process? A blinded, placebo-controlled pilot study. HOMEOPATHY 2005; 93:179-85. [PMID: 15532695 DOI: 10.1016/j.homp.2004.07.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Homeopathic pathogenetic trials (HPTs) (provings) are the pillar of homeopathy. Symptoms experienced by healthy volunteers are used to find the correct medicine for therapy. It is unclear whether these symptoms are specific or due to placebo noise. Furthermore, it is uncertain whether proving effects, if present at all, are due to a local or non-local process OBJECTIVES To develop a test model which allows for testing if homeopathic proving symptoms are caused by placebo or causative mechanisms, and if these symptoms are due to local or non-local processes. DESIGN Randomised, blinded, placebo-controlled, parallel-group study, with 1-week baseline and 2-weeks proving period. SUBJECTS 11 healthy volunteers from two different homeopathic schools. PROVING SUBSTANCE: An homeopathic medicine (Cantharis 30c), blindly chosen from 12 potential medicines, compared to placebo. OUTCOME MEASURE Number of symptoms typical for the medicine in the experimental and control group during baseline and proving period. RESULTS During baseline there was no difference in the number of typical or atypical symptoms in either group. During the proving period, both more typical symptoms for Cantharis (P= 0.03) and more atypical symptoms (P= 0.02) were observed compared to baseline. Between-group differences were not significant. Effect sizes for the difference between the proving and control group for typical symptoms was d=0.4, and for atypical symptoms d=0.6. DISCUSSION This proving model could be valuable in studying the validity of proving symptoms of homeopathic substances in healthy volunteers. CONCLUSION Homeopathic proving symptoms appear to be specific to the medicine and do not seem to be due to a local process. Since this was a pilot study using a small number of provers, rival hypotheses cannot be ruled out and the study needs replication.
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Abstract
We examine the effects of IL18 on monocytes by performing microarray experiments using cell line KG1. Based on sensitivity to IL18, we identified three functionally distinct gene expression clusters (EC). We see little proinflammatory gene induction at low IL18 concentrations, but instead observe induction of diverse NF kappa B signaling inhibitors. Conversely, intermediate concentrations of IL18 induced proinflammatory genes including the activating subunits of NF kappa B. At the highest IL18 concentration, we observe a third gene cluster containing the proapoptotic Fas gene among others. Clustering of IL18-responsive genes based on cis-elements in their promoters agreed well with the ECs. We conclude that IL18 produces a dose-dependent transcriptional response that can in part be attributed to the composition of cis-elements in the promoters of IL18-responsive genes. These results also support a model for regulatory mechanisms that prevent spurious immune response due to weak cytokine fluctuations and a separate mechanism enabling induction of proinflammatory functions by higher levels of cytokine.
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Abstract
We have characterized "MnO2 Resin," a new resin developed by the PG Research Foundation, for radium adsorption over wide ranges of pH, reaction times and salt concentrations. We show that the sorption of 133Ba (used as a proxy for Ra) is highly dependent on pH with the most useful range from pH 4 to 8. The surface layers of the Mn oxides apparently become more positively charged under acidic conditions (below pH 4), which prevents diffusion of positively charged alkaline earth species (e.g. Ba2+, Ra2+) into the sorption sites. Adsorption at higher pH is thought to be inhibited because of carbonate complexation. We found that the sorption characteristics for radium onto MnO2 Resin are especially favorable for low-salinity waters but the sorption is still very satisfactory for highly salted solutions (KD=2.8x10(4) in both cases) but with slower kinetics. For analytical purposes, both column and pump experiments showed high recoveries with no measurable discrimination between Ra and Ba regardless of flow rates in fresh water. Seawater tests showed that recoveries of Ra and Ba are lower than fresh water at elevated flow rates with Ra adsorption higher than Ba at flow rates above 10 ml/min.
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Abstract
BACKGROUND Trends in deliberate self-harm (DSH) are important because they have implications for hospital services, may indicate levels of psychopathology in the community and future trends in suicide, and can assist in identification of means of suicide prevention. METHOD We have investigated trends in DSH and characteristics of DSH patients between 1990 and 2000 based on data collected through the Oxford Monitoring System for Attempted Suicide. RESULTS During the 11-year study period 8590 individuals presented following 13858 DSH episodes. The annual numbers of persons and episodes increased overall by 36.3% and 63.1% respectively. Rates (Oxford City) declined, however, in the final 3 years. There were gender- and age-specific changes, with a rise in DSH rates in males aged > or = 55 years and in females overall and those aged 15-24 years and 35-54 years. Repetition of DSH increased markedly during the study period. Antidepressant overdoses, especially of SSRIs, increased substantially. Paracetamol overdoses declined towards the end of the study period. Alcohol abuse, use of alcohol in association with DSH, and violence increased, especially in females, and the proportion of patients in current psychiatric care and misusing drugs also rose. CONCLUSIONS While overall rates of DSH did not increase markedly between 1990 and 2000, substantial changes in the characteristics of the DSH population and a rise in repetition suggest that the challenges facing clinical services in the management of DSH patients have grown.
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Metal polypyrazolylborate complexes. I. Reactions of perfluoroalkylmetal carbonyl halides of iron and cobalt with polypyrazolylborates. J Am Chem Soc 2002. [DOI: 10.1021/ja00812a012] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Metal polypyrazolylborate complexes. III. Reactions of allyliron tricarbonyl iodide with polypyrazolylborates. J Am Chem Soc 2002. [DOI: 10.1021/ja00812a014] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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