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Liu J, Poon JL, Bispham J, Perez-Nieves M, Hughes A, Chapman K, Mitchell B, Hood K, Snoek F, Fisher L. Development and validation of fear of hypoglycemia screener: results from the T1D exchange registry. J Patient Rep Outcomes 2023; 7:43. [PMID: 37160500 PMCID: PMC10169988 DOI: 10.1186/s41687-023-00585-9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 04/24/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND Fear of Hypoglycemia (FoH) in people with diabetes has a significant impact on their quality of life, psychological well-being, and self-management of disease. There are a few questionnaires assessing FoH in people living with diabetes, but they are more often used in research than clinical practice. This study aimed to develop and validate a short and actionable FoH screener for adults living with type 1 diabetes (T1D) for use in routine clinical practice. METHODS We developed an initial screener based on literature review and, interviews with healthcare providers (HCPs) and people with T1D. We developed a cross-sectional web-based survey, which was then conducted to examine the reliability and validity of the screener. Adults (aged ≥ 18 years) with diagnosis of T1D for ≥ 1 year were recruited from the T1D Exchange Registry (August-September 2020). The validation analyses were conducted using exploratory factor analyses, correlation, and multivariable regression models for predicting cut-off scores for the final screener. RESULTS The final FoH screener comprised nine items assessing two domains, "worry" (6-items) and "avoidance behavior" (three items), in 592 participants. The FoH screener showed good internal consistency (Cronbach's α = 0.88). The screener also demonstrated high correlations (r = 0.71-0.75) with the Hypoglycemia Fear Survey and moderate correlations with depression, anxiety, and diabetes distress scales (r = 0.44-0.66). Multivariable regression analysis showed that higher FoH screener scores were significantly associated with higher glycated hemoglobin (HbA1c) (b = 0.04) and number of comorbidities (b = 0.03). CONCLUSIONS This short FoH screener demonstrated good reliability and validity. Further research is planned to assess clinical usability to identify patients with FoH and assist effective HCP-patient conversations.
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Affiliation(s)
| | - Jiat-Ling Poon
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, 46285, USA
| | | | | | | | | | - Beth Mitchell
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, 46285, USA.
| | - Korey Hood
- Stanford University School of Medicine, Stanford, CA, USA
| | - Frank Snoek
- Department of Medical Psychology Amsterdam University Medical Centres, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Lawrence Fisher
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, CA, USA
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2
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James N, Pirrie S, Liu W, Jefferson K, Gallagher J, Hughes A, Knight A, Nanton V, Mintz H, Pope A, Doyle H, Singh J, Hafeez S, Patel P, Catto J, Bryan R. 1733MO First results from BladderPath: A randomised trial of MRI versus cystoscopic staging for newly diagnosed bladder cancer. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1811] [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: 11/01/2022] Open
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3
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Bhullar P, Boudreaux B, Severson K, Zhang N, Butterfield R, Brumfiel C, Patel M, Li X, Hughes A, Zunich S, Branch E, Nelson S, Sekulic A, Pittelkow M, Mangold A. LB947 An open-label study of topical ruxolitinib in necrobiosis lipoidica. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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4
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Joshi R, Wannamethee G, Engmann J, Gaunt T, Lawlor D, Price J, Tillin T, Chaturvedi N, Kivimaki M, Hughes A, Wong A, Hingorani A, Schmidt A. Association of triglyceride and cholesterol content in fourteen lipoprotein subfractions with coronary heart disease: A mendelian randomisation analysis. Atherosclerosis 2022. [DOI: 10.1016/j.atherosclerosis.2022.06.425] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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5
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Greenwood DA, Litchman ML, Isaacs D, Blanchette JE, Dickinson JK, Hughes A, Colicchio VD, Ye J, Yehl K, Todd A, Peeples MM. A New Taxonomy for Technology-Enabled Diabetes Self-Management Interventions: Results of an Umbrella Review. J Diabetes Sci Technol 2022; 16:812-824. [PMID: 34378424 PMCID: PMC9264439 DOI: 10.1177/19322968211036430] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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] [Indexed: 01/08/2023]
Abstract
BACKGROUND A 2017 umbrella review defined the technology-enabled self-management (TES) feedback loop associated with a significant reduction in A1C. The purpose of this 2021 review was to develop a taxonomy of intervention attributes in technology-enabled interventions; review recent, high-quality systematic reviews and meta-analyses to determine if the TES framework was described and if elements contribute to improved diabetes outcomes; and to identify gaps in the literature. METHODS We identified key technology attributes needed to describe the active ingredients of TES interventions. We searched multiple databases for English language reviews published between April 2017 and April 2020, focused on PwD (population) receiving diabetes care and education (intervention) using technology-enabled self-management (comparator) in a randomized controlled trial, that impact glycemic, behavioral/psychosocial, and other diabetes self-management outcomes. AMSTAR-2 guidelines were used to assess 50 studies for methodological quality including risk of bias. RESULTS The TES Taxonomy was developed to standardize the description of technology-enabled interventions; and ensure research uses the taxonomy for replication and evaluation. Of the 26 included reviews, most evaluated smartphones, mobile applications, texting, internet, and telehealth. Twenty-one meta-analyses with the TES feedback loop significantly lowered A1C. CONCLUSIONS Technology-enabled diabetes self-management interventions continue to be associated with improved clinical outcomes. The ongoing rapid adoption and engagement of technology makes it important to focus on uniform measures for behavioral/psychosocial outcomes to highlight healthy coping. Using the TES Taxonomy as a standard approach to describe technology-enabled interventions will support understanding of the impact technology has on diabetes outcomes.
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Affiliation(s)
- Deborah A. Greenwood
- School of Nursing, UT Health San
Antonio, TX, USA
- Deborah A. Greenwood, PhD, RN, BC-ADM,
CDCES, FADCES, School of Nursing, UT Health San Antonio, 7703 Floyd Curl Dr, San
Antonio, TX 78229 USA.
| | | | - Diana Isaacs
- Cleveland Clinic Diabetes Center,
Cleveland, OH, USA
| | | | | | | | | | - Jiancheng Ye
- Northwestern University Feinberg School
of Medicine, Chicago, IL, USA
| | - Kirsten Yehl
- Association of Diabetes Care &
Education Specialists, Chicago, IL, USA
| | - Andrew Todd
- University of Central Florida, College
of Nursing, University Tower, Orlando, FL, USA
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6
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Katsioli S, Adam R, Ade P, Ajeddig H, André P, Artis E, Aussel H, Beelen A, Benoît A, Berta S, Bing L, Bourrion O, Calvo M, Catalano A, De Looze I, De Petris M, Désert FX, Doyle S, Driessen EC, Ejlali G, Galametz M, Galliano F, Gomez A, Goupy J, Jones A, Hughes A, Kéruzoré F, Kramer C, Ladjelate B, Lagache G, Leclercq S, Lestrade JF, Macías-Pérez JF, Madden S, Maury A, Mauskopf P, Mayet F, Monfardini A, Muñoz-Echeverría M, Nersesian A, Perotto L, Pisano G, Ponthieu N, Revéret V, Rigby A, Ritacco A, Romero C, Roussel H, Ruppin F, Schuster K, Shu S, Sievers A, Smith MWL, Tabatabaei F, Tucker C, Xilouris EM, Zylka R. Exploring the millimetre emission in nearby galaxies: Analysis of the edge-on galaxy NGC 891. EPJ Web Conf 2022. [DOI: 10.1051/epjconf/202225700023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
New observations of the edge-on galaxy NGC 891, at 1.15 and 2mm obtained with the IRAM 30-m telescope and the NIKA2 camera, within the framework of the IMEGIN (Interpreting the Millimetre Emission of Galaxies with IRAM and NIKA2) Large Program, are presented in this work. By using multiwavelength maps (from the mid-IR to the cm wavelengths) we perform SED fitting in order to extract the physical properties of the galaxy on both global and local (~kpc) scales. For the interpretation of the observations we make use of a state-of-the-art SED fitting code, HerBIE (HiERarchical Bayesian Inference for dust Emission). The observations indicate a galaxy morphology, at mm wavelengths, similar to that of the cold dust emission traced by submm observations and to that of the molecular gas. The contribution of the radio emission at the NIKA2 bands is very small (negligible at 1.15 mm and ~ 10% at 2 mm) while it dominates the total energy budget at longer wavelengths (beyond 5 mm). On local scales, the distribution of the free-free emission resembles that of the dust thermal emission while the distribution of the synchrotron emission shows a deficiency along the major axis of the disc of the galaxy.
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7
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Ejlali G, Adam R, Ade P, Ajeddig H, André P, Artis E, Aussel H, Beelen A, Benoît A, Berta S, Bing L, Bourrion O, Calvo M, Catalano A, de Looze I, De Petris M, Désert FX, Doyle S, Driessen EC, Galametz M, Galliano F, Gomez A, Goupy J, Jones A, Hughes A, Katsioli S, Kéruzoré F, Kramer C, Ladjelate B, Lagache G, Leclercq S, Lestrade JF, Macías-Pérez JF, Madden S, Maury A, Mauskopf P, Mayet F, Monfardini A, Muñoz-Echeverría M, Nersesian A, Perotto L, Pisano G, Ponthieu N, Revéret V, Rigby A, Ritacco A, Romero C, Roussel H, Ruppin F, Schuster K, Shu S, Sievers A, Smith MWSL, Tabatabaei FS, Tucker C, Xilouris E, Zylka R. Dust Emission in Galaxies at Millimeter Wavelengths: Cooling of star forming regions in NGC6946. EPJ Web Conf 2022. [DOI: 10.1051/epjconf/202225700016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Interstellar dust plays an important role in the formation of molecular gas and the heating and cooling of the interstellar medium. The spatial distribution of the mm-wavelength dust emission from galaxies is largely unexplored. The NIKA2 Guaranteed Time Project IMEGIN (Interpreting the Millimeter Emission of Galaxies with IRAM and NIKA2) has recently mapped the mm emission in the grand design spiral galaxy NGC6946. By subtracting the contributions from the free-free, synchrotron, and CO line emission, we map the distribution of the pure dust emission at 1:15mm and 2mm. Separating the arm/interarm regions, we find a dominant 2mm emission from interarms indicating the significant role of the general interstellar radiation field in heating the cold dust. Finally, we present maps of the dust mass, temperature, and emissivity index using the Bayesian MCMC modeling of the spectral energy distribution in NGC6946.
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8
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Hughes DL, Hughes A, White PB, Silva MA. Acute pancreatitis in pregnancy: meta-analysis of maternal and fetal outcomes. Br J Surg 2021; 109:12-14. [PMID: 34179950 PMCID: PMC10364714 DOI: 10.1093/bjs/znab221] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 12/13/2020] [Accepted: 05/14/2021] [Indexed: 12/31/2022]
Abstract
The impact of acute pancreatitis in pregnancy on maternal and fetal outcomes is unclear. Historical case series document very poor outcomes, with maternal mortality rates of 20 per cent and fetal loss of 50 per cent. However, this is based on outdated clinical practice. This meta-analysis quantified both maternal and fetal outcomes following acute pancreatitis in pregnancy based on the concurrent literature. Maternal and fetal outcomes after acute pancreatitis in pregnancy have improved with advances in the management of pancreatitis.
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Affiliation(s)
- D Ll Hughes
- Department of Oncology, University of Oxford, Oxford, UK.,Department of Hepatobiliary and Pancreatic Surgery, Oxford University Hospitals NHS, Oxford, UK
| | - A Hughes
- Cardiff University Medical School, Cardiff, UK
| | - P B White
- Department of Obstetrics and Gynaecology, University Hospital of Wales, Cardiff, UK
| | - M A Silva
- Department of Hepatobiliary and Pancreatic Surgery, Oxford University Hospitals NHS, Oxford, UK
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9
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Al Saikhan L, Park C, Tillin T, Williams S, Jones S, Manisty C, Mayet J, Chaturvedi N, Hughes A. Myocardial strain by 3D-speckle tracking echocardiography predicts long-term risk of cardiovascular morbidity and mortality in the general population: the Southall And Brent Revisited (SABRE) study. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Both left ventricular (LV) ejection fraction (EF) and Global Longitudinal Strain (GLS) by 2D-echocardiography predict mortality and cardiac events, and GLS may be superior to EF. 3D-speckle tracking echocardiography (3D-STE), a recently validated method, allows simultaneous assessment of EF, GLS and principal tangential strain (PTS), but its prognostic utility in the general population is unknown.
Purpose
We hypothesized that 3D-STE derived LV myocardial strains predict a composite of cardiac endpoints, and that GLS would be a better prognostic marker than EF. We also investigated the utility of PTS compared with GLS and EF.
Methods
A total of 529 individuals (69±6y; 76.6% male) from SABRE study, a UK-based tri-ethnic community cohort, underwent health examinations. The association between 3D-STE EF or multidirectional myocardial strains and a composite cardiac endpoints comprising coronary heart disease (fatal/non-fatal), heart failure hospitalization, new-onset arrhythmia was determined using Cox proportional hazards models with and without adjustment for potential confounders and Harrell's C statistics were calculated. Associations with cardiovascular (CV) mortality was examined as a secondary objective. The incremental value of 3D-STE EF, GLS and PTS in improving CV risk stratification by the established Framingham risk score (FRS) was investigated using a likelihood ratio test on a series of nested Cox proportional hazards models.
Results
During follow-up (median, 8y), there were 56 composite cardiac endpoints and 24 CV deaths. EF and radial strain were negatively associated, while GLS, global circumferential strain and PTS were positively associated with the composite cardiac endpoints in unadjusted models (Table 1). Associations were only marginally affected by adjustment for potential confounders although confidence intervals of the estimate increased slightly (Table 1). There was little difference in the C-statistics for EF, GLS or PTS for the composite cardiac endpoints (Table 1). Associations with CV mortality were generally weaker and only GLS showed some evidence of a positive association with CV mortality in unadjusted and adjusted models (Table 1). Compared to EF and GLS, PTS most improved the predictive value (model fit) of FRS for composite cardiac endpoints (Table 2). None of the measures convincingly improved calibration for CV mortality.
Conclusions
3D-STE-derived LV myocardial strains predicted adverse cardiac events and CV mortality in a multi-ethnic sample of the UK general population. PTS/3D-strain was an independent predictor of cardiac events with some evidence of it being a slightly better predictor than conventional indices of LV function (GLS and EF). Future prospective studies are needed to confirm and extend these findings.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): The main SABRE study is supported by the Wellcome Trust and BHF.
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Affiliation(s)
- L Al Saikhan
- University College London, Institute of Cardiovascular Sciences/MRC Unit for LHA/School of Life and Medical Sciences, London, United Kingdom
| | - C Park
- University College London, Institute of Cardiovascular Sciences/MRC Unit for LHA/School of Life and Medical Sciences, London, United Kingdom
| | - T Tillin
- University College London, Institute of Cardiovascular Sciences/MRC Unit for LHA/School of Life and Medical Sciences, London, United Kingdom
| | - S Williams
- University College London, Institute of Cardiovascular Sciences/MRC Unit for LHA/School of Life and Medical Sciences, London, United Kingdom
| | - S Jones
- University College London, Institute of Cardiovascular Sciences/MRC Unit for LHA/School of Life and Medical Sciences, London, United Kingdom
| | - C Manisty
- University College London, Institute of Cardiovascular Sciences/MRC Unit for LHA/School of Life and Medical Sciences, London, United Kingdom
| | - J Mayet
- Imperial College London, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - N Chaturvedi
- University College London, Institute of Cardiovascular Sciences/MRC Unit for LHA/School of Life and Medical Sciences, London, United Kingdom
| | - A Hughes
- University College London, Institute of Cardiovascular Sciences/MRC Unit for LHA/School of Life and Medical Sciences, London, United Kingdom
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10
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Olabisi O, Choi S, Hughes A, Torkington J. 913 Near-Peer Teaching for Surgical Foundation Year Doctors During COVID-19 Pandemic. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Introduction
Literature has shown near-peer teaching to be an effective method of improving learning. There is little data on surgical teaching initiatives of this kind. Nationally and locally, teaching sessions and courses have been cancelled due to the pandemic. A new surgical lunch-time virtual course was created to fill this gap.
Method
FY1 doctors from University Hospital Wales were invited to participate in a survey exploring the need and topics for surgical teaching. Results were used to create a surgical teaching course. Near-peer, core surgical trainees were recruited to teach. A post-course questionnaire was distributed to FY1 doctors who attended the teaching to assess the success of the course.
Results
15 FY1 doctors completed the initial questionnaire. 33% (5) were currently on a surgical placement. 60% (9) had an upcoming surgical placement. 73% (11) felt they did not have sufficient teaching on surgical specialties during medical school. 93% (14) felt they did not have sufficient teaching on how to manage surgical patients as a FY1. 100% (15) responded they would be interested in surgical teaching delivered by core surgical trainees. Eight topics were suggested, and lunchtime sessions were created. Post-course feedback was completed by 12 FY1 doctors. 88% (10) of respondents found the course ‘extremely useful’ and relevant to their surgical jobs.
Conclusions
There is a demand for surgical teaching for FY1s. Near-peer education designed by FY1s and delivered by CSTs is an effective way for teaching relevant surgical knowledge. Lunch-time virtual teaching is a good way to continue teaching sessions through the pandemic.
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Affiliation(s)
- O Olabisi
- University Hospital Wales, Cardiff, United Kingdom
| | - S Choi
- University Hospital Wales, Cardiff, United Kingdom
| | - A Hughes
- University Hospital Wales, Cardiff, United Kingdom
| | - J Torkington
- University Hospital Wales, Cardiff, United Kingdom
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11
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ToxIC Fentalog Study Group, Levine M, Meyn A, Krotulski A, Logan B, Amaducci A, Hughes A, Schwarz E, Pizon A, Wax P, Brent J, Manini A. 71 Adulteration of Illicit Drugs in Emergency Department Patients With Acute Opioid Overdose: A Multicenter Cohort. Ann Emerg Med 2021. [DOI: 10.1016/j.annemergmed.2021.09.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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12
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Hughes A, Heydarian N, Gerardo D, Solis I, Morera O. Seeking Health Information and Social Support in the Diabetes Online Community. Front Clin Diabetes Healthc 2021; 2:708405. [PMID: 36994327 PMCID: PMC10012138 DOI: 10.3389/fcdhc.2021.708405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 08/30/2021] [Indexed: 11/13/2022]
Abstract
PurposePeople with type 1 diabetes (T1D) search for health information online in the Diabetes Online Community (DOC), where individuals with diabetes, researchers and caregivers post and respond to health questions. The aims of this study were 1) to understand how people with T1D are seeking health information and engaging in health behaviors in the DOC, and 2) develop a measure of online health information seeking in adults with T1D.Research MethodNinety-five adults with T1D completed qualitative prompts online.ResultsThemes that emerged in this study included sense of community, and multiple types of social support that are necessary in disease management.ConclusionsThis study used qualitative methods to develop a valid scale tailored for adults with T1D. Future research should seek to collect additional data to bolster validity and reliability.
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Affiliation(s)
- Allyson Hughes
- Department of Primary Care, Ohio University Heritage College of Osteopathic Medicine, Athens, OH, United States
- *Correspondence: Allyson Hughes,
| | - Nazanin Heydarian
- Department of Social Work, School of Social Work, University of Texas Rio Grande Valley, Edinburg, TX, United States
| | - Diana Gerardo
- Department of Psychology, The University of Texas at El Paso, El Paso, TX, United States
| | - Isabela Solis
- Department of Psychology, The University of Texas at El Paso, El Paso, TX, United States
| | - Osvaldo Morera
- Department of Psychology, The University of Texas at El Paso, El Paso, TX, United States
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13
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Seraphim A, Knott K, Menacho K, Augusto J, Davies R, Joy G, Hui X, Treibel T, Cooper J, Petersen S, Fontana M, Hughes A, Moon J, Manisty C, Kellman P. Comparison of the prognostic value of stress and rest pulmonary transit time estimation using myocardial perfusion CMR. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeab090.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): British Heart Foundation Clinical Research Training Fellowship
Background
Pulmonary transit time (PTT) is a quantitative biomarker of cardiopulmonary status. Rest PTT was previously shown to predict outcomes in specific disease models, but clinical adoption is hindered but challenges in data acquisition. Whether evaluation of PTT during stress encodes incremental prognostic information has not been previously investigated as scale.
Objectives
To compare the prognostic value of stress and rest PTT derived from a fully automated, in-line method of estimation using perfusion CMR, in a large patient cohort.
Methods
A retrospective two-center study of patients referred clinically for adenosine stress myocardial perfusion assessment using CMR. Analysis of right and left ventricular cavity arterial input function curves from first pass perfusion was performed automatically, allowing the in-line estimation of both rest and stress PTT. Association with major adverse cardiovascular events (MACE) was evaluated. MACE was defined as a composite outcome of myocardial infarction, stroke, heart failure admission and ventricular tachycardia or appropriate ICD treatment (including ICD shock and/or anti-tachycardia pacing).
Results
985 patients (67% male, median age 62 years (IQR 52,71)) were included, with median left ventricular ejection fraction (LVEF) of 62% (IQR 54-69). Median stress PTT was shorter than rest PTT 6.2 (IQR 5.1, 7.7) seconds versus 7.7 (IQR, 6.4, 9.2) seconds. Stress and rest PTT were highly correlated (r = 0.69; p < 0.001). Stress PTT also correlated with LVEF (r=-0.37), stress MBF (r=-0.31), LVEDVi (r = 0.24), LA area index (r = 0.32) (p < 0.001 for all). Over a median follow-up period of 28.6 (IQR, 22.6 35,7) months, MACE occurred in 61 (6.2%) patients. After adjusting for prognostic factors, both rest and stress PTT, independently predicted MACE, but not all-cause mortality. For every 1xSD (2.39s) increase in rest PTT the adjusted hazard ratio (HR) for MACE was 1.43 (95% CI 1.10-1.85, p = 0.007). The hazard ratio for one standard deviation (2.64s) increase in stress PTT was 1.34 (95% CI 1.048-1.723; p = 0.020) after adjusting for age, LVEF, hypertension, diabetes, sex and presence of LGE
Conclusions
In this 2-center study of 985 patients, we deploy a fully automated method of PTT estimation using perfusion mapping with CMR and show that both stress and rest PTT are independently associated with adverse cardiovascular outcomes. In this patient cohort, there is no clear incremental prognostic value of stress PTT, over its evaluation during rest.
Figure 1. Stress and Rest Pulmonary Transit Time estimation using myocardial perfusion CMR
Figure 2. Event-free survival curves for major adverse cardiovascular events (Heart failure hospitalization, myocardial infarction, stroke and ventricular tachycardia/ICD treatment) according to mean rest PTT (8.05seconds) and mean stress PTT (6.7seconds). Log-rank for both p < 0.05
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Affiliation(s)
- A Seraphim
- University College London, Institute of Cardiovascular Science, London, United Kingdom of Great Britain & Northern Ireland
| | - K Knott
- University College London, Institute of Cardiovascular Science, London, United Kingdom of Great Britain & Northern Ireland
| | - K Menacho
- University College London, Institute of Cardiovascular Science, London, United Kingdom of Great Britain & Northern Ireland
| | - J Augusto
- University College London, Institute of Cardiovascular Science, London, United Kingdom of Great Britain & Northern Ireland
| | - R Davies
- University College London, Institute of Cardiovascular Science, London, United Kingdom of Great Britain & Northern Ireland
| | - G Joy
- St Bartholomew"s Hospital, Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - X Hui
- National Institutes of Health, Bethesda, United States of America
| | - T Treibel
- University College London, Institute of Cardiovascular Science, London, United Kingdom of Great Britain & Northern Ireland
| | - J Cooper
- Queen Mary University of London, London, United Kingdom of Great Britain & Northern Ireland
| | - S Petersen
- Queen Mary University of London, London, United Kingdom of Great Britain & Northern Ireland
| | - M Fontana
- Royal Free Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - A Hughes
- University College London, Institute of Cardiovascular Science, London, United Kingdom of Great Britain & Northern Ireland
| | - J Moon
- University College London, Institute of Cardiovascular Science, London, United Kingdom of Great Britain & Northern Ireland
| | - C Manisty
- University College London, Institute of Cardiovascular Science, London, United Kingdom of Great Britain & Northern Ireland
| | - P Kellman
- National Institutes of Health, Bethesda, United States of America
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Li X, Brumfiel C, Patel M, Hughes A, DiCaudo D, Comfere N, Torres-cabala C, Pittelkow M, Mangold A. 078 Drug targeting and comparative transcriptomics of alpha-beta subcutaneous panniculitis-like T-cell lymphoma and primary cutaneous gamma delta T-cell lymphoma. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.02.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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Li X, Patel M, Brumfiel C, Hughes A, Sekulic A, Pittelkow M, Nelson S, Mangold A. 104 Comparative transcriptomic profiles of cutaneous sarcoidosis and granuloma annulare. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.02.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Li X, Patel M, Brumfiel C, Hughes A, Sekulic A, Pittelkow M, Nelson S, Mangold A. 101 Upregulated immune response networks in granuloma annulare. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.02.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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17
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Yap J, Slade D, Goddard H, Dawson C, Ganesan R, Velangi S, Sahu B, Kaur B, Hughes A, Luesley D. Sinecatechins ointment as a potential novel treatment for usual type vulval intraepithelial neoplasia: a single-centre double-blind randomised control study. BJOG 2021; 128:1047-1055. [PMID: 33075197 DOI: 10.1111/1471-0528.16574] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2020] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To compare the safety and efficacy of 10% sinecatechins (Veregen® ) ointment against placebo in the treatment of usual type vulvar intraepithelial neoplasia (uVIN). DESIGN A Phase II double-blind randomised control trial. SETTING A tertiary gynaecological oncology referral centre. POPULATION All women diagnosed with primary and recurrent uVIN. METHODS Eligible patients were randomised 1:1 to receive either sinecatechins or placebo ointment (applied three times daily for 16 weeks) and were followed up at 2, 4, 8, 16, 32 and 52 weeks. MAIN OUTCOME MEASURES The primary outcome measure, recorded at 16 and 32 weeks, was histological response (HR). Secondary outcome measures included clinical (CR) response, toxicity, quality of life and pain scores. RESULTS There was no observed difference in HR between the two arms. However, of the 26 patients who were randomised, all 13 patients who received sinecatechins showed either complete (n = 5) or partial (n = 8) CR, when best CR was evaluated. In placebo group, three patients had complete CR, two had partial CR, six had stable disease and two were lost to follow up. Patients in the sinecatechins group showed a statistically significant improvement in best observed CR as compared with the placebo group (P = 0.002). There was no difference in toxicity reported in either group. CONCLUSION Although we did not observe a difference in HR between the two treatment arms, we found that 10% sinecatechins application is safe and shows promise in inducing clinical resolution of uVIN lesions and symptom improvement, thus warranting further investigation in a larger multicentre study. TWEETABLE ABSTRACT A randomised control study indicating that sinecatechins ointment may be a novel treatment for uVIN.
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Affiliation(s)
- J Yap
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Pan Birmingham Gynaecological Cancer Centre, City Hospital, Birmingham, UK
| | - D Slade
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - H Goddard
- Pan Birmingham Gynaecological Cancer Centre, City Hospital, Birmingham, UK
| | - C Dawson
- Department of Microbiology & Infection, Warwick Medical School, University of Warwick, Coventry, UK
| | - R Ganesan
- Department of Histopathology, Birmingham Women's NHS Foundation Trust, Birmingham, UK
| | - S Velangi
- Department of Dermatology, Queen Elizabeth Hospital, Birmingham, UK
| | - B Sahu
- Department of Obstetrics and Gynaecology, The Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, UK
| | - B Kaur
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - A Hughes
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - D Luesley
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Pan Birmingham Gynaecological Cancer Centre, City Hospital, Birmingham, UK
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Li X, Brumfiel C, Patel M, Hughes A, Sekulic A, Pittelkow M, Nelson S, Mangold A. 102 Transcriptomic profiling of cutaneous sarcoidosis. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.02.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Hughes A, Li X, Brumfiel C, Patel M, Pittelkow M, Nelson S, Mangold A, Sekulic A. 495 From transcriptomes to drugs: Psoriasis as a model. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.02.519] [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: 11/16/2022]
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20
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Torlasco C, D"silva A, Bhuva AN, Faini A, Augusto JB, Knott KD, Benedetti G, Scully P, Parati G, Lloyd G, Hughes A, Sharma S, Manisty C, Osculati G, Moon JC. Pulsatile and resistive systolic loads as determinants of left ventricular remodelling after physical training. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): British Heart Foundation Barts Cardiovascular Biomedical Research Centre
onbehalf
The Marathon Study Consortium
Introduction
Cardiovascular function depends on the inter-relation between heart and vasculature. The contribution of aorta and peripheral vessels to the total systolic load of the left ventricle (LV) can be represented respectively by a "pulsatile" and a "resistive" component. We sought to understand their interrelation by exploring how LV remodelling occurred with altered load associated with an external stimulus (training). Methods: 237 untrained healthy male and female subjects volunteering for their first-time marathon were recruited. At baseline and after 6 months of unsupervised training, race completers underwent 1.5T cardiac magnetic resonance, brachial and non-invasive central blood pressure assessment. For analysis, runners were divided into 4 groups according to the variation (positive versus null or negative) in Total Arterial Compliance Index (TACi), representing the pulsatile component of the LV load, and in Systemic Vascular Resistance Index (SVRI), representing the resistive component of the LV load. Results: 138runners (age 21-69 years; F: 51%) completed the race. Data are reported for each variable as Δ mean [95% Confidence Interval]. In the whole cohort, training was associated with a small increase in LV mass index (+3g/m2, [0, 6 g/m2]), indexed LV end-diastolic volume (EDVi) (+3ml/m2, [-2, 5 3ml/m2]), in LV mass/LVEDV ratio (+0.02g/ml, [0.00, 0.04 g/ml]) and in TACi (+0.02ml/m2, [0.02, 0.38 ml/m2]). SVRi mildly fell (-43dyn·s/cm2[-103, 17dyn·s/cm2]). TACi increase was associated with LVEDVi increase and no change in LV mass/EDV (eccentric remodelling). On the other hand, both TACi reduction and SVRi increase were associated with increase in LV mass/EDV and no significant change in LVEDVi (concentric remodelling). A similar increase in LV mass was observed in all groups. See Table. Conclusion: Cardiac remodelling observed after mild, medium term, unsupervised training seems to be related to the modifications of aorta and peripheral vessels. In particular, a reduction in pulsatile load seems associated with eccentric LV remodelling, while an increase in both pulsatile and resistive with concentric LV remodelling. Further research is needed to understand the interaction between TACi and SVRi.
Table 1 LV EDVi (ml/m2) LV mass index (g/m2) LV mass/EDV TACi increase (n = 75) +4 [0, 9] +3 [0, 7] 0 [-0.03, 0.03] TACi decrease (n = 62) -1 [-6, 4] +3 [0, 8] 0.04 [0.01, 0.07] SVRi increase (n = 63) 0 [-4,4] +3 [0, 7] +0.03 [0, 0.06] SVRi decrease (n = 73) +3 [-3, 7] +3 [-1, 6] +0.01 [-0.02, 0.04]
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Affiliation(s)
- C Torlasco
- IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - A D"silva
- St George"s University of London, London, United Kingdom of Great Britain & Northern Ireland
| | - AN Bhuva
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - A Faini
- IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - JB Augusto
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - KD Knott
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - G Benedetti
- Guy"s & St Thomas" NHS Foundation Trust, guy"s and , London, United Kingdom of Great Britain & Northern Ireland
| | - P Scully
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - G Parati
- IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - G Lloyd
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - A Hughes
- University College London, London, United Kingdom of Great Britain & Northern Ireland
| | - S Sharma
- St George"s University of London, London, United Kingdom of Great Britain & Northern Ireland
| | - C Manisty
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - G Osculati
- IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - JC Moon
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
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21
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Piras de Oliveira C, Mitchell BD, Fan L, Garey C, Liao B, Bispham J, Vint N, Perez-Nieves M, Hughes A, McAuliffe-Fogarty A. Patient perspectives on the use of half-unit insulin pens by people with type 1 diabetes: a cross-sectional observational study. Curr Med Res Opin 2021; 37:45-51. [PMID: 33108218 DOI: 10.1080/03007995.2020.1843423] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Half-unit pens offer the ability to dose insulin more precisely. Information about half-unit pen use and evidence of their benefits and drawbacks is limited. This study aims to characterize people with type 1 diabetes (T1D) who have used (current/former = EVER) vs. those who have never used half-unit pens (NEVER users) and to understand their perspective. METHODS An observational cross-sectional online survey was administered through T1D Exchange's online patient community, myGlu.org, to understand the use of half-unit insulin pens. RESULTS The 278 adult participants (156 EVER, 122 NEVER) had a mean age of 41.8 ± 12.7 years, body mass index of 26.0 ± 3.8 kg/m2, glycated hemoglobin of 6.3% ± 1.0%, and 55% were male. EVER users had T1D for a shorter duration than NEVER users (p < .001). EVER users were less likely to use continuous subcutaneous insulin infusion (p < .001) and more likely to start correcting high blood glucose at a lower level (p < .001) and low blood glucose at a higher level (p < .001). The highest ranked benefits of half-unit pen reported by its current users (N = 131) included prevention of hyperglycemia (40.5%), less anxiety or worry (23.7%), and prevention of hypoglycemia (16.8%). CONCLUSIONS Half-unit insulin pen is perceived as an insulin device that may help people with T1D to avoid hypo- and hyperglycemic events and decrease their level of disease worry and anxiety. This study highlights the need for patients and health care providers to understand the benefits of half-unit pens while considering options for individualized diabetes management.
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Affiliation(s)
| | | | - Ludi Fan
- Eli Lilly and Company, Indianapolis, IN, USA
| | | | - Birong Liao
- Eli Lilly and Company, Indianapolis, IN, USA
| | | | - Nan Vint
- Eli Lilly and Company, Indianapolis, IN, USA
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22
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Joshi R, Hingorani A, Engmann J, Dale C, Gaunt T, Jefferis B, Lawlor D, Price J, Papacosta O, Shah T, Tillin T, Chaturvedi N, Kivimaki M, Kuh D, Kumari M, Hughes A, Whincup P, Casas J, Humphries S, Schmidt A, Wannamethee S. Establishing reference intervals for triglyceride containing lipoprotein sub-fraction metabolites measured using nuclear magnetic resonance spectroscopy in a UK population. Atherosclerosis 2020. [DOI: 10.1016/j.atherosclerosis.2020.10.295] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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23
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Garey C, Lynn J, Floreen Sabino A, Hughes A, McAuliffe-Fogarty A. Preeclampsia and other pregnancy outcomes in nulliparous women with type 1 diabetes: a retrospective survey. Gynecol Endocrinol 2020; 36:982-985. [PMID: 32281439 DOI: 10.1080/09513590.2020.1749998] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Obstetric complications are more common in women with diabetes than in the general population. This study aimed to learn about the first pregnancy of women with type 1 diabetes from the perspective of women from T1D Exchange-Glu and the T1D Exchange Clinic Registry. Participants were ≥18, diagnosed with type 1 diabetes before conception, and either currently pregnant or had given birth in the preceding 10 years. The final sample size was 533 women. Women who planned pregnancy had significantly lower HbA1c (A1c) at conception. Women who had higher A1cs at conception were at a higher risk for cesarean birth, increased weight gain, hypoglycemia during pregnancy, and earlier onset of preeclampsia. Overall 29% of women developed preeclampsia in this population, over seven times the rate in the general population. This study helps to expand our knowledge of women with type 1 diabetes during the perinatal period. Planning pregnancy, expanding education and support, and preventing preeclampsia may help to improve pregnancy outcomes.
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Affiliation(s)
| | - Jessica Lynn
- NYC Health and Hospitals | Woodhull Medical Center, Brooklyn, NY, USA
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24
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Vyas M, Chaturvedi N, Hughes A, Marmot M, Tillin T. Cardiovascular disease recurrence and long-term mortality in a tri-ethnic British cohort: a retrospective study. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
People of South Asian and of African Caribbean descent have elevated risks of some cardiovascular diseases compared to Europeans. How ethnicity relates to recurrent risk, and explanations for between ethnic group differences in recurrence are unclear. We characterized long-term risk of major adverse cardiovascular event (MACE) and mortality following a non-fatal cardiovascular event in a tri-ethnic British cohort.
Methods
We linked hospital and mortality records of a population-based cohort of South Asian, African Caribbean and European men and women aged 40–69 years with no prior history of cardiovascular disease. We identified index and recurrent cardiovascular events (stroke, transient ischaemic attack, myocardial infarction, or ischaemic heart disease), and mortality from 1988 to 2017. Using multivariable proportional hazards models, we separately calculated the adjusted hazard ratios (HR) of MACE and death following index event. We adjusted for demographics, vascular and lifestyle risk factors. We used interaction terms to evaluate if diabetes or decade of index event modified the association between ethnicity and outcomes.
Results
We included 801 participants with first non-fatal cardiovascular events, 647 coronary and 127 cerebrovascular, of whom 335 (41.8%) were European, 396 (49.5%) South Asian, and 70 (8.7%) African Caribbean. During a mean follow-up of 5.3 years, 537 patients developed MACE and 338 died. Crude incidence rate of MACE was higher in South Asians (135.9 per 1000-person-years) compared to Europeans (117.1) and African Caribbeans (123.6). Higher risk of MACE in South Asian compared to Europeans was eliminated in the adjusted models (HR 0.97, 95% confidence interval 0.77–1.21), whereas their mortality advantage was eliminated when the younger age at index event was accounted for (HR 0.95, 0.72–1.26). African Caribbeans had similar outcomes to Europeans (HR MACE 1.04, 0.74–1.47; and HR death 1.07, 0.70–1.64). There was no modification by diabetes for outcomes, whereas survival following index event improved more in South Asian, than African Caribbean, compared to European over three decades (Pinteraction = 0.04).
Conclusions
Baseline vascular risk factors explained the observed ethnic variation in cardiovascular disease recurrence and long-term mortality, with a relative improvement in survival of minority ethnic groups over time.
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): UK Medical Research Council, Wellcome Trust
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Affiliation(s)
- M Vyas
- University of Toronto, Toronto, Canada
| | - N Chaturvedi
- University College London, Medical Research Council Unit for Lifelong Health and Ageing, London, United Kingdom
| | - A Hughes
- University College London, Medical Research Council Unit for Lifelong Health and Ageing, London, United Kingdom
| | - M Marmot
- University College London, Institute of Health Equity, London, United Kingdom
| | - T Tillin
- University College London, Medical Research Council Unit for Lifelong Health and Ageing, London, United Kingdom
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25
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Sharma V, Al Saikhan L, Park C, Hughes A, Gu H, Saeed S, Boguslavskyi A, Carr-White G, Chambers J, Chowienczyk P, Jain M, Jessop H, Turner C, Bassindale-Maguire G, Baig W, Kidambi A, Abdel-Rahman ST, Schlosshan D, Sengupta A, Fitzpatrick A, Sandoval J, Hickman S, Procter H, Taylor J, Kaur H, Knowles C, Wheatcroft S, Witte K, Gatenby K, Willis JA, Kendler-Rhodes A, Slegg O, Carson K, Easaw J, Kandan SR, Rodrigues JCL, MacKenzie-Ross R, Hall T, Robinson G, Little D, Hudson B, Pauling J, Redman S, Graham R, Coghlan G, Suntharalingam J, Augustine DX, Nowak JWM, Masters AT. Report from the Annual Conference of the British Society of Echocardiography, October 2018, ACC Liverpool, Liverpool. Echo Res Pract 2020; 7:M1. [PMID: 33112840 PMCID: PMC8693154 DOI: 10.1530/erp-20-0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- V Sharma
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - L Al Saikhan
- MRC Unit for Lifelong Health and Aging at UCL, Department of Population Science & Experimental Medicine, UCL Institute of Cardiovascular Science, University College London, London, UK.,Department of Cardiac Technology, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - C Park
- MRC Unit for Lifelong Health and Aging at UCL, Department of Population Science & Experimental Medicine, UCL Institute of Cardiovascular Science, University College London, London, UK
| | - A Hughes
- MRC Unit for Lifelong Health and Aging at UCL, Department of Population Science & Experimental Medicine, UCL Institute of Cardiovascular Science, University College London, London, UK
| | - H Gu
- British Heart Foundation Centre, King's College London, London, UK
| | - S Saeed
- Haukeland University Hospital, Bergen, Norway
| | - A Boguslavskyi
- British Heart Foundation Centre, King's College London, London, UK
| | - G Carr-White
- British Heart Foundation Centre, King's College London, London, UK.,Cardiothoracic Centre, St Thomas' Hospital, London, UK
| | - J Chambers
- Cardiothoracic Centre, St Thomas' Hospital, London, UK
| | - P Chowienczyk
- British Heart Foundation Centre, King's College London, London, UK
| | - M Jain
- Yorkshire Heart Centre, Leeds General Infirmary, Leeds, UK
| | - H Jessop
- Yorkshire Heart Centre, Leeds General Infirmary, Leeds, UK
| | - C Turner
- Yorkshire Heart Centre, Leeds General Infirmary, Leeds, UK.,Department of Cardiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - W Baig
- Yorkshire Heart Centre, Leeds General Infirmary, Leeds, UK
| | - A Kidambi
- Yorkshire Heart Centre, Leeds General Infirmary, Leeds, UK
| | | | - D Schlosshan
- Yorkshire Heart Centre, Leeds General Infirmary, Leeds, UK
| | - A Sengupta
- Department of Cardiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - A Fitzpatrick
- Department of Cardiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - J Sandoval
- Department of Cardiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - S Hickman
- Department of Cardiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - H Procter
- Department of Cardiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - J Taylor
- Department of Cardiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - H Kaur
- Department of Cardiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - C Knowles
- Department of Cardiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - S Wheatcroft
- Department of Cardiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - K Witte
- Department of Cardiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - K Gatenby
- Department of Cardiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - J A Willis
- Royal United Hospitals Bath, NHS Foundation Trust, Bath, UK
| | | | - O Slegg
- Royal United Hospitals Bath, NHS Foundation Trust, Bath, UK
| | - K Carson
- Royal United Hospitals Bath, NHS Foundation Trust, Bath, UK
| | - J Easaw
- Royal United Hospitals Bath, NHS Foundation Trust, Bath, UK
| | - S R Kandan
- Royal United Hospitals Bath, NHS Foundation Trust, Bath, UK
| | | | | | - T Hall
- Royal United Hospitals Bath, NHS Foundation Trust, Bath, UK
| | - G Robinson
- Royal United Hospitals Bath, NHS Foundation Trust, Bath, UK
| | - D Little
- Royal United Hospitals Bath, NHS Foundation Trust, Bath, UK
| | - B Hudson
- Royal United Hospitals Bath, NHS Foundation Trust, Bath, UK
| | - J Pauling
- Royal United Hospitals Bath, NHS Foundation Trust, Bath, UK
| | - S Redman
- Royal United Hospitals Bath, NHS Foundation Trust, Bath, UK
| | - R Graham
- Royal United Hospitals Bath, NHS Foundation Trust, Bath, UK
| | - G Coghlan
- Department of Cardiology, Royal Free Hospital, London, UK
| | - J Suntharalingam
- Royal United Hospitals Bath, NHS Foundation Trust, Bath, UK.,University of Bath, Bath, UK
| | - D X Augustine
- Royal United Hospitals Bath, NHS Foundation Trust, Bath, UK
| | - J W M Nowak
- Royal United Hospitals Bath, NHS Foundation Trust, Bath, UK
| | - A T Masters
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK
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Liu J, Bispham J, Fan L, Poon JL, Hughes A, Mcauliffe-Fogarty A, Varnado O, Mitchell B. Factors associated with fear of hypoglycaemia among the T1D Exchange Glu population in a cross-sectional online survey. BMJ Open 2020; 10:e038462. [PMID: 32895285 PMCID: PMC7476480 DOI: 10.1136/bmjopen-2020-038462] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVES Fear of hypoglycaemia (FoH) has been associated with suboptimal diabetes management and health outcomes. This study investigated factors associated with behavioural and emotional aspects of FoH among adults living with type 1 diabetes (T1D) mellitus. DESIGN Cross-sectional study. SETTING Online survey hosted on T1D Exchange Glu, an online community for patients living with T1D mellitus. MEASURES The Hypoglycaemia Fear Survey II-short form and the Hypoglycaemic Attitudes and Behaviour Scale were used to assess FoH. Multivariable regressions were performed on assessment scores. RESULTS The study included 494 participants (mean±SD age 43.9±12.2 years, duration of T1D mellitus 16.6±16.8 years, self-reported glycosylated hemoglobin (HbA1c) 6.9%±0.8% (52±9 mmol/mol)), 63% men, 89% on insulin pump, 25% experienced a severe hypoglycaemic event in the last 6 months. Multivariable regression analyses showed higher anxiety, depression severity and diabetes distress were independently associated with FoH (all p<0.01). Longer diabetes duration was associated with lower FoH (p<0.01). Past experience with severe hypoglycaemia was associated with higher worry of hypoglycaemia (p<0.01) but not avoidance behaviour (ns). CONCLUSIONS These results highlighted the multifaceted nature of FoH, which warrants further discussion between providers and patients to uncover drivers of and actions required to reduce FoH and improve patient care and outcomes.
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Affiliation(s)
- Jingwen Liu
- Patient-Centered Research, T1D Exchange, Boston, Massachusetts, USA
| | - Jeoffrey Bispham
- Patient-Centered Research, T1D Exchange, Boston, Massachusetts, USA
| | - Ludi Fan
- Lilly Diabetes, Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Jiat-Ling Poon
- Lilly Diabetes, Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Allyson Hughes
- Patient-Centered Research, T1D Exchange, Boston, Massachusetts, USA
| | | | - Oralee Varnado
- Lilly Diabetes, Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Beth Mitchell
- Lilly Diabetes, Eli Lilly and Company, Indianapolis, Indiana, USA
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27
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Wagner G, Jindrich C, Hughes A, Daniels E, Hanson J. An Evaluation of the Macronutrient Impact of Plant-based Milks in Childcare Menus. J Acad Nutr Diet 2020. [DOI: 10.1016/j.jand.2020.06.127] [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: 11/27/2022]
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28
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Hughes A, Harrison S, Dixon P, Dickson M, Davies A, Rice F, Davies N, Howe L. The wider consequences of obesity: estimated social and economic costs from Mendelian Randomization. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.1028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Obesity is a key public health issue worldwide. Accurate estimates of its full impacts on health, social, and economic outcomes are required, but are difficult to obtain due to bias from confounding and reverse causality (the impact of social and economic factors on obesity).
Methods
Using data from the UK Biobank and ALSPAC, we applied a genetic causal inference approach (Mendelian Randomization, MR) to estimate the impact of body mass index (BMI) on key social and economic outcomes. Because genetic variants are assigned before birth and cannot change, estimates from MR studies are less liable to confounding and reverse causation.
Results
Effects of higher BMI were often larger in MR than conventional (non-genetic) models, suggesting previous studies may have underestimated the impact of BMI. For example, in adolescents, MR models implied a standard deviation increase in BMI led to exam scores around 1/3 of a grade lower in all subjects at age 16, and 8.7% (CI: 1.8% to 16.1%) more school absence. In adults a 5kg/m2 increase in BMI corresponded, among other negative outcomes, to £2,778 less annual household income (CI: £1,864 to £3,693), less chance of owning one's home (-1.6%, CI: -2.4% to -0.8%), and higher chance of being lonely (2.4%, CI: 1.4% to 3.5%). At £21.22 (CI: £14.35 to £28.07) per person per marginal kg/m2 per year, MR estimates for inpatient hospital costs were around 40% higher than conventional estimates.
Conclusions
Findings from causal inference based on genetic variation indicate that high BMI has negative impacts on social and economic outcomes that may be larger than previously estimated. This evidence highlights the potential social and economic value of preventing high BMI across the life course.
Key messages
High BMI has considerable negative impacts not only for health, but for individuals’ education and socioeconomic outcomes, and overall health care costs. Previous attempts to quantify these effects may have underestimated BMI’s full impact.
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Affiliation(s)
- A Hughes
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - S Harrison
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - P Dixon
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - M Dickson
- Institute for Policy Research, University of Bath, Bath, UK
| | - A Davies
- Research and Evaluation Division, Knowledge Directorate, Public Health Wales, Cardiff, UK
| | - F Rice
- School of Medicine, University of Cardiff, Cardiff, UK
| | - N Davies
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - L Howe
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
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Hannaway N, Jiang X, Aspray T, Burns A, Ferguson J, Pedley I, Frew J, Azzabi A, Pearson R, Chandler R, Hughes A, Showler H, Bennett A, McMenemin R. 673P Assessing bone health and osteoporotic risk in patients requiring anti androgen therapy for prostate cancer. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Feeley I, McAleese T, Clesham K, Moloney D, Crozier-Shaw G, Hughes A, Bayer T. Foot and ankle service adaptation in response to COVID-19 and beyond. Ann Med Surg (Lond) 2020; 54:62-64. [PMID: 32346473 PMCID: PMC7187812 DOI: 10.1016/j.amsu.2020.04.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 04/19/2020] [Indexed: 01/28/2023] Open
Abstract
The disruption to healthcare provision as a result of the COVID-19 pandemic has compelled us to streamline healthcare delivery. This has given us an opportunity to implement healthcare technology, reform inter-disciplinary collaboration and ultimately enhance patient care. We discuss some of the advances made by the foot and ankle department at our hospital. These innovations have broad applicability and will hopefully ignite discussion amoung a number of healthcare teams about improving the future care of their patients.
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Affiliation(s)
- I Feeley
- Department of Trauma and Orthopaedics, Midlands Regional Hospital Tullamore, Tullamore, Ireland
| | - T McAleese
- Department of Trauma and Orthopaedics, Midlands Regional Hospital Tullamore, Tullamore, Ireland.,National University of Ireland Galway, Co Galway, Ireland
| | - K Clesham
- Department of Trauma and Orthopaedics, Midlands Regional Hospital Tullamore, Tullamore, Ireland
| | - D Moloney
- Department of Trauma and Orthopaedics, Midlands Regional Hospital Tullamore, Tullamore, Ireland
| | - G Crozier-Shaw
- Department of Trauma and Orthopaedics, Midlands Regional Hospital Tullamore, Tullamore, Ireland
| | - A Hughes
- Department of Trauma and Orthopaedics, Midlands Regional Hospital Tullamore, Tullamore, Ireland
| | - T Bayer
- Department of Trauma and Orthopaedics, Midlands Regional Hospital Tullamore, Tullamore, Ireland
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Liu Y, Dash A, Krez A, Kim HJ, Cunningham M, Schwab F, Hughes A, Carlson B, Samuel A, Marty E, Moore H, McMahon DJ, Carrino JA, Bockman RS, Stein EM. Low volumetric bone density is a risk factor for early complications after spine fusion surgery. Osteoporos Int 2020; 31:647-654. [PMID: 31919536 DOI: 10.1007/s00198-019-05245-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 11/20/2019] [Indexed: 12/17/2022]
Abstract
UNLABELLED This study aims to investigate lumbar spine (LS) volumetric bone density (vBMD) as a risk factor for complications (pseudoarthrosis, instrumentation failure, adjacent fractures), re-operation, and time to complication after fusion. INTRODUCTION Lumbar spine (LS) fusion surgery is increasingly performed worldwide. Complications after fusion result in significant morbidity and healthcare costs. Multiple factors, including osteoporosis, have been suggested to contribute to risk of complications and re-operation. However, most studies have used DXA, which is subject to artifact in patients with spine pathology, and none have investigated the relationship between BMD and timing of post-operative complications. This study aims to investigate LS volumetric bone density (vBMD) as a risk factor for complications (pseudoarthrosis, instrumentation failure, adjacent fractures), re-operation, and time to complication after fusion. METHODS We evaluated a cohort of 359 patients who had initial LS fusion surgery at our institution, had pre-operative LS CTs and post-operative imaging available for review. Demographic factors, smoking status, vBMD, and details of surgical procedure were related to likelihood and timing of post-operative complications. RESULTS Mean age was 60 ± 14 years, vBMD 122 ± 37 g/cm3. Median follow-up was 11 months. Skeletal complications occurred in 47 patients (13%); 34 patients (10%) required re-operation. Low vBMD (directly measured and estimated using HU) and smoking were associated with increased risk of skeletal complications. Each increase in baseline vBMD of 10 g/cm3 decreased the complication hazard and increased the complication-free duration in time-to-event analysis (hazard ratio 0.91, 95% CI 0.83-0.98, p < 0.02). CONCLUSIONS Low vBMD was a significant risk factor for early post-operative complications in patients undergoing LS fusion. Prospective studies are needed to confirm these findings and to elucidate the optimal timing for follow-up and strategies for prevention of post-operative complications in this population.
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Affiliation(s)
- Y Liu
- Division of Endocrinology and Metabolic Bone Disease, Hospital for Special Surgery, 535 East 70th Street, New York, NY, USA
- Department of Medicine, Lahey Clinic, Burlington, MA, USA
| | - A Dash
- Division of Endocrinology and Metabolic Bone Disease, Hospital for Special Surgery, 535 East 70th Street, New York, NY, USA
| | - A Krez
- Division of Endocrinology and Metabolic Bone Disease, Hospital for Special Surgery, 535 East 70th Street, New York, NY, USA
| | - H J Kim
- Department of Orthopedics, Hospital for Special Surgery, New York, NY, USA
| | - M Cunningham
- Department of Orthopedics, Hospital for Special Surgery, New York, NY, USA
| | - F Schwab
- Department of Orthopedics, Hospital for Special Surgery, New York, NY, USA
| | - A Hughes
- Department of Orthopedics, Hospital for Special Surgery, New York, NY, USA
| | - B Carlson
- Department of Orthopedics, Hospital for Special Surgery, New York, NY, USA
- Department of Orthopedics, University of Kansas Medical Center, Kansas City, KS, USA
| | - A Samuel
- Department of Orthopedics, Hospital for Special Surgery, New York, NY, USA
| | - E Marty
- Department of Orthopedics, Hospital for Special Surgery, New York, NY, USA
| | - H Moore
- Weill Cornell Medical College, New York, NY, USA
| | - D J McMahon
- Division of Endocrinology and Metabolic Bone Disease, Hospital for Special Surgery, 535 East 70th Street, New York, NY, USA
| | - J A Carrino
- Department of Radiology, Hospital for Special Surgery, New York, NY, USA
| | - R S Bockman
- Division of Endocrinology and Metabolic Bone Disease, Hospital for Special Surgery, 535 East 70th Street, New York, NY, USA
| | - E M Stein
- Division of Endocrinology and Metabolic Bone Disease, Hospital for Special Surgery, 535 East 70th Street, New York, NY, USA.
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Menon-Johansson AS, Curtis H, Mohammad H, Hamlyn E, Hughes A, McClean H, Pal N, Tayal S, Sullivan AK. Improved results demonstrated in the 2017 national audit of early syphilis management in the United Kingdom. Int J STD AIDS 2020; 31:375-379. [PMID: 32041481 DOI: 10.1177/0956462419896706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The revised British Association of Sexual Health and HIV UK guidelines on the management of syphilis were published in 2015 and this audit measures performance against those standards and recommendations. Although not included in the guideline recommendations, an exploratory question on clinics’ HIV testing policy was also included. The audit was conducted over a two-month period in 2017 in genitourinary medicine (GUM) clinics across the UK of cases presenting in 2016. A total of 161 GUM clinics participated, and data were collected for 3017 cases. The standard for adherence to recommended treatment was met (97%, standard: 97%) and almost met for documented pre-treatment syphilis serology (95%, standard: 97%). Even though only 74% of patients had a documented action in relation to informing sexual contacts (standard: 97%), the standard for contacts seen and tested per index case within four weeks was met (0.9, standard: 0.6). Finally, those clinics with a formal policy on HIV testing after a syphilis diagnosis were twice as likely to test after the HIV window period, compared to clinics without a policy; a concurrent HIV diagnosis was made in 75 (3%) patients. More work is required to standardize documented delivery of effective partner notification and a formal policy on HIV testing appears to be effective.
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Affiliation(s)
| | - H Curtis
- British HIV Association, London, UK
| | | | - E Hamlyn
- Chelsea and Westminster NHS Foundation Trust, London, UK
| | | | - H McClean
- Royal Society of Medicine, Cheshire, UK
| | - N Pal
- Berkshire Healthcare Foundation Trust, Garden Clinic, Upton Hospital, Slough, UK
| | | | - A K Sullivan
- Chelsea and Westminster NHS Foundation Trust, London, UK
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Comella A, Michail M, Cameron J, McCormick L, Gooley R, Parker K, Mathur A, Hughes A, Brown A, Cameron J. 895 The Immediate Physiological Impact of Transcatheter Aortic Valve Replacement on Central Aortic Pressure in Patients With Severe Aortic Stenosis. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
OBJECTIVE To report baseline no-show rates in the hospital-employed otolaryngology practice setting and to identify factors that may affect clinic show rates that are targets for potential improvement. STUDY DESIGN Retrospective chart review. METHODS Electronic medical records from October 2012 through July 2014 of a hospital-employed otolaryngology practice were reviewed. Patients were classified by insurance type: commercial, Medicare, Medicaid, and self-pay. Clinic visits were classified as new patient, follow-up, or postoperative. No-show rates were tabulated for each type of clinic visit and compared. Factors to improve no-show rates are discussed. RESULTS There was an overall no-show rate of 8.3% for 5817 scheduled clinic visits. Among visit types, follow-up visits had the highest no-show rates. Among insurance types, Medicaid had the highest no-show rates. New patient Medicaid patients, follow-up Medicaid patients, and follow-up commercial insurance patients had the highest rate of no-shows among visit/insurance type combinations. Persistent reminders are a key factor in improving rate of clinic visit adherence. CONCLUSION A previously unreported baseline no-show rate was established for hospital-employed otolaryngology clinics. The utilization of repeated, live-person reminders to mitigate the impact of clinic no-show rates needs to be further investigated.
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Affiliation(s)
- Brett T Comer
- Department of Otolaryngology-Head and Neck Surgery, University of Kentucky, Lexington, KY, USA
| | - Lauren E Harris
- University of Kentucky School of Medicine, Lexington, KY, USA
| | - Caitlin E Fiorillo
- Department of Otolaryngology-Head and Neck Surgery, University of Kentucky, Lexington, KY, USA
| | - Thomas J Gal
- Department of Otolaryngology-Head and Neck Surgery, University of Kentucky, Lexington, KY, USA
| | - Allyson Hughes
- Department of Internal Medicine, University of Tennessee at Nashville, Memphis, TN, USA
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Tillin T, Tuson C, Sowa B, Chattopadhyay K, Sattar N, Welsh P, Roberts I, Ebrahim S, Kinra S, Hughes A, Chaturvedi N. Yoga and Cardiovascular Health Trial (YACHT): a UK-based randomised mechanistic study of a yoga intervention plus usual care versus usual care alone following an acute coronary event. BMJ Open 2019; 9:e030119. [PMID: 31685500 PMCID: PMC6858127 DOI: 10.1136/bmjopen-2019-030119] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To determine the effects of yoga practice on subclinical cardiovascular measures, risk factors and neuro-endocrine pathways in patients undergoing cardiac rehabilitation (CR) following acute coronary events. DESIGN 3-month, two-arm (yoga +usual care vs usual care alone) parallel randomised mechanistic study. SETTING One general hospital and two primary care CR centres in London. Assessments were conducted at Imperial College London. PARTICIPANTS 80 participants, aged 35-80 years (68% men, 60% South Asian) referred to CR programmes 2012-2014. INTERVENTION A certified yoga teacher conducted yoga classes which included exercises in stretching, breathing, healing imagery and deep relaxation. It was pre-specified that at least 18 yoga classes were attended for inclusion in analysis. Participants and partners in both groups were invited to attend weekly a 6- to 12-week local standard UK National Health Service CR programme. MAIN OUTCOME MEASURES (i) Estimated left ventricular filling pressure (E/e'), (ii) distance walked, fatigue and breathlessness in a 6 min walk test, (iii) blood pressure, heart rate and estimated peak VO2 following a 3 min step-test. Effects on the hypothalamus-pituitary-adrenal axis, autonomic function, body fat, blood lipids and glucose, stress and general health were also explored. RESULTS 25 participants in the yoga + usual care group and 35 participants in the usual care group completed the study. Following the 3-month intervention period, E/e' was not improved by yoga (E/e': between-group difference: yoga minus usual care:-0.40 (-1.38, 0.58). Exercise testing and secondary outcomes also showed no benefits of yoga. CONCLUSIONS In this small UK-based randomised mechanistic study, with 60 completing participants (of whom 25 were in the yoga + usual care group), we found no discernible improvement associated with the addition of a structured 3-month yoga intervention to usual CR care in key cardiovascular and neuroendocrine measures shown to be responsive to yoga in previous mechanistic studies. TRIAL REGISTRATION NUMBER NCT01597960; Pre-results.
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Affiliation(s)
- Therese Tillin
- Department of Population Science and Experimental Medicine, Institute of Cardiovascular Science, University College London, London, UK
| | | | - Barbara Sowa
- West London Mental Health NHS Trust, Southall, UK
| | - Kaushik Chattopadhyay
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Paul Welsh
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Ian Roberts
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Shah Ebrahim
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Sanjay Kinra
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - A Hughes
- Department of Population Science and Experimental Medicine, Institute of Cardiovascular Science, University College London, London, UK
| | - Nishi Chaturvedi
- Department of Population Science and Experimental Medicine, Institute of Cardiovascular Science, University College London, London, UK
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Hughes A, Underwood J, Nelson GE, Larue RW, Scalise ML. Variable urine Histoplasma antigen with volume status. J Community Hosp Intern Med Perspect 2019; 9:489-490. [PMID: 32002155 PMCID: PMC6968524 DOI: 10.1080/20009666.2019.1698263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 11/08/2019] [Indexed: 10/31/2022] Open
Abstract
A patient with progressive disseminated histoplasmosis was noted to have an increase in urine Histoplasma antigen level during monitoring of her disease. The patient revealed she had inadequately hydrated, and her urine volume was low and subjectively concentrated. Following hydration, urine antigen was retested and became undetectable.
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Affiliation(s)
- Allyson Hughes
- The Department of Medicine, University of Tennessee Health Science Center, Saint Thomas-UT Internal Medicine Clinic, Nashville, TN, USA
| | - Joy Underwood
- The Department of Medicine, University of Tennessee Health Science Center, Saint Thomas-UT Internal Medicine Clinic, Nashville, TN, USA
| | - George E. Nelson
- The Division of Infectious Disease, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Richard W. Larue
- The Division of Infectious Disease, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Melissa L. Scalise
- The Department of Medicine, University of Tennessee Health Science Center, Saint Thomas-UT Internal Medicine Clinic, Nashville, TN, USA
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Al Saikhan L, Park C, Tillin T, Williams S, Mayet J, Chaturvedi N, Hughes A. P2444Comparison of 3D and 2D echocardiography-derived indices of left ventricular function and structure to predict long-term mortality in the general population: Southall And Brent Revisited (SABRE) study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0776] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Three-dimensional echocardiography (3DE) may have advantages over two-dimensional echocardiography (2DE) for the assessment of left ventricular (LV) function and structure. However, studies comparing 3DE and 2DE-derived indices in relation to mortality are limited, particularly in the general population.
Purpose
We examined associations between 2DE and 3DE-derived LV ejection fractions (LVEF) and volumes for all-cause mortality in a population-based sample.
Methods
A total of 899 individuals (age, 69.6±6.1 years; 77.5%male) from the SABRE study, a UK-based tri-ethnic community cohort, underwent a comprehensive transthoracic echocardiography examination. 2D LVEF and volumes were calculated, and full-volume 3D LV datasets acquired over 4 sub-volumes were obtained using a matrix-array transducer and were analysed offline using Qlab advanced, v7.0. The associations between both 2D- and 3D-derived LVEF (≥55% vs. <55%), body surface area indexed end-diastolic volume (iEDV) and end-systolic volume (iESV), and all-cause mortality were determined using Cox proportional hazards models. Survival curves were constructed using the Kaplan-Meier method.
Results
Of the 899 individuals, 118 (13.1%) died over a median follow-up period of 8 years to 2018. Kaplan Meier survival estimates (Figure 1 illustrates LVEF) and Cox regression revealed that 2D and 3D LVEF, iEDV and iESV were associated with increased risk of all-cause mortality (LVEF (≥55% vs. <55%), 3DE: HR=0.53 (0.35, 0.80); 2DE: HR=0.51 (0.34, 0.75), iEDV (per 1SD increment), 3DE: HR=1.20 (1.0, 1.41); 2DE: HR=1.19 (1.0–1.41), iESV (per 1SD increment), 3DE: HR=1.27 (1.1, 1.52), 2DE: HR=1.32 (1.15, 0.1.51)). However, 3DE associations tended to be stronger in models adjusted for classical risk factors including age, sex, ethnicity, systolic blood pressure, cholesterol:HDL ratio, body mass index, antihypertensive medications, diabetes, and smoking (LVEF (≥55% vs. <55%), 3DE: HR=0.59 (0.39, 0.90); 2DE: HR=0.69 (0.46, 1.0), iEDV (per 1SD increment), 3DE: HR=1.20 (1.0, 1.41); 2DE: HR=1.10 (0.93, 1.31), iESV (per 1SD increment), 3DE: HR=1.27 (1.1, 1.52), 2DE: HR=1.20 (1.04, 0.1.39)).
Figure 1. Kaplan-Meier curves.
Conclusions
In this population-based study, both 2DE and 3DE-derived indices of LV structure and function were associated with all-cause mortality independently of classical risk factors, with some indication that strengths of association were greater for 3DE-derived indices.
Acknowledgement/Funding
SABRE is funded by BHF, Diabetes UK, the MRC and the Wellcome Trust. LA holds a scholarship grant from Imam Abdulrahman Bin Faisal University, SA
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Affiliation(s)
- L Al Saikhan
- University College London, Institute of Cardiovascular Sciences/MRC Unit for LHA/School of Life and Medical Sciences, London, United Kingdom
| | - C Park
- University College London, Institute of Cardiovascular Sciences/MRC Unit for LHA/School of Life and Medical Sciences, London, United Kingdom
| | - T Tillin
- University College London, Institute of Cardiovascular Sciences/MRC Unit for LHA/School of Life and Medical Sciences, London, United Kingdom
| | - S Williams
- University College London, Institute of Cardiovascular Sciences/MRC Unit for LHA/School of Life and Medical Sciences, London, United Kingdom
| | - J Mayet
- Imperial College London, National Heart and Lung Institute (NHLI), London, United Kingdom
| | - N Chaturvedi
- University College London, Institute of Cardiovascular Sciences/MRC Unit for LHA/School of Life and Medical Sciences, London, United Kingdom
| | - A Hughes
- University College London, Institute of Cardiovascular Sciences/MRC Unit for LHA/School of Life and Medical Sciences, London, United Kingdom
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Wong BLH, Chaturvedi N, Tillin T, Richards M, Hughes A, Stewart R, Shibata D, Park C. 6070Association of blood pressure measures with brain structure and function: the Southall and Brent REvisited (SABRE) study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
In our rapidly ageing society, dementia and neurocognitive decline are significant global public health problems. Blood pressure (BP), an established cardiovascular risk factor, has been extensively studied with respect to brain structure and function; however, findings across the literature differ depending on the BP component in consideration, and the use of brachial rather than central BP.
Purpose
We set out to assess associations between detailed measures of brain structure and function with comprehensive measures of central and peripheral BP. Furthermore, we performed comprehensive mediation analyses on the associations to investigate potential micro and macro vascular mediatory pathways.
Methods
A community-based sample of 1438 individuals (69.7±6.2 years) from a tri-ethnic cohort. underwent vascular, cognitive and MRI based structural brain measures. BP measures included central (cSBP (Pulsecor)) and peripheral systolic BP (pSBP), diastolic BP (DBP), brachial (bPP) and central pulse pressure (cPP), and mean arterial pressure (MAP). Cognitive assessments comprised tests which explored global/overall function (CSID), executive function and memory. For brain structure, hippocampal brain volume was our key measure. Potential macro- and microvascular mediators included: arterial stiffness (cfPWV), carotid intima-media thickness, retinopathy, white matter hyperintensities and infarcts. Multivariable regression analyses were used to assess associations of BP components with cognitive function scores and brain volumes, adjusted for age, sex and ethnicity as well as macro- and microvascular risk factors. Multiple imputation was performed to account for missing data.
Results
After adjusting for age, sex and ethnicity, both cSBP and pSBP were negatively associated with memory (data are β±SE (z-score) −0.014±0.006, p=0.04), while DBP was positively associated with hippocampal volume (0.006±0.003, p=0.03). cPP was negatively associated with memory (−0.020±0.009, p=0.03), executive function (−0.018±0.006, p=0.002) and hippocampal volume (−0.007±0.003, p=0.005), while bPP was negatively associated with CSID (−0.008±0.004, p=0.04), memory (−0.020±0.008, p=0.02), executive function (−0.016±0.005, p=0.002) and hippocampal volume (−0.006±0.002, p=0.007). There was a stronger association between both PP measures and brain structure and function than with the other BP components, especially MAP. There was little difference in association between cPP and bPP measures with brain structure and function. Furthermore, these associations do not appear to be mediated by either macro- or microvascular disease.
Conclusion
These results suggest that there is a direct association between increased PP and a decline in brain structure and function. This implies that older patients with suboptimal PP control may be at increased risk of developing cognitive impairment and that measuring PP offers mechanistic information above and beyond conventional BP measures.
Acknowledgement/Funding
Wellcome Trust, British Heart Foundation
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Affiliation(s)
- B L H Wong
- University College London, Institute of Cardiovascular Science, London, United Kingdom
| | - N Chaturvedi
- University College London, MRC Unit for Lifelong Health and Ageing; Institute of Cardiovascular Science, London, United Kingdom
| | - T Tillin
- University College London, Institute of Cardiovascular Science, London, United Kingdom
| | - M Richards
- University College London, MRC Unit for Lifelong Health and Ageing, London, United Kingdom
| | - A Hughes
- University College London, Institute of Cardiovascular Science, London, United Kingdom
| | - R Stewart
- Kings College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
| | - D Shibata
- University of Washington, Department of Radiology, Seattle, United States of America
| | - C Park
- University College London, Institute of Cardiovascular Science, London, United Kingdom
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Alfarih M, Leu C, Moon J, Hughes A, Nihoyannopoulos P, Captur G. P909Echocardiographic Assessment of Left Ventricular Function in Patients with Aortic Stenosis and the short-term effects after intervention. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Aortic stenosis (AS) is the most prevalent form of acquired valvular heart disease, it affects ∼2% of people aged over 75. Series of compensatory mechanisms occur, in order for LV to adapt to high pressure overload. Aortic valve replacement has been the mainstay AS treatment either surgically or percutaneously. The evaluation of myocardial strains after Transcatheter Aortic Valve Implantation (TAVI) and Surgical Aortic Valve Replacement (SAVR) is still underexplored and there is no single study to date scouting the difference between TAVI and SAVR.
Aim
To assess the impact of unloading LV after TAVI and SAVR on LV remodelling.
Methods
In this prospective study, we have recruited 111 patients (75±11 years, 63% were females) with varying degrees of aortic stenosis. Of the 111 patients, 43 patients and 11 patients underwent TAVI and SAVR respectively between November 2017 and May 2018. Demographics, clinical and echocardiographic measurements along with speckle tracking parameters were recorded for all participants and again 4±2 weeks after intervention.
Results
Pre-TAVI LV-GLS mean was −10.8±3.5% and after implantation of aortic prosthesis immediate improvement of the myocardial deformation to −13.98±2.9% was observed after one month of the intervention, mean difference of −3.16% following procedure. There was an evidence of significant improvement in LV-GRS after TAVI (44.86±12.9% to 49.77±10.8%, P value= 0.047). Per contra, when comparing pre and post TAVI LV-GCS, no statistical evidence was noted. However, a difference of −2.4% in GCS following the intervention might be clinically important, but no previous evidence can support this. This is attributed to the poor reproducibility and yet not available standardisation.
Table 1 Variables TAVI (n=43) SAVR (n=11) P value† Pre Post P* value Pre Post P* value GLS (%) −10.82±3.5 −13.98±2.9 <0.001 −12.75±4.3 −16.1±2 0.021 0.152 GCS (%) −30.1±8.1 −32.49±9.2 0.134 −27±9.8 −33.9±4.69 0.063 0.062 GRS (%) 44.86±12.9 49.77±10.8 0.047 36.6±13.3 44.97±4.9 0.074 0.058 Data are expressed as mean ± SD. Comparisons were performed using paired Student's t tests. *Pre and post intervention. †Post TAVI vs. post SAVR. Comparison done using unpaired t test of the differences.
Conclusion
Significant improvement was evident in myocardial deformation parameters – in particular GLS – after weeks of the intervention demonstrating a strong evidence of reversed remodelling following SAVR and TAVI.
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Affiliation(s)
- M Alfarih
- University College London, London, United Kingdom
| | - C Leu
- Queen Mary University of London, London, United Kingdom
| | - J Moon
- University College London, London, United Kingdom
| | - A Hughes
- University College London, London, United Kingdom
| | | | - G Captur
- University College London, London, United Kingdom
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41
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Lamb D, Hofman A, Clark J, Hughes A, Sukhera A. Taking a seat at the table: an educational model for nursing empowerment. Int Nurs Rev 2019; 67:118-126. [DOI: 10.1111/inr.12549] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 07/05/2019] [Accepted: 07/19/2019] [Indexed: 11/30/2022]
Affiliation(s)
- D. Lamb
- Academic Department of Military NursingRoyal Centre for Defence Medicine, Medical Directorate, Birmingham Research ParkBirmingham UK
| | | | - J. Clark
- Headquarters 2 Medical Brigade Army Medical Services Training Centre York UK
| | - A. Hughes
- Royal Centre for Defence Medicine, Medical Directorate, Birmingham Research Park BirminghamUK
| | - A.M. Sukhera
- Pakistan Army Medical Corps and Director General Medical Services (Inter‐Services) Rawalpindi Pakistan
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42
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Seo HS, Captur G, Ittermann B, Pang W, Keenan K, Kellman P, Nezafat R, Chaturvedi N, Hughes A, Moon JC. 27A medical device grade T2 phantom to quality control inflammation imaging by CMR. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez111.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- H S Seo
- MRC Unit for Lifelong Health and Ageing at UCL, London, United Kingdom of Great Britain & Northern Ireland
| | - G Captur
- MRC Unit for Lifelong Health and Ageing at UCL, London, United Kingdom of Great Britain & Northern Ireland
| | - B Ittermann
- Physikalisch-Technische Bundesanstalt (PTB), Berlin, Germany
| | - W Pang
- Resonance Health (RH), Claremont, Australia
| | - K Keenan
- National Institutes of Standards and Technology(NIST), Boulder, United States of America
| | - P Kellman
- National Institutes of Health (NIH), Bethesda, United States of America
| | - R Nezafat
- Harvard Medical School, Department of Medicine, Boston, United States of America
| | - N Chaturvedi
- MRC Unit for Lifelong Health and Ageing at UCL, London, United Kingdom of Great Britain & Northern Ireland
| | - A Hughes
- MRC Unit for Lifelong Health and Ageing at UCL, London, United Kingdom of Great Britain & Northern Ireland
| | - J C Moon
- St. Bartholomew"s Hospital, Barts Heart Centre , Greater London, United Kingdom of Great Britain & Northern Ireland
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43
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Abstract
We present the anaesthetic management of a parturient with kyphomelic dysplasia and Pierre Robin Sequence who underwent elective caesarean delivery. Potential anaesthetic issues and management strategies are discussed.
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Affiliation(s)
- A Hughes
- Bradford Royal Infirmary, Bradford, West Yorkshire, UK.
| | - S Cooper
- Bradford Royal Infirmary, Bradford, West Yorkshire, UK
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44
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James SN, Jones S, Tillin T, Key D, Hughes A, Richards M, Chaturvedi N. 133DEPRESSIVE SYMPTOMS ARE ASSOCIATED WITH PERCEIVED, NOT OBJECTIVE, EXERTION DURING EXERCISE IN EUROPEAN, INDIAN ASIAN AND AFRICAN-CARIBBEAN GROUPS. Age Ageing 2019. [DOI: 10.1093/ageing/afy207.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- S N James
- MRC Lifelong Health and Ageing, University College London, London, UK
| | - S Jones
- MRC Lifelong Health and Ageing, University College London, London, UK
| | - T Tillin
- MRC Lifelong Health and Ageing, University College London, London, UK
| | - D Key
- MRC Lifelong Health and Ageing, University College London, London, UK
| | - A Hughes
- MRC Lifelong Health and Ageing, University College London, London, UK
| | - M Richards
- MRC Lifelong Health and Ageing, University College London, London, UK
| | - N Chaturvedi
- MRC Lifelong Health and Ageing, University College London, London, UK
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45
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Martin CJ, Temperton DH, Jupp T, Hughes A. IPEM topical report: personal dose monitoring requirements in healthcare. ACTA ACUST UNITED AC 2019; 64:035008. [DOI: 10.1088/1361-6560/aafa3f] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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46
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Steel N, Ford J, Newton J, Davis A, Vos T, Naghavi M, Hughes A, Dalton A, Schmidt J, Murray C. Global burden of disease (GBD) 2016 subnational estimates for 150 English local authorities. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky212.828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- N Steel
- University of East Anglia, Norwich, UK
| | - J Ford
- University of East Anglia, Norwich, UK
| | - J Newton
- Public Health England, London, UK
| | - A Davis
- Public Health England, London, UK
| | - T Vos
- Institute for Health Metrics and Evaluation, Seattle, USA
| | - M Naghavi
- Institute for Health Metrics and Evaluation, Seattle, USA
| | - A Hughes
- Public Health England, London, UK
| | - A Dalton
- University of East Anglia, Norwich, UK
| | | | - C Murray
- Institute for Health Metrics and Evaluation, Seattle, USA
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47
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Hughes A, Woodward A, Fritz M, Reeves M. UNMET NEEDS AMONG ACUTE STROKE SURVIVORS TRANSITIONING HOME. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- A Hughes
- Michigan State University School of Social Work
| | - A Woodward
- Michigan State University School of Social Work
| | - M Fritz
- Michigan State University Department of Epidemiology
| | - M Reeves
- Michigan State University Department of Epidemiology
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48
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Villa S, Pillai M, Graham D, Kilgour E, Overton N, Vasudev N, Hughes A, Walker A, Dransfield S, Thistlethwaite F. TRIBE; Tyrosine kinase inhibitor therapy in renal-cell carcinoma: Immune biomarker evaluation. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy315.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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49
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Joshi R, Wannamethee G, Rhodes D, Engmann J, Dale C, Gaunt T, Jefferis B, Papacosta O, Shah T, Tillin T, Wong A, Chaturvedi N, Kivimaki M, Kuh D, Kumari M, Hughes A, Ben-Shlomo Y, Casas JP, Hingorani AD, Schmidt AF. P15 TRIGLYCERIDE-CONTAINING LIPOPROTEIN SUB-FRACTIONS AND CORONARY HEART DISEASE AND STROKE RISK. Cardiovasc Res 2018. [DOI: 10.1093/cvr/cvy216.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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50
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Awad F, Jennison T, Hughes A. Radiolucent triangle and U-bolster for lower leg positioning for circular frame application. Ann R Coll Surg Engl 2018; 101:76. [PMID: 30112940 DOI: 10.1308/rcsann.2018.0122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- F Awad
- Royal Devon and Exeter Hospital , Exeter , UK
| | - T Jennison
- Royal Devon and Exeter Hospital , Exeter , UK
| | - A Hughes
- Royal Devon and Exeter Hospital , Exeter , UK
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