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Howell KL, Ferasin L, Walls A, Smith N. Prevalence of iatrogenic heart murmurs in a population of apparently healthy cats. J Small Anim Pract 2022; 63:597-602. [PMID: 35316860 DOI: 10.1111/jsap.13498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 01/31/2022] [Accepted: 03/01/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To determine the prevalence of iatrogenic heart murmurs in a population of apparently healthy cats and to investigate factors that may predispose cats to iatrogenic murmurs. MATERIALS AND METHODS Apparently healthy cats presenting for routine examinations were prospectively enrolled. Following a physical examination to confirm there were no abnormalities, a cardiac examination was performed before and during a provocative manoeuvre performed independently by two clinicians. The provocative manoeuvre was performed on the right side of the chest wall by applying gentle pressure with a stethoscope to ascertain whether a murmur became audible, graded using a modified descriptive scale (soft/moderate). The cat's heart rate before and during the provocative manoeuvre and their age, sex, body condition score and bodyweight were recorded. RESULTS One hundred and six cats were prospectively enrolled. The average prevalence of iatrogenic murmurs was 28.2% with good interobserver agreement recorded on both the presence (kappa 0.67 and 0.62) and grade of the murmur (kappa 0.6 and 0.53). A significant association was noted between age and body condition score, with iatrogenic murmurs more likely in cats with increasing age and decreasing body condition score. There was no association between heart rate and the presence of an iatrogenic murmur. CLINICAL SIGNIFICANCE Iatrogenic murmurs are a common finding in cats with increasing prevalence noted in older and lean cats. Iatrogenic murmurs should therefore be considered as a differential diagnosis in a cat when an audible soft systolic right-sided murmur occurs with gentle pressure application to the chest wall during auscultation.
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Affiliation(s)
- K L Howell
- Sarah Smith Cardiology, Ivy Court, Etwall, Derby, DE65 6JG, UK
| | - L Ferasin
- Specialist Veterinary Cardiology Consultancy, Alton, Hampshire, UK
| | - A Walls
- Broad Lane Vets, Coventry, CV5 7AQ, UK
| | - N Smith
- Broad Lane Vets, Coventry, CV5 7AQ, UK
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2
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Walls A, Plaat F, Delgado A. Maternal death: lessons for anaesthesia and critical care. BJA Educ 2022; 22:146-153. [PMID: 35531079 PMCID: PMC9073293 DOI: 10.1016/j.bjae.2021.11.009] [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] [Accepted: 11/03/2021] [Indexed: 10/19/2022] Open
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3
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Jefferies O, Walls A, McKeag P, Houston R, Kealey D. 1403 Leadership and Teamwork in The Major Trauma Service – Implementation of A New Approach to Secondary Surveys. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.156] [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]
Abstract
Abstract
Aim
Trauma Audit and Research Network (TARN) guidelines at a Major Trauma Centre in Northern Ireland state that all patients admitted with Major Trauma should have a secondary survey completed and documented within 24 hours of admission.
Method
All patients admitted with major trauma had their medical notes reviewed on discharge to look for evidence of a documented secondary survey. Two audit cycles were completed. The first from January 2018 to April 2018 (n = 38). Following a quality improvement project with specific interventions to improve compliance, including improved communication behaviours and the implementation of a revised trauma booklet, a second cycle was performed from October 2019 to January 2019 (n = 44)
Results
58% of group 1 and 75% of group 2 had a documented secondary survey within 24 hours of admission. The interventions therefore resulted in an overall 17% increase in the number of secondary surveys completed within 24 hours. Patients admitted under Orthopaedic care had a significant improvement of 26% between cycles to 89% compliance. Cardiothoracics (33% to 40%), Neurosurgery (14% to 43%) and General Surgery (75% to 66%).
Conclusions
A quality improvement drive led by the Orthopaedic team involving the education of doctors, improving communication channels and the introduction of revised trauma documentation, resulted in a significant increase in the number of secondary surveys completed within 24 hours. Patients under the care of Orthopaedics were more likely to have a survey completed compared with other specialties. This highlights the need for more education and engagement of other specialities to increase compliance in secondary surveys.
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Affiliation(s)
- O Jefferies
- Royal Victoria Hospital, Belfast, United Kingdom
| | - A Walls
- Royal Victoria Hospital, Belfast, United Kingdom
| | - P McKeag
- Royal Victoria Hospital, Belfast, United Kingdom
| | - R Houston
- Royal Victoria Hospital, Belfast, United Kingdom
| | - D Kealey
- Royal Victoria Hospital, Belfast, United Kingdom
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4
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Affiliation(s)
- S. Marwah
- Departments of Haematology, City Hospital, Birmingham B18 7QH, UK
| | - A. Walls
- Departments of Biochemistry, City Hospital, Birmingham B18 7QH, UK
| | - A. D. Blann
- Departments of Medicine, City Hospital, Birmingham B18 7QH, UK
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5
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Emily Kettle J, Warren L, Glenn Robinson P, Walls A, Gibson BJ. 'I didn't want to pass that on to my child, being afraid to go to the dentist': making sense of oral health through narratives of connectedness over the life course. Sociol Health Illn 2019; 41:658-672. [PMID: 30582176 DOI: 10.1111/1467-9566.12845] [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] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
While previous sociological research on oral health has identified the relevance of personal relationships, there is more scope to analyse the mouth through a lens of connectedness. Recent qualitative interviews with 43 older people (65+) in England and Scotland found that participants constructed relational narratives to make sense of their oral health practices. By drawing on ideas of family practices, family display and personal life, we illustrate how the mouth can be understood relationally. Participants presented their own embodied experiences as connected to the actions of their parents. Narratives also reflected how, as parents and grandparents themselves, participants tried to shape the experiences of others. In this way, oral health practices were conceptualised as being about family. This can be seen in self-narratives that demonstrated how participants located themselves as embedded in webs of ongoing relationships. We highlight the importance of narrated practices of thinking and feeling, whereby participants imagined doing oral health, and indeed family, in different ways. We thereby demonstrate how oral health practices are constituted through family connectedness and at the same time how these practices contribute to the constitution of family. Policy should therefore pay attention to family relations when promoting improvements in oral health practices.
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Affiliation(s)
| | - Lorna Warren
- Sociological Studies, University of Sheffield, Sheffield, United Kingdom
| | | | - Angus Walls
- Edinburgh Dental Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Barry John Gibson
- Oral Health and Development, University of Sheffield, Sheffield, United Kingdom
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6
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Wilson N, Walls A, Chapple I. The Oral and Dental Research Trust: 30 years of achievement. Br Dent J 2019; 226:381. [PMID: 30903038 DOI: 10.1038/s41415-019-0107-z] [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: 11/09/2022]
Affiliation(s)
- Nairn Wilson
- Trustee, Past-Chair and Director, ODRT, London, UK.
| | - Angus Walls
- Trustee, Chair and Director, ODRT, Edinburgh, UK
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Raman KS, Stokes M, Shah R, Walls A, Steele P, Burdeniuk C, De Pasquale C, Celermajer D, Selvanayagam J. Feasibility of Oxygen Sensitive Cardiac Magnetic Resonance in Demonstrating Right Ventricular Myocardial Ischaemia in Patients with Pulmonary Arterial Hypertension. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.270] [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: 10/26/2022]
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Saksono P, Hijryana M, Walls A, Kusdhany L, Indrasari M, Ariani N. Relationships Between Tooth Loss and Masticatory Performance, Nutrition Intake, and Nutritional Status in the Elderly. Pesqui bras odontopediatria clín integr 2019. [DOI: 10.4034/pboci.2019.191.148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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9
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Shah R, Raman KS, Walls A, Woodman R, Faull R, Gleadle J, Selvanayagam J. Gadolinium Free Cardiovascular Magnetic Resonance (CMR) Stress T1 mapping in patients with Chronic Kidney Disease (CKD). Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.271] [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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Affiliation(s)
- A Walls
- 1 Edinburgh Dental Institute, University of Edinburgh, Edinburgh, UK
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11
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Palmeiro MRL, Bronstrup MB, Durham J, Walls A, Shinkai RSA. Quality of life and mastication in denture wearers and cleft lip and palate adults. Braz Oral Res 2018; 32:e113. [DOI: 10.1590/1807-3107bor-2018.vol32.0113] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Accepted: 09/12/2018] [Indexed: 11/22/2022] Open
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12
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Gibson BJ, Kettle JE, Robinson PG, Walls A, Warren L. Oral care as a life course project: A qualitative grounded theory study. Gerodontology 2018; 36:8-17. [DOI: 10.1111/ger.12372] [Citation(s) in RCA: 5] [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: 03/28/2018] [Revised: 07/31/2018] [Accepted: 08/10/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Barry J. Gibson
- Academic Unit of Oral Health, Dentistry and Society, School of Clinical Dentistry University of Sheffield Sheffield UK
| | - Jennifer E. Kettle
- Academic Unit of Oral Health, Dentistry and Society, School of Clinical Dentistry University of Sheffield Sheffield UK
| | | | | | - Lorna Warren
- Department of Sociological Studies University of Sheffield Sheffield UK
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13
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Bermingham ML, Campbell A, Porteous D, Walls A. Clinically driven analysis reveals gene-socioeconomic status interaction influencing periodontal disease in the electronic health record-linked Generation Scotland: Scottish Family Health Study (GS: SFHS) cohort. Int J Popul Data Sci 2018. [DOI: 10.23889/ijpds.v3i4.787] [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: 10/28/2022] Open
Abstract
IntroductionHeritability (proportion of trait variation attributable to genetic factors) is not a fixed property. It can vary across different social settings and environments. Exploration of gene-environment interaction has been limited by lack of large sample sizes. Biobanks linked to electronic health records pose a solution to this sample size problem.
Objectives and ApproachSocial inequalities in periodontal health have been well documented in the dental scientific literature. However, gene-socioeconomic status interaction has yet to be examined. We identified 2,192 cases and 11,525 controls from linked electronic periodontal treatment records within the Generation Scotland: Scottish Family Health Study (GS: SFHS) (www.generationscotland.org). The measure of socioeconomic status used was the Scottish Index of Multiple Deprivation. The objective of this study was to investigate the gene-socioeconomic status interaction within this data. A reaction norm model was used to evaluate the presence of a gene-socioeconomic status interaction in the statistical software ASReml.
ResultsWe estimated the heritability of periodontal disease at 10.42% (95% confidence interval 5.97-14.88%). Socioeconomic status modified the heritability of periodontal disease. The heritability of was 13.37%, 0.14% and 11.70% in areas of high, moderate and low deprivation respectively; indicating the occurrence of a gene-socioeconomic status interaction with periodontal disease. These results indicate that socioeconomic status explains a large portion of genetic variation in periodontal disease risk. This information suggests that effective intervention and prevention programs for periodontal disease should involve socioeconomic aspects in their planning, implementations and evaluation. For instance, interventions targeted to reduce smoking in more deprived subjects with a genetic predisposition to periodontal disease could enhance the effect of health promotion strategies in reducing risk.
Conclusion/ImplicationsThis study presents contemporary evidence in a large population based cohort that gene-socioeconomic interaction leads to the progression of periodontal disease. This information may lead to the development of better preventative strategies for clinical dentistry.
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Affiliation(s)
- J H Meurman
- 1 Department of Oral and Maxillofacial Diseases, Helsinki University Hospital, Helsinki, Finland
| | - G McKenna
- 2 Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - H Murtomaa
- 1 Department of Oral and Maxillofacial Diseases, Helsinki University Hospital, Helsinki, Finland
| | - M Nakao
- 3 GC Corporation, Tokyo, Japan
| | - H Ogawa
- 4 WHO Collaborating Centre for Translation of Oral Health Science, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - A Walls
- 5 Edinburgh Dental Institute, University of Edinburgh, Edinburgh, UK
| | - D Williams
- 6 Barts and The London School of Medicine and Dentistry, London, UK
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15
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Lyons M, Smith C, Boaden E, Brady MC, Brocklehurst P, Dickinson H, Hamdy S, Higham S, Langhorne P, Lightbody C, McCracken G, Medina-Lara A, Sproson L, Walls A, Watkins DC. Oral care after stroke: Where are we now? Eur Stroke J 2018; 3:347-354. [PMID: 31236482 DOI: 10.1177/2396987318775206] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Accepted: 04/12/2018] [Indexed: 01/25/2023] Open
Abstract
Purpose There appears to be an association between poor oral hygiene and increased risk of aspiration pneumonia - a leading cause of mortality post-stroke. We aim to synthesise what is known about oral care after stroke, identify knowledge gaps and outline priorities for research that will provide evidence to inform best practice. Methods A narrative review from a multidisciplinary perspective, drawing on evidence from systematic reviews, literature, expert and lay opinion to scrutinise current practice in oral care after a stroke and seek consensus on research priorities.Findings: Oral care tends to be of poor quality and delegated to the least qualified members of the caring team. Nursing staff often work in a pressured environment where other aspects of clinical care take priority. Guidelines that exist are based on weak evidence and lack detail about how best to provide oral care. Discussion Oral health after a stroke is important from a social as well as physical health perspective, yet tends to be neglected. Multidisciplinary research is needed to improve understanding of the complexities associated with delivering good oral care for stroke patients. Also to provide the evidence for practice that will improve wellbeing and may reduce risk of aspiration pneumonia and other serious sequelae. Conclusion Although there is evidence of an association, there is only weak evidence about whether improving oral care reduces risk of pneumonia or mortality after a stroke. Clinically relevant, feasible, cost-effective, evidence-based oral care interventions to improve patient outcomes in stroke care are urgently needed.
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Affiliation(s)
- Mary Lyons
- Faculty of Health and Wellbeing, University of Central Lancashire, UK.,Department of International Public Health, Liverpool School of Tropical Medicine, UK
| | - Craig Smith
- Division of Cardiovascular Sciences, Manchester Academic Health Science Centre, University of Manchester, UK.,Department of Neurosciences, Salford Royal NHS Foundation Trust, UK
| | - Elizabeth Boaden
- Faculty of Health and Wellbeing, University of Central Lancashire, UK
| | - Marian C Brady
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, UK
| | - Paul Brocklehurst
- North Wales Organisation for Randomised Trials in Health, Bangor Institute of Health and Medical Research and Salford Royal NHS Foundation Trust, UK
| | - Hazel Dickinson
- Faculty of Health and Wellbeing, University of Central Lancashire, UK
| | - Shaheen Hamdy
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - Susan Higham
- Institute of Psychology, Health and Society, University of Liverpool, UK
| | - Peter Langhorne
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK
| | | | - Giles McCracken
- Centre for Oral Health Research, School of Dental Sciences, Newcastle University, UK
| | | | - Lise Sproson
- National Institute for Health Research Devices for Dignity Healthcare Technology Cooperative, Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | - Angus Walls
- Edinburgh Dental Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, UK
| | - Dame Caroline Watkins
- Faculty of Health and Wellbeing, University of Central Lancashire, UK.,Faculty of Health Sciences, Australian Catholic University, Australia
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Meurman JH, Janket SJ, Surakka M, Jackson EA, Ackerson LK, Fakhri HR, Chogle S, Walls A. Lower risk for cardiovascular mortality for patients with root filled teeth in a Finnish population. Int Endod J 2017; 50:1158-1168. [DOI: 10.1111/iej.12772] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 03/19/2017] [Indexed: 12/13/2022]
Affiliation(s)
- J. H. Meurman
- Department of Oral and Maxillofacial Diseases; Helsinki University Hospital and University of Helsinki; Helsinki Finland
| | - S.-J. Janket
- Department of Periodontology; Center for Clinical Research, General Dentistry; H. M. Goldman School of Dental Medicine; Boston University; Boston MA USA
| | - M. Surakka
- Otorhinolaryngology/Maxillofacial Surgery; Kuopio University Hospital; Kuopio Finland
| | - E. A. Jackson
- Preventive Cardiology, Internal Medicine; University of Michigan; Ann Arbor MI USA
| | - L. K. Ackerson
- Department of Public Health; University of Massachusetts; Lowell MA USA
| | - H. R. Fakhri
- Department of Periodontology; Center for Clinical Research, General Dentistry; H. M. Goldman School of Dental Medicine; Boston University; Boston MA USA
| | - S. Chogle
- Endodontics; H. M. Goldman School of Dental Medicine; Boston University; Boston MA USA
| | - A. Walls
- Edinburgh Dental Institute; University of Edinburgh; Scotland UK
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Bermingham M, Campbell A, Porteous D, Walls A. Genetic parameters for periodontal disease: an analysis of electronic dental treatment records linked to pedigree, genomic, sociodemographic and clinical data. Int J Popul Data Sci 2017. [PMCID: PMC9351282 DOI: 10.23889/ijpds.v1i1.373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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18
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Kunkler IH, Fielding RG, Brebner J, Prescott R, Maclean JR, Cairns J, Chetty U, Neades G, Walls A, Bowman A, Dixon JM, Gardner T, Smith M, MacCoubrey J, Lee AJ, Swann S, Mcnab M, Wilson J, Nawroz I. A comprehensive approach for evaluating telemedicine-delivered multidisciplinary breast cancer meetings in southern Scotland. J Telemed Telecare 2016; 11 Suppl 1:71-73. [PMID: 16124136 DOI: 10.1258/1357633054461804] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Multidisciplinary team (MDT) meetings for decisions on cancer management are a cornerstone of UK cancer policy. We have proposed a comprehensive methodology to assess the clinical and economic effectiveness of telemedicine in this setting, which is being tested in a randomized breast cancer trial. Pre- and post-telemedicine assessment includes attitudes to and expectations of telemedicine, based on semistructured interviews. The communication content of videotapes of the MDT meeting is being scored using Borgatta's revised Interaction Process Analysis System. The technical performance of the telemedicine equipment is reported on a standardized pro forma. A short questionnaire captures key elements of professional satisfaction for each patient discussion (consensus on future management, confidence in and sharing of decision), added value of linkage, group atmosphere, overall conduct of the meeting and compliance with SIGN guidelines. A cost-minimization analysis will be used for economic assessment.
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Affiliation(s)
- I H Kunkler
- University Department of Clinical Oncology and Edinburgh Breast Unit, Western General Hospital, UK.
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19
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Fielding RG, Macnab M, Swann S, Kunkler IH, Brebner J, Prescott RJ, Maclean JR, Chetty U, Neades G, Walls A, Bowman A, Dixon JM, Gardner T, Smith M, Lee MJ, Lee RJ. Attitudes of breast cancer professionals to conventional and telemedicine-delivered multidisciplinary breast meetings. J Telemed Telecare 2016; 11 Suppl 2:S29-34. [PMID: 16447355 DOI: 10.1258/135763305775124812] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We surveyed the attitudes of breast cancer professionals to standard face-to-face and future telemedicine-delivered breast multidisciplinary team (MDT) meetings. Interviews, which included the Group Behaviour Inventory, were conducted face-to-face (n = 19) or by telephone (n = 26). The mean total score on the Group Behaviour Inventory was 96 (SD 19) for 33 respondents, which indicated satisfaction with standard MDT meetings, irrespective of role and base hospital. Positive attitudes to videoconferencing were more common among participants with previous experience of telemedicine (Spearman's rank correlation 0.26, P = 0.91). Common themes emerging from the interviews about telemedicine-delivered MDTs included group leadership, meeting efficiency, group interaction, group atmosphere and technical quality of communication. Most participants were satisfied with standard breast MDTs. Nurses and allied health professionals were least supportive of telemedicine.
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Smith CJ, Horne M, McCracken G, Young D, Clements I, Hulme S, Ardron C, Hamdy S, Vail A, Walls A, Tyrrell PJ. Development and feasibility testing of an oral hygiene intervention for stroke unit care. Gerodontology 2016; 34:110-120. [PMID: 27198495 DOI: 10.1111/ger.12232] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To develop an oral hygiene complex intervention and evaluate its feasibility in a single UK stroke centre. BACKGROUND Oral hygiene interventions might improve clinical outcomes after stroke but evidence-based practice is lacking. MATERIALS AND METHODS We used a sequential mixed methods approach and developed an oral hygiene complex intervention comprising: (i) web-based education and 'hands-on' practical training for stroke unit nursing staff, (ii) a pragmatic oral hygiene protocol consisting of twice-daily powered (or manual if preferred) brushing with chlorhexidine gel (or non-foaming toothpaste) ± denture care. We evaluated feasibility of (i) the staff education and training and (ii) the oral hygiene protocol in consenting inpatients with confirmed stroke, requiring assistance with at least one aspect of personal care. RESULTS The staff education and training were feasible, acceptable and raised knowledge and awareness. Several barriers to completing the education and training were identified. The oral hygiene protocol was feasible and well-tolerated. 22% of eligible patients screened declined participation in the study. Twenty-nine patients (median age = 78 year; National Institutes of Health Stroke Scale score = 8.5; 73% dentate) were recruited at a median of 7 days from stroke onset. 97% of participants chose the default chlorhexidine-based protocol; the remainder chose the non-foaming toothpaste-based protocol. The mouth hygiene protocol was administered as prescribed on 95% of occasions, over a median duration of 28 days. There were no adverse events attributed to the oral hygiene protocol. CONCLUSION Our oral hygiene complex intervention was feasible in a single UK stroke centre. Further studies to optimise patient selection, model health economics and explore efficacy are now required.
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Affiliation(s)
- Craig J Smith
- Greater Manchester Comprehensive Stroke Centre, Manchester Academic Health Science Centre, Salford Royal Foundation Trust, Salford, UK.,Stroke and Vascular Centre, Institute of Cardiovascular Sciences, University of Manchester, Manchester, UK
| | - Maria Horne
- Faculty of Health Studies, School of Nursing, University of Bradford, Bradford, UK
| | - Giles McCracken
- School of Dental Sciences, Newcastle University, Newcastle, UK
| | - David Young
- The Greater Manchester School for Dental Care Professionals (MANDCP), Salford, UK
| | - Ian Clements
- Patient, Carer and Public Involvement Group, North West Stroke Research Network, Salford Royal NHS Foundation Trust, Salford, UK
| | - Sharon Hulme
- Stroke and Vascular Centre, Institute of Cardiovascular Sciences, University of Manchester, Manchester, UK
| | - Claire Ardron
- Greater Manchester Comprehensive Stroke Centre, Manchester Academic Health Science Centre, Salford Royal Foundation Trust, Salford, UK
| | - Shaheen Hamdy
- Centre for Gastrointestinal Sciences, Institute of Inflammation and Repair, University of Manchester, Manchester, UK
| | - Andy Vail
- Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester, UK
| | - Angus Walls
- Edinburgh Dental Institute, University of Edinburgh, Edinburgh, UK
| | - Pippa J Tyrrell
- Greater Manchester Comprehensive Stroke Centre, Manchester Academic Health Science Centre, Salford Royal Foundation Trust, Salford, UK.,Stroke and Vascular Centre, Institute of Cardiovascular Sciences, University of Manchester, Manchester, UK
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Abstract
OBJECTIVE This paper reviews potential age-associated risk factors for satisfactory oral function and oral disease to inform the development of care pathways for the older person. BACKGROUND Alterations in dental status or both physical and biological change associated with age can impact on oral disease and oral function. MATERIALS AND METHODS Older people tend to have fewer teeth and some are edentulous. Physical and biological changes in bodily function with age can also affect oral health care either directly or indirectly. RESULTS Reductions in chewing ability impact on the foods people choose to eat because of perceived difficulty with chewing, with a potentially deleterious affect on dietary quality. This is worse in people with xerostomia where chewing and swallowing are impaired anyway. Change in the cell-mediated inflammatory response impacts on gingival and periodontal disease manifestation and progression. Sarcopenia makes the physical act of toothbrushing more challenging. Caries remains a clinical problem that affects both the crowns and the roots of teeth. Coronal lesions tend to be around existing restorations where there is no evidence base about care/prevention. CONCLUSION The physical and clinical changes that occur with ageing require an altered pattern of care for older people which is adjusted to their disease risk and encourage diversity of foods consumption.
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Affiliation(s)
- Angus Walls
- Edinburgh Dental Institute, University of Edinburgh, Edinburgh, UK
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22
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Pretty IA, Ellwood RP, Lo ECM, MacEntee MI, Müller F, Rooney E, Murray Thomson W, Van der Putten GJ, Ghezzi EM, Walls A, Wolff MS. The Seattle Care Pathway for securing oral health in older patients. Gerodontology 2015; 31 Suppl 1:77-87. [PMID: 24446984 DOI: 10.1111/ger.12098] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2013] [Indexed: 02/06/2023]
Abstract
There is a need for a structured, evidence based approach to care for older dental patients. The following article describes the development of the Seattle Care Pathway based upon a workshop held in 2013. An overview is provided on the key issues of older persons dental care including the demography shift, the concept of frailty, the need for effective prevention and treatment to be linked to levels of dependency and the need for a varied and well educated work force. The pathway is presented in tabular form and further illustrated by the examples in the form of clinical scenarios. The pathway is an evidence based, pragmatic approach to care designed to be globally applicable but flexible enough to be adapted for local needs and circumstances. Research will be required to evaluate the pathways application to this important group of patients.
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Affiliation(s)
- Iain A Pretty
- Colgate Dental Health Unit, School of Dentistry, University of Manchester, Manchester, UK
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Horne M, McCracken G, Walls A, Tyrrell PJ, Smith CJ. Organisation, practice and experiences of mouth hygiene in stroke unit care: a mixed-methods study. J Clin Nurs 2014; 24:728-38. [PMID: 25134638 DOI: 10.1111/jocn.12665] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2014] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To (1) investigate the organisation, provision and practice of oral care in typical UK stroke units; (2) explore stroke survivors', carers' and healthcare professionals' experiences and perceptions about the barriers and facilitators to receiving and undertaking oral care in stroke units. BACKGROUND Cerebrovascular disease and oral health are major global health concerns. Little is known about the provision, challenges and practice of oral care in the stroke unit setting, and there are currently no evidence-based practice guidelines. DESIGN Cross-sectional survey of 11 stroke units across Greater Manchester and descriptive qualitative study using focus groups and semi-structured interviews. METHODS A self-report questionnaire was used to survey 11 stroke units in Greater Manchester. Data were then collected through two focus groups (n = 10) with healthcare professionals and five semi-structured interviews with stroke survivors and carers. Focus group and interview data were recorded, transcribed verbatim and analysed using framework approach. RESULTS Eleven stroke units in Greater Manchester responded to the survey. Stroke survivors and carers identified a lack of oral care practice and enablement by healthcare professionals. Healthcare professionals identified a lack of formal training to conduct oral care for stroke patients, inconsistency in the delivery of oral care and no set protocols or use of formal oral assessment tools. CONCLUSION Oral care post-stroke could be improved by increasing healthcare professionals' awareness, understanding and knowledge of the potential health benefits of oral care post-stroke. Further research is required to develop and evaluate the provision of oral care in stroke care to inform evidence-based education and practice. RELEVANCE TO CLINICAL PRACTICE Development of staff training and education, and evidence-based oral care protocols may potentially benefit patient care and outcomes and be implemented widely across stroke care.
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Affiliation(s)
- Maria Horne
- Division of Nursing, School of Health Studies, University of Bradford, Bradford, UK
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24
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Walls A, Johnston PC, Kluczewska-Zygan K, Vazir MH, McBride GB, Lindsay JR. Patellar fracture: atypical presentation of parathyroid bone disease. QJM 2013; 106:771-2. [PMID: 22927542 DOI: 10.1093/qjmed/hcs155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- A Walls
- Department of Trauma and Orthopaedics, Altnagelvin Area Hospital, Londonderry, UK
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25
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Ewan V, Sails A, Walls A, Newton J. Respiratory. Age Ageing 2013. [DOI: 10.1093/ageing/aft026] [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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26
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Marwah S, Walls A, Blann AD. Relationship between vitamin D and red blood cell indices in South Asians and White Europeans. Br J Biomed Sci 2012; 69:182-185. [PMID: 23304797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- S Marwah
- Department of Haematology, City Hospital, Birmingham B18 7QH, UK
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27
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Ewan V, Perry JD, Mawson T, McCracken G, Brown AN, Newton J, Walls A. Detecting potential respiratory pathogens in the mouths of older people in hospital. Age Ageing 2010; 39:122-5. [PMID: 19749149 PMCID: PMC2794360 DOI: 10.1093/ageing/afp166] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Victoria Ewan
- Institute for Ageing and Health Newcastle University, Campus for Ageing and Vitality Newcastle upon Tyne, UK.
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28
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Ellis JS, Burawi G, Walls A, Thomason JM. Patient satisfaction with two designs of implant supported removable overdentures; ball attachment and magnets. Clin Oral Implants Res 2009; 20:1293-8. [DOI: 10.1111/j.1600-0501.2009.01810.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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29
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Moynihan P, Thomason M, Walls A, Gray-Donald K, Morais JA, Ghanem H, Wollin S, Ellis J, Steele J, Lund J, Feine J. Researching the impact of oral health on diet and nutritional status: methodological issues. J Dent 2009; 37:237-49. [PMID: 19157673 DOI: 10.1016/j.jdent.2008.12.003] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2008] [Revised: 12/05/2008] [Accepted: 12/13/2008] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVES Assessment of the impact of dental function on diet and nutritional status requires robust methodologies and a standardised approach to increase accuracy of results and to facilitate cross study comparisons. The objectives of this paper are: to report the outcomes of a consensus workshop that critically reviewed publications reporting on dietary methodologies in relation to the impact of oral health on nutrition; to highlight future directions for research and; to make recommendations for appropriate use of methodologies for future research. DATA Data relevant to nutrition and dental status published from 1980 to 2005 in English were presented at the consensus workshop for discussion and appraisal. SOURCES Relevant papers were retrieved through PubMed. Relevant texts were obtained from the library at Newcastle University, UK. STUDY SELECTION A purposive sample of original articles that illustrated the application of a range of nutritional methodologies to the study of oral health impacts was identified. Original flagship texts on nutritional methodologies were reviewed. CONCLUSIONS Numerous studies have shown an association between loss of teeth and inferior diet. Further research is required to elucidate the impact of novel approaches to prosthetic rehabilitation and the impact of contemporaneous dietary and dental intervention on diet, nutritional status, disease progression and quality of life. The recommendation of the consensus workshop was that future studies should adopt a comprehensive approach to the assessment of nutrition that encompasses measurement of diet, body composition, biochemical indices of intake and levels of nutrients, and functional biomarkers of disease.
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Affiliation(s)
- Paula Moynihan
- School of Dental Sciences, WHO Collaborating Centre for Nutrition and Oral Health, Newcastle University, Framlington Place, Newcastle upon Tyne, United Kingdom.
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30
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Walls A, Wood B, Hamlyn A. Eldred Wright Walls. West J Med 2008. [DOI: 10.1136/bmj.a2867] [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: 11/04/2022]
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31
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Jamous I, Sidhu S, Walls A. An evaluation of the performance of cast gold bonded restorations in clinical practice, a retrospective study. J Dent 2007; 35:130-6. [PMID: 16919861 DOI: 10.1016/j.jdent.2006.06.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2006] [Revised: 06/07/2006] [Accepted: 06/10/2006] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES To evaluate the performance of cast gold bonded restorations in clinical practice. MATERIALS AND METHODS The records of all patients treated with cast gold bonded restorations between 1997 and 2004 of The Dental Hospital of Newcastle upon Tyne were reviewed. The following data were recorded: sex of patient, location of teeth (anterior or posterior), position of teeth (upper or lower) and type of cement (glass ionomer, zinc phosphate or resin cement). The survival time was calculated for each restoration; and the reason for failure (either debond or change of treatment plan) identified for each case. The restorations were stratified according to the age of the patient into 10-year age bands and survival analysis was used to identify variables associated with increased risk of failure. RESULTS Restorations luted with resin cement showed the highest rate of survival after 7 years of follow-up. The alternative lutes had significantly worse survival (p<0.05). Restorations on anterior teeth had poorer survival than on posterior teeth but there were no differences between those placed in the mandible and the maxilla. CONCLUSIONS Within the limitations of this study resin cements are most appropriate for this type of restoration with 80% survival at 7 years. Restorations placed on posterior teeth survived better.
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Affiliation(s)
- Issam Jamous
- Department of Restorative Dentistry, School of Dental Sciences, University of Newcastle upon Tyne, Framlington Place, Newcastle upon Tyne NE2 4BW, United Kingdom.
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32
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Cameron L, Christodoulopoulos P, Lavigne F, Nakamura Y, Eidelman D, McEuen A, Walls A, Tavernier J, Minshall E, Moqbel R, Hamid Q. Evidence for local eosinophil differentiation within allergic nasal mucosa: inhibition with soluble IL-5 receptor. J Immunol 2000; 164:1538-45. [PMID: 10640772 DOI: 10.4049/jimmunol.164.3.1538] [Citation(s) in RCA: 117] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Eosinophil differentiation occurs within the bone marrow in response to eosinopoietic cytokines, particularly IL-5. Recently, however, eosinophil precursors (CD34/IL-5Ralpha+ cells) and IL-5 mRNA+ cells have been identified within the lungs of asthmatics, indicating that a population of eosinophils may differentiate in situ. In this report, we examined the presence of eosinophil precursors within allergic nasal mucosa and examined whether they undergo local differentiation following ex vivo stimulation. We cultured human nasal mucosa obtained from individuals with seasonal allergic rhinitis with either specific allergen, recombinant human IL-5 (rhIL-5), or allergen + soluble IL-5Ralpha (sIL-5Ralpha), shown to antagonize IL-5 function. Simultaneous immunocytochemistry and in situ hybridization demonstrated that there were fewer cells coexpressing CD34 immunoreactivity and IL-5Ralpha mRNA following culture with allergen or rhIL-5, compared with medium alone. Immunostaining revealed that the number of major basic protein (MBP) immunoreactive cells (eosinophils) was higher within tissue stimulated with allergen or rhIL-5, compared with unstimulated tissue. In situ hybridization detected an increase in IL-5 mRNA+ cells in sections from tissue cultured with allergen, compared with medium alone. These effects were not observed in tissue cultured with a combination of allergen and sIL-5Ralpha. Colocalization analysis indicated this expression to be mainly, but not exclusively, T cell (44%) and eosinophil (10%) derived. Our findings suggest that a subset of eosinophils may differentiate locally within allergic nasal mucosa, in what appears to be a highly IL-5-dependent fashion, and imply that this process might be regulated in vivo by endogenous production of sIL-5Ralpha.
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MESH Headings
- Allergens/immunology
- Antibodies, Monoclonal/metabolism
- Antigens, CD34/immunology
- Antigens, CD34/metabolism
- Blood Proteins/chemistry
- Blood Proteins/immunology
- Cell Differentiation/immunology
- Coloring Agents
- Culture Techniques
- Eosinophil Granule Proteins
- Eosinophils/chemistry
- Eosinophils/immunology
- Eosinophils/pathology
- Gene Expression Regulation/immunology
- Growth Inhibitors/physiology
- Humans
- Naphthalenesulfonates
- Nasal Mucosa/chemistry
- Nasal Mucosa/immunology
- Nasal Mucosa/pathology
- Pollen/immunology
- Receptors, Interleukin/biosynthesis
- Receptors, Interleukin/genetics
- Receptors, Interleukin/physiology
- Receptors, Interleukin-5
- Rhinitis, Allergic, Perennial/immunology
- Rhinitis, Allergic, Perennial/metabolism
- Rhinitis, Allergic, Perennial/pathology
- Ribonucleases
- Solubility
- Staining and Labeling
- Stem Cells/chemistry
- Stem Cells/immunology
- Stem Cells/pathology
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Affiliation(s)
- L Cameron
- Meakins-Christie Laboratories, McGill University, Montreal, Quebec, Canada
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33
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Walls A. Restorative Dental Care of the elderly. Gerodontology 1999. [DOI: 10.1111/j.1741-2358.1999.xiv_2.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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34
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Krishna M, Madden J, Teran L, Biscione G, Lau L, Withers N, Sandstrom T, Mudway I, Kelly F, Walls A, Frew A, Holgate S. Alterações dos biomarcadores da inflamação no líquido de Lavagem Broncoalveolar e Mucosa Brônquica de individuos saudáveis expostos a 0.2PPM de Ozono. Revista Portuguesa de Pneumologia 1998. [DOI: 10.1016/s0873-2159(15)31056-4] [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] Open
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35
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Krishna MT, Madden J, Teran LM, Biscione GL, Lau LC, Withers NJ, Sandström T, Mudway I, Kelly FJ, Walls A, Frew AJ, Holgate ST. Effects of 0.2 ppm ozone on biomarkers of inflammation in bronchoalveolar lavage fluid and bronchial mucosa of healthy subjects. Eur Respir J 1998; 11:1294-300. [PMID: 9657569 DOI: 10.1183/09031936.98.11061294] [Citation(s) in RCA: 84] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Short-term exposure to ozone at peak ambient levels induces neutrophil influx and impairs lung function in healthy humans. In order to investigate the mechanisms contributing to neutrophil recruitment and to examine the role of T-cells in the acute inflammatory response, we exposed 12 healthy humans to 0.2 parts per million (ppm) of ozone and filtered air on two separate occasions for 2 h with intermittent periods of rest and exercise (minute ventilation = 30 L x min(-1)). Fibreoptic bronchoscopy was performed 6 h after the end of exposures. Total protein, tryptase, histamine, myeloperoxidase, interleukin (IL)-8 and growth-related oncogene-alpha (Gro-alpha) were measured and total and differential cell counts were performed in bronchoalveolar lavage (BAL) fluid. Flow cytometry was performed on BAL cells to study total T-cells, T-cell receptors (alphabeta and gammadelta), T-cell subsets (CD4+ and CD8+ cells) and activated T-cell subsets (CD25+). Using immunohistochemistry, neutrophils, mast cells, total T-cell numbers, T-cell subsets, CD25+ T-cells and leukocyte endothelial adhesion molecules including P-selectin, E-selectin, intercellular adhesion molecule (ICAM)-1 and vascular adhesion molecule (VCAM)-1 were quantified in the bronchial biopsies. Paired samples were available from nine subjects. Following ozone exposure there was a threefold increase in the proportion of polymorphonuclear neutrophils (PMNs) (p=0.07) and epithelial cells (p=0.05) in BAL fluid. This was accompanied by increased concentrations of IL-8 (p=0.01), Gro-alpha (p=0.05) and total protein (p=0.058). A significant positive correlation was demonstrated between the two chemokines and proportion of PMNs in BAL fluid. After ozone exposure there was a significant decrease in the CD4/CD8 ratio (p=0.05) and the proportion of activated CD4+ (p=0.01) and CD8+ T-cells (p=0.04). However, no significant changes were demonstrable in any of the inflammatory markers studied in the biopsies. Short-term exposure of healthy humans to 0.2 ppm ozone induced a neutrophil influx in peripheral airways at 6 h post exposure, but no apparent inflammatory response in proximal airways. This response seems to be mediated at least in part by interleukin-8 and growth-related oncogene-alpha.
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Affiliation(s)
- M T Krishna
- University Medicine, Southampton General Hospital, University of Southampton, UK
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36
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Djukanović R, Homeyard S, Gratziou C, Madden J, Walls A, Montefort S, Peroni D, Polosa R, Holgate S, Howarth P. The effect of treatment with oral corticosteroids on asthma symptoms and airway inflammation. Am J Respir Crit Care Med 1997; 155:826-32. [PMID: 9117012 DOI: 10.1164/ajrccm.155.3.9117012] [Citation(s) in RCA: 72] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
To improve understanding of the mechanisms of action of oral corticosteroids in asthma, we have conducted a double-blind, placebo-controlled study with prednisolone (20 mg for 2 wk followed by 10 mg for 4 wk) or placebo in 14 and 13 atopic corticosteroid-naive asthmatic subjects, respectively. Before and after treatment subjects underwent bronchoscopy with bronchoalveolar lavage (BAL) and bronchial biopsy. Treatment with prednisolone, but not placebo, significantly reduced asthma symptoms (from mean +/- SEM total weekly score of 34 +/- 6.2 to 15.7 +/- 3.2, p = 0.02) and albuterol usage (from mean +/- SEM number of puffs/wk of 29.7 +/- 6.2 to 18.2 +/- 3.7, p = 0.01) and significantly increased FEV1 (from 89.8 +/- 4.4% to 99.3 +/- 4.1% of predicted, p = 0.03). There were no significant changes in inflammatory or epithelial cell counts, levels of T-cell activation or albumin concentration in BAL. However, immunohistochemistry of bronchial biopsies showed that in the submucosa prednisolone significantly decreased numbers of mast cells by 62% (from median 45 to 17/mm2, p = 0.01), eosinophils by 81% (from median 30.1 to 5.7/mm2, p = 0.004), and CD4+ T-cells by 68% (from median 64.6 to 18.5/mm2, p = 0.02). In the epithelium only the reduction in the numbers of eosinophils was significant (from median 1.1 to 0/mm of epithelium, p = 0.02). There were no significant changes in any cell counts in the subjects receiving placebo, and comparison of the changes between the treatment groups identified a significant prednisolone-related reduction in submucosal eosinophil and mast cell counts (p = 0.003 and 0.03, respectively). The temporal association between the clinical and physiologic improvement, and the correlation between the magnitude of change in CD4+ T-cell counts in the submucosa and increase in PC20 methacholine (rs = 0.60, p = 0.049) suggests that the reduction in airways inflammatory cell numbers underlies the clinical efficacy of oral corticosteroids.
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Affiliation(s)
- R Djukanović
- Immunopharmacology Group, University Medicine, University of Southampton, United Kingdom
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37
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Djukanović R, Feather I, Gratziou C, Walls A, Peroni D, Bradding P, Judd M, Howarth PH, Holgate ST. Effect of natural allergen exposure during the grass pollen season on airways inflammatory cells and asthma symptoms. Thorax 1996; 51:575-81. [PMID: 8693436 PMCID: PMC1090485 DOI: 10.1136/thx.51.6.575] [Citation(s) in RCA: 73] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Bronchial challenge with allergen causes a specific form of airways inflammation consisting of an influx of neutrophils, eosinophils, and T cells. Because the relevance of the challenge model to clinical asthma is uncertain, the cellular changes that occur in the lungs of asthmatic subjects during natural seasonal allergen exposure were investigated. METHODS Seventeen grass pollen sensitive asthmatic subjects with previously reported seasonal exacerbations of asthma kept records of symptoms and underwent fibreoptic bronchoscopy with bronchoalveolar lavage (BAL) and endobronchial biopsy before and during the peak of the grass pollen season. The BAL cells were analysed for differential cell counts and by flow cytometry for T cell subsets and surface activation markers. The biopsy samples were processed into glycol methacrylate resin and immunohistochemical analysis was performed for mast cells, activated eosinophils, T cells and interleukin 4 (IL-4), a cytokine with a pivotal role in allergen-induced inflammation. RESULTS In the pollen season there was an increase in T lymphocyte activation in the BAL fluid as identified by increased expression of interleukin 2 receptor (IL-2R). In the submucosa these changes were paralleled by an increase in CD4+ T cells. By contrast, the numbers of metachromatic cells in BAL fluid staining with toluidine blue were reduced, possibly because of degranulation following allergen stimulation. In keeping with mast cell activation, the number of mucosal mast cells staining for secreted IL-4 increased during the season. In comparison with the period shortly before the onset of the season, all but two subjects experienced an asthma exacerbation which followed the rise in pollen counts but, compared with the period preceding the first bronchoscopic examination, asthma symptoms were not increased during the pollen season. CONCLUSIONS The data suggest that natural allergen exposure, leading to a clinical exacerbation of asthma, may induce an inflammatory response involving T cells, mast cells and eosinophils. The relationship between allergen exposure, cellular infiltration and activation, and clinical symptoms appears to be complex, with factors other than allergen also contributing to asthmatic activity.
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Affiliation(s)
- R Djukanović
- Immunopharmacology Group, University Medicine, Southampton, UK
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38
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Nasser S, Christie PE, Pfister R, Sousa AR, Walls A, Schmitz-Schumann M, Lee TH. Effect of endobronchial aspirin challenge on inflammatory cells in bronchial biopsy samples from aspirin-sensitive asthmatic subjects. Thorax 1996; 51:64-70. [PMID: 8658372 PMCID: PMC472802 DOI: 10.1136/thx.51.1.64] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The aspirin-induced bronchoconstriction in patients with aspirin-sensitive asthma is caused by cysteinyl leukotriene release. The cellular source of the leukotrienes is unknown. The inflammatory cell infiltrate in bronchial biopsy samples from seven aspirin-sensitive asthmatic (ASA) subjects and eight non-ASA subjects before and after local challenge with lysine aspirin was therefore examined. METHODS Using flexible bronchoscopy, airway mucosal biopsy samples were taken and lysine aspirin solution was placed directly onto a carina of the contralateral lung. Twenty minutes later a second series of biopsy samples was taken from the site of the local endobronchial lysine aspirin challenge. The biopsy samples were double immunostained with a rabbit polyclonal antibody to the enzyme 5-lipoxygenase and monoclonal antibodies to mast cells (AA1), neutrophils (NP57), macrophages (EBM11), T lymphocytes (anti-CD3), and total (BMK13) and activated eosinophils (EG2). RESULTS A decrease in both absolute mast cell numbers staining with mast cell tryptase (AA1) and the percentage of mast cells co-immunostaining with 5-lipoxygenase was seen in the ASA patients after lysine aspirin challenge compared with the non-ASA control group. There was also an increase in the numbers of activated eosinophils (EG2) in the ASA subjects compared with the non-ASA group. No changes were observed in the total numbers of macrophages (EBM11), neutrophils (NP57), total eosinophils (BMK13), and T lymphocytes (anti-CD3) after challenge with lysine aspirin. CONCLUSIONS The decrease in numbers of mast cells staining for tryptase and the increase in activated eosinophils after endobronchial challenge with lysine aspirin may represent degranulation of these cell types, and may be an early event associated with aspirin-sensitive reactions in ASA subjects.
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Affiliation(s)
- S Nasser
- Department of Allergy and Respiratory Medicine, UMDS, Guy's Hospital, London, UK
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39
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Gratziou C, Carroll M, Walls A, Howarth PH, Holgate ST. Early changes in T lymphocytes recovered by bronchoalveolar lavage after local allergen challenge of asthmatic airways. Am Rev Respir Dis 1992; 145:1259-64. [PMID: 1595988 DOI: 10.1164/ajrccm/145.6.1259] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
To assess the role of T lymphocytes in the initiation of the allergic asthmatic response we have investigated T-cells subsets and their activation markers in bronchoalveolar lavage (BAL) fluid recovered 10 min after local challenge of the bronchial mucosa with allergen or saline. Endobronchial challenge was performed in 13 mildly atopic asthmatic patients (FEV1% predicted range, 78.2 to 116.5) and 10 normal volunteers. In all of the asthmatics but in none of the normal subjects allergen but not saline exposure resulted in visible bronchoconstriction. Analysis of BAL by flow cytometry showed no differences in the overall number of T cells (CD3+) and their CD4+ and CD8+ subsets per milliliter of BAL between the groups of normal subjects and asthmatics. However, within 10 min of allergen challenge, in the asthmatics but not in the normal subjects, there occurred a significant loss of CD3+ cells (p less than 0.01) comprising mostly CD4+ (p less than 0.05) but also CD8+ cells, with a consequent decrease in the CD4:CD8 ratio. At this early time point no differences in the extent of expression of the T-cell activation markers, IL-2 receptor, and HLA-DR were found. These results provide evidence to support a role of T lymphocytes early in the allergen-induced inflammatory response in asthma.
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Affiliation(s)
- C Gratziou
- Immunopharmacology Group, Medicine I, Southampton University General Hospital, United Kingdom
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40
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Howarth PH, Wilson J, Djukanovic R, Wilson S, Britten K, Walls A, Roche WR, Holgate ST. Airway inflammation and atopic asthma: a comparative bronchoscopic investigation. Int Arch Allergy Appl Immunol 1991; 94:266-9. [PMID: 1937887 DOI: 10.1159/000235379] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Flexible fibre-optic bronchoscopy under local anaesthesia has been used to investigate the cellular airway events in atopic asthma. The findings have been compared to those from atopic individuals without asthma and non-atopic healthy controls, in an attempt to discern those changes relevant to clinical disease expression. Immunohistochemical and electron-microscopic analyses of airway biopsies identified that an atopic diathesis is associated with tissue eosinophil infiltration and mast cell degranulation. The eosinophilia was greatest in those atopic individuals with asthma. Flow-cytometric analysis of airway lavage revealed significantly enhanced T lymphocyte activation in clinical asthma. These findings are consistent with the hypothesis that T lymphocyte activation, through cytokine release, amplifies the tissue eosinophilia in asthma and that this combination is associated with clinical disease expression.
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Affiliation(s)
- P H Howarth
- Medicine I, Level D, Southampton General Hospital, UK
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Robertson J, Brydon WG, Tadesse K, Wenham P, Walls A, Eastwood MA. The effect of raw carrot on serum lipids and colon function. Am J Clin Nutr 1979; 32:1889-92. [PMID: 474479 DOI: 10.1093/ajcn/32.9.1889] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Two hundred grams of raw carrot eaten at breakfast each day for 3 weeks significantly reduced serum cholesterol by 11%, increased fecal bile acid and fat excretion by 50%, and modestly increased stool weight by 25%. This suggests an associated change in bacterial flora or metabolism. The changes in serum cholesterol, fecal bile acids, and fat persisted 3 weeks after stopping treatment.
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Walls A. Granulomatous rectal ulcer following cryotherapy to haemorrhoids. J R Coll Surg Edinb 1978; 23:315-6. [PMID: 702419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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