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Longman K, Frampas C, Lewis H, Costa C, Nilforooshan R, Chambers M, Bailey M. Noninvasive drug adherence monitoring of antipsychotic patients via finger sweat testing. Front Chem 2023; 11:1245089. [PMID: 37720721 PMCID: PMC10500062 DOI: 10.3389/fchem.2023.1245089] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 08/02/2023] [Indexed: 09/19/2023] Open
Abstract
Collection of finger sweat is explored here as a rapid and convenient way of monitoring patient adherence to antipsychotic drugs. Finger sweat samples (n = 426) collected from patients receiving treatment with clozapine, quetiapine and olanzapine were analysed by liquid chromatography mass spectrometry, including a subgroup of patients with paired plasma samples. Finger sweat samples were also analysed from a negative control group and patients who had handled antipsychotic medication only. The finger sweat test (based on the detection of parent drug in one donated sample) was 100% effective in monitoring adherence within commonly prescribed dosing ranges. In comparison to participants who handled the medication only, the test could distinguish between contact and administration through monitoring of the drug metabolite, or the level of parent drug. Additionally, in a subgroup of patients prescribed clozapine, a statistically significant correlation was observed between the mass of parent drug in finger sweat and plasma concentration. The finger sweat technology shows promise as a dignified, noninvasive method to monitor treatment adherence in patients taking antipsychotics.
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Affiliation(s)
- K. Longman
- School of Chemistry and Chemical Engineering, University of Surrey, Guildford, United Kingdom
| | - C. Frampas
- School of Chemistry and Chemical Engineering, University of Surrey, Guildford, United Kingdom
| | - H. Lewis
- School of Chemistry and Chemical Engineering, University of Surrey, Guildford, United Kingdom
| | - C. Costa
- Surrey Ion Beam Centre, University of Surrey, Guildford, United Kingdom
| | - R. Nilforooshan
- Abraham Cowley Unit, St Peter’s Hospital, Surrey and Borders Partnership NHS Foundation Trust, Chertsey, United Kingdom
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - M. Chambers
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - M. Bailey
- School of Chemistry and Chemical Engineering, University of Surrey, Guildford, United Kingdom
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Lewis H, Norrington A. Paediatric preoperative assessment. BJA Educ 2023; 23:238-244. [PMID: 37223694 PMCID: PMC10201399 DOI: 10.1016/j.bjae.2023.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 01/27/2023] [Indexed: 05/25/2023] Open
Affiliation(s)
- H. Lewis
- The Royal London Hospital, London, UK
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Tiller E, Lewis H, Harrison VA. Paroxysmal nocturnal hemoglobinuria: a rare cause of acute renal failure in a pediatric patient. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00263-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: 01/28/2023]
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Jangda Z, Menke H, Busch A, Geiger S, Bultreys T, Lewis H, Singh K. Pore-scale visualization of hydrogen storage in a sandstone at subsurface pressure and temperature conditions: Trapping, dissolution and wettability. J Colloid Interface Sci 2023; 629:316-325. [PMID: 36162389 DOI: 10.1016/j.jcis.2022.09.082] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 09/12/2022] [Accepted: 09/15/2022] [Indexed: 10/14/2022]
Abstract
HYPOTHESIS Underground hydrogen (H2) storage is a potentially viable solution for large-scale cyclic H2 storage; however, the behavior of H2 at subsurface pressure and temperature conditions is poorly known. This work investigates if the pore-scale displacement processes in H2-brine systems in a porous sandstone can be sufficiently well defined to enable effective and economic storage operations. In particular, this study investigates trapping, dissolution, and wettability of H2-brine systems at the pore-scale, at conditions that are realistic for subsurface H2 storage. EXPERIMENTS We have performed in situ X-ray imaging during a flow experiment to investigate pore-scale processes during H2 injection and displacement in a brine saturated Bentheimer sandstone sample at temperature and pressure conditions representative of underground reservoirs. Two injection schemes were followed for imbibition: displacement of H2 with H2-equilibrated brine and with non-H2-equilibrated brine. The results from the two cycles were compared with each other. FINDINGS The sandstone was found to be wetting to the brine and non-wetting to H2 after both displacement cycles, with average contact angles of 54° and 53° for H2-equilibrated and non-H2-equilibrated brine respectively. We also found a higher recovery of H2 (43.1%) when displaced with non-H2-equilibrated brine compared to that of H2-equilibrated brine (31.6%), indicating potential dissolution of H2 in the unequilibrated imbibing brine at reservoir conditions. Our results suggest that underground H2 storage may indeed be a suitable strategy for energy storage, but considerable further research is needed to fully comprehend the pore-scale interactions at reservoir conditions.
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Affiliation(s)
- Zaid Jangda
- Institute of GeoEnergy Engineering, Heriot-Watt University, EH14 4AS Edinburgh, United Kingdom.
| | - Hannah Menke
- Institute of GeoEnergy Engineering, Heriot-Watt University, EH14 4AS Edinburgh, United Kingdom.
| | - Andreas Busch
- Institute of GeoEnergy Engineering, Heriot-Watt University, EH14 4AS Edinburgh, United Kingdom.
| | - Sebastian Geiger
- Department of Geoscience and Engineering, Delft University of Technology, 2628 CN Delft, Netherlands.
| | - Tom Bultreys
- UGCT/PProGRess, Department of Geology, Ghent University, 9000 Ghent, Belgium.
| | - Helen Lewis
- Institute of GeoEnergy Engineering, Heriot-Watt University, EH14 4AS Edinburgh, United Kingdom.
| | - Kamaljit Singh
- Institute of GeoEnergy Engineering, Heriot-Watt University, EH14 4AS Edinburgh, United Kingdom.
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Lewis H, Couples G, Tengattini A, Buckman J, Tudisco E, Etxegarai M, Viggiani G, Hall SA. Interactions Between Imbibition and Pressure-Driven Flow in a Microporous Deformed Limestone. Transp Porous Media 2022. [DOI: 10.1007/s11242-022-01873-6] [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: 11/22/2022]
Abstract
AbstractNeutron imaging is used for direct observation of evolving water–air and deuterated water–normal water exchanges in flow experiments performed on a laboratory-deformed, microporous laminated limestone, an extremely fine-textured rock altered by arrays of superposed fractures generated in a rock mechanics apparatus. The neutron images document significant, evolving, water speed and flow direction variability at the deci-micron scale and spatially complex patterns of both increasing and decreasing water saturation. We infer that capillarity-driven and pressure-driven water movement occurs concurrently, in close proximity and in competition, and that as local and global water saturations evolve these two drivers can change their dominance in both matrix and deformed elements. Thin sections are used to obtain sub-micron resolution SEM images that provide multi-scale information on the textural features’ spatial arrangements. The textural characteristics are consistent with the inferences made from the coarser flow imaging. Alternating lamina types provide the primary lithological heterogeneity, while the experimentally created deformations lead to quasi-planar zones of highly comminuted matrix and fracture-like voids, each with lengths ranging from sub-mm to cm. Together deformation features delineate a partially connected array. The interplay between fluid movement through deformation features, and flow into (and out of) the laminae, implies near-equivalence of local driving pressure- and capillary-related energies, with subtle shifts in this balance as water saturation increases. The insights gained invite a re-examination of common rules-of-thumb for multi-phase fluid flow often adopted in fractured, low-permeability microporous rocks.
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Howell TJ, Nieforth L, Thomas-Pino C, Samet L, Agbonika S, Cuevas-Pavincich F, Fry NE, Hill K, Jegatheesan B, Kakinuma M, MacNamara M, Mattila-Rautiainen S, Perry A, Tardif-Williams CY, Walsh EA, Winkle M, Yamamoto M, Yerbury R, Rawat V, Alm K, Avci A, Bailey T, Baker H, Benton P, Binney C, Boyle S, Brandes H, Carr AM, Coombe W, Coulter K, Darby A, Davies L, Delisle E, Enders-Slegers MJ, Fournier A, Fox M, Gee N, Graham TM, Hamilton-Bruce A, Hansen TGB, Hart L, Heirs M, Hooper J, Howe R, Johnson E, Jones M, Karagiannis C, Kieson E, Kim SA, Kivlen C, Lanning B, Lewis H, Linder D, Mai DL, Mariti C, Mead R, Ferreira GM, Ngai D, O’Keeffe S, O’Connor G, Olsen C, Ormerod E, Power ER, Pritchard PA, Rodriguez K, Rook D, Ruby MB, Schofield L, Signal T, Steel J, Stone W, Symonds M, van Rooy D, Warda T, Wilson M, Young J, Bennett P. Defining Terms Used for Animals Working in Support Roles for People with Support Needs. Animals (Basel) 2022; 12:ani12151975. [PMID: 35953965 PMCID: PMC9367407 DOI: 10.3390/ani12151975] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/12/2022] [Accepted: 07/15/2022] [Indexed: 01/20/2023] Open
Abstract
Simple Summary Although animals are being employed for a growing number of roles to support people, the terms used to describe those animals (e.g., “therapy animal” and “emotional support animal”) can be confusing. The same term may be used to describe different types of work, or the same role can be described with different terms. This paper presents the results of a collaboration between over 100 researchers, practitioners, and end users of animal-based supports from all over the world. We created working definitions for the following nine terms: “assistance animal”, “companion animal”, “educational/school support animal”, “emotional support animal”, “facility animal”, “service animal”, “skilled companion animal”, “therapy animal”, and “visiting/visitation animal”. In this paper, we describe the defining characteristics of each animal type and how it is different from the other types. We recommend phasing out the terms “skilled companion animal” and “service animal”, because they are similar to other terms. We discuss how our definitions may be received in different parts of the world. Abstract The nomenclature used to describe animals working in roles supporting people can be confusing. The same term may be used to describe different roles, or two terms may mean the same thing. This confusion is evident among researchers, practitioners, and end users. Because certain animal roles are provided with legal protections and/or government-funding support in some jurisdictions, it is necessary to clearly define the existing terms to avoid confusion. The aim of this paper is to provide operationalized definitions for nine terms, which would be useful in many world regions: “assistance animal”, “companion animal”, “educational/school support animal”, “emotional support animal”, “facility animal”, “service animal”, “skilled companion animal”, “therapy animal”, and “visiting/visitation animal”. At the International Society for Anthrozoology (ISAZ) conferences in 2018 and 2020, over 100 delegates participated in workshops to define these terms, many of whom co-authored this paper. Through an iterative process, we have defined the nine terms and explained how they differ from each other. We recommend phasing out two terms (i.e., “skilled companion animal” and “service animal”) due to overlap with other terms that could potentially exacerbate confusion. The implications for several regions of the world are discussed.
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Affiliation(s)
- Tiffani J. Howell
- School of Psychology and Public Health, La Trobe University, Bendigo, VIC 3552, Australia
- Correspondence:
| | - Leanne Nieforth
- OHAIRE, Comparative Pathobiology, Center for the Human Animal Bond, College of Veterinary Medicine, Purdue University, West Lafayette, IN 47907, USA
| | - Clare Thomas-Pino
- Human-Animal Interaction, Department of Animal and Agriculture, Hartpury University, Gloucester GL19 3BE, UK
- School of Food and Agriculture, University of Maine, Orono, ME 04469, USA
| | | | | | - Francisca Cuevas-Pavincich
- Centro de Estudios en Bienestar y Convivencia Social, Facultad de Psicología, Universidad del Desarrollo, Santiago 7610658, Chile
| | - Nina Ekholm Fry
- Institute for Human-Animal Connection, University of Denver, Denver, CO 80208, USA
| | - Kristine Hill
- EASE Working Group, College of Social Sciences and International Studies, University of Exeter, Exeter EX4 4PY, UK
| | | | - Miki Kakinuma
- Department of Veterinary Medicine, Nippon Veterinary and Life Science University, Musashino, Tokyo 180-8602, Japan
| | - Maureen MacNamara
- Department of Social Work, Beaver College of Health Sciences, Appalachian State University, Boone, NC 28607, USA
| | - Sanna Mattila-Rautiainen
- Sports and Exercise Medicine, Biomedicine, University of Eastern Finland, Yliopistonranta 1, 70600 Kuopio, Finland
| | - Andy Perry
- Department of Anthrozoology, University of Exeter (alumnus), Exeter EX4 4PY, UK
| | | | | | - Melissa Winkle
- Dogwood Therapy Services, Albuquerque, NM 87120, USA
- Animal Assisted Interventions International, 6537 HN Nijmegen, The Netherlands
| | - Mariko Yamamoto
- Department of Animal Sciences, Teikyo University of Science, Uenohara, Yamanashi 409-0193, Japan
| | - Rachel Yerbury
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW 2522, Australia
| | - Vijay Rawat
- School of Health, Medical & Applied Sciences, Central Queensland University, Melbourne, VIC 3000, Australia
| | - Kathy Alm
- Professional Association of Therapeutic Horsemanship International, Denver, CO 80233, USA
| | - Ashley Avci
- Risk Frontiers, St Leonards, NSW 2065, Australia
- Faculty of Law, Macquarie University, Sydney, NSW 2019, Australia
| | - Tanya Bailey
- Boynton Health, Office of Student Affairs, University of Minnesota, Minneapolis, MN 55455, USA
| | - Hannah Baker
- University Centre Sparsholt, University of Winchester, Sparsholt, Winchester SO21 2NF, UK
| | - Pree Benton
- Dogs for Life, Caulfield South, VIC 3162, Australia
| | | | - Sara Boyle
- Virginia-Maryland College of Veterinary Medicine, Virginia Polytechnic Institute and State University, Blacksburg, VA 24061, USA
| | - Hagit Brandes
- The Program for Animal-Assisted-Psychotherapy, Tel-Hai College, Upper Galilee 1220800, Israel
| | - Alexa M. Carr
- Department of Human Development, Washington State University, Pullman, WA 99164, USA
| | - Wendy Coombe
- Animal Therapies Ltd., Gold Coast, QLD 4209, Australia
| | - Kendra Coulter
- Management and Organizational Studies, Huron University College at Western University, London, ON N6G 1H3, Canada
| | - Audrey Darby
- Equine Therapy Unit, ChildVision National Education Centre for Blind Children, D09 WKOH Dublin, Ireland
| | | | - Esther Delisle
- The Canadian Institute of Animal-Assisted Interventions, Montréal, QC H3V 1C7, Canada
| | - Marie-Jose Enders-Slegers
- Faculty of Psychology and Educational Sciences, Open University the Netherlands, 6419 AT Heerlen, The Netherlands
| | - Angela Fournier
- Department of Psychology, Bemidji State University, Bemidji, MN 56601, USA
| | - Marie Fox
- School of Law & Social Justice, University of Liverpool, Liverpool L69 3BX, UK
| | - Nancy Gee
- Center for Human-Animal Interaction, School of Medicine, Virginia Commonwealth University, Richmond, VA 23298, USA
| | | | - Anne Hamilton-Bruce
- Stroke Research Programme, The Queen Elizabeth Hospital & Basil Hetzel Institute for Translational Health Research, Woodville South, SA 5011, Australia
| | - Tia G. B. Hansen
- Center for Human Animal Psychology, Department of Communication and Psychology, Aalborg University, 9000 Aalborg, Denmark
| | - Lynette Hart
- School of Veterinary Medicine, University of California, Davis, CA 95616, USA
| | - Morag Heirs
- Clinical Animal Behaviour, Well Connected Canine, York YO24 3HG, UK
| | - Jade Hooper
- Faculty of Social Science, University of Stirling, Stirling FK9 4LA, UK
| | - Rachel Howe
- School of Nursing, Midwifery & Health Systems, University College Dublin, D04 V1W8 Dublin, Ireland
| | - Elizabeth Johnson
- Department of Anthropology, University of Nevada, Las Vegas, Las Vegas 89183, NV, USA
| | - Melanie Jones
- Orygen Centre for Excellence in Youth Mental Health, University of Melbourne, Melbourne, VIC 3000, Australia
- Lead The Way Institute Ferntree Gully, Boronia, VIC 3156, Australia
| | | | | | - Sun-A Kim
- Clinical Animal Behavior Service, Veterinary Medical Teaching Hospital, Chungbuk National University, Cheongju 28644, Korea
| | - Christine Kivlen
- Occupational Therapy, Health Care Sciences, Wayne State University, Detroit, MI 48202, USA
| | - Beth Lanning
- Department of Public Health, Baylor University, Waco, TX 76798, USA
| | - Helen Lewis
- Department of Education and Childhood Studies, Swansea University, Swansea SA2 8PP, UK
| | - Deborah Linder
- Department of Clinical Sciences, Tufts Institute for Human-Animal Interaction, Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA 01536, USA
| | - Dac Loc Mai
- School of Psychology and Public Health, La Trobe University, Bendigo, VIC 3552, Australia
| | - Chiara Mariti
- Department of Veterinary Sciences, University of Pisa, 56124 Pisa, Italy
| | | | - Gilly Mendes Ferreira
- Scottish SPCA (Scottish Society for the Prevention of Cruelty to Animals), Dunfermline KY11 8RY, UK
| | - Debbie Ngai
- Hong Kong Animal Assisted Therapy Association (HKAATA), Hong Kong, China
| | | | | | | | - Elizabeth Ormerod
- Society for Companion Animal Studies, Godmachester, Cambridgeshire PE29 2BQ, UK
| | - Emma R. Power
- Institute for Culture and Society, School of Social Sciences, Western Sydney University, Penrith, NSW 2751, Australia
| | - Peggy A. Pritchard
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, ON N1G 2W1, Canada
| | - Kerri Rodriguez
- Human-Animal Bond in Colorado, School of Social Work, Colorado State University, Fort Collins, CO 80526, USA
| | - Deborah Rook
- Northumbria Law School, Northumbria University, Newcastle upon Tyne NE1 8ST, UK
| | - Matthew B. Ruby
- School of Psychology and Public Health, La Trobe University, Bendigo, VIC 3552, Australia
| | - Leah Schofield
- Solihull College and University Centre, Solihull B91 1SB, UK
- The Royal (Dick) School of Veterinary Studies, The University of Edinburgh, Midlothian EH25 9RG, UK
| | - Tania Signal
- School of Health, Medical & Applied Sciences, College of Psychology, Central Queensland University, Rockhampton, QLD 4702, Australia
| | - Jill Steel
- Moray House School of Education and Sports Science, University of Edinburgh, Edinburgh EH8 8AQ, UK
| | - Wendy Stone
- Centre for Urban Transitions, Swinburne University of Technology, Melbourne, VIC 3000, Australia
| | - Melissa Symonds
- Faculty of Health, Education and Society, The University of Northampton, Northampton NN1 5PH, UK
| | | | - Tiamat Warda
- Institute for Human-Animal Connection, University of Denver, Denver, CO 80208, USA
| | - Monica Wilson
- School of Education, Communication and Language Sciences, Newcastle University, Newcastle upon Tyne NE1 7RU, UK
| | - Janette Young
- Allied Health and Human Performance, University of South Australia, Adelaide, SA 5000, Australia
| | - Pauleen Bennett
- School of Psychology and Public Health, La Trobe University, Bendigo, VIC 3552, Australia
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Glynn N, Martin S, Lewis H. 779 An Unusual Manifestation of Tophaceous Gout in The Flexor Digitorum Superficialis Tendon of An Immunocompromised Patient: A Case Report and Literature Review. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.319] [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
Aim
This case report showcases an unusual presentation of tophaceous gout, in an immunocompromised patient. Furthermore, through a literature review, we highlight challenges posed by immunocompromised patients, the clinical manifestations of gout in the hand and principles of management.
Method
We report the case of a 62-year-old lady with previous liver transplant on immunosuppressants. She was admitted with a left palmar abscess, pyogenic tenosynovitis of the index finger and was taken to theatre for debridement and washout. Superimposed infection was apparent. This originated from an exophytic mass extending from the palm to FDS tendon insertion. This was debulked and histologically confirmed as gout. A review of the literature was performed using key search terms on PubMed relating to manifestations of gout in the tendons of the hand, and in patients on immunosuppression.
Results
Reports in the literature describe cases of gouty tendinopathy in both flexor and extensor tendons. Reported symptoms include triggering, tendon rupture and tenosynovitis. Gout occurs in a higher frequency in transplant patients. This can be attributed to medications such as cyclosporine which predispose to hyperuricaemia. Management of this condition involves medical optimisation. Despite concurrent problems with wound healing in the immunocompromised with gout, surgical intervention may be required. Indications include superimposed infection, attenuated tendon glide, joint movement, and neuropathy. Perioperative antibiotics are recommended in all immunocompromised patients.
Conclusions
This case highlights an unusual presentation of gout and the challenges of managing patients on immunosuppressant therapy. A greater awareness of this condition will allow for appropriate management in this high-risk patient cohort.
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Affiliation(s)
- N Glynn
- Ulster Hospital, Belfast, United Kingdom
| | - S Martin
- Ulster Hospital, Belfast, United Kingdom
| | - H Lewis
- Ulster Hospital, Belfast, United Kingdom
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Hammond K, Cipcigan F, Al Nahas K, Losasso V, Lewis H, Cama J, Martelli F, Simcock PW, Fletcher M, Ravi J, Stansfeld PJ, Pagliara S, Hoogenboom BW, Keyser UF, Sansom MSP, Crain J, Ryadnov MG. Switching Cytolytic Nanopores into Antimicrobial Fractal Ruptures by a Single Side Chain Mutation. ACS Nano 2021; 15:9679-9689. [PMID: 33885289 PMCID: PMC8219408 DOI: 10.1021/acsnano.1c00218] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Disruption of cell membranes is a fundamental host defense response found in virtually all forms of life. The molecular mechanisms vary but generally lead to energetically favored circular nanopores. Here, we report an elaborate fractal rupture pattern induced by a single side-chain mutation in ultrashort (8-11-mers) helical peptides, which otherwise form transmembrane pores. In contrast to known mechanisms, this mode of membrane disruption is restricted to the upper leaflet of the bilayer where it exhibits propagating fronts of peptide-lipid interfaces that are strikingly similar to viscous instabilities in fluid flow. The two distinct disruption modes, pores and fractal patterns, are both strongly antimicrobial, but only the fractal rupture is nonhemolytic. The results offer wide implications for elucidating differential membrane targeting phenomena defined at the nanoscale.
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Affiliation(s)
- Katharine Hammond
- National Physical Laboratory, Hampton Road, Teddington, TW11 0LW, UK
- London Centre for Nanotechnology, University College London, London WC1H 0AH, UK
- Department of Physics & Astronomy, University College London, London WC1E 6BT, UK
| | | | - Kareem Al Nahas
- Cavendish Laboratory, University of Cambridge, Cambridge CB3 0HE, UK
| | | | - Helen Lewis
- National Physical Laboratory, Hampton Road, Teddington, TW11 0LW, UK
| | - Jehangir Cama
- Living Systems Institute, University of Exeter, Exeter EX4 4QD, UK
- College of Engineering, Mathematics and Phys Sciences, University of Exeter, Exeter EX4 4QF, UK
| | | | - Patrick W Simcock
- Department of Biochemistry, University of Oxford, Oxford OX1 3QU, UK
| | - Marcus Fletcher
- Cavendish Laboratory, University of Cambridge, Cambridge CB3 0HE, UK
| | - Jascindra Ravi
- National Physical Laboratory, Hampton Road, Teddington, TW11 0LW, UK
| | | | - Stefano Pagliara
- Living Systems Institute, University of Exeter, Exeter EX4 4QD, UK
- College of Life and Environmental Sciences, University of Exeter, Exeter EX4 4QD, UK
| | - Bart W Hoogenboom
- London Centre for Nanotechnology, University College London, London WC1H 0AH, UK
- Department of Physics & Astronomy, University College London, London WC1E 6BT, UK
| | - Ulrich F Keyser
- Cavendish Laboratory, University of Cambridge, Cambridge CB3 0HE, UK
| | - Mark S P Sansom
- Department of Biochemistry, University of Oxford, Oxford OX1 3QU, UK
| | - Jason Crain
- IBM Research Europe, Hartree Centre, Daresbury WA4 4AD, UK
- Department of Biochemistry, University of Oxford, Oxford OX1 3QU, UK
| | - Maxim G Ryadnov
- National Physical Laboratory, Hampton Road, Teddington, TW11 0LW, UK
- Department of Physics, King’s College London, London, WC2R 2LS, UK
- Corresponding author: Prof Maxim G Ryadnov; National Physical Laboratory, Hampton Road, Teddington, TW11 0LW, UK, Tel: (+44) 20 89436078;
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Johnston E, McGarry K, Martin S, Lewis H. 483 Complete Sciatic Nerve Transection from A Closed Femoral Fracture: A Case Report. Br J Surg 2021. [DOI: 10.1093/bjs/znab134.287] [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: 11/13/2022]
Abstract
Abstract
Introduction
Complete transection of the sciatic nerve following a closed femoral fracture is exceedingly uncommon. Delayed diagnosis may result due to this unrecognised injury pattern.
Case Description:
An 18-year-old male motorcyclist was referred following a significantly displaced closed, femoral fracture. The patient was sedated at the scene and transferred to theatre for definitive fixation, where an open reduction was performed via an anterior approach. Symptoms of paresthesia and weakness were reported immediately postoperatively, and formal neurological examination prompted an emergency MRI. On this basis, the patient was transferred to plastics and underwent surgical exploration, where complete transection of the sciatic nerve was identified just proximal to the bifurcation into the common peroneal and tibial nerve. A nerve gap of five centimetres was identified requiring reconstruction with grouped fascicular sural nerve grafts.
Discussion:
Complete transection of the sciatic nerve is a devastating injury that compromises the function of the posterior compartment of the thigh and all motor function below the knee. To our knowledge, reports of complete sciatic nerve transection secondary to a closed fracture of the femoral shaft are extremely rare in the pertinent literature, with only two other cases reported to date.
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Affiliation(s)
- E Johnston
- Queens University, Belfast, United Kingdom
| | - K McGarry
- Ulster Hospital, Dundonald, United Kingdom
| | - S Martin
- Ulster Hospital, Dundonald, United Kingdom
| | - H Lewis
- Ulster Hospital, Dundonald, United Kingdom
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Clements J, McBride M, Fogarty B, Lewis H. 613 Microsurgical Salvage of Neonatal Upper Limb Ischaemia Subsequent to Intrauterine Brachial Vessel Constriction. Br J Surg 2021. [DOI: 10.1093/bjs/znab134.305] [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
Introduction
We report a case of limb salvage due to intra uterine brachial artery thrombosis. Treatment modalities include medical, endovascular, and surgical. Early recognition, prompt institution of appropriate treatment and monitoring is vital to achieve successful revascularisation and prevention of lifelong morbidity.
Description
A male baby at (36 + 6week) gestation was born to a nulliparous mother with gestational diabetes via uncomplicated elective caesarean section. The child was noted to have a ‘flail’ ischeamic limb post-delivery. There were no palpable pulses in the limb and ultrasonography confirmed thrombosis of the proximal brachial artery. Aetiology was due to dense fibrotic circumferential constriction of the brachial vessels and plexus. Successful revascularisation was achieved with a contralateral interposition reversed great saphenous vein graft.
Discussion
Neonatal limb ischaemia is a rare disease entity with devastating morbidity- including compartment syndrome, tissue loss, limb loss, reduced limb growth, irreparable neuropathies and Volkmann’s syndrome. The initial diagnosis is based on the characteristic sequelae of ischaemia. Therapy should be individualised based on the clinical presentation. Early recognition, prompt institution of appropriate treatment and monitoring is vital to achieve successful revascularisation and prevention of lifelong morbidity.
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Affiliation(s)
- J Clements
- The Ulster Hospital, Belfast, United Kingdom
- The Royal Victoria Hospital, Belfast, United Kingdom
| | - M McBride
- The Ulster Hospital, Belfast, United Kingdom
- The Royal Victoria Hospital, Belfast, United Kingdom
| | - B Fogarty
- The Royal Victoria Hospital, Belfast, United Kingdom
| | - H Lewis
- The Ulster Hospital, Belfast, United Kingdom
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11
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McGarry K, Martin S, McBride M, Beswick W, Lewis H. The Operative Incidence of Syndactyly in Northern Ireland. A 10-Year Review. Ulster Med J 2021; 90:3-6. [PMID: 33642625 PMCID: PMC7907904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/19/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Syndactyly is a common congenital condition that can present sporadically or in relation to an underlying genetic condition. Little contemporary published data exists detailing specific rates of presentation and surgical intervention, especially in Western European population. This is the first published review of operative intervention rates for the condition over time in Northern Ireland. METHODS A ten-year retrospective review of electronic operative records from January 2007 - October 2017 was carried out within Northern Ireland's regional tertiary centre Royal Belfast Hospital for Sick Children (RBHSC). All congenital hand surgery in the country was performed here during the period reviewed, by a single surgeon. Patient age at surgical intervention, their sex, digits involved and clinical grade of syndactyly was recorded. RESULTS One hundred and twenty four cases were returned following the review. On individual analysis 22 cases were excluded as they were not primary congenital syndactyly. The remaining 102 cases were all Caucasian. Six cases were toe syndactyly while 96 cases involved the upper limb digits. The group consisted of 70 males and 32 female infants. Age range at time of surgical intervention was 8 months to 14 years with a median age of 26 months. For clinical grade of upper limb syndactyly; 35 cases in the data set were classed as simple incomplete, 34 cases as simple complete, 17 as complex and 5 cases as complicated syndactyly. The remaining 5 cases lacked clear documentation. The most common site of syndactyly was between the ring and middle finger (40/102). Annual frequency of operative intervention has trended upwards in the period studied. CONCLUSION This case review adds epidemiological data on the operative incidence of syndactyly cases in Northern Ireland - a relatively isolated genetic population. Overall rates of incidence have increased over the past 10 years. It remains unclear if this is due to new environmental influences on the developing population or increased referral for surgical intervention over time.Levels of evidence - IV (Case Series).
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Affiliation(s)
- H Lewis
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - I James
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Institute of Child Health, University College London, London, UK
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13
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Piarali S, Marlinghaus L, Viebahn R, Lewis H, Ryadnov MG, Groll J, Salber J, Roy I. Activated Polyhydroxyalkanoate Meshes Prevent Bacterial Adhesion and Biofilm Development in Regenerative Medicine Applications. Front Bioeng Biotechnol 2020; 8:442. [PMID: 32671021 PMCID: PMC7326089 DOI: 10.3389/fbioe.2020.00442] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 04/17/2020] [Indexed: 12/13/2022] Open
Abstract
Regenerative medicine has become an extremely valuable tool offering an alternative to conventional therapies for the repair and regeneration of tissues. The re-establishment of tissue and organ functions can be carried out by tissue engineering strategies or by using medical devices such as implants. However, with any material being implanted inside the human body, one of the conundrums that remains is the ease with which these materials can get contaminated by bacteria. Bacterial adhesion leads to the formation of mature, alive and complex three-dimensional biofilm structures, further infection of surrounding tissues and consequent development of complicated chronic infections. Hence, novel tissue engineering strategies delivering biofilm-targeted therapies, while at the same time allowing tissue formation are highly relevant. In this study our aim was to develop surface modified polyhydroxyalkanoate-based fiber meshes with enhanced bacterial anti-adhesive and juvenile biofilm disrupting properties for tissue regeneration purposes. Using reactive and amphiphilic star-shaped macromolecules as an additive to a polyhydroxyalkanoate spinning solution, a synthetic antimicrobial peptide, Amhelin, with strong bactericidal and anti-biofilm properties, and Dispersin B, an enzyme promoting the disruption of exopolysaccharides found in the biofilm matrix, were covalently conjugated to the fibers by addition to the solution before the spinning process. Staphylococcus epidermidis is one of the most problematic pathogens responsible for tissue-related infections. The initial antibacterial screening showed that Amhelin proved to be strongly bactericidal at 12 μg/ml and caused >50% reductions of biofilm formation at 6 μg/ml, while Dispersin B was found to disperse >70% of pre-formed biofilms at 3 μg/ml. Regarding the cytotoxicity of the agents toward L929 murine fibroblasts, a CC50 of 140 and 115 μg/ml was measured for Amhelin and Dispersin B, respectively. Optimization of the electrospinning process resulted in aligned fibers. Surface activated fibers with Amhelin and Dispersin B resulted in 83% reduction of adhered bacteria on the surface of the fibers. Additionally, the materials developed were found to be cytocompatible toward L929 murine fibroblasts. The strategy reported in this preliminary study suggests an alternative approach to prevent bacterial adhesion and, in turn biofilm formation, in materials used in regenerative medicine applications such as tissue engineering.
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Affiliation(s)
- Sheila Piarali
- Department of Surgery, Universitätsklinikum Knappschaftskrankenhaus Bochum, Ruhr-University, Bochum, Germany
- Applied Biotechnology Research Group, School of Life Sciences, College of Liberal Arts and Sciences, University of Westminster, London, United Kingdom
| | | | - Richard Viebahn
- Department of Surgery, Universitätsklinikum Knappschaftskrankenhaus Bochum, Ruhr-University, Bochum, Germany
| | - Helen Lewis
- National Physical Laboratory, Teddington, United Kingdom
| | | | - Jürgen Groll
- Department for Functional Materials in Medicine and Dentistry and Bavarian Polymer Institute, University of Würzburg, Würzburg, Germany
| | - Jochen Salber
- Department of Surgery, Universitätsklinikum Knappschaftskrankenhaus Bochum, Ruhr-University, Bochum, Germany
| | - Ipsita Roy
- Department of Material Science and Engineering, Faculty of Engineering, University of Sheffield, Sheffield, United Kingdom
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14
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Kepiro IE, Marzuoli I, Hammond K, Ba X, Lewis H, Shaw M, Gunnoo SB, De Santis E, Łapińska U, Pagliara S, Holmes MA, Lorenz CD, Hoogenboom BW, Fraternali F, Ryadnov MG. Engineering Chirally Blind Protein Pseudocapsids into Antibacterial Persisters. ACS Nano 2020; 14:1609-1622. [PMID: 31794180 DOI: 10.1021/acsnano.9b06814] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Antimicrobial resistance stimulates the search for antimicrobial forms that may be less subject to acquired resistance. Here we report a conceptual design of protein pseudocapsids exhibiting a broad spectrum of antimicrobial activities. Unlike conventional antibiotics, these agents are effective against phenotypic bacterial variants, while clearing "superbugs" in vivo without toxicity. The design adopts an icosahedral architecture that is polymorphic in size, but not in shape, and that is available in both l and d epimeric forms. Using a combination of nanoscale and single-cell imaging we demonstrate that such pseudocapsids inflict rapid and irreparable damage to bacterial cells. In phospholipid membranes they rapidly convert into nanopores, which remain confined to the binding positions of individual pseudocapsids. This mechanism ensures precisely delivered influxes of high antimicrobial doses, rendering the design a versatile platform for engineering structurally diverse and functionally persistent antimicrobial agents.
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Affiliation(s)
- Ibolya E Kepiro
- National Physical Laboratory , Hampton Road , Teddington , TW11 0LW , U.K
| | - Irene Marzuoli
- National Physical Laboratory , Hampton Road , Teddington , TW11 0LW , U.K
- Randall Centre for Cell and Molecular Biophysics , King's College London , London , SE1 1UL , U.K
| | - Katharine Hammond
- National Physical Laboratory , Hampton Road , Teddington , TW11 0LW , U.K
- Department of Physics and Astronomy , University College London , London , WC1E 6BT , U.K
- London Centre for Nanotechnology , University College London , London , WC1H 0AH , U.K
| | - Xiaoliang Ba
- Department of Veterinary Medicine , University of Cambridge , Cambridge , CB3 0ES , U.K
| | - Helen Lewis
- National Physical Laboratory , Hampton Road , Teddington , TW11 0LW , U.K
| | - Michael Shaw
- National Physical Laboratory , Hampton Road , Teddington , TW11 0LW , U.K
- Department of Computer Science , University College London , London , WC1 6BT , U.K
| | - Smita B Gunnoo
- National Physical Laboratory , Hampton Road , Teddington , TW11 0LW , U.K
| | - Emiliana De Santis
- National Physical Laboratory , Hampton Road , Teddington , TW11 0LW , U.K
| | - Urszula Łapińska
- Living Systems Institute , University of Exeter , Exeter , EX4 4QD , U.K
| | - Stefano Pagliara
- Living Systems Institute , University of Exeter , Exeter , EX4 4QD , U.K
| | - Mark A Holmes
- Department of Veterinary Medicine , University of Cambridge , Cambridge , CB3 0ES , U.K
| | - Christian D Lorenz
- Department of Physics , King's College London , Strand Lane , London , WC2R 2LS , U.K
| | - Bart W Hoogenboom
- Department of Physics and Astronomy , University College London , London , WC1E 6BT , U.K
- London Centre for Nanotechnology , University College London , London , WC1H 0AH , U.K
| | - Franca Fraternali
- Randall Centre for Cell and Molecular Biophysics , King's College London , London , SE1 1UL , U.K
| | - Maxim G Ryadnov
- National Physical Laboratory , Hampton Road , Teddington , TW11 0LW , U.K
- Department of Physics , King's College London , Strand Lane , London , WC2R 2LS , U.K
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Jukes A, Hewett R, Speakman A, Harwood S, Lewis H, Arnold S, Jones R, Marini S. Palliative Home Parenteral Nutrition – a review in adult patients in Wales over a 5-year period. Clin Nutr ESPEN 2020. [DOI: 10.1016/j.clnesp.2019.12.067] [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: 10/25/2022]
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16
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Hammond K, Lewis H, Faruqui N, Russell C, Hoogenboom BW, Ryadnov MG. Helminth Defense Molecules as Design Templates for Membrane Active Antibiotics. ACS Infect Dis 2019; 5:1471-1479. [PMID: 31117348 DOI: 10.1021/acsinfecdis.9b00157] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 12/18/2022]
Abstract
A design template for membrane active antibiotics against microbial and tumor cells is described. The template is an amino acid sequence that combines the properties of helminth defense molecules, which are not cytolytic, with the properties of host-defense peptides, which disrupt microbial membranes. Like helminth defense molecules, the template folds into an amphipathic helix in both mammalian host and microbial phospholipid membranes. Unlike these molecules, the template exhibits antimicrobial and anticancer properties that are comparable to those of antimicrobial and anticancer antibiotics. The selective antibiotic activity of the template builds upon a functional synergy between three distinctive faces of the helix, which is in contrast to two faces of membrane-disrupting amphipathic structures. This synergy enables the template to adapt pore formation mechanisms according to the nature of the target membrane, inducing the lysis of microbial and tumor cells.
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Affiliation(s)
- Katharine Hammond
- National Physical Laboratory, Hampton Road, Teddington TW11 0LW, United Kingdom
- Department of Physics & Astronomy, University College London, Gower Street, London WC1E 6BT, United Kingdom
- London Centre for Nanotechnology, University College London, Gordon Street, London WC1H 0AH, United Kingdom
| | - Helen Lewis
- National Physical Laboratory, Hampton Road, Teddington TW11 0LW, United Kingdom
| | - Nilofar Faruqui
- National Physical Laboratory, Hampton Road, Teddington TW11 0LW, United Kingdom
| | - Craig Russell
- National Physical Laboratory, Hampton Road, Teddington TW11 0LW, United Kingdom
| | - Bart W. Hoogenboom
- Department of Physics & Astronomy, University College London, Gower Street, London WC1E 6BT, United Kingdom
- London Centre for Nanotechnology, University College London, Gordon Street, London WC1H 0AH, United Kingdom
| | - Maxim G. Ryadnov
- National Physical Laboratory, Hampton Road, Teddington TW11 0LW, United Kingdom
- Department of Physics, King’s College London, Strand Lane, London WC2R, United Kingdom
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17
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Martin G, Pace M, Meyerowitz J, Thornhill J, Lwanga J, Lewis H, Solano T, Bull R, Fox J, Nwokolo N, Fidler S, Willberg C, Frater J. Persistent elevation of Tim-3 and PD-1 on memory T cells despite early ART initiation during primary HIV infection. J Virus Erad 2019. [DOI: 10.1016/s2055-6640(20)31031-1] [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: 10/23/2022] Open
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18
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Cushen R, Brunt H, Jones S, Lewis H, Callow P, Kibble A. An unusual incident: carbon monoxide poisoning risk in 540 homes due to faulty wood burner installations. Public Health 2019; 173:17-20. [PMID: 31207424 DOI: 10.1016/j.puhe.2019.05.003] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 04/29/2019] [Accepted: 05/02/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND This report describes the public health management of an unusual incident involving an increased risk of carbon monoxide (CO) exposure due to the installation of at least 541 wood burners in a local authority area in Wales. PUBLIC HEALTH ACTIONS An incident management team (IMT) was convened. The IMT assessed and managed the public health risk associated with the wood burners and promoted CO awareness in the local population. OUTCOMES At least 541 homes were found to have had a wood burner potentially incorrectly installed by a Heating Equipment Testing and Approval Scheme-registered engineer. Local residents were made aware of the dangers and provided with free CO alarms. CONCLUSIONS This incident highlights that even registered engineers may fail to follow guidelines. It is important to inform the public of the need to have a working CO alarm at home, as well as educating the public and professionals about the symptoms and signs of CO poisoning.
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Affiliation(s)
- R Cushen
- Specialty Registrar in Public Health, Public Health Wales, United Kingdom
| | - H Brunt
- Consultant in Environmental Health Protection, Public Health Wales, United Kingdom
| | - S Jones
- Consultant in Environmental Health Protection, Public Health Wales, United Kingdom.
| | - H Lewis
- Consultant in Health Protection, Public Health Wales, United Kingdom
| | - P Callow
- Public Health England Centre for Radiation, Chemicals and the Environment - Wales, United Kingdom
| | - A Kibble
- Public Health England Centre for Radiation, Chemicals and the Environment - Wales, United Kingdom
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19
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Blackwell C, Lewis H, Knight A, Ofotokun I, Haddad L. Bacterial vaginosis creates a proinflammatory environment within the female genital tract. Am J Obstet Gynecol 2018. [DOI: 10.1016/j.ajog.2018.10.091] [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: 12/01/2022]
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20
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Sheffield KJ, Hunnam JC, Cuzner TN, Morse-McNabb EM, Sloan SM, Nunan J, Smith J, Harvey W, Lewis H. Automated identification of intensive animal production locations from aerial photography. Aust Vet J 2018; 96:323-331. [DOI: 10.1111/avj.12732] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 03/28/2018] [Accepted: 04/30/2018] [Indexed: 11/29/2022]
Affiliation(s)
- KJ Sheffield
- Agriculture Victoria Research, Department of Economic Development; Jobs, Transport and Resources, AgriBio, 5 Ring Road; Bundoora Victoria 3083 Australia
| | - JC Hunnam
- Agriculture Victoria, Energy and Resources, Department of Economic Development; Jobs, Transport and Resources; Attwood VIC Australia
| | - TN Cuzner
- Agriculture Victoria, Energy and Resources, Department of Economic Development; Jobs, Transport and Resources; Attwood VIC Australia
| | - EM Morse-McNabb
- Agriculture Victoria Research, Department of Economic Development, Jobs; Transport and Resources; Epsom VIC Australia
| | - SM Sloan
- Agriculture Victoria, Energy and Resources, Department of Economic Development; Jobs, Transport and Resources; Attwood VIC Australia
| | - J Nunan
- Agriculture Victoria, Energy and Resources, Department of Economic Development; Jobs, Transport and Resources; Attwood VIC Australia
| | - J Smith
- Agriculture Victoria, Energy and Resources, Department of Economic Development; Jobs, Transport and Resources; Attwood VIC Australia
| | - W Harvey
- Agriculture Victoria Research, Department of Economic Development, Jobs; Transport and Resources; Epsom VIC Australia
| | - H Lewis
- Agriculture Victoria Research, Department of Economic Development, Jobs; Transport and Resources; Tatura VIC Australia
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21
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Bosanquet K, Adamson J, Atherton K, Bailey D, Baxter C, Beresford-Dent J, Birtwistle J, Chew-Graham C, Clare E, Delgadillo J, Ekers D, Foster D, Gabe R, Gascoyne S, Haley L, Hamilton J, Hargate R, Hewitt C, Holmes J, Keding A, Lewis H, McMillan D, Meer S, Mitchell N, Nutbrown S, Overend K, Parrott S, Pervin J, Richards DA, Spilsbury K, Torgerson D, Traviss-Turner G, Trépel D, Woodhouse R, Gilbody S. CollAborative care for Screen-Positive EldeRs with major depression (CASPER plus): a multicentred randomised controlled trial of clinical effectiveness and cost-effectiveness. Health Technol Assess 2018; 21:1-252. [PMID: 29171379 DOI: 10.3310/hta21670] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Depression in older adults is common and is associated with poor quality of life, increased morbidity and early mortality, and increased health and social care use. Collaborative care, a low-intensity intervention for depression that is shown to be effective in working-age adults, has not yet been evaluated in older people with depression who are managed in UK primary care. The CollAborative care for Screen-Positive EldeRs (CASPER) plus trial fills the evidence gap identified by the most recent guidelines on depression management. OBJECTIVES To establish the clinical effectiveness and cost-effectiveness of collaborative care for older adults with major depressive disorder in primary care. DESIGN A pragmatic, multicentred, two-arm, parallel, individually randomised controlled trial with embedded qualitative study. Participants were automatically randomised by computer, by the York Trials Unit Randomisation Service, on a 1 : 1 basis using simple unstratified randomisation after informed consent and baseline measures were collected. Blinding was not possible. SETTING Sixty-nine general practices in the north of England. PARTICIPANTS A total of 485 participants aged ≥ 65 years with major depressive disorder. INTERVENTIONS A low-intensity intervention of collaborative care, including behavioural activation, delivered by a case manager for an average of six sessions over 7-8 weeks, alongside usual general practitioner (GP) care. The control arm received only usual GP care. MAIN OUTCOME MEASURES The primary outcome measure was Patient Health Questionnaire-9 items score at 4 months post randomisation. Secondary outcome measures included depression severity and caseness at 12 and 18 months, the EuroQol-5 Dimensions, Short Form questionnaire-12 items, Patient Health Questionnaire-15 items, Generalised Anxiety Disorder-7 items, Connor-Davidson Resilience Scale-2 items, a medication questionnaire, objective data and adverse events. Participants were followed up at 12 and 18 months. RESULTS In total, 485 participants were randomised (collaborative care, n = 249; usual care, n = 236), with 390 participants (80%: collaborative care, 75%; usual care, 86%) followed up at 4 months, 358 participants (74%: collaborative care, 70%; usual care, 78%) followed up at 12 months and 344 participants (71%: collaborative care, 67%; usual care, 75%) followed up at 18 months. A total of 415 participants were included in primary analysis (collaborative care, n = 198; usual care, n = 217), which revealed a statistically significant effect in favour of collaborative care at the primary end point at 4 months [8.98 vs. 10.90 score points, mean difference 1.92 score points, 95% confidence interval (CI) 0.85 to 2.99 score points; p < 0.001], equivalent to a standard effect size of 0.34. However, treatment differences were not maintained in the longer term (at 12 months: 0.19 score points, 95% CI -0.92 to 1.29 score points; p = 0.741; at 18 months: < 0.01 score points, 95% CI -1.12 to 1.12 score points; p = 0.997). The study recorded details of all serious adverse events (SAEs), which consisted of 'unscheduled hospitalisation', 'other medically important condition' and 'death'. No SAEs were related to the intervention. Collaborative care showed a small but non-significant increase in quality-adjusted life-years (QALYs) over the 18-month period, with a higher cost. Overall, the mean cost per incremental QALY for collaborative care compared with usual care was £26,016; however, for participants attending six or more sessions, collaborative care appears to represent better value for money (£9876/QALY). LIMITATIONS Study limitations are identified at different stages: design (blinding unfeasible, potential contamination), process (relatively low overall consent rate, differential attrition/retention rates) and analysis (no baseline health-care resource cost or secondary/social care data). CONCLUSION Collaborative care was effective for older people with case-level depression across a range of outcomes in the short term though the reduction in depression severity was not maintained over the longer term of 12 or 18 months. Participants who received six or more sessions of collaborative care did benefit substantially more than those who received fewer treatment sessions but this difference was not statistically significant. FUTURE WORK RECOMMENDATIONS Recommendations for future research include investigating the longer-term effect of the intervention. Depression is a recurrent disorder and it would be useful to assess its impact on relapse and the prevention of future case-level depression. TRIAL REGISTRATION Current Controlled Trials ISRCTN45842879. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 67. See the NIHR Journals Library website for further project information.
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Affiliation(s)
| | - Joy Adamson
- Department of Health Sciences, University of York, York, UK
| | - Katie Atherton
- Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - Della Bailey
- Department of Health Sciences, University of York, York, UK
| | | | | | | | - Carolyn Chew-Graham
- Research Institute, Primary Care and Health Sciences, Keele University, Stoke-on-Trent, UK
| | - Emily Clare
- Northumberland, Tyne and Wear NHS Foundation Trust, National Institute for Health Research Clinical Research Network (Mental Health) North East and North Cumbria, Newcastle upon Tyne, UK
| | - Jaime Delgadillo
- Department of Health Sciences, University of York, York, UK.,Primary Care Mental Health Service, Leeds Community Healthcare NHS Trust, Leeds, UK
| | - David Ekers
- Mental Health Research Group, Durham University, Durham, UK.,Research and Development Department, Tees, Esk & Wear Valleys NHS Foundation Trust, Middlesbrough, UK
| | - Deborah Foster
- Department of Health Sciences, University of York, York, UK
| | - Rhian Gabe
- Department of Health Sciences, University of York, York, UK.,Hull York Medical School, University of York, York, UK
| | | | - Lesley Haley
- Research and Development Department, Tees, Esk & Wear Valleys NHS Foundation Trust, Middlesbrough, UK
| | - Jahnese Hamilton
- Northumberland, Tyne and Wear NHS Foundation Trust, National Institute for Health Research Clinical Research Network (Mental Health) North East and North Cumbria, Newcastle upon Tyne, UK
| | | | | | - John Holmes
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Ada Keding
- Department of Health Sciences, University of York, York, UK
| | - Helen Lewis
- Department of Health Sciences, University of York, York, UK
| | - Dean McMillan
- Department of Health Sciences, University of York, York, UK.,Hull York Medical School, University of York, York, UK
| | - Shaista Meer
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Sarah Nutbrown
- Department of Health Sciences, University of York, York, UK
| | - Karen Overend
- Department of Health Sciences, University of York, York, UK
| | - Steve Parrott
- Department of Health Sciences, University of York, York, UK
| | - Jodi Pervin
- Department of Health Sciences, University of York, York, UK
| | - David A Richards
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | | | | | | | - Dominic Trépel
- Department of Health Sciences, University of York, York, UK
| | | | - Simon Gilbody
- Department of Health Sciences, University of York, York, UK.,Hull York Medical School, University of York, York, UK
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Taylor AK, Gilbody S, Bosanquet K, Overend K, Bailey D, Foster D, Lewis H, Chew-Graham CA. How should we implement collaborative care for older people with depression? A qualitative study using normalisation process theory within the CASPER plus trial. BMC Fam Pract 2018; 19:116. [PMID: 30021506 PMCID: PMC6052715 DOI: 10.1186/s12875-018-0813-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 06/29/2018] [Indexed: 04/27/2023]
Abstract
Background Depression in older people may have a prevalence as high as 20%, and is associated with physical co-morbidities, loss, and loneliness. It is associated with poorer health outcomes and reduced quality of life, and is under-diagnosed and under-treated. Older people may find it difficult to speak to their GPs about low mood, and GPs may avoid identifying depression due to limited consultation time and referral options for older patients. Methods A qualitative study nested within a randomised controlled trial for older people with moderate to severe depression: the CASPER plus Trial (Care for Screen Positive Elders). We interviewed patient participants, GPs, and case managers (CM) to explore patients’ and professionals’ views on collaborative care developed for older people, and how this model could be implemented at scale. Transcripts were analysed thematically using normalization process theory. Results Thirty-three interviews were conducted. Across the three data-sets, four main themes were identified based on the main principles of the Normalization Process Theory: understanding of collaborative care, interaction between patients and professionals, liaison between GPs and case managers, and the potential for implementation. Conclusions A telephone-delivered intervention, incorporating behavioural activation, is acceptable to older people with depression, and is deliverable by case managers. The collaborative care framework makes sense to case managers and has the potential to optimize patient outcomes, but implementation requires integration in day to day general practice. Increasing GPs’ understanding of collaborative care might improve liaison and collaboration with case managers, and facilitate the intervention through better support of patients. The CASPER plus model, delivering therapy to older adults with depression by telephone, offers the potential for implementation in a resource-poor health service.
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Affiliation(s)
- Anna Kathryn Taylor
- Faculty of Health Sciences, University of Bristol, Senate House, Tyndall Avenue, Bristol, BS8 1TH, UK.
| | - Simon Gilbody
- Mental Health and Addictions Research Group (MHARG), Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Katharine Bosanquet
- Mental Health and Addictions Research Group (MHARG), Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Karen Overend
- Mental Health and Addictions Research Group (MHARG), Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Della Bailey
- Mental Health and Addictions Research Group (MHARG), Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Deborah Foster
- Mental Health and Addictions Research Group (MHARG), Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Helen Lewis
- Mental Health and Addictions Research Group (MHARG), Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Carolyn Anne Chew-Graham
- Research Institute, Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK.,West Midlands CLAHRC (Collaboration for Leadership in Applied Health Research and Care), Warwick, UK
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Vaz J, Floyd C, Mason B, Shankar AG, Lewis H. Control of a community outbreak of hepatitis A in an area of low endemicity, Wales, 2016. Hum Vaccin Immunother 2018; 13:2352-2356. [PMID: 28708951 DOI: 10.1080/21645515.2017.1347242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 10/19/2022] Open
Abstract
Incidence of hepatitis A in Wales is low (average of 0.48/100,000 inhabitants from 2004-2015). We describe a community outbreak of hepatitis A involving 3 schools (primary and secondary) in South Wales between March and June 2016 and reflect on the adequacy of the control measures used. Anyone in South Wales epidemiologically linked to a serological and/or RNA positive confirmed case of hepatitis A during the 15-50 d before onset of symptoms (diarrhea, vomiting, fever, nausea, AND jaundice, or jaundice-associated symptom) was defined as a case. Case identification was based on laboratory or GP suspicion notification, changing to active surveillance toward the end. As per national guidance, household contacts were identified and offered immunisation while in schools vaccination followed evidence of transmission. We went beyond guidance by vaccinating street play mates and in secondary schools. Mass vaccination uptake was calculated. There were 17 cases, mostly in children under 16 y of age. All cases had an epidemiological link to either a school or a household case (except primary) and no travel history. Street playing was the only epidemiological link between 2 cases in different schools. A total of 139 household contacts were identified. All schools, including secondary one, had a transmission event preceding mass vaccination (overall uptake 85%, reaching 1,574 individuals) and no tertiary cases emerged after the campaigns. We recommend extending guidance to include actions taken that helped curb this outbreak: 1) vaccinating in secondary school and 2) broadening the household contact definition. Based on our learning we further suggest 3) vaccinating upon identification of a single case who attended school while infectious regardless of source and 4) active case finding by serologically testing contacts.
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Affiliation(s)
- J Vaz
- a European Programme for Intervention Epidemiology Training , European Centre for Disease Prevention, Stockholm, Sweden and Control and Public Health Wales , Cardiff , UK
| | - C Floyd
- b Public Health Specialty Registrar , Public Health Wales , Cardiff , UK
| | - B Mason
- c Consultant in Communicable Disease Control , Public Health Wales , Cardiff , UK
| | - A G Shankar
- d Professional Lead Consultant for Health Protection , Public Health Wales , Cardiff , UK
| | - H Lewis
- e Consultant in Health Protection , Public Health Wales , Cardiff , UK
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Grigg R, Lewis H. Moving the andragogy of teacher educators forward: the potential and challenges of Problem-Based Learning in teacher education. J Probl Based Learn 2018. [DOI: 10.24313/jpbl.2018.5.1.4] [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: 11/12/2022] Open
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Grigg R, Lewis H. Moving the andragogy of teacher educators forward: the potential and challenges of Problem-Based Learning in teacher education. J Probl Based Learn 2018. [DOI: 10.24313/jpbl.2018.5.1.5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Lewis H, Adamson J, Atherton K, Bailey D, Birtwistle J, Bosanquet K, Clare E, Delgadillo J, Ekers D, Foster D, Gabe R, Gascoyne S, Haley L, Hargate R, Hewitt C, Holmes J, Keding A, Lilley-Kelly A, Maya J, McMillan D, Meer S, Meredith J, Mitchell N, Nutbrown S, Overend K, Pasterfield M, Richards D, Spilsbury K, Torgerson D, Traviss-Turner G, Trépel D, Woodhouse R, Ziegler F, Gilbody S. CollAborative care and active surveillance for Screen-Positive EldeRs with subthreshold depression (CASPER): a multicentred randomised controlled trial of clinical effectiveness and cost-effectiveness. Health Technol Assess 2018; 21:1-196. [PMID: 28248154 DOI: 10.3310/hta21080] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Efforts to reduce the burden of illness and personal suffering associated with depression in older adults have focused on those with more severe depressive syndromes. Less attention has been paid to those with mild disorders/subthreshold depression, but these patients also suffer significant impairments in their quality of life and level of functioning. There is currently no clear evidence-based guidance regarding treatment for this patient group. OBJECTIVES To establish the clinical effectiveness and cost-effectiveness of a low-intensity intervention of collaborative care for primary care older adults who screened positive for subthreshold depression. DESIGN A pragmatic, multicentred, two-arm, parallel, individually randomised controlled trial with a qualitative study embedded within the pilot. Randomisation occurred after informed consent and baseline measures were collected. SETTING Thirty-two general practitioner (GP) practices in the north of England. PARTICIPANTS A total of 705 participants aged ≥ 75 years during the pilot phase and ≥ 65 years during the main trial with subthreshold depression. INTERVENTIONS Participants in the intervention group received a low-intensity intervention of collaborative care, which included behavioural activation delivered by a case manager for an average of six sessions over 7-8 weeks, alongside usual GP care. Control-arm participants received only usual GP care. MAIN OUTCOME MEASURES The primary outcome measure was a self-reported measure of depression severity, the Patient Health Questionnaire-9 items PHQ-9 score at 4 months post randomisation. Secondary outcome measures included the European Quality of Life-5 Dimensions, Short Form questionnaire-12 items, Patient Health Questionnaire-15 items, Generalised Anxiety Disorder seven-item scale, Connor-Davidson Resilience Scale two-item version, a medication questionnaire and objective data. Participants were followed up for 12 months. RESULTS In total, 705 participants were randomised (collaborative care n = 344, usual care n = 361), with 586 participants (83%; collaborative care 76%, usual care 90%) followed up at 4 months and 519 participants (74%; collaborative care 68%, usual care 79%) followed up at 12 months. Attrition was markedly greater in the collaborative care arm. Model estimates at the primary end point of 4 months revealed a statistically significant effect in favour of collaborative care compared with usual care [mean difference 1.31 score points, 95% confidence interval (CI) 0.67 to 1.95 score points; p < 0.001]. The difference equates to a standard effect size of 0.30, for which the trial was powered. Treatment differences measured by the PHQ-9 were maintained at 12 months' follow-up (mean difference 1.33 score points, 95% CI 0.55 to 2.10 score points; p = 0.001). Base-case cost-effectiveness analysis found that the incremental cost-effectiveness ratio was £9633 per quality-adjusted life-year (QALY). On average, participants allocated to collaborative care displayed significantly higher QALYs than those allocated to the control group (annual difference in adjusted QALYs of 0.044, 95% bias-corrected CI 0.015 to 0.072; p = 0.003). CONCLUSIONS Collaborative care has been shown to be clinically effective and cost-effective for older adults with subthreshold depression and to reduce the proportion of people who go on to develop case-level depression at 12 months. This intervention could feasibly be delivered in the NHS at an acceptable cost-benefit ratio. Important future work would include investigating the longer-term effect of collaborative care on the CASPER population, which could be conducted by introducing an extension to follow-up, and investigating the impact of collaborative care on managing multimorbidities in people with subthreshold depression. TRIAL REGISTRATION Current Controlled Trials ISRCTN02202951. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 8. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Helen Lewis
- Department of Health Sciences, University of York, York, UK
| | - Joy Adamson
- Department of Health Sciences, University of York, York, UK
| | - Katie Atherton
- Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - Della Bailey
- Department of Health Sciences, University of York, York, UK
| | | | | | - Emily Clare
- Northumberland, Tyne and Wear NHS Foundation Trust, NIHR Clinical Research Network (Mental Health) North East and North Cumbria, Newcastle upon Tyne, UK
| | - Jaime Delgadillo
- Primary Care Mental Health Service, Leeds Community Healthcare NHS Trust, Leeds, UK
| | - David Ekers
- Mental Health Research Group, University of Durham, Durham, UK
| | - Deborah Foster
- Department of Health Sciences, University of York, York, UK
| | - Rhian Gabe
- Department of Health Sciences, University of York, York, UK.,Hull York Medical School, University of York, York, UK
| | | | - Lesley Haley
- Tees, Esk and Wear Valleys NHS Foundation Trust, NIHR Clinical Research Network North East and North Cumbria, Research and Development Department, Middlesbrough, UK
| | | | | | - John Holmes
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Ada Keding
- Department of Health Sciences, University of York, York, UK
| | | | - Jahnese Maya
- Northumberland, Tyne and Wear NHS Foundation Trust, NIHR Clinical Research Network (Mental Health) North East and North Cumbria, Newcastle upon Tyne, UK
| | - Dean McMillan
- Department of Health Sciences, University of York, York, UK.,Hull York Medical School, University of York, York, UK
| | - Shaista Meer
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Jodi Meredith
- Department of Health Sciences, University of York, York, UK
| | | | - Sarah Nutbrown
- Department of Health Sciences, University of York, York, UK
| | - Karen Overend
- Department of Health Sciences, University of York, York, UK
| | | | - David Richards
- Department of Psychology, College of Life and Environmental Sciences, University of Exeter, Exeter, UK
| | | | | | | | - Dominic Trépel
- Department of Health Sciences, University of York, York, UK
| | | | | | - Simon Gilbody
- Department of Health Sciences, University of York, York, UK.,Hull York Medical School, University of York, York, UK
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Gilbody S, Lewis H, Adamson J, Atherton K, Bailey D, Birtwistle J, Bosanquet K, Clare E, Delgadillo J, Ekers D, Foster D, Gabe R, Gascoyne S, Haley L, Hamilton J, Hargate R, Hewitt C, Holmes J, Keding A, Lilley-Kelly A, Meer S, Mitchell N, Overend K, Pasterfield M, Pervin J, Richards DA, Spilsbury K, Traviss-Turner G, Trépel D, Woodhouse R, Ziegler F, McMillan D. Effect of Collaborative Care vs Usual Care on Depressive Symptoms in Older Adults With Subthreshold Depression: The CASPER Randomized Clinical Trial. JAMA 2017; 317:728-737. [PMID: 28241357 DOI: 10.1001/jama.2017.0130] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE There is little evidence to guide management of depressive symptoms in older people. OBJECTIVE To evaluate whether a collaborative care intervention can reduce depressive symptoms and prevent more severe depression in older people. DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial conducted from May 24, 2011, to November 14, 2014, in 32 primary care centers in the United Kingdom among 705 participants aged 65 years or older with Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) subthreshold depression; participants were followed up for 12 months. INTERVENTIONS Collaborative care (n=344) was coordinated by a case manager who assessed functional impairments relating to mood symptoms. Participants were offered behavioral activation and completed an average of 6 weekly sessions. The control group received usual primary care (n=361). MAIN OUTCOMES AND MEASURES The primary outcome was self-reported depression severity at 4-month follow-up on the 9-item Patient Health Questionnaire (PHQ-9; score range, 0-27). Included among 10 prespecified secondary outcomes were the PHQ-9 score at 12-month follow-up and the proportion meeting criteria for depressive disorder (PHQ-9 score ≥10) at 4- and 12-month follow-up. RESULTS The 705 participants were 58% female with a mean age of 77 (SD, 7.1) years. Four-month retention was 83%, with higher loss to follow-up in collaborative care (82/344 [24%]) vs usual care (37/361 [10%]). Collaborative care resulted in lower PHQ-9 scores vs usual care at 4-month follow-up (mean score with collaborative care, 5.36 vs with usual care, 6.67; mean difference, -1.31; 95% CI, -1.95 to -0.67; P < .001). Treatment differences remained at 12 months (mean PHQ-9 score with collaborative care, 5.93 vs with usual care, 7.25; mean difference, -1.33; 95% CI, -2.10 to -0.55). The proportions of participants meeting criteria for depression at 4-month follow-up were 17.2% (45/262) vs 23.5% (76/324), respectively (difference, -6.3% [95% CI, -12.8% to 0.2%]; relative risk, 0.83 [95% CI, 0.61-1.27]; P = .25) and at 12-month follow-up were 15.7% (37/235) vs 27.8% (79/284) (difference, -12.1% [95% CI, -19.1% to -5.1%]; relative risk, 0.65 [95% CI, 0.46-0.91]; P = .01). CONCLUSIONS AND RELEVANCE Among older adults with subthreshold depression, collaborative care compared with usual care resulted in a statistically significant difference in depressive symptoms at 4-month follow-up, of uncertain clinical importance. Although differences persisted through 12 months, findings are limited by attrition, and further research is needed to assess longer-term efficacy. TRIAL REGISTRATION isrctn.org Identifier: ISRCTN02202951.
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Affiliation(s)
- Simon Gilbody
- Department of Health Sciences, University of York, Heslington, England2Hull York Medical School, University of York, Heslington, England
| | - Helen Lewis
- Department of Health Sciences, University of York, Heslington, England
| | - Joy Adamson
- Department of Health Sciences, University of York, Heslington, England
| | - Katie Atherton
- Leeds and York Partnership NHS Foundation Trust, Leeds, England
| | - Della Bailey
- Department of Health Sciences, University of York, Heslington, England
| | | | | | - Emily Clare
- Northumberland Tyne and Wear NHS Foundation Trust, NIHR Clinical Research Network (Mental Health) North East and North Cumbria, Academic Psychiatry, Wolfson Research Centre, Campus for Ageing and Vitality, Newcastle Upon Tyne, England
| | | | - David Ekers
- Mental Health Research Group, University of Durham, Durham, England8Tees Esk and Wear Valleys NHS Foundation Trust, NIHR Clinical Research Network North East and North Cumbria, Research and Development Department, Middlesbrough, England
| | - Deborah Foster
- Department of Health Sciences, University of York, Heslington, England
| | - Rhian Gabe
- Department of Health Sciences, University of York, Heslington, England
| | - Samantha Gascoyne
- Department of Health Sciences, University of York, Heslington, England
| | - Lesley Haley
- Tees Esk and Wear Valleys NHS Foundation Trust, NIHR Clinical Research Network North East and North Cumbria, Research and Development Department, Middlesbrough, England
| | - Jahnese Hamilton
- Northumberland Tyne and Wear NHS Foundation Trust, NIHR Clinical Research Network (Mental Health) North East and North Cumbria, Academic Psychiatry, Wolfson Research Centre, Campus for Ageing and Vitality, Newcastle Upon Tyne, England
| | - Rebecca Hargate
- Leeds and York Partnership NHS Foundation Trust, Leeds, England
| | - Catherine Hewitt
- Department of Health Sciences, University of York, Heslington, England
| | - John Holmes
- Leeds Institute of Health Sciences, University of Leeds, Leeds, England
| | - Ada Keding
- Department of Health Sciences, University of York, Heslington, England
| | | | - Shaista Meer
- Leeds Institute of Health Sciences, University of Leeds, Leeds, England
| | - Natasha Mitchell
- Department of Health Sciences, University of York, Heslington, England
| | - Karen Overend
- Department of Health Sciences, University of York, Heslington, England
| | | | - Jodi Pervin
- Department of Health Sciences, University of York, Heslington, England
| | - David A Richards
- Institute of Health Research, Medical School, University of Exeter, Exeter, England
| | - Karen Spilsbury
- School of Healthcare, Faculty of Medicine and Health, University of Leeds, Leeds, England
| | | | - Dominic Trépel
- Department of Health Sciences, University of York, Heslington, England
| | - Rebecca Woodhouse
- Department of Health Sciences, University of York, Heslington, England
| | - Friederike Ziegler
- Department of Urban Studies and Planning, University of Sheffield, Sheffield, England
| | - Dean McMillan
- Department of Health Sciences, University of York, Heslington, England2Hull York Medical School, University of York, Heslington, England
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Newton K, Lewis H, Pugh M, Paladugu M, Woywodt A. Twelve tips for turning quality assurance data into undergraduate teaching awards: A quality improvement and student engagement initiative. Med Teach 2017; 39:141-146. [PMID: 27832725 DOI: 10.1080/0142159x.2016.1248912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Data on teaching awards in undergraduate medical education are sparse. The benefits of an awards system may seem obvious at first glance. However, there are also potential problems relating to fairness, avoidance of bias, and alignment of the awards system with a wider strategy for quality improvement and curriculum development. Here, we report five- year single center experience with establishing undergraduate teaching awards in a large academic teaching hospital. Due to lack of additional funding we based our awards not on peer review but mainly on existing and very comprehensive quality assurance (QA) data. Our 12 tips describe practical points but also pitfalls with awards categories and criteria, advertising and disseminating the awards, the actual awards ceremony and finally embedding the awards in the hospital's wider strategy. To be truly successful, teaching awards and prizes need to be carefully considered, designed and aligned with a wider institutional strategy of rewarding enthusiastic educators.
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Affiliation(s)
- Kate Newton
- a Department of Undergraduate Medical Education , Lancashire Teaching Hospitals NHS Foundation Trust , Preston , UK
| | - Helen Lewis
- a Department of Undergraduate Medical Education , Lancashire Teaching Hospitals NHS Foundation Trust , Preston , UK
| | - Mark Pugh
- a Department of Undergraduate Medical Education , Lancashire Teaching Hospitals NHS Foundation Trust , Preston , UK
| | - Madhavi Paladugu
- a Department of Undergraduate Medical Education , Lancashire Teaching Hospitals NHS Foundation Trust , Preston , UK
| | - Alexander Woywodt
- a Department of Undergraduate Medical Education , Lancashire Teaching Hospitals NHS Foundation Trust , Preston , UK
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Lewis H, Keding A, Bosanquet K, Gilbody S, Torgerson D. An randomized controlled trial of Post-it® notes did not increase postal response rates in older depressed participants. J Eval Clin Pract 2017; 23:102-107. [PMID: 27569403 DOI: 10.1111/jep.12618] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 06/30/2016] [Accepted: 07/01/2016] [Indexed: 11/28/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Our aim was to evaluate the effectiveness of a Post-it® note to increase response rates and shorten response times to a 4-month postal follow-up questionnaire sent to participants taking part in the Collaborative Care in Screen-Positive Elders (CASPER) trials. METHOD Our trial was a two-arm randomized controlled trial comparing response rates to questionnaires with a printed Post-it® note (intervention) and without (control), nested in multi centred randomized controlled trials of older people with varying levels of depressive symptoms; the CASPER+ and CASPER Self Help for those At Risk of Depression (SHARD) trials. A total of 611 participants were eligible and randomized. The primary outcome was response rates, secondary outcomes were time to response and need for a reminder. RESULTS Of 297 participants, 266 (89.6%) returned their 4-month questionnaire in the post-it note arm, compared with 282 of 314 participants (89.8%) in the control arm (OR = 0.97, 95% CI: 0.57, 1.65, P = 0.913). There were no statistically significant differences in time to respond or the need to be sent a reminder. Patients with a major depressive episode were more likely to return questionnaires with post-it notes (P of interaction = .019). CONCLUSION There was no significant difference in response rates, time to response, or the need for a reminder between the intervention and control at 4-month follow up for older people with depressive symptoms. However, there was a significant interaction between the Post-it® note group and level of depression.
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Affiliation(s)
- Helen Lewis
- Department of Health Sciences, Mental Health and Addictions Research Group, Alcuin Research Resource Centre, Heslington Campus, University of York, York, North Yorkshire, UK
| | - Ada Keding
- Department of Health Sciences, York Trials Unit, Alcuin Research Resource Centre, Heslington Campus, University of York, York, North Yorkshire, UK
| | - Katharine Bosanquet
- Department of Health Sciences, Mental Health and Addictions Research Group, Alcuin Research Resource Centre, Heslington Campus, University of York, York, North Yorkshire, UK
| | - Simon Gilbody
- Department of Health Sciences, York Trials Unit, Alcuin Research Resource Centre, Heslington Campus, University of York, York, North Yorkshire, UK
| | - David Torgerson
- Department of Health Sciences, Mental Health and Addictions Research Group, Alcuin Research Resource Centre, Heslington Campus, University of York, York, North Yorkshire, UK
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Valsesia A, Iavicoli P, Lewis H, Desmet C, Mehn D, Calzolai L, Colpo P, Rossi F, Ryadnov MG. Nano-mechanical in-process monitoring of antimicrobial poration in model phospholipid bilayers. RSC Adv 2017. [DOI: 10.1039/c7ra01274h] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Nanomechanical monitoring of known mechanisms of membrane poration mediated by host defense peptides is reported.
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Affiliation(s)
- Andrea Valsesia
- European Commission – Directorate General Joint Research Centre Directorate F – Health
- Consumers and Reference Materials – Consumer Products Safety
- 21027 Ispra
- Italy
| | - Patrizia Iavicoli
- European Commission – Directorate General Joint Research Centre Directorate F – Health
- Consumers and Reference Materials – Consumer Products Safety
- 21027 Ispra
- Italy
| | - Helen Lewis
- National Physical Laboratory
- Teddington TW11 0LW
- UK
| | - Cloé Desmet
- European Commission – Directorate General Joint Research Centre Directorate F – Health
- Consumers and Reference Materials – Consumer Products Safety
- 21027 Ispra
- Italy
| | - Dora Mehn
- European Commission – Directorate General Joint Research Centre Directorate F – Health
- Consumers and Reference Materials – Consumer Products Safety
- 21027 Ispra
- Italy
| | - Luigi Calzolai
- European Commission – Directorate General Joint Research Centre Directorate F – Health
- Consumers and Reference Materials – Consumer Products Safety
- 21027 Ispra
- Italy
| | - Pascal Colpo
- European Commission – Directorate General Joint Research Centre Directorate F – Health
- Consumers and Reference Materials – Consumer Products Safety
- 21027 Ispra
- Italy
| | - François Rossi
- European Commission – Directorate General Joint Research Centre Directorate F – Health
- Consumers and Reference Materials – Consumer Products Safety
- 21027 Ispra
- Italy
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Taylor J, Mahmoodi N, Stubbs B, Lewis H, Hosali P, Hewitt C, Smith R, Wright J, McDermid K, Kayalackakom T, Keller I, Ajjan R, Alderson S, Hughes T, Holt R, Siddiqi N. P15 Improving diabetes outcomes in severe mental illness: A systematic review and meta-analysis of pharmacological and non-pharmacological interventions. Br J Soc Med 2016. [DOI: 10.1136/jech-2016-208064.114] [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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Abstract
BACKGROUND A lack of consensus exists concerning how to identify "heavy users" of inpatient mental health services. AIM To identify a statistical approach that captures, in a clinically meaningful way, "heavy" users of inpatient services using number of admissions and total time spent in hospital. METHODS "Simple" statistical methods (e.g. top 2%) and data driven methods (e.g. the Poisson mixture distribution) were applied to admissions made to adult acute services of a London mental health trust. RESULTS The Poisson mixture distribution distinguished "frequent users" of inpatient services, defined as having 4 + admissions in the study period. It also distinguished "high users" of inpatient services, defined as having 52 + occupied bed days. Together "frequent" and "high" users were classified as "heavy users". CONCLUSIONS Data driven criteria such as the Poisson mixture distribution can identify "heavy" users of inpatient services. The needs of this group require particular attention.
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Affiliation(s)
- Alison Beck
- a South London and Maudsley NHS Foundation Trust , London , UK and
| | - Victoria Harris
- b Institute of Psychiatry, Psychology and Neuroscience, King's College London , London , UK
| | - Loveday Newman
- a South London and Maudsley NHS Foundation Trust , London , UK and
| | | | - Helen Lewis
- a South London and Maudsley NHS Foundation Trust , London , UK and
| | - Ruth Pegler
- a South London and Maudsley NHS Foundation Trust , London , UK and
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Gibberd RW, Lewis H. Properties of aggregated Markov chains. ADV APPL PROBAB 2016. [DOI: 10.2307/1426808] [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: 11/10/2022]
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Avery P, Salm L, Bird F, Hutchinson A, Matthies A, Hudson A, Jarman H, Nilsson MB, Konig T, Tai N, Fevang E, Hognestad B, Abrahamsen HB, Cheetham OV, Thomas MJC, Rooney KD, Murray J, Tunnicliff M, Collinson JW, Brown T, Pritchett C, Pritchett CSA, Jadav M, Meredith G, Plumb J, Harris S, Langford R, Hunter JG, Sage A, Madden R, Flamank O, Broadbent B, Marsh S, Lewis H, Daniels E, Roberts N, Hunter JG, Sage A, Madden R, Flamank O, Broadbent B, Marsh S, Lewis H, Daniels E, Lin N, Roberts N, Bulford S, Houghton-Budd S, Pearson S, Clear-Hill M, Menzies DJ, Leonard JP, Keogh C, Quinn R, Hinds JD, Roberts N, Ashton-Cleary D, Jadav M, Mahmood I, El-Menyar A, Younis B, Khalid A, Nabir S, Ahmed MN, Al-Yahri O, Al-Thani H, Young K, Hendrickson SA, Phillips G, Gardiner MD, Hettiaratchy S, Crossland AA, Hudson A, Brassington NC, Hudson A, McWhirter E, Reid BO, Rehn M, Uleberg O, Krüger AJ, Jennings C, Kapadia Y, Bew D, Townsend J, Hurst TP, Foster EA, Brown TB, Collinson J, Pritchett C, Slade T, Tønsager K, Rehn M, G.Ringdal K, J.Krüger A, Hesselfeldt R, Wulffeld S, Sonne A, Rasmussen LS, Steinmetz J, Renninson TJ, Thomson N, Pynn H, Hooper TJ, Hudson A, Dawson J, Matthies A, Friberg ML, Rognås L, Wills JFG, Hudson A, Turner CDA, Rehn M, Nunn J, Erdogan M, Green RS, Minor S, Erdogan M, Hartlen K, Green RS, Bird R, Grupping RL, Stacey AM, Rehn M, Lockey DJ, Abiks S, Cutler L, Monaghan K, Al-Rais A, Hymers C, Bloomer R, Kapadia Y, Seidenfaden SC, Riddervold IS, Kirkegaard H, Juul N, Bøtker MT, Gao A, Perkins Z, Grier G, Tzannes A, Hudson-Peacock NJ, Otto Q, Phillipson L, Thomas R, Heyworth A, Otto Q, Hudson-Peacock NJ, Phillipson L, Heyworth A, Ley E, Banner D, Heyworth A, Ley E, Benson M, Hudson-Peacock N, Stone T, Ley E, Rousson L, Heyworth A, Lineham BA, Lee MJ, Gough M, Seligman WH, Thould HE, Dinsmore A, Tan C, Thompson J, Eynon CA, Lockey DJ, Wahlin RMR, Lindström V, Ponzer S, Vicente V, Eligio P, Hudson A, Young R, Amiras D, Sinha I. London Trauma Conference 2015. Scand J Trauma Resusc Emerg Med 2016; 24 Suppl 1:78. [PMID: 27357386 PMCID: PMC4928155 DOI: 10.1186/s13049-016-0248-x] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
I1: Trauma, Pre-hospital and Cardiac Arrest Care 2015 Pascale Avery, Leopold Salm, Flora Bird A1: Retrospective evaluation of HEMS ‘Direct to CT’ protocol Anja Hutchinson, Ashley Matthies, Anthony Hudson, Heather Jarman A2 Rush hour – Crush hour: temporal relationship of cyclist vs. HGV trauma admissions. A single site observational study Maria Bergman Nilsson, Tom Konig, Nigel Tai A3 Semiprone position endotracheal intubation during continuous cardiopulmonary resuscitation in drowned children with regurgitation: a case report and experimental manikin study Espen Fevang, Børge Hognestad, Håkon B. Abrahamsen A4 An audit of CO2 A-a gradient in non-trauma patients receiving pre-hospital anaesthesia Olivia V Cheetham, Matthew JC Thomas, Kieron D Rooney A5 Can the use of c-spine immobilisation collars be avoided in non-trauma patients presenting to the Emergency Department? Josephine Murray, Malcolm Tunnicliff A6 Curriculum mapping in ED point of care simulation Joseph W Collinson, Thomas Brown, Christopher Pritchett A7 Point of care multidisciplinary trauma team simulation & participant satisfaction in a geographically remote trauma unit in Cornwall Christopher SA Pritchett, Mark Jadav, Gareth Meredith, Jamie Plumb, Steve Harris, Roger Langford A8 Conservative management of head injury inpatients - the challenge of simplifying injury management in a non-neurosurgical hospital JG Hunter, A Sage, R Madden, O Flamank, B Broadbent, S Marsh, H Lewis, E Daniels, N Roberts A9 Improving the care of traumatic brain injury at non-neurosurgical hospitals: Introducing a head injury pathway and single place of care is associated with significant improvements in neurological observation JG Hunter, A Sage, R Madden, O Flamank, B Broadbent, S Marsh, H Lewis, E Daniels, N Lin, N Roberts A10 The experience of inter-disciplinary students undertaking cardiac arrest moulage training Samuel Bulford, Silas Houghton-Budd, Sam Pearson, Megan Clear-Hill A11 Impact brain apnoea – nine cases David J Menzies, James P Leonard, Conor Keogh, Ray Quinn, John D Hinds A12 Time well spent? Improving the performance improvement programme in a busy Trauma Unit N Roberts, D Ashton-Cleary, M Jadav A14 Clinical significant and outcome of pulmonary contusions in patients with blunt chest trauma Ismail Mahmood, Ayman El-Menyar, Basil Younis, Ahmed Khalid, Syed Nabir, Mohamed Nadeem Ahmed, Omer Al-Yahri, Hassan Al-Thani A15 Plastics operative workload in major trauma centres: a national prospective survey Katie Young, Susan A. Hendrickson, Georgina Phillips, Matthew D. Gardiner, Shehan Hettiaratchy A16 A survey to assess the accuracy of estimating height by pre-hospital clinicians: can we reliably predict those most at risk of serious injury? Alexandra Alice Crossland, Anthony Hudson A17 An audit of the cause, outcome and adherence to treatment Standard Operating Procedure (SOP) for all traumatic cardiac arrests at a Helicopter Emergency Medical Service over a 12-month period Nicholas C Brassington, Anthony Hudson, Emily McWhirter A18 Should we “stay-and-play? A study of patient physiology in Norwegian Helicopter Emergency Services Bjørn O Reid, Marius Rehn, Oddvar Uleberg, Andreas J Krüger A19 Training in resuscitative thoracotomy: have we cracked it? A survey of higher Emergency Medicine trainees in London Cara Jennings, Yasmin Kapadia, Duncan Bew A20 London’s Air Ambulance (LAA): 25-years of drownings in an urban environment Jenny Townsend, Tom P Hurst, Elizabeth A Foster A21 Live patients in trauma simulation – more than just simulation on a shoestring? Thomas B Brown, Joseph Collinson, Christopher Pritchett, Toby Slade A22 Collecting core data in pre-hospital critical care using a consensus based template Kristin Tønsager, Marius Rehn, Kjetil G.Ringdal, Andreas J.Krüger A23 Prehospital interventions before and after implementation of a physician staffed helicopter Rasmus Hesselfeldt, Sandra Wulffeld, Asger Sonne, Lars S. Rasmussen, Jacob Steinmetz A24 Duration of ventilation following prehospital drug assisted intubation; a retrospective review Thomas J Renninson, Nadine Thomson, Harvey Pynn, Timothy J Hooper A25 Non-haemorrhagic shock in trauma: a novel guideline for management in ED Anthony Hudson, Jacinta Dawson, Ashley Matthies A26 Patient-tailored triage decisions by anaesthetist-staffed pre-hospital critical care teams Morten Langfeldt Friberg, Leif Rognås A27 Anatomical accuracy and appropriate sizing of pre-hospital thoracostomies Jessica FG Wills, Anthony Hudson A28 Pre-hospital management of mass casualty civilian shootings Conor DA Turner, Marius Rehn A30 The prevalence of alcohol-related trauma recidivism: a systematic review James Nunn, Mete Erdogan, Robert S. Green A31 Development of a hospital-wide program for simulation-based training in trauma care and management Samuel Minor, Mete Erdogan, Kathy Hartlen, Robert S. Green A32 Out of Hospital Cardiac Arrests (OOHCA); lessons from Hollywood Ruth Bird, Rachael L. Grupping A33 Mechanism of injury as a predictor of severity of injury in road traffic collisions: a literature review Amelia M. Stacey, Marius Rehn, David J. Lockey A34 Lessons to be learned from prehospital airway intervention documentation? Are airway intervention documentation templates as successful in-hospital as prehospitally? S. Abiks, L. Cutler, K. Monaghan, A. Al-Rais, C. Hymers, R. Bloomer, Y. Kapadia A35 Novel biomarkers in prehospital management of traumatic brain injury (the PreTBI study protocol) Sophie-Charlott Seidenfaden, Ingunn S. Riddervold, Hans Kirkegaard, Niels Juul, Morten T. Bøtker A36 Hospital outcomes of traumatic railway incidents: a seven-year observational retrospective study of a major trauma centre Alice Gao, Zane Perkins; Gareth Grier, Alex Tzannes A37 Does taking a third crew member affect the on-scene time of HEMS jobs? Nathan Hudson-Peacock, Quentin Otto, Laurie Phillipson, Rik Thomas, Ainsley Heyworth A38 Does pre-hospital rapid sequence induction affect on-scene time of HEMS jobs? Quentin Otto, Nathan Hudson-Peacock, Laurie Phillipson, Ainsley Heyworth, Erica Ley A39 Code red: shock index as a prehospital indicator of massive haemorrhage Daniel Banner, Ainsley Heyworth, Erica Ley A40 Air ambulance tasking: how accurate are our current methods? Madeleine Benson, Nathan Hudson-Peacock, Tony Stone, Erica Ley, Louise Rousson, Ainsley Heyworth A41 Modern trauma burden in a district general hospital Beth A Lineham, Matthew J Lee, Martin Gough A42 Establishing a legal service for major trauma patients in two UK major trauma centres William H Seligman, Hannah E Thould, Andrew Dinsmore, Charlotte Tan, Julian Thompson, C Andy Eynon, David J Lockey A43 Prehospital assessment and care of patients – a study of the use of guidelines when assessing head trauma Rebecka M Rubenson Wahlin, Veronica Lindström, Sari Ponzer, Veronica Vicente A44 An audit of pre-hospital blood pressure management resulting from head injury Pamela Eligio, Anthony Hudson A45 The surgical contribution of surface shading volumetric rendering techniques in rib fracture management Robert Young, Dimitri Amiras, Ian Sinha
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Overend K, Lewis H, Bailey D, Bosanquet K, Chew-Graham C, Ekers D, Gascoyne S, Hems D, Holmes J, Keding A, McMillan D, Meer S, Meredith J, Mitchell N, Nutbrown S, Parrott S, Richards D, Traviss G, Trépel D, Woodhouse R, Gilbody S. Erratum to: CASPER plus (CollAborative care in screen-positive EldeRs with major depressive disorder): study protocol for a randomised controlled trial. Trials 2016; 17:217. [PMID: 27121377 PMCID: PMC4848845 DOI: 10.1186/s13063-016-1361-x] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 04/22/2016] [Indexed: 11/10/2022] Open
Affiliation(s)
- Karen Overend
- Department of Health Sciences, University of York, Seebohm Rowntree, Building Heslington, York, YO10 5DD, UK
| | - Helen Lewis
- Department of Health Sciences, University of York, Seebohm Rowntree, Building Heslington, York, YO10 5DD, UK
| | - Della Bailey
- Department of Health Sciences, University of York, Seebohm Rowntree, Building Heslington, York, YO10 5DD, UK
| | - Kate Bosanquet
- Department of Health Sciences, University of York, Seebohm Rowntree, Building Heslington, York, YO10 5DD, UK
| | - Carolyn Chew-Graham
- Research Institute, Primary Care and Health Sciences, Keele University, Keele, ST5 5BG, UK
| | - David Ekers
- Centre for Mental Health Research, University of Durham, Durham, TS17 6BH, UK
| | - Samantha Gascoyne
- Department of Health Sciences, University of York, Seebohm Rowntree, Building Heslington, York, YO10 5DD, UK
| | - Deborah Hems
- Department of Health Sciences, University of York, Seebohm Rowntree, Building Heslington, York, YO10 5DD, UK
| | - John Holmes
- Leeds Institute of Health Sciences, University of Leeds, Charles Thackrah, Building, 101 Clarendon Road, Leeds, LS2 9LJ, UK
| | - Ada Keding
- Department of Health Sciences, University of York, Seebohm Rowntree, Building Heslington, York, YO10 5DD, UK
| | - Dean McMillan
- Department of Health Sciences, University of York, Seebohm Rowntree, Building Heslington, York, YO10 5DD, UK
| | - Shaista Meer
- Leeds Institute of Health Sciences, University of Leeds, Charles Thackrah, Building, 101 Clarendon Road, Leeds, LS2 9LJ, UK
| | - Jodi Meredith
- Department of Health Sciences, University of York, Seebohm Rowntree, Building Heslington, York, YO10 5DD, UK
| | - Natasha Mitchell
- Department of Health Sciences, University of York, Seebohm Rowntree, Building Heslington, York, YO10 5DD, UK
| | - Sarah Nutbrown
- Department of Health Sciences, University of York, Seebohm Rowntree, Building Heslington, York, YO10 5DD, UK
| | - Steve Parrott
- Department of Health Sciences, University of York, Seebohm Rowntree, Building Heslington, York, YO10 5DD, UK
| | - David Richards
- Washington Singer Laboratories, School of Psychology, University of Exeter, Perry Road, Exeter, EX4 4QG, UK
| | - Gemma Traviss
- Leeds Institute of Health Sciences, University of Leeds, Charles Thackrah, Building, 101 Clarendon Road, Leeds, LS2 9LJ, UK
| | - Dominic Trépel
- Department of Health Sciences, University of York, Seebohm Rowntree, Building Heslington, York, YO10 5DD, UK
| | - Rebecca Woodhouse
- Department of Health Sciences, University of York, Seebohm Rowntree, Building Heslington, York, YO10 5DD, UK
| | - Simon Gilbody
- Department of Health Sciences, University of York, Seebohm Rowntree, Building Heslington, York, YO10 5DD, UK.
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Zar HJ, Madhi SA, White DA, Masekela R, Risenga S, Lewis H, Feldman C, Morrow B, Jeena P. Acute viral bronchiolitis in South Africa: Strategies for management and prevention. S Afr Med J 2016; 106:27-29. [PMID: 27303780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
Management of acute viral bronchiolitis is largely supportive. There is currently no proven effective therapy other than oxygen for hypoxic children. The evidence indicates that there is no routine benefit from inhaled, rapid short-acting bronchodilators, adrenaline or ipratropium bromide for children with acute viral bronchiolitis. Likewise, there is no demonstrated benefit from routine use of inhaled or oral corticosteroids, inhaled hypertonic saline nebulisation, montelukast or antibiotics. The last should be reserved for children with severe disease, when bacterial co-infection is suspected. Prevention of respiratory syncytial virus (RSV) disease remains a challenge. A specific RSV monoclonal antibody, palivizumab, administered as an intramuscular injection, is available for children at risk of severe bronchiolitis, including premature infants, young children with chronic lung disease, immunodeficiency, or haemodynamically significant congenital heart disease. Prophylaxis should be commenced at the start of the RSV season and given monthly during the season. The development of an RSV vaccine may offer a more effective alternative to prevent disease, for which the results of clinical trials are awaited. Education of parents or caregivers and healthcare workers about diagnostic and management strategies should include the following: bronchiolitis is caused by a virus; it is seasonal; it may start as an upper respiratory tract infection with low-grade fever; symptoms are cough and wheeze, often with fast breathing; antibiotics are generally not needed; and the condition is usually self limiting, although symptoms may occur for up to four weeks in some children.
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Donoghue HM, Traviss-Turner GD, House AO, Lewis H, Gilbody S. Life adversity in depressed and non-depressed older adults: A cross-sectional comparison of the brief LTE-Q questionnaire and life events and difficulties interview as part of the CASPER study. J Affect Disord 2016; 193:31-8. [PMID: 26766034 DOI: 10.1016/j.jad.2015.12.070] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 12/06/2015] [Accepted: 12/26/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND There is a paucity of research on the nature of life adversity in depressed and non-depressed older adults. Early life events work used in-depth interviews; however, larger epidemiological trials investigate life adversity using brief questionnaires. This study investigates the type of life adversity experienced in later life and its association with depression and compares adversity captured using a brief (LTE-Q) and in-depth (LEDS) measure. METHODS 960 participants over 65 years were recruited in UK primary care to complete the PHQ-9 and LTE-Q. A sub-sample (n=19) completed the LEDS and a question exploring the subjective experience of the LTE-Q and LEDS. RESULTS Important life adversity was reported on the LTE-Q in 48% of the sample. In the LTE-Q sample the prevalence of depression (PHQ-9≥10) was 12%. Exposure to recent adversity was associated with doubling of the odds of depression. The LTE-Q only captured a proportion of adversity measured by the LEDS (42% vs 84%). Both measures showed health, bereavement and relationship events were most common. LIMITATIONS The cross-sectional design limits the extent to which inferences can be drawn around the direction of causality between adversity and depression. Recall in older adults is questionable. CONCLUSIONS UK older adults face adversity in areas of health, bereavement and relationships which are associated with depression. This has clinical relevance for psychological interventions for older adults to consider social context and social support. It helps identify the strengths and weaknesses of a brief adversity measure in large scale research. Further research is needed to explore the mechanisms of onset and direction of causality.
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Affiliation(s)
- Hjördis M Donoghue
- Leeds Institute of Health Sciences, Academic Unit of Psychiatry & Behavioural Sciences, University of Leeds, UK
| | - Gemma D Traviss-Turner
- Leeds Institute of Health Sciences, Academic Unit of Psychiatry & Behavioural Sciences, University of Leeds, UK.
| | - Allan O House
- Leeds Institute of Health Sciences, Academic Unit of Psychiatry & Behavioural Sciences, University of Leeds, UK
| | - Helen Lewis
- Department of Health Sciences, Seebohm Rowntree Building, University of York, Heslington, York YO10 5DD, UK
| | - Simon Gilbody
- Department of Health Sciences, Seebohm Rowntree Building, University of York, Heslington, York YO10 5DD, UK
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Keding A, Lewis H, Bosanquet K, Gilbody S, Buckley H, Tilbrook H, Torgerson D. Post-it notes to improve questionnaire response rates in RCTs - findings from a randomised sub-study. Trials 2015. [PMCID: PMC4660291 DOI: 10.1186/1745-6215-16-s2-p102] [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: 11/10/2022] Open
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Overend K, Bosanquet K, Bailey D, Foster D, Gascoyne S, Lewis H, Nutbrown S, Woodhouse R, Gilbody S, Chew-Graham C. Revealing hidden depression in older people: a qualitative study within a randomised controlled trial. BMC Fam Pract 2015; 16:142. [PMID: 26481581 PMCID: PMC4617777 DOI: 10.1186/s12875-015-0362-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 10/07/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND The prevalence of depressive symptoms in older people may be as high as 20 %. Depression in older people is associated with loss, loneliness and physical co-morbidities; it is known to be under-diagnosed and under-treated. Older people may find it difficult to speak to their GPs about low mood, and GPs may avoid identifying depression due to limited consultation time and referral options for older patients. METHODS A nested qualitative study in a randomised controlled trial for older people with moderate to severe depression: the CASPER Plus Trial (Collaborative Care for Screen Positive Elders). We interviewed GPs, case managers (CM) and patient participants to explore perspectives and experiences of delivering and receiving a psychosocial intervention, developed specifically for older adults in primary care, within a collaborative care framework. Transcripts were analysed thematically using principles of constant comparison. RESULTS Thirty three interviews were conducted and, across the three data-sets, four main themes were identified: revealing hidden depression, reducing the 'blind spots', opportunity to talk outside the primary care consultation and 'moving on' from depression. CONCLUSIONS Depression in older people is commonly hidden, and may coexist with physical conditions that are prioritised by both patients and GPs. Being invited to participate in a trial about depression may allow older people to disclose their feelings, name the problem, and seek help. Offering older people an opportunity to talk outside the primary care consultation is valued by patients and GPs. A psychosocial intervention delivered by a case manager in the primary care setting may fill the gap in the care of older people with depression. TRIAL REGISTRATION Current Controlled Trials ISRCTN45842879 .
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Affiliation(s)
| | | | - Della Bailey
- University of York, Heslington, York, YO10 5DD, UK.
| | | | | | - Helen Lewis
- University of York, Heslington, York, YO10 5DD, UK.
| | | | | | | | - Carolyn Chew-Graham
- Research Institute, Primary Care and Health Sciences, NIHR CLAHRC West Midlands, Keele, Staffordshire, ST5 5BG, UK.
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Lewis H, Arber S. The role of the body in end-stage kidney disease in young adults: Gender, peer and intimate relationships. Chronic Illn 2015; 11:184-97. [PMID: 25589149 DOI: 10.1177/1742395314566823] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 12/12/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To understand how the physical body, and changes in the physical body, influence peer and intimate relationships and parenting in young adults on renal replacement therapies (RRT). METHODS Qualitative interview data from 40 young adults aged 16-30 years with end-stage kidney disease (ESKD), first diagnosed aged 0-19 years, were analysed using modified grounded theory. FINDINGS Alternating modalities of RRT had a 'yo-yo' effect on the bodies of interviewees, repeatedly reconstructing them as either 'transplanted' bodies, often initially obese, or as 'dialysis' bodies', often underweight. Invisible somatic changes had a major impact on gendered social identity, making intimate social relationships and parenthood problematic. Prepubertal onset interviewees were generally less successful in forming partnerships than those with postpubertal onset; and interviewees on dialysis were likely to postpone partnering until they were transplanted. Social networks were essential for finding a partner, but male interviewees had fewer networks than females. Parenthood was particularly challenging for female interviewees. CONCLUSIONS In ESKD, life-saving RRT brings major changes to the body. These adversely affect social relationships and family formation during the crucial period of early adulthood. Effects vary according to age of onset, RRT modality, and gender, with those who were ill before puberty and those on dialysis worst affected.
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Affiliation(s)
- Helen Lewis
- Department of Sociology, University of Surrey, Guildford, UK
| | - Sara Arber
- Department of Sociology, University of Surrey, Guildford, UK
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Bosanquet K, Mitchell N, Gabe R, Lewis H, McMillan D, Ekers D, Bailey D, Gilbody S. Diagnostic accuracy of the Whooley depression tool in older adults in UK primary care. J Affect Disord 2015; 182:39-43. [PMID: 25969415 DOI: 10.1016/j.jad.2015.04.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 04/09/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE OF RESEARCH To validate the Whooley questions as a screening tool for depression amongst a population of older adults in UK primary care. OBJECTIVE To assess the diagnostic performance of the Whooley questions as a screening tool for depression amongst older adults in UK primary care. PARTICIPANTS A cross-sectional validation study was conducted with 766 patients aged ≥75 from UK primary care, recruited via 17 general practices based in the North of England during the pilot phase of a randomized controlled trial. MAIN OUTCOME MEASURES Sensitivity, specificity and likelihood ratios comparing the index test (two Whooley questions) with a diagnosis of major depressive disorder (MDD) ascertained by the reference standard Mini International Neuropsychiatric Interview (MINI). RESULTS The two screening questions had a sensitivity of 94.3% (95% confidence interval, 80.8-99.3%) and specificity of 62.7% (95% confidence interval, 59.0-66.2%). The likelihood ratio for a positive test was 2.5 (95% confidence interval, 2.2-2.9) and the likelihood ratio for a negative test was 0.09 (95% confidence interval, 0.02-0.35). CONCLUSION The two Whooley questions missed few cases of depression. However, they were responsible for a high rate of false positives. This creates additional burden on general practitioners, to conduct more detailed investigation on patients who screen positive, but many of whom turn out not to have MDD.
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Affiliation(s)
- Katharine Bosanquet
- Department of Health Sciences, Seebohm Rowntree Building, University of York, Heslington, York YO10 5DD, UK.
| | - Natasha Mitchell
- Department of Health Sciences, Seebohm Rowntree Building, University of York, Heslington, York YO10 5DD, UK
| | - Rhian Gabe
- Department of Health Sciences, Seebohm Rowntree Building, University of York, Heslington, York YO10 5DD, UK
| | - Helen Lewis
- Department of Health Sciences, Seebohm Rowntree Building, University of York, Heslington, York YO10 5DD, UK
| | - Dean McMillan
- Department of Health Sciences, Seebohm Rowntree Building, University of York, Heslington, York YO10 5DD, UK; Hull York Medical School, University of York, Heslington, York YO10 5DD, UK
| | - David Ekers
- Mental Health Research Group, University of Durham, Durham TS17 6BH, UK
| | - Della Bailey
- Department of Health Sciences, Seebohm Rowntree Building, University of York, Heslington, York YO10 5DD, UK
| | - Simon Gilbody
- Department of Health Sciences, Seebohm Rowntree Building, University of York, Heslington, York YO10 5DD, UK; Hull York Medical School, University of York, Heslington, York YO10 5DD, UK
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Little K, Goodridge S, Lewis H, Lingard S, Din S, Tidley M, Roberts R, Williams N, Hayes S. Occupational vaccination of health care workers: uptake, attitudes and potential solutions. Public Health 2015; 129:755-62. [DOI: 10.1016/j.puhe.2015.02.031] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Revised: 12/31/2014] [Accepted: 02/22/2015] [Indexed: 01/05/2023]
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Bedson E, Bell D, Carr D, Carter B, Hughes D, Jorgensen A, Lewis H, Lloyd K, McCaddon A, Moat S, Pink J, Pirmohamed M, Roberts S, Russell I, Sylvestre Y, Tranter R, Whitaker R, Wilkinson C, Williams N. Folate Augmentation of Treatment--Evaluation for Depression (FolATED): randomised trial and economic evaluation. Health Technol Assess 2015; 18:vii-viii, 1-159. [PMID: 25052890 DOI: 10.3310/hta18480] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Folate deficiency is associated with depression. Despite the biological plausibility of a causal link, the evidence that adding folate enhances antidepressant treatment is weak. OBJECTIVES (1) Estimate the clinical effectiveness and cost-effectiveness of folic acid as adjunct to antidepressant medication (ADM). (2) Explore whether baseline folate and homocysteine predict response to treatment. (3) Investigate whether response to treatment depends on genetic polymorphisms related to folate metabolism. DESIGN FolATED (Folate Augmentation of Treatment - Evaluation for Depression) was a double-blind and placebo-controlled, but otherwise pragmatic, randomised trial including cost-utility analysis. To yield 80% power of detecting standardised difference on the Beck Depression Inventory version 2 (BDI-II) of 0.3 between groups (a 'small' effect), FolATED trialists sought to analyse 358 participants. To allow for an estimated loss of 21% of participants over three time points, we planned to randomise 453. SETTINGS Clinical - Three centres in Wales - North East Wales, North West Wales and Swansea. Trial management - North Wales Organisation for Randomised Trials in Health in Bangor University. Biochemical analysis - University Hospital of Wales, Cardiff. Genetic analysis - University of Liverpool. PARTICIPANTS Four hundred and seventy-five adult patients presenting to primary or secondary care with confirmed moderate to severe depression for which they were taking or about to start ADM, and able to consent and complete assessments, but not (1) folate deficient, vitamin B12 deficient, or taking folic acid or anticonvulsants; (2) misusing drugs or alcohol, or suffering from psychosis, bipolar disorder, malignancy or other unstable or terminal illness; (3) (planning to become) pregnant; or (4) participating in other clinical research. INTERVENTIONS Once a day for 12 weeks experimental participants added 5 mg of folic acid to their ADM, and control participants added an indistinguishable placebo. All participants followed pragmatic management plans initiated by a trial psychiatrist and maintained by their general medical practitioners. MAIN OUTCOME MEASURES Assessed at baseline, and 4, 12 and 25 weeks thereafter, and analysed by 'area under curve' (main); by analysis of covariance at each time point (secondary); and by multi-level repeated measures (sensitivity analysis): Mental health - BDI-II (primary), Clinical Global Impression (CGI), Montgomery-Åsberg Depression Rating Scale (MADRS), UKU side effects scale, and Mini International Neuropsychiatric Interview (MINI) suicidality subscale; General health - UK 12-item Short Form Health Survey (SF-12), European Quality of Life scale - 5 Dimensions (EQ-5D); Biochemistry - serum folate, B12, homocysteine; Adherence - Morisky Questionnaire; Economics - resource use. RESULTS Folic acid did not significantly improve any of these measures. For example it gained a mean of just 2.9 quality-adjusted life-days [95% confidence interval (CI) from -12.7 to 7.0 days] and saved a mean of just £48 (95% CI from -£292 to £389). In contrast it significantly reduced mental health scores on the SF-12 by 3.0% (95% CI from -5.2% to -0.8%). CONCLUSIONS The FolATED trial generated no evidence that folic acid was clinically effective or cost-effective in augmenting ADM. This negative finding is consistent with improving understanding of the one-carbon folate pathway suggesting that methylfolate is a better candidate for augmenting ADM. Hence the findings of FolATED undermine treatment guidelines that advocate folic acid for treating depression, and suggest future trials of methylfolate to augment ADM. TRIAL REGISTRATION Current Controlled Trials ISRCTN37558856. FUNDING This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 18, No. 48. See the HTA programme website for further project information.
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Affiliation(s)
- Emma Bedson
- Clinical Trials Research Centre, University of Liverpool, Liverpool, UK
| | - Diana Bell
- Ysbyty Gwynedd, Betsi Cadwalladr University Health Board, Bangor, UK
| | - Daniel Carr
- Wolfson Centre for Personalised Medicine, University of Liverpool, Liverpool, UK
| | - Ben Carter
- School of Medicine, Cardiff University, Cardiff, UK
| | - Dyfrig Hughes
- Centre for Economics and Policy in Health, Bangor University, Bangor, UK
| | - Andrea Jorgensen
- Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Helen Lewis
- Department of Health Sciences, University of York, York, UK
| | - Keith Lloyd
- College of Medicine, Swansea University, Swansea, UK
| | - Andrew McCaddon
- North Wales Centre for Primary Care Research, Bangor University, Bangor, UK
| | - Stuart Moat
- Medical Biochemistry & Immunology, University Hospital of Wales, Cardiff, UK
| | - Joshua Pink
- Centre for Economics and Policy in Health, Bangor University, Bangor, UK
| | - Munir Pirmohamed
- Wolfson Centre for Personalised Medicine, University of Liverpool, Liverpool, UK
| | - Seren Roberts
- Centre for Mental Health & Society, Bangor University, Bangor, UK
| | - Ian Russell
- College of Medicine, Swansea University, Swansea, UK
| | | | - Richard Tranter
- Department of Psychological Medicine, University of Otago, Christchurch, NZ
| | - Rhiannon Whitaker
- North Wales Organisation for Randomised Trials in Health, Bangor University, Bangor, UK
| | - Clare Wilkinson
- North Wales Centre for Primary Care Research, Bangor University, Bangor, UK
| | - Nefyn Williams
- North Wales Centre for Primary Care Research, Bangor University, Bangor, UK
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Dinning PG, Wiklendt L, Maslen L, Patton V, Lewis H, Arkwright JW, Wattchow DA, Lubowski DZ, Costa M, Bampton PA. Colonic motor abnormalities in slow transit constipation defined by high resolution, fibre-optic manometry. Neurogastroenterol Motil 2015; 27:379-88. [PMID: 25557630 DOI: 10.1111/nmo.12502] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 12/03/2014] [Indexed: 12/15/2022]
Abstract
BACKGROUND Slow transit constipation (STC) is associated with colonic motor abnormalities. The underlying cause(s) of the abnormalities remain poorly defined. In health, utilizing high resolution fiber-optic manometry, we have described a distal colonic propagating motor pattern with a slow wave frequency of 2-6 cycles per minute (cpm). A high calorie meal caused a rapid and significant increase in this activity, suggesting the intrinsic slow wave activity could be mediated by extrinsic neural input. Utilizing the same protocol our aim was to characterize colonic meal response STC patients. METHODS A fiber-optic manometry catheter (72 sensors at 1 cm intervals) was colonoscopically placed with the tip clipped at the ascending or transverse colon, in 14 patients with scintigraphically confirmed STC. Manometric recordings were taken, for 2 h pre and post a 700 kCal meal. Data were compared to 12 healthy adults. KEY RESULTS Prior to and/or after the meal the cyclic propagating motor pattern was identified in 13 of 14 patients. However, the meal, did not increase the cyclic motor pattern (preprandial 7.4 ± 7.6 vs postprandial 8.3 ± 4.5 per/2 h), this is in contrast to the dramatic increase observed in health (8.3 ± 13.3 vs 59.1 ± 89.0 per/2 h; p < 0.001). CONCLUSIONS & INFERENCES In patients with STC a meal fails to induce the normal increase in the distal colonic cyclic propagating motor patterns. We propose that these data may indicate that the normal extrinsic parasympathetic inputs to the colon are attenuated in these patients.
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Affiliation(s)
- P G Dinning
- Departments of Gastroenterology and Surgery, Flinders Medical Centre, Flinders University, Bedford Park, SA, Australia; St.George Hospital Clinical School, Faculty of Medicine, University of New South Wales, Kogarah, NSW, Australia
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Hodgins N, Damkat-Thomas L, Shamsian N, Yew P, Lewis H, Khan K. Analysis of the increasing prevalence of necrotising fasciitis referrals to a regional plastic surgery unit: A retrospective case series. J Plast Reconstr Aesthet Surg 2015; 68:304-11. [DOI: 10.1016/j.bjps.2014.11.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 10/25/2014] [Accepted: 11/09/2014] [Indexed: 12/20/2022]
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Lewis H, Marks SD. Differences between paediatric and adult presentation of ESKD in attainment of adult social goals. Pediatr Nephrol 2014; 29:2379-85. [PMID: 24986102 DOI: 10.1007/s00467-014-2864-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [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] [Received: 10/05/2013] [Revised: 04/12/2014] [Accepted: 05/20/2014] [Indexed: 01/07/2023]
Abstract
BACKGROUND Living with end-stage kidney disease (ESKD) is complex for young adults who experience difficulties with adherence to medications and attainment of social markers of adulthood. METHODS We studied adult outcomes (education, employment and accommodation) and evaluated adherence in young adults (age 16-30 years) according to paediatric (<16 years) and adult presentation (16-30 years) of ESKD. Initial questionnaire surveys were undertaken with patients (n = 931) identified from the databases of 12 adult and two paediatric nephrology programmes in England. RESULTS Young adults (n = 296, 52 % male, 79 % Caucasian and 73 % with functioning renal allograft) with a mean age at first presentation of ESKD and current age of 17 and 25 years, respectively, were surveyed, of whom 5 % still attended paediatric services. Outcomes of patients aged >23 years and in stable health (n = 146) were compared between paediatric and adult presentation, with 30 and 20 % of patients, respectively, registered as disabled (p = 0.02). Educational attainment, based on percentage of those not achieving the General Certificate of Secondary Education (GCSE) level for England, was lower in the paediatric presentation group than in the adult one (7 vs. 18 %, respectively; p = 0.04). Compared to adult presentation patients, paediatric presentation patients were less likely to have full or part time paid work (57 vs. 76 %; p = 0.2). They also tended to be less likely to be living independently, less likely to be living with a partner, and, if living with their parents, more likely to be living in rented accommodation. Only 10 % patients missed taking medication weekly or more often. A higher frequency of missing medication was related to dialysis patients (p = 0.05), who assigned lower importance to taking medication (p < 0.001). However, patients aged <23 years attached less importance to complying with advice about treatment and health (p = 0.02), especially those who presented with ESKD during childhood (p = 0.01). CONCLUSIONS Among our study cohort, young adults who presented with ESKD during childhood have poorer social and educational attainment compared to their counterparts who presented in adulthood. Adherence to medications remains important to ESKD patients. However, young adults wish to have personal control over their own life and health and need additional support and healthcare advice from the multi-disciplinary team. Qualitative work is required to understand the meaning of these outcomes on the quality of life for each individual patient.
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Affiliation(s)
- Helen Lewis
- Department of Sociology, University of Surrey, Guildford, Surrey, UK, GU2 7XH
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Weeks KL, Lewis H, Karas A, Ashcroft AS, Puhl SL, Avkiran M. PARADOXICAL DEPHOSPHORYLATION OF CARDIAC HISTONE DEACETYLASE 5 BY BETA-ADRENERGIC STIMULATION. Heart 2014. [DOI: 10.1136/heartjnl-2014-306916.64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Beck A, Burdett M, Lewis H. The association between waiting for psychological therapy and therapy outcomes as measured by the CORE-OM. Br J Clin Psychol 2014; 54:233-48. [DOI: 10.1111/bjc.12072] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Revised: 09/19/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Alison Beck
- Psychology and Psychotherapy, South London and Maudsley NHS Foundation Trust; London UK
| | - Mark Burdett
- Psychology and Psychotherapy, South London and Maudsley NHS Foundation Trust; London UK
| | - Helen Lewis
- Psychology and Psychotherapy, South London and Maudsley NHS Foundation Trust; London UK
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Overend K, Lewis H, Bailey D, Bosanquet K, Chew-Graham C, Ekers D, Gascoyne S, Hems D, Holmes J, Keding A, McMillan D, Meer S, Meredith J, Mitchell N, Nutbrown S, Parrott S, Richards D, Traviss G, Trépel D, Woodhouse R, Gilbody S. CASPER plus (CollAborative care in Screen-Positive EldeRs with major depressive disorder): study protocol for a randomised controlled trial. Trials 2014; 15:451. [PMID: 25409776 PMCID: PMC4247639 DOI: 10.1186/1745-6215-15-451] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [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: 07/08/2014] [Accepted: 10/14/2014] [Indexed: 11/25/2022] Open
Abstract
Background Depression accounts for the greatest disease burden of all mental health disorders, contributes heavily to healthcare costs, and by 2020 is set to become the second largest cause of global disability. Although 10% to 16% of people aged 65 years and over are likely to experience depressive symptoms, the condition is under-diagnosed and often inadequately treated in primary care. Later-life depression is associated with chronic illness and disability, cognitive impairment and social isolation. With a progressively ageing population it becomes increasingly important to refine strategies to identity and manage depression in older people. Currently, management may be limited to the prescription of antidepressants where there may be poor concordance; older people may lack awareness of psychosocial interventions and general practitioners may neglect to offer this treatment option. Methods/design CASPER Plus is a multi-centre, randomised controlled trial of a collaborative care intervention for individuals aged 65 years and over experiencing moderate to severe depression. Selected practices in the North of England identify potentially eligible patients and invite them to participate in the study. A diagnostic interview is carried out and participants with major depressive disorder are randomised to either collaborative care or usual care. The recruitment target is 450 participants. The intervention, behavioural activation and medication management in a collaborative care framework, has been adapted to meet the complex needs of older people. It is delivered over eight to 10 weekly sessions by a case manager liaising with general practitioners. The trial aims to evaluate the clinical and cost effectiveness of collaborative care in addition to usual GP care versus usual GP care alone. The primary clinical outcome, depression severity, will be measured with the Patient Health Questionnaire-9 (PHQ-9) at baseline, 4, 12 and 18 months. Cost effectiveness analysis will assess health-related quality of life using the SF-12 and EQ-5D and will examine cost-consequences of collaborative care. A qualitative process evaluation will be undertaken to explore acceptability, gauge the extent to which the intervention is implemented and to explore sustainability beyond the clinical trial. Discussion Results will add to existing evidence and a positive outcome may lead to the commissioning of this model of service in primary care. Trial registration ISRCTN45842879 (24 July 2012).
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Simon Gilbody
- Department of Health Sciences, University of York, Seebohm Rowntree, Building, Heslington, York YO10 5DD, UK.
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