1
|
Grove T, Howell AM, Kontovounisios C, Nicolay C, Mehta A, Warren O. P-012 ESTABLISHING THE NORTH-WEST LONDON MDT FOR COMPLEX ABDOMINAL RECONSTRUCTION: OUR EXPERIENCE. Br J Surg 2022. [DOI: 10.1093/bjs/znac308.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Aim
Complex patients have been shown to have favourable outcomes when managed under the care of the multi-disciplinary teams (MDT) 1,2. In 2019 we published our experience of a single centre complex AWH MDT and advocated its use 3 in line with EHS and a collaborative group from AWRE 2020 4,5.
Expansion
Further development has led to the set-up of a regional, tertiary, complex, abdominal wall reconstruction MDT service. This has facilitated identification of patients who will ultimately benefit from management of the regional AWH MDT surgical teams undertaking the most complex of abdominal wall procedures together.
Since 2021 our regional MDT discussed 87 cases including tertiary referrals from within and out with the immediate geographical area. 71 abdominal wall hernias including 15 recurrent, 6 with concurrent parastomal hernias, 9 parastomal hernias and one perineal hernia.
Progression
The development of virtual conferencing services has allowed the MDT improved access for healthcare professionals. With resources for benign cases becoming increasing restricted, having an MDT approved management plan for patients streamlines services and allows costs to be rationalised. Scheduling joint operations between different hospitals facilitates pooling of expertise for difficult cases.
We are developing an online registry for involved abdominal wall units to allow data sharing, service evaluation and improve accountability.
Conclusion
Appreciation of complex abdominal wall surgery as a stand-alone sub-specialty is increasing and there is a consensus among hernia surgeons that these patients should be managed by the MDT in specialist centres by specialist surgeons enhancing learning, proficiency, and accountability.
Collapse
Affiliation(s)
- T Grove
- Surgery, Chelsea and Westminster Hospital , London , United Kingdom
| | - A M Howell
- Surgery, Chelsea and Westminster Hospital , London , United Kingdom
| | - C Kontovounisios
- Surgery, Chelsea and Westminster Hospital , London , United Kingdom
| | - C Nicolay
- Surgery, Chelsea and Westminster Hospital , London , United Kingdom
| | - A Mehta
- Surgery, St Marks Hospital , London , United Kingdom
| | - O Warren
- Surgery, Chelsea and Westminster Hospital , London , United Kingdom
| |
Collapse
|
2
|
Cutler T, Trellue H, Blood M, Grove T, Luther E, Thompson N, Wynne N. The Hypatia Experiment: Yttrium Hydride and Highly Enriched Uranium Critical Experiment. NUCL TECHNOL 2022. [DOI: 10.1080/00295450.2022.2027146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- T. Cutler
- Los Alamos National Laboratory, Nuclear Engineering and Nonproliferation Division, Los Alamos, New Mexico
| | - H. Trellue
- Los Alamos National Laboratory, Nuclear Engineering and Nonproliferation Division, Los Alamos, New Mexico
| | - M. Blood
- Los Alamos National Laboratory, Nuclear Engineering and Nonproliferation Division, Los Alamos, New Mexico
| | - T. Grove
- Los Alamos National Laboratory, Nuclear Engineering and Nonproliferation Division, Los Alamos, New Mexico
| | - E. Luther
- Los Alamos National Laboratory, Sigma Division, Los Alamos, New Mexico
| | - N. Thompson
- Los Alamos National Laboratory, Nuclear Engineering and Nonproliferation Division, Los Alamos, New Mexico
| | - N. Wynne
- Los Alamos National Laboratory, Nuclear Engineering and Nonproliferation Division, Los Alamos, New Mexico
| |
Collapse
|
3
|
Fukushima M, Goda J, Oizumi A, Bounds J, Cutler T, Grove T, Hayes D, Hutchinson J, McKenzie G, McSpaden A, Sanchez R, Walker J, Tsujimoto K. Systematic Measurements and Analyses for Lead Void Reactivity Worth in a Plutonium Core and Two Uranium Cores with Different Enrichments. NUCL SCI ENG 2019. [DOI: 10.1080/00295639.2019.1663089] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- M. Fukushima
- Japan Atomic Energy Agency, Nuclear Science and Engineering Center, 2-4 Shirane, Shirakata, Tokai-mura, Naka-gun, Ibaraki 319-1195, Japan
| | - J. Goda
- Los Alamos National Laboratory, Nuclear Engineering and Non-Proliferation Division, P.O. Box 1663, Los Alamos, New Mexico 87544
| | - A. Oizumi
- Japan Atomic Energy Agency, Nuclear Science and Engineering Center, 2-4 Shirane, Shirakata, Tokai-mura, Naka-gun, Ibaraki 319-1195, Japan
| | - J. Bounds
- Los Alamos National Laboratory, Nuclear Engineering and Non-Proliferation Division, P.O. Box 1663, Los Alamos, New Mexico 87544
| | - T. Cutler
- Los Alamos National Laboratory, Nuclear Engineering and Non-Proliferation Division, P.O. Box 1663, Los Alamos, New Mexico 87544
| | - T. Grove
- Los Alamos National Laboratory, Nuclear Engineering and Non-Proliferation Division, P.O. Box 1663, Los Alamos, New Mexico 87544
| | - D. Hayes
- Los Alamos National Laboratory, Nuclear Engineering and Non-Proliferation Division, P.O. Box 1663, Los Alamos, New Mexico 87544
| | - J. Hutchinson
- Los Alamos National Laboratory, Nuclear Engineering and Non-Proliferation Division, P.O. Box 1663, Los Alamos, New Mexico 87544
| | - G. McKenzie
- Los Alamos National Laboratory, Nuclear Engineering and Non-Proliferation Division, P.O. Box 1663, Los Alamos, New Mexico 87544
| | - A. McSpaden
- Los Alamos National Laboratory, Nuclear Engineering and Non-Proliferation Division, P.O. Box 1663, Los Alamos, New Mexico 87544
| | - R. Sanchez
- Los Alamos National Laboratory, Nuclear Engineering and Non-Proliferation Division, P.O. Box 1663, Los Alamos, New Mexico 87544
| | - J. Walker
- Los Alamos National Laboratory, Nuclear Engineering and Non-Proliferation Division, P.O. Box 1663, Los Alamos, New Mexico 87544
| | - K. Tsujimoto
- Japan Atomic Energy Agency, Nuclear Science and Engineering Center, 2-4 Shirane, Shirakata, Tokai-mura, Naka-gun, Ibaraki 319-1195, Japan
| |
Collapse
|
4
|
Fukushima M, Goda J, Bounds J, Cutler T, Grove T, Hutchinson J, James M, McKenzie G, Sanchez R, Oizumi A, Iwamoto H, Tsujimoto K. Lead Void Reactivity Worth in Two Critical Assembly Cores with Differing Uranium Enrichments. NUCL SCI ENG 2017. [DOI: 10.1080/00295639.2017.1373520] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- M. Fukushima
- Japan Atomic Energy Agency, Nuclear Science and Engineering Center, 2-4 Shirane, Shirakata, Tokai-mura, Naka-gun, Ibaraki 319-1195, Japan
| | - J. Goda
- Los Alamos National Laboratory, Nuclear Engineering and Non-Proliferation Division, P.O. Box 1663, Los Alamos, New Mexico 87544
| | - J. Bounds
- Los Alamos National Laboratory, Nuclear Engineering and Non-Proliferation Division, P.O. Box 1663, Los Alamos, New Mexico 87544
| | - T. Cutler
- Los Alamos National Laboratory, Nuclear Engineering and Non-Proliferation Division, P.O. Box 1663, Los Alamos, New Mexico 87544
| | - T. Grove
- Los Alamos National Laboratory, Nuclear Engineering and Non-Proliferation Division, P.O. Box 1663, Los Alamos, New Mexico 87544
| | - J. Hutchinson
- Los Alamos National Laboratory, Nuclear Engineering and Non-Proliferation Division, P.O. Box 1663, Los Alamos, New Mexico 87544
| | - M. James
- Los Alamos National Laboratory, Nuclear Engineering and Non-Proliferation Division, P.O. Box 1663, Los Alamos, New Mexico 87544
| | - G. McKenzie
- Los Alamos National Laboratory, Nuclear Engineering and Non-Proliferation Division, P.O. Box 1663, Los Alamos, New Mexico 87544
| | - R. Sanchez
- Los Alamos National Laboratory, Nuclear Engineering and Non-Proliferation Division, P.O. Box 1663, Los Alamos, New Mexico 87544
| | - A. Oizumi
- Japan Atomic Energy Agency, Nuclear Science and Engineering Center, 2-4 Shirane, Shirakata, Tokai-mura, Naka-gun, Ibaraki 319-1195, Japan
| | - H. Iwamoto
- Japan Atomic Energy Agency, Nuclear Science and Engineering Center, 2-4 Shirane, Shirakata, Tokai-mura, Naka-gun, Ibaraki 319-1195, Japan
| | - K. Tsujimoto
- Japan Atomic Energy Agency, Nuclear Science and Engineering Center, 2-4 Shirane, Shirakata, Tokai-mura, Naka-gun, Ibaraki 319-1195, Japan
| |
Collapse
|
5
|
Edwards T, Patel B, Brandford-White H, Banfield D, Woods D, Thayaparan A, Grove T. A review of functional outcomes and union rates in patients with lateral clavicular fractures treated with hook plate fixation. Int J Surg 2016. [DOI: 10.1016/j.ijsu.2016.08.420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
6
|
Abstract
OBJECTIVES To examine changes in the prevalence of smoking in young adult diabetic patients between 1990 and 1999. SETTING Walton Diabetes Centre, University Hospital Aintree, Liverpool, UK. DESIGN Direct questioning as well as the urinary cotinine:creatinine ratio were used to assess the smoking habits of 99 young type 1 diabetic patients in 1991 (mean age 21.5 years, duration of diabetes 7.3 years), and in 112 similar patients in 1999 (mean age 23.4 years, duration of diabetes 9.6 years). RESULTS The admitted smoking rate was 31/99 (31%) in 1990 compared with 31/112 (28%) in 1999 (not significant). However, in 1990 there were an additional 17 "covert" smokers (patients who denied smoking, but had an unequivocally raised urinary cotinine:creatinine ratio), but only three in 1999 (p<0.05). This gave a corrected validated smoking rate of 48/99 (48%) in 1990 and 34/112 (30%) in 1999, representing a significant fall (p<0.02). CONCLUSION Smoking rates in young type 1 diabetic patients appear to have fallen during the last decade, and reporting of smoking behaviour is now more honest.
Collapse
Affiliation(s)
- I MacFarlane
- Department of Diabetes and Endocrinology, University Hospital Aintree, Liverpool L9 1AE, UK
| | | | | | | |
Collapse
|
7
|
Celum CL, Coombs RW, Lafferty W, Inui TS, Louie PH, Gates CA, McCreedy BJ, Egan R, Grove T, Alexander S. Indeterminate human immunodeficiency virus type 1 western blots: seroconversion risk, specificity of supplemental tests, and an algorithm for evaluation. J Infect Dis 1991; 164:656-64. [PMID: 1894929 DOI: 10.1093/infdis/164.4.656] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The human immunodeficiency virus type 1 (HIV-1) Western blot is indeterminate in 10%-20% of sera reactive by EIA. Eighty-nine individuals with prior repeatedly reactive EIA and indeterminate Western blots were followed prospectively to study the risk of seroconversion and specificity of supplemental tests. Four high-risk cases seroconverted within 10 months after enrollment (seroconversion risk, 4.5%, 95% confidence interval, 1.2%-11.1%). Among cases with p24 bands initially, 4 (18.2%) of 22 high-risk individuals seroconverted compared with 0 of 33 low-risk cases (P = .03). Specificities of HIV-1 culture, serum p24 antigen, polymerase chain reaction, and recombinant ENV 9 EIA were 100%, 100%, 98.6%, and 94.4%, respectively. An expedited evaluation protocol is proposed. Low-risk individuals with nonreactive EIAs upon repeat testing do not need further follow-up; high-risk individuals should be followed serologically for at least 6 months, especially those with p24 bands on Western blot.
Collapse
Affiliation(s)
- C L Celum
- Department of Medicine, University of Washington, Seattle
| | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Chiang CS, Grove T, Cooper M, Cuan J, Kowalski A, Parcells K, Tsunokawa M, Rosenberg M, Arcuri E, Franklin S. Development of a confirmatory enzyme-linked immunosorbent assay for HIV-1 antibodies. Clin Chem 1989; 35:946-52. [PMID: 2659223] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
We subcloned six discrete protein-coding regions representing the gag (Kp24 and Kp55), env (Kp41, Kp120N, and Kp120CC), and pol (Kp66/31) gene products of the human immunodeficiency virus type 1 (HIV-1) and expressed them in Escherichia coli as fusion proteins with the first 56 residues of galactokinase. An enzyme-linked immunosorbent assay for confirming the presence of HIV-1 antibodies was developed by coating the six purified antigens on individual wells of a microtiter plate (the HIVAGEN assay). This assay yielded no false-negative results and fewer indeterminate results than the Western blot assay for 143 specimens from patients with acquired immunodeficiency syndrome (AIDS) or AIDS-related complex (ARC). Analysis of 1016 specimens from seronegative donors by the HIVAGEN assay yielded no false-positive results, and the rate of indeterminate results was substantially lower than for the Western blot assay. The HIVAGEN assay is well suited for routine confirmation of the presence of HIV-1 antibodies because it is objective, quantitative, rapid, precise, and readily automatable.
Collapse
Affiliation(s)
- C S Chiang
- SmithKline Bio-Science Laboratories, Van Nuys, CA 91405
| | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Chiang CS, Grove T, Cooper M, Cuan J, Kowalski A, Parcells K, Tsunokawa M, Rosenberg M, Arcuri E, Franklin S. Development of a confirmatory enzyme-linked immunosorbent assay for HIV-1 antibodies. Clin Chem 1989. [DOI: 10.1093/clinchem/35.6.946] [Citation(s) in RCA: 11] [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: 11/12/2022]
Abstract
Abstract
We subcloned six discrete protein-coding regions representing the gag (Kp24 and Kp55), env (Kp41, Kp120N, and Kp120CC), and pol (Kp66/31) gene products of the human immunodeficiency virus type 1 (HIV-1) and expressed them in Escherichia coli as fusion proteins with the first 56 residues of galactokinase. An enzyme-linked immunosorbent assay for confirming the presence of HIV-1 antibodies was developed by coating the six purified antigens on individual wells of a microtiter plate (the HIVAGEN assay). This assay yielded no false-negative results and fewer indeterminate results than the Western blot assay for 143 specimens from patients with acquired immunodeficiency syndrome (AIDS) or AIDS-related complex (ARC). Analysis of 1016 specimens from seronegative donors by the HIVAGEN assay yielded no false-positive results, and the rate of indeterminate results was substantially lower than for the Western blot assay. The HIVAGEN assay is well suited for routine confirmation of the presence of HIV-1 antibodies because it is objective, quantitative, rapid, precise, and readily automatable.
Collapse
Affiliation(s)
- C S Chiang
- SmithKline Bio-Science Laboratories, Van Nuys, CA 91405
| | - T Grove
- SmithKline Bio-Science Laboratories, Van Nuys, CA 91405
| | - M Cooper
- SmithKline Bio-Science Laboratories, Van Nuys, CA 91405
| | - J Cuan
- SmithKline Bio-Science Laboratories, Van Nuys, CA 91405
| | - A Kowalski
- SmithKline Bio-Science Laboratories, Van Nuys, CA 91405
| | - K Parcells
- SmithKline Bio-Science Laboratories, Van Nuys, CA 91405
| | - M Tsunokawa
- SmithKline Bio-Science Laboratories, Van Nuys, CA 91405
| | - M Rosenberg
- SmithKline Bio-Science Laboratories, Van Nuys, CA 91405
| | - E Arcuri
- SmithKline Bio-Science Laboratories, Van Nuys, CA 91405
| | - S Franklin
- SmithKline Bio-Science Laboratories, Van Nuys, CA 91405
| |
Collapse
|