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1. Planned Versus Bailout Rotational Atherectomy: A Systematic Review and Meta-Analysis

Author: Saul Lovatt, Josip Anđelo Borovac, Konstantin Schwarz, Chun Shing Kwok, and Sathish Parasuraman
Subjects: Atherectomy, Coronary, medicine.medical_specialty, Myocardial Infarction, Target vessel revascularization, Coronary Artery Disease, Rotational atherectomy, Coronary artery disease, Internal medicine, medicine, Humans, Stent thrombosis, Vascular Calcification, Stroke, Retrospective Studies, business.industry, General Medicine, medicine.disease, R1, Confidence interval, Treatment Outcome, Meta-analysis, Relative risk, Cardiology, Stents, Cardiology and Cardiovascular Medicine, business, percutaneous coronary intervention, PCI, rotational atherectomy, planned, bailout, periprocedural outcomes, calcification, coronary artery disease, rotablation
Abstract: Background/purpose Rotational atherectomy (RA) plays a central role in the treatment of heavily calcified coronary artery lesions. Our aim was to compare periprocedural characteristics and outcomes of planned (PA) vs. bailout (BA) rotational atherectomy. Methods We conducted a systematic review and performed a meta-analysis on studies which compared PA vs. BA strategy. Results Five studies fulfilled the inclusion criteria, pooling a total of 2120 patients. There was no difference in procedural success, PA vs. BA risk ratio (RR) 1.03 and 95% confidence interval (95% CI) 0.99–1.07. Compared to BA, PA was associated with a shorter procedural time [mean difference (MD) -25.88 min, 95% CI -35.55 to −16.22], less contrast volume (MD -43.71 ml, 95% CI -69.17 to −18.25), less coronary dissections (RR 0.50, 95% CI 0.26–0.99), fewer stents (MD -0.20, 95% CI -0.29 to −0.11), and a trend favouring less periprocedural myocardial infarctions (MI) (RR 0.77, 95% CI 0.54–1.11). There was no difference in major adverse cardiovascular events on follow-up (RR 1.04, 95% CI 0.62–1.74), death (RR 0.98, 95% CI 0.59–1.64), MI (RR 1.16, 95% CI 0.62–2.18), target vessel revascularization (RR 1.40, 95% CI 0.83 to 2.36), stroke (RR 1.50, 95% CI 0.46–4.86) or stent thrombosis (RR 0.82, 95% CI 0.06–10.74); all PA vs. BA comparisons. Conclusions Compared to bailout RA, planned RA resulted in significantly shorter procedural times, less contrast use, lesser dissection rates and fewer stents used. The bailout RA approach appears to enhance periprocedural risk, but there is no difference on mid-term outcomes.
Published: 2022
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2. Patient and Public Involvement in research: A journey to co-production

Author: Larry F. Chu, Doreen Tembo, Yasmine Nelken, Marjorie Kirkpatrick, Sophie Staniszewska, Amy Price, and Mike Clarke
Subjects: business.industry, Psychological intervention, General Medicine, Public relations, Health benefits, Public involvement, R1, Research Personnel, Knowledge, Work (electrical), General partnership, Health care, Humans, Production (economics), Health Services Research, Patient Participation, business, Psychology, Commons, Referral and Consultation, RA
Abstract: The public and patients can be powerful sensors for shaping and powering healthcare research. They are joining research teams as investigators and collaborators to co-produce evidence for the practical use of interventions in clinical practice. While clinicians and researchers are encouraged by funders and policymakers to involve the public and patients as partners in research, knowledge on what involvement consists of is limited, and the continuum between consultation, collaboration and co-production are not clearly defined. In this article, we explore Patient and Public Involvement (PPI) and introduce greater involvement through research co-production. Co-production describes ways that research partnership can work through public and patient involvement and we outline the similarities of co-production to "The Commons", a strategy utilized by economists to increase effective use of resources. We share examples of how public and patient involvement have used co-production, to demonstrate financial and health benefits. We then outline practical challenges at system, social and cultural levels and consider how others have worked to resolve them. [Abstract copyright: Copyright © 2021 Elsevier B.V. All rights reserved.]
Published: 2022
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3. Associations between partial foot amputation level, gait parameters, and minimum impairment criteria in para-sport: A research study protocol

Author: Sean O'Connor, Dina Christa Janse van Rensburg, Samuel Williamson, Babette M Pluim, Fábio C. Lucas de Oliveira, Marleen G.T. Jansen, Linda J. Schoonmade, Jane S Thornton, Neil Heron, and Clare L Ardern
Subjects: medicine.medical_specialty, medicine.medical_treatment, Physical Therapy, Sports Therapy and Rehabilitation, CINAHL, RC1200, Physical medicine and rehabilitation, Wheelchair, Amputees, Medicine, Orthopedics and Sports Medicine, Set (psychology), Congenital deficiency, Protocol (science), business.industry, Paralympic sport, R1, Gait, Wheelchair tennis, Systematic review, Amputation, Gait analysis, Partial foot amputation, business, human activities, RC
Abstract: Altered biomechanics due to amputation can contribute to substantial limitations, influencing sporting activities. Individuals with lower extremity amputations or congenital lower limb deficiency are encouraged to participate in para-sports. However, to compete in Paralympic sports, the candidate must have an impairment that results in lower extremity loss of function and meets or exceeds the sport's minimum impairment criteria (MIC). This review will focus on the MIC for competitive wheelchair tennis. Limb deficiency is known as one of the MIC used to regulate participation in competitive para-sports since it impacts gait, kinematics, and biomechanics of both the upper and lower body. Notwithstanding, it is questionable whether the MIC concerning limb deficiency is set at the correct level for determining eligibility for participating in Paralympic sports. This study aims to provide an overview of the evidence examining the impact of different partial foot amputation (PFA) levels on gait as a proxy for sporting performance. This scoping review will be based on a 6-step methodological framework and Preferred Reporting Items for Systematic Reviews and Meta-Analysis, extension for scoping reviews (PRISMA-ScR). Studies will be selected from PubMed, Embase, CINAHL, and SPORTDiscus. Two authors will screen the titles/abstracts independently. Selected studies will be scrutinised, and the same authors will extract data. Findings will be relevant to informing the evidence-based development of MIC for lower limb impairment after PFA and may be extrapolated to specific Paralympic sports, including wheelchair tennis. Results will be disseminated through scientific publications and conferences to audiences interested in Paralympic sports.
Published: 2022
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4. Osteoarthritis year in review 2021: epidemiology & therapy

Author: P.G. Conaghan, Jonathan G Quicke, George Peat, and Nadia Corp
Subjects: Longitudinal study, medicine.medical_specialty, Biomedical Engineering, Context (language use), Comorbidity, Osteoarthritis, Global Health, law.invention, RC925, Rheumatology, Randomized controlled trial, RA0421, law, Internal medicine, Epidemiology, medicine, Humans, Orthopedics and Sports Medicine, Disease burden, business.industry, Incidence, Anti-Inflammatory Agents, Non-Steroidal, COVID-19, Disease Management, medicine.disease, R1, Canakinumab, business, RA, medicine.drug
Abstract: This “Year in review” presents a selection of research themes and individual studies from the clinical osteoarthritis (OA) field (epidemiology and therapy) and includes noteworthy descriptive, analytical-observational, and intervention studies. The electronic database search for the review was conducted in Medline, Embase and medRxiv (15th April 2020 to 1st April 2021). Following study screening, the following OA-related themes emerged: COVID-19; disease burden; occupational risk; prediction models; cartilage loss and pain; stem cell treatments; novel pharmacotherapy trials; therapy for less well researched OA phenotypes; benefits and challenges of Individual Participant Data (IPD) meta-analyses; patient choice- balancing benefits and harms; OA and comorbidity; and inequalities in OA. Headline study findings included: a longitudinal cohort study demonstrating no evidence for a harmful effect of non-steroidal anti-inflammatory drugs (NSAIDs) in terms of COVID-19 related deaths; a Global Burden of Disease study reporting a 102% increase in crude incidence rate of OA in 2017 compared to 1990; a longitudinal study reporting cartilage thickness loss was associated with only a very small degree of worsening in pain over 2 years; an exploratory analysis of a non-OA randomised controlled trial (RCT) finding reduced risk of total joint replacement with an Interleukin -1β inhibitor (canakinumab); a significant relationship between cumulative disadvantage and clinical outcomes of pain and depression mediated by perceived discrimination in a secondary analysis from a RCT; worsening socioeconomic circumstances were associated with future arthritis diagnosis in an innovative natural experiment (with implications for unique research possibilities arising from the COVID-19 pandemic context).
Published: 2022
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5. Essential Features of an Interstitial Lung Disease Multidisciplinary Meeting An International Delphi Survey

Author: Alan K. Y. Teoh, Anne E. Holland, Julie Morisset, Kevin R. Flaherty, Athol U. Wells, Simon L. F. Walsh, Ian Glaspole, Wim A. Wuyts, Tamera J. Corte, Huzaifa Adamali, J. Shirine Allam, Sofia Antillon, Katherina M. Antoniou, Rodrigo Athanazio, Sergey Avdeev, Alexander Averyanov, Arata Azuma, Bruno Baldi, Elisabetta Balestro, Rebecca Bascom, Shalini Bastiampillai, Lutz Beckert, Jü¨ergen Behr, Paul Beirne, David Bennett, Raphael Borie, Demosthenes Bouros, Ben Brockway, Kevin Brown, Francisco Javier Callejas González, Diego Castillo, Ronald Chacon Chaves, Daniel Chambers, Sally Chapman, Nazia Chaudhuri, Harold Collard, Vincent Cottin, Bruno Crestani, Jesper Rømhild Davidsen, Devesh J. Dhasmana, Sahajal Dhooria, Juan Ignacio Enghelmayer, Alexandre Todorovic Fabro, Puneet Garcha, Nicole Goh, Alejandro Gomez, Christopher Grainge, Tomohiro Handa, Tristan Huie, Gary Hunninghake, Yoshikazu Inoue, Helen Jo, Kerri Johannson, Rene Jonkers, Eoin Judge, Yasemin Kabasakal, Leticia Kawano Dourado, Gregory Keir, Nasreen Khalil, Yet Hong Khor, Melissa King Biggs, Maria Kokosi, Yasuhiro Kondoh, Vasillis Kouranos, Michael Kreuter, David Lederer, Su Ying Low, Joachim Mü¨ller Quernheim, Toby Maher, Eliane Mancuzo, George Margaritopoulos, Carol Mason, Mariano Mazeini, Nesrin Mogulkoc, Maria Molina, Yuben Moodley, António Morais, Anoop Nambiar, Imre Noth, Hilario Nunes, Takashi Ogura, Oguzhan Okutan, Nina Patel, Carlos Pereira, Wojciech Piotrowski, Venerino Poletti, Silvia Quadrelli, Elzbieta Radzikowska, Pilar Rivera Ortega, Christopher J. Ryerson, Mauricio Salinas, Rafaela Sanchez, Recep Savas, Moises Selman, Adrian Shifren, Maria Raquel Soares, Eman Sobh, Jin Woo Song, Paolo Spagnolo, Martina Sterclova, Irina Strambu, Mary E. Strek, Takafumi Suda, Gabriela Tabaj, Jasna Tekavec Trkanjec, Fatma Tokgoz Akyil, Claudia Toma, Rade Tomic, Hiromi Tomioka, Daniel Traila, Lauren Troy, Sergio Trukillo, Argyrios Tzouvelekis, Carlo Vancheri, Brenda Elena Varela, Francesco Varone, Martina Vasakova, Elizabeth Veitch, Vanesa Vicens Zygmunt, Thomas Wessendorf, Glen Westall, Marlies Wijsenbeek, Margaret L. Wilsher, Jeremy Wrobel, Cesar Yoshito Fukuda, Chris Zappala, Pulmonary Medicine, University of St Andrews. School of Medicine, University of St Andrews. Infection and Global Health Division, AII - Amsterdam institute for Infection and Immunity, Pulmonology, and AII - Inflammatory diseases
Subjects: Pulmonary and Respiratory Medicine, PNEUMONIA, medicine.medical_specialty, Respiratory System, Delphi method, NDAS, Interstitial lung disease, THORACIC SOCIETY, R Medicine (General), DIAGNOSIS, behavioral disciplines and activities, Delphi, 03 medical and health sciences, 0302 clinical medicine, Lung diseases, interstitial/diagnosis, Multidisciplinary approach, Delphi technique, Medicine, Humans, CRITERIA, Medical physics, 030212 general & internal medicine, Pulmonologists, Essential features, Science & Technology, business.industry, STATEMENT, respiratory system, medicine.disease, R1, respiratory tract diseases, body regions, surgical procedures, operative, 030228 respiratory system, AGREEMENT, Multidisciplinary meeting, business, Surveys and questionnaires, CONSENSUS, Life Sciences & Biomedicine
Abstract: Supported by the National Health and Medical Research Council Centre of Research Excellence in Pulmonary Fibrosis (GNT1116371), and by foundation partner, Boehringer Ingelheim, and program partners, Roche and Galapagos. Rationale : The interstitial lung disease (ILD) multidisciplinary meetings (MDM), composed of pulmonologists, radiologists, and pathologists, is integral to the rendering of an accurate ILD diagnosis. However, there is significant heterogeneity in the conduct of ILD MDMs, and questions regarding their best practices remain unanswered. Objectives : To achieve consensus among ILD experts on essential components of an ILD MDM. Methods : Using a Delphi methodology, semi-structured interviews with ILD experts were used to identify key themes and features of ILD MDMs. These items informed two subsequent rounds of online questionnaires that were used to achieve consensus among a broader, international panel of ILD experts. Experts were asked to rate their level of agreement on a five-point Likert scale. An a priori threshold for consensus was set at a median score 4 or 5 with an interquartile range of 0. Results : We interviewed 15 ILD experts, and 102 ILD experts participated in the online questionnaires. Five items and two exploratory statements achieved consensus on being essential for an ILD MDM following two questionnaire rounds. There was consensus that the presence of at least one radiologist, a quiet setting with a visual projection system, a high-quality chest high-resolution computed tomography, and a standardized template summarizing collated patient data are essential components of an ILD MDM. Experts also agreed that it would be useful for ILD MDMs to undergo an annual benchmarking process and a validation process by fulfilling a minimum number of cases annually. Twenty-seven additional features were considered to be either highly desirable or desirable features based on the degree of consensus. Although our findings on desirable features are similar to the current literature, several of these remain controversial and warrant further research. The study also showed an agreement among participants on several future concepts to improve the ILD MDM, such as performing regular self-assessments and conducting research into shared practices to develop an international expert guideline statement on ILD MDMs. Conclusions : This Delphi study showed consensus among international ILD experts on essential and desirable features of an ILD MDM. Our data represent an important step toward potential collaborative research into future standardization of ILD MDMs. Postprint
Published: 2022
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6. Liverpool LASER Talks: A Community 'Studio-Laboratory'?

Author: Caroline Wilkinson and Mark Roughley
Subjects: Engineering, Visual Arts and Performing Arts, business.industry, N1, Q1, Laser, R1, Computer Science Applications, law.invention, Visual arts, law, NX, NC, business, Engineering (miscellaneous), Music, Studio
Abstract: Liverpool LASER talks encourage artists, researchers and the public to question the work carried out by artists and scientists in transdisciplinary art-science spaces by recognizing shared aims, examining processes and constructing a shared language. In this paper, the authors reflect upon their first year as LASER hosts and propose that Liverpool LASER events—supported by an accessible network of leading artists and scientists—act as community “studio-laboratories,” spaces where speakers and publics engage in two-way conversations, present and gain confidence in their ideas, gather feedback on new concepts and outputs, and facilitate knowledge transfer.
Published: 2022
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7. Racial Disparities in Management and Outcomes of Out-of-Hospital Cardiac Arrest Complicating Myocardial Infarction: A National Study From England and Wales

Author: Muhammad Rashid, Purvi Parwani, Michelle M. Graham, Triston B. B. J. Smith, Mohamed Dafaalla, Rachel M. Bond, Saadiq M Moledina, Ritu Thamman, and Mamas A. Mamas
Subjects: medicine.medical_specialty, business.industry, Cardiogenic shock, Ethnic group, RC666, medicine.disease, Logistic regression, R1, Out of hospital cardiac arrest, RA0421, RC666-701, Internal medicine, medicine, National study, Diseases of the circulatory (Cardiovascular) system, Original Article, In patient, Myocardial infarction, Cardiology and Cardiovascular Medicine, business, National audit, RA
Abstract: Background Studies of racial disparities in care of patients admitted with an out-of-hospital cardiac arrest (OHCA) in the setting of acute myocardial infarction (AMI) have shown inconsistent results. Whether these differences in care exist in the universal healthcare system in United Kingdom is unknown. Methods Patients admitted with a diagnosis of AMI and OHCA between 2010 and 2017 from the Myocardial Ischaemia National Audit Project (MINAP) were studied. All patients were stratified based on ethnicity into a Black, Asian, or minority ethnicity (BAME) group vs a White group. We used multivariable logistic regression models to evaluate the predictors of clinical outcomes and treatment strategy. Results From 14,287 patients admitted with AMI complicated by OHCA, BAME patients constituted a minority of patients (1185 [8.3%]), compared with a White group (13,102 [91.7%]). BAME patients were younger (median age [interquartile range]) for BAME group, 58 [50-70] years; for White group, 65 [55-74] years). Cardiogenic shock (BAME group, 33%; White group, 20.7%; P < 0.001) and severe left ventricular impairment (BAME group, 21%; White group, 16.5%; P < 0.003) were more frequent among BAME patients. BAME patients were more likely to be seen by a cardiologist (BAME group, 95.9%; White group, 92.5%; P < 0.001) and were more likely to receive coronary angiography than the White group (odds ratio [OR] 1.5, 95% confidence interval [CI] 1.2-1.88). The BAME group had significantly higher in-hospital mortality (OR 1.26, 95% CI 1.04-1.52) and re-infarction (OR 1.52, 95% CI 1.06-2.18) than the White group. Conclusions BAME patients were more likely to be seen by a cardiologist and receive coronary angiography than White patients. Despite this difference, the in-hospital mortality of BAME patients, particularly in the Asian population, was significantly higher., Graphical abstract
Published: 2021
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8. Susceptibility vessel sign as a predictor for recanalization and clinical outcome in acute ischaemic stroke: A systematic review and meta-analysis

Author: Yong Geng Goh, Jon Sen, Si Zhao Tang, and Gopinathan Anil
Subjects: medicine.medical_specialty, medicine.medical_treatment, Brain Ischemia, Physiology (medical), Internal medicine, Ischaemic stroke, medicine, Humans, In patient, Ischemic Stroke, business.industry, General Medicine, Thrombolysis, Magnetic Resonance Imaging, R1, Stroke, Mechanical thrombectomy, Pooled analysis, Neurology, Meta-analysis, Reperfusion, Cardiology, Surgery, Neurology (clinical), business, RC
Abstract: Objective To assess the prognostic values of susceptibility vessel sign (SVS) on T2*-weighted MRI using GRE and SWI sequences for recanalization status and clinical outcomes in patients with acute ischaemic stroke undergoing different therapies. Methods Literature search on PubMed, EMBASE databases and other sources from inception up to 01 June 2021 was conducted. 11 studies which reported SVS, recanalization and clinical outcomes were included in qualitative synthesis and meta-analysis. Results Pooled analysis demonstrated significant association between good clinical outcome and SVS-positive patients who underwent mechanical thrombectomy (RR = 1.34, 95% CI = 1.07–1.67, p = 0.01), which is in line with higher recanalization rate in SVS-positive patients who were treated with mechanical thrombectomy compared to intravenous thrombolysis only. No statistically significant association was demonstrated between presence of SVS and successful recanalization, likely due to limitations in the recruited studies. Conclusions Presence of SVS in patients with acute ischaemic stroke who underwent mechanical thrombectomy is associated with good clinical outcome. SVS-positive patients treated with mechanical thrombectomy also shows better recanalization rate comparing to intravenous thrombolysis only, although not statistically significant. MRI assessment of the clot content using SVS is useful in selection of reperfusion strategy for acute ischaemic stroke and prognostication.
Published: 2021
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9. Experiencing a virtual patient to practice patient counselling skills

Author: Stephen J. Chapman, Simon D. M. White, and Charlotte Lucy Richardson
Subjects: Counseling, LB2300, education, Pharmacy, Pharmacists, Experiential learning, Virtual patient, Health care, Humans, Learning, General Pharmacology, Toxicology and Pharmaceutics, Medical education, business.industry, R735, Problem-Based Learning, L1, R1, Patient counselling, Adjunct, LB, Clinical Competence, Thematic analysis, business, Psychology, Patient education
Abstract: Introduction Virtual patients (VPs) are a safe and standardised method of simulating clinical environments but few studies have explored health care professional's experiences of learning via a VP. This study explored how users experienced and used a VP that aimed to teach the user to deliver non-vitamin K oral anticoagulant patient education. Methods The study used semi-structured interviews with pharmacists and pre-registration trainees from a wider research study. Interview topics were based on key areas concerning VP use. Interviews were audio-recorded and transcribed verbatim before being analysed using the framework approach to thematic analysis. Ethical approval was granted by Keele University. Results There was variation in the type and nature of use of the VP and in the reported learning, which included reinforcement of knowledge, an opportunity to promote reflection, and acquisition and application of knowledge to clinical, patient-facing interactions. The VP was seen as an adjunct to other education and training. The majority of users indicated that they used the VP more than once. Some users seemed to have gamified their learning with a drive to achieve perfect feedback rather than true engagement with the learning, whereas for others the learning appeared to be deep with a reflective focus. Conclusions The VP offered an educational use as experiential learning, although the users experienced the VP differently; commonly the VP facilitated learning via reinforcement of pre-existing knowledge. The users reported that the VP had value as an adjunct to other education and training resources.
Published: 2021
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10. Pre-hospital transdermal glyceryl trinitrate in patients with stroke mimics: data from the RIGHT-2 randomised-controlled ambulance trial

Author: Bronwyn Tunnage, Lisa J. Woodhouse, Mark Dixon, Craig Anderson, Sandeep Ankolekar, Jason Appleton, Lesley Cala, Timothy England, Kailash Krishnan, Diane Havard, Grant Mair, Keith Muir, Steve Phillips, John Potter, Christopher Price, Marc Randall, Thompson G. Robinson, Christine Roffe, Else Sandset, Niro Siriwardena, Polly Scutt, Joanna M. Wardlaw, Nikola Sprigg, Philip M. Bath, and on behalf of the RIGHT-2 Investigators
Subjects: Adult, A300 Clinical Medicine, Ambulances, Ambulance, Glyceryl trinitrate, Brain Ischemia, Nitroglycerin, Seizures, RA0421, Medicine, Humans, In patient, Paramedic, Prospective Studies, Migraine, Aged, RC86-88.9, business.industry, RC952-1245, Stroke mimics, Transdermal glyceryl trinitrate, R735, Medical emergencies. Critical care. Intensive care. First aid, RC346, R1, Hospitals, Stroke, Treatment Outcome, Special situations and conditions, Anesthesia, B780 Paramedical Nursing, Emergency Medicine, Functional stroke, business, RA, Mimic, Research Article
Abstract: Background Prehospital stroke trials will inevitably recruit patients with non-stroke conditions, so called stroke mimics. We undertook a pre-specified analysis to determine outcomes in patients with mimics in the second Rapid Intervention with Glyceryl trinitrate in Hypertensive stroke Trial (RIGHT-2). Methods RIGHT-2 was a prospective, multicentre, paramedic-delivered, ambulance-based, sham-controlled, participant-and outcome-blinded, randomised-controlled trial of transdermal glyceryl trinitrate (GTN) in adults with ultra-acute presumed stroke in the UK. Final diagnosis (intracerebral haemorrhage, ischaemic stroke, transient ischaemic attack, mimic) was determined by the hospital investigator. This pre-specified subgroup analysis assessed the safety and efficacy of transdermal GTN (5 mg daily for 4 days) versus sham patch among stroke mimic patients. The primary outcome was the 7-level modified Rankin Scale (mRS) at 90 days. Results Among 1149 participants in RIGHT-2, 297 (26%) had a final diagnosis of mimic (GTN 134, sham 163). The mimic group were younger, mean age 67 (SD: 18) vs 75 (SD: 13) years, had a longer interval from symptom onset to randomisation, median 75 [95% CI: 47,126] vs 70 [95% CI:45,108] minutes, less atrial fibrillation and a lower systolic blood pressure and Face-Arm-Speech-Time tool score than the stroke group. The three most common mimic diagnoses were seizure (17%), migraine or primary headache disorder (17%) and functional disorders (14%). At 90 days, the GTN group had a better mRS score as compared to the sham group (adjusted common odds ratio 0.54; 95% confidence intervals 0.34, 0.85; p = 0.008), a difference that persisted at 365 days. There was no difference in the proportion of patients who died in hospital, were discharged to a residential care facility, or suffered a serious adverse event. Conclusions One-quarter of patients suspected by paramedics to have an ultra-acute stroke were subsequently diagnosed with a non-stroke condition. GTN was associated with unexplained improved functional outcome observed at 90 days and one year, a finding that may represent an undetected baseline imbalance, chance, or real efficacy. GTN was not associated with harm. Trial registration This trial is registered with International Standard Randomised Controlled Trials Number ISRCTN 26986053.
Published: 2022
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11. Testosterone Therapy: Increase in Hematocrit is Associated with Decreased Mortality

Author: Sudarshan Ramachandran, Carola S. König, Amro Maarouf, Karim Sultan Haider, Farid Saad, Pieter Desnerck, Nathan Lorde, Geoff Hackett, Richard C. Strange, A Haider, and Adeeba Ahmed
Subjects: medicine.medical_specialty, medicine.diagnostic_test, business.industry, hematocrit, Ocean Engineering, Testosterone (patch), hemoglobin, Hematocrit, mortality, R1, surgical procedures, operative, Endocrinology, immune system diseases, RA0421, hemic and lymphatic diseases, Internal medicine, medicine, testosterone therapy, adult-onset hypogonadism, business, RA
Abstract: Copyright © Richard C. Strange et al., 2021. Objective: Testosterone therapy (TTh) may reduce morbidity/mortality in men with adult-onset testosterone deficiency (TD), though some cardiovascular safety concerns remain. Increased hematocrit (HCT), a recognized effect of therapy, may be associated with cardiovascular disease and mortality. We examined HCT change (Δ) in men prescribed/not prescribed testosterone, and associations with mortality. Methods: We analyzed data from a prospective registry study with adult-onset TD patients: 353 men given testosterone undecanoate (TU) and 384 opting against TTh. Change in HCT after 12, 48, 72, and 96 months of TU and at final assessment was compared (nonparametric tests). The association between baseline HCT, ΔHCT, and mortality was studied using logistic and Cox regression. Results: HCT increased significantly (median change at final assessment: +5.0%) in men on TTh. HCT was higher (p = 0.021, rank-sum test) in those alive than in those who died, although median values were identical (49.0%). Baseline HCT and ΔHCT were inversely associated with mortality after adjustment for age in both logistic and Cox regression models. Men with final HCT >49.0% (median) suffered lower mortality than men with HCT ≤49.0%. Conclusions: A median HCT increase of 5.0% was associated with TTh, mostly within 48 months of commencing therapy. An increase in HCT (up to 52.0% at final assessment) was independently associated with reduced mortality, indicating current guidelines using a HCT value of 54.0% as a threshold for management change are appropriate until further study. No funding was received for this article.
Published: 2021
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12. Does statin-treated hyperlipidemia affect rotator cuff healing or muscle fatty infiltration after rotator cuff repair?

Author: Priyadarshi Amit, Steven James, Martyn Snow, and Jan Herman Kuiper
Subjects: medicine.medical_specialty, Statin, medicine.drug_class, Elbow, Hyperlipidemias, Rotator Cuff Injuries, Rotator Cuff, RC925, Dash, Hyperlipidemia, medicine, Humans, Orthopedics and Sports Medicine, In patient, Rotator cuff, medicine.diagnostic_test, business.industry, Magnetic resonance imaging, General Medicine, medicine.disease, R1, United States, Surgery, Treatment Outcome, medicine.anatomical_structure, Fatty infiltration, Hydroxymethylglutaryl-CoA Reductase Inhibitors, business
Abstract: Hyperlipidemia is linked to poor tendon-to-bone healing and progression of fatty infiltration after rotator cuff repair. Statins effectively treat hyperlipidemia, but it is unknown if they have any potential detrimental effects following rotator cuff repair. The aim of this study was to evaluate the effect of statins on rotator cuff healing and fatty infiltration following repair.A total of 77 patients undergoing arthroscopic rotator cuff repair were recruited prospectively, 38 patients who were prescribed a statin for hyperlipidemia (statin group) and 39 patients who were not taking a statin (control group). Patients who did not have both preoperative and 1-year postoperative magnetic resonance imaging (MRI) scans were excluded from the study. Patient-reported outcome measures, namely the Western Ontario Rotator Cuff (WORC) index, Constant-Murley score, American Shoulder and Elbow Surgeons (ASES) score, and Disabilities of the Arm, Shoulder and Hand (DASH) score, were collected preoperatively and at 1 year. Fatty infiltration was assessed on MRI according to the Goutallier grade preoperatively and at 12 months; rotator cuff healing was assessed at 12 months according to the Sugaya classification. Following propensity score weighting to adjust for baseline imbalances, 12-month outcomes were compared between the 2 groups.At 12 months, all patient-reported outcome measures had improved significantly compared with baseline (WORC score, 85.9 vs. 32.5, P.001; ASES score, 87.3 vs. 37.5, P.001; Constant-Murley score, 77 vs. 31, P.001; and DASH score, 13.6 vs. 61.4, P.001). There was no significant difference in postoperative scores in the statin group vs. the control group (WORC score, 84.9 vs. 89.6, P = .94; ASES score, 87.5 vs. 86.6, P = .40; Constant-Murley score, 77 vs. 81, P = .90; and DASH score, 14.4 vs. 11.4, P = .14), and for 3 of these scores, the 95% confidence intervals excluded a clinically meaningful difference. Similarly, rotator cuff healing at 12 months and Goutallier fatty infiltration grades were comparable between the 2 groups. Retears were seen in 6 patients (15.8%) in the statin group and 8 (20.5%) in the control group. Progression of fatty infiltration was seen in 4 patients (10.5%) in the statin and 4 (10.3%) in the control group. Statin use did not demonstrate a significant association with either retear risk (P = .41) or progression of fatty atrophy (P = .69).Patient-reported outcomes, rotator cuff retear rate, and fatty infiltration on MRI at 12 months after rotator cuff repair in patients with hyperlipidemia treated with statins are similar to those in a control group.
Published: 2021
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13. Renal Doppler indices and their correlation with laboratory indices of human immunodeficiency virus sero-positive adult individuals

Author: Andrew England, Mohammed Sidi, P.O. Manafa, Mohammed Kabir Saleh, Anas Ya’u, Joseph Dlama Zira, Abdu Hamisu Dambatta, Anthony Chukwuka Ugwu, and Umar Mansur
Subjects: Adult, Male, medicine.medical_specialty, Medullary pyramid, Human immunodeficiency virus (HIV), Renal function, medicine.disease_cause, Gastroenterology, 030218 nuclear medicine & medical imaging, RC902, Correlation, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Internal medicine, Humans, Medicine, Radiology, Nuclear Medicine and imaging, In patient, Prospective Studies, Creatinine, Proteinuria, business.industry, HIV, Ultrasonography, Doppler, R1, Cross-Sectional Studies, chemistry, 030220 oncology & carcinogenesis, Urea, Female, medicine.symptom, Laboratories, business
Abstract: Introduction Renal Doppler resistive index (RI) and pulsatility index (PI) values are potentially more sensitive at detecting renal abnormalities when compared to standard laboratory indices in patients with HIV/AIDS. To the best of our knowledge, there are no published research articles on renal Doppler indices and their correlation with laboratory indices of HIV sero-positive adult individuals. This study aimed to assess the renal function of HIV-sero-positive adults using RI and PI, and correlating these indices against laboratory values. Methods A prospective cross-sectional study was conducted from July 2019 to April 2020. A purposive sampling method was employed and included 396 HIV sero-positive adult individuals. Sampling for the renal RI and PI was performed at the level of the inter-lober arteries, in between the medullary pyramids. An RI value above 0.70 and a PI value above 1.56 were consider abnormal. Serum creatine and urea together with evidence of proteinuria were recorded at the time of scanning. Results Forty-three (10.9%) men had an abnormal RI, 32 (8.1%) had abnormal PI, five (2.5%) had abnormal creatinine, two (1%) abnormal urea and eight (4.1%) with proteinuria. In women, 29 (7.3%) had abnormal RI, 22 (5.6%) abnormal PI, four (2%) abnormal creatinine and urea and six (3%) had proteinuria. There was a statistically significant weak positive correlation between RI and PI and serum creatinine and urea (r > 0.2, P Conclusion The proportion of patients with abnormal RI and PI was higher than the proportion of participants with abnormal serum urea, creatinine and proteinuria. Renal Doppler indices could be used be used in the early assessment of renal function in HIV sero-positive adults individuals. Implications for practice Serum creatinine and urea are routinely used to evaluate renal function in patients with HIV/AIDS. Findings from this initial study show that RI and PI could be used detecting early renal abnormalities when compared to standard laboratory values.
Published: 2021
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14. Patient satisfaction with the first contact physiotherapy service: Results from the national evaluation survey

Author: Siobhán Stynes, Annette Bishop, R. Goodwin, and Lianne Wood
Subjects: First contact, medicine.medical_specialty, Nursing (miscellaneous), Physical Therapy, Sports Therapy and Rehabilitation, Context (language use), Primary care, Patient satisfaction, RC925, Rheumatology, General Practitioners, Musculoskeletal Pain, Health care, Humans, Medicine, Orthopedics and Sports Medicine, Referral and Consultation, Physical Therapy Modalities, Service (business), business.industry, Rehabilitation, R1, Test (assessment), Patient Satisfaction, Physical therapy, Chiropractics, Thematic analysis, business, RA
Abstract: BACKGROUND: Musculoskeletal (MSK) First Contact Physiotherapists (FCPs) are diagnostic clinicians able to assess and manage undifferentiated and undiagnosed MSK presentations. The FCP role in primary care has been introduced to allow patients with MSK pain to see a FCP directly rather than wait to see a General Practitioner (GP) first, which improves capacity within primary care. A national evaluation was undertaken of the FCP model. This article reports the thematic analysis of the free-text responses of patients who participated in the national evaluation. METHODS: An online platform collected patient-reported experience and outcomes following the FCP consultation and at 1, 2 and 3 months follow-up. Free-text responses to the Friends and Family test, reasons for consulting another health care professional (HCP) and general comments were thematically analysed and grouped according to their responses. RESULTS: Over 13 months, 680 of 2825 registered patients (24%) completed the initial questionnaire and 54% (n = 370) completed the 3-month follow-up. During the course of the evaluation, 785 participants provided free-text responses. Themes identified from free-text responses were: communication and knowledge, clinicians' characteristics, efficiency, treatment provided, assessment skills and service provided in comparison to GP care. Complaints represented 4% (n = 26 comments) of total feedback. The main reasons for consulting other HCPs after seeing a FCP were persistent pain, delays in referrals or already attending NHS physiotherapy. CONCLUSION: Thematic analysis of free-text responses in the national FCP evaluation provides context and detail to the positive outcomes reported by patients after consulting a FCP in primary care.
Published: 2021
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15. Paragons, Mavericks and Innovators—A typology of orthopaedic surgeons' professional identities. A comparative case study of evidence‐based practice

Author: Grove, A, David, SJ, Pope, C, currie, G, and Clarke, A
Subjects: Surgeons, Typology, Health (social science), Evidence-based practice, Social Identification, business.industry, Health Policy, Comparative case, media_common.quotation_subject, Prestige, Public Health, Environmental and Occupational Health, Identity (social science), Orthopedic Surgeons, Public relations, R1, Negotiation, Evidence-Based Practice, Humans, Narrative, Sociology, business, Delivery of Health Care, RD, Legitimacy, media_common
Abstract: Clinical guidelines, as vehicles for evidence-based practice (EBP) attempt to standardize health-care practice, reduce variation and increase quality. However, their use for surgery has been contested, and often resisted. This article examines professional responses to EBP in hip replacement surgery using data from case study observations and interviews in three English orthopaedic departments. A professional identity perspective is adopted to explain how standardization through EBP, represents an empirical phenomenon around which surgeons enact their identities as Paragons, Mavericks or Innovators, to enhance legitimacy and stratify themselves in their response to EBP. Attention is drawn to variation between Paragon surgeons working in university (teaching) hospitals and Maverick and Innovator types located in general hospitals, and the ways this interacts with adoption of EBP. The typology shows how practice variation is related to surgeons' tendencies to align to characteristic types, with distinct social processes, power and prestige, and which are in turn influenced by organizational context. The dynamics of EBP and professional identity continues to limit attempts to standardize surgical practice. The typology contributes to the understanding of failures to follow EBP, as associated with the identities individuals create and negotiate, and with identity narratives used to legitimize differing responses to EBP.
Published: 2021
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16. Development and validation of a prognostic model for leflunomide discontinuation with abnormal blood tests during long-term treatment: cohort study using data from the Clinical Practice Research Datalink Gold and Aurum

Author: Georgina Nakafero, Maarten W. Taal, Weiya Zhang, Christian D Mallen, Abhishek Abhishek, Michael Doherty, Timothy R. Card, Christopher P. Fox, Matthew J. Grainge, and Guruprasad P. Aithal
Subjects: medicine.medical_specialty, Cytopenia, Hematologic Tests, business.industry, Proportional hazards model, Separation (statistics), Hazard ratio, Prognosis, Missing data, medicine.disease, R1, Discontinuation, Cohort Studies, Rheumatology, RA0421, Internal medicine, medicine, Humans, Pharmacology (medical), business, RA, Leflunomide, Cohort study, medicine.drug
Abstract: Objective To develop and validate a prognostic model for LEF discontinuation with abnormal blood test results. Methods Data from the Clinical Practice Research Datalink Gold and Aurum were used for model development and external validation, respectively. Participants prescribed LEF between 1 January 2007 and 31 December 2019 were followed up from 6 months after the first general practitioner prescription to the earliest of date of outcome, death, 5 year follow-up or 31 December 2019. Candidate prognostic factors were ascertained using theory and data-driven approaches. Penalized Cox regression was performed to develop the risk equation, followed by internal validation using 500 bootstraps to correct for optimism. Multiple imputation was applied to handle missing data. Model performance was assessed in terms of calibration and discrimination. Results Data for 1487 and 2329 participants contributing 3140 and 5246 person-years follow-up were included in the development and validation cohorts, respectively. Thirteen candidate predictors were included in the model. Epilepsy and either cytopenia or elevated liver enzymes during the first 6 months of shared-care LEF prescription were strong predictors of drug discontinuation with a hazard ratio of 4.39 (95% CI 1.74, 11.06) and 3.06 (2.15, 4.35), respectively. The unadjusted and optimism-adjusted calibration slope in development data was 1.00 (95% CI 0.75, 1.25) and 0.72 (95% CI 0.47, 0.97), respectively. The calibration slope in validation data was 0.91 (95% CI 0.74, 1.07). The model showed prognostic separation with an optimism-adjusted Royston D statistic of 0.73 (95% CI 0.44, 1.02). Conclusion We have developed and externally validated an easy-to-use prognostic model that may be used to risk stratify monitoring for LEF toxicity and to make informed choices about risks when choosing treatments.
Published: 2021
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17. What non-pharmacological treatments do people with polymyalgia rheumatica try: results from the PMR Cohort Study

Author: Weddell, Jake, Hider, Samantha L., Mallen, Christian D., and Muller, Sara
Subjects: Complementary Therapies, Male, musculoskeletal diseases, medicine.medical_specialty, Immunology, Primary care, Observational Research, Cohort Studies, Polymyalgia rheumatica, Rheumatology, Surveys and Questionnaires, Internal medicine, medicine, High doses, Humans, Immunology and Allergy, Adverse effect, Exercise, Non pharmacological, Aged, business.industry, R735, Middle Aged, medicine.disease, Combined Modality Therapy, R1, INCEPTION COHORT, Diet, Exercise Therapy, Disease Progression, Female, business, Diet Therapy, RC, Cohort study
Abstract: Polymyalgia rheumatica (PMR) is common. The mainstay of treatment, glucocorticoids, are associated with significant adverse effects and many patients remain on high doses for a number of years. Little is known about the use of other, non-pharmacological therapies as adjuncts in PMR. The PMR Cohort Study is an inception cohort study of patients diagnosed with PMR in primary care. This analysis presents data on the use and perceived impact of non-pharmacological therapies from a long-term follow-up survey. Non-pharmacological treatments were classified as either diet, exercise, or complementary therapies. Results are presented as adjusted means, medians, and raw counts where appropriate. One hundred and ninety-seven participants completed the long-term follow-up questionnaire, of these 81 (41.1%) reported using non-pharmacological therapy. Fifty-seven people reported using a form of complementary therapy, 35 used exercise and 20 reported changing their diet. No individual non-pharmacological therapy appeared to be associated with long-term outcomes. The use of non-pharmacological therapies is common amongst PMR patients, despite the paucity of evidence supporting their use. This suggests that people perceive a need for treatment options in addition to standard glucocorticoid regimens. Further research is needed to understand patients’ aims when seeking additional treatments and to strengthen the evidence base for their use so that patients can be guided towards effective options.
Published: 2021
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18. Assessment of the effect of the COVID-19 pandemic on UK HbA1c testing: implications for diabetes management and diagnosis

Author: David Holland, John Pemberton, Sarah Robinson, Fahmy Hanna, Adrian H. Heald, Ian Halsall, Mike Stedman, Pensee Wu, Christine Bloor, Lewis Green, Christopher J. Duff, Neil Gaskell, and Anthony A. Fryer
Subjects: Potential impact, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), diagnosis, business.industry, RC660, COVID-19, General Medicine, medicine.disease, R1, Pathology and Forensic Medicine, Hba1c level, Diabetes management, Diabetes mellitus, diabetes mellitus, Health care, Pandemic, Emergency medicine, medicine, Prediabetes, business, Original Research
Abstract: AimsThe COVID-19 pandemic, and the focus on mitigating its effects, has disrupted diabetes healthcare services worldwide. We aimed to quantify the effect of the pandemic on diabetes diagnosis/management, using glycated haemoglobin (HbA1c) as surrogate, across six UK centres.MethodsUsing routinely collected laboratory data, we estimated the number of missed HbA1c tests for ‘diagnostic’/‘screening’/‘management’ purposes during the COVID-19 impact period (CIP; 23 March 2020 to 30 September 2020). We examined potential impact in terms of: (1) diabetes control in people with diabetes and (2) detection of new diabetes and prediabetes cases.ResultsIn April 2020, HbA1c test numbers fell by ~80%. Overall, across six centres, 369 871 tests were missed during the 6.28 months of the CIP, equivalent to >6.6 million tests nationwide. We identified 79 131 missed ‘monitoring’ tests in people with diabetes. In those 28 564 people with suboptimal control, this delayed monitoring was associated with a 2–3 mmol/mol HbA1c increase. Overall, 149 455 ‘screening’ and 141 285 ‘diagnostic’ tests were also missed. Across the UK, our findings equate to 1.41 million missed/delayed diabetes monitoring tests (including 0.51 million in people with suboptimal control), 2.67 million screening tests in high-risk groups (0.48 million within the prediabetes range) and 2.52 million tests for diagnosis (0.21 million in the pre-diabetes range; ~70 000 in the diabetes range).ConclusionsOur findings illustrate the widespread collateral impact of implementing measures to mitigate the impact of COVID-19 in people with, or being investigated for, diabetes. For people with diabetes, missed tests will result in further deterioration in diabetes control, especially in those whose HbA1c levels are already high.
Published: 2021
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19. Musculoskeletal injuries in military personnel—Descriptive epidemiology, risk factor identification, and prevention

Author: Ran Yanovich, Bradley C. Nindl, Sam D. Blacker, Mita Lovalekar, Keith G. Hauret, Bruce H. Jones, Phillip Newman, Kathryn M. Taylor, Chen Fleischmann, Tanja C. Roy, and Michelle Canham-Chervak
Subjects: medicine.medical_specialty, Clinical Decision-Making, Physical fitness, Physical Therapy, Sports Therapy and Rehabilitation, Q1, Machine Learning, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Epidemiology, medicine, Humans, Orthopedics and Sports Medicine, Musculoskeletal Diseases, 030212 general & internal medicine, business.industry, Incidence, Public health, 030229 sport sciences, Risk factor (computing), medicine.disease, QP, R1, United States, Identification (information), Military personnel, Military Personnel, Physical Fitness, Imaging technology, Musculoskeletal injury, Wounds and Injuries, Medical emergency, business
Abstract: Objectives: To provide an overall perspective on musculoskeletal injury (MSI) epidemiology, risk factors, and preventive strategies in military personnel.\ud \ud Design: Narrative review.\ud \ud Methods: The thematic session on MSIs in military personnel at the 5th International Congress on Soldiers’ Physical Performance (ICSPP) included eight presentations on the descriptive epidemiology, risk factor identification, and prevention of MSIs in military personnel. Additional topics presented were bone anabolism, machine learning analysis, and the effects of non-steroidal anti-inflammatory drugs (NSAIDs) on MSIs. This narrative review focuses on the thematic session topics and includes identification of gaps in existing literature, as well as areas for future study.\ud Results: MSIs cause significant morbidity among military personnel. Physical training and occupational tasks are leading causes of MSI limited duty days (LDDs) for the U.S. Army. Recent studies have shown that MSIs are associated with the use of NSAIDs. Bone MSIs are very common in training; new imaging technology such as high resolution peripheral quantitative computed tomography allows visualization of bone microarchitecture and has been used to assess new bone formation during military training. Physical activity monitoring and machine learning have important applications in monitoring and informing evidence-based solutions to prevent MSIs.\ud \ud Conclusions: Despite many years of research, MSIs continue to have a high incidence among military personnel. Areas for future research include quantifying exposure when determining MSI risk; understanding associations between health-related components of physical fitness and MSI occurrence; and application of innovative imaging, physical activity monitoring and data analysis techniques for MSI prevention and return to duty.
Published: 2021
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20. Allograft Versus Autograft Osteochondral Transplant for Chondral Defects of the Talus: Systematic Review and Meta-analysis

Author: Filippo Migliorini, Matthias Knobe, Alice Baroncini, Jörg Eschweiler, Hanno Schenker, Nicola Maffulli, and Markus Tingart
Subjects: Cartilage, Articular, Male, medicine.medical_specialty, Intra-Articular Fractures, Physical Therapy, Sports Therapy and Rehabilitation, Transplantation, Autologous, Talus, Humans, Medicine, Orthopedics and Sports Medicine, ddc:610, Autografts, Retrospective Studies, business.industry, Allografts, Magnetic Resonance Imaging, R1, Surgery, Cartilage, Treatment Outcome, surgical procedures, operative, Meta-analysis, Female, business, Cartilage Diseases
Abstract: The American journal of sports medicine (2021). doi:10.1177/03635465211037349, Published by Sage, London [u.a.]
Published: 2021
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21. Surgical Management of Focal Chondral Defects of the Talus: A Bayesian Network Meta-analysis

Author: Hanno Schenker, Jörg Eschweiler, Matthias Knobe, Markus Tingart, Nicola Maffulli, Alice Baroncini, Arne Driessen, and Filippo Migliorini
Subjects: Cartilage, Articular, medicine.medical_specialty, business.industry, Chondral defect, Network Meta-Analysis, Bayesian network, Bayes Theorem, Physical Therapy, Sports Therapy and Rehabilitation, R1, Transplantation, Autologous, Talus, Treatment Outcome, Meta-analysis, Humans, Medicine, Orthopedics and Sports Medicine, Radiology, business, Surgical treatment, Cartilage Diseases, Chondrogenesis
Abstract: The American journal of sports medicine 50(10), 2853-2859 (2022). doi:10.1177/03635465211029642, Published by Sage, London [u.a.]
Published: 2021
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22. Opportunities and challenges around adapting supported employment interventions for people with chronic low back pain

Author: Robert J. Froud, Gwenllian Wynne-Jones, Vigdis Sveinsdottir, Tone Langjordet Johnsen, Michiel F. Reneman, Rob J. E. M. Smeets, Michele C. Battié, Serena Bartys, Martin Underwood, Kim Burton, Tamar Pincus, Nadine E. Foster, Pål André Amundsen, Revalidatiegeneeskunde, RS: CAPHRI - R3 - Functioning, Participating and Rehabilitation, and Extremities Pain and Disability (EXPAND)
Subjects: HD, 030506 rehabilitation, Psychological intervention, IPS, Legislation, Funding Mechanism, K1, Q1, GUIDELINES, 03 medical and health sciences, Individualised Placement and Support (IPS), 0302 clinical medicine, Employment, Supported, Nominal group technique, Humans, Workplace, Health policy, Supported employment, business.industry, Rehabilitation, Administrative Personnel, Flexibility (personality), health policy, Public relations, R1, Research Personnel, Intervention (law), nominal group technique, supported employment interventions, H1, Chronic low back pain, INDIVIDUAL PLACEMENT, 0305 other medical science, business, RB, B1, Low Back Pain, 030217 neurology & neurosurgery, PRIORITIES
Abstract: Purpose: To identify and rank opportunities and challenges around adapting supported employment interventions for people with chronic low back pain (LBP).Methods: Delegates from an international back and neck research forum were invited to join an expert panel. A modified nominal group technique (NGT) was used with four stages: silent generation, round robin, clarification, and ranking. Ranked items were reported back and ratified by the panel.Results: Nine experienced researchers working in the fields related to LBP and disability joined the panel. Forty-eight items were generated and grouped into 12 categories of opportunities/challenges. Categories ranked most important related respectively to policy and legislation, ensuring operational integration across different systems, funding interventions, and managing attitudes towards work and health, workplace flexibility, availability of "good" work for this client group, dissonance between client and system aims, timing of interventions, and intervention development.Conclusions: An expert panel believes the most important opportunities/challenges around adapting supporting employment interventions for people with chronic LBP are facilitating integration/communication between systems and institutions providing intervention components, optimising research outputs for informing policy needs, and encouraging discussion around funding mechanisms for research and interventions. Addressing these factors may help improve the quality and impact of future interventions.Implications for rehabilitationInteraction pathways between health, employment, and social systems need to be improved to effectively deliver intervention components that necessarily span these systems.Research-policy communication needs to be improved by researchers and policy makers, so that research outputs can be consumed by policy makers, and so that researchers recognise the gaps in knowledge needed to underpin policy.Improvements in research-policy communication and coordination would facilitate the delivery of research output at a time when it is likely to make the most impact on policy-making.Discussion and clarification surrounding funding mechanisms for research and interventions may facilitate innovation generally.
Published: 2021
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23. Efficacy and safety of colchicine in patients with coronary artery disease: A systematic review and meta‐analysis of randomized controlled trials

Author: Gani Bajraktari, Michael Y. Henein, Ibadete Bytyçi, Peter E. Penson, and Maciej Banach
Subjects: RM, medicine.medical_specialty, Myocardial Infarction, Coronary Artery Disease, Placebo, Lower risk, law.invention, Coronary artery disease, Randomized controlled trial, law, Internal medicine, Clinical endpoint, medicine, Humans, Pharmacology (medical), Myocardial infarction, Stroke, Randomized Controlled Trials as Topic, Pharmacology, business.industry, medicine.disease, R1, C-Reactive Protein, Treatment Outcome, Meta-analysis, Colchicine, business
Abstract: AIMS Inflammation plays a central role in the pathogenesis and clinical manifestations of atherosclerosis. Randomized controlled trials have investigated the potential benefit of colchicine in reducing cardiovascular (CV) events in patients with coronary artery disease (CAD) but produced conflicting results. The aim of this meta-analysis was to evaluate the efficacy and safety of colchicine in patients with CAD. METHODS We systematically searched selected electronic databases from inception until 10 December 2020. Primary clinical endpoints were: major adverse cardiac events; all-cause mortality; CV mortality; recurrent myocardial infarction; stroke; hospitalization; and adverse medication effects. Secondary endpoints were short-term effect of colchicine on inflammatory markers. RESULTS Twelve randomized controlled trials with a total of 13 073 patients with CAD (colchicine n = 6351 and placebo n = 6722) were included in the meta-analysis. At mean follow-up of 22.5 months, the colchicine group had lower risk of major adverse cardiac events (6.20 vs. 8.87%; P
Published: 2021
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24. Misdiagnosis of Heart Failure: A Systematic Review of the Literature

Author: Christian D Mallen, Simon Duckett, Ziyad Azam, Chun Shing Kwok, Ashish Patwala, Fozia Z. Ahmed, Duwarakan Satchithananda, Diane Barker, Jacopo Tafuro, and Chun Wai Wong
Subjects: Pediatrics, medicine.medical_specialty, Population, Cardiomyopathy, Comorbidity, Disease, 030204 cardiovascular system & hematology, Pulmonary Disease, Chronic Obstructive, 03 medical and health sciences, 0302 clinical medicine, medicine, Humans, 030212 general & internal medicine, Diagnostic Errors, education, Heart Failure, education.field_of_study, COPD, business.industry, Atrial fibrillation, RC666, medicine.disease, R1, Heart failure, Chronic Disease, Cohort, Cardiology and Cardiovascular Medicine, business, RA, Kidney disease
Abstract: Background Heart failure (HF) is a chronic disease associated with a significant burden to patients, families, and health services. The diagnosis of HF can be easily missed owing to similar symptoms with other conditions especially respiratory diseases. Methods and Results We conducted a systematic review to determine the rates of HF and cardiomyopathy misdiagnosis and explored the potential causes. The included studies were narratively synthesized. Ten studies were identified including a total of 223,859 patients. There was a lack of definition of HF misdiagnosis in the studies and inconsistent diagnostic criteria were used. The rates of HF misdiagnosis ranged from 16.1% in hospital setting to 68.5% when general practitioner referred patients to specialist setting. The most common cause for misdiagnosis was chronic obstructive pulmonary disease (COPD). One study using a COPD cohort showed that HF was unrecognized in 20.5% of patients and 8.1% had misdiagnosis of HF as COPD. Another study suggests that anemia and chronic kidney disease are associated with an increase in the odds of unrecognized left ventricular systolic dysfunction. Other comorbidities such as obesity, old age, atrial fibrillation, and ischemic heart disease are prevalent in patients with a misdiagnosis of HF. Conclusions The misdiagnosis of HF is an unfortunate part of everyday clinical practice that occurs with a variable rate depending on the population studied. HF is frequently misdiagnosed as COPD. More research is needed to better understand the missed opportunities to correctly diagnose HF so that harm to patients can be avoided and effective treatments can be implemented.
Published: 2021
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25. An evaluation of the measurement properties of the Olerud Molander Ankle Score in adults with an ankle fracture

Author: David R. Ellard, Helen Parsons, Rebecca McKeown, and Rebecca S. Kearney
Subjects: Adult, 030506 rehabilitation, medicine.medical_specialty, medicine.medical_treatment, Physical Therapy, Sports Therapy and Rehabilitation, HN, Ankle Fractures, 03 medical and health sciences, 0302 clinical medicine, Cronbach's alpha, Quality of life, Surveys and Questionnaires, Internal consistency, Outcome Assessment, Health Care, Humans, Medicine, 030212 general & internal medicine, Core (anatomy), Rehabilitation, business.industry, Outcome measures, R1, Treatment Outcome, medicine.anatomical_structure, Convergent validity, Physical therapy, Ankle, 0305 other medical science, business, Ankle Joint, RD
Abstract: Objectives\ud The aim of this study is to evaluate the measurement properties of the Olerud Molander Ankle Score in adults with an ankle fracture.\ud \ud Methods\ud Patients completed outcome measure questionnaires at baseline, six, 10- and 16-weeks post-injury as part of an ongoing clinical trial on ankle fracture rehabilitation. The internal consistency, convergent validity, structural validity and interpretability of the Olerud Molander Ankle Score was assessed. This was achieved through using the respective analysis methods of Cronbach's alpha, correlation coefficients, principal component analysis, evaluation of floor and ceiling scores and estimation of the minimally important change using anchor-based methods.\ud \ud Results\ud The Olerud Molander Ankle Score showed adequate convergent validity against hypotheses set in relation to scores of comparator instruments. Principal component analysis demonstrated that the measure has two subscales: ankle function and ankle symptoms. The internal consistency of the measure and the ankle function subscale was sufficient, but inconclusive for the ankle symptoms subscale. There were no floor and ceiling effects present within the scores and the estimated minimally important change was 9.7 points.\ud \ud Conclusion\ud The Olerud Molander Ankle Score demonstrates sufficient measurement properties and is likely to be primarily measuring the construct of patient reported function following ankle fracture. Further research should evaluate the relevance of other domains to individuals recovering from and ankle fracture, such as social participation and psychological wellbeing. The development of a core outcome set would be advantageous to standardise outcome measurement collection in this area.
Published: 2021
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26. Biochemical abnormalities in COVID-19 : a comparison of white versus ethnic minority populations in the UK

Author: Georgios K Dimitriadis, Wiaam Al-Hasani, Jessica Kearney, Tina Mazaheri, David R Taylor, Royce P Vincent, Ruvini N K Ranasinghe, and Devon Buchanan
Subjects: medicine.medical_specialty, Minority group, Ethnic group, 030204 cardiovascular system & hematology, Pathology and Forensic Medicine, 03 medical and health sciences, 0302 clinical medicine, Intensive care, medicine, biochemistry, 030212 general & internal medicine, Original Research, White (horse), biology, Troponin T, business.industry, Mortality rate, Public health, C-reactive protein, COVID-19, General Medicine, R1, inflammation, biology.protein, business, RA, Demography, RC
Abstract: AimsPublic Health England has identified that in COVID-19, death rates among ethnic minorities far exceeds that of the white population. While the increase in ethnic minorities is likely to be multifactorial, to date, no studies have looked to see whether values for routine clinical biochemistry parameters differ between ethnic minority and white individuals.MethodsBaseline biochemical data for 22 common tests from 311 SARS-CoV-2 positive patients presenting to hospital in April 2020 in whom ethnicity data were available was retrospectively collected and evaluated. Data comparisons between ethnic minority and white groups were made for all patient data and for the subset of patients subsequently admitted to intensive care.ResultsWhen all patient data were considered, the ethnic minority population had statistically significant higher concentrations of C reactive protein (CRP), aspartate aminotransferase and gamma-glutamyl transferase, while troponin T was higher in the white group. A greater proportion of ethnic minority patients were subsequently admitted to intensive care, but when the presenting biochemistry of this subset of patients was compared, no significant differences were observed between ethnic minority and white groups.ConclusionOur data show for the first time that routine biochemistry at hospital presentation in COVID-19 differs between ethnic minority and white groups. Among the markers identified, CRP was significantly higher in the ethnic minority group pointing towards an increased tendency for severe inflammation in this group.
Published: 2022

27. Eight‐week exercise training in humans with obesity: Marked improvements in insulin sensitivity and modest changes in gut microbiome

Author: Hauke Smidt, Prokopis Konstanti, Ad R. M. M. Hermus, Dick H. J. Thijssen, Rebecca J. H. M. Verheggen, and Maria T. E. Hopman
Subjects: medicine.medical_specialty, food.ingredient, Endocrinology, Diabetes and Metabolism, Vascular damage Radboud Institute for Health Sciences [Radboudumc 16], Medicine (miscellaneous), Type 2 diabetes, Gut flora, Microbiology, RC1200, Endocrinology, food, Anaerostipes, Microbiologie, RNA, Ribosomal, 16S, Internal medicine, medicine, Life Science, Humans, Aerobic exercise, MolEco, Obesity, Exercise, VLAG, WIMEK, Nutrition and Dietetics, biology, business.industry, Metabolic Disorders Radboud Institute for Health Sciences [Radboudumc 6], Lachnospiraceae, VO2 max, Cardiorespiratory fitness, Middle Aged, medicine.disease, biology.organism_classification, R1, Gastrointestinal Microbiome, Diabetes Mellitus, Type 2, Insulin Resistance, business, Rare cancers Radboud Institute for Health Sciences [Radboudumc 9]
Abstract: Contains fulltext : 237734.pdf (Publisher’s version ) (Open Access) OBJECTIVE: Obesity is associated with impaired gut microbiota diversity, which has been linked to the development of type 2 diabetes. This study aims to examine the effects of an 8-week aerobic exercise intervention on insulin sensitivity, visceral adiposity, and gut microbiota diversity and composition in participants with obesity. METHODS: Fourteen participants (mean [SD], age 51 [11] years; BMI 34.9 [4.9] kg/m(2) ) performed an 8-week exercise intervention (2 to 4 times/week on 65% to 85% of heart rate reserve). Insulin sensitivity (hyperinsulemic euglycemic clamp), cardiorespiratory fitness (maximal oxygen uptake), visceral adiposity (dual-energy X-ray absorptiometry scan) and gut microbiota composition (16S rRNA gene sequencing) were measured before and after the intervention. RESULTS: Insulin sensitivity showed a significant increase (pre: 3.8 [1.9] mg/min/kg; post: 4.5 [1.7] mg/min/kg; p = 0.007) after training, whereas visceral adiposity decreased (pre: 959 [361] cm(3) ; post: 897 [364] cm(3) ; p = 0.02). No change in gut microbiota α- or β-diversity was found. At the genus level, the abundance of Ruminococcus gauvreauii (p = 0.02); Lachnospiraceae FCS020 group (p = 0.04), and Anaerostipes (p = 0.04) significantly increased after exercise training. Significant positive correlations were present for M-value (R. gauvreauii) and VO(2) max (R. gauvreauii and Anaerostipes). CONCLUSIONS: Eight-week exercise training in humans with obesity leads to marked improvements in insulin sensitivity and body composition and is accompanied by modest changes in 3 gut microbiome genera, all belonging to the Firmicutes phylum.
Published: 2021
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28. Cell therapy for cartilage repair

Author: Martyn Snow, Charlotte H Hulme, Claire Mennan, Karina T. Wright, Jade Perry, Sally Roberts, and Helen S. McCarthy
Subjects: Cartilage, Articular, Aging, Cell type, chondrocytes, Cell- and Tissue-Based Therapy, regenerative medicine, Osteoarthritis, Mesenchymal Stem Cell Transplantation, Bioinformatics, Regenerative medicine, General Biochemistry, Genetics and Molecular Biology, Cell therapy, RA0421, medicine, cartilage, Review Articles, mesenchymal stem cell, Tissue Engineering, business.industry, Stem Cells, Cartilage, Regeneration (biology), Mesenchymal stem cell, R735, Mesenchymal Stem Cells, medicine.disease, R1, osteoarthritis, medicine.anatomical_structure, Translational Science, Bone marrow, cell therapy, General Agricultural and Biological Sciences, business, RA
Abstract: Regenerative medicine, using cells as therapeutic agents for the repair or regeneration of tissues and organs, offers great hope for the future of medicine. Cell therapy for treating defects in articular cartilage has been an exemplar of translating this technology to the clinic, but it is not without its challenges. These include applying regulations, which were designed for pharmaceutical agents, to living cells. In addition, using autologous cells as the therapeutic agent brings additional costs and logistical challenges compared with using allogeneic cells. The main cell types used in treating chondral or osteochondral defects in joints to date are chondrocytes and mesenchymal stromal cells derived from various sources such as bone marrow, adipose tissue or umbilical cord. This review discusses some of their biology and pre-clinical studies before describing the most pertinent clinical trials in this area.
Published: 2021
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29. Identifying Consensus and Open Questions around Assessing or Predicting the Quality and Success of Cartilage Repair: A Delphi Study

Author: Jan Herman Kuiper, James B. Richardson, and Timothy Hopkins
Subjects: medicine.medical_specialty, RD1-811, media_common.quotation_subject, assessment, Delphi method, law.invention, law, medicine, Medical physics, Quality (business), Cartilage repair, expert panel, computer.programming_language, media_common, Repair cartilage, business.industry, Cartilage, R735, prediction, R1, medicine.anatomical_structure, consensus, CLARITY, cartilage repair, Surgery, cell therapy, business, computer, Delphi
Abstract: A range of surgical techniques have been developed for the repair or regeneration of lesioned cartilage in the human knee and a corresponding array of scoring systems have been created to assess their outcomes. The published literature displays a wide range of opinions regarding the factors that influence the success of surgical cartilage repair and which parameters are the most useful for measuring the quality of the repair at follow-up. Our objective was to provide some clarity to the field by collating items that were agreed upon by a panel of experts to be important in these areas. A modified, three-round Delphi consensus study was carried out consisting of one idea-generating focus-group and two subsequent, self-completed questionnaire rounds. In each round, items were assessed for their importance and level of consensus against pre-determined threshold levels. In total, 31 items reached consensus, including a hierarchy of tissues in the joint based on their importance in cartilage repair, markers of repair cartilage quality and the implications of environmental and patient-related factors. Items were stratified into those that can be employed for predicting the success of cartilage repair and those that could be used for assessing the structural quality of the resulting repair cartilage. Items that did not reach consensus represent areas where dissent remains and could, therefore, be used to guide future clinical and fundamental scientific research.
Published: 2021

30. Randomized Trial—PrEscription of intraDialytic exercise to improve quAlity of Life in Patients Receiving Hemodialysis

Author: Claire White, David C. Wheeler, Maarten W. Taal, James O. Burton, Ken Farrington, Mick Kumwenda, Thomas H. Mercer, Sandip Mitra, Iain C. Macdougall, Ian Ford, Sunil Bhandari, Alice C. Smith, Magdi Yaqoob, Claudia-Martina Messow, Philip A. Kalra, Pelagia Koufaki, Peter C. Thomson, Sharlene A. Greenwood, Indranil Dasgupta, Jamie H. Macdonald, Chante Reid, and Sharon Kean
Subjects: medicine.medical_specialty, 030232 urology & nephrology, physical activity, 030204 cardiovascular system & hematology, rehabilitation, law.invention, 03 medical and health sciences, physical function, 0302 clinical medicine, Randomized controlled trial, Quality of life, Clinical Research, law, medicine, Aerobic exercise, Medical prescription, business.industry, VO2 max, medicine.disease, R1, Nephrology, Cohort, Physical therapy, Exercise prescription, business, chronic kidney disease, Kidney disease
Abstract: Introduction Whether clinically implementable exercise interventions in people receiving hemodialysis (HD) therapy improve health-related quality of life (HRQoL) remains unknown. The PrEscription of intraDialytic exercise to improve quAlity of Life (PEDAL) study evaluated the clinical benefit and cost-effectiveness of a 6-month intradialytic exercise program. Methods In a multicenter, single-blinded, randomized, controlled trial, people receiving HD were randomly assigned to (i) intradialytic exercise training (exercise intervention group [EX]) and (ii) usual care (control group [CON]). Primary outcome was change in Kidney Disease Quality of Life Short-Form Physical Component Summary (KDQOL-SF 1.3 PCS) from baseline to 6 months. Cost-effectiveness was determined using health economic analysis; physiological impairment was evaluated by peak oxygen uptake; and harms were recorded. Results We randomized 379 participants; 335 and 243 patients (EX n = 127; CON n = 116) completed baseline and 6-month assessments, respectively. Mean difference in change PCS from baseline to 6 months between EX and CON was 2.4 (95% confidence interval [CI]: −0.1 to 4.8) arbitrary units (P = 0.055); no improvements were observed in peak oxygen uptake or secondary outcome measures. Participants in the intervention group had poor compliance (47%) and poor adherence (18%) to the exercise prescription. Cost of delivering intervention ranged from US$598 to US$1092 per participant per year. The number of participants with harms was similar between EX (n = 69) and CON (n = 56). A primary limitation was the lack of an attention CON. Many patients also withdrew from the study or were too unwell to complete all physiological outcome assessments. Conclusions A 6-month intradialytic aerobic exercise program was not clinically beneficial in improving HRQoL as delivered to this cohort of deconditioned patients on HD., Graphical abstract
Published: 2021
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31. Neutrophil‐to‐lymphocyte ratio and outcomes in patients with new‐onset or worsening heart failure with reduced and preserved ejection fraction

Author: Stefan D. Anker, Dirk J. van Veldhuisen, Leong L. Ng, Fraser M Curran, U Bhalraam, Jagdeep Singh, Gerasimos Filippatos, Marco Metra, Chim C. Lang, Jacob George, Alex S. F. Doney, Kenneth Dickstein, Colin N. A. Palmer, Ify R. Mordi, Nilesh J. Samani, Mohapradeep Mohan, Adriaan A. Voors, and Cardiovascular Centre (CVC)
Subjects: Neutrophils, 030204 cardiovascular system & hematology, THERAPY, DISEASE, 0302 clinical medicine, Original Research Articles, Medicine, 030212 general & internal medicine, Lymphocytes, Original Research Article, Neutrophil-to-lymphocyte ratio, TUMOR-NECROSIS-FACTOR, Outcome, education.field_of_study, Framingham Risk Score, Ejection fraction, Incidence (epidemiology), Hazard ratio, ASSOCIATION, Prognosis, 3. Good health, PROGNOSTIC VALUE, RECEPTORS, Neutrophil‐to‐lymphocyte ratio, Cardiology, TRIAL, Cardiology and Cardiovascular Medicine, medicine.medical_specialty, Population, Heart failure, 03 medical and health sciences, Internal medicine, Humans, Diseases of the circulatory (Cardiovascular) system, Neutrophil to lymphocyte ratio, education, Inflammation, business.industry, MORTALITY, QH, CYTOKINES, fungi, Stroke Volume, medicine.disease, R1, Confidence interval, QR, RC666-701, Biomarkers, Heart Failure, business, RB, RC
Abstract: Inflammation is thought to play a role in heart failure (HF) pathophysiology. Neutrophil-to-lymphocyte ratio (NLR) is a simple, routinely available measure of inflammation. Its relationship with other inflammatory biomarkers and its association with clinical outcomes in addition to other risk markers have not been comprehensively evaluated in HF patients.\ud \ud Methods\ud We evaluated patients with worsening or new-onset HF from the BIOlogy Study to Tailored Treatment in Chronic Heart Failure (BIOSTAT-CHF) study who had available NLR at baseline. The primary outcome was time to all-cause mortality or HF hospitalization. Outcomes were validated in a separate HF population.\ud \ud Results\ud 1622 patients were evaluated (including 523 ventricular ejection fraction [LVEF] < 40% and 662 LVEF ≥ 40%). NLR was significantly correlated with biomarkers related to inflammation as well as NT-proBNP. NLR was significantly associated with the primary outcome in patients irrespective of LVEF (hazard ratio [HR] 1.18 per standard deviation increase; 95% confidence interval [CI] 1.11–1.26, P < 0.001). Patients with NLR in the highest tertile had significantly worse outcome than those in the lowest independent of LVEF (
Published: 2021

32. Association between serum secretory phospholipase A2 and risk of ischaemic stroke

Author: Smith, Jed W, Barlas, Raphae S, Mamas, Mamas A, Boekholdt, S Matthijs, Mallat, Ziad, Luben, Robert N, Wareham, Nicholas J, Khaw, Kay-Tee, Myint, Phyo K, Smith, Jed W [0000-0002-7654-7171], Barlas, Raphae S [0000-0002-2902-0019], Mamas, Mamas A [0000-0001-9241-8890], Boekholdt, S Matthijs [0000-0002-0861-0765], Mallat, Ziad [0000-0003-0443-7878], Luben, Robert N [0000-0002-5088-6343], Wareham, Nicholas J [0000-0003-1422-2993], Khaw, Kay-Tee [0000-0002-8802-2903], Myint, Phyo K [0000-0003-3852-6158], Apollo - University of Cambridge Repository, Cardiology, ACS - Atherosclerosis & ischemic syndromes, and ACS - Heart failure & arrhythmias
Subjects: medicine.medical_specialty, Logistic regression, Secretory Phospholipase A2, Brain Ischemia, Coronary artery disease, Internal medicine, Ischaemic stroke, medicine, Humans, Prospective Studies, Phospholipases A2, Secretory, Ischemic Stroke, ischaemic stroke, business.industry, Confounding, Cancer, prediction, Odds ratio, medicine.disease, R1, Confidence interval, Stroke, Neurology, Case-Control Studies, secretory phospholipase A2, Neurology (clinical), business, RA
Abstract: Background and purpose Previous literature has demonstrated an association between high serum levels of type-II secretory phospholipase A2 (sPLA2) concentration and an increased risk of coronary artery disease. However, such association has not been established in terms of ischemic stroke risk. We aimed to evaluate the association between both sPLA2 concentration and activity as continuous variables with risk of future ischemic stroke. Methods We conducted a nested case-control study using data from the European Prospective Investigation into Cancer - Norfolk study. Cases (n=145) in the current study were participants who developed ischemic stroke during follow-up, with controls (n=290) matched in a 2:1 ratio based on age and sex. Statistical analyses were performed using SPSS (version 25.0, Chicago, Ill) software. Logistic regression was used to determine odds ratios (OR) and corresponding 95% confidence intervals (95% CIs) for ischemic stroke. Results After adjusting for a wide array of cardiovascular confounders, sPLA2 activity was found to be associated with an increased risk of ischemic stroke using both multiple imputations with chained equations and complete case analysis: OR 1.20 (95% CI: 1.01-1.43) and OR 1.23 (95% CI: 1.01 -1.49), respectively. However, sPLA2 concentration was not found to be associated with increased risk of ischemic stroke. Conclusions The activity of sPLA2, but not sPLA2 concentration, is associated with an increased risk of future ischemic stroke. This finding may be significant in risk group stratification, allowing targeted prophylactic treatment, or the development of novel therapeutic agents.
Published: 2021
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33. Initial Management of Seizure in Adults

Author: Phil Smith
Subjects: Adult, medicine.medical_specialty, Levetiracetam, Adolescent, MEDLINE, Electroencephalography, Lamotrigine, Diagnosis, Differential, Seizures, otorhinolaryngologic diseases, medicine, Humans, Medical history, Intensive care medicine, Epilepsy, Ethanol, medicine.diagnostic_test, business.industry, Valproic Acid, General Medicine, R1, Clinical diagnosis, Practice Guidelines as Topic, RC0321, Anticonvulsants, Female, Epileptic seizure, medicine.symptom, business
Abstract: • The clinical diagnosis of an epileptic seizure requires a detailed history taking and, ideally, an eyewitness account of the seizure.\ud• Evaluation with 12-lead electrocardiography is essential in a patient who has had a first seizure or an unexplained blackout spell.\ud• In children and teenagers, interictal electroencephalography, ideally within 24 hours after a first seizure, is particularly important.\ud• All patients who have had a suspected focal-onset seizure should undergo detailed magnetic resonance imaging of the head.\ud• Patients who have had an epileptic seizure should be informed about factors that may provoke seizures (e.g., sleep deprivation and alcohol use), the risk of a seizure occurring while driving or engaging in solitary activities, and the risks of harm from further seizures.\ud• Data from long-term pragmatic trials suggest that the first-line medication for patients with focal-onset seizures is either lamotrigine or levetiracetam, although other reasonable options are available; for patients with generalized-onset seizures, the first choice is sodium valproate, except for women of childbearing potential, in whom the first-line medication is usually levetiracetam.
Published: 2021
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34. Five-fraction Radiotherapy for Breast Cancer: FAST-Forward to Implementation

Author: J.R. Yarnold, A.M. Brunt, Navita Somaiah, Joanne S Haviland, Judith M Bliss, Duncan Wheatley, and Anna M. Kirby
Subjects: Oncology, medicine.medical_specialty, Radiobiology, medicine.medical_treatment, Breast Neoplasms, Mastectomy, Segmental, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, 0302 clinical medicine, Breast cancer, Internal medicine, medicine, Humans, Radiology, Nuclear Medicine and imaging, Fraction (mathematics), RM695, Adverse effect, Pathological, Mastectomy, Neoplasm Staging, business.industry, medicine.disease, R1, Radiation therapy, Regimen, Moist desquamation, 030220 oncology & carcinogenesis, Female, Radiotherapy, Adjuvant, Neoplasm Recurrence, Local, business, RA, RC
Abstract: Introduction The phase 3 FAST-Forward trial reported outcomes for 26 and 27 Gy schedules delivered in 5 fractions over 1 week versus 40 Gy in 15 fractions over 3 weeks in 4000 patients. We discuss concerns raised by the radiotherapy community in relation to implementing this schedule. Ipsilateral Breast Tumour Relapse (IBTR) Published estimated 5-year IBTR with 95% CI after 40 Gy in 15 fractions was 2.1% (95% CI 1.4–3.1), 1.7% (1.2–1.6) after 27 Gy and 1.4% (0.2–2.2) after 26 Gy, emphatically showing non-inferiority of the 5-fraction regimens. Subgroup analyses comparing IBTR in 26 Gy versus 40 Gy show no evidence of differential effect regarding age, grade, pathological tumour size, nodal status, tumour bed boost, adjuvant chemotherapy, HER2 status and triple negative status. The number of events in these analyses is small and results should be interpreted with caution. There was only 1 IBTR event post-mastectomy. Normal tissue effects The 26 Gy schedule, on the basis of similar NTE to 40 Gy in 15 fractions, is the recommended regimen for clinical implementation. There is a low absolute rate of moderate/marked NTE, these are predominantly moderate not severe change. Subgroup analyses comparing clinician-assessed moderate or marked adverse effect for 26 Gy versus 40 Gy show no evidence of differential effects according to age, breast size, surgical deficit, tumour bed boost, or adjuvant chemotherapy. Radiobiological considerations The design of the FAST-Forward trial does not control for time-related effects, and the ability to interpret clinical outcomes in terms of underlying biology is limited. There could conceivably be a time-effect for tumour control. A slight reduction in α/β estimate for the late normal tissue effects of test regimens might be a chance effect, but if real could reflect fewer consequential late effects due to lower rates of moist desquamation. Conclusion The 26 Gy 5-fraction daily regimen for breast radiotherapy can be implemented now.
Published: 2021
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35. Co-producing a multi-stakeholder Core Outcome Set for distal Tibia and Ankle fractures (COSTA): a study protocol

Author: Nathan A Pearson, David J Keene, Alexander Joeris, Kirstie L. Haywood, Elizabeth Tutton, Richard P. Grant, and Stephen Gwilym
Subjects: medicine.medical_specialty, Medicine (General), Delphi Technique, injury, Delphi method, Psychological intervention, Medicine (miscellaneous), Ankle Fractures, Trauma, Distal tibia, law.invention, Study Protocol, Interviews, 03 medical and health sciences, 0302 clinical medicine, R5-920, Randomized controlled trial, law, Ankle fracture, Outcome Assessment, Health Care, medicine, Humans, Pharmacology (medical), 030212 general & internal medicine, Malleolar, Randomized Controlled Trials as Topic, 030203 arthritis & rheumatology, Tibia, business.industry, Focus group, R1, Delphi study, Clinical trial, Treatment Outcome, Systematic review, medicine.anatomical_structure, Reporting bias, Research Design, Physical therapy, Core outcome sets, Ankle, business, RD
Abstract: BackgroundAnkle fracture is a common injury with a strong evidence base focused on effectiveness of treatments. However, there are no reporting guidelines on distal tibia and ankle fractures. This has led to heterogeneity in outcome reporting and consequently, restricted the contribution of evidence syntheses. Over the past decade, core outcome sets have been developed to address this issue and are available for several common fractures, including those of the hip, distal radius, and open tibial fractures. This protocol describes the process to co-produce—with patient partners and other key stakeholders—a multi-stakeholder derived Core Outcome Set for distal Tibia and Ankle fractures (COSTA). The scope of COSTA will be for clinical trials.MethodsThe study will have five-stages which will include the following: (i) systematic reviews of existing qualitative studies and outcome reporting in randomised controlled trial studies to inform a developing list of potential outcome domains; (ii) qualitative interviews (including secondary data) and focus groups with patients and healthcare professionals to explore the impact of ankle fracture and the outcomes that really matter; (iii) generation of meaningful outcome statements with the study team, international advisory group and patient partners; (iv) a multi-round, international e-Delphi study to achieve consensus on the core domain set; and (v) an evidence-based consensus on a core measurement set will be achieved through a structured group consensus meeting, recommending best assessment approaches for each of the domains in the core domain set.DiscussionDevelopment of COSTA will provide internationally endorsed outcome assessment guidance for clinical trials for distal tibia and ankle fractures. This will enhance comparative reviews of interventions, potentially reducing reporting bias and research waste.
Published: 2021

36. The Additive Prognostic Value of Serial Plasma Interleukin-6 Levels over Changes in Brain Natriuretic Peptide in Patients with Acute Heart Failure

Author: Peter van der Meer, Marco Metra, Piotr Ponikowski, Dirk J. van Veldhuisen, Jasper Tromp, John G.F. Cleland, Hans L. Hillege, Michael M. Givertz, Christopher M. O'Connor, Robert J. Mentz, Beth A. Davison, John R. Teerlink, George Markousis-Mavrogenis, Adriaan A. Voors, Gad Cotter, Cardiovascular Centre (CVC), Groningen Kidney Center (GKC), Life Course Epidemiology (LCE), and Restoring Organ Function by Means of Regenerative Medicine (REGENERATE)
Subjects: medicine.medical_specialty, Infarction, 030204 cardiovascular system & hematology, 03 medical and health sciences, Risk model, 0302 clinical medicine, Natriuretic Peptide, landmark, Internal medicine, Natriuretic Peptide, Brain, Clinical endpoint, change, Medicine, Humans, In patient, 030212 general & internal medicine, Interleukin 6, BNP, IL-6, NT-proBNP, Serial, Biomarkers, Cross-Sectional Studies, Peptide Fragments, Prognosis, Retrospective Studies, Heart Failure, Interleukin-6, biology, business.industry, Brain, medicine.disease, Brain natriuretic peptide, R1, Heart failure, Cohort, biology.protein, Cardiology, Cardiology and Cardiovascular Medicine, business, INFARCTION
Abstract: Background: \ud Elevated plasma interleukin-6 (IL-6) concentrations are frequently observed in patients with acute heart failure (AHF). However, the predictive value of serial IL-6 measurements beyond brain natriuretic peptide (BNP) remains poorly characterized.\ud \ud Methods and Results: \ud This was a retrospective analysis of the PROTECT cohort (2033 patients with AHF). Plasma IL-6 and BNP levels were determined on days 1, 2, 7 and 14 after admission for AHF in 1591 (78.3%), 1462 (71.9%), 1445 (71.1%) and 1451 (71.4%) patients, respectively. The primary endpoint was 180-day all-cause mortality. The median day-1 IL-6 concentration was 11.1 pg/mL (IQR: 6.6, 20.9) and decreased to 10.1 pg/mL (IQR: 5.6-18.5) at day-7. Higher cross-sectional IL-6 concentrations at all time-points predicted the primary endpoint, independent of a risk model for this cohort and changes in BNP. Each doubling of IL-6 between day-1 and day-7 predicted the primary endpoint independent of baseline IL-6 concentrations, the risk model, baseline BNP and changes in BNP [HR (95% CI): 1.18 (1.07-1.30), p=0.0013]. Collectively, 214 (17%) patients experienced at least a doubling of their IL-6 concentrations between day-1 and day-7.\ud \ud Conclusions: \ud We demonstrate that the temporal evolution patterns of IL-6 in patients with AHF have additive prognostic value independent of changes in BNP.
Published: 2021

37. Renin-angiotensin system inhibitors effect before and during hospitalization in COVID-19 outcomes: Final analysis of the international HOPE COVID-19 (Health Outcome Predictive Evaluation for COVID-19) registry

Author: Martino Pepe, Rodolfo Romero, Francisco Marín, Álvaro López-Masjuan, Juan García-Prieto, Marcos García-Aguado, Javier Elola, Antonio Fernández-Ortiz, Hope Covid Investigators, Carolina Espejo, Sergio Raposeiras-Roubín, Víctor Manuel Becerra-Muñoz, Christoph Liebetrau, Ivan Olier, Carlos Macaya, Jorge Luis Jativa Mendez, Charbel Maroun-Eid, Elvira Bondia, Alex F Castro-Mejía, Enrico Cerrato, Adelina Gonzalez, Javier López-Pais, Inmaculada Fernández-Rozas, Aitor Uribarri, Fabrizio Ugo, Harish Ramakrishna, Iván J. Núñez-Gil, María C Viana-Llamas, Mohammad Abumayyaleh, Miguel Corbí-Pascual, Gisela Feltes, Emilio Alfonso-Rodríguez, and Vicente Estrada
Subjects: QA75, Male, medicine.medical_specialty, Heart disease, Infecciones por coronavirus, medicine.medical_treatment, Inhibidores enzimáticos, Population, Clinical Investigations, Enfermedad transmisible, Angiotensin-Converting Enzyme Inhibitors, Sistema renina-angiotensina, Comorbidity, 030204 cardiovascular system & hematology, Severity of Illness Index, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Outcome Assessment, Health Care, Severity of illness, medicine, Humans, Registries, 030212 general & internal medicine, Medical prescription, education, Heart Failure, Mechanical ventilation, education.field_of_study, SARS-CoV-2, business.industry, COVID-19, Middle Aged, Prognosis, medicine.disease, R1, Respiration, Artificial, Hospitalization, Italy, Spain, Heart failure, Emergency medicine, Female, Observational study, Cardiology and Cardiovascular Medicine, business
Abstract: Background The use of Renin-Angiotensin system inhibitors (RASi) in patients with coronavirus disease 2019 (COVID-19) has been questioned because both share a target receptor site. Methods HOPE-COVID-19 (NCT04334291) is an international investigator-initiated registry. Patients are eligible when discharged after an in-hospital stay with COVID-19, dead or alive. Here, we analyze the impact of previous and continued in-hospital treatment with RASi in all-cause mortality and the development of in-stay complications. Results We included 6503 patients, over 18 years, from Spain and Italy with data on their RASi status. Of those, 36.8% were receiving any RASi before admission. RASi patients were older, more frequently male, with more comorbidities and frailer. Their probability of death and ICU admission was higher. However, after adjustment, these differences disappeared. Regarding RASi in-hospital use, those who continued the treatment were younger, with balanced comorbidities but with less severe COVID19. Raw mortality and secondary events were less frequent in RASi. After adjustment, patients receiving RASi still presented significantly better outcomes, with less mortality, ICU admissions, respiratory insufficiency, need for mechanical ventilation or prone, sepsis, SIRS and renal failure (p
Published: 2021
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38. Mortality in Patients With Gout Treated With Allopurinol: A Systematic Review and Meta‐Analysis

Author: John Belcher, Charles A. Hay, Christian D Mallen, James A. Prior, and Edward Roddy
Subjects: Adult, Male, musculoskeletal diseases, congenital, hereditary, and neonatal diseases and abnormalities, medicine.medical_specialty, Time Factors, Gout, Allopurinol, MEDLINE, Cochrane Library, Q1, Risk Assessment, Gout Suppressants, 03 medical and health sciences, 0302 clinical medicine, Rheumatology, Risk Factors, Cause of Death, Internal medicine, medicine, Humans, Aged, 030203 arthritis & rheumatology, business.industry, Hazard ratio, R735, nutritional and metabolic diseases, Middle Aged, medicine.disease, R1, Confidence interval, Treatment Outcome, Meta-analysis, Female, business, RA, medicine.drug, Cohort study
Abstract: OBJECTIVE Urate-lowering therapy (predominantly allopurinol) is highly effective as a treatment for gout, but its wider long-term effects remain unclear. This systematic review and meta-analysis aimed to ascertain the association between mortality and the use of allopurinol in patients with gout. METHOD Medline, Embase, CINAHL, and the Cochrane Library were searched from inception to August 2018. Articles eligible for inclusion used a cohort design and examined cardiovascular or all-cause mortality in patients diagnosed with gout and prescribed allopurinol. Information on study characteristics, design, sample size, and mortality risk estimates were extracted. Article quality was assessed using the Newcastle-Ottawa Scale. Included articles were described in a narrative synthesis and, where possible, risk estimate data were pooled. RESULTS Four articles reported a hazard ratio (HR) risk estimate for all-cause mortality in patients with gout using allopurinol, and 2 of these also reported cardiovascular mortality. Two articles found allopurinol to be protective in patients with gout, 1 found no statistically significant association, and 1 found no statistically significant effect of escalation of allopurinol dosage on all-cause or cardiovascular-related mortality. Data pooling was possible for all-cause mortality and found no association between allopurinol use in patients with gout and all-cause mortality compared to patients with gout not using allopurinol (adjusted HR 0.80 [95% confidence interval 0.60-1.05]). CONCLUSION There was no significant association between all-cause mortality and allopurinol use in people with gout. However, the number of included studies was small, suggesting that further studies are needed.
Published: 2021
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39. Coverage with evidence development schemes for medical devices in Europe: characteristics and challenges

Author: Carlo Federici, Sándor Kovács, Vivian Reckers-Droog, Bogdan Grigore, Michael Drummond, Florian Dams, Werner B. F. Brouwer, Zoltán Kaló, Kosta Shatrov, Oriana Ciani, and Health Economics (HE)
Subjects: Value of information, Technology Assessment, Biomedical, Cost-Benefit Analysis, Economics, Econometrics and Finance (miscellaneous), 610 Medicine & health, ADOPTION AND REIMBURSEMENT OF MEDICAL DEVICES, COVERAGE WITH EVIDENCE DEVELOPMENT, EUROPEAN HTA POLICIES, MEDICAL DEVICES, VALUE OF INFORMATION, Health care management, 03 medical and health sciences, 0302 clinical medicine, SDG 3 - Good Health and Well-being, 650 Management & public relations, Humans, Longitudinal Studies, 030212 general & internal medicine, Marketing, 350 Public administration & military science, Coverage with evidence development, Original Paper, Health economics, I18, 030503 health policy & services, Health Policy, R1, 330 Economics, Europe, European HTA policies, Adoption and reimbursement of medical devices, Structured interview, Medical devices, Business, 0305 other medical science, Public finance
Abstract: Objectives Medical devices are potentially good candidates for coverage with evidence development (CED) schemes, as clinical data at market entry are often sparse and (cost-)effectiveness depends on real-world use. The objective of this research was to explore the diffusion of CED schemes for devices in Europe, and the factors that favour or hamper their utilization. Methods We conducted structured interviews with 25 decision-makers from 22 European countries to explore the characteristics of existing CED programmes for devices, and how decision makers perceived 13 pre-identified challenges associated with initiating and operating CED schemes for devices. We also collected data on individual schemes that were either initiated or still ongoing in the last 5 years. Results We identified seven countries with CED programmes for devices and 78 ongoing schemes. The characteristics of CED programmes varied across countries, including eligibility criteria, roles and responsibilities of stakeholders, funding arrangements, and type of decisions being contemplated at the outset of each scheme. We observed a high variability in how decision makers perceived CED-related challenges possibly reflecting country-specific arrangements and different experiences with CED. One general finding across all countries was that relatively little attention was paid to the evaluation of schemes, both during and at their completion. Conclusions CED programmes for devices with different characteristics exist in Europe. Decision-makers’ perceptions differ on the challenges associated with these schemes. More exchange of knowledge and experience will help decision makers anticipate the likely challenges in CED schemes for devices, and to learn from good practices existing elsewhere.
Published: 2021
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40. R1 resection margin after organ-sparing/oncoplastic surgeries for breast cancer

Author: E. A. Rasskazova, A. D. Zikiryakhodzhaev, N. N. Volchenko, and Sh. G. Khakimova
Subjects: medicine.medical_specialty, r0, R1 resection, medicine.medical_treatment, surgical treatment, Lobular carcinoma, Malignancy, r1, organ-sparing surgeries, Breast cancer, breast cancer, medicine, Pharmacology (medical), Radiology, Nuclear Medicine and imaging, resection margins, oncoplastic resection, Invasive carcinoma, business.industry, Carcinoma in situ, Obstetrics and Gynecology, Gynecology and obstetrics, medicine.disease, Surgery, Radiation therapy, breast cancer recurrence, Oncology, molecular types, Resection margin, combination treatment, RG1-991, business
Abstract: The recurrence rate after organ-sparing surgeries for breast cancer depends on the resection margins: R1 status is associated with a higher risk of recurrence than R0.We analyzed a group of breast cancer patients with an R1 resection margin who underwent organ-sparing/oncoplastic surgeries. The R1 resection margin was detected in 62 out of 1279 patients who had organ-sparing/oncoplastic surgeries (4.9 % ± 0.6 %). In the group with invasive cancer and R1 resection margin, 80 % of patients were diagnosed with lobular carcinoma, whereas 14.8 % of patients had invasive cancer with no specific signs.We divided the group of repeated surgeries according to their histological structure at the resection margin: 28 patients were found to have carcinoma in situ, while 13 patients had invasive cancer.Among patients with carcinoma in situ, the resection margin after repeated surgery had no signs of malignancy in 14 women (50 %), while 10 (35.7 %) and 4 (14.3 %) women were diagnosed with carcinoma in situ and invasive cancer, respectively.In case of invasive cancer, 4 patients (30.8 %) had no signs of malignancy in their resection margins, while 1 (7.7 %) and 8 (61.5 %) patients were found to have carcinoma in situ and invasive cancer, respectivelyFollow-up of patients with an R1 resection margin after repeated surgery or radiotherapy revealed no cases of local recurrence between 3 and 65 months.
Published: 2021

41. Patient-reported outcome measurement: a bridge between health and social care?

Author: Sarah E. Hughes, Olalekan Lee Aiyegbusi, Jon Glasby, Daniel Lasserson, Philip Collis, and Melanie Calvert
Subjects: business.industry, Social Support, General Medicine, R1, Bridge (interpersonal), HV, Nursing, Commentaries, Humans, Medicine, Social care, Patient-reported outcome, Patient Reported Outcome Measures, business, Delivery of Health Care, RA
Abstract: Social care is under increasing pressure globally. For economically developed countries, the cost pressures on long-term care services are set to grow as governments struggle to provide high-quality social care to an ageing population and a growing number of working age adults with complex needs.1 In England in 2018/2019, 841,850 people received publicly funded long-term social care, primarily in care/nursing homes or in their own home with a government spend of £22 billion.2 However, austerity has meant social care funding in real terms has fallen. Funding per person was at a lower level in 2019 than in 2010/2011, with an estimated funding gap of £1.5 billion. This funding shortfall, projected to be at least £2.7 billion by 2023/2024, means unmet need (i.e. people going without care and support) is a significant concern.3 Issues around workforce sustainability and a fragmented, means-tested social care system further challenge the delivery of social care.4 Healthcare, too, is confronted with the challenge of delivering safe, effective, quality care in the face of constrained budgets and, with COVID-19, a rapidly changing healthcare delivery landscape. As such, stakeholders across health and social care must give consideration to initiatives that will drive improvement in outcomes and quality of care.\ud \ud
Published: 2021
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42. European Union Child Guarantee—challenges raised by the welcome promise of free healthcare for marginalized children

Author: Michael Rigby
Subjects: Economic growth, Adolescent, RJ, Parliament, RJ101, media_common.quotation_subject, JN, 03 medical and health sciences, 0302 clinical medicine, 030225 pediatrics, Health care, Humans, media_common.cataloged_instance, Family, AcademicSubjects/MED00860, AcademicSubjects/SOC01210, European Union, 030212 general & internal medicine, European union, Child, media_common, Reproductive health, Data collection, Right to health, business.industry, Health Policy, Public Health, Environmental and Occupational Health, R1, Mental health, Europe, Policy, business, RA, Delivery of Health Care, AcademicSubjects/SOC02610, Adolescent health
Abstract: Background Children are dependent on the way in which society provides healthcare, with primary and preventive care being initial components. They also have a generally acclaimed right to health, and to lack of impediment to access to healthcare. In a major initiative, the European Parliament has proposed a Child Guarantee to include free access to healthcare for marginalized children, and a Feasibility Study has been completed with positive results. However, there has been little analysis of national policies toward free access to healthcare for children, including longer-term treatment, mental health or adolescent health services, or of charges and indirect financial barriers to access Methods Data on policies for children’s access to healthcare from two recent European Community wide studies were re-analyzed and matched. Primary care, immunization, surveillance screening, minor illness, a more significant medium-term condition, and reproductive health were included. Additionally, data from a European survey of children reported as having unmet medical needs were revisited. Composite summaries relating to all 28 EU countries as of 2019 were produced. Results Only three EU-28 countries provided totally free services, though 26 countries provide free primary and preventive services. There is evidence of some children having unmet medical needs in 21 countries, with Expense being the main quoted factor. Conclusion There is widespread variation across Europe in free access for children to healthcare, little comparative study of policies and their effects on enabling or hindering access, and minimal data collection. This compromises achievement of the Guarantee, and initiatives are needed.
Published: 2021
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43. Safety cases for digital health innovations: can they work?

Author: Mark-Alexander Sujan and Ibrahim Habli
Subjects: business.industry, 030503 health policy & services, Health Policy, Information technology, Context (language use), R1, Digital health, Telemedicine, 03 medical and health sciences, Patient safety, 0302 clinical medicine, Procurement, Risk analysis (engineering), Health care, Humans, Medicine, Safety case, 030212 general & internal medicine, 0305 other medical science, business, Risk management
Abstract: Innovations in digital health, such as the introduction of smart infusion pumps, have the potential to improve patient safety, even though the evidence base remains weak.1 Equally, however, new risks can be introduced, which might contribute to adverse events and patient harm.2 3 The Healthcare Safety Investigation Branch (HSIB), which carries out independent investigations into patient safety concerns in the National Health Service (NHS) in England, published in December 2020 its findings from a national investigation into the procurement, usability and adoption of smart infusion pumps.4 The report includes safety observations (suggested actions for wider learning and improvement) that suggest the use of (clinical) safety cases in order to demonstrate that patient safety risks have been addressed rigorously and proactively. Safety cases are a common regulatory instrument used in UK safety-critical industries, as well as other countries such as Norway, Australia and New Zealand.5 Previous attempts at importing safety management practices from other industries to healthcare have not always delivered the anticipated benefits, for example, the application of failure mode and effects analysis6 or the adoption of incident reporting systems.7 It is important to understand both the principles underlying such approaches and the context within which they were developed, as well as the unique cultural and institutional context that is specific to healthcare.8 9 In this paper, we review the thinking that underpins the use of safety cases across different safety-critical industries, and then reflect on their potential use for assuring the safety of digital health innovations. This builds in part on a previous review,10 but also considers the recent debate about the need for an evidence base for safety case adoption. We focus on digital health innovations, because safety cases are likely to be particularly relevant for software-based systems including, more …
Published: 2021
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44. Leveraging electronic health record data to inform hospital resource management

Author: Henrique Martins, Mónica Duarte Oliveira, Filipe Janela, Jose Ferrao, and Daniel Gartner
Subjects: Computer science, Decision tree, Medicine (miscellaneous), Feature selection, Logistic regression, computer.software_genre, Health informatics, Value of information, Machine Learning, 03 medical and health sciences, 0302 clinical medicine, Data Mining, Electronic Health Records, Humans, Resource management, 030212 general & internal medicine, Categorical variable, business.industry, 030503 health policy & services, Regression analysis, R1, Hospitals, Logistic Models, General Health Professions, Data mining, 0305 other medical science, business, computer
Abstract: Early identification of resource needs is instrumental in promoting efficient hospital resource management. Hospital information systems, and electronic health records (EHR) in particular, collect valuable demographic and clinical patient data from the moment patients are admitted, which can help predict expected resource needs in early stages of patient episodes. To this end, this article proposes a data mining methodology to systematically obtain predictions for relevant managerial variables by leveraging structured EHR data. Specifically, these managerial variables are: i) Diagnosis categories, ii) procedure codes, iii) diagnosis-related groups (DRGs), iv) outlier episodes and v) length of stay (LOS). The proposed methodology approaches the problem in four stages: Feature set construction, feature selection, prediction model development, and model performance evaluation. We tested this approach with an EHR dataset of~5,089 inpatient episodes and compared different classification and regression models (for categorical and continuous variables, respectively), performed temporal analysis of model performance, analyzed the impact of training set homogeneity on performance and assessed the contribution of different EHR data elements for model predictive power. Overall, our results indicate that inpatient EHR data can effectively be leveraged to inform resource management on multiple perspectives. Logistic regression (combined with minimal redundancy maximum relevance feature selection) and bagged decision trees yielded best results for predicting categorical and numerical managerial variables, respectively. Furthermore, our temporal analysis indicated that, while DRG classes are more difficult to predict, several diagnosis categories, procedure codes and LOS amongst shorter-stay patients can be predicted with higher confidence in early stages of patient stay. Lastly, value of information analysis indicated that diagnoses, medication and structured assessment forms were the most valuable EHR data elements in predicting managerial variables of interest through a data mining approach.
Published: 2021
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45. How machine learning is impacting research in atrial fibrillation: implications for risk prediction and future management

Author: Ivan Olier, Gregory Y.H. Lip, Mark Pieroni, and Sandra Ortega-Martorell
Subjects: QA75, Risk analysis, Blood pressure control, Artificial intelligence, Databases, Factual, Physiology, Computer science, Spotlight Reviews, Clinical Decision-Making, Atrial fibrillation, 030204 cardiovascular system & hematology, Machine learning, computer.software_genre, Risk Assessment, Decision Support Techniques, Machine Learning, Translational Research, Biomedical, Stroke risk, Electrocardiography, 03 medical and health sciences, 0302 clinical medicine, Predictive Value of Tests, Risk Factors, Physiology (medical), Atrial Fibrillation, medicine, Animals, Data Mining, Humans, AcademicSubjects/MED00200, Diagnosis, Computer-Assisted, mHealth, Modalities, Modality (human–computer interaction), Wearables, business.industry, Prognosis, medicine.disease, R1, Therapy, Computer-Assisted, Deep neural networks, Cardiology and Cardiovascular Medicine, business, computer, 030217 neurology & neurosurgery
Abstract: There has been an exponential growth of artificial intelligence (AI) and machine learning (ML) publications aimed at advancing our understanding of atrial fibrillation (AF), which has been mainly driven by the confluence of two factors: the advances in deep neural networks (DeepNNs) and the availability of large, open access databases. It is observed that most of the attention has centred on applying ML for dvsetecting AF, particularly using electrocardiograms (ECGs) as the main data modality. Nearly a third of them used DeepNNs to minimize or eliminate the need for transforming the ECGs to extract features prior to ML modelling; however, we did not observe a significant advantage in following this approach. We also found a fraction of studies using other data modalities, and others centred in aims, such as risk prediction, AF management, and others. From the clinical perspective, AI/ML can help expand the utility of AF detection and risk prediction, especially for patients with additional comorbidities. The use of AI/ML for detection and risk prediction into applications and smart mobile health (mHealth) technology would enable ‘real time’ dynamic assessments. AI/ML could also adapt to treatment changes over time, as well as incident risk factors. Incorporation of a dynamic AI/ML model into mHealth technology would facilitate ‘real time’ assessment of stroke risk, facilitating mitigation of modifiable risk factors (e.g. blood pressure control). Overall, this would lead to an improvement in clinical care for patients with AF., Graphical Abstract
Published: 2021
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46. Sharing a written medical summary with patients on the <scp>post‐admission</scp> ward round: A qualitative study of clinician and patient experience

Author: Caroline S. Lebus, Zoe Fritz, Aaron P. L. Fleming, Anne-Marie Slowther, Anna L. Crucefix, Fleming, Aaron PL [0000-0002-4816-3867], Fritz, Zoë [0000-0001-9403-409X], Apollo - University of Cambridge Repository, and Fleming, Aaron P. L. [0000-0002-4816-3867]
Subjects: medicine.medical_specialty, diagnosis, education, ORIGINAL PAPERS, 03 medical and health sciences, Pregnancy, Physicians, Acute care, Patient experience, Health care, Humans, Medicine, Confidentiality, Hospitals, Teaching, Qualitative Research, patient‐centred care, business.industry, ORIGINAL PAPER, Communication, 030503 health policy & services, Health Policy, Medical record, Public Health, Environmental and Occupational Health, healthcare, R1, Patient Outcome Assessment, Jargon, patient-centred care, medical ethics, Family medicine, Female, explanation, 0305 other medical science, business, RA, Medical ethics, Qualitative research
Abstract: Rationale, Aims and Objectives:\ud Sharing aspects of the traditional medical record with patients has been successful in primary and antenatal care, but has not been investigated in the UK inpatient setting. Our aim was to evaluate the impact on patient and clinician experience of providing patients with a written lay summary of their care-plan in the acute care setting.\ud \ud Method:\ud We carried out a qualitative interview study on two acute medicine wards in an NHS University Teaching Hospital for a 4-week period in 2019. A summary record, designed in response to suggestions from doctors and patients from a previous study, was distributed to patients on the first ward round after admission. Eligible participants included all doctors and nurses working on and all patients and their families attending the acute medical units; patients were excluded if they lacked capacity to consent or were under 18. We interviewed 20 patients, 10 relatives, 10 doctors and 7 nurses.\ud \ud Results:\ud Patients felt that the summary improved their ability to remember details about their care so they could more accurately and easily update their relatives. They did not feel that the summary induced anxiety. Patient-doctor communication was improved: patients felt empowered to ask more questions and doctors felt that it solidified their plan and encouraged them to avoid medical jargon. Most patients felt the summary included the ‘right’ amount of information. Healthcare professionals were more concerned about the risk of breaching confidentiality than patients. Doctors felt that providing summaries was time-consuming; there were differing opinions about whether this was a worthwhile investment of time. Clinicians recognized that the traditional medical record has many roles.\ud \ud Conclusions:\ud A summary record could empower patients and improve patient-doctor communication but would require additional clinician and administrative time.
Published: 2021
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47. Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

Author: Obbina Abani, Ali Abbas, Fatima Abbas, Mustafa Abbas, Sadia Abbasi, Hakam Abbass, Alfie Abbott, Nabeel Abdallah, Ashraf Abdelaziz, Mohamed Abdelfattah, Bushra Abdelqader, David Abdo, Basir Abdul, Althaf Abdul Rasheed, Ajibode Abdulakeem, Rezan Abdul-Kadir, Amina Abdulle, Abdulfatahi Abdulmumeen, Rasheed Abdul-Raheem, Niyaz Abdulshukkoor, Kula Abdusamad, Yazeed Abed El Khaleq, Mai Abedalla, Abeer Ul Amna Abeer Ul Amna, Katrina Abernethy, Adebanke Aboaba, Hani Abo-Leyah, Ahmed Abou-Haggar, Mahmoud Abouibrahim, Miriam Abraham, Tizzy Abraham, Abraheem Abraheem, Judith Abrams, Hyacinth-John Abu, Ahmed Abu-Arafeh, Syed M Abubacker, Akata Abung, Yaa Aceampong, Amaka Achara, Devikumar Acharya, Sarah Acheampong, Janet Acheson, Andres Acosta, Catherine Acton, Jacqueline Adabie-Ankrah, Sara Adair, Fiona Adam, Matthew Adam, Huzaifa Adamali, Carol Adams, Charlotte Adams, Kate Adams, Lisa Adams, Richard Adams, Tim Adams, Kirsty Adcock, Jemaimah Addai, Ade Adebiyi, Ken Adegoke, Vicki Adell, Debo Ademokun, Sherna Adenwalla, Oluwasegun A Adesemoye, Emmanuel O Adewunmi, Joyce Adeyemi, Rina Adhikary, Gabrielle Adkins, Adnan Adnan, John Aeron-Thomas, Debbie Affleck, Dominic Affron, Carmel Afnan, Muhammad Afridi, Zainab A Aftab, Meenakshi Agarwal, Rachel Agbeko, Chris Agbo, Penny Agent, Sunil Aggarwal, Arameh Aghababaie, Shafana Ahamed Sadiq, Mohamed H Ahammed Nazeer, Humayun Ahmad, Mohammad Ahmad, Syed Ahmad, Asim Ahmed, Bilal Ahmed, Forizuddin Ahmed, Hamze Ahmed, Iram Ahmed, Irshad Ahmed, Khaled Ahmed, Liban Ahmed, Mahin Ahmed, Maria C Ahmed, Muhammad S Ahmed, Naseer Ahmed, Nausheen Ahmed, Osama Ahmed, Rajia A Ahmed, Rizwan Ahmed, Saif Ahmed, Sammiya Ahmed, Sara Ahmed, Sophia Ahmed, Syed Ahmed, Syed Haris Ahmed, Roa Ahmed Ali, Sana Ahmed, Sana Ahmer, Dhiraj Ail, Mark Ainsworth, Giulia Airoldi, Myriam Aissa, Lindianne Aitken, Bini Ajay, Francis Ajeneye, Abdulakeem Ajibode, Ayesha Ajmi, Tahir Akbar, Naim Akhtar, Nasim Akhtar, Nauman Akhtar, Suha Akili, Oludoyinsola Akindolie, Yinka Akinfenwa, Olugbenga Akinkugbe, Ibrahim Akinpelu, Olajide Akinwumiju, Olugbenro Aktinade, Ahmad Al Aaraj, Asma Al Balushi, Majd Al Dakhola, Aladdin Al Swaifi, Eslam Al-Abadi, Narendra Aladangady, Ayaz Alam, Sajid Alam, Abbas Al-Asadi, Karina Al-Asadi, Kyriaki Alatzoglou, Manaf Al-Bayati, Paul Albert, Lorraine Albon, Gemma Alcorn, Stephen Alcorn, Aggie Aldana, David Alderdice, Rayan Aldouri, Jonathan Aldridge, Nicolas Aldridge, Ana Alegria, Alison Alexander, John Alexander, Peter D G Alexander, Charlotte Alford, Julyan Al-Fori, Laith Alghazawi, Bahij Al-Hakim, Shams Al-Hity, Ali Ali, Asad Ali, Fawzia R Ali, Hoodo Ali, Jawad Ali, Mariam Ali, Mohammad Ali, Nayab Ali, Oudai Ali, Sabira Ali, Sakina Ali, Syed Ali, Abid Alina, Fine Aliyuda, Katrin Alizadeh, Maithem Al-Jibury, Saba Al-Juboori, Majid Al-Khalil, Moutaz Alkhusheh, Allameddine Allameddine, Fiona Allan, Rachel Allan, Alison Allanson, Robert Allcock, Beverley Allen, Eireann Allen, Jess Allen, Kerry Allen, Laura Allen, Louise Allen, Poppy Allen, Rebecca Allen, Sam Allen, Sharon Allen, Simon Allen, Kathryn Allison, Bethan Allman, Lynne Allsop, Hassan Al-Moasseb, Magda Al-Obaidi, Lina Alomari, Akram Al-Rabahi, Bahar Al-Ramadhani, Zayneb Al-Saadi, Inji Alshaer, Rustam Al-Shahi Salman, Warkaq Al-Shamkhani, Bashar Al-Sheklly, Sara Altaf, Mary Alvarez, Balaal Alyas, Maysaa Alzetani, Susan Amamou, Noor Amar, Sakkarai Ambalavanan, Sarah-Jayne Ambler, Robert Ambrogetti, Chris Ambrose, Amir Ameen, Kenneth Amenyah, Maria R Amezaga, Allison Amin, Amina Amin, Kanish Amin, Syed Amin, Tara Amin, Amjad Amjad, Neelma Amjad, Mariam Ammoun, Victoria Amosun, Khaled Amsha, Pugh Amy, Atul Anand, Rekha Anand, Samantha Anandappa, Julie Anderson, Kevin Anderson, Laura Anderson, Michelle Anderson, Nicola Anderson, Rachel Anderson, Rory Anderson, Wendy Anderson, Prematie Andreou, Angela Andrews, Antonette Andrews, Jill Andrews, Susan Andrews, Gregory Andrikopoulos, Kanayochukwu Aneke, Andrew Ang, Wan Wei Ang, Tammy Angel, Aramburo Angela, Paola Angelini, Lazarus Anguvaa, Oleg Anichtchik, Millicent Anim-Somuah, Krishnan Aniruddhan, Jessica Annett, Patrick J Anstey, Rebekah Anstey, Alpha Anthony, Aaron Anthony-Pillai, Philip Antill, Zhelyazkova Antonina, Varghese Anu, Muhammad Anwar, George Apostolides, Aristeidis Apostolopoulos, Sarah Appleby, Diane Appleyard, Maia Far Aquino, Bianca Araba, Samuel Aransiola, Mariana Araujo, Emily Arbon, Ann Archer, Denise Archer, Simon Archer, Christian Ardley, Ana-Maria Arias, Ryoki Arimoto, Charlotte Arkley, Charlotte Armah, Ilianna Armata, Adam Armitage, Ceri Armstrong, Maureen Armstrong, Sonia Armstrong, Sylvia Armstrong-Fisher, Philippa Armtrong, Heike Arndt, Clare Arnison-Newgass, David Arnold, Rachael Arnold, Sarah Arnott, Dhawal Arora, Kavan Arora, Pardeep Arora, Rishi Arora, Andrea Arroyo, Arslam Arter, Ayush Arya, Rita Arya, Denisa Asandei, Adeeba Asghar, Catherine Ashbrook-Raby, Glen Ashby, Helen Ashby, Jan Ashcroft, John Ashcroft, Samuel Ashcroft, Deborah Asher, Ayesha Ashfaq, Ben Ashford, Suhail Ashgar, Abdul Ashish, Sally Ashman-Flavell, Sundar Ashok, Abd-El-Aziz Ashour, Muhammad Z Ashraf, Saima Ashraf, Mohammad B Ashraq, Deborah Ashton, Susan Ashton, Andrew Ashworth, Rebecca Ashworth, Arshia Aslam, Harshini Asogan, Abigail Asquith, Atif Asrar, Omar Assaf, Raine Astin-Chamberlain, Richard Athay-Hunt, Deborah Athorne, Billie Atkins, Christopher Atkins, Stacey Atkins, John Atkinson, Vicki Atkinson, Brygitta Atraskiewicz, Claire Atterbury, Abdul Ahmad Attia, Rita Atugonza, Paula Aubrey, Avinash Aujayeb, Aye Chan Thar Aung, Hnin Aung, Kyaw Thu Aung, Ni Aung, Yin Aung, Zaw Myo Aung, Emily Austin, Karen Austin, Abdusshakur Auwal, Miriam Avery, Joanne Avis, Georgina Aviss, Cristina Avram, Paula Avram, Gabriel Awadzi, Atia Awan, Aszad Aya, Eman Ayaz, Amanda Ayers, Jawwad Azam, Mohammed Azharuddin, Ghazala Aziz, N Aziz, Ali Azkoul, Ashaari Azman Shah, Giada Azzopardi, Hocine Azzoug, Fiyinfoluwa Babatunde, Melvin Babi, Babiker Babiker, Gayna Babington, Matthew Babirecki, Marta Babores, Adetona O Babs-Osibodu, Sammy Bacciarelli, Roudi Bachar, Gina Bacon, Jenny Bacon, Bibi Badal, Gurpreet R Badhan, Shreya Badhrinarayanan, Joseph P Bae, Sibel Bafekr Mishamandani, Alice Baggaley, Amy Baggott, Graham Bagley, Dinesh Bagmane, Lynsey Bagshaw, Kasra Bahadori, James Bailey, Katie Bailey, Lindsey Bailey, Liz Bailey, Morgan Bailey, Pippa Bailey, Sarah Bailey, Stephen Bailey, Hamish Baillie, J Kenneth Baillie, Jennifer Bain, Sanchia Baines, Vikram Bains, Aimi Baird, David Baird, Susan Baird, Tracy Baird, Yolanda Baird, Aiysha Bajandouh, Charles Baker, Emma Baker, Evelyn Baker, Johanne Baker, Josephine Baker, Kenneth Baker, Rebecca Baker, Terri-Anne Baker, Victoria Baker, Hugh Bakere, Nawar Bakerly, Michelle Baker-Moffatt, Nauman Bakhtiar, Panos Bakoulas, Julie Balaam, Niranjan Balachandran, Andrea Balan, Theodosios Balaskas, Madhu Balasubramaniam, Alison Balcombe, Alexander Baldwin, Ashley Baldwin, Caron Baldwin, Danielle Baldwin, Rebekah Baldwin-Jones, James Balfour, Gagan Bali, Sonya Balkee, Ceri Ball, Kasia Ballard, Amy Ballinger, Ismael Balluz, Craig Balmforth, Emese Balogh, Amir Baluwala, Gabby Bambridge, Alasdair Bamford, Amy Bamford, Peter Bamford, Adefunke Bamgboye, Elizabeth Bancroft, Hollie Bancroft, Tanya Bancroft, Joyce Banda, Krishna Bandaru, Srini Bandi, Nageswar Bandla, Somaditya Bandyopadhyam, Amit Banerjee, Millie Banerjee, Ritwik Banerjee, Harrison Banks, Lauren Banks, Luke Banks, Paul Banks, Oliver Bannister, Bharat Bansal, Robert Banthorpe, Laura Banton, Mariamma Baptist, Tanya Baqai, Ananya Mouli Baral, Desislava Baramova, Alex Barber, Russel Barber, Emma Barbon, Miriam Barbosa, Monica Barbosa, Jamie Barbour, Alexander Barclay, Claire Barclay, George Bardsley, Stephanie Bareford, Shahedal Bari, Amy Barker, Debbie Barker, Helen Barker, Joseph Barker, Leon Barker, Oliver Barker, Kerry Barker-Williams, Sinha Barkha, Juliana Barla, Gavin Barlow, Richard Barlow, Valerie Barlow, James Barnacle, Alex Barnard, Debi Barnes, Nicky Barnes, Theresa Barnes, Calum Barnetson, Amy Barnett, Matthew Barnett, Ashton Barnett-Vanes, William Barnsley, Andrew Barr, David Barr, Shaney Barratt, Manuella Barrera, Amy Barrett, Fiona Barrett, Jessica Barrett, Joe Barry, Jazz Bartholomew, Claire Bartlett, Georgina Bartlett, Greg Barton, Jill Barton, Lorna Barton, Rachael Barton, Rosaleen Baruah, Sonia Baryschpolec, Archana Bashyal, Betsy Basker, Ayten Basoglu, Gilda Bass, John Bassett, G Bassett, Chris Bassford, Pavinder Bassi, Betsy Bassis, Bengisu Bassoy, Victoria Bastion, Anupam Basumatary, Tristan Bate, Harry J Bateman, Ian Bateman, Kathryn Bateman, Vhairi Bateman, Eleanor Bates, Hayley Bates, Michelle Bates, Simon Bates, Sally Batham, Ana Batista, Amit Batla, Dushyant Batra, Donna Batty, Harry Batty, Thomas Batty, Peter Baughan, Miranda Baum, Carina Bautista, Fareha Bawa, Fatima S Bawani, Simon Bax, Lydia Baxter, Matt Baxter, Nicola Baxter, Zachary Baxter, Hannah Bayes, Charlotte Baylem, Lee Bayliss, Eileen Bays, Farid Bazari, Rohit Bazaz, Ahmad Bazli, Laura Beacham, Wendy Beadles, Philip Beak, Andy Beale, Kirk Beard, Jack Bearpark, Karen Beaumont, Dawn Beaumont-Jewell, Theresa Beaver, Sarah Beavis, Christy Beazley, Sarah Beck, Virginia Beckett, Rosie Beckitt, Heidi Beddall, Seonaid Beddows, Deborah Beeby, Gail Beech, Michelle Beecroft, Sally Beer, Jane Beety, Gabriela Bega, Alison Begg, Susan Begg, Sara Beghini, Ayesha Begum, Salman Begum, Selina Begum, Teresa Behan, Jasmine Beharry, Roya Behrouzi, Jon Beishon, Claire Beith, James Belcher, Holly Belfield, Katherine Belfield, Ajay Belgaumkar, Dina Bell, Gareth Bell, Gill Bell, Gillian Bell, Joshua Bell, Lauren Bell, Louise Bell, Nicholas Bell, Pippa Bell, Stephanie Bell, Jennifer L Bell, Jennifer Bellamu, Mary Bellamy, Arianna Bellini, Amanda Bellis, Fionn Bellis, Lesley Bendall, Naveena Benesh, Nicola Benetti, Leonie Benham, Guy Benison-Horner, Alexander Bennett, Ann Bennett, Caroline Bennett, Christopher Bennett, Gillian Bennett, Ian Bennett, Kristopher Bennett, Lorraine Bennett, Sara Bennett, Karen Bennion, Vivienne Benson, Jane Benstead, Andrew Bentley, Dionne Bentley, James Bentley, Ian Benton, Eva Beranova, Matthew Beresford, Colin Bergin, Malin Bergstrom, Jolanta Bernatoniene, Thomas Berriman, Zoe Berry, Marnie Berwick, Kimberley Best, Ans-Mari Bester, Yvonne Beuvink, Emily Bevan, Sarah Bevins, Tom Bewick, Andrew Bexley, Sonay Beyatli, Fenella Beynon, Arjun Bhadi, Sanjay Bhagani, Shiv Bhakta, Rekha Bhalla, Khushpreet Bhandal, Kulbinder Bhandal, Ashwin Bhandari, Sangam Bhandari, Aashutosh Bhanot, Ravina Bhanot, Sruti Bhaskara, Prashanth Bhat, Nikhil Bhatia, Rahul Bhatnagar, Karan Bhatt, Janki Bhayani, Deepika Bhojwani, Salimuzzaman Bhuiyan, Anna Bibby, Fatima Bibi, Naheeda Bibi, Salma Bibi, Tihana Bicanic, Sarah Bidgood, Julie Bigg, Sarah Biggs, Alphonsa Biju, Andras Bikov, Sophie Billingham, Jessica Billings, Carron Bilton, Teodirico Binas, Martin Binney, Alice Binns, Muhammad BinRofaie, Oliver Bintcliffe, Catherine Birch, Jenny Birch, Louann Birch, Janet Birchall, Katherine Birchall, Sam Bird, Sumedha Bird, Charndip Biring, Mark Birt, Raquel Bisa, Kilanalei Bishop, Linda Bishop, Lisa Bishop, Karen Bisnauthsing, Nibedan Biswas, Sahar Biuk, Karen Blachford, Ethel Black, Helen Black, Karen Black, Mairead Black, Polly Black, Hayley Blackgrove, Bethan Blackledge, Joanne Blackler, Samantha Blackley, Helen Blackman, Stuart Blackmore, Caroline Blackstock, Loraine Blackwood, Francesca Blakemore, Helen Blamey, Alison Bland, Sujata Blane, Simon Blankley, Mary Blanton, Parry Blaxill, Jenny Blaxland, Katie Blaylock, Jane Blazeby, Carol Blears, Natalie Blencowe, Donna Blofield, Ben Bloom, Jack Bloomfield, Angela Bloss, Hannah Bloxham, Louise Blundell, Andrew Blunsum, Mark Blunt, Ian Blyth, Kevin Blyth, Andrew Blythe, Karen Blythe, Marilyn Boampoaa, Boniface Bobie, Karen Bobruk, Pritesh Bodalia, Neena Bodasing, Tanya Bodenham, Sherin Bodh, Gabriele Boehmer, Marta Boffito, Kristyna Bohmova, Sumit Bokhandi, Maria Bokhar, Saba Bokhari, Sakina Bokhari, Syed Owais Bokhari, Ambrose Boles, Sarah Bollington, Sam Bolton, Charlotte Bomken, Charlotte Bond, Hayley Bond, Helena Bond, Stuart Bond, Thomas Bond, Alice Bone, Georgia Boniface, Wendy Bonnert, Lizzy Bonney, Leigh Boorman, Catherine Booth, Joanne Borbone, Cameron Borhani, Naomi Borman, Rachel Borrell, Mamu Boshir, Fiona Bottrill, Laura Bough, Hayley Boughton, Zoe Boult, Miriam Bourke, Stephen Bourke, Michelle Bourne, Rachel Bousfield, Lucy Boustred, Darren Bowen, Kaye Bowen, Alexandra Bowes, Amy Bowes, Philip Bowker, Louise Bowman, Simon Bowman, Rachel Bowmer, Angie Bowring, Geoff Bowyer, Helen Bowyer, Carmel Boyd, Jenny Boyd, Laura Boyd, Maxine Boyd, Namoi Boyle, Pauline Boyle, Rosalind Boyle, Louise Boyles, Osman Bozdag, Leanna Brace, David Brack, Charlotte Brackstone, Rob Bradburn, Jodie Bradder, Barry Bradley, Clare Jane Bradley, Pamela Bradley, Patrick Bradley, Paul Bradley, Joanne Bradley-Potts, Lynne Bradshaw, Sarah Bradshaw, Zena Bradshaw, Rebecca Brady, Shirin Brady, Denise Braganza, Suhail Brailsford, Jill Braithwaite, Marie Branch, Thomas Brankin-Frisby, Jamie Brannigan, Louise Brassington, Sophie Brattan, Fiona Bray, Nancy Bray, Angela Brazier, Manny Brazil, Lucy Brear, Tracy Brear, Stephen Brearey, Laura Bremner, Morwenna Brend, Giovanna Bretland, Chris Brewer, Hannah Bridge, Gavin Bridgwood, Hayley Briggs, Mark Briggs, Sara Brigham, John Bright, Chris Brightling, Lutece Brimfield, Elaine Brinkworth, Robin Brittain-Long, Vianne Britten, Terri Brittin, Lauren Broad, Sarah Broad, Rosie Broadhurst, Andrew Broadley, Marie Broadway, Christopher Brockelsby, Megan Brocken, Tomos Brockley, Andrew Broderick, Mary Brodsky, Fiona Brogan, David Broggio, Liz Brohan, Felicity Brokke, Jacob Brolly, David Bromley, Hannah Brooke-Ball, Verity Brooker, Ceri Brookes, Matthew Brookes, Alison Brooks, Karen Brooks, Nicole Brooks, Philip Brooks, Rachel Brooks, Sophie Brooks, Natalie Broomhead, Chloe Broughton, Nathaniel Broughton, Matt Brouns, Marie Browett, Alison Brown, Ammani Brown, Carly Brown, Catrin Brown, Chloe Brown, Elizabeth Brown, Ellen Brown, Heather Brown, Janet Brown, Louise Brown, Niall Brown, Pauline Brown, Rachel Brown, Richard Brown, Robert Brown, Steven Brown, Tom Brown, Wayne Brown, Bria Browne, Charlotte Browne, Duncan Browne, Mitchell Browne, Stephen Brownlee, Alba Brraka, David Bruce, Johanna Bruce, Michelle Bruce, Wojciech Brudlo, Nigel Brunskill, Alan Brunton, Margaret Brunton, Mandy Bryan, Meera Bryant, April Buazon, Maya Buch, Julie Buchan, Ruaridh Buchan, Alexis Buchanan, Ruaridh Buchanan, Danielle Buche, Amanda Buck, Matthew Buckland, Laura Buckley, Philip Buckley, Sarah Buckley, Carol Buckman, Kathleen Buckmire, George Bugg, Ramadan Bujazia, Marwan Bukhari, Shanze Bukhari, Richard Bulbulia, Alex Bull, Damian Bull, Rhian Bull, Thomas Bull, Naomi Bulteel, Kasun Bumunarachchi, Roneleeh Bungue-Tuble, Caroline Burchett, Dorota Burda, Christy Burden, Thomas G Burden, 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Chandler, Kim J Chandler, Stuart Chandler, Zoe Chandler, Vikki Chandler-Vizard, Sumit Chandra, Navin Chandran, Badrinathan Chandrasekaran, Cherry Chang, Yvonne Chang, Josephine Chaplin, Graeme Chapman, John Chapman, Katie Chapman, Laura Chapman, Lianne Chapman, Polly Chapman, Timothy Chapman, Lucy Chappell, Linda Chapple, Amanda Charalambou, Bethan Charles, Dianne Charlton, Sally Charlton, Kevin Chatar, Calvin Chatha, Ritesh Chaube, Muhammad YN Chaudhary, Iram Chaudhry, Nazia Chaudhuri, Muhammad Chaudhury, Anoop Chauhan, Ruchi S Chauhan, Vipul Chauhan, Nicola Chavasse, Iknam Chaven, Rosanna Chavez, Vipal Chawla, Maria Cheadle, Lindsay Cheater, James Cheaveau, Charlotte Cheeld, Michelle Cheeseman, Fang Chen, Hui Min Chen, Terence Chen, Lok Yin Cheng, Zhihang Cheng, Helen Chenoweth, Chun How Cheong, Shiney Cherian, Suzanne Cherif, Mary Cherrie, Helen Cheshire, Barry Chesterson, Betty Cheung, Chee Kay Cheung, Elaine Cheung, Michelle Cheung, Claire Cheyne, Swati Chhabra, Wei Ling Chia, Eric Chiang, Angela Chiapparino, Rosavic Chicano, Zviedzo A Chikwanha, Sam Chilcott, Phillipa Chimbo, KokWai Chin, Wen Jie Chin, Rumbidzai Chineka, Amol Chingale, Karen Chinn, Vashira Chiroma, Heather Chisem, Claire Chisenga, Ben Chisnall, Carolyn Chiswick, Sunder Chita, Nihil Chitalia, Matthew Chiu, Brenda Chivima, Catherine Chmiel, Soha Choi, Willy Choon Kon Yune, Vandana Choudhary, Sarah Choudhury, Bing-Lun Chow, Fateha Chowdhury, Mahibbur Chowdhury, Shahid Chowdhury, Victoria Christenssen, Peter Christian, Alexander Christides, Fiona Christie, Daniel Christmas, Thereza Christopherson, Mark Christy, Paris Chrysostomou, Yunli Chua, Shabs Chucha, Dip Chudgar, Richard Chudleigh, Srikanth Chukkambotla, Michael E Chukwu, Izu Chukwulobelu, Chi Y Chung, Ben Church, Elaine Church, Sara R Church, David Churchill, Nicole Cianci, Nick Ciccone, Paola Cicconi, Paola Cinardo, Zdenka Cipinova, Bessie Cipriano, Sarah Clamp, Melanie Clapham, Edel Clare, Sarbjit Clare, Andrew Clark, Charlotte Clark, Diane Clark, Felicity Clark, Gabrielle Clark, James Clark, Katherine Clark, Kaylea Clark, Louise Clark, Lucy Clark, Matthew Clark, Patricia Clark, Richard Clark, Thomas Clark, Wendy Clark, Zoe Clark, Andrea Clarke, Heather Clarke, Mark Clarke, Paul Clarke, Robert Clarke, Roseanne Clarke, Samantha Clarke, Sarah Clarke, Sheron Clarke, Tracy Clarke, Andrew Clarkson, Alleyna Claxton, Kate Clay, Elizabeth Clayton, Olivia Clayton, Jill Clayton-Smith, Chris Cleaver, Carlota Clemente de la Torre, Jayne Clements, Suzanne Clements, Francesca Clemons, Lee Clifford, Lynne Clifford, Rachael Clifford, Sarah Clifford, Amelia Clive, Jonathan Clouston, Samantha Clueit, Andrea Clyne, Michelle Coakley, Peter G L Coakley, Tony Coates, Kathryn Cobain, Alexandra Cochrane, Patricia Cochrane, Maeve Cockerell, Helen Cockerill, Shirley Cocks, Rachel Codling, Adam Coe, Samantha Coetzee, David Coey, Danielle Cohen, Jonathan Cohen, Oliver Cohen, Mike Cohn, Louise Coke, Olutoyin Coker, Nicholas Colbeck, Roghan 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Davies, Ffyon Davies, Helen Davies, James Davies, Jane Davies, Jeni Davies, Jim Davies, Karen Davies, Kelly Davies, Kim Davies, Louisa Davies, Mark Davies, Matthew Davies, Michelle Davies, Nina Davies, Owen Davies, Patrick Davies, Rachel Davies, Rhys Davies, Ruth Davies, Sarah Davies, Simon Davies, Alison Davis, Gwyneth Davis, Illinos Davis, Julie-Ann Davis, Katherine Davis, Peter Davis, Alexander Davison, Sophia Davison, Mark Davy, Christine Dawe, H Dawe, Mark Dawkins, Danielle Dawson, Elizabeth Dawson, Joy Dawson, Susan Dawson, Tom Dawson, Andrew Daxter, Andrew Day, Helena Day, Jacob Day, Jeremy Day, Lynn Day, Jamie D'Costa, Parijat De, Duneesha de Fonseka, Toni de Freitas, Frederico De Santana Miranda, Eleanor de Sausmarez, Shanika de Silva, Thushan de Silva, Jessica De Sousa, Paulo De Sousa, James de Souza, Anthony de Soyza, Natasha de Vere, Johannes de Vos, Bethan Deacon, Sharon Dealing, Anna Dean, Julie Dean, Katrina Dean, Stephen Dean, Tessa Dean, Jill Deane, James Dear, Effie Dearden, Alison Deary, Catherine Deas, Samuel Debbie, Gabor Debreceni, Vashist Deelchand, Matthew Deeley, Joanne Deery, Emmanuel Defever, Raji Dehulia, Max Deighton, Manuela Del Forno, Arnold Dela Rosa, Lisa Delaney, Amanda Dell, Carrie Demetriou, David DeMets, Jane Democratis, Jacqueline Denham, Emmanuelle Denis, Laura Denley, Craig Denmade, Kathy Dent, Martin Dent, Elise Denton, Tom Denwood, Nishigandh Deole, Darshita Depala, Maria Depante, Randle Derbyshire, Susan Dermody, Amisha Desai, Asmita Desai, Purav Desai, Sanjeev Deshpande, Vai Deshpande, Brendan Devine, Sirjana Devkota, Nicola Dewland, Prakash Dey, Vishal Dey, Rogin Deylami, Jazz Dhaliwal, Kevin Dhaliwal, Jas Dhalliwal, Mandeep Dhanda, Sundip Dhani, Amandeep Dhanoa, Mili Dhar, Devesh Dhasmana, Aman Dhesi, Ekanjali Dhillon, Reiss Dhillon, Pamela Diamond, Priya Dias, Stephanie Diaz, Kayleigh Diaz-Pratt, Debbie Dickerson, Pamela Dicks, Stuart Dickson, Julie Dijo, Sean Dillane, Sarah Diment, Paul Dimitri, Maria Dineen, ThaiHa Dinh, Tri Dinh, Alex Dipper, Laura Dirmantaite, Lisa Ditchfield, Sarah Diver, Lavanya Diwakar, Caroline Dixon, Giles Dixon, Stephen Dixon-Mould, Brice Djeugam, Petr Dlouhy, Laurence Dobbie, Marinela Dobranszky Oroian, Charlotte Dobson, Lee Dobson, Marie Docherty, David Dockrell, James Dodd, Jackie Dodds, Rebecca Dodds, Steve Dodds, Richi Dogra, Erin Doherty, Warren Doherty, Yumiko Doi, Iain Doig, Eleanor Doke, Daniel Dolan, Mark Dolman, Rozzie Dolman, Lisa Donald, Callum Donaldson, Christopher Donaldson, Denise Donaldson, Gillian Donaldson, Kate Donaldson, Joanne Donnachie, Christopher Donnelly, Eilish Donnelly, Ronan Donnelly, Aravindhan Donohoe, Gemma Donohoe, Bryan Donohue, Sinead Donton, Emma Dooks, Grainne Doran, Kane Dorey, Sharon Dorgan, Amanda Dornan, Moonira Dosani, Davinder Dosanjh, Paula Dospinescu, Katie Douglas, Jonathan Douse, Lucy Dowden, Michelle Dower, Kerry Dowling, Sud Dowling, Nicola Downer, Charlotte Downes, Rob Downes, Thomas Downes, Damian Downey, Philippa 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Christopher Flood, Ian Floodgate, Vincent Florence, Sharon Floyd, Kelly Flynn, Rachel Flynn, Sara Flynn, Claire Foden, Adama Fofana, Georgina Fogarty, Claire Foley, Paul Foley, Linda Folkes, Daniela Mock Font, Evodian Fonyonga, Aiwyne Foo, Jane Foo, Andrew Foot, Jayne Foot, Jane Forbes, Jamie Ford, Kathy Ford, Jennifer Foreman, Caroline Fornolles, Adam Forrest, Ellie Forsey, Miranda Forsey, Thomas Forshall, Elliot Forster, Julian Forton, Emily Foster, Joseph Foster, Rachel A Foster, Tracy Foster, Theodora Foukanelli, Angela Foulds, Ian Foulds, Folakemi Fowe, Emily Fowler, Robert Fowler, Stephen Fowler, Caroline Fox, Claire Fox, Daniel Fox, Heather Fox, Jonathan Fox, Lauren Fox, Natalie Fox, Olivia Fox, Simon Fox, Sarah-Jane Foxton, Yasin Fozdar, Rebecca Frake, Alex Francioni, Olesya Francis, Rebecca Francis, Sarah Francis, Theodora Francis-Bacon, Jason Frankcam, Helen Frankland, Gayle Franklin, Jessica Franklin, Darron Franks, Catherine Fraser, Laura Fraser, Sharon Frayling, Martyn Fredlund, Matthew Free, Carol Freeman, Elaine Freeman, Hannah Freeman, Nicola Freeman, Clare Freer, Ian Freestone, Eleanor French, Matthew Frise, Renate Fromson, Claire Froneman, Adam Frosh, John Frost, Victoria Frost, Oliver Froud, Rachel Frowd, Arun Fryatt, Jake Fryer, Janet Fu, Bridget Fuller, Liz Fuller, Neil Fuller, Tracy Fuller, Duncan Fullerton, Jenny Fullthorpe, Carrie Fung, Gayle Fung, Sarah Funnell, John Furness, Charlene Furtado, Andrew Fyfe, Nytianandan G, Elizabeth Gabbitas, Claire Gabriel, Diana Gabriel, Hadiza Gachi, Rose Gad, Joshua Gahir, Sarveen Gajebasia, Katarzyna Gajewska-Knapik, Zacharoula Galani, Christopher Gale, Hugo Gale, Rebecca Gale, Swetha Gali, Karen Galilee, Bernadette Gallagher, Jude Gallagher, Rosie Gallagher, William Gallagher, Joanne Galliford, Catherine Galloway, Chris Galloway, Emma Galloway, Jacqui Galloway, James Galloway, Laura Gamble, Liz Gamble, Brian Gammon, Jaikumar Ganapathi, Ramesh Ganapathy, Kaminiben Gandhi, Sarah Gandhi, Usha Ganesh, 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Kerry Gibbons, Alex Gibson, Bethan Gibson, Kimberley Gibson, Kirsty Gibson, Sian Gibson, Cat Gilbert, Jeanette Gilbert, Joanne Gilbert, Kayleigh Gilbert, Sean Gilchrist, Benjamin Giles, Mandy Gill, Rose Gill, Lynne Gill, Paul Gillen, Annelies Gillesen, Katherine Gillespie, Matt Gillespie, Elizabeth Gillham, Andrew Gillian, Deborah Gilliland, Robert Gillott, Danielle Gilmour, Kate Gilmour, Theodora Giokanini-Royal, Anna Gipson, Joanna Girling, Rhian Gisby, Angelena Gkioni, Aikaterini Gkoritsa, Effrossyni Gkrania-Klotsas, Amy Gladwell, James Glanville, Jessica Glasgow, Susannah Glasgow, Jon Glass, Lynn Glass, Sharon Glaysher, Lisa Gledhill, Ana Glennon, John Glover, Kyle Glover, Jan Glover Bengtsson, Chevanthy Gnanalingam, Julie Goddard, Wendy Goddard, Emily Godden, Jo Godden, Gillian Godding, Emma Godson, Gerry Gogarty, Sukanya Gogoi, Aiky Goh, Rebeca Goiriz, Sriya Gokaraju, Philip Gold, Raphael Goldacre, Arthur Goldsmith, Portia Goldsmith, Darren Gomersall, Lucia Gomez, Raquel 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Matthew Grant, Pauleen Grant, Rhys Gravell, Jenny Graves, Alasdair Gray, Catherine Gray, Georgina Gray, Harriet Gray, Ingrid Gray, Jackie Gray, Karen Gray, Nicola Gray, Sebastian Gray, Alan Grayson, Patricia Grealish, Fiona Greaves, Jack Greaves, Paul Greaves, Charlotte Green, Christopher Green, David Green, Frederick Green, Grace Green, Joel Green, Marie Green, Nicola Green, Stacey Green, Teresa Green, Diarra Greene, Philippa Greenfield, Alan Greenhalgh, Maraneka Greenslade, Daniel Greenwood, Sandra Greer, James Gregory, Jane Gregory, Katie Gregory, Tamsin Gregory, James Gregson, Jill Greig, Julia Greig, Rebecca Grenfell, Teena Grenier, Susan Grevatt, Glaxy Grey, Andrew Gribbin, Amy Gribble, Beverley Grice, Natasha Grieg, Douglas Grieve, Ben Griffin, Denise Griffin, Mel Griffin, Sian Griffith, Alexandra Griffiths, Andrew Griffiths, Daniel Griffiths, David Griffiths, Donna Griffiths, Isabel Griffiths, Mark Griffiths, Nicola Griffiths, Oliver Griffiths, Sarah Griffiths, Sharon 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Jennie Hale, Carmel Halevy, Paul Halford, William Halford, Alistair Hall, Anthony Hall, Claire Hall, Elizabeth Hall, Emma Hall, Fiona Hall, Helen Hall, Jennifer Hall, Kathryn Hall, Bill Hall, Jan Hallas, Kyle Hallas, Charles Hallett, Becky-Lee Halls, Heather Halls, Maryam Hamdollah-Zadeh, Bilal Hameed, Imran Hamid, Mohamad Hamie, Bethany Hamilton, Fergus Hamilton, Leigh Hamilton, Nicola Hamilton, Ruth Hamlin, Eleanor Hamlyn, Beatrice Hammans, Shirley Hammersley, Kate Hammerton, Bev Hammond, Leah Hammond, Sara Hammond, Fiona Hammonds, Ibrahim Hamoodi, Karen Hampshire, Elizabeth Hampson, Jude Hampson, Lucy Hampson, Ozan Hanci, Ian Hancock, Sadiyah Hand, Jasmine Handford, Soran Handrean, Sarah Haney, Sheharyar Hanif, E Hanison, Alison Hanlon, Jennifer Hannah, Amy Hannington, Merhej Hannun, Aidan Hanrath, Anita Hanson, Jane Hanson, Kathryn Hanson, Steve Hanson, Helen Hanwell, Mazhar Ul Haq, Ala Haqiqi, Monjurul Haque, Lesley Harden, Zoe Harding, Simon Hardman, Joanna Hardy, Kumar Haresh, Rachel Harford, Beverley Hargadon, Carolyn Hargreaves, Emily Hargreaves, James Hargreaves, Alice Harin, Mohammed Haris, Edward Harlock, Sandra Harlow, Paula Harman, Tracy Harman, Mark Harmer, Muhammad A Haroon, Charlie Harper, Fiona Harper, Heather Harper, Melanie Harper, Peter Harper, Rosemary Harper, Sarah Harrhy, Sian Harrington, Yasmin Harrington-Davies, Jade Harris, Jess Harris, John Harris, Laura Harris, Marie-Clare Harris, Naomi Harris, Nichola Harris, Sophie Harris, Alex Harrison, David Harrison, Julie Harrison, Laura Harrison, Melanie Harrison, Rowan Harrison, Susie Harrison, Thomas Harrison, Wendy Harrison, Elizabeth Harrod, Ciaran Hart, Dominic Hart, Lisa Hartley, Rosemary Hartley, Ruth Hartley, Tom Hartley, William Hartrey, Phillipa Hartridge, Stuart Hartshorn, Heli Harvala, Alice Harvey, Angela Harvey, Max Harvey, Catherine Harwood, Helen Harwood, Brigitte Haselden, Kazi Hashem, Mohammed Hashimm, Tadaaki Hashimoto, Imranullah Hashmi, Sarah Haskins, Zena Haslam, Adil Hassan, Ali Hassan, Wagae UI Hassan, Waqar Ul Hassan, Sapna Hassasing, Jane Hassell, Philip Hassell, Alex Hastings, Bethany Hastings, Janice Hastings, Stephanie Hatch, Jonathan Hatton, Sheryl Haviland, May Havinden-Williams, Stefan Havlik, Daniel B Hawcutt, Kadean Hawes, Liz Hawes, Nicola Hawes, Annie Hawkins, Catherine Hawkins, Nancy Hawkins, Tanya Hawkins, Dan Hawley, Ed Hawley-Jones, Edward Haworth, Cathy Hay, Amna Hayat, Jamal Hayat, Mohamed-Riyal Hayathu, Tamsin Haydon, Anne Hayes, Jonas Hayes, Kate Hayes, Melony Hayes, Vanessa Hayes, Fiona Hayes, Patrick Hayle, Chloe Haylett, Antara Hayman, Melanie Hayman, Matthew Haynes, Richard Haynes, Rachel Hayre, Sarah Haysom, James Hayward, Patrick Haywood, Tracy Hazelton, Phoebe Hazenberg, Zhengmai He, Elizabeth Headon, Carrie Heal, Brendan Healy, Amy Hearn, Angela Heath, Rowan Heath, Diane Heaton, Kerry Hebbron, Gemma Hector, Andy Hedges, Katrine Hedges, Cheryl Heeley, Elaine Heeney, Rajdeep Heire, Ulla Hemmila, Cassie Hemmings, Scott 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Susie Holt, Alexandra Holyome, Marie Home, Toni Home, Renate Homewood, Kate Hong, Laura Hontoria del Hoyo, Clare Hooper, Sarah Hoosdally, Samantha Hope, Susan Hope, Bridget Hopkins, Peter W Horby, Stephanie Horler, Anil Hormis, Daniel Hornan, Nicola Hornby, Zoey Horne, Latoya Horsford, Megan Horsford, Mark Horsford, Valana Horsham, Alexander Horsley, Ashley Horsley, Elizabeth Horsley, Sarah Horton, Nicola Horton-Turner, Jane Hosea, Toby Hoskins, Muhammad S Hossain, Rashed Hossain, Leanne Hostler, Maxine Hough, Sarah Hough, Brittany Houghton, Catherine Houghton, Iain Houghton, Kathryn Houghton, Rebecca Houlihan, Angela Houston, Hamish Houston, Tawedzegwa Hove, Roseanna Hovvels, Lee How, Laura Howaniec, Laura Howard, Linda Howard, Lucy Howard, Sarah Howard, Stuart Howard, Richard Howard-Griffin, Alison Howarth, Diane Howarth, Serena Howe, Mark Howells, Lyn Howie, Kerry Howlett, Sophie Howlett, Joanne Hoyle, Josh Hrycaiczuk, Naing Zaya Htoon, Su Htwe, Ying Hu, Chiang Ooi Huah Huah, Abby Huckle, Shahzya Huda, Alison Hudak, Lisa Hudig, Alex Hudson, Cara Hudson, Heather Hudson, Peter Hudson, Oli Hudson, Alison Hufton, Connor Huggins, Alistair Hughes, Eithne Hughes, Emma Hughes, Gareth Hughes, Heather Hughes, Luke Hughes, Rachel Hughes, Rebecca Hughes, Samantha Hughes, Stephen Hughes, Vikki Hughes, Wesley Hughes, Lukas Huhn, Ching Hui, Ruth Hulbert, Diana Hull, Grace Hull, Robert Hull, Amanda Hulme, Peter Hulme, Wendy Hulse, George Hulston, Ryan Hum, Laura Humber, Megan Hume, Charlotte Humphrey, Ismay Humphreys, Alasdair Humphries, Joanne Humphries, Lena Hunold, Fiona Hunt, Kristen Hunt, Luke Hunt, Sophie Hunt, Al Hunter, Alexandra Hunter, Isobel Hunter, Karl Hunter, Neil Hunter, George Huntington, Elizabeth Hurditch, Cian Hurley, Katrina Hurley, Mohammed A Husain, Syeda Yusra Husaini, Coralie Huson, Afreen Hussain, Ibraar Hussain, Ifza Hussain, Mohammad Hussain, Muhammad Hussain, Reda Hussain, Sajid Hussain, Samia Hussain, Sanniah Hussain, Wasim Hussain, Yasmin Hussain, Mohammed Hussam El-Din, Raheem Hussein, Rebecca Hussey, Camille Hutchinson, Dorothy Hutchinson, Elizabeth Hutchinson, John Hutchinson, Claire Hutsby, Paula Hutton, Daniella Hydes, Jamie Hyde-Wyatt, Niamh Hynes, Megan Hyslop, Mazen Ibraheim, Abdalla Ibrahim, Ahmed Ibrahim, Asil Ibrahim, Mohamed Ibrahim, Monzeer Ibrahim, Wadah Ibrahim, Adetokunbo I Idowu, Muhammad Idrees, Hina Iftikhar, Mawara Iftikhar, Chukwuemeka Igwe, Mohammad Ijaz, Amaju Ikomi, Clare Iles, Stamatina Iliodromiti, Mary Ilsley, Lorna Ilves, La'ali Imam-Gutierrez, Christopher Imray, Alison Imtiaz, Haider Imtiaz, Claire Ingall, Jack Ingham, Julie Ingham, Rory Ingham, Tejas Ingle, Jennifer Inglis, Anne Ingram, Luke Ingram, Peter Inns, Ken Inweregbu, Andreea A Ionescu, Ana Ionita, Ilian P Iordanov, Anil Ipe, Adil Iqbal, Madiha Iqbal, Mohammed Iqbal, Faisal Iqbal Sait, Jane Ireland, Robert Irons, Mohannad Irshad, Muhammad S Irshad, Janice Irvine, Val Irvine, Pamela Irving, Robert Irving, Mina Ishak, Erica Isherwood, Aminul Islam, Abdurrahman Islim, Ali Ismail, Omar Ismail, Caroline Ison, M'hamedi Israa, Sharon Isralls, Ali Issa, Monica Ivan, Catrina Ivel, Chineze Ivenso, Ashleigh Ivy, Sophie Iwanikiw, Karen Ixer, Menaka Iyer, Mia Iyer, Calum Jack, Amanda Jackson, Anthony Jackson, Ben Jackson, Beth Jackson, Douglas Jackson, Ella Jackson, Hayley Jackson, Helen Jackson, Jane Jackson, Julie Jackson, Karin Jackson, Lauren Jackson, Melanie Jackson, Nicola Jackson, Shane Jackson, Sharon Jackson, Nikita Jacob, Patricia Jacob, Reni Jacob, Nicola Jacques, Terri-Lisa Jacques-Brown, Anisa Jafar, Daniel Jafferji, Ali Jaffery, Chandrashekar Jagadish, Vijay Jagannathan, Sam Jaggard, Mandeep Jagpal, Fernandez R Jaime, Neemisha Jain, Seema Jain, Susan Jain, Sanjay Jaiswal, Danyal Jajbhay, Thomas Jaki, Bintou Jallow, Yusuf Jaly, Sabine Jamal, Zeba Jamal, Yasmin Jameel, Albie James, Christie James, Kate James, Lee James, Linda James, Mark James, Nicholas James, Olivia James, Rebecca James, Ruth James, Tracy James, Jack Jameson, Aaron Jamison, Phoebe Jane, Azara Janmohamed, Sabrina Jansz, Deepa Japp, Lorraine Jappy, Victor Jardim, Catherine Jardine, Emma Jarnell, Ellie Jarvie, Ann Jarvis, Claire Jarvis, Lisa Jarvis, Rosina Jarvis, Patrycja Jastrzebska, Hafsa Javed, Mays Jawad, Lona Jawaheer, Kauky Jawaid, Anu Jayachandran, Dinakaran Jayachandran, Angelina Jayakumar, Deepak Jayaram, Ravi Jayaram, Geeshath Jayasekera, Thilina Jayatilleke, Abi Jayebalan, Saman Jeddi, Vandana Jeebun, Mohammad S Jeelani, Zeynab Jeewa, Emma Jefferson, Katie Jeffery, Helen Jeffrey, Jenni Jeffrey, Rachel Jeffrey, Sue Jeffrey, Nathan Jeffreys, Benjamin Jeffs, Debbie Jegede, Taylor Jemima, Ifan Jenkin, Alison Jenkins, Christopher Jenkins, David Jenkins, Elinor Jenkins, Sarah Jenkins, Sian Jenkins, Stephen Jenkins, Jacqui Jennings, Louise Jennings, Rebecca Jennings, Virginia Jennings, Ellen Jerome, Douglas Jerry, Ellen Jessup-Dunton, Jorge Antonio Jesus Silva, Champa Jetha, Kishan Jethwa, Jeby Jeyachandran, Visuvanathan Jeyakumar, Dharshana Jeyapalan, Shaman Jhanji, Khoo Jian, Zhixin Jiao, Laura Jimenez, Ana Jimenez Gil, Jithin Jith, Teishel Joefield, Navraj Johal, Karine Johannessen, Aisyah Johari, Annie John, Anu John, Navin John, Sarah John, Emma Johns, Margaret Johns, Anne-Marie Johnson, Antoinette Johnson, David Johnson, Emma Johnson, Gillian Johnson, Kathryn Johnson, Katie Johnson, Luke Johnson, Mark Johnson, Nelsonseelan Johnson, Oliver Johnson, Rachel Johnson, Tracy Johnson, Zoe Johnson, Claire Johnston, Janet Johnston, Laura Johnston, Susan Johnston, Victoria Johnston, Dawn Johnstone, Ed Johnstone, Janet Johnstone, Manohar Joishy, Adam Jones, Alistair Jones, Annabel Jones, Ben Jones, Bryony Jones, Carys Jones, Ceri Jones, Charlotte Jones, Christine E Jones, Debra Jones, Emily Jones, Gareth Jones, Geraldine Jones, Hazel Jones, Jac Jones, James Jones, Jamie Jones, Jessica Jones, Jonathon Jones, Julie Jones, Karen Jones, Kate E Jones, Kevin Jones, Laura Jones, Laura M Jones, Lorna Jones, Louise Jones, Mathew Jones, Nicola Jones, Paul Jones, Rhianna Jones, Ruth E Jones, Samantha Jones, Sophie Jones, Stefanie Jones, Steve Jones, Taya Jones, Tim Jones, Tracey Jones, Ramya Jonnalagadda, Rebecca Jordache, Annette Jose, Sanal Jose, Anna Joseph, Joseph Joseph, Rosane Joseph, Sibet Joseph, Dhaara Joshi, Mehul Joshi, Pratichi Joshi, Revati Joshi, Benz Josiah, Tiffany Joyce, Adriel Ju Wen Kwek, Edward Jude, Parminder Judge, Jessica Juhl, Sirisha Jujjavarapu, Mark Juniper, Edmund Juszczak, Deepthi Jyothish, Kasamu Kabiru Dawa, Mark Kacar, Katarina Kacinova, Nikhil Kadam, Rebecca Kahari, Gail Kakoullis, Azad Kala Bhushan, Richard JK Kalayi, Roobala Kaliannan Periyasami, Efthymia Kallistrou, Seika Kalsoom, Elisa Kam, John Kamara, Mohamed Kamara, Ajay Kamath, Prakash Kamath, Ravindra Kamath, Siddharth Arun Kamerkar, Nick Kametas, Musaiwale Kamfose, Arul Kandaswamy, Leia Kane, Osei Kankam, Thogulava Kannan, Abhinav Kant, Vikas Kapil, Ritoo Kapoor, Sonal Kapoor, Sourjya Kar, Janaka Kara, Vasita Kara, Marina Karakantza, Rona Kark, Nicholas Karunaratne, Natashja Kasianczuk, Vidya Kasipandian, Rizwan Kassam, Janarth Kathirgamachelvam, Victoria Katsande, Kulbinder Kaul, Daljit Kaur, Dervinder Kaur, Jasmin Kaur, Jaspreet Kaur, Satvinder Kaur, Zunaira Kausar, Mohammad AA Kawser, Andrea Kay, Sarah Kay, Jossy N Kayappurathu, Callum Kaye, Ahemd Kazeem, Naved Kazi, Sharon Kaznica, Samantha Kearley, Rachel Kearns, Nichola Kearsley, Joanne Keating, John Keating, Liza Keating, Elizabeth Keddie-Gray, Katie Keen, Natalie Keenan, Jonathan Kefas, Stephen Kegg, Laura Keith, Uzoamaka Keke, Tosin Kelani, Joanne Kellett, Jeremy Kellington, Alison Kelly, Conor Kelly, David Kelly, Diane Kelly, Dominic Kelly, Emma Kelly, Laura Kelly, Martin Kelly, Michael Kelly, Rosalind Kelly, Sinead Kelly, Stephen Kelly, Thomas Kelly, Mary Kelly-Baxter, Marketa Keltos, Timothy Kemp, Kelly Kemsley, Alexandra Kendall-Smith, Sarah Kennard, Ann Kennedy, Caroline Kennedy, James Kennedy, Sophie Kennedy-Hay, Julia Kenny, Kelly Kent, Melanie Kent, Lynne Keogan, Alexander Keough, Clement Kerlin, A Kerr, Andrew Kerr, Maria Kerr, Caroline Kerrison, Anthony Kerry, Samantha Kershaw, Helen Kerslake, Ian Kerslake, Helen Kerss, Jocelyn Keshet-Price, Margaret Kevern, Georgina Keyte, Abdul Khadar, Ali Khalid, Muhammad U Khalid, Syed Khalid, Amir Khalil, Asma Khalil, Sijjad Khalil, Abubakar Khan, Ali Khan, Al-Imran Khan, Arham Khan, Asad Khan, Aurangzeb Khan, Burhan Khan, Camran Khan, Fatimah Khan, Kausik Khan, Malik Aamaz Khan, Marria Khan, Mehrunnisha Khan, Mohammad Khan, Mohammed Khan, Nayeem Khan, Omar Khan, Rahe Khan, Rahila Khan, Sabiya Khan, Shabana Khan, Shahul Khan, Shoaib Khan, Tasaduksultan Khan, Waseem Khan, Usman F Khatana, Jibran Khatri, Jyoti Khatri, Hafiza Khatun, Taslima Khatun, Mena Kheia, Jacyntha Khera, Htet Ei Khin, Najaf Khoja, Kiran Khokhar, Jayne Khorsandi, Chloe Khurana, Faith Kibutu, Andrew Kidd, Michelle Kidd, Joe Kidney, Shane Kidney, Will Kieffer, James Kilbane, Caroline Kilby, 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Korcierz, James Korolewicz, George Koshy, Chris Kosmidis, Jalpa Kotecha, Easwari Kothandaraman, Leonidas Koukouflis, Koushan Kouranloo, Rukhsana Kousar'c, Margarita Kousteni, Maja Kovac, Alex Kozak Eskenazia, Kestutis Krasauskas, Raghu Krishnamurthy, Vinodh Krishnamurthy, Manju Krishnan, Hari Krishnan, Suzanne Krizak, Sean Krupej, Agnieszka Kubisz-Pudelko, Soren Kudsk-Iversen, Aurimas Kudzinskas, Chirag Kukadiya, Nainesha Kulkarni, Aditi Kumar, Mayur Kumar, Ramesh Kumar, Ravi Kumar, Rita Kumar, Rupa Kumar, Satish Kumar, Vimal Kumar, Arun Kundu, Heinke Kunst, Amit Kurani, Mohammed Kurdy, Rincy Kurian, Vimal Kurmars, Cameron Kuronen-Stewart, Ranganai S Kusangaya, Vlad Kushakovsky, Mandy Kuunal, Apexa Kuverji, Amma Kyei-Mensah, Thyra Kyere-Diabour, Moe Kyi, Nyan M Kyi, Laura Kyle, Karali-Tsilimpari Kyriaki, Julius Labao, Louise Lacey, Nikki Lack, Emma Ladlow, Heather Lafferty, Shondipon Laha, Sushil Lahane, Clement Lai, James Lai, Emma Laing, Robert Laing, Inez Laing-Faiers, Emily Laity, Michelle Lake, Nicki Lakeman, David Lalloo, Fiona Lalloo, Alison Lam, Fiona Lamb, Lucy Lamb, Thomas Lamb, Nick Lambe, Pauline Lambert, Claudia Lameirinhas, Mohammed KG Lami, Abigail Lamikanra, Holly Lamont, Michal Lamparski, Djillali Lamrani, Christine Lanaghan, Rebecca Lanaway, Ivone Lancona-Malcolm, Julia Lancut, Geraldine Landers, Martin J Landray, Matthew Lane, Nicholas Lane, Alidih Lang, Stephen Lang, Daniel Langer, Margaret Langley, Charles Langoya, Emily Langthorne, Taiya Large, Wojciech Lason, Anna Last, Scott Latham, John Latham-Mollart, Afzal Latheef, Darren Latimer, Nang Latt, Carly-Jane Lattimore, Dawn Lau, Eva Lau, Myra Laurenson, Hou Law, Jennifer Law, Jessica Law, Penny Law, Richard Law, Colin Lawler, Mark Lawley, Emma Lawrence, Jo Lawrence, Neil Lawrence, Ryan Lawrie, Jemima Lawson, Joanne Lawson, Louise Lawson, Rebecca Lawton, Michael Lay, Christine Laycock, Reina Layug, Maria Lazo, Vietland Le, Amelia Lea, William Lea, Ian Leadbitter, Thomas Leahy, Richard Lean, Lorna Leandro, Darren Leaning, Sandra Leason, Christina Leaver, Marie Anne Ledingham, Emma Lee, Hannah Lee, Irish Lee, Judith Lee, Sam Lee, Shi Han Lee, Simon Lee, Sindy Lee, Stephanie Lee, Tracey Lee, Xiang Lee, Diana Lees, Jennifer Lees, Helen Legge, Julian Leggett, Katie Leigh-Ellis, Kevan Leighton, Nicky Leitch, Eleni Lekoudis, Petula Lemessy, Nicholas Lemoine, Joana Lemos, Irina Lenchuk, Katy Leng, Katrina Lennon, Liz Lennon, Isabel Lentell, Kelly Leonard, Wen Leong, Nicky Leopold, Oskar Lepiarczyk, Isla Leslie, Eleni Lester, Joe Leung, Ullrich Leuschner, Emma Levell, Chris Levett, Alice Lewin, Michaela Lewin, Alison Lewis, David Lewis, Dee Lewis, Georgina Lewis, Gillian Lewis, Joanne Lewis, Joseph Lewis, Kathryn Lewis, Keir Lewis, Leon Lewis, Lisa Lewis, Marissa Lewis, Rob Lewis, Robert Lewis, Catherine Lewis-Clarke, Lorraine Lewis-Prosser, Katherine Lewiston, Adam Lewszuk, Penny Lewthwaite, Samantha Ley, Anna Li, Jenny Li, Angela Liao, Victoria Licence, David Lieberman, Susan 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Kaatje Lomme, Emily London, Gabriella Long, Natalie Long, Bev Longhurst, Mark Longshaw, Jennifer Lonnen, Caroline Lonsdale, Laura Looby, Ronda Loosley, Paola Lopez, Paula Lopez, Robert Lord, Stuart Lord, Laura Lordache, Kieron Loregnard, Catherine Lorenzen, Claire Lorimer, Francesco Loro, Rachel Lorusso, Eva Loutraris, Robert Loveless, Maxine Lovell, Angeliki Loverdou, Huw Lovett, Daniel Loveys, Andrew Low, Jen Mae Low, Alastair Lowe, Caroline Lowe, Catherine Lowe, Emily Lowe, Faye Lowe, Michael Lowe, Linda Lowrey, Richard Lowsby, Vicki Lowthorpe, Emma Loxley, Gamu Lubimbi, Alexandra Lubina Solomon, Georgia Lucas, Jacob Lucas, Alice Lucey, Olivia Lucey, Suzanne Luck, H Luke, Jane Luke, Hayley Lund, Apurva Lunia, Muriel Lunn, Ji Luo, Julia Lussier, Cindy Nisha Luximon, Elisa Ly, Barrie Lyell, Elisavet Lyka, Sarah Lymn, Audrey Lynas, Ceri Lynch, Daniel Lynch, Daniella Lynch, Stephen Lynch, Helen Lyon, Rea-Grace Maamari, Hannah Mabb, Louies Mabelin, Jessica Macaro, Angela Macauley, 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Thushika Mahendiran, Siva Mahendran, Sarah Maher, Anistta Maheswaran, Shameera Maheswaran, Tina Maheswaran, Parisa Mahjoob-Afag, Ahmed Mahmood, Farhana Mahmood, Waheed Mahmood, Zahra Mahmood, Hager Mahmoud, Ewan Mahony, Luke Mair, Toluwani Majekdunmi, Kesson Majid, Rupert Major, Jaydip Majumdar, Mohammad KH Majumder, Stephen Makin, Marius Malanca, Hannah Malcolm, Flora Malein, Neeraj Malhan, Ayesha Malik, Gulshan Malik, Mohammed Maljk, Paul Mallett, Petrina Mallinder, Georgia Mallison, Louise Mallon, Edward Malone, Gracie Maloney, Edgar Malundas, Madhu Mamman, Irene Man, Kathy Man, Rossana Mancinelli, Marco Mancuso-Marcello, Tracy Manders, Lauren Manderson, Justin Mandeville, Roope Manhas, Carmen Maniero, Ravi Manikonda, Bobby Mann, Jonathan Manning, Lynne Mannion, Katherine Mansi, Katarina Manso, Dina Mansour, Isheunesu T Mapfunde, Predeesh Mappa, Hemant Maraj, Garikayi Marange, Lisa March, Clare Marchand, Neil Marcus, Maria Marecka, Gomathi Margabanthu, Jordi Margalef, Lavinia Margarit, Georgios Margaritopoulos, Mike Margarson, Fernandez M Maria del Rocio, Teresa Maria Pfyl, Victor Mariano, Helen Maria-Osborn, Ashleigh Maric, Grace Markham, John Markham, Maria Marks, Pamela Marks, Elisabeth Marouzet, Arran Marriott, Cheryl Marriott, Nemonie Marriott, Brian Marsden, Karen Marsden, Paul Marsden, Sarah Marsden, Tracy Marsden, Robyn Marsh, Adam Marshall, Andrew Marshall, Gail Marshall, Henry Marshall, Jaimie Marshall, James Marshall, Jenna Marshall, Nicola Marshall, Riley Marshall, Jennifer Marshall, Samantha Marston, Emmeline Martin, Hayley Martin, Hope Martin, Jane Martin, Karen Martin, Kate Martin, Laila Martin, Michael Martin, Noelia Martin, Tim Martin, Winston Martin, Sarah Martin, Tim Martindale, Marcus Martineau, Alexander Martinez, Lauren Martinez, Jose Carlos Martinez Garrido, Juan Martin-Lazaro, Olivia Martins, Lucas Martins Ferreira, Vijay Kumar Maruthamuthu, Gemma Maryan, Roman Mary-Genetu, Sam Maryosh, Vidan Masani, Diego Maseda, Sheila Mashate, Yasaman Mashhoudi, Al Mashta, Izhaq Masih, Sanna Masih, Nick Maskell, Perry Maskell, Matthew Masoli, Lynn Mason, Rebecca Mason, Richard Mason, Ruth Mason, Claire Mason, Mohammad Masood, Mohammad T Masood, Syed Masood, Syed SME Masood, Aaqib Masud, Lear Matapure, Cristina Matei, Ropafadzo Matewe, Manraj Matharu, Stephy Mathen, Alex Mather, Nicole Mather, Jonathan Mathers, Joanna Matheson, Amal Mathew, Anna Mathew, Moncy Mathew, Verghese Mathew, Caroline Mathews, Jesha Mathews, Kate Mathias, Marion Mathie, Darwin Matila, Wadzanai Matimba-Mupaya, Nashaba Matin, Elina Matisa, Max Matonhodze, Elijah Matovu, Jaysankar Mattappillil, Alison J Matthews, Heather Matthews, Helen Matthews, Sue Matthews, Gwynn Matthias, Fiona Maxton, Adam Maxwell, Gemma Maxwell, Veronica Maxwell, James May, Joanne May, Oliver May, Philippa May, Irving Mayanagao, Matthew Maycock, Graham Mayers, Lee Maynard, Shelley Mayor, Ibreaheim Mazen, Andrea Mazzella, Nyambura Mburu, Mercy Mbwembwe, Martyn McAdam, Eleanor 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Munt, Nafissah Munu, McDonald Mupudzi, Arshid Murad, Oluwatosin H Muraina, Koteshwara Muralidhara, Diane Murdoch, Mhairi Murdoch, Jennifer Murira, Alison Murphy, Carl Murphy, Emily Murphy, Fidelma Murphy, Gail Murphy, Jo Murphy, Peter Murphy, Sheenagh Murphy, Simon Murphy, Clare Murray, David Murray, Eleanor Murray, Katie Murray, Kenneth Murray, Lisa Murray, Lorna Murray, Tracey Murray, Eoin Murtagh, Mithun Murthy, Catherine Murton, Rosie Murton, Neeka Muru, Rosemary Musanhu, Maimuna Mushabe, Kaiser Mushtaq, Omaisa Mushtaq, Ahmed M Mustafa, Elhaytham Mustafa, Mustafa Mustafa, Ibrahim Mustapha, Zhain Mustufvi, Callum Mutch, Eric Mutema, Balakumar Muthukrishnan, Sheree Mutton, Natasha Muzengi, Memory Mwadeyi, Bettina Mwale, Esther Mwaura, Raji Myagerimath, Alice Myers, Sam Myers, Khin Swe Myint, Yadee Myint, Libor Myslivecek, Helen Nabakka, Evelyn Nadar, Iftikhar Nadeem, Moosa Nadheem, Asma Naeem, Hassan Naeem, Salman Naeem, Samraiz Nafees, Mohamed Nafei, Parminder Naga, Thapas 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Wiltsher, Marlar Win, Tin Win, Wut Yee Win Win, Lucinda Winckworth, Laura Winder, Piers Winder, Phillip Windrum, Kerry Winham-Whyte, Helen Winmill, Simon Winn, Carmen Winpenny, Helen Winslow, Helen Winter, Jonathan Winter, Pascal Winter, Barbara Winter-Goodwin, Stephen Wisdom, Matthew Wise, Martin Wiselka, Rebecca Wiseman, Sophie Wiseman, Steven Wishart, Holly Wissett, Eric Witele, Nicholas Withers, Janet Wittes, Donna Wixted, Therese Wodehouse, Will Wolf, Nicola Wolff, Kirsten Wolffsohn, Rebecca Wolf-Roberts, Magda Wolna, Elena Wolodimeroff, Adam Wolstencroft, Alan Wong, Charlotte Wong, Chi-Hung Wong, Edwin Wong, Jessica Sue Yi Wong, Kit Y Wong, Lee Wong, Mei Yin Wong, Nick Wong, Sam Wong, Yun Man Wong, Amanda Wood, Caroline Wood, Carrie Anne Wood, Dianne Wood, Fiona Wood, Hannah Wood, Jennifer Wood, Joe Wood, Julia Wood, Kathryn Wood, Lisa Wood, Louise Wood, Michelle Wood, Stephen Wood, Tracy Wood, Ursula Wood, Katharine Woodall, Rebecca Woodfield, Christopher Woodford, Elizabeth Woodford, Jill Woodford, Luke Woodford, Louise Woodhead, Timothy Woodhead, Philip Woodland, Marc Woodman, Debra Woods, Jane Woods, Katherine Woods, Sarah Woods, Zoe Woodward, Rachel Wookey, Megan Woolcock, Gemma Wooldridge, Rebecca Woolf, Chris Woollard, Christopher Woollard, Louisa Woollen, Emma Woolley, Jade Woolley, Daniel Woosey, Dan Wootton, Joanne Wootton, Daniel Worley, Stephy Worton, Jonathan Wraight, Maria Wray, Tim Wreford-Bush, Joanne Wren, Kim Wren, Lynn Wren, Caroline Wrey Brown, Catherine Wright, Demi Wright, Francesca Wright, Imogen Wright, Lee Wright, Lianne Wright, Pete Wright, Rachel Wright, Rebecca Wright, Stephanie Wright, Tim Wright, Caroline Wroe, Hannah Wroe, Henry Wu, Peishan Wu, Pensee Wu, Jonathan Wubetu, Retno Wulandari, Craig Wyatt, Frederick Wyn-Griffiths, Inez Wynter, Bindhu Xavier, Arnold Xhikola, Zhongyang Xia, Huiyuan Xiao, Masseh Yakubi, May Yan, Freda Yang, Yingjia Yang, Michael Yanney, Woei Lin Yap, Nabil Yaqoob, Naairah Yaqub, Salima Yasmin, Bryan Yates, David Yates, Edward Yates, Helen Yates, Julie Yates, Mark Yates, Charlotte Yearwood Martin, Andrew Yeatman, Khin Yein, Fiona Yelnoorkar, Peter Yew, Kawai Yip, Laura Ylquimiche, Laura Ylquimiche Melly, Inez Ynter, H Yong, Jemma Yorke, Jasmine Youens, Abdel Younes Ibrahim, Eoin Young, Gail Young, Louise Young, Richard Young, Asfand Yousafzar, Sajeda Youssouf, Ahmed Yousuf, Chrissie Yu, Bernard Yung, Daniel Yusef, Said Yusef, Intekhab Yusuf, Anna-Sophia Zafar, Silvia Zagalo, Su Zaher, Aqsa Zahoor, Kareem Zaki, Nabhan Zakir, Kasia Zalewska, Ane Zamalloa, Mohsin Zaman, Raisa Zaman, Shakir Zaman, Julie Zamikula, Louise Zammit, Marie Zammit-Mangion, Lynn Zarb, Esther Zebracki, Daniel Zehnder, Lisa Zeidan, Marian Zelman, Xiaobei Zhao, Dongling Zheng, Doreen Zhu, Madiha Zia, Omar Zibdeh, Rabia Zill-E-Huma, Ei Thankt Zin, Veronica Zindonda, Eleanor Zinkin, Vivian Zinyemba, Christos Zipitis, Arkadiusz Zmierczak, Azam Zubir, Roslin Zuha, Naz Zuhra, Rasha Zulaikha, Sabrina Zulfikar, Carol Zullo, Ana Zuriaga-Alvaro, Will Zuurbier, Sheba Zyengi, and University of St Andrews. School of Medicine
Subjects: Male, Convalescent plasma, medicine.medical_treatment, 030204 cardiovascular system & hematology, Antibodies, Viral, Rate ratio, 0302 clinical medicine, RA0421, RA0421 Public health. Hygiene. Preventive Medicine, Medicine, Hospital Mortality, 030212 general & internal medicine, 11 Medical and Health Sciences, Aged, 80 and over, Medicine(all), Mortality rate, Covid19, Articles, 3rd-DAS, General Medicine, Middle Aged, Hospitals, Treatment Outcome, Female, Open label, Coronavirus Infections, Life Sciences & Biomedicine, RM, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), 03 medical and health sciences, Medicine, General & Internal, SDG 3 - Good Health and Well-being, General & Internal Medicine, Internal medicine, Humans, In patient, Pandemics, COVID-19 Serotherapy, Aged, Mechanical ventilation, Science & Technology, SARS-CoV-2, business.industry, Significant difference, Immunization, Passive, COVID-19, Length of Stay, NIS, R1, Respiration, Artificial, United Kingdom, RM Therapeutics. Pharmacology, RECOVERY Collaborative Group, business
Abstract: Background: Many patients with COVID-19 have been treated with plasma containing anti-SARS-CoV-2 antibodies. We aimed to evaluate the safety and efficacy of convalescent plasma therapy in patients admitted to hospital with COVID-19. Methods: This randomised, controlled, open-label, platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]) is assessing several possible treatments in patients hospitalised with COVID-19 in the UK. The trial is underway at 177 NHS hospitals from across the UK. Eligible and consenting patients were randomly assigned (1:1) to receive either usual care alone (usual care group) or usual care plus high-titre convalescent plasma (convalescent plasma group). The primary outcome was 28-day mortality, analysed on an intention-to-treat basis. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936. Findings: Between May 28, 2020, and Jan 15, 2021, 11558 (71%) of 16287 patients enrolled in RECOVERY were eligible to receive convalescent plasma and were assigned to either the convalescent plasma group or the usual care group. There was no significant difference in 28-day mortality between the two groups: 1399 (24%) of 5795 patients in the convalescent plasma group and 1408 (24%) of 5763 patients in the usual care group died within 28 days (rate ratio 1·00, 95% CI 0·93–1·07; p=0·95). The 28-day mortality rate ratio was similar in all prespecified subgroups of patients, including in those patients without detectable SARS-CoV-2 antibodies at randomisation. Allocation to convalescent plasma had no significant effect on the proportion of patients discharged from hospital within 28 days (3832 [66%] patients in the convalescent plasma group vs 3822 [66%] patients in the usual care group; rate ratio 0·99, 95% CI 0·94–1·03; p=0·57). Among those not on invasive mechanical ventilation at randomisation, there was no significant difference in the proportion of patients meeting the composite endpoint of progression to invasive mechanical ventilation or death (1568 [29%] of 5493 patients in the convalescent plasma group vs 1568 [29%] of 5448 patients in the usual care group; rate ratio 0·99, 95% CI 0·93–1·05; p=0·79). Interpretation: In patients hospitalised with COVID-19, high-titre convalescent plasma did not improve survival or other prespecified clinical outcomes. Funding: UK Research and Innovation (Medical Research Council) and National Institute of Health Research.
Published: 2021
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48. Why, when and how do secondary-care clinicians have emergency care and treatment planning conversations? Qualitative findings from the ReSPECT Evaluation study

Author: Catherine Baldock, Karin Eli, Caroline J. Huxley, Cynthia A Ochieng, Jonathan Fuld, Gavin D. Perkins, Anne-Marie Slowther, Peter-Marc Fortune, Claire Hawkes, and Frances Griffiths
Subjects: Emergency Medical Services, Palliative care, media_common.quotation_subject, 030204 cardiovascular system & hematology, Emergency Nursing, Patient Care Planning, State Medicine, Secondary care, 03 medical and health sciences, 0302 clinical medicine, Nursing, Humans, Medicine, Conversation, Radiation treatment planning, media_common, business.industry, Communication, Level of detail (writing), Treatment options, 030208 emergency & critical care medicine, National health service, R1, England, Emergency Medicine, Thematic analysis, Cardiology and Cardiovascular Medicine, business, RC
Abstract: Background: The Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) is an emergency care and treatment planning (ECTP) process, developed to offer a patient-centred approach to deciding about and recording treatment recommendations. Conversations between clinicians and patients or their representatives are central to the ReSPECT process. This study aims to understand why, when, and how ReSPECT conversations unfold in practice.\ud \ud Methods: ReSPECT conversations were observed in hospitals within six acute National Health Service (NHS) trusts in England; the clinicians who conducted these conversations were interviewed. Following observation-based thematic analysis, five ReSPECT conversation types were identified: resuscitation and escalation; confirmation of decision; bad news; palliative care; and clinical decision. Interview-based thematic analysis examined the reasons and prompts for each conversation type, and the level of detail and patient engagement in these different conversations.\ud \ud Results: Whereas resuscitation and escalation conversations concerned possible futures, palliative care and bad news conversations responded to present-tense changes. Conversations were timed to respond to organisational, clinical, and patient/relative prompts. While bad news and palliative care conversations included detailed discussions of treatment options beyond CPR, this varied in other conversation types. ReSPECT conversations varied in doctors’ engagement with patient/relative preferences, with only palliative care conversations consistently including an open-ended approach.\ud \ud Conclusions: While ReSPECT supports holistic, person-centred, anticipatory decision-making in some situations, a gap remains between the ReSPECT’s aims and their implementation in practice. Promoting an understanding and valuing of the aims of ReSPECT among clinicians, supported by appropriate training and structural support will enhance ReSPECT conversations.
Published: 2021
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49. Development of a video-observation method for examining doctors’ clinical and interpersonal skills in a hospital outpatient clinic in Ibadan, Oyo State, Nigeria

Author: Olufunke Fayehun, Abimbola Margaret Obimakinde, Sinmisola O. Bolaji, Achiaka E. Irabor, Motunrayo Ajisola, Temitope Ilori, Samuel I. Watson, Eme T. Owoaje, Navneet Aujla, Timothy P. Hofer, Richard J. Lilford, and Akinyinka O. Omigbodun
Subjects: Adult, medicine.medical_specialty, Quality management, Outpatient Clinics, Hospital, consultation quality, physicians, media_common.quotation_subject, BF, Nigeria, Context (language use), HM, Quality of healthcare, Health administration, Social Skills, 03 medical and health sciences, 0302 clinical medicine, Ambulatory care, ambulatory care, Outpatient clinic, Medicine, Humans, Quality (business), 030212 general & internal medicine, Child, media_common, business.industry, 030503 health policy & services, Health Policy, Nursing research, video-observation, R1, Checklist, low-and middle-income countries, Cross-Sectional Studies, Family medicine, Public aspects of medicine, RA1-1270, 0305 other medical science, business, Research Article
Abstract: Background Improving the quality of primary healthcare provision is a key goal in low-and middle-income countries (LMICs). However, to develop effective quality improvement interventions, we first need to be able to accurately measure the quality of care. The methods most commonly used to measure the technical quality of care all have some key limitations in LMICs settings. Video-observation is appealing but has not yet been used in this context. We examine preliminary feasibility and acceptability of video-observation for assessing physician quality in a hospital outpatients’ department in Nigeria. We also develop measurement procedures and examine measurement characteristics. Methods Cross-sectional study at a large tertiary care hospital in Ibadan, Nigeria. Consecutive physician-patient consultations with adults and children under five seeking outpatient care were video-recorded. We also conducted brief interviews with participating physicians to gain feedback on our approach. Video-recordings were double-coded by two medically trained researchers, independent of the study team and each other, using an explicit checklist of key processes of care that we developed, from which we derived a process quality score. We also elicited a global quality rating from reviewers. Results We analysed 142 physician-patient consultations. The median process score given by both coders was 100 %. The modal overall rating category was ‘above standard’ (or 4 on a scale of 1–5). Coders agreed on which rating to assign only 44 % of the time (weighted Cohen’s kappa = 0.26). We found in three-level hierarchical modelling that the majority of variance in process scores was explained by coder disagreement. A very high correlation of 0.90 was found between the global quality rating and process quality score across all encounters. Participating physicians liked our approach, despite initial reservations about being observed. Conclusions Video-observation is feasible and acceptable in this setting, and the quality of consultations was high. However, we found that rater agreement is low but comparable to other modalities that involve expert clinician judgements about quality of care including in-person direct observation and case note review. We suggest ways to improve scoring consistency including careful rater selection and improved design of the measurement procedure for the process score.
Published: 2021

50. Deceased Donation Uterus Transplantation: A Review

Author: Si Liang Yao and Natasha Hammond-Browning
Subjects: Infertility, medicine.medical_specialty, RD1-811, lessons, K1, 030230 surgery, outcomes, Living donor, First birth, 03 medical and health sciences, births, 0302 clinical medicine, Uterus transplantation, Medicine, procedures, 030219 obstetrics & reproductive medicine, business.industry, Obstetrics, medicine.disease, R1, deceased donors, Clinical trial, Transplantation, Donation, Surgery, RG, uterus transplantation, business
Abstract: Uterus transplantation (UTx) offers women with absolute uterine factor infertility the option to gestate and birth their own biologically related child. The first birth following living donation UTx happened in 2014. The first birth following deceased donation happened in December 2017, with further successes since. Interest in deceased donation UTx is increasing. The authors established a database to track UTx clinical trials and outcomes. Utilising this database and existing literature, this article reviews the first reported cases of deceased donation UTx and outcomes, and drawing upon comparisons with living donor UTx, comments upon the future for this area of reproductive transplantation research. This is the first article to bring together the literature on deceased donation UTx procedures and outcomes.
Published: 2021
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