58 results on '"Jonathan Shaffer"'
Search Results
2. The Gates Foundation’s new AI initiative: attempting to leapfrog global health inequalities?
- Author
-
Jonathan Shaffer, Arsenii Alenichev, and Marlyn C Faure
- Subjects
Medicine (General) ,R5-920 ,Infectious and parasitic diseases ,RC109-216 - Published
- 2023
- Full Text
- View/download PDF
3. Pre‐analytical factors affecting the establishment of a single tube assay for multiparameter liquid biopsy detection in melanoma patients
- Author
-
Svenja Schneegans, Lelia Lück, Katharina Besler, Leonie Bluhm, Julia‐Christina Stadler, Janina Staub, Rüdiger Greinert, Beate Volkmer, Mikael Kubista, Christoffer Gebhardt, Alexander Sartori, Darryl Irwin, Elina Serkkola, Taija afHällström, Evi Lianidou, Markus Sprenger‐Haussels, Melanie Hussong, Peter Mohr, Stefan W. Schneider, Jonathan Shaffer, Klaus Pantel, and Harriet Wikman
- Subjects
CTC ,ctDNA ,EV ,liquid biopsy ,melanoma ,miRNA ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
The combination of liquid biomarkers from a single blood tube can provide more comprehensive information on tumor development and progression in cancer patients compared to single analysis. Here, we evaluated whether a combined analysis of circulating tumor cells (CTCs), circulating tumor DNA (ctDNA), and circulating cell‐free microRNA (miRNA) in total plasma and extracellular vesicles (EV) from the same blood sample is feasible and how the results are influenced by the choice of different blood tubes. Peripheral blood from 20 stage IV melanoma patients and five healthy donors (HD) was collected in EDTA, Streck, and Transfix tubes. Peripheral blood mononuclear cell fraction was used for CTC analysis, whereas plasma and EV fractions were used for ctDNA mutation and miRNA analysis. Mutations in cell‐free circulating DNA were detected in 67% of patients, with no significant difference between the tubes. CTC was detected in only EDTA blood and only in 15% of patients. miRNA NGS (next‐generation sequencing) results were highly influenced by the collection tubes and could only be performed from EDTA and Streck tubes due to hemolysis in Transfix tubes. No overlap of significantly differentially expressed miRNA (patients versus HD) could be found between the tubes in total plasma, whereas eight miRNA were commonly differentially regulated in the EV fraction. In summary, high‐quality CTCs, ctDNA, and miRNA data from a single blood tube can be obtained. However, the choice of blood collection tubes is a critical pre‐analytical variable.
- Published
- 2020
- Full Text
- View/download PDF
4. Increased antitumor efficacy of PD-1-deficient melanoma-specific human lymphocytes
- Author
-
Nathalie Labarrière, Lucine Marotte, Sylvain Simon, Virginie Vignard, Emilie Dupre, Malika Gantier, Jonathan Cruard, Jean-Baptiste Alberge, Melanie Hussong, Cecile Deleine, Jean-Marie Heslan, Jonathan Shaffer, Tiffany Beauvais, Joelle Gaschet, Emmanuel Scotet, Delphine Fradin, and Anne Jarry
- Subjects
Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
BackgroundGenome editing offers unique perspectives for optimizing the functional properties of T cells for adoptive cell transfer purposes. So far, PDCD1 editing has been successfully tested mainly in chimeric antigen receptor T (CAR-T) cells and human primary T cells. Nonetheless, for patients with solid tumors, the adoptive transfer of effector memory T cells specific for tumor antigens remains a relevant option, and the use of high avidity T cells deficient for programmed cell death-1 (PD-1) expression is susceptible to improve the therapeutic benefit of these treatments.MethodsHere we used the transfection of CAS9/sgRNA ribonucleoproteic complexes to edit PDCD1 gene in human effector memory CD8+ T cells specific for the melanoma antigen Melan-A. We cloned edited T cell populations and validated PDCD1 editing through sequencing and cytometry in each T cell clone, together with T-cell receptor (TCR) chain’s sequencing. We also performed whole transcriptomic analyses on wild-type (WT) and edited T cell clones. Finally, we documented in vitro and in vivo through adoptive transfer in NOD scid gamma (NSG) mice, the antitumor properties of WT and PD-1KO T cell clones, expressing the same TCR.ResultsHere we demonstrated the feasibility to edit PDCD1 gene in human effector memory melanoma-specific T lymphocytes. We showed that PD-1 expression was dramatically reduced or totally absent on PDCD1-edited T cell clones. Extensive characterization of a panel of T cell clones expressing the same TCR and exhibiting similar functional avidity demonstrated superior antitumor reactivity against a PD-L1 expressing melanoma cell line. Transcriptomic analysis revealed a downregulation of genes involved in proliferation and DNA replication in PD-1-deficient T cell clones, whereas genes involved in metabolism and cell signaling were upregulated. Finally, we documented the superior ability of PD-1-deficient T cells to significantly delay the growth of a PD-L1 expressing human melanoma tumor in an NSG mouse model.ConclusionThe use of such lymphocytes for adoptive cell transfer purposes, associated with other approaches modulating the tumor microenvironment, would be a promising alternative to improve immunotherapy efficacy in solid tumors.
- Published
- 2020
- Full Text
- View/download PDF
5. 4226 Poor provider-patient communication, lack of readiness for discharge, and perceived illness threat are associated with quality of life after survival from cardiac arrest
- Author
-
Alex Presciutti, Jonathan Shaffer, Mary Newman, and Sarah Perman
- Subjects
Medicine - Abstract
OBJECTIVES/GOALS: Studies have shown that cardiac arrest survivors have poor quality of life (QoL) secondary to neurologic injury. We hypothesized that poor provider-patient communication, lack of readiness for discharge, and perceived illness threat would be associated with QoL in cardiac arrest survivors. METHODS/STUDY POPULATION: We distributed an online survey to the Sudden Cardiac Arrest Foundation listserv. Survivors completed the Questionnaire for the Quality of Provider-Patient Interactions (QQPPI), Readiness for Hospital Discharge Scale (RHDS), and the Brief Illness Perception Questionnaire (B-IPQ). When completing the QQPPI and RHDS, survivors were asked to think back to their hospitalization and discharge. QoL domains (physical, psychological, social) were measured via the WHO-QOL BREF. Three multiple regression models examined associations between QQPPI, RHDS, and B-IPQ scores with QoL domains, adjusted for age, sex, months since arrest, and understanding of arrest and post-arrest symptoms at discharge. RESULTS/ANTICIPATED RESULTS: A total of 163 survivors (mean age 50.1 years, 50.3% women) provided complete survey data. Greater perceived illness threat (β: −.45, p < .001) and lower readiness for discharge (β: .22, p = .01) were associated with worse physical QoL; greater perceived illness threat (β: −.45, p < .001) was associated with worse psychological QoL; and greater perceived illness threat (β: −.3, p < .001) and poor provider-patient communication (β: .35, p < .001) were associated with worse social QoL. Our models explained 48%, 43%, and 30% of the variance in physical, psychological, and social QoL, respectively (p < .001). DISCUSSION/SIGNIFICANCE OF IMPACT: In-hospital interactions and perceived illness threat have important ramifications for cardiac arrest survivors attempting to return to daily life. Discussions regarding cardiac arrest sequelae, expectations, and specific treatment options during hospitalization could impact future QoL.
- Published
- 2020
- Full Text
- View/download PDF
6. Mild-to-Moderate Kidney Dysfunction and Cardiovascular Disease: Observational and Mendelian Randomization Analyses
- Author
-
Liam Gaziano, Luanluan Sun, Matthew Arnold, Steven Bell, Kelly Cho, Stephen K. Kaptoge, Rebecca J. Song, Stephen Burgess, Daniel C. Posner, Katja Mosconi, Cassianne Robinson-Cohen, Amy M. Mason, Thomas R. Bolton, Ran Tao, Elias Allara, Petra Schubert, Lingyan Chen, James R. Staley, Natalie Staplin, Servet Altay, Pilar Amiano, Volker Arndt, Johan Ärnlöv, Elizabeth L.M. Barr, Cecilia Björkelund, Jolanda M.A. Boer, Hermann Brenner, Edoardo Casiglia, Paolo Chiodini, Jackie A. Cooper, Josef Coresh, Mary Cushman, Rachel Dankner, Karina W. Davidson, Renate T. de Jongh, Chiara Donfrancesco, Gunnar Engström, Heinz Freisling, Agustín Gómez de la Cámara, Vilmundur Gudnason, Graeme J. Hankey, Per-Olof Hansson, Alicia K. Heath, Ewout J. Hoorn, Hironori Imano, Simerjot K. Jassal, Rudolf Kaaks, Verena Katzke, Jussi Kauhanen, Stefan Kiechl, Wolfgang Koenig, Richard A. Kronmal, Cecilie Kyrø, Deborah A. Lawlor, Börje Ljungberg, Conor MacDonald, Giovanna Masala, Christa Meisinger, Olle Melander, Conchi Moreno Iribas, Toshiharu Ninomiya, Dorothea Nitsch, Børge G. Nordestgaard, Charlotte Onland-Moret, Luigi Palmieri, Dafina Petrova, Jose Ramón Quirós Garcia, Annika Rosengren, Carlotta Sacerdote, Masaru Sakurai, Carmen Santiuste, Matthias B. Schulze, Sabina Sieri, Johan Sundström, Valérie Tikhonoff, Anne Tjønneland, Tammy Tong, Rosario Tumino, Ioanna Tzoulaki, Yvonne T. van der Schouw, W.M. Monique Verschuren, Henry Völzke, Robert B. Wallace, S. Goya Wannamethee, Elisabete Weiderpass, Peter Willeit, Mark Woodward, Kazumasa Yamagishi, Raul Zamora-Ros, Elvis A. Akwo, Saiju Pyarajan, David R. Gagnon, Philip S. Tsao, Sumitra Muralidhar, Todd L. Edwards, Scott M. Damrauer, Jacob Joseph, Lisa Pennells, Peter W.F. Wilson, Seamus Harrison, Thomas A. Gaziano, Michael Inouye, Colin Baigent, Juan P. Casas, Claudia Langenberg, Nick Wareham, Elio Riboli, J.Michael Gaziano, John Danesh, Adriana M. Hung, Adam S. Butterworth, Angela M. Wood, Emanuele Di Angelantonio, Anna Koettgen, Jonathan Shaw, Robert Atkins, Paul Zimmet, Peter Whincup, Johann Willeit, Christoph Leitner, Anne Tybjaerg-Hansen, Peter Schnohr, Shoaib Afzal, David Lora Pablos, Cristina Martin Arriscado, Carmen Romero Ferreiro, Hannah Stocker, Ben Schöttker, Bernd Holleczek, Angela Chetrit, Lennart Welin, Kurt Svärdsudd, Lauren Lissner, Dominique Hange, Kirsten Mehlig, Dorothea Nagel, Paul E. Norman, Osvaldo Almeida, Leon Flicker, Jun Hata, Takanori Honda, Yoshihiko Furuta, Hiroyasu Iso, Akihiko Kitamura, Isao Muraki, Jukka T. Salonen, Tomi-Pekka Tuomainen, E. M. van Zutphen, N. M. van Schoor, Cinzia Lo Noce, Richard Kronmal, Georg Lappas, Peter M. Nilsson, Bo Hedblad, Jonathan Shaffer, Joseph Schwartz, Daichi Shimbo, Shinichi Sato, Mina Hayama-Terada, Simerjot Jassal, Thor Aspelund, Bolli Thorsson, Gunnar Sigurdsson, Layal Chaker, Kamran M. Ikram, Maryam Kavousi, Hugh Tunstall-Pedoe, Günay Can, Hüsniye Yüksel, Uğur Özkan, Hideaki Nakagawa, Yuko Morikawa, Masao Ishizaki, Edith Feskens, Johanna M Geleijnse, Daan Kromhout, Internal Medicine, Neurology, Epidemiology, Bell, Steven [0000-0001-6774-3149], Posner, Daniel C [0000-0002-3056-6924], Mason, Amy M [0000-0002-8019-0777], Allara, Elias [0000-0002-1634-8330], Staplin, Natalie [0000-0003-4482-4418], Arndt, Volker [0000-0001-9320-8684], Ärnlöv, Johan [0000-0002-6933-4637], Barr, Elizabeth LM [0000-0003-4284-1716], Boer, Jolanda MA [0000-0002-9714-4304], Brenner, Hermann [0000-0002-6129-1572], Casiglia, Edoardo [0000-0002-0003-3289], Chiodini, Paolo [0000-0003-0139-2264], Coresh, Josef [0000-0002-4598-0669], Cushman, Mary [0000-0002-7871-6143], Davidson, Karina W [0000-0002-9162-477X], de Jongh, Renate T [0000-0001-8414-3938], Engström, Gunnar [0000-0002-8618-9152], de la Cámara, Agustín Gómez [0000-0001-6827-6319], Gudnason, Vilmundur [0000-0001-5696-0084], Hankey, Graeme J [0000-0002-6044-7328], Hansson, Per-Olof [0000-0001-6323-0506], Heath, Alicia K [0000-0001-6517-1300], Hoorn, Ewout J [0000-0002-8738-3571], Imano, Hironori [0000-0002-6661-4254], Katzke, Verena [0000-0002-6509-6555], Kiechl, Stefan [0000-0002-9836-2514], Koenig, Wolfgang [0000-0002-2064-9603], Kronmal, Richard A [0000-0002-9897-7076], Kyrø, Cecilie [0000-0002-9083-8960], Ljungberg, Börje [0000-0002-4121-3753], MacDonald, Conor [0000-0002-4989-803X], Masala, Giovanna [0000-0002-5758-9069], Ninomiya, Toshiharu [0000-0003-1345-9032], Nordestgaard, Børge G [0000-0002-1954-7220], Onland-Moret, Charlotte [0000-0002-2360-913X], Palmieri, Luigi [0000-0002-4298-2642], Rosengren, Annika [0000-0002-5409-6605], Schulze, Matthias B [0000-0002-0830-5277], Sieri, Sabina [0000-0001-5201-172X], Sundström, Johan [0000-0003-2247-8454], Tikhonoff, Valérie [0000-0001-7846-0101], Tong, Tammy [0000-0002-0284-8959], Tzoulaki, Ioanna [0000-0002-4275-9328], van der Schouw, Yvonne T [0000-0002-4605-435X], Wannamethee, S Goya [0000-0001-9484-9977], Weiderpass, Elisabete [0000-0003-2237-0128], Willeit, Peter [0000-0002-1866-7159], Woodward, Mark [0000-0001-9800-5296], Yamagishi, Kazumasa [0000-0003-3301-5519], Zamora-Ros, Raul [0000-0002-6236-6804], Gagnon, David R [0000-0002-6367-3179], Tsao, Philip S [0000-0001-7274-9318], Edwards, Todd L [0000-0003-4318-6119], Damrauer, Scott M [0000-0001-8009-1632], Joseph, Jacob [0000-0002-7279-4896], Pennells, Lisa [0000-0002-8594-3061], Gaziano, Thomas A [0000-0002-5985-345X], Langenberg, Claudia [0000-0002-5017-7344], Wareham, Nick [0000-0003-1422-2993], Hung, Adriana M [0000-0002-3203-1608], Butterworth, Adam S [0000-0002-6915-9015], Di Angelantonio, Emanuele [0000-0001-8776-6719], Apollo - University of Cambridge Repository, Gaziano, Liam, Sun, Luanluan, Arnold, Matthew, Bell, Steven, Cho, Kelly, Kaptoge, Stephen K, Song, Rebecca J, Burgess, Stephen, Posner, Daniel C, Mosconi, Katja, Robinson-Cohen, Cassianne, Mason, Amy M, Bolton, Thomas R, Tao, Ran, Allara, Elia, Schubert, Petra, Chen, Lingyan, Staley, James R, Staplin, Natalie, Altay, Servet, Amiano, Pilar, Arndt, Volker, Ärnlöv, Johan, Barr, Elizabeth L M, Björkelund, Cecilia, Boer, Jolanda M A, Brenner, Hermann, Casiglia, Edoardo, Chiodini, Paolo, Cooper, Jackie A, Coresh, Josef, Cushman, Mary, Dankner, Rachel, Davidson, Karina W, de Jongh, Renate T, Donfrancesco, Chiara, Engström, Gunnar, Freisling, Heinz, de la Cámara, Agustín Gómez, Gudnason, Vilmundur, Hankey, Graeme J, Hansson, Per-Olof, Heath, Alicia K, Hoorn, Ewout J, Imano, Hironori, Jassal, Simerjot K, Kaaks, Rudolf, Katzke, Verena, Kauhanen, Jussi, Kiechl, Stefan, Koenig, Wolfgang, Kronmal, Richard A, Kyrø, Cecilie, Lawlor, Deborah A, Ljungberg, Börje, Macdonald, Conor, Masala, Giovanna, Meisinger, Christa, Melander, Olle, Moreno Iribas, Conchi, Ninomiya, Toshiharu, Nitsch, Dorothea, Nordestgaard, Børge G, Onland-Moret, Charlotte, Palmieri, Luigi, Petrova, Dafina, Garcia, Jose Ramón Quiró, Rosengren, Annika, Sacerdote, Carlotta, Sakurai, Masaru, Santiuste, Carmen, Schulze, Matthias B, Sieri, Sabina, Sundström, Johan, Tikhonoff, Valérie, Tjønneland, Anne, Tong, Tammy, Tumino, Rosario, Tzoulaki, Ioanna, van der Schouw, Yvonne T, Monique Verschuren, W M, Völzke, Henry, Wallace, Robert B, Wannamethee, S Goya, Weiderpass, Elisabete, Willeit, Peter, Woodward, Mark, Yamagishi, Kazumasa, Zamora-Ros, Raul, Akwo, Elvis A, Pyarajan, Saiju, Gagnon, David R, Tsao, Philip S, Muralidhar, Sumitra, Edwards, Todd L, Damrauer, Scott M, Joseph, Jacob, Pennells, Lisa, Wilson, Peter W F, Harrison, Seamu, Gaziano, Thomas A, Inouye, Michael, Baigent, Colin, Casas, Juan P, Langenberg, Claudia, Wareham, Nick, Riboli, Elio, Gaziano, J Michael, Danesh, John, Hung, Adriana M, Butterworth, Adam S, Wood, Angela M, Di Angelantonio, Emanuele, Internal medicine, AMS - Ageing & Vitality, AMS - Musculoskeletal Health, Amsterdam Gastroenterology Endocrinology Metabolism, Epidemiology and Data Science, APH - Aging & Later Life, and APH - Personalized Medicine
- Subjects
kidney disease ,General Practice ,Emerging Risk Factors Collaboration/EPIC-CVD/Million Veteran Program ,Coronary Disease ,coronary disease ,Kidney ,Malalties coronàries ,1117 Public Health and Health Services ,Coronary diseases ,SDG 3 - Good Health and Well-being ,cardiovascular disease ,Risk Factors ,Physiology (medical) ,Diabetes Mellitus ,Humans ,Cardiac and Cardiovascular Systems ,Prospective Studies ,1102 Cardiorespiratory Medicine and Haematology ,Kardiologi ,Kidney diseases ,Malalties cardiovasculars ,Cardiovascular Diseases ,Kidney Diseases ,Stroke ,1103 Clinical Sciences ,Mendelian Randomization Analysis ,kidney diseases ,stroke ,Allmänmedicin ,Cardiovascular diseases ,Cardiovascular System & Hematology ,Malalties del ronyó ,Cardiology and Cardiovascular Medicine ,cardiovascular diseases - Abstract
Background: End-stage renal disease is associated with a high risk of cardiovascular events. It is unknown, however, whether mild-to-moderate kidney dysfunction is causally related to coronary heart disease (CHD) and stroke. Methods: Observational analyses were conducted using individual-level data from 4 population data sources (Emerging Risk Factors Collaboration, EPIC-CVD [European Prospective Investigation into Cancer and Nutrition–Cardiovascular Disease Study], Million Veteran Program, and UK Biobank), comprising 648 135 participants with no history of cardiovascular disease or diabetes at baseline, yielding 42 858 and 15 693 incident CHD and stroke events, respectively, during 6.8 million person-years of follow-up. Using a genetic risk score of 218 variants for estimated glomerular filtration rate (eGFR), we conducted Mendelian randomization analyses involving 413 718 participants (25 917 CHD and 8622 strokes) in EPIC-CVD, Million Veteran Program, and UK Biobank. Results: There were U-shaped observational associations of creatinine-based eGFR with CHD and stroke, with higher risk in participants with eGFR values 105 mL·min –1 ·1.73 m –2 , compared with those with eGFR between 60 and 105 mL·min –1 ·1.73 m –2 . Mendelian randomization analyses for CHD showed an association among participants with eGFR –1 ·1.73 m –2 , with a 14% (95% CI, 3%–27%) higher CHD risk per 5 mL·min –1 ·1.73 m –2 lower genetically predicted eGFR, but not for those with eGFR >105 mL·min –1 ·1.73 m –2 . Results were not materially different after adjustment for factors associated with the eGFR genetic risk score, such as lipoprotein(a), triglycerides, hemoglobin A1c, and blood pressure. Mendelian randomization results for stroke were nonsignificant but broadly similar to those for CHD. Conclusions: In people without manifest cardiovascular disease or diabetes, mild-to-moderate kidney dysfunction is causally related to risk of CHD, highlighting the potential value of preventive approaches that preserve and modulate kidney function.
- Published
- 2022
7. Systematic assessment of commercially available low-input miRNA library preparation kits
- Author
-
Melanie A. Hussong, Marianne Dalland, Sabrina Shore, Xiangfu Zhong, Jordana M. Henderson, Benedicte A. Lie, Arvind Y. M. Sundaram, Fatima Heinicke, Johannes Breidenbach, Hoichong Karen Yip, Pamela Moll, Andrew Farmer, Simon Rayner, Magnus Leithaug, Jana Vitkovska, Jonathan Shaffer, Siri Tennebø Flåm, Amanda McNulty, Gregor D. Gilfillan, Loan T. Nguyen, and Manuela Zucknick
- Subjects
Library preparation ,Sequencing bias ,Total rna ,Differentially expressed mirnas ,Computational biology ,Biology ,DNA sequencing ,03 medical and health sciences ,0302 clinical medicine ,Next generation sequencing ,microRNA ,Humans ,Molecular Biology ,Gene Library ,030304 developmental biology ,Low RNA input ,0303 health sciences ,VDP::Landbruks- og Fiskerifag: 900 ,Sequence Analysis, RNA ,Mirna sequencing ,Low input ,High-Throughput Nucleotide Sequencing ,Reproducibility of Results ,RNA ,MicroRNA ,Cell Biology ,UMI ,MicroRNAs ,NGS ,030220 oncology & carcinogenesis ,Genetic Engineering ,MiRNA ,Small RNA-seq ,Research Paper - Abstract
High-throughput sequencing is increasingly favoured to assay the presence and abundance of micro RNAs (miRNAs) in biological samples, even from low RNA amounts, and a number of commercial vendors now offer kits that allow miRNA sequencing from sub-nanogram (ng) inputs. However, although biases introduced during library preparation have been documented, the relative performance of current reagent kits has not been investigated in detail. Here, six commercial kits capable of handling
- Published
- 2019
8. Abstract 11503: Mindfulness is Inversely Associated with Psychological Symptoms in Long-Term Cardiac Arrest Survivors
- Author
-
Alex Presciutti, Jonathan Greenberg, Ethan Lester, Mary M Newman, Jonathan Elmer, Jonathan Shaffer, Ana-maria Vranceanu, and Sarah M Perman
- Subjects
Physiology (medical) ,Cardiology and Cardiovascular Medicine - Abstract
Introduction: We sought to identify correlates with psychological symptoms in long-term cardiac arrest (CA) survivors. Mindfulness, or nonjudgmental awareness of the present moment, is a modifiable protective factor against psychological symptoms in various clinical populations and could be a potential treatment target for CA survivors. Methods: We conducted a longitudinal survey study between 10-11/2019 (baseline) and 10-11/2020 (1-year follow-up) with long-term CA survivor members of the Sudden Cardiac Arrest Foundation. We collected demographic and CA characteristics at baseline. At both timepoints, we assessed posttraumatic stress symptoms (PTS) through the PTSD Checklist-5 (PCL-5) and depression and anxiety symptoms through the Patient Health Questionnaire-4 (PHQ-4). At follow-up, we assessed mindfulness through the Cognitive and Affective Mindfulness Scale-Revised (CAMS-R). We used adjusted linear regression to predict 1-year PCL-5 and PHQ-4 scores, with particular consideration of the CAMS-R as a cross-sectional correlate of outcome. Results: We included 129 CA survivors (mean age: 52 years, 52% male, 98% white). At 1-year follow-up, in adjusted models, CAMS-R (β: -0.35, p Conclusion: Mindfulness was inversely associated with psychological symptoms in long-term CA survivors. Future studies should examine the longitudinal relationship of mindfulness and psychological symptoms after CA.
- Published
- 2021
9. Marissa Mika, Africanizing Oncology: creativity, crisis, and cancer in Uganda. Athens OH: Ohio University Press (hb US$80 – 978 0 8214 2465 0; pb US$34.95 – 978 0 8214 2509 1). 2021, 260 pp
- Author
-
Jonathan Shaffer
- Subjects
Arts and Humanities (miscellaneous) ,Anthropology ,Geography, Planning and Development - Published
- 2022
10. Analysis of Motivational Concepts in Tweets Related to Jogging.
- Author
-
Sunmoo Yoon, Jonathan Shaffer, Jessica Lynn Momberg, and Suzanne Bakken
- Published
- 2013
11. Development and Initial Psychometric Testing of the Midwifery Practice Climate Scale - Part 2
- Author
-
E. Brie Thumm, Jonathan Shaffer, and Paula Meek
- Subjects
Adult ,Male ,Psychometrics ,Nurse Midwives ,Obstetrics and Gynecology ,Reproducibility of Results ,Middle Aged ,Midwifery ,Organizational Culture ,Cross-Sectional Studies ,Pregnancy ,Surveys and Questionnaires ,Maternity and Midwifery ,Humans ,Female ,Maternal Health Services ,Factor Analysis, Statistical ,Workplace - Abstract
A supportive practice climate is demonstrated to improve patient outcomes, health care provider well-being, and workforce stability. Midwives are an integral component to improving maternal health care; however, there has been limited research into the qualities and measurement of a supportive practice climate for midwives.The Midwifery Practice Climate Scale is a self-report instrument designed to measure midwives' perceptions of their work environments. We tested the scale's validity and reliability in multiphase, national cross-sectional survey of the full roster of certified nurse-midwives and certified midwives practicing in the United States. To test structural validity and reliability testing, 2 subsamples of 330 participants were randomly extracted from the sample of 2887 for exploratory and confirmatory factor analyses and internal consistency determination. Convergent validity was tested in the remaining sample of 1673 respondents.Exploratory factor analysis revealed 2 5-subscale structures consistent with the loading values and theoretical structure. Confirmatory factor analysis revealed a mediocre fit of the models identified in the exploratory analysis. Consequently, items were systematically reviewed for redundancy, skew, and generalizability and 24 items were removed from the scale. The resulting structure is a 10-item scale comprising 2 subscales: Practice Leadership and Participation and Support for the Midwifery Model of Care. The revised Midwifery Practice Climate Scale was a good fit with the data demonstrating adequate construct validity (χThese findings indicate that the Midwifery Practice Climate Scale accurately and reliably measures the midwives' perceptions of their practice environment. The next steps include determining the scale's sensitivity to change and assessing the relationship with maternal health outcomes.
- Published
- 2019
12. Patient preferences for Personalized (N-of-1) Trials: A conjoint analysis
- Author
-
Nathalie Moise, Dallas Wood, Ying Kuen K. Cheung, Naihua Duan, Tara St. Onge, Joan Duer-Hefele, Tiffany Pu, Karina W. Davidson, Ian M. Kronish, Carmela Alcantara, Paul Appelbaum, Eileen Carter, Elizabeth Cohn, Richard Kravitz, Scott Kelly, Jose Luchsinger, Ty Ridenour, Michele Romandetto, Jonathan Shaffer, and Steven Shea
- Subjects
N of 1 trial ,Adult ,Male ,medicine.medical_specialty ,Blinding ,Epidemiology ,Computer science ,Article ,03 medical and health sciences ,0302 clinical medicine ,Surveys and Questionnaires ,medicine ,Humans ,Medical physics ,030212 general & internal medicine ,Duration (project management) ,Precision Medicine ,Selection (genetic algorithm) ,Aged ,Discrete choice ,Clinical Trials as Topic ,Evidence-Based Medicine ,030503 health policy & services ,Age Factors ,Patient Preference ,Middle Aged ,Patient preference ,Conjoint analysis ,Standard error ,Cross-Sectional Studies ,Logistic Models ,Socioeconomic Factors ,Female ,Health Expenditures ,0305 other medical science - Abstract
OBJECTIVE: Despite their promise for increasing treatment precision, Personalized Trials (i.e., N-of-1 trials) have not been widely adopted. We aimed to ascertain patient preferences for Personalized Trials. STUDY DESIGN AND SETTING: We recruited 501 adults with ≥2 common chronic conditions from Harris Poll Online. We used Sawtooth Software to generate 45 plausible Personalized Trial designs comprised of combinations of 8 key attributes (treatment selection, treatment type, clinician involvement, blinding, time commitment, self-monitoring frequency, duration, cost) at different levels. Conditional logistic regression was used to assess relative importance of different attributes using a random utility maximization model. RESULTS: Overall, participants preferred Personalized Trials with no costs vs. $100 cost (utility difference 1.52 [standard error 0.07], p
- Published
- 2018
13. Abstract P360: Diagnostic Accuracy Provided by Different Approaches to Office Blood Pressure Measurement: How Many Readings Are Enough?
- Author
-
Ian M Kronish, Donald Edmondson, Daichi Shimbo, Jonathan Shaffer, Lawrence Krakoff, and Joseph Schwartz
- Subjects
Internal Medicine - Abstract
Importance: Guidelines lack consensus about the optimal approach to measuring office blood pressure (BP) when screening for hypertension. Objective: To compare the accuracy provided by different office BP measurement approaches that differ based on number of office BP readings within a visit, number of visits, and assessment method. Design: Cross-sectional Setting: Primary care. Participants: 707 employees without prior diagnosis of hypertension or cardiovascular disease and with screening BP Measures: Six standardized BP readings were taken during each of 3 office visits at least 1 week apart, using 2 assessment methods (mercury sphygmomanometer and BpTRU oscillometric device) for a total of 12,645 readings. Confirmatory factor analysis was used to develop a model from which estimates of the probability of correctly classifying an individual’s office BP status using differing numbers and types of office BP readings were generated. Results: A single systolic BP reading correctly classified an individual as having BP above or below the cutpoint for elevated office BP (i.e. 140 mmHg) when the reading was 155 mmHg, respectively. Averaging three systolic BP readings across two visits correctly classified an individual 95% of the time if the averaged reading was 148 mmHg. There was more confidence gained by increasing the number of visits than the number of readings within a visit. There was no clinically significant confidence gained by dropping the first reading versus averaging all readings, nor by measuring with a manual mercury device versus with an automated oscillometric device. Limitations: Only evaluated research quality BP readings. Similar probabilities may not apply to BP measured in routine clinical practice. Conclusions and Relevance: Averaging BP readings across two or more office visits might best balance increased confidence in BP status with efficiency of BP measurement, though the preferred measurement strategy may vary with the clinical context. Patients with average readings modestly below the 140/90 mmHg cutpoint (e.g., 134-139 mmHg) might be appropriate for referral to out-of-office BP testing as one cannot gain strong confidence that their “true” office BP is below goal.
- Published
- 2017
14. Radiation enteritis leading to intestinal failure: 1994 patient-years of experience in a national referral centre
- Author
-
Ramya Kalaiselvan, I.D. Anderson, Martyn Dibb, Gordon L Carlson, Simon Lal, Antje Teubner, V S Theis, and Jonathan Shaffer
- Subjects
Adult ,Male ,Short Bowel Syndrome ,medicine.medical_specialty ,Pediatrics ,Referral ,Medicine (miscellaneous) ,Enteral administration ,Intestinal Fistula ,medicine ,Radiation Enteritis ,Humans ,Medical nutrition therapy ,Aged ,Retrospective Studies ,Aged, 80 and over ,Nutrition and Dietetics ,Radiotherapy ,business.industry ,Retrospective cohort study ,Middle Aged ,Short bowel syndrome ,medicine.disease ,Enteritis ,United Kingdom ,Surgery ,Intestinal Diseases ,Treatment Outcome ,Parenteral nutrition ,Cohort ,Female ,Nutrition Therapy ,Parenteral Nutrition, Home ,business ,Intestinal Obstruction ,Urogenital Neoplasms - Abstract
Chronic radiation enteritis (RE) has been reported in up to 20% of patients receiving pelvic radiotherapy and can lead to intestinal failure (IF), accounting for 3.9% of new registrants for home parenteral nutrition (HPN) in the UK annually. Our aim is to report nutritional and survival outcomes for patients with RE referred to a national IF unit. A retrospective study of all new admissions over a 13-year period at the Intestinal Failure Centre, Manchester, UK. Data are presented as median (range). Twenty-three (3.8%) of 611 patients were admitted with IF secondary to RE. The primary site of malignancy was genitourinary in 17 (74%) patients. Radiotherapy was administered 9.5 (1–42) years previously. Patients underwent 2 (1–5) laparotomies prior to intestinal failure unit (IFU) admission. Twelve (52%) patients were admitted with intestinal obstruction and 11 (48%) with intractable weight loss and/or high output fistulae/stomas. Additional conditions contributing to IF were noted in 11 (48%) patients. Twenty-two (96%) patients had 2 (1–5) laparotomies prior to IFU referral. At discharge, 5 (22%) patients resumed oral diet without the need for artificial nutrition support, 3 (13%) required enteral feeding and 13 (56%) commenced HPN. The 10-year survival of the patient cohort was 48.2%. Surgical intervention is infrequently required, whereas the majority of patients with IF secondary to RE require long-term HPN. The judicious use of surgery in selected patients, coupled with an aggressive medical strategy to detect and treat contributing factors, and optimal enteral feeding may allow a modest proportion of patients with IF secondary to RE to achieve independence from PN.
- Published
- 2013
15. Adult small intestinal transplantation in England and Wales
- Author
-
Alexander Gimson, S.J. Middleton, Jonathan Shaffer, Stephen Pollard, Peter J. Friend, E. A. B. Cameron, J. A. Bradley, Neville V. Jamieson, M. Davies, Roy Y. Calne, and Christopher J.E. Watson
- Subjects
Adult ,Parenteral Nutrition ,medicine.medical_specialty ,Small intestinal transplantation ,Transplantation procedure ,Disease ,Tacrolimus ,Intestine, Small ,Humans ,Medicine ,Survival rate ,Wales ,business.industry ,Mortality rate ,Public health ,Graft Survival ,Survival Analysis ,Surgery ,Transplantation ,Intestinal Diseases ,Treatment Outcome ,Parenteral nutrition ,England ,business ,Immunosuppressive Agents ,Follow-Up Studies - Abstract
Background In 1996 two transplantation centres in the UK were commissioned by the National Specialist Commissioning Advisory Group for England and Wales to assess small intestinal transplantation in adults. The joint experience of the two centres is presented. Methods Patients with irreversible small intestinal failure and complications of parenteral nutrition, and those with abdominal disease requiring extensive visceral resection, were assessed as candidates and where appropriate listed for surgery. Results Thirty-six patients were assessed for small intestinal transplantation and, of these, 14 underwent surgery. Twelve patients survived the transplantation procedure. Of these, seven patients were alive at 1 year, five at 3 years and three at 5 years. Three patients remain alive. Patient and graft survival improved with experience; the 1-year survival rate improved in the last 4 years of this experience from 43 to 57 per cent, and the 3-year survival rate from 29 to 43 per cent. Conclusion Small intestinal transplantation is associated with a high mortality rate but may benefit carefully selected patients in whom conservative management is likely to carry a greater mortality rate.
- Published
- 2016
16. Management of acute intestinal failure: A position paper from the European Society for Clinical Nutrition and Metabolism (ESPEN) Special Interest Group
- Author
-
Henrik Hwjgaard Rasmussen, Alastair Forbes, Stanislaw Klek, Mette Holst, Ruben G. J. Visschers, Geert J. A. Wanten, Jonathan Shaffer, Simon M. Gabe, Stéphane M. Schneider, Шivind Irtun, Rosa Burgos Pelaez, Marina Panisic-Sekeljic, Steven W.M. Olde Damink, Ronan Thibault, Annika Reintam Blaser, Loris Pironi, Centre Hospitalier Universitaire de Nice (CHU Nice), Unité de Nutrition Humaine - Clermont Auvergne (UNH), Institut National de la Recherche Agronomique (INRA)-Université Clermont Auvergne (UCA), CHU Pontchaillou [Rennes], Foie, métabolismes et cancer, Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Surgery, MUMC+: MA Heelkunde (9), RS: NUTRIM - R2 - Gut-liver homeostasis, MUMC+: MA AIOS Heelkunde (9), Klek, Stanislaw, Forbes, Alastair, Gabe, Simon, Holst, Mette, Wanten, Geert, Irtun, Øivind, Damink, Steven Olde, Panisic-Sekeljic, Marina, Pelaez, Rosa Burgo, Pironi, Lori, Blaser, Annika Reintam, Rasmussen, Henrik Højgaard, Schneider, Stéphane M., Thibault, Ronan, Visschers, Ruben G.J., Shaffer, Jonathan, Unité de Nutrition Humaine (UNH), Institut National de la Recherche Agronomique (INRA)-Université d'Auvergne - Clermont-Ferrand I (UdA)-Clermont Université, Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), and Université d'Auvergne - Clermont-Ferrand I (UdA)-Clermont Université-Institut National de la Recherche Agronomique (INRA)
- Subjects
medicine.medical_specialty ,Resuscitation ,[SDV]Life Sciences [q-bio] ,medicine.medical_treatment ,acute intestinal failure ,lnfectious Diseases and Global Health Radboud Institute for Molecular Life Sciences [Radboudumc 4] ,Clinical nutrition ,Critical Care and Intensive Care Medicine ,Intestinal absorption ,Sepsis ,AIF ,03 medical and health sciences ,0302 clinical medicine ,intestinal failure ,Intestinal failure ,SOWATS ,Nutrition and Dietetic ,medicine ,Humans ,Nutritional Physiological Phenomena ,030212 general & internal medicine ,Medical nutrition therapy ,cardiovascular diseases ,Intensive care medicine ,Nutrition and Dietetics ,Rehabilitation ,business.industry ,Liver Diseases ,SNAP ,Special Interest Group ,medicine.disease ,3. Good health ,Europe ,Gastrointestinal Tract ,Intestinal Diseases ,Intestinal Absorption ,Acute Disease ,Position paper ,Interdisciplinary Communication ,030211 gastroenterology & hepatology ,Nutrition Therapy ,biological phenomena, cell phenomena, and immunity ,business ,Acute intestinal failure (AIF) - Abstract
Contains fulltext : 165702.pdf (Publisher’s version ) (Closed access) Intestinal failure (IF) is the consequence of a reduction of gut function below the minimum necessary for the absorption of nutrients from the gastrointestinal tract. Types I and II comprise acute intestinal failure (AIF). Although its prevalence is relatively low, type II AIF is serious and requires specialist multidisciplinary care, often for prolonged periods before its resolution. The key aspects are: sepsis control, fluid and electrolyte resuscitation, optimization of nutritional status, wound care, appropriate surgery and active rehabilitation. The ESPEN Acute Intestinal Failure Special Interest Group (AIF SIG) has devised this position paper to provide a state-of-the-art overview of the management of type II AIF and to point out areas for future research.
- Published
- 2016
17. An unblinded randomised controlled trial of preoperative oral supplements in colorectal cancer patients
- Author
-
James Hill, Jonathan Shaffer, Chris Todd, Malcolm Campbell, and Sorrel Burden
- Subjects
medicine.medical_specialty ,Nutrition and Dietetics ,Colorectal cancer ,business.industry ,Medicine (miscellaneous) ,Subgroup analysis ,Perioperative ,Odds ratio ,medicine.disease ,Surgery ,law.invention ,Randomized controlled trial ,Weight loss ,law ,Internal medicine ,Cohort ,medicine ,medicine.symptom ,Complication ,business - Abstract
Background: Perioperative oral supplementation has been shown to reduce post-operative complications. However, the use of preoperative standard oral supplements in a cohort of colorectal cancer patients has not been evaluated. The present study examined whether preoperative supplements are beneficial in this group. Methods: In a randomised controlled trial, patients were assigned to receive 400 mL of oral supplement and dietary advice or dietary advice alone. Primary outcome was the number of post-operative complications. One hundred and twenty-five patients were recruited (59 randomised to the intervention group and 66 to the control group) and nine were excluded. Results: In the intervention group, 24 (44%) patients had a complication compared to 26 (42%) in the control group (P = 0.780). In the intervention and control groups, there were eight (15%) and 16 (25%) surgical site infections, respectively (P = 0.140) and seven (13%) and 11 (17%) chest infections, respectively (P = 0.470). Subgroup analysis for hypothesis generation included 83 (71%) weight-losing patients, where there was a significant reduction in surgical site infections using the Buzby definition (P = 0.034), although this was not the case for the Centre for Disease Control definition (P = 0.052). Conclusions: There was no evidence that preoperative supplements were beneficial in reducing the number of complications, although there may be some benefit for surgical site infections in selected weight-losing preoperative
- Published
- 2011
18. Nutritional status of preoperative colorectal cancer patients
- Author
-
Jonathan Shaffer, Sorrel Burden, Chris Todd, and James Hill
- Subjects
medicine.medical_specialty ,Nutrition and Dietetics ,Colorectal cancer ,business.industry ,Medicine (miscellaneous) ,medicine.disease ,Gastroenterology ,Malnutrition ,Weight loss ,Internal medicine ,Hand strength ,Severity of illness ,medicine ,medicine.symptom ,business ,Bioelectrical impedance analysis ,Body mass index ,Cancer staging - Abstract
Background: The present study aimed to determine the extent of malnutrition in preoperative colorectal cancer patients. Malnutrition has been shown to affect post-operative outcome, so it would be beneficial to identify those who are malnourished or who are at risk of becoming so preoperatively. We examine whether weight loss is related to the length of stay or changes in fat free mass. Methods: Patients were enrolled consecutively from outpatients 2?4 weeks prior to surgery. Assessments included body mass index, percentage weight loss, dynamometry, Malnutrition Universal Screening Tool, Subjective Global Assessment and bioelectrical impedance. Cancer staging and hospital length of stay were recorded. Results: One hundred and thirty-two patients were eligible and 87 enrolled. Sixty-seven patients were weight losing and 20% had lost >10% of their usual body weight. Handgrip strength was lower in malnourished patients compared to those who had not lost weight (mean 19.4 and 27.3 kg, respectively, P = 0.013). Mean (SD) fat free mass in patients with a weight loss >10% was 39.7 (13.5) kg and, in those with
- Published
- 2010
19. What information should lead to a suspicion of catheter sepsis in HPN?
- Author
-
Anna Clare, Antje Teubner, and Jonathan Shaffer
- Subjects
Catheterization, Central Venous ,medicine.medical_specialty ,medicine.medical_treatment ,Critical Care and Intensive Care Medicine ,Diagnosis, Differential ,Sepsis ,Leukocyte Count ,Catheters, Indwelling ,Liver Function Tests ,Predictive Value of Tests ,medicine ,Humans ,Serum Albumin ,Retrospective Studies ,Nutrition and Dietetics ,medicine.diagnostic_test ,business.industry ,Bilirubin ,Retrospective cohort study ,medicine.disease ,Surgery ,Catheter ,C-Reactive Protein ,Parenteral nutrition ,ROC Curve ,Predictive value of tests ,Bacteremia ,Equipment Contamination ,Parenteral Nutrition, Home ,Liver function tests ,business ,Central venous catheter - Abstract
Summary Background & aims The diagnosis of catheter sepsis in patients on home parenteral nutrition can be difficult and patients often do not present with classical symptoms of pyrexia whilst feeding. This study reviews the clinical and diagnostic criteria needed to diagnose catheter sepsis. Methods A retrospective consecutive notes review of 2 years of patients presenting with catheter infections assessed symptoms, inflammatory markers and some liver function tests. The same data was also collected on those same patients who had successfully under gone line salvage. The two sets were compared using the Mann–Whitney U-test and predictive calculations were carried out using receiver operated characteristic curves. Results Over the two year period there were 37 episodes of CRBSI in 31 patients recorded. Successful catheter salvage was achieved in 30 episodes (in 24 patients) which is an 81% salvage rate. The most significant abnormality seen was a raised C-reactive protein, but less than a third of patients had a raised white cell count. However, there were significant changes in the bilirubin (p = 0.0007) and albumin (p = 0.0013) in these patients. Almost a third of patients who feel unwell do not present with a raised temperature. Conclusions The diagnosis of CRBSI remains difficult, but it should be suspected in patients with newly abnormal CRP, albumin or bilirubin and in the non-specifically unwell patient a clinician should not be misled by a normal white cell count and apyrexia.
- Published
- 2008
20. A patient with impaired gastric motility
- Author
-
W Rees, Qasim Aziz, G Armstrong, Jonathan Shaffer, Peter Paine, H Burnett, and C Babbs
- Subjects
Helicobacter pylori infection ,medicine.medical_specialty ,business.industry ,digestive, oral, and skin physiology ,education ,Gastroenterology ,Gastric motility ,Gastrointestinal pathology ,medicine.disease ,Gut Tutorial ,Internal medicine ,medicine ,Gastroparesis ,business ,health care economics and organizations - Abstract
This is an introduction to the Gut tutorial “A patient with impaired gastric motility” hosted on BMJ Learning—the best available learning website for medical professionals from the BMJ Group. The functional as opposed to inflammatory effects of gastrointestinal pathology are often neglected by clinicians. Helicobacter pylori infection may impair gastric function either due to …
- Published
- 2007
21. artificial nutritional support for improved patient care
- Author
-
C. R. Pennington, Jonathan Shaffer, and J Powell-Tuck
- Subjects
medicine.medical_specialty ,Hepatology ,Normal diet ,business.industry ,Gastroenterology ,Nutrition Disorders ,Nutritional status ,Disease ,medicine.disease ,Enteral administration ,Review article ,Malnutrition ,Parenteral nutrition ,medicine ,Pharmacology (medical) ,Intensive care medicine ,business - Abstract
SUMMARY Malnutrition is common and undiagnosed in the majority of affected hospital patients; it is associated with impaired organ function, morbidity, and increased length of hospital stay. Artifical nutritional support in malnourished patients leads to improvement in nutritional status and clinical outcome. Nutritional support is required in malnourished patients, patients who are unable to take normal diet and patients with intestinal failure. Gastroenterologists are required to supervise patients with intestinal failure, to insert endoscopic feeding devices, and increasingly to participate in, or lead, nutritional support teams. Major developments in nutrient delivery have included percutaneous endoscopic feeding devices, the recognition that enteral feeding is possible in patients with gastric stasis, and that nutrient needs can be met by peripheral parenteral nutrition. There is much interest in the use of new substrates, or substrates delivered in pharmacological doses such as glutamine and arginine, to manipulate the response to disease. Many hospitals lack an organized approach to artificial nutritional support. Patients continue to suffer from a lack of treatment or the consequences of inappropriate or inadequate treatment. This article reviews the current status of artificial nutritional support and provides guidelines for patient managment.
- Published
- 2007
22. Proceedings From FDA/A.S.P.E.N. Public Workshop: Clinical Trial Design for Intravenous Fat Emulsion Products, October 29, 2013
- Author
-
Richard J. Deckelbaum, Gary P. Zaloga, Andrew E. Mulberg, Karyn L Berry, Mary Hise, Donna Griebel, Randall C. O'Reilly, Berthold Koletzko, Thomas R. Ziegler, Elke von Kleist, Staffan Bark, Steven A. Abrams, Jay M. Mirtallo, Denis Bonnot, Daniel H. Teitelbaum, J. Thomas Brenna, Jonathan Shaffer, Bruce R. Bistrian, Yvon Carpentier, Peggi Guenter, and Mary B. Baker
- Subjects
medicine.medical_specialty ,Pathology ,Fat Emulsions, Intravenous ,Parenteral Nutrition ,Nutrition and Dietetics ,urogenital system ,business.industry ,United States Food and Drug Administration ,Clinical study design ,Alternative medicine ,Medicine (miscellaneous) ,Congresses as Topic ,Fat emulsion ,United States ,Food and drug administration ,Parenteral nutrition ,Enteral Nutrition ,medicine ,Humans ,Intensive care medicine ,business ,reproductive and urinary physiology ,Societies, Medical - Abstract
The development of intravenous fat emulsion (IVFE) is the culmination of physiological, biochemical, nutritional, and medical scientific advancements. IVFEs have the ability to deliver critical nutritional substrates to the patient. Recent literature purports that they may also play roles in modulation of immune functionality and pulmonary physiology, but data supporting these potential benefits are limited. While soybean-based IVFEs have comprised the dominant fat in U.S. markets, a number of other novel IVFEs may prove to optimize the care of children and adults in both hospitalized and home settings. The October 2013 U.S. Food and Drug Administration (FDA)/American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) Public Workshop brought together scientists, researchers, and clinical experts to present updated clinical perspectives of IVFEs, including historical development, current state of usage throughout the world, and considerations for the regulatory approval of new IVFEs in the United States.
- Published
- 2014
23. Home enteral nutrition in adults: a European multicentre survey
- Author
-
Marek Pertkiewicz, Jonathan Shaffer, P. Thul, J.M. Moreno Villares, Xavier Hébuterne, Federico Bozzetti, A. Van Gossum, and M. Staun
- Subjects
Adult ,Male ,Pediatrics ,medicine.medical_specialty ,Adolescent ,medicine.medical_treatment ,Neurological disorder ,Critical Care and Intensive Care Medicine ,Age Distribution ,Enteral Nutrition ,Bolus (medicine) ,Surveys and Questionnaires ,Percutaneous endoscopic gastrostomy ,Prevalence ,medicine ,Humans ,Intubation, Gastrointestinal ,Aged ,Retrospective Studies ,Aged, 80 and over ,Gastrostomy ,Nutrition and Dietetics ,business.industry ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Home Care Services ,Dysphagia ,Europe ,Malnutrition ,Parenteral nutrition ,Female ,medicine.symptom ,Deglutition Disorders ,business - Abstract
Aims: This study was undertaken to report indications and practice of home enteral nutrition (HEN) in Europe. Methods: A questionnaire on HEN practice was sent to 23 centres from Belgium (B), Denmark (D), France (F), Germany (G), Italy (I), Poland (P), Spain (S) and the United Kingdom (UK). This involved adult patients newly registered in HEN programme from 1 January 1998 to 31 December 1998. Results: A total of 1397 patients (532 women, 865 men) were registered. The median incidence of HEN was 163 patients/million inhabitants/year (range: 62–457). Age distribution was 7.5%, 16–40 years; 37.1%, 41–65 years; 34.5%, 66–80 years and 20.9% >80 years. The chief underlying diseases were a neurological disorder (49.1%), or head and neck cancer (26.5%); the main reason for HEN was dysphagia (84.6%). A percutaneous endoscopic gastrostomy (58.2%) or a naso-gastric tube (29.3%) were used to infuse commercial standard or high energy diets (65.3%), or fibre diets (24.5%); infusion was cyclical (61.5%) or bolus (34.1%). Indications and feeds were quite similar throughout the different centres but some differences exist concerning the underlying disease. There was greater variation in the choice of tubes and mode of infusion. In F, G, I, S, and UK, costs of HEN are fully funded. In B, D, and P patients have to pay part or all of the charges. Conclusions: In Europe, HEN was utilised mainly in dysphagic patients with neurological disorders or cancer, using a standard feed via a PEG. However, there were important differences among the countries in the underlying diseases treated, the routes used, the mode of administration and the funding.
- Published
- 2003
24. Home artificial nutritional support: the value of the British Artificial Nutrition Survey
- Author
-
Jonathan Shaffer, C. Holden, C. Wheatley, S. Woods, A. Micklewright, Marinos Elia, N. Meadows, Rebecca J. Stratton, A. Thomas, C.A. Russell, and D. Scott
- Subjects
medicine.medical_specialty ,Nutrition and Dietetics ,Health economics ,business.industry ,Audit ,Clinical nutrition ,Critical Care and Intensive Care Medicine ,medicine.disease ,Enteral administration ,Malnutrition ,Parenteral nutrition ,Family medicine ,Health care ,medicine ,Intensive care medicine ,business ,Enteral Tube Feeding - Abstract
The British Artificial Nutrition Survey (BANS) was established in 1996 by the British Association for Enteral and Parenteral Nutrition to audit and research nutritional care in hospital and the community, with the overall aim of improving the quality of nutritional support in patients with disease-related malnutrition. In this article the following information emerging from BANS is presented: growth and prevalence of artificial nutrition (enteral tube feeding and parenteral nutrition), clinical outcome of a wide range of diagnoses receiving artificial nutrition in the community, an economic perspective on home artificial nutrition, and some ethical issues. This information is used to illustrate how BANS can be of value in a wide range of health care activities, including health planning, health economics, clinical practice and patient care.
- Published
- 2001
25. Primary antibody deficiency and Crohn's disease
- Author
-
David Nicholson, Mansel Heaney, Aled Jones, Wynne Rees, Derek P. Jewell, Jonathan Shaffer, P Conlong, and Neil Snowden
- Subjects
Adult ,Diarrhea ,Male ,medicine.medical_specialty ,Pathology ,Short Report ,Disease ,Gastroenterology ,Inflammatory bowel disease ,Diagnosis, Differential ,Crohn Disease ,Internal medicine ,medicine ,Humans ,Crohn's disease ,biology ,business.industry ,Immunologic Deficiency Syndromes ,General Medicine ,Middle Aged ,medicine.disease ,digestive system diseases ,Granuloma ,Etiology ,biology.protein ,Female ,Steroids ,medicine.symptom ,Differential diagnosis ,Antibody ,business - Abstract
Summary Five patients with primary antibody deficiency were investigated because of intermittent but persistent diarrhoea of several years duration despite immunoglobulin replacement therapy. We found no evidence of Giardia lambia or other intestinal pathogens to explain their gastrointestinal symptoms. All five had definite radiological evidence of small bowel Crohn's disease and three had histological specimens available with abnormalities consistent with Crohn's disease. One patient had a non-caseating granuloma in an oral ulcer. A second patient with stricturing disease in the small bowel had a mucosal inflammatory infiltrate with non-caseating granulomas. A third had transmural inflammation but no granulomas. All five patents were diagnosed as having Crohn's disease and have responded symptomatically to steroid therapy.
- Published
- 1999
26. Coronary artery disease in South Asian immigrants living in New York City: angiographic findings and risk factor burdens
- Author
-
Jeffrey J, Silbiger, Russell, Stein, Monisankar, Roy, Murali K, Nair, Pilar, Cohen, Jonathan, Shaffer, Arthur, Pinkhasov, and Mazullah, Kamran
- Subjects
Male ,Bangladesh ,Asian ,Smoking ,India ,Coronary Artery Disease ,Middle Aged ,Coronary Angiography ,White People ,Logistic Models ,Risk Factors ,Hypertension ,Diabetes Mellitus ,Prevalence ,Humans ,Female ,New York City ,Pakistan ,Obesity ,Aged ,Dyslipidemias - Abstract
The prevalence of coronary artery disease (CAD) among South Asians (SAs) significantly exceeds that of Caucasians. South Asians also suffer from more premature, clinically aggressive and angiographically extensive (3-vessel) disease. The role of conventional CAD risk factors (CCRFs) remains controversial.We sought to determine if the CCRF burdens of SA immigrants differed from Caucasians. We also sought to determine whether angiographic CAD was more extensive among SAs and whether SA ethnicity was an independent predictor of 3-vessel disease.We reviewed the CCRFs and angiograms of 520 SAs and 219 Caucasians consecutively referred with stable angina pectoris or acute coronary syndrome.Three-vessel CAD was significantly more common among SAs than Caucasians (32.5% vs 22.4%; P = .006). Diabetes mellitus (DM), age and male sex independently predicted 3-vessel disease. South Asian ethnicity showed a trend toward predicting 3-vessel disease (P = .06). The frequency of DM (55% vs 31.1%; P.001), hypertension (77.5% vs 68.5%; P = .01), obesity (63.1% vs 44.3%; P.001) and dyslipidemia (75.6% vs 61.6%; P.001) were significantly greater among SAs; however, smoking was significantly more common among Caucasians (44.3% vs 21.3%; P.001). Compared to Caucasians, SAs were significantly younger at the time of presentation for coronary angiography (58.5 vs 61.1 yrs; P = .001).SAs referred for coronary angiography with stable angina and acute coronary syndromes are younger, have significantly higher rates of 3-vessel disease, as well as higher rates of DM, hypertension, obesity and dyslipidemia than Caucasians. Aggressive screening, prevention and treatment may be warranted in this population.
- Published
- 2013
27. Coronary angiographic findings and conventional coronary artery disease risk factors of Indo-Guyanese immigrants with stable angina pectoris and acute coronary syndromes
- Author
-
Jeffrey J, Silbiger, Russell, Stein, Biana, Trost, Jonathan, Shaffer, Jin-Hee, Kim, Pilar, Cohen, and Mazullah, Kamran
- Subjects
Male ,New York ,Emigrants and Immigrants ,Coronary Disease ,Middle Aged ,Coronary Angiography ,White People ,Angina Pectoris ,Phenotype ,Risk Factors ,Hypertension ,Diabetes Mellitus ,Prevalence ,Humans ,Female ,Guyana ,Acute Coronary Syndrome ,Dyslipidemias - Abstract
The prevalence of coronary artery disease (CAD) among migrant Indian populations exceeds that of Caucasians. Migrant Indians also suffer from more premature, clinically aggressive and angiographically extensive, (i.e., 3-vessel disease). It is not known whether the extent of angiographic CAD or the conventional CAD risk factors of Indo-Guyanese (IG) immigrants differs from that of Caucasians.We reviewed the conventional CAD risk factors and angiographic findings of 198 IG and 191 Caucasians who were consecutively referred for cardiac catheterization with a diagnosis of stable angina pectoris or acute coronary syndrome.Three-vessel CAD was approximately 1.5 times more common among IG than Caucasians (34.8% vs. 24.0%; P = .02). Age (P = .01), male sex (P = .03) and diabetes mellitus (P = .05) were independently associated with an increased likelihood of 3-vessel CAD and there was a trend towards IG ethnicity predicting 3-vessel disease (P = .13). The frequency of diabetes mellitus (51.5% vs. 30.9%; P.001), hypertension (82.3% vs. 67.0%; P.001) and dyslipidemia (75.5% vs. 60.2%; P = .001) were significantly greater among IG, however, that of smoking was not. While IG were significantly leaner than Caucasians (27.7 kg/m2 vs. 30.0 kg/m2 ; P.001), their mean body mass index fell within the ethnic-specific range for obesity.We conclude that IG immigrants presenting for coronary angiography have significantly higher rates of 3-vessel CAD as well as higher rates of diabetes mellitus, hypertension and dyslipidemia than Caucasians. Aggressive screening, prevention and treatment may be warranted in this cohort.
- Published
- 2012
28. Can a Nutritional Support Team improve the nutritional standard of care in patients with fractured neck of femur?
- Author
-
A. Padwick, Jonathan Shaffer, K. Farrer, N. M. Smith, N. Pendleton, and A. Myers
- Subjects
Patient Consent ,Hip fracture ,medicine.medical_specialty ,Nutrition and Dietetics ,Standard of care ,Mid arm circumference ,business.industry ,Medicine (miscellaneous) ,medicine.disease ,Grip strength ,Malnutrition ,Physical therapy ,Medicine ,In patient ,Femur ,business - Abstract
which is associated with increased risk of complications, morbidity and mortality. Adequate nutrition is essential in thecare of the hip fracture patients in order to achieve recovery without complications. The aim of this pilot was to investigate the effects ofan improved care intervention in relation to nutritional status. Following patient consent, Mid Arm Circumference (MAC) and Hand GripStrength were measured on admission and discharge and length of stay recorded (Table 1).From January 2008 to June 2008, a total of 81 patients over the age of 75 years with a fractured femur were seen by the NutritionSupport Team (NST). Seventy six patients (94%) were screened by the NST on admission using the Malnutrition Universal ScreeningTool (MUST); 43 (57%) of patients were assessed as medium or high risk. Due to cognitive impairment only 31 and 21 patientsrespectively consented to MAC and grip strength being measured on admission and discharge
- Published
- 2010
29. Malnutrition universal screening tool: a risk factor for Clostridium difficile infection in hospital?
- Author
-
K. Farrer, M. Wale, Jonathan Shaffer, and John McLaughlin
- Subjects
medicine.medical_specialty ,Nutrition and Dietetics ,business.industry ,Malnutrition universal screening tool ,medicine ,Medicine (miscellaneous) ,Risk factor ,Clostridium difficile ,Intensive care medicine ,business - Published
- 2009
30. Home parenteral nutrition--an effective and safe long-term therapy for systemic sclerosis-related intestinal failure
- Author
-
Jonathan Shaffer, Ariane L. Herrick, A. Teubner, and M. Brown
- Subjects
Intestinal pseudo-obstruction ,Adult ,Male ,medicine.medical_specialty ,Malabsorption ,Gastrointestinal Diseases ,medicine.medical_treatment ,Nutritional Status ,Systemic scleroderma ,Asymptomatic ,Gastroenterology ,Rheumatology ,Internal medicine ,medicine ,Humans ,Pharmacology (medical) ,Retrospective Studies ,Scleroderma, Systemic ,business.industry ,Retrospective cohort study ,Raynaud Disease ,Middle Aged ,medicine.disease ,Intestinal Diseases ,Parenteral nutrition ,Treatment Outcome ,Gastrointestinal disease ,Female ,medicine.symptom ,Safety ,business ,Parenteral Nutrition, Home ,Central venous catheter - Abstract
Objectives. To examine the outcome in patients with SSc requiring parenteral nutrition (PN), and to compare their clinical characteristics with those of other SSc patients and of patients requiring PN/home parenteral nutrition (HPN) for other conditions. Methods. Retrospective review of SSc and Intestinal Failure Unit databases at a tertiary referral centre for SSc/national unit for intestinal failure over a 13-yr period. Results. Eight patients with SSc requiring PN during the study period were identified (2 males, 6 females: median age at commencement of PN 51 yrs, range 42–56 yrs). All patients commencing PN had bacterial overgrowth and malabsorption not responding to antibiotic therapy. The median duration of PN therapy in the eight patients was 40 months (range 0.8–192 months). Between them the eight patients had a total of 13851 catheter-use days and only two line infections (0.14/1000 catheter days), a lower rate of line infection than in other HPN-treated patients at Hope Hospital (0.52/1000 catheter days). Three patients died during the 13-yr period, none of causes related to their PN. Six were unable to manage their HPN regime themselves, mainly because of problems with hand function. Conclusions. Although patient numbers were small, our findings suggest that HPN can be safely and successfully used long-term in patients with SSc and should be considered for patients unable to maintain their nutritional status because of severe gastrointestinal involvement. Impaired hand function should not preclude SSc patients from receiving HPN: family members or community nurses may be trained in the care of the HPN line. Background Approximately 90% of patients with the multisystem connective tissue disease SSc develop gastrointestinal involvement of their disease, although many are asymptomatic [1, 2]. Gastrointestinal problems occur in both the lcSSc and dcSSc disease subtypes [3]. Any part of the gastrointestinal tract may become involved and an autopsy study showed that approximately half of the patients have histological involvement of their small bowel [4]. A small minority of patients develop intestinal failure. The usual scenario in this minority is that small intestinal involvement, with impaired peristalsis, results in bowel dilatation and stasis that in turn lead to bacterial overgrowth, malabsorption, and sometimes pseudoobstruction. Gastrointestinal involvement in SSc can therefore be life-threatening: of 264 patients with dcSSc from 29 centres, with an average duration of follow-up of 5.2 yrs, 13 (5%) died of gastrointestinal disease, representing 15% of deaths definitely related to SSc [5]. When a patient is unable to maintain his/her nutritional status, as in SSc-related intestinal failure, parenteral nutrition (PN) may be required to prevent, or correct, malnutrition. Other forms of artificial feeding, including oral supplementation, naso-jejunal feeding and feeding via percutaneous enterogastrostomy (PEG)/ percutaneous jejunostomy tubes may be tried before introducing PN. Complications of PN administration include central venous catheter infections, occlusions and fractures of the central line, hepatic disease and osteoporosis. If the indication for PN suggests that long-term treatment will be required, as in SSc, home parenteral nutrition (HPN) may be considered. PN is a potentially life-saving treatment but training the patient as carer for the central line for HPN may pose particular problems in SSc because of concomitant problems including impaired hand function and cardiorespiratory disease. The aim of this retrospective study was to examine the outcome in patients with SSc requiring PN, and to compare their clinical characteristics with those of other SSc patients and of patients requiring PN/HPN for other conditions.
- Published
- 2007
31. Management of intestinal failure in Europe. A questionnaire based study on the incidence and management
- Author
-
Jonathan Shaffer, P. Thul, Xavier Hébuterne, F. Bozzetti, A. Micklewright, Michael Staun, José Moreno, Kent V. Haderslev, Marek Pertkiewicz, Loris Pironi, Staun, M., Hebuterne, X., Shaffer, J., Haderslev, K. V., Bozzetti, F., Pertkiewicz, M., Micklewright, A., Moreno, J., Thul, P., and Pironi, Loris
- Subjects
Pediatrics ,medicine.medical_specialty ,Referral ,Sports medicine ,Physiology ,business.industry ,Research ,Incidence (epidemiology) ,Human physiology ,Bioinformatics ,INTESTINAL FAILURE ,Enteral administration ,HOME PARENTERAL NUTRITION ,Intestinal failure ,Treatment practice ,MANAGEMENT ,Medicine ,Orthopedics and Sports Medicine ,Lost to follow-up ,business - Abstract
Background Intestinal failure is the outcome of a number of gastrointestinal diseases and characterized by significant reduction in functional gut mass. If not resolved patients often face long-term nutritional support. This study gathered information about how patients referred with intestinal failure are managed in specialised European centres. Methods A questionnaire was circulated in 7 European countries via representatives of the ESPEN-HAN working group to seek information about experience in treating patients with intestinal failure. We asked about clinical outcome, information about structure and organisation of the department, referral criteria, treatment procedures and guidelines. Results 17 centres in 6 European countries completed the questionnaire: UK, n = 6, France, n = 4, Spain, n = 3, Denmark, n = 2, Italy, n = 1, Poland, n = 1. The experience of the centres in treating patients was in the range 12–30 years. The total number of patients on HPN in all centres was 590. The number of patients referred to centres with intestinal failure during the period January to December 2000 was n = 882: UK, n = 375 (range 2–175), France, n = 308 (range 24–182), Italy and Spain, n = 43 (range 9–52), Denmark n = 51 (range 14–37), the centre in Poland included 53 patients. Comparing all centres the following distribution among patients (median % (range%)) with regard to the endpoints were reported: Oral nutrition 32% (23–50%), enteral/tube feeding 11% (4–23%), HPN 36% (15–57%), lost to follow up 10% (0–35%), dead 9% (5–18%). No patients had an intestinal transplant. Conclusion The study provides information about how patients with intestinal failure are managed across Europe and the data indicates that treatment practice varies between countries.
- Published
- 2007
32. Infliximab use in Crohn's disease: impact on health care resources in the UK
- Author
-
Sue M Turner, Hazel E. Drummond, Alan J Lobo, Chris Probert, Barry Rodgers-Gray, Jack Satsangi, Derek P. Jewell, Jonathan Shaffer, Markus B. Frenz, Gill Troy, Mark Moosa, Alastair Forbes, Subrata Ghosh, Lyn Evans, Lisa Younge, and Scot Buchan
- Subjects
musculoskeletal diseases ,Adult ,Male ,medicine.medical_specialty ,Adolescent ,Cost-Benefit Analysis ,MEDLINE ,Audit ,Drug Costs ,Crohn Disease ,immune system diseases ,Health care ,medicine ,Humans ,skin and connective tissue diseases ,Intensive care medicine ,Aged ,Aged, 80 and over ,Crohn's disease ,Hepatology ,Cost–benefit analysis ,business.industry ,Tumor Necrosis Factor-alpha ,Public health ,Gastroenterology ,Health services research ,Antibodies, Monoclonal ,Health Care Costs ,Middle Aged ,medicine.disease ,Infliximab ,United Kingdom ,Surgery ,Hospitalization ,stomatognathic diseases ,Treatment Outcome ,Antirheumatic Agents ,Health Resources ,Female ,Health Services Research ,business ,Epidemiologic Methods ,medicine.drug - Abstract
OBJECTIVE: To quantify the impact of infliximab therapy on health care resource utilization in the UK. METHODS: A retrospective audit was undertaken at seven centres in the UK, which reviewed patient notes for a period of 6 months before and 6 months after an initial infliximab infusion. Details of hospital admissions, outpatient visits, operations, diagnostic procedures, drug usage, and overall efficacy were collected. Results were compared for the two 6 month study periods. RESULTS: A total of 205 patients (62% female, median age 33 years) with moderate/severe Crohn's disease were audited. The majority of patients had chronic active disease (62%) and most received one infusion initially (72%). Clinicians rated 74% of responses as good to excellent and patients 72%. Most patients had concomitant immunosuppression (pre: 75%, post: 75%). Approximately half of the patients (45%) stopped taking steroids, with a further 34% having a dosage reduction. A fall of 1093 inpatient days was seen (1435 vs. 342) in the 6 months following infliximab administration. There were seven fewer operations, 33 fewer examinations under anaesthetic, and 99 fewer diagnostic procedures. Outpatient visits were similar pre- versus post- (555 vs. 534). The total reduction in direct costs amounted to an estimated pounds 591,006. Three hundred and fifty-three infliximab infusions were administered at an estimated cost of pounds 562,719. Thus, there was a net reduction of pounds 28,287 or pounds 137.98 per patient. CONCLUSIONS: Infliximab appears to be a potentially cost effective treatment for selected patients based on the reduced number of inpatient stays, examinations under anaesthetic, and diagnostic procedures over a 6 month period.
- Published
- 2005
33. Can we use mid upper arm anthropometry to detect malnutrition in medical inpatients? A validation study
- Author
-
Chris Todd, Sorrel Burden, E.R. Stoppard, A.J. Makin, and Jonathan Shaffer
- Subjects
Adult ,Male ,medicine.medical_specialty ,Percentile ,Validation study ,Adolescent ,Medicine (miscellaneous) ,Nutritional Status ,Sensitivity and Specificity ,Body Mass Index ,Predictive Value of Tests ,Internal medicine ,medicine ,Humans ,Aged ,Triceps skin fold ,Aged, 80 and over ,Nutrition and Dietetics ,business.industry ,Malnutrition ,Reproducibility of Results ,Nutritional status ,Anthropometry ,Middle Aged ,medicine.disease ,Skinfold Thickness ,medicine.anatomical_structure ,Nutrition Assessment ,Physical therapy ,Arm ,Upper limb ,Female ,business ,Body mass index - Abstract
Background and aims Mid upper arm anthropometry (MUAA) is often used as a measure of nutritional status to detect changes in body composition. The aim of this study was to investigate the reliability and validity of MUAA including mid arm circumference (MAC) and triceps skin fold thickness (TSFT) to determine the usefulness in clinical practice. Method We measured MUAA in 158 consecutive admissions along with subjective global assessment (SGA) and body mass index (BMI). Inter- and intra-rater reliability was evaluated in an additional 50 patients. Results The sensitivity and specificity of MUAA
- Published
- 2005
34. Home enteral tube feeding following cerebrovascular accident
- Author
-
C. Wheatley, A. Micklewright, C. Holden, A. Thomas, C.A. Russell, Marinos Elia, Jonathan Shaffer, Rebecca J. Stratton, N. Meadows, D. Scott, and S. Woods
- Subjects
Adult ,Male ,Pediatrics ,medicine.medical_specialty ,Time Factors ,Adolescent ,Home Nursing ,Artificial nutrition ,Critical Care and Intensive Care Medicine ,Enteral administration ,Enteral Nutrition ,Swallowing ,Medicine ,Humans ,In patient ,Longitudinal Studies ,Cause of death ,Enteral Tube Feeding ,Aged ,Nutrition and Dietetics ,business.industry ,Age Factors ,Middle Aged ,Deglutition ,Nursing Homes ,Stroke ,Cross-Sectional Studies ,Treatment Outcome ,England ,Female ,Homebound Persons ,Nursing homes ,business ,Oral feeding - Abstract
Background and aims: In the UK, cerebrovascular accident (CVA) is the third commonest cause of death and the commonest diagnosis in patients receiving home enteral feeding (HETF). This study aimed to use data from the British Artificial Nutrition Survey (BANS) collected between 1996 and 1999 to assess the outcome of patients on HETF, including mortality, return to oral feeding, level of physical activity, and level of dependency, which has resource implications. Results: it is estimated that about 1.7% of all patients suffering a CVA in the UK between 1996 and 1999 received HETF. At one year, 29.6% died while receiving HETF and another 13% returned to oral feeding. Mortality increased with age and was twice as high in those managed in nursing homes compared to those in their own homes. The patients receiving tube feeding spent only 0.6% of their time in hospital. A total of 43.9% of patients were bed-bound at home (1.9% unconscious) and an additional 30.3% were house-bound. Only 21.2% were independent, and the majority were totally dependent on their carers. In CVA patients on HETF the level of dependency was greater than for those with all types of diagnoses (n=12,997). Conclusion: This study has described the outcome of a large number of patients receiving HETF in the UK. Since patients spent less than 1% of their time in hospital, HETF relieves pressure on the expensive hospital environment, but places more demands on the carers, who have to deal with severely disabled patients. Recovery of swallowing function should be assessed intermittently to prevent unnecessary HETF.
- Published
- 2001
35. P213 WHAT IS THE LONG-TERM OUTCOME OF ACUTE INTESTINAL FAILURE?
- Author
-
A. Teubner, Gordon L Carlson, Ramya Kalaiselvan, and Jonathan Shaffer
- Subjects
medicine.medical_specialty ,Nutrition and Dietetics ,business.industry ,Intestinal failure ,medicine ,Medicine (miscellaneous) ,Critical Care and Intensive Care Medicine ,Intensive care medicine ,business ,Outcome (game theory) ,Term (time) - Published
- 2009
36. P196 Outstanding abstract FISTULOCLYSIS AND DISTAL ENTERAL FEEDING CAN SUCCESSFULLY REPLACE TPN IN ACUTE INTESTINAL FAILURE
- Author
-
Jonathan Shaffer, K. Farrer, A. Myers, Gordon L Carlson, S. Heydari Khajehpour, and A. Teubner
- Subjects
medicine.medical_specialty ,Nutrition and Dietetics ,business.industry ,Internal medicine ,Intestinal failure ,medicine ,Medicine (miscellaneous) ,Critical Care and Intensive Care Medicine ,business ,Enteral administration ,Gastroenterology - Published
- 2008
37. Home parenteral nutrition in adults: a multicentre survey in Europe in 1993
- Author
-
K. Ladefoged, Marek Pertkiewicz, H. Bakker, Bernard Messing, P. Thul, S. Wood, Loris Pironi, A. De Francesco, Jonathan Shaffer, M. Leon-Sanz, and A. Van Gossum
- Subjects
Technology ,Pediatrics ,medicine.medical_specialty ,Economics ,Population ,Pharmacy ,Disease ,Critical Care and Intensive Care Medicine ,Education ,Biopharmaceutics ,Rational Use of Drugs and Pharmaco-epidemiology ,Clinical ,Pharmacotherapy ,Drug Therapy ,Acquired immunodeficiency syndrome (AIDS) ,Medical ,Evaluation Studies ,medicine ,Technology, Pharmaceutical ,Pharmacokinetics ,Economics, Pharmaceutical ,education ,Pharmacology ,education.field_of_study ,Nutrition and Dietetics ,Education, Medical ,business.industry ,Pharmacoepidemiology ,Incidence (epidemiology) ,Outcome and Process Assessment (Health Care) ,Short bowel syndrome ,medicine.disease ,Catheter ,Parenteral nutrition ,Pharmaceutical ,Pharmacology, Clinical ,Rationeel Geneesmiddelengebruik en Farmaco-epidemiologie ,business - Abstract
A retrospective survey was performed in 1994, involving 496 adult home parenteral nutrition (HPN) cases, newly enrolled in the year 1993 from 13 European countries from 75 centres. From the 8 countries having registered more than 80% of cases (423 patients), incidence and prevalence ranged from 0.2 to 4.6 and 0.3 to 12.2 patients/106 population/year. In the patients studied, the diagnosis was cancer (42%), Crohn's disease (15%), vascular diseases (13%), radiation enteritis (8%), AIDS (4%) and other nonmalignant non-AIDS diseases (18%). Short bowel syndrome and intestinal obstruction were the two major indications for HPN in 31% and 22%, respectively. Seventy-three percent of the centres had a nutrition team. HPN was administered through a tunnelled venous central catheter in 73%, cyclical nocturnal infusions were used in 90% of patients, and intravenous feeding was the sole source of nutrition in 33%. Only 44% undertook HPN unaided. The present report indicates that cancer has now become the main indication for HPN in Europe; there was, however, a heterogeneous distribution of diseases amongst the reporting countries. The observed 9 (6–12)-month probability of survival was poor in AIDS (n = 8; 12%) and cancer patients (n = 78; 29%) but better for the other HPN indications (n = 115; 92%).
- Published
- 1995
38. Hepatic complications of parenteral nutrition
- Author
-
Jonathan Shaffer
- Subjects
medicine.medical_specialty ,Nutrition and Dietetics ,Bone disease ,business.industry ,Hepatobiliary disease ,Critical Care and Intensive Care Medicine ,medicine.disease ,Hepatic Complication ,Gastroenterology ,Parenteral nutrition ,Cholestasis ,Metabolic complication ,Internal medicine ,medicine ,business - Abstract
Apart from bone disease, the major metabolic complication of parenteral nutrition is that of hepatobiliary disease) -9 This review concerns only a discussion of hepatic problems. Furthermore, children will not be considered since the problems in this group are somewhat different. The apparent predilection of infants to total parenteral nutrition (TPN) related cholestasis may be based on the relative immaturity of the neonatal biliary excretory system.
- Published
- 1995
39. Biotin deficiency complicating long-term total parenteral nutrition in an adult patient
- Author
-
A. Shenkin, D. Isherwood, N. Williams, M.H. Irving, D. Barber, Jonathan Shaffer, Gordon L Carlson, and S. Wales
- Subjects
medicine.medical_specialty ,Pediatrics ,Nutrition and Dietetics ,business.industry ,Biotin deficiency ,Critical Care and Intensive Care Medicine ,medicine.disease ,Surgery ,chemistry.chemical_compound ,Parenteral nutrition ,Biotin ,chemistry ,Medicine ,business ,Complication - Published
- 1995
40. 902 Prognostic Indicators in Jaundiced Patients On Total Parenteral Nutrition for Intestinal Failure
- Author
-
Ramya Kalaiselvan, Salman Heydari Khajehpour, Salil Singh, Jonathan Shaffer, and Gordon L Carlson
- Subjects
medicine.medical_specialty ,Parenteral nutrition ,Hepatology ,business.industry ,Internal medicine ,Intestinal failure ,Gastroenterology ,Medicine ,business - Published
- 2009
41. Spectrum of intestinal failure in a specialised unit
- Author
-
T. O'Hanrahan, Jonathan Shaffer, M.H. Irving, S. Finnegan, D J Leinhardt, and N.A. Scott
- Subjects
Adult ,Male ,Pediatrics ,medicine.medical_specialty ,Adolescent ,Gastrointestinal Diseases ,Fistula ,Disease ,Recurrence ,Intestinal failure ,Medicine ,Humans ,Child ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Infant ,Retrospective cohort study ,General Medicine ,Middle Aged ,medicine.disease ,Prognosis ,Chronic intestinal failure ,Intestines ,Self Care ,Parenteral nutrition ,Evaluation Studies as Topic ,Child, Preschool ,Chronic Disease ,Self care ,Female ,Parenteral Nutrition, Total ,business ,Complication - Abstract
300 consecutive admissions over 7 years to a purpose-built intestinal failure unit are reviewed. The commonest underlying condition was Crohn's disease (42%), and the commonest complication precipitating admission was intestinal fistula (42%). Total parenteral nutrition was used in 85% and surgery in 50%. A multidisciplinary approach to management gave a high success rate--90% of patients were discharged from hospital, although nearly 25% needed home parental nutrition. These results suggest that chronic intestinal failure should be managed in specialised units in the same manner as other types of organ failure.
- Published
- 1991
42. Nutritional status and treatment 10 years on from the king's fund report
- Author
-
E.R. Stoppard, K. Ward, Jonathan Shaffer, Sorrel Burden, M.J. Connolly, and A.J. Makin
- Subjects
medicine.medical_specialty ,Nutrition and Dietetics ,business.industry ,Family medicine ,Medicine ,Nutritional status ,Critical Care and Intensive Care Medicine ,business - Published
- 2003
43. Does tube feeding affect hospital mortality
- Author
-
Sorrel Burden, Jonathan Shaffer, E.R. Stoppard, M.J. Connolly, A.J. Makin, and K. Ward
- Subjects
medicine.medical_specialty ,Nutrition and Dietetics ,business.industry ,medicine ,Tube (fluid conveyance) ,Hospital mortality ,Critical Care and Intensive Care Medicine ,Intensive care medicine ,business ,Affect (psychology) - Published
- 2003
44. Validation of mid-arm anthropometry in hospitalized medical patients
- Author
-
Jonathan Shaffer, Chris Todd, A.J. Makin, E.R. Stoppard, and Sorrel Burden
- Subjects
medicine.medical_specialty ,Nutrition and Dietetics ,business.industry ,Physical therapy ,medicine ,Anthropometry ,Critical Care and Intensive Care Medicine ,business - Published
- 2003
45. Drosophila CK2 phosphorylates Deadpan, a member of the HES family of basic-helix-loop-helix (bHLH) repressors.
- Author
-
Umesh C. Karandikar, Jonathan Shaffer, Clifton P. Bishop, and Ashok P. Bidwai
- Abstract
Abstract In Drosophila, protein kinase CK2 regulates a diverse array of developmental processes. One of these is cell-fate specification (neurogenesis) wherein CK2 regulates basic-helix-loop-helix (bHLH) repressors encoded by the Enhancer of Split Complex (E(spl)C). Specifically, CK2 phosphorylates and activates repressor functions of E(spl)M8 during eye development. In this study we describe the interaction of CK2 with an E(spl)-related bHLH repressor, Deadpan (Dpn). Unlike E(spl)-repressors which are expressed in cells destined for a non-neural cell fate, Dpn is expressed in the neuronal cells and is thought to control the activity of proneural genes. Dpn also regulates sex-determination by repressing sxl, the primary gene involved in sex differentiation. We demonstrate that Dpn is weakly phosphorylated by monomeric CK2a, whereas it is robustly phosphorylated by the embryo-holoenzyme, suggesting a positive role for CK2ß. The weak phosphorylation by CK2a is markedly stimulated by the activator polylysine to levels comparable to those with the holoenzyme. In addition, pull down assays indicate a direct interaction between Dpn and CK2. This is the first demonstration that Dpn is a partner and target of CK2, and raises the possibility that its repressor functions might also be regulated by phosphorylation. [ABSTRACT FROM AUTHOR]
- Published
- 2005
46. Home parenteral nutrition: A review of 100 patient years of treatment in 76 consecutive cases
- Author
-
Jonathan Shaffer, M. Mughal, S H Pettit, D J Almond, Miles Irving, Mark A. Turner, and M A Stokes
- Subjects
Adult ,Male ,Pediatrics ,medicine.medical_specialty ,Resuscitation ,Time Factors ,Adolescent ,Home Nursing ,Sepsis ,Quality of life ,Intestinal failure ,medicine ,Humans ,Per patient per year ,Child ,Aged ,business.industry ,Mortality rate ,Middle Aged ,medicine.disease ,Thrombosis ,Parenteral nutrition ,England ,Quality of Life ,Female ,Parenteral Nutrition, Total ,Surgery ,business - Abstract
Over the last 10 years, the Nutrition Unit at Hope Hospital has trained and looked after 76 patients on home parenteral nutrition for a total of 100 patient years. Although 40 per cent of patients have required home parenteral nutrition for 6 months or less one patient has been on treatment for 7 years. The quality of life measured on a 4 point scale was good for the majority of patients. Sepsis and superior vena caval thrombosis are the main problems encountered. Overall mortality rate was 18 per cent and the sepsis rate was 0·14 episodes per patient per year. Home parenteral nutrition is an effective and safe treatment of intestinal failure.
- Published
- 1988
47. A comparison of standard and sustained release clonidine with respect to plasma concentration and blood pressure changes
- Author
-
Jonathan Shaffer, DS Davies, S Murray, and BJ Pleuvry
- Subjects
Adult ,Male ,Pharmacology ,Chromatography ,business.industry ,Blood Pressure ,Clonidine ,Gas Chromatography-Mass Spectrometry ,Delayed-Action Preparations ,Blood pressure ,Plasma concentration ,medicine ,Humans ,Female ,Pharmacology (medical) ,Gas chromatography–mass spectrometry ,business ,Research Article ,medicine.drug - Published
- 1985
48. The effect of rifampicin on sulphapyridine plasma concentrations following sulphasalazine administration
- Author
-
JB Houston and Jonathan Shaffer
- Subjects
Adult ,Male ,Sulfapyridine ,Pharmacology ,Crohn Disease ,Sulfasalazine ,Sulfanilamides ,Humans ,Medicine ,Drug Interactions ,Pharmacology (medical) ,Ethambutol ,business.industry ,Crohn disease ,Sulfanilamide ,Middle Aged ,Plasma concentration ,Female ,Rifampin ,business ,Rifampicin ,Research Article ,medicine.drug - Published
- 1985
49. Tinnitus in a patient with beta-thalassaemia intermedia on long-term treatment with desferrioxamine
- Author
-
M. N. Marsh, C. Clark, I. B. Holbrook, and Jonathan Shaffer
- Subjects
Adult ,medicine.medical_specialty ,Long term treatment ,Time Factors ,Thalassemia ,Iron ,Deferoxamine ,Gastroenterology ,Tinnitus ,Internal medicine ,hemic and lymphatic diseases ,medicine ,Humans ,Beta thalassaemia intermedia ,business.industry ,General Medicine ,medicine.disease ,Surgery ,stomatognathic diseases ,Female ,medicine.symptom ,Intermedia ,business ,Complication ,medicine.drug ,Research Article - Abstract
Summary A women with β-thalassemia intermedia, and iron overload following many years’ treatment with oral iron, was treated with subcutaneous desferrioxamine. During the course of this treatment she developed tinnitus, which was considered to be a rare complication of the use of this chelating agent. The mechanism of this effect is not understood.
- Published
- 1981
50. Pharmacokinetics of promethazine and its sulphoxide metabolite after intravenous and oral administration to man
- Author
-
JB Houston, G Taylor, G Mawer, and Jonathan Shaffer
- Subjects
Adult ,Male ,Metabolite ,Administration, Oral ,Pharmacology ,Promethazine ,Route of administration ,First pass effect ,chemistry.chemical_compound ,Pharmacokinetics ,Oral administration ,Medicine ,Humans ,Pharmacology (medical) ,Volume of distribution ,business.industry ,Area under the curve ,Kinetics ,chemistry ,Injections, Intravenous ,business ,medicine.drug ,Half-Life ,Research Article - Abstract
Blood concentrations of promethazine and promethazine sulphoxide have been measured following oral and intravenous administration of promethazine to seven healthy male volunteers. Promethazine disposition is characterised by a large volume of distribution (1970 1) and a high blood clearance (1.141 min-1). Less than 1% of the dose is excreted unchanged in the urine, therefore total body clearance is essentially metabolic clearance. In accord with this high clearance the oral availability of promethazine is only 25%. The absorption of promethazine from the gastrointestinal tract exceeds 80% in most subjects. Minimal metabolism by the gastrointestinal mucosa is implicated. Promethazine sulphoxide pharmacokinetics are consistent with a pronounced first pass effect. Although the area under the curve for this metabolite is not route dependent, there is a marked alteration in the shape of the metabolite curve when oral and intravenous data are compared. Evidence is presented to support the hypothesis that S-oxidation of promethazine is predominantly an hepatic event. The conclusions of previous investigators with regard to the role of the gut mucosa in S-oxidation of phenothiazines is critically assessed.
- Published
- 1983
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.