1,326 results on '"North Bristol NHS Trust [Bristol, UK]"'
Search Results
2. Dissimilarity of the gut–lung axis and dysbiosis of the lower airways in ventilated preterm infants
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Gallacher, David, Mitchell, Emma, Alber, Dagmar, Wach, Richard, Klein, Nigel, Marchesi, Julian R., Kotecha, Sailesh, Department of Child Health, School of Medicine, Cardiff University, Cardiff, UK, Institute of Child Health, University College London, London, UK, Neonatal Unit, North Bristol NHS Trust, Bristol, UK, School of Biosciences, Cardiff University, Cardiff, UK, and Division of Integrative Systems Medicine and Digestive Disease, Imperial College London, London, UK
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DNA, Bacterial ,Male ,0301 basic medicine ,Pulmonary and Respiratory Medicine ,RJ101 ,Respiratory System ,030106 microbiology ,Feces ,03 medical and health sciences ,Ureaplasma ,0302 clinical medicine ,RNA, Ribosomal, 16S ,030225 pediatrics ,medicine ,Humans ,Microbiome ,Respiratory system ,Lung ,11 Medical and Health Sciences ,Bronchopulmonary Dysplasia ,Bacteria ,medicine.diagnostic_test ,biology ,business.industry ,Infant, Newborn ,respiratory system ,medicine.disease ,biology.organism_classification ,Gastrointestinal Microbiome ,respiratory tract diseases ,Trachea ,Bronchoalveolar lavage ,medicine.anatomical_structure ,Bronchopulmonary dysplasia ,Immunology ,Dysbiosis ,Female ,Airway ,business ,Bronchoalveolar Lavage Fluid ,Infant, Premature - Abstract
BackgroundChronic lung disease of prematurity (CLD), also called bronchopulmonary dysplasia, is a major consequence of preterm birth, but the role of the microbiome in its development remains unclear. Therefore, we assessed the progression of the bacterial community in ventilated preterm infants over time in the upper and lower airways, and assessed the gut–lung axis by comparing bacterial communities in the upper and lower airways with stool findings. Finally, we assessed whether the bacterial communities were associated with lung inflammation to suggest dysbiosis.MethodsWe serially sampled multiple anatomical sites including the upper airway (nasopharyngeal aspirates), lower airways (tracheal aspirate fluid and bronchoalveolar lavage fluid) and the gut (stool) of ventilated preterm-born infants. Bacterial DNA load was measured in all samples and sequenced using the V3–V4 region of the 16S rRNA gene.ResultsFrom 1102 (539 nasopharyngeal aspirates, 276 tracheal aspirate fluid, 89 bronchoalveolar lavage, 198 stool) samples from 55 preterm infants, 352 (32%) amplified suitably for 16S RNA gene sequencing. Bacterial load was low at birth and quickly increased with time, but was associated with predominant operational taxonomic units (OTUs) in all sample types. There was dissimilarity in bacterial communities between the upper and lower airways and the gut, with a separate dysbiotic inflammatory process occurring in the lower airways of infants. Individual OTUs were associated with increased inflammatory markers.ConclusionsTaken together, these findings suggest that targeted treatment of the predominant organisms, including those not routinely treated, such as Ureaplasma spp., may decrease the development of CLD in preterm-born infants.
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- 2020
3. Gender Equity in Academic Rheumatology, Current Status and Potential for Improvement: A Cross-Sectional Study to Inform an EULAR Task Force
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Pavel V Ovseiko, Laure Gossec, Laura Andreoli, Uta Kiltz, Leonieke van Mens, Neelam Hassan, Marike van der Leeden, Heidi J Siddle, Alessia Alunno, Iain B McInnes, Nemanja S Damjanov, Florence Apparailly, Caroline Ospelt, Irene E van der Horst-Bruinsma, Elena Nikiphorou, Katie L Druce, Zoltán Szekanecz, Alexandre Sepriano, Tadej Avcin, George Bertsias, Georg Schett, Anne-Maree Keenan, Linda H Pololi, Laura C Coates, University of Oxford, Service de Rhumatologie [CHU Pitié Salpêtrière], CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), University of Brescia, Ruhr University Bochum (RUB), Department of Clinical Immunology and Rheumatology [Academic Medical Center, Amsterdam], University of Amsterdam [Amsterdam] (UvA), North Bristol NHS Trust [Bristol, UK], University of Bristol [Bristol], Amsterdam UMC - Amsterdam University Medical Center, University of Leeds, University of L'Aquila [Italy] (UNIVAQ), University of Glasgow, University of Belgrade [Belgrade], Cellules Souches, Plasticité Cellulaire, Médecine Régénératrice et Immunothérapies (IRMB), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), University hospital of Zurich [Zurich], VU University Medical Center [Amsterdam], King‘s College London, University of Manchester [Manchester], University of Debrecen Egyetem [Debrecen], Leiden University Medical Center (LUMC), Universidade Nova de Lisboa = NOVA University Lisbon (NOVA), University Medical Centre Ljubljana [Ljubljana, Slovenia] (UMCL), University of Crete [Heraklion] (UOC), Universitätsklinikum Erlangen [Erlangen], NIHR - Leeds Musculoskeletal Biomedical Research Unit (LMBRU), National Institute for Health Research (NIHR), Brandeis University, Gestionnaire, Hal Sorbonne Université, Rehabilitation medicine, AMS - Ageing & Vitality, AMS - Musculoskeletal Health, APH - Aging & Later Life, APH - Health Behaviors & Chronic Diseases, APH - Societal Participation & Health, Rheumatology, AII - Inflammatory diseases, and AMS - Tissue Function & Regeneration
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Gender Equity ,Male ,[SDV]Life Sciences [q-bio] ,Immunology ,health services research ,Europe ,[SDV] Life Sciences [q-bio] ,Cross-Sectional Studies ,Rheumatology ,Inflammatory diseases Radboud Institute for Health Sciences [Radboudumc 5] ,Immunology and Allergy ,Humans ,Female ,epidemiology ,ddc:610 ,Rheumatologists ,qualitative research - Abstract
ObjectivesEvidence on the current status of gender equity in academic rheumatology in Europe and potential for its improvement is limited. The EULAR convened a task force to obtain empirical evidence on the potential unmet need for support of female rheumatologists, health professionals and non-clinical scientists in academic rheumatology.MethodsThis cross-sectional study comprised three web-based surveys conducted in 2020 among: (1) EULAR scientific member society leaders, (2) EULAR and Emerging EULAR Network (EMEUNET) members and (3) EULAR Council members. Statistics were descriptive with significance testing for male/female responses assessed by χ2 test and t-test.ResultsData from EULAR scientific member societies in 13 countries indicated that there were disproportionately fewer women in academic rheumatology than in clinical rheumatology, and they tended to be under-represented in senior academic roles. From 324 responses of EULAR and EMEUNET members (24 countries), we detected no gender differences in leadership aspirations, self-efficacy in career advancement and work–life integration as well as the share of time spent on research, but there were gender differences in working hours and the levels of perceived gender discrimination and sexual harassment. There were gender differences in the ranking of 7 of 26 factors impacting career advancement and of 8 of 24 potential interventions to aid career advancement.ConclusionsThere are gender differences in career advancement in academic rheumatology. The study informs a EULAR task force developing a framework of potential interventions to accelerate gender-equitable career advancement in academic rheumatology.
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- 2022
4. Factors Influencing Atypical Clinical Presentations during the 2017 Madagascar Pneumonic Plague Outbreak: A Prospective Cohort Study
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Rindra Randremanana, Reziky Tiandraza Mangahasimbola, Rodrigue N. E. Hasiniatsy, Dominique Razafimandimby, Tiana Razafinambinintsoa, Anna L. Funk, Laurence Baril, Andrew M. Lovering, Randrianirina Frédérique, Minoarisoa Rajerison, Alex P. Salam, Arnaud Fontanet, Mihaja Raberahona, Faraniaina Andrianarintsiferantsoa, Mamy Jean de Dieu Randria, Norosoa Harline Razanajatovo, Voahangy Andrianaivoarimanana, Peter Horby, Eric Bertherat, Prisca Andriantsalama, Rado Rakotomalala, Jean-Michel Heraud, Lyndsey Castle, Bertrand Renaud, Liam Read, University of Oxford, UK Public Health Rapid Support Team [London] (UK-PHRST), London School of Hygiene and Tropical Medicine (LSHTM)-Public Health England [London], Hôpital Joseph Raseta Befelatanana, CHU d’Antananarivo, Institut Pasteur de Madagascar, Réseau International des Instituts Pasteur (RIIP), North Bristol NHS Trust [Bristol, UK], Centre Hospitalier Anti-pesteux d'Ambohimiandra [Antananarivo, Madagascar] (CHAPA), Centre Hospitalier de Soavinandriana (CENHOSOA), Institut Pasteur [Paris] (IP), Université Paris Descartes - Paris 5 (UPD5), World Health Organisation (WHO), Organisation Mondiale de la Santé / World Health Organization Office (OMS / WHO), Conservatoire National des Arts et Métiers [CNAM] (CNAM), HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM), This study was funded by the United Kingdom Public Health Rapid Support Team., University of Oxford [Oxford], and Institut Pasteur [Paris]
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Male ,Pediatrics ,Cohort Studies ,MESH: Madagascar ,0302 clinical medicine ,[SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases ,MESH: Child ,Prospective Studies ,Overdiagnosis ,Child ,Prospective cohort study ,MESH: Cohort Studies ,MESH: Aged ,[SDV.MHEP.ME]Life Sciences [q-bio]/Human health and pathology/Emerging diseases ,MESH: Middle Aged ,Articles ,Middle Aged ,MESH: Infant ,3. Good health ,Infectious Diseases ,Child, Preschool ,[SDV.MP.VIR]Life Sciences [q-bio]/Microbiology and Parasitology/Virology ,Cohort ,Female ,medicine.symptom ,Cohort study ,Adult ,Pneumonic plague ,medicine.medical_specialty ,Adolescent ,030231 tropical medicine ,MESH: Plague ,Bubonic plague ,03 medical and health sciences ,Virology ,Madagascar ,medicine ,Humans ,Aged ,MESH: Adolescent ,Plague ,MESH: Humans ,business.industry ,MESH: Child, Preschool ,Infant ,Outbreak ,MESH: Adult ,[SDV.BBM.BM]Life Sciences [q-bio]/Biochemistry, Molecular Biology/Molecular biology ,medicine.disease ,MESH: Male ,MESH: Prospective Studies ,Sputum ,[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie ,Parasitology ,business ,MESH: Female - Abstract
International audience; In late 2017, Madagascar experienced a large urban outbreak of pneumonic plague, the largest outbreak to date this century. During the outbreak, there were widespread reports of plague patients presenting with atypical symptoms, such as prolonged duration of illness and upper respiratory tract symptoms. Reported mortality among plague cases was also substantially lower than that reported in the literature (25% versus 50% in treated patients). A prospective multicenter observational study was carried out to investigate potential reasons for these atypical presentations. Few subjects among our cohort had confirmed or probable plague, suggesting that, in part, there was overdiagnosis of plague cases by clinicians. However, 35% subjects reported using an antibiotic with anti-plague activity before hospital admission, whereas 55% had antibiotics with anti-plague activity detected in their serum at admission. Although there may have been overdiagnosis of plague by clinicians during the outbreak, the high frequency of community antibiotic may partly explain the relatively few culture-positive sputum samples during the outbreak. Community antibiotic use may have also altered the clinical presentation of plague patients. These issues make accurate detection of patients and the development of clinical case definitions and triage algorithms in urban pneumonic plague outbreaks difficult.
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- 2020
5. Respective roles of non-pharmaceutical interventions in bronchiolitis outbreaks: an interrupted time-series analysis based on a multinational surveillance system
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Lea, Lenglart, Naim, Ouldali, Kate, Honeyford, Zsolt, Bognar, Silvia, Bressan, Danilo, Buonsenso, Liviana, Da Dalt, Tisham, De, Ruth, Farrugia, Ian K, Maconochie, Henriette A, Moll, Rianne, Oostenbrink, Niccolo, Parri, Damian, Roland, Katy, Rose, Esra, Akyüz Özkan, François, Angoulvant, Camille, Aupiais, Clarissa, Barber, Michael, Barrett, Romain, Basmaci, Susana, Castanhinha, Antonio, Chiaretti, Sheena, Durnin, Patrick, Fitzpatrick, Laszlo, Fodor, Borja, Gomez, Susanne, Greber-Platzer, Romain, Guedj, Florian, Hey, Lina, Jankauskaite, Daniela, Kohlfuerst, Ines, Mascarenhas, Anna Maria, Musolino, Zanda, Pučuka, Sofia, Reis, Alexis, Rybak, Petra, Salamon, Matthias, Schaffert, Keren, Shahar-Nissan, Maria Chiara, Supino, Ozlem, Teksam, Caner, Turan, Roberto, Velasco, Ruud G, Nijman, Luigi, Titomanlio, Vanda, Anacleto, Orkun, Aydin, Elena, Bellelli, Ron, Berant, Thibault, De Groc, Sara, Geitoeira, Florian, Hoffmann, Franziska, Leeb, Fiona, Leonard, Mark, Lyttle, Lia, Mano, Vytenis, Masillonis, Rosa, Morello, Francisa, Saraiva, Gabor, Simon, Ines Silva, Costa, Joao Sous, Marques, Jonas, Thüminger, Corinne, Vasilico, Anna Chiara, Vittucci, Christoph, Zurl, Pediatrics, Business Economics, Hôpital Robert Debré, Hôpital Robert Debré-Centre Hospitalier Universitaire de Reims (CHU Reims), CHU Sainte Justine [Montréal], Epidémiologie Clinique et Evaluation Economique Appliquées aux Populations Vulnérables (ECEVE (U1123 / UMR_S_1123)), Institut National de la Santé et de la Recherche Médicale (INSERM)-AP-HP Hôpital universitaire Robert-Debré [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Cité (UPCité), Association Clinique et Thérapeutique Infantile du Val de Marne (ACTIV), The institute of cancer research [London], Pál Heim Children's Hospital = Heim Pál Gyermekkórház [Budapest], Azienda Ospedale Università di Padova = Hospital-University of Padua (AOUP), Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Imperial College London, Mater Dei Hospital [Malta], St Mary's Hospital [London], Hammersmith Hospital NHS Imperial College Healthcare, Erasmus University Medical Center [Rotterdam] (Erasmus MC), Azienda Ospedaliero Universitaria A. Meyer [Firenze, Italy], University of Leicester, University Hospitals Leicester, Ondokuz Mayis University (OMU), Université Paris Cité (UPCité), AP-HP Hôpital universitaire Robert-Debré [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hôpital Jean Verdier [AP-HP], North Bristol NHS Trust [Bristol, UK], Children's Health Ireland [Crumlin, Dublin, Ireland] (CHI), University College Dublin [Dublin] (UCD), Hôpital Louis Mourier - AP-HP [Colombes], Centro Hospitalar de Lisboa Central E.P.E, CHI at Tallaght Children's Outpatient and Emergency Care Unit [Tallaght, Ireland] (COECU), CHI at Temple Street [Temple Street, Ireland] (TS), Fejér County Szent György University Teaching Hospital [Szekesfehervar, Hungary] (FCSGUTH), Hospital Universitario Cruces = Cruces University Hospital, Medizinische Universität Wien = Medical University of Vienna, Equipe 1 : EPOPé - Épidémiologie Obstétricale, Périnatale et Pédiatrique (CRESS - U1153), Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS (U1153 / UMR_A_1125 / UMR_S_1153)), Conservatoire National des Arts et Métiers [CNAM] (CNAM), HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Conservatoire National des Arts et Métiers [CNAM] (CNAM), HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Dr von Hauner Children's Hospital [Munich, Germany], Ludwig-Maximilians-Universität München (LMU), Ludwig-Maximilians University [Munich] (LMU), Hospital of Lithuanian University of Health Sciences Kauno Klinikos [Kaunas, Lithuania], Medical University of Graz, Hospital Prof Doutor Fernando Fonseca [Amadora, Portugal], Bambino Gesù Children’s Hospital [Rome, Italy], Children's Clinical University Hospital [Riga, Latvia] (CCUH), Centro Hospitalar Tondela-Viseu [Viseu, Portugal] (CHTV), Paracelsus Medizinische Privatuniversität = Paracelsus Medical University (PMU), Schneider Children’s Medical Center [Petah Tikva, Israel] (SCMC), Hacettepe University = Hacettepe Üniversitesi, Mersin University, Rio Hortega University Hospital (Hospital Universitario Río Hortega) [Valladolid, Spain] (RHUH), Maladies neurodéveloppementales et neurovasculaires (NeuroDiderot (UMR_S_1141 / U1141)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), EPISODES Study Group., and Angoulvant, François
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[SDV] Life Sciences [q-bio] ,Pulmonary and Respiratory Medicine ,SDG 3 - Good Health and Well-being ,[SDV]Life Sciences [q-bio] - Abstract
BackgroundBronchiolitis is a major source of morbimortality among young children worldwide. Non-pharmaceutical interventions (NPIs) implemented to reduce the spread of severe acute respiratory syndrome coronavirus 2 may have had an important impact on bronchiolitis outbreaks, as well as major societal consequences. Discriminating between their respective impacts would help define optimal public health strategies against bronchiolitis. We aimed to assess the respective impact of each NPI on bronchiolitis outbreaks in 14 European countries.MethodsWe conducted a quasi-experimental interrupted time-series analysis based on a multicentre international study. All children diagnosed with bronchiolitis presenting to the paediatric emergency department of one of 27 centres from January 2018 to March 2021 were included. We assessed the association between each NPI and change in the bronchiolitis trend over time by seasonally adjusted multivariable quasi-Poisson regression modelling.ResultsIn total, 42 916 children were included. We observed an overall cumulative 78% (95% CI −100– −54%; pConclusionsSeveral NPIs were associated with a reduction of bronchiolitis outbreaks, including full lockdown, school closure, teleworking and facial masking. Some of these public health interventions may be considered to further reduce the global burden of bronchiolitis.
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- 2022
6. IMproving the practice of intrapartum electronic fetal heart rate MOnitoring with cardiotocography for safer childbirth (the IMMO programme): protocol for a qualitative study
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Tim Draycott, Cathy Winter, Guillaume Lamé, James Ward, Mary Dixon-Woods, Jennifer Anne Burt, Elisa Liberati, Lamé, Guillaume [0000-0001-9514-1890], Apollo - University of Cambridge Repository, University of Cambridge [UK] (CAM), THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care, University of Cambridge, University of Cambridge [UK] (CAM)-University of Cambridge [UK] (CAM), University of Bristol [Bristol], North Bristol NHS Trust [Bristol, UK], and Department of Engineering [Cambridge]
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Risk analysis ,electronic fetal heartrate monitoring ,fetal medicine ,Decision support system ,Cardiotocography ,[SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics ,risk management ,quality in health care ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,Protocol ,Health services research ,Humans ,Medicine ,Systems thinking ,030212 general & internal medicine ,Fetal Monitoring ,Qualitative Research ,Risk management ,Quality of Health Care ,Research ethics ,Medical education ,030219 obstetrics & reproductive medicine ,business.industry ,General Medicine ,Heart Rate, Fetal ,Delivery, Obstetric ,Quality Improvement ,3. Good health ,Obstetrics ,Harm ,Research Design ,[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie ,Female ,cardiotocography ,business ,qualitative research ,Qualitative research - Abstract
International audience; Introduction: Sub-optimal electronic fetal heart rate monitoring (EFM) in labour using CardioTocoGraphy (CTG) has been identified as one of the most common causes of avoidable harm in maternity care. Training staff is a frequently proposed solution to reduce harm. However, current approaches to training are heterogeneous in content and format, making it difficult to assess effectiveness. Technological solutions, such as digital decision support, have not yet demonstrated improved outcomes. Effective improvement strategies require in-depth understanding of the technical and social mechanisms underpinning the EFM process. The aim of this study is to advance current knowledge of the types of errors, hazards and failure modes in the process of classifying, interpreting, and responding to, CTG traces. This study is part of a broader research programme aimed at developing and testing an intervention to improve intrapartum EFM.Methods and analysis: The study is organised into two workstreams. First, we will conduct observations and interviews in three UK maternity units to gain an in-depth understanding of how intrapartum EFM is performed in routine clinical practice. Data analysis will combine the insights of an ethnographic approach (focused on the social norms and interactions, values and meanings that appear to be linked with the process of EFM) with a systems thinking approach (focused on modelling processes, actors and their interactions). Second, we will use risk analysis techniques to develop a framework of the errors, hazards and failure modes that affect intrapartum EFM. Ethics and dissemination: This study has been approved by the West Midlands - South Birmingham Research Ethics Committee, reference number: 18/WM/0292. Dissemination will take the form of academic articles in peer-reviewed journals and conferences, along with tailored communication with various stakeholders in maternity care. Strengths and limitations of this study:•A multidisciplinary team of obstetricians, social scientists, midwives and engineers will collaborate to characterise the technical and social mechanisms that may affect the safety of EFM in labour.•The study combines the strengths of ethnographic research and engineering approaches to systems analysis and risk assessment.•This project will generate a detailed characterisation of the errors, hazards and failure modes in intrapartum EFM and will help to inform the development of an intervention that will directly target the reasons for problems in interpretation and response to CTG traces.•Three maternity units across the UK will be selected; the generalisability of the findings will require careful assessment.
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- 2019
7. The DESCARTES-Nantes survey of kidney transplant recipients displaying clinical operational tolerance identifies 35 new tolerant patients and 34 almost tolerant patients
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Michaela Prokopova, Friedrich Thaiss, Andries J. Hoitsma, Bruno Hurault de Ligny, Anja Mühlfeld, Séverine Martin, Oliver Gross, Władysław Sułowicz, Annick Massart, Judith Racapé, Miguel Angel Gentil Govantes, A. Yussim, Frieder Keller, Umberto Maggiore, Matthew Howse, Gian Benedetto Piredda, Ricardo Lauzurica, Magali Giral, Luis Antonio Jiménez del Cerro, Marie-Christine Moal, Tomas Reischig, François Glowacki, Jean-François Subra, Bénédicte Janbon, Consuelo De Biase, María José Pérez-Sáez, Marian Klinger, Goce Spasovski, Philippe Gatault, Gaetano La Manna, David Berglund, Cem Tugmen, Giovanni M. Frascà, Uyen Huynh-Do, Christophe Legendre, Annaïck Pallier, Christopher Dudley, Mélanie Chesneau, Laura Braun, Daniel Abramowicz, Karine Hadaya, Christian Noel, Evangeline Pillebout, Carmen Díaz-Corte, Julio Pascual, Ondrej Viklicky, Florence Villemain, Luigi Biancone, Ana Ramírez Puga, Marije C. Baas, Alain Le Moine, Marc Abramowicz, Frederike J. Bemelman, Rainer Oberbauer, Jean-Paul Soulillou, Nurhan Seyahi, Jadranka Buturović Ponikvar, Johan W. de Fijter, Maarten Naesens, Vania Cuna, Klemens Budde, Serhan Tuglular, Pierrick Guerif, Angel Alonso Hernandez, Piero Stratta, Arnaud Garnier, Hulya Colak, K. Clemente, Sophie Brouard, Marc Hazzan, Søren Schwartz Sørensen, Giuseppe Orlando, Daniel Serón, Luboslav Beňa, Quirino Lai, Francesco Pisani, Aisling E. Courtney, Alexandre Dufay, Mehmet Sukru Sever, Thomas Wekerle, Hervé Le Monies De Sagazan, Hakim Mazouz, Aljoša Kandus, Maria Carmen Cantarell, André Gaasbeek, Massart, A, Pallier, A, Pascual, J, Viklicky, O, Budde, K, Spasovski, G, Klinger ,M, Sever, MS, Sørensen, SS, Hadaya, K, Oberbauer, R, Dudley, C, De Fijter, JW, Yussim, A, Hazzan, M, Wekerle, T, Berglund, D, De Biase, C, Pérez-Sáez, MJ, Mühlfeld, A, Orlando, G, Clemente, K, Lai, Q, Pisani, F, Kandus, A, Baas, M, Bemelman, F, Ponikvar, JB, Mazouz ,H, Stratta, P, Subra, JF, Villemain, F, Hoitsma, A, Braun, L, Cantarell, MC, Colak, H, Courtney, A, Frasca, GM, Howse, M, Naesens, M, Reischig, T, Serón, D, Seyahi, N, Tugmen, C, Alonso Hernandez, A, Beňa, L, Biancone, L, Cuna, V, Díaz-Corte, C, Dufay, A, Gaasbeek, A, Garnier, A, Gatault, P, Gentil Govantes, MA, Glowacki, F, Gross, O, Hurault de Ligny, B, Huynh-Do, U, Janbon, B, Jiménez Del Cerro, LA, Keller, F, La Manna, Gaetano, Lauzurica, R, Le Monies De Sagazan, H, Thaiss, F, Legendre, C, Martin, S, Moal, MC, Noël, C, Pillebout, E, Piredda, GB, Puga, AR, Sulowicz, W, Tuglular, S, Prokopova, M, Chesneau, M, Le Moine, A, Guérif, P, Soulillou, JP, Abramowicz, M, Giral, M, Racapé, J, Maggiore, U, Brouard, S, Abramowicz, D, AII - Amsterdam institute for Infection and Immunity, Nephrology, Renal Unit [Brussels, Belgium] (ULB), Université libre de Bruxelles (ULB)-CUB Hôpital Erasme [Bruxelles, Belgium], Medical Genetics Department [Brussels, Belgium], Université libre de Bruxelles (ULB), Centre de Recherche en Transplantation et Immunologie (U1064 Inserm - CRTI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN), Nephrology [Barcelona, Spain] (Hospital del Mar), Hospital del Mar [Barcelona, Spain], Department of Nephrology [Prague, Czech Republic] (Transplant Center), Institute for Clinical and Experimental Medicine (IKEM), Department of Nephrology [Berlin, Germany], Charité - UniversitätsMedizin = Charité - University Hospital [Berlin], Department of Nephrology [Skopje, Macedonia], Ss. Cyril and Methodius University in Skopje, Nephrology and Transplantation Medicine [Wrocław, Poland], University of Wrocław [Poland] (UWr), Internal Medicine, Nephrology [Istanbul, Turkey], Istanbul School of Medicine [Istanbul, Turkey], Nephrology P [Copenhagen, Denmark], Rigshospitalet [Copenhagen], Copenhagen University Hospital-Copenhagen University Hospital, Nephrology and Transplantation [Geneva, Switzerland], Geneva University Hospitals - HUG [Switzerland], Department of Medicine III–Nephrology, Hypertension and Renal Transplantation [Linz, Austria], Krankenhaus Elisabethinen Linz [Linz, Austria], Richard Bright Renal Centre [Bristol, UK], Southmead Hospital [Bristol, UK]-North Bristol NHS Trust [Bristol, UK], Department of Nephrology [Leiden, The Netherlands], Leiden University Medical Center (LUMC), Department of Transplantation [Tel Aviv, Israël] (Rabin Medical Center), Rabin Medical Center [Tel Aviv, Israël]-Tel Aviv University Sackler School of Medicine [Tel Aviv, Israël], Département de Néphrologie [CHRU Lille], Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Department of Surgery [Vienna, Austria] (Section of Transplantation Immunology), Medizinische Universität Wien = Medical University of Vienna, Section of Clinical Immunology [Uppsala, Sweden] (Department of Immunology, Genetics and Pathology), Uppsala University, UOS Trapianti Rene Pancreas [Parma, Italy] (Centro Trapianti di Parma), Azienda Ospedaliero-Universitaria di Parma, Department of Nephrology [Aachen, Germany], University Hospital Aachen, Section of Transplantation [Winston-Salem, NC, USA] (Department of Surgery), Wake Forest School of Medicine [Winston-Salem], Wake Forest Baptist Medical Center-Wake Forest Baptist Medical Center, U.O.C. Trapianti D’Organo [L’Aquila, Italy], Department of Nephrology [Ljubljana, Slovenia] (Renal Transplantation Centre Ljubljana), University Medical Centre Ljubljana [Ljubljana, Slovenia] (UMCL), Kidney Diseases [Nijmegen, The Netherlands], Radboudumc Nijmegen [The Netherlands], Renal Transplant Unit [Amsterdam, The Netherlands] (Department of Nephrology), Academic Medical Center [Amsterdam, Netherlands], Unité de Transplantation Rénale et Pancréatique [CHU Sud, Amiens] (Service de Néphrologie), CHU Amiens-Picardie, Department of Translational Medicine [Novara, Italy], Amedeo Avogadro University of Eastern Piedmont, Service de Néphrologie-Dialyse-Transplantation [Angers], Université d'Angers (UA)-Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM), service de Néphrologie et Transplantation Rénale [CHU Strasbourg] (Hôpital de jour de Néphrologie), Centre Hospitalier Universitaire de Strasbourg (CHU de Strasbourg )-Nouvel Hôpital Civil - NHC [Strasbourg], Pediatric Nephrology [Barcelona, Spain] (Vall d’Hebron Hospital), Universitat Autònoma de Barcelona (UAB)-Vall d'Hebron University Hospital [Barcelona], Department of Nephrology [Izmir, Turkey], Tepecik Training and Research Hospital [Izmir, Turkey], Regional Nephrology Unit [Belfast, UK], Belfast City Hospital [Belfast, UK], Nefrologia, Dialisi e Trapianto di rene [Ancona, Italy], AO Torrette Umberto I [Ancona, Italy], Nephrology/Transplantation [Liverpool, UK], Royal Liverpool University Hospital [Liverpool, UK], Department of Nephrology and Renal Transplantation [Leuven, Belgium], University Hospitals Leuven [Leuven]-Catholic University Leuven, Nephrology Ward [Pilsen, Czech Republic] (Department of Internal Medicine), University Hospital Pilsen [Pilsen, Czech Republic], Istanbul University, Servicio de Nefrología, Hospital Universitario, A Coruña, Transplant Centre, University Hospital Louis Pasteur Kosice, University of Turin, St. Orsola University Hospital, University of Bologna, Hospital Universitario Central de Asturias (HUCA), Service Néphrologie [Roubaix], Hôpital Victor Provo, Leids Universitair Medisch Centrum [Leiden, The Netherlands], Néphrologie - Médecine Interne - Hypertension Pédiatrique, Hôpital des Enfants, CHU Toulouse [Toulouse]-CHU Toulouse [Toulouse], Service Néphrologie - Immunoclinique [CHRU Tours], Hôpital Bretonneau, Hospital Universitario Virgen del Rocío [Sevilla], Service de Néphrologie et Transplantation rénale [CHRU-lille], University Medicine Göttingen, Service de Néphrologie-Dialyse-Transplantation rénale [CHU Caen], Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU)-CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Tumorothèque de Caen Basse-Normandie (TCBN), University of Bern [Bern, Switzerland] (University Hospital Bern ), Transplantation rénale [CHU Grenoble], Centre Hospitalier Universitaire [Grenoble] (CHU), Hospital General Universitario de Alicante, Universitätsklinikum Ulm - University Hospital of Ulm, Hospital Universitario Germans Trias I Pujol, University Hospital Hamburg-Eppendorf, Universitaetsklinikum Hamburg-Eppendorf = University Medical Center Hamburg-Eppendorf [Hamburg] (UKE), Université Paris Descartes - Paris 5 (UPD5), CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service d'hémodialyse et de Néphrologie [Libourne], Hôpital Robert Boulin, CHRU - Service de néphrologie, dialyse et transplantation rénale, Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Département de Néphrologie et transplantation [Hôpital Saint Louis - APHP], Hopital Saint-Louis [AP-HP] (AP-HP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Kidney Transplant Az. Osp. G. Brotzu, Hospital Universitario Insular de Gran Canaria, University Hospital in Krakow, Marmara School of Medicine Hastanesi, Institute of Transplantation Urology and Nephrology [CHU Nantes], Centre hospitalier universitaire de Nantes (CHU Nantes), Institut de Recherche Interdisciplinaire en Biologie Humaine et Moleculaire, Research Center of Epidemiology, Biostatistics and Clinical Research, Nephrology-Renal Transplantation Department, Université libre de Bruxelles (ULB)-Universitair Ziekenhuis Antwerp, ERA-EDTA-DESCARTES working group, the Fonds Erasme (research grant), the Fonds Carine Vyghen, the Fonds Horlait-Dapsens, the RTRS Fondation de Coopération Scientifique CENTAURE and the IHUCesti project., ANR-10-IBHU-0005,CESTI (TSI-IHU),Centre Européen des Sciences de la Transplantation et de l'Immunothérapie (TSI-IHU)(2010), Le Bihan, Sylvie, Instituts Hospitalo-Universitaires B - Centre Européen des Sciences de la Transplantation et de l'Immunothérapie (TSI-IHU) - - CESTI (TSI-IHU)2010 - ANR-10-IBHU-0005 - IBHU - VALID, Ss. Cyril and Methodius University in Skopje (UKIM), Tel Aviv University (TAU)-Rabin Medical Center [Tel Aviv, Israël], Università degli studi di Torino = University of Turin (UNITO), University of Bologna/Università di Bologna, Service Néphrologie, médecine interne et hypertension pédiatrique [CHU Toulouse], Pôle Enfants [CHU Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), CUB Hôpital Erasme [Bruxelles, Belgium]-Université libre de Bruxelles (ULB), and Hadaya, Karine
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0301 basic medicine ,Nephrology ,Graft Rejection ,Male ,medicine.medical_treatment ,030230 surgery ,Kidney transplant ,0302 clinical medicine ,Surveys and Questionnaires ,Allograft survival ,Kidney transplantation ,ddc:616 ,Graft Survival/immunology ,Survival Rate/trends ,[SDV.MHEP] Life Sciences [q-bio]/Human health and pathology ,Incidence ,Graft Survival ,Immunosuppression ,operational tolerance ,Transplantation ,3. Good health ,Europe ,Survival Rate ,frequency ,minimally immunosuppressed patients ,Female ,Hemodialysis ,Graft Rejection/epidemiology/immunology/prevention & control ,Homologous ,Adult ,medicine.medical_specialty ,Ronyons -- Trasplantació -- Aspectes immunològics ,Immunosuppression/methods ,kidney transplantation ,Europe/epidemiology ,03 medical and health sciences ,Immune Tolerance/immunology ,Internal medicine ,medicine ,Immune Tolerance ,Humans ,Transplantation, Homologous ,Survival rate ,Immunosuppression Therapy ,graft survival ,business.industry ,medicine.disease ,Kidney Transplantation ,Transplant Recipients ,Surgery ,030104 developmental biology ,Operational tolerance ,Human medicine ,Renal disorders Radboud Institute for Health Sciences [Radboudumc 11] ,business ,[SDV.MHEP]Life Sciences [q-bio]/Human health and pathology - Abstract
Background Kidney recipients maintaining a prolonged allograft survival in the absence of immunosuppressive drugs and without evidence of rejection are supposed to be exceptional. The ERA-EDTA-DESCARTES working group together with Nantes University launched a European-wide survey to identify new patients, describe them and estimate their frequency for the first time. Methods Seventeen coordinators distributed a questionnaire in 256 transplant centres and 28 countries in order to report as many operationally tolerant patients (TOL; defined as having a serum creatinine
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8. Patient-reported outcomes, postoperative pain and pain relief after day case surgery (POPPY): methodology for a prospective, multicentre observational study.
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Hare WM, Belete M, Brayne AB, Daykin H, Everson M, Ratcliffe A, Samuel K, Sorrell L, and Rockett M
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Background: In the UK, approximately 70% of surgical procedures are undertaken as day-cases. Little information exists about recovery from day-case surgery, yet international data highlights patients are at risk of developing significant longer-term health problems including chronic post-surgical pain and persistent postoperative opioid use. The Patient-reported Outcomes, Postoperative Pain and pain relief after daY case surgery (POPPY) study was a national prospective multicentre observational study, measuring short- and longer-term patient-reported outcomes, postoperative pain and pain relief after day-case surgery., Methods: This was a collaborative project led by resident anaesthetists under the Research and Audit Federation of Trainees umbrella. Adult day-case surgical patients were recruited on the day of surgery. Baseline data including patient characteristics; procedure details; pre-operative analgesic use; pre-existing pain; and quality of life scores were recorded. Patients were followed up through automated short message service messages. Short-term (postoperative days 1, 3 and 7) outcomes included: quality of recovery; pain severity; impact of pain on function; and analgesic use. Longer-term outcomes (postoperative day 97) included: quality of life; analgesic use; incidence of chronic post-surgical pain; and incidence persistent postoperative opioid use. Additional outcomes were completed by those patients with chronic post-surgical pain and persistent postoperative opioid use, with 30 patients recruited to a qualitative semi-structured interview study exploring postoperative expectations, recovery, postoperative pain and opioid use., Results: An embedded pilot study at four sites recruited 129 patients. Responses to the automated short message service were gained from 129 patients (100%) at day 1; 116 (89.9%) at day 3; 108 (83.7%) at day 7; and 77 (59.7%) at day 97 postoperatively. The pilot enabled refinement of the methods and processes before the national roll out., Conclusion: This paper outlines the methods for the POPPY study, the largest UK multicentre prospective observational study considering short- and longer-term outcomes following day-case surgery., (© 2024 The Author(s). Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of Anaesthetists.)
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- 2024
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9. Clinical Characteristics of Anti-Synthetase Syndrome: Analysis from the CLASS project.
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Faghihi-Kashani S, Yoshida A, Bozan F, Zanframundo G, Rozza D, Loganathan A, Dourado E, Sambataro G, Ventura IB, Bae SS, Lim D, Gallegos DR, Yamano Y, Selva-O'Callaghan A, Mammen AL, Scirè CA, Montecucco C, Oddis CV, Fiorentino D, Bonella F, Miller FW, Lundberg IE, Schmidt J, Rojas-Serrano J, Hudson M, Kuwana M, González-Gay MA, McHugh N, Corte TJ, Doyle TJ, Werth VP, Gupta L, Roman DIP, Bianchessi LM, Devarasetti PK, Shinjo SK, Luppi F, Cavazzana I, Moghadam-Kia S, Fornaro M, Volkmann ER, Piga M, Loarce-Martos J, De Luca G, Knitza J, Wolff-Cecchi V, Sebastiani M, Schiffenbauer A, Rider LG, Campanilho-Marques R, Marts L, Bravi E, Gunawardena H, Aggarwal R, and Cavagna L
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Objective: Anti-synthetase syndrome (ASSD) is a rare systemic autoimmune rheumatic disease (SARD) with significant heterogeneity and no shared classification criteria. We aimed to identify clinical and serological features associated with ASSD that may be suitable for inclusion in the data-driven classification criteria for ASSD., Methods: We utilized a large, international, multi-center "Classification Criteria for Anti-synthetase Syndrome" (CLASS) project database, which includes both ASSD patients and controls with mimicking conditions, namely SARDs and/or interstitial lung disease (ILD). The local diagnoses of ASSD and controls were confirmed by project team members. We employed univariable logistic regression and multivariable Ridge regression to evaluate clinical and serological features associated with an ASSD diagnosis in a randomly selected subset of the cohort., Results: Our analysis included 948 ASSD cases and 1077 controls. Joint, muscle, lung, skin, and cardiac involvement were more prevalent in ASSD than in controls. Specific variables associated with ASSD included arthritis, diffuse myalgia, muscle weakness, muscle enzyme elevation, ILD, mechanic's hands, secondary pulmonary hypertension due to ILD, Raynaud phenomenon, and unexplained fever. In terms of serological variables, Jo-1 and non-Jo-1 anti-synthetase autoantibodies, antinuclear antibodies with cytoplasmic pattern, and anti-Ro52 autoantibodies were associated with ASSD. In contrast, isolated arthralgia, dysphagia, electromyography/MRI/muscle biopsy findings suggestive of myopathy, inflammatory rashes, myocarditis, and pulmonary arterial hypertension did not differentiate between ASSD and controls or were inversely associated with ASSD., Conclusion: We identified key clinical and serological variables associated with ASSD, which will help clinicians and offer insights into the development of data-driven classification criteria for ASSD., (This article is protected by copyright. All rights reserved.)
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- 2024
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10. Opioid use in the bleeding obstetric patient: a clarification regarding NAP7.
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Cook TM, Lucas DN, and Soar J
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- 2024
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11. Resuscitation on the field of play: a best-practice guideline from Resuscitation Council UK.
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Smith CM, Moore F, Drezner JA, Aird R, Benson Clarke A, Cant J, Hamilton-Bower I, Hampshire S, Hodgson L, Johnston C, O'Sullivan J, Patterson M, Pitcher D, Smith A, Soar J, Thomas L, Zideman DA, and Perkins GD
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- Humans, United Kingdom, Electric Countershock standards, Sports, Practice Guidelines as Topic, Consensus, Cardiopulmonary Resuscitation standards, Death, Sudden, Cardiac prevention & control, Sports Medicine standards
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Sudden cardiac arrest (SCA) is the leading cause of sudden death in athletes during high-level, organised sport. Patient-related and event-related factors provide an opportunity for rapid intervention and the potential for high survival rates. The aim of this consensus was to develop a best-practice guideline for dedicated field-of-play medical teams responding to SCA during an organised sporting event. A task-and-finish group from Resuscitation Council UK identified a stakeholder group of relevant experts and cardiac arrest survivors in March and April 2022. Together, they developed a best-practice guideline using the best available evidence. A public consultation period further refined the guideline before it was finalised in December 2023. Any sudden collapse, without rapid recovery during sporting activity, should be considered an SCA until proven otherwise. Field-of-play medical teams should be empowered to access the collapsed athlete as soon as possible and perform initial essential interventions in situ. This includes a suggested minimum of three cycles of cardiopulmonary resuscitation and defibrillation in persistent shockable rhythms while other aspects of advanced life support are initiated. There should be careful organisation and practice of the medical response, including plans to transport athletes to dedicated facilities for definitive medical care. This best-practice guideline complements, rather than supersedes, existing resuscitation guidelines. It provides a clear approach to how to best treat an athlete with SCA and how to organise the medical response so treatments are delivered effectively and optimise outcomes., Competing Interests: Competing interests: Author affiliations are listed in the acknowledgements. In addition, the following authors report these conflicts of interest: JAD is editor-in-chief of BJSM., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2024
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12. The Diagnostic Complexities of Reactive Angioendotheliomatosis.
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Gelson-Thomas ASI, Bridgewater K, Vilenchik V, Wright B, Oxley J, Garty F, Singh K, Woodrow S, and Keith D
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- 2024
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13. Outcome study of the Pipeline Vantage Embolization Device (second version) in unruptured (and ruptured) aneurysms (PEDVU(R) study).
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Booth TC, Bassiouny A, Lynch J, Sonwalkar H, Bleakley A, Iqbal A, Minett T, Buwanabala J, Narata AP, Patankar T, Islim FI, Kandasamy N, Balasundaram P, Sciacca S, Siddiqui J, Walsh D, Tolias C, Kailaya-Vasan A, Sultan AA, Abd El-Latif M, Mortimer A, and Sastry A
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- Humans, Male, Female, Middle Aged, Prospective Studies, Aged, Retrospective Studies, Adult, Treatment Outcome, Aged, 80 and over, Intracranial Aneurysm therapy, Intracranial Aneurysm diagnostic imaging, Embolization, Therapeutic instrumentation, Embolization, Therapeutic methods, Embolization, Therapeutic adverse effects, Aneurysm, Ruptured therapy
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Background: The Pipeline Vantage Embolization Device (PEDV) is the fourth-generation pipeline flow diverter for intracranial aneurysm treatment. There are no outcome studies for the second PEDV version. We aimed to evaluate safety and efficacy outcomes. Primary and secondary objectives were to determine outcomes for unruptured and ruptured cohorts, respectively., Methods: In this multicenter retrospective and prospective study, we analyzed outcome data from eight centers using core laboratory assessments. We determined 30-day and ≥3-month mortality and morbidity rates, and 6- and 18-month radiographic aneurysm occlusion rates for procedures performed during the period July 2021-March 2023., Results: We included 121 consecutive patients with 131 aneurysms. The adequate occlusion rate for the unruptured cohort at short-term and medium-term follow up, and also for the ruptured cohort at short-term follow up, was >90%. Two aneurysms (1.5%) underwent retreatment. When mortality attributed to a palliative case in the unruptured cohort, or subarachnoid hemorrhage in the ruptured cohort, was excluded then the overall major adverse event rate in respective cohorts was 7.5% and 23.5%, with 0% mortality rates for each. When all event causes were included on an intention-to-treat basis, the major adverse event rates in respective cohorts were 8.3% and 40.9%, with 0.9% and 22.7% mortality rates., Conclusions: For unruptured aneurysm treatment, the second PEDV version appears to have a superior efficacy and similar safety profile to previous-generation PEDs. These are acceptable outcomes in this pragmatic and non-industry-sponsored study. Analysis of ruptured aneurysm outcomes is limited by cohort size. Further prospective studies, particularly for ruptured aneurysms, are needed., Competing Interests: Competing interests: Microvention core laboratory for neurointerventional study: payment to TCB. Siemens Healthineers Speakers Bureau Educational lecture on brain tumours, not related to aneurysms: payment to TCB. Medtronic Speakers Bureau Educational lecture on an independent non-industry-sponsored study published in AJNR 2019 on Pipeline Flow Diverter device: payment to TCB. Bayer Speakers Bureau Educational lecture on Explainability in AI, not related to aneurysms: payment to TCB. Consulting and proctoring agreement with Medtronic, Stryker, Balt, and Cerenovus: payment to TP. Microvention, Balt, and Medtronic support to attend meetings: payment to TM., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)
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- 2024
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14. Health and humanitarian toll of Sudan's forgotten war.
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Saleh E, Dousa KM, Babiker A, Rahma NEAA, Hadi HA, Elsayed M, Elkhalifa SI, Momin SMA, Abubaker A, Nemery OM, Bashir LM, Bedri S, Fadul N, Hamad Y, and Babiker ZOE
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- Humans, Sudan, Warfare, Armed Conflicts history, Altruism
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Competing Interests: AB has served on a clinical advisory board for Beckman Coulter and was partly supported by an Antibacterial Resistance Leadership Group Early Faculty Seedling Award from the US National Institute of Allergy and Infectious Diseases (UM1AI104681). NF is the President of the non-profit Sustainable Development Response Organization. ES has received funding from a US Centers for Disease Control and Prevention contract (75D30123P18282) and is a member of the Global Health Committee of the Pediatric Infectious Diseases Society and a member of the Advisory Board of the Sudanese American Medical Association. All other authors declare no competing interests. ZOEB used Grammarly and OpenAI's ChatGPT to improve language and readability of this Comment; the authors reviewed and edited the content as needed and take full responsibility for the manuscript's content.
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- 2024
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15. Association between kidney function, frailty and receipt of invasive management after acute coronary syndrome.
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Scott JK, Johnson T, Caskey FJ, Bailey P, Selman LE, Mulla A, Glampson B, Davies J, Papdimitriou D, Woods K, O'Gallagher K, Williams B, Asselbergs FW, Mayer EK, Lee R, Herbert C, Grant SW, Curzen N, Squire I, Kharbanda R, Shah A, Perera D, Patel RS, Channon K, Mayet J, Kaura A, and Ben-Shlomo Y
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- Humans, Male, Female, Retrospective Studies, Aged, Middle Aged, Risk Factors, Coronary Angiography, Aged, 80 and over, Percutaneous Coronary Intervention, Risk Assessment methods, England epidemiology, Myocardial Revascularization methods, Myocardial Revascularization statistics & numerical data, Follow-Up Studies, Acute Coronary Syndrome therapy, Acute Coronary Syndrome physiopathology, Acute Coronary Syndrome mortality, Acute Coronary Syndrome diagnosis, Acute Coronary Syndrome epidemiology, Glomerular Filtration Rate, Frailty diagnosis, Frailty epidemiology, Frailty physiopathology, Frailty complications, Kidney physiopathology
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Background: Reduced estimated glomerular filtration rate (eGFR) is associated with lower use of invasive management and increased mortality after acute coronary syndrome (ACS). The reasons for this are unclear., Methods: A retrospective clinical cohort study was performed using data from the English National Institute for Health Research Health Informatics Collaborative (2010-2017). Multivariable logistic regression was used to investigate whether eGFR<90 mL/min/1.73 m
2 was associated with conservative ACS management and test whether (a) differences in care could be related to frailty and (b) associations between eGFR and mortality could be related to variation in revascularisation rates., Results: Among 10 205 people with ACS, an eGFR of <60 mL/min/1.73m2 was found in 25%. Strong inverse linear associations were found between worsening eGFR category and receipt of invasive management, on a relative and absolute scale. People with an eGFR <30 mL compared with ≥90 mL/min/1.73 m2 were half as likely to receive coronary angiography (OR 0.50, 95% CI 0.40 to 0.64) after non-ST-elevation (NSTE)-ACS and one-third as likely after STEMI (OR 0.30, 95% CI 0.19 to 0.46), resulting in 15 and 17 per 100 fewer procedures, respectively. Following multivariable adjustment, the ORs for receipt of angiography following NSTE-ACS were 1.05 (95% CI 0.88 to 1.27), 0.98 (95% CI 0.77 to 1.26), 0.76 (95% CI 0.57 to 1.01) and 0.58 (95% CI 0.44 to 0.77) in eGFR categories 60-89, 45-59, 30-44 and <30, respectively. After STEMI, the respective ORs were 1.20 (95% CI 0.84 to 1.71), 0.77 (95% CI 0.47 to 1.24), 0.33 (95% CI 0.20 to 0.56) and 0.28 (95% CI 0.16 to 0.48) (p<0.001 for linear trends). ORs were unchanged following adjustment for frailty. A positive association between the worse eGFR category and 30-day mortality was found (test for trend p<0.001), which was unaffected by adjustment for frailty., Conclusions: In people with ACS, lower eGFR was associated with reduced receipt of invasive coronary management and increased mortality. Adjustment for frailty failed to change these observations. Further research is required to explain these disparities and determine whether treatment variation reflects optimal care for people with low eGFR., Trial Registration Number: NCT03507309., Competing Interests: Competing interests: YB-S is partly funded as the Data Science co-lead by the National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West) and University of Bristol. RL reports funding unrelated to this work from the Royal Marsden Cancer charity, Cancer Research UK, Innovate UK (co-funded by Roche), RM Partners Cancer Alliance, the NIHR and NHS England and consulting fees from Royal Marsden Private Care for personal private practice and is NHS England Joint National Clinical Lead for the Targeted Lung Health Check Programme and NIHR Clinical Research Network National Specialty Lead for Screening, Prevention and Early Detection., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)- Published
- 2024
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16. An exploration of the cognitive and affective processes for anaesthetists when performing an emergency front of neck airway.
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Kidd LR, Wegrzynek P, Newell C, and Wainwright E
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Emergency front of neck airway (eFONA) is a potentially lifesaving but very high-stress procedure. We explored the cognitive and affective processes involved via semi-structured interviews with 17 UK anaesthetists who had attempted eFONA within the previous two years. Thematic analyses generated two meta-themes: 'Making the decision is the hardest part; the doing is easier' and 'What helps make the decision?'. We found concerns around scrutiny, lack of a flat hierarchy, unfamiliarity with the situation and the lack of a model for transitioning to eFONA. Culture change, using a shared mental model, priming and emotional disengagement, assisted with eFONA decision-making. Conclusions and implications for practice are presented., (© 2024 Association of Anaesthetists.)
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- 2024
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17. Rare disease genomic testing in the UK and Ireland: promoting timely and equitable access.
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Ellard S, Morgan S, Wynn SL, Walker S, Parrish A, Mein R, Juett A, Ahn JW, Berry I, Cassidy EJ, Durkie M, Fish L, Hall R, Howard E, Rankin J, Wright CF, Deans ZC, Scott RH, Hill SL, Baple EL, and Taylor RW
- Abstract
Purpose and Scope: The aim of this position statement is to provide recommendations regarding the delivery of genomic testing to patients with rare disease in the UK and Ireland. The statement has been developed to facilitate timely and equitable access to genomic testing with reporting of results within commissioned turnaround times., Methods of Statement Development: A 1-day workshop was convened by the UK Association for Clinical Genomic Science and attended by key stakeholders within the NHS Genomic Medicine Service, including clinical scientists, clinical geneticists and patient support group representatives. The aim was to identify best practice and innovations for streamlined, geographically consistent services delivering timely results. Attendees and senior responsible officers for genomic testing services in the UK nations and Ireland were invited to contribute., Results and Conclusions: We identified eight fundamental requirements and describe these together with key enablers in the form of specific recommendations. These relate to laboratory practice (proportionate variant analysis, bioinformatics pipelines, multidisciplinary team working model and test request monitoring), compliance with national guidance (variant classification, incidental findings, reporting and reanalysis), service development and improvement (multimodal testing and innovation through research, informed by patient experience), service demand, capacity management, workforce (recruitment, retention and development), and education and training for service users. This position statement was developed to provide best practice guidance for the specialist genomics workforce within the UK and Ireland but is relevant to any publicly funded healthcare system seeking to deliver timely rare disease genomic testing in the context of high demand and limited resources., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2024
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18. The Effect of Early Beta-Blockade with Esmolol on Therapy Intensity Level in Adults with Severe Traumatic Brain Injury.
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Baumer T, Higginbotham G, Hayes K, and Thomas M
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Following severe traumatic brain injury (TBI), elevated catecholamine levels are associated with worsened secondary brain injury and poorer clinical outcomes. The mechanisms are uncertain but may include cerebral ischemia and blood-brain barrier disruption, with consequent cerebral edema manifesting as intracranial hypertension. Early beta-blockade (EBB) may mitigate these detrimental hyperadrenergic effects. Therapy Intensity Level (TIL) is a validated score that quantifies intracranial pressure (ICP)-lowering interventions, with higher TIL being a surrogate for more severe intracranial hypertension. In this post hoc secondary analysis of a dose-finding study of EBB with esmolol in adults with TBI, we compared summary TIL (TIL24) and domain TIL between patients who received esmolol and those who did not. The primary outcome was TIL24 for each 24-h epoch of the esmolol intervention period of 96 h. Baseline characteristics were comparable in the esmolol (E) and non-esmolol (NE) groups. Mean TIL24 was similar in both groups up to 48 h but then diverged. The mean (standard deviation) TIL24 score between 48 and 72 h was 4.8 (1.5) in group E versus 6.6 (5.4) in group NE and at 72-96 h 4.5 (1.5) in group E versus 7.0 (4.0) in group NE. TIL domain scores were lower in group E for hyperosmolar therapy, targeted temperature management, and surgical management (cerebrospinal fluid drainage, evacuation, or decompressive craniectomy). The association between esmolol use after TBI and the reduction in ICP-directed interventions is consistent with an effect of beta-blockade on reduction of cerebral edema. Further research is necessary to determine causality and mechanism., (© The Author(s) 2024. Published by Mary Ann Liebert, Inc.)
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- 2024
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19. Coronary artery calcification is prevalent in systemic sclerosis and is associated with adverse prognosis.
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Rossdale J, Graby J, Harris M, Jones C, Greenish D, Bartlett J, Gilroy A, Sanghera J, Pauling JD, Skeoch S, Flower V, Mackenzie Ross R, Suntharalingam J, and Rodrigues JC
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Objective: Coronary artery calcification assessed on thoracic computed tomography represents the calcific component of established coronary artery disease, is a biomarker of total atheromatous plaque burden and predicts mortality. Systemic sclerosis is a pro-inflammatory condition, and inflammation is also a driver of coronary artery disease. We assessed coronary artery calcification prevalence, mortality risk and potential clinical impact on primary prevention in a cohort of patients with systemic sclerosis, differentiated by clinical phenotype including the presence of interstitial lung disease and pulmonary arterial hypertension., Methods: Retrospective analysis of 258 computed tomographies in systemic sclerosis patients from three prospectively maintained clinical and research databases at a single tertiary rheumatology/pulmonary hypertension (PH) service between March 2007 and September 2020 (mean age = 65 ± 12, 14% male). Co-morbidities, statin prescription and all-cause mortality were recorded. Patients were subtyped according to underlying systemic sclerosis complications. Computed tomographies were re-reviewed for coronary artery calcification; severity was graded using a 4-point scale per vessel and summed for total coronary artery calcification score. The impact of reporting coronary artery calcification was assessed against pre-existing statin prescriptions., Results: Coronary artery calcification was present in 58% (149/258). Coronary artery calcification was more prevalent in systemic sclerosis-pulmonary arterial hypertension than in systemic sclerosis subgroups with interstitial lung disease or without pulmonary arterial hypertension, controlling for age, sex, co-morbidities and smoking status (71%; χ
2 (13) = 81.4; p < 0.001). The presence and severity of coronary artery calcification were associated with increased risk of mortality independently of age and co-morbidities (hazard ratio = 2.8; 95% confidence interval = 1.2-6.6; p = 0.018). The 'number needed to report' coronary artery calcification presence to potentially impact management was 3., Conclusions: Coronary artery calcification is common in systemic sclerosis. Coronary artery calcification predicts mortality independently of age and confounding co-morbidities which suggests this finding has clinical relevance and is a potential target for screening and therapeutic intervention., Competing Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship and/or publication of this article: Dr J.C.L.R. discloses: Co-founder, Chief Medical Officer and share holder, Heart & Lung Imaging Ltd.; Stock options, Radnet, Inc.; Speakers fees, Sanofi; Speakers fees, Aidence; Consultation fees, NHSX; Physician services, HeartFlow and Professor J.S. discloses: Stock options, Ingenium; Speaker fees, Janssen Pharmaceuticals, Chiesi and AstraZaneca; Consultancy fees, MSD, Apollo therapeutics and Janssen Pharmaceuticals. All other authors have declared no conflicts of interest., (© The Author(s) 2024.)- Published
- 2024
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20. The association of outdoor temperature and self-reported Raynaud's phenomenon severity among people with systemic sclerosis: a Scleroderma Patient-centered Intervention Network Cohort study.
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Virgili-Gervais G, Matthews B, Nassar EL, Carrier ME, Kwakkenbos L, Pauling JD, Bartlett SJ, Gietzen A, Gottesman K, Guillot G, Hudson M, Hummers LK, Lawrie-Jones A, Malcarne VL, Mayes MD, Richard M, Sauvé M, Wojeck RK, Mouthon L, Benedetti A, and Thombs BD
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- Humans, Female, Male, Middle Aged, Adult, Temperature, Aged, Cohort Studies, Seasons, Raynaud Disease epidemiology, Raynaud Disease etiology, Scleroderma, Systemic complications, Severity of Illness Index, Self Report
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Background: Raynaud's phenomenon is the earliest and most common systemic sclerosis manifestation. Episodes can be triggered by cold exposure and ambient temperature changes. Small studies have found that Raynaud's phenomenon outcomes were associated with season. We aimed to map the degree that differences in ambient temperature are associated with Raynaud's phenomenon outcomes across the temperature spectrum., Methods: People with Raynaud's phenomenon secondary to systemic sclerosis in the Scleroderma Patient-centered Intervention Network Cohort completed past-week Raynaud's phenomenon severity assessments (0-10 numerical rating scale) at enrolment and longitudinally at 3-month intervals. Mean daily temperature and feels like temperature, which incorporates wind chill and humidity, for the week before each assessment were extracted for each participant from a weather site close to the participant's recruiting centre via the Iowa Environmental Mesonet. We used linear mixed models with basis splines to flexibly model non-linear changes in Raynaud's phenomenon severity across the temperature spectrum. People with lived experience of systemic sclerosis contributed to the study design and interpretation., Findings: Between April 15, 2014 and Aug 1, 2023, we included data on 20 233 Raynaud's phenomenon severity assessments from 2243 participants. 1964 (88%) of 2243 participants were women, 279 (12%) were men, and 1813 (82%) were White. Mean age was 54·8 (SD 12·7) years. The maximum predicted Raynaud's phenomenon severity score was 6·8 points (95% CI 5·6-8·1), which occurred at -25°C. Severity scores decreased minimally from -15°C to 5°C (0·05-0·21 points per 5°C difference), then decreased in larger steps between 5°C and 25°C (0·37-0·54 points per 5°C difference). The minimum predicted score was at 25°C (2·6 points [95% CI 2·5-2·7]). Scores increased at temperatures above 25°C to 3·5 points (3·0-4·1) at 35°C and 5·6 points (4·5-6·8) at 40°C. Results were similar for feels like temperature., Interpretation: Raynaud's phenomenon severity is worst at very cold temperatures but also increases with very warm temperatures, presumably due to air conditioning. Clinical management and Raynaud's phenomenon intervention trial designs should consider temperature patterns., Funding: Scleroderma Society of Ontario, Scleroderma Canada, Sclérodermie Québec, Scleroderma Manitoba, Scleroderma Atlantic, Scleroderma Association of BC, Scleroderma SASK, Scleroderma Australia, Scleroderma New South Wales, Scleroderma Victoria, the Canadian Institutes of Health Research, the Arthritis Society, the Lady Davis Institute for Medical Research of the Jewish General Hospital, the Jewish General Hospital Foundation, and McGill University., Competing Interests: Declaration of interests JDP has received speaker honoraria or consultancy fees from Astra Zeneca, Boehringer Ingelheim, IsoMab, Janssen, Permeatus, and Sojournix Pharma. MDM has received research grants or contracts from Prometheus Biosciences, Mitsubishi Tanabe, Boehringer Ingelheim, EICOS, Corbus, and Horizon Pharma; consulting fees from Cabaletta Pharma; an honorarium from GSK Pharma; and was a member of a data safety monitoring board or advisory board with Mitsubishi Tanabe, Boehringer Ingelheim, and EICOS. All other authors declare no competing interests., (Copyright © 2024 Elsevier Ltd. All rights reserved, including those for text and data mining, AI training, and similar technologies.)
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- 2024
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21. Dermoscopy of periungual Bowen's disease: a retrospective case series.
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Xie F, Nightingale K, and de Berker DA
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- 2024
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22. Peri-operative Replacement of Exogenous Steroids (PREdS): a national audit of current peri-operative prescribing for patients taking therapeutic steroids.
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Barker OJH, Ramesh AV, Kangesan I, Barnes J, Harrogate S, Gupta S, Reeves BC, and Gibbison B
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- Humans, Female, Male, Middle Aged, Aged, United Kingdom, Adult, Glucocorticoids therapeutic use, Glucocorticoids administration & dosage, Medical Audit methods, Prednisolone therapeutic use, Guideline Adherence statistics & numerical data, Adrenal Insufficiency drug therapy, Adrenal Cortex Hormones therapeutic use, Young Adult, Hormone Replacement Therapy methods, Aged, 80 and over, Perioperative Care methods
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Introduction: Approximately 1% of the UK population take oral corticosteroids for ≥ 28 days each year, for broadly two reasons: deficiency in corticosteroid requiring replacement; or therapeutic corticosteroid for inflammatory conditions. Acute deficiency can occur at times of physiological stress (e.g. surgery), potentially leading to major complications. The Association of Anaesthetists' 2020 consensus guideline provides detailed advice for the management of glucocorticoids during the peri-operative period for patients with adrenal insufficiency. This national audit aimed to assess compliance with this guideline., Methods: Data were collected from 59 Trusts over 14 consecutive days for all eligible patients undergoing procedures under the care of an anaesthetist. Patients who were prescribed ≥ 5 mg oral prednisolone equivalents pre-operatively, in whom supplementary corticosteroid would be indicated, were compared with those prescribed < 5 mg oral prednisolone equivalents., Results: Operations for 21,731 patients were audited: 277 (1.3%) patients were taking therapeutic corticosteroids. Detailed peri-operative data were collected for all patients receiving therapeutic corticosteroids: 201/277 (73%) were ASA physical status ≥ 3; 184/277 (66%) underwent elective procedures; and 252/277 (91%) were prescribed prednisolone pre-operatively, of whom 219/277 (79%) were prescribed ≥ 5 mg oral prednisolone equivalents. In the patients who were prescribed ≥ 5 mg oral prednisolone equivalents, 186/219 (85%) received pre-operative glucocorticoid supplementation and 97/219 (42%) received it postoperatively; however, only 67/219 (31%) and 43/219 (20%) respectively received glucocorticoid supplementation according to the guidelines. Overall, peri-operative prescribing was compliant in 19/219 (9%) patients. A similar proportion, 30/219 (14%), received no supplementation. In the patients taking < 5 mg oral prednisolone equivalents pre-operatively, 28/58 (48%) received inappropriate supplementation., Conclusions: Despite 125/277 (45%) of anaesthetists reporting Association of Anaesthetists' guidelines use, compliance remained low, with adherence in only 27/125 (22%) patients. Further research is required to identify the correct peri-operative strategy for patients taking therapeutic corticosteroids., (© 2024 Association of Anaesthetists.)
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- 2024
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23. Breakthrough SARS-CoV-2 infection in fully vaccinated patients with systemic lupus erythematosus: results from the COVID-19 Vaccination in Autoimmune Disease (COVAD) study.
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Palazzo L, Lindblom J, Kihlgren Olsson E, Nikiphorou E, Wincup C, Saha S, Shaharir SS, Katchamart W, Akarawatcharangura Goo P, Traboco L, Chen YM, Lilleker JB, Nune A, Pauling JD, Agarwal V, Dzifa D, Toro Gutiérrez CE, Caballero-Uribe CV, Chinoy H, Agarwal V, Gupta L, and Parodis I
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- Humans, Female, Male, Middle Aged, Adult, SARS-CoV-2 immunology, Vaccination, Case-Control Studies, Aged, Autoimmune Diseases epidemiology, Rheumatic Diseases drug therapy, Breakthrough Infections, Lupus Erythematosus, Systemic complications, Lupus Erythematosus, Systemic immunology, Lupus Erythematosus, Systemic epidemiology, COVID-19 prevention & control, COVID-19 epidemiology, COVID-19 Vaccines administration & dosage
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Objective: To determine the occurrence of breakthrough COVID-19 infections (BIs) in patients with systemic lupus erythematosus (SLE) compared with patients with other rheumatic autoimmune diseases (rAIDs), patients with non-rheumatic autoimmune diseases (nrAIDs), and healthy controls (HCs)., Methods: The study was based on data from 7035 fully vaccinated respondents to the online COVAD questionnaire with SLE (N = 852), rAIDs (N = 3098), or nrAIDs (N = 414), and HCs (N = 2671). BI was defined as COVID-19 infection occurring in individuals vaccinated with ≥ 2 doses (or 1 dose of J&J) ≥ 14 days after vaccination and not after 6 months since the last vaccine dose. Data were analysed using linear and logistic regression models., Results: A total of 91/852 (10.7%) SLE patients reported at least one BI. The frequency of BIs in SLE patients was comparable to that among HCs (277/2671; p = 0.847) and patients with nrAID (39/414; p = 0.552) but higher than that among patients with other rAIDs (235/3098; p = 0.005). No demographic factors or treatments were associated with BIs in SLE patients (p ≥ 0.05 for all). Joint pain was more frequent in SLE patients than in HCs (odds ratio [OR]: 3.38; 95% confidence interval [CI]: 1.89-6.04; p < 0.001) or nrAID patients (OR: 2.44; 95% CI: 1.04-5.75; p = 0.041). Patient with SLE did not report a higher frequency of hospitalisation or need for advanced treatment for COVID-19 infection compared with disease controls and HCs, respectively., Conclusion: COVID-19 vaccination conferred similar protection against COVID-19 infection in terms of frequency and severity in patients with SLE to that reported by healthy individuals., (© 2024. The Author(s).)
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- 2024
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24. Usability of mixed reality in awake craniotomy planning.
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Moon RDC and Barua NU
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- Humans, Brain Neoplasms surgery, Brain Neoplasms diagnostic imaging, Magnetic Resonance Imaging, Male, Augmented Reality, Female, Adult, Virtual Reality, Surgery, Computer-Assisted methods, User-Computer Interface, Diffusion Tensor Imaging, Craniotomy methods, Wakefulness
- Abstract
Purpose: This study aimed to describe our institutional use of a commercially available mixed reality viewer within a multi-disciplinary planning workflow for awake craniotomy surgery and to report an assessment of its usability., Materials and Methods: Three Tesla MRI scans, including 32-direction diffusion tensor sequences, were reconstructed with BrainLab Elements auto-segmentation software. Magic Leap mixed reality viewer headsets were registered to a shared virtual viewing space to display image reconstructions. System Usability Scale was used to assess the usability of the mixed reality system., Results: The awake craniotomy planning workflow utilises the mixed reality viewer to facilitate a stepwise discussion through four progressive anatomical layers; the skin, cerebral cortex, subcortical white matter tracts and tumour with surrounding vasculature. At each stage relevant members of the multi-disciplinary team review key operative considerations, including patient positioning, cortical and subcortical speech mapping protocols and surgical approaches to the tumour.The mixed reality system was used for multi-disciplinary awake craniotomy planning in 10 consecutive procedures over a 5-month period. Ten participants (2 Anaesthetists, 5 Neurosurgical trainees, 2 Speech therapists, 1 Neuropsychologist) completed System Usability Scale assessments, reporting a mean score of 71.5. Feedback highlighted the benefit of being able to rehearse important steps in the procedure, including patient positioning and anaesthetic access and visualising the testing protocol for cortical and subcortical speech mapping., Conclusions: This study supports the use of mixed reality for multidisciplinary planning for awake craniotomy surgery, with an acceptable degree of usability of the interface. We highlight the need to consider the requirements of non-technical, non-neurosurgical team members when involving mixed reality activities.
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- 2024
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25. Information Provision to Facilitate Vascular Surgery Shared Decision Making in the Face of Uncertainty.
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Gwilym BL, Twine CP, and Bosanquet DC
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- Humans, Uncertainty, Patient Participation, Patient Education as Topic, Vascular Surgical Procedures, Decision Making, Shared
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- 2024
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26. Exploring locoregional treatment reporting in neoadjuvant systemic breast cancer treatment studies: A systematic review.
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Jiang M, Avery K, Ahmed R, de Boniface J, Chatterjee S, Dodwell D, Dubsky P, Finestone S, Iwata H, Lee HB, MacKenzie M, Meyn A, Poulakaki F, Richardson AL, Sepulveda K, Spillane A, Thompson AM, Werutsky G, Wright JL, Zdenkowski N, Cowan K, McIntosh SA, and Potter S
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- Humans, Female, Breast Neoplasms therapy, Breast Neoplasms pathology, Neoadjuvant Therapy
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Accurate information about locoregional treatments in breast cancer neoadjuvant systemic therapy (NST) trials is vital to support surgical decision-making and allow meaningful interpretation of long-term oncological outcomes. This systematic review (PROSPERO registration CRD42023470891) aimed to describe the current practice of outcome reporting in NST studies. A systematic search identified primary research studies published 01/01/2018-08/09/2023 reporting outcomes in patients receiving NST for breast cancer followed by locoregional treatment. Included were randomised controlled trials (RCTs) and non-randomised studies (NRS) with >250 participants reporting at least one locoregional treatment outcome. Outcomes were extracted verbatim and categorised using content analysis. Descriptive statistics were used to summarise results. Of the 3111 abstracts screened, 137 studies (22 RCTs and 115 NRS) reporting at least one locoregional outcome in 575,531 patients were included. The 137 studies reported a total of 510 surgical outcomes with a median of 3 (range 1-12) per study. No single outcome was reported in all studies. Type of breast (n = 129, 94.2 %) and axillary (n = 86, 62.8 %) surgery were reported most frequently. Only 34 % (n = 47) studies reported how treatment response was assessed and if/how this informed surgical decision-making. Only a fifth (n = 28) reported outcomes relating to surgical de-escalation. Only 72 studies (52.6 %) reported any radiation therapy (RT)-related outcome, most frequently whether RT had been received (n = 63/72, 87.5 %). Current reporting of locoregional treatment outcomes in NST studies is poor, inconsistent and urgently needs to be improved. A core outcome set and reporting guidelines may improve the quality and value of future research., Competing Interests: Declaration of competing interest SMcI reports speaker honoraria from MSD, Roche, BD and Astra Zeneca; advisory boards for Lilly, Novartis, MSD, Roche and Astra Zeneca; conference travel and support from Roche, Lilly and MSD, and institutional research funding from Novartis. HI reports consulting fees from Daiichi Sankyo, Chugai, Astra Zeneca, Lilly, MSD, Pfizer and Gilead; honoraria from Daiichi Sankyo, Chugai, Astra Zeneca, Lilly, MSD, Pfizer, Taiho and Kyowa Kirin, and institutional research funding from Chugai, Daiichi Sankyo and Astra Zeneca. H-BL reports being a co-founder and member of the DCGen Co., Ltd board of directors; research funding from Devicor Medical Product, Inc.; consulting fees and honoraria from Alvogen, Boryung, Hologic, Lilly, Need, Novartis, Roche, Takeda, Celltrion, and Shin Poong. PD reports institutional research funding from Cepheid and Roche; consulting fees from Roche, and honoraria from Astra Zeneca and Oncoviews, and conference and travel support from Roche. NZ reports consulting fees from Lilly, Eisai, Astra Zeneca, MSD, Novartis and Gilead; honorarium from Roche, Pfizer, Eisai, Gilead, Novartis, Lilly and Astra Zeneca; and conference travel support from Novartis, Roche, Pfizer and Lilly. The remaining authors have no conflicts or competing of interest to declare., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)
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- 2024
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27. Measuring and improving the cradle-to-grave environmental performance of urological procedures.
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John JB, Gray WK, Briggs TWR, and McGrath JS
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An urgent need for societal transformation exists to reduce the environmental impact of humanity, because environmental health affects human health. Health care causes ~5% of global greenhouse gas emissions and other substantial and ongoing environmental harms. Thus, health-care professionals and managers must lead ongoing efforts to improve the environmental performance of health systems. Life-cycle assessment (LCA) is a methodology that enables estimation of environmental impacts of products and processes. It models environmental effects from 'cradle' (raw material extraction) to 'grave' (end of useful life) and conventionally reports a range of different impact categories. LCA is a valuable tool when used appropriately. Maximizing its utility requires rational assumptions alongside careful consideration of system boundaries and data sources. Well-executed LCAs are detailed and transparently reported, enabling findings to be adapted or generalized to different settings. Attention should be given to modelling mitigation solutions in LCAs. This important step can guide health-care systems towards new and innovative solutions that embed progress towards international climate agreements. Many urological conditions are common, recurrent or chronic, requiring resource-intensive management with large associated environmental impacts. LCAs in urology have predominantly focussed on greenhouse gas emissions and have enabled identification of modifiable 'hotspots' including electricity use, travel, single-use items, irrigation, reprocessing and waste incineration. However, the methodological and reporting quality of published urology LCAs generally requires improvement and standardization. Health-care evaluation and commissioning frameworks that value LCA findings alongside clinical outcomes and cost could accelerate sustainable innovations. Rapid implementation strategies for known environmentally sustainable solutions are also needed., (© 2024. Springer Nature Limited.)
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- 2024
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28. New compact micro-hole zone catheter enables women to achieve effective bladder emptying without flow-stops.
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Thiruchelvam N, Hashim H, Forman CR, Jacobsen L, Sperup T, and Andersen K
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- Humans, Female, Middle Aged, Urinary Catheterization instrumentation, Urinary Catheterization methods, Self Care instrumentation, Aged, Equipment Design, Adult, Urinary Catheters, Intermittent Urethral Catheterization instrumentation, Urinary Retention therapy, Cross-Over Studies
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Background: Clean intermittent self-catheterisation (CISC) with conventional eyelet catheters (CECs) is associated with urine flow-stops, which require the catheter to be repositioned so flow can resume. Flow-stops often occur because bladder mucosa is sucked into the eyelets., Aims: This investigation aimed to compare the bladder-emptying performance of the micro-hole zone catheter (MHZC) with the CEC., Methods: This was a multi-centre, randomised, open-label, controlled cross-over study with 82 women comparing the MHZC to the CEC. The endpoints relating to bladder-emptying performance included the residual volume at first flow-stop, the number of flow-stops and the proportion of successful treatment responses. The women's perception of the catheters was assessed as well as device discomfort., Findings: Catheterisations with MHZC significantly reduced the risk of flow-stops, with relative risk results showing a 2.74 times lower risk of flow-stops with a health professional-led catheterisation and a 2.52 times lower risk during self-catheterisation. There was no statistical difference in residual urine volume at first flow-stop between the two catheters. Catheterisations with the MHZC were significantly more likely to achieve zero flow-stops and a residual urine volume of <10 ml at first flow-stop. The women had a significantly more positive perception of the MHZC than the CEC in areas including handling, confidence, sensation and satisfaction., Conclusion: The MHZC enabled effective bladder emptying without catheters needing to be repositioned, supporting the women by simplifying the procedure and making them feel confident that their bladders were empty.
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- 2024
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29. Treatment of mosaic ALPK1 driven Blaschkoid cylindroma with Mohs micrographic surgery.
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Carson L, Roberts C, Carson N, Bray A, Adams DJ, and Rajan N
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- 2024
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30. Evaluating the effectiveness of simvastatin in slowing the progression of disability in secondary progressive multiple sclerosis (MS-STAT2): protocol for a multicentre, randomised controlled, double-blind, phase 3 clinical trial in the UK.
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Blackstone J, Williams T, Nicholas JM, Bordea E, De Angelis F, Bianchi A, Calvi A, Doshi A, John N, Apap Mangion S, Wade C, Merry R, Barton G, Lyle D, Jarman E, Mahad D, Shehu A, Arun T, McDonnell G, Geraldes R, Craner M, Hillier C, Ganesalingam J, Fisniku L, Hobart J, Spilker C, Robertson N, Kalra S, Pluchino S, Harikrishnan S, Mattoscio M, Harrower T, Young C, Lee M, Chhetri S, Ahmed F, Rog D, Silber E, Gallagher P, Duddy M, Straukiene A, Nicholas R, Rice C, Nixon SJ, Beveridge J, Hawton A, Tebbs S, Braisher M, Giovannoni G, Ciccarelli O, Greenwood J, Thompson AJ, Hunter R, Pavitt S, Pearson O, Evangelou N, Sharrack B, Galea I, Chandran S, Ford HL, Frost C, and Chataway J
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- Humans, Double-Blind Method, United Kingdom, Middle Aged, Adult, Multicenter Studies as Topic, Clinical Trials, Phase III as Topic, Cost-Benefit Analysis, Male, Female, Hydroxymethylglutaryl-CoA Reductase Inhibitors therapeutic use, Randomized Controlled Trials as Topic, Disability Evaluation, Aged, Treatment Outcome, Simvastatin therapeutic use, Multiple Sclerosis, Chronic Progressive drug therapy, Multiple Sclerosis, Chronic Progressive physiopathology, Disease Progression
- Abstract
Introduction: There remains a high unmet need for disease-modifying therapies that can impact disability progression in secondary progressive multiple sclerosis (SPMS). Following positive results of the phase 2 MS-STAT study, the MS-STAT2 phase 3 trial will evaluate the efficacy and cost-effectiveness of repurposed high-dose simvastatin in slowing the progression of disability in SPMS., Methods and Analysis: MS-STAT2 will be a multicentre, randomised, placebo-controlled, double-blind trial of participants aged between 25 and 65 (inclusive) who have SPMS with an Expanded Disability Status Scale (EDSS) score of 4.0-6.5 (inclusive). Steady progression rather than relapse must be the major cause of increasing disability in the preceding 2 years.Participants will be allocated to simvastatin or placebo in a 1:1 ratio. The active treatment will be 80 mg daily, after 1 month at 40 mg daily. 31 hospitals across the UK will participate.The primary outcome is (confirmed) disability progression at 6 monthly intervals, measured as change from EDSS baseline score. Recruitment of 1050 participants will be required to achieve a total of 330 progression events, giving 90% power to demonstrate a 30% relative reduction in disability progression versus placebo. The follow-up period is 36 months, extendable by up to 18 months for patients without confirmed progression.Clinician-reported measures include Timed 25 Foot Walk; 9 Hole Peg Test; Single Digit Modalities Test; Sloan Low Contrast Visual Acuity; Relapse assessment; modified Rankin Scale and Brief International Cognitive Assessment For Multiple Sclerosis. Patient-reported outcomes include MS-specific walking, fatigue and impact scales. A health economic analysis will occur., Ethics and Dissemination: The protocol was approved by the London-Westminster REC (17/LO/1509). This manuscript is based on protocol version 8.0, 26 February 2024. Trial findings will be disseminated through peer-reviewed publications and conference presentations., Trial Registration Numbers: NCT03387670; ISRCTN82598726., Competing Interests: Competing interests: JC has received support in the last 3 years from the Health Technology Assessment (HTA) Programme (National Institute for Health Research, NIHR), the UK MS Society, the US National MS Society and the Rosetrees Trust. He is supported in part by the NIHR University College London Hospitals (UCLH) Biomedical Research Centre, London, UK. He has been a local principal investigator for a trial in MS funded by MS Canada. A local principal investigator for commercial trials funded by Ionis and Roche; and has taken part in advisory boards/consultancy for Biogen, Janssen, Lucid, Merck, NervGen, Novartis and Roche. OC declares being NIHR Research Professor (RP-2017-08-ST2-004); over the last 2 years, member of independent DSMB for Novartis; she gave a teaching talk in a Merck local symposium and contributed to an Advisory Board for Biogen; she is Deputy Editor of Neurology, for which she receives an honorarium; has received research grant support from the UK MS Society, the NIHR UCLH Biomedical Research Centre, the Rosetree Trust, the US National MS Society and the NIHR-HTA. HLF has received honoraria for advisory boards and/or educational activities from Biogen, Merck, Novartis and Roche. HLF has research grant support from the NIHR Health Technology Assessment Programme and EME, UK MS Society and the Horne Family Charitable Trust. LF has received honoraria for speaking or as an advisory board member from Biogen, Novartis, Merck, Sanofi Genzyme and Roche, and received support for attending educational meetings from Biogen, Novartis, Merck, Sanofi Genzyme and Teva. GG declares that in the last 2 years he has received compensation for serving as a consultant or speaker or research support from Astoria Biologica, Aurinia Pharmaceuticals, Biogen, BMS-Celgene, GlaxoSmithKline, Janssens/J&J, Japanese Tobacco, Merck KGaA/EMD Serono, Moderna, Novartis, Sandoz, Sanofi, Roche/Genentech, Vir Biotechnology and Viracta. NJ is a principal investigator on commercial MS trials sponsored by Roche, Novartis and Biogen. He has received speakers honoraria from Merck and travel congress sponsorship from Novartis. MM has received travel support, speaker honoraria and consultation fees from Genzyme, Merck-Sereno, Novartis, Roche, the MS Academy and the Italian Multiple Sclerosis Foundation (FISM). RN attended paid advisory board for Novartis and Roche. SPavitt was MRC/National Institute for Health Research (NIHR)—Efficacy & Mechanism Evaluation Board Member from 2012–2018. SPluchino is founder, CSO and shareholder (>5%) of CITC and Chair of the Scientific Advisory Board at ReNeuron plc. CR declares research funding from Sanofi. DR declares consulting and/or speaker fees received from Biogen, Celgene, Janssen, MedDay, Merck, Novartis, Roche, Sanofi Genzyme and Teva. Additionally, research support paid to an institutional fund from Actelion, Biogen, GW Pharmaceuticals, Merck Serono, Mitsubishi, Novartis, Sanofi Genzyme, Teva and TG Therapeutics. AJT receives a fee from being Co-Chair, UCL-Eisai Steering Committee drug discovery collaboration; Member, National MS Society (USA) Research Programs Advisory Committee; Clinical Trials Committee, Progressive MS Alliance; Board member, European Charcot Foundation; Editor in Chief, Multiple Sclerosis Journal; Editorial Board Member, The Lancet Neurology. He receives no fee from being: Chair (Scientific Ambassadors), ‘Stop MS’ Appeal Board, UK MS Society; Research & academic counsellor, Fundació Privada Cemcat; Ambassador, European Brain Council. AJT additionally holds a patent for the MSIS-29 Impact Scale., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)
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31. Supplemental Iron and Recombinant Erythropoietin for Anemia in Infants Born Very Preterm: A Survey of Clinical Practice in Europe.
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Reibel-Georgi NJ, Scrivens A, Heeger LE, Lopriore E, New HV, Deschmann E, Stanworth SJ, Carrascosa MA, Brække K, Cardona F, Cools F, Farrugia R, Ghirardello S, Krivec JL, Matasova K, Muehlbacher T, Sankilampi U, Soares H, Szabó M, Szczapa T, Zaharie G, Roehr CC, Fustolo-Gunnink S, and Dame C
- Abstract
Objectives: To survey practices of iron and recombinant human erythropoietin (rhEpo) administration to infants born preterm across Europe., Study Design: Over a 3-month period, we conducted an online survey in 597 neonatal intensive care units (NICUs) of 18 European countries treating infants born with a gestational age of <32 weeks., Results: We included 343 NICUs (response rate 56.3%) in the survey. Almost all NICUs (97.7%) routinely supplement enteral iron, and 74.3% of respondents to all infants born <32 weeks of gestation. We found that 65.3% of NICUs routinely evaluate erythropoiesis and iron parameters beyond day 28 after birth. Most NICUs initiate iron supplementation at postnatal age of 2 weeks and stop after 6 months (34.3%) or 12 months (34.3%). Routine use of rhEpo was reported in 22.2% of NICUs, and in individual cases in 6.9%. RhEpo was mostly administered subcutaneously (70.1%) and most frequently at a dose of 250 U/kg 3 times a week (44.3%), but the dose varied greatly between centers., Conclusions: This survey highlights wide heterogeneity in evaluating erythropoietic activity and iron deficiency in infants born preterm. Variation in iron supplementation during infancy likely reflects an inadequate evidence base. Current evidence on the efficacy and safety profile of rhEpo is only poorly translated into clinical practice. This survey demonstrates a need for standards to optimize patient blood management in anemia of prematurity., Competing Interests: Declaration of Competing Interest The authors declare no conflicts of interest., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)
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32. Correction: Complex organisational factors influence multidisciplinary care for patients with hip fractures: a qualitative study of barriers and facilitators to service delivery.
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Fox F, Drew S, Gregson CL, Patel R, Chesser T, Johansen A, Javaid MK, Griffin XL, and Gooberman-Hill R
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33. IgG4-related disease in the nervous system.
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Yang L, Smith RJP, Scolding NJ, and Rice CM
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IgG4-related disease (IgG4-RD) is a recently described multisystemic disorder with a spectrum of manifestations that continue to be described. Nonetheless, there are recognised distinct patterns of disease. Neurological involvement is rare, particularly in isolation, but IgG4-RD may present with orbital disease, hypophysitis or pachymeningitis. Typically, it is highly responsive to treatment. This review highlights neurological manifestations of IgG4-RD and emphasises the importance of a high index of clinical suspicion to facilitate investigation and appropriate management, avoiding irreversible tissue damage and neurological dysfunction. We present a treatment algorithm for suggested management of IgG4-RD affecting the nervous system., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)
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34. Holistic modelling as a catalyst for effective obesity policy.
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McLaughlin J, Rejon CS, Bell M, Schwander B, Coulman K, and McLeod H
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- Humans, Holistic Health, Obesity prevention & control, Health Policy
- Abstract
Competing Interests: Competing interests: We have read and understood the BMJ policy on declaration of interests and have the following interests to declare: BS is general manager of the Agency for Health Economic Assessment and Dissemination (AHEAD), which supports the planning, evaluation and implementation of market access and reimbursement strategies for digital health applications, medical devices, and pharmaceuticals in Germany. Provenance and peer review: Not commissioned; externally peer reviewed.
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35. A retrospective propensity-score-matched cohort study of the impact of procalcitonin testing on antibiotic use in hospitalized patients during the first wave of COVID-19.
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Sandoe JAT, Grozeva D, Albur M, Bond SE, Brookes-Howell L, Dark P, Euden J, Hamilton R, Hellyer TP, Henley J, Hopkins S, Howard P, Howdon D, Knox-Macaulay C, Llewelyn MJ, Maboshe W, McCullagh IJ, Ogden M, Parsons HK, Partridge DG, Powell N, Prestwich G, Shaw D, Shinkins B, Szakmany T, Thomas-Jones E, Todd S, West RM, Carrol ED, and Pallmann P
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Background: Procalcitonin (PCT) is a blood marker used to help diagnose bacterial infections and guide antibiotic treatment. PCT testing was widely used/adopted during the COVID-19 pandemic in the UK., Objectives: Primary: to measure the difference in length of early (during first 7 days) antibiotic prescribing between patients with COVID-19 who did/did not have baseline PCT testing during the first wave of the pandemic. Secondary: to measure differences in length of hospital/ICU stay, mortality, total days of antibiotic prescribing and resistant bacterial infections between these groups., Methods: Multi-centre, retrospective, observational, cohort study using patient-level clinical data from acute hospital Trusts/Health Boards in England/Wales. Inclusion: patients ≥16 years, admitted to participating Trusts/Health Boards and with a confirmed positive COVID-19 test between 1 February 2020 and 30 June 2020., Results: Data from 5960 patients were analysed: 1548 (26.0%) had a baseline PCT test and 4412 (74.0%) did not. Using propensity-score matching, baseline PCT testing was associated with an average reduction in early antibiotic prescribing of 0.43 days [95% confidence interval (CI): 0.22-0.64 days, P < 0.001) and of 0.72 days (95% CI: 0.06-1.38 days, P = 0.03] in total antibiotic prescribing. Baseline PCT testing was not associated with increased mortality or hospital/ICU length of stay or with the rate of antimicrobial-resistant secondary bacterial infections., Conclusions: Baseline PCT testing appears to have been an effective antimicrobial stewardship tool early in the pandemic: it reduced antibiotic prescribing without evidence of harm. Our study highlights the need for embedded, rapid evaluations of infection diagnostics in the National Health Service so that even in challenging circumstances, introduction into clinical practice is supported by evidence for clinical utility., Study Registration Number: ISRCTN66682918., (© The Author(s) 2024. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy.)
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36. Cross Sectional Survey of Antenatal Educators' Views About Current Antenatal Education Provision.
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Russell-Webster T, Davies A, Toolan M, Lynch M, Plachcinski R, Larkin M, Fraser A, Barnfield S, Smith M, Burden C, and Merriel A
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- Humans, Cross-Sectional Studies, Female, Adult, United Kingdom, Pregnancy, Surveys and Questionnaires, Prenatal Care methods, Pregnant Women psychology, State Medicine, Middle Aged, Prenatal Education methods
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Objectives: Antenatal education (ANE) is part of National Health Service (NHS) care and is recommended by The National Institute for Health and Care Excellence (NICE) to increase birth preparedness and help pregnant women/birthing people develop coping strategies for labour and birth. We aimed to understand antenatal educator views about how current ANE supports preparedness for childbirth, including coping strategy development with the aim of identifying targets for improvement., Methods: A United Kingdom wide, cross-sectional online survey was conducted between October 2019 and May 2020. Antenatal educators including NHS midwives and private providers were purposively sampled. Counts and percentages were calculated for closed responses and thematic analysis used for open text responses., Results: Ninety-nine participants responded, 62% of these did not believe that ANE prepared women for labour and birth. They identified practical barriers to accessing ANE, particularly for marginalised groups, including financial and language barriers. Educators believe class content is medically focused, and teaching is of variable quality with some midwives being ill-prepared to deliver antenatal education. 55% of antenatal educators believe the opportunity to develop coping strategies varies between location and educators and only those women who can pay for non-NHS classes are able to access all the coping strategies that can support them with labour and birth., Conclusions for Practice: Antenatal educators believe current NHS ANE does not adequately prepare women for labour and birth, leading to disparities in birth preparedness for those who cannot access non-NHS classes. To reduce this healthcare inequality, NHS classes need to be standardised, with training for midwives in delivering ANE enhanced., (© 2024. The Author(s).)
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37. Integration of genetics and MRD to define low risk patients with B-cell precursor acute lymphoblastic leukaemia with intermediate MRD levels at the end of induction.
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Moorman AV, Enshaei A, Murdy D, Joy M, Boer JM, den Boer ML, Pieters R, de Haas V, Horstmann MA, Escherich G, Johansson B, Marquart HV, Schmiegelow K, Hancock J, Moppett J, and Heyman M
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- Humans, Male, Prognosis, Female, Adolescent, Child, Induction Chemotherapy, Adult, Precursor B-Cell Lymphoblastic Leukemia-Lymphoma genetics, Precursor B-Cell Lymphoblastic Leukemia-Lymphoma pathology, Neoplasm, Residual genetics, Neoplasm, Residual pathology
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- 2024
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38. The effectiveness of evidence-based healthcare educational interventions on healthcare professionals' knowledge, skills, attitudes, professional practice and healthcare outcomes: Systematic review and meta-analysis.
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Hill J, Gratton N, Kulkarni A, Hamer O, Harrison J, Harris C, Chesters J, Duddy E, Collins L, and Clegg A
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- Humans, Attitude of Health Personnel, Randomized Controlled Trials as Topic, Health Personnel education, Health Knowledge, Attitudes, Practice, Clinical Competence, Evidence-Based Practice
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Objective: The primary aim of this systematic review is to assess the effectiveness of evidence-based healthcare (EBHC) educational interventions on healthcare professionals' knowledge, skills, attitudes, behaviour of EBHC, clinical process and care outcomes. A secondary aim of the review is to assess the effects of important pedagogical moderating factors for EBHC educational interventions., Method: This systematic review used a forward and backward citation search strategy on the Web of Science platform (date of inception to 28 April 2023). Only randomised controlled trials (RCTs) and cluster RCTs which compared EBHC educational interventions for healthcare professionals were included. A random effects meta-analysis was undertaken for EBHC compared with an active and nonactive control for all outcomes., Results: Sixty-one RCTs were identified which included a total of 5208 healthcare professionals. There was a large effect for EBHC educational interventions compared with waiting list/no treatment/sham control on knowledge (SMD, 2.69; 95% CI, 1.26-4.14, GRADE Low), skills (SMD, 0.88; 95% CI, 0.25-1.73, Very Low Certainty), attitude (SMD, 0.81; 95% CI, 0.16-1.47, Very Low Certainty) and behaviour of EBHC (SMD, 0.82; 95% CI, 0.25-1.40, Very Low Certainty). Over time the effect of EBHC educational interventions substantially decreased with no evidence of effect at 6 months for any outcome except behaviour (SMD,1.72; 95% CI, 0.74-2.71, Low Certainty). There was some evidence that blended learning, active learning and consistency in the individual delivering the intervention may be important positive moderating factors., Conclusion: These findings suggest that EBHC educational interventions may have a large short-term effect on improving healthcare professionals' knowledge, skills, attitude and behaviour of EBHC. These effects may be longer-lasting regarding EBHC behaviour. In terms of pedagogy, blended learning, active learning, and consistency of the individual delivering the intervention may be important positive moderating factors., (© 2024 The Authors. Journal of Evaluation in Clinical Practice published by John Wiley & Sons Ltd.)
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- 2024
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39. Management of impacted fetal head at cesarean birth: A systematic review and meta-analysis.
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Cornthwaite K, van der Scheer JW, Kelly S, Schmidt-Hansen M, Burt J, Dixon-Woods M, Draycott T, and Bahl R
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- Humans, Female, Pregnancy, Fetus, Birth Injuries prevention & control, Cesarean Section, Head
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Introduction: Despite increasing incidence of impacted fetal head at cesarean birth and associated injury, it is unclear which techniques are most effective for prevention and management. A high quality evidence review in accordance with international reporting standards is currently lacking. To address this gap, we aimed to identify, assess, and synthesize studies comparing techniques to prevent or manage impacted fetal head at cesarean birth prior to or at full cervical dilatation., Material and Methods: We searched MEDLINE, Emcare, Embase and Cochrane databases up to 1 January 2023 (PROSPERO: CRD420212750016). Included were randomized controlled trials (any size) and non-randomized comparative studies (n ≥ 30 in each arm) comparing techniques or adjunctive measures to prevent or manage impacted fetal head at cesarean birth. Following screening and data extraction, we assessed risk of bias for individual studies using RoB2 and ROBINS-I, and certainty of evidence using GRADE. We synthesized data using meta-analysis where appropriate, including sensitivity analyses excluding data published in potential predatory journals or at risk of retraction., Results: We identified 24 eligible studies (11 randomized and 13 non-randomized) including 3558 women, that compared vaginal disimpaction, reverse breech extraction, the Patwardhan method and/or the Fetal Pillow®. GRADE certainty of evidence was low or very low for all 96 outcomes across seven reported comparisons. Pooled analysis mostly showed no or equivocal differences in outcomes across comparisons of techniques. Although some maternal outcomes suggested differences between techniques (eg risk ratio of 3.41 [95% CI: 2.50-4.66] for uterine incision extension with vaginal disimpaction vs. reverse breech extraction), these were based on unreliable pooled estimates given very low GRADE certainty and, in some cases, additional risk of bias introduced by data published in potential predatory journals or at risk of retraction., Conclusions: The current weaknesses in the evidence base mean that no firm recommendations can be made about the superiority of any one impacted fetal head technique over another, indicating that high quality training is needed across the range of techniques. Future studies to improve the evidence base are urgently required, using a standard definition of impacted fetal head, agreed maternal and neonatal outcome sets for impacted fetal head, and internationally recommended reporting standards., (© 2024 The Author(s). Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG).)
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- 2024
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40. Understanding Patient Experiences to Inform Future Studies to Optimize Personalization of Treatment for Early Breast Cancer.
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McIntosh SA, Mactier M, Fairhurst K, Gath J, Stobart H, and Potter S
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- Humans, Female, Middle Aged, Surveys and Questionnaires, Adult, Aged, Prognosis, Follow-Up Studies, Combined Modality Therapy, Survival Rate, Aged, 80 and over, Breast Neoplasms therapy, Breast Neoplasms pathology, Quality of Life, Precision Medicine
- Abstract
Background: Breast cancer treatment is multimodal, but not all patients benefit from each treatment, and many experience morbidities significantly impacting quality of life. There is increasing interest in tailoring breast cancer treatments to optimize oncological outcomes and reduce treatment burden, but it is vital that future trials focus on treatments that most impact patients. This study was designed to explore patient experiences of treatment to inform future research., Methods: An online survey was co-developed with patient advocates to explore respondents' experiences of breast cancer treatment. Questions included simple demographics, treatments received, and views regarding omitting treatments if that is deemed safe. The survey was circulated via social media and patient advocacy groups. Responses were summarized by using simple statistics; free text was analyzed thematically., Results: Of the 235 participants completing the survey, 194 (82.6%) would choose to omit a specific treatment if safe to do so. The most commonly selected treatments were chemotherapy (n = 69, 35.6%) and endocrine therapy (n = 61, 31.4%) mainly due to side effects. Fewer respondents would choose to omit surgery (n = 40, 20.6%) or radiotherapy (n = 20, 10.3%). Several women commented that survival was their "absolute priority" and that high-quality evidence to support the safety of reducing treatment would be essential., Conclusions: Patients with breast cancer are individuals who may wish to optimize different components of their treatment. A portfolio of studies co-designed with patients is needed to establish an evidence base for greater treatment personalization with studies focused on reducing avoidable chemotherapy and endocrine therapy a priority., (© 2024. The Author(s).)
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- 2024
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41. Acute diabetic foot disease.
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Jones A and Hinchliffe R
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- Humans, Acute Disease, Diabetic Foot surgery, Diabetic Foot therapy
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- 2024
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42. Incidence and outcomes of kidney replacement therapy for end-stage kidney disease due to primary glomerular disease in Europe: findings from the ERA Registry.
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Abd ElHafeez S, Kramer A, Arici M, Arnol M, Åsberg A, Bell S, Belliere J, Corte CD, Fresnedo GF, Hemmelder M, Heylen L, Hommel K, Kerschbaum J, Naumović R, Nitsch D, Santamaria R, Finne P, Palsson R, Pippias M, Resic H, Rosenberg M, de Pablos CS, Segelmark M, Sørensen SS, Soler MJ, Vidal E, Jager KJ, Ortiz A, and Stel VS
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- Humans, Incidence, Female, Male, Europe epidemiology, Middle Aged, Adult, Aged, Survival Rate, Young Adult, Adolescent, Glomerulonephritis epidemiology, Glomerulonephritis complications, Kidney Failure, Chronic epidemiology, Kidney Failure, Chronic therapy, Kidney Failure, Chronic mortality, Registries statistics & numerical data, Renal Replacement Therapy statistics & numerical data
- Abstract
Background: Primary glomerular disease (PGD) is a major cause of end-stage kidney disease (ESKD) leading to kidney replacement therapy (KRT). We aimed to describe incidence (trends) in individuals starting KRT for ESKD due to PGD and to examine their survival and causes of death., Methods: We used data from the European Renal Association (ERA) Registry on 69 854 patients who started KRT for ESKD due to PGD between 2000 and 2019. ERA primary renal disease codes were used to define six PGD subgroups. We examined age and sex standardized incidence, trend of the incidence and survival., Results: The standardized incidence of KRT for ESKD due to PGD was 16.6 per million population (pmp), ranging from 8.6 pmp in Serbia to 20.0 pmp in France. Immunoglobulin A nephropathy (IgAN) and focal segmental glomerulosclerosis (FSGS) had the highest incidences, of 4.6 pmp and 2.6 pmp, respectively. Histologically non-examined PGDs represented over 50% of cases in Serbia, Bosnia and Herzegovina, and Romania and were also common in Greece, Estonia, Belgium and Sweden. The incidence declined from 18.6 pmp in 2000 to 14.5 pmp in 2013, after which it stabilized. All PGD subgroups had 5-year survival probabilities above 50%, with crescentic glomerulonephritis having the highest risk of death [adjusted hazard ratio 1.8 (95% confidence interval 1.6-1.9)] compared with IgAN. Cardiovascular disease was the most common cause of death (33.9%)., Conclusion: The incidence of KRT for ESKD due to PGD showed large differences between countries and was highest and increasing for IgAN and FSGS. Lack of kidney biopsy facilities in some countries may have affected accurate assignment of the cause of ESKD. The recognition of the incidence and outcomes of KRT among different PGD subgroups may contribute to a more individualized patient care approach., (© The Author(s) 2024. Published by Oxford University Press on behalf of the ERA.)
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- 2024
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43. IgG4-related disease presenting with gastric outlet obstruction.
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Masterman B, Zhang Y, Pauling JD, and Zeino Z
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- Humans, Female, Adult, Diagnosis, Differential, Immunoglobulin G blood, Methylprednisolone therapeutic use, Methylprednisolone administration & dosage, Prednisolone therapeutic use, Stomach Ulcer complications, Stomach Ulcer diagnosis, Vomiting etiology, Pyloric Stenosis diagnosis, Pyloric Stenosis complications, Duodenum pathology, Gastric Outlet Obstruction etiology, Gastric Outlet Obstruction diagnosis, Immunoglobulin G4-Related Disease complications, Immunoglobulin G4-Related Disease diagnosis
- Abstract
A woman in her 20s presented with 6 weeks of fever, persistent vomiting and 28% loss of body weight. Symptoms were refractory to treatment with antiemetics and broad spectrum antibiotics.Further investigation via oesophageogastroduedenoscopy revealed a large gastric ulcer and pyloric stricture, causing gastric outlet obstruction (GOO). Biopsies of the stomach and duodenum showed plasma cell infiltration with a large proportion being IgG4 positive.Treatment with methylprednisolone, and later prednisolone, quickly improved inflammatory markers and symptoms. Balloon dilatation of the pyloric stricture also improved vomiting, allowing eventual re-establishment of oral nutrition. The patient made a full recovery with maintenance treatment on mycophenolate mofetil.IgG4-related disease (IgG4-RD) is a multisystem disorder with unpredictable presentation. The case highlights diagnostic challenges in IgG4-RD and identifies it as a rare differential in upper gastrointestinal symptoms. To our knowledge this is the first published case of IgG4-RD in the duodenum causing GOO., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2024. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2024
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44. Venous thromboembolism during neoadjuvant chemotherapy for ovarian cancer.
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Oxley S, Ahmed S, Baxter K, Blake D, Braden V, Brincat MR, Bryan S, Dilley J, Dobbs S, Durden A, Gomes N, Johnston B, Kaushik S, Kokka F, Lockley M, Lowe-Zinola J, Manchanda R, McCormick A, Nott C, Owens GL, Pandya A, Prince J, Ryan N, Ryan N, Sideris M, Tanna S, Waters J, Zamesa N, Thomas M, and Olaitan A
- Abstract
Objective: To determine the incidence of venous thromboembolism in patients with advanced epithelial ovarian cancer undergoing neoadjuvant chemotherapy in UK gynecological cancer centers. Secondary outcomes included incidence and timing of venous thromboembolism since cancer presentation, impact on cancer treatment, and mortality., Methods: All UK gynecological cancer centers were invited to participate in this multi-center retrospective audit through the British Gynecological Cancer Society. Data were captured on all patients undergoing neoadjuvant chemotherapy for International Federation of Gynecology and Obstetrics (FIGO) stage III/IV epithelial ovarian cancer within a 12-month period during 2021-2022. Patients on anticoagulation prior to cancer presentation were excluded. Patients who were diagnosed with venous thromboembolism between cancer presentation and commencing neoadjuvant chemotherapy were also excluded from our analysis of venous thromboembolism rates from neoadjuvant chemotherapy., Results: Fourteen UK gynecological cancer centers returned data on 660 eligible patients. The median age was 67 years (range 34-96). In total, 131/660 (19.8%) patients were diagnosed with venous thromboembolism from cancer presentation until discharge following cytoreductive surgery. Between commencing neoadjuvant chemotherapy and post-operative discharge, 65/594 (10.9%) patients developed venous thromboembolism (median 11.3%, IQR 5.9-11.3); 55/594 (9.3%) during neoadjuvant chemotherapy, 10/594 (1.7%) during post-operative admission. There was no significant difference across centers (p=0.47). Of these 65 patients, 44 (68%) were diagnosed with pulmonary embolism and 30 (46%) with deep-vein thrombosis (nine had both), including in major abdominal/pelvic vessels, with 36 (55%) presenting symptomatically and 29 (45%) diagnosed incidentally on imaging. Venous thromboembolism resulted in mortality (n=3/65, 5%), and delays/changes/cancelation of treatment (n=18/65, 28%)., Conclusion: Across a large, representative sample of UK gynecological cancer centers, one in five patients undergoing neoadjuvant chemotherapy were diagnosed with a potentially preventable venous thromboembolism, including one in nine diagnosed after commencing chemotherapy. This led to adverse clinical consequences for one third, including delay to oncological treatment and mortality. This high venous thromboembolism rate justifies the consideration of thromboprophylaxis in this patient group., Competing Interests: Competing interests: MT declares research funding from Thrombosis UK and Anthos, has received speaker fees from Bayer, Sanofi and Anthos, served on advisory boards for Ablynx, Sanofi and Bayer, consultancy for Bayer and Anthos, and is the senior author for the British Society of Haematology Guideline - Cancer-associated venous thrombosis in adults (second edition). SO and RM acknowledge funding outside this work from the Rosetrees trust. RM declares research funding from Barts Charity, the Eve Appeal, NHS Innovation Accelerator, British Gynaecological Cancer Society, GSK and Yorkshire Cancer Research outside this work, an honorarium for grant review from Israel National Institute for Health Policy Research and honoraria for advisory board membership from Astrazeneca, MSD, EGL, GSK. RM is the Topic Advisor for the NICE Guideline [GID-NG10225] -- Ovarian cancer: identifying and managing familial and genetic risk. NeR is supported by a NES/CSO Postdoctoral Clinical Lectureship Scheme – PCL/23/03 from the Chief Scientist Office Scotland. The other authors declare no conflicts of interest., (© IGCS and ESGO 2024. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2024
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45. The RELIEF feasibility trial: topical lidocaine patches in older adults with rib fractures.
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Clout M, Turner N, Clement C, Braude P, Benger J, Gagg J, Gendall E, Holloway S, Ingram J, Kandiyali R, Lewis A, Maskell NA, Shipway D, Smith JE, Taylor J, Darweish Medniuk A, and Carlton E
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- Humans, Female, Aged, Male, Aged, 80 and over, England, Scotland, Transdermal Patch, Emergency Service, Hospital, Surveys and Questionnaires, Lidocaine administration & dosage, Lidocaine therapeutic use, Rib Fractures complications, Rib Fractures drug therapy, Feasibility Studies, Anesthetics, Local administration & dosage, Anesthetics, Local therapeutic use
- Abstract
Background: Lidocaine patches, applied over rib fractures, may reduce pulmonary complications in older patients. Known barriers to recruiting older patients in emergency settings necessitate a feasibility trial. We aimed to establish whether a definitive randomised controlled trial (RCT) evaluating lidocaine patches in older patients with rib fracture(s) was feasible., Methods: This was a multicentre, parallel-group, open-label, feasibility RCT in seven hospitals in England and Scotland. Patients aged ≥65 years, presenting to ED with traumatic rib fracture(s) requiring hospital admission were randomised to receive up to 3×700 mg lidocaine patches (Ralvo), first applied in ED and then once daily for 72 hours in addition to standard care, or standard care alone. Feasibility outcomes were recruitment, retention and adherence. Clinical end points (pulmonary complications, pain and frailty-specific outcomes) and patient questionnaires were collected to determine feasibility of data collection and inform health economic scoping. Interviews and focus groups with trial participants and clinicians/research staff explored the understanding and acceptability of trial processes., Results: Between October 23, 2021 and October 7, 2022, 206 patients were eligible, of whom 100 (median age 83 years; IQR 74-88) were randomised; 48 to lidocaine patches and 52 to standard care. Pulmonary complications at 30 days were determined in 86% of participants and 83% of expected 30-day questionnaires were returned. Pulmonary complications occurred in 48% of the lidocaine group and 59% in standard care. Pain and some frailty-specific outcomes were not feasible to collect. Staff reported challenges in patient compliance, unfamiliarity with research measures and overwhelming the patients with research procedures., Conclusion: Recruitment of older patients with rib fracture(s) in an emergency setting for the evaluation of lidocaine patches is feasible. Refinement of data collection, with a focus on the collection of pain, frailty-specific outcomes and intervention delivery are needed before progression to a definitive trial., Trial Registration Number: ISRCTN14813929., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)
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- 2024
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46. Patient and carer perceptions of video, telephone and in-person clinics for Phenylketonuria (PKU).
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McBride H, Evans S, Pinto A, Daly A, Ashmore C, Ilgaz F, Ford S, Buckley S, and MacDonald A
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- Humans, Male, Female, Surveys and Questionnaires, Adult, Caregivers psychology, SARS-CoV-2, Young Adult, Telemedicine, Adolescent, United Kingdom, Phenylketonurias, Telephone, COVID-19
- Abstract
Background: In phenylketonuria (PKU), attending multidisciplinary clinic reviews is an important aspect of life-long care. Since the COVID-19 pandemic, video and telephone clinics are used as alternative methods for people with PKU to have contact with their care team. There is limited research concerning patient preference, experience and perceptions of alternative types of clinic review. Individuals from the UK with PKU and their caregivers were invited to complete an online questionnaire, hosted on the National Society for PKU (NSPKU) website and social media platform., Results: Data was available from 203 respondents. Forty one per cent of respondents (n = 49/119) preferred in-person clinics; 41% (n = 49) a hybrid of in-person, video and telephone clinics; 9% (n = 11) video clinics only, 6% (n = 7) telephone only and 3% (n = 3) were unsure. The main respondent obstacles to in-person clinics were costs, travel and time, but this was balanced by the benefits of a physical examination and better patient engagement/motivation. Twenty one per cent (n = 36/169) of respondents were uncomfortable with the number of healthcare professionals (HCPs) in a clinic room. Patients were less likely to consult with a doctor on video (64%, n = 91/143) or phone (50%, n = 59/119) reviews compared to in-person (80%, n = 146/183). Issues with video and telephone reviews included the shorter time length of review, distractions, technical issues and poor patient engagement., Conclusions: Online video and telephone clinic platforms were effective in overcoming the challenging circumstances in management, monitoring and treatment of patients with PKU during the COVID-19 pandemic. However, in-person clinics remain the preferred respondent option. It is important that HCPs are flexible, enabling people with PKU a choice of clinic options according to their individual clinical need and circumstances., (© 2024. The Author(s).)
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- 2024
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47. National audit of patient reported experience of radical cystectomy for bladder cancer pathways.
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Kuppanda P, Hermans L, Uren A, Cotterill N, Rowe E, Narahari K, Dickinson A, Rigby J, Aning J, Featherstone J, and Okpii E
- Abstract
Objective: The objective of this study was to measure and describe the national patient experience of radical cystectomy (RC) pathways in the UK using the validated Cystectomy-Pathway Assessment Tool (C-PAT)., Patients and Methods: A cohort of 1081 patients who underwent RC for bladder cancer, between 1 January 2021 and 31 July 2022 at 33 UK cystectomy centres, returned completed C-PAT responses. SPSS was employed for data summary statistics, including median, interquartile range, Mann Whitney U test or Chi-square test with a 95% confidence interval to assess statistical significance between potentially associated variables. Open-text responses in the C-PAT tool were analysed and coded using NVivo software., Results: In this cohort, the greatest perceived delay in the RC pathway, reported by 19% of patients ( n = 208), was at the GP consultation to first hospital referral stage with suspected bladder cancer. Around 10% of patients perceived delays at each of the other stages in their pathway. Cancer nurse specialist (CNS) contact was strongly associated with an improved patient experience ( p < 0.001); however, 9.5% of patients reported that they were not assigned a cancer nurse specialist in their pathway. Overall, 96% ( n = 1028) reported their experience of RC pathway care to be good or excellent. There were no significant differences in reported patient experience found between cystectomy centres., Conclusion: This audit demonstrates the feasibility of measuring patient experience of RC pathways at scale. The C-PAT tool demonstrated utility in identifying specific pathway areas for quality improvement. Overall UK patients report a high quality pathway experience. A focus on improving the referral pathway between primary and secondary care is necessary., Competing Interests: The authors declare no conflict of interest., (© 2024 The Author(s). BJUI Compass published by John Wiley & Sons Ltd on behalf of BJU International Company.)
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- 2024
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48. IgG and plasma viscosity as markers of disease activity in primary Sjogren's syndrome-related lymphocytic interstitial pneumonia.
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Alawi S, Dixon G, Bhatt N, Adamali HI, and Gunawardena H
- Subjects
- Humans, Female, Middle Aged, Male, Blood Viscosity physiology, Aged, Sjogren's Syndrome complications, Sjogren's Syndrome blood, Lung Diseases, Interstitial etiology, Lung Diseases, Interstitial blood, Biomarkers blood, Immunoglobulin G blood
- Abstract
Competing Interests: Competing interests: None declared.
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- 2024
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49. Successful Treatment of Darier-White Disease with Ablative Fractional Carbon Dioxide Laser.
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Michelmore C, Hitchens E, Johnstone L, and Keith D
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- 2024
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50. Spinal Cord Stimulation Improves Quality of Life for Patients With Chronic Pain-Data From the UK and Ireland National Neuromodulation Registry.
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Martin SC, Baranidharan G, Thomson S, Gulve A, Manfield JH, Mehta V, Love-Jones S, Strachan R, Bojanić S, Eldabe S, and FitzGerald JJ
- Abstract
Introduction: Spinal cord stimulation (SCS) is a well-established treatment for chronic pain and is supported by numerous studies. However, some recent articles have questioned its efficacy. This article examines a cohort of >1800 patients with SCS from the UK and Ireland National Neuromodulation Registry. It is intended to provide a "real-world" assessment of efficacy and compare its effects with other procedures performed for painful indications., Materials and Methods: Quality of life (QoL) data (EuroQoL five-level [EQ5D]) and demographic data were extracted from the National Neuromodulation Registry for all patients (N = 1811) who underwent SCS for chronic pain in 27 centers in the UK between February 2018 and July 2022. These were compared with data from the published literature for other commonly performed elective surgical procedures., Results: The EQ5D utility index increased by a mean of 0.202 in the 1236 patients with paired pre- and postoperative utility scores. The median utility was 0.263 (interquartile range [IQR] = 0.384; n = 1811) preoperatively, whereas at six months after the operation, it was 0.550 (IQR = 0.396; n = 1025), p < 0.0001, Wilcoxon rank sum test. The median utility score at 12 months postoperation was 0.548 (IQR = 0.417; n = 970). There was no difference in utility scores at six months and 12 months after implantation (p = 0.15, Wilcoxon rank sum test). There was a significant improvement in QoL in all five domains of the five-level EQ5D tool at six months after baseline (p < 0.01, for all subcategories), and this was sustained at one year after implantation. The baseline utility was lower than in patients who underwent elective surgery for other painful conditions, and the absolute (and proportionate) increase in utility produced by SCS was greater than that achieved with most other interventions., Conclusions: SCS increases the QoL in patients requiring surgery for pain. Similar results were seen regardless of SCS indication. When comparing analogous data bases, SCS produces a greater percentage improvement in EQ5D utility than do many other elective surgical procedures for painful conditions, including spinal surgery and some joint replacements., Competing Interests: Conflict of Interest Ganesan Baranidharan has received consulting fees from Abbott, Boston Scientific, Medtronic, and Saluda Medical; has received honoraria from Abbott, Boston Scientific, Mainstay Medical, Saluda Medical, Stryker, and Nevro Corp; and sits on the international data safety board for Saluda Medical. Stana Bojanić sits on the board of the International Neuromodulation Society. Sam Eldabe has received departmental grants from Boston Scientific and Saluda Medical; and consulting fees from Medtronic, Saluda Medical, Mainstay Medical, and Esteve Pharmaceutical. James J. FitzGerald has received institutional research grants from Merck and UCB; consulting fees from Abbott and Lilly; educational honoraria from Abbott; and advisory board fees from Medtronic and Abbott. Sarah Love-Jones has received travel honoraria from Boston Scientific, Nevro Corp, Abbott, Medtronic, and Saluda Medical; research grants from Boston Scientific, Mainstay Medical, Nevro Corp, Saluda Medical, Nalu Medical, and Abbott; and sits on the medical advisory board for Boston Scientific, Nevro Corp, Saluda Medical, Medtronic, and Pfizer. Vivek Mehta has received consulting fees from Mainstay Medical, Lundbeck, Pfizer, Boston Scientific, and Medtronic; holds an advisory position with Medtronic, Pfizer, and Man & Science; and sits on the board of the Neuromodulation Society of UK and Ireland, and the Education Committee of the North American Neuromodulation Society. Simon Thomson has received grants, honoraria, and consulting fees from Boston Scientific, Mainstay Medical, and Saluda Medical and holds an advisory position with Galvani Bioelectronics. The remaining authors report no conflict of interest., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)
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- 2024
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