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1. A qualitative study exploring the lived experiences of patients living with mild, moderate and severe frailty, following hip fracture surgery and hospitalisation.

Author: Vanisha Patel, Antje Lindenmeyer, Fang Gao, and Joyce Yeung
Subjects: Medicine, Science
Abstract: It is well recognised that hip fracture surgery is associated with a negative impact on short and long-term post-operative physical health and emotional well-being for patients. Furthermore, these patients are known to be frail with multiple co-morbidities. This study explores how frailty shapes the lived experiences of rehabilitation and recovery for patients who have undergone hip fracture surgery. Semi-structured interviews were conducted with sixteen participants, recently discharged from hospital following hip fracture surgery. Interpretative phenomenological analysis was applied to explore the lived experiences of frail patients and ascertain important themes. Patient experiences were captured in seven overarching themes: 1) the hospital as a place of "safety", 2) placing trust in others, 3) the slow recovery journey impeded by attitude and support, 4) maintaining autonomy and dignity whilst feeling vulnerable, 5) seeking a new normal, 6) loneliness and social isolation and 7) the ageing body. Based on our study findings, we have been able to suggest a number of opportunities to improve support for frailer patients in finding a new routine to their everyday lives, these include on-going physical and psychological support, information and education and a robust pathway for transition of care into the community. A conceptual thematic diagram is presented which helps to understand the experience and the complex needs of frail older people undergoing hip fracture surgery.
Published: 2023
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2. De novo non-alcoholic fatty liver disease after pancreatectomy: A systematic review

Author: Parth Shah, Vanisha Patel, and Motaz Ashkar
Subjects: General Medicine
Published: 2022

3. The analgesic benefit of Pericapsular Nerve Group (PENG) block in hip arthroscopic surgery: a retrospective pragmatic analysis at an academic health center

Author: Vanisha Patel, Vivesh Patel, Faraj Abdallah, Daniel Whelan, Shikha Bansal, Martino Gabra, and Richard Brull
Subjects: Anesthesiology and Pain Medicine, General Medicine
Abstract: IntroductionThe novel pericapsular nerve group (PENG) block has recently been reported to provide effective motor-sparing local anesthetic-based analgesia to the hip joint. We aimed to evaluate the analgesic efficacy and safety of a preoperative PENG block among patients undergoing ambulatory hip arthroscopic surgery where systemic analgesia is the gold standard.MethodsWe conducted a single-center, retrospective pragmatic exploratory cohort study of consecutive outpatient hip arthroscopic surgery cases from January 2017 to March 2019. We identified 164 cases in which patients received general anesthesia with or without a preoperative PENG block. The primary analgesic outcome measures were time to first postoperative analgesic request, intraoperative and postoperative opioid consumption (intravenous morphine equivalent), and postoperative pain severity (visual analog scale 10 cm scale ranging from 0=no pain to 10=severe pain) in hospital. Secondary outcomes included duration of stay in the postanesthesia care unit, opioid-related side effects, time to discharge readiness, and block-related complications.ResultsSeventy-five cases received a preoperative PENG block and 89 cases received systemic analgesia alone. The addition of a PENG block reduced intraoperative (6.6 mg vs 7.5 mg, difference: 0.9 mg; 95% CI 0.2 to 1.7; p=0.01) and postoperative (10.7 mg vs 13.9 mg, difference: 3.2 mg; 95% CI 0.9 to 5.5; p=0.01) intravenous morphine consumption, as well as the mean (3.5 vs 4.2, difference: 0.7; 95% CI 0.1 to 1.3; p=0.03) and highest (5.5 vs 6.5, difference: 1.0; 95% CI 0.2 to 1.7; p=0.02) postoperative pain severity scores in hospital. The PENG block did not prolong the time to first analgesic request (15.8 min vs 12.3 min, difference: 3.5 min; 95% CI −9.0 to 2.0; p=0.23). Fewer patients in the PENG group experienced postoperative nausea and vomiting compared with systemic analgesia alone (36% vs 52%, OR 1.9; 95% CI 1.0 to 3.6; p=0.02), while the PENG block expedited discharge readiness (165.0 min vs 202.8 min, difference: 37.8 min; 95% CI 2.9 to 72.3; p=0.04). No block-related complications were noted in any patient.DiscussionBased on our retrospective dataset, this pragmatic exploratory cohort study suggests that a preoperative PENG block is associated with questionable improvements in postoperative in-hospital analgesic outcomes which may or may not prove to be clinically relevant when compared with systemic analgesia alone for patients undergoing hip arthroscopic surgery. This small signal should be investigated in a prospective randomized trial.
Published: 2022

4. Budd-Chiari Syndrome as an Initial Presentation of Non-Promyelocytic Acute Myelogenous Leukemia

Author: Jiten P. Kothadia, Vanisha Patel, Rajiv Heda, Wesley A. Angel, Vishwas Vanar, Benedict J. Maliakkal, and Rajanshu Verma
Subjects: General Medicine
Published: 2022

5. Overview of an emergent, arts-based resiliency curriculum to mitigate medical trainee burnout

Author: Angela Dittmar, Mukta Panda, Unsa Shafi, Laurie Melnik Allen, Vanisha Patel, Savannah Brackman, and Adera Causey
Subjects: Narrative medicine, Emergent curriculum, education.field_of_study, Medical education, Students, Medical, media_common.quotation_subject, education, Art Therapy, Medicine (miscellaneous), Training Support, Burnout, The arts, Physician Assistants, Arts and Humanities (miscellaneous), Surveys and Questionnaires, Humans, Curriculum, Psychological resilience, Psychology, Burnout, Professional, media_common
Abstract: Physician and trainee burnout are becoming an epidemic within the medical community. This paper describes an innovative emergent curriculum that uses narrative medicine, creative activities, and g...
Published: 2020

6. The Role of Neurovascular System in Neurodegenerative Diseases

Author: Mohammad Moshahid Khan, Vanisha Patel, Ajmal Ahmad, and Jianfeng Xiao
Subjects: 0301 basic medicine, Parkinson's disease, Models, Neurological, Neuroscience (miscellaneous), Context (language use), Disease, Nervous System, 03 medical and health sciences, Cellular and Molecular Neuroscience, 0302 clinical medicine, Huntington's disease, medicine, Animals, Humans, Amyotrophic lateral sclerosis, business.industry, Neurodegeneration, Neurodegenerative Diseases, Neurovascular bundle, medicine.disease, Review article, 030104 developmental biology, nervous system, Neurology, Blood-Brain Barrier, Cerebrovascular Circulation, business, Neuroscience, 030217 neurology & neurosurgery
Abstract: The neurovascular system (NVS), which consisted of neurons, glia, and vascular cells, is a functional and structural unit of the brain. The NVS regulates blood-brain barrier (BBB) permeability and cerebral blood flow (CBF), thereby maintaining the brain's microenvironment for normal functioning, neuronal survival, and information processing. Recent studies have highlighted the role of vascular dysfunction in several neurodegenerative diseases. This is not unexpected since both nervous and vascular systems are functionally interdependent and show close anatomical apposition, as well as similar molecular pathways. However, despite extensive research, the precise mechanism by which neurovascular dysfunction contributes to neurodegeneration remains incomplete. Therefore, understanding the mechanisms of neurovascular dysfunction in disease conditions may allow us to develop potent and effective therapies for prevention and treatment of neurodegenerative diseases. This review article summarizes the current research in the context of neurovascular signaling associated with neurodegenerative diseases, such as Alzheimer's disease (AD), Parkinson's disease (PD), amyotrophic lateral sclerosis (ALS), and Huntington's disease (HD). We also discuss the potential implication of neurovascular factor as a novel therapeutic target and prognostic marker in patients with neurodegenerative conditions. Graphical Abstract.
Published: 2020

7. Recollection of Fertility Discussion in Adolescent and Young Adult Oncology Patients: A Single-Institution Study

Author: Pamela Jones, Vanisha Patel, Alexis Judd, Valerie Senko, Gina Altieri, and Daniel Pettee
Subjects: Male, Infertility, medicine.medical_specialty, Adolescent, media_common.quotation_subject, Fertility, 03 medical and health sciences, 0302 clinical medicine, Quality of life, Statistical significance, Humans, Medicine, 030212 general & internal medicine, Fertility preservation, Young adult, Child, Retrospective Studies, media_common, Oncofertility, Recall, business.industry, Infant, Newborn, Fertility Preservation, Infant, medicine.disease, Oncology, Child, Preschool, 030220 oncology & carcinogenesis, Family medicine, Pediatrics, Perinatology and Child Health, Quality of Life, Female, business
Abstract: Purpose: With increasing number of childhood cancer survivors, focus has recently shifted to improving future quality of life and long-term complications, such as infertility. Despite national guidelines, fertility preservation is discussed in less than half of the eligible patients. In this study, we sought to discover if education gaps regarding fertility exist within our practice, in efforts to address these gaps to improve the quality of cancer care we provide. Methods: A retrospective electronic survey was administered to eligible adolescent and young adult oncology patients. Results: Of the 63 patients approached, 47 responded to the survey. Before initiation of antineoplastic therapy, 22/47 (46.8%) stated that they were concerned about their fertility to some degree; however, only 11/47 (23.4%) report pursuing fertility preservation. When asked why they decided against steps to preserve fertility, 15/36 (41.6%) reported that they did not know they had options. Of all patients that completed the survey, 28/47 (59.6%) requested additional information regarding their fertility. Conclusion: Majority of respondents recall having a discussion regarding the impact of antineoplastic therapy on their fertility at the time of diagnosis, which was initiated by their oncologist. However, less than half reported satisfaction with these discussions. Although this study did not demonstrate statistical significance, it has resulted in development of a multidisciplinary oncofertility team for fertility preservation referrals, at our institution, as well as education materials for all newly diagnosed oncology patients.
Published: 2020

8. Development of de novo nonalcoholic fatty liver disease following pancreatectomy

Author: Vanisha Patel, Parth Shah, Daniel R. Ludwig, Chet W. Hammill, and Motaz Ashkar
Subjects: General Medicine
Published: 2023

9. S1651 Sociodemographic Factors Associated With Hospital Readmission in Patients With Peptic Ulcer Disease in the State of Florida

Author: Vanisha Patel, John Sahrmann, Anne Butler, Yin Cao, Jose Saenz, and Cassandra D. L. Fritz
Subjects: Hepatology, Gastroenterology
Published: 2022

10. Critical care usage after major gastrointestinal and liver surgery: a prospective, multicentre observational study

Author: T. Yang, T. Pitts-Tucker, Daron Smith, S. Suresh, A.A. Khetarpal, C. Brathwaite-Shirley, Justine Davies, Sayinthen Vivekanantham, A. A. Adebayo, T. Sorah, N. Yim, H.R. Jackson, Salim Tayeh, R.H. Bremner, A. Piquet, L. Higgs, R. Yuen, P. Fergurson, N.K. Sim, A. Hibberd, A. Mehdi, N. Moody, D. Maru, C. Joyner, I. Hindle Fisher, Vartan Balian, N. Wetherall, Siyin Liu, P.N. Phan, S. Mallick, C. Lek, B. Oremule, S. Nelaj, M. Williams, Maqsood Qamar, A. Menon, M. Mohamud, H. Cheema, C. Chan, H.M. Omer, S.J. Cole, E. Craig, K.E. Leslie, S.S. Talukdar, R.B.S. Holliday, J. Heskin, A. Cody, Syed Shumon, S. McAleer, S. Abburu, P. Deekonda, S.F. Ashraf, R. Bose, AE Cotton, C. McGowan, S. Rashid, K. Theodoropoulou, A. MacAskill, Vishal Narwani, R. Maamari, S. Stokes, L.N. Harris, Peng Yong Sim, Evie Gardner, Leo Ng, N. Chandan, J.W. Lockey, M. Acres, H. Jhala, M.L. Kwan, A. Abdulmajid, A.E. Cardwell, P. Buakuma, C.P. Keane, M. Ahmed, N.J. Chilvers, E. Semple, J. Meek, A.K. Clarke, K. Koysombat, A. Hague, E.J.H. Turner, N. Keelty, P. Karunakaran, K.D. Clement, Mansoor Khan, Y. Cao, O. Prys-Jones, S.L. Walsh, C.N. McKerr, Sanjay Shah, S. Peroos, A. Dhanji, Joseph M. Norris, Neil Smith, M. Lakhani, M. Wijesekera, M. Bhatti, Midhun Mohan, C.Y. Luk, M. Elkawafi, S. Wadanamby, Jameel Mushtaq, Jonathan C. M. Wan, A. Ghaffar, M. Siddiqui, S. Naqib, Michaeline Kelly, J.W. Duncumb, F. Hughes, H.E.M. Jordan, R. Callan, G. Hung, C.F. Brewer, E.M. Ruiz, A. Higgins, C. Horst, C. Roberts, S. Kanabar, C. Wall, A.M. Buchan, A. Luhishi, R.P. Watson, D. Xylas, A. McBride, A. Bell, G. Heppenstall-Harris, A. Pericleous, Akanksha Chhabra, N. Hitchen, P. Raut, Shahzada Ahmed, M. Mirza, C.H. Archer, G. Russell, C.T. Francescon, D.T. Robertson, N. Gardiner, K. Cheng, A. Mishra, E. Webb, L. Rothwell, Dee A. Carter, V. Gupta, M. Johnstone, M.E. Kelly, R.D.C. Moon, E. Woin, K. Nadanakumaran, U. White, J. Empey, F. Bulley, R. Morley, G. Charalambous, L. Turner, S. Angelov, D. Coffey, S. Hartley, S. Pronin, E. Seager, R.K. Varma, Sharifullah Khan, S.B. Husnoo, R.K. Sethi, H.M. Chang, A. Duffy, Hew D.T. Torrance, P. Cunha, L. Kimani, W. Din, E.G. Heywood, C. O'Connell, D. Wylam, L. Anderson, N. Ahern, A.J. Trist, D. Burke, A. He, M. Sundar-Singh, A. Odeleye, G. Kumaran, N.L. Salloum, T.M. Brooks, A.S. Lynch, R. Debenham, Howard Gardner, M. Nielsen, M. Das, G. Bingham, S. Qureshi, Aditya Borakati, J. Wylie, Z. Kazmi, J.H. Park, P. Gill, A.R. Craig, M. Chen, Jonathan Wild, S.J. Lim, K.P. Choo, G. Culleton, G. Deas, E.Y. Chua, D. Vanniasegaram, A.H. Amphlett, N. Rajan, J.H. Chen, M. Hameed, Paul Ziprin, C. Toale, D. Gold, N. Keane, Jacob H Matthews, E. Palkhi, Nick Watson, C.M. Hewitt, A. Yousif, Faheem Ahmed, D. Wilkinson, John Mason, C. Reeder, R. Sagar, Deirdre A. Collins, S. Sandhu, S. Singh, J. Herron, A.Y.L. Ng, K. Brennan, K.A. Hoban, V. Navayogaarajah, A.S. Jawad, J.Y.L. Low, Julian R. Johnston, J. Wye, Inge Bernstein, John Parkin, A.D. Henson, Y.H. Soo, C. Topham, M. Steel, Priyank Patel, C.M. Lankage, U. Ashfaq, E.J. Brown, N.L. Foster, C.W. Rookes, R.J. Greig, K.L. McKevitt, N. Jathanna, J.M. Geraghty, M. Karia, S. Cumming, H. Holyoak, S. Parthiban, R.B. Karsan, V.C. Wing, T.E. Glover, R.D. Adams, B.H. Miranda, S. Gaffney, S. Rogers, G.E. Torlot, J.J. Filby, S. Sii, N.M. Rafiq, M. Shoa, S. Singagireson, N. Ungcharoen, Jennie Parker, B.F. Chong, N.M. Shafiq, V. Wong, E. Shakweh, A. Al-Mousawi, J. Pearce, S. Botchey, L. Horne, L. Fletcher, B. Singh, E.A. Whatling, K. Duke, A. Mastan, A.L. Frank, S. Verma, Humaira Shaheen, W. Liew, J. Turner, R. Rampal, T. Filipescu, R.M. Markham, B.A. Patel, S. Lim, A. Atayi, S. Yoganathan, N. Ramsay, M. Khattak, O. Amin, E. McAleer, K. Gohil, H. Shufflebotham, George S Bethell, M. Dhar, J.E. Davies, A.F. Carroll, E. Cornish, S. Omara, J. Bartlett, D. Loughran, A. Iqbal, L.R. Springford, D.R. McCormack, S. Leong, R. Ingham, D. Tan, A. Khajuria, M. Tonkins, M. Petrarca, A.M. Bucko, L.L. McKelvey, C. Gill, C.E. Thakker, K. Mohan, J. Turnbull, G. Cuthbert, W. Dean, R.D.J. Whitham, D.M. Lees, N. Chan, D. Osei-Kuffour, A. Sahathevan, K. Ng, L.B. Anderson, J. Eraifej, A. O'Connor, O.J. Cundy, C. Kong, R.K. Hughes, Bryan Paul Traynor, P. Keane, C. Liu, E. Canning, E.D. Mills, C. Gouldthrope, S. Patel, M.J.V. Holmes, C. Cullen, Lisa McNamee, Alberto Pizzolato, P. Harries, M. Elseedawy, R. Varley, C. Whacha, S.G. Ratu, A. Wright, S. Parsons, Pishoy Gouda, A. Mian, R. Bhudia, R. Adams, N. Bell, Talisa Ross, R. Reid, J.P. Shah, Sarah Dean, C. Neophytou, Alex Ward, J.D. Thompson, M. Seedat, A. Ramnarine, R.T. Harris, A. Qureshi, C. Major, Y. Sinha, A.S. Rocke, C.S. Yong, P. Kwang, David Neil Cooper, L. Aildasani, R.W. Goh, A.R. Dyal, L. Braganza, L. Healy, N. Davies, T. Reakes, N. Patel, S. Sng, C. Brennan, Z.R. Bakewell, S.L. Jenkin, Ahmed Daoub, I.A. Rhema, R.A. Walford, O. Spence, L. Yow, E.J. Roberts, W. Cymes, Y. Liew, E. Segall, June A. Sullivan, K.K. Sandhu, L. Satterthwaite, G.X. Xu, R.M. Waldron, S. McGarvie, D. Brown, M. Alizadeh, J.A. Syeed, H.F. Roberts, P. Dawson, H.R. Abdikadir, S. O'Connor, Y. Maheswaran, B.A. Hughes, B.A. Atraszkiewicz, K. Singh, C. Mcgenity, A.D. Wood, Ewan D. Kennedy, S.X. Poo, S. Mitrasinovic, Max Marsden, A. Ibrahim, Daniel F. McAuley, M. Attalla, S. Govinden, Siti Asma' Hassan, T. Raghvani, T. Bloomfield, R. Heminway, M. Ali, K.L. Robertson, P. Lalor, T. Dogra, I. Antoniou, A. Tahmina, Markus L. Sagmeister, Ronan McMullan, J. Matthams, Richard J. Egan, Elspeth Cumber, M. Dolaghan, P. Sritharan, S. Sarwar, E.S.M. Tan, S.E. Murray, S. Morris, S. Mansoor, M. King, Randall V. Martin, P. Williams, G. Brent, N.B. Reid, S. Collinson, T. Sarvanandan, R. Ratnakumaran, R.E. Keeling, M.A. Sherif, D. Thomas, I.J. Clark, R. Coulson, T.P. Bemand, A. Abid, A.L. Martin, J.C.K. Ng, P. Avery, Y. Narang, R. Manson, H. Petra, J.E. Giles, A.E. Lim, N.A. Vithanage, S. Osman, D. Elf, Panagis M. Lykoudis, A. Ang, Debra Salmon, A. Croall, T. Sale, S. Bonsu, Y.P. Mogan, G.E. Cooper, J. Lamont, S.T. Marchal, P. Naran, A.N. Kumar, R. Owasil, F. Koumpa, J.Q. Ng, P.N. Nesargikar, J. Boyle, Ryan Preece, E. Sewart, S. Lee, S. Kosasih, N. Jamal, Stephen J Chapman, N.A. Redgrave, C. Holmes, A.E. Barthorpe, S. Mistry, J.A. Yates, Robin Wilson, E. Prakash, J.Y. Kee, S.M. Anderson, R.S. Suresh, N. Hussain, S. Gentry, S. Darr, H. Heneghan, H.D. McRobbie, S. Assadullah, Shivam Bhanderi, C. Weston, A. Delport, A. Winarski, M.M. Li, T. Tharmachandirar, N. Canning, P.R. Forrest, Adam J Boulton, A. Ponweera, G.E. Stewart, J.S. Ahn, J. Hartley, A. Isaac, J.L.Y. Allen, R. Carr, S. Gokani, J. Zhao, C. Player, D. Sim, W. English, R.J. McGalliard, S. Cullen, R. Thethi, A. Livesey, K.N. Lwin, M. K. Abd Ghaffar, C.L. Knight, P.C. Hurst, A.Y. Tay, Devender Mittapalli, F. Winslow, G. Bhaskaran, L. Gauntlett, W. Leung, D.M. Golding, A. Wali, D.C. Marshall, H. Ross, K.P. Raman, P.J. Teoh, C. Allan, I. Nehikhare, C.M. Ventre, M. Venn, J.A. Crewdson, A. Shukla, N. Ramjeeawon, S. Shahid, P. Mithrakumar, J. Fern, Y. Tan, H. Haq, S. Turaga, U. Hayat, C. Palmer, H. Goradia, T. Ramtoola, J. Bloomer, C. Chhina, Z. Momoh, W.M. Wynell-Mayow, N. Jayakody, M. Bravo, J. Gabriel, R. Khanijau, L. Esteve, A. Malik, R.D. Obute, S. Sheth, S. Lunawat, U. Qureshi, C. Rees, A. Kerai, M. Peters, A.Y. Tsui, K. Kow, M. Trail, A. Coates, F. Long, V. Paraoan, M.T. Stoddart, N. Li, M. Bright, W.W. Chaudhry, M.K. Malys, S. Owczarek, C.L. Jubainville, E. Brennan, M. Hanrahan, A. Wang, A. Burgess, S. Dutt, N. Varma, R.P. Williams, A. Ledsam, R.T. Buckle, W. Ho, U. Sajjad, B. Goh, M.R. Hardy, E. Lim, L.J. Burney, C.S.D. Roy, Thomas M Drake, Harry J. Gilbert, A. Yener, A. Trimble, Archana Shah, H. Ahmed, E.C. Barton, K. Eparh, C. McCrann, F. Harding, J. Mah, D. Kotecha, A. Al-Robeye, J. MacDonald, S. Kim, Andrew Logan, C. McLaughin, H. Collier, O. Brewster, J. Loveday, L. Tung, S. Dindyal, O. Al-Obaedi, A. Simpson, M. Sirakaya, F. Morgan, G.S. Ng, S. Mahboob, D. FitzPatrick, A. Jindal, O. O'Carroll, Y. Devabalan, T. Axelson, D. Rojoa, K. Sasapu, Kirsty Davies, J. Moradzadeh, Ewen M Harrison, K. Gandhi, S. Beecroft, G. McCabe, C.P. Chilima, T. Goldsmith, H.Z. Bazeer, N. Kalra, P. Morrison, T.C. Hoskins, J.J. Wiltshire, A. Narain, D. Joshi, D. Horth, H.C.P. Wilson, Y.F. Dennis, M. Mills, C. Diaper, J.A. Sanders, S.M. Chiu, J. Coffin, V. Elangovan, K.S. Dolbec, H.L. Warwick, R.H. Shuttleworth, T. Patel, R. Goodson, F.S. Brown, Jane Lim, O. Ziff, M. Rashid, V. Mirdavoudi, K.G. Reid, A. Broyd, E. Woon, M. Zuhair, A.D. Greenhalgh, L.R. Wingfield, S. Stevens, O. Hussain, G. Pandey, A. Bakhsh, I.B. Ptacek, J. Dobson, L. Bolton, A.L. Kerr, T.M.P. Fung, P. Narayan, T. Ward, Ruth Lyons, C. Robinson, Buket Gundogan, S. Akhtar, P. Vanmali, L. Austreng, N. Kelly, M. Kadicheeni, H Ali, P. Holton, H. Turley, C.J. Morrison, L. Hu, M. Sukkari, D.A. O'Sullivan, J. Brecher, C.J. White, M.A. Charalambos, William Bolton, M. Tahir, L. Grundy, T.P. Pezas, Ewan Brown, Nicholas Bullock, A.M.A. Shafi, A. Aslanyan, Michael F. Bath, H. Wilson, P.C. Copley, S.E. Scotcher, Heather Kennedy, N. Bassam, A. Omar, G.D. Stott, S. Ashraf, E. Galloway, R.D. Bartlett, H. Amin, Y.N. Neo, W.C. Soon, S. Rabinthiran, C. Phillips, L.A. Henderson, K. Whitehurst, A. Kahar, S. Sukumar, M.R. Williams, W.A. Gatfield, C. Ntala, K. Dear, A.R. Chitnis, M. Eragat, H.C. Huang, K. O'Sullivan, N. Yong, J. Robson, A. Valli, A. Mohite, G.J. Salam, F. Tongo, S. Lopes, R.A. O'Loughlin, S.L. Hickling, J. Fong, A. Chung, Kathy Nicholls, H. Abid, S. Balaji, J. Hardie, T. Reeves, H.R. Paine, M. Hayat, H. Nayee, Y.N. Suleman, S. Tan, M. Sharifpour, X. Chen, I. Barai, A. Yan, M.A. Gillies, T.W. Tilston, A. Kreibich, Y.H. Tan, A. Murtaza, Chris Dunn, P. Jull, J.W. Kim, A.D. Semana, N. Abuhussein, P. Shepherd, L. Derbyshire, P.M. McEnhill, J.B. Patel, C. Toh, T. Arif, B.W. Matthews, D. Shanahan, N. Seneviratne, L. Carr, A. Curran, A. Batho, L.D. O'Flynn, R. McAllister, A. Durr, Rahul Bhome, S. Mackin, K. Ahmad, R. Shaunak, S. Bassiony, H.A. Khokhar, R. Chin, R. Priestland, G.X.J. Sherliker, J.H. Entwisle, C. Anandarajah, H. Aziz, M. Chaudhary, A. Kishore, H. Adjei, M. Minhas, S.W. McLure, T. Kane, E. Ingram, T. Fautz, D. Chrastek, R. Singh, B.N. Shurovi, A. Asmadi, N. Ansari, J. Mahmood, K. Patel, A.N. Street, A. Thacoor, C. Girling, L. Cheskes, V. Shatkar, B. Ali, A. McGrath, Shaun Trecarten, J.D. Farmer, R. Dean, R.C. McLean, P.L.M. Harrison, S. Iqbal, S. Hirani, R. Fleck, S. Pope, C.Y. Kong, A.M. Demetri, H. Selvachandran, M. Malaj, H.K. Blege, B.D. Mistry, C.M. Grossart, R. Slade, S.A. Stanger, A.J. Dhutia, A. Amajuoyi, Ased Ali, M. Robinson, R. Punj, Jane Dickson, J. Lucas de Carvalho, Jessica Harvey, L.M. Bullman, D Nepogodiev, H.L. Joyce, Catrin Morgan, J. Paul, R. Vaughan, A. Prabhudesai, C. Egerton, A. Sheldon, C. Holloway, K. Brzyska, J. Ashwood, Christine McGarrigle, S. Pal, H. Rosen O'Sullivan, A. Rangedara, A. Hill, A. Szczap, S. Hudson-Phillips, J. Lavery, Harriet Mitchell, J.D.B. Hayes, M. Salem, F.A. Bamgbose, J. Bassett, V. Raghuvir, R. Dennis, S.E. Cox, C.J. Dewdney, N. Mitha, A.W. Roberts, Brij Patel, J. Wills, R. Goodier, R.M. Koshy, D. Weinberg, E.J. Griffin, Harriet L. Mills, A. Marsh, Z. Khonat, Kenneth A. McLean, E. Hester, T. Spencer, A.H.Y. Lee, J. Chong, L.R. Bookless, Michael J. Raphael, P. Sangal, M. McMenamin, H. Khalid, G.S. Harbhajan Singh, F.I. Chaudhry, N. Favero, J.E.F. Fitzgerald, Chetan Khatri, J. Remedios, A. Charania, Daniel J. George, S. Jackson, C. Murkin, R. Dawar, I. Kisyov, E. Wong, R.J. Pearse, A.N. Baker, L. Carthew, N. Warren, I. Adeleja, M. McCann, C. Drislane, R. Tan, S. Ho, K. Hulley, L. Doan, E.M. O'Neill, R. Gratton, M. Srikantharajah, C. Henderson, L. Puan, H. Whittingham, A. Johnston, E. Mckean, A.K. Tear, D. Varma, H. McFarlane, C.N. Lou, E.M. Cumber, Aneel Bhangu, Z.H. Siddiqui, J. Cleere, M. Chamberlain, James Glasbey, Sarah Ali, M. Masood, A. Linton, G. Chillarge, M. Davis-Hall, A. Anilkumar, U. Khan, A. Tai, R. Shepherd, Joshua Burke, W. Loke, M. Edison, A. Mortimer, N. Anim-Addo, R.S. Reehal, R. Blessed, Daniyal J. Jafree, M.S. Sait, H.C. Copley, N. Ward, M. Wells, K. Raji, J. Gulati, H. Keevil, C.A. Asbjoernsen, A. White, Nikita R. Bhatt, J. Barnes, S. Wang, F. Cheung, Clive Graham, K. Dynes, C. Dorman, E. Strange, A. Radotra, A. Reed, R. Nachiappan, I. Ibrahim, F. Acquaah, P. Jalota, S. Stezaker, J.E. Rogers, MI Perera, R. Kiff, T. Rangan, R. Weaver, E. Mazumdar, J. Beckett, Rowena McGregor, E.V. Wright, N. Punjabi, V. Charavanamuttu, Stephen O'Neill, S. Majid, Zulfiqarali G. Abbas, S.M. Lakhani, G. Rattan, J. Lua Boon Xuan, K. Joshi, HE Whewell, M. Patel, T.M. Schulz, O.K. Vernon, L.F. McClymont, N. Woodcock, L. Gray, Reena Shah, H. Thakur, F.S. Peck, P. Karia, L. Ashken, S. Rinkoff, M. McDowell, L. Chew, C.D. Blore, A.C.D. Smith, E. Auyoung, L.M. Sabine, O. Parker, S.M. Choi, V. Thirumal, J. Pickard, L. Murphy, C.J. Coffey, P. Dube, M.H. Abul, T. Khan, J. Campbell, M.T. Turner, Adam Gwozdz, K.K. Ong, B. Durrani, A. O'Kane, A.S. North, Najeeb Ahmed, C. Xiao, D. Maclennan, Nora Abdul Aziz, S.A. Semnani, L. Bell, Amy Ashton, L. Crozier, V. Teng, M. O'Bryan, K. Clesham, Vanisha Patel, L. Kretzmer, T. Lo, G.H. Stanley, M.D. Theodoreson, J.K. Mehta, F. Morris, L. Howells, R. Pinto, T. Bergara, J. Matheson, E. Devlin, E.T. Tan, E. Toner, L. Jacob, Sher Ahmad, J. Sellathurai, Catherine Doherty, J. Norton, C. Maxwell-Armstrong, S. Ng, T.R. Barrow, N. Boxall, A.A. Thevathasan, M. Ryan, E. Uppal, C. Jenvey, G.E. Aidoo-Micah, Karan Verma, U. Datta, F. Hirst, H. Woodward, J. Khangura, J. Chervenkoff, F. Edozie, E. Burke, M.G. Rasiah, A. Jaitley, Thomas L. Lewis, D. Lazenby, A. Lotfallah, A. Khan, E. McCance, Henry A. Claireaux, A.S. Fawaz, P.D. Jewell, R.G. Tharakan, R. Narramore, E. Heathcote, G. Nixon, H. Chin, E. Sun, L.S. Chew, K. Lim, G. Lakshmipathy, R. Telfer, B.A. Shuker, H. Kitt, O.D. Thompson, N. Behar, H. Naveed, R. Allot, E. Batt, E.J. Stone, J.M. Aithie, I. Henderson, Rakesh Heer, C. Deall, C.J. McIntyre, L. Dinsmore, S. Milne, Bhavik Anil Patel, N. Cody, A. Pandey, A. Kaushal, M.C. Sykes, N. Maple, R. Simpson, S. Lynne, S. Shahidi, M.I. Zegeye, B. Forte, P. Khonsari, G. Thomas, O. Sitta, V. Robertson, K. Mazan, J. Prest-Smith, D. O'Reilly, A. Sreh, A.E. Salih, Anna Craig-Mcquaide, Vandana Agarwal, E.G. Chisholm, Z. Afzal, G.L. de Bernier, P.W. Stather, Lucy Elliott, A. Collins, D. Lim, M. Abdelhadi, Q. Lu, and J. Stein
Subjects: Adult, Male, medicine.medical_specialty, Adolescent, Critical Care, medicine.medical_treatment, Patient Care Planning, Young Adult, 03 medical and health sciences, Patient Admission, 0302 clinical medicine, 030202 anesthesiology, Laparotomy, Intensive care, medicine, Humans, Hospital Mortality, Prospective Studies, Prospective cohort study, Digestive System Surgical Procedures, Aged, Aged, 80 and over, Postoperative Care, business.industry, Patient Selection, Professional Practice, Odds ratio, Middle Aged, United Kingdom, Confidence interval, Anesthesiology and Pain Medicine, Cohort, Emergency medicine, Female, Observational study, Emergencies, business, Ireland, Abdominal surgery
Abstract: Patient selection for critical care admission must balance patient safety with optimal resource allocation. This study aimed to determine the relationship between critical care admission, and postoperative mortality after abdominal surgery.This prespecified secondary analysis of a multicentre, prospective, observational study included consecutive patients enrolled in the DISCOVER study from UK and Republic of Ireland undergoing major gastrointestinal and liver surgery between October and December 2014. The primary outcome was 30-day mortality. Multivariate logistic regression was used to explore associations between critical care admission (planned and unplanned) and mortality, and inter-centre variation in critical care admission after emergency laparotomy.Of 4529 patients included, 37.8% (n=1713) underwent planned critical care admissions from theatre. Some 3.1% (n=86/2816) admitted to ward-level care subsequently underwent unplanned critical care admission. Overall 30-day mortality was 2.9% (n=133/4519), and the risk-adjusted association between 30-day mortality and critical care admission was higher in unplanned [odds ratio (OR): 8.65, 95% confidence interval (CI): 3.51-19.97) than planned admissions (OR: 2.32, 95% CI: 1.43-3.85). Some 26.7% of patients (n=1210/4529) underwent emergency laparotomies. After adjustment, 49.3% (95% CI: 46.8-51.9%, P0.001) were predicted to have planned critical care admissions, with 7% (n=10/145) of centres outside the 95% CI.After risk adjustment, no 30-day survival benefit was identified for either planned or unplanned postoperative admissions to critical care within this cohort. This likely represents appropriate admission of the highest-risk patients. Planned admissions in selected, intermediate-risk patients may present a strategy to mitigate the risk of unplanned admission. Substantial inter-centre variation exists in planned critical care admissions after emergency laparotomies.
Published: 2019

11. S1586 Pancreatic Immune-Related Adverse Events Due to Immune Checkpoint Inhibitor Therapy

Author: Vanisha Patel and Motaz Ashkar
Subjects: Immune system, Hepatology, business.industry, Immune checkpoint inhibitors, Immunology, Gastroenterology, Medicine, business, Adverse effect
Published: 2021

12. Prolonged Fever, Diarrhea, Abdominal Pain, and Joint Pain in a 9-Year- Old Boy

Author: Anna Brown, Vanisha Patel, Moussa El-Hallak, Prabi Rajbhandari, and Yamini Mandelia
Subjects: Diarrhea, Male, Vasculitis, musculoskeletal diseases, medicine.medical_specialty, Abdominal pain, Time Factors, Prodromal Symptoms, Arthritis, Physical examination, Fever of Unknown Origin, Lymphohistiocytosis, Hemophagocytic, Diagnosis, Differential, 03 medical and health sciences, 0302 clinical medicine, 030225 pediatrics, medicine, Back pain, Humans, Lupus Erythematosus, Systemic, Treatment Failure, Child, Physical Examination, Fatigue, medicine.diagnostic_test, business.industry, General surgery, Comprehensive metabolic panel, medicine.disease, Arthralgia, Arthritis, Juvenile, Abdominal Pain, Interleukin 1 Receptor Antagonist Protein, Antirheumatic Agents, Joint pain, Pediatrics, Perinatology and Child Health, medicine.symptom, Interphalangeal Joint, business, Low Back Pain
Abstract: A 9-year-old African American boy was admitted to hospital with a 12-day history of fevers, diarrhea, abdominal pain and a 1-day history of joint pain. His abdominal pain and diarrhea resolved within the first few days of admission, but he continued with high-grade fevers and intermittent joint pain. The joints affected included the right first interphalangeal joint, right wrist, right elbow, and left knee joint. His initial laboratory tests revealed normal complete blood count, comprehensive metabolic panel, and C-reactive protein. Consequently, he developed fatigue, lower back pain, and bicytopenias. After 19 days of fevers, a multispecialty collaborative evaluation arrived at a final diagnosis and treatment plan. In this article, we discuss the child’s hospital course and our clinical thought process. Written consent was obtained from the family.
Published: 2020

13. S73 Development of De Novo Nonalcoholic Fatty Liver Disease Following Pancreatectomy

Author: Motaz Ashkar, Daniel R. Ludwig, Chet W. Hammill, Vanisha Patel, Greg Williams, and Parth Shah
Subjects: medicine.medical_specialty, Hepatology, business.industry, medicine.medical_treatment, Internal medicine, Pancreatectomy, Nonalcoholic fatty liver disease, Gastroenterology, medicine, medicine.disease, business
Published: 2021

14. Safety Profile and Efficacy of Cidofovir for Adenovirus in Pediatric Stem Cell Transplant Recipients Following Reduced-Intensity Conditioning

Author: Vanisha Patel, Paul Szabolcs, and Breana K. Goscicki
Subjects: Transplantation, medicine.medical_specialty, business.industry, animal diseases, viruses, medicine.medical_treatment, virus diseases, Brincidofovir, Hematology, Hematopoietic stem cell transplantation, ThioTEPA, Gastroenterology, Nephrotoxicity, Fludarabine, chemistry.chemical_compound, chemistry, Internal medicine, Medicine, Alemtuzumab, business, Viral load, Cidofovir, medicine.drug
Abstract: Background Adenovirus (ADV) infection remains a significant cause of morbidity and mortality following allogeneic hematopoietic stem cell transplantation (allo-HSCT), particularly in the pediatric population. Pre-emptive monitoring by polymerase chain reaction (PCR) assay for ADV viremia in high risk patients permits prompt initiation of therapy. Cidofovir (CDV) is a nucleotide analogue which is utilized for treatment of ADV infections in immunocompromised patients; however, CDV can be associated with substantial dose-dependent nephrotoxicity. The use of reduced intensity conditioning (RIC) has invariably necessitated the use of anti-thymocyte globulin or alemtuzumab for rejection prophylaxis, putting patients at higher risk for viral infections. We report our single-center experience with CDV for treatment of ADV infection in 20 allo-HSCT patients. Methods We performed a retrospective review, from 2012-2019, of children with non-malignant diseases that received RIC with alemtuzumab, fludarabine, melphalan, and thiotepa. ClinicalTrials.gov Identifier: NCT01962415 Recipients of CDV were identified and reviewed for ADV PCR results (blood, stool, urine, respiratory viral panel), CDV course characteristics (mg/kg dose, frequency, and duration), and changes in renal function. All patients received a combination of probenecid and hydration to reduce nephrotoxicity. Results A total of 25 CDV courses, in 20 patients (median age: 4 years, range 0.6-22) were identified. Of the 20 patients, 18 patients (90%) received umbilical cord blood as their graft source. Of the 25 courses prescribed, 20 courses (80%) were in patients with a positive blood ADV PCR, and 19 courses (76%) with a positive stool ADV PCR. Typically, 5 mg/kg/dose (range 1-9) was given weekly, then every 2 weeks once viral load declined. The median number of doses of CDV was 8 doses (range 2-32) with treatment duration ranging from 7-169 days. Renal dysfunction with CDV appeared to be reversible, with 14 courses (56%) having peak serum creatinine (SCr) >50% of baseline during CDV treatment, though average rise in SCr when comparing baseline to CDV discontinuation values was 20%. Only 2 courses had a peak SCr ≥ 1 mg/dL during CDV treatment. In 16 courses (64%) CDV therapy was discontinued due to clinical resolution, PCR negativity, or a combination of both, in 6 courses (24%) patients were switched to brincidofovir, and in 1 course (4%) the patient transferred care. 18 of 20 are alive, one child died of complications of multiple infections including ADV, and another due to accelerated CNS demyelination. Conclusion CDV appeared remarkably safe and effective post RIC conditioning. Prospective screening allowed for early initiation of CDV and limiting poor outcomes associated with ADV.
Published: 2020

15. Safety of Cytomegalovirus Prophylaxis on Engraftment in Pediatric Umbilical Cord Blood Transplant Following Reduced Intensity Conditioning

Author: Jessie L. Barnum, Beth A. Carella, Paul Szabolcs, Vanisha Patel, and Breana K. Goscicki
Subjects: Foscarnet, Ganciclovir, Transplantation, medicine.medical_specialty, Neutrophil Engraftment, Platelet Engraftment, business.industry, virus diseases, Hematology, ThioTEPA, Gastroenterology, Umbilical cord, Fludarabine, medicine.anatomical_structure, Internal medicine, medicine, Alemtuzumab, business, medicine.drug
Abstract: Background Reduced intensity conditioning (RIC) transplant carries the advantage of decreased transplant related morbidity and mortality, however comes with an increased risk of viral infections, particularly cytomegalovirus (CMV) in the setting of serotherapy and umbilical cord blood (UCB) grafts. Given this, the use of prophylaxis is considered, though with hesitation given associated myelosuppression and nephrotoxicity. We report outcomes of CMV prophylaxis with ganciclovir and foscarnet on engraftment and viremia in the setting of RIC umbilical cord blood transplant (UCBT). Methods A retrospective chart review was conducted reviewing patients with non-malignant disease who underwent UCBT on an institutional protocol between 2016 - 2019. A RIC regimen was administered using alemtuzumab (Day -14), hydroyxurea (Day -14 to -5), fludarabine (Day -9 to -5), melphalan (split Day -4 & -3), and thiotepa (Day -2). ClinicalTrials.gov: NCT01962415. The patients were divided into 3 groups: patients who did not receive CMV prophylaxis (Group 1), patients who did (Group 2), and patients who received preemptive treatment prior to Day 0 due to CMV DNAemia (Group 3). CMV prophylaxis included ganciclovir 5 mg/kg/d (Day -10 to -2) followed by foscarnet 90 mg/kg daily (from Day +1) to reduce marrow suppression. Results Group 1 included 14 patients. Neutrophil engraftment occurred in all patients [median: 16 days; range: 11 – 33]. Platelet engraftment (> 50k) occurred at a median of 45.5 days (range: 33 – 79). Of the 14 patients, 1 patient received acyclovir as CMV prophylaxis while the remaining 13 received ganciclovir/foscarnet. 5 developed CMV viremia (max copies of 95,000 IU/mL); one of whom had graft rejection attributed to CMV. These patients were treated preemptively following detection of DNAemia. Group 2 included 6 patients. Neutrophil engraftment occurred in all patients [median: 15 days; range: 13 – 18]. Platelet engraftment occurred at a median of 32 days (range: 26 – 39). 5 patients developed CMV viremia (max copies of 3290 IU/mL). Similar to Group 1, these patients were also escalated to treatment doses of ganciclovir and switched to foscarnet and/or human CMV immune globulin (CytoGAM) with treatment failure. Group 3 included 2 patients who were found to have CMV DNAemia prior to Day 0 therefore received preemptive treatment. Neutrophil and platelet engraftment occurred at a median of 14 and 42 days, respectively. In all groups, no patient developed end-organ disease. Conclusion In our single-institution pediatric UCB transplant dataset, there is no suggestion that pre-engraftment exposure to CMV prophylaxis with ganciclovir and foscarnet impacted the kinetics of either neutrophil or platelet engraftment. Therefore, CMV prophylaxis in seropositive patients undergoing UCB transplant could be considered alongside preemptive therapy as an option for management of viral reactivation.
Published: 2020

16. Diagnostic delay and morbidity of central nervous system tumors in children and young adults: a pediatric hospital experience

Author: Vanisha Patel, Neil L. McNinch, and Sarah Rush
Subjects: Adult, Male, Cancer Research, Pediatrics, medicine.medical_specialty, Neurology, Delayed Diagnosis, Adolescent, Central nervous system, Central Nervous System Neoplasms, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Interquartile range, Pediatric hospital, Chart review, medicine, Humans, Symptom onset, Registries, Young adult, Child, Ohio, Retrospective Studies, business.industry, Infant, Hospitals, Pediatric, Prognosis, Survival Rate, medicine.anatomical_structure, Oncology, 030220 oncology & carcinogenesis, Child, Preschool, Etiology, Female, Neurology (clinical), Morbidity, business, Delivery of Health Care, 030217 neurology & neurosurgery, Follow-Up Studies
Abstract: For children with central nervous system (CNS) tumors, survival rates remain significantly lower than other childhood malignancies with a substantial increase in disability of survivors. Given this, it is imperative that these children are identified at the earliest sign of symptom onset. Our institution aimed to identify diagnostic delays, morbidity and mortality, and specific barriers that may exist within our specific healthcare system that result in diagnostic delay. A retrospective chart review was performed of newly diagnosed CNS tumors between January 1, 2008 and December 31, 2017. 235 patient cases were reviewed, 34 (14.5%) of which had an associated tumor predisposition syndrome. Median age at the time of diagnosis was 9 years (range 1 day to 25 years), with median number of days from symptom onset to definitive diagnosis of 42 days (interquartile range 14–120 days). Delays longer than 60 days occurred in 95 (47.5%) patients. The 10 year relative survival rate for all tumors was 86.8%. Our institution had a shorter interval from symptom onset to diagnosis than currently reported in the literature, as well as a decrease in associated morbidity. In addition, for those with longer delays, we were able to characterize the etiology and barriers leading to these delays. With these identified, we are able to utilize this knowledge to further improve education and awareness in community members and healthcare professionals to continue to improve the time to diagnosis in the future.
Published: 2019

17. The effect of regional versus general anaesthesia on post-operative delirium in elderly patients undergoing surgery for hip fracture : a systematic review

Author: Rita Champaneria, Janine Dretzke, Joyce Yeung, and Vanisha Patel
Subjects: medicine.medical_specialty, Anesthesia, General, Anaesthesia, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, systematic review, Quality of life, Anesthesia, Conduction, 030202 anesthesiology, regional anaesthesia, medicine, Forest plot, Humans, general anaesthesia, General anaesthesia, Postoperative delirium, 030212 general & internal medicine, Adverse effect, Aged, Hip fracture, Hip Fractures, business.industry, Research, Incidence (epidemiology), Delirium, General Medicine, medicine.disease, Surgery, Clinical trial, hip fracture, business, RD
Abstract: ObjectiveOlder patients with hip fractures who are undergoing surgery are at high risk of significant mortality and morbidity including postoperative delirium. It is unclear whether different types of anaesthesia may reduce the incidence of postoperative delirium. This systematic review will investigate the impact of anaesthetic technique on postoperative delirium. Other outcomes included mortality, length of stay, complications and functional outcomes.DesignSystematic review of randomised controlled trials and non-randomised controlled studies.Data sourcesBibliographic databases were searched from inception to June 2018. Web of Science and ZETOC databases were searched for conference proceedings. Reference lists of relevant articles were checked, and clinical trial registers were searched to identify ongoing trials.Eligibility criteriaStudies were eligible if general and regional anaesthesia were compared in patients (aged 60 and over) undergoing hip fracture surgery, reporting primary outcome of postoperative delirium and secondary outcomes of mortality, length of hospital stay, adverse events, functional outcomes, discharge location and quality of life. Exclusion criteria were anaesthetic technique or drug not considered current standard practice; patients undergoing hip fracture surgery alongside other surgery and uncontrolled studies.ResultsOne hundred and four studies were included. There was no evidence to suggest that anaesthesia type influences postoperative delirium or mortality. Some studies suggested a small reduction in length of hospital stay with regional anaesthesia. There was some evidence to suggest that respiratory complications and intraoperative hypotension were more common with general anaesthesia. Heterogeneity precluded meta-analysis. All findings were described narratively and data were presented where possible in forest plots for illustrative purposes.ConclusionsWhile there was no evidence to suggest that anaesthesia types influence postoperative delirium, the evidence base is lacking. There is a need to ascertain the impact of type of anaesthesia on outcomes with an adequately powered, methodologically rigorous study.PROSPERO registration numberCRD42015020166.
Published: 2018

18. Methylphenidate Overdose Causing Secondary Polydipsia and Severe Hyponatremia in an 8-Year-Old Boy

Author: Cassandra Lefevre, Michael Wittkamp, Ashwin Krishna, Vanisha Patel, and Mildred Kaagaza
Subjects: Male, medicine.medical_specialty, hyponatremia, Treatment outcome, MEDLINE, Illustrative Cases, Sodium Chloride, lisdexamfetamine, Affect (psychology), polydipsia, 03 medical and health sciences, 0302 clinical medicine, Humans, Medicine, 0501 psychology and cognitive sciences, Lisdexamfetamine Dimesylate, Child, Psychiatry, Social functioning, business.industry, Methylphenidate, 05 social sciences, Water Intoxication, Cognition, General Medicine, medicine.disease, 030227 psychiatry, attention deficit hyperactivity disorder, Treatment Outcome, Attention Deficit Disorder with Hyperactivity, Phenytoin, Pediatrics, Perinatology and Child Health, Emergency Medicine, Central Nervous System Stimulants, medicine.symptom, business, Hyponatremia, Polydipsia, 050104 developmental & child psychology, medicine.drug
Abstract: Objective Attention deficit hyperactivity disorder (ADHD) is an increasingly common diagnosis of childhood that manifests with symptoms that affect cognitive, academic, behavioral, emotional, and social functioning. There are a multitude of pharmaceutical therapies to choose from when managing this condition, and though many studies on the safety and efficacy of these medications have been published, adverse effects still occur. Case This case discusses a previously healthy 8-year-old boy who had been prescribed 20-mg lisdexamfetamine dimesylate for ADHD however mistakenly took his brother's 36-mg methylphenidate extended-release tablets, resulting in hyperhidrosis, excessive thirst, polydipsia, and combative behavior that began within 3 hours of ingestion. He was evaluated at a community hospital emergency department and given lorazepam due to agitation and combativeness before discharge. However, he returned with hypothermia, hyponatremia, and status epilepticus resulting in intubation. Patient was transferred to our facility where a computer tomography of his head was negative and hyponatremia was corrected with 3% NaCl saline solution. A lumbar puncture was performed due to temperature instability before starting broad-spectrum antibiotics. Cerebrospinal fluid findings were normal, and he was extubated at 18 hours postingestion. Patient was discharged home after 3 days with no residual symptoms. Discussion/Conclusions Though both lisdexamfetamine dimesylate and methylphenidate are widely used among pediatricians today for treatment of ADHD, reports of life-threatening water intoxication as a result of overdose is rare. Studies have reported that severe 3,4-methylenedioxymethamphtamine toxicity in adults is associated with syndrome of inappropriate diuretic hormone (SIADH) secretion, hyponatremia, and seizures, along with serotonin-induced transient elevation in antidiuretic hormone. Adult schizophrenics who receive psychostimulants have also been shown to develop polydipsia with hyponatremia. Although the use of psychostimulants in adult schizophrenic patients has been studied, literature on toxicity and effects in the pediatric psychiatric population is scarce. We would suggest that this patient's polydipsia and hyponatremia are most likely a result of his ingestion of a toxic dose of a long-acting agent known to cause secondary psychosis.
Published: 2017

19. Ageing and frailty

Author: Joyce Yeung and Vanisha Patel
Subjects: Gerontology, business.industry, Ageing, Medicine, business
Published: 2018

20. Cancelled operations: a 7-day cohort study of planned adult inpatient surgery in 245 UK National Health Service hospitals

Author: Jennifer Morrish, Emily J Robson, Georgina Ashfield, Karuna Kotur, Jashmin Maria, Charlotte Downes, Shweta Patro, Mark Scrutton, George Gladstone, Andy Burton, Paula Mulligan, Wei Lin Allen, Michael McCusker, Dee Leonard, James Edwards, Sarah Dolling, Katherine Pass, Hywel Garrard, Francis Young, Paul Edgar, Elaine Matthews, Douglas Findlay, Helen Whittle, Aillison MacLean, Chris Levett, Claire-Marie Agius, Kim Porter, Nurse Charlotte White, Bridget Campbell, Gemma Scotland, Patrick Haywood, Liz Shenton, Tom Hatton, Laura McAffrey, Jane Hunt, Jaime Carungcong, Sara Owen, Fiona Christie, Lesley Milne, Liza Tharakan, Ruth Smith, Henry Nash, Timothy Gould, Jodie Fitzgerald, Wael Zghaibe, Mark Gaskell, Dushyanthi Jayasekera, Elana Owen, Kinga Dwornik, Amr Ali, Donna Cotterill, Martyn Cain, Peter Wicks, Daniel West, Catriona Walker, Rebecca Lee, Amanda Isaac, Naresh Rajasekar, Sally Collins, Laura Hammon, Tim Hendra, Yemi Adelaja, Mike Pollard, Ellen L. Brown, Matt Clayton, Rachel Bown, Sally Moore, Keyury Desai, Tony Kinsey, Charlotte Dunn, Li Lian Loh, Emelia Passaro, Timothy Faccini, Stephen Linter, Sumant Shanbhag, David Lee, David Restall, Angela Cook, Simon Ripoll, Rachael Bird, Vicky Murray, Alex Wollaston, Daniel Yarwood, Sonia Bhangu, Sahar Biuk, Jenny Ferry, Alexander Michael Stewart, Ceri Lynch, Lucy Sheppard, Denise Webster, Jamie Allen, Merle Cohen, James Hanison, Shilpa Rawat, Prabhakaran Premraj, Gamunu Ratnayake, Clare Bird, Lorna Filby, Clare Allcock, Babak Sedghi, Celly Weegenaar, Dawn Collier, Sreekanth Rayalu Uppugonduri, Amanda Whileman, Su Ying Ong, Jack Carmichael, Victoria O'Loughlin, Barbara Linklater-Jones, Maria Lackmann, Vitul Manhas, Albert Brennan, Alasdair Waite, Andrew Smallwood, Salvatore Bruni, Catriona Barr, Thomas Murphy, Gemma Hudson, Khalid Hasan, Alison J. Campbell, Radu Chiravasuta, Charlotte Maden, Roddy Chapman, Jon Clark, Nauman Iftikhar, Sarah Hagyard, Denis O'Leary, Steven Forde, Joanne Webb, Ryan W Haines, Andrea Galloway, Richard Siviter, Heidi Lightfoot, Hew D.T. Torrance, Christopher Smith, Hollie Robinson-Perrie, Josh Wall, Carina Cruz, Andrew Song, Stephen T. Webb, Nurse Sara-Beth Sutherland, Carol-Ann Woolley, Susan Martin, S.L.M. Walker, George Koshy, Renee Ford, Mona Mubarak, Robert Stuart, Keshava Reddy Burijinti Chenna, Rizana Ghafoor, Katie Hanlon, Fiona Faulds, Hiba Khaled, Richard Jones, Karin Duckett, Cathryn Matthews, Charles Chan, Sanjeewa Ranaweera, Nurse Rebecca Hinch, Richard Shawyer, Jo Cudlip, Marion Ashe, Steve Harris, Ravi K. Alagar, Jonathan Hetherington, Sara Churchill, Yolanda Baird, Maria Tritean, Gabriela Wong, Dermot Moloney, Lee Tbaily, Jonathan Finnity, Norbert Bokor, Peter Indoe, Lucy Stelfox, Simon Marcus, Bryony Burrill, Ellie Roderick, Carina Lilley, Alex Yusaf, Lucy Corbett, Esther Neilly, Christine Ryan, Amon Wijunamai, Katie Atterbury, Abigail Clarke, Josh Patch, Otto Mohr, Ronan Mukherjee, Asokan Krishnaier, Chen Yun-Han, Prasan Panagoda, Polly Rice, Katherine Jones, James Hudson, Sophie Uren, Peter Sutton, Evangelia Poimenidi, Tracy Marsden, Veronica Barnes, Alice Drysdale, Tara Lawrence, Lisa Sharpe, John G. Francis, N. M. Wharton, Claire Kurasz, Marina Iaverdino, Caradog Thomas, Emma Gold, Raj McNab, Tom E.F. Abbott, Claire Dowse, Jane Hamilton, Tony Sutherland, Robert P. Jones, Peter Alston, Daniel Haslam, Philippa Marshall, Bernadette Tilley, Cathleen Chabo, Adam Carpenter, Steve Cole, Nicholas Hooper, Kate Arrow, Alka Shah, Rosie Furness, Susie Chapman, Sachini Dhamaratne, Constandinos Papageorgiou, Michael Girgis, Sandra Pearson, Andrew W. Wood, Jaya Nariani, Sonia White, Christopher Godden, Mary Bellamy, Indra Chadbourn, Laura Parker, Peter Knowlden, Cat Griffiths, Jeanette Smith, David Brooks, Jonathan Smith-Williams, Elizabeth Barnes, Sunil Jamadarkhana, Andrew Feneley, Maria Croft, Tom Disney, Paramesh Kumara, Anna Warrington, Seetal Aggarwal, Zackriah Badsha, Suman Biswas, Suzanne Shuttleworth, Ben Jones, Jose Lourtie, Mark Stubbington, Asya Mussad, Patrick Johnson, Sister Amanda Cowton, James Spargo, Kelly Hard, Annette Fraine, William Weston, Farrukh Ameer, Andrew Prenter, Lisa Bacon, Sunil kumar Chaurasia, Claire Nicholas, Amy Kitching, Sneha Prasad, Catriona Ferguson, Martin P. Huntley, Claire Cameron, Hugh Cutler, Anne Harrison, Kunal Joshi, Anna Cormack, Rebecca Jones, Martin Paul, Jean Bage, Stephen Cole, Usman Razaque, Robert Lewis, David O'Callaghan, Samantha Strong, Victoria Frost, Peter Ip, Victoria Male, Mat Molyneux, Christopher Worth, Michael Brett, Megan Smith, Shayan Arshed, Timothy McMillan, Lorri James, Frances Lay, Jennifer Bennett-Britton, Patrick Colhoun, Alison Shaw, Michael Stewart, Maie Templeton, Karin Gupwell, Mujeeb Khan, Elena Stanton, Chandini Chuni, Janette Brown, Mariam Latif, Rebecca L. Wilson, Felix Fombon, Jo Novaga, Cindy Persad, Matthew Thomas, Maryna Garmash, Metod Oblak, Sarah Maher, Rahul Muddanyake, Morgan Foster, Kris Parker, Tim Sutton, Ndi Ekwere, Samuel Armanious, Mohammad Bhatti, Steve Phillips, Maria Rivero-Bosch, Nick Spittle, David Harding, Henry Hammerbeck, Rose Buckley, Jonathan Hatton, Ahmed Gilani, Ali Watts, Neeraj Bhardwaj, Lesley McShane, Simon Ridler, Martin Murphy, Vandana Goel, S Ramani Moonesinghe, Sophie Scutt, Sanniah Hussain, Hannah Donaldson, Tom Bennett, Helen Boys, David Steven Davies, Bev Hammond, Bryan Yates, Victoria Hawley, Chris Gibb, Ulrika Winstone, Keith Couper, Benedict Williams, Louise Duncan, Georgina Wilson, Anil Hormis, Emily Dana, Jens Full, Amina Chohan, Amanda Ebejer, Sian McKillop, Tomas Bakonyi, Georgina Bird, George Davies, Christina Penny, Helen Thornley, Karen Jewers, Kingsin Ang, Mishell Cunningham, Conny Blunt, Ronald Carrera, Kay Finney, Alvin Soosay, Nagaraj Rao, Jason Mann, Carol Edwards, Richard Lowe, Paul Stevens, Hilary Ashton, Rachel Codling, Rhys Davies, Muthuraj Kanakaraj, Zoe Apple, Kirsty Meats, Tammy Smith, Charmaine Beirnes, John Gardner, Peter Featherstone, Claire Williams, Rohit Mittal, Emma Shinn, Alex Moore, Michael Whitear, Hannah Rose, Paul Kelly, Megan Thomas, Matthew Gibbins, Jack Reid, Caroline Clarke, Victoria Irvine, Bhavesh Pratap, Ella Buchanan, Nurse Francesca Wright, Vatsharlan Santhirapala, Richard Gould, Dionne Dervin, Behzad Sohail, Lauren Duraman, Thecla Scully, Adnaan Qureshi, Muditha Peiris, Thomas Ratcliffe-Law, Samuel J. Clark, Ben Vowles, Sam Keable, Hoda Abou Ghoneim, Becky Morris, Aidan Hulbert, Rachael Craven, Ashish Kundu, Emma M. Casely, Maya Kommer, Tom Poulton, Greg Nussbaum, Ahmad Huda, Caroline Davis, Suzanne Gleeson, Paul Clements, Matt Willis, Isobel Amey, David J. Perry, Rachel Harford, Bianca Hulance, Kirsty Baron, Charlotte Grove, Sergio Dominguez, Susanna Richie-Mclean, John Stones, Ioana Simionescu, Khaled Razouk, Cristina Niciu, Ben Hyams, Mark Doran, Carolyn Colvin, Jonathan Rivers, Raluca Ene, Rebecca Jackson, Jonathan Edgar, Ben Robinson, Lisa Wilkinson-Guy, Aji Mathew, Christopher Patrick, Gauhar Sharih, Ismail Tariq, Andrea Kay, Joshua O'Donnell, Dafydd Watterson, Lail Zaheer, Fiona Reed, Tom Johnson, Christopher Oscier, Mirain Phillips, Edmund Gerrans, Joanna Hackney, Sally M. Dunlop, Elizabeth Willetts, Jiang Yuchen, Lizzie Ashton, Theresa Cooper, Paul W. Davies, Carly Brown, James Small, Julie Lowe, Amarjeet Patil, Filipe Helder, Joshua Cuddihy, Faisal Sheikh, Hayley Tarft, Enid Leung, Adrian Percuin, Paolo Mazzone, Rochelle Rhodes, Jane Pilsbury, Kerry Cullis, Peter Brook, Helen McNamara, Carin Swanevelder, Claire Frith, Adrian Clarke, Stuart Watson, Glenn Vetuz, Zoe Riddell, Drew Welch, Geoff Warnock, Lalani Induruwage, Paul Mallett, Elizabeth Cervi, Santinder Dalay, Supriya Antrolikar, Sinead O'Kane, Toby Hoskins, Stephen Duberley, Sophie Parcell, Jayne Sutherland, Lynn Fairless, Dave Parkinson, Matron Beryl Davis, Abigail Patrick, Jithu Jayan, Nicola Harvey, Catherine Pitman, Donata Banni, Samuel Passey, Omar Alex Pemberton, Becky Sands, Hon Sum Liu, Alexandra Mudd, Sheldon Zhang, Ange Lise John-Baptiste, Thomas Clayton, Charlotte Marriot, Tom Reevell, Nicola Mackenzie, Temitope Aiyedun, Andy Cruickshanks, Jacqueline Gunn, Alison Moss, Martyn Clark, Swetha Rambhatla, Claire Matata, Ben Cracknell, Pauline Mercer, Matthew Morgans, Catrin Williams, Shareef Madhi, Jane Montgomery, George Kohler, Yasir Hameed, Muneeba Ahmed, Glenn Saunders, Anand Kulkarni, Craig Pinner, Lauren Pearce, Vishnu Bhardwa, Judi Ramsey, Meghna Sharma, Rob Hull, Srinivasan Perumal, Julia Critchley, Stephen Hill, Bethany Fitzmaurice, Robert Crichton, Cormac O'Connor, M. Dickinson, Alison Pearce-Smith, Julie Toms, Kathleen Horan, Ammy Dodd, Rachel Crone, Graeme Finnie, Suman Shrestha, Saul Sundayi, Shamini Sivakumaran, Robert Collin, Janine Musselwhite, Yuvaraj Kummur, Mariana Bernardo, Amrinda Sayan, Gabrielle De Selincourt, Laura Bridge, Melissa Rosbergen, Philip Barclay, Garry Davenport, Daniel Murrell, Andrew Drummond, Eireann Allen, Emma Fadden, Subha Arunachalam, David Robinson, Stephanie Dukes, Catherine Jardine, Sunny Bhat, Hemantha Shiva, Amy Kerr, Henry Elms, Anam Asif, Sandra Evans, Girish Rangaswamy, Laura Thomson, Asad Javed, Jenny Shuttleworth Davies, Maren Kleine-Brueggeney, Sian Edwards, Jean-Paul Zahra, Jo simpson, Priya Verma, Bhamini Tharmalingam, Matthew Edmunds, Stephen Adshead, Hannah Luckhurst, Lara Allen, Colin Merrill, Fiona Lyle, Falguni Choksey, Mohyman El Habishi, Holly Notman, Lisa Murthen, Christiana Georgiou, Georgina Singleton, Tim Cook, Melba Knighton, Shirley Pyke, Amit Gadre, Maria Rehnstrom, Helen Hothersall, Anja Kuttler, Anita Boltres, Sarah Williams, Sarah Welch, Yamuna Madhu, Pramod Nalwaya, Alistair Coleman, Jeanie Worthington, Jasmine Samuel, Rajashekar Gowni, Karen Burt, Shamim Haque, Reynard Knoetze, Hakeem Yusuff, Tom Taylor, Val Parkinson, Sheik Pahary, Jonathan Fortune, Natalie Long, David Gilhooly, Karthick Duraisamy, Duncan Baines, Shondipon Laha, Marie Appleby, Jyothi Hosahalli, Christine Catley, Jasmine Jose, Damien Mantle, Dinkar Gowda, Permendra Singh, Ramesh Khoju, Carol Bradbury, Sarah Hazeldine, Karan Kanal, Sonal Lodhi, James Craig, Rachel Wong, Teresa Ferreira, Charis Banks, Ben Chandler, Asia Sarwar, Sivaprakash Vaitheeswaran, Sam Bews, Katie Hunter, Sohan Bisonoothan, Lauren Hunt, Melony Hayes, Nilesh Chauhan, Janet Pickett, Sharon Dealing, Jamie Plumb, Thomas Hollins, Claire Hill, Claire Hindmoor, Nicolas Hooker, Hannah Davis, Laura Mee, Elizabeth Thomas, James Self, Jenny May-Ling Cheung, Jane Varin, Manish Kakkar, Anuj Wali, Omar Siddique, Sophie Earl, Elizabeth Longdon, Alison Meadows, Shafi Ahmed, David MacPherson, Shaima Elnour, Suzi Hale, Ramez Ibrahim, Fei Long, Orlanda Allen, Alice Groves, Mohammed Wahid, Angela Stevens, Carl Ilyas, Richard Robley, Nichola Bleasby, Peter Havalda, Ursula McHugh, Judith Brade, Georgia Monantera, Stuart Younie, Brian Johnston, Jamie Brookes, Linda Park, Graeme Wilson, Mark Greasley, Lohita Nanda, Vineetha Jayakumar, Ian M. Lyons, Ayman Abdu, Paul Athanasopoulos, Justin Woods, Kariem El-Boghdadly, Diane Simpson, Georgina Williamson, Jonathan McCarter, Anil Golhar, Alicia Waite, Claire Halligan, Sarah Anne Leir, Joanne Turner, Matthew O'Meara, Claire Atkinson, Adam Yarnold, Mark Fernie, Rhiann Marie O'Shaughnessy, Jamie Elwood, Laura Harvey, Ali Atrah, Helen Terrett, Sam Scholes, Rebecca E. Saunders, Vin Vyapury, Amir Rafi, Peter Bradley, Srikant Ganesh, Zehrin Nassa, Ulf Buhmann, Laura Carrick, Natalie Rogers, Said Seifalan, Ian Ryder, Jennifer Partridge, Tim Lovell, Martin Priestley, Caroline Wrey Brown, Joanna Moore, Vidhya Nagaratnam, Saba Iqbal, Francesca Mazzola, Samantha Weller, Laura Gould, Helen Johnston, Jenny Spimpolo, Carmen Scott, Stephen J. Brett, Paul Cripps, Amit Kurani, Alexander Knight, Nirav Shah, Pushkar Patankar, Fraser Waterson, Sarah Martindale, Johannes Mellinghoff, Joanne Wootton, Sarah McCormick, Sameer Somanath, Bilal Yasin, Christopher Skeoch, Toby Jacobs, Katrina Eaton, Lynne Connell, Harry Soar, Yvonne Bramma, Tom Gately, Renjith Joseph, Anish Gupta, Lucie Hobson, Charindri Wariyapola, Maryam Zaky, Nimu Varsani, Gerhardus Van Rensberg, Jackie Evans, Rosahn Saleh, William Sutcliffe, Louise Potter, Harvey Dymond, Catherine (Katie) Patton, Andrew Selman, Stephen Traynor, Kate Tizzard, Rumyana Nyathi, Caroline Reavley, Saima Hashmi, Kerry Hughes, Isabelle Sykes, Kate Slade, Anne Troy, David Castillo, Jennifer Quinton, Anne Adams, Joanne Gresty, Stella Wright, Victoria Christenssen, Iain Mooney, Fiqry Fadhlillah, Seema Pai, Gabor Debreceni, Aleinmar Winthein, Denise Griffin, Hannah Beadle, Elisa Kam, Marie Williams, Helen Howes, Tariq Tabiner, Saxon Prentice, James Bedford, Emma Craig, Peter Standen, Stephen Petley, Janaki Pearson, Cheryl Marriott, Harry Barclay, Alexandra Matson, Michael P.W. Grocott, Alison Thorne, Joanne Humphreys, Vishal Patil, Nick Greenwood, Richard Wassall, S.K. Harris, Valpuri Luoma, Dancho Ignatov, Rebecca Fry, Anamika Sehgal, Antonio Paredes-Guerra, Manjula Yadagiri, Yuvraj Doriaswami, Benjamin O'Donovan, Adam Mounce, Stephanie Wright, Linda Webber, Tracy Hazelton, Ethan Bateson, Theresa Garrett, Chris Honstvet, John Scriven, Rahul Dimber, Phillip Lo, Jenny Stead, Catherine Plowright, Rachel Morris, Pallavbhai Desai, Nicola Johnson, Neil Muchatuta, Vijayakumar Gopal, Sherma Turner, Karina Fitzgibbon, John B. Davis, Sarah Patch, Erica Jolly, Rob Gregory, Christopher Lochrin, Geoffrey Ryder, Sam Michlig, Liana Zucco, Susan Nimmo, Jessica Whiston, Sarah Goellner, Rohan Babla, Deborah Skelton, Lucy Mcmanoman, Darcy Pearson, Diane Forrest, Sanjeev Garg, Joanne Bradley-Potts, Joel Perfitt, Danny J.N. Wong, Mike Weisz, Caroline Lowrie, Timothy Alce, Alice Michell, Charlotte Soulsby, Dominic Hayes, Arnab Mandal, Stephanie Ridgway, Angela Willberry, Alka Grover, Simran Minhas, Kerwei Tan, Sharon Jones, Sam Marcangelo, Ben Millette, Hilary Thatcher, Greg Foster, Krishna Balachandar, Megan McAtear, Richard Shellard, Chris Littler, Thunga Setty, Kavita Sasi-Kumar, Theodore Floyd, Duncan Adshead, Stephen Hickey, South Yorkshire Hospitals Audit, Amy Barker, Ewen Cameron, Dawn Trodd, Wendy Nichols, Beth Farr, Mike Salmon, Naomi Fleming, Umairali Ikram, Ben Straughan, Peter J O'Brien, Laura Purandare, Janine Thomas, Elizabeth Wood, Kate Bosworth, Stewart Mckie, Samantha Evans, Tamilselvan Rajamanickam, Srinivasan Dhileepan, Paul Hindmarch, Colin Bergin, Sange Mansoor, Lisa Armstrong, Nagendra Natarajan, Irmeet Banga, Fiona Osborne, Lynne Williams, Pieter Bothma, Jade Woolley, Joanne Finn, Bernd Oliver Rose, Shaman Jhanji, Bennur Katyayani, Gillian Robertson, Laura Bird, Pauline Fitzell, Sally Anne Smith, Serena Yen, Stuart Clelland, Thomas Urwin, Luff Delme, Rocio Ochoa Ferraro, Nurse Cheryl Padilla Harris, Asad Naqvi, Andy Cumpstey, Natalie C. Wood, Samar Al-Rawi, Pulak Padhi, Claire Botfield, Bhavesh Raithatha, Michael Briskoe, Jolyon Cohen, Ben Gibbison, John John, Stephen Washington, Jayne Foot, Karen Chadwick, Naomi Cochrane, Sophie Spencer, Alexandra Gatehouse, Susan Smolen, Aaron D'Sa, John Sturrock, Christopher P Bourdeaux, Kumud Bhandari, Neil Kellie, Elizabeth Denman, Samson Tou, Laura Kettley, Alex Eros, Stuart McLellan, Nicola Ball, Emily Kirk, Sue Smyth, Kim Gibson, Oliver Barker, Mohammad Masood, Dabeeruddeen Ahmed, Geoff Thorning, Jennifer Van Ross, Esme Elloway, Kat Rhead, Sei Nishimura, Maximiliane Kellner, Benjamin Jacobs, Sanjoy Shah, Matthew Stubbs, Faye Moore, Greg Cox, Nishita Patel, Ashok Nair, Elizabeth Hawes, A Espinosa, Kavita Wankhade, Vladimir Bashliyski, Carina Bautista, Susan Lyjko, Michelle Rowe, Nikita Whotton, Julie Temple, Inthu Kangesan, Gemma McIntosh, Samir Nazir, R. N. Kumar, Jen Warren, Alex Coombs, Marilyn Boampomaa, Kaya Jeyarajah, Heather Savill, Claudette Jones, Vinayak Vanjari, Caroline Tierney, Santhana Kannan, Jennifer Aston, Helen Melsom, Valantine Woodham, Nichola White, Niraj Barot, Paolo Perella, Mayumi Vianzon, Padmanabhan Vatsala, Claire Boynton, Alexandra Edwards, Elisa Masoni, Jayne Edwards, Julie Edwards, Thomas Garth, Amanda Skinner, Kate Blethyn, Jonathan Chambers, Katie Ramm, Rosada Jackson, Thomas Coleman, Tracey White, Emma McKenna, Kanchan Umbarje, Thomas Sheppard, Deepa Jumani, Emma Murphy, Peter Lawley, David Howe, Daisy Alston, Ania Dean, Prasun Mukerjee, Julian Hood, Mahmoud Alkholany, Sarah Goff, Gillian Rennie, Bridget Fuller, Ciara Walker, Jonathan Pipe, Alex Eeles, Wai Soon, Catherine McMillan, Martha Wrigley, Neil Brown, Peter Sandbach, Claire McCahill, Anna Wilson Charlotte Yates, Paul Sampson, Natasha Muzengi, Colum Slorach, Moyra Hynd, Arjun Ardeshna, Trish Boateng, James C. Geoghegan, Rhys Williams, Karoline Middleton, Brian Campbell, Srikanth Chukkambotla, Daniel Leslie, Sherrie Samuels, Michael Allan, Ruth Clarke, Christopher Nutt, Kirsten Reid, Hannah Smith, Surabhi Jain, Stephanie Reed, Hywel Evans, Irene Gardner, Ben Griffiths, Guy Shinner, Marek Frenkiel, Jacek Zeber, Gary Minto, Simon Parrington, Louise Harrison, Carlos Kidel, Hawa Desai, Lois Steuart, Claire Hirst, Johann Harten, Marc Slorach, Angela Christofides, Claire Macey, Helen Moore, Chantal Busby, Andrew Robertson, Leanne Milner, Catherine Chapman, Rebecca Reeves, Lawrence Wilson, Alice Aarvold, Lizzie Irvine, Narayanan Suresh, Kirsteen Brown, James Dalton, Sam Miller, Yasir Rashid, Andrew Swain, Liliana Czukowska, Natasha Permall, Carys Durie, Peter Carroll, Lauren Cooper, Prerna Mehrotra, Sarah Clayton, Martina McMonagle, Sarah Buckley, Enoch Onya, Elizabeth Perritt, Domonique Georgiou, Manjeet Save, Lauren Friedman, David W. Hewson, Katherine McAndrew, Simon Morton, James Morgan, Susan Underwood, Helen Bowyer, Avninder Chana, Lucy Sootheran, Kieron Rooney, Pooja Patel, Jessica Summers, Laura Farmer, Kiran Keshvara, Victoria Richardson, Hannah Crowther, Geejo Rappai, Adam E. Green, Sarah Willcock, Smitangshu Mukherjee, Samuel Tyrrell, Geraldine Landers, Claire McAteer, Jennifer Awolesi, Sarah Higgin, Orla O'Neill, Chrissie Chevis, Paul Winwright, Vikram Malhotra, Jonathan Ogor, Maria Muelmenstaedt, Richard Stead, Lindsay Roughley, Sara Balliston, Nevena Kalcheva, Marc Wittenberg, Adrian Taylor, Lydia Shatanda, Anjali Soodan, Angela Moon, Sarah Elgarf, Matthew Roche, Sanchita Bhatia, Clare Howcroft, Emma Butterfield, Emily Gannon, Matthew Needham, Jacqueline McCormick, Daniel Bendel, Victoria Martinson, David Hall, Richard A. Armstrong, Lara Herbert, Beverly Kilner, Kathy Dent, Victoria Thwaites, Issy Thomas, Maggie Peat, Lisa Macbeth, Alex James, Rachel Flight, Nick Black, Elizabeth Boyd, Catherine Gedling, Suzanne Body, Nadine Farrell, Samantha Clayton, Paula Hiltout, Richard Haddon, Bethany Philpott, Victoria A Burgess, John Jackson, Anita Patil, Chris Platt, Lindsey Iles, Chrissy Braybrook, Katherine Morris, Emma Karsten, Minna Meritahti, Anastasia Lynn-Smith, Dorothy Hutchinson, Rebecca Darbyshire, Joanne Riches, Astri Luoma, Andy Gibson, Dushanthi Thurairasa, Roisin Baker, Xantha Holmwood, Alda Remegoso, Trusha Mistry, Sarah Hennell, Suganthi Joachim, Stephen Harris, Sam Eggleston, Melanie Morrison, Boon Ang, Natalie Jackson, Nicola Jones, Zena Haslam, Beata Iwanicka, Laura Graham, King Dhar, Melanie Kent, Daniel Wirth, Umakanth Kempanna, Laura Troth, Robert Orme, D. Campbell, Raquel Duarte, Muzaffar Sheik, Robert Maher, Jon Bramall, Rebecca Coates, Tracey Cosier, Sarah Vest, Kajan Kamalanathan, Graeme Foggo, Amanda Mohabir, Ritoo Kapoor, Precious Basvi, Jamie McCanny, Christian Frey, Bruce Emerson, Anantharaman Venkataraman, Karen Burns, Gail Pottinger, Mohamed Elwkhiee, Farkhunda Waqas, Alison Loftus, Amanda Kirrage, Ilma Songaile, Craig Smith, Jo Mullender, Hannah McPhee, Miriam Namih, Linda Gregson, Rachel K. Walker, Iain K. Moppett, Christine Adamson, Katie Flower, Tina Stoycheva, Beena Parker, Caroline Thompson, Kootharajan Kamraj, Vignesh Ashok, Ranjit Gidda, Istvan Koczka, Sadie Perkin, Vandita Ralhan, Arun Sengottaiyans, Ruth Hodgson, Peter Valentine, David Nunn, John Hickman, Molly Waldron, Lauren Elliott, Irene Echaveznaguicni, Lisa Dunlop, Julian Sonksen, Robert Fallon, Huw Griffiths, Thoy Ruth, Olivia Clancy, Lucy Dudgeon, Alicia Rodgers, Pamela Oracki, Phoebe Syme, Maria Newton, Stuart P. D. Gill, Julie Foxton, Jane Perez, Liam Gleeson, Richard Green, Sally Beer, Rohit Juneja, Loretta Barnett, Alex Bonner, Eunice Emeakaroha, Andrew V. Bradley, Ravishankar Jakkala Saibaba, Dipali Verma, J. Joseph Kinsella, Swee Ang Tung, Anju Raina, Verity Calder, Andrea Ortu, Chris Walmsley, Suneal Sharma, Michelle Reichman, Tom Stocks, Annika Smith, Ross Cruikshank, Sharon Storton, Matyas Andorka, Abhishek Kakkar, Allison Daniels, Priya Datar, Nichola Wakeford, Sheila Black, Usman Choudhry, Stephen Hackett, Huw Wilkins, Kirtida Mukherjee, Tim Green, Rebecca Hill, Ishan Dharmarathna, Jennifer Crooks, Serah Mungai, Luisa Howlett, Niveen El-Wahab, Linda Prasad, Amy Sadler, David Sharpley, Daphne Varveris, Victoria Ashton, Rajeev Jeevananthan, Safia Begum, Helen Anderson, Katherine Nahajski, Vanessa Linnett, Laura Morland, Stephen Mowat, Nenette Abano, Kathryn James, Ian Butler, Madelaine Ocampo, D. Williams, Gabriella Frunza, Wendy Deamer, Dominic Espitalier-Noel, Sian Liddle, Jane McConniffe, Anthony E. Pickering, Lisha Aju, Catherine Morgan, Hao Ern Tan, Jemma Tate, Emma Dooks, Anna Moore, Alison Hardwick, Liam Scott, Zak Rob, Rajeev Jha, Sujesh Bansal, Lynda Connor, Seliat Sanusi, Sophie Mason, Nipun Agarwal, James Woodier, Julian Giles, Lauren Collis, Jill Brown, Natalie Constable, Nichola Cahill, Anne Cowley, Mai Wakatsuki, Kelly Mintrim, Glenn Arnold, Donna Doyle, Ryhs Millington, Richard Dobson, Monica Serrano, Saqib Naji, Walid Hammad, Jacob Osbourne-Wylde, David Rollins, Claudia Paoloni, Nathan Anderson, Rachel Ingham, Alison Whitcher, Vicky Hills, Nina Toms, Jon Witby, Amy Nash, Marcus Fletcher, Jane Gibson, Martin Warin, Katherine McDowall, William Malein, Madhurima Das, Wael Abdelrhamen, Tom Neal, Sister Jenny Ritzema, James Collins, Chandana Rao, Joyce Yeung, Nadeem Shakir, Andrea Weigert, Atideb Mitra, Hari Arunachalam, Amy Morgan, Richard J. Jackson, Julie Chadwick, Debbie Callaghan, Frank Swinton, Lorraine Lock, Rahul Wakhle, Krish Kapoor, Ryan Humphries, Sarah Beavis, John-Paul Cutts, Julie Wilson, Keith Kelly, James Gill, Angela Loughlin, Rhys Rhidian, Christopher McGovern, Tom Hickish, Rachel Campbell, James Pennington, James Tozer, Philip Coakley, Lynn Fenner, Sally Tomkins, Lester Ribeiro, Shabir Qadri, Hristina Petkova, Christina Timmons, Katy Smith, Jonathan Perry, Stephen Crotty, Tanmay Patil, Mayavan Abayalingam, Ahmed Foly, Anna Wahed, Lewys Winfield-Young, Naomi Goodwin, Mark Verlander, Clare Donovan, Milena Vannahme, David Helm, Murali Vallabhaneni, Clare Ingram, Neil Moreland, Lorraine Stephenson, Jenny Jackson, Lindsay McOwat, Sathya Visvendra, Rhiannon Jones, Sarah Bird, M. H. Nathanson, Beryl Jones, Claire Davies, Beena David, Ian Sheldrake, Jeremy Guilford, Sister Bryony Storey, Rajeev Mishra, Irina Halfacree, Kiran Rait, Sameer Ahmed, Victoria Poyntz, Pamela Birks, Tom Kennedy, Angiy Michael, Michael McEvoy, Ian Davies, James Chan, Sajjad Ahmed, Laura Sweeney, Anne Whaley, Andrew Moores, Stella Gillies, Gearoid Crosbie, Antoinette Wilson, Iain Walker, Fiona Brailsford, Virginia Solanki, Elizabeth Turnbull, Lyndon Harkett, Sarah Ramsay, Thomas Syratt, Pushpaj Gajendragadkar, Cathal Small, Joanna Poole, Annabelle Whapples, Raghavendran Krishnaiyan, Elizabeth Smee, Richard Pierson, Taslima Rabbi, Alexandra Murphy, Angela Rooney, Sarah Crawford, Peter Bamford, Stephen Worthy, Sarah Munsie, Lucy Venyo, Henry Wang, Aditya Kuravi, Dennis Barnes, Ruth Han, Benjamin Gupta, Nurse Lynn Wren, Robert Hartley, Emma Edmunds, Laura Blood, Valerie J. Page, Thomas Judd, Puvan Suppiah, Emma Jenkins, Kate Gallagher, Fionnuala Lenehen, Rashidat Adeniba, Julius Cranshaw, Julie Wollaston, Kathryn Allison, Richard Kirkdale, Samantha Griffith-Norris, Jenna Kelly, Snehasish Guha, Stefan Schraag, Joy Dearden, Elizabeth Bell, Stephen Smith, Sarah Longhurst, Elizabeth Wilby, Annaliza Sevillano, Raksha Mistry, Aalisha Mariam Karimi, Kaung Pyae, Sarang Puranik, Maggie Collingborn, Karen Cranmer, Chandrashekhar Vaidyanath, M. Chincholkar, Narendra Siddaiah, Gillian Bell, Edward Rintoul, Nicki Devooght-Johnson, Tom Lovejoy, Eleanor Roscoe, Zoe Neilson, Joanne Hill, Kamal Sharif, Sharon Meehan, Bassey Nkanang, Thomas Georgiou, Martin Goodman, Prashant Kakodkar, Rebecca Martin, Philip Roddam, Evanna McEvoy, Peter Tsim, Janakan Anandarajah, Shub Gupta, Oliver Pratt, Yang Ng, Francesca Th'ng, Linda Kent, Graham Soulsby, Danielle Kirk, Ramana Govindaraju, Rebecca McClean, Samantha Harkett, Obaid Tarin, Shalini Chinna, Susan Gallagher, Laura Gardiner, Marc Turnbull, James Briscoe, Anna McSkeane, Melanie Claridge, Gillian Fleming, Thomas Huttley, Elaine Spruce, Lianne Hufton, Susan Hendy, Adrian Barry, Jeremy Drake, Cody Allen, James Hillier, Manju Patel, C. Gray, Nasreen Iqbal, Karen Markwell, Linzi Heaton, Michelle Nicholas, Gary Lau, Laura Catchpole, Nurse Sonia Walia, Kerry Elliott, Jake Hartford-Beynon, Amee Samani, Kathryn King, José William Martínez, Skylar Paulich, Ifan Patchell, Killian McCourt, Rebekah Rodgers, Christine Wood, Richard Wan, Karan Verma, H. W. Cain, Eleonore Quinn, Lisa Richardson, Muhammad Usman Latif, Nicholas Hingley, Rajesh Gilla, Roopa McCrossan, Mayeth Recto, Russell Hedley, Lucy McClelland, Suzie Marriott, Deepak Seharawat, Gururaj Mudimadagu, Claire Jones, Michelle Yare, Sophia Henderson, Rupinder Kaur, Emily Spence, David Wright, Bhaskar Dutta, Tom Pettigrew, Vikki Atkinson, Lorna Sissons, Segun Oladele, Sue Thomas, Hani Ali, Rebecca Robson, David Buckley, Kevin Hamilton, Amanda Hall, Anaesthetic Audit, Anna Watkin, Donna Kelly, Graham White, Sarah Sanders, Henry Boyle, Joao Galente, Thomas Williams, Justin Ang, Sarah Horton, Abdelrahman Soliman, Vijay Jeganath, Kavita Upadhyaya, Plamen Stoyanov, Murray Geddes, Alan Pope, Khaled Ellisy, Thomas Walker, Emma Finlay, Penny Parsons, McDonald Mupudzi, Adam Duffen, James Goodwin, Rob Penson, Laura O'Sullivan, Vinesh Mistry, Ravindra Mallavalli, Krzysztos Guz, Deepti Bhuwanee, Eleanor Andrews, Justine Burns, Sarah Kirk, Faith Kibutu, Sam Stafford, Julia Blackburn, Joellene Mitchell, Robert Spencer, Helen Williams, Karen Riley, Gabbie Young, Tom Williams, James Wu, Emma Wheatley, Alistair Johnstone, Rachel Stoeter, Timothy Cominos, Guy Coady, Ruth Mawhinney, Sam Spinney, ruthy Arumugam, Myura Nagendram, Jason Lie, Sian Hughes, Linda Bairkdar, Peter Evans, Daniel Pygall, Graeme Brown, Susan Livingstone, Norbert Skarbit, Amit Pruthi, Zakaulla Belagodu, Ben Linton-Willoughby, Richard A Cowan, Helena Prady, Mike Raffles, Sonia Rasoli, Katherine Cullen, Jessica Lees, Peter Lax, Ashok Puttapa, Fran Millinchamp, Aneta Oborska, Benita Adams, Kathryn Newton, Mrutyunjaya Rao Rambhatla, Sunny Nayee, Madlena Ivanova Vrazhalska, Jonathan Clarke, Aariana Sohal, Siobhan King, James Bain, Jessica Wilson, Anthony Carver, Jack Davies, Lucy Connolly, Samuel Morrish, Robyn Lee, Lucia Stancombe, Satyanarayan Jakkampudi, Kath Rosedale, Philip Hopkins, Clovis Rau, Katherine Hunter, Amy Farrow, Kathleen Holding, Elizabeth Vassell, Oliver Boney, Julia Icke, Ewa Prusack, Osi Egole, Fiona Linton, Suresh Eapen, Wendy Goddard, Ayda Borjian Boroojeny, Simon J. Davies, Jackie Terry, Fiona Graham, Thomas Pratt, Hanzla Naeem, Viv Colclough, Yeng Yap, Tejuswi Patel, Susan Midgley, Mark MacGregor, Ben Marshall, Talitha Devries, Cheng Ong, Katie Molloy, Kat Walker, Katy Irwin, Abbas Majeed, Mark Pinkerton, Nicki Russell, Sibtain Anwar, Ian A Jenkins, Lucy Allen, Elaine Coulborn, Ganesh Nair, Stewart Brown, Melissa Addy, Matt Milner, Amr Hassan, Victoria Millar, Sarah Turner, Gary Baigel, Amanda Lyle, Simon Young, Kathy Malinovszky, Heather Short, Mary Newmarch, Colin McAdam, Andrew Robert Bailey, Kevin Draper, Michael Agyemang, Kieran Oglesby, Clare Mewies, Ruth Ugochukwu, Shibu Jacob, Susan O'Connell, Charlotte Topham, Xiao Zhao, Shay Willoughby, Ossian Aukland Child, Manish Torne, Ben Wetherell, Divya Veluvolu, Dominic Wu, Elizabeth Evans, Daniel Eden, Suzannah Peggler, Lucy Emmett, Romit Samanta, Ravi Parekh, Jane Hermanowski, Will Shankey-Smith, Sam Papadopoullos, Julie Camsooksai, Sara Mistry, James Wigley, Anna Todd, Bally Purewal, Natalie Baldry, Kate Wilkinson, Aalia Sange, Kirsty Baillie, Joanne Topliffe, Denise McSorland, Saheli Das, Nikki Staines, Catherine Harris, Anna-Marie Boniface, Gemma Milne, Tessa Rowlands, Leanne Quinn, Svetlana Kulikouskaya, Christopher Bull, Angus Sutherland, Mihir Desai, Hannah Goodhand, Meenal Rana, John Bugo, Maria Chazapis, Sarah Kent, Sarah Siew, Marcin Pachucki, Tim Forsyth-Jones, John McKenna, Sarah Driscoll, Laura Hunter, Penny Bedoes, Natasha Santana-Vaz, Sandra Latham, Robert Coe, Sharon Christie, Lawrence R Kidd, Katy Redington, Alastair Sawyer, Abdalla Ali, Rekha Jayapal, Manfred Staber, Emma Pearson, Stuart Reilley, Tom Bird, Kristofor Inkpin, Annette Haines, Manish Verma, Naomi Wee, Ozerah Choudhry, Daniel Tucker, Euan Campbell, Aaron Stokes, Ashley Allan, Emma Reeves, Helen Fenner, Melanie Cockroft, Tom Nicholls, Sinan Bahlool, Sharon Drake, Nalini Sethia, Lesley Jordan, Martin Northey, Paul Glyn Jones, Lara Jeanes, Emma Simpson, Julia Brown, Samantha Coetzee, James Nicholas, Adam Samways, Ritesh Ganesh, Martin Ward Platt, Mizan Khondoker, Helen Wibberley, Lauren Simmonds, Sunita Agarwal, Linda Titinchi, Fran O'Higgins, David Pritchard, Laura Beard, Yvonne Lester, Charlotte Hirst, Louise Wills, Kevin Windsor, Haren Jyothiraj, Carmela Martella, Stephanie Bell, Christopher Nwaefulu, Hemamangala Venkatesh, Camilla Stagg, Soumi Ghosh, Thomas Dawes, Jennifer Lockhart, Stavros Papadopoulos, Nanci Doyle, Gillian Whalley, Rachael Britton, James Goddin, Maggie Dawson, Carole Holder, Elaine Morsman, Rachel Lovatt, Venu Mehta, John J.B. Allen, Anna Perham, Stephanie Wallis, Dmitry Zabauski, Peter Hart, Tracy Sharp, Martin Pope, Jo Knight, Jane Wright, Nageena Hussain, Josie Snell, Thomas Knight, Philippa Hill, Nic Martins, Robin Williams, Beverley Stidolph, Beth Peers, Brian Lafferty, Alicja A'Court, Joanna Collins, Charlie Kennedy, Andy Bates, Graham Walkden, Mia Marsden, Lauren Shillito, Poonam Bopanna, Raheel Ahmed, Ada Ezihe-Ejiofor, Kate Driver, Mevan Gooneratne, Carolyn Smith, Caroline Abernethy, Kathy Shammas, Chanice Alcock, Yin Yong Choo, Mark Vertue, Ratna Makker, Victoria C. Smith, Sachin Mehta, Clare Denford, Wint Mon, Jose Miguel Sabugueiro, Liz Varghese, Mohamed Ahmed, Rebekah Chan, Alexandra Williams, Stephanie Pauling, Maria Faulkner, Ryan Wilkins, Sara Stevenson, Kathryn Simpson, Moiz Alibhai, Patricia Williams, Pascal Defeyter, Siva Sangaralingham, Lucy Evans, Shirley Cocks, Simon Dyer, William Rea, Caroline Renton, Karl Braid, Ranjit Bains, Holly Owen, Sue Brixey, Calum Taylor, Laura Coleman, Andrew Peeling, Daniel Solomon, Christopher Perman, Roisin McCallum, Helen Church, Martin Watson, Amy Bamford, Elizabeth Bradshaw, Elizabeth Turner, Owen Vale, Suneetha Ramani Moonesinghe, Preeti Mahidik, Lynsey Cubitt, Catherine Hunter, Eleanor Warwick, Sam McAleer, Suresh Singaravelu, James Hilton, Rebecca Aspinall, Icel Souleimanova, Muna Elsheikh Idris, Wei Teo, Sarah El-Sheika, Adrienne Stewart, Sadia Habib, Emily Wade, Liesl Despy, Sharmin Shohelly, Colin Williams, Louise Shaw, Shree Voralia, Dafydd Lloyd, Barbara A. Crooks, Laura D Howe, Una Gunter, Edward Hare, Louise Nimako, Ruth Young, Helen Doherty, Sock Huang Koh, Stephen Merron, Martina Coulding, Agilan Kaliappan, Clare Bolton-Hill, Jill Wain, Maria O'Callaghan, Catherine Cartmell, Nicola Pemberton, Hannah Bennett, Lynda Garcia, Riquella Abbott, Sally Jeffrey, Thomas McLoughlin, Andrew Gratrix, Christopher Harrison, Matt Mackenzie, Jayshree Gracey, Chris Moore, Benjamin Parsons, Nehal Patel, Stephanie Brooks, Catherine Riley, Jemma Gilmore, Ilya Kantsedikas, Simon Whiteley, Emily Pallister, Angie Organ, Yohinee Rajendran, Gopinath Selvraj, Priya Thorat, Ilona Schmidt, Pauline Austin, Nitin Madhukar Sadavarte, James Haddock, Alastair Duncan, Richard Bateman, Elaine Chinery, Martin Gray, Felicity Corcoran, Shanelle Tharuka Wijesuria, Bryany Bond, Charlene Otieno, Sion Lewis, Cieron Roe, Dan Freshwater-Turner, Annette Bolger, Sarah Steynberg, Louie Saclot, Charlotte Busby, Jack Roberts, Richard Dagnan, Jasna Comara, Krishnakar Melachuri, Sian Gibson, Joanne Taylor, Manju Agarwal, Mark Sheils, Matthew Bell, Rosemary Anna Lewis, Kiran Patel, Mansoor Siddiqui, Christopher J. Groves, Mini Thankachen, Sharon Turney, Viral Dalal, Pele Banugo, Andrew Baird, Euan Kerr, Simon Tomlins, Laura Osbourne, Nicola Pattison, Stuart Joy, Susan Merotra, Lorna Ryan, Lisa-Jayne Cottam, Chye Siaw, Keelan Jerram, Nurse Diane Scarletta, Carole Paley, Jennie Smith, Will Gatfield, Stephen Alderson, Claire Swarbrick, Amelia van Manen, Stephan Clements, Sophia Strong-Sheldrake, Jake Drinkwater, John McLenachan, Lucinda Williams, Dianne Heaton, Sandor Orosz, Chloe O'Hara, Nina Barratt, Justine Elliot, Michael Gardner, Nicola Crowther, Bharati Rajdev, Linda Hall, Youssef Girgis, Michael Kinsella, Alison Potter, Matthew Martin, Rosie Reece-Anthony, Richard Pugh, Tracey Taylor, Esme Marshall, Wendy Stoker, Helen Worrell, Kay Housley, Rebecca Leslie, Helen Jewitt, Sandeep Sharma, Maire Gallagher, Jon Fenn, Jade Harrison, Hannah Watson, Natalie Morris, Lewis Schofield, Nisha Pattni, Charlotte Thomas, Eleanor Walshe, Richard Snooks, Ruth Murphy, Emily Pickford, Gnanshree Krishnamurthy, Donna McIntosh, Rachel Dolan, Emma Stoddard, Kelly Goffin, Shady Elhallous, Adrian Butler, Ildiko Nemeth, Hannah Wilson, James Sylvester, Melanie Sahni, James Wardlow, Ann Lachana, Emma Barr, Kayleigh Gilbert, Yazzim Hammoud, Peter Csabi, Maqsood Bajwa, James D Turner, Alex Hunt, Samantha Moore, Stephanie Hii, Philip Atkinson, Michelle Walter, Elizabeth Bailey, Frances Tait, Annie Newby, Jane Martin, Greg Forshaw, Bert Quartermain, Sally Humphreys, Aoife Hegarty, Caroline Bennett, Satyajeet Ghatge, Charles Prior, Kribashnie Nundlall, Priaykam Chowdhury, Jill Fitchett, Daiva Bernotaitis, Sandeep Varma, Alex Dunn, Rebecca Dooley, Mahamed Mostafa, Shelly Wood, James Humphreys, Anna Celnik, John Bailes, Mark Snazelle, Christina McCarroll, Matthew Govier, Emert White, Matthew Taylor, Alastair Rose, Brigid Hairsine, Natalie Whybro, Allen George, Robin Wilson, Filipe Vieira, Leon Cohen, Jonathan Womack, Thomas Woodward, Nimali Lochanie, Ben Howes, Joshua Nelson, Preea Gill, Gayle Clifford, Lushani Suntharanathan, Duncan Wagstaff, Steve Pryn, Lalindra Bandara, Sneh Shah, Nowfal Rahman, Iolo Roberts, Mirriam Sangombe, Shaik Subhani, Hannah Phelan, William Udall, Katy Allan, Nicola Zondo, Tim J Peters, James Roe, Catherine Addleton, Angus McKnight, James McCaul, Flora Kormendy, Anil Rao, Luke Vamplew, Andrew Rees, Jeanette Gilbert, Mandy Austin, Thomas Hunt, Sian Birch, Catherine Lloyd, Stewart D'Sylva, Jill Smith, Wendy Lum Hee, Michael Munro, Jean Denton, Julia Hindle, Alice Brown, Ursula Kirwan, Dinithi Yogya, Maria Mclaughlin, Nurse Louise Moran, Larysa Duniec, Sophie Benoliel, Gail Evans, Linda Bailey, Colin Hall, Katie Rowland, Krupali Patel, Ashwini Keshkamat, Zorba Begum, Resti Varquez, Victoria Apps, Giles Bond-Smith, Shirin Dastur, Andy Chapman, Amy Smith, Sarada Gurung, Ruth Delascasas, Nicole Issit, Pauline Sibley, Jaina Parmar, George Madden, Eveliina Nurmi, Katja van de Snepscheut-Jones, Louise Peacock, Vanja Srbljak, Kellie Allen, Andy Chamberlain, Suhail Zaidi, Andrew Boyle, Daniel Stolady, Rita Saha, Mark Clayton, Mitul Patel, Emily King, Hannah Oliver, Ewa Werpachowska, Holly Coles, John Dereix, Agnieszka Kubisz-Pudelko, Clare Watkinson, David Rogerson, Laurence Inman, Jaspreet Rayet, Jenny Finch, Emma Stewart, K. E. Wilson, Emma Tyson, Asif Gani, Reni Jacob, Neil Smith, Johnny Holland, Max Richardson, Mark Chen, Richard George, Helen Laycock, Anoushka Winton, Emily Hignell, Li Fang, Emma Welfare, Rochelle Velho, Fayaz Baba, Finbar O'Sullivan, Lisa Zeidan, N. Beauchamp, Neil Rasburn, Guy Rousseau, Victoria Roberts, Hollie Bancroft, Holly Maguire, Mechele Couch-Upite, Rahul Kumar, Chandra Bhimarasetty, Matt Lovell, Sujata Anipindi, Charlotte Small, Matthew Faulds, Alex Mattin, Alice O'Donnell, James Jack, Richard Boulding, Tarek Mostafa, Rhian Bull, Corinne Pawley, Ruth Killen, Jessica Lowe, Frances Taylor, Ethel Black, Michael F. M. James, Jenny Child, Lisa Emery, Kim Hoyland, David Hay, Janet Cotta, Josephine Stewart, Sue Spearritt, Laura MacNally, Fatma Lahloub, Katie Welham, Sanjoy Bhattacharyya, Shanteela McCooty, Heena Bidd, Hugo Buckley, Ervin Shpuza, Zaid Ahmed, Emily Craven, Amanda Cook, Caroline Dixon, Tara Pauley, Tariq Azad, Helena Barcraft-Barnes, Sindy Lee, Kate Penhaligon, Bernice Dudkowsky, Karen Ellis, Laura Montague, Ching Pang, Elsie Bickmore, Veronica Marsh, Toby Winterbottom, Marta Campbell, Rhys Hughes, Issie Gardner, Elizabeth Steel, Ramai Santhirapala, Katie Sweet, Michelle Scott, John Ekpa, Bhavia Janardhana, Catriona Frankling, Julia Ottaway, Alexander Middleditch, Elna Cifre, Annabel Pearson, Amanda Cotterill, Sarah Raut, Hannah Blanshard, Sara Eddy, Garry Henry, Elizabeth Hood, Maria Loy, Matthew Campbell, Marc Gimenez, Jessica Thrush, Jeremy Henning, Vlad Kushakavsky, Nikolaos Makris, Deborah Fradkin, Karen Fan, Fiona Hammonds, Kathryn Jackson, John Hadfield, Pyda Venkatesh, David Read, Daniel Zeinali, Ryan Hynd, James Carvell, Richard McCormick, Emily Dodds, Sana Rizvi, Amelia Daniel, Dan Sellers, Thomas E. Miller, Daniel Haigh, Nicky Moss, Patrick Dill-Russell, Priya Shekar, Teresa Melody, Randeep Dhaliwal, Nigel Hollister, Andrew Burtenshaw, Adrian Wagstaff, Ben Scoones, Eduardo Osorio, Joanna Allison, Lucy Willsher, Carol McArthur, Stephan Dalchow, Elaine Winkley, Eleanor Reeves, Ben Eden Green, Andrea Ingham, Mohammad Auldin, Freda Amoakwa-Adu, Jonathan Adams, Fiona Oglesby, Charlotte Steeds, Nurse Sara Greig, Obla Suganthi, Puja Chhaniyara, Clare De'Ath, Chandrakant Gosavi, Bart Ordys, Adele Flowerdew, Doug Tunney, Rachel Alexander, Oliver Griffith, Thomas Saunders, Matthew Maton-Howarth, Gabi Metiu, Akmal Shakoor, Elizabeth Willard, Katherine Russell, Matthew Robinson, Emma O'Kane, Meera Raja, Phillippa Falkner, Kerry Colling, Natasha Joshi, Laura Pearse, Tim J. Smith, Anitha James, Mona Mohamed, Richard Kennedy, Samson Ma, Tasmeen Ghafoor, Matthew N. Davies, Henry Lewith, Samuel Mindel, Sarah-Jane Dunn, Hemangini Barot, Sadie Diamond-Fox, Jenny Macallan, Arun Menon, Helen Farrah, Emma Plunkett, Brendon Spooner, Sorana White, Katie Samuel, David Crabtree, Katherine Cheshire, Gareth Harrop, Dionne Wortley, Tim Warrener, Joanne Mullen, Peter Taysum, John Whitaker, Kathy Wilkinson, Jean Dent, Nicola Farmer, Thelma Darian, Guru Hosdurga, Phillipa Wakefield, Christopher W Horner, Julie Steen, Elena Teh, Helen Gerrish, Betty Travasso, Mhairi Jhugursing, Michelle Gardener, Alexandra Crook, Edward W. Miles, Patricia Doble, Ashok Raj, Hanna Wong, Kay Protheroe, Chiraag Talati, Banher Sandhu, Cara Marshall, Matt Holl, Julie Sheriff, Frances Forrest, Adam Mitchell, Hindusha Keerthikumar, Mohamad Mahmoud, Simon Ben-Nathan, Janice Hartley, Danielle Ormandy, Hayleigh Morris, Steven Tran, Imogen Hayes, Trudy Smith, Kirsty Duell, Jennifer Cunningham, Richard Appleton, Lucy Pippard, Debroah Beeby, Hayley Bridger, Manuel Pinto, Susan Beames, Huiqi Wang, Cain Hunter, Flora Darch, Debbie Weller, Jonathan Hulme, Jacqueline Howes, Michael Kriger, Badrinath Manikundalam, D.J.N. Wong, Tim Arnold, Belinda Wroath, Rachel McKendry, Harry Knight, Caroline Bushell, Victoria Siddons, Louise Humphries, Joanne Vere, Vinanti Cherian, Janine Birch, Kate Blyth, Tatyana Bolonenkova, Meredith Harris, Alice Sisson, Sarah Clark, Sandeep Saxena, Samira Green, Amit Ranjan, Gillian Bennett, Chris Smales, Laura Ferguson, Ash Bharti, Francisca Mautadin, Katherine Brown, Lydia Jones, Christopher Adeney, Nikkita Carden, Sanjay Behl, Sonia Sathe, Elizabeth Neale, Helen French, Charlotte Mundy, Anna Batchelor, David Morris, Nithin Roy, Evelyn Philip, P.A.-A. Marc Hastie, Andrea Cole, Edmund Quak, Claire Totten, Karen McIntosh, Fiona Davis, Søren Kudsk-Iversen, Vanessa Unsworth, Andrew McIndoe, Jeremy Bewley, Sarbpreet Sarao, Laura Wood, Elaine Walker, Egidio Da Silva, Danielle Gilmour, Richard Yardley, Zara Eagle, Vijay Ragothaman, Sean Rayappu, Moira Tait, Alex Hamilton, Chris Gillett, Adeel Majeed, John Elton, Arlo Whitehouse, Fiona Robertson, Tim Martindale, Kin So, Kathryn Dixon, Toby Shipway, Fiona Mcneela, Simon Cousins, Brian Conway, Merate Place, Phil Duggleby, Rhian Morgan, Racquel Carpio, Carina Casey, Edward Mew, Jo Han Gan, Caroline Clark, Natasha Sharma, Kay Anne Mak, Gahan Bose, Chris Ford, Ruoling Yan, Anand Sathiapillai, Panagiotis Sgardelis, Sue Redhead, Arjun Alva, Cathy Jones, Vincent Hamlyn, Gemma Squires, Karen Smallshaw, John Whitwell, Sarah Shaw, Paul Watson, Michelle Cheeseman, Kimberley Netherton, Juneenath Karattuparambil, Niyesa Ranasinghe, Jeet Patel, Rob Lyons, Gemma Bown, Helen Bromhead, Zhana Ignatova, Kudakwashe Nyangoni, Linden Baxter, Thomas Moody, Sachin Valap, Esme Sleap, Mario Fernandes, Kinga Bodo, Jane Silk, Charlie Pope, Donna Ferraioli, Chloe Billingham, Rachel Butterworth, Andrew Kelly, Lesley Hawkins, Issac Gill, Hannah Greenlee, Sue Kirby, Jessica Giles, Anna Pierson, Roxana Sandhar, Claire Smyth, Rhona Younger, Ciara Coary, Arif Qureshi, Tahir Abbas, Corinne Rimmer, James Evans, Ida Ponce, Fenner Christoper, Buzz Shephard, Sophie Tang, Lauren Milian, Joanne Hiden, Dhania Haron, Jamie Calderwood, David Freeman, Virginia McTaggart, Carla Lewis, Chai Obeysekera, Alan H. Cohen, Melvin Leong, Jenni Law, Noor Elahi, Kim Holland, Victor Maduekwe, James Garwood, Lizzie Dawson, Virginia Iqbal, Thomas J Craig, Daniel Shuttleworth, Anand Perumal, Mahmood Saad, Seema Charters, Bethany Tookey, P Gunning, Suresh Panchakshariah, I.J. Wrench, Mayur Murali, Susan McInerney, Paul Foley, Charlotte Perkins, Marie-Louise Svensson, Karen Birnie, Samantha Hagan, Emily Hetherington, Anna-Marie Love, Annette Woods, Karen Green, Steve Hillier, Hannah Conway, Rebecca Reilly, Laura Bubb, Amy Ashford, Andrew Savva, Melody MacGregor, Stephen Lord, Ahmed Hassanin, Ramdas Howard, Laura Ashton, Arihant Jain, Simon Williams, Michael Shaw, Jill Deane, Abbie Singleton, Catriona Routley, Christopher Hall, Robin Webber, Tressy Pitt-Kerby, Stuart M. White, Shannon Gawley, Nick Heseltine, Christina Lalani, Claudia Dulea, Arindam Biswas, Rebecca Harris, Aislinn Brown, Nicholas Francis, Ben Holst, Ryan Perry, Cathie Melvin, Mark Darbyshire, Stephen Mulvany, Amy Ashton, Petrus Fourie, Emma Temlett, Jason Cupitt, Vanisha Patel, Alice Trimble, Andrew Brammar, Sarah Grayland, Eleanor Pett, Tom Standley, Carly Webb, Manamohan Rangaiah, Laura Peltola, Leanne Darwin, Yvonne Grimes, Elizabeth Brodier, Scott Berwick, Adam Janeczko, Madeleine McKee, Katherine Davidson, Jan Woodward, Saurabh Mehotra, Tara Keogh, Kofi Mensah, Joyce Guy, James King, Matt Aldridge, Nicolas Price, Alaine Done, Teresa Jones, Julia Sampson, Smita Bapat, Lauren Perkins, Tamas Szelei, Ryan Kingan, Suleman Mulla, Celia Montgomery, Alex Belcher, Salma Kadiri, Bryan Singizi, Peter Chater-Lea, Jennifer Claire Taylor, Lauren Oswald, Stephanie L. Lee, Rhys Griffiths, Samuel Pestell, John Livesy, Sarah Ciechanowicz, Alexander Stephen Harrison, Richard Partridge, Alex Daniels, Beth Penhaligan, Lyndsay Bibb, Jonathan Little, Margaret Cullen, Anya Eijk, Charlotte Earnshaw, Elena Lynes, Nicholas Jenkins, Inthekab Mohammed Ali, Madhu Balasubramaniam, Vusumuzi Shabangu, Paul-Simon Whitney, Rebecca Denyer, Kathryn Potts, Andrew Ray, Jonny Guy, Mike (Stephen) Kinsella, Pearl Baker, Olga Fernandez, Julian Berry, Callum Forbes, Southcoast Peri-operative Audit, Rebecca Rice, Lisa Horner, Sally Pitts, Kirat Panesar, Joe Stevens, Timothy Molitor, Oon Chiu, Piers Murphy, Sudeshkumar Muniyappa, David George, Jonathan Veitch, Shifa Yaruk, Lynn O'Donohoe, Theresa Murray, Laura Tasker, Johanna Wales, Diane Mellers, Robert Sparrow, Olivia Ward, Emma Shacklock, Janet Middle, Sarah MacLennan, Martin Knight, Lindsay Dawson, Teodora Orasanu, Jo Fletcher, Sarah Martin, Pnt Laloë, Gregor Imrie, Harriet Pudge, Tamsin Gregory, Andrea Wood, Colin Christie, James Penketh, Mia Andrews, Nicky Ford, Ellie Fisher, Sophie Robin, Richard Stewart, Steve Williams, Harriet Gardiner, Alison Evans, Guanmei Luo, Urmila Ratnasabapathy, Ruth Joslyn, R. Sneyd, John Westwood, Naomi Cassells, Olivia Kay, Jordi Margalef, S Butler, Hari Nageswaran, Chloe Searles, Geoffrey Wright, Thomas Potter, Drew Norwood-Green, Jonathan Ramsden, Sarah Bean, Emma Sadler, Anaesthetic Trainees, Stephanie Lewis, Kevin E. Thorpe, Sarah MacLean, Paul Ogle, Mary O'Sullivan, Diane Whitehouse, Mandy Oakley, Rachel Coathup, Harisg Venkatesh, Lisa Burgess, Daniela Smith, Kimberley Plummer, Hilary Robb, Jeanette Grocott, Rebecca Mairs, Helen Gilfillan, Moira Morrison, Sharon Garner, and Tammy Towers
Subjects: Adult, medicine.medical_specialty, Adolescent, State Medicine, Cohort Studies, 03 medical and health sciences, Young Adult, 0302 clinical medicine, 030202 anesthesiology, Pregnancy, Risk Factors, Neoplasms, medicine, Humans, 030212 general & internal medicine, Prospective Studies, Young adult, Prospective cohort study, health care economics and organizations, Aged, Aged, 80 and over, Health Facility Size, Postoperative Care, Models, Statistical, business.industry, Incidence (epidemiology), Incidence, Health services research, Operating room management, Odds ratio, Middle Aged, Confidence interval, United Kingdom, Surgery, Obstetrics, Anesthesiology and Pain Medicine, Hospital Bed Capacity, General Surgery, Female, business, Emergency Service, Hospital, human activities, Cohort study
Abstract: Background: cancellation of planned surgery impacts substantially on patients and health systems. This study describes the incidence and reasons for cancellation of inpatient surgery in the UK NHS. Methods: we conducted a prospective observational cohort study over 7 consecutive days in March 2017 in 245 NHS hospitals. Occurrences and reasons for previous surgical cancellations were recorded. Using multilevel logistic regression, we identified patient- and hospital-level factors associated with cancellation due to inadequate bed capacity. Results: we analysed data from 14 936 patients undergoing planned surgery. A total of 1499 patients (10.0%) reported previous cancellation for the same procedure; contemporaneous hospital census data indicated that 13.9% patients attending inpatient operations were cancelled on the day of surgery. Non-clinical reasons, predominantly inadequate bed capacity, accounted for a large proportion of previous cancellations. Independent risk factors for cancellation due to inadequate bed capacity included requirement for postoperative critical care [odds ratio (OR)=2.92; 95% confidence interval (CI), 2.12–4.02; PConclusions: a significant proportion of patients presenting for surgery have experienced a previous cancellation for the same procedure. Cancer surgery is relatively protected, but bed capacity, including postoperative critical care requirements, are significant risk factors for previous cancellations.
Published: 2018

21. 2178. Sensitivity of Blood Cultures in Detection of Bacteremia in Febrile Neutropenia

Author: Vanisha Patel, Jose Amadeo A Ferrolino, Randall Hayden, and Aditya H Gaur
Subjects: medicine.medical_specialty, biology, medicine.diagnostic_test, Streptococcus, business.industry, Klebsiella pneumoniae, Pseudomonas aeruginosa, medicine.disease_cause, biology.organism_classification, medicine.disease, Gastroenterology, Abstracts, Infectious Diseases, Blood culture positive, Oncology, Internal medicine, Bacteremia, Poster Abstracts, medicine, Anaerobic microbial culture, Blood culture, business, Febrile neutropenia
Abstract: Background Febrile neutropenia (FN) secondary to bacteremia is a treatable complication of chemotherapy that increases mortality if not promptly recognized and managed. Methods The sensitivity of blood cultures collected in pediatric oncology patients with FN was assessed and stratified based on the day of FN episode, culture media type, and the source of blood culture draw at a single US center between 2013 and 2018. Paired aerobic and lytic media bottles were inoculated with each culture draw using a weight-based volume of blood; anaerobic cultures were included with initial cultures starting in September of 2015. Results In a retrospective analysis of 10,596 patients, a total of 3,039 episodes of FN were identified. Of the FN episodes, 17.7% had at least one positive blood culture; 84.5%, 1.3%, 0.9% and 13.3% of positive cultures were collected on day 0, day 1, day 2 and ≥ day 3 of a febrile episode. Among the positive day 0 cultures, the median time to detection of an organism was 14.1 hours. Host characteristics of blood culture-positive FN episodes are summarized in Table 1. Bacteremia was identified in 537 FN cases; 18.1%, 11.9% and 2.6% of cultures were positive in only aerobic, lytic or anaerobic media cultures, respectively. The most commonly isolated organisms were Escherichia coli, coagulase-negative Staphylococcus, viridans group streptococcus, Klebsiella pneumoniae and Pseudomonas aeruginosa. Fifteen percent of infectious episodes with a positive blood culture were polymicrobial. Conclusion In summary, the study findings have important clinical implications such as emphasizing the value of day 0 cultures and highlighting the importance of routinely collecting blood cultures in more than one media type. Despite an optimized blood culture approach, less than a fifth of FN episodes had a blood culture-based diagnosis. Disclosures Randall Hayden, MD, Abbott Molecular: Advisory Board; Quidel: Advisory Board; Roche Diagnostics: Advisory Board.
Published: 2019

22. Abstract 3006: A novel strategy of targeting opioidergic receptors to potentially reduce human breast cancer cell proliferation, colony formation, invasion, and migration

Author: Sengottuvelan Murugan, Dipak K. Sarkar, and Vanisha Patel
Subjects: Cancer Research, business.industry, Cancer, Cell migration, medicine.disease, δ-opioid receptor, Breast cancer, Oncology, Cancer cell, Cancer research, Medicine, Cytotoxic T cell, business, Receptor, Clonogenic assay
Abstract: Breast cancer is the second most prevalent cancer after lung cancer among American women. The efficacy of current antitumor therapies is still quite limited. Endogenous opioid peptides, such as endorphin, which is involved in body stress controlling mechanisms, have been shown to enhance immune function and prevent cancer growth and progression in various animal models of cancers. Therefore, targeting the endogenous opioid peptides receptors in the regulation of cancer chemoprevention may offer new promise for the design of therapeutic strategies. Our previous studies have shown differential actions of mu-opioid receptor (MOR) and delta opioid receptor (DOR) on various cell types. In this study we tested the effects of a MOR antagonist naltrexone (NTX) and a DOR agonist (D-Ala2-,N-Me-Phe4,Gly-ol Enkephalin; DPDPE) on proliferation and invasion of human breast cancer cells of different molecular subtype such as T47D (Luminal A), MDA-MB-231 (triple negative, Claudin-Low) and MDA-MB- 468 (triple negative, basal A) in cultures. We used cytotoxicity, clonogenic, cell migration and cell invasion assays to identify effects of these drugs on cancer cells. We found that both NTX and DPDPE have significant cytotoxic effects on these breast cancer cells. Our work from clonogenic, cell migration and cell invasion assays showed that both NTX and DPDPE inhibit the formation of colony, migration and invasion of cancer cells in a concentration-dependent manner. These data suggest that naltrexone and DPDPE have anticancer efficacy in subtypes of human breast cancer cells. The anticancer effects varied depending on the concentration of the drugs and the subtype of breast cancer cells. (Supported by NIH grant R01 CA20863201). Citation Format: Sengottuvelan Murugan, Vanisha Patel, Dipak K. Sarkar. A novel strategy of targeting opioidergic receptors to potentially reduce human breast cancer cell proliferation, colony formation, invasion, and migration [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 3006.
Published: 2019

23. Regional versus general anaesthesia in elderly patients undergoing surgery for hip fracture: protocol for a systematic review

Author: Joyce, Yeung, Vanisha, Patel, Rita, Champaneria, and Janine, Dretzke
Subjects: Anesthesia, Conduction, Hip Fractures, Research Design, Protocol, Humans, Anesthesia, General, Aged, Systematic Reviews as Topic
Abstract: Background With an ageing population, the incidence of hip fractures requiring surgery is increasing. Post-operative delirium is common following hip fracture surgery. Delirium is associated with high mortality and morbidity, poor long-term functional outcomes and institutionalisation. There is some evidence to suggest that perioperative intervention, specifically the anaesthetic technique employed, may reduce the incidence of delirium in this population. The aim of this systematic review is to investigate the impact of anaesthesia type on post-operative delirium. Method We will conduct a systematic literature review using Embase, MEDLINE, CINAHL and the Cochrane Library (CENTRAL) bibliographic databases and the ZETOC and Web of Science websites. Authors of these trials will be invited to contribute unpublished data. PROSPERO register and clinical trial registers will also be searched to identify any ongoing reviews and trials. Eligible studies will assess the incidence of post-operative delirium in patients having regional or general anaesthesia for hip fracture surgery. The primary outcome of interest will be post-operative delirium; secondary outcomes will include mortality, measures of functional outcome, quality of life, length of hospital stay, discharge location and adverse events. Two reviewers will independently screen references identified by electronic literature searches. Two independent reviewers will extract data from studies fulfilling our inclusion criteria using a piloted data extraction form. Methodological quality and bias of included randomised controlled trials will be assessed using the ‘Cochrane Collaborations tool for assessing risk of bias’; for non-randomised studies, this will be assessed using the Newcastle-Ottawa scale. Data on similar outcomes will be pooled when possible. Where possible, meta-analysis will be undertaken using Review Manager (RevMan version 5.3) software. Discussion This systematic review will provide an updated evidence base with which to guide clinical practice and research for this group of challenging patients. If the anaesthetic technique employed is shown to reduce the incidence of post-operative cognition dysfunction, then this may lead to a change in evidence-based practice, influence future guidelines and support further randomised controlled trial research. There is no known effective treatment for delirium, creating the urgent need for research into delirium prevention. Systematic review registration PROSPERO CRD42015020166 Electronic supplementary material The online version of this article (doi:10.1186/s13643-016-0246-0) contains supplementary material, which is available to authorized users.
Published: 2016

24. Additional file 2: Table S1. of Regional versus general anaesthesia in elderly patients undergoing surgery for hip fracture: protocol for a systematic review

Author: Yeung, Joyce, Vanisha Patel, Champaneria, Rita, and Dretzke, Janine
Abstract: Sample search strategy. (DOCX 63 kb)
Published: 2016
Full Text: View/download PDF

25. Additional file 1: of Regional versus general anaesthesia in elderly patients undergoing surgery for hip fracture: protocol for a systematic review

Author: Yeung, Joyce, Vanisha Patel, Champaneria, Rita, and Dretzke, Janine
Abstract: PRISMA Checklist. (DOCX 92 kb)
Published: 2016
Full Text: View/download PDF

26. Osteogenesis imperfecta

Author: Clare Michell, Vanisha Patel, Rouin Amirfeyz, and Martin Gargan
Subjects: Orthopedics and Sports Medicine
Published: 2007

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26 results on '"Vanisha Patel"'

1. A qualitative study exploring the lived experiences of patients living with mild, moderate and severe frailty, following hip fracture surgery and hospitalisation.

2. De novo non-alcoholic fatty liver disease after pancreatectomy: A systematic review

3. The analgesic benefit of Pericapsular Nerve Group (PENG) block in hip arthroscopic surgery: a retrospective pragmatic analysis at an academic health center

4. Budd-Chiari Syndrome as an Initial Presentation of Non-Promyelocytic Acute Myelogenous Leukemia

5. Overview of an emergent, arts-based resiliency curriculum to mitigate medical trainee burnout

6. The Role of Neurovascular System in Neurodegenerative Diseases

7. Recollection of Fertility Discussion in Adolescent and Young Adult Oncology Patients: A Single-Institution Study

8. Development of de novo nonalcoholic fatty liver disease following pancreatectomy

9. S1651 Sociodemographic Factors Associated With Hospital Readmission in Patients With Peptic Ulcer Disease in the State of Florida

10. Critical care usage after major gastrointestinal and liver surgery: a prospective, multicentre observational study

11. S1586 Pancreatic Immune-Related Adverse Events Due to Immune Checkpoint Inhibitor Therapy

12. Prolonged Fever, Diarrhea, Abdominal Pain, and Joint Pain in a 9-Year- Old Boy

13. S73 Development of De Novo Nonalcoholic Fatty Liver Disease Following Pancreatectomy

14. Safety Profile and Efficacy of Cidofovir for Adenovirus in Pediatric Stem Cell Transplant Recipients Following Reduced-Intensity Conditioning

15. Safety of Cytomegalovirus Prophylaxis on Engraftment in Pediatric Umbilical Cord Blood Transplant Following Reduced Intensity Conditioning

16. Diagnostic delay and morbidity of central nervous system tumors in children and young adults: a pediatric hospital experience

17. The effect of regional versus general anaesthesia on post-operative delirium in elderly patients undergoing surgery for hip fracture : a systematic review

18. Methylphenidate Overdose Causing Secondary Polydipsia and Severe Hyponatremia in an 8-Year-Old Boy

19. Ageing and frailty

20. Cancelled operations: a 7-day cohort study of planned adult inpatient surgery in 245 UK National Health Service hospitals

21. 2178. Sensitivity of Blood Cultures in Detection of Bacteremia in Febrile Neutropenia

22. Abstract 3006: A novel strategy of targeting opioidergic receptors to potentially reduce human breast cancer cell proliferation, colony formation, invasion, and migration

23. Regional versus general anaesthesia in elderly patients undergoing surgery for hip fracture: protocol for a systematic review

24. Additional file 2: Table S1. of Regional versus general anaesthesia in elderly patients undergoing surgery for hip fracture: protocol for a systematic review

25. Additional file 1: of Regional versus general anaesthesia in elderly patients undergoing surgery for hip fracture: protocol for a systematic review

26. Osteogenesis imperfecta

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