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Stafford P, Ghevaert C, Campbell K, Smith G, Williamson L, Huntington J, Watkins N, Ouwehand W. YS04 Recombinant Mini-?3 Integrin Fragments for the Detection of HPA Antibodies. Transfus Med 2006. [DOI: 10.1111/j.1365-3148.2006.00693_38.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Williamson L, Arlt W, Shackleton C, Kelley RI, Braddock SR. Linking Antley–Bixler syndrome and congenital adrenal hyperplasia: A novel case of P450 oxidoreductase deficiency. Am J Med Genet A 2006; 140A:1797-803. [PMID: 16906539 DOI: 10.1002/ajmg.a.31385] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The Antley-Bixler syndrome (ABS) is a multiple congenital malformation syndrome with craniosynostosis, radiohumeral synostosis, femoral bowing, choanal atresia or stenosis, joint contractures, urogenital abnormalities and, often, early death. Autosomal recessive and dominant inheritance have been postulated, as has fluconazole teratogenesis. Mutations in POR (P450 (cytochrome) oxidoreductase, an essential electron donor to enzymes participating in cholesterol biosynthesis), have been identified in some patients with the ABS phenotype. Recent evidence suggests that these mutations cause attenuated steroid hydroxylation, which in turn, causes congenital adrenal hyperplasia (CAH) with ambiguous genitalia in both sexes and glucocorticoid deficiency. Here, we report on a new patient with findings of both ABS and CAH that further illustrates how low maternal estriol at prenatal screening can serve as a marker steroid facilitating early diagnosis.
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Affiliation(s)
- L Williamson
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
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Cardigan R, Lawrie A, Mackie I, Williamson L. The above letter was sent to Dr Cardigan et al.; Dr Cardigan and colleagues offered the following reply. Transfusion 2006. [DOI: 10.1111/j.1537-2995.2006.00844.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Krailadsiri P, Seghatchian J, Macgregor I, Drummond O, Perrin R, Spring F, Prescott R, Williamson L, Prowse C, Anstee D, Turner M. The effects of leukodepletion on the generation and removal of microvesicles and prion protein in blood components. Transfusion 2006; 46:407-17. [PMID: 16533284 DOI: 10.1111/j.1537-2995.2006.00737.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Universal leukodepletion (LD) has been implemented in the United Kingdom to reduce the risk of transfusion-transmitted variant Creutzfeldt-Jakob disease. If LD causes microvesiculation of blood cells, however, potentially infectious membrane-associated prion could reach the final products. STUDY DESIGN AND METHODS We have measured microvesicles (MV) derived from red cells (RBC-MV), platelets (PLT-MV), and white blood cells (WBC-MV) and cellular prion protein (PrP(c)) in blood components produced by four whole-blood, five RBC, three PLT, and two plasma LD filters and three plateletpheresis techniques. RESULTS RBC-MV and PLT-MV were either unaltered or reduced by all processes, with PLT-MV reduced 10-fold by RBC LD and greater than 300-fold by plasma LD. WBC-MV were reduced or unchanged by RBC and PLT LD and reduced by plasma LD. Whole-blood filtration appeared to increase MVs derived from granulocytes, but the load in the final components was comparable to that in processed RBCs in additive solution. PrP(c) was reduced by whole-blood, RBC, and plasma LD and unchanged by PLT techniques. There were differences between various filters and techniques, which were generally minor compared to the overall effects. CONCLUSION These findings suggest no detrimental effects of LD processes in terms of generation of MVs or PrP(c) release.
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Affiliation(s)
- Pranee Krailadsiri
- National Blood Service (England and North Wales), Scottish National Blood Transfusion Service, Bristol Institute for Transfusion Sciences, University of Edinburgh and University of Cambridge, United Kingdom
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Abstract
OBJECTIVES To gather data on current preoperative transfusion practice and postoperative complications in sickle cell disease (SCD) as a prelude to a randomised trial. METHODS A prospective one year survey of 114 SCD patients undergoing elective surgery in 31 English hospitals was undertaken. RESULTS 43%, 39% and 23% of patients respectively [corrected] received no transfusion, top-up and exchange transfusion preoperatively. Overall postoperative complication rates were 18%, 26% and 17%, with SCD related complications of 12%, 8% and 0% respectively. 85% of patients with [corrected]HbSC/HbSss(+)thalassaemia and 71% of obstetric and gynaecology patients were not transfused preoperatively, whereas 59% patients undergoing ENT procedures and 83% of hip replacements had top-up and exchange transfusions respectively. Multivariable logistic regression analysis revealed that having moderate/high risk procedures was a predictor of postoperative complications (OR 4.9 (95% CL: 1.3 to 18), P = 0.017) [corrected] while preoperative transfusion was not (OR 1.7, (95% CL: [corrected] 0.5 to 6), P = 0.41). CONCLUSION The lack of clear benefit of transfusion confirms the need for a randomised controlled trial of transfusion vs. no transfusion in patients with HbSS and HbSss(0)thalassaemia.
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Affiliation(s)
- Jackie Buck
- National Blood Service/Medical Research Council (NBS/MRC) Clinical Studies Unit, Long Road, Cambridge CB2 2PT, UK
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Massey E, Stanworth S, Brunskill S, Hyde C, Lucas G, Marks D, Murphy M, Navarrete C, Pamphilon D, Roberts D, Wallington T, Williamson L. Granulocyte transfusions for treating infections in patients with neutropenia or neutrophil dysfunction. Hippokratia 2005. [DOI: 10.1002/14651858.cd004612.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Stainsby D, Williamson L, Jones H, Cohen H. 6 Years of shot reporting--its influence on UK blood safety. Transfus Apher Sci 2005; 31:123-31. [PMID: 15501416 DOI: 10.1016/j.transci.2004.07.006] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2004] [Accepted: 07/05/2004] [Indexed: 11/19/2022]
Abstract
Recognition of the importance of systematic surveillance of adverse effects of transfusion has led to the development of haemovigilance schemes [Faber JC. Haemovigilance around the world. Vox Sang 2002;83(suppl.1):71], of which the Serious Hazards of Transfusion (SHOT) scheme, launched in 1996, was one of the first. Over 90% of UK hospitals now participate in the scheme; in 6 years of reporting, SHOT analysed 1630 events of which 64% were errors in the transfusion process, leading to 193 instances of ABO incompatible transfusion. Transfusion related acute lung injury, bacterial contamination of platelets and transfusion-associated graft-versus-host disease were also identified as important preventable causes of mortality and morbidity. Data from SHOT has provided evidence to support the development of blood safety strategies in the UK.
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Affiliation(s)
- Dorothy Stainsby
- Serious Hazards of Transfusion (SHOT) Steering Group and Standing Working Group, SHOT Office, Manchester Blood Centre, Manchester M13 9LL, UK.
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Holden W, Joseph J, Williamson L. Re: Goodacre and Goodacre. Factors influencing the beliefs of patients with rheumatoid arthritis regarding disease-modifying medication. Rheumatology (Oxford) 2004; 43:1594; author reply 1594. [PMID: 15564646 DOI: 10.1093/rheumatology/keh402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Williamson L, Dalbeth N, Dockerty JL, Gee BC, Weatherall R, Wordsworth BP. Extended report: nail disease in psoriatic arthritis--clinically important, potentially treatable and often overlooked. Rheumatology (Oxford) 2004; 43:790-4. [PMID: 15113998 DOI: 10.1093/rheumatology/keh198] [Citation(s) in RCA: 147] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES To examine the relationship between the severity of nail disease and characteristics of psoriatic arthritis (PsA). We also wished to assess the clinical management of nail disease in patients with PsA. METHODS We studied 69 patients with PsA at two visits. On the first visit, a rheumatology assessment of joint, skin and nail disease was made. On the second visit, a detailed dermatology assessment of skin and nails was made. Nail disease was analysed using a 20-nail psoriasis nail severity score (PNSS). RESULTS There were 57 (83%) patients with clinical evidence of psoriatic nail disease. Although 66 (96%) patients had been treated for skin disease, only one (1%) had received any treatment for nail disease. Severe nail disease measured by the PNSS correlated with severe skin psoriasis as indicated by the percentage of body surface area affected by psoriasis (r = 0.34, P = 0.004) and physician global assessment of psoriasis (r = 0.45, P<0.001). Patients with distal interphalangeal (DIP) joint disease had higher PNSS scores (P = 0.03). The PNSS was also associated with unremitting and progressive arthritis (P<0.001), and correlated with Stanford health assessment questionnaire (HAQ) (r = 0.34, P = 0.004), depression (r = 0.39, P<0.001) and anxiety (r = 0.34, P = 0.004) scores. Compared with dermatology assessment, the rheumatology examination of nail disease had a positive predictive value of 84% and negative predictive value of 83%. CONCLUSIONS In patients with PsA, the severity of nail disease correlates with indicators of severity of both skin and joint disease. Although rheumatologists can adequately screen for nail disease, the management of this aspect of PsA is often overlooked.
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Affiliation(s)
- L Williamson
- Department of Rheumatology, Nuffield Orthopaedic Centre, Oxford, UK.
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Teh J, Stevens K, Williamson L, Leung J, McNally EG. Power Doppler ultrasound of rheumatoid synovitis: quantification of therapeutic response. Br J Radiol 2004; 76:875-9. [PMID: 14711774 DOI: 10.1259/bjr/40466706] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The aim of this study is to quantify power Doppler assessment of therapeutic response in rheumatoid synovitis. 13 patients (6 male, 7 female) with rheumatoid arthritis, who had an acute exacerbation of small joint synovitis in the hands, were examined with quantitative power Doppler, before and after intravenous corticosteroid treatment. All patients were examined by a single radiologist, using an ATL HDI 5000 ultrasound machine (ATL, Boswell). The images were analysed using a specially developed software package (HDI Lab), which quantifies power Doppler signal. All patients improved clinically following treatment, which was reflected in functional disability scores, and in the C-reactive protein levels and erythrocyte sedimentation rate. In all cases, there was a significant decrease in synovial vascularity as measured by the mean amplitude of signal on quantitative power Doppler. Quantitative power Doppler may allow objective assessment of treatment in small joint synovitis.
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Affiliation(s)
- J Teh
- Department of Radiology, Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxford OX3 7LD, UK
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Massey E, Stanworth S, Brunskill S, Hyde C, Lucas G, Marks D, Murphy M, Navarrete C, Pamphilon D, Roberts D, Wallington T, Williamson L. Granulocyte transfusions for treating infections in patients with neutropenia or neutrophil dysfunction. Hippokratia 2004. [DOI: 10.1002/14651858.cd004612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Williamson L, Dockerty JL, Dalbeth N, McNally E, Ostlere S, Wordsworth BP. Clinical assessment of sacroiliitis and HLA-B27 are poor predictors of sacroiliitis diagnosed by magnetic resonance imaging in psoriatic arthritis. Rheumatology (Oxford) 2004; 43:85-8. [PMID: 13130147 DOI: 10.1093/rheumatology/keg475] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To determine the frequency and clinical predictors of sacroiliitis diagnosed by magnetic resonance imaging (MRI) in a psoriatic arthritis (PsA) population. METHODS The studied comprised 103 patients with PsA. A careful clinical assessment for sacroiliitis was made from history and examination, and HLA-B27 testing was performed. Sixty-eight patients underwent tilted coronal fat-saturated T1-weighted and STIR MRI of the sacroiliac joints. RESULTS Clinical features of moderate or severe sacroiliitis were found in 24/68 (35%) patients. MRI features of sacroiliitis were found in 26/68 (38%) patients. Clinical features of sacroiliitis were present in 14/42 (33%) with normal MRI scans and 10/26 (38%) with abnormal scans (normal vs abnormal scans, P = 0.7). The presence of sacroiliitis on MRI was associated with restricted spinal movements (P = 0.004) and the duration of PsA (P = 0.04). There was no correlation between HLA-B27 and sacroiliitis diagnosed by MRI. CONCLUSION Sacroiliitis diagnosed by MRI occurs commonly in PsA but is difficult to detect clinically.
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Affiliation(s)
- L Williamson
- Nuffield Orthopaedic Centre, Headington, Oxford OX3 7LD, UK.
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Abstract
An important principle of the use of blood components is the ability to trace them from the donor to the recipient. This study set out to establish whether there was sufficient documentation in patient case notes to confirm the transfusion of blood components in a sample of computer blood bank records at two large teaching hospitals in UK. The criteria for verification of transfusion were taken from guidelines from the British Committee for Standards in Haematology (Transfusion Medicine 1999, 9, 227-238). The blood bank computer records indicated that 486 units of blood components were issued and not returned to the blood bank for 80 patients during a 2-month period. Of the 486 units, transfusion of 409 units (84%) was verified against patient notes, but 77 units (16%) could not be verified as received by the patient. The study showed that documentation of transfusions was variable. For example, written prescriptions were only found for 204 units (42%). These results have implications for 'lookback studies' involving blood transfusion. Further efforts are required to educate those involved in transfusing blood about the need for accurate documentation.
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Affiliation(s)
- S Ballard
- National Blood Service/Medical Research Council Clinical Studies Unit, Cambridge, UK.
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Williamson L. The Desktop Guideto Complementary and Alternative Medicine—an Evidence‐based approach. Edited by E. Ernst, M. H. Pittler, C. Stevinson and A. White. £25.99. Mosby, Philadelphia, USA, 2001. 448 pages. ISBN 0‐7234‐3207‐4. Rheumatology (Oxford) 2003. [DOI: 10.1093/rheumatology/keg126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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72
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Cardigan R, Allford S, Williamson L. Levels of von Willebrand factor-cleaving protease are normal in methylene blue-treated fresh-frozen plasma. Br J Haematol 2002; 117:253-4. [PMID: 11918568 DOI: 10.1046/j.1365-2141.2002.3406_6.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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74
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Williamson L, Stoops N, Heywood A. Developing a District Health Information System in South Africa: a social process or technical solution? Stud Health Technol Inform 2002; 84:773-7. [PMID: 11604842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
South Africa initiated a national District Health Information System rollout strategy in the latter half of 1999. Experience has demonstrated that the implementation of an information system as a vehicle for the delivery of accountability in the management of health services, demands organisational change within a framework of human resource development and technical support. The aim of training, to empower facility and district staff to use locally generated information to improve coverage and quality of primary health care services, can only be realized if training and innovation for change are appropriately marketed and supported. The appeal of HISP software, a locally developed application system lies in its user acceptance. While computers form a vital tool in providing easily accessible information for decision-making, their use must not be seen as a panacea for all information problems in primary health care services. Strategies for promoting sustainability of DHIS implementation lie in the social processes of human resource development, changing organisational infrastructure and the use of ongoing evaluation rather than those of technical infrastructure. South Africa has developed a variety of mechanisms to facilitate this process.
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Affiliation(s)
- L Williamson
- HISP, Public Health Programme, University of Western Cape, Cape Town, South Africa.
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75
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Krailadsiri P, Perry R, Drummond O, Smith K, Hockley D, Seghatchian J, Spring F, Macgregor I, Williamson L, Prowse C, Lubenko A, Anstee D, Barrowcliffe T, Turner M. The effects of leucocyte depletion on the generation and removal of microvesicles and prion related protein in blood components. Transfus Apher Sci 2001; 25:177-8. [PMID: 11846133 DOI: 10.1016/s1473-0502(01)00115-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Williamson L. Soul sisters: the St. John and Raynard nurses in nineteenth century London. Int Hist Nurs J 2001; 2:33-47. [PMID: 11618488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
This paper uses the archives of the St John's training institution for nurses and the Raynard Mission to determine the extent to which cultural images and specialised space defined and drove the nursing profession in nineteenth and early twentieth century London. Emphasis is placed upon image and rhetoric, both sacred and secular, and the way the two combined to define the 'ideal' Victorian woman and nursing in the nineteenth and early twentieth centuries, and the understanding and treatment of illness. Research to date suggests that through a process of rationalisation of biblical and socio-cultural rhetoric, a specialisation of space, symbolic and literal, abstract and real was created; this enabled women to work in a gendered enclave, the organisational structure and rhetoric of which paralleled that of nunneries or convents. And even as the 'secular' became dominant in medical attitudes and treatment, the 'sacred'aspect of nursing and the emphasis placed upon it as being a vocation remained strong.
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Engelfriet CP, Reesink HW, Pietersz RN, Schwartz DW, Mayr WR, Blajchman MA, Goldman M, Décary F, Sher G, Georgsen J, Sprogøe-Jakobsen U, Kekomäki R, Kühnl P, Seitz R, Maniatis A, Pintér J, Baróti K, Shinar E, Rebulla P, Greppi N, Sirchia G, Faber JC, Flanagan P, Brand A, Lêtowska M, Nel T, Argelagues E, Martin-Vega C, AuBuchon JP, Williamson L, Wallington T. Universal leucocyte-depletion of blood components: cell concentrates and plasma. Vox Sang 2001; 81:56-77. [PMID: 11520421 DOI: 10.1046/j.1423-0410.2001.00043.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- C P Engelfriet
- Central Laboratory, Netherlands Red Cross, Blood Transfusion Service, Amsterdam, The Netherland
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Abstract
OBJECTIVE Surgery can prevent extensor tendon rupture in the rheumatoid wrist but it is difficult to identify patients at risk. Extensor digiti minimi (EDM) usually ruptures first, but rupture may pass unnoticed because extensor digitorum communis (EDC) extends all four fingers simultaneously. We assessed the value of screening for EDM rupture by examining for absent independent extension of the little finger in a hospital rheumatoid arthritis population. METHODS The EDM test was performed in 550 previously unoperated wrists. Disease activity, joint damage, wrist swelling, tenderness and crepitus were recorded. RESULTS Unsuspected EDM loss was found in nine of the 550 wrists (1.6%); dorsal synovitis was absent or minimal in eight and ulnar tenderness was absent in six. EDM loss was not associated with activity, severity or duration of disease. CONCLUSIONS The EDM test is simple and cheap. It may identify patients at risk and permit prophylactic surgery before hand function is lost.
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Affiliation(s)
- L Williamson
- Department of Rheumatology, Nuffield Orthopaedic Centre, Oxford OX3 7LD, UK
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Whitehead C, Wundke R, Williamson L, Finucane P. Accessing residential care from an acute hospital: can we be more efficient? J Qual Clin Pract 2001; 21:9-12; discussion 13. [PMID: 11422708 DOI: 10.1046/j.1440-1762.2001.00394.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Hospitalized patients who require admission to residential care are often thought to make prolonged and inappropriate use of hospital resources. There are no Australian data on the factors that contribute to length of hospital stay for such patients. The aim of this study was to determine the timing of critical steps in discharge planning for hospitalized patients who need residential care. We prospectively audited 100 consecutive referrals to an Aged Care Assessment Team (ACAT) from one acute hospital in South Australia. Case notes were examined to determine the timings of critical events in discharge planning. We found 47% of patients were discharged to a nursing home, 16% to a hostel, 11% died, 10% returned home and 16% went to another facility. The average length of hospital stay was 27.2 days, and an average of 8.4 days elapsed before a decision to seek residential care was first recorded. A further 4.5 days elapsed before ACAT referral, 4.6 days before ACAT approval and 9.7 days before a residential care bed became available. We conclude that people admitted to our hospital from the community and who subsequently need residential care, spend 36% of their stay awaiting a residential care bed. Most of their hospital stay has elapsed before residential care is considered necessary and referral and approval processes have been activated. Strategies to reduce length of stay should perhaps focus on the earlier recognition of the need for residential care and accelerated referral and assessment processes. Earlier involvement by social work and occupational therapy should be considered.
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Affiliation(s)
- C Whitehead
- Flinders University Department of Rehabilitation and Aged Care, Repatriation General Hospital, Daws Road, Daw Park SA 5041, Australia.
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80
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Williamson L, Cohen H, Love E, Jones H, Todd A, Soldan K. The Serious Hazards of Transfusion (SHOT) initiative: the UK approach to haemovigilance. Vox Sang 2001; 78 Suppl 2:291-5. [PMID: 10938972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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81
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Abstract
BACKGROUND Sickle cell disease is one of the most common inherited diseases in the world, and causes haemolytic anaemia, vaso-occlusive crises and dysfunction in virtually any organ system in the body. Surgical procedures are often required. Blood transfusion regimes can be used preoperatively in an attempt to increase transport of oxygen around the body and dilute the sickled red blood cells, thus reducing the risk of vaso-occlusion. OBJECTIVES To assess the relative risks and benefits of preoperative blood transfusion regimes in patients with sickle cell disease undergoing surgery of any type in any setting. SEARCH STRATEGY We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group specialist trials register which comprises references identified from comprehensive electronic database searches, handsearching relevant journals and handsearching abstract books of conference proceedings. Date of the most recent search: January 2001 SELECTION CRITERIA All randomised or quasi-randomised controlled trials comparing preoperative blood transfusion regimes to different regimes or no transfusion in patients with sickle cell disease undergoing surgery. DATA COLLECTION AND ANALYSIS Both reviewers independently assessed trial quality and extracted data from the study included. MAIN RESULTS Only one trial met the inclusion criteria for the review. The trial compared an aggressive transfusion regime (decreasing sickle haemoglobin to less than 30%) to a conservative transfusion regime (increasing haemoglobin to 10 g/dl) in 604 elective operations in patients with sickle cell disease. The conservative regime was found to be as effective as the aggressive regime in preventing perioperative complications, and was associated with less transfusion related adverse events. No randomised controlled trials were found for transfusion compared to no transfusion. REVIEWER'S CONCLUSIONS While in general conservative therapy appears to be as effective as aggressive in preparation for surgery in sickle cell patients, further research is needed to examine the optimal regime for different surgical types, and to address whether preoperative transfusion is needed in all surgical situations.
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Affiliation(s)
- C Riddington
- Institute of Child Health, University of Liverpool, Alder Hey Children's Hospital, Eaton Road, Liverpool, UK, L12 2AP.
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Ashford P, Gozzard D, Jones J, Revill J, Wallis J, Bruce M, Chapman J, Cohen H, Duguid J, Kelsy PR, Knowles SM, Murphy MF, Williamson L. Guidelines for blood bank computing. Transfus Med 2000; 10:307-14. [PMID: 11123815 DOI: 10.1046/j.1365-3148.2000.00273.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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83
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Engelfriet CP, Reesink HW, Snyder EL, Dzik WH, Masse M, Naegelen C, Brand A, Williamson L, Knipe J, Bruce M, Woodfield DG, Sekiguchi S, Myllylä G, Sabliński J, Zupańska B. The official requirements for platelet concentrates. Vox Sang 2000; 75:308-17. [PMID: 9873268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Affiliation(s)
- C P Engelfriet
- Central Laboratory of The Netherlands, Red Cross Blood Transfusion Service, Amsterdam
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Williamson L, Illingworth H, Smith D, Mowat A. Oral quinine in ankylosing spondylitis: a randomized placebo controlled double blind crossover trial. J Rheumatol 2000; 27:2054-5. [PMID: 10955360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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Abstract
BACKGROUND There is concern that people living in residential care in Australia make significant and often inappropriate use of acute in-patient hospital services. To date, no factual information has been collected in Australia and its absence may allow myths and negative stereotypes to proliferate. OBJECTIVE To determine how and why people living in residential care in Australia use in-patient hospital beds. To determine the outcome of hospitalisation and functional status at 3 months following discharge. METHODS Prospective study of 184 consecutive admissions to hospital following Emergency Department (ED) attendance involving people aged over 65 years and living in residential care in southern Adelaide, South Australia. Information was obtained from the facilities' transfer letters, and where these were inadequate or absent, telephone interviews were held with residential care staff. RESULTS 153 people accounted for the 184 admissions. They had a mean age of 84 years and 69% were female. 61% came from hostels and 35% from nursing homes. They had a wide range of clinical problems and twice as many were admitted to medical than to surgical units. Their mean length of hospital stay was 7.9 days, 2.3 days higher than for non-same-day patients and was higher for hostel than for nursing home residents. All but two admissions were considered unavoidable though the provision of specialised care within residential care could have prevented a further 19 (10%) admissions. 96% of admissions resulted in survival to leave hospital and in 74%, people returned directly to their place of origin. At 3 months follow-up, a further 20% of the group had died while 5% were in hospital. In all, 14% of the original group were in a different long-term care facility while 56% were living at their former residence. CONCLUSIONS People living in residential care are often hospitalised because of acute illness. In the vast majority of cases hospitalisation is both appropriate and unavoidable. Most did not require prolonged hospitalisation and were discharged alive, usually to their original residence. However, within 3 months many had died or had functionally declined. Strategies that prevent health breakdown in the residential care setting need to be developed and trialed.
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Affiliation(s)
- P Finucane
- Flinders Medical Centre and Flinders University of South Australia, Bedford Park, Adelaide, SA, Australia.
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Williamson L, Bowness P, Mowat A, Ostman-Smith I. Lesson of the week: difficulties in diagnosing acute rheumatic fever-arthritis may be short lived and carditis silent. BMJ 2000; 320:362-5. [PMID: 10657336 PMCID: PMC1127146 DOI: 10.1136/bmj.320.7231.362] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/25/1999] [Indexed: 11/03/2022]
Affiliation(s)
- L Williamson
- Department of Rheumatology, Nuffield Orthopaedic Centre, Oxford OX3 7LD.
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Beard MJ, Seghatchian J, Cardigan R, Bennett J, Smith KM, Williamson L. Leucofiltration of sickle cell trait blood "the blocker": NBS London & S.E. experience. Transfus Sci 2000; 22:71-3. [PMID: 10771388 DOI: 10.1016/s0955-3886(00)00017-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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89
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Abstract
BACKGROUND Elderly people in residential care are among the most infirm in society and are at high risk of developing acute medical problems. There are no Australian data on the use of acute hospital emergency services by this group. AIM To determine patterns of use of a major public hospital's Emergency Department (ED) by elderly people living in residential care, their presenting problems and the outcome of attendance. METHODS Prospective study of 300 consecutive referrals to a teaching hospital's ED involving people aged over 65 years and living in residential care in southern Adelaide, South Australia. Case records were examined and residential care staff were interviewed by telephone when information required clarification. This occurred in 25% of referrals. RESULTS The 300 referrals were seen over a three month period and accounted for 2.43% of the 12,371 ED attendances during this period. During this time, at least 4.9% of people in residential care in the region were referred to the ED. The referrals involved 239 residents, 196 (82%) who were referred once only, 32 (13%) twice and 11 (5%) three or more times. Residents had a mean age of 84 years and 70% were female. A broad range of acute medical problems precipitated referral and 61% of people referred were immediately hospitalised. There was no general practitioner (GP) involvement in the management of the presenting illness in 58% of all referrals and in 45% of those where symptoms had been present for over three days. CONCLUSIONS People living in residential care are frequently referred to an ED service, often bypassing their GP in the process. They present with a wide range of acute medical problems for which most are hospitalised. Strategies that anticipate, prevent and manage health breakdown in residential care and so minimise the need for ED referral should be trialed.
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Affiliation(s)
- P M Finucane
- Flinders Medical Centre and Flinders University of South Australia, Adelaide
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90
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Bruce M, Chapman JF, Duguid J, Kelsey P, Knowles S, Murphy M, Williamson L. Addendum for guidelines for blood grouping and red cell antibody testing during pregnancy. BCSH Transfusion Task Force. Transfus Med 1999; 9:99. [PMID: 10428575 DOI: 10.1046/j.1365-3148.1999.009001099.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Williamson L. Women's history and biography. Gend Hist 1999; 11:379-384. [PMID: 20583372 DOI: 10.1111/1468-0424.00147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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92
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Hayes C, Williamson L. Injection technique. Intravenous--1. Nurs Times 1998; 94:supp 1-2. [PMID: 9935362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Affiliation(s)
- C Hayes
- Queen's Medical Centre, Nottingham
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Williamson L. The Use and Quality Control of Leukocyte-Depleted Cell Concentrates. Vox Sang 1998. [DOI: 10.1046/j.1423-0410.1998.75100829.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Williamson L. Self-destruction in the pancreas. Nurs Times 1998; 94:57-9. [PMID: 9749032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- L Williamson
- Nursing Development Centre, City Hospital, Nottingham
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Williamson L. Postoperative care--2. Nurs Times 1998; 94:suppl 1-2. [PMID: 9616628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- L Williamson
- Research and Development, Nottingham City Hospital NHS Trust
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Williamson L. Postoperative care--1. Nurs Times 1998; 94:33A-33B. [PMID: 9697527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- L Williamson
- Research and Development, Nottingham City Hospital NHS Trust
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Williamson L. Pre-operative care--2. Nurs Times 1998; 94:suppl 1-2. [PMID: 9735771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Williamson L. Pre-operative care--1. Nurs Times 1998; 94:suppl 1-2. [PMID: 9735747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Williamson L. Red Blood Cell Substitutes: Basic Principles and Clinical Applications. . Edited by A LAN S. R UDOLPH, R EUVEN R ABINIVICI and G IORA Z. F EUERSTEIN. Marcel Dekker, 1998. Pp. 476. $175. Br J Haematol 1998. [DOI: 10.1046/j.1365-2141.1998.100004804.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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