51
|
Singh RH, Thaxton L, Carr S, Leeman L, Schneider E, Espey E. A randomized controlled trial of nitrous oxide for intrauterine device insertion in nulliparous women. Int J Gynaecol Obstet 2016; 135:145-148. [PMID: 27481016 DOI: 10.1016/j.ijgo.2016.04.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 04/15/2016] [Accepted: 07/07/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of inhaled nitrous oxide for pain management among nulliparous women undergoing intrauterine device (IUD) insertion. METHODS A double-blind, randomized controlled trial was conducted among nulliparous women aged 13-45years who underwent IUD insertion at a US center between October 1, 2013, and August 31, 2014. Using a computer-generated randomization sequence, participants were randomly assigned to inhale either oxygen (O2) or a mixture of 50% nitrous oxide and 50% oxygen (N2O/O2) through a nasal mask for 2minutes before insertion. Only the person administering the inhalation agent was aware of group assignment. The primary outcome was maximum pain assessed 2minutes after insertion via a 100-mm visual analog scale. Analyses were by intention to treat. RESULTS Forty women were assigned to each group. Mean maximum pain score at the time of insertion was 54.3±24.8mm for the N2O/O2 group and 55.3±20.9mm for the O2 group (P=0.86). Adverse effects were reported for 6 (15%) women in the N2O/O2 group and 7 (18%) in the O2 group (P=0.32). CONCLUSION N2O/O2 did not reduce the pain of IUD insertion among nulliparous women. ClinicalTrials.gov: NCT02391714.
Collapse
|
52
|
Fotis L, Shaikh N, Baszis K, French A, Tarr P, Grevich S, Lee P, Ringold S, Leroux B, Leahey H, Yuasa M, Foster J, Sokolove J, Lahey L, Robinson W, Newsom J, Stevens A, Karasawa R, Tamaki M, Tanaka M, Sato T, Yudoh K, Jarvis JN, Moncrieffe H, Bennett MF, Tsoras M, Luyrink L, Xu H, Prahalad S, Morris P, Dare J, Nigrovic PA, Rosenkranz M, Becker M, O’Neil KM, Griffin T, Lovell DJ, Grom AA, Medvedovic M, Thompson SD, Zhu L, Jiang K, Wong L, Buck MJ, Chen Y, Moncrieffe H, Brungs L, Liu T, Wang T, Jarvis JN, Alsaeid K, Alfailakawi J, Alenezi H, Alsaeed H, Beukelman T, Natter M, Ilowite N, Mieszkalski K, Burrell G, Best B, Bristow H, Carr S, Dennos A, Kaufmann R, Kimura Y, Schanberg L, Blier PR, Boneparth A, Wenderfer SE, Moorthy LN, Radhakrishna SM, Sagcal-Gironella ACP, von Scheven E, Gedik KC, Siddique S, Aguiar CL, Erkan D, Cohen E, Lee Y, Dossett M, Mehta D, Davis R, Gilbert M, Goilav B, Meidan E, Hsu J, Boneparth A, Chua A, Ardoin S, Wenderfer SE, Von Scheven E, Ruth NM, Hui-Yuen J, Gedik KC, Bermudez L, Cook A, Imundo L, Starr A, Eichenfield A, Askanase A, Janow G, Schanberg LE, Setoguchi S, Hasselblad V, Mellins ED, Schneider R, Kimura Y, Kimura Y, Grevich S, Beukelman T, Morgan E, Graham TB, Ibarra M, Ruas YS, Klein-Gitelman M, Onel K, Prahalad S, Punaro M, Ringold S, Toib D, Van Mater H, Weiss JE, Weiss PF, Mieszkalski K, Schanberg LE, Kwok TSH, Bisaillon J, Smith C, Brosseau L, Stinson J, Huber AM, Duffy CM, April KT, Lewandowski LB, Scott C, Li SC, Torok KS, Rabinovich CE, Hong SD, Becker ML, Dedeoglu F, Ibarra MF, Ferguson PJ, Fuhbrigge RC, Stewart KG, Pope E, Laxer RM, Mason TG, Higgins GC, Li X, Punaro MG, Tomlinson G, Pullenayegum E, Matelski J, Schanberg L, Feldman BM, Manthiram K, Correa H, Edwards K, Oberle EJ, Bayer M, Co DO, Baris HE, Chiu Y, Huber A, Kim S, Oberle EJ, Beukelman T, Orandi AB, Baszis KW, Dharnidharka V, Hoeltzel MF, Reed A, Huber A, Tomlinson G, Pullenayegum E, Matelski J, Goh YI, Schanberg L, Feldman BM, Schnabel A, Range U, Hahn G, Siepmann T, Berner R, Hedrich CM, Stevens B, Torok KS, Li S, Hershey N, Curran M, Higgins G, Moore K, Rabinovich E, Stevens AM, Stinson J, Connelly M, Huber A, Luca N, Spiegel L, Tsimicalis A, Luca S, Tajuddin N, Berard R, Barsalou J, Campillo S, Dancey P, Duffy C, Feldman B, Johnson N, McGrath P, Shiff N, Tse S, Tucker L, Victor C, Stinson J, Lalloo C, Harris L, Cafazzo J, Spiegel L, Feldman B, Luca N, Laxer R, Bullock DR, Vehe RK, Zhang L, Correll CK, Ganguli S, Shenberger M, Korumilli R, Gottlieb B, Rodriguez M, de Ranieri D, Onel K, Wagner-Weiner L, Tesher M, Wojcicki ER, Maletta KL, Co DO, Malloy M, Thomson S, Olson JC, Wenderfer SE, Gilbert M, Hsu J, Sule S, Rubinstein TB, Goilav B, Okamura DM, Chua A, Greenbaum LA, Lane JC, von Scheven E, Ardoin SP, Ruth NM, Woo JMP, Malloy MM, Jegers JA, Hahn DJ, Hintermeyer MK, Martinetti SM, Heckel GR, Roth-Wojcicki EL, Co DO. Proceedings of the 2016 Childhood Arthritis and Rheumatology Research Alliance (CARRA) Scientific Meeting : Toronto, Canada. 14-17 April 2016. Pediatr Rheumatol Online J 2016; 14 Suppl 1:41. [PMID: 27409414 PMCID: PMC4943514 DOI: 10.1186/s12969-016-0098-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
P1 Serologic evidence of gut-driven systemic inflammation in juvenile idiopathic arthritis Lampros Fotis, Nur Shaikh, Kevin Baszis, Anthony French, Phillip Tarr P2 Oral health and anti-citrullinated peptide antibodies (ACPA) in juvenile idiopathic arthritis Sriharsha Grevich, Peggy Lee, Sarah Ringold, Brian Leroux, Hannah Leahey, Megan Yuasa, Jessica Foster, Jeremy Sokolove, Lauren Lahey, William Robinson, Joshua Newsom, Anne Stevens P3 Novel autoantigens for endothelial cell antibodies in pediatric rheumatic diseases identified by proteomics Rie Karasawa, Mayumi Tamaki, Megumi Tanaka, Toshiko Sato, Kazuo Yudoh, James N. Jarvis P4 Transcriptional profiling reveals monocyte signature associated with JIA patient poor response to methotrexate Halima Moncrieffe, Mark F. Bennett, Monica Tsoras, Lorie Luyrink, Huan Xu, Sampath Prahalad, Paula Morris, Jason Dare, Peter A. Nigrovic, Margalit Rosenkranz, Mara Becker, Kathleen M. O’Neil, Thomas Griffin, Daniel J. Lovell, Alexei A. Grom, Mario Medvedovic, Susan D. Thompson P5 A multi-dimensional genomic map for polyarticular juvenile idiopathic arthritis Lisha Zhu, Kaiyu Jiang, Laiping Wong, Michael J Buck, Yanmin Chen, Halima Moncrieffe, Laura Brungs, Tao Liu, Ting Wang, James N Jarvis P6 Tocilizumab for treatment of children with refractory JIA Khaled Alsaeid, Jasim Alfailakawi, Hamid Alenezi, Hazim Alsaeed P7 Clinical characteristics of the initial patients enrolled in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry Tim Beukelman, Marc Natter, Norm Ilowite, Kelly Mieszkalski, Grendel Burrell, Brian Best, Helen Bristow, Shannon Carr, Anne Dennos, Rachel Kaufmann, Yukiko Kimura, Laura Schanberg P8 Comparative performance of small and large clinical centers in a comprehensive pediatric rheumatology disease registry Peter R Blier P9 Clinical characteristics of children with membranous lupus nephritis: The Childhood Arthritis and Rheumatology Research Alliance Legacy Registry Alexis Boneparth, Scott E. Wenderfer, L. Nandini Moorthy, Suhas M. Radhakrishna, Anna Carmela P. Sagcal-Gironella, Emily von Scheven P10 Rituximab use in pediatric lupus anticoagulant hypoprothrombinemia syndrome - a two center experience Kader Cetin Gedik, Salma Siddique, Cassyanne L. Aguiar, Doruk Erkan P11 Predictors of complementary and alternative medicine use and response in children with musculoskeletal conditions Ezra Cohen, Yvonne Lee, Michelle Dossett, Darshan Mehta, Roger Davis P12 Comparison of pediatric rheumatology and nephrology survey results for the treatment of refractory proliferative lupus nephritis and renal flare in juvenile SLE Mileka Gilbert, Beatrice Goilav, Esra Meidan, Joyce Hsu, Alexis Boneparth, Anabelle Chua, Stacy Ardoin, Scott E. Wenderfer, Emily Von Scheven, Natasha M. Ruth P13 Transitioning lupus patients from pediatric to adult rheumatology Joyce Hui-Yuen, Kader Cetin Gedik, Liza Bermudez, Ashlea Cook, Lisa Imundo, Amy Starr, Andrew Eichenfield, Anca Askanase P14 The systemic juvenile idiopathic arthritis cohort of the Childhood Arthritis & Rheumatology Research Alliance Registry Ginger Janow, Laura E. Schanberg, Soko Setoguchi, Victor Hasselblad, Elizabeth D. Mellins, Rayfel Schneider, Yukiko Kimura, The CARRA Legacy Registry Investigators P15 Results of the pilot study of the Childhood Arthritis and Rheumatology Research Alliance (CARRA) consensus treatment plans for new-onset systemic juvenile idiopathic arthritis Yukiko Kimura, Sriharsha Grevich, Timothy Beukelman, Esi Morgan, T Brent Graham, Maria Ibarra, Yonit Sterba Ruas, Marisa Klein-Gitelman, Karen Onel, Sampath Prahalad, Marilynn Punaro, Sarah Ringold, Dana Toib, Heather Van Mater, Jennifer E. Weiss, Pamela F. Weiss, Kelly Mieszkalski, Laura E. Schanberg P16 A systemic review of pain relief modalities in juvenile idiopathic arthritis: First step in developing a novel decision support intervention Timothy S. H. Kwok, Jacinthe Bisaillon, Christine Smith, Lucie Brosseau, Jennifer Stinson, Adam M. Huber, Ciaran M. Duffy, Karine Toupin April P17 Barriers and facilitators to care retention for pediatric systemic lupus erythematous patients in South Africa: A qualitative study Laura B Lewandowski, Christiaan Scott P18 Evaluating the feasibility of conducting comparative effectiveness studies in juvenile Localized Scleroderma (jLS) Suzanne C. Li, Kathryn S. Torok, C. Egla Rabinovich, Sandy D. Hong, Mara L Becker, Fatma Dedeoglu, Maria F. Ibarra, Polly J Ferguson, Rob C. Fuhbrigge, Katie G. Stewart, Elena Pope, Ronald M. Laxer, Thomas G. Mason, Gloria C. Higgins, Xiaohu Li, Marilynn G. Punaro, George Tomlinson, Eleanor Pullenayegum, John Matelski, Laura Schanberg, Brian M. Feldman P19 Tonsillar histology in patients with periodic fever, aphthous stomatitis, pharyngitis, adenitis (PFAPA) syndrome Kalpana Manthiram, Hernan Correa, Kathryn Edwards P20 Clinical course of juvenile dermatomyositis presenting as skin predominant disease Edward J. Oberle, Michelle Bayer, Dominic O. Co, Hatice Ezgi Baris, Yvonne Chiu, Adam Huber, Susan Kim P21 A Survey of musculoskeletal ultrasound practices of pediatric rheumatologists in North America Edward J Oberle, Timothy Beukelman P22 Assessment, classification and treatment of calcinosis as a complication of juvenile dermatomyositis: A survey of pediatric rheumatologists by the Childhood Arthritis and Rheumatology Research Alliance Amir B. Orandi, Kevin W. Baszis, Vikas Dharnidharka, Mark F. Hoeltzel, for the CARRA JDM Committee P23 CARRA dermatomyositis CTP pilot study Ann Reed, Adam Huber, George Tomlinson, Eleanor Pullenayegum, John Matelski, Y. Ingrid Goh, Laura Schanberg, Brian M. Feldman P24 Unexpectedly high incidences and prolonged disease activity in children with chronic non-bacterial osteomyelitis (CNO) as compared to bacterial osteomyelitis Anja Schnabel, Ursula Range, Gabriele Hahn, Timo Siepmann, Reinhard Berner, Christian Michael Hedrich P25 Juvenile systemic sclerosis cohort within the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Legacy Registry: Follow up characteristics Brandi Stevens, Kathryn S. Torok, Suzanne Li, Nicole Hershey, Megan Curran, Gloria Higgins, Katharine Moore, Egla Rabinovich, Anne M. Stevens, for the CARRA Registry Investigators P26 Development and usability testing of an iPad and desktop psycho-educational game for children with Juvenile Idiopathic Arthritis and their parents Jennifer Stinson, Mark Connelly, Adam Huber, Nadia Luca, Lynn Spiegel, Argerie Tsimicalis, Stephanie Luca, Naweed Tajuddin, Roberta Berard, Julia Barsalou, Sarah Campillo, Paul Dancey, Ciaran Duffy, Brian Feldman, Nicole Johnson, Patrick McGrath, Natalie Shiff, Shirley Tse, Lori Tucker, Charles Victor P27 iCanCopeTM: User-centred design and development of a smartphone app to support self-management for youth with arthritis pain Jennifer Stinson, Chitra Lalloo, Lauren Harris, Joseph Cafazzo, Lynn Spiegel, Brian Feldman, Nadia Luca, Ronald Laxer P28 Accessing pediatric rheumatology care: Despite barriers, few parents prefer telemedicine Danielle R. Bullock, Richard K. Vehe, Lei Zhang, Colleen K. Correll1 P29 Exploration of factors contributing to time to achieve clinically inactive disease (CID) in juvenile idiopathic arthritis (JIA): A preliminary report Suhas Ganguli, Max Shenberger, Ritesh Korumilli, Beth Gottlieb P30 Pediatric rheumatology referral patterns: Presenting complaints of new patients at a large, urban academic center Martha Rodriguez, Deirdre de Ranieri, Karen Onel, Linda Wagner-Weiner, Melissa Tesher P31 Quality improvement (QI) initiatives in childhood systemic lupus erythematosus (cSLE) Elizabeth Roth Wojcicki, Kristyn L. Maletta, Dominic O. Co, Marsha Malloy, Sarah Thomson, Judyann C. Olson P32 Proliferative lupus nephritis in juvenile SLE: Support from the pediatric nephrology community for the definitions of responsiveness and flare in the 2012 consensus treatment plans Scott E. Wenderfer, Mileka Gilbert, Joyce Hsu, Sangeeta Sule, Tamar B. Rubinstein, Beatrice Goilav, Daryl M. Okamura, Annabelle Chua, Laurence A. Greenbaum, Jerome C. Lane, Emily von Scheven, Stacy P. Ardoin, Natasha M. Ruth P33 The steroid taper app: Making of a mobile app Jennifer M. P. Woo, Marsha M. Malloy, James A. Jegers, Dustin J. Hahn, Mary K. Hintermeyer, Stacey M. Martinetti, Gretchen R. Heckel, Elizabeth L. Roth-Wojcicki, Dominic O. Co
Collapse
|
53
|
Carr S, Thevasagayam R. The Sheffield ACS sickle knife for endoscopic anterior cricoid split. Clin Otolaryngol 2016; 41:305. [DOI: 10.1111/coa.12595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2015] [Indexed: 12/31/2022]
|
54
|
Carr S, Twigg V, Mirza S. Radiological study of the anatomy of the keystone area of the nasal septum using computed tomography to aid septal surgery. Clin Otolaryngol 2016. [PMID: 26215205 DOI: 10.1111/coa.12507] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES An optimum septoplasty result may require complete detachment of the superior osseocartilaginous junction (OCJ), but this may lead to disruption of the keystone area with loss of nasal support and consequent supratip depression deformity. The aim of this study was to analyse normal keystone anatomy using CT scan images and to estimate the incidence of risk of supratip depression when completely detaching the OCJ. DESIGN Retrospective study. SETTING Tertiary referral centre. PARTICIPANTS Adult patients who underwent CT paranasal sinuses prior to transsphenoidal hypophysectomy in a tertiary referral centre between 2009 and 2013. MAIN OUTCOME MEASURES Length of the keystone area. A length of <5 mm and certain anatomical configurations were considered at risk of a supratip depression with complete detachment of the OCJ. RESULTS CT scans of 91 patients were reviewed. The mean keystone length was 9.04 mm (range 0-23 mm). Twenty-nine (32%) cases were at risk of supratip depression. Relatively shorter nasal bones (nasal bone length: overall dorsal length <0.37) (n = 26) were associated with a shorter keystone area (P = 0.0051). CONCLUSIONS Thirty-two per cent of patients have keystone anatomy on radiology predisposing them to supratip depression with complete detachment of the OCJ. Relatively shorter nasal bones were significantly associated with a shorter, higher risk keystone area. In cases with a high septal deviation undergoing a septoplasty, a preoperative CT enables the surgeon to assess the keystone area and determine whether it is safe to completely detach the OCJ.
Collapse
|
55
|
Yahia R, Viviani L, Carr S, Bush A. S17 Do pre-school lung ventilation scans predict outcome by 6 years of age in children with Cystic Fibrosis (CF)? Thorax 2015. [DOI: 10.1136/thoraxjnl-2015-207770.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
56
|
Donnelly R, Carr S, Harper R. Diabetes Insulin Guidance System: a real-world evaluation of new technology (d-Nav) to achieve glycaemic control in insulin-treated type 2 diabetes. PRACTICAL DIABETES 2015. [DOI: 10.1002/pdi.1966] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
57
|
Twigg V, Carr S, Peres C, Mirza S. Turbinoplasty surgery for nasal obstruction in craniometaphyseal dysplasia: A case report and review of the literature. Int J Pediatr Otorhinolaryngol 2015; 79:935-937. [PMID: 25890400 DOI: 10.1016/j.ijporl.2015.03.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 03/26/2015] [Accepted: 03/28/2015] [Indexed: 10/23/2022]
Abstract
Craniometaphyseal dysplasia is a rare genetic condition characterised by hyperostosis of the skull base and sclerosis of craniofacial bones. This can cause nasal obstruction. This paper presents the case of a 14-year old with craniometaphyseal dysplasia presenting with nasal obstruction successfully treated with turbinoplasty. A literature search was conducted using PUBMED and EMBASE. In conclusion, in cases of craniometaphyseal dysplasia with nasal obstruction conventional techniques such as submucosal diathermy and outfracturing of inferior turbinates may not be adequate. Bony turbinoplasties along the whole length of the inferior turbinate may be required.
Collapse
|
58
|
Carr S, John R, Moraleda J, Ray J. Ultrasound to locate the bone-anchored hearing aid cover screw for placement of the abutment at bone-anchored hearing aid second stage. Clin Otolaryngol 2015; 40:295-6. [DOI: 10.1111/coa.12305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2014] [Indexed: 11/29/2022]
|
59
|
Marsh G, Collins N, Bush A, Hogg C, Carr S. P103 Do Children With Primary Ciliary Dyskinesia Harbour The Same Pathogens In The Upper And Lower Airway? Thorax 2014. [DOI: 10.1136/thoraxjnl-2014-206260.244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
60
|
Sunther M, Carr S, Hogg C, Bush A. P102 Recovery Of Baseline Lung Function After A Pulmonary Exacerbation In Children With Primary Ciliary Dyskinesia (pcd). Thorax 2014. [DOI: 10.1136/thoraxjnl-2014-206260.243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
61
|
Singh RH, Espey E, Carr S, Pereda B, Ogburn T, Leeman L. Nitrous oxide for pain management of first trimester surgical abortion -- a randomized controlled pilot study. Contraception 2014; 91:164-6. [PMID: 25459096 DOI: 10.1016/j.contraception.2014.09.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 09/15/2014] [Accepted: 09/30/2014] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The objective was to determine feasibility of a study comparing mean pain scores between women randomized to nitrous oxide/oxygen (NO) versus oxygen+oral analgesics for trimester surgical abortion. STUDY DESIGN Pilot randomized controlled trial comparing NO (n=10) versus oxygen+oral analgesics (n=10). Feasibility of subject recruitment, and pain and satisfaction scores on a visual analog scale were evaluated. RESULTS Fifty-seven percent of eligible women participated. Mean pain scores were similar between groups, and mean satisfaction scores were higher for the NO group (77.5 vs. 46.7, P=.048). CONCLUSIONS The majority of eligible women agreed to participate in this study evaluating an uncommon pain control intervention.
Collapse
|
62
|
Thong KY, McDonald TJ, Hattersley AT, Blann AD, Ramtoola S, Duncan C, Carr S, Adamson K, Nayak AU, Khurana R, Hunter SJ, Ali A, Au S, Ryder REJ. The association between postprandial urinary C-peptide creatinine ratio and the treatment response to liraglutide: a multi-centre observational study. Diabet Med 2014; 31:403-11. [PMID: 24246138 DOI: 10.1111/dme.12367] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Revised: 10/01/2013] [Accepted: 11/13/2013] [Indexed: 01/22/2023]
Abstract
AIMS The response to glucagon-like peptide 1 receptor agonist treatment may be influenced by endogenous β-cell function. We investigated whether urinary C-peptide creatinine ratio assessed before or during liraglutide treatment was associated with treatment response. METHODS A single, outpatient urine sample for urinary C-peptide creatinine ratio was collected 2 h after the largest meal of the day among two separate groups: (1) subjects initiating liraglutide (0.6 → 1.2 mg daily) or (2) subjects already treated with liraglutide for 20-32 weeks. The associations between pretreatment and on-treatment urinary C-peptide creatinine ratio and HbA1c change at 32 weeks were assessed using univariate and multivariate analyses (the ratio was logarithm transformed for multivariate analyses). Changes in HbA1c according to pretreatment urinary C-peptide creatinine ratio quartiles are shown. RESULTS One hundred and sixteen subjects (70 pretreatment, 46 on treatment) with Type 2 diabetes from 10 diabetes centres were studied. In univariate analyses, neither pretreatment nor on-treatment urinary C-peptide creatinine ratio correlated with HbA1c change (Spearman rank correlation coefficient, r = -0.17, P = 0.17 and r = -0.20, P = 0.19, respectively). In multi-linear regression analyses, entering baseline HbA1c and log urinary C-peptide creatinine ratio, pretreatment and on-treatment log urinary C-peptide creatinine ratio became significantly associated with HbA1c change (P = 0.048 and P = 0.040, respectively). Mean (sd) HbA1c changes from baseline in quartiles 1 to 4 of pretreatment urinary C-peptide creatinine ratio were -3 ± 17 mmol/mol (-0.3 ± 1.6%) (P = 0.52), -12 ± 15 mmol/mol (-1.1 ± 1.4%) (P = 0.003), -11 ± 13 mmol/mol (-1.0 ± 1.2%) (P = 0.002) and -12±17 mmol/mol (-1.1±1.6%) (P=0.016), respectively. CONCLUSIONS Postprandial urinary C-peptide creatinine ratios before and during liraglutide treatment were weakly associated with the glycaemic response to treatment. Low pretreatment urinary C-peptide creatinine ratio may be more useful than higher values by predicting poorer glycaemic response.
Collapse
|
63
|
Peerally MF, Carr S. Opportunities in postgraduate medical education via clinical academic training. Br J Hosp Med (Lond) 2014; 75:C34-7. [DOI: 10.12968/hmed.2014.75.sup3.c34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
64
|
Brennan LC, Thia LP, Hoo A, Nguyen T, Chudleigh J, Lum S, Wade A, Wallis C, Bush A, Balfour-Lynn I, Wyatt H, Carr S, Stocks J. S7 Evolution of lung function during the first two years of life in infants with cystic fibrosis diagnosed by newborn screening. Thorax 2013. [DOI: 10.1136/thoraxjnl-2013-204457.13] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
65
|
Singh R, Espey E, Carr S, Ogburn T, Pereda B, Leeman L. Nitrous oxide for pain management of first trimester abortion—a pilot study. Contraception 2013. [DOI: 10.1016/j.contraception.2013.05.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
66
|
Croft A, Smith S, Carr S, Youssouf S, Salama A, Pusey C, Harper L, Morgan M. THU0199 Successful outcomes of pregnancy in patients with ANCA vasculitis. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.2164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
67
|
Kutlay S, Kurultak I, Nergizoglu G, Erturk S, Karatan O, Azevedo P, Pinto CT, Pereira CM, Marinho A, Vanmassenhove J, Hoste E, Glorieux G, Dhondt A, Vanholder R, Van Biesen W, Rei S, Aleksandrova I, Kiselev V, Ilynskiy M, Berdnikov G, Marchenkova L, Vanmassenhove J, Hoste E, Glorieux G, Dhondt A, Vanholder R, Van Biesen W, Daher EF, Vieira APF, Souza JB, Falcao FS, Costa CR, Fernandes AACS, Mota RMS, Lima RSA, Silva Junior GB, Ulusal Okyay G, Erten Y, Er R, Aybar M, Inal S, Tekbudak M, Aygencel G, Onec K, Bali M, Sindel S, Soto K, Fidalgo P, Papoila AL, Vanmassenhove J, Hoste E, Glorieux G, Dhondt A, Vanholder R, Van Biesen W, Lentini P, Zanoli L, Granata A, Contestabile A, Basso A, Berlingo G, de Cal M, Pellanda V, Dell'Aquila R, Fortrie G, Stads S, van Bommel J, Zietse R, Betjes MG, Berrada A, Arias C, Riera M, Orfila MA, Rodriguez E, Barrios C, Peruzzi L, Chiale F, Camilla R, Martano C, Cresi F, Bertino E, Coppo R, Klimenko A, Villevalde S, Efremovtseva M, Kobalava Z, Pipili C, Ioannidou S, Kokkoris S, Poulaki S, Tripodaki ES, Parisi M, Papastylianou A, Nanas S, Wang YN, Cheng H, Chen YP, Wen Z, Li X, Shen P, Zou Y, Lu Y, Ma X, Chen Y, Ren H, Chen X, Chen N, Yue T, Cheng H, Chen YP, Elmamoun S, Wodeyar H, Goldsmith C, Abraham A, Wootton A, Ahmed S, Hill C, Curtis S, Miller A, Hine T, Stevens KK, Patel RK, Mark PB, Delles C, Jardine AG, Wilflingseder J, Heinzel A, Mayer P, Perco P, Kainz A, Mayer B, Oberbauer R, Huang TM, Wu VC, Park DJ, Bae EJ, Kang YJ, Cho HS, Chang SH, Lentini P, Zanoli L, Granata A, Contestabile A, Berlingo G, Basso A, Pellanda V, de Cal M, Stramana R, Cognolato D, Baiocchi M, Dell'Aquila R, Chiella BM, Pilla C, Balbinotto A, Antunes VH, Heglert A, Collares FM, Thome FS, Gjyzari A, Thereska N, Xhango O, Xue J, Chen MC, Wang L, Chen YJ, Sun XZ, An WS, Kim ES, Son YK, Kim SE, Kim KH, Oh YJ, Tsai HB, Ko WJ, Chao CT, Fortrie G, Stads S, Aarnoudse AJL, Zietse R, Betjes MG, Peride I, Radulescu D, Niculae A, Ciocalteu A, Checherita AI, Kao CC, Wang CY, Lai CF, Huang TM, Chen HH, Wu VC, Ko WJ, Wu KD, Klaus F, Goldani JC, Cantisani G, Zanotelli ML, Carvalho L, Klaus D, Garcia VD, Keitel E, Hussaini SM, Rao PN, Kul A, Ye N, Zhang Y, Cheng H, Chen YP, Baines R, Westacott R, Trew J, Kirtley J, Selby N, Carr S, Xu G, Steffgen J, Blaschke S, Brun-Schulte-Wissing N, Pagel P, Huber F, Mapes J, Jaehnige A, Pestel S, Deray G, Rouviere O, Bacigalupo L, Maes B, Hannedouche T, Vrtovsnik F, Rigothier C, Billiouw JM, Campioni P, Marti-Bonmati L, Gao YM, Li D, Cheng H, Chen YP, Woo S, Lee J, Noh H, Kwon SH, Han DC, Hetherington L, Valluri A, McQuarrie E, Fleming S, Geddes C, Bell S, MacKinnon B, Bell S, Patton A, Sneddon J, Donnan P, Vadiveloo T, Marwick C, Bennie M, Davey P, Yasuda H, Tsuji N, Tsuji T, Iwakura T, Ohashi N, Kato A, Fujigaki Y, Sasaki S, Kawarazaki H, Shibagaki Y, Kimura K, Lingaraju U, Rajanna S, Radhakrishnan H, Parekh A, Sreedhar CG, Sarvi R, Rainone F, Merlino L, Ritchie JP, Kalra PA, Daher EF, Vieira APF, Jacinto CN, Abreu KLS, Silva Junior GB, Neves M, Baptista JP, Rodrigues L, Pinho J, Teixeira L, Pimentel J, Gonzalez Sanchidrian S, Rangel Hidalgo G, Cebrian Andrada C, Deira Lorenzo J, Marin Alvarez J, Garcia-Bernalt Funes V, Gallego Dominguez S, Labrador Gomez P, Castellano Cervino I, Novillo Santana R, Gomez-Martino Arroyo J, Kim Y, Choi BS, Kim YO, Yoon SA, Lin MC, Wu VC, Ko WJ, Wu KD, Wang WJ, Melo MJ, Lopes JA, Raimundo M, Fragoso A, Antunes F, Martin-Moreno PL, Varo N, Restituto P, Sayon-Orea C, Garcia-Fernandez N, Leite Filho NCV, Souza LEO, Cavalcante RM, Silva Junior GB, Morais BM, Leite TT, Silva SL, Kubrusly M, Daher EF, Jung YS, Kim YN, Shin HS, Rim H, Bentall A, Al-Baaj F, Williamson S, Cheshire S, Jelakovic M, Ivkovic V, Laganovic M, Karanovic S, Pecin I, Premuzic V, Vukovic Lela I, Vrdoljak A, Fucek M, Cvitkovic A, Juric D, Bozina N, Bitunjac M, Leko N, Abramovic Baric M, Matijevic V, Jelakovic B, Ullah A, Exarchou K, Archer T, Anijeet H, Brown R, Ahmed S, Zhang Y, Ye N, Cheng H, Cheng YP, Rocha JCG, Gushiken da Silva T, de Castro PF, Kioroglo PS, Branco Martins JP, Tzanno-Martins C, Biesenbach P, Luf F, Fleischmann E, Grunberger T, Druml W, Gaipov A, Turkmen K, Toker A, Solak Y, Cicekler H, Ucar R, Kilicaslan A, Gormus N, Tonbul HZ, Yeksan M, Turk S, Monteburini T, Cenerelli S, Santarelli S, Boggi R, Tazza L, Bossola M, Ferraresi M, Merlo I, Giovinazzo G, Quercia AD, Gai M, Leonardi G, Anania P, Guarena C, Cantaluppi V, Pacitti A, Biancone L, Hissa PNG, Daher EDF, Liborio AB, Thereza BMF, Mendes CCP, Sousa ARO. AKI - human studies. Nephrol Dial Transplant 2013. [DOI: 10.1093/ndt/gft129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
68
|
Karrar S, Shiwen X, Nikotorowicz-Buniak J, Abraham DJ, Denton C, Stratton R, Bayley R, Kite KA, Clay E, Smith JP, Kitas GD, Buckley C, Young SP, Ye L, Zhang L, Goodall J, Gaston H, Xu H, Lutalo PM, Zhao Y, Meng Choong L, Sangle S, Spencer J, D'Cruz D, Rysnik OJ, McHugh K, Bowness P, Rump-Goodrich L, Mattey D, Kehoe O, Middleton J, Cartwright A, Schmutz C, Askari A, Middleton J, Gardner DH, Jeffery LE, Raza K, Sansom DM, Clay E, Bayley R, Fitzpatrick M, Wallace G, Young S, Shaw J, Hatano H, Cauli A, Giles JL, McHugh K, Mathieu A, Bowness P, Kollnberger S, Webster S, Ellis L, O'Brien LM, Fitzmaurice TJ, Gaston H, Goodall J, Nazeer Moideen A, Evans L, Osgood L, Williams A, Jones S, Thomas C, O'Donnell V, Nowell M, Ouboussad L, Savic S, Dickie LJ, Hintze J, Wong CH, Cook GP, Buch M, Emery P, McDermott MF, Hardcastle SA, Gregson CL, Deere K, Davey Smith G, Dieppe P, Tobias JH, Dennison E, Edwards M, Bennett J, Coggon D, Palmer K, Cooper C, McWilliams D, Young A, Kiely PD, Walsh D, Taylor HJ, Harding I, Hutchinson J, Nelson I, Blom A, Tobias J, Clark E, Parker J, Bukhari M, McWilliams D, Jayakumar K, Young A, Kiely P, Walsh D, Diffin J, Lunt M, Marshall T, Chipping J, Symmons D, Verstappen S, Taylor HJ, Harding I, Hutchinson J, Nelson I, Tobias J, Clark E, Bluett J, Bowes J, Ho P, McHugh N, Buden D, Fitzgerald O, Barton A, Glossop JR, Nixon NB, Emes RD, Dawes PT, Farrell WE, Mattey DL, Scott IC, Steer S, Seegobin S, Hinks AM, Eyre S, Morgan A, Wilson AG, Hocking L, Wordsworth P, Barton A, Worthington J, Cope A, Lewis CM, Guerra S, Ahmed BA, Denton C, Abraham D, Fonseca C, Robinson J, Taylor J, Haroon Rashid L, Flynn E, Eyre S, Worthington J, Barton A, Isaacs J, Bowes J, Wilson AG, Barrett JH, Morgan A, Kingston B, Ahmed M, Kirwan JR, Marshall R, Chapman K, Pearson R, Heycock C, Kelly C, Rynne M, Saravanan V, Hamilton J, Saeed A, Coughlan R, Carey JJ, Farah Z, Matthews W, Bell C, Petford S, Tibbetts LM, Douglas KMJ, Holden W, Ledingham J, Fletcher M, Winfield R, Price Z, Mackay K, Dixon C, Oppong R, Jowett S, Nicholls E, Whitehurst D, Hill S, Hammond A, Hay E, Dziedzic K, Righetti C, Lebmeier M, Manning VL, Hurley M, Scott DL, Choy E, Bearne L, Nikiphorou E, Morris S, James D, Kiely P, Walsh D, Young A, Wong EC, Long J, Fletcher A, Fletcher M, Holmes S, Hockey P, Abbas M, Chattopadhyay C, Flint J, Gayed M, Schreiber K, Arthanari S, Nisar M, Khamashta M, Gordon C, Giles I, Robson J, Kiran A, Maskell J, Arden N, Hutchings A, Emin A, Culliford D, Dasgupta B, Hamilton W, Luqmani R, Jethwa H, Rowczenio D, Trojer H, Russell T, Loeffler J, Hawkins P, Lachmann H, Verma I, Syngle A, Krishan P, Garg N, Flint J, Gayed M, Schreiber K, Arthanari S, Nisar M, Khamashta M, Gordon C, Giles I, McGowan SP, Gerrard DT, Chinoy H, Ollier WE, Cooper RG, Lamb JA, Taborda L, Correia Azevedo P, Isenberg D, Leyland KM, Kiran A, Judge A, Hunter D, Hart D, Javaid MK, Arden N, Cooper C, Edwards MH, Litwic AE, Jameson KA, Deeg D, Cooper C, Dennison E, Edwards MH, Jameson KA, Cushnaghan J, Aihie Sayer A, Deeg D, Cooper C, Dennison E, Jagannath D, Parsons C, Cushnaghan J, Cooper C, Edwards MH, Dennison E, Stoppiello L, Mapp P, Ashraf S, Wilson D, Hill R, Scammell B, Walsh D, Wenham C, Shore P, Hodgson R, Grainger A, Aaron J, Hordon L, Conaghan P, Bar-Ziv Y, Beer Y, Ran Y, Benedict S, Halperin N, Drexler M, Mor A, Segal G, Lahad A, Haim A, Rath U, Morgensteren DM, Salai M, Elbaz A, Vasishta VG, Derrett-Smith E, Hoyles R, Khan K, Abraham DJ, Denton C, Ezeonyeji A, Takhar G, Denton C, Ong V, Loughrey L, Bissell LA, Hensor E, Abignano G, Redmond A, Buch M, Del Galdo F, Hall FC, Malaviya A, Nisar M, Baker S, Furlong A, Mitchell A, Godfrey AL, Ruddlesden M, Hadjinicolaou A, Hughes M, Moore T, O'Leary N, Tracey A, Ennis H, Dinsdale G, Roberts C, Herrick A, Denton CP, Guillevin L, Hunsche E, Rosenberg D, Schwierin B, Scott M, Krieg T, Anderson M, Hall FC, Herrick A, McHugh N, Matucci-Cerinic M, Alade R, Khan K, Xu S, Denton C, Ong V, Nihtyanova S, Ong V, Denton CP, Clark KE, Tam FWK, Unwin R, Khan K, Abraham DJ, Denton C, Stratton RJ, Nihtyanova S, Schreiber B, Ong V, Denton CP, Seng Edwin Lim C, Dasgupta B, Corsiero E, Sutcliffe N, Wardemann H, Pitzalis C, Bombardieri M, Tahir H, Donnelly S, Greenwood M, Smith TO, Easton V, Bacon H, Jerman E, Armon K, Poland F, Macgregor A, van der Heijde D, Sieper J, Elewaut D, Pangan AL, Nguyen D, Badenhorst C, Kirby S, White D, Harrison A, Garcia JA, Stebbings S, MacKay JW, Aboelmagd S, Gaffney K, van der Heijde D, Deodhar A, Braun J, Mack M, Hsu B, Gathany T, Han C, Inman RD, Cooper-Moss N, Packham J, Strauss V, Freeston JE, Coates L, Nam J, Moverley AR, Helliwell P, Hensor E, Wakefield R, Emery P, Conaghan P, Mease P, Fleischmann R, Wollenhaupt J, Deodhar A, Kielar D, Woltering F, Stach C, Hoepken B, Arledge T, van der Heijde D, Gladman D, Fleischmann R, Coteur G, Woltering F, Mease P, Kavanaugh A, Gladman D, van der Heijde D, Purcaru O, Mease P, McInnes I, Kavanaugh A, Gottlieb AB, Puig L, Rahman P, Ritchlin C, Li S, Wang Y, Mendelsohn A, Doyle M, Tillett W, Jadon D, Shaddick G, Cavill C, Robinson G, Sengupta R, Korendowych E, de Vries C, McHugh N, Thomas RC, Shuto T, Busquets-Perez N, Marzo-Ortega H, McGonagle D, Tillett W, Richards G, Cavill C, Sengupta R, Shuto T, Marzo-Ortega H, Thomas RC, Bingham S, Coates L, Emery P, John Hamlin P, Adshead R, Cambridge S, Donnelly S, Tahir H, Suppiah P, Cullinan M, Nolan A, Thompson WM, Stebbings S, Mathieson HR, Mackie SL, Bryer D, Buch M, Emery P, Marzo-Ortega H, Krutikov M, Gray L, Bruce E, Ho P, Marzo-Ortega H, Busquets-Perez N, Thomas RC, Gaffney K, Keat A, Innes W, Pandit R, Kay L, Lapshina S, Myasoutova L, Erdes S, Wallis D, Waldron N, McHugh N, Korendowych E, Thorne I, Harris C, Keat A, Garg N, Syngle A, Vohra K, Khinchi D, Verma I, Kaur L, Jones A, Harrison N, Harris D, Jones T, Rees J, Bennett A, Fazal S, Tugnet N, Barkham N, Basu N, McClean A, Harper L, Amft EN, Dhaun N, Luqmani RA, Little MA, Jayne DR, Flossmann O, McLaren J, Kumar V, Reid DM, Macfarlane GJ, Jones G, Yates M, Watts RA, Igali L, Mukhtyar C, Macgregor A, Robson J, Doll H, Yew S, Flossmann O, Suppiah R, Harper L, Hoglund P, Jayne D, Mukhtyar C, Westman K, Luqmani R, Win Maw W, Patil P, Williams M, Adizie T, Christidis D, Borg F, Dasgupta B, Robertson A, Croft AP, Smith S, Carr S, Youssouf S, Salama A, Pusey C, Harper L, Morgan M. Basic Science * 208. Stem Cell Factor Expression is Increased in the Skin of Patients with Systemic Sclerosis and Promotes Proliferation and Migration of Fibroblasts in vitro. Rheumatology (Oxford) 2013. [DOI: 10.1093/rheumatology/ket195] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
|
69
|
Carr S, Espey E. Intrauterine devices and pelvic inflammatory disease among adolescents. J Adolesc Health 2013; 52:S22-8. [PMID: 23535053 DOI: 10.1016/j.jadohealth.2013.01.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Revised: 01/25/2013] [Accepted: 01/31/2013] [Indexed: 02/02/2023]
Abstract
Adolescents may be ideal candidates for intrauterine device (IUD) use, given high rates of unintended pregnancy and less successful use of short-acting contraceptive methods. Concerns about elevated risks of pelvic inflammatory disease in adolescents, with the consequences of infertility, ectopic pregnancy, and pelvic pain, prevent many clinicians from inserting IUDs in adolescents. The body of evidence examining risks of pelvic infection related to IUD use specifically in adolescents is limited, but is reassuring that the absolute risk of pelvic infection is small and that the benefits of IUD use likely outweigh the risks.
Collapse
|
70
|
Butler M, Williams-Gunn M, Watson D, Kuitert L, Cowlard J, Pao C, Carr S, Lambert C. 305 Comparison of contacts to adult and paediatric cystic fibrosis Clinical Nurse Specialists. J Cyst Fibros 2012. [DOI: 10.1016/s1569-1993(12)60473-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
71
|
Chae SC, Lee N, Horibe Y, Tanimura M, Mori S, Gao B, Carr S, Cheong SW. Direct observation of the proliferation of ferroelectric loop domains and vortex-antivortex pairs. PHYSICAL REVIEW LETTERS 2012; 108:167603. [PMID: 22680757 DOI: 10.1103/physrevlett.108.167603] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Indexed: 06/01/2023]
Abstract
We discovered stripe patterns of trimerization-ferroelectric domains in hexagonal REMnO(3) (RE=Ho,···,Lu) crystals (grown below ferroelectric transition temperatures (T(c)), reaching up to 1435 °C), in contrast with the vortex patterns in YMnO(3). These stripe patterns roughen with the appearance of numerous loop domains through thermal annealing just below T(c), but the stripe domain patterns turn to vortex-antivortex domain patterns through a freezing process when crystals cross T(c) even though the phase transition appears to not be Kosterlitz-Thouless-type. The experimental systematics are compared with the results of our six-state clock model simulation and also the Kibble-Zurek mechanism for trapped topological defects.
Collapse
|
72
|
Desjardins M, Clarke A, Alizadehfar R, Grenier D, Eisman H, Carr S, Vander Leek T, Teperman L, Higgins N, Joseph L, Shand G, Ben-Shoshan M. Comparison between Allergists and Non-allergists on Issues Related to Food-induced Anaphylaxis. J Allergy Clin Immunol 2012. [DOI: 10.1016/j.jaci.2011.12.251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
73
|
Scott DJ, Clarke JA, Baynham DE, Bayliss V, Bradshaw T, Burton G, Brummitt A, Carr S, Lintern A, Rochford J, Taylor O, Ivanyushenkov Y. Demonstration of a high-field short-period superconducting helical undulator suitable for future TeV-scale linear collider positron sources. PHYSICAL REVIEW LETTERS 2011; 107:174803. [PMID: 22107527 DOI: 10.1103/physrevlett.107.174803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Indexed: 05/31/2023]
Abstract
The first demonstration of a full-scale working undulator module suitable for future TeV-scale positron-electron linear collider positron sources is presented. Generating sufficient positrons is an important challenge for these colliders, and using polarized e(+) would enhance the machine's capabilities. In an undulator-based source polarized positrons are generated in a metallic target via pair production initiated by circularly polarized photons produced in a helical undulator. We show how the undulator design is developed by considering impedance effects on the electron beam, modeling and constructing short prototypes before the successful fabrication, and testing of a final module.
Collapse
|
74
|
Burgener A, Rahman S, Ahmad R, Lajoie J, Ramdahin S, Mesa C, Brunet S, Wachihi C, Kimani J, Fowke K, Carr S, Plummer F, Ball TB. Comprehensive proteomic study identifies serpin and cystatin antiproteases as novel correlates of HIV-1 resistance in the cervicovaginal mucosa of female sex workers. J Proteome Res 2011; 10:5139-49. [PMID: 21973077 DOI: 10.1021/pr200596r] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Not all individuals exposed to HIV-1 become infected, and evidence from HIV-1 highly exposed seronegative women (HIV-1-resistant) suggests that mucosal factors in the female genital tract, the first site of contact for the virus, are playing a role. To better understand factors mediating protection from HIV-1, we performed a large clinical study using the tools of systems biology to fully characterize the cervicovaginal mucosa proteome in HIV-1-resistant women. Cervicovaginal lavage fluid was collected from 293 HIV-1-resistant, uninfected, and infected sex workers and analyzed by 2D-LC LTQ-FT-MS. Of the more than 360 unique proteins identified, 41 were differentially abundant (>3-fold cutoff) in HIV-1-resistant women. The majority of over-abundant proteins were antiproteases (>40%), some with described anti-inflammatory and anti-HIV-1 activity. Quantification of specific anti-HIV-1 antiproteases Serpin A1, Serpin A3, and Cystatin B and an epithelial antiprotease A2ML1 found them to be significantly over-abundant in HIV-1-resistant women (p = 0.004; p = 0.046; p = 0.0003; and p = 0.04, respectively). Expression levels were not correlated to sexual practices or other epidemiological factors. Mucosal antiprotease levels correlated with pro-inflammatory cytokine concentration (p = <0.0001), but independently of pro-inflammatory cytokine levels in HIV-1-resistant women including TNF-alpha, IL-1 alpha, IL-1 beta, IL-6, and IL-8. This comprehensive systems biology approach identifies mucosal serpins and cystatins as novel correlates of HIV-1-resistance. This represents the first study characterizing these factors in the female genital tract.
Collapse
|
75
|
Carr S. Reflecting identities: using portraiture with people suffering from life threatening illnesses. BMJ Support Palliat Care 2011. [DOI: 10.1136/bmjspcare-2011-000105.94] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
76
|
Carr S, Déclais AC, Lilley DMJ, Phillips SEV. Towards the molecular mechanism of Holliday junction resolution. Acta Crystallogr A 2011. [DOI: 10.1107/s0108767311092877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
77
|
Munro S, Khaire N, Inche A, Carr S, La Thangue NB. Lysine methylation regulates the pRb tumour suppressor protein. Oncogene 2010; 29:2357-67. [PMID: 20140018 DOI: 10.1038/onc.2009.511] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The pRb tumour suppressor protein has a central role in coordinating early cell cycle progression. An important level of control imposed on pRb occurs through post-translational modification, for example, phosphorylation. We describe here a new level of regulation on pRb, mediated through the targeted methylation of lysine residues, by the methyltransferase Set7/9. Set7/9 methylates the C-terminal region of pRb, both in vitro and in cells, and methylated pRb interacts with heterochromatin protein HP1. pRb methylation is required for pRb-dependent cell cycle arrest and transcriptional repression, as well as pRb-dependent differentiation. Our results indicate that methylation can influence the properties of pRb, and raise the interesting possibility that methylation modulates pRb tumour suppressor activity.
Collapse
|
78
|
Kinn S, MacDonald C, Hinks S, Nandwani R, Ilett R, Shields N, Carr S, Bigrigg A. Client and staff views on facilities and services, before and after the convergence of sexual, reproductive and women's services. EUR J CONTRACEP REPR 2009. [DOI: 10.1080/ejc.8.2.65.74] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
79
|
Abstract
OBJECTIVE Septoplasty is one of the most common operations performed by otorhinolaryngologists. Nasal packing is not an innocuous procedure. The most common problem encountered by the patients after septoplasty is the pain and discomfort during removal of the nasal packs. The objective of this study was to evaluate the results of septoplasty without postoperative nasal packing. METHODS Septoplasty was performed by standard technique. No nasal packing was used in these cases. RESULTS Seventy-eight patients were included in the study. The majority of the patients (64.1%; 50/78) on a morning list were operated. Sixty-two patients were discharged home the same day, the remaining others were discharged the next day. Our postoperative haemorrhage rate was 7.7% (6/78) and only 3.8% (3/78) patients required nasal packing. Majority (84.6%) of the patients were satisfied with the operation at the postoperative follow up 3 months later. CONCLUSIONS Septoplasty can be safely performed without postoperative nasal packing. Only 3.8% patients required nasal packing in this study.
Collapse
|
80
|
Wilson R, Spiers A, Ewan J, Johnson P, Jenkins C, Carr S. Effects of high dose oestrogen therapy on circulating inflammatory markers. Maturitas 2009; 62:281-6. [DOI: 10.1016/j.maturitas.2009.01.009] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2008] [Revised: 01/07/2009] [Accepted: 01/14/2009] [Indexed: 11/25/2022]
|
81
|
Ankrom A, Patel J, Shao E, Carr S, Kawano M, Kittleson M, Kiyosaki K, Moriguchi J, Ardehali A, Kobashigawa J. 76: Obesity Confers Protection from Cardiac Allograft Vasculopathy? J Heart Lung Transplant 2009. [DOI: 10.1016/j.healun.2008.11.753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
82
|
Mason J, Kleemann F, Bankart J, Medcalf J, Carr S. Blood Pressure in Renal Transplant Recipients: Are There Independent Predictors for Achieving Target Blood Pressure? ACTA ACUST UNITED AC 2009; 111:c159-66. [DOI: 10.1159/000198236] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2008] [Accepted: 09/19/2008] [Indexed: 11/19/2022]
|
83
|
Carr S, Bowyer D. Correct site marking in otolaryngology: a prospective three-cycle audit. Clin Otolaryngol 2009; 33:638-9. [PMID: 19126157 DOI: 10.1111/j.1749-4486.2008.01771.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
84
|
|
85
|
Carr S, Fraser L. Re: Use of a towel clip to prevent slipping of Draffin rods. Clin Otolaryngol 2008; 33:501. [PMID: 18983399 DOI: 10.1111/j.1749-4486.2008.01769.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
86
|
Dalton S, Madden H, Chamberlain K, Carr S, Lyons AC. ‘It's gotten a bit old, charity’: Young adults in New Zealand talk about poverty, charitable giving and aid appeals. JOURNAL OF COMMUNITY & APPLIED SOCIAL PSYCHOLOGY 2008. [DOI: 10.1002/casp.966] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
87
|
Muldowney FP, Carr S. The concept of quality control in medicine: Emedicine.ie and the mobile phone. IRISH MEDICAL JOURNAL 2008; 101:225. [PMID: 18807818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
|
88
|
Collins NC, Carr S, Nasim S, Mulkeen M, Martin AJ, O'Donnell JJ. The impact of a contaminated city water supply on an emergency department. IRISH MEDICAL JOURNAL 2008; 101:78-79. [PMID: 18540544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
In March 2007 Galway City and County's water supply was officially contaminated by cryptosporidiosis. The medical and nursing staff at the city's only Emergency Department had noted a rise in an atypical form of gastroenteritis in the preceding months. A retrospective audit of 11,723 charts from January 1st 2007 to 22nd March (day after contamination was confirmed) was performed to identify these patients. The number of potential gastroenteritis cases was 185 (incidence 1.6%), with a peak five weeks before the outbreak was confirmed. Half the patients were aged between 20 and 34. Pain (80%), nausea or vomiting (74%) and diarrhoea (66.5%) were the most frequent symptoms. The mean duration of symptoms at presentation was 2 days. Stool samples were sent for nine patients and four of these were tested for Cryptosporidium. Over a quarter (28.6%) of patients were admitted and almost three-quarters (69.7% +/- 7%) had a residential address in the affected area. Difficulty exists in the early identification of new outbreaks and many of the affected patients are not detected using routine surveillance or current capture methods.
Collapse
|
89
|
Jicha G, Abner E, Schmitt F, Cooper G, Stiles N, Hamon R, Carr S, Smith C, Markesbery W. Clinical features of mild cognitive impairment differ in the research and tertiary clinic settings. Dement Geriatr Cogn Disord 2008; 26:187-92. [PMID: 18724049 PMCID: PMC2667338 DOI: 10.1159/000151635] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/23/2008] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Comparative analysis of subjects with mild cognitive impairment (MCI) diagnosed in a primary research setting and those seen in a tertiary care memory disorders clinic. METHODS Subjects who received a diagnosis of MCI between July 1, 2005, and December 31, 2006, in a longitudinal research study of normal cognition (n = 48) and patients diagnosed in a tertiary care referral clinic (n = 34) were evaluated using similar methodologies. Comparative analyses of detailed medical, neurological and neuropsychological data are presented. RESULTS The diagnosis of MCI was not accepted by 13 of 48 subjects (27%) classified as MCI in the primary research setting. Nondegenerative, potentially treatable causes of cognitive decline were found in 3 of 34 subjects (9%) seen in the tertiary referral clinic and in 11 of 35 subjects (31%) identified as MCI in the primary research setting (p = 0.02, Fisher's exact test). MCI subjects identified in the primary research setting were older than those referred to the memory clinic (mean +/- SD, 79.7 +/- 7.0 vs. 71.5 +/- 9.0 years, p < 0.0001, t test) and had more years of education (16.0 +/- 3.2 vs. 13.6 +/- 4.2 years, p < 0.01, t test). MCI subjects in the primary research setting appeared to be in a milder stage of disease, characterized by higher Mini-Mental State Examination scores (28.2 +/- 1.8 vs. 25.7 +/- 1.8, p < 0.0001), and a tendency towards single domain involvement, predominantly memory (mean number of domains involved, 1.0 vs. 2.5, p < 0.0001). More advanced stages of MCI, seen in the tertiary referral population, had additional involvement of attention (p < 0.0001, Fisher's exact test) and visuospatial domains (p < 0.0002, Fisher's exact test). Semiquantitative grading of hippocampal and medial temporal lobe atrophy did not differ between groups (p = 0.81, Mann-Whitney U test). CONCLUSIONS The diagnosis of MCI may be unwelcome in naïve persons. Remedial causes of MCI should be actively investigated. Demographic and clinical characteristics of MCI differ between research subjects and patients referred to a tertiary care clinic.
Collapse
|
90
|
Gilligan P, Pountney A, Wilson B, Mehigan C, Kidney E, Jennings P, Cooper J, Hegarty D, Lee J, Khan A, Lumsden G, Godden D, Shepherd M, Allonby-Neve L, Broderick A, Carr S, Wilson S, O' Sullivan J. SOCRATES Episode II (synopsis of Cochrane reviews applicable to emergency services Episode II): the return of Series III. Emerg Med J 2007; 24:489-91. [PMID: 17582042 PMCID: PMC2658398 DOI: 10.1136/emj.2006.043679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
91
|
Cowlard J, Carr S. 321 What do professionals think about adherence in CF? J Cyst Fibros 2007. [DOI: 10.1016/s1569-1993(07)60294-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
92
|
Gilligan P, Lee J, Khan A, Jennings P, Cooper J, Hegarty D, Lumsden G, Godden D, Pountney A, Wilson B, Shepherd M, Allonby-Neve L, Mehigan C, Kidney E, Broderick A, Carr S, Wilson S, O'Sullivan J. SOCRATES episode II (synopsis of cochrane reviews applicable to emergency services episode II): the return of the series II. Arch Emerg Med 2007; 24:115-7. [PMID: 17251619 PMCID: PMC2658187 DOI: 10.1136/emj.2006.038018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
93
|
Gilligan P, Jennings P, Cooper J, Hegarty D, Lee J, Khan A, Lumsden G, Godden D, Pountney A, Wilson B, Shepherd M, Allonby-Neve L, Mehigan C, Kidney E, Broderick A, Carr S, Wilson S, O' Sullivan J. SOCRATES episode II: (synopsis of Cochrane Reviews applicable to emergency services episode II) the return of the series. Arch Emerg Med 2007. [DOI: 10.1136/emj.2006.037713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
94
|
Longhurst HJ, Carr S, Khair K. C1-inhibitor concentrate home therapy for hereditary angioedema: a viable, effective treatment option. Clin Exp Immunol 2007; 147:11-7. [PMID: 17177958 PMCID: PMC1804208 DOI: 10.1111/j.1365-2249.2006.03256.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2006] [Indexed: 11/24/2022] Open
Abstract
Economic and political factors have led to the increased use of home therapy programmes for patients who have traditionally been treated in hospital. Many patients with hereditary angioedema (HAE) experience intermittent severe attacks that affect their quality of life and may be life-threatening. These attacks are treated with C1-inhibitor concentrate which, for most patients, is infused at the local hospital. Home therapy programmes for HAE are currently being established. This paper reviews the extent of use of these programmes and summarizes the advantages and potential disadvantages of the concept so far.
Collapse
|
95
|
Carr S. The Foundation Programme assessment tools: an opportunity to enhance feedback to trainees? Postgrad Med J 2006; 82:576-9. [PMID: 16954453 PMCID: PMC2585733 DOI: 10.1136/pgmj.2005.042366] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The recent change in working patterns of doctors in training has meant that the traditional systems of education are under increasing pressure and that there is the need to maximise new opportunities for learning. One new opportunity may arise after the introduction of the mandatory assessment systems (Mini-CEX, DOPPS, Multi-source feedback, and Case based discussion) in the Foundation Programmes. In this review the new assessment procedures for the Foundation Programmes are outlined and the potential of these assessments (using Mini-CEX as main example) as an opportunity to give feedback to trainees discussed. The importance of feedback in professional development and some of the techniques available for giving feedback are described. The Foundation Programme assessments will occupy a significant amount of trainees' and trainers' time and it is important that opportunity for feedback and learning is maximised.
Collapse
|
96
|
Abstract
The immuno-osseous dysplasias are a rare group of conditions in which short-limbed dwarfism is associated with an immune defect. The best known of these is cartilage hair hypoplasia. However, several reports of other distinct conditions exist, which have been arbitrarily classified on the basis of the immune defect. We present a child with a previously unreported combination of immune and skeletal abnormalities in whom there was an unusual and distinctive skin appearance associated with defective cutaneous elastic fibers. These cutaneous features suggest a unifying link with other immuno-osseous dysplasia but the combination of immune and skeletal defects exposes weaknesses in the current method of classification.
Collapse
|
97
|
Ridgway D, White SA, Nixon M, Carr S, Blanchard K, Nicholson ML. Primary endoluminal stenting of transplant renal artery stenosis from cadaver and non-heart-beating donor kidneys. Clin Transplant 2006; 20:394-400. [PMID: 16824160 DOI: 10.1111/j.1399-0012.2006.00499.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This study evaluated the efficacy of primary endovascular stenting in cases of transplant renal artery stenosis (TRAS) from cadaver and non-heart-beating donor kidneys. Patients with TRAS (n = 13) from a single-centre transplant population (n = 476) were treated by primary percutaneous angioplasty and endovascular stenting. The short-term efficacy of this intervention is demonstrated in terms of serum creatinine, glomerular filtration rate (GFR) biochemical, anti-hypertensive medications and mean arterial blood pressure control. Stenting for TRAS was performed in male (n = 10) and female (n = 3) recipients. The median age at transplantation was 55 yr (range 10-67 yr). Stenting occurred at a median duration of 410 d post-transplantation (range 84-5799 d). Mean serum creatinine (pre, 247 micromol/L; post, 214 micromol/L; p = 0.002), GFR (pre, 82.6 mL/min; post, 100.9 mL/min; p < 0.001), arterial blood pressure (pre, 104 mmHg; post, 97 mmHg; p = 0.036) and the number of anti-hypertensive medications required (pre, 3.4; post, 3.0; p = 0.002) showed significant improvement after post-endovascular therapy. There were no serious complications encountered. Primary endovascular stenting of TRAS produces a significant improvement in biochemical parameters of renal graft function and in blood pressure stability, with the benefit of low patient morbidity and single arterial puncture. Primary endoluminal stenting of TRAS is a safe and effective procedure for the treatment of TRAS.
Collapse
|
98
|
Phillpotts RJ, O'brien L, Appleton RE, Carr S, Bennett A. Intranasal immunisation with defective adenovirus serotype 5 expressing the Venezuelan equine encephalitis virus E2 glycoprotein protects against airborne challenge with virulent virus. Vaccine 2005; 23:1615-23. [PMID: 15694514 DOI: 10.1016/j.vaccine.2004.06.056] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2004] [Accepted: 06/15/2004] [Indexed: 11/18/2022]
Abstract
There is no vaccine licensed for human use to protect laboratory or field workers against infection with Venezuelan equine encephalitis virus (VEEV). Infection of these groups is most likely to occur via the airborne route and there is evidence to suggest that protection against airborne infection may require high antibody levels and the presence of antibody on the mucosal surface of the respiratory tract. Recombinant defective type 5 adenoviruses, expressing the E3E26K structural genes of VEEV were examined for their ability to protect mice against airborne challenge with virulent virus. After intranasal administration, good protection was achieved against the homologous serogroup 1A/B challenge virus (strain Trinidad donkey). There was less protection against enzootic serogroup II and III viruses, indicating that inclusion of more than one E3E26K sequence in a putative vaccine may be necessary. These studies confirm the potential of recombinant adenoviruses as vaccine vectors for VEEV and will inform the development of a live replicating adenovirus-based VEEV vaccine, deliverable by a mucosal route and suitable for use in humans.
Collapse
MESH Headings
- Adenoviruses, Human/genetics
- Adenoviruses, Human/immunology
- Administration, Intranasal
- Animals
- Antigens, Viral/administration & dosage
- Antigens, Viral/genetics
- Antigens, Viral/immunology
- Cell Line, Tumor
- Defective Viruses/classification
- Defective Viruses/genetics
- Encephalitis Virus, Venezuelan Equine/genetics
- Encephalitis Virus, Venezuelan Equine/immunology
- Encephalitis Virus, Venezuelan Equine/pathogenicity
- Encephalomyelitis, Venezuelan Equine/immunology
- Encephalomyelitis, Venezuelan Equine/prevention & control
- Encephalomyelitis, Venezuelan Equine/virology
- Humans
- Immunization Schedule
- Mice
- Mice, Inbred BALB C
- Serotyping
- Species Specificity
- Vaccines, Synthetic/administration & dosage
- Vaccines, Synthetic/genetics
- Vaccines, Synthetic/immunology
- Viral Envelope Proteins/biosynthesis
- Viral Envelope Proteins/genetics
- Viral Envelope Proteins/immunology
- Viral Vaccines/administration & dosage
- Viral Vaccines/genetics
- Viral Vaccines/immunology
- Virulence
- Virus Replication/genetics
- Virus Replication/immunology
Collapse
|
99
|
Abstract
Alfentanil is becoming an alternative to diamorphine when parental opioids are required, especially in the presence of renal insufficiency. Its pharmacokinetic properties suggest that tolerance may be rapidly induced, whilst concomitant administration of drugs that interfere with the cytochrome P450 system may alter its metabolism. This retrospective audit looked at the use of subcutaneous alfentanil in a palliative care setting over a 21-month period. Forty-eight out of the 81 notes identified were available for analysis. Alfentanil was used for a median of 9 days (range 1-81) with median increase in dose of 80% (range 0-1125%). No significant correlation was found between duration of infusion and dose escalation. In addition no significant correlation was found between dose escalation and concomitant drugs that either inhibited or induced the P450 system. This is the first study to investigate the use of relatively long-term use of parenteral alfentanil. The results suggest that neither tolerance nor concomitant drug administration is of clinical significance in the dose escalation.
Collapse
|
100
|
Abstract
Over recent years several factors have impacted upon the education of doctors in training in medicine and other specialties. These factors include the European Working Time Directive and shift patterns of working, increasing service demands, changes in the examination and assessment processes, and clinical governance issues. In addition, over the next few years further changes will take place with the implementation of "Modernising Medical Careers" document and the establishment of the new Postgraduate Medical Education and Training Board. This article attempts to review the effects of these changes on education of junior doctors and to suggest some possible ways to address these challenges.
Collapse
|