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Abe K, Adam J, Aihara H, Andreopoulos C, Aoki S, Ariga A, Assylbekov S, Autiero D, Barbi M, Barker G, Barr G, Bartet-Friburg P, Bass M, Batkiewicz M, Bay F, Berardi V, Berger B, Berkman S, Bhadra S, Blaszczyk F, Blondel A, Bolognesi S, Bordoni S, Boyd S, Brailsford D, Bravar A, Bronner C, Buchanan N, Calland R, Caravaca Rodríguez J, Cartwright S, Castillo R, Catanesi M, Cervera A, Cherdack D, Chikuma N, Christodoulou G, Clifton A, Coleman J, Coleman S, Collazuol G, Connolly K, Cremonesi L, Dabrowska A, Das R, Davis S, de Perio P, De Rosa G, Dealtry T, Dennis S, Densham C, Dewhurst D, Di Lodovico F, Di Luise S, Dolan S, Drapier O, Duffy K, Dumarchez J, Dytman S, Dziewiecki M, Emery-Schrenk S, Ereditato A, Escudero L, Feusels T, Finch A, Fiorentini G, Friend M, Fujii Y, Fukuda Y, Furmanski A, Galymov V, Garcia A, Giffin S, Giganti C, Gilje K, Goeldi D, Golan T, Gonin M, Grant N, Gudin D, Hadley D, Haegel L, Haesler A, Haigh M, Hamilton P, Hansen D, Hara T, Hartz M, Hasegawa T, Hastings N, Hayashino T, Hayato Y, Helmer R, Hierholzer M, Hignight J, Hillairet A, Himmel A, Hiraki T, Hirota S, Holeczek J, Horikawa S, Hosomi F, Huang K, Ichikawa A, Ieki K, Ieva M, Ikeda M, Imber J, Insler J, Irvine T, Ishida T, Ishii T, Iwai E, Iwamoto K, Iyogi K, Izmaylov A, Jacob A, Jamieson B, Jiang M, Johnson S, Jo J, Jonsson P, Jung C, Kabirnezhad M, Kaboth A, Kajita T, Kakuno H, Kameda J, Kanazawa Y, Karlen D, Karpikov I, Katori T, Kearns E, Khabibullin M, Khotjantsev A, Kielczewska D, Kikawa T, Kilinski A, Kim J, King S, Kisiel J, Kitching P, Kobayashi T, Koch L, Koga T, Kolaceke A, Konaka A, Kopylov A, Kormos L, Korzenev A, Koshio Y, Kropp W, Kubo H, Kudenko Y, Kurjata R, Kutter T, Lagoda J, Lamont I, Larkin E, Laveder M, Lawe M, Lazos M, Lindner T, Lister C, Litchfield R, Longhin A, Lopez J, Ludovici L, Magaletti L, Mahn K, Malek M, Manly S, Marino A, Marteau J, Martin J, Martins P, Martynenko S, Maruyama T, Matveev V, Mavrokoridis K, Mazzucato E, McCarthy M, McCauley N, McFarland K, McGrew C, Mefodiev A, Metelko C, Mezzetto M, Mijakowski P, Miller C, Minamino A, Mineev O, Mine S, Missert A, Miura M, Moriyama S, Mueller T, Murakami A, Murdoch M, Murphy S, Myslik J, Nakadaira T, Nakahata M, Nakamura K, Nakamura K, Nakayama S, Nakaya T, Nakayoshi K, Nantais C, Nielsen C, Nirkko M, Nishikawa K, Nishimura Y, Nowak J, O’Keeffe H, Ohta R, Okumura K, Okusawa T, Oryszczak W, Oser S, Ovsyannikova T, Owen R, Oyama Y, Palladino V, Palomino J, Paolone V, Payne D, Perevozchikov O, Perkin J, Petrov Y, Pickard L, Pinzon Guerra E, Pistillo C, Plonski P, Poplawska E, Popov B, Posiadala-Zezula M, Poutissou JM, Poutissou R, Przewlocki P, Quilain B, Radicioni E, Ratoff P, Ravonel M, Rayner M, Redij A, Reeves M, Reinherz-Aronis E, Riccio C, Rodrigues P, Rojas P, Rondio E, Roth S, Rubbia A, Ruterbories D, Rychter A, Sacco R, Sakashita K, Sánchez F, Sato F, Scantamburlo E, Scholberg K, Schoppmann S, Schwehr J, Scott M, Seiya Y, Sekiguchi T, Sekiya H, Sgalaberna D, Shah R, Shaikhiev A, Shaker F, Shaw D, Shiozawa M, Short S, Shustrov Y, Sinclair P, Smith B, Smy M, Sobczyk J, Sobel H, Sorel M, Southwell L, Stamoulis P, Steinmann J, Suda Y, Suzuki A, Suzuki K, Suzuki S, Suzuki Y, Tacik R, Tada M, Takahashi S, Takeda A, Takeuchi Y, Tanaka H, Tanaka H, Tanaka M, Terhorst D, Terri R, Thompson L, Thorley A, Tobayama S, Toki W, Tomura T, Touramanis C, Tsukamoto T, Tzanov M, Uchida Y, Vacheret A, Vagins M, Vasseur G, Wachala T, Wakamatsu K, Walter C, Wark D, Warzycha W, Wascko M, Weber A, Wendell R, Wilkes R, Wilking M, Wilkinson C, Williamson Z, Wilson J, Wilson R, Wongjirad T, Yamada Y, Yamamoto K, Yanagisawa C, Yano T, Yen S, Yershov N, Yokoyama M, Yoo J, Yoshida K, Yuan T, Yu M, Zalewska A, Zalipska J, Zambelli L, Zaremba K, Ziembicki M, Zimmerman E, Zito M, Żmuda J. Measurement of the electron neutrino charged-current interaction rate on water with the T2K ND280π0detector. Int J Clin Exp Med 2015. [DOI: 10.1103/physrevd.91.112010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Abe K, Adam J, Aihara H, Andreopoulos C, Aoki S, Ariga A, Assylbekov S, Autiero D, Barbi M, Barker G, Barr G, Bartet-Friburg P, Bass M, Batkiewicz M, Bay F, Berardi V, Berger B, Berkman S, Bhadra S, Blaszczyk F, Blondel A, Bolognesi S, Bordoni S, Boyd S, Brailsford D, Bravar A, Bronner C, Buchanan N, Calland R, Caravaca Rodríguez J, Cartwright S, Castillo R, Catanesi M, Cervera A, Cherdack D, Chikuma N, Christodoulou G, Clifton A, Coleman J, Coleman S, Collazuol G, Connolly K, Cremonesi L, Dabrowska A, Danko I, Das R, Davis S, de Perio P, De Rosa G, Dealtry T, Dennis S, Densham C, Dewhurst D, Di Lodovico F, Di Luise S, Dolan S, Drapier O, Duffy K, Dumarchez J, Dytman S, Dziewiecki M, Emery-Schrenk S, Ereditato A, Escudero L, Ferchichi C, Feusels T, Finch A, Fiorentini G, Friend M, Fujii Y, Fukuda Y, Furmanski A, Galymov V, Garcia A, Giffin S, Giganti C, Gilje K, Goeldi D, Golan T, Gonin M, Grant N, Gudin D, Hadley D, Haegel L, Haesler A, Haigh M, Hamilton P, Hansen D, Hara T, Hartz M, Hasegawa T, Hastings N, Hayashino T, Hayato Y, Hearty C, Helmer R, Hierholzer M, Hignight J, Hillairet A, Himmel A, Hiraki T, Hirota S, Holeczek J, Horikawa S, Hosomi F, Huang K, Ichikawa A, Ieki K, Ieva M, Ikeda M, Imber J, Insler J, Irvine T, Ishida T, Ishii T, Iwai E, Iwamoto K, Iyogi K, Izmaylov A, Jacob A, Jamieson B, Jiang M, Johnson S, Jo J, Jonsson P, Jung C, Kabirnezhad M, Kaboth A, Kajita T, Kakuno H, Kameda J, Kanazawa Y, Karlen D, Karpikov I, Katori T, Kearns E, Khabibullin M, Khotjantsev A, Kielczewska D, Kikawa T, Kilinski A, Kim J, King S, Kisiel J, Kitching P, Kobayashi T, Koch L, Koga T, Kolaceke A, Konaka A, Kopylov A, Kormos L, Korzenev A, Koshio Y, Kropp W, Kubo H, Kudenko Y, Kurjata R, Kutter T, Lagoda J, Lamont I, Larkin E, Laveder M, Lawe M, Lazos M, Lindner T, Lister C, Litchfield R, Longhin A, Lopez J, Ludovici L, Magaletti L, Mahn K, Malek M, Manly S, Marino A, Marteau J, Martin J, Martins P, Martynenko S, Maruyama T, Matveev V, Mavrokoridis K, Mazzucato E, McCarthy M, McCauley N, McFarland K, McGrew C, Mefodiev A, Metelko C, Mezzetto M, Mijakowski P, Miller C, Minamino A, Mineev O, Missert A, Miura M, Moriyama S, Mueller T, Murakami A, Murdoch M, Murphy S, Myslik J, Nakadaira T, Nakahata M, Nakamura K, Nakamura K, Nakayama S, Nakaya T, Nakayoshi K, Nantais C, Nielsen C, Nirkko M, Nishikawa K, Nishimura Y, Nowak J, O’Keeffe H, Ohta R, Okumura K, Okusawa T, Oryszczak W, Oser S, Ovsyannikova T, Owen R, Oyama Y, Palladino V, Palomino J, Paolone V, Payne D, Perevozchikov O, Perkin J, Petrov Y, Pickard L, Pinzon Guerra E, Pistillo C, Plonski P, Poplawska E, Popov B, Posiadala-Zezula M, Poutissou JM, Poutissou R, Przewlocki P, Quilain B, Radicioni E, Ratoff P, Ravonel M, Rayner M, Redij A, Reeves M, Reinherz-Aronis E, Riccio C, Rodrigues P, Rojas P, Rondio E, Roth S, Rubbia A, Ruterbories D, Rychter A, Sacco R, Sakashita K, Sánchez F, Sato F, Scantamburlo E, Scholberg K, Schoppmann S, Schwehr J, Scott M, Seiya Y, Sekiguchi T, Sekiya H, Sgalaberna D, Shah R, Shaker F, Shaw D, Shiozawa M, Short S, Shustrov Y, Sinclair P, Smith B, Smy M, Sobczyk J, Sobel H, Sorel M, Southwell L, Stamoulis P, Steinmann J, Still B, Suda Y, Suzuki A, Suzuki K, Suzuki S, Suzuki Y, Tacik R, Tada M, Takahashi S, Takeda A, Takeuchi Y, Tanaka H, Tanaka H, Tanaka M, Terhorst D, Terri R, Thompson L, Thorley A, Tobayama S, Toki W, Tomura T, Totsuka Y, Touramanis C, Tsukamoto T, Tzanov M, Uchida Y, Vacheret A, Vagins M, Vasseur G, Wachala T, Wakamatsu K, Walter C, Wark D, Warzycha W, Wascko M, Weber A, Wendell R, Wilkes R, Wilking M, Wilkinson C, Williamson Z, Wilson J, Wilson R, Wongjirad T, Yamada Y, Yamamoto K, Yanagisawa C, Yano T, Yen S, Yershov N, Yokoyama M, Yoo J, Yoshida K, Yuan T, Yu M, Zalewska A, Zalipska J, Zambelli L, Zaremba K, Ziembicki M, Zimmerman E, Zito M, Żmuda J. Measurement of theνμcharged current quasielastic cross section on carbon with the T2K on-axis neutrino beam. Int J Clin Exp Med 2015. [DOI: 10.1103/physrevd.91.112002] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Md Yusof M, Shaw D, El-Sherbiny Y, Dass S, Rawstron A, Vital E, Emery P. THU0390 Management of Primary and Secondary Non-Response to B Cell Depletion Therapy in Systemic Lupus Erythematosus: 10-Year Experience at a Single Centre. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.6453] [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]
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Sundararajan K, Gopaldas JA, Somehsa H, Edwards S, Shaw D, Sambrook P. Morbidity and mortality in patients admitted with submandibular space infections to the intensive care unit. Anaesth Intensive Care 2015; 43:420-422. [PMID: 25943620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Shaw D, Gardiner D. A reply. Anaesthesia 2015; 70:630-1. [DOI: 10.1111/anae.13088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Robertson P, Smith A, Mead A, Smith I, Khanna N, Wright P, Joannidis P, Boyd S, Anderson M, Hamilton A, Shaw D, Stewart A. Risk-assessment-based approach to patients exposed to endoscopes contaminated with Pseudomonas spp. J Hosp Infect 2015; 90:66-9. [DOI: 10.1016/j.jhin.2014.12.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 12/03/2014] [Indexed: 10/24/2022]
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O'Hara R, Johnson M, Hirst E, Weyman A, Shaw D, Mortimer P, Newman C, Storey M, Turner J, Mason S, Quinn T, Shewan J, Siriwardena AN. DECISION MAKING AND SAFETY IN AMBULANCE SERVICE TRANSITIONS. Emerg Med J 2015. [DOI: 10.1136/emermed-2015-204880.4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Hodgson D, Anderson J, Reynolds C, Meakin G, Bailey H, Pavord I, Shaw D, Harrison T. A randomised controlled trial of small particle inhaled steroids in refractory eosinophilic asthma (SPIRA). Thorax 2015; 70:559-65. [PMID: 25858909 PMCID: PMC4453493 DOI: 10.1136/thoraxjnl-2014-206481] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 03/15/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND Some patients with refractory asthma have evidence of uncontrolled eosinophilic inflammation in the distal airways. While traditional formulations of inhaled steroids settle predominantly in the large airways, newer formulations with an extra-fine particle size have a more peripheral pattern of deposition. Specifically treating distal airway inflammation may improve asthma control. METHODS 30 patients with refractory asthma despite high dose inhaled corticosteroids were identified as having persistent airway eosinophilia. Following 2 weeks of prednisolone 30 mg, patients demonstrating an improvement in asthma control were randomised to receive either ciclesonide 320 µg twice daily or placebo in addition to usual maintenance therapy for 8 weeks. The primary outcome measure was sputum eosinophil count at week 8. Alveolar nitric oxide was measured as a marker of distal airway inflammation. RESULTS There was continued suppression of differential sputum eosinophil counts with ciclesonide (median 2.3%) but not placebo (median 4.5%) though the between-group difference was not significant. When patients who had changed their maintenance prednisolone dose during the trial were excluded the difference between groups was significant (1.4% vs 4.5%, p=0.028). Though alveolar nitric oxide decreased with ciclesonide the value did not reach statistical significance. CONCLUSIONS These data demonstrate that patients with ongoing eosinophilic inflammation are not truly refractory, and that suppression of airway eosinophilia may be maintained with additional inhaled corticosteroid. Further work is needed with a focus on patient-orientated outcome measures such as exacerbation rate, with additional tests of small airway function. TRIAL REGISTRATION NUMBER NCT01171365. Protocol available at http://www.clinicaltrials.gov.
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Abe K, Adam J, Aihara H, Akiri T, Andreopoulos C, Aoki S, Ariga A, Assylbekov S, Autiero D, Barbi M, Barker G, Barr G, Bartet-Friburg P, Bass M, Batkiewicz M, Bay F, Berardi V, Berger B, Berkman S, Bhadra S, Blaszczyk F, Blondel A, Bojechko C, Bolognesi S, Bordoni S, Boyd S, Brailsford D, Bravar A, Bronner C, Buchanan N, Calland R, Caravaca Rodríguez J, Cartwright S, Castillo R, Catanesi M, Cervera A, Cherdack D, Christodoulou G, Clifton A, Coleman J, Coleman S, Collazuol G, Connolly K, Cremonesi L, Dabrowska A, Das R, Davis S, de Perio P, De Rosa G, Dealtry T, Dennis S, Densham C, Dewhurst D, Di Lodovico F, Di Luise S, Dolan S, Drapier O, Duboyski T, Duffy K, Dumarchez J, Dytman S, Dziewiecki M, Emery-Schrenk S, Ereditato A, Escudero L, Feusels T, Finch A, Fiorentini G, Friend M, Fujii Y, Fukuda Y, Furmanski A, Galymov V, Garcia A, Giffin S, Giganti C, Gilje K, Goeldi D, Golan T, Gonin M, Grant N, Gudin D, Hadley D, Haegel L, Haesler A, Haigh M, Hamilton P, Hansen D, Hara T, Hartz M, Hasegawa T, Hastings N, Hayashino T, Hayato Y, Hearty C, Helmer R, Hierholzer M, Hignight J, Hillairet A, Himmel A, Hiraki T, Hirota S, Holeczek J, Horikawa S, Huang K, Ichikawa A, Ieki K, Ieva M, Ikeda M, Imber J, Insler J, Irvine T, Ishida T, Ishii T, Iwai E, Iwamoto K, Iyogi K, Izmaylov A, Jacob A, Jamieson B, Jiang M, Johnson S, Jo J, Jonsson P, Jung C, Kabirnezhad M, Kaboth A, Kajita T, Kakuno H, Kameda J, Kanazawa Y, Karlen D, Karpikov I, Katori T, Kearns E, Khabibullin M, Khotjantsev A, Kielczewska D, Kikawa T, Kilinski A, Kim J, King S, Kisiel J, Kitching P, Kobayashi T, Koch L, Koga T, Kolaceke A, Konaka A, Kormos L, Korzenev A, Koshio Y, Kropp W, Kubo H, Kudenko Y, Kurjata R, Kutter T, Lagoda J, Lamont I, Larkin E, Laveder M, Lawe M, Lazos M, Lindner T, Lister C, Litchfield R, Longhin A, Lopez J, Ludovici L, Magaletti L, Mahn K, Malek M, Manly S, Marino A, Marteau J, Martin J, Martins P, Martynenko S, Maruyama T, Matveev V, Mavrokoridis K, Mazzucato E, McCarthy M, McCauley N, McFarland K, McGrew C, Mefodiev A, Metelko C, Mezzetto M, Mijakowski P, Miller C, Minamino A, Mineev O, Missert A, Miura M, Moriyama S, Mueller T, Murakami A, Murdoch M, Murphy S, Myslik J, Nakadaira T, Nakahata M, Nakamura K, Nakamura K, Nakayama S, Nakaya T, Nakayoshi K, Nantais C, Nielsen C, Nirkko M, Nishikawa K, Nishimura Y, Nowak J, O’Keeffe H, Ohta R, Okumura K, Okusawa T, Oryszczak W, Oser S, Ovsyannikova T, Owen R, Oyama Y, Palladino V, Palomino J, Paolone V, Payne D, Perevozchikov O, Perkin J, Petrov Y, Pickard L, Pinzon Guerra E, Pistillo C, Plonski P, Poplawska E, Popov B, Posiadala-Zezula M, Poutissou JM, Poutissou R, Przewlocki P, Quilain B, Radicioni E, Ratoff P, Ravonel M, Rayner M, Redij A, Reeves M, Reinherz-Aronis E, Riccio C, Rodrigues P, Rojas P, Rondio E, Roth S, Rubbia A, Ruterbories D, Rychter A, Sacco R, Sakashita K, Sánchez F, Sato F, Scantamburlo E, Scholberg K, Schoppmann S, Schwehr J, Scott M, Seiya Y, Sekiguchi T, Sekiya H, Sgalaberna D, Shah R, Shaker F, Shaw D, Shiozawa M, Short S, Shustrov Y, Sinclair P, Smith B, Smy M, Sobczyk J, Sobel H, Sorel M, Southwell L, Stamoulis P, Steinmann J, Still B, Suda Y, Suzuki A, Suzuki K, Suzuki S, Suzuki Y, Tacik R, Tada M, Takahashi S, Takeda A, Takeuchi Y, Tanaka H, Tanaka H, Tanaka M, Terhorst D, Terri R, Thompson L, Thorley A, Tobayama S, Toki W, Tomura T, Touramanis C, Tsukamoto T, Tzanov M, Uchida Y, Vacheret A, Vagins M, Vasseur G, Wachala T, Wakamatsu K, Wallbank M, Walter C, Wark D, Warzycha W, Wascko M, Weber A, Wendell R, Wilkes R, Wilking M, Wilkinson C, Williamson Z, Wilson J, Wilson R, Wongjirad T, Yamada Y, Yamamoto K, Yanagisawa C, Yano T, Yen S, Yershov N, Yokoyama M, Yoshida K, Yuan T, Yu M, Zalewska A, Zalipska J, Zambelli L, Zaremba K, Ziembicki M, Zimmerman E, Zito M, Żmuda J. Search for short baselineνedisappearance with the T2K near detector. Int J Clin Exp Med 2015. [DOI: 10.1103/physrevd.91.051102] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Patel M, Shaw D. A review of standard pharmacological therapy for adult asthma – Steps 1 to 5. Chron Respir Dis 2015; 12:165-76. [PMID: 25711467 DOI: 10.1177/1479972315573529] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The aim of pharmacological therapy for asthma is to improve symptoms and lung function and minimize the risk of asthma attacks. The intensity of treatment is based on the level of asthma control and the potential risk of future deterioration. In the British asthma guidelines, treatments are divided into steps 1 to 5, with each step signifying a need for an increase in therapy in response to symptoms or to prevent exacerbations. Treatments comprise of inhaled or systemic medications. Inhaled therapy includes short-acting and long-acting medication to improve symptoms and inhaled corticosteroids that reduce airway inflammation. Systemic treatments include medications that act on specific biological pathways, such as the leukotriene or immunoglobulin E pathways, or systemic corticosteroids. In choosing a particular therapy, treatment benefits are balanced by the potential risks of medication-related adverse effects. This review will provide a practical guide to the key pharmacological therapies for adult asthma at steps 1 to 5 based on British guidelines and consider future options for new treatments.
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Brown M, Shaw D, Sharples S, Jeune IL, Blakey J. A survey-based cross-sectional study of doctors' expectations and experiences of non-technical skills for Out of Hours work. BMJ Open 2015; 5:e006102. [PMID: 25687899 PMCID: PMC4336458 DOI: 10.1136/bmjopen-2014-006102] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES The skill set required for junior doctors to work efficiently and safely Out of Hours (OoH) in hospitals has not been established. This is despite the OoH period representing 75% of the year and it being the time of highest mortality. We set out to explore the expectations of medical students and experiences of junior doctors of the non-technical skills needed to work OoH. DESIGN Survey-based cross-sectional study informed by focus groups. SETTING Online survey with participants from five large teaching hospitals across the UK. PARTICIPANTS 300 Medical Students and Doctors OUTCOME MEASURE Participants ranked the importance of non-technical skills, as identified by literature review and focus groups, needed for OoH care. RESULTS The focus groups revealed a total of eight non-technical skills deemed to be important. In the survey 'Task Prioritisation' (mean rank 1.617) was consistently identified as the most important non-technical skill. Stage of training affected the ranking of skills, with significant differences for 'Communication with Senior Doctors', 'Dealing with Clinical Isolation', 'Task Prioritisation' and 'Communication with Patients'. Importantly, there was a significant discrepancy between the medical student expectations and experiences of doctors undertaking work. CONCLUSIONS Our findings suggest that medical staff particularly value task prioritisation skills; however, these are not routinely taught in medical schools. The discrepancy between expectations of students and experience of doctors reinforces the idea that there is a gap in training. Doctors of different grades place different importance on specific non-technical skills with implications for postgraduate training. There is a pressing need for medical schools and deaneries to review non-technical training to include more than communication skills.
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Shaw D, Blakey J, Rylance J. Measuring the true impact of an electronic physiological surveillance system (EPSS). BMJ Qual Saf 2015; 24:175-6. [DOI: 10.1136/bmjqs-2014-003804] [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]
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Patel M, Pilcher J, Hancox RJ, Sheahan D, Pritchard A, Braithwaite I, Shaw D, Black P, Weatherall M, Beasley R. The use of β2-agonist therapy before hospital attendance for severe asthma exacerbations: a post-hoc analysis. NPJ Prim Care Respir Med 2015; 25:14099. [PMID: 25569185 PMCID: PMC4532151 DOI: 10.1038/npjpcrm.2014.99] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 08/04/2014] [Accepted: 08/30/2014] [Indexed: 12/03/2022] Open
Abstract
Background: Patterns of inhaled β2-agonist therapy use during severe asthma exacerbations before hospital attendance are poorly understood. Aims: To assess β2-agonist use prior to hospital attendance. Methods: We undertook an exploratory post hoc analysis of data from a 6-month clinical trial of 303 patients randomised to combination budesonide/formoterol inhaler according to a Single combination inhaler as Maintenance And Reliever Therapy regimen (‘SMART’) or fixed-dose budesonide/formoterol with salbutamol as reliever (‘Standard’). Patterns of β2-agonist use for 14 days before hospital attendance with a severe asthma exacerbation were determined by electronic monitoring of inhaler use. Results: There were 22 hospital attendances in 16 patients during the study. Seven and nine hospital attendances were eligible for analysis in the SMART and Standard groups, respectively. In both regimens, β2-agonist use increased before hospital attendance, with a median (range) maximum daily number of actuations of 14 (9 to 63) budesonide/formoterol in SMART and 46 (6 to 95) salbutamol in Standard with 4 (0 to 10) budesonide/formoterol actuations on the day of maximal salbutamol use. There was delay in obtaining medical review despite high β2-agonist use, in 9/16 patients. Different patterns of use were observed, including repeated days of no inhaled corticosteroid despite marked salbutamol use, which occurred in 3/9 patients in the Standard group. Conclusions: Delay in obtaining medical review in association with high β2-agonist use is common in patients before hospital presentation with severe exacerbations of asthma. The SMART regimen reduced nonadherence with inhaled corticosteroid therapy during severe exacerbations.
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Goh SS, Kho A, Couch G, Shaw D, McCrystal G, Singh H. Operative risks and mid-term outcomes following offpump coronary artery bypass grafting at Christchurch Hospital. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2014.12.056] [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]
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Rogers GB, Shaw D, Marsh RL, Carroll MP, Serisier DJ, Bruce KD. Respiratory microbiota: addressing clinical questions, informing clinical practice. Thorax 2015; 70:74-81. [PMID: 25035125 PMCID: PMC4283665 DOI: 10.1136/thoraxjnl-2014-205826] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 06/23/2014] [Indexed: 12/23/2022]
Abstract
Over the last decade, technological advances have revolutionised efforts to understand the role played by microbes in airways disease. With the application of ever more sophisticated techniques, the literature has become increasingly inaccessible to the non-specialist reader, potentially hampering the translation of these gains into improvements in patient care. In this article, we set out the key principles underpinning microbiota research in respiratory contexts and provide practical guidance on how best such studies can be designed, executed and interpreted. We examine how an understanding of the respiratory microbiota both challenges fundamental assumptions and provides novel clinical insights into lung disease, and we set out a number of important targets for ongoing research.
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Shaw D, Cuison R, Ito H. Follicular dendritic cell sarcoma of the stomach: case report and review of the literature. ACTA ACUST UNITED AC 2014; 21:e775-8. [PMID: 25489266 DOI: 10.3747/co.21.2091] [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] [Indexed: 12/14/2022]
Abstract
Follicular dendritic cell sarcoma (fdcs) is a rare entity, often presenting a diagnostic challenge for both the pathologist and the clinician. It accounts for only 0.4% of soft-tissue sarcomas, and its underlying causes are largely unknown. Most of these tumours occur in lymph nodes, and extranodal involvement is uncommon. In the gastrointestinal tract, fdcs is extremely rare. Here, we report a case of primary fdcs originating in the stomach. Upon review of the literature, we identified only 2 additional cases of fdcs presenting as a primary stomach tumour. Given the rarity of this tumour in gastrointestinal sites and the lack of consensus on treatment, evaluation of this entity must continue.
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Marek A, Smith A, Peat M, Connell A, Gillespie I, Morrison P, Hamilton A, Shaw D, Stewart A, Hamilton K, Smith I, Mead A, Howard P, Ingle D. Endoscopy supply water and final rinse testing: five years of experience. J Hosp Infect 2014; 88:207-12. [DOI: 10.1016/j.jhin.2014.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 09/09/2014] [Indexed: 11/17/2022]
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Anderson J, Hodgson D, Wilson E, Harrison T, Shaw D. P49 Can The Asthma Control Questionnaire (acq) And/or The Blood Eosinophil Count Accurately Detect Sputum Eosinophilia? Thorax 2014. [DOI: 10.1136/thoraxjnl-2014-206260.190] [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]
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Collins A, Wright A, Mitsi E, Gritzfeld J, Hancock C, Shaw D, Pennington S, Morton B, Ferreira D, Gordon S. T4 Pneumococcal Conjugate Vaccine Reduces Rate, Density And Duration Of Experimental Human Pneumococcal Colonisation: First Human Challenge Testing Of A Pneumococcal Vaccine. Thorax 2014. [DOI: 10.1136/thoraxjnl-2014-206260.4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Shaw D, Gardiner D. Moral distance and distributive justice: how the increase in organ donation is helping us make better ethical decisions. Anaesthesia 2014; 70:10-3. [DOI: 10.1111/anae.12931] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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121
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Blakey JD, Shaw D, Brown M. Letter by Blakey et al regarding article, "Mortality among high-risk patients with acute myocardial infarction admitted to US teaching-intensive hospitals in July: a retrospective observational study". Circulation 2014; 130:e93. [PMID: 25210101 DOI: 10.1161/circulationaha.114.007492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Howard S, Lang A, Patel M, Sharples S, Shaw D. Electronic Monitoring of Adherence to Inhaled Medication in Asthma. CURRENT RESPIRATORY MEDICINE REVIEWS 2014. [DOI: 10.2174/1573398x10666140429005007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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123
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Wilson E, McKeever T, Hargadon B, Hearson G, Anderson J, Hodgson D, Bailey H, Meakin G, Thomas M, Pavord ID, Harrison T, Shaw D. Exhaled nitric oxide and inhaled corticosteroid dose reduction in asthma: a cohort study. Eur Respir J 2014; 44:1705-7. [PMID: 25142486 DOI: 10.1183/09031936.00093614] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Patel M, Pilcher J, Reddel HK, Qi V, Mackey B, Tranquilino T, Shaw D, Black P, Weatherall M, Beasley R. Predictors of severe exacerbations, poor asthma control, and β-agonist overuse for patients with asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2014; 2:751-8. [PMID: 25439367 DOI: 10.1016/j.jaip.2014.06.001] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 05/18/2014] [Accepted: 06/09/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Predictors of asthma exacerbations, poor asthma control, or extreme β-agonist overuse may be of clinical utility in the management of asthma. OBJECTIVE To investigate characteristics that predict subsequent adverse outcomes in asthma. METHODS An independent 24-week, randomized controlled trial of 303 adult patients with asthma who are at risk, which compared the efficacy of SMART (single budesonide-formoterol inhaler as maintenance and reliever therapy) with a fixed-dose regimen with salbutamol as reliever ("Standard"). Inhaled medication use was measured by electronic monitoring. Baseline characteristics that were predictors of subsequent severe asthma exacerbations, poor asthma control (Asthma Control Questionnaire -5 score ≥1.5), and "extreme" β-agonist overuse (>16 budesonide-formoterol actuations/d in SMART and >32 salbutamol actuations/d in Standard) were assessed by multivariate analyses. RESULTS FEV₁ % predicted (rate ratio [RR] 1.14 [95% CI, 1.03-1.27] per 10% lower), more previous exacerbations (RR 1.15 [95% CI, 1.01-1.31]), Standard therapy (RR 1.62 [95% CI, 1.07-2.47]), and female sex (RR 2.18 [95% CI, 1.29-3.67]) were associated with future severe exacerbations. Asthma Control Questionnaire--5 (regression coefficient 0.20 [95% CI, 0.13-0.27] per 0.5 points higher) and age (regression coefficient 0.09 [95% CI, 0.01-0.17] per decade older) were associated with future poorly controlled asthma. Higher reliever use (RR 1.63 [95% CI, 1.36-1.95] per categorical score in Asthma Control Questionnaire question no. 6), Māori ethnicity (RR 2.20 [95% CI, 1.43-3.38]) and FEV₁ % predicted (RR 1.16 [95% CI, 1.03-1.31] per 10% lower) were associated with future extreme β-agonist overuse. CONCLUSION Future severe asthma exacerbations, poor asthma control, and extreme β-agonist overuse are predicted by different baseline clinical and demographic characteristics and management approaches in at-risk asthma.
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Slater M, Rivett DW, Williams L, Martin M, Harrison T, Sayers I, Bruce KD, Shaw D. The impact of azithromycin therapy on the airway microbiota in asthma. Thorax 2014; 69:673-4. [PMID: 24287164 PMCID: PMC4078717 DOI: 10.1136/thoraxjnl-2013-204517] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Revised: 11/05/2013] [Accepted: 11/06/2013] [Indexed: 11/24/2022]
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Kyle S, Shaw D. Doctor–patient communication, patient knowledge and health literacy: how difficult can it all be? ACTA ACUST UNITED AC 2014. [DOI: 10.1308/rcsbull.2014.96.6.e9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Patients who understand their injuries, the aims and potential of their treatment are likely to experience superior outcomes. We review the literature on positive, encouraging doctor–patient communication, and the impact of health literacy and education on patient knowledge in medicine and surgery, with a particular emphasis on orthopaedic surgery. We also highlight methods of improving doctor–patient communication and patient knowledge.
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Patel M, Pilcher J, Reddel HK, Pritchard A, Corin A, Helm C, Tofield C, Shaw D, Black P, Weatherall M, Beasley R. Metrics of salbutamol use as predictors of future adverse outcomes in asthma. Clin Exp Allergy 2014; 43:1144-51. [PMID: 24074332 DOI: 10.1111/cea.12166] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Revised: 06/18/2013] [Accepted: 06/21/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Beta-agonist overuse is associated with adverse outcomes in asthma, however, the relationships between different metrics of salbutamol use and future risk are uncertain. OBJECTIVE To investigate the relationship between metrics of salbutamol use and adverse outcome. METHODS In a 24-week randomized controlled trial of 303 asthma patients at risk of severe exacerbations which compared the efficacy and safety of combination budesonide/formoterol inhaler according to a single inhaler regimen (SMART) with a fixed-dose regimen with salbutamol as reliever ('Standard'), actual medication use was measured by electronic monitoring (Australian New Zealand Clinical Trials Registry Number ACTRN12610000515099). A nested cohort study explored the relationship between metrics of baseline salbutamol use over 2 weeks and future severe asthma exacerbations, poor asthma control (ACQ-5 ≥ 1.5) or 'extreme' salbutamol overuse (> 32 salbutamol actuations/24-h period). RESULTS Higher mean daily salbutamol use (per two actuations/day) [Odds ratio (OR) (95% CI) 1.24 (1.06-1.46)], higher days of salbutamol use (per 2 days in 2 weeks) [OR 1.15 (1.00-1.31)] and higher maximal 24-h use (per two actuations/day) [OR 1.09 (1.02-1.16)] were associated with future severe exacerbations. Higher mean daily salbutamol use was associated with future poor asthma control [OR 1.13 (1.02-1.26)]. Higher mean daily salbutamol use [OR 2.73 (1.84-4.07)], number of days of use [OR 1.46 (1.24-1.71)], and maximal daily use [OR 1.57 (1.31-1.89)] were associated with an increased risk of future extreme salbutamol overuse. CONCLUSION AND CLINICAL RELEVANCE Electronically recorded frequency of current salbutamol use is a strong predictor of risk of future adverse outcomes in asthma, with average daily use performing the best. These findings provide new information for clinicians considering metrics of salbutamol as predictors of future adverse outcomes in asthma.
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Shaw D. Provision of complementary and alternative medicine in Swiss hospitals: neither increasing nor evidence-based. Swiss Med Wkly 2014; 144:w13926. [DOI: 10.4414/smw.2014.13926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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McKeever T, Harrison TW, Hubbard R, Shaw D. Inhaled corticosteroids and the risk of pneumonia in people with asthma: a case-control study. Chest 2014; 144:1788-1794. [PMID: 23990003 DOI: 10.1378/chest.13-0871] [Citation(s) in RCA: 111] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND In clinical trials, the use of inhaled corticosteroids is associated with an increased risk of pneumonia in people with COPD, but whether the same is true for people with asthma is not known. METHODS With the use of primary care data from The Health Improvement Network, we identified people with asthma, and from this cohort, we identified patients with pneumonia or lower respiratory tract infection and age- and sex-matched control subjects. Conditional logistic regression was used to determine the association between the dose and type of inhaled corticosteroid and the risk of pneumonia or lower respiratory tract infection. RESULTS A dose-response relationship was found between the strength of inhaled corticosteroid dose and risk of pneumonia or lower respiratory tract infection (P < .001 for trend) such that after adjusting for confounders, people receiving the highest strength of inhaled corticosteroid (≥ 1,000 μg) had a 2.04 (95% CI, 1.59-2.64) increased risk of pneumonia or lower respiratory tract infection compared with those with asthma who did not have a prescription for inhaled corticosteroids within the previous 90 days. CONCLUSIONS People with asthma receiving inhaled corticosteroids are at an increased risk of pneumonia or lower respiratory infection, with those receiving higher doses being at greater risk. Pneumonia should be considered as a possible side effect of inhaled corticosteroids, and the lowest possible dose of inhaled corticosteroids should be used in the management of asthma.
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Patel M, Pilcher J, Shaw D, Weatherall M, Beasley R. P165 The reliability and performance of electronic monitors of inhaler use in a real world asthma clinical trial. Thorax 2013. [DOI: 10.1136/thoraxjnl-2013-204457.316] [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]
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131
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Naveed S, Shaw D, Johnson SR. P186 Mast cell mediators stimulate human airway smooth muscle growth, a feature of airway remodelling in asthma via matrix metalloproteinase (MMP-1) activity. Thorax 2013. [DOI: 10.1136/thoraxjnl-2013-204457.338] [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]
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Patel M, Pilcher J, Shaw D, Weatherall M, Beasley R. P161 A randomised controlled trial of single combination budesonide/formoterol inhaler as maintenance and reliever therapy in asthma patients at risk of severe exacerbations. Thorax 2013. [DOI: 10.1136/thoraxjnl-2013-204457.312] [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]
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133
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Patel M, Pilcher J, Shaw D, Weatherall M, Knox A, Beasley R. P164 Use of beta-agonists prior to hospital attendance for severe exacerbations of asthma: insights from a randomised controlled trial using electronic monitoring of inhaler use. Thorax 2013. [DOI: 10.1136/thoraxjnl-2013-204457.315] [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]
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134
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Shaw D, Blakey J, Housley G. Acute care. Less talk, more data. THE HEALTH SERVICE JOURNAL 2013; 123:26-27. [PMID: 24383242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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135
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Martin M, Shaw D. Effect of inhaled corticosteroids on the microbiology of the respiratory tract. Respirology 2013; 18:201-2. [PMID: 23347106 DOI: 10.1111/resp.12024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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136
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Shaw D, Fletcher E, Wilde JS. An automatic potentiostat system for corrosion studies. ACTA ACUST UNITED AC 2013. [DOI: 10.1179/bcj.1969.4.5.249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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137
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Patel M, Pilcher J, Munro C, Hosking A, Pritchard A, Shaw D, Black P, Weatherall M, Beasley R. Short-acting β-agonist use as a marker of current asthma control. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2013; 1:370-7. [PMID: 24565542 DOI: 10.1016/j.jaip.2013.04.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 04/18/2013] [Accepted: 04/23/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND The relationship between current asthma symptoms and rescue bronchodilator (reliever) use is uncertain, leading to different recommendations about the preferred reliever metric to use when assessing asthma control. In a 6-month randomized controlled trial of combination budesonide/formoterol as maintenance and reliever therapy versus combination budesonide/formoterol as maintenance treatment with albuterol as reliever, we measured inhaler use by electronic monitoring. OBJECTIVE To determine the agreement between current asthma symptoms and different metrics of albuterol use for patients randomly assigned to maintenance budesonide/formoterol treatment. METHODS Data on albuterol use were extracted for the 7-day period before visit 2 (at week 3) from 150 adult patients with asthma. Current asthma symptoms were measured by Asthma Control Questionnaire-5 (ACQ-5) score at the clinic visit. RESULTS The number of days of albuterol use, the average number of albuterol actuations/day, and the highest number of albuterol actuations/day in the 1-week period were all positively associated with ACQ-5 score (r = 0.41-0.45, P < .001) and had moderate discrimination for well-controlled and not well-controlled asthma (ACQ-5 scores ≤0.75 and ≥1.5, respectively), with receiver operator characteristic area under the curve of 0.80 to 0.82 and 0.70 to 0.77, respectively. Cut points of ≥3 days of albuterol use, average albuterol use of ≥1 actuation/day, and highest albuterol use of ≥4 actuations/day in the 1-week period had 73% sensitivity and 62% specificity, 78% sensitivity and 67% specificity, and 78% sensitivity and 66% specificity, respectively, for predicting an ACQ-5 ≥1.5. CONCLUSION Our findings support the use of the number of days of albuterol use, the average number of albuterol actuations per day, and the highest number of albuterol actuations per day over a 1-week period of observation as comparable markers of current asthma control.
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Patel M, Pilcher J, Pritchard A, Perrin K, Travers J, Shaw D, Holt S, Harwood M, Black P, Weatherall M, Beasley R. Efficacy and safety of maintenance and reliever combination budesonide-formoterol inhaler in patients with asthma at risk of severe exacerbations: a randomised controlled trial. THE LANCET RESPIRATORY MEDICINE 2013; 1:32-42. [PMID: 24321802 DOI: 10.1016/s2213-2600(13)70007-9] [Citation(s) in RCA: 93] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND The Single combination budesonide-formoterol inhaler Maintenance And Reliever Therapy (SMART) regimen reduces severe asthma exacerbations in patients, but whether the high doses of corticosteroid and β agonist increase the risk of adverse effects with both short-term and cumulative exposure is not certain. Our aim was to investigate whether the SMART regimen would reduce the risk of overuse of β agonist, reduce the likelihood of patients to seek medical review when such episodes occurred, and if any reduction in severe asthma exacerbations would be at the cost of a higher burden of systemic corticosteroid. METHODS In this 24-week trial undertaken at four primary health-care practices and one hospital in New Zealand, patients (aged 16-65 years) with a recent asthma exacerbation were randomly assigned in a 1:1 ratio to the SMART or standard fixed-dose regimen. Treatment in the SMART group consisted of two actuations of budesonide-formoterol (200 μg and 6 μg, respectively, per actuation) twice daily, delivered through a combination metered dose inhaler (MDI), with one extra actuation as needed for relief of symptoms; treatment in the standard group consisted of two actuations of budesonide-formoterol (200 μg and 6 μg, respectively, per actuation) twice daily through a combination MDI with one to two actuations of salbutamol (100 μg per actuation) by MDI as needed for relief of symptoms. MDIs were monitored electronically to measure actual use of medication. The allocation sequence for randomisation was computer generated, with a block size of eight per site. Participants, investigators, and the statistician were not masked to group assignment. The primary outcome was the proportion of participants with at least one high-use episode of β agonist (more than eight actuations per day of budesonide-formoterol in addition to the four maintenance doses in the SMART group or more than 16 actuations per day of salbutamol in the standard group). Analysis was by intention to treat. This trial is registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12610000515099. FINDINGS 303 patients were randomly assigned to the SMART (n=151) or standard group (n=152). No significant difference was noted between the SMART and standard groups in the proportion of participants with at least one high-use episode of β agonist (84 [56%] vs 68 [45%], respectively, relative risk 1·24 [95% CI 0·99-1·56]; p=0·058). There were fewer days of high use in the SMART group (mean 5·1 days [SD 14·3] vs 8·9 days [20·9], relative rate 0·58 [0·39-0·88]; p=0·01). Of the patients who had at least one high-use episode, those in the SMART group had fewer days of high use without medical review (8·5 days [17·8] vs 18·3 days [24·8], 0·49 [0·31-0·75]; p=0·001). The SMART regimen resulted in higher inhaled corticosteroid exposure (943·5 μg budesonide per day [1502·5] vs 684·3 μg budesonide per day [390·5], respectively; ratio of means 1·22 [1·06-1·41]; p=0·006), but reduced oral corticosteroid exposure (77·5 mg prednisone [240·5] vs 126·6 mg prednisone [382·1], respectively; p=0·011), with no significant difference in composite systemic corticosteroid exposure (793·7 mg prednisone equivalent per year [893·1] vs 772·1 mg prednisone equivalent per year [1062·7], respectively; 1·03 [0·86-1·22]; p=0·76). Participants in the SMART group had fewer severe asthma exacerbations (35 [weighted mean rate per year 0·53] vs 66 [0·97]; relative rate 0·54 [0·36-0·82]; p=0·004). INTERPRETATION The SMART regimen has a favourable risk-to-benefit profile and can be recommended for use in adults at risk of severe asthma exacerbations. FUNDING Health Research Council of New Zealand.
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Shaw D, Green R, Berry M, Mellor S, Hargadon B, Shelley M, McKenna S, Thomas M, Pavord I. A cross-sectional study of patterns of airway dysfunction, symptoms and morbidity in primary care asthma. PRIMARY CARE RESPIRATORY JOURNAL : JOURNAL OF THE GENERAL PRACTICE AIRWAYS GROUP 2013; 21:283-7. [PMID: 22786814 DOI: 10.4104/pcrj.2012.00057] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Most patients with asthma are managed exclusively in primary care. Little is known about the patterns of airway dysfunction in these patients and how these relate to other aspects of the disease. AIMS We set out to assess this in a cross-sectional study of 262 patients. METHODS Symptoms, spirometry, airway responsiveness, reversibility, and airway inflammation were all assessed. Exacerbations requiring oral corticosteroids in the preceding year were enumerated. RESULTS Patients had heterogeneous patterns of airway dysfunction. Those with a post-bronchodilator forced expiratory volume in 1 sec/ forced vital capacity ratio of <0.7 had more exacerbations in the previous year (2.2 vs. 0.8; mean difference 1.4; 95% CI 0.4 to 2.4; p=0.007). Patients with normal results had less inflammation (proportion with a sputum eosinophil count of >1.9%, 20% vs. 48%, χ²=14.8, df=3; p<0.001) and fewer exacerbations (0.5 vs. 1.4; mean difference -0.9; 95% CI -1.4 to -0.4; p=0.001) but similar symptom scores (6.2 vs. 6.9; p=0.2) compared with patients with any abnormality. CONCLUSIONS Patients with a diagnosis of asthma have mixed patterns of physiological impairment; many have no airflow obstruction or airway hyper-responsiveness. The physiological characterisation of asthma is not related to symptoms and is of little value in predicting exacerbations or eosinophilic airway inflammation.
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Shaw D. A counterstatement to a counterstatement - Reply to the letter to the editor " Familiarity, objectivity – and misconduct Counterstatement to Shaw: Swiss Report". Swiss Med Wkly 2013; 143:w13722. [DOI: 10.4414/smw.2013.13722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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141
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Shaw D. Author reply to letter: The report „Homeopathy in healthcare: effectiveness, appropriateness, safety, costs“ is not a „Swiss report“. Swiss Med Wkly 2012. [DOI: 10.4414/smw.2012.13724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Shaw D. Technology: Wireless brings night-time care out of the dark ages. THE HEALTH SERVICE JOURNAL 2012; 122:29-31. [PMID: 23390686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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143
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144
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Rogers NK, Clements D, Harrison TW, Shaw D, Johnson SR. S11 Expression of Tenascin-C Regulates Airway Smooth Muscle Derived Matrix Metalloproteinase-1 in Asthma. Thorax 2012. [DOI: 10.1136/thoraxjnl-2012-202678.017] [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]
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145
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Patel M, Pilcher J, Travers J, Perrin K, Shaw D, Black P, Weatherall M, Beasley R. Use of metered-dose inhaler electronic monitoring in a real-world asthma randomized controlled trial. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2012; 1:83-91. [PMID: 24229826 DOI: 10.1016/j.jaip.2012.08.004] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Revised: 08/27/2012] [Accepted: 08/29/2012] [Indexed: 11/16/2022]
Abstract
BACKGROUND Electronic monitoring of inhaled asthma medications is one method to measure medication adherence and patterns of use. Information on the performance of monitors in a randomized controlled trial allows researchers and clinicians to understand their utility and limitations. The Smartinhaler Tracker is an electronic monitor for metered-dose inhalers (MDIs) that records the date, time, and number of actuations. OBJECTIVE To determine the performance of the Smartinhaler monitors used in a 24-week randomized controlled trial of 303 patients with asthma in a real-world setting. METHODS Prestudy use checks involved 2 actuations of the MDI, with a further 2 performed 2 hours later. Within-study monitor checks, performed before dispensing at clinic visits 2 to 4, included a computerized check of monitor clock function, actuation accuracy, and battery life. Within-study data checks involved computerized checks of monitor clock function before data upload. RESULTS Two thousand six hundred seventy-eight of 2728 monitors (98.2%) passed prestudy use checks. Seventy-six of 2642 monitors (2.9%) dispensed to participants failed within-study monitor checks. Fifty-one of 2642 monitors (1.9%) malfunctioned before data upload, mostly as a result of fluid immersion. Ninety-three of 2642 monitors (3.5%) were lost or thrown away by participants. Complete data was available from 2498 of 2642 dispensed monitors (94.5%) and 2498 of 2549 returned monitors (98.0%). CONCLUSIONS The Smartinhaler Tracker is a reliable monitor for measuring MDI use in a real-world setting. Use of extensive monitor and data-checking protocols reduces data loss. In a research or clinical setting, the use of a validated and reliable electronic monitor represents the reference standard for assessing patterns of medication use.
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Farah MH, Edwards R, Lindquist M, Leon C, Shaw D. International monitoring of adverse health effects associated with herbal medicines. Pharmacoepidemiol Drug Saf 2012; 9:105-12. [PMID: 19025809 DOI: 10.1002/(sici)1099-1557(200003/04)9:2<105::aid-pds486>3.0.co;2-2] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Herbal medicines are used in health care around the world and may increase in importance. There is much uncertainty, however, with regard to their composition, efficacy and safety. There is substantial evidence that herbal medicines can cause serious adverse reactions, but more data are needed as regard their nature, frequency and preventability. In this respect the Uppsala Monitoring Centre of the World Health Organization can play a crucial role. Better reporting of adverse reactions to herbal medicines is needed, in particular with regard to the precise identity and composition of these products. A consistent use by producers, regulators and reporters of the international Latin binomial nomenclature and the use of the new Herbal Anatomical Therapeutic Chemical (ATC) classification are recommended. Copyright (c) 2000 John Wiley & Sons, Ltd.
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147
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Aldeen A, Hartman N, Segura A, Phull A, Shaw D, Chiampas G, Courtney D. 210 Effect of Video Self-instruction Training on Law Enforcement Attitudes Toward Cardiopulmonary Resuscitation and Automated External Defibrillators. Ann Emerg Med 2012. [DOI: 10.1016/j.annemergmed.2012.06.188] [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]
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148
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Abbas K, Birattari C, Bonardi M, Groppi F, Menapace E, Severgnini M, Shaw D, Stroosnijder MF. Cyclotron production of N.C.A. copper-64 from deuteron irradiation on zinc target. J Labelled Comp Radiopharm 2012. [DOI: 10.1002/jlcr.25804401282] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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149
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Schock A, Higgins R, Crawshaw T, Clifton-Hadley R, Shaw D, Gunn-Moore D. Mycobacterial Disease in British Cats. J Comp Pathol 2012. [DOI: 10.1016/j.jcpa.2011.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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150
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Blakey JD, Guy D, Simpson C, Fearn A, Cannaby S, Wilson P, Shaw D. Multimodal observational assessment of quality and productivity benefits from the implementation of wireless technology for out of hours working. BMJ Open 2012; 2:e000701. [PMID: 22466035 PMCID: PMC3317138 DOI: 10.1136/bmjopen-2011-000701] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The authors investigated if a wireless system of call handling and task management for out of hours care could replace a standard pager-based system and improve markers of efficiency, patient safety and staff satisfaction. DESIGN Prospective assessment using both quantitative and qualitative methods, including interviews with staff, a standard satisfaction questionnaire, independent observation, data extraction from work logs and incident reporting systems and analysis of hospital committee reports. SETTING A large teaching hospital in the UK. PARTICIPANTS Hospital at night co-ordinators, clinical support workers and junior doctors handling approximately 10 000 tasks requested out of hours per month. OUTCOME MEASURES Length of hospital stay, incidents reported, co-ordinator call logging activity, user satisfaction questionnaire, staff interviews. RESULTS Users were more satisfied with the new system (satisfaction score 62/90 vs 82/90, p=0.0080). With the new system over 70 h/week of co-ordinator time was released, and there were fewer untoward incidents related to handover and medical response (OR=0.30, p=0.02). Broad clinical measures (cardiac arrest calls for peri-arrest situations and length of hospital stay) improved significantly in the areas covered by the new system. CONCLUSIONS The introduction of call handling software and mobile technology over a medical-grade wireless network improved staff satisfaction with the Hospital at Night system. Improvements in efficiency and information flow have been accompanied by a reduction in untoward incidents, length of stay and peri-arrest calls.
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