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Service Desk Calls in a Home-based Clinical Informatics Study: Supporting End Users in the Field. NI 2012 : 11TH INTERNATIONAL CONGRESS ON NURSING INFORMATICS, JUNE 23-27, 2012, MONTREAL, CANADA. INTERNATIONAL CONGRESS IN NURSING INFORMATICS (11TH : 2012 : MONTREAL, QUEBEC) 2012; 2012:427. [PMID: 24199135 PMCID: PMC3799103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Home-based clinical informatics technologies are being developed to facilitate health care provision and management. Given the novelty of these technologies, end users such as patients and their formal and informal caregivers may require support during use. This paper presents a case study within the United States of the service desk calls generated over a 31-month period by patients enrolled in a large randomized field experiment, HeartCare II. This case study provides future deployers of home-based clinical information technologies with an understanding of the types of support that may be required during use. Our analysis reveals that calls to the service desk originated as a result of user problems, hardware problems, software problems, and internal communication problems among individuals involved in the delivery and use of the technology. Implications of these needs for support during use are also discussed.
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Canagliflozin improves glycaemic control over 28 days in subjects with type 2 diabetes not optimally controlled on insulin. Diabetes Obes Metab 2012; 14:539-45. [PMID: 22226086 DOI: 10.1111/j.1463-1326.2012.01558.x] [Citation(s) in RCA: 187] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
AIM Canagliflozin is a sodium-glucose co-transporter 2 (SGLT2) inhibitor that is being investigated for the treatment of type 2 diabetes mellitus (T2DM). METHODS This was a randomized, double-blind, placebo-controlled, parallel-group, 28-day study conducted at two sites, in 29 subjects with T2DM not optimally controlled on insulin and up to one oral antihyperglycaemic agent. Subjects were treated with canagliflozin 100 mg QD or 300 mg twice daily (BID) or placebo. Safety, tolerability, pharmacokinetic characteristics and pharmacodynamic effects of canagliflozin were examined. Glucose malabsorption following a 75-g oral glucose challenge was also examined. RESULTS Canagliflozin pharmacokinetics were dose-dependent, and the elimination half-life ranged from 12 to 15 h. After 28 days, the renal threshold for glucose excretion was reduced; urinary glucose excretion was increased; and A1C, fasting plasma glucose and body weight decreased in subjects administered canagliflozin (A1C reductions: 0.19% with placebo, 0.73% with 100 mg QD, 0.92% with 300 mg BID; body weight changes: 0.03 kg increase with placebo, 0.73 kg reduction with 100 mg QD, 1.19 kg reduction with 300 mg BID). Glucose malabsorption was not observed with canagliflozin treatment. There were no deaths, serious adverse events or severe hypoglycaemic episodes. The incidence of adverse events was similar across groups. There were no clinically meaningful changes in routine laboratory safety tests, vital signs or electrocardiograms. CONCLUSION In subjects receiving insulin and oral antihyperglycaemic therapy, canagliflozin was well tolerated without evidence for glucose malabsorption, had pharmacokinetic characteristics consistent with once-daily dosing, and improved glycaemic control.
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P66 Changes in mitochondrial function over time and with exercise in patients with mitochondrial disease. Neuromuscul Disord 2012. [DOI: 10.1016/s0960-8966(12)70074-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Thrombolysis in Myocardial Infarction (TIMI) Risk Score and Sex Is There a difference? Heart Lung Circ 2012. [DOI: 10.1016/j.hlc.2012.05.448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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155
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Rates of Procedural Success in Percutaneous Coronary Intervention via the Radial Artery is Similar During Emergency Cases When Compared with Non-emergency Cases. Heart Lung Circ 2012. [DOI: 10.1016/j.hlc.2012.05.426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
BACKGROUND Cannabis consumption continues to be identified as a causal agent in the onset and development of psychosis. However, recent findings have shown that the effect of cannabis on psychosis may be moderated by childhood traumatic experiences. METHOD Using hierarchical multivariate logistic analyses the current study examined both the independent effect of cannabis consumption on psychosis diagnosis and the combined effect of cannabis consumption and childhood sexual abuse on psychosis diagnosis using data from the Adult Psychiatric Morbidity Survey 2007 (n=7403). RESULTS Findings suggested that cannabis consumption was predictive of psychosis diagnosis in a bivariate model; however, when estimated within a multivariate model that included childhood sexual abuse, the effect of cannabis use was attenuated and was not statistically significant. The multivariate analysis revealed that those who had experienced non-consensual sex in childhood were over six times [odds ratio (OR) 6.10] more likely to have had a diagnosis of psychosis compared with those who had not experienced this trauma. There was also a significant interaction. Individuals with a history of non-consensual sexual experience and cannabis consumption were over seven times more likely (OR 7.84) to have been diagnosed with psychosis compared with those without these experiences; however, this finding must be interpreted with caution as it emerged within an overall analytical step which was non-significant. CONCLUSIONS Future studies examining the effect of cannabis consumption on psychosis should adjust analyses for childhood trauma. Childhood trauma may advance existing gene-environment conceptualisations of the cannabis-psychosis link.
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Increased lung clearance of isoflurane shortens emergence in obesity: a prospective randomized-controlled trial. Acta Anaesthesiol Scand 2011; 55:995-1001. [PMID: 21770896 DOI: 10.1111/j.1399-6576.2011.02486.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is a concern that obesity may play a role in prolonging emergence from fat-soluble inhalational anaesthetics. We hypothesized that increased pulmonary clearance of isoflurane will shorten immediate recovery from anaesthesia and post-anaesthesia care unit (PACU) stay in obese patients. METHODS After Ethics Review Board approval, 44 ASA I-III patients with BMI>30 kg/m(2) undergoing elective gynaecological or urological surgery were randomized after completion of surgery to either an isocapnic hyperpnoea (IH) or a conventional recovery (C) group. The anaesthesia protocol included propofol, fentanyl, morphine, rocuronium and isoflurane in air/O(2) . Groups were compared using unpaired t-test and ANOVA. RESULTS Minute ventilation in the IH group before extubation was 22.6 ± 2.7 vs. 6.3 ± 1.8 l/min in the C group. Compared with C, the IH group had a shorter time to extubation (5.4 ± 2.7 vs. 15.8 ± 2.7 min, P<0.01), initiation of spontaneous ventilation (2.7 ± 2.3 vs. 6.5 ± 4.5 min, P<0.01), BIS recovery >75 (3.2 ± 2.3 vs. 8.9 ± 5.8 min, P<0.01), eye opening (4.6 ± 2.9 vs. 13.6 ± 7.1 min, P<0.01) and eligibility for leaving the operating room (7.1 ± 2.9 vs. 19.9 ± 11.9 min, P<0.01). There was no difference in time for eligibility for PACU discharge. CONCLUSION Increasing alveolar ventilation enhances anaesthetic elimination and accelerates short-term recovery in obese patients.
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Peripheral-venous-catheter-related Staphylococcus aureus bacteraemia: a multi-factorial approach to reducing incidence. J Hosp Infect 2011; 79:173-4. [PMID: 21741116 DOI: 10.1016/j.jhin.2011.04.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Accepted: 04/26/2011] [Indexed: 11/30/2022]
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160
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SU-C-110-02: Reducing 4D CT Artifacts Using Optimized Sorting Based on Anatomic Similarity. Med Phys 2011. [DOI: 10.1118/1.3611486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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SU-C-BRC-01: RapidArc Planning Standardization for High Quality and Efficiency in Prostate and Post-Prostatectomy Radiation Therapy. Med Phys 2011. [DOI: 10.1118/1.3611473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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1324 poster RAPID DOUBLE ARC REPLACES DYNAMIC IMRT IN PROSTATE BED AND STOMACH RADIATION THERAPY. Radiother Oncol 2011. [DOI: 10.1016/s0167-8140(11)71446-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Bispectral index monitoring reduces sedative and vasopressor requirements during percutaneous tracheostomy. Crit Care 2011. [PMCID: PMC3067022 DOI: 10.1186/cc9768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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The impact of prophylactic salpingo-oophorectomy on menopausal symptoms and sexual function in women who carry a BRCA mutation. Gynecol Oncol 2011; 121:163-8. [PMID: 21216453 DOI: 10.1016/j.ygyno.2010.12.326] [Citation(s) in RCA: 148] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Revised: 12/01/2010] [Accepted: 12/06/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Prophylactic salpingo-oophorectomy is recommended to women who carry a BRCA1 or BRCA2 mutation to reduce the risks of breast, ovarian and fallopian tube cancer. We measured the impact of prophylactic salpingo-oophorectomy on menopausal symptoms and sexual functioning in women with a BRCA mutation. METHODS Women who underwent prophylactic salpingo-oophorectomy between October 1, 2002 and June 26, 2008 for a known BRCA1 or BRCA2 mutation were invited to participate. Participants completed questionnaires before prophylactic surgery and again one year after surgery. Measures of sexual functioning and menopausal symptoms before and after surgery were compared. Satisfaction with the decision to undergo prophylactic salpingo-oophorectomy was evaluated. RESULTS 114 women who underwent prophylactic surgery completed questionnaires before and one year after surgery. Subjects who were premenopausal at the time of surgery (n=75) experienced a significant worsening of vasomotor symptoms (hot flashes, night sweats and sweating) and a decline in sexual functioning (desire, pleasure, discomfort and habit). The increase in vasomotor symptoms and the decline in sexual functioning were mitigated by HRT, but symptoms did not return to pre-surgical levels. HRT decreased vaginal dryness and dyspareunia; however, the decrease in sexual pleasure was not alleviated by HRT. Satisfaction with the decision to undergo prophylactic salpingo-oophorectomy remained high regardless of increased vasomotor symptoms and decreased sexual function. CONCLUSIONS Women who undergo prophylactic salpingo-oophorectomy prior to menopause experience an increase in vasomotor symptoms and a decrease in sexual functioning. These symptoms are improved by HRT, but not to pre-surgical levels.
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Prognostic Value of Metabolic Tumor Volume and Velocity in Predicting Head and Neck Cancer Outcomes. Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.1079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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167
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An Assessment of the Demographic and Clinical Correlates of the Dimensions of Alcohol Use Behaviour. Alcohol Alcohol 2010; 45:563-72. [DOI: 10.1093/alcalc/agq052] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Impact of a novel nutritional formula on asthma control and biomarkers of allergic airway inflammation in children. Clin Exp Allergy 2010; 40:1163-74. [PMID: 20545703 DOI: 10.1111/j.1365-2222.2010.03523.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND A novel nutritional formula (NNF) enriched in eicosapentaenoic (EPA) and gamma-linolenic fatty acids and antioxidants reduces airway inflammation and improves clinical outcomes in critically ill patients, but NNF has not been evaluated in chronic inflammatory diseases such as persistent asthma. OBJECTIVE To evaluate the efficacy, compliance, and safety of NNF in asthmatic children. METHODS Children, 6-14 years of age, with mild to moderate persistent asthma, on as needed albuterol alone, were randomized to receive daily NNF (n=23) or control formula (n=20) for 12 weeks, with multiple assessments of asthma control, spirometry, measures of airway inflammation, formula tolerance, and adverse events. RESULTS Daily consumption of either NNF or a control formula showed improvement in asthma-free days over time (P=0.04) but there was no difference between groups. However, the NNF group had lower exhaled nitric oxide levels compared with the control group at weeks 4, 8, and 12 (P<0.05). An overall group difference in log FEV1 PC20 (P=0.05) was found in favour of the NNF group as well. Significantly higher levels of EPA in plasma (P<0.01) and peripheral blood mononuclear cell (PBMC) (P<0.01) phospholipids in the NNF group compared with control group within 2 weeks indicated good adherence with daily NNF intake. There were no differences in adverse events for NNF vs. control after 12 weeks. CONCLUSIONS Both NNF and control groups demonstrated improvement in asthma-free days. NNF-treated group had reduced biomarkers of disease activity. Rapid PBMC fatty acid composition changes reflected an anti-inflammatory profile. Dietary supplementation with NNF was safe and well tolerated (ClinicalTrials.gov number NCT01087710).
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Psychometric properties of the Hospital Survey on Patient Safety Culture: findings from the UK. Qual Saf Health Care 2010; 19:e2. [PMID: 20211960 DOI: 10.1136/qshc.2008.031625] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Patient safety culture is measured using a range of survey tools. Many provide limited data on psychometric properties and few report findings outside of the US healthcare context. This study reports an assessment of the psychometric properties and suitability of the American Hospital Survey on Patient Safety Culture for use within the UK. METHODS A questionnaire survey of three hospitals within a large UK Acute NHS Trust. 1437 questionnaires were completed (37% response rate). Exploratory factor analysis, confirmatory factor analysis and reliability analyses were carried out to assess the psychometric performance of this survey instrument and to explore potential improvements. RESULTS Reliability analysis of the items within each proposed scale showed that more than half failed to achieve satisfactory internal consistency (Cronbach's α<0.7). Furthermore, a confirmatory factor analysis carried out on the UK data set achieved a poor fit when compared with the original American model. An optimal measurement model was then constructed via exploratory and confirmatory factor analyses with split-half sample validation and consisted of nine dimensions compared with the original 12 in the American model. CONCLUSION This is one of the few studies to provide an evaluation of an American patient safety culture survey using data from the UK. The results indicate that there is need for caution in using the Hospital Survey on Patient Safety Culture survey in the UK and underline the importance of appropriate validation of safety culture surveys before extending their usage to populations outside of the specific geographical and healthcare contexts in which they were developed.
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Plerixafor Plus G-CSF Resulted In Similar Cost But More Predictable Days Of Apheresis Compared To Chemotherapy Plus G-CSF For Mobilization Of Autologous Hematopoietic Stem Cells. Biol Blood Marrow Transplant 2010. [DOI: 10.1016/j.bbmt.2009.12.153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Abstract
REASONS FOR PERFORMING STUDY Prevalence of gastric ulcerations differs widely according to breed and circumstances of management. Further study of the biological variables involved is required in order to identify more exactly the reasons for the reported range. OBJECTIVES The objectives of this present study, which do not appear to have been addressed previously in the literature, were 1) the prevalence of gastric ulceration in horses with abdominal pain. 2) difference in prevalence in horses responding to medical therapy and those requiring surgical intervention. 3) whether gastric ulceration is associated with any particular gastrointestinal tract lesion. METHODS Horses were included in the study if gastroscopy was performed within 24 h of presentation. The presence and grade of gastric ulceration was recorded together with the medical records. Data were analysed categorically using a Fisher's exact test or Chi-squared test. RESULTS One hundred horses met the selection criteria. Forty-nine percent (49/100) of horses had gastric ulceration, 63% (63/100) responded to medical therapy and 37% (37/100) to surgical intervention, and prevalence was higher in the former (59%) than the latter (32%). Horses with duodenitis-proximal jejunitis (DPJ) had a trend towards higher prevalence of gastric ulceration compared to those with other GI lesions. Sixty-eight percent (13/19) of horses diagnosed with DPJ, 32% (8/25) with a large colon impaction and 14% (1/7) with large colon volvulus had gastric ulceration. CONCLUSIONS The presence of gastric ulceration in all horses with abdominal pain was moderate. Horses responding to medical therapy had a higher prevalence of gastric ulceration compared to horses requiring surgery and there was a trend towards higher prevalence in cases of DPJ compared to other GI lesions. There was not a statistically significant difference in gastric ulceration detected between specific lesions, including large colon impactions and large colon volvulus. POTENTIAL RELEVANCE The clinical relevance of ulceration is still unclear and further studies are required to differentiate between incidental and clinically important gastric ulceration.
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Sentinel lymph node biopsy vs. pelvic lymphadenectomy in early stage cervical cancer: Is it time to change the gold standard? Gynecol Oncol 2010; 116:28-32. [DOI: 10.1016/j.ygyno.2009.10.049] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2009] [Revised: 10/03/2009] [Accepted: 10/08/2009] [Indexed: 11/30/2022]
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Late, Acute Presentation of a Large Brachial Artery Aneurysm Following Ligation of a Brescia-Cimino Arteriovenous Fistula. Eur J Vasc Endovasc Surg 2010. [DOI: 10.1016/j.ejvs.2009.09.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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9148 Phase 1 study of the toll-like receptor 9 (TLR9) agonist, IMO-2055, combined with erlotinib (E) and bevacizumab (B) in patients (pts) with advanced or metastatic non-small cell lung cancer (NSCLC). EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)71861-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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178
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Breast and ovarian cancer risk perception after prophylactic salpingo-oophorectomy due to an inherited mutation in theBRCA1orBRCA2gene. Clin Genet 2009; 75:220-4. [DOI: 10.1111/j.1399-0004.2008.01117.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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180
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Letter in response to 'Unacceptable variation in abdominoperineal excision rates for rectal cancer: time to intervene?'. Gut 2009; 58:146; author response 146-7. [PMID: 19091835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
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181
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Abstract
Removal of excess abdominal fat may be necessary to facilitate major gynaecological surgery for oncology patients. The aim of the study was to assess the feasibility, associated morbidity of such operation when combined with other major gynaecological procedures. This was a retrospective review of cases performed in a tertiary gynaecological oncology centre. All of the patients were diagnosed with gynaecological cancers. The results show a modest increase in operative time; however the procedure was feasible and safe with no other increased risk. This represents time saving for the patients and hospital in having two operations in one session.
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CT evaluation of Chamberlain's, McGregor's, and McRae's skull-base lines. Clin Radiol 2008; 64:64-9. [PMID: 19070699 DOI: 10.1016/j.crad.2008.03.012] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2007] [Revised: 01/10/2008] [Accepted: 03/06/2008] [Indexed: 11/26/2022]
Abstract
AIM To evaluate the mean distance from the odontoid process of C2 to the standard skull-base lines (Chamberlain's, McGregor's, and McRae's lines) on computed tomography (CT) imaging. To compare these measurements to previously documented plain radiograph and magnetic resonance imaging (MRI) measurements. MATERIALS AND METHODS Reformatted midline sagittal CT images of 150 adults were retrospectively evaluated. The shortest perpendicular distance was measured from the Chamberlain's, McGregor's and McRae's baselines for each subject to the odontoid tip. Statistical analysis was performed to compare the CT data with the previously obtained MRI and plain film data. RESULTS The mean position of the odontoid process was 1.4mm below Chamberlain's line (median 1.2 mm, SD 2.4 mm), 0.8 mm (median 0.9 mm, SD 3 mm) below McGregor's line and 5 mm (median 5 mm, SD 1.8 mm) below McRae's line. There is no significant difference between male and female results (p>0.05) or between these CT and previous MRI measurements (p>0.05). CONCLUSION These results provide the mean and range of normal distance from the odontoid process to the most frequently used skull-base lines on the current population on CT.
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Vascular Endothelial Growth Factor production in breast cancer is reduced by Camptothecin regardless of Cyclooxygenase-2 expression. Eur J Surg Oncol 2008. [DOI: 10.1016/j.ejso.2008.06.176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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184
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Letter in response to colorectal disease article on intersphincteric resection. Colorectal Dis 2008; 10:737; author reply 736-7. [PMID: 18462228 DOI: 10.1111/j.1463-1318.2008.01531.x] [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: 02/08/2023]
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185
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Radical vaginal trachelectomy vs. radical hysterectomy for small early stage cervical cancer: A matched case–control study. Gynecol Oncol 2008; 110:168-71. [DOI: 10.1016/j.ygyno.2008.04.027] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2008] [Revised: 04/22/2008] [Accepted: 04/23/2008] [Indexed: 10/22/2022]
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186
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Right ventricular outflow tract tachycardia in the parturient. Int J Obstet Anesth 2008; 17:275-8. [PMID: 18511258 DOI: 10.1016/j.ijoa.2007.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2007] [Accepted: 09/01/2007] [Indexed: 10/22/2022]
Abstract
Parturition is marked by physiological changes that may elicit electrocardiographic anomalies. Sustained right ventricular tachycardia is an uncommon arrhythmia that necessitates cardioversion using physical, pharmaceutical or electrical means. Patients with right ventricular tachycardia must be evaluated for right ventricular dysplasia. Long-term management of right ventricular tachycardia includes beta-adrenergic blockade and/or radio ablation of right ventricle outflow region usually below the pulmonary annuls. This report discusses the case of a 28-year-old previously healthy primigravid who experienced right ventricular outflow tract tachycardia during labor.
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Localisation training of unilateral cochlear implanted children. Clin Otolaryngol 2008. [DOI: 10.1111/j.1749-4486.2008.01747_6.x] [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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Abstract
OBJECTIVE There has been an increasing demand for diagnostic flexible sigmoidoscopy. In order to improve our diagnostic services, we established a nurse specialist led flexible sigmoidoscopy clinic in 1999. The aim of this study was to review the outcomes of this service between 1999 and 2004. METHOD The following information was collected prospectively: source of referral, presenting symptoms, the result of the flexible sigmoidoscopy, depth of insertion, the follow-up plan and complications. RESULTS A total of 3956 patients had a flexible sigmoidoscopy performed between 1999 and 2004. The presenting symptoms were as follows: rectal bleeding (RB) in 1915 patients, change of bowel habit (CBH) in 421 patients, RB+CBH in 814 patients. The depth of insertion of the sigmoidoscope was as follows: rectum in 85 patients, sigmoid colon in 595 patients, descending colon in 1969 patients, splenic flexure in 958 patients and transverse colon in 311 patients. The findings at sigmoidoscopy were as follows: normal in 1560 patients, cancer in 132 patients, inflammatory bowel disease in 276 patients, polyps in 415 patients, diverticular disease in 584 patients and haemorrhoids in 926 patients. Two patients sustained an iatrogenic rectal perforation. CONCLUSION The nurse specialist led flexible sigmoidoscopy clinic offers an efficient and safe diagnostic service for patients presenting with colorectal symptoms.
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Functional results of intersphincteric resection for low rectal cancer (Br J Surg 2007; 94: 1272-1277). Br J Surg 2008; 95:397; author reply 397-8. [PMID: 18278786 DOI: 10.1002/bjs.6164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
The Editors welcome topical correspondence from readers relating to articles published in the Journal. Responses should be sent electronically via the BJS website (www.bjs.co.uk). All letters will be reviewed and, if approved,appear on the website. A selection of these will be edited and published in the Journal. Letters must be no more than 250 words in length.
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Frequency and appropriateness of antipsychotic medication use in older people in long-term care. Ir J Med Sci 2008; 177:35-7. [DOI: 10.1007/s11845-008-0121-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2007] [Accepted: 01/08/2008] [Indexed: 10/22/2022]
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191
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Thyroid dysfunction in Down's syndrome and screening for hypothyroidism in children and adolescents using capillary TSH measurement. J Pediatr Endocrinol Metab 2008; 21:155-63. [PMID: 18422028 DOI: 10.1515/jpem.2008.21.2.155] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
UNLABELLED Thyroid dysfunction is more common in individuals with Down's syndrome (DS) than in the general population, whose clinical features can mask the presenting signs and symptoms of hypothyroidism. Biochemical screening is necessary; however, venepuncture may be difficult. AIMS To assess the prevalence of thyroid dysfunction in children and adolescents with DS and the feasibility of screening for hypothyroidism using capillary dried blood spot thyroid stimulating hormone (TSH) from infancy. METHODS 394 children (217 boys, 177 girls) were clinically assessed for thyroid dysfunction and 305 children (aged 4 months to 18.9 years) were screened for hypothyroidism by capillary whole blood TSH sample. RESULTS Thyroid dysfunction was detected in 4.6%, with 50% unscreened since neonatal screening. Parents reported minimal distress by fingerprick screening. CONCLUSION DS is associated with an increased prevalence of thyroid dysfunction, particularly in preschool children. Biochemical screening is essential and capillary whole blood TSH sampling for hypothyroidism is feasible, less invasive and acceptable.
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Attitudes toward HPV testing: interview findings from a random sample of women in Ontario, Canada. Health Care Women Int 2008; 28:782-98. [PMID: 17907007 DOI: 10.1080/07399330701563061] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
As most women diagnosed with cervical carcinoma have been "inadequately screened," improvements in screening are critical. After abnormal Pap test findings (through liquid-based cytology), residual specimens now can be tested simultaneously for oncogenic types of Human Papilloma virus (HPV). If these "reflex" HPV tests are negative, Pap tests need not be repeated for 12 months. Women with positive oncogenic HPV tests, however, can be referred immediately for colposcopy. There has been concern that "stigma" issues could be associated with positive HPV status (because of its sexual transmission) that might cause women to avoid this reflex HPV testing. We addressed this concern by assessing whether stigma issues surface in relation to HPV testing. We randomly selected 20 women and administered to them semistructured telephone interviews that included responses to a scenario of reflex HPV-DNA testing. Interview transcripts were analyzed qualitatively. Highly limited knowledge levels were found about HPV, but, following education about screening options, there was no rejection of HPV testing. In conclusion, it appears that women favor reflex HPV testing due to its "convenience" and perceptions that it is "the least intrusive option more definitive than Pap testing."
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Assessment of the effects of increasing levels of physiological realism in the computational fluid dynamics analyses of implanted coronary stents. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2008; 2008:5906-5909. [PMID: 19164062 DOI: 10.1109/iembs.2008.4650559] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Coronary stent implantation can improve blood flow in an artery that has been narrowed by the build up of arterial plaque. However, the implantation of the stent will change the geometry of the vessel wall. The haemodynamic effects of the stents presence and alteration of the vessel wall are unclear. The redistribution of flow induced vessel wall shear stress (WSS) and wall shear stress gradient (WSSG) may directly contribute to restenosis (re-blockage). Computational fluid dynamics (CFD) is used extensively to identify these parameters in stented vessels. However, simplifications to the model of the stented artery are common. In this paper, computational domains of stented arteries with increasing levels of physiological realism are created. CFD is used to predict the WSS and WSSG for each set of computational domains. Finally, the results show that certain simplifications are not valid for CFD analyses of implanted coronary stents.
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Evaluation of RT-PCR and reverse line blot hybridization for detection and genotyping F+ RNA coliphages from estuarine waters and molluscan shellfish. J Appl Microbiol 2007; 104:1203-12. [PMID: 18028362 DOI: 10.1111/j.1365-2672.2007.03646.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS To evaluate a PCR-based detection and typing method for faecal indicator viruses (F+ RNA coliphages) in water and shellfish, and apply the method for better understanding of the ecology and microbial source tracking potential of these viruses. METHODS AND RESULTS Water and shellfish samples were collected over 3 years at nine estuaries in the East, West and Gulf Coasts of the USA, providing 1033 F+ RNA coliphage isolates. F+ RNA coliphage genotyping rates by reverse transcriptase-PCR-reverse line blot (RLB) hybridization ranged from 94.7% to 100% among estuaries, and were not significantly different in oysters, clams, mussels or water (P = 0.8427). Twenty samples negative by RLB were nucleotide sequenced for confirmation, and to refine RLB probes. More F+ RNA coliphages were genotyped from colder water than warmer waters, while the water salinity did not affect F+ RNA coliphage levels. CONCLUSIONS RT-PCR-RLB was a robust method for detecting and genotyping F+ RNA coliphages from diverse coastal areas, which provided new information on the ecology of F+ RNA coliphages. SIGNIFICANCE AND IMPACT OF THE STUDY This performance-validated F+ RNA coliphage method can be used for faecal indicator monitoring and microbial source tracking, to protect recreational bathers and shellfish consumers from exposure to pathogenic virus and their disease risks.
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Delayed diagnosis of rhabdomyoblastoma: a cautionary tale. Colorectal Dis 2007; 9:854-5. [PMID: 17509047 DOI: 10.1111/j.1463-1318.2007.01248.x] [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: 02/08/2023]
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Abstract
OBJECTIVES Vagus nerve stimulation (VNS) is an effective treatment for intractable epilepsy. It is unknown whether acute response is correlated with the amplitude of output current. The purpose of this study was to determine if the output current of VNS is correlated with percent reductions in seizure frequency and response. MATERIALS AND METHODS Retrospective analysis of a multicenter randomized trial of three unique paradigms of VNS was carried out in patients with intractable partial onset epilepsy. Output current at 1 and 3 months was correlated with percent reduction in seizure frequency and response rates. RESULTS Sixty-one subjects were enrolled and completed the study. Output current, ranging from 0.25 to 1.5 mA, was not correlated with reductions in seizure frequency, or with > or = 50% reduction in seizures. Six of seven initial non-responders did experience > or = 50% reductions in seizures after current was increased. CONCLUSIONS The output current is not a major determinant of acute response to VNS for epilepsy. Many patients respond to low current (<1 mA). Some (20%) initial non-responders may respond to an increase in output current.
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Abstract
The peripartum period is of critical importance to subsequent health and fertility. Most cows enter a state of negative energy balance (NEB) associated with many metabolic changes which have carry over effects on the resumption and normality of estrous cyclicity and the success of subsequent inseminations. A dataset on 500 lactations explored the relationships between metabolic traits measured before and after calving with fertility. Stepwise multiple regression analysis showed that longer calving to conception intervals were associated with altered profiles of IGF-I, urea and body condition score. These relationships between metabolic profiles and fertility differed between first lactation cows (which are still growing but produce less milk) and mature animals. Early postpartum the liver undergoes extensive biochemical and morphological modifications to adapt to NEB, the uterus is extensively remodeled and must clear bacterial infections, and the ovary must resume ovulatory cycles. RNA isolated from liver and uterine tissues harvested 2 weeks postpartum from cows in mild (MNEB) and severe (SNEB) energy balance was used to screen the Affymetrix 23K bovine microarray. In liver, SNEB resulted in differential expression of key genes involved in lipid catabolism, gluconeogenesis, and the synthesis and stability of IGF-I. This was accompanied by reduced systemic concentrations of IGF-I which is likely to impact on ovarian function and early embryo development. Within endometrium, cows in SNEB showed histological evidence for higher levels of inflammation and the microarray analysis identified groups of differentially expressed genes involved in tissue remodeling and immune response. This may delay uterine repair after calving, likely contributing to the observed reduction in fertility.
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Aryepiglottoplasty for laryngomalacia: results and recommendations following a case series of 84. Int J Pediatr Otorhinolaryngol 2007; 71:1271-5. [PMID: 17597233 DOI: 10.1016/j.ijporl.2007.05.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2007] [Revised: 05/01/2007] [Accepted: 05/02/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To examine one consultant's experience of aryepiglottoplasty at Leeds General Infirmary. To identify risk factors for post-operative complications. Comparing the outcomes of surgery with the published literature on aryepiglottoplasty. DESIGN A retrospective case series of consecutive patients undergoing aryepiglottoplasty identified from theatre records. SETTING The Otolaryngology Department, Leeds General Infirmary. This is part of Leeds Teaching Hospitals NHS Trust and is a tertiary referral centre with regional paediatric intensive care unit (PICU) and specialises in managing paediatric airway pathology. PARTICIPANTS Ninety-one consecutive cases of aryepiglottoplasties, between 1997 and 2005. The medical records for 84 cases were reviewed. MAIN OUTCOME MEASURES Unplanned admissions to PICU, complication rate, length of post-operative hospital stay, and successful resolution of symptoms amongst our patient group. RESULTS The primary indication for surgery was found to be severe stridor. There was a low rate (3.6%) of unplanned admissions to the PICU. 7.1% of patients suffered a post-operative aspiration pneumonia. The majority (66.7%) of patients were able to return home after just one night in hospital. 11.9% of patients continued to have some stridor at follow-up. CONCLUSIONS The majority of patients undergoing aryepiglottoplasty for isolated laryngomalacia can be monitored overnight on a paediatric surgical ward and return home the following day (85%). Furthermore, they should expect improvement of their stridor with a single procedure (90%). Aryepiglottoplasty at an experienced unit is a low-risk procedure with a high success rate.
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MR small bowel enterography: optimization of imaging timing. Clin Radiol 2007; 62:804-7. [PMID: 17604772 DOI: 10.1016/j.crad.2007.02.010] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2006] [Revised: 01/15/2007] [Accepted: 02/04/2007] [Indexed: 11/19/2022]
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Abstract
The implementation of the European Working Time Directive, from the Council of the European Union (93/104/EC), in August 2004 has provoked a change in the working hours of junior doctors in the United Kingdom. With the evolution of the subsequent cross-cover arrangements combined with the modernising of medical careers,(1) training is becoming increasingly important. Here we present a simple method of teaching junior doctors the skills and competencies required to aspirate a peritonsillar abscess or 'quinsy'. The model is easy to construct, low cost and reusable.
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