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Lodha A, Moser JJ, Walker A, Lodha A, Tang S, McAllister D. Association of epidural analgesia in labor with neurodevelopmental outcomes in premature infants born at <29 weeks of gestational age. J Perinatol 2024; 44:548-553. [PMID: 38355736 DOI: 10.1038/s41372-024-01893-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/17/2024] [Accepted: 01/23/2024] [Indexed: 02/16/2024]
Abstract
OBJECTIVE To explore associations between epidural administration to mothers in labor with neurodevelopmental outcomes at 3 years corrected age in preterm infants born <29 weeks gestational age. STUDY DESIGN Infants born <29 weeks gestational age between 2006 and 2012 were included. Our primary outcome was a composite of death or neurodevelopmental impairment at 3 years corrected age. Infants were divided into those whose mothers did or did not receive epidural analgesia in labor. Univariable and multivariable regression was used for analysis. RESULTS There were 548 infants in the no epidural analgesia group and 121 in the epidural analgesia group. The adjusted odds ratio (95%CI) of neurodevelopmental impairment or death in the epidural group was 1.25 (0.82-1.93). Propensity score-matched results were 1.32 (0.79-2.22). CONCLUSION Preterm infants born <29 weeks gestational age to mothers who received epidural analgesia during labor were not associated with poor neurodevelopmental outcomes at 3 years corrected age.
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Affiliation(s)
- Arijit Lodha
- Medical Student, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - J J Moser
- Clinical Assistant Professor, Department of Anesthesiology, Perioperative and Pain Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - A Walker
- Senior Consultant, Department of Anesthesiology, Perioperative and Pain Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - A Lodha
- Professor, Department of Pediatrics & Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - S Tang
- Analyst, Department of Obstetrics & Gynecology and Alberta Children's Hospital Neonatal Follow-up Clinic, Alberta Health Services, Calgary, Alberta, Canada
| | - D McAllister
- Clinical Associate Professor, Department of Anesthesiology, Perioperative and Pain Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
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Baghirzada L, Walker A, Yu HC, Endersby R. The analgesic effect of transversalis fascia plane block after caesarean section under spinal anaesthesia with intrathecal morphine: a randomised controlled trial. Anaesthesia 2024; 79:63-70. [PMID: 37961945 DOI: 10.1111/anae.16173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2023] [Indexed: 11/15/2023]
Abstract
We aimed to test whether bilateral injection of bupivacaine 0.25% in the transversalis fascia plane reduced 24 h opioid dose after singleton caesarean section, under spinal anaesthesia with intrathecal morphine, compared with saline 0.9% injectate. We allocated randomly 52 women to bilateral injection of 20 ml saline 0.9% on arrival in the post-anaesthesia care unit and 54 women to bilateral injection of 20 ml bupivacaine 0.25% (with adrenaline 2.5 μg.ml-1 ). Mean (SD) cumulative morphine equivalent opioid dose 24 h after saline injection was 32.3 (28.3) mg and 18.7 (20.2) mg after bupivacaine injection, a mean (95%CI) difference of 13.7 (4.1-23.2) mg (p = 0.006). Median (IQR [range]) time to first postoperative opioid dose was 3.0 (1.5-10.3 [0.0-57.4]) h after saline 0.9% and 8.2 (2.7-29.6 [0.2-55.4]) h after bupivacaine 0.25% (p = 0.054). Transversalis fascia plane with bupivacaine 0.25% with adrenaline reduced postoperative pain at rest during 48 h (0-10-point scale) by a mean (95%CI) of 0.9 (0.2-1.6) points (p = 0.013) and on movement by 1.2 (0.4-2.1) points (p = 0.004). We conclude that transversalis fascia plane bupivacaine 0.25% with adrenaline reduces pain and opioid dose after caesarean section compared with saline 0.9%.
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Affiliation(s)
- L Baghirzada
- Department of Anaesthesiology, Perioperative and Pain Medicine, University of Calgary, Canada
| | - A Walker
- Department of Anaesthesiology, Perioperative and Pain Medicine, University of Calgary, Canada
| | - H C Yu
- Department of Anaesthesiology, Perioperative and Pain Medicine, University of Calgary, Canada
| | - R Endersby
- Department of Anaesthesiology, Perioperative and Pain Medicine, University of Calgary, Canada
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Michelet F, Smyth M, Lall R, Noordali H, Starr K, Berridge L, Yeung J, Fuller G, Petrou S, Walker A, Mark J, Canaway A, Khan K, Perkins GD. Randomised controlled trial of analgesia for the management of acute severe pain from traumatic injury: study protocol for the paramedic analgesia comparing ketamine and morphine in trauma (PACKMaN). Scand J Trauma Resusc Emerg Med 2023; 31:84. [PMID: 38001541 PMCID: PMC10668487 DOI: 10.1186/s13049-023-01146-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Prehospital analgesia is often required after traumatic injury, currently morphine is the strongest parenteral analgesia routinely available for use by paramedics in the United Kingdom (UK) when treating patients with severe pain. This protocol describes a multi-centre, randomised, double blinded trial comparing the clinical and cost-effectiveness of ketamine and morphine for severe pain following acute traumatic injury. METHODS A two arm pragmatic, phase III trial working with two large NHS ambulance services, with an internal pilot. Participants will be randomised in equal numbers to either (1) morphine or (2) ketamine by IV/IO injection. We aim to recruit 446 participants over the age of 16 years old, with a self-reported pain score of 7 or above out of 10. Randomised participants will receive a maximum of 20 mg of morphine, or a maximum of 30 mg of ketamine, to manage their pain. The primary outcome will be the sum of pain intensity difference. Secondary outcomes measure the effectiveness of pain relief and overall patient experience from randomisation to arrival at hospital as well as monitoring the adverse events, resource use and cost-effectiveness outcomes. DISCUSSION The PACKMAN study is the first UK clinical trial addressing the clinical and cost-effectiveness of ketamine and morphine in treating acute severe pain from traumatic injury treated by NHS paramedics. The findings will inform future clinical practice and provide insights into the effectiveness of ketamine as a prehospital analgesia. TRIAL REGISTRATION ISRCTN, ISRCTN14124474. Registered 22 October 2020, https://www.isrctn.com/ISRCTN14124474.
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Affiliation(s)
- F Michelet
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK.
| | - M Smyth
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - R Lall
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - H Noordali
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - K Starr
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - L Berridge
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - J Yeung
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
- Critical Care Directorate, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - G Fuller
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - S Petrou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - A Walker
- West Midlands Ambulance Services NHS Trust, Brierley Hill, Dudley, UK
| | - J Mark
- Yorkshire Ambulance Services NHS Trust, Wakefield, UK
| | - A Canaway
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - K Khan
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - G D Perkins
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
- Critical Care Directorate, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Sabo MT, Walker A, Elmi Assadzadeh G, Hildebrand KA. Rotator cuff outcomes and mental health indices: Correlation or causation? Shoulder Elbow 2023; 15:108-118. [PMID: 37974603 PMCID: PMC10649477 DOI: 10.1177/17585732221076027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 10/12/2021] [Accepted: 12/22/2021] [Indexed: 11/19/2023]
Abstract
Background Psychological factors such as catastrophizing, anxiety, and depression influence clinical outcomes in many conditions. Our purpose was to examine trends and associations between these and outcomes of rotator cuff surgery. Methods 148 patients (76 W:72 M, 55.1 ± 8.2 years) with unilateral symptomatic rotator cuff syndrome were followed for 1 year after surgery. The Western Ontario Rotator Cuff Score (WORC), the Pain Catastrophizing Score (PCS), and the Hospital Anxiety and Depression Score (HADS) were administered. Evolution and associations of WORC, HADS and PCS scores were examined using uni- and multivariate analyzes. Results At 1 year, PCS, HADS-A, and HADS-D scores negatively correlated with WORC score (R = -0.6, -0.61, -0.69). The strength of correlation was lower between baseline PCS, HADS-A, and HADS-D scores and 1-year WORC score (R = -0.38, -0.43, -0.42). Prior anxiety diagnosis was associated with higher HADS-A scores at 2- and 6- weeks post-op (p = 0.013, 0.011). 106 participants experienced an improving HADS-D over the year of follow-up. Worse pre-op pain, WORC, PCS, HADS-A, HADS-D, cardiovascular disease and current smoking were associated with non-improving HADS-D. Discussion Patient-reported outcomes of rotator cuff surgery are associated with patient-reported anxiety, depression, and pain catastrophizing. In many, all outcome scores improved over time suggesting a two-way association between shoulder condition and psychological parameters. Level of evidence II.
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Affiliation(s)
- MT Sabo
- SCRUBS Research Unit, University of Calgary, Calgary, AB, Canada
| | - A Walker
- Department of Anaesthesia, University of Calgary, Calgary, AB, Canada
| | | | - KA Hildebrand
- Department of Surgery, University of Calgary, Calgary, AB, Canada
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Kennedy J, Parker M, Seaborne M, Mhereeg M, Walker A, Walker V, Denaxas S, Kennedy N, Katikireddi SV, Brophy S. Healthcare use attributable to COVID-19: a propensity-matched national electronic health records cohort study of 249,390 people in Wales, UK. BMC Med 2023; 21:259. [PMID: 37468884 PMCID: PMC10354936 DOI: 10.1186/s12916-023-02897-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 05/10/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND To determine the extent and nature of changes associated with COVID-19 infection in terms of healthcare utilisation, this study observed healthcare contact 1 to 4 and 5 to 24 weeks following a COVID-19 diagnosis compared to propensity-matched controls. METHODS Two hundred forty nine thousand three hundred ninety Welsh individuals with a positive reverse transcription-polymerase chain reaction (RT-PCR) test were identified from data from national PCR test results. After elimination criteria, 98,600 positive individuals were matched to test negative and never tested controls using propensity matching. Cohorts were split on test location. Tests could be taken in either the hospital or community. Controls were those who had tested negative in their respective environments. Survival analysis was utilised for first clinical outcomes which are grouped into primary and secondary. Primary outcomes include post-viral-illness and fatigue as an indication of long-COVID. Secondary outcomes include clinical terminology concepts for embolism, respiratory conditions, mental health conditions, fit notes, or hospital attendance. Increased instantaneous risk for positive individuals was quantified using hazard ratios (HR) from Cox regression, while absolute risk (AR) and relative risk were quantified using life table analysis. RESULTS Analysis was conducted using all individuals and stratified by test location. Cases are compared to controls from the same test location. Fatigue (HR: 1.77, 95% CI: 1.34-2.25, p = < 0.001) and embolism (HR: 1.50, 95% CI: 1.15-1.97, p = 0.003) were more likely to occur in all positive individuals in the first 4 weeks; however, anxiety and depression (HR: 0.83, 95% CI: 0.73-0.95, p = 0.007) were less likely. Positive individuals continued to be more at risk of fatigue (HR: 1.47, 95% CI: 1.24-1.75, p = < 0.001) and embolism (HR: 1.51, 95% CI: 1.13-2.02, p = 0.005) after 4 weeks. All positive individuals are also at greater risk of post-viral illness (HR: 4.57, 95% CI: 1.77-11.80, p = 0.002). Despite statistical association between testing positive and several conditions, life table analysis shows that only a small minority of the study population were affected. CONCLUSIONS Community COVID-19 disease is associated with increased risks of post-viral-illness, fatigue, embolism, and respiratory conditions. Despite elevated risks, the absolute healthcare burden is low. Subsequently, either very small proportions of people experience adverse outcomes following COVID-19 or they are not presenting to healthcare.
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Affiliation(s)
- J Kennedy
- National Centre for Population Health and Wellbeing Research, Swansea University Medical School, Swansea, Wales, UK
| | - M Parker
- National Centre for Population Health and Wellbeing Research, Swansea University Medical School, Swansea, Wales, UK.
| | - M Seaborne
- National Centre for Population Health and Wellbeing Research, Swansea University Medical School, Swansea, Wales, UK
| | - M Mhereeg
- National Centre for Population Health and Wellbeing Research, Swansea University Medical School, Swansea, Wales, UK
| | - A Walker
- Datalab, Nuffield Dept of Primary Care Health Science, Radcliffe Primary Care Building, Oxford, OX2 6GG, UK
| | - V Walker
- Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - S Denaxas
- Institute for Health Informatics, UCL, London, UK
| | - N Kennedy
- National Centre for Population Health and Wellbeing Research, Swansea University Medical School, Swansea, Wales, UK
| | - S V Katikireddi
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - S Brophy
- National Centre for Population Health and Wellbeing Research, Swansea University Medical School, Swansea, Wales, UK
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6
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Steele D, Walker A. 'Vancowax' for haemostasis and topical antibiotic post sternotomy. Ann R Coll Surg Engl 2023; 105:385. [PMID: 36239947 PMCID: PMC10066641 DOI: 10.1308/rcsann.2022.0105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2022] [Indexed: 11/07/2022] Open
Affiliation(s)
- D Steele
- Blackpool Teaching Hospitals NHS Foundation Trust, UK
| | - A Walker
- Blackpool Teaching Hospitals NHS Foundation Trust, UK
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Posadas Ruiz J, Walker A, Zhu H, Bota-Rabassedas N, Wijeratne S, Connolly C, Wynes M, Sanchez-Espiridion B, Dacic S, Wistuba I, Lee J. PP01.53 Pathologic Response Assessment Tool – Architecting a Cloud-Based Tool to Streamline Logistics for Shipping, Tracking, Scoring, and Reporting. J Thorac Oncol 2023. [DOI: 10.1016/j.jtho.2022.09.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Bota-Rabassedas N, Wijeratne S, Connolly C, Wynes M, Sanchez-Espiridion B, Fujimoto J, Posadas J, Walker A, Zhu H, Dacic S, Travis W, Lee J, Kerr K, Glass C, Saqui A, Sholl L, Cooper W, Roden A, Poleri C, Chung JH, Lopez-Martin J, Borczuk A, Weissferdt A, Wistuba I. PP01.39 Infrastructure for Interobserver Variability Assessment of Pathologic Response (PR), in Surgical Resection Specimens Following Neoadjuvant Immune Check Point Inhibitor (ICI) Therapies in Early Stage NSCLC. J Thorac Oncol 2023. [DOI: 10.1016/j.jtho.2022.09.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Pell R, Walker A, Ganti L, Quinones A, Vera A, Rosario J, Ragusa A. 196 An Infographic Utilized as a Just-In-Time Tool for Paramedic EKG Interpretation. Ann Emerg Med 2022. [DOI: 10.1016/j.annemergmed.2022.08.220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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10
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Chen H, Walker A, Schollaert-Fitch K, Torok K, Jacobe H. 191 Clinical characteristics associated with functional abnormalities in pediatric and adult morphea: A cross-sectional study. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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11
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Walker A, Black S, Walocko F, Li X, Chong B. 181 Development of systemic lupus in patients with cutaneous lupus: A comparison of three classification criteria. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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12
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Walker A, Teske N, Zigler C, Jacobe H. 162 Validation of a patient-reported outcome measure in adults with morphea. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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13
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Wang A, Walker A, Niven D, Mirakhur A. Abstract No. 156 Fibrinogen level as a predictor of bleeding risk during catheter-directed thrombolysis. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Abstract
CASE HISTORY A 1-year-old Border Terrier presented with acute onset of neurological signs and neck pain. CLINICAL FINDINGS Severe generalised ataxia, muscle tremors and cranial nerve deficits were noted. Multifocal brain lesions were suspected based on neurological examination. Computed tomography revealed an abdominal mass and cerebellar herniation through the foramen magnum. LABORATORY AND PATHOLOGICAL FINDINGS Cytological and histopathological analysis of the abdominal mass revealed necrotising and granulomatous lymphadenitis with intralesional algal elements most consistent with Prototheca spp.. Culture of a sample from the mesenteric lymph node confirmed the presence of Prototheca spp. which was identified as P. bovis based on sequencing of a DNA fragment amplified by PCR. Following inadequate response to symptomatic therapy and poor prognosis, the dog was subjected to euthanasia. Histopathological evaluation of the central nervous system lesions, identified granulomatous meningitis and ventriculitis with the presence of intralesional algae. DIAGNOSIS Disseminated protothecosis with granulomatous meningitis and ventriculitis caused by Prototheca bovis (formerly P. zopfii gen. 2). CLINICAL RELEVANCE This is the first case report of disseminated protothecosis with central nervous system involvement in a dog in New Zealand.
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Affiliation(s)
- A Walker
- Veterinary Specialist Aotearoa, Auckland, New Zealand
| | - I MacEwan
- Veterinary Specialist Aotearoa, Auckland, New Zealand
| | - T Fluen
- Veterinary Specialist Aotearoa, Auckland, New Zealand
| | - M Hardcastle
- Gribbles Veterinary Pathology, Auckland, New Zealand
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Abstract
Allergic rhinitis affects 20% of the population of the UK. It confers a significant health burden upon the individual as it affects the patient's quality of life and is associated with serious comorbidities including asthma, sinusitis and conjunctivitis. Owing to its prevalence, it has a significant economic impact through its effects on education, productivity and use of healthcare resources. This review focuses on the management of allergic rhinitis and potential future treatments, because of the lack of clear national guidelines and because this illness is often misdiagnosed and mismanaged. The article provides a comprehensive overview of allergic rhinitis and illustrates the assessment criteria for various subcategories.
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Affiliation(s)
- ZA Siddiqui
- Department of Ear, Nose and Throat Surgery, University Hospital Lewisham, London, UK
| | - A Walker
- Department of Ear, Nose and Throat Surgery, University Hospital Lewisham, London, UK
| | - MM Pirwani
- Department of Life Sciences and Medicine, King's College London, London, UK
| | - M Tahiri
- Department of Life Sciences and Medicine, King's College London, London, UK
| | - I Syed
- Department of Ear, Nose and Throat Surgery, University Hospital Lewisham, London, UK
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Hopkins C, Surda P, Walker A, Wolf A, Speth MM, Jacques T, Hox V, Van Gerven L, Santamaria-Gadea A, Segboer C, Lourijsen E, Turri-Zanoni M, Huart C, Rennie C, Green R, The Samter's Society TSS, Kelly CE, Knill A, Lund VJ, Fokkens WJ. EPOS 4 Patients. Rhinology 2021; 0:2946. [PMID: 34762718 DOI: 10.4193/rhin20.950] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
EPOS2020 is the 4th and most recent version of the European Position Paper on Rhinosinusitis and Nasal Polyps which was first published in 2005. It aims to provide the most up to date scientifically robust information on the topic published in the literature which has been critically analysed by an international group of clinicians drawn from all disciplines dealing with these problems together with patients. The guidelines offer evidence-based recommendations and care pathways for acute and chronic rhinosinusitis in both adults and children. Management of these diseases from the patients' perspective is an important part of EPOS2020. Not only is this included in the main document but, for the first time, we have produced a separate supplement dedicated to and in collaboration with patients, EPOS4Patients, which aims to provide information in an accessible format, to answer frequently asked questions about these diseases and their treatment options as well as including useful patient resources and websites. It has never been more important for patients to be actively involved in their care. Being well informed helps you to make the best decisions together with your doctor.
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Affiliation(s)
- C Hopkins
- Guy's and St Thomas' NHS Hospitals Trust, UK
| | - P Surda
- Guy's and St Thomas' NHS Hospitals Trust, UK
| | - A Walker
- St George's University Hospitals NHS Foundation Trust, UK
| | - A Wolf
- Medical University Graz, Graz, Austria
| | - M M Speth
- Klinik für Hals-, Nasen-, Ohren- Krankheiten, Hals-und Gesichtschirurgie, Kantonsspital Aarau, Switzerland
| | - T Jacques
- St George's University Hospitals NHS Foundation Trust, UK
| | - V Hox
- Department of Otorhinolaryngology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - L Van Gerven
- Department of Otorhinolaryngology, University Hospitals Leuven, Leuven, Belgium
| | | | - C Segboer
- Dijklander Hospital, Hoom and Purmerend, The Netherlands
| | - E Lourijsen
- Department of Otorhinolaryngology, Amsterdam UMC location AMC, Amsterdam, The Netherlands
| | - M Turri-Zanoni
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - C Huart
- Department of Otorhinolaryngology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - C Rennie
- Imperial College Healthcare NHS Trust, UK
| | - R Green
- Ninewells Hospital, Dundee, UK
| | | | | | - A Knill
- Patient representative, Opuscomms, London
| | - V J Lund
- Royal National Throat, Nose and Ear Hospital, UCLH Foundation Trust, London, UK
| | - W J Fokkens
- Department of Otorhinolaryngology, Amsterdam UMC location AMC, Amsterdam, The Netherlands
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Shah K, Modi V, Gandhi H, Thyagaturu H, Walker A, Shirani J. Predictors of cardiac implantable electronic device infection in the United States. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Cardiac implantable electronic devices (CIED) are important tools for managing arrhythmias, improving hemodynamics, and preventing sudden cardiac death. Device infection (DI) remains a significant complication of CIED and is associated with high morbidity, mortality, and healthcare cost.
Purpose
To analyze predictors of DI and its in-hospital outcomes.
Methods
National Inpatient Sample 2011–2018 database was analyzed for admissions for CIED implantation or DI. Baseline and hospital level characteristics were derived. The Chi-square test and student t-test were used for comparison of categorical and continuous variables respectively. Variables with p<0.20 from univariate analysis were included in the multivariate logistic regression to identify independent predictors of DI.
Results
A total of 1,604,173 admissions for CIED implantations and 71,007 (4.4%) admissions for DI were reported during 2011–2018. There was no significant change in annual admissions for DI (range 8550 to 9307, p for trend=0.98). Those with DI were more likely to be male (69.3 vs 57%, p<0.001) and had higher Charlson comorbidity index score ≥3 (46.6%-vs-36.8%, p<0.001). Multivariate analysis identified post-procedural hematoma (odds ratio (OR)=3.96; 95% Confidence Interval (CI)=3.46–4.54), congestive heart failure (CHF; OR=2.80, 95% CI=2.66–2.96), age group 45–60 years (OR=2.46, 95% CI=2.30–2.63), malnutrition (OR=1.99, 95% CI=1.85–2.15), coagulopathy (OR=1.75, 95% CI=1.64–1.86), end-stage renal disease (OR=1.65, 95% CI=1.53–1.78), atrial fibrillation (OR=1.42; 95% CI=1.35–1.49), non-Hispanic race (OR=1.25; 95% CI=1.16–1.36), coronary artery disease (OR=1.21; 95% CI=1.15–1.26), and thyroid disease (OR=1.15; 95% CI=1.09–1.12) [all p<0.001] as independent predictors of DI. Prevalence of CHF, malnutrition, and atrial fibrillation increased in those admitted with DI over the observation period as shown in Figure 1 (p for trend <0.001). Prevalence of diabetes mellitus also increased during the observation period although it was not an independent predictor of DI (p for trend <0.001). Pulmonary embolism and deep vein thrombosis were most common complications in those with DI (4.1 and 3.6% respectively). Annual in-hospital mortality ranged from 3.9 to 5.7% (mean 4.4%, p for trend=0.07).
Conclusion
DI is relatively common and continues to be associated with high morbidity and mortality. Prevalence of DI has not changed significantly despite technical and technological advances in device implantation. Evaluation of risk factors for DI and management of modifiable comorbidities may be needed to reduce the incidence of this important complication of CIED implantation.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- K Shah
- St. Luke's University Hospital, Bethlehem, United States of America
| | - V Modi
- St. Luke's University Hospital, Bethlehem, United States of America
| | - H Gandhi
- Monmouth Medical Center, Long Branch, United States of America
| | - H Thyagaturu
- Bassett Medical Center, Cooperstown, United States of America
| | - A Walker
- Lewis Katz School of Medicine at Temple University, Philadelphia, United States of America
| | - J Shirani
- St. Luke's University Hospital, Bethlehem, United States of America
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Mirajkar A, Logan G, Rivera M, Macintosh T, Walker A, Lebowitz D, Ganti L. 2 Racial Disparities in Patients Hospitalized for COVID-19: An Observational Cohort Study. Ann Emerg Med 2021. [PMCID: PMC8335415 DOI: 10.1016/j.annemergmed.2021.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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19
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Brighi C, Waddington D, Walker A, Holloway L, Aly F, Koh E, Keall P. OC-0398 Stability of multiparametric MR imaging biomarker-derived dose prescriptions for glioblastoma. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)06885-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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20
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Péros JP, Cousins P, Launay A, Cubry P, Walker A, Prado E, Peressotti E, Wiedemann-Merdinoglu S, Laucou V, Merdinoglu D, This P, Boursiquot JM, Doligez A. Genetic diversity and population structure in Vitis species illustrate phylogeographic patterns in eastern North America. Mol Ecol 2021; 30:2333-2348. [PMID: 33710711 DOI: 10.1111/mec.15881] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 02/22/2021] [Accepted: 03/02/2021] [Indexed: 12/21/2022]
Abstract
Geographical distribution and diversity of current plant species have been strongly shaped by climatic oscillations during the Quaternary. Analysing the resulting divergence among species and differentiation within species is crucial to understand the evolution of taxa like the Vitis genus, which provides very useful genetic resources for grapevine improvement and might reveal original recolonization patterns due to growth habit and dispersal mode. Here, we studied the genetic structure in natural populations of three species from eastern North America: Vitis aestivalis, V. cinerea and V. riparia using different marker types. Vitis aestivalis and V. cinerea showed higher diversity than V. riparia. The two former species are less differentiated, confirming an earlier divergence of V. riparia. V. aestivalis and V. riparia exhibited different genetic groups on both sides of the Appalachian Mountains that could mirror different recolonization routes from southern refugia. Genetic structure was stronger in V. cinerea, for which two varieties (var. berlandieri and var. cinerea) are morphologically recognized. Our results confirm this distinction and suggest the existence of three other lineages within var. cinerea. These discontinuities appear linked to adaptation of var. berlandieri to dry and limy areas of Texas and partially to the Mississippi River Valley. Rapid range expansions from refugia upon climate warming are also suggested by the low linkage disequilibrium values observed. Furthermore, large variation for downy mildew resistance was observed in the three species. Our findings appeared consistent with the vegetation history of eastern North America.
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Affiliation(s)
- Jean-Pierre Péros
- UMR AGAP Institut, CIRAD, INRAE, Institut Agro, University of Montpellier, Montpellier, France
| | | | - Amandine Launay
- UMR AGAP Institut, CIRAD, INRAE, Institut Agro, University of Montpellier, Montpellier, France
| | - Philippe Cubry
- UMR DIADE, University of Montpellier, IRD, Montpellier, France
| | - Andy Walker
- Department of Viticulture and Enology, University of Davis, Davis, CA, USA
| | | | | | | | - Valérie Laucou
- UMR AGAP Institut, CIRAD, INRAE, Institut Agro, University of Montpellier, Montpellier, France
| | | | - Patrice This
- UMR AGAP Institut, CIRAD, INRAE, Institut Agro, University of Montpellier, Montpellier, France
| | - Jean-Michel Boursiquot
- UMR AGAP Institut, CIRAD, INRAE, Institut Agro, University of Montpellier, Montpellier, France
| | - Agnès Doligez
- UMR AGAP Institut, CIRAD, INRAE, Institut Agro, University of Montpellier, Montpellier, France
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Kim S, Walker A, Okerlund D, Hsieh J. Intelligent Motion Correction Significantly Impacts The Volumes Of Calcium Blooming Artifacts For Coronary Computed Tomography Angiography (CCTA). J Cardiovasc Comput Tomogr 2020. [DOI: 10.1016/j.jcct.2020.06.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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22
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Mistry R, Walker A, Kim D, Ofo E. Transoral robotic surgery for the benefit of patients with head and neck cancer of unknown primary: our experience at St George's University Hospital, London. Ann R Coll Surg Engl 2020; 102:442-450. [PMID: 32347742 PMCID: PMC7388938 DOI: 10.1308/rcsann.2020.0071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2020] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Head and neck carcinoma of unknown primary represents 1-5% of all head and neck cancers and presents a diagnostic and therapeutic dilemma. In approximately 40% of cases, a primary tumour location remains unknown despite investigation. With advancements in our understanding of the role of high-risk human papilloma virus in head and neck cancer, transoral robotic surgery presents an option for diagnosis and therapy. MATERIALS AND METHODS This is a retrospective case series from a single centre. Case notes were reviewed for 28 patients who had transoral robotic surgery for head and neck carcinoma of unknown primary between May 2015 and July 2019. RESULTS Transoral robotic surgery identified an oropharyngeal primary tumour in 19 of 28 (67.8%) patients. All oropharyngeal primaries were p16 positive. The base of tongue identification rate was 63.2%. Median length of inpatient stay postoperatively was 1.0 day. Normal oral intake resumed within 48 hours in 96% (27/28) of patients. Three patients (10.3%) suffered minor postoperative bleeds that were all managed conservatively. DISCUSSION The base of tongue primary identification rate (63.2%) in this series is consistent with that previously reported (43-63%; 95% confidence interval). Primary tumour identification rate if a patient is p16 positive is 86.3% (19/22), with 100% of these being oropharyngeal. We suggest future investigation into p16 status as a means of stratifying patients with head and neck carcinoma of unknown primary for transoral robotic surgery. CONCLUSION Transoral robotic base of tongue mucosectomy (or lingual tonsillectomy) is a promising technique that offers a high yield of positive identification for the primary tumour. It is well tolerated with minimal associated morbidity. Our findings are comparable with those in the current literature.
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Affiliation(s)
- R Mistry
- St George’s University Hospitals NHS Foundation Trust, Tooting, London, UK
| | - A Walker
- St George’s University Hospitals NHS Foundation Trust, Tooting, London, UK
| | - D Kim
- St George’s University Hospitals NHS Foundation Trust, Tooting, London, UK
| | - E Ofo
- St George’s University Hospitals NHS Foundation Trust, Tooting, London, UK
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Roy T, Banang-Mbeumi S, Boateng S, Chamcheu R, Walker A, Chamcheu J. 615 Inverse docking assisted identification of flavonols as c-Kit, CDK2 and mTOR inhibitors for melanoma and non-melanoma skin cancer management. J Invest Dermatol 2020. [DOI: 10.1016/j.jid.2020.03.625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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24
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Walker A. Future Regulatory, Market and Technology Trends in the Global Passenger Car and Commercial Vehicle Sectors. Johnson Matthey Technology Review 2020. [DOI: 10.1595/205651320x15898840921326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The world is at the start of an energy revolution: the biggest energy transformation since the Industrial Revolution. The growing recognition that the carbon dioxide emissions associated with the combustion of fossil fuels leads to a dramatic increase in global temperatures is driving the need to implement strategies to reduce the carbon footprint across power- and energy-hungry sectors such as power generation, domestic heating, industrial processes and transportation. This article looks at the moves that the global passenger car and commercial vehicle segments will need to make to minimise the CO2 and greenhouse gas (GHG) emissions of the sector, which is one of the largest contributors to the global CO2 inventory today. A number of countries have already pledged to meet net zero GHG emissions by 2050, and more are set to follow, so this article also considers what is necessary for the ground transportation sector to hit net zero.
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Abstract
SHARE THIS PAGE:The world is at the start of an energy revolution: the biggest energy transformation since the Industrial Revolution, during which the use of fossil fuels drove growth and prosperity, with global temperature increase implications that we have only started to understand relatively recently. This energy revolution will drive the world towards a lower carbon, more sustainable future, with major implications for energy and electricity generation, heating, industrial power and transportation. Governments, states and regions are proposing, and in some cases (such as the UK) committing to, net zero greenhouse gas (GHG) or carbon dioxide emission targets over the coming years. To date, 15 countries have set defined targets to become net zero economies by 2050 or earlier, with over 50 others, including Germany and Canada, discussing when to implement such a target. Perhaps most significantly, the European Union (EU) intends to be net zero by 2050: this objective is at the heart of the European Green Deal and in line with the EU’s commitment to global climate action under the Paris Agreement.
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Vergidis P, Moore CB, Novak-Frazer L, Rautemaa-Richardson R, Walker A, Denning DW, Richardson MD. High-volume culture and quantitative real-time PCR for the detection of Aspergillus in sputum. Clin Microbiol Infect 2019; 26:935-940. [PMID: 31811917 DOI: 10.1016/j.cmi.2019.11.019] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 11/05/2019] [Accepted: 11/09/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Sputum culture is an insensitive method for the diagnosis of pulmonary aspergillosis. Growth of the organism allows identification of the causative species and susceptibility testing, both of which can inform treatment choices. The current practice is to culture an aliquot of diluted sputum. We assessed the value of culturing large volumes of unprocessed sputum, a method that we have termed high-volume culture (HVC). METHODS Specimens were processed by conventional culture (using an aliquot of homogenized, diluted sputum on Sabouraud agar at 37°C and 45°C for up to 5 days) and HVC (using undiluted sputum on Sabouraud agar at 30°C for up to 14 days). A separate specimen was tested by quantitative real-time PCR. Antifungal susceptibility testing was performed by the EUCAST standard. RESULTS We obtained sputum specimens from 229 individuals with the following conditions: chronic pulmonary aspergillosis (66.8%, 153/229), allergic bronchopulmonary aspergillosis (25.3%, 58/229) and Aspergillus bronchitis (7.9%, 18/229). Individuals with invasive pulmonary aspergillosis were not included. The positivity rate of conventional culture was 15.7% (36/229, 95% CI 11.6%-21.0%) and that of HVC was 54.2% (124/229, 95% CI 47.7%-60.5%) (p < 0.001). The higher positivity rate of HVC was demonstrated regardless of administration of antifungal treatment. Quantitive real-time PCR had an overall positivity rate of 49.2% (65/132, 95% CI 40.9%-57.7%), comparable to that of HVC. CONCLUSION Detection of Aspergillus spp. in sputum is greatly enhanced by HVC. HVC allows for detection of azole-resistant isolates that would have been missed by conventional culture. This method can be performed in any microbiology laboratory without the need for additional equipment.
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Affiliation(s)
- P Vergidis
- National Aspergillosis Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK; Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA
| | - C B Moore
- Mycology Reference Centre Manchester, ECMM Excellence Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - L Novak-Frazer
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Mycology Reference Centre Manchester, ECMM Excellence Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - R Rautemaa-Richardson
- National Aspergillosis Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK; Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Mycology Reference Centre Manchester, ECMM Excellence Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - A Walker
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - D W Denning
- National Aspergillosis Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK; Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - M D Richardson
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Mycology Reference Centre Manchester, ECMM Excellence Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK.
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Hutchison M, Gittins J, Walker A, Moore A, Burton C, Sparks N. Washing table eggs: a review of the scientific and engineering issues. WORLD POULTRY SCI J 2019. [DOI: 10.1079/wps20030015] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- M.L. Hutchison
- ADAS Microbiology Department, Woodthorne, Wergs Road, Wolverhampton. WV6 8QT, United Kingdom
| | - J. Gittins
- ADAS Poultry Team, Woodthorne, Wergs Road, Wolverhampton, WV6 8QT, United Kingdom
| | - A. Walker
- ADAS Gleadthorpe, Meden Vale, Mansfield, Notts. NG20 9PD, United Kingdom
| | - A. Moore
- ADAS Microbiology Department, Woodthorne, Wergs Road, Wolverhampton. WV6 8QT, United Kingdom
| | - C. Burton
- Silsoe Research Institute, Wrest Park, Silsoe MK45 4HS, United Kingdom
| | - N. Sparks
- Avian Science Research Centre, SAC, Ayr, KA6 5HW, United Kingdom
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Barlet B, Hauson A, Connors E, Colonna-Moseley A, Reszegi K, Sarkissians S, Walker A. C-31 A Meta-analysis Examining Fluency Measures in Depressed Elderly. Arch Clin Neuropsychol 2019. [DOI: 10.1093/arclin/acz034.193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Objective
Late-life depression (LLD) has been associated with cognitive impairments in domains such as memory, processing speed, and executive functions (e.g., initiation). However, it is unclear whether or not LLD is associated with language fluency difficulties that are often seen in some forms of dementia. Broadly, letter fluency is often observed to be associated with frontal deficits while category fluency is thought to be linked to temporal lobe dysfunction. Both tests are commonly used to assess language in older adults. The current meta-analysis examined potential differences between letter and category fluency in LLD and the robustness of previous findings in this population.
Data Selection
Investigators searched eight databases including PubMed and PsycINFO using terms such as “neuropsychol*,” “late-life,” and “depression.” Studies were excluded if participants were diagnosed with severe mental illness, neurological or other medical conditions that impact neurocognition.
Data Synthesis
Independent coders extracted data from 27 studies (k = 10 letter fluency, k = 17 semantic fluency). The effect size for semantic fluency was g = 0.64 (p < 0.001) with significant heterogeneity I² = 73.53% (Q = 60.45, df = 16, p < 0.001). The effect size for letter fluency was g = 0.49 (p < 0.001) also with significant heterogeneity I² = 52.08% (Q = 18.78, df = 9, p < 0.027).
Conclusions
Depressed individuals exhibited poorer performance on both category and letter fluency when compared to controls. This may indicate that depressed elderly individuals have difficulty with initiating verbal responses regardless of whether these responses rely on semantic networks or executive control.
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Pollard A, Hauson A, Stelmach N, Sarkissians S, Walker A, Cabral C, Wollman S, Hall M. A-25 Paced Auditory Serial Addition Test in Individuals with Cocaine Versus Methamphetamine Dependence. Arch Clin Neuropsychol 2019. [DOI: 10.1093/arclin/acz034.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objective
Research suggests that cocaine and methamphetamine differ in their impact on executive functions (EF). The Paced Auditory Serial Addition Test (PASAT) is used to assess working memory; a component of EF. The purpose of this meta-analysis was to examine the difference between the effect of these two drugs on PASAT scores.
Data Selection
Three researchers independently searched nine databases (e.g., PsycINFO, Pubmed, ProceedingsFirst), extracted required data, and calculated effect sizes. Inclusion criteria identified studies that had (a) compared cocaine or methamphetamine dependent groups to healthy controls and (b) matched groups on either age, education, or IQ (at least 2 out of 3). Studies were excluded if participants were reported to have Axis I diagnoses (other than cocaine or methamphetamine dependence) or comorbidities known to impact neuropsychological functioning. Six articles were coded and analyzed for the current study.
Data Synthesis
Cocaine studies showed a medium statistically significant effect size (g = 0.370, p = 0.020), while methamphetamine did not (g = 0.198, p = 0.172). There was no heterogeneity in effect sizes for both drugs. Subgroup analysis found no significant difference between the two drugs on the PASAT (Q-between = 0.646, p = 0.421).
Conclusions
In contrast to methamphetamine, cocaine is associated with poorer performance on PASAT. This is in line with previous studies that found that cocaine had more significant impact on EF than methamphetamine. Given the preliminary nature of this meta-analysis and the small number of studies on the topic, future primary studies should directly contrast how these two drugs impact EF.
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Walker A, Hauson A, Sarkissians S, Pollard A, Flora-Tostado C, Stelmach N, Holt A, Wollman S, Hall M. A-17 Category Test performance in individuals with alcohol versus methamphetamine dependence. Arch Clin Neuropsychol 2019. [DOI: 10.1093/arclin/acz034.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objective
The Category Test (CT) has consistently been found to be sensitive at detecting the effects of alcohol on the brain. However, this test has not been as widely used in examining the effects of methamphetamine. The current meta-analysis compared effect sizes of studies that have examined performance on the CT in alcohol versus methamphetamine dependent participants.
Data selection
Three researchers independently searched nine databases (e.g., PsycINFO, Pubmed, ProceedingsFirst), extracted required data, and calculated effect sizes. Inclusion criteria identified studies that had (a) compared alcohol or methamphetamine dependent groups to healthy controls and (b) matched groups on either age, education, or IQ (at least 2 out of 3). Studies were excluded if participants were reported to have Axis I diagnoses (other than alcohol or methamphetamine dependence) or comorbidities known to impact neuropsychological functioning. Sixteen articles were coded and analyzed for the current study.
Data synthesis
Alcohol studies showed a large effect size (g = 0.745, p < 0.001) while methamphetamine studies evidenced a moderate effect size (g = 0.406, p = 0.001); both without statistically significant heterogeneity (I2 = 0). Subgroup analysis revealed a statistically significant difference between the effect sizes from alcohol versus methamphetamine studies (Q-between = 5.647, p = 0.017).
Conclusions
The CT is sensitive to the effects of both alcohol and methamphetamine and should be considered when examining dependent patients who might exhibit problem solving, concept formation, and set loss difficulties in everyday living.
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31
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Meda M, Gentry V, Walker A. Are perineal swabs required as part of initial staff screening in healthcare-associated Streptococcus pyogenes outbreaks? J Hosp Infect 2019; 102:241-242. [DOI: 10.1016/j.jhin.2018.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 11/29/2018] [Indexed: 10/27/2022]
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Hurley MV, Semple A, Sibley F, Walker A. Evaluation of a health trainer–led service for people with knee, hip and back pain. Perspect Public Health 2019; 139:308-315. [DOI: 10.1177/1757913919833721] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Aims: Chronic knee, hip and back pain is extremely prevalent. Management guidelines emphasise maintaining physical activity and healthy weight to reduce pain and improve physical and mental wellbeing. Unfortunately, few people receive support to make lifestyle changes. We evaluated whether a health trainer—led ‘joint pain advice’ (JPA) service delivering person-centred lifestyle coaching was feasible, acceptable and effective for people with knee, hip and back pain. Methods: Feasibility of delivering a JPA service was assessed by documenting whether the health trainers could deliver JPA and its uptake. Nine health trainers delivered JPA. Participants were offered up to four appointments. At each appointment, health trainers gave people information about their condition, co-developed care plans, suggested self-management strategies and used behavioural change techniques (motivational interviewing, goal-setting and action planning) to increase physical activity and reduce body weight. Pain, function, physical activity and body mass index (BMI) were collected at baseline, 3 weeks, 6 weeks and 6 months. Focus groups captured people’s opinions of the service’s effectiveness, acceptability and usefulness. Results: Of the 105 people who enquired about JPA, 85 (81%) used the service, after which their physical activity and function improved, and pain, use of analgesia and BMI decreased. They felt more knowledgeable and better motivated to adopt and maintain healthier behaviours. They attributed these improvements to the JPA service, because of its better consultations and collaborative holistic approach. Only a minority attended all four appointments because they felt they received sufficient advice from the initial appointments. The health trainers gained knowledge and skills to support clients with musculoskeletal conditions. Conclusions: Using a holistic, patient-centred approach, health trainers can deliver lifestyle advice to people with chronic knee, hip or back pain safely, effectively and efficiently. The service was popular with recipients and health trainers, and helped people adopt healthier lifestyles that lead to reduced pain and other clinical improvements.
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Affiliation(s)
- MV Hurley
- Musculoskeletal Programme, Health Innovation Network, London, UK
- Faculty of Health, Social Care and Education, St George’s University of London and Kingston University, 6th Floor, Hunter Wing, Cranmer Terrace, London SW17 0RE, UK
| | - A Semple
- Musculoskeletal Programme, Health Innovation Network, London, UK
| | - F Sibley
- Musculoskeletal Programme, Health Innovation Network, London, UK
| | - A Walker
- Musculoskeletal Programme, Health Innovation Network, London, UK
- Faculty of Health, Social Care and Education, St George’s University of London and Kingston University, London, UK
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Lee D, Amadi A, Sabater J, Ellis J, Johnson H, Kotapati S, McNamara S, Walker A, Cooper M, Patterson K, Roskell N, Meng Y. Can We Accurately Predict Cost Effectiveness Without Access to Overall Survival Data? The Case Study of Nivolumab in Combination with Ipilimumab for the Treatment of Patients with Advanced Melanoma in England. Pharmacoecon Open 2019; 3:43-54. [PMID: 29790020 PMCID: PMC6393277 DOI: 10.1007/s41669-018-0080-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
BACKGROUND Nivolumab with ipilimumab (the Regimen) is the first immuno-oncology combination treatment to demonstrate long-term clinical benefit for advanced melanoma patients. We evaluated the cost effectiveness of the Regimen in this population, with and without the availability of overall survival (OS) data. METHODS A partitioned survival model and a Markov state-transition model were developed to estimate the lifetime costs and benefits of the Regimen versus ipilimumab. These models were built with and without the availability of OS data, as only progression-free survival data were available from the head-to-head, phase III trial against ipilimumab at the time of the National Institute for Health and Care Excellence (NICE) submission. Patient utilities and resource use data were sourced from trial data or the literature. RESULTS Incremental cost-effectiveness ratios (ICERs) and absolute costs were similar between the models with and without OS data, but the model with OS data generated more than 1 additional quality-adjusted life-year (QALY) across both treatment arms. In both models, based on list prices, the Regimen was the most cost-effective treatment. CONCLUSIONS The analyses show that the Regimen is a cost-effective treatment for advanced melanoma patients in England, and methods to overcome the lack of OS can give reasonable estimates of QALYs gained and ICERs.
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Affiliation(s)
- D Lee
- BresMed Health Solutions, Sheffield, UK.
| | - A Amadi
- Bristol-Myers Squibb Pharmaceuticals, Uxbridge, UK
| | - J Sabater
- Bristol-Myers Squibb, Princeton, NJ, USA
| | - J Ellis
- Bristol-Myers Squibb Pharmaceuticals, Uxbridge, UK
| | - H Johnson
- Helen Johnson Consulting Ltd, Welwyn Garden City, UK
| | - S Kotapati
- Bristol-Myers Squibb, Princeton, NJ, USA
| | - S McNamara
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | | | - M Cooper
- BresMed Health Solutions, Sheffield, UK
| | | | - N Roskell
- BresMed Health Solutions, Sheffield, UK
| | - Y Meng
- BresMed Health Solutions, Sheffield, UK
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Lee D, Amadi A, Sabater J, Ellis J, Johnson H, Kotapati S, McNamara S, Walker A, Cooper M, Patterson K, Roskell N, Meng Y. Correction to: Can We Accurately Predict Cost Effectiveness Without Access to Overall Survival Data? The Case Study of Nivolumab in Combination with Ipilimumab for the Treatment of Patients with Advanced Melanoma in England. Pharmacoecon Open 2019; 3:127. [PMID: 30206825 PMCID: PMC6393273 DOI: 10.1007/s41669-018-0096-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The second Key Point for Decision Makers, which reads.
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Affiliation(s)
- D Lee
- BresMed Health Solutions, Sheffield, UK.
| | - A Amadi
- Bristol-Myers Squibb Pharmaceuticals, Uxbridge, UK
| | - J Sabater
- Bristol-Myers Squibb, Princeton, NJ, USA
| | - J Ellis
- Bristol-Myers Squibb Pharmaceuticals, Uxbridge, UK
| | - H Johnson
- Helen Johnson Consulting Ltd, Welwyn Garden City, UK
| | - S Kotapati
- Bristol-Myers Squibb, Princeton, NJ, USA
| | - S McNamara
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | | | - M Cooper
- BresMed Health Solutions, Sheffield, UK
| | | | - N Roskell
- BresMed Health Solutions, Sheffield, UK
| | - Y Meng
- BresMed Health Solutions, Sheffield, UK
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Abstract
Prevention of chronicity of disease and minimising its impact with individualized treatment is a fundamental tenet of precision medicine. A review of the literature has been undertaken to explore how this may apply to chronic rhinosinusitis (CRS). Prevention may be thought of across 3 main domains. Primary prevention of CRS focuses on the avoidance of exposure to environmental factors associated with increased incidence of disease. This includes avoidance of tobacco smoke and occupational toxins. Although allergic rhinitis, respiratory infections and gastro-oesophageal reflux have been shown to be risk factors, there is no evidence as yet that treatment of these conditions is associated with reduced incidence of CRS. Secondary prevention of CRS is concerned with detecting a disease in its earliest stages, intervening to achieve disease and symptom control and preventing future exacerbations. Evidence based guidelines facilitate early diagnosis and appropriate use of medical and surgical interventions. In the future the use of endotypes to direct optimal is like to allow more clinically and cost-effective use of current and emerging treatments, such as monoclonal antibodies. Tertiary prevention aims to minimise the impact of an ongoing illness or injury that has lasting effects. Anxiety and depression have been shown to be associated with symptom amplification and may require treatment. The role of disease-related factors such as the role of the microbiome and osteo-neogenesis in the development of chronicity, and the development of severe combined upper airway disease needs further research.
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Affiliation(s)
- C Hopkins
- ENT Department, Guys and St Thomas Hospitals, SE1 9RT London, United Kingdom
| | - P Surda
- ENT Department, Guys and St Thomas Hospitals, SE1 9RT London, United Kingdom
| | - F Bast
- ENT Department, Guys and St Thomas Hospitals, SE1 9RT London, United Kingdom
| | - R Hettige
- ENT Department, Guys and St Thomas Hospitals, SE1 9RT London, United Kingdom
| | - A Walker
- ENT Department, Guys and St Thomas Hospitals, SE1 9RT London, United Kingdom
| | - P W Hellings
- Department of Otorhinolaryngology, Head and Neck Surgery University Hospitals Leuven, Belgium
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Harb JN, George EV, Walker A, Schoch JJ. Concomitant granuloma annulare and necrobiosis lipoidica: do they have a related pathogenesis? Clin Exp Dermatol 2018; 44:674-676. [DOI: 10.1111/ced.13844] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2018] [Indexed: 11/28/2022]
Affiliation(s)
- J. N. Harb
- Department of Dermatology University of Florida College of Medicine Gainesville FL USA
| | - E. V. George
- Department of Dermatology University of Florida College of Medicine Gainesville FL USA
| | - A. Walker
- Department of Dermatology University of Florida College of Medicine Gainesville FL USA
| | - J. J. Schoch
- Department of Dermatology University of Florida College of Medicine Gainesville FL USA
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Affiliation(s)
- A Walker
- Oral Roberts University, Tulsa, Oklahoma, United States
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Walker A. UNJUST AGEING: WHY POLITICAL ECONOMY IS STILL ESSENTIAL TO GERONTOLOGY. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.1363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A Walker
- The University of Sheffield, Sheffield, England, United Kingdom
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Abstract
AIM Despite an estimated 40 000 people diagnosed with young onset dementia (YOD) in the UK, there is a general lack of awareness of the condition when compared with late onset dementia. The aim of this study was to explore the experiences and needs of people living with YOD (younger than 65 years) and gain an understanding of the issues that impact on them. SETTING Participants' homes, support group premises or university rooms. PARTICIPANTS 14 people with a diagnosis of YOD from a northern UK city. DESIGN Semistructured, in-depth interviews were audio recorded, transcribed and analysed cross-sectionally following principles of interpretative phenomenological analysis. RESULTS Four superordinate themes are reported on 'process of diagnosis', 'the impact of living YOD', 'needs of people with YOD' and 'living well with YOD'. Nine subordinate themes captured participant experiences of developing cognitive difficulties, after being diagnosed with YOD, and subsequently living with the condition. Key issues that emerging included a lack of general awareness of YOD; how this can delay help seeking; commonalities in prediagnosis trajectories; retrospective understanding of prediagnosis symptom patterns; the difficulties of obtaining a firm diagnosis; the importance of face-to-face support and difficulties associated with daily living. Participants also described the emotional and psychological impact of the condition and the importance of formal and informal support networks. CONCLUSIONS People who have a diagnosis of YOD regard themselves as distinct from older people with dementia. Despite similar symptoms, the context in which they experience the condition creates a range of distinct psychosocial concerns not commonly well addressed by health and social care services. As awareness of YOD continues to grow, the development (or adaptation) of services that take into account the idiosyncratic needs of people with YOD should be addressed.
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Affiliation(s)
- Luisa I Rabanal
- Salford Institute for Dementia, University of Salford, Salford, UK
| | - John Chatwin
- Salford Institute for Dementia, University of Salford, Salford, UK
| | - Andy Walker
- Salford Institute for Dementia, University of Salford, Salford, UK
| | - Maria O’Sullivan
- Salford Institute for Dementia, University of Salford, Salford, UK
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Nash B, Walker A, Chambers T. A simulator based on virtual reality to dismantle a research reactor assembly using master-slave manipulators. ANN NUCL ENERGY 2018. [DOI: 10.1016/j.anucene.2018.05.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Walker A, Abeysekara N, Youssef E, Nadir H, Arora A. 41PRESCRIBING VS DEPRESCRIBING: CHECKING THE BALANCE. DO GERIATRICIANS SAVE MONEY BY INPATIENT MEDICINES OPTIMISATION? Age Ageing 2018. [DOI: 10.1093/ageing/afy121.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- A Walker
- Department for Older Adults, University Hospital of North Midlands, Stoke-on-Trent
| | - N Abeysekara
- Department for Older Adults, University Hospital of North Midlands, Stoke-on-Trent
| | - E Youssef
- Department for Older Adults, University Hospital of North Midlands, Stoke-on-Trent
| | - H Nadir
- Department for Older Adults, University Hospital of North Midlands, Stoke-on-Trent
| | - A Arora
- Department for Older Adults, University Hospital of North Midlands, Stoke-on-Trent
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Villa S, Pillai M, Graham D, Kilgour E, Overton N, Vasudev N, Hughes A, Walker A, Dransfield S, Thistlethwaite F. TRIBE; Tyrosine kinase inhibitor therapy in renal-cell carcinoma: Immune biomarker evaluation. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy315.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Surda P, Putala M, Siarnik P, Walker A, Bernic A, Fokkens W. Rhinitis and its impact on quality of life in swimmers. Allergy 2018; 73:1022-1031. [PMID: 29150854 DOI: 10.1111/all.13359] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2017] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Limited data suggest that swimmers might be affected by rhinitis significantly more often than the general population. This can have impact on quality of life but also on performance. The aim of this study was to determine the prevalence and impact of QOL of rhinitis in swimming compared to nonswimming athletes and controls. MATERIALS AND METHODS This was an observational case-control, questionnaire-based study involving elite (n = 101) and nonelite swimming athletes (n = 107), nonswimming athletes (n = 38) and sex- and age-matched controls (n = 50). The survey instrument consisted of a general and the miniRQLQ. Main question used to assess the prevalence of rhinitis was from the ISAAC study. RESULTS Rhinitis was reported significantly more often by the elite swimmers (45%) than nonelite swimmers (31%), nonswimming athletes (32%) and controls (24%). Allergic rhinitis prevalence was similar in all groups (12%-18%). The prevalence of nonallergic rhinitis (NAR) was significantly higher in elite swimmers (33%) and nonelite swimmers (22%) compared to nonswimming athletes and controls. Overall mean miniRQLQ score and all subdomains except the "eye" domain showed significantly reduced QOL in elite and nonelite swimmers compared to nonswimming athletes and controls. Regular nasal medication was used significantly less by elite swimmers (18%) compared to controls (67%) and nonswimming athletes (42%). CONCLUSION This study revealed a high prevalence of NAR in swimmers and related impact on QoL. These findings highlight the importance to increase the awareness towards upper airway disorders in the swimming athletes and to ensure adequate management.
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Affiliation(s)
- P. Surda
- Department of Otorhinolaryngology; Guy's and St Thomas’ University Hospital; London UK
- Department of Otorhinolaryngology; Academic Medical Center; Amsterdam The Netherlands
| | - M. Putala
- Department of Physical Education and Sports; Comenius University; Bratislava Slovakia
| | - P. Siarnik
- Department of Neurology; Faculty of Medicine; Comenius University; Bratislava Slovakia
| | - A. Walker
- Department of Otorhinolaryngology; Guy's and St Thomas’ University Hospital; London UK
| | - A. Bernic
- Department of Otorhinolaryngology; Guy's and St Thomas’ University Hospital; London UK
| | - W. Fokkens
- Department of Otorhinolaryngology; Academic Medical Center; Amsterdam The Netherlands
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Walker A, Buckley J, Zhang K, Dong B, Holloway L, Liney G. PV-0533: Methods for distortion assessment and correction on the Australian MRI-linac. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)30843-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Ramaswamy M, Beeman A, Henwood S, Hawkyard A, Robertson A, Ridout D, Walker A, Patel R, Simmonds J, Muthialu N. Supplemental Use of Blood Cardioplegia Before Graft Implantation in Pediatric Heart Transplantation. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.1030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Abstract
Four patients with five wounds were randomly assigned to treatment with three occlusive dressings: DuoDERM®, Restore® and Comfeel Ulcus®; the dressings were left intact for 24-48 h. When the dressings were removed, it was found that wounds that had been covered with Restore and Comfeel contained coagulated sanguinous material. Two wounds that had been covered with Comfeel and Restore, respectively, were then covered with DuoDERM, while one wound previously covered with DuoDERM was covered with Restore. Either no clotting occurred under DuoDERM or clots may have resolved. Although these preliminary data suggest that DuoDERM gel may have fibrinolytic properties, more extensive and controlled studies are needed to assess the characteristics of this dressing.
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Affiliation(s)
- G D Mulder
- Surgery Department, Veterans Administration Hospital, Denver, Colorado
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Walker A, Williams R, Sibley F, Stamp D, Carter A, Hurley M. Improving access to better care for people with knee and/or hip pain: service evaluation of allied health professional-led primary care. Musculoskeletal Care 2018; 16:222-232. [PMID: 28401656 DOI: 10.1002/msc.1189] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Chronic knee and hip pain is prevalent, impairing mobility, function and quality of life. Allied health professions (AHPs) are better trained and have more time than general practitioners in primary care to advise and support people to adopt healthier lifestyles (maintain healthy weight, increase physical activity) that reduce joint pain. We evaluated whether AHP-led primary care delivering person-centred, practical lifestyle coaching was a feasible, effective way to manage chronic knee and/or hip pain. METHODS At initial assessment the 'Joint Pain Advisor' assessed pain, function, quality of life, physical activity, waist circumference and body mass, taught simple self-management strategies and used behaviour change techniques (motivational interviewing, goal setting, action/coping planning) to alter participants' lifestyles. Participants were invited for 6-week and 6-month reviews, when the Advisor reassessed clinical outcomes, fed back progress and reinforced health messages. Feasibility and effectiveness of the service was evaluated using quantitative and qualitative methods. RESULTS Uptake of the service was good: 498 people used the service. Between initial assessment and reviews, participants' pain, function, quality of life, weight, waist circumference and physical activity improved (p < 0.005). Service user satisfaction was high; they reported easier access to advice and support tailored to their needs that translated into clinical benefits and a more efficient pathway reducing unnecessary consultations and investigations. Relatively few people returned for a 6-month review as they considered they had received sufficient advice. CONCLUSIONS AHP-led care is a popular, effective, efficient and sustainable way to manage joint pain, without compromising safety or quality of care.
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Affiliation(s)
- A Walker
- St George's, University of London and Kingston University, UK
- Health Innovation Network, London, UK
| | - R Williams
- Lewisham NHS Clinical Commissioning Group, UK
| | - F Sibley
- Health Innovation Network, London, UK
| | - D Stamp
- Lewisham and Greenwich NHS Trust, UK
| | - A Carter
- Health Innovation Network, London, UK
| | - M Hurley
- St George's, University of London and Kingston University, UK
- Health Innovation Network, London, UK
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Bradley JA, Sparks I, Prior P, Bergom C, Walker A, Wilson JF, Li XA, White J. Abstract P2-11-06: Analysis of cardiac events among node positive breast cancer (NPBC) patients treated with three-dimensional conformal radiation therapy (3D-CRT). Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p2-11-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Regional nodal irradiation (RNI) in addition to the chest wall and/or breast can maximize local regional control and improve overall survival, but has been associated with late cardiac morbidity. We examined NPBC patients treated with RNI using 3D-CT based radiation therapy (RT) to evaluate incidence and type of cardiac events.
Methods: Between 2000 and 2007, 156 NPBC patients were treated with RNI following lumpectomy or mastectomy using 3D-CRT. In all cases, treatment target and normal tissue volumes were delineated on treatment CT scans. The heart contour included the left ventricle and the atria. Prescription dose was typically 50Gy in 25 fractions (range 44-54 Gy) to the chest wall and/or breast PTVeval. 37% received a boost to the chest wall and 73% to the lumpectomy cavity. The mean prescription dose to the axilla and supraclavicular lymph nodes was 47.6 Gy (range 43.2 – 54 Gy) and 46.8 Gy to the IMN (range 35.3 – 50.4 Gy). The dose-volume cardiac data and incidence of cardiac events is reported.
Results: Median follow-up of surviving patients was 7 years (range, 0.3-10.6). Median patient age was 50 (range, 27-91), 52% were premenopausal, 76% estrogen receptor positive, and 18% were HER-2 positive. The IMN received > 40 Gy in 66%. Chemotherapy was used in 94% of patients, and it was anthracycline-based in 82.3%. At the time of RT, 12.5% smoked, 9% had diabetes, 33% with HTN, and 4.4% had a history of CAD.
Average mean heart dose for the cohort was 5.2 Gy (range, 0.2 - 25.3 Gy). Mean cardiac V25 was 5.4% (range, 0-20%), mean cardiac V45 was 1.7% (range, 0-13.3%), and mean maximum cardiac point dose was 45.4 Gy.
There was 1 (0.7% of cohort) right sided patient with cardiac events and 8 (5.1% of cohort) left experiencing cardiac events. A total of 18 cardiac diagnoses were experienced among the 9 patients: Coronary artery disease with or without myocardial infarction (4), congestive heart failure (6), cardiomyopathy (3), and arrhythmia (5).
Conclusions: The cardiac event rate among these NPBC patients treated with RNI and anthracycline-based chemotherapy was low, but more common in women with left-sided breast cancer compared to right. Additional analysis using 3DCRT volumes are important to validate these findings and better define the dose-volume parameters for cardiac toxicity.
Citation Format: Bradley JA, Sparks I, Prior P, Bergom C, Walker A, Wilson JF, Li XA, White J. Analysis of cardiac events among node positive breast cancer (NPBC) patients treated with three-dimensional conformal radiation therapy (3D-CRT) [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P2-11-06.
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Affiliation(s)
- JA Bradley
- University of Florida; Medical College of Wisconsin; University of Chicago; Ohio State University
| | - I Sparks
- University of Florida; Medical College of Wisconsin; University of Chicago; Ohio State University
| | - P Prior
- University of Florida; Medical College of Wisconsin; University of Chicago; Ohio State University
| | - C Bergom
- University of Florida; Medical College of Wisconsin; University of Chicago; Ohio State University
| | - A Walker
- University of Florida; Medical College of Wisconsin; University of Chicago; Ohio State University
| | - JF Wilson
- University of Florida; Medical College of Wisconsin; University of Chicago; Ohio State University
| | - XA Li
- University of Florida; Medical College of Wisconsin; University of Chicago; Ohio State University
| | - J White
- University of Florida; Medical College of Wisconsin; University of Chicago; Ohio State University
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Jappe U, Minge S, Kreft B, Ludwig A, Przybilla B, Walker A, Varga R, Seidel P, Biedermann T, Anemüller W, Kromminga A, Ruëff F, Merk H, Wagner N, Treudler R, Worm M, Waldmann I, Saloga J, Becker WM, Goldmann T, Platts‐Mills TA, Homann A. Meat allergy associated with galactosyl-α-(1,3)-galactose (α-Gal)-Closing diagnostic gaps by anti-α-Gal IgE immune profiling. Allergy 2018; 73:93-105. [PMID: 28670695 DOI: 10.1111/all.13238] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Glycoproteins and glycolipids of some mammalian species contain the disaccharide galactosyl-α-(1,3)-galactose (α-Gal). It is known that α-Gal is immunogenic in humans and causes glycan-specific IgG and also IgE responses with clinical relevance. α-Gal is part of the IgE-reactive monoclonal therapeutic antibody cetuximab (CTX) and is associated with delayed anaphylaxis to red meat. In this study, different α-Gal-containing analytes are examined in singleplex and multiplex assays to resolve individual sensitization patterns with IgE against α-Gal. METHODS Three serum groups, α-Gal-associated meat allergy (MA) patients, idiopathic anaphylaxis (IA) patients with suspected MA, and non-meat-allergic healthy control individuals (HC), were analyzed via singleplex allergy diagnostics and a newly established immunoblot diagnostic system. The new dot blot detection system resolved individual IgE sensitization profiles for α-Gal-containing analytes CTX, bovine thyroglobulin (Bos d TG), and human serum albumin (HSA)-conjugated α-Gal. RESULTS Singleplex allergy diagnostics using the α-Gal analytes CTX and Bos d TG confirms the history of MA patients in 91% and 88% of the cases, respectively. A novel dot blot-based assay system for the detection of IgE against α-Gal reveals individual IgE sensitization profiles for α-Gal-containing analytes. An α-Gal-associated IgE cross-reactivity profile (IgE against CTX, Bos d TG, and HSA-α-Gal) was identified, which is associated with MA. CONCLUSIONS Detection of individual sensitization patterns with different α-Gal-containing analytes provides the basis for an individual allergy diagnosis for α-Gal-sensitized patients. Higher amounts of α-Gal in pork and beef innards compared to muscle meat as indicated by a higher staining intensity are a plausible explanation for the difference in allergic symptom severity.
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Affiliation(s)
- U. Jappe
- Division of Clinical and Molecular Allergology Priority Research Area Asthma & Allergy Research Center Borstel Airway Research Center North (ARCN) Member of the German Center for Lung Research (DZL) Borstel Germany
- Interdisciplinary Allergy Division Department of Internal Medicine University of Lübeck Lübeck Germany
| | - S. Minge
- Division of Clinical and Molecular Allergology Priority Research Area Asthma & Allergy Research Center Borstel Airway Research Center North (ARCN) Member of the German Center for Lung Research (DZL) Borstel Germany
| | - B. Kreft
- Department of Dermatology and Venereology Martin‐Luther‐University Halle‐Wittenberg Halle (Saale) Germany
| | - A. Ludwig
- Department of Dermatology and Allergology Klinikum Augsburg Augsburg Germany
| | - B. Przybilla
- Department of Dermatology Ludwig‐Maximilians University Munich Germany
| | - A. Walker
- Department of Dermatology Ludwig‐Maximilians University Munich Germany
| | - R. Varga
- Department of Dermatology Ludwig‐Maximilians University Munich Germany
| | - P. Seidel
- Department of Dermatology University of Tübingen Tübingen Germany
| | - T. Biedermann
- Department of Dermatology University of Tübingen Tübingen Germany
- Department of Dermatology and Allergology Technical University of Munich Munich Germany
| | - W. Anemüller
- Department of Dermatology University of Lübeck Lübeck Germany
| | | | - F. Ruëff
- Department of Dermatology Ludwig‐Maximilians University Munich Germany
| | - H. Merk
- Department of Dermatology RWTH Aachen University Aachen Germany
| | - N. Wagner
- Department of Dermatology Klinikum Darmstadt Germany
| | - R. Treudler
- Department of Dermatology, Venereology and Allergology University of Leipzig Leipzig Germany
| | - M. Worm
- Department of Dermatology and Allergy Allergy Center Charité Berlin Germany
| | - I. Waldmann
- Dermatology & Allergology St. Bernward Klinik Hildesheim Germany
| | - J. Saloga
- Department of Dermatology University of Mainz Mainz Germany
| | - W. M. Becker
- Division of Clinical and Molecular Allergology Priority Research Area Asthma & Allergy Research Center Borstel Airway Research Center North (ARCN) Member of the German Center for Lung Research (DZL) Borstel Germany
| | - T. Goldmann
- Pathology of the University Medical Center Schleswig‐Holstein (UKSH) Campus Lübeck and Research Center Borstel Airway Research Center North (ARCN) Member of the German Center for Lung Research (DZL) Borstel Germany
| | - T. A. Platts‐Mills
- University of Virginia Asthma and Allergic Diseases Center Charlottesville USA
| | - A. Homann
- Division of Clinical and Molecular Allergology Priority Research Area Asthma & Allergy Research Center Borstel Airway Research Center North (ARCN) Member of the German Center for Lung Research (DZL) Borstel Germany
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Challoumas D, Ferro A, Walker A, Brassett C. Observations on the inconsistency of dermatome maps and its effect on knowledge and confidence in clinical students. Clin Anat 2017; 31:293-300. [DOI: 10.1002/ca.23031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 11/20/2017] [Accepted: 12/01/2017] [Indexed: 11/10/2022]
Affiliation(s)
- D. Challoumas
- Department of Physiology, Development and Neuroscience; University of Cambridge, Downing Site; Cambridge CB2 1DY United Kingdom
| | - A. Ferro
- University of Cambridge School of Clinical Medicine, Addenbrooke's Hospital, Hills Road; Cambridge CB2 0SP United Kingdom
| | - A. Walker
- Department of Physiology, Development and Neuroscience; University of Cambridge, Downing Site; Cambridge CB2 1DY United Kingdom
| | - C. Brassett
- Department of Physiology, Development and Neuroscience; University of Cambridge, Downing Site; Cambridge CB2 1DY United Kingdom
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