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Bateman M, Skeggs A, Whitby E, Fletcher-Barrett V, Stephens G, Dawes M, Davis D, Beckhelling J, Cooper K, Saunders B, Littlewood C, Vicenzino B, Foster NE, Hill JC. Optimising physiotherapy for people with lateral elbow tendinopathy - Results of a mixed-methods pilot and feasibility randomised controlled trial (OPTimisE). Musculoskelet Sci Pract 2024; 69:102905. [PMID: 38194841 PMCID: PMC10843168 DOI: 10.1016/j.msksp.2023.102905] [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: 08/02/2023] [Revised: 11/14/2023] [Accepted: 12/26/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND The OPTimisE intervention was developed to address uncertainty regarding the most effective physiotherapy treatment strategy for people with Lateral Elbow Tendinopathy (LET). OBJECTIVES To assess the feasibility of conducting a fully-powered randomised controlled trial (RCT) evaluating whether the OPTimisE intervention is superior to usual physiotherapy treatment for adults with LET. DESIGN A mixed-methods multi-centred, parallel pilot and feasibility RCT, conducted in three outpatient physiotherapy departments in the UK. METHOD Patients were independently randomised 1:1 in mixed blocks, stratified by site, to the OPTimisE intervention or usual care. Outcomes were assessed using pre-defined feasibility progression criteria. RESULTS 50 patients were randomised (22 Female, 28 Male), mean age 48 years (range 27-75). Consent rate was 71% (50/70), fidelity to intervention 89% (16/18), attendance rate in the OPTimisE group 82% (55/67) vs 85% (56/66) in usual care, outcome measure completion 81% (39/48) at six-month follow-up. There were no related adverse events. Patients and physiotherapists reported that the OPTimisE intervention was acceptable but suggested improvements to the trial design. 49 patients were recruited from physiotherapy referrals vs one from primary care records. Outcome measure return rates were higher when completed online (74%) compared to postal questionnaire (50%). Exploratory analysis showed improvements in both groups over time. CONCLUSIONS It is methodologically feasible to conduct a fully powered RCT comparing the clinical and cost-effectiveness of the OPTimisE intervention versus usual physiotherapy treatment. Considering the similar improvements observed in both groups, careful consideration is needed regarding the priority research question to be addressed in future research.
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Affiliation(s)
- M Bateman
- University Hospitals of Derby & Burton NHS Foundation Trust, Derby, UK; School of Medicine, Keele University, UK.
| | - A Skeggs
- Derby Clinical Trials Support Unit, Derby, UK
| | - E Whitby
- University Hospitals of Derby & Burton NHS Foundation Trust, Derby, UK
| | | | - G Stephens
- Royal Orthopaedic Hospital, Birmingham, UK
| | - M Dawes
- Royal Orthopaedic Hospital, Birmingham, UK
| | - D Davis
- Derby Clinical Trials Support Unit, Derby, UK
| | | | - K Cooper
- Patient Representative, Derby, UK
| | - B Saunders
- School of Medicine, Keele University, UK
| | | | - B Vicenzino
- University of Queensland, Brisbane, Australia
| | - N E Foster
- School of Medicine, Keele University, UK; STARS Education and Research Alliance, Surgical Treatment and Rehabilitation Service (STARS), The University of Queensland and Metro North Health, Brisbane, Australia
| | - J C Hill
- School of Medicine, Keele University, UK
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Saunders B, Burton C, van der Windt DA, Myers H, Chester R, Pincus T, Wynne-Jones G. Patients' and clinicians' perspectives towards primary care consultations for shoulder pain: qualitative findings from the Prognostic and Diagnostic Assessment of the Shoulder (PANDA-S) programme. BMC Musculoskelet Disord 2023; 24:1. [PMID: 36588148 PMCID: PMC9805906 DOI: 10.1186/s12891-022-06059-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 12/06/2022] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Clinical management of musculoskeletal shoulder pain can be challenging due to diagnostic uncertainty, variable prognosis and limited evidence for long-term treatment benefits. The UK-based PANDA-S programme (Prognostic And Diagnostic Assessment of the Shoulder) is investigating short and long-term shoulder pain outcomes. This paper reports linked qualitative research exploring patients' and clinicians' views towards primary care consultations for shoulder pain. METHODS Semi-structured interviews were conducted with 24 patients and 15 primary care clinicians. Twenty-two interviews (11 patients, 11 clinicians) were conducted as matched patient-clinician 'dyads'. Data were analysed thematically. RESULTS Clinicians reported attempts to involve patients in management decisions; however, there was variation in whether patients preferred treatment choice, or for decisions to be clinician-led. Some patients felt uncertain about the decisions made, due to a lack of discussion about available management options. Many General Practitioners expressed a lack of confidence in diagnosing the underlying cause of shoulder pain. Patients reported either not being given a diagnosis, or receiving different diagnoses from different professionals, resulting in confusion. Whilst clinicians reported routinely discussing prognosis of shoulder pain, patients reported that prognosis was not raised. Patients also expressed concern that their shoulder pain could be caused by serious pathology; however, clinicians felt that this was not a common concern for patients. CONCLUSIONS Findings showed disparities between patients' and clinicians' views towards shoulder pain consultations, indicating a need for improved patient-clinician communication. Findings will inform the design of an intervention to support treatment and referral decisions for shoulder pain that will be tested in a randomised controlled trial.
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Affiliation(s)
- B. Saunders
- grid.9757.c0000 0004 0415 6205Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire ST5 5BG UK
| | - C. Burton
- grid.9757.c0000 0004 0415 6205Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire ST5 5BG UK
| | - D. A. van der Windt
- grid.9757.c0000 0004 0415 6205Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire ST5 5BG UK
| | - H. Myers
- grid.9757.c0000 0004 0415 6205Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire ST5 5BG UK ,grid.9757.c0000 0004 0415 6205Clinical Trials Unit, Keele University, Keele, UK
| | - R. Chester
- grid.8273.e0000 0001 1092 7967School of Health Sciences, Faculty of Medicine and Health, University of East Anglia, Norwich Research Park, Norwich, UK
| | - T. Pincus
- grid.5491.90000 0004 1936 9297Faculty of Environmental and Life Sciences (FELS), University of Southampton, Southampton, UK
| | - G. Wynne-Jones
- grid.9757.c0000 0004 0415 6205Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire ST5 5BG UK
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Sarigiovannis P, Foster NE, Jowett S, Saunders B. Delegation of workload from musculoskeletal physiotherapists to physiotherapy assistants/support workers: A UK online survey. Musculoskelet Sci Pract 2022; 62:102631. [PMID: 35964497 DOI: 10.1016/j.msksp.2022.102631] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 07/18/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE There are approximately 9000 physiotherapy assistants/support workers in the UK. Many of them work in NHS physiotherapy outpatient services treating patients with musculoskeletal conditions, but their role(s) are relatively undefined and as such there is considerable variation in the duties and tasks they undertake. This study aimed to explore current practice of UK musculoskeletal physiotherapists in relation to delegation to physiotherapy assistants/support workers. METHODS An online cross-sectional descriptive survey was designed and collected data on delegation practice and training in delegation. The survey was piloted with 10 physiotherapists. The final questionnaire was distributed via the interactive Chartered Society of Physiotherapy's website and the authors' professional networks via Twitter. Responses were collected over a five-week-period from October to November 2020. RESULTS Of 302 survey responses, 232 were analysed (46 incomplete, 24 ineligible). The majority of respondents (66.3%, 154/232) had worked as physiotherapists for over 10 years. Most respondents indicated they had neither formal training (84%, 195/232) nor informal training (60.3%, 140/232) regarding how to delegate tasks. The clinical tasks most commonly delegated by physiotherapists were supervision of exercises (81.0%, 188/232) and walking aid provision (78.5%, 182/232) whereas the least delegated clinical task was the application of electrotherapy (19.8%, 46/232). CONCLUSION These survey results provide evidence for the need to improve training in delegation for both physiotherapists and physiotherapy assistants, and to ensure clearer delegation processes to facilitate good delegation practice in the musculoskeletal setting.
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Affiliation(s)
- P Sarigiovannis
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Staffordshire, ST5 5BG, United Kingdom; Midlands Partnership NHS Foundation Trust, Newcastle Under Lyme, Staffordshire, ST5 1QG, United Kingdom.
| | - N E Foster
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Staffordshire, ST5 5BG, United Kingdom; STARS Education and Research Alliance, Surgical Treatment and Rehabilitation Service (STARS), The University of Queensland and Metro North Health, Herston, Brisbane, Australia
| | - S Jowett
- Health Economics Unit, Institute of Applied Health Research, Public Health Building, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom
| | - B Saunders
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Staffordshire, ST5 5BG, United Kingdom
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Bateman M, Saunders B, Littlewood C, Davis D, Beckhelling J, Cooper K, Skeggs A, Foster NE, Vicenzino B, Hill JC. Comparing an optimised physiotherapy treatment package with usual physiotherapy care for people with tennis elbow - protocol for the OPTimisE pilot and feasibility randomised controlled trial. Pilot Feasibility Stud 2022; 8:178. [PMID: 35953842 PMCID: PMC9367116 DOI: 10.1186/s40814-022-01132-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 07/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Physiotherapy is recommended for people with tennis elbow, but whilst a wide array of treatments is available, the optimal approach remains uncertain. We have therefore recently developed an optimised physiotherapy treatment package for tennis elbow based on a synthesis of the evidence, patient input and clinical consensus. It consists of detailed advice and education, a structured progressive exercise programme and provision of a counter-force elbow brace. Here, we report the protocol for our multicentre pilot and feasibility randomised controlled trial (RCT) designed to (a) examine the feasibility of our optimised physiotherapy treatment package and (b) to pilot trial processes for a future fully powered RCT to test clinical and cost-effectiveness compared with usual physiotherapy treatment. METHODS A multicentre pilot and feasibility RCT will be conducted across three sites in England, recruiting up to 50 patients (or for a maximum of 12 months). Participants with tennis elbow, identified from physiotherapy clinic waiting lists and general practice surgeries, will be randomly allocated to receive the optimised physiotherapy treatment package or usual physiotherapy care. Analysis will focus on feasibility measures including consent rate, intervention fidelity, follow-up rate and outcome completion rate. A nested qualitative study will explore the acceptability of the study processes and patient and physiotherapist experiences of the new optimised intervention. DISCUSSION This study will determine the feasibility of a new optimised physiotherapy treatment package for people with tennis elbow and pilot the processes for a future fully powered RCT. In the longer term, this treatment package may provide superior clinical outcomes for patients, in terms of pain and quality of life, and be more cost-effective for the health service. TRIAL REGISTRATION Registered with the ISRCTN database 19/7/2021, https://www.isrctn.com/ISRCTN64444585.
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Affiliation(s)
- M Bateman
- University Hospitals of Derby & Burton NHS Foundation Trust, Derby, UK. .,School of Medicine, Keele University, Newcastle-under-Lyme, UK.
| | - B Saunders
- School of Medicine, Keele University, Newcastle-under-Lyme, UK
| | - C Littlewood
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK
| | - D Davis
- Derby Clinical Trials Support Unit , Royal Derby Hospital, Derby, UK
| | - J Beckhelling
- Derby Clinical Trials Support Unit , Royal Derby Hospital, Derby, UK
| | - K Cooper
- Patient Representative, Derby, UK
| | - A Skeggs
- Derby Clinical Trials Support Unit , Royal Derby Hospital, Derby, UK
| | - N E Foster
- School of Medicine, Keele University, Newcastle-under-Lyme, UK.,STARS Education and Research Alliance, The University of Queensland and Metro North Health, Herston, Australia
| | - B Vicenzino
- School of Health & Rehabilitation Sciences: Physiotherapy, University of Queensland, St Lucia, Brisbane, Australia
| | - J C Hill
- School of Medicine, Keele University, Newcastle-under-Lyme, UK
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Barreto G, Loureiro LMR, Reis CEG, Saunders B. Effects of caffeine chewing gum supplementation on exercise performance: a systematic review and meta-analysis. Eur J Sport Sci 2022; 23:714-725. [PMID: 35239468 DOI: 10.1080/17461391.2022.2049885] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The aim of this systematic review with meta-analysis was to determine the effect of caffeine gum (Caff-gum) on exercise performance-related outcomes. Medline, EmBase, and SPORTSDiscus, and the register ClinicalTrials.gov were searched in March 2021, for studies assessing the effect of Caff-gum in placebo-controlled protocols involving healthy adults (i.e., with no chronic diseases or health conditions). Risk of bias was assessed using the RoB 2 tool. Random-effects meta-analyses using standardized mean differences (SMD) were performed to determine the effect of Caff-gum on exercise outcomes with several sub-analyses (training status, exercise type, timing and dose) for potential modifying factors. 14 studies were included, totaling 200 participants. There was a significant overall effect of Caff-gum compared to placebo (SMD = 0.21, 95%CI: 0.10-0.32; p = 0.001). Subgroup analysis showed improved performance for trained (SMD = 0.23, 95%CI: 0.08-0.37; p = 0.004), but not for untrained (SMD = 0.14, 95%CI: -0.02-0.29; p = 0.07) individuals. Caff-gum improved both endurance (SMD = 0.27, 95%CI: 0.12-0.42; p = 0.002) and strength/power (SMD = 0.20, 95%CI: 0.03-0.37; p = 0.03) performance outcomes. Caff-gum was ergogenic when consumed within 15 min prior to initiating exercise (SMD = 0.27, 95%CI: 0.07-0.4; p = 0.01), but not when provided >15 min prior (SMD=-0.48, 95%CI= -1.7-0.82; p = 0.25). There was no significant effect of Caff-gum with doses <3 mg/kg body mass (BM) (SMD = 0.20, 95%CI: -0.03-0.43; p = 0.07), but there was a significant effect when the dose was ≥3 mg/kg BM (SMD = 0.22, 95%CI: 0.07-0.37; p = 0.01). Caff-gum supplementation may be an effective ergogenic strategy for trained athletes involved in both endurance and strength/power exercise, using a recommended dose of ≥3 mg/kg BM consumed within 15 minutes before the exercise.
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Affiliation(s)
- G Barreto
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport; Rheumatology Division; Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, BR, University of São Paulo, SP, Brazil
| | - L M R Loureiro
- Faculty of Nutrition FANUT, Department of Food and Nutrition, Universidade Federal de Mato Grosso, Cuiabá, MT, Brazil
| | - C E G Reis
- Department of Nutrition, Universidade de Brasília, Brasília, DF, Brazil
| | - B Saunders
- Institute of Orthopaedics and Traumatology, Faculty of Medicine FMUSP, University of São Paulo, Brazil
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De Zayas-Enriquez A, Hristova H, Saunders B, Entwisle K. Endometrial cancer: MRI staging accuracy audit. Clin Radiol 2022. [DOI: 10.1016/j.crad.2022.01.010] [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: 11/03/2022]
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7
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Hill J, Garvin S, Bromley K, Saunders B, Kigozi J, Cooper V, Lewis M, Protheroe J, Wathall S, Chudyk A, Dunn K, Birkinshaw H, Jowett S, Hay E, van der Windt D, Mallen C, Foster N. Computer-based stratified care in general practice for common musculoskeletal consultations: Results of the STarT MSK cluster randomised controlled trial (ISRCTN15366334). Physiotherapy 2022. [DOI: 10.1016/j.physio.2021.12.245] [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: 10/19/2022]
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8
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Sarigiovannis P, Jowett S, Saunders B, Corp N, Bishop A. Clinical and cost-effectiveness and perceptions of delegation by Allied Health Professionals to Allied Health Assistants: A mixed methods systematic review. Physiotherapy 2021. [DOI: 10.1016/j.physio.2021.10.104] [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: 10/19/2022]
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9
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Peacock J, Sparks SA, Middlebrook I, Hilton NP, Tinnion D, Leach N, Saunders B, McNaughton LR. Extracellular buffer choice influences acid-base responses and gastrointestinal symptoms. Res Sports Med 2021; 29:505-516. [PMID: 33715526 DOI: 10.1080/15438627.2021.1896517] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
To compare the bicarbonate kinetics and gastrointestinal (GI) symptom responses between an equal dose of sodium bicarbonate and sodium citrate using delayed-release capsules. Thirteen active males (age 20.5 ± 2.1 y, height 1.8 ± 0.1 m and body mass [BM] 76.5 ± 9.6 kg) consumed either 0.3 g.kg-1 BM sodium bicarbonate, sodium citrate or a placebo, using a double-blind, randomized crossover design. Blood bicarbonate ion (HCO3-) concentration, pH and GI symptoms were measured pre-consumption and every 10 min for 180 min post-consumption. Blood HCO3- concentration (P < 0.001) and pH (P = 0.040) were significantly higher in the sodium bicarbonate condition compared with sodium citrate condition up to 3 h post-consumption. Peak blood HCO3- concentration was significantly higher with the sodium bicarbonate compared with citrate (P < 0.001). Mean GI symptom scores were lower (P = 0.037) for sodium citrate (1.5 ± 1.8 AU) than bicarbonate (2.6 ± 3.1 AU), with considerable inter-individual variability. No GI symptoms were reported following consumption of the placebo. Both substances increase HCO3- values significantly, with sodium bicarbonate causing significantly higher pH and HCO3- values than the same dose of sodium citrate, but results in slightly more severe GI symptoms.
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Affiliation(s)
- J Peacock
- Sports Nutrition and Performance Research Group, Department of Sport and Physical Activity, Edge Hill University, Ormskirk, UK
| | - S A Sparks
- Sports Nutrition and Performance Research Group, Department of Sport and Physical Activity, Edge Hill University, Ormskirk, UK
| | - I Middlebrook
- Sports Nutrition and Performance Research Group, Department of Sport and Physical Activity, Edge Hill University, Ormskirk, UK
| | - N P Hilton
- Sports Nutrition and Performance Research Group, Department of Sport and Physical Activity, Edge Hill University, Ormskirk, UK
| | - D Tinnion
- Sports Nutrition and Performance Research Group, Department of Sport and Physical Activity, Edge Hill University, Ormskirk, UK
| | - N Leach
- Sports Nutrition and Performance Research Group, Department of Sport and Physical Activity, Edge Hill University, Ormskirk, UK
| | - B Saunders
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport; Rheumatology Division; Faculdade De Medicina FMUSP, Universidade De Sao Paulo, Sao Paulo, SP, BR, University of São Paulo, SP, Brazil.,Institute of Orthopaedics and Traumatology, Faculty of Medicine FMUSP, University of São Paulo, Brazil
| | - L R McNaughton
- Sports Nutrition and Performance Research Group, Department of Sport and Physical Activity, Edge Hill University, Ormskirk, UK.,Department of Sport and Movement Studies, Faculty of Health Science, University of Johannesburg, Johannesburg, South Africa
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Sarigiovannis P, Jowett S, Saunders B, Corp N, Bishop A. Delegation by Allied Health Professionals to Allied Health Assistants: a mixed methods systematic review. Physiotherapy 2020; 112:16-30. [PMID: 34020200 DOI: 10.1016/j.physio.2020.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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] [Received: 01/23/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Delegation by Allied Health Professionals (AHPs) to Allied Health Assistants (AHAs) was introduced in response to various challenges affecting modern health care delivery. However, the clinical and cost-effectiveness of using AHAs is relatively unexplored. OBJECTIVES The aim of this review was to synthesise the available evidence on; firstly, the clinical and cost-effectiveness of interventions delegated by AHPs to AHAs and secondly, AHPs', AHAs' and patients' attitudes and beliefs towards delegation. DATA SOURCES MEDLINE, AMED, CINAHL, Cochrane Library, PsycINFO, PEDro, OTseeker and Web of Science databases were searched from inception until January 2019 without restrictions. STUDY SELECTION Primary studies investigating the clinical and cost-effectiveness of any intervention delegated by an AHP, across the spectrum of clinical areas in relation to adult patients, as well as AHPs', AHAs' and patients' attitudes and beliefs about delegation. DATA EXTRACTION & SYNTHESIS Data were extracted by pairs of reviewers. Thematic analysis and synthesis of descriptive and analytical themes was conducted. RESULTS Thirteen publications of variable methodological quality were included. Three studies reported quantitative research and ten qualitative research. No study explored the cost-effectiveness. Only one study investigated clinical effectiveness. Training for both AHPs and AHAs and having clear processes in place were identified as important facilitators of delegation. CONCLUSION AND IMPLICATIONS OF KEY FINDINGS Delegation is not standardised across AHPs or within each profession. There are clear knowledge gaps regarding the clinical and cost-effectiveness of delegation by AHPs and patients' attitudes and preferences. Further research is needed to facilitate the standardisation of delegation. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42019119557.
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Affiliation(s)
- P Sarigiovannis
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Staffordshire ST5 5BG, United Kingdom; Midlands Partnership NHS Foundation Trust, Newcastle under Lyme, Staffordshire ST5 2BQ, United Kingdom.
| | - S Jowett
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Staffordshire ST5 5BG, United Kingdom; Health Economics Unit, Institute of Applied Health Research, IOEM Building, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom
| | - B Saunders
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Staffordshire ST5 5BG, United Kingdom
| | - N Corp
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Staffordshire ST5 5BG, United Kingdom
| | - A Bishop
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Staffordshire ST5 5BG, United Kingdom
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Konstantinou K, Lewis M, Dunn K, Kigozi J, Saunders B, Hill J, Artus M, Jowett S, Foster N. Stratified care for patients consulting with suspected sciatica in primary care: the SCOPiC RCT (ISRCTN75449581). Physiotherapy 2020. [DOI: 10.1016/j.physio.2020.03.315] [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: 10/24/2022]
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12
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Saunders B, Hill J, Foster N, Cooper V, Protheroe J, Chudyk A, Graham CC, Campbell P, Bartlam B. Patients’ and general practitioners’ views of stratified care for musculoskeletal pain: qualitative findings from the STarT MSK pilot trial. Physiotherapy 2020. [DOI: 10.1016/j.physio.2020.03.076] [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: 10/24/2022]
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13
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Eguchi T, Bredvik J, Graham S, LeRoux R, Saunders B, Seminoff JA. Effects of a power plant closure on home ranges of green turtles in an urban foraging area. ENDANGER SPECIES RES 2020. [DOI: 10.3354/esr01027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
A natural experiment was conducted to determine effects of a fossil-fueled power plant on home ranges of east Pacific green turtles Chelonia mydas in an urban foraging ground. The power plant, located in south San Diego Bay, California, USA, co-existed with a resident foraging aggregation of ~60 green turtles for ~50 yr. It was decommissioned during a long-term green turtle monitoring study, thus providing a rare opportunity to evaluate how the cessation of warm-water effluent affected turtle movements and habitat use in the area. During pre- and post-decommissioning of the power plant, 7 and 23 green turtles, respectively, were equipped with GPS-enabled satellite transmitters. Useful data were obtained from 17 turtles (4 for pre- and 13 for post-decommissioning). Core use areas (50% utilization distribution [UD]) increased from 0.71 to 1.37 km2 after the power plant decommissioning. Increase in post-power plant 50% UD was greater during nighttime (0.52 to 1.44 km2) than daytime (1.32 to 1.43 km2). Furthermore, UDs moved from the effluent channel to an area closer to seagrass pastures, a presumed foraging habitat of the turtles. The observed expansion of green turtle home ranges may increase turtle-human interactions, such as boat strikes, within the foraging ground; this underscores how seemingly innocuous human actions contribute to inadvertent consequences to wildlife. Possible management and conservation actions include increasing awareness of the public regarding turtle presence in the area through signage and education as well as legislating for a reduction in boat speeds in select areas of the bay.
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Affiliation(s)
- T Eguchi
- Southwest Fisheries Science Center, National Marine Fisheries Service, National Oceanic and Atmospheric Administration, La Jolla, CA 92037-1508, USA
| | - J Bredvik
- United States Navy, Naval Facilities Engineering Command Southwest, San Diego, CA 93132-5190, USA
| | - S Graham
- United States Navy, Naval information Warfare Center, San Diego, CA 92152-5001, USA
| | - R LeRoux
- Southwest Fisheries Science Center, National Marine Fisheries Service, National Oceanic and Atmospheric Administration, La Jolla, CA 92037-1508, USA
| | - B Saunders
- United States Navy, Naval information Warfare Center, San Diego, CA 92152-5001, USA
| | - JA Seminoff
- Southwest Fisheries Science Center, National Marine Fisheries Service, National Oceanic and Atmospheric Administration, La Jolla, CA 92037-1508, USA
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Hill JC, Garvin S, Chen Y, Cooper V, Wathall S, Saunders B, Lewis M, Protheroe J, Chudyk A, Dunn KM, Hay E, van der Windt D, Mallen C, Foster NE. Stratified primary care versus non-stratified care for musculoskeletal pain: findings from the STarT MSK feasibility and pilot cluster randomized controlled trial. BMC Fam Pract 2020; 21:30. [PMID: 32046647 PMCID: PMC7014664 DOI: 10.1186/s12875-019-1074-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 12/23/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Musculoskeletal (MSK) pain from the five most common presentations to primary care (back, neck, shoulder, knee or multi-site pain), where the majority of patients are managed, is a costly global health challenge. At present, first-line decision-making is based on clinical reasoning and stratified models of care have only been tested in patients with low back pain. We therefore, examined the feasibility of; a) a future definitive cluster randomised controlled trial (RCT), and b) General Practitioners (GPs) providing stratified care at the point-of-consultation for these five most common MSK pain presentations. METHODS The design was a pragmatic pilot, two parallel-arm (stratified versus non-stratified care), cluster RCT and the setting was 8 UK GP practices (4 intervention, 4 control) with randomisation (stratified by practice size) and blinding of trial statistician and outcome data-collectors. Participants were adult consulters with MSK pain without indicators of serious pathologies, urgent medical needs, or vulnerabilities. Potential participant records were tagged and individuals sent postal invitations using a GP point-of-consultation electronic medical record (EMR) template. The intervention was supported by the EMR template housing the Keele STarT MSK Tool (to stratify into low, medium and high-risk prognostic subgroups of persistent pain and disability) and recommended matched treatment options. Feasibility outcomes included exploration of recruitment and follow-up rates, selection bias, and GP intervention fidelity. To capture recommended outcomes including pain and function, participants completed an initial questionnaire, brief monthly questionnaire (postal or SMS), and 6-month follow-up questionnaire. An anonymised EMR audit described GP decision-making. RESULTS GPs screened 3063 patients (intervention = 1591, control = 1472), completed the EMR template with 1237 eligible patients (intervention = 513, control = 724) and 524 participants (42%) consented to data collection (intervention = 231, control = 293). Recruitment took 28 weeks (target 12 weeks) with > 90% follow-up retention (target > 75%). We detected no selection bias of concern and no harms identified. GP stratification tool fidelity failed to achieve a-priori success criteria, whilst fidelity to the matched treatments achieved "complete success". CONCLUSIONS A future definitive cluster RCT of stratified care for MSK pain is feasible and is underway, following key amendments including a clinician-completed version of the stratification tool and refinements to recommended matched treatments. TRIAL REGISTRATION Name of the registry: ISRCTN. TRIAL REGISTRATION NUMBER 15366334. Date of registration: 06/04/2016.
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Affiliation(s)
- J C Hill
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, ST5 5BG, UK.
| | - S Garvin
- Keele Clinical Trials Unit, School for Primary, Community and Social Care, Faculty of Medicine and Health Sciences, Keele University, Newcastle, UK
| | - Y Chen
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, ST5 5BG, UK
- Keele Clinical Trials Unit, School for Primary, Community and Social Care, Faculty of Medicine and Health Sciences, Keele University, Newcastle, UK
| | - V Cooper
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - S Wathall
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, ST5 5BG, UK
- Keele Clinical Trials Unit, School for Primary, Community and Social Care, Faculty of Medicine and Health Sciences, Keele University, Newcastle, UK
| | - B Saunders
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - M Lewis
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, ST5 5BG, UK
- Keele Clinical Trials Unit, School for Primary, Community and Social Care, Faculty of Medicine and Health Sciences, Keele University, Newcastle, UK
| | - J Protheroe
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - A Chudyk
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - K M Dunn
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - E Hay
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - D van der Windt
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - C Mallen
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - N E Foster
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, ST5 5BG, UK
- Keele Clinical Trials Unit, School for Primary, Community and Social Care, Faculty of Medicine and Health Sciences, Keele University, Newcastle, UK
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Mosher SL, Gough LA, Deb S, Saunders B, Mc Naughton LR, Brown DR, Sparks S. High dose Nitrate ingestion does not improve 40 km cycling time trial performance in trained cyclists. Res Sports Med 2019; 28:138-146. [DOI: 10.1080/15438627.2019.1586707] [Citation(s) in RCA: 6] [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] [Indexed: 10/27/2022]
Affiliation(s)
- S. L. Mosher
- Sports Performance and Nutrition Group, Edge Hill University, Ormskirk, UK
| | - L. A. Gough
- School of Health Sciences, Birmingham City University, Birmingham, UK
| | - S. Deb
- Department of Life Science, Westminster University, London, United Kingdom
| | - B. Saunders
- Applied Physiology & Nutrition Research Group, Universidade de São Paulo, São Paulo, Brazil
| | - L. R. Mc Naughton
- Sports Performance and Nutrition Group, Edge Hill University, Ormskirk, UK
| | - D. R. Brown
- Sports Performance and Nutrition Group, Edge Hill University, Ormskirk, UK
| | - S.A Sparks
- Sports Performance and Nutrition Group, Edge Hill University, Ormskirk, UK
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Rutter MD, Dolwani S, East J, Beckett C, Bhandari P, McKaig B, Phull P, Ragunath K, Saunders B, O'Toole P. Defining, recognizing and describing significant polyp and early colorectal cancer lesions. Colorectal Dis 2019; 21 Suppl 1:11-13. [PMID: 30809904 DOI: 10.1111/codi.14491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 09/23/2018] [Indexed: 02/08/2023]
Affiliation(s)
- M D Rutter
- Department of Gastroenterology, University Hospital of North Tees, Stockton-on-Tees, UK.,Northern Institute for Cancer Research, Newcastle University, Newcastle-upon-Tyne, UK
| | - S Dolwani
- Department of Gastroenterology, University Hospital of Wales, Cardiff, UK
| | - J East
- Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford, UK
| | - C Beckett
- Gastroenterology, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - P Bhandari
- Gastroenterology, Portsmouth Hospital, Portsmouth, UK
| | - B McKaig
- Gastroenterology, Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - P Phull
- Gastrointestinal and Liver Service, Aberdeen Royal Infirmary, Aberdeeen, UK
| | - K Ragunath
- Faculty of Medicine and Health Sciences, University of Nottingham School of Medicine, Nottingham, UK
| | - B Saunders
- Wolfson Unit for Endoscopy, St Mark's Hospital and Imperial College London, Harrow, UK
| | - P O'Toole
- Gastroenterology, Royal Liverpool 45 3 and Broadgreen University Hospitals NHS Trust, Liverpool, UK
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Basoalto HC, Panwisawas C, Sovani Y, Anderson MJ, Turner RP, Saunders B, Brooks JW. A computational study on the three-dimensional printability of precipitate-strengthened nickel-based superalloys. Proc Math Phys Eng Sci 2019; 474:20180295. [PMID: 30602927 DOI: 10.1098/rspa.2018.0295] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 11/16/2018] [Indexed: 11/12/2022] Open
Abstract
This paper presents a computational framework to study the differences in process-induced microvoid and precipitate distributions during selective laser melting (SLM) of two nickel-based superalloys representative of low (IN718) and high (CM247LC) volume fraction precipitate-strengthened alloys. Simulations indicate that CM247LC has a higher propensity to form process-induced microvoids than IN718. Particle sintering is predicted to be strongly influenced by the powder size distribution. For deposition thickness of approximately 40 μm, thermal gradients during cooling are predicted to be larger for CM247LC than IN718 and consequently expect the development of larger residual stresses for a high volume fraction γ' alloy. A coupled mean field/finite-element approach has been used to predict the precipitate distributions across a simple rectangular build and during a subsequent hot isostatic pressing (HIP) cycle. Unimodal and multi-modal particle distributions are predicted for IN718 and CM247LC at the end of the SLM, respectively. A higher volume fraction of γ' is predicted for CM247LC at the end of the SLM process. During HIP, simulations indicate a dramatic increase in the γ' volume fraction in CM247LC, which can result in a reduction in stress relaxation and lead to a ductility drop.
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Affiliation(s)
- H C Basoalto
- School of Metallurgy and Materials, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - C Panwisawas
- School of Metallurgy and Materials, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.,Currently at Department of Materials, University of Oxford, Oxford OX1 3PH, UK
| | - Y Sovani
- School of Metallurgy and Materials, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - M J Anderson
- School of Metallurgy and Materials, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - R P Turner
- School of Metallurgy and Materials, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - B Saunders
- Rolls-Royce plc., PO BOX 31, Derby DE24 8BJ, UK
| | - J W Brooks
- School of Metallurgy and Materials, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
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Dolan E, Saunders B, Dantas WS, Murai IH, Roschel H, Artioli GG, Harris R, Bicudo JEPW, Sale C, Gualano B. A Comparative Study of Hummingbirds and Chickens Provides Mechanistic Insight on the Histidine Containing Dipeptide Role in Skeletal Muscle Metabolism. Sci Rep 2018; 8:14788. [PMID: 30283073 PMCID: PMC6170442 DOI: 10.1038/s41598-018-32636-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 09/12/2018] [Indexed: 12/14/2022] Open
Abstract
Histidine containing dipeptides (HCDs) have numerous ergogenic and therapeutic properties, but their primary role in skeletal muscle remains unclear. Potential functions include pH regulation, protection against reactive oxygen/nitrogen species, or Ca2+ regulation. In recognition of the challenge of isolating physiological processes in-vivo, we employed a comparative physiology approach to investigate the primary mechanism of HCD action in skeletal muscle. We selected two avian species (i.e., hummingbirds and chickens), who represented the extremes of the physiological processes in which HCDs are likely to function. Our findings indicate that HCDs are non-essential to the development of highly oxidative and contractile muscle, given their very low content in hummingbird skeletal tissue. In contrast, their abundance in the glycolytic chicken muscle, indicate that they are important in anaerobic bioenergetics as pH regulators. This evidence provides new insights on the HCD role in skeletal muscle, which could inform widespread interventions, from health to elite performance.
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Affiliation(s)
- E Dolan
- Applied Physiology and Nutrition Research Group, Rheumatology Division; Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR, University of São Paulo, São Paulo, SP, Brazil
| | - B Saunders
- Applied Physiology and Nutrition Research Group, Rheumatology Division; Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR, University of São Paulo, São Paulo, SP, Brazil
| | - W S Dantas
- Applied Physiology and Nutrition Research Group, Rheumatology Division; Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR, University of São Paulo, São Paulo, SP, Brazil
| | - I H Murai
- Applied Physiology and Nutrition Research Group, Rheumatology Division; Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR, University of São Paulo, São Paulo, SP, Brazil
| | - H Roschel
- Applied Physiology and Nutrition Research Group, Rheumatology Division; Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR, University of São Paulo, São Paulo, SP, Brazil
| | - G G Artioli
- Applied Physiology and Nutrition Research Group, Rheumatology Division; Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR, University of São Paulo, São Paulo, SP, Brazil
| | - R Harris
- Junipa Ltd; Newmarket, Suffolk, United Kingdom
| | - J E P W Bicudo
- School of Biological Sciences, University of Wollongong, Wollongong, Australia
| | - C Sale
- Sport, Health and Performance Enhancement Research Centre; Musculoskeletal Physiology Research Group; School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom
| | - B Gualano
- Applied Physiology and Nutrition Research Group, Rheumatology Division; Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR, University of São Paulo, São Paulo, SP, Brazil.
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Woodfield G, Belluomo I, Panesar H, Lin G, Boshier P, Romano A, Martin J, Groves C, Saunders B, Atkin W, Hanna G. Early detection of colorectal cancer using breath biomarkers: Preliminary study. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy281.074] [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: 11/14/2022] Open
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20
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Saunders B, Beale B, Kowaleski M, Hulse D. Extra-articular stabilization of the cranial cruciate deficient stifle with anchor systems. Tierarztl Prax Ausg K 2018. [DOI: 10.1055/s-0038-1623601] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryComplete or partial rupture of the cranial cruciate ligament (CCL) is a common injury of the canine stifle. Most practicing veterinarians would agree that optimal outcome is best achieved with surgical intervention. A popular method of stabilization is an extra-articular suture stabilization. The objective of this manuscript is to describe suture placement in a more isometric position as compared to traditional suture placement. A second objective is to introduce the veterinary surgeon to novel anchor products used for stabilization.
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Gualano B, Gonçalves LDS, Painelli VDS, Yamaguchi G, de Oliveira LF, Saunders B, da Silva RP, Maciel E, Artioli GG, Roschel H. Reply to Areta et al.: Time to withdraw and let the myth rest. J Appl Physiol (1985) 2017; 123:1415. [PMID: 29167206 DOI: 10.1152/japplphysiol.00567.2017] [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] [Received: 06/21/2017] [Accepted: 06/21/2017] [Indexed: 11/22/2022] Open
Affiliation(s)
- B Gualano
- University of Sao Paulo, São Paulo, Brazil
| | | | | | | | | | - B Saunders
- University of Sao Paulo, São Paulo, Brazil
| | | | - E Maciel
- University of Sao Paulo, São Paulo, Brazil
| | | | - H Roschel
- University of Sao Paulo, São Paulo, Brazil
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Wahida R, Ahmad S, Saunders B, How N, Anwar M. P26 CT abdomen and pelvis for unprovoked pulmonary embolism – what is the best practice? Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.169] [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: 11/03/2022]
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23
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Saunders B, de Oliveira LF, da Silva RP, de Salles Painelli V, Gonçalves LS, Yamaguchi G, Mutti T, Maciel E, Roschel H, Artioli GG, Gualano B. Placebo in sports nutrition: a proof-of-principle study involving caffeine supplementation. Scand J Med Sci Sports 2016; 27:1240-1247. [DOI: 10.1111/sms.12793] [Citation(s) in RCA: 119] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2016] [Indexed: 12/01/2022]
Affiliation(s)
- B. Saunders
- Applied Physiology & Nutrition Research Group; University of São Paulo; Brazil
| | - L. F. de Oliveira
- Applied Physiology & Nutrition Research Group; University of São Paulo; Brazil
| | - R. P. da Silva
- Applied Physiology & Nutrition Research Group; University of São Paulo; Brazil
| | | | - L. S. Gonçalves
- Applied Physiology & Nutrition Research Group; University of São Paulo; Brazil
| | - G. Yamaguchi
- Applied Physiology & Nutrition Research Group; University of São Paulo; Brazil
| | - T. Mutti
- Applied Physiology & Nutrition Research Group; University of São Paulo; Brazil
| | - E. Maciel
- Rheumatology Division; School of Medicine; University of São Paulo; Brazil
| | - H. Roschel
- Applied Physiology & Nutrition Research Group; University of São Paulo; Brazil
- Rheumatology Division; School of Medicine; University of São Paulo; Brazil
| | - G. G. Artioli
- Applied Physiology & Nutrition Research Group; University of São Paulo; Brazil
- Rheumatology Division; School of Medicine; University of São Paulo; Brazil
| | - B. Gualano
- Applied Physiology & Nutrition Research Group; University of São Paulo; Brazil
- Rheumatology Division; School of Medicine; University of São Paulo; Brazil
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Oliveira LF, de Salles Painelli V, Nemezio K, Gonçalves LS, Yamaguchi G, Saunders B, Gualano B, Artioli GG. Chronic lactate supplementation does not improve blood buffering capacity and repeated high-intensity exercise. Scand J Med Sci Sports 2016; 27:1231-1239. [DOI: 10.1111/sms.12792] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2016] [Indexed: 11/27/2022]
Affiliation(s)
- L. F. Oliveira
- Applied Physiology & Nutrition Research Group; University of Sao Paulo; São Paulo Brazil
| | - V. de Salles Painelli
- Applied Physiology & Nutrition Research Group; University of Sao Paulo; São Paulo Brazil
| | - K. Nemezio
- Applied Physiology & Nutrition Research Group; University of Sao Paulo; São Paulo Brazil
| | - L. S. Gonçalves
- Applied Physiology & Nutrition Research Group; University of Sao Paulo; São Paulo Brazil
| | - G. Yamaguchi
- Applied Physiology & Nutrition Research Group; University of Sao Paulo; São Paulo Brazil
| | - B. Saunders
- Applied Physiology & Nutrition Research Group; University of Sao Paulo; São Paulo Brazil
| | - B. Gualano
- Applied Physiology & Nutrition Research Group; University of Sao Paulo; São Paulo Brazil
| | - G. G. Artioli
- Applied Physiology & Nutrition Research Group; University of Sao Paulo; São Paulo Brazil
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Kim A, Akilesh S, Koziell A, Saunders B, Jain S, Hodgin J, Zinselmeyer B, Stappenback T, Miner J, Shaw A. AB0013 Glomerular IL-4 Signaling Mediates Foot Process Effacement and Proteinuria in Nephrotic Syndromes. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.4376] [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: 11/03/2022]
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Booth R, Higgin R, Saunders B, Cadoux-Hudson D. Improving medical student education in the operating theatre through a novel, multidisciplinary theatre induction course. Int J Surg 2015. [DOI: 10.1016/j.ijsu.2015.07.501] [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]
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Zinicola R, Hill J, Binda GA, Saunders B. Positive margins after local excision of early rectal cancer: a dedicated multidisciplinary team. Colorectal Dis 2015; 17:735. [PMID: 25990346 DOI: 10.1111/codi.13007] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 03/24/2015] [Indexed: 02/08/2023]
Affiliation(s)
- R Zinicola
- Department of General Surgery, Parma Hospital, Parma, Italy.
| | - J Hill
- Department of Colorectal Surgery, Manchester Royal Infirmary, Central Manchester University Hospital NHS Foundation Trust, Manchester, UK
| | - G A Binda
- Department of Colorectal Surgery, Galliera Hospital, Genoa, Italy
| | - B Saunders
- Wolfson Unit for Endoscopy, St Mark's Hospital, London, UK
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Galloro G, Ruggiero S, Russo T, Saunders B. Recent advances to improve the endoscopic detection and differentiation of early colorectal neoplasia. Colorectal Dis 2015; 17 Suppl 1:25-30. [PMID: 25511858 DOI: 10.1111/codi.12818] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- G Galloro
- Department of Clinical Medicine and Surgery, Special Unit of Surgical Digestive Endoscopy, University of Naples Federico II - School of Medicine, Napoli, Italy
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La Nauze R, Suzuki N, Saunders B, Clark S, Thomas-Gibson S. The endoscopist's guide to serrated polyposis. Colorectal Dis 2014; 16:417-25. [PMID: 24702773 DOI: 10.1111/codi.12475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Accepted: 10/10/2013] [Indexed: 01/14/2023]
Abstract
AIM Serrated polyposis is a condition of the colon characterized by multiple serrated polyps. This review aims to provide a practical guide to the day-to-day management of serrated polyposis, including diagnosis, endoscopic identification of serrated polyps, surveillance, the role of endoscopic and surgical management and the screening of family members. METHOD The literature was searched using PubMed and MEDLINE databases for the terms "serrated polyp", "serrated polyposis" and "hyperplastic polyposis". English-language abstracts were read and the full article was retrieved if relevant to the review. Expert opinion from the authors was also sought. RESULTS Advances in our knowledge of the molecular pathways involved in serrated polyposis and an improved clinical picture of the disease from retrospective studies have led to better understanding of its pathogenesis and natural history. However, there are still areas not answered by the literature, and hence empirical management or expert opinion has to be followed. CONCLUSION Improvements in our understanding of serrated polyposis, together with improvements in endoscopic equipment and technique, have enabled the endoscopist to be at the forefront of managing this condition from diagnosis to endoscopic surveillance and control of the polyps.
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Affiliation(s)
- R La Nauze
- The Wolfson Unit for Endoscopy, St Mark's Hospital, Harrow, London, UK; Department of Gastroenterology, Alfred Hospital, Melbourne, Victoria, Australia
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Hassan C, Bretthauer M, Kaminski MF, Polkowski M, Rembacken B, Saunders B, Benamouzig R, Holme O, Green S, Kuiper T, Marmo R, Omar M, Petruzziello L, Spada C, Zullo A, Dumonceau JM. Bowel preparation for colonoscopy: European Society of Gastrointestinal Endoscopy (ESGE) guideline. Endoscopy 2013; 45:142-50. [PMID: 23335011 DOI: 10.1055/s-0032-1326186] [Citation(s) in RCA: 293] [Impact Index Per Article: 26.6] [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: 12/12/2022]
Abstract
BACKGROUND AND AIM This Guideline is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE). It addresses the choice amongst regimens available for cleansing the colon in preparation for colonoscopy. METHODS This Guideline is based on a targeted literature search to evaluate the evidence supporting the use of bowel preparation for colonoscopy. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was adopted to define the strength of recommendation and the quality of evidence. RESULTS The main recommendations are as follows. (1) The ESGE recommends a low-fiber diet on the day preceding colonoscopy (weak recommendation, moderate quality evidence). (2) The ESGE recommends a split regimen of 4 L of polyethylene glycol (PEG) solution (or a same-day regimen in the case of afternoon colonoscopy) for routine bowel preparation. A split regimen (or same-day regimen in the case of afternoon colonoscopy) of 2 L PEG plus ascorbate or of sodium picosulphate plus magnesium citrate may be valid alternatives, in particular for elective outpatient colonoscopy (strong recommendation, high quality evidence). In patients with renal failure, PEG is the only recommended bowel preparation. The delay between the last dose of bowel preparation and colonoscopy should be minimized and no longer than 4 hours (strong recommendation, moderate quality evidence). (3) The ESGE advises against the routine use of sodium phosphate for bowel preparation because of safety concerns (strong recommendation, low quality evidence).
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Affiliation(s)
- C Hassan
- Digestive Endoscopy Unit, Catholic University, Rome, Italy
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Abstract
This study investigated if the quantity of high-speed running (movements >15 km.h(-1) completed in the first 15 min of competitive football matches differed from that completed in the corresponding 15 min of the second half. 20 semi-professional soccer players (age 21.2±3.6 years, body mass 76.4±3.8 kg, height 1.89±0.05 m) participated in the study. 50 competitive soccer matches and 192 data files were analysed (4±2 files per match) using Global Positioning Satellite technology. Data were analysed using 2-way repeated measures ANOVA and Pearson correlations. No differences were found between the first 15 min of each half for the distance completed at high-speed (>15 km.h(-1) or sprinting (>21 km.h(-1), or in the number of sprints undertaken (p>0.05). However, total distance covered was shorter (1st half vs. 2nd half: 1746±220 vs. 1644±224 m; p<0.001) and mean speed lower (1st half vs. 2nd half: 7.0±0.9 vs. 6.6±0.9 km.h(-1); p<0.001) in the first 15 min of the second half compared to the first. The correlations between the duration of the half-time interval and the difference in the high-speed running or sprinting between first and second halves (0-15 min) were very small (r=0.08 [p=0.25] and r=0.04 [p=0.61] respectively). Therefore, this study did not find any difference between the amount of high-speed running and sprinting completed by semi-professional soccer players when the first 15 min of the first and second half of competitive matches were compared The maintenance of high-speed running and sprinting, as total distance and mean speed declined, may be a function of the pacing strategies adopted by players in competitive matches.
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Affiliation(s)
- C Mugglestone
- Sport, Health and Performance Enhancement Research Group, School of Science and Technology, Nottingham Trent University, Nottingham, UK
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Abstract
The concept of the dependence syndrome has largely replaced that of 'alcoholism' and 'addiction' in official classifications of alcohol- and drug-related disorders. However, the utility of the concept has been widely disputed by psychologists and other social scientists. The authors of this paper, both clinical psychologists, hold opposing positions on this issue. Following a brief statement of these positions and an outline of the dependence syndrome, the authors debate a range of disputed issues.
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Affiliation(s)
- T Stockwell
- National Centre for Research into the Prevention of Drug Abuse, Addiction Studies Unit, Perth, WA, 6001, Australia
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Podzielinski I, Saunders B, Kimbler K, Ferguson K, Branscum A, Fung E, DePriest P, Van Nagell J, Ueland F, Baron A. Apolipoproteins are highly expressed in malignant ovarian cyst fluids. Gynecol Oncol 2012. [DOI: 10.1016/j.ygyno.2011.12.245] [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: 11/24/2022]
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Hobson RM, Saunders B, Ball G, Harris RC, Sale C. Effects of β-alanine supplementation on exercise performance: a meta-analysis. Amino Acids 2012; 43:25-37. [PMID: 22270875 PMCID: PMC3374095 DOI: 10.1007/s00726-011-1200-z] [Citation(s) in RCA: 167] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Accepted: 12/09/2011] [Indexed: 11/16/2022]
Abstract
Due to the well-defined role of β-alanine as a substrate of carnosine (a major contributor to H+ buffering during high-intensity exercise), β-alanine is fast becoming a popular ergogenic aid to sports performance. There have been several recent qualitative review articles published on the topic, and here we present a preliminary quantitative review of the literature through a meta-analysis. A comprehensive search of the literature was employed to identify all studies suitable for inclusion in the analysis; strict exclusion criteria were also applied. Fifteen published manuscripts were included in the analysis, which reported the results of 57 measures within 23 exercise tests, using 18 supplementation regimes and a total of 360 participants [174, β-alanine supplementation group (BA) and 186, placebo supplementation group (Pla)]. BA improved (P = 0.002) the outcome of exercise measures to a greater extent than Pla [median effect size (IQR): BA 0.374 (0.140–0.747), Pla 0.108 (−0.019 to 0.487)]. Some of that effect might be explained by the improvement (P = 0.013) in exercise capacity with BA compared to Pla; no improvement was seen for exercise performance (P = 0.204). In line with the purported mechanisms for an ergogenic effect of β-alanine supplementation, exercise lasting 60–240 s was improved (P = 0.001) in BA compared to Pla, as was exercise of >240 s (P = 0.046). In contrast, there was no benefit of β-alanine on exercise lasting <60 s (P = 0.312). The median effect of β-alanine supplementation is a 2.85% (−0.37 to 10.49%) improvement in the outcome of an exercise measure, when a median total of 179 g of β-alanine is supplemented.
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Affiliation(s)
- R M Hobson
- Biomedical, Life and Health Sciences Research Centre, School of Science and Technology, Nottingham Trent University, Clifton Lane, Nottingham, NG11 8NS, UK
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37
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Hulse D, Saunders B, Beale B, Kowaleski M. Extra-articular stabilization of the cranial cruciate deficient stifle with anchor systems. Tierarztl Prax Ausg K Kleintiere Heimtiere 2011; 39:363-367. [PMID: 22134663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/08/2011] [Accepted: 09/06/2011] [Indexed: 05/31/2023]
Abstract
Complete or partial rupture of the cranial cruciate ligament (CCL) is a common injury of the canine stifle. Most practicing veterinarians would agree that optimal outcome is best achieved with surgical intervention. A popular method of stabilization is an extra-articular suture stabilization. The objective of this manuscript is to describe suture placement in a more isometric position as compared to traditional suture placement. A second objective is to introduce the veterinary surgeon to novel anchor products used for stabilization.
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Affiliation(s)
- D Hulse
- Department Small Animal Surgery, College Veterinary Medicine, Texas A&M University, College Station, TX 77845, USA.
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38
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Aravind B, Saunders B, Navin T, Sandison A, Monaco C, Paleolog E, Davies A. Inhibitory Effect of TIMP Influences the Morphology of Varicose Veins. Eur J Vasc Endovasc Surg 2010; 40:754-65. [DOI: 10.1016/j.ejvs.2010.04.028] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2009] [Accepted: 04/25/2010] [Indexed: 11/17/2022]
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Neves R, Fateh SA, Saunders B, Kimchi E, Bannon E, Drabick JJ. Neoadjuvant treatment with imatinib for locally advanced dermatofibrosarcoma protuberans. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e20507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Blaze-Temple D, Howat P, Barney J, Saunders B, Saxon S. Legislative and humanitarian impetus for development of alcohol and other drug policy at an Australian university. Community Health Stud 2010; 13:463-70. [PMID: 2627784 DOI: 10.1111/j.1753-6405.1989.tb00705.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The rationale for comprehensive alcohol and other drug policy at a tertiary institution is presented here as a health promotion strategy for educating University policy makers. Particular emphasis is placed on a discussion of humanitarian issues, that is, the right to a healthy environment, and the potential for legal liability in an environment where alcohol is readily available and other drugs are present. There is little attention paid to drug use related legal issues in the University, but at the same time drawing the attention of policy makers to the organisation's vulnerability to lawsuits has been reported to be a motivating force for adoption of drug use policy. Universities do experience problems related to alcohol and other drug use by staff and students. Problem reduction, and better management of problems, are the major goals of policy in this area. Local initiatives, for example at the organisational level, make important contributions to the overall drug prevention efforts of the nation. Well-developed policy and procedures and effective implementation constitute an important structural health promotion strategy. Such policy would comply with the immediate requirements of Occupational Health, Safety and Welfare legislation and provide some protection against wrongful dismissal claims and negligence lawsuits, as well as providing long-term educative effects. Situations for which policies are needed, range widely due to the University's unique environment and complex roles.
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Abstract
This paper asks what prevents the prevention of alcohol and drug use problems. Five prevention paradoxes can be identified, all of which may well be interfering with our attempts to reduce the problems associated with drug use. Drug problem preventers should be aware of these paradoxes and, thus, be able to avoid becoming ensnared by them.
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Abstract
In this study the Australian system of self-regulation of alcoholic beverage advertising was examined. Sixteen advertisements, eight print and eight television advertisements, were subjected to public scrutiny. Respondents rated advertisements using a self-completion questionnaire based directly on the Australian Alcoholic Beverage Advertising Code. Responses were collated and where a majority of respondents had endorsed items that constituted a breach of the cose, a complaint, ostensibly from a member of the general public, was made to the Advertising Standards Council. All sixteen advertisements were regarded by the public as containing aspects which breached the code. However, the Advertising Standards Council rejected all but one of the sixteen complaints, often directly contradicting the opinions of our respondents. The social policy implications of these results are considered. It is contended that the system of self-regulation of alcohol advertising does not serve the public interest.
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Affiliation(s)
- B Saunders
- Addiction Studies Unit, Division of Health Sciences, Curtin University of Technology, GPO Box U1987, Perth, Western Australia, 6001, Australia
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Abstract
In this paper the literature on patterns of use of alcohol by teenagers is reviewed. The model as proposed by Thorley is used to describe the specific nature of alcohol problems experienced by young people. A systemic approach to prevention is explored and recommendations are made about ways to minimise the harm associated with alcohol use by young people.
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Affiliation(s)
- B Saunders
- Addiction Studies Unit, School of Psychology, Curtin University of Technology, GPO Box U1987, Perth, Western Australia, 6001, Australia
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Abstract
In this paper traditional ideas about motivation and the addiction behaviours are critically considered. It is proposed that rather than viewing motivation as a static quality that clients either have or have not, motivation is more usefully perceived as the balance between the costs and benefits of undertaking any behaviour, juxtaposed with the costs and benefits of ceasing the behaviour. It is also proposed that confrontation approaches, rather than inducing motivation, actually increase the client's resistance. Motivational interventions therefore need to be based on a client-generated inventory of problems and concerns rather than a therapist-dictated one. A decision-making framework for motivational intervention is emphasized and the effectiveness of motivational strategies based on this paradigm is considered.
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Affiliation(s)
- B Saunders
- Addiction Studies Unit, Curtin University of Technology, GPO Box U1987, Perth, WA, 6001, Australia
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Abstract
While the prevention of drug use problems comes well recommended, there is limited agreement on which preventive strategies are the most effective. Furthermore there is debate as to where activity most effectively occurs-should it be at the national or local level? In this study a university community was investigated with the aim of determining whether members of that community appreciated the need for prevention of drug use problems and which preventive strategies they deemed to be of value. The difficulties inherent in taking action within a tertiary environment are also considered and an agenda for action described.
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Affiliation(s)
- A Lockwood
- Addiction Studies Unit, Division of Health Sciences, Curtin University of Technology, GPO Box U1987, Perth, W.A., 6001, Australia
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Carvajal-Carmona LG, Howarth KM, Lockett M, Polanco-Echeverry GM, Volikos E, Gorman M, Barclay E, Martin L, Jones AM, Saunders B, Guenther T, Donaldson A, Paterson J, Frayling I, Novelli MR, Phillips R, Thomas HJW, Silver A, Atkin W, Tomlinson IPM. Molecular classification and genetic pathways in hyperplastic polyposis syndrome. J Pathol 2007; 212:378-85. [PMID: 17503413 DOI: 10.1002/path.2187] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Hyperplastic Polyposis (HPPS) is a poorly characterized syndrome that increases colorectal cancer (CRC) risk. We aimed to provide a molecular classification of HPPS. We obtained 282 tumours from 32 putative HPPS patients with >or= 10 hyperplastic polyps (HPs); some patients also had adenomas and CRCs. We found no good evidence of microsatellite instability (MSI) in our samples. The epithelium of HPs was monoclonal. Somatic BRAF mutations occurred in two-thirds of our patients' HPs, and KRAS2 mutations in 10%; both mutations were more common in younger cases. The respective mutation frequencies in a set of 'sporadic' HPs were 18% and 10%. Importantly, the putative HPPS patients generally fell into two readily defined groups, one set whose polyps had BRAF mutations, and another set whose polyps had KRAS2 mutations. The most plausible explanation for this observation is that there exist different forms of inherited predisposition to HPPS, and that these determine whether polyps follow a BRAF or KRAS2 pathway. Most adenomas and CRCs from our putative HPPS patients had 'classical' morphology and few of these lesions had BRAF or KRAS2 mutations. These findings suggest that tumourigenesis in HPPS does not necessarily follow the 'serrated' pathway. Although current definitions of HPPS are sub-optimal, we suggest that diagnosis could benefit from molecular analysis. Specifically, testing BRAF and KRAS2 mutations, and perhaps MSI, in multiple polyps could help to distinguish HPPS from sporadic HPs. We propose a specific model which would have diagnosed five more of our cases as HPPS compared with the WHO clinical criteria.
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Affiliation(s)
- L G Carvajal-Carmona
- Molecular and Population Genetics Laboratory, London Research Institute, Cancer Research UK, London WC2A 3PX, UK.
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Abstract
Chronic radiation proctitis is a relatively common late complication of pelvic irradiation. The main symptoms are diarrhea, urgency, tenesmus, and rectal bleeding. While mild cases may settle spontaneously over some months, severe hemorrhagic radiation proctitis may require repeated blood transfusions and is difficult to treat with medical therapy. Argon plasma coagulation (APC) is a noncontact thermal coagulation technique which can be applied endoscopically. A probe passed through the scope delivers a field of argon gas to the mucosal surface where it is ionized by a high voltage filament, resulting in superficial mucosal heating and coagulation of friable blood vessels. The technique reduces rectal bleeding in 80%-90% of cases, and may improve the other troublesome symptoms of diarrhea and urgency. APC is probably less effective in very severe cases of hemorrhagic radiation proctitis; in these cases topical formalin or a combination of APC and topical formalin can be useful. Overall, APC has proved to be a safe and well tolerated technique.
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Affiliation(s)
- A Postgate
- Wolfson Unit for Endoscopy, St. Mark's Hospital, London, UK.
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Brown G, Fraser C, Schofield G, Taylor S, Bartram C, Phillips R, Saunders B. Video capsule endoscopy in peutz-jeghers syndrome: a blinded comparison with barium follow-through for detection of small-bowel polyps. Endoscopy 2006; 38:385-90. [PMID: 16680639 DOI: 10.1055/s-2006-925028] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.6] [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] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND STUDY AIMS Video capsule endoscopy has shown promise for the surveillance of significant small-bowel polyps in patients with Peutz-Jeghers syndrome. In this study the yield of significant small-bowel polyps by capsule endoscopy was compared to the yield of these polyps by barium follow-through in adults with Peutz-Jeghers syndrome. PATIENTS AND METHODS A total of 19 adults with Peutz-Jeghers syndrome who were undergoing surveillance underwent both capsule endoscopy and barium follow-through examinations, and the number of small-bowel polyps of at least 1 cm in diameter that were detected was recorded for each method. The two methods were assessed in terms of comfort and convenience for the patients and their preferred future surveillance method, using a questionnaire. RESULTS Capsule endoscopy detected a median of four significant small-bowel polyps while barium follow-through detected a median of one (P = 0.008). There was a trend towards more participants having at least one significant small-bowel polyp detected by capsule endoscopy than was the case with barium follow-through, though capsule endoscopy seemed to be less reliable for accurate sizing of polyps that were at the limit of clinical significance. Most participants expressed a preference for capsule endoscopy for future surveillance. CONCLUSIONS Capsule endoscopy should replace barium follow-through for the surveillance of small-bowel polyps in adults with Peutz-Jeghers syndrome, but the findings of this study should be interpreted with caution until a more reliable means of sizing polyps by capsule endoscopy is available.
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Affiliation(s)
- G Brown
- The Wolfson Unit for Endoscopy, St. Mark's Hospital, Harrow, United Kingdom
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50
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