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Greenhalgh C, Williams G, Harrison A, Garrow A, Mitchell S, Verma A. Modified realist evaluation of a complex, multi-centred, multi-intervention programme. J Public Health (Oxf) 2023; 45:i5-i9. [PMID: 38127565 DOI: 10.1093/pubmed/fdad029] [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: 09/02/2021] [Revised: 11/11/2022] [Indexed: 12/23/2023] Open
Abstract
Well North was a complex, multi-intervention health improvement programme spanning 10 sites across the North of England. The aim was to address inequalities by improving the health of the poorest fastest, increasing resilience and reducing levels of worklessness. The intention of the programme was for all sites to have freedom and flexibility to conduct different interventions reflecting local priorities. Evaluation ran concurrently with the programme, and an iterative approach was required to ensure constant feedback, allowing the programme to be adapted and improved as necessary. Realist methodology was chosen for evaluation, as it provides insight into what works, for whom and in what circumstances. Due to the complex nature of the programme and diverse approaches, it was necessary to adapt the methodology to meet the needs of the evaluation. The Evaluation Team utilized a range of qualitative and quantitative techniques within the context of a Rapid Cycle Evaluation framework. For each project, Contexts, Mechanisms and Outcomes (CMOs) were identified at three stages and were incorporated into the CMO configuration, leading to the development of a middle range theory. Validation and testing of theory took place at every stage. Realist methodology was the most appropriate existing method. However, it still necessitated modification.
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Affiliation(s)
- C Greenhalgh
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Oxford Road, Manchester M13 9PT, UK
| | - G Williams
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Oxford Road, Manchester M13 9PT, UK
| | - A Harrison
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Oxford Road, Manchester M13 9PT, UK
| | - A Garrow
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Oxford Road, Manchester M13 9PT, UK
| | - S Mitchell
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Oxford Road, Manchester M13 9PT, UK
| | - A Verma
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Oxford Road, Manchester M13 9PT, UK
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Karbowniczek JE, Berniak K, Knapczyk-Korczak J, Williams G, Bryant JA, Nikoi ND, Banzhaf M, de Cogan F, Stachewicz U. Strategies of nanoparticles integration in polymer fibers to achieve antibacterial effect and enhance cell proliferation with collagen production in tissue engineering scaffolds. J Colloid Interface Sci 2023; 650:1371-1381. [PMID: 37480652 DOI: 10.1016/j.jcis.2023.07.066] [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] [Received: 05/02/2023] [Revised: 06/30/2023] [Accepted: 07/11/2023] [Indexed: 07/24/2023]
Abstract
Current design strategies for biomedical tissue scaffolds are focused on multifunctionality to provide beneficial microenvironments to support tissue growth. We have developed a simple yet effective approach to create core-shell fibers of poly(3-hydroxybuty-rate-co-3-hydroxyvalerate) (PHBV), which are homogenously covered with titanium dioxide (TiO2) nanoparticles. Unlike the blend process, co-axial electrospinning enabled the uniform distribution of nanoparticles without the formation of large aggregates. We observed 5 orders of magnitude reduction in Escherichia coli survival after contact with electrospun scaffolds compared to the non-material control. In addition, our hybrid cores-shell structure supported significantly higher osteoblast proliferation after 7 days of cell culture and profound generation of 3D networked collagen fibers after 14 days. The organic-inorganic composite scaffold produced in this study demonstrates a unique combination of antibacterial properties and increased bone regeneration properties. In summary, the multifunctionality of the presented core-shell cPHBV+sTiO2 scaffolds shows great promise for biomedical applications.
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Affiliation(s)
- J E Karbowniczek
- AGH University of Krakow, Faculty of Metals Engineering and Industrial Computer Science, Cracow, Poland
| | - K Berniak
- AGH University of Krakow, Faculty of Metals Engineering and Industrial Computer Science, Cracow, Poland
| | - J Knapczyk-Korczak
- AGH University of Krakow, Faculty of Metals Engineering and Industrial Computer Science, Cracow, Poland
| | - G Williams
- University of Birmingham, Institute for Microbiology and Infection, B15 2TT Birmingham, UK
| | - J A Bryant
- University of Birmingham, Institute for Microbiology and Infection, B15 2TT Birmingham, UK
| | - N D Nikoi
- University of Nottingham, School of Pharmacy, NG7 2RD Nottingham, UK
| | - M Banzhaf
- University of Birmingham, Institute for Microbiology and Infection, B15 2TT Birmingham, UK
| | - F de Cogan
- University of Nottingham, School of Pharmacy, NG7 2RD Nottingham, UK
| | - U Stachewicz
- AGH University of Krakow, Faculty of Metals Engineering and Industrial Computer Science, Cracow, Poland.
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McNair M, Porter M, Isaacs T, Pillay K, Williams G, Roberts R, Peter J, Lehloenya RJ. Lichenoid drug eruption in patients on anti-TB therapy in a high HIV prevalence setting. Int J Tuberc Lung Dis 2023; 27:643-645. [PMID: 37491745 PMCID: PMC10365564 DOI: 10.5588/ijtld.23.0162] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 04/18/2023] [Indexed: 07/27/2023] Open
Affiliation(s)
| | - M Porter
- Division of Dermatology, Department of Medicine, Faculty of Health Sciences
| | - T Isaacs
- Division of Dermatology, Department of Medicine, Faculty of Health Sciences
| | - K Pillay
- Division of Anatomical Pathology, Department of Pathology, Faculty of Health Sciences
| | | | - R Roberts
- Division of Anatomical Pathology, Department of Pathology, Faculty of Health Sciences
| | - J Peter
- Division of Allergy and Clinical Immunology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - R J Lehloenya
- Division of Dermatology, Department of Medicine, Faculty of Health Sciences
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Boyle TP, Dugas JN, Liu J, Stapleton SN, Medzon R, Walsh BM, Corey P, Shubitowski L, Horne JR, O'Connell R, Williams G, Nelson KP, Nadkarni VM, Camargo CA, Feldman JA. Adaptation of a Simulation Model and Checklist to Assess Pediatric Emergency Care Performance by Prehospital Teams. Simul Healthc 2023; 18:82-89. [PMID: 35238848 PMCID: PMC9437138 DOI: 10.1097/sih.0000000000000649] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Simulation tools to assess prehospital team performance and identify patient safety events are lacking. We adapted a simulation model and checklist tool of individual paramedic performance to assess prehospital team performance and tested interrater reliability. METHODS We used a modified Delphi process to adapt 3 simulation cases (cardiopulmonary arrest, seizure, asthma) and checklist to add remote physician direction, target infants, and evaluate teams of 2 paramedics and 1 physician. Team performance was assessed with a checklist of steps scored as complete/incomplete by raters using direct observation or video review. The composite performance score was the percentage of completed steps. Interrater percent agreement was compared with the original tool. The tool was modified, and raters trained in iterative rounds until composite performance scoring agreement was 0.80 or greater (scale <0.20 = poor; 0.21-0.39 = fair, 0.40-0.59 = moderate; 0.60-0.79 = good; 0.80-1.00 = very good). RESULTS We achieved very good interrater agreement for scoring composite performance in 2 rounds using 6 prehospital teams and 4 raters. The original 175 step tool was modified to 171 steps. Interrater percent agreement for the final modified tool approximated the original tool for the composite checklist (0.80 vs. 0.85), cardiopulmonary arrest (0.82 vs. 0.86), and asthma cases (0.80 vs. 0.77) but was lower for the seizure case (0.76 vs. 0.91). Most checklist items (137/171, 80%) had good-very good agreement. Among 34 items with fair-moderate agreement, 15 (44%) related to patient assessment, 9 (26%) equipment use, 6 (18%) medication delivery, and 4 (12%) cardiopulmonary resuscitation quality. CONCLUSIONS The modified checklist has very good agreement for assessing composite prehospital team performance and can be used to test effects of patient safety interventions.
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Affiliation(s)
- Tehnaz P Boyle
- From the Department of Pediatrics (T.P.B., B.M.W.), Boston Medical Center, Boston University School of Medicine; Department of Emergency Medicine (J.N.D., J.L., S.N.S., R.M., J.A.F.), Boston Medical Center, Boston University School of Medicine; Solomont Center for Simulation (T.P.B., S.N.S., R.M., B.M.W., P.C.), Boston Medical Center; Boston Emergency Medical Services (L.S., J.R.H., R.O.C., G.W.); Department of Biostatistics (K.P.N.), Boston University, Boston, MA; Center for Simulation, Advanced Education and Innovation (V.M.N.); Department of Anesthesiology and Critical Care Medicine (V.M.N.); The Children's Hospital of Philadelphia (V.M.N.), University of Pennsylvania Perelman School of Medicine (V.M.N.), Philadelphia, PA; and Department of Emergency Medicine (C.A.C.), Massachusetts General Hospital, Harvard Medical School, Boston, MA
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Luppi A, Mediano P, Rosas F, Allanson J, Pickard J, Williams G, Menon D, Bor D, Stamatakis E. P-37 Modelling the network origins of the brain’s synergistic dynamics and their disruption in chronically unconscious patients. Clin Neurophysiol 2023. [DOI: 10.1016/j.clinph.2023.02.054] [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: 03/08/2023]
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Gamlin CR, Schneider-Mizell CM, Mallory M, Elabbady L, Gouwens N, Williams G, Mukora A, Dalley R, Bodor A, Brittain D, Buchanan J, Bumbarger D, Kapner D, Kinn S, Mahalingam G, Seshamani S, Takeno M, Torres R, Yin W, Nicovich PR, Bae JA, Castro MA, Dorkenwald S, Halageri A, Jia Z, Jordan C, Kemnitz N, Lee K, Li K, Lu R, Macrina T, Mitchell E, Mondal SS, Mu S, Nehoran B, Popovych S, Silversmith W, Turner NL, Wong W, Wu J, Yu S, Berg J, Jarsky T, Lee B, Seung HS, Zeng H, Reid RC, Collman F, da Costa NM, Sorensen SA. Integrating EM and Patch-seq data: Synaptic connectivity and target specificity of predicted Sst transcriptomic types. bioRxiv 2023:2023.03.22.533857. [PMID: 36993629 PMCID: PMC10055412 DOI: 10.1101/2023.03.22.533857] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Neural circuit function is shaped both by the cell types that comprise the circuit and the connections between those cell types 1 . Neural cell types have previously been defined by morphology 2, 3 , electrophysiology 4, 5 , transcriptomic expression 6-8 , connectivity 9-13 , or even a combination of such modalities 14-16 . More recently, the Patch-seq technique has enabled the characterization of morphology (M), electrophysiology (E), and transcriptomic (T) properties from individual cells 17-20 . Using this technique, these properties were integrated to define 28, inhibitory multimodal, MET-types in mouse primary visual cortex 21 . It is unknown how these MET-types connect within the broader cortical circuitry however. Here we show that we can predict the MET-type identity of inhibitory cells within a large-scale electron microscopy (EM) dataset and these MET-types have distinct ultrastructural features and synapse connectivity patterns. We found that EM Martinotti cells, a well defined morphological cell type 22, 23 known to be Somatostatin positive (Sst+) 24, 25 , were successfully predicted to belong to Sst+ MET-types. Each identified MET-type had distinct axon myelination patterns and synapsed onto specific excitatory targets. Our results demonstrate that morphological features can be used to link cell type identities across imaging modalities, which enables further comparison of connectivity in relation to transcriptomic or electrophysiological properties. Furthermore, our results show that MET-types have distinct connectivity patterns, supporting the use of MET-types and connectivity to meaningfully define cell types.
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Farana R, Williams G, Fujihara T, Wyatt HE, Naundorf F, Irwin G. Current issues and future directions in gymnastics research: biomechanics, motor control and coaching interface. Sports Biomech 2023; 22:161-185. [PMID: 34962219 DOI: 10.1080/14763141.2021.2016928] [Citation(s) in RCA: 1] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The sport of gymnastics is undergoing a global examination of its culture and the relationship between the gymnast, coach and environment is a central focus. The aim of this review is to explore biomechanics and motor control research in skill development and technique selection in artistic gymnastics with a focus on the underlying concepts and scientific principles that allow performance enhancement, skill development and injury risk reduction. The current review examines peer reviewed papers from 2000 onwards, with a focus on contemporary approaches in the field of gymnastics research, and highlights several key directions for future gymnastics research. Based on our review and the integration of the models of Newell (1986) and Irwin et al. (2005), we recommend that future gymnastics research should embrace at the very least a multidisciplinary approach and aim for an interdisciplinary paradigm.
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Affiliation(s)
- R Farana
- University of Ostrava, Ostrava, Czech Republic
| | | | - T Fujihara
- Osaka University of Health and Sport Sciences, Osaka, Japan
| | - H E Wyatt
- Sports Performance Research Institute New Zealand (SPRINZ), Auckland University of Technology, Auckland, New Zealand
| | - F Naundorf
- Institute for Applied Training Science Leipzig, Leipzig, Germany
| | - G Irwin
- University of Ostrava, Ostrava, Czech Republic.,Cardiff Metropolitan University, Cardiff, UK
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Williams G, Buchan J, Zapata T. Health workforce governance during the COVID-19 pandemic: learning lessons from Europe. Eur J Public Health 2022. [PMCID: PMC9593464 DOI: 10.1093/eurpub/ckac129.041] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background This study considers some of the effective governance tools that have been utilised to mobilise, redeploy and repurpose the health workforce during the COVID-19 pandemic to create surge capacity, protect workforce health and wellbeing and ensure effective implementation of vaccination programmes. Methods Data were systematically extracted from the Observatory/WHO Europe/European Commission Health System and Response Monitor, covering the period from March 2020 to May 2021 with a focus on four dimensions of health workforce governance: national/regional government policies; legislation; regulation; the role and remit of employers and management. Results A wide-range of governance actions across all levels were required to ensure the health workforce could provide effective pandemic responses. Creating surge capacity, for example, often required adoption of emergency legislation to facilitate exceptional hiring procedures and the changing of (re-)registration requirements, as well as additional training and development of new competencies among other actions. Putting in place physical and mental health support meanwhile required defining infection control policies, monitoring PPE supply and distribution, ensuring access to free mental health support, and implementation of breaks. Some countries also allowed “new” types of workers to vaccinate; online or in person training; adjustments to payment mechanisms; and creating new supervision requirements. Conclusions Pandemic responses have broken up sclerotic governance structures which have hampered past health workforce development and reform, new training programmes have been rapidly developed, leadership roles have been delegated to a wider-range of health professionals than before and monitoring systems that provide more rapid data on staffing levels have been put into place. Learning from and evaluating these changes will be important to help inform future pandemic responses.
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Affiliation(s)
- G Williams
- European Observatory on Health Systems and Policies, London, UK
- Contact:
| | - J Buchan
- University of Edinburgh, Edinburgh, UK
- Health Foundation, London, UK
| | - T Zapata
- WHO Regional Office for Europe, Copenhagen, Denmark
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Tinker M, Betten A, Morris S, Gibson N, Allison G, Ng L, Williams G, Chappell A. A comparison of the kinematics and kinetics of barefoot and shod running in children with cerebral palsy. Gait Posture 2022; 98:271-278. [PMID: 36215856 DOI: 10.1016/j.gaitpost.2022.09.084] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 09/19/2022] [Accepted: 09/24/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND The biomechanics of barefoot and shod running are different for typically developing children but unknown for children with cerebral palsy (CP). Such differences may have implications for injury and performance. AIMS The primary aims of this study were to compare the lower limb biomechanics of barefoot and shod running in children with CP, and to determine whether any differences were the same in GMFCS levels I and II. METHODS This cross-sectional study examined 38 children with CP (n = 24 (GMFCS) level I; n = 14 GMFCS II), running overground at 3 speeds (jog, run, sprint) in barefoot and shod conditions. Marker trajectories and force plate data were recorded, and lower limb kinematics, kinetics and spatiotemporal variables were derived. Differences between barefoot and shod running were analysed using linear mixed models. RESULTS For both GMFCS levels, barefoot running resulted in higher loading rates, but smaller impact peaks at all speeds. Barefoot running was associated with greater hip and knee power; less ankle dorsiflexion and hip flexion at initial contact, and less ankle and knee range of motion during stance, compared to shod running, at all speeds. Barefoot stride length was shortened, and cadence increased compared to shod during jogging and running but not sprinting. For GMFCS level I only, barefoot running involved a higher incidence of forefoot strike, greater ankle power generation and less hip range of motion during stance. SIGNIFICANCE Running barefoot may facilitate running performance by increasing power generation at the ankle in children with CP, GMFCS level I. Higher barefoot loading rates may have implications for performance and injury.
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Affiliation(s)
- M Tinker
- School of Allied Health, Curtin University, Bentley WA 6102, Australia
| | - A Betten
- School of Allied Health, Curtin University, Bentley WA 6102, Australia
| | - S Morris
- School of Allied Health, Curtin University, Bentley WA 6102, Australia
| | - N Gibson
- School of Allied Health, Curtin University, Bentley WA 6102, Australia; Perth Children's Hospital, Nedlands WA 6009, Australia
| | - G Allison
- School of Allied Health, Curtin University, Bentley WA 6102, Australia
| | - L Ng
- School of Allied Health, Curtin University, Bentley WA 6102, Australia
| | - G Williams
- School of Physiotherapy, University of Melbourne, Victoria 3010, Australia
| | - A Chappell
- School of Allied Health, Curtin University, Bentley WA 6102, Australia; Western Kids Health, Mt Hawthorn WA 6016, Australia.
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Ubersax C, Harmon C, Irvin M, Bhatia S, Williams G, Giri S. Impact of baseline frailty on Early Mortality among older adults with Gastrointestinal Malignancies: A nested Case Control Study. J Geriatr Oncol 2022. [DOI: 10.1016/s1879-4068(22)00409-x] [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: 11/05/2022]
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Harmon C, Al-Obaidi M, Giri S, Zubkoff L, Outlaw D, Khushman M, Bhatia S, Williams G. Implementation of the Web-Enabled Cancer & Aging Resilience Evaluation (WeCARE) in an Outpatient Oncology Setting. J Geriatr Oncol 2022. [DOI: 10.1016/s1879-4068(22)00351-4] [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: 11/07/2022]
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Torkington J, Harries R, O'Connell S, Knight L, Islam S, Bashir N, Watkins A, Fegan G, Cornish J, Rees B, Cole H, Jarvis H, Jones S, Russell I, Bosanquet D, Cleves A, Sewell B, Farr A, Zbrzyzna N, Fiera N, Ellis-Owen R, Hilton Z, Parry C, Bradbury A, Wall P, Hill J, Winter D, Cocks K, Harris D, Hilton J, Vakis S, Hanratty D, Rajagopal R, Akbar F, Ben-Sassi A, Francis N, Jones L, Williamson M, Lindsey I, West R, Smart C, Ziprin P, Agarwal T, Faulkner G, Pinkney T, Vimalachandran D, Lawes D, Faiz O, Nisar P, Smart N, Wilson T, Myers A, Lund J, Smolarek S, Acheson A, Horwood J, Ansell J, Phillips S, Davies M, Davies L, Bird S, Palmer N, Williams M, Galanopoulos G, Rao PD, Jones D, Barnett R, Tate S, Wheat J, Patel N, Rahmani S, Toynton E, Smith L, Reeves N, Kealaher E, Williams G, Sekaran C, Evans M, Beynon J, Egan R, Qasem E, Khot U, Ather S, Mummigati P, Taylor G, Williamson J, Lim J, Powell A, Nageswaran H, Williams A, Padmanabhan J, Phillips K, Ford T, Edwards J, Varney N, Hicks L, Greenway C, Chesters K, Jones H, Blake P, Brown C, Roche L, Jones D, Feeney M, Shah P, Rutter C, McGrath C, Curtis N, Pippard L, Perry J, Allison J, Ockrim J, Dalton R, Allison A, Rendell J, Howard L, Beesley K, Dennison G, Burton J, Bowen G, Duberley S, Richards L, Giles J, Katebe J, Dalton S, Wood J, Courtney E, Hompes R, Poole A, Ward S, Wilkinson L, Hardstaff L, Bogden M, Al-Rashedy M, Fensom C, Lunt N, McCurrie M, Peacock R, Malik K, Burns H, Townley B, Hill P, Sadat M, Khan U, Wignall C, Murati D, Dhanaratne M, Quaid S, Gurram S, Smith D, Harris P, Pollard J, DiBenedetto G, Chadwick J, Hull R, Bach S, Morton D, Hollier K, Hardy V, Ghods M, Tyrrell D, Ashraf S, Glasbey J, Ashraf M, Garner S, Whitehouse A, Yeung D, Mohamed SN, Wilkin R, Suggett N, Lee C, Bagul A, McNeill C, Eardley N, Mahapatra R, Gabriel C, Datt P, Mahmud S, Daniels I, McDermott F, Nodolsk M, Park L, Scott H, Trickett J, Bearn P, Trivedi P, Frost V, Gray C, Croft M, Beral D, Osborne J, Pugh R, Herdman G, George R, Howell AM, Al-Shahaby S, Narendrakumar B, Mohsen Y, Ijaz S, Nasseri M, Herrod P, Brear T, Reilly JJ, Sohal A, Otieno C, Lai W, Coleman M, Platt E, Patrick A, Pitman C, Balasubramanya S, Dickson E, Warman R, Newton C, Tani S, Simpson J, Banerjee A, Siddika A, Campion D, Humes D, Randhawa N, Saunders J, Bharathan B, Hay O. Incisional hernia following colorectal cancer surgery according to suture technique: Hughes Abdominal Repair Randomized Trial (HART). Br J Surg 2022; 109:943-950. [PMID: 35979802 PMCID: PMC10364691 DOI: 10.1093/bjs/znac198] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 05/09/2022] [Accepted: 05/13/2022] [Indexed: 11/14/2022]
Abstract
BACKGROUND Incisional hernias cause morbidity and may require further surgery. HART (Hughes Abdominal Repair Trial) assessed the effect of an alternative suture method on the incidence of incisional hernia following colorectal cancer surgery. METHODS A pragmatic multicentre single-blind RCT allocated patients undergoing midline incision for colorectal cancer to either Hughes closure (double far-near-near-far sutures of 1 nylon suture at 2-cm intervals along the fascia combined with conventional mass closure) or the surgeon's standard closure. The primary outcome was the incidence of incisional hernia at 1 year assessed by clinical examination. An intention-to-treat analysis was performed. RESULTS Between August 2014 and February 2018, 802 patients were randomized to either Hughes closure (401) or the standard mass closure group (401). At 1 year after surgery, 672 patients (83.7 per cent) were included in the primary outcome analysis; 50 of 339 patients (14.8 per cent) in the Hughes group and 57 of 333 (17.1 per cent) in the standard closure group had incisional hernia (OR 0.84, 95 per cent c.i. 0.55 to 1.27; P = 0.402). At 2 years, 78 patients (28.7 per cent) in the Hughes repair group and 84 (31.8 per cent) in the standard closure group had incisional hernia (OR 0.86, 0.59 to 1.25; P = 0.429). Adverse events were similar in the two groups, apart from the rate of surgical-site infection, which was higher in the Hughes group (13.2 versus 7.7 per cent; OR 1.82, 1.14 to 2.91; P = 0.011). CONCLUSION The incidence of incisional hernia after colorectal cancer surgery is high. There was no statistical difference in incidence between Hughes closure and mass closure at 1 or 2 years. REGISTRATION NUMBER ISRCTN25616490 (http://www.controlled-trials.com).
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Abstract
Background Androgenetic alopecia (AGA) is the most common cause of hair loss, often challenging to treat. While oral finasteride (1 mg/day) is an FDA-approved treatment for male AGA, oral minoxidil and oral dutasteride are not approved yet. However, clinicians have been increasingly using these two drugs off-label for hair loss. Recently, Japan and South Korea have approved oral dutasteride (0.5 mg/day) for male AGA.Efficacy and safety A probable efficacy ranking, in decreasing order, is- dutasteride 0.5 mg/day, finasteride 5 mg/day, minoxidil 5 mg/day, finasteride 1 mg/day, followed by minoxidil 0.25 mg/day. Oral minoxidil predominantly causes hypertrichosis and cardiovascular system (CVS) symptoms/signs in a dose-dependent manner, whereas oral finasteride and dutasteride are associated with sexual dysfunction and neuropsychiatric side effects.Pharmacokinetics and pharmacodynamics The average plasma half-lives of minoxidil, finasteride, and dutasteride are ∼4 hours, ∼4.5 hours, and ∼5 weeks, respectively. Minoxidil acts through multiple pathways to promote hair growth. It has been shown as a vasodilator, an anti-inflammatory agent, a Wnt/β-catenin signaling inducer, and an antiandrogen. Finasteride inhibits 5 α-reductase (5AR) type II isoenzyme, while dutasteride inhibits both type I and type II. Thus, dutasteride suppresses DHT levels more than finasteride in the serum and scalp.
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Affiliation(s)
- A K Gupta
- Mediprobe Research Inc., London, ON, Canada.,Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Canada
| | - M Talukder
- Mediprobe Research Inc., London, ON, Canada
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Senaratne A, Christen P, Williams G, Omran PG. Unsupervised Identification of Abnormal Nodes and Edges in Graphs. J Data and Information Quality 2022. [DOI: 10.1145/3546912] [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: 10/17/2022]
Abstract
Much of today’s data are represented as graphs, ranging from social networks to bibliographic citations. Nodes in such graphs correspond to records that generally represent entities, while edges represent relationships between these entities. Both nodes and edges in a graph can have attributes that characterize the entities and their relationships. Relationships are either explicitly known (like friends in a social network), or they are inferred using link prediction (such as two babies are siblings because they have the same mother). Any graph representing real-world data likely contains nodes and edges that are abnormal, and identifying these can be important for outlier detection in applications ranging from crime and fraud detection to viral marketing. We propose a novel approach to unsupervised detection of abnormal nodes and edges in graphs. We first characterize nodes and edges using a set of features, and then employ a one-class classifier to identify abnormal nodes and edges. We extract patterns of features from these abnormal nodes and edges, and apply clustering to identify groups of patterns with similar characteristics. We finally visualize these abnormal patterns to show co-occurrences of features and relationships between those features that mostly influence the abnormality of nodes and edges. We evaluate our approach on datasets from diverse domains, including historical birth certificates, COVID patient records, emails, books, and movies. This evaluation demonstrates that our approach is well suited to identify both abnormal nodes and edges in graphs in an unsupervised way, and it can outperform several baseline anomaly detection techniques.
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Affiliation(s)
| | | | | | - Pouya G. Omran
- School of Computing, The Australian National University, Australia
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Kouli O, Murray V, Bhatia S, Cambridge WA, Kawka M, Shafi S, Knight SR, Kamarajah SK, McLean KA, Glasbey JC, Khaw RA, Ahmed W, Akhbari M, Baker D, Borakati A, Mills E, Thavayogan R, Yasin I, Raubenheimer K, Ridley W, Sarrami M, Zhang G, Egoroff N, Pockney P, Richards T, Bhangu A, Creagh-Brown B, Edwards M, Harrison EM, Lee M, Nepogodiev D, Pinkney T, Pearse R, Smart N, Vohra R, Sohrabi C, Jamieson A, Nguyen M, Rahman A, English C, Tincknell L, Kakodkar P, Kwek I, Punjabi N, Burns J, Varghese S, Erotocritou M, McGuckin S, Vayalapra S, Dominguez E, Moneim J, Salehi M, Tan HL, Yoong A, Zhu L, Seale B, Nowinka Z, Patel N, Chrisp B, Harris J, Maleyko I, Muneeb F, Gough M, James CE, Skan O, Chowdhury A, Rebuffa N, Khan H, Down B, Fatimah Hussain Q, Adams M, Bailey A, Cullen G, Fu YXJ, McClement B, Taylor A, Aitken S, Bachelet B, Brousse de Gersigny J, Chang C, Khehra B, Lahoud N, Lee Solano M, Louca M, Rozenbroek P, Rozitis E, Agbinya N, Anderson E, Arwi G, Barry I, Batchelor C, Chong T, Choo LY, Clark L, Daniels M, Goh J, Handa A, Hanna J, Huynh L, Jeon A, Kanbour A, Lee A, Lee J, Lee T, Leigh J, Ly D, McGregor F, Moss J, Nejatian M, O'Loughlin E, Ramos I, Sanchez B, Shrivathsa A, Sincari A, Sobhi S, Swart R, Trimboli J, Wignall P, Bourke E, Chong A, Clayton S, Dawson A, Hardy E, Iqbal R, Le L, Mao S, Marinelli I, Metcalfe H, Panicker D, R HH, Ridgway S, Tan HH, Thong S, Van M, Woon S, Woon-Shoo-Tong XS, Yu S, Ali K, Chee J, Chiu C, Chow YW, Duller A, Nagappan P, Ng S, Selvanathan M, Sheridan C, Temple M, Do JE, Dudi-Venkata NN, Humphries E, Li L, Mansour LT, Massy-Westropp C, Fang B, Farbood K, Hong H, Huang Y, Joan M, Koh C, Liu YHA, Mahajan T, Muller E, Park R, Tanudisastro M, Wu JJG, Chopra P, Giang S, Radcliffe S, Thach P, Wallace D, Wilkes A, Chinta SH, Li J, Phan J, Rahman F, Segaran A, Shannon J, Zhang M, Adams N, Bonte A, Choudhry A, Colterjohn N, Croyle JA, Donohue J, Feighery A, Keane A, McNamara D, Munir K, Roche D, Sabnani R, Seligman D, Sharma S, Stickney Z, Suchy H, Tan R, Yordi S, Ahmed I, Aranha M, El Sabawy D, Garwood P, Harnett M, Holohan R, Howard R, Kayyal Y, Krakoski N, Lupo M, McGilberry W, Nepon H, Scoleri Y, Urbina C, Ahmad Fuad MF, Ahmed O, Jaswantlal D, Kelly E, Khan MHT, Naidu D, Neo WX, O'Neill R, Sugrue M, Abbas JD, Abdul-Fattah S, Azlan A, Barry K, Idris NS, Kaka N, Mc Dermott D, Mohammad Nasir MN, Mozo M, Rehal A, Shaikh Yousef M, Wong RH, Curran E, Gardner M, Hogan A, Julka R, Lasser G, Ní Chorráin N, Ting J, Browne R, George S, Janjua Z, Leung Shing V, Megally M, Murphy S, Ravenscroft L, Vedadi A, Vyas V, Bryan A, Sheikh A, Ubhi J, Vannelli K, Vawda A, Adeusi L, Doherty C, Fitzgerald C, Gallagher H, Gill P, Hamza H, Hogan M, Kelly S, Larry J, Lynch P, Mazeni NA, O'Connell R, O'Loghlin R, Singh K, Abbas Syed R, Ali A, Alkandari B, Arnold A, Arora E, Azam R, Breathnach C, Cheema J, Compton M, Curran S, Elliott JA, Jayasamraj O, Mohammed N, Noone A, Pal A, Pandey S, Quinn P, Sheridan R, Siew L, Tan EP, Tio SW, Toh VTR, Walsh M, Yap C, Yassa J, Young T, Agarwal N, Almoosawy SA, Bowen K, Bruce D, Connachan R, Cook A, Daniell A, Elliott M, Fung HKF, Irving A, Laurie S, Lee YJ, Lim ZX, Maddineni S, McClenaghan RE, Muthuganesan V, Ravichandran P, Roberts N, Shaji S, Solt S, Toshney E, Arnold C, Baker O, Belais F, Bojanic C, Byrne M, Chau CYC, De Soysa S, Eldridge M, Fairey M, Fearnhead N, Guéroult A, Ho JSY, Joshi K, Kadiyala N, Khalid S, Khan F, Kumar K, Lewis E, Magee J, Manetta-Jones D, Mann S, McKeown L, Mitrofan C, Mohamed T, Monnickendam A, Ng AYKC, Ortu A, Patel M, Pope T, Pressling S, Purohit K, Saji S, Shah Foridi J, Shah R, Siddiqui SS, Surman K, Utukuri M, Varghese A, Williams CYK, Yang JJ, Billson E, Cheah E, Holmes P, Hussain S, Murdock D, Nicholls A, Patel P, Ramana G, Saleki M, Spence H, Thomas D, Yu C, Abousamra M, Brown C, Conti I, Donnelly A, Durand M, French N, Goan R, O'Kane E, Rubinchik P, Gardiner H, Kempf B, Lai YL, Matthews H, Minford E, Rafferty C, Reid C, Sheridan N, Al Bahri T, Bhoombla N, Rao BM, Titu L, Chatha S, Field C, Gandhi T, Gulati R, Jha R, Jones Sam MT, Karim S, Patel R, Saunders M, Sharma K, Abid S, Heath E, Kurup D, Patel A, Ali M, Cresswell B, Felstead D, Jennings K, Kaluarachchi T, Lazzereschi L, Mayson H, Miah JE, Reinders B, Rosser A, Thomas C, Williams H, Al-Hamid Z, Alsadoun L, Chlubek M, Fernando P, Gaunt E, Gercek Y, Maniar R, Ma R, Matson M, Moore S, Morris A, Nagappan PG, Ratnayake M, Rockall L, Shallcross O, Sinha A, Tan KE, Virdee S, Wenlock R, Donnelly HA, Ghazal R, Hughes I, Liu X, McFadden M, Misbert E, Mogey P, O'Hara A, Peace C, Rainey C, Raja P, Salem M, Salmon J, Tan CH, Alves D, Bahl S, Baker C, Coulthurst J, Koysombat K, Linn T, Rai P, Sharma A, Shergill A, Ahmed M, Ahmed S, Belk LH, Choudhry H, Cummings D, Dixon Y, Dobinson C, Edwards J, Flint J, Franco Da Silva C, Gallie R, Gardener M, Glover T, Greasley M, Hatab A, Howells R, Hussey T, Khan A, Mann A, Morrison H, Ng A, Osmond R, Padmakumar N, Pervaiz F, Prince R, Qureshi A, Sawhney R, Sigurdson B, Stephenson L, Vora K, Zacken A, Cope P, Di Traglia R, Ferarrio I, Hackett N, Healicon R, Horseman L, Lam LI, Meerdink M, Menham D, Murphy R, Nimmo I, Ramaesh A, Rees J, Soame R, Dilaver N, Adebambo D, Brown E, Burt J, Foster K, Kaliyappan L, Knight P, Politis A, Richardson E, Townsend J, Abdi M, Ball M, Easby S, Gill N, Ho E, Iqbal H, Matthews M, Nubi S, Nwokocha JO, Okafor I, Perry G, Sinartio B, Vanukuru N, Walkley D, Welch T, Yates J, Yeshitila N, Bryans K, Campbell B, Gray C, Keys R, Macartney M, Chamberlain G, Khatri A, Kucheria A, Lee STP, Reese G, Roy choudhury J, Tan WYR, Teh JJ, Ting A, Kazi S, Kontovounisios C, Vutipongsatorn K, Amarnath T, Balasubramanian N, Bassett E, Gurung P, Lim J, Panjikkaran A, Sanalla A, Alkoot M, Bacigalupo V, Eardley N, Horton M, Hurry A, Isti C, Maskell P, Nursiah K, Punn G, Salih H, Epanomeritakis E, Foulkes A, Henderson R, Johnston E, McCullough H, McLarnon M, Morrison E, Cheung A, Cho SH, Eriksson F, Hedges J, Low Z, May C, Musto L, Nagi S, Nur S, Salau E, Shabbir S, Thomas MC, Uthayanan L, Vig S, Zaheer M, Zeng G, Ashcroft-Quinn S, Brown R, Hayes J, McConville R, French R, Gilliam A, Sheetal S, Shehzad MU, Bani W, Christie I, Franklyn J, Khan M, Russell J, Smolarek S, Varadarassou R, Ahmed SK, Narayanaswamy S, Sealy J, Shah M, Dodhia V, Manukyan A, O'Hare R, Orbell J, Chung I, Forenc K, Gupta A, Agarwal A, Al Dabbagh A, Bennewith R, Bottomley J, Chu TSM, Chu YYA, Doherty W, Evans B, Hainsworth P, Hosfield T, Li CH, McCullagh I, Mehta A, Thaker A, Thompson B, Virdi A, Walker H, Wilkins E, Dixon C, Hassan MR, Lotca N, Tong KS, Batchelor-Parry H, Chaudhari S, Harris T, Hooper J, Johnson C, Mulvihill C, Nayler J, Olutobi O, Piramanayagam B, Stones K, Sussman M, Weaver C, Alam F, Al Rawi M, Andrew F, Arrayeh A, Azizan N, Hassan A, Iqbal Z, John I, Jones M, Kalake O, Keast M, Nicholas J, Patil A, Powell K, Roberts P, Sabri A, Segue AK, Shah A, Shaik Mohamed SA, Shehadeh A, Shenoy S, Tong A, Upcott M, Vijayasingam D, Anarfi S, Dauncey J, Devindaran A, Havalda P, Komninos G, Mwendwa E, Norman C, Richards J, Urquhart A, Allan J, Cahya E, Hunt H, McWhirter C, Norton R, Roxburgh C, Tan JY, Ali Butt S, Hansdot S, Haq I, Mootien A, Sanchez I, Vainas T, Deliyannis E, Tan M, Vipond M, Chittoor Satish NN, Dattani A, De Carvalho L, Gaston-Grubb M, Karunanithy L, Lowe B, Pace C, Raju K, Roope J, Taylor C, Youssef H, Munro T, Thorn C, Wong KHF, Yunus A, Chawla S, Datta A, Dinesh AA, Field D, Georgi T, Gwozdz A, Hamstead E, Howard N, Isleyen N, Jackson N, Kingdon J, Sagoo KS, Schizas A, Yin L, Aung E, Aung YY, Franklin S, Han SM, Kim WC, Martin Segura A, Rossi M, Ross T, Tirimanna R, Wang B, Zakieh O, Ben-Arzi H, Flach A, Jackson E, Magers S, Olu abara C, Rogers E, Sugden K, Tan H, Veliah S, Walton U, Asif A, Bharwada Y, Bowley D, Broekhuizen A, Cooper L, Evans N, Girdlestone H, Ling C, Mann H, Mehmood N, Mulvenna CL, Rainer N, Trout I, Gujjuri R, Jeyaraman D, Leong E, Singh D, Smith E, Anderton J, Barabas M, Goyal S, Howard D, Joshi A, Mitchell D, Weatherby T, Badminton R, Bird R, Burtle D, Choi NY, Devalia K, Farr E, Fischer F, Fish J, Gunn F, Jacobs D, Johnston P, Kalakoutas A, Lau E, Loo YNAF, Louden H, Makariou N, Mohammadi K, Nayab Y, Ruhomaun S, Ryliskyte R, Saeed M, Shinde P, Sudul M, Theodoropoulou K, Valadao-Spoorenberg J, Vlachou F, Arshad SR, Janmohamed AM, Noor M, Oyerinde O, Saha A, Syed Y, Watkinson W, Ahmadi H, Akintunde A, Alsaady A, Bradley J, Brothwood D, Burton M, Higgs M, Hoyle C, Katsura C, Lathan R, Louani A, Mandalia R, Prihartadi AS, Qaddoura B, Sandland-Taylor L, Thadani S, Thompson A, Walshaw J, Teo S, Ali S, Bawa JH, Fox S, Gargan K, Haider SA, Hanna N, Hatoum A, Khan Z, Krzak AM, Li T, Pitt J, Tan GJS, Ullah Z, Wilson E, Cleaver J, Colman J, Copeland L, Coulson A, Davis P, Faisal H, Hassan F, Hughes JT, Jabr Y, Mahmoud Ali F, Nahaboo Solim ZN, Sangheli A, Shaya S, Thompson R, Cornwall H, De Andres Crespo M, Fay E, Findlay J, Groves E, Jones O, Killen A, Millo J, Thomas S, Ward J, Wilkins M, Zaki F, Zilber E, Bhavra K, Bilolikar A, Charalambous M, Elawad A, Eleni A, Fawdon R, Gibbins A, Livingstone D, Mala D, Oke SE, Padmakumar D, Patsalides MA, Payne D, Ralphs C, Roney A, Sardar N, Stefanova K, Surti F, Timms R, Tosney G, Bannister J, Clement NS, Cullimore V, Kamal F, Lendor J, McKay J, Mcswiggan J, Minhas N, Seneviratne K, Simeen S, Valverde J, Watson N, Bloom I, Dinh TH, Hirniak J, Joseph R, Kansagra M, Lai CKN, Melamed N, Patel J, Randev J, Sedighi T, Shurovi B, Sodhi J, Vadgama N, Abdulla S, Adabavazeh B, Champion A, Chennupati R, Chu K, Devi S, Haji A, Schulz J, Testa F, Davies P, Gurung B, Howell S, Modi P, Pervaiz A, Zahid M, Abdolrazaghi S, Abi Aoun R, Anjum Z, Bawa G, Bhardwaj R, Brown S, Enver M, Gill D, Gopikrishna D, Gurung D, Kanwal A, Kaushal P, Khanna A, Lovell E, McEvoy C, Mirza M, Nabeel S, Naseem S, Pandya K, Perkins R, Pulakal R, Ray M, Reay C, Reilly S, Round A, Seehra J, Shakeel NM, Singh B, Vijay Sukhnani M, Brown L, Desai B, Elzanati H, Godhaniya J, Kavanagh E, Kent J, Kishor A, Liu A, Norwood M, Shaari N, Wood C, Wood M, Brown A, Chellapuri A, Ferriman A, Ghosh I, Kulkarni N, Noton T, Pinto A, Rajesh S, Varghese B, Wenban C, Aly R, Barciela C, Brookes T, Corrin E, Goldsworthy M, Mohamed Azhar MS, Moore J, Nakhuda S, Ng D, Pillay S, Port S, Abdullah M, Akinyemi J, Islam S, Kale A, Lewis A, Manjunath T, McCabe H, Misra S, Stubley T, Tam JP, Waraich N, Chaora T, Ford C, Osinkolu I, Pong G, Rai J, Risquet R, Ainsworth J, Ayandokun P, Barham E, Barrett G, Barry J, Bisson E, Bridges I, Burke D, Cann J, Cloney M, Coates S, Cripps P, Davies C, Francis N, Green S, Handley G, Hathaway D, Hurt L, Jenkins S, Johnston C, Khadka A, McGee U, Morris D, Murray R, Norbury C, Pierrepont Z, Richards C, Ross O, Ruddy A, Salmon C, Shield M, Soanes K, Spencer N, Taverner S, Williams C, Wills-Wood W, Woodward S, Chow J, Fan J, Guest O, Hunter I, Moon WY, Arthur-Quarm S, Edwards P, Hamlyn V, McEneaney L, N D G, Pranoy S, Ting M, Abada S, Alawattegama LH, Ashok A, Carey C, Gogna A, Haglund C, Hurley P, Leelo N, Liu B, Mannan F, Paramjothy K, Ramlogan K, Raymond-Hayling O, Shanmugarajah A, Solichan D, Wilkinson B, Ahmad NA, Allan D, Amin A, Bakina C, Burns F, Cameron F, Campbell A, Cavanagh S, Chan SMZ, Chapman S, Chong V, Edelsten E, Ekpete O, El Sheikh M, Ghose R, Hassane A, Henderson C, Hilton-Christie S, Husain M, Hussain H, Javid Z, Johnson-Ogbuneke J, Johnston A, Khalil M, Leung TCC, Makin I, Muralidharan V, Naeem M, Patil P, Ravichandran S, Saraeva D, Shankey-Smith W, Sharma N, Swan R, Waudby-West R, Wilkinson A, Wright K, Balasubramanian A, Bhatti S, Chalkley M, Chou WK, Dixon M, Evans L, Fisher K, Gandhi P, Ho S, Lau YB, Lowe S, Meechan C, Murali N, Musonda C, Njoku P, Ochieng L, Pervez MU, Seebah K, Shaikh I, Sikder MA, Vanker R, Alom J, Bajaj V, Coleman O, Finch G, Goss J, Jenkins C, Kontothanassis A, Liew MS, Ng K, Outram M, Shakeel MM, Tawn J, Zuhairy S, Chapple K, Cinnamond A, Coleman S, George HA, Goulder L, Hare N, Hawksley J, Kret A, Luesley A, Mecia L, Porter H, Puddy E, Richardson G, Sohail B, Srikaran V, Tadross D, Tobin J, Tokidis E, Young L, Ashdown T, Bratsos S, Koomson A, Kufuor A, Lim MQ, Shah S, Thorne EPC, Warusavitarne J, Xu S, Abigail S, Ahmed A, Ahmed J, Akmal A, Al-Khafaji M, Amini B, Arshad M, Bogie E, Brazkiewicz M, Carroll M, Chandegra A, Cirelli C, Deng A, Fairclough S, Fung YJ, Gornell C, Green RL, Green SV, Gulamhussein AHM, Isaac AG, Jan R, Jegatheeswaran L, Knee M, Kotecha J, Kotecha S, Maxwell-Armstrong C, McIntyre C, Mendis N, Naing TKP, Oberman J, Ong ZX, Ramalingam A, Saeed Adam A, Tan LL, Towell S, Yadav J, Anandampillai R, Chung S, Hounat A, Ibrahim B, Jeyakumar G, Khalil A, Khan UA, Nair G, Owusu-Ayim M, Wilson M, Kanani A, Kilkelly B, Ogunmwonyi I, Ong L, Samra B, Schomerus L, Shea J, Turner O, Yang Y, Amin M, Blott N, Clark A, Feather A, Forrest M, Hague S, Hamilton K, Higginbotham G, Hope E, Karimian S, Loveday K, Malik H, McKenna O, Noor A, Onsiong C, Patel B, Radcliffe N, Shah P, Tye L, Verma K, Walford R, Yusufi U, Zachariah M, Casey A, Doré C, Fludder V, Fortescue L, Kalapu SS, Karel E, Khera G, Smith C, Appleton B, Ashaye A, Boggon E, Evans A, Faris Mahmood H, Hinchcliffe Z, Marei O, Silva I, Spooner C, Thomas G, Timlin M, Wellington J, Yao SL, Abdelrazek M, Abdelrazik Y, Bee F, Joseph A, Mounce A, Parry G, Vignarajah N, Biddles D, Creissen A, Kolhe S, K T, Lea A, Ledda V, O'Loughlin P, Scanlon J, Shetty N, Weller C, Abdalla M, Adeoye A, Bhatti M, Chadda KR, Chu J, Elhakim H, Foster-Davies H, Rabie M, Tailor B, Webb S, Abdelrahim ASA, Choo SY, Jiwa A, Mangam S, Murray S, Shandramohan A, Aghanenu O, Budd W, Hayre J, Khanom S, Liew ZY, McKinney R, Moody N, Muhammad-Kamal H, Odogwu J, Patel D, Roy C, Sattar Z, Shahrokhi N, Sinha I, Thomson E, Wonga L, Bain J, Khan J, Ricardo D, Bevis R, Cherry C, Darkwa S, Drew W, Griffiths E, Konda N, Madani D, Mak JKC, Meda B, Odunukwe U, Preest G, Raheel F, Rajaseharan A, Ramgopal A, Risbrooke C, Selvaratnam K, Sethunath G, Tabassum R, Taylor J, Thakker A, Wijesingha N, Wybrew R, Yasin T, Ahmed Osman A, Alfadhel S, Carberry E, Chen JY, Drake I, Glen P, Jayasuriya N, Kawar L, Myatt R, Sinan LOH, Siu SSY, Tjen V, Adeboyejo O, Bacon H, Barnes R, Birnie C, D'Cunha Kamath A, Hughes E, Middleton S, Owen R, Schofield E, Short C, Smith R, Wang H, Willett M, Zimmerman M, Balfour J, Chadwick T, Coombe-Jones M, Do Le HP, Faulkner G, Hobson K, Shehata Z, Beattie M, Chmielewski G, Chong C, Donnelly B, Drusch B, Ellis J, Farrelly C, Feyi-Waboso J, Hibell I, Hoade L, Ho C, Jones H, Kodiatt B, Lidder P, Ni Cheallaigh L, Norman R, Patabendi I, Penfold H, Playfair M, Pomeroy S, Ralph C, Rottenburg H, Sebastian J, Sheehan M, Stanley V, Welchman J, Ajdarpasic D, Antypas A, Azouaghe O, Basi S, Bettoli G, Bhattarai S, Bommireddy L, Bourne K, Budding J, Cookey-Bresi R, Cummins T, Davies G, Fabelurin C, Gwilliam R, Hanley J, Hird A, Kruczynska A, Langhorne B, Lund J, Lutchman I, McGuinness R, Neary M, Pampapathi S, Pang E, Podbicanin S, Rai N, Redhouse White G, Sujith J, Thomas P, Walker I, Winterton R, Anderson P, Barrington M, Bhadra K, Clark G, Fowler G, Gibson C, Hudson S, Kaminskaite V, Lawday S, Longshaw A, MacKrill E, McLachlan F, Murdeshwar A, Nieuwoudt R, Parker P, Randall R, Rawlins E, Reeves SA, Rye D, Sirkis T, Sykes B, Ventress N, Wosinska N, Akram B, Burton L, Coombs A, Long R, Magowan D, Ong C, Sethi M, Williams G, Chan C, Chan LH, Fernando D, Gaba F, Khor Z, Les JW, Mak R, Moin S, Ng Kee Kwong KC, Paterson-Brown S, Tew YY, Bardon A, Burrell K, Coldwell C, Costa I, Dexter E, Hardy A, Khojani M, Mazurek J, Raymond T, Reddy V, Reynolds J, Soma A, Agiotakis S, Alsusa H, Desai N, Peristerakis I, Adcock A, Ayub H, Bennett T, Bibi F, Brenac S, Chapman T, Clarke G, Clark F, Galvin C, Gwyn-Jones A, Henry-Blake C, Kerner S, Kiandee M, Lovett A, Pilecka A, Ravindran R, Siddique H, Sikand T, Treadwell K, Akmal K, Apata A, Barton O, Broad G, Darling H, Dhuga Y, Emms L, Habib S, Jain R, Jeater J, Kan CYP, Kathiravelupillai A, Khatkar H, Kirmani S, Kulasabanathan K, Lacey H, Lal K, Manafa C, Mansoor M, McDonald S, Mittal A, Mustoe S, Nottrodt L, Oliver P, Papapetrou I, Pattinson F, Raja M, Reyhani H, Shahmiri A, Small O, Soni U, Aguirrezabala Armbruster B, Bunni J, Hakim MA, Hawkins-Hooker L, Howell KA, Hullait R, Jaskowska A, Ottewell L, Thomas-Jones I, Vasudev A, Clements B, Fenton J, Gill M, Haider S, Lim AJM, Maguire H, McMullan J, Nicoletti J, Samuel S, Unais MA, White N, Yao PC, Yow L, Boyle C, Brady R, Cheekoty P, Cheong J, Chew SJHL, Chow R, Ganewatta Kankanamge D, Mamer L, Mohammed B, Ng Chieng Hin J, Renji Chungath R, Royston A, Sharrad E, Sinclair R, Tingle S, Treherne K, Wyatt F, Maniarasu VS, Moug S, Appanna T, Bucknall T, Hussain F, Owen A, Parry M, Parry R, Sagua N, Spofforth K, Yuen ECT, Bosley N, Hardie W, Moore T, Regas C, Abdel-Khaleq S, Ali N, Bashiti H, Buxton-Hopley R, Constantinides M, D'Afflitto M, Deshpande A, Duque Golding J, Frisira E, Germani Batacchi M, Gomaa A, Hay D, Hutchison R, Iakovou A, Iakovou D, Ismail E, Jefferson S, Jones L, Khouli Y, Knowles C, Mason J, McCaughan R, Moffatt J, Morawala A, Nadir H, Neyroud F, Nikookam Y, Parmar A, Pinto L, Ramamoorthy R, Richards E, Thomson S, Trainer C, Valetopoulou A, Vassiliou A, Wantman A, Wilde S, Dickinson M, Rockall T, Senn D, Wcislo K, Zalmay P, Adelekan K, Allen K, Bajaj M, Gatumbu P, Hang S, Hashmi Y, Kaur T, Kawesha A, Kisiel A, Woodmass M, Adelowo T, Ahari D, Alhwaishel K, Atherton R, Clayton B, Cockroft A, Curtis Lopez C, Hilton M, Ismail N, Kouadria M, Lee L, MacConnachie A, Monks F, Mungroo S, Nikoletopoulou C, Pearce L, Sara X, Shahid A, Suresh G, Wilcha R, Atiyah A, Davies E, Dermanis A, Gibbons H, Hyde A, Lawson A, Lee C, Leung-Tack M, Li Saw Hee J, Mostafa O, Nair D, Pattani N, Plumbley-Jones J, Pufal K, Ramesh P, Sanghera J, Saram S, Scadding S, See S, Stringer H, Torrance A, Vardon H, Wyn-Griffiths F, Brew A, Kaur G, Soni D, Tickle A, Akbar Z, Appleyard T, Figg K, Jayawardena P, Johnson A, Kamran Siddiqui Z, Lacy-Colson J, Oatham R, Rowlands B, Sludden E, Turnbull C, Allin D, Ansar Z, Azeez Z, Dale VH, Garg J, Horner A, Jones S, Knight S, McGregor C, McKenna J, McLelland T, Packham-Smith A, Rowsell K, Spector-Hill I, Adeniken E, Baker J, Bartlett M, Chikomba L, Connell B, Deekonda P, Dhar M, Elmansouri A, Gamage K, Goodhew R, Hanna P, Knight J, Luca A, Maasoumi N, Mahamoud F, Manji S, Marwaha PK, Mason F, Oluboyede A, Pigott L, Razaq AM, Richardson M, Saddaoui I, Wijeyendram P, Yau S, Atkins W, Liang K, Miles N, Praveen B, Ashai S, Braganza J, Common J, Cundy A, Davies R, Guthrie J, Handa I, Iqbal M, Ismail R, Jones C, Jones I, Lee KS, Levene A, Okocha M, Olivier J, Smith A, Subramaniam E, Tandle S, Wang A, Watson A, Wilson C, Chan XHF, Khoo E, Montgomery C, Norris M, Pugalenthi PP, Common T, Cook E, Mistry H, Shinmar HS, Agarwal G, Bandyopadhyay S, Brazier B, Carroll L, Goede A, Harbourne A, Lakhani A, Lami M, Larwood J, Martin J, Merchant J, Pattenden S, Pradhan A, Raafat N, Rothwell E, Shammoon Y, Sudarshan R, Vickers E, Wingfield L, Ashworth I, Azizi S, Bhate R, Chowdhury T, Christou A, Davies L, Dwaraknath M, Farah Y, Garner J, Gureviciute E, Hart E, Jain A, Javid S, Kankam HK, Kaur Toor P, Kaz R, Kermali M, Khan I, Mattson A, McManus A, Murphy M, Nair K, Ngemoh D, Norton E, Olabiran A, Parry L, Payne T, Pillai K, Price S, Punjabi K, Raghunathan A, Ramwell A, Raza M, Ritehnia J, Simpson G, Smith W, Sodeinde S, Studd L, Subramaniam M, Thomas J, Towey S, Tsang E, Tuteja D, Vasani J, Vio M, Badran A, Adams J, Anthony Wilkinson J, Asvandi S, Austin T, Bald A, Bix E, Carrick M, Chander B, Chowdhury S, Cooper Drake B, Crosbie S, D Portela S, Francis D, Gallagher C, Gillespie R, Gravett H, Gupta P, Ilyas C, James G, Johny J, Jones A, Kinder F, MacLeod C, Macrow C, Maqsood-Shah A, Mather J, McCann L, McMahon R, Mitham E, Mohamed M, Munton E, Nightingale K, O'Neill K, Onyemuchara I, Senior R, Shanahan A, Sherlock J, Spyridoulias A, Stavrou C, Stokes D, Tamang R, Taylor E, Trafford C, Uden C, Waddington C, Yassin D, Zaman M, Bangi S, Cheng T, Chew D, Hussain N, Imani-Masouleh S, Mahasivam G, McKnight G, Ng HL, Ota HC, Pasha T, Ravindran W, Shah K, Vishnu K S, Zaman S, Carr W, Cope S, Eagles EJ, Howarth-Maddison M, Li CY, Reed J, Ridge A, Stubbs T, Teasdaled D, Umar R, Worthington J, Dhebri A, Kalenderov R, Alattas A, Arain Z, Bhudia R, Chia D, Daniel S, Dar T, Garland H, Girish M, Hampson A, Kyriacou H, Lehovsky K, Mullins W, Omorphos N, Vasdev N, Venkatesh A, Waldock W, Bhandari A, Brown G, Choa G, Eichenauer CE, Ezennia K, Kidwai Z, Lloyd-Thomas A, Macaskill Stewart A, Massardi C, Sinclair E, Skajaa N, Smith M, Tan I, Afsheen N, Anuar A, Azam Z, Bhatia P, Davies-kelly N, Dickinson S, Elkawafi M, Ganapathy M, Gupta S, Khoury EG, Licudi D, Mehta V, Neequaye S, Nita G, Tay VL, Zhao S, Botsa E, Cuthbert H, Elliott J, Furlepa M, Lehmann J, Mangtani A, Narayan A, Nazarian S, Parmar C, Shah D, Shaw C, Zhao Z, Beck C, Caldwell S, Clements JM, French B, Kenny R, Kirk S, Lindsay J, McClung A, McLaughlin N, Watson S, Whiteside E, Alyacoubi S, Arumugam V, Beg R, Dawas K, Garg S, Lloyd ER, Mahfouz Y, Manobharath N, Moonesinghe R, Morka N, Patel K, Prashar J, Yip S, Adeeko ES, Ajekigbe F, Bhat A, Evans C, Farrugia A, Gurung C, Long T, Malik B, Manirajan S, Newport D, Rayer J, Ridha A, Ross E, Saran T, Sinker A, Waruingi D, Allen R, Al Sadek Y, Alves do Canto Brum H, Asharaf H, Ashman M, Balakumar V, Barrington J, Baskaran R, Berry A, Bhachoo H, Bilal A, Boaden L, Chia WL, Covell G, Crook D, Dadnam F, Davis L, De Berker H, Doyle C, Fox C, Gruffydd-Davies M, Hafouda Y, Hill A, Hubbard E, Hunter A, Inpadhas V, Jamshaid M, Jandu G, Jeyanthi M, Jones T, Kantor C, Kwak SY, Malik N, Matt R, McNulty P, Miles C, Mohomed A, Myat P, Niharika J, Nixon A, O'Reilly D, Parmar K, Pengelly S, Price L, Ramsden M, Turnor R, Wales E, Waring H, Wu M, Yang T, Ye TTS, Zander A, Zeicu C, Bellam S, Francombe J, Kawamoto N, Rahman MR, Sathyanarayana A, Tang HT, Cheung J, Hollingshead J, Page V, Sugarman J, Wong E, Chiong J, Fung E, Kan SY, Kiang J, Kok J, Krahelski O, Liew MY, Lyell B, Sharif Z, Speake D, Alim L, Amakye NY, Chandrasekaran J, Chandratreya N, Drake J, Owoso T, Thu YM, Abou El Ela Bourquin B, Alberts J, Chapman D, Rehnnuma N, Ainsworth K, Carpenter H, Emmanuel T, Fisher T, Gabrel M, Guan Z, Hollows S, Hotouras A, Ip Fung Chun N, Jaffer S, Kallikas G, Kennedy N, Lewinsohn B, Liu FY, Mohammed S, Rutherfurd A, Situ T, Stammer A, Taylor F, Thin N, Urgesi E, Zhang N, Ahmad MA, Bishop A, Bowes A, Dixit A, Glasson R, Hatta S, Hatt K, Larcombe S, Preece J, Riordan E, Fegredo D, Haq MZ, Li C, McCann G, Stewart D, Baraza W, Bhullar D, Burt G, Coyle J, Deans J, Devine A, Hird R, Ikotun O, Manchip G, Ross C, Storey L, Tan WWL, Tse C, Warner C, Whitehead M, Wu F, Court EL, Crisp E, Huttman M, Mayes F, Robertson H, Rosen H, Sandberg C, Smith H, Al Bakry M, Ashwell W, Bajaj S, Bandyopadhyay D, Browlee O, Burway S, Chand CP, Elsayeh K, Elsharkawi A, Evans E, Ferrin S, Fort-Schaale A, Iacob M, I K, Impelliziere Licastro G, Mankoo AS, Olaniyan T, Otun J, Pereira R, Reddy R, Saeed D, Simmonds O, Singhal G, Tron K, Wickstone C, Williams R, Bradshaw E, De Kock Jewell V, Houlden C, Knight C, Metezai H, Mirza-Davies A, Seymour Z, Spink D, Wischhusen S. Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study. Lancet Digit Health 2022; 4:e520-e531. [PMID: 35750401 DOI: 10.1016/s2589-7500(22)00069-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 01/07/2022] [Accepted: 04/06/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications. METHODS We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC). FINDINGS In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]). INTERPRETATION In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required. FUNDING British Journal of Surgery Society.
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Till K, Lloyd RS, McCormack S, Williams G, Baker J, Eisenmann JC. Optimising long-term athletic development: An investigation of practitioners' knowledge, adherence, practices and challenges. PLoS One 2022; 17:e0262995. [PMID: 35077515 PMCID: PMC8789126 DOI: 10.1371/journal.pone.0262995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 01/10/2022] [Indexed: 11/23/2022] Open
Abstract
Long-term athletic development practices have been recommended for the past two decades. However, limited research exists exploring the knowledge and skills required by practitioners to optimise long-term athletic development. Therefore, this study aimed to evaluate the knowledge, adherence, practices, and challenges of practitioners responsible for delivering long-term athletic development. A mixed methods survey was completed by 236 practitioners (e.g., sport coaches, physical education teachers) consisting of four parts; 1) demographics, 2) knowledge, 3) adherence, and 4) practices and challenges. Quantitative and qualitative data were analysed by Friedman’s analysis of variance and thematic analyses, respectively. Quantitative findings showed practitioners 1) recognised their responsibility for delivering long-term athletic development, 2) have a familiarity with existing developmental models, and 3) had high adherence, focused upon health and wellbeing, to delivering long-term athletic development. However, practices associated with growth and maturity, monitoring and assessment, and the systematic progression and individualisation of training had lower adherence. Qualitative analysis indicated that practitioner’s perceived definitions of athleticism and long-term athletic development were inconsistent, especially according to the psychological components (i.e., confidence). Practitioners’ descriptions of their long-term athletic development practices identified two higher order themes; 1) goals, in which long-term athletic development “is for life” and the importance of “an individual centered journey” highlighted as sub-themes; and 2) realities of delivering long-term athletic development, whereby variety in programme delivery, monitoring development and practical challenges were noted as key priorities. Eight practical challenges were identified including governance and priorities, resources, education, early specialization, high training volumes, staff communication, parents and youth motivation. This mixed method survey highlighted a multitude of knowledge, adherence, practices and challenges towards long-term athletic development. These novel findings can help inform policy to optimise long-term athletic development and to support the complex problem of developing a healthier, fitter and more physically active youth population.
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Affiliation(s)
- Kevin Till
- Carnegie School of Sport, Leeds Beckett University, Leeds, United Kingdom
- Leeds Rhinos Rugby League Club, Leeds, United Kingdom
- * E-mail:
| | - Rhodri S. Lloyd
- Youth Physical Development Centre, Cardiff School of Sport, Cardiff Metropolitan University, Cardiff, United Kingdom
- Sports Performance Research Institute New Zealand (SPRINZ), AUT University, Auckland, New Zealand
- Centre for Sport Science and Human Performance, Waikato Institute of Technology, Hamilton, New Zealand
| | - Sam McCormack
- Carnegie School of Sport, Leeds Beckett University, Leeds, United Kingdom
- England Performance Unit, Rugby Football League, Leeds, United Kingdom
| | | | - Joseph Baker
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
| | - Joey C. Eisenmann
- Carnegie School of Sport, Leeds Beckett University, Leeds, United Kingdom
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Johar J, Kohansal AR, Farina D, Gruchy SE, Williams G, Patel S. A122 OUTCOMES OF COLD SNARE POLYPECTOMY FOR POLYPS GREATER THAN 20 MM: DATA FROM AN ACADEMIC CENTER. J Can Assoc Gastroenterol 2022. [PMCID: PMC8859137 DOI: 10.1093/jcag/gwab049.121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background Cold snare polypectomy (CSP) is widely utilized for resection of small polyps (less than 10mm), due to the technique’s favourable safety profile. However, Hot Snare Endoscopic Mucosal Resection (HSEMR) remains the standard of care for large polyps greater than or equal to 20mm. HSEMR carries an increased risk of complications. These include delayed bleeding, perforation, and post-polypectomy syndrome, along with residual or recurrent adenomatous (RRA). More recently, Cold Snare Endoscopic Mucosal Resection (CSEMR) technique has been used selectively for polyps greater than 20mm. Published studies have demonstrated a significantly lower adverse event rate of complications as compared with HSEMR. RRA utilizing CSP remains a concern, with a recent publication reporting a recurrence of 34.8% on follow-up endoscopy. We present the experience at a single Canadian academic centre with patients undergoing CSEMR for polyps greater than 20mm. Aims To demonstrate the efficacy and safety of cold snare endoscopic mucosal resection CSEMR of large (greater than or equal to 20mm) polyps at a single Canadian academic centre. Methods We retrospectively reviewed colonoscopies performed by endoscopists employing this technique at our centre from January 2020 to August 2021. 15 total cases were identified for patients with polyps greater than or equal to 20 mm, removed by CSEMR technique. Results Patient age ranged from 41 to 76, with a median patient age was 66. There were 10 males and 5 females. There were no adverse events intraoperatively. 15/15 (100%) polyps were successfully resected using CSEMR technique. Polyp size ranged from 2 cm to 7 cm, and there was a median polyp size of 3 cm. 14/15 (93%) polyps were proximal to the splenic flexure, with 1/15 (7%) polyp in the rectum. 6/15 (40%) patients received snare tip soft coagulation to the edges of the polypectomy site. Polyp histology included 7 tubular adenomas, 3 tubulovillous adenomas, 4 sessile serrated polyps, and one hyperplastic polyp. Two patients were on aspirin 81 mg daily, and there were zero patients on any other antiplatelets or anticoagulation. 1/15 patient presented with late bleeding requiring emergent colonoscopy. There were no immediate or delayed perforations or other serious adverse events recorded. Approximately 50% of patients have had follow-up colonoscopy within 3–6 months of their initial procedure. Follow-up ranged from 12 to 252 days, with a median time to follow up of 171 days. 3/7 (43%) patients had histologic evidence of recurrence at follow-up colonoscopy, all of which were successfully treated endoscopically. Conclusions Selective CSEMR is a safe and effective technique, with a low risk of complications. There may be a higher rate of residual polyp at follow-up colonoscopy compared to HSEMR. This data will need further validation with a larger sample size. ![]()
Funding Agencies None
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Affiliation(s)
- J Johar
- Medicine, Dalhousie University, Halifax, NS, Canada
| | - A R Kohansal
- Medicine, Dalhousie University, Halifax, NS, Canada
| | - D Farina
- Dalhousie University, Halifax, NS, Canada
| | - S E Gruchy
- Medicine, Dalhousie University, Halifax, NS, Canada
| | - G Williams
- Dalhousie University, Halifax, NS, Canada
| | - S Patel
- Medicine, Dalhousie University, Halifax, NS, Canada
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Cho S, Darby J, Williams G, Dimasi C, Holman S, Selvanayagam J, Macgowan C, Morrison J, Seed M. Regional Left Ventricular Myocardial Injury and Function Characterisation by Cardiac Magnetic Resonance Imaging in a Sheep Model of Myocardial Infarction. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.283] [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: 10/16/2022]
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19
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Rivera AD, Pieropan F, Williams G, Calzolari F, Butt AM, Azim K. Drug connectivity mapping and functional analysis reveal therapeutic small molecules that differentially modulate myelination. Biomed Pharmacother 2022; 145:112436. [PMID: 34813998 PMCID: PMC8664715 DOI: 10.1016/j.biopha.2021.112436] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/29/2021] [Accepted: 11/12/2021] [Indexed: 12/30/2022] Open
Abstract
Disruption or loss of oligodendrocytes (OLs) and myelin has devastating effects on CNS function and integrity, which occur in diverse neurological disorders, including Multiple Sclerosis (MS), Alzheimer's disease and neuropsychiatric disorders. Hence, there is a need to develop new therapies that promote oligodendrocyte regeneration and myelin repair. A promising approach is drug repurposing, but most agents have potentially contrasting biological actions depending on the cellular context and their dose-dependent effects on intracellular pathways. Here, we have used a combined systems biology and neurobiological approach to identify compounds that exert positive and negative effects on oligodendroglia, depending on concentration. Notably, next generation pharmacogenomic analysis identified the PI3K/Akt modulator LY294002 as the most highly ranked small molecule with both pro- and anti-oligodendroglial concentration-dependent effects. We validated these in silico findings using multidisciplinary approaches to reveal a profoundly bipartite effect of LY294002 on the generation of OPCs and their differentiation into myelinating oligodendrocytes in both postnatal and adult contexts. Finally, we employed transcriptional profiling and signalling pathway activity assays to determine cell-specific mechanisms of action of LY294002 on oligodendrocytes and resolve optimal in vivo conditions required to promote myelin repair. These results demonstrate the power of multidisciplinary strategies in determining the therapeutic potential of small molecules in neurodegenerative disorders.
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Affiliation(s)
- A D Rivera
- Institute of Biomedical and Biomolecular Sciences, School of Pharmacy and Biomedical Sciences, University of Portsmouth, St Michael's Building, White Swan Road, PO1 2DT Portsmouth, UK; Section of Human Anatomy, Department of Neuroscience, University of Padua, Padua, Italy.
| | - F Pieropan
- Institute of Biomedical and Biomolecular Sciences, School of Pharmacy and Biomedical Sciences, University of Portsmouth, St Michael's Building, White Swan Road, PO1 2DT Portsmouth, UK
| | - G Williams
- Wolfson Centre for Age-Related Diseases, King's College London, Guy's Campus, London, UK
| | - F Calzolari
- Research Group Adult Neurogenesis & Cellular Reprogramming Institute of Physiological Chemistry, University Medical Center, Johannes Gutenberg University Mainz, Hanns-Dieter-Hüsch-Weg 19, 55128 Mainz, Germany
| | - A M Butt
- Institute of Biomedical and Biomolecular Sciences, School of Pharmacy and Biomedical Sciences, University of Portsmouth, St Michael's Building, White Swan Road, PO1 2DT Portsmouth, UK
| | - K Azim
- Department of Neurology, Neuroregeneration, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany.
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Field E, Dyda A, Hewett M, Weng H, Shi J, Curtis S, Law C, McHugh L, Sheel M, Moore J, Furuya-Kanamori L, Pillai P, Konings P, Purcell M, Stocks N, Williams G, Lau CL. Development of the COVID-19 Real-Time Information System for Preparedness and Epidemic Response (CRISPER), Australia. Front Public Health 2021; 9:753493. [PMID: 34858930 PMCID: PMC8631999 DOI: 10.3389/fpubh.2021.753493] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 10/19/2021] [Indexed: 11/13/2022] Open
Abstract
Accurate and current information has been highlighted across the globe as a critical requirement for the COVID-19 pandemic response. To address this need, many interactive dashboards providing a range of different information about COVID-19 have been developed. A similar tool in Australia containing current information about COVID-19 could assist general practitioners and public health responders in their pandemic response efforts. The COVID-19 Real-time Information System for Preparedness and Epidemic Response (CRISPER) has been developed to provide accurate and spatially explicit real-time information for COVID-19 cases, deaths, testing and contact tracing locations in Australia. Developed based on feedback from key users and stakeholders, the system comprises three main components: (1) a data engine; (2) data visualization and interactive mapping tools; and (3) an automated alert system. This system provides integrated data from multiple sources in one platform which optimizes information sharing with public health responders, primary health care practitioners and the general public.
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Affiliation(s)
- Emma Field
- National Centre for Epidemiology and Population Health, Research School of Population Health, ANU College of Health and Medicine, Australian National University, Canberra, ACT, Australia.,Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Amalie Dyda
- School of Public Health, University of Queensland, Herston, QLD, Australia
| | - Michael Hewett
- The National Centre for Geographic Resources & Analysis in Primary Health Care (GRAPHC), Research School of Population Health, Australian National University, Canberra, ACT, Australia
| | - Haotian Weng
- Software Innovation Institute, Australian National University, Canberra, ACT, Australia
| | - Jingjing Shi
- Software Innovation Institute, Australian National University, Canberra, ACT, Australia
| | - Stephanie Curtis
- National Centre for Epidemiology and Population Health, Research School of Population Health, ANU College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Charlee Law
- National Centre for Epidemiology and Population Health, Research School of Population Health, ANU College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Lisa McHugh
- School of Public Health, University of Queensland, Herston, QLD, Australia
| | - Meru Sheel
- National Centre for Epidemiology and Population Health, Research School of Population Health, ANU College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Jess Moore
- School of Computing, Australian National University, Canberra, ACT, Australia
| | - Luis Furuya-Kanamori
- UQ Centre for Clinical Research, University of Queensland, Herston, QLD, Australia
| | | | - Paul Konings
- The National Centre for Geographic Resources & Analysis in Primary Health Care (GRAPHC), Research School of Population Health, Australian National University, Canberra, ACT, Australia
| | - Michael Purcell
- Software Innovation Institute, Australian National University, Canberra, ACT, Australia
| | - Nigel Stocks
- Discipline of General Practice, University of Adelaide, Adelaide, SA, Australia.,Australian Partnership for Preparedness Research on InfectiouS Disease Emergencies (APPRISE), The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Graham Williams
- Software Innovation Institute, Australian National University, Canberra, ACT, Australia
| | - Colleen L Lau
- School of Public Health, University of Queensland, Herston, QLD, Australia.,Research School of Population Health, ANU College of Health and Medicine, Australian National University, Canberra, ACT, Australia
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Pasala M, Anabtawi N, Grimshaw A, Clark D, Ubersax C, Williams G, Giri S. The impact of sarcopenia on survival among adults with hematologic malignancies: A systematic review and meta-analysis. J Geriatr Oncol 2021. [DOI: 10.1016/s1879-4068(21)00359-3] [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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22
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Dyda A, Purcell M, Curtis S, Field E, Pillai P, Ricardo K, Weng H, Moore JC, Hewett M, Williams G, Lau CL. Differential privacy for public health data: An innovative tool to optimize information sharing while protecting data confidentiality. Patterns 2021; 2:100366. [PMID: 34909703 PMCID: PMC8662814 DOI: 10.1016/j.patter.2021.100366] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Coronavirus disease 2019 (COVID-19) has highlighted the need for the timely collection and sharing of public health data. It is important that data sharing is balanced with protecting confidentiality. Here we discuss an innovative mechanism to protect health data, called differential privacy. Differential privacy is a mathematically rigorous definition of privacy that aims to protect against all possible adversaries. In layperson's terms, statistical noise is applied to the data so that overall patterns can be described, but data on individuals are unlikely to be extracted. One of the first use cases for health data in Australia is the development of the COVID-19 Real-Time Information System for Preparedness and Epidemic Response (CRISPER), which provides proof of concept for the use of this technology in the health sector. If successful, this will benefit future sharing of public health data. Differential privacy is an innovative technique that can be applied to data to protect confidentiality. This has been used primarily to protect private sector data, but has significant implications for public health. We describe the methods of differential privacy in terms understandable to a non-computer-science audience. To our knowledge, this is the first article describing differential privacy in language and context appropriate for a health audience. The case study described shows the feasibility of the use of differential privacy for public health surveillance data to optimize information sharing while protecting data confidentiality. This method allows for data to be released in more granular detail in terms of time, place, and person without compromising privacy and confidentiality. Future research needs to consider other use cases, including a range of surveillance systems and applications in other types of health data.
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Rangarajan S, Clark D, Ubersax C, Ye S, Bal S, Godby K, Ravi G, Costa L, Williams G, Bhatia S, Giri S. Discordance between simplified Frailty Score and the IMWG frailty score among newly diagnosed older adults with Multiple Myeloma: Findings from the CARE-HEME registry. J Geriatr Oncol 2021. [DOI: 10.1016/s1879-4068(21)00453-7] [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: 10/19/2022]
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Williams G, Karanikolos M. Mobilizing human resources. Eur J Public Health 2021. [PMCID: PMC8574555 DOI: 10.1093/eurpub/ckab164.288] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The COVID-19 pandemic has confronted health systems with extraordinary changes in demand for health services, which magnified underlying disparities in the health workforce. Initial health workforce capacities were critical, as health systems only have two options to increase workforce level: increasing capacity among the existing workforce or mobilising/recruiting additional personnel. Workforce capacity became a limiting factor in an effective pandemic response, particularly in countries with acute workforce shortages. Countries in Europe have pursued various strategies to rapidly surge the numbers of health workers and using their existing human resources differently, including by introducing or expanding on alternative and flexible approaches such as task shifting and other skill-mix changes. The pressure to provide services across the continuum of care, from prevention and vaccination to specialist and inpatient care, led several countries to re-evaluate the distribution of tasks among the health workforce. In the best cases, multidisciplinary team-based staffing models combined the skills of multiple health professionals, enabling provision of the right care at the right time. This presentation will provide an overview of strategies to increase capacity for surges in human resources requirements, as well as supporting measures that help recognise the key role of health workers in the pandemic response. A brief overview of key metrics to assess resilience in the area of human resources will also be provided.
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Affiliation(s)
- G Williams
- European Observatory on Health Systems and Policies, London, UK
- London School of Economics and Political Science, London, UK
| | - M Karanikolos
- European Observatory on Health Systems and Policies, London, UK
- LSHTM, London, UK
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Abstract
Abstract
Background
Models used to forecast the effects of population ageing on health financing usually only explore effects on health spending, while neglecting effects on health revenues.
Methods
Using publicly available data, we construct simulation models to project how changes in the population age mix affect both public sector health revenues and expenditures across a range of countries representing a diverse mix of health financing systems in Europe as well as the Western Pacific (Australia, Bulgaria, Japan, Slovenia, United Kingdom and Vietnam).
Results
By 2100, the largest gap between health revenues and expenditures due to population ageing under current health financing arrangements is expected in Vietnam; the majority of that health financing gap (87.1%) is attributable to expected growth in health expenditures. In Slovenia and Japan, the financing gaps are forecast to reach less than half that of Vietnam by 2100; however, the reasons for the increases in gaps vary. In Slovenia, nearly half of the increase in the gap (44.2%) is due to reductions in health revenues compared with just under one-third (28.7%) in Japan.
Conclusions
There is a perception that population ageing will have deleterious effects on the sustainability of public sector health financing. However, this is highly dependent on how financing systems are designed. Our simulation models demonstrate that comparative analyses that give equal attention to both health expenditures and revenues provide decision makers a balanced set of policy options for addressing the challenges of population ageing. The options range from targeting expenditures and utilization of services to diversifying revenue generation.
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Affiliation(s)
- J Cylus
- London Hub, European Observatory on Health Systems and Policies, London, UK
| | - G Williams
- London Hub, European Observatory on Health Systems and Policies, London, UK
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Williams G, Scarpetti G, Bezzina A, Vincenti K, Grech K, Kowalska-Bobko I, Sowada C, Furman M, Gałązka-Sobotka M, Maier CB. How are countries supporting health workers? Data from the COVID-19 Health System Response Monitor. Eur J Public Health 2021. [PMCID: PMC8574721 DOI: 10.1093/eurpub/ckab164.060] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Health workers have been at the forefront of treating and caring for patients with COVID-19. They were often under immense pressure to care for severely ill patients with a new disease, under strict hygiene conditions and with lockdown measures creating practical barriers to working. This study aims to explore the range of mental health, financial and other practical support measures that 36 countries in Europe and Canada have put in place to support health workers and enable them to do their job. Methods We use data extracted from the COVID-19 Health Systems Response Monitor (HSRM). We only consider initiatives implemented outside of clinical settings where COVID-19 patients are treated, and therefore exclude workplace provisions such as availability of personal protective equipment, working time limits or mandatory rest periods. Results We show that countries have implemented a range of measures, ranging from mental health and well-being support initiatives, to providing bonuses and temporary salary increases. Practical measures such as childcare provision and free transport and accommodation have also been implemented to ensure health workers can get to their workplace and have their children looked after. Other initiatives such as offering continuing professional development credits for knowledge learnt during the crisis were also offered in some countries, albeit less frequently. Conclusions While a large number of initiatives have been introduced, often as ad-hoc measures, their effectiveness in helping staff is unknown in most countries. The effectiveness of these initiatives should be evaluated to inform future crisis responses and strategies for health workforce development.
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Affiliation(s)
- G Williams
- European Observatory on Health Systems and Policies, London, UK
| | - G Scarpetti
- Technical University Berlin, Berlin, Germany
- European Observatory on Health Systems and Policies, Berlin, Germany
| | - A Bezzina
- Department for Policy in Health, Ministry of Health, Malta, Malta
| | - K Vincenti
- Department for Policy in Health, Ministry of Health, Malta, Malta
| | - K Grech
- University of Malta, Malta, Malta
| | - I Kowalska-Bobko
- Institute of Public Health, Jagiellonian University Medical College, Krakow, Poland
| | - C Sowada
- Institute of Public Health, Jagiellonian University Medical College, Krakow, Poland
| | - M Furman
- Institute of Public Health, Jagiellonian University Medical College, Krakow, Poland
| | - M Gałązka-Sobotka
- Institute of Health Care Management, Lazarski University, Warsaw, Poland
| | - CB Maier
- Technical University Berlin, Berlin, Germany
- European Observatory on Health Systems and Policies, Berlin, Germany
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Webb E, Hernández-Quevedo C, Williams G, Scarpetti G, Reed S, Panteli D. A cross-country comparison on providing health services effectively during the first wave of COVID-19. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.712] [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: 11/14/2022] Open
Abstract
Abstract
At the onset of the COVID-19 pandemic, health care providers had to abruptly change their way of providing care in order to simultaneously plan for and manage a rise of COVID-19 cases while maintaining essential health services. Even the most well-resourced health systems faced pressures from new challenges brought on by COVID-19, and every country had to make difficult choices about how to maintain access to essential care while treating a novel communicable disease. Using the information available on the HSRM platform from the early phases of the pandemic, we analyze how countries planned services for potential surge capacity, designed patient flows ensuring separation between COVID-19 and non-COVID-19 patients, and maintained routine services in both hospital and outpatient settings. Many country responses displayed striking similarities despite very real differences in the organization of health and care services. These include transitioning the management of COVID-19 mild cases from hospitals to outpatient settings, increasing the use of remote consultations, and cancelling or postponing non-urgent services during the height of the first wave. In the immediate future, countries will have to continue balancing care for COVID-19 and non-COVID-19 patients to minimize adverse health outcomes, ideally with supporting guidelines and COVID-19-specific care zones. Many countries expect to operate at lower capacity for routinely provided care, which will impact patient access and waiting times. Looking forward, policymakers will have to consider whether strategies adopted during the COVID-19 pandemic will become permanent features of care provision.
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Affiliation(s)
- E Webb
- Department of Health Care Management, Technical University Berlin, Berlin, Germany
- European Observatory on Health Systems and Policies, Technical University Berlin, Berlin, Germany
| | - C Hernández-Quevedo
- European Observatory on Health Systems and Policies, London School of Economics and Political Science, London, UK
| | - G Williams
- European Observatory on Health Systems and Policies, London School of Economics and Political Science, London, UK
| | - G Scarpetti
- Department of Health Care Management, Technical University Berlin, Berlin, Germany
- European Observatory on Health Systems and Policies, Technical University Berlin, Berlin, Germany
| | - S Reed
- Nuffield Trust, London, UK
| | - D Panteli
- European Observatory on Health Systems and Policies, Brussels, Belgium
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Whittaker T, Abdelrazek M, Fitzpatrick A, Froud J, Kelly J, Williamson J, Williams G. 732 Delay to Elective Colorectal Cancer Surgery and its Potential Implications During the Covid-19 Pandemic: A Systematic Review and Metanalysis. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.817] [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: 11/13/2022]
Abstract
Abstract
Aim
The ongoing Covid-19 pandemic has interrupted the surgical treatment of colorectal cancer (CRC). This systematic review will assess literature concerning the risk of delay of elective surgery for CRC patients, focusing on overall survival (OS) and disease-free survival (DFS).
Method
A systematic review was performed as per PRISMA guidelines (PROSPERO ID: CRD42020189158). Medline, EMBASE and Scopus were searched. Delay to elective surgery was defined as the period between CRC diagnosis and the day of surgery. Metanalyses of the outcome’s OS and DFS were conducted. Forest plots, funnel plots, and tests of heterogeneity were produced. An estimated Number Needed to Harm (NNH) was calculated for statistically significant pooled Hazard Ratios (HRs).
Results
Of 3753 articles identified, seven met the inclusion criteria. Encompassing 314560 patients, three of the seven studies showed that a delay to elective resection is associated with poorer OS or DFS. OS was assessed at a one-month delay, the HR for six datasets was 1.13 (95%CI 1.02-1.26, p = 0.020) and at three months the pooled HR for three datasets was 1.57 (95%CI 1.16-2.12, p = 0.004). Estimated NNHs for a delay at one month and three months were 35 and 10 respectively. Delay was non-significantly negatively associated with DFS on meta-analysis.
Conclusions
This review recommends that elective surgery for CRC patients is not postponed, as evidence suggests delays from diagnosis are associated with poorer outcomes. Focused research is essential so that patient groups can be prioritized based on risk factors for future pandemics.
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Affiliation(s)
- T Whittaker
- Cardiff University School of Medicine, Cardiff, United Kingdom
| | - M Abdelrazek
- Cardiff University School of Medicine, Cardiff, United Kingdom
| | - A Fitzpatrick
- Cardiff University School of Medicine, Cardiff, United Kingdom
| | - J Froud
- Cardiff University School of Medicine, Cardiff, United Kingdom
| | - J Kelly
- Cardiff University School of Medicine, Cardiff, United Kingdom
| | | | - G Williams
- Royal Gwent Hospital, Newport, United Kingdom
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Chappell A, Allison GT, Gibson N, Williams G, Morris S. The effect of a low-load plyometric running intervention on leg stiffness in youth with cerebral palsy: A randomised controlled trial. Gait Posture 2021; 90:441-448. [PMID: 34600178 DOI: 10.1016/j.gaitpost.2021.09.194] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 09/14/2021] [Accepted: 09/22/2021] [Indexed: 02/02/2023]
Abstract
AIM To determine whether a running intervention utilising plyometric activities improved leg stiffness in youth with cerebral palsy (CP), GMFCS levels I and II. METHOD This stratified randomised controlled trial examined the lower limb kinetics and kinematics of a sample of youths with CP during sub-maximal hopping and running, prior to and immediately following a 12-week running intervention that incorporated low load plyometric training. Included participants were 13 in the control group (mean age 13 years 2 months [SD 2 years 7 months]; six males; nine GMFCS level I; six unilateral) and 18 in the intervention group (mean age 12 years 9 months [SD 2 years 10 months]; 13 males; 11 GMFCS level I; nine unilateral). Derived variables included three-dimensional leg stiffness as well as resultant ground reaction force and change in leg length. Generalised linear mixed models were developed for statistical analysis. RESULTS At follow-up the intervention group had greater leg stiffness than the control group during submaximal hopping (Intervention median = 3278Nm-1; Control median = 1556Nm-1; p < 0.01). At follow-up, participants in the intervention group in GMFCS Level I had greater leg stiffness than the control group during jogging (Intervention mean=38.84 (SD=25.55); Control mean=29.38 (SD=11.11); t = 2.61 p = 0.01). INTERPRETATION A running training intervention which includes plyometric activities can improve leg stiffness in young people with CP, especially those in GMFCS level I.
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Affiliation(s)
- A Chappell
- School of Physiotherapy and Exercise Sciences, Curtin University, Kent St., Bentley, Western Australia 6102, Australia.
| | - G T Allison
- School of Physiotherapy and Exercise Sciences, Curtin University, Kent St., Bentley, Western Australia 6102, Australia
| | - N Gibson
- Perth Children's Hospital, Locked Bag 2010, Nedlands, Western Australia 6909, Australia
| | - G Williams
- School of Health Sciences, University of Melbourne, Victoria 3010, Australia
| | - S Morris
- School of Physiotherapy and Exercise Sciences, Curtin University, Kent St., Bentley, Western Australia 6102, Australia
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30
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Ryan JC, Williams G, Wiggins BW, Flitton AJ, McIntosh JT, Carmen MJ, Cox DN. Exploring the active ingredients of workplace physical and psychological wellbeing programs: a systematic review. Transl Behav Med 2021; 11:1127-1141. [PMID: 33677571 DOI: 10.1093/tbm/ibab003] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Previous reviews have established that workplace wellbeing initiatives are effective at promoting wellbeing, but less is known about which intervention characteristics or "active ingredients" underpin this effectiveness (i.e., behavior change techniques [BCTs]). This review aims to illuminate the connections between the types of BCTs and the level of intervention intensity with intervention effectiveness. A systematic search for peer-reviewed studies evaluating a workplace wellbeing initiative was undertaken across five databases: Medline, Scopus, PsycInfo, and CINAHL (Ovid Emcare). Eligible studies included those that evaluated the effect of a workplace wellbeing initiative on participants' physical wellbeing (e.g., physical activity and quality of life) and psychological wellbeing (e.g., mental health and stress), were published between 2009 and September 2019, and utilized a comparator (e.g., control group or prepost change). Studies were screened in independent duplicate to minimize bias. Effect sizes were calculated. Following removal of duplicates, 1,541 studies were identified and screened for eligibility. Of these, 23 studies reporting 28 comparisons were deemed to meet eligibility criteria. Just over 50% of these studies reported evidence of either a strong or moderate effect across a physical and a psychological outcome, providing a positive indication that workplace wellbeing programs can promote physical and psychological wellbeing in workers. Interventions tended to employ multiple BCTs (mean range 8.1-9.4), however, no discernible patterns between the types or numbers of BCTs employed and intervention effectiveness was found. Further experimental work is required that compares and contrasts workplace wellbeing initiatives to enable a better understanding of how to develop and implement highly effective programs.
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Affiliation(s)
- J C Ryan
- Precision Health Future Science Platform, Commonwealth Scientific and Industrial Research Organisation, Adelaide, South Australia.,Public Health and Wellbeing Research Group, Commonwealth Scientific and Industrial Research Organisation, Adelaide, South Australia
| | - G Williams
- Public Health and Wellbeing Research Group, Commonwealth Scientific and Industrial Research Organisation, Adelaide, South Australia
| | - B W Wiggins
- Precision Health Future Science Platform, Commonwealth Scientific and Industrial Research Organisation, Adelaide, South Australia.,Public Health and Wellbeing Research Group, Commonwealth Scientific and Industrial Research Organisation, Adelaide, South Australia
| | - A J Flitton
- Physiotherapy Discipline, Allied Health and Human Performance Unit, University of South Australia, Adelaide, South Australia
| | - J T McIntosh
- Physiotherapy Discipline, Allied Health and Human Performance Unit, University of South Australia, Adelaide, South Australia
| | - M J Carmen
- Physiotherapy Discipline, Allied Health and Human Performance Unit, University of South Australia, Adelaide, South Australia
| | - D N Cox
- Precision Health Future Science Platform, Commonwealth Scientific and Industrial Research Organisation, Adelaide, South Australia.,Public Health and Wellbeing Research Group, Commonwealth Scientific and Industrial Research Organisation, Adelaide, South Australia
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31
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Ooi R, Stimson IB, Williams G. 467 Impact of the Coronavirus Pandemic on Acute Surgical Patients’ Discharge Summaries. Br J Surg 2021. [PMCID: PMC8135886 DOI: 10.1093/bjs/znab134.428] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Background
The emergence of the Coronavirus pandemic has placed increased demands on the NHS workforce, especially in medical and intensive care units. The subsequent redistribution of surgical house officers to accommodate this in a single centre has possibly negatively impacted on the effective discharge notification of acute surgical patients.
Methods:
Discharge summaries of all patients discharged from a Surgical Assessment Unit were collected and analysed, to identify the date of completion and grade of responsible clinician. Data collection was carried out over three weeks before the initiation of lockdown measures and continued for a further three weeks during the peak of the Coronavirus pandemic with a three-week interventional period in between.
Results
In the initial audit, 36.2% of the 246 patients had delayed discharge summaries with an average of 7 days to complete. On re-evaluation, 45.3% of the 223 patients had delayed discharge summaries, with an average of 12 days to complete. A survey conducted post-re-audit identified that the most common reason for this was due to time constraints.
Conclusions
The reallocation of surgical staff has affected communication between primary and secondary care. Given the potential repercussions of these delays, healthcare systems should be made aware of this consequence, especially in preparation for any future resurgences.
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Affiliation(s)
- R Ooi
- Royal Gwent Hospital, Newport, United Kingdom
| | - I B Stimson
- Royal Gwent Hospital, Newport, United Kingdom
| | - G Williams
- Royal Gwent Hospital, Newport, United Kingdom
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Stewart MJ, Heisler C, Kohansal AR, Patel S, Williams G, Williams S, Miles M, Zhu J, Kulai T, Peltekian K, Gruchy SE, Epstein I, Farina D, Jones J. A109 LINKING PRIMARY AND SPECIALTY CARE FOR THE MANAGEMENT OF DIGESTIVE HEALTH CONDITIONS: AN EVALUATION OF GUT LINK IMPLEMENTATION. J Can Assoc Gastroenterol 2021. [PMCID: PMC7989500 DOI: 10.1093/jcag/gwab002.107] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Severe restrictions on in-person encounters and endoscopic procedures for digestive care have occurred as a result of the COVID-19 pandemic. This has exacerbated pre-existing barriers in access to gastroenterology (GI) care across Nova Scotia (NS) for patients and primary healthcare providers (PHCPs). In response, a provincial PHCP-GI consultative service (GUT LINK) was implemented at a single tertiary care center with the goal of supporting PHCPs in the management of non-urgent GI referral conditions. Aims To implement and evaluate the acceptability, feasibility, appropriateness, and early effectiveness of the GUT LINK PHCP-GI consultation service. Methods This is an ongoing prospective observational cohort study. All referrals received through the EMR-based referral and triage management system between May and November 2020 that were deemed to be amenable to management within primary care with specialist support were returned to the PHCP with the suggestion to arrange a GUT LINK telephone consultation. GUT LINK appointments were scheduled through an administrative support telephone line with the PHCP and a GI specialist. A post-consultation e-questionnaire was distributed to PHCPs who consented to participate. Feasibility (number of and indication for referrals, PHCP participation rates), acceptability and appropriateness (satisfaction, future use, likelihood to recommend) metrics and outcomes (case resolution, re-referrals, proportion requiring endoscopic investigations) were recorded. Patient charts were reviewed to determine whether the patient ultimately required GI speciality care. Analyses were descriptive and expressed as frequencies, means (+/-SD), medians (+/-SE), and proportions (%). Results A total of 45 GUT LINK consultations were completed between May and November 2020. Of these, 20% required GI specialist care and 80% have remained within primary care, with a median follow-up of 101 (+/-9.1) days. The indications for GUT LINK consultation included lower GI symptoms (64%), abnormal imaging or investigations (17%), and upper GI symptoms (19%). To date, 21 PHCP agreed to be contacted for the post-consultation survey and 10 have been completed. All PHCPs reported that GUT LINK consultation was easy to access, while 90% found the advice helpful and 80% reported that that it resolved the issue. Following the GUT LINK appointment, 80% felt they would not need to refer their patient to GI. Conclusions The implementation of GUT LINK was acceptable, feasible, and improved access to specialist support for management of undifferentiated GI symptoms. Future research will focus on comprehensive stakeholder engagement in order to design, implement, and evaluate GUT LINK PHCP care pathways. Funding Agencies CAG
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Affiliation(s)
- M J Stewart
- Dalhousie University Department of Medicine, Halifax, NS, Canada
| | - C Heisler
- Dalhousie University Department of Medicine, Halifax, NS, Canada
| | - A R Kohansal
- Dalhousie University Department of Medicine, Halifax, NS, Canada
| | - S Patel
- Dalhousie University Department of Medicine, Halifax, NS, Canada
| | - G Williams
- Dalhousie University Department of Medicine, Halifax, NS, Canada
| | - S Williams
- Dalhousie University Department of Medicine, Halifax, NS, Canada
| | - M Miles
- Dalhousie University Department of Medicine, Halifax, NS, Canada
| | - J Zhu
- Dalhousie University Department of Medicine, Halifax, NS, Canada
| | - T Kulai
- Dalhousie University Department of Medicine, Halifax, NS, Canada
| | - K Peltekian
- Dalhousie University Department of Medicine, Halifax, NS, Canada
| | - S E Gruchy
- Dalhousie University Department of Medicine, Halifax, NS, Canada
| | - I Epstein
- Dalhousie University Department of Medicine, Halifax, NS, Canada
| | - D Farina
- Dalhousie University Department of Medicine, Halifax, NS, Canada
| | - J Jones
- Dalhousie University Department of Medicine, Halifax, NS, Canada
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Lim DR, Tsai M, Gruchy SE, Jones J, Williams G, Farina D, Kohansal AR. A85 THE CLINICAL IMPACT OF COVID-19 DELAYS ON PLASTIC BILIARY STENT REMOVAL IN NOVA SCOTIA. J Can Assoc Gastroenterol 2021. [PMCID: PMC7958731 DOI: 10.1093/jcag/gwab002.083] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The COVID-2019 pandemic continues to restrict access to endoscopy, resulting in delays or cancellation of non-urgent endoscopic procedures. A delay in the removal or exchange of plastic biliary stents may lead to stent occlusion with consensus recommendation of stent removal or exchange at three-month intervals [1–4]. We postulated that delayed plastic biliary stent removal (DPBSR) would increase complication rates.
Aims
We aim to report our single-centre experience with complications arising from DPBSR.
Methods
This was a retrospective, single-center, observational cohort study. All subjects who had ERCP-guided plastic biliary stent placement in Halifax, Nova Scotia between Dec 2019 and June 2020 were included in the study. DPBSR was defined as stent removal >=90 days from insertion. Four endpoints were assigned to patients: 1. Stent removed endoscopically, 2. Died with stent in-situ (measured from stent placement to documented date of death/last clinical encounter before death), 3. Pending removal (subjects clinically well, no liver enzyme elevation, not expired, endpoint 1 Nov 2020), and 4. Complication requiring urgent reintervention. Kaplan-Meier survival analysis was used to represent duration of stent patency (Fig.1).
Results
102 (47.2%) had plastic biliary stents placed between 2/12/2019 and 29/6/2020. 49 (48%) were female, and the median age was 68 (R 16–91). Median follow-up was 167.5 days, 60 (58.8%) subjects had stent removal, 12 (11.8%) died before replacement, 21 (20.6%) were awaiting stent removal with no complications (median 230d, R 30–332), 9 (8.8%) had complications requiring urgent ERCP. Based on death reports, no deaths were related to stent-related complications.
72(70.6%) of patients had stents in-situ for >= 90 days. In this population, median time to removal was 211.5d (R 91-441d). 3 (4.2%) subjects had stent-related complications requiring urgent ERCP, mean time to complication was 218.3d (R 94–441). Stent removal >=90 days was not associated with complications such as occlusion, cholangitis, and migration (p=1.0). Days of stent in-situ was not associated with occlusion, cholangitis, and migration (p=0.57). Sex (p=0.275), cholecystectomy (p=1.0), cholangiocarcinoma (p=1.0), cholangitis (p=0.68) or pancreatitis (p=1.0) six weeks prior to ERCP, benign vs. malignant etiology (p=1.0) were not significantly associated with stent-related complications.
Conclusions
Plastic biliary stent longevity may have been previously underestimated. The findings of this study agree with CAG framework recommendations [5] that stent removal be prioritized as elective (P3). Limitations include small sample size that could affect Kaplan-Meier survival analysis. Despite prolonged indwelling stent time as a result of COVID-19, we did not observe an increased incidence of stent occlusion or other complications.
Funding Agencies
None
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Affiliation(s)
- D R Lim
- Gastroenterology, Dalhousie University, Halifax, NS, Canada
| | - M Tsai
- Gastroenterology, Dalhousie University, Halifax, NS, Canada
| | - S E Gruchy
- Gastroenterology, Dalhousie University, Halifax, NS, Canada
| | - J Jones
- Gastroenterology, Dalhousie University, Halifax, NS, Canada
| | - G Williams
- Gastroenterology, Dalhousie University, Halifax, NS, Canada
| | - D Farina
- Gastroenterology, Dalhousie University, Halifax, NS, Canada
| | - A R Kohansal
- Gastroenterology, Dalhousie University, Halifax, NS, Canada
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Pengelly J, Royse C, Royse A, El-Ansary D, Williams G, Bryant A. R01 Sternal Micromotion During Early Weighted Upper Limb Exercise Following Median Sternotomy: An Interim Analysis of the SAFE-ARMS Study. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.03.159] [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: 10/21/2022]
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Pengelly J, Royse C, Williams G, Bryant A, Clarke-Errey S, Royse A, El-Ansary D. The Effect of Supervised Early Resistance Training Versus Aerobic-Based Rehabilitation on Cognitive Recovery Following Cardiac Surgery via Median Sternotomy (SEcReT): A Pilot Randomised Controlled Trial. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.010] [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: 10/20/2022]
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Fang XT, Williams G, Castner S, Holden D, Zheng M, Najafzadeh S, Ropchan JR, Arnsten AF, Horvath T, Carson RE. The aging rhesus macaque as a potential model for Alzheimer's disease/dementia: An
in vivo
study of [
11
C]PIB, [
11
C]UCB‐j, [
18
F]MK‐6240 and working memory performance. Alzheimers Dement 2020. [DOI: 10.1002/alz.038467] [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: 11/06/2022]
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Sundaram V, Mohammed T, Rampersad S, Williams G. A rare report on 18-month survival of a dog born with multiple anomalies including atresia ani. Morphologie 2020; 105:252-258. [PMID: 33172785 DOI: 10.1016/j.morpho.2020.10.001] [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] [Received: 07/23/2020] [Revised: 10/06/2020] [Accepted: 10/07/2020] [Indexed: 10/23/2022]
Abstract
Long term survival of animals with major congenital anomalies is very rare. This report documents the 18-month survival of a dog with multiple anomalies including atresia ani. An 18-month-old black Cocker Spaniel bitch was presented for evaluation of prolapsed glands of the third eyelid involving both the eyes. Clinical examination revealed a single perineal opening, fecal matter in the vestibule, distended abdomen, hypoplastic vulva, and the absence of a tail without any neurological deficits. Abdominal contrast radiography revealed a distended colon with fecal stasis, rectovestibular fistula, termination of the rectum as a blind pouch, lumbar scoliosis due to block vertebrae, and the presence of only two hypoplastic coccygeal vertebrae. The case was diagnosed as atresia ani type II with rectovestibular fistula, hypoplastic vulva, lumbar scoliosis, and anury, in the global context of a caudal regression syndrome. The wide aperture fistula, connected to the vestibule, undamaged spinal cord and sacrum without any neurological deficits were the favorable prognostic factors that maintained continence and allowed the dog to survive to adult life with these anomalies. Thus, an appropriate bowel management program and specialty care can improve the quality of life and longevity of this animal.
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Affiliation(s)
- V Sundaram
- Anatomy Unit, Department of Basic Veterinary Sciences, School of Veterinary Medicine, Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago.
| | - T Mohammed
- Anatomy Unit, Department of Basic Veterinary Sciences, School of Veterinary Medicine, Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - S Rampersad
- Anatomy Unit, Department of Basic Veterinary Sciences, School of Veterinary Medicine, Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - G Williams
- Anatomy Unit, Department of Basic Veterinary Sciences, School of Veterinary Medicine, Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago
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Williams G, Kwan E, Giraldo CN, Lincoln M, Lewin-Smith M. Panniculitis at the Site of Injection: Infection or Foreign Body Reaction? Am J Clin Pathol 2020. [DOI: 10.1093/ajcp/aqaa161.058] [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: 11/13/2022] Open
Abstract
Abstract
Introduction/Objective
A 63 year old diabetic female presented to the dermatology clinic with painful abdominal nodules. The nodules seemed to wax and wane every 1–2 weeks and appeared in different locations on the abdomen. The lesions were subcutaneous, tender, firm, and mobile with no discoloration. The patient had diabetes treated with injectable exenatide but no other significant medical or travel history.
Methods
The differential diagnoses included mycobacterial infection, mechanical insult from injectable diabetes medication, erythema nodosum, erythema induratum, and lupus panniculitis. Ultrasound was indicative of panniculitis. A biopsy of the active lesion was performed.
Results
The biopsy showed septal and lobular panniculitis with mixed inflammation and multinucleated giant cells. Small, circular, non-polarizable pink amphorous material was associated with the infiltrate. The amphorous material was strongly acid fast. The patient had a negative quantiferon-TB test. Scanning electron microscopy with energy dispersive x-ray analysis showed that the material contained more oxygen and less carbon than surrounding tissue, but no abnormal elements were identified. Infrared spectroscopy of the foreign material most closely matched poly(L- lactide-co-glycolide).
Conclusion
The diagnosis of exenatide induced granulomatous panniculitis was made. The patient had recently started using this injectable glucagon-like peptide-1 receptor agonist, which has been associated with panniculitis. The injectable formulation is loaded onto microspheres composed of poly (DL-lactic-co-glycolic acid), which is closely related to poly(L-lactide-co-glycolide). This material has been shown to stain strongly acid fast. This case of granulomatous panniculitis due to injectable diabetic medication highlights an important potential pitfall that pathologists should be aware of, especially in cases where mycobacterial infection is in the differential.
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Affiliation(s)
- G Williams
- DPALS, SAUSHEC, Schertz, Texas, UNITED STATES
| | - E Kwan
- DPALS, SAUSHEC, Schertz, Texas, UNITED STATES
| | - C N Giraldo
- DPALS, SAUSHEC, Schertz, Texas, UNITED STATES
| | - M Lincoln
- DPALS, SAUSHEC, Schertz, Texas, UNITED STATES
| | - M Lewin-Smith
- The Joint Pathology Center, Silver Spring, Maryland, UNITED STATES
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Broadwater DR, Williams G, Messersmith L, Brady R. Does PD-L1 Positivity in Inflammatory Cells Correlate with PD-L1 Expression in Tumor Cells in Colorectal Adenocarcinoma? Am J Clin Pathol 2020. [DOI: 10.1093/ajcp/aqaa161.343] [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: 11/12/2022] Open
Abstract
Abstract
Introduction/Objective
Drugs targeting the programmed death-1 (PD-1) and programmed death-ligand 1 (PD-L1) checkpoint is an important type of novel immunotherapy. These checkpoint inhibitors are being used in a wide variety of cancers, including colorectal carcinoma (CRC). PD-L1 expression on tumor cells in CRC is predictive of good response to checkpoint inhibitor therapies. PD-L1 expression on tumor infiltrating immune cells (TIIC) is increasingly observed and independently portends good prognosis. The relationship between PD-L1 positivity in TIIC and tumor cells is not well established. In this study, the relationship and correlation of PD-L1 positivity in TIIC and tumor cells were retrospectively reviewed.
Methods
197 sections of CRC from 33 cases (mean of 6 sections/case) with heterogeneous expression of PD-L1 on tumor cells were stained for PD-L1 with immunohistochemistry. None of the patients had received neo-adjuvant therapy. The presence of tumor cells and immune cells with positive PD-L1 expression was noted for each section.
Results
Immune cells were positive in 79% of the sections examined. TIIC were positive in 56% of the sections examined. A Cohen’s correlation study showed correlation between tumor cells and TIIC in 77% of the cases (k=0.51, moderate agreement). There was at least one section with PD-L1 positive TIIC in 97% of cases.
Conclusion
This study shows that PD-L1 is expressed in TIIC in the vast majority of CRC cases designated PD-L1 positive and that PD-L1 is positive in TIIC at a higher rate than in tumor cells. The moderate correlation is interesting, perhaps suggesting that if TIIC are noted to be positive for PD-L1 and tumor cells are not, additional sections of tumor should be stained.
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Affiliation(s)
| | - G Williams
- Pathology, SAUSHEC, San Antonio, Texas, UNITED STATES
| | - L Messersmith
- Pathology, SAUSHEC, San Antonio, Texas, UNITED STATES
| | - R Brady
- Pathology, SAUSHEC, San Antonio, Texas, UNITED STATES
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Messersmith L, Williams G, Broadwater` DR, Brady R. Heterogeneity and Geographical Patterns of PD-L1 Positive Tumor Infiltrating Immune Cells in Colonic Adenocarcinoma. Am J Clin Pathol 2020. [DOI: 10.1093/ajcp/aqaa161.340] [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: 11/12/2022] Open
Abstract
Abstract
Introduction/Objective
Programmed death-ligand 1 (PD-L1) status is an important prognostic and predictive biomarker. PD-L1 status is difficult to accurately assess in tumor cells (TCs) due to tumor heterogeneity and lack of standardized histologic evaluation. PD-L1 expression by tumor infiltrating immune cells (TIICs) is an independent prognostic marker and may provide fewer diagnostic challenges, as TIICs appear less heterogeneous. We examined the geographical patterns of PD-L1 expression in TCs and TIICs in order to evaluate heterogeneity and ease of histological evaluation.
Methods
197 blocks of colonic adenocarcinoma from 33 patients were retrospectively reviewed and stained for PD- L1. PD-L1 was interpreted as positive or negative in the TCs and TIICs. Geographical patterns of expression were recorded for the TCs and the TIICs at the surface, center of tumor, and invasive margin. Geographical patterns were compared using a chi-square test.
Results
56% of blocks had PD-L1 positive TCs. 42.7% showed positive TCs at the invasive margin. 38.2% had positive TCs at the invasive margin and surface. No blocks had positive TCs at the center of the tumor. 79% of blocks had PD-L1 positive TIICs. 20% showed positive TIICs at the invasive margin. 37.4% had positive TIICs at the surface and invasive margin. 15.5% of TIICs expressed PD-L1 throughout the tumor. There was a statistically significant difference in PD-L1 expression on TCs versus TIICs in 4 of the 7 geographic patterns.
Conclusion
PD-L1 expression on TCs of colonic adenocarcinoma is more heterogeneous than PD-L1 expression by TIICs. TIICs express PD-L1 more consistently throughout the tumor and are easier to identify and report. PD-L1 expression by TIICs is an independent prognostic indicator and may be more useful than TCs when evaluating the tumor microenvironment and determining PD-L1 status.
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Affiliation(s)
- L Messersmith
- DPALS, Brooke Army Medical Center, Ft. Sam Houston, Texas, UNITED STATES
| | - G Williams
- DPALS, Brooke Army Medical Center, Ft. Sam Houston, Texas, UNITED STATES
| | - D R Broadwater`
- DPALS, Brooke Army Medical Center, Ft. Sam Houston, Texas, UNITED STATES
| | - R Brady
- DPALS, Brooke Army Medical Center, Ft. Sam Houston, Texas, UNITED STATES
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Williams G, Jacob G, Scotter C, Rakovac I, Wismar M. Health professional mobility and the Global Code of Practice: joint EUROSTAT/OECD/WHO survey data. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.105] [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: 11/15/2022] Open
Abstract
Abstract
Background
This study assesses the impact and continuing relevance of the Code of Practice on the International Recruitment of Health Personnel in the WHO Europe region by analysing trends over time in intra- and inter-regional health worker mobility.
Methods
Data from the joint EUROSTAT/OECD/WHO questionnaire are analysed to determine 1) the proportion of foreign-born and foreign-trained doctors and nurses working in WHO Europe Member States, 2) trends in health workforce mobility over time by country of origin and destination, and 3) how the Global Code has impacted mobility patterns.
Results
The size of the foreign-trained health workforce in Europe varies widely, with foreign-trained doctors comprising over a quarter of the workforce in Norway, Switzerland and the UK, but below 2% in Estonia and Serbia. While annual in-flows across the region have been stable since 2009, the share of foreign-trained doctors and nurses have both increased by over 30%. Mobility between The Commonwealth of Independent States has remained steady, but an increase in East-West and South-North migration is observed, driven by European Union expansion in 2004 and the economic crisis. Migration of health workers into Europe from developing countries covered by the Code has fluctuated, with increased numbers seen from some origin countries (e.g. Nigeria, Pakistan). Some Western countries remain reliant on a foreign-trained health workforce. This contributes to a high outward flow of health professionals from other European countries and creates challenges for sustainable workforce development.
Conclusions
The Global Code remains highly relevant, but other factors have more impact on migration flows, such as free movement in the EU. Health workforce mobility data can be improved to support a 'whole of workforce' approach to policy and planning by including more professional groups, and by adding qualitative indicators, e.g. individual perceptions and intention to leave.
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Affiliation(s)
- G Williams
- European Observatory on Health Systems and Policies, London, UK
| | - G Jacob
- WHO/Europe, Copenhagen, Denmark
| | | | | | - M Wismar
- European Observatory on Health Systems and Policies, Brussels, Belgium
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McLean KA, Ahmed WUR, Akhbari M, Claireaux HA, English C, Frost J, Henshall DE, Khan M, Kwek I, Nicola M, Rehman S, Varghese S, Drake TM, Bell S, Nepogodiev D, McLean KA, Drake TM, Glasbey JC, Borakati A, Drake TM, Kamarajah S, McLean KA, Bath MF, Claireaux HA, Gundogan B, Mohan M, Deekonda P, Kong C, Joyce H, Mcnamee L, Woin E, Burke J, Khatri C, Fitzgerald JE, Harrison EM, Bhangu A, Nepogodiev D, Arulkumaran N, Bell S, Duthie F, Hughes J, Pinkney TD, Prowle J, Richards T, Thomas M, Dynes K, Patel M, Patel P, Wigley C, Suresh R, Shaw A, Klimach S, Jull P, Evans D, Preece R, Ibrahim I, Manikavasagar V, Smith R, Brown FS, Deekonda P, Teo R, Sim DPY, Borakati A, Logan AE, Barai I, Amin H, Suresh S, Sethi R, Bolton W, Corbridge O, Horne L, Attalla M, Morley R, Robinson C, Hoskins T, McAllister R, Lee S, Dennis Y, Nixon G, Heywood E, Wilson H, Ng L, Samaraweera S, Mills A, Doherty C, Woin E, Belchos J, Phan V, Chouari T, Gardner T, Goergen N, Hayes JDB, MacLeod CS, McCormack R, McKinley A, McKinstry S, Milligan W, Ooi L, Rafiq NM, Sammut T, Sinclair E, Smith M, Baker C, Boulton APR, Collins J, Copley HC, Fearnhead N, Fox H, Mah T, McKenna J, Naruka V, Nigam N, Nourallah B, Perera S, Qureshi A, Saggar S, Sun L, Wang X, Yang DD, Caroll P, Doyle C, Elangovan S, Falamarzi A, Perai KG, Greenan E, Jain D, Lang-Orsini M, Lim S, O'Byrne L, Ridgway P, Van der Laan S, Wong J, Arthur J, Barclay J, Bradley P, Edwin C, Finch E, Hayashi E, Hopkins M, Kelly D, Kelly M, McCartan N, Ormrod A, Pakenham A, Hayward J, Hitchen C, Kishore A, Martins T, Philomen J, Rao R, Rickards C, Burns N, Copeland M, Durand C, Dyal A, Ghaffar A, Gidwani A, Grant M, Gribbon C, Gruhn A, Leer M, Ahmad K, Beattie G, Beatty M, Campbell G, Donaldson G, Graham S, Holmes D, Kanabar S, Liu H, McCann C, Stewart R, Vara S, Ajibola-Taylor O, Andah EJE, Ani C, Cabdi NMO, Ito G, Jones M, Komoriyama A, Patel P, Titu L, Basra M, Gallogly P, Harinath G, Leong SH, Pradhan A, Siddiqui I, Zaat S, Ali A, Galea M, Looi WL, Ng JCK, Atkin G, Azizi A, Cargill Z, China Z, Elliot J, Jebakumar R, Lam J, Mudalige G, Onyerindu C, Renju M, Babu VS, Hussain M, Joji N, Lovett B, Mownah H, Ali B, Cresswell B, Dhillon AK, Dupaguntla YS, Hungwe C, Lowe-Zinola JD, Tsang JCH, Bevan K, Cardus C, Duggal A, Hossain S, McHugh M, Scott M, Chan F, Evans R, Gurung E, Haughey B, Jacob-Ramsdale B, Kerr M, Lee J, McCann E, O'Boyle K, Reid N, Hayat F, Hodgson S, Johnston R, Jones W, Khan M, Linn T, Long S, Seetharam P, Shaman S, Smart B, Anilkumar A, Davies J, Griffith J, Hughes B, Islam Y, Kidanu D, Mushaini N, Qamar I, Robinson H, Schramm M, Tan CY, Apperley H, Billyard C, Blazeby JM, Cannon SP, Carse S, Göpfert A, Loizidou A, Parkin J, Sanders E, Sharma S, Slade G, Telfer R, Huppatz IW, Worley E, Chandramoorthy L, Friend C, Harris L, Jain P, Karim MJ, Killington K, McGillicuddy J, Rafferty C, Rahunathan N, Rayne T, Varathan Y, Verma N, Zanichelli D, Arneill M, Brown F, Campbell B, Crozier L, Henry J, McCusker C, Prabakaran P, Wilson R, Asif U, Connor M, Dindyal S, Math N, Pagarkar A, Saleem H, Seth I, Sharma S, Standfield N, Swartbol T, Adamson R, Choi JE, El Tokhy O, Ho W, Javaid NR, Kelly M, Mehdi AS, Menon D, Plumptre I, Sturrock S, Turner J, Warren O, Crane E, Ferris B, Gadsby C, Smallwood J, Vipond M, Wilson V, Amarnath T, Doshi A, Gregory C, Kandiah K, Powell B, Spoor H, Toh C, Vizor R, Common M, Dunleavy K, Harris S, Luo C, Mesbah Z, Kumar AP, Redmond A, Skulsky S, Walsh T, Daly D, Deery L, Epanomeritakis E, Harty M, Kane D, Khan K, Mackey R, McConville J, McGinnity K, Nixon G, Ang A, Kee JY, Leung E, Norman S, Palaniappan SV, Sarathy PP, Yeoh T, Frost J, Hazeldine P, Jones L, Karbowiak M, Macdonald C, Mutarambirwa A, Omotade A, Runkel M, Ryan G, Sawers N, Searle C, Suresh S, Vig S, Ahmad A, McGartland R, Sim R, Song A, Wayman J, Brown R, Chang LH, Concannon K, Crilly C, Arnold TJ, Burgin A, Cadden F, Choy CH, Coleman M, Lim D, Luk J, Mahankali-Rao P, Prudence-Taylor AJ, Ramakrishnan D, Russell J, Fawole A, Gohil J, Green B, Hussain A, McMenamin L, McMenamin L, Tang M, Azmi F, Benchetrit S, Cope T, Haque A, Harlinska A, Holdsworth R, Ivo T, Martin J, Nisar T, Patel A, Sasapu K, Trevett J, Vernet G, Aamir A, Bird C, Durham-Hall A, Gibson W, Hartley J, May N, Maynard V, Johnson S, Wood CM, O'Brien M, Orbell J, Stringfellow TD, Tenters F, Tresidder S, Cheung W, Grant A, Tod N, Bews-Hair M, Lim ZH, Lim SW, Vella-Baldacchino M, Auckburally S, Chopada A, Easdon S, Goodson R, McCurdie F, Narouz M, Radford A, Rea E, Taylor O, Yu T, Alfa-Wali M, Amani L, Auluck I, Bruce P, Emberton J, Kumar R, Lagzouli N, Mehta A, Murtaza A, Raja M, Dennahy IS, Frew K, Given A, He YY, Karim MA, MacDonald E, McDonald E, McVinnie D, Ng SK, Pettit A, Sim DPY, Berthaume-Hawkins SD, Charnley R, Fenton K, Jones D, Murphy C, Ng JQ, Reehal R, Robinson H, Seraj SS, Shang E, Tonks A, White P, Yeo A, Chong P, Gabriel R, Patel N, Richardson E, Symons L, Aubrey-Jones D, Dawood S, Dobrzynska M, Faulkner S, Griffiths H, Mahmood F, Patel P, Perry M, Power A, Simpson R, Ali A, Brobbey P, Burrows A, Elder P, Ganyani R, Horseman C, Hurst P, Mann H, Marimuthu K, McBride S, Pilsworth E, Powers N, Stanier P, Innes R, Kersey T, Kopczynska M, Langasco N, Patel N, Rajagopal R, Atkins B, Beasley W, Lim ZC, Gill A, Ang HL, Williams H, Yogeswara T, Carter R, Fam M, Fong J, Latter J, Long M, Mackinnon S, McKenzie C, Osmanska J, Raghuvir V, Shafi A, Tsang K, Walker L, Bountra K, Coldicutt O, Fletcher D, Hudson S, Iqbal S, Bernal TL, Martin JWB, Moss-Lawton F, Smallwood J, Vipond M, Cardwell A, Edgerton K, Laws J, Rai A, Robinson K, Waite K, Ward J, Youssef H, Knight C, Koo PY, Lazarou A, Stanger S, Thorn C, Triniman MC, Botha A, Boyles L, Cumming S, Deepak S, Ezzat A, Fowler AJ, Gwozdz AM, Hussain SF, Khan S, Li H, Morrell BL, Neville J, Nitiahpapand R, Pickering O, Sagoo H, Sharma E, Welsh K, Denley S, Khan S, Agarwal M, Al-Saadi N, Bhambra R, Gupta A, Jawad ZAR, Jiao LR, Khan K, Mahir G, Singagireson S, Thoms BL, Tseu B, Wei R, Yang N, Britton N, Leinhardt D, Mahfooz M, Palkhi A, Price M, Sheikh S, Barker M, Bowley D, Cant M, Datta U, Farooqi M, Lee A, Morley G, Amin MN, Parry A, Patel S, Strang S, Yoganayagam N, Adlan A, Chandramoorthy S, Choudhary Y, Das K, Feldman M, France B, Grace R, Puddy H, Soor P, Ali M, Dhillon P, Faraj A, Gerard L, Glover M, Imran H, Kim S, Patrick Y, Peto J, Prabhudesai A, Smith R, Tang A, Vadgama N, Dhaliwal R, Ecclestone T, Harris A, Ong D, Patel D, Philp C, Stewart E, Wang L, Wong E, Xu Y, Ashaye T, Fozard T, Galloway F, Kaptanis S, Mistry P, Nguyen T, Olagbaiye F, Osman M, Philip Z, Rembacken R, Tayeh S, Theodoropoulou K, Herman A, Lau J, Saha A, Trotter M, Adeleye O, Cave D, Gunwa T, Magalhães J, Makwana S, Mason R, Parish M, Regan H, Renwick P, Roberts G, Salekin D, Sivakumar C, Tariq A, Liew I, McDade A, Stewart D, Hague M, Hudson-Peacock N, Jackson CES, James F, Pitt J, Walker EY, Aftab R, Ang JJ, Anwar S, Battle J, Budd E, Chui J, Crook H, Davies P, Easby S, Hackney E, Ho B, Imam SZ, Rammell J, Andrews H, Perry C, Schinle P, Ahmed P, Aquilina T, Balai E, Church M, Cumber E, Curtis A, Davies G, Dennis Y, Dumann E, Greenhalgh S, Kim P, King S, Metcalfe KHM, Passby L, Redgrave N, Soonawalla Z, Waters S, Zornoza A, Gulzar I, Hole J, Hull K, Ishaq H, Karaj J, Kelkar A, Love E, Patel S, Thakrar D, Vine M, Waterman A, Dib NP, Francis N, Hanson M, Ingleton R, Sadanand KS, Sukirthan N, Arnell S, Ball M, Bassam N, Beghal G, Chang A, Dawe V, George A, Huq T, Hussain A, Ikram B, Kanapeckaite L, Khan M, Ramjas D, Rushd A, Sait S, Serry M, Yardimci E, Capella S, Chenciner L, Episkopos C, Karam E, McCarthy C, Moore-Kelly W, Watson N, Ahluwalia V, Barnfield J, Ben-Gal O, Bloom I, Gharatya A, Khodatars K, Merchant N, Moonan A, Moore M, Patel K, Spiers H, Sundaram K, Turner J, Bath MF, Black J, Chadwick H, Huisman L, Ingram H, Khan S, Martin L, Metcalfe M, Sangal P, Seehra J, Thatcher A, Venturini S, Whitcroft I, Afzal Z, Brown S, Gani A, Gomaa A, Hussein N, Oh SY, Pazhaniappan N, Sharkey E, Sivagnanasithiyar T, Williams C, Yeung J, Cruddas L, Gurjar S, Pau A, Prakash R, Randhawa R, Chen L, Eiben I, Naylor M, Osei-Bordom D, Trenear R, Bannard-Smith J, Griffiths N, Patel BY, Saeed F, Abdikadir H, Bennett M, Church R, Clements SE, Court J, Delvi A, Hubert J, Macdonald B, Mansour F, Patel RR, Perris R, Small S, Betts A, Brown N, Chong A, Croitoru C, Grey A, Hickland P, Ho C, Hollington D, McKie L, Nelson AR, Stewart H, Eiben P, Nedham M, Ali I, Brown T, Cumming S, Hunt C, Joyner C, McAlinden C, Roberts J, Rogers D, Thachettu A, Tyson N, Vaughan R, Verma N, Yasin T, Andrew K, Bhamra N, Leong S, Mistry R, Noble H, Rashed F, Walker NR, Watson L, Worsfold M, Yarham E, Abdikadir H, Arshad A, Barmayehvar B, Cato L, Chan-lam N, Do V, Leong A, Sheikh Z, Zheleniakova T, Coppel J, Hussain ST, Mahmood R, Nourzaie R, Prowle J, Sheik-Ali S, Thomas A, Alagappan A, Ashour R, Bains H, Diamond J, Gordon J, Ibrahim B, Khalil M, Mittapalli D, Neo YN, Patil P, Peck FS, Reza N, Swan I, Whyte M, Chaudhry S, Hernon J, Khawar H, O'Brien J, Pullinger M, Rothnie K, Ujjal S, Bhatte S, Curtis J, Green S, Mayer A, Watkinson G, Chapple K, Hawthorne T, Khaliq M, Majkowski L, Malik TAM, Mclauchlan K, En BNW, Parton S, Robinson SD, Saat MI, Shurovi BN, Varatharasasingam K, Ward AE, Behranwala K, Bertelli M, Cohen J, Duff F, Fafemi O, Gupta R, Manimaran M, Mayhew J, Peprah D, Wong MHY, Farmer N, Houghton C, Kandhari N, Khan K, Ladha D, Mayes J, McLennan F, Panahi P, Seehra H, Agrawal R, Ahmed I, Ali S, Birkinshaw F, Choudhry M, Gokani S, Harrogate S, Jamal S, Nawrozzadeh F, Swaray A, Szczap A, Warusavitarne J, Abdalla M, Asemota N, Cullum R, Hartley M, Maxwell-Armstrong C, Mulvenna C, Phillips J, Yule A, Ahmed L, Clement KD, Craig N, Elseedawy E, Gorman D, Kane L, Livie J, Livie V, Moss E, Naasan A, Ravi F, Shields P, Zhu Y, Archer M, Cobley H, Dennis R, Downes C, Guevel B, Lamptey E, Murray H, Radhakrishnan A, Saravanabavan S, Sardar M, Shaw C, Tilliridou V, Wright R, Ye W, Alturki N, Helliwell R, Jones E, Kelly D, Lambotharan S, Scott K, Sivakumar R, Victor L, Boraluwe-Rallage H, Froggatt P, Haynes S, Hung YMA, Keyte A, Matthews L, Evans E, Haray P, John I, Mathivanan A, Morgan L, Oji O, Okorocha C, Rutherford A, Spiers H, Stageman N, Tsui A, Whitham R, Amoah-Arko A, Cecil E, Dietrich A, Fitzpatrick H, Guy C, Hair J, Hilton J, Jawad L, McAleer E, Taylor Z, Yap J, Akhbari M, Debnath D, Dhir T, Elbuzidi M, Elsaddig M, Glace S, Khawaja H, Koshy R, Lal K, Lobo L, McDermott A, Meredith J, Qamar MA, Vaidya A, Acquaah F, Barfi L, Carter N, Gnanappiragasam D, Ji C, Kaminski F, Lawday S, Mackay K, Sulaiman SK, Webb R, Ananthavarathan P, Dalal F, Farrar E, Hashemi R, Hossain M, Jiang J, Kiandee M, Lex J, Mason L, Matthews JH, McGeorge E, Modhwadia S, Pinkney T, Radotra A, Rickard L, Rodman L, Sales A, Tan KL, Bachi A, Bajwa DS, Battle J, Brown LR, Butler A, Calciu A, Davies E, Gardner I, Girdlestone T, Ikogho O, Keelan G, O'Loughlin P, Tam J, Elias J, Ngaage M, Thompson J, Bristow S, Brock E, Davis H, Pantelidou M, Sathiyakeerthy A, Singh K, Chaudhry A, Dickson G, Glen P, Gregoriou K, Hamid H, Mclean A, Mehtaji P, Neophytou G, Potts S, Belgaid DR, Burke J, Durno J, Ghailan N, Hanson M, Henshaw V, Nazir UR, Omar I, Riley BJ, Roberts J, Smart G, Van Winsen K, Bhatti A, Chan M, D'Auria M, Green S, Keshvala C, Li H, Maxwell-Armstrong C, Michaelidou M, Simmonds L, Smith C, Wimalathasan A, Abbas J, Cairns C, Chin YR, Connelly A, Moug S, Nair A, Svolkinas D, Coe P, Subar D, Wang H, Zaver V, Brayley J, Cookson P, Cunningham L, Gaukroger A, Ho M, Hough A, King J, O'Hagan D, Widdison A, Brown R, Brown B, Chavan A, Francis S, Hare L, Lund J, Malone N, Mavi B, McIlwaine A, Rangarajan S, Abuhussein N, Campbell HS, Daniels J, Fitzgerald I, Mansfield S, Pendrill A, Robertson D, Smart YW, Teng T, Yates J, Belgaumkar A, Katira A, Kossoff J, Kukran S, Laing C, Mathew B, Mohamed T, Myers S, Novell R, Phillips BL, Thomas M, Turlejski T, Turner S, Varcada M, Warren L, Wynell-Mayow W, Church R, Linley-Adams L, Osborn G, Saunders M, Spencer R, Srikanthan M, Tailor S, Tullett A, Ali M, Al-Masri S, Carr G, Ebhogiaye O, Heng S, Manivannan S, Manley J, McMillan LE, Peat C, Phillips B, Thomas S, Whewell H, Williams G, Bienias A, Cope EA, Courquin GR, Day L, Garner C, Gimson A, Harris C, Markham K, Moore T, Nadin T, Phillips C, Subratty SM, Brown K, Dada J, Durbacz M, Filipescu T, Harrison E, Kennedy ED, Khoo E, Kremel D, Lyell I, Pronin S, Tummon R, Ventre C, Walls L, Wootton E, Akhtar A, Davies E, El-Sawy D, Farooq M, Gaddah M, Griffiths H, Katsaiti I, Khadem N, Leong K, Williams I, Chean CS, Chudek D, Desai H, Ellerby N, Hammad A, Malla S, Murphy B, Oshin O, Popova P, Rana S, Ward T, Abbott TEF, Akpenyi O, Edozie F, El Matary R, English W, Jeyabaladevan S, Morgan C, Naidu V, Nicholls K, Peroos S, Prowle J, Sansome S, Torrance HD, Townsend D, Brecher J, Fung H, Kazmi Z, Outlaw P, Pursnani K, Ramanujam N, Razaq A, Sattar M, Sukumar S, Tan TSE, Chohan K, Dhuna S, Haq T, Kirby S, Lacy-Colson J, Logan P, Malik Q, McCann J, Mughal Z, Sadiq S, Sharif I, Shingles C, Simon A, Burnage S, Chan SSN, Craig ARJ, Duffield J, Dutta A, Eastwood M, Iqbal F, Mahmood F, Mahmood W, Patel C, Qadeer A, Robinson A, Rotundo A, Schade A, Slade RD, De Freitas M, Kinnersley H, McDowell E, Moens-Lecumberri S, Ramsden J, Rockall T, Wiffen L, Wright S, Bruce C, Francois V, Hamdan K, Limb C, Lunt AJ, Manley L, Marks M, Phillips CFE, Agnew CJF, Barr CJ, Benons N, Hart SJ, Kandage D, Krysztopik R, Mahalingam P, Mock J, Rajendran S, Stoddart MT, Clements B, Gillespie H, Lee S, McDougall R, Murray C, O'Loane R, Periketi S, Tan S, Amoah R, Bhudia R, Dudley B, Gilbert A, Griffiths B, Khan H, McKigney N, Roberts B, Samuel R, Seelarbokus A, Stubbing-Moore A, Thompson G, Williams P, Ahmed N, Akhtar R, Chandler E, Chappelow I, Gil H, Gower T, Kale A, Lingam G, Rutler L, Sellahewa C, Sheikh A, Stringer H, Taylor R, Aglan H, Ashraf MR, Choo S, Das E, Epstein J, Gentry R, Mills D, Poolovadoo Y, Ward N, Bull K, Cole A, Hack J, Khawari S, Lake C, Mandishona T, Perry R, Sleight S, Sultan S, Thornton T, Williams S, Arif T, Castle A, Chauhan P, Chesner R, Eilon T, Kamarajah S, Kambasha C, Lock L, Loka T, Mohammad F, Motahariasl S, Roper L, Sadhra SS, Sheikh A, Toma T, Wadood Q, Yip J, Ainger E, Busti S, Cunliffe L, Flamini T, Gaffing S, Moorcroft C, Peter M, Simpson L, Stokes E, Stott G, Wilson J, York J, Yousaf A, Borakati A, Brown M, Goaman A, Hodgson B, Ijeomah A, Iroegbu U, Kaur G, Lowe C, Mahmood S, Sattar Z, Sen P, Szuman A, Abbas N, Al-Ausi M, Anto N, Bhome R, Eccles L, Elliott J, Hughes EJ, Jones A, Karunatilleke AS, Knight JS, Manson CCF, Mekhail I, Michaels L, Noton TM, Okenyi E, Reeves T, Yasin IH, Banfield DA, Harris R, Lim D, Mason-Apps C, Roe T, Sandhu J, Shafiq N, Stickler E, Tam JP, Williams LM, Ainsworth P, Boualbanat Y, Doull C, Egan E, Evans L, Hassanin K, Ninkovic-Hall G, Odunlami W, Shergill M, Traish M, Cummings D, Kershaw S, Ong J, Reid F, Toellner H, Alwandi A, Amer M, George D, Haynes K, Hughes K, Peakall L, Premakumar Y, Punjabi N, Ramwell A, Sawkins H, Ashwood J, Baker A, Baron C, Bhide I, Blake E, De Cates C, Esmail R, Hosamuddin H, Kapp J, Nguru N, Raja M, Thomson F, Ahmed H, Aishwarya G, Al-Huneidi R, Ali S, Aziz R, Burke D, Clarke B, Kausar A, Maskill D, Mecia L, Myers L, Smith ACD, Walker G, Wroe N, Donohoe C, Gibbons D, Jordan P, Keogh C, Kiely A, Lalor P, McCrohan M, Powell C, Foley MP, Reynolds J, Silke E, Thorpe O, Kong JTH, White C, Ali Q, Dalrymple J, Ge Y, Khan H, Luo RS, Paine H, Paraskeva B, Parker L, Pillai K, Salciccioli J, Selvadurai S, Sonagara V, Springford LR, Tan L, Appleton S, Leadholm N, Zhang Y, Ahern D, Cotter M, Cremen S, Durrigan T, Flack V, Hrvacic N, Jones H, Jong B, Keane K, O'Connell PR, O'sullivan J, Pek G, Shirazi S, Barker C, Brown A, Carr W, Chen Y, Guillotte C, Harte J, Kokayi A, Lau K, McFarlane S, Morrison S, Broad J, Kenefick N, Makanji D, Printz V, Saito R, Thomas O, Breen H, Kirk S, Kong CH, O'Kane A, Eddama M, Engledow A, Freeman SK, Frost A, Goh C, Lee G, Poonawala R, Suri A, Taribagil P, Brown H, Christie S, Dean S, Gravell R, Haywood E, Holt F, Pilsworth E, Rabiu R, Roscoe HW, Shergill S, Sriram A, Sureshkumar A, Tan LC, Tanna A, Vakharia A, Bhullar S, Brannick S, Dunne E, Frere M, Kerin M, Kumar KM, Pratumsuwan T, Quek R, Salman M, Van Den Berg N, Wong C, Ahluwalia J, Bagga R, Borg CM, Calabria C, Draper A, Farwana M, Joyce H, Khan A, Mazza M, Pankin G, Sait MS, Sandhu N, Virani N, Wong J, Woodhams K, Croghan N, Ghag S, Hogg G, Ismail O, John N, Nadeem K, Naqi M, Noe SM, Sharma A, Tan S, Begum F, Best R, Collishaw A, Glasbey J, Golding D, Gwilym B, Harrison P, Jackman T, Lewis N, Luk YL, Porter T, Potluri S, Stechman M, Tate S, Thomas D, Walford B, Auld F, Bleakley A, Johnston S, Jones C, Khaw J, Milne S, O'Neill S, Singh KKR, Smith R, Swan A, Thorley N, Yalamarthi S, Yin ZD, Ali A, Balian V, Bana R, Clark K, Livesey C, McLachlan G, Mohammad M, Pranesh N, Richards C, Ross F, Sajid M, Brooke M, Francombe J, Gresly J, Hutchinson S, Kerrigan K, Matthews E, Nur S, Parsons L, Sandhu A, Vyas M, White F, Zulkifli A, Zuzarte L, Al-Mousawi A, Arya J, Azam S, Yahaya AA, Gill K, Hallan R, Hathaway C, Leptidis I, McDonagh L, Mitrasinovic S, Mushtaq N, Pang N, Peiris GB, Rinkoff S, Chan L, Christopher E, Farhan-Alanie MMH, Gonzalez-Ciscar A, Graham CJ, Lim H, McLean KA, Paterson HM, Rogers A, Roy C, Rutherford D, Smith F, Zubikarai G, Al-Khudairi R, Bamford M, Chang M, Cheng J, Hedley C, Joseph R, Mitchell B, Perera S, Rothwell L, Siddiqui A, Smith J, Taylor K, Wright OW, Baryan HK, Boyd G, Conchie H, Cox L, Davies J, Gardner S, Hill N, Krishna K, Lakin F, Scotcher S, Alberts J, Asad M, Barraclough J, Campbell A, Marshall D, Wakeford W, Cronbach P, D'Souza F, Gammeri E, Houlton J, Hall M, Kethees A, Patel R, Perera M, Prowle J, Shaid M, Webb E, Beattie S, Chadwick M, El-Taji O, Haddad S, Mann M, Patel M, Popat K, Rimmer L, Riyat H, Smith H, Anandarajah C, Cipparrone M, Desai K, Gao C, Goh ET, Howlader M, Jeffreys N, Karmarkar A, Mathew G, Mukhtar H, Ozcan E, Renukanthan A, Sarens N, Sinha C, Woolley A, Bogle R, Komolafe O, Loo F, Waugh D, Zeng R, Crewe A, Mathias J, Mills A, Owen A, Prior A, Saunders I, Baker A, Crilly L, McKeon J, Ubhi HK, Adeogun A, Carr R, Davison C, Devalia S, Hayat A, Karsan RB, Osborne C, Scott K, Weegenaar C, Wijeyaratne M, Babatunde F, Barnor-Ahiaku E, Beattie G, Chitsabesan P, Dixon O, Hall N, Ilenkovan N, Mackrell T, Nithianandasivam N, Orr J, Palazzo F, Saad M, Sandland-Taylor L, Sherlock J, Ashdown T, Chandler S, Garsaa T, Lloyd J, Loh SY, Ng S, Perkins C, Powell-Chandler A, Smith F, Underhill R. Perioperative intravenous contrast administration and the incidence of acute kidney injury after major gastrointestinal surgery: prospective, multicentre cohort study. Br J Surg 2020; 107:1023-1032. [PMID: 32026470 DOI: 10.1002/bjs.11453] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 09/21/2019] [Accepted: 11/08/2019] [Indexed: 01/14/2023]
Abstract
BACKGROUND This study aimed to determine the impact of preoperative exposure to intravenous contrast for CT and the risk of developing postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. METHODS This prospective, multicentre cohort study included adults undergoing gastrointestinal resection, stoma reversal or liver resection. Both elective and emergency procedures were included. Preoperative exposure to intravenous contrast was defined as exposure to contrast administered for the purposes of CT up to 7 days before surgery. The primary endpoint was the rate of AKI within 7 days. Propensity score-matched models were adjusted for patient, disease and operative variables. In a sensitivity analysis, a propensity score-matched model explored the association between preoperative exposure to contrast and AKI in the first 48 h after surgery. RESULTS A total of 5378 patients were included across 173 centres. Overall, 1249 patients (23·2 per cent) received intravenous contrast. The overall rate of AKI within 7 days of surgery was 13·4 per cent (718 of 5378). In the propensity score-matched model, preoperative exposure to contrast was not associated with AKI within 7 days (odds ratio (OR) 0·95, 95 per cent c.i. 0·73 to 1·21; P = 0·669). The sensitivity analysis showed no association between preoperative contrast administration and AKI within 48 h after operation (OR 1·09, 0·84 to 1·41; P = 0·498). CONCLUSION There was no association between preoperative intravenous contrast administered for CT up to 7 days before surgery and postoperative AKI. Risk of contrast-induced nephropathy should not be used as a reason to avoid contrast-enhanced CT.
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Chappell A, Allison GT, Williams G, Gibson N, Morris S. The effect of a running training intervention on ankle power generation in children and adolescents with cerebral palsy: A randomized controlled trial. Clin Biomech (Bristol, Avon) 2020; 76:105024. [PMID: 32416406 DOI: 10.1016/j.clinbiomech.2020.105024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 06/01/2019] [Revised: 04/09/2020] [Accepted: 04/28/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Children and adolescents with cerebral palsy who are classified as Gross Motor Function Classification Scale level I or II are usually able to run but lack ankle power generation for push-off. The aim of this study was to analyze the efficacy of a running training program in improving ankle power generation in children and adolescents with cerebral palsy. METHODS This randomized controlled trial compared kinematic and spatiotemporal data collected during running from 38 children and adolescents with unilateral or bilateral cerebral palsy before and after a 12-week running program. Normalized speed, stride length, cadence, foot strike pattern, peak ankle power generation, peak hip flexor power generation in swing and propulsion strategy were calculated. Linear mixed models were developed to analyze differences between groups. FINDINGS At follow-up the intervention group had increased normalized speed of running (t = -3.68 p < .01) while the control group got slower (t = 3.17 p < .01). In running, children in Gross Motor Function Classification Scale level II in the intervention group increased ankle power (t = 2.49 p = .01) while the control group did not change (t = 0.38 p = .71). In sprinting, children in Gross Motor Function Classification Scale levels I and II in the intervention group maintained ankle power (level I t = 0.32 p = .75; level II t = 1.56 p = .12) while those in the control group decreased ankle power (level I t = 4.69 p < .01; level II t = 2.52 p = .01). Most within-group differences did not result in significant between-group differences at follow-up. INTERPRETATION Power generation for running may be responsive to targeted intervention in children with cerebral palsy.
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Affiliation(s)
- A Chappell
- School of Physiotherapy and Exercise Science, Curtin University, Bentley, Western Australia, Australia; Ability Centre, Coolbinia, Western Australia, Australia.
| | - G T Allison
- School of Physiotherapy and Exercise Science, Curtin University, Bentley, Western Australia, Australia
| | - G Williams
- School of Health Sciences, University of Melbourne, Victoria, Australia; Epworth HealthCare, Victoria, Australia.
| | - N Gibson
- School of Physiotherapy and Exercise Science, Curtin University, Bentley, Western Australia, Australia; Ability Centre, Coolbinia, Western Australia, Australia; Perth Children's Hospital, Perth, Western Australia, Australia.
| | - S Morris
- School of Physiotherapy and Exercise Science, Curtin University, Bentley, Western Australia, Australia
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Guerra J, Smith L, Vicinanza D, Stubbs B, Veronese N, Williams G. The use of sonification for physiotherapy in human movement tasks: A scoping review. Sci Sports 2020. [DOI: 10.1016/j.scispo.2019.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Singh R, Williams G, Stephenson BM. The lateral rectus abdominis positioned stoma (LRAPS) trephine: the hope in Pandora's box. Hernia 2020; 24:909-911. [PMID: 32367449 DOI: 10.1007/s10029-020-02196-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 04/11/2020] [Indexed: 10/24/2022]
Affiliation(s)
- R Singh
- Royal Gwent Hospital, Aneurin Bevan University Health Board, Newport, UK
| | - G Williams
- Royal Gwent Hospital, Aneurin Bevan University Health Board, Newport, UK
| | - B M Stephenson
- Royal Gwent Hospital, Aneurin Bevan University Health Board, Newport, UK.
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Williams G. Commentary - Emergency surgery under COVID-19 pandemic: what is important to know for practice. Ann R Coll Surg Engl 2020; 102:333. [DOI: 10.1308/rcsann.2020.0096] [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: 11/22/2022] Open
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Williams G, MacNamara Á. "I Didn't Make It, but…": Deselected Athletes' Experiences of the Talent Development Pathway. Front Sports Act Living 2020; 2:24. [PMID: 33345018 PMCID: PMC7739725 DOI: 10.3389/fspor.2020.00024] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 03/04/2020] [Indexed: 11/13/2022] Open
Abstract
The experiences of youth athletes on specialized talent development pathways has received considerable attention in both the media and literature. Despite the low conversion of pathway entrants into senior athletes, the experiences of deselected athletes have received less attention. The purpose of this study therefore was to explore the talent pathway experiences of youth athletes who were deselected from a pathway and to consider how those experiences influenced their life post deselection. Ten participants were purposefully sampled based on their prior involvement in a formalized and selective talent programme. Individual semi-structured interviews were conducted, and data was analyzed via a thematic analysis. Participants identified constructs of the talent development environment, psychobehavioral skills for future development and personal responsibility for future development as facilitators for future success beyond the talent pathway. Specifically, environmental constructs, such as high performance support systems and expectations of professionalism positively contributed toward the acquisition of transferable psychobehavioral skills, such as a determination to be successful, a confidence to back oneself and social maturity. Youth athletes reported feeling empowered to take personal responsibility for development, through attributes such as a commitment to be the best they can be and an intrinsic motivation to succeed. These findings suggest positive experiences, built around the development of transferable skills and behaviors, can accrue from being on the talent pathway. As such, the talent pathway can be a successful foundation for both success in that sport and as a facilitator of success beyond sport.
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Affiliation(s)
- Graham Williams
- Institute of Coaching and Performance, University of Central Lancashire, Preston, United Kingdom
- Millfield School, Somerset, United Kingdom
| | - Áine MacNamara
- Faculty of Science and Health, School of Health and Human Performance, Dublin City University, Dublin, Ireland
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Mullen T, Williams G. A152 FOREIGN BODY INGESTIONS AT A TERTIARY CARE CENTRE - A QUALITY ASSURANCE STUDY. J Can Assoc Gastroenterol 2020. [DOI: 10.1093/jcag/gwz047.151] [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: 11/12/2022] Open
Abstract
Abstract
Background
Foreign body ingestion and esophageal food bolus impaction are common emergencies encountered by gastroenterologists. If not treated in a timely fashion these can result in significant morbidity, or even mortality. The mainstay of diagnosis and therapy is endoscopy. Guidelines regarding timing of endoscopy have been published by both the American and European Societies of Gastrointestinal Endoscopy, and both suggest emergent endoscopy, meaning within 2 to 6 hours, for complete esophageal obstructions. There is relatively sparse data regarding the endoscopic techniques used in real world practice.
Aims
This is a quality assurance study looking at the endoscopic practices at an adult tertiary care hospital in Halifax, Nova Scotia with respect to foreign body and food impaction management.
Methods
The hospital records of all patients presenting with ingested foreign bodies or esophageal food bolus impactions between May 2018 and July 2019 were included. Patients were identified by searching the call-back forms used by our department which documents all on-call endoscopy cases. This was then cross-referenced by endoscopy nursing charting which documents every endoscopy performed. Information such as demographics, obstruction type, endoscopic method of removal, complications, time between consultation and endoscopy, underlying pathology, and others were analyzed.
Results
70 cases were identified. Average patient age was 51.3 years old (range 16–96). 18 (25.7%) were female and 52 (74.3%) were male. 64 cases (91.4%) were esophageal food impactions and 6 (8.57%) were foreign body ingestions. Of the food impactions, 39 cases (60.9%) were cleared by the push/slide-by technique only and 10 (16.7%) were relieved using instruments such as snares, forceps, or nets. 15 (23.4%) passed spontaneously prior to scope, of which 7 received glucagon. An overtube was used in 1 case (0.16%). Complications occurred in 5 (7.8%) cases and included 3 mucosal tears, 2 of which required therapeutic interventions, and 2 episodes of oxygen desaturation in which the procedure was aborted. Complete obstructions occurred in 42 (65.6%) cases with average time of consultation to endoscopy of 2.4 hours. However, 3 (7.1%) cases exceeded 6 hours. The most common pathology was eosinophilic esophagitis with 20 cases (31.3%).
Ingested foreign bodies included 2 long objects, 3 sharp objects, and a cylindrical battery, and all but one were in the stomach. 5 (83.3%) cases used an overtube. No complications occurred.
Conclusions
At our institution 67/70 (95.7%) cases were performed within the timelines recommended by society guidelines. No complications occurred in the cases not performed within those time limits. An overtube was used in only one case in which a food bolus was retrieved out of the esophagus. Overall this study suggests that our centre is meeting recommended targets, however there is room for improvement.
Funding Agencies
None
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Affiliation(s)
- T Mullen
- Dalhousie University, Halifax, NS, Canada
| | - G Williams
- Dalhousie University, Halifax, NS, Canada
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Almudaires A, Williams G, Gruchy SE, Morgenthau A. A269 EUS-GUIDED ROSE FNA AND CNB FOR THE DIAGNOSIS OF PANCREATIC CANCER: A COMPARATIVE ANALYSIS. J Can Assoc Gastroenterol 2020. [DOI: 10.1093/jcag/gwz047.268] [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: 11/12/2022] Open
Abstract
Abstract
Background
Endoscopic ultrasound-guided fine-needle aspiration with Rapid On Site Evaluation (ROSE EUS-FNA) and endoscopic ultrasound-guided core-needle biopsy (EUS-CNB) are widely used for the diagnosis of pancreatic tumors. There is no known published randomized control trial that compares between the two modalities. Given the aggressive nature of pancreatic cancer, it is crucial to make a prompt diagnosis in order to initiate treatment in a timely fashion.
Aims
This study compares the diagnostic performance of ROSE EUS-FNA and EUS-CNB for diagnosis of pancreatic cancer.
Methods
A retrospective review was performed for patients who underwent ROSE EUS-FNA and/ or EUS-CNB for solid pancreatic lesion. Diagnostic yield (defined as percentage of diagnostic samples), diagnostic accuracy (defined as percentage of correct diagnosis), sensitivity and specificity for malignancy were compared between ROSE EUS- FNA and EUS- CNB. Baseline characteristics for both patients and lesions were also obtained.
Results
A total of 82 patients with solid pancreatic lesions were reviewed. 84 EUS with 61 FNA and 74 CNB were performed. The diagnostic yield was 42/61 (69%) and 59/74 (79.7%) for FNA and CNB respectively (P 0.166). The diagnostic accuracy was 33/61 (54%) and 53/74 (71%) for FNA and CNB respectively (P 0.0326).
50 patients underwent both FNA and CNB during the same EUS. The calculated diagnostic yield among this subgroup was 33/50 (66%) and 39/50 (78%) for FNA and CNB respectively (P 0.265); with diagnostic accuracy of 26/50 (52%) for FNA and 34/50 (68%) for CNB (P 0.152). The diagnostic accuracy after combining both techniques was 40/50 (80%).
The incremental increase in diagnostic yield by combining both methods was 12/50 (24%) and 6/50 (12%) relative to FNA and CNB respectively.
The sensitivity for the diagnosis of malignancy for FNA and CNB was 60.8% and 92.7%, respectively. The specificity was 100% for both methods.
Conclusions
EUS-guided CNB is a superior method of assessing solid pancreatic lesion and pancreatic malignancy with better diagnostic yield and accuracy and higher sensitivity than ROSE EUS-FNA.
Funding Agencies
None
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Affiliation(s)
| | - G Williams
- Dalhousie University, Halifax, NS, Canada
| | - S E Gruchy
- Dalhousie University, Halifax, NS, Canada
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50
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Bhangu A, Nepogodiev D, Ives N, Magill L, Glasbey J, Forde C, Bisgaard T, Handley K, Mehta S, Morton D, Pinkney T, Mehta S, Handley K, Ives N, Bhangu A, Brown J, Forde C, Futaba K, Glasbey J, Handley K, Ives N, Khan S, Magill L, Mehta S, Morton D, Nepogodiev D, Pallan A, Patel A, Ashdown-Phillips S, Roberts T, Jowett S, Munetsi L, Pinkney T, Torrance A, Brown J, Handley K, Hilken N, Hill M, Hunter M, Ives N, Khan S, Leek S, Lilly H, Magill L, Mehta S, Sawant A, Vince A, Walters M, Bemelman W, Blussé M, Borstlap W, Busch ORC, Buskens C, Klaver C, Marsman H, van Ruler O, Tanis P, Westerduin E, Wicherts D, Das P, Essapen S, Frost V, Glennon A, Gray C, Hussain A, McNichol L, Nisar P, Scott H, Trickett J, Trivedi P, White D, Amarnath T, Ardley R, Gupta R, Hall E, Hodgkins K, Narula H, Sewell TA, Simms JM, Toms J, White T, Atkinson A, Beral D, Lancaster N, Mackenzie F, Wilson T, Cruttenden-Wood D, Gibbins J, Halls M, Hill D, Hogben K, Jones S, Lamparelli MJ, Lewis M, Moreton S, Ng P, Oglesby A, Orbell J, Stubbs B, Subramanian K, Talwar A, Wilsher S, Al-Rashedy M, Fensom C, Gok M, Hardstaff L, Malik K, Sadat M, Townley B, Wilkinson L, Cosier T, Mangam S, Rabie M, Broadley G, Canny J, Fallis S, Green N, Hawash A, Karandikar S, Mirza M, Rawstorne E, Reddan J, Richardson J, Thompson C, Waite K, Youssef H, Bisgaard T, De Nes L, Rosenstock S, Strandfelt P, Westen M, Aryal K, Kshatriya KS, Lal R, Velchuru V, Wilhelmsen E, Akbar A, Antoniou A, Clark S, Datt P, Goh J, Jenkins I, Kennedy R, Maeda Y, Nastro P, Owen H, Phillips RKS, Warusavitarne J, Bradley-Potts J, Charleston P, Clouston H, Duff S, Fatayer T, Gipson A, Heywood N, Junejo M, Kennedy J, Lalor H, Manning C, McCormick R, Parmar K, Preston S, Ramesh A, Sharma A, Telford K, Adeosun A, Hammond T, Smolen S, Topliffe J, Docherty JG, Lim M, Lim M, Macleod K, Monaghan E, Patience L, Thomas I, Walker KG, Walker M, Watson AJM, Burgess A, Ghanem Y, Glister G, Kapur S, Paily A, Pal A, Ravikumar R, Rosbergen M, Sargen K, Speakman C, Agarwal AK, Banerjee A, Borowski D, Garg D, Gill T, Johnston T, Kelsey S, Munipalle PC, Tabaqchali M, Wilson D, Acheson A, Cripps H, El-Sharkawy A, Ng O, Sharma P, Ward K, Chandler D, Courtney E, Bunni J, Butcher K, Dalton S, Flindall I, Katebe J, Roy P, Tate J, Vincent T, Williamson MER, Wood J, Bignell M, Branagan G, Broardhurst J, Chave H, Dean H, D'Souza N, Foster G, Sleight S, Sutaria R, Ahmed I, Budhoo MR, Colley J, Cruickshank N, Gill K, Hayes A, Joy H, Kamabjha C, Plowright J, Radley S, Rea M, Thumbe V, Torrance A, Varghese P, Wilkin R, Zulueta E, Allsop L, Atkari B, Badrinath K, Daliya P, Dube M, Heeley C, Hind R, Nash D, Palfreman A, Peacock O, Watson N, Blodwell M, Javaid A, Mohamad A, Muhammad K, Qureshi N, Ridgway S, Siddiqui K, Solkar M, Vere J, Wordie A, Chang J, Elgaddal S, Green M, Hollyman M, Mirza N, Rankin J, Williams G, Ali W, Hardwick A, Mohamed Z, Navid A, Netherton K, Obreja M, Rao M, Stringer J, Tennakoon A, Bullen T, Butt M, Dawson R, Dawson S, Farmer M, Garimella V, Gates Z, Wilkings L, Yeomans N, Adedeji O, Alalawi R, Al Araimi A, Ashraf S, Bach S, Beggs A, Cagigas C, Dattani M, Dimitriou N, Futaba K, Ghods-Ghorbani M, Glasbey J, Gourevitch D, Haydon G, Ismail T, Keh C, Morton DG, Narewal M, Nepogodiev D, Papettas T, Pinkney T, Poh A, Ranstorne E, Royle TJ, Shah T, Singh J, Smart C, Suggett N, Tayyab M, Vijayan D, Vohra R, Wairaich N, Yeung D, Bamford R, Chambers J, Cotton D, Houlihan R, Kynaston J, Longman R, Lowe A, Messenger D, Owais A, Phillpott C, Shabbir J, Baragwanath P, El-Sayed C, Gaunt A, Khatri C, McCullough P, Patel A, Ward S, Wilkin R, Obukofe R, Stroud R, Mason D, Williams N, Wong LS, Chaudhri S, Cooke J, Cunha M, Fairey H, Norwood M, Singh B, Thomasset S, Abbott S, Addison S, Archer J, Bhangu A, Church R, Holford E, Lenehan F, Odogwu S, Richardson L, Sidebotham J, Swan E, Tilley A, Wagstaff L, Amey I, Baird Y, Cripps N, Greenslade S, Harris G, Levy B, Mckenzie P, Misselbrook A, Moore S, Skull A, Nicol D, Reddy B, Thrush J, Iglesias Vecchio M, Dunn Y, Williams C, Furtado S, Gill M, Gilmore L, Goldsmith P, Kocialkowski C, Loganathan S, Nath R, Paraoan M, Taylor T, Allison A, Allison J, Curtis N, Dalton R, D'Costa C, Dennison G, Foster J, Francis N, Gibbons J, Hamdan M, Lewis A, Ockrim J, Sharma R, Spurdle K, Varadharajan S, Aghahoseini A, Alexander DJ, Bandyopadhyay D, Bradford I, Chitsabesan P, Coleman Z, Gibson A, Lasithiotakis K, Panagiotou D, Polyzois K, Stojkovic S, Woodcock N, Wright M, Hargest R, Jackson R, Rajesh A, Ogunbiyi O, Slater A, Yu LM. Prophylactic biological mesh reinforcement versus standard closure of stoma site (ROCSS): a multicentre, randomised controlled trial. Lancet 2020; 395:417-426. [PMID: 32035551 PMCID: PMC7016509 DOI: 10.1016/s0140-6736(19)32637-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 10/11/2019] [Accepted: 10/18/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Closure of an abdominal stoma, a common elective operation, is associated with frequent complications; one of the commonest and impactful is incisional hernia formation. We aimed to investigate whether biological mesh (collagen tissue matrix) can safely reduce the incidence of incisional hernias at the stoma closure site. METHODS In this randomised controlled trial (ROCSS) done in 37 hospitals across three European countries (35 UK, one Denmark, one Netherlands), patients aged 18 years or older undergoing elective ileostomy or colostomy closure were randomly assigned using a computer-based algorithm in a 1:1 ratio to either biological mesh reinforcement or closure with sutures alone (control). Training in the novel technique was standardised across hospitals. Patients and outcome assessors were masked to treatment allocation. The primary outcome measure was occurrence of clinically detectable hernia 2 years after randomisation (intention to treat). A sample size of 790 patients was required to identify a 40% reduction (25% to 15%), with 90% power (15% drop-out rate). This study is registered with ClinicalTrials.gov, NCT02238964. FINDINGS Between Nov 28, 2012, and Nov 11, 2015, of 1286 screened patients, 790 were randomly assigned. 394 (50%) patients were randomly assigned to mesh closure and 396 (50%) to standard closure. In the mesh group, 373 (95%) of 394 patients successfully received mesh and in the control group, three patients received mesh. The clinically detectable hernia rate, the primary outcome, at 2 years was 12% (39 of 323) in the mesh group and 20% (64 of 327) in the control group (adjusted relative risk [RR] 0·62, 95% CI 0·43-0·90; p=0·012). In 455 patients for whom 1 year postoperative CT scans were available, there was a lower radiologically defined hernia rate in mesh versus control groups (20 [9%] of 229 vs 47 [21%] of 226, adjusted RR 0·42, 95% CI 0·26-0·69; p<0·001). There was also a reduction in symptomatic hernia (16%, 52 of 329 vs 19%, 64 of 331; adjusted relative risk 0·83, 0·60-1·16; p=0·29) and surgical reintervention (12%, 42 of 344 vs 16%, 54 of 346: adjusted relative risk 0·78, 0·54-1·13; p=0·19) at 2 years, but this result did not reach statistical significance. No significant differences were seen in wound infection rate, seroma rate, quality of life, pain scores, or serious adverse events. INTERPRETATION Reinforcement of the abdominal wall with a biological mesh at the time of stoma closure reduced clinically detectable incisional hernia within 24 months of surgery and with an acceptable safety profile. The results of this study support the use of biological mesh in stoma closure site reinforcement to reduce the early formation of incisional hernias. FUNDING National Institute for Health Research Research for Patient Benefit and Allergan.
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