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Gliddon HD, Ward Z, Heinsbroek E, Croxford S, Edmundson C, Hope VD, Simmons R, Mitchell H, Hickman M, Vickerman P, Stone J. Has the HCV cascade of care changed among people who inject drugs in England since the introduction of direct-acting antivirals? Int J Drug Policy 2024:104324. [PMID: 38218700 DOI: 10.1016/j.drugpo.2024.104324] [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: 08/24/2023] [Revised: 12/31/2023] [Accepted: 01/03/2024] [Indexed: 01/15/2024]
Abstract
BACKGROUND In England, over 80 % of those with hepatitis C virus (HCV) infection have injected drugs. We quantified the HCV cascade of care (CoC) among people who inject drugs (PWID) in England and determined whether this improved after direct-acting antivirals (DAAs) were introduced. METHODS We analysed data from nine rounds of national annual cross-sectional surveys of PWID recruited from drug services (2011-2019; N = 12,320). Study rounds were grouped as: 'Pre-DAAs' (2011-2014), 'Prioritised DAAs' (2015-2016) and 'Unrestricted DAAs' (2017-2019). Participants were anonymously tested for HCV antibodies and RNA and completed a short survey. We assessed the proportion of PWID recently (current/previous year) tested for HCV. For participants ever HCV treatment eligible (past chronic infection with history of treatment or current chronic infection), we assessed the CoC as: HCV testing (ever), received a positive test result, seen a specialist nurse/doctor, and ever treated. We used logistic regression to determine if individuals progressed through the CoC differently depending on time-period, whether time-period was associated with recent testing (all participants) and lifetime HCV treatment (ever eligible participants), and predictors of HCV testing and treatment in the Unrestricted DAAs period. RESULTS The proportion of ever HCV treatment eligible PWID reporting lifetime HCV treatment increased from 12.5 % in the Pre-DAAs period to 25.6 % in the Unrestricted DAAs period (aOR:2.40, 95 %CI:1.95-2.96). There were also increases in seeing a specialist nurse/doctor. The largest loss in the CoC was at treatment for all time periods. During the Unrestricted DAAs period, recent (past year) homelessness (vs never, aOR:0.66, 95 %CI:0.45-0.97), duration of injecting (≤3 years vs >3 years; aOR:0.26, 95 %CI:0.12-0.60), never (vs current, aOR:0.31, 95 %CI:0.13-0.75) or previously being prescribed OAT (vs current, aOR:0.67, 95 %CI:0.47-0.95), and never using a NSP (vs past year, aOR:0.27, 95 %CI:0.08-0.89) were negatively associated with lifetime HCV treatment. The proportion of PWID reporting recent HCV testing was higher during Unrestricted DAAs (56 %) compared to Pre-DAAs (48 %; aOR:1.28, 95 %CI:1.06-1.54). CONCLUSION COC stages from seeing a specialist onwards improved after DAAs became widely available. Further improvements in HCV testing are needed to eliminate HCV in England.
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Affiliation(s)
- H D Gliddon
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom; National Public Health Specialty Training Programme, South West, United Kingdom
| | - Z Ward
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom; NIHR Health Protection Research Unit in Behavioural Science and Evaluation at University of Bristol, United Kingdom
| | - E Heinsbroek
- Blood Safety, Hepatitis, Sexually Transmitted Infections and HIV Service, UK Health Security Agency, London, United Kingdom
| | - S Croxford
- National Public Health Speciality Training Programme, West Midlands, United Kingdom
| | - C Edmundson
- Blood Safety, Hepatitis, Sexually Transmitted Infections and HIV Service, UK Health Security Agency, London, United Kingdom
| | - V D Hope
- Public Health Institute, Liverpool John Moores University, Liverpool, United Kingdom
| | - R Simmons
- Blood Safety, Hepatitis, Sexually Transmitted Infections and HIV Service, UK Health Security Agency, London, United Kingdom
| | - H Mitchell
- Blood Safety, Hepatitis, Sexually Transmitted Infections and HIV Service, UK Health Security Agency, London, United Kingdom
| | - M Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom; NIHR Health Protection Research Unit in Behavioural Science and Evaluation at University of Bristol, United Kingdom
| | - P Vickerman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom; NIHR Health Protection Research Unit in Behavioural Science and Evaluation at University of Bristol, United Kingdom
| | - J Stone
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom; NIHR Health Protection Research Unit in Behavioural Science and Evaluation at University of Bristol, United Kingdom.
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2
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Mitchell H, Cairnduff V, O'Hare S, Simpson L, White R, Gavin AT. Factors associated with emergency admission for people dying from cancer in Northern Ireland: an observational data linkage study. BMC Health Serv Res 2023; 23:1184. [PMID: 37907903 PMCID: PMC10617099 DOI: 10.1186/s12913-023-10228-w] [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: 06/14/2023] [Accepted: 10/27/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND Many people living with cancer are admitted as an emergency, some just prior to diagnosis and others in their last year of life. Factors associated with accessing emergency care for people dying of cancer are complex and not well understood. This can make it difficult to have the resources and staffing in place to best care for individuals in their last year of life and their families. METHODS This study uses routinely collected administrative data from people who died of cancer in N. Ireland (NI) during 2015 and explores how personal characteristics (e.g., gender, age) and disease related factors (e.g., tumour site, cancer stage at initial diagnosis) were associated with having an emergency admission to hospital in the last year and the last 28 days of their lives, using multivariate logistic regression. RESULTS Almost three in four people had at least one emergency admission in the last year of life, and over one in three had an emergency admission the last 28 days of life. Patterns were similar for both time outcomes with males, people with haematological, lung or brain cancers, younger persons, those diagnosed with late-stage cancer, and people diagnosed close to time of death, being significantly more likely to have an emergency admission. While there was no significant association between deprivation and emergency admission rates, those living in urban areas were more likely to have an emergency admission in their last month of life compared to rural dwellers. Late diagnosis was evident with 538 people (12.8% of all deaths from cancer) being diagnosed within one month of death and 1242 (29%) within 3 months of death. CONCLUSION The high level of emergency admissions points to gaps in routine end-of-life care, and the need for additional training for hospital staff including frontline emergency department (ED) staff who are often the 'gatekeepers' to emergency inpatient care for people living with cancer. The levels of late diagnosis indicate a need for increased population awareness of cancer symptoms and system change to promote earlier diagnosis.
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Affiliation(s)
- H Mitchell
- Centre for Public Health, Northern Ireland Cancer Registry, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom.
| | - V Cairnduff
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
| | - S O'Hare
- Centre for Public Health, Northern Ireland Cancer Registry, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
| | - L Simpson
- Centre for Public Health, Northern Ireland Cancer Registry, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
| | - R White
- Macmillan Cancer Support, London, England, United Kingdom
| | - A T Gavin
- Centre for Public Health, Northern Ireland Cancer Registry, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
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Ronchi E, Wahlqvist J, Ardinge A, Rohaert A, Gwynne SMV, Rein G, Mitchell H, Kalogeropoulos N, Kinateder M, Bénichou N, Kuligowski E, Kimball A. The verification of wildland-urban interface fire evacuation models. Nat Hazards (Dordr) 2023; 117:1493-1519. [PMID: 37251348 PMCID: PMC10220130 DOI: 10.1007/s11069-023-05913-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 03/07/2023] [Indexed: 05/31/2023]
Abstract
This paper introduces a protocol for the verification of multi-physics wildfire evacuation models, including a set of tests used to ensure that the conceptual modelling representation of each modelling layer is accurately implemented, as well as the interactions between different modelling layers and sub-models (wildfire spread, pedestrian movement, traffic evacuation, and trigger buffers). This work presents a total of 24 verification tests, including (1) 4 tests related to pedestrians, (2) 15 tests for traffic evacuation, (3) 5 tests concerning the interaction between different modelling layers, along with 5 tests for wildfire spread and trigger buffers. The evacuation tests are organized in accordance with different core components related to evacuation modelling, namely Population, Pre-evacuation, Movement, Route/destination selection, Flow constraints, Events, Wildfire spread and Trigger buffers. A reporting template has also been developed to facilitate the application of the verification testing protocol. An example application of the testing protocol has been performed using an open wildfire evacuation modelling platform called WUI-NITY and its associated trigger buffer model k-PERIL. The verification testing protocol is deemed to improve the credibility of wildfire evacuation model results and stimulate future modelling efforts in this domain. Supplementary Information The online version contains supplementary material available at 10.1007/s11069-023-05913-2.
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Affiliation(s)
- E. Ronchi
- Department of Fire Safety Engineering, Lund University, Lund, Sweden
| | - J. Wahlqvist
- Department of Fire Safety Engineering, Lund University, Lund, Sweden
| | - A. Ardinge
- Department of Fire Safety Engineering, Lund University, Lund, Sweden
| | - A. Rohaert
- Department of Fire Safety Engineering, Lund University, Lund, Sweden
| | - S. M. V. Gwynne
- Department of Fire Safety Engineering, Lund University, Lund, Sweden
- Movement Strategies, London, UK
| | - G. Rein
- Imperial College London, London, UK
| | | | | | | | | | - E. Kuligowski
- Royal Melbourne Institute of Technology, Melbourne, Australia
| | - A. Kimball
- Fire Protection Research Foundation, Quincy, USA
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4
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Snell LB, Vink JP, Verlander NQ, Miah S, Lackenby A, Williams D, Mitchell H, Beviz C, Kabia M, Cunningham E, Batra R, Edgeworth JD, Zambon M, Nebbia G. Nosocomial acquisition of influenza is associated with significant morbidity and mortality: Results of a prospective observational study. J Infect Public Health 2022; 15:1118-1123. [PMID: 36137361 PMCID: PMC10166711 DOI: 10.1016/j.jiph.2022.08.021] [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: 06/07/2022] [Revised: 08/04/2022] [Accepted: 08/31/2022] [Indexed: 10/14/2022] Open
Abstract
BACKGROUND Nosocomial acquisition of influenza is known to occur but the risk after exposure to a known case and the outcomes after acquisition are poorly defined. METHODS Prospective observational study of patients exposed to influenza from another patient in a multi-site healthcare organisation, with follow-up of 7 days or until discharge, and PCR-confirmation of symptomatic disease. Multivariable analysis was used to investigate association of influenza acquisition with high dependency unit/intensive care unit (HDU/ITU) admission and in-hospital mortality. RESULTS 23/298 (7.7%) contacts of 11 cases were subsequently symptomatic and tested influenza-positive during follow-up. HDU/ITU admission was significantly higher in these secondary cases (6/23, 26%) compared to flu-negative contacts (20/275, 7.2%; p = 0.002). In-hospital mortality was significantly higher in secondary cases (5/23, 21.7%) compared to flu-negative contacts (11/275, 4%; p < 0.001). In multivariable analysis, age (OR 1.25 95% CI: 1.01-1.54, p = 0.02) and being a secondary case (OR 4.77, 95% CI: 1.63-13.9, p = 0.008) were significantly associated with HDU/ITU admission in contacts. Age (OR 1.00, 95% CI: 0.93-1.00, p = 0.02), being a secondary case after exposure to influenza (OR 3.81, 95% CI 1.09-13.3, p = 0.049) and co-morbidity (OR 1.29 per unit increment in the Charlson score, 95% CI 1.02-1.61, p = 0.03) were significantly associated with in-hospital mortality in contacts. CONCLUSIONS Nosocomial acquisition of influenza was significantly associated with increased risk of HDU/ITU admission and in-hospital mortality.
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Affiliation(s)
- L B Snell
- Centre for Clinical Infection and Diagnostics Research, Guy's and St. Thomas' NHS Foundation Trust, London, UK; Department of Infection, Guy's and St Thomas' NHS Foundation Trust, UK.
| | - J P Vink
- Centre for Clinical Infection and Diagnostics Research, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | | | - S Miah
- UK Health Security Agency, Colindale, UK
| | - A Lackenby
- UK Health Security Agency, Colindale, UK
| | - D Williams
- UK Health Security Agency, Colindale, UK
| | - H Mitchell
- Department of Infection, Guy's and St Thomas' NHS Foundation Trust, UK
| | - C Beviz
- Department of Infection, Guy's and St Thomas' NHS Foundation Trust, UK
| | - M Kabia
- Department of Infection, Guy's and St Thomas' NHS Foundation Trust, UK
| | | | - R Batra
- Centre for Clinical Infection and Diagnostics Research, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - J D Edgeworth
- Centre for Clinical Infection and Diagnostics Research, Guy's and St. Thomas' NHS Foundation Trust, London, UK; Department of Infection, Guy's and St Thomas' NHS Foundation Trust, UK
| | - M Zambon
- UK Health Security Agency, Colindale, UK
| | - G Nebbia
- Centre for Clinical Infection and Diagnostics Research, Guy's and St. Thomas' NHS Foundation Trust, London, UK; Department of Infection, Guy's and St Thomas' NHS Foundation Trust, UK
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5
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Blair R, Harkin DW, Lim A, Johnston D, McFetridge L, Mitchell H. Open Surgery for Abdominal Aortic Aneurysm: 994 Consecutive Patient Outcomes. Eur J Vasc Endovasc Surg 2022. [DOI: 10.1016/j.ejvs.2022.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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6
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Solway L, Mitchell H, Meade S, Benghiat H, Augustus H, Stange R, Jackson T, Heyes G, Monksfield P, Kay A, Irving R, Chavda S, Hartley A, Sanghera P. PO-1125 Long-term efficacy and toxicity following CyberKnife radiation for Vestibular Schwannoma. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03089-4] [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: 10/18/2022]
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7
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Kwiatkowska M, Ahmed S, Ardern‐Jones M, Bhatti LA, Bleiker TO, Gavin A, Hussain S, Huws DW, Irvine L, Langan SM, Millington GWM, Mitchell H, Murphy R, Paley L, Proby CM, Thomson CS, Thomas R, Turner C, Vernon S, Venables ZC. An updated report on the incidence and epidemiological trends of keratinocyte cancers in the United Kingdom 2013-2018. Skin Health Dis 2021; 1:e61. [PMID: 35663774 PMCID: PMC9060124 DOI: 10.1002/ski2.61] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 07/02/2021] [Accepted: 07/06/2021] [Indexed: 12/29/2022]
Abstract
Introduction The most common cancers in the UK are keratinocyte cancers (KCs): the combined term for basal cell carcinomas (BCCs) and cutaneous squamous cell carcinomas (cSCCs). Registration of KC is challenging due to high numbers and multiplicity of tumours per person. Methods We provide an updated report on the descriptive epidemiology of trends in KC incidence for the resident populations of UK countries (England, Northern Ireland, Scotland and Wales) using population-based cancer registry and pathology report data, 2013-18. Results Substantial increases in cSCC incidence in England, Scotland and Northern Ireland can be detected for the period of 2013-18, and the incidence of cSCC also increased in Wales from 2016 to 2018. In contrast, however, the pattern of annual change in the incidence of BCC across the nations differs. In England, the incidence of BCC declined slightly from 2016 to 2018, however, the overall trend across 2013-18 is not statistically significant. In Scotland, the incidence of BCC shows some variability, declining in 2017 before increasing in 2018, and the overall trend across 2013-18 was also not statistically significant. In Northern Ireland, the incidence of BCC increased significantly over the study period, and in Wales, the incidence of BCC increased from 2016 to 2018. One in five people will develop non-melanoma skin cancers (NMSC) in their lifetime in England. This estimate is much higher than the lifetime risk of melanoma (1 in 36 males and 1 in 47 females born after 1960 in the UK), which further highlights the burden of the disease and importance of early prevention strategies. Conclusions We highlight how common these tumours are by publishing the first ever lifetime incidence of NMSC. Additionally, the first time reporting of the age standardised incidence of KC in Wales further confirms the scale of the disease burden posed by these cancers in the UK. With approximately one in five people developing NMSC in their lifetime, optimisation of skin cancer prevention, management and research are essential.
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Affiliation(s)
- M. Kwiatkowska
- National Cancer Registration and Analysis ServiceLondonUK
- British Association of DermatologistsLondonUK
| | - S. Ahmed
- British Association of DermatologistsLondonUK
| | - M. Ardern‐Jones
- Department of Clinical Experimental SciencesFaculty of MedicineUniversity of SouthamptonSouthamptonUK
| | | | - T. O. Bleiker
- University Hospitals of Derby and Burton NHS Foundation TrustDerbyUK
| | - A. Gavin
- North Ireland Cancer RegistryBelfastUK
| | - S. Hussain
- British Association of DermatologistsLondonUK
| | | | - L. Irvine
- National Cancer Registration and Analysis ServiceLondonUK
| | - S. M. Langan
- London School of Hygiene & Tropical MedicineSt. John's Institute of DermatologyLondonUK
| | - G. W. M. Millington
- Department of DermatologyNorfolk and Norwich University HospitalNorwichUK
- University of East Anglia Norwich Medical SchoolNorwichUK
| | | | - R. Murphy
- Sheffield Teaching Hospitals NHS Foundation TrustSheffieldUK
| | - L. Paley
- National Cancer Registration and Analysis ServiceLondonUK
| | - C. M. Proby
- Department of DermatologyNinewells Hospital and Medical SchoolDundeeUK
| | | | | | - C. Turner
- National Cancer Registration and Analysis ServiceLondonUK
| | - S. Vernon
- National Cancer Registration and Analysis ServiceLondonUK
| | - Z. C. Venables
- National Cancer Registration and Analysis ServiceLondonUK
- Department of DermatologyNorfolk and Norwich University HospitalNorwichUK
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8
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Kwiatkowska MM, Ahmed S, Ardern-Jones MR, Bhatti LA, Bleiker TO, Gavin A, Hussain S, Huws DW, Irvine L, Langan SM, Millington GWM, Mitchell H, Murphy R, Paley L, Proby CM, Thomson C, Thomas R, Turner C, Vernon S, Venables ZC. A summary of the updated report on the incidence and epidemiological trends of keratinocyte cancers in the United Kingdom 2013-2018. Br J Dermatol 2021; 186:367-369. [PMID: 34564854 DOI: 10.1111/bjd.20764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 08/04/2021] [Accepted: 09/22/2021] [Indexed: 11/30/2022]
Abstract
Skin cancer is the commonest cancer in the UK. Skin cancer referrals via the two-week wait (urgent suspected cancer) pathway outnumber any other suspected malignancy.1, 2 The commonest skin cancers are keratinocyte cancers (KCs) which represents Basal Cell Carcinomas (BCC) and Cutaneous Squamous Cell Carcinomas (cSCC). Accurate KC incidence reporting is crucial for healthcare planning.
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Affiliation(s)
- M M Kwiatkowska
- Public Health England London Region, London, U.K.,British Association of Dermatologists, London, U.K
| | - S Ahmed
- British Association of Dermatologists, London, U.K
| | - M R Ardern-Jones
- Clinical Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, U.K
| | - L A Bhatti
- London School of Hygiene and Tropical Medicine and St. John's Institute of Dermatology, London, U.K
| | - T O Bleiker
- British Association of Dermatologists, London, U.K.,University Hospital of Derby, Burton NHS Foundation Trust, Derby, U.K
| | - A Gavin
- Northern Ireland Cancer Registry, Belfast, U.K
| | - S Hussain
- British Association of Dermatologists, London, U.K
| | - D W Huws
- Welsh Cancer Intelligence and Surveillance Unit, Health Intelligence Division
| | - L Irvine
- Public Health England London Region, London, U.K
| | - S M Langan
- London School of Hygiene and Tropical Medicine and St. John's Institute of Dermatology, London, U.K
| | - G W M Millington
- British Association of Dermatologists, London, U.K.,Department of Dermatology, Norfolk and Norwich University Hospital, U.K.,Norwich Medical School, University of East Anglia, Norwich, UK
| | - H Mitchell
- Northern Ireland Cancer Registry, Belfast, U.K
| | - R Murphy
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, U.K
| | - L Paley
- Public Health England London Region, London, U.K
| | - C M Proby
- Ninewells Hospital & Medical School, University of Dundee, Dundee, U.K
| | - C Thomson
- Scottish Cancer Registry, Public Health Scotland (PHS)
| | - R Thomas
- Welsh Cancer Intelligence and Surveillance Unit, Health Intelligence Division
| | - C Turner
- Public Health England London Region, London, U.K
| | - S Vernon
- Public Health England London Region, London, U.K
| | - Z C Venables
- Public Health England London Region, London, U.K.,British Association of Dermatologists, London, U.K.,Department of Dermatology, Norfolk and Norwich University Hospital, U.K
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9
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Vink JP, Snell LB, Bernard K, Mitchell H, Heathcock RT, Cordery R, Newsholme W. Mapping a nosocomial outbreak of measles, coinciding with a period of sustained transmission in South London in 2018. J Hosp Infect 2020; 105:747-751. [PMID: 32544506 DOI: 10.1016/j.jhin.2020.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 06/03/2020] [Indexed: 11/25/2022]
Abstract
A measles outbreak in London is described, involving 34 cases across two hospitals and a local community across two countries. After a single introduction to hospital, spread propagated via unvaccinated retail shop workers to healthcare staff, highlighting the importance of expanding occupational health policies to non-clinical hospital staff. Further spread into an under-vaccinated Traveller community is a reminder that measles can spread in the absence of herd immunity. Subsequently endemic measles transmission has been re-established in the UK.
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Affiliation(s)
- J P Vink
- Department of Infection, Guy's and St Thomas' NHS Foundation Trust, London, UK; Centre for Clinical Infection and Diagnostics Research, King's College London, London, UK.
| | - L B Snell
- Department of Infection, Guy's and St Thomas' NHS Foundation Trust, London, UK; Centre for Clinical Infection and Diagnostics Research, King's College London, London, UK
| | - K Bernard
- South London Health Protection Team, Public Health England, London, UK
| | - H Mitchell
- Department of Infection, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - R T Heathcock
- South London Health Protection Team, Public Health England, London, UK
| | - R Cordery
- South London Health Protection Team, Public Health England, London, UK
| | - W Newsholme
- Department of Infection, Guy's and St Thomas' NHS Foundation Trust, London, UK
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10
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Anadani M, Orabi MY, Alawieh A, Goyal N, Alexandrov AV, Petersen N, Kodali S, Maier IL, Psychogios MN, Swisher CB, Inamullah O, Kansagra AP, Giles JA, Wolfe SQ, Singh J, Gory B, De Marini P, Kan P, Nascimento FA, Freire LI, Pandhi A, Mitchell H, Kim JT, Fargen KM, Al Kasab S, Liman J, Rahman S, Allen M, Richard S, Spiotta AM. Blood Pressure and Outcome After Mechanical Thrombectomy With Successful Revascularization. Stroke 2019; 50:2448-2454. [PMID: 31318633 DOI: 10.1161/strokeaha.118.024687] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [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: 12/12/2022]
Abstract
Background and Purpose- Successful reperfusion can be achieved in more than two-thirds of patients treated with mechanical thrombectomy. Therefore, it is important to understand the effect of blood pressure (BP) on clinical outcomes after successful reperfusion. In this study, we investigated the relationship between BP on admission and during the first 24 hours after successful reperfusion with clinical outcomes. Methods- This was a multicenter study from 10 comprehensive stroke centers. To ensure homogeneity of the studied cohort, we included only patients with anterior circulation who achieved successful recanalization at the end of procedure. Clinical outcomes included 90-day modified Rankin Scale, symptomatic intracerebral hemorrhage (sICH), mortality, and hemicraniectomy. Results- A total of 1245 patients were included in the study. Mean age was 69±14 years, and 51% of patients were female. Forty-nine percent of patients had good functional outcome at 90-days, and 4.7% suffered sICH. Admission systolic BP (SBP), mean SBP, maximum SBP, SBP SD, and SBP range were associated with higher risk of sICH. In addition, patients in the higher mean SBP groups had higher rates of sICH. Similar results were found for hemicraniectomy. With respect to functional outcome, mean SBP, maximum SBP, and SBP range were inversely associated with the good outcome (modified Rankin Scale score, 0-2). However, the difference in SBP parameters between the poor and good outcome groups was modest. Conclusions- Higher BP within the first 24 hours after successful mechanical thrombectomy was associated with a higher likelihood of sICH, mortality, and requiring hemicraniectomy.
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Affiliation(s)
- Mohammad Anadani
- From the Department of Neurology, Medical University of South Carolina, Charleston (M.A, Y.O, S.A).,Department of Neurology, Washington University School of Medicine, Saint Louis, MO (S.K, J.G, M.A)
| | - Mohamad Y Orabi
- From the Department of Neurology, Medical University of South Carolina, Charleston (M.A, Y.O, S.A)
| | - Ali Alawieh
- Department of Neurosurgery, Medical University of South Carolina, Charleston (A.A, A.S)
| | - Nitin Goyal
- Department of Neurology, University of Tennessee Health Science Center, Memphis (N.G, A.V.A, A.P, H.M)
| | - Andrei V Alexandrov
- Department of Neurology, University of Tennessee Health Science Center, Memphis (N.G, A.V.A, A.P, H.M)
| | - Nils Petersen
- Department of Neurology, Yale University School of Medicine, New Haven, CT (N.P, S.K)
| | - Sreeja Kodali
- Department of Neurology, Yale University School of Medicine, New Haven, CT (N.P, S.K).,Department of Neurology, Washington University School of Medicine, Saint Louis, MO (S.K, J.G, M.A)
| | - Ilko L Maier
- Department of Neurology, University Medical Center Göttingen, Germany (I.M, J.L)
| | | | - Christa B Swisher
- Department of Neurology, Duke University Hospital, Durham, NC(O.I, S.R, C.S)
| | - Ovais Inamullah
- Department of Neurology, Duke University Hospital, Durham, NC(O.I, S.R, C.S)
| | - Akash P Kansagra
- Department of Radiology, Washington University School of Medicine, Saint Louis, MO (A.P.K)
| | - James A Giles
- Department of Neurology, Washington University School of Medicine, Saint Louis, MO (S.K, J.G, M.A)
| | - Stacey Q Wolfe
- Department of Neurosurgery, Wake Forest University, Winston-Salem, NC (S.W, K.M.F)
| | - Jasmeet Singh
- Department of Radiology, Wake Forest University, Winston-Salem, NC (J.S)
| | - Benjamin Gory
- Department of Diagnostic and Therapeutic Neuroradiology, INSERM U1254, University Hospital of Nancy, France (B.G, P.D.M., S.R.)
| | - Pierre De Marini
- Department of Diagnostic and Therapeutic Neuroradiology, INSERM U1254, University Hospital of Nancy, France (B.G, P.D.M., S.R.)
| | - Peter Kan
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX (P.K)
| | | | - Luis Idrovo Freire
- Department of Neurology, Leeds General Infirmary, University of Leeds, United Kingdom (L.I.F)
| | - Abhi Pandhi
- Department of Neurology, University of Tennessee Health Science Center, Memphis (N.G, A.V.A, A.P, H.M)
| | - Hunter Mitchell
- Department of Neurology, University of Tennessee Health Science Center, Memphis (N.G, A.V.A, A.P, H.M)
| | - Joon-Tae Kim
- Department of Neurology (J-T. K), Chonnam National University Hospital Gwangju, South Korea
| | - Kyle M Fargen
- Department of Neurosurgery, Wake Forest University, Winston-Salem, NC (S.W, K.M.F)
| | - Sami Al Kasab
- From the Department of Neurology, Medical University of South Carolina, Charleston (M.A, Y.O, S.A)
| | - Jan Liman
- Department of Neurology, University Medical Center Göttingen, Germany (I.M, J.L)
| | - Shareena Rahman
- Department of Neurology, Duke University Hospital, Durham, NC(O.I, S.R, C.S).,Department of Diagnostic and Therapeutic Neuroradiology, INSERM U1254, University Hospital of Nancy, France (B.G, P.D.M., S.R.)
| | | | - Sébastien Richard
- Department of Neurology, Stroke Unit, CIC-P 1433, INSERM U1116, University Hospital of Nancy, France (S.R.)
| | - Alejandro M Spiotta
- Department of Neurosurgery, Medical University of South Carolina, Charleston (A.A, A.S)
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LAMBERT K, Lau K, Davison S, Mitchell H, Harman A, Carrie M. SAT-254 USE OF A RENAL DIET SPECIFIC QUESTION PROMPT SHEET INCREASES PATIENT CENTEREDNESS AND PATIENT ENGAGEMENT IN RENAL DIETETIC CLINICS. Kidney Int Rep 2019. [DOI: 10.1016/j.ekir.2019.05.290] [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: 10/26/2022] Open
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12
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Anadani M, Orabi Y, Alawieh A, Goyal N, Pandhi A, Mitchell H, Alexandrov A, Maier IL, Psychogios MN, Liman J, Inamullah O, Swisher C, Rahman S, Keyrouz S, Giles JA, Allen M, Wolfe SQ, Kan P, Nascimento FA, Turkk AS, Spiotta AM. Abstract 3: Effect of BP Goal on Outcome post Mechanical Thrombectomy: Multicenter Study. Stroke 2019. [DOI: 10.1161/str.50.suppl_1.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Current AHA/ASA guidelines recommend keeping blood pressure (BP) <180/105 after successful recanalization with MT. However, due to a concern of reperfusion injury, different BP goals are utilized across various endovascular centers. In this study, we compared functional and hemorrhagic outcomes between different BP goals.
Methods:
This was a multicenter international retrospective study that included 7 comprehensive stroke centers. Inclusion criteria were anterior circulation large vessel occlusion (LVO) that was treated with MT, and successful recanalization at the conclusion of the procedure. Patients were divided into three groups based on systolic BP (SBP) goals in the first 24 hours post MT. Group 1) included patients with SBP goal ≤140 mm Hg or ≤120 mm Hg; group 2 included patients with SBP goal ≤160 mm Hg; group 3) included patients with SBP goal ≤220 mm Hg or ≤180 mm Hg. Successful recanalization was defined as TICI 2b-3. Outcome measures included symptomatic intracerebral hemorrhage (sICH), 90-day modified Rankin Scale (mRS), and 90-day mortality.
Results:
A total of 985 patients were included in the study. More patients in group 3 were white and had Afib than groups 1-2. Likewise, more patients in group 3 received IV tPA. Complete recanalization (TICI 2c-3) was achieved in 88.2%, 53.6%, and 73.2% in groups 1,2,3 respectively (p <0.001). With respect to outcome, mRS 0-2 was achieved in 50%, 52, and 38% of patients (p=0.001) in groups 1,2,3 respectively. Similarly, sICH occurred in 2.8%, 7.1%, and 5.2% (p=0.04) in the respective groups. In multivariate analysis, moderate and intensive BP goals (groups 1-2) were associated with mRS 0-2 but not with sICH or mortality. In subgroup analysis that included only patients who achieved BP goal, group 1 but not 2 or 3 were associated with functional outcome.
Conclusion:
Blood pressure goals ≤140 and ≤160 were associated with favorable functional outcome.
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Affiliation(s)
| | - Yser Orabi
- Nerology, Med Univ of South Carolina, Charleston, SC
| | - Ali Alawieh
- Nerosurgery, Med Univ of South Carolina, Charleston, SC
| | - Nitin Goyal
- Neurology, Univ of Tennessee Health Science Cntr, Memphis, TN
| | - Abhi Pandhi
- Nerology, Univ of Tennessee Health Science Cntr, Memphis, TN
| | - Hunter Mitchell
- Nerology, Univ of Tennessee Health Science Cntr, Memphis, TN
| | | | - Ilko L Maier
- Neurology, Univ Med Cntr Göttingen, Göttingen, Germany
| | | | - Jan Liman
- Nerology, Univ Med Cntr Göttingen, Göttingen, Germany
| | | | | | | | - Salah Keyrouz
- Neurology, Washington Univ Sch of Medicine, St. Louis, MO
| | - James A Giles
- Neurology, Washington Univ Sch of Medicine, St. Louis, MO
| | - Michelle Allen
- Neurology, Washington Univ Sch of Medicine, St. Louis, MO
| | - Stacey Q Wolfe
- Neurosurgery, Wake Forest Sch of Medicine, Winston Salem, NC
| | - Peter Kan
- Neurosurgery, Baylor College of Medicine, Houston, Houston, TX
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Anadani M, Orabi Y, Alawieh A, Goyal N, Pandhi A, Mitchell H, Alexandrov A, L. Maier I, Psychogios MN, Liman J, Inamullah O, Rahman S, Shah S, A Giles J, Allen M, Kansagra A, Q.Wolf S, Kan P, A. Nascimento F, Chaudry MI, M. Spiotta A. Abstract TMP3: Blood Pressure Variability Within 24 Hours After Mechanical Thrombectomy Correlates With Worse Outcome. Stroke 2019. [DOI: 10.1161/str.50.suppl_1.tmp3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
blood pressure variability (BPV) in the acute phase following ischemic stroke is associated with worse outcomes, especially in patients with large vessel occlusions. However, the relationship between BPV and outcome after successful recanalization is not well documented.
Objective:
The aim of this study was to evaluate the association between BPV and outcome after successful recanalization.
Methods:
This was a retrospective multicenter study of patients with anterior circulation large vessel occlusions who achieved successful recanalization with MT. Successful recanalization was defined as TICI≥2b. BP was recorded in hourly intervals for 24 hours post MT. BPV was defined as the difference between maximum and minimum blood pressure within 24 hours. BPV was calculated for mean arterial pressure (MAP), systolic BP (SBP), and diastolic BP (DBP). Outcome measures included 90 days mRS, symptomatic ICH (sICH), and mortality. sICH was defined based on ECASS criteria. Good outcome was defined as mRS 0-2.
Results:
A total of 985 patients were included. SBP and MAP variability were higher in poor outcome group (65.2±26 vs. 57± 24.6; p <0.001, and 49.7±21.2 vs. 46.9± 22.3; p=0.048 respectively). Likewise, SBP and MAP variability were higher in sICH group. The association between SBP variability and 90 day mRS, sICH, and mortality remained significant after adjusting for potential confounders.
Conclusion:
Higher blood pressure variability was associated with worse functional outcomes, higher likelihood of symptomatic hemorrhage, and increased mortality.
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Affiliation(s)
| | - Yser Orabi
- Med Univ of South Carolina, Charleston, SC
| | | | - Nitin Goyal
- Neurology, Univ of Tennessee Health Science Cntr, Memphis, TN
| | - Abhi Pandhi
- Neurology, Univ of Tennessee Health Science Cntr, Memphis, TN
| | | | | | - Ilko L. Maier
- Neurology, Univ Med Cntr Göttingen, Göttingen, Germany
| | | | - Jan Liman
- Neurology, Univ Med Cntr Göttingen, Göttingen, Germany
| | | | | | | | | | | | - Akash Kansagra
- Radiology, Washington Univ Sch of Medicine, Saint Louis, MO
| | | | - Peter Kan
- Neurosurgery, Baylor College of Medicine, Houston, TX
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14
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Anadani M, Orabi Y, Alawieh A, Goyal N, Pandhi A, Mitchell H, Alexandrov A, Maier IL, Psychogios MN, Liman J, Inamullah O, Swisher C, Rahman S, Kansagra A, Giles JA, Allen M, Wolfe SQ, Kan P, Nascimento FA, Turner RD, Spiotta AM. Abstract WP17: Blood Pressure Reduction Within 24 Hours After Mechanical Thrombectomy Does Not Correlate With Outcome: A Collaborative Pooled Analysis. Stroke 2019. [DOI: 10.1161/str.50.suppl_1.wp17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Previous studies showed that lowering blood pressure in the acute phase after stroke may be harmful. However, the effect of blood pressure lowering on outcome after successful recanalization is not well known.
Objective:
The aim of this study was to evaluate the association between systolic blood pressure (SBP) reduction and outcome of thrombectomy after successful recanalization.
Methods:
This was a retrospective multicenter study of patients with anterior circulation large vessel occlusions who achieved successful recanalization (TICI 2b-3) with MT. Degree of SBP reduction was calculated using the following formula: 100*(admission SBP - minimum SBP within 24 hours)/admission SBP. Patients were divided into two groups: group 1) included patients with ≤25% SBP drop; group 2) included patients with > 25% SBP drop. Outcome measures included 90 days mRS, symptomatic ICH (sICH), and mortality
Results:
Of 991 screened patients, 917 had available admission SBP data. Average age was 68+14 years. The average admission SBP was 143 ±27 mm Hg. 383 (38.6%) patients had less than 25% SBP reduction, whereas 495 (49.9%) had > 25% SBP reduction in the first 24 hrs. There was no difference in the proportion of patients who achieved good outcome (mRS) between the two groups. Likewise there was no difference in the rate of sICH between two groups (4..2% vs. 4.5%;p=0.84). SBP reduction was not significantly associated with functional outcome on multivariate analysis (OR=1.003; 95% CI 0.99-1.013, p=0.54).
Conclusion:
blood pressure lowering after successful recanalization appears to be safe and was not associated with worse outcome. Further studies are needed to determine whether BP lowering is actually beneficial
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Affiliation(s)
| | - Yser Orabi
- Neurology, Med Univ of South Carolina, Charleston, SC
| | - Ali Alawieh
- Neurosurgery, Med Univ of South Carolina, Charleston, SC
| | | | - Abhi Pandhi
- Neurology, Univ of Tennessee Health Science Cntr, Memphis, TN
| | - Hunter Mitchell
- Neurology, Univ of Tennessee Health Science Cntr, Memphis, TN
| | | | - Ilko L Maier
- Neurology, Univ Med Cntr Göttingen, Göttingen, Germany
| | | | - Jan Liman
- Neurology, Univ Med Cntr Göttingen, Göttingen, Germany
| | | | | | | | - Akash Kansagra
- Radiology, Neurological Surgery; and Neurology, Washington Univ Sch of Medicine and Barnes-Jewish Hosp, St. Louis, MO
| | - James A Giles
- Neurology, Washington Univ Sch of Medicine, St. Louis, MO
| | - Michelle Allen
- Neurology, Washington Univ Sch of Medicine, St. Louis, MO
| | - Stacey Q Wolfe
- Neurosurgery, Wake Forest Sch of Medicine, Winston Salem, NC
| | - Peter Kan
- Neurosurgery, Baylor College of Medicine, Houston, TX
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McLean K, Glasbey J, Borakati A, Brooks T, Chang H, Choi S, Goodson R, Nielsen M, Pronin S, Salloum N, Sewart E, Vanniasegaram D, Drake T, Gillies M, Harrison E, Chapman S, Khatri C, Kong C, Claireaux H, Bath M, Mohan M, McNamee L, Kelly M, Mitchell H, Fitzgerald J, Bhangu A, Nepogodiev D, Antoniou I, Dean R, Davies N, Trecarten S, Henderson I, Holmes C, Wylie J, Shuttleworth R, Jindal A, Hughes F, Gouda P, Fleck R, Hanrahan M, Karunakaran P, Chen J, Sykes M, Sethi R, Suresh S, Patel P, Patel M, Varma R, Mushtaq J, Gundogan B, Bolton W, Khan T, Burke J, Morley R, Favero N, Adams R, Thirumal V, Kennedy E, Ong K, Tan Y, Gabriel J, Bakhsh A, Low J, Yener A, Paraoan V, Preece R, Tilston T, Cumber E, Dean S, Ross T, McCance E, Amin H, Satterthwaite L, Clement K, Gratton R, Mills E, Chiu S, Hung G, Rafiq N, Hayes J, Robertson K, Dynes K, Huang H, Assadullah S, Duncumb J, Moon R, Poo S, Mehta J, Joshi K, Callan R, Norris J, Chilvers N, Keevil H, Jull P, Mallick S, Elf D, Carr L, Player C, Barton E, Martin A, Ratu S, Roberts E, Phan P, Dyal A, Rogers J, Henson A, Reid N, Burke D, Culleton G, Lynne S, Mansoor S, Brennan C, Blessed R, Holloway C, Hill A, Goldsmith T, Mackin S, Kim S, Woin E, Brent G, Coffin J, Ziff O, Momoh Z, Debenham R, Ahmed M, Yong C, Wan J, Copley H, Raut P, Chaudhry F, Nixon G, Dorman C, Tan R, Kanabar S, Canning N, Dolaghan M, Bell N, McMenamin M, Chhabra A, Duke K, Turner L, Patel T, Chew L, Mirza M, Lunawat S, Oremule B, Ward N, Khan M, Tan E, Maclennan D, McGregor R, Chisholm E, Griffin E, Bell L, Hughes B, Davies J, Haq H, Ahmed H, Ungcharoen N, Whacha C, Thethi R, Markham R, Lee A, Batt E, Bullock N, Francescon C, Davies J, Shafiq N, Zhao J, Vivekanantham S, Barai I, Allen J, Marshall D, McIntyre C, Wilson H, Ashton A, Lek C, Behar N, Davis-Hall M, Seneviratne N, Esteve L, Sirakaya M, Ali S, Pope S, Ahn J, Craig-McQuaide A, Gatfield W, Leong S, Demetri A, Kerr A, Rees C, Loveday J, Liu S, Wijesekera M, Maru D, Attalla M, Smith N, Brown D, Sritharan P, Shah A, Charavanamuttu V, Heppenstall-Harris G, Ng K, Raghvani T, Rajan N, Hulley K, Moody N, Williams M, Cotton A, Sharifpour M, Lwin K, Bright M, Chitnis A, Abdelhadi M, Semana A, Morgan F, Reid R, Dickson J, Anderson L, McMullan R, Ahern N, Asmadi A, Anderson L, Boon Xuan JL, Crozier L, McAleer S, Lees D, Adebayo A, Das M, Amphlett A, Al-Robeye A, Valli A, Khangura J, Winarski A, Ali A, Woodward H, Gouldthrope C, Turner M, Sasapu K, Tonkins M, Wild J, Robinson M, Hardie J, Heminway R, Narramore R, Ramjeeawon N, Hibberd A, Winslow F, Ho W, Chong B, Lim K, Ho S, Crewdson J, Singagireson S, Kalra N, Koumpa F, Jhala H, Soon W, Karia M, Rasiah M, Xylas D, Gilbert H, Sundar-Singh M, Wills J, Akhtar S, Patel S, Hu L, Brathwaite-Shirley C, Nayee H, Amin O, Rangan T, Turner E, McCrann C, Shepherd R, Patel N, Prest-Smith J, Auyoung E, Murtaza A, Coates A, Prys-Jones O, King M, Gaffney S, Dewdney C, Nehikhare I, Lavery J, Bassett J, Davies K, Ahmad K, Collins A, Acres M, Egerton C, Cheng K, Chen X, Chan N, Sheldon A, Khan S, Empey J, Ingram E, Malik A, Johnstone M, Goodier R, Shah J, Giles J, Sanders J, McLure S, Pal S, Rangedara A, Baker A, Asbjoernsen C, Girling C, Gray L, Gauntlett L, Joyner C, Qureshi S, Mogan Y, Ng J, Kumar A, Park J, Tan D, Choo K, Raman K, Buakuma P, Xiao C, Govinden S, Thompson O, Charalambos M, Brown E, Karsan R, Dogra T, Bullman L, Dawson P, Frank A, Abid H, Tung L, Qureshi U, Tahmina A, Matthews B, Harris R, O'Connor A, Mazan K, Iqbal S, Stanger S, Thompson J, Sullivan J, Uppal E, MacAskill A, Bamgbose F, Neophytou C, Carroll A, Rookes C, Datta U, Dhutia A, Rashid S, Ahmed N, Lo T, Bhanderi S, Blore C, Ahmed S, Shaheen H, Abburu S, Majid S, Abbas Z, Talukdar S, Burney L, Patel J, Al-Obaedi O, Roberts A, Mahboob S, Singh B, Sheth S, Karia P, Prabhudesai A, Kow K, Koysombat K, Wang S, Morrison P, Maheswaran Y, Keane P, Copley P, Brewster O, Xu G, Harries P, Wall C, Al-Mousawi A, Bonsu S, Cunha P, Ward T, Paul J, Nadanakumaran K, Tayeh S, Holyoak H, Remedios J, Theodoropoulou K, Luhishi A, Jacob L, Long F, Atayi A, Sarwar S, Parker O, Harvey J, Ross H, Rampal R, Thomas G, Vanmali P, McGowan C, Stein J, Robertson V, Carthew L, Teng V, Fong J, Street A, Thakker C, O'Reilly D, Bravo M, Pizzolato A, Khokhar H, Ryan M, Cheskes L, Carr R, Salih A, Bassiony S, Yuen R, Chrastek D, Rosen O'Sullivan H, Amajuoyi A, Wang A, Sitta O, Wye J, Qamar M, Major C, Kaushal A, Morgan C, Petrarca M, Allot R, Verma K, Dutt S, Chilima C, Peroos S, Kosasih S, Chin H, Ashken L, Pearse R, O'Loughlin R, Menon A, Singh K, Norton J, Sagar R, Jathanna N, Rothwell L, Watson N, Harding F, Dube P, Khalid H, Punjabi N, Sagmeister M, Gill P, Shahid S, Hudson-Phillips S, George D, Ashwood J, Lewis T, Dhar M, Sangal P, Rhema I, Kotecha D, Afzal Z, Syeed J, Prakash E, Jalota P, Herron J, Kimani L, Delport A, Shukla A, Agarwal V, Parthiban S, Thakur H, Cymes W, Rinkoff S, Turnbull J, Hayat M, Darr S, Khan U, Lim J, Higgins A, Lakshmipathy G, Forte B, Canning E, Jaitley A, Lamont J, Toner E, Ghaffar A, McDowell M, Salmon D, O'Carroll O, Khan A, Kelly M, Clesham K, Palmer C, Lyons R, Bell A, Chin R, Waldron R, Trimble A, Cox S, Ashfaq U, Campbell J, Holliday R, McCabe G, Morris F, Priestland R, Vernon O, Ledsam A, Vaughan R, Lim D, Bakewell Z, Hughes R, Koshy R, Jackson H, Narayan P, Cardwell A, Jubainville C, Arif T, Elliott L, Gupta V, Bhaskaran G, Odeleye A, Ahmed F, Shah R, Pickard J, Suleman Y, North A, McClymont L, Hussain N, Ibrahim I, Ng G, Wong V, Lim A, Harris L, Tharmachandirar T, Mittapalli D, Patel V, Lakhani M, Bazeer H, Narwani V, Sandhu K, Wingfield L, Gentry S, Adjei H, Bhatti M, Braganza L, Barnes J, Mistry S, Chillarge G, Stokes S, Cleere J, Wadanamby S, Bucko A, Meek J, Boxall N, Heywood E, Wiltshire J, Toh C, Ward A, Shurovi B, Horth D, Patel B, Ali B, Spencer T, Axelson T, Kretzmer L, Chhina C, Anandarajah C, Fautz T, Horst C, Thevathasan A, Ng J, Hirst F, Brewer C, Logan A, Lockey J, Forrest P, Keelty N, Wood A, Springford L, Avery P, Schulz T, Bemand T, Howells L, Collier H, Khajuria A, Tharakan R, Parsons S, Buchan A, McGalliard R, Mason J, Cundy O, Li N, Redgrave N, Watson R, Pezas T, Dennis Y, Segall E, Hameed M, Lynch A, Chamberlain M, Peck F, Neo Y, Russell G, Elseedawy M, Lee S, Foster N, Soo Y, Puan L, Dennis R, Goradia H, Qureshi A, Osman S, Reeves T, Dinsmore L, Marsden M, Lu Q, Pitts-Tucker T, Dunn C, Walford R, Heathcote E, Martin R, Pericleous A, Brzyska K, Reid K, Williams M, Wetherall N, McAleer E, Thomas D, Kiff R, Milne S, Holmes M, Bartlett J, Lucas de Carvalho J, Bloomfield T, Tongo F, Bremner R, Yong N, Atraszkiewicz B, Mehdi A, Tahir M, Sherliker G, Tear A, Pandey A, Broyd A, Omer H, Raphael M, Chaudhry W, Shahidi S, Jawad A, Gill C, Fisher IH, Adeleja I, Clark I, Aidoo-Micah G, Stather P, Salam G, Glover T, Deas G, Sim N, Obute R, Wynell-Mayow W, Sait M, Mitha N, de Bernier G, Siddiqui M, Shaunak R, Wali A, Cuthbert G, Bhudia R, Webb E, Shah S, Ansari N, Perera M, Kelly N, McAllister R, Stanley G, Keane C, Shatkar V, Maxwell-Armstrong C, Henderson L, Maple N, Manson R, Adams R, Semple E, Mills M, Daoub A, Marsh A, Ramnarine A, Hartley J, Malaj M, Jewell P, Whatling E, Hitchen N, Chen M, Goh B, Fern J, Rogers S, Derbyshire L, Robertson D, Abuhussein N, Deekonda P, Abid A, Harrison P, Aildasani L, Turley H, Sherif M, Pandey G, Filby J, Johnston A, Burke E, Mohamud M, Gohil K, Tsui A, Singh R, Lim S, O'Sullivan K, McKelvey L, O'Neill S, Roberts H, Brown F, Cao Y, Buckle R, Liew Y, Sii S, Ventre C, Graham C, Filipescu T, Yousif A, Dawar R, Wright A, Peters M, Varley R, Owczarek S, Hartley S, Khattak M, Iqbal A, Ali M, Durrani B, Narang Y, Bethell G, Horne L, Pinto R, Nicholls K, Kisyov I, Torrance H, English W, Lakhani S, Ashraf S, Venn M, Elangovan V, Kazmi Z, Brecher J, Sukumar S, Mastan A, Mortimer A, Parker J, Boyle J, Elkawafi M, Beckett J, Mohite A, Narain A, Mazumdar E, Sreh A, Hague A, Weinberg D, Fletcher L, Steel M, Shufflebotham H, Masood M, Sinha Y, Jenvey C, Kitt H, Slade R, Craig A, Deall C, Reakes T, Chervenkoff J, Strange E, O'Bryan M, Murkin C, Joshi D, Bergara T, Naqib S, Wylam D, Scotcher S, Hewitt C, Stoddart M, Kerai A, Trist A, Cole S, Knight C, Stevens S, Cooper G, Ingham R, Dobson J, O'Kane A, Moradzadeh J, Duffy A, Henderson C, Ashraf S, McLaughin C, Hoskins T, Reehal R, Bookless L, McLean R, Stone E, Wright E, Abdikadir H, Roberts C, Spence O, Srikantharajah M, Ruiz E, Matthews J, Gardner E, Hester E, Naran P, Simpson R, Minhas M, Cornish E, Semnani S, Rojoa D, Radotra A, Eraifej J, Eparh K, Smith D, Mistry B, Hickling S, Din W, Liu C, Mithrakumar P, Mirdavoudi V, Rashid M, Mcgenity C, Hussain O, Kadicheeni M, Gardner H, Anim-Addo N, Pearce J, Aslanyan A, Ntala C, Sorah T, Parkin J, Alizadeh M, White A, Edozie F, Johnston J, Kahar A, Navayogaarajah V, Patel B, Carter D, Khonsari P, Burgess A, Kong C, Ponweera A, Cody A, Tan Y, Ng A, Croall A, Allan C, Ng S, Raghuvir V, Telfer R, Greenhalgh A, McKerr C, Edison M, Patel B, Dear K, Hardy M, Williams P, Hassan S, Sajjad U, O'Neill E, Lopes S, Healy L, Jamal N, Tan S, Lazenby D, Husnoo S, Beecroft S, Sarvanandan T, Weston C, Bassam N, Rabinthiran S, Hayat U, Ng L, Varma D, Sukkari M, Mian A, Omar A, Kim J, Sellathurai J, Mahmood J, O'Connell C, Bose R, Heneghan H, Lalor P, Matheson J, Doherty C, Cullen C, Cooper D, Angelov S, Drislane C, Smith A, Kreibich A, Palkhi E, Durr A, Lotfallah A, Gold D, Mckean E, Dhanji A, Anilkumar A, Thacoor A, Siddiqui Z, Lim S, Piquet A, Anderson S, McCormack D, Gulati J, Ibrahim A, Murray S, Walsh S, McGrath A, Ziprin P, Chua E, Lou C, Bloomer J, Paine H, Osei-Kuffour D, White C, Szczap A, Gokani S, Patel K, Malys M, Reed A, Torlot G, Cumber E, Charania A, Ahmad S, Varma N, Cheema H, Austreng L, Petra H, Chaudhary M, Zegeye M, Cheung F, Coffey D, Heer R, Singh S, Seager E, Cumming S, Suresh R, Verma S, Ptacek I, Gwozdz A, Yang T, Khetarpal A, Shumon S, Fung T, Leung W, Kwang P, Chew L, Loke W, Curran A, Chan C, McGarrigle C, Mohan K, Cullen S, Wong E, Toale C, Collins D, Keane N, Traynor B, Shanahan D, Yan A, Jafree D, Topham C, Mitrasinovic S, Omara S, Bingham G, Lykoudis P, Miranda B, Whitehurst K, Kumaran G, Devabalan Y, Aziz H, Shoa M, Dindyal S, Yates J, Bernstein I, Rattan G, Coulson R, Stezaker S, Isaac A, Salem M, McBride A, McFarlane H, Yow L, MacDonald J, Bartlett R, Turaga S, White U, Liew W, Yim N, Ang A, Simpson A, McAuley D, Craig E, Murphy L, Shepherd P, Kee J, Abdulmajid A, Chung A, Warwick H, Livesey A, Holton P, Theodoreson M, Jenkin S, Turner J, Entwisle J, Marchal S, O'Connor S, Blege H, Aithie J, Sabine L, Stewart G, Jackson S, Kishore A, Lankage C, Acquaah F, Joyce H, McKevitt K, Coffey C, Fawaz A, Dolbec K, O'Sullivan D, Geraghty J, Lim E, Bolton L, FitzPatrick D, Robinson C, Ramtoola T, Collinson S, Grundy L, McEnhill P, Harbhajan Singh G, Loughran D, Golding D, Keeling R, Williams R, Whitham R, Yoganathan S, Nachiappan R, Egan R, Owasil R, Kwan M, He A, Goh R, Bhome R, Wilson H, Teoh P, Raji K, Jayakody N, Matthams J, Chong J, Luk C, Greig R, Trail M, Charalambous G, Rocke A, Gardiner N, Bulley F, Warren N, Brennan E, Fergurson P, Wilson R, Whittingham H, Brown E, Khanijau R, Gandhi K, Morris S, Boulton A, Chandan N, Barthorpe A, Maamari R, Sandhu S, McCann M, Higgs L, Balian V, Reeder C, Diaper C, Sale T, Ali H, Archer C, Clarke A, Heskin J, Hurst P, Farmer J, O'Flynn L, Doan L, Shuker B, Stott G, Vithanage N, Hoban K, Nesargikar P, Kennedy H, Grossart C, Tan E, Roy C, Sim P, Leslie K, Sim D, Abul M, Cody N, Tay A, Woon E, Sng S, Mah J, Robson J, Shakweh E, Wing V, Mills H, Li M, Barrow T, Balaji S, Jordan H, Phillips C, Naveed H, Hirani S, Tai A, Ratnakumaran R, Sahathevan A, Shafi A, Seedat M, Weaver R, Batho A, Punj R, Selvachandran H, Bhatt N, Botchey S, Khonat Z, Brennan K, Morrison C, Devlin E, Linton A, Galloway E, McGarvie S, Ramsay N, McRobbie H, Whewell H, Dean W, Nelaj S, Eragat M, Mishra A, Kane T, Zuhair M, Wells M, Wilkinson D, Woodcock N, Sun E, Aziz N, Ghaffar MKA. Critical care usage after major gastrointestinal and liver surgery: a prospective, multicentre observational study. Br J Anaesth 2019; 122:42-50. [PMID: 30579405 DOI: 10.1016/j.bja.2018.07.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 07/19/2018] [Accepted: 07/23/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Patient selection for critical care admission must balance patient safety with optimal resource allocation. This study aimed to determine the relationship between critical care admission, and postoperative mortality after abdominal surgery. METHODS This prespecified secondary analysis of a multicentre, prospective, observational study included consecutive patients enrolled in the DISCOVER study from UK and Republic of Ireland undergoing major gastrointestinal and liver surgery between October and December 2014. The primary outcome was 30-day mortality. Multivariate logistic regression was used to explore associations between critical care admission (planned and unplanned) and mortality, and inter-centre variation in critical care admission after emergency laparotomy. RESULTS Of 4529 patients included, 37.8% (n=1713) underwent planned critical care admissions from theatre. Some 3.1% (n=86/2816) admitted to ward-level care subsequently underwent unplanned critical care admission. Overall 30-day mortality was 2.9% (n=133/4519), and the risk-adjusted association between 30-day mortality and critical care admission was higher in unplanned [odds ratio (OR): 8.65, 95% confidence interval (CI): 3.51-19.97) than planned admissions (OR: 2.32, 95% CI: 1.43-3.85). Some 26.7% of patients (n=1210/4529) underwent emergency laparotomies. After adjustment, 49.3% (95% CI: 46.8-51.9%, P<0.001) were predicted to have planned critical care admissions, with 7% (n=10/145) of centres outside the 95% CI. CONCLUSIONS After risk adjustment, no 30-day survival benefit was identified for either planned or unplanned postoperative admissions to critical care within this cohort. This likely represents appropriate admission of the highest-risk patients. Planned admissions in selected, intermediate-risk patients may present a strategy to mitigate the risk of unplanned admission. Substantial inter-centre variation exists in planned critical care admissions after emergency laparotomies.
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Wikramanayake TC, Hirt P, Almastadi M, Mitchell H, Tomic‐Canic M, Romero L, Garcia D, Strbo N. Increased IL‐17‐expressing γδ T cells in seborrhoeic dermatitis‐like lesions of the
Mpzl3
knockout mice. Exp Dermatol 2018; 27:1408-1411. [DOI: 10.1111/exd.13798] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 10/01/2018] [Indexed: 01/05/2023]
Affiliation(s)
- Tongyu C. Wikramanayake
- Department of Dermatology and Cutaneous SurgeryUniversity of Miami Miller School of Medicine Miami Florida
| | - Penelope Hirt
- Department of Dermatology and Cutaneous SurgeryUniversity of Miami Miller School of Medicine Miami Florida
| | - Maram Almastadi
- Department of Dermatology and Cutaneous SurgeryUniversity of Miami Miller School of Medicine Miami Florida
| | - Hunter Mitchell
- Department of Dermatology and Cutaneous SurgeryUniversity of Miami Miller School of Medicine Miami Florida
| | - Marjana Tomic‐Canic
- Department of Dermatology and Cutaneous SurgeryUniversity of Miami Miller School of Medicine Miami Florida
| | - Laura Romero
- Department of Microbiology and ImmunologyUniversity of Miami Miller School of Medicine Miami Florida
| | - Denisse Garcia
- Department of Microbiology and ImmunologyUniversity of Miami Miller School of Medicine Miami Florida
| | - Natasa Strbo
- Department of Microbiology and ImmunologyUniversity of Miami Miller School of Medicine Miami Florida
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Abstract
STUDY QUESTION What is the impact of endometriosis on male partners of women with the condition? SUMMARY ANSWER Endometriosis significantly impacts men across several life domains and can negatively impact emotional well-being. WHAT IS KNOWN ALREADY Endometriosis has been shown to negatively impact women's quality of life and may strain intimate relationships. Little is known about the impact on male partners. STUDY DESIGN, SIZE, DURATION The ENDOPART study was a cross-sectional, qualitative study of 22 women with endometriosis and their male partners (n = 44) in the UK (2012–2013). PARTICIPANTS/MATERIALS, SETTING, METHODS Inclusion criteria: laparoscopic diagnosis of endometriosis; the presence of symptoms for at least a year; partners living together. Data were collected via face to face, semi structured interviews with partners interviewed separately. Data were analysed thematically, assisted by NVivo 10. MAIN RESULTS AND THE ROLE OF CHANCE Men reported that endometriosis affected many life domains including sex and intimacy, planning for and having children, working lives and household income. It also required them to take on additional support tasks and roles. Endometriosis also had an impact on men's emotions, with responses including helplessness, frustration, worry and anger. The absence of professional or wider societal recognition of the impact on male partners, and a lack of support available to men, results in male partners having a marginalized status in endometriosis care. LIMITATIONS REASONS FOR CAUTION Self-selection of participants may have resulted in a sample representing those with more severe symptoms. Couples included are in effect ‘survivors’ in relationship terms, therefore, findings may underestimate the contribution of endometriosis to relationship breakdown. WIDER IMPLICATIONS OF THE FINDINGS The study extends knowledge about the impact of endometriosis on relationships, which thus far has been drawn largely from studies with women, by providing new insights about how this condition affects male partners. Healthcare practitioners need to take a more couple-centred, biopsychosocial approach toward the treatment of endometriosis, inclusive of partners and relationship issues. The findings demonstrate a need for information and support resources aimed at partners and couples. STUDY FUNDING/COMPETING INTEREST(S) This study was funded by the Economic and Social Research Council (reference ES/J003662/1). The authors have no conflicts of interest.
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Affiliation(s)
- L Culley
- School of Applied Social Sciences, Faculty of Health and Life Sciences, The Gateway, De Montfort University, Hawthorn Building, Leicester LE1 9BH, UK
| | - C Law
- School of Applied Social Sciences, Faculty of Health and Life Sciences, The Gateway, De Montfort University, Hawthorn Building, Leicester LE1 9BH, UK
| | - N Hudson
- School of Applied Social Sciences, Faculty of Health and Life Sciences, The Gateway, De Montfort University, Hawthorn Building, Leicester LE1 9BH, UK
| | - H Mitchell
- School of Applied Social Sciences, Faculty of Health and Life Sciences, The Gateway, De Montfort University, Hawthorn Building, Leicester LE1 9BH, UK
| | - E Denny
- Faculty of Health, Education and Life Sciences, Birmingham City University, Westbourne Road, Edgbaston, Birmingham B15 3TN, UK
| | - N Raine-Fenning
- Nurture Fertility, East Midlands Fertility Centre, 25 Business Park, Bostocks Lane, Sandiacre, Nottingham NG10 5QS, UK.,Division of Obstetrics and Gynaecology, School of Clinical Sciences, University of Nottingham, University Park, Nottingham NG7 2RD, UK
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Ting A, May M, Mitchell H, Carver C, Kim Y. 0865 Dyadic Effects of Daily Stress and Satisfaction on Sleep Efficiency: A Preliminary Report among Colorectal Cancer Survivors and Their Spouses. Sleep 2018. [DOI: 10.1093/sleep/zsy061.864] [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: 11/13/2022] Open
Affiliation(s)
- A Ting
- University of Miami, Coral Gables, FL
| | - M May
- University of Miami, Coral Gables, FL
| | | | - C Carver
- University of Miami, Coral Gables, FL
| | - Y Kim
- University of Miami, Coral Gables, FL
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Filella X, Ballesta A, Fox M, Mitchell H, Molina R, Pürstner P, Thome H. Multicentre Clinical Evaluation of the COBAS CORE CEA, CA 125 II and PSA Tumor Marker Assays. Int J Biol Markers 2018. [DOI: 10.1177/172460089601100108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The aim of our study was to evaluate the clinical usefulness of the tumor markers CEA, CA 125 and PSA using the COBAS CORE system from Roche Diagnostic Systems. Our results demonstrate that determination of these markers on the COBAS CORE immunoassasy analyser provides the performance required for routine use in clinical practice. The results obtained in this clinical trial validate the correlation with disease extension, a characteristic that defines and determines the clinical utility of the tumor markers. We also conclude that learning to operate the COBAS CORE system is simple, as is management of the system through the user-friendly software.
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Affiliation(s)
- X. Filella
- Department of Clinical Biochemistry (Unit for Cancer Research), Hospital Clinic Provincial, Barcelona - Spain
| | - A.M. Ballesta
- Department of Clinical Biochemistry (Unit for Cancer Research), Hospital Clinic Provincial, Barcelona - Spain
| | - M. Fox
- Department of Medical Oncology, Charing Cross Hospital, London - United Kingdom
| | - H. Mitchell
- Department of Medical Oncology, Charing Cross Hospital, London - United Kingdom
| | - R. Molina
- Department of Clinical Biochemistry (Unit for Cancer Research), Hospital Clinic Provincial, Barcelona - Spain
| | - P. Pürstner
- Endocrinology Laboratory, University Hospital for Women, Graz - Austria
| | - H. Thome
- Department of Biochemistry, Hospital of Chambéry, Chambéry - France
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Eng N, Chen C, Aldridge M, Osborne A, Vega J, Mitchell H, Smith A, Hurtik M, Morris A, Gupta D, Bhatt K, Laskar S, Cole R. Preemptive vs. Upfront CMV Prophylaxis Strategies and Risk of Non-CMV Herpesvirus Infections in Intermediate Risk Heart Transplant Recipients. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Walker T, Edge D, Shaw J, Wilson H, McNair L, Mitchell H, Gutridge K, Senior J, Sutton M, Meacock R, Abel K. Contemporary women's secure psychiatric services in the United Kingdom: A qualitative analysis of staff views. J Psychiatr Ment Health Nurs 2017; 24:660-670. [PMID: 28783204 DOI: 10.1111/jpm.12416] [Citation(s) in RCA: 2] [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] [Accepted: 08/02/2017] [Indexed: 11/28/2022]
Abstract
UNLABELLED WHAT IS KNOWN ON THE SUBJECT?: Three pilot UK-only Women's Enhanced Medium Secure Services (WEMSS) was opened in 2007 to support women's movement from high secure care and provide a bespoke, women-only service. Evidence suggests that women's secure services are particularly challenging environments to work in and staffing issues (e.g., high turnover) can cause difficulties in establishing a therapeutic environment. Research in this area has focused on the experiences of service users. Studies which have examined staff views have focused on their feelings towards women in their care and the emotional burden of working in women's secure services. No papers have made a direct comparison between staff working in different services. WHAT DOES THIS STUDY ADD TO EXISTING KNOWLEDGE?: This is the first study to explore the views and experiences of staff in the three UK WEMSS pilot services and contrast them with staff from women's medium secure services. Drawing upon data from eighteen semi-structured interviews (nine WEMSS, nine non-WEMSS), key themes cover staff perceptions of factors important for women's recovery and their views on operational aspects of services. This study extends our understanding of the experiences of staff working with women in secure care and bears relevance for staff working internationally, as well as in UK services. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The study reveals the importance of induction and training for bank and agency staff working in women's secure services. Further, regular clinical supervision should be mandatory for all staff so they are adequately supported. ABSTRACT Introduction Women's Enhanced Medium Secure Services (WEMSS) is bespoke, gender-sensitive services which opened in the UK in 2007 at three pilot sites. This study is the first of its kind to explore the experiences of WEMSS staff, directly comparing them to staff in a standard medium secure service for women. The literature to date has focused on the experiences of service users or staff views on working with women in secure care. Aim This qualitative study, embedded in a multimethod evaluation of WEMSS, aimed to explore the views and experiences of staff in WEMSS and comparator medium secure services. Methods Qualitative interviews took place with nine WEMSS staff and nine comparator medium secure staff. Interviews focused on factors important for recovery, barriers to facilitating recovery and operational aspects of the service. Discussion This study provides a rare insight into the perspectives of staff working in UK women's secure services, an under-researched area in the UK and internationally. Findings suggest that the success of services, including WEMSS, is compromised by operational factors such as the use of bank staff. Implications for practice Comprehensive training and supervision should be mandatory for all staff, so best practice is met and staff adequately supported.
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Affiliation(s)
- T Walker
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - D Edge
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - J Shaw
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, Offender Health Research Network, University of Manchester, Manchester, UK
| | - H Wilson
- Lancashire Care NHS Foundation Trust, Preston, UK
| | - L McNair
- Cheshire and Wirral Partnership NHS Foundation Trust, Chester, UK
| | - H Mitchell
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, Centre for Women's Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - K Gutridge
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, Centre for Women's Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - J Senior
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, Offender Health Research Network, University of Manchester, Manchester, UK
| | - M Sutton
- Centre for Health Economics, School of Health Sciences, University of Manchester, Manchester, UK
| | - R Meacock
- Centre for Health Economics, School of Health Sciences, University of Manchester, Manchester, UK
| | - K Abel
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, Centre for Women's Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
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Hollis A, Quinn L, Begum R, Mitchell H, Hodson J, Whiting J, Griffiths E. Tumour Length in Oesophageal Cancer. Int J Surg 2017. [DOI: 10.1016/j.ijsu.2017.08.053] [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: 10/18/2022]
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23
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Furegato M, Mitchell H, Ogaz D, Woodhall S, Connor N, Hughes G, Nardone A, Mohammed H. The role of frequent HIV testing in diagnosing HIV in men who have sex with men. HIV Med 2017; 19:118-122. [PMID: 28984407 DOI: 10.1111/hiv.12558] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVES In the UK, quarterly HIV testing is recommended for high-risk men who have sex with men (MSM). In this manuscript we determined the risk of being newly diagnosed with HIV in MSM by their HIV testing history, considering both the frequency and periodicity of testing. METHODS Data on HIV incidence in MSM attending a sexual health clinic (SHC) in England in 2013-2014 with testing history (previous 2 years) were obtained from GUMCAD, the national sexually transmitted infection (STI) surveillance system in England. HIV testing patterns among MSM were defined using the frequency and periodicity of testing, based on 3 month intervals, in the year preceding the first attendance during the study period. Cox proportional hazards regression was used to determine the association between HIV testing pattern and time to HIV diagnosis with and without adjustment for demographic confounders. Analyses were stratified by risk stratum, with 'high risk' defined as a history of a bacterial STI in the past year. Adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) are reported. RESULTS Among the 37 702 HIV-negative MSM attending an SHC in 2013-2014, 1105 (3%) were diagnosed with HIV infection within 1 year of their first attendance. The probability of HIV diagnosis was highest in MSM who were tested quarterly compared with those who were not tested in the past year (aHR 2.51; 95% CI 1.33-4.74); this increased 1.8-fold among high-risk MSM (aHR 4.48; 95% CI 0.97-21.17). CONCLUSIONS The probability of subsequent HIV diagnosis was greatest in high-risk MSM who were tested most frequently. Quarterly HIV testing increased the likelihood of identifying undiagnosed HIV infection and should remain a continued recommendation for high-risk MSM.
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Affiliation(s)
- M Furegato
- National Infection Service, Public Health England, London, UK
| | - H Mitchell
- National Infection Service, Public Health England, London, UK
| | - D Ogaz
- National Infection Service, Public Health England, London, UK
| | - S Woodhall
- National Infection Service, Public Health England, London, UK
| | - N Connor
- National Infection Service, Public Health England, London, UK
| | - G Hughes
- National Infection Service, Public Health England, London, UK
| | - A Nardone
- National Infection Service, Public Health England, London, UK
| | - H Mohammed
- National Infection Service, Public Health England, London, UK
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Feng J, Anderson K, Singh AK, Ehsan A, Mitchell H, Liu Y, Sellke FW. Diabetes Upregulation of Cyclooxygenase 2 Contributes to Altered Coronary Reactivity After Cardiac Surgery. Ann Thorac Surg 2017; 104:568-576. [PMID: 28223053 PMCID: PMC5891657 DOI: 10.1016/j.athoracsur.2016.11.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 09/26/2016] [Accepted: 11/07/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND We hypothesized that upregulation of inducible cyclooxygenase 2 (COX-2) contributes to altered coronary arteriolar reactivity early after cardioplegic arrest and cardiopulmonary bypass (CP/CPB) in patients with diabetes mellitus who are undergoing cardiac surgery. METHODS The right atrial tissue samples of nondiabetes (ND), controlled diabetes (CDM), and uncontrolled diabetes (UDM) patients undergoing cardiac surgery were harvested before and after CP/CPB. Coronary arterioles (80 to 150 μm) were dissected from the harvested atrial tissue samples, cannulated, and pressurized. The changes in diameter were measured with video microscopy. The protein expression and localization of COX-1 and COX-2 were assayed by Western blot and immunohistochemistry. RESULTS In the diabetes arterioles, bradykinin-induced relaxation response was inhibited by the selective COX-2 inhibitor NS398 at baseline (p < 0.05). This effect was more pronounced in UDM arterioles than CDM (p < 0.05). After CP/CPB, bradykinin-induced responses in all groups were inhibited by NS398, but this effect was more pronounced in the UDM patients (p < 0.05). The intensities of COX-2 staining of coronary arterioles and COX-2 protein levels in myocardium were higher in diabetes than nondiabetes at baseline (p < 0.05). The post-CP/CPB protein levels of the inducible COX-2 were significantly increased compared with pre-CP/CPB values in all groups (p < 0.05), whereas this increase was higher with diabetes than with ND (p < 0.05). Furthermore, these effects were more profound in UDM than CDM (p < 0.05). CONCLUSIONS Diabetes and CP/CPB are associated with upregulation in COX-2 expression in human coronary vasculature. Upregulation of COX-2 expression may contribute to bradykinin-induced coronary arteriolar relaxation in diabetic patients undergoing cardiac surgery.
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Affiliation(s)
- Jun Feng
- Division of Cardiothoracic Surgery, Department of Surgery, Cardiovascular Research Center, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Kelsey Anderson
- Division of Cardiothoracic Surgery, Department of Surgery, Cardiovascular Research Center, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Arun K Singh
- Division of Cardiothoracic Surgery, Department of Surgery, Cardiovascular Research Center, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Afshin Ehsan
- Division of Cardiothoracic Surgery, Department of Surgery, Cardiovascular Research Center, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Hunter Mitchell
- Division of Cardiothoracic Surgery, Department of Surgery, Cardiovascular Research Center, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Yuhong Liu
- Division of Cardiothoracic Surgery, Department of Surgery, Cardiovascular Research Center, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Frank W Sellke
- Division of Cardiothoracic Surgery, Department of Surgery, Cardiovascular Research Center, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, Rhode Island.
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Fernando S, Okonta L, Sandri I, Wardley A, Mitchell H, Conway A. Changes in Ejection Fraction (EF) Following Sequential Anthracycline and Trastuzumab in Patients with HER2+ Early Breast Cancer (EBC) – Is There a Need for Two Echocardiograms Pre-trastuzumab? Clin Oncol (R Coll Radiol) 2017. [DOI: 10.1016/j.clon.2017.01.020] [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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Fernando S, Conway A, Mitchell H, Sandri I, Wardley A, Okonta L, Mansi J. ATwo-Centre Audit on Changes in Ejection Fraction (EF) following sequential anthracycline chemotherapy and Trastuzumab (T) in patients with HER2+ Early Breast Cancer (EBC). Breast 2017. [DOI: 10.1016/s0960-9776(17)30399-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Bobdiwala S, Guha S, Van Calster B, Ayim F, Mitchell-Jones N, Al-Memar M, Mitchell H, Stalder C, Bottomley C, Kothari A, Timmerman D, Bourne T. The clinical performance of the M4 decision support model to triage women with a pregnancy of unknown location as at low or high risk of complications. Hum Reprod 2016; 31:1425-35. [PMID: 27165655 DOI: 10.1093/humrep/dew105] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [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: 11/05/2015] [Accepted: 04/07/2016] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION What are the adverse outcomes associated with using the M4 model in everyday clinical practice for women with pregnancy of unknown location (PUL)? SUMMARY ANSWER There were 17/835 (2.0%) adverse events and no serious adverse events associated with the performance of the M4 model in clinical practice. WHAT IS KNOWN ALREADY The M4 model has previously been shown to stratify women classified as a PUL as at low or high risk of complications with a good level of test performance. The triage performance of the M4 model is better than single measurements of serum progesterone or the hCG ratio (serum hCG at 48 h/hCG at presentation). STUDY DESIGN, SIZE, DURATION A prospective multi-centre cohort study of 1022 women with a PUL carried out between August 2012 and December 2013 across 2 university teaching hospitals and 1 district general hospital. PARTICIPANTS/MATERIALS, SETTING, METHODS All women presenting with a PUL to the early pregnancy units of the three hospitals were recruited. The final outcome for PUL was either a failed PUL (FPUL), intrauterine pregnancy (IUP) or ectopic pregnancy (EP) (including persistent PUL (PPUL)), with EP and PPUL considered high-risk PUL. Their hCG results at 0 and 48 h were entered into the M4 model algorithm. If the risk of EP was ≥5%, the PUL was predicted to be high-risk and the participant was asked to re-attend 48 h later for a repeat hCG and transvaginal ultrasound scan by a senior clinician. If the PUL was classified as 'low risk, likely failed PUL', the participant was asked to perform a urinary pregnancy test 2 weeks later. If the PUL was classified as 'low risk, likely intrauterine', the participant was scheduled for a repeat scan in 1 week. Deviations from the management protocol were recorded as either an 'unscheduled visit (participant reason)', 'unscheduled visit (clinician reason)' or 'differences in timing (blood test/ultrasound)'. Adverse events were assessed using definitions outlined in the UK Good Clinical Practice Guidelines' document. MAIN RESULTS AND THE ROLE OF CHANCE A total of 835 (82%) women classified as a PUL were managed according to the M4 model (9 met the exclusion criteria, 69 were lost to follow-up, 109 had no hCG result at 48 h). Of these, 443 (53%) had a final outcome of FPUL, 298 (36%) an IUP and 94 (11%) an EP. The M4 model predicted 70% (585/835) PUL as low risk, of which 568 (97%) were confirmed as FPUL or IUP. Of the 17 EP and PPUL misclassified as low risk, 5 had expectant management, 7 medical management with methotrexate and 5 surgical intervention.Nineteen PUL had an unscheduled visit (participant reason), 38 PUL had an unscheduled visit (clinician reason) and 68 PUL had deviations from protocol due to a difference in timing (blood test/ultrasound).Adverse events were reported in 26 PUL and 1 participant had a serious adverse event. A total of 17/26 (65%) adverse events were misclassifications of a high risk PUL as low risk by the M4 model, while 5/26 (19%) adverse events were related to incorrect clinical decisions. Four of the 26 adverse events (15%) were secondary to unscheduled admissions for pain/bleeding. The serious adverse event was due to an incorrect clinical decision. LIMITATIONS, REASONS FOR CAUTION A limitation of the study was that 69/1022 (7%) of PUL were lost to follow-up. A 48 h hCG level was missing for 109/1022 (11%) participants. WIDER IMPLICATIONS OF THE FINDINGS The low number of adverse events (2.0%) suggests that expectant management of PUL using the M4 prediction model is safe. The model is an effective way of triaging women with a PUL as being at high- and low-risk of complications and rationalizing follow-up. The multi-centre design of the study is more likely to make the performance of the M4 model generalizable in other populations. STUDY FUNDING/COMPETING INTERESTS None. TRIAL REGISTRATION NUMBER Not applicable.
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Affiliation(s)
- S Bobdiwala
- Tommy's National Early Miscarriage Research Centre, Queen Charlottes & Chelsea Hospital, Imperial College, Du Cane Road, London W12 0HS, UK
| | - S Guha
- Tommy's National Early Miscarriage Research Centre, Queen Charlottes & Chelsea Hospital, Imperial College, Du Cane Road, London W12 0HS, UK West Middlesex University Hospital, Twickenham Road, Isleworth, London TW7 6AF, UK
| | - B Van Calster
- Department of Development and Regeneration, KU Leuven, Herestraat 49 Box 7003, Leuven B-3000, Belgium
| | - F Ayim
- Hillingdon Hospital, Pield Heath Road, Uxbridge UB8 3NN, UK
| | - N Mitchell-Jones
- Chelsea & Westminster Hospital, 329 Fulham Road, London SW10 9NH, UK
| | - M Al-Memar
- Tommy's National Early Miscarriage Research Centre, Queen Charlottes & Chelsea Hospital, Imperial College, Du Cane Road, London W12 0HS, UK
| | - H Mitchell
- Hillingdon Hospital, Pield Heath Road, Uxbridge UB8 3NN, UK
| | - C Stalder
- Tommy's National Early Miscarriage Research Centre, Queen Charlottes & Chelsea Hospital, Imperial College, Du Cane Road, London W12 0HS, UK
| | - C Bottomley
- Chelsea & Westminster Hospital, 329 Fulham Road, London SW10 9NH, UK
| | - A Kothari
- Hillingdon Hospital, Pield Heath Road, Uxbridge UB8 3NN, UK
| | - D Timmerman
- Department of Development and Regeneration, KU Leuven, Herestraat 49 Box 7003, Leuven B-3000, Belgium Department of Obstetrics and Gynaecology, University Hospitals Leuven, Campus Gasthuisberg, KU Leuven, Belgium
| | - T Bourne
- Tommy's National Early Miscarriage Research Centre, Queen Charlottes & Chelsea Hospital, Imperial College, Du Cane Road, London W12 0HS, UK Department of Development and Regeneration, KU Leuven, Herestraat 49 Box 7003, Leuven B-3000, Belgium Department of Obstetrics and Gynaecology, University Hospitals Leuven, Campus Gasthuisberg, KU Leuven, Belgium
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Conway A, Mitchell H, Morrisey D, Armstrong A, Wardley A, Howell S. Cardiac Events and Cardiac Monitoring in Adjuvant Trastuzumab Patients at The Christie: a Retrospective Audit. Clin Oncol (R Coll Radiol) 2016. [DOI: 10.1016/j.clon.2016.01.018] [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: 10/22/2022]
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Holmes EA, Bonsall MB, Hales SA, Mitchell H, Renner F, Blackwell SE, Watson P, Goodwin GM, Di Simplicio M. Applications of time-series analysis to mood fluctuations in bipolar disorder to promote treatment innovation: a case series. Transl Psychiatry 2016; 6:e720. [PMID: 26812041 PMCID: PMC5068881 DOI: 10.1038/tp.2015.207] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [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] [Received: 07/21/2015] [Revised: 11/09/2015] [Accepted: 11/10/2015] [Indexed: 01/09/2023] Open
Abstract
Treatment innovation for bipolar disorder has been hampered by a lack of techniques to capture a hallmark symptom: ongoing mood instability. Mood swings persist during remission from acute mood episodes and impair daily functioning. The last significant treatment advance remains Lithium (in the 1970s), which aids only the minority of patients. There is no accepted way to establish proof of concept for a new mood-stabilizing treatment. We suggest that combining insights from mood measurement with applied mathematics may provide a step change: repeated daily mood measurement (depression) over a short time frame (1 month) can create individual bipolar mood instability profiles. A time-series approach allows comparison of mood instability pre- and post-treatment. We test a new imagery-focused cognitive therapy treatment approach (MAPP; Mood Action Psychology Programme) targeting a driver of mood instability, and apply these measurement methods in a non-concurrent multiple baseline design case series of 14 patients with bipolar disorder. Weekly mood monitoring and treatment target data improved for the whole sample combined. Time-series analyses of daily mood data, sampled remotely (mobile phone/Internet) for 28 days pre- and post-treatment, demonstrated improvements in individuals' mood stability for 11 of 14 patients. Thus the findings offer preliminary support for a new imagery-focused treatment approach. They also indicate a step in treatment innovation without the requirement for trials in illness episodes or relapse prevention. Importantly, daily measurement offers a description of mood instability at the individual patient level in a clinically meaningful time frame. This costly, chronic and disabling mental illness demands innovation in both treatment approaches (whether pharmacological or psychological) and measurement tool: this work indicates that daily measurements can be used to detect improvement in individual mood stability for treatment innovation (MAPP).
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Affiliation(s)
- E A Holmes
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK,Department for Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden,University Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK,Medical Research Council Cognition and Brain Sciences Unit, 15 Chaucer Road, Cambridge CB2 7EF, UK. E-mail:
| | - M B Bonsall
- Mathematical Ecology Research Group, Department of Zoology, University of Oxford, Oxford, UK,St Peter's College, University of Oxford, Oxford, UK
| | - S A Hales
- University Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - H Mitchell
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK
| | - F Renner
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK
| | - S E Blackwell
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK
| | - P Watson
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK
| | - G M Goodwin
- University Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - M Di Simplicio
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK
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Potz BA, Sabe AA, Elmadhun NY, Feng J, Liu Y, Mitchell H, Quesenberry P, Abid MR, Sellke FW. Calpain inhibition decreases myocardial apoptosis in a swine model of chronic myocardial ischemia. Surgery 2015; 158:445-52. [PMID: 25991048 DOI: 10.1016/j.surg.2015.03.034] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 02/27/2015] [Accepted: 03/18/2015] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Calpain is a family of cysteine proteases that has an important role in the initiation, regulation, and execution of cell death. Our recent studies using a hypercholesterolemic swine model demonstrated that in the setting of the metabolic syndrome, calpain inhibition (CI) improved collateral-dependent perfusion and increased expression of proteins implicated in angiogenesis and vasodilation. In this study, we hypothesized that CI (by MLD28170) would decrease myocardial apoptosis in the same model. METHODS Yorkshire swine, all fed a high-cholesterol diet for 4 weeks underwent placement of an ameroid constrictor on the left circumflex coronary artery. Three weeks later, animals received either no drug, termed the high-cholesterol control group (HCC; n = 8); low-dose CI (0.12 mg/kg; LCI, n = 9); or high-dose CI (0.25 mg/kg; HCI, n = 8). The high-cholesterol diet and the CI were continued for 5 weeks, after which the pig was humanely killed and the left ventricular myocardium was harvested and analyzed via terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) staining, oxyblot analysis, and Western blots. Data were analyzed using the Kruskal-Wallis test. RESULTS The percentage of apoptotic cells to total cells in ischemic myocardial territory was decreased in the LCI and HCI groups compared with the HCC group as shown by TUNEL staining (P = .018). There was a decrease in proapoptotic proteins, including cleaved caspase 3, caspase 9, cleaved caspase 9, Bax, BAD, p-BAD, and Erk 1/2 (P ≤ .049 each), but no decrease in caspase 3 (P = .737). There was also an increase in antiapoptotic proteins, including BCL-2 and p-BCL2 (P ≤ .025 each). In the ischemic myocardium, several proangiogenic proteins were increased in the LCI and HCI groups compared with the HCC group, including p-AKT, p-eNOS, and eNOS (P ≤ .006 each) but there was no increase in AKT (P = .311). CI decreased tissue oxidative stress in both the LCI and HCI groups compared to the HCC group as shown by oxyblot analysis (P = .021). CONCLUSION In the setting of hypercholesterolemia, CI decreases apoptosis and the expression of proteins in proapoptotic signaling pathways. CI also increased expression of proteins implicated in anti apoptotic pathways and improves oxidative stress in ischemic myocardial tissue.
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Affiliation(s)
- Brittany A Potz
- Division of Cardiothoracic Surgery, Department of Surgery, Cardiovascular Research Center, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, RI
| | - Ashraf A Sabe
- Division of Cardiothoracic Surgery, Department of Surgery, Cardiovascular Research Center, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, RI
| | - Nassrene Y Elmadhun
- Division of Cardiothoracic Surgery, Department of Surgery, Cardiovascular Research Center, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, RI
| | - Jun Feng
- Division of Cardiothoracic Surgery, Department of Surgery, Cardiovascular Research Center, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, RI
| | - Yuhong Liu
- Division of Cardiothoracic Surgery, Department of Surgery, Cardiovascular Research Center, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, RI
| | - Hunter Mitchell
- Division of Cardiothoracic Surgery, Department of Surgery, Cardiovascular Research Center, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, RI
| | - Peter Quesenberry
- Division of Cardiothoracic Surgery, Department of Surgery, Cardiovascular Research Center, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, RI
| | - M Ruhul Abid
- Division of Cardiothoracic Surgery, Department of Surgery, Cardiovascular Research Center, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, RI
| | - Frank W Sellke
- Division of Cardiothoracic Surgery, Department of Surgery, Cardiovascular Research Center, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, RI.
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Malek R, Mitchell H, Furegato M, Simms I, Mohammed H, Nardone A, Hughes G. Contribution of transmission in HIV-positive men who have sex with men to evolving epidemics of sexually transmitted infections in England: an analysis using multiple data sources, 2009-2013. ACTA ACUST UNITED AC 2015; 20. [PMID: 25953130 DOI: 10.2807/1560-7917.es2015.20.15.21093] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
HIV seroadaptive behaviours may have contributed to greater sexually transmitted infection (STI) transmission in HIV-positive men who have sex with men(MSM) and to the global increase in STIs. Using multiple national surveillance data sources and population survey data, we estimated the risk of STIs in HIV-positive MSM and assessed whether transmission in HIV-positive MSM has contributed to recent STI epidemics in England. Since 2009, an increasing proportion of STIs has been diagnosed in HIV-positive MSM, and currently, the population rate of acute bacterial STIs is up to four times that of HIV-negative or undiagnosed MSM. Almost one in five of all diagnosed HIV-positive MSM in England had an acute STI diagnosed in 2013. From 2009 to 2013, the odds of being diagnosed with syphilis increased from 2.71 (95% confidence interval (CI) 2.41–3.05, p<0.001) to 4.05 (95%CI 3.70-4.45, p<0.001) in HIV-positive relative to HIV negative/undiagnosed MSM. Similar trends were seen for gonorrhoea and chlamydia. Bacterial STI re-infection rates were considerably higher in HIV-positive MSM over a five-year follow-up period, indicative of rapid transmission in more dense sexual networks.These findings strongly suggest that the sexual health of HIV-positive MSM in England is worsening, which merits augmented public health interventions and continued monitoring.
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Affiliation(s)
- R Malek
- Public Health England, London, United Kingdom
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Desai S, Croxford S, Brown AE, Mitchell H, Hughes G, Delpech V. An overview of the HIV epidemic among men who have sex with men in the United Kingdom, 1999-2013. ACTA ACUST UNITED AC 2015; 20. [PMID: 25884147 DOI: 10.2807/1560-7917.es2015.20.14.21086] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We describe epidemiological trends in HIV among men who have sex with men (MSM) in the United Kingdom (UK) to inform prevention strategies. National HIV surveillance data were analysed for trends. Multivariable analyses identified predictors of late diagnosis (<350 copies/µL) and mortality. Between 1999 and 2013, 37,560 MSM (≥15 years) were diagnosed with HIV in the UK. New diagnoses rose annually from 1,440 in 1999 to 3,250 in 2013. The majority of MSM were of white ethnicity (85%) and UK-born (68%). Median CD4 count increased steadily from 350 cells/µL to 463 cells/µL. HIV testing in England increased from 10,900 tests in 1999 to 102,600 in 2013. One-year death rates after diagnosis declined among late presenters (4.7% to 1.9%). Despite declining late diagnosis (50% to 31%), the number of men diagnosed late annually has remained high since 2004. Older age (≥50 years), and living outside London were predictors of late presentation; older age and late presentation were predictors of one-year mortality. Increases in new diagnoses reflect increased testing and ongoing transmission. Over 900 men present late each year and mortality in this group remains high and preventable. Appropriate prevention and testing strategies require strengthening to reduce HIV transmission and late diagnosis.
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Affiliation(s)
- S Desai
- HIV and STI Department, Centre for Infectious Disease Surveillance and Control, Health Protection England, London, United Kingdom
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Affiliation(s)
| | - J. Porter
- Dietetics; Eastern Health; VIC Australia
- Nutrition & Dietetics; Monash University; Notting Hill VIC Australia
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Pfau T, Jennings C, Mitchell H, Olsen E, Walker A, Egenvall A, Tröster S, Weller R, Rhodin M. Lungeing on hard and soft surfaces: Movement symmetry of trotting horses considered sound by their owners. Equine Vet J 2014; 48:83-9. [PMID: 25297461 DOI: 10.1111/evj.12374] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [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: 06/03/2014] [Accepted: 09/30/2014] [Indexed: 11/30/2022]
Abstract
REASONS FOR PERFORMING STUDY Lungeing is often part of the clinical lameness examination. The difference in movement symmetry, which is a commonly employed lameness measure, has not been quantified between surfaces. OBJECTIVES To compare head and pelvic movement symmetry between surfaces and reins during lungeing. STUDY DESIGN Quantitative gait analysis in 23 horses considered sound by their owners. METHODS Twenty-three horses were assessed in-hand and on the lunge on both reins on hard and soft surfaces with inertial sensors. Seven movement symmetry parameters were quantified and used to establish 2 groups, namely symmetrical (n = 9) and forelimb-lame horses (n = 14), based on values from straight-line assessment. Movement symmetry values for left rein measurements were side corrected to allow comparison of the amount of movement symmetry between reins. A mixed model (P<0.05) was used to study effects on movement symmetry of surface (hard/soft) and rein (inside/outside with respect to movement symmetry on the straight). RESULTS In forelimb-lame horses, surface and rein were identified as significantly affecting all head movement symmetry measures (rein, all P<0.0001; surface, all P<0.042). In the symmetrical group, no significant influence of surface or rein was identified for head movement symmetry (rein, all P>0.245; surface, all P>0.073). No significant influence of surface or rein was identified for any of the pelvic movement symmetry measures in either group. CONCLUSIONS While more symmetrical horses showed a consistent amount of movement symmetry across surfaces/reins, horses objectively quantified as lame on the straight showed decreased movement symmetry during lungeing, in particular with the lame limb on the inside of a hard circle. The variation within group questions straight-line movement symmetry as a sole measure of lameness without quantification of movement symmetry on the lunge, ideally on hard and soft surfaces to evaluate differences between reins and surfaces. In future, thresholds for lungeing need to be determined using simultaneous visual and objective assessment.
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Affiliation(s)
- T Pfau
- Department of Clinical Science and Services, The Royal Veterinary College, University of London, Hatfield, UK
| | - C Jennings
- Department of Clinical Science and Services, The Royal Veterinary College, University of London, Hatfield, UK
| | - H Mitchell
- Department of Clinical Science and Services, The Royal Veterinary College, University of London, Hatfield, UK
| | - E Olsen
- Department of Clinical Science and Services, The Royal Veterinary College, University of London, Hatfield, UK.,Department of Large Animal Sciences, Faculty of Health and Medical Science, University of Copenhagen, Taastrup, Denmark
| | - A Walker
- Equine Studies, Moulton College, Moulton, UK
| | - A Egenvall
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - S Tröster
- Department of Clinical Science and Services, The Royal Veterinary College, University of London, Hatfield, UK
| | - R Weller
- Department of Clinical Science and Services, The Royal Veterinary College, University of London, Hatfield, UK
| | - M Rhodin
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
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Gordon AL, Mjojo J, Forrester-Paton C, Forrester-Paton J, Bracewell N, Mitchell H, Masud T, Gladman JRF, Blundell AG. 95 * UPDATING THE BRITISH GERIATRICS SOCIETY RECOMMENDED UNDERGRADUATE CURRICULUM AGAINST TOMORROW'S DOCTOR'S 3. Age Ageing 2014. [DOI: 10.1093/ageing/afu041.1] [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: 11/12/2022] Open
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Taylor MJ, Gregory R, Mitchell H, Alblihed M, Alsabih A, Tomlins P, Sahota TS. Insulin pump users would not rule out using an implantable artificial pancreas. Practical Diabetes 2014. [DOI: 10.1002/pdi.1822] [Citation(s) in RCA: 3] [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: 11/06/2022]
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Mitchell H, Jennings C, Olsen E, Walker A, Weller R, Pfau T. Lunging on soft and hard ground: differences between sound and mildly lame horses. J Equine Vet Sci 2013. [DOI: 10.1016/j.jevs.2013.08.068] [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: 10/26/2022]
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Mitchell H, Jennings C, Olsen E, Walker A, Weller R, Pfau T. Movement Symmetry Patterns During Lungeing in Trot on Hard and Soft Surface Differ Between Sound and Mildly Forelimb Lame Horses. Equine Vet J 2013. [DOI: 10.1111/evj.12145_11] [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: 11/28/2022]
Affiliation(s)
- H. Mitchell
- Royal Veterinary College; North Mymms; Hertfordshire; UK
| | - C. Jennings
- Royal Veterinary College; North Mymms; Hertfordshire; UK
| | - E. Olsen
- Royal Veterinary College; North Mymms; Hertfordshire; UK
| | - A. Walker
- Royal Veterinary College; North Mymms; Hertfordshire; UK
| | - R. Weller
- Royal Veterinary College; North Mymms; Hertfordshire; UK
| | - T. Pfau
- Royal Veterinary College; North Mymms; Hertfordshire; UK
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Culley L, Hudson N, Law C, Denny E, Mitchell H, Raine-Fenning N. Disrupted reproduction: the impact of endometriosis on couples’ plans for childbearing. Fertil Steril 2013. [DOI: 10.1016/j.fertnstert.2013.07.791] [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: 10/26/2022]
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Van Parys H, Wyverkens E, Provoost V, Ravelingien A, Raes I, Somers S, Stuyver I, De Sutter P, Pennings G, Buysse A, Anttila VS, Salevaara M, Suikkari AM, Listijono DR, Mooney S, Chapman MG, Res Muravec U, Pusica S, Lomsek M, Cizek Sajko M, Parames S, Semiao-Francisco L, Sato H, Ueno J, van den Wijngaard L, Mochtar MH, van Dam H, van der Veen F, van Wely M, Derks-Smeets IAP, Habets JJG, Tibben A, Tjan-Heijnen VCG, Meijer-Hoogeveen M, Geraedts JPM, van Golde R, Gomez-Garcia E, de Die-Smulders CEM, van Osch LADM, Habets JJG, Derks-Smeets IAP, Tibben A, Tjan-Heijnen VCG, Geraedts JPM, van Golde R, Gomez-Garcia E, Kets CM, de Die-Smulders CEM, van Osch LADM, Gullo S, Donarelli Z, Coco GL, Marino A, Volpes A, Sammartano F, Allegra A, Nekkebroeck J, Tournaye H, Stoop D, Donarelli Z, Lo Coco G, Gullo S, Marino A, Volpes A, Coffaro F, Allegra A, Diaz DG, Gonzalez MA, Tirado M, Chamorro S, Dolz P, Gil MA, Ballesteros A, Velilla E, Castello C, Moina N, Lopez-Teijon M, Chan CHY, Chan CLW, Leong MKH, Cheung IKM, Chan THY, Hui BNL, van Dongen AJCM, Huppelschoten AG, Kremer JAM, Nelen WLDM, Verhaak CM, Sun HG, Lee KH, Park IH, Kim SG, Lee JH, Kim YY, Kim HJ, Cho JD, Yoo YJ, Frokjaer V, Pinborg A, Larsen EC, Heede M, Stenbaek DS, Henningsson S, Nielsen AP, Svarer C, Holst KK, Knudsen GM, Emery M, DeJonckheere L, Rothen S, Wisard M, Germond M, Stenbaek DS, Toftager M, Hjordt LV, Jensen PS, Holst K, Holland T, Bryndorf T, Bogstad J, Hornnes P, Frokjaer VG, Dornelles LMN, MacCallum F, Lopes RCS, Piccinini CA, Passos EP, Bruegge C, Thorn P, Daniels K, Imrie S, Jadva V, Golombok S, Arens Y, De Krom G, Van Golde RJT, Coonen E, Van Ravenswaaij-Arts CMA, Meijer-Hoogeveen M, Evers JLH, Geraedts JPM, De Die-Smulders CEM, Ghazeeri G, Awwad J, Fakih A, Abbas H, Harajly S, Tawidian L, Maalouf F, Ajdukovic D, Pibernik-Okanovic M, Alebic MS, Baccino G, Calatayud C, Ricciarelli E, de Miguel ERH, Stuyver I, Wierckx K, Verstraelen H, Van Glabeke L, Van den Abbeel E, Gerris J, T'Sjoen G, De Sutter P, Monica B, Calonge RN, Peregrin PC, Cserepes R, Kollar J, Wischmann T, Bugan A, Pinkard C, Harrison C, Bunting L, Boivin J, Fulford B, Boivin J, Theusink-Kirchhoff N, van Ravenswaaij-Arts CMA, Bakker MK, Volks C, Papaligoura Z, Papadatou D, Bellali TH, Thorn P, Wischmann T, Wischmann T, Thorn P, Jarvholm S, Broberg M, Thurin-Kjellberg A, Weitzman G, Van Der Putten-Landau TM, Chudnoff S, Panagopoulou E, Tarlatzis B, Tamhankar V, Jones GL, Magill P, Skull JD, Ledger W, Hvidman HW, Specht IO, Pinborg A, Schmidt KT, Larsen EC, Andersen AN, Freeman T, Zadeh S, Smith V, Golombok S, Whitaker LHR, Reid J, Wilson J, Critchley HOD, Horne AW, Zadeh S, Freeman T, Smith V, Golombok S, Peterson B, Pirritano M, Schmidt L, Volgsten H, Wyverkens E, Van Parys H, Provoost V, Ravelingien A, Raes I, Somers S, Stuyver I, Pennings G, De Sutter P, Buysse A, Hudson N, Culley L, Law C, Denny E, Mitchell H, Baumgarten M, Raine-Fenning N, Blake L, Jadva V, Golombok S, Lee KH, Sun HG, Park IH, Kim SG, Lee JH, Kim YY, Kim HJ, Kim KH. Psychology and counselling. Hum Reprod 2013. [DOI: 10.1093/humrep/det218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Lybol C, Sweep F, Harvey R, Mitchell H, Short D, Thomas C, Ottevanger P, Savage P, Massuger L, Seckl M. Relapse rates after two versus three consolidation courses of methotrexate in the treatment of low-risk gestational trophoblastic neoplasia. Gynecol Oncol 2012; 125:576-9. [DOI: 10.1016/j.ygyno.2012.03.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Revised: 02/29/2012] [Accepted: 03/04/2012] [Indexed: 10/28/2022]
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Hurley MV, Walsh NE, Mitchell H, Nicholas J, Patel A. Long-term outcomes and costs of an integrated rehabilitation program for chronic knee pain: a pragmatic, cluster randomized, controlled trial. Arthritis Care Res (Hoboken) 2012; 64:238-47. [PMID: 21954131 DOI: 10.1002/acr.20642] [Citation(s) in RCA: 126] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Chronic joint pain is a major cause of pain and disability. Exercise and self-management have short-term benefits, but few studies follow participants for more than 6 months. We investigated the long-term (up to 30 months) clinical and cost effectiveness of a rehabilitation program combining self-management and exercise: Enabling Self-Management and Coping of Arthritic Knee Pain Through Exercise (ESCAPE-knee pain). METHODS In this pragmatic, cluster randomized, controlled trial, 418 people with chronic knee pain (recruited from 54 primary care surgeries) were randomized to usual care (pragmatic control) or the ESCAPE-knee pain program. The primary outcome was physical function (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC] function), with a clinically meaningful improvement in physical function defined as a ≥15% change from baseline. Secondary outcomes included pain, psychosocial and physiologic variables, costs, and cost effectiveness. RESULTS Compared to usual care, ESCAPE-knee pain participants had large initial improvements in function (mean difference in WOMAC function -5.5; 95% confidence interval [95% CI] -7.8, -3.2). These improvements declined over time, but 30 months after completing the program, ESCAPE-knee pain participants still had better physical function (difference in WOMAC function -2.8; 95% CI -5.3, -0.2); lower community-based health care costs (£-47; 95% CI £-94, £-7), medication costs (£-16; 95% CI £-29, £-3), and total health and social care costs (£-1,118; 95% CI £-2,566, £-221); and a high probability (80-100%) of being cost effective. CONCLUSION Clinical and cost benefits of ESCAPE-knee pain were still evident 30 months after completing the program. ESCAPE-knee pain is a more effective and efficient model of care that could substantially improve the health, well-being, and independence of many people, while reducing health care costs.
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Affiliation(s)
- M V Hurley
- St Georges University of London and Kingston University, London, UK.
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Farrell C, Mitchell H, Morrissey D. 4182 POSTER Nurse-led Clinics Benefit Patients on Adjuvant Herceptin. Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)71348-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: 10/17/2022]
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Freyer G, You B, Harvey R, Golfier F, Mitchell H, Savage P, Tod M, Philip C, Hajri T, Seckl M. Validation of the predictive value of modeled hCG decline profiles in low-risk gestational trophoblastic neoplasia (GTN) treated with methotrexate (MTX). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.5099] [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: 11/20/2022] Open
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White S, Harvey R, Mitchell H, Schmid P, Seckl M, Savage P. Characterisation of transient benign hCG elevations in women following chemotherapy for GTT. J OBSTET GYNAECOL 2011; 31:169-72. [PMID: 21281036 DOI: 10.3109/01443615.2010.536859] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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
The occurrence of post-chemotherapy transient low level hCG elevations has been observed in a number of women treated for gestational trophoblastic tumours (GTT). The authors reviewed the records of patients treated at Charing Cross Hospital over the last 10 years and identified those with a benign rise in hCG. Stored serum samples were assayed for hCG, LH, FSH and oestradiol at varying points during patient management. The endocrine profile in patients experiencing benign hCG elevation is comparable with that seen in post-menopausal women, with low oestradiol, combined with greatly elevated LH and FSH levels. In contrast, women with genuine disease relapse as the cause of their post-chemotherapy hCG elevation had normal or only minor elevations of LH and FSH. These findings support the observation that a major rise in LH and FSH can be used as an indicator for benign pituitary hCG production in patients experiencing a low level rise in hCG levels following chemotherapy for GTT.
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Affiliation(s)
- S White
- Charing Cross Hospital, London, UK
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Ndosi M, Vinall K, Hale C, Bird H, Hill J, Cornell P, Westlake S, Richards S, Sanderson T, Calnan M, Morris M, Richards P, Hewlett S, Richards A, Taylor S, Porcheret M, Grime J, Jordan K, Dziedzic K, Hewlett S, Ambler N, Knops B, Cliss A, Almeida C, Pope D, Hammond A, Swinkels A, Kitchen K, Pollock J, Hurley M, Walsh N, Mitchell H, Nicholas J, Day SH, Butt S, Deighton C, Gadsby K. Concurrent Oral 5 - BHPR Audit/Service Delivery and Research [OP32-OP39]: OP32. Is Nurse-Led Care Effective in Rheumatology? a Systematic Review. Rheumatology (Oxford) 2010. [DOI: 10.1093/rheumatology/keq705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Norton S, Done J, Sacker A, Young A, Cox N, Treharne GJ, McGavock ZC, Tonks A, Kafka SA, Hale ED, Kitas GD, Fletcher D, Sanderson T, Baker G, Street P, Hewlett S, Stynes S, Peat G, Myers H, Croft P, Bosworth AM, Crake D, Hurley M, Patel A, Walsh N, Mitchell H, Kumar K, Gordhan C, Situnayake D, Raza K, Bacon P, Hewlett S, Sanderson T, May J, Bingham CO, March L, Alten R, Pohl C, Woodworth T, Bartlett S, Stevenson K, Roddy E, Jordan K, Waldron N, Brown S, McCabe C, McHugh N, Hewlett S, Shelmerdine J, Ferenkeh-Koroma A, Breslin A, Sawyer S, Haas M, Elliott B, Law RJ, Breslin A, Oliver E, Mawn L, Markland D, Peter M, Thom J, Hewlett S, Sanderson T, May J, Bingham CO, March L, Alten R, Pohl C, Woodworth T, Bartlett S, Cliss A, Morris M, Ambler N, Knops B, Hammond A, Almeida C, Hewlett S. BHPR: Research [278-290]: 278. What does the Hospital Anxiety and Depression Scale Measure? Evidence of a Bifactor Structure and Item Bias. Rheumatology (Oxford) 2010. [DOI: 10.1093/rheumatology/keq731] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Schmidt HMA, Andres S, Nilsson C, Kovach Z, Kaakoush NO, Engstrand L, Goh KL, Fock KM, Forman D, Mitchell H. The cag PAI is intact and functional but HP0521 varies significantly in Helicobacter pylori isolates from Malaysia and Singapore. Eur J Clin Microbiol Infect Dis 2010; 29:439-51. [PMID: 20157752 DOI: 10.1007/s10096-010-0881-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2009] [Accepted: 01/05/2010] [Indexed: 12/16/2022]
Abstract
Helicobacter pylori-related disease is at least partially attributable to the genotype of the infecting strain, particularly the presence of specific virulence factors. We investigated the prevalence of a novel combination of H. pylori virulence factors, including the cag pathogenicity island (PAI), and their association with severe disease in isolates from the three major ethnicities in Malaysia and Singapore, and evaluated whether the cag PAI was intact and functional in vitro. Polymerase chain reaction (PCR) was used to detect dupA, cagA, cagE, cagT, cagL and babA, and to type vacA, the EPIYA motifs, HP0521 alleles and oipA ON status in 159 H. pylori clinical isolates. Twenty-two strains were investigated for IL-8 induction and CagA translocation in vitro. The prevalence of cagA, cagE, cagL, cagT, babA, oipA ON and vacA s1 and i1 was >85%, irrespective of the disease state or ethnicity. The prevalence of dupA and the predominant HP0521 allele and EPIYA motif varied significantly with ethnicity (p < 0.05). A high prevalence of an intact cag PAI was found in all ethnic groups; however, no association was observed between any virulence factor and disease state. The novel association between the HP0521 alleles, EPIYA motifs and host ethnicity indicates that further studies to determine the function of this gene are important.
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Affiliation(s)
- H-M A Schmidt
- School of Biotechnology and Biomolecular Sciences, University of New South Wales, Sydney, NSW, Australia
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Abstract
Regular participation in a high-quality screening program by all 'at risk' women is necessary if Australia is to be maximally successful in preventing cervical cancer. This paper discusses the use of reminder letters as one method of facilitating participation. Options for the source of the letters are discussed. It is concluded that basing the recall letters on a register of previously screened women is the only feasible approach within the Australian health care system. The impact of reminder letters on achieving regular participation by Australian women remains to be tested.
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Affiliation(s)
- H Mitchell
- Victorian Cytology (Gynaecological) Service, Melbourne
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Abstract
This paper reports on the second of four regionally-based campaigns co-ordinated in rural Victoria by the Anti-Cancer Council of Victoria. The campaign encompassed community-based activities, general practitioner involvement and screening clinics. The impact of the campaign on Pap test rates and on the profile of women whose tests were reported by the Victorian Cytology Gynaecological Service is examined. We conclude that the campaign was successful in achieving its primary objective of attracting older and relatively underscreened women into having a Pap test. The special screening clinics were considered particularly effective in reaching women in the target audience. As a result of this campaign, new initiatives, were incorporated into subsequent programs.
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Affiliation(s)
- S Hirst
- Anti-Cancer Council of Victoria, Carlton
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