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Hutchings HA, Rahman M, Carter K, Islam S, O'Neill C, Roberts S, John A, Fegan G, Dave U, Hawkes N, Ahmed F, Hasan M, Azad AK, Rahman MM, Kibria MG, Rahman MM, Mia T, Akhter M, Williams JG. Did the COVID-19 pandemic affect levels of burnout, anxiety and depression among doctors and nurses in Bangladesh? A cross-sectional survey study. BMJ Open 2024; 14:e079350. [PMID: 38453200 PMCID: PMC10921535 DOI: 10.1136/bmjopen-2023-079350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 02/14/2024] [Indexed: 03/09/2024] Open
Abstract
INTRODUCTION COVID-19 has caused severe disruption to clinical services in Bangladesh but the extent of this, and the impact on healthcare professionals is unclear. We aimed to assess the perceived levels of anxiety, depression and burnout among doctors and nurses during COVID-19 pandemic. METHODS We undertook an online survey using RedCap, directed at doctors and nurses across four institutions in Bangladesh (The Sheikh Russel Gastro Liver Institute & Hospital (SRNGIH), Dhaka Medical College Hospital (DMCH), Mugda Medical College Hospital (MMCH) and M Abdur Rahim Medical College (MARMC) Hospital). We collected information on demographics, awareness of well-being services, COVID-19-related workload, as well as anxiety, depression and burnout using two validated questionnaires: the Hospital Anxiety and Depression Scale (HADS) and the Maslach Burnout Inventory (MBI). RESULTS Of the 3000 participants approached, we received responses from 2705 (90.2%). There was a statistically significant difference in anxiety, depression and burnout scores across institutions (p<0.01). Anxiety, depression and burnout scores were statistically worse in COVID-19 active staff compared with those not working on COVID-19 activities (p<0.01 for HADS anxiety and depression and MBI emotional exhaustion (EE), depersonalisation (DP) and personal accomplishment (PA)). Over half of the participants exhibited some level of anxiety (SRNGIH: 52.2%; DMCH: 53.9%; MMCH: 61.3%; MARMC: 68%) with a high proportion experiencing depression (SRNGIH: 39.5%; DMCH: 38.7%; MMCH: 53.7%; MARMC: 41.1%). Although mean burnout scores were within the normal range for each institution, a high proportion of staff (almost 20% in some instances) were shown to be classified as experiencing burnout by their EE, DP and PA scores. CONCLUSION We identified a high prevalence of perceived anxiety, depression and burnout among doctors and nurses during the COVID-19 pandemic. This was worse in staff engaged in COVID-19-related activities. These findings could help healthcare organisations to plan for future similar events.
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Affiliation(s)
| | - Mesbah Rahman
- Swansea Bay University Health Board, Port Talbot, UK
| | | | | | | | | | | | | | - Umakant Dave
- Swansea Bay University Health Board, Port Talbot, UK
| | - Neil Hawkes
- Cwm Taf Morgannwg University Health Board, Abercynon, UK
| | - Faruque Ahmed
- Department of Gastroenterology, Sheikh Russel National Gastroliver Institute and Hospital, Dhaka, Bangladesh
| | | | | | | | - Md Golam Kibria
- Sheikh Russel National Gastroliver Institute, Dhaka, Bangladesh
| | | | - Titu Mia
- Mugda Medical College and Hospital, Dhaka, Bangladesh
| | | | - John G Williams
- Faculty of Medicine, Health and Life Science, Swansea University, Swansea, UK
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Grant RK, Jones GR, Plevris N, Lynch RW, Brindle WM, Hutchings HA, Williams JG, Alrubaiy L, Watkins A, Lees CW, Arnott IDR. Validation of the ACE [Albumin, CRP, and Endoscopy] Index in Acute Colitis: Analysis of the CONSTRUCT dataset. J Crohns Colitis 2024; 18:286-290. [PMID: 37615649 DOI: 10.1093/ecco-jcc/jjad148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND AND AIMS In 2020 we reported the ACE Index in acute colitis which used biochemical and endoscopic parameters to predict steroid non-response on admission in patients with acute ulcerative colitis [UC]. We aimed to validate the ACE Index in an independent cohort. METHODS The validation cohort comprised patients screened as eligible for inclusion in the CONSTRUCT study, a prospective, randomized, placebo-controlled trial which compared the effectiveness of treatment with infliximab vs ciclosporin in patients admitted with acute UC. The CONSTRUCT cohort database was reviewed at The Edinburgh IBD Unit and the same biochemical and endoscopic variables and cut-off values as those in the derivation cohort were applied to the validation cohort. RESULTS In total, 800 patients were identified; 62.5% [55/88] of patients with a maximum ACE Index of 3 did not respond to intravenous [IV] steroids (positive predictive value [PPV] 62.5%, negative predictive value [NPV] 79.8%). Furthermore, 79.8% [158/198] of patients with an ACE Index of 0 responded to IV steroids [PPV 79.8%, NPV 62.5%]. Receiver operator characteristic [ROC] curve analysis produced an area under the curve [AUC] of 0.663 [p < 0.001]. CONCLUSIONS We have now reported and externally validated the ACE Index in acute colitis in a combined cohort of over 1000 patients from across the UK. The ACE Index may be used in conjunction with clinical judgement to help identify patients admitted with active UC who are at high risk of not responding to IV steroids. Further studies are required to improve objectivity and accuracy of assessment.
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Affiliation(s)
- Rebecca K Grant
- The Edinburgh IBD Unit, Western General Hospital, Edinburgh, UK
| | | | - Nikolas Plevris
- The Edinburgh IBD Unit, Western General Hospital, Edinburgh, UK
| | - Ruairi W Lynch
- The Edinburgh IBD Unit, Western General Hospital, Edinburgh, UK
- Department of Gastroenterology, Ninewells Hospital, Dundee, UK
| | - William M Brindle
- The Edinburgh IBD Unit, Western General Hospital, Edinburgh, UK
- Department of Gastroenterology, Victoria Hospital, Kirkcaldy, UK
| | - Hayley A Hutchings
- School of Medicine, Faculty of Medicine, Health and Life Science, Swansea University, Swansea, UK
| | - John G Williams
- School of Medicine, Faculty of Medicine, Health and Life Science, Swansea University, Swansea, UK
| | - Laith Alrubaiy
- School of Medicine, Faculty of Medicine, Health and Life Science, Swansea University, Swansea, UK
| | - Alan Watkins
- School of Medicine, Faculty of Medicine, Health and Life Science, Swansea University, Swansea, UK
| | - Charlie W Lees
- The Edinburgh IBD Unit, Western General Hospital, Edinburgh, UK
| | - Ian D R Arnott
- The Edinburgh IBD Unit, Western General Hospital, Edinburgh, UK
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Roberts SE, John A, Carter T, G Williams J. Suicide rates in the UK Armed Forces, compared with the general workforce and merchant shipping during peacetime years since 1900. BMJ Mil Health 2024:e002309. [PMID: 37028908 DOI: 10.1136/military-2022-002309] [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: 11/08/2022] [Accepted: 03/02/2023] [Indexed: 04/09/2023]
Abstract
INTRODUCTION The main objective was to compare suicide rates and their trends across the three UK Armed forces (Royal Navy, Army and Royal Air Force) from 1900 to 2020. Further objectives were to compare suicide rates with those in the corresponding general population and in UK merchant shipping and to discuss preventative measures. METHODS Examination of annual mortality reports and returns, death inquiry files and official statistics. The main outcome measure was the suicide rate per 100 000 population employed. RESULTS Since 1990, there have been significant reductions in suicide rates in each of the Armed Forces, although a non-significant increase in the Army since 2010. Compared with the corresponding general population, during the most recent decade from 2010 up to 2020, suicide rates were 73% lower in the Royal Air Force, 56% lower in the Royal Navy and 43% lower in the Army. Suicide rates have been significantly decreased in the Royal Air Force since the 1950s, in the Royal Navy since the 1970s and in the Army since the 1980s (comparisons for the Royal Navy and the Army were not available from the late 1940s to the 1960s).During the earliest decades from 1900 to the 1930s, suicide rates in the Armed Forces were mostly quite similar or moderately increased compared with the general population, but far lower than in merchant shipping. Following legislative changes in the last 30 years, suicide rates through poisoning by gases and through firearms or explosives have fallen sharply. CONCLUSIONS The study shows that suicide rates in the Armed Forces have been lower than in the general population over many decades. The sharp reductions in suicide rates over the last 30 years suggest the effectiveness of recent preventative measures, including reductions in access to a method of suicide and well-being initiatives.
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Affiliation(s)
| | - A John
- Medical School, Swansea University, Swansea, UK
| | - T Carter
- Norwegian Centre for Maritime and Diving Medicine, Haukeland Universitetssjukehus, Bergen, Norway
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Roberts SE, Morrison-Rees S, Thapar N, Williams JG. Incidence and prevalence of eosinophilic oesophagitis across Europe: A systematic review and meta-analysis. United European Gastroenterol J 2024; 12:89-102. [PMID: 37921701 PMCID: PMC10859717 DOI: 10.1002/ueg2.12465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 08/15/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Several studies have reported large increases in the incidence of eosinophilic oesophagitis (EoE) in the last 20 years. We aimed to systematically review the incidence and prevalence of EoE, focused on all European countries. METHODS Systematic review and meta-analysis up to 31 December 2022, based on PubMed, CINAHL and extensive hand searching of reference lists. Twenty-five eligible studies were identified and included. RESULTS For both adults and children, the highest EoE incidence and prevalence have been reported from regional studies in Spain. EoE incidence for both adults and children was significantly lower (p < 0.001) in nationwide studies (meta-analysis = 3.64 per 100,000 person-years overall) compared with regional or centre-based studies (7.16). EoE incidence and prevalence were significantly higher (p < 0.001) in adults than children. All studies that reported on longitudinal trends in EoE incidence showed increases over time, more markedly during more recent years. Larger increases in incidence tend to refer to regional rather than nationwide studies; from Spain, Switzerland and Denmark, both for paediatric and adult age groups. Increases in EoE incidence 100,000 person-years were larger than for incidence per number of diagnostic endoscopies. The most frequently reported co-morbidities in adults were rhinitis, followed by asthma, food allergy and gastroesophageal reflux disease, and in children, erosive oesophagitis, asthma, food allergy and rhinitis. CONCLUSIONS The incidence of EoE has increased in Europe over the last 30 years, exceeding increases in the volume of oesophago-gastro-duodenoscopies performed. The patchy and low incidence and prevalence of EoE generally in Europe and compared with North America, may reflect a lack of clinical awareness and research focus rather than a genuinely low incidence of EoE. A co-ordinated Europe-wide study that uses standardised methodology is urgently needed to provide a comprehensive picture of EoE incidence and prevalence across Europe.
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Affiliation(s)
| | | | - Nikhil Thapar
- Department of Paediatric Gastroenterology, Queensland Children's Hospital, Brisbane, Australia
- School of Medicine, University of Queensland, St Lucia, Brisbane, Australia
- Stem Cells and Regenerative Medicine, UCL Great Ormond Street Institute of Child Health, London, UK
| | - John G Williams
- Swansea University Medical School, Swansea University, Swansea, UK
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Constante-Amores CR, Kahouadji L, Williams JG, Turney BW, Shin S, Chergui J, Juric D, Moulton DE, Waters SL. Role of Kidney Stones in Renal Pelvis Flow. J Biomech Eng 2023; 145:1153591. [PMID: 36511096 DOI: 10.1115/1.4056461] [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] [Received: 07/16/2022] [Accepted: 12/02/2022] [Indexed: 12/15/2022]
Abstract
Ureteroscopy is a commonly performed medical procedure to treat stones in the kidney and ureter using a ureteroscope. Throughout the procedure, saline is irrigated through the scope to aid visibility and wash-out debris from stone fragmentation. The key challenge that this research addresses is to build a fundamental understanding of the interaction between the kidney stones/stone fragments and the flow dynamics in the renal pelvis flow. We examine the time-dependent flow dynamics inside an idealized renal pelvis in the context of a surgical procedure for kidney stone removal. Here, we examine the time-dependent evolution of these vortical flow structures in three dimensions, and incorporate the presence of rigid kidney stones. We perform direct numerical simulations, solving the transient Navier-Stokes equations in a spherical domain. Our numerical predictions for the flow dynamics in the absence of stones are validated with available experimental and numerical data, and the governing parameters and flow regimes are chosen carefully in order to satisfy several clinical constraints. The results shed light on the crucial role of flow circulation in the renal cavity and its effect on the trajectories of rigid stones. We demonstrate that stones can either be washed out of the cavity along with the fluid, or be trapped in the cavity via their interaction with vortical flow structures. Additionally, we study the effect of multiple stones in the flow field within the cavity in terms of the kinetic energy, entrapped fluid volume, and the clearance rate of a passive tracer modeled via an advection-diffusion equation. We demonstrate that the flow in the presence of stones features a higher vorticity production within the cavity compared with the stone-free cases.
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Affiliation(s)
| | - L Kahouadji
- Department of Chemical Engineering, Imperial College London, London SW7 2AZ, UK
| | - J G Williams
- Urology & Pelvic Health Division, Boston Scientific Corporation, Marlborough, MA 01752
| | - B W Turney
- Nuffield Department of Surgical Sciences, University of Oxford John Radcliffe Hospital, Oxford OX2 6GG, UK
| | - S Shin
- Department of Mechanical and System Design Engineering, Hongik University, Seoul 04066, Korea
| | - J Chergui
- Université Paris Saclay, LISN, CNRS, Orsay 91405, France
| | - D Juric
- Université Paris Saclay, LISN, CNRS, Orsay 91405, France; Department of Applied Mathematics and Theoretical Physics, University of Cambridge, Cambridge CB3 0WA, UK
| | - D E Moulton
- Mathematical Institute, University of Oxford, Oxford OX2 6GG, UK
| | - S L Waters
- Mathematical Institute, University of Oxford, Oxford OX2 6GG, UK
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Alam MF, Longo M, Cohen D, Groves S, Alrubaiy L, Hutchings HA, Watkins A, Sebastain S, Williams JG. Infliximab versus ciclosporin in steroid resistant acute severe ulcerative colitis: a model-based cost-utility analysis of data from CONSTRUCT pragmatic trial. BMC Health Serv Res 2023; 23:226. [PMID: 36890533 PMCID: PMC9993375 DOI: 10.1186/s12913-023-09233-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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 03/01/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND There is limited evidence in the literature on the long-term effectiveness and cost-effectiveness of treatments for Acute Severe Ulcerative Colitis (ASUC). The study aimed to perform decision analytic model-based long-term cost-utility analysis (CUA) of infliximab versus ciclosporin for steroid-resistant ASUC investigated in CONSTRUCT pragmatic trial. METHODS A decision tree (DT) model was developed using two-year health effect, resource use and costs data from CONSTRUCT trial to estimate relative cost-effectiveness of two competing drugs from the United Kingdom (UK) National Health Services (NHS) perspective. Using short-term trial data, a Markov model (MM) was then developed and evaluated over further 18 years. Both DT and MM were combined to investigate cost-effectiveness of infliximab versus ciclosporin for ASUC patients over 20-year time horizon, with a rigorous multiple deterministic and probabilistic sensitivity analyses to address uncertainty in results. RESULTS The decision tree mirrored trial-based results. Beyond 2-year trial follow-up, Markov model predicted a decrease in colectomy rate, but it remained slightly higher for ciclosporin. NHS costs and quality adjusted life years (QALYs) over base-case 20 year time horizon were £26,793 and 9.816 for ciclosporin and £34,185 and 9.106 for infliximab, suggesting ciclosporin dominates infliximab. Ciclosporin had 95% probability of being cost-effective at a willingness-to-pay (WTP) threshold value up to £20,000. CONCLUSION Using data from a pragmatic RCT, the cost-effectiveness models produced incremental net health benefit in favour of ciclosporin relative to infliximab. Results from long-term modelling indicated that ciclosporin remains dominant compared with infliximab for the treatment of NHS ASUC patients, however, these need to be interpreted cautiously. TRIAL REGISTRATION CONSTRUCT Trial registration number ISRCTN22663589; EudraCT number: 2008- 001968-36 (Date 27/08/2008).
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Affiliation(s)
- Mohammed Fasihul Alam
- Department of Public Health, College of Health Sciences, QU-Health, Qatar University, PO Box 2713, Doha, Qatar.
| | - Mirella Longo
- Marie Curie Palliative Care Research Centre, Cardiff University, 8th Floor Neuadd Meirionnydd, Heath Park Way, Cardiff, CF14 4YS, UK
| | - David Cohen
- Faculty of Health, Sport and Professional Practice, University of South Wales, Lower Glyntaff, Pontypridd, CF37 1DL, UK
| | - Sam Groves
- Swansea Centre for Health Economics, College of Health and Human Sciences, Swansea University, Singleton Park, Swansea, SA2 8PP, UK
| | - Laith Alrubaiy
- Swansea University Medical School, Swansea University, Singleton Park, Swansea, SA2 8PP, UK
| | - Hayley A Hutchings
- Swansea University Medical School, Swansea University, Singleton Park, Swansea, SA2 8PP, UK
| | - Alan Watkins
- Swansea University Medical School, Swansea University, Singleton Park, Swansea, SA2 8PP, UK
| | - Shaji Sebastain
- IBD Unit, Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - John G Williams
- Swansea University Medical School, Swansea University, Singleton Park, Swansea, SA2 8PP, UK
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Bhasin S, Williams JG. Rectal foreign body removal: increasing incidence and cost to the NHS. Ann R Coll Surg Engl 2021; 103:734-737. [PMID: 34719960 DOI: 10.1308/rcsann.2020.7129] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Insertion of foreign objects into the rectum is a well-described phenomenon and not an uncommon referral to the general surgeon on call. Although usually not life-threatening, there can be consequences following migration of the object or perforation of the large bowel. This study looks at the incidence of removal of foreign objects from the rectum over the last decade and the financial burden it presents to the NHS. METHODS Hospital Episode Statistics for 2010-2019 were used to calculate the number of rectal foreign bodies that required removal in hospital. Data for age groups and genders have been compared. RESULTS A total of 3,500 rectal foreign bodies were removed over the course of 9 years. Males accounted for 85.1% of rectal foreign bodies whilst 14.9% were females. This equates to 348 bed-days per annum. Admission peaks were observed in the second and fifth decades of life. CONCLUSION This study shows that the incidence of rectal foreign bodies is higher in men and has been increasing over the period studied. Most foreign bodies can be removed trans-anally with the use of anaesthesia, with only a small proportion of patients requiring hospital stay over 24 hours (mean length of stay = 24 hours). Nearly 400 rectal foreign body removals are performed each year with an annual cost of £338,819, illustrating the effect this has on NHS resources.
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Affiliation(s)
- S Bhasin
- Royal Wolverhampton Hospitals NHS Trust, UK
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Roberts SE, Carter T, Smith HD, John A, Williams JG. Forgotten fatalities: British military, mining and maritime accidents since 1900. Occup Med (Lond) 2021; 71:277-283. [PMID: 34415338 PMCID: PMC8486268 DOI: 10.1093/occmed/kqab108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background Comparative long-term trends in fatal accident rates in the UK’s most hazardous occupations have not been reported. Aims To compare trends in fatal accident rates in six of the most hazardous occupations (the three armed forces, merchant shipping, sea fishing and coal mining) and the general British workforce during peacetime years since 1900. Methods Examinations of annual mortality reports, returns, inquiry files and statistics. The main outcome measure was the fatal accident rate per 100 000 population employed. Results These six occupations accounted for ~40% of all fatal accidents in the British workforce. Fatal accident rates were highest in merchant shipping to 1914 (400–600 per 100 000) and in the Royal Air Force and sea fishing by the early 1920s (around 300 per 100 000). Since the 1950s sea fishing has remained the most hazardous occupation (50–200). Widespread reductions in fatal accident rates for each occupation have been greatest in recent years in the three armed forces and merchant shipping. Compared with the general workforce, relative risks of fatalities have increased in recent decades in all these occupations except shipping. Conclusions All six occupations still have high fatal accident rates. The greatly increased fatalities in sea fishing generally and in the Royal Air Force during its early years reflect, for different reasons, cultures of extreme risk-taking in these two sectors. Reductions in fatality rates in the armed forces over the last 20 years are due largely to decreases in land transport accidents.
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Affiliation(s)
- S E Roberts
- Swansea University Medical School, Swansea University, Swansea, UK
| | - T Carter
- Norwegian Centre for Maritime and Diving Medicine, Haukeland University Hospital, Bergen, Norway
| | - H D Smith
- School of Earth and Environmental Sciences, Cardiff University, Cardiff, UK
| | - A John
- Swansea University Medical School, Swansea University, Swansea, UK
| | - J G Williams
- Swansea University Medical School, Swansea University, Swansea, UK
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So JY, O'Hara NN, Kenaa B, Williams JG, deBorja CL, Slejko JF, Zafari Z, Sokolow M, Zimand P, Deming M, Marx J, Pollak AN, Reed RM. Population Decline in COPD Admissions During the COVID-19 Pandemic Associated with Lower Burden of Community Respiratory Viral Infections. Am J Med 2021; 134:1252-1259.e3. [PMID: 34126098 PMCID: PMC8196237 DOI: 10.1016/j.amjmed.2021.05.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 03/27/2021] [Accepted: 05/17/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND The Coronavirus disease 2019 (COVID-19) pandemic has led to widespread implementation of public health measures, such as stay-at-home orders, social distancing, and masking mandates. In addition to decreasing spread of severe acute respiratory syndrome coronavirus 2, these measures also impact the transmission of seasonal viral pathogens, which are common triggers of chronic obstructive pulmonary disease (COPD) exacerbations. Whether reduced viral prevalence mediates reduction in COPD exacerbation rates is unknown. METHODS We performed retrospective analysis of data from a large, multicenter health care system to assess admission trends associated with community viral prevalence and with initiation of COVID-19 pandemic control measures. We applied difference-in-differences analysis to compare season-matched weekly frequency of hospital admissions for COPD prior to and after implementation of public health measures for COVID-19. Community viral prevalence was estimated using regional Centers for Disease Control and Prevention test positivity data and correlated to COPD admissions. RESULTS Data involving 4422 COPD admissions demonstrated a season-matched 53% decline in COPD admissions during the COVID-19 pandemic, which correlated to community viral burden (r = 0.73; 95% confidence interval, 0.67-0.78) and represented a 36% greater decline over admission frequencies observed in other medical conditions less affected by respiratory viral infections (incidence rate ratio 0.64; 95% confidence interval, 0.57-0.71, P < .001). The post-COVID-19 decline in COPD admissions was most pronounced in patients with fewer comorbidities and without recurrent admissions. CONCLUSION The implementation of public health measures during the COVID-19 pandemic was associated with decreased COPD admissions. These changes are plausibly explained by reduced prevalence of seasonal respiratory viruses.
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Affiliation(s)
- Jennifer Y So
- Division of Pulmonary and Critical Care, University of Maryland School of Medicine, Baltimore
| | - Nathan N O'Hara
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore
| | - Blaine Kenaa
- Division of Pulmonary and Critical Care, University of Maryland School of Medicine, Baltimore
| | - John G Williams
- Division of Pulmonary and Critical Care, University of Maryland School of Medicine, Baltimore
| | - Christopher L deBorja
- Department of Medicine, University of Maryland Baltimore Washington Medical Center, Glen Burnie, Md
| | - Julia F Slejko
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore
| | - Zafar Zafari
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore
| | - Michael Sokolow
- Quality Management Department, University of Maryland Medical System, Baltimore
| | - Paul Zimand
- Quality Management Department, University of Maryland Medical System, Baltimore
| | - Meagan Deming
- Division of Infectious Disease, University of Maryland School of Medicine, Baltimore
| | - Jason Marx
- Department of Medicine, University of Maryland St. Joseph's Medical Center, Towson
| | - Andrew N Pollak
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore
| | - Robert M Reed
- Division of Pulmonary and Critical Care, University of Maryland School of Medicine, Baltimore.
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Williams JG, Lerner AD. Managing complications of pleural procedures. J Thorac Dis 2021; 13:5242-5250. [PMID: 34527363 PMCID: PMC8411187 DOI: 10.21037/jtd-2019-ipicu-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 04/29/2020] [Indexed: 11/06/2022]
Abstract
Pleural disease is common and often requires procedural intervention. Given this prevalence, pleural procedures are performed by a wide range of providers with varying skill level in both medical and surgical specialties. Even though the overall complication rate of pleural procedures is low, the proximity to vital organs and blood vessels can lead to serious complications which if left unrecognized can be life threatening. As a result, it is of the utmost importance for the provider to have a firm grasp of the local anatomy both conceptually when preparing for the procedure and physically, via physical exam and the use of a real time imaging modality such as ultrasound, when performing the procedure. With this in mind, anyone who wishes to safely perform pleural procedures should be able to appropriately anticipate, quickly identify, and efficiently manage any potential complication including not only those seen with many procedures such as pain, bleeding, and infection but also those specific to procedures performed in the thorax such as pneumothorax, re-expansional pulmonary edema, and regional organ injury. In this article, we will review the basic approach to most pleural procedures along with essential local anatomy most often encountered during these procedures. This will lay the foundation for the remainder of the article where we will discuss clinical manifestations and management of various pleural procedure complications.
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Affiliation(s)
- John G Williams
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Andrew D Lerner
- Department of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Roberts SE, Morrison-Rees S, Thapar N, Benninga MA, Borrelli O, Broekaert I, Dolinsek J, Martin-de-Carpi J, Mas E, Miele E, Pienar C, Ribes-Koninckx C, Thomassen RA, Thomson M, Tzivinikos C, Thorne K, John A, Williams JG. Systematic review and meta-analysis: the incidence and prevalence of paediatric coeliac disease across Europe. Aliment Pharmacol Ther 2021; 54:109-128. [PMID: 34115894 DOI: 10.1111/apt.16337] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 09/30/2020] [Accepted: 03/04/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Coeliac disease is one of the most prevalent immune-mediated gastrointestinal disorders in children. AIM To review the incidence and prevalence of paediatric coeliac disease, and their trends, regionally across Europe, overall and according to age at diagnosis. METHODS Systematic review and meta-analysis from January 1, 1950 to December 31, 2019, based on PubMed, CINAHL and the Cochrane Library, searches of grey literature and websites and hand searching of reference lists. A total of 127 eligible studies were included. RESULTS The prevalence of previously undiagnosed coeliac disease from screening surveys (histology based) ranged from 0.10% to 3.03% (median = 0.70%), with a significantly increasing annual trend (P = 0.029). Prevalence since 2000 was significantly higher in northern Europe (1.60%) than in eastern (0.98%), southern (0.69%) and western (0.60%) Europe. Large increases in the incidence of diagnosed coeliac disease across Europe have reached 50 per 100 000 person-years in Scandinavia, Finland and Spain. The median age at diagnosis increased from 1.9 years before 1990 to 7.6 since 2000. Larger increases in incidence were found in older age groups than in infants and ages <5 years. CONCLUSIONS Paediatric coeliac disease incidence and prevalence have risen across Europe and appear highest in Scandinavia, Finland and Spain. The most recent evidence shows large increases in incidence in most regions, but stabilisation in some (notably Sweden and Finland). Sharp increases in the age at diagnosis may reflect increases in milder and asymptomatic cases diagnosed since reliable serology testing became widely used, through endomysial antibodies after 1990 and tissue transglutaminase antibodies around 2000.
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12
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Major A, Williams JG, McGuire WC, Floyd E, Chacko K. Removing Barriers: A Confidential Opt-Out Mental Health Pilot Program for Internal Medicine Interns. Acad Med 2021; 96:686-689. [PMID: 33538479 PMCID: PMC9036551 DOI: 10.1097/acm.0000000000003965] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PROBLEM There are significant barriers for resident physicians seeking mental health care, including lack of time, cost, and concerns about confidentiality. The authors sought to improve access to mental health resources by addressing these barriers through the development of a confidential opt-out mental health pilot program for interns and to assess the feasibility, acceptability, and resident satisfaction with the program. APPROACH All internal medicine and internal medicine-pediatrics interns in the 2017-2018 residency class at the University of Colorado were enrolled in the confidential opt-out mental health program. Each intern was provided with an additional half-day off during their continuity clinic week, during which a mental health screening appointment at the campus health center with an in-network mental health provider was scheduled. All costs were covered by the residency program. An anonymous follow-up survey was sent to all interns to assess participation in the program and its perceived impact on their wellness. OUTCOMES Appointments were made for 80 interns: 23 (29%) attended the appointment, 45 (56%) opted out in advance, and 12 (15%) were no-shows. The total cost of the program was $940 or $11.75 per intern. Of the 41 interns who responded to the survey, 35 (85%) agreed the program should continue next year. The majority of interns felt the program positively affected their wellness regardless of whether they attended the appointment. Of the 16 interns who attended the appointment and completed the survey, 4 (25%) reported receiving additional mental health referrals or follow-up appointments. NEXT STEPS This confidential opt-out mental health pilot program for interns was feasible, relatively low cost and simple to implement, and had positive impacts on self-reported wellness. Further study of interventions that remove barriers to accessing mental health care for residents is urgently needed.
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Affiliation(s)
- Ajay Major
- A. Major is a hematology/oncology fellow, Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, Illinois; ORCID: https://orcid.org/0000-0001-7261-1335
| | - John G Williams
- J.G. Williams is a pulmonary/critical care fellow, Division of Pulmonary & Critical Care Medicine, Department of Medicine, University of Maryland, Baltimore, Maryland
| | - W Cameron McGuire
- W.C. McGuire is a pulmonary/critical care fellow, Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of California, San Diego, La Jolla, California
| | - Eleanor Floyd
- E. Floyd is an instructor of internal medicine, Department of Medicine, University of Colorado, Aurora, Colorado
| | - Karen Chacko
- K. Chacko is professor of medicine, Department of Medicine, University of Colorado, Aurora, Colorado
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13
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Roberts SE, Thorne K, Thapar N, Broekaert I, Benninga MA, Dolinsek J, Mas E, Miele E, Orel R, Pienar C, Ribes-Koninckx C, Thomson M, Tzivinikos C, Morrison-Rees S, John A, Williams JG. A Systematic Review and Meta-analysis of Paediatric Inflammatory Bowel Disease Incidence and Prevalence Across Europe. J Crohns Colitis 2020; 14:1119-1148. [PMID: 32115645 DOI: 10.1093/ecco-jcc/jjaa037] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS Inflammatory bowel disease [IBD] is often one of the most devastating and debilitating chronic gastrointestinal disorders in children and adolescents. The main objectives here were to systematically review the incidence and prevalence of paediatric IBD across all 51 European states. METHODS We undertook a systematic review and meta-analysis based on PubMed, CINAHL, the Cochrane Library, searches of reference lists, grey literature and websites, covering the period from 1970 to 2018. RESULTS Incidence rates for both paediatric Crohn's disease [CD] and ulcerative colitis [UC] were higher in northern Europe than in other European regions. There have been large increases in the incidence of both paediatric CD and UC over the last 50 years, which appear widespread across Europe. The largest increases for CD have been reported from Sweden, Wales, England, the Czech Republic, Denmark and Hungary, and for UC from the Czech Republic, Ireland, Sweden and Hungary. Incidence rates for paediatric CD have increased up to 9 or 10 per 100 000 population in parts of Europe, including Scandinavia, while rates for paediatric UC are often slightly lower than for CD. Prevalence reported for CD ranged from 8.2 per 100 000 to approximately 60 and, for UC, from 8.3 to approximately 30. CONCLUSIONS The incidence of paediatric IBD continues to increase throughout Europe. There is stronger evidence of a north-south than an east-west gradient in incidence across Europe. Further prospective studies are needed, preferably multinational and based on IBD registries, using standardized definitions, methodology and timescales.
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Affiliation(s)
- S E Roberts
- Medical School, Swansea University, Swansea, Wales, UK
| | - K Thorne
- Medical School, Swansea University, Swansea, Wales, UK
| | - N Thapar
- Neurogastroenterology and Motility Unit, Department of Gastroenterology, Great Ormond Street Hospital, London, UK
- Stem Cells and Regenerative Medicine, UCL Great Ormond Street Institute of Child Health, London, UK
- Prince Abdullah Ben Khalid Celiac Research Chair, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Gastroenterology, Hepatology and Liver Transplant, Queensland Children's Hospital, Brisbane, Australia
| | - I Broekaert
- Department of Paediatrics, University Children's Hospital, University of Cologne, Cologne, Germany
| | - M A Benninga
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Department of Pediatric Gastroenterology, Hepatology and Nutrition, Amsterdam, The Netherlands
| | - J Dolinsek
- Department of Pediatrics, University Medical Center Maribor, Maribor, Slovenia
| | - E Mas
- Unité de Gastroentérologie, Hépatologie, Nutrition, Diabétologie et Maladies Héréditaires, du Métabolisme, Hôpital des Enfants, CHU de Toulouse, Toulouse, France
- IRSD, Université de Toulouse, INSERM, INRA, ENVT, UPS, Toulouse, France
| | - E Miele
- Department of Translational Medical Science, Section of Pediatrics, University of Naples 'Federico II', Naples, Italy
| | - R Orel
- Department of Gastroenterology, Hepatology and Nutrition, Children's Hospital, University Medical Centre, 1000 Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - C Pienar
- Department of Pediatrics, 'Victor Babes' University of Medicine and Pharmacy, Timisoara, Romania
| | - C Ribes-Koninckx
- Department of Paediatric Gastroenterology, Hepatology & Nutrition, La FE University Hospital, Valencia, Spain
| | - M Thomson
- Centre for Paediatric Gastroenterology, Sheffield Children's Hospital, Sheffield, UK
| | - C Tzivinikos
- Department of Paediatric Gastroenterology, Al Jalila Children's Specialty Hospital, Dubai, UAE
| | | | - A John
- Medical School, Swansea University, Swansea, Wales, UK
| | - J G Williams
- Medical School, Swansea University, Swansea, Wales, UK
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Abstract
Objective To derive and validate a mathematical model to predict laser-induced temperature changes in a kidney during kidney stone treatment. Methods A simplified mathematical model to predict temperature change in the kidney for any given renal volume, irrigation flow rate, irrigation fluid temperature, and laser power was derived. We validated our model with matched in vitro experiments.
Results Excellent agreement between the mathematical model predictions and laboratory data was obtained. Conclusion The model obviates the need for repeated experimental validation. The model predicts scenarios where risk of renal tissue damage is high. With real-time knowledge of flow rate, irrigating fluid temperature and laser usage, safety warning levels could be predicted. Meanwhile, clinicians should be aware of the potential risk from thermal injury and take measures to reduce the risk, such as using room temperature irrigation fluid and judicious laser use.
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Affiliation(s)
- J G Williams
- Mathematical Institute, Andrew Wiles Building, Woodstock Road, Oxford, OX2 6GG, UK.
| | - L Goldsmith
- Nuffield Department of Surgical Sciences, John Radcliffe Hospital, University of Oxford, Headington, Oxford, OX2 6GG, UK
| | - D E Moulton
- Mathematical Institute, Andrew Wiles Building, Woodstock Road, Oxford, OX2 6GG, UK
| | - S L Waters
- Mathematical Institute, Andrew Wiles Building, Woodstock Road, Oxford, OX2 6GG, UK
| | - B W Turney
- Nuffield Department of Surgical Sciences, John Radcliffe Hospital, University of Oxford, Headington, Oxford, OX2 6GG, UK
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15
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Shah AD, Quinn NJ, Chaudhry A, Sullivan R, Costello J, O'Riordan D, Hoogewerf J, Orton M, Foley L, Feger H, Williams JG. Recording problems and diagnoses in clinical care: developing guidance for healthcare professionals and system designers. BMJ Health Care Inform 2020; 26:bmjhci-2019-100106. [PMID: 31874855 PMCID: PMC7062352 DOI: 10.1136/bmjhci-2019-100106] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 12/10/2019] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Accurate recording of problems and diagnoses in health records is key to safe and effective patient care, yet it is often done poorly. Electronic health record systems vary in their functionality and ease of use, and are not optimally designed for easy recording and sharing of clinical information. There is a lack of professional consensus and guidance on how problems and diagnoses should be recorded. METHODS The Professional Record Standards Body commissioned work led by the Royal College of Physicians Health Informatics Unit to carry out a literature review, draft guidance, carry out an online consultation and round table discussion, and produce a report including recommendations for systems. A patient workshop was held to explore patient preferences for mechanisms for sharing diagnosis information between primary and secondary care. RESULTS Consensus was reached among medical specialties on key elements of diagnosis recording, and draft guidance was produced ready for piloting in a variety of care settings. Patients were keen for better ways for diagnosis information to be shared. DISCUSSION Improving the recording of diagnoses and problems will require a major effort of which the new guidance is only a part. The guidance needs to be embedded in training, and clinical systems need to have improved, standardised functionality. Front-line clinicians, specialist societies, clinical informaticians and patients need to be engaged in developing information models for diagnoses to support care and research, accessible via user-friendly interfaces.
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Affiliation(s)
- Anoop Dinesh Shah
- Institute of Health Informatics, University College London, London, UK .,Health Informatics Unit, Royal College of Physicians, London, UK
| | - Nicola J Quinn
- Health Informatics Unit, Royal College of Physicians, London, UK
| | - Afzal Chaudhry
- Cambridge Transplant Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, UK.,Professional Record Standards Body, London, UK
| | - Ralph Sullivan
- RCGP-CIRC: Clinical Innovation and Research Centre, Royal College of General Practitioners, London, UK.,RCGP-HIG: Health Informatics Group, Royal College of General Practitioners, London, UK
| | - Julian Costello
- RCGP-HIG: Health Informatics Group, Royal College of General Practitioners, London, UK.,NHS Wales Informatics Service, Cardiff, UK
| | | | - Jan Hoogewerf
- Health Informatics Unit, Royal College of Physicians, London, UK.,Faculty of Clinical Informatics, London, UK
| | | | | | | | - John G Williams
- Health Informatics Unit, Royal College of Physicians, London, UK.,Swansea University Medical School, Swansea University, Swansea, West Glamorgan, UK
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16
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Carter T, John A, Williams JG, Roberts SE. Suicide, fatal injuries and drowning among the crews of United Kingdom and Bermuda registered cruise and passenger ships from 1976 to 2018. Int Marit Health 2020; 71:12-19. [PMID: 32212143 DOI: 10.5603/imh.2020.0006] [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: 11/12/2019] [Revised: 01/09/2020] [Accepted: 01/10/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Little has been reported about mortality among crews in passenger shipping. The aim of the study was to determine the detailed causes and circumstances of deaths from unnatural causes among crews employed in United Kingdom (UK) and Bermudan registered passenger shipping, their trends, how they relate to the type of passenger ship and crew rank and to discuss preventative measures. MATERIALS AND METHODS A longitudinal study from 1976 to 2018, based on reviews of marine accident investigation reports, death inquiry files, cruise shipping websites and online searches. RESULTS One hundred and forty crew fatalities in UK (127) and Bermudan (13) passenger ships were identified: from accidents and drowning (91), suicides and disappearances at sea (38), homicide, other and unexplained causes (11). Over the 43-year study period, a reduction in mortality (per 1000 ship-years) from accidents and drowning was identified (mean annual reduction: 4.3%; 95% confidence interval: 2.1-6.5%) but no significant reduction for suicides and disappearances at sea (annual reduction: 1.2% confidence interval: -1.3% to +3.7%). Most suicides and disappearances (70%) were among customer service Staff and, of 19 employed on large cruise ships, most (79%) were non-Europeans. CONCLUSIONS The number of suicides and probable suicides is a cause for concern, especially among customer service staff on cruise ships. These findings indicate the need for interventions to reduce suicide risks. Further studies are needed to improve the targeting of interventions. These will need both to analyse the circumstances of individual deaths and derive suicide rates according to rank, department and nationality, based on reliable population denominators.
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Affiliation(s)
- Tim Carter
- Norwegian Centre for Maritime and Diving Medicine, Haukeland University Hospital, Norway.
| | - Ann John
- Medical School, Swansea University, Swansea, United Kingdom
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17
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Carter T, John A, Williams JG, Roberts SE. Suicide, fatal injuries and drowning among the crews of United Kingdom and Bermuda registered cruise and passenger ships from 1976 to 2018. Int Marit Health 2020; 71:12-19. [PMID: 32212143 DOI: 10.5603/imh.2020.000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 01/09/2020] [Accepted: 01/10/2020] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Little has been reported about mortality among crews in passenger shipping. The aim of the study was to determine the detailed causes and circumstances of deaths from unnatural causes among crews employed in United Kingdom (UK) and Bermudan registered passenger shipping, their trends, how they relate to the type of passenger ship and crew rank and to discuss preventative measures. MATERIALS AND METHODS A longitudinal study from 1976 to 2018, based on reviews of marine accident investigation reports, death inquiry files, cruise shipping websites and online searches. RESULTS One hundred and forty crew fatalities in UK (127) and Bermudan (13) passenger ships were identified: from accidents and drowning (91), suicides and disappearances at sea (38), homicide, other and unexplained causes (11). Over the 43-year study period, a reduction in mortality (per 1000 ship-years) from accidents and drowning was identified (mean annual reduction: 4.3%; 95% confidence interval: 2.1-6.5%) but no significant reduction for suicides and disappearances at sea (annual reduction: 1.2% confidence interval: -1.3% to +3.7%). Most suicides and disappearances (70%) were among customer service Staff and, of 19 employed on large cruise ships, most (79%) were non-Europeans. CONCLUSIONS The number of suicides and probable suicides is a cause for concern, especially among customer service staff on cruise ships. These findings indicate the need for interventions to reduce suicide risks. Further studies are needed to improve the targeting of interventions. These will need both to analyse the circumstances of individual deaths and derive suicide rates according to rank, department and nationality, based on reliable population denominators.
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Affiliation(s)
- Tim Carter
- Norwegian Centre for Maritime and Diving Medicine, Haukeland University Hospital, Norway.
| | - Ann John
- Medical School, Swansea University, Swansea, United Kingdom
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18
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Rapport F, Clement C, Seagrove AC, Alrubaiy L, Hutchings HA, Williams JG. Patient views about the impact of ulcerative colitis and its management with drug treatment and surgery: a nested qualitative study within the CONSTRUCT trial. BMC Gastroenterol 2019; 19:166. [PMID: 31615445 PMCID: PMC6794775 DOI: 10.1186/s12876-019-1085-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 10/01/2019] [Indexed: 01/05/2023] Open
Abstract
Background A nested qualitative interview study within the CONSTRUCT trial was conducted to explore experiences and perceptions of patients with acute severe ulcerative colitis following treatment with infliximab or ciclosporin, surgery, or other medication. Methods Two hundred seventy patients with steroid-resistant ulcerative colitis were randomised to either infliximab or ciclosporin. Interviews were conducted with 20 trial participants. Thirty-five data capture events took place in total, 20 interviews conducted 3 months after treatment and a further 15 interviews with the same cohort as second interviews at 12 months. Results Disease duration varied but similar stories emerged about how people adjusted to living with ulcerative colitis. Issues raised by patients included; the debilitating effect of the disease on quality of life, living with the unpredictability of symptoms and treatment, dealing with embarrassment and stigma and the desire to share knowledge of the disease with others to combat the private nature of this debilitating illness and bring greater visibility to patient experience of symptoms and outcomes. Conclusion Patients were more positive about treatment with infliximab than ciclosporin, mainly due to the cumbersome intravenous regimen required for ciclosporin. Prompt diagnosis is required and early reporting of changes in symptoms is encouraged to ensure appropriate treatment. Trial registration This trial is registered with the ISRCTN registry; number ISRCTN22663589. The date of registration was 16/05/2008.
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Affiliation(s)
- Frances Rapport
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia.
| | - Clare Clement
- Bristol Medical School, University of Bristol, Bristol, UK
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19
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Cope JR, Kahler AM, Causey J, Williams JG, Kihlken J, Benjamin C, Ames AP, Forsman J, Zhu Y, Yoder JS, Seidel CJ, Hill VR. Response and remediation actions following the detection of Naegleria fowleri in two treated drinking water distribution systems, Louisiana, 2013-2014. J Water Health 2019; 17:777-787. [PMID: 31638028 PMCID: PMC7075671 DOI: 10.2166/wh.2019.239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Naegleria fowleri causes the usually fatal disease primary amebic meningoencephalitis (PAM), typically in people who have been swimming in warm, untreated freshwater. Recently, some cases in the United States were associated with exposure to treated drinking water. In 2013, a case of PAM was reported for the first time in association with the exposure to water from a US treated drinking water system colonized with culturable N. fowleri. This system and another were found to have multiple areas with undetectable disinfectant residual levels. In response, the water distribution systems were temporarily converted from chloramine disinfection to chlorine to inactivate N. fowleri and reduced biofilm in the distribution systems. Once >1.0 mg/L free chlorine residual was attained in all systems for 60 days, water testing was performed; N. fowleri was not detected in water samples after the chlorine conversion. This investigation highlights the importance of maintaining adequate residual disinfectant levels in drinking water distribution systems. Water distribution system managers should be knowledgeable about the ecology of their systems, understand potential water quality changes when water temperatures increase, and work to eliminate areas in which biofilm growth may be problematic and affect water quality.
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Affiliation(s)
- Jennifer R Cope
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infections Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30329, USA E-mail:
| | - Amy M Kahler
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infections Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30329, USA E-mail:
| | - Jake Causey
- Corona Environmental Consulting, 1001 Hingham St, Suite 102, Rockland, MA 02370, USA
| | - John G Williams
- Louisiana Department of Health, 628 North 4th St, Baton Rouge, LA 70802, USA
| | - Jennifer Kihlken
- Louisiana Department of Health, 628 North 4th St, Baton Rouge, LA 70802, USA
| | - Caryn Benjamin
- Louisiana Department of Health, 628 North 4th St, Baton Rouge, LA 70802, USA
| | - Amanda P Ames
- Louisiana Department of Health, 628 North 4th St, Baton Rouge, LA 70802, USA
| | - Johan Forsman
- Louisiana Department of Health, 628 North 4th St, Baton Rouge, LA 70802, USA
| | - Yuanda Zhu
- Louisiana Department of Health, 628 North 4th St, Baton Rouge, LA 70802, USA
| | - Jonathan S Yoder
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infections Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30329, USA E-mail:
| | - Chad J Seidel
- Corona Environmental Consulting, 1001 Hingham St, Suite 102, Rockland, MA 02370, USA
| | - Vincent R Hill
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infections Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30329, USA E-mail:
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20
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Roberts SE, John A, Lewis KE, Brown J, Lyons RA, Williams JG. Weekend admissions and mortality for major acute disorders across England and Wales: record linkage cohort studies. BMC Health Serv Res 2019; 19:619. [PMID: 31477110 PMCID: PMC6720086 DOI: 10.1186/s12913-019-4286-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 06/20/2019] [Indexed: 11/17/2022] Open
Abstract
Background To establish which major disorders are susceptible to increased mortality following acute admissions on weekends, compared with week days, and how this may be explained. Methods Cohorts based on national administrative inpatient and mortality data for 14,168,443 hospitalised patients in England and 913,068 in Wales who were admitted for 66 disorders that were associated with at least 200 deaths within 30 days of acute admission. The main outcome measure was the weekend mortality effect (defined as the conventional mortality odds ratio for admissions on weekends compared with week days). Results There were large, statistically significant weekend mortality effects (> 20%) in England for 22 of the 66 conditions and in both countries for 14. These 14 were 4 of 13 cancers (oesophageal, colorectal, lung and lymphomas); 4 of 13 circulatory disorders (angina, abdominal aortic aneurysm, peripheral vascular disease and arterial embolism & thrombosis); one of 8 respiratory disorders (pleural effusion); 2 of 12 gastrointestinal disorders (alcoholic and other liver disease); 2 of 3 ageing-related disorders (Alzheimer’s disease and dementia); none of 7 trauma conditions; and one of 10 other disorders (acute renal failure). Across the disorders, 64% of the variation in weekend mortality effects in England and Wales was explained by reductions in admission rates at weekends and the medical disease category. Conclusions The effect of weekend admission on 30 day mortality is seen mainly for cancers, some circulatory disorders, liver disease and a few other conditions which are mainly ageing- or cancer-related. Most of the increased mortality is associated with reduced admission rates at weekends and the medical disease category. Electronic supplementary material The online version of this article (10.1186/s12913-019-4286-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Stephen E Roberts
- Swansea University Medical School, Swansea University, Singleton Park, Swansea, UK. .,Health Data Research UK, Swansea University, Swansea, UK.
| | - Ann John
- Swansea University Medical School, Swansea University, Singleton Park, Swansea, UK.,Health Data Research UK, Swansea University, Swansea, UK
| | - Keir E Lewis
- Swansea University Medical School, Swansea University, Singleton Park, Swansea, UK.,Department of Respiratory Medicine, Prince Philip Hospital, Llanelli, UK
| | - Jonathan Brown
- Swansea University Medical School, Swansea University, Singleton Park, Swansea, UK.,Department of Gastroenterology, Gloucestershire Royal Hospital, Gloucester, UK
| | - Ronan A Lyons
- Swansea University Medical School, Swansea University, Singleton Park, Swansea, UK.,Health Data Research UK, Swansea University, Swansea, UK
| | - John G Williams
- Swansea University Medical School, Swansea University, Singleton Park, Swansea, UK.,Health Data Research UK, Swansea University, Swansea, UK
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21
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Carter T, Williams JG, Roberts SE. Crew and passenger deaths from vessel accidents in United Kingdom passenger ships since 1900. Int Marit Health 2019; 70:1-10. [PMID: 30931511 DOI: 10.5603/imh.2019.0001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 03/06/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND There is very limited systematic analysis of the causes and consequences of maritime accidents across the whole passenger sector during the twentieth century either in United Kingdom (UK) or in other maritime nations, but some of the larger events have been the subject of detailed investigations that led to improved safety measures. In recent years, there has been increased attention to the analysis of passenger ship accidents, especially in relation to the two now dominant markets: vehicle/passenger ferries and cruise ships. MATERIALS AND METHODS Long-term trends since 1900 in passenger and crew deaths on UK seagoing pas- senger ships that have sustained a maritime accident, as defined by Lloyds Register, have been collated and analysed. RESULTS Over the course of the 20th century, there has been a continuous fall in the number of incidents and in their severity. This may be a reflection of improved vessel safety, however the scale and nature of UK passenger shipping has also changed markedly over the period. CONCLUSIONS In addition to the reducing frequency of deaths it is apparent that the majority of fatalities in both crew and passengers came from a very small number of major events during the study period. Altho- ugh there has been no major disaster involving a UK passenger ship in the last 30 years, major casualties with heavy loss of life continue in the world passenger fleet, in recent years involving flags such as Greece, Indonesia, Italy, Panama and The Philippines.
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Affiliation(s)
- Tim Carter
- Norwegian Centre for Maritime and Diving Medicine, Haukeland University Hospital, Norway.
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Williams JG, Moyle PB, Halls AS. Comment on "Designing river flows to improve food security futures in the Lower Mekong Basin". Science 2019; 364:364/6444/eaav8755. [PMID: 31171665 DOI: 10.1126/science.aav8755] [Citation(s) in RCA: 1] [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] [Received: 10/28/2018] [Accepted: 04/25/2019] [Indexed: 11/03/2022]
Abstract
Sabo et al (Research Articles, 8 December 2017, p. 1270) used statistical relationships between flow and catch in a major Lower Mekong Basin fishery to propose a flow regime that they claim would increase catch, if implemented by proposed dams. However, their catch data were not adjusted for known variation in monitoring effort, invalidating their analysis.
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Affiliation(s)
| | - Peter B Moyle
- Department of Wildlife, Fish, and Conservation Biology, Center for Watershed Sciences, University of California, Davis, CA 95616, USA
| | - Ashley S Halls
- Aquae Sulis Research Ltd., Midway House, Turleigh, Wiltshire BA15 2LR, UK
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Roberts SE, John A, Brown J, Napier DJ, Lyons RA, Williams JG. Early and late mortality following unscheduled admissions for severe liver disease across England and Wales. Aliment Pharmacol Ther 2019; 49:1334-1345. [PMID: 30972781 PMCID: PMC6519290 DOI: 10.1111/apt.15232] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 11/29/2018] [Revised: 12/17/2018] [Accepted: 02/27/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND There is a known shortfall in hepatology service resources across England and Wales. AIM To investigate early and late mortality following unscheduled admissions for severe liver disease, overall and by cause of death, and to determine how mortality is related to admissions to transplant centres, transplant surgery, hospital size, consultant specialty, patient socio-demographics, seasonal and geographical factors. METHODS Cohorts of people with a first unscheduled admission for severe liver disease across England and Wales from 2004, based on record linkage of national inpatient and mortality data. FINDINGS Mortality for alcoholic liver disease and hepatic failure was 23.4% and 35.4% respectively at 60 days and 61.8% and 57.1% at 5 years. Standardised mortality ratios (SMRs) were extremely high at 60 days (184 and 117 respectively) and remained highly increased at 5 years (16.7 and 6.3). Mortality at 5 years was most elevated from liver disease, viral hepatitis and varices. The 60-day mortality was significantly lower for patients seen by consultant hepatologists and gastroenterologists. Both early and late mortality were significantly reduced for patients admitted to transplant centres or larger hospitals, who received a liver transplant, or were resident in London. Early mortality was significantly higher for patients admitted in winter and autumn, while elevated mortality among the most vs least deprived quintile increased with longer follow-up. CONCLUSIONS The study shows a very poor prognosis for people with unscheduled hospitalisation for severe liver disease. The findings suggest that access to specialist expertise and services improves survival, both in the short and long term.
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Affiliation(s)
- Stephen E. Roberts
- Medical SchoolSwansea UniversitySwanseaUK,Health Data Research UKSwansea UniversitySwanseaUK
| | - Ann John
- Medical SchoolSwansea UniversitySwanseaUK,Health Data Research UKSwansea UniversitySwanseaUK
| | - Jonathan Brown
- Medical SchoolSwansea UniversitySwanseaUK,Department of GastroenterologyGloucestershire Royal HospitalGloucesterUK
| | | | - Ronan A. Lyons
- Medical SchoolSwansea UniversitySwanseaUK,Health Data Research UKSwansea UniversitySwanseaUK
| | - John G. Williams
- Medical SchoolSwansea UniversitySwanseaUK,Health Data Research UKSwansea UniversitySwanseaUK
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Jidkov L, Alexander M, Bark P, Williams JG, Kay J, Taylor P, Hemingway H, Banerjee A. Health informatics competencies in postgraduate medical education and training in the UK: a mixed methods study. BMJ Open 2019; 9:e025460. [PMID: 30928942 PMCID: PMC6475211 DOI: 10.1136/bmjopen-2018-025460] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE To assess health informatics (HI) training in UK postgraduate medical education, across all specialties, against international standards in the context of UK digital health initiatives (eg, Health Data Research UK, National Health Service Digital Academy and Global Digital Exemplars). DESIGN A mixed methods study of UK postgraduate clinician training curricula (71 specialties) against international HI standards: scoping review, curricular content analysis and expert consultation. SETTING AND PARTICIPANTS A scoping literature review (PubMed until March 2017) informed development of a contemporary framework of HI competency domains for doctors. National training curricula for 71 postgraduate medical specialties were obtained from the UK General Medical Council and were analysed. Seven UK HI experts were consulted regarding findings. OUTCOMES The International Medical Informatics Association (IMIA) Recommendations for Biomedical and Health Informatics Education were used to develop a framework of competency domains. The number (maximum 50) of HI competency domains included in each of the 71 UK postgraduate medical specialties was investigated. After expert review, a universal HI competency framework was proposed. RESULTS A framework of 50 HI competency domains was developed using 21 curricula from a scoping review, curricular content analysis and expert consultation. All 71 UK postgraduate medical curricula documents were mapped across 29 of 50 framework domains; that is, 21 domains were unrepresented. Curricula mapped between 0 (child and adolescent psychiatry and core surgical training) and 16 (chemical pathology and paediatric and perinatal pathology) of the 50 domains (median=7). Expert consultation found that HI competencies should be universal and integrated with existing competencies for UK clinicians and were under-represented in current curricula. Additional universal HI competencies were identified, including information governance and security and secondary use of data. CONCLUSIONS Postgraduate medical education in the UK neglects HI competencies set out by international standards. Key HI competencies need to be urgently integrated into training curricula to prepare doctors for work in increasingly digitised healthcare environments.
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Affiliation(s)
- Lydia Jidkov
- Institute of Health Informatics, University College London, London, UK
| | - Matthew Alexander
- Royal Victoria Infirmary, Newcastle upon Tyne, Newcastle upon Tyne, UK
| | - Pippa Bark
- Institute of Health Informatics, University College London, London, UK
| | - John G Williams
- School of Medicine, Swansea University, Swansea, UK
- Health Informatics Unit, Royal College of Physicians, London, UK
| | - Jonathan Kay
- Health Informatics Unit, Royal College of Physicians, London, UK
| | - Paul Taylor
- Institute of Health Informatics, University College London, London, UK
| | - Harry Hemingway
- Institute of Health Informatics, University College London, London, UK
| | - Amitava Banerjee
- Institute of Health Informatics, University College London, London, UK
- Health Informatics Unit, Royal College of Physicians, London, UK
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Thomas MG, Bayliss C, Bond S, Dowling F, Galea J, Jairath V, Lamb C, Probert C, Timperley-Preece E, Watson A, Whitehead L, Williams JG, Parkes M, Kaser A, Raine T. Trial summary and protocol for a phase II randomised placebo-controlled double-blinded trial of Interleukin 1 blockade in Acute Severe Colitis: the IASO trial. BMJ Open 2019; 9:e023765. [PMID: 30772849 PMCID: PMC6398753 DOI: 10.1136/bmjopen-2018-023765] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Acute severe ulcerative colitis (ASUC) is a severe manifestation of ulcerative colitis (UC) that warrants hospitalisation. Despite significant advances in therapeutic options for UC and in the medical management of steroid-refractory ASUC, the initial treatment paradigm has not changed since 1955 and is based on the use of intravenous corticosteroids. This treatment is successful in approximately 50% of patients but failure of this and subsequent medical therapy still occurs, with colectomy rates of up to 40% reported. The Interleukin 1 (IL-1) blockade in Acute Severe Colitis (IASO) trial aims to investigate whether antagonism of IL-1 signalling using anakinra in addition to intravenous corticosteroid treatment can improve outcomes in patients with ASUC. METHODS AND ANALYSIS IASO is a phase II, multicentre, two-arm (parallel group), randomised (1:1), placebo-controlled, double-blinded trial of short-duration anakinra in ASUC. Its primary outcome will be the incidence of medical (eg, infliximab/ciclosporin) or surgical rescue therapy (colectomy) within 10 days following the commencement of intravenous corticosteroid therapy. Secondary outcomes will include disease activity, time to clinical response, time to rescue therapy, colectomy incidence by day 98 post intravenous corticosteroids and safety. The trial aims to recruit 214 patients across 20 sites in the UK. ETHICS AND DISSEMINATION The trial has received approval from the Cambridge Central Research Ethics Committee (Ref: 17/EE/0347), the Health Research Authority (Ref: 201505) and Clinical Trials Authorisation from the Medicines and Healthcare products Regulatory Agency. We plan to present trial findings at scientific conferences and publish in high-impact peer-reviewed journals. TRIAL REGISTRATION NUMBER ISRCTN43717130; EudraCT 2017-001389-10.
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Affiliation(s)
| | | | - Simon Bond
- Cambridge Clinical Trials Unit, Cambridge, UK
- MRC Biostatistics Unit, Cambridge, UK
| | | | | | - Vipul Jairath
- Division of Gastroenterology, Department of Medicine, Western University, London, Ontario, Canada
- Division of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Christopher Lamb
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
- Department of Gastroenterology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | | | | | - Alastair Watson
- Department of Gastroenterology, University of East Anglia, Norwich, UK
| | - Lynne Whitehead
- Clinical Trials Pharmacy Department, Addenbrooke's Hospital, Cambridge, UK
| | | | - Miles Parkes
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK
- Department of Gastroenterology, Addenbrooke's Hospital, Cambridge University Hospitals NHS FoundationTrust, Cambridge, UK
| | - Arthur Kaser
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK
- Department of Gastroenterology, Addenbrooke's Hospital, Cambridge University Hospitals NHS FoundationTrust, Cambridge, UK
| | - Tim Raine
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK
- Department of Gastroenterology, Addenbrooke's Hospital, Cambridge University Hospitals NHS FoundationTrust, Cambridge, UK
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Jitsumura M, Cunningham AL, Hitchings MD, Islam S, Davies AP, Row PE, Riddell AD, Kinross J, Wilkinson TS, Jenkins GJ, Williams JG, Harris DA. Protocol for faecal microbiota transplantation in ulcerative colitis (FMTUC): a randomised feasibility study. BMJ Open 2018; 8:e021987. [PMID: 30341117 PMCID: PMC6196852 DOI: 10.1136/bmjopen-2018-021987] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The interaction of the gut microbiota with the human host is implicated in the pathogenesis of inflammatory and immunological diseases including ulcerative colitis (UC). Faecal microbiota transplantation (FMT) as a method of restoring gut microbial diversity is of increasing interest as a therapeutic approach in the management of UC. The current literature lacks consensus about the dose of FMT, route of administration and duration of response. METHODS AND ANALYSIS This single-blinded randomised trial will explore the feasibility of FMT in 30 treatment-naïve patients with histologically confirmed distal UC limited to the recto-sigmoid region (up to 40 cm from the anal verge). This study aims to estimate the magnitude of treatment response to FMT under controlled conditions. The intervention (FMT) will be administered by rectal retention enema. It will test the feasibility of randomising patients to: (i) single FMT dose, (ii) five daily FMT doses or (iii) control (no FMT dose). All groups will receive standard antibiotic gut decontamination and bowel preparation before FMT. Recruitment will take place over a 24-month period with a 12-week patient follow-up. Trial objectives include evaluation of the magnitude of treatment response to FMT, investigation of the clinical value of metabolic phenotyping for predicting the clinical response to FMT and testing the recruitment rate of donors and patients for a study in FMT. This feasibility trial will enable an estimate of number of patients needed, help determine optimal study conditions and inform the choice of endpoints for a future definitive phase III study. ETHICS AND DISSEMINATION The trial is approved by the regional ethics committee and is sponsored by Abertawe Bro Morgannwg University's Health Board. Written informed consent from all patients will be obtained. Serious adverse events will be reported to the sponsor. Trial results will be disseminated via peer review publication and shared with trial participants. TRIAL REGISTRATION NUMBER ISRCTN 58082603; Pre-results.
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Affiliation(s)
- Maki Jitsumura
- Department of Colorectal Surgery, Singleton Hospital, Swansea, UK
| | | | - Matthew David Hitchings
- Medical Microbiology and Infectious Diseases, Swansea University Medical School, Swansea, UK
| | - Saiful Islam
- Swansea Trial Unit, Swansea University, Swansea, UK
| | - Angharad P Davies
- Public Health Wales Microbiology, Singleton Hospital, Swansea University Medical School, Swansea, UK
| | - Paula E Row
- Biochemistry Group, Swansea University Medical School, Swansea, UK
| | - Andrew D Riddell
- Department of Colorectal Surgery, Redcliffe Hospital, Brisbane, Queensland, Australia
| | - James Kinross
- Department of Surgery and Cancer, St. Mary's Hospital, Imperial College London, London, UK
| | - Tom S Wilkinson
- Medical Microbiology and Infectious Diseases, Swansea University Medical School, Swansea, UK
| | - G J Jenkins
- Molecular Carcinogenesis, Institute of Life Science, Swansea University Medical School, Swansea, UK
| | - John G Williams
- Institute of Life Science 2, Swansea University Medical School, Swansea, UK
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Williams JG. Comment on "Designing river flows to improve food security futures in the Lower Mekong Basin". Science 2018; 361:361/6398/eaat1225. [PMID: 30002225 DOI: 10.1126/science.aat1225] [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] [Received: 01/25/2018] [Accepted: 05/25/2018] [Indexed: 11/02/2022]
Abstract
Sabo et al (Research Articles, 8 December 2017, p. 1270) use sophisticated analyses of flow and fishery data from the Lower Mekong Basin to design a "good" hydrograph that, if implemented by planned hydropower dams, would increase the catch by a factor of 3.7. However, the hydrograph is not implementable, and, if it were, it would devastate the fishery. Further, the analyses are questionable.
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Williams JG, Alam MF, Alrubaiy L, Arnott I, Clement C, Cohen D, Gordon JN, Hawthorne AB, Hilton M, Hutchings HA, Jawhari AU, Longo M, Mansfield J, Morgan JM, Rapport F, Seagrove AC, Sebastian S, Shaw I, Travis SPL, Watkins A. Infliximab versus ciclosporin for steroid-resistant acute severe ulcerative colitis (CONSTRUCT): a mixed methods, open-label, pragmatic randomised trial. Lancet Gastroenterol Hepatol 2018; 1:15-24. [PMID: 27595142 PMCID: PMC4994668 DOI: 10.1016/s2468-1253(16)30003-6] [Citation(s) in RCA: 155] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Infliximab and ciclosporin are of similar efficacy in treating acute severe ulcerative colitis, but there has been no comparative evaluation of their relative clinical effectiveness and cost-effectiveness. Methods In this mixed methods, open-label, pragmatic randomised trial, we recruited consenting patients aged 18 years or older at 52 district general and teaching hospitals in England, Scotland, and Wales who had been admitted, unscheduled, with severe ulcerative colitis and failed to respond to intravenous hydrocortisone within about 5 days. Patients were randomly allocated (1:1) to receive either infliximab (5 mg/kg intravenous infusion given over 2 h at baseline, and again at 2 weeks and 6 weeks after the first infusion) or ciclosporin (2 mg/kg per day by continuous infusion for up to 7 days, followed by twice-daily tablets delivering 5·5 mg/kg per day for 12 weeks). Randomisation used a web-based password-protected site, with a dynamic algorithm to generate allocations on request, thus protecting against investigator preference or other subversion, while ensuring that each trial group was balanced by centre, which was the only stratification used. Local investigators and participants were aware of the treatment allocated, but the chief investigator and analysts were masked. Analysis was by treatment allocated. The primary outcome was quality-adjusted survival—ie, the area under the curve (AUC) of scores from the Crohn's and Ulcerative Colitis Questionnaire (CUCQ) completed by participants at baseline, 3 months, and 6 months, then every 6 months from 1 year to 3 years. This trial is registered with the ISRCTN Registry, number ISRCTN22663589. Findings Between June 17, 2010, and Feb 26, 2013, 270 patients were recruited. 135 patients were allocated to the infliximab group and 135 to the ciclosporin group. 121 (90%) patients in each group were included in the analysis of the primary outcome. There was no significant difference between groups in quality-adjusted survival (mean AUC 564·0 [SD 241·9] in the infliximab group vs 587·0 [226·2] in the ciclosporin group; mean adjusted difference 7·9 [95% CI −22·0 to 37·8]; p=0·603). Likewise, there were no significant differences between groups in the secondary outcomes of CUCQ scores, EQ-5D, or SF-6D scores; frequency of colectomy (55 [41%] of 135 patients in the infliximab group vs 65 [48%] of 135 patients in the ciclosporin group; p=0·223); or mean time to colectomy (811 [95% CI 707–912] days in the infliximab group vs 744 [638–850] days in the ciclosporin group; p=0·251). There were no differences in serious adverse reactions (16 reactions in 14 participants receiving infliximab vs ten in nine patients receiving ciclosporin); serious adverse events (21 in 16 patients vs 25 in 17 patients); or deaths (three in the infliximab group vs none in the ciclosporin group). Interpretation There was no significant difference between ciclosporin and infliximab in clinical effectiveness. Funding NIHR Health Technology Assessment programme.
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Affiliation(s)
| | - M Fasih Alam
- College of Human and Health Sciences, Swansea University, Swansea, UK
| | | | - Ian Arnott
- NHS Lothian, Western General Hospital, Edinburgh, UK
| | | | | | - John N Gordon
- Hampshire Hospitals NHS Foundation Trust, Royal Hampshire County Hospital, Winchester, UK
| | - A Barney Hawthorne
- Cardiff and Vale University Health Board, University Hospital of Wales, Cardiff, UK
| | - Mike Hilton
- Swansea University Medical School, Swansea, UK
| | | | - Aida U Jawhari
- National Institute for Health Research (NIHR), Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospital NHS Trust, Nottingham, UK
| | - Mirella Longo
- College of Human and Health Sciences, Swansea University, Swansea, UK
| | - John Mansfield
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | | | | | | | | | - Ian Shaw
- Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK
| | - Simon P L Travis
- Translational Gastroenterology Unit, Oxford University Hospitals NHS Trust, Oxford, UK
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Roberts SE, John A, Kandalama U, Williams JG, Lyons RA, Lloyd K. Suicide following acute admissions for physical illnesses across England and Wales. Psychol Med 2018; 48:578-591. [PMID: 28714426 PMCID: PMC5964467 DOI: 10.1017/s0033291717001787] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 05/30/2017] [Accepted: 06/06/2017] [Indexed: 01/26/2023]
Abstract
BACKGROUND The study aim was to establish and quantify suicide risk following acute admissions for all major physical illnesses, for confirmatory purposes, from two independent information sources from different countries. METHODS Record linkage of inpatient and death certificate data for 11 004 389 acute admissions for physical illnesses in England and 713 496 in Wales. The main outcome measure was standardised mortality ratios (SMRs) for suicide at 1 year following discharge from hospital. RESULTS There were 1781 suicides within 1 year of discharge in England (SMR = 1.7; 95% = 1.6-1.8) and 131 in Wales (SMR = 2.0; 1.7-2.3). Of 48 major physical illnesses that were associated with at least eight suicides in either country, there was high consistent suicide mortality (significant SMR >3) in both countries for constipation (SMR = 4.1 in England, 7.5 in Wales), gastritis (4.4 and 4.9) and upper gastrointestinal bleeding (3.4 and 4.5). There was high suicide mortality in one country for alcoholic liver disease, other liver disease and chronic pancreatitis; for epilepsy and Parkinson's disease; for diabetes, hypoglycaemia and hypo-osmolality & hyponatraemia; and for pneumonia, back pain and urinary tract infections. CONCLUSIONS There is little or no increased suicide mortality following acute admissions for most physical illnesses. Much of the increased suicide mortality relates to gastrointestinal disorders that are often alcohol related or specific chronic conditions, which may be linked to side effects from certain therapeutic medications. Acute hospital admissions for physical illnesses may therefore provide an opportunity for targeted suicide prevention among people with certain conditions, particularly alcohol related disorders.
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Affiliation(s)
- S E Roberts
- Swansea University Medical School,Singleton Park,Swansea University,Swansea,UK
| | - A John
- Swansea University Medical School,Singleton Park,Swansea University,Swansea,UK
| | - U Kandalama
- Swansea University Medical School,Singleton Park,Swansea University,Swansea,UK
| | - J G Williams
- Swansea University Medical School,Singleton Park,Swansea University,Swansea,UK
| | - R A Lyons
- Swansea University Medical School,Singleton Park,Swansea University,Swansea,UK
| | - K Lloyd
- Swansea University Medical School,Singleton Park,Swansea University,Swansea,UK
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Williams JG, Alam MF, Alrubaiy L, Clement C, Cohen D, Grey M, Hilton M, Hutchings HA, Longo M, Morgan JM, Rapport FL, Seagrove AC, Watkins A. Comparison Of iNfliximab and ciclosporin in STeroid Resistant Ulcerative Colitis: pragmatic randomised Trial and economic evaluation (CONSTRUCT). Health Technol Assess 2018; 20:1-320. [PMID: 27329657 DOI: 10.3310/hta20440] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The efficacy of infliximab and ciclosporin in treating severe ulcerative colitis (UC) is proven, but there has been no comparative evaluation of effectiveness. OBJECTIVE To compare the clinical effectiveness and cost-effectiveness of infliximab and ciclosporin in treating steroid-resistant acute severe UC. METHOD Between May 2010 and February 2013 we recruited 270 participants from 52 hospitals in England, Scotland and Wales to an open-label parallel-group, pragmatic randomised trial. Consented patients admitted with severe colitis completed baseline quality-of-life questionnaires before receiving intravenous hydrocortisone. If they failed to respond within about 5 days, and met other inclusion criteria, we invited them to participate and used a web-based adaptive randomisation algorithm to allocate them in equal proportions between 5 mg/kg of intravenous infliximab at 0, 2 and 6 weeks or 2 mg/kg/day of intravenous ciclosporin for 7 days followed by 5.5 mg/kg/day of oral ciclosporin until 12 weeks from randomisation. Further treatment was at the discretion of physicians responsible for clinical management. The primary outcome was quality-adjusted survival (QAS): the area under the curve (AUC) of scores derived from Crohn's and Ulcerative Colitis Questionnaires completed by participants at 3 and 6 months, and then 6-monthly over 1-3 years, more frequently after surgery. Secondary outcomes collected simultaneously included European Quality of Life-5 Dimensions (EQ-5D) scores and NHS resource use to estimate cost-effectiveness. Blinding was possible only for data analysts. We interviewed 20 trial participants and 23 participating professionals. Funded data collection finished in March 2014. Most participants consented to complete annual questionnaires and for us to analyse their routinely collected health data over 10 years. RESULTS The 135 participants in each group were well matched at baseline. In 121 participants analysed in each group, we found no significant difference between infliximab and ciclosporin in QAS [mean difference in AUC/day 0.0297 favouring ciclosporin, 95% confidence interval (CI) -0.0088 to 0.0682; p = 0.129]; EQ-5D scores (quality-adjusted life-year mean difference 0.021 favouring ciclosporin, 95% CI -0.032 to 0.096; p = 0.350); Short Form questionnaire-6 Dimensions scores (mean difference 0.0051 favouring ciclosporin, 95% CI -0.0250 to 0.0353; p = 0.737). There was no statistically significant difference in colectomy rates [odds ratio (OR) 1.350 favouring infliximab, 95% CI 0.832 to 2.188; p = 0.223]; numbers of serious adverse reactions (event ratio = 0.938 favouring ciclosporin, 95% CI 0.590 to 1.493; p = 0.788); participants with serious adverse reactions (OR 0.660 favouring ciclosporin, 95% CI 0.282 to 1.546; p = 0.338); numbers of serious adverse events (event ratio 1.075 favouring infliximab, 95% CI 0.603 to 1.917; p = 0.807); participants with serious adverse events (OR 0.999 favouring infliximab, 95% CI 0.473 to 2.114; p = 0.998); deaths (all three who died received infliximab; p = 0.247) or concomitant use of immunosuppressants. The lower cost of ciclosporin led to lower total NHS costs (mean difference -£5632, 95% CI -£8305 to -£2773; p < 0.001). Interviews highlighted the debilitating effect of UC; participants were more positive about infliximab than ciclosporin. Professionals reported advantages and disadvantages with both drugs, but nurses disliked the intravenous ciclosporin. CONCLUSIONS Total cost to the NHS was considerably higher for infliximab than ciclosporin. Nevertheless, there was no significant difference between the two drugs in clinical effectiveness, colectomy rates, incidence of SAEs or reactions, or mortality, when measured 1-3 years post treatment. To assess long-term outcome participants will be followed up for 10 years post randomisation, using questionnaires and routinely collected data. Further studies will be needed to evaluate the efficacy and effectiveness of new anti-tumour necrosis factor drugs and formulations of ciclosporin. TRIAL REGISTRATION Current Controlled Trials ISRCTN22663589. FUNDING This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 20, No. 44. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- John G Williams
- Swansea University Medical School, Swansea University, Swansea, UK
| | - M Fasihul Alam
- Swansea Centre for Health Economics, College of Human and Health Science, Swansea University, Swansea, UK
| | - Laith Alrubaiy
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Clare Clement
- Swansea University Medical School, Swansea University, Swansea, UK
| | - David Cohen
- Faculty of Health Sport and Science, University of South Wales, Pontypridd, UK
| | - Michelle Grey
- Swansea University Medical School, Swansea University, Swansea, UK
| | | | | | - Mirella Longo
- Swansea Centre for Health Economics, College of Human and Health Science, Swansea University, Swansea, UK
| | - Jayne M Morgan
- Swansea University Medical School, Swansea University, Swansea, UK
| | | | - Anne C Seagrove
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Alan Watkins
- Swansea University Medical School, Swansea University, Swansea, UK
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Roberts SE, Brown TH, Thorne K, Lyons RA, Akbari A, Napier DJ, Brown JL, Williams JG. Weekend admission and mortality for gastrointestinal disorders across England and Wales. Br J Surg 2017; 104:1723-1734. [PMID: 28925499 PMCID: PMC5656931 DOI: 10.1002/bjs.10608] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 02/09/2017] [Accepted: 05/08/2017] [Indexed: 01/18/2023]
Abstract
BACKGROUND Little has been reported on mortality following admissions at weekends for many gastrointestinal (GI) disorders. The aim was to establish whether GI disorders are susceptible to increased mortality following unscheduled admission on weekends compared with weekdays. METHODS Record linkage was undertaken of national administrative inpatient and mortality data for people in England and Wales who were hospitalized as an emergency for one of 19 major GI disorders. RESULTS The study included 2 254 701 people in England and 155 464 in Wales. For 11 general surgical and medical GI disorders there were little, or no, significant weekend effects on mortality at 30 days in either country. There were large consistent weekend effects in both countries for severe liver disease (England: 26·2 (95 per cent c.i. 21·1 to 31·6) per cent; Wales: 32·0 (12·4 to 55·1 per cent) and GI cancer (England: 21·8 (19·1 to 24·5) per cent; Wales: 25·0 (15·0 to 35·9) per cent), which were lower in patients managed by surgeons. Admission rates were lower at weekends than on weekdays, most strongly for severe liver disease (by 43·3 per cent in England and 51·4 per cent in Wales) and GI cancer (by 44·6 and 52·8 per cent respectively). Both mortality and the weekend mortality effect for GI cancer were lower for patients managed by surgeons. DISCUSSION There is little, or no, evidence of a weekend mortality effect for most major general surgical or medical GI disorders, but large weekend effects for GI cancer and severe liver disease. Lower admission rates at weekends indicate more severe cases. The findings for severe liver disease may suggest a lack of specialist hepatological resources. For cancers, reduced availability of end-of-life care in the community at weekends may be the cause.
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Affiliation(s)
- S E Roberts
- Swansea University Medical School, Swansea University, Swansea, UK
- Farr Institute of Health Informatics Research, Swansea University, Swansea, UK
| | - T H Brown
- Swansea University Medical School, Swansea University, Swansea, UK
| | - K Thorne
- Swansea University Medical School, Swansea University, Swansea, UK
| | - R A Lyons
- Swansea University Medical School, Swansea University, Swansea, UK
- Farr Institute of Health Informatics Research, Swansea University, Swansea, UK
| | - A Akbari
- Swansea University Medical School, Swansea University, Swansea, UK
- Farr Institute of Health Informatics Research, Swansea University, Swansea, UK
| | - D J Napier
- Department of Gastroenterology, Gloucestershire Royal Hospital, Gloucester, UK
| | - J L Brown
- Swansea University Medical School, Swansea University, Swansea, UK
- Department of Gastroenterology, Gloucestershire Royal Hospital, Gloucester, UK
| | - J G Williams
- Swansea University Medical School, Swansea University, Swansea, UK
- Farr Institute of Health Informatics Research, Swansea University, Swansea, UK
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Josephson MD, Williams JG. Functional-Strengthening: A Pilot Study on Balance Control Improvement in Community-Dwelling Older Adults. Monten J Sports Sci Med 2017. [DOI: 10.26773/mjssm.2017.09.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Williams JG, Phan H, Winston HR, Fugit RV, Graney B, Jamroz B, English B, Chan ED. A 27-Year-Old Man With Acute Severe Low Back Pain and Bilateral Leg Swelling That Prompted Renting a Wheelchair for Mobility. Chest 2017; 151:e35-e39. [PMID: 28183502 DOI: 10.1016/j.chest.2016.08.1459] [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] [Received: 06/17/2016] [Revised: 07/30/2016] [Accepted: 08/16/2016] [Indexed: 11/29/2022] Open
Abstract
A 27-year-old man with OSA, posttraumatic stress disorder, and chronic mechanical back pain presented with a 3-day history of acute atraumatic worsening of his low back pain as well as right groin numbness that was exacerbated by walking. He also complained of bilateral leg "heaviness," pain, and swelling, all becoming so severe that he rented a wheelchair for mobility.
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Affiliation(s)
- John G Williams
- Department of Medicine, University of Colorado Denver Anschutz Medical Campus, Aurora, CO
| | - Huy Phan
- Department of Medicine, University of Colorado Denver Anschutz Medical Campus, Aurora, CO
| | - Helena R Winston
- Department of Medicine, University of Colorado Denver Anschutz Medical Campus, Aurora, CO
| | - Randolph V Fugit
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Denver Anschutz Medical Campus, Aurora, CO; Department of Pharmacy, Denver Veterans Affairs Medical Center, Denver, CO
| | - Bridget Graney
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Denver Anschutz Medical Campus, Aurora, CO
| | - Brant Jamroz
- Department of Radiology, Denver Veterans Affairs Medical Center, Denver, CO
| | - Benjamin English
- Department of Radiology, Denver Veterans Affairs Medical Center, Denver, CO
| | - Edward D Chan
- Department of Medicine, University of Colorado Denver Anschutz Medical Campus, Aurora, CO; Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Denver Anschutz Medical Campus, Aurora, CO; Department of Medicine, Denver Veterans Affairs Medical Center, Denver, CO; Department of Medicine and Academic Affairs, National Jewish Health, Denver, CO.
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Thorne K, Johansen A, Akbari A, Williams JG, Roberts SE. 127THE IMPACT OF SOCIAL DEPRIVATION ON MORTALITY FOLLOWING HIP FRACTURE IN ENGLAND AND WALES: A RECORD LINKAGE STUDY. Age Ageing 2017. [DOI: 10.1093/ageing/afx072.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Affiliation(s)
- Wayne C. Jouse
- University of Arizona, Department of Nuclear and Energy Engineering Room 200, Old Engineering Building, Tucson, Arizona 85721
| | - John G. Williams
- University of Arizona, Department of Nuclear and Energy Engineering Room 200, Old Engineering Building, Tucson, Arizona 85721
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Abstract
BACKGROUND Plastic surgery as a discipline is poorly understood by many, including primary care physicians, nurses, medical students, and the public. These misconceptions affect the specialty in a number of ways, including referral patterns and recruitment of medical students into residency programs. The reason for these commonly held misconceptions has not yet been addressed in the plastic surgery literature. As such, we assessed medical students' knowledge and perceptions of plastic surgery as a discipline and explored factors influencing these opinions. METHODS To assess medical students' knowledge and perceptions of plastic surgery, we conducted an online survey. A total of 231 medical students responded. Interviews were then conducted with 2 focus groups, in which we explored the survey results and reasons behind these misconceptions. RESULTS As with previous studies, medical students showed a gap in knowledge with respect to plastic surgery. Although they were generally aware that plastic surgeons perform cosmetic procedures and treat burns, they were largely unaware that plastic surgeons perform hand and craniofacial surgeries. Focus groups revealed that television plays a large role in shaping their ideas of plastic surgery. CONCLUSION Medical students have a skewed perception of the discipline of plastic surgery, and this is largely influenced by television. Interventions aimed at educating medical students on the matter are recommended, including a greater presence in the preclerkship medical school curriculum.
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Affiliation(s)
- S J Fraser
- Division of Plastic & Reconstructive Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - S Al Youha
- Division of Plastic & Reconstructive Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - P J Rasmussen
- Division of Plastic & Reconstructive Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - J G Williams
- Division of Plastic & Reconstructive Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
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Abstract
Applying research findings on the perception of human movement it was predicted that enhancement of a model's limbs with points of light so as to convey particular postures clearly would significantly facilitate the fidelity of modeling a gymnastic action. Four 14-yr.-old boys judged to be equally skilled in the performance of a headspring vault practiced to improve their form (extension of knees) either in an enhanced or a normal video-modeling condition. The performance criterion was the average angle at the knee for sampled frames between the piked position in the initial phase of the vault and the fully extended body position at the start of the flight phase. Analysis yielded a significant main effect for practice but no differences among the experimental conditions.
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Hutchings HA, Alrubiay L, Watkins A, Cheung WY, Seagrove AC, Williams JG. Validation of the Crohn's and Ulcerative Colitis questionnaire in patients with acute severe ulcerative colitis. United European Gastroenterol J 2016; 5:571-578. [PMID: 28588889 DOI: 10.1177/2050640616671627] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 09/04/2016] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The Crohn's and Ulcerative Colitis questionnaire (CUCQ) has previously been validated in patients with mild to moderate Crohn's and ulcerative colitis (UC). The aim of this study was to validate the tool in patients with acute severe UC. METHODS We undertook a validation of the CUCQ in patients recruited to the COmparison of iNfliximab and ciclosporin in STeroid Resistant Ulcerative Colitis Trial (CONSTRUCT). We carried out psychometric analysis to examine the underlying dimensions of the scale, internal consistency and construct validity. We carried out stepwise regression to examine which items accounted for the greatest variance in the scale. RESULTS We obtained complete data for 270 patients. The internal consistency of the CUCQ was excellent (Cronbach's alpha > 0.8). The CUCQ scores achieved significant correlations with two generic quality of life scales (SF-12 and EQ-5D), demonstrating good construct validity. Stepwise regression identified 16 items that accounted for greater than 95% of the variance of the CUCQ. Only three of the eight items selected for a short form in mild to moderate patients were selected for patients with acute severe UC. CONCLUSIONS The CUCQ demonstrated good validity in our sample of acute severe UC patients. Stepwise regression identified potential to shorten the tool, but that different items would be selected compared with less severe patients. If the tool is to be applied across the spectrum of disease it would be more appropriate to use the full 32 items in the scale. Further work to explore test-retest is required in acute patients.
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Affiliation(s)
| | | | | | - W-Y Cheung
- Swansea University Medical School, Swansea, UK
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Thorne K, Johansen A, Akbari A, Williams JG, Roberts SE. The impact of social deprivation on mortality following hip fracture in England and Wales: a record linkage study. Osteoporos Int 2016; 27:2727-2737. [PMID: 27098537 PMCID: PMC4981619 DOI: 10.1007/s00198-016-3608-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 03/01/2016] [Indexed: 12/02/2022]
Abstract
UNLABELLED We used routine hospital data to investigate whether socially deprived patients had an increased risk of dying following hip fracture compared with affluent patients. We found that the most deprived patients had a significantly increased risk of dying at 30, 90 and 365 days compared with the most affluent patients. INTRODUCTION To identify whether social deprivation has any effect on mortality risk after emergency admission with hip fracture and to determine whether any increased mortality observed among deprived groups was associated with patient and hospital-related factors. METHODS We used routine, linked hospital inpatient and mortality data for emergency admissions with a hip fracture in both England and Wales between 2004 and 2011. Mortality rates at 30, 90 and 365 days were reported. Logistic regression was used to identify any significant increases in mortality with higher levels of social deprivation and the influence of other risk factors on any increased mortality among the most deprived group. RESULTS Mortality rates at 30, 90 and 365 days were 9.3, 17.4 and 29.0 % in England and 8.3, 16.1 and 27.9 % in Wales. Social deprivation was significantly associated with increased mortality in the most deprived quintile compared with the least deprived quintile at 30, 90 and 365 days in England (OR = 1.187, 1.185 and 1.154, respectively) and at 90 and 365 days in Wales (1.135 and 1.203). There was a little interaction between deprivation and other risk factors influencing 30- and 365-day mortality except for patient age, pre-fracture residence and hospital size. CONCLUSIONS We demonstrated a positive association between social deprivation and increased mortality at 30 days post-admission for hip fracture in both England and Wales that was still evident at 90 and 365 days. We found little influence of other factors on social inequalities in mortality risk at 30 and 365 days post-admission.
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Affiliation(s)
- K Thorne
- Swansea University Medical School, Swansea University, Singleton Park, Swansea, SA2 8PP, UK.
| | - A Johansen
- Swansea University Medical School, Swansea University, Singleton Park, Swansea, SA2 8PP, UK
- Trauma Unit, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK
| | - A Akbari
- Swansea University Medical School, Swansea University, Singleton Park, Swansea, SA2 8PP, UK
| | - J G Williams
- Swansea University Medical School, Swansea University, Singleton Park, Swansea, SA2 8PP, UK
| | - S E Roberts
- Swansea University Medical School, Swansea University, Singleton Park, Swansea, SA2 8PP, UK
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Abstract
A review of how fracture mechanics can be applied to the various fracture modes observed in composites is given. It is shown that rather conventional methods may be used for short-fibre composites but that oriented laminates undergo delamination, often parallel to the applied loads, and energy release rate methods must be used to analyse these failures. The importance of delamination toughness in determining composite behaviour is emphasized and details of the various test methods and analysis techniques are given. Finally, some discussion of the more complex failures seen in cross-ply laminates is presented.
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Affiliation(s)
- J G Williams
- Department of Mechanical Engineering, Imperial College of Science, Technology and Medicine, Exhibition Road, London
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Abstract
The process of cutting is analysed in fracture mechanics terms with a view to quantifying the various parameters involved. The model used is that of orthogonal cutting with a wedge removing a layer of material or chip. The behaviour of the chip is governed by its thickness and for large radii of curvature the chip is elastic and smooth cutting occurs. For smaller thicknesses, there is a transition, first to plastic bending and then to plastic shear for small thicknesses and smooth chips are formed. The governing parameters are tool geometry, which is principally the wedge angle, and the material properties of elastic modulus, yield stress and fracture toughness. Friction can also be important. It is demonstrated that the cutting process may be quantified via these parameters, which could be useful in the study of cutting in biology.
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Affiliation(s)
- J G Williams
- Department of Mechanical Engineering, Imperial College London, South Kensington, London SW7 2AZ, UK; Department of Aero, Mechanical and Mechatronics Engineering, University of Sydney, Sydney, Australia
| | - Y Patel
- Department of Mechanical Engineering , Imperial College London , South Kensington, London SW7 2AZ , UK
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Roberts SE, Morrison-Rees S, Samuel DG, Thorne K, Akbari A, Williams JG. Review article: the prevalence of Helicobacter pylori and the incidence of gastric cancer across Europe. Aliment Pharmacol Ther 2016; 43:334-45. [PMID: 26592801 DOI: 10.1111/apt.13474] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 03/15/2015] [Accepted: 10/22/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND There is little up-to-date review evidence on the prevalence of Helicobacter pylori across Europe. AIM To establish regional and national patterns in H. pylori prevalence across Europe. Secondly, to establish trends over time in H. pylori prevalence and gastric cancer incidence and, thirdly, to report on the relationship between H. pylori prevalence and age group across Europe. METHODS A review of H. pylori prevalence from unselected surveys of adult or general populations across 35 European countries and four European regions since 1990. Secondly, an analysis of trends over time in H. pylori prevalence and in gastric cancer incidence from cancer registry data. RESULTS Helicobacter pylori prevalence was lower in northern and western Europe than in eastern and southern Europe (P < 0.001). In 11 of 12 European studies that reported on trends, there were sharp reductions in H. pylori prevalence (mean annual reduction = 3.1%). The mean annual reduction in the incidence of gastric cancer across Europe from 1993 to 2007 was 2.1% with little variation regionally across Europe (north 2.2%, west 2.3%, east 1.9% and south 2.0%). Sharp increases in age-related prevalence of H. pylori often levelled off for middle age groups of about 50 years onwards, especially in areas with high prevalence. CONCLUSIONS This review shows that H. pylori prevalence is much higher in less affluent regions of Europe and that age-related increases in prevalence are confined to younger age groups in some areas. There were sharp reductions in both H. pylori prevalence and gastric cancer incidence throughout Europe.
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Affiliation(s)
- S E Roberts
- Medical School, Swansea University, Swansea, UK
| | | | - D G Samuel
- Medical School, Swansea University, Swansea, UK.,West Wales General Hospital, Carmarthen, UK
| | - K Thorne
- Medical School, Swansea University, Swansea, UK
| | - A Akbari
- Medical School, Swansea University, Swansea, UK
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Williams JG. Covariances for Gamma Spectrometer Efficiency Calibrations. EPJ Web of Conferences 2016. [DOI: 10.1051/epjconf/201610607004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Krauss EM, Bezuhly M, Williams JG. Selecting the best and brightest: A comparison of residency match processes in the United States and Canada. Plast Surg (Oakv) 2015; 23:225-30. [PMID: 26665135 DOI: 10.4172/plastic-surgery.1000943] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Selecting candidates for plastic surgery residency training remains a challenge. In the United States, academic measures (United States Medical Licensing Exam Step I scores, medical school class rank and publications) are used as primary criteria for candidate selection for residency. In contrast, Canadian medical education de-emphasizes academic measures by using a pass-fail grading system. As a result, choosing residents from many qualified applicants may pose a challenge for Canadian programs without objective measures of academic success. METHODS A 25-question online survey was distributed to program directors of Canadian plastic surgery residency-training programs. Program directors commented on number of yearly residents and applicants; application sections (ranked in importance using a Likert scale); interview invitation and rank-order list determination; and their satisfaction with the selection process. RESULTS Ten Canadian plastic surgery program directors responded (90.9% response rate). The most important application components determining invitation to interview were letters of reference from a plastic surgeon (mean importance of 5.0 on the Likert scale), clinical electives in plastic surgery (mean 4.6) and electives with their program (mean 4.5). Applicants invited for interview were assessed on the quality of their responses to questions, maturity and personality. The majority of program directors agreed that a clinical elective with their program was important for consideration on their rank-order list. Program directors were neutral on their satisfaction with the selection process. CONCLUSION Canadian plastic surgery residency programs emphasize clinical electives with their program and letters of reference from colleagues when selecting applicants for interviews. In contrast to their American counterparts, Canadian program directors rely on clinical interactions with prospective residents in the absence of objective academic measures.
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Affiliation(s)
- E M Krauss
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia
| | - M Bezuhly
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia
| | - J G Williams
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia
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Krauss EM, Bezuhly M, Williams JG. Selecting the best and brightest: A comparison of residency match processes in the United States and Canada. Plast Surg (Oakv) 2015. [DOI: 10.1177/229255031502300410] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
Background Selecting candidates for plastic surgery residency training remains a challenge. In the United States, academic measures (United States Medical Licensing Exam Step I scores, medical school class rank and publications) are used as primary criteria for candidate selection for residency. In contrast, Canadian medical education de-emphasizes academic measures by using a pass-fail grading system. As a result, choosing residents from many qualified applicants may pose a challenge for Canadian programs without objective measures of academic success. Methods A 25-question online survey was distributed to program directors of Canadian plastic surgery residency-training programs. Program directors commented on number of yearly residents and applicants; application sections (ranked in importance using a Likert scale); interview invitation and rank-order list determination; and their satisfaction with the selection process. Results Ten Canadian plastic surgery program directors responded (90.9% response rate). The most important application components determining invitation to interview were letters of reference from a plastic surgeon (mean importance of 5.0 on the Likert scale), clinical electives in plastic surgery (mean 4.6) and electives with their program (mean 4.5). Applicants invited for interview were assessed on the quality of their responses to questions, maturity and personality. The majority of program directors agreed that a clinical elective with their program was important for consideration on their rank-order list. Program directors were neutral on their satisfaction with the selection process. Conclusion Canadian plastic surgery residency programs emphasize clinical electives with their program and letters of reference from colleagues when selecting applicants for interviews. In contrast to their American counterparts, Canadian program directors rely on clinical interactions with prospective residents in the absence of objective academic measures.
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Affiliation(s)
- EM Krauss
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia
| | - M Bezuhly
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia
| | - JG Williams
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia
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Hutchings HA, Cheung WY, Alrubaiy L, Durai D, Russell IT, Williams JG. Development and validation of the Gastrointestinal Endoscopy Satisfaction Questionnaire (GESQ). Endoscopy 2015; 47:1137-43. [PMID: 26349066 DOI: 10.1055/s-0034-1392547] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND STUDY AIMS Patient satisfaction is a key indicator of the quality of gastrointestinal (GI) endoscopy. The aim of this study was to develop and validate a specific patient satisfaction questionnaire for patients undergoing GI endoscopy--the Gastrointestinal Endoscopy Satisfaction Questionnaire (GESQ). PATIENTS AND METHODS We developed and validated the GESQ within the context of a national multi-institution nurse endoscopy trial, based in secondary care, in three stages: (1) item generation with a panel of patients and professionals following a detailed literature review to identify the most relevant items from existing scales; (2) development and piloting of a draft questionnaire on a sample of patients referred for GI endoscopy; and (3) testing of the questionnaire within a large multicenter pragmatic randomized trial. We undertook psychometric analysis of the questionnaire to identify the underlying dimensions and assessed the questionnaire for reliability and validity. RESULTS The final version of the GESQ contains 21 items. Principal components analysis revealed four subscales with high internal consistency: skills and hospital (seven items; Cronbach's alpha 0.83), pain and discomfort during and after endoscopy (four items; Cronbach's alpha 0.84), information before endoscopy (five items; Cronbach's alpha 0.80), and information after endoscopy (five items; Cronbach's alpha 0.76). CONCLUSIONS The four identified subscales are clinically relevant and correspond to domains of patient satisfaction identified in previous studies. Our development and validation of the GESQ confirmed that it is a valid, reliable, interpretable, and acceptable tool to measure satisfaction in patients who have undergone a GI endoscopy.
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Affiliation(s)
| | | | | | - Dharmaraj Durai
- Department of Gastroenterology, University Hospital of Wales, Cardiff, UK
| | - Ian T Russell
- College of Medicine, Swansea University, Swansea, UK
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Hutchings HA, Thorne K, Jerzembek GS, Cheung WY, Cohen D, Durai D, Rapport FL, Seagrove AC, Williams JG, Russell IT. Successful development and testing of a Method for Aggregating The Reporting of Interventions in Complex Studies (MATRICS). J Clin Epidemiol 2015; 69:193-8. [PMID: 26327489 DOI: 10.1016/j.jclinepi.2015.08.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 08/14/2015] [Accepted: 08/21/2015] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To develop a tool for the accurate reporting and aggregation of findings from each of the multiple methods used in a complex evaluation in an unbiased way. STUDY DESIGN AND SETTING We developed a Method for Aggregating The Reporting of Interventions in Complex Studies (MATRICS) within a gastroenterology study [Evaluating New Innovations in (the delivery and organisation of) Gastrointestinal (GI) endoscopy services by the NHS Modernisation Agency (ENIGMA)]. We subsequently tested it on a different gastroenterology trial [Multi-Institutional Nurse Endoscopy Trial (MINuET)]. We created three layers to define the effects, methods, and findings from ENIGMA. We assigned numbers to each effect in layer 1 and letters to each method in layer 2. We used an alphanumeric code based on layers 1 and 2 to every finding in layer 3 to link the aims, methods, and findings. We illustrated analogous findings by assigning more than one alphanumeric code to a finding. We also showed that more than one effect or method could report the same finding. We presented contradictory findings by listing them in adjacent rows of the MATRICS. RESULTS MATRICS was useful for the effective synthesis and presentation of findings of the multiple methods from ENIGMA. We subsequently successfully tested it by applying it to the MINuET trial. CONCLUSION MATRICS is effective for synthesizing the findings of complex, multiple-method studies.
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Affiliation(s)
- Hayley A Hutchings
- Patient and Population Health and Informatics Research (PPHI), Swansea University Medical School, Institute of Life Sciences 2, Swansea University, Singleton Park, Swansea SA2 8PP, UK.
| | - Kymberley Thorne
- Patient and Population Health and Informatics Research (PPHI), Swansea University Medical School, Institute of Life Sciences 2, Swansea University, Singleton Park, Swansea SA2 8PP, UK
| | - Gabi S Jerzembek
- Institute of Health Service Effectiveness (IHSE), Aston University Business School, Aston Triangle, Birmingham B4 7ET, UK
| | - Wai-Yee Cheung
- Patient and Population Health and Informatics Research (PPHI), Swansea University Medical School, Institute of Life Sciences 2, Swansea University, Singleton Park, Swansea SA2 8PP, UK
| | - David Cohen
- Faculty of Health Sport and Science, University of South Wales, Treforest, Pontypridd CF37 1DL, UK
| | - Dharmaraj Durai
- Department of Medicine, University Hospital of Wales, Heath Park, Cardiff CF4 4XW, UK
| | - Frances L Rapport
- Patient and Population Health and Informatics Research (PPHI), Swansea University Medical School, Institute of Life Sciences 2, Swansea University, Singleton Park, Swansea SA2 8PP, UK
| | - Anne C Seagrove
- Patient and Population Health and Informatics Research (PPHI), Swansea University Medical School, Institute of Life Sciences 2, Swansea University, Singleton Park, Swansea SA2 8PP, UK
| | - John G Williams
- Patient and Population Health and Informatics Research (PPHI), Swansea University Medical School, Institute of Life Sciences 2, Swansea University, Singleton Park, Swansea SA2 8PP, UK
| | - Ian T Russell
- Patient and Population Health and Informatics Research (PPHI), Swansea University Medical School, Institute of Life Sciences 2, Swansea University, Singleton Park, Swansea SA2 8PP, UK
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