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Jayasooriya N, Pollok RC, Blackwell J, Bottle A, Petersen I, Creese H, Saxena S. Adherence to 5-aminosalicylic acid maintenance treatment in young people with ulcerative colitis: a retrospective cohort study in primary care. Br J Gen Pract 2023; 73:e850-e857. [PMID: 37666511 PMCID: PMC10498382 DOI: 10.3399/bjgp.2023.0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 05/16/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND Maintenance treatment with 5-aminosalicylic acid (5-ASA) is recommended in ulcerative colitis (UC), but accurate estimates of discontinuation and adherence in adolescents transitioning to young adulthood are lacking. AIM To determine rates and risk factors for discontinuation and adherence to oral 5-ASA in adolescents and young adults 1 year following diagnosis of UC. DESIGN AND SETTING Observational cohort study using the UK Clinical Practice Research Datalink among adolescents and young adults (aged 10-24 years) diagnosed with UC between 1 January 1998 and 1 May 2016. METHOD Time to oral 5-ASA discontinuation (days) and adherence rates (proportion of days covered) were calculated during the first year of treatment using Kaplan-Meier survival analysis. Cox regression models were built to estimate the impact of sociodemographic and health-related risk factors. RESULTS Among 607 adolescents and young adults starting oral 5-ASA maintenance treatment, one-quarter (n = 152) discontinued within 1 month and two- thirds (n = 419) within 1 year. Discontinuation was higher among those aged 18-24 years (74%) than younger age groups (61% and 56% in those aged 10-14 and 15-17 years, respectively). Adherence was lower among young adults than adolescents (69% in those aged 18-24 years versus 80% in those aged 10-14 years). Residents in deprived versus affluent postcodes were more likely to discontinue treatment (adjusted hazard ratio [aHR] 1.46, 95% confidence interval [CI] = 1.10 to 1.92). Early corticosteroid use for an acute flare lowered the likelihood of oral 5-ASA discontinuation (aHR 0.68, 95% CI = 0.51 to 0.90). CONCLUSION The first year of starting long-term therapies in adolescents and young adults diagnosed with UC is a critical window for active follow-up of maintenance treatment, particularly in those aged 18-24 years and those living in deprived postcodes.
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Affiliation(s)
- Nishani Jayasooriya
- Department of Gastroenterology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Richard C Pollok
- Department of Gastroenterology, St George's University Hospitals NHS Foundation Trust, London, UK
| | | | - Alex Bottle
- School of Public Health, Imperial College London, London, UK
| | - Irene Petersen
- Department of Primary Care and Population Health, University College London, London, UK; Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Hanna Creese
- School of Public Health, Imperial College London, London, UK
| | - Sonia Saxena
- School of Public Health, Imperial College London, London, UK
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2
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Blackwell J, Oluniran G, Tuohy B, Destrade M, Kraśny MJ, Colgan N. Corrigendum to "Experimental assessment of clinical MRI-induced global SAR distributions in head phantoms" [Phys. Med. 66 (2019) 113-118]. Phys Med 2023; 112:102598. [PMID: 37127499 DOI: 10.1016/j.ejmp.2023.102598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/03/2023] Open
Affiliation(s)
- J Blackwell
- School of Physics, National University of Ireland Galway, Galway, Ireland; School of Mathematics, Statistics and Applied Mathematics, National University of Ireland Galway, Galway, Ireland.
| | - G Oluniran
- School of Physics, National University of Ireland Galway, Galway, Ireland
| | - B Tuohy
- Medical Physics and Bioengineering, Galway University Hospital, Galway, Ireland
| | - M Destrade
- School of Mathematics, Statistics and Applied Mathematics, National University of Ireland Galway, Galway, Ireland
| | - M J Kraśny
- School of Physics, National University of Ireland Galway, Galway, Ireland
| | - N Colgan
- School of Physics, National University of Ireland Galway, Galway, Ireland
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3
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Pollok RC, Jayasooriya N, Baillie S, Blackwell J, Petersen I, Bottle A, Saxena S. Letter: delays to diagnosis of IBD-Challenges requiring a systematic approach. Authors' reply. Aliment Pharmacol Ther 2023; 57:1479. [PMID: 37243462 DOI: 10.1111/apt.17548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 04/28/2023] [Indexed: 05/28/2023]
Affiliation(s)
- Richard C Pollok
- Department of Gastroenterology, St George's Healthcare NHS Trust, St George's University, London, UK
- Institute of Infection and Immunity, St George's University, London, UK
- School of Public Health, Imperial College London, London, UK
| | - Nishani Jayasooriya
- Department of Gastroenterology, St George's Healthcare NHS Trust, St George's University, London, UK
- Institute of Infection and Immunity, St George's University, London, UK
- School of Public Health, Imperial College London, London, UK
| | - Samantha Baillie
- Department of Gastroenterology, St George's Healthcare NHS Trust, St George's University, London, UK
- Institute of Infection and Immunity, St George's University, London, UK
- School of Public Health, Imperial College London, London, UK
| | - Jonathan Blackwell
- Department of Gastroenterology, St George's Healthcare NHS Trust, St George's University, London, UK
- Institute of Infection and Immunity, St George's University, London, UK
- School of Public Health, Imperial College London, London, UK
| | - Irene Petersen
- Department of Primary Care and Population Health, University College London, London, UK
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Alex Bottle
- School of Public Health, Imperial College London, London, UK
| | - Sonia Saxena
- School of Public Health, Imperial College London, London, UK
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4
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Sethi S, Kumar A, Dias S, Blackwell J, Brookes MJ, Segal JP. Editorial: proactive anti-TNF drug monitoring in IBD-Ready for the prime time? Authors' reply. Aliment Pharmacol Ther 2023; 57:1455-1456. [PMID: 37243471 DOI: 10.1111/apt.17339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Sonika Sethi
- Department of Gastroenterology, Sandwell and West Birmingham NHS Trust, Birmingham, West Midlands, UK
| | - Aditi Kumar
- Department of Gastroenterology, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Shiluka Dias
- Department of Gastroenterology, Guys and St Thomas' NHS Trust, London, UK
| | - Jonathan Blackwell
- Department of Gastroenterology, Croydon Healthcare NHS Trust, London, UK
| | - Matthew J Brookes
- Department of Gastroenterology, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
- Research Institute in Healthcare Sciences, University of Wolverhampton, Wolverhampton, UK
| | - Jonathan P Segal
- Department of Gastroenterology, University of Melbourne, Melbourne, Australia
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Rodríguez-Lago I, Blackwell J, Mateos B, Marigorta UM, Barreiro-de Acosta M, Pollok R. Recent Advances and Potential Multi-Omics Approaches in the Early Phases of Inflammatory Bowel Disease. J Clin Med 2023; 12:jcm12103418. [PMID: 37240524 DOI: 10.3390/jcm12103418] [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: 03/20/2023] [Revised: 05/01/2023] [Accepted: 05/09/2023] [Indexed: 05/28/2023] Open
Abstract
Inflammatory bowel disease leads to debilitating gastrointestinal symptoms and reduced quality of life, resulting in a significant burden on healthcare utilization and costs. Despite substantial advancements in diagnosis and treatment, there may still be considerable delays in diagnosing some patients. To reduce disease progression before the full disease spectrum appears and improve prognostic outcomes, several strategies have concentrated on early intervention and prevention. Recent evidence shows that initial immune response changes and endoscopic lesions may exist for years before diagnosis, implying the existence of a preclinical phase of inflammatory bowel disease comparable to findings in other immune-mediated disorders. In this review, we highlight the most relevant findings regarding preclinical inflammatory bowel disease and the prospective role of novel omics techniques in this field.
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Affiliation(s)
- Iago Rodríguez-Lago
- Gastroenterology Department, Hospital Universitario de Galdakao, 48960 Galdakao, Spain
- Biocruces Bizkaia Health Research Institute, 48960 Galdakao, Spain
- Deusto University, 48007 Bilbao, Spain
| | | | - Beatriz Mateos
- Integrative Genomics Lab, Center for Cooperative Research in Biosciences (CIC bioGUNE), Basque Research and Technology Alliance (BRTA), Bizkaia Technology Park, 48160 Derio, Spain
| | - Urko M Marigorta
- Integrative Genomics Lab, Center for Cooperative Research in Biosciences (CIC bioGUNE), Basque Research and Technology Alliance (BRTA), Bizkaia Technology Park, 48160 Derio, Spain
- IKERBASQUE, Basque Foundation for Sciences, 48009 Bilbao, Spain
| | - Manuel Barreiro-de Acosta
- Gastroenterology Department, Hospital Clínico Universitario de Santiago, 15706 Santiago de Compostela, Spain
| | - Richard Pollok
- Gastroenterology Department, St George's University of London, London SW17 0RE, UK
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Pollok RC, Baillie S, Jayasooriya N, Blackwell J, Petersen I, Bottle A, Saxena S. Letter: diagnostic delay in inflammatory bowel disease-Authors' reply. Aliment Pharmacol Ther 2023; 57:1205-1206. [PMID: 37094317 DOI: 10.1111/apt.17493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 03/17/2023] [Indexed: 04/26/2023]
Affiliation(s)
- Richard C Pollok
- Department of Gastroenterology, St George's Healthcare NHS Trust, St George's University, London, UK
- Institute of Infection and Immunity, St George's University, London, UK
- School of Public Health, Imperial College London, London, UK
| | - Samantha Baillie
- Department of Gastroenterology, St George's Healthcare NHS Trust, St George's University, London, UK
- Institute of Infection and Immunity, St George's University, London, UK
- School of Public Health, Imperial College London, London, UK
| | - Nishani Jayasooriya
- Department of Gastroenterology, St George's Healthcare NHS Trust, St George's University, London, UK
- Institute of Infection and Immunity, St George's University, London, UK
- School of Public Health, Imperial College London, London, UK
| | - Jonathan Blackwell
- Department of Gastroenterology, St George's Healthcare NHS Trust, St George's University, London, UK
- Institute of Infection and Immunity, St George's University, London, UK
- School of Public Health, Imperial College London, London, UK
| | - Irene Petersen
- Department of Primary Care and Population Health, University College London, London, UK
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Alex Bottle
- School of Public Health, Imperial College London, London, UK
| | - Sonia Saxena
- School of Public Health, Imperial College London, London, UK
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7
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Destrade M, Du Y, Blackwell J, Colgan N, Balbi V. Canceling the elastic Poynting effect with geometry. Phys Rev E 2023; 107:L053001. [PMID: 37329069 DOI: 10.1103/physreve.107.l053001] [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: 02/15/2023] [Accepted: 05/04/2023] [Indexed: 06/18/2023]
Abstract
The Poynting effect is a paragon of nonlinear soft matter mechanics. It is the tendency (found in all incompressible, isotropic, hyperelastic solids) exhibited by a soft block to expand vertically when sheared horizontally. It can be observed whenever the length of the cuboid is at least four times its thickness. Here we show that the Poynting effect can be easily reversed and the cuboid can shrink vertically, simply by reducing this aspect ratio. In principle, this discovery means that for a given solid, say one used as a seismic wave absorber under a building, an optimal ratio exists where vertical displacements and vibrations can be completely eliminated. Here we first recall the classical theoretical treatment of the positive Poynting effect, and then show experimentally how it can be reversed. Using finite-element simulations, we then investigate how the effect can be suppressed. We find that cubes always provide a reverse Poynting effect, irrespective of their material properties (in the third-order theory of weakly nonlinear elasticity).
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Affiliation(s)
- M Destrade
- School of Mathematical and Statistical Sciences, University of Galway, Galway H91 TK33, Ireland
| | - Y Du
- Department of Mathematics and Statistics, University of Glasgow, Glasgow G12 8QQ, Scotland
| | - J Blackwell
- School of Mathematical and Statistical Sciences, University of Galway, Galway H91 TK33, Ireland
| | - N Colgan
- School of Mathematical and Statistical Sciences, University of Galway, Galway H91 TK33, Ireland
| | - V Balbi
- School of Mathematical and Statistical Sciences, University of Galway, Galway H91 TK33, Ireland
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8
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Jayasooriya N, Baillie S, Blackwell J, Bottle A, Petersen I, Creese H, Saxena S, Pollok RC. Systematic review with meta-analysis: Time to diagnosis and the impact of delayed diagnosis on clinical outcomes in inflammatory bowel disease. Aliment Pharmacol Ther 2023; 57:635-652. [PMID: 36627691 DOI: 10.1111/apt.17370] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/29/2022] [Accepted: 12/10/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND The impact of diagnostic delay on the clinical course of inflammatory bowel disease (IBD) remains uncertain. AIM To perform a systematic review of time to diagnosis and the impact of delayed diagnosis on clinical outcomes in Crohn's disease (CD) and ulcerative colitis (UC). METHODS We searched EMBASE and Medline from inception to 30th November 2022 for studies reporting diagnostic interval, from symptom onset to IBD diagnosis. We calculated the median, interquartile range (IQR) and pooled weighted median, of median diagnostic intervals of eligible studies. We defined delayed diagnosis as individuals above the 75th centile of longest time to diagnosis in each study. Using random effects meta-analysis, we pooled odds ratios (ORs) with 95% confidence intervals (CI) for studies reporting clinical outcomes, according to delayed diagnosis. RESULTS One hundred and one studies representing 112,194 patients with IBD (CD = 59,359; UC = 52,835) met inclusion criteria. The median of median times to diagnosis was 8.0 (IQR: 5.0-15.2) and 3.7 months (IQR: 2.0-6.7) in CD and UC, respectively. In high-income countries, this was 6.2 (IQR: 5.0-12.3) and 3.2 months (IQR: 2.2-5.3), compared with 11.7 (IQR: 8.3-18.0) and 7.8 months (IQR: 5.2-21.8) in low-middle-income, countries, for CD and UC respectively. The pooled weighted median was 7.0 (95% CI: 3.0-26.4) and 4.6 (95% CI: 1.0-96.0) months, for CD and UC respectively. Eleven studies, representing 6164 patients (CD = 4858; UC = 1306), were included in the meta-analysis that examined the impact of diagnostic delay on clinical outcomes. In CD, delayed diagnosis was associated with higher odds of stricturing (OR = 1.88; CI: 1.35-2.62), penetrating disease (OR = 1.64; CI: 1.21-2.20) and intestinal surgery (OR = 2.24; CI: 1.57-3.19). In UC, delayed diagnosis was associated with higher odds of colectomy (OR = 4.13; CI: 1.04-16.40). CONCLUSION Delayed diagnosis is associated with disease progression in CD, and intestinal surgery in both CD and UC. Strategies are needed to achieve earlier diagnosis of IBD.
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Affiliation(s)
- Nishani Jayasooriya
- Department of Gastroenterology, St George's Healthcare NHS Trust, St George's University, London, UK
- Institute of Infection and Immunity, St George's University, London, UK
- School of Public Health, Imperial College London, London, UK
| | - Samantha Baillie
- Department of Gastroenterology, St George's Healthcare NHS Trust, St George's University, London, UK
- Institute of Infection and Immunity, St George's University, London, UK
- School of Public Health, Imperial College London, London, UK
| | - Jonathan Blackwell
- Department of Gastroenterology, St George's Healthcare NHS Trust, St George's University, London, UK
- Institute of Infection and Immunity, St George's University, London, UK
- School of Public Health, Imperial College London, London, UK
| | - Alex Bottle
- School of Public Health, Imperial College London, London, UK
| | - Irene Petersen
- Department of Primary Care and Population Health, University College London, London, UK
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Hanna Creese
- School of Public Health, Imperial College London, London, UK
| | - Sonia Saxena
- School of Public Health, Imperial College London, London, UK
| | - Richard C Pollok
- Department of Gastroenterology, St George's Healthcare NHS Trust, St George's University, London, UK
- Institute of Infection and Immunity, St George's University, London, UK
- School of Public Health, Imperial College London, London, UK
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9
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Sethi S, Dias S, Kumar A, Blackwell J, Brookes MJ, Segal JP. Meta-analysis: The efficacy of therapeutic drug monitoring of anti-TNF-therapy in inflammatory bowel disease. Aliment Pharmacol Ther 2022; 57:1362-1374. [PMID: 36495020 DOI: 10.1111/apt.17313] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/21/2022] [Accepted: 11/07/2022] [Indexed: 04/20/2023]
Abstract
BACKGROUND AND AIMS This systematic review and meta-analysis aimed to determine whether the use of therapeutic drug monitoring (TDM) in inflammatory bowel disease (IBD) patients on anti-tumour necrosis factor (anti-TNF) therapy results in improved rates of clinical and endoscopic remission, surgery, corticosteroid-free remission and hospitalisation. METHODS MEDLINE, EMBASE, EMBASE classic, PubMed, Cochrane central databases register of controlled trials and Cochrane Specialised Trials Register were searched between 01 Janurary 1946 and 08 April 2022. Randomised controlled trials (RCTs) and prospective and retrospective observational studies were included, comparing TDM to standard of care (SOC) or reactive vs proactive TDM. Results were reported as pooled relative risks (RR) with 95% confidence intervals (95% CI). RESULTS Twenty-six studies, including 9 RCTs, were included. Compared to SOC, proactive TDM was associated with a significantly decreased risk of treatment failure (RR 0.64, 95% CI 0.48-0.85 p<0.01), and a non-significant decrease in need for surgery (RR 0.51, 95% CI 0.25-1.02) and hospitalisation (RR 0.64, 95% CI 0.40-1.00). Furthermore compared to SOC, Proactive TDM was associated with higher rates of endoscopic remission (RR 1.19, 95% CI 0.93-1.53) and clinical remission (RR 1.07, 95% CI 0.97-1.18). Compared to reactive TDM, proactive TDM was associated with significant decreased risk of treatment failure (RR 0.46, 95% CI 0.21 = 0.98, p = 0.04) and significant reduction in hospitalisation (RR 0.33, 95% CI 0.21-0.54, p < 0.01). CONCLUSIONS Compared to SOC, proactive TDM was associated with significant benefit in reducing treatment failure. Compared to reactive TDM, proactive TDM led to a significant reduction in hospitalisation and treatment failure. More studies with larger RCTs and standardised assays are needed to substantiate these results and validate the cost-effectiveness of TDM.
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Affiliation(s)
- Sonika Sethi
- Department of Gastroenterology, Sandwell and West Birmingham NHS Trust, West Midlands, West Bromwich, UK
| | - Shiluka Dias
- Department of Gastroenterology, Guys and St Thomas' NHS Trust, London, UK
| | - Aditi Kumar
- Department of Gastroenterology, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Jonathan Blackwell
- Department of Gastroenterology, Croydon Healthcare NHS Trust, London, UK
| | - Matthew J Brookes
- Department of Gastroenterology, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
- Research Institute in Healthcare Sciences, University of Wolverhampton, Wolverhampton, UK
| | - Jonathan P Segal
- Department of Medicine, University of Melbourne, Melbourne, Australia
- Department of Gastroenterology, Northern Hospital, Epping, Melbourne, Australia
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Hawthorne AB, Glatter J, Blackwell J, Ainley R, Arnott I, Barrett KJ, Bell G, Brookes MJ, Fletcher M, Muhammed R, Nevill AM, Segal J, Selinger CP, St. Clair Jones A, Younge L, Lamb CA, Arnott I, Barrett K, Bell G, Bhatnagar G, Blackwell J, Bloom S, Bramwell C, Brookes MJ, Burman A, Cairnes V, Crook KP, Dobson E, Epstein J, Faiz O, Feakins RM, Fletcher M, Garrick V, Keetarut K, Hawthorne AB, Lamb CA, Lee M, Meade U, Muhammed R, Murdock A, Pitney‐Hall N, Rochford A, Rowse G, Sagar P, Segal J, Selinger CP, Sleet S, St. Clair Jones A, Taylor SA, Wakeman R, Weaver S, Younge L. Inflammatory bowel disease patient-reported quality assessment should drive service improvement: a national survey of UK IBD units and patients. Aliment Pharmacol Ther 2022; 56:625-645. [PMID: 35770866 PMCID: PMC9541797 DOI: 10.1111/apt.17042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 04/06/2022] [Accepted: 05/09/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND Healthcare service provision in inflammatory bowel disease (IBD) is often designed to meet targets set by healthcare providers rather than those of patients. It is unclear whether this meets the needs of patients, as assessed by patients themselves. AIMS To assess patients' experience of IBD and the healthcare they received, aiming to identify factors in IBD healthcare provision associated with perceived high-quality care. METHODS Using the 2019 IBD standards as a framework, a national benchmarking tool for quality assessment in IBD was developed by IBD UK, comprising a patient survey and service self-assessment. RESULTS 134 IBD services and 9757 patients responded. Perceived quality of care was lowest in young adults and increased with age, was higher in males and those >2 years since diagnosis. No hospital services met all the national IBD standards for recommended workforce numbers. Key metrics associated with patient-reported high- quality care were: identification as a tertiary centre, patient information availability, shared decision- making, rapid response to contact for advice, access to urgent review, joint medical/surgical clinics, and access to research (all p < 0.001). Higher numbers of IBD nurse specialists in a service was strongly associated with patients receiving regular reviews and having confidence in self-management and reporting high- quality care. CONCLUSIONS This extensive patient and healthcare provider survey emphasises the importance of aspects of care less often measured by clinicians, such as communication, shared decision- making and provision of information. It demonstrates that IBD nurse specialists are crucial to meeting the needs of people living with IBD.
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Affiliation(s)
- A. Barney Hawthorne
- Department of GastroenterologyCardiff & Vale University Health BoardCardiffUK,Cardiff UniversityCardiffUK
| | | | | | | | - Ian Arnott
- Edinburgh IBD UnitWestern General HospitalEdinburghUK
| | | | | | - Matthew J. Brookes
- Department of GastroenterologyRoyal Wolverhampton NHS TrustWolverhamptonUK,Research Institute in Healthcare ScienceUniversity of WolverhamptonWolverhamptonUK
| | | | - Rafeeq Muhammed
- Department of Paediatric GastroenterologyBirmingham Children's HospitalBirminghamUK
| | - Alan M. Nevill
- Faculty of Health Education and WellbeingUniversity of WolverhamptonWolverhamptonUK
| | - Jonathan Segal
- Department of GastroenterologyImperial College Healthcare NHS TrustLondonUK
| | - Christian P. Selinger
- Department of GastroenterologyLeeds Teaching Hospitals NHS TrustLeedsUK,University of LeedsLeedsUK
| | - Anja St. Clair Jones
- Department of PharmacyBrighton & Sussex University Hospitals NHS TrustBrightonUK
| | - Lisa Younge
- Department of GastroenterologySt Marks HospitalHarrowUK
| | | | - Christopher A. Lamb
- Translational & Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUK,Department of GastroenterologyNewcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
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11
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Jayasooriya N, Blackwell J, Saxena S, Bottle A, Petersen I, Creese H, Hotopf M, Pollok RCG. Antidepressant medication use in Inflammatory Bowel Disease: a nationally representative population-based study. Aliment Pharmacol Ther 2022; 55:1330-1341. [PMID: 35244961 PMCID: PMC9311162 DOI: 10.1111/apt.16820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/23/2021] [Accepted: 02/01/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND Despite high rates of depression and anxiety, little is known about the use of antidepressants amongst individuals diagnosed with inflammatory bowel disease (IBD). AIMS To evaluate temporal trends in the use of antidepressants; rates of antidepressant initiation and adherence of antidepressant use to international guidelines amongst individuals with IBD. METHODS This is a study of 14,525 incident IBD cases from 2004 to 2016 compared with 58,027 controls matched 1:4 for age and sex from the Clinical Practice Research Datalink. After excluding tricyclic antidepressants, we performed a Cox regression analysis to determine the risk associated with antidepressant use and logistic regression analysis to determine risk associated with antidepressant undertreatment. RESULTS Antidepressant use amongst individuals with IBD increased by 51% during the 12-year study period, who were 34% more likely to initiate antidepressants in the year after IBD diagnosis compared with controls (aHR:1.34, 95% CI 1.21-1.49). In those with IBD starting antidepressants, 67% received treatment lasting less than the duration recommended in international guidelines, of which 34% were treated for 1 month or less. 18-24 year olds were twice as likely to discontinue treatment within 1 month compared with those aged 40-60 years (aHR:2.03, 95% CI 1.40-2.95). Socioeconomic deprivation was also associated with early treatment discontinuation (aHR:1.40, 95% CI 1.07-1.83). CONCLUSIONS In the year following IBD diagnosis individuals are significantly more likely to start antidepressants compared with controls, but treatment duration fell short of recommendations in the majority. Better integration of services may benefit individuals with IBD and psychiatric comorbidity.
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Affiliation(s)
- Nishani Jayasooriya
- Department of Gastroenterology, St George’s Healthcare NHS TrustSt George’s UniversityLondonUK
- Institute for Infection and ImmunitySt George’s UniversityLondonUK
- School of Public HealthImperial College LondonLondonUK
| | - Jonathan Blackwell
- Department of Gastroenterology, St George’s Healthcare NHS TrustSt George’s UniversityLondonUK
- Institute for Infection and ImmunitySt George’s UniversityLondonUK
- School of Public HealthImperial College LondonLondonUK
| | - Sonia Saxena
- School of Public HealthImperial College LondonLondonUK
| | - Alex Bottle
- School of Public HealthImperial College LondonLondonUK
| | - Irene Petersen
- Department of Primary Care and Population HealthUniversity College LondonLondonUK
- Department of Clinical EpidemiologyAarhus UniversityDenmark
| | - Hanna Creese
- School of Public HealthImperial College LondonLondonUK
| | - Matthew Hotopf
- Institute of Psychiatry Psychology & NeuroscienceKing’s College LondonLondonUK
- South London and Maudsley NHS Foundation TrustLondonUK
| | - Richard C. G. Pollok
- Department of Gastroenterology, St George’s Healthcare NHS TrustSt George’s UniversityLondonUK
- Institute for Infection and ImmunitySt George’s UniversityLondonUK
- School of Public HealthImperial College LondonLondonUK
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12
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Blackwell J, Saxena S, Petersen I, Hotopf M, Creese H, Bottle A, Alexakis C, Pollok RC. Depression in individuals who subsequently develop inflammatory bowel disease: a population-based nested case-control study. Gut 2021; 70:1642-1648. [PMID: 33109601 DOI: 10.1136/gutjnl-2020-322308] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 10/01/2020] [Accepted: 10/04/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Depression is a potential risk factor for developing IBD. This association may be related to GI symptoms occurring before diagnosis. We aimed to determine whether depression, adjusted for pre-existing GI symptoms, is associated with subsequent IBD. DESIGN We conducted a nested case-control study using the Clinical Practice Research Datalink identifying incident cases of UC and Crohn's disease (CD) from 1998 to 2016. Controls without IBD were matched for age and sex. We measured exposure to prevalent depression 4.5-5.5 years before IBD diagnosis. We created two sub-groups with prevalent depression based on whether individuals had reported GI symptoms before the onset of depression. We used conditional logistic regression to derive ORs for the risk of IBD depending on depression status. RESULTS We identified 10 829 UC cases, 4531 CD cases and 15 360 controls. There was an excess of prevalent depression 5 years before IBD diagnosis relative to controls (UC: 3.7% vs 2.7%, CD 3.7% vs 2.9%). Individuals with GI symptoms prior to the diagnosis of depression had increased adjusted risks of developing UC and CD compared with those without depression (UC: OR 1.47, 95% CI 1.21 to 1.79; CD: OR 1.41, 95% CI 1.04 to 1.92). Individuals with depression alone had similar risks of UC and CD to those without depression (UC: OR 1.13, 95% CI 0.99 to 1.29; CD: OR 1.12, 95% CI 0.91 to 1.38). CONCLUSIONS Depression, in the absence of prior GI symptoms, is not associated with subsequent development of IBD. However, depression with GI symptoms should prompt investigation for IBD.
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Affiliation(s)
| | - Sonia Saxena
- School of Primary Care and Public Health, Imperial College, London, UK
| | - Irene Petersen
- Department of Primary Care and Population Health, University College London, London, UK.,Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Matthew Hotopf
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Hanna Creese
- School of Primary Care and Public Health, Imperial College, London, UK
| | - Alex Bottle
- School of Primary Care and Public Health, Imperial College, London, UK.,Dr Foster Unit, School of Primary Care and Public Health, Imperial College, London, UK
| | - Christopher Alexakis
- Gastroenterology, Royal Surrey County Hospital NHS Foundation Trust, Guildford, Surrey, UK
| | - Richard C Pollok
- Gastroenterology, St George's University of London, London, UK .,Institute of Infection and Immunity, University of London St George's, London, UK
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13
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Blackwell J, Alexakis C, Saxena S, Creese H, Bottle A, Petersen I, Hotopf M, Pollok RCG. Association between antidepressant medication use and steroid dependency in patients with ulcerative colitis: a population-based study. BMJ Open Gastroenterol 2021; 8:bmjgast-2020-000588. [PMID: 34045238 PMCID: PMC8162076 DOI: 10.1136/bmjgast-2020-000588] [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] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/22/2021] [Accepted: 02/24/2021] [Indexed: 12/17/2022] Open
Abstract
Background Animal studies indicate a potential protective role of antidepressant medication (ADM) in models of colitis but the effect of their use in humans with ulcerative colitis (UC) remains unclear. Objective To study the relationship between ADM use and corticosteroid dependency in UC. Design Using the Clinical Practice Research Datalink we identified patients diagnosed with UC between 2005 and 2016. We grouped patients according to serotonin selective reuptake inhibitor (SSRI) and tricyclic antidepressant (TCA) exposure in the 3 years following diagnosis: ‘continuous users’, ‘intermittent users’ and ‘non-users’. We used logistic regression to estimate the adjusted risk of corticosteroid dependency between ADM exposure groups. Results We identified 6373 patients with UC. Five thousand two hundred and thirty (82%) use no ADMs, 627 (10%) were intermittent SSRI users and 282 (4%) were continuous SSRI users, 246 (4%) were intermittent TCA users and 63 (1%) were continuous TCA users. Corticosteroid dependency was more frequent in continuous SSRI and TCA users compared with non-users (19% vs 24% vs 14%, respectively, χ2 p=0.002). Intermittent SSRI and TCA users had similar risks of developing corticosteroid dependency to non-users (SSRI: OR 1.19, 95% CI 0.95 to 1.50, TCA: OR 1.14, 95% CI 0.78 to 1.66). Continuous users of both SSRIs and TCAs had significantly higher risks of corticosteroid dependency compared with non-users (SSRI: OR 1.62, 95% CI 1.15 to 2.27, TCA: OR 2.02, 95% CI 1.07 to 3.81). Conclusions Continuous ADM exposure has no protective effect in routine clinical practice in UC and identifies a population of patients requiring more intensive medical therapy. ADM use is a flag for potentially worse clinical outcomes in UC.
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Affiliation(s)
- Jonathan Blackwell
- Imperial College London Department of Primary Care and Public Health, London, UK .,Department Gastroenterology, St George's University Hospitals NHS Foundation Trust, London, UK.,The POP-IBD study group, London, UK
| | - Christopher Alexakis
- The POP-IBD study group, London, UK.,Gastroenterology, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - Sonia Saxena
- Imperial College London Department of Primary Care and Public Health, London, UK.,The POP-IBD study group, London, UK
| | - Hanna Creese
- Imperial College London Department of Primary Care and Public Health, London, UK.,The POP-IBD study group, London, UK
| | - Alex Bottle
- The POP-IBD study group, London, UK.,Primary Care and Public Health, Imperial College, London, UK.,Dr Foster Unit, School of Public Health, Faculty of Medicine, Imperial College, London, UK
| | - Irene Petersen
- The POP-IBD study group, London, UK.,Department of Primary Care & Population Health, University College London, London, UK
| | - Matthew Hotopf
- The POP-IBD study group, London, UK.,Division of Academic Psychiatry, Institute of Psychiatry Psychology and Neuroscience, London, UK.,South London and Maudsley Mental Health NHS Trust, London, London, UK
| | - Richard C G Pollok
- Department Gastroenterology, St George's University Hospitals NHS Foundation Trust, London, UK.,The POP-IBD study group, London, UK.,Institute for Infection and Immunity, St George's University of London, London, UK
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Tavabie O, Clough J, Blackwell J, Bashyam M, Martin H, Soubieres A, Direkze N, Graham D, Groves C, Preston S, DeMartino S, Gill U, Hayee B, Joshi D. IDDF2020-ABS-0163 Reduced survival post-endoscopy for upper gastrointestinal bleeding in the COVID-19 era is a secondary effect of the response to the global pandemic. Abstracts 2020. [DOI: 10.1136/gutjnl-2020-iddf.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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15
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Tavabie OD, Clough JN, Blackwell J, Bashyam M, Martin H, Soubieres A, Direkze N, Graham D, Groves C, Preston SL, DeMartino S, Gill US, Hayee B, Joshi D. Reduced survival after upper gastrointestinal bleed endoscopy in the COVID-19 era is a secondary effect of the response to the global pandemic: a retrospective cohort study. Frontline Gastroenterol 2020; 12:279-287. [PMID: 34249312 PMCID: PMC8231434 DOI: 10.1136/flgastro-2020-101592] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 08/19/2020] [Accepted: 09/08/2020] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE The COVID-19 pandemic has placed increased strain on healthcare systems worldwide with enormous reorganisation undertaken to support 'COVID-centric' services. Non-COVID-19 admissions reduced secondary to public health measures to halt viral transmission. We aimed to understand the impact of the response to COVID-19 on the outcomes of upper gastrointestinal (UGI) bleeds. DESIGN/METHODS A retrospective observational multicentre study comparing outcomes following endoscopy for UGI bleeds from 24 March 2020 to 20 April 2020 to the corresponding dates in 2019. The primary outcome was in-hospital survival at 30 days with secondary outcomes of major rebleeding within 30 days postprocedure and intervention at the time of endoscopy. RESULTS 224 endoscopies for 203 patients with UGI bleeds were included within this study. 19 patients were diagnosed with COVID-19. There was a 44.4% reduction in the number of procedures performed between 2019 and 2020. Endoscopies performed for UGI bleeds in the COVID-19 era were associated with an adjusted reduced 30-day survival (OR 0.25, 95% CI 0.08-0.67). There was no increased risk of major rebleeding or interventions during this era. Patients with COVID-19 did not have reduced survival or increased complication rates. CONCLUSION Endoscopy for UGI bleeds in the COVID-19 era is associated with reduced survival. No clear cause has been identified but we suspect that this is a secondary effect of the response to the COVID-19 pandemic. Urgent work is required to encourage the public to seek medical help if required and to optimise patient pathways to ensure that the best possible care is provided.
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Affiliation(s)
- Oliver D Tavabie
- Institute of Liver Studies, King’s College Hospital NHS Foundation Trust, London, UK
| | - Jennie N Clough
- Department of Gastroenterology, Guy’s and Saint Thomas’ NHS Foundation Trust, London, UK
| | - Jonathan Blackwell
- Department of Gastroenterology, St George’s Hospitals NHS Foundation Trust, London, UK
| | - Maria Bashyam
- The Liver Unit, St Mary’s Hospital, Imperial College Healthcare NHS Trust, London, London, UK
| | - Harry Martin
- Pancreaticobiliary Medicine Unit, UCLH, London, London, UK
| | - Anet Soubieres
- Department of Gastroenterology, Imperial College Healthcare NHS Trust, London, London, UK
| | - Natalie Direkze
- Department of Gastroenterology, Imperial College Healthcare NHS Trust, London, London, UK
| | - David Graham
- Department of Gastroenterology, UCLH, London, London, UK
| | - Christopher Groves
- Department of Gastroenterology, St George’s Hospitals NHS Foundation Trust, London, UK
| | - Sean L Preston
- Department of Gastroenterology, Royal London Hospital, London, London, UK
| | - Sabina DeMartino
- Department of Gastroenterology, Guy’s and Saint Thomas’ NHS Foundation Trust, London, UK
| | - Upkar S Gill
- Department of Gastroenterology, Royal London Hospital, London, London, UK,Barts Liver Centre, Immunobiology, Barts and the London School of Medicine and Dentistry, QMUL, London, London, UK
| | - Bu'Hussain Hayee
- Department of Gastroenterology, King’s College Hospital, London, UK
| | - Deepak Joshi
- Institute of Liver Studies, King’s College Hospital NHS Foundation Trust, London, UK
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16
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Blackwell J, Saxena S, Jayasooriya N, Bottle A, Petersen I, Hotopf M, Alexakis C, Pollok RC. Prevalence and duration of gastrointestinal symptoms before diagnosis of Inflammatory Bowel Disease and predictors of timely specialist review: a population-based study. J Crohns Colitis 2020; 15:jjaa146. [PMID: 32667962 DOI: 10.1093/ecco-jcc/jjaa146] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Lack of timely referral and significant waits for specialist review amongst individuals with unresolved gastrointestinal (GI) symptoms can result in delayed diagnosis of Inflammatory Bowel Disease (IBD). AIMS To determine the frequency and duration of GI symptoms and predictors of timely specialist review before the diagnosis of both Crohn's Disease (CD) and ulcerative colitis (UC). METHODS Case-control study of IBD matched 1:4 for age and sex to controls without IBD using the Clinical Practice Research Datalink from 1998-2016. RESULTS We identified 19,555 cases of IBD, and 78,114 controls. 1 in 4 cases of IBD reported gastrointestinal symptoms to their primary care physician more than 6 months before receiving a diagnosis. There is a significant excess prevalence of GI symptoms in each of the 10 years before IBD diagnosis. GI symptoms were reported by 9.6% and 10.4% at 5 years before CD and UC diagnosis respectively compared to 5.8% of controls. Amongst patients later diagnosed with IBD, <50% received specialist review within 18 months from presenting with chronic GI symptoms. Patients with a previous diagnosis of irritable bowel syndrome or depression were less likely to receive timely specialist review (IBS: HR=0.77, 95%CI 0.60-0.99, depression: HR=0.77, 95%CI 0.60-0.98). CONCLUSIONS There is an excess of GI symptoms 5 years before diagnosis of IBD compared to the background population which are likely attributable to undiagnosed disease. Previous diagnoses of IBS and depression are associated with delays in specialist review. Enhanced pathways are needed to accelerate specialist referral and timely IBD diagnosis.
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Affiliation(s)
- J Blackwell
- Dept. Gastroenterology, St George's Healthcare NHS Trust, St George's University London, UK
| | - S Saxena
- School of Public Health, Imperial College London, London, UK
| | - N Jayasooriya
- Dept. Gastroenterology, St George's Healthcare NHS Trust, St George's University London, UK
| | - A Bottle
- School of Public Health, Imperial College London, London, UK
| | - I Petersen
- Dept. Primary Care and Population Health, University College London, London, UK
- Dept. Clinical Epidemiology, Aarhus University, Denmark
| | - M Hotopf
- Institute of Psychiatry, Kings College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - C Alexakis
- Dept. Gastroenterology, St George's Healthcare NHS Trust, St George's University London, UK
| | - R C Pollok
- Dept. Gastroenterology, St George's Healthcare NHS Trust, St George's University London, UK
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17
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Blackwell J, Selinger C, Raine T, Parkes G, Smith MA, Pollok R. Steroid use and misuse: a key performance indicator in the management of IBD. Frontline Gastroenterol 2020; 12:207-213. [PMID: 33907617 PMCID: PMC8040510 DOI: 10.1136/flgastro-2019-101288] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 03/06/2020] [Accepted: 03/18/2020] [Indexed: 02/04/2023] Open
Abstract
Corticosteroids remain an important tool for inducing remission in inflammatory bowel disease (IBD) but they have no role in maintenance of remission. The significant adverse side effect profile of these drugs means their use should be avoided where possible or measures taken to reduce their risk. Despite an expanding array of alternative therapies, corticosteroid dependency and excess remain common. Appropriate steroid use is now regarded a key performance indicator in the management of IBD. This article aims to outline indications for corticosteroid use in IBD, their risks and strategies to reduce their use and misuse.
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Affiliation(s)
- Jonathan Blackwell
- Department of Gastroenterology, St George's Hospitals NHS Foundation Trust, London, UK,School of Public Health, Imperial College London, London, UK
| | - Christian Selinger
- Leeds Gastroenterology Institute, Leeds Teaching Hospitals NHS Trust, Leeds, UK,The Leeds Institute of Research at St James’, University of Leeds, Leeds, UK
| | - Tim Raine
- Department of Gastroenterology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Gareth Parkes
- Department of Gastroenterology, Royal London Hospital, London, UK
| | - Melissa A Smith
- Digestives Diseases Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK,Department of Gastroenterology, Brighton and Sussex Medical School, Brighton, UK
| | - Richard Pollok
- Department of Gastroenterology, St George's Hospitals NHS Foundation Trust, London, UK,Division of Infection and Immunity, St George’s University London, London, UK
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18
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Blackwell J, Saxena S, Pollok RC. Changing trends in coding for depression among the UK inflammatory bowel disease population. Gut 2020; 69:606-607. [PMID: 30760487 DOI: 10.1136/gutjnl-2019-318296] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 01/28/2019] [Indexed: 12/08/2022]
Affiliation(s)
| | - Sonia Saxena
- Primary Care and Public Health, Imperial College, London, UK
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19
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Tavabie O, Clough JN, Blackwell J, Bashyam M, Martin H, Soubieres A, Direkze N, Graham D, Groves C, Preston SL, DeMartino S, Gill US, Hayee B, Joshi D. Reduced Survival After Gastrointestinal Bleed Endoscopy in the COVID-19 Era Is a Secondary Effect of the Global Pandemic: A Retrospective Cohort Study. SSRN Journal 2020. [DOI: 10.2139/ssrn.3627299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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20
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Blackwell J, Oluniran G, Tuohy B, Destrade M, Kraśny MJ, Colgan N. Experimental assessment of clinical MRI-induced global SAR distributions in head phantoms. Phys Med 2019; 66:113-118. [PMID: 31593874 DOI: 10.1016/j.ejmp.2019.09.242] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 09/05/2019] [Accepted: 09/28/2019] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE Accurate estimation of SAR is critical to safeguarding vulnerable patients who require an MRI procedure. The increased static field strength and RF duty cycle capabilities in modern MRI scanners mean that systems can easily exceed safe SAR levels for patients. Advisory protocols routinely used to establish quality assurance protocols are not required to advise on the testing of MRI SAR levels and is not routinely measured in annual medical physics quality assurance checks. This study aims to develop a head phantom and protocol that can independently verify global SAR for MRI clinical scanners. METHODS A four-channel birdcage head coil was used for RF transmission and signal reception. Proton resonance shift thermometry was used to estimate SAR. The SAR estimates were verified by comparing results against two other independent measures, then applied to a further four scanners at field strengths of 1.5 T and 3 T. RESULTS Scanner output SAR values ranged from 0.42 to 1.52 W/kg. Percentage SAR differences between independently estimated values and those calculated by the scanners differed by 0-2.3%. CONCLUSION We have developed a quality assurance protocol to independently verify the SAR output of MRI scanners.
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Affiliation(s)
- J Blackwell
- School of Physics, National University of Ireland Galway, Galway, Ireland; School of Mathematics, Statistics and Applied Mathematics, National University of Ireland Galway, Galway, Ireland.
| | - G Oluniran
- School of Physics, National University of Ireland Galway, Galway, Ireland
| | - B Tuohy
- Medical Physics and Bioengineering, Galway University Hospital, Galway, Ireland
| | - M Destrade
- School of Mathematics, Statistics and Applied Mathematics, National University of Ireland Galway, Galway, Ireland
| | - M J Kraśny
- School of Physics, National University of Ireland Galway, Galway, Ireland
| | - N Colgan
- School of Physics, National University of Ireland Galway, Galway, Ireland
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21
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Blackwell J, Saxena S, Alexakis C, Bottle A, Cecil E, Majeed A, Pollok RC. The impact of smoking and smoking cessation on disease outcomes in ulcerative colitis: a nationwide population-based study. Aliment Pharmacol Ther 2019; 50:556-567. [PMID: 31389044 DOI: 10.1111/apt.15390] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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: 03/14/2019] [Revised: 03/29/2019] [Accepted: 06/06/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Smokers are less likely to develop ulcerative colitis (UC) but the impact of smoking and subsequent cessation on clinical outcomes in UC is unclear. AIM To evaluate the effect of smoking status and smoking cessation on disease outcomes. METHODS Using a nationally representative clinical research database, we identified incident cases of UC during 2005-2016. Patients were grouped as never-smokers, ex-smokers and smokers based on smoking status recorded in the 2 years preceding UC diagnosis. We defined subgroups of persistent smokers and smokers who quit within 2 years after diagnosis. We compared the rates of overall corticosteroid use, corticosteroid-requiring flares, corticosteroid dependency, thiopurine use, hospitalisation and colectomy between these groups. RESULTS We identified 6754 patients with a new diagnosis of UC over the study period with data on smoking status, of whom 878 were smokers at diagnosis. Smokers had a similar risk of corticosteroid-requiring flares (OR 1.16, 95% CI 0.92-1.25), thiopurine use (HR 0.84, 95% CI 0.62-1.14), corticosteroid dependency (HR 0.85, 95% CI 0.60-1.11), hospitalisation (HR 0.92, 95% CI 0.72-1.18) and colectomy (HR 0.78, 95% CI 0.50-1.21) in comparison with never-smokers. Rates of flares, thiopurine use, corticosteroid dependency, hospitalisation and colectomy were not significantly different between persistent smokers and those who quit smoking after a diagnosis of UC. CONCLUSIONS Smokers and never-smokers with UC have similar outcomes with respect to flares, thiopurine use, corticosteroid dependency, hospitalisation and colectomy. Smoking cessation was not associated with worse disease course. The risks associated with smoking outweigh any benefits. UC patients should be counselled against smoking.
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Affiliation(s)
- Jonathan Blackwell
- Department of Gastroenterology, St George's Healthcare NHS Trust and St George's University, London, UK
| | - Sonia Saxena
- School of Public Health, Imperial College London, London, UK
| | - Christopher Alexakis
- Department of Gastroenterology, St George's Healthcare NHS Trust and St George's University, London, UK
| | - Alex Bottle
- School of Public Health, Imperial College London, London, UK
| | - Elizabeth Cecil
- School of Public Health, Imperial College London, London, UK
| | - Azeem Majeed
- School of Public Health, Imperial College London, London, UK
| | - Richard C Pollok
- Department of Gastroenterology, St George's Healthcare NHS Trust and St George's University, London, UK
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22
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Affiliation(s)
- Jonathan Blackwell
- Department of Gastroenterology, St George's NHS Foundation Trust, London, UK
| | - Sonia Saxena
- Department of Primary Care and Public Health, Imperial College, London, UK
| | - Richard C Pollok
- Department of Gastroenterology, St George's NHS Foundation Trust, London, UK
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23
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Wang SSY, Lee MB, George A, Wang SB, Blackwell J, Moran S, Francis IC. Five cases of orbital extramedullary plasmacytoma: diagnosis and management of an aggressive malignancy. Orbit 2018; 38:218-225. [PMID: 29985709 DOI: 10.1080/01676830.2018.1490437] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Purpose: Multiple myeloma is an insidious haematological malignancy characterised by monoclonal proliferation of plasma cells in the bone marrow. Extramedullary plasmacytoma is a rare manifestation of multiple myeloma and usually occurs in the upper respiratory tract. Orbital involvement is particularly uncommon, but may be associated with devastating visual impairment and poor clinical outcomes. Therefore, this article aims to highlight the need for multidisciplinary management of orbital extramedullary plasmacytoma. Methods: This is a retrospective observational case series of five patients. All presented to the authors for management of orbital extramedullary plasmacytomas from 2004 to 2015 at Prince of Wales and Mater Hospitals in Sydney, Australia. Medical records were reviewed for pertinent information including demographics, disease features, management strategy, and clinical progress. The study met Medical Ethics Board standards and is in accordance with the Helsinki Agreements. Results: This case series of five patients underscores the poor prognosis of orbital extramedullary plasmacytoma. Despite aggressive multidisciplinary management, four of these five patients succumbed to their illness during the study period. However, multidisciplinary management did manage to minimise symptoms and preserve quality of life. Conclusions: On a case-by-case basis, patients may derive palliative benefit from orbital surgery in conjunction with radiotherapy and chemotherapy. Orbital surgeons are encouraged to work within a multidisciplinary framework of medical specialists, including haematologists and radiation oncologists, when determining the optimal management plan in cases of orbital extramedullary plasmacytoma.
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Affiliation(s)
- Samuel S Y Wang
- a Faculty of Medicine , University of New South Wales , Sydney, Australia
| | - Mitchell B Lee
- b Sydney Medical School , University of Sydney , Sydney, Australia
| | - Adarsh George
- a Faculty of Medicine , University of New South Wales , Sydney, Australia
| | - Sarah B Wang
- b Sydney Medical School , University of Sydney , Sydney, Australia
| | | | - Steve Moran
- c Department of Haematology , Mater Hospital , Sydney , Australia
| | - Ian C Francis
- a Faculty of Medicine , University of New South Wales , Sydney, Australia.,d Department of Ophthalmology , Prince of Wales Hospital , Sydney , Australia
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24
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Egan T, Blackwell J, Haithcock B, Long J, Birchard K, Lobo J, Masuodi S, Requard J, Thys C. Lessons Learned from the First Clinical Trial to Compare Outcomes of Lungs Transplanted from Uncontrolled Donation After Circulatory Determination of Death Donors (uDCDDs) Assessed by Ex-Vivo Lung Perfusion (EVLP) and CT Scan and Lungs Transplanted from Conventional Donors (CONV). J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Masuodi S, Blackwell J, Stewart P, Egan T. Cytokine Levels in Steen Solution Perfusate Increase During Ex-Vivo Lung Perfusion (EVLP) of Lungs from Conventional Donors (Conv) and Uncontrolled Donation After Circulatory Determination of Death Donors (uDCDDs). J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.1508] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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26
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Doleman B, Blackwell J, Karangizi A, Butt W, Bhalla A, Lund JN, Williams JP. Anaesthetists stress is induced by patient ASA grade and may impair non-technical skills during intubation. Acta Anaesthesiol Scand 2016; 60:910-6. [PMID: 26940201 DOI: 10.1111/aas.12716] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 01/29/2016] [Accepted: 02/07/2016] [Indexed: 01/17/2023]
Abstract
BACKGROUND The aims of this study were to determine if patient ASA grade was associated with increased stress in anaesthetists with a subsequent effect on non-technical skills. METHODS Stress was measured using a validated objective (heart rate variability or heart rate) and subjective tool. We studied eight consultant anaesthetists at baseline (rest) and during 16 episodes of intubation with an ASA 1 or 2 patient vs. an ASA 3 or 4 patient. The primary outcome for the study was objective and subjective stress between both patient groups. Secondary outcomes were non-technical skill ratings and the association between stress measurements. RESULTS ASA 3 or 4 patients were associated with increases in objective stress when compared to baseline (mean 4.6 vs. 6.7; P = 0.004). However, ASA 1 or 2 patients were not associated with increases in stress when compared to baseline (mean 4.6 vs. 4.7; P = 1). There was no significant difference in subjective stress between the groups (P = 0.18). Objective stress negatively affected situational awareness (P = 0.03) and decision-making (P = 0.03); however, these did not decline to a clinically significant threshold. Heart rate variability (r = 0.60; P = 0.002) better correlated with subjective stress when compared to heart rate (r = 0.30; P = 0.15). Agreement between raters for Anaesthetic Non-Technical Skills (ANTS) scores was acceptable (ICC = 0.51; P = 0.003). CONCLUSION This study suggests that higher patient ASA grade can increase stress in anaesthetists, which may impair non-technical skills.
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Affiliation(s)
- B. Doleman
- Division of Medical Sciences and Graduate Entry Medicine; Royal Derby Hospital; University of Nottingham; Derby UK
| | - J. Blackwell
- Division of Medical Sciences and Graduate Entry Medicine; Royal Derby Hospital; University of Nottingham; Derby UK
| | - A. Karangizi
- Division of Medical Sciences and Graduate Entry Medicine; Royal Derby Hospital; University of Nottingham; Derby UK
| | - W. Butt
- Division of Medical Sciences and Graduate Entry Medicine; Royal Derby Hospital; University of Nottingham; Derby UK
| | - A. Bhalla
- Division of Medical Sciences and Graduate Entry Medicine; Royal Derby Hospital; University of Nottingham; Derby UK
| | - J. N. Lund
- Division of Medical Sciences and Graduate Entry Medicine; Royal Derby Hospital; University of Nottingham; Derby UK
| | - J. P. Williams
- Division of Medical Sciences and Graduate Entry Medicine; Royal Derby Hospital; University of Nottingham; Derby UK
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Huang Y, Wang DN, Liu P, Song Y, Cui HM, Zhang JY, Blackwell J, Liao DN. Effects of local radiofrequency denervation on ventricular electrophysiological properties in normal and acute myocardial ischemia heart. Eur Rev Med Pharmacol Sci 2016; 20:2673-2679. [PMID: 27383322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To observe the effects of local radiofrequency denervation on ventricular effective refractory periods, electrical alternans and ventricular arrhythmia susceptibility post myocardial infarction. MATERIALS AND METHODS Thirty-four mongrel dogs were randomly divided into the normal heart group (n = 16, 8 in sham and 8 in local sympathetic denervation - LSD) and the acute myocardial ischemia (AMI) group (n = 18, 9 in control and 9 in LSD). The left cardiac sympathetic nerve was denervated with irrigated catheter radiofrequency ablation. Left ventricular effective refractory periods (ERP), monophasic action potential duration at 90% (APD90) and APD alternans were measured at baseline and 2 hours after LSD in the normal heart group. AMI was induced by ligating the left anterior descending coronary artery 2 hours after LSD was performed. Then APD90, the occurrence of ventricular arrhythmias (VAs) were measured. RESULTS Compared with baseline, LSD significantly prolonged ventricular ERP and APD90 at all sites (p < 0.05 for all) in the LSD group, whereas no significant change was shown in the sham group. But their spatial dispersions did not change in both groups. APD alternans occurred at shorter pacing cycle length at each site after LAD→LSD when compared to the sham group (p < 0.05 for all). After AMI, the occurrence of VAs was significantly lower in the LSD group than in the control group (p < 0.05). CONCLUSIONS LSD may have a beneficial impact on ventricular arrhythmias induced by AMI through modulation of autonomic tone.
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Affiliation(s)
- Y Huang
- Department of Cardiology, and Department of Endocrinology; Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China.
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Ricketts S, Blackwell J, Lloyd P, Lund J, Tierney G. Using the 5F's as a diagnostic aid for gallstone disease. Int J Surg 2015. [DOI: 10.1016/j.ijsu.2015.07.500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Humes DJ, Walker AJ, Blackwell J, Hunt BJ, West J. Variation in the risk of venous thromboembolism following colectomy. Br J Surg 2015; 102:1629-38. [DOI: 10.1002/bjs.9923] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 07/01/2015] [Accepted: 07/22/2015] [Indexed: 02/05/2023]
Abstract
Abstract
Background
Guidelines recommend extended thromboprophylaxis following colectomy for malignant disease, but not for non-malignant disease. The aim of this study was to determine absolute and relative rates of venous thromboembolism (VTE) following colectomy by indication, admission type and time after surgery.
Methods
A cohort study of patients undergoing colectomy in England was undertaken using linked primary (Clinical Practice Research Datalink) and secondary (Hospital Episode Statistics) care data (2001–2011). Crude rates and adjusted hazard ratios (HRs) were calculated for the risk of first VTE following colectomy using Cox regression analysis.
Results
Some 12 388 patients were identified; 312 (2·5 per cent) developed VTE after surgery, giving a rate of 29·59 (95 per cent c.i. 26·48 to 33·06) per 1000 person-years in the first year after surgery. Overall rates were 2·2-fold higher (adjusted HR 2·23, 95 per cent c.i. 1·76 to 2·50) for emergency compared with elective admissions (39·44 versus 25·78 per 1000 person-years respectively). Rates of VTE were 2·8-fold higher in patients with malignant disease versus those with non-malignant disease (adjusted HR 2·84, 2·04 to 3·94). The rate of VTE was highest in the first month after emergency surgery, and declined from 121·68 per 1000 person-years in the first month to 25·65 per 1000 person-years during the rest of the follow-up interval. Crude rates of VTE were similar for malignant and non-malignant disease (114·76 versus 120·98 per 1000 person-years respectively) during the first month after emergency surgery.
Conclusion
Patients undergoing emergency colectomy for non-malignant disease have a similar risk of VTE as patients with malignant disease in the first month after surgery.
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Affiliation(s)
- D J Humes
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
- National Institute for Health Research Nottingham Digestive Disease Biomedical Research Unit, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - A J Walker
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - J Blackwell
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - B J Hunt
- Thrombosis and Haemophilia Centre, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, UK
| | - J West
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
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Egan T, Blackwell J, Gazda S, Forrest L, Haithcock B, Long J, Birchard K, Reddy S, Casey N. Assessment of Human Lungs Recovered From Uncontrolled Donation After Circulatory Determination of Death (uDCDD) Donors By Ex-Vivo Lung Perfusion (EVLP) and CT Scan. J Heart Lung Transplant 2015. [DOI: 10.1016/j.healun.2015.01.687] [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: 11/25/2022] Open
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Egan T, Dong B, Blackwell J, Birchard K, Stewart P, Funkhouser W, Simmons W, Jernigan E, Venkataraman A, Reddy S, Haithcock B. Assessing Human Lungs Unsuitable for Transplant By Ex-Vivo Lung Perfusion (EVLP) and Ex-Vivo CT Scan: Does EVLP Cause Inflammation? J Heart Lung Transplant 2015. [DOI: 10.1016/j.healun.2015.01.375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Helge EW, Randers MB, Hornstrup T, Nielsen JJ, Blackwell J, Jackman SR, Krustrup P. Street football is a feasible health-enhancing activity for homeless men: Biochemical bone marker profile and balance improved. Scand J Med Sci Sports 2014; 24 Suppl 1:122-9. [DOI: 10.1111/sms.12244] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2014] [Indexed: 11/28/2022]
Affiliation(s)
- E. W. Helge
- Department of Nutrition, Exercise and Sports; Section of Integrated Physiology; Copenhagen Centre for Team Sport and Health; University of Copenhagen; Copenhagen Denmark
| | - M. B. Randers
- Department of Nutrition, Exercise and Sports; Section of Integrated Physiology; Copenhagen Centre for Team Sport and Health; University of Copenhagen; Copenhagen Denmark
| | - T. Hornstrup
- Department of Nutrition, Exercise and Sports; Section of Integrated Physiology; Copenhagen Centre for Team Sport and Health; University of Copenhagen; Copenhagen Denmark
| | - J. J. Nielsen
- Department of Nutrition, Exercise and Sports; Section of Integrated Physiology; Copenhagen Centre for Team Sport and Health; University of Copenhagen; Copenhagen Denmark
| | - J. Blackwell
- Sport and Health Sciences, College of Life and Environmental Sciences; St Luke's Campus; University of Exeter; Exeter UK
| | - S. R. Jackman
- Sport and Health Sciences, College of Life and Environmental Sciences; St Luke's Campus; University of Exeter; Exeter UK
| | - P. Krustrup
- Department of Nutrition, Exercise and Sports; Section of Integrated Physiology; Copenhagen Centre for Team Sport and Health; University of Copenhagen; Copenhagen Denmark
- Sport and Health Sciences, College of Life and Environmental Sciences; St Luke's Campus; University of Exeter; Exeter UK
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Egan T, Blackwell J, Forrest L, Gazda S, Requard III J, Haithcock B, Birchard K, Stewart P, Randell S, Venkataraman A, Beamer S, Reddy S, Myers B, Bachman M, Casey N, Niedfeldt D. Evaluation of Human Lungs from Uncontrolled Donation After Cardiac Death Donors (uDCDDs) with Ex-vivo Lung Perfusion (EVLP). J Heart Lung Transplant 2014. [DOI: 10.1016/j.healun.2014.01.157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Egan T, Haithcock B, Long J, Noone P, Blackwell J, Forrest L, Gazda S, Reddy S, Davis R, Birchard K, Stewart P. Preliminary Results of a Phase II Trial Comparing Outcomes of Patients Transplanted with Lungs from Uncontrolled Donation After Cardiac Death Donors (uDCDDs) Assessed with Ex-vivo Lung Perfusion (EVLP) to Lungs from Conventional Brain-Dead Donors. J Heart Lung Transplant 2014. [DOI: 10.1016/j.healun.2014.01.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Singh T, Fakiola M, Oommen J, Chakravarty J, Sundar S, Blackwell J. HLA class II association with visceral leishmaniasis: The road to identifying vaccine candidates. Int J Infect Dis 2014. [DOI: 10.1016/j.ijid.2014.03.1319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Hoon M, Jones A, Johnson N, Blackwell J, Broad E, Lundy B, Rice A, Burke L. Dose response of nitrate supplementation on 2000m rowing ergometer performance. J Sci Med Sport 2013. [DOI: 10.1016/j.jsams.2013.10.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Egan T, Dong B, Tikunov A, Semelka C, Blackwell J, Simmons W, Kuan PF, Macdonald J. Effect of Ex-Vivo Lung Perfusion (EVLP) on Metabolomic Profile of Human Lungs. J Heart Lung Transplant 2013. [DOI: 10.1016/j.healun.2013.01.638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Decuypere S, Pyke J, Tull D, Buddhisa S, McConville M, Blackwell J, Lertmemongkolchai G. Metabolomics based biomarker discovery for infectious diseases, the case of melioidosis. Int J Infect Dis 2012. [DOI: 10.1016/j.ijid.2012.05.810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Tang NLS, Chan CY, Leung CC, Tam CM, Blackwell J. Tuberculosis susceptibility genes in the chemokine cluster region of chromosome 17 in Hong Kong Chinese. Hong Kong Med J 2011; 17 Suppl 6:22-25. [PMID: 22147355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Affiliation(s)
- N L S Tang
- Department of Chemical Pathology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR, China.
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Chvalun SN, Blackwell J, Kwon YK, Percec V. Small angle x-ray analysis of the effect of temperature on the self-assembling columnar structures formed by a polymethacrylate with highly tapered side groups and by one of its low molar mass precursors. ACTA ACUST UNITED AC 2011. [DOI: 10.1002/masy.19971180186] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Field M, Blackwell J, Jaipersad A, Wall M, Silva MA, Morgan RH, Pherwani AD. Distal revascularisation with interval ligation (DRIL): an experience. Ann R Coll Surg Engl 2009; 91:394-8. [PMID: 19409151 DOI: 10.1308/003588409x392153] [Citation(s) in RCA: 12] [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: 11/22/2022] Open
Abstract
INTRODUCTION The global increase of chronic renal failure has resulted in a growing number of patients on haemodialysis using arteriovenous fistulas (AVFs). By virtue of their very function, AVFs at times shunt blood away from regions distally, resulting in an ischaemic steal syndrome. Distal revascularisation with interval ligation (DRIL) has been described as a procedure to treat symptomatic ischaemic steal. We present our experience in the management of this complication. PATIENTS AND METHODS Six patients with severe ischaemic steal were treated using a DRIL procedure between May 2004 and June 2007. There were three males and three females, all with elbow brachiocephalic AVFs. Symptoms ranged from severe rest pain to digital gangrene. Published results from international studies of 135 DRIL procedures were also reviewed. RESULTS Vascular access was maintained along with the elimination of ischaemic symptoms in the six patients using an ipsilateral reversed basilic vein graft. Interval ligation of the distal brachial artery was performed at the same time. All patients showed immediate and sustained clinical improvement of symptoms with a demonstrable increase in digital pulse oximetry. CONCLUSIONS DRIL is a beneficial treatment option that has proven successful at alleviating ischemic steal symptoms and preserving vascular access. This avoids placement of central lines, its associated risks, and the need to create an alternative sited fistula.
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Affiliation(s)
- M Field
- The Vascular Unit, University Hospital of North Staffordshire NHS Trust, Stoke-on-Trent, UK.
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Abstract
BACKGROUND Liver transplantation is a very successful therapy for those with end stage disease. Although there are numerous data on patient and graft survival after liver transplantation, life expectancy and possible loss of life (compared with a normal matched population) in those who survive remains unknown. AIMS To assess the life expectancy and life years lost of adult liver allograft recipients, compared with an age and sex matched UK population to provide patients with more information and to improve the use of a scarce resource. METHODS Using the National Transplant Database held by UK Transplant, on over 3600 adult liver allograft recipients transplanted between 1985 and 2003, we analysed survival of all adults who survived more than six months after transplantation and compared survival after transplantation with national age and sex matched controls to assess life years lost. RESULTS Estimated median survival time of the analysis cohort of 2702 adult liver allograft recipients was 22.2 years (95% confidence interval 19.3-25.6), with an estimated loss of seven life years compared with an age and sex matched population. CONCLUSIONS Overall, female recipients have a longer life expectancy and lose fewer life years than male recipients. While younger recipients have a longer life expectancy, they also lose more life years. Those transplanted for cancer, hepatitis C virus infection, and alcoholic liver disease had the greatest loss of life years.
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Casiraghi M, Mendoza A, Blackwell J, Watson L, Tatreau J, Sevala M, Randell S, Egan T. 52: Non-hypoxic ischemia: An accurate cell culture model of ischemia reperfusion injury in lung transplantation. J Heart Lung Transplant 2007. [DOI: 10.1016/j.healun.2006.11.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Chvalun SN, Shcherbina MA, Yakunin AN, Blackwell J, Percec V. Structure of gyroid mesophase formed by monodendrons with fluorinated alkyl tails. Polym Sci Ser A 2007. [DOI: 10.1134/s0965545x07020083] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Sidhu HS, Manpreet-Singh, Humphreys E, Yadvinder-Singh, Balwinder-Singh, Dhillon SS, Blackwell J, Bector V, Malkeet-Singh, Sarbjeet-Singh. The Happy Seeder enables direct drilling of wheat into rice stubble. ACTA ACUST UNITED AC 2007. [DOI: 10.1071/ea06225] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Lack of suitable machinery is a major constraint to direct drilling into combine-harvested rice residues due to the heavy straw load, and the presence of loose tough straw deposited by the harvester. Therefore, most rice stubbles are burnt in the mechanised rice–wheat systems of south Asia and Australia, as this is a rapid and cheap option, and allows for quick turn around between crops. As well as loss of organic matter and nutrients, rice stubble burning causes very serious and widespread air pollution in the north-west Indo-Gangetic Plains, where rice–wheat systems predominate. A novel approach with much promise is the Happy Seeder, which combines the stubble mulching and seed drilling functions in the one machine. The stubble is cut and picked up in front of the sowing tynes, which engage bare soil, and deposited behind the seed drill as mulch. Evaluation of the technology over 3 years in replicated experiments and farmers’ fields in Punjab, India, showed that establishment of wheat sown into rice residues with the Happy Seeder was comparable with establishment using conventional methods (straw burnt followed by direct drilling or cultivation before sowing) for sowings around the optimum time into stubbles up to 7.5 t/ha. For late sowings, plant density declined significantly at straw loads above 5 t/ha. The mulch also reduced weed biomass by ~60%, and reduced soil evaporation. Yield of wheat sown around the optimum time into rice residues, using the Happy Seeder, was comparable with or higher than yield after straw removal or burning, in replicated experiments and farmers’ fields, for straw loads up to 9 t/ha. In farmers’ fields there was an average yield increase of 9 and 11% in 2004–05 and 2005–06, respectively, compared with farmer practice. For sowings after the optimum time, yield declined significantly at straw loads greater than 7.5 t/ha. The Happy Seeder offers the means of drilling wheat into rice stubble without burning, eliminating air pollution and loss of nutrients and organic carbon due to burning, at the same time as maintaining or increasing yield.
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Affiliation(s)
- R. Minke
- a Department of Macromolecular , Science Case Western Reserve University Cleveland , Ohio, 44106
| | - J. Blackwell
- a Department of Macromolecular , Science Case Western Reserve University Cleveland , Ohio, 44106
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Laing SJ, Gwynne D, Blackwell J, Williams M, Walters R, Walsh NP. Salivary IgA response to prolonged exercise in a hot environment in trained cyclists. Eur J Appl Physiol 2004; 93:665-71. [PMID: 15778895 DOI: 10.1007/s00421-004-1270-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2004] [Indexed: 10/26/2022]
Abstract
UNLABELLED The aim of this study was to determine the effects of prolonged exercise in hot conditions on saliva IgA (s-IgA) responses in trained cyclists. On two occasions, in random order and separated by 1 week, 12 male cyclists cycled for 2 h on a stationary ergometer at 62 (3)% V(.)O(2 max) [194 (4) W; mean (SEM)], on one occasion (HOT: 30.3 degrees C, 76% RH) and on another occasion ( CONTROL 20.4 degrees C, 60% RH). Water was available ad-libitum. Venous blood samples and 2-min whole unstimulated saliva samples were collected at pre, post and 2 h post-exercise. The s-IgA concentration was determined using a sandwich-type ELISA. Exercising heart rate, rating of perceived exertion, rectal temperature, corrected body mass loss (P<0.01) and plasma cortisol (P<0.05) were greater during HOT. The decrease in plasma volume post-exercise was similar on both trials [HOT: -6.7 (1.1) and CONTROL -6.6 (1.3)%; P<0.01]. Saliva flow rate decreased post-exercise by 43% returning to pre-exercise levels by 2 h post-exercise (P<0.05) with no difference between trials. Saliva IgA concentration increased post-exercise (P<0.05) with no difference between trials. Saliva IgA secretion rate decreased post-exercise by 34% returning to pre-exercise levels by 2 h post-exercise (P<0.05) with no difference between trials. These data show that a prolonged bout of exercise results in a reduction in s-IgA secretion rate. Additionally, these data demonstrate that performing prolonged exercise in the heat, with ad libitum water intake, does not influence s-IgA responses to prolonged exercise.
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Affiliation(s)
- S J Laing
- School of Sport, Health and Exercise Sciences, University of Wales, Bangor LL57 2PX, UK
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Southwick JG, McDonnell ME, Jamieson AM, Blackwell J. Solution Studies of Xanthan Gum Employing Quasielastic Light Scattering. Macromolecules 2002. [DOI: 10.1021/ma60068a029] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Percec V, Schlueter D, Kwon YK, Blackwell J, Moeller M, Slangen PJ. Dramatic Stabilization of a Hexagonal Columnar Mesophase Generated from Supramolecular and Macromolecular Columns by the Semifluorination of the Alkyl Groups of Their Tapered Building Blocks. Macromolecules 2002. [DOI: 10.1021/ma00130a013] [Citation(s) in RCA: 104] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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