1
|
McCullagh J, Basham P, Davies J, Hicks V, Hunter A, Lancut J, Green L. The feasibility of introducing a whole blood component for traumatic haemorrhage in the UK. Transfus Med 2024. [PMID: 38576265 DOI: 10.1111/tme.13039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 02/24/2024] [Accepted: 03/19/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND The interest in re-introducing whole blood (WB) transfusion for the management of traumatic major haemorrhage is increasing. However, due to the current leucodepletion filters used in the UK a WB component was not readily available. Instead, an alternative but similar component, leucocyte depleted red cell and plasma (LD-RCP), which provided a unique experience in assessing the feasibility of a WB component was used whilst a WB component was being manufactured. STUDY DESIGN AND METHODS Between November 2018 and October 2020, LD-RCP replaced RBC as standard of care for all trauma patients with major haemorrhage in London. The aims of the study were to assess (a) deliverability, (b) component wastage and (c) safety. RESULTS Over the study period a total of 1208 LD-RCP units were delivered, of which 96.5% were delivered 'On Time In Full' (OTIF). Of the 1208 units, 733 (60.68%) were transfused and 475 (39.3%) units were wasted. Component wastage reduced significantly throughout the study (p = 0.001). A total of 177 patients had a blood group recorded, 86 were group O and 91 were non-group O. There was no statistically significantly difference between haemoglobin (p = 0.422), or bilirubin levels (p = 0.084) between group O and non-group O patients. DISCUSSION It was feasible for NHS Blood and Transplant to deliver LD-RCP on time in full, however component wastage was high due to short shelf life and limited use of the component. Low titre group O LD-RCP units were not associated with clinical evidence of haemolysis.
Collapse
Affiliation(s)
- Josephine McCullagh
- Clinical Haematology, Barts Health NHS Trust, London, UK
- Red Cell Immunoheamatology, NHS Blood and Transplant (NHSBT), London, UK
| | - Peter Basham
- Manufacturing, NHS Blood and Transplant, London, UK
| | - Jane Davies
- Manufacturing, NHS Blood and Transplant, London, UK
| | - Vicky Hicks
- Manufacturing, NHS Blood and Transplant, London, UK
| | | | - Julia Lancut
- Blood Transfusion, East and Southeast London Pathology Partnership, London, UK
| | - Laura Green
- Clinical Haematology, Barts Health NHS Trust, London, UK
- Blizard Institute, Queen Mary University of London, London, UK
- Blood Transfusion and Components, NHS Blood and Transplant, London, UK
| |
Collapse
|
2
|
McCullagh J. Evidence cornered: Transfusion evidence summary-efficacy and safety of early administration of 4-factor prothrombin complex concentrate in patients with trauma at risk of massive transfusion-the PROCOAG randomised clinical trial (JAMA). Transfus Med 2024. [PMID: 38511592 DOI: 10.1111/tme.13035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/09/2024] [Accepted: 03/12/2024] [Indexed: 03/22/2024]
|
3
|
Tucker H, Brohi K, Tan J, Aylwin C, Bloomer R, Cardigan R, Davenport R, Davies ED, Godfrey P, Hawes R, Lyon R, McCullagh J, Stanworth S, Thompson J, Uprichard J, Walsh S, Weaver A, Green L. Association of red blood cells and plasma transfusion versus red blood cell transfusion only with survival for treatment of major traumatic hemorrhage in prehospital setting in England: a multicenter study. Crit Care 2023; 27:25. [PMID: 36650557 PMCID: PMC9847037 DOI: 10.1186/s13054-022-04279-4] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 12/14/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND In-hospital acute resuscitation in trauma has evolved toward early and balanced transfusion resuscitation with red blood cells (RBC) and plasma being transfused in equal ratios. Being able to deliver this ratio in prehospital environments is a challenge. A combined component, like leukocyte-depleted red cell and plasma (RCP), could facilitate early prehospital resuscitation with RBC and plasma, while at the same time improving logistics for the team. However, there is limited evidence on the clinical benefits of RCP. OBJECTIVE To compare prehospital transfusion of combined RCP versus RBC alone or RBC and plasma separately (RBC + P) on mortality in trauma bleeding patients. METHODS Data were collected prospectively on patients who received prehospital transfusion (RBC + thawed plasma/Lyoplas or RCP) for traumatic hemorrhage from six prehospital services in England (2018-2020). Retrospective data on patients who transfused RBC from 2015 to 2018 were included for comparison. The association between transfusion arms and 24-h and 30-day mortality, adjusting for age, injury mechanism, age, prehospital heart rate and blood pressure, was evaluated using generalized estimating equations. RESULTS Out of 970 recruited patients, 909 fulfilled the study criteria (RBC + P = 391, RCP = 295, RBC = 223). RBC + P patients were older (mean age 42 vs 35 years for RCP and RBC), and 80% had a blunt injury (RCP = 52%, RBC = 56%). RCP and RBC + P were associated with lower odds of death at 24-h, compared to RBC alone (adjusted odds ratio [aOR] 0.69 [95%CI: 0.52; 0.92] and 0.60 [95%CI: 0.32; 1.13], respectively). The lower odds of death for RBC + P and RCP vs RBC were driven by penetrating injury (aOR 0.22 [95%CI: 0.10; 0.53] and 0.39 [95%CI: 0.20; 0.76], respectively). There was no association between RCP or RBC + P with 30-day survival vs RBC. CONCLUSION Prehospital plasma transfusion for penetrating injury was associated with lower odds of death at 24-h compared to RBC alone. Large trials are needed to confirm these findings.
Collapse
Affiliation(s)
- Harriet Tucker
- grid.4868.20000 0001 2171 1133Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, 4 Newark Street, London, E1 2AT UK
| | - Karim Brohi
- grid.4868.20000 0001 2171 1133Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, 4 Newark Street, London, E1 2AT UK ,grid.139534.90000 0001 0372 5777Barts Health NHS Trust, London, UK
| | - Joachim Tan
- grid.264200.20000 0000 8546 682XSt George’s University of London, London, UK
| | - Christopher Aylwin
- grid.426467.50000 0001 2108 8951St Mary’s Hospital, Imperial College NHS Foundation Trust, London, UK
| | - Roger Bloomer
- grid.429705.d0000 0004 0489 4320Kings College Hospital NHS Foundation Trust, London, UK
| | - Rebecca Cardigan
- grid.436365.10000 0000 8685 6563NHS Blood and Transplant, Cambridge, UK
| | - Ross Davenport
- grid.4868.20000 0001 2171 1133Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, 4 Newark Street, London, E1 2AT UK ,grid.139534.90000 0001 0372 5777Barts Health NHS Trust, London, UK
| | - Edward D. Davies
- grid.416204.50000 0004 0391 9602Royal Preston Hospital, Preston, UK
| | - Phillip Godfrey
- grid.411812.f0000 0004 0400 2812James Cook University Hospital, Middlesbrough, UK
| | - Rachel Hawes
- Newcastle Upon Tyne NHS Foundation Trust, Newcastle, UK ,Great North Air Ambulance, Stockton-on-Tees, UK
| | | | | | - Simon Stanworth
- grid.436365.10000 0000 8685 6563NHS Blood and Transplant, Cambridge, UK ,grid.4991.50000 0004 1936 8948Oxford University Hospital NHS Foundation Trust, Oxford, UK
| | - Julian Thompson
- grid.416201.00000 0004 0417 1173Southmead Hospital, Bristol, UK ,Great West Air Ambulance, Bristol, UK
| | - James Uprichard
- grid.264200.20000 0000 8546 682XSt George’s University Hospital NHS Foundation Trust, London, UK
| | - Simon Walsh
- grid.426467.50000 0001 2108 8951St Mary’s Hospital, Imperial College NHS Foundation Trust, London, UK ,Essex and Hertfordshire Air Ambulance Trust, Essex, UK
| | - Anne Weaver
- grid.139534.90000 0001 0372 5777Barts Health NHS Trust, London, UK
| | - Laura Green
- grid.4868.20000 0001 2171 1133Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, 4 Newark Street, London, E1 2AT UK ,grid.139534.90000 0001 0372 5777Barts Health NHS Trust, London, UK ,grid.436365.10000 0000 8685 6563NHS Blood and Transplant, Cambridge, UK
| |
Collapse
|
4
|
Maher L, Collins V, McCullagh J, McGarrigle A, Vaughan C. Assessment of Newer Radiation Dose Reduction Techniques During Coronary Angiography. Ir Med J 2022; 115:558. [PMID: 35532344] [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: 06/14/2023]
Abstract
Aims To evaluate the impact of Allura Clarity technology on radiation exposure in patients undergoing diagnostic coronary angiography. Methods A retrospective analysis was undertaken of invasive coronary angiograms performed by a single experienced operator in Cork University Hospital (CUH) (Allura Xper FD10 angiography system). In order to reduce operator variability, we also analysed cases performed by the same operator in the Bon Secours Hospital Cork (BSHC) (Allura Clarity FD10 angiography system). Cases were selected consecutively, having excluded those involving percutaneous coronary intervention, graft studies, aortography, ventriculography, right heart studies or fractional flow reserve studies. Results A total of 178 patients were included, equally distributed between the CUH arm (n=89) and the BSHC arm (n=89). Cohorts were very well matched in terms of age, gender, Body Mass Index, and procedural approach. The median radiation dose in CUH was a Dose Area Product (DAP) of 10,460 mGy.cm2 vs. median DAP of 12,795 mGy.cm2 in BSHC (p=0.148). The median fluoroscopy time in CUH was 2.25mins vs. median fluoroscopy time of 2.17mins in BSHC (p=0.675). Conclusion The use of the Allura Clarity system for diagnostic coronary angiography did not result in a significant difference in radiation dose or fluoroscopy time when compared to the reference Allura Xper system. Further research is needed to investigate the benefit of this new image noise reduction technology in diagnostic coronary angiography.
Collapse
Affiliation(s)
- L Maher
- Department of Cardiology, Cork University Hospital, Ireland
| | - V Collins
- Department of Radiology, Bon Secours Hospital, Cork, Ireland
| | - J McCullagh
- Department of Medical Physics, Cork University Hospital, Ireland
| | - A McGarrigle
- Cork Radiation Protection Services, Cork, Ireland
| | - C Vaughan
- Department of Cardiology, Cork University Hospital, Ireland
- Department of Cardiology, Bon Secours Hospital, Cork, Ireland
| |
Collapse
|
5
|
McCullagh J, Proudlove N, Tucker H, Davies J, Edmondson D, Lancut J, Maddison A, Weaver A, Davenport R, Green L. Making every drop count: reducing wastage of a novel blood component for transfusion of trauma patients. BMJ Open Qual 2021; 10:bmjoq-2021-001396. [PMID: 34244177 PMCID: PMC8268902 DOI: 10.1136/bmjoq-2021-001396] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 06/19/2021] [Indexed: 01/03/2023] Open
Abstract
Recent research demonstrates that transfusing whole blood (WB=red blood cells (RBC)+plasma+platelets) rather than just RBC (which is current National Health Service (NHS) practice) may improve outcomes for major trauma patients. As part of a programme to investigate provision of WB, NHS Blood and Transplant undertook a 2-year feasibility study to supply the Royal London Hospital (RLH) with (group O negative, 'O neg') leucodepleted red cell and plasma (LD-RCP) for transfusion of trauma patients with major haemorrhage in prehospital settings.Incidents requiring such prehospital transfusion occur randomly, with very high variation. Availability is critical, but O neg LD-RCP is a scarce resource and has a limited shelf life (14 days) after which it must be disposed of. The consequences of wastage are the opportunity cost of loss of overall treatment capacity across the NHS and reputational damage.The context was this feasibility study, set up to assess deliverability to RLH and subsequent wastage levels. Within this, we conducted a quality improvement project, which aimed to reduce the wastage of LD-RCP to no more than 8% (ie, 1 of the 12 units delivered per week).Over this 2-year period, we reduced wastage from a weekly average of 70%-27%. This was achieved over four improvement cycles. The largest improvement came from moving near-expiry LD-RCP to the emergency department (ED) for use with their trauma patients, with subsequent improvements from embedding use in ED as routine practice, introducing a dedicated LD-RCP delivery schedule (which increased the units ≤2 days old at delivery from 42% to 83%) and aligning this delivery schedule to cover two cycles of peak demand (Fridays and Saturdays).
Collapse
Affiliation(s)
- Josephine McCullagh
- NHS Higher Specialist Scientist Training (HSST), DClinSci Programme, The University of Manchester, Manchester, UK .,Pathology, Barts Health NHS Trust, London, UK
| | - Nathan Proudlove
- Alliance Manchester Business School, The University of Manchester, Manchester, UK
| | - Harriet Tucker
- Blizard Institute, Queen Mary, University of London, UK, London, UK
| | - Jane Davies
- Manufacturing and Development, NHS Blood and Transplant, Bristol, UK
| | - Dave Edmondson
- Manufacturing and Development, NHS Blood and Transplant, Bristol, UK
| | | | | | - Anne Weaver
- Major Trauma Centre, Barts Health NHS Trust, London, UK
| | - Ross Davenport
- Blizard Institute, Queen Mary, University of London, UK, London, UK.,Major Trauma Centre, Barts Health NHS Trust, London, UK
| | - Laura Green
- Pathology, Barts Health NHS Trust, London, UK.,Blizard Institute, Queen Mary, University of London, UK, London, UK.,Blood Component Department, NHS Blood and Transplant, London, UK
| |
Collapse
|
6
|
Platton S, Elegbe O, Bower L, Cardigan R, Lancut J, McCullagh J, Green L. Thawing times and hemostatic assessment of fresh frozen plasma thawed at 37°C and 45°C using water-bath methods. Transfusion 2019; 59:3478-3484. [PMID: 31618455 DOI: 10.1111/trf.15553] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 07/15/2019] [Accepted: 07/17/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND The Barkey Plasmatherm (BP; Barkey GmbH & Co. KG) can thaw plasma at 37°C and 45°C. No studies have assessed thawing times or hemostatic qualities of plasma thawed at 45°C with BP. This study assessed fresh frozen plasma (FFP) thawing times with use of BP at 37°C and 45°C and Thermogenesis ThermoLine (TT; Helmer Scientific) at 37°C and compared the hemostatic quality of LG-Octaplas (Octapharma) with use of BP at 37°C and 45°C with TT at 37°C. STUDY DESIGN AND METHODS The thawing time of FFP (pairs or fours) was assessed using BP at 37°C and 45°C (not prewarmed and prewarmed) and TT at 37°C. Hemostasis was assessed in LG-Octaplas at 5 minutes, 24 hours, 48 hours, and 120 hours after thawing with use of the three methods. RESULTS Thawing time for two units was 13.44 minutes using TT, the same as using BP at 37°C (12.94 min not prewarmed; 12.20 min prewarmed) or 45°C (12.38 min not prewarmed), but longer than using BP prewarmed to 45°C (11.31 min, p < 0.001). Thawing time for four units was 13.41 minutes using TT, shorter than using BP at 37°C (17.19 min not prewarmed, 18.47 min prewarmed; both p < 0.001) or 45°C (15.03 min not prewarmed, p = 0.012; 15.22 min prewarmed, p = 0.004). There was no reduction in hemostatic markers in LG-Octaplas with use of BP at 37°C or 45°C compared to TT. CONCLUSION BP is quicker than TT by 2 minutes when thawing two units of FFP if it is prewarmed to 45°C. BP is slower than TT by at least 2 minutes when thawing four units of FFP at 37o C. There was no significant difference in the hemostatic qualities of plasma whether thawed at 37°C or 45°C.
Collapse
Affiliation(s)
| | | | | | - Rebecca Cardigan
- NHS Blood and Transplant, UK.,Department of Haematology, University of Cambridge, Cambridge, UK
| | | | | | - Laura Green
- Barts Health NHS Trust, London, UK.,NHS Blood and Transplant, UK.,Blizard Institute, Queen Mary University of London, London, UK
| |
Collapse
|
7
|
Bullock T, Hazell M, McCullagh J. Advances in Transfusion Medicine RCPath, November 2018. Transfus Med 2019; 29:4-15. [DOI: 10.1111/tme.12590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 02/07/2019] [Accepted: 02/11/2019] [Indexed: 11/27/2022]
Affiliation(s)
| | - M. Hazell
- NHS Blood and Transplant; Bristol UK
| | - J. McCullagh
- Whipps Cross University Hospital; Barts Health NHS Trust; London UK
| |
Collapse
|
8
|
McCullagh J, Keavey E, Egan G, Phelan N. Experience with the European quality assurance guidelines for digital mammography systems in a national screening programme. Radiat Prot Dosimetry 2013; 153:223-226. [PMID: 23173219 DOI: 10.1093/rpd/ncs297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The transition to a fully digital breast screening programme, utilising three different full-field digital mammography (FFDM) systems has presented many challenges to the implementation of the European guidelines for physico-technical quality assurance (QA) testing. An analysis of the QA results collected from the FFDM systems in the screening programme over a 2-y period indicates that the three different systems have similar QA performances. Generally, the same tests were failed by all systems and failure rates were low. The findings provide some assurance that the QA guidelines are being correctly implemented. They also suggest that there is more scope for the development of the relevance of the guidelines with respect to modern FFDM systems. This study has also shown that a summary review of the QA data can be achieved by simple organisation of the QA data storage and by automation of data query and retrieval using commonly available software.
Collapse
Affiliation(s)
- J McCullagh
- Southern Unit, BreastCheck, Infirmary Road, Cork, Ireland
| | | | | | | |
Collapse
|
9
|
McCullagh J. The invisible man -- development of a national men's health training programme for public health practitioners: challenges and successes. Public Health 2011; 125:401-6. [PMID: 21771549 DOI: 10.1016/j.puhe.2011.04.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To develop a national men's health training programme for healthcare and social care practitioners to address gender health inequalities and facilitate the effective delivery of health services to men. STUDY DESIGN A 1-day training course, that combined epidemiological data with the social and behavioural context of men's health behaviour and attitudes, was developed and delivered to 38 public health practitioners working in primary care trusts, local authorities and charities. METHODS A post-training questionnaire was completed by all participants to evaluate the efficacy of the training, levels of satisfaction and impact on future work practice. RESULTS The training was well received and met participants' requirements in terms of content and delivery. The combination of clinical information, practical examples of men's health initiatives and interactive scenario-based tasks increased knowledge and assisted reflective practice. Following the training, all participants intended to adopt a male-gendered approach into their work practice, and stated that they would recommend the course to other public health colleagues. CONCLUSIONS The evaluation highlights the potential of delivering men's health training to increase public health practitioners' knowledge of men's health inequalities, and to promote the development of gender-sensitive services. Future development could incorporate a 'train the trainer' element to maximize capacity building and enhance sustainability. Longer-term follow-up may be required to determine the continuing impact on public health practice.
Collapse
Affiliation(s)
- J McCullagh
- Heart of Mersey, 1st Floor, Burlington House, Crosby Road North, Waterloo L22 0QB, UK.
| |
Collapse
|
10
|
Abstract
The primary purpose of this study was to evaluate the impact of digital mammography screening on breast dose by analysing the results of a patient dose survey of the Irish breast screening programme. Results from the survey were used to determine a dose reference level for the screening programme. Approximately, 100 examinations were acquired for each of the digital mammography systems operational in the screening programme. Each examination consisted of two standard views of each breast. The mean glandular dose for each acquired image was calculated. The dose reference level was established by calculating the 95th percentile of the average mean glandular dose for the average compressed breast thickness of the mediolateral oblique views. The overall average mean glandular dose per examination was 2.72 ± 0.04 mGy. The average compressed breast thickness was 61.4 ± 0.03 mm. The average compression force was 109 ± 7 N. A dose reference level value of 1.75 mGy was established for the screening programme. The results of this clinical dose survey provide a valuable indication of the dose performance of modern full field digital mammographic imaging systems. The results demonstrate clearly the dose benefits of digital mammography. The dose benefit of digital screening was further demonstrated by the establishment of a comparatively lower diagnostic reference level for the screening programme. The comparison of the dose performance of individual X-ray systems with the diagnostic reference level highlights the need for more optimisation within the service.
Collapse
Affiliation(s)
- P Baldelli
- BreastCheck, The National Cancer Screening Service, 36 Eccles Street, Dublin 7, Ireland.
| | | | | | | |
Collapse
|
11
|
Abstract
AIM To evaluate the efficacy of a health promotion initiative on men's knowledge of testicular cancer and self-examination rates. METHOD A quasi-experimental, pre- and post-test questionnaire study of men at 14 workplace and leisure sites across two primary care trusts was undertaken: ten experimental sites received the intervention and four acted as a control. Men at all 14 sites were given a pre- and post-test questionnaire. RESULTS Of the 835 pre-test and 835 post-test questionnaires distributed, 518 (62.0 per cent) and 356 (42.6 per cent) were respectively returned for evaluation. In the intervention group, the median total knowledge score increased from three points (interquartile range: 2,4) at baseline to four points (interquartile range: 2,4) at post-test. However, no statistically significant change was observed in the control group. Post-intervention, the percentage of test participants examining their testicles regularly increased from 58.4 per cent to 68.3 per cent, while levels among control peers did not significantly alter. CONCLUSION This evaluation highlights the potential of using a low-cost initiative which targets innovative venues to improve men's knowledge of testicular cancer and rates of self-examination. Longer-term follow-up may be required to determine whether such increases are sustained.
Collapse
Affiliation(s)
- J McCullagh
- Sefton Health Improvement Support Service, Liverpool.
| | | | | |
Collapse
|
12
|
McCullagh J. Nurses on the leading edge. Nurs BC 2001; 33:8-9. [PMID: 12152570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
|
13
|
Bellis MA, McCullagh J, Thomson R, Regan D, Syed Q, Kelly T. Inequality in funding for AIDS across England threatens regional services. BMJ 1997; 315:950-1. [PMID: 9361559 PMCID: PMC2127613 DOI: 10.1136/bmj.315.7113.950a] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
|
14
|
McCullagh J. Continuing our saga of efforts for coordination of education. RNABC News 1977; 9:14. [PMID: 245010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
|
15
|
McCullagh J. How the association approves B.C.'s basic nursing programs. RNABC News 1977; 9:12. [PMID: 245008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
|
16
|
McCullagh J. The education scene: reality shock may be what's causing problems for new graduates. RNABC News 1977; 9:14-5. [PMID: 585153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
|
17
|
McCullagh J. More background provided in sequel to 'RN2=RN3?'. RNABC News 1976; 8:17. [PMID: 1045445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
|
18
|
McCullagh J. Treatment of Hallux Valgus and Rigidus. West J Med 1936. [DOI: 10.1136/bmj.2.3946.404-c] [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: 11/04/2022]
|