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Goodwin PC, Wright CC, Allan C, Crowther L, Darley C, Heap A, Paul E, White L, Rushton A. Evidence-based development of a post-surgical lumbar discectomy leaflet intervention: a Delphi consensus study. BMJ Open 2015; 5:e006069. [PMID: 25762227 PMCID: PMC4360785 DOI: 10.1136/bmjopen-2014-006069] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To produce free, expert-informed postoperative information for lumbar discectomy patients, satisfying UK National Health Service Information Standards. DESIGN A mixed methods approach utilising the Delphi technique and focus groups. SETTING Five spinal centres across the UK. PARTICIPANTS Panel members included 23 physiotherapists, 11 patients and 17 spinal surgeons. INTERVENTION Three rounds of questionnaires including open and closed questions and attendance at a clinician/patient focus group. RESULTS Response rates of 85%, 26% and 35% were achieved for the Delphi rounds. Ten clinicians and six patients participated in the focus groups. Consensus for leaflet sections was achieved in round 1 and content in round 3. The focus groups informed further revisions. CONCLUSIONS A consensually agreed, Information Standard compliant, patient lumbar discectomy leaflet was produced containing: (1) normal spine anatomy; (2) anatomy disc herniation and surgery; (3) back protection strategies and (4) frequently asked questions. Illustrations of exercises enable tailoring to the individual patient.
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Affiliation(s)
- P C Goodwin
- Department of Health Professions, Manchester Metropolitan University, Manchester, UK
| | - C C Wright
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
| | - C Allan
- Physiotherapy Department, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - L Crowther
- Physiotherapy Department, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - C Darley
- Physiotherapy Department, The Robert Jones and Agnes Hunt Orthopaedic and District Hospital NHS Trust, Oswestry, UK
| | - A Heap
- Physiotherapy Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - E Paul
- Physiotherapy Department, Salford Royal NHS Foundation Trust, Salford, UK
| | - L White
- Physiotherapy Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - A Rushton
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
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Swallow V, Smith T, Webb NJA, Wirz L, Qizalbash L, Brennan E, Birch A, Sinha MD, Krischock L, van der Voort J, King D, Lambert H, Milford DV, Crowther L, Saleem M, Lunn A, Williams J. Distributed expertise: qualitative study of a British network of multidisciplinary teams supporting parents of children with chronic kidney disease. Child Care Health Dev 2015; 41:67-75. [PMID: 24827413 PMCID: PMC4368419 DOI: 10.1111/cch.12141] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/28/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Long-term childhood conditions are often managed by hospital-based multidisciplinary teams (MDTs) of professionals with discipline specific expertise of a condition, in partnership with parents. However, little evidence exists on professional-parent interactions in this context. An exploration of professionals' accounts of the way they individually and collectively teach parents to manage their child's clinical care at home is, therefore, important for meeting parents' needs, informing policy and educating novice professionals. Using chronic kidney disease as an exemplar this paper reports on one aspect of a study of interactions between professionals and parents in a network of 12 children's kidney units in Britain. METHODS We conducted semi-structured, qualitative interviews with a convenience sample of 112 professionals (clinical-psychologists, dietitians, doctors, nurses, pharmacists, play-workers, therapists and social workers), exploring accounts of their parent-educative activity. We analysed data using framework and the concept of distributed expertise. RESULTS Four themes emerged that related to the way expertise was distributed within and across teams: (i) recognizing each other's' expertise, (ii) sharing expertise within the MDT, (iii) language interpretation, and (iv) acting as brokers. Two different professional identifications were also seen to co-exist within MDTs, with participants using the term 'we' both as the intra-professional 'we' (relating to the professional identity) when describing expertise within a disciplinary group (for example: 'As dietitians we aim to give tailored advice to optimize children's growth'), and the inter-professional 'we' (a 'team-identification'), when discussing expertise within the team (for example: 'We work as a team and make sure we're all happy with every aspect of their training before they go home'). CONCLUSIONS This study highlights the dual identifications implicit in 'being professional' in this context (to the team and to one's profession) as well as the unique role that each member of a team contributes to children's care. Our methodology and results have the potential to be transferred to teams managing other conditions.
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Affiliation(s)
- V Swallow
- School of Nursing, Midwifery and Social Work, Faculty of Medical and Human Sciences, Manchester Academic Health Sciences Centre, University of ManchesterManchester, UK,
Correspondence:, Veronica Swallow, School of Nursing, Midwifery and Social Work, Faculty of Medical and Human Sciences, Manchester Academic Health Sciences Centre, University of Manchester, Oxford Road, Manchester M13 9PT, UK, E-mail:
| | - T Smith
- Royal Manchester Children's HospitalManchester, UK
| | - N J A Webb
- Royal Manchester Children's HospitalManchester, UK
| | - L Wirz
- Health Psychology (Old Ward 1 Offices), Royal Victoria InfirmaryNewcastle, UK
| | - L Qizalbash
- The Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle, UK
| | - E Brennan
- Great Ormond Street Children's HospitalLondon, UK
| | - A Birch
- Nephrology, Alder Hey Children's NHS Foundation TrustLiverpool, UK
| | - M D Sinha
- Department of Pediatric Nephrology, Evelina Children's Hospital, Guy's & St Thomas' NHS Foundation TrustLondon, UK
| | - L Krischock
- Sydney Children's HospitalRandwick, NSW, Australia
| | | | - D King
- Yorkhill Children's HospitalGlasgow, UK
| | - H Lambert
- The Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle, UK
| | - D V Milford
- Birmingham Children's HospitalBirmingham, UK
| | - L Crowther
- Royal Manchester Children's Hospital, Central Manchester University Hospitals NHS Foundation TrustManchester, UK
| | - M Saleem
- University of Bristol Children's Renal Unit, Bristol Royal Hospital for ChildrenBristol, UK
| | - A Lunn
- Children's Renal and Urology Unit, Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, QMC CampusNottingham, UK
| | - J Williams
- School of Environment, Education and Development, University of ManchesterUK
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Dienstag JL, Schiff ER, Wright TL, Perrillo RP, Hann HW, Goodman Z, Crowther L, Condreay LD, Woessner M, Rubin M, Brown NA. Lamivudine as initial treatment for chronic hepatitis B in the United States. N Engl J Med 1999; 341:1256-63. [PMID: 10528035 DOI: 10.1056/nejm199910213411702] [Citation(s) in RCA: 1066] [Impact Index Per Article: 42.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND METHODS Although the nucleoside analogue lamivudine has shown promise in patients with chronic hepatitis B, long-term data on patients from the United States are lacking. We randomly assigned previously untreated patients with chronic hepatitis B to receive either 100 mg of oral lamivudine or placebo daily for 52 weeks. We then followed them for an additional 16 weeks to evaluate post-treatment safety and the durability of responses. The primary end point with respect to efficacy was a reduction of at least 2 points in the score on the Histologic Activity Index. On this scale, scores can range from 0 (normal) to 22 (most severe abnormalities). RESULTS Of the 143 randomized patients, 137 were included in the efficacy analysis: 66 in the lamivudine group and 71 in the placebo group. The other six patients were excluded at the base-line visit because of the absence of a documented history of hepatitis B surface antigen for at least six months. After 52 weeks of treatment, lamivudine recipients were more likely than placebo recipients to have a histologic response (52 percent vs. 23 percent, P<0.001), loss of hepatitis B e antigen (HBeAg) in serum (32 percent vs. 11 percent, P=0.003), sustained suppression of serum hepatitis B virus (HBV) DNA to undetectable levels (44 percent vs. 16 percent, P<0.001), and sustained normalization of serum alanine aminotransferase levels (41 percent vs. 7 percent, P<0.001), and they were less likely to have increased hepatic fibrosis (5 percent vs. 20 percent, P=0.01). Lamivudine recipients were also more likely to undergo HBeAg seroconversion, defined as the loss of HBeAg, undetectable levels of serum HBV DNA, and the appearance of antibodies against HBeAg (17 percent vs. 6 percent, P=0.04). HBeAg responses persisted in most patients for 16 weeks after the discontinuation of treatment. Lamivudine was well tolerated. Self-limited post-treatment elevations in serum alanine aminotransferase were more common in lamivudine recipients: 25 percent had serum alanine aminotransferase levels that were at least three times base-line levels, as compared with 8 percent of placebo recipients (P=0.01). The clinical condition of all patients remained stable during the study. CONCLUSIONS In U.S. patients with previously untreated chronic hepatitis B, one year of lamivudine therapy had favorable effects on histologic, virologic, and biochemical features of the disease and was well tolerated. HBeAg responses were generally sustained after treatment.
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Affiliation(s)
- J L Dienstag
- Liver-Biliary-Pancreas Center, Massachusetts General Hospital, and the Department of Medicine, Harvard Medical School, Boston 02114, USA.
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Dienstag JL, Schiff ER, Mitchell M, Casey DE, Gitlin N, Lissoos T, Gelb LD, Condreay L, Crowther L, Rubin M, Brown N. Extended lamivudine retreatment for chronic hepatitis B: maintenance of viral suppression after discontinuation of therapy. Hepatology 1999; 30:1082-7. [PMID: 10498663 DOI: 10.1002/hep.510300427] [Citation(s) in RCA: 150] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
In patients with chronic hepatitis B, brief lamivudine therapy suppresses hepatitis B virus (HBV) DNA but results infrequently in sustained losses of virus replication posttreatment. We evaluated treatment response and its posttreatment durability during up to 18 months of lamivudine therapy (100 mg/d) in 24 patients who had hepatitis B e antigen (HBeAg) despite 1 to 3 months of prior therapy. Therapy was to be stopped after HBeAg loss or seroconversion (acquisition of antibody to HBeAg); posttreatment monitoring continued for 6 months. During therapy, which was well tolerated, HBV DNA became undetectable in all evaluable patients, accompanied by reduced alanine transaminase (ALT) activity. The cumulative 18-month confirmed loss of HBeAg during therapy was 9 of 24 (38%) and seroconversion was 5 of 24 (21%). Therapy was discontinued after HBeAg loss/seroconversion in 7 patients, and HBeAg status was maintained in all. Four of the patients with HBeAg responses lost HBsAg at least once. In 10 (43%) of 23 patients tested, we identified HBV polymerase YMDD mutations, 3 with detectable HBV DNA (2 with ALT elevations) and 7 without virological/biochemical breakthrough. In conclusion, up to 18 months of lamivudine therapy was well tolerated, suppressed HBV replication consistently, and tripled the frequency of HBeAg losses observed during brief-duration therapy; HBeAg loss/seroconversion remained durable posttreatment. The emergence of YMDD-variant HBV was relatively common but occurred typically without reappearance of detectable HBV DNA or ALT elevation. Our observations suggest that lamivudine can be stopped after confirmed HBeAg loss or seroconversion.
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Affiliation(s)
- J L Dienstag
- Gastrointestinal Unit, Liver-Biliary-Pancreas Center, Massachusetts General Hospital, Boston, MA 02114, USA.
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Perrillo R, Rakela J, Dienstag J, Levy G, Martin P, Wright T, Caldwell S, Schiff E, Gish R, Villeneuve JP, Farr G, Anschuetz G, Crowther L, Brown N. Multicenter study of lamivudine therapy for hepatitis B after liver transplantation. Lamivudine Transplant Group. Hepatology 1999; 29:1581-6. [PMID: 10216146 DOI: 10.1002/hep.510290507] [Citation(s) in RCA: 228] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Hepatitis B after liver transplantation is often fatal, and no proven medical therapy exists for this condition. We chose to study the potential efficacy of lamivudine therapy for patients with chronic hepatitis B after liver transplantation. Fifty-two patients with chronic hepatitis B after liver transplantation were treated in an open label, multicenter study. Each had detectable hepatitis B virus (HBV) DNA in serum and 45 (87%) had detectable serum hepatitis B e antigen before treatment. Patients were treated for 52 weeks with lamivudine (100 mg daily). The primary endpoint was undetectability of HBV DNA; secondary endpoints included normalization of serum alanine transaminase (ALT) levels, disappearance of hepatitis B e antigen, and improvement in liver histology. After treatment, 60% of patients had undetectable HBV DNA by solution hybridization assay, 14 (31%) of the initially positive patients lost hepatitis B e antigen; hepatitis B surface antigen was undetectable in 3 (6%); and serum ALT levels normalized in 71%. Blinded histological assessments showed improvement in the histological activity index (P =.007 for periportal necrosis,.001 for lobular necrosis, and.013 for portal inflammation). YMDD variants of HBV, potentially associated with drug resistance, were detected in 14 (27%) of the patients. Repeat liver biopsies in 7 patients with the mutated virus were unchanged in 2, improved in 2, and worse in 3. We conclude that lamivudine is a potentially effective therapy for hepatitis B after liver transplantation.
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Affiliation(s)
- R Perrillo
- Section of Gastroenterology, Ochsner Clinic, New Orleans, LA 70121, USA.
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Crowther L. A New Lining for Vulcanite Plates. Am J Dent Sci 1893; 26:564-565. [PMID: 30749589 PMCID: PMC6061308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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