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Abayomi J, Charnley M, Stone G, Lane K, Stevenson L, Davies I, Webb R. Editorial: nutrition at key stages of the lifecycle. Proc Nutr Soc 2024:1-7. [PMID: 38240093 DOI: 10.1017/s0029665124000089] [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] [Indexed: 02/16/2024]
Abstract
Nutritional requirements of individuals vary across the lifecycle, according to activity, age and gender. To optimize human health, consideration of nutritional priorities at each stage is needed. This conference brought together multidisciplinary experts in maternal and child nutrition and health, cardiometabolic and plant-based nutrition and dietitians involved in the care of vulnerable populations, plus nutritional metabolism, health and ageing. The presentations highlighted the most important nutrition research in these areas, updating knowledge and suggesting how dietary advice and policy could be adapted to incorporate research findings. With the global increase in non-communicable disease (NCD) and nutrition being considered as a key modifiable risk factor for the prevention and management of NCD, this conference was much needed.
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Affiliation(s)
- Julie Abayomi
- School of Medicine & Nutrition, Faculty of Health, Social Care and Medicine, Edge Hill University, OrmskirkL39 4PQ, UK
| | - Margaret Charnley
- School of Health & Sport Sciences, Liverpool Hope University, Liverpool, UK
| | - Genevieve Stone
- School of Medicine & Nutrition, Faculty of Health, Social Care and Medicine, Edge Hill University, OrmskirkL39 4PQ, UK
| | - Katie Lane
- Research Institute for Sport and Exercise Sciences (RISES), Faculty of Science, Liverpool John Moores University, Liverpool, UK
| | - Leo Stevenson
- School of Health & Sport Sciences, Liverpool Hope University, Liverpool, UK
| | - Ian Davies
- Research Institute for Sport and Exercise Sciences (RISES), Faculty of Science, Liverpool John Moores University, Liverpool, UK
| | - Richard Webb
- School of Health & Sport Sciences, Liverpool Hope University, Liverpool, UK
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Stevenson L, Yu A, Haughey S, Barry H. Delivery of the Dementia Friends programme on the MPharm degree course: a qualitative exploration of pharmacy students’ perspectives. International Journal of Pharmacy Practice 2021. [DOI: 10.1093/ijpp/riab015.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Introduction
A person-centred approach to dementia care has been advocated1, but limited literature exists on integration of this into pharmacist undergraduate education. The Alzheimer’s Society Dementia Friends programme was developed to change peoples’ perceptions and promote understanding of living with dementia. In 2019, the School piloted provision of Dementia Friends training; Level 3 MPharm students (n=102) were invited by email to participate as an optional part of a Clinical Therapeutics module. Sixty-three students (61.8%) attended the workshop, which combined Dementia Friends training with an interactive session facilitated by a person living with dementia (PLWD).
Aim
To explore undergraduate pharmacy students’ views and experiences of the Dementia Friends pilot.
Methods
All students who had attended the workshop were invited by email to participate in a focus group during February 2020. Participants provided written informed consent. The topic guide focused on students’ views of workshop delivery, improvements that could be made, their understanding of person-centred care, and the impact of the workshop on their clinical practice. The focus group was audio-recorded, transcribed verbatim, and analysed using thematic analysis.
Results
One focus group was conducted with eight students. Three overarching themes were identified: learning from an expert patient; importance of person-centred care; and dementia education during MPharm degree. Students valued the opportunity to learn from a PLWD and felt it allowed them to relate the condition to a real person: “it felt more personal so you could really connect with them [PLWD] and understand their experience”. Hearing about the ‘lived experience’ helped to contextualise learning from other methods of delivery, e.g. lectures: “you don’t know what’s going on in someone else’s life, and sometimes we’re all a bit quick to judge, I think [the workshop] put that into perspective”. Students described having greater understanding of person-centred care and taking a holistic approach to pharmaceutical care provision for PLWD: “it’s very important to take into account their quality of life…we can focus on the clinical but looking at the person as a whole actually helps their treatment” and “one of the things I found most interesting was that they might not remember the interaction but they will [retain] the feeling or emotion”. Students reported feeling more confident in engaging with PLWD following the workshop, which is something they would not have had the opportunity to learn from lectures alone: “If we hadn’t had that dementia training, I feel like I would still have no confidence chatting to dementia patients”. Students suggested that future Dementia Friends training should be delivered earlier in the MPharm degree course.
Conclusion
This study has shown that Dementia Friends training complemented students’ existing knowledge of dementia and increased their confidence to communicate with PLWD. The use of an expert patient was an effective way of supporting MPharm students to develop a person-centred approach to their professional practice. The study was limited to one university so findings may not be generalisable. However, these data provide a good basis for future development and evaluation of Dementia Friends training provision to MPharm students.
References
1. Kitwood, T. M. Dementia reconsidered: the person comes first. 1997. Buckingham [England], Open University Press
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Affiliation(s)
- L Stevenson
- School of Pharmacy, Queen’s University Belfast, Belfast, UK
| | - A Yu
- School of Pharmacy, Queen’s University Belfast, Belfast, UK
| | - S Haughey
- School of Pharmacy, Queen’s University Belfast, Belfast, UK
| | - H Barry
- School of Pharmacy, Queen’s University Belfast, Belfast, UK
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Nichols M, Stevenson L, Koski L, Basler C, Wise M, Whitlock L, Francois Watkins L, Friedman CR, Chen J, Tagg K, Joseph L, Caidi H, Patel K, Tolar B, Hise K, Classon A, Ceric O, Reimschuessel R, Williams IT. Detecting national human enteric disease outbreaks linked to animal contact in the United States of America. REV SCI TECH OIE 2020; 39:471-480. [PMID: 33046928 DOI: 10.20506/rst.39.2.3098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Enteric pathogens, such as non-typhoidal Salmonella, Campylobacter and Escherichia coli, can reside in the intestinal tract of many animals, including livestock, companion animals, small mammals and reptiles. Often, these animals can appear healthy; nonetheless, humans can become infected after direct or indirect contact, resulting in a substantial illness burden. An estimated 14% of the 3.2 million illnesses that occur in the United States of America (USA) each year from such enteric pathogens are attributable to animal contact. Surveillance for enteric pathogens in the USA includes the compilation and interpretation of both laboratory and epidemiologic data. However, the authors feel that a collaborative, multisectoral and transdisciplinary - or One Health - approach is needed for data collection and analysis, at every level. In addition, they suggest that the future of enteric illness surveillance lies in the development of improved technologies for pathogen detection and characterisation, such as genomic sequencing and metagenomics. In particular, using whole-genome sequencing to compare genetic sequences of enteric pathogens from humans, food, animals and the environment, can help to predict antimicrobial resistance among these pathogens, determine their genetic relatedness and identify outbreaks linked to a common source. In this paper, the authors describe three recent, multi-state human enteric illness outbreaks linked to animal contact in the USA and discuss how integrated disease surveillance was essential to outbreak detection and response. Additional datasharing between public health and animal health laboratories and epidemiologists at the local, national, regional and international level may help to improve surveillance for emerging animal and human health threats and lead to new opportunities for prevention.
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Douglas R, McKinney C, Stevenson L, Cairns L, Kennedy R, Blayney J, Turkington R. Hypoxia gene expression defines a poor prognostic sub-group in oesophageal adenocarcinoma. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy282.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Lowe J, Stevenson L, Wilding D, McLaughlin D, West M. 5 The fluro project: a review of the approach and understanding of fluid resuscitation in a military tertiary centre from the perspective of care providers in the emergency setting. J ROY ARMY MED CORPS 2018. [DOI: 10.1136/jramc-2018-000959.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
IntroductionThe term fluid resuscitation (FR) is defined as the use of fluids to restore a state of normovolaemia, or to correct a hypovolaemic state. To establish normovolaeamia via FR, the term ‘fluid bolus’ is used to describe a prescribed fluid volume. As such, the authors looked to investigate the understanding of this term and to review approaches to fluid resuscitation by those healthcare workers closely associate with critically unwell patients.MethodsA questionnaire was distributed to all clinical staff across Emergency Medicine (EM), Anaesthesia and Theatres (AT), Intensive Care Medicine (ICM) and Acute Medicine (AM). The questionnaire recorded role, area of responsibility, training grade, type, volume and administration time, time to reassessment and parameters to be assessed in relation to a clinical vignette. The results were then compared directly to the NICE Clinical Audit Standards (NCAS) for FR.Results153 responses were received from across all working environments. Overall, 52% of respondents gave volumes aligned with NCAS (500 ml). 99% of respondents suggested crystalloid use with 88% giving an appropriate time for administration of less than 15 min. 55% of respondents suggested appropriate review times (0–5 min). 99% of respondents agreed heart rate and blood pressure should be reassessed, but other parameters for monitoring were poorly recognised.Between specialties, EM suggested larger volumes while ICM were more likely to continuously review the patient during a bolus. AM were the only group to administer fluids over 60 min. EM and ICM were more likely to review lactate as a marker for effect. Higher specialist trainees were more likely to give a larger volume when compared to other grades.DiscussionThe overall perception of a fluid bolus varies between specialties and training grades. Most responses were aligned to NCAS with notable outliers. This suggests a discrepancy in the understanding of the term fluid bolus. This may also cause issues in fluid administration with multiple patients. It is therefore suggested that further work be undertaken on clarifying the term ‘fluid bolus’, aiming to minimise uncertainty and increase understanding to prevent adverse effects.
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Werth V, Merola J, Furie R, Reynolds T, Stevenson L, Wang W, Musselli C, Christmann R, Hamann S, Zhang X, Barbey C, Rabah D, Franchimont N. 1081 BIIB059, a monoclonal antibody targeting BDCA2, decreases Type I Interferon-related genes transcriptional activity in subjects with systemic lupus erythematosus (SLE) and active cutaneous LE (CLE). J Invest Dermatol 2018. [DOI: 10.1016/j.jid.2018.03.1094] [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: 11/30/2022]
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Gambino-Shirley K, Stevenson L, Concepción-Acevedo J, Trees E, Wagner D, Whitlock L, Roberts J, Garrett N, Van Duyne S, McAllister G, Schick B, Schlater L, Peralta V, Reporter R, Li L, Waechter H, Gomez T, Fernández Ordenes J, Ulloa S, Ragimbeau C, Mossong J, Nichols M. Flea market finds and global exports: Four multistate outbreaks of human Salmonella infections linked to small turtles, United States-2015. Zoonoses Public Health 2018; 65:560-568. [PMID: 29577654 DOI: 10.1111/zph.12466] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Indexed: 11/28/2022]
Abstract
Zoonotic transmission of Salmonella infections causes an estimated 11% of salmonellosis annually in the United States. This report describes the epidemiologic, traceback and laboratory investigations conducted in the United States as part of four multistate outbreaks of Salmonella infections linked to small turtles. Salmonella isolates indistinguishable from the outbreak strains were isolated from a total of 143 ill people in the United States, pet turtles, and pond water samples collected from turtle farm A, as well as ill people from Chile and Luxembourg. Almost half (45%) of infections occurred in children aged <5 years, underscoring the importance of the Centers for Disease Control and Prevention recommendation to keep pet turtles and other reptiles out of homes and childcare settings with young children. Although only 43% of the ill people who reported turtle exposure provided purchase information, most small turtles were purchased from flea markets or street vendors, which made it difficult to locate the vendor, trace the turtles to a farm of origin, provide education and enforce the United States federal ban on the sale and distribution of small turtles. These outbreaks highlight the importance of improving public awareness and education about the risk of Salmonella from small turtles not only in the United States but also worldwide.
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Affiliation(s)
- K Gambino-Shirley
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - L Stevenson
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - J Concepción-Acevedo
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - E Trees
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - D Wagner
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - L Whitlock
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - J Roberts
- Louisiana Department of Agriculture & Forestry, Office of Animal Health & Food Safety, Baton Rouge, LA, USA
| | - N Garrett
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - S Van Duyne
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - G McAllister
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - B Schick
- Service Center 4, USDA, APHIS, Veterinary Services, Oklahoma City, OK, USA
| | - L Schlater
- Diagnostic Bacteriology Laboratory, National Veterinary Services Laboratories, Ames, IA, USA
| | - V Peralta
- California Department of Public Health, Richmond, CA, USA
| | - R Reporter
- Los Angeles County Department of Public Health, Los Angeles, CA, USA
| | - L Li
- New York City Department of Health & Mental Hygiene, Long Island City, NY, USA
| | - H Waechter
- New York City Department of Health & Mental Hygiene, Long Island City, NY, USA
| | - T Gomez
- USDA, APHIS, Veterinary Services Liaison to CDC, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - S Ulloa
- Instituto de Salud Pública de Chile, Santiago-Chile, Chile
| | - C Ragimbeau
- Laboratoire National de Santé, Dudelange, Luxembourg
| | - J Mossong
- Laboratoire National de Santé, Dudelange, Luxembourg
| | - M Nichols
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Curran KG, Heiman Marshall KE, Singh T, Doobovsky Z, Hensley J, Melius B, Whitlock L, Stevenson L, Leinbach J, Oltean H, Glover WA, Kunesh T, Lindquist S, Williams I, Nichols M. An outbreak of Escherichia coli O157:H7 infections following a dairy education school field trip in Washington state, 2015. Epidemiol Infect 2018; 146:442-449. [PMID: 29271327 PMCID: PMC9134535 DOI: 10.1017/s0950268817002862] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 10/30/2017] [Accepted: 11/21/2017] [Indexed: 11/07/2022] Open
Abstract
On 27 April 2015, Washington health authorities identified Escherichia coli O157:H7 infections associated with dairy education school field trips held in a barn 20-24 April. Investigation objectives were to determine the magnitude of the outbreak, identify the source of infection, prevent secondary illness transmission and develop recommendations to prevent future outbreaks. Case-finding, hypothesis generating interviews, environmental site visits and a case-control study were conducted. Parents and children were interviewed regarding event activities. Odds ratios (OR) and 95% confidence intervals (CI) were computed. Environmental testing was conducted in the barn; isolates were compared to patient isolates using pulsed-field gel electrophoresis (PFGE). Sixty people were ill, 11 (18%) were hospitalised and six (10%) developed haemolytic uremic syndrome. Ill people ranged in age from <1 year to 47 years (median: 7), and 20 (33%) were female. Twenty-seven case-patients and 88 controls were enrolled in the case-control study. Among first-grade students, handwashing (i.e. soap and water, or hand sanitiser) before lunch was protective (adjusted OR 0.13; 95% CI 0.02-0.88, P = 0.04). Barn samples yielded E. coli O157:H7 with PFGE patterns indistinguishable from patient isolates. This investigation provided epidemiological, laboratory and environmental evidence for a large outbreak of E. coli O157:H7 infections from exposure to a contaminated barn. The investigation highlights the often overlooked risk of infection through exposure to animal environments as well as the importance of handwashing for disease prevention. Increased education and encouragement of infection prevention measures, such as handwashing, can prevent illness.
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Affiliation(s)
- K. G. Curran
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - T. Singh
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Z. Doobovsky
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - J. Hensley
- Whatcom County Health Department, Bellingham, WA, USA
| | - B. Melius
- Washington State Department of Health, Shoreline, WA, USA
| | - L. Whitlock
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - L. Stevenson
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
| | - J. Leinbach
- Whatcom County Health Department, Bellingham, WA, USA
| | - H. Oltean
- Washington State Department of Health, Shoreline, WA, USA
| | - W. A. Glover
- Washington State Public Health Laboratories, Shoreline, WA, USA
| | - T. Kunesh
- Whatcom County Health Department, Bellingham, WA, USA
| | - S. Lindquist
- Washington State Department of Health, Shoreline, WA, USA
| | - I. Williams
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - M. Nichols
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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Bush L, Stevenson L, Lane KE. The oxidative stability of omega-3 oil-in-water nanoemulsion systems suitable for functional food enrichment: A systematic review of the literature. Crit Rev Food Sci Nutr 2017; 59:1154-1168. [DOI: 10.1080/10408398.2017.1394268] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Linda Bush
- Liverpool John Moores University, School of Sport Studies, Leisure and Nutrition, I.M. Marsh Campus, Liverpool, L17 6BD, United Kingdom
| | - Leo Stevenson
- Liverpool John Moores University, School of Sport Studies, Leisure and Nutrition, I.M. Marsh Campus, Liverpool, L17 6BD, United Kingdom
| | - Katie E. Lane
- Liverpool John Moores University, School of Sport Studies, Leisure and Nutrition, I.M. Marsh Campus, Liverpool, L17 6BD, United Kingdom
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Elder D, Ferguson S, Fyfe K, Stevenson L, Robertson A. 073_16786 Experience Of A Cardiac Physiologist-Led Implantable Loop Recorder Insertion Service. JACC Clin Electrophysiol 2017. [DOI: 10.1016/j.jacep.2017.09.170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Kittleson M, Shah P, Lala A, McLean R, Pamboukian S, Horstmanshof D, Thibodeau J, Shah K, Lanfear D, Teuteberg J, Taddei-Peters W, Khalatbari S, Stevenson L, Mann D, Aaronson K, Stewart G. Painting Profiles of Ambulatory Advanced Heart Failure: A Report from the REVIVAL Registry. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.446] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Ambardekar A, Thibodeau J, DeVore A, Kittleson M, Forde-McLean R, Palardy M, Mountis M, Cadaret L, Teuteberg J, Pamboukian S, Stevenson L, Xie R, Stewart G. Slow Gait Speed Linked to More Severe Disease but Not with Early Events in Ambulatory Advanced Heart Failure: Results from the Medical Arm of Mechanically Assisted Circulatory Support (MedaMACS) Registry. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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13
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Lala A, Ambardekar A, Estep J, Stehlik J, Mountis M, Haas D, Horstmanshof D, Thibodeau J, Shah K, Lanfear D, Teuteberg J, Taddei-Peters W, Khalatbari S, Stevenson L, Mann D, Aaronson K, Stewart G. Slower Gait Speed as a Measure of Frailty Tracks with INTERMACS Profiles, Quality of Life and Predicted Mortality in Ambulatory Patients with Advanced Heart Failure: A Report from the REVIVAL Registry. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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14
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Ambardekar V, Kittleson M, Palardy M, Mountis M, Forde-McLean R, DeVore A, Pamboukian S, Thibodeau J, Teuteberg J, Cadaret L, Xie R, Stevenson L, Stewart G. Advanced Therapy Utilization and Survival in Ambulatory Patients with Advanced Heart Failure: Results from the Medical Arm of Mechanically Assisted Circulatory Support (MedaMACS) Registry. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.508] [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: 11/30/2022] Open
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15
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McQuilten ZK, Zatta AJ, Andrianopoulos N, Aoki N, Stevenson L, Badami KG, Bird R, Cole-Sinclair MF, Hurn C, Cameron PA, Isbister JP, Phillips LE, Wood EM. Evaluation of clinical coding data to determine causes of critical bleeding in patients receiving massive transfusion: a bi-national, multicentre, cross-sectional study. Transfus Med 2016; 27:114-121. [PMID: 27966239 DOI: 10.1111/tme.12377] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 10/26/2016] [Accepted: 10/31/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To evaluate the use of routinely collected data to determine the cause(s) of critical bleeding in patients who receive massive transfusion (MT). BACKGROUND Routinely collected data are increasingly being used to describe and evaluate transfusion practice. MATERIALS/METHODS Chart reviews were undertaken on 10 randomly selected MT patients at 48 hospitals across Australia and New Zealand to determine the cause(s) of critical bleeding. Diagnosis-related group (DRG) and International Classification of Diseases (ICD) codes were extracted separately and used to assign each patient a cause of critical bleeding. These were compared against chart review using percentage agreement and kappa statistics. RESULTS A total of 427 MT patients were included with complete ICD and DRG data for 427 (100%) and 396 (93%), respectively. Good overall agreement was found between chart review and ICD codes (78·3%; κ = 0·74, 95% CI 0·70-0·79) and only fair overall agreement with DRG (51%; κ = 0·45, 95% CI 0·40-0·50). Both ICD and DRG were sensitive and accurate for classifying obstetric haemorrhage patients (98% sensitivity and κ > 0·94). However, compared with the ICD algorithm, DRGs were less sensitive and accurate in classifying bleeding as a result of gastrointestinal haemorrhage (74% vs 8%; κ = 0·75 vs 0·1), trauma (92% vs 62%; κ = 0·78 vs 0·67), cardiac (80% vs 57%; κ = 0·79 vs 0·60) and vascular surgery (64% vs 56%; κ = 0·69 vs 0·65). CONCLUSION Algorithms using ICD codes can determine the cause of critical bleeding in patients requiring MT with good to excellent agreement with clinical history. DRG are less suitable to determine critical bleeding causes.
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Affiliation(s)
- Z K McQuilten
- Transfusion Research Unit, Monash University, Melbourne, Australia.,Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Monash University, Melbourne, Australia
| | - A J Zatta
- Transfusion Research Unit, Monash University, Melbourne, Australia.,Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Monash University, Melbourne, Australia
| | - N Andrianopoulos
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - N Aoki
- Transfusion Research Unit, Monash University, Melbourne, Australia
| | - L Stevenson
- Barwon Health, University Hospital Geelong, Geelong, Australia
| | - K G Badami
- New Zealand Blood Service, Christchurch, New Zealand
| | - R Bird
- Princess Alexandra Hospital, Brisbane, Queensland.,School of Medicine, Griffith University, Brisbane, Australia
| | - M F Cole-Sinclair
- Department of Haematology, St Vincent's Hospital, Melbourne, Australia
| | - C Hurn
- School of Medicine, University of Queensland, Brisbane, Australia
| | - P A Cameron
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - J P Isbister
- Royal North Shore Hospital, The University of Sydney, Sydney, Australia
| | - L E Phillips
- Transfusion Research Unit, Monash University, Melbourne, Australia
| | - E M Wood
- Transfusion Research Unit, Monash University, Melbourne, Australia
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Stevenson L, Cairns L, Douglas R, McCabe N, Gavory G, Harrison T, Kennedy R, Turkington R. Targeting Akt in oesophageal adenocarcinoma. Eur J Cancer 2016. [DOI: 10.1016/s0959-8049(16)33032-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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17
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Tan KYM, van der Beek EM, Chan MY, Zhao X, Stevenson L. Health claims on food products in Southeast Asia: regulatory frameworks, barriers, and opportunities. Nutr Rev 2016; 73:634-41. [PMID: 26269489 DOI: 10.1093/nutrit/nuv029] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The Association of Southeast Asian Nations aims to act as a single market and allow free movement of goods, services, and manpower. The purpose of this article is to present an overview of the current regulatory framework for health claims in Southeast Asia and to highlight the current barriers and opportunities in the regulatory frameworks in the Association of Southeast Asian Nations. To date, 5 countries in Southeast Asia, i.e., Indonesia, Malaysia, the Philippines, Singapore, and Thailand, have regulations and guidelines to permit the use of health claims on food products. There are inconsistencies in the regulations and the types of evidence required for health claim applications in these countries. A clear understanding of the regulatory frameworks in these countries may help to increase trade in this fast-growing region and to provide direction for the food industry and the regulatory community to develop and market food products with better nutritional quality tailored to the needs of Southeast Asian consumers.
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Affiliation(s)
- Karin Y M Tan
- K.Y.M. Tan and M.Y. Chan are with the Human Nutrition Research Centre, Newcastle University, Singapore, Republic of Singapore. E.M.v.d.Beek is with Nutricia Research, Danone-Nutricia Early Life Nutrition, Singapore, Republic of Singapore. X.J. Zhao is with Nutricia Early Life Nutrition (Shanghai) Co., Ltd, Pudong, Shanghai, People's Republic of China. L. Stevenson is with the Nutrition & Health Research Group, Liverpool John Moores University, Aigburth, Liverpool, United Kingdom.
| | - Eline M van der Beek
- K.Y.M. Tan and M.Y. Chan are with the Human Nutrition Research Centre, Newcastle University, Singapore, Republic of Singapore. E.M.v.d.Beek is with Nutricia Research, Danone-Nutricia Early Life Nutrition, Singapore, Republic of Singapore. X.J. Zhao is with Nutricia Early Life Nutrition (Shanghai) Co., Ltd, Pudong, Shanghai, People's Republic of China. L. Stevenson is with the Nutrition & Health Research Group, Liverpool John Moores University, Aigburth, Liverpool, United Kingdom
| | - M Y Chan
- K.Y.M. Tan and M.Y. Chan are with the Human Nutrition Research Centre, Newcastle University, Singapore, Republic of Singapore. E.M.v.d.Beek is with Nutricia Research, Danone-Nutricia Early Life Nutrition, Singapore, Republic of Singapore. X.J. Zhao is with Nutricia Early Life Nutrition (Shanghai) Co., Ltd, Pudong, Shanghai, People's Republic of China. L. Stevenson is with the Nutrition & Health Research Group, Liverpool John Moores University, Aigburth, Liverpool, United Kingdom
| | - Xuejun Zhao
- K.Y.M. Tan and M.Y. Chan are with the Human Nutrition Research Centre, Newcastle University, Singapore, Republic of Singapore. E.M.v.d.Beek is with Nutricia Research, Danone-Nutricia Early Life Nutrition, Singapore, Republic of Singapore. X.J. Zhao is with Nutricia Early Life Nutrition (Shanghai) Co., Ltd, Pudong, Shanghai, People's Republic of China. L. Stevenson is with the Nutrition & Health Research Group, Liverpool John Moores University, Aigburth, Liverpool, United Kingdom
| | - Leo Stevenson
- K.Y.M. Tan and M.Y. Chan are with the Human Nutrition Research Centre, Newcastle University, Singapore, Republic of Singapore. E.M.v.d.Beek is with Nutricia Research, Danone-Nutricia Early Life Nutrition, Singapore, Republic of Singapore. X.J. Zhao is with Nutricia Early Life Nutrition (Shanghai) Co., Ltd, Pudong, Shanghai, People's Republic of China. L. Stevenson is with the Nutrition & Health Research Group, Liverpool John Moores University, Aigburth, Liverpool, United Kingdom
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Affiliation(s)
- E. M. Wood
- Transfusion Research Unit; Monash University; Melbourne Vic. Australia
- Department of Health Victoria; Serious Transfusion Incident Reporting (STIR) system; Blood Matters Programme; Melbourne Vic. Australia
| | - L. Stevenson
- Department of Health Victoria; Serious Transfusion Incident Reporting (STIR) system; Blood Matters Programme; Melbourne Vic. Australia
| | - L. Bielby
- Department of Health Victoria; Serious Transfusion Incident Reporting (STIR) system; Blood Matters Programme; Melbourne Vic. Australia
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Langley R, Coyle C, Gilbert D, Rowley S, Murphy C, Stevenson L, Cameron D, Parmar M, Wilson R. Are the Benefits of Aspirin in Colorectal Cancer Limited to PIK3CA Mutated Cancers? Ann Oncol 2014. [DOI: 10.1093/annonc/mdu193.12] [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: 11/13/2022] Open
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20
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Anderson MA, Glazebrook B, Cutts B, Stevenson L, Bielby L, Borosak M. When do we transfuse cryoprecipitate? Intern Med J 2014; 43:896-902. [PMID: 23425520 DOI: 10.1111/imj.12104] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2012] [Accepted: 02/08/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND The 2001 National Health and Medical Research Council/Australasian Society of Blood Transfusion Clinical Practice Guidelines for cryoprecipitate are being updated, and cryoprecipitate has been incorporated into new Patient Blood Management modules. AIMS This clinical audit sought to clarify current cryoprecipitate use in Victoria, Tasmania and the Australian Capital Territory; assess adherence to guidelines; and gain insights into deviations from recommended practice. This information can be utilised in updating guidelines to make them more relevant, to identify areas for clinician education and to form a baseline of practice prior to release of the 2011 guidelines. METHODS Participating institutions were invited to audit up to 30 consecutive episodes of cryoprecipitate transfusion over an 11-month period in 2008. The audits were conducted using a standardised pro forma and involved review of patient records. These were collated electronically using algorithms to determine alignment versus non-alignment with guidelines. RESULTS Cryoprecipitate is used in a variety of situations with surgery accounting for the highest volume. Twenty-six per cent (26%) of transfusions were aligned with 2001 guidelines rising to 61% with a modified fibrinogen trigger. Fibrinogen levels did not appear to dictate all clinical decisions regarding cryoprecipitate use perhaps owing to the acuity of many cases. Additional bleeding risk together with low fibrinogen levels (e.g. thrombocytopenic patients) may contribute to empiric cryoprecipitate use. CONCLUSIONS These results highlight discrepancies between guidelines and practice, providing rationale for the update of the guidelines that is currently underway. Cryoprecipitate has attendant risks, and it is appropriate that transfusion be restricted to situations with good evidence or sound principles to underpin use.
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Affiliation(s)
- M A Anderson
- Transfusion Medicine, Australian Red Cross Blood Service, Melbourne, Victoria, Australia
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21
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Thomas MP, Avula SK, England R, Stevenson L. Appendicitis in a Spigelian hernia: an unusual cause for a tender right iliac fossa mass. Ann R Coll Surg Engl 2013; 95:e66-8. [PMID: 23676802 DOI: 10.1308/003588413x13511609957731] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [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
Spigelian hernias are a rare type of hernia through the Spigelian aponeurosis, whose contents commonly include omentum or small bowel. In the absence of incarceration or strangulation, they can be difficult to diagnose clinically. In the emergency setting, they can present rarely as a painful abdominal mass and computed tomography provides a reliable diagnostic imaging modality. We report an emergency presentation of a Spigelian hernia containing the appendix.
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Affiliation(s)
- M P Thomas
- North Cumbria University Hospitals NHS Trust, UK.
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22
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Okines AFC, Langley RE, Thompson LC, Stenning SP, Stevenson L, Falk S, Seymour M, Coxon F, Middleton GW, Smith D, Evans L, Slater S, Waters J, Ford D, Hall M, Iveson TJ, Petty RD, Plummer C, Allum WH, Blazeby JM, Griffin M, Cunningham D. Bevacizumab with peri-operative epirubicin, cisplatin and capecitabine (ECX) in localised gastro-oesophageal adenocarcinoma: a safety report. Ann Oncol 2012; 24:702-9. [PMID: 23108952 DOI: 10.1093/annonc/mds533] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Peri-operative chemotherapy and surgery is a standard treatment of localised oesophagogastric adenocarcinoma; however, the outcomes remain poor. PATIENTS AND METHODS ST03 is a multicentre, randomised, phase II/III study comparing peri-operative ECX with or without bevacizumab (ECX-B). The primary outcome measure of phase II (n = 200) was safety, specifically gastrointestinal (GI) perforation rates and cardiotoxicity. RESULTS Two hundred patients were randomised between October 2007 and April 2010. Ninety-one/101 (90%) ECX and 86/99 (87%) ECX-B patients completed pre-operative chemotherapy; 7 ECX and 9 ECX-B patients stopped due to toxicity. Gastrointestinal perforations (3 ECX, 1 ECX-B), cardiac events (1 ECX, 4 ECX-B) and venous thromboembolic events (VTEs, 8 ECX, 7 ECX-B) were uncommon. Arterial thromboembolic events (ATEs, myocardial infarction (MI) or cerebrovascular accident) were more frequent with ECX-B (5 versus 1 with ECX). Delayed wound healing, anastomotic leaks and GI bleeding rates were similar. More asymptomatic left ventricular ejection fraction (LVEF) falls (≥15% and/or to <50%) occurred with ECX-B (21.2% versus 11.1% with ECX). Clinically significant falls (≥10% to below lower limit of normal, LLN) occurred in (15.3%) and (8.9%) respectively, with no associated cardiac failure (median 22 months follow-up). CONCLUSIONS Addition of bevacizumab to peri-operative ECX chemotherapy is feasible with acceptable toxicity and no negative impact on surgical outcomes.
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Affiliation(s)
- A F C Okines
- Department of Medicine, The Royal Marsden Hospital NHS Foundation Trust London & Surrey SM2 5PT, London
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Jackson A, Stevenson L, Coggeshall P, Whitman TJ. A Patient Returning from Africa Finds a Mass Imbedded in the Skin of Her Right Foot. Clin Infect Dis 2012. [DOI: 10.1093/cid/cis609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
Wheat bran is a concentrated source of insoluble fibre. Fibre intakes are generally lower than recommendations. This paper reviews the physiological effects of wheat bran and the health benefits it may provide in terms of the prevention of diseases such as colon and breast cancers, cardiovascular disease, obesity and gastrointestinal diseases. In recognition of the weight of evidence, the European Food Safety Authority has recently approved two health claims for wheat bran and gastrointestinal health.
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Affiliation(s)
- Leo Stevenson
- Food & Nutrition Research Group, Faculty of Education, Community & Leisure, Liverpool John Moores University, Liverpool, UK
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Stevenson L, Baker A, Littler J, Mayles H, Reilly A, Scott A, Jain P. PO-0776 DOSIMETRIC IMPACT OF GEOMETRIC UNCERTAINTIES IN SABR FOR EARLY LUNG CANCER TO THE TUMOUR AND OARS. Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)71109-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Grady K, Naftel D, Stevenson L, Dew M, Weidner G, Pagani F, Kirklin J, Myers S, Baldwin J, Shah M, Young J. 28 Improvement in Quality of Life after Left Ventricular Assist Device Implant Is Similar, Regardless of Baseline Severity of Heart Failure. J Heart Lung Transplant 2012. [DOI: 10.1016/j.healun.2012.01.031] [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: 10/28/2022] Open
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27
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Teuteberg J, Stewart G, Jessup M, Kormos R, Sun B, Frazier O, Naftel D, Stevenson L. 3 Implant Strategies for Continuous Flow LVAD Therapy in INTERMACS – Impact on Outcomes and Variability over Time. J Heart Lung Transplant 2012. [DOI: 10.1016/j.healun.2012.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Okines AFC, Langley RE, Thompson LC, Stenning SP, Stevenson L, Falk S, Seymour MT, Coxon FY, Middleton GW, Smith D, Evans L, Slater S, Waters JS, Ford D, Hall M, Iveson T, Petty RD, Plummer C, Allum W, Cunningham D. Safety results from a randomized trial of perioperative epirubicin, cisplatin plus capecitabine (ECX) with or without bevacizumab (B) in patients (pts) with gastric or type II/III oesophagogastric junction (OGJ) adenocarcinoma. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.4092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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30
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Turkington RC, Allen WL, Stevenson L, Coyle V, Jithesh PV, Proutski I, Fenning C, Stewart G, Van Schaeybroeck S, Longley D, Johnston PG. Inhibition of FGFR4 increases oxaliplatin and 5-fluorouracil sensitivity in Kras wild-type and mutant colorectal cancer cells. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e14087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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32
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Ling L, Amirahmadi F, Foster A, Khammy O, Stevenson L, Buxton K, Zhang L, dos Remedios C, Chen C, Kaye D. Impact of Atrial Fibrillation on Ventricular Calcium Handling and Contractile Function: The Role of Irregularity. Heart Lung Circ 2010. [DOI: 10.1016/j.hlc.2010.06.875] [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: 12/01/2022]
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Abstract
We report three cases of thyrotoxicosis who presented acutely with headache to our neurology service in a 1-year period. In two of these patients there was a pre-existing or subsequent history of migraine. With hindsight, there were other clinical features of thyrotoxicosis but this diagnosis had been missed in primary care. Severe headache can be a striking presenting feature of thyrotoxicosis, but these cases provide reassurance to the clinician that when this does occur, other clinical features of hyperthyroidism are usually present.
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Affiliation(s)
- J Stone
- School of Molecular and Clinical Medicine, University of Edinburgh, Western General Hospital, Edinburgh, UK.
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Yancy C, Massie B, Krum H, Silver M, Stevenson L, Mills R. Chronic Serial Infusion of Nesiritide Is Not Associated with Worsening Renal Function in Chronic Decompensated Heart Failure Patients with Renal Insufficiency: An Analysis from the FUSION-II Trial. J Card Fail 2007. [DOI: 10.1016/j.cardfail.2007.06.524] [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: 10/22/2022]
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Duvigneau JC, Sipos W, Hartl RT, Bayer M, Moldzio R, Stevenson L, Adair B, Gemeiner M. Heparin and EDTA as anticoagulant differentially affect cytokine mRNA level of cultured porcine blood cells. J Immunol Methods 2007; 324:38-47. [PMID: 17568606 DOI: 10.1016/j.jim.2007.04.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2007] [Revised: 04/24/2007] [Accepted: 04/27/2007] [Indexed: 10/23/2022]
Abstract
Cytokine mRNA expression profiles serve to characterize immune cell activation in different test systems. Both, diluted whole blood and isolated PBMC are widely applied for these studies. Comprehensive data regarding the suitability of different anticoagulants for profiling cytokine expression are not available for the pig. Therefore the aim of this study was to compare the effect of two commonly used anticoagulants (heparin and EDTA) on the cytokine expression pattern of porcine blood cells. IL-1alpha, IL-2, IL-4, IL-6, IL-10 and IFN-gamma mRNA levels were detected ex-vivo and upon in-vitro stimulation in diluted porcine whole blood and isolated PBMC by real-time PCR. The cells were stimulated with ConA or LPS, known to act on different target cells and implying different signalling pathways. Additionally the integrity of the isolated RNA was investigated. Ex-vivo cytokine expression pattern of fresh whole blood were not affected by the investigated anticoagulants. In contrast, stimulation of cultured diluted whole blood or PBMC resulted in significant differences depending on the applied anticoagulant. Using EDTA we found a significantly decreased capacity of whole blood to express cytokines. However, isolated PBMC from EDTA anticoagulated blood showed a higher cytokine expression capacity than PBMC from heparinized blood. Comparing diluted whole blood and PBMC we found that cultured porcine whole blood responded better to bacterial products than isolated PBMC, probably because sufficient auxiliary plasma derived factors such as LPS-binding protein, are present. However, isolated PBMC showed a higher T-cell response than diluted whole blood. In conclusion, our findings underline that each application demands a specific assay system.
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Affiliation(s)
- J C Duvigneau
- Institute for Medical Chemistry, Department of Natural Sciences, University of Veterinary Medicine Vienna, Veterinärplatz 1, A-1210 Vienna, Austria.
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Abstract
BACKGROUND Relationships between income inequality and various health indicators have been the subject of much study and some controversy. We investigated associations between child mortality and income inequality amongst the wealthier OECD countries as well as changes in their relative child mortality rankings over time. METHODS Data were drawn from the 2003-2006 'State of the World's Children' reports published by UNICEF; Gini coefficients on income inequality were also used. Pearson correlation coefficients were calculated to investigate associations. Longitudinal child mortality data was used to compare rankings. RESULTS We discovered very strong associations between child mortality and income inequality. In contrast to earlier results, these associations persist when the USA is excluded from the analysis. The countries with the worst child mortality figures were previously singled out in a 1993 UNICEF study on child neglect in rich nations. We also report their worsening child mortality rankings, since 1960, relative to the other OECD countries. CONCLUSIONS The results strengthen the existing evidence linking child mortality with income inequality in wealthy nations, and add to the evidence that sociopolitical factors are important in this regard.
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Affiliation(s)
- D Collison
- School of Acccounting and Finance, University of Dundee, Dundee, DD1 4HN, UK.
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37
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Ahmed M, Prasad J, Gill H, Stevenson L, Gopal P. Impact of consumption of different levels of Bifidobacterium lactis HN019 on the intestinal microflora of elderly human subjects. J Nutr Health Aging 2007; 11:26-31. [PMID: 17315077] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
BACKGROUND Age-related changes in the physiology and intestinal function of the elderly render them more susceptible to gut-related illnesses. Probiotic dietary supplementation has been shown to enhance the health indices in the elderly. OBJECTIVE To determine the effect of three different doses [5 x 109 CFU/day (high), 1.0 x 109 CFU/day (medium) and 6.5 x 107 CFU/day (low)] of Bifidobacterium lactis HN019 (DR10TM) on the intestinal flora of elderly human subjects and the dose response effect. DESIGN Randomised, double-blind and placebo-controlled human dietary intervention study consisting of four groups of 20 elderly (over 60 years old) volunteers. Each volunteer consumed 250 mL per day of reconstituted skim milk (RSM) which either did not contain any probiotic supplement (placebo group) or contained B. lactis HN019 at different levels (low, medium and high dose groups). The study comprised three stages: a 2-week pre-intervention (without any supplement), followed by 4 weeks of test feeding (dietary intervention) and then a 2-week washout period. RESULTS After dietary intervention, statistically significant increases in bifidobacteria, lactobacilli and enterococci were observed. At the end of the 4-week feeding period the mean number of bifidobacteria recorded in the placebo group were 9.31 +/- 0.01 log CFU/g of faeces. In the high, medium and low dose groups the bifidobacteria levels were significantly (p < 0.006) higher (9.88 +/- 0.1, 9.75 +/- 0.14 and 9.74 +/- 0.11 log CFU/g of faeces, respectively), when compared to the respective pre-intervention levels. There were no significant differences (p superior 0.05) between the responses of the different dose groups, indicating that even the lowest dose tested augmented the changes in bifidobacteria. Similar trends were observed for lactobacilli and enterococci. In contrast, the counts of enterobacteria were reduced in all the probiotic dose groups. CONCLUSION The present study showed that dietary supplementation with B. lactis HN019 significantly increased the number of resident bifidobacteria and reduced the enterobacteria counts. In addition, enterococci and lactobacilli were also increased. Based on this study and already published clinical evidence (4, 5, 8, 9) we conclude that, B. lactis HN019 is a suitable probiotic for elderly human subjects and even the lowest dose (6.5 x 107 CFU/day) tested is able to confer desired changes in the intestinal microflora.
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Affiliation(s)
- M Ahmed
- Institute of Food, Nutrition and Human Health, Massey University, Palmerston North, New Zealand
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Shing CM, Jenkins DG, Stevenson L, Coombes JS. The influence of bovine colostrum supplementation on exercise performance in highly trained cyclists. Br J Sports Med 2006; 40:797-801. [PMID: 16825268 PMCID: PMC2564397 DOI: 10.1136/bjsm.2006.027946] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE The aim of this experiment was to investigate the influence of low dose bovine colostrum supplementation on exercise performance in cyclists over a 10 week period that included 5 days of high intensity training (HIT). METHODS Over 7 days of preliminary testing, 29 highly trained male road cyclists completed a VO(2max) test (in which their ventilatory threshold was estimated), a time to fatigue test at 110% of ventilatory threshold, and a 40 km time trial (TT40). Cyclists were then assigned to either a supplement (n = 14, 10 g/day bovine colostrum protein concentrate (CPC)) or a placebo group (n = 15, 10 g/day whey protein) and resumed their normal training. Following 5 weeks of supplementation, the cyclists returned to the laboratory to complete a second series of performance testing (week 7). They then underwent five consecutive days of HIT (week 8) followed by a further series of performance tests (week 9). RESULTS The influence of bovine CPC on TT40 performance during normal training was unclear (week 7: 1+/-3.1%, week 9: 0.1+/-2.1%; mean+/-90% confidence limits). However, at the end of the HIT period, bovine CPC supplementation, compared to the placebo, elicited a 1.9+/-2.2% improvement from baseline in TT40 performance and a 2.3+/-6.0% increase in time trial intensity (% VO(2max)), and maintained TT40 heart rate (2.5+/-3.7%). In addition, bovine CPC supplementation prevented a decrease in ventilatory threshold following the HIT period (4.6+/-4.6%). CONCLUSION Low dose bovine CPC supplementation elicited improvements in TT40 performance during an HIT period and maintained ventilatory threshold following five consecutive days of HIT.
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Affiliation(s)
- C M Shing
- School of Human Movement Studies, The University of Queensland, St. Lucia, Brisbane, Qld 4072, Australia.
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Abstract
AIM To assess the influence of high extracellular glucose on the expression of the bone morphogenetic protein (BMP) antagonist, gremlin, in cultured bovine retinal pericytes (BRPC). METHODS BRPC were cultured under conditions of 5 mM and 30 mM d-glucose for 7 days and total RNA was isolated. Gremlin mRNA levels were correlated, by RT-PCR, with other genes implicated in the pathogenesis of diabetic retinopathy and the signalling pathways in high glucose induced gremlin expression were probed using physiological inhibitors. Gremlin expression was also examined in the retina of streptozotocin induced diabetic mice. RESULTS High glucose stimulated a striking increase in BRPC gremlin mRNA levels in parallel with increases in mRNA for the growth factors vascular endothelial growth factor (VEGF), transforming growth factor beta (TGFbeta), and connective tissue growth factor (CTGF) and changes in other genes including fibronectin and plasminogen activator inhibitor-1 (PAI-1). High glucose triggered gremlin expression was modulated by anti-TGFbeta antibody, by the uncoupler of oxidative phosphorylation, CCCP, and by inhibition of MAP-kinase (MAPK) activation. Striking gremlin expression was observed in the outer retina of diabetic mice and also at the level of the vascular wall. CONCLUSIONS Gremlin gene expression is induced in BRPC in response to elevated glucose and in the retina of the streptozotocin induced diabetic mouse. Its expression is modulated by hyperglycaemic induction of the MAPK, reactive oxygen species, and TGFbeta pathways, all of which are reported to have a role in diabetic fibrotic disease. This implicates a role for gremlin in the pathogenesis of diabetic retinopathy.
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Affiliation(s)
- R Kane
- Institute of Ophthalmology, 60 Eccles Street, Dublin 7, Ireland.
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40
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Beasley LJ, Hackett AF, Maxwell SM, Stevenson L. The effect of a dietary preload on estimation of usual food portion size by photograph in female volunteers. J Hum Nutr Diet 2004; 17:219-25; quiz 227-30. [PMID: 15139893 DOI: 10.1111/j.1365-277x.2004.00515.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The aim of this study was to investigate whether a subject's level of satiety influences perception of their usual portion size. METHODS A total of 62 school children were recruited for the pilot study. Half of the group assessed food photographs for their usual portion size before lunch, and half after lunch. For the main study, 55 female students were recruited to test within-subject variation in perception of usual portion size before and after consuming a preload. RESULTS Significant differences in perception of portion size were found for four of the six foods used. CONCLUSION Some subjects' perception of their usual portion size was influenced by their level of satiety. Further study is needed to investigate this using a wider variety of food photographs and an alternative preload.
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Affiliation(s)
- L J Beasley
- School of the Outdoors, Leisure and Food, Liverpool John Moores University, Liverpool, UK.
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Abstract
There is controversy about how cancer care should be provided to patients in remote and rural areas. The aim of this project was to measure consensus among health professionals who treat rural patients with cancer about priorities for cancer care. A modified Delphi process was used. Of 78 health professionals in Grampian, 62 responded (79%). Of 49 items suggested, there was agreement on 26 (53%), encompassing fast access to diagnosis, high-quality specialist treatment, and well-coordinated delivery of care with good and fast communication and effective team working between all health professionals involved. Specialist oncology nurses in local hospitals were considered a priority along with good facilities, accommodation, and transport for patients. There was no agreement on the best location for chemotherapy (local or central). The only large difference of opinion between participants based in primary and secondary care concerned chemotherapy provision at local community hospitals (primary care was in favour, hospital practitioners against, P&<0.001). In making their decisions, participants took problems of access into account, but were also concerned with quality of care and feasibility in the current health service. Our findings show that more evidence is needed regarding the balance of risks and benefits of local chemotherapy provision. Overall, however, there is agreement on many principles for cancer care that could be translated into practice.
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Affiliation(s)
- L Stevenson
- Department of General Practice and Primary Care, University of Aberdeen, Foresterhill Health Centre, Aberdeen AB25 2AY, UK
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Ghebrehewet S, Stevenson L. Effectiveness of home-based food storage training: a community development approach. Int J Environ Health Res 2003; 13 Suppl 1:S169-S174. [PMID: 12775393 DOI: 10.1080/0960312031000102930] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
A community-based home hygiene training initiative, funded by Merseyside Health Action Zone, was piloted in Dingle, a deprived area of Liverpool, UK, during Spring and early Summer 2000. The project actively involved the community, and home-based domestic hygiene training was delivered by community-based facilitators to households in Dingle, Liverpool. During the project the community-based facilitators visited 904 households on two separate occasions. During the first visit, the community-based facilitators completed a questionnaire and an 'action sheet' which had been designed to measure participants' prior knowledge and behaviour, in relation to a range of important food hygiene issues, and delivered the home-based food hygiene training. Within 8 weeks of the first visit, the community-based facilitators returned to the participating households and completed a second questionnaire and action sheet. Home-based training is effective in raising awareness, and community development approach has the advantage of facilitating access to households which otherwise would have been difficult to reach.
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Affiliation(s)
- S Ghebrehewet
- Cheshire and Wirral Communicable Disease Unit, Chester, UK.
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Affiliation(s)
- L Stevenson
- New York City Health and Hospitals Corporation, USA
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Ellis RJ, Timms-Wilson TM, Beringer JE, Rhodes D, Renwick A, Stevenson L, Bailey MJ. Ecological basis for biocontrol of damping-off disease by pseudomonas fluorescens 54/96. J Appl Microbiol 1999; 87:454-63. [PMID: 10540249 DOI: 10.1046/j.1365-2672.1999.00851.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Pseudomonas fluorescens 54/96, originally isolated from the rhizosphere of sugar beet, has been shown to be commercially effective in field trials for the suppression of a number of fungal diseases of seedlings. In vitro and microcosm-based assays revealed that both the timing and method of application of bacteria were important for effective control of Pythium ultimum, the causative agent of damping-off disease. Following transposon mutagenesis (Tn5lac), mutants deficient for the suppression of Pythium ultimum infections of peas were isolated. Three major classes of insertional mutants of Ps. fluorescens 54/96 were identified which either inhibited sporulation, reduced mycelial growth or affected the regulation of bacterial metabolic activity. Evaluation of the metabolic capability of pathogen and antagonist revealed evidence for direct competition, as both the fungus and bacterium had similar sole carbon source nutrient utilization profiles. Further comparisons of the activity of the transposon mutants indicated that although the mechanisms of disease control were multifactorial, the most significant factor was the prevention of rapid spore germination in the presence of pea seeds.
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Patrick S, Gilpin D, Stevenson L. Detection of intrastrain antigenic variation of Bacteroides fragilis surface polysaccharides by monoclonal antibody labelling. Infect Immun 1999; 67:4346-51. [PMID: 10456873 PMCID: PMC96751 DOI: 10.1128/iai.67.9.4346-4351.1999] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Bacteroides fragilis is a constituent of the normal resident microbiota of the human intestine and is the gram-negative obligately anaerobic bacterium most frequently isolated from clinical infection. Surface polysaccharides are implicated as potential virulence determinants. We present evidence of within strain immunochemical variation of surface polysaccharides in populations that are noncapsulate by light microscopy as determined by monoclonal antibody labelling. Expression of individual epitopes can be enriched from a population of an individual strain by use of immunomagnetic beads. Also, individual colonies in which either >94% or <7% of the bacteria carry an individual epitope retain this level of expression when subcultured into broth. In broth cultures where >94% of the bacteria carry a given epitope, there is no enrichment for other epitopes recognized by different polysaccharide-specific monoclonal antibodies. This intrastrain variation has important implications for the development of potential vaccines or immunodiagnostic tests.
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Affiliation(s)
- S Patrick
- Department of Microbiology and Immunobiology, School of Medicine, Queen's University of Belfast, Belfast BT12 6BN, United Kingdom.
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Abstract
Older adults comprise the majority of people receiving hospital services in many regions of our country today. Current literature is fraught with stories of how risky hospitalization can be for an older adult. Even with the best intentions, being in hospital can set up a cascade of events for older adults and their families that result in longer lengths of stay and functional disability. In a climate of fiscal restraint, competing priorities and public pressure, meeting the challenges of hospitalization for this population is not an easy task. As the number of older adults in acute care rises and the average length of stay continues to decrease, it is necessary for acute care hospitals to rethink their views of caring for older adults; fundamental shifts are required. The purpose of this paper is to describe the "Elder Friendly Hospital" (EFH) concept and explain the strategies taken by the Capital Health Region in Victoria British Columbia.
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Di Marzo V, Bisogno T, Melck D, Ross R, Brockie H, Stevenson L, Pertwee R, De Petrocellis L. Interactions between synthetic vanilloids and the endogenous cannabinoid system. FEBS Lett 1998; 436:449-54. [PMID: 9801167 DOI: 10.1016/s0014-5793(98)01175-2] [Citation(s) in RCA: 124] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The chemical similarity between some synthetic agonists of vanilloid receptors, such as olvanil (N-vanillyl-cis-9-octadecenoamide), and the 'endocannabinoid' anandamide (arachidonoyl-ethanolamide, AEA), suggests possible interactions between the cannabinoid and vanilloid signalling systems. Here we report that olvanil is a stable and potent inhibitor of AEA facilitated transport into rat basophilic leukemia (RBL-2H3) cells. Olvanil blocked both the uptake and the hydrolysis of [14C]AEA by intact RBL-2H3 cells (IC50 = 9 microM), while capsaicin and pseudocapsaicin (N-vanillyl-nonanamide) were much less active. Olvanil was more potent than previously reported inhibitors of AEA facilitated transport, i.e. phloretin (IC50 = 80 microM), AM404 (12.9% inhibition at 10 microM) or oleoylethanolamide (27.5% inhibition at 10 microM). Olvanil was a poor inhibitor of [14C]AEA hydrolysis by RBL-2H3 and N18TG2 cell membranes, suggesting that the inhibitory effect on [14C]AEA breakdown observed in intact cells was due to inhibition of [14C]AEA uptake. Olvanil was stable to enzymatic hydrolysis, and (i) displaced the binding of high affinity cannabinoid receptor ligands to membrane preparations from N18TG2 cells and guinea pig forebrain (Ki = 1.64-7.08 microM), but not from cells expressing the CB2 cannabinoid receptor subtype; (ii) inhibited forskolin-induced cAMP formation in intact N18TG2 cells (IC50 = 1.60 microM), this effect being reversed by the selective CB1 antagonist SR141716A. Pseudocapsaicin, but not capsaicin, also selectively bound to CB1 receptor-containing membranes. These data suggest that some of the analgesic actions of olvanil may be due to its interactions with the endogenous cannabinoid system, and may lead to the design of a novel class of cannabimimetics with potential therapeutic applications as analgesics.
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Affiliation(s)
- V Di Marzo
- Istituto per la Chimica di Molecole di Interesse Biologico, CNR, Napoli, Italy.
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Abstract
BACKGROUND/AIMS Patients undergoing scleral buckling and cryotherapy suffer from mild to moderate postoperative pain. As good pain relief facilitates post-operative ocular examination, as well as patient comfort and recovery, the authors designed a prospective randomised double masked trial to evaluate the efficacy of indomethacin as a satisfactory analgesic for such patients. METHOD Patients with a primary uncomplicated rhegmatogenous retinal detachment requiring scleral buckling and cryotherapy were randomly allocated to receive either indomethacin or placebo. A rectal suppository was administered 2 hours before surgery, followed by two capsules twice daily for 10 days. Pain relief was assessed with a linear graphic rating scale at the end of each day. Supplementary analgesia was allowed and recorded. RESULTS 12 patients received indomethacin (group A) and 16 received placebo (group B). The extent of surgery was similar in both groups. One patient in group A, and two in group B withdrew after 3 days. The pain scores were converted to changes from the baseline (score on day 1), and the area under the curve calculated for each patient. The means of the areas were analysed with the Mann-Whitney test and showed that indomethacin caused a statistically significant reduction in pain score, both at 3 days (p = 0.04) and at 10 days (p = 0.014). There was no statistically significant difference in extra analgesic requirements between the two groups (p = 0.2). CONCLUSIONS Indomethacin is recommended for short to medium term pain relief following scleral buckling and cryotherapy.
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Affiliation(s)
- S A Sadiq
- Department of Ophthalmology, Queen's Medical Centre, Nottingham
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Stevenson L. Weekly Risk of Death While Awaiting Transplantation: Relationship to Support Required. J Am Coll Cardiol 1998. [DOI: 10.1016/s0735-1097(97)84798-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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