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Yiannakis C, Hamilton L, Slim M, Kontorinis G. A systematic review and meta-analysis of prophylactic medication of vestibular migraine. J Laryngol Otol 2023; 137:953-961. [PMID: 36200521 DOI: 10.1017/s0022215122001979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
OBJECTIVE Vestibular migraine is in the process of recognition as an individual clinical entity. At present, no guidelines exist for its management. This study aimed to conduct a systematic review and meta-analysis to determine the effectiveness of available prophylactic medication. METHOD A literature search was performed using PubMed, Ovid and Embase databases. Qualitative and quantitative analysis were performed as well as risk of bias analysis. Meta-analysis for the mean differences for pre- and post-treatment impact based on Dizziness Handicap Inventory and Vertigo Symptom Scale were performed. Proportionate transformation meta-analysis for the successful event rate based on complete symptoms control was explored. RESULTS Thirteen publications were identified: 3 were randomised, controlled trials and 10 were non-randomised, controlled trials. Propranolol and venlafaxine improved the Vertigo Symptom Scale score by -13.31 points and -4.16 points, respectively, and the Dizziness Handicap Inventory score by -32.24 and -21.24, respectively. Only propranolol achieved statistically significant impact with 60 per cent of patients achieving complete symptom control. CONCLUSION Propranolol should be offered as the first-line treatment for vestibular migraine followed by venlafaxine. Amitriptyline, flunarizine and cinnarizine showed a trend for symptom improvement, but this was not statistically significant.
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Affiliation(s)
- C Yiannakis
- Department of Otolaryngology, Queen Elizabeth University Hospital, Glasgow, Scotland, UK
| | - L Hamilton
- Department of Otolaryngology, Queen Elizabeth University Hospital, Glasgow, Scotland, UK
| | - M Slim
- Department of Otolaryngology, Queen Elizabeth University Hospital, Glasgow, Scotland, UK
| | - G Kontorinis
- Department of Otolaryngology, Queen Elizabeth University Hospital, Glasgow, Scotland, UK
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Assumpção M, Hamilton L, Díaz Miranda E, Zigo M, Jones A, Rissman J, Taylor J, Schnabel R, Sutovsky P. 167 Role of ADGRA2/TEM5/GPR124 protein during spermatogenesis and fertilisation events. Reprod Fertil Dev 2022. [DOI: 10.1071/rdv35n2ab167] [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: 12/11/2022] Open
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Lim CSE, Hamilton L, Low SBL, Toms A, Macgregor A, Gaffney K. Identifying Axial Spondyloarthritis in Inflammatory Bowel Disease Patients Utilising Computed Tomography. J Rheumatol Suppl 2022:jrheum.220362. [PMID: 36243419 DOI: 10.3899/jrheum.220362] [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: 11/22/2022]
Abstract
OBJECTIVE The diagnosis of axial spondyloarthritis (axSpA) is hampered by diagnostic delay. Computed Tomography (CT) undertaken for non-musculoskeletal (MSK) indications in patients with inflammatory bowel disease (IBD) offers an opportunity to identify sacroiliitis for prompt rheumatology referral. The study aims to identify what proportion of IBD patients who underwent abdominopelvic CT for non-MSK indications have axSpA and explore the role of a standardised screening tool to prospectively identify axSpA on imaging. METHODS Abdominopelvic CT scans of verified IBD patients, age range 18-55, performed for non-MSK indications were reviewed by radiology for presence of CT-defined sacroiliitis (CTSI, using criteria from a validated CT screening tool). All patients identified were sent a screening questionnaire and those with self-reported chronic back pain (CBP), duration > 3 months, onset < 45 years were invited for rheumatology review. RESULTS CTSI was identified in 60 of 301 patients. Thirty-two (53%) responded to the invitation to participate and 27 were enrolled. Of these, eight had a pre-existing axSpA diagnosis and five did not report CBP. Fourteen patients underwent rheumatology assessment; three of 14 (21.4% [95% CI: 4.7%, 50.8%]) had undiagnosed axSpA. In total, 11 of 27 (40.7% [95% CI: 22.4%, 61.2%]) patients had a rheumatologist verified diagnosis of axSpA. CONCLUSION At least 5.0% of IBD patients (3/60) undergoing abdominopelvic CT for non-MSK indications with CTSI have undiagnosed axSpA, and overall, 18.3% (11/60) have axSpA. This reveals a significant hidden population of axSpA and highlights the need for a streamlined pathway from sacroiliitis detection to rheumatology referral.
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Affiliation(s)
- Chong Seng Edwin Lim
- Funding: AbbVie (The grant was for an investigator-initiated study). Authors, Role & Affiliations: C.S.E.L, Lim, Consultant Rheumatologist, MBBS; L.H, Hamilton, Consultant Rheumatologist, MD; L.L, Low, Consultant Radiologist, MBBS; A.T, Toms, Consultant Radiologist; A.M. Macgregor, Consultant Rheumatologist; K.G. Gaffney, Consultant Rheumatologist, MB BCh BAO (Hons). Rheumatology Department, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom; Radiology Department, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom. Conflict of Interest: CL reports grants from AbbVie, during the conduct of the study. KG reports grants and personal fees from AbbVie, grants and personal fees from Eli Lilly, grants and personal fees from Novartis, grants and personal fees from UCB Pharma, grants from Gilead, during and outside the conduct of the study. LH, SL, AT, AM had nothing to disclose. Corresponding Author: Dr Chong Seng Edwin Lim, Norfolk and Norwich University Hospitals NHS Foundation Trust, Rheumatology Department, Norfolk & Norwich University Hospital, Colney Lane, Norwich, United Kingdom, NR4 7UY Primary , Alternate . Statement of ethics and consent: This study was conducted in accordance with the Declaration of Helsinki and was approved by the local ethics committee (252117 19/EE/0125). All participants gave written informed consent before study inclusion
| | - Louise Hamilton
- Funding: AbbVie (The grant was for an investigator-initiated study). Authors, Role & Affiliations: C.S.E.L, Lim, Consultant Rheumatologist, MBBS; L.H, Hamilton, Consultant Rheumatologist, MD; L.L, Low, Consultant Radiologist, MBBS; A.T, Toms, Consultant Radiologist; A.M. Macgregor, Consultant Rheumatologist; K.G. Gaffney, Consultant Rheumatologist, MB BCh BAO (Hons). Rheumatology Department, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom; Radiology Department, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom. Conflict of Interest: CL reports grants from AbbVie, during the conduct of the study. KG reports grants and personal fees from AbbVie, grants and personal fees from Eli Lilly, grants and personal fees from Novartis, grants and personal fees from UCB Pharma, grants from Gilead, during and outside the conduct of the study. LH, SL, AT, AM had nothing to disclose. Corresponding Author: Dr Chong Seng Edwin Lim, Norfolk and Norwich University Hospitals NHS Foundation Trust, Rheumatology Department, Norfolk & Norwich University Hospital, Colney Lane, Norwich, United Kingdom, NR4 7UY Primary , Alternate . Statement of ethics and consent: This study was conducted in accordance with the Declaration of Helsinki and was approved by the local ethics committee (252117 19/EE/0125). All participants gave written informed consent before study inclusion
| | - Samantha Bee Lian Low
- Funding: AbbVie (The grant was for an investigator-initiated study). Authors, Role & Affiliations: C.S.E.L, Lim, Consultant Rheumatologist, MBBS; L.H, Hamilton, Consultant Rheumatologist, MD; L.L, Low, Consultant Radiologist, MBBS; A.T, Toms, Consultant Radiologist; A.M. Macgregor, Consultant Rheumatologist; K.G. Gaffney, Consultant Rheumatologist, MB BCh BAO (Hons). Rheumatology Department, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom; Radiology Department, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom. Conflict of Interest: CL reports grants from AbbVie, during the conduct of the study. KG reports grants and personal fees from AbbVie, grants and personal fees from Eli Lilly, grants and personal fees from Novartis, grants and personal fees from UCB Pharma, grants from Gilead, during and outside the conduct of the study. LH, SL, AT, AM had nothing to disclose. Corresponding Author: Dr Chong Seng Edwin Lim, Norfolk and Norwich University Hospitals NHS Foundation Trust, Rheumatology Department, Norfolk & Norwich University Hospital, Colney Lane, Norwich, United Kingdom, NR4 7UY Primary , Alternate . Statement of ethics and consent: This study was conducted in accordance with the Declaration of Helsinki and was approved by the local ethics committee (252117 19/EE/0125). All participants gave written informed consent before study inclusion
| | - Andoni Toms
- Funding: AbbVie (The grant was for an investigator-initiated study). Authors, Role & Affiliations: C.S.E.L, Lim, Consultant Rheumatologist, MBBS; L.H, Hamilton, Consultant Rheumatologist, MD; L.L, Low, Consultant Radiologist, MBBS; A.T, Toms, Consultant Radiologist; A.M. Macgregor, Consultant Rheumatologist; K.G. Gaffney, Consultant Rheumatologist, MB BCh BAO (Hons). Rheumatology Department, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom; Radiology Department, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom. Conflict of Interest: CL reports grants from AbbVie, during the conduct of the study. KG reports grants and personal fees from AbbVie, grants and personal fees from Eli Lilly, grants and personal fees from Novartis, grants and personal fees from UCB Pharma, grants from Gilead, during and outside the conduct of the study. LH, SL, AT, AM had nothing to disclose. Corresponding Author: Dr Chong Seng Edwin Lim, Norfolk and Norwich University Hospitals NHS Foundation Trust, Rheumatology Department, Norfolk & Norwich University Hospital, Colney Lane, Norwich, United Kingdom, NR4 7UY Primary , Alternate . Statement of ethics and consent: This study was conducted in accordance with the Declaration of Helsinki and was approved by the local ethics committee (252117 19/EE/0125). All participants gave written informed consent before study inclusion
| | - Alexander Macgregor
- Funding: AbbVie (The grant was for an investigator-initiated study). Authors, Role & Affiliations: C.S.E.L, Lim, Consultant Rheumatologist, MBBS; L.H, Hamilton, Consultant Rheumatologist, MD; L.L, Low, Consultant Radiologist, MBBS; A.T, Toms, Consultant Radiologist; A.M. Macgregor, Consultant Rheumatologist; K.G. Gaffney, Consultant Rheumatologist, MB BCh BAO (Hons). Rheumatology Department, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom; Radiology Department, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom. Conflict of Interest: CL reports grants from AbbVie, during the conduct of the study. KG reports grants and personal fees from AbbVie, grants and personal fees from Eli Lilly, grants and personal fees from Novartis, grants and personal fees from UCB Pharma, grants from Gilead, during and outside the conduct of the study. LH, SL, AT, AM had nothing to disclose. Corresponding Author: Dr Chong Seng Edwin Lim, Norfolk and Norwich University Hospitals NHS Foundation Trust, Rheumatology Department, Norfolk & Norwich University Hospital, Colney Lane, Norwich, United Kingdom, NR4 7UY Primary , Alternate . Statement of ethics and consent: This study was conducted in accordance with the Declaration of Helsinki and was approved by the local ethics committee (252117 19/EE/0125). All participants gave written informed consent before study inclusion
| | - Karl Gaffney
- Funding: AbbVie (The grant was for an investigator-initiated study). Authors, Role & Affiliations: C.S.E.L, Lim, Consultant Rheumatologist, MBBS; L.H, Hamilton, Consultant Rheumatologist, MD; L.L, Low, Consultant Radiologist, MBBS; A.T, Toms, Consultant Radiologist; A.M. Macgregor, Consultant Rheumatologist; K.G. Gaffney, Consultant Rheumatologist, MB BCh BAO (Hons). Rheumatology Department, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom; Radiology Department, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom. Conflict of Interest: CL reports grants from AbbVie, during the conduct of the study. KG reports grants and personal fees from AbbVie, grants and personal fees from Eli Lilly, grants and personal fees from Novartis, grants and personal fees from UCB Pharma, grants from Gilead, during and outside the conduct of the study. LH, SL, AT, AM had nothing to disclose. Corresponding Author: Dr Chong Seng Edwin Lim, Norfolk and Norwich University Hospitals NHS Foundation Trust, Rheumatology Department, Norfolk & Norwich University Hospital, Colney Lane, Norwich, United Kingdom, NR4 7UY Primary , Alternate . Statement of ethics and consent: This study was conducted in accordance with the Declaration of Helsinki and was approved by the local ethics committee (252117 19/EE/0125). All participants gave written informed consent before study inclusion
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Lim CSE, Tremelling M, Hamilton L, Kim M, Macgregor A, Turmezei T, Gaffney K. Prevalence of undiagnosed axial spondyloarthritis in inflammatory bowel disease patients with chronic back pain: secondary care cross-sectional study. Rheumatology (Oxford) 2022; 62:1511-1518. [PMID: 35993905 DOI: 10.1093/rheumatology/keac473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 08/06/2022] [Accepted: 08/06/2022] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To elucidate the prevalence of undiagnosed rheumatologist-verified diagnosis of axial spondyloarthritis (RVD-axSpA) in patients attending routine secondary care IBD clinics with chronic back pain. METHODS Screening questionnaires were sent to consecutive patients attending IBD clinics in a university teaching hospital. Patients fulling the eligibility criteria (gastroenterologist-verified diagnosis, 18-80 years old, biologic therapy naïve, no previous diagnosis of axSpA); and a moderate diagnostic probability of axSpA (self-reported chronic back pain [CBP] > 3 months, onset < 45 years) were invited for rheumatology assessment. This included medical review, physical examination, patient reported outcome measures, human leucocyte antigen B27, C-reactive protein, pelvic radiograph and axSpA protocol magnetic resonance imaging. A diagnosis of RVD-axSpA was made by a panel of rheumatologists. RESULTS Of the 470 patients approached, 91 had self-reported CBP > 3 months, onset < 45 years, of whom 82 were eligible for clinical assessment. The prevalence of undiagnosed RVD-axSpA in patients attending IBD clinics in a secondary care setting, with self-reported CBP, onset < 45 years is estimated at 5% (95% CI 1.3,12.0) with a mean symptom duration of 12 (S.D. 12.4) years. CONCLUSION There is a significant hidden disease burden of axSpA among IBD patients. Appropriate identification and referral from gastroenterology is needed to potentially shorten the delay to diagnosis and allow access to appropriate therapy.
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Affiliation(s)
- Chong Seng Edwin Lim
- Rheumatology Department, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom
| | - Mark Tremelling
- Gastroenterology Department, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom
| | - Louise Hamilton
- Rheumatology Department, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom
| | - Matthew Kim
- Radiology Department, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom
| | - Alexander Macgregor
- Rheumatology Department, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom
| | - Tom Turmezei
- Radiology Department, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom
| | - Karl Gaffney
- Rheumatology Department, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom
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Xiang L, Fong W, Low AHL, Leung YY, Gandhi M, Xin X, Uy EJB, Hamilton L, Thumboo J. Early identification of axial spondyloarthritis in a multi-ethnic Asian population. Clin Rheumatol 2021; 41:1095-1103. [PMID: 34625882 DOI: 10.1007/s10067-021-05951-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 09/01/2021] [Accepted: 09/30/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION/OBJECTIVES To address the diagnostic delay in axial spondyloarthritis (axSpA), we have cross-culturally adapted the Hamilton axSpA questionnaire, a self-administered screening questionnaire, in the Singapore population. In this study, we compared the performance of various scoring methods for this questionnaire in detecting axSpA. METHOD The questionnaire was self-administered by eligible subjects. Scoring methods included method A, the original questionnaire scoring, and methods B-E, scoring developed based on the Assessment of SpondyloArthritis International Society (ASAS) criteria for inflammatory back pain (IBP) and the referral, classification and both referral and classification of axSpA, respectively. The reference standard was diagnosis by a rheumatologist. Since the ASAS criteria-based scoring methods were mainly based on clinical axSpA features, self-report and rheumatologist-assessment of clinical axSpA features were also compared in subjects with axSpA. RESULTS Of 1418 subjects (age: 54 ± 14 years, female: 73%) recruited, 46 were diagnosed with axSpA by a rheumatologist. Sensitivities of methods A-E were 35%, 61%, 63%, 48% and 83%, respectively. Self-report of clinical axSpA features exceeded rheumatologist-assessment for arthritis (83 vs 26%), good response to NSAIDs (37 vs 30%), enthesitis (35 vs 30%), dactylitis (20 vs 2%) and family history for axSpA (13 vs 4%). The reverse was true for IBP (41 vs 63%) and uveitis (4 vs 15%). CONCLUSIONS A self-administered questionnaire using the ASAS referral and classification criteria-based scoring yielded relatively high sensitivity in detecting axSpA in subjects newly referred to rheumatology clinics. This supports its evaluation as a screening and referral tool in the general population in future studies. Key Points • A self-administered questionnaire could be used as a screening and referral tool. • ASAS referral and classification criteria-based scoring yielded relatively high sensitivity. • Inaccurate perception of clinical axSpA features was observed in axSpA patients.
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Affiliation(s)
- Ling Xiang
- Department of Rheumatology and Immunology, Singapore General Hospital, Academia Building, Level 4, 20 College Road, Singapore, 169856, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Warren Fong
- Department of Rheumatology and Immunology, Singapore General Hospital, Academia Building, Level 4, 20 College Road, Singapore, 169856, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Andrea Hsiu Ling Low
- Department of Rheumatology and Immunology, Singapore General Hospital, Academia Building, Level 4, 20 College Road, Singapore, 169856, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Ying Ying Leung
- Department of Rheumatology and Immunology, Singapore General Hospital, Academia Building, Level 4, 20 College Road, Singapore, 169856, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Mihir Gandhi
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore.,Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore, Singapore.,Biostatistics, Singapore Clinical Research Institute, Singapore, Singapore.,The Center for Child Health Research, Tampere University, Tampere, Finland
| | - Xiaohui Xin
- Academic Clinical Program for Medicine, Singapore General Hospital, Singapore, Singapore
| | - Elenore Judy B Uy
- Department of Rheumatology and Immunology, Singapore General Hospital, Academia Building, Level 4, 20 College Road, Singapore, 169856, Singapore
| | - Louise Hamilton
- Department of Rheumatology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Julian Thumboo
- Department of Rheumatology and Immunology, Singapore General Hospital, Academia Building, Level 4, 20 College Road, Singapore, 169856, Singapore. .,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. .,Duke-NUS Medical School, Singapore, Singapore.
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Xiang L, Fong W, Low A, Leung YY, Gandhi M, Xin X, Uy E, Hamilton L, Thumboo J. POS1411 EARLY IDENTIFICATION OF AXIAL SPONDYLOARTHRITIS IN A MULTI-ETHNIC ASIAN POPULATION. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.449] [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: 11/03/2022]
Abstract
Background:To facilitate earlier diagnosis of spondyloarthritis (SpA), we have previously cross-culturally adapted a self-administered screening questionnaire.Objectives:We aimed to improve the sensitivity of this questionnaire as a screening tool by comparing various scoring methods.Methods:Subjects newly referred to a rheumatology clinic self-administered the questionnaire before seeing a rheumatologist. Identification of axial SpA by the questionnaire using original scoring (Method A) and scoring based on Assessment of SpondyloArthritis International Society (ASAS) inflammatory back pain (IBP) criteria (Method B), ASAS referral criteria (Method C), ASAS classification criteria (Method D) and a combination of ASAS referral and classification criteria (Method E) were compared to classification by the ASAS classification criteria and diagnosis by rheumatologist. Since Methods B-E were based on SpA features, we compared self-reported vs rheumatologist-documented features in subjects with axial SpA.Results:Of 1418 subjects (age: 54 ± 14 years, female: 73%), 39 were classified as axial SpA cases by classification criteria. Methods A-E yielded sensitivities of 39%, 72%, 67%, 49% and 85%, respectively, among patients newly referred to the rheumatology clinic (Table 1). Rheumatologist-documented clinical SpA features exceeded self-report for IBP (62 vs 44%) and uveitis (15 vs 5%). The reverse was true for arthritis (21 vs 80%), enthesitis (28 vs 33%), dactylitis (3 vs 18%), good response to NSAIDs (33 vs 41%) and family history for SpA (5 vs 10%).Table 1.Performance of the five scoring methods for the cross-culturally adapted Hamilton axial SpA questionnaire.Scoring methodSensitivity(95% confidence interval)Specificity(95% confidence interval)Positive predictive value(95% confidence interval)Negative predictive value(95% confidence interval)Method A38.5(23.4 – 55.4)93.7(92.3 – 94.9)14.7(8.5 – 23.1)98.2(97.3 – 98.8)Method B71.8(55.1 – 85.0)73.1(70.7 – 75.4)7.0(4.7 – 10.0)98.9(98.1 – 99.5)Method C66.7(49.8 – 80.9)77.8(75.5 – 80.0)7.8(5.2 – 11.3)98.8(98.0 – 99.4)Method D48.7(32.4 – 65.2)74.9(72.5 – 77.2)5.2(3.2 – 8.0)98.1(97.1 – 98.8)Method E84.6(69.5 – 94.1)37.2(34.6 – 39.8)3.7(2.5 – 5.1)98.8(97.5 – 99.6)Method A: the original scoring defined by the questionnaire developers; Method B: a scoring based on the ASAS IBP criteria; Method C: a scoring based on the ASAS referral criteria; Method D: a scoring based on the ASAS classification criteria for axial and peripheral SpA; Method E: a scoring based on a combination of the ASAS referral and classification criteria.Conclusion:A self-administered questionnaire scored based on a combination of ASAS referral and classification criteria achieved high sensitivity in identifying axial SpA in subjects referred to a rheumatology clinic. This supports its evaluation as a screening tool for axial SpA in the general population.References:[1]Xiang L, Teo EPS, Low AHL, Leung YY, Fong W, Xin X, et al. Cross-cultural adaptation of the Hamilton axial spondyloarthritis questionnaire and development of a Chinese version in a multi-ethnic Asian population. Int J Rheum Dis. 2019;22(9):1652-60.[2]Sieper J, Rudwaleit M, Baraliakos X, Brandt J, Braun J, Burgos-Vargas R, et al. The Assessment of SpondyloArthritis international Society (ASAS) handbook: a guide to assess spondyloarthritis. Annals of the rheumatic diseases. 2009;68 Suppl 2:ii1-44.[3]Poddubnyy D, van Tubergen A, Landewe R, Sieper J, van der Heijde D. Development of an ASAS-endorsed recommendation for the early referral of patients with a suspicion of axial spondyloarthritis. Annals of the rheumatic diseases. 2015;74(8):1483-7.[4]Rudwaleit M, van der Heijde D, Landewe R, Akkoc N, Brandt J, Chou CT, et al. The Assessment of SpondyloArthritis International Society classification criteria for peripheral spondyloarthritis and for spondyloarthritis in general. Annals of the rheumatic diseases. 2011;70(1):25-31.Acknowledgements:This work was supported by a Health Services Research Grant (HSRG) from the Singapore Ministry of Health National Medical Research Council [grant number: NMRC/HSRG/0075/2017].Disclosure of Interests:None declared
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Lim CSE, Hamilton L, Low S, Toms A, Macgregor A, Gaffney K. POS0035 ONE IN TWENTY INFLAMMATORY BOWEL DISEASE PATIENTS WHO UNDERWENT ABDOMINOPELVIC COMPUTED TOMOGRAPHY HAVE UNDIAGNOSED AXIAL SPONDYLOARTHRITIS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2047] [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
Background:The diagnosis of axial spondyloarthritis (axSpA) is challenging and hindered by delay. There may be an opportunity to identify sacroiliitis for further rheumatology review in inflammatory bowel disease (IBD) patients who undergo Computed Tomography (CT) for non-musculoskeletal (MSK) indications.Objectives:To identify what proportion of IBD patients who underwent abdominopelvic CT for non-MSK indications have axSpA and to explore the role of an imaging strategy for identifying axSpA.Methods:Abdominopelvic CT scans of verified IBD patients were identified retrospectively from eight years of imaging archive. Patients between 18-55 yrs. were selected as having the highest diagnostic yield for axSpA. CT review (using criteria from a validated CT screening tool developed by Chan1) was undertaken by a trained radiology team for presence of CT-defined sacroiliitis (CTSI). All CTSI patients were sent a screening questionnaire. Those with self-reported chronic back pain (CBP), duration > 3 months, onset < 45 years were invited for rheumatology review. This included a medical interview, physical examination (joint count, MASES, dactylitis count, BASMI), patient reported outcomes (BASDAI, BASFI, BASGI, Harvey-Bradshaw-Index, Partial-Mayo-Index), relevant laboratory tests (CRP, ESR, HLA-B27), axSpA protocol MRI, and remote review by a panel of experienced rheumatologists with a special interest in axSpA.Results:CTSI was identified in 60 of 301 patients. Thirty-two (53%) responded to the invitation to participate and 27 (84%) were enrolled. Of these, eight had a pre-existing axSpA diagnosis and five did not report chronic back pain. Fourteen patients underwent rheumatological assessment; three of 14 (21.4% [95% CI: 4.7%, 50.8%]) had undiagnosed axSpA. In total, 11 of 27 (40.7% [95% CI: 22.4%, 61.2%]) patients had a rheumatologist verified diagnosis of axSpA.Conclusion:One in five patients (60/301) with IBD who underwent abdominopelvic CT for non-MSK indications have CTSI and at least one in five (11/60) have axSpA. Five percent (3/60) were previously undiagnosed. This highlights a hidden disease burden and a potential strategy for identifying new cases.References:[1]Chan J, Sari I, Salonen D, Inman RD, Haroon N. Development of a Screening Tool for the Identification of Sacroiliitis in Computed Tomography Scans of the Abdomen. J Rheumatol 2016; 43(9); 1687-94.Acknowledgements:We are indebted to Baljeet Dhillon and Shin Azegami for their assistance in the scoring of the CTSI.Disclosure of Interests:Chong Seng Edwin Lim Grant/research support from: AbbVie, Louise Hamilton: None declared, Samantha Low: None declared, Andoni Toms: None declared, Alex MacGregor: None declared, Karl Gaffney Speakers bureau: AbbVie, Eli Lilly, Novartis, UCB Pharma, Consultant of: AbbVie, Eli Lilly, Novartis, UCB Pharma, Grant/research support from: AbbVie, Gilead, Eli Lilly, Novartis, UCB Pharma.
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Cox J, Hamilton L, Doucette S, Foster G, Thabane L, Parkash R, Xie F, MacKillop J, Ciaccia A, Choudhri S, Nemis-White J. The effect of computer decision support on optimizing appropriate dosing of novel oral anticoagulant therapy in the IMPACT-AF study. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0642] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Guidelines favour use of the non-vitamin K oral anticoagulants (NOACs) over vitamin-K antagonists for stroke prevention in atrial fibrillation (AF). However, studies have shown these agents are being under-dosed relative to the doses recommended in the product labels.
Purpose
To assess the ability of a CDS tool, employed to support management of patients with AF in primary care, to optimize NOAC prescribing.
Methods
The Integrated Management Program Advancing Community Treatment of Atrial Fibrillation (IMPACT-AF) study was a cluster randomized controlled trial that assessed the ability of a CDS tool to optimize care of community-based AF patients. Between September 2014 and December 2016, 203 primary care providers (104 randomized to CDS use, 99 to usual care [UC]) and 1133 of their patients (n=597 CDS, n=548 UC) were enrolled. Among other functions, 9 CDS program rules provided recommendations on NOAC prescribing based upon a given patient's clinical profile, as per product labels. Appropriate NOAC prescribing within the IMPACT-AF study population was compared between patients managed with the CDS versus UC at baseline and 12-months.
Results
Of those patients prescribed a NOAC, a high proportion (approximately 70%) were managed as per NOAC prescribing recommendations at baseline (Fig. 1). At 12 months, this proportion did not appreciably change in the UC arm (Fig. 1). In the CDS arm, an 8.2% absolute/11.8% relative improvement in appropriate NOAC prescribing over baseline was seen at 12-months (Fig. 1).
A comparison of patients at baseline and 12-months within each arm revealed a non-significant decline in the level of appropriate NOAC prescribing in the UC group (p=0.53). In the CDS arm, a significant improvement was observed in appropriate NOAC prescribing over time (p<0.001).
Conclusion
Even prior to any quality improvement efforts, appropriate NOAC prescribing was higher than anticipated in this contemporary cohort of community-based AF patients. At 12-months, significant further improvements were seen in the CDS but not the UC arm. These findings suggest that physician decision support can help enhance appropriate NOAC prescribing in the primary care setting.
Figure 1. Appropriate NOAC prescribing
Funding Acknowledgement
Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): Bayer Inc.
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Affiliation(s)
- J Cox
- Dalhousie University, Professor of Medicine, Halifax, Canada
| | - L Hamilton
- Nova Scotia Health Authority, Halifax, Canada
| | - S Doucette
- Nova Scotia Health Authority, Halifax, Canada
| | - G Foster
- McMaster University, Health Research Methods, Evidence and Impact, Hamilton, Canada
| | - L Thabane
- McMaster University, Health Research Methods, Evidence and Impact, Hamilton, Canada
| | - R Parkash
- Dalhousie University, Professor of Medicine, Halifax, Canada
| | - F Xie
- McMaster University, Health Research Methods, Evidence and Impact, Hamilton, Canada
| | - J MacKillop
- Nova Scotia Health Authority, Halifax, Canada
| | | | | | - J Nemis-White
- Strive Health Management Consulting Ltd., Halifax, Canada
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Abstract
The first documented mention of a needlestick injury (NSI) in the medical literature appeared in 1906. Despite growth in academic and clinical interest for NSI prevention, a global report identified that approximately 3 million healthcare workers have suffered percutaneous exposure to blood-borne pathogens. Legislation is an important component of NSI prevention. Unfortunately, the impact of legislation may not always reduce the incidence of NSI as much as expected. Safety-engineered device (SED) implementation has demonstrated a substantial reduction in NSI rates compared with non-SEDs. More importantly, passive SEDs are 10 times less likely to be connected with an NSI incident.
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Affiliation(s)
- Andrew Paul Jackson
- IV Nurse Consultant, The Rotherham NHS Foundation Trust, and Director, IVTEAM.com
| | - Leo Andrew Almerol
- Vascular Access Clinical Nurse Specialist, Bedfordshire Hospitals NHS Foundation Trust
| | | | - Louise Hamilton
- IV Clinical Nurse Specialist, Ashford and St Peter's NHS Foundation Trust
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Lim CSE, Tremelling M, Hamilton L, Macgregor A, Gaffney K. SAT0380 ENHANCING RHEUMATOLOGY REFERRALS AMONG INFLAMMATORY BOWEL DISEASE PATIENTS WITH SUSPECTED AXIAL SPONDYLOARTHRITIS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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
Background:Axial spondyloarthritis (axSpA) is associated with inflammatory bowel disease (IBD). In IBD patients, the clinical probability of axSpA increases in those with chronic back pain (CBP) whose symptoms started before the age of forty-five years old. In practice, this should trigger a rheumatology review especially if accompanied by other symptoms suspicious of inflammatory disease. However, in any health system, the goal of identifying all possible cases need to be balanced with the practical realisation of the finite resources available.Objectives:The study aimed to define the clinical characteristics of a subgroup of IBD patients who are routinely managed in secondary care who have an increased clinical probability for axSpA. Identification of these characteristics may help improve the quality and specificity of referrals to Rheumatology from Gastroenterology clinics.Methods:An analytical cross-sectional study was undertaken. Consecutive IBD patients attending routine Gastroenterology clinics were sent a modified validated back pain questionnaire. The questionnaire included the presence or absence of a previous diagnosis of axSpA; components of validated inflammatory back pain criteria; diagrams to indicate the location of back pain and other musculoskeletal pain; personal and family history of known axSpA manifestations; and details of their IBD course, activity and treatment.IBD patients, with back pain duration > 3 months with onset before 45 years were considered to have a medium diagnostic probability (MDP) for axSpA. MDP-positive IBD patients were compared with MDP-negative IBD patients and logistic regression was used to model the association with clinical features.Results:Four hundred and seventy consecutive IBD patients (mean age 54 years; 46% male) were surveyed. Two hundred and nine patients (59%) replied, of whom 191 patients (69%) consented to participate. One hundred and seventy-three (91%) of those who consented had a valid completed questionnaire and were included for data analysis. Of these, 74% had Ulcerative Colitis and 26% had Crohn’s disease. Their mean age was 58 years, 39% male. Mean age at IBD diagnosis was 39 years, mean IBD disease duration 19 yrs. CBP (back pain greater than three months) was reported by 76%. Inflammatory back pain fulfilling Calin, Berlin, ASAS criteria was seen in 23%, 29%, and 15% respectively. In addition, 80% reported peripheral musculoskeletal pain. Self-reported personal history of enthesitis, reactive arthritis (ReA), acute anterior uveitis (AAU), skin psoriasis (PSO) and dactylitis were 50%, 30%, 24%, 15% and 0% respectively. Self-reported family history of IBD, ReA, PSO, axSpA and AAU were 60%, 36%, 22%, 11%, and 1% respectively.Ninety-one (53%) patients were MDP-positive and 82 (47%) patients were MDP-negative. The clinical characteristics associated with MDP (adjusted for age at invitation) were: the presence of inflammatory back pain using ASAS criteria [OR 8.84 (1.61,48.67); p=0.01], longer interval between symptom onset and gastroenterologist diagnosis of IBD [OR 1.09 (1.03,1.16); p=0.005], and use of rectal topical 5-aminosalicylic acid [OR 3.27 (1.11,9.68); p=0.03].Conclusion:Chronic back pain and peripheral musculoskeletal pain are common in a secondary care IBD population. In IBD patients, with back pain duration > 3 months and onset before 45 years, the presence of inflammatory back pain, longer diagnostic delay of IBD and the use of rectal topical 5-aminosalicylic acid were associated with a higher clinical probability of axSpA. The identification of these clinical features may not only improve the quality and specificity of Rheumatology referrals from Gastroenterology in this subgroup of patients but also lends real world evidence to current ASAS-endorsed recommendations for early referral of patients with a suspicion of axial spondyloarthritis.Disclosure of Interests:Chong Seng Edwin Lim Grant/research support from: AbbVie - Research support/grant but NOT for this study., Mark Tremelling: None declared, Louise Hamilton: None declared, Alexander Macgregor: None declared, Karl Gaffney Grant/research support from: AbbVie, Celgene, MSD, Novartis, Pfizer, and UCB Pharma, Consultant of: AbbVie, Celgene, MSD, Novartis, Pfizer, and UCB Pharma, Speakers bureau: AbbVie, Celgene, MSD, Novartis, Pfizer, and UCB Pharma
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11
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Morley J, Moayyeri A, Ali L, Taylor A, Feudjo-Tepie M, Hamilton L, Bayly J. Persistence and compliance with osteoporosis therapies among postmenopausal women in the UK Clinical Practice Research Datalink. Osteoporos Int 2020; 31:533-545. [PMID: 31758206 PMCID: PMC7076063 DOI: 10.1007/s00198-019-05228-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 11/06/2019] [Indexed: 12/16/2022]
Abstract
UNLABELLED Gaining full benefits from osteoporosis medications requires long-term treatment. Investigating the real-world persistence of women receiving osteoporosis medications in the UK, we found that most patients stop treatment within a year. To prevent osteoporotic fragility fractures, long-term treatment persistence must be improved. INTRODUCTION Persistence with osteoporosis therapies has historically been poor. To treat this chronic and progressive disease, it is essential that patients receive the full benefit of these medications. We estimated persistence and compliance with osteoporosis therapies in a large sample of postmenopausal women in the UK. METHODS Data were obtained from the Clinical Practice Research Datalink for all women aged 50 years and over or women with early menopause, who received at least one prescription in primary care for any licensed osteoporosis therapy between January 1, 2010 and December 31, 2015. Persistence and compliance at 24 months (primary objective) and at 5 years (exploratory objective) were estimated in three patient cohorts: "All Patients," "Naïve Patients," and "Drug-Specific." RESULTS The All Patients cohort included 72,256 women. Persistence with any therapy was 56.1%, 43.6%, 36.4%, and 31.0% at 6, 12, 18, and 24 months, respectively, and 23.2% and 13.1% at 3 years and 5 years, respectively. Patients were generally more persistent and compliant if evaluated from their first exposure to osteoporosis therapy (Naïve Patients cohort). In the drug-specific analysis, 64% of patients receiving denosumab (administered subcutaneously every 6 months) were persistent at 24 months compared with 28% and 23% of those taking oral bisphosphonates and intravenous bisphosphonates, respectively. CONCLUSIONS Only about one in three patients who received osteoporosis therapy continued to be on treatment after 2 years. There is a need to improve persistence with osteoporosis therapy, especially for high-risk patients.
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Affiliation(s)
| | | | | | | | | | | | - J Bayly
- University of Derby, Derby, UK
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12
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Hamilton L, Farrell M, Mielke B, Solano M, Silva S, Calvo I. The natural history of canine occult Grade II medial patellar luxation: an observational study. J Small Anim Pract 2020; 61:241-246. [PMID: 32003012 DOI: 10.1111/jsap.13093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 10/08/2019] [Accepted: 11/07/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To determine the risk of lameness and the rate of subsequent medial patellar luxation surgery in dogs that present with occult Grade II medial patellar luxation. MATERIALS AND METHODS Retrospective owner survey and review of clinical records of adult dogs diagnosed with Grade II medial patellar luxation that were initially asymptomatic and managed non-surgically that had a minimum of 4-year follow-up. Clinical notes and owner questionnaires identified dogs that subsequently developed lameness and required surgery on the previously asymptomatic stifle. RESULTS Thirty-eight dogs were included with an average follow-up of 51 months. Seventeen dogs re-presented for unscheduled contralateral medial patellar luxation surgery at an average of 15 months after initial presentation. A further two dogs had chronic contralateral limb lameness after an average of 33 months after initial surgery and may have been potential surgical candidates. CLINICAL SIGNIFICANCE Fifty percent of adult dogs presenting with occult Grade II medial patellar luxation subsequently developed chronic lameness or required surgery.
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Affiliation(s)
- L Hamilton
- Davies Veterinary Specialists, Higham Gobion, Hertfordshire, SG53HR, UK
| | - M Farrell
- Davies Veterinary Specialists, Higham Gobion, Hertfordshire, SG53HR, UK
| | - B Mielke
- Department of Orthopaedic Surgery, Royal Veterinary College, Hertfordshire, UKAL97TA, UK
| | - M Solano
- Department of Orthopaedic Surgery, Fitzpatrick Referrals, Surrey, GU72Q, UK
| | - S Silva
- Department of Orthopaedic Surgery, Fitzpatrick Referrals, Surrey, GU72Q, UK
| | - I Calvo
- Department of Orthopaedic Surgery, Royal Veterinary College, Hertfordshire, UKAL97TA, UK
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13
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Xiang L, Teo EPS, Low AHL, Leung YY, Fong W, Xin X, Gandhi M, Kwan YH, Uy EJB, Hamilton L, Thumboo J. Cross‐cultural adaptation of the Hamilton axial spondyloarthritis questionnaire and development of a Chinese version in a multi‐ethnic Asian population. Int J Rheum Dis 2019; 22:1652-1660. [DOI: 10.1111/1756-185x.13645] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 05/18/2019] [Accepted: 05/31/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Ling Xiang
- Department of Rheumatology and Immunology Singapore General Hospital Singapore City Singapore
| | - Edmund Pek Siang Teo
- Health Services Research Unit Singapore General Hospital Singapore City Singapore
| | - Andrea Hsiu Ling Low
- Department of Rheumatology and Immunology Singapore General Hospital Singapore City Singapore
- Duke‐NUS Medical School Singapore City Singapore
- Yong Loo Lin School of Medicine National University of Singapore Singapore City Singapore
| | - Ying Ying Leung
- Department of Rheumatology and Immunology Singapore General Hospital Singapore City Singapore
- Duke‐NUS Medical School Singapore City Singapore
- Yong Loo Lin School of Medicine National University of Singapore Singapore City Singapore
| | - Warren Fong
- Department of Rheumatology and Immunology Singapore General Hospital Singapore City Singapore
- Duke‐NUS Medical School Singapore City Singapore
- Yong Loo Lin School of Medicine National University of Singapore Singapore City Singapore
| | - Xiaohui Xin
- Academic Clinical Program for Medicine Singapore General Hospital Singapore City Singapore
| | - Mihir Gandhi
- Biostatistics, Singapore Clinical Research Institute Singapore City Singapore
- Centre for Quantitative Medicine Duke‐NUS Medical School Singapore City Singapore
| | - Yu Heng Kwan
- Duke‐NUS Medical School Singapore City Singapore
| | - Elenore J. B. Uy
- Department of Rheumatology and Immunology Singapore General Hospital Singapore City Singapore
| | - Louise Hamilton
- Department of Rheumatology Norfolk and Norwich University Hospitals NHS Foundation Trust Norwich UK
| | - Julian Thumboo
- Department of Rheumatology and Immunology Singapore General Hospital Singapore City Singapore
- Duke‐NUS Medical School Singapore City Singapore
- Yong Loo Lin School of Medicine National University of Singapore Singapore City Singapore
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14
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Scovil CY, Delparte JJ, Walia S, Flett HM, Guy SD, Wallace M, Burns AS, Wolfe DL, Wolfe D, Kras-Dupuis A, Walia S, Guy S, Askes H, Casalino A, Fraser C, Paiva M, Miles S, Gagliardi J, Orenczuk S, Sommerdyk J, Genereaux M, Jarvis D, Wesenger J, Bloetjes L, Flett H, Burns A, Scovil C, Delparte J, Leber D, McMillan L, Domingo T, Wallace M, Stoesz B, Aguillon G, Koning C, Mumme L, Cwiklewich M, Bayless K, Crouse L, Crocker J, Erickson G, Mark M, Charbonneau R, Lloyd A, Van Doesburg C, Knox J, Wright P, Mouneimne M, Parmar R, Isaacs T, Reader J, Oga C, Birchall N, McKenzie N, Nicol S, Joly C, Laramée M, Robidoux I, Casimir M, Côté S, Lubin C, Lemay J, Beaulieu J, Truchon C, Noreau L, Lemay V, Vachon J, Bélanger D, Proteau F, O'Connell C, Savoie J, McCullum S, Brown J, Duda M, Bassett-Spiers K, Riopelle R, Hsieh J, Reinhart-McMillan W, Joshi P, Noonan V, Humphreys S, Hamilton L, MacIsaac G. Implementation of Pressure Injury Prevention Best Practices Across 6 Canadian Rehabilitation Sites: Results From the Spinal Cord Injury Knowledge Mobilization Network. Arch Phys Med Rehabil 2019; 100:327-335. [DOI: 10.1016/j.apmr.2018.07.444] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 07/11/2018] [Accepted: 07/20/2018] [Indexed: 12/19/2022]
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15
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Hamilton L, Allard E. INVESTIGATING HOW THE AGING BODY IMPACTS EMOTION-COGNITION ACROSS ADULTHOOD. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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16
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Krassioukov A, Holmgren T, Lee A, Shea H, Hamilton L, Sandholdt N, Hellsing I, Elliott S, Claes H. Breastfeeding and motherhood after spinal cord injury: Barriers and challenges. Ann Phys Rehabil Med 2018. [DOI: 10.1016/j.rehab.2018.05.555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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17
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Yahya F, Gaffney K, Hamilton L, Lonsdale E, Leeder J, Brooksby A, Cavill C, Berry-Jenkins J, Boyle C, Bond D, Sengupta R. Comment on: Tumour necrosis factor inhibitor survival and predictors of response in axial spondyloarthritis—findings from a United Kingdom cohort: reply. Rheumatol Adv Pract 2018; 2:rky037. [PMID: 31433399 PMCID: PMC6649945 DOI: 10.1093/rap/rky037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Revised: 08/10/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Fariz Yahya
- Department of Rheumatology, Royal National Hospital for Rheumatic Diseases, Bath, UK
- Department of Medicine, University Malaya, Kuala Lumpur, Malaysia
| | - Karl Gaffney
- Department of Rheumatology, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich
| | - Louise Hamilton
- Department of Rheumatology, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich
| | - Ellie Lonsdale
- Department of Rheumatology, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich
| | - Jane Leeder
- Department of Rheumatology, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich
| | - Alan Brooksby
- Department of Rheumatology, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich
| | - Charlotte Cavill
- Department of Rheumatology, Royal National Hospital for Rheumatic Diseases, Bath, UK
| | - Joshua Berry-Jenkins
- Department of Rheumatology, Royal National Hospital for Rheumatic Diseases, Bath, UK
| | - Cathal Boyle
- Department of Rheumatology, Royal National Hospital for Rheumatic Diseases, Bath, UK
| | - Debbie Bond
- Department of Rheumatology, Royal National Hospital for Rheumatic Diseases, Bath, UK
| | - Raj Sengupta
- Department of Rheumatology, Royal National Hospital for Rheumatic Diseases, Bath, UK
- Department of Pharmacology, University of Bath, Bath, UK
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18
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Abstract
Objective Acute anterior uveitis (AAU) is the most common extra-articular manifestation of axial spondyloarthritis (axSpA). In this study, patients presenting with AAU were evaluated clinically and with MRI in order to estimate the prevalence of axSpA. Methods Consecutive patients presenting to a university teaching hospital between February 2014 and March 2015 with AAU were invited to participate. Those with a history of chronic back pain (CBP) beginning <45 years were evaluated clinically and with MRI of thoracolumbar spine and sacroiliac joints. Results Of 366 patients with AAU, 57 had a pre-existing diagnosis of axSpA; 77 others fulfilled the study eligibility criteria and 73 (95%) completed the study. Seventeen patients (23.3%) were diagnosed with axSpA by an experienced rheumatologist; of these, eight were human leucocyte antigen-B27 negative. Including those with a previous diagnosis, this equates to a minimum axSpA prevalence of 20.2%; one-quarter of patients were previously undiagnosed. Conclusion This is the first study to actively search for the presence of axSpA in unselected patients presenting with AAU utilising MRI as an essential part of the assessment. There is a significant burden of undiagnosed axSpA in patients with AAU, but there does not appear to be a simple mechanism for screening. We recommend that ophthalmologists refer all patients with AAU with CBP, onset <45 years, to rheumatology for further evaluation.
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Affiliation(s)
- Mark P Sykes
- Department of Rheumatology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Louise Hamilton
- Department of Rheumatology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Colin Jones
- Department of Ophthalmology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Karl Gaffney
- Department of Rheumatology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
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Yahya F, Gaffney K, Hamilton L, Lonsdale E, Leeder J, Brooksby A, Cavill C, Berry-Jenkins J, Boyle C, Bond D, Sengupta R. Tumour necrosis factor inhibitor survival and predictors of response in axial spondyloarthritis—findings from a United Kingdom cohort. Rheumatology (Oxford) 2017; 57:619-624. [DOI: 10.1093/rheumatology/kex457] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Indexed: 12/17/2022] Open
Affiliation(s)
- Fariz Yahya
- Department of Rheumatology, Royal National Hospital for Rheumatic Diseases, Bath, UK
- Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Karl Gaffney
- Department of Rheumatology, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich
| | - Louise Hamilton
- Department of Rheumatology, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich
| | - Ellie Lonsdale
- Department of Rheumatology, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich
| | - Jane Leeder
- Department of Rheumatology, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich
| | - Alan Brooksby
- Department of Rheumatology, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich
| | - Charlotte Cavill
- Department of Rheumatology, Royal National Hospital for Rheumatic Diseases, Bath, UK
| | - Joshua Berry-Jenkins
- Department of Rheumatology, Royal National Hospital for Rheumatic Diseases, Bath, UK
| | - Cathal Boyle
- Department of Rheumatology, Royal National Hospital for Rheumatic Diseases, Bath, UK
| | - Debbie Bond
- Department of Rheumatology, Royal National Hospital for Rheumatic Diseases, Bath, UK
| | - Raj Sengupta
- Department of Rheumatology, Royal National Hospital for Rheumatic Diseases, Bath, UK
- Department of Pharmacology, University of Bath, Bath, UK
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Oliver-Welsh L, Hamilton L, Slater N. A novel cabling technique. Ann R Coll Surg Engl 2017; 100:417-418. [PMID: 29046097 DOI: 10.1308/rcsann.2017.0168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- L Oliver-Welsh
- Maidstone and Tunbridge Wells NHS Trust, Tunbridge Wells Hospital , Pembury, Tunbridge Wells , UK
| | - L Hamilton
- Maidstone and Tunbridge Wells NHS Trust, Tunbridge Wells Hospital , Pembury, Tunbridge Wells , UK
| | - N Slater
- Maidstone and Tunbridge Wells NHS Trust, Tunbridge Wells Hospital , Pembury, Tunbridge Wells , UK
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Abstract
Abstract
Skin wounds are a common presentation in small animal practice. These wounds may be acute or chronic with a complicated healing process. An important aspect of the healing of wounds is debridement which may be carried out by surgical, autolytic, mechanical or enzymatic methods. The debridement method is chosen according to the individual skin defect and influenced by factors such as wound size and location, the age of the wound, and the presence of infection or exudate. Enzymatic debridement is a method that is not commonly used in veterinary practice, and involves the use of enzyme preparations to remove necrotic tissue from a wound. The aim of this study was to investigate the effects of the enzymatic ointment collagenase as a method of debridement, and its effect on the macroscopic appearance of chronic skin wounds in cats and dogs. We observed that the application of Iruxol Mono directly to the wound changes the progress of the healing process, with no obvious adverse effects. The time of healing of chronic wounds was decreased and healthy granulation tissue was developed within a couple of days after application of the ointment. Enzymatic debridement appears to be a promising method of debridement for use in chronic wounds, and should be considered in cases where more conventional methods of debridement are ineffective or unsuitable.
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Affiliation(s)
- L. Hamilton
- University of Veterinary Medicine and Pharmacy, Komenského 73, 04181 Košice, Slovakia
| | - M. Kožár
- University of Veterinary Medicine and Pharmacy, Komenského 73, 04181 Košice, Slovakia
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Sykes M, Hamilton L, Gaffney K. 102. A PROSPECTIVE EVALUATION OF THE DUBLIN UVEITIS EVALUATION TOOL IN UK CLINICAL PRACTICE. Rheumatology (Oxford) 2017. [DOI: 10.1093/rheumatology/kex062.102] [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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Steel L, Yates M, Hamilton L, Gaffney K. 106. IS THERE A SUSTAINED RESPONSE TO TUMOUR NECROSIS FACTOR INHIBITOR DOSE TAPERING IN ANKYLOSING SPONDYLITIS? Rheumatology (Oxford) 2017. [DOI: 10.1093/rheumatology/kex062.106] [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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Hamilton L, Barkham N, Bhalla A, Brittain R, Cook D, Jones G, Mackay K, Marshall D, Marzo-Ortega H, Murphy D, Riddell C, Sengupta R, Siebert S, Van Rossen L, Gaffney K. BSR and BHPR guideline for the treatment of axial spondyloarthritis (including ankylosing spondylitis) with biologics. Rheumatology (Oxford) 2016; 56:313-316. [DOI: 10.1093/rheumatology/kew223] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 04/12/2016] [Indexed: 11/13/2022] Open
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Sykes M, Hamilton L, Jones C, Gaffney K. FRI0427 The Prevalence of Axial Spondyloarthritis in Patients Presenting with Acute Anterior Uveitis. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.3739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Leeder J, Lonsdale E, Hamilton L. 133 Do Patients on Anti-Tumour Necrosis Factor Monotherapy Need Regular Blood Tests? An Audit of Blood Monitoring in People with Ankylosing Spondylitis. Rheumatology (Oxford) 2016. [DOI: 10.1093/rheumatology/kew128.006] [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: 11/12/2022] Open
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Hamilton L. Psychiatric input into the assessment and management of chronic pelvic pain. J Sci Med Sport 2015. [DOI: 10.1016/j.jsams.2015.12.373] [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: 11/28/2022]
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Hamilton L. Psychology, the Nurse and the Patient by Doris M. Odlum. Int J Group Psychother 2015. [DOI: 10.1080/00207284.1956.11508681] [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]
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Hamilton L, Keh S, Spielmann PM, Hussain SSM. How we do it: locating the posterior semicircular canal in occlusion surgery for refractory benign paroxysmal positional vertigo: a cadaveric temporal bone study. Clin Otolaryngol 2015; 41:190-3. [PMID: 26095673 DOI: 10.1111/coa.12479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2015] [Indexed: 10/23/2022]
Affiliation(s)
- L Hamilton
- Temporal Bone Laboratory, Department of Otolaryngology, University of Dundee School of Medicine & Ninewells Hospital, Dundee, UK
| | - S Keh
- Temporal Bone Laboratory, Department of Otolaryngology, University of Dundee School of Medicine & Ninewells Hospital, Dundee, UK
| | - P M Spielmann
- Temporal Bone Laboratory, Department of Otolaryngology, University of Dundee School of Medicine & Ninewells Hospital, Dundee, UK
| | - S S M Hussain
- Temporal Bone Laboratory, Department of Otolaryngology, University of Dundee School of Medicine & Ninewells Hospital, Dundee, UK
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Armstrong C, Hamilton L, Shenkin SD. 26 * FACTORS PREDICTIVE OF NURSING HOME ADMISSION DIRECTLY FROM HOSPITAL: A SYSTEMATIC REVIEW. Age Ageing 2015. [DOI: 10.1093/ageing/afv029.26] [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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Hamilton L, Macgregor A, Toms A, Warmington V, Pinch E, Gaffney K. O12. The Prevalence of Axial Spondyloarthropathy in the UK: A Cross Sectional Cohort Study in a Primary Care Population. Rheumatology (Oxford) 2014. [DOI: 10.1093/rheumatology/keu086.006] [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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Gaffney K, Elender F, Hamilton L, Yates M, Dean L, Doll H. O31. An Open Label, Pilot, Multi-Centre, Step-Down, Randomized Controlled Trial to Examine Whether Etanercept 25 mg Once Weekly is Effective in Maintaining a Clinical Response in Patients with Ankylosing Spondylitis who have Responded to 50 mg Once Weekly. Rheumatology (Oxford) 2014. [DOI: 10.1093/rheumatology/keu091.001] [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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Yang JC, Simon C, Schneider A, Seritan AL, Hamilton L, Hagerman PJ, Hagerman RJ, Olichney JM. Abnormal semantic processing in females with fragile X-associated tremor/ataxia syndrome. Genes Brain Behav 2013; 13:152-62. [PMID: 24299169 DOI: 10.1111/gbb.12114] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 11/12/2013] [Accepted: 11/28/2013] [Indexed: 11/29/2022]
Abstract
Fragile X-associated tremor/ataxia syndrome (FXTAS), a neurodegenerative disorder, affects fragile X (FMR1) gene premutation carriers in late life. Studies have shown cognitive impairments in FXTAS including executive dysfunction, working memory and visuospatial deficits. However, less is known about cognition in females with FXTAS. Thus, we examined semantic processing and verbal memory in female FXTAS patients with event-related potentials (ERPs) and neuropsychological testing. Sixty-one females (34 FXTAS, Mage = 62.7; 27 controls, Mage = 60.4) were studied with 32-channel ERPs during a category judgment task in which semantically congruous (50%) and incongruous items were repeated approximately 10-140 seconds later. N400 and P600 amplitude data were submitted to analysis of covariance. Neuropsychological testing demonstrated lower performance in verbal learning and executive function in females with FXTAS. Event-related potential analyses showed a significant reduction of the N400 congruity effect (incongruous - congruous) in the FXTAS group. The N400 congruity effect reduction in females with FXTAS was mainly due to increased N400 amplitude to congruous new words. No significant abnormalities of the N400 repetition effect or the P600 repetition effect were found, indicating preserved implicit memory and verbal memory, respectively, in females with FXTAS. The decreased N400 congruity effect suggests abnormal semantic expectancy and/or semantic network disorganization in female FXTAS patients. The enhanced N400 amplitude to congruous new words may reflect decreased cognitive flexibility among FXTAS women, making access to less typical category exemplar words more difficult.
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Affiliation(s)
- J-C Yang
- Department of Neurology, University of California Davis School of Medicine, Sacramento; Center for Mind and Brain, University of California Davis, Davis
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Hamilton L, Macgregor A, Warmington V, Pinch E, Gaffney K. The prevalence of inflammatory back pain in a UK primary care population. Rheumatology (Oxford) 2013; 53:161-4. [DOI: 10.1093/rheumatology/ket344] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [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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Ranasinghe A, Clark S, Corris P, Fisher A, Gould K, Hamilton L, Lordan J, Meachery G, Morley K, Parry G, Perry A, Pillay T, Schueler S, Tocewicz K, Dark J. Improving Outcomes in Lung Transplantation for Cystic Fibrosis – A Unified Approach. J Heart Lung Transplant 2013. [DOI: 10.1016/j.healun.2013.01.542] [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] Open
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Harris C, Remedios D, Aptowitzer T, Keat A, Hamilton L, Guile G, Belkhiri A, Newman D, Toms A, Macgregor A, Gaffney K, Morton L, Jones GT, MacDonald AG, Downham C, Macfarlane GJ, Tillett W, Jadon D, Wallis D, Costa L, Waldron N, Griffith N, Cavill C, Korendowych E, de Vries C, McHugh N, Iaremenko O, Fedkov D, Emery P, Baeten D, Sieper J, Braun J, van der Heijde D, McInnes I, Van Laar J, Landewe R, Wordsworth BP, Wollenhaupt J, Kellner H, Paramarta I, Bertolino A, Wright AM, Hueber W, Sofat N, Smee C, Hermansson M, Wajed J, Sanyal K, Kiely P, Howard M, Howe FA, Barrick TR, Abraham AM, Pearce MS, Mann KD, Francis RM, Birrell F, Carr A, Macleod I, Ng WF, Kavanaugh A, van der Heijde D, Chattopadhyay C, Gladman D, Mease P, McInnes I, Krueger G, Xu W, Goldstein N, Beutler A, Van Laar J, Baraliakos X, Braun J, Laurent DD, Baeten D, van der Heijde D, Sieper J, Emery P, McInnes I, Landewe R, Wordsworth BP, Wollenhaupt J, Kellner H, Wright AM, Gsteiger S, Hueber W, Conaghan PG, Peterfy CG, DiCarlo J, Olech E, Alberts AR, Alper JA, Devenport J, Anisfeld AM, Troum OM, Cooper P, Gimpel M, Deakin G, Jameson K, Godtschailk M, Gadola S, Stokes M, Cooper C, Gordon C, Kalunian K, Petri M, Strand V, Kilgallen B, Barry A, Wallace D, Flurey CA, Morris M, Pollock J, Hughes R, Richards P, Hewlett S. Oral abstracts 1: Spondyloarthropathies * O1. Detecting axial spondyloarthritis amongst primary care back pain referrals. Rheumatology (Oxford) 2012. [DOI: 10.1093/rheumatology/kes118] [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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Gregory P, Woollard M, Lighton D, Munro G, Jenkinson E, Newcombe RG, O'Meara P, Hamilton L. Comparison of malleable stylet and reusable and disposable bougies by paramedics in a simulated difficult intubation. Anaesthesia 2012; 67:371-6. [PMID: 22288931 DOI: 10.1111/j.1365-2044.2011.06999.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In a randomised crossover study, 60 ambulance paramedics attempted tracheal intubation of a manikin model of a Cormack and Lehane grade 3/4 view using a Portex stylet, Portex and Frova single-use bougies, and a Portex reusable bougie. Tracheal intubation within 30 s was achieved by 34/60 (57%) using the stylet, 18/60 (30%) using a Portex single-use bougie, 16/60 (27%) using a Frova single-use bougie and 5/60 (8%) using a Portex reusable bougie. The proportion intubating within 30 s was significantly higher with the stylet compared with any bougie (p < 0.001), but significantly lower with a Portex reusable bougie than any other device (p < 0.004). Participants rated the Portex reusable bougie as significantly more difficult to use than the other devices (p < 0.001). There was no evidence of a relationship between previous experience and success rate for any device.
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Hamilton L, Dredge B. Efficiency. The hire value way to purchase. Health Serv J 2011; 121:22-24. [PMID: 21998997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Jeffery ND, Hamilton L, Granger N. Designing clinical trials in canine spinal cord injury as a model to translate successful laboratory interventions into clinical practice. Vet Rec 2011; 168:102-7. [PMID: 21493470 DOI: 10.1136/vr.d475] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Many interventions have been shown to improve outcome after experimental spinal cord injury in laboratory animals. The challenge now is to determine whether any of these can be translated to become an efficacious therapy for clinical lesions - a process that is often difficult and frequently fails. Here, we discuss the steps that are required to make this transition and the need for rigorous clinical trials. A key component is an outcome measure that is amenable to statistical analysis; we describe methods that we have developed to accurately measure function after spinal cord injury in dogs. The general methodology may have parallels in the development of veterinary models to test putative therapies for other diseases of humans and animals.
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Affiliation(s)
- N D Jeffery
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, 1600 South 16th Street, Ames, IA 50011, USA.
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Castillo-Gallego C, de Miguel Mendieta E, Garcia-Arias M, Plasencia-Rodriguez C, Lojo-Oliveira L, Martin-Mola E, Tillett W, Cavill C, Korendowych E, McHugh N, Coates L, Bhalla AK, Creamer P, Packham J, Hailwood S, Taylor G, Hamilton L, Brooksby A, Leeder J, Gaffney K, Malipeddi AS, Neame R, Francis J, Hassan W, Mease P, Olds M, Kary S, Kupper H, Bell C, Peffers G, Rees F, Lanyon P, Obrenovic K, Sandhu R, Packham J, Erb N, Coates LC, Conaghan P, Emery P, Green M, Ibrahim G, MakIver H, Helliwell P, Giles JL, McHugh K, DiGleria K, Shaw J, Kollnberger S, Maenaka K, Marroquin O, Renner C, Bowness P, Landewe R, Ritchlin C, Olds M, Guerette B, Lavie F, Kavanaugh A, McInnes I, Krueger GG, Gladman D, Zrubek J, Goldstein N, Xu S, Mudivarthy S, Mack M, Prevosto C, McDonald S, De Riva A, Goodman R, Key T, Hill Gaston JS, Deery MJ, Busch R, Fischer R, Wright C, Kessler B, Bowness P, Sheehy C, Jois RN, Leeder J, Kerrigan N, Mills KS, Somerville M, Scott DG, Gaffney K, Kavanaugh A, van der Heijde D, Chattopadhyay C, Gladman D, Mease P, McInnes I, Krueger GG, Xu W, Rahman MU, Zrubek J, Baratelle A, Beutler A, Stober CB, Benham HJ, Goodall JC, Hill Gaston JS, Sanyal K, Walker-Bone K, Coates LC, Conaghan P, Emery P, Green M, Ibrahim G, MakIver H, Helliwell PS, Vastesaeger N, Wang Y, Inman R, Deodhar A, Hsu B, Rahman MU, Dijkmans B, Braun J, Geusens P, Sieper J, van der Heijde D, El Miedany Y, Palmer D, McHugh K, Giles JL, Shaw J, Kollnberger S, Payeli S, Utriainen L, Milling S, Renner C, Bowness P. Spondylarthropathies (including psoriatic arthritis): 244. Validity of Colour Doppler and Spectral Doppler Ultrasound of Sacroilicac Joints Againts Physical Examination as Gold Standard. Rheumatology (Oxford) 2011. [DOI: 10.1093/rheumatology/ker034] [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: 11/14/2022] Open
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Hamilton L, Gilbert A, Skerrett J, Dickinson S, Gaffney K. Services for people with ankylosing spondylitis in the UK--a survey of rheumatologists and patients. Rheumatology (Oxford) 2011; 50:1991-8. [PMID: 21421687 DOI: 10.1093/rheumatology/ker013] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE . To investigate the services offered to patients with AS in the UK in 2010. METHODS Two thousand non-health-care professional members of the National Ankylosing Spondylitis Society (NASS) were sent a questionnaire asking about their experiences surrounding diagnosis, treatment and access to therapies (response rate 40%). A separate questionnaire was sent to a consultant rheumatologist in every acute NHS trust in the UK, asking about services offered to patients with AS (response rate 68%). RESULTS Overall, there was a mean diagnostic delay of 8.57 years. Almost one-third (32.2%) of patients were not reviewed in secondary care. Non-attendance was associated with increasing age and longer disease duration. Twenty per cent of patients were taking anti-TNF drugs, but 18.8% of departments reported that their ability to give anti-TNF therapy was restricted (64% reported primary-care trust rationing and 14% lack of staff). Almost all rheumatology departments had access to MRI, but 70.9% still used X-ray radiographs as their first-line investigation. A minority (5.6%) of patients reported they had never seen a physiotherapist, but less than one-third could self-refer for treatment during a flare. CONCLUSION This is the first study to explore the services available to people with AS in the UK. Almost one-third of patients are not seen in rheumatology departments and therefore may be under-treated. For those who are seen, access to anti-TNF drugs and other therapies remains an issue.
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Affiliation(s)
- Louise Hamilton
- Rheumatology Department, Norfolk and Norwich University Hospital, Colney Lane, Norwich NR4 7UY, UK.
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Rennerfelt K, Zhang Q, Hamilton L, Styf J. Patient pain drawing in diagnosing the cause of exercise-induced leg pain. Br J Sports Med 2011. [DOI: 10.1136/bjsm.2010.081554.51] [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: 11/03/2022]
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Van Belle S, Dalivoust P, Reinthaller A, Tzanninis D, Urbanski K, Hamilton L, Pujol B. P92 Current practice use of darbepoetin alfa in the management of chemotherapy-induced anaemia in patients < 65 and ≥65 years: interim data from CHOICE, an international, observational study. Crit Rev Oncol Hematol 2009. [DOI: 10.1016/s1040-8428(09)70130-1] [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] Open
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Woollard M, Lighton D, Gregory P, Munro G, Jenkinson E, Hamilton L, Newcombe R, O'Meara P. Malleable stylet vs re-useable and disposable bougies in a model of difficult intubation: a randomised cross-over trial. Emerg Med J 2009. [DOI: 10.1136/emj.2009.075416l] [Citation(s) in RCA: 2] [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: 11/03/2022]
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Hamilton L, Fay S, Rockwood K. Misplacing objects in mild to moderate Alzheimer's disease: a descriptive analysis from the VISTA clinical trial. J Neurol Neurosurg Psychiatry 2009; 80:960-5. [PMID: 19293172 DOI: 10.1136/jnnp.2008.166801] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Misplacing objects is a commonly reported symptom of Alzheimer's disease (AD) but it is little described systematically and conflicting characterisations (losing/forgetting the location of objects versus inappropriate placement) of this "warning sign" of dementia currently exist. Patient and carer descriptions of misplacing in clinical interviews are reported here. METHODS This was a secondary qualitative analysis of video recorded, open ended and semistructured clinical interviews with 130 community dwelling patients with mild to moderate AD (mean age 77 (7.7) years; 63% women; 67% mild AD) and their carers who participated in the Video Imaging Synthesis of Treating Alzheimer's Disease (VISTA) study, a 4 month, randomised, placebo controlled trial of galantamine. Employing a framework analysis approach, we summarised descriptive accounts of misplacing with relevant proportions. RESULTS Recurrent incidents of misplacing were described for 96/130 (74%) study patients, 45 of whom established treatment goals to track this problem. For most (78/96, 81%), misplacing was the inability to recall where an item had been set down or put away. Fewer patients (25/96, including 18 with recall misplacing) put objects in unusual or incorrect places. Patients were commonly aware of their misplacing (56/96, 58%) and were distressed by it (31/56). Patients who misplaced also displayed tendencies towards delusions/hallucinations (51/96, but only directly related to misplacing in 17 cases) and hiding items (15%) CONCLUSION Misplacing is a common phenomenon in mild to moderate AD. Here, misplacing was usually described as an inability to recall where an item was set down, more so than the inappropriate placement of items.
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Affiliation(s)
- L Hamilton
- Geriatric Medicine Research Unit, Capital District Health Authority and Dalhousie University, Halifax, Nova Scotia, Canada
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Hamilton L, Evans A, Cornford E, James J, Burrell H. Ultrasound diagnosis of fibroadenoma — is biopsy always necessary? Clin Radiol 2008; 63:1070-1. [DOI: 10.1016/j.crad.2008.05.006] [Citation(s) in RCA: 5] [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] [Received: 04/29/2008] [Accepted: 05/09/2008] [Indexed: 11/24/2022]
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Bristow AR, Agrawal A, Evans AJ, Burrell HC, Cornford EJ, James JJ, Hamilton L, Robertson JFR, Chan SY, Lawton PA, Cheung KL. Can computerised tomography replace bone scintigraphy in detecting bone metastases from breast cancer? A prospective study. Breast 2008; 17:98-103. [PMID: 17890090 DOI: 10.1016/j.breast.2007.07.042] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2007] [Revised: 07/24/2007] [Accepted: 07/25/2007] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND The aim of this study was to determine whether bone scans (BS) can be avoided if pelvis was included in CT thorax and abdomen to detect bony metastases from breast cancer. MATERIALS AND METHODS Results of 77 pairs of CT (thorax, abdomen, and pelvis) and BS in newly diagnosed patients with metastatic breast cancer (MBC) were compared prospectively for 12 months. Both scans were blindly assessed by experienced radiologists and discussed at multidisciplinary team meetings regarding the diagnosis of bone metastases. RESULTS CT detected metastatic bone lesions in 43 (98%) of 44 patients with bone metastases. The remaining patient had a solitary, asymptomatic bony metastasis in shaft of femur. BS was positive in all patients with bone metastases. There were 11 cases of false positive findings on BS. CONCLUSION Our findings suggest routine BS of patients presenting with MBC is not required if CT (thorax, abdomen, and pelvis) is performed.
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Affiliation(s)
- A R Bristow
- Division of Breast Surgery, University of Nottingham, UK
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