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Cullington HE, Jiang D, Broomfield SJ, Chung M, Craddock LC, Driver S, Edwards D, Gallacher JM, Jones LL, Koleva T, Martin J, Meakin H, Nash R, Rocca C, Schramm DR, Willmott NS, Vanat ZH. Cochlear implant services for children, young people and adults. Quality standard. Cochlear Implants Int 2023:1-13. [PMID: 37114384 DOI: 10.1080/14670100.2023.2197344] [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: 04/29/2023]
Affiliation(s)
- H E Cullington
- University of Southampton Auditory Implant Service, SO17 1BJ, UK
| | - D Jiang
- Hearing Implant Centre, Guy's and St. Thomas NHS Foundation Trust, London, UK
- Centre for Craniofacial and Regenerative Biology, King's College London, London, UK
| | - S J Broomfield
- West of England Hearing Implant Programme, University Hospitals Bristol and Weston NHS Foundation Trust, UK
| | - M Chung
- Auditory Implant Department, Royal National ENT & Eastman Dental Hospitals, University College London Hospitals NHS Foundation Trust, UK
| | - L C Craddock
- Midlands Hearing Implant Programme (Adult service), University Hospitals Birmingham NHS Foundation Trust, UK
| | - S Driver
- Hearing Implant Centre, Guy's and St. Thomas NHS Foundation Trust, London, UK
| | - D Edwards
- Emmeline Centre for Hearing Implants, Cambridge University Hospitals NHS Trust, UK
| | - J M Gallacher
- Scottish Cochlear Implant Program, Crosshouse Hospital, Kilmarnock, UK
| | - L Ll Jones
- North Wales Auditory Implant Service, Betsi Cadwaladr University Health Board, Bodelwyddan, UK
| | - T Koleva
- Emmeline Centre for Hearing Implants, Cambridge University Hospitals NHS Trust, UK
| | - J Martin
- Cochlear Implant Programme, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
| | - H Meakin
- Emmeline Centre for Hearing Implants, Cambridge University Hospitals NHS Trust, UK
| | - R Nash
- Cochlear Implant Programme, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
| | - C Rocca
- Hearing Implant Centre, Guy's and St. Thomas NHS Foundation Trust, London, UK
| | - D R Schramm
- University of Ottawa Auditory Implant Centre, Ottawa, Canada
| | - N S Willmott
- Auditory Implant Centre, Belfast Health and Social Care Trust, UK
| | - Z H Vanat
- Emmeline Centre for Hearing Implants, Cambridge University Hospitals NHS Trust, UK
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Naumann FL, Nash R, Schumacher U, Taylor J, Cottrell N. Interprofessional education clinical placement program: a qualitative case study approach. J Interprof Care 2020; 35:899-906. [PMID: 33190512 DOI: 10.1080/13561820.2020.1832448] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The goal of health professional education programs is to produce competent graduates, with an ability to work collaboratively as effective healthcare team members. We explored the reflections of students and clinical facilitators, in response to participation in a structured interprofessional education (IPE) clinical placement program. In our qualitative study we used an exploratory case study design. In our analysis, we highlight the benefits of interprofessional practice. Key themes identified by students included: limited opportunities to engage in IPE across their course; lack of clarity around IPE; value of IPE for students, practitioners, and patient outcomes; and need for IPE opportunities to be integrated into placements. Key themes identified by the clinical facilitators included: being reminded of the value of IPE for students and patients; preparation for IPE placements need to be embedded in curricula; coordination and communication of IPE learning activities need to be clear for staff and students; and IPE should continue as part of the broader clinical education agenda. Our findings reinforce the notion that students and clinical facilitators value the importance of IPE for student learning within the clinical placement setting. The outcomes offer valuable insights for universities and hospital and health care contexts for setting up and implementing IPE activities, and we provide recommendations for improving ongoing IPE efforts within clinical placement setting.
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Affiliation(s)
- F L Naumann
- Faculty of Health, Queensland University of Technology, Kelvin Grove, Australia
| | - R Nash
- Faculty of Health, Queensland University of Technology, Kelvin Grove, Australia
| | - U Schumacher
- Metro North Hospital and Health Service, Queensland Health, Brisbane, Australia
| | - J Taylor
- Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia
| | - N Cottrell
- Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia
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Bowles PFD, Reading J, Albert D, Nash R. Subglottic cysts: The Great Ormond Street experience in 105 patients. Eur Arch Otorhinolaryngol 2020; 278:2137-2141. [PMID: 32875392 DOI: 10.1007/s00405-020-06321-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 08/24/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE The aim of the study was to assess the contemporary presentation and management of subglottic cysts and make recommendations on the treatment of these patients. METHODS Retrospective case series of 105 patients between October 1999 and November 2017 from a paediatric teaching hospital. RESULTS Ninety-one percentage (n = 96) had a history of prematurity, with a mean gestation of 27.2 weeks (SD ± 4.1). A history of intubation was found in 99% (n = 104) of cases [median 18 days (range = 1-176)]. Presenting symptoms were: Stridor 57.1%, (n = 60), difficult intubation 14% (n = 15), recurrent croup 11.4% (n = 12), failed extubation 7.6%, (n = 8), hoarseness/weak cry 10.5% (n = 10). Ninety percentage (n = 94) underwent intervention for management of SGCs with 86% (n = 81) treated with cold steel marsupialisation and 14% (n = 13) with CO 2 laser. Recurrent cysts occurred in 56% (n = 53) of cases. Treatment modality did not affect recurrence (p = 0.594 Δ). Sixty-six percentage (n = 69/105) of patients had one or more concurrent airway pathology at MLB. Most frequent was subglottic stenosis 47% (n = 49), with 16% (n = 8) subsequently requiring open reconstructive airway surgery. Mean duration of follow-up was 47.6 months (SD ± 38.3). CONCLUSION SGC are an uncommon, reversible cause of upper airway obstruction and should be considered in the list of differential diagnoses in patients with a history of prematurity and perinatal intubation, presenting with stridor. While concurrent SGS is common, adequate symptom improvement in such cases may be achieved with SGC removal alone. Management is by surgical marsupialisation. Recurrence and additional airway pathologies are common and may necessitate longer-term treatment in centres with paediatric airway expertise.
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Affiliation(s)
- P F D Bowles
- Department of Otolaryngology, Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK.
| | - J Reading
- Department of Otolaryngology, Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK
| | - D Albert
- Department of Otolaryngology, Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK
| | - R Nash
- Department of Otolaryngology, Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK
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Srinivasan R, So CW, Amin N, Jaikaransingh D, D'Arco F, Nash R. A review of the safety of MRI in cochlear implant patients with retained magnets. Clin Radiol 2019; 74:972.e9-972.e16. [PMID: 31324337 DOI: 10.1016/j.crad.2019.06.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 06/12/2019] [Indexed: 10/26/2022]
Abstract
The number of patients with cochlear implants (CIs) is increasing due to expanding indications, and improving CI services. Furthermore, as the use of imaging increases in clinical medicine, it is increasingly likely that patients with CIs will require a magnetic resonance imaging (MRI) examination during their lifetime. Therefore it is important that clinicians are aware of the safety aspects and manufacturer recommendations for CI patients with retained magnets. This article summarises guidelines from all major CI manufacturers and reviews the published literature on the safety of MRI in CI patients with magnets in situ. The most commonly reported complication of MRI in CI patients was pain. Other significant complications included magnet displacement, depolarisation, and polarity reversal. Artefacts caused by the CI remain an issue, but may be reduced by the use of specific sequences. Manufacturer recommendations should be followed to reduce the risk of complications, although complications may occur even when guidelines are followed. For this reason, the indication for imaging these patients should be reviewed, and patients should be appropriately counselled and consented.
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Affiliation(s)
- R Srinivasan
- Department of Radiology, Guy's & St Thomas' Hospital, London, UK
| | - C W So
- Department of Radiology, Northwick Park Hospital, London, UK
| | - N Amin
- Department of ENT, St George's Hospital, London, UK
| | | | - F D'Arco
- Department of Radiology, Great Ormond Street Hospital, London, UK
| | - R Nash
- Cochlear Implant Department, Great Ormond Street Hospital, London, UK.
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Abstract
African swine fever virus causes a haemorrhagic fever in domestic pigs and wild boar. The continuing spread in Africa, Europe and Asia threatens the global pig industry. The lack of a vaccine limits disease control. To underpin rational strategies for vaccine development improved knowledge is needed of how the virus interacts with and modulates the host's responses to infection. The virus long double-stranded DNA genome codes for more than 160 proteins of which many are non-essential for replication in cells but can have important roles in evading the host's defences. Here we review knowledge of the pathways targeted by ASFV and the mechanisms by which these are inhibited. The impact of deleting single or multiple ASFV genes on virus replication in cells and infection in pigs is summarised providing information on strategies for rational development of modified live vaccines.
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Affiliation(s)
- L K Dixon
- The Pirbright Institute, Ash Road, Pirbright, Woking, Surrey, GU24 0NF, UK.
| | - M Islam
- The Pirbright Institute, Ash Road, Pirbright, Woking, Surrey, GU24 0NF, UK
| | - R Nash
- The Pirbright Institute, Ash Road, Pirbright, Woking, Surrey, GU24 0NF, UK
| | - A L Reis
- The Pirbright Institute, Ash Road, Pirbright, Woking, Surrey, GU24 0NF, UK
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Abstract
NHS Resolution provides indemnity cover for legal claims against the NHS, assists the NHS with risk management and aims to share lessons from claims in order to improve safety. The study aimed to investigate the financial costs of litigation against English Health Trusts in otolaryngology over a 10-year period, to see if any lessons have been learned and identify trends that may lead to a potential reduction in costs and improve patient safety. A Freedom of Information request was made to NHS Resolution for information regarding claims made to otolaryngology departments over the last 10 years. There was a total of 612 successful claims in the 10-year period between 2008/2009 and 2017/2018 with costs of nearly £87 million. Overall, the costs of litigation have increased dramatically, and the main areas for these successful claims can be identified, but restrictions in the detail of information released allows too little insight for improvements to be made to avoid them in future. This continues to be a major problem for healthcare funding and practice.
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Affiliation(s)
- N Zorlu
- 1 Diabetes & Endocrinology, Watford General Hospital, West Hertfordshire Hospitals NHS Trust, Watford, UK
| | - R Nash
- 2 Ear, Nose & Throat Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - R Srinivasan
- 3 Clinical Radiology, Guy's & St. Thomas' NHS Foundation Trust, London, UK
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Rajput K, Saeed M, Ahmed J, Chung M, Munro C, Patel S, Leal C, Jiang D, Nash R. Findings from aetiological investigation of Auditory Neuropathy Spectrum Disorder in children referred to cochlear implant programs. Int J Pediatr Otorhinolaryngol 2019; 116:79-83. [PMID: 30554714 DOI: 10.1016/j.ijporl.2018.10.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 10/08/2018] [Accepted: 10/09/2018] [Indexed: 01/14/2023]
Abstract
OBJECTIVES Auditory neuropathy spectrum disorder (ANSD) is an audiological diagnosis characterised by hearing dysfunction in the presence of intact outer hair cell function in the cochlea. ANSD is thought to account for 7-10% of all childhood permanent hearing impairment, and can result from a range of pathological processes. This paper describes the rationale, methods and findings from the aetiological investigation of ANSD. METHODS Retrospective audit of four cochlear implant programmes. RESULTS 97 patients were identified. 79% of patients were identified before the age of one. Prematurity and jaundice were the most frequently identified aetiological factors. 33 patients had cochlear nerve deficiency on imaging. Genetic diagnoses identified included otoferlin, SX010 gene, connexin 26 and A1FM1 gene mutations. ANSD was seen in conjunction with syndromes including Kallman syndrome, CHARGE syndrome, X-linked deafness, SOTOS syndrome, Brown Vieletto Van Laere syndrome, and CAPOS syndrome. DISCUSSION We present a two-level system of aetiological investigation that is clinically practical. Patients with ANSD sufficiently severe to consider cochlear implantation are generally identified at an early age. Aetiological investigation is important to guide prognosis and identify comorbidity. CONCLUSION Prematurity and jaundice are the most commonly identified aetiological factors in ANSD. Imaging findings identify crucial factors in a significant minority. An important minority may have genetic and syndromic diagnoses that require further management.
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Affiliation(s)
- K Rajput
- Cochlear Implant Department, Great Ormond Street Hospital, London, United Kingdom
| | - M Saeed
- Cochlear Implant Department, Great Ormond Street Hospital, London, United Kingdom
| | - J Ahmed
- Cochlear Implant Department, Great Ormond Street Hospital, London, United Kingdom
| | - M Chung
- Auditory Implant Department, Royal National Throat Nose and Ear Hospital, London, United Kingdom
| | - C Munro
- Auditory Implant Department, Royal National Throat Nose and Ear Hospital, London, United Kingdom
| | - S Patel
- Auditory Implant Service, St.George's Hospital, London, United Kingdom
| | - C Leal
- Hearing Implant Centre, Guy's Hospital, London, United Kingdom
| | - D Jiang
- Hearing Implant Centre, Guy's Hospital, London, United Kingdom
| | - R Nash
- Cochlear Implant Department, Great Ormond Street Hospital, London, United Kingdom.
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Mahon AM, O'Connell B, Healy MG, O'Connor I, Officer R, Nash R, Morrison L. Microplastics in Sewage Sludge: Effects of Treatment. Environ Sci Technol 2017; 51:810-818. [PMID: 27936648 DOI: 10.1021/acs.est.6b04048] [Citation(s) in RCA: 433] [Impact Index Per Article: 61.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Waste water treatment plants (WWTPs) are receptors for the cumulative loading of microplastics (MPs) derived from industry, landfill, domestic wastewater and stormwater. The partitioning of MPs through the settlement processes of wastewater treatment results in the majority becoming entrained in the sewage sludge. This study characterized MPs in sludge samples from seven WWTPs in Ireland which use anaerobic digestion (AD), thermal drying (TD), or lime stabilization (LS) treatment processes. Abundances ranged from 4196 to 15 385 particles kg-1 (dry weight). Results of a general linear mixed model (GLMM) showed significantly higher abundances of MPs in smaller size classes in the LS samples, suggesting that the treatment process of LS shears MP particles. In contrast, lower abundances of MPs found in the AD samples suggests that this process may reduce MP abundances. Surface morphologies examined using scanning electron microscopy (SEM) showed characteristics of melting and blistering of TD MPs and shredding and flaking of LS MPs. This study highlights the potential for sewage sludge treatment processes to affect the risk of MP pollution prior to land spreading and may have implications for legislation governing the application of biosolids to agricultural land.
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Affiliation(s)
- A M Mahon
- Marine and Freshwater Research Centre (MFRC), Galway-Mayo Institute of Technology , Dublin Road, Galway, Ireland
| | - B O'Connell
- Marine and Freshwater Research Centre (MFRC), Galway-Mayo Institute of Technology , Dublin Road, Galway, Ireland
| | - M G Healy
- Civil Engineering, National University of Ireland , Galway, Ireland
| | - I O'Connor
- Marine and Freshwater Research Centre (MFRC), Galway-Mayo Institute of Technology , Dublin Road, Galway, Ireland
| | - R Officer
- Marine and Freshwater Research Centre (MFRC), Galway-Mayo Institute of Technology , Dublin Road, Galway, Ireland
| | - R Nash
- Marine and Freshwater Research Centre (MFRC), Galway-Mayo Institute of Technology , Dublin Road, Galway, Ireland
| | - L Morrison
- Earth and Ocean Sciences, Schools of Natural Sciences and Ryan Institute, National University of Ireland , Galway, Ireland
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Abstract
Encounters with jugular bulb abnormalities during ear surgery are a rare but recognised problem. A high riding jugular bulb is present in 10%-15% of patients and its variable position within the temporal bone can lead to problems as brisk venous haemorrhage can result if the bulb is inadvertently opened. The case of a 52-year-old woman with a central tympanic membrane perforation who underwent elective endaural myringoplasty and experienced brisk bleeding on raising the tympanomeatal flap is presented.
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Affiliation(s)
- R Fox
- Northwick Park Hospital , Harrow , the UK
| | - R Nash
- Northwick Park Hospital , Harrow , the UK
| | - T Tatla
- Northwick Park Hospital , Harrow , the UK
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Taylor DL, Nash R, Fellows LE, Kang MS, Tyms AS. Naturally Occurring Pyrrolizidines: Inhibition of α-Glucosidase 1 and Anti-HIV Activity of One Stereoisomer. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/095632029200300504] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Alexine, a naturally occurring pyrrolizidine alkaloid, isolated from Alexa leiopetala, and four stereoisomers, isolated from Castanospermum australe, were investigated for inhibitory activity against the growth of HIV-1. Only treatment with the 7,7a-diepialexine restricted virus growth (IC50 0.38 mm) although it was less active than the indolizidine alkaloid castanospermine (IC50 0.02 mm). The antiviral effects of 7,7a-diepialexine, like castanospermine, correlated with the inhibitory activity against purified pig kidney α-glucosidase 1 of the glycoprotein processing enzymes and the reduced cleavage of the precursor HIV-1 glycoprotein gp160.
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Affiliation(s)
- D. L. Taylor
- MRC Collaborative Centre, 1-3 Burtonhole Lane, Mill Hill, London NW7 1AD, UK
| | - R. Nash
- Royal Botanic Gardens, Kew, Surrey TW9 3DS, UK
| | | | - M. S. Kang
- Marion Merrell Dow Research Institute, Cincinnati, OH, USA
| | - A. S. Tyms
- MRC Collaborative Centre, 1-3 Burtonhole Lane, Mill Hill, London NW7 1AD, UK
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Nash R, Hughes J, Kuchai R, Sandison A, Sandhu G. Assessment and management of laryngeal mucous membrane pemphigoid: our experience in six patients and a proposed severity scale. Clin Otolaryngol 2016; 42:752-756. [DOI: 10.1111/coa.12676] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2016] [Indexed: 11/28/2022]
Affiliation(s)
- R. Nash
- Department of ENT; Charing Cross Hospital; London UK
| | - J. Hughes
- Department of ENT; Charing Cross Hospital; London UK
| | - R. Kuchai
- Department of ENT; Charing Cross Hospital; London UK
| | - A. Sandison
- Department of Histopathology; Charing Cross Hospital; London UK
| | - G. Sandhu
- Department of ENT; Charing Cross Hospital; London UK
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12
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Ramessur KT, Greenwell P, Nash R, Dwek MV. Breast cancer invasion is mediated by β-N-acetylglucosaminidase (β-NAG) and associated with a dysregulation in the secretory pathway of cancer cells. Br J Biomed Sci 2016; 67:189-96. [DOI: 10.1080/09674845.2010.11730318] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- K. T. Ramessur
- Departments of Molecular and Applied Biosciences, University of Westminster, London, W1W 6UW
| | - P. Greenwell
- Biomedical Sciences, University of Westminster, London, W1W 6UW
| | - R. Nash
- Summit (Wales), IBERS, Plas Gogerddan, Aberystwyth, Ceredigion SY23 3EB
| | - M. V. Dwek
- Departments of Molecular and Applied Biosciences, University of Westminster, London, W1W 6UW
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13
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Nash R, Kalan A, Lingam R, Singh A. The role of diffusion-weighted magnetic resonance imaging in assessing residual/recurrent cholesteatoma after canal wall down mastoidectomy. Clin Otolaryngol 2016; 41:307-9. [DOI: 10.1111/coa.12612] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2015] [Indexed: 11/29/2022]
Affiliation(s)
- R. Nash
- Department of Otolaryngology, Head and Neck Surgery; Northwick Park Hospital; Middlesex UK
| | - A. Kalan
- Department of Otolaryngology, Head and Neck Surgery; Northwick Park Hospital; Middlesex UK
| | - R.K. Lingam
- Department of Radiology; Northwick Park Hospital; Middlesex UK
| | - A. Singh
- Department of Otolaryngology, Head and Neck Surgery; Northwick Park Hospital; Middlesex UK
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Beiter R, Nash R, McCrady M, Rhoades D, Linscomb M, Clarahan M, Sammut S. The prevalence and correlates of depression, anxiety, and stress in a sample of college students. J Affect Disord 2015; 173:90-6. [PMID: 25462401 DOI: 10.1016/j.jad.2014.10.054] [Citation(s) in RCA: 600] [Impact Index Per Article: 66.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 10/15/2014] [Accepted: 10/28/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Over the past four years, the Franciscan University Counseling Center has reported a 231% increase in yearly visits, as well as a 173% increase in total yearly clients. This trend has been observed at many universities as mental health issues pose significant problems for many college students. The objective of this study was to investigate potential correlates of depression, anxiety, and stress in a sample of college students. METHODS The final analyzed sample consisted of 374 undergraduate students between the ages of 18 and 24 attending Franciscan University, Steubenville, Ohio. Subjects completed a survey consisting of demographic questions, a section instructing participants to rate the level of concern associated with challenges pertinent to daily life (e.g. academics, family, sleep), and the 21 question version of the Depression Anxiety Stress Scale (DASS21). RESULTS The results indicated that the top three concerns were academic performance, pressure to succeed, and post-graduation plans. Demographically, the most stressed, anxious, and depressed students were transfers, upperclassmen, and those living off-campus. CONCLUSIONS With the propensity for mental health issues to hinder the success of college students, it is vital that colleges continually evaluate the mental health of their students and tailor treatment programs to specifically target their needs.
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Affiliation(s)
- R Beiter
- Department of Psychology, Sociology, and Social Work, Franciscan University of Steubenville, 1235 University Blvd, Steubenville, OH 43952, USA
| | - R Nash
- Department of Psychology, Sociology, and Social Work, Franciscan University of Steubenville, 1235 University Blvd, Steubenville, OH 43952, USA
| | - M McCrady
- Department of Psychology, Sociology, and Social Work, Franciscan University of Steubenville, 1235 University Blvd, Steubenville, OH 43952, USA
| | - D Rhoades
- Department of Psychology, Sociology, and Social Work, Franciscan University of Steubenville, 1235 University Blvd, Steubenville, OH 43952, USA
| | - M Linscomb
- Department of Psychology, Sociology, and Social Work, Franciscan University of Steubenville, 1235 University Blvd, Steubenville, OH 43952, USA
| | - M Clarahan
- Department of Psychology, Sociology, and Social Work, Franciscan University of Steubenville, 1235 University Blvd, Steubenville, OH 43952, USA
| | - S Sammut
- Department of Psychology, Sociology, and Social Work, Franciscan University of Steubenville, 1235 University Blvd, Steubenville, OH 43952, USA.
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15
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Mcintyre C, Allen J, Jones S, Nash R, Clarke P. Quality of Life after Orbital Exenteration. Skull Base Surg 2014. [DOI: 10.1055/s-0034-1384047] [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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16
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Alberry M, Hassan WA, Goodburn S, Brockelsby J, Wladimiroff J, Nash R, Lees C. The impact of national guidance for anomaly screening and invasive testing: unintended consequences. Arch Dis Child Fetal Neonatal Ed 2014; 99:F83-6. [PMID: 23833074 DOI: 10.1136/archdischild-2013-303914] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Recent guidance from the UK National Screening Committee (NSC) and the Fetal Anomaly Screening Programme (FASP) has led to important changes in prenatal ultrasound diagnosis and invasive testing. These relate to prenatal ultrasound investigation of what were previously known as 'soft markers' for Down's syndrome at the time of the detailed anomaly scan and as to whether full karyotype or FISH (fluorescent in situ hybridisation)/QFPCR (quantitative fluorescence PCR) testing for trisomies should be carried out when an invasive test is performed. Neither recommendation is directly related to the other but both in combination could have profound implications for the detection of chromosomal abnormalities other than trisomy 21 (Down's syndrome). In the light of two cases recently managed in one regional fetal medicine unit, we retrospectively reviewed cases where, with correct application of the NSC and FASP recommendations, non-lethal and clinically important chromosomal abnormalities would most likely not have been detected.
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Affiliation(s)
- M Alberry
- Department of Fetal Medicine, Rosie Hospital, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, , Cambridge, UK
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Nash R, Scott L, Chakravarthy U, Harding SP, Reeves BC, Rogers CA. Modelling of longitudinal outcomes with highly skewed distributions: applications in the IVAN trial. Trials 2013. [PMCID: PMC3981619 DOI: 10.1186/1745-6215-14-s1-o39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Rogers CA, Mazza G, Paramasivan S, Smith N, Nash R, Blazeby JM, Donovan J. Integrating qualitative research in a multi-centre trial - the clinical trials unit perspective. Trials 2013. [PMCID: PMC3980820 DOI: 10.1186/1745-6215-14-s1-p67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Jacques T, Nash R, Kenway B, Vlastarakos P. Pitfalls of operative management of secondary post-tonsillectomy haemorrhage--a case report. B-ENT 2013; 9:335-337. [PMID: 24597111] [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: 06/03/2023] Open
Abstract
INTRODUCTION The authors present a potential complication associated with the surgical management of post-tonsillectomy haemorrhage using absorbable cellulose haemostatic dressings. The article discusses the deficiencies of our current understanding of how best to manage this common and potentially life-threatening ENT emergency. CASE REPORT A 40-year-old man presented to Accident-and-Emergency with a post-tonsillectomy haemorrhage on the 7th postoperative day. The bleeding was managed surgically, with suturing of the faucial pillars incorporating a piece of Surgicel into the closure. Two days later the patient experienced an episode of partial airway obstruction, due to a piece of dislodged haemostatic material, owing to failure of the closure. The techniques used in the operative management of post-tonsillectomy bleeding are not formally evaluated or discussed in the current literature, and in some cases are unreliable or even potentially hazardous. Further discussion, research, and formulation of a more stepwise approach would be of considerable benefit.
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Affiliation(s)
| | - R Nash
- Lister Hospital, Stevenage
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20
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Majithia A, Lingam R, Nash R, Khemani S, Kalan A, Singh A. Staging primary middle ear cholesteatoma with non-echoplanar (half-Fourier-acquisition single-shot turbo-spin-echo) diffusion-weighted magnetic resonance imaging helps plan surgery in 22 patients: Our experience. Clin Otolaryngol 2012; 37:325-30. [DOI: 10.1111/j.1749-4486.2012.02502.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [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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Saccardi R, Freedman MS, Sormani MP, Atkins H, Farge D, Griffith LM, Kraft G, Mancardi GL, Nash R, Pasquini M, Martin R, Muraro PA. A prospective, randomized, controlled trial of autologous haematopoietic stem cell transplantation for aggressive multiple sclerosis: a position paper. Mult Scler 2012; 18:825-34. [PMID: 22383228 PMCID: PMC3389500 DOI: 10.1177/1352458512438454] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background: Haematopoietic stem cell transplantation (HSCT) has been tried in the last 15 years as a therapeutic option in patients with poor-prognosis autoimmune disease who do not respond to conventional treatments. Worldwide, more than 600 patients with multiple sclerosis (MS) have been treated with HSCT, most of them having been recruited in small, single-centre, phase 1–2 uncontrolled trials. Clinical and magnetic resonance imaging outcomes from case series reports or Registry-based analyses suggest that a major response is achieved in most patients; quality and duration of response are better in patients transplanted during the relapsing–remitting phase than in those in the secondary progressive stage. Objectives: An interdisciplinary group of neurologists and haematologists has been formed, following two international meetings supported by the European and American Blood and Marrow Transplantation Societies, for the purpose of discussing a controlled clinical trial, to be designed within the new scenarios of evolving MS treatments. Conclusions: Objectives of the trial, patient selection, transplant technology and outcome assessment were extensively discussed. The outcome of this process is summarized in the present paper, with the goal of establishing the background and advancing the development of a prospective, randomized, controlled multicentre trial to assess the clinical efficacy of HSCT for the treatment of highly active MS.
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Affiliation(s)
- R Saccardi
- Hematology Department, Careggi University Hospital, Florence, Italy.
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Sullivan K, Froshaug D, Furst D, Nash R, Mayes M, Crofford L, McSweeney P, Goldmuntz E, Keyes-Elstein L, Khanna D, Sullivan K, Woolson R, Wallace P, Sempowski G, McSweeney P, Mayes M, Crofford L, Nash R, Furst D, Storek J, Quirici N, Corti L, Scavullo C, Ferri C, Manfredi A, Giuggioli D, Lambertenghi Deliliers G, Del Papa N, Foeldvari I, Wierk A, Fargue D. S.1.1 Organ function and quality of life correlates at randomization on the SCOT (Scleroderma: Cyclophosphamide Or Transplantion) Trial. Rheumatology (Oxford) 2012. [DOI: 10.1093/rheumatology/ker456] [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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Abstract
We aimed to determine whether the type of outcome expectation, stemming from HPV vaccination, would have any effect on young men's HPV vaccine intent. We recruited young men (18-24 years of age) from two university campuses (n = 150). After answering a series of questions they were randomly assigned to one of three information conditions (all delivered by computer): (1) how women may benefit from men's HPV vaccination, (2) preventing genital warts and (3) preventing head and neck cancers. Intent to be vaccinated against HPV in the next 12 months was assessed before and after receiving the informational session corresponding to the assigned condition. A repeated-measures t-test indicated that a significant increase in young men's intent to be vaccinated after they received the assigned information (t = 9.48, [147], P = 0.0001). However, the increase in intent to be vaccinated did not vary by group assignment as there were no significant differences in mean intent scores between the three groups (F = 0.59, [2/144], P = 0.56). Information that promotes the outcome expectations of protecting women from cervical cancer, preventing genital warts for men and preventing head and neck cancers for men may be equally effective in promoting increased intent for HPV vaccine acceptance among young university men.
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Affiliation(s)
- R J DiClemente
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Atlanta, GA, USA
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Abstract
Carotid body tumours cause characteristic splaying of the internal and external carotid arteries, known as ‘Lyre Sign’. Vagal paragangliomas are rare tumours that arise from glomus cells along the length of the vagus nerve. We present a case in which a vagal paraganglioma has arisen from the vagus nerve at the carotid bifurcation, and has mimicked the ‘Lyre Sign’ of a carotid body tumour.
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Affiliation(s)
- R Nash
- Northwick Park Hospital, London, UK
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Abdurahman E, Houghton P, Nash R, Mahmood N. Irvingia gabonensis : inhibition of glycosidase activity and blockage of growth of Juman Immunodeficiency Virus (HIV) in vitro. ACTA ACUST UNITED AC 2010. [DOI: 10.4314/wajpdr.v11i1.53381] [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: 11/17/2022]
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Tyreman M, Abbott KM, Willatt LR, Nash R, Lees C, Whittaker J, Simonic I. High resolution array analysis: diagnosing pregnancies with abnormal ultrasound findings. J Med Genet 2009; 46:531-41. [PMID: 19451135 DOI: 10.1136/jmg.2008.065482] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- M Tyreman
- Medical Genetics Department, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK
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Hirschman JE, Engel S, Hong E, Balakrishnan R, Christie K, Costanzo M, Dwight S, Fisk D, Nash R, Park J, Skrzypek M, Dolinski K, Livstone M, Oughtred R, Andrada R, Binkley G, Dong Q, Hitz B, Miyasoto S, Schroeder M, Weng S, Wong E, Botstein D, Cherry JM. The
Saccharomyces
Genome Database provides comprehensive information about the biology of
S. cerevisiae
and tools for studies in comparative genomics. FASEB J 2007. [DOI: 10.1096/fasebj.21.5.a264-c] [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] [Indexed: 11/11/2022]
Affiliation(s)
- Jodi Ellen Hirschman
- Department of GeneticsStanford University, Stanford University School of MedicineStanfordMA94305‐5120
| | - S. Engel
- Department of GeneticsStanford University, Stanford University School of MedicineStanfordMA94305‐5120
| | - E. Hong
- Department of GeneticsStanford University, Stanford University School of MedicineStanfordMA94305‐5120
| | - R. Balakrishnan
- Department of GeneticsStanford University, Stanford University School of MedicineStanfordMA94305‐5120
| | - K. Christie
- Department of GeneticsStanford University, Stanford University School of MedicineStanfordMA94305‐5120
| | - M. Costanzo
- Department of GeneticsStanford University, Stanford University School of MedicineStanfordMA94305‐5120
| | - S. Dwight
- Department of GeneticsStanford University, Stanford University School of MedicineStanfordMA94305‐5120
| | - D. Fisk
- Department of GeneticsStanford University, Stanford University School of MedicineStanfordMA94305‐5120
| | - R. Nash
- Department of GeneticsStanford University, Stanford University School of MedicineStanfordMA94305‐5120
| | - J. Park
- Department of GeneticsStanford University, Stanford University School of MedicineStanfordMA94305‐5120
| | - M. Skrzypek
- Department of GeneticsStanford University, Stanford University School of MedicineStanfordMA94305‐5120
| | - K. Dolinski
- Lewis‐Sigler Institute for Integrative Genomics, Princeton UniversityCarl Icahn Lab Room 134, Washington RoadPrincetonNJ08544
| | - M. Livstone
- Lewis‐Sigler Institute for Integrative Genomics, Princeton UniversityCarl Icahn Lab Room 134, Washington RoadPrincetonNJ08544
| | - R. Oughtred
- Lewis‐Sigler Institute for Integrative Genomics, Princeton UniversityCarl Icahn Lab Room 134, Washington RoadPrincetonNJ08544
| | - R. Andrada
- Department of GeneticsStanford University, Stanford University School of MedicineStanfordMA94305‐5120
| | - G. Binkley
- Department of GeneticsStanford University, Stanford University School of MedicineStanfordMA94305‐5120
| | - Q. Dong
- Department of GeneticsStanford University, Stanford University School of MedicineStanfordMA94305‐5120
| | - B. Hitz
- Department of GeneticsStanford University, Stanford University School of MedicineStanfordMA94305‐5120
| | - S. Miyasoto
- Department of GeneticsStanford University, Stanford University School of MedicineStanfordMA94305‐5120
| | - M. Schroeder
- Lewis‐Sigler Institute for Integrative Genomics, Princeton UniversityCarl Icahn Lab Room 134, Washington RoadPrincetonNJ08544
| | - S. Weng
- Department of GeneticsStanford University, Stanford University School of MedicineStanfordMA94305‐5120
| | - E. Wong
- Department of GeneticsStanford University, Stanford University School of MedicineStanfordMA94305‐5120
| | - D. Botstein
- Lewis‐Sigler Institute for Integrative Genomics, Princeton UniversityCarl Icahn Lab Room 134, Washington RoadPrincetonNJ08544
| | - J. M. Cherry
- Department of GeneticsStanford University, Stanford University School of MedicineStanfordMA94305‐5120
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Mcsweeney P, Pasquini M, Kukreja M, Bredeson C, Nash R, Horowitz M, Atkins H. 86: Hematopoietic stem cell transplantation (HCT) for autoimmune diseases (AI). Biol Blood Marrow Transplant 2007. [DOI: 10.1016/j.bbmt.2006.12.090] [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: 11/26/2022]
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Ellis IO, Coleman D, Wells C, Kodikara S, Paish EM, Moss S, Al-Sam S, Anderson N, Bobrow L, Buley I, Connolly CE, Dallimore NS, Hales S, Hanby A, Humphreys S, Knox F, Lowe J, Macartney J, Nash R, Parham D, Patnick J, Pinder SE, Quinn CM, Robertson AJ, Shrimankar J, Walker RA, Winder R. Impact of a national external quality assessment scheme for breast pathology in the UK. J Clin Pathol 2006; 59:138-45. [PMID: 16443727 PMCID: PMC1860326 DOI: 10.1136/jcp.2004.025551] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.6] [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: 11/04/2022]
Abstract
BACKGROUND This article presents the results and observed effects of the UK National Health Service Breast Screening Programme (NHSBSP) external quality assurance scheme in breast histopathology. AIMS/METHODS The major objectives were to monitor and improve the consistency of diagnoses made by pathologists and the quality of prognostic information in pathology reports. The scheme is based on a twice yearly circulation of 12 cases to over 600 registered participants. The level of agreement was generally measured using kappa statistics. RESULTS Four main situations were encountered with respect to diagnostic consistency, namely: (1) where consistency is naturally very high-this included diagnosing in situ and invasive carcinomas (and certain distinctive subtypes) and uncomplicated benign lesions; (2) where the level of consistency was low but could be improved by making guidelines more detailed and explicit-this included histological grading; (3) where consistency could be improved but only by changing the system of classification-this included classification of ductal carcinoma in situ; and (4) where no improvement in consistency could be achieved-this included diagnosing atypical hyperplasia and reporting vascular invasion. Size measurements were more consistent for invasive than in situ carcinomas. Even in cases where there is a high level of agreement on tumour size, a few widely outlying measurements were encountered, for which no explanation is readily forthcoming. CONCLUSIONS These results broadly confirm the robustness of the systems of breast disease diagnosis and classification adopted by the NHSBSP, and also identify areas where improvement or new approaches are required.
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Affiliation(s)
- I O Ellis
- Department of Histopathology, Nottingham City Hospital, Hucknall Road, Nottingham NG5 1PB, UK.
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Parham DM, Coleman D, Kodikara S, Moss S, Ellis IO, Al-Sam S, Anderson N, Bobrow L, Buley I, Connolly CE, Dallimore NS, Hales S, Hanby A, Humphreys S, Knox F, Lowe J, Macartney J, Nash R, Patnick J, Pinder SE, Quinn CM, Robertson AJ, Shrimankar J, Walker RA, Wells C, Winder R, Patel N. The NHS breast screening programme (pathology) EQA: experience in recent years relating to issues involved in individual performance appraisal. J Clin Pathol 2006; 59:130-7. [PMID: 16443726 PMCID: PMC1860311 DOI: 10.1136/jcp.2004.025619] [Citation(s) in RCA: 18] [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: 11/04/2022]
Abstract
BACKGROUND The original role of the National Health Service breast screening programme (pathology) external quality assessment (EQA) scheme was educational; it aimed to raise standards, reinforce use of common terminology, and assess the consistency of pathology reporting of breast disease in the UK. AIMS/METHODS To examine the performance (scores) of pathologists participating in the scheme in recent years. The scheme has evolved to help identify poor performers, reliant upon setting an acceptable cutpoint. Therefore, the effects of different cutpoint strategies were evaluated and implications discussed. RESULTS/CONCLUSIONS Pathologists who joined the scheme improved over time, particularly those who did less well initially. There was no obvious association between performance and the number of breast cancer cases reported each year. This is not unexpected because the EQA does not measure expertise, but was established to demonstrate a common level of performance (conformity to consensus) for routine cases, rather than the ability to diagnose unusual/difficult cases. A new method of establishing cutpoints using interquartile ranges is proposed. The findings also suggest that EQA can alter a pathologist's practice: those who leave the scheme (for whatever reason) have, on average, marginally lower scores. Consequently, with the cutpoint methodology currently used (which is common to several EQA schemes) there is the potential for the cutpoint to drift upwards. In future, individuals previously deemed competent could subsequently be erroneously labelled as poor performers. Due consideration should be given to this issue with future development of schemes.
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Affiliation(s)
- D M Parham
- Department of Pathology, Royal Bournemouth Hospital, Bournemouth, Dorset BH7 7DW, UK.
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Sorror M, Gooley T, Nash R, Petersdorf E, Martin P, Deeg H, Baron F, Davis C, Sanders J, Flowers M, Carpenter P, Witherspoon R, Appelbaum F, Storb R. Risk factors associated with increased grades III-IV acute graft-versus-host disease (GVHD) after allogeneic hematopoietic cell transplantation (HCT). Biol Blood Marrow Transplant 2006. [DOI: 10.1016/j.bbmt.2005.11.172] [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: 10/25/2022]
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Rickman L, Fiegler H, Shaw-Smith C, Nash R, Cirigliano V, Voglino G, Ng BL, Scott C, Whittaker J, Adinolfi M, Carter NP, Bobrow M. Prenatal detection of unbalanced chromosomal rearrangements by array CGH. J Med Genet 2005; 43:353-61. [PMID: 16199537 PMCID: PMC2563226 DOI: 10.1136/jmg.2005.037648] [Citation(s) in RCA: 111] [Impact Index Per Article: 5.8] [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: 12/13/2022]
Abstract
BACKGROUND Karyotype analysis has been the standard method for prenatal cytogenetic diagnosis since the 1970s. Although highly reliable, the major limitation remains the requirement for cell culture, resulting in a delay of as much as 14 days to obtaining test results. Fluorescent in situ hybridisation (FISH) and quantitative fluorescent PCR (QF-PCR) rapidly detect common chromosomal abnormalities but do not provide a genome wide screen for unexpected imbalances. Array comparative genomic hybridisation (CGH) has the potential to combine the speed of DNA analysis with a large capacity to scan for genomic abnormalities. We have developed a genomic microarray of approximately 600 large insert clones designed to detect aneuploidy, known microdeletion syndromes, and large unbalanced chromosomal rearrangements. METHODS This array was tested alongside an array with an approximate resolution of 1 Mb in a blind study of 30 cultured prenatal and postnatal samples with microscopically confirmed unbalanced rearrangements. RESULTS At 1 Mb resolution, 22/30 rearrangements were identified, whereas 29/30 aberrations were detected using the custom designed array, owing to the inclusion of specifically chosen clones to give increased resolution at genomic loci clinically implicated in known microdeletion syndromes. Both arrays failed to identify a triploid karyotype. Thirty normal control samples produced no false positive results. CONCLUSIONS Analysis of 30 uncultured prenatal samples showed that array CGH is capable of detecting aneuploidy in DNA isolated from as little as 1 ml of uncultured amniotic fluid; 29/30 samples were correctly diagnosed, the exception being another case of triploidy. These studies demonstrate the potential for array CGH to replace conventional cytogenetics in the great majority of prenatal diagnosis cases.
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Affiliation(s)
- L Rickman
- University of Cambridge, Department of Medical Genetics, Addenbrooke's Hospital, Hills Road, Cambridge,UK.
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Attwell A, Ludkowski M, Nash R, Kugelmas M. Treatment of Budd-Chiari syndrome in a liver transplant unit, the role of transjugular intrahepatic porto-systemic shunt and liver transplantation. Aliment Pharmacol Ther 2004; 20:867-73. [PMID: 15479358 DOI: 10.1111/j.1365-2036.2004.02190.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Budd-Chiari syndrome is an uncommon cause of liver failure usually associated with an underlying hypercoagulable state. AIM To evaluate current trends in management of Budd-Chiari syndrome at our institution. METHODS Twenty-two patients with Budd-Chiari syndrome underwent transjugular intrahepatic porto-systemic shunt, liver transplantation, or both in between 1992 and 2001. We analysed underlying diagnosis, medical therapy, complications, follow-up and overall outcomes. RESULTS Five patients (17%) presented with fulminant liver failure and 17 patients (83%) with new-onset ascites or chronic liver disease. Seventeen patients (74%) underwent transjugular intrahepatic porto-systemic shunt: improvement or stabilization occurred initially in 14 (82%), whereas the other three patients died within a month. At a mean 3 years follow-up eight patients (47%) continued to do well clinically and four have died (23.5%); seven have required transjugular intrahepatic porto-systemic shunt revisions (mean 2.3 interventions), five have experienced transjugular intrahepatic porto-systemic shunt occlusion managed with new transjugular intrahepatic porto-systemic shunt placement and five patients underwent subsequent transplantation. Of the 10 patients who underwent liver transplantation, patient and graft survival are 80% at a mean 5.7 years of follow-up. No patient developed post-transplant Budd-Chiari syndrome. CONCLUSIONS Transjugular intrahepatic porto-systemic shunt is usually feasible in patients with Budd-Chiari syndrome, and is best suited as a bridge to more timely liver transplantation. Long-term success of transjugular intrahepatic porto-systemic shunt is limited and usually requires revision, placement of a new shunt or liver transplantation. Liver transplantation with chronic anticoagulation offers excellent short- and medium-term patient and graft survival. In our series, there was no recurrence of Budd-Chiari syndrome after liver transplantation.
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Affiliation(s)
- A Attwell
- Department of Medicine, University of Colorado, Health Sciences Center, Denver, CO, USA
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Aranda S, Yates P, Edwards H, Nash R, Skerman H, McCarthy A. Barriers to effective cancer pain management: a survey of Australian family caregivers. Eur J Cancer Care (Engl) 2004; 13:336-43. [PMID: 15305901 DOI: 10.1111/j.1365-2354.2004.00483.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Cancer pain continues to be an important focus of health research and intervention development. The continuing shift of cancer care to the community increases the family caregiver's role in pain management and highlights the need to understand family experiences and also family barriers to effective pain management. This paper presents the findings of an Australian study exploring attitudinal barriers to effective pain management amongst 75 family caregivers of people with cancer attending an outpatient clinic. Approximately 75% of the caregivers demonstrated concerns or were unsure about addiction, a belief likely to impact on the use of prescribed opioids in the home. Caregivers demonstrated similar levels of concern about side-effects or whether the presence of pain indicated disease progression. These findings support research in other populations and are further evidence of the need to include family caregivers, along with patients, in intervention studies aimed at reducing the impact of these barriers on effective pain management.
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Affiliation(s)
- S Aranda
- Peter MacCallum Cancer Institute, Melbourne, Victoria, Australia.
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Offiah AC, Mansour S, Jeffrey I, Nash R, Whittock N, Pyper R, Bewley S, Clayton PT, Hall CM. Greenberg dysplasia (HEM) and lethal X linked dominant Conradi-Hünermann chondrodysplasia punctata (CDPX2): presentation of two cases with overlapping phenotype. J Med Genet 2004; 40:e129. [PMID: 14684697 PMCID: PMC1735332 DOI: 10.1136/jmg.40.12.e129] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Shaw MBK, Braithwaite BD, DeNunzio M, Hinwood D, Nash R, Callum KG. Outcome of subintimal angioplasty in a district general hospital. Br J Surg 2002. [DOI: 10.1046/j.1365-2168.2001.01757-50.x] [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: 11/20/2022]
Abstract
Abstract
Background
The results from major institutions of subintimal angioplasty are good. The aim was to determine the early and intermediate outcome of the technique of subintimal angioplasty in a district general hospital.
Methods
After formal training, two consultant radiologists performed subintimal angioplasty on 50 consecutive patients for the treatment of intermittent claudication (23 patients) and ulceration or gangrene (27). Patients were classified as Rutherford grade III–VI. The patient group contained 35 men and 15 women with a median age of 72 (range 45–93) years. The median treated length was 17·5 cm in the superficial femoral artery, 12·5 cm in the popliteal artery and 7·5 cm in the peroneal artery. Those with a technically successful procedure were followed with clinical assessment at 6 weeks and colour duplex ultrasonography at 6 months.
Results
Thirty-nine (78 per cent) of the 50 procedures were technically successful. Sixty per cent of these were patent at 6 months on colour duplex ultrasonography. The primary technical success rate in the first 25 consecutive patients to undergo angioplasty was 64 per cent (16 patients), compared with 92 per cent (23 patients) in the second group of 25; this difference was significant (P = 0·004, χ2 test). The overall patency rate at 6 months in the first 25 consecutive patients was 43 per cent, compared with 69 per cent in the second 25; this difference was statistically significant (P = 0·02, χ2 test).
Conclusion
After a short learning interval, subintimal angioplasty can be used effectively in a district general hospital, with good medium-term patency rates.
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Affiliation(s)
| | | | | | - D Hinwood
- Derbyshire Royal Infirmary, Derby, UK
| | - R Nash
- Derbyshire Royal Infirmary, Derby, UK
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Shaw MBK, DeNunzio M, Hinwood D, Nash R, Callum KG, Braithwaite BD. The results of subintimal angioplasty in a district general hospital. Eur J Vasc Endovasc Surg 2002; 24:524-7. [PMID: 12443748 DOI: 10.1053/ejvs.2002.1764] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.8] [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: 11/11/2022]
Abstract
OBJECTIVES AND DESIGN we report a prospective study to determine if subintimal angioplasty can be performed in non-teaching centres and to establish its learning curve. MATERIALS AND METHODS subintimal angioplasty was performed on 50 limbs in 46 patients (34 male) with a median age of 72 years (range 45-93 years). Indication was critical limb ischaemia (27 limbs) or intermittent claudication (23 limbs). Occlusions were located in the superficial femoral artery in 44 limbs, popliteal artery in 4 limbs and the peroneal artery in two limbs. At a median of 7.9 months patients had colour duplex imaging of the vessels that underwent angioplasty to assess vessel patency. RESULTS primary technical success was achieved in 39 cases (78%). Primary technical success was greater in the second group of 25 consecutive limbs to undergo angioplasty at 92% (23 cases) compared with the first 25 consecutive limbs at 64% (16 cases). At 6 months the overall vessel patency rate on duplex imaging was 57%, improving to 64% in the group having a primarily successful procedure. The equivalent rate of symptomatic improvement was 59 and 66% respectively. Complications occurred in five procedures, most were minor, but a single fatality was directly attributable to the procedure. CONCLUSION subintimal angioplasty can reasonably be performed outside major teaching institutions. There is a short learning curve associated with the procedure.
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Affiliation(s)
- M B K Shaw
- Department of Surgery, Derbyshire Royal Infirmary, London Road, Derby, UK
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Bárcena Marugán R, García-Hoz F, Vázquez Romero M, Nash R, Mateos M, González Alonso R, García González M, García Plaza A. Prevention of de novo hepatitis B infection in liver allograft recipients with previous hepatitis B infection or hepatitis B vaccination. Am J Gastroenterol 2002; 97:2398-401. [PMID: 12358263 DOI: 10.1111/j.1572-0241.2002.05994.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To assess de novo hepatitis B virus (HBV) transmission from liver donors with HBV serum markers (HBM) to their recipients and the need for HBV vaccination before liver transplantation. METHODS A total of 108 orthotopic liver transplantations for nonviral disease and the risk of developing de novo hepatitis B based on HBMs before transplantation have been studied. Of the 108 patients, 94 met the study criteria and were divided into two groups: 27 who had HBMs before transplantation (from past infection or by previous vaccination) and 67 who had no HBM. Development of de novo hepatitis B was determined by analytical, serological, and histological parameters. RESULTS No case (0%) of de novo hepatitis B was detected in the pretransplantation HBM group, whereas there were 10 cases (14.5%) in the other group (p < 0.005). CONCLUSIONS The presence of pretransplantation HBM in liver transplant recipients protects these patients against the development of de novo hepatitis B. This is especially important considering that there is a high prevalence of donors with positive hepatitis B core antibody (especially in some countries), and that these donors transmit HBV infection to recipients without HBM in a significant number of cases. Thus, vaccination against HBV in patients who are candidates for liver transplantation is fundamental to avoid cases of de novo hepatitis B.
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Helmrich S, Yates P, Nash R, Hobman A, Poulton V, Berggren L. Factors influencing nurses' decisions to use non-pharmacological therapies to manage patients' pain. AUST J ADV NURS 2001; 19:27-35. [PMID: 11876349] [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: 02/24/2023]
Abstract
This study investigated nurses' beliefs and attitudes toward the use of non-pharmacological therapies as adjunct pain management strategies. Registered nurses (RNs) (n=37) from the medical, surgical, oncology/palliative care and critical care areas of two Australian hospitals participated in a series of focus group discussions that explored the use of non-pharmacological therapies to help manage patients' pain in a hospital setting. Results from the discussions identified that nurses believe non-pharmacological therapies offer several advantages to the management of patients' pain and general well being. For example non-pharmacological therapies were recognised to be useful as adjuncts while waiting for medications to take effect. However significant barriers such as lack of organisational and professional support were also identified as hindering nurses' current usage of non-pharmacological therapies. Further investigation of the key issues from this study is recommended to improve non-pharmacological pain management and enhance patient outcomes.
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Affiliation(s)
- S Helmrich
- The Wesley Hospital, Brisbane, Australia
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Stochmal A, Simonet AM, Macias FA, Oliveira MA, Abreu JM, Nash R, Oleszek W. Acylated apigenin glycosides from alfalfa (Medicago sativa L.) var. Artal. Phytochemistry 2001; 57:1223-1226. [PMID: 11454348 DOI: 10.1016/s0031-9422(01)00204-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Three flavones, including 4'-O-[2'-O-E-feruloyl-O-beta-D-glucuronopyranosyl(1-->2)-O-beta-D-glucuronopyranoside]apigenin, 7-O-beta-D-glucuronopyranosyl-4'-O-[2'-O-E-feruloyl-O-beta-D-glucuronopyranosyl(1-->2)-O-beta-D-glucuronopyranoside]apigenin and 7-O-beta-D-glucuronopyranosyl-4'-O-[2'-O-p-E-coumaroyl-O-beta-D-glucuronopyranosyl(1-->2)-O-beta-D-glucuronopyranoside]apigenin have been identified in alfalfa var. Artal. The known flavone 7-O-[2-O-E-feruloyl-[beta-D-glucuronopyranosyl(1-->3)]-O-beta-D-glucuronopyranosyl(1-->2)-O-beta-D-glucurono-pyranoside] apigenin was also isolated. The structures of these compounds were deduced on the basis of their spectral data.
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Affiliation(s)
- A Stochmal
- Department of Biochemistry, Institute of Soil Science and Plant Cultivation, ul. Czartoryskich 8, 24-100, Pulawy, Poland.
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Abstract
Systemic sclerosis (SSc) is an uncommon, progressive, sometimes lethal fibrotic disease whose pathogenesis probably includes immunologic elements, especially early in its course. There is no proven therapy for this disease, although some promising results have been obtained with the use of immunosuppressive drugs such as cyclophosphamide. There exists a subgroup of patients who have rapidly progressive disease or who are not responsive to conventional treatment, and who may benefit from intensive immunosuppression with stem cell rescue (stem cell transplantation). The rationale for bone marrow transplantation (BMT), and, more recently, peripheral blood stem cell transplantation (SCT), has been validated by studies on animal models of autoimmunity. Autologous transplantation has shown encouraging anecdotal results, and it is now being evaluated in phase I/II studies in patients with predictably poor outcome. In this light, reliably identifying patients early in the course of SSc is extremely important in order to establish correct eligibility criteria. For patients unable to tolerate transplant regimens, other approaches may be feasible. In this regard, nonmyeloablative approaches, such as immunosuppression without rescue and mixed chimerism, are also discussed.
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Affiliation(s)
- F Viganego
- Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, D1-100, Seattle, WA 98109-4417, USA.
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Abstract
This study was performed to study the prevalence, origin, and clinical implication of striated muscle cells in congenital non-neoplastic lung abnormalities. Five cases of striated muscle cell proliferation within congenital non-neoplastic pulmonary abnormalities were identified from a series of 31 (16%) resected specimens obtained at King's College Hospital, London, during the period 1992 to 1998. Lung tissue was also obtained from 48 normal human fetuses and serial sections stained for the presence of striated muscle. A histologic and immunohistochemical study of the clinical cases and the fetal material was performed by using phosphotungstic acid hematoxylin staining and immunostaining for myoglobin and desmin. Striated muscle cells were identified either as a diffuse or a focal proliferation within the lung interstitia of five infants. The congenital lung anomalies were intra-abdominal pulmonary sequestration associated with congenital cystic adenomatoid malformation (CCAM), intrathoracic sequestration again with features of CCAM, an intrathoracic sequestration associated with a congenital diaphragmatic hernia, and 2 Stocker type II intrathoracic CCAMs. Striated muscle cells were not identified in any section of lung tissue derived from the fetal series. Striated muscle cells proliferation in non-neoplastic lung tissue is more common than usually reported. Although the exact origin of such cells is speculative, because it is always detected within pulmonary anomalies, a wide morphogenetic error is likely. The clinical implication of its presence has to be further defined. HUM PATHOL 31:1477-1481.
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Affiliation(s)
- F Fraggetta
- Department of Histopathology, King's College Hospital, Denmark Hill, London, England
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Openshaw H, Stuve O, Antel JP, Nash R, Lund BT, Weiner LP, Kashyap A, McSweeney P, Forman S. Multiple sclerosis flares associated with recombinant granulocyte colony-stimulating factor. Neurology 2000; 54:2147-50. [PMID: 10851379 DOI: 10.1212/wnl.54.11.2147] [Citation(s) in RCA: 110] [Impact Index Per Article: 4.6] [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: 12/28/2022] Open
Abstract
Four of 10 patients who were enrolled on protocols of high-dose immunosuppression with peripheral blood stem cell rescue for MS experienced neurologic worsening while receiving recombinant human granulocyte colony-stimulating factor. There was improvement when methylprednisolone was given to three of the patients, but one patient died of respiratory failure. The mechanism of the neurologic worsening is uncertain.
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Affiliation(s)
- H Openshaw
- Department of Neurology, City of Hope National Medical Center, Duarte, CA 91010, USA.
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Bhattacharya V, McSweeney PA, Shi Q, Bruno B, Ishida A, Nash R, Storb RF, Sauvage LR, Hammond WP, Wu MH. Enhanced endothelialization and microvessel formation in polyester grafts seeded with CD34(+) bone marrow cells. Blood 2000; 95:581-5. [PMID: 10627466] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Abstract
The authors have shown accelerated endothelialization on polyethylene terephthalate (PET) grafts preclotted with autologous bone marrow. Bone marrow cells have a subset of early progenitor cells that express the CD34 antigen on their surfaces. A recent in vitro study has shown that CD34(+) cells can differentiate into endothelial cells. The current study was designed to determine whether CD34(+) progenitor cells would enhance vascular graft healing in a canine model. The authors used composite grafts implanted in the dog's descending thoracic aorta (DTA) for 4 weeks. The 8-mm x 12-cm composite grafts had a 4-cm PET graft in the center and 4-cm standard ePTFE grafts at each end. The entire composite was coated with silicone rubber to make it impervious; thus, the PET segment was shielded from perigraft and pannus ingrowth. There were 5 study grafts and 5 control grafts. On the day before surgery, 120 mL bone marrow was aspirated, and CD34(+) cells were enriched using an immunomagnetic bead technique, yielding an average of 11.4 +/- 5. 3 x 10(6). During surgery, these cells were mixed with venous blood and seeded onto the PET segment of composite study grafts; the control grafts were treated with venous blood only. Hematoxylin and eosin, immunocytochemical, and AgNO(3 )staining demonstrated significant increases of surface endothelialization on the seeded grafts (92% +/- 3.4% vs 26.6% +/- 7.6%; P =.0001) with markedly increased microvessels in the neointima, graft wall, and external area compared with controls. In dogs, CD34(+) cell seeding enhances vascular graft endothelialization; this suggests practical therapeutic applications. (Blood. 2000;95:581-585)
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Affiliation(s)
- V Bhattacharya
- The Hope Heart Institute and Providence Seattle Medical Center, the Fred Hutchinson Cancer Research Center, and the Departments of Surgery and Medicine, University of Washington School of Medicine, Seattle, WA
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Lowry TF, Forster HV, Pan LG, Serra A, Wenninger J, Nash R, Sheridan D, Franciosi RA. Effects on breathing of carotid body denervation in neonatal piglets. J Appl Physiol (1985) 1999; 87:2128-35. [PMID: 10601159 DOI: 10.1152/jappl.1999.87.6.2128] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.2] [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: 11/22/2022] Open
Abstract
The purpose of these studies was to test the hypothesis that carotid chemoreceptor activity is necessary for postnatal maturation of the ventilatory control system. By using a lateral surgical access, 17 piglets were carotid body denervated (CBD) and 14 were sham denervated at 3-25 days of age. After surgery, there was no irregular breathing in any group. There was no significant hypoventilation when CBD was performed at less than 5 days of age (n = 5) and only a mild (arterial PCO(2) 5 Torr; P < 0.05) to moderate, transient (arterial PCO(2) 8 Torr; P < 0.5) hypoventilation in piglets denervated at 10-15 (n = 6) and 20-25 (n = 6) days of age, respectively. Three weeks after surgery, both breathing of a hypoxic gas mixture and jugular venous NaCN injections elicited a hyperpnea in the CBD piglets that was attenuated compared with that in sham CBD piglets. In the CBD piglets, there was no response to injections of NaCN in the carotid arteries, but there was a response to NaCN injected into the proximal descending aorta, suggesting the residual peripheral chemosensitivity was of aortic origin. Carotid chemoreceptor-intact piglets had carotid and aortic NaCN chemosensitivity by 2 days of age. The carotid response persisted for the 40 days of the study, but the aortic reflex persisted only until approximately 8 days of age. We conclude that 1) the major effect of CBD per se in neonatal piglets is age-dependent hypoventilation and 2) there is a high degree of plasticity in peripheral chemosensitivity in neonates that may contribute to minimizing the changes in breathing after CBD.
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Affiliation(s)
- T F Lowry
- Departments of Physiology and Pediatrics, Medical College of Wisconsin, Zablocki Veterans Affairs Medical Center, and Program in Physical Therapy, Marquette University, Milwaukee, Wisconsin 53226, USA
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Abstract
Pain of moderate to severe intensity continues to be an important problem for many hospitalized patients. Nurses spend more time with patients than any other health professional group and have a key role to play in the management of patients' pain. This paper reports the findings from a series of focus group interviews which were undertaken to explore nurses' perceptions regarding pain and the administration of narcotic analgesia. Themes identified from participants' comments related to (1) the pivotal role of nurses in pain management; (2) nursing assessment and pain management decisions (3) individual factors influencing nurses' pain management decisions and (4) the influence of others on nurses' pain management decisions.
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Affiliation(s)
- R Nash
- School of Nursing, Queensland University of Technology, Kelvin Grove, Australia.
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Affiliation(s)
- R Storb
- Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1024, USA
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Abstract
The aim of this paper is to describe the prevalence and perceptions of pain and pain management amongst hospital in-patients. A cross-sectional descriptive survey of 205 patients was conducted. Presence and severity of pain was assessed using verbal descriptor and visual analogue scales, and perceptions of pain were assessed using multi-item scales. Although the severity of pain reported was consistent across age groups and clinical areas, women in the study sample were significantly more likely to report high levels of pain than men. Differences in how men and women communicate their pain were observed, with women indicating that they were less willing to ask for help with their pain. Results suggest that pain continues to be an important problem for a large number of men and women in hospital, and that the experience of pain impacts negatively upon their well-being. Gender differences in the experience of and response to pain remain important considerations for clinical nurses who have major responsibilities for the management of pain in hospitalized patients.
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Affiliation(s)
- P Yates
- Queensland University of Technology, QLD, Australia
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Martin PJ, Schoch G, Gooley T, Anasetti C, Deeg HJ, Nash R, Sanders J, Storb R, Appelbaum F. Methods for assessment of graft-versus-host disease. Blood 1998; 92:3479-81. [PMID: 9787194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
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