1
|
Jandhyala R, Rout R. Observing expert opinion of medical affairs pharmaceutical physicians on the value of their clinical experience to the pharmaceutical industry using the Jandhyala method. Curr Med Res Opin 2023; 39:1541-1550. [PMID: 36632732 DOI: 10.1080/03007995.2023.2165814] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 12/14/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND The pharmaceutical industry requires a highly qualified workforce with diverse skillsets. Medical affairs pharmaceutical physicians (MAPPs) have unique qualifications among pharmaceutical company employees, but the exact contribution of their education and training is unknown. This study aimed to identify the medical education and training competencies MAPPs use in the pharmaceutical industry in relation to the four external stakeholders, regulators, payors, prescribers, and patients. METHOD Ten MAPPs were recruited using convenience sampling via professional networks. A systematic literature review and the Jandhyala method, a two-stage qualitative online consensus method, identified which of MAPPs' medical education and training competencies they used in their work with each external stakeholder. Statistical analyses determined heterogeneity in the relevance of competencies and competency categories to each stakeholder. RESULTS Nine MAPPs completed the study. Of the 59 competencies identified, 54 were relevant to all external stakeholders. Relevance of competencies varied significantly between external stakeholders (p = .0434). Binary competency scores varied significantly for three pairs of stakeholders, "patient vs. payor" (p = .025), "prescriber vs. regulator" (p = .013) and "prescriber vs. payor" (p = .008). Between-stakeholder overall frequency count varied significantly for two of the nine competency categories. CONCLUSION MAPPs develop a highly specialized set of competencies during medical education and training from which they use distinct subsets to meet the needs of external stakeholders in the pharmaceutical industry. Undergraduate and postgraduate competency-based medical education appears to prepare MAPPs for cognitive and technical work. Further exploration may aid understanding of how they develop soft skills.
Collapse
Affiliation(s)
- Ravi Jandhyala
- Medialis Ltd., England, UK
- Centre for Pharmaceutical Medicine Research, King's College London, University of London, London, UK
| | - Raj Rout
- Vertex Pharmaceuticals, London, UK
| |
Collapse
|
2
|
Ge W, Wang D, Chuang CC, Li Y, Rout R, Siddiqui S, Kamat S. Real-World Cost of Nasal Polyps Surgery and Risk of Major Complications in the United States: A Descriptive Retrospective Database Analysis. CEOR 2022; 14:691-697. [PMID: 36389100 PMCID: PMC9651015 DOI: 10.2147/ceor.s380411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 10/20/2022] [Indexed: 11/09/2022] Open
Abstract
Background Endoscopic nasal polyp (NP) surgery is a treatment option for patients with chronic rhinosinusitis with nasal polyps (CRSwNP). Previous studies report NP surgery costs of $8000-13,000 and risk of major complications of NP surgery of ~0.1-1%. Limited contemporary data for costs and complications associated with NP surgery in US clinical practice are available. Methods IQVIA PharMetrics Plus claims data were used to identify patients with NP surgery in 2019 with ≥3 years continuous baseline health-plan enrollment prior to index date (date of first eligible NP surgery) and ≥30 days continuous enrollment after index (follow-up). In this descriptive analysis, total costs of NP surgery were estimated as all medical costs on the index date (or during the entire hospital stay for patients who received surgery in the inpatient setting). Total medical costs (all-cause) were estimated for all medical services occurring from the index date to the index date +9 or +29 days (10-day and 30-day). Major complication was defined as cerebrospinal fluid (CSF) leak, orbital injury, or major hemorrhage within 30 days of index. Results Of 6311 patients, median age was 46 years (interquartile range: 34-56); 59.7% were male; 88.2% had no NP surgery in the prior 3 years; 63.7% had allergic rhinitis, and 37.1% had asthma. Mean (SD) total medical cost of surgery was $14,697 (11,679) and mean (SD) 10-day total medical cost was $15,401 (11,968). Major complications occurred in 102 (1.7%) patients. Total medical costs and 10-day costs were higher in patients with major complications than those without ($23,605 [19,264] vs $15,251 [11,741]). Conclusion In this descriptive analysis, NP surgery costs and rates of major surgical complications were updated using recent real-world data in the US. Results indicated that NP surgery complication rates were numerically higher than previously reported.
Collapse
Affiliation(s)
- Wenzhen Ge
- Health Economics and Outcomes Research, Medical Affairs, Regeneron, Tarrytown, NY, USA
| | - Degang Wang
- Health Economics and Outcomes Research, Medical Affairs, Regeneron, Tarrytown, NY, USA
| | - Chien-Chia Chuang
- Global Health Economics and Value Assessment, Sanofi, Cambridge, MA, USA
| | - Yongtao Li
- Global Medical Affairs, Sanofi, Bridgewater, NJ, USA
| | - Raj Rout
- Global Medical Affairs, Sanofi, Reading, UK
| | - Shahid Siddiqui
- Health Economics and Outcomes Research, Medical Affairs, Regeneron, Tarrytown, NY, USA
| | - Siddhesh Kamat
- Health Economics and Outcomes Research, Medical Affairs, Regeneron, Tarrytown, NY, USA
- Correspondence: Siddhesh Kamat, Email
| |
Collapse
|
3
|
Augustin M, Misery L, Kobyletzski LV, Mealing S, Redding M, Chuang CC, Massey R, Cawkwell M, Bego Le-Bagousse G, Haddy L, Rout R. Systematic literature review assessing the overall costs and societal impacts of moderate-to-severe atopic dermatitis in Europe. J Eur Acad Dermatol Venereol 2022; 36:2316-2324. [PMID: 35920758 DOI: 10.1111/jdv.18481] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 07/11/2022] [Indexed: 11/29/2022]
Abstract
Atopic dermatitis (AD) is a chronic inflammatory disease, driven by type 2 inflammation. The condition manifests as moderate-to-severe disease in approximately 20% of adults with AD across Europe, and is associated with a substantial burden on patients, society, and healthcare systems. However, systematic assessments capturing the totality of disease burden associated with moderate-to-severe AD are limited; therefore, the overall impacts of the disease may be underestimated. A systematic literature review was carried out to assess the overall costs of moderate-to-severe AD across Europe, including the financial, societal, and humanistic impacts. PubMed, Embase and Cochrane databases were searched to identify relevant studies published between 1 January 2010 and 2 June 2020. Scientific conference proceedings, health technology assessment websites and patient association group websites were also searched for relevant information. Twenty-seven publications, corresponding to 22 unique studies, were included in the analysis. Total costs (direct and productivity losses) reached €20 695 per-person-per-year (PPPY) for adults with uncontrolled symptoms of moderate-to-severe AD. Direct medical costs ranged between €307 and €6993 PPPY; prescription medications and specialist dermatologist visits were the main contributors. Costs increased with disease severity or with uncontrolled disease. Patients with AD also incurred personal costs of €927 per year for healthcare items not reimbursed, which increased by 9% for those with moderate-to-severe forms. Annual work productivity losses comprised most of the total costs reported for adults with moderate-to-severe AD (up to 60.8% of the total burden) and were highest in those with uncontrolled disease (€13 702 PPPY). Patients with moderate-to-severe disease also experienced physical, emotional, and social impacts. The overall costs of moderate-to-severe AD greatly impact on healthcare systems, patients, and society. Sustained control of moderate-to-severe AD, through effective treatment and care management, is essential to limit the burden caused by the disease.
Collapse
Affiliation(s)
- M Augustin
- University Medical Center Hamburg, Hamburg, Germany
| | - L Misery
- University Hospital of Brest, Brest, France
| | | | - S Mealing
- York Health Economics Consortium (YHEC), York, UK
| | - M Redding
- Eczema Outreach Support, Linlithgow, Scotland
| | | | | | | | | | - L Haddy
- Aixial on behalf of Sanofi, Chilly-Mazarin, France
| | | |
Collapse
|
4
|
Hopkins C, Conlon S, Chavda S, Hudson R, Rout R. Investigating the secondary care system burden of CRSwNP in sinus surgery patients with clinically relevant comorbidities using the HES database. Rhinology 2022; 60:252-260. [PMID: 35230356 DOI: 10.4193/rhin21.264] [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: 11/08/2022]
Abstract
BACKGROUND Chronic rhinosinusitis with nasal polyps (CRSwNP) is a chronic condition that can adversely affect quality of life for patients. There is no cure for CRSwNP, and patients may require intermittent systemic corticosteroids (SCS) and surgery in addition to intranasal treatment throughout their lifetime. This places a significant burden on the NHS which can be compounded by comorbid conditions such as asthma or NSAID-exacerbated respiratory disease (NERD). Patients with comorbidities are likely to experience higher rates of surgery and more secondary care visits. The aim of this study was to evaluate revision rates and the associated burden for patients with CRSwNP undergoing surgery and compare this to sub-cohorts of patients with comorbidities. MATERIALS AND METHODS This study has utilised the Hospital Episodes Statistics (HES) database across a ten-year time period (April 2010 to March 2020) to investigate the NHS resource use attributable to CRSwNP for all patients with the condition who have undergone sinus surgery, and to examine the burden of clinically relevant sub-groups. RESULTS Our results showed that 101,054 patients underwent at least one sinus surgery in relation to their nasal polyps, with Kaplan Meier survival analysis estimating that the 10-year probability of revision is between 71-90% for comorbid patients, and 51% for non-comorbid patients. Patients with a relevant comorbid condition in addition to their CRSwNP were up to 4.7 times more likely to undergo at least one revision surgery during the ten-year analytical time window when compared to patients without a comorbidity. Further to this, comorbid patients had a higher tariff associated with their CRSwNP care across the analytical time window and were therefore likely to be more costly to the healthcare system. CONCLUSIONS In conclusion, this study demonstrates that there is a high burden attached to CRSwNP-related sinus surgery and that comorbidities are a key driver of NHS resource use.
Collapse
Affiliation(s)
- C Hopkins
- Guy's and St. Thomas' Hospital, Kings college, London, UK
| | | | | | | | - R Rout
- Sanofi Genzyme UK, Reading, UK
| |
Collapse
|
5
|
Bachert C, Peters AT, Heffler E, Han JK, Olze H, Pfaar O, Chuang CC, Rout R, Attre R, Goga L, Jacob-Nara JA, Rowe PJ, Deniz Y, Chen Z, Kamat S, Siddiqui S. Responder analysis to demonstrate the effect of targeting type 2 inflammatory mechanisms with dupilumab across objective and patient-reported endpoints for patients with severe chronic rhinosinusitis with nasal polyps in the SINUS-24 and SINUS-52 studies. Clin Exp Allergy 2022; 52:244-249. [PMID: 35092110 DOI: 10.1111/cea.14051] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/13/2021] [Accepted: 10/28/2021] [Indexed: 12/24/2022]
Affiliation(s)
- Claus Bachert
- Ghent University, Ghent, Belgium
- Karolinska Institutet, Stockholm, Sweden
- The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Anju T Peters
- Allergy-Immunology Division and the Sinus and Allergy Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Enrico Heffler
- Personalized Medicine, Asthma & Allergy - Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy
- Department of Biomedical Science, Humanitas University, Milan, Italy
| | - Joseph K Han
- Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Heidi Olze
- Department of Otorhinolaryngology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Oliver Pfaar
- Section of Rhinology and Allergy, Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany
| | | | | | - Richa Attre
- Regeneron Pharmaceuticals, Inc., Tarrytown, New York, USA
| | | | | | | | - Yamo Deniz
- Regeneron Pharmaceuticals, Inc., Tarrytown, New York, USA
| | - Zhen Chen
- Regeneron Pharmaceuticals, Inc., Tarrytown, New York, USA
| | - Siddhesh Kamat
- Regeneron Pharmaceuticals, Inc., Tarrytown, New York, USA
| | | |
Collapse
|
6
|
Aldridge P, Parish R, Castle H, Russell E, Rout R, Singh R. Head home: implementation during COVID-19 pandemic. Emerg Med J 2021; 38:692-693. [PMID: 34289965 PMCID: PMC8380872 DOI: 10.1136/emermed-2020-211007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 07/10/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Recent research suggests that between 20% and 50% of paediatric head injuries attending our emergency department (ED) could be safely discharged soon after triage, without the need for medical review, using a 'Head Injury Discharge At Triage' tool (HIDAT). We sought to implement this into clinical practice. METHODS Paediatric ED triage staff underwent competency-based assessments for HIDAT with all head injury presentations 1 May to 31 October 2020 included in analysis. We determined which patients were discharged using the tool, which underwent CT of the brain and whether there was a clinically important traumatic brain injury or representation to the ED. RESULTS Of the 1429 patients screened; 610 (43%) screened negative with 250 (18%) discharged by nursing staff. Of the entire cohort, 32 CTs were performed for head injury concerns (6 abnormal) with 1 CT performed in the HIDAT negative group (normal). Of those discharged using HIDAT, four reattended, two with vomiting (no imaging or admission) and two with minor scalp wound infections. Two patients who screened negative declined discharge under the policy with later medical discharge (no imaging or admission). Paediatric ED attendances were 29% lower than in 2018. CONCLUSION We have successfully implemented HIDAT into local clinical practice. The number discharged (18%) is lower than originally described; this is likely multifactorial. The relationship between COVID-19 and paediatric ED attendances is unclear but decreased attendances suggest those for whom the tool was originally designed are not attending ED and may be accessing other medical/non-medical resources.
Collapse
Affiliation(s)
- Patrick Aldridge
- Paediatric Emergency Department, Frimley Park Hospital NHS Foundation Trust, Frimley, UK
| | - Rachel Parish
- Emergency Department, Frimley Park Hospital NHS Foundation Trust, Frimley, Surrey, UK
| | - Heather Castle
- Paediatric Emergency Department, Frimley Park Hospital NHS Foundation Trust, Frimley, UK
| | - Emma Russell
- Paediatric Emergency Department, Frimley Park Hospital NHS Foundation Trust, Frimley, UK
| | - Raj Rout
- Global Medical Affairs, Sanofi Genzyme, Guildford, UK
| | - Roohi Singh
- University of East Anglia Norwich Medical School, Norwich, Norfolk, UK
| |
Collapse
|
7
|
O’Kane D, Davis L, Ardern-Jones M, Laws P, Shaw L, Cork M, Velangi S, Cooper HL, Hudson R, Smith AB, Rout R. Treatment outcomes of patients with Atopic Dermatitis (AD) treated with dupilumab through the Early Access to Medicines Scheme (EAMS) in the UK. Ulster Med J 2021; 90:70-76. [PMID: 34276083 PMCID: PMC8278937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/29/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Dupilumab, a monoclonal antibody against interleukin (IL)-4 receptor alpha that inhibits IL-4/IL-13 signalling is indicated in dermatology for the treatment of moderate-to-severe atopic dermatitis (AD) in adult and adolescent patients 12 years and older and severe AD in children 6-11 years, who are candidates for systemic therapy. Dupilumab received Early Access to Medicines Scheme (EAMS) approval for adults in March 2017. OBJECTIVES The purpose of this study was to assess the efficacy outcomes of treatment with dupilumab in EAMS. METHODS A retrospective analysis of adult patients enrolled in the dupilumab EAMS in the UK. Scores were assessed at baseline and follow up, including the Eczema Area and Severity Index (EASI), Investigator's Global Assessment Score (IGA) and Dermatology Life Quality Index (DLQI). RESULTS Data were available for 57 adult patients treated with dupilumab for at least 12 weeks; 73.6% of patients had received prior treatment with 3 or 4 immunosuppressants. Baseline scores for the EASI and DLQI were 27.93 (standard deviation, SD 13.09) and 18.26 (SD 6.18) respectively. AD severity scores showed statistically significant improvement at week 16±4 weeks (p <0.001 for all). The mean change in EASI was 14.13 points with 66.7% and 36.7% achieving a 50% (EASI-50) and 75% (EASI-75) improvement in EASI, respectively at 16+/- 4 weeks. IGA scores improved by at least two categories for 75% patients. DLQI scores decreased by a mean of 9.0 points, with 80% patients demonstrating a MCID 4-point improvement. For 85% patients, clinicians rated the treatment response as being either 'better' (19%) or 'much better' (65%). CONCLUSIONS Dupilumab is associated with a significant and clinically relevant improvements in AD as measured by patient- and physician-reported outcome measures. Importantly, the clinical efficacy, despite the refractory disease of this EAMS cohort, is comparable to that previously reported in clinical trials.
Collapse
|
8
|
Bachert C, Peters A, Heffler E, Han J, Olze H, Pfaar O, Chuang CC, Rout R, Attre R, Goga L, Jacob-Nara J, Rowe P, Deniz Y, Chen Z, Kamat S, Siddiqui S. A Responder Analysis To Demonstrate Dupilumab Treatment Effect Across Objective and Patient-Reported Subjective Endpoints For Patients with Severe Chronic Rhinosinusitis with Nasal Polyps (CRSwNP). J Allergy Clin Immunol 2021. [DOI: 10.1016/j.jaci.2020.12.483] [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: 10/22/2022]
|
9
|
Aldridge P, Castle H, Phillips C, Russell E, Guerrero-Luduena R, Rout R. Head home: a prospective cohort study of a nurse-led paediatric head injury clinical decision tool at a district general hospital. Emerg Med J 2020; 37:680-685. [PMID: 32759348 DOI: 10.1136/emermed-2019-208892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 05/22/2020] [Accepted: 06/20/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To assess if a nurse-led application of a paediatric head injury clinical decision tool would be safe compared with current practice. METHODS All paediatric (<17 years) patients with head injuries presenting to Frimley Park Emergency Department (ED), England from 1 May to 31 October 2018 were prospectively screened by a nurse using a mandated electronic 'Head Injury Discharge At Triage' questionnaire (HIDATq). We determined which patients underwent CT of brain and whether there was a clinically important intracranial injury or re-presentation to the ED. The negative predictive value of the screening tool was assessed. We determined what proportion of patients could have been sent home from triage using this tool. RESULTS Of the 1739 patients screened, 61 had CTs performed due to head injury (six abnormal) with a CT rate of 3.5% and 2% re-presentations. Of the entire cohort, 1052 screened negative. 1 CT occurred in this group showing no abnormalities. Of those screened negative, 349 (33%)/1052 had 'no other injuries' and 543 (52%)/1052 had 'abrasions or lacerations'. HIDATq's negative predictive value for CT was 99.9% (95% CI 99.4% to 99.9%) and 100% (95% CI 99.0% to 100%) for intracranial injury. The positive predictive value of the tool was low. Five patients screened negative and re-presented within 72 hours but did not require CT imaging. CONCLUSION A negative HIDATq appears safe in our ED. Potentially 20% (349/1739) of all patients with head injuries presenting to our department could be discharged by nurses at triage with adequate safety netting advice. This increases to 50% (543/1739), if patients with lacerations or abrasions were given advice and discharged at triage. A large multicentre study is required to validate the tool.
Collapse
Affiliation(s)
- Patrick Aldridge
- Paediatric Emergency Department, Frimley Park Hospital NHS Foundation Trust, Frimley, UK
| | - Heather Castle
- Paediatric Emergency Department, Frimley Park Hospital NHS Foundation Trust, Frimley, UK
| | - Clare Phillips
- Paediatric Emergency Department, Frimley Park Hospital NHS Foundation Trust, Frimley, UK
| | - Emma Russell
- Paediatric Emergency Department, Frimley Park Hospital NHS Foundation Trust, Frimley, UK
| | - Richard Guerrero-Luduena
- School of Health Sciences, Centre for Implementation Science, University of Southampton, Southampton, Hampshire, UK
| | - Raj Rout
- Global Medical Affairs, Sanofi Genzyme, Guildford, UK
| |
Collapse
|
10
|
Eckert L, Amand C, Gadkari A, Rout R, Hudson R, Ardern-Jones M. Treatment patterns in UK adult patients with atopic dermatitis treated with systemic immunosuppressants: data from The Health Improvement Network (THIN). J DERMATOL TREAT 2019; 31:815-820. [PMID: 31305182 DOI: 10.1080/09546634.2019.1639604] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background: There is limited understanding on patterns of systemic treatment in adults with moderate-to-severe atopic dermatitis (AD) in the UK.Objective: To characterize treatment patterns in adult AD patients prescribed immunosuppressants (IMMs) in the primary care setting.Results: Six hundred and fifty-six patients with AD (6.6%) were prescribed IMM in the analysis (mean age 52.1 years; 59.1% female; age-adjusted Charlson comorbidity index 1.4). Most prevalent (>5%) conditions at baseline were depression (10.8%), contact dermatitis (10.7%), rheumatological disease (7.9%), skin/subcutaneous tissue disorders (6.4%), upper respiratory disease (5.8%), and psoriasis (5.2%). At baseline, up to 50% of patients were prescribed ≥1 IMM. During follow-up, 42.7% of patients were prescribed oral corticosteroids (OCSs), increasing in line with IMM exposure. The most commonly prescribed IMM was methotrexate (43.3%). Ciclosporin, the only approved IMM for AD, was prescribed to 16.9% of patients.Conclusions: The prevalence of comorbidities and high rate of IMM prescriptions demonstrate the impact of AD on quality of life. The frequency of OCS prescribing in AD patients treated with IMMs suggests a lack of disease control with existing therapies, and an unmet need for safe and effective targeted agents for long-term disease control.
Collapse
|
11
|
Abstract
Purpose Management of atopic dermatitis (AD) typically requires application of topical treatments, often multiple times a day. The cosmetic properties and burdensome application of these treatments can be detrimental to quality of life (QoL). Patients who achieve good disease control through use of systemic therapies may reduce the frequency and amount of topical applications, improving QoL. This study aimed to quantify the utility and disutility for topical AD treatment processes. Methods Seven vignettes describing different skincare regimens for people with moderate-to-severe AD were developed with input from healthcare professionals. 484 respondents from the general population completed time trade-off items for each vignette. Utility values for each regimen, and disutilities associated with the impact of changes to skincare regimens, were calculated. Analysis of variance assessed differences between skincare regimens. Results As skincare regimens increased in intensity (0.7968 for the most intense; 0.9999 for the least), utility values decreased. There were no statistically significant differences between skincare regimens followed by patients with good disease control (0.9862 to 0.9999); however, when compared to those involving topical corticosteroids and emollient combinations (0.7968 to 0.8835), significant differences were observed (p < 0.001). The largest disutilities (0.1521 to 0.1705) were between skincare regimens describing the use of topical corticosteroids plus emollient and those followed by patients with good disease control. Conclusions The application of topical treatments has a detrimental effect on QoL, which increases with the duration and frequency of applications. Further research is needed to investigate how health and process utilities interact and both can be integrated into medical decision-making. Electronic supplementary material The online version of this article (10.1007/s11136-019-02174-0) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Jenny Retzler
- York Health Economics Consortium, University of York, York, UK. .,Department of Psychology, University of Huddersfield, Huddersfield, UK.
| | - Adam Smith
- York Health Economics Consortium, University of York, York, UK
| | - Matthew Reaney
- Sanofi Genzyme UK and Ireland, One Onslow Street, Guildford, Surrey, GU1 4SY, UK
| | - Raj Rout
- Sanofi Genzyme UK and Ireland, One Onslow Street, Guildford, Surrey, GU1 4SY, UK
| | - Richard Hudson
- Sanofi Genzyme UK and Ireland, One Onslow Street, Guildford, Surrey, GU1 4SY, UK
| |
Collapse
|
12
|
Mishra R, Joshi M, Meisenberg O, Gierl S, Prajith R, Kanse SD, Rout R, Sapra BK, Mayya YS, Tschiersch J. Deposition and spatial variation of thoron decay products in a thoron experimental house using the Direct Thoron Progeny Sensors. J Radiol Prot 2017; 37:379-389. [PMID: 28418936 DOI: 10.1088/1361-6498/aa6408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Experiments have been carried out using the deposition-based Direct Thoron Progeny Sensors (DTPS) in a thoron experimental house. The objective was to study the thoron decay product characteristics such as the deposition velocities, spatial variability and dependence on aerosol particle concentrations. Since the deposition velocity is an important characteristic in the calibration of the DTPS, it is very important to study its dependence on aerosol concentration in a controlled environment. At low aerosol concentration (1500 particles/cm3) the mean effective deposition velocity was measured to be 0.159 ± 0.045 m h-1; at high aerosol concentration (30 000 particles/cm3) it decreased to 0.079 ± 0.009 m h-1. The deposition velocity for the attached fraction of the thoron decay products did not change with increasing aerosol concentration, showing measurement results of 0.048 ± 0.005 m h-1 and 0.043 ± 0.014 m h-1, respectively. At low particle concentration, the effective deposition velocity showed large scattering within the room at different distances from center. The attached fraction deposition velocity remained uniform at different distances from the wall. The measurements in the thoron experimental house can be used as a sensitivity test of the DTPS in an indoor environment with changing aerosol concentration. The uniform spatial distribution of thoron decay products was confirmed within the experimental house. This indicates that direct measurement of thoron decay product concentration should be carried out instead of inferring it from thoron gas concentration, which is very inhomogeneous within the experimental house.
Collapse
Affiliation(s)
- R Mishra
- Bhabha Atomic Research Centre, Radiological Physics and Advisory Division, Mumbai 400 085, India
| | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Bottomley N, Jones LD, Rout R, Alvand A, Rombach I, Evans T, Jackson WFM, Beard DJ, Price AJ. A survival analysis of 1084 knees of the Oxford unicompartmental knee arthroplasty: a comparison between consultant and trainee surgeons. Bone Joint J 2017; 98-B:22-27. [PMID: 27694512 PMCID: PMC5047132 DOI: 10.1302/0301-620x.98b10.bjj-2016-0483.r1] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 08/02/2016] [Indexed: 01/30/2023]
Abstract
Aims The aim of this to study was to compare the previously unreported
long-term survival outcome of the Oxford medial unicompartmental
knee arthroplasty (UKA) performed by trainee surgeons and consultants. Patients and Methods We therefore identified a previously unreported cohort of 1084
knees in 947 patients who had a UKA inserted for anteromedial knee
arthritis by consultants and surgeons in training, at a tertiary
arthroplasty centre and performed survival analysis on the group
with revision as the endpoint. Results The ten-year cumulative survival rate for revision or exchange
of any part of the prosthetic components was 93.2% (95% confidence
interval (CI) 86.1 to 100, number at risk 45). Consultant surgeons
had a nine-year cumulative survival rate of 93.9% (95% CI 90.2 to
97.6, number at risk 16). Trainee surgeons had a cumulative nine-year
survival rate of 93.0% (95% CI 90.3 to 95.7, number at risk 35).
Although there was no differences in implant survival between consultants
and trainees (p = 0.30), there was a difference in failure pattern
whereby all re-operations performed for bearing dislocation (n =
7), occurred in the trainee group. This accounted for 0.6% of the
entire cohort and 15% of the re-operations. Conclusion This is the largest single series of the Oxford UKA ever reported
and demonstrates that good results can be achieved by a heterogeneous
group of surgeons, including trainees, if performed within a high-volume
centre with considerable experience with the procedure. Cite this article: Bone Joint J 2016;(10 Suppl
B):22–7.
Collapse
Affiliation(s)
- N Bottomley
- NDORMs, University of Oxford, Botnar Research Centre, Old Road, Oxford OX3 7LD, UK
| | - L D Jones
- NDORMs, University of Oxford, Botnar Research Centre, Old Road, Oxford OX3 7LD, UK
| | - R Rout
- NDORMs, University of Oxford, Botnar Research Centre, Old Road, Oxford OX3 7LD, UK
| | - A Alvand
- NDORMs, University of Oxford, Botnar Research Centre, Old Road, Oxford OX3 7LD, UK
| | - I Rombach
- NDORMs, University of Oxford, Botnar Research Centre, Old Road, Oxford OX3 7LD, UK
| | - T Evans
- NDORMs, University of Oxford, Botnar Research Centre, Old Road, Oxford OX3 7LD, UK
| | - W F M Jackson
- NDORMs, University of Oxford, Botnar Research Centre, Old Road, Oxford OX3 7LD, UK
| | - D J Beard
- NDORMs, University of Oxford, Botnar Research Centre, Old Road, Oxford OX3 7LD, UK
| | - A J Price
- NDORMs, University of Oxford, Botnar Research Centre, Old Road, Oxford OX3 7LD, UK
| |
Collapse
|
14
|
Kruger N, McNally E, Al-Ali S, Rout R, Rees JL, Price AJ. Three-dimensional reconstructed magnetic resonance scans: Accuracy in identifying and defining knee meniscal tears. World J Orthop 2016; 7:731-737. [PMID: 27900270 PMCID: PMC5112342 DOI: 10.5312/wjo.v7.i11.731] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 08/18/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To determine whether three-dimensional (3D) reconstruction from conventional magnetic resonance imaging (MRI) is able to accurately detect a meniscal tear, and define the configuration.
METHODS Thirty-three patients’ 3T MRI scan data were collected and sagittal uni-planar 3D reconstructions performed from the preoperative MRI. There were 24 meniscal tears in 24 patients, and nine controls. All patients had arthroscopic corroboration of MRI findings. Two independent observers prospectively reported on all 33 reconstructions. Meniscal tear presence or absence was noted, and tear configuration subsequently categorised as either radial, bucket-handle, parrot beak, horizontal or complex.
RESULTS Identification of control menisci or meniscal tear presence was excellent (Accuracy: observer 1 = 90.9%; observer 2 = 81.8%). Of the tear configurations, bucket handle tears were accurately identified (Accuracy observer 1 and 2 = 80%). The remaining tear configurations were not accurately discernable.
CONCLUSION Uni-planar 3D reconstruction from 3T MRI knee scan sequences are useful in identifying normal menisci and menisci with bucket-handle tears. Advances in MRI sequencing and reconstruction software are awaited for accurate identification of the remaining meniscal tear configurations.
Collapse
|
15
|
Mishra R, Rout R, Prajith R, Jalalluddin S, Sapra BK, Mayya YS. INNOVATIVE EASY-TO-USE PASSIVE TECHNIQUE FOR 222RN AND 220RN DECAY PRODUCT DETECTION. Radiat Prot Dosimetry 2016; 171:181-186. [PMID: 27009245 DOI: 10.1093/rpd/ncw053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The decay products of radon and thoron are essentially the radioisotopes of polonium, bismuth and lead, and are solid particulates, which deposit in different parts of the respiratory tract upon inhalation, subsequently emitting high-energy alpha particles upon their radioactive decay. Development of passive deposition-based direct progeny sensors known as direct radon and thoron progeny sensors have provided an easy-to-use technique for time-integrated measurements of the decay products only. These dosemeters are apt for large-scale population dosimetry to assign inhalation doses to the public. The paper gives an insight into the technique, the calibration, comparison with the prevalently used active grab filter paper sampling technique, alpha track diameter analysis in these progeny sensors, progeny deposition velocity measurements carried out using these detector systems in the indoor as well as outdoor environment, and applications of these sensors for time-integrated unattached fraction estimation.
Collapse
Affiliation(s)
- Rosaline Mishra
- Radiological Physics and Advisory Division, Bhabha Atomic Research Centre, Mumbai 400 094, India
| | - R Rout
- Radiological Physics and Advisory Division, Bhabha Atomic Research Centre, Mumbai 400 094, India
| | - R Prajith
- Radiological Physics and Advisory Division, Bhabha Atomic Research Centre, Mumbai 400 094, India
| | - S Jalalluddin
- Radiological Physics and Advisory Division, Bhabha Atomic Research Centre, Mumbai 400 094, India
| | - B K Sapra
- Radiological Physics and Advisory Division, Bhabha Atomic Research Centre, Mumbai 400 094, India
| | - Y S Mayya
- Indian Institute of Technology, Bombay, India
| |
Collapse
|
16
|
Snelling S, Rout R, Davidson R, Clark I, Carr A, Hulley P, Price A. A gene expression study of normal and damaged cartilage in anteromedial gonarthrosis, a phenotype of osteoarthritis. Osteoarthritis Cartilage 2014; 22:334-43. [PMID: 24361742 PMCID: PMC3988961 DOI: 10.1016/j.joca.2013.12.009] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2013] [Revised: 11/27/2013] [Accepted: 12/10/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To identify osteoarthritis (OA) relevant genes and pathways in damaged and undamaged cartilage isolated from the knees of patients with anteromedial gonarthrosis (AMG) - a specific form of knee OA. DESIGN Cartilage was obtained from nine patients undergoing unicompartmental knee replacement (UKR) for AMG. AMG provides a spatial representation of OA progression; showing a reproducible and histologically validated pattern of cartilage destruction such that damaged and undamaged cartilage from within the same knee can be consistently isolated and examined. Gene expression was analysed by microarray and validated using real-time PCR. RESULTS Damaged and undamaged cartilage showed distinct gene expression profiles. 754 genes showed significant up- or down-regulation (non-False discovery rate (FDR) P < 0.05) with enrichment for genes involved in cell signalling, Extracellular Matrix (ECM) and inflammatory response. A number of genes previously unreported in OA showed strongly altered expression including RARRES3, ADAMTSL2 and DUSP10. Confirmation of genes previously identified as modulated in OA was also obtained e.g., SFRP3, MMP3 and IGF1. CONCLUSIONS This is the first study to examine a common and consistent phenotype of OA to allow direct comparison of damaged and undamaged cartilage from within the same joint compartment. We have identified specific gene expression profiles in damaged and undamaged cartilage and have determined relevant genes and pathways in OA progression. Importantly this work also highlights the necessity for phenotypic and microanatomical characterization of cartilage in future studies of OA pathogenesis and therapeutic development.
Collapse
Affiliation(s)
- S. Snelling
- The Botnar Research Centre, University of Oxford, UK,Address correspondence and reprint requests to: S. Snelling. The Botnar Research Centre, University of Oxford, UK.
| | - R. Rout
- The Botnar Research Centre, University of Oxford, UK
| | - R. Davidson
- Biomedical Research Unit, University of East Anglia, UK
| | - I. Clark
- Biomedical Research Unit, University of East Anglia, UK
| | - A. Carr
- The Botnar Research Centre, University of Oxford, UK
| | - P.A. Hulley
- The Botnar Research Centre, University of Oxford, UK
| | - A.J. Price
- The Botnar Research Centre, University of Oxford, UK
| |
Collapse
|
17
|
Rout R, McDonnell S, Hulley P, Jayadev C, Khan T, Carr A, Murray D, Gill H, Price A. The pattern of cartilage damage in antero-medial osteoarthritis of the knee and its relationship to the anterior cruciate ligament. J Orthop Res 2013; 31:908-13. [PMID: 23423802 DOI: 10.1002/jor.22253] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [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] [Received: 08/18/2011] [Accepted: 09/25/2012] [Indexed: 02/04/2023]
Abstract
Within antero-medial gonarthrosis (AMG) of the knee, there is a spectrum of damage seen in the functionally intact anterior cruciate ligament (ACL). Our aim was to correlate the degree of ACL damage to the geographical extent and degree of cartilage loss on the tibial plateau. Ninety tibial plateaus resected during unicompartmental arthroplasty were photographed and digitally mapped. The ACL damage was graded (0: normal, 1: synovium loss, 2: longitudinal splits), and dimensions of full thickness cartilage loss and damage recorded. The percentage of full thickness loss in patients with a normal ACL was compared to those with a damaged, but functionally intact ligament. All specimens showed similar elliptical loss of cartilage in the antero-medial part of the tibial plateau. A total of 45(50%) patients had a macroscopically normal ACL, 21(23%) had synovial loss, and 24(27%) had longitudinal splits. An increase in the area of cartilage damage was seen with progressive ACL damage (p < 0.001). The area of macroscopically normal cartilage found posteriorly did not change. This study demonstrates that phenotypic distribution of cartilage damage in AMG is highly reproducible with a pattern of increasing cartilage erosion associated with increasing ACL damage.
Collapse
Affiliation(s)
- Raj Rout
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, NIHR Biomedical Research Unit, Nuffield Orthopaedic Centre, University of Oxford, Oxford, United Kingdom
| | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Goardon N, Marchi E, Atzberger A, Quek L, Schuh A, Soneji S, Woll P, Mead A, Alford KA, Rout R, Chaudhury S, Gilkes A, Knapper S, Beldjord K, Begum S, Rose S, Geddes N, Griffiths M, Standen G, Sternberg A, Cavenagh J, Hunter H, Bowen D, Killick S, Robinson L, Price A, Macintyre E, Virgo P, Burnett A, Craddock C, Enver T, Jacobsen SEW, Porcher C, Vyas P. Coexistence of LMPP-like and GMP-like leukemia stem cells in acute myeloid leukemia. Cancer Cell 2011; 19:138-52. [PMID: 21251617 DOI: 10.1016/j.ccr.2010.12.012] [Citation(s) in RCA: 456] [Impact Index Per Article: 35.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2010] [Revised: 10/23/2010] [Accepted: 12/15/2010] [Indexed: 12/13/2022]
Abstract
The relationships between normal and leukemic stem/progenitor cells are unclear. We show that in ∼80% of primary human CD34+ acute myeloid leukemia (AML), two expanded populations with hemopoietic progenitor immunophenotype coexist in most patients. Both populations have leukemic stem cell (LSC) activity and are hierarchically ordered; one LSC population gives rise to the other. Global gene expression profiling shows the LSC populations are molecularly distinct and resemble normal progenitors but not stem cells. The more mature LSC population most closely mirrors normal granulocyte-macrophage progenitors (GMP) and the immature LSC population a previously uncharacterized progenitor functionally similar to lymphoid-primed multipotential progenitors (LMPPs). This suggests that in most cases primary CD34+ AML is a progenitor disease where LSCs acquire abnormal self-renewal potential.
Collapse
MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Animals
- Antigens, CD/metabolism
- Antigens, CD34/metabolism
- Cell Differentiation/physiology
- Cell Lineage/physiology
- Gene Expression Profiling
- Graft Survival
- Granulocyte-Macrophage Progenitor Cells/cytology
- Granulocyte-Macrophage Progenitor Cells/metabolism
- Hematopoietic Stem Cells/cytology
- Hematopoietic Stem Cells/metabolism
- Humans
- Immunophenotyping
- Leukemia, Myeloid, Acute/metabolism
- Leukemia, Myeloid, Acute/pathology
- Leukocyte Common Antigens/metabolism
- Lymphoid Progenitor Cells/cytology
- Lymphoid Progenitor Cells/metabolism
- Mice
- Mice, Inbred NOD
- Mice, SCID
- Middle Aged
- Neoplastic Stem Cells/metabolism
- Neoplastic Stem Cells/pathology
- Neoplastic Stem Cells/transplantation
- Transplantation, Heterologous/pathology
- Young Adult
Collapse
|
19
|
McDonnell SM, Bottomley NJ, Hollinghurst D, Rout R, Thomas G, Pandit H, Ostlere S, Murray DW, Beard DJ, Price AJ. Skyline patellofemoral radiographs can only exclude late stage degenerative changes. Knee 2011; 18:21-3. [PMID: 19897370 DOI: 10.1016/j.knee.2009.10.008] [Citation(s) in RCA: 10] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2009] [Revised: 10/16/2009] [Accepted: 10/19/2009] [Indexed: 02/02/2023]
Abstract
Accurate preoperative assessment of the patellofemoral joint is especially important in compartment specific knee arthritis. This study aims to show the actual intraoperative grade of patellofemoral cartilage damage that may be reliably detected or excluded by preoperative standard radiographic views. 100 consecutive knees awaiting arthroplasty underwent preoperative lateral and skyline radiographs and were scored using the Ahlback score. Intraoperative cartilage damage was assessed using the Collins score. The sensitivity and specificity were calculated for each grade of cartilage damage. Preoperative anterior knee pain and function were assessed and correlated to the degree of cartilage damage. The lateral radiograph shows poor sensitivity for all grades of disease (0.05-0.23). The skyline shows good sensitivity for grade 4 (large full thickness) damage (0.90) but decreases substantially for grades 1-3 (0.19-0.46). Significantly more people with skyline radiograph joint space narrowing complained of anterior knee pain than those with a normal radiograph (p<0.001). There was only a poor correlation between preoperative anterior pain and intraoperative patellofemoral cartilage damage (r=0.24). The lateral radiograph cannot exclude even large areas of full thickness cartilage damage whereas a normal skyline radiograph can reliably exclude significant (grade 4) patellofemoral disease and should be used in addition to the lateral view.
Collapse
Affiliation(s)
- S M McDonnell
- Nuffield Orthopaedic Centre NIHR Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, United Kingdom
| | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Kendrick BJL, Rout R, Bottomley NJ, Pandit H, Gill HS, Price AJ, Dodd CAF, Murray DW. The implications of damage to the lateral femoral condyle on medial unicompartmental knee replacement. ACTA ACUST UNITED AC 2010; 92:374-9. [DOI: 10.1302/0301-620x.92b3.23561] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
With medial unicompartmental osteoarthritis (OA) there is occasionally a full-thickness ulcer of the cartilage on the medial side of the lateral femoral condyle. It is not clear whether this should be considered a contraindication to unicompartmental knee replacement (UKR). The aim of this study was to determine why these ulcers occur, and whether they compromise the outcome of UKR. Case studies of knees with medial OA suggest that cartilage lesions on the medial side of the lateral condyle are caused by impingement on the lateral tibial spine as a result of the varus deformity and tibial subluxation. Following UKR the varus and the subluxation are corrected, so that impingement is prevented and the damaged part of the lateral femoral condyle is not transmitting load. An illustrative case report is presented. Out of 769 knees with OA of the medial compartment treated with the Oxford UKR, 59 (7.7%) had partial-thickness cartilage loss and 20 (2.6%) had a full-thickness cartilage deficit on the medial side of the lateral condyle. The mean Oxford Knee Score (OKS) at the last follow-up at a mean of four years was 41.9 (13 to 48) in those with partial-thickness cartilage loss and 41.0 (20 to 48) in those with full-thickness loss. In those with normal or superficially damaged cartilage the mean was 39.5 (5 to 48) and 39.7 (8 to 48), respectively. There were no statistically significant differences between the pre-operative OKS, the final review OKS or of change in the score in the various groups. We conclude that in medial compartment OA, damage to the medial side of the lateral femoral condyle is caused by impingement on the tibial spine and should not be considered a contraindication to an Oxford UKR, even if there is extensive full-thickness ulceration of the cartilage.
Collapse
Affiliation(s)
- B. J. L. Kendrick
- Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7LD, UK
| | - R. Rout
- Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7LD, UK
| | - N. J. Bottomley
- Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7LD, UK
| | - H. Pandit
- Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7LD, UK
| | - H. S. Gill
- Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7LD, UK
| | - A. J. Price
- Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7LD, UK
| | - C. A. F. Dodd
- Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7LD, UK
| | - D. W. Murray
- Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7LD, UK
| |
Collapse
|
21
|
Rout U, Rout R, Rout J. Stress, mental health and satisfaction among women doctors in England. Eur Psychiatry 2008. [DOI: 10.1016/j.eurpsy.2008.01.694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
|
22
|
Abstract
Closure of laparoscopic trocar sites can be difficult, particularly in the obese patient. We have begun using a spring-loaded needle to facilitate closure of these sites. We have found that the device allows for accurate suture placement, the potential of decreased closure time, reduced risk for trocar site dehiscence, and can be used in obtaining hemostasis of abdominal wall vessels.
Collapse
Affiliation(s)
- M G Garzotto
- Department of Surgery, University of Florida, Gainesville
| | | | | | | | | |
Collapse
|