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Agrawal A, Romics L, Thekkinkattil D, Soliman M, Kaushik M, Barmpounakis P, Mortimer C, Courtney CA, Goyal A, Garreffa E, Carmichael A, Lane RA, Rutherford C, Kim B, Achuthan R, Pitsinis V, Goh S, Ray B, Grover K, Vidya R, Murphy J. 'PartBreCon' study. A UK multicentre retrospective cohort study to assess outcomes following PARTial BREast reCONstruction with chest wall perforator flaps. Breast 2023; 71:82-88. [PMID: 37544090 PMCID: PMC10430575 DOI: 10.1016/j.breast.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 06/27/2023] [Accepted: 07/11/2023] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND Partial breast reconstruction with a pedicled chest wall perforator flap (CWPF) enables breast conservation in a higher tumour: breast volume ratio scenario. Since there is limited evidence, this retrospective cohort study aimed to ascertain immediate (30-days) and medium-term (follow-up duration) surgical outcomes. METHODS STROBE-compliant protocol ascertained CWPF outcomes between March 2011-March 2021. UK centres known to perform CWPF were invited to participate if they performed at least 10 cases. Data were retrospectively collected, including patient demographics, tumour and treatment characteristics, and surgical and oncological outcomes. Statistical analysis (R™) included multivariable logistic regression and sensitivity analysis. RESULTS Across 15 centres, 507 patients with median age (54 years, IQR; 48-62), body mass index (25.4 kg/m2, IQR; 22.5-29), tumour size (26 mm, IQR; 18-35), and specimen weight (62 g, IQR; 40-92) had following flap types: LiCAP (54.1%, n = 273), MiCAP/AiCAP (19.6%, n = 99), LiCAP + LTAP (19.8%, n = 100) and TDAP (2.2%, n = 11). 30-days complication rates were in 12%: haematoma (4.3%, n = 22), wound infection (4.3%, n = 22), delayed wound healing (2.8%, n = 14) and flap loss (0.6%, n = 3; 1 full) leading to readmissions (2.6%, n = 13) and re-operations (2.6%, n = 13). Positive margins (n = 88, 17.7%) led to 15.9% (n = 79) re-excisions, including 7.5% (n = 37) at the planned 2nd of 2-stage surgery and 1.8% (n = 9) mastectomy. At median 23 months (IQR; 11-39) follow-up, there were 1.2% (n = 6) symmetrisations; recurrences: local (1%), regional/nodal (0.6%) and distant (3.2%). CONCLUSIONS This large multicentre cohort study demonstrates acceptable complication and margin re-excision rates. CWPF extends the range of breast conservation techniques. Further studies are required for long-term oncological outcomes.
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Affiliation(s)
- A Agrawal
- Cambridge University Hospitals, Cambridge, UK.
| | - L Romics
- New Victoria Hospital, Glasgow, UK.
| | | | - M Soliman
- Cambridge University Hospitals, Cambridge, UK; Mansoura University, Egypt.
| | - M Kaushik
- University Hospitals of Leicester NHS Trust, Leicester, UK.
| | - P Barmpounakis
- Department of Statistics, Athens University of Economics and Business, Athens, Greece.
| | | | | | - A Goyal
- Royal Derby Hospital, Derby, UK.
| | | | - A Carmichael
- University Hospital of Derby and Burton, Belvedere Road, Burton on Trent, UK.
| | - R A Lane
- Cambridge University Hospitals, Cambridge, UK.
| | | | - B Kim
- St. James's University Hospital, Leeds, UK.
| | - R Achuthan
- St. James's University Hospital, Leeds, UK.
| | | | - S Goh
- Peterborough Hospital, Peterborough, UK.
| | - B Ray
- Harrogate NHS Trust, Harrogate, UK.
| | | | - R Vidya
- Royal Wolverhampton NHS Trust, Wolverhampton, UK.
| | - J Murphy
- Manchester University Hospital, Manchester, UK.
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Jaya-Bodestyne S, Goh S, Merchant K, Chonkar S, Mathur M. 76P To do or not to do? Endometrial biopsy in younger women with abnormal uterine bleeding. ESMO Open 2023. [DOI: 10.1016/j.esmoop.2023.100806] [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: 02/27/2023] Open
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Goh S, Wong RSM, Quah ELY, Chua KZY, Lim WQ, Ng ADR, Tan XH, Kow CS, Teo YH, Lim EG, Pisupati A, Chong EJX, Kamal NHA, Tan LHE, Tay KT, Ong YT, Chiam M, Lee ASI, Chin AMC, Mason S, Krishna LKR. Mentoring in palliative medicine in the time of covid-19: a systematic scoping review : Mentoring programs during COVID-19. BMC Med Educ 2022; 22:359. [PMID: 35545787 PMCID: PMC9094135 DOI: 10.1186/s12909-022-03409-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 04/06/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION The redeployment of mentors and restrictions on in-person face-to-face mentoring meetings during the COVID-19 pandemic has compromised mentoring efforts in Palliative Medicine (PM). Seeking to address these gaps, we evaluate the notion of a combined novice, peer-, near-peer and e-mentoring (CNEP) and interprofessional team-based mentoring (IPT) program. METHODS A Systematic Evidence Based Approach (SEBA) guided systematic scoping review was carried out to study accounts of CNEP and IPT from articles published between 1st January 2000 and 28th February 2021. To enhance trustworthiness, concurrent thematic and content analysis of articles identified from structured database search using terms relating to interprofessional, virtual and peer or near-peer mentoring in medical education were employed to bring together the key elements within included articles. RESULTS Fifteen thousand one hundred twenty one abstracts were reviewed, 557 full text articles were evaluated, and 92 articles were included. Four themes and categories were identified and combined using the SEBA's Jigsaw and Funnelling Process to reveal 4 domains - characteristics, mentoring stages, assessment methods, and host organizations. These domains suggest that CNEP's structured virtual and near-peer mentoring process complement IPT's accessible and non-hierarchical approach under the oversight of the host organizations to create a robust mentoring program. CONCLUSION This systematic scoping review forwards an evidence-based framework to guide a CNEP-IPT program. At the same time, more research into the training and assessment methods of mentors, near peers and mentees, the dynamics of mentoring interactions and the longitudinal support of the mentoring relationships and programs should be carried out.
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Affiliation(s)
- Sherill Goh
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Ruth Si Man Wong
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Elaine Li Ying Quah
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Keith Zi Yuan Chua
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Wei Qiang Lim
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Aubrey Ding Rui Ng
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Xiu Hui Tan
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Cheryl Shumin Kow
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Yao Hao Teo
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Elijah Gin Lim
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Anushka Pisupati
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Eleanor Jia Xin Chong
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Nur Haidah Ahmad Kamal
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Lorraine Hui En Tan
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Kuang Teck Tay
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Yun Ting Ong
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Min Chiam
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore.
| | - Alexia Sze Inn Lee
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Annelissa Mien Chew Chin
- Medical Library, National University of Singapore Libraries, Block MD6, Centre for Translational Medicine, 14 Medical Drive, #05-01, Singapore, 117599, Singapore
| | - Stephen Mason
- Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, University of Liverpool, Cancer Research Centre, University of Liverpool, 200 London Rd, Liverpool, L3 9TA, UK
| | - Lalit Kumar Radha Krishna
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
- Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, University of Liverpool, Cancer Research Centre, University of Liverpool, 200 London Rd, Liverpool, L3 9TA, UK
- Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857, Singapore
- Centre of Biomedical Ethics, National University of Singapore, 21 Lower Kent Ridge Rd, Singapore, 119077, Singapore
- PalC, The Palliative Care Centre for Excellence in Research and Education, PalC c/o Dover Park Hospice, 10 Jalan Tan Tock Seng, Singapore, 308436, Singapore
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Goh CXY, Tan YK, Tan CH, Leow AST, Ho JSY, Tan NHW, Goh S, Ho AFW, Sharma VK, Chan BPL, Yeo LLL, Tan BYQ. The use of colchicine as an anti-inflammatory agent for stroke prevention in patients with coronary artery disease: a systematic review and meta-analysis. J Thromb Thrombolysis 2022; 54:183-190. [PMID: 35538274 DOI: 10.1007/s11239-022-02659-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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] [Accepted: 04/14/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The primary objective is to evaluate the use of colchicine as an anti-inflammatory agent for stroke prevention in patients with coronary artery disease. BACKGROUND There has been a rising number of randomized controlled trials conducted in patients with coronary artery disease on the use of colchicine in reducing cardiovascular complications. Recent publications suggest colchicine reduces the risk of stroke and other cardiovascular events. METHODS We performed a systematic review of known trials in the current literature to characterize the clinical characteristics and outcomes of colchicine treatment in patients with coronary artery disease. A literature search was performed in PubMed, Embase and SCOPUS using a suitable keyword search strategy from inception to 4 June 2021. All studies evaluating cardiovascular outcomes of colchicine treatment in patients with coronary artery disease were included. RESULTS The systemic review included 5 randomized controlled trials assessing a total of 11,790 patients. Majority of studies used a colchicine dosing regimen of 0.5 mg once daily, with the median follow-up duration ranging from 6 to 36 months. Meta-analytic estimates for stroke incidence highlighted a statistically significant benefit for patients that were administered colchicine compared to placebo (OR 0.47, 95% CI 0.27-0.81, p = 0.006), and a non-significant benefit for myocardial infarction. There was no significant association between colchicine treatment and the adverse effects of gastrointestinal symptoms and myopathy/myalgia. CONCLUSIONS The use of colchicine reduces the risk of stroke in patients with a history of coronary artery disease, without a significant increase in gastrointestinal and myopathy/myalgia adverse effects.
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Affiliation(s)
- Claire X Y Goh
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, Singapore, Singapore
| | - Ying Kiat Tan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, Singapore, Singapore
| | - Choon Han Tan
- Department of Medicine, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Aloysius S T Leow
- Division of Neurology, Department of Medicine, National University Health System, Singapore, Singapore
| | - Jamie S Y Ho
- Academic Foundation Programme, North Middlesex University Hospital NHS Trust, London, UK
| | - Natalie H W Tan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, Singapore, Singapore
| | - Sherill Goh
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, Singapore, Singapore
| | - Andrew F W Ho
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
| | - Vijay K Sharma
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, Singapore, Singapore.,Division of Neurology, Department of Medicine, National University Health System, Singapore, Singapore
| | - Bernard P L Chan
- Division of Neurology, Department of Medicine, National University Health System, Singapore, Singapore
| | - Leonard L L Yeo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, Singapore, Singapore. .,Division of Neurology, Department of Medicine, National University Health System, Singapore, Singapore.
| | - Benjamin Y Q Tan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, Singapore, Singapore.,Division of Neurology, Department of Medicine, National University Health System, Singapore, Singapore
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Goh S, Tan NHW, Tan CH, Leow AST, Sia CH, Ho AFW, Lim MJR, Yeo LLL, Tan BYQ. Evaluating the safety and efficacy of intravenous thrombolysis for acute ischemic stroke patients with a history of intracerebral hemorrhage: a systematic review and meta-analysis. J Thromb Thrombolysis 2021; 53:485-494. [PMID: 34302590 DOI: 10.1007/s11239-021-02531-2] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/06/2021] [Indexed: 12/29/2022]
Abstract
Previous intracerebral hemorrhage (ICH) is labelled as a contraindication for the use of intravenous tissue plasminogen activator (IV-tPA) in acute ischemic stroke (AIS) based on expert opinion. However, there is a paucity of data available regarding the benefits and risks of IV-tPA in this population. Recent small retrospective cohort studies reporting its off-label use suggest it may be beneficial. This study aims to investigate the safety and efficacy of IV-tPA in AIS patients with previous ICH. We performed a systematic review and meta-analysis of studies reporting on IV-tPA use in AIS patients with and without previous ICH. We searched Embase, PubMed and Cochrane Library from inception to 20 April 2021. Outcomes measured included symptomatic ICH (sICH), 3-month modified Rankin Scale (mRS) score, and 3-month mortality. We included seven retrospective cohort studies comprising 5760 AIS patients who had received IV-tPA, of which 134 had previous ICH. There was no significant difference in the odds of sICH (OR 1.57, 95% CI 0.78-3.15, p = 0.21) and 3-month mRS (mRS 0-1: OR 0.78, 95% CI 0.37-1.65, p = 0.52; mRS 0-2: OR 1.07, 95% CI 0.36-3.15, p = 0.90) between patients with and without previous ICH. There was a trend towards higher 3-month mortality in patients with previous ICH (OR 1.69, 95% CI 0.98-2.91, p = 0.06), although this did not reach statistical significance. The use of IV-tPA in AIS patients with previous ICH was not associated with an increased risk of sICH or disability at 3 months. Further larger studies are needed to establish the safety and efficacy of IV-tPA use in this population.
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Affiliation(s)
- Sherill Goh
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Natalie H W Tan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Choon Han Tan
- Department of Medicine, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Aloysius S T Leow
- Division of Neurology, Department of Medicine, National University Health System, Singapore, Singapore
| | - Ching-Hui Sia
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Cardiology, National University Heart Centre Singapore, Singapore, Singapore
| | - Andrew F W Ho
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
- Pre-hospital & Emergency Research Centre, Duke-National University of Singapore Medical School, Singapore National Heart Research Institute Singapore, National Heart Centre, Singapore, Singapore
| | - Mervyn J R Lim
- Division of Neurosurgery, Department of General Surgery, National University Hospital, Singapore, Singapore
| | - Leonard L L Yeo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
- Division of Neurology, Department of Medicine, National University Health System, Singapore, Singapore.
| | - Benjamin Y Q Tan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Neurology, Department of Medicine, National University Health System, Singapore, Singapore
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Rajdev K, Watts E, Eastwood M, Goh S, Ahmed U, Bowyer D. 771 Shaping the Virtual Learning Environment: Emojis As A Novel Feedback Modality for Content Delivery in Postgraduate Medical Education. Br J Surg 2021. [PMCID: PMC8135842 DOI: 10.1093/bjs/znab134.168] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Introduction
Postgraduate medical education in the wake of a pandemic has sparked creativity, evolving novel platforms concordant with socially distanced learning. Inevitably, evaluation is critical in navigating improvements in content delivery. However, as culture continues to shift away from didactic teaching, students are at risk of ‘feedback overload’. We propose a novel emoji scale to facilitate rapid appraisal.
Method
A three-point emoji scale was developed within the novel virtual learning environment for core surgical training in the West Midlands. Engagement with the emoji system was assessed and correlated with conventional post-course questionnaires.
Results
The novel emoji system provided a rapid mechanism for trainees to express opinion on individual modules immediately following completion. Parallels to social media meant this modality felt familiar to trainees. Simplification of feedback permitted prompt, targeted review of modules for improvement, as opposed to laborious collection and analysis of standard post-course questionnaires. Literature review revealed limited research regarding similar emoji-based responses, or the validity of Likert or free-text based feedback systems.
Conclusion
As virtual learning evolves following COVID-19, feedback systems help guide evolution. Emoji-based feedback may provide the key to prompt, accessible evaluation of VLE platforms.
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Affiliation(s)
- K Rajdev
- New Cross Hospital, Wolverhampton, United Kingdom
- Postgraduate Virtual Learning Environment, West Midlands School of Surgery, United Kingdom
| | - E Watts
- University Hospital Coventry and Warwickshire, Coventry, United Kingdom
- Postgraduate Virtual Learning Environment, West Midlands School of Surgery, United Kingdom
| | - M Eastwood
- Princess Royal Hospital, Telford, United Kingdom
- Postgraduate Virtual Learning Environment, West Midlands School of Surgery, United Kingdom
| | - S Goh
- New Cross Hospital, Wolverhampton, United Kingdom
- Postgraduate Virtual Learning Environment, West Midlands School of Surgery, United Kingdom
| | - U Ahmed
- Princess Royal Hospital, Telford, United Kingdom
- Postgraduate Virtual Learning Environment, West Midlands School of Surgery, United Kingdom
| | - D Bowyer
- Princess Royal Hospital, Telford, United Kingdom
- Postgraduate Virtual Learning Environment, West Midlands School of Surgery, United Kingdom
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Ashcroft J, Havers N, Seebacher-Tomas A, Plesci E, Goh S, Hudson V. 11 A Sequential Simulation Experience for Interim Foundation Doctors and Analysis of Preparedness to Practice Early. Br J Surg 2021. [PMCID: PMC8135804 DOI: 10.1093/bjs/znab135.005] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Introduction Covid-19 necessitated the early graduation of medical students to join the healthcare workforce as Foundation Interim Year 1 (FiY1) doctors. A sequential simulation session was implemented to improve and assess FiY1 preparedness towards approaching deteriorating patients. Method 12 FiY1 doctors participated in the session containing three sequential major stations: complex new admission, ward-based management, and acute deterioration. Participants interpreted investigations, performed examinations, created management plans, and escalated using a pager. Results There was a significant improvement in preparedness for giving treatment (median(IQR): pre-simulation 3(3-4) vs. post-simulation 4(4-4.75); p = 0.04) and paperwork (2(2-3.75) vs. 4(3.25-4.75); p = 0.03). Following four weeks of FiY1 participants demonstrated significant improvement in preparedness for giving treatment (median(IQR): pre-simulation 3(3-4) vs. post-FiY1 4.5(4-5); p = 0.01), communication and teamworking (4(3.25-4.75) vs. 5(5-5.75); p = 0.01), and paperwork (2(2-3.75) vs. 5(5-5); p = 0.01). The FiY1 programme improved integration within teams and facilitated training whilst medical school placements left participants feeling apprehensive and unprepared to practice. Conclusions This session provided an engaging method of increasing preparedness towards common challenges new physicians face. This study suggests future senior medical student apprenticeships should give the same investment, opportunities, and responsibilities as that of the FiY1 programme.
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Affiliation(s)
- J Ashcroft
- University of Cambridge, Cambridge, United Kingdom
- Addenbrooke's Hospital, Cambridge, United Kingdom
| | - N Havers
- Addenbrooke's Hospital, Cambridge, United Kingdom
| | | | - E Plesci
- Addenbrooke's Hospital, Cambridge, United Kingdom
| | - S Goh
- Addenbrooke's Hospital, Cambridge, United Kingdom
| | - V Hudson
- Addenbrooke's Hospital, Cambridge, United Kingdom
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Goh S, Smith S, Pearse B, Margale S, Smith I, Thomson B, Tesar P. R44 The Impact of Targeted Bleeding Management on Blood Component Therapy in Heart Transplant Recipients. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.03.202] [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: 10/21/2022]
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Mantoo S, Mandovra P, Goh S. Using preoperative three-dimensional endoanal ultrasound to determine operative procedure in patients with perianal fistulas. Colorectal Dis 2020; 22:931-938. [PMID: 31991037 DOI: 10.1111/codi.14993] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 01/03/2020] [Indexed: 02/08/2023]
Abstract
AIM Accurate preoperative identification of perianal fistula tracts and internal openings can facilitate the choice of surgical procedure and may lead to improved healing rates. Our aim was to explore the effectiveness of three-dimensional endoanal ultrasound (3D-EAUS) in determining the type of perianal fistula and planning operative management. METHOD This was a cohort longitudinal study. Patients with perianal fistulas from January 2017 to January 2018 who underwent 3D-EAUS and subsequent surgery were included. Intra-operative findings were considered as standard for comparison with clinical examination and 3D-EAUS findings. The primary outcome measure was to evaluate the concordance between 3D-EAUS and intra-operative findings and the secondary outcome measure was healing rates. RESULTS Sixty-eight patients with a mean age of 43.1 ± 14.1 years were included. Twenty-eight patients had inter-sphincteric (41.2%) and 40 (14 high and 26 low) trans-sphincteric fistulas (58.8%). 3D-EAUS, clinical examination and intra-operative exploration could predict the location of internal openings in 62/68 (91.2%), 48/68 (70.5%) and 56/68 (82.4%) patients, respectively. Hydrogen peroxide (H₂O₂)-enhanced 3D-EAUS accurately predicted the location of internal openings when compared with 3D-EAUS without H₂O₂ (concordance K = 0.963, P = 0.05). High concordance rates were seen between intra-operative and 3D-EAUS findings on the type of perianal fistula. No significant difference was seen between the suggested surgical treatment based on 3D-EAUS and the eventual surgical treatment (P > 0.05). Study limitations were the small sample size and lack of randomization. CONCLUSION 3D-EAUS may be considered as a first-line investigation for patients with perianal fistulas because of high concordance with intra-operative assessment and facilitation of surgical planning.
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Affiliation(s)
- S Mantoo
- Department of Surgery, Khoo Teck Puat Hospital, Singapore City, Singapore
| | - P Mandovra
- Department of Surgery, Khoo Teck Puat Hospital, Singapore City, Singapore
| | - S Goh
- Department of Surgery, Khoo Teck Puat Hospital, Singapore City, Singapore
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Goh S, Saw A, Kountouris A, Orchard J, Saw R. Neurocognitive changes associated with concussion in elite cricket players are distinct from changes due to post-match fatigue. J Sci Med Sport 2019. [DOI: 10.1016/j.jsams.2019.08.225] [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: 10/25/2022]
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Madden AM, Baines S, Bothwell S, Chen E, Goh S, Jerome L, Sommariva-Nagle C, Szychta M. A laboratory-based evaluation of tube blocking and microbial risks associated with one blended enteral feed recipe. J Hum Nutr Diet 2019; 32:667-675. [PMID: 31270891 DOI: 10.1111/jhn.12685] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 12/27/2022]
Abstract
BACKGROUND Concerns associated with blended enteral feeds include the risk of blocked tubes and microbial contamination, although the available evidence is limited. The present laboratory-based investigation aimed to examine these risks in a blended feed providing a nutritionally adequate intake for a hypothetical patient. METHODS A one-blended feed recipe was made using three different methods (professional, jug and stick blenders) and three storage procedures. Feed samples were syringed via 10-, 12- and 14-French (Fr) enteral feeding tubes and both blockages and the time taken were recorded. Feed samples were diluted, plated on agars, incubated and bacterial colony-forming units (CFU) counted. After storage at -80 °C, identification was undertaken using 16S rRNA polymerase chain reaction sequencing. RESULTS Two blockages occurred during 27 administrations of feed made using a professional blender, although they were resolved with a water flush. No blockages occurred with the 14-Fr tube and administration was quicker with wider tubes (P < 0.00001). There was no significant difference between the total bacterial CFU of feeds prepared using different methods (P = 0.771) or stored differently. The genus of bacteria identified included Enterococcus, Bacillus, lactose-fermenting Enterobacteriaceae, Pseudomonas and Staphylococcus. Pathogens, such as Clostridium spp., Salmonella spp. and Vibrio spp., were not identified by phenotypic tests used. Sequencing identified Escherichia coli, Shigella spp., Streptococcus lutetiensis and Staphylococcus epidermidis. CONCLUSIONS The present study found no risk of tube blockages when one blended feed recipe made using three methods was delivered via a 14-Fr tube. There is concern about bacterial contamination, although this was not influenced by the methods of preparation or storage used in the present study.
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Affiliation(s)
- A M Madden
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - S Baines
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - S Bothwell
- Hertfordshire Independent Living Service, Letchworth, UK
| | - E Chen
- Nutrition and Dietetic Department, Peterborough City Hospital, Peterborough, UK
| | - S Goh
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - L Jerome
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - C Sommariva-Nagle
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - M Szychta
- Nutrition and Dietetic Department, Bedford Hospital NHS Trust, Bedford, UK
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Rajapakse S, Wee Y, Goh S, Smith S. Does Utilisation of Hospital in the Home Services Reduce the Length of Admission for Patients With Infective Endocarditis. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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13
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Gilmore J, Dorman A, Archie R, Goh S. Does GP-initiated knee MRI improve management of knee pain in adults over 40 years? An assessment by epidemiology and treatment mapping of the role of pre-referral knee MRI in general orthopaedic outpatient setting in metropolitan Australia. Asia Pac J Sports Med Arthrosc Rehabil Technol 2018. [DOI: 10.1016/j.asmart.2018.06.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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14
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Dalan R, Goh S, Bing S, Seneviratna A, Phua CT. Proof-of-Concept Study for an Enhanced Surrogate Marker of Endothelial Function in Diabetes. Sci Rep 2018; 8:8649. [PMID: 29872121 PMCID: PMC5988679 DOI: 10.1038/s41598-018-26931-2] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 05/21/2018] [Indexed: 11/30/2022] Open
Abstract
Diabetes mellitus affects distal small vessels earlier and to a greater extent than proximal vessels. Vascular disease starts from activation of the endothelial cells, which if prolonged may lead to reduced distensibility of the vessel when maximally stimulated. Hence a device which measures distensibility of a distal vessel should be a good biomarker for subclinical disease. We have developed a device capable of measuring reactive hyperaemia induced changes in the radial artery flow, volumetric changes and accompanying effects on the vessel wall. The measurement is based on the magnetic flux disturbance upon haemodynamic modulation as blood flows through a uniformly applied magnetic field, and generates what we have termed the radial artery maximum distensibility index (RA-MDI). In a proof-of-concept study we found significant correlations between RA-MDI and cardiovascular risk factors, scoring systems and carotid artery intima-media thickness. Further large scale prospective studies need to be conducted to ascertain the correlations with cardiovascular events.
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Affiliation(s)
- R Dalan
- Tan Tock Seng Hospital, National Healthcare Group, Singapore, Singapore.
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
- Yong Loo Lin School of Medicine, Singapore, Singapore.
| | - S Goh
- Nanyang Polytechnic, School of Engineering, Singapore, Singapore
| | - Sun Bing
- Tan Tock Seng Hospital, National Healthcare Group, Singapore, Singapore
| | - A Seneviratna
- Tan Tock Seng Hospital, National Healthcare Group, Singapore, Singapore
| | - C T Phua
- Nanyang Polytechnic, School of Engineering, Singapore, Singapore
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15
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Kim H, Goh S, Hwang S. EVALUATION OF THE SYSTEMS FOR PERSON-CENTERED ELDER CARE (SPEC) MODEL: STUDY DESIGN AND RATIONALE. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.3761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- H. Kim
- Harvard University School of Public Health,
Boston, Massachusetts
- Department of Public Health Science, School of Public Health, Seoul National University, Seoul, Korea (the Republic of),
- SNU Institute of Ageing, Seoul, Korea (the Republic of),
| | - S. Goh
- Department of Public Health Science, School of Public Health, Seoul National University, Seoul, Korea (the Republic of),
| | - S. Hwang
- Department of Public Health Science, School of Public Health, Seoul National University, Seoul, Korea (the Republic of),
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16
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Joseph J, Randhawa P, Hannan SA, Long J, Goh S, O'Shea N, Saleh H, Hansen E, Veale D, Andrews P. Body dysmorphic disorder in patients undergoing septorhinoplasty surgery: should we be performing routine screening? Clin Otolaryngol 2016; 42:508-513. [PMID: 27627585 DOI: 10.1111/coa.12752] [Citation(s) in RCA: 19] [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] [Accepted: 09/05/2016] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Body dysmorphic disorder (BDD) is defined as having a preoccupation with a perceived flaw in one's appearance, which appears slight to others and significantly interferes with a person's functioning. When undetected in septorhinoplasty patients, it will often lead to poor outcomes. DESIGN We performed a prospective cohort study to determine the prevalence of BDD in our patients and whether surgical correction could be considered. SETTING AND PARTICIPANTS We recruited 34 patients being considered for septorhinoplasty in a tertiary referral rhinology clinic and a control group of 50 from the otology clinic giving a total of 84. MAIN OUTCOME MEASURES Participants completed the Body Dysmorphic Disorder Questionnaire (BDDQ), the sino-nasal outcome test-23 (SNOT-23) and underwent nasal inspiratory peak flow (NIPF). Those found to be at high risk for BDD were referred to a clinical psychologist. RESULTS Of the septorhinoplasty patients, 11 (32%) were high risk for BDD. Following psychological assessment, 7 (63%) patients were felt to be unsuitable for surgery and were offered psychological therapy. SNOT-23 scores were significantly higher in the BDD group indicating a negative impact on quality of life. NIPF readings were not significantly different in the BDD group compared to the control group. CONCLUSIONS The BDDQ is a valid tool for identifying patients at risk of BDD. A close working relationship with clinical psychology has been advantageous to help the selection process of candidates for surgery when there is a high risk of BDD.
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Affiliation(s)
- J Joseph
- Department of Rhinology and Facial Plastics Surgery, Royal National Throat Nose and Ear Hospital, London, UK
| | - P Randhawa
- Department of Rhinology and Facial Plastics Surgery, Royal National Throat Nose and Ear Hospital, London, UK
| | - S A Hannan
- Department of Rhinology and Facial Plastics Surgery, Royal National Throat Nose and Ear Hospital, London, UK
| | - J Long
- Department of Rhinology and Facial Plastics Surgery, Royal National Throat Nose and Ear Hospital, London, UK
| | - S Goh
- Department of Rhinology and Facial Plastics Surgery, Royal National Throat Nose and Ear Hospital, London, UK
| | - N O'Shea
- Department of Rhinology and Facial Plastics Surgery, Royal National Throat Nose and Ear Hospital, London, UK
| | - H Saleh
- Department of Rhinology and Facial Plastics Surgery, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - E Hansen
- Department of Plastic and Reconstructive Surgery, Royal Free London NHS Foundation Trust, London, UK
| | - D Veale
- The Institute of Psychiatry, Psychology and Neuroscience, King's College London and the South London and Maudsley NHS Foundation Trust, London, UK
| | - P Andrews
- Department of Rhinology and Facial Plastics Surgery, Royal National Throat Nose and Ear Hospital, London, UK.,The Ear Institute, UCL, London, UK
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17
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Ballingall K, Goh S, Pemberton JM, Dicks K. P4071 Extensive functional class I MHC diversity in sheep. J Anim Sci 2016. [DOI: 10.2527/jas2016.94supplement4114a] [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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18
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Andrews P, Randhawa PS, Joseph J, Goh S, Li Q, Poirrier AL, Leong S, Lesser T, Saeed SR. A prospective 4-year study of the objective and subjective outcomes of fifteen patients after dynamic facial reanimation surgery. Clin Otolaryngol 2016; 41:825-829. [PMID: 26506507 DOI: 10.1111/coa.12574] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2015] [Indexed: 11/28/2022]
Affiliation(s)
- P Andrews
- The Royal National Throat Nose and Ear Hospital London, London, UK.,Ear Institute, University College London, London, UK
| | - P S Randhawa
- The Royal National Throat Nose and Ear Hospital London, London, UK
| | - J Joseph
- The Royal National Throat Nose and Ear Hospital London, London, UK
| | - S Goh
- The Royal National Throat Nose and Ear Hospital London, London, UK
| | - Q Li
- The Royal National Throat Nose and Ear Hospital London, London, UK
| | - A-L Poirrier
- The Royal National Throat Nose and Ear Hospital London, London, UK
| | - S Leong
- Aintree University Hospital NHS Foundation Trust, Liverpool, UK
| | - T Lesser
- Aintree University Hospital NHS Foundation Trust, Liverpool, UK
| | - S R Saeed
- The Royal National Throat Nose and Ear Hospital London, London, UK.,Ear Institute, University College London, London, UK
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19
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Goh S, Ali M, Mokhtar A, Mohamed I. Injury risk predictors among student badminton players in a Malaysian national sports school: Preliminary study. J Sci Med Sport 2013. [DOI: 10.1016/j.jsams.2013.10.140] [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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20
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Goh S, Mohamed I, Rambli A, Jaafar Z, Mohamed M. Limited value of international physical activity questionnaire-short form (IPAQ-SF) for use in university students. J Sci Med Sport 2013. [DOI: 10.1016/j.jsams.2013.10.191] [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: 10/25/2022]
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21
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Goh S. Systematic review and meta-analysis of the evidence for flexible sigmoidoscopy as a screening method for the prevention of colorectal cancer (Br J Surg 2012; 99: 1488-1500). Br J Surg 2013; 100:1540. [PMID: 24037580 DOI: 10.1002/bjs.9267] [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: 12/19/2022]
Affiliation(s)
- S Goh
- Fairfield Hospital, Sydney, New South Wales 2000, Australia.
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22
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Milat F, Goh S, Gani LU, Suriadi C, Gillespie MT, Fuller PJ, Teede HJ, Strickland AH, Allan CA. Prolonged hypocalcemia following denosumab therapy in metastatic hormone refractory prostate cancer. Bone 2013; 55:305-8. [PMID: 23685544 DOI: 10.1016/j.bone.2013.04.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2012] [Revised: 03/12/2013] [Accepted: 04/15/2013] [Indexed: 11/23/2022]
Abstract
Prostate cancer is a leading cause of cancer death, frequently associated with widespread bone metastases. We report two cases of hypocalcemia following the first dose of denosumab in metastatic hormone refractory prostate cancer, the first case requiring 26 days of intravenous calcium therapy. This is the first report of prolonged hypocalcemia following denosumab in a patient with normal renal function.
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Affiliation(s)
- F Milat
- Department of Endocrinology, Monash Health, Monash Medical Centre, Clayton, Australia.
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23
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Goh S, Price RI, Leedman PJ, Singer KP. AGE-INDEPENDENT CORRELATION OF OPTICALLY DETERMINED THORACIC KYPHOSIS WITH LUMBAR SPINE BONE MINERAL DENSITY. ACTA ACUST UNITED AC 2011. [DOI: 10.1142/s0218957799000294] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The thoracic spine is susceptible to age-related increases in the sagittal curve, a process which is accentuated in osteoporosis. Previous studies have demonstrated an association between low vertebral bone mineral density (BMD) and accentuation of kyphosis. However, concerns of ionizing radiation associated with radiographic evaluation of osteoporotic fracture risks create a demand for alternative noninvasive detection methods. Back shape, and in particular the thoracic kyphosis, may act as a surrogate for bone density and complement methods of screening individuals for osteoporosis or monitoring progression. The aim of this prospective study is to establish the statistical association of mean lumbar spine BMD and the age-independent BMD Z-score with kyphosis, measured from noninvasive, rasterstereographic analysis of back shape. Back shape imaging of 42 females was performed following routine lumbar bone densitometry using dual energy X-ray absorptiometry. Kyphosis parameters derived from an optical back shape imaging system were correlated, using simple linear regression models, against mean lumbar BMD and BMD Z-scores. Moderate associations were noted between lumbar BMD and thoracic kyphosis (r=0.63 to 0.71, p<0.0001). The trend was still evident when correlating kyphosis against BMD Z-scores (r=0.57 to 0.68, p<0.0001). These data confirm earlier studies comparing radiographic indices of thoracic curvature with vertebral BMD, and suggest potential application of noninvasive back shape imaging to assist in the screening of individuals at risk of spinal osteoporosis, particularly in younger populations.
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Affiliation(s)
- S. Goh
- School of Physiotherapy, Curtin University of Technology, Western Australia, Australia
| | - R. I. Price
- Medical Technology and Physics, Sir Charles Gairdner Hospital, Western Australia, Australia
| | - P. J. Leedman
- University Department of Medicine, and Department of Endocrinology and Diabetes, Royal Perth Hospital, Western Australia, Australia
| | - K. P. Singer
- School of Physiotherapy, Curtin University of Technology, Western Australia, Australia
- Department of Imaging Services, Royal Perth Hospital, Western Australia, Australia
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Tatterton M, Perry D, Skene A, Goh S, Evans A, Graham M. Breast Reconstruction in a Regional Breast Cancer Network. Eur J Surg Oncol 2011. [DOI: 10.1016/j.ejso.2011.08.074] [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: 10/16/2022] Open
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Vivancos R, Showell D, Keeble B, Goh S, Kroese M, Lipp A, Battersby J. Vaccination of poultry workers: delivery and uptake of seasonal influenza immunization. Zoonoses Public Health 2010; 58:126-30. [PMID: 20042057 DOI: 10.1111/j.1863-2378.2009.01315.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: 11/27/2022]
Abstract
Avian influenza is a highly infectious disease in poultry and although the risk of human infection is low, concerns exist that it could evolve into a new human strain of pandemic potential if reassortment with a human influenza virus occurs. In January 2007, the UK government introduced a programme to vaccinate poultry workers to reduce the potential of such an event. This study evaluates the delivery, uptake and costs of the programme in three counties of England. A questionnaire survey was completed by consultants in public health in all the Primary Care Trusts in Norfolk, Suffolk and Cambridgeshire in May 2007. The delivery of the programme varied between Primary Care Trusts, including being delivered in some cases by clinics in primary care, by general practitioners and occupational health services in others. The uptake of vaccination was low ranging from 7% to 29% at a cost of £29 to £132 per person vaccinated. Vaccination of poultry workers as a public health measure to prevent an influenza pandemic is likely to be ineffective with the level of coverage found in this evaluation in our region.
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Affiliation(s)
- R Vivancos
- Biomedical Research Centre, School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, UK.
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26
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Fisher A, Goh S, Srikusalanukul W, Davis M. Elevated serum PTH is independently associated with poor outcomes in older patients with hip fracture and vitamin D inadequacy. Calcif Tissue Int 2009; 85:301-9. [PMID: 19763373 DOI: 10.1007/s00223-009-9283-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [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] [Received: 04/07/2009] [Accepted: 08/12/2009] [Indexed: 02/03/2023]
Abstract
To determine whether serum 25(OH)D and/or PTH levels in older patients with hip fracture (HF) could predict short-term clinical outcomes, we conducted a prospective observational study of 287 consecutive HF patients (mean age 81.9 + or - 7.5 [SD] years, 72% females). The prevalence of vitamin D inadequacy (25[OH]D < 80 nmol/l) was 97.1%, that of vitamin D deficiency (25[OH]D < 50 nmol/l) was 79.8%, and that of elevated PTH level (>6.8 pmol/l) was 35.5%. After adjustment for age and sex, PTH was significantly associated with in-hospital mortality (OR = 1.12, 95% CI 10.5-1.20, P < 0.001), myocardial injury (OR = 1.05, 95% CI 1.03-1.15, P = 0.002), prolonged length of stay (LOS > or = 20 days; OR = 1.05, 95% CI 1.01-1.06, P = 0.044), and being discharged to institutional care (OR = 1.07, 95% CI 1.01-1.18, P = 0.48). Secondary hyperparathyroidism (SHPT), but not vitamin D deficiency, was associated with older age, a higher prevalence of trochanteric fracture, coronary artery disease, hypertension, previous stroke, renal impairment, increased levels of serum osteocalcin, bone-specific alkaline phosphatase, and adiponectin as well as a significantly higher in-hospital mortality (11.8 vs. 0.54%, P = 0.001), perioperative myocardial injury (32.7 vs. 22.5%, P = 0.043), LOS > or = 20 days (40.2 vs. 26.9%, P = 0.017), and being discharged to institutional care (29.5 vs. 14.6%, P = 0.019). In multivariate regression analyses, SHPT was strongly associated with in-hospital mortality and LOS > or = 20 days. We conclude that elevated PTH (but not vitamin D deficiency per se) is a strong independent predictor of poor outcomes in older patients.
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Affiliation(s)
- A Fisher
- Department of Geriatric Medicine, The Canberra Hospital, Canberra, ACT, Australia.
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Delhomme C, Weuster-Botz D, Goh S, Domanovic N, Zhang-Preße M, Kühn F. Prozessintegration von Fermentation und Katalyse zur Herstellung von Carbonsäurederivaten. CHEM-ING-TECH 2009. [DOI: 10.1002/cite.200950413] [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: 11/08/2022]
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Sangthongpitag K, Wu X, Khng H, Goh S, Ng P, Hu C, Bonday Z, Wang H, Wood J, Entzeroth M. 162 POSTER Pharmacological profile of SB939, a novel, potent and orally active histone deacetylase inhibitor. EJC Suppl 2006. [DOI: 10.1016/s1359-6349(06)70168-9] [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: 10/23/2022] Open
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Ott H, Matthiessen T, Brechtken J, Xin X, Nelson W, Goh S, Taylor D. 25. J Heart Lung Transplant 2006. [DOI: 10.1016/j.healun.2005.11.026] [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: 10/25/2022] Open
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31
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Goh S, Newman C, Knowles M, Bolton FJ, Hollyoak V, Richards S, Daley P, Counter D, Smith HR, Keppie N. E. coli O157 phage type 21/28 outbreak in North Cumbria associated with pasteurized milk. Epidemiol Infect 2002; 129:451-7. [PMID: 12558327 PMCID: PMC2869906 DOI: 10.1017/s0950268802007835] [Citation(s) in RCA: 39] [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: 11/07/2022] Open
Abstract
In March 1999, a large community outbreak of Escherichia coli O157 infection occurred in North Cumbria. A total of 114 individuals were reported to the Outbreak Control Team (OCT); 88 had laboratory confirmed E. coli O157. Twenty-eight (32%) of the confirmed cases were admitted to hospital, including three children (3.4%) with haemolytic uraemic syndrome. There were no deaths. A case-control study found that illness was strongly associated with drinking pasteurized milk from a local farm (P = <0.0001) on single variable analysis. Microbiological investigations at the farm revealed E. coli O157 phage type (PT) 21/28 VT 2 which was indistinguishable from the human isolates by pulsed field gel electrophoresis. At the time of occurrence this was the largest E. coli O157 outbreak in England and Wales and the first E. coli O157 PT 21/28 VT 2 outbreak associated with pasteurized milk. This outbreak highlights lessons to be learnt regarding on-farm pasteurization.
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Affiliation(s)
- S Goh
- North Cumbria Health Authority, Wavell Drive, Rosehill, Carlisle, Cumbria CAI 2SE
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Goh S, Price RI, Song S, Davis S, Singer KP. Magnetic resonance-based vertebral morphometry of the thoracic spine: age, gender and level-specific influences. Clin Biomech (Bristol, Avon) 2000; 15:417-25. [PMID: 10771120 DOI: 10.1016/s0268-0033(99)00100-x] [Citation(s) in RCA: 17] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The aim of this study was to examine age, gender, and segmental trends in thoracic vertebral body shape, utilising thoracic spine magnetic resonance images involving an age range spanning the life span. DESIGN A quantitative, cross-sectional, retrospective study design involving a sample of convenience. BACKGROUND Thoracic vertebral shape data are commonly derived from radiographic resources. The non-ionising properties of magnetic resonance imaging and availability of digital data for image analysis suggest potential for MR-based morphometric studies. For the thoracic spine, there is limited vertebral shape data on males, while few studies have examined the pattern of age-related changes across the life span. METHODS Morphometry was performed on 220 mid sagittal T1-weighted MR images using image analysis software. Three indices of vertebral shape were utilised: the antero-posterior height ratio or anterior wedge index, mid-posterior height ratio or biconcavity index, and ratio of posterior vertebral height to mid antero-posterior diameter or compression index. RESULTS Different segmental patterns were noted for the vertebral shape indices. Significantly lower mean values were noted in males for the compression index. Age trends were significant, with a linear age-related decline demonstrated for the anterior wedge and biconcavity indices, and a quadratic trend noted for the compression index. CONCLUSIONS Thoracic vertebral body shape may be uniquely described using specific shape indices, for examining various segmental, gender and age-associated changes. RELEVANCE These results suggest the importance of defining specific reference criteria for thoracic vertebral body shape indices, particularly age-related data encompassing a wide age range. Magnetic resonance studies enable interpretation of vertebral shape data in relation to the wide spectrum of pathologies afflicting the thoracic spine, without the concerns of ionising radiation.
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Affiliation(s)
- S Goh
- Department of Surgery, Centre for Musculoskeletal Studies, The University of Western Australia.
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Tan NC, Goh S, Leong H, Ng CJ, Thai V, Siew WF, Emmanuel S, Lim TK. Relation between morbidity and current treatment in patients who present with acute asthma to polyclinics. Singapore Med J 2000; 41:259-63. [PMID: 11109340] [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: 02/18/2023]
Abstract
BACKGROUND It has been suggested that resources for asthma intervention should be focused mainly on patients in the community who experience a high burden of disease. These are who patients who have acute exacerbations which require urgent treatment. AIM To assess the morbidity and identify deficiencies in the treatment of patients who present for urgent treatment of acute exacerbations to primary care clinics. PATIENTS Adult patients who received urgent treatment for acute exacerbation of bronchial asthma SETTING 4 primary care polyclinics. METHODS A cross-sectional survey of consecutive patients which related regular preventive treatment to current asthma activity. Poor asthma control was defined as step 2 or higher (American National Asthma Education and Prevention Program, report II, 1997) or > or = 2 emergency room visits in 6 months. RESULTS There were 116 patients of whom 53% were women. The mean (SD) age was 45(15) years and duration of current exacerbation 3 (3) days. The acute symptoms were successfully treated in 93% of patients. Quick relief medication was used regularly in 91% and inhaled corticosteroids (ICS) in 55%. Oral salbutamol was prescribed in 14% of patients. The asthma was poorly controlled in 54%. In the poorly controlled group 33% were not on regular ICS treatment and 64% were not receiving "add on" medication. CONCLUSIONS Patients treated for acute asthma in primary care clinics: (1) were older and had less acutely severe exacerbations than those who presented to emergency rooms, (2) over half had poorly controlled asthma and (3) a third of patients with poor asthma control were inadequately treated.
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Affiliation(s)
- N C Tan
- Family Health Service, Ministry of Health, Singapore
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Abstract
OBJECTIVES To compare the Cobb technique for measuring kyphosis with an alternative Cobb method and a computer-assisted curve assessment technique, and to examine the influence of vertebral body and disc shape on kyphosis. METHODS Kyphosis measurements were derived from 93 lateral spinal radiographs or sagittal computed tomography images of cadaveric spines, using: (i) a computer-assisted method for estimating radius of curvature; (ii) the traditional Cobb method; and (iii) an alternative Cobb method. Regression models were applied for agreement analyses, and to examine the relative contribution of vertebral body and disc shape on the extent of curvature. Results and conclusions. Strong associations existed between curvature and angle data derived from the three methods, confirming the clinical utility of these techniques for the quantification of thoracic kyphosis. However, the traditional Cobb method tended to overestimate kyphosis in the presence of vertebral body end-plate deformation. The degree of kyphosis was strongly reflective of the extent of deformity of the vertebral bodies, and to a lesser extent the shape of the thoracic discs.
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Affiliation(s)
- S Goh
- Centre for Musculoskeletal Studies, UDS, The University of Western Australia, Australia
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Levine BA, Patchell VB, Sharma P, Gao Y, Bigelow DJ, Yao Q, Goh S, Colyer J, Drago GA, Perry SV. Sites on the cytoplasmic region of phospholamban involved in interaction with the calcium-activated ATPase of the sarcoplasmic reticulum. Eur J Biochem 1999; 264:905-13. [PMID: 10491139 DOI: 10.1046/j.1432-1327.1999.00688.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Proton NMR studies have shown that when a peptide corresponding to the N-terminal region of phospholamban, PLB(1-20), interacts with the Ca2+ATPase of the sarcoplasmic reticulum, SERCA1a, docking involves the whole length of the peptide. Phosphorylation of Ser16 reduced the affinity of the peptide for the pump by predominantly affecting the interaction with the C-terminal residues of PLB(1-20). In the phosphorylated peptide weakened interaction occurs with residues at the N-terminus of PLB(1-20). PLB(1-20) is shown to interact with a peptide corresponding to residues 378-405 located in the cytoplasmic region of SERCA2a and related isoforms. This interaction involves the C-terminal regions of both peptides and corresponds to that affected by phosphorylation. The data provide direct structural evidence for complex formation involving residues 1-20 of PLB. They also suggest that phospholamban residues 1-20 straddle separate segments of the cytoplasmic domain of SERCA with the N-terminus of PLB associated with a region other than that corresponding to SERCA2a(378-405).
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Affiliation(s)
- B A Levine
- School of Biochemistry, University of Birmingham, UK.
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Abstract
OBJECTIVE The aim of this study was to quantify the morphology or shape of thoracic vertebral bodies and intervertebral discs, and to examine the ex vivo association of thoracic kyphosis with these shape parameters. DESIGN A quantitative, retrospective study design was applied to define vertebral body and disc influences on thoracic kyphosis. BACKGROUND Age-related progression of thoracic kyphosis is a well-defined process that is influenced by the morphology of vertebral bodies. However, little is known about the contribution of intervertebral disc shape to the thoracic curvature. METHODS Vertebral and disc morphology, as represented by antero-posterior height ratios, were quantified in 93 lateral spine radiographs and midsagittal computed tomography films of ex vivo spines. Kyphosis was indicated by the Cobb angle. Linear and stepwise regression were applied to examine relationships for cumulative (T1-T12) and regional (T4-T9) analyses. RESULTS Vertebral morphology was highly predictive of thoracic curvature, while a poorer association was noted for disc morphology. The combined influence of both accounted for >85% of the variability in kyphosis. There was a trend for a more pronounced anterior wedge configuration of the midthoracic vertebral bodies and discs. Higher associations between variables were also noted in this region. CONCLUSIONS The normal kyphosis of the thoracic spine reflects the morphological adaptation of both the vertebral bodies and intervertebral discs. RELEVANCE This study contributes new data on the thoracic spine, particularly the characteristics of thoracic discs and their contribution to kyphosis genesis. Future directions for morphology studies should encompass more detailed examination of the thoracic discs and greater emphasis on the midthoracic segments, considering the prevalence of osteoporosis related fractures and subsequent deformity at these levels.
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Affiliation(s)
- S Goh
- School of Physiotherapy, Curtin University of Technology, Selby Street, Shenton Park, Australia
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Tan NC, Ng CJ, Goh S, Lee CE. Assessment of metered dose inhaler technique in family health service patients in Singapore. Singapore Med J 1999; 40:465-7. [PMID: 10560273] [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: 02/14/2023]
Abstract
OBJECTIVE To assess the metered-dose inhaler technique in polyclinic patients with chronic lung disease. METHOD A cross-sectional study was conducted in three polyclinics. The inhalation technique was assessed in six steps. RESULTS Only 7.1% of patients could perform all six steps correctly. Percentage of patients performing each of the following steps correctly were: preparation (89.1%), exhalation (53.8%), lip closure (69.2%), inhalation (57.7%), breath-holding (32.1%) and puff interval (35.4%). CONCLUSION This study showed a high incidence of incorrect usage of metered dose inhaler amongst polyclinic patients.
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Affiliation(s)
- N C Tan
- Queenstown Polyclinic, Singapore
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Sandifer QD, Davies J, Goh S, Tom B, Harvey I, Frankel S, Marks R, Shalom D, Morgan M. Foot morbidity and exposure to chiropody. BMJ 1998. [DOI: 10.1136/bmj.316.7144.1608a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Goh S, Tom B. Foot morbidity and exposure to chiropody. Study needs to address several issues. BMJ 1998; 316:1608-9. [PMID: 9616031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Brock C, Knowles M, Goh S. A school and community outbreak of influenza A. Commun Dis Rep CDR Rev 1995; 5:R177-9. [PMID: 8541938] [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] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
In May 1995 a department of public health medicine was informed of an outbreak of respiratory and gastrointestinal illness in a local school. Eighty-three pupils and staff were affected out of a total of 247 people--an attack rate of 34%. The outbreak was investigated, control measures were instigated, and the outbreak subsided. Pupils and staff were surveyed and faecal specimens were collected. Blood specimens from a sample of pupils were examined serologically. No organisms were isolated from faecal specimens. Nine of the 18 blood specimens taken showed raised antibody titres against influenza A. This labour intensive investigation revealed a community outbreak of influenza A. Investigations in schools can be useful in community surveillance.
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Affiliation(s)
- C Brock
- North Cumbria Health Authority
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Goh S, Holland AJ. A framework for commissioning services for people with learning disabilities. J Public Health Med 1994; 16:279-85. [PMID: 7999378] [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] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The needs of people who have global developmental learning disabilities (mental handicap) are complex and lifelong. Unless social and health service commissioners agree a framework for conceptualizing their need, there is a danger that services could become fragmented. This paper uses the World Health Organization's model of disabilities to put in context these needs. Using this model it is logical for health services to focus on (1) ensuring access to the full range of primary and secondary health services, (2) reducing the occurrence and severity of intellectual and associated impairments and (3) ensuring the provision of assessment and treatment of behaviour disorders and associated mental health problems. Some of these inputs are required before birth and in early childhood, but a number of people will require health services throughout life because of the presence of other disabilities or continuing behaviour and/or mental health problems. At school age, the education authority should provide the lead in ensuring the best physical and social learning environment. All children with learning disabilities will be socially disadvantaged in adulthood unless they are provided with opportunities for social integration, continuing education, skills training, employment and normal living facilities which meet their needs. Although there appears a logical shift in agencies' responsibilities as children with intellectual impairment progress through life, there is considerable diversity within this group and care can only be effectively provided on the basis of a sophisticated assessment of individual need and provision of integrated care.
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Affiliation(s)
- S Goh
- Cambridge Health Authority, District Headquarters, Fulbourn Hospital
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Goh S. Malaria. Aust Nurses J 1977; 6:27, 42. [PMID: 585334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Abstract
Fair to moderate yields of
insertion products of dichloro- and dibromo- carbenes can be achieved from aqueous
reaction mixtures using the phase transfer method. Insertions are very
selective; benzylic, tertiary C-H bonds of hydrocarbons and α-C-H bonds of
ethers are particularly reactive. The convenience of this method makes it
potentially attractive for certain synthetic applications.
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