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Durham J, Ohrbach R, Baad-Hansen L, Davies S, De Laat A, Goncalves DG, Gordan VV, Goulet JP, Häggman-Henrikson B, Horton M, Koutris M, Law A, List T, Lobbezoo F, Michelotti A, Nixdorf DR, Oyarzo JF, Peck C, Penlington C, Raphael KG, Santiago V, Sharma S, Svensson P, Visscher CM, Yoshiki I, Alstergren P. Constructing the brief diagnostic criteria for temporomandibular disorders (bDC/TMD) for field testing. J Oral Rehabil 2024; 51:785-794. [PMID: 38151896 DOI: 10.1111/joor.13652] [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: 06/09/2023] [Revised: 08/29/2023] [Accepted: 12/13/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND Despite advances in temporomandibular disorders' (TMDs) diagnosis, the diagnostic process continues to be problematic in non-specialist settings. OBJECTIVE To complete a Delphi process to shorten the Diagnostic Criteria for TMD (DC/TMD) to a brief DC/TMD (bDC/TMD) for expedient clinical diagnosis and initial management. METHODS An international Delphi panel was created with 23 clinicians representing major specialities, general dentistry and related fields. The process comprised a full day workshop, seven virtual meetings, six rounds of electronic discussion and finally an open consultation at a virtual international symposium. RESULTS Within the physical axis (Axis 1), the self-report Symptom Questionnaire of the DC/TMD did not require shortening from 14 items for the bDC/TMD. The compulsory use of the TMD pain screener was removed reducing the total number of Axis 1 items by 18%. The DC/TMD Axis 1 10-section examination protocol (25 movements, up to 12 sets of bilateral palpations) was reduced to four sections in the bDC/TMD protocol involving three movements and three sets of palpations. Axis I then resulted in two groups of diagnoses: painful TMD (inclusive of secondary headache), and common joint-related TMD with functional implications. The psychosocial axis (Axis 2) was shortened to an ultra-brief 11 item assessment. CONCLUSION The bDC/TMD represents a substantially reduced and likely expedited method to establish (grouping) diagnoses in TMDs. This may provide greater utility for settings requiring less granular diagnoses for the implementation of initial treatment, for example non-specialist general dental practice.
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Affiliation(s)
- Justin Durham
- School of Dental Sciences, Newcastle University, Newcastle, UK
- Newcastle Hospitals' NHS Foundation Trust, Newcastle, UK
| | - Richard Ohrbach
- Oral Diagnostic Sciences, University at Buffalo School of Dental Medicine, Buffalo, New York, USA
| | - Lene Baad-Hansen
- Department of Dentistry and Oral Health, Section for Orofacial Pain and Jaw Function, Aarhus University, Aarhus, Denmark
| | - Stephen Davies
- Division of Dentistry, University of Manchester UK, Manchester, UK
| | - Antoon De Laat
- Department Oral health Sciences KU Leuven and Department Dentistry, UZ Leuven, Belgium
| | | | - Valeria V Gordan
- Restorative Dental Sciences Department, University of Florida College of Dentistry, Gainesville, Florida, USA
| | - Jean-Paul Goulet
- Faculty of Dental Medicine, Laval University, Quebec, Quebec, Canada
| | - Birgitta Häggman-Henrikson
- Orofacial Pain and Jaw Function, Faculty of Odontology, Malmö University, Malmö, Sweden
- Scandinavian Center for Orofacial Neurosciences, Malmö, Sweden
| | | | - Michail Koutris
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Alan Law
- Endodontist, The Dental Specialists, Woodbury, Minnesota, USA
- Research Professor, Division of Endodontics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Thomas List
- Orofacial Pain and Jaw Function, Faculty of Odontology, Malmö University, Malmö, Sweden
- Scandinavian Center for Orofacial Neurosciences, Malmö, Sweden
- Skåne University Hospital, Specialized Pain Rehabilitation, Lund, Sweden
| | - Frank Lobbezoo
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ambra Michelotti
- Department of Neurosciences, School of Orthodontics, Reproductive Sciences and Oral Sciences, University of Naples Federico II, Naples, Italy
| | - Donald R Nixdorf
- Division of TMD & Orofacial Pain, School of Dentistry and Department of Radiology, Medical School, University of Minnesota, Minneapolis, Minnesota, USA
| | - Juan Fernando Oyarzo
- TMD and Orofacial Pain Program, Faculty of Odontology, Universidad Andres Bello, Santiago, Chile
| | - Chris Peck
- Faculty of Dentistry, National University of Singapore, Singapore, Singapore
| | - Chris Penlington
- School of Dental Sciences, Newcastle University, Newcastle, UK
- Newcastle Hospitals' NHS Foundation Trust, Newcastle, UK
| | - Karen G Raphael
- Department of Oral and Maxillofacial Pathology, Radiology & Medicine, New York University College of Dentistry, New York, New York, USA
| | - Vivian Santiago
- Department of Oral and Maxillofacial Pathology, Radiology & Medicine, New York University College of Dentistry, New York, New York, USA
| | - Sonia Sharma
- Oral Diagnostic Sciences, University at Buffalo School of Dental Medicine, Buffalo, New York, USA
| | - Peter Svensson
- Department of Dentistry and Oral Health, Section for Orofacial Pain and Jaw Function, Aarhus University, Aarhus, Denmark
| | - Corine M Visscher
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Imamura Yoshiki
- Department of Oral Diagnostic Sciences, Nihon University School of Dentistry, Tokyo, Japan
| | - Per Alstergren
- Scandinavian Center for Orofacial Neurosciences, Malmö, Sweden
- Skåne University Hospital, Specialized Pain Rehabilitation, Lund, Sweden
- Orofacial Pain Unit, Malmö University, Malmö, Sweden
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Ruphrect-Smith H, Davies S, Jacob J, Edbrooke-Childs J. Ethnic differences in treatment outcome for children and young people accessing mental health support. Eur Child Adolesc Psychiatry 2024; 33:1121-1131. [PMID: 37245162 PMCID: PMC11032270 DOI: 10.1007/s00787-023-02233-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 09/08/2022] [Accepted: 05/16/2023] [Indexed: 05/29/2023]
Abstract
Children and Young People (CYP) from minoritized ethnic backgrounds experience structural inequalities in Children and Young People's Mental Health Settings (CYPMHS). This mixed methods study explores whether CYP's ethnicity is associated with their treatment outcomes (operationalised as 'measurable change') from CYPMHS. A multilevel multi-nominal regression analysis, controlling for age, gender, referral source, presenting difficulty, case closure reason, suggests that CYP from Asian backgrounds (OR = 0.82, CI [0.70, 0.96]) and Mixed-race (odds ratio (OR) = 0.80; 95% CI [0.69, 0.92]) are less likely to report measurable improvement in mental health difficulties compared to White British CYP. Three themes from a thematic analysis of semi-structured interviews with 15 CYP from minoritized ethnic backgrounds focused on views and experiences of ending mental health support are also presented. CYP view personalised support and the right therapist as conducive to good endings and valued a range of outcomes pertaining to empowerment. Experiences of stigma and inequalities may begin to explain the less positive outcomes experienced by Asian and Mixed-race CYP found in the regression analysis. The implications of these findings and future areas of research are suggested.
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Affiliation(s)
- H Ruphrect-Smith
- Clinical, Educational, and Health Psychology, University College London, London, UK
| | - S Davies
- Evidence Based Practice Unit, University College London and the Anna Freud Centre, Anna Freud, 4-8 Rodney Street, London, N1 9JH, UK
| | - J Jacob
- Clinical, Educational, and Health Psychology, University College London, London, UK
- Child Outcomes Research Consortium, Anna Freud, London, UK
| | - J Edbrooke-Childs
- Clinical, Educational, and Health Psychology, University College London, London, UK.
- Evidence Based Practice Unit, University College London and the Anna Freud Centre, Anna Freud, 4-8 Rodney Street, London, N1 9JH, UK.
- Child Outcomes Research Consortium, Anna Freud, London, UK.
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3
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Abstract
Some dentists choose to ignore the subject of occlusion, while others propose a set of doctrinal rules. It is of little wonder therefore that it can become a source of confusion and even controversy. This series of two papers aims, firstly, to answer the very simple question of 'what is occlusion?'. It will put occlusion into the context of the articulatory system because that is the bio-mechanical environment where the majority of dentists do their work. The concept of jaw relation will also be discussed but within the context of this locomotive system. Ideal occlusion will be described but only after answering the question: for whom or what might an occlusion be considered ideal? Although, in the book of which this is the first chapter, he presents what has worked for him during many years as a general dental practitioner, university lecturer and specialist in restorative dentistry, he has tried not to be didactic because he feels that, in a profession, there are no right answers, only the right questions.
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Affiliation(s)
- Stephen Davies
- Specialist in Restorative Dentistry, Lecturer in Occlusal and Temporomandibular Studies, Division of Dentistry, Faculty of Biology, Medicine and Health, University of Manchester, A Lead Clinician, Temporomandibular Disorder Clinic, University Dental Hospital of Manchester, Manchester, UK.
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4
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Abstract
Some dentists choose to ignore the subject of occlusion, while others propose a set of doctrinal rules. It is of little wonder therefore that it can become a source of confusion and even controversy. This series of two papers aims, firstly, to answer the very simple question of 'what is occlusion?'. It will put occlusion into the context of the articulatory system because that is the bio-mechanical environment where the majority of dentists do their work. The concept of jaw relation will also be discussed but within the context of this locomotive system. Ideal occlusion will be described but only after answering the question: for whom or what might an occlusion be considered ideal? Although, in the book of which this is the first chapter, he presents what has worked for him during many years as a general dental practitioner, university lecturer and specialist in restorative dentistry, he has tried not to be didactic because he feels that, in a profession, there are no right answers, only the right questions.
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Affiliation(s)
- Stephen Davies
- Specialist in Restorative Dentistry, Lecturer in Occlusal and Temporomandibular Studies, Division of Dentistry, Faculty of Biology, Medicine and Health, University of Manchester, A Lead Clinician, Temporomandibular Disorder Clinic, University Dental Hospital of Manchester, Manchester, UK.
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Luyckx VA, Alasfar S, Bajpai D, Atwater CE, Knight J, Talbot B, Davies S, Niang A. Providing environmentally sustainable nephrology care: focus in low- and middle-income countries. Kidney Int 2024; 105:259-268. [PMID: 38008159 DOI: 10.1016/j.kint.2023.09.034] [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: 07/03/2023] [Revised: 09/14/2023] [Accepted: 09/25/2023] [Indexed: 11/28/2023]
Abstract
Health care on a global scale significantly contributes to carbon emissions, with high-income countries being the primary culprits. Within health care, dialysis plays a significant role as a major source of emissions. Low- and middle-income countries have a high burden of kidney disease and are facing an increasing demand for dialysis. This reality presents multiple opportunities to plan for environmentally sustainable and quality kidney care. By placing a stronger emphasis on primary and secondary prevention of kidney disease and its progression, within the framework of universal health coverage, as well as empowering patients to enhance self-care, we can significantly reduce the need for costly and environmentally detrimental kidney replacement therapy. Mandating the adoption of lean and innovative low-carbon dialysis practices while also promoting the growth of kidney transplantation would enable low- and middle-income countries to take the lead in implementing environmentally friendly nephrology practices and reducing costs, thus optimizing sustainability and the well-being of individuals living with kidney disease.
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Affiliation(s)
- V A Luyckx
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland; Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa.
| | - S Alasfar
- Department of Medicine, Mayo Clinic, Phoenix, Arizona, USA
| | - D Bajpai
- Department of Nephrology, Seth G.S.M.C. and K.E.M. Hospital, Mumbai, India
| | - C E Atwater
- Department of Dialysis Capacity and Technical Operations, Bridge of Life, founded by Davita Inc., Denver, Colorado, USA
| | - J Knight
- The George Institute for Global Health, Newtown, Australia; Faculty of Medicine & Health, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - B Talbot
- The George Institute for Global Health, Newtown, Australia; Faculty of Medicine & Health, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - S Davies
- School of Medicine, Keele University, Keele, Staffordshire, UK
| | - Abdou Niang
- Nephrology Department, Cheikh Anta Diop University & Dalal Jamm University Hospital, Dakar, Senegal
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6
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Davies S, Raju D. Powerful disinfectant properties. Br Dent J 2023; 234:844. [PMID: 37349415 DOI: 10.1038/s41415-023-6035-y] [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] [Received: 04/19/2023] [Accepted: 04/27/2023] [Indexed: 06/24/2023]
Affiliation(s)
- S Davies
- Founder of CleanCert Hygiene, Tisbury, United Kingdom.
| | - D Raju
- Founder of Green Dentistry, Bognor Regis, United Kingdom.
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7
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Yates DRA, Davies S, Kane AD. Death is not the worst that can happen: risk scoring and outcomes in emergency laparotomy. Anaesthesia 2023. [PMID: 37017990 DOI: 10.1111/anae.16018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2023] [Indexed: 04/06/2023]
Affiliation(s)
- D R A Yates
- Department of Anaesthesia and Intensive Care Medicine, York and Scarborough Teaching Hospitals NHS Foundation Trust, York, UK
- North Yorkshire Academic Alliance of Perioperative Medicine, York, UK
| | - S Davies
- Hull York Medical School, York, UK
- North Yorkshire Academic Alliance of Perioperative Medicine, York, UK
| | - A D Kane
- South Tees University Hospital NHS Foundation Trust, Middlesborough, UK
- North Yorkshire Academic Alliance of Perioperative Medicine, York, UK
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8
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Westwood S, Lippa K, Shimuzu Y, Lalerle B, Saito T, Duewer D, Dai X, Davies S, Ricci M, Baldan A, Lang B, Sarge S, Wang H, Pratt K, Josephs R, Mariassy M, Pfeifer D, Warren J, Bremser W, Ellison S, Toman B, Nelson M, Huang T, Fajgelj A, Gören A, Mackay L, Wielgosz R. Methods for the SI-traceable value assignment of the purity of organic compounds (IUPAC Technical Report). PURE APPL CHEM 2023. [DOI: 10.1515/pac-2020-0804] [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: 01/20/2023]
Abstract
Abstract
The “purity” of an organic compound typically refers, in practice, to an assignment of the mass fraction content of the primary organic component present in the material. The “purity” value of an organic primary calibrator material is the ultimate source of metrological traceability of any quantitative measurement of the content of that compound in a given matrix. The primary calibrator may consist of a Certified Reference Material (CRM) whose purity has been assigned by the CRM producer or a laboratory may choose to value-assign a material to the extent necessary for their intended application by using appropriately valid methods. This report provides an overview of the approach, performance and applicability of the principal methods used to determine organic purity including mass balance, quantitative NMR, thermal methods and direct-assay techniques. A statistical section reviews best practice for combination of data, value assignment as the upper limit values corresponding to 100 % purity are approached and how to report and propagate the standard uncertainty associated with the assigned values.
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Affiliation(s)
- Steven Westwood
- Bureau International des Poids et Mesures (BIPM) , Sèvres , France
| | - Katrice Lippa
- National Institute of Standards and Technology (NIST) , Gaithersburg , MD , USA
| | | | - Beatrice Lalerle
- Laboratoire Nationale de Métrologie et d’Essais (LNE) , Paris , France
| | - Takeshi Saito
- National Metrology Institute of Japan (NMIJ) , Tsukuba , Japan
| | - David Duewer
- National Institute of Standards and Technology (NIST) , Gaithersburg , MD , USA
| | - Xinhua Dai
- National Institute of Metrology (China) (NIM) , Beijing , China
| | - Stephen Davies
- National Measurement Institute Australia (NMIA) , North Ryde , NSW , Australia
| | | | - Annarita Baldan
- Nederlands Metrologisch Instituut (VSL) , Delft , The Netherlands
| | - Brian Lang
- National Institute of Standards and Technology (NIST) , Gaithersburg , MD , USA
| | - Stefan Sarge
- Physikalisch-Technische Bundesanstalt (PTB) , Braunschweig , Germany
| | - Haifeng Wang
- National Institute of Metrology (China) (NIM) , Beijing , China
| | - Ken Pratt
- National Institute of Standards and Technology (NIST) , Gaithersburg , MD , USA
| | - Ralf Josephs
- Bureau International des Poids et Mesures (BIPM) , Sèvres , France
| | | | - Dietmar Pfeifer
- Bundesanstalt für Materialforschung und -Prüfung (BAM) , Berlin , Germany
| | | | - Wolfram Bremser
- Bundesanstalt für Materialforschung und -Prüfung (BAM) , Berlin , Germany
| | | | - Blaza Toman
- National Institute of Standards and Technology (NIST) , Gaithersburg , MD , USA
| | - Michael Nelson
- National Institute of Standards and Technology (NIST) , Gaithersburg , MD , USA
| | - Ting Huang
- National Institute of Metrology (China) (NIM) , Beijing , China
| | - Ales Fajgelj
- International Atomic Energy Agency , Vienna , Austria
| | - Ahmet Gören
- Kimya Bölümü, Gebze Teknik Üniversitesi , Gebze , Turkey
| | - Lindsey Mackay
- National Measurement Institute Australia (NMIA) , North Ryde , NSW , Australia
| | - Robert Wielgosz
- Bureau International des Poids et Mesures (BIPM) , Sèvres , France
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Jahnke V, Cotier S, Martin M, Davies S. SOC-I-03 Advanced qualitative and quantitative 3t3 neutral red uptake tests for more physiologically relevant in vitro phototoxicity assessment. Toxicol Lett 2022. [DOI: 10.1016/j.toxlet.2022.07.074] [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: 10/14/2022]
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10
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Day C, Battes K, Butler B, Davies S, Farina L, Frattolillo A, George R, Giegerich T, Hanke S, Härtl T, Igitkhanov Y, Jackson T, Jayasekera N, Kathage Y, Lang P, Lawless R, Luo X, Neugebauer C, Ploeckl B, Santucci A, Schwenzer J, Teichmann T, Tijssen T, Tosti S, Varoutis S, Cortes AV. The pre-concept design of the DEMO tritium, matter injection and vacuum systems. Fusion Engineering and Design 2022. [DOI: 10.1016/j.fusengdes.2022.113139] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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O’Connell Francischetto E, Jones J, Davies S, Allen K, Combes G, Damery S. 682 IMPACT OF DISCHARGE INTERVENTIONS FOR OLDER PATIENTS LEAVING HOSPITAL: A SYSTEMATIC REVIEW OF REVIEWS. Age Ageing 2022. [DOI: 10.1093/ageing/afac036.682] [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: 11/13/2022] Open
Abstract
Abstract
Introduction
The UK has an aging population and there is an increasing need for additional care and support services for elderly patients discharged from hospital. Despite a large evidence base on different discharge services there is inconsistent findings on their effectiveness. This systematic review of reviews aimed to evaluate the impact of a variety of discharge interventions on older people leaving hospital.
Method
Ten databases were searched (including Medline and The Cochrane Library) using multiple key search terms related to ‘systematic reviews’, ‘older people’ and ‘discharge’. Only systematic reviews of interventions for people aged over 60 years that provided additional support or adapted their discharge processes were included. Outcomes of interest included mortality, readmissions, length of hospital stay, patient health status and costs. Abstract, title and full-text screening was conducted independently by two reviewers. Interventions were categorised by intervention type and a narrative synthesis was conducted on data extracted.
Results
Of the 8,748 title and abstracts reviewed, 859 full texts were assessed for eligibility, of these 91 were taken forward to quality assessment and 66 moderate or high-quality reviews were included in the final synthesis. Interventions were categorised into 10 types and had varying impact on outcomes. A statistically significant positive impact on the outcomes of interest was found for: Interventions providing ‘rehabilitation, therapy or care at home (or in the community) around the time of discharge’ reducing length of stay; ‘primary care interventions’, ‘Discharge planning/coordination or case management’ and ‘patient education’.
Conclusion
This systematic review of reviews shows that different types and configurations of discharge interventions can benefit older patients in multiple ways when compared to usual care and highlights which intervention types make no difference or have negative impacts. These findings will help to inform the development of new discharge interventions and the direction of future research.
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Affiliation(s)
- E O’Connell Francischetto
- Prevention, Wellbeing and Communities Hub, Gloucestershire County Council & Applied Research Collaborations (ARC) West Midlands, University of Birmingham; Applied Research Collaborations (ARC) West Midlands, University of Birmingham; Surrey and Sussex Healthcare NHS Trust; Health Services Management Centre, University of Birmingham; Applied Research Collaborations (ARC) West Midlands, University of Birmingham; Applied Research Collaborations (ARC) West Midlands, University of Birmingham
| | - J Jones
- Prevention, Wellbeing and Communities Hub, Gloucestershire County Council & Applied Research Collaborations (ARC) West Midlands, University of Birmingham; Applied Research Collaborations (ARC) West Midlands, University of Birmingham; Surrey and Sussex Healthcare NHS Trust; Health Services Management Centre, University of Birmingham; Applied Research Collaborations (ARC) West Midlands, University of Birmingham; Applied Research Collaborations (ARC) West Midlands, University of Birmingham
| | - S Davies
- Prevention, Wellbeing and Communities Hub, Gloucestershire County Council & Applied Research Collaborations (ARC) West Midlands, University of Birmingham; Applied Research Collaborations (ARC) West Midlands, University of Birmingham; Surrey and Sussex Healthcare NHS Trust; Health Services Management Centre, University of Birmingham; Applied Research Collaborations (ARC) West Midlands, University of Birmingham; Applied Research Collaborations (ARC) West Midlands, University of Birmingham
| | - K Allen
- Prevention, Wellbeing and Communities Hub, Gloucestershire County Council & Applied Research Collaborations (ARC) West Midlands, University of Birmingham; Applied Research Collaborations (ARC) West Midlands, University of Birmingham; Surrey and Sussex Healthcare NHS Trust; Health Services Management Centre, University of Birmingham; Applied Research Collaborations (ARC) West Midlands, University of Birmingham; Applied Research Collaborations (ARC) West Midlands, University of Birmingham
| | - G Combes
- Prevention, Wellbeing and Communities Hub, Gloucestershire County Council & Applied Research Collaborations (ARC) West Midlands, University of Birmingham; Applied Research Collaborations (ARC) West Midlands, University of Birmingham; Surrey and Sussex Healthcare NHS Trust; Health Services Management Centre, University of Birmingham; Applied Research Collaborations (ARC) West Midlands, University of Birmingham; Applied Research Collaborations (ARC) West Midlands, University of Birmingham
| | - S Damery
- Prevention, Wellbeing and Communities Hub, Gloucestershire County Council & Applied Research Collaborations (ARC) West Midlands, University of Birmingham; Applied Research Collaborations (ARC) West Midlands, University of Birmingham; Surrey and Sussex Healthcare NHS Trust; Health Services Management Centre, University of Birmingham; Applied Research Collaborations (ARC) West Midlands, University of Birmingham; Applied Research Collaborations (ARC) West Midlands, University of Birmingham
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Davies S, Clarke E, Hardy E, Hepworth C. COVID-19, child inactivity and the introduction of an online exercise class. Physiotherapy 2022. [PMCID: PMC8848158 DOI: 10.1016/j.physio.2021.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Collins M, Brown D, Davies S, Chan B, Trotter B, Moawad M, Blakey K, Collins-Brown L. Case study: Identification and characterization of N-[2-(dimethylamino)cyclohexyl]-N-methylnaphthalene-2-carboxamide, a regioisomer of the synthetic opioid U10. Drug Test Anal 2022; 14:188-195. [PMID: 34390197 DOI: 10.1002/dta.3133] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/21/2021] [Accepted: 07/21/2021] [Indexed: 11/07/2022]
Affiliation(s)
- Michael Collins
- Australian Forensic Drug Laboratory, National Measurement Institute, North Ryde, New South Wales, Australia
| | - David Brown
- Forensic Science Laboratory, ChemCentre, Bentley, Western Australia, Australia
- School of Molecular and Life Sciences, Curtin University, Bentley, Western Australia, Australia
| | - Stephen Davies
- Australian Forensic Drug Laboratory, National Measurement Institute, North Ryde, New South Wales, Australia
| | - Benjamin Chan
- Australian Forensic Drug Laboratory, National Measurement Institute, North Ryde, New South Wales, Australia
| | - Brendan Trotter
- Australian Forensic Drug Laboratory, National Measurement Institute, North Ryde, New South Wales, Australia
| | - Michael Moawad
- Australian Forensic Drug Laboratory, National Measurement Institute, North Ryde, New South Wales, Australia
| | - Karen Blakey
- Illicit Drug Group, Forensic Chemistry, Queensland Health Forensic Science Service, Coopers Plains, Queensland, Australia
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Kalogeras K, Zuhair M, Kabir T, Jabbour R, Dalby M, Ghada M, Shai S, Katsianos E, Iqbal M, Naganuma T, Davies S, Shannon J, Duncan A, Vavuranakis M, Panoulas V. Real-world comparison of the last generation balloon-expandable and self-expanding valves in patients undergoing TAVI. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background/Introduction
The balloon expandable (BE) Edwards Sapien-S3/Ultra, and the self-expanding (SE) Medtronic Evolut-Pro represent the main volume of transcatheter aortic valve implantation (TAVI) procedures conducted worldwide.
Purpose
The present study represents the largest real-world comparison of periprocedural and short-term outcome between the aforementioned last generation devices.
Methods
Consecutive patients who had undergone TAVI with either the BE (S3/Ultra) or SE (Evolut-Pro/R-34mm if 34mm valve was required) device, in five centers were retrospectively studied. Periprocedural and short-term outcomes were recorded and compared.
Results
In total, 1341 patients (58.5% male) were treated with contemporary BE and SE valves (574 and 767pts with BE and SE respectively) and followed up for a median of 18.7 (IQR 30) months. Baseline demographics were similar between the two groups apart from severe left ventricle (LV) systolic impairment and extensive aorta calcification, being more prevalent amongst BE and SE groups respectively. Patients treated with the Evolut-Pro/R34mm device had significantly lower peak (16±9mmHg for SE vs 23.9±6mmHg for the BE valves, p=0.001) and mean (8.6±6mmHg SE vs 11.2±5.2mmHg BE, p=0.001) gradients at discharge.
Conversely, the BE group demonstrated significantly lower rates of at least moderate residual aortic regurgitation (AR) post-operatively (0.7% vs 5.2% for BE and SE valves respectively, p<0.001). Interestingly, the rate of new permanent pacemaker (PPM) required after the implantation in initially pacemaker-free patients, was higher for the S3/Ultra cohort compared to the self-expanding valve group (14.4% vs 12.3% respectively, p=0.001). No statistical difference was recorded between valve groups regarding cerebrovascular events (3.4% vs. 2.7% for SE and BE respectively, p=0.466), major vascular complications (4.2% vs. 3.0% for SE and BE respectively, p=0.251) and death to hospital discharge (1.6% vs. 2.9% for SE and BE respectively, p=0.117).
One-year Kaplan-Meier estimated survival was similar between the two groups (88.7% for BE vs. 91.4% for SE valves, plog-rank=0.093). When adjusting for age, extensive calcification of the aorta and baseline LV function all caused mortality hazard ratios were similar between patients treated with BE vs SE valves (HR 1.39; 95% CI 0.97 to 1.98, p=0.07).
Conclusions
Real life comparison of the last generation balloon expandable and self-expanding devices demonstrates superiority of the former in terms of residual PVL, at the expense of higher transvalvular gradients and higher need of new PPM implantation. The latter however may represent differences in center practices with regards to thresholds for permanent pacing. Long-term follow-up and future larger trials are required to establish any potential long-term difference in clinical outcomes and prognosis.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- K Kalogeras
- Athens Chest Hospital Sotiria, 3rd Department of Cardiology, University of Athens, Athens, Greece
| | - M Zuhair
- Imperial College London, London, United Kingdom
| | - T Kabir
- Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - R Jabbour
- Imperial College London, London, United Kingdom
| | - M Dalby
- Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - M Ghada
- Imperial College London, London, United Kingdom
| | - S Shai
- Royal Brompton Hospital Imperial College London, London, United Kingdom
| | - E Katsianos
- Athens Chest Hospital Sotiria, 3rd Department of Cardiology, University of Athens, Athens, Greece
| | - M Iqbal
- Imperial College London, London, United Kingdom
| | | | - S Davies
- Imperial College London, London, United Kingdom
| | - J Shannon
- Royal Brompton Hospital Imperial College London, London, United Kingdom
| | - A Duncan
- Royal Brompton Hospital Imperial College London, London, United Kingdom
| | - M Vavuranakis
- Athens Chest Hospital Sotiria, 3rd Department of Cardiology, University of Athens, Athens, Greece
| | - V Panoulas
- Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
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15
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Georgiou K, Winter D, Davies S, Katsiana A. "But Who Knows What Autism Is?" Negotiating the Notion of Autism During Free Associative Narrative Interviews with Psychoanalytic Psychotherapists. Mater Sociomed 2021; 33:138-144. [PMID: 34483743 PMCID: PMC8385723 DOI: 10.5455/msm.2021.33.138-144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 06/22/2021] [Indexed: 12/04/2022] Open
Abstract
Background: Critically informed discursive research has rarely been used to capture the way psychoanalytic psychotherapists organize their talk with regards to Autism Spectrum Disorders (ASD). Objective: To understand the language about autism in psychoanalytic talk in terms of i) interpretive repertoires, ii) subject positions and iii) autistic ways of being that circulate inside psychoanalysts’ discourses. Methods: This paper presents the data and findings of a critical discursive psychological research which analyzed the talk of eight experienced psychoanalysts. As part of a wider research project this study strived to provide an understanding of the way autism was deployed in free associative narrative interviews. Results: Focusing on the micro and the macro level of discourse, the analysis of the data pointed to a rather dilemmatic framework mobilizing therapeutic talk. This framework was organised around a quadrant of interpretive repertoires, which on the one hand fought against the traditional medicalized discourses about autism, while on the other repositioned autism in the same subordinate positions crafted by biomedical regimes. Conclusion: A need for breaking from this rather malleable discursive ecosystem is advocated in order to give life to a more democratic let alone emancipating clinical and political environment.
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Affiliation(s)
- Konstantinos Georgiou
- Department of Occupational Therapy, School of Health Sciences, University of Western Macedonia, Greece
| | - David Winter
- Department of Psychology, Sport, and Geography, University of Hertfordshire, UK
| | - Stephen Davies
- Hertfordshire Partnership University NHS Foundation Trust, UK
| | - Aikaterini Katsiana
- Department of Occupational Therapy, School of Health Sciences, University of Western Macedonia, Greece
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16
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Davies S, Kallioras N, Tsakalis P, Christopikou D, Daskalopoulou Z, Zaxaria S, Mastrominas M, Lagaros N. MACHINE LEARNING-BASED ASSESSMENT MODEL AS A PREDICTIVE TOOL FOR BLASTOCYST GRADING UTILIZING MORPHOKINETIC PARAMETERS PRIOR TO THE THIRD CLEAVAGE DIVISION. Fertil Steril 2021. [DOI: 10.1016/j.fertnstert.2021.07.478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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17
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Christopikou D, Davies S, Zaxaria S, Tsorva E, Karagianni A, Echave P, Harton GL, Mastrominas M. NON-INVASIVE PREIMPLANTATION GENETIC TESTING (NIPGT) FOR ANEUPLOIDY AND STRUCTURAL REARRANGEMENTS USING NEXT GENERATION SEQUENCING (NGS) ON SPENT CULTURE MEDIA (SCM). Fertil Steril 2021. [DOI: 10.1016/j.fertnstert.2021.07.609] [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: 11/25/2022]
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18
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Davies S. COVID‐19 and complexity: Hayekian economics and the world after the pandemic. Economic Affairs 2021. [PMCID: PMC8444853 DOI: 10.1111/ecaf.12472] [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] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
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19
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Davies C, Davies S. Assessing competition in the hip implant industry in the light of recent policy guidance. Soc Sci Med 2021; 287:114055. [PMID: 34144844 DOI: 10.1016/j.socscimed.2021.114055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 05/12/2021] [Accepted: 05/17/2021] [Indexed: 11/15/2022]
Abstract
NHS procurement is a highly topical area, attracting a great deal of recent policy focus. The pivotal report by Lord Carter of Coles (2016) highlighted unwarranted variation, estimating it to be worth approximately £5bn in efficiency savings. In relation to hip replacement surgery, recent procurement policy guidance has recommended the use of cemented hip implants for all patients aged 68 years and over in England and Wales. Previous work established that the hip implant supplying market was very concentrated, with only a few large suppliers, especially for cemented implants. The advocated major shift towards cemented implants would almost certainly increase further the market share of the dominant manufacturer of cemented sector thus raising potential competition and welfare issues. We carry out a market study to establish whether there might be a potential competition concern, using data from the National Joint Registry (2005-2018, 37 suppliers, nearly 700 models). We first establish the structure of the industry with a specific focus on seller concentration. Secondly we evaluate the dynamics underlying concentration in the market, assessing the innovative performance of the sector using a novel statistical analysis of the dynamics of market shares. We then look to three comparable but alternative markets for similarities or differences to the THR implant industry. We find a high and increasingly concentrated oligopolistic and static market structure, largely devoid of dynamics and with no real sign of innovation. These findings are further emphasized when compared with the three close alternative markets. Although this stability could just be a mature market where technical advances have already taken place, our findings highlight the potential welfare and policy implications of concentrating on cemented fixation. Given the current emphasis on efficiency in procurement, it is essential that there should also be scrutiny of the firms dealing with public procurement.
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Affiliation(s)
- Charlotte Davies
- Health Economics Group, Norwich Medical School, University of East Anglia, UK.
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20
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Mcleod RJW, Wilks L, Davies S, Elhassan HA. 448 The Impact of Noise in the Operating Theatre: A Review of the Evidence. Br J Surg 2021. [DOI: 10.1093/bjs/znab134.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Background
Noise has been recognised to have a negative impact on performance and wellbeing in many settings. Average noise levels have been found to range between 51-79 dB in operating theatres. Despite this, there is little research investigating the effect of noise on surgical team functioning.
Method
A literature review to look at the impact of noise in the operating theatre was performed on MEDLINE which included the search terms ‘noise’ OR ‘distraction’ AND ‘technical skill’ OR ‘Surgical skill’ OR ‘Operating Room’. 10 of 307 articles identified were deemed relevant.
Results
8 of 10 studies found noise to be detrimental to communication and surgical performance, particularly regarding total errors and time to task completion. No studies found noise to be beneficial. Two studies found case irrelevant verbal communication to be a frequent form of noise pollution in operating theatres; this is both perceived by surgeons to be distracting and delays patient care. Noise was most harmful to trainees.
Conclusions
Noise and irrelevant verbal communications were both found to be harmful to surgical performance, surgeon experience and team functioning. The worsened effect on the trainee exposes an urgent need to address noise pollution in the training environment.
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Affiliation(s)
| | - L Wilks
- Morriston Hospital, Swansea, United Kingdom
| | - S Davies
- Morriston Hospital, Swansea, United Kingdom
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21
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Maishman T, Sheikh H, Boger P, Kelly J, Cozens K, Bateman A, Davies S, Fay M, Sharland D, Jackson A. A Phase II Study of Biodegradable Stents Plus Palliative Radiotherapy in Oesophageal Cancer. Clin Oncol (R Coll Radiol) 2021; 33:e225-e231. [PMID: 33402268 DOI: 10.1016/j.clon.2020.12.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 12/02/2020] [Accepted: 12/10/2020] [Indexed: 01/21/2023]
Abstract
AIMS Self-expanding metal stents provide rapid improvement of dysphagia in oesophageal cancer but are associated with complications. The aim of the present study was to test the effectiveness of an alternative treatment of combining biodegradable stents with radiotherapy. MATERIALS AND METHODS A Simon two-stage single-arm prospective phase II trial design was used to determine the efficacy of biodegradable stents plus radiotherapy in patients with dysphagia caused by oesophagus cancer who were unsuitable for radical treatment. Fourteen patients were recruited and data from 12 were included in the final analyses. RESULTS Five of 12 patients met the primary end point: one stent-related patient death; four further interventions for dysphagia within 16 weeks of stenting (41.7%, 95% confidence interval 15.2-72.3%). The median time to a 10-point deterioration of quality of life was 2.7 weeks. Nine patients died within 52 weeks of registration. The median time to death from any cause was 15.0 weeks (95% confidence interval 9.6-not reached). CONCLUSION The high re-intervention observed, which met the pre-defined early stopping criteria, meant that the suggested alternative treatment was not sufficiently effective to be considered for a larger scale trial design. Further work is needed to define the place of biodegradable stents in the management of malignant oesophageal strictures.
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Affiliation(s)
- T Maishman
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - H Sheikh
- The Christie NHS Foundation Trust, Manchester, UK
| | - P Boger
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - J Kelly
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - K Cozens
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - A Bateman
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - S Davies
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - M Fay
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - D Sharland
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - A Jackson
- University Hospital Southampton NHS Foundation Trust, Southampton, UK.
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22
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Hamed MO, Barlow AD, Dolezalova N, Khosla S, Sagar A, Gribble FM, Davies S, Murphy MP, Hosgood SA, Nicholson ML, Saeb-Parsy K. Ex vivo normothermic perfusion of isolated segmental porcine bowel: a novel functional model of the small intestine. BJS Open 2021; 5:6220254. [PMID: 33839750 PMCID: PMC8038264 DOI: 10.1093/bjsopen/zrab009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 01/26/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND There is an unmet need for suitable ex vivo large animal models in experimental gastroenterology and intestinal transplantation. This study details a reliable and effective technique for ex vivo normothermic perfusion (EVNP) of segmental porcine small intestine. METHODS Segments of small intestine, 1.5-3.0 m in length, were retrieved from terminally anaesthetized pigs. After a period of cold ischaemia, EVNP was performed for 2 h at 37°C with a mean pressure of 80 mmHg using oxygenated autologous blood diluted with Ringer's solution. The duration of EVNP was extended to 4 h for a second set of experiments in which two segments of proximal to mid-ileum (1.5-3.0 m) were retrieved from each animal and reperfused with whole blood (control) or leucocyte-depleted blood to examine the impact of leucocyte depletion on reperfusion injury. RESULTS After a mean cold ischaemia time of 5 h and 20 min, EVNP was performed in an initial group of four pigs. In the second set of experiments, five pigs were used in each group. In all experiments bowel segments were well perfused and exhibited peristalsis during EVNP. Venous glucose levels significantly increased following luminal glucose stimulation (mean(s.e.m.) basal level 1.8(0.6) mmol/l versus peak 15.5(5.8) mmol/l; P < 0.001) and glucagon-like peptide 1 (GLP-1) levels increased in all experiments, demonstrating intact absorptive and secretory intestinal functions. There were no significant differences between control and leucocyte-depleted animals regarding blood flow, venous glucose, GLP-1 levels or histopathology at the end of 4 h of EVNP. CONCLUSIONS This novel model is suitable for the investigation of gastrointestinal physiology, pathology and ischaemia reperfusion injury, along with evaluation of potential therapeutic interventions.
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Affiliation(s)
- M O Hamed
- Correspondence to: Department of Surgery, Addenbrookes Hospital, Hills Road, Cambridge, CB2 0QQ, UK (e-mail:)
| | - A D Barlow
- Department of Surgery, University of Cambridge, and NIHR Cambridge Biomedical Research Campus, Cambridge, UK
| | - N Dolezalova
- Department of Surgery, University of Cambridge, and NIHR Cambridge Biomedical Research Campus, Cambridge, UK
| | - S Khosla
- Wellcome Trust – MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - A Sagar
- Wellcome Trust – MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - F M Gribble
- Department of Histopathology, University of Cambridge, Cambridge, UK
| | - S Davies
- Department of Histopathology, University of Cambridge, Cambridge, UK
| | - M P Murphy
- MRC Mitochondrial Biology Unit, Cambridge, UK
| | - S A Hosgood
- Department of Surgery, University of Cambridge, and NIHR Cambridge Biomedical Research Campus, Cambridge, UK
| | - M L Nicholson
- Department of Surgery, University of Cambridge, and NIHR Cambridge Biomedical Research Campus, Cambridge, UK
| | - K Saeb-Parsy
- Department of Surgery, University of Cambridge, and NIHR Cambridge Biomedical Research Campus, Cambridge, UK
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23
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Schneider J, Davies S, Howarth A, GARCIA SANCHEZ J, Rao N, Grandy S, Bhatt P, Parackal A, Wong D, Briggs A. POS-321 TRANSLATING THE FINDINGS OF THE ROXADUSTAT NDD GLOBAL PHASE 3 PROGRAM INTO COST OFFSETS FROM A CANADIAN HEALTHCARE PERSPECTIVE. Kidney Int Rep 2021. [DOI: 10.1016/j.ekir.2021.03.337] [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] Open
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24
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Ahmad S, Surya A, Hayhurst C, Davies S. Pituitary infundibular epidermoid cyst: a rare cause of hypopituitarism. BMJ Case Rep 2021; 14:14/3/e241065. [PMID: 33762289 PMCID: PMC7993165 DOI: 10.1136/bcr-2020-241065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 53-year-old man presented with 6 months history of weight loss associated with nausea, fatigue, dizziness and headache. On arrival he was in adrenal crisis. Biochemistry revealed anterior hypopituitarism with low cortisol, thyroxine, testosterone and a slightly raised prolactin. He was commenced on steroids, thyroxine and testosterone. MRI pituitary gland was reported to have a 9.4 mm microadenoma. Cabergoline was started for a possible microprolactinoma. Follow-up MRI showed increase in the size of complex cystic lesion causing chiasmal compression raising a possibility of craniopharyngioma. Visual fields assessment was normal. In view of the rapid enlargement, to protect vision and obtain a tissue diagnosis he underwent endoscopic trans-sphenoidal surgery. A cystic lesion was noted intraoperatively originating from pituitary stalk with intrasellar and suprasellar extension. It was filled with white caseous material and fluid. Histology revealed epidermoid cyst. His headache resolved postoperatively.
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Affiliation(s)
- Sajjad Ahmad
- Department of Diabetes and Endocrinology, University Hospital of Wales, Cardiff, Cardiff, UK
| | - Ashutosh Surya
- Department of Diabetes and Endocrinology, University Hospital of Wales, Cardiff, Cardiff, UK
| | - Caroline Hayhurst
- Division of Neurosurgery, University Hospital of Wales, Cardiff, Cardiff, UK
| | - Stephen Davies
- Department of Endocrinology, University of Wales College of Medicine, Cardiff, UK
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25
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Flexman AM, Shillcutt SK, Davies S, Lorello GR. Current status and solutions for gender equity in anaesthesia research. Anaesthesia 2021; 76 Suppl 4:32-38. [PMID: 33682100 DOI: 10.1111/anae.15361] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2020] [Indexed: 11/24/2022]
Abstract
Despite increasing numbers of women entering anaesthesia, they remain persistently under-represented within academic anaesthesia and research. Gender discordance is seen across multiple aspects of research, including authorship, editorship, peer review, grant receipt, speaking and leading. Women are also under-represented at higher faculty ranks and in department chair positions. These inequities are further magnified for women with intersectional identities, such as those who identify as Black, indigenous and women of colour. Several barriers to participation in research have been identified to date, including a disproportionate amount of family responsibilities, a disproportionate burden of clinical service, gender bias, sexual harassment and the gender pay gap. Several strategies to improve gender equity have been proposed. Increasing access to formal mentorship of women in academic medicine is frequently cited and has been used by healthcare institutions and medical societies. Senior faculty and leaders must also be conscious of including women in sponsorship and networking opportunities. Institutions should provide support for parents of all genders, including supportive parental leave policies and flexible work models. Women should also be materially supported to attend formal educational conferences targeted for women, aimed at improving networking, peer support and professional development. Finally, leaders must display a clear intolerance for sexual harassment and discrimination to drive culture change. Peers and leaders alike, of all genders, can act as upstanders and speak up on behalf of targets of discrimination, both in the moment or after the fact. Gender inequities have persisted for far too long and can no longer be ignored. Diversifying the anaesthesia research community is essential to the future of the field.
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Affiliation(s)
- A M Flexman
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - S K Shillcutt
- Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - S Davies
- Trinity College, Cambridge University, Cambridge, UK
| | - G R Lorello
- Department of Anesthesiology and Pain Medicine, University Health Network and University of Toronto, Toronto, ON, Canada
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26
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Mulder PA, van Balkom IDC, Landlust AM, Priolo M, Menke LA, Acero IH, Alkuraya FS, Arias P, Bernardini L, Bijlsma EK, Cole T, Coubes C, Dapia I, Davies S, Di Donato N, Elcioglu NH, Fahrner JA, Foster A, González NG, Huber I, Iascone M, Kaiser AS, Kamath A, Kooblall K, Lapunzina P, Liebelt J, Lynch SA, Maas SM, Mammì C, Mathijssen IB, McKee S, Mirzaa GM, Montgomery T, Neubauer D, Neumann TE, Pintomalli L, Pisanti MA, Plomp AS, Price S, Salter C, Santos-Simarro F, Sarda P, Schanze D, Segovia M, Shaw-Smith C, Smithson S, Suri M, Tatton-Brown K, Tenorio J, Thakker RV, Valdez RM, Van Haeringen A, Van Hagen JM, Zenker M, Zollino M, Dunn WW, Piening S, Hennekam RC. Development, behaviour and sensory processing in Marshall-Smith syndrome and Malan syndrome: phenotype comparison in two related syndromes. J Intellect Disabil Res 2020; 64:956-969. [PMID: 33034087 PMCID: PMC8957705 DOI: 10.1111/jir.12787] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 08/19/2020] [Accepted: 09/15/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Ultrarare Marshall-Smith and Malan syndromes, caused by changes of the gene nuclear factor I X (NFIX), are characterised by intellectual disability (ID) and behavioural problems, although questions remain. Here, development and behaviour are studied and compared in a cross-sectional study, and results are presented with genetic findings. METHODS Behavioural phenotypes are compared of eight individuals with Marshall-Smith syndrome (three male individuals) and seven with Malan syndrome (four male individuals). Long-term follow-up assessment of cognition and adaptive behaviour was possible in three individuals with Marshall-Smith syndrome. RESULTS Marshall-Smith syndrome individuals have more severe ID, less adaptive behaviour, more impaired speech and less reciprocal interaction compared with individuals with Malan syndrome. Sensory processing difficulties occur in both syndromes. Follow-up measurement of cognition and adaptive behaviour in Marshall-Smith syndrome shows different individual learning curves over time. CONCLUSIONS Results show significant between and within syndrome variability. Different NFIX variants underlie distinct clinical phenotypes leading to separate entities. Cognitive, adaptive and sensory impairments are common in both syndromes and increase the risk of challenging behaviour. This study highlights the value of considering behaviour within developmental and environmental context. To improve quality of life, adaptations to environment and treatment are suggested to create a better person-environment fit.
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Affiliation(s)
- P A Mulder
- Autism Team Northern-Netherlands, Jonx Department of (Youth) Mental Health and Autism, Lentis Psychiatric Institute, Groningen, Netherlands
| | - I D C van Balkom
- Autism Team Northern-Netherlands, Jonx Department of (Youth) Mental Health and Autism, Lentis Psychiatric Institute, Groningen, Netherlands
- Rob Giel Research Centre, Department of Psychiatry, University Medical Center Groningen, Groningen, Netherlands
| | - A M Landlust
- Autism Team Northern-Netherlands, Jonx Department of (Youth) Mental Health and Autism, Lentis Psychiatric Institute, Groningen, Netherlands
| | - M Priolo
- Unità Operativa di Genetica Medica, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - L A Menke
- Department of Paediatrics, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - I H Acero
- Genetics Unit, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - F S Alkuraya
- Saudi Human Genome Project, King Abdulaziz City for Science and Technology, and Department of Genetics, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - P Arias
- Institute of Medical and Molecular Genetics (INGEMM), Hospital Universitario La Paz, IdiPAZ, Universidad Autónoma de Madrid, and CIBERER, Centro de Investigación Biomédica en Red de Enfermedades Raras, ISCIII, Madrid, Spain
| | - L Bernardini
- Cytogenetics Unit, Casa Sollievo della Sofferenza Foundation, San Giovanni Rotondo, Italy
| | - E K Bijlsma
- Department of Clinical Genetics, Leiden University Medical Centre, Leiden, Netherlands
| | - T Cole
- Department of Clinical Genetics, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - C Coubes
- Département de Génétique Médicale, Hôpital Arnaud de Villeneuve, CHRU Montpellier, Montpellier, France
| | - I Dapia
- Institute of Medical and Molecular Genetics (INGEMM), Hospital Universitario La Paz, IdiPAZ, Universidad Autónoma de Madrid, and CIBERER, Centro de Investigación Biomédica en Red de Enfermedades Raras, ISCIII, Madrid, Spain
| | - S Davies
- Institute of Medical Genetics, University Hospital of Wales, Cardiff, UK
| | - N Di Donato
- Institute for Clinical Genetics, TU Dresden, Dresden, Germany
| | - N H Elcioglu
- Department of Pediatric Genetics, Marmara University Medical School, Istanbul and Eastern Mediterranean University, Mersin, Turkey
| | - J A Fahrner
- McKusick-Nathans Institute of Genetic Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - A Foster
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - N G González
- Unit Hospital Universitario Central de Asturias, Oviedo, Spain
| | - I Huber
- Sørland Hospital, Kristiansand, Norway
| | - M Iascone
- Medical Genetics Laboratory, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - A-S Kaiser
- Institute of Human Genetics, Heidelberg University, Heidelberg, Germany
| | - A Kamath
- Institute of Medical Genetics, University Hospital of Wales, Cardiff, UK
| | - K Kooblall
- Academic Endocrine Unit, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - P Lapunzina
- Institute of Medical and Molecular Genetics (INGEMM), Hospital Universitario La Paz, IdiPAZ, Universidad Autónoma de Madrid, and CIBERER, Centro de Investigación Biomédica en Red de Enfermedades Raras, ISCIII, Madrid, Spain
| | - J Liebelt
- South Australian Clinical Genetics Services, Women's and Children's Hospital, North Adelaide, Australia
| | - S A Lynch
- UCD Academic Centre on Rare Diseases, School of Medicine and Medical Sciences, University College Dublin, and Clinical Genetics, Temple Street Children's University Hospital, Dublin, Ireland
| | - S M Maas
- Department of Clinical Genetics, Academic Medical Center, Amsterdam, Netherlands
| | - C Mammì
- Unità Operativa di Genetica Medica, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - I B Mathijssen
- Department of Clinical Genetics, Academic Medical Center, Amsterdam, Netherlands
| | - S McKee
- Northern Ireland Regional Genetics Service, Belfast Health and Social Care Trust, Belfast, UK
| | - G M Mirzaa
- Center for Integrative Brain Research, Seattle Children's Research Institute, and Division of Genetic Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - T Montgomery
- Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | - D Neubauer
- Institute of Human Genetics, University Hospital Magdeburg, Magdeburg, Germany
| | - T E Neumann
- Mitteldeutscher Praxisverbund Humangenetik, Halle, Germany
| | - L Pintomalli
- Unità Operativa di Genetica Medica, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - M A Pisanti
- Medical Genetic and Laboratory Unit, "Antonio Cardarelli" Hospital, Naples, Italy
| | - A S Plomp
- Department of Clinical Genetics, Academic Medical Center, Amsterdam, Netherlands
| | - S Price
- Department of Clinical Genetics, Northampton General Hospital NHS Trust, Northampton, UK
| | - C Salter
- Wessex Clinical Genetics Service, Princess Ann Hospital, Southampton, UK
| | - F Santos-Simarro
- Institute of Medical and Molecular Genetics (INGEMM), Hospital Universitario La Paz, IdiPAZ, Universidad Autónoma de Madrid, and CIBERER, Centro de Investigación Biomédica en Red de Enfermedades Raras, ISCIII, Madrid, Spain
| | - P Sarda
- Département de Génétique Médicale, Hôpital Arnaud de Villeneuve, CHRU Montpellier, Montpellier, France
| | - D Schanze
- Institute of Human Genetics, University Hospital Magdeburg, Magdeburg, Germany
| | - M Segovia
- CENAGEM, Centro Nacional de Genética, Buenos Aires, Argentina
| | - C Shaw-Smith
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - S Smithson
- University Hospitals Bristol NHS Trust, Bristol, UK
| | - M Suri
- Nottingham Clinical Genetics Service, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - K Tatton-Brown
- Division of Genetics and Epidemiology, Institute of Cancer Research, London and South West Thames Regional Genetics Service, St. George's University Hospitals NHS Foundation Trust, London, UK
| | - J Tenorio
- Institute of Medical and Molecular Genetics (INGEMM), Hospital Universitario La Paz, IdiPAZ, Universidad Autónoma de Madrid, and CIBERER, Centro de Investigación Biomédica en Red de Enfermedades Raras, ISCIII, Madrid, Spain
| | - R V Thakker
- Academic Endocrine Unit, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - R M Valdez
- Genetics Unit, Hospital Militar Central "Cirujano Mayor Dr. Cosme Argerich", Buenos Aires, Argentina
| | - A Van Haeringen
- Department of Clinical Genetics, Leiden University Medical Centre, Leiden, Netherlands
| | - J M Van Hagen
- Department of Clinical Genetics, VU University Medical Centre, Amsterdam, Netherlands
| | - M Zenker
- Institute of Human Genetics, University Hospital Magdeburg, Magdeburg, Germany
| | - M Zollino
- Department of Laboratory Medicine, Institute of Medical Genetics, Catholic University, Rome, Italy
| | - W W Dunn
- Department of Occupational Therapy Education, School of Health Professions, University of Missouri, Columbia, MO, USA
| | - S Piening
- Autism Team Northern-Netherlands, Jonx Department of (Youth) Mental Health and Autism, Lentis Psychiatric Institute, Groningen, Netherlands
- Rob Giel Research Centre, Department of Psychiatry, University Medical Center Groningen, Groningen, Netherlands
| | - R C Hennekam
- Autism Team Northern-Netherlands, Jonx Department of (Youth) Mental Health and Autism, Lentis Psychiatric Institute, Groningen, Netherlands
- Department of Paediatrics, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
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Vandenbriele C, Balthazar T, Wilson J, Ledot S, Smith R, Caetano A, Adriaenssens T, Goetschalckx K, Janssens S, Dubois C, Jacobs S, Meyns B, Davies S, Price S. Left heart Impella-device to bridge acute mitral regurgitation to MitraClip-procedure: a novel implementation of percutaneous mechanical circulatory support. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1849] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Acute mitral regurgitation (MR) is an emergency, often requiring urgent surgery. Severe acute MR presenting with hemodynamic collapse is usually caused by papillary muscle rupture or dysfunction after acute myocardial infarction (AMI) or chordal rupture, resulting in flail mitral leaflet(s). Preoperative stabilization is complex due to concomitant hemodynamic collapse and hypoxic respiratory failure. Finding the right balance between both preload and inotropic support is challenging. When patients are too sick for immediate surgical intervention, mechanical circulatory support can be considered because of its ability to both unload and reduce of cardiac work while increasing coronary perfusion and cardiac output. Nevertheless, even after initial stabilization, surgical risk remains high in critically ill acute severe MR patients and transcatheter treatments such as MitraClip are increasingly being explored.
Methods
Between August 2017 and September 2019, patients presenting with acute severe mitral regurgitation and considered too ill for immediate surgical intervention (EURO-II score >11.2% plus pulmonary oedema necessitating mechanical ventilation and/or hemodynamic instability), were selected for an Impella-assisted LV unloading technique as bridge to MitraClip-procedure. Five patients were selected for the combined left Impella/MitraClip-procedure in two tertiary cardiac ICUs.
Results
The mean age was 72 years. The cause of MR was ischemic in 20% and all patients presented in cardiogenic shock state, necessitating mechanical ventilation. The overall cardiac operative risk assessment (Euro-II) score predicted a 35% chance of in-hospital mortality. Cardiac output was severely impaired (mean LVOT VTI 8.2 cm). All patients were on inotropic support and supported by an Impella-CP pVAD (mean flow 2.5 Liter per minute; mean 6.3 days of support). In all cases, we managed to reduce the LVEDP below 15 mmHg using the combination of medical therapy (afterload reduction, inotropes), mechanical ventilation and pVAD-therapy. The MR was significantly reduced by a MitraClip-procedure in each Impella supported patient. The overall survival at discharge was 80%. One patient with late referral and multiple organ failure at presentation deceased due to refractory cardiogenic shock. Overall, severe MR was reduced to grade 1+ and all four patients survived 6 months after discharge with only one readmission for decompensated heart failure.
Conclusions
A combined strategy of Impella and MitraClip appears to be a novel, feasible alternative for patients presenting with acute, severe MR unable to proceed to a corrective surgical procedure at presentation due to severe left ventricular forward flow failure. In these cases, the early initiation of pVAD-support may reduce the risk of development of irreversible end- organ damage and dysfunction. Exploration in a larger, randomised population is warranted to investigate this strategy further.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- C Vandenbriele
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | - T Balthazar
- University Hospitals (UZ) Leuven, Leuven, Belgium
| | - J Wilson
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | - S Ledot
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | - R Smith
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | - A.F Caetano
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | | | | | - S Janssens
- University Hospitals (UZ) Leuven, Leuven, Belgium
| | - C Dubois
- University Hospitals (UZ) Leuven, Leuven, Belgium
| | - S Jacobs
- University Hospitals (UZ) Leuven, Leuven, Belgium
| | - B Meyns
- University Hospitals (UZ) Leuven, Leuven, Belgium
| | - S Davies
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | - S Price
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
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Uribe CF, Fletcher BP, Davies S, Norton PT, Kern JA, Clouse WD. Use of ascending aortic access for imaging and wire rail access for endograft delivery in complex aortic arch anatomy. J Vasc Surg Cases Innov Tech 2020; 7:6-9. [PMID: 33665523 PMCID: PMC7902275 DOI: 10.1016/j.jvscit.2020.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 10/06/2020] [Indexed: 11/15/2022]
Abstract
In cases of complex aortic arch anatomy, it can be difficult to obtain wire access into the ascending aorta for deployment of a thoracic endograft (thoracic endovascular aortic repair [TEVAR]) using a transfemoral approach. This can result from tortuosity or patulous aneurysmal areas, making platform stability difficult. We report the case of a young adult man with a large proximal left subclavian aneurysm that made zone 0 TEVAR placement very difficult with transfemoral access alone. Direct ascending aortic access through the open chest allowed for a stable through-and-through platform for endograft delivery, highlighting the efficacy of this seldom-needed technique during debranching TEVAR procedures.
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Affiliation(s)
- Celso F Uribe
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, Va
| | - Brian P Fletcher
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, Va
| | - Stephen Davies
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, Va
| | - Patrick T Norton
- Division of Body Imaging, Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Va
| | - John A Kern
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, Va
| | - W Darrin Clouse
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, Va
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Arshaghi TE, Clifford J, Davies S, Barry F. Mesenchymal stem cell exosome characterisation and high-throughput quantification by fluorescence polarisation spectroscopy. Cytotherapy 2020. [DOI: 10.1016/j.jcyt.2020.03.057] [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: 10/24/2022]
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Skapinakis P, Lewis G, Davies S, Brugha T, Prince M, Singleton N. Panic disorder and subthreshold panic in the UK general population: Epidemiology, comorbidity and functional limitation. Eur Psychiatry 2020; 26:354-62. [DOI: 10.1016/j.eurpsy.2010.06.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2010] [Revised: 06/14/2010] [Accepted: 06/23/2010] [Indexed: 10/19/2022] Open
Abstract
AbstractObjectiveThe epidemiology of panic disorder has not been investigated in the past in the UK using a nationally representative sample of the population. The aim of the present paper was to examine the epidemiology, comorbidity and functional impairment of subthreshold panic and panic disorder with or without agoraphobia.MethodWe used data from the 2000 Office for National Statistics Psychiatric Morbidity survey (N = 8580). Panic disorder and agoraphobia were assessed with the Revised Clinical Interview Schedule (CIS-R).ResultThe prevalence of panic disorder with or without agoraphobia was 1.70% (95% confidence interval: 1.41–2.03%). Subthreshold panic was more common. Economic inactivity was consistently associated with all syndromes. The comorbidity pattern of the panic syndromes and the associated functional impairment show that panic-related conditions are important public health problems, even in subthreshold status.ConclusionsThe findings show that efforts to reduce the disability associated with psychiatric disorders should include detection and management of panic disorder.
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Brown EA, Davies SJ, Heimbürger O, Meeus F, Mellotte G, Rosman J, Rutherford P, Van Bree M, Borras M, Brown E, Caillette–Beaudoin A, Clutterbuck E, Davies S, D'Auzac C, Ekstrand A, Frandsen N, Freida P, Heimbürger O, Kuypers+ D, Gasthuisberg+ A, Mactier R, MacNamara E, Malmsten G, Mastrangelo F, Meeus F, Melotte G, Perez–Contreras J, Riegel W, Rodrigues A, Rodriguez–Carmona A, Rosman J, Rutherford P, Scanziani R, Vega Diaz N, Vychytil A, Weinreich T. Adequacy Targets Can be Met in Anuric Patients by Automated Peritoneal Dialysis: Baseline Data from Eapos. Perit Dial Int 2020. [DOI: 10.1177/089686080102103s19] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
♦ Objective Conventional continuous ambulatory peritoneal dialysis (CAPD) in patients without residual renal function and with high solute transport is associated with worse clinical outcomes. Automated peritoneal dialysis (APD) has the potential to improve both solute clearance and ultrafiltration in these circumstances, but its efficacy as a treatment modality is unknown. The European Automated Peritoneal Dialysis Outcomes Study (EAPOS) is a 2-year, prospective, European multi-center study designed to determine APD feasibility and clinical outcomes in anuric patients. The present article describes the baseline data for patients recruited into the study. ♦ Design All PD patients treated in the participating centers were screened for inclusion criteria [urinary output < 100 mL/24 h, or residual renal function (RRF) < 1 mL/min, or both]. After enrollment, changes were made to the dialysis prescription to achieve a weekly creatinine clearance above 60 L per 1.73 m2 and an ultrafiltration rate above 750 mL in 24 hours. ♦ Setting The study is being conducted in 26 dialysis centers in 13 European countries. ♦ Baseline Data Collection The information collected includes patient demographics, dialysis prescription, achieved weekly creatinine clearance, and 24-hour ultra-filtration (UF). ♦ Results The study enrolled 177 anuric patients. Median dialysis duration before enrollment was 22.5 months (range: 0 – 285 months). Mean solute transport measured as the dialysate-to-plasma ratio of creatinine (D/PCr) was 0.74 ± 0.12. Patients received APD for a median of 9.0 hours overnight (range: 7 – 12 hours) using a median of 11.0 L of fluid (range: 6 – 28.75 L). Median daytime volume was 4.0 L (range: 0.0 – 9.0 L). Tidal dialysis was used in 26 patients, and icodextrin in 86 patients. At baseline, before treatment optimization, the weekly mean total creatinine clearance was 65.2 ± 14.4 L/1.73 m2, with 105 patients (60%) achieving the target of more than 60 L/1.73 m2. At baseline, 81% of patients with high transport, 69% with high-average transport, and 40% with low-average transport met the target. At baseline, 70% of patients with a body surface area (BSA) below 1.7 m2, 60% with a BSA of 1.7 – 2.0 m2, and 56% with a BSA above 2.0 m2 achieved 60 L/1.73 m2 weekly. Median UF was 1090 mL/24 h, and 75% of patients achieved the UF target of more than 750 mL/24 h. ♦ Conclusion This baseline analysis of anuric patients recruited into the EAPOS study demonstrates that a high proportion of anuric patients on APD can achieve dialysis and ultrafiltration targets using a variety of regimes. This 2-year follow-up study aims to optimize APD prescription to reach predefined clearance and ultrafiltration targets, and to observe the resulting clinical outcomes.
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Affiliation(s)
| | | | | | | | | | | | | | | | - M. Borras
- Hospital Amau de Vilanova, Lerida, Spain
| | - E. Brown
- Charing Cross Hospital, London, U.K
| | | | | | - S. Davies
- North Staffordshire Hospital, Stoke-on-Trent, U.K
| | - C. D'Auzac
- Hôpital Européen Georges Pompidou, Paris, France
| | - A. Ekstrand
- Helsinki University Hospital, Helsinki, Finland
| | | | - P. Freida
- Centre Hospitalier Louis Pasteur, Cherbourg, France
| | | | | | | | - R. Mactier
- Stobhill Hospital NHS Trust, Glasgow, Scotland, U.K
| | - E. MacNamara
- Centre Hospitalier Germon et Gauthier, Bethune, France
| | - G. Malmsten
- Orebro Medical Center Hospital, Orebro, Sweden
| | | | - F. Meeus
- Centre Hospitalier Louise Michel Evry, Evry, France
| | | | | | - W. Riegel
- Klinikum Darmstadt, Darmstadt, Germany
| | | | | | - J. Rosman
- Westeinde Hospital, The Hague, Netherlands
| | | | | | - N. Vega Diaz
- Hospital Nuestra Senora del Pino, Las Palmas, Spain
| | - A. Vychytil
- Universitat Klinik für Innere Medezin III, Vienna, Austria
| | - T. Weinreich
- Dialyse Institüt Villingen– Schwenningen, Schwenningen, Germany
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Peacock M, Paterson J, Reed L, Davies S, Carter S, Coe A, Clarkson J. Innovation in Fischer–Tropsch: Developing Fundamental Understanding to Support Commercial Opportunities. Top Catal 2020. [DOI: 10.1007/s11244-020-01239-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AbstractIn this contribution we provide details of the BP-Johnson Matthey proprietary Fischer–Tropsch technology and the advanced CANS reactor and catalyst system. The advanced CANS catalyst carrier reactor provides superior heat transfer, reduced pressure drop and higher productivity that lead to major economic savings. Fundamental understanding of catalyst behaviour is also key to obtaining a catalyst that is stable over the lifetime of its use. Synthesis, calcination and reduction steps introduce changes in the catalyst properties prior to syngas introduction. In particular, the presence of water can affect the final catalyst performance. The activity of a good catalyst can be significantly reduced by a sub-optimal activation or start-up. Similarly, stable operation and minimising deactivation are vital for long and stable catalyst life, with years of operation without requiring regeneration. In this report we also share a fundamental study on the catalyst activation across different catalyst supports. This combines advanced in situ techniques with reactor testing to explore the role of the support on catalyst performance. The results illustrate the critical need for a logical and systematic catalyst development programme to explore these effects to optimise the whole FT process. The combination of a joint approach in development plays a key role in a long term success in a process. The fundamental catalyst understanding, optimisation and improvements in combination with the novel CANS reactor design maximise their potential and offer the potential for a world leading technology.
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Davies S, Marino L, Underwood T, West M. Handgrip strength and nutritional status as a predictor of postoperative complications following oesophagectomy and gastrectomy. Clin Nutr ESPEN 2020. [DOI: 10.1016/j.clnesp.2019.12.039] [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: 11/25/2022]
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Riley P, Glenny AM, Worthington HV, Jacobsen E, Robertson C, Durham J, Davies S, Petersen H, Boyers D. Oral splints for patients with temporomandibular disorders or bruxism: a systematic review and economic evaluation. Health Technol Assess 2020; 24:1-224. [PMID: 32065109 PMCID: PMC7049908 DOI: 10.3310/hta24070] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Splints are a non-invasive, reversible management option for temporomandibular disorders or bruxism. The clinical effectiveness and cost-effectiveness of splints remain uncertain. OBJECTIVES The objectives were to evaluate the clinical effectiveness and cost-effectiveness of splints for patients with temporomandibular disorders or bruxism. This evidence synthesis compared (1) all types of splint versus no/minimal treatment/control splints and (2) prefabricated versus custom-made splints, for the primary outcomes, which were pain (temporomandibular disorders) and tooth wear (bruxism). REVIEW METHODS Four databases, including MEDLINE and EMBASE, were searched from inception until 1 October 2018 for randomised clinical trials. The searches were conducted on 1 October 2018. Cochrane review methods (including risk of bias) were used for the systematic review. Standardised mean differences were pooled for the primary outcome of pain, using random-effects models in temporomandibular disorder patients. A Markov cohort, state-transition model, populated using current pain and Characteristic Pain Intensity data, was used to estimate the incremental cost-effectiveness ratio for splints compared with no splint, from an NHS perspective over a lifetime horizon. A value-of-information analysis identified future research priorities. RESULTS Fifty-two trials were included in the systematic review. The evidence identified was of very low quality with unclear reporting by temporomandibular disorder subtype. When all subtypes were pooled into one global temporomandibular disorder group, there was no evidence that splints reduced pain [standardised mean difference (at up to 3 months) -0.18, 95% confidence interval -0.42 to 0.06; substantial heterogeneity] when compared with no splints or a minimal intervention. There was no evidence that other outcomes, including temporomandibular joint noises, decreased mouth-opening, and quality of life, improved when using splints. Adverse events were generally not reported, but seemed infrequent when reported. The most plausible base-case incremental cost-effectiveness ratio was uncertain and driven by the lack of clinical effectiveness evidence. The cost-effectiveness acceptability curve showed splints becoming more cost-effective at a willingness-to-pay threshold of ≈£6000, but the probability never exceeded 60% at higher levels of willingness to pay. Results were sensitive to longer-term extrapolation assumptions. A value-of-information analysis indicated that further research is required. There were no studies measuring tooth wear in patients with bruxism. One small study looked at pain and found a reduction in the splint group [mean difference (0-10 scale) -2.01, 95% CI -1.40 to -2.62; very low-quality evidence]. As there was no evidence of a difference between splints and no splints, the second objective became irrelevant. LIMITATIONS There was a large variation in the diagnostic criteria, splint types and outcome measures used and reported. Sensitivity analyses based on these limitations did not indicate a reduction in pain. CONCLUSIONS The very low-quality evidence identified did not demonstrate that splints reduced pain in temporomandibular disorders as a group of conditions. There is insufficient evidence to determine whether or not splints reduce tooth wear in patients with bruxism. There remains substantial uncertainty surrounding the most plausible incremental cost-effectiveness ratio. FUTURE WORK There is a need for well-conducted trials to determine the clinical effectiveness and cost-effectiveness of splints in patients with carefully diagnosed and subtyped temporomandibular disorders, and patients with bruxism, using agreed measures of pain and tooth wear. STUDY REGISTRATION This study is registered as PROSPERO CRD42017068512. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 7. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Philip Riley
- Cochrane Oral Health, Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Anne-Marie Glenny
- Cochrane Oral Health, Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Helen V Worthington
- Cochrane Oral Health, Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Elisabet Jacobsen
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Clare Robertson
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Justin Durham
- Centre for Oral Health Research and School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Stephen Davies
- TMD Unit, University Dental Hospital of Manchester, Manchester, UK
| | - Helen Petersen
- University Dental Hospital of Manchester, Manchester, UK
| | - Dwayne Boyers
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
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Roberts J, Kontou K, Davies S, Gray T. P1.07-02 Implementation of a Health and Wellbeing Programme in Conjunction with Pulmonary Rehabiliatation. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1011] [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: 11/26/2022]
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Davidson M, Mansukhani S, Starling N, Chau I, Watkins D, Cunningham D, Rao S, Lazaro-Alcausi R, Griffiths B, Barber L, Morganstein D, Forster M, Davies S, Begum R, Gillbanks A, Kalaitzaki E, Wotherspoon A, Von Loga K, Chaudry A, Gerlinger M. Perioperative FLOT + anti-PD-L1 avelumab (FLOT-A) chemo-immunotherapy in resectable oesophagogastric adenocarcinoma (OGA): Safety and biomarker data from the ICONIC trial safety run-in. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz247.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Vandenbriele C, Wilson J, Baker A, Azzu A, Gambaro A, Morosin M, Arachchillage D, Rosenberg A, Davies S, Trimlett R, Ledot S, Price S. P1718Veno-arterial ECMO versus Left Impella bleeding complications in cardiogenic shock patients on dual antiplatelet therapy. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Selective groups of patients, presenting with INTERMACS-1 cardiogenic shock due to acute ischaemic heart failure, may benefit from mechanical circulatory support (MCS). Patients with biventricular failure, severe septic shock or oxygenation problems should be selected for VA-ECMO, although the left Impella-CP heart pump can be considered as a less invasive alternative in supporting predominantly left ventricular failure. Bleeding issues are a major concern in patients on MCS, especially in this group where triple anticoagulation therapy (unfractionated heparin (UFH) for prevention of pump thrombosis and dual antiplatelet therapy (DAPT) after coronary stenting) is necessitated. We aim to investigate the bleeding and transfusion rate in DAPT-patients on VA-ECMO versus Impella.
Methods
We report single center data for 51 VA-ECMO and 8 Impella patients between 2011 and 2019. Indication for MCS was acute ischaemic cardiogenic shock. Patient demographics, transfusions and reported/radiographically diagnosed bleeding (BARC-classification) complications were analyzed. All patients received UFH and low dose aspirin plus clopidogrel or ticagrelor. Impella flow was at least 2.5 L/min. Transfusion targets were Hb >7 g/dl, fibrinogen >100 mg/dl (or >150 mg/dl when active bleeding) and platelet count >50/fL.
Results
Impella patients were significantly older (VA-ECMO 52.8 vs. Impella 62.4; p=0.02) as compared to the VA-ECMO group. Anti-Xa-levels and length of the MCS-run (mean 7.9 VA-ECMO vs. 6.4 days Impella) were comparable in both groups. Occurrences of minor bleeds was comparable between both groups (mainly oozing from the insertion site in the ImpellaTM group 63% vs. VA-ECMO 72%; p>0.05) but major bleedings with BARC score of 3 or more were significantly lower in the Impella group (13% vs. VA-ECMO 65%; p=0.005). Platelet and red blood cell transfusions were significantly lower in the Impella group (0.1 units of platelets per day vs. 1.1 units of platelets per day on VA-ECMO; p=0.002 and 0.8 units of RBCs per day vs. 2.6 units of RBCs per day on VA-ECMO; p=0.02).
Bleeding/transfusion VA-ECMO vs Impella
Conclusions
Bleeding is a frequent complication of MCS. However, in our cohort, triple anticoagulation in acute cardiogenic shock due to ischaemic left ventricle failure resulted in a lower major bleeding rate when support was given by the left Impella device as compared with VA-ECMO therapy group. As a result, platelet and red blood cell transfusions were lower in the Impella group. These findings are likely to be partly explained by the increased number and size of cannulas in VA-ECMO, as well as the increased risk of haemolysis and consumptive coagulopathy due to the complexity and extensive foreign body surface of the ECMO-circuit. We conclude that Impella support should be considered as a safer option than VA-ECMO with regards to bleeding in patients with ischaemic left ventricular failure who require DAPT and MCS as a bridge to recovery or other definitive therapy.
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Affiliation(s)
- C Vandenbriele
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | - J Wilson
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | - A Baker
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | - A Azzu
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | - A Gambaro
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | - M Morosin
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | - D Arachchillage
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | - A Rosenberg
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | - S Davies
- Royal Brompton and Harefield NHS Foundation Trust, Cardiology, London, United Kingdom
| | - R Trimlett
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | - S Ledot
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | - S Price
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
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Autran-Martínez M, Cortes-Acevedo P, Cerón-Gutiérrez L, Davies S, Mendoza-Elvira ES, Martínez-Rodríguez HA, Liboni C, Pérez-Valencia V, Döffinger R, Barcenas-Morales G. High incidence of anti-cytokine autoantibodies in dogs with immune diseases suggests important immuno-regulatory functions. Vet Immunol Immunopathol 2019; 214:109902. [PMID: 31378221 DOI: 10.1016/j.vetimm.2019.109902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 07/09/2019] [Accepted: 07/14/2019] [Indexed: 11/30/2022]
Abstract
Autoantibodies against cytokines have been associated with immunodeficiency, susceptibility to infectious diseases, autoimmunity and inflammation in humans, but have not yet been investigated in the Veterinary field so far. The aim of the current study was to determine the presence of anti-cytokine autoantibodies in canines suffering from various conditions including recurrent infections, autoimmune diseases and cancer in comparison to healthy controls. This is the first report of the presence of autoantibodies against cytokines in dogs. A total of 101 serum samples (51 patients and 50 clinically healthy dogs) from the state of Mexico and surroundings were analysed using a multiplex bead-based flow cytometry assay. Results show significant levels of various anti-cytokine autoantibodies in diseased dogs but not in healthy controls. In addition we show distinct associations of various disease types to the specificity of anti-cytokine autoantibodies and to response complexities. Apart from the direct functional/causal implication of anti-cytokine auto-antibodies on disease processes, this findings point to the possibility to use anti-cytokine response patterns as diagnostic tools.
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Affiliation(s)
- M Autran-Martínez
- Laboratorio 2 Inmunología, Facultad de Estudios Superiores (FES) Cuautitlán, Universidad Nacional Autonoma de México (UNAM), Mexico
| | - P Cortes-Acevedo
- Laboratorio 2 Inmunología, Facultad de Estudios Superiores (FES) Cuautitlán, Universidad Nacional Autonoma de México (UNAM), Mexico
| | - L Cerón-Gutiérrez
- Department of Clinical Biochemistry and Immunology, Addenbrookes Hospital and National Institute of Health Research (NIHR), Cambridge Biomedical Research Centre, Cambridge, UK
| | - S Davies
- Department of Clinical Biochemistry and Immunology, Addenbrookes Hospital and National Institute of Health Research (NIHR), Cambridge Biomedical Research Centre, Cambridge, UK
| | - E S Mendoza-Elvira
- Laboratorio de Microbiología. FES Cuautitlan, UNAM, Estado de México, Mexico
| | | | - C Liboni
- Universitá degli studi di Padova, Dipartimento di Scienze Biomediche- Via Ugo Bassi, 58/B-35131 Padova Italy Fondazione Istituto di Ricerca Pediatrica Cittá della Speranza-Corso Stati Uniti, 4-37127, Padova, Italy
| | | | - R Döffinger
- Department of Clinical Biochemistry and Immunology, Addenbrookes Hospital and National Institute of Health Research (NIHR), Cambridge Biomedical Research Centre, Cambridge, UK.
| | - G Barcenas-Morales
- Laboratorio 2 Inmunología, Facultad de Estudios Superiores (FES) Cuautitlán, Universidad Nacional Autonoma de México (UNAM), Mexico
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41
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Cullis B, Brusselmans A, Davies S, Finkelstein O F, Hendricks K, McCulloch M, Smoyer E W, Feehally J. SAT-157 THE SAVING YOUNG LIVES PROGRAM: PROOF OF PRINCIPLE AND OVERCOMING BARRIERS. Kidney Int Rep 2019. [DOI: 10.1016/j.ekir.2019.05.189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Howell S, Hoeks S, West R, Wheatcroft S, Hoeft A, Leva B, Plichon B, Damster S, Momeni M, Watremez C, Kahn D, Dincq AS, Danila A, Wittmann M, Struck R, Rüddel T, Kessler F, Rasche S, Matsota P, Hasani A, Gudaityte J, Karbonskiene A, Ferreira R, Carvalho S, Tomescu D, Martac C, Grintescu I, Mirea L, Serrano L, Serrano L, Sierra P, Sabaté S, Hernando D, Matute P, Trashorras M, Suñé M, Sarmiento L, Hervias A, González O, Hermina A, González O, Hermina A, Navarro Perez R, Orts M, Fernandez-Garcia R, Sanchez Pérez D, Sepulveda Gil I, Monedero P, Hidalgo F, Mbongo C, Pont A, Reyes H, Bartolo C, Galera S, Valentijn T, Stolker R, Tugrul M, Emre Demirel E, Hough M, Griffiths K, Birch S, Beardow Z, Elliot S, Thompson J, Bowrey S, Northey M, Melson H, Telford R, Nadolski M, Potter A, Fuller D, Rose A, Varma S, Simeson K, Pettit J, Smith N, Martinson V, Sleight L, Naylor C, Watt P, Raymode P, Dunk N, Twohey L, Hollos L, Davies S, Gibson A, Coleman Z, Tamm T, Joscak J, Zsisku L, Zuleika M, Carvalho P, Collyer T, Ryan J, Colling K, Dharmarajah S, Krishnan A, Paddle J, Fouracres A, Arnell K, Muhammad K. Prospective observational cohort study of the association between antiplatelet therapy, bleeding and thrombosis in patients with coronary stents undergoing noncardiac surgery. Br J Anaesth 2019; 122:170-179. [DOI: 10.1016/j.bja.2018.09.029] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 09/16/2018] [Accepted: 09/24/2018] [Indexed: 01/19/2023] Open
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Ramsdell G, Davies S, Ailawadi G, Singh KE. An unusual appearance of a large mitral valve cleft within a prolapsing segment diagnosed by three-dimensional transesophageal echocardiography. Echocardiography 2018; 35:2124-2126. [PMID: 30324625 DOI: 10.1111/echo.14159] [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] [Received: 07/19/2018] [Accepted: 09/12/2018] [Indexed: 11/27/2022] Open
Abstract
Eighty-year-old woman presented for minimally invasive mitral valve repair for severe mitral regurgitation. Intraoperative two-dimensional transesophageal echocardiography (2DTEE) and subsequent three-dimensional transesophageal echocardiography examination showed severe mitral valve regurgitation with a bidirectional jet caused by both P2 segment prolapse and a large cleft within the P2 segment. The preoperative diagnosis of this complex pathology was challenging by 2DTEE, and a 3D examination of the mitral valve was helpful to confirm the presence of a cleft within the prolapsing segment.
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Affiliation(s)
- Geoffrey Ramsdell
- Department of Anesthesiology, University of Virginia, Charlottesville, Virginia
| | - Stephen Davies
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Gorav Ailawadi
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Karen E Singh
- Department of Anesthesiology, University of Virginia, Charlottesville, Virginia
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Davies S, George A, Macallister A, Barton H, Youssef A, Boyle L, Sequeiros I. “It's all in the history”: A service evaluation of the quality of radiological requests in acute imaging. Radiography (Lond) 2018; 24:252-256. [DOI: 10.1016/j.radi.2018.03.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 03/11/2018] [Accepted: 03/18/2018] [Indexed: 10/17/2022]
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Kaseda R, Tsuchida Y, Gamboa JL, Zhong J, Zhang L, Yang H, Dikalova A, Bian A, Davies S, Fogo AF, Linton MF, Brown NJ, Ikizler TA, Kon V. Angiotensin receptor blocker vs ACE inhibitor effects on HDL functionality in patients on maintenance hemodialysis. Nutr Metab Cardiovasc Dis 2018; 28:582-591. [PMID: 29691148 PMCID: PMC5959764 DOI: 10.1016/j.numecd.2018.02.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 02/26/2018] [Accepted: 02/28/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Angiotensin receptor blockers (ARB) and angiotensin converting enzyme inhibitors (ACEI) reduce cardiovascular events in the general population. Maintenance hemodialysis (MHD) patients are at high cardiovascular risk but few studies have directly addressed the comparative efficacy of these drugs. MHD disrupts the normally atheroprotective actions of high density lipoprotein (HDL), therefore, we compared ACEI or ARB treatment on HDL functions in MHD. METHODS AND RESULTS HDL was isolated at the starting point (pre) and 3-6 months later (post) in 30 MHD randomly assigned to placebo, ramipril or valsartan. Outcomes included cholesterol efflux, inflammatory cytokine response, effects on Toll-like receptors (TLR), superoxide production, methylarginine and serum amyloid A (SAA) levels. HDL from ARB- or ACEI-treated subjects was more effective in maintaining efflux than HDL of placebo. HDL from ARB- or ACEI-treated subjects but not placebo lessened cellular superoxide production. In contrast, neither ARB nor ACEI improved HDL anti-inflammatory effect. Indeed, HDL of ACEI-treated subjects potentiated the cytokine responses in association with activation of TLR but did not alter the HDL content of methylarginines or SAA. CONCLUSION Both ACEI and ARB stabilized HDL cholesterol acceptor function and sustained cellular anti-oxidative effects but not anti-inflammatory effects, and ACEI-treatment instead amplified the HDL inflammatory response. The findings reveal possible utility of antagonizing angiotensin actions in MDH and suggest a possible mechanism for superiority of ARB vs ACEI in the setting of advanced kidney disease.
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Affiliation(s)
- R Kaseda
- Pediatric Nephrology, VUMC, Nashville, TN, USA
| | - Y Tsuchida
- Pediatric Nephrology, VUMC, Nashville, TN, USA
| | | | - J Zhong
- Pediatric Nephrology, VUMC, Nashville, TN, USA; Pathology, Microbiology and Immunology, Nashville, TN, USA
| | - L Zhang
- Pharmacology, Nashville, TN, USA
| | - H Yang
- Pediatric Nephrology, VUMC, Nashville, TN, USA; Pathology, Microbiology and Immunology, Nashville, TN, USA
| | | | - A Bian
- Biostatistics, Vanderbilt Medical Center, Nashville, TN, USA
| | - S Davies
- Pharmacology, Nashville, TN, USA
| | - A F Fogo
- Pediatric Nephrology, VUMC, Nashville, TN, USA; Medicine, Nashville, TN, USA; Pathology, Microbiology and Immunology, Nashville, TN, USA
| | | | | | | | - V Kon
- Pediatric Nephrology, VUMC, Nashville, TN, USA.
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46
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Damen A, Heyenbruch D, Gong N, Maurer K, Grimley M, Nelson A, Davies S, Lutzko C, Zhu X, Bollard C, Hanley P, Leemhuis T. Production of quadrivalent virus-specific t cells utilizing peptide stimulation. Cytotherapy 2018. [DOI: 10.1016/j.jcyt.2018.02.292] [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: 10/17/2022]
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Abstract
Background A growing number of hemodialysis patients are dependent upon central venous catheters (CVCs) for long-term vascular access. Although many complications of CVCs have been documented, the phenomenon of the stuck catheter is described relatively infrequently. Case report We describe a case where attempts to remove the line by exploration of the jugular insertion site in theater were unsuccessful and the line was internalized. Discussion The case is then discussed with all available cases in the literature to suggest principles of managing and preventing the stuck catheter phenomenon.
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Affiliation(s)
- M. Field
- Department of Vascular and General Surgery, University Hospital North Staffordshire, Stoke-on-Trent - UK
| | - J. Pugh
- The Medical School, Keele University, Stoke-on-Trent - UK
| | - J. Asquith
- Department of Radiology, University Hospital North Staffordshire, Stoke-on-Trent - UK
| | - S. Davies
- Department of Nephrology, University Hospital North Staffordshire, Stoke-on-Trent - UK
| | - A.D. Pherwani
- Department of Vascular and General Surgery, University Hospital North Staffordshire, Stoke-on-Trent - UK
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48
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Riddick SN, Hancock BR, Robinson AD, Connors S, Davies S, Allen G, Pitt J, Harris NRP. Development of a low-maintenance measurement approach to continuously estimate methane emissions: A case study. Waste Manag 2018; 73:210-219. [PMID: 28003116 DOI: 10.1016/j.wasman.2016.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 12/02/2016] [Accepted: 12/04/2016] [Indexed: 06/06/2023]
Abstract
The chemical breakdown of organic matter in landfills represents a significant source of methane gas (CH4). Current estimates suggest that landfills are responsible for between 3% and 19% of global anthropogenic emissions. The net CH4 emissions resulting from biogeochemical processes and their modulation by microbes in landfills are poorly constrained by imprecise knowledge of environmental constraints. The uncertainty in absolute CH4 emissions from landfills is therefore considerable. This study investigates a new method to estimate the temporal variability of CH4 emissions using meteorological and CH4 concentration measurements downwind of a landfill site in Suffolk, UK from July to September 2014, taking advantage of the statistics that such a measurement approach offers versus shorter-term, but more complex and instantaneously accurate, flux snapshots. Methane emissions were calculated from CH4 concentrations measured 700m from the perimeter of the landfill with observed concentrations ranging from background to 46.4ppm. Using an atmospheric dispersion model, we estimate a mean emission flux of 709μgm-2s-1 over this period, with a maximum value of 6.21mgm-2s-1, reflecting the wide natural variability in biogeochemical and other environmental controls on net site emission. The emissions calculated suggest that meteorological conditions have an influence on the magnitude of CH4 emissions. We also investigate the factors responsible for the large variability observed in the estimated CH4 emissions, and suggest that the largest component arises from uncertainty in the spatial distribution of CH4 emissions within the landfill area. The results determined using the low-maintenance approach discussed in this paper suggest that a network of cheaper, less precise CH4 sensors could be used to measure a continuous CH4 emission time series from a landfill site, something that is not practical using far-field approaches such as tracer release methods. Even though there are limitations to the approach described here, this easy, low-maintenance, low-cost method could be used by landfill operators to estimate time-averaged CH4 emissions and their impact downwind by simultaneously monitoring plume advection and CH4 concentrations.
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Affiliation(s)
- S N Riddick
- Centre for Atmospheric Science, Dept. of Chemistry, University of Cambridge, United Kingdom.
| | - B R Hancock
- Centre for Atmospheric Science, Dept. of Chemistry, University of Cambridge, United Kingdom
| | - A D Robinson
- Centre for Atmospheric Science, Dept. of Chemistry, University of Cambridge, United Kingdom
| | - S Connors
- Centre for Atmospheric Science, Dept. of Chemistry, University of Cambridge, United Kingdom
| | - S Davies
- Viridor Waste Management Limited, Peninsula House, Rydon Lane, Exeter, United Kingdom
| | - G Allen
- Centre for Atmospheric Science, University of Manchester, United Kingdom
| | - J Pitt
- Centre for Atmospheric Science, University of Manchester, United Kingdom
| | - N R P Harris
- Centre for Atmospheric Science, Dept. of Chemistry, University of Cambridge, United Kingdom
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49
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Lei JT, Shao J, Zhang J, Iglesia M, Chan DW, Cao J, Anurag M, Singh P, Haricharan S, Kavuri SM, Matsunuma R, Schmidt C, Kosaka Y, Crowder R, Hoog J, Phommaly C, Goncalves R, Ramalho S, Rodrigues-Peres RM, Lai WC, Hampton O, Rogers A, Tobias E, Parikh P, Davies S, Ma C, Suman V, Hunt K, Watson M, Hoadley KA, Thompson A, Perou CM, Creighton CJ, Maher C, Ellis MJ. Abstract PD8-03: ESR1 gene fusions drive endocrine therapy resistance and metastasis in breast cancer. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-pd8-03] [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: 11/16/2022]
Abstract
Abstract
Background. Dysregulation of the estrogen receptor gene (ESR1) is an established mechanism of inducing endocrine therapy resistance. We previously discovered a chromosomal translocation event generating an estrogen receptor gene fused in-frame to C-terminal sequences of YAP1 (ESR1-YAP1) that contributed to endocrine therapy resistance in estrogen receptor positive (ER+) breast cancer models. This study compares functional, transcriptional, and pharmacological properties of additional ESR1 gene fusion events of both early stage (ESR1-NOP2) late stage (ESR1-YAP1 and ESR1-PCDH11x) breast cancers to gain a better understanding of therapeutic resistance and metastasis. Understanding the role of ESR1 fusions in inducing metastasis is critical, since the primary cause of death in breast cancer patients is through metastasis to distant sites.
Methods. RNA-seq screens identified ESR1 fusions from early and late stage, endocrine therapy resistant breast tumor samples. Functional experiments were conducted using ER+ breast cancer cell lines, xenograft, and PDX models to test the ability of ESR1 fusions to induce therapeutic resistance and metastasis. ChIP-seq and RNA-seq were performed to examine transcriptional properties and differential gene expression induced by the fusions which directed subsequent pharmacological experiments with a CDK4/6 inhibitor.
Results. ESR1-YAP1 and ESR1-PCDH11x promoted estrogen-independent and fulvestrant-resistant growth in vitro and induced greater tumor growth and increased metastatic capacity to the lungs of xenografted mice. In contrast, the ESR1-NOP2 fusion was sensitive to low estrogen conditions in vitro, and did not promote tumor growth. RNA-seq profiling revealed E2F targets pathway as the most highly enriched pathway induced by the ESR1 fusions. IHC revealed higher levels of pRb in ESR1-YAP1 and ESR1-PCDH11x xenograft tumors and subsequent CDK4/6 inhibition completely blocked tumor growth in an ESR1-YAP1 PDX model. Integrating RNA-seq with ChIP-seq data, we discovered a set of EMT and metastasis genes bound by all ESR1 fusions and WT-ER, but whose expression was strongly and uniquely up-regulated only by the ESR1-YAP1 and ESR1-PCDH11x fusions. These studies also revealed gained sites bound only by the ESR1-YAP1 and ESR1-PCDH11x fusions, not bound by WT-ER nor ESR1-NOP2. Genes mapping to these sites have a role in metastatic biology and were highly up-regulated by the YAP1 and PCDH11x fusions, potentially mediated by long range transcriptional activation.
Conclusion. ESR1-YAP1 and ESR1-PCDH11x are driver fusions that occur in drug-resistant, advanced stage breast cancer and are a new class of recurrent somatic mutation that can cause acquired endocrine therapy resistance, yet can be treated with CDK4/6 inhibition. These driver fusions also confer increased metastatic ability through their ability to drive expression of genes that contribute to EMT and metastasis. In contrast, ESR1-NOP2 did not produce functional protein and appears to be a passenger event. These studies may provide pre-clinical rationale for targeting ESR1 translocated breast tumors, since the presence of an ESR1 driver fusion places a patient in a therapeutic category where none of the currently available endocrine therapies are likely to be effective.
Citation Format: Lei JT, Shao J, Zhang J, Iglesia M, Chan DW, Cao J, Anurag M, Singh P, Haricharan S, Kavuri SM, Matsunuma R, Schmidt C, Kosaka Y, Crowder R, Hoog J, Phommaly C, Goncalves R, Ramalho S, Rodrigues-Peres RM, Lai W-C, Hampton O, Rogers A, Tobias E, Parikh P, Davies S, Ma C, Suman V, Hunt K, Watson M, Hoadley KA, Thompson A, Perou CM, Creighton CJ, Maher C, Ellis MJ. ESR1 gene fusions drive endocrine therapy resistance and metastasis in breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr PD8-03.
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Affiliation(s)
- JT Lei
- Baylor College of Medicine, Houston, TX; Washington University, St. Louis, MO; University of North Carolina; Kitasato University School of Medicine, Japan; University of Sao Paulo School of Medicine, Brazil; State University of Campinas, Brazil; Mayo Clinic; MD Anderson Cancer Center, Houston, TX
| | - J Shao
- Baylor College of Medicine, Houston, TX; Washington University, St. Louis, MO; University of North Carolina; Kitasato University School of Medicine, Japan; University of Sao Paulo School of Medicine, Brazil; State University of Campinas, Brazil; Mayo Clinic; MD Anderson Cancer Center, Houston, TX
| | - J Zhang
- Baylor College of Medicine, Houston, TX; Washington University, St. Louis, MO; University of North Carolina; Kitasato University School of Medicine, Japan; University of Sao Paulo School of Medicine, Brazil; State University of Campinas, Brazil; Mayo Clinic; MD Anderson Cancer Center, Houston, TX
| | - M Iglesia
- Baylor College of Medicine, Houston, TX; Washington University, St. Louis, MO; University of North Carolina; Kitasato University School of Medicine, Japan; University of Sao Paulo School of Medicine, Brazil; State University of Campinas, Brazil; Mayo Clinic; MD Anderson Cancer Center, Houston, TX
| | - DW Chan
- Baylor College of Medicine, Houston, TX; Washington University, St. Louis, MO; University of North Carolina; Kitasato University School of Medicine, Japan; University of Sao Paulo School of Medicine, Brazil; State University of Campinas, Brazil; Mayo Clinic; MD Anderson Cancer Center, Houston, TX
| | - J Cao
- Baylor College of Medicine, Houston, TX; Washington University, St. Louis, MO; University of North Carolina; Kitasato University School of Medicine, Japan; University of Sao Paulo School of Medicine, Brazil; State University of Campinas, Brazil; Mayo Clinic; MD Anderson Cancer Center, Houston, TX
| | - M Anurag
- Baylor College of Medicine, Houston, TX; Washington University, St. Louis, MO; University of North Carolina; Kitasato University School of Medicine, Japan; University of Sao Paulo School of Medicine, Brazil; State University of Campinas, Brazil; Mayo Clinic; MD Anderson Cancer Center, Houston, TX
| | - P Singh
- Baylor College of Medicine, Houston, TX; Washington University, St. Louis, MO; University of North Carolina; Kitasato University School of Medicine, Japan; University of Sao Paulo School of Medicine, Brazil; State University of Campinas, Brazil; Mayo Clinic; MD Anderson Cancer Center, Houston, TX
| | - S Haricharan
- Baylor College of Medicine, Houston, TX; Washington University, St. Louis, MO; University of North Carolina; Kitasato University School of Medicine, Japan; University of Sao Paulo School of Medicine, Brazil; State University of Campinas, Brazil; Mayo Clinic; MD Anderson Cancer Center, Houston, TX
| | - SM Kavuri
- Baylor College of Medicine, Houston, TX; Washington University, St. Louis, MO; University of North Carolina; Kitasato University School of Medicine, Japan; University of Sao Paulo School of Medicine, Brazil; State University of Campinas, Brazil; Mayo Clinic; MD Anderson Cancer Center, Houston, TX
| | - R Matsunuma
- Baylor College of Medicine, Houston, TX; Washington University, St. Louis, MO; University of North Carolina; Kitasato University School of Medicine, Japan; University of Sao Paulo School of Medicine, Brazil; State University of Campinas, Brazil; Mayo Clinic; MD Anderson Cancer Center, Houston, TX
| | - C Schmidt
- Baylor College of Medicine, Houston, TX; Washington University, St. Louis, MO; University of North Carolina; Kitasato University School of Medicine, Japan; University of Sao Paulo School of Medicine, Brazil; State University of Campinas, Brazil; Mayo Clinic; MD Anderson Cancer Center, Houston, TX
| | - Y Kosaka
- Baylor College of Medicine, Houston, TX; Washington University, St. Louis, MO; University of North Carolina; Kitasato University School of Medicine, Japan; University of Sao Paulo School of Medicine, Brazil; State University of Campinas, Brazil; Mayo Clinic; MD Anderson Cancer Center, Houston, TX
| | - R Crowder
- Baylor College of Medicine, Houston, TX; Washington University, St. Louis, MO; University of North Carolina; Kitasato University School of Medicine, Japan; University of Sao Paulo School of Medicine, Brazil; State University of Campinas, Brazil; Mayo Clinic; MD Anderson Cancer Center, Houston, TX
| | - J Hoog
- Baylor College of Medicine, Houston, TX; Washington University, St. Louis, MO; University of North Carolina; Kitasato University School of Medicine, Japan; University of Sao Paulo School of Medicine, Brazil; State University of Campinas, Brazil; Mayo Clinic; MD Anderson Cancer Center, Houston, TX
| | - C Phommaly
- Baylor College of Medicine, Houston, TX; Washington University, St. Louis, MO; University of North Carolina; Kitasato University School of Medicine, Japan; University of Sao Paulo School of Medicine, Brazil; State University of Campinas, Brazil; Mayo Clinic; MD Anderson Cancer Center, Houston, TX
| | - R Goncalves
- Baylor College of Medicine, Houston, TX; Washington University, St. Louis, MO; University of North Carolina; Kitasato University School of Medicine, Japan; University of Sao Paulo School of Medicine, Brazil; State University of Campinas, Brazil; Mayo Clinic; MD Anderson Cancer Center, Houston, TX
| | - S Ramalho
- Baylor College of Medicine, Houston, TX; Washington University, St. Louis, MO; University of North Carolina; Kitasato University School of Medicine, Japan; University of Sao Paulo School of Medicine, Brazil; State University of Campinas, Brazil; Mayo Clinic; MD Anderson Cancer Center, Houston, TX
| | - RM Rodrigues-Peres
- Baylor College of Medicine, Houston, TX; Washington University, St. Louis, MO; University of North Carolina; Kitasato University School of Medicine, Japan; University of Sao Paulo School of Medicine, Brazil; State University of Campinas, Brazil; Mayo Clinic; MD Anderson Cancer Center, Houston, TX
| | - W-C Lai
- Baylor College of Medicine, Houston, TX; Washington University, St. Louis, MO; University of North Carolina; Kitasato University School of Medicine, Japan; University of Sao Paulo School of Medicine, Brazil; State University of Campinas, Brazil; Mayo Clinic; MD Anderson Cancer Center, Houston, TX
| | - O Hampton
- Baylor College of Medicine, Houston, TX; Washington University, St. Louis, MO; University of North Carolina; Kitasato University School of Medicine, Japan; University of Sao Paulo School of Medicine, Brazil; State University of Campinas, Brazil; Mayo Clinic; MD Anderson Cancer Center, Houston, TX
| | - A Rogers
- Baylor College of Medicine, Houston, TX; Washington University, St. Louis, MO; University of North Carolina; Kitasato University School of Medicine, Japan; University of Sao Paulo School of Medicine, Brazil; State University of Campinas, Brazil; Mayo Clinic; MD Anderson Cancer Center, Houston, TX
| | - E Tobias
- Baylor College of Medicine, Houston, TX; Washington University, St. Louis, MO; University of North Carolina; Kitasato University School of Medicine, Japan; University of Sao Paulo School of Medicine, Brazil; State University of Campinas, Brazil; Mayo Clinic; MD Anderson Cancer Center, Houston, TX
| | - P Parikh
- Baylor College of Medicine, Houston, TX; Washington University, St. Louis, MO; University of North Carolina; Kitasato University School of Medicine, Japan; University of Sao Paulo School of Medicine, Brazil; State University of Campinas, Brazil; Mayo Clinic; MD Anderson Cancer Center, Houston, TX
| | - S Davies
- Baylor College of Medicine, Houston, TX; Washington University, St. Louis, MO; University of North Carolina; Kitasato University School of Medicine, Japan; University of Sao Paulo School of Medicine, Brazil; State University of Campinas, Brazil; Mayo Clinic; MD Anderson Cancer Center, Houston, TX
| | - C Ma
- Baylor College of Medicine, Houston, TX; Washington University, St. Louis, MO; University of North Carolina; Kitasato University School of Medicine, Japan; University of Sao Paulo School of Medicine, Brazil; State University of Campinas, Brazil; Mayo Clinic; MD Anderson Cancer Center, Houston, TX
| | - V Suman
- Baylor College of Medicine, Houston, TX; Washington University, St. Louis, MO; University of North Carolina; Kitasato University School of Medicine, Japan; University of Sao Paulo School of Medicine, Brazil; State University of Campinas, Brazil; Mayo Clinic; MD Anderson Cancer Center, Houston, TX
| | - K Hunt
- Baylor College of Medicine, Houston, TX; Washington University, St. Louis, MO; University of North Carolina; Kitasato University School of Medicine, Japan; University of Sao Paulo School of Medicine, Brazil; State University of Campinas, Brazil; Mayo Clinic; MD Anderson Cancer Center, Houston, TX
| | - M Watson
- Baylor College of Medicine, Houston, TX; Washington University, St. Louis, MO; University of North Carolina; Kitasato University School of Medicine, Japan; University of Sao Paulo School of Medicine, Brazil; State University of Campinas, Brazil; Mayo Clinic; MD Anderson Cancer Center, Houston, TX
| | - KA Hoadley
- Baylor College of Medicine, Houston, TX; Washington University, St. Louis, MO; University of North Carolina; Kitasato University School of Medicine, Japan; University of Sao Paulo School of Medicine, Brazil; State University of Campinas, Brazil; Mayo Clinic; MD Anderson Cancer Center, Houston, TX
| | - A Thompson
- Baylor College of Medicine, Houston, TX; Washington University, St. Louis, MO; University of North Carolina; Kitasato University School of Medicine, Japan; University of Sao Paulo School of Medicine, Brazil; State University of Campinas, Brazil; Mayo Clinic; MD Anderson Cancer Center, Houston, TX
| | - CM Perou
- Baylor College of Medicine, Houston, TX; Washington University, St. Louis, MO; University of North Carolina; Kitasato University School of Medicine, Japan; University of Sao Paulo School of Medicine, Brazil; State University of Campinas, Brazil; Mayo Clinic; MD Anderson Cancer Center, Houston, TX
| | - CJ Creighton
- Baylor College of Medicine, Houston, TX; Washington University, St. Louis, MO; University of North Carolina; Kitasato University School of Medicine, Japan; University of Sao Paulo School of Medicine, Brazil; State University of Campinas, Brazil; Mayo Clinic; MD Anderson Cancer Center, Houston, TX
| | - C Maher
- Baylor College of Medicine, Houston, TX; Washington University, St. Louis, MO; University of North Carolina; Kitasato University School of Medicine, Japan; University of Sao Paulo School of Medicine, Brazil; State University of Campinas, Brazil; Mayo Clinic; MD Anderson Cancer Center, Houston, TX
| | - MJ Ellis
- Baylor College of Medicine, Houston, TX; Washington University, St. Louis, MO; University of North Carolina; Kitasato University School of Medicine, Japan; University of Sao Paulo School of Medicine, Brazil; State University of Campinas, Brazil; Mayo Clinic; MD Anderson Cancer Center, Houston, TX
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Abstract
Despite the widespread belief that the involvement of users and carers in the training of psychiatrists would provide a valuable addition to the training process, it is clear that many trainees do not receive this input as part of their current teaching. This article explores some of the questions and concerns that all those parties involved have raised and draws on the experience of users, carers and psychiatrists to address some of these issues and promote the further development of this practice.
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