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Crooks CJ, West J, Morling JR, Simmonds M, Juurlink I, Cruickshank S, Briggs S, Hammond-Pears S, Shaw D, Card TR, Fogarty AW. Pulse oximetry has limited utility in identifying potential patients for long-term oxygen therapy. Int J Tuberc Lung Dis 2024; 28:253-255. [PMID: 38659138 DOI: 10.5588/ijtld.23.0491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024] Open
Affiliation(s)
- C J Crooks
- Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK, Nottingham University Hospitals NHS Trust, UK
| | - J West
- NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK, Nottingham University Hospitals NHS Trust, UK, Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK, East Midlands Academic Health Science Network, University of Nottingham, Nottingham, UK
| | - J R Morling
- Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - M Simmonds
- Nottingham University Hospitals NHS Trust, UK
| | - I Juurlink
- Nottingham University Hospitals NHS Trust, UK
| | | | - S Briggs
- Nottingham University Hospitals NHS Trust, UK
| | - S Hammond-Pears
- Nottingham University Hospitals NHS Trust, UK, East Midlands Academic Health Science Network, University of Nottingham, Nottingham, UK
| | - D Shaw
- NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK, Division of Respiratory Medicine, School of Medicine, University of Nottingham, Nottingham
| | - T R Card
- NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK, Nottingham University Hospitals NHS Trust, UK, Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - A W Fogarty
- NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK, Nottingham University Hospitals NHS Trust, UK, Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
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Adiamah A, Rashid A, Crooks CJ, Hammond J, Jepsen P, West J, Humes DJ. The impact of urgency of umbilical hernia repair on adverse outcomes in patients with cirrhosis: a population-based cohort study from England. Hernia 2024; 28:109-117. [PMID: 38017324 PMCID: PMC10891219 DOI: 10.1007/s10029-023-02898-6] [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: 07/07/2023] [Accepted: 09/18/2023] [Indexed: 11/30/2023]
Abstract
INTRODUCTION Umbilical hernia is common in patients with cirrhosis; however, there is a paucity of dedicated studies on postoperative outcomes in this group of patients. This population-based cohort study aimed to determine the outcomes after emergency and elective umbilical hernia repair in patients with cirrhosis. METHODS Two linked electronic healthcare databases from England were used to identify all patients undergoing umbilical hernia repair between January 2000 and December 2017. Patients were grouped into those with and without cirrhosis and stratified by severity into compensated and decompensated cirrhosis. Length of stay, readmission, 90-day case fatality rate and the odds ratio of 90-day postoperative mortality were defined using logistic regression. RESULTS In total, 22,163 patients who underwent an umbilical hernia repair were included and 297 (1.34%) had cirrhosis. More patients without cirrhosis had an elective procedure, 86% compared with 51% of those with cirrhosis (P < 0.001). In both the elective and emergency settings, patients with cirrhosis had longer hospital length of stay (elective: 0 vs 1 day, emergency: 2 vs 4 days, P < 0.0001) and higher readmission rates (elective: 4.87% vs 11.33%, emergency:11.39% vs 29.25%, P < 0.0001) than those without cirrhosis. The 90-day case fatality rates were 2% and 0.16% in the elective setting, and 19% and 2.96% in the emergency setting in patients with and without cirrhosis respectively. CONCLUSION Emergency umbilical hernia repair in patients with cirrhosis is associated with poorer outcomes in terms of length of stay, readmissions and mortality at 90 days.
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Affiliation(s)
- A Adiamah
- National Institute for Health Research Nottingham Digestive Diseases Biomedical Research Unit, E Floor West Block, QMC Campus, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK.
| | - A Rashid
- National Institute for Health Research Nottingham Digestive Diseases Biomedical Research Unit, E Floor West Block, QMC Campus, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
| | - C J Crooks
- National Institute for Health Research Nottingham Digestive Diseases Biomedical Research Unit, E Floor West Block, QMC Campus, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
| | - J Hammond
- Division of Hepatobiliary and Transplant Surgery, Freeman Hospital, Freeman Rd, High Heaton, Newcastle Upon Tyne, NE7 7DN, UK
| | - P Jepsen
- Department of Hepatology and Gastroenterology and Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - J West
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Clinical Sciences Building, City Hospital, Nottingham, NG5 1PB, UK
| | - D J Humes
- National Institute for Health Research Nottingham Digestive Diseases Biomedical Research Unit, E Floor West Block, QMC Campus, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Clinical Sciences Building, City Hospital, Nottingham, NG5 1PB, UK
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Strobl MAR, Gallaher J, Robertson-Tessi M, West J, Anderson ARA. Treatment of evolving cancers will require dynamic decision support. Ann Oncol 2023; 34:867-884. [PMID: 37777307 PMCID: PMC10688269 DOI: 10.1016/j.annonc.2023.08.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 02/10/2023] [Revised: 08/01/2023] [Accepted: 08/21/2023] [Indexed: 10/02/2023] Open
Abstract
Cancer research has traditionally focused on developing new agents, but an underexplored question is that of the dose and frequency of existing drugs. Based on the modus operandi established in the early days of chemotherapies, most drugs are administered according to predetermined schedules that seek to deliver the maximum tolerated dose and are only adjusted for toxicity. However, we believe that the complex, evolving nature of cancer requires a more dynamic and personalized approach. Chronicling the milestones of the field, we show that the impact of schedule choice crucially depends on processes driving treatment response and failure. As such, cancer heterogeneity and evolution dictate that a one-size-fits-all solution is unlikely-instead, each patient should be mapped to the strategy that best matches their current disease characteristics and treatment objectives (i.e. their 'tumorscape'). To achieve this level of personalization, we need mathematical modeling. In this perspective, we propose a five-step 'Adaptive Dosing Adjusted for Personalized Tumorscapes (ADAPT)' paradigm to integrate data and understanding across scales and derive dynamic and personalized schedules. We conclude with promising examples of model-guided schedule personalization and a call to action to address key outstanding challenges surrounding data collection, model development, and integration.
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Affiliation(s)
- M A R Strobl
- Integrated Mathematical Oncology Department, H. Lee Moffitt Cancer Center & Research Institute, Tampa; Translational Hematology and Oncology Research, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, USA
| | - J Gallaher
- Integrated Mathematical Oncology Department, H. Lee Moffitt Cancer Center & Research Institute, Tampa
| | - M Robertson-Tessi
- Integrated Mathematical Oncology Department, H. Lee Moffitt Cancer Center & Research Institute, Tampa
| | - J West
- Integrated Mathematical Oncology Department, H. Lee Moffitt Cancer Center & Research Institute, Tampa
| | - A R A Anderson
- Integrated Mathematical Oncology Department, H. Lee Moffitt Cancer Center & Research Institute, Tampa.
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Pratt L, Rehan S, West J, Watts P. 4 Peripapillary hyperreflective ovoid mass-like structures (PHOMS) in children: optical coherence tomography measurements and refractive status. BMJ Open Ophthalmol 2023; 8:A2. [PMID: 37797983 DOI: 10.1136/bmjophth-2023-biposa.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023] Open
Abstract
Peripapillary hyperreflective ovoid mass-like structures (PHOMS) are a recently described entity. They are a common and non-specific cause of pseudopapilloedema. We aim to determine if there is a relationship between optical coherence tomography (OCT) measurements and refractive status on the presence of PHOMS.Retrospective analysis of optic nerve head OCT scans from children seen in the suspected papilledema virtual clinic between August 2016 and March 2021 at University Hospital of Wales, Cardiff. Three assessors graded each scan for the presence of PHOMS. Numerical data on the disc morphology (disc area (DA (mm2)) and scleral canal diameter (SCD (µm)) was obtained from the OCT scans. Refractive data was obtained from the initial optometric referral where available. Logistic regression analysis was performed to assess the effect of age, sex, spherical equivalent, DA and SCD on the likelihood of the presence of PHOMS.The SCD was significantly larger in eyes with PHOMS (mean diameter 1771 µm) vs no PHOMS (mean diameter 1621 µm). Odds ratio 1.0042 (1.0016 to 1.0069). The other variables were not significantly associated, but there was a tendency towards a younger age, larger disc area and the presence of a refractive error if PHOMS were present.Anatomical and developmental differences in the size of the scleral canal and optic nerve may explain the presence of PHOMS in children. In contrast to other recently published studies, we show that a wider scleral canal diameter was significantly associated with the presence of PHOMS.
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Affiliation(s)
- L Pratt
- University Hospital of Wales, Cardiff, UK
| | - S Rehan
- University Hospital of Wales, Cardiff, UK
| | - J West
- University Hospital of Wales, Cardiff, UK
| | - P Watts
- University Hospital of Wales, Cardiff, UK
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Lloyd MS, Brisben AJ, Reddy VY, Blomström-Lundqvist C, Boersma LV, Bongiorni MG, Burke MC, Cantillon DJ, Doshi R, Friedman PA, Gras D, Kutalek SP, Neuzil P, Roberts PR, Wright DJ, Appl U, West J, Carter N, Stein KM, Mont L, Knops RE. Design and rationale of the MODULAR ATP global clinical trial: A novel intercommunicative leadless pacing system and the subcutaneous implantable cardioverter-defibrillator. Heart Rhythm O2 2023; 4:448-456. [PMID: 37520021 PMCID: PMC10373150 DOI: 10.1016/j.hroo.2023.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023] Open
Abstract
Background The subcutaneous implantable cardioverter-defibrillator (S-ICD) has demonstrated safety and efficacy for the treatment of malignant ventricular arrhythmias. However, a limitation of the S-ICD lies in the inability to either pace-terminate ventricular tachycardia or provide prolonged bradycardia pacing support. Objective The rationale and design of a prospective, single-arm, multinational trial of an intercommunicative leadless pacing system integrated with the S-ICD will be presented. Methods A technical description of the modular cardiac rhythm management (mCRM) system (EMPOWER leadless pacemaker and EMBLEM S-ICD) and the implantation procedure is provided. MODULAR ATP (Effectiveness of the EMPOWER™ Modular Pacing System and EMBLEM™ Subcutaneous ICD to Communicate Antitachycardia Pacing) is a multicenter, international trial enrolling up to 300 patients at risk of sudden cardiac death at up to 60 centers trial design. The safety endpoint of freedom from major complications related to the mCRM system or implantation procedure at 6 months and 2 years are significantly higher than 86% and 81%, respectively, and all-cause survival is significantly >85% at 2 years. Results Efficacy endpoints are that at 6 months mCRM communication success is significantly higher than 88% and the percentage of subjects with low and stable thresholds is significantly higher than 80%. Substudies to evaluate rate-responsive features and performance of the pacing module are also described. Conclusion The MODULAR ATP global clinical trial will prospectively test the safety and efficacy of the first intercommunicating leadless pacing system with the S-ICD. This trial will allow for robust validation of device-device communication, pacing performance, rate responsiveness, and system safety.
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Affiliation(s)
| | | | - Vivek Y. Reddy
- Icahn School of Medicine, Mount Sinai, New York, New York
| | - Carina Blomström-Lundqvist
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Department of Medical Sciences, Cardiology - Arrhythmia, Uppsala University, Uppsala, Sweden
| | - Lucas V.A. Boersma
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands
- Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | | | | | | | - Rahul Doshi
- Heart and Vascular Health, HonorHealth Research Institute, Scottsdale, Arizona
- College of Medicine, University of Arizona, Phoenix, Arizona
| | - Paul A. Friedman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Daniel Gras
- Departement de Cardiologie, Hôpital Privé du Confluent, Nantes, France
| | - Steven P. Kutalek
- Department of Cardiology, Saint Mary Medical Center, Langhorne, Pennsylvania
- Cardiac Electrophysiology, Drexel University, Philadelphia, Pennsylvania
| | - Petr Neuzil
- Department of Cardiology, Na Homolce Hospital, Prague, Czech Republic
| | - Paul R. Roberts
- Cardiac Rhythm Management Research Department, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - David J. Wright
- Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Ursula Appl
- Boston Scientific Corporation, St. Paul, Minnesota
| | - Julie West
- Boston Scientific Corporation, St. Paul, Minnesota
| | | | | | - Lluis Mont
- Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Institut de Recerca Biomèdica, August Pi i Sunyer Biomedical Research Institute, Barcelona, Spain
| | - Reinoud E. Knops
- Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands
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Crooks CJ, West J, Morling JR, Simmonds M, Juurlink I, Briggs S, Cruickshank S, Hammond-Pears S, Shaw D, Card TR, Fogarty AW. Differential pulse oximetry readings between ethnic groups and delayed transfer to intensive care units. QJM 2023; 116:63-67. [PMID: 36066450 PMCID: PMC9928225 DOI: 10.1093/qjmed/hcac218] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 08/31/2022] [Accepted: 09/01/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Pulse oximeters are widely used to monitor blood oxygen saturations, although concerns exist that they are less accurate in individuals with pigmented skin. AIMS This study aimed to determine if patients with pigmented skin were more severely unwell at the period of transfer to intensive care units (ICUs) than individuals with White skin. METHODS Using data from a large teaching hospital, measures of clinical severity at the time of transfer of patients with COVID-19 infection to ICUs were assessed, and how this varied by ethnic group. RESULTS Data were available on 748 adults. Median pulse oximetry demonstrated similar oxygen saturations at the time of transfer to ICUs (Kruskal-Wallis test, P = 0.51), although median oxygen saturation measurements from arterial blood gases at this time demonstrated lower oxygen saturations in patients classified as Indian/Pakistani ethnicity (91.6%) and Black/Mixed ethnicity (93.0%), compared to those classified as a White ethnicity (94.4%, Kruskal-Wallis test, P = 0.005). There were significant differences in mean respiratory rates in these patients (P < 0.0001), ranging from 26 breaths/min in individuals with White ethnicity to 30 breaths/min for those classified as Indian/Pakistani ethnicity and 31 for those who were classified as Black/Mixed ethnicity. CONCLUSIONS These data are consistent with the hypothesis that differential measurement error for pulse oximeter readings negatively impact on the escalation of clinical care in individuals from other than White ethnic groups. This has implications for healthcare in Africa and South-East Asia and may contribute to differences in health outcomes across ethnic groups globally.
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Affiliation(s)
- C J Crooks
- Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK
- NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham NG7 2UH, UK
- Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK
| | - J West
- NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham NG7 2UH, UK
- Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK
- Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham NG5 1PB, UK
- East Midlands Academic Health Science Network, University of Nottingham, Nottingham NG7 2TU, UK
| | - J R Morling
- NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham NG7 2UH, UK
- Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK
- Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham NG5 1PB, UK
| | - M Simmonds
- Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK
| | - I Juurlink
- Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK
| | - S Briggs
- Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK
| | - S Cruickshank
- Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK
| | - S Hammond-Pears
- Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK
- East Midlands Academic Health Science Network, University of Nottingham, Nottingham NG7 2TU, UK
| | - D Shaw
- Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK
- Division of Respiratory Medicine, School of Medicine, University of Nottingham, Nottingham NG5 1PB, UK
| | - T R Card
- NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham NG7 2UH, UK
- Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK
- Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham NG5 1PB, UK
| | - A W Fogarty
- Address correspondence to Dr A.W. Fogarty, NIHR Nottingham Biomedical Research Centre (BRC), Nottingham City Hospital, Nottingham NG5 1PB, UK.
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West J, Hathaway D, Parish A. 226 What Is the Effect of Training on the Performance of Different Video Laryngoscope Geometries Versus Direct Laryngoscopy to Achieve First Pass Success During Emergent Tracheal Intubation? A Systematic Review and Meta-Analysis. Ann Emerg Med 2022. [DOI: 10.1016/j.annemergmed.2022.08.249] [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: 11/24/2022]
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Adiamah A, Ban L, Otete H, Crooks CJ, West J, Humes DJ. O23 Outcomes after non-operative management of perforated diverticular disease: a population based cohort study. Br J Surg 2021. [DOI: 10.1093/bjs/znab282.028] [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]
Abstract
Abstract
Introduction
The management of perforated diverticular disease has changed in the last 10 years with a move towards less surgical intervention. This population based cohort study aimed to define the risk of mortality and readmission following non-operative management of perforated diverticular disease (DD).
Method
Patients diagnosed with perforated DD and managed without surgery were identified from the linked Clinical Practice Research Datalink and Hospital Episode Statistics data from 2000 to 2013. The outcomes were 1-year case-fatality, re-admissions and surgery at re-admission.
Result
In total, 880 patients with perforated DD were managed without surgery, comprising of 523 females (59.4%). One year case-fatality was 33.2% (293/880). The majority of deaths occurred in the first 90 days following the index admission with a 90 day case-fatality of 28.8%. 90 day survival varied by age with 97.2% survival at 90 days in those under 65 years compared to 85.0% in those between 65–74 years and 51.5% in those over 75 years.
Of 767 patients discharged from hospital, 250 (32.6%, 250/767) were re-admitted (47 elective(6.1%) and 203 emergency(26.5%)) during a median of 1.6 years of follow-up (iqr 0.1–3.9 years) with similar proportions in each age category. In the first year of follow-up only 5.1% of patients required surgery of whom 16/767 (2.1%) required elective and 23/767 (3.0%) emergency surgery.
Conclusion
Conservative management of perforated diverticulitis in those under 65 years is feasible and safe. A third of patients are readmitted during follow-up, however, re-intervention rates following conservative management were low across all age categories.
Take-home Message
In younger patients (<65yrs) conservative management of perforated diverticulitis is feasible and safe. A third of conservatively managed patients are readmitted during follow-up, however, need for surgery on readmission is rare.
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Affiliation(s)
- A Adiamah
- National Institute for Health Research Nottingham Digestive Diseases Biomedical Research Unit, E Floor West Block, QMC Campus, Nottingham University Hospitals NHS Trust, Nottingham, UK, NG7 2UH
| | - L Ban
- National Institute for Health Research Nottingham Digestive Diseases Biomedical Research Unit, E Floor West Block, QMC Campus, Nottingham University Hospitals NHS Trust, Nottingham, UK, NG7 2UH
| | - H Otete
- School of Medicine, Harrington building, University of Central Lancashire, Preston, UK, PR1 2HE
| | - C J Crooks
- National Institute for Health Research Nottingham Digestive Diseases Biomedical Research Unit, E Floor West Block, QMC Campus, Nottingham University Hospitals NHS Trust, Nottingham, UK, NG7 2UH
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Clinical Sciences Building, City, Hospital, Nottingham, UK, NG5 1PB
| | - J West
- National Institute for Health Research Nottingham Digestive Diseases Biomedical Research Unit, E Floor West Block, QMC Campus, Nottingham University Hospitals NHS Trust, Nottingham, UK, NG7 2UH
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Clinical Sciences Building, City, Hospital, Nottingham, UK, NG5 1PB
| | - D J Humes
- National Institute for Health Research Nottingham Digestive Diseases Biomedical Research Unit, E Floor West Block, QMC Campus, Nottingham University Hospitals NHS Trust, Nottingham, UK, NG7 2UH
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Clinical Sciences Building, City, Hospital, Nottingham, UK, NG5 1PB
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Adiamah A, Crooks CJ, Hammond JS, Jepsen P, West J, Humes DJ. O2 Mortality following elective and emergency colorectal surgery in patients with cirrhosis: a population-based cohort study. Br J Surg 2021. [DOI: 10.1093/bjs/znab282.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Introduction
This population based cohort study, aimed to quantify the risk of mortality following colectomy in patients with cirrhosis by urgency of surgery and stage of cirrhosis.
Method
Linked primary and secondary-care electronic healthcare data from England was used to identify all patients undergoing colectomy from January 2001 to December 2017. Patients were classified into three cohorts, non-cirrhotics, compensated cirrhotics and decompensated cirrhosis and followed up for 90-days from the date of surgery. Cox proportional hazards models were used to estimate the hazard ratio (HR) of postoperative mortality.
Result
A total of 36380 eligible patients were included. Of these, 248(0.7%) had liver cirrhosis and 70% had compensated disease. The proportion undergoing a colectomy who had a diagnosis of cirrhosis increased from 0.40% in 2001 to 1.07% in 2017 (χ2(16, N = 36380)=50.53, P < 0.0001).
Following elective colectomy, 90-day case fatality was 4% in non-cirrhotics , 7% in compensated cirrhotics and 10% in decompensated cirrhotics. Following emergency colectomy 90-day case fatality was higher, it was 16% in non-cirrhotics, 35% in compensated cirrhotics and 41% in decompensated cirrhotics. This corresponded to an adjusted 2-fold (HR 2.57(95% CI 1.75–3.76)) and 3-fold (3.43(95% CI 2.02–5.83)) increased mortality rate in compensated and decompensated cirrhotics respectively compared to non-cirrhotics following emergency colectomy.
Conclusion
Over the study period, the proportion of patients undergoing colectomy who had liver cirrhosis increased to 1 in every 100 colectomies. The 90-day case fatality rates were high in all patients with cirrhosis in both emergency and elective settings but the greatest mortality risk was seen in those with decompensation following emergency surgery.
Take-home Message
1 in 100 colectomy procedures are in patients with cirrhosis. These cirrhotic patients have a very high risk of postoperative mortality, especially, emergency colectomy in patients with decompensated cirrhosis.
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Affiliation(s)
- A Adiamah
- Nottingham Digestive Diseases Centre, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen’s Medical Centre, Nottingham, UK
| | - C J Crooks
- Nottingham Digestive Diseases Centre, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen’s Medical Centre, Nottingham, UK
| | - J S Hammond
- Department of Hepatobiliary and Transplantation Surgery, Freeman Hospital, Freeman Rd, High Heaton, Newcastle upon Tyne NE7 7DN, UK
| | - P Jepsen
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - J West
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Clinical Sciences Building, City, Hospital, Nottingham NG5 1PB, UK
| | - D J Humes
- Nottingham Digestive Diseases Centre, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen’s Medical Centre, Nottingham, UK
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Clinical Sciences Building, City, Hospital, Nottingham NG5 1PB, UK
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Adiamah A, Ban L, Otete H, Crooks CJ, West J, Humes DJ. Outcomes after non-operative management of perforated diverticular disease: a population-based cohort study. BJS Open 2021; 5:6246781. [PMID: 33889950 PMCID: PMC8062256 DOI: 10.1093/bjsopen/zraa073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 12/17/2020] [Indexed: 11/24/2022] Open
Abstract
Background The management of perforated diverticular disease has changed in the past 10 years with a move towards less surgical intervention. This population-based cohort study aimed to define the risk of death and readmission following non-operative management of perforated diverticular disease. Methods Patients diagnosed with perforated diverticular disease and managed without surgery were identified from the linked Clinical Practice Research Datalink and Hospital Episode Statistics data from 2000 to 2013. The outcomes were 1-year case fatality, readmissions, and surgery at readmission. Results In total, 880 patients with perforated diverticular disease were managed without surgery, comprising 523 women (59.4 per cent). The 1-year case fatality rate was 33.2 per cent (293 of 880). The majority of deaths occurred in the first 90 days after the index admission, with a 90-day case fatality rate of 28.8 per cent. The 90-day survival rate varied by age, and was 97.2 per cent among those aged less than 65 years, compared with 85.0 per cent for those aged between 65 and 74 years, and 47.7 per cent in those at least 75 years old. Of 767 patients discharged from hospital, 250 (32.6 per cent) were readmitted (47 elective, 6.1 per cent; 203 emergency, 26.5 per cent) during a median of 1.6 (i.q.r. 0.1–3.9) years of follow-up, with similar proportions in each age category. In the first year of follow-up, only 5.1 per cent of patients required surgery, of whom 16 of 767 (2.1 per cent) required elective and 23 (3.0 per cent) emergency operation. Conclusion Non-operative management of perforated diverticulitis in those aged less than 65 years is feasible and safe. Reintervention rates following conservative management were low across all age categories.
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Affiliation(s)
- A Adiamah
- National Institute for Health Research Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - L Ban
- National Institute for Health Research Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - H Otete
- School of Medicine, Harrington building, University of Central Lancashire, Preston, UK
| | - C J Crooks
- National Institute for Health Research Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals NHS Trust, Nottingham, UK.,Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, City Hospital, Nottingham, UK
| | - J West
- National Institute for Health Research Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals NHS Trust, Nottingham, UK.,Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, City Hospital, Nottingham, UK
| | - D J Humes
- National Institute for Health Research Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals NHS Trust, Nottingham, UK.,Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, City Hospital, Nottingham, UK
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11
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Power R, Bartha G, Harris J, Boyle S, Levy E, Milani P, Tandon P, McNitt P, Morra M, Desai S, Saldivar S, Clark M, Haudenschild C, West J, Chen R. 87P An augmented exome/transcriptome-based platform for precision cancer therapy selection, clinical trial matching, and oncology research applications, enabling next-generation composite biomarkers by combining tumour and immune features. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.10.575] [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: 11/16/2022] Open
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12
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Nguyen MH, Patel K, West J, Scharschmidt T, Chetta M, Schulz S, Mendel E, Valerio IL. A multidisciplinary approach to complex oncological spine coverage in high-risk patients. J Neurosurg Spine 2020; 34:277-282. [PMID: 33096531 DOI: 10.3171/2020.6.spine2024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 06/11/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The consequences of failed spinal hardware secondary to wound complications can increase the burden on the patient while also significantly escalating the cost of care. The objective of this study was to demonstrate the effectiveness of a protocol-based multidisciplinary approach in optimizing wound outcome in complex oncological spine care patients. METHODS A retrospective consecutive case series was performed from 2015 to 2019 of all patients who underwent oncological spine surgery. A protocol was established to identify oncological patients at high risk for potential wound complications. Preoperative and postoperative treatment plans were developed by the multidisciplinary tumor board team members. Wound healing risk factors such as diabetes, obesity, prior spine surgery, pre- or postoperative chemotherapy or radiation exposure, perioperative steroid use, and poor nutritional status were recorded. Operative details, including the regions of spinal involvement, presence of instrumentation, and number of vertebral levels operated on, were reviewed. Primary outcomes were the length of hospitalization and major (requiring reoperation) and minor wound complications in the setting of the aforementioned identified risk factors. RESULTS A total of 102 oncological cases were recorded during the 5-year study period. Of these patients, 99 had local muscle flap reconstruction with layered closure over their surgical hardware. The prevalence of smoking, diabetes, and previous spine surgery for the cohort was 21.6%, 20.6%, and 27.5%, respectively. Radiation exposure was seen in 72.5% of patients (37.3% preoperative vs 48% postoperative exposure). Chemotherapy was given to 66.7% of the patients (49% preoperatively and 30.4% postoperatively). The rate of perioperative steroid exposure was 60.8%. Prealbumin and albumin levels were 15.00 ± 7.47 mg/dL and 3.23 ± 0.43 mg/dL, respectively. Overall, an albumin level of < 3.5 mg/dL and BMI < 18.5 were seen in 64.7% and 13.7% of the patients, respectively. The mean number of vertebral levels involved was 6.76 ± 2.37 levels. Instrumentation of 7 levels or more was seen in 52.9% of patients. The average spinal wound defect size was 22.06 ± 7.79 cm. The rate of minor wound complications, including superficial skin breakdown (epidermolysis) and nonoperative seromas, was 6.9%, whereas that for major complications requiring reoperation within 90 days of surgery was 2.9%. CONCLUSIONS A multidisciplinary team approach utilized in complex multilevel oncological spine reconstruction surgery optimizes surgical outcomes, reduces morbidities, and improves care and satisfaction in patients with known risk factors.
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Affiliation(s)
| | | | - Julie West
- Departments of1Plastic and Reconstructive Surgery
| | - Thomas Scharschmidt
- 3Orthopedic Surgery, The Ohio State Wexner Medical Center, Columbus, Ohio; and
| | | | | | | | - Ian L Valerio
- 4Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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13
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West J, Wetherhold J, Schulz S, Valerio I. A Novel Use of Next-Generation Closed Incision Negative Pressure Wound Therapy After Major Limb Amputation and Amputation Revision. Cureus 2020; 12:e10393. [PMID: 33062513 PMCID: PMC7550024 DOI: 10.7759/cureus.10393] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
We report our experience with next-generation incisional negative pressure wound therapy (iNPWT) applied after major limb amputation or amputation revision. In this high-risk patient population, the need for reliable post-operative soft tissue management is imperative. In both cases reported, healing was uncomplicated. Using the next generation iNPWT in this unique way optimizes the post-operative residual limb by improved incision healing, residual limb edema reduction, and reduced risk of surgical site infection (SSI). This is the first case report of its kind reporting a novel use of next-generation iNPWT, and it demonstrates a need to examine this particular use further.
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Affiliation(s)
- Julie West
- Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, USA
| | - Julia Wetherhold
- Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, USA
| | - Steven Schulz
- Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, USA
| | - Ian Valerio
- Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, USA
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14
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Beckstead E, Niedfeldt H, Chahalis E, Jensen M, Reher B, Torres S, Jusril H, Rachmi CN, West J, Hall C. Using technology to access health information: greater WASH knowledge/behaviors in Indonesian mothers. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.686] [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
Background
Despite attention, childhood stunting in Indonesia persists. Proper WASH (Water, Sanitation, and Hygiene) practices help lower childhood stunting. As internet access in Indonesia grows, seeking health information online is increasing. However, research on using technology to increase WASH knowledge and behaviors in Indonesia is limited. The purpose of this study is to assess whether Indonesian women using technology to access health information have higher WASH knowledge and behaviors.
Methods
1,740 mothers with children under the age of two were randomly selected with three-stage cluster sampling. They were surveyed and interviewed about handwashing and sanitary defecation benefits, steps, and practices. Adjusted and unadjusted logistic and linear regression models were used to compare WASH outcomes between those who used technology to access health information and the control group. The models controlled for mother's age, mother's education, and total household income.
Results
Participants who used technology to access health information were more likely to know the benefits (OR = 2.603; CI = 1.666-4.067) and five critical times (OR = 1.217; CI=.969-1.528) of proper handwashing. Mothers were more likely to know the risks of open defecation (OR = 1.627; CI = 1.170-2.264) and understand disease transmission from stool (OR = 1.894; CI = 1.438-2.495). Those using technology to access health information were more likely to report using a gooseneck, squat toilet, septic tank, or closed ground to discard feces than the control group (OR = 3.858; CI = 2.628-5.665).
Conclusions
Using technology to access health information was associated with increased handwashing and defecation knowledge and safe elimination of feces. It was not associated with an increase in handwashing with soap. Technology can be used to increase WASH knowledge and behavior, but further research is needed to effectively use technology to increase optimal handwashing behaviors.
Key messages
Increasing technology access may encourage good water, sanitation and hygiene behavior change. Using technology to access health information yielded safer defecation practices but not better handwashing practices. Further research is needed.
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Affiliation(s)
- E Beckstead
- Public Health, Brigham Young University, Provo, USA
| | - H Niedfeldt
- Public Health, Brigham Young University, Provo, USA
| | - E Chahalis
- Public Health, Brigham Young University, Provo, USA
| | - M Jensen
- Public Health, Brigham Young University, Provo, USA
| | - B Reher
- Public Health, Brigham Young University, Provo, USA
| | - S Torres
- Neglected Tropical Diseases, RTI International, Washington D.C., USA
| | - H Jusril
- Center for Health Research, Universitas Indonesia, Depok, Indonesia
| | - C N Rachmi
- Utama Integra, Reconstra, Jakarta, Indonesia
| | - J West
- Public Health, Brigham Young University, Provo, USA
| | - C Hall
- Public Health, Brigham Young University, Provo, USA
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15
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Daines C, Norton A, Hunt L, Friedbaum E, Topham D, West J, Torres S. Exposure to a National Communication Campaign to Prevent Stunting in Indonesia. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.042] [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
Background
Reducing childhood stunting continues to be a priority in Indonesia. In 2015, the National Nutrition Communication Campaign (NNCC) implemented mass media and interpersonal communication (IPC) interventions to disseminate stunting-related information. The purpose of this study was to understand the factors associated with exposure to the media and IPC components of NNCC. The mass-media component was designed to influence attitudes, norms, and behaviors, while the IPC component was designed to develop skills to lead to behavior change.
Methods
The media campaign targeted a national audience and the IPC component of the campaign operated at a district level. IMA World Health collected data in three rural districts targeted with both media and IPC intervention components. Using simple random sampling, a sample of 1,734 caregivers was collected. Responses relating to demographic and socioeconomic factors, use of social media and WhatsApp, and electronic device ownership were analyzed using multiple linear regression analyses.
Results
Participants averaged 28.9 years old and most completed primary school. Exposure to the media component was higher than exposure to IPC. Ownership of an internet-accessible device (IAD) and social media use was negatively associated with exposure to IPC. Mothers who used a device to access health information were more likely to have been exposed to the media component. Exposure to the media campaign was positively associated with owning an IAD with WhatsApp.
Conclusions
Access to internet-accessible devices was predictive of positive exposure to mass-media and negative exposure to IPC. This latter finding was unexpected and may suggest people with IADs consume health online and feel less inclined to participate in IPC activities. Caregivers with technology and internet access may benefit from media-based interventions, whereas those with limited access may benefit from traditional interpersonal mediums.
Key messages
Future community health efforts in similar rural regions, should consider the use of both mass media and interpersonal communication interventions to influence health behaviors. Use of internet-accessible technology was positively related to exposure to the mass media campaign while negatively related to IPC exposure.
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Affiliation(s)
- C Daines
- Department of Public Health, Brigham Young University, Provo, Utah, USA
| | - A Norton
- Department of Public Health, Brigham Young University, Provo, Utah, USA
| | - L Hunt
- Department of Public Health, Brigham Young University, Provo, Utah, USA
| | - E Friedbaum
- Department of Public Health, Brigham Young University, Provo, Utah, USA
| | - D Topham
- Department of Public Health, Brigham Young University, Provo, Utah, USA
| | - J West
- Department of Public Health, Brigham Young University, Provo, Utah, USA
| | - S Torres
- RTI International, Washington DC, USA
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16
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Jassam N, Luvai A, Narayanan D, Turnock D, Lee G, Earp K, West J, Day A, Jeffery J, Zouwail S, El-Farhan N, Dearman R, Hayden K, Willett S, Osborne J, Barth JH. Albumin and calcium reference interval using healthy individuals and a data-mining approach. Ann Clin Biochem 2020; 57:373-381. [PMID: 32646226 DOI: 10.1177/0004563220944204] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 11/15/2022]
Abstract
BACKGROUND Harmonization of reference intervals for analytes that have a sound calibration and metrological traceability is a widely recommended practice. The UK Pathology Harmony has recently harmonized reference intervals for calcium and albumin. In this study, we have determined the reference intervals for calcium and albumin on the UK's most commonly used analytical platforms. METHOD A prospective reference population of healthy individuals was recruited according to the IFCC CRIDL criteria. A second indirect population was collected from 14 primary care setting and measured in laboratories using various analytical platforms and methods (Roche, Abbott, Beckman and Siemens analytical platforms). RESULTS In total, 299 subjects were recruited; the central 95th centile values for calcium for three out of four analytical platforms were in a close agreement with UK Pathology Harmony reference intervals of 2.2-2.6 mmol/L. Reference intervals of BCG methods from both cohorts and irrespective of analytical platforms were higher for both lower and upper reference limits than those for BCP. In comparison, the indirect study showed an age-related variation. The younger population reference intervals varied by up to 5.7% at the lower reference limit and up to 12% at the upper reference limit compared with Pathology Harmony reference intervals, and the older population showed a variation of up to 14% at both limits. CONCLUSION While calcium reference intervals can be a subject for harmonization, albumin reference intervals studied showed large variation which is unsupportive of embracing a common reference interval for albumin.
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Affiliation(s)
- N Jassam
- Department of Clinical Biochemistry, Harrogate Foundation Trust, Harrogate, UK
| | - A Luvai
- Department of Clinical Biochemistry, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - D Narayanan
- Department of Blood Sciences, Hull Royal Infirmary, Hull, UK
| | - D Turnock
- Department of Clinical Biochemistry, York Teaching Hospital NHS Foundation Trust, York, UK
| | - G Lee
- Department of Clinical Biochemistry, Mater Misericordiae University Hospital, Dublin, Ireland
| | - K Earp
- Department of Clinical Chemistry, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - J West
- Department of Clinical Biochemistry and Immunology, Peterborough City Hospital, Peterborough, UK
| | - A Day
- Department of Clinical Biochemistry, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - J Jeffery
- Derriford Combined Laboratory, Derriford Hospital, Plymouth, UK
| | - S Zouwail
- Department of Biochemistry & Immunology, University Hospital of Wales, Cardiff, UK
| | - N El-Farhan
- Department of Biochemistry, Aneurin Bevan University Health Board, Newport, UK
| | - R Dearman
- Faculty of Biology, Medicine and Health, Manchester University, Manchester, UK
| | - K Hayden
- Department of Clinical Biochemistry, Manchester University Hospital, Manchester, UK
| | - S Willett
- Department of Clinical Biochemistry, North Cumbria University Hospitals, Carlisle, UK
| | - J Osborne
- Department of Clinical Biochemistry, Manchester University Hospital, Manchester, UK
| | - J H Barth
- Department of Clinical Biochemistry, Leeds Teaching Hospitals Trust, Leeds, UK
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17
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Jassam N, Narayanan D, Turnock D, Lee G, Earp K, West J, Day A, Jeffery J, Zouwail S, El-Farhan N, Dearman R, Hayden K, Osborne J, Willett S, Barth JH. The effect of different analytical platforms and methods on the performance of population-specific adjusted calcium equation. Ann Clin Biochem 2020; 57:300-311. [DOI: 10.1177/0004563220931876] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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
BackgroundA recent attempt to improve the diagnostic value of adjusted calcium addressed a primary care-specific adjusted calcium equation, but validated the new equation for Roche Cobas, BCG and NM-BAPTA methods only. In this study, we aim to validate a population-specific equation for other methods and platforms.MethodWe collected retrospective patient data-sets from 15 hospital laboratories using a range of commercially available analytical platforms and methods for calcium and albumin measurements. Raw data-sets were collected and filtered according to Payne’s criteria, and separate adjusted calcium equations were derived for hospitalized and primary care patients.ResultsMean albumin and calcium results were significantly higher in primary care populations ( P < 0.0001). The prevalence of hypocalcaemia using adjusted calcium ranged between 6% and 44% for inpatient data-sets and was higher in users of BCG methods. The application of community-specific adjustment equation to primary care data-sets reduced the prevalence of hypocalcaemia (mean 1.7%, range 0.8–3.7%).ConclusionWe demonstrated that the use of a community-specific calcium adjustment equation to a primary care population reduces both the percentage and the variation of hypocalcaemia between different laboratories.
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Affiliation(s)
- N Jassam
- Department of Clinical Biochemistry, Harrogate Foundation Trust, Harrogate, UK
| | - D Narayanan
- Department of Blood Sciences, Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - D Turnock
- Department of Clinical Biochemistry, York Teaching Hospital NHS Foundation Trust, York, UK
| | - G Lee
- Department of Clinical Biochemistry, Mater Misericordiae University Hospital, Dublin, Ireland
| | - K Earp
- Department of Clinical Chemistry, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - J West
- Department of Clinical Biochemistry and Immunology, Peterborough City Hospital, Peterborough, UK
| | - A Day
- Department of Clinical Biochemistry, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - J Jeffery
- Derriford Combined Laboratory, Derriford Hospital, Plymouth, UK
| | - S Zouwail
- Department of Biochemistry & Immunology, University Hospital of Wales, Cardiff, UK
| | - N El-Farhan
- Department of Biochemistry, Aneurin Bevan University Health Board, Newport, UK
| | - R Dearman
- Faculty of Biology, Medicine and Health, Manchester University, Manchester, UK
| | - K Hayden
- Department Clinical Biochemistry, Manchester University Hospital, Manchester, UK
| | - J Osborne
- Department Clinical Biochemistry, Manchester University Hospital, Manchester, UK
| | - S Willett
- Department of Clinical Biochemistry, North Cumbria University Hospitals, Carlisle, UK
| | - JH Barth
- Department of Clinical Biochemistry, Leeds Teaching Hospitals Trust, Leeds, UK
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18
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Power R, Bartha G, Harris J, Boyle S, Levy E, Milani P, Tandon P, Li R, Chinnappa M, Haddad A, McNitt P, McClory R, Morra M, Saldivar S, Clark M, Haudenschild C, Newburn E, Johnson C, Chen R, West J. A comprehensive tumour immunogenomics platform for precision immunotherapy: Enabling simultaneous characterization of tumours and the TME from a single FFPE sample. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz447.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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19
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O'Leary C, Edwards V, McCulloch A, Loftus A, West J, Hardcastle K, Duckers J. WS14-3-2 The prevalence of adverse childhood experiences (ACEs) in cystic fibrosis. J Cyst Fibros 2019. [DOI: 10.1016/s1569-1993(19)30201-2] [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: 11/16/2022]
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20
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Gallard S, West J, Duckers J, Buttress A, Bridges C. P382 Obstructive sleep apnoea in cystic fibrosis: an under-recognised complication of cystic fibrosis? J Cyst Fibros 2019. [DOI: 10.1016/s1569-1993(19)30674-5] [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: 11/24/2022]
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21
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Santos S, Voerman E, Amiano P, Barros H, Beilin LJ, Bergström A, Charles MA, Chatzi L, Chevrier C, Chrousos GP, Corpeleijn E, Costa O, Costet N, Crozier S, Devereux G, Doyon M, Eggesbø M, Fantini MP, Farchi S, Forastiere F, Georgiu V, Godfrey KM, Gori D, Grote V, Hanke W, Hertz-Picciotto I, Heude B, Hivert MF, Hryhorczuk D, Huang RC, Inskip H, Karvonen AM, Kenny LC, Koletzko B, Küpers LK, Lagström H, Lehmann I, Magnus P, Majewska R, Mäkelä J, Manios Y, McAuliffe FM, McDonald SW, Mehegan J, Melén E, Mommers M, Morgen CS, Moschonis G, Murray D, Ní Chaoimh C, Nohr EA, Nybo Andersen AM, Oken E, Oostvogels A, Pac A, Papadopoulou E, Pekkanen J, Pizzi C, Polanska K, Porta D, Richiardi L, Rifas-Shiman SL, Roeleveld N, Ronfani L, Santos AC, Standl M, Stigum H, Stoltenberg C, Thiering E, Thijs C, Torrent M, Tough SC, Trnovec T, Turner S, van Gelder M, van Rossem L, von Berg A, Vrijheid M, Vrijkotte T, West J, Wijga AH, Wright J, Zvinchuk O, Sørensen T, Lawlor DA, Gaillard R, Jaddoe V. Impact of maternal body mass index and gestational weight gain on pregnancy complications: an individual participant data meta-analysis of European, North American and Australian cohorts. BJOG 2019; 126:984-995. [PMID: 30786138 DOI: 10.1111/1471-0528.15661] [Citation(s) in RCA: 211] [Impact Index Per Article: 42.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2019] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To assess the separate and combined associations of maternal pre-pregnancy body mass index (BMI) and gestational weight gain with the risks of pregnancy complications and their population impact. DESIGN Individual participant data meta-analysis of 39 cohorts. SETTING Europe, North America, and Oceania. POPULATION 265 270 births. METHODS Information on maternal pre-pregnancy BMI, gestational weight gain, and pregnancy complications was obtained. Multilevel binary logistic regression models were used. MAIN OUTCOME MEASURES Gestational hypertension, pre-eclampsia, gestational diabetes, preterm birth, small and large for gestational age at birth. RESULTS Higher maternal pre-pregnancy BMI and gestational weight gain were, across their full ranges, associated with higher risks of gestational hypertensive disorders, gestational diabetes, and large for gestational age at birth. Preterm birth risk was higher at lower and higher BMI and weight gain. Compared with normal weight mothers with medium gestational weight gain, obese mothers with high gestational weight gain had the highest risk of any pregnancy complication (odds ratio 2.51, 95% CI 2.31- 2.74). We estimated that 23.9% of any pregnancy complication was attributable to maternal overweight/obesity and 31.6% of large for gestational age infants was attributable to excessive gestational weight gain. CONCLUSIONS Maternal pre-pregnancy BMI and gestational weight gain are, across their full ranges, associated with risks of pregnancy complications. Obese mothers with high gestational weight gain are at the highest risk of pregnancy complications. Promoting a healthy pre-pregnancy BMI and gestational weight gain may reduce the burden of pregnancy complications and ultimately the risk of maternal and neonatal morbidity. TWEETABLE ABSTRACT Promoting a healthy body mass index and gestational weight gain might reduce the population burden of pregnancy complications.
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Affiliation(s)
- S Santos
- The Generation R Study Group, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.,Department of Pediatrics, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - E Voerman
- The Generation R Study Group, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.,Department of Pediatrics, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - P Amiano
- Public Health Division of Gipuzkoa, San Sebastián, Spain.,BioDonostia Research Institute, San Sebastián, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - H Barros
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.,Department of Public Health and Forensic Sciences and Medical Education, Unit of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal
| | - L J Beilin
- Medical School, Royal Perth Hospital Unit, The University of Western Australia, Perth, WA, Australia
| | - A Bergström
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden
| | - M-A Charles
- INSERM, UMR1153 Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), ORCHAD Team, Villejuif, France.,Paris Descartes University, Villejuif, France
| | - L Chatzi
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Faculty of Medicine, Department of Social Medicine, University of Crete, Heraklion, Greece.,Department of Genetics and Cell Biology, Maastricht University, Maastricht, the Netherlands
| | - C Chevrier
- Inserm UMR 1085, Irset - Research Institute for Environmental and Occupational Health, Rennes, France
| | - G P Chrousos
- First Department of Pediatrics, Athens University Medical School, 'Aghia Sophia' Children's Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - E Corpeleijn
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - O Costa
- Epidemiology and Environmental Health Joint Research Unit, FISABIO-Universitat Jaume I-Universitat de València, Valencia, Spain
| | - N Costet
- Inserm UMR 1085, Irset - Research Institute for Environmental and Occupational Health, Rennes, France
| | - S Crozier
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - G Devereux
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - M Doyon
- Centre de Recherche du Centre Hospitalier de l'Universite de Sherbrooke, Sherbrooke, QC, Canada
| | - M Eggesbø
- Department of Exposure and Environmental Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - M P Fantini
- The Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - S Farchi
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - F Forastiere
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - V Georgiu
- Faculty of Medicine, Department of Social Medicine, University of Crete, Heraklion, Greece
| | - K M Godfrey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - D Gori
- The Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - V Grote
- Division of Metabolic and Nutritional Medicine, Dr. von Hauner Children's Hospital, Ludwig-Maximilian-Universität Munich, Munich, Germany
| | - W Hanke
- Department of Environmental Epidemiology, Nofer Institute of Occupational Medicine, Lodz, Poland
| | - I Hertz-Picciotto
- Department of Public Health Sciences, School of Medicine, University of California Davis, Davis, CA, USA
| | - B Heude
- INSERM, UMR1153 Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), ORCHAD Team, Villejuif, France.,Paris Descartes University, Villejuif, France
| | - M-F Hivert
- Centre de Recherche du Centre Hospitalier de l'Universite de Sherbrooke, Sherbrooke, QC, Canada.,Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, MA, USA.,Diabetes Unit, Massachusetts General Hospital, Boston, MA, USA
| | - D Hryhorczuk
- Center for Global Health, University of Illinois College of Medicine, Chicago, IL, USA
| | - R-C Huang
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - H Inskip
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - A M Karvonen
- Department of Health Security, National Institute for Health and Welfare, Kuopio, Finland
| | - L C Kenny
- Irish Centre for Fetal and Neonatal Translational Research, Cork University Maternity Hospital, University College Cork, Cork, Ireland.,Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, Cork, Ireland
| | - B Koletzko
- Division of Metabolic and Nutritional Medicine, Dr. von Hauner Children's Hospital, Ludwig-Maximilian-Universität Munich, Munich, Germany
| | - L K Küpers
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.,MRC Integrative Epidemiology Unit, Oakfield House, Oakfield Grove, University of Bristol, Bristol, UK.,Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK.,Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands
| | - H Lagström
- Department of Public Health, University of Turku, Turku, Finland
| | - I Lehmann
- Department of Environmental Immunology/Core Facility Studies, Helmholtz Centre for Environmental Research - UFZ, Leipzig, Germany
| | - P Magnus
- Division of Health Data and Digitalization, Norwegian Institute of Public Health, Oslo, Norway
| | - R Majewska
- Department of Epidemiology, Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - J Mäkelä
- Turku Centre for Biotechnology, University of Turku and Abo Akademi University, Turku, Finland
| | - Y Manios
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - F M McAuliffe
- UCD Perinatal Research Centre, Obstetrics& Gynaecology, School of Medicine, National Maternity Hospital, University College Dublin, Dublin, Ireland
| | - S W McDonald
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - J Mehegan
- UCD Perinatal Research Centre, School of Public Health and Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - E Melén
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Sach's Children Hospital, Stockholm, Sweden
| | - M Mommers
- Department of Epidemiology, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - C S Morgen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.,Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark
| | - G Moschonis
- Department of Rehabilitation, Nutrition and Sport, La Trobe University, Melbourne, Vic, Australia
| | - D Murray
- Irish Centre for Fetal and Neonatal Translational Research, Cork University Maternity Hospital, University College Cork, Cork, Ireland.,Paediatrics & Child Health, University College Cork, Cork, Ireland
| | - C Ní Chaoimh
- Irish Centre for Fetal and Neonatal Translational Research, Cork University Maternity Hospital, University College Cork, Cork, Ireland.,Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, University College Cork, Cork, Ireland
| | - E A Nohr
- Research Unit for Gynaecology and Obstetrics, Institute for Clinical Research, University of Southern Denmark, Odense, Denmark
| | - A-M Nybo Andersen
- Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark
| | - E Oken
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Ajjm Oostvogels
- Department of Public Health, Amsterdam Public Health Research Institute, Academic Medical Center, Amsterdam, the Netherlands
| | - A Pac
- Department of Epidemiology, Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - E Papadopoulou
- Department of Environmental Exposures and Epidemiology, Domain of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - J Pekkanen
- Department of Health Security, National Institute for Health and Welfare, Kuopio, Finland.,Department of Public Health, University of Helsinki, Helsinki, Finland
| | - C Pizzi
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - K Polanska
- Department of Environmental Epidemiology, Nofer Institute of Occupational Medicine, Lodz, Poland
| | - D Porta
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - L Richiardi
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - S L Rifas-Shiman
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - N Roeleveld
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - L Ronfani
- Institute for Maternal and Child Health - IRCCS 'Burlo Garofolo', Trieste, Italy
| | - A C Santos
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.,Department of Public Health and Forensic Sciences and Medical Education, Unit of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal
| | - M Standl
- Institute of Epidemiology, Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg, Germany
| | - H Stigum
- Department of Non-communicable Diseases, Norwegian Institute of Public Health, Oslo, Norway
| | - C Stoltenberg
- Norwegian Institute of Public Health, Oslo, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - E Thiering
- Institute of Epidemiology, Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg, Germany.,Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - C Thijs
- Department of Epidemiology, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - M Torrent
- Ib-salut, Area de Salut de Menorca, Menorca, Spain
| | - S C Tough
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - T Trnovec
- Department of Environmental Medicine, Slovak Medical University, Bratislava, Slovak Republic
| | - S Turner
- Child Health, Royal Aberdeen Children's Hospital, Aberdeen, UK
| | - Mmhj van Gelder
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands.,Radboud REshape Innovation Center, Radboud University Medical Center, Nijmegen, the Netherlands
| | - L van Rossem
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - A von Berg
- Department of Pediatrics, Research Institute, Marien-Hospital Wesel, Wesel, Germany
| | - M Vrijheid
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,ISGlobal, Institute for Global Health, Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Tgm Vrijkotte
- Department of Public Health, Amsterdam Public Health Research Institute, Academic Medical Center, Amsterdam, the Netherlands
| | - J West
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
| | - A H Wijga
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - J Wright
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
| | - O Zvinchuk
- Department of Medical and Social Problems of Family Health, Institute of Pediatrics, Obstetrics and Gynecology, Kyiv, Ukraine
| | - Tia Sørensen
- Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark.,Section of Metabolic Genetics, Faculty of Health and Medical Sciences, The Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
| | - D A Lawlor
- MRC Integrative Epidemiology Unit, Oakfield House, Oakfield Grove, University of Bristol, Bristol, UK.,Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
| | - R Gaillard
- The Generation R Study Group, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.,Department of Pediatrics, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Vwv Jaddoe
- The Generation R Study Group, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.,Department of Pediatrics, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.,Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
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22
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Kelly B, West J, Yang TC, Mason D, Hasan T, Wright J. The association between body mass index, primary healthcare use and morbidity in early childhood: findings from the Born In Bradford cohort study. Public Health 2019; 167:21-27. [PMID: 30610958 DOI: 10.1016/j.puhe.2018.10.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 08/08/2018] [Revised: 10/01/2018] [Accepted: 10/25/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVES The objective of the article was to examine the association between body mass index (BMI), health and general practice (GP) healthcare use in early childhood. STUDY DESIGN This study is a prospective cohort study. METHODS Multivariate Poisson and logistic regression models were used to explore the association between BMI and health outcomes using data from the Born In Bradford cohort study, linked to routine data capturing objective measures of BMI at age 5 years, alongside GP appointment rates, GP prescriptions and specific morbidities in the subsequent 3-year period. RESULTS Compared with healthy weight, children who were obese at the age of 5 years had significantly higher rates of GP appointments (incident rate ratio 1.14, 95% confidence interval [CI]: 1.06-1.23), GP prescriptions (incident rate ratio 1.15, 95% CI: 1.04-1.27), asthma (odds ratio 1.46, 95% CI: 1.21-1.77), sleep apnoea (odds ratio 2.50, 95% CI: 1.36-4.58), infections (incident rate ratio 1.19, 95% CI: 1.08-1.30), antibiotic prescriptions (incident rate ratio 1.25, 95% CI: 1.10-1.42) and accidents (incident rate ratio 1.20, 95% CI: 1.01-1.42) in the subsequent 3 years. Underweight children were found to have higher rates of GP appointments (incident rate ratio 1.25, 95% CI: 1.04-1.52), but there were no differences between overweight and healthy weight children. CONCLUSIONS Childhood obesity was found to be associated with increased primary healthcare use and a range of poorer health outcomes at the age of 8 years, underlining the importance of reducing childhood obesity in early childhood.
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Affiliation(s)
- B Kelly
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK.
| | - J West
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - T C Yang
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - D Mason
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - T Hasan
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK; Department of Health Sciences, University of York, York, UK
| | - J Wright
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
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23
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Boswell K, Cameron H, West J, Fleming C, Ibbotson S, Dawe R, Foerster J. Cost of narrowband ultraviolet B for psoriasis. Br J Dermatol 2018. [DOI: 10.1111/bjd.17210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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24
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Boswell K, Cameron H, West J, Fleming C, Ibbotson S, Dawe R, Foerster J. 窄波 UVB 用于银屑病治疗的费用. Br J Dermatol 2018. [DOI: 10.1111/bjd.17224] [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: 11/30/2022]
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25
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Ajrouch K, Read JG, West J. DISPARITIES IN DISABILITY AMONG ARAB AMERICANS BY NATIVITY STATUS AND IMMIGRANT ARRIVAL COHORT. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- K Ajrouch
- Eastern Michigan University, Ypsilanti, Michigan, United States
| | - J G Read
- Duke University Durham, NC , Duke Univeristy Durham, NC
| | - J West
- Eastern Michigan University, Ypsilanti, Michigan, United States
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26
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Mwaiselage J, Lidenge S, Ngowi J, Haynatzki G, Wood C, West J. Differential Immune Responses in Epidemic and Endemic Tanzanian Kaposi Sarcoma Patients. J Glob Oncol 2018. [DOI: 10.1200/jgo.18.81800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Mechanisms underlying Kaposi sarcoma (KS) development are unclear. The high incidence of KS in HIV-1+ individuals implicates immune dysregulation in epidemic KS (EpKS) development. In African endemic KS (EnKS), the immune response is uncharacterized. Aim: The aim was to assess a comparative quantification between newly diagnosed Tanzanian EpKS and EnKS patients, and asymptomatic controls. We also report the first comparison of KSHV NAb prevalence and titer between EpKS and EnKS patients. Methods: To compare innate and adaptive immune responses, we recruited histologically confirmed Tanzanian EpKS and EnKS patients, as well as noncancer controls. After differential detection of KSHV nucleic acids in tissues, neutralizing antibody (NAb), levels of cytokines/chemokines, and T-cell differentiation subsets were quantified. The Mann-Whitney U-test was used to assess median differences between groups. All tests were 2-tailed and P-values < 0.05 were considered significant. Results: A total of 180 patients have been recruited in this study. In addition, a comparable 25 EpKS and 10 EnKS as well as 10 noncancer controls were recruited for this study. KSHV was significantly more frequently detected in EpKS patients than in EnKS. While all EpKS, and some EnKS patients mounted NAb responses, the EpKS patients had higher prevalence and titer of NAb compared with EnKS patients ( P = 0.001). Levels of the cytokines IP-10 and IL-10 were higher in EpKS vs EnKS patients ( P = 0.006 and P = 0.005 respectively), whereas, IL-4 was lower in EpKS vs EnKS patients ( P = 0.004). The levels of all 14 cytokines/chemokines measured were comparable between EnKS patients and HIV− controls ( P < .05 ). The distribution of CD4+ and CD8+ T-cells was similar between EpKS and EnKS such as naive and effector T-cells were depleted while central memory T-cells were elevated in both KS forms. Conclusion: The detection of similar abnormalities in T-cell differentiation subsets in both EpKS and EnKS as compared with controls, suggests that KSHV-induced T-cell dysfunction plays a major role in the disease, and that HIV-1 coinfection is only exacerbating and accelerating KSHV pathogenesis and KS development.
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Affiliation(s)
- J.D. Mwaiselage
- Ocean Road Cancer Institute, Cancer Prevention Services, Dar es Salaam, United Republic of Tanzania
| | - S. Lidenge
- Ocean Road Cancer Institute, Academic and Research, Dar es Salaam, United Republic of Tanzania
| | - J.R. Ngowi
- Ocean Road Cancer Institute, Cancer Prevention Services, Dar es Salaam, United Republic of Tanzania
| | - G. Haynatzki
- University of Nebraska Medical Center, College of Public Health, Omaha, NE
| | - C. Wood
- University of Nebraska - Lincoln, Center for Virology, Lincoln, NE
| | - J. West
- University of Nebraska - Lincoln, Center for Virology, Lincoln, NE
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27
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Caputo N, Oliver M, West J, Hackett R, Sakles J. 101 The Efficacy of Current Preoxygenation Strategies During Rapid Sequence Intubation in the Emergency Department. Ann Emerg Med 2018. [DOI: 10.1016/j.annemergmed.2018.08.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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28
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Boswell K, Cameron H, West J, Fleming C, Ibbotson S, Dawe R, Foerster J. Narrowband ultraviolet B treatment for psoriasis is highly economical and causes significant savings in cost for topical treatments. Br J Dermatol 2018; 179:1148-1156. [PMID: 29901862 DOI: 10.1111/bjd.16716] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Narrowband ultraviolet B (NB-UVB) treatment for psoriasis is considered expensive. However, existing data are based on estimates and do not consider indirect cost savings. OBJECTIVES To define the actual costs of NB-UVB incurred by the service provider, as well as treatment-associated cost savings. METHODS We performed data linkage of (i) comprehensive treatment records and (ii) prescribing data for all NB-UVB treatment episodes spanning 6 years in a population of 420 000. We minimized data fluctuation by compiling data from four independent treatment sites, and using drug prescriptions unrelated to psoriasis as a negative control. RESULTS National Health Service Tayside spent an average of £257 per NB-UVB treatment course (mean 257 ± 63, range 150-286, across four independent treatment sites), contrasting sharply with the estimate of £1882 used by the U.K. National Institute for Health and Care Excellence. The cost of topical treatments averaged £128 per patient in the 12 months prior to NB-UVB, accounting for 42% of the overall drug costs incurred by these patients. This was reduced by 40% to £53 per patient over the 12-month period following NB-UVB treatment, while psoriasis-unrelated drug prescription remained unchanged, suggesting disease-specific effects of NB-UVB. The data were not due to site-specific factors, as confirmed by highly similar results observed between treatment sites operated by distinct staff. Finally, we detail all staff hours directly and indirectly involved in treatment, allowing direct translation of cost into other healthcare systems. CONCLUSIONS NB-UVB is a low-cost treatment; cost figures currently used in health technology appraisals are an overestimate based on the data presented here. Creating or extending access to NB-UVB is likely to offer additional savings by delaying or avoiding costly third-line treatments for many patients.
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Affiliation(s)
- K Boswell
- University of Dundee, Medical School, Dundee, U.K.,Department of Dermatology and Photobiology Unit, NHS Tayside, Dundee, U.K
| | - H Cameron
- University of Dundee, Medical School, Dundee, U.K.,Department of Dermatology and Photobiology Unit, NHS Tayside, Dundee, U.K
| | - J West
- University of Dundee, Medical School, Dundee, U.K.,Department of Dermatology and Photobiology Unit, NHS Tayside, Dundee, U.K
| | - C Fleming
- University of Dundee, Medical School, Dundee, U.K.,Department of Dermatology and Photobiology Unit, NHS Tayside, Dundee, U.K
| | - S Ibbotson
- University of Dundee, Medical School, Dundee, U.K.,Department of Dermatology and Photobiology Unit, NHS Tayside, Dundee, U.K
| | - R Dawe
- University of Dundee, Medical School, Dundee, U.K.,Department of Dermatology and Photobiology Unit, NHS Tayside, Dundee, U.K.,National Managed Clinical Network for Phototherapy (Photonet), NHS Scotland, Dundee, U.K
| | - J Foerster
- University of Dundee, Medical School, Dundee, U.K.,Department of Dermatology and Photobiology Unit, NHS Tayside, Dundee, U.K
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29
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Cezard G, Smith L, Petherick E, Cameron N, West J, Lawlor D, Bhopal R. 1.11-P19Ethnic differences in early life adiposity trajectories between White British and Pakistani children: results from the Born in Bradford cohort study in the UK. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky048.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- G Cezard
- University of St Andrews, Scotland
| | - L Smith
- University of Leeds, United Kingdom
| | | | - N Cameron
- Loughborough University, United Kingdom
| | - J West
- Bradford Institute for Health Research, United Kingdom
| | - D Lawlor
- University of Bristol, United Kingdom
| | - R Bhopal
- University of Edinburgh, United Kingdom
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30
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Collings P, Ball H, Santorelli G, West J, Barber S, McEachan R, Wright J. 1.11-P15Sleep duration and adiposity in early childhood: evidence for bidirectional associations from the Born in Bradford Study. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky048.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- P Collings
- Born in Bradford, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, United Kingdom
| | - H Ball
- Parent-Infant Sleep Lab & Anthropology of Health Research Group, Department of Anthropology, Durham University, United Kingdom
| | - G Santorelli
- Born in Bradford, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, United Kingdom
| | - J West
- Born in Bradford, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, United Kingdom
| | - S Barber
- Born in Bradford, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, United Kingdom
| | - R McEachan
- Born in Bradford, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, United Kingdom
| | - J Wright
- Born in Bradford, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, United Kingdom
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31
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Collings P, Brage S, Bingham D, Costa S, West J, McEachan R, Wright J, Barber S. 7.1-O2Physical activity, sedentary time, and fatness in a Biethnic aample of young children. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky047.232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- P Collings
- Bradford Institute for Health Research, Bradford NHS Foundation Trust, United Kingdom
| | - S Brage
- MRC Epidemiology Unit, University of Cambridge, United Kingdom
| | - D Bingham
- Bradford Institute for Health Research, Bradford NHS Foundation Trust, United Kingdom
| | - S Costa
- UKCRC Centre for Diet and Activity Research (CEDAR), University of Cambridge School of Clinical Medicine, United Kingdom
| | - J West
- Bradford Institute for Health Research, Bradford NHS Foundation Trust, United Kingdom
| | - R McEachan
- Bradford Institute for Health Research, Bradford NHS Foundation Trust, United Kingdom
| | - J Wright
- Bradford Institute for Health Research, Bradford NHS Foundation Trust, United Kingdom
| | - S Barber
- Bradford Institute for Health Research, Bradford NHS Foundation Trust, United Kingdom
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32
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Humes DJ, Abdul-Sultan A, Walker AJ, Ludvigsson JF, West J. Duration and magnitude of postoperative risk of venous thromboembolism after planned inguinal hernia repair in men: a population-based cohort study. Hernia 2018; 22:447-453. [DOI: 10.1007/s10029-017-1716-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 12/13/2017] [Indexed: 11/30/2022]
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33
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West J, Ogston S, Berg J, Palmer C, Fleming C, Kumar V, Foerster J. HLA-Cw6-positive patients with psoriasis show improved response to methotrexate treatment. Clin Exp Dermatol 2017; 42:651-655. [DOI: 10.1111/ced.13100] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2016] [Indexed: 01/22/2023]
Affiliation(s)
- J. West
- University of Dundee; College of Medicine, Dentistry, and Nursing; Dundee UK
| | - S. Ogston
- University of Dundee; College of Medicine, Dentistry, and Nursing; Dundee UK
| | - J. Berg
- University of Dundee; College of Medicine, Dentistry, and Nursing; Dundee UK
| | - C. Palmer
- University of Dundee; College of Medicine, Dentistry, and Nursing; Dundee UK
| | - C. Fleming
- Department of Dermatology and Photobiology; Ninewells Hospital; Dundee UK
| | - V. Kumar
- Department of Rheumatology; Ninewells Hospital; Dundee UK
| | - J. Foerster
- University of Dundee; College of Medicine, Dentistry, and Nursing; Dundee UK
- Department of Dermatology and Photobiology; Ninewells Hospital; Dundee UK
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34
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Elsey EJ, Griffiths G, Humes DJ, West J. Meta-analysis of operative experiences of general surgery trainees during training. Br J Surg 2017; 104:22-33. [PMID: 28000937 DOI: 10.1002/bjs.10396] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 07/20/2016] [Accepted: 08/24/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND General surgical training curricula around the world set defined operative numbers to be achieved before completion of training. However, there are few studies reporting total operative experience in training. This systematic review aimed to quantify the published global operative experience at completion of training in general surgery. METHODS Electronic databases were searched systematically for articles in any language relating to operative experience in trainees completing postgraduate general surgical training. Two reviewers independently assessed citations for inclusion using agreed criteria. Studies were assessed for quantitative data in addition to study design and purpose. A meta-analysis was performed using a random-effects model of studies with appropriate data. RESULTS The search resulted in 1979 titles for review. Of these, 24 studies were eligible for inclusion in the review and data from five studies were used in the meta-analysis. Studies with published data of operative experience at completion of surgical training originated from the USA (19), UK (2), the Netherlands (1), Spain (1) and Thailand (1). Mean total operative experience in training varied from 783 procedures in Thailand to 1915 in the UK. Meta-analysis produced a mean pooled estimate of 1366 (95 per cent c.i. 1026 to 1707) procedures per trainee at completion of training. There was marked heterogeneity between studies (I2 = 99·6 per cent). CONCLUSION There is a lack of robust data describing the operative experiences of general surgical trainees outside the USA. The number of surgical procedures performed by general surgeons in training varies considerably across the world.
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Affiliation(s)
- E J Elsey
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - G Griffiths
- Department of Vascular Surgery, Ninewells Hospital, Dundee, UK
| | - D J Humes
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK.,National Institute for Health Research Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - J West
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
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35
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West J, Card TR, Aithal GP, Fleming KM. Risk of hepatocellular carcinoma among individuals with different aetiologies of cirrhosis: a population-based cohort study. Aliment Pharmacol Ther 2017; 45:983-990. [PMID: 28144999 DOI: 10.1111/apt.13961] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 04/04/2016] [Accepted: 01/10/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Among patients with cirrhosis, only those determined to be at risk for hepatocellular carcinoma (HCC) should undergo surveillance. However, little is known about how different aetiologies of cirrhosis affect risk for HCC. AIM To quantify the cumulative incidence of HCC among a representative population of people with cirrhosis of the liver of varying aetiology. METHODS We identified subjects with hepatic cirrhosis from the UK's General Practice Research Database (1987-2006). Diagnoses of HCC were obtained from linked national cancer registries (1971-2006). Cox proportional hazards regression was used to estimate hazard ratios. The predicted 10-year cumulative incidence of HCC for each aetiology of cirrhosis was estimated while accounting for competing risks of death from any cause and liver transplant. RESULTS Among 3107 people with cirrhosis, the adjusted relative risk of HCC was increased twofold to threefold among people with viral and autoimmune/metabolic aetiologies, compared to those with alcohol-associated cirrhosis. The 10-year predicted cumulative incidence estimates of HCC for each aetiology were alcohol, 1.2%; chronic viral hepatitis, 4.0%; autoimmune or metabolic disease, 3.2%; and cryptogenic, 1.1%. CONCLUSIONS In a population-based study in the UK, people with cirrhosis have an estimated cumulative 10-year incidence of HCC of 4% or lower. Cumulative incidence varies with aetiology such that individuals with alcohol or cryptogenic cirrhosis have the lowest risk for HCC. These findings provide important information for cost-effectiveness analyses of HCC surveillance.
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Affiliation(s)
- J West
- Division of Epidemiology and Public Health, The University of Nottingham, Nottingham, UK
| | - T R Card
- Division of Epidemiology and Public Health, The University of Nottingham, Nottingham, UK
- NIHR Nottingham Digestive Diseases Biomedical Research Unit at Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham, UK
| | - G P Aithal
- NIHR Nottingham Digestive Diseases Biomedical Research Unit at Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham, UK
| | - K M Fleming
- Division of Epidemiology and Public Health, The University of Nottingham, Nottingham, UK
- Public Health Institute, Liverpool John Moores University, Liverpool, UK
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Lee Y, Ramalingam N, Szpankowski L, Leyrat A, Angeles N, Wu A, West J, Bhagat A. 56P Single circulating tumor cells RNA profiling by label-free enrichment and active single cell selection on an integrated fluidic system. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw574.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Lee Y, Ramalingam N, Szpankowski L, Leyrat A, Angeles N, Wu A, West J, Bhagat A. 56P Single circulating tumor cells RNA profiling by label-free enrichment and active single cell selection on an integrated fluidic system. Ann Oncol 2016. [DOI: 10.1016/s0923-7534(21)00216-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Beck J, Newburn E, Clark M, Lefterova M, Helman E, Alla R, Church D, Boyle S, Luo S, Morra M, Harris J, Leng N, Haudenschild C, Chen R, West J. Analytical validation of comprehensive assays for genomic profiling of cancer from DNA and RNA. Eur J Cancer 2016. [DOI: 10.1016/s0959-8049(16)32781-2] [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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Caputo N, Donner L, Williams A, West J, Ryan M, Raja A, Kanter M, Scott S. 9 The Use of Emergency Department Diffuse Apneic Oxygenation Versus Usual Care During Rapid Sequence Intubation of Emergency Department Patients: A Randomized Controlled Trial (Preliminary Results of the ENDAO Study). Ann Emerg Med 2016. [DOI: 10.1016/j.annemergmed.2016.08.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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West J, Barrack M. Prevalence and Predictors of Disordered Eating among a Diverse Sample of College Freshmen. J Acad Nutr Diet 2016. [DOI: 10.1016/j.jand.2016.06.196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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West J, Santorelli G, Fairley L, Wright J, Lawlor DA. OP87 Maternal determinants of differences in size and adiposity between Pakistani origin and White British origin children age 4/5 participating in the Born in Bradford cohort study. Br J Soc Med 2016. [DOI: 10.1136/jech-2016-208064.87] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Zingone F, Abdul Sultan A, Crooks CJ, Tata LJ, Ciacci C, West J. The risk of community-acquired pneumonia among 9803 patients with coeliac disease compared to the general population: a cohort study. Aliment Pharmacol Ther 2016; 44:57-67. [PMID: 27151603 DOI: 10.1111/apt.13652] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 02/13/2016] [Accepted: 04/14/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Patients with coeliac disease are considered as individuals for whom pneumococcal vaccination is advocated. AIM To quantify the risk of community-acquired pneumonia among patients with coeliac disease, assessing whether vaccination against streptococcal pneumonia modified this risk. METHODS We identified all patients with coeliac disease within the Clinical Practice Research Datalink linked with English Hospital Episodes Statistics between April 1997 and March 2011 and up to 10 controls per patient with coeliac disease frequency matched in 10-year age bands. Absolute rates of community-acquired pneumonia were calculated for patients with coeliac disease compared to controls stratified by vaccination status and time of diagnosis using Cox regression in terms of adjusted hazard ratios (HR). RESULTS Among 9803 patients with coeliac disease and 101 755 controls, respectively, there were 179 and 1864 first community-acquired pneumonia events. Overall absolute rate of pneumonia was similar in patients with coeliac disease and controls: 3.42 and 3.12 per 1000 person-years respectively (HR 1.07, 95% CI 0.91-1.24). However, we found a 28% increased risk of pneumonia in coeliac disease unvaccinated subjects compared to unvaccinated controls (HR 1.28, 95% CI 1.02-1.60). This increased risk was limited to those younger than 65, was highest around the time of diagnosis and was maintained for more than 5 years after diagnosis. Only 26.6% underwent vaccination after their coeliac disease diagnosis. CONCLUSIONS Unvaccinated patients with coeliac disease under the age of 65 have an excess risk of community-acquired pneumonia that was not found in vaccinated patients with coeliac disease. As only a minority of patients with coeliac disease are being vaccinated there is a missed opportunity to intervene to protect these patients from pneumonia.
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Affiliation(s)
- F Zingone
- Division of Epidemiology and Public Health, University of Nottingham, City Hospital, Nottingham, UK.,Coeliac center, Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - A Abdul Sultan
- Division of Epidemiology and Public Health, University of Nottingham, City Hospital, Nottingham, UK
| | - C J Crooks
- Division of Epidemiology and Public Health, University of Nottingham, City Hospital, Nottingham, UK
| | - L J Tata
- Division of Epidemiology and Public Health, University of Nottingham, City Hospital, Nottingham, UK
| | - C Ciacci
- Coeliac center, Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - J West
- Division of Epidemiology and Public Health, University of Nottingham, City Hospital, Nottingham, UK
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West J, Ogston S, Palmer C, Fleming C, Dawe R, Kumar V, Waterston S, Foerster J. Methotrexate in psoriasis under real‐world conditions: long‐term efficacy and tolerability. Br J Dermatol 2016; 174:1407-10. [DOI: 10.1111/bjd.14452] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- J. West
- Medical School University of Dundee Dundee U.K
| | - S. Ogston
- Medical School University of Dundee Dundee U.K
| | - C. Palmer
- Medical School University of Dundee Dundee U.K
| | - C. Fleming
- Department of Dermatology and Photobiology University of Dundee Dundee U.K
| | - R. Dawe
- Department of Dermatology and Photobiology University of Dundee Dundee U.K
| | - V. Kumar
- Department of Rheumatology University of Dundee Dundee U.K
| | - S. Waterston
- Department of Dermatology and Photobiology University of Dundee Dundee U.K
| | - J. Foerster
- Medical School University of Dundee Dundee U.K
- Department of Dermatology and Photobiology University of Dundee Dundee U.K
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Kapitsinou PP, Rajendran G, Astleford L, Schonfeld MP, Michael M, Shay S, French JL, West J, Haase VH, Fields T. ID: 113: THE ENDOTHELIAL PHD2/HIF-2 AXIS REGULATES PULMONARY ARTERY PRESSURE IN MICE. J Investig Med 2016. [DOI: 10.1136/jim-2016-000120.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundPulmonary hypertension (PH), a common clinical problem characterized by increased pulmonary artery (PA) pressure, is frequently triggered by hypoxia. Key mediators of cellular hypoxia responses are hypoxia-inducible factors (HIF)-1 and -2, the activity of which is regulated by prolyl-4-hydroxylase domain (PHD) proteins, with PHD2 being the main oxygen sensor that controls HIF activity under normoxia. Although both transcription factors are expressed in the lung, little is known about their cell type-specific roles in the pathogenesis of PH.Methods and ResultsHere we used a genetic approach to investigate the role of endothelial PHD2/HIF axis in the regulation of PA pressure. Endothelial cell specific HIF activation was achieved by crossing Vecadherin (Cdh5)-Cre transgenics to Phd2 floxed mice (ePhd2), while the contribution of each HIF isoform was assessed by generating double mutants lacking Phd2 and Hif-2 (ePhd2Hif2) or Phd2 and Hif-1 (Phd2Hif1). Right ventricular systolic pressure (RVSP) was measured via insertion of a 1.4F Mikro-tip catheter transducer into a surgically exposed right internal jugular vein. ePhd2 mice showed activation of HIF-signaling as shown by immunoblot analysis of lung tissue for HIF-1 and HIF-2. These mice developed spontaneous PH (RVSP, ePhd2: 54.3±6.9 vs Cre-: 24.8±2.2 mm Hg, P=0.005), which was associated with right ventricular hypertrophy (RVH) (Fulton Index, ePhd2: 0.52 vs Cre-: 0.28, P=0.0004) and early mortality. While morphologic analysis of ePhd2 lungs did not demonstrate plexiform or lumen-obliterating lesions, enhanced muscularization of peripheral PAs was detected in mutants compared to controls, as indicated by an increase in the number of arteries with diameters <100 µm that stained positive for αSMA (22.1±1.6 vs. 7.6±1.5 muscularized vessels/10 hpf, P<0.0001). The PH phenotype was maintained in ePhd2Hif1 mutants but was reversed in ePhd2Hif2 mutants. To assess the contribution of endothelial HIF-2 in hypoxia induced PH, endothelial Hif2 single mutants or Cre-littermates were exposed to normobaric hypoxia (10% O2) for 4 weeks. In contrast to controls, eHif2 mutants were protected from development of PH and RVH. Bone marrow transplantation studies showed no contribution from hematopoietic HIF-2 in hypoxia induced PH. Because hypoxia regulates endothelin 1 (EDN1), a potent vasoconstrictor but also apelin (APLN), a vasodilatory peptide acting through binding to the apelin G-protein-coupled receptor (APLNR), we assessed the role of endothelial HIF-2 axis in the regulation of these molecules. Endothelial deletion of Phd2 resulted in 6.4-fold induction of pulmonary Edn1 mRNA (P=0.029), but not Apln mRNA. In contrast, Aplnr was downregulated by 2.5-fold in ePhd2 mutants (P=0.037). A similar pattern of expression was detected in ePhd2Hif1 mice, whereas simultaneous deletion of Hif2a and Phd2 reversed these changes. To investigate the differences between acute and chronic hypoxia, we examined the effects of acute HIF activation on Edn1 and Apln/Aplnr gene expression in vivo. To model acute hypoxia, we subjected WT mice to 8% O2 for 48 hrs and maintained controls in room air. Acute hypoxia resulted in a 4.3-fold and 1.6-fold up-regulation of Edn1 and Apln transcripts respectively (P=0.0011 for Edn1, P=0.08 for Apln) while Aplnr was reduced by 4.3-fold (P=0.0005). We observed similar gene expression changes in mice treated with a prolyl-4-hydroxylase inhibitor (PHI) that results in global HIF activation.ConclusionsOur studies identify endothelial HIF-2 as a key transcription factor in the pathogenesis of PH and suggest that HIF-2 regulates PA pressure by modulating the expression of vasoactive molecules. Our findings identify the PHD2/HIF2 axis as a potential target for PH therapies.
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Langan S, Smeeth L, West J. Reply to: Validation of database search strategies for the epidemiological study of pemphigus and pemphigoid. Br J Dermatol 2016; 174:696-7. [DOI: 10.1111/bjd.14397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- S.M. Langan
- Faculty of Epidemiology and Population Health; London School of Hygiene and Tropical Medicine; London U.K
| | - L. Smeeth
- Faculty of Epidemiology and Population Health; London School of Hygiene and Tropical Medicine; London U.K
| | - J. West
- Department of Epidemiology; University of Nottingham; Nottingham U.K
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Humes DJ, Walker AJ, Hunt BJ, Sultan AA, Ludvigsson JF, West J. Risk of symptomatic venous thromboembolism following emergency appendicectomy in adults. Br J Surg 2016; 103:443-50. [DOI: 10.1002/bjs.10091] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 10/30/2015] [Accepted: 11/23/2015] [Indexed: 12/25/2022]
Abstract
Abstract
Background
Appendicectomy is the commonest intra-abdominal emergency surgical procedure, and little is known regarding the magnitude and timing of the risk of venous thromboembolism (VTE) after surgery. This study aimed to determine absolute and relative rates of symptomatic VTE following emergency appendicectomy.
Methods
A cohort study was undertaken using linked primary (Clinical Practice Research Datalink) and secondary (Hospital Episode Statistics) care data of patients who had undergone emergency appendicectomy from 2001 to 2011. Crude rates and adjusted incidence rate ratios (IRRs) for VTE were calculated using Poisson regression, compared with baseline risk in the year before appendicectomy.
Results
A total of 13 441 patients were identified, of whom 56 (0·4 per cent) had a VTE in the first year after surgery. The absolute rate of VTE was highest during the in-hospital period, with a rate of 91·29 per 1000 person-years, which was greatest in those with a length of stay of 7 days or more (267·12 per 1000 person-years). This risk remained high after discharge, with a 19·1- and 6·6-fold increased risk of VTE in the first and second months respectively after discharge, compared with the year before appendicectomy (adjusted IRR: month 1, 19·09 (95 per cent c.i. 9·56 to 38·12); month 2, 6·56 (2·62 to 16·44)).
Conclusion
The risk of symptomatic VTE following appendicectomy is relatively high during the in-hospital admission and remains increased after discharge. Trials of extended thromboprophylaxis are warranted in patients at particularly high risk.
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Affiliation(s)
- D J Humes
- Division of Epidemiology and Public Health, School of Medicine, Queens Medical Centre Campus, University of Nottingham, Nottingham, UK
- Nottingham Digestive Diseases Biomedical Research Unit, Queens Medical Centre Campus, University of Nottingham, Nottingham, UK
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - A J Walker
- Division of Epidemiology and Public Health, School of Medicine, Queens Medical Centre Campus, University of Nottingham, Nottingham, UK
| | - B J Hunt
- Thrombosis and Haemophilia Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - A A Sultan
- Division of Epidemiology and Public Health, School of Medicine, Queens Medical Centre Campus, University of Nottingham, Nottingham, UK
| | - J F Ludvigsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
- Department of Paediatrics, Örebro University Hospital, Örebro, Sweden
| | - J West
- Division of Epidemiology and Public Health, School of Medicine, Queens Medical Centre Campus, University of Nottingham, Nottingham, UK
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Pickworth J, Shay S, Gladson S, Iremonger J, Rothman AMK, Francis S, West J, Lawrie A. S3 Reduced BMPR2 expression potentiates a pulmonary artery smooth muscle cell specific IL-1ß response. Thorax 2015. [DOI: 10.1136/thoraxjnl-2015-207770.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Campbell CA, Lefroy EC, Caddy-Retalic S, Bax N, Doherty PJ, Douglas MM, Johnson D, Possingham HP, Specht A, Tarte D, West J. Designing environmental research for impact. Sci Total Environ 2015; 534:4-13. [PMID: 25557212 DOI: 10.1016/j.scitotenv.2014.11.089] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [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: 09/26/2014] [Revised: 11/19/2014] [Accepted: 11/20/2014] [Indexed: 06/04/2023]
Abstract
Transdisciplinary research, involving close collaboration between researchers and the users of research, has been a feature of environmental problem solving for several decades, often spurred by the need to find negotiated outcomes to intractable problems. In 2005, the Australian government allocated funding to its environment portfolio for public good research, which resulted in consecutive four-year programmes (Commonwealth Environmental Research Facilities, National Environmental Research Program). In April 2014, representatives of the funders, researchers and research users associated with these programmes met to reflect on eight years of experience with these collaborative research models. This structured reflection concluded that successful multi-institutional transdisciplinary research is necessarily a joint enterprise between funding agencies, researchers and the end users of research. The design and governance of research programmes need to explicitly recognise shared accountabilities among the participants, while respecting the different perspectives of each group. Experience shows that traditional incentive systems for academic researchers, current trends in public sector management, and loose organisation of many end users, work against sustained transdisciplinary research on intractable problems, which require continuity and adaptive learning by all three parties. The likelihood of research influencing and improving environmental policy and management is maximised when researchers, funders and research users have shared goals; there is sufficient continuity of personnel to build trust and sustain dialogue throughout the research process from issue scoping to application of findings; and there is sufficient flexibility in the funding, structure and operation of transdisciplinary research initiatives to enable the enterprise to assimilate and respond to new knowledge and situations.
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Affiliation(s)
- C A Campbell
- Research Institute for the Environment and Livelihoods, Charles Darwin University, Ellengowan Drive, Darwin 0909, Australia
| | - E C Lefroy
- Centre for Environment, University of Tasmania, Private Bag 141, Hobart 7001, Australia
| | - S Caddy-Retalic
- Australian Centre for Evolutionary Biology and Biodiversity, School of Earth and Environmental Science, University of Adelaide, North Terrace, SA 5005, Australia
| | - N Bax
- CSIRO Oceans and Atmosphere Flagship, Castray Esplanade, Hobart 7001, Australia; Institute for Marine and Antarctic Science, University of Tasmania, Hobart 7001, Australia
| | - P J Doherty
- Australian Institute of Marine Science, PMB 3, Townsville 4810, Australia
| | - M M Douglas
- Research Institute for the Environment and Livelihoods, Charles Darwin University, Ellengowan Drive, Darwin 0909, Australia
| | - D Johnson
- Department of the Environment, Australian Government, GPO Box 787, Canberra 2601, Australia
| | - H P Possingham
- ARC Centre of Excellence for Environmental Decisions, University of Queensland, St Lucia 4067, Australia
| | - A Specht
- Australian Centre for Ecological Analysis and Synthesis, Terrestrial Ecosystem Research Network, University of Queensland, St Lucia 4067, Australia
| | - D Tarte
- Marine Ecosystem Policy Advisers, Brisbane, Australia
| | - J West
- Department of the Environment, Australian Government, GPO Box 787, Canberra 2601, Australia
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Ban L, West J, Abdul Sultan A, Dhalwani NN, Ludvigsson JF, Tata LJ. Risk of Congenital Anomalies in Children of Mothers with Coeliac Disease: A United Kingdom Population-based Cohort Study. Int J Epidemiol 2015. [DOI: 10.1093/ije/dyv097.284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Dhalwani NN, West J, Abdul Sultan A, Ban L, Tata LJ. Do Women with Coeliac Disease Clinically Present with Fertility Problems more often than Women in the General Population. Int J Epidemiol 2015. [DOI: 10.1093/ije/dyv096.368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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