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McDarby G, Mustafa S, Zhang Y, Seifieldin R, Saikat S, Hendricks L, McNicholas T. Essential Public Health Functions in Ireland: Perspectives to strengthen capacities and stewardship. Eur J Public Health 2022. [PMCID: PMC9594443 DOI: 10.1093/eurpub/ckac129.207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background COVID-19 has caused unprecedented disruptions to health, social and economic systems in countries worldwide including Ireland. Weaknesses in Public Health capacities have undermined health system resilience compounding the effects of the pandemic. The Essential Public Health Functions (EPHFs) provide a comprehensive, cost-effective approach to operationalising public health and a means to build health systems resilience. As Ireland looks to recovery, the Department of Health engaged the World Health Organization (WHO) to undertake a mapping of the current state of delivery of EPHFs to identify opportunities for improvement and support wider health system strengthening towards resilience. Methods A strategic review of the delivery of EPHFs in Ireland was conducted with respect to policy, infrastructure, service provision and coordination and integration. Findings were reported in the context of international lessons identified through experience with COVID-19 and major health system challenges within the Irish context. Results There are significant capacities present within the Irish context to support the delivery of the EPHFs though they are limited in strategic cohesion, coordination and implementation. These include a high level of Public Health expertise, an agile and resourceful workforce, a strongly engaged community and significant evidence generation and synthesis capacities. Gaps recognised included ICT infrastructure and capacity, workforce resourcing and support, pandemic planning and public health governance, visibility, legislation, strategy and resourcing. COVID-19 has led to the development and strengthening of mechanisms to leverage a whole-of-government and -society approach to health that should be sustained to tackle ongoing and future stressors. Conclusions The use of the EPHFs within the Irish setting provides a comprehensive approach to strengthening capacities for public health and enhanced population health and wellbeing.
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Affiliation(s)
- G McDarby
- Health Services Resilience Team, WHO , Geneva, Switzerland
| | - S Mustafa
- Health Services Resilience Team, WHO , Geneva, Switzerland
| | - Y Zhang
- Health Services Resilience Team, WHO , Geneva, Switzerland
| | - R Seifieldin
- Health Services Resilience Team, WHO , Geneva, Switzerland
| | - S Saikat
- Health Services Resilience Team, WHO , Geneva, Switzerland
| | - L Hendricks
- Department of Health, Government of Ireland , Dublin, Ireland
| | - T McNicholas
- Department of Health, Government of Ireland , Dublin, Ireland
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Claffey P, Pérez-Denia L, Dyer A, McNicholas T, Briggs R, Finucane C, Kenny RA. 239 IS ORTHOSTATIC HYPOTENSION ASSOCIATED WITH ALTERED CEREBRAL PERFUSION DURING ACTIVE STANDING? Age Ageing 2021. [DOI: 10.1093/ageing/afab216.239] [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: 02/25/2023] Open
Abstract
Abstract
Background
Orthostatic Hypotension (OH) is associated with poor health outcomes in later life including depression, cognitive impairment, frailty and falls. Whilst it is hypothesised that OH compromises cerebral autoregulation leading to hypoperfusion, this has not been robustly demonstrated to date. This study investigated the association between OH and cerebral perfusion during orthostasis using a non-invasive surrogate of cerebral perfusion, Near Infrared Spectroscopy (NIRS).
Methods
Four hundred and ninety one participants (58% female, median age 65, IQR 38–92) attending a falls and syncope service underwent measurement of beat-to-beat blood pressure (BP) by finometry and real-time frontal lobe perfusion (% TSI: Tissue Saturation Index) by NIRS during the active stand manoeuvre. We examined the association between OH and change in cerebral perfusion (delta TSI) using mixed-effects linear regression, with adjustment for important clinical covariates.
Results
Nearly two-fifths of the sample (189/491,38.5%) met criteria for OH occurring between 30 and 120 seconds after standing. Using mixed effects linear regression models, we observed a significant relationship between OH and TSI at the same timepoint (β −0.53, −0.59 to −0.46, p < 0.001) which persisted following adjustment for confounders including age, sex, baseline blood pressure, cerebrovascular and cardiovascular disease, depression/anxiety, diabetes, systolic blood pressure, antihypertensives, and antidepressants (β −0.51, −0.58 to −0.44, p < 0.001). Cerebral perfusion levels differed for those with OH compared to those without.
Conclusion
OH is independently associated with lower frontal lobe cerebral perfusion. This association may indicate disruption to dynamic cerebral autoregulation and explain the significant link between OH and poor health outcomes.
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Affiliation(s)
- P Claffey
- Department of Medical Gerontology, Trinity College Dublin , Dublin, Ireland
- Mercer's Institute for Successful Ageing, St. James's Hospital , Dublin, Ireland
| | - L Pérez-Denia
- Department of Medical Physics & Bioengineering, St. James's Hospital , Dublin, Ireland
- Mercer's Institute for Successful Ageing, St. James's Hospital , Dublin, Ireland
- Department of Medical Gerontology, Trinity College Dublin , Dublin, Ireland
| | - A Dyer
- Department of Medical Gerontology, Trinity College Dublin , Dublin, Ireland
- Mercer's Institute for Successful Ageing, St. James's Hospital , Dublin, Ireland
| | - T McNicholas
- Department of Medical Gerontology, Trinity College Dublin , Dublin, Ireland
| | - R Briggs
- Department of Medical Gerontology, Trinity College Dublin , Dublin, Ireland
- Mercer's Institute for Successful Ageing, St. James's Hospital , Dublin, Ireland
| | - C Finucane
- Department of Medical Physics & Bioengineering, St. James's Hospital , Dublin, Ireland
- Mercer's Institute for Successful Ageing, St. James's Hospital , Dublin, Ireland
- Department of Medical Gerontology, Trinity College Dublin , Dublin, Ireland
| | - R A Kenny
- Mercer's Institute for Successful Ageing, St. James's Hospital , Dublin, Ireland
- Department of Medical Gerontology, Trinity College Dublin , Dublin, Ireland
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Tamhankar A, Spencer N, Hampson A, Noel J, El-Taji O, Arianayagam R, McNicholas T, Boustead G, Lane T, Adshead J, Vasdev N. Real-time assessment of learning curve for robot-assisted laparoscopic prostatectomy. Ann R Coll Surg Engl 2020; 102:717-725. [PMID: 32538121 DOI: 10.1308/rcsann.2020.0139] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The learning curves analysed to date for robot-assisted laparoscopic prostatectomy are based on arbitrary cut-offs of the total cases. METHODS We analysed a large dataset of robot-assisted laparoscopic prostatectomies from a single centre between 2008 and 2019 for assessment of the learning curve for perioperative outcomes with respect to time and individual cases. RESULTS A total of 1,406 patients were evaluated, with mean operative time 198.08 minutes and mean console time 161.05 minutes. A plot of operative time and console time showed an initial decline followed by a near-constant phase. The inflection points were detected at 1,398 days (308th case) for operative time and 1,470 days (324th case) for console time, with a declining trend of 8.83 minutes and 7.07 minutes, respectively, per quarter-year (p<0.001). Mean estimated blood loss showed a 70.04% reduction between the start (214.76ml) and end (64.35ml) (p<0.001). The complication rate did not vary with respect to time (p=0.188) or the number of procedures (p=0.354). There was insufficient evidence to claim that the number of operations (p=0.326), D'Amico classification (p=0.114 for intermediate versus low; p=0.158 for high versus low) or time (p=0.114) was associated with the odds of positive surgical margins. CONCLUSIONS It takes about 300 cases and nearly 4 years to standardise operative and console times, with a requirement of around 80 cases per annum for a single surgical team in the initial years to optimise the outcomes of robot-assisted laparoscopic prostatectomy.
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Affiliation(s)
| | | | - A Hampson
- East and North Hertfordshire NHS Trust, UK
| | - J Noel
- East and North Hertfordshire NHS Trust, UK
| | - O El-Taji
- East and North Hertfordshire NHS Trust, UK
| | | | | | - G Boustead
- East and North Hertfordshire NHS Trust, UK
| | - T Lane
- East and North Hertfordshire NHS Trust, UK
| | - J Adshead
- East and North Hertfordshire NHS Trust, UK
| | - N Vasdev
- East and North Hertfordshire NHS Trust, UK.,University of Hertfordshire, UK
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4
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Affiliation(s)
- Tom McNicholas
- Consultant Urological Surgeon, Pinehill Hospital, Hitchin, and Spire Hospital Harpenden
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Marron L, Segurado R, Kenny RA, McNicholas T. The association between benzodiazepine use and falls, and the impact of sleep quality on this association: data from the TILDA study. QJM 2020; 113:31-36. [PMID: 31424520 DOI: 10.1093/qjmed/hcz217] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 08/10/2019] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Benzodiazepines (BZD) are associated with adverse effects, particularly in older adults. AIM This study assesses the association between BZD use and falls, and the impact of sleep quality on this association, in community dwelling adults aged over 50. DESIGN Cross-sectional analysis of data from wave 1 of The Irish Longitudinal Study on Ageing. METHODS Participants were classed as BZD users or non-users and asked if they had fallen in the last year, and whether any falls were unexplained. Sleep quality was assessed via self-reported trouble falling asleep, daytime somnolence and early-rising. Logistic regression assessed for an association between BZD use and falls, and the impact of sleep quality on this association was assessed by categorizing based on BZD use and sleep quality variables. RESULTS Of 8175 individuals, 302 (3.69%) reported taking BZDs. BZD use was associated with falls, controlling for confounders [Odds Ratio (OR) 1.40; 1.08, 1.82; P-value 0.012]. There was no significant association between BZDs and unexplained falls, controlling for confounders [OR 1.41; 95% Confidence Interval (CI) 0.95, 2.10; P-value 0.09]. Participants who use BZDs and report daytime somnolence (OR 1.93; 95% CI 1.12, 3.31; P-value 0.017), early-rising (OR 1.93; 95% CI 1.20, 3.11; P-value 0.007) or trouble falling asleep (OR 1.83; 95% CI 1.12, 2.97; P-value 0.015), have an increased odds of unexplained falls. CONCLUSION BZD use is associated with falls, with larger effect size in those reporting poor sleep quality in community dwelling older adults. Appropriate prescription of medications such as BZDs is an important public health issue.
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Affiliation(s)
- L Marron
- UCD School of Public Health, Physiotherapy and Sports Science, Woodview House University College Dublin Belfield, Dublin 4, D04 V1W8, Ireland
- Department of Public Health, Health Service Executive, Dr. Steevens' Hospital, Dublin 8, D08 W2AB, Ireland
| | - R Segurado
- UCD School of Public Health, Physiotherapy and Sports Science, Woodview House University College Dublin Belfield, Dublin 4, D04 V1W8, Ireland
| | - R A Kenny
- The Irish Longitudinal Study on Ageing (TILDA), Lincoln Gate, Trinity College, Dublin 2, D02 PN40, Ireland
- Department of Medical Gerontology, Trinity College, Dublin 2, D02 PN40, Ireland
- Mercer's Institute for Successful Ageing, St James's Hospital, James's St, Dublin 8, D08 RT2X, Ireland
| | - T McNicholas
- The Irish Longitudinal Study on Ageing (TILDA), Lincoln Gate, Trinity College, Dublin 2, D02 PN40, Ireland
- Department of Medical Gerontology, Trinity College, Dublin 2, D02 PN40, Ireland
- Mercer's Institute for Successful Ageing, St James's Hospital, James's St, Dublin 8, D08 RT2X, Ireland
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Affiliation(s)
- T McNicholas
- Trinity College Dublin, The Irish Longitudinal Study on Ageing, Dublin, Ireland
| | - K Tobin
- Trinity College Dublin, The Irish Longitudinal Study on Ageing, Dublin, Ireland
| | - L Newman
- Trinity College Dublin, The Irish Longitudinal Study on Ageing, Dublin, Ireland
| | - P Claffey
- St James Hospital, Mercer's Institute for Successful Ageing, Dublin, Ireland
| | - R Briggs
- Trinity College Dublin, The Irish Longitudinal Study on Ageing, Dublin, Ireland
| | - R A Kenny
- Trinity College Dublin, The Irish Longitudinal Study on Ageing, Dublin, Ireland
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McNicholas T. The trials of doing trials: will the prostatic stent rise from the dead? BJU Int 2018; 122:4-5. [DOI: 10.1111/bju.14225] [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: 11/28/2022]
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Abstract
It is important to consider alternative causes when treating refractory cases of urinary tract infection in the elderly population.
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Affiliation(s)
- G Price
- Department of Radiology, Lister Hospital, Stevenage, Herts SG1 4AB, UK
| | - T McNicholas
- Department of Urology, Lister Hospital, Stevenage, Herts SG1 4AB, UK
| | - S Buckingham
- Department of Radiology, Lister Hospital, Stevenage, Herts SG1 4AB, UK
| | - S Chang
- Department of Radiology, Lister Hospital, Stevenage, Herts SG1 4AB, UK
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McNicholas T, Tobin K, O'Callaghan S, Kenny RA. Is orthostatic hypotension more common in individuals with atrial fibrillation?-Findings from The Irish Longitudinal Study on Ageing (TILDA). Age Ageing 2017; 46:1006-1010. [PMID: 28985288 DOI: 10.1093/ageing/afx096] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 05/30/2017] [Indexed: 12/17/2022] Open
Abstract
Introduction atrial fibrillation (AF) and orthostatic hypotension (OH) share common risk factors such as age, hypertension and cardiovascular (CV) disease. The autonomic nervous system (ANS) also plays a role in the pathogenesis of both AF and OH. The aim of this study is to assess whether individuals with AF are more likely to have OH than those without AF. Methods data from wave 1 of The Irish Longitudinal Study on Ageing were used. Beat-to-beat blood pressure was measured during active stand lasting 110 s. OH, defined as a drop in systolic blood pressure (SBP) ≥20 mmHg or a drop in diastolic blood pressure ≥10 mmHg at 30, 60 and 90 s was assessed. Initial OH (IOH) was assessed as a drop in SBP ≥40 mmHg or a drop in diastolic BP≥20 mmHg. Results in total 4,408 participants aged ≥50 had active stand and electrocardiogram data suitable for analysis. AF was identified in 101 of these. Logistic regression found participants with AF were more likely to have OH at 30 (odds ratio (OR) 1.95, 95% confidence interval (CI) 1.24-3.06) and 60 (OR 2.13, 95% CI 1.18-3.87) seconds, and IOH (OR 1.81, 95% CI 1.21-2.70). The association between IOH and OH at 30 s remained significant following adjustment for confounders (age, sex, baseline HR, education, BP, smoking, frailty, beta blocker (BB) use, anti-hypertensive use (excluding BBs) and number of CV conditions). Conclusion OH is more common in individuals with AF, this may reflect the role of the ANS in both AF and OH.
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Affiliation(s)
- T McNicholas
- The Irish Longitudinal Study on Ageing, Lincoln gate, Trinity College Dublin, Dublin, Ireland
- Mercer's Institute for Successful Ageing, St James' Hospital, Dublin, Ireland
| | - K Tobin
- The Irish Longitudinal Study on Ageing, Lincoln gate, Trinity College Dublin, Dublin, Ireland
- Global Brain Health Institute, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - S O'Callaghan
- The Irish Longitudinal Study on Ageing, Lincoln gate, Trinity College Dublin, Dublin, Ireland
- Department of Medical Gerontology, Trinity College Dublin, Dublin, Ireland
| | - R A Kenny
- The Irish Longitudinal Study on Ageing, Lincoln gate, Trinity College Dublin, Dublin, Ireland
- Mercer's Institute for Successful Ageing, St James' Hospital, Dublin, Ireland
- Department of Medical Gerontology, Trinity College Dublin, Dublin, Ireland
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Gray M, Vasdev N, Gowrie-Mohan S, McNicholas T. The Management of Unplanned Erection during Endoscopic Urological Surgery. Curr Urol 2017; 10:113-117. [PMID: 28878592 DOI: 10.1159/000447163] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 01/16/2016] [Accepted: 01/31/2016] [Indexed: 02/02/2023] Open
Abstract
Penile erection at the time of urological surgery is a rare but problematic event which can delay, complicate or even lead to the cancellation of planned surgery. Erection may occur irrespective of the type of anesthetic method employed. Several techniques for treatment of this troublesome complication have been described in the literature, all with varying levels of success and potential adverse effects. In our experience over the last 25 years, we have found that intracavernous injection of ephedrine into the penis has a 100% success rate in safely producing detumescence with minimum side effects and should therefore be considered early among the treatment options for this condition.
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Affiliation(s)
- Martin Gray
- Department of Anesthesia, Lister Hospital, Stevenage, UK
| | - Nikhil Vasdev
- Department of Urological Surgery, Lister Hospital, Stevenage, UK
| | | | - Tom McNicholas
- Department of Urological Surgery, Lister Hospital, Stevenage, UK
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Abstract
Vasovagal syncope, or the "common faint", is the most common cause of syncope. Although it is considered a benign condition, there is a significant economic burden and significant impact on quality of life in patients with recurrent syncope, particularly in older adults. Typical vasovagal syncope usually occurs in young adults, and can often be diagnosed on the basis of history, in the absence of structural heart disease. Atypical vasovagal syncope, which is more common in older adults, can be more difficult to diagnose, however. In atypical vasovagal syncope, there is often a short or absent prodrome, and amnesia for loss of consciousness is common and it can, therefore, often be misdiagnosed, for example as falls. A more standardized approach to the diagnosis and management of patients presenting with syncope or unexplained falls is required, and it is anticipated that the number of Syncope Units will increase. Treatment of vasovagal syncope is largely conservative; however, medical or device therapy may be required when syncope is severe and refractory to conservative treatment, as there is significant impact on quality of life and it can be associated with injury. The aim of this article is to provide an overview of the diagnosis and management of vasovagal syncope.
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Affiliation(s)
- R A Kenny
- From the Mercers Institute, St James's Hospital, Dublin, Ireland
| | - T McNicholas
- From the Mercers Institute, St James's Hospital, Dublin, Ireland
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Furniss G, Opel A, Hussein A, Pearman C, Grace A, Connelly D, Orlowski A, Banerjee A, McNicholas T, Providencia R, Montañes M, Providencia R, Panagopoulos D, Tomlinson D, Dalrymple-Hay M, Haywood G, Butler A, Ang R, Ullah W, Schwartz R, Fannon M, Finlay M, Hunter R, Schilling R, Das M, Asfour I, Morgan M, Ronayne C, Shaw M, Snowdon R, Gupta D, Todd D, King R, Hall M, Modi S, Mediratta N, Gupta D, Reddy V, Neuzil P, Willems S, Verma A, Heck P, Schilling R, Lambiase P, Hall M, Nicholl B, McQueenie R, Jani BD, McKeag N, Gallacher K, Mair F, Heaton D, Macdonald J, Burnell J, Ryan R, Marshall T, Sutton C, O'Callaghan S, Kenny R, Karim N, Srinivasan N, Ferreira M, Goncalves L, Lambiase P, Toledano M, Field E, Walsh H, Maguire K, Cervi E, Kaski J, Perez Tome M, Pantazis A, Elliott P, Lambiase P, Segal O. ORAL ABSTRACTS (3)EP & Ablation31LEFT ATRIAL POSTERIOR WALL ISOLATION (THE “BOX LESION PATTERN”) IN THE TREATMENT OF ATRIAL FIBRILLATION: A SINGLE CENTRE EXPERIENCE32DAY CASE CRYOBLATION (CRYO) FOR PAROXYSMAL ATRIAL FIBRILLATION (pAF) IN THE DISTRICT GENERAL HOSPITAL IS SAFE AND EFFECTIVE IF DONE IN HIGH VOLUME WITH EXPERIENCED OPERATORS33ABLATION INDEX-GUIDED PULMONARY VEIN ISOLATION FOR ATRIAL FIBRILLATION MAY IMPROVE CLINICAL OUTCOMES IN COMPARISON TO CONTACT FORCE-GUIDED ABLATION34THE PROCEDURAL COMPLICATION RATES AND SHORT-TERM SUCCESS RATES OF THORACOSCOPIC AF ABLATION DURING THE INSTITUTIONAL LEARNING CURVE35INITIAL PROCEDURAL RESULTS FROM DDRAMATIC-SVT STUDY: DD MECHANISM IDENTIFICATION AND LOCALISATION USING DIPOLE DENSITY MAPPING TO GUIDE ABLATION STRATEGY36MORBIDITY AND MORTALITY IN MIDDLE-AGED INDIVIDUALS WITH ATRIAL FIBRILLATION: UK BIOBANK DATAClinical EP37THE GM AHSN AF LANDSCAPE TOOL: A SHARED PUBLIC DATA PLATFORM TO PROMOTE QUALITY IMPROVEMENTS AND IDENTIFY OPPORTUNITIES TO PREVENT AF-RELATED STROKE IN THE DEVOLVED GREATER MANCHESTER HEALTH SYSTEM38REAL WORLD PERSISTENCE, ADHERENCE AND SWITCH-OVER ACROSS ANTICOAGULANTS IN ATRIAL FIBRILLATION-A NATIONAL POPULATION-BASED STUDY39ORTHOSTATIC HYPOTENSION AND ATRIAL FIBRILLATION40PREVALENCE OF SHORT QT AND CRITERIA OF SEVERITY IN A YOUNG ASYMPTOMATIC COHORT41SURFACE ELECTROCARDIOGRAPHIC FEATURES AND PREVALENCE OF ARRHYTHMIAS IN PAEDIATRIC FRIEDREICH'S ATAXIA42RISK STRATIFICATION OF TYPE 1 MYOTONIC DYSTROPHY: IS THE ECG ACCURATE ENOUGH TO SELECT PATIENTS AT RISK OF BRADYARRHYTHMIC EVENTS? Europace 2016. [DOI: 10.1093/europace/euw272] [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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Faithfull S, Lemanska A, Aslet P, Bhatt N, Coe J, Drudge-Coates L, Feneley M, Glynn-Jones R, Kirby M, Langley S, McNicholas T, Newman J, Smith CC, Sahai A, Trueman E, Payne H. Integrative review on the non-invasive management of lower urinary tract symptoms in men following treatments for pelvic malignancies. Int J Clin Pract 2015; 69:1184-208. [PMID: 26292988 PMCID: PMC5042099 DOI: 10.1111/ijcp.12693] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
AIM To develop a non-invasive management strategy for men with lower urinary tract symptoms (LUTS) after treatment for pelvic cancer, that is suitable for use in a primary healthcare context. METHODS PubMed literature searches of LUTS management in this patient group were carried out, together with obtaining a consensus of management strategies from a panel of authors for the management of LUTS from across the UK. RESULTS Data from 41 articles were investigated and collated. Clinical experience was sought from authors where there was no clinical evidence. The findings discussed in this paper confirm that LUTS after the cancer treatment can significantly impair men's quality of life. While many men recover from LUTS spontaneously over time, a significant proportion require long-term management. Despite the prevalence of LUTS, there is a lack of consensus on best management. This article offers a comprehensive treatment algorithm to manage patients with LUTS following pelvic cancer treatment. CONCLUSION Based on published research literature and clinical experience, recommendations are proposed for the standardisation of management strategies employed for men with LUTS after the pelvic cancer treatment. In addition to implementing the algorithm, understanding the rationale for the type and timing of LUTS management strategies is crucial for clinicians and patients.
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Affiliation(s)
- S Faithfull
- School of Health Sciences, University of Surrey, Stag Hill, Guildford, UK
| | - A Lemanska
- School of Health Sciences, University of Surrey, Stag Hill, Guildford, UK
| | - P Aslet
- Department of Urology, Hampshire Hospitals Foundation Trust, Basingstoke, Hampshire, UK
| | - N Bhatt
- Sutton & Merton Community Services, The Royal Marsden NHS Foundation Trust, London, UK
| | - J Coe
- University College Hospital, London, UK
| | | | - M Feneley
- University College Hospital, London, UK
| | | | - M Kirby
- Faculty of Health & Human Sciences, Centre for Research in Primary & Community Care (CRIPACC), University of Hertfordshire, Hertfordshire, UK
| | - S Langley
- The Royal Surrey County Hospital, Guildford, UK
| | | | - J Newman
- Oxford University Hospital, Oxford, UK
| | - C C Smith
- School of Health and Social Care, Bournemouth University, Dorset, UK
| | - A Sahai
- Guy's and St Thomas' NHS Foundation Trust, King's Health Partners, London, UK
| | - E Trueman
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - H Payne
- University College Hospital, London, UK
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Sturch P, Woo HH, McNicholas T, Muir G. Ejaculatory dysfunction after treatment for lower urinary tract symptoms: retrograde ejaculation or retrograde thinking? BJU Int 2014; 115:186-7. [DOI: 10.1111/bju.12868] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Paul Sturch
- Department of Urology; King's College Hospital; London UK
| | - Henry H. Woo
- Sydney Adventist Hospital Clinical School; University of Sydney; Sydney Australia
| | - Tom McNicholas
- Lister Hospital and University of Hertfordshire; Stevenage UK
| | - Gordon Muir
- Department of Urology; King's College Hospital; London UK
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McNicholas T. Going with the flow! Relieving lower urinary tract symptoms and preserving ejaculation. BJU Int 2014; 113:518-9. [PMID: 24629085 DOI: 10.1111/bju.12609] [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: 11/30/2022]
Affiliation(s)
- Tom McNicholas
- Lister Hospital, East and North Hertfordshire NHS Trust, Stevenage, UK; University of Hertfordshire, Hatfield, UK.
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Schröder F, Bangma C, Angulo JC, Alcaraz A, Colombel M, McNicholas T, Tammela TL, Nandy I, Castro R. Reply from Authors re: Behfar Ehdaie, Karim A. Touijer. 5-Alpha Reductase Inhibitors in Prostate Cancer: From Clinical Trials to Clinical Practice. Eur Urol 2013;63:788–9. Eur Urol 2013. [DOI: 10.1016/j.eururo.2013.02.005] [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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Schröder F, Bangma C, Angulo JC, Alcaraz A, Colombel M, McNicholas T, Tammela TL, Nandy I, Castro R. Dutasteride treatment over 2 years delays prostate-specific antigen progression in patients with biochemical failure after radical therapy for prostate cancer: results from the randomised, placebo-controlled Avodart After Radical Therapy for Prostate Cancer Study (ARTS). Eur Urol 2012. [PMID: 23176897 DOI: 10.1016/j.eururo.2012.11.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Rising prostate-specific antigen (PSA) levels after radical therapy are indicative of recurrent or residual prostate cancer (PCa). This biochemical recurrence typically predates clinically detectable metastatic disease by several years. Management of patients with biochemical recurrence is controversial. OBJECTIVE To assess the effect of dutasteride on progression of PCa in patients with biochemical failure after radical therapy. DESIGN, SETTING, AND PARTICIPANTS Randomised, double-blind, placebo-controlled trial in 294 men from 64 centres across 9 European countries. INTERVENTION The 5α-reductase inhibitor, dutasteride. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary end point was time to PSA doubling from start of randomised treatment, analysed by log-rank test stratified by previous therapy and investigative-site cluster. Secondary end points included time to disease progression and the proportion of subjects with disease progression. RESULTS AND LIMITATIONS Of the 294 subjects randomised (147 in each treatment group), 187 (64%) completed 24 mo of treatment and 107 discontinued treatment prematurely (71 [48%] of the placebo group, 36 [24%] of the dutasteride group). Dutasteride significantly delayed the time to PSA doubling compared with placebo after 24 mo of treatment (p<0.001); the relative risk (RR) reduction was 66.1% (95% confidence interval [CI], 50.35-76.90) for the overall study period. Dutasteride also significantly delayed disease progression (which included PSA- and non-PSA-related outcomes) compared with placebo (p<0.001); the overall RR reduction in favour of dutasteride was 59% (95% CI, 32.53-75.09). The incidence of adverse events (AEs), serious AEs, and AEs leading to study withdrawal were similar between the treatment groups. A limitation was that investigators were not blinded to PSA levels during the study. CONCLUSIONS Dutasteride delayed the biochemical progression of PCa in patients with biochemical failure after radical therapy for clinically localised disease. The safety and tolerability of dutasteride were generally consistent with previous experience. CLINICAL TRIAL REGISTRY ClinicalTrials.gov, NCT00558363.
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McNicholas T, Kirby R. Benign prostatic hyperplasia and male lower urinary tract symptoms. Am Fam Physician 2012; 86:359-360. [PMID: 22963025] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Oelke M, Burger M, Castro-Diaz D, Chartier-Kastler E, Cidre MAJ, McNicholas T, Radziszewski P, Kirby M. Diagnosis and medical treatment of lower urinary tract symptoms in adult men: applying specialist guidelines in clinical practice. BJU Int 2011; 110:710-8. [DOI: 10.1111/j.1464-410x.2011.10808.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [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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Shah T, Davies T, Mazaris E, McNicholas T. MP-15.19 Management of Testicular Ischaemia Following an Inguinal Hernia Repair. Urology 2011. [DOI: 10.1016/j.urology.2011.07.363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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McNicholas T, Kirby R. Benign prostatic hyperplasia and male lower urinary tract symptoms (LUTS). BMJ Clin Evid 2011; 2011:1801. [PMID: 21871136 PMCID: PMC3217770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
INTRODUCTION Lower urinary tract symptoms related to benign prostatic hyperplasia (BPH) and bladder outlet obstruction may affect up to 30% of men in their early 70s. Symptoms can improve without treatment, but the usual course is a slow progression of symptoms, with acute urinary retention occurring in 1% to 2% of men with BPH per year. METHODS AND OUTCOMES We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of medical, herbal, and surgical treatments? We searched: Medline, Embase, The Cochrane Library, and other important databases up to July 2009 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS We found 63 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS In this systematic review we present information relating to the effectiveness and safety of the following interventions: 5 alpha-reductase inhibitors, alpha-blockers, beta-sitosterol plant extract, Pygeum africanum, rye grass pollen extract, saw palmetto plant extracts, transurethral electrovaporisation, transurethral Holmium laser enucleation of the prostate, transurethral microwave thermotherapy, transurethral needle ablation, and transurethral resection (including transurethral resection versus transurethral incision, and transurethral resection versus visual laser ablation/laser vaporisation).
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Affiliation(s)
- Tom McNicholas
- and Visiting Professor, Faculty of Health and Human Sciences, University of Hertfordshire, Hatfield, UK
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Gittelman M, Ramsdell J, Young J, McNicholas T. Dutasteride Improves Objective and Subjective Disease Measures in Men With Benign Prostatic Hyperplasia and Modest or Severe Prostate Enlargement. J Urol 2006; 176:1045-50; discussion 1050. [PMID: 16890688 DOI: 10.1016/j.juro.2006.04.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2005] [Indexed: 10/24/2022]
Abstract
PURPOSE We determined whether the effect of dutasteride for benign prostatic hyperplasia is influenced by baseline prostate volume using data from 3 phase III clinical trials. MATERIALS AND METHODS Patients randomized to dutasteride or placebo in the double-blind portion of the phase III studies were eligible to receive 0.5 mg dutasteride daily in a 2-year open label extension in dutasteride/dutasteride and placebo/dutasteride groups. Patients were prospectively stratified according to baseline prostate volume 30 to less than 40 and 40 cc or greater. RESULTS In patients treated with dutasteride throughout the study (dutasteride/dutasteride group) the mean reduction in prostate volume from baseline to month 48 was 30.3% in those with a baseline prostate volume of 30 to less than 40 cc and 26.2% in those with a prostate volume of 40 cc or greater. Mean improvements in peak urinary flow from baseline to month 48 were 2.7 ml per second regardless of baseline prostate volume. Improvements in the American Urological Association symptom index score were 6.3 in men with a prostate volume of 30 to less than 40 cc and 6.5 in those with a prostate volume of 40 cc or greater. No significant relationships between treatment effect and baseline prostate volume were observed for these parameters. In dutasteride/dutasteride treated patients the risk of acute urinary retention was decreased by 60% in those with a prostate volume of 30 to less than 40 cc and 55% in those with a prostate volume of 40 cc or greater vs values in placebo/dutasteride treated patients (p = 0.036 and <0.001, respectively). The corresponding values for benign prostatic hyperplasia related surgery were 27% and 48% (p = 0.35 and <0.001, respectively). CONCLUSIONS This analysis demonstrates that dutasteride significantly improves objective (prostate volume and peak urinary flow) and subjective (symptom scores) measures even in patients with only a slightly enlarged prostate (30 to less than 40 cc). The risks of acute urinary retention and benign prostatic hyperplasia related surgery were decreased regardless of baseline prostate volume.
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Affiliation(s)
- Marc Gittelman
- South Florida Medical Research, 21150 Biscayne Boulevard, Aventura, FL 33180, USA
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Abstract
Hypogonadism is a medical condition characterised by testosterone deficiency in males, accompanied by numerous clinical symptoms, which can negatively affect quality of life and multiple organ systems. Late-onset hypogonadism describes testosterone deficiency or reduced effect seen in ageing men. The conditions are generally managed using testosterone supplementation. Many formulations of testosterone are available, including deep-muscle injections, buccal formulations, transdermal patches and topical gels. Testim gel 1% testosterone gel (Auxilium Pharmaceuticals, Inc. and Ipsen) has been shown to restore serum testosterone concentrations to within the normal range in men with hypogonadism. Two randomised, controlled studies showed that Testim gel significantly improved sexual motivation, desire, performance and function, as well as positive and negative mood scores and body composition after 90 days, compared with baseline. The magnitude of improvement seen with Testim gel was similar to that achieved with testosterone patches, but with fewer application-site reactions. In another study, improvements in mood and sexual function were seen within the first 2 weeks of treatment. Long-term, open-label extension studies of Testim gel suggest that clinical benefits are maintained for < or = 12 months without an additional increase in side effects. Notably, Testim gel treatment for 12 months was associated with a gradual increase in bone mineral density, suggesting that Testim gel may help to prevent osteoporosis. The most common adverse events associated with Testim gel were application-site reactions, increased haematological parameters, and moderately increased prostate-specific antigen levels that remained within the normal range in 96% of subjects. Men on any testosterone therapy will require careful monitoring, including serial digital rectal examination and prostate-specific antigen testing. Overall, the clinical evidence so far indicates that Testim gel is a safe and effective treatment option for daily use in the management of male hypogonadism.
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Affiliation(s)
- Tom McNicholas
- Department of Urology, Lister Hospital, University of Hertfordshire, Stevenage, Hertfordshire, SG1 4AB, UK.
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McNicholas T, Tamella T, Te A, Harkaway R. The novel dual 5α-reductase inhibitor dutasteride is well tolerated with the concomitant use of commonly prescribed cardiovascular medications and PDE-5 inhibitors. ACTA ACUST UNITED AC 2003. [DOI: 10.1016/s1569-9056(03)80293-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Affiliation(s)
- D Ralph
- Institute of Urology, London W1P 7PN, UK.
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Abstract
OBJECTIVE To examine the feasibility and acceptability of screening for cancer of the prostate by digital rectal examination (DRE), prostate specific antigen (PSA) determination and subsequent transrectal ultrasound (TRUS) in selected patients in a single general practice in Hertfordshire. SUBJECTS AND METHODS A total of 568 of 856 men aged 55 to 70 accepted an invitation for a health check which included screening for prostate cancer. Of these, 80 individuals with either a raised PSA level or an abnormal DRE underwent TRUS. In 29 individuals biopsies were taken, 11 of which confirmed the presence of adenocarcinoma of the prostate giving an overall detected prevalence of 2%. Of the 11 tumours identified by screening, two were T1M0, four were T2M0, two were T3M0 and three were T3M1. RESULTS To assess the acceptability of the screening exercise a postal questionnaire was sent to all 568 participants: 83% replied and 69% reported no concern. Of the 67 individuals who had undergone TRUS, 69% reported discomfort. A total of 448 (95%) of respondents declared that they would be prepared to undergo the screening exercise again. CONCLUSION Screening for prostate cancer would seem to be technically feasible and generally acceptable. However, there is a considerable false positive rate in the PSA range 4 ng/ml to 10 ng/ml, particularly among men with clinical evidence of benign prostatic hyperplasia. To establish the true benefit of screening a large-scale prospective controlled study will be necessary.
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Affiliation(s)
- R S Kirby
- Department of Urology, St Bartholomew's Hospital, London, UK
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Affiliation(s)
- J F Buckley
- Department of Urology, Middlesex Hospital, London
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McNicholas T. Endoscopic application of lasers in urology. Br J Hosp Med (Lond) 1988; 40:197-206. [PMID: 3064848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Urology is an increasingly endoscopic surgical specialty. The unique physical characteristics of lasers lend themselves to a range of urological applications at present in specialist centres but increasingly in more general urological practice.
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Abstract
We report on two cases of spontaneous intramural rupture and haematoma formation in the oesophagus. This is an unusual and often misdiagnosed condition. Its diagnosis relies on the history and a barium swallow. Instrumentation can result in further damage to the oesophagus and should be avoided. Treatment is conservative and results in resolution of the haematoma and a return to normal swallowing.
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Abstract
In children lymphoid polyps of the rectum are uncommon benign lesions with a good prognosis following local treatment. We report a girl in whom a cluster of lymphoid polyps occurred 9 months following removal of a single lymphoid polyp. All of the polyps, including the original lesion, displayed a monoclonal nature on immunocytochemical examination.
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