52 results found
Woodfield G, Tyson LD, Orhan O, et al., 2021, Development of a north-west London paracentesis simulation course for core medical trainees., Future Healthc J, Vol: 8, Pages: e131-e136, ISSN: 2514-6645
We designed, implemented and evaluated a near-peer simulation training programme teaching diagnostic and therapeutic abdominal paracentesis to core medical trainees (CMTs). We taught diagnostic and therapeutic abdominal paracentesis to 77 north-west London CMTs over 8 training days over 4 years, 2015 to 2019. The programme was optimised by use of plan, do, study, act (PDSA) cycles and the content was evaluated by anonymous pre- and post-course questionnaires. There was a need for this training; 89% of participants reported inadequate training opportunities pre-course and only 28% felt 'confident' or 'very confident' to insert an ascitic drain. Simulation training appears effective when teaching these skills. Having been low in confidence before the course, all participants reported increased confidence after completing the course. Simulation training has been highlighted as a key aspect of the new internal medicine training programme, which replaces CMT. We would recommend using PDSA cycles to implement effective simulation programmes.
Uthayanan M, Szram J, Mehta A, et al., 2020, The GMC national training survey: Does it have an impact?, Future Healthc J, Vol: 7, Pages: 205-207, ISSN: 2514-6645
The General Medical Council (GMC) national trainee survey (NTS) monitors junior doctor training experience annually, which is then used by organisations such as Health Education England to inform quality management. Its validity as an assessment of the learning environment to drive improvement is frequently questioned; currently there are no published evidence-based studies to demonstrate its impact. To explore the effects of the GMC survey, we carried out a retrospective cohort study using publicly available GMC NTS survey data. We compared 2018 and 2019 scores in paediatrics in London across all 18 survey indicators, to identify any relationship between these 2 consecutive years of data. Our findings demonstrate that results of the GMC NTS in 1 year are associated with a change in the NTS the following year, with both an improvement in below average departments and deterioration in above average units. These findings suggest that annual GMC NTS results may have an impact on the quality of learning environments as measured in subsequent surveys - therefore they act as both a measure and a potential modifier of outcome.
Szram J, 2020, Occupational airways disease, Medicine (United Kingdom), Vol: 48, Pages: 412-416, ISSN: 1357-3039
Airway diseases can be either caused or made worse by workplace exposures; early recognition of occupational disease is crucial to achieving a successful outcome for the patient. Population research estimates that 10–15% of adult asthma presentations (either new cases or exacerbations of existing disease) can be attributed to a work exposure. Work-exacerbated and occupational asthma have different causal pathways and therefore require different approaches by healthcare professionals in partnership with patients, and their employers. Obtaining a comprehensive, precise job history and carefully applying simple but powerful diagnostic investigations are key to successfully distinguishing between the two conditions. Appropriate management can result in cure, although in most cases there is a significant socioeconomic cost to the patient. Toxic exposures to workplace respiratory irritants can also result in airways disease; symptoms are generally short lived and self-limiting but can occasionally result in an asthma-like syndrome as well as inducible laryngeal obstruction or other upper airway disorders. Several specific occupational exposures have been causally associated with chronic obstructive pulmonary disease; diagnosis is complicated by the long latency between exposure and clinically evident disease, and frequent confounding by smoking. Other rare, occupationally induced airway diseases such as obliterative bronchiolitis require specialist consideration.
Szram J, Vaux E, 2020, Pandemic times: Learning well in a time of COVID-19., Future Healthc J, Vol: 7, Pages: 100-101, ISSN: 2514-6645
Feary J, Cannon J, Fitzgerald B, et al., 2020, Follow-up survey of patients with occupational asthma., Occupational Medicine, Vol: 70, Pages: 231-234, ISSN: 0962-7480
BACKGROUND: Occupational asthma (OA) is often associated with a poor prognosis and the impact of a diagnosis on an individual's career and income can be significant. AIMS: We sought to understand the consequences of a diagnosis of OA to patients attending our clinic. METHODS: Using a postal questionnaire, we surveyed all patients attending our specialist occupational lung disease clinic 1 year after having received a diagnosis of OA due to a sensitizer (n = 125). We enquired about their current health and employment status and impact of their diagnosis on various aspects of their life. Additional information was collected by review of clinical records. RESULTS: We received responses from 71 (57%) patients; 77% were referred by an occupational health (OH) provider. The median duration of symptoms prior to referral was 18 months (interquartile range (IQR) 8-48). At 1 year, 79% respondents were no longer exposed to the causal agent. Whilst the unexposed patients reported an improvement in symptoms compared with those still exposed (82% versus 53%; P = 0.023), they had poorer outcomes in terms of career, income and how they felt treated by their employer; particularly those not currently employed. Almost all (>90%) of those still employed had been referred by an OH provider compared with 56% of those currently unemployed (P = 0.002)x. CONCLUSIONS: The negative impact of OA on people's careers, livelihood and quality of life should not be underestimated. However, with early detection and specialist care, the prognosis is often good and particularly so for those with access to occupational health.
Schofield SJ, Woods A, Szram J, et al., 2019, COPD and breathlessness in older workers predict economic inactivity; A prospective cohort study, American Journal of Respiratory and Critical Care Medicine, Vol: 200, Pages: 1228-1233, ISSN: 1073-449X
RATIONALE: There is an aspiration to retain increasing numbers of older workers in employment and strategies to achieve this need to make provision for the increasing prevalence of chronic diseases with age. There is a consistent body of cross-sectional evidence that suggests that patients with chronic obstructive pulmonary disease are more likely to have adverse employment outcomes. OBJECTIVES: We report the findings of the first longitudinal study of this issue. METHODS: We recruited full-time employed men and women in their 50's and followed them for a period of 18 months; we examined, after adjustment for potential confounders, the associations between breathlessness and airway obstruction at baseline and loss of employment in the intervening period. MEASUREMENTS AND MAIN RESULTS: Among participants responding to the follow up questionnaire (1656/1773 (93%)), the majority (78.5%) continued in full-time employment, but 10.6% were in part-time employment and 10.9% were no longer in paid employment. The adjusted risk of loss of employment was significantly increased for those with moderate or severe chronic obstructive pulmonary disease (RR 2.89, 95% ci 1.80-4.65) or breathlessness (3.07, 2.16-4.37) at baseline. There was no evident modification by sex or by manual/non-manual work. CONCLUSIONS: Airway obstruction and breathlessness are independently associated with premature loss from the workforce in older workers; these observations provide strong support to the available cross-sectional evidence and suggest that interventions to help those with chronic obstructive pulmonary disease who wish to remain in work need to be tested.
Vaux E, Szram J, 2019, Learning to speak up and to learn differently., Future Healthc J, Vol: 6, Pages: 150-151, ISSN: 2514-6645
McNulty M, Carty E, Chakravorty I, et al., 2019, Creation of novel training programmes mapped to the Joint Royal Colleges of Physicians Training Board Internal Medicine stage 1 curriculum., Future Healthc J, Vol: 6, ISSN: 2514-6645
De Matteis S, Feary J, Macfarlane J, et al., 2018, Update of the British Occupational Health Research Foundation (BOHRF) guidelines on occupational asthma., 28th International Congress of the European-Respiratory-Society (ERS), Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Fernandes D, Cannon J, Fitzgerald B, et al., 2017, INVESTIGATING THE DIAGNOSTIC PERFORMANCE OF SPECIFIC IMMUNOLOGICAL TESTS IN OCCUPATIONAL ASTHMA, Winter Meeting of the British-Thoracic-Society, Publisher: BMJ PUBLISHING GROUP, Pages: A62-A63, ISSN: 0040-6376
De Matteis S, Feary J, Macfarlane J, et al., 2017, UPDATE OF THE BRITISH OCCUPATIONAL HEALTH FOUNDATION (BOHRF) EVIDENCE-BASED GUIDELINES ON THE PREVENTION AND MANAGEMENT OF OCCUPATIONAL ASTHMA, Winter Meeting of the British-Thoracic-Society, Publisher: BMJ PUBLISHING GROUP, Pages: A205-A205, ISSN: 0040-6376
Reynolds C, De Matteis S, Cullinan P, et al., 2017, Pubmed mining for occupational idiopathic pulmonary fibrosis papers, European-Respiratory-Society (ERS) International Congress, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Moffatt MF, Cullinan P, James PL, et al., 2017, Metal worker’s lung; spatial association with Mycobacterium avium, Thorax, Vol: 73, Pages: 151-156, ISSN: 1468-3296
Background Outbreaks of hypersensitivity pneumonitis(HP) are not uncommon in workplaces where metalworking fluid (MWF) is used to facilitate metal turning.Inhalation of microbe-contaminated MWF has beenassumed to be the cause, but previous investigationshave failed to establish a spatial relationship between acontaminated source and an outbreak.Objectives After an outbreak of five cases of HP ina UK factory, we carried out blinded, molecular-basedmicrobiological investigation of MWF samples in orderto identify potential links between specific microbial taxaand machines in the outbreak zone.Methods Custom-quantitative PCR assays, microscopyand phylogenetic analyses were performed on blindedMWF samples to quantify microbial burden and identifypotential aetiological agents of HP in metal workers.Measurements and main results MWF frommachines fed by a central sump, but not those with anisolated supply, was contaminated by mycobacteria. Thefactory sump and a single linked machine at the centre ofthe outbreak zone, known to be the workstation of theindex cases, had very high levels of detectable organisms.Phylogenetic placement of mycobacterial taxonomicmarker genes generated from these samples indicatedthat the contaminating organisms were closely related toMycobacterium avium.Conclusions We describe, for the first time, a closespatial relationship between the abundance of amycobacterium-like organism, most probably M. avium,and a localised outbreak of MWF-associated HP.The further development of sequence-based analytictechniques should assist in the prevention of thisimportant occupational disease.
Szram JB, Schofield SJ, Fitzgerald B, et al., 2017, A Study Of Uk Firefighter Applicants referred For Assessment Of declared Asthma: Physiological Characteristics And Outcome, International Conference of the American-Thoracic-Society (ATS), Publisher: AMER THORACIC SOC, ISSN: 1073-449X
Feary J, Fitzgerald B, Szram J, et al., 2016, INDUCIBLE LARYNGEAL OBSTRUCTION MASQUERADING AS WORK-RELATED ASTHMA; A NEW APPROACH, THORAX, Vol: 71, Pages: A71-A71, ISSN: 0040-6376
Szram J, Schofield SJ, Fitzgerald B, et al., 2016, ASTHMA IN FIRE FIGHTER APPLICANTS: BURDEN OF DISEASE AND FACTORS PREDICTING SUCCESSFUL APPLICATION, THORAX, Vol: 71, Pages: A71-A71, ISSN: 0040-6376
Cookson WOC, 2016, Genetics and gene-environment interactions, Parkes' Occupational Lung Disorders, Fourth Edition, Pages: 137-144, ISBN: 9781498715805
Szram J, 2016, Occupational airways disease, Medicine (United Kingdom), Vol: 44, Pages: 329-332, ISSN: 1357-3039
Airway disease can be either caused or made worse by occupational exposures; early recognition of work-related disease is crucial to achieving a successful outcome for the patient. It has been estimated from population research that 10-15% of adult asthma presentations (either new cases or exacerbations of existing disease) can be attributed to a work exposure. Work-exacerbated and occupational asthma have different causal pathways and therefore require different management by healthcare professionals as well as employers. Obtaining a full, precise job history and carefully applying simple but powerful diagnostic investigations are key in successfully distinguishing between the two conditions. Appropriate management can result in cure, although in most cases there is a significant socioeconomic cost to the patient. Toxic exposures to workplace respiratory irritants can also result in airways disease; symptoms are generally short lived and self-limiting but can occasionally result in an asthma-like syndrome ('irritant-induced asthma'). Several specific occupational exposures have been causally associated with chronic obstructive airways disease; diagnosis can be complicated because of the long latency between exposure and clinically evident disease, and can be confounding by smoking. Other rare, occupationally induced airway diseases such as obliterative bronchiolitis require specialist consideration.
Jones M, Welch J, Turvey J, et al., 2016, Prevalence of sensitization to ‘improver’ enzymes in UK supermarket bakers, Allergy, Vol: 71, Pages: 997-1000, ISSN: 1398-9995
BACKGROUND: Supermarket bakers are exposed not only to flour and alpha amylase but also other 'improver' enzymes, the nature of which is usually shrouded by commercial sensitivity. We aimed to determine the prevalence of sensitisation to 'improver' enzymes in UK supermarket bakers. METHODS: We examined the prevalence of sensitisation to enzymes in 300 bakers, employed by one of two large supermarket bakeries, who had declared work related respiratory symptoms during routine health surveillance. Sensitisation was determined using radioallergosorbent assay to eight individual enzymes contained in the specific 'improver' mix used by each supermarket. RESULTS: The prevalence of sensitisation to 'improver' enzymes ranged from 5% to 15%. Sensitisation was far more likely if the baker was sensitised also to either flour and or alpha amylase. The prevalence of sensitisation to an 'improver' enzyme did not appear to be related to the concentration of that enzyme in the mix. CONCLUSIONS: We report substantial rates of sensitisation to enzymes other than alpha amylase in UK supermarket bakers; in only a small proportion of bakers was there evidence of sensitisation to 'improver mix' enzymes without sensitisation to either alpha amylase or flour. The clinical significance of these findings need further investigation but our findings indicate that specific sensitisation in symptomatic bakers may not be identified without consideration of a wide range of workplace antigens. This article is protected by copyright. All rights reserved.
Feary JR, Szram J, 2016, Occupational hypersensitivity pneumonitis: what is the evidence, when to think of it, and what to do, Clinical Pulmonary Medicine, Vol: 23, Pages: 23-29, ISSN: 1536-5956
Hypersensitivity pneumonitis (HP), or extrinsic allergic alveolitis, is a relatively rare condition with a variable natural history (acute, subacute, or chronic) and fairly nonspecific features. Patients present with pulmonary symptoms with or without constitutional disturbance. HP can be caused by >300 different agents, which broadly comprise microbial agents (bacteria, fungus), animal antigens, and chemicals, and exposure to these agents may occur in occupational settings-the focus of this article-or elsewhere. HP, particularly due to occupational exposures, is underdiagnosed due to a lack of awareness of the condition and difficulties in identifying and confirming the diagnosis. Bird fancier's lung and farmer's lung have historically been the most common causes of HP. More recently, metalworking fluids used in engineering have emerged as an increasingly common etiological agent for occupational HP and several outbreaks have been reported. Making a diagnosis of occupational HP is crucial both for the individual, so as to remove them from exposure and maximize the chance of a full recovery, and for the employer, so that they can identify other cases and put into place strategies to prevent further cases. There is no single gold standard test used to confirm HP, and a combination of a careful occupational exposure history, clinical history, radiology, and immunology findings can help ascertain a diagnosis. Certain key questions can be useful in eliciting a work-related pattern to symptoms.
Szram J, Schofield S, Cullinan P, 2015, Future job instability in older workers can be predicted by breathlessness and airflow obstruction, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Szram J, Schofield SJ, Mollan IA, et al., 2014, ASTHMA IN ROYAL AIR FORCE (RAF) PERSONNEL: MEASURING SEVERITY, CONTROL AND PREVIOUS IMPACT ON SERVICE CAREER, Meeting of the British-Thoracic-Society, Publisher: BMJ PUBLISHING GROUP, Pages: A138-A138, ISSN: 0040-6376
Szram J, Schofield SJ, Woods APM, et al., 2014, BREATHLESSNESS AND LUNG FUNCTION PREDICTS FUTURE WORK DISABILITY IN OLDER WORKERS: DETECTION, INTERVENTION, RETENTION?, Meeting of the British-Thoracic-Society, Publisher: BMJ PUBLISHING GROUP, Pages: A134-A134, ISSN: 0040-6376
Cannon J, Jones M, Welch J, et al., 2014, PREVALENCE OF SENSITISATION TO SOYA FLOUR IN THE BAKING INDUSTRY WITHIN THE UK, Meeting of the British-Thoracic-Society, Publisher: BMJ PUBLISHING GROUP, Pages: A138-A138, ISSN: 0040-6376
Jones M, Welch J, Turvey J, et al., 2014, PREVALENCE OF IGE SENSITISATION TO 'IMPROVER MIX' ENZYMES AMONG SYMPTOMATIC BAKERS WORKING IN UK SCRATCH BAKERIES, Meeting of the British-Thoracic-Society, Publisher: BMJ PUBLISHING GROUP, Pages: A5-A6, ISSN: 0040-6376
Marongiu A, Minelli C, Canova C, et al., 2014, SYSTEMATIC REVIEW AND META-ANALYSIS OF CROSS-SECTIONAL STUDIES ON ARC WELDING FUME EFFECTS AND OBSTRUCTIVE LUNG DISEASE, Meeting of the British-Thoracic-Society, Publisher: BMJ PUBLISHING GROUP, Pages: A135-A136, ISSN: 0040-6376
Cannon J, Fitzgerald B, Jones M, et al., 2014, Prevalence of sensitisation to soya flour in the baking industry within the UK, European-Academy-of-Allergy-and-Clinical-Immunology Congress, Publisher: WILEY-BLACKWELL, Pages: 118-118, ISSN: 0105-4538
Jones M, Welch J, Turvey J, et al., 2014, Prevalence of sensitisation to enzymes contained in 'dough improver' mix in bakers employed within the UK in-store supermarket bakeries, European-Academy-of-Allergy-and-Clinical-Immunology Congress, Publisher: WILEY-BLACKWELL, Pages: 118-118, ISSN: 0105-4538
Marongiu A, Hasan O, Ali A, et al., 2014, 0407 An old trade with an unanswered question: does arc-welding fume exposure increase the risks of obstructive pulmonary diseases? First findings from the WELSHIP cross-sectional study., Occup Environ Med, Vol: 71 Suppl 1
OBJECTIVES: Increasingly, global manufacturing is shifting to emerging economies and with it the use of arc-welding for applications in different industries. The chronic respiratory adverse effects resulting from exposure to gases and ultrafine metal particles in welding fume are incompletely understood. We aimed to measure the prevalence of arc-welding related pulmonary obstructive outcomes by analysing data collected in a shipyard in the Middle East. METHOD: Between January and December 2013, through cross-sectional survey, we collected spirometry data and behavioural, occupational and respiratory symptoms information from a random sample of male shipyard workers; 397 were exposed to welding fume and 127 were non-exposed. The sample was selected from a total population of about 8000 employees, by frequency matching for ethnicity and age relatively to full-time welders ('highly' exposed). RESULTS: Of the 580 workers invited, 26 subsequently left their job; of the remainder, 95%(524) agreed to participate. The participants, from the Indian subcontinent (90%) or Philippines (10%), had a median age of 38 years. Ever smoking was reported by 37%, with full-time welders reporting the lowest proportion of current smoking, 18%(24/131). Overall, 13% reported respiratory symptoms with a higher prevalence in the winter months. Post-bronchodilator spirometry data were available for 91% of workers. Mean values for FEV1 and FVC were 2.87L and 3.48L, with no statistically significant differences across exposure groups (p-values: 0.71 and 0.48). CONCLUSIONS: These preliminary results need to be explored further in relation to smoking, past and current occupational exposure. This population, it is hoped, will form the basis for a longitudinal study.
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