588 results found
Chowdhury D, Mahmood F, Edwards C, et al., 2021, Five-day outcome of hepatitis E-induced acute liver failure in the ICU, Egyptian Liver Journal, Vol: 11, Pages: 1-9, ISSN: 2090-6226
BackgroundHepatitis E virus (HEV) is an important cause of acute liver failure (ALF) in Bangladesh with pregnant mothers being more vulnerable. As HEV occurs in epidemics, it limits medical capabilities in this resource-poor country. Cerebral oedema, resulting in raised intracranial pressure (ICP), is an important cause of morbidity and mortality. Practical treatments are currently few.To study the baseline characteristics and clinical outcome of HEV-induced ALF in a recent HEV epidemicTo detect raised ICP clinically and observe response to mannitol infusion.This was a prospective cohort study from June until August 2018 of 20 patients admitted to the intensive care unit (ICU) of a major Bangladeshi Referral Hospital with HEV-induced ALF. We diagnosed HEV infection by detecting serum anti-HEV IgM antibody. All were negative for hepatitis B surface antigen and hepatitis A IgM antibody. Data were collected on 5-day outcome after admission to ICU, monitoring all patients for signs of raised ICP. An intravenous bolus of 20% mannitol was administered at a single time point to patients with raised ICP.ResultsTwenty patients were included in the study. Ten (50%) patients, seven (70%) females, received mannitol infusion. HE worsened in eight (40%): seven female and three pregnant. Glasgow Coma scores deteriorated in six (30%): all (100%) females and three pregnant. Consciousness status was not significantly different between pregnant and non-pregnant subjects, nor between those who received mannitol and those who did not. Six patients met King’s College Criteria for liver transplantation.ConclusionsFemale patients had a worse outcome, but pregnancy status was not an additional risk factor in our cohort. Mannitol infusion was also not associated with a significant difference in outcome.
Cordell HJ, Fryett JJ, Ueno K, et al., 2021, An international genome-wide meta-analysis of primary biliary cholangitis: Novel risk loci and candidate drugs, JOURNAL OF HEPATOLOGY, Vol: 75, Pages: 572-581, ISSN: 0168-8278
Taylor-Robinson SD, 2021, Covid-19 dysphonia-unconscious bias and the Central role of speech and language therapists., QJM: an international journal of medicine, ISSN: 1460-2393
Chowdhury D, Mahmood F, Edwards C, et al., 2021, 5 Day outcome of hepatitis E virus induced acute liver failure in the ICU, Publisher: WILEY, Pages: 75-75, ISSN: 0815-9319
Oleribe O, Miller R, Wadzeck M, et al., 2021, Klamath Tribal response to the pandemic of COVID-19 among Klamath Tribal Community in Oregon, USA, Global advances in health and medicine : improving healthcare outcomes worldwide, Vol: 10, Pages: 1-7, ISSN: 2164-9561
IntroductionSocially-disadvantaged populations are more at risk of contracting COVID-19 than those with access to better medical facilities. We looked at responses of Klamath Tribes in Oregon, USA to mitigate spread of COVID-19 in a community with a higher incidence of obesity, diabetes and coronary heart disease, compared to the general US population. This study reports on Klamath Tribes response to COVID-19 March -September 2020.MethodsKlamath Tribes Tribal Health and Family Services established a COVID-19 Incident Management Team (IMT), instituting creative programs including a Walk-In Testing Center, implementing strict infection control protocols and regular sharing of information on the pandemic and prevalence of COVID-19 amongst Klamath Tribes. All COVID-19 tests were documented with positive cases isolated and people with high risk exposures quarantined and provided with wrap-around medical and social services until recovered or past quarantine time period.ResultsA total of 888 (12%) tribal members were tested for COVID1-19 between March to September 2020; 50 were found positive for COVID-19, giving a test positivity rate of 5.6% (Male – 6.3%; Female – 5.2%). No deaths have been reported amongst the local Klamath Tribes and other American Indians/Alaska Native (AI/AN) population served by the tribe.ConclusionDespite the fact that structural inequities including income disparities have shaped racial and ethnic impact of epidemics around the world, the timely response, establishment of partnerships and proactive control of the epidemic resulted in minimal impact among the Klamath Tribal and other AI/AN populations served by the tribal facilities.
Taylor-Robinson S, Rhodes-Kendler O, Parker R, 2021, The Antiviral Diet, Publisher: Europe Books, ISBN: 9791220109789
Asselta R, Paraboschi EM, Gerussi A, et al., 2021, X chromosome contribution to the genetic architecture of primary biliary cholangitis., Gastroenterology, Vol: 160, Pages: 2483-2495.e26, ISSN: 0016-5085
BACKGROUND & AIMS: Genome-wide association studies in primary biliary cholangitis (PBC) have failed to find X chromosome (chrX) variants associated with the disease. Here, we specifically explore the chrX contribution to PBC, a sexually dimorphic complex autoimmune disease. METHODS: We performed a chrX-wide association study, including genotype data from 5 genome-wide association studies (from Italy, United Kingdom, Canada, China, and Japan; 5244 case patients and 11,875 control individuals). RESULTS: Single-marker association analyses found approximately 100 loci displaying P < 5 × 10-4, with the most significant being a signal within the OTUD5 gene (rs3027490; P = 4.80 × 10-6; odds ratio [OR], 1.39; 95% confidence interval [CI], 1.028-1.88; Japanese cohort). Although the transethnic meta-analysis evidenced only a suggestive signal (rs2239452, mapping within the PIM2 gene; OR, 1.17; 95% CI, 1.09-1.26; P = 9.93 × 10-8), the population-specific meta-analysis showed a genome-wide significant locus in East Asian individuals pointing to the same region (rs7059064, mapping within the GRIPAP1 gene; P = 6.2 × 10-9; OR, 1.33; 95% CI, 1.21-1.46). Indeed, rs7059064 tags a unique linkage disequilibrium block including 7 genes: TIMM17B, PQBP1, PIM2, SLC35A2, OTUD5, KCND1, and GRIPAP1, as well as a superenhancer (GH0XJ048933 within OTUD5) targeting all these genes. GH0XJ048933 is also predicted to target FOXP3, the main T-regulatory cell lineage specification factor. Consistently, OTUD5 and FOXP3 RNA levels were up-regulated in PBC case patients (1.75- and 1.64-fold, respectively). CONCLUSIONS: This work represents the first comprehensive study, to our knowledge, of the chrX contribution to the genetics of an autoimmune liver disease and shows a novel PBC-related genome-wide significant locus.
Omotunde SM, Oleribe OO, Taylor-Robinson S, 2021, Community psychiatry care: an urgent need in Nigeria, Journal of Multidisciplinary Healthcare, Vol: 14, Pages: 1145-1148, ISSN: 1178-2390
Nigeria’s mental health policy was formulated in 1991, but it did not make adequate provision for community-based psychiatric care. Since there are only seven government-owned psychiatry facilities in Nigeria and these are always overwhelmed, there is the need to overhaul the existing policy and emphasise the urgency of a shift from inpatient psychiatric mental healthcare towards a community-based multidisciplinary psychiatric healthcare system.
Taylor-Robinson SD, 2021, Retirement - a time to dread or to cherish?, QJM: an international journal of medicine, Vol: 114, Pages: 296-297, ISSN: 1460-2393
Retirement is often a taboo subject amongst medical professionals. Many have dedicated a major part of their lives to the practice of medicine to the exclusion of anything else. The thought of empty days or lack of externally driven purpose is something that unsettles many who are approaching pensionable age. In reality such fears rarely materialise. The challenge of transition to a new phase of life is all the more poignant if ill health intervenes early, causing premature cessation of work.
Taylor-Robinson SD, 2021, Personal perspectives: Having a series of cardiac events, QJM: an international journal of medicine, Vol: 114, Pages: 291-292, ISSN: 1460-2393
It has never been clear to me whether being a medically-qualified patient has positive or negative associations. In 2019, after a prostatectomy, where I had extended bleeding per urethra, I suffered two myocardial infarctions, underwent three coronary angiograms and eventually coronary stenting. Junior doctors never examined me at any point, while senior ones worried over the risk of stent placement in an actively bleeding patient. I report my views on how this seemed as a largely passive, but still actively thinking patient.
Oleribe O, Olawepo O, Ezechi O, et al., 2021, Describing the epidemiology of COVID-19 in Nigeria: an analysis of the first year of the pandemic, Journal of Health Care for the Poor and Underserved, ISSN: 1049-2089
We report the COVID-19 experience across Nigeria from March 2020 to March 2021.Demographics were obtained from Nigerian Center for Disease Control. By 21 March 2021,161,737 people were confirmed positive for SARS-COV-2. Overall, testing rates were 0.8% ofthe population, with positivity rates of 9.6%, complete recovery rates without long-termsequelae of 91.4%, and case fatality rates of 1.3%. Most Nigerian regions contributed to figuresfor recent cases and deaths in 2021. The picture may change as testing is scaled-up to includecommunity testing. Given so-called “pandemic fatigue” among the general population, variousconspiracy theories being prevalent, and the recent introduction of COVID-19 vaccines inNigeria, we assume that Nigeria is at a pivotal stage of the outbreak. Effort must be made bygovernment to learn successful strategies in other countries to adapt to prevent a rise in casenumbers and deaths.
Rice S, Albani V, Minos D, et al., 2021, Effects of primary biliary cholangitis on quality of life and health care costs in the United Kingdom, Clinical Gastroenterology and Hepatology, Vol: 19, Pages: 768-776.e10, ISSN: 1542-3565
Background & Aims: There have been few high-quality studies of the costs, preference-based health-related quality of life (HRQoL) and cost effectiveness of treatments for primary biliary cholangitis (PBC). We aimed to estimate the marginal effects of PBC complications and symptoms, accounting for treatment, on HRQoL and the annual cost of health care in the United Kingdom (UK). These are essential components for evaluation of cost effectiveness and this information will aid in evaluation of new treatments.Methods: Questionnaires were mailed to 4583 participants in the UK-PBC research cohort and data were collected on HRQoL and use of the National Health Service (NHS) in the UK from 2015 through 2016. HRQoL was measured using the EQ-5D-5L instrument. The annual cost of resource use was calculated using unit costs obtained from NHS sources. We performed econometric analyses to determine the effects of treatment, symptoms, complications, liver transplantation status, and patient characteristics on HRQoL and annual costs.Results: In an analysis of data from 2240 participants (over 10% of all UK PBC patients), we found that PBC symptoms have a considerable effect on HRQoL. Ursodeoxycholic acid therapy was associated with significantly higher HRQoL regardless of response status. Having had a liver transplant and ascites were also independently associated with reduced HRQoL. Having had a liver transplant (US$4294) and esophageal varices (US$3401) were the factors with the two greatest mean annual costs to the NHS. Symptoms were not independently associated with cost but were associated with reduction in HRQoL for patients, indicating the lack of effective treatments for PBC symptoms.Conclusions: In an analysis of data from 2240 participants in the UK PBC, we found that HRQoL and cost estimates provide greater insight into the relative importance of PBC-related symptoms and complications. These findings provide estimates for health technology assessments of new treatmen
Taylor-Robinson SD, De Souza Lopes PA, Zdravkov J, et al., 2021, Is there still bullying in medicine at all levels - undergraduate and postgraduate? [Response to Letter], Advances in Medical Education and Practice, Vol: 12, Pages: 303-304, ISSN: 1179-7258
Hawkes N, Dave U, Rahman M, et al., 2021, The role of national specialist societies in influencing transformational change in low-middle income countries – reflections on the model of implementation for a National Endoscopy Training Programme in Bangladesh, Clinical and Experimental Gastroenterology, Vol: 14, Pages: 103-111, ISSN: 1178-7023
The British Society of Gastroenterology (BSG) and the Bangladesh Gastroenterology Society (BGS) have collaborated on an endoscopy training programme, which has grown up over the past decade from a small scheme borne out of the ideas of consultant gastroenterologists in Swansea, South Wales (United Kingdom) to improve gastroenterology services in Bangladesh to become a formalised training programme with broad reach. In this article, we document the socioeconomic and historical problems that beset Bangladesh, the current training needs of doctors and how the BSG-BGS collaboration has made inroads into changing outcomes both for gastroenterologists in Bangladesh, but also for the populations they serve.
Taylor-Robinson SD, 2021, Personal perspectives: having the time to observe the patient, Journal of Medical Ethics, Pages: 1-2, ISSN: 0306-6800
Being a medically qualified patient can be an unpleasant experience for a person who is used to making decisions. For the most part, this applies to the vast majority of doctors and other healthcare professionals. Becoming passive and surrendering the decision-making process to others is alien to the medical culture we were taught. However, when as a hospitalised medically qualified patient, one sees fellow patients in difficulty, or deteriorating clinically, unnoticed by medical staff, the question of whether it is ethical to intervene arises. I report my views on this as a largely passive, but still actively thinking patient.
Ohihoin AG, Ohihoin EN, Bakare A, et al., 2021, The effect of first line anti-retroviral drugs on the menstrual cycle of HIV positive patients, Annals of Medical and Health Sciences Research, Vol: 11, Pages: 1328-1331, ISSN: 2141-9248
Background: The quality of life and life expectancy of individuals living with HIV has improved significantly. This improvement is largely due to the use of Highly Active Anti-Retroviral Therapy (HAART). The effect of prolonged usage of this therapy on the menstrual function of the females within the reproductive age range is poorly understood.Methodology: A cross-sectional comparative study that involved women within the reproductive age range of 15-45 years. The women were grouped into A, B and C categories. Group A had HIV positive women already on Anti-Retroviral (ARV) therapy. Group B were HIV positive women naïve to anti-retroviral drugs at the time of recruitment. Group C comprised of HIV negative women within the reproductive age range not being managed for infertility.Results: The mean age of the participants across the study groups were respectively 32 years, 33.4 years and 37.58 years. The average weight among participants in the study was 66.38 kg, with a range of 53- 94 kg. The average duration of use of ARVs was 81.12 months (6.7 years). The mean CD4 values across the study population who were HIV positive were 725 and the average viral load was 20 copies per ml. The commonest menstrual abnormality was oligomenorrhea, occurring in close to 25% of respondent who were HIV positive and on ARVs. Menstrual abnormality was more in the HIV positive women receiving antiretroviral drugs than in the other two cohorts. (p=0.007).Conclusion: Long term usage of some first line highly active anti-retroviral therapy is associated with increased menstrual abnormality.
Taylor-Robinson SD, 2021, COVID hypoxia - promoting the use of hand-held pulse oximeters to save lives, QJM: an international journal of medicine, ISSN: 1460-2393
Chatzimichail S, Rahimi F, Saifuddin A, et al., 2021, Hand-portable HPLC with broadband spectral detection enables analysis of complex polycyclic aromatic hydrocarbon mixtures, Communications Chemistry, Vol: 4, ISSN: 2399-3669
Polycyclic aromatic hydrocarbons (PAHs) are considered priority hazardous substances due to their carcinogenic activity and risk to public health. Strict regulations are in place limiting their release into the environment, but enforcement is hampered by a lack of adequate field-testing procedure, instead relying on sending samples to centralised analytical facilities. Reliably monitoring levels of PAHs in the field is a challenge, owing to the lack of field-deployable analytical methods able to separate, identify, and quantify the complex mixtures in which PAHs are typically observed. Here, we report the development of a hand-portable system based on high-performance liquid chromatography incorporating a spectrally wide absorption detector, capable of fingerprinting PAHs based on their characteristic spectral absorption profiles: identifying 100% of the 24 PAHs tested, including full coverage of the United States Environmental Protection Agency priority pollutant list. We report unsupervised methods to exploit these new capabilities for feature detection and identification, robust enough to detect and classify co-eluting and hidden peaks. Identification is fully independent of their characteristic retention times, mitigating matrix effects which can preclude reliable determination of these analytes in challenging samples. We anticipate the platform to enable more sophisticated analytical measurements, supporting real-time decision making in the field.
Taylor-Robinson S, de Souza Lopes PA, Zdravkov J, et al., 2021, A Personal Perspective: Is Bullying Still a Problem in Medicine?, Advances in Medical Education and Practice, Vol: 12, Pages: 141-145, ISSN: 1179-7258
Bullying of whatever form should have no place in the Medical Profession. Reforms to junior doctor training and reduction in working hours have helped to control most of the individual bullying which may have existed in the past. However, the complexities of institutional bullying still exist. In the United Kingdom, centralised monitoring systems, such as Athena SWAN, are designed to reward academic and medical institutions for positive steps to introduce equality and mitigate bullying. However, the reality is that such processes may be conducted in healthcare or educational establishments that have little intention to address the problem thoroughly. We report the personal experience of both individual and institutional bullying in the medical career of a medically-qualified interviewee and reflect on ways to mitigate the problem. We also consider whether unconscious bias affects our relationships with patients. In a caring medical profession, there should be no room for intolerance, unconscious bias or bullying.
Taylor-Robinson SD, Spearman CW, Suliman AAA, 2021, Why is there a paucity of clinical trials in Africa?, QJM: an international journal of medicine, ISSN: 1460-2393
Disproportionately few clinical trials are undertaken on the African continent, in part due to lingering neocolonial attitudes in the Global North which keep research activity primarily in developing countries, while being skeptical of the abilities of those in the Global South to undertake organized clinical studies. In the era of the COVID-19 pandemic, applicable research and clinical trials should be undertaken in relevant populations in order to extrapolate to a population level. This is all the more important in Africa, which has a rich genetic diversity. We suggest that a lack of organized research ethics committees across the continent and a deficiency of appropriate training are responsible in part for the reluctance of clinical trial organizers in the developed countries of the Global North to engage with medical leadership in Africa. We consider ways of alleviating this problem, including suggesting a pan-continental surveillance of ethics committee agendas and of training, either through the auspices of the African Union or the World Health Organization. In addition, medical leadership in African nations must be encouraged to take ownership of their medical ethics agendas to facilitate decent international clinical trial participation for the good of the continent as a whole.
Taylor-Robinson SD, 2021, COVID hypoxia—personal reflections, QJM: an international journal of medicine, ISSN: 1460-2393
Agyei-Nkansah A, Taylor-Robinson S, 2021, The state of Ghanaian liver medicine, Pan African Medical Journal, Vol: 39
This paper aims to highlight the challenges in managing liver diseases in Ghana and the efforts needed to improve services to help curb the high rate of liver mortality in the young adults. Ghana is a rising, middle-income West African country with well-established administrative systems for healthcare, albeit with hospitals lacking modern equipment and being devoid of infrastructure for sophisticated interventional procedures. Although liver disease is common, due to the high prevalence of chronic viral hepatitis B and C infection, antiviral drugs are commonly unavailable, even in the rare instances where they can be afforded. Hospital wards and outpatient clinics are usually over-crowded with long waiting times and limited doctor-patient time interaction. Treatment for end-stage liver disease can be a challenge, with limited endoscopic services, which are centered in the big cities and with expertise which is not widespread. The training program in endoscopic therapies by the Mayo Clinic (Rochester, Minnesota, USA), with faculty coming to Ghana to disseminate practical skills during a “training of trainers” program has gone a long way spreading the knowledge of managing life-threatening complications, such as variceal hemorrhage, albeit on a small scale in national terms. Collaboration between institutions from well-resourced and poorly-resourced countries exemplifies how such partnerships can go a long way in helping to support local training needs and the development of transferrable skills. Such partnerships may effectively provide healthcare workers with adequate training, with hepatology treatment protocols that are adapted to the local environment and thus allowing contextualisation of generic guidelines from the developed world and making them applicable to local settings.
If we were told that one day the entire world would take its guidance for managing a health crisis from empirical thought, nobody would have believed it. However, with the December 2019 arrival of COVID-19 in China, the world subsequently went into a frenzied state that resulted in widespread adoption of untested strategies or potential cures; circumstantial evidence provided without randomized control trials (RCTs) was published rapidly and widely considered the gold standard in medical research and therapeutics. Nigeria and much of the rest of the world blindly adopted treatments like chloroquine or hydroxychloroquine and various prevention strategies, often without monitoring the efficacy of these treatment and social control strategies. COVID-19 provided Nigeria a critical opportunity to create or strengthen its national laboratory system by building up its Level 3 laboratories in all parts of the country with the capability to perform PCR tests and viral isolation. There was also an opportunity to establish hospitals in every region of a sufficient standard to reduce the numbers of Nigerians travelling abroad to seek medical treatment; to invest in building capacity to develop antiviral medications and vaccines in Nigeria, and to ensure better international health policies. Rather, Nigerian leaders, government, and health managers decided (like most other nations of the world) to shut down society using isolationist policies that were not necessarily tailored to local needs. Despite adopting these methods, COVID-19 cases continued to skyrocket in Nigeria. In the future, before adopting such broad sweeping policies, there should be local tailoring to assess their effectiveness in different communities. Given that the country has much experience in controlling Lassa and Marburg Fever outbreaks, Nigeria should lead by developing new strategies, new protocols, and new local guidelines, based on validated and reproducible studies to ensure that the public health aut
Larsson E, Mawkin M, Taylor-Robinson S, et al., 2020, Implementing Innovative Approaches to Healthcare in a Lower-Middle Income Country: Perspectives from Malawi, International Journal of General Medicine, Vol: 2020, Pages: 1723-1730, ISSN: 1178-7074
Middle Income Country: Perspectives from Malawi AbstractFulltextMetricsGet PermissionCite this articleAuthors Larsson E, Mawkin M, Taylor-Robinson SD, Harrington P, Gondwe H, Watson C, Gallagher J, Ledwidge M, Chirambo GB, O'Donoghue JReceived 3 October 2020Accepted for publication 2 December 2020Published 31 December 2020 Volume 2020:13 Pages 1723—1730DOI https://doi.org/10.2147/IJGM.S285130Checked for plagiarism YesReview by Single anonymous peer reviewPeer reviewer comments 2Editor who approved publication: Dr Scott FraserArticle has an altmetric score of 5Emma Larsson,1 Mala Mawkin,1 Simon D Taylor-Robinson,1 Peter Harrington,2 Hastings Gondwe,3 Chris Watson,2,4 Joseph Gallagher,2 Mark Ledwidge,2 Griphin Baxter Chirambo,5,6 John O’Donoghue2,6,71Imperial College London, South Kensington, London SW7 2BX, UK; 2gHealth Research Group, University College Dublin, Dublin, Ireland; 3St John’s Hospital, Mzuzu, Malawi; 4Wellcome-Wolfson Institute for Experimental Medicine, Queens University Belfast, Belfast, Northern Ireland; 5Mzuzu University, Mzuzu, Malawi; 6Malawi eHealth Research Centre, University College Cork, Cork, Ireland; 7ASSERT Research Centre, University College Cork, Cork, IrelandCorrespondence: John O’DonoghueASSERT Research Centre, University College Cork, College Road, Cork T12 K8AF, IrelandTel +353 21 420 5616Email firstname.lastname@example.orgIntroduction: Safe, reliable, and effective healthcare systems are essential for all nations to ensure the health and wellbeing of their citizens. However, this is not always achievable with clinical therapies constantly evolving, resulting in a domino effect of structural, policy and training changes. For low- and middle-income countries (LMICs), implementing change is restricted. It is essential that innovative and realistic solutions are developed, so that effective change can be realised in LMICs.Materials and Methods: In this report of a global health conference held in July 2019, six pe
Taylor-Robinson SD, 2020, Retirement - Reflections on Time, Wisdom and Expression, QJM: an international journal of medicine, ISSN: 1460-2393
Rose CF, Amodio P, Bajaj JS, et al., 2020, Hepatic encephalopathy: Novel insights into classification, pathophysiology and therapy, Journal of Hepatology, Vol: 73, Pages: 1526-1547, ISSN: 0168-8278
Hepatic encephalopathy (HE) is a frequent and serious complication of both chronic liver disease and acute liver failure. HE manifests as a wide spectrum of neuropsychiatric abnormalities, from subclinical changes (mild cognitive impairment) to marked disorientation, confusion and coma. The clinical and economic burden of HE is considerable, and it contributes greatly to impaired quality of life, morbidity and mortality. This review will critically discuss the latest classification of HE, as well as the pathogenesis and pathophysiological pathways underlying the neurological decline in patients with end-stage liver disease. In addition, management strategies, diagnostic approaches, currently available therapeutic options and novel treatment strategies are discussed.
Ahmad A, Atzori S, Maurice J, et al., 2020, Non-invasive splenic parameters of portal hypertension: Assessment and utility, World Journal of Hepatology, Vol: 12, Pages: 1055-1066, ISSN: 1948-5182
BACKGROUNDPortal hypertension is a major complication of cirrhosis that is associated with significant morbidity and mortality. The present gold-standard method to risk stratify and observe cirrhosis patients with portal hypertension is hepatic venous pressure gradient measurement or esophagogastroduodenoscopy. However, these methods are invasive, carry a risk of complications and are associated with significant patient discomfort. Therefore, non-invasive splenic parameters are of clinical interest as potential useful markers in determining the presence of portal hypertension. However, diagnostic accuracy and reproducibility remains unvalidated.AIMTo assess the diagnostic accuracy of spleen stiffness, area and diameter in predicting the presence of portal hypertension.METHODSOf 50 patients with varying liver disease pathologies were prospectively recruited from the St. Mary’s Hospital Liver Unit in London; 25 with evidence of portal hypertension and 25 with no evidence of portal hypertension. Liver stiffness, spleen stiffness, spleen diameter and spleen area were measured using the Philips Affiniti 70 elastography point quantification point shear wave elastography system. The aspartate aminotransferase-to-platelet-ratio-index (APRI) score was also calculated. Performance measures, univariate and multivariate logistic regression were used to evaluate demographic, clinical and elastography variables. Interclass correlation coefficient was used to determine the reproducibility of splenic area and diameter.RESULTSOn univariate and individual performance, platelet count [area under the receiver operating characteristic (AUROC) 0.846, P value < 0.001], spleen area (AUROC 0.828, P value = 0.002) and APRI score (AUROC 0.827, P value < 0.001) were the most accurate variables in identifying the presence of portal hypertension. On multivariate logistic regression models constructed, the combination of spleen area greater than 57.90 cm2 and platelet count less than
Dave U, Dave A, Taylor-Robinson S, 2020, Mindfulness in gastroenterology training and practice: a personal perspective, Clinical and Experimental Gastroenterology, Vol: 13, Pages: 497-502, ISSN: 1178-7023
Background: Work-related stress is becoming an increasingly recognised occupational hazard that can have detrimental effects on the health of both patient and doctor. The practice of gastroenterology not only includes the demands of clinics and in-patient work faced by other medical specialities but also the additional burden of complex, and often high-risk, endoscopic interventions. Mindfulness, a secular form of meditation, can relieve stress, even if only practiced for a few minutes a day.Methods and Results: We present a personal perspective of the burnout experienced in stressful gastroenterology careers and the personal use of mindfulness in the daily routine to provide a source of calm when surrounded by many different pressures. We review some of the literature exploring the role of mindfulness in clinical practice with an emphasis on gastroenterology. While the practice of mindfulness is not designed to obviate immediacy and quick decisions in a rapidly changing clinical environment, it has been held widely useful to mitigate the stress involved in making those decisions.Conclusion: Practicing mindfulness, meditation and mindful living offers many advantages to gastroenterologists’ wellbeing as well improved patient care. We advocate its teaching to both gastroenterology trainees and consultants who are not familiar with the technique.
Taylor-Robinson SD, Dykes K, Hawkes B, 2020, Personal perspectives: having a prostatectomy and the role of the cancer specialist nurse, International Journal of General Medicine, Vol: 13, Pages: 897-901, ISSN: 1178-7074
Background: Doctors are often ill-prepared to become patients, despite knowing the technicalities of surgical procedures and the day-to-day workings of hospital life intimately. Surrendering the decision-making process to other healthcare professionals can be an unnerving process for many of those who are medically qualified. Aim: Although the sequelae of prostatectomy have often been written about, little is in the literature from medically qualified patients about their personal experiences of the procedure. We aimed to highlight areas where communication between medically qualified patients and their carers may be strengthened. Methods and Results: We present a personal perspective of the emotional issues surrounding a potential cancer diagnosis, the experience of having a prostatectomy and what the hospital encounters were like in reality with a viewpoint of informing the medical profession in providing better patient information when they ask "what will it be like?". From this perspective, the critical role of the cancer specialist nurse is highlighted as the lynch pin in providing a continuing source of information to medically qualified patients and in not treating them as omniscient, simply because of a medical degree. Conclusion: Prostatectomy is a common procedure, but often questions about recovery after the procedure including impotence and incontinence are left unanswered in dealing with medically qualified colleagues when they are patients. Human behaviour is predictable, and medically qualified patients are just as apt to forget what is said to them as anyone else. However, the central role of the cancer specialist nurse as the bridge between the medical team and the patient should not be underestimated.
Oleribe O, Ezechi O, Osita-Oliberi P, et al., 2020, Public perception of COVID-19 management and response in Nigeria: a cross-sectional survey, BMJ Open, Vol: 10, Pages: 1-7, ISSN: 2044-6055
Objectives: A study designed to assess the public perception of the response of government and its institutions to the COVID-19 pandemic in Nigeria. Setting: Self-selecting participants throughout Nigeria completed a self-administered questionnaire through an online cross-sectional survey. Participants: 495 Results: The majority of respondents were married (76.6%), were males (61.8%), had tertiary level education (91.0%), were public servants (36.8%), Christians (82.6%), and resident either in the Federal Capital Territory (Abuja) (49.1%) or in the South-East Region of Nigeria (36.6%). Over 95% of the respondents had heard of COVID-19 (98.8%) and knew it is a viral disease (95.4%). The government and its institutions response to the pandemic were rated as poor, with the largest rating as poor for Federal President’s Office (57.5%). Communication (50.0%) and prevention messages (43.7%) received the highest perception good rating. Female respondents and those less than 40 years generally rated the governmental responses as poor. Conclusions/Recommendations: It is recommended that as a public-private partnership approached was efficiently used to more effectively disseminate public health communication and prevention messages, the Nigerian Government should expand this collaboration to improve the quality of services provided in other areas of COVID-19 outbreak management.
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