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    ABSTRACT: Introduction. The two-week wait (2WW) referral guideline for suspected central nervous system (CNS) tumours was implemented more than a decade ago to facilitate early cancer diagnosis with the aim of improving tumour survival rates. Short-term studies have shown poor compliance and low detection rates of the guideline. This study aimed to provide a decade analysis of referral patterns, and compliance and detection rates of the guideline. Methods. All patients referred via the 2WW pathway for suspected CNS tumour to the Newcastle Department of Neurosurgery from 1st January 2002 to 31st December 2011 were retrospectively identified from the local cancer registry. Data from referral letters, case notes, radiographic images and final outcomes were recorded. Trends in waiting time, time to diagnosis, compliance and detection rate of the guideline in identifying CNS tumours were analysed. Results. Over the last decade, there were no significant changes in trends in waiting time, time to diagnosis and compliance and detection rates of the guideline. Of 85 2WW referrals, 41.2% were non-compliant and 21.2% identified CNS tumours. The detection rate was higher in referrals that complied with the guideline compared to those that did not (32.0% vs 5.2%, p < 0.05). The non-compliant referrals which identified CNS tumours consisted of patients with cognitive decline. The guideline sensitivity and specificity were 88.8% (63.9%-98.1%, 95% CI) and 49.3% (40.0%-61.6%), respectively. Most of CNS tumour diagnoses were made independent of the 2WW pathway (N = 1093, 98.4%). Conclusion. There have not been any major changes in terms of waiting time, time to diagnosis, compliance and detection rates of the 2WW guideline during the last decade. The 2WW pathway generated very few referrals but among these, the positive detection rate was high and the addition of time-based cognitive decline onto the current guideline may further improve the detection rate.
    British Journal of Neurosurgery 03/2013;
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    ABSTRACT: BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is common and many affected individuals have normal-range alanine aminotransferase (ALT) levels. There is a need for a robust screening tool to triage individuals with advanced fibrosis for specialist care. AIM: The aim of this study was to assess the performance of noninvasive fibrosis tests in patients with biopsy-proven NAFLD and normal levels of ALT. METHODS: Patients presenting at a fatty liver clinic between 1999 and 2009 were included in the study. Liver biopsies were assessed using the Kleiner score. The aspartate aminotransferase (AST)/ALT ratio, BARD, FIB-4 and NAFLD fibrosis scores were calculated. RESULTS: A total of 305 patients were included [70 with normal ALT levels (women: ALT≤30 IU/l, men: ALT≤45 IU/l) and 235 with elevated levels]. In total, 24% of patients with normal ALT levels and 17% of those with elevated ALT levels had advanced fibrosis (Kleiner stage 3-4). The FIB-4 performed best in identifying advanced fibrosis in patients with normal ALT (area under receiver operating characteristic curve=0.86, 82% sensitivity, 77% specificity and 92% negative predictive value). The sensitivity of the AST/ALT ratio and BARD and NAFLD fibrosis scores for advanced fibrosis was good in patients with normal ALT levels (94, 94 and 82%, respectively), but the specificity was low (44, 26 and 51%, respectively). The FIB-4 yielded best results in patients with elevated ALT levels. Using the FIB-4, 61% of patients with normal ALT levels and 63% of those with elevated ALT levels could avoid liver biopsy to exclude advanced fibrosis. In contrast, AST/ALT ratio and BARD and NAFLD scores would have led to a high proportion of patients with mild disease having to undergo a biopsy. CONCLUSION: The FIB-4 yielded good results in patients with normal or elevated ALT levels, reliably excluding advanced fibrosis and reducing the need for liver biopsy.
    European journal of gastroenterology & hepatology 01/2013;
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    ABSTRACT: Antiplatelet therapy with aspirin and a platelet P2Y12 receptor antagonist reduces thrombotic and ischemic events after percutaneous coronary intervention and acute coronary syndrome. The platelet inhibitory effect of the thienopyridine clopidogrel varies widely among individuals, and high on-treatment platelet reactivity has been associated with a substantial hazard for post-PCI cardiovascular events, including stent thrombosis. The clinical availability of ex vivo methods to measure the antiplatelet effect of P2Y12 antagonists raises the possibility that incorporating platelet function testing into clinical practice could facilitate a stratified and efficient approach to antiplatelet therapy following PCI, although data from definitive randomized trials supporting a routine approach are currently lacking.
    Current Cardiology Reports 01/2013; 15(1):321.
  • The Clinical Teacher 10/2012; 9(5):350.
  • Medical Teacher 08/2012;
  • Medical Teacher 08/2012;
  • Journal of the Royal Society of Medicine 08/2012; 105(8):324.
  • Biomarkers in Medicine 06/2012; 6(3):301-4.
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    ABSTRACT: The renal glomerulus and its components have been intensively studied using microscopy - both light and electron - for decades and much has been learnt about their role in the pathogenesis of chronic kidney diseases such as diabetic nephropathy. In order to get more than purely qualitative information from the images, stereological tools have been applied to obtain unbiased quantitative data and thus allow structural-functional relationships to be explored. These techniques are likely to continue to be used in the coming decades in order to provide vital information about the disease process, complementing knowledge obtained from molecular techniques.
    Micron 05/2012; 43(10):1001-9.
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    ABSTRACT: Sudden cardiac death is the leading cause of mortality among young athletes with an incidence of 1-2 per 100,000 athletes per annum. It is described as 'an event that is non-traumatic, non-violent, unexpected, and resulting from sudden cardiac arrest within six hours of previously witnessed normal health'. Most predisposed athletes have no symptoms and there is no warning for the impending tragic event. The majority of cases are caused by an underlying structural cardiac abnormality, most commonly hypertrophic cardiomyopathy. More recently, the understanding of non-structural causes such as long QT syndrome and Brugada syndrome has grown and diagnostic criteria have been developed. This review presents the known aetiologies of sudden cardiac death among athletes and outlines their identification and management including implications for future sporting participation as laid out in the consensus documents produced by the European Society of Cardiology and the 36th Bethesda Conference.
    Postgraduate medical journal 02/2012; 88(1041):382-90.
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