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    Bulletin of the World Health Organisation 05/2013; 91(5):314-314A.
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    ABSTRACT: Nonmelanoma skin cancer (NMSC) is the most common malignancy in the western world, with an incidence of 98 000 in the U.K. Since 2009 the Department of Health (DoH) has collected patient-reported outcome measure (PROM) data following four common surgical procedures. However, a DoH PROM for NMSC does not exist. A systematic review of questionnaires published on patient concerns due to NMSC of the face was conducted. Keywords relevant to PROMs, NMSC and the facial region were comprehensively searched in medical databases. Inclusion criteria stipulated questionnaires from relevant papers that recruited patients with NMSC for both the item formulation and subsequent validation.
    British Journal of Dermatology 02/2013;
  • Clinical medicine (London, England) 10/2012; 12(5):461-6.
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    ABSTRACT: Shared medical appointments (SMAs) are group clinics where practitioners see several patients, with common health needs, at once. There is a great financial strain on the National Health Service (NHS) to provide bariatric surgery. The aim of this study was to review patient satisfaction with the SMA that is the default means of following up patients after bariatric surgery at one particular NHS trust. A patient-validated questionnaire was designed and handed out at the end of the SMAs. Patients who attended an SMA earlier in 2011 were also retrospectively sent questionnaires via post. A total of 47 patients completed the questionnaire from seven different SMAs covering the period from January to July 2011. All patients underwent laparoscopic adjustable gastric banding. After attending an SMA, patients gave an overall mean satisfaction rating of 4.13 ± 0.163 (on a scale of 1 to 5, 1 = very poor and 5 = excellent) which represented an increase (p < 0.01) compared to preconceptions before the clinic (3.59 ± 0.175). A cost analysis estimated a yearly saving of £4,617 or 65.1% made by the SMAs compared to 1:1 appointments. The bariatric surgery SMA demonstrates high levels of patient satisfaction and is cost-effective.
    Obesity Surgery 04/2012; 22(4):641-5.
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    ABSTRACT: Vascular dysfunction is a common consequence of diabetes mellitus. Stable propagation of gene expression from cell to cell generation during development of diseases (like diabetes) is regulated by epigenetic mechanisms. These are heritable patterns of gene expression that cannot solely be explained by changes in DNA sequence. Recent evidence shows that diabetes-induced epigenetic changes can affect gene expression in vascular endothelial cells and vascular smooth muscles cells. Such effects further influence inflammatory and insulin production pathways in these cells and thus ensure a long-term memory, whereby epigenetic changes are maintained even long after restoring normo-glycaemic conditions by appropriate therapeutic approaches. This review focuses on the epigenetic marks, which endure on the vascular chromatin under diabetic conditions.
    Endocrine, metabolic & immune disorders drug targets. 01/2012; 12(2):107-17.
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    ABSTRACT: Cardioplegic arrest and cardiopulmonary bypass are key triggers of myocardial injury during aortic valve surgery. Cardioplegic ischaemic arrest is associated with disruption to metabolic and ionic homeostasis in cardiomyocytes. These changes predispose the heart to reperfusion injury caused by elevated intracellular reactive oxygen species and calcium. Cardiopulmonary bypass is associated with an inflammatory response that can generate systemic oxidative stress which, in turn, provokes further damage to the heart. Techniques of myocardial protection are routinely applied to all hearts, irrespective of their pathology, although different cardiomypathies respond differently to ischaemia and reperfusion injury. In particular, the efficacy of cardioprotective interventions used to protect the hypertrophic heart in patients with aortic valve disease remains controversial. This review will describe key cellular changes in hypertrophy, response to ischaemia and reperfusion and cardioplegic arrest and highlight the importance of optimising cardioprotective strategies to suit hypertrophic hearts.
    Perfusion 09/2011; 26 Suppl 1:48-56.
  • The Lancet 07/2011; 378(9788):293-4.
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    ABSTRACT: This brief report assesses the impact of community birth attendant training and explores barriers to safe delivery in rural Madagascar. We assessed the knowledge of 25 community birth attendants using interviewer-administered questionnaires and explored attitudes to delivery in 4 focus groups of 10 women of reproductive age and 1 focus group of 10 birth attendants. We found a mismatch between hygiene knowledge and reported practice. Clinical experience appears to reinforce training to achieve longer lasting change in practitioner knowledge (e.g. of labour complications). Focus groups helped to identify practical barriers to clean (delivery kits) and safe delivery (cost) despite this knowledge. We proposed that a facilitated women's group programme may complement such training.
    Journal of Tropical Pediatrics 02/2011; 57(1):59-61.
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    ABSTRACT: This article seeks to explore utilitarian conceptions of personhood which for a long time have been employed as part of a rational moral justification for the termination of pregnancy. Michael Tooley's desires-based rights approach to personhood presented in his work Abortion and Infanticide is considered and, it is argued, is found wanting when one considers unconscious adults and their ability to desire life. This article will offer that unconscious sleeping individuals only have the potential to regain the capacity to value their own life and, as such, under Tooley's formula for personhood, temporarily lose their status as a person. Following this, John Harris's utilitarian views on the status of the sleeping adult will be considered and deconstructed to show that, like Tooley, his ascription for personhood falls down at the sleeping adult. This article illustrates that utilitarian conceptions of personhood leave the sleeping adult human devoid of the rights of a person and hence render the value of this consquentialist theory, with regard to the idea of personhood, in severe doubt. The paper argues that utilitarian conceptions of personhood do little more than obstruct the worthy debate over the morality of abortion.
    Journal of medical ethics 01/2011; 37(5):318-20.
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    ABSTRACT: Multiple imputation is increasingly recommended in epidemiology to adjust for the bias and loss of information that may occur in analyses restricted to study participants with complete data ("complete-case analyses"). However, little guidance is available on applying the method, including which variables to include in the imputation model and the number of imputations needed. Here, the authors used multiple imputation to analyze the prevalence of wheeze among 81-month-old children in the Avon Longitudinal Study of Parents and Children (Avon, United Kingdom; 1991-1999) and the association of wheeze with gender, maternal asthma, and maternal smoking. The authors examined how inclusion of different types of variables in the imputation model affected point estimates and precision, and assessed the impact of number of imputations on Monte Carlo variability. Inclusion of variables associated with the outcome in the imputation model increased odds ratios and reduced standard errors. When only 5 or 10 imputations were used, variability due to the imputation procedure was substantial enough to affect conclusions. Careful preliminary analysis identified the scope for multiple imputation to reduce bias and improve efficiency and provided guidance for building the imputation model. When data are missing, such preliminary analyses should be routinely undertaken and reported, regardless of whether multiple imputation is used in the final analysis.
    American journal of epidemiology 08/2010; 172(4):478-87.
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