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Publications (104)
Background
Chronic pancreatitis (CP) is a multifaceted and irreversible inflammatory condition that impacts both endocrine and exocrine pancreatic functions. Whilst there is evidence of a general intestinal microbial dysbiosis, differences across CP resulting from diverse triggers remains poorly elucidated.
Methods
In this study, we investigated ho...
Introduction Inhaled corticosteroids (ICS) can improve clinical
outcomes in patients with chronic obstructive pulmonary
disease (COPD) and eosinophilic airway inflammation, but they
also increase the risk of side effects like pneumonia. Blood
eosinophils guide ICS use, though evidence is limited. The
predictors of treatment REsponse to ICS in COPD:...
Background
Fluid therapy is universally administered in the management of patients with sepsis, however excessive cumulative fluid balance has been shown to result in worse outcomes. Hyperoncotic albumin results in both lower fluid volumes and early cumulative fluid balance, and may reduce short-term mortality in patients with septic shock.
Method...
There is a clinical need to better understand and improve post-operative pain for patients undergoing laparoscopic repair of incisional hernia. The aim of this single-centre, double-blind, randomised controlled trial was to compare post-operative pain between absorbable and non-absorbable tack fixation in patients undergoing IPOM + repair. Patients...
Aims
Clinical pathways have been shown to improve outcomes in patients with heart failure (HF). Although patients with HF often have a cardiac implantable electronic device, few studies have reported the utility of device‐derived risk scores to augment and organize care. TriageHF Plus is a device‐based HF clinical pathway (DHFP) that uses remote mo...
Introduction
Patients with congenital hyperinsulinism (HI) require constant glucose monitoring to detect and treat recurrent and severe hypoglycemia. Historically, this has been achieved with intermittent self-monitoring blood glucose (SMBG), but patients are increasingly using continuous glucose monitoring (CGM). Given the rapidity of CGM device d...
Background
Encapsulating peritoneal sclerosis (EPS) is a rare complication of prolonged peritoneal dialysis (PD) exposure, characterised by peritoneal thickening, calcification, and fibrosis ultimately presenting with life-threatening bowel obstruction. The presence or role of peritoneal calcification in the pathogenesis of EPS is poorly characteri...
Background:
Donor hyperglycaemia following brain death has been attributed to reversible insulin resistance. However, our islet and pancreas transplant data suggest that other mechanisms may be predominant. We aimed to determine the relationships between donor insulin use and markers of beta-cell death and beta-cell function in pancreas donors aft...
Introduction
Easypod-connect™ for childhood growth disorders is a unique connected system that enables transmission of injection adherence information for recombinant human growth hormone (r-hGH). Although this system has the potential to facilitate greater adherence, observational studies have shown declining adherence over prolonged periods when...
Introduction:
Outcomes following pancreas transplantation are suboptimal and better donor selection is required to improve this. Vasoactive drugs (VaD) are commonly used to correct the abnormal haemodynamics of organ donors in intensive care units. VaDs can differentially affect insulin secretion positively (dobutamine) or negatively (noradrenalin...
Introduction
Advances in cystic fibrosis (CF) therapies mean that there is a growing need for reliable measures of assessing lung function in clinical practice that are more sensitive than spirometry. Multiple breath washout (MBW) is well placed to do this, and is widely used in CF research. Clinical application has been restricted by practical and...
Introduction/Background
Postmenopausal bleeding (PMB) prompts urgent investigation with sequential invasive and costly tests that can be painful or distressing. A simple, non-invasive test to identify cancer and safely reassure women with benign causes of PMB would transform patient care. We previously showed proof-of-concept that malignant cells c...
Background
The aim of this study was to investigate for links between reported pain and inflammation within a sub-cohort of patients undergoing the IPOM plus repair through the measurement of serum/plasma levels of established inflammatory biomarkers in trial participants across 1-year follow up.
Methods
22 patients (12 Protack™ and 10 Reliatack™)...
Background
A study examining post-op pain, comparing permanent versus absorbable tack fixation devices, Protack™ versus Reliatack™, in IPOM plus repair.
Methods
TACKoMesh is a single-centre double-blind RCT conducted from 2017–2020 with 1-year follow up. Patients were randomised to either Protack™ (titanium tacks) or Reliatack™ (an articulating-ar...
Background
The aim of this study was to determine the temporal evolution of extracellular matrix (ECM) remodelling and collagen biomarkers and their influence on incisional hernia recurrence after the IPOM plus repair.
Methods
A sub-cohort of patients (n=25) undergoing laparoscopic incisional hernia repair within the TACKoMesh randomised controlle...
Background
The use of patient reported outcome measures (PROMs) for incisional hernia has been established. This study aims to explore relationships between persistent pain at Day365 post laparoscopic-IPOM repair and other clinical and patient-reported data for patients within the TACKoMESH randomised trial.
Methods
Clinical, operative and PROMs d...
Aims
Provide a report on all patients who underwent laparoscopic incisional hernia repair as part of the TACKoMesh RCT prior to unblinding of treatment arms.
Methods
Trial recruitment was for primary incisional hernia with a defect diameter of 3–10cm. 63 patients (target 74–136) were operated on prior to the outbreak of COVID-19. Post-operative pa...
Importance:
Endogenous cortisol levels in children and adolescents during acute illnesses can contribute to the evidence base required to optimize glucocorticoid (GC) stress doses for children and adolescents known to have GC deficiency.
Objective:
To identify endogenous cortisol levels during a range of acute illnesses in children and adolescen...
Background: This study provides a global overview of the management of patients with acute cholecystitis during the initial phase of the COVID-19 pandemic.
Background:
This study provides a global overview of the management of patients with acute cholecystitis during the initial phase of the COVID-19 pandemic.
Methods:
CHOLECOVID is an international, multicentre, observational comparative study of patients admitted to hospital with acute cholecystitis during the COVID-19 pandemic. Data on managemen...
Purpose:
Cardiac catheter ablations are an established treatment for supraventricular tachycardia (SVT) involving prolonged cannulation of the common femoral vein with multiple catheters. This study aimed to identify the risk of deep vein thrombosis (DVT) by studying the frequency of this complication after catheter ablation.
Methods:
This was a...
Aim
Laparoscopic adrenalectomy is considered the optimal approach for most lesions. Various subsets of minimally invasive adrenalectomy are practiced in the UK, including trans-abdominal (TLA), hand-assisted (HLA) and retroperitoneal (RLA) laparoscopic procedures. We aimed to examine the relative operative outcomes between the 3 techniques.
Method...
Background
Adult and paediatric basic life support (BLS) training are often conducted via group training with an accredited instructor every 24 months. Multiple studies have demonstrated a decline in the quality of cardio-pulmonary resuscitation (CPR) performed as soon as 3-month post-training. The ‘Resuscitation Quality Improvement’ (RQI) programm...
Aim
Provide a report on all patients who underwent laparoscopic incisional hernia repair as part of the TACKoMesh RCT prior to unblinding of treatment arms.
Material and Methods
Trial recruitment was for primary incisional hernia with a defect diameter of 3–10cm. 63 patients (target 74-136) were operated on prior to the outbreak of COVID-19. Post-...
Children with Bronchopulmonary dysplasia (BPD) have increased incidence of respiratory illness, often necessitating Pediatric ICU admission. Little is known about the outcome of these admissions.
Aim: This study aimed to determine clinical and demographic data of this cohort and determine factors affecting mortality and length of ICU stay. Oxygen...
Background
Surgery has a recognised role in the treatment of ‘sportsman’s groin’. This study hypothesises that elite athletes have a superior advantage in both pre- and post-op rehabilitation and therefore will present and resume sporting activities quicker.
Methods
A retrospective analysis on a secure database of athletes presenting with groin pa...
Background:
Lung clearance index (LCI) is a valuable research tool in cystic fibrosis (CF) but clinical application has been limited by technical challenges and uncertainty about how to interpret longitudinal change. In order to help inform clinical practice, this study aimed to assess feasibility, repeatability and longitudinal LCI change in chil...
Aims/hypothesis
Approximately 50% of organ donors develop hyperglycaemia in intensive care, which is managed with insulin therapy. We aimed to determine the relationships between donor insulin use (DIU) and graft failure in pancreas transplantation.
Methods
UK Transplant Registry organ donor data were linked with national data from the UK solid pa...
Objective:
To assess the diagnostic utility of corneal confocal microscopy (CCM) for diabetic peripheral neuropathy (DPN) and the risk factors for corneal nerve loss.
Research design and methods:
A total of 490 participants, including 72 healthy control subjects, 149 with type 1 diabetes, and 269 with type 2 diabetes, underwent detailed assessme...
Aims:
The relationship between peri-transplant glycaemic control and outcomes following pancreas transplantation is unknown. We aimed to relate peri-transplant glycaemic control to pancreas graft survival and to develop a framework for defining early graft dysfunction.
Methods:
Peri-transplant glycaemic control profiles over the first five days...
Objective:
International type 1 diabetes registries have shown that HbA1c levels are highest in young people with type 1 diabetes; however, improving their glycemic control remains a challenge. We propose that use of the factory-calibrated Dexcom G6 CGM system would improve glycemic control in this cohort.
Research design and methods:
We conduct...
AimThe aim of the study was to evaluate any social, occupational and physical factors, which may influence the occurence or cause of a primary inguinal hernia in two European countries.MethodsA questionnaire was completed by all the respondents in the setting of an out-patient clinic prospectively at the time of initial presentation and the data we...
Improving glycaemic control in young people with type 1 diabetes (T1D) remains challenging. No study has specifically evaluated efficacy and usability of DexCom G6 CGM in this cohort. Adolescents and young adults with T1D (age 16 to 25 years old) on multiple daily insulin injections (MDI) or insulin pump therapy (CSII) were recruited into an 8-week...
Insulin is routinely used to manage hyperglycaemia in organ donors and during the peri‐transplant period in islet transplant recipients. However, it is unknown whether Donor Insulin Use (DIU) predicts beta‐cell dysfunction after islet transplantation. We reviewed data from the United Kingdom (UK) Transplant Registry and the UK Islet Transplant Cons...
Introduction: Standardized outcome measures are importantfor accurately monitoring the language development of pre-lingually deaf children receiving auditory implants. Current commonly used outcome measures are time-consuming,limiting the practicality of regular testing. To address these limitations, the Manchester Spoken Language Development Scale...
Introduction
Lung clearance index (LCI) is a sensitive measure of early lung disease, but adoption into clinical practice has been slow. Challenges include the time taken to perform each test. We recently described a closed-circuit inert gas wash-in method that reduces overall testing time by decreasing the time to equilibration. The aim of this st...
Aims:
Remote monitoring of patients with physiological data derived from cardiac implanted electronic devices (CIEDs) offers potential to reconfigure clinical services. The 'Heart Failure Risk Score' (HFRS) uses input from integrated device physiological monitoring to risk-stratify patients as low-risk, medium-risk, or high-risk of a heart failure...
Background: Closed circuit washin offers a quicker test with the advantages of an exogenous tracer to measure FRC and LCI. We measured LCI in CF paediatric and adult outpatient clinics to assess repeatability of LCI and track changes over time, and in healthy volunteers (HV) to establish normal range.
Methods: Washin was by rebreathing through a c...
Objective:
To characterise the burden of voice disorders in teachers in a UK population, compare it with non-teachers; and identify groups of teachers who may be particularly at risk of developing a voice problem.
Design:
Questionnaire based survey of primary, secondary teachers and non-teachers. Questions consisted of general demographics, VHI-...
Introduction:
Mucopolysaccharidosis (MPS) type IVA is a rare, autosomal recessive lysosomal storage disease causing substrate accumulation in various organs and tissues. MPS IVA is associated with both obstructive and restrictive airway disease, with the former often resulting in sleep disordered breathing (SDB). Respiratory failure is a primary c...
Objectives: Allergic bronchopulmonary aspergillosis (ABPA) is a rare but
serious complication of cystic fibrosis (CF). Treatment usually involves long
term tapered use of systemic corticosteroids and antifungals. Recently,
pulsed methylprednisolone (MP) over 3 months has been used with
anecdotal evidence of increased safety and increased compliance...
Notice of republication This article was republished on February 22, 2019 to remove a Supporting Information file that was incorrectly included in the originally published article. Please download this article again to view the correct version. © 2019 Ahmed et al. This is an open access article distributed under the terms of the Creative Commons At...
Objective:
People with type 1 diabetes and kidney failure have an increased risk for major adverse cardiovascular events (MACE). Simultaneous pancreas and kidney transplantation (SPKT) improves survival, but the long-term risk for MACE is uncertain.
Research design and methods:
We assessed the frequency and risk factors for MACE (defined as fata...
Background
There are limited reports outlining the financial cost of treating cardiac implantable electronic device (CIED) infection outside the United States. This study aimed to determine the average treatment cost of CIED infection in a large UK tertiary referral centre and compared costs of different treatment pathways that are recognised in th...
Thoracotomy is a common surgical procedure performed worldwide for lung disease. Despite major advances in analgesia, patients still experience severe shoulder, central back and surgical incision site pain in the postoperative period. This study aimed to assess whether intraoperative phrenic nerve infiltration reduces the incidence of postoperative...
Aim
To investigate total serum levobupivacaine concentrations after a caudal‐epidural loading dose followed by a maintenance infusion in infants aged 3‐6 months over 48 hours.
Background
The local anaesthetic, levobupivacaine, is the safer enantiomer of racemic bupivacaine. Present protocols for levobupivacaine are based on studies and pharmacokin...
Aims
To assess the impact of social deprivation, demographics and centre on HbA1c outcomes with continuous subcutaneous insulin infusion (CSII) in adults with Type 1 diabetes.
Methods
Demographic data, postcode‐derived English Index of Multiple Deprivation data and 12‐month average HbA1c (mmol/mol) pre‐ and post‐CSII were collated from three diabe...
Purpose:
Microbial keratitis (MK) is a major cause of corneal blindness worldwide. Variations in season and temperature can affect MK incidence due to specific causative organisms; however, few studies have examined these factors in the UK.
Methods:
Retrospective review of all corneal scrapes from patients with MK presenting to Manchester Royal...
Purpose:
Changing trends of infective keratitis have been identified worldwide. The aim of this study was to define the clinical associations, characteristics, and outcomes of patients with culture-proven Moraxella keratitis from a large tertiary corneal unit in the United Kingdom.
Methods:
Patients with confirmed Moraxella isolates presenting b...
Objectives: In recent times, non-tubercular mycobacteria (NTM) has
emerged as a major pathogen in children affected with cystic fibrosis
(CF). NTM pulmonary disease (NTM - PD) is often difficult to diagnose,
results in accelerated lung disease and requires protracted, potentially toxic
and often inefficient polymicrobial therapy. The aim of this st...
PurposeTo investigate the frequencies, trends, and in vitro drug susceptibilities of the causative pathogens in microbial keratitis in Manchester Royal Eye Hospital.Patients and methodsCorneal scrape results recorded by the microbiology service between 2004 and 2015 were extracted from an established database. A total of 4229 corneal scrape specime...
Background
Predicting which individuals will have a decline in left ventricular (LV) function after pacemaker implantation remains an important challenge. We investigated whether LV global longitudinal strain (GLS), measured by 2D speckle tracking strain echocardiography, can identify patients at risk of pacing-induced left ventricular dysfunction...
The minimal dataset used to perform the multivariate analysis is presented herein.
(PDF)
Effect of global longitudinal strain <14.5 compared to >14.5 on risk of decline in LVEF ≥5% at 12 months according to level of adjustments.
(DOCX)
Aims:
To ascertain any predictors of potential food poisoning pathogens and development of post-infective irritable bowel syndrome (IBS) in UK travellers. An analysis was undertaken on prospectively collected data on 527 patients reporting symptoms of suspected food poisoning between June 2012 and June 2015.
Main outcome measures:
Positive stool...
Background Effective paediatric basic life support improves survival and neurological outcomes.1 Current CPR training involves 4-yearly courses plus annual updates, yet skills degrade significantly by 3–6 months.2,3 To date, no method has been described to motivate frequent and persistent CPR practice. To achieve this we explored the use of competi...
Background Effective paediatric basic life support improves survival and outcomes. Current cardiopulmonary resuscitation (CPR) training involves 4-yearly courses plus annual updates. Skills degrade by 3–6 months. No method has been described to motivate frequent and persistent CPR practice. To achieve this, we explored the use of competition and a...
Aims: To examine the utility of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in the early diagnosis of cardiac implantable electronic device (CIED) generator pocket infection. Methods and results: A total of 86 patients with CIEDs were evaluated with 18F-FDG PET/CT imaging: 46 with suspected generator poc...
There is widespread concern regarding excess mortality for patients admitted to hospital out of hours. We introduced an electronic track and trigger system (Patientrack) with automated alerts in a large university teaching hospital between 2010 and 2012. The system computes the patient's early warning score and alerts medical staff via a pager. It...
Bladder Exstrophy and Epispadias Complex (BEEC) is associated with an increased risk of impaired mental health, quality of life, and psychosocial functioning. Therefore, screening patients to help identify and evaluate potential psychosocial difficulty is arguably an important consideration for BEEC Services.
To screen paediatric BEEC patients for...
To examine the utility of (18)F-fluorodeoxyglucose positron emission tomography/computed tomography ((18)F-FDG PET/CT) in the early diagnosis of cardiac implantable electronic device (CIED) generator pocket infection.
A total of 86 patients with CIEDs were evaluated with (18)F-FDG PET/CT imaging: 46 with suspected generator pocket infection and 40...
Erratum to: World J Surg DOI 10.1007/s00268-014-2837-zThe authors of this Reply, Letter to the Editor are correct as presented in this erratum.
Background
AKI is common among hospital in-patients and places a huge financial burden on the UK National Health Service, causing increased length of hospital stay and use of critical care services, with increased requirement for complex interventions including dialysis. This may account for up to 0.6% of the total Health Service budget. To investi...
Background:
Permissive hypercapnia is routinely practiced in neonatal intensive care units. The effect of permissive hypercapnia on the preterm brain and brain electrical activity is unknown. In this study, we aimed to determine the effect of chronic changes in partial pressure of blood carbon dioxide (PcO2) on brain electrical activity in preterm...
The aim of this study was to conduct a comprehensive systematic review comparing tissue glue (TG) against tacks/staples for mesh fixation in laparoscopic (totally extra-peritoneal and trans-abdominal pre-peritoneal) groin hernia repair with the incidence of post-operative chronic pain as the primary outcome measure.
A computerized search of MEDLINE...
Clinical staging determines antiretroviral therapy (ART) eligibility when CD4 count is not available. Haemoglobin (Hb) ≤8 g/dL is an indication for the treatment. We measured Hb in HIV-positive Malawian adults undergoing clinical assessment for ART eligibility and calculated the percentage of patients with CD4 ≤ 350 cells/μL deemed eligible for ART...
To determine the effectiveness of an intervention to enhance self management support for patients with chronic conditions in UK primary care.
Pragmatic, two arm, cluster randomised controlled trial.
General practices, serving a population in northwest England with high levels of deprivation.
5599 patients with a diagnosis of diabetes (n=2546), chro...
Whole system informing self management engagement (WISE) training
Results of service utilisation
Supplementary material
Background. Shared decision making (SDM) and patient self-management support are key components of US and UK policy for chronic disease management, whereby SDM is seen as enhancing physician-patient negotiation around self-management. The WISE trial is implementing training in self-management support for primary care physicians in one UK region. Th...
Background:
Shared decision making (SDM) and patient self-management support are key components of US and UK policy for chronic disease management, whereby SDM is seen as enhancing physician-patient negotiation around self-management. The WISE trial is implementing training in self-management support for primary care physicians in one UK region. T...
ROUTINE HEMOGLOBIN MEASUREMENT AT ART ELIGIBILITY ASSESSMENT: INCREASING ACCESS TO ART WHERE CD4 COUNTING IS NOT AVAILABLE
Iain D PAGE1, Aubrey G KUDZALA3, Stephen J McKEW2, Catherine FULLWOOD 4, Imelda BATES5, Joep J van OOSTERHOUT3
1. The University of Manchester, Respiratory Research Group, Manchester, UK.
2. Malawi-Liverpool-Wellcome Trust C...
To examine the reasons why practices exempt patients from the UK Quality and Outcomes Framework pay for performance scheme (exception reporting) and to identify the characteristics of general practices associated with informed dissent.
Retrospective analysis.
Data for 2008-9 extracted from the clinical computing systems of general practices in Engl...
Increasing the effective targeting and promotion of self-care support for long-term conditions requires more of a focus on patient contexts and networks. The aim of this paper is to describe how within a programme of research and implementation, social networks are viewed as being centrally involved in the mobilisation and deployment of resources i...
Small general practices are often perceived to provide worse care than larger practices.
To describe the comparative performance of small practices on the UK's pay-for-performance scheme, the Quality and Outcomes Framework.
Longitudinal analysis (2004-2005 to 2006-2007) of quality scores for 48 clinical activities.
Family practices in England (n =...
To investigate the association between indicators of quality of diabetic management in English family practices and emergency hospital admissions for short-term complications of diabetes.
A total of 8,223 English family practices from 2001/2002 to 2006/2007.
Multiple regression analyses of associations between admissions and proportions of practice...
The quality and outcomes framework is a financial incentive scheme that remunerates general practices in the UK for their performance against a set of quality indicators. Incentive schemes can increase inequalities in the delivery of care if practices in affluent areas are more able to respond to the incentives than are those in deprived areas. We...
In the English pay-for-performance program, physicians use a range of criteria to exclude individual patients from the quality calculations that determine their pay. This process, which is called exception reporting, is intended to safeguard patients against inappropriate treatment by physicians seeking to maximize their income. However, exception...
