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34
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Introduction
Current institution
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August 2012 - September 2015
August 2012 - present
Publications
Publications (34)
Background
HE is a common neurologic complication in cirrhosis associated with substantial disease and economic burden. HE symptoms are nonspecific and there are limited ways of identifying patients with cirrhosis at high risk of later developing HE. A risk score was previously developed to identify patients at risk of developing HE in a predominat...
499
Background: Regorafenib was the first treatment to demonstrate a survival benefit in patients with HCC after progression on sorafenib. The RESORCE trial found that regorafenib improved overall survival with acceptable toxicity, in patients with disease progression on sorafenib who tolerated ≥400mg sorafenib daily and had Child-Pugh A liver func...
Background:
Non-alcoholic steatohepatitis (NASH) is a common type of chronic liver disease that can lead to cirrhosis. Obeticholic acid, a farnesoid X receptor agonist, has been shown to improve the histological features of NASH. Here we report results from a planned interim analysis of an ongoing, phase 3 study of obeticholic acid for NASH.
Meth...
The purpose of this study was to produce two statistical survival models in those with cirrhosis utilising only routine parameters, including non-liver-related clinical factors that influence survival. The first model identified and utilised factors impacting short-term survival to 90-days post incident diagnosis, and a further model characterised...
Background:
The incidence of liver disease is increasing in the UK and primary care is a key setting where improvement in the detection and management of liver disease is required. Little is known about GPs' understanding and confidence in detecting liver disease.
Aim:
To explore GPs' experiences of liver disease with a focus on early detection...
Background
Liver function tests (LFTs) are commonly abnormal; most patients with ‘incidental’ abnormal LFTs are not investigated appropriately and for those who are, current care pathways are geared to find an explanation for the abnormality by a lengthy process of investigation and exclusion, with costs to the patient and to the health service.
O...
Background
Liver disease is the third most common cause of premature death in the UK. The symptoms of terminal liver disease are often difficult to treat, but very few patients see a palliative care specialist and a high proportion die in hospital. Primary care has been identified as a setting where knowledge and awareness of liver disease is poor....
Objective:
One promising approach for a continuous, noninvasive, cuff-less ambulatory blood pressure (BP) monitor is to measure the pulse wave velocity or the inversely proportional pulse transit time (PTT), based on electrical and optical physiological measurements in the chest area. A device termed IsenseU-BP+ has been developed for measuring co...
Late-onset LAL deficiency, previously referred to as cholesteryl ester storage disorder, is a rare lysosomal storage disorder characterized by accumulation of cholesteryl esters. It has a heterogeneous clinical phenotype including abdominal pain, poor growth, hyperlipidemia with vascular complications and hepatosplenomegaly. End-stage liver disease...
Background:
The lack of progress in developing and delivering new therapies for hepatocellular carcinoma (HCC) is in part attributed to the risk related avoidance of tumour biopsy at diagnosis. Circulating tumour cells (CTCs) are a potential source of tumour tissue that could aid biological or biomarker research, treatment stratification and monit...
Purpose:
Hepatic encephalopathy (HE) is a complication of cirrhosis signaling decompensation and is associated with mortality. There has been little characterization of HE once an incident episode has occurred and of what effect the transition to overt HE might have on outcomes. We characterized the relationships between the number of previous HE...
Background & aims:
Rifaximin-α reduces the risk of recurrence of overt hepatic encephalopathy. However, there remain concerns regarding the financial cost of the drug. We aimed to study the impact of treatment with rifaximin-α on healthcare resource utilisation using data from seven United Kingdom liver treatment centres.
Methods:
All seven cent...
Translational medicine, rather than being a unidirectional clinical utilization of basic research discoveries, should be a bidirectional process of cross-fertilization between basic science, medical knowledge and clinical utilization. While steps and processes differ across these branches of research, clear language and proper definitions are prere...
A personal health system platform for the management of patients with chronic liver disease that incorporates a novel approach to integrate decision support and guidance through care pathways for patients and their doctors is presented in this paper. The personal health system incorporates an integrated decision support engine that guides patients...
Cirrhosis has a long natural history with considerable symptomatic impacts, particularly in advancing disease. Measuring Health Related Quality of Life (HRQOL) in liver disease provides detail about the nature and extent of its effects on individuals. Understanding the drivers of impaired HRQOL can help identify targets for improvement through new...
Background:
Assessment and quantification of actual liver function is crucial in patients with chronic liver disease to monitor disease progression and predict individual prognosis. Mathematical models, such as model for end-stage liver disease, are used for risk stratification of patients with chronic liver disease but do not include parameters t...
IntroductionHealth-related quality of life (HRQOL) is severely impaired in advanced liver disease. The purpose of this study was to evaluate the impact of actual liver function and disease specific factors on HRQOL of patients evaluated for liver transplantation.Patients and Methods
Disease-specific QOL was analysed in 142 patients evaluated for li...
Introduction Cirrhosis is associated with impaired Health-Related Quality of Life (HRQoL) and considerable resource use. The association between healthcare utilisation and HRQoL in cirrhosis has not been previously studied.
Methods Four HRQoL tools (SF-36v2, CLDQ, PBC-40 and PROMIS-HAQ) and a healthcare utilisation tool were completed by patients w...
Introduction Overt hepatic encephalopathy (HE) is associated with frequent hospitalisations which are expensive to manage and result in poor quality of life. The aim was to estimate the resource use associated with HE and hospitalisation in the UK.
Methods The Clinical Practice Research Datalink (CPRD) with linked hospital data from Health Episode...
Introduction Ascites is the most common complication of cirrhosis, but tools to assess its impact on Health Related Quality of Life (HRQoL) are limited. The Newcastle Patient Reported Ascites Measure (N-PRAM) was developed to measure the multidimensional impact of ascites on HRQoL.
Methods Structured interviews were carried out with patients with a...
Introduction Rifaximin-α is a non-absorbable antibiotic increasingly being used for the secondary prevention of recurrent overt hepatic encephalopathy (HE) in the UK. The therapeutic mechanism of rifaximin has yet to be elucidated, with reduction in gut ammonia production postulated. We undertook a UK multi-centre retrospective audit of patients re...
Macrophage activation syndrome (MAS) is a rare, potentially fatal condition, which most frequently complicates rheumatological conditions and is often associated with liver dysfunction. In this case report of a patient with MAS, acute liver failure developed despite conventional immunosuppressive therapy. Liver transplantation resulted in rapid rec...
Introduction Overt Hepatic Encephalopathy (HE) frequently results in emergency admission to hospital. Treatment with the non-absorbable antibiotic rifaximin is effective at preventing recurrence of overt HE but there are concerns about the high cost of the drug. The aim of this study was to evaluate the cost-effectiveness of rifaximin at reducing e...
The NHS’s four hour target for being treated in accident and emergency departments has dramatically changed the way unscheduled care services are run. It aims to improve the “patient journey” by emphasising the length of time it takes for a patient to be seen, assessed, treated, and “disposed of” by the emergency department. However, the effects of...
Gliotoxin has been shown to promote a reversal of liver fibrosis in an animal model of the disease although its mechanism of action in the liver is poorly defined. The effects of gliotoxin on activated hepatic stellate cells (HSCs) and hepatocytes have therefore been examined. Addition of gliotoxin (1.5 microM) to culture-activated HSCs resulted in...
