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Healthcare staff well-being and use of support services during COVID-19:a UK perspective

General Psychiatry 2021年第3期34卷 143-153页

作者： Anika R Petrella Luke Hughes Lorna A Fern Lisa Monaghan Benjamin Hannon Adam Waters Rachel M Taylor Cancer division University College London Hospitals NHS Foundation TrustLondonUK Staff Psychological and Welfare Service University College London Hospitals NHS Foundation TrustLondonUK Centre for Nurse Midwife and AHP Led Research(CNMAR)University College London Hospitals NHS Foundation TrustLondonUK

Background The COVID-19 pandemic has drastically increased demands on healthcare workers(HCWs)leaving them vulnerable to acute psychological distress,burnout and post-traumatic *** response,supportive services in a central London hospital mobilised mental health support specifically for *** This rapid evaluation assessed HCW psychological welfare during the acute phase of the COVID-19 pandemic and their use of supportive services made *** During the acute phase of COVID-19(April to May 2020)all staff working for the hospital were invited to complete an online survey assessing well-being(self-rated health,moral distress exposure,symptoms of burnout and psychological distress)and use of available supportive services(awareness of,use and perceived helpfulness).Associations among personal characteristics and psychological well-being were explored using correlations and linear *** A total of 1127 staff participated in the rapid *** average,psychological distress was high(mean(SD):22(7.57))regardless of role,with 84%of this sample scoring above the general population mean(14.5).Nearly half of the sample reported feeling emotionally drained and a profile emerged displaying higher levels of psychological distress and burnout in those who were younger and exposed to morally distressing situations,with this group also exhibiting greater support service *** levels of burnout were associated with increased psychological distress when controlling for personal *** this acute phase of the pandemic,majority of staff used at least one service and rated it as *** HCWs experienced high levels of psychological distress requiring continued support as the COVID-19 pandemic *** HCWs were aware of supportive services,uptake *** order to mitigate the risk of burnout and post-traumatic stress,long-term,effective strategies that facilitate staff accessing support are urgently required.

关键词： distress younger staff

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Identifying the best therapy for chronic anal fissure

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World Journal of Gastrointestinal Pharmacology and Therapeutics 2011年第2期2卷 9-16页

作者： Mariusz H Madalinski nhs lothian-university hospitals division Edinburgh EH4 2XUUnited Kingdom

Chronic anal fissure(CAF)is a painful tear or crack which occurs in the *** optimal algorithm of therapy for CAF is still *** internal sphincterotomy(LIS)is a surgical treatment,considered as the'gold standard'therapy for *** relieves CAF symptoms with a high rate of *** sphincterotomy(CS)with nitrates,calcium blockers or botulinum toxin(BTX)is safe,with the rapid relief of pain,mild sideeffects and no risk of surgery or anesthesia,but is a statistically less effective therapy for CAF than *** article considers if aggressive treatment should only be offered to patients who fail pharmacological *** of anal fissure etiology,epidemiology and pathophysiology are considered with their meaning for further management of CAF.A molecular model of chemical interdependence significant for the chemistry of CAF healing is *** application may influence the development of optimal therapy for *** is currently considered the most effective type of CS and discussion in this article scrutinizes this method *** the effectiveness of BTXvs LIS has been discussed,the essential focus of the article concerns identifying the best therapy application for anal *** are presented which may help us to predict CAF *** provide rationale for the expansion of the CAF therapy *** and economic factors are also considered in *** long as the patient is willing to accept the potential risk of fecal incontinence,we have grounds for the'gold standard'(LIS)as the first-line treatment for *** author concludes that,when the diagnosis of the anal fissure is established,CS should be considered for both ethical and economic *** is convinced that a greater understanding and recognition of benign anal disorders by the GP and a proactive involvement at the point of initial diagnosis would facilitate the consideration of CS at an earlier,more practical stage with improved outc

关键词： Anal fissure Benign anal diseases Chemical sphincterotomy Botulinum toxin Lateral internal sphincterotomy Fissurectomy Ethics Teaching

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Prospective,multicentre study of screening,investigation and management of hyponatraemia after subarachnoid haemorrhage in the UK and Ireland

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Stroke & Vascular Neurology 2023年第3期8卷 207-216,I0028-I0059页

作者： James J M Loan Steven Tominey Kirun Baweja Julie Woodfield Thomas J G Chambers Mark Haley Simran S Kundu H Y Josephine Tang Anthony N Wiggins Michael T C Poon Paul M Brennan Translational Neurosurgery The University of Edinburgh Centre for Clinical Brain SciencesEdinburghUK Neurosurgery NHS LothianEdinburghUK Neurosurgery Institute of Neurological SciencesGlasgowUK Department of Medicine School of MedicineDentisty and NuringUniversity of GlasgowGlasgowUK Internal Medicine Queen's UniversityKingstonOntarioCanada Centre for Discovery Brain Sciences University of EdinburghEdinburghUK Edinburgh Centre for Diabetes and Endocrinology NHS LothianEdinburghUK Radiology University Hospitals Plymouth NHS TrustPlymouthUK Department of Medicine Cork University HospitalUniversity College CorkCorkIreland

Background Hyponatraemia often occurs after subarachnoid haemorrhage(SAH).However,its clinical significance and optimal management are *** audited the screening,investigation and management of hyponatraemia after *** We prospectively identified consecutive patients with spontaneous SAH admitted to neurosurgical units in the United Kingdom or *** reviewed medical records daily from admission to discharge,21 days or death and extracted all measurements of serum sodium to identify hyponatraemia(10 *** of hyponatraemia with outcome were assessed using logistic regression with adjustment for predictors of outcome after SAH and admission *** assessed hyponatraemia-free survival using multivariable Cox *** 175/407(43%)patients admitted to 24 neurosurgical units developed hyponatraemia.5976 serum sodium measurements were *** osmolality,urine osmolality and urine sodium were measured in 30/166(18%)hyponatraemic patients with complete *** most frequently target daily fluid intake was>3 L and this did not differ during hyponatraemic or non-hyponatraemic episodes.26%(n/N=42/164)patients with hyponatraemia received sodium supplementation.133(35%)patients were dead or dependent within the study period and 240(68%)patients had hospital admission for over 10 *** the multivariable analyses,hyponatraemia was associated with less dependency(adjusted OR(aOR)=0.35(95%CI 0.17 to 0.69))but longer admissions(aOR=3.2(1.8 to 5.7)).World Federation of Neurosurgical Societies grade I-III,modified Fisher 2-4 and posterior circulation aneurysms were associated with greater hazards of *** In this comprehensive multicentre prospective-adjusted analysis of patients with SAH,hyponatraemia was investigated inconsistently and,for most patients,was not associated with changes in management or clinical outcome.T

关键词： admitted urine centre

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Prognostic value of ΔSYNTAX% score in octogenarians undergoing percutaneous coronary intervention

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Journal of Geriatric Cardiology 2023年第7期20卷 509-515页

作者： Joanna Abramik Nestoras Kontogiannis Roberto Scarsini Giovanni Luigi De Maria Tushar Raina Nikolaos Fragakis George Kassimis Department of Cardiology Cheltenham General HospitalGloucestershire Hospitals NHS Foundation TrustCheltenhamUnited Kingdom Department of Cardiology Oxford University Hospitals NHS Foundation TrustOxfordUnited Kingdom division of Cardiology Department of MedicineUniversity of VeronaVeronaItaly Second Department of Cardiology Hippokration HospitalMedical SchoolAristotleUniversity of ThessalonikiThessalonikiGreece

OBJECTIVES To verify whether incomplete revascularisation(IR),quantified using the rSYNTAX(Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery)score andΔSYNTAX%score,could predict short-(in-hospital mortality)and long-term outcomes(12-month mortality)in octogenarians undergoing percutaneous coronary intervention(PCI).METHODS&RESULTS A retrospective analysis of 665 consecutive octogenarian patients presenting for PCI to a UK centre was *** baseline SYNTAX and rSYNTAX scores were assessed from angiographic images.ΔSYNTAX%score was calculated(ΔSYNTAX%=((SYNTAX-rSYNTAX)/SYNTAX)×100%))to measure the relative completeness of ***-Meier analysis assessed survival at 12 months by tertiles of rSYNTAX andΔSYNTAX%***ΔSYNTAX%score was associated with reduced in-hospital mortality(P=0.017),and improved survival benefit(log rank 14.8,P=0.001)at 12 *** Enhancing the completeness of revascularisation in octogenarians selected to undergo PCI is associated with a lower in-hospital mortality and a survival benefit at 12 months.

关键词： SYNTAX mortality coronary

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To bridge or not to bridge:summary of the new evidence in endovascular stroke treatment

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Stroke & Vascular Neurology 2022年第3期7卷 179-181页

作者： Anna Podlasek Permesh Singh Dhillon Waleed Butt Iris Q Grunwald Timothy J England Tayside Innovation MedTech Ecosystem(TIME) University of DundeeDundeeUK NIHR Nottingham Biomedical Research Centre University of NottinghamNottinghamUK Interventional Neuroradiology Nottingham University Hospitals NHS TrustNottinghamUK Interventional Neuroradiology University Hospitals Birmingham NHS TrustBirminghamUK Stroke Division of Mental Health and Clinical NeurosciencesSchool of MedicineUniversity of NottinghamNottinghamUK Stroke University Hospitals of Derby and Burton NHS Foundation TrustDerbyUK

WHAT IS ALREADY KNOWN Recently published summaries and meta-analyses of four randomised controlled trials(RCTs)1-5 comparing direct mechan-ical thrombectomy(dMT)and bridging therapy with intravenous(IV)thrombolytics(alteplase)suggested that dMT is non-inferior to bridging therapy to achieve good functional outcome 3 months after stroke(modified Rankin Score 0-2)with the non-inferiority margin(NIM)<−5%.

关键词： intravenous bridging treatment

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Cerebral misery perfusion due to carotid occlusive disease

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Stroke & Vascular Neurology 2017年第2期2卷 88-93页

作者： Mohana Maddula Nikola Sprigg Philip M Bath Sunil Munshi Acute Stroke Unit Tauranga HospitalTaurangaNew Zealand division of Clinical Neuroscience University of NottinghamNottinghamUK Department of Stroke Nottingham University Hospitals NHS TrustNottinghamUK

Purpose Cerebral misery perfusion(CMP)is a condition where cerebral autoregulatory capacity is exhausted,and cerebral blood supply in insufficient to meet metabolic *** present an educational review of this important condition,which has a range of clinical *** A non-systematic review of published literature was undertaken on CMP and major cerebral artery occlusive disease,using Pubmed and *** Patients with CMP may present with strokes in watershed territories,collapses and transient ischaemic attacks or episodic movements associated with an orthostatic *** positron emission tomography is the gold standard investigation for misery perfusion,advanced MRI is being increasingly used as an alternative investigation *** presence of CMP increases the risk of *** addition to the devastating effect of stroke,there is accumulating evidence of impaired cognition and quality of life with carotid occlusive disease(COD)and misery *** evidence for revascularisation in the setting of complete carotid occlusion is *** management constitutes careful blood pressure management while addressing other vascular risk *** The evidence for the management of patients with COD and CMP is discussed,together with recommendations based on our local *** this review,we focus on misery perfusion due to *** Patients with CMP and COD may present with a wide-ranging clinical phenotype and therefore to many *** identification of patients with misery perfusion may allow appropriate management and focus on strategies to maintain or improve cerebral blood flow,while avoiding potentially harmful treatment.

关键词： perfusion carotid impaired

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Remote platelet function testing using P-selectin expression in patients with recent cerebral ischaemia on clopidogrel

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Stroke & Vascular Neurology 2021年第1期6卷 103-108页

作者： Jason Philip Appleton Carla Richardson Natalia Dovlatova Jane May Nikola Sprigg Stan Heptinstall Philip M Bath Stroke Trials Unit Division of Clinical NeuroscienceUniversity of NottinghamNottinghamUK Stroke division Nottingham University Hospitals NHS TrustNottinghamUK Platelet Solutions Ltd Division of Clinical NeuroscienceQueen's Medical CentreUniversity of NottinghamNottinghamUK Platelet Research Group Division of Clinical NeuroscienceQueen's Medical CentreUniversity of NottinghamNottinghamUK

Background Antiplatelet agents reduce recurrence after cerebral ischaemia but are not effective in all patients,in part because of treatment *** primary aim was to assess the proportion of patients who are insensitive to *** secondary aim was to assess the association between insensitivity to clopidogrel and recurrent cerebrovascular *** Following written informed consent,independent patients with a recent non-cardioembolic ischaemic stroke or transient ischaemic attack,and taking clopidogrel,were *** function was assessed with remote measurement of surface expression of P-selectin(CD62P)using commercial kits sensitive to aspirin or ***’general practitioners provided details on recurrent vascular events at least 90 days *** are mean(SD)and median[IQR].Resistance was defined as:aspirin median fluorescence(MF)>500 units,clopidogrel MF>860 ***-parametric descriptors and tests were *** 63 patients were recruited:mean age 64(13.7)years,women 47%.At baseline,59(95%)patients were taking clopidogrel alone with 3(5%)on combined clopidogrel and *** of platelet surface P-selectin revealed:aspirin test 528[317,834],>50054.8%;clopidogrel test 429[303,656],>86011.3%.No participants on aspirin and clopidogrel showed aspirin ***(20.6%)patients had a recurrent cerebrovascular event;those with an ischaemic stroke had a non-significantly higher baseline P-selectin using the clopidogrel test as compared with those with no recurrence:626[380,801]versus 406[265,609],p=*** Remote measurement of platelet function assessed using the platelet surface expression of P-selectin is feasible.11%of patients taking clopidogrel showed *** significant associations were noted between clopidogrel resistance and recurrent ischaemic events.

关键词： patients cerebral function

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Adipose-derived regenerative therapies for the treatment of knee osteoarthritis

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World Journal of Stem Cells 2024年第4期16卷 324-333页

作者： Ilias E Epanomeritakis Wasim S Khan division of Trauma and Orthopaedic Surgery Addenbrooke’s HospitalCambridge University Hospitals NHS Foundation TrustCambridge CB20QQUnited Kingdom division of Trauma and Orthopaedic Surgery Department of SurgeryUniversity of CambridgeCambridge CB20QQUnited Kingdom

Knee osteoarthritis is a degenerative condition with a significant disease burden and no disease-modifying *** treatment ultimately requires joint *** capable of regenerating cartilage could significantly reduce financial and clinical *** regenerative potential of mesenchymal stromal cells(MSCs)has been extensively studied in the context of knee *** has yielded promising results in human studies,and is likely a product of immunomodulatory and chondroprotective biomolecules produced by MSCs in response to ***-derived MSCs(ASCs)are becoming increasingly popular owing to their relative ease of isolation and high proliferative *** vascular fraction(SVF)and micro-fragmented adipose tissue(MFAT)are produced by the enzymatic and mechanical disruption of adipose tissue,*** avoids expansion of isolated ASCs ex vivo and their composition of heterogeneous cell populations,including immune cells,may potentiate the reparative function of *** this editorial,we comment on a multicenter randomized trial regarding the efficacy of MFAT in treating knee *** discuss the study’s findings in the context of emerging evidence regarding adipose-derived regenerative *** underlying mechanism of action of ASCs is proposed while drawing important distinctions between the properties of isolated ASCs,SVF,and MFAT.

关键词： Knee osteoarthritis Mesenchymal stromal cells Adipose tissue Stromal vascular fraction Micro-fragmented adipose tissue Regeneration

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Obstructive sleep apnea syndrome and fatty liver: Association or causal link?

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World Journal of Gastroenterology 2010年第34期16卷 4243-4252页

作者： Mohamed H Ahmed Christopher D Byrne Chemical Pathology Department Southampton University Hospital NHS Trust Southampton SO16 6YD United Kingdom Endocrinology and Metabolism DOHaD Division University of Southampton and Southampton University Hospitals Trust Southampton SO16 6YD United Kingdom

Obstructive sleep apnea (OSA) is a complex disorder that consists of upper airway obstruction, chronic intermittent hypoxia and sleep fragmentation. OSA is well known to be associated with hypoxia, insulin resistance and glucose intolerance, and these factors can occur in the presence or absence of obesity and metabolic syndrome. Although it is well established that insulin resistance, glucose intolerance and obesity occur frequently with non-alcoholic fatty liver disease (NAFLD), it is now becoming apparent that hypoxia might also be important in the development of NAFLD, and it is recognized that there is increased risk of NAFLD with OSA. This review discusses the association between OSA, NAFLD and cardiovascular disease, and describes the potential role of hypoxia in the development of NAFLD with OSA.

关键词： Sleep apnea syndrome Hyperlipidemia Non-alcoholic fatty liver disease Insulin resistance

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A matched-pair analysis of laparoscopic versus open pancreaticoduodenectomy: oncological outcomes using Leeds Pathology Protocol

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Hepatobiliary & Pancreatic Diseases International 2014年第4期13卷 435-441页

作者： Abdul R Hakeem Caroline S Verbeke Alison Cairns Amer Aldouri Andrew M Smith Krishna V Menon Department of HPB and Transplant Surgery St James's University Hospital NHS TrustLeeds Teaching Hospitals Beckett street Leeds LS9 7TF United Kingdom division of Pathology Department of Laboratory Medicine Karolinska Institutet Stockholm Sweden Department of Histopathology St James's University Hospital NHS TrustLeeds Teaching Hospitals Beckett street Leeds LS9 7TF United Kingdom

BACKGROUND： Laparoscopic pancreaticoduodenectomy（LPD）is a safe procedure. Oncological safety of LPD is still a matter for debate. This study aimed to compare the oncological outcomes,in terms of adequacy of resection and recurrence rate following LPD and open pancreaticoduodenectomy（OPD）.METHODS： Between November 2005 and April 2009, 12LPDs（9 ampullary and 3 distal common bile duct tumors）were performed. A cohort of 12 OPDs were matched for age,gender, body mass index（BMI） and American Society of Anesthesiologists（ASA） score and tumor ***： Mean tumor size LPD vs OPD（19.8 vs 19.2 mm,P=0.870）. R0 resection was achieved in 9 LPD vs 8 OPD（P=1.000）. The mean number of metastatic lymph nodes and total number resected for LPD vs OPD were 1.1 vs 2.1（P=0.140）and 20.7 vs 18.5（P=0.534） respectively. Clavien complications grade I/II（5 vs 8）, III/IV（2 vs 6） and pancreatic leak（2 vs 1）were statistically not significant（LPD vs OPD）. The mean high dependency unit（HDU） stay was longer in OPD（3.7 vs 1.4 days,P〈0.001）. There were 2 recurrences each in LPD and OPD（logrank,P=0.983）. Overall mortality for LPD vs OPD was 3 vs 6（log-rank, P=0.283） and recurrence-related mortality was 2 vs *** was one death within 30 days in the OPD group secondary to severe sepsis and none in the LPD ***： Compared to open procedure, LPD achieved a similar rate of R0 resection, lymph node harvest and longterm recurrence for tumors less than 2 cm. Though technically challenging, LPD is safe and does not compromise oncological outcome.

关键词： pancreaticoduodenectomy minimally invasive laparoscopic open oncological outcomes resection margins pathology

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