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“Flow” Transcranial Direct Current Stimulation (tDCS) for Depression Treatment in a Primary Healthcare General Practice—An Open-Label Cohort Study Measuring Montgomery-Åsberg Depression Rating Scale (MADRS-S) Outcomes

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Open Journal of Psychiatry 2024年第4期14卷 386-399页

作者： Chris Griffiths Harmony Jiang David Smart Azhar Zafar Northamptonshire Healthcare nhs Foundation Trust Northampton UK University of Northampton Northampton UK General Practice alliance Ltd. Northampton UK

Background: Flow FL-100 is a transcranial direct current stimulation (tDCS) device self-administered by a patient at home in combination with a software application delivered wellbeing behaviour therapy training. tDCS has evidence of effectiveness in treating symptoms of depression. Purpose/Aim: This post marketing study evaluated the effect of Flow on depression for primary care general practice patients with depression symptoms. Methods: Open-label patient cohort design with no control group. Inclusion criteria were aged 18 years or over and reporting depression symptoms. Participants self-administered five 30 minute tDCS sessions per week for the first three weeks, and then 3 sessions per week following this. Three, six and ten week assessment with participant self-report measure: Montgomery- Åsberg Depression Rating Scale (MADRS-S). Results: MADRS-S remission rates were between 29% - 30% at three weeks, 33% - 34% at six-weeks and 50% at 10-weeks treatment. There was a significant improvement in MADRS-S with large effect sizes at all time points. Conclusions: Flow tDCS can be delivered through a primary healthcare general practice service and patients will choose to use. Flow tDCS provides an effective depression treatment in addition and as an alternative to antidepressants and psychotherapy. tDCS has evidence as an effective depression treatment, and the widespread availability of tDCS in primary care general practice should be considered.

关键词： Depression Transcranial Direct Current Stimulation Wellbeing General Practice

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Native and transplant kidney histopathological manifestations in association with COVID-19 infection: A systematic review

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World Journal of Transplantation 2021年第11期11卷 480-502页

作者： Vishnu Jeyalan Joshua Storrar Henry H L Wu Arvind Ponnusamy Smeeta Sinha Philip A Kalra Rajkumar Chinnadurai Department of Renal Medicine Royal Preston HospitalPreston PR29HTUnited Kingdom Department of Renal Medicine Salford Care OrganisationNorthern Care Alliance NHS Foundation TrustSalford M68HDUnited Kingdom Faculty of Biology Medicine and HealthUniversity of ManchesterManchester M139PLUnited Kingdom

BACKGROUND Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)can result in clinically significant multi-system disease including involvement in the *** underlying histopathological processes were unknown at the start of the *** case reports and series have been published describing the underlying renal histopathology from kidney biopsies,we have started to gain an insight into the renal manifestations of this novel *** To provide an overview of the current literature on the renal histopathological features and mechanistic insights described in association with coronavirus disease 2019(COVID-19)*** A systematic review was performed by conducting a literature search in the following websites-‘PubMed’,‘Web of Science’,‘Embase’and‘Medline-ProQuest’with the following search terms-“COVID-19 AND kidney biopsy”,“COVID-19 AND renal biopsy”,“SARS-CoV-2 AND kidney biopsy”and“SARS-CoV-2 AND renal biopsy”.We have included published data up until February 15,2021,which includes kidney biopsies(native,transplant and postmortem)from patients with *** on clinical presentation,histopathological features,management and outcome was extracted from the reported *** The total number of biopsies reported on here is 288,of which 189 are postmortem,84 native and 15 *** results are varied and show underlying pathologies ranging from collapsing glomerulopathy and acute tubular injury(ATI)to anti-nuclear cytoplasmic antibody associated vasculitis and pigment *** was variation in the specific treatment used for the various renal conditions,which included steroids,hydroxychloroquine,eculizumab,convalescent plasma,rituximab,anakinra,cyclophosphamide and renal replacement therapy,amongst *** pathological process which occurs in the kidney following COVID-19 infection and leads to the described biopsy findings has been hypothesized in some conditions but not others(for example,sepsis related hypoperf

关键词： COVID-19 Histopathology Kidney biopsy Transplant SARS-CoV-2

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COVID-19 and hepatorenal syndrome

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World Journal of Gastroenterology 2022年第39期28卷 5666-5678页

作者： Henry H L Wu Varinder S Athwal Philip A Kalra Rajkumar Chinnadurai Kolling Institute of Medical Research Royal North Shore HospitalSydney 2065New South WalesAustralia Faculty of Biology Medicine&Health(Division of DiabetesMetabolism&Gastroenterology)The University of ManchesterManchester M139PLUnited Kingdom Department of Renal Medicine Northern Care Alliance NHS Foundation TrustSalford M68HDUnited Kingdom

Coronavirus disease 2019(COVID-19)is a highly infectious disease which emerged into a global *** it primarily causes respiratory symptoms for affected patients,COVID-19 was shown to have multi-organ *** liver enzymes appear to be commonly observed during the course of COVID-19,and there have been numerous reports of liver injury secondary to COVID-19 *** has been established that patients with pre-existing chronic liver disease(CLD)are more likely to have poorer outcomes following COVID-19 infection compared to those without ***-morbidities such as diabetes,hypertension,obesity,cardiovascular and chronic kidney disease frequently co-exist in individuals living with CLD,and a substantial population may also live with some degree of *** mechanisms of how COVID-19 induces liver injury have been *** syndrome(HRS)is the occurrence of kidney dysfunction in patients with severe CLD/fulminant liver failure in the absence of another identifiable cause,and is usually a marker of severe decompensated liver *** reports of HRS following acute COVID-19 infection have been presented,although the risk factors and pathophysiological mechanisms leading to HRS in COVID-19 infection or following COVID-19 treatment remain largely unestablished due to the relative lack and novelty of published *** discussing the management of HRS in highdependency care and intensive care contexts is only *** this article,we provide an overview on the speculative pathophysiological me-chanisms of COVID-19 induced HRS and propose strategies for clinical diagnosis and management to optimize outcomes in this scenario.

关键词： COVID-19 Hepatorenal syndrome Pathophysiology Clinical assessment Management Prognosis

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Using statistics and mathematical modelling to understand infectious disease outbreaks:COVID-19 as an example

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Infectious Disease Modelling 2020年第1期5卷 409-441页

作者： Christopher E.Overton Helena B.Stage Shazaad Ahmad Jacob Curran-Sebastian Paul Dark Rajenki Das Elizabeth Fearon Timothy Felton Martyn Fyles Nick Gent Ian Hall Thomas House Hugo Lewkowicz Xiaoxi Pang Lorenzo Pellis Robert Sawko Andrew Ustianowski Bindu Vekaria Luke Webb Department of Mathematics University of ManchesterUK IBM Research Hartree CentreSciTech DaresburyUK Department of Global Health and Development London School of Hygiene and Tropical MedicineUK Emergency Response Department Public Health EnglandUK Division of Infection Immunity and Respiratory MedicineNIHR Biomedical Research CentreUniversity of ManchesterUK Department of Virology Manchester Medical Microbiology PartnershipManchester Foundation TrustUK Regional Infectious Diseases Unit North Manchester General HospitalUK School of Medical Sciences University of ManchesterUK Intensive care Unit Wythenshawe HospitalManchester University NHS Foundation TrustUK Department of Health Sciences University of ManchesterUK Department of Mathematical Sciences University of LiverpoolUK The Alan Turing Institute UK Manchester Academic Health Sciences Centre UK Critical care Unit Salford Royal HospitalNorthern Care Alliance NHS GroupUK

During an infectious disease outbreak,biases in the data and complexities of the underlying dynamics pose significant challenges in mathematically modelling the outbreak and designing *** by the ongoing response to COVID-19,we provide a toolkit of statistical and mathematical models beyond the simple SIR-type differential equation models for analysing the early stages of an outbreak and assessing *** particular,we focus on parameter estimation in the presence of known biases in the data,and the effect of non-pharmaceutical interventions in enclosed subpopulations,such as households and care *** illustrate these methods by applying them to the COVID-19 pandemic.

关键词： COVID-19 Epidemic modelling Parameter estimation Outbreak Bias Intervention

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Antihypertensive prescribing patterns in non-dialysis dependent chronic kidney disease:Findings from the Salford Kidney Study

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World Journal of Nephrology 2023年第5期12卷 168-181页

作者： Rajkumar Chinnadurai Henry H L Wu Jones Abuomar Sharmilee Rengarajan David I New Darren Green Philip A Kalra Donal O’Donoghue Renal Research Centre&Department of Renal Medicine Northern Care Alliance NHS Foundation TrustSalford M68HDUnited Kingdom Department of Renal Research Kolling Institute of Medical ResearchRoyal North Shore Hospital&The University of SydneySt.Leonards(Sydney)2065New South WalesAustralia Faculty of Biology Medicine&HealthThe University of ManchesterManchester M17HRUnited Kingdom

BACKGROUND Hypertension is commonly observed in patients living with chronic kidney disease(CKD).Finding an optimal treatment regime remains challenging due to the complex bidirectional cause-and-effect relationship between hypertension and *** remains variability in antihypertensive treatment *** To analyze data from the Salford Kidney Study database in relation to antihypertensive prescribing patterns amongst CKD *** The Salford Kidney Study is an ongoing prospective study that has been recruiting CKD patients since *** patients are followed up annually,and their medical records including the list of medications are updated until they reach study endpoints[starting on renal replacement therapy or reaching estimated glomerular filtration rate(eGFR)expressed as mL/min/1.73 m2≤10 mL/min/1.73 m2,or the last follow-up date,or data lock on December 31,2021,or death].Data on antihypertensive prescription practices in correspondence to baseline eGFR,urine albumin-creatinine ratio,primary CKD aetiology,and cardiovascular disease were *** between patients who were prescribed three or more antihypertensive agents and their clinical outcomes were studied by Cox regression ***-Meier analysis demonstrated differences in survival *** Three thousand two hundred and thirty non-dialysis-dependent CKD patients with data collected between October 2002 and December 2019 were *** median age was 65 years.A greater proportion of patients were taking three or more antihypertensive agents with advancing CKD stages(53%of eGFR≤15 mL/min/1.73 m2 vs 26%of eGFR≥60 mL/min/1.73 m2,P<0.001).An increased number of patients receiving more classes of antihypertensive agents was observed as the urine albumin-creatinine ratio category increased(category A3:62%vs category A1:40%,P<0.001),with the upward trends particularly noticeable in the number of individuals prescribed renin angiotensin system *** pr

关键词： Hypertension Chronic kidney disease Antihypertensive agents Prescribing patterns Cardiovascular complications Renin angiotensin system blockers

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Teledermatology During the COVID-19 Pandemic in a Developing Country:Could This Be the Answer to Improving the Reach of Dermatology care?

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International Journal of Dermatology and Venereology 2023年第3期6卷 141-146页

作者： Shakirat Gold-Olufadi Damilola Jesuyajolu Olufolakemi Cole-Adeife Didi Emokpare Omololu Enigbokan Department of Medicine University College HospitalIbadanOyo state 200212Nigeria Salford Royal nhs Foundation Trust Northern Care Alliance NHS Foundation TrustManchester M68HDUnited Kingdom Lagos State University Teaching Hospital Lagos State 100271Nigeria Outpost Healthcare Saskatchewan S4P 0J3Canada

Introduction:The COVID-19 pandemic has changed the way telemedicine is utilized globally,with most countries reporting an increase in its *** first review of teledermatology in Nigeria reported poor service *** present report outlines an improvement in the adoption of telemedicine and factors that may account for this increased ***:We performed a retrospective review of all patients who registered through 2 telemedicine platforms to access dermatology services during a 1-year *** were collated with an online questionnaire and analyzed by t test and chi-square ***:Sixty patients booked appointments through the platform,with 38 and 22 patients booking virtual and physical consultations,*** response rate was 68.4%and 50.0%for those that booked virtual and physical consultations,respectively,with no significant age difference between the groups(P=0.42).More women booked appointments,and all respondents were educated to at least college *** majority learned about booking a dermatologist appointment through social *** was no difference in the clinical outcome between patients who booked a virtual or physical consultation(P=0.89).Conclusion:More patients are resorting to teledermatology services because of the convenience;however,most of these patients are situated in urban *** this study showed no significant differences in the clinical outcome between patients who booked virtual and physical consultations,the adoption of teledermatology may be the answer to increasing coverage of dermatology services in developing countries where specialists are *** must be made to increase the reach of teledermatology to rural areas.

关键词： teledermatology COVID-19 telehealth acne black skin

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Evaluation of a rehabilitation support service after acute stroke: Feasibility and patient/carer benefit

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Health 2013年第7期5卷 1124-1131页

作者： Joanna J. McAdam Michael J. Leathley Margaret S. Crichton Julie Dickens Cathy I. A. Jack Caroline L. Watkins Belfast Health and Social care Trust Belfast Northern Ireland Crossroads care (Liverpool Sefton and Warrington) Liverpool UK School of Health University of Central Lancashire Preston UK Therapies Directorate The Royal Liverpool and Broadgreen University Hospitals NHS Trust Liverpool UK

Background: Stroke survivors returning home after discharge from hospital and their carers require support to meet their rehabilitation needs (independence in Activities of Daily Living, exercise, psychosocial support). Voluntary or charitable care providers may be able to address some of these needs. Objective: To explore the feasibility of delivering and evaluating enhanced support to stroke survivors and their carers, with a Rehabilitation Support Worker (RSW). Methods: 16 consecutive stroke survivors and their carers were included. All participants received usual hospital care. Seven of these patients and their carers were also allocated an RSW from a charitable care provider. The RSW accompanied therapy training sessions with the patient, carer and therapist in hospital. On discharge, the RSW visited the patient and carer at home over the initial 6 week post-discharge period to support them in practising rehabilitation skills. Patient function (Barthel Index) and patient/carer confidence were independently assessed at discharge (Week 0). The above assessments and patient/carer mood (GHQ-12) and carer Giver Strain were also assessed at Weeks 1, 6 and 12. RSWs were interviewed for their views about the service. Results: Participants’ functional ability at Week 1 post-discharge was significantly higher in the RSW group. At 6 and 12 weeks post-discharge, functional ability was not significantly different between groups. carers in the intervention group were less confident at all time points, however, this was not significant. There was no significant effect on carer strain or well-being. Interviews with RSWs highlighted areas of their training that could be enhanced and the need for greater clarity as to their role. Conclusions: The results showed that a definitive trial of rehabilitation support is feasible. A number of obstacles however would need to be overcome including: difficulty in identifying suitable patients, clarity of the RSW role, and appropriate train

关键词： Stroke Rehabilitation Activities of Daily Living Instrumental Activities of Daily Living

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Alpha-Stim Cranial Electrotherapy Stimulation (CES) for Anxiety Treatment: Outcomes in a United Kingdom (UK) Primary care Practice

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Open Journal of Psychiatry 2021年第3期11卷 186-201页

作者： Chris Griffiths Chloe Leathlean David Smart Azhar Zafar Cara-Leigh Hall Sarah Deeks Innovation and Research Department Northamptonshire Healthcare NHS Foundation Trust (NHFT) Northampton UK General Practice alliance (GPA) Northampton UK

Background: Anxiety disorders are the most common mental disorders, typically treated with psychotherapy and medication. These treatments are not suitable for, acceptable to, or effective for everyone. Alpha-Stim AID is a Cranial Electrotherapy Stimulation (CES) treatment with evidence of effectiveness in treating anxiety disorders. Objective: The aim of this paper is to present outcomes on anxiety, depression, and quality of life of Alpha-Stim use in primary care patients in the United Kingdom’s (UK) National Health Service (nhs) who reported symptoms of anxiety. Methods: Open label patient cohort design. Self-report measures: PHQ-9 (depression), GAD-7 (anxiety) and EQ-5D-5L (health related quality of life). Twenty-three patients with symptoms of anxiety completed a six-week course of Alpha-Stim intervention. Results: Reliable improvement and remission rates respectively were 60.9% and 17.4% for the GAD-7;42.9% and 22.7% for the PHQ-9. Significant improvement and medium/large effect sizes (n2 = 0.59 and 0.56 respectively). EQ-5D-5L results showed significant improvements in quality of life. Perceived quality of life doubled with an improvement of 0.36 on the health index score, this intervention adds 3.64 Quality Adjusted Life Years (QALYs). Limitations: The study was not an RCT, there was no control group. Conclusions: Alpha-Stim AID CES can be delivered through a UK primary care practice, and can have a significant impact on symptoms of anxiety and depression, and improve quality of life in primary care patients with anxiety symptoms. Further feasibility studies in primary care and sufficiently powered RCT are required.

关键词： Alpha-Stim Primary care Cranial Electrotherapy Stimulation Service Delivery Anxiety Depression Quality of Life Social Prescription Co-Morbidity GAD

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Narrow Band Imaging Can Be Used for Anastomotic Assessment

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Surgical Science 2016年第2期7卷 126-135页

作者： Ahmed Z. Kaleem Nabish Naheed Syed M. Ahmad Department of Colorectal Surgery Northern Lincolnshire and Goole Hospital Scunthorpe UK nhs Foundation Trust Scunthorpe General Hospital Scunthorpe UK

Background: Anastomotic leak is the most dreaded complication and it accounts for one third of post-operative deaths in colorectal surgery. There is strong need of research in this field in order to reduce anastomotic leak rate. If there was a test available to signify probability of leak at the time of surgery, it would potentially avoid a leak at a later date. Aim: We propose that intra operative use of narrow band imaging colonoscopy in left sided colonic anastomosis can predict and detect anastomosis related problems, problems i.e. vascularity, anastomotic lumen patency and rigidness of anastomosis which in turn lead to correction at the time of surgery resulting in significant decrease in anastomotic leak rate associated with morbidity and mortality. Methodology: A pilot, single blind, prospective, randomised controlled trial. Aim is to divide patient in 2 groups, containing 15 patients in each group. One group will be assessed by intra-operative NBI colonoscopy and other with standard technique. Analysis: This will be performed using SPSS with the help of statistician. Significance: This area of research is particularly important because it improves survival by reducing morbidity and mortality associated with anastomotic leak. If a leak is avoided then it does not only mean early recovery but it also saves nhs in terms of ICU care, nhs bed, inpatient nursing care and home help, unfortunately all required if leak is to occur. As a result, this research will have better financial implication with significantly improve patient care.

关键词： Anastomotic Leak Colorectal Surgery Anastomotic Assessment

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Frailty and antineutrophil cytoplasmic antibody-associated vasculitis:What do we know?

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Rheumatology & Autoimmunity 2023年第4期3卷 250-252页

作者： Henry H.L.Wu Nina Brown Rajkumar Chinnadurai Renal Research Kolling Institute of Medical ResearchRoyal North Shore HospitalThe University of SydneySydneyAustralia Department of Renal Medicine Northern Care Alliance NHS Foundation TrustSalfordUK Faculty of Biology Medicine&HealthThe University of ManchesterManchesterUK

To the Editor,Anti-neutrophil cytoplasmic antibody(ANCA)-associated vasculitis(AAV)is an autoimmune condition that mainly affects small vessels of the *** is a condition that may have multisystem manifestations and has an increased prevalence among older individuals.1 AAV patients conventionally present with symptoms at 65 years of age or *** studies have demonstrated worse clinical outcomes in the aging *** older patients live with various comorbidities in addition to potentially relapsing *** with the pathophysiological impact of AAV can be burdensome,as this multifaceted condition may lead to impairment of physical function and contribute to significant mental and emotional *** impact of aging on the pathophysiology of AAV is not fully *** dysregulation induced by cell senescence is hypothesized to be a key factor,alongside a mixture of genetic and environmental factors2.

关键词： neutrophil clinical impairment

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