Clinical outcomes and operational impact of a medical photography based teledermatology service with over 8,000 patients in the UK

2021 ◽  
pp. 1-12
Author(s):  
Ioulios Palamaras ◽  
Helen Wark ◽  
Billy Short ◽  
Omair Akhtar Hameed ◽  
Adil Ahmed Sheraz ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Medical Photography ◽  
The Uk ◽  
Operational Impact

scholarly journals Growing up with perinatal HIV: changes in clinical outcomes before and after transfer to adult care in the UK

2017 ◽  
Vol 20 ◽  
pp. 21577 ◽  
Author(s):  
Ali Judd ◽  
Intira Jeannie Collins ◽  
Francesca Parrott ◽  
Teresa Hill ◽  
Sophie Jose ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Growing Up ◽  
Adult Care ◽  
Perinatal Hiv ◽  
Before And After ◽  
The Uk

scholarly journals Clinical outcomes and programming strategies of implantable cardioverter-defibrillator devices in paediatric hypertrophic cardiomyopathy: a UK National Cohort Study

EP Europace ◽  
2020 ◽  
Author(s):  
Gabrielle Norrish ◽  
Henry Chubb ◽  
Ella Field ◽  
Karen McLeod ◽  
Maria Ilina ◽  
...  
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Implantable Cardioverter Defibrillator ◽  
Incidence Rate ◽  
Clinical Outcomes ◽  
Cardioverter Defibrillator ◽  
National Cohort ◽  
Icd Shock ◽  
The Uk ◽  
Device Complications

Abstract Aims Sudden cardiac death (SCD) is the most common mode of death in paediatric hypertrophic cardiomyopathy (HCM). This study describes the implant and programming strategies with clinical outcomes following implantable cardioverter-defibrillator (ICD) insertion in a well-characterized national paediatric HCM cohort. Methods and results Data from 90 patients undergoing ICD insertion at a median age 13 (±3.5) for primary (n = 67, 74%) or secondary prevention (n = 23, 26%) were collected from a retrospective, longitudinal multi-centre cohort of children (<16 years) with HCM from the UK. Seventy-six (84%) had an endovascular system [14 (18%) dual coil], 3 (3%) epicardial, and 11 (12%) subcutaneous system. Defibrillation threshold (DFT) testing was performed at implant in 68 (76%). Inadequate DFT in four led to implant adjustment in three patients. Over a median follow-up of 54 months (interquartile range 28–111), 25 (28%) patients had 53 appropriate therapies [ICD shock n = 45, anti-tachycardia pacing (ATP) n = 8], incidence rate 4.7 per 100 patient years (95% CI 2.9–7.6). Eight inappropriate therapies occurred in 7 (8%) patients (ICD shock n = 4, ATP n = 4), incidence rate 1.1/100 patient years (95% CI 0.4–2.5). Three patients (3%) died following arrhythmic events, despite a functioning device. Other device complications were seen in 28 patients (31%), including lead-related complications (n = 15) and infection (n = 10). No clinical, device, or programming characteristics predicted time to inappropriate therapy or lead complication. Conclusion In a large national cohort of paediatric HCM patients with an ICD, device and programming strategies varied widely. No particular strategy was associated with inappropriate therapies, missed/delayed therapies, or lead complications.

scholarly journals Generic clozapine: outcomes after switching formulations

2006 ◽  
Vol 189 (2) ◽  
pp. 184-185 ◽  
Author(s):  
Carol Paton
Keyword(s):  
Mental Health ◽  
Mental Health Service ◽  
Health Service ◽  
Clinical Outcomes ◽  
Clinical Global Impression ◽  
Severity Of Illness ◽  
Clinical Deterioration ◽  
Change Scores ◽  
Before And After ◽  
The Uk

SummaryTwo generic preparations of clozapine have been licensed in the UK. The bioequivalence of these products compared with Clozaril® has not been unequivocally demonstrated. Clinical equivalence has also been questioned. The objective of this study was to determine clinical outcomes for all patients switched from Clozaril® to a generic formulation in one mental health service. We examined dosage data and Clinical Global Impression (CGI) of Severity of Illness scores for 337 patients before and after the switch and CGI change scores after the switch. There was no evidence of clinical deterioration or need to use higher dosages. Generic clozapine is not inferior to Clozaril®.

scholarly journals Systematic Review of Prognostic Models Compared to the Mayo Risk Score for Primary Sclerosing Cholangitis

2021 ◽  
Vol 10 (19) ◽  
pp. 4476
Author(s):  
Paul A. Schmeltzer ◽  
Mark W. Russo
Keyword(s):  
Systematic Review ◽  
Liver Disease ◽  
Clinical Outcomes ◽  
Primary Sclerosing Cholangitis ◽  
Sclerosing Cholangitis ◽  
Prognostic Models ◽  
Free Survival ◽  
Clinical Endpoints ◽  
Non Invasive ◽  
The Uk

Background: Primary sclerosing cholangitis (PSC) is a cholestatic liver disease with a variable clinical course that can ultimately lead to end-stage liver disease, cholangiocarcinoma, and the need for liver transplantation. Several prognostic models have been developed to predict clinical outcomes and have been compared to the revised Mayo Risk Score (rMRS). Aim: To conduct a systematic review comparing the rMRS to other non-invasive prognostic tests for PSC. Methods: A systematic review of studies from 2000 to 2020 was performed that compared non-invasive biochemical prognostic models to the rMRS in predicting outcomes in patients with PSC. Results: Thirty-seven studies were identified, of which five studies that collectively included 3230 patients were reviewed. Outcomes included transplant-free survival or composite clinical outcomes. The rMRS was better than the Amsterdam–Oxford model for predicting 1-year transplant-free survival, c-statistics 0.75 and 0.70, respectively. The UK-PSC score outperformed the rMRS for 10-year transplant-free survival, c-statistics 0.85 and 0.69, respectively. An enhanced liver fibrosis score was independently associated with transplant-free survival after adjusting for rMRS. PREsTo predicts 5-year hepatic decompensation with a c-statistic modestly higher than rMRS; 0.90 and 0.85, respectively. Conclusion: Newer prognostic models, including the UK-PSC score and PREsTo, are more accurate at predicting clinical endpoints in PSC compared to the rMRS. Time frames and clinical endpoints are not standard among studies.

scholarly journals Vascular Access Support Team: A Multi-Disciplinary Response to Optimise Patients’ Care during COVID-19 Pandemic

2020 ◽  
Author(s):  
Manish Sinha ◽  
Prakash Saha ◽  
Melhem Nabil ◽  
Nicos Kessaris ◽  
Lukla Biasi ◽  
...  
Keyword(s):  
Critical Care ◽  
Clinical Outcomes ◽  
Vascular Access ◽  
Online Survey ◽  
High Rate ◽  
Minor Bleeding ◽  
Complication Rates ◽  
Support Team ◽  
The Uk ◽  
The Impact

Abstract Background: Vascular access support teams have been set up to help offload procedural tasks from critical care teams during the coronavirus disease 2019 (COVID-19) global pandemic. However, the impact of VAST on clinical outcomes and on workload has not been shown previously with no reports to date from the UK. Our aim was to evaluate clinical outcomes of a multidisciplinary vascular access support team (VAST) and the value of the service to critical care teams. Methods: Prospectively collected data on all patients requiring vascular access at St Thomas’ Hospital, London over a 5-week period during the first wave of the pandemic in the UK. At the end of study period, online anonymised questionnaire administered to critical care team members, including nursing and medical professionals, to evaluate their experience of the service. We report access-related complication until discharge from centre and description of results of online survey.Results: 122 patients aged 52.1 ± 13 years with high rate of pre-existing co-morbidities, underwent line insertion including 190 catheters (central venous n=182, arterial n=8). Median (range) number of 5 (0-17) lines were placed per day in patients of whom 90% tested positive for Severe Acute Respiratory Syndrome Coronavirus-type 2 pathogen (SARS-CoV-2). A single line (n=146) was inserted in 96 out of 122 patients (78.7%) and n=18 patients (14.7%) ‘double puncture’ technique used. 45 line insertions (24%) had complications with minor [bleeding (n=19), line infection (n=10)] and 2 lines (1%) with major complication. The survey respondents, n=54 professionals, highlighted ease of referral and timely access placement (>90% responses); with agreement that VAST service saved them precious time and allow them to focus on other jobs.Conclusions: We describe the successful deployment of a multidisciplinary vascular access team with low complication rates and high rates of satisfaction. We recommend similar models can be considered by health services to optimise patient care and ICU management.

scholarly journals Genetically downregulated interleukin-6 signaling is associated with a favorable cardiometabolic profile: a phenome-wide association study

2020 ◽  
Author(s):  
Marios K. Georgakis ◽  
Rainer Malik ◽  
Xue Li ◽  
Dipender Gill ◽  
Michael G. Levin ◽  
...  
Keyword(s):  
Association Study ◽  
Clinical Outcomes ◽  
Interleukin 6 ◽  
Lower Risk ◽  
Bacterial Infections ◽  
Interleukin 4 ◽  
Uk Biobank ◽  
The Uk ◽  
Tract Infections ◽  
Cardiometabolic Profile

AbstractBackgroundInterleukin-6 (IL6) signaling is a key inflammatory pathway widely implicated in the pathogenesis of multiple diseases including autoimmune, vascular, and metabolic disorders. While IL6-receptor (IL6R) inhibitors are already in use for the treatment of autoimmune diseases, their repurposing potential and safety profile is still debated.MethodsWe used 7 genetic variants at the IL6R locus as proxies for IL6 signaling downregulation and explored their effects on 1,428 clinical outcomes in a phenome-wide association study (PheWAS) using data from the UK Biobank (339,256 unrelated individuals). Significant associations were meta-analyzed with data from the Penn Medicine (10,244 individuals) and BioMe (9,054 individuals) Biobanks for validation. We further investigated associations between genetically downregulated IL6 signaling and 366 biomarkers and endophenotypes of human disease in the UK Biobank and other phenotype-specific consortia. All associations were examined by Mendelian randomization (MR) analyses scaled to the effects of tocilizumab, a monoclonal antibody targeting IL6R.ResultsThe PheWAS-MR analyses showed significant associations with 16 clinical outcomes and 17 biomarkers following correction for multiple comparisons. Genetically downregulated IL6 signaling was associated with a lower risk of several atherosclerotic phenotypes including ischemic heart disease (OR: 0.84, 95%CI: 0.77-0.90) and abdominal aortic aneurysm (OR: 0.44, 95%CI: 0.29-0.67). We further found significant associations with lower risk of type 2 diabetes (OR: 0.80, 95%CI: 0.73-0.88), lower glycated hemoglobin A1c (HbA1c) levels (beta: −0.07, 95%CI: −0.08 to −0.05), and higher HDL-cholesterol levels (beta: 0.04, 95%CI: 0.02-0.06). In accord with clinical trials examining pharmacological IL6 blockade, genetically downregulated IL6 signaling was associated with higher risk of neutropenia and bacterial infections (cellulitis and urinary tract infections) and with higher hemoglobin concentrations. We further found significant associations with higher risk of atopic dermatitis and higher levels of the pro-allergic cytokine interleukin-4.ConclusionsGenetic IL6 signaling downregulation associates with a lower risk of vascular outcomes and a more favorable cardiometabolic profile. These findings further support a repurposing of IL6R blockade for lowering cardiovascular risk while also informing on potential side effects.

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