Infectious diseases and tropical medicine

Mapping Intimacies ◽

10.1093/med/9780198729426.003.0013 ◽

2016 ◽

Keyword(s):

Clinical Trials ◽

Clinical Practice ◽

Statistical Analysis ◽

Infectious Diseases ◽

Clinical Evidence ◽

Critical Evaluation ◽

Duration Of Treatment ◽

The Uk ◽

Clinical Problems ◽

Key Questions

Some of the earliest clinical trials were conducted in infectious diseases. In the 1940s, the development of the first antibiotics for treating tuberculosis coincided with the recognition that rigorous clinical trials were required to determine optimum drug combinations and duration of treatment. The joint efforts of bacteriologists, clinicians, and statisticians promoted the development of clinical trials, acknowledging that clinically valid endpoints and careful statistical analysis are vital for trials to provide evidence of sufficient quality to guide clinical practice. This chapter covers key questions in this field addressed by good-quality trials. It covers clinical evidence important to practitioners both overseas and in the UK. It focuses on trials that have generated key data, while also covering trials which address clinical problems that are important worldwide and less commonly seen in the UK where critical evaluation of current trials might be difficult.

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Separating myths from reality for vaccines causing adverse events following immunization: an interview with Manish Sadarangani

Future Microbiology ◽

10.2217/fmb-2019-0187 ◽

2019 ◽

Vol 14 (11) ◽

pp. 925-926

Author(s):

Manish Sadarangani

Keyword(s):

Clinical Trials ◽

Adverse Events ◽

Infectious Diseases ◽

Meningococcal Disease ◽

Assistant Professor ◽

Vaccine Candidates ◽

Vaccine Preventable Diseases ◽

Group B ◽

The Uk ◽

Hospital Research

Dr Manish Sadarangani is Director of the Vaccine Evaluation Center at the BC Children's Hospital Research Institute and an Assistant Professor in the Division of Infectious Diseases, UBC Department of Pediatrics. He completed his undergraduate medical and pediatric training in Cambridge, Oxford and London in the UK. He then completed his DPhil with the Oxford Vaccine Group in the UK, developing novel vaccine candidates for protection against capsular group B meningococcal disease, and completed a fellowship in pediatric infectious diseases in Vancouver in 2013 before returning to Oxford to work as a pediatric infectious diseases physician. His research links clinical trials with basic microbiology, immunology and epidemiology to address clinically relevant problems related to immunization and vaccine-preventable diseases.

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Nutritional Care in Relation to COVID-19

British Journal of Nursing ◽

10.12968/bjon.2020.29.19.1096 ◽

2020 ◽

Vol 29 (19) ◽

pp. 1096-1103

Author(s):

Emer Delaney

Keyword(s):

Weight Loss ◽

Clinical Practice ◽

Enteral Feeding ◽

Clinical Evidence ◽

Icu Patients ◽

Initial Wave ◽

Target Volumes ◽

The Uk ◽

Second Wave ◽

Ventilated Patients

The following article was written after the initial wave of the COVID-19 pandemic in the UK. On reflection of clinical practice during this time, it was noted by the ICU team that the majority of ventilated patients appeared to have lost weight during their stay. Unfortunately, there was no ability to weigh patients during the pandemic, so this weight loss was a subjective observation. Regardless, this observation lead the ICU dietitian to retrospectively audit prescribed versus delivered feed. It was found that only 10% of admissions received the prescribed daily volume of feed within the first 7 days of admission. A further 6% of admissions were within 10% of achieving daily prescribed target volumes. The main reasons for this were proning patients, high gastric residual volumes and the overwhelming nature of the pandemic. Three areas of practice have been highlighted that will improve feed delivery should a second wave occur. 1. A nasojejunal team comprising 20 members of the ICU multidiciplinary team will be established to insert bedside nasojejunal tubes in all ICU patients on admission. 2. All proned patients will be enterally fed and practice adjusted as per British Dietetic Association recommendations. 3. The international enteral feeding guidelines regarding hypocaloric feeding for the first 7 days will not be followed due to minimal clinical evidence for the ICU COVID-19 demographic.

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Efficient use of sentinel sites: detection of invasive honeybee pests and diseases in the UK

Journal of The Royal Society Interface ◽

10.1098/rsif.2016.0908 ◽

2017 ◽

Vol 14 (129) ◽

pp. 20160908 ◽

Cited By ~ 4

Author(s):

Matt J. Keeling ◽

Samik Datta ◽

Daniel N. Franklin ◽

Ivor Flatman ◽

Andy Wattam ◽

...

Keyword(s):

Infectious Diseases ◽

Mathematical Modelling ◽

Spatial Model ◽

Rapid Detection ◽

Disease Outbreaks ◽

Costs And Benefits ◽

Pests And Diseases ◽

Computationally Intensive ◽

The Uk ◽

Key Questions

Sentinel sites, where problems can be identified early or investigated in detail, form an important part of planning for exotic disease outbreaks in humans, livestock and plants. Key questions are: how many sentinels are required, where should they be positioned and how effective are they at rapidly identifying new invasions? The sentinel apiary system for invasive honeybee pests and diseases illustrates the costs and benefits of such approaches. Here, we address these issues with two mathematical modelling approaches. The first approach is generic and uses probabilistic arguments to calculate the average number of affected sites when an outbreak is first detected, providing rapid and general insights that we have applied to a range of infectious diseases. The second approach uses a computationally intensive, stochastic, spatial model to simulate multiple outbreaks and to determine appropriate sentinel locations for UK apiaries. Both models quantify the anticipated increase in success of sentinel sites as their number increases and as non-sentinel sites become worse at detection; however, unexpectedly sentinels perform relatively better for faster growing outbreaks. Additionally, the spatial model allows us to quantify the substantial role that carefully positioned sentinels can play in the rapid detection of exotic invasions.

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Franco-British Disparities in Medicine

Journal of the Royal Society of Medicine ◽

10.1177/014107688107400810 ◽

1981 ◽

Vol 74 (8) ◽

pp. 605-609 ◽

Cited By ~ 1

Author(s):

Colin Reisner ◽

James Andrews

Keyword(s):

Clinical Practice ◽

Geriatric Medicine ◽

Present Position ◽

French And English ◽

Basic Solutions ◽

The Uk ◽

Clinical Problems

A questionnaire in French and English was sent to physicians practising geriatric medicine in France and the UK concerning certain aspects of their clinical practice. It also enquired of the doctors their place of practice, year of qualification, present position held, and in which part of the respective country they worked. Most of the answers reflect major divergencies in methods of clinical practice between the two countries. These answers are reported, highlighted, commented on, and speculation made of the possible reasons for the differences. We feel that international questionnaires are a useful way of alerting doctors to areas of practice which are falsely assumed to be correct; they may also reveal the possible basic solutions to common clinical problems.

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Depression in Primary Care: Review of AHCPR Guidelines

Annals of Pharmacotherapy ◽

10.1177/106002809703100620 ◽

1997 ◽

Vol 31 (6) ◽

pp. 782-785 ◽

Cited By ~ 8

Author(s):

Lawrence J Cohen ◽

Sally K Guthrie

Keyword(s):

Clinical Trials ◽

Clinical Practice ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Health Care Policy ◽

Critical Evaluation ◽

Periodic Review ◽

Independent Panel ◽

Treatment Of Depression ◽

Data Source

OBJECTIVE: To present an overview and evaluation of the Agency for Health Care Policy and Research (AHCPR) clinical practice guidelines for the treatment of depression. INTRODUCTION: One responsibility of the AHCPR is the development and periodic review and update of clinical practice guidelines. This process is undertaken by an independent panel composed of groups of clinicians and other experts from the private sector. Their findings are published in a four-volume, softcover set of booklets. DATA SOURCE AND EVALUATION: Volume 2 in the four-volume set includes a comprehensive compilation, synthesis, and critical evaluation of the studies of different treatments for depression. Studies included for evaluation were randomized, prospective clinical trials that were pertinent to all topics concerning the treatment of depression. In some areas, the opinions of the panel were included due to a paucity of data from well-controlled clinical trials. Each AHCPR guideline was followed by a code that indicated whether the strength of evidence supporting that guideline was based on good or fair research-based evidence, or whether it was based primarily on panel members' opinions. CONCLUSIONS: With regard to drug treatment, the guidelines are good. However, since these guidelines were published in 1993 they might be considered somewhat dated because more antidepressants have become available in the interim. Overall, the AHCPR guidelines reflect an extensive review of the literature provided by the panel, as well as input from a highly respected group of reviewers. The panel included physicians, a nurse, a social worker, a psychologist, and a consumer representative. Unfortunately, a pharmacist was not included on the panel. Input from pharmacy practitioners would have been valuable.

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Synthesis of qualitative research studies regarding the factors surrounding UK critical care trial infrastructure

BMJ Open ◽

10.1136/bmjopen-2019-030815 ◽

2019 ◽

Vol 9 (12) ◽

pp. e030815 ◽

Cited By ~ 1

Author(s):

Natalie Pattison ◽

Nishkantha Arulkumaran ◽

Geraldine O'Gara ◽

Bronwen Connolly ◽

Sally Humphreys ◽

...

Keyword(s):

Clinical Trials ◽

Critical Care ◽

Intensive Care ◽

Clinical Practice ◽

Patient Care ◽

Human Study ◽

Qualitative Synthesis ◽

Research Activity ◽

Patient Consent ◽

The Uk

Conducting clinical trials in critical care is integral to improving patient care. Unique practical and ethical considerations exist in this patient population that make patient recruitment challenging, including narrow recruitment timeframes and obtaining patient consent often in time-critical situations. Units currently vary significantly in their ability to recruit according to infrastructure and level of research activity.AimTo identify variability in the research infrastructure of UK intensive care units and their ability to conduct research and recruit patients into clinical trials.DesignWe evaluated factors related to intensive care patient enrolment into clinical trials in the UK. This consisted of a qualitative synthesis carried out with two datasets of in-depth interviews (distinct participants across the two datasets) conducted with 27 intensive care consultants (n=9), research nurses (n=17) and trial coordinators (n=1) from 27 units across the UK. Primary and secondary analyses of two datasets (one dataset had been analysed previously) were undertaken in the thematic analysis.FindingsThe synthesis yielded an overarching core theme of normalising research, characterised by motivations for promoting research and fostering research-active cultures within resource constraints, with six themes under this to explain the factors influencing critical care research capacity: organisational, human, study, practical resources, clinician and patient/family factors. There was a strong sense of integrating research in routine clinical practice, and recommendations are outlined.ConclusionsThe central and transferable tenet of normalising research advocates the importance of developing a culture where research is inclusive alongside clinical practice in routine patient care and is a requisite for all healthcare individuals from organisational to direct patient contact level.

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Clinical evidence for Japanese population based on prospective studies—Linking clinical trials and clinical practice

Journal of Cardiology ◽

10.1016/j.jjcc.2009.05.001 ◽

2009 ◽

Vol 54 (2) ◽

pp. 171-182 ◽

Cited By ~ 3

Author(s):

Hisao Ogawa ◽

Sunao Kojima

Keyword(s):

Clinical Trials ◽

Clinical Practice ◽

Prospective Studies ◽

Japanese Population ◽

Clinical Evidence ◽

Population Based

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The Effect of Qigong Exercise on Immunity and Infections: A Systematic Review of Controlled Trials

The American Journal of Chinese Medicine ◽

10.1142/s0192415x1250084x ◽

2012 ◽

Vol 40 (06) ◽

pp. 1143-1156 ◽

Cited By ~ 16

Author(s):

Chong-Wen Wang ◽

Siu-Man Ng ◽

Rainbow T.H. Ho ◽

Eric T.C. Ziea ◽

Vivian C.W. Wong ◽

...

Keyword(s):

Clinical Trials ◽

Infectious Diseases ◽

Clinical Evidence ◽

Clinical Symptoms ◽

Controlled Trials ◽

Controlled Clinical Trials ◽

Randomized Controlled ◽

Induced Immunity ◽

Quality Of Research

The objective of this review was to summarize and critically evaluate the clinical evidence of the effect of qigong exercise on immunity and its efficacy in the prevention or treatment of infectious diseases. Thirteen databases were searched from their respective inceptions through January 2011, and all controlled clinical trials of qigong exercise on immunity and infections were included. Quality and validity of the included studies were evaluated using standard scales. Seven studies including two randomized controlled trials (RCTs), two controlled clinical trials (CCTs) and three retrospective observational studies (ROSs) met the inclusion criteria. One study focused on functional measures of immunity (antigen-induced immunity) and six studies on enumerative parameters of immunity. No study on clinical symptoms relevant to infectious diseases could be identified. Overall, the included studies suggested favorable effects of qigong exercise on immunity, but the quality of research for most of the studies examined in this review was poor. Further rigorously designed studies are required, which should adhere to accepted standards of methodology for clinical trials.

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Clinical Practice Guideline for Tripterygium Glycosides/Tripterygium wilfordii Tablets in the Treatment of Rheumatoid Arthritis

Frontiers in Pharmacology ◽

10.3389/fphar.2020.608703 ◽

2021 ◽

Vol 11 ◽

Author(s):

Na Lin ◽

Yan-Qiong Zhang ◽

Quan Jiang ◽

Wei Liu ◽

Jian Liu ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Clinical Practice ◽

Clinical Application ◽

Clinical Practice Guideline ◽

Practice Guideline ◽

Clinical Evidence ◽

Evidence Based ◽

Tripterygium Wilfordii ◽

Two Agents ◽

Clinical Problems

Tripterygiumwilfordii Hook F (TwHF) is one of the most commonly used and effective traditional Chinese herbal medicines against rheumatoid arthritis (RA). Both Tripterygium Glycoside Tablets (TGT) and Tripterygium wilfordii Tablets (TWT) are the representative TwHF-based agents enrolled into the 2019 edition of Medicine Catalog for National Basic Medical Insurance, Injury Insurance, and Maternity Insurance. However, individual differences in TGT/TWT response across patients usually exist in the process of treating RA, implying that the clinical application of the two agents may not be standardized leading to the ineffective treatment and the risk of side effects. Growing evidence show that the bioactive constituents of TwHF may often have toxicity, the package insert of TGT and TWT may not be described in detail, and the therapeutic windows of the two agents are narrow. Thus, it is an urgent task to develop a standardized clinical practice guideline for TGT and TWT in the treatment of RA. In the current study, a group of clinical experts of traditional Chinese medicine and Western medicine in the research field of rheumatism diseases, pharmacists, and methodologists of evidence-based medicine were invited to select the clinical questions, to determine the levels of the evidence and the strength of the recommendations, and to develop the recommendations and good practice points. The guideline is formed based on the combination of clinical research evidence and expert experience (evidence-based, consensus, supplemented by experience). The clinical problems which are supported by clinical evidence may form recommendations, and the clinical problems without clinical evidence may form experts’ suggestions. Both recommendations and experts' suggestions in this guideline summarized the clinical indications, usage, dosage, combined medication, and safety of TGT and TWT against RA systematically and comprehensively, which may offer a professional guidance in the context of the clinical application of the two TwHF-based agents.

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