Factors impacting time to ileostomy closure after anterior resection: the UK closure of ileostomy timing cohort study (CLOSE‐IT)

2021 ◽  
Author(s):  
◽  
Adam Chambers ◽  
Adam Stearns ◽  
Adam Walsh ◽  
Adeline Rankin ◽  
...  
Keyword(s):  
Cohort Study ◽  
Anterior Resection ◽  
Ileostomy Closure ◽  
Closure Of Ileostomy ◽  
The Uk

Improving the time to ileostomy closure following an anterior resection for rectal cancer in the UK

2021 ◽  
Author(s):  
I. Vogel ◽  
P.G. Vaughan‐Shaw ◽  
K. Gash ◽  
K.L. Withers ◽  
G. Carolan‐Rees ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Anterior Resection ◽  
Ileostomy Closure ◽  
The Uk

scholarly journals Protocol for a multicentre, dual prospective and retrospective cohort study investigating timing of ileostomy closure after anterior resection for rectal cancer: The CLOSurE of Ileostomy Timing (CLOSE-IT) study

BMJ Open ◽  
2018 ◽  
Vol 8 (10) ◽  
pp. e023305
Author(s):  
Peter G Vaughan-Shaw ◽  
Katherine Gash ◽  
Katie Adams ◽  
Abigail E Vallance ◽  
Sophie A Pilkington ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Anterior Resection ◽  
Linear Regression Analysis ◽  
Ileostomy Closure ◽  
Rectal Cancer Surgery ◽  
Multivariate Linear Regression Analysis ◽  
Low Anterior Resection Syndrome ◽  
Treatment Pathways ◽  
Study Results ◽  
Closure Of Ileostomy

IntroductionA defunctioning ileostomy is often formed during rectal cancer surgery to reduce the potentially fatal sequelae of anastomotic leak. Once the ileostomy is closed and bowel continuity restored, many patients can suffer poor bowel function, that is, low anterior resection syndrome (LARS). It has been suggested that delay to closure can increase incidence of LARS which is known to significantly reduce quality of life. Despite this, within the UK, time to closure of ileostomy is not subject to national targets within the National Health Service and delay to closure exceeds 18 months in one-third of patients. Clinical factors, surgeon and patient preference or service pressures may all impact time to closure, yet to date no study has investigated this. The aim of this UK-wide study is to assess time to ileostomy closure and identify reasons for delays.Methods and analysisA UK-wide multicentre prospective snapshot study, together with retrospective analysis of ileostomy closure through The Dukes’ Club Research Collaborative including patients undergoing ileostomy closure in a 3-month period (April to June 2018) and all patients who underwent anterior resection and ileostomy formation over a historical 12-month period (2015). Time to closure and incidence of ‘non-closure’ will be calculated. Units will be surveyed to determine local clinical and management protocols and barriers to timely closure. Multivariate linear regression analysis will be used to determine factors significantly associated with delay to ileostomy closure.Ethics and disseminationStudy approved by the South West-Exeter Research Ethics Committee and the Health Research Authority. Study results will be submitted for presentation at international conferences and for publication in peer-reviewed journals. Results will be presented to and discussed with the patient and public representatives and relevant national bodies to facilitate the development of consensus guidelines on optimum treatment pathways.

scholarly journals Retrospective cohort study of 925 OAGB procedures. The UK MGB/OAGB collaborative group

2019 ◽  
Vol 69 ◽  
pp. 13-18 ◽  
Author(s):  
A. Hussain ◽  
M. Van den Bossche ◽  
D.D. Kerrigan ◽  
A. Alhamdani ◽  
C. Parmar ◽  
...  
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Collaborative Group ◽  
The Uk

scholarly journals Review of orthopaedic trauma surgery during the peak of COVID-19 pandemic – An observational cohort study in the UK

2021 ◽  
Author(s):  
Chiranjit De ◽  
Nimrath Kainth ◽  
Pratap Karavadra Harbham ◽  
Margaret Brooks ◽  
Sujit Agarwal
Keyword(s):  
Cohort Study ◽  
Trauma Surgery ◽  
Observational Cohort Study ◽  
Orthopaedic Trauma ◽  
Observational Cohort ◽  
The Uk

scholarly journals Clinical laboratory tests and five-year incidence of major depressive disorder: a prospective cohort study of 433,890 participants from the UK Biobank

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Michael Wainberg ◽  
Stefan Kloiber ◽  
Breno Diniz ◽  
Roger S. McIntyre ◽  
Daniel Felsky ◽  
...  
Keyword(s):  
Public Health ◽  
Major Depressive Disorder ◽  
Cohort Study ◽  
Confidence Interval ◽  
Depressive Disorder ◽  
Blood Cell ◽  
Biological Processes ◽  
Uk Biobank ◽  
Major Depressive ◽  
The Uk

AbstractPrevention of major depressive disorder (MDD) is a public health priority. Identifying biomarkers of underlying biological processes that contribute to MDD onset may help address this public health need. This prospective cohort study encompassed 383,131 white British participants from the UK Biobank with no prior history of MDD, with replication in 50,759 participants of other ancestries. Leveraging linked inpatient and primary care records, we computed adjusted odds ratios for 5-year MDD incidence among individuals with values below or above the 95% confidence interval (<2.5th or >97.5th percentile) on each of 57 laboratory measures. Sensitivity analyses were performed across multiple percentile thresholds and in comparison to established reference ranges. We found that indicators of liver dysfunction were associated with increased 5-year MDD incidence (even after correction for alcohol use and body mass index): elevated alanine aminotransferase (AOR = 1.35, 95% confidence interval [1.16, 1.58]), aspartate aminotransferase (AOR = 1.39 [1.19, 1.62]), and gamma glutamyltransferase (AOR = 1.52 [1.31, 1.76]) as well as low albumin (AOR = 1.28 [1.09, 1.50]). Similar observations were made with respect to endocrine dysregulation, specifically low insulin-like growth factor 1 (AOR = 1.34 [1.16, 1.55]), low testosterone among males (AOR = 1.60 [1.27, 2.00]), and elevated glycated hemoglobin (HbA1C; AOR = 1.23 [1.05, 1.43]). Markers of renal impairment (i.e. elevated cystatin C, phosphate, and urea) and indicators of anemia and macrocytosis (i.e. red blood cell enlargement) were also associated with MDD incidence. While some immune markers, like elevated white blood cell and neutrophil count, were associated with MDD (AOR = 1.23 [1.07, 1.42]), others, like elevated C-reactive protein, were not (AOR = 1.04 [0.89, 1.22]). The 30 significant associations validated as a group in the multi-ancestry replication cohort (Wilcoxon p = 0.0005), with a median AOR of 1.235. Importantly, all 30 significant associations with extreme laboratory test results were directionally consistent with an increased MDD risk. In sum, markers of liver and kidney dysfunction, growth hormone and testosterone deficiency, innate immunity, anemia, macrocytosis, and insulin resistance were associated with MDD incidence in a large community-based cohort. Our results support a contributory role of diverse biological processes to MDD onset.

scholarly journals Paediatric rotavirus vaccination, coeliac disease and type 1 diabetes in children: a population-based cohort study

BMC Medicine ◽  
2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Thomas Inns ◽  
Kate M. Fleming ◽  
Miren Iturriza-Gomara ◽  
Daniel Hungerford
Keyword(s):  
Type 1 Diabetes ◽  
Cohort Study ◽  
Coeliac Disease ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Rotavirus Vaccine ◽  
Rotavirus Vaccination ◽  
Increased Risk ◽  
The Uk

Abstract Background Rotavirus infection has been proposed as a risk factor for coeliac disease (CD) and type 1 diabetes (T1D). The UK introduced infant rotavirus vaccination in 2013. We have previously shown that rotavirus vaccination can have beneficial off-target effects on syndromes, such as hospitalised seizures. We therefore investigated whether rotavirus vaccination prevents CD and T1D in the UK. Methods A cohort study of children born between 2010 and 2015 was conducted using primary care records from the Clinical Practice Research Datalink. Children were followed up from 6 months to 7 years old, with censoring for outcome, death or leaving the practice. CD was defined as diagnosis of CD or the prescription of gluten-free goods. T1D was defined as a T1D diagnosis. The exposure was rotavirus vaccination, defined as one or more doses. Mixed-effects Cox regression was used to estimate hazard ratios (HR) and 95% confidence intervals (CIs). Models were adjusted for potential confounders and included random intercepts for general practices. Results There were 880,629 children in the cohort (48.8% female). A total of 343,113 (39.0%) participants received rotavirus vaccine; among those born after the introduction of rotavirus vaccination, 93.4% were vaccinated. Study participants contributed 4,388,355 person-years, with median follow-up 5.66 person-years. There were 1657 CD cases, an incidence of 38.0 cases per 100,000 person-years. Compared with unvaccinated children, the adjusted HR for a CD was 1.05 (95% CI 0.86–1.28) for vaccinated children. Females had a 40% higher hazard than males. T1D was recorded for 733 participants, an incidence of 17.1 cases per 100,000 person-years. In adjusted analysis, rotavirus vaccination was not associated with risk of T1D (HR = 0.89, 95% CI 0.68–1.19). Conclusions Rotavirus vaccination has reduced diarrhoeal disease morbidity and mortality substantial since licencing in 2006. Our finding from this large cohort study did not provide evidence that rotavirus vaccination prevents CD or T1D, nor is it associated with increased risk, delivering further evidence of rotavirus vaccine safety.

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