scholarly journals FRI0649-HPR HYDROXYCHLOROQUINE PRESCRIBING AND OPHTHALMOLOGY SCREENING WITHIN RHEUMATOLOGY DEPARTMENTS IN THE NORTH-WEST OF THE UNITED KINGDOM: A PROSPECTIVE REGIONAL AUDIT

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 928.2-929
Author(s):  
S. Juman ◽  
T. David ◽  
L. Gray ◽  
R. Hamad ◽  
S. Horton ◽  
...  
Keyword(s):  
High Risk ◽  
Risk Group ◽  
Service Level ◽  
High Risk Group ◽  
North West ◽  
The North ◽  
The United Kingdom ◽  
The Uk ◽  
Treatment Dosage ◽  
Sd Oct

Background:Hydroxychloroquine (HCQ) is widely used in the management of rheumatoid arthritis and connective tissue disease. The prevalence of retinopathy in patients taking long-term HCQ is approximately 7.5%, increasing to 20-50% after 20 years of therapy. Hydroxychloroquine prescribed at ≤5 mg/kg poses a toxicity risk of <1% up to five years and <2% up to ten years, but increases sharply to almost 20% after 20 years. Risk factors for retinopathy include doses >5mg/kg/day, concomitant tamoxifen or chloroquine use and renal impairment. The UK Royal College of Ophthalmologists (RCOphth) 2018 guidelines for HCQ screening recommend optimal treatment dosage and timing for both baseline and follow-up ophthalmology review for patients on HCQ, with the aim of preventing iatrogenic visual loss. This is similar to recommendations made by the American Academy of Ophthalmology (2016).Objectives:To determine adherence to the RCOphth guidelines for HCQ screening within the Rheumatology departments in the North-West of the UK.Methods:Data for patients established on HCQ and those initiated on HCQ therapy were collected over a 7 week period from 9 Rheumatology departments.Results:473 patients were included of which 56 (12%) were new starters and 417 (88%) were already established on HCQ. 79% of the patients were female, with median ages of 60.5 and 57 years for new and established patients respectively. The median (IQR) weight for new starters was 71 (27.9) kg and for established patients, 74 (24.7) kg.20% of new starters exceeded 5mg/kg daily HCQ dose. 16% were identified as high risk (9% had previously taken chloroquine, 5% had an eGFR <60ml/min/m2and 2% had retinal co-pathology). Of the high-risk group, 44% were taking <5mg/kg. In total, 36% of new starters were referred for a formal baseline Ophthalmology review.In the established patients, 74% were taking ≤5mg/kg/day HCQ dose and 16% were categorized as high risk (10% had an eGFR less than 60ml/min/m2, 3% had previous chloroquine or tamoxifen use and 2% had retinal co-pathology). In the high-risk group, 75% were not referred for spectral domain optical coherence tomography (SD-OCT). 41% of patients established on HCQ for <5 years, and 33% of patients on HCQ for >5 years were not referred for SD-OCT. Reasons for not referring included; awaiting 5 year review, previous screening already performed and optician review advised.Since the introduction of the RCOphth guidelines, 29% patients already established on HCQ had an alteration in the dosage of HCQ in accordance with the guidelines. In the high-risk group, 16% were not on the recommended HCQ dose.Conclusion:This audit demonstrates inconsistencies in adherence to the RCOphth guidelines for HCQ prescribing and ophthalmology screening within Rheumatology departments in the North-West of the UK for both new starters and established patients. Plans to improve this include wider dissemination of the guidelines to Rheumatology departments and strict service level agreements with ophthalmology teams to help optimize HCQ prescribing and screening for retinopathy.Acknowledgments:Drs. S Jones, E MacPhie, A Madan, L Coates & Prof L Teh. Co-1st author, T David.Disclosure of Interests:None declared

scholarly journals Building partnerships

2017 ◽  
Vol 1 (1) ◽  
pp. 1-8
Author(s):  
Richard Byrne
Keyword(s):  
Water Quality ◽  
Landscape Conservation ◽  
Sustainable Change ◽  
North West ◽  
The North ◽  
Quality Issue ◽  
The United Kingdom ◽  
Peat Deposits ◽  
The Uk ◽  
Water Quality Issue

Water is generally plentiful in the United Kingdom; however, there is an emerging water quality issue driven by agricultural intensification. Poor land management over generations has contributed to the degradation of upland peat deposits leading to discolouration of potable water and the loss of valuable habitats. Employing agri-environmental schemes operated by the UK Government and private Capital One water company in the North West of England is achieving water quality gains as well as landscape, conservation and habitat benefit at the same time as supporting tenant farm incomes. We describe the pressures on the uplands and how innovative partnerships are achieving sustainable change.

Analysis of Early Disease Response in Childhood ALL: Can Peripheral Blood Replace Bone Marrow Analysis?.

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 2523-2523
Author(s):  
David O'Connor ◽  
Jennifer Jesson ◽  
Melanie Bahey ◽  
Lisa Eyre ◽  
Sarah Lawson
Keyword(s):  
Bone Marrow ◽  
High Risk ◽  
Peripheral Blood ◽  
Risk Group ◽  
Early Time ◽  
High Risk Group ◽  
Time Points ◽  
Post Induction ◽  
Flow Cytometric ◽  
The Uk

Abstract Abstract 2523 The detection of minimal residual disease (MRD) is highly predictive of outcome in pediatric acute lymphoblastic leukemia (ALL) and has now been integrated into the majority of treatment regimens. Early studies demonstrated the strong prognostic value of post-induction MRD measurement, using both molecular and flow cytometric techniques, allowing treatment intensity to be tailored to response. More recent studies have examined the value of MRD measurement at earlier time points and using peripheral blood (PB) in place of bone marrow (BM) in an attempt to reduce invasive procedures. Within the United Kingdom (UK), previous national trials have shown that post-induction MRD assessment, using molecular techniques, is highly predictive of relapse, allowing treatment stratification based on MRD levels. We have previously demonstrated the value of flow cytometric MRD assessment at early time points in response prediction (Motwani et al, Blood 2007a), however, as yet there has been no assessment of MRD in peripheral blood at early time points using flow cytometric methods in the context of a UK national trial. To address this we assessed MRD by flow cytometry using Day 8 (D8) and/or D15 paired PB and BM samples taken from children being treated for ALL at our unit on the UK MRC UKALL2003 trial or ALLR3 relapse trial. Samples were analyzed by 4-color flow cytometry using a large panel of monoclonal antibodies to identify all leukemia-associated immunophenotypes (LAIP). For follow up samples a minimum of 2 markers were identified for each patient and sequential gating was used for analysis. 500 000 to 106cells were acquired for each antibody combination for analysis to be sufficiently sensitive (0.01%). The number of residual leukemic cells was calculated as the percentage of blasts present within total nucleated cells counted. Sensitivity experiments were performed using dilutions of leukemic blasts in normal bone marrow or peripheral blood and demonstrated a sensitivity of 0.01%. Fifty paired BM and PB samples from 46 patients (41 newly diagnosed, 5 relapse) were included in the study (Age 2–22 years, mean 7.8 years). Of these, 22 were taken at D8 and 28 at D15. Forty-two samples were from patients with B-cell ALL, whilst 8 were from patients with T-cell ALL. The most frequent LAIPs used to identify blasts in B-ALL were CD58 (90% of cases), CD45 (75%), CD38 (86%), CD123 (77%). In T-ALL the most common LAIP combinations were CD34 (75%), CD5/CD56 (62.5%), CD5/CD2 (50%) and CD5/CD99 (50%). In keeping with previous reports, B-ALL MRD levels in PB blood were approximately 1.3-log lower than BM MRD levels (D8 mean 2.27% vs. 27.8%; D15 levels 0.63% vs. 7.99%). T-ALL levels were approximately 0.5-log lower. Importantly, the level of MRD in BM and PB in B-ALL showed a strong correlation (r=0.77). Whilst there were insufficient relapses to allow correlation with long-term outcome, PB MRD levels at D8 showed good prediction of post-induction molecular MRD, the current time point used for risk stratification in the UK trial. In patients with PB MRD >1% at D8, 100% (5/5) were in the high-risk group post-induction, significantly more than those with PB MRD <1% at D8, of which only 36.4% (4/11) were allocated to the high risk group post-induction (p=0.023). MRD levels in BM at D8 did not show similar predictive value. Importantly, this early prediction of risk could offer an early opportunity to intensify treatment in this high-risk group, potentially enhancing disease clearance during the induction phase. This study further supports that early assessment of MRD using flow cytometric techniques enhances treatment stratification in pediatric ALL. Furthermore, it shows that PB sampling may provide a markedly less invasive means of MRD assessment in these patients. Validation in a larger cohort of patients is warrented. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Clinical Performance Status and Technical Factors Affecting Outcomes from Percutaneous Transhepatic Biliary Interventions; A Multicentre, Prospective, Observational Cohort Study

2021 ◽  
Author(s):  
Gregory C. Makris ◽  
Andrew C. Macdonald ◽  
Kader Allouni ◽  
Hannah Corrigall ◽  
Charles R. Tapping ◽  
...  
Keyword(s):  
Cohort Study ◽  
High Risk ◽  
Risk Group ◽  
Performance Status ◽  
Group Versus ◽  
High Risk Group ◽  
Low Risk ◽  
Karnofsky Score ◽  
The Uk ◽  
Biliary Interventions

Abstract Purpose The purpose of this study was to evaluate the predictive value of a ‘Modified Karnofsky Scoring System’ on outcomes and provide real-world data regarding the UK practice of biliary interventions. Materials and Methods A prospective multi-centred cohort study was performed. The pre-procedure modified Karnofsky score, the incidence of sepsis, complications, biochemical improvement and mortality were recorded out to 30 days post procedure. Results A total of 292 patients (248 with malignant lesions) were suitable for inclusion in the study. The overall 7 and 30 day mortality was 3.1% and 16.1%, respectively. The 30 day sepsis rate was 10.3%. In the modified Karnofsky ‘high risk’ group the 7 day mortality was 9.7% versus 0% for the ‘low risk’ group (p = 0.002), whereas the 30 day mortality was 28.8% versus 13.3% (p = 0.003). The incidence of sepsis at 30 days was 19% in the high risk group versus 3.3% at the low risk group (p = 0.001) Conclusion Percutaneous biliary interventions in the UK are safe and effective. Scoring systems such as the Karnofsky or the modified Karnofsky score hold promise in allowing us to identify high risk groups that will need more careful consideration and enhanced patient informed consent but further research with larger studies is warranted in order to identify their true impact on patient selection and outcomes post biliary interventions.

scholarly journals Suicide in older people – can it be prevented?

2001 ◽  
Vol 11 (2) ◽  
pp. 107-108
Author(s):  
RC Baldwin
Keyword(s):  
High Risk ◽  
Health Services ◽  
Older People ◽  
Risk Group ◽  
Developed Countries ◽  
High Risk Group ◽  
Age Group ◽  
The Uk

EditorialIn the UK, one of the strategic aims for the health services is to reduce death by suicide. Older people are over-represented in national suicide figures in most developed countries so they are de facto a high risk group. For example, in the UK, people aged over 65 comprise about 15% of the population but this age group accounts for between 20 and 25% of all completed suicides.

Geographical Perspectives on United States Investment in the United Kingdom

1976 ◽  
Vol 8 (6) ◽  
pp. 685-705 ◽  
Author(s):  
P Dicken ◽  
P E Lloyd
Keyword(s):  
Direct Investment ◽  
Motor Vehicles ◽  
Total Output ◽  
North West ◽  
Manufacturing Operations ◽  
The North ◽  
The United Kingdom ◽  
Considerable Impact ◽  
The Uk ◽  
High Degree

American direct investment in Britain has a long history, dating back to 1851. In the past twenty years, however, the magnitude of US investment in Britain has dramatically increased. Events such as the closure of the Imperial Typewriter Co. at Hull and the threatened withdrawal of Chrysler from its UK manufacturing operations have served to focus attention on the activities of US based multinationals in Britain. Direct investment by US companies has a very considerable impact on the UK economy. American owned enterprises employ one in every fourteen workers in private enterprise manufacturing and account for more than 10% of total output. There is a high degree of sectoral concentration in this ownership pattern with the main emphasis in vehicles, electrical engineering, mechanical engineering, and the food, drink, and tobacco industries. Spatially there is a particular tendency toward concentration in the South East. In terms of net gains over time, however, Scotland has fared particularly well in attracting US companies. Within the North West of England there is also a tendency toward sectoral and spatial concentration. The motor vehicles industry on Merseyside represents the most prominent cluster and, in a region chronically prone to serious unemployment, there is potentially a degree of vulnerability which might give legitimate cause for concern.

Introduction

2021 ◽  
pp. 1-6
Author(s):  
Terry Robinson ◽  
Jane Scullion
Keyword(s):  
Respiratory Diseases ◽  
Mortality And Morbidity ◽  
North West ◽  
The North ◽  
The United Kingdom ◽  
Common Causes ◽  
Drug Treatments ◽  
The Common ◽  
The Uk ◽  
Lung Health

Respiratory diseases are one of the most common forms of ill-health, affecting about 12.5 million in the United Kingdom (UK); approximately one in five people. Globally the UK is in the top 20 countries for lung cancer and COPD deaths, with prevalence being highest in the North-West and South-West of England. More women than men have a diagnosed lung disease, mainly due to higher pneumonia incidence; most other lung conditions are more common in men. This chapter begins with an overview of respiratory disease, and outlines some of the common causes that impact on lung health. The mortality and morbidity of various respiratory diseases is covered, and the costs of consultations and drug treatments are discussed.

scholarly journals Study of demographic, hematological profile and risk stratification in chronic myeloid leukemia patients, in and around North-West Punjab, India

2020 ◽  
Vol 7 (12) ◽  
pp. 1789
Author(s):  
Rajandeep Kaur ◽  
Rajeev Gupta ◽  
Manish Chandey ◽  
Parminder Singh ◽  
Gurinder Mohan ◽  
...  
Keyword(s):  
High Risk ◽  
Chronic Myeloid Leukemia ◽  
Rural Area ◽  
Myeloid Leukemia ◽  
Risk Group ◽  
Chronic Phase ◽  
High Risk Group ◽  
Low Risk ◽  
North West ◽  
Haematological Profile

Background: Chronic myeloid leukemia (CML) is a hematopoietic stem cell disorder with cytogenic profile and tyrosine kinase inhibitors used as its therapy. Objective of the present study was to determine the demographic, haematological profile and to characterize them in low and high-risk group on presentation with European treatment and outcome study score (EUTOS) in CML patients in and around North-West Punjab, India.Methods: Diagnosed cases of CML were taken. Investigations were done. Molecular and cytogenetic studies were also done whenever required and with EUTOS patients were stratified and then treatment was individualized.Results: Total 100 patients were enrolled. The mean age of presentation of CML was 44.7 years with M:F ratio was 1:1. 20% cases were of Hindu religion and 80% cases were Sikh by religion. 68% cases from rural area and 32% cases were from urban area. 92 patients were in chronic phase, 5 patients in accelerated phase, and 3 patients were found in blast crisis phase. Out of total 100 cases, 32% cases were of high-risk group and 68% cases were of low-risk group on presentation according to EUTOS.Conclusions: Most CML patients in north west Punjab are young (31-40 years) with male: female ratio is 1:1. Majority of them were Sikh by religion and from rural area. Most of them presented in Chronic phase of the disease and with low-risk strata according to EUTOS. Conclusion is that most patients presents in early phase of disease, with anaemia, leucocytosis or splenomegaly.

Acromegaly and Obstructive Sleep Apnea: Identifying the High-Risk Group

2019 ◽  
Author(s):  
Xiaojun Zhan ◽  
Chandala Chitguppi ◽  
Ethan Berman ◽  
Gurston Nyquist ◽  
Tomas Garzon-Muvdi ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
High Risk ◽  
Risk Group ◽  
High Risk Group ◽  
Obstructive Sleep

Anamnestic factors that shape reproductive health of women with repeated unsuccessful popygamy in vitro fertilization

2016 ◽  
pp. 140-143
Author(s):  
N.V. Cotsabin ◽  
◽  
O.M. Makarchuk ◽  
Keyword(s):  
High Risk ◽  
Risk Group ◽  
Polycystic Ovary ◽  
High Risk Group ◽  
Stress Factors ◽  
Control Group ◽  
Fertilization In Vitro ◽  
Infertile Women ◽  
Group I

The proportion of patients with multiple unsuccessful attempts of assisted reproductive technology (ART) is about 30% of all patients treated with the use of ART. Women with history of unsuccessful ART attempts - a special category of patients who require emergency attention and a thorough examination at the stage of preparation for superovulation stimulation,the selection of embryos and endometrium preparation for embryo transfer. The objective: to distinguish high-risk group of unsuccessful attempts based on a detailed analysis of anamnestic and clinical data of infertile women with repeated unsuccessful ART attempts that requires more in-depth study of hormonal features, ovarian reserve and condition of the endometrium. Materials and methods. For better understanding of the problem of repeated unsuccessful ART attempts and сreation of efficient infertility treatment algorithms for these couples we conducted a thorough analysis of anamnestic data of three groups of infertile women (105 patients), which were distributed by age: group I – younger than 35, the II group – from 35 to 40, the III group - over 40 years. These groups of patients were compared with each other and with the control group of healthy women (30 persons). Results. Leading stress factors in the percentage three times prevailed in the group of infertile women and had a direct connection with the fact of procedure «fertilization in vitro» and chronic stressors caused by prolonged infertility. Primary infertility was observed significantly more frequent in patients younger than 35 years (p <0.05), secondary infertility - mostly in the second and third experimental groups (p <0.05). Noteworthy significant percentage of wellknown causes of infertility and idiopathic factor in all groups, and the prevalence of tubal-peritoneal factor in the second and third experimental groups, and endocrine dysfunction in the I experimental group. The most common disorder among this category of woman was polycystic ovary syndrome. Frequency of usual miscarriage among patients of I ana II groups was two times higher than in the third group (p <0.05). Among the experimental groups the leading place belongs urinary tract infection, respiratory tract diseases, pathologies of the cardiovascular system. Data of the stratified analysis show an increase likelihood of repeated unsuccessful ART attempts under the influence of constant chronic stress (odds ratio OR=2.06; 95% CI: 0.95–3.17; p<0.05). Conclusions. Among infertile patients with repeated unsuccessful ART attempts must be separated a high risk group of failures. The identity depends on the duration of infertility, female age and leading combination of factors. Key words: repeated unsuccessful ART attempts, anamnesis, infertility, high risk.

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